Original Agreement Addendum

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Original Agreement Addendum

Agreement Addendum Revision #

Revised 8/12/173

Page 1 of 10

I.Background:

The spread of vaccine-preventable diseases presents a real threat to the health and quality of life of the residentsof North Carolina.With a grant the Immunization Branch receives from the Centers for Disease Control and Prevention (CDC) and by partnering with local health departments (LHDs), the Branch’s Immunization Program provides preventative health measures through the administration of vaccine to age-appropriate populations within the state. The Immunization Branch’s goal is to eliminate vaccine-preventable diseases in North Carolina.

II.Purpose:

The goal of the Immunization Action Plan is to prevent disease, disability -and death from vaccine preventable disease in children. Immunization Branch programs, services and subrecipients help to reduce the spread of vaccine preventablediseases by assuring that individuals are age appropriately immunized, and by managing outbreaks of vaccine-preventable diseases.

Local health departments will support the North Carolina Immunization Program (NCIP) in reaching that goal by working together to accomplish the following objectives as supported by Healthy People-2020:

1. By the year 2020, increase the age-appropriate immunization levels of two-year old children to 90% or more; and
2. By the year 2020, assure that at least 95% of North Carolina children aged <6 years are represented in the North Carolina Immunization Registry (NCIR).

III.Scope of Work and Deliverables:

1.Immunization Service Delivery

To eliminate barriers that delay or prevent delivery of age appropriate immunizations, and to assure the safe delivery of vaccines, the Local Health Department shall:

1. Follow the current CDC and NCIPguidelines for storage of vaccines to ensure proper safeguarding including risks of loss from theft, expiration, or improper storage temperature;
2. Maintain current standing orders as part of the Local Health Department’s immunization policy and protocol. All standing orders or protocols developed for nurses in support of this program must have policies in place that allow for the use of standing orders and procedures that describe the process for development and approval of standing orders within the agency. Additionally, standing orders must be written in the NC Board of Nursing format as described at this link: This immunization policy and protocol, which is reviewed and evaluated by immunization staff during every Local Health Department visit, shall:

i.be updated and signed annually by a currently employed physician;

ii.provide for age-appropriate immunizations or physician referrals when contraindications exist;

iii.contain temporary and permanent contraindications as outlined in the North Carolina Administrative Code (NCAC);

iv.comply with the most current immunization schedule recommended by the Advisory Committee on Immunization Practices (ACIP) and the NC Immunization Rules.The immunization schedules can be found at these links:

• Children:
• Adolescents: and
• Adults:

v.specify simultaneous administration of needed vaccines, reviewing vaccines given at each routine visit.

1. Refer, as needed, clients being seen for immunization-only services to other services within the Local Health Department or to a Pprivate Pprovider as needed;
2. Follow all conditions outlined in the most recent Vaccines For Children (VFC) Program Provider Agreement and the NCIP Local Health Department Vaccine Agreement;
3. Ensure that vaccinations are provided for 100% of eligible two-year-old children for the annual statewide immunization assessment. The basis for determining whether the vaccine provision percentage has been achieved will be a report generated from the NCIR;
4. Ensure that vaccinations are provided for 100% of eligible children ages 0 to 18 years seeking vaccinations. The basis for determining whether the vaccine provision has been achieved will be a report generated from the NCIR;
5. Follow the most current (ACIP) recommendations for vaccine administration for 100% of clients;
6. By the close of business each day, completely and accurately enter into the NCIR all information regarding publicly and privately purchased vaccines administered by the Local Health Department;
7. Vaccinate walk-in patients who are eligible for vaccinations.

2.Vaccine-Preventable Disease Surveillance

To ensure that vaccine-preventable diseases are identified, monitored, and managed, the Local Health Department shall:

1. Identify, upon the receipt of any suspect vaccine-preventable disease or condition, and investigate immediately,the circumstances surrounding the occurrence of the disease or condition to determine the authenticity of the report;
2. Ensure that all health care providers are educated on reporting laws and requirements and are reporting any suspected vaccine-preventable disease to the Local Health Department within 24 hours;
3. Notify the Communicable Disease Branch’s on-call Epidemiologist within one hourby phone (919-733-3419) of any suspected cases of diphtheria, measles, polio, rubella, congenital rubella syndrome (CRS), mumps, and report by phone within 24 hours of any suspected cases of pertussis involving high-risk settings (such as healthcare settings and childcare settings providing care to infants);
4. Identify 100% of persons for whom control measures is required;
5. Follow the most current guidelines and recommendations for the prevention and treatment of vaccine-preventable disease, as outlined in the CDC’sManual for the Surveillance of Vaccine- Preventable Diseases, the American Public Health Association’sControl of Communicable Diseases Manual, and the CDC’s Guidelines for the Control of Pertussis Outbreaks;
6. Collect and submit appropriate laboratory examination clinical specimens for laboratory testingspecimensspecimen’snecessary to assist in the diagnosis of disease and indication of the duration of control measures required, including coordination with private physicians to submit appropriate specimens to the Division of Public Health’s State Laboratory of Public Health;
7. Ensure two State Laboratory of Public Health Pertussis PCR and culture test kits with nonexpired media are available for immediate use in the Local Health Department at all times;
8. Determine and ensure control measures have been provided for and complied with as directed in 10A NCAC 41A .0201;
9. Provide or ensure provision of Perinatal Hepatitis B case-management services following current ACIPand these CDC guidelines:

i.All pregnant women are tested for HBsAg during each pregnancy;

iiAllinfants born to HBsAg-positive women and all infants born to women with unknown HBsAg status receiveHBIG and a dose of hepatitis B vaccine within 12 hours of birth;

iii.All infants born to HBsAg-positive women complete the hepatitis B vaccine series per the most current ACIP recommended schedule; and

iv.All infants receive timely post-vaccination serology testingper CDC guidelines.

1. Follow the reporting requirements in the Agreement for Local Health Department Participation in the North Carolina Electronic Disease Surveillance System (NC EDSS);
2. Implement a comprehensive immunization policy and protocol, as defined by CDC, ACIP and the Hospital Infection Control Practices Advisory Committee (HICPAC)for all Local Health Department health-care personnel who have the potential for exposure to patients and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air, as specified in the most current Immunization of Health Care Personnel.

3.Education and Outreach

The Local Health Department shall:

1. Conduct or facilitate Offer Provide education and training forto community stakeholders (private and public healthcare providers, community health centers, rural health center) on regarding immunization-related topics, recommendations and requirements as needed;
2. Collaborate Partner with local provider organizations such as Women’s Infants and Children (WIC), women’s health care physicians, pediatricians and social service agencies community stakeholdersto provide educational materials on preventing perinatal hepatitis B transmission for distribution to appropriate clients to provide community and outreach and education activities by incorporating immunization education in prenatal, parenting and other health education curriculum;
3. Increase community awareness by conducting at least one immunization outreach or education event within the county per fiscal quarter based on available funding. The event should be constructed to help improve immunization awareness in the community and subsequently increase vaccine coverage rates among residents of the county. Educational and outreach interventions will, ultimately, help the NCIP reach its goal of eliminating vaccine-preventable disease in North Carolina. Such events may include but are not limited to: health fairs, after-hour immunization clinics, educational mail-outs, on-site or off-site immunization related trainings, and in-school clinics*. *Please contact the NCIP for technical guidance prior to scheduling any off-site vaccine clinics.

4.North Carolina Immunization Registry

To assure quality of community-wide immunization service delivery, the Local Health Department shall coordinate countywide immunization monitoring and follow-up, and shall:

a.Ensure that the Local Health Department uses the NCIR to identify its active clients two years of age residing in the county who are due or past due for immunizations;

b.Assign at least one staff person to conduct immunization monitoring and follow-up services to:

i.track 100% of active Local Health Department clients that are due or past due for immunizations;

ii.ensure that all immunizations administered and the associated historical immunization information is entered into the NCIR; and

iii.ensure that NCIR information is provided to interested private providers;

c.Identify and target under-immunized areas in the community using the NCIR and conduct at least two interventions to improve the immunization rate in one area of need in the county by May 31, 20198;

d.Integrate immunization screening and referral within WIC and other appropriate programs using the NCIR.

IV.Performance Measures/Reporting Requirements:

The population information used to ascertain whether the Local Health Department is meeting the percentage targets listed below is found in NCIR.

To continue making progress towards the Healthy People2020 goals,for state fiscal year 20198, the Local Health Department shall:

1.Ensure that at least __% of all eligible two-year-old children served by the Local Health Department with a status of “active” in the North Carolina Immunization Registry (NCIR) shall have documentation of age-appropriate immunizations in the NCIR;

2.Ensure that at least__% of all eligible two-year-old children residing in the county shall have documentation of age-appropriate immunizations in the NCIR;

V.Performance Monitoring and Quality Assurance:

1.Immunization coverage will be monitored through the NCIR, and the National Immunization Survey (NIS);reports of vaccine preventable disease will be monitored through the North Carolina Electronic Disease Surveillance System (NC EDSS).

2.The NCIP will monitor the performance of this Agreement Addendum by conductinga minimum of one clinical or technical site visit annually.

3.If the Local Health Department is deemed out of compliance, the Program Monitor shall make every effort to work with the Local Health Department to produce a corrective action plan. If the plan is not followed and the Local Health Department remains out of compliance, funds may be withheld and the Agreement Addendum may be terminated.

VI.Funding Guidelines or Restrictions:

1. Requirements for pass-through entities: In compliance with 2 CFR §200.331 – Requirements for pass-through entities, the Division provides Federal Award Reporting Supplements to the Local Health Department receiving federally funded Agreement Addenda.
2. Definition: A Supplement discloses the required elements of a single federal award. Supplements address elements of federal funding sources only; state funding elements will not be included in the Supplement. Agreement Addenda (AAs) funded by more than one federal award will receive a disclosure Supplement for each federal award.
3. Frequency: Supplements will be generated as the Division receives information for federal grants. Supplements will be issued to the Local Health Department throughout the state fiscal year.For federally funded AAs, Supplements will accompany the original AA. If AAs are revised and if the revision affects federal funds, the AA Revisions will include Supplements. Supplements can also be sent to the Local Health Department even if no change is needed to the AA. In those instances, the Supplements will be sent to provide newly received federal grant information for funds already allocated in the existing AA.
4. Ifthe CDC funding is delayed for any reason, allocations may be reduced temporarily in the Aid-to-Counties database. These temporary reductions will be restored once the CDC awards those delayed grant funds.If this should happen,neither these temporarily reduced allocations nor their restoration will require Agreement Addendum revisions. The Immunization Branch will provide written notice via email to the Local Health Department’s health director 30 days prior to any temporary reduction and 30 days prior to the restoration of funds in the Aid-to-Counties database.
5. Attachment A discloses the total planned allocation for your county. Attachment B provides a template on which planned and actual expenditures of allocations may be tracked. Each line item shall require a rough estimate of how much of the total planned allotted funds (see Attachment A) will be used in each category and a brief explanation of the planned expenditure. Since the However, Local Health Department’sfunds will may be received in rounds as DPH receives them from the CDC. If this should happen, the Immunization Branch will follow the guidelines explained in Paragraph #2 above. , and since funds may be allotted in multiple funding categories throughout the course of the year, the Local Health Department may use the funding categories indicated on the attached Budgetary Estimate for initial planning purposes of the total planned allocation for your county indicated in Attachment A. Then, near the end of the year, the Local Health Department will be notified when to complete the “Actual” expenditures column of Attachment B of the funds once all allocations have been made. All funding provided must be spent only for immunization program activities.See Attachment C B for guidance on allowable use of these funds.
6. It is the CDC’s policy of the CDC’s Vaccines for Children Program that the use of appropriated funds, including gift funds, to purchase promotional items is prohibited unless it is an absolutely necessary expense to support the Local Health Department’s mission. Such prohibited promotional items include, but are not limited to plaques, clothing and commemorative items such as pens, mugs, cups, folders, folios, lanyards, and conference bags.In general, such items or tokens to begiven to individuals are considered personal gifts for which appropriated funds may not be expended even when these items contain educational or promotional information.

Requests for exceptions to this policy must be submitted in writing to the Immunization BranchNCIP which will confer with the CDC to see if it is an acceptable use of funds.

5.These funds may be used for the printing of immunization educational materials. However, these materials may not be printed on a gift item, as described in Paragraph 45above without prior CDC authorization. Request for exceptions to this requirement must be submitted in writing to the Immunization BranchNCIP which will confer with the CDC to see if it is an acceptable use of funds.

6.Costs associated with food and meals are NOT permitted unless included with per diem as a part of official travel.

7.Attachment C B provides a table containing a detailed, item-by-item list of allowable uses of federal Immunization Program funds per funding category (RCC and FRC funding codes). Expenses (listed in the table’s left-most column) which are allowable are so indicated by the presence of an “X” in the corresponding funding category columns.(Blank cells indicate expenditures which are NOT allowed in that funding category.)

Attachment A

Estimated Total Allocation for this FY 20187-198Agreement Addendum for the Entire Service Period

Attachment B

FY 2017-2018 Planned and Actual Use of Federal Immunization Program Funds