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DocuSign Envelope ID: 167F763C-D16E-41D3-B98F-F5E24EE9CC37 <br /> Page 4 of 4 <br /> IV. Performance Measures/Reporting Requirements: <br /> A, Electronic submission of service logs is required monthly of the CHAC and are due to State EHDI <br /> Program staff by the fifth day of the following month. The monthly services logs shall include: <br /> 1. Performance Measure #1: Evidence of at least 17 consultations, technical assistance and/or <br /> training sessions per month provided for hospitals and other EHDI stakeholders. <br /> 2. Performance Measure #2; Evidence of timely interventions with 95% of families whose children <br /> need follow-up from newborn hearing screening, Entries will be made in the WCSWeb Hearing <br /> Link notes section to document counseling and education provided to families of children who <br /> failed the newborn hearing screening, and to document consultation with their direct service <br /> providers. <br /> 3. Performance Measure #3: Evidence of timely coordination of service delivery for children with <br /> or at risk of hearing loss. This will include: (a) at least four in-service sessions provided to com- <br /> munity collaborators or private providers per year; (b) at least three public awareness activities <br /> per year; and (c) the total number of hearing screenings provided at mass screening events. <br /> V. Performance Monitoriniz and Quality Assurance: <br /> A. The Local Health Department shall adhere to the following Quality Assurance measures: <br /> I, Ensure that the Audiologist is board certified, <br /> 2. Ensure that the Audiologist is licensed in North Carolina, <br /> 3. Ensure that services are provided in a culturally and linguistically appropriate manner. <br /> B, The State EHDI Program staff will monitor the CHAC's work plan progress through; <br /> 1. Monthly reviews of electronic service logs. <br /> 2. Quarterly contacts (phone and email) with the CHAC, <br /> 3. An annual site visit with the Local Health Department, and with additional visits if needed, <br /> 4. Semi-annual review of CHAC's work plan. <br /> 5. Quarterly reviews of data on hospitals served by the CHAC from the WCSWeb Hearing Link <br /> data tracking system. <br /> 6. Meetings with the CHAC during DPH EHDI Team Meetings and other DPH required activities. <br /> C. Should the performance of the CHAC be inadequate-because of non-completion of expected <br /> activities, poor communication with team members/community collaborators or insufficient <br /> documentation, a meeting will be convened with the Local Health Department supervisor to <br /> determine an action plan or corrective measures. <br /> VI. Funding Guidelines or Restrictions: <br /> A. Requirements for pass-through entities: In compliance with 2 CFR §200.331 —Requirements for <br /> pass-through entities,the Division provides Federal Award Reporting Supplements to the Local <br /> Health Department receiving federally funded Agreement Addenda. <br /> 1. Definition: A Supplement discloses the required elements of a single federal award, Supplements <br /> address elements of federal funding sources only; state funding elements will not be included in <br /> the Supplement Agreement Addenda (AAs) funded by more than one federal award will receive <br /> a disclosure Supplement for each federal award, <br /> 2. Frequency: Supplements will be generated as the Division receives information for federal <br /> grants. Supplements will be issued to the Local Health Department throughout the state fiscal <br /> year, For federally funded AM, Supplements will accompany the original AA. If AAs are <br /> revised and if the revision affects federal funds, the AA Revisions will include Supplements. <br /> Supplements can also be sent to the Local Health Department even if no change is needed to the <br /> AA. In those instances, the Supplements will be sent to provide newly received federal grant <br /> information for funds already allocated in the existing AA. <br /> Revised June 2016 <br />