HomeMy WebLinkAboutResolution - 2022-R0265 - Amendment No. 4 to Contract HHS000109800001 with DSHS - ImmunizationResolution No. 2022-RO265
Item No. 6.13
June 14, 2022
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. 4 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
AT EST:
&4/h -- A -VI
Reb cca Garza, City Secre ry
APPROVED AS TO CONTENT:
Bill Ho rton, Deputy Ci ger
I APPROVED AS TO FORM:
Ryan Bro e, Assistant City Attorney
RES.Amend No. 4 Contract No. HHS00o109800001 DSHS
5.1 1.22
June 14, 2022
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
0TEXAS
`�V Health and Human
Services
The Honorable Daniel Pope, Mayor
City of Lubbock
PO Box 2000
Lubbock, Texas 79408
Texas Department of State Health Services
John Hellerstedt, M.D.
Commissioner
Subject: IMM/LOCALS
Contract Number: HHS000109800001, Amendment No. 4
Contract Amount: $1,274,373.00
Contract Term: September 1, 2018 through August 31, 2023
Dear Mayor Pope:
Enclosed is Amendment No. 4 to 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 by $232,115.00 for FY 2023 and extends the
end of the contract term to August 31, 2023.
Please let me know if you have any questions or need additional information.
Sincerely,
Holly Zoerner, CTCM
Contract Manager
Holly. Zoerner dshs.texas.gov
DocuSign Envelope ID: 0DE5633D-6369-463l3-l369E-A52F01 F63AD9
Resolution No. 2022-RO265
DEPARTMENT OF STATE HEALTH SERVICES
CONTRACT No. HHS000109800001
AMENDMENT No. 4
The DEPARTMENT OF STATE HEALTH SERVICES (DSHS or System Agency) and CITY OF
LUBBOCK (Grantee), Parties to that certain Immunization/Locals Grant Program Contract, effective
September 1, 2018, and denominated DSHS Contract No. HHS000109800001 (the Contract), as
amended, now want to further amend the Contract.
WHEREAS, DSHS wants to exercise its option to extend the Contract term for an additional
year, representing the fourth and final extension option ("Fourth and Final Extension Option");
WHEREAS, DSHS wants to add funds to the Contract to pay for services provided during the
extended term;
WHEREAS, DSHS wants to revise ATTACHMENT A, STATEMENT OF WORK and
ATTACHMENT H-2, IMMUNIZATION/LOCALS PROGRAM GUIDANCE DOCUMENT.
Now, THEREFORE, the Parties agree as follows:
1. The Contract is extended in accordance with SECTION III, DURATION, for an additional
year. The Fourth and Final Extension Option shall begin September 1, 2022 and end
August 31, 2023, unless terminated sooner.
2. SECTION IV, BUDGET, of the Contract, is amended to increase funding in the amount of
$232,115.00 for State Fiscal Year 2023 ("FY 2023"). The total not -to -exceed amount of
this Contract is increased to $1,274,373.00. All expenditures of the additional funds must
conform with ATTACHMENT B-4, FY 2023 BUDGET.
ATTACHMENT A-1, REVISED STATEMENT OF WORK, of the Contract, is deleted and
replaced in its entirety with ATTACHMENT A-2, FY 2023 STATEMENT OF WORK.
4. ATTACHMENT B-3, REVISED BUDGET, of the Contract, is supplemented with the
addition of ATTACHMENT B4, FY 2023 BUDGET.
5. ATTACHMENT H-2, IMMUNIZATION/LOCALS PROGRAM GUIDANCE DOCUMENT is
deleted and replaced in its entirety with ATTACHMENT H-3, IMMUNIZATION/LOCALS
PROGRAM GUIDANCE DOCUMENT.
6. This Amendment shall be effective September 1, 2022.
7. Except as modified by this Amendment, all terms and conditions of the Contract, as
amended, shall remain in full force and effect.
DSHS Contract No. HHS000109800001 Page l of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01 F63AD9
Any further revisions to the Contract shall be by written agreement of the Parties.
SIGNATURE PAGE FOLLOWS
DSHS Contract No. HHS000109800001 Page 2 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
SIGNATURE PAGE FOR AMENDMENT No. 4
DSHS CONTRACT No. HHS000109800001
DEPARTMENT OF STATE HEALTH
SERVICES
By: F�DocuSigned by:
& Cb(,t,
04DD3FAAF59048D...
Date of Signature:
July 7, 2022
CITY OF LUBBOCK
5rea,
ocuSigned by:
By: vi, ar
FDEBFC88C4AE411...
Date of Signature
June 29, 2022
THE FOLLOWING DOCUMENTS ARE ATTACHED TO THIS AMENDMENT AND THEIR TERMS ARE
INCORPORATED INTO THE CONTRACT BY REFERENCE:
ATTACHMENT A-2 — FY 2023 STATEMENT OF WORK
ATTACHMENT B-4 - FY 2023 BUDGET
ATTACHMENT F-4 - FEDERAL FUNDING ACCOUNTABILITY AND
TRANSPARENCY ACT (FFATA)
ATTACHMENT H-3 - IMMUNIZATION/LOCALS PROGRAM GUIDANCE
DOCUMENT
ATTACHMENTS FOLLOW
DSHS Contract No. HHS000109800001 Page 3 of 33
Amendment 4
DocuSign Envelope ID: 0DE5633D-6369-463l3-l369E-A52F01 F63AD9
ATTACHMENT A-2
FY 2023 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 (EFI1-13999).
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-3,
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 TVFCiASN 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:
DSHS Contract No. HHS000109800001 Page 4 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01 F63AD9
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.
O. 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.
DSHS Contract No. HHSOOO 109800001 Page 5 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-4636-669E-A521701 F63AD9
Q. Submit out-of-state travel requests to the Immunization Section for approval when
utilizing Contract funds or program income.
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 (ILA) Quarterly Report
form, utilizing the format provided by the DSHS Immunization Section and available
at https: `, dshs.texas.gov: immunizes 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/ 1 /2022 to 11 /30/2022
12/31 /2022
Programmatic
12/1/2022 to 02/28/2023
03/31/2023
Programmatic
03/l/2023 to 05/30/2023
06/30/2023
Programmatic
06/l/2023 to 08/31/2023
09/30/2023
Submit quarterly reports electronically through an online tool according to the
timeframes stated above. DSHS Immunization Section will provide instructions at the
beginning of each state fiscal year through CMS. Supplemental report documents
(PEAR and AFIX reports, vacancy letters, etc.) should be sent to
dshsimmunizationcontracts(ddshs.texas.gov.
II. PERFORMANCE MEASURES
A. The System Agency will monitor the Grantee's performance of the requirements in this
Attachment A-2 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.jzov/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
Section.
At a minimum vouchers should include:
1. Grantee name, address, email address, vendor identification number, and telephone
number;
DSHS Contract No. HHS000109800001 Page 6 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01 F63AD9
2. DSHS Contract or Purchase Order number;
3. Dates services were completed and/or products were delivered;
4. The total invoice amount; and
5. DSHS Supporting documentation.
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 to
the Immunization Section at DSHSImmunizationContracts(@,dshs.texas.gov.
Department of State Health Services
Claims Processing Unit, MC 1940
1100 West 491h Street
P.O. Box 149347
Austin, TX 78714-9347
FAX: (512) 458-7442
EMAIL: invoices a_dshs.texas.gov and to CMSinvoices,(g dshs.texas. gov
Grantee will be paid on a cost reimbursement basis and in accordance with the Budget in
Attachment B-4, FY 2023 Budget of this Contract.
DSHS Contract No. HHS000109800001 Page 7 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01 F63AD9
ATTACHMENT B-4
FY 2023 BUDGET
Organization Name: City of Lubbock
Program ID: IMM/LOCALS
Contract Number: HHS000109800001
Budget Categories
Budget for FY 2023
September 1, 2022 -
August 31, 2023
Personnel
$153,985.00
Fringe
$64,674.00
Travel
$0.00
Equipment
$0.00
Supplies
$5,656.00
Contractual
$7,800.00
Other
$0.00
Total Direct
$232,115.00
Indirect
$0.00
Total
$232,115.00
Remainder of page intentionally left blank
DSHS Contract No. HHSOOO 109800001 Page 8 of 33
Amendment 4
DocuSign Envelope ID: 0DE5633D-6369-463B-B69E-A52F01 F63AD9
ATTACHMENT F-4
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. ff the
Signor 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.
City Of Lubbock
Katherine Wells
kwells@mylubbock.us
806-775-2941
Primary Address of Contractor:
FFATA Contact#2 Name, Email and Phone Number.
PO BOX 2000
Amber Aguilar
LUBBOCK, TX
aaguilar@mylubbock.us
806-775-2149
ZIP Code: 9-digits Required www.usos.com
DUNS Number. 9-digits Required www.sam.eov
State of Texas Comptroller Vendor Identification Number (VIN)14 Digits
Printed Name of Authorized Representative
Signature of Authorized Representative
Amber Aguilar
DocuSiyned by:
QN1�I,.Ir Q
Title of Authorized Representative
D EA2037DENEUB4 .
Senior Grant Accountant
April 20,2022
Department of State Health Services
DSHS Contract No. HHS000109800001
Amendment 4
Form 4734 —June 2013
Page 9 of 33
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
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 Reeardine %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 [X—] No
B. Certification Reeardine 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?
NA
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:
N: A
-2-
Department of State Health Services Form 4734 — June 2013
DSHS Contract No. HHS000109800001 Page 10 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
ATTACHMENT H-3
IMMUNIZATION/LOCALS PROGRAM GUIDANCE DOCUMENT
GRANTEE RESPONSIBILITIES
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 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 Immunization 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
in the Immunization Program Contractor's Guide. Ensure that
the Immunization Program Manager and TVFC and ASN
Coordinator attend the annual Immunization Unit mandatory in -
person meeting
Required
Activity
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
(EF 11-13999) 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)
DSHS Contract No. HHS000109800001 Page I I of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
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
DSHS Contract No. HHS000109800001 Page 12 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
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 (Form 13-13) 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 allStandard
funds will be properly expended before the end of the contract
(Universal)
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 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 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
DSHS Contract No. HHS000109800001 Page 13 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
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 IMMUNIZATION 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 Child Health Reporting System
(CHRS)
DSHS Contract No. HHS000109800001 Page 14 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
2.1.03 Complete 100% of assigned public and private school audits,
assessments, and/or validation/retrospective surveys in
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 (Alchemer, possibly
via email)
2.2. CHILDCARE & SCHOOL COMPLIANCE QA
2.2.01
2.2.02
Required
Activity
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
Provide feedback to DSHS ACE Group regarding
trends/ issues for vaccine requirements in accordance with the
DSHS Immunization Contractor's Guide for Local Health
Departments
Required
Activity
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 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 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%
DSHS Contract No. HHS000109800001
Amendment 4
Page 15 of 33
DocuSign Envelope ID: 0DE5633D-6369-463B-B69E-A52F01 F63AD9
3.1.02 Ensure New Enrollment 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
3.2.02
Sustain a network (through re -enrollment) of TVFC providers Required Activity
to administer vaccines to program -eligible populations
Promote TVFC and ASN Provider achievements:
- 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
Suggested Activity
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 (VAOS);
- 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
hqps://www.cdc.gov/vaccines/hcp/vis/index.html
distributed to patients prior to patient vaccination
DSHS Contract No. HHS000109800001 Page 16 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
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 improvementsltrainings
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 Vaccine Allocation and Ordering System Required Activity
(VAOS) 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
DSHS Contract No. HHSOOO 109800001 Page 17 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
3.4.03 Ensure provider participation in vaccine ordering and Standard
inventory management using the Vaccine Allocation and (Universal)
Ordering System (VAOS):
- Educate providers regarding vaccine ordering policies; and
- Train providers to use VAOS 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
Vaccine Allocation and Ordering System (VAOS).
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 QUALITY 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
DSHS Contract No. HHSOOO 109800001 Page 18 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
3.5.05 Utilize Texas Immunization 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:
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
Required Activity
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 Syntropi; and
- 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 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 VAOS 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
DSHS Contract No. HHSOOO 109800001 Page 19 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
3.5.15 Utilize the CDC IQIP database and directly enter data to document Required
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
3.6.02 Complete program evaluation activities with TVFC and 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 procedures
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
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
assurance on 10% of the temperature recording logs that were
reviewed by their staff each quarter
3.8. RE COMPLIANCE
Standard
(Universal)
Required
Activity
Required Activity
Required Activity
Suggested Activity
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 VAOS within 24 hours of the (Universal)
transfer occurring
DSHS Contract No. HHS000109800001 Page 20 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
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 Emergency 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. PERINATAL
HEPATITIS B CASE IDENTIFICATION
4.1.01
Conduct identification and case management of perinatal
Standard (Universal)
hepatitis B cases
4.1.02
Determine the number of newborns that do not receive the
Required Activity
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
Required Activity
DSHS Contract No. HHS000109800001 Page 21 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
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
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
Required Activity
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
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.
Required Activity
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
DSHS Contract No. HHSOOO 109800001 Page 22 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463l3-l369E-A52F01 F63AD9
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
4.5.06
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 Suggested Activity
4.7.01
DSHS Contract No. HHS000109800001 Page 23 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
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
and ASN Provider Manual and LHD procedures for
implementing them. These include:
- procedures for following storage and handling guidelines;
- procedures for vaccine management; and
- procedures for using the DSHS vaccine management
system (VAOS) procedures for other compliance
guidelines
Required
Activity
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
DSHS Contract No. HHS000109800001 Page 24 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
5.2.04
Develop and implement a policy on the use of the Texas
Immunization Registry. Train LHD staff on conducting
client searches in the Texas Immunization Registry and how
to effectively enter client demographic and immunization
information
5.3. CLINIC IMMUNIZATION PRACTICES
Required
Activity
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)
make 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:
hLtps://www.cdc.jzov/vaccines/schedules/index.html
DSHS Contract No. HHSOOO 109800001 Page 25 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01 F63AD9
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/forins.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
5.3.16
Verbally and with DSHS-produced literature, inform parents
at LHD Grantee's clinics about the Texas Immunization
Registry, the benefits of inclusion in the Registry, and the
importance of maintaining a complete immunization history in
the Registry
Update all demographic information, including address,
email, and telephone number, at every client encounter in
EMR and the Texas Immunization Registry
Standard
(Universal)
Standard
(Universal)
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 5
Required
pm, 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
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
eligibility for TVFC vaccines. The policy must be consistent
with the TVFC requirements outlined in the current TVFC and
ASN Provider Manual
Standard
(Universal)
5.3.24 Participate in public health emergencies and exercises that Suggested
may require vaccine administration to the public or first Activity
responders
DSHS Contract No. HHS000109800001 Page 26 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
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 Vaccine
Allocation and Ordering System (VAOS) 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 Ensure that appropriate routine and emergency vaccine Required Activity
storage and handling plans are in place at each of the LHD
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
5.6. CLINIC REPORTING
5.6.02
Conduct timely reporting of monthly clinic activities by
recording vaccine inventory, doses administered,
temperature logs and other reportable activities by the 51h of
each month as described in the TVFC/ ASN Provider
Manual
Report all notifiable conditions as specified in the DSHS
Immunization Contractor's Guide for Local Health
Departments
Required Activity
Standard (Universal)
5.6.03 Report all vaccine adverse events as specified in the DSHS Standard (Universal)
Immunization Contractor's Guide for Local Health
Departments
DSHS Contract No. HHSOOO 109800001 Page 27 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
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
& 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
DSHS Contract No. HHSOOO109800001 Page 28 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01 F63AD9
6.4. TEXAS IMMUNIZATION REGISTRY USER EDUCATION
6.4.01
Provide education, training, and technical assistance to
promote the effective use of the Texas Immunization
Registry by organizations
Suggested Activity
6.4.02 Identify and assist providers to establish electronic Required Activity
affirmation of consent
6.5. TEXAS IMMUNIZATION REGISTRY PROMOTION
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 registrars on
the effective use of the Texas Immunization Registry
Suggested
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 IMMUNIZATION 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 29 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01 F63AD9
6.6.03
Conduct a minimum of 60 Texas Immunization Registry
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
Required Activity
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 (hqps:/;,www.cdc.gov/vaccines/ed/webinar-
eRv/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/Rubs/12inkbook/index.html
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
DSHS Contract No. HHS000109800001 Page 30 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
7.2.05
Provide training opportunities and/or resources to assist
immunization providers in communicating with patients and/or
parents (e.g., making a strong recommendation, addressing
vaccine hesitancy, etc.)
7.3 STAFF EDUCATION
Required
Activity
7.3.01 Work to ensure that all Immunization Program Grantee staff are
knowledgeable about vaccines and VPDs
Standard
(Universal)
7.3.02 Develop and implement a written communications and
Required Activity
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
7.3.03 Educate healthcare workers on the importance of keeping
Required Activity
themselves up-to-date with the vaccine schedule
7.4 COALITION BUILDING
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
Suggested Activity
sustaining a coalition
7.4.04
Engage and recruit community groups and immunization
Suggested Activity
stakeholders into a coalition
7.4.05
Facilitate and host coalition meetings Y
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)
7.5 COMMUNITY PARTNERSHIP
DSHS Contract No. HHS000109800001 Page 31 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01 F63AD9
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
service area, including information about online and satellite -
broadcast continuing education opportunities from the CDC
Continuing Education website at
https://www.cdc.gov/vaccines/ed/index.html
Suggested Activity
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)
7.6.02 Host at least 1 immunization stakeholder meeting per Suggested Activity
quarter (4 per contract year)
DSHS Contract No. HHSOOO 109800001 Page 32 of 33
Amendment 4
DocuSign Envelope ID: ODE5633D-6369-463B-B69E-A52F01F63AD9
7.7 MEDIA CAMPAIGNS
7.7.01
7.7.02
Distribute ASN information and educational materials at Required Activity
venues and clinics that serve eligible adults
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.ImmunizeTexas.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
DSHS Contract No. HHS000109800001 Page 33 of 33
Amendment 4
CITY OF LUBBOCK
ATTDECCA
finl
By:
GARZAA, ACity Secretaryy
APPROVED A TO CONTENT:
�- a T,,�, � k&
By:
KATHERINE WELLS, Director of Public Health
APPROVED AS TO FORM:
By: - —__r
RYAN §KOOKt, Assistant City Attorney