Common use of Additional Periodic Reporting Clause in Contracts

Additional Periodic Reporting. The Subrecipient is responsible for reporting the information listed in the table below by the dates indicated. The information requested shall be submitted by entering data into the Blueprint portal or another data reporting system if required by the State. CHT/MAT/WHI Staffing and Practice Information: October 15, 2020 Enter updated CHT/MAT/WHI staffing and Practice information. This includes practice closures, mergers, and openings. January 15, 2021 April 15, 2021 July 15, 2021 Monitor NCQA PCMH Recognition: October 15, 2020 Each quarter, the State shall notify and identify to the Program Manager a cohort of Practices which are scheduled to undergo NCQA PCMH recognition approximately 6 months in the future. January 15, 2021 April 15, 2021 For those identified Practices, the Program Manager, in partnership with the assigned QI Facilitator, shall closely monitor progress towards the reporting date and ensure all appropriate Practice and provider information is updated in the Blueprint Portal (or other data reporting system) accordingly. July 15, 2021 (for each such date, with respect to Practices identified to Subrecipient within the prior quarter) New Practice Total Unique Patient Counts: December 15, 2020 For practices new to the Blueprint ONLY, enter Practice-level patient counts to determine CHT staffing ratios. March 15, 2021 June 15, 2021 September 15, 2021 The maximum dollar amount payable under this Grant Agreement is not intended as any form of a guaranteed amount. This is a reimbursement agreement. Funds shall be distributed to the Subrecipient as a reimbursement of actual allowable costs by the Subrecipient in the performance of program functions described in Attachment A, up to the maximum allowable amount specified in Part 1 – Grant Award Detail Page of this agreement. The Subrecipient shall demonstrate that funds have been properly expended in order to be reimbursed by the State. 1. Prior to commencement of work and release of any payments, the Subrecipient shall submit to the State: a. a certificate of insurance consistent with the requirements set forth in Attachment C, Section 8 (Insurance), and with any additional requirements for insurance as may be set forth elsewhere in this Grant Agreement; and b. a current IRS Form W-9 (signed within the last six months). 2. Payment terms are Net 00 days from the date the State receives an error-free invoice with all necessary and complete supporting documentation. 3. Subrecipient shall submit detailed invoices itemizing all work performed during the invoice period, including the dates of service, rates of pay, hours of work performed, and any other information and/or documentation appropriate and sufficient to substantiate the amount invoiced for payment by the State. All invoices must include the Grant # for this agreement. Subrecipient shall submit invoices to the State in accordance with the schedule set forth in this Attachment B. Invoices shall be submitted not more frequently than monthly. 4. Original invoices and reports must be signed and dated by the Subrecipient and shall be submitted to the State at the following address: XXX.XXXXXxxxxxxx@xxxxxxx.xxx. 5. The Subrecipient shall submit monthly for costs incurred in connection with services rendered in the previous month or quarter, on or before the 15th day of the following month. Costs incurred prior to the previous month, but not previously claimed, shall be clearly identified. All costs must be incurred within the Grant Term. a. Invoices will only be paid upon the approval of State after completion of program activities agreed upon in Attachment A. b. Invoices will include specified line items for program costs, training costs, and travel expenses. i. Program costs includes: 1. Approved salary and fringe benefits of Program Manager and Self- Management Regional Coordinator; a. Salary and fringe benefits will be subject to quarterly caps. Subrecipient will not invoice the State, and the State will not pay, for more than 25% of the total salary and fringe benefits for Project Management and Self-Management Regional Coordinator per quarter. b. If the Program Manager position is vacant, Subrecipient shall not invoice for, and State shall not pay, these costs. 2. Training costs (costs associated with providing training) that have been approved by the State; 3. Self-Management Program delivery costs (i.e. leader stipends and program materials); 4. Tobacco training funds, if applicable; and 5. Other approved expenses by the State. ii. Travel expenses are limited to: 1. Costs approved by the State in writing prior to incurring expenses. Routine mileage travel expenses will not require prior approval. 2. Travel costs are not reimbursable for travel expenses incurred within the HSA. 3. Training costs (costs associated with receiving training) that have been approved by the State. c. Invoices must include: i. Name, address, signature, and point of contact information of Subrecipient; ii. Date of invoice submission; iii. Date(s) of program period the invoice covers; iv. Unique invoice number; v. Itemized expenses organized by activity. All reimbursable expenses will fall in one of the following line items: 1. Program costs, or 2. Travel expenses vi. All itemized expenses and State-approved back-up documentation must be submitted in accordance with the State of Vermont Agency of Administration Bulletin

Additional Periodic Reporting. The Subrecipient is responsible for reporting the information listed in the table below by the dates indicated. The information requested shall be submitted by entering data into the Blueprint portal or another data reporting system if required by the State. CHT/MAT/WHI Staffing and Practice Information: October 15, 2020 Enter updated CHT/MAT/WHI staffing and Practice information. This includes practice closures, mergers, and openings. January 15, 2021 April 15, 2021 July 15, 2021 Monitor NCQA PCMH Recognition: October 15, 2020 Each quarter, the State shall notify and identify to the Program Manager a cohort of Practices which are scheduled to undergo NCQA PCMH recognition approximately 6 months in the future. January 15, 2021 April 15, 2021 For those identified Practices, the Program Manager, in partnership with the assigned QI Facilitator, shall closely monitor progress towards the reporting date and ensure all appropriate Practice and provider information is updated in the Blueprint Portal (or other data reporting system) accordingly. July 15, 2021 (for each such date, with respect to Practices identified to Subrecipient within the prior quarter) New Practice Total Unique Patient Counts: December 15, 2020 For practices new to the Blueprint ONLY, enter Practice-level patient counts to determine CHT staffing ratios. March 15, 2021 June 15, 2021 September 15, 2021 The maximum dollar amount payable under this Grant Agreement is not intended as any form of a guaranteed amount. This is a reimbursement agreement. Funds shall be distributed to the Subrecipient as a reimbursement of actual allowable costs by the Subrecipient in the performance of program functions described in Attachment A, up to the maximum allowable amount specified in Part 1 – Grant Award Detail Page of this agreement. The Subrecipient shall demonstrate that funds have been properly expended in order to be reimbursed by the State. 1. Prior to commencement of work and release of any payments, the Subrecipient shall submit to the State: a. a certificate of insurance consistent with the requirements set forth in Attachment C, Section 8 (Insurance), and with any additional requirements for insurance as may be set forth elsewhere in this Grant Agreement; and b. a current IRS Form W-9 (signed within the last six months). 2. Payment terms are Net 00 days from the date the State receives an error-free invoice with all necessary and complete supporting documentation. 3. Subrecipient shall submit detailed invoices itemizing all work performed during the invoice period, including the dates of service, rates of pay, hours of work performed, and any other information and/or documentation appropriate and sufficient to substantiate the amount invoiced for payment by the State. All invoices must include the Grant # for this agreement. Subrecipient shall submit invoices to the State in accordance with the schedule set forth in this Attachment B. Invoices shall be submitted not more frequently than monthly. 4. Original invoices and reports must be signed and dated by the Subrecipient and shall be submitted to the State at the following address: XXX.XXXXXxxxxxxx@xxxxxxx.xxx. 5. The Subrecipient shall submit monthly for costs incurred in connection with services rendered in the previous month or quarter, on or before the 15th day of the following month. Costs incurred prior to the previous month, but not previously claimed, shall be clearly identified. All costs must be incurred within the Grant Term. a. Invoices will only be paid upon the approval of State after completion of program activities agreed upon in Attachment A. b. Invoices will include specified line items for program costs, training costs, and travel expenses. i. Program costs includes: 1. Approved salary and fringe benefits of Program Manager Manager, QI Facilitator. and Self- Self-Management Regional Coordinator; a. Salary and fringe benefits will be subject to quarterly caps. Subrecipient will not invoice the State, and the State will not pay, for more than 25% of the total salary and fringe benefits for Project Management Management, QI Facilitation, and Self-Management Regional Coordinator per quarter. b. If the Program Manager or QI Facilitator position is vacant, Subrecipient shall not invoice for, and State shall not pay, these costs. 2. Training costs (costs associated with providing training) that have been approved by the State; 3. Self-Management Program delivery costs (i.e. leader stipends and program materials); 4. Tobacco training funds, if applicable; and 5. Other approved expenses by the State. ii. Travel expenses are limited to: 1. Costs approved by the State in writing prior to incurring expenses. Routine mileage travel expenses will not require prior approval. 2. Travel costs are not reimbursable for travel expenses incurred within the HSA. 3. Training costs (costs associated with receiving training) that have been approved by the State. c. Invoices must include: i. Name, address, signature, and point of contact information of Subrecipient; ii. Date of invoice submission; iii. Date(s) of program period the invoice covers; iv. Unique invoice number; v. Itemized expenses organized by activity. All reimbursable expenses will fall in one of the following line items: 1. Program costs, or 2. Travel expenses vi. All itemized expenses and State-approved back-up documentation must be submitted in accordance with the State of Vermont Agency of Administration Bulletin

Additional Periodic Reporting. The Subrecipient is responsible for reporting the information listed in the table below by the dates indicated. The information requested shall be submitted by entering data into the Blueprint portal or another data reporting system if required by the State. CHT/MAT/WHI Staffing and Practice Information: October 15, 2020 Enter updated CHT/MAT/WHI staffing and Practice information. This includes practice closures, mergers, and openings. January 15, 2021 April 15, 2021 July 15, 2021 Monitor NCQA PCMH Recognition: October 15, 2020 Each quarter, the State shall notify and identify to the Program Manager a cohort of Practices which are scheduled to undergo NCQA PCMH recognition approximately 6 months in the future. January 15, 2021 April 15, 2021 For those identified Practices, the Program Manager, in partnership with the assigned QI Facilitator, shall closely monitor progress towards the reporting date and ensure all appropriate Practice and provider information is updated in the Blueprint Portal (or other data reporting system) accordingly. July 15, 2021 (for each such date, with respect to Practices identified to Subrecipient within the prior quarter) New Practice Total Unique Patient Counts: December 15, 2020 For practices new to the Blueprint ONLY, enter Practice-level patient counts to determine CHT staffing ratios. March 15, 2021 June 15, 2021 September 15, 2021 The maximum dollar amount payable under this Grant Agreement is not intended as any form of a guaranteed amount. This is a reimbursement agreement. Funds shall be distributed to the Subrecipient as a reimbursement of actual allowable costs by the Subrecipient in the performance of program functions described in Attachment A, up to the maximum allowable amount specified in Part 1 – Grant Award Detail Page of this agreement. The Subrecipient shall demonstrate that funds have been properly expended in order to be reimbursed by the State. 1. Prior to commencement of work and release of any payments, the Subrecipient shall submit to the State: a. a certificate of insurance consistent with the requirements set forth in Attachment C, Section 8 (Insurance), and with any additional requirements for insurance as may be set forth elsewhere in this Grant Agreement; and b. a current IRS Form W-9 (signed within the last six months). 2. Payment terms are Net 00 days from the date the State receives an error-free invoice with all necessary and complete supporting documentation. 3. Subrecipient shall submit detailed invoices itemizing all work performed during the invoice period, including the dates of service, rates of pay, hours of work performed, and any other information and/or documentation appropriate and sufficient to substantiate the amount invoiced for payment by the State. All invoices must include the Grant # for this agreement. Subrecipient shall submit invoices to the State in accordance with the schedule set forth in this Attachment B. Invoices shall be submitted not more frequently than monthly. 4. Original invoices and reports must be signed and dated by the Subrecipient and shall be submitted to the State at the following address: XXX.XXXXXxxxxxxx@xxxxxxx.xxx. 5. The Subrecipient shall submit monthly for costs incurred in connection with services rendered in the previous month or quarter, on or before the 15th day of the following month. Costs incurred prior to the previous month, but not previously claimed, shall be clearly identified. All costs must be incurred within the Grant Term. a. Invoices will only be paid upon the approval of State after completion of program activities agreed upon in Attachment A. b. Invoices will include specified line items for program costs, training costs, and travel expenses. i. Program costs includes: 1. Approved salary and fringe benefits of Program Manager and Self- Management Regional Coordinator; a. Salary and fringe benefits will be subject to quarterly caps. Subrecipient will not invoice the State, and the State will not pay, for more than 25% of the total salary and fringe benefits for Project Management and Self-Management Regional Coordinator per quarter. b. If the Program Manager position is vacant, Subrecipient shall not invoice for, and State shall not pay, these costs. 2. Training costs (costs associated with providing training) that have been approved by the State; 3. Self-Management Program delivery costs (i.e. leader stipends and program materials); 4. Tobacco training funds, if applicable; and 5. Other approved expenses by the State. ii. Travel expenses are limited to: 1. Costs approved by the State in writing prior to incurring expenses. Routine mileage travel expenses will not require prior approval. 2. Travel costs are not reimbursable for travel expenses incurred within the HSA. 3. Training costs (costs associated with receiving training) that have been approved by the State. c. Invoices must include: i. Name, address, signature, and point of contact information of Subrecipient; ii. Date of invoice submission; iii. Date(s) of program period the invoice covers; iv. Unique invoice number; v. Itemized expenses organized by activity. All reimbursable expenses will fall in one of the following line items: 1. Program costs, or 2. Travel expenses vi. All itemized expenses and State-approved back-up documentation must be submitted in accordance with the State of Vermont Agency of Administration Bulletin

Additional Periodic Reporting. The Subrecipient is responsible for reporting the information listed in the table below by the dates indicated. The information requested shall be submitted by entering data into the Blueprint portal or another data reporting system if required by the State. CHT/MAT/WHI Staffing and Practice Information: October 15, 2020 Enter updated CHT/MAT/WHI staffing and Practice information. This includes practice closures, mergers, and openings. January 15, 2021 April 15, 2021 July 15, 2021 Monitor NCQA PCMH Recognition: October 15, 2020 Each quarter, the State shall notify and identify to the Program Manager a cohort of Practices which are scheduled to undergo NCQA PCMH recognition approximately 6 months in the future. January 15, 2021 April 15, 2021 For those identified Practices, the Program Manager, in partnership with the assigned QI Facilitator, shall closely monitor progress towards the reporting date and ensure all appropriate Practice and provider information is updated in the Blueprint Portal (or other data reporting system) accordingly. July 15, 2021 (for each such date, with respect to Practices identified to Subrecipient within the prior quarter) New Practice Total Unique Patient Counts: December 15, 2020 For practices new to the Blueprint ONLY, enter Practice-level patient counts to determine CHT staffing ratios. March 15, 2021 June 15, 2021 September 15, 2021 The maximum dollar amount payable under this Grant Agreement is not intended as any form of a guaranteed amount. This is a reimbursement agreement. Funds shall be distributed to the Subrecipient as a reimbursement of actual allowable costs by the Subrecipient in the performance of program functions described in Attachment A, up to the maximum allowable amount specified in Part 1 – Grant Award Detail Page of this agreement. The Subrecipient shall demonstrate that funds have been properly expended in order to be reimbursed by the State. 1. Prior to commencement of work and release of any payments, the Subrecipient shall submit to the State: a. a certificate of insurance consistent with the requirements set forth in Attachment C, Section 8 (Insurance), and with any additional requirements for insurance as may be set forth elsewhere in this Grant Agreement; and b. a current IRS Form W-9 (signed within the last six months). 2. Payment terms are Net 00 days from the date the State receives an error-free invoice with all necessary and complete supporting documentation. 3. Subrecipient shall submit detailed invoices itemizing all work performed during the invoice period, including the dates of service, rates of pay, hours of work performed, and any other information and/or documentation appropriate and sufficient to substantiate the amount invoiced for payment by the State. All invoices must include the Grant # for this agreement. Subrecipient shall submit invoices to the State in accordance with the schedule set forth in this Attachment B. Invoices shall be submitted not more frequently than monthly. 4. Original invoices and reports must be signed and dated by the Subrecipient and shall be submitted to the State at the following address: XXX.XXXXXxxxxxxx@xxxxxxx.xxx.to 5. The Subrecipient shall submit monthly for costs incurred in connection with services rendered in the previous month or quarter, on or before the 15th day of the following month. Costs incurred prior to the previous month, but not previously claimed, shall be clearly identified. All costs must be incurred within the Grant Term. a. Invoices will only be paid upon the approval of State after completion of program activities agreed upon in Attachment A. b. Invoices will include specified line items for program costs, training costs, and travel expenses. i. Program costs includes: 1. Approved salary and fringe benefits of Program Manager and Self- Management Regional Coordinator; a. Salary and fringe benefits will be subject to quarterly caps. Subrecipient will not invoice the State, and the State will not pay, for more than 25% of the total salary and fringe benefits for Project Management and Self-Management Regional Coordinator per quarter. b. If the Program Manager position is vacant, Subrecipient shall not invoice for, and State shall not pay, these costs. 2. Training costs (costs associated with providing training) that have been approved by the State; 3. Self-Management Program delivery costs (i.e. leader stipends and program materials); 4. Tobacco training funds, if applicable; and 5. Other approved expenses by the State. ii. Travel expenses are limited to: 1. Costs approved by the State in writing prior to incurring expenses. Routine mileage travel expenses will not require prior approval. 2. Travel costs are not reimbursable for travel expenses incurred within the HSA. 3. Training costs (costs associated with receiving training) that have been approved by the State. c. Invoices must include: i. Name, address, signature, and point of contact information of Subrecipient; ii. Date of invoice submission; iii. Date(s) of program period the invoice covers; iv. Unique invoice number; v. Itemized expenses organized by activity. All reimbursable expenses will fall in one of the following line items: 1. Program costs, or 2. Travel expenses vi. All itemized expenses and State-approved back-up documentation must be submitted in accordance with the State of Vermont Agency of Administration Bulletin