The URL can be used to link to this page

Home My WebLink AboutFresno Metropolitan Ministry-Fresno Community Health Improvement Partnership_A-24-386 A-21-539 A-23-047.pdf coU Hall of Records, Room 301 County of Fresno 2281 Tulare Street r9, � Fresno,California` Board of Supervisors 93721-2198 O� 1856 0 Telephone:(559)600-3529 F1ZE`'� Minute Order Toll Free: 1-800-742-1011 www.fresnocountyca.gov July 9, 2024 Present: 5- Supervisor Steve Brandau,Chairman Nathan Magsig,Vice Chairman Buddy Mendes, Supervisor Brian Pacheco,and Supervisor Sal Quintero Agenda No. 50. Public Health File ID:24-0651 Re: Approve and authorize the Chairman to execute a Second Amendment to Agreement with Fresno Metropolitan Ministry to continue the work with Fresno Community Health Improvement Partnership to provide health intervention activities for Fresno County's Community Health Worker Network, effective upon execution,extending the term by twenty-two(22)months from August 1,2024 to May 31,2026, and increasing the maximum by$2,883,893 to a total of$12,496,869 APPROVED AS RECOMMENDED Ayes: 5- Brandau, Magsig, Mendes, Pacheco,and Quintero Agreement No.24-386 County of Fresno Page 53 coU�, Board Agenda Item 50 p 1856 p FRE'_77 DATE: July 9, 2024 TO: Board of Supervisors SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health SUBJECT: Second Amendment to Agreement with Fresno Metropolitan Ministry RECOMMENDED ACTION(S): Approve and authorize the Chairman to execute a Second Amendment to Agreement with Fresno Metropolitan Ministry to continue the work with Fresno Community Health Improvement Partnership to provide health intervention activities for Fresno County's Community Health Worker Network, effective upon execution,extending the term by twenty-two (22) months from August 1, 2024 to May 31, 2026, and increasing the maximum by$2,883,893 to a total of$12,496,869. There is no additional Net County Cost associated with the recommended action. The recommended action will allow Fresno Metropolitan Ministry (FMM)to continue their partnership with Fresno Community Health Improvement Partnership (FCHIP)and subcontracted agencies to continue providing essential services to Fresno County residents through the Community Health Worker(CHW) Hub by increasing FMM's budget by $2,883,893, increasing the term of the agreement by twenty-two months, and updating the budget and scope of work to reflect the changes. The recommended action will also allow for federal terms and conditions to be included in the agreement. All recommended actions are fully funded with existing grant funds. This item is countywide. ALTERNATIVE ACTION(S): Should your Board not approve the recommended action, FCHIP will have a limited duration to embed substantial capacity building into the CHW Network infrastructure.Within the current timeline, sustainability efforts will be limited to shorter outcomes than funding would allow. The intention of this recommended action is to maximize federal grant funding and assure sustainability of the CHW Network. Should it not be approved, FCHIP will have a limited time to focus on sustainable approaches that will provide a longer-lasting impact beyond the contracted period. FISCAL IMPACT: There is no increase in Net County Cost associated with the recommended action.The maximum compensation of the agreement with FMM will increase by$2,883,893 to$12,496,869 for the proposed increased term. This increase is in alignment with FMM's current expenditure rate of$3.4M per year and will allow for the program to remain funded through the extended term. The agreement is fully funded by federal grant revenue from The Center for Disease Control and Prevention's Initiative to Address COVID-19 Related Health Disparities (Health Disparities)and Epidemiology and Laboratory Capacity COVID-19 (ELC). Sufficient appropriations and estimated revenues will be included in the Department's Org 5620 FY 2024-25 Recommended Budget and will be included in subsequent budget requests. DISCUSSION: County of Fresno Page 1 File Number:24-0651 File Number..-24-0651 On December 14, 2021, your board approved agreement No. 21-539 which allowed the County to partner with FMM to allow FMM to act as the fiscal sponsor for FCHIP. This agreement also allowed FCHIP to contract with community-based organizations (CBO)to continue critical COVID-19 response activities as well as develop a CHW Network Hub that would provide service delivery through a nationally recognized evidence-based model. Through COVID-19 county specific data, the Department was able to identify areas heavily impacted by COVID-19 to deploy community partners and resources to mitigate negative impacts in health burdened areas. In February of 2022, FCHIP launched the Fresno HOPE Pathways Community Hub (HOPE HUB)and released a request for applications for contractors to provide wrap around services to community members negatively impacted by COVID-19. This transition of the CBOs contracted under the HOPE HUB structure allowed organizations to continue providing direct services during COVID-19 surges as well as additional services including isolation and quarantine support, vaccination and testing support, COVID-19 education and outreach, community linkages and other wrap around services. Implementation of the HOPE HUB infrastructure was also foundational for a more sustainable CHW intervention approach. The contracted period was designed as a three-phase implementation process to allow for a structured timeline to carry out contracted activities and provide capacity building to CBO partners. The third and final phase of the contract period was designed to transition contracted agencies to a fiscally sustainable payment for outcome structure. The payment for outcome structure allows for organizations to be reimbursed based on successfully providing care-coordination services by leveraging the skills of community health workers and confirmed through measurable outcomes. The HOPE HUB has been instrumental through each phase in providing guidance and technical assistance to build each contracted agency's capacity and ensure success in becoming a fully outcome-based program. The HOPE HUB initially had seven contracted agencies providing services. Of the seven original agencies, six were able to adhere to the HOPE HUB's compliance standards and have either transitioned or are on track to transition to the outcome-based payment structure. During phase transitions and ongoing quality improvement measures, one of the agencies was unable to maintain adherence with the evidence-based model despite on-going technical assistance and support, leading to the early termination of the contracted partnership. The current subcontracted CBOs include: Black Wellness and Prosperity Center, Centro La Familia Advocacy Services, Cultiva La Salud, Exceptional Parents Unlimited, The Fresno Center, and Valley Center for the Blind. These agencies administer unique approaches to serving specialized populations and offer services in 15 different languages. Phase one of implementation, which concluded in August 2022, served as a capacity building period for the HOPE HUB and contracted partners. The innovative nature of the HUB required organizations to complete extensive training in a standardized and linguistically appropriate manner. CHWs and supervisors completed 300 hours of evidence-based training through the nationally recognized Pathways Community Hub Institute (PCHI). The HOPE HUB and contracted partners also received training in the Care Coordination Systems (CCS)which serves as the integrated data management system that standardizes data tracking and provides invoicing capabilities. In September of 2022, the HOPE HUB began phase two of the implementation process. During phase two, CHWs recruit clients through an in-depth enrollment process that includes a social determinants of health (SDoH)screening. Once enrolled, clients begin an evidenced-based intervention (Pathways)to address their determined barriers to health. Under this model, each pathway is tied to an identified SDoH need expressed by the client. Since September 1, 2022, CHWs have completed 5,243 SDoH screening tools for community members.Also, during this time, a total of 10,354 pathways have been opened, of which, 7,476 were successfully completed, meaning 7,476 unique needs of community members were met. The community's top identified needs were social services, learning, medical referral, health coverage, and food security. The top ten client zip codes serviced are: 93701, 93702, 93703, 93706, 93720, 93722, 93725, 93726, 93727, and 93630. All zip codes are within the Healthy Place Index Quartile 1 which are recognized County of Fresno page 2 File Number.24-0651 File Number.-24-0651 as some of the most health burdened zip codes in California. Attachment A is the HOPE HUB's annual impact summary for the period of September 1, 2022 through August 31, 2023. On January 24, 2023, your Board approved agreement No. 23-047 which amended agreement No. 21-539 to allow the agreement to be extended through July 31, 2024, and increased the total maximum compensation of the agreement by$2,400,000. This amendment also allowed phase two to be extended for further evaluation to establish best practices,which ensured an uninterrupted transition to phase three. Phase three of implementation began August 1, 2023. During phase three, organizations have begun transitioning to the outcome-based reimbursement structure for the remainder of term of the Agreement. Two of the seven organizations are fully reimbursed through the outcome-based structure,while the remaining five are in a 50/50 transitionary period while the HOPE HUB continues to build their capacity with the intent to move all agencies to a fully outcome-based payment structure. To remain sustainable, phase three leverages outside sources that creates a blended funding structure. In addition to County resources, the HOPE HUB has successfully secured additional funding opportunities from other organizations including: The California Department of Health Care Services' CHW Benefit, CaIAIM, Kaiser Permanente, Substance Abuse and Mental Health Services Administration, Parlier Unified School District, CalViva/Healthnet, and continues to assess other local managed care programs, such as, a partnership with Anthem Blue Cross and other regional community funding opportunities. Fresno HOPE HUB currently has the highest utilization for the CHW Benefit across active CalViva Health and Health Net counties. Securing additional funding will be pivotal in providing the HOPE HUB sustainable revenue past the lifetime of the agreement and after initial federal and state funded grants have expired. As the County has moved into a post pandemic era, the HOPE HUB has transitioned from being primarily a COVID-19 response program, to a care coordination agency with an emphasis on the health disparities exacerbated by COVID-19.The project's primary focus is to enroll clients into the program and provide services to address underlying health issues identified through SDoH screeners. Since the inception of the HOPE HUB, this model has been able to successfully enroll 2,439 total unique participants who have received individualized intervention services. Cross sector partnerships have been created through various taskforces, including the Community Advisory Council, which has memberships from local hospitals, managed care programs, community foundations, mental health care providers, government agencies, as well as CBOs. In alignment with initial plans for this funding, The Department is also strategizing with the other County Departments, including the Department of Social Services and the Department of Behavioral Health, on how to maximize the HOPE HUB's model and structure within existing County programs who have agreements for similar services and/or are contracted with the same CBOs.This approach aims at avoiding duplication of services and maximizing reach in a standardized way where outcomes are being tracked through a multi-agency collaboration. The success of the HOPE HUB has led to receiving national acknowledgment by various Federal and State entities. On March 26, 2024, Department staff were selected to present at the Centers for Disease Control and Prevention, COVID-19 Health Disparities Grant(OT21-2103)Convening to share information about the CHW Network on a national level. Additionally, at the request of the Public Health Alliance of Southern California, Department of Public Health and HOPE HUB staff were given the opportunity to present on the program's infrastructure, lessons learned, and best practices. Through this partnership and funding opportunity, the HOPE HUB infrastructure and model has become nationally certified and evolved into the largest PCHI evidence-based CHW Hub in California. Approval of the recommend action will allow the County to continue to partner with FMM and FCHIP to continue to provide critical services to residents of Fresno County through the HOPE HUB during the COVID-19 recovery phase. With the extension of the ELC and Health Disparities grant funds, the County has an opportunity to continue to support FCHIP in their transition to a fiscally sustainable model by contracting and leveraging with other payors that will provide reimbursement for these services beyond the County of Fresno Page 3 File Number.24-0651 File Number.24-0651 contracted period. The extension and supplementation of funds will also allow the HOPE HUB to strengthen their infrastructure to serve as a provider of capacity building and technical assistance for the CHW network, extending their reach beyond their contracted partners for a more equitable service delivery to Fresno County residents. In addition, fiscal sustainability has always been a priority for the Department, the recommended action will allow the County to capitalize on remaining ELC funding to assure that other County Departments have the access to leverage the benefits of the HOPE HUB and the services in alignment with this program's outcome-based model. If approved, the recommended action would allow FMM's agreement to be extended for an additional two years, increase the budget by$2,883,893, and allow for a reallocation of funds in Personnel, Operating Costs, and Other Costs budget categories.This recommended action will also allow the agreement to be updated to reflect a more accurate scope of work and include federal terms and conditions of the agreement's funding sources. REFERENCE MATERIAL: BAI #39, January 24, 2023 BAI #68, December 14, 2021 ATTACHMENTS INCLUDED AND/OR ON FILE: On file with Clerk-Attachment A Annual Impact Summary On file with Clerk-Second Amendment to Agreement with FMM CAO ANALYST: Ron Alexander County of Fresno Page 4 File Number.24-0651 Agreement No. 24-386 1 AMENDMENT II TO AGREEMENT 2 THIS SECOND AMENDMENT TO AGREEMENT (hereinafter"Amendment") is made and 3 entered into this 91h day of July , 2024, by and between COUNTY OF FRESNO, a 4 Political Subdivision of the State of California, Fresno, California (hereinafter "COUNTY"), and Fresno 5 Metropolitan Ministry, a California Non-Profit Corporation, whose address is 3845 N. Clark St. Suite 6 101, Fresno, California 93726, hereinafter referred to as "CONTRACTOR". 7 WITNESSETH: 8 WHEREAS, COUNTY and CONTRACTOR entered into Agreement number A-21-539, dated 9 the 14th of December 2021; and 10 WHEREAS, COUNTY and CONTRACTOR entered into a First Amendment number A-23-047, 11 dated the 24th of January 2023 (Agreement number A-21-539 and First Amendment number A-23-047, 12 collectively, shall be referred to herein as "the Agreement"); and 13 WHEREAS, COUNTY and CONTRACTOR modified the budget, referenced as Revised Exhibit 14 B-2, on the 6th of March 2024 through formal letter and written consent of both parties pursuant to 15 Section 7 (Modification) of the Agreement; and 16 WHEREAS, COUNTY and CONTRACTOR now desire to amend the Agreement in order to 17 extend the term of the Agreement; and 18 WHEREAS, COUNTY and CONTRACTOR now desire to amend the Agreement in order to 19 increase the total compensation of the Agreement; and 20 WHEREAS, COUNTY and CONTRACTOR now desire to amend the Agreement in order to 21 update the Scope of Work of the Agreement; and 22 WHEREAS, COUNTY and CONTRACTOR now desire to amend the Agreement in order to 23 include a Compliance with Federal Requirements section and 24 WHEREAS, COUNTY and CONTRACTOR now desire to amend the Agreement in order to 25 attach the Federal Terms and Conditions to the Agreement. 26 NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of 27 which is hereby acknowledged, COUNTY and CONTRACTOR agree as follows: 28 1. That Section Three (3) —TERM, of the Agreement, on Page Three (3), beginning on Line Six - 1 - 1 (6) and ending on Page Three (3), Line Eleven (11) with the word "Performance" shall be deleted in its 2 entirety and replaced with the following: 3 "3. TERM 4 The term of this Agreement shall commence upon execution and be for a period 5 through and including May 31, 2026." 6 2. That all references in Agreement to "Revised Exhibit B-1" and "Revised Exhibit B-2" shall be 7 changed to read "Revised Exhibit B-3". Revised Exhibit B-3 is attached hereto and incorporated 8 herein by this reference. 9 3. That Section Five (5)— COMPENSATION/INVOICING, of the Agreement, on Page Four(4), 10 beginning with Part B on Line Eighteen (18) and ending on Page Four (4), Line Twenty-One (21)with 11 the word "Contractor" shall be deleted in its entirety and replaced with the following: 12 "B. In no event shall services performed under this Agreement by CONTRACTOR be in excess 13 of Twelve Million Four Hundred and Ninety-Six Thousand Eight Hundred and Sixty-Eight and 80/100 14 Dollars ($12,496,868.80) during the term of this Agreement. It is understood that all expenses 15 incidental to CONTRACTOR'S performance of services under this Agreement shall be borne by 16 CONTRACTOR." 17 4. That all references in Agreement to "Exhibit A' and "Revised Exhibit A" shall be changed to 18 read "Revised Exhibit A-1". Revised Exhibit A-1 is attached hereto and incorporated herein by this 19 reference. 20 5. That Paragraph Thirty (30)—COMPLIANCE WITH FEDERAL REQUIREMENTS shall be 21 included in the Agreement on Page Twenty-Six (26) beginning on Line Nine (9) with the word 22 "Compliance" and ending on Line Thirteen (13) with the word "Herein" and include the following: 23 "30. COMPLIANCE WITH FEDERAL REQUIREMENTS: CONTRACTOR recognizes that 24 COUNTY operates its Advancing Health Literacy grant program with the use of Federal funds, and 25 that the use of these funds imposes certain requirements on the COUNTY and its subcontractors. 26 CONTRACTOR shall adhere to all Federal requirements, including those identified in Exhibit D, 27 attached hereto and by this reference incorporated herein." 28 6. That Exhibit D is attached hereto and incorporated herein by this reference. - 2 - 1 COUNTY and CONTRACTOR agree that this Second Amendment is sufficient to amend the 2 Agreement, and that upon execution of this Second Amendment, the Agreement, the First 3 Amendment, and this Second Amendment together shall be considered the Agreement. 4 The parties agree that this Second Amendment may be executed by electronic signature as 5 provided in this section. An "electronic signature" means any symbol or process intended by an 6 individual signing this Amendment to represent their signature, including but not limited to (1) a digital 7 signature; (2) a faxed version of an original handwritten signature; or (3) an electronically scanned and 8 transmitted (for example by PDF document) of a handwritten signature. Each electronic signature 9 affixed or attached to this Amendment (1) is deemed equivalent to a valid original handwritten 10 signature of the person signing this Amendment for all purposes, including but not limited to 11 evidentiary proof in any administrative or judicial proceeding, and (2) has the same force and effect as 12 the valid original handwritten signature of that person. The provisions of this section satisfy the 13 requirements of Civil Code section 1633.5, subdivision (b), in the Uniform Electronic Transaction Act 14 (Civil Code, Division 3, Part 2, Title 2.5, beginning with section 1633.1). Each party using a digital 15 signature represents that it has undertaken and satisfied the requirements of Government Code 16 section 16.5, subdivision (a), paragraphs (1) through (5), and agrees that each other party may rely 17 upon that representation. This Amendment is not conditioned upon the parties conducting the 18 transactions under it by electronic means and either party may sign this Amendment with an original 19 handwritten signature. 20 The Agreement, as hereby amended, is ratified and continued. All provisions, terms, 21 covenants, conditions, and promises contained in the Agreement and not amended herein shall 22 remain in full force and effect. This Amendment shall become effective upon execution. 23 /// 24 /// 25 /// 26 /// 27 /// 28 /// - 3 - ii DocuSign Envelope ID:FBFA30F6-F3E2-4EB7-B1AA-F6A804848150 1 IN WITNESS WHEREOF,the parties hereto have executed this Amendment I as of the day and 2 year first hereinabove written. 3 4 CONTRACTOR COUNTY OFFRESNO Fresno Metropolitan Ministry 5 DoeuSigned by: ,.--- 6 r,". Nam.►. �` _ .®_.e a m (Au onzeslgnature) Nathan Magsig,Chairman of the Board 7 of Supervisors of the County of Fresno Emogene Nelson a Emogene Nelson, Executive director 9 6/24/2024 1 3:48 PM PDT '10 Date 11 12 Mailing Address: ATTEST: 3845 N_ Clark Street#101 Bernice E. Seidel .13 Fresno, CA 93726 Cleric of the Board of Supervisors County of Fresno, State of Califomia '14 '15 By Deputy '16 FOR ACCOUNTING USE ONLY: 17 FundfSubclaSS: 0001110000 18 Organization: 5620i558, 56201018, 56201019 19 Account: 729E 20 21 22 23 24 25 26 27 28 -4- CN _d O 2 cn (D a) cn cn a) U (6 O M UU) Co U) c O)- OC (D-O � O U 0 'BO >d c O o co - � .� tea) o) E !✓ tL � � � � 0a E O = ca a) 0 O c Q!] O O -O � L '0 Q c -0 E 2 a� � -E � LL 0- IL Qa o co 0 cn U E c O E � U >,Y a O 0 0 cn c 3 (6 Co L 0-0- a) Q " IL 0 Z O E3 = •cL) w (nLL c o CU a� U O ayi U 2 2 a L � U � c Z � aLL IUi IUi c ` 0) >•, o Z 3 O) O -0 a d O U O C: U Z Ups QE cccoo U Co c o a) 06 U CU `�- U c co U — `O c UU o co) �, U) o ° o a) 0 3 cOoQ a � E �� oL0- 0 0 o = = 0 '` 0 0 0 -0 - -0 L N Q m 0 cQo 0 LL E > _ m0 -c c m C o c W L •L o 0 0 c c Mn o }' 2 -0 a) O co Z p N O O Z E 'O w O cn m O 47— Co N a) a) LL Y � Q U cn O a) W � c00 c d � � j � cn = C > > — O U U) p)•— U a� E Eve 3 � Z c`nauoi2 � <n Q) cnc � ca > V LU c6 0 0 ` o c � 0- aa)i a2 0 a. o a � m >. o � EO I— � 0 > _ cam c� U p c cn=3 a) cn � o cn � _ o cn o m o N L a) . c 0 a) "= -O o °) ` Z � 0 — was Eo � cc V o � � a�i w m � UL Q � -0cn0 O m 0 con 2 ` � _ U) Co Mn cn � U) c c � .O c J- . cU .. O cn ca c —_ O O c N U co O .2 .O C O L Q- Q co m mQm 3 uio 3w 3m � m I N i -c U 0 c L o Co ai c Y c o aoi cn O p N 0 O V) � U 'p c L V- L C7 L a) p o3 D- o a 0 a � mom � 3 IL co d mom 0 v _ � Z -0LL v ca -0 cco = Co oo EUxc 0 n a _r > U)) Q c E O :3 M r o .. O CML — U L c6 U r L d O O Q) (D O ca E Y L C: E J c ~ a p) Z o U m O 06 n. m U) cn _ d a) L 2 0 >+ > E 0 E 3 0 U 7 O O a U) 0 Q LL — O U > o CDcU0 N c •� � U a E v � N r) u- > = c .. co a 0 a o ' Q- L c � � a p O N c 0 _ 'O U) U -0 cn _ co -0 U3 a) � 0 a) 00E Ea' m oL L (L6 � LO m Co a) X O m L X O O E U a) o cu O V U c W 00 a- o 0 0 cou- a E nL_ co° 0 a a- a- a- �_.. 2 0 2 0 U- U- � U- cn c 0) U p c U C o C -0 L U +� O a) Cor- m ._a co = : L (a tea) �00 E O 0 _0 cn � U � co 'O a) � O '--� 00 cm c 0 o Y 0 T 0 a) p c E a) Q (D E p E � i a) a) Q co a a) U L co E =En U) U 0- E O Q-O .O 0 L co Q) c c (n N c . co � 3 � Qm � a) o oc � c) CCnv � 0 0 '0 ocE Qco Way) 0) 0) E co >> c O ui a) 0 c m Q 0 U) 0 ~ 0 0 cn 0 � c "= �- c0) E E u 0 E -a — � � a � � mom- c 0) C .� Q 3EcTgom 0 flp > > c c °)ao _ 0 c0) aa)) Oco � m °) � c\o 00 m e OU 0 co co .> Q 3s p 0 Q) - n. 0 L �_ a) -0 Q > �� a) U co m _ � a � E 0 =) •cn = o � :3 QVOi C a n ._ K N M I a co O LO U a) U p Q w a) U O U N a) Q L m N W m 0 > 0) C = `t n ) aa)i = � 07 (1) � cLo >, co E � Q > Q 'C a) � � � Q -0 co � 0 � 3 H � c cn � � � cn � ? cn -0 � � m U o O L N � U r. c -0 c_o a) 0 c U) L co .o Q Q U - a) F- cB 0 0 C '> 00ocNcn Uc 0E 0 � U) tUi_ omc0n � c�oco , � Q� -0 EE � � � 0 00m LLco a) a) 0 � Q c: a) cc � a) a) 00)� OQ d 3 ca > 06 O a) 0 U cn O U) m O m � cc0o3 � "_ aci � 0 � mE �) � UC0 � � � a' � f= L � � � a �Uo U � E c o 0 rn-0 ME c co a) � U °� �' o - co � nCo °'� a) c � E � � °� � c N o "_' o � c � � coo -c-0 a o E oLa 0 cm = ,�' °c' E � o Qo 'cn � � tea) co 0) 0 � "J m co (D le c a 0 '>_ c '— � 3 ° UO � c � � > n � U `- � c 0 c co a) N L 0 p 0 0 — m D m U O a) j, OL 0" 0 (o Co co co 0 co a) (-6 3E � � c � � � _0 U) E � m 3 � � UL � ccncodcn Uwo- a) � E �� o -o U "' � U U c m N O p Q • • • • • • • • • mEcno � � a M -00 n mco co 0- co 0 (n U co E L Q) c U) O U cn O co m w U 0 Lo 0)2 m CU) >, m U ca --t U- +- O co L E � E � � ui -0 -0 U) = =3 M C co U) a-cnao �o ca U L c6 O ` C N (D L) = 00 C ' C UUmmom LLLLUa_ Z Q co Enai 0 0 m Q (D = 1 Co (B c0 co Q O- N O) Q E L Q L U L N � O — O O N O O Q Z Q p U C > r u, p cu aQO 3 c c o U) j 2 cU _ m C a) _ � 0 a) � " o0 ca, m2 mL- U E U C p L 0 LL o � �+ L _X � LL a� m C a) a) (Q CL U 0) o _ W _ '� y� Q LL � Q' a� c N U U � �J �_ _ C _ �F m "O c _ 'p M W .� .Q O Q- U O (6 N •� O .� y_ cn •�•. '� .0 p 70 (a [Cl ' � "O N U �_ - L +� O E N N 0 co =3N a Q cu M � p m .� C Co N M C C lA O - C C N p O L i> c � D C C N .V N 'a N p > C C U N N (B O U (n om Qc�L° Qo = Ca ciao C Q o '� >, � '� � v � � � aQ .-� 3 — 'E O (6 O L ._+ od UO C a) E d C � J 'C Q• Q 3 �a� c c� CQ E pa) C LU CR Co L O QC a O p O 0 aNO O cm vm = 02 Zn E O C C -0 E • • • • • • • • • = • • cC• (D a = 0 m M o C m a F- IL F F- F- a- F- a 0) c .E ca L F- r 2 � �a L) i m U- O O .O E Q� U U N o co y Q (n om wU � � 0 EUQU O Q ' O a> a U) o = U i O d CO () U) = O c 4) m 0 � O. LLUUIL N c cn p E N U) O O U) +' a O o �- O n O W cB C mc c6 U EL .0 O -a O O O NO. n a > C Coc6 O QUU)) N a) cn Z a) cD E •� O O( C - cuR Qc 0 U U (6 U p -0 a p C Q�'_ (B (6 2 Cl) 0) c 0) m C° Yz C: o1 : a) (n - 0 � U) 0-- E O O) +� N O iz - • � v �O 0cc E po a ao EO op co= U) K . a W n a U a a Ili E c Op ) LL W La O U caU) ' Q (D.� 0U) p UE .E cnW � — - > U1 CCL , co 0 — CL cn c: OO Q � Up M > � O OCU Ua O > cu Q > O O Q) Q cu O a to p U) ca -p .O U a) p c U M O a) c U 0 m a s� 0- O m0 � oC c cu : � � E� (D 0Q F 0 ° � p2 > co o� 0 � �o (na) O o Om0 cm o c- 0 Q) n V Q. 3 � � � U � UcUU .� > Uc .� 006WILUcnc 30 N Cam_ c •c -Ca � O O o IL tea O � aUa) a a� c c p U a) m Z > V > O O Q m Q U U) A v Q 04 0 % 3e t / � E Lt@ a -t -C \ E 0 £ kCL0 @ o D- CL 0 � U ± _0 ƒ $ E '% 2 0 o 3 $ _0 c / i to k f § � \ 0 k k 03 � 2 ƒ � � § c D a Q � _ � § @ O E3k .g � a ° § 0 � C 2 0 ° e q = 2 $ % 2 2 § m 3 ¥ U k _ _ CO (D � � § 2 .- % �k q % f t £ 0U £ ƒ 3y 2 � � � \ 2 � 2 � k / LLJ 2 / k / M ( k (D � \ \ ok \ § k0 k LO m o S �. Q 7 % £ D E 2 / ® 3 § @ E = t o m e ( z > E ; c 2 E e a) 0 m e § 0 3 .t © m 0- O o � n 0 \ R \ o 2 E k � / 3 § cu U > � (n � � cDQE 020 cz Cn &/ k / t \ Z - ƒ d / > T 7 e0 -0 E 03 � 70a2 3k D_ - QU / 5 \mc � \ � k T ? �� § n � amE \ § 0kE § kUk § u § § q � ¥ m ¥ E § = a- a a a- k 0 § £ a 0 E 0 / 0 0 / k \ § � f G cl� � 2 c — cn d FD U) 0 Z) Qo 0) C c - 0-W aoEo(nU) `° C � o - �' 0-� 0) cn c0o 00m >�, cccn z L-. � FaU Fn pU � > B Cu p 0 60- +- — U O fn Q U) O OU 0- Cu U to a) CD 2 2 ❑ U UU U- LLLL _0 aciCo U) `) ry L W O 70 N Co OC: Cu- N O O O 0 0 _ O U C O N 0 CA O N C O N (a C: N 'O CD oo � of m a) 0-o � a � cn o � cE o >, a) c �. cU U «� C O y- Y -0 cn 4— O � N Q Q O C p Q cQ C fn L .� L O O Q0 > >+ 0 0 0 0 u) Co 0 co O 0 Q to c � O -0 IL c -O U) Q CuCo C C Co U O C O O C O O V Q N Cu N nin Q CU c6 E .c O) -0 O L L- cu 'an) N cn C L Co L (6 � «. 4= Q U N cA z c O U p O c - O O >' o � >, O } L Cn -p lL U O Co = O O O a L- -0 O O c .� N U .� cII "O Q — = U t0 N E c0 C L N > Q �' U +. _ ' Q a) Co>' c Q C 0 U O 0 0 0 N UCD (B 'O 0 .� Q 0 •� Co CuCo M U O U m (C w Q U c p N N N N O Co _ L -p 'o U m L Y/ O cD L cCj C U m �- NQ O 0 Q O n O n CL p O cn +• (6 O L =_ c -C =- Co � O U U Lnn-`� •L cnn� O .� OQ U z ,- ncn�� N c6 .�' 0 2� -0n� nUn�� c /C�� Ca c O O L 0 U) N Q N '— N N E N 0 p c C Q -o :, 0 c' U W 0 5) C En ai ac ' c � U Q � U 2 m a) n � � o p ❑ =3 N _ p O p o 0- CL O n L Q u) cL6 p = m = c6 N Co 0 = c0 3a) � 3cILC" Ew W ° W naU ° � o � Hcci � UO2aE 3c a) U U O a) C o c6 a_ U O U d N CO N _ Cn N O L O :3 C C 0 En Cu _p E M U O a _ Co U m U W c� d' N N O O C O a) 0 U) c (n 0) c U) C � _0 (n 0 N Q 0) a) m O c m U O a) E >, Fn E cn °cu >, U i CU p _ a) N m a) = — n a � � -°c ° > c � o 0 c_ m � m Cl) E ° -0 07 L d N E ccu LUL o- o = D � o 2oOc � LL a- LL LL c c L o 0 c ° = L : a) U o c �eS Q U � e nan♦♦ nLn♦♦ L CA Z ° L m 0 U D 0 Q � � Q L � N 0 m c U Q) = Q c U O Yln/ a) Q Q Q c) OQ E _ 0c (n o Oa) ° a) LQ r O con Q Oc c0) V06 o � cE 0 -c � UE � 0 > E Q oU � c`na Uo c�iaU'i co � pE Eou) E � Q � Nm 0 °' Q ° "= -o mom" o a) Qc' a) `- , m c 70 o lj ESN 0) C/) � c � � 0 cno aQ � E ° ° � � � "= 70 > Q � �' a c c m "= a - c c E ui o = o " ° o � ° a) ° � ai M Q o Q p >, oc oo co OQ Uci `- U) c) � .- N U •"= > `~ ate) Lo Qm E L) °) -c m Q �� 3 m ° � � � � E ' Q-= •> `= -0 O E p O L (Lo U U 0 c6 c ° `' ,� -0 +� a L m >, to c U Q c ca 3 Q) cn +' L m U c U Q) a) c a7 a) 0)0.. °Q E Q o m � � ° '0 Q� m N Q� a) c E m � 0 0 m c Y Q E 07 a) 0 a) 0 Q 0) O L c m cn (n .c E m o co L Q, c m 0 o ° ° c n.: aE -0 = - E � � '� � -0.- co ° '3 L c � o Q = a�i M L) a) as co o a) 0) w e coo L '0 ° 0 co a o W— ° m U U m U U E .� Q U c O c c U a) O) c c0 Co U a) Q c 0 U 3E (D EacoCL .sEn OU Ec �= � � C� CACA0 � cn � cn ,� Q a) ,Z' m m 0 0, 0 .— ° "' • • • • • : .T m '� c 0 • • • • > c U dim a- ma) c � L. ca ° c 0 m L 0 m a) ° m U Q m E E � U IC! N N _ c _ i O O � a) Q �Q CU U a Q ❑ U U ❑ OY L Q) ❑ a) m (6 U �'"_ U C U Cu LL _0 E cu L. p LLEn 0 > p' O 3 a) 0 0 0 C � -0 a en -c O m� a � E �LU vc -0 � � a- • m c oa o ` oocu c a � o � U)EE U oE "c00cc :EU) n U °' O C EU � O CD .N c o a a � aLL LL as L O U p -a p C "O a) U p a) �_ r L Q a) C p U C '3 U 3 C .p L- a) w — m O � C O E (6 C C cn �O � U 14 U m 'E C CO c -0 cu U O) Q E C 0- (B as �Lp O O a 0 N ++ =06 E O U C a) (D �p a) cn a) U L t) O �- U N O (6 (n U C Co C O W R c6 a) m = �O U � d? 'L O E O U o Q 3o Q) � c tf � Q0)� v � -0 d N L U O U p C o U M vi C Q c .60 c VJ N Q) -C C (0 N Q U p CY6 a) m (6 0 � Q 0 07.= a) U U � O � U �, U U C �- c . co a) o E *= a) : o 0 � '- -E co E � L- a) � o cn E _ (0 — "- "� a) E U Y O Y o C c� c — E - � Inm .E -o — Om U `� nUEc � U o m o .� �. a) m o 3 m rn m �' U) cU a� a� a) p _L L o Uu- ZLL cn �E E LUG F- -a 1") in32 -c: E 'L a) > a) N ❑_ V b a- 0 In U 3 L TO (� m n TI- Z U > O U .,> O a a C) Q C7 C) � ca co % 7 / 0 _ @ . > A2 0 E E U £ E E o � CU� � k � m .E 3 Q m e o ¥ U LL &2 ƒ 0 $ E a) c \ : cu ° 2 0 ( o Q $ 0 I E 2 % a)E _0 E e 70 E a 2 � / £ Q a) m ] co o e 0 " £ C� E E e -0 = E E ® _ cn _ E m 2 .2 @ % -0% E m 2 m z E : ° 2 e t L a § f k Q 0 (D - -o 7 o E c � ? § .- -o 4 § O 2 � � � E m k _ - -0 o 0 § E / £ 0) / > co f § .s01 5 / c d k § 2 co / % / \? E k@e % ° 22 e � 3 ® _0 % �CL� kk E � � W y y / ) 0 - ' E ^ R k / _ = 0 e ® Q � � § ƒ o \ = 0 C: 2m �£ y2n � tE 2 060 § .g — 0 E / [ / 2 M 2: C "CD 0 0 =3 > _0 E ° ° $ 3 0 E CL 3 3 ° k § @ £ Q o 0 o m 2 . E e -- £ 0 o a) .0- \ R 2 J P = E o ) / ° E % E % / f CD ] E = 2 m = E Q m m 2 E C E n E e E » 2 k �: @ � ° CU ° E % 0 R 0 ® q 2 q \ \ % / e CL o >' / � �_ / b ._ / u oyg = / \ _ >, e £ E � nE . ( 3 ¥ a) a / E § $ \ [ J § E $ § ® § @ G i v e « E « E « 3 0 3 0 -2 0 0 £ Co E o .- E / \ \ . , , . - - k 2-0 e o E 2 b a § § 0- � 2 E � U n O m U n C15 0 s § k / \ � a 3 3 E@ � Q c 0 E e o 6 / ƒ G ¢ , a)-0 ) q = / k •J k h / m@ ± m E E ± cr IL CL � 3 U Q U- ± ® / $ e 0 2 \ E u 06 t § q a k2 � § / = J k: (D = \ Qoc t \ / \ (D @ § E /_ [ § \ 3 E _ ± CL 0 .. / E 2 ° / cn 2 2 � � k o - .. @ v > P = E E >, o c '> @ o m •- .� E e q3 0 cn / ' � � W cncn Q) § cn / =) ' 2 -0 0-a)E � o 2 \ y q 7 / § 3 / / E k k Q § a E � \ 3 § E 3 % � 2 2 ' 3 6 ® ° ) 5 § o a @ ' U 2 % t— o £ @3 ± a % E \ a � � � 0 c m k k � E (D a) t = ® ® N o E = 0 o : @ e . k § k / / cm % J \ / / f : j 2 E _E 5 CL o - $ § % > _0 n 2 w a 7 / : § / C 2 q § / § $ -i \ § \ 2La > E E . . , f E co \ . . . M \ E 0 o § .E % / 3 § ± > ] \ (n E � @ Cl- m O E § q 30 ,It Q C15 cli \ ± CIO k % f § t c \ : E k m Cn L � n 3q ± LL § % 2 0 � (D e 2 © 3 E @ Q E E _ � co � cc \ a � o = o ) / 3 / \ ƒ \ « 7 -0 � � a) 0- E 73 ƒ f LL § 2 9 m 3 ) 7- o £ o t \ @ a § 5 m t _ LU� � � - % \ 7 krL § � L m 0 0 �E o c: E £ £ m . n o > 7 ƒ 3 k J 7mi 22m « � h � .� ® M P —Cuq Z" a £ 7 CL o o ' w / L = o L- � � £ : : e E : 7 / ƒ ƒ § ) ƒ o E U E O 2 0 b E (D o E f f $ . . , . . o 2 m E E � 2 . _ E % c » 0 ¥ -L o = 0 @ k _ 0 —0 .§ (3) d E \ 9k _ E E m e o Z- � y U ± § � £ �_ 0 0 E_ % 06 � § 2 c k 2 •- _ \ k % 2 c ° k t E .2 7 E E o o \ § y d ) tf � > 2 2 E 0 E 2 t ' 0- o 'e m o - @ " - c E E a- o _0 o = E E ® (N x ) o _ . z _ W E > 0 m § 0 CL -0 0 0 : \ E n : 2 k o E E Q 2 _ % 0/ 2 2 E CMq 2 2 E § § > CU -0E ■ O � % Fo E o o * C)C E_ d �§ ° (d : �E \ o � a & a) o � E ¥ D- o� k � 2 E '§ § 0 @ -E OD- 0- 5 o ¥ q � ? C O � k 3 0 D 3 / ƒ / -0 :6 S - - - - -0 k = a-aU © = c = (U e � =3 ELL O U) cn 0 (D E E 0 n ¥ ¥ . r: £ 3 (13 ■ . _ � � � 3 = n m = o \ $ \ oaf k_ k � $ © dE LL o 0 0 - � O � 2 0 § n ƒ ƒ _ LJ o ■ U U > CL ± ± W § 3 2 0 0 E v ' ) E [ : E n E 8 E = c 3 cE0000 E Eck " -O m E / .§ / 2 k m 2 .- k 0 � % / k / 2 % \ ? �) 7D . @ ° E " o E - £ - -0 F . 0 " q 2 0 j 2 � 0 -0 2 0 E a \ o e = £ E £ = e ¥ > � cuE ƒ \ f > \ 2 \ � . 2 2 § � M x / -0 > c E @ 3 ® 0 ' § » ¥ w _ L- E o o a o 0 3 U c § = o = e -0 f E : 2 E E / § ¥ R@ t § o T % § > £ % -0 0C > o £ 33E0 k " 0- aE . 0 0 0 2 E co E ® 0 0) CY) E Co a y E £ § / % § o § cm / W ° _0 - 2 ui k . k ( � 2 0-k \ � % / g § 7 m E E _ w 2 = 5 5 e •- E 0 2 m o 5 g ) = e e ® o m 3 > 7 e : � E E k 2 7 0 . E £ � > E m o § ® 2 f �� 2 f k 5 2 E d § a E - o e o > � > a e 2 5 0 6 E 2 ± § �k Q e y U) : 3 :2 E o 3 O E E = o § 2 e E > > / � E ■ 2 § 7 m > 2 : : 0 � � « � � W @ ■ . @ m a 0 U ' £ _ cu / k / CI o cn « / 2 5 k o t m u / k CO) k 0 0)U) § cn Ok a)E% E M /$.�> 0 =•\2 E () U m 0 §E cn \ § cn § k2E 'E ±k0 3£ « % CU E 3 7 L 2 ƒ ƒ 0 U E 5 L v u % cu 3 3 ULL 2 0 a- / % y / O < E U Z 3 � q C o 0 » < Q U U U U L � 7 m ± ¥ ■ § . . . . . . . . . . . . . 0 t c €v E 'a am 01 o c c t , ; s ° C ° ooaB 1. 'v `o E o 9 t c .o ng s = ECo E N — o w c E a E I °oa E a s E s m.12 = E r u 9 ; E - eo E o - Eo O 0 v s M m o n _ .5 z c 3 E E g m j a Q g $ .E.c N lr Q€ $ E CV El E s E n rynry ' E E o � 'C.« a E Y a E S E E �u E E ri E M N c m e 88 v W 8 g E u m E 8 S E 3mo v, m E n m E a r E V E W _ N eO 6 a °E - a �_� ..�'m^ i ;,'c_ a` �� a Sf N+ o. do w A. y c o ee ee _N e m°^ =N LL a _ m m _N c c ea m _No n mee ch 2 �` w ° i g .n E m'a C .a N a e m o I rtOi vmi m m M a o a m EE m w O 0 N O E o o E � @J ry v rn - ¢ tl N O N E E rm c .Ni E E E E •@1 E f 4 � o a o 2 Im ° H o m .3 o m u E txi a S c 'E `o G .. x _ o •E " a o a n¢ E LL E 0 c d 2 0 � v O N U U U O a a � u a'4 o f Z 3 $ A Lo. C _ - - O E ° `m a ` � " m x C a 90 a ° A E o E c ea`w A E c x = w - � - _ j E 5 _ x $ w A E n - x s _ C E - E E C S d °c « ` w e i E m E E e wo m_ 18 E° $S 3 ° ry T A d$ _ cmE a 2E r 0 xt - c E c Via = �� vEm S dd o0 ('' m$c c? �•E E > E v""i 'o Q E q v Mq E E - mg + 0 0..1r• v C g $ ,. v' E ° g E `m x % '"' n E S S E .mi. E u a c E 9 E - H 2 ^E c ° a p' '^ m E 8 E E$ S ti.° It. ut a ."'ipf yC geed E - "§ F : o 6_ xO E og N W c m E S $ c ° o �, n ¢ry a E Epg E � E o m b E -u E .n 88S" zmE G 3`xt9 c c o ^^t + H o8 _ "� ' n n n m q E'�" N o$ v a `° E < 'f 0 2 $ o o r$ m C $f mm N E mm I„ o rvn uN nn u tMa' < ='^ O} O MN YI Tn 'O 'O O O vi QIli W 1p Q�D e1 1� tG Q rl ti b Itf ei Vl r1 ei N p V O N n °'y1 8 000 l0° O O p 00 M O M N Q N m o c o , a c n ry u y s`a v u v _ c d a o ~ � o o 3 x � m u p a w E E $ _ � c m — w a u 0 n n atz ,°� °XX' > o C O 1� V K m r s m 3 m U V (7 m O U C N m U A m in d a = m uI I 1 10 1 1 1 1 1x aq Z - o E ° E oE d % E E - $ E y E u r A G.tl i A E E - T. E o � d _ ada Ez �Q E c$ _ _ u E n m c 'v6 E v'i a y m x u O E E i E o § x .ii`-' E E m ZL E RE & E ° ° is E am 3 A = E E c z o c a A - u E 3 E c C ° c F� E c r C C x a E E M _ Eo En SngA me !� Mi "'•m EEm .: > c a2^S E mv'-fie Aa .e m q NN E E ti c E E 2 m ' E E °Pv' .= ry� S B n �� r e �: E ro o mm W E E m T E E E 8 m E 0 - W« L m °c E E N w r o o r� t LL mxm�- m 't m �$ Ec "� a E > LYh N E E� E= t mG u , ��" N E E o _ f M :E u u + d A o o h a LL t °°n° << _"^ a asS w A a<' 8°.q c' u2 ` ''c '�'@'�"QLL@iS gv' �= as `�"^• °' 9 9a �' 9 n 9 d= E 9 D 5 E � n as N e E v ° o° A i 5 H w¢m u'uu >' u° n >b YO T°� N nNON O Tm N 00 n T m m T n N N C n P O °1 W O g ei e1 ri O C @! C C A V O r C E Mm a dU � F v Ti u } C d c � E O C O N N C 8 u o r44 c m s m a .�i g c �a m N E w E m E o f m t ° o > V N ~ � V m W m d O s U E E Z u - E � - - E E E G 3 3 3 Z - _ i c X � E a E W 0 o n o o n n m o uv'i, e m O e N N 00 01 01 Q N N O v�l m b n O �D N Of n O m N e l!1 Vf l0 'I m b 1�O1 C_ N 2 w O Ean c a E - o v s m ow u � C � Z a a c c o 0 3 - _ v u m - w V 9 o � E o Q V L L 75 _ OC _ � V F O O m v = � c u = m a � a O 0 V Exhibit D ` `� U.S.DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service t Centers for Disease Control and Prevention(CDC) Atlanta GA 30333 General Terms and Conditions for Non-Research Grant and Cooperative Agreements Incorporation: The Department of Health and Human Services (HHS) grant recipients must comply with all terms and conditions outlined in the Notice of Funding Opportunity (NOFO), their Notice of Award (NOA), grants policy contained in applicable HHS Grants Policy Statements, 45 CFR Part 75, requirements imposed by program statutes and regulations, Executive Orders, and HHS grant administration regulations, as applicable; as well as any requirements or limitations in any applicable appropriations acts. The term grant is used throughout these general terms and conditions of award and includes cooperative agreements. Note: In the event that any requirement in the NOA, the NOFO, the HHS Grants Policy Statement, 45 CFR Part 75, or applicable statutes/appropriations acts conflict, then statutes and regulations take precedence. FEDERAL REGULATIONS AND POLICIES 45 CFR Part 75— Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards. https://www.ecfr.gov/cgi-bin/text- idx?node=pt45.1.75&rgn=div5 HHS Grants Policy and Regulations https://www.hhs.gov/grants/ rq ants/grants-policies-regulations/index.html HHS Grants Policy Statement https://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgpsl 07.pdf Federal Funding Accountability and Transparency Act (FFATA) https://www.fsrs.gov/ Trafficking In Persons: Consistent with 2 CFR 175, awards are subject to the requirements of the Trafficking Victims Protection Act of 2000, as amended (22 U.S.C. Part 7104(g)). https://www,law.cornel1.edu/cfr/text/2/part-175 CDC Additional Requirements (AR) may apply. The NOFO will detail which specific ARs apply to resulting awards. Links to full texts can be found at: https://www.cdc.gov/qrants/additional-requirements/index.htm1. CDC General Terms and Conditions for Non-research Awards,Revised:September 2022 D-1 Exhibit D FUNDING RESTRICTIONS AND LIMITATIONS Cost Limitations as stated in Appropriations Acts. Recipients must follow applicable fiscal year appropriations law in effect at the time of award. See AR-32 Appropriations Act, General Requirements: https://www.cdc.gov/qrants/additional-requirements/ar-32.html. Though Recipients are required to comply with all applicable appropriations restrictions, please find below specific ones of note. CDC notes that the cited section for each below provision may change annually. A. Cap on Salaries (Division H, Title ll, General Provisions, Sec. 202): None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level ll. Note: The salary rate limitation does not restrict the salary that an organization may pay an individual working under an HHS contract or order; it merely limits the portion of that salary that may be paid with federal funds. B. Gun Control Prohibition (Div. H, Title Il, Sec. 210): None of the funds made available in this title may be used, in whole or in part, to advocate or promote gun control. C. Lobbying Restrictions (Div. H, Title V, Sec. 503): • 503(a): No part of any appropriation contained in this Act or transferred pursuant to section 4002 of Public Law 111-148 shall be used, other than for normal and recognized executive- legislative relationships, for publicity or propaganda purposes, for the preparation, distribution, or use of any kit, pamphlet, booklet, publication, electronic communication, radio, television, or video presentation designed to support or defeat the enactment of legislation before the Congress or any State or local legislature or legislative body, except in presentation to the Congress or any State or local legislature itself, or designed to support or defeat any proposed or pending regulation, administrative action, or order issued by the executive branch of any State or local government itself. • 503(b): No part of any appropriation contained in this Act or transferred pursuant to section 4002 of Public Law 111-148 shall be used to pay the salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or Executive order proposed or pending before the Congress or any State government, State legislature or local legislature or legislative body, other than for normal and recognized executive-legislative relationships or participation by an agency or officer of a State, local or tribal government in policymaking and administrative processes within the executive branch of that government. • 503(c): The prohibitions in subsections (a) and (b) shall include any activity to advocate or promote any proposed, pending or future federal, state or local tax increase, or any proposed, pending, or future requirement or restriction on any legal consumer product, including its sale of marketing, including but not limited to the advocacy or promotion of gun control. CDC General Terms and Conditions for Non-research Awards, Revised:September 2022 D-2 Exhibit D For additional information, see Additional Requirement 12 at https://www.cdc.gov/qrants/additional-requirements/ar-12.html. D. Needle Exchange (Div. H, Title V, Sec. 520): Notwithstanding any other provision of this Act, no funds appropriated in this Act shall be used to carry out any program of distributing sterile needles or syringes for the hypodermic injection of any illegal drug. E. Blocking access to pornography (Div. H, Title V, Sec. 521): (a) None of the funds made available in this Act may be used to maintain or establish a computer network unless such network blocks the viewing, downloading, and exchanging of pornography; (b) Nothing in subsection (a) shall limit the use of funds necessary for any federal, state, tribal, or local law enforcement agency or any other entity carrying out criminal investigations, prosecution, or adjudication activities. Prohibition on certain telecommunications and video surveillance services or equipment (Pub. L. 115-232, section 889): For all new, non-competing continuation, renewal or supplemental awards issued on or after August 13, 2020, recipients and subrecipients are prohibited from obligating or expending grant funds (to include direct and indirect expenditures as well as cost share and program funds) to: 1. Procure or obtain, 2. Extend or renew a contract to procure or obtain; or 3. Enter into contract (or extend or renew contract)to procure or obtain equipment, services, or systems that use covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. As described in Pub. L. 115-232, section 889, covered telecommunications equipment is telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any subsidiary or affiliate of such entities). i. For the purpose of public safety, security of government facilities, physical security surveillance of critical infrastructure, and other national security purposes, video surveillance and telecommunications equipment produced by Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company (or any subsidiary or affiliate of such entities). ii. Telecommunications or video surveillance services provided by such entities or using such equipment. iii. Telecommunications or video surveillance equipment or services produced or provided by an entity that the Secretary of Defense, in consultation with the Director of the National Intelligence or the Director of the Federal Bureau of Investigation, reasonably believes to be an entity owned or controlled by, or otherwise, connected to the government of a covered foreign country. President's Emergency Plan for AIDS Relief(PEPFAR) funding is exempt from the prohibition under Pub. L. 115-232, section 889 until September 30, 2022. During the exemption period, PEPFAR recipients are expected to work toward implementation of the requirements. Cancel Year: 31 U.S.C. Part 1552(a) Procedure for Appropriation Accounts Available for Definite Periods states the following: On September 30th of the 5th fiscal year after the period of availability for obligation of a fixed appropriation account ends, the account shall be closed and any remaining balances (whether obligated or unobligated) in the account shall be canceled and thereafter shall not be available for obligation or expenditure for any purpose. CDC General Terms and Conditions for Non-research Awards, Revised:September 2022 D-3 Exhibit D REPORTING REQUIREMENTS Annual Federal Financial Report (FFR, SF-425): The Annual Federal Financial Report (FFR) SF-425 is required and must be submitted no later than 90 days after the end of the budget period in the Payment Management System. Additional guidance on submission of Federal Financial Reports can be found at https://www.cdc.gov/grants/documents/change-in-federal-reporting-fv-2021-recipients.pdf. If more frequent reporting is required, the Notice of Award terms and conditions will explicitly state the reporting requirement. Annual Performance Progress and Monitoring Reporting: The Annual Performance Progress and Monitoring Report (PPMR) is due no later than 120 days prior to the end of the budget period and serves as the continuation application for the follow-on budget period. Submission instructions, due date, and format will be included in the guidance from the assigned GMO/GMS via www.grantsolutions.gov. Any change to the existing information collection noted in the award terms and conditions will be subject to review and approval by the Office of Management and Budget (OMB) under the Paperwork Reduction Act. Data Management Plan: CDC requires recipients for projects that involve the collection or generation of data with federal funds to develop, submit and comply with a Data Management Plan (DMP) for each collection or generation of public health data undertaken as part of the award and, to the extent consistent with law and appropriate, provide access to and archiving/long-term preservation of collected or generated data. Additional information on the Data Management and Access requirements can be found at https://www.cdc.gov/grants/additional-requirements/ar-25.html. Audit Requirement Domestic Organizations (including US-based organizations implementing projects with foreign components): An organization that expends $750,000 or more in a fiscal year in federal awards shall have a single or program-specific audit conducted for that year in accordance with the provisions of 45 CFR Part 75. The audit period is an organization's fiscal year. The audit must be completed along with a data collection form (SF-SAC), and the reporting package shall be submitted within the earlier of 30 days after receipt of the auditor's report(s), or nine (9) months after the end of the audit period. The audit report must be sent to: Federal Audit Clearing House Internet Data Entry System Electronic Submission: https://harvester.census.gov/facides/(S(Ovkwl zaelyziibnahocga5i0))/account/login.aspx AND Office of Financial Resources, Risk Management and Internal Control Unit's Audit Resolution Team (ART), RMICU.Audit.Resolution(cDcdc.gov. Audit Requirement Foreign Organizations: An organization that expends $300,000 or more in a fiscal year on its federal awards must have a single or program-specific audit conducted for that CDC General Terms and Conditions for Non-research Awards,Revised:September 2022 D-4 Exhibit D year. The audit period is an organization's fiscal year. The auditor shall be a U.S.-based Certified Public Accountant firm, the foreign government's Supreme Audit Institution or equivalent, or an audit firm endorsed by the U.S. Agency for International Development's Office of Inspector General. The audit must be completed in English and in US dollars, and submitted within the earlier of 30 days after receipt of the auditor's report(s), or nine (9) months after the end of the audit period. The audit report must be sent to the Office of Financial Resources, Risk Management and Internal Control Unit's Audit Resolution Team (ART) at RMICU.Audit.Resolution(a-)cdc.gov. After receipt of the audit report, CDC will resolve findings by issuing Final Management Determination Letters. Domestic and Foreign organizations: Audit requirements for Subrecipients to whom 45 CFR 75 Subpart F applies: The recipient must ensure that the subrecipients receiving CDC funds also meet these requirements. The recipient must also ensure to take appropriate corrective action within six months after receipt of the subrecipient audit report in instances of non-compliance with applicable federal law and regulations (45 CFR 75 Subpart F and HHS Grants Policy Statement). The recipient may consider whether subrecipient audits necessitate adjustment of the recipient's own accounting records. If a subrecipient is not required to have a program-specific audit, the recipient is still required to perform adequate monitoring of subrecipient activities. The recipient shall require each subrecipient to permit the independent auditor access to the subrecipient's records and financial statements. The recipient must include this requirement in all subrecipient contracts. Required Disclosures for Federal Awardee Performance and Integrity Information System (FAPIIS): Consistent with 45 CFR 75.113, applicants and recipients must disclose in a timely manner, in writing to the CDC, with a copy to the HHS Office of Inspector General (OIG), all information related to violations of federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the federal award. Subrecipients must disclose, in a timely manner in writing to the prime recipient (pass through entity) and the HHS OIG, all information related to violations of federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the federal award. Disclosures must be sent in writing to the assigned GMS/GMO identified in the NOA, and to the HHS OIG at the following address: U.S. Department of Health and Human Services Office of the Inspector General ATTN: Mandatory Grant Disclosures, Intake Coordinator 330 Independence Avenue, SW Cohen Building, Room 5527 Washington, DC 20201 Fax: (202)-205-0604 (Include "Mandatory Grant Disclosures" in subject line) or Email: Man datoryGranteeDisclosures(a)oig.hhs.gov Recipients must include this mandatory disclosure requirement in all subawards and contracts under this award. Failure to make required disclosures can result in any of the remedies described in 45 CFR 75.371. Remedies for noncompliance, including suspension or debarment (See 2 CFR parts 180 and 376, and 31 U.S.C. 3321). CDC General Terms and Conditions for Non-research Awards,Revised:September 2022 D-5 Exhibit D CDC is required to report any termination of a federal award prior to the end of the period of performance due to material failure to comply with the terms and conditions of this award in the OMB-designated integrity and performance system accessible through SAM (currently FAPIIS) (45 CFR 75.372(b)). CDC must also notify the recipient if the federal award is terminated for failure to comply with the federal statutes, regulations, or terms and conditions of the federal award (45 CFR 75.373(b)). 1. General Reporting Requirement If the total value of currently active grants, cooperative agreements, and procurement contracts from all federal awarding agencies exceeds $10,000,000 for any period of time during the period of performance of this federal award, the recipient must maintain the currency of information reported to the System for Award Management (SAM) and made available in the designated integrity and performance system (currently the Federal Awardee Performance and Integrity Information System (FAPIIS)) about civil, criminal, or administrative proceedings described in section 2 of this award term and condition. This is a statutory requirement under section 872 of Public Law 110-417, as amended (41 U.S.C. 2313). As required by section 3010 of Public Law 111-212, all information posted in the designated integrity and performance system on or after April 15, 2011, except past performance reviews required for federal procurement contracts, will be publicly available. 2. Proceedings About Which You Must Report Submit the information required about each proceeding that: a. Is in connection with the award or performance of a grant, cooperative agreement, or procurement contract from the federal government; b. Reached its final disposition during the most recent five-year period; and c. If one of the following: (1) A criminal proceeding that resulted in a conviction, as defined in paragraph 5 of this award term and condition; (2) A civil proceeding that resulted in a finding of fault and liability and payment of a monetary fine, penalty, reimbursement, restitution, or damages of$5,000 or more; (3) An administrative proceeding, as defined in paragraph 5 of this award term and condition, that resulted in a finding of fault and liability and your payment of either a monetary fine or penalty of$5,000 or more or reimbursement, restitution, or damages in excess of$100,000; or (4) Any other criminal, civil, or administrative proceeding if: (i) It could have led to an outcome described in paragraph 2.c.(1), (2),or (3) of this award term and condition; (ii) It had a different disposition arrived at by consent or compromise with an acknowledgement of fault on your part; and (iii) The requirement in this award term and condition to disclose information about the proceeding does not conflict with applicable laws and regulations. CDC General Terms and Conditions for Non-research Awards,Revised:September 2022 D-6 Exhibit D 3. Reporting Procedures Enter in the SAM Entity Management area the information that SAM requires about each proceeding described in section 2 of this award term and condition. You do not need to submit the information a second time under assistance awards that you received if you already provided the information through SAM because you were required to do so under federal procurement contracts that you were awarded. 4. Reporting Frequency During any period of time when you are subject to this requirement in section 1 of this award term and condition, you must report proceedings information through SAM for the most recent five year period, either to report new information about any proceeding(s) that you have not reported previously or affirm that there is no new information to report. Recipients that have federal contract, grant, and cooperative agreement awards with a cumulative total value greater than $10,000,000 must disclose semiannually any information about the criminal, civil, and administrative proceedings. 5. Definitions For purposes of this award term and condition: a. Administrative proceeding means a non-judicial process that is adjudicatory in nature in order to make a determination of fault or liability (e.g., Securities and Exchange Commission Administrative proceedings, Civilian Board of Contract Appeals proceedings, and Armed Services Board of Contract Appeals proceedings). This includes proceedings at the federal and state level but only in connection with performance of a federal contract or grant. It does not include audits, site visits, corrective plans, or inspection of deliverables. b. Conviction, for purposes of this award term and condition, means a judgment or conviction of a criminal offense by any court of competent jurisdiction, whether entered upon a verdict or a plea, and includes a conviction entered upon a plea of nolocontendere. c. Total value of currently active grants, cooperative agreements, and procurement contracts includes— (1) Only the federal share of the funding under any federal award with a recipient cost share or match; (2) The value of all expected funding increments under a federal award and options, even if not yet exercised. GENERAL REQUIREMENTS You must administer your project in compliance with federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age and, in some circumstances, religion, conscience, and sex (including gender identity, sexual orientation, and pregnancy). This includes taking reasonable steps to provide meaningful access to persons with limited English proficiency and providing programs that are accessible to and usable by persons with disabilities. The HHS Office for Civil Rights provides guidance on complying with civil rights laws enforced by HHS. See https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html and https://www.hhs.gov/civil-rights/for-individuals/nondiscrimination/index.htmi. • You must take reasonable steps to ensure that your project provides meaningful access to persons with limited English proficiency. For guidance on meeting your legal obligation to take CDC General Terms and Conditions for Non-research Awards,Revised:September 2022 D-7 Exhibit D reasonable steps to ensure meaningful access to your programs or activities by limited English proficient individuals, see https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited- english-proficiency/fact-sheet-quidance/index.html and https://www.lep.gov/. • For information on your specific legal obligations for serving qualified individuals with disabilities, including providing program access, reasonable modifications, and taking appropriate steps to provide effective communication, see http://www.hhs.gov/ocr/civilrights/understanding/disability/index.htmi. • HHS funded health and education programs must be administered in an environment free of sexual harassment, see https://www.hhs.gov/civil-rights/for-individuals/sex- discrimination/index.html. • For guidance on administering your project in compliance with applicable federal religious nondiscrimination laws and applicable federal conscience protection and associated anti- discrimination laws, see https://www.hhs.gov/conscience/conscience-protections/index.htmi and https://www.hhs.gov/conscience/religious-freedom/index.html. Termination (45 CFR Part 75.372) applies to this award and states, in part, the following: (a) This award may be terminated in whole or in part. (1) By the HHS awarding agency or pass-through entity, if a non-Federal entity fails to comply with the terms and conditions of a Federal award; (2) By the HHS awarding agency or pass-through entity for cause; (3) By the HHS awarding agency or pass-through entity with the consent of the non-Federal entity, in which case the two parties must agree upon the termination conditions, including the effective date and, in the case of partial termination, the portion to be terminated; (4) By the non-Federal entity upon sending to the HHS awarding agency or pass-through entity written notification setting forth the reasons for such termination, the effective date, and, in the case of partial termination, the portion to be terminated. However, if the Federal awarding agency or pass-through entity determines in the case of partial termination that the reduced or modified portion of the Federal award or subaward will not accomplish the purposes for which the Federal award was made, the HHS awarding agency or pass-through entity may terminate the Federal award in its entirety. Travel Cost: In accordance with HHS Grants Policy Statement, travel costs are allowable when the travel will provide a direct benefit to the project or program. To prevent disallowance of cost, the recipient is responsible for ensuring travel costs are clearly stated in their budget narrative and are applied in accordance with their organization's established travel policies and procedures. The recipient's established travel policies and procedures must also meet the requirements of 45 CFR Part 75.474. Food and Meals: Costs associated with food or meals are allowable when consistent with applicable federal regulations and HHS policies. See https://www.hhs.gov/grants/contracts/contract-policies-regulations/spending-on-food/index.html. In addition, costs must be clearly stated in the budget narrative and be consistent with organization approved policies. Recipients must make a determination of reasonableness and organization approved policies must meet the requirements of 45 CFR Part 75.432. CDC General Terms and Conditions for Non-research Awards,Revised:September 2022 D-8 Exhibit D Prior Approval: All requests which require prior approval, must bear the signature (or electronic authorization) of the authorized organization representative. The recipient must submit these requests no later than 120 days prior to the budget period's end date. Additionally, any requests involving funding issues must include an itemized budget and a narrative justification of the request. The following types of requests are examples of actions that require prior approval, unless an expanded authority, or conversely a high risk condition, is explicitly indicated in the NOA. • Use of unobligated funds from prior budget period(Carryover) • Lift funding restriction • Significant redirection of funds (i.e., cumulative changes of 25% of total award) • Change in scope • Implement a new activity or enter into a sub-award that is not specified in the approved budget • Apply for supplemental funds • Extensions to period of performance Templates for prior approval requests can be found at: https://www.cdc.gov/qrants/already-have-grant/PriorApproval Requests.html. Additional information on the electronic grants administration system CDC non-research awards utilize, Grants Solutions, can be found at: https://www.cdc.gov/grants/grantsolutions/index.html. Key Personnel: In accordance with 45 CFR Part 75.308, CDC recipients must obtain prior approval from CDC for (1) change in the project director/principal investigator, authorized organizational representative, business official, financial director, or other key persons specified in the NOFO, application or award document; and (2) the disengagement from the project for more than three months, or a 25 percent reduction in time devoted to the project, by the approved project director or principal investigator. Inventions: Acceptance of grant funds obligates recipients to comply with the standard patent rights clause in 37 CFR Part 401.14. Acknowledgment of Federal Funding: When issuing statements, press releases, publications, requests for proposal, bid solicitations and other documents --such as tool-kits, resource guides, websites, and presentations (hereafter"statements")--describing the projects or programs funded in whole or in part with U.S. Department of Health and Human Services (HHS) federal funds, the recipient must clearly state: 1. the percentage and dollar amount of the total costs of the program or project funded with federal money; and, 2. the percentage and dollar amount of the total costs of the project or program funded by non-governmental sources. CDC General Terms and Conditions for Non-research Awards,Revised:September 2022 D-9 Exhibit D When issuing statements resulting from activities supported by HHS financial assistance, the recipient entity must include an acknowledgement of federal assistance using one of the following or a similar statement. If the HHS Grant or Cooperative Agreement is NOT funded with other non-governmental sources: This [project/publication/program/website, etc.] [is/was] supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $XX with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government. If the HHS Grant or Cooperative Agreement IS partially funded with other non-governmental sources: This [project/publication/program/website, etc.] [is/was] supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $XX with XX percentage funded by CDC/HHS and $XX amount and XX percentage funded by non- government source(s). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government. The federal award total must reflect total costs (direct and indirect) for all authorized funds (including supplements and carryover)for the total competitive segment up to the time of the public statement. Any amendments by the recipient to the acknowledgement statement must be coordinated with the HHS Awarding Agency. If the recipient plans to issue a press release concerning the outcome of activities supported by HHS financial assistance, it should notify the HHS Awarding Agency in advance to allow for coordination. Copyright Interests Provision: This provision is intended to ensure that the public has access to the results and accomplishments of public health activities funded by CDC. Pursuant to applicable grant regulations and CDC's Public Access Policy, Recipient agrees to submit into the National Institutes of Health (NIH) Manuscript Submission (NIHMS) system an electronic version of the final, peer-reviewed manuscript of any such work developed under this award upon acceptance for publication, to be made publicly available no later than 12 months after the official date of publication. Also, at the time of submission, Recipient and/or the Recipient's submitting author must specify the date the final manuscript will be publicly accessible through PubMed Central (PMC). Recipient and/or Recipient's submitting author must also post the manuscript through PMC within twelve (12) months of the publisher's official date of final publication; however, the author is strongly encouraged to make the subject manuscript available as soon as possible. The recipient must obtain prior approval from the CDC for any exception to this provision. The author's final, peer-reviewed manuscript is defined as the final version accepted for journal publication and includes all modifications from the publishing peer review process, and all graphics and supplemental material associated with the article. Recipient and its submitting authors working CDC General Terms and Conditions for Non-research Awards, Revised:September 2022 D-10 Exhibit D under this award are responsible for ensuring that any publishing or copyright agreements concerning submitted article reserve adequate right to fully comply with this provision and the license reserved by CDC. The manuscript will be hosted in both PMC and the CDC Stacks institutional repository system. In progress reports for this award, recipient must identify publications subject to the CDC Public Access Policy by using the applicable NIHMS identification number for up to three (3) months after the publication date and the PubMed Central identification number (PMCID) thereafter. Disclaimer for Conference/Meeting/Seminar Materials: If a conference/meeting/seminar is funded by a grant, cooperative agreement, sub-grant and/or a contract, the recipient must include the following statement on conference materials, including promotional materials, agenda, and internet sites: Funding for this conference was made possible (in part) by the Centers for Disease Control and Prevention. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. Logo Use for Conference and Other Materials: Neither the Department of Health and Human Services (HHS) nor the CDC logo may be displayed if such display would cause confusion as to the funding source or give false appearance of Government endorsement. Use of the HHS name or logo is governed by U.S.C. Part 1320b-10, which prohibits misuse of the HHS name and emblem in written communication. A non-federal entity is not authorized to use the HHS name or logo governed by U.S.C. Part 1320b-10. The appropriate use of the HHS logo is subject to review and approval of the HHS Office of the Assistant Secretary for Public Affairs (OASPA). Moreover, the HHS Office of the Inspector General has authority to impose civil monetary penalties for violations (42 CFR Part 1003). Additionally, the CDC logo cannot be used by the recipient without the express, written consent of CDC. The Program Official/Project Officer identified in the NOA can assist with facilitating such a request. It is the responsibility of the recipient to request consent for use of the logo in sufficient detail to ensure a complete depiction and disclosure of all uses of the Government logos. In all cases for utilization of Government logos, the recipient must ensure written consent is received. Further, the HHS and CDC logo cannot be used by the recipient without a license agreement setting forth the terms and conditions of use. Equipment and Products: To the greatest extent practical, all equipment and products purchased with CDC funds should be American-made. CDC defines equipment as tangible non- expendable personal property (including exempt property) charged directly to an award having a useful life of more than one year AND an acquisition cost of$5,000 or more per unit. However, consistent with recipient policy, a lower threshold may be established. Please provide the information to the Grants Management Officer to establish a lower equipment threshold to reflect your organization's policy. The recipient may use its own property management standards and procedures, provided it CDC General Terms and Conditions for Non-research Awards,Revised:September 2022 D-11 Exhibit D observes provisions in applicable grant regulations found at 45 CFR Part 75. Federal Information Security Management Act (FISMA): All information systems, electronic or hard copy, that contain federal data must be protected from unauthorized access. This standard also applies to information associated with CDC grants. Congress and the OMB have instituted laws, policies and directives that govern the creation and implementation of federal information security practices that pertain specifically to grants and contracts. The current regulations are pursuant to the Federal Information Security Management Act (FISMA), Title III of the E- Government Act of 2002, PL 107-347. FISMA applies to CDC recipients only when recipients collect, store, process, transmit or use information on behalf of HHS or any of its component organizations. In all other cases, FISMA is not applicable to recipients of grants, including cooperative agreements. Under FISMA, the recipient retains the original data and intellectual property, and is responsible for the security of these data, subject to all applicable laws protecting security, privacy, and research. If/When information collected by a recipient is provided to HHS, responsibility for the protection of the HHS copy of the information is transferred to HHS and it becomes the agency's responsibility to protect that information and any derivative copies as required by FISMA. For the full text of the requirements under Federal Information Security Management Act (FISMA), Title III of the E- Government Act of 2002 Pub. L. No. 107-347, please review the following website: https://www.govinfo.gov/content/pkq/PLAW-107publ347/pdf/PLAW-107pub[347.pdf. Whistleblower Protections: As a recipient of this award you must comply with the National Defense Authorization Act (NDAA) for Fiscal Year(FY) 2013 (Pub. L. 112-239, 41 U.S.C. § 4712) "Enhancement of contractor protection from reprisal for disclosure of certain information," and 48 CFR part 3 subpart 3.9, "Whistleblower Protections for Contractor Employees." For more information see: https:Hoig.hhs.gov/fraud/whistleblower/. PAYMENT INFORMATION Fraud Waste or Abuse: The HHS Office of the Inspector General (OIG) maintains a toll-free number (1-800-HHS-TI PS [1-800-447-8477])for receiving information concerning fraud, waste, or abuse under grants and cooperative agreements. Information also may be submitted online at https:Htips.oig.hhs.gov/ or by mail to U.S. Department of Health and Human Services, Office of the Inspector General, Attn: OIG HOTLINE OPERATIONS, P.O. Box 23489 Washington DC 20026. Such reports are treated as sensitive material and submitters may decline to give their names if they choose to remain anonymous. For additional information, see: https://oig.hhs.gov/fraud/report- fraud/. Automatic Drawdown (Direct/Advance Payments): Payments under CDC awards will be made available through the Department of Health and Human Services (HHS) Payment Management System (PMS), under automatic drawdown, unless specified otherwise in the NOA. Recipients must comply with requirements imposed by the PMS on-line system. Questions concerning award payments or audit inquiries should be directed to the payment management services office. PMS Website: https://pms.psc.gov/ PMS Phone Support: +1(877)614-5533 PMS Email Support: PMSSupport(d)psc.gov CDC General Terms and Conditions for Non-research Awards,Revised:September 2022 D-12 Exhibit D Payment Management System Subaccount: Funds awarded in support of approved activities will be obligated in an established subaccount in the PMS. Funds must be used in support of approved activities in the NOFO and the approved application. All award funds must be tracked and reported separately. Exchange Rate: All requests for funds contained in the budget, shall be stated in U.S. dollars. Once an award is made, CDC will generally not compensate foreign recipients for currency exchange fluctuations through the issuance of supplemental awards. Acceptance of the Terms of an Award: By drawing or otherwise obtaining funds from PMS, the recipient acknowledges acceptance of the terms and conditions of the award and is obligated to perform in accordance with the requirements of the award. If the recipient cannot accept the terms, the recipient should notify the Grants Management Officer within thirty (30) days of receipt of the N OA. Certification Statement: By drawing down funds, the recipient certifies that proper financial management controls and accounting systems, to include personnel policies and procedures, have been established to adequately administer federal awards and funds drawn down. Recipients must comply with all terms and conditions in the NOFO, outlined in their NOA, grant policy terms and conditions contained in applicable HHS Grant Policy Statements, and requirements imposed by program statutes and regulations and HHS grants administration regulations, as applicable; as well as any regulations or limitations in any applicable appropriations acts. CLOSEOUT REQUIREMENTS Recipients must submit all closeout reports identified in this section within 90 days of the period of performance end date. The reporting timeframe is the full period of performance. If the recipient does not submit all reports in accordance with this section and the terms and conditions of the Federal Award, CDC may proceed to close out with the information available within one year of the period of performance end date unless otherwise directed by authorizing statutes. Failure to submit timely and accurate final reports may affect future funding to the organization or awards under the direction of the same Project Director/Principal Investigator (PD/Pl). Final Performance Progress and Evaluation Report (PPER): This report should include the information specified in the NOFO and is submitted upon solicitation from the GMS/GMO via www.grantsolutions.gov. At a minimum, the report will include the following: • Statement of progress made toward the achievement of originally stated aims; • Description of results (positive or negative) considered significant;and • List of publications resulting from the project, with plans, if any, for further publication. All manuscripts published as a result of the work supported in part or whole by the grant must be submitted with the performance progress reports. Final Federal Financial Report (FFR, SF-425): The FFR should only include those funds authorized and expended during the timeframe covered by the report. The Final FFR, SF-425 is required and must be submitted no later than 90 days after the period of performance end date through recipient online accounts in the Payment Management System. The final FFR will CDC General Terms and Conditions for Non-research Awards,Revised:September 2022 D-13 Exhibit D consolidate data reporting responsibilities to one entry point within PMS which will assist with the reconciliation of expenditures and disbursements to support the timely close-out of grants. The final FFR must indicate the exact balance of unobligated funds and may not reflect any unliquidated obligations. Remaining unobligated funds will be de-obligated and returned to the U.S. Treasury. Every recipient should already have a PMS account to allow access to complete the SF-425. Additional guidance on submission of Federal Financial Reports can be found at https://www.cdc.gov/qrants/documents/change-in-federal-reporting-fv-2021-recipients.pdf. Equipment and Supplies -Tangible Personal Property Report (SF-428): A completed Tangible Personal Property Report SF-428 and Final Report SF-428B addendum must be submitted, along with any Supplemental Sheet SF-428S detailing all major equipment acquired or furnished under this project with a unit acquisition cost of$5,000 or more. Electronic versions of the forms can be downloaded by visiting: https://www.grants.gov/web/grants/forms/post-award- reporting- forms.html#sortby=1. If no equipment was acquired under an award, a negative report is required. The recipient must identify each item of equipment that it wishes to retain for continued use in accordance with 45 CFR Part 75. The awarding agency may exercise its rights to require the transfer of equipment purchased under the assistance award. CDC will notify the recipient if transfer to title will be required and provide disposition instruction on all major equipment. Equipment with a unit acquisition cost of less than $5,000 that is no longer to be used in projects or programs currently or previously sponsored by the federal government may be retained, sold, or otherwise disposed of, with no further obligation to the federal government. CDC STAFF RESPONSIBILITIES Roles and Responsibilities: Grants Management Specialists/Officers (GMO/GMS) and Program Officials (PO) work together to award and manage CDC grants and cooperative agreements. From the pre-planning stage to closeout of an award, grants management and program staff have specific roles and responsibilities for each phase of the grant cycle. Award specific terms and conditions will include contact information for the PO/GMO/GMS. Program Official: The PO is the federal official responsible for monitoring the programmatic, scientific, and/or technical aspects of grants and cooperative agreements including: • The development of programs and NOFOs to meet the CDC's mission; • Providing technical assistance to applicants in developing their applications, e.g., explanation of programmatic requirements, regulations, evaluation criteria, and guidance to applicants on possible linkages with other resources; • Providing technical assistance to recipients in the performance of their project;and • Post-award monitoring of recipient performance such as review of progress reports, review of prior approval requests, conducting site visits, and other activities complementary to those of the GMO/GMS. For Cooperative Agreements, substantial involvement is required from CDC. The PO is the federal CDC General Terms and Conditions for Non-research Awards,Revised:September 2022 D-14 Exhibit D official responsible for the collaboration or participation in carrying out the effort under the award. Substantial involvement will be detailed in the NOFO and award specific terms and conditions and may include, but is not limited to: • Review and approval of one stage of work before work can begin on a subsequent stage; • Review and approval of substantive programmatic provisions of proposed subawards or contracts(beyond existing federal review of procurement or sole source policies); • Involvement in the selection of key relevant personnel; • CDC and recipient collaboration or joint participation; and • Implementing highly prescriptive requirements prior to award limiting recipient discretion with respect to scope of services, organizational structure, staffing, mode of operation, and other management processes. Grants Management Officer: The GMO is the only official authorized to obligate federal funds and is responsible for signing the NOA, including revisions to the NOA that change the terms and conditions. The GMO serves as the counterpart to the business officer of the recipient organization. The GMO is the federal official responsible for the business and other non- programmatic aspects of grant awards including: • Determining the appropriate award instrument, i.e., grant or cooperative agreement; • Determining if an application meets the requirements of the NOFO; • Ensuring objective reviews are conducted in an above-the-board manner and according to guidelines set forth in grants policy; • Ensuring recipient compliance with applicable laws, regulations, and policies; • Negotiating awards, including budgets; • Responding to recipient inquiries regarding the business and administrative aspects of an award; • Providing recipients with guidance on the closeout process and administering the closeout of grants; • Receiving and processing reports and prior approval requests such as changes in funding, budget redirection, or changes to the terms and conditions of an award; and • Maintaining the official grant file and program book. Grants Management Specialist: The GMS is the federal staff member responsible for the day- to-day management of grants and cooperative agreements. The GMS is the primary contact of recipients for business and administrative matters pertinent to grant awards. Many of the functions described in the GMO section are performed by the GMS, on behalf of the GMO. CDC General Terms and Conditions for Non-research Awards,Revised:September 2022 D-15 Transforming Care with Community Connection ..................................................................................................................................... ..................................................... Fresno HOPE Impact Summary •� PATHWAYS COMMUNITY HUB OF HP Sept 2022-Aug 2023 Knowingsomeone is therefor me makes all the difference tome." HOPE RESIDENT Transforming Care Through Community Connection In Pursuit of Lasting Care Friends and Partners, Our approach centers around more healthy, equitable, a network that prioritizes sup- and inclusive Fresno County. Fresno HOPE Pathways portive relationships between Together, we can all become Community HUB prides the CHWs and the communities the leading transformative itself on implementing they serve to effectively miti- force for health equity. evidence-based practic- gate health disparities. es across organizations to achieve sustainable change By diminishing linguistic In Solidarity, in health equity and wellbe- and cultural barriers ing. We partner with care through community coordination agencies(CCAs), connection, we establish county departments, health trust for sustainable, rea UL�tjy systems, school districts, and and lasting solutions. others to achieve improved outcomes for families with During the reporting period, health and social needs. Fresno HOPE convened seven Since our inception in 20i7, Care Coordination Agencies our mission remains to im- With 35 CHWs to serve the Ashlee prove the health of our commu- community of Fresno County. Hernandez,MS nity by working together with To further our impact,we invite shared purpose and com- you to join us in dismantling Program Director, mitment. In partnership with systemic inequities by amplify- Fresno HOPE Pathways our local Community Health ing community voices to be the Community HUB Workers(CHWs), we provide driver of their health.Working culturally-affirming care and collectively with the community health outcomes to neighbor- will create awareness, effect hoods historically lacking in change, and offer solutions investment and resources. within systems to realize a _.. .. ..._............ ............. ..... .................. .......................... ........... .. odel C. 1 21 Nationally Certified HUB Fresno HOPE has achieved a national certification from the Pathways Community HUB Institute Model. The national certification demonstrates Fresno HOPE has achieved the national standards for quality community care coordination services and is committed to pursuing excellence. Note:the data used in this report was obtained through a HIPAA compliant electronic health ?1.1 , ,=` record system which collects health information.The demographic data presented includes those who consent to participate in the data collection. Level 1 Ccrlificatinn i Fresno HOPE Impact Summary For Community The first step to a successful outcome is to identify a primary Community Health By Community Worker who can develop a supportive relationship with the Resident. �. Trigger warning:domestic violence I homelessness I substance abuse Angela is a mother to four children ages I nine months, four, ten, and thirteen years old. When her school-aged children were absent from school, the district connected the fam- ily with a Community Health Worker (CHW). The CHW, Andrew, informed the family about Fresno HOPE services and what resources can be provided for her and her family. Prior to meeting, Angela disclosed that she is currently fleeing a domestic violence situation Mama, all I want which led her to be unhoused. Angela's family was immediately placed at a motel. is foryou to be Angela began to share her story after she welcomed Andrew into their space. Andrew able to mare me assessed the surroundings and began to build rapport by sitting calmly across Angela and warm arroz con her children on the motel bed. Angela shared pollo again" A N G E L A'S S o N *The case study is based on a combination of several cases to protect resident information and privacy. 2 Transforming Care Through Community Connection THE IMPACT ON OUR COMMUNITY 9 9 : Total screenings 640% 51% ....... .................... ra ra of CHWs speak more of CHWs reside in the than one language same zip code as the Total clients people they serve ..........................................I.............................. BUILDING FOUNDATIONS 0 O allocation of county funding toward care 7 coordination agencies to support in workforce 0 development and infrastructure building ) . . ..... ...................................... 35 additional nationally certified CHWs minutes provided to agencies JOG � 5 0 0 for Technical Assistance and Quality Improvement ..... .................... .......................... minutes provided to CHWs for Workforce Development and Training Based on network-wide data. 3 Fresno HOPE fmpactSummary Re i m a g i n i n g Once a relationship between the Commu- nity Health Worker and Resident forms, Pathways to successful outcomes are measured by the Evidence-based Pathways Community HUB Whole Person Institute TM (PCHI) Model, which helps identify risk factors and barriers that impede the & Household resident's ability to thrive through a whole person, whole household approach. Health ..................... Andrew assessed Angela's risks through trust-building and active listening. An initial Social Determinant of Health screening helps identify and assign five immediate Social Service Pathways for Angela's family: 1. Personal items Clothing, diapers, and hygiene items 2. Citizenship Birth certificate requirements for Angela's two eldest children 3. Financial Money to support day-to-day living and child items during the holiday season 4. Housing Permanent and stable housing is foundational for Angela and her family to thrive 5. Food Security Accessed adequate food for the entire household 4 Transforming Care Through Community Connection COMMUNITY HEALTH WORKERS IN ACTION 4825 � 1 rr v Resources and services provided ..................... ............ .. ... .......................... ............... THE AVERAGE IMPACT OF ONE COMMUNITY HEALTH O WORKER IN ONE YEAR 0 residents cared for pathways opened 58 Pathways completed successfully under the PCHI Model home visits 27 5 months of care per client 5 Fresno HOPE ImpactSummmy Individualized After each assessment, an individualized Pathways-based care plan is developed Care Plans for to help prioritize residents' unique needs in order to live a full life. Individual Needs 'T "I loom,& Together with their school district, community resources and other partners, Andrew was able to provide the family with the following: • Permanent housing • $600 dollars in gift cards • Hygiene items, clothing and diapers • Food • Culturally-affirming mental health services • Assistance with obtaining the birth certificates for two eldest children to continue path to citizenship The top priority of the five categories of needs is meeting the basic needs of the family by providing direct financial assistance. From short-to long-term solutions, these pathways help create immediate and lasting solutions for Angela and her family. 6 Transforming Care Through Community Connection DIFFERENT NEEDS FOR DIFFERENT DEMOGRAPHICS Fresno,CA • • • • y0-8% 3.2% 1 1.- 93657 93723 1.7% 93654 :=r 0.1% 1.8% ... :� :«r,y ;3725 9... • • • • • 0.2% 1.0% 9 27% 0.4% .4% Mr 662 93608 9 3 3609 LO%L0% 0.1% 0 0.2%4% 93631 93656 93242 93624 1.5% 0.1% 0.2% 9 out of 10 residents are 8.7% live in zip code 93706 people of color and half range from ages 26 to 55 years old 6 i% 370 of all enrolled clients have no formal education identified as female 54% 733 O/o has $0-$i0k house- are unemployed hold income Fresno HOPE Impact Si n inary Long-term As a care plan is completed over time and Pathways are closed, barriers Outcomes can be identified in the community service structure both at the individual Completes and population level. Pathways not completed are also documented. The a Pathwaycommunity can use this information to assess gaps in services and address these issues on a policy level. 1 O Andrew continues to assist the family with is long-term pathways such as Housing and Citizenship. He works consistently to get Angela and her children safe and stable affordable housing permanently. A local resource will support with a full year rent payment to allow Angela time to stabilize her family. Angela is connected resources for housing and down payment assistance to get her family their own place to call home and stabilize the children to increase their attendance in grade school. a Transforming Care Through Community Connection BEHIND THE NUMBERS Top Needs Met by Case Social Service Referral Confirmation of items and services 13 , 824 . 35433 received, connection to urgent Needs met resources or services, confirmed attendance at the service. Top categories:translation,personal items, utilities,financial assistance,legal services Health Education Resident demonstrates under- ' standing of learning materials. Top categories:stress,sun exposure,adult and child nutrition,COVIDA9 Vaccine,employment Medical Referral Confirmed appointment kept 192 with Resident. Top categories:primary care,mental health services,dental services,vision services,labs 128 Food Security No problems, or anxiety about, consistently accessing adequate food for the past 30 days. 123 Employment Resident is still working 30 days from the date of hire. 88 Transportation Household member(s) had no problems, or anxiety about, consistently using transportation for the past 30 days. 83 Immunization Referrals Provider, pharmacist, or clinic confirms that Resident's immunizations received and are up to date. 9 Help us grow our reach and connect our community to their needs for whole, healthy lives. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Visit the HOPE website to support our work and your community Read and share the full one- year Impact Data Report to expand our outreach Donate ............... Sign up for newsletter [3 Follow us on social media a Facebook • D Instagram 0 Twitter :......... .. . fchip.org/transform You can always email us directly at admin@fresnohope.org. io Transforming Care Through Community Connection The impact on our community would not be possible without the support of our 2022 - 2023 partners and funders. Funding Investor HEALTHY FRESNO COUNTY Better Together 40111111 W African //I\\\� American C U LTI VA�-S A L U D Coalition FRESNO COVID-19 Exceptional Parents Unlimited EQUITY PROJECT ERDENOiyjygj/o�9! FRESNO VCB CENTRO LA FAMILIA �FF��EEM{NiS��`S CENTER ADVOCACY SERVICES ...................................................................... .......................................................................I............ . Tha nK y o u! This report is supported by the Centers for Disease Control and Prevention of the U.S.Department of Health and Human Services(HHS)as part of a financial assistance award totaling$9,M,976 with 100 percent funded by CDC/HHS.The contents are those of the author(s)and do not necessarily represent the official views of,nor an endorsement,by CDC/HHS,or the U.S.Government. ii Data collection showcases CHW's commitment and positive impact, particularly in bridging language barriers and advocating passionately for their Residents. The HOPE program reaffirms the value and effectiveness of CHW's work, promoting a sense of pride in the services we provide to the most underseraed in our community." CHW SUPERVISOR ...................................................................................................................................................................... HEALTH. OUTREACH. PREVENTION. EQUITY. Get Connected Fresno HOPE (Health, Outreach, Prevention, fchip.org/hope Equity) seeks to identify specific health inequities and provide sustainable, long-term Phone (559)257-2522 health outcomes. Email admin@fresnohope.org w N � y N � � h W m 0 o� _ 3Cl) QE maw s C ° c v tw s m ❑ �. d o � 4-1 • LLao Q0 ❑ ❑ L. aLL CD L U . • ■ ■