Updates for Family Planning Agreement Addendum in North Carolina 2023-2024

NC Department of Health and Human Services, Division of Public Health (DPH) Women,Infant and Community Wellness Section (WICWS) Reproductive Health Branch (RHB) Family PlanningAgreementAddendum Updates Fiscal Year 2023-2024 March2023 1 NCDHHS, Division of Public Health, Women s Health Branch | Family Planning AA Webinar| March 2022

New Contact for Family Planning Agreement Addenda Kristen Carroll is the Reproductive Health Branch Head and will be the contact for Agreement Addendum (AA) budget questions and AA submissions: Kristen.Carroll@dhhs.nc.gov Update: The contact person for the Family Planning Agreement Addendum has been updated. It is now Kristen Carroll; the Reproductive Health Branch Head. 2 2 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

III. Scope of Work and Deliverables New: All website links have been relocated to the bottom of the page as footnotes. This change was made to hopefully, make the AA content easier to read and to find the web links. 3 3 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

New Names To Know Women s Health Branch Women, Infant, and Community Wellness Section (WICWS) Family Planning and Reproductive Health Unit Reproductive Health Branch (RHB) Women s Health Regional Nurse Consultants Women, Infant, and Community Wellness Regional Nurse Consultants Update: Names/titles updated in the AA document to reflect the name changes that occurred in April 2022 4 4 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

III. Scope of Work and Deliverables The Activity 151 Family Planning Agreement Addendum requires further negotiation between the Reproductive Health Branch (RHB) and the Local Health Department. For this Agreement Addendum, the Local Health Department shall: Complete the Family Planning Patients and Physicians Contact tables (Attachment B) Complete the TANF Out-of-Wedlock Birth Prevention Program Deliverables worksheet (Attachment D), and Return both with the signed and dated Agreement Addendum. In addition, a detailed budget must be submitted, as described below in Paragraph 1, with instructions provided in Attachment A. Update: This section is now bulleted to draw attention to the components that are required to submit along with the signed AA to complete the process 5 5 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

III. Scope of Work and Deliverables 7. The policies that address family planning services in each Local Health Department shall include: a. Clinical Services 6. Abortion / Pregnancy Termination e. Title X requires if a pregnant patient requests a referral for prenatal care and delivery, infant care, foster care or adoption, or pregnancy termination, a referral must be provided. The referral process should include providing a patient with a provider list that includes the name, address, telephone number, what services they offer, and other relevant factual information. Agencies may not take further action (making an appointment, providing transportation) to secure pregnancy termination services for the patient. Where a referral to another provider who might perform an abortion is medically indicated because of the patient s condition (such as where the woman s life would be endangered by continuing the pregnancy or the condition of the fetus), such a referral is not prohibited and is required New: This information is not new but was added to the AA for clarity regarding the Title X requirements regarding referrals for pregnancy options, specifically termination. 6 6 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

III. Scope of Work and Deliverables 7. The policies that address family planning services in each Local Health Department shall include: c. Informed Consents 3. All information as to personal facts and circumstances obtained by the Local Health Department about individuals receiving services must be held confidential and must not be disclosed without the individual s documented consent, except as may be necessary to provide services to the individual or as required by law, with appropriate safeguards for confidentiality. Information may otherwise be disclosed only in summary, statistical, or other form that does not identify the individual. The Local Health Department must inform the individual of any potential for disclosure of their confidential health information to policyholders where the policyholder is someone other than the individual receiving services. New: This information is not new, but this was added to the AA for clarity regarding patient confidentiality 7 7 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

III. Scope of Work and Deliverables 7. The policies that address family planning services in each Local Health Department shall include: REQUIRED TRAINING COURSES f. It is the responsibility of the Local Health Director or their designee to have all Title X funded staff and staff who provide services to Title X patients (e.g., management support, lab, social workers, health educators, clinicians/providers/Medical Directors, nurses, and other staff) complete the following federal and state required training: 1) a. One time, on hire, Title X-funded staff and staff who provide services to Title X patients are required to complete the Title X Orientation Checklists. The applicable Orientation Checklists must be completed within 60 days of hire. 1) The Orientation Checklists can be accessed at the WICWS website under the Required Title X/Family Planning Trainings section.11 Update: This update was made based on guidance from Title X. The documentation/tracking of orientation and annual training has been updated for clarity 8 8 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

III. Scope of Work and Deliverables 7. The policies that address family planning services in each Local Health Departmentshall include: f. REQUIRED TRAINING COURSES (continued) The Orientation Checklists is a Microsoft Excel workbook which contains tabbed sheets, and each sheet designates which types of staff must complete that sheet. All new staff must complete the tab labeled All Staff Orientation. Other tabs are role-specific; new staff must complete the tab that matches their role in working with Title X patients. Originals of initial orientation documents (i.e., All Staff Title X Orientation Checklist and Role-specific Checklists) must be on file in the employee s personnel file and retained in accordance with 2021 General Records Schedule, Standard 4, Items 4.28 and 4.41.12 Copies must be readily accessible and available for review by the WICWS Regional Nurse Consultant during monitoring. 2) 3) Update: This update was made based on guidance from Title X. The documentation of orientation and training tracking has been updated for clarity 9 9 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

There will be a webinar reviewing the forms and the process later in the spring 10 1 0 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

There will be a webinar reviewing the forms and the process later in the spring 11 1 1 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

III. Scope of Work and Deliverables 7. The policies that address family planning services in each Local Health Department shall include: f. REQUIRED TRAINING COURSES b. All Title X-funded staff and staff who provide services to Title X patients are required to complete the trainings indicated on the Title X Family Planning Program Training Record13 under the Required Title X/Family Planning Trainings section by May 31, 2024. This Record must be signed by the Family Planning Medical Director and submitted no later than June 30, 2024, to Kristen Carroll, Reproductive Health Branch Head, at kristen.carroll@dhhs.nc.gov. c. Even if the Local Health Director position is not Title X-funded, DPH recommends the above training courses for the Local Health Director. Update: This update was made based on guidance from Title X. The documentation of orientation and training tracking has been updated for clarity 12 1 2 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

There will be a webinar reviewing the forms and the process later in the spring 13 1 3 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

III. Scope of Work and Deliverables 7. The policies that address family planning services in each Local Health Department shall include: m. Planned Clinic Closures or New Clinical Sites 2. If a Local Health Department plans to open an additional clinic site, including a mobile clinic, the Local Health Department must provide written notice to the Branch Head in the RHB at least 45 days in advance of such an action. New: This requirement is not new, but it was not listed in the AA. Just as we need to be informed when a clinic site is closing, we must be notified when a new site will be opening. We must report this to the Office of Population Affairs for approval. 14 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

III. Scope of Work and Deliverables 7. The policies that address family planning services in each Local Health Department shall include: n. Office of Population Affairs (OPA) Clinic Locator 2. If the individual with login credentials does not log onto the system at least every 6 months, the login credentials will be inactivated. Additionally, two-factor authentication is now required to log in to the Title X clinic locator database. To establish the two-factor authentication, follow the prompts that appear after entering your email address and password, and click on the log in button. The RHB recommends logging in and reviewing the information every other month to ensure the password and the account remain active and the information is accurate. New: OPA made changes to the clinic locator database around login frequency, two factor authentication, and what to do when staff leave. We included in the AA for clarity. 15 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

III. Scope of Work and Deliverables 7. The policies that address family planning services in each Local Health Department shall include: n. Office of Population Affairs (OPA) Clinic Locator 3. If the responsible individual leaves the organization, their database account must be disabled, not transferred after entering your email address and password, click on the log in button. The RHB recommends logging in and reviewing the information every other month to ensure the password and the account remain active and the information is accurate. New: OPA made changes to the clinic locator database around login frequency, two factor authentication, and what to do when staff leave. We included in the AA for clarity. 16 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

III. Scope of Work and Deliverables 7. The policies that address family planning services in each Local Health Department shall include: o. Quality Improvement and Quality Assurance 2. The Local Health Department must annually survey Family Planning patients regarding their levels of satisfaction with the clinical services they received. The clinic manager and staff are to review surveys and identify specific actions to improve services. At a minimum, documentation must include how the top finding is addressed and submitted to the Reproductive Health Branch Head with the Community Engagement Plan due August 15, 2023 (see Section IV, Paragraph 2.g.). A template survey can be found on the WICWS website.20 Update: Quality Improvement and Quality Assurance (#1-#4) relocated to the Update: This section was moved to Scope of Work and Deliverables from Performance Monitoring Section This update was made based on guidance f correct section, Scope of Work and Deliverables. In #2 above, added clarifying language on how the information gathered from the survey should be utilized 17 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

IV. Performance Measures/Reporting Requirements: 1. The Local Health Department shall improve reproductive health access and services, prioritizing low-income individuals. The Outcome Objectives are listed below, and the actual county-specific numbers are located in the Agreement Addenda section on the Women, Infant, and Community Wellness Section website.22 a. Increase number of family planning patients b. Increase number of adolescent patients ages 15-19 c. Reduce repeat pregnancy age 17 and under d. Increase access to the most effective contraceptives e. Ensure at least 90% of family planning clients served are at or below 200% of federal poverty level f. Ensure at least 85% of female family planning clients ages 15-24 are screened for chlamydia Update: The outcome objectives above were updated to match the parameters that Title X uses for these data points. This will allow each agency to compare data to the goals set by Title X. 18 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

V. Performance Measures/Quality Assurance: The WICWS Regional Nurse Consultants (RNCs) conduct performance monitoring and quality assurance activities. 1. a. The RNCs will facilitate the monitoring process. The process includes the development of a pre-monitoring plan four to six months prior to the designated monitoring month; virtual/on- site monitoring visits every three years; and technical assistance visits via phone or email as needed. Virtual/On-site monitoring visits include a review of audited charts, clinic observations, a review of policies/procedures/protocols and standing orders, and an assessment of billing and coding. A pre-monitoring visit from the RNC is optional. b. A written report is completed for each virtual or on-site monitoring visit. The written report will be emailed within 30 days after the monitoring site visit to the local Health Director and those Local Health Department staff overseeing the Family Planning clinic. If a Corrective Action Plan (CAP) is needed, the written report will indicate that. Update: This the same information included in previous AAs, but it has been reorganized to match the Maternal Health AA for ease of use. 19 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

V. Performance Measures/Quality Assurance: Consequences: 2. a. If a CAP is required, the Local Health Department must prepare and submit it to the DPH Program Contact within 30 days of receiving the monitoring report. The DPH Program Contact will notify the Health Director whether the final CAP is acceptable within 90 days of having sent the Monitoring Report. If the final CAP is acceptable, monitoring closure is reached. If instead, the DPH Program Contact finds the final CAP to be unacceptable, the Local Health Department will be placed on high-risk monitoring status which will require annual monitoring of that Local Health Department and it will be referred for continuing technical assistance. b. A loss of up to 5% of funds may result for the Local Health Department that does not meet the level of Family Planning Patients (Attachment B) or expend all Title X and Healthy Mothers/Healthy Children (HMHC) funds for a two-year period. Update: This the same information included in previous AAs, but it has been reorganized to match the Maternal Health AA for ease of use. 20 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

Attachment A Detailed Budget Instructions and Information Travel This was the correct rate at the time theAgreement Addenda were finalized Current Mileage Rates For informational purposes, the Office of State Budget and Management (OSBM) lists the standard mileage rate set by the Internal Revenue Service as $0.625per mile, effective July 1, 2022. Effective January 1, 2023, the OSBM updated the mileage rate to $0.655 per mile. This is the rate to use when submitting your budget. Update: This is updated annually. As of January 1, 2023, the new rate is $0.655 per mile. 21 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

Funding attached to Family Planning AA The funding awarded to your local health department is listed in the budgetary estimate (BE) of the AA. Below is a list of the different cost centers, funding sources, and any stipulations attached to those funds. Cost Center 13A1-5151-T2 Description Family Planning Out-of- Wedlock Family Planning State Funding Source TANF (100% Federal) Funding stipulations Complete Attachment D of AA Use toward program needs* 13A1-5735-00 State Appropriations (100% State) Title V (57.14% Federal; 42.86% State) Title X (100% Federal) 13A1-5735-AP Healthy Mothers Healthy Children (HMHC) Family Planning Title X April 2024 - May 2024 (2 months) Family Planning Title X June 2023 - March 2024 (10 months) Women s Health Service Funds Use toward program needs* 13A1-5900-FP Use toward program needs* 13A1-5900-FP Title X (100% Federal) Use toward program needs* 13A1-6021-FR State Appropriations (100% State) Can only be used for purchasing contraceptive methods *program needs may include salary/fringe, clinical supplies, contraceptives, program incentives, educational materials, advertising, etc. 22 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

Attachment C Family Planning (FP) Clinical and Educational Services FP Clinical Services Female and Male Clients HISTORY Depression screening with modified PHQ-2 questions; if the client responds yes to any of the depression screening questions on the health history, a PHQ-9 or provider assessment is required. Postpartum clients must be screened with a validated assessment tool, such as the PHQ-9 or the Edinburgh Postpartum Depression Screening R Update: Update: Only updated language for clarification regarding responses to the PHQ- 2 questions. If the client responds yes, then a full PHQ-9 or a provider assessment is required 23 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

Attachment C FP Patient Education Requirements Female and Male Clients Patient Method Counseling 2. Client centered contraceptive counseling/education provided R Update: Update: Client centered added for clarification and to match Title X Program language 24 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

Attachment D TANF Out of Wedlock Birth Prevention Program Deliverables If the Local Health Department decides to amend their previously submitted Attachment D, an additional Attachment D must be submitted that includes the original signatures of the Local Director of Social Services and the Local Health Director or their representative. The amended Attachment D can be mailed to the RHB at 1929 Mail Service Center, Raleigh, NC 27699-1929, attention Kristen Carroll, Reproductive Health Branch Head or scanned and emailed to kristen.carroll@dhhs.nc.gov. Update: Update: This was updated for clarification that the contact around the AA is the same individual, the Reproductive Health Branch Head. 25 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

What if I have questions about these FPAA Updates?? Glad you asked!! We are planning to conduct a live Q &AsessionApril 18, 2023. The session for questions related to the FP AA is scheduled for 9- 10:30 a.m. 26 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023

Contacts for Questions From March 31 through April 12, 2023, submit your questions through a short online survey at https://www.surveymonkey.com/r/MYWRBSR. This survey will enable us to quickly organize the questions and answer them in a timely manner. After April 12, 2023, Data questions: Marissa Peters marissa.peters@dhhs.nc.gov Budget questions: Kristen Carroll, kristen.carroll@dhhs.nc.gov Clinical, training and other questions: The Women s Health Regional Nurse Consultant assigned to your health department (https://wicws.dph.ncdhhs.gov/docs/RNC-Map.pdf) 27 NCDHHS, Division of Public Health, Women, Infant, & Community Wellness Section | FP Agreement Addenda | March 2023