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DocuSign Envelope ID:35E8DCE7-1CAA-4177-A55F-37F14DE3307B <br /> Page 4of5 <br /> IV. Performance Measures/Reporting Requirements: <br /> A. Electronic submission of service logs is required monthly of the CHAC and are clue 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 25 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 a newborn hearing screening. Entries will be made in the WCSWeb <br /> Hearing Link notes section to document counseling and education provided to families of <br /> children who failed the newborn hearing screening, and to document consultation with their <br /> direct service 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: <br /> a. At least four in-service sessions provided to community collaborators or private providers <br /> per year; <br /> b. At least three public awareness activities per year; and <br /> c. The total number of hearing screenings provided at mass screening events. <br /> V. Performance Monitoring and Quality Assurance: <br /> A. The Local Health Department shall adhere to the following Quality Assurance measures: <br /> 1. Ensure that the CHAC is board certified. <br /> 2. Ensure that the CHAC 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. <br /> 5. Quarterly reviews of data from the WCSWeb Hearing Link data tracking system on hospitals <br /> served by the CHAC. <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 deemed inadequate because of non-completion of expected <br /> activities,poor communication with team members or 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. Funning 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 /> Revised July 2018 <br />