Professional Documents
Culture Documents
Applicant:
Application Number:
FPH2015007161
Project Title:
Status:
Awarded
Online Forms
1. SF-424 Application for Federal Assistance Version 2
(Upload #1): BudgetNarrativeAttachments-Attachments-1235-PPLM Title X Budget
Narrative.pdf
(Upload #2): Attachments-ATT1-1234-PPLM Title X Appendices Final 2015.pdf
(Upload #3): ProjectNarrativeAttachments-Attachments-1236-PPLM Title X Project
Narrative Final 2015.pdf
(Upload #4): Form Attachments-V1.1.pdf
2. SF-424A Budget Information - Non-Construction
3. SF-424B Assurances - Non-Construction
4. SF-LLL Disclosure of Lobbying Activities
5. Key Personnel
6. Project Abstract Summary
Program Narrative
1. Budget Narrative
2. Program Narrative
Additional Information to be Submitted
1. Negotiated Rate Agreement
Proof of Filing
1. Copy of By-Laws
2. Proof of Non-Profit Status
Note: Upload document(s) printed in order after online forms.
PSC-HHS-000001
Page 1 of 181
Approved by OMB
0348-0046
93.217
11.
Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of
lobbying activities is a material representation of fact upon which reliance was placed by the tier above when
the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This
information will be reported to the Congress semi-annually and will be available for public inspection. Any
person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and
not more than $100,000 for each such failure.
Date: 12/23/2014
PSC-HHS-000002
Page 2 of 181
Catalog of Federal
Domestic Assistance
Number
(b)
Non-Federal
(d)
Federal
(e)
Non-Federal
(f)
Total
(g)
$846,378.00
(b) (4)
(b) (4)
$846,378.00
(b) (4)
(b) (4)
Totals
SECTION B - BUDGET CATEGORIES
a. Personnel
$514,071.00
(b) (4)
b. Fringe Benefits
$108,212.00
(b) (4)
c. Travel
Total
$4,200.00
(5)
(b) (4)
(b) (4)
$4,200.00
d. Equipment
e. Supplies
f. Contractual
$65,341.00
(b) (4)
(b) (4)
$6,250.00
$6,250.00
g. Construction
h. Other
$148,304.00
$846,378.00
(b) (4)
$846,378.00
(b) (4)
(b) (4)
(b) (4)
(b) (4)
j. Indirect Charges
k. TOTALS (sum of 6i and 6j)
7. Program Income
Authorized for Local Reproduction
Previous Edition Usable
Page 3 of 181
(b) (4)
(e) TOTALS
(b) (4)
13. Federal
$846,378.00
(b) (4)
14. Non-Federal
15. TOTAL (sum of lines 13 and 14)
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
$211,595.00
$211,595.00
$211,594.00
$211,594.00
(b) (4)
(b) (4)
(b) (4)
(b) (4)
(b) (4)
SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
(a) Grant Program
(b) First
16. Family Planning Services
$846,378.00
$869,983.00
$893,587.00
$846,378.00
$869,983.00
$893,587.00
(e) Fourth
23. Remarks:
Authorized for Local Reproduction
Page 4 of 181
Standard Form
424A (Rev. 7-97) Page 2
PSC-HHS-000004
93.217
* Program Announcement (Funding Opportunity Number)
PA-FPH-15-003
* Closing Date
12/31/2014
* Applicant Name
36
EIN: 04-2698497
Federal Share Requested (for each year)
* Federal Share 1st Year
846,378.00
869,983.00
0.00
893,587.00
0.00
$ (b) (4)
0.00
(b) (4)
(b) (4)
0.00
* Project Title
PSC-HHS-000005
Page 5 of 181
Planned Parenthood League of Massachusetts (PPLM) provides high-quality family planning and related preventive health
services, as well as evidence-based information, education, and counseling services. At four Title X health centers in
Central Massachusetts (MA), PPLM integrates all program requirements and incorporates feedback after each Title X
program review. PPLM is poised to continue its administration of the Title X grant and will work toward decreasing
unintended pregnancy, preventing and treating STDs and HIV/AIDS, and increasing preventive services, including breast
and cervical cancer screenings, in Central MA.
Continued funding will enable PPLM???s strong clinical capacity to provide at least 8,500 client visits in the grant???s first
year (2015). In addition to focusing on providing access to a broad range of family planning services, PPLM will provide
education and community outreach, especially to vulnerable and hard to reach populations. PPLM???s education programs
for adolescents and parents will serve hundreds more and increase awareness about the services provided at the Title X
centers in Central MA. In addition, community events and advertising campaigns will generate knowledge of the services
available. PPLM will focus additional efforts on forging vital partnerships with primary care providers, other health care
agencies, and community-based organizations to help clients connect with a broader range of services and care.
To meet clients??? full health care needs, PPLM will strengthen its work to connect more clients to health care insurance
coverage, and will continue to further increase its efficiency through its partnerships, infrastructure, and staffing priorities.
8500
PSC-HHS-000006
Page 6 of 181
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND
IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE:
Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such
is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1.
2.
3.
4.
5.
6.
8.
PSC-HHS-000007
Page 7 of 181
9.
Will comply, as applicable, with the provisions of the DavisBacon Act (40 U.S.C. 276a to 276a-7), the Copeland Act
(40 U.S.C. 276c and 18 U.S.C. 874), and the Contract Work
Hours and Safety Standards Act (40 U.S.C. 327- 333),
regarding labor standards for federally-assisted construction
subagreements.
13.
10.
14.
15.
11.
12.
18.
19.
* TITLE
CEO
* DATE SUBMITTED
12/23/2014
Standard Form 424B (Rev. 7-97) Back
PSC-HHS-000008
Page 8 of 181
Key Personnel
Name
Position Title
Annual Salary
No.Months
Budget
%
Time
Fed
Amount
Non-Fed
Amount
Total Amount
Requested
PSC-HHS-000009
Page 9 of 181
Version 02
* 2. Type of Application:
Preapplication
New
Application
Continuation
Changed/Corrected Application
Revision
* 3. Date Received:
* Other (Specify)
4. Applicant Identifier:
12/23/2014
5a. Federal Entity Identifier:
EIN: 04-2698497
State Use Only:
6. Date Received by State:
8. APPLICANT INFORMATION:
* a. Legal Name:
* c. Organizational DUNS:
04-2698497
0308126480000
d. Address:
* Street1:
Street2:
* City:
Boston
County:
* State:
Massachusetts
Province:
* Country:
UNITED STATES
02215-1001
e. Organizational Unit:
Division Name:
Department Name:
* First Name:
Susan
Middle Name:
* Last Name:
Lit
Suffix:
Title:
Organizational Affiliation:
* Telephone Number:
* Email:
617-616-1662
Fax Number:
617-616-1665
slit@pplm.org
PSC-HHS-000010
Page 10 of 181
Version 02
Nonprofit with 501C3 IRS Status (Other than Institution of Higher Education)
Type of Applicant 2: Select Applicant Type:
* Other (specify):
93.217
CFDA Title:
PA-FPH-15-003
* Title:
FY15 Announcement of Anticipated Availability of Funds for Family Planning Services Grants Region 1 Massachusetts
(entire state)
PA-FPH-15-003-049962
Title:
FY15 Announcement of Anticipated Availability of Funds for Family Planning Services Grants Region 1 Massachusetts
(entire state)
PSC-HHS-000011
Page 11 of 181
Version 02
* b. Program/Project
2-5
2-5
* b. End Date:
04/01/2015
03/31/2018
846378
* b. Applicant
* c. State
(b) (4)
* d. Local
(b) (4)
* e. Other
* f. Program Income
* g. TOTAL
2483927
* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?
a. This application was made available to the State under the Executive Order 12372 Process for review on
b. Program is subject to E.O. 12372 but has not been selected by the State for review.
c. Program is not covered by E.O. 12372.
* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes", provide explanation.)
Yes
No
21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements
herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to com
ply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may
subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001)
** I AGREE
** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency
specific instructions.
Authorized Representative:
* First Name:
Prefix:
Middle Name:
* Last Name:
Walz
Martha
Suffix:
* Title:
CEO
* Telephone Number:
* Email:
Fax Number:
617-616-1651
617-616-1665
mwalz@pplm.org
Susan Lit
* Date Signed:
12/23/2014
Standard Form 424 (Revised 10/2005)
Prescr bed by OMB Circular A-102
PSC-HHS-000012
Page 12 of 181
Version 02
PSC-HHS-000013
Page 13 of 181
Upload #1
Applicant:
Application Number:
FPH2015007161
Project Title:
Status:
Awarded
Document Title:
PSC-HHS-000014
Page 14 of 181
Title X Allocation
Year 1
Title X Allocation
Year 2
Title X Allocation
Year 3
(b) (4)
$514,071
$529,216
Title X Allocation
Year 1
Title X Allocation
Year 2
$544,360
2. Fringe Benefits
Type of benefit
FICA
Health and Dental
Retirement
Life insurance
Workers comp
Unemployment
EAP and MBTA
Total
Title X Allocation
Year 3
(b) (4)
$108,212
$111,400
$114,588
Title X Allocation
Year 1
$4,200
Title X Allocation
Year 2
$4,200
Title X Allocation
Year 3
$4,200
Title X Allocation
Year 1
Title X Allocation
Year 2
Title X Allocation
Year 3
3. Travel
4. Equipment $0 no equipment
budgeted.
5. Supplies
Supplies
Contraceptives
Clinic disposables
Medication
Lab Services
Lab Supplies
Office & Program Supplies
Total
(b) (4)
$65,341
$68,608
Title X Allocation
Year 1
(b) (4)
Title X Allocation
Year 2
$71,875
6. Contractual
Contractual
Contracted Services (b) (4)
Page 15 of 181
Title X Allocation
Year 3
PSC-HHS-000015
TOTAL BUDGET
Page 16 of 181
Title X Allocation
Year 2
Title X Allocation
Year 3
(b) (4)
$148,304
$150,310
$152,315
$846,378
$869,983
$893,587
PSC-HHS-000016
Title X Allocation
(b) (4)
Non-Federal
(b) (4)
$514,071
Page 17 of 181
PSC-HHS-000017
Staff type
Center Managers and
Coordinators
Advance Practice
Clinicians (APCs)
Health Care Assistants
(HCAs)
Registered Nurses (RNs)
Total
FTEs
Allowable
Annual
Salary
% of
Salary
for
Title X
Salary
Applied
to Grant
%
Allocated
to Title X
Title X
allocation
(b) (4)
(b) (4)
21.20
$896,021
NonFederal
$355,772
$896,021
Key Personnel
Organizational leadership involved in oversight and administration of Title X program.
Name
Martha Walz
Susan Lit
OPEN
(b) (6)
Deb Fenton
(b) (6)
(b) (6)
Total
Position
President/CEO
COO
CFO
Medical Director
VP of HC Ops/
FP Manager
Quality
Assurance
Manager
Director of
Patient Services
Allowable
Annual
Salary
% of
Salary
for
Title X
Salary
Applied
to Grant
(b) (6)
$946,103
$160,838
%
Allocated
to Title X
Title X
allocation
NonFederal
(b) (4)
Administrative Personnel
Administrative staff supporting Title X activities include: call center staff who help clients make
appointments; finance staff, including accounting staff who handle all financial reporting and
auditing, purchasing staff who oversee health center supplies and medication purchasing, and
billing staff who oversee medical billing and claims processing; Information Systems staff
supporting computer systems and Electronic Health Records system; lab staff that perform tests;
and outreach and education staff handling Title X outreach and education-related programs.
Page 18 of 181
PSC-HHS-000018
Name
Call Center
(b) (6)
6.0 FTEs
Lab
(b) (6)
(b) (6)
Finance
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
4.0 FTEs
Outreach &
Education
(b) (6)
(b) (6)
Information
Technology
(b) (6)
(b) (6)
Total
Position
Patient Contact
Center Manager
Patient
Engagement
Specialist
Lab Manager
Lab Assistant
Allowable
Annual
Salary
% of
Salary
for
Title X
Salary
Applied
to Grant
%
Allocated
to Title X
Title X
allocation
NonFederal
(b) (4)
(b) (6)
Controller
Accounting
Associate
Purchasing
Manager
Director of
Revenue Cycle
Billing Manager
Medical Billers
Community
Parent Educator
& Outreach
Specialist
VP of Business
Development
(b) (6)
Associate
Director of IST
Applications
Analyst
$1,095,634
$187,404
$108,404
2. Fringe Benefits
Fringe benefits for staff salaries allocated to Title X include FICA, medical/dental insurance, life
insurance, workers' compensation, retirement plan, state unemployment taxes, EAP (Employee
Assistance Program), and reimbursement for monthly public transportation (e.g., MBTA).
Page 19 of 181
PSC-HHS-000019
% of salary
Title X
Allocation
NonFederal
(b) (4)
21.05%
$108,212
(b) (4)
3. Travel
Travel is 100% of the cost for Title X-related trainings/conferences, including regional/state
conferences and national conferences.
Travel
Location
TBD
TBD
Total
Staff Traveling
VP of HC Ops
(Family Planning
Program Manager)
NP/VP of HC Ops
Purpose of Travel
Regional Grantee
Meeting
Title X Conference
Budgeted
Expense
$2,200
$2,000
$4,200
Title X
Allocation
$2,200
$2,000
$4,200
NonFederal
(b) (4)
4. Equipment
$0 equipment expense
5. Supplies
Supplies include contraceptive methods (IUDs, implants, oral contraceptives, hormonal
injection, patch, ring, and emergency contraception), clinic disposables used during exams,
medications, lab services and supplies, including pregnancy tests, Pap tests, blood tests and STI
tests, and office supplies used for Title X activities.
Page 20 of 181
PSC-HHS-000020
Budgeted
Expense
% allocated
to Title X
Title X
allocation
Non-Federal
(b) (4)
(b) (4)
$384,357
$65,341
6. Contractual
Contractual includes (b) (4)
services.
Contractual
Contracted Services (b) (4)
Total
Budgeted
Expense
(b) (4)
% allocated
to Title X
Title X
allocation
Non-Federal
$0
$0
7. Other
This includes additional costs of operating PPLM's Title X program.
Budgeted
Expense
Printing
Telephone
Rent
Repairs/Maintenance
Security
Utilities/Office Expense
Educational Materials/Literature
Outreach Materials/Activity
Translation Services
Computer Services
Subscriptions/Publications
Dues & Fees (incl PPFA)
Postage, Shipping, Freight
Insurance/Malpractice
Total
Page 21 of 181
% allocated
to Title X
Title X
allocation
(b) (4)
(b) (4)
$582,940
Non-Federal
$148,304
PSC-HHS-000021
Personnel Summary
Following is a staffing summary, including the total to be funded with Title X dollars. Detail for
each line item appears below.
Staff type
Advance Practice Clinicians
Key Personnel
Administrative Staff
Total
Title X Allocation
(b) (4)
Non-Federal
(b) (4)
$529,216
Page 22 of 181
PSC-HHS-000022
Staff type
Center Managers and
Coordinators
Advance Practice
Clinicians (APCs)
Health Care Assistants
(HCAs)
Registered Nurses (RNs)
Total
FTEs
Allowable
Annual
Salary
% of
Salary
for
Title X
Salary
Applied
to Grant
%
Allocated
to Title X
Title X
allocation
(b) (4)
(b) (4)
21.20
$922,901
$922,901
NonFederal
$366,445
Key Personnel
Organizational leadership involved in oversight and administration of Title X program.
Name
Martha Walz
Susan Lit
OPEN
(b) (6)
(b) (6)
(b) (6)
(b) (6)
Total
Position
President/CEO
COO
CFO
Medical Director
VP of HC Ops/ FP
Manager
Quality Assurance
Manager
Director of Patient
Services
Allowable
Annual
Salary
% of
Salary
for
Title X
Salary
Applied
to Grant
%
Allocated
to Title X
Title X
allocation
(b) (4)
(b) (6)
$963,596
$163,811
NonFederal
$51,114
Administrative Personnel
Administrative staff supporting Title X activities include: call center staff who help clients make
appointments; finance staff, including accounting staff who handle all financial reporting and
auditing, purchasing staff who oversee health center supplies and medication purchasing, and
billing staff who oversee medical billing and claims processing; Information Systems staff
supporting computer systems and Electronic Health Records system; lab staff that perform tests;
Page 23 of 181
PSC-HHS-000023
Name
Call Center
(b) (6)
6.0 FTEs
Lab
(b) (6)
(b) (6)
Finance
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
4.0 FTEs
Outreach &
Education
(b) (6)
(b) (6)
Information
Technology
(b) (6)
(b) (6)
Total
Position
Patient Contact
Center Manager
Patient
Engagement
Specialist
Lab Manager
Lab Assistant
Allowable
Annual
Salary
% of
Salary
for
Title X
Salary
Applied
to Grant
%
Allocated
to Title X
Title X
allocation
NonFederal
(b) (4)
(b) (6)
Controller
Accounting
Associate
Purchasing
Manager
Director of
Revenue Cycle
Billing Manager
Medical Billers
Community Parent
Educator &
Outreach
Specialist
VP of Business
Development
(b) (4)
(b) (6)
Associate Director
of IST
Applications
Analyst
$1,128,503
$193,027
$111,656
2. Fringe Benefits
Fringe benefits for staff salaries allocated to Title X include FICA, medical/dental insurance, life
insurance, workers' compensation, retirement plan, state unemployment taxes, EAP (Employee
Assistance Program), and reimbursement for monthly public transportation (e.g., MBTA). Grant
Page 24 of 181
PSC-HHS-000024
% of salary
Title X
Allocation
NonFederal
(b) (4)
21.05%
$111,400
(b) (4)
3. Travel
Travel is 100% of the cost for Title X-related trainings/conferences, including regional/state
conferences and national conferences. No anticipated change in expense for grant year 2.
Travel
Location
TBD
TBD
Total
Staff Traveling
VP of HC Ops
(Family Planning
Program Manager)
NP/VP of HC Ops
Purpose of Travel
Regional Grantee
Meeting
Title X Conference
Budgeted
Expense
$2,200
$2,000
$4,200
Title X
Allocation
$2,200
$2,000
$4,200
NonFederal
(b) (4)
4. Equipment
$0 equipment expense
5. Supplies
Supplies include contraceptive methods (IUDs, implants, oral contraceptives, hormonal
injection, patch, ring, and emergency contraception), clinic disposables used during exams,
medications, lab services and supplies, including pregnancy tests, Pap tests, blood tests and STI
tests, and office supplies used for Title X activities. Grant year 2 includes a 5% increase in
supply expenses, based on projected increase in visits.
Page 25 of 181
PSC-HHS-000025
Supplies
Contraceptives
Clinic disposables
Medication
Lab Services
Lab Supplies
Office & Program Supplies
Total
% allocated
to Title X
Title X
allocation
Non-Federal
(b) (4)
$403,575
$68,608
(b) (4)
6. Contractual
Contractual includes (b) (4)
Budgeted
Expense
(b) (4)
% allocated
to Title X
Title X
allocation
Non-Federal
$0
$0
7. Other
Includes additional costs of operating PPLM's Title X program. Grant year 2 includes an
anticipated 2% increase in expenses.
Budgeted
Expense
Printing
Telephone
Rent
Repairs/Maintenance
Security
Utilities/Office Expense
Educational Materials/Literature
Outreach Materials/Activity
Translation Services
Computer Services
Subscriptions/Publications
Dues & Fees (incl PPFA)
Postage, Shipping, Freight
Insurance/Malpractice
Total
Page 26 of 181
% allocated
to Title X
Title X
allocation
Non-Federal
(b) (4)
$590,157
$150,310
(b) (4)
PSC-HHS-000026
Personnel Summary
Following is a staffing summary, including total to be funded with Title X dollars. Detail for
each line item appears below.
Staff type
Advance Practice Clinicians
Key Personnel
Administrative Staff
Total
Title X Allocation
(b) (4)
Non-Federal
(b) (4)
$544,360
Page 27 of 181
PSC-HHS-000027
Staff type
Center Managers and
Coordinators
Advance Practice
Clinicians (APCs)
Health Care Assistants
(HCAs)
Registered Nurses (RNs)
Total
FTEs
Allowable
Annual
Salary
% of
Salary
for
Title X
Salary
Applied
to Grant
%
Allocated
to Title X
Title X
allocation
NonFederal
(b) (4)
21.20
$949,782
$949,782
$377,118
(b) (4)
Key Personnel
Organizational leadership involved in oversight and administration of Title X program.
Name
Martha Walz
Susan Lit
OPEN
(b) (6)
(b) (6)
(b) (6)
(b) (6)
Total
Position
President/CEO
COO
CFO
Medical Director
VP of HC Ops/
FP Manager
Quality
Assurance
Manager
Director of
Patient Services
Allowable
Annual
Salary
% of
Salary
for
Title X
Salary
Applied
to Grant
%
Allocated
to Title X
Title X
allocation
(b) (6)
$981,089
$166,785
NonFederal
(b) (4)
$52,334
Administrative Personnel
Administrative staff supporting Title X activities includes: call center staff who help clients
make appointments; finance staff, including accounting staff who handle all financial reporting
and auditing, purchasing staff who oversee health center supplies and medication purchasing,
and billing staff who oversee medical billing and claims processing; Information Systems staff
supporting computer systems and Electronic Health Records system; lab staff that perform tests;
Page 28 of 181
PSC-HHS-000028
Name
Call Center
(b) (6)
6.0 FTEs
Lab
(b) (6)
(b) (6)
Finance
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
4.0 FTEs
Outreach &
Education
(b) (6)
(b) (6)
Information
Technology
Position
Patient Contact
Center Manager
Patient
Engagement
Specialist
Lab Manager
Lab Assistant
Allowable
Annual
Salary
% of
Salary
for
Title X
Salary
Applied
to Grant
%
Allocated
to Title X
Title X
allocation
NonFederal
(b) (4)
(b) (6)
Controller
Accounting
Associate
Purchasing
Manager
Director of
Revenue Cycle
Billing Manager
Medical Billers
Community Parent
Educator &
Outreach Specialist
VP of Business
Development
(b) (6)
(b) (4)
Associate Director
of IST
Applications
Analyst
(b) (6)
(b) (6)
Total
$1,161,372
$198,649
$114,908
2. Fringe Benefits
Fringe benefits for staff salaries allocated to Title X include FICA, medical/dental insurance, life
insurance, workers' compensation, retirement plan, state unemployment taxes, EAP (Employee
Assistance Program), and reimbursement for monthly public transportation (e.g., MBTA). Grant
Page 29 of 181
PSC-HHS-000029
% of salary
Title X
Allocation
NonFederal
(b) (4)
21.05%
$114,588
(b) (4)
3. Travel
Travel is 100% of the cost for Title X-related trainings/conferences, including regional/state
conferences and national conferences. No anticipated change in expense for grant year 3.
Travel
Location
TBD
TBD
Total
Staff Traveling
VP of HC Ops
(Family Planning
Program
Manager)
NP/VP of HC
Ops
Purpose of Travel
Regional Grantee
Mtg
Title X Conference
Budgeted
Expense
Title X
Allocation
$2,200
$2,200
$2,000
$4,200
$2,000
$4,200
NonFederal
(b) (4)
4. Equipment
$0 equipment expense
5. Supplies
Supplies include contraceptive methods (IUDs, implants, oral contraceptives, hormonal
injection, patch, ring, and emergency contraception), clinic disposables used during exams,
medications, lab services and supplies, including pregnancy tests, Pap tests, blood tests and STI
tests, and office supplies used for Title X activities. Grant year 3 includes a 5% increase in
supply expenses, based on projected increase in visits.
Page 30 of 181
PSC-HHS-000030
Supplies
Contraceptives
Clinic disposables
Medication
Lab Services
Lab Supplies
Office & Program Supplies
Total
% allocated
to Title X
Title X
allocation
Non-Federal
(b) (4)
$422,793
$71,875
(b) (4)
6. Contractual
Contractual includes (b) (4)
Budgeted
Expense
(b) (4)
% allocated
to Title X
Title X
allocation
Non-Federal
$0
$0
7. Other
Includes additional costs of operating PPLM's Title X program. Grant year 3 includes an
anticipated 2% increase in expenses.
Budgeted
Expense
Printing
Telephone
Rent
Repairs/Maintenance
Security
Utilities/Office Expense
Educational Materials/Literature
Outreach Materials/Activity
Translation Services
Computer Services
Subscriptions/Publications
Dues & Fees (incl PPFA)
Postage, Shipping, Freight
Insurance/Malpractice
Total
Page 31 of 181
% allocated
to Title X
Title X
allocation
Non-Federal
(b) (4)
$597,375
$152,315
(b) (4)
PSC-HHS-000031
Upload #2
Applicant:
Application Number:
FPH2015007161
Project Title:
Status:
Awarded
Document Title:
PSC-HHS-000032
Page 32 of 181
Fitchburg
Health Center
Location
Hours
91 Main Street
Ste. 103
Marlborough, MA 01752
Milford
208 Main Street
Health Center Ste. 101
Milford, MA 01757
Central
470 Pleasant Street
Massachusetts Worcester MA 01609
Health Center
Marlborough
Health Center
Projected Client
Visits/Year
Year 1: 1289
Year 2: 1350
Year 3: 1,417
Year 1: 950
Year 2: 998
Year 3: 1,047
Year 1: 1160
Year 2: 1,218
Year 3: 1,278
Year 2: 5101
Year 2: 5,356
Year 3: 5,623
PSC-HHS-000033
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Problem/Need: Individuals and families in Central MA need greater access to quality family
planning services. Many low-income, culturally diverse community members may need
specialized outreach activities to learn about and access family planning services.
Timeline
April 2015
March 2018
Responsibility
VP of Health
Center
Operations
Evaluation Plan
Volume data
April 2015
March 2018
VP of Business
Development
Volume and
market data
reports.
PSC-HHS-000034
Page 34 of 181
Develop at least 4
robust community
partnerships with PCPs
to develop mutually
beneficial referral
relationships to assist
patients in locating
family planning
services and primary
health care.
Sept. 2015
March 2016
Dissemination of
PPLM materials
and replacement
requests.
Volume data.
Center
Managers
Parent Educator
and Community
Outreach
Specialist
April 2015
March 2016
Community
Parent Educator
and Outreach
Specialist
Participants
understanding of
services
including
confidentiality/
sliding fee scale.
PSC-HHS-000035
Page 35 of 181
Expand Outreach
Committee by inviting
three additional/new
members representative
of our priority
populations to help
with client-facing
materials review and
outreach suggestions.
Provide at least 2 open
house/health center
tours to local providers
to educate them about
PPLM and Title X
services each year.
Teach 450 in year 1
and 475 in year 2 and
500 in year 3 bi-lingual
parents or other caring
adults in Central MA
through Seamos
Honestos parent
workshops to increase
their confidence in
being a go-to resource
for their children/teens.
The workshops
increase parental
awareness of Title X
services at PPLM.
13 PPLM trained (bilingual and culturally
diverse) tenth and
twelfth grade teens will
offer sexual health
training to at least 500
of their peers in year 1
and 525 in year 2 and
550 in year 3. Includes
information about Title
X free/confidential
health services that do
not require parental
consent.
April 2015
March 2016
Worcester
Health Center
Manager
Meeting minutes
Yearly, April
2015
March 2018
Community
Parent Educator
and Outreach
Specialist
April 2015
March 2018
Community
Parent Educator
and Outreach
Specialist
Participants
understanding of
PPLM services
including
confidentiality/
slide fee scale
Post workshop
surveys.
April 2015
March 2018
Get Real
Trainer
Pre/post-test of
trainers about
their knowledge
of STDs,
protection
methods, consent
and healthy
relationships and
comfort as a
PPLM
ambassador and
comfort with
their facilitation
skills.
4
PSC-HHS-000036
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Problem/Need: Clients should have high quality family planning care that provides all of the
information necessary to make the best choice of a contraceptive method that meets their needs.
Clients also need factual information to make decisions about STD/HIV testing, as well as access
to testing services that provide accurate and confidential results to insure they receive
appropriate care.
Goal II. Insure that staff providing education and information about contraceptives are welltrained to provide appropriate client-centered care that focuses on the efficacy of the full range of
contraceptive choices available including side-effect management. Ensure staff is well-trained to
provide education and information about the importance of STD/HIV testing, including accurate
test results and follow up care as needed.
Objective
II.A.1) Improve client
outcomes by training staff
through annually revised
scripts on contraceptive
counseling and the
importance of STD/HIV
testing.
Timeline
April 2015
March 2016
Responsibility
Director of
Patient
Services
Training
VP of
materials will Education and
be used on an Training
ongoing
basis from
April 2015
March 2018
Evaluation Plan
Staff post training
assessment. Staff
observation.
Staff observation
using a youthfriendly
assessment tool.
PSC-HHS-000037
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Heath Services
Director
Staff observation
and chart audit.
Manager of
Internal
Training
(b) (4)
Training
compliance is
audited on a
quarterly basis by
the Manager of
Internal Training.
Manager of
Internal
Training
Post-Training
assessments
April 2015
March 2018
Health
Services
Director
Point of Care
audits
PSC-HHS-000038
Page 38 of 181
II.G.2) Continuously
improve chlamydia and
gonorrhea testing by
routinely testing clients
within routine and
standalone visits.
April 2015
March 2018
Health
Services
Director
Visit stats
April 2015
March 2018
Quality
Assurance
Manager
Review audit
results with
clinicians.
April 2015
March 2018
Quality
Assurance
Manager
Review of
benchmarking
results
April 2015
March 2018
Patient
Services
Director
Documentation of
protocol review
within internal
training staff
documentation
system.
Training
compliance is
audited on a
quarterly basis by
the Manager of
Internal Training.
Problem/Need: As a Title X grantee, PPLM must comply with all Title X administrative
standards to ensure prudently managed resources and adherence to Title X regulations regarding
project administration of quality health care, planning and evaluation.
Goal III. PPLM will address all Title X administrative standards regarding resource
management, quality health care, planning and evaluation by insuring efficiency and quality
through ongoing program evaluation. PPLM is committed to employing rigorous nationally
recognized programs or processes for achieving quality health care improvement.
PSC-HHS-000039
Page 39 of 181
Objective
III.A.3) Ensure that Patient
Contact Center staff (the
call center) and Patient
Services Specialists
(reception staff) are welltrained regarding clients
rights to care, charges,
billing and collection
requirements to insure
proper use of Title X
funding.
Timeline
March
2015
April 2016
Responsibility
Center
Managers
Evaluation Plan
Training
assessments and
ongoing
observation and
audits.
April 2015
June
2015
VP of Health
Center
Operations
April 2015
March
2018
Center
Mangers
Documentation
audit
HR
documentation
April 2015
March
2016
Documentation
of enrollment
effort in
Electronic
Practice
Management
system.
Center
Managers
April 2016March
2017
PSC-HHS-000040
Page 40 of 181
April 2015
March
2018
Quality
Assurance
Manger
(b) (4)
April 2015
March
2018
Quality
Assurance
Manger
September
2015
April 2016
Center Manger
Internal Training
assessment and
documentation in
database of
successful staff
training
completion.
Client
satisfaction
survey responses
and review both
pre and post
PDSA.
(b) (4)
Goal IV. Provide and maintain quality training for all project staff to insure the delivery of
quality protocol-driven client care, community outreach and education in Central MA.
Objective
IV.A.4) Ensure that 100% of
staff who work at reception or
in PPLMs Call Center
Timeline
April
2015
March
Responsibility
Director of
Revenue Cycle
Evaluation Plan
Skills assessment
checklist
PSC-HHS-000041
Page 41 of 181
2018
initial
training,
training of
new staff
each year
December
2015
March
2018
Medical
Director
Quarterly chart
review by visit
type.
May 2015
July
2015 and
yearly
Training is provided in
Yearly
health center staff meetings each
October
2015-2018
Clinicians will receive
April,
coding review and training October,
at mandatory quarterly
January
clinician meetings.
training
each year
2015-2018
Staff participate in training October
arranged at the health
2016/2017
center with an outside
/2018
vendor.
Institute one TeamSTEPPS April
concept at all four Title X
2015
Central MA sites by March March
2016.
2016
Patient
Services
Director
Quarterly chart
review/audits.
Center
Manager
Internal Training
Documentation
Director of
Revenue Cycle
Billing reviews
and coding
audits.
Health
Services
Directors
Successful
completion of
test at end of
training.
Internal Training
assessment and
documentation.
Quality
Assurance
Manager
Client
satisfaction
surveys.
10
PSC-HHS-000042
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11
PSC-HHS-000043
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(b) (6)
12
PSC-HHS-000044
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13
PSC-HHS-000045
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14
PSC-HHS-000046
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15
PSC-HHS-000047
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PSC-HHS-000048
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17
PSC-HHS-000049
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18
PSC-HHS-000050
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19
PSC-HHS-000051
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20
PSC-HHS-000052
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21
PSC-HHS-000053
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22
PSC-HHS-000054
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PSC-HHS-000055
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24
PSC-HHS-000056
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25
PSC-HHS-000057
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26
PSC-HHS-000058
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PSC-HHS-000059
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28
PSC-HHS-000060
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29
PSC-HHS-000061
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30
PSC-HHS-000062
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31
PSC-HHS-000063
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32
PSC-HHS-000064
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(b)
(4)
(b) (4)
(b) (4)
33
PSC-HHS-000065
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34
PSC-HHS-000066
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PSC-HHS-000067
Page 67 of 181
TABLE OF CONTENTS
ARTICLEI NAME,PURPOSES,POWERSANDRELATEDMATTERS 38
ARTICLEII DIRECTORS 38
1. Powers ........................................................................................................................................................... 38
2. Number, Election and Term of Office .................................................................................................... 38
3. Annual Meeting ............................................................................................................................................ 38
4. Regular Meetings .......................................................................................................................................... 38
5. Special Meetings ........................................................................................................................................... 39
6. Notice of Meetings ...................................................................................................................................... 39
7. Action at Meetings ....................................................................................................................................... 39
8. Action Without Meeting ............................................................................................................................. 39
9. Resignation .................................................................................................................................................... 39
10. Removal ....................................................................................................................................................... 39
11. Vacancies ..................................................................................................................................................... 40
12. Disqualification .......................................................................................................................................... 40
13. Compensation ............................................................................................................................................ 40
ARTICLEIII MEMBERS 6
ARTICLEIV COMMITTEES
41
ARTICLEV OFFICERS
1.
2.
4.
5.
6.
7.
8.
44
Powers ........................................................................................................................................................... 44
Chair ............................................................................................................................................................... 44
Vice Chair ...................................................................................................................................................... 45
Treasurer........................................................................................................................................................ 45
Clerk... ............................................................................................................................................................ 45
Resignation .................................................................................................................................................... 45
Removal ......................................................................................................................................................... 46
ARTICLEVI PRESIDENT/CEO
46
1. Powers ........................................................................................................................................................... 46
2. Duties ............................................................................................................................................................. 46
ARTICLEVII MISCELLANEOUSPROVISIONS
1.
2.
3.
4.
5.
6.
7.
46
ARTICLEVIIIINDEMNIFICATION 47
36
PSC-HHS-000068
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PSC-HHS-000069
Page 70 of 181
38
PSC-HHS-000070
PSC-HHS-000071
11. Vacancies
Any vacancy on the Board of Directors may be filled by vote of the remaining directors, provided
that a director so elected shall serve until the next annual meeting, at which time the Board of
Directors shall elect a director for the remainder of the unexpired term. Service of a partial term to
fill a vacancy shall not preclude eligibility to serve two full terms.
The position of any member of the Board of Directors who shall be absent from three (3) or more
consecutive meetings without giving valid reason may, at the recommendation of the Executive
Committee and subject to the approval of the Board, be declared vacant and shall be filled in
accordance with the provision of this Section. Board members so affected shall be notified by the
Clerk. In the event of any vacancy in the Board of Directors, the remaining directors may exercise
the powers of the full Board until successors are elected.
12. Disqualification
No paid member of the Corporations staff shall serve as a member of the Board of Directors. No
close relative of the Corporations staff shall serve as a member of the Board of Directors nor shall
any close relative of a member of the Board of Directors be an employee of the Corporation.
No employee of Planned Parenthood Federation of America (PPFA) or any of the Corporations
affiliates may serve on the Board of Directors of the Corporation.
13. Compensation
No director shall receive any compensation for his or her services as a member of the Board of
Directors as such; provided, however, that any director may, if authorized by the Board of Directors,
be reimbursed for necessary expenses, including travel expenses, reasonably incurred by a director in
the performance of duties as a director.
ARTICLE III: MEMBERS
1.
Members
1.1
The Corporation shall have no statutory members. Any action or vote required or
permitted by law to be taken by members of the Corporation shall be taken by action
or vote of the same percentage of the directors. The members described in Article III,
Section 1.2 are not statutory members.
1.2
The members of the Corporation shall include Donor Members, Network Members,
and National Members (collectively, the Associate Members). Associate Members
are not statutory members and shall have no voting or other rights with respect to the
Corporation.
Donor Members shall include any individual who has made a contribution of $25.00 or
more to the Corporation during any of the preceding three calendar years.
Network Members shall include any individual registered as a member of the
Corporations Legislative Alert Network.
Page 72 of 181
40
PSC-HHS-000072
Page 73 of 181
41
PSC-HHS-000073
PSC-HHS-000074
PSC-HHS-000075
to the Corporations Board of Directors as to which persons the Corporation should appoint as
directors of The Advocacy Fund.
In making its nominations, the Governance Committee shall work affirmatively to include diversity
among the Board of Directors and officers and shall not discriminate on the basis of race, color,
religion, sex, national origin, age, sexual orientation, disability, income, marital status, or other bases
protected by applicable law.
10. Other Committees
The Board of Directors or the Executive Committee may appoint other committees including
Regional Advisory Committees, and delegate such responsibilities to any such committee so
appointed as shall be considered desirable from time to time. The Executive Committee shall not
delegate to any Committee which is appointed by it, responsibilities which conflict with any
responsibilities previously delegated by the Board of Directors to a committee then functioning.
The Board of Directors or the Executive Committee may delegate to the Chairperson of any
committee so appointed the responsibility to appoint the members of such committee, subject to the
approval of such appointments by the Chair.
ARTICLE V: OFFICERS
1. Powers
The officers of the Corporation shall be a Chair, a Vice Chair, a Treasurer, a Clerk and such other
officers as the Board of Directors may from time to time elect, including a Chair Elect. All officers
shall be elected by the Board of Directors from among the directors. Two or more offices may be
held by the same person. The Board of Directors may elect co-holders of an office, each of whom
may from time to time perform the duties of such office. A vacancy in any duly constituted office
may be filled by vote of the Board of Directors.
Subject to these By-laws, in addition to the duties and powers specifically set forth in these By-laws,
each officer shall have such duties and powers as are customarily incident to his or her office, and
such duties and powers as the Board of Directors or the Executive Committee may from time to
time designate.
2. Chair
The Chair shall preside at all meetings of the Board of Directors and meetings of the Executive
Committee. The Chair shall, with the approval of the Board, appoint the chairpersons of all
committees except the Executive Committee, the Finance and Audit Committee and the
Governance Committee.
The Chair of the Corporation shall hold office for a two-year term until the second annual meeting
following his or her election and thereafter until his or her successor is chosen and qualified. The
Chair may be re-elected for a consecutive one (1) year term but no Chair shall serve for more than a
total of three (3) consecutive years. Service of a partial term to fill a vacancy shall not preclude
eligibility to serve a full two-year term. Notwithstanding the provisions of Article II, Section 2, in the
circumstance where the Chair of the Corporation is required to rotate off of the Board of Directors
because his or her term as a director coincides with the end of his or her term as Chair, such
immediate past Chair may serve an additional year on the Board of Directors. Thereafter, the Chair
Page 76 of 181
44
PSC-HHS-000076
PSC-HHS-000077
receipt, unless it is specified to be effective upon its acceptance by the Board of Directors or by the
Executive Committee, as the case may be.
7. Removal
The Board of Directors may remove from office any officer by vote of a majority of its entire
number then in office.
ARTICLE VI: PRESIDENT/CEO
1. Powers
The President/CEO is the chief executive and senior staff person of the Corporation.
The Board of Directors shall appoint the President/CEO, who shall be responsible to the Board of
Directors for all aspects of the Corporations operations in accordance with Board policies and
directives. The Board of Directors shall undertake an annual review of job performance of the
President/CEO.
2. Duties
The President/CEO shall be responsible to the Board of Directors through the Chair. He or she
shall have full responsibility for the general management and administration of the day-to-day
business of the Corporation. He or she shall also have additional duties and responsibilities as the
officers or directors of the Corporation may from time to time delegate.
ARTICLE VII: MISCELLANEOUS PROVISIONS
1. Fiscal Year
Except as from time to time otherwise determined by the Board of Directors or by the Executive
Committee, the fiscal year of the Corporation shall be the twelve (12) months ending June 30.
2. Annual Audit
The account books of the Corporation shall be audited annually by an independent certified public
accountant retained with the approval of the Board of Directors upon the recommendation of the
Finance and Audit Committee and the report of such accountant shall be filed with the records of
the Corporation.
3. Execution of Instruments
All deeds, leases, transfers, contracts, bonds, notes and other instruments authorized to be executed
by an officer of the Corporation on its behalf shall be signed by the Chair or the Treasurer except as
the Board of Directors or the Executive Committee may generally or in particular cases otherwise
determine. The Chair may delegate this authorization to the President/CEO.
4. Voting of Securities
Except as the Board of Directors or the Executive Committee may otherwise designate, the Chair or
Treasurer may waive notice of, and appoint any person or persons to act as proxy or attorney-in-fact
for this Corporation (with or without power of substitution) at any meeting of stockholders or
Page 78 of 181
46
PSC-HHS-000078
shareholders of any other corporation or organization, the securities of which may be held by this
Corporation.
5. Charitable Contributions
The Board of Directors or the Executive Committee may authorize from time to time contributions
to be made by the Corporation in such amounts as it may determine to be reasonable to
corporations, trusts, funds or foundations organized and operated exclusively for charitable, scientific
or educational purposes, no part of the net earnings of which inures to the benefit of a member of
the Board of Directors.
6. Evidence of Authority
A certificate by the Clerk or by a Temporary Clerk as to any action taken by the Board of Directors,
Executive Committee or any officer or representative of the Corporation shall, as to all persons who
rely thereon in good faith, be conclusive evidence of such action. The exercise of any power which
by law, by the Articles of Organization or by these By-laws, or under any vote of the Board of
Directors or the Executive Committee, may be exercised by an officer of the Corporation only in the
event of the absence of another officer or any other contingency, and shall bind the Corporation in
favor of anyone relying thereon in good faith, whether or not such absence or contingency existed.
7. Amendments
Any part or all of these By-laws may be altered, amended or repealed from time to time by a majority
vote of the directors present at a regular or special meeting of the Board duly called for the purpose,
provided that notice of the substance of the proposed alteration, amendment or repeal shall be stated
in a notice for such meeting given no less than seven (7) days before such meeting.
ARTICLE VIII: INDEMNIFICATION
The Corporation shall, to the extent legally permissible, indemnify each of its directors and officers
(including persons who serve at its request as directors and officers of another organization in which
it has an interest) against all liabilities and expenses, including amounts paid in satisfaction of
judgments, in compromise or as fines and penalties, and counsel fees, reasonably incurred by him or
her in connection with the defense or disposition of any action, suit or other proceeding, whether
civil or criminal, in which he or she may be involved or with which he or she may be threatened,
while in office or thereafter, by reason of being or having been such a director or officer, except
with respect to any matter as to which he or she shall have been adjudicated not to have acted in
good faith in the reasonable belief that his or her action was in the best interests of the Corporation;
provided, however, that as to any matter disposed of by a compromise payment by such director or
officer pursuant to a consent decree or otherwise, no indemnification either for said payment or for
any other expenses shall be provided unless (a) such indemnification shall be ordered by a court; (b)
such compromise shall be approved as being in the best interests of the Corporation by a majority
of the directors then in office exclusive of any interested director; or (c) the Corporation has
received an opinion in writing of independent legal counsel to the effect that such director or officer
appears to have acted in good faith in the reasonable belief that his or her action was in the best
interests of the Corporation. Expenses, including counsel fees, reasonably incurred by any such
director or officer in connection with the defense or disposition of any such action, suit or other
proceeding may be paid from time to time by the Corporation in advance of the final disposition
thereof upon receipt of an undertaking by such individual to repay the amounts so paid to the
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47
PSC-HHS-000079
PSC-HHS-000080
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49
PSC-HHS-000081
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50
PSC-HHS-000082
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(b) (4)
(b) (4)
(b) (4)
(b) (4)
(b) (4)
(b) (4)
(b) (4)
(b) (4)
(b) (4)
(b) (4)
(b) (4)
PSC-HHS-000083
(b) (4)
PSC-HHS-000084
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(b) (4)
(b) (4)
PSC-HHS-000085
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(b) (4)
(b) (4)
PSC-HHS-000086
Page 86 of 181
Job Title: Vice President Health Center Operations Department: Health Center (860000)
Manager: Chief Operations Officer
Location: Springfield
Job Summary:
The Vice President of Health Center Operations will direct and manage the daily operation of PPLMs
health centers, providing leadership and assuring a focus on patient satisfaction and efficiency. S/he will
work collaboratively with the Medical Director and Director of Patient Services to assure that all services
conform to professional standards, PPFA protocols, PPLM quality standards, and are consistent with all
regulatory requirements and monitoring agencies. This position also oversees the implementation and
management of PPLM government and any private grants supporting health care services, including Title
X and State DPH Family Planning Grants.
(b) (4)
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55
PSC-HHS-000087
(b) (4)
(b) (4)
PSC-HHS-000088
Page 88 of 181
Occupation/
Background
Alicia L. Abad
TERM
DATES
2012-2015
2014-2017
David Bechhofer
2013-2016
Jill Block
2013-2016
2014-2017
Nonnie S. Burnes
2011-2017
Magnolia Contreras
2013-2016
2014-2017
2012-2015
2013-2016
2014-2017
2013-2016
2011-2017
Susan L. Kaufman
2011-2017
NAME
Page 89 of 181
(b) (6)
Philanthropy, consulting
Law
Strategic planning,
Finance
Prevention Programs,
Community Health, Public
Health
Pediatrics
Philanthropy, law
Law
Finance
Public health consulting
Finance, philanthropy
Pediatrics
Strategy, Finance
Philanthropy
OB GYN
Marketing, philanthropy
Law
Pediatrics
Marketing, philanthropy
Health care, finance
57
PSC-HHS-000089
Name
Residence
(b) (4)
(b) (4)
Occupation Background
M.D., Adolescent Medicine Specialty
Commercial Painting Business Owner
Retired Attorney
Non-Profit Consultant
Volunteer
Attorney
Human Resources Professional
Pathologist
Graphic Design Professional
Health and Human Services Consultant
Attorney
Social Worker
Middle School Teacher
Insurance Enrollment Specialists
Dean of Students, Community College
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58
PSC-HHS-000090
APPENDIX J: Central MA Approved Health Care and Social Services Referral List
Sterilization
OB/GYN
Adoption
Abortion
Reproductive endocrinology
Reproductive cancer screening
and treatment
Adult primary care
Substance abuse
Domestic violence
Sexual assault
Housing
Food insecurity
Page 91 of 181
59
PSC-HHS-000091
(b) (4)
PSC-HHS-000092
Page 92 of 181
(b) (4)
PSC-HHS-000093
Page 93 of 181
(b) (4)
Page 94 of 181
62
PSC-HHS-000094
(b) (4)
Page 95 of 181
63
PSC-HHS-000095
(b) (4)
Page 96 of 181
64
PSC-HHS-000096
(b) (4)
Page 97 of 181
65
PSC-HHS-000097
(b) (4)
Page 98 of 181
66
PSC-HHS-000098
(b) (4)
Page 99 of 181
67
PSC-HHS-000099
(b) (4)
68
PSC-HHS-000100
(b) (4)
69
PSC-HHS-000101
PSC-HHS-000102
Area of Competence
Competence
Needs
Supervision
Desires
Training
Not trained or
observed
Medical Records
Interviewing/Hx taking
Charting
Informed Consent
Client Education
Referral/Follow-up system
Other
Lab Microscopy
Venipuncture
Wet Mounts/KOH/pH
Dipstick
Hematocrit
Obtaining STD tests
Exposure control procedures
Other
Procedures/Treatments
# of procedures observed
Vital signs
IUC insertion (CU IUD/LNG IUS)
IUC removal (CU IUD/LNG IUS)
Implant insertion
Implant removal
Endometrial biopsy
Ultrasound
TCA/BCA application
Vulvar Biopsy
IM injection
Diaphragm fitting
FemCap fitting
Emergency plans/drugs
Skin Biopsy
MVA
Other
Education
Hormonal Contraceptives
-General
71
PSC-HHS-000103
Demonstrates
Area of Competence
Competence
Needs
Supervision
Desires
Training
Not trained or
observed
-Initiation
-Problem Management
Emergency contraception
IUC
Barrier Contraceptives
Spermicide and Condoms
Reproductive Life Planning
Pregnancy Options
Abortion
-Medication
-Surgical
Other
STDs/Vaginitis/UTI
Bacterial Vaginosis
Bartholinitis
Candidiasis
Cervicitis
Chlamydia
Gonorrhea
HSV
HIV counseling
HPV
Molluscum
Pediculosis
Syphilis
Trichomonas
UTI
Other
GYN Conditions
Abnormal cytology/HPV follow up
Abnormal Bleeding
Amenorrhea
Dysmenorrhea
PID
Galactorrhea
Abnormal breast conditions
Infertility
Gestational Sizing
HT/ET
Other
Other
Other
Cancer Screening
72
PSC-HHS-000104
Demonstrates
Area of Competence
Needs
Supervision
Competence
Desires
Training
Not trained or
observed
Proctor Signature:
Date:
RECOMMENDATION:
Approved to provide services as checked in Column I above.
Needs supervised clinical practice in the following areas:
Plan for providing additional training (Journal review, In-service training, On-line
training, CEU/Conference)
Signature of Clinician:
Date:
Date:
73
PSC-HHS-000105
(b) (4)
74
PSC-HHS-000106
(b) (4)
75
PSC-HHS-000107
(b) (4)
76
PSC-HHS-000108
PSC-HHS-000109
!Measles, Mumps and Rubella Vaccine (MMR) !Hepatitis B Vaccine !HPV Vaccine
Contraceptive History
What methods of birth control have you used in the past? _____________________________________________________________
Any problems with these methods? _________________________________________________________________
_____________________________________________________________________________________________________________
Menstrual History
How old were you when your period started? ___________
How often do you get a period now? !more than once a month !once a month !less than once a month
Are your periods? !Regular
!Irregular
How many days does your period usually last? ________________
Overall, is your flow? !Light
!Moderate
!Heavy
Pregnancy History
! Never pregnant (skip to the next section) ! Currently pregnant ___Total number of times pregnant
#Births ___ # C-sections ____ #Miscarriages ____ #Abortions ____ #Ectopics (tubal pregnancies) ____ #Living Children ______
st
Are you currently breastfeeding?
!Yes !No
Age at 1 pregnancy: ____ Age at last pregnancy: ____
Any problems with pregnancy, birth or abortion?
!Yes !No
If yes, please describe the problem(s):
!Yes
!Yes
!Yes
!Yes
!Yes !Unknown
!Yes !Sometimes
!Yes !Unknown
!Yes !Unknown
!Yes
!Yes !Unknown
!Yes
I use condoms
Have you been exposed to any STIs (sexually transmitted infections)?
Have you had a partner with any STI symptoms in the past 90 days
Have you used any IV drugs? If yes, have you shared needles? _____
Do your partners use IV drugs?
Have you had a blood transfusion before the year 1985?
Substance Use
!No
!No
!No
!No
!Yes
!Yes
!Yes
!Yes
Life Style/Support
!No
!No
!No
!No
!No
!No
!No
!No
!No
!No
!No
!No
!No
!No
!Yes
!Yes
!Yes
!Yes
!Yes
!Yes
!Yes
!Yes
!Yes
!Yes
!Yes
!Yes
!Yes
!Yes
78
PSC-HHS-000110
Review of Systems If you have recently had any of the following problems, please check
q Weight gain
q Weight loss
q Fever
q Hot flashes
q Fatigue, lethargy, malaise
q Chronic cough
q Shortness of breath
qDifficulty breathing on exertion
q Painful breathing
q Wheezing
q Spitting up blood
q Chest pain
q Irregular heartbeat/palpitations
q Syncope (fainting)
q Abdominal pain
q Constipation
q Diarrhea
q Nausea/Vomi ing
q Rectal bleeding
q Bloody stool
qInvoluntary loss of gas/stool
q Diminished interest or pleasure
in normal ac ivities
q Depressed mood
q Suicidal
q Seeing a therapist
qAnxiety
qAlopecia
q Cold or heat intolerance
q Excessive hunger, thirst or urina ion
he box.
Pharmacy Information
Please list the name of your preferred pharmacy _____________________ and the address, including zip code:
Updated 4.16.2014 http://i/x/6YCl (EMR Trainings & Workflows)
79
PSC-HHS-000111
Persons in
Family
1
2
3
4
5
6
7
8
For each
additional
person, add
Slide 1
Slide 2
Slide 3
Slide 4
ANNUAL
INCOME
100% or less
101-150% of Income
151-200% of Income
201-300% of Income
$11,670
$15,730
$19,790
$23,850
$27,910
$31,970
$36,030
$40,090
Up to $11,670
Up to $15,730
Up to $19,790
Up to $23,850
Up to $27,910
Up to $31,970
Up to $36,030
Up to $40,090
$11,671 - 17,505
$15,731 - 23,595
$19,791 - 29,685
$23,851 - 35,775
$27,911 - 41,865
$31,971 - 47,955
$36,031 - 54,045
$40,091 - 60,135
$17,506 - 23,340
$23,596 - 31,460
$29,686 - 39,580
$35,776 - 47,700
$41,866 - 55,820
$47,956- 63,940
$54,046 - 72,060
$60,136 - 80,180
$23,341 - 35,010
$31,461 - 47,190
$39,581 - 59,370
$47,701 - 71,550
$55,821 - 83,730
$63,941 - 95,910
$72,061- 108,090
$80,181 - 120,270
$4,060
Updated 1/31/2014
Persons in
Family
1
2
3
4
5
6
7
8
For each
additional
person, add
Slide 1
Slide 2
Slide 3
Slide 4
WEEKLY
INCOME
100% or less
101-150% of Income
151-200% of Income
201-300% of Income
$224
$303
$381
$459
$537
$615
$693
$771
Up to $224
Up to $303
Up to $381
Up to $459
Up to $537
Up to $615
Up to $693
Up to $771
$225 - 337
$304 - 454
$382 - 571
$460 - 688
$538 - 805
$616 - 922
$694 - 1,039
$772 - 1,156
$338 - 449
$455 - 605
$572 - 761
$689 - 917
$806 - 1,073
$923 - 1,230
$1,040 - 1,386
$1,157 - 1,542
$450 - 673
$606 - 908
$762 - 1,142
$918 - 1,376
$1,074 - 1,610
$1,231 - 1,844
$1,387 - 2,079
$1,543 - 2,313
$78
Updated 1/31/2014
80
PSC-HHS-000112
CPT CODE
VISIT DESCRIPTION
Self Pay
>300% FPL
Level 100
99201
LEVEL 1
17
33
49
99202
LEVEL 2
23
45
68
90
99203
LEVEL 3
30
60
90
120
99204
LEVEL 4
40
80
120
160
99205
LEVEL 5
50
100
150
200
LEVEL 1
15
30
45
60
99212
LEVEL 2
15
30
45
60
99213
LEVEL 3
22
43
64
85
99214
LEVEL 4
33
65
98
130
LEVEL 5
44
88
132
175
99215
AGE 12 - 17
38
75
113
150
99385
AGE 18 - 39
38
75
113
150
99386
AGE 40 - 64
44
88
132
175
AGE 12 - 17
34
68
102
135
99395
AGE 18 - 39
35
70
105
140
99396
AGE 40 - 64
44
88
132
175
10
15
20
OTHER VISITS
96372
IM INJECTION
GYN PROCEDURES-CONTRACEPTIVE
57170
38
75
112
149
58300
IUC INSERTION
50
100
150
200
58301
IUC REMOVAL
34
68
102
135
11981
NEXPLANON INSERTION
63
125
188
250
11982
NEXPLANON REMOVAL
75
150
225
300
11983
113
225
338
450
GYN PROCEDURES-OTHER
57452
COLPOSCOPY EVALUATION
50
100
100
150
200
57454
COLPOSCOPY w/ BIOPSY
50
100
100
150
215
54050
11
25
35
75
150
56501
11
25
35
75
150
57061
25
50
50
100
150
57522
CONIZATION W/ LEEP
88
175
175
300
360
57511
CRYOTHERAPY
63
125
125
200
250
17110
11
25
35
75
150
17111
11
25
35
75
150
58100
ENDOMETRIAL BIOPSY
45
90
125
150
180
56605
38
75
75
95
150
56606
13
13
25
25
50
CONTRACEPTIVE SUPPLIES
APRI
APRI
15
23
30
AVIA
AVIANE
15
23
30
A4267,C
CONDOMS (6 units)
A4269
CONTRACEPTIVE JELLY
J1050
18
30
39
A4266
DIAPHRAGM
13
19
25
J7304
15
24
30
Page 1 of 3
Updated 11/03/2014
81
PSC-HHS-000113
CPT CODE
VISIT DESCRIPTION
Self Pay
>300% FPL
Level 100
99070,F
J7307
NEXPLANON
75
150
225
300
JOLE
23
45
68
90
KARI
KARIVA
15
23
30
LEVOR
LEVORA
15
23
30
99070,L
LUBRICANT -DPH
99070,8
LUBRICANT 8 OZ
LUT
LUTERA
15
23
30
MC1 5
MICROGESTIN 1.5/30
15
23
30
MC20
MICROGESTIN FE 1/20
15
23
30
MICRO
MICRONOR
15
23
30
NORA
NORA-BE
15
23
30
J7302
MIRENA IUC
118
235
353
470
4
A4267,3
A4267,6
J7303
NUVA RING
18
26
35
S4993
OCELLA
15
23
30
ORCYC
ORTHOCYCLEN
15
23
30
ORTRI
ORTHOTRICYCLEN
15
23
30
ORTLO
ORTHOTRICYCLEN-LO
15
23
30
J7300
PARAGARD IUC
90
180
270
360
SPRI
SPR NTEC
15
23
30
TRIS
TRISPRINTEC
15
23
30
99070,V
YAZ
YAZ
50
50
50
50
50
EMERGENCY CONTRACEPTION
J3490,ELLA
ELLA
18
26
35
J3490,NC
Next Choice
18
26
35
MEDICATIONS
ACYC
Acyclovir
10
15
20
AZIT
Azithromicin
10
15
20
DOXY
Doxycycline
J0696
Rocephin (Injection)
26
35
ZITHROMAX
Zithromax
14
20
27
HPV VACCINE
90471
Immunization Administration
25
25
25
25
25
90649
HPV Vaccine
150
150
150
150
150
LABORATORY (OFF-SITE)
88305
65
65
65
65
65
88307
75
75
75
75
75
130
BVVPAN
BVV Panel
130
130
130
130
85025
CBC W/DIFFERENTIAL
87491
13
19
25
87081
CULTURE
11
17
22
80051
ELECTROLYTES
82670
ESTRADIOL
13
19
25
82274
60
83001
FSH
10
15
20
87070
GENITAL CULTURE
10
87591
13
19
25
Page 2 of 3
Updated 11/03/2014
82
PSC-HHS-000114
CPT CODE
VISIT DESCRIPTION
Self Pay
>300% FPL
Level 100
82947
GLUCOSE
84702
13
19
25
86706
HEP B sAB
12
12
20
86803
HEP C sAB
12
12
20
87340
HEP B sAG
15
20
87252
HERPES CULTURE
12
17
23
87255
19
38
56
75
86701
HIV I ANTIBODY
18
26
35
86702
HIV II ANTIBODY
25
50
75
100
86695
13
19
25
86696
13
19
25
86790
13
20
26
80061
LIPID PROFILE
12
80076
LIVER PROFILE
12
85595
PLATELET COUNT
84146
PROLACTIN
13
17
85610
PT
85730
PTT
86592
10
86762
RUBELLA SCREEN
85651
88142
10
20
29
39
87621
14
28
41
55
84443
TSH
11
15
87086
13
25
38
50
YEAST CULTURE
11
15
87102
LABORATORY (ON-SITE)
87480
CANDIDA SPECIES
10
87491,IH
13
19
25
25
87591,IH
13
19
87164
GRAM STAIN
84702, IH
25
25
25
25
25
85018
HEMOGLOBIN
99000
81025,N
NON-SENSITIVE UCG
83986
PH TESTING
86901
RH TYPING
81025,S
10
15
20
87660
TRICHOMONAS VAGINALIS
10
86701,R
35
81002
URINE DIPSTICK
36415
VENIPUNCTURE
81025,WI
10
15
20
87210
WET MOUNT
Page 3 of 3
Updated 11/03/2014
83
PSC-HHS-000115
Commercial General Liability (CGL): Protects against liability claims for bodily injury and property
damage arising out of premises, operations, products as well as advertising and personal injury liability.
Limits of liability: $1 million per occurrence; $2 million general aggregate limit. Company: (b) (4)
Umbrella Liability: Provides broader coverage and higher limits over other underlying policies: Nonowned and hired Automobile Liability, General Liability and Employers' Liability. Limits of liability: $25
million per occurrence/annual aggregate excess of scheduled underlying coverages. Company: (b) (4)
Directors and Officers Liability (D&O) Insures directors, officers, employees, volunteers and/or
members of duly organized committees against allegations of wrongful conduct when they are acting in
their capacity as company executives. Also insures affiliates to the extent they indemnify the individual
insureds for covered loss. Limits of liability: $2 million per occurrence each insured; $4 million annual
aggregate. Company: (b) (4)
Data Security Liability: Provides coverage for network security, privacy liability, privacy breaches,
cyber extortion threats, digital asset replacement, and business income loss. $500,000 to $1 million per
occurrence. Company: (b) (4)
Employment Practices Liability (EPL): Provides coverage for liability arising out of employment
related exposures, such wrongful termination, discrimination, sexual harassment and workplace torts
liability. Limits of liability: $350,000 each claim; $700,000 annual aggregate to each affiliate; $4 million
annual policy aggregate. Company: (b) (4)
Media Special Perils Policy (Media): Liability for claims arising out of publications including books,
newsletters, newspapers, magazines, brochures, monographs, electronically transmitted information and
databases, films, video cassettes, advertising materials and other materials related directly to such
scheduled media. Limits of Liability: $5 million each loss/aggregate. Company: (b) (4)
(b) (4)
Group Travel Accident Insurance: Provides coverage for accidental death and dismemberment for staff
and volunteers traveling on business on behalf of an affiliate. Limits of liability: $5 million aggregate
limit per accident. $1 million emergency medical evacuation and repatriation Company: (b) (4)
(b) (4)
In addition, PPLM maintains Property Insurance and Workers Compensation Insurance policies.
84
PSC-HHS-000116
Upload #3
Applicant:
Application Number:
FPH2015007161
Project Title:
Status:
Awarded
Document Title:
PSC-HHS-000117
I.
NEEDS ASSESSMENT
PPLMs Central Massachusetts (MA) Title X health centers serve more than 900,000 people,
approximately 14% of the Commonwealths population. Numerous family planning health status
indicators, including higher teen pregnancy rates, increased numbers of people living in poverty
and more people living with STDs, HIV, and AIDS, reveal a real need for continued and
additional services in Central MA. These indicators are particularly troubling given the
significant health disparities found among racial and ethnic populations. PPLMs long history of
providing services in Massachusetts, in addition to its success in implementing the Title X
program at its health centers in Fitchburg, Marlborough, Milford, and Worcester, make it poised
to continue to deliver high-quality care in the area.
A.
PPLMs four Title X health centers in Central MA serve Worcester County and western
Middlesex County, and are located in the more populous cities of Fitchburg (Worcester County),
Marlborough (Middlesex County), Milford (Worcester County) and Worcester (Worcester
County) (See Map 1). Fitchburgs population is greater than 40,000,1 Marlboroughs population
is greater than 39,400,2 Milfords population is greater than 25,0003 and Worcesters population
is greater than 182,500.4 Worcester County is the largest county in Massachusetts based on area5
U.S. Census Bureau (2013). State and County QuickFacts: Fitchburg, MA. Retrieved
November 1, 2014, from http://quickfacts.census.gov/qfd/states/25/2523875.html.
2
U.S. Census Bureau (2013). State and County QuickFacts; Marlborough, MA. Retrieved
November 1, 2014, from http://quickfacts.census.gov/qfd/states/25/2538715.html.
3
U.S. Census Bureau (2013). State and County QuickFacts: Milford, MA. Retrieved November
1, 2014, from http://quickfacts.census.gov/qfd/states/25/2541200.html.
4
See footnote 3.
5
U.S. Census Bureau (2014). U.S. Gazetteer Files. Retrieved October 5, 2014, from
http://www.census.gov/geo/maps-data/data/docs/gazetteer/counties_list_25.txt.
1
PPLM
Page 118 of 181
PSC-HHS-000118
and the second-most populous county in the Commonwealth after Middlesex County.6 Worcester
County includes more than 60 cities and towns, and when combined with Marlborough in
Middlesex County, includes a population of more than 900,000, which represents nearly 14% of
the population in Massachusetts. Although this region contains communities that are rural and/or
have lower population densities (mainly in the western and southwestern sections of the region),
the majority of Central MA's residents live in or adjacent to urban areas like those where
PPLMs health centers are located.
Map 1: Map of Massachusetts7
Many residents must travel considerable distances to access family planning services. Major
highways cross the county east-west (I-90/MassTurnpike) and north-south (Routes 190, 290 and
395). Modest bus service is provided in Worcester and adjacent communities by the Worcester
U.S. Census Bureau (2013). State and County QuickFacts. Retrieved October 5, 2014, from
http://quickfacts.census.gov/qfd/states/25/25027.html.
7
Galvin, W.F., Secretary of the Commonwealth (2014). Map of Massachusetts Counties.
Retrieved October 5, 2014, from http://www.sec.state.ma.us/cis/cispdf/County_Map.pdf.
Highlighting added to cities where PPLMs Title X health centers are located.
6
PPLM
Page 119 of 181
PSC-HHS-000119
Regional Transit Authority, in Marlborough and Milford by the Metro West Regional Transit
Authority and in Fitchburg by the Montachusett Regional Transit Authority.
B.
Between 2000 and 2010, Central MA has experienced the greatest population increase in the
Commonwealth.8 In Worcester County, Framingham and Marlborough, the total population
increased 5.7% (from 854,128 in 20009 to 905,369 in 201010). This rate of population growth is
expected to continue in the region well through 2030.11 Growth is attributed to a higher birth
than death rate and an increase in number of people moving to the area.12 In particular, there are
approximately 15% more 15 to 19 year olds coming to the region, which is partially attributed to
the many large institutions of higher education in the region.13 There is also a greater percentage
of people in their 30s, often families with young children, moving to the area.14
Populations of Focus
Based on the needs analysis and a review of the health disparities PPLM observes at its health
centers and in the community, PPLM will continue to direct attention and resources to serve and
PPLM
Page 120 of 181
PSC-HHS-000120
connect with individuals with low- and limited income, diverse populations based on race,
ethnicity and English language proficiency, and adolescents. In Worcester County, Framingham
and Marlborough, nearly 51% of the population is female and 20% of these women are of
reproductive age (between the ages of 15 and 44 years of age).15 As the overall population is
increasing, the highest rate of growth is amongst 15 to 25 year olds, Blacks, Asians and
Hispanics/Latinos,16 and it is imperative PPLM focus on these communities as well as those who
have difficulty accessing and affording family planning services due to their limited income.
Individuals from Low-Income Households: PPLM will continue to reach out to and serve
those in need of family planning services who are living below the Federal Poverty Level (FPL)
and near poverty. More than 20% of all Worcester residents and 19% of Fitchburg residents live
below the FPL versus 11% of state residents overall.17 Poverty is disproportionately high among
Hispanics/Latinos, Blacks, and Asians. (See Table 1). In addition, in many towns and cities in
Central MA, more women are living below the FPL than the state average. (See Table 2).
2.8%
9.9%
7.5%
10.1%
4.5%
16.1%
14.0%
3.1%
6.5%
2.8%
8.6%
6.7%
8.0%
3.7%
13.2%
12.6%
2.4%
% Black
21.4%
16.6%
1.9%
41.1%
28.7%
30.9%
16.8%
1.5%
8.6%
4.7%
26.6%
2.0%
11.4%
15.9%
6.9%
% Asian
14.1%
20.8%
0.0%
12.2%
3.8%
0.2%
0.0%
1.1%
17.2%
8.0%
0.9%
6.2%
8.8%
21.9%
1.1%
% Hispanic
30.0%
41.1%
2.8%
32.8%
22.6%
9.0%
27.6%
6.2%
19.8%
18.3%
31.6%
12.5%
26.6%
37.7%
25.9%
Fitchburg
Webster
6.3%
12.8%
Southbridge
Marlborough
13.0%
7.1%
Shrewsbury
Leominster
9.6%
15.6%
Milford
Holden
19.1%
5.9%
Gardner
6.2%
18.8%
Framingham
20.1%
8.6%
Auburn
11.0%
% White
Worcester
% Total
MA
Grafton
Westborough
PPLM
Page 121 of 181
PSC-HHS-000121
MA
Worcester
Auburn
Fitchburg
Framingham
Gardner
Grafton
Holden
Leominster
Marlborough
Milford
Shrewsbury
Southbridge
Webster
Westborough
Table 2: Percentage of Female Population Living Below FPL in Past 12 Months (2008-2012
American Community Survey 5-Year Estimates)19
% Total
11.0%
20.1%
6.2%
19.1%
9.6%
13.0%
6.3%
2.8%
9.9%
7.5%
10.1%
4.5%
16.1%
14.0%
3.1%
% Women
12.1%
22.0%
6.0%
18.2%
11.4%
15.7%
7.2%
3.1%
11.8%
8.0%
12.3%
5.1%
19.5%
1.7%
3.1%
Race and Ethnicity: The population growth among Asians, Blacks and Hispanics/Latinos, as
well as increases in immigrant populations in Fitchburg, Marlborough, Milford, and Worcester,
make reaching and serving diverse populations a priority. The percentage of the population that
identified as Black was 7.1% in 2000 and increased to 9.8% in 2010.20 The percentage of the
population that identified as Asian was 2.9% in 2000 and increased to 4.3% in 2010.21 Similarly,
the percentage of people who identified as Hispanic/Latino was 2.9% in 2000 and increased to
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4.3% in 2010.22 PPLMs Central MA clients reflect a similar diversity (see Table 3).
Table 3: PPLM Title X Health Centers Clients by Self-Identified Race and Ethnicity,
Client Demographics, 2010 and 2013
White
Black
Asian
Hispanic
2010
69.2%
6.6%
2.4%
19.7%
2013
66.8%
9.3%
3.5%
16.3%
There are many robust immigrant communities in Central MA as well. In both Marlborough and
Milford, there is a large population of people from Puerto Rico, Portugal, Ecuador, and Brazil.
Persons of Puerto Rican descent are the dominant Latino group in Central MA. Many
Hispanic/Latino, Black and Asian populations are also foreign-born. These population groups
face special barriers to learning how to navigate the U.S. health care system and may lack
language skills to do so. These immigrant populations are more likely to be living in poverty. For
example, in Worcester County, 12.4% of the foreign born population lives below the FPL versus
10.3% of the total population, and 18.8% of the foreign born population is between 100% and
199% of FPL versus 13.2% of the total population.23 In addition, cultural differences in
acceptance of family planning services often exist among certain communities, making it even
more important for appropriate education and outreach activities.
Limited English Proficiency: PPLM serves all people, regardless of English proficiency. In
many Central MA communities, many residents primarily speak a language other than English.
For example, in Framingham, 34.3% of residents do not speak English at home, and only 51.2%
22
See footnote 10.
23
See footnote 10.
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of these residents speak English well.24 Many of these residents live in linguistically isolated
households, as 11.6% of households do not include anyone aged 14 or older who speaks English
well.25 Similarly, in Marlborough, 23.5% of residents do not speak English at home, and 57.5%
of these residents speak English well.26 PPLMs Central MA health centers welcomes clients
whose primary language is Spanish (2.5%), Portuguese (2%) or other (2.25%). (See Table 4).
Table 4: PPLM Fiscal Year 2014 Clients by Primary Language, Client Demographics for
January 1, 2014 June 16, 2014
Fitchburg
Marlborough
Milford
Worcester
Total
English
98%
91%
84%
95%
92%
Spanish
1%
1%
7%
1%
2.5%
Portuguese
0%
4%
3%
1%
2%
Other
0%
1%
6%
2%
2.25%
Unknown
1%
3%
0%
1%
1.25%
Adolescents: The continued population growth among 15 to 25 year olds in Central MA makes
serving adolescents a priority for PPLM. The percentage of the population in the area aged 15 to
25 years increased from 12.3% in 2000 to 13.8% in 2010.27 Adolescents face unique challenges
in accessing family planning services and need confidential and affordable resources.
C.
To continue serving high-need communities and reach even more vulnerable communities and
hard-to-reach people, PPLM will expand its educational outreach regarding its Title X services.
24
MetroWest Health Foundation (Summer 2012). Community Health Profiles. Retrieved
November 2, 2014, from
http://www.mwhealth.org/Portals/0/Uploads/Documents/Public/Special_Reports/Community_
Health_Profiles_Sept_2012.pdf.
25
See footnote 24.
26
See footnote 24.
27
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more than 100,100 women in Worcester County who are in need of contraceptive
services, especially those who have low-incomes, are un- or underinsured, are
adolescents and/or are Black and/or Hispanic/Latino;
breast and cervical cancer screenings to help women seek treatment early;
all Central MA residents to reduce the high rates of STDs and HIV/AIDS, especially in
towns with higher incidences and among populations known to be at-risk.
Family Planning
While there has been a considerable decline in unintended pregnancy rates in the U.S., at least
37% of pregnancies are unintended.28 Unintended pregnancy rates for women with incomes at or
below the FPL are five times that of women at the highest income level.29 In Massachusetts, the
percentage of unintended pregnancies in 2010 was 18.6%, which is below the national rate and
within the Healthy People 2020 benchmarks.30 Despite this, great disparities exist for women
based on their age, income level and race/ethnicity. For example, 62% of unintended pregnancies
occurred for women aged 18 to 24 whereas only 14% of unintended pregnancies were to women
28
Kost K. (2013). Unintended Pregnancy Rates at the State Level: Estimates for 2002, 2004,
2006 and 2008. New York: Guttmacher Institute. Retrieved November 20, 2014, from
http://www.guttmacher.org/pubs/StateUP08.pdf.
29
Finer LB and Zolna MR (2014). Shifts in intended and unintended pregnancies in the United
States, 20012008, American Journal of Public Health, 2014, 104(S1): S44-S48. Retrieved
November 20, 2014, from http://www.guttmacher.org/pubs/journals/ajph.2013.301416.pdf.
30
Health Survey Program, Division of Research and Epidemiology Bureau for Health
Information, Statistics, Research, and Evaluation, Massachusetts Department of Public
Health. (March 2014). A Profile of Family Planning Among Massachusetts Adults, 20082010. Retrieved November 20, 2014, from http://www.mass.gov/eohhs/docs/dph/behavioralrisk/profile-family-planning-among-adults.pdf.
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aged 35 to 44.31 The unintended pregnancy rates were much higher for women aged 18 to 44
considered to be low-income: 31% of unintended pregnancies occurred to low-income women
versus 13% to women with higher-incomes.32 Black women experienced 39% of unintended
pregnancies, Hispanic/Latino women experienced 37% of unintended pregnancies and white
women experienced only 16% of unintended pregnancies.33
<100% FPL
100-137%
FPL
138-199%
FPL
200-249%
FPL
Greater than
250% FPL
Massachusetts
778,300
108,140
34,520
61,750
51,780
522,110
Worcester
88,510
13,140
3,290
7,910
6,260
57,910
Teen birth rates have decreased over the years, but there are still significant disparities. For
example, Black and Hispanic/Latino teen birth continue to be more than two times higher than
the rate for white teens. 38 This remains true in Massachusetts where the teen birth rate is one of
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the lowest in the country yet the number of teen births in Central MA and for Black and
Hispanic/Latino teens is disproportionately higher. For Black teens in Massachusetts, the teen
birth rate was three times greater than white teens.39 For Hispanic/Latino teens, the rate was
almost seven times greater than white teens.40 In 2013, Massachusetts overall teen birth rate was
12 per 1,000 females aged 15 to 19, but the rate was significantly higher in many Central MA
towns.41 (See Table 6). In Framingham, 65.6% of teen births were to Hispanic/Latino mothers,
and in Worcester, 56.4% of teen births were to Hispanic/Latino mothers.42
Table 6: Trends in Teen Birth Rates (per 1,000 females ages 15-19 per city/town), Ranked
by 2013 Teen Birth Rate, Massachusetts, 2003, 2011, 201343
State
Rank
Municipality
Number
of Teen
Births
2003
Teen
Birth
Rate
Number
of Teen
Births
2011
Teen
Birth
Rate
Number
of Teen
Births
2013
Teen
Birth
Rate
State Total
4,639
23.0
3,480
15.4
2,732
12
Southbridge
37
68.6
28
49.0
25
43.8
14
Worcester
263
38.7
193
25.0
179
23.2
15
Leominster
43
35.5
27
20.6
30
22.9
17
Marlborough
24
27.7
22.4
26
22
21.4
18
Fitchburg
75
49.9
56
31.5
38
21.4
21
Framingham
38
19.9
31
13.2
32
13.6
Freyer, Felice J. (December 12, 2014). Mass. teen birth rate at all-time low. The Boston Globe.
Retrieved December 19, 2014, from http://www.bostonglobe.com/metro/2014/12/12/teenbirth-rate-mass-reaches-historic-low-state-officialssay/C4wDQWGL1Os2wSlRvydXTN/story.html.
40
See footnote 39.
41
Massachusetts Alliance on Teen Pregnancy (2014). Trends in Teen Birth Rates for Selected
Massachusetts Communities, 2012. Retrieved November 18, 2014, from
http://www.massteenpregnancy.org/research/teen-pregnancy-and-birthrates?start=2011&end=2012.
42
See footnote 42.
43
See footnote 42.
39
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PSC-HHS-000127
during their teen years.44 Addressing teen pregnancy rates will address school dropout rates, a
significant contributor to cycles of poverty.
Over the years PPLM has served Central MA residents as a Title X provider, PPLM has been a
trusted provider, especially for adolescents. In the first half of 2014, 18.25% of PPLMs female
clients are between the ages of 15 and 19, and 14.5% of PPLMs male clients are between the
ages of 15 and 19. (See Table 7).
Table 7: PPLM Fiscal Year 2014 Female and Male Clients by Age, Client Demographics
for January 1, 2014 June 16, 2014
Female
15-17
18-19
20-24
25-29
30-34
35-39
40-44
45-49
Male
15-17
18-19
20-24
25-29
30-34
35-39
40-44
45-49
Fitchburg
Marlborough
Milford
Worcester
Total
10%
12%
37%
19%
10%
5%
4%
1%
7%
9%
32%
27%
13%
6%
2%
2%
6%
12%
27%
28%
13%
8%
3%
1%
6%
11%
38%
23%
11%
6%
2%
1%
7.25%
11%
33.5%
24.25%
11.75%
6.25%
2.75%
1.25%
2%
8%
29%
22%
12%
9%
5%
5%
2%
2%
27%
24%
17%
8%
4%
8%
1%
4%
35%
25%
16%
6%
4%
5%
5%
34%
26%
25%
6%
5%
3%
2%
2.5%
12%
29.25%
24%
12.75%
7%
4%
5%
44
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PSC-HHS-000128
women.45 Massachusetts has the third highest breast cancer incidence rates. In 2011, there were
135.5 incidences per 100,000 women compared to the national rate of 122 incidences per
100,000 women.46 While incidents and mortality trends for cervical cancer have decreased,47
screening is vitally important for prevention and treatment. Massachusetts has a cervical cancer
incidence rate of 5.2 per 100,000 women compared to the national rate of 7.5.48 Still, cervical
cancer screening rates remains low for many populations.49
45
Centers for Disease Control and Prevention (2014). Breast Cancer Statistics. Retrieved
November 18, 2014, from http://www.cdc.gov/cancer/breast/statistics/index.htm.
46
Centers for Disease Control and Prevention (2014). U.S. Cancer Statistics; 2011 Selected
cancers ranked by state. Retrieved November 18, 2014, from
http://apps.nccd.cdc.gov/uscs/cancersrankedbystate.aspx.
47
Centers for Disease Control and Prevention (2014). Cervical Cancer Trends. Retrieved
November 18, 2014, from http://www.cdc.gov/cancer/cervical/statistics/trends.htm.
48
See footnote 46.
49
Centers for Disease Control and Prevention (2014). Cervical Cancer Screening Rates.
Retrieved November 18, 2014, from
http://www.cdc.gov/cancer/cervical/statistics/screening.htm.
50
MassCHIP, Massachusetts Executive Office of Health and Human Services (2014). Health
Status Indicators. Retrieved October 6, 2014, from
http://www.mass.gov/eohhs/researcher/community-health/masschip/health-statusindicators.html#cities_towns.
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PSC-HHS-000129
Auburn
Fitchburg
Framingham
Gardner
Grafton
Holden
Leominster
Milford
Shrewsbury
Southbridge
Webster
Westborough
HIV/AIDS
261
501.6
115.9
246.8
295.5
143.2
83.4
NA
163.8
131.9
79.9
81.4
177.1
172.1
85.2
Chlamydia
Gonorrhea
322.1
37.9
622.8
80.1
128.1
NA
286.3
22.2
330.5
24.4
200.4
23.9
208.5
NA
90.5
0
455.8
26.1
145.3
18.8
141.8
NA
150.7
NA
108.6
NA
326.4
NA
117.1
NA
Syphilis
11.7
9.4
NA
NA
9.1
NA
NA
NA
NA
MA
Worcester
Marlborough
Fitchburg
Gardner
Grafton
Holden
Leominster
Marlborough
Milford
Shrewsbury
Southbridge
Webster
Westborough
1310.9
2109.6
NA
902.6
1901.3
698.7
1309.5
NA
1741.2
797
557.9
684.9
NA
2132.5
707.5
Gonorrhea
76.6
76.8
NA
NA
NA
NA
Framingham
Auburn
Chlamydia
MA
Worcester
STDs disproportionately impact Blacks and Hispanics/Latinos. In 2010, the rate of chlamydia
infection was 18 times higher in Blacks and 13 times higher in Hispanics/Latinos compared to
whites.53 Similarly, the rate of gonorrhea incidence was 16 times higher in Blacks and seven
times higher in Hispanics/Latinos compared to whites.54 A disproportionate number of people
living with HIV/AIDS are Hispanic/Latino and Black (See Table 10).
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PSC-HHS-000130
Table 10: People living with HIV/AIDS on December 31, 2012 by gender and
race/ethnicity55
Central MA
D.
MetroWest MA
Number
Number
Male
Female
983
615
62%
38%
1,886
742
72%
28%
White
675
42%
1,322
50%
Black
405
25%
907
35%
Hispanic/Latino
490
31%
330
13%
55
Massachusetts Executive Office of Health and Human Services (2013). Regional HIV/AIDS
Epidemiologic Profile of Central Health Service Region (HSR), Massachusetts. Retrieved
November 22, 2014, from http://www.mass.gov/eohhs/docs/dph/aids/2013-profiles/hsrcentral.pdf; Massachusetts Executive Office of Health and Human Services (2013). Regional
HIV/AIDS Epidemiologic Profile of MetroWest Health Service Region (HSR), Massachusetts.
Retrieved November 22, 2014, from http://www.mass.gov/eohhs/docs/dph/aids/2013profiles/hsr-metrowest.pdf.
PPLM
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PSC-HHS-000131
Worcester: Girls Inc.s Preventing Teen Pregnancy Program, AIDS Project Worcester,
UMass Medical Center, DPH-funded family planning programs, United Ways Womens
Initiative, Common Pathways, and Edward M. Kennedy CHC
Table 11: Family Planning Services in Central MA
City/Town
Fitchburg
Framingham
Gardner
Leominster
Marlborough
Milford
Worcester
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AIDS Action Committee and Fenway Healths website and hotline (Maria Talks)
II.
A.
Founded in 1928 as the Birth Control League of Massachusetts, PPLM is a private, non-profit
organization and a statewide affiliate of Planned Parenthood Federation of America (PPFA).
PPLMs mission is to protect and promote sexual and reproductive health and freedom of choice
by providing clinical services, education and advocacy. (Appendix B: PPLM Articles of
Organization; Appendix C: PPLM By-Laws; Appendix D: Proof of Nonprofit Status). Last year,
PPLM provided more than 48,000 client visits at its seven health centers around the
Commonwealth; 25% of those visits were in Central MA. PPLMs Sexual Health Matters
PPLM
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PSC-HHS-000133
PSC-HHS-000134
2020, the National HIV/AIDS Strategy (NHAS) and the CDCs Revised Recommendations for
HIV Testing of Adults, Adolescents and Pregnant Women in Health Care Settings. In addition
to clinical services, PPLM is committed to fulfilling its medical education and teaching mission.
PPLM, in partnership with Brigham & Womens Hospital, serves as a training site for a family
planning fellowship program.
Grossman, J. M., Tracy, A. J., Charmaraman, L., Ceder, I. and Erkut, S. (2014).Protective
Effects of Middle School Comprehensive Sex Education With Family Involvement. Journal of
School Health, 84: 739747. doi:10.1111/josh.12199.
57
For recent press about the results of the Get Real program, see:
https://time.com/3525125/planned-parenthood-sex-education/;
http://www.youthhealthmag.com/articles/1574/20141026/sex-among-teens-get-realprogram.htm; http://www.bustle.com/articles/45718-planned-parenthoods-sex-ed-program-getreal-has-some-of-the-best-results-around-and-thats;
http://www.latinpost.com/articles/24232/20141026/real-comprehensive-sex-education-worksproves-delay-activity-teens.htm; https://time.com/3525125/planned-parenthood-sex-education/;
http://www.slate.com/blogs/xx_factor/2014/10/22/get_real_planned_parenthood_s_sex_ed_is_
better_than_abstinence_only_programs.html;
56
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PSC-HHS-000135
PSC-HHS-000136
PSC-HHS-000137
comprehensive and age-appropriate health education, and education reform. She is also
the author of the states anti-bullying law. In addition to her legislative experience, Ms.
Walz has held leadership positions at non-profit and public organizations including
Jumpstart for Young Children and Boston Public Schools. Her volunteer positions have
included serving on the Charles River Water Quality Commission, the Kingsley
Montessori School Advisory Council, the Womens Lunch Place Board of Directors and
Advisory Committee, and seven years on the NARAL Pro-Choice Massachusetts Board
of Directors. She holds a MPA from Harvard Universitys John F. Kennedy School of
Government, where she was a Kennedy Fellow and a Lucius N. Littaur Fellow. Ms. Walz
has a JD from New York University School of Law and a BA from Colgate University.
Ms. Walz regularly convenes an Executive Team comprised of the Chief Operating
Officer (COO), Chief Financial Officer (CFO), Chief Information Officer (CIO), Medical
Director, Vice President (VP) for Education and Internal Training, Chief Development
Officer (CDO), Director for Clinical Research and Training, VP of Human Resources and
Organizational Effectiveness, VP of Business Development and Director for Public
Affairs. The Executive Team implements the strategic and operational plans of the
organization and oversees management of day-to-day operations of health services,
education, advocacy, and clinical research and training.
Susan Lit, Chief Operating Officer: Susan previously served as the organizations
CFO. As CFO, Ms. Lit worked closely with medical and administrative staff, helping
them to navigate the complex world of health care finance. She developed new finance
dashboards for management reporting, managed a reorganization of billing operations
and introduced new processes for improving revenue cycle results. In November 2013,
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PSC-HHS-000138
Ms. Lit was promoted to COO and she oversees PPLMs Health Services and Clinical
Research and Training, Education and Internal Training, Information Systems and
Technology, and Business Development and Marketing. She oversees Title X financial
management and compliance, and works closely with (b) (4)
PPLMs
Controller, who manages accounting and financial reporting. She prepares documents for
the Board of Directors Finance Committee and Risk Management and Compliance
Committee, which hosts quarterly meetings. Both Ms. Lit and Ms. Chandler prepare for
PPLMs annual financial audit. Prior to joining PPLM, Susan contributed more than 20
years to publishing management.
(b) (4)
2011 as the Associate Medical Director. She assumed the position of Medical Director in
October 2012. (b) (4)
Medicine and completed her residency training in Obstetrics and Gynecology at Tufts
Medical Center. She then completed a fellowship in Family Planning at Boston
University where she received her MPH degree. (b) (4)
is an Assistant Professor in
Obstetrics and Gynecology at Tufts University School of Medicine where she serves as
the Director of Family Planning. Among her clinical expertise is second trimester
abortion provision, complex first trimester abortion, and contraception provision for
medically complicated women. (See Appendix F: Medical Director Job Description).
Deb Fenton, VP of Health Center Operations: Ms. Fenton joined PPLM in March
2005 as the Western Mass. Center Director. In October 2011, Ms. Fenton was promoted
to Regional Director of Central and Western Massachusetts overseeing five health
centers. In 2014, Ms. Fenton was promoted to VP of Health Center Operations
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PSC-HHS-000139
overseeing operations for all seven PPLM health centers. Prior to PPLM, she was the VP
of Community Services at the United Way of Pioneer Valley. In that capacity, she ran the
Volunteer Center and First Call for Help. Ms. Fenton also served as the chair of
Springfields Public Health Council during her tenure at the United Way. (See Appendix
G: VP of Health Center Operations Job Description).
(b) (4)
plan identified the need for this new position begun in November 2014. Directly
responsible for developing more robust partnerships with primary care providers (PCPs),
higher education institutions, and other community-based organization, (b) (4)
joined PPLM from Health Leads, a non-profitorganizationthataddressesclients
socialdeterminationsofhealthbyprovidingcasemanagementservicestohospitals,
healthcenters,andhealthplans.Since2006,(b) (4)
helpeddevelopHealth
LeadsvisionandstrategyandestablishedlocationsinBaltimoreandBoston.He
wasresponsiblefornegotiatingpartnershipswithCHCsandhospitalsandsecured
governmentcontracts.HedevelopedaHealthLeadssponsoreduniversitycourse
andmanagedstrategicpartnerships.Duringhistenure,clientvolumegrewby50%
inthreeyearsinBoston.(b) (4)
volunteeredatPlannedParenthoodinOhio
duringhighschoolandcollegeandthenworkedasaLabTechnicianandthen
conductedhealtheducationtrainingforthePeaceCorps.
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PSC-HHS-000140
committees: Finance and Audit; Risk Management and Compliance; Medical Quality and Patient
Service; Governance; Education; Development; and Executive. The Boards Governance
Committee actively recruits members for the Board of Directors based on the organizations
annual operating goals and strives to achieve a mix of gender, age, ethnicity, geography, and
professional expertise. Incoming Board Members receive an orientation, which is hosted on an
annual basis. A comprehensive review of Title X is incorporated into new Board members
orientations and the Board of Directors receive updates on Title X on at least an annual basis.
Especially important for PPLMs Title X health centers is the Outreach Committee, which works
with PPLMs Central MA Health Center Director, (b) (4)
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PSC-HHS-000141
III.
PPLM built and continues to improve its organizational structure and program management
practices to ensure high-quality services that meet the Title X program requirements. In 2010,
PPLM leveraged its nearly 30 years of experience as a family planning provider in Central MA
to establish itself as a Title X service provider. Since the summer of 2010, PPLMs three new
health centers have reached an increasing number of clients each year and raised awareness
about the services offered in the communities where they are located.
PPLM projects 8,500 client visits (6,375 unique clients) in Grant Year 1 (2015-2016). (See Table
12). PPLM estimates a continued increase in the number of clients and visits based on its
experience in Central MA, population and demographic projections, its demonstrated ability to
provide high-quality family planning services, and its expanded plan for community outreach.
Table 12: Projected Number of PPLM Clients Visits, (April 2015 March 2018)
PPLM Title X Health
Center Location
Family Planning
Hours/Month
Projected Client
Visits/Year
Grant year 1 (April
2015-March 2016)
Projected Client
Visits/Year
Projected Client
Visits/Year
Fitchburg
67
1289
1350
1417
Marlborough
69
950
998
1047
Milford
69
1160
1218
1278
Worcester
244
5101
5356
5623
Total
449
8,500
8,922
9,365
45%
45%
45%
% of low income
(below 100% FPL)
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PSC-HHS-000142
PSC-HHS-000143
PSC-HHS-000144
PSC-HHS-000145
unresolved follow-up speaks with PPLM staff about next steps to resolve any issues. In this case,
PPLMs Patient Contact Center staff, Health Care Assistants (HCAs) or clinicians who have
contact with the client will try to address the issue(s).
In addition, PPFA provided APCs with a self-study Breast Health Initiative Workbook. These
workbooks provided information on Breast Cancer Screening and Risk Assessment; Clinical
Breast Exam; Exam Documentation; and Interpretation of Mammogram findings. The workbook
contained resources such as algorithms to help in the management of breast conditions; an exam
competency checklist; a guide on establishing referral relationships; breast cancer information
resources; and client education principles.
Beginning in 2014, PPLM updated its audit calendar to increase the frequency with which breast
related visits are audited from once to twice a year in recognition of the importance of ensuring
PPLMs clinicians are providing the most up-to-date evidence-based care.
This past year, PPLMs health centers also participated in a benchmarking project in partnership
with PPFAs Clinical Quality Improvement department to increase cervical cancer screening
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PSC-HHS-000146
PSC-HHS-000147
PSC-HHS-000148
Forty percent of PPLMs Call Center staff who make the initial appointment is bilingual. PPLM
has access to American Sign Language and language interpreters through the American
Translation Association and the Massachusetts Medical Interpreters Association. Bilingual staff
complete a language assessment for medical interpretation prior to acting as a medical
interpreter. Every effort is made to match LEP clients with staff who speaks their native
language. Documentation of interpreter services by staff is placed in the clients record. If a
client requests a friend or family interpret for her/him, then the client and friend or family
member must complete the Interpreter Consent Form which a PPLM staff member witnesses. Per
PPLM policy, a family or friend interpreter can only attend a visit at the recommendation of the
client. PPLMs Central MA Bilingual Parent Educator and Community Outreach Specialist,
(b) (4)
outreach to insure that PPLM reaches communities that can most benefit from family planning
services. Because of her strong ties to the Central MA community and non-profit providers, she
is an important internal resource for staff and clients.
4.
Laboratory Services
PPLM opened a high-complexity in-house laboratory in August 2009 to decrease client costs and
improve turnaround time for results. It processes chlamydia, gonorrhea, bacterial vaginitis, and
HCG blood tests for all PPLM centers, presenting a cost savings of 30% over PPLMs former lab
services provider. PPLM recently contracted for new lab equipment for chlamydia and gonorrhea
testing called (b) (4)
This new equipment speeds PPLMs turnaround time for testing by 50%
and increases capacity to handle more testing in the future. The health centers perform rapid
HIV, rapid pregnancy testing, urinalysis, hemoglobin, Rh, and glucose tests for clients on-site.
PPLM
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(b) (4)
MT
Quality control checks are conducted daily and weekly. All equipment is maintained and
inspected regularly. PPLM is enrolled in the American Proficiency Institute, which provides
proficiency testing to determine the performance of individual laboratories for specific tests or
measurements and is used to monitor laboratories continuing performance. PPLM also has lab
safety and infection control guidelines. PPLM complies with Occupational Safety and Health
Administration (OSHA) blood-borne pathogen standards and chemical hazard communication
standards. PPLM contracts with (b) (4) to provide laboratory analysis for syphilis, Pap smears,
herpes, Beta, and HCG. Criteria used to select and monitor outside labs includes quality,
references, reputation, efficiency, and cost. PPLMs lab manual includes training and orientation
of new personnel, procedures, quality control, tracking systems, and specimen collection.
5.
Pharmacy Services
PPLM provides clients the option to pick up birth control supplies and medications directly at the
health centers, including birth control pills, emergency contraception, patch, and ring.
Pharmaceuticals are packaged and labeled according to state law by licensed personnel including
mid-level clinicians and nurses with the requisite credentials. The Central MA Health Center
purchases contraceptives and pharmaceuticals based on an automated replenishment system
and/or a manual request through PPLMs centralized purchasing department, maintaining
quantities equal to 45 days usage. All pharmaceuticals used at each center location are approved
for use through a formulary system controlled by PPLM. All drugs and medical devices used are
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PSC-HHS-000151
PSC-HHS-000152
PSC-HHS-000153
shows; reaches out to community partners, including school nurses, adolescent programs,
YWCA, WIC, (b) (4)
where PPLM
provided bags, along with Title X brochures, for customers making purchases and who might
benefit from PPLM family planning services. Other specific initiatives include:
Get Real Teen Council: PPLM engages teens and offers sexual health training to a
bilingual and culturally diverse group of 10th and 11th grade students who, in turn, train
their peers. In addition to educating teens about sexuality and healthy decision-making,
they learn about PPLM and Title Xs free and confidential health services. This year,
PPLM will train 13 teens from Central MA for this program who will train at least 500 of
their peers.
Parent Educators: PPLM conducts workshops parents to raise awareness about the
importance of family planning. In 2015, PPLMs parent educators training will include
an overview of PPLMs health services including contraceptive methods, emergency
contraception, STD and HIV/AIDS prevention testing and treatment, breast and cervical
cancer prevention screenings, and the HPV vaccine. Workshops will reach 900 parents
throughout Central MA through collaborations with social service agencies, health
centers, faith-based organizations, and schools. Also, PPLMs Manager of Parent
Education will conduct a two-hour professional training for 10 new Counseling and
Referral Hotline volunteers on how to talk with parents and teens who call the hotline
including explaining services for minors, the importance of parent-child communication,
and how to offer additional resources in family communication. PPLMs Seamos
Honestos parent workshops will also educate 450 bilingual parents and other caring
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PSC-HHS-000155
cultural background of individuals served. Material review occurs annually and written
records of the committees determinations are kept in a signed binder.
Community Partnerships: PPLM has established many relationships with PCPs, CHCs,
and other community partners and will continue to strengthen these under the leadership
of the new VP of Business Development. PPLM partners with the (b) (4)
(b) (4)
(b) (4)
(b) (4)
PPLM
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PSC-HHS-000157
Commission on Accreditation of Allied Health Education Programs, and passing the National
Commission for Certification of PAs examination. PAs must have a supervising physician with
final responsibility for care, a State Controlled Substances registration number, and a DEA
registration number to prescribe controlled substances.
2.
PPLMs infrastructure for Title X program management will continue to support PPLMs
compliance with all Title X requirements. Responsible for all health center operations, the COO
oversees the program and the VP of Health Center Operations, who serves as the Family
Planning Manager, and co-chairs the Health Center Management Team (HCMT) with the
Medical Director. These staff ensure high-quality services are provided to all Central MA clients
and PPLM works to reach the goals outlined in the Project Work Plan.
a board-certified
OB/GYN, leads PPLMs medical practice and is responsible for clinical care provided at all
PPLM health centers, including the four Title X centers located in Central MA. She advises the
President/CEO, COO, Medical Quality and Patient Service Committee of the Board of Directors,
and works in partnership with the COO to ensure safe, effective, and client-focused medical
services. (b) (4)
provision of Title X services. She also serves as the Director for the colposcopy and LEEP
programs; she supervises and advises the Director of Patient Services who supervises the Health
Services Directors (including the Central MA Title X Health Services Director) regarding the
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Worcester, and Springfield health centers, practicing alongside clinicians and reviewing cases.
(b) (4)
issues, and she performs structured annual clinician observations. (b) (4)
acts as an in-house
consultant to clinicians and is available via phone and email anytime she is not available in
person, with clinical backup from on-call physicians and the Director of Patient Services. She is
responsible for ensuring PPLMs clinical practice guidelines and care are consistent with PPFA
medical standards and guidelines, as well as Title X regulations and guidelines. (b) (4)
leads PPLMs Quality Assurance program, performs direct observation at PPLMs health
centers, and completes periodic chart review. (b) (4)
management of quality efforts, including audits, compliance, and improving clinical practice.
(See Appendix F: Medical Director Job Description).
2008 as a clinician in the Boston Health Center. In 2010, she began work as one of two
Quality Assurance Managers, while continuing to provide clinical services. In June 2013,
(b) (4)
(b) (4)
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Indian Health Service. She received her Masters Degree in Nursing from Yale
University School of Nursing with a specialty in nurse-midwifery.
Services Director at the Central MA Health Center located in Worcester. She has been
employed with PPLM for 25 years and oversees services and Advance Practice Clinicians
at all of PPLMs centers in Central and Western Massachusetts. In conjunction with the
Medical Director, she has clinical oversight for clinical services in both regions. (b) (4)
(b) (4)
brings extensive family planning experience, has continuity with many clients
due to her tenure at PPLM and managed PPLMs previous Massachusetts DPH STD
grant. (See Appendix K: Health Services Director Job Description).
joined
PPLM in January 2012 as the Center Manager for the Central MA Health Center.
Previously, she was the Center Director with Planned Parenthood of the Gulf Coast in
New Orleans and Baton Rouge and as a Family Planning Intern with Marie Stopes
International Pacific.
Fitchburg, Marlborough. Milford Title X health centers and in 2013, she began to oversee
the Title X FPER/FPAR data submission, including screening for accuracy. Prior to
PPLM, (b) (4)
practices for residential group homes, including several independent housing units, for
chronically mentally ill adults. (b) (4)
where she ran two residential programs for adolescent males aged 14 to 22 with dually
diagnosed disorders (mental health and substance abuse).
PPLM
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management, assurance, and evaluation activities. Prior to working at PPLM, (b) (4)
was a RN in Labor and Delivery as well as an OB/GYN practice at Beth Israel Deaconess
Medical Center in Boston. She joined PPLM in March 2009 as a RN in the Boston Health
Center. In 2010, she was hired as an APC and soon assumed a part-time role as one of
two Quality Assurance Managers while working as an APC. In June 2013, (b) (4)
became the full-time Quality Assurance Manager while continuing to practice as an APC.
Central MA Bilingual Parent Educator and Community Outreach Specialist: (b) (4)
(b) (4)
community. She joined PPLM in March 2014, and provides parent education and
community outreach to reach communities that can benefit from family planning
services. She also teaches PPLMs parent education program Lets Be Honest in
English and Spanish and directs outreach to agencies and organizations throughout
Central MA. She presents the Services Overview Training and provides information
about health services, education, and advocacy programs. (b) (4)
previously worked
3.
Personnel Policies
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recruiting and retaining staff that represent PPLMs diverse client base. PPLM participates in a
national Planned Parenthood affiliate applicant-tracking database, (b) (4)
that aids in
recruitment of qualified candidates. In addition, PPLM uses ADP as the organizations Human
Resources Information System (HRIS). PPLM also has a contract with labor attorney, (b) (4)
(b) (4)
employee handbook and personnel policies at least annually and, if law or regulation mandates a
revision outside of the review cycle, makes an immediate adjustment. The employee handbook is
provided electronically to all employees, and all new employees participate in an extensive
orientation program to PPLM. (See Appendix L: PPLM General Personnel Policies).
professional development needs for the whole organization. Opportunities for learning on family
planning regulations and clinical protocols, including Title X, are priorities for staff. PPLM also
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utilizes the resources of the Regional Training Center, John Snow, Inc. (b) (4) in reviewing annual
staff needs, in addition to the wide range of information and resources available through their
website at www.famplan.org.
Clinical staff participate in regular case review to learn from real-life scenarios. On an annual
basis, they also receive updated training on STDs, CPR, and contraceptive methods. In addition,
PPFA and PPLMs insurance and risk management company, (b) (4)
(b) (4)
specifically developed for reproductive health practices. New clinicians undergo a period of
proctoring during which a supervisor monitors the clinicians skills and recommends specific
follow-up trainings. (See Appendix M: Clinician Skills Checklist). Trainings are available for all
checklist items and include a period of observation, supervised practice, and independent work
with chart review. As with all employees, clinicians undergo an annual performance evaluation.
Likewise, HCA training includes a period of observation, supervised practice and independent
work. Required HCA skills are documented in the HCA competency-training checklist. PPLM
has a career ladder for HCAs has been created to provide them with the opportunity to acquire
specific and advanced skills.
PPLM
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credentialing and
PPLMs Boston headquarters. PPLMs Senior Health Center Operations Coordinator tracks
license expirations and notifies the clinician whose license is coming up for renewal in advance
of license expiration. (See Appendix N: Provider Credentialing and Licensing Policy).
E.
PPLM adheres to PPFAs medical protocols, which meet Title X guidelines, to ensure highquality, comprehensive, client-focused care for women, men, and adolescents. Education and
information are provided in an age-appropriate, confidential, non-judgmental manner. Clients
first point of contact when making an appointment at PPLM is often through the Patient Contact
Center where appointments and online appointment requests are centrally handled. The Center is
open six days a week and 40% of the staff is bilingual. Walk-in clients are welcome at all of
PPLMs health centers. Once clients enter the health center, they proceed to the receptionist to
check in for their appointment.
PPLM takes pride in the health center facilities, which are inviting and fully stocked with a
PPLM
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PSC-HHS-000165
PSC-HHS-000166
PSC-HHS-000167
PSC-HHS-000168
Reporting is based on Massachusettss law and was recently updated to include human
trafficking. If indicated, PPLM staff consult with the Health Center Manager or lead clinician,
who files the formal report, at which time the COO is notified. The Massachusetts Department of
Children & Families receives the reports for any suspected abuse and neglect of a minor. The
National Human Trafficking Resource Center is also contacted if human trafficking is suspected
for a minor or an adult. PPLM adheres to state guidelines requiring an oral report be given within
the same day and a written filing within 48 hours. Every staff person is trained on this law at hire
and retrained annually. Copies of reports of suspected negligence or abuse (called 51As in
Massachusetts) are kept on file at PPLM.
Accounting System
and allocates and separates all expenses to cost codes designated as specific to abortion or family
planning/GYN services. PPLM can accurately track all cost center expenses and maintains
separate inventory for abortion and non-abortion services.
PPLMs Board of Directors has two committees (Finance and Audit and Risk Management and
Compliance) that oversee compliance with Section 1008 on behalf of PPLM. Risk Management
and Compliance Committee meets at least three times a year and receives reports on compliance
with PPLMs Title X program requirements. The Finance Committee meets at least quarterly and
reviews the Federal OMB A-133 audit and receives any reports on non-compliance in the Title X
program. The CFO reviews general ledger records monthly with regards to reimbursement and
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PSC-HHS-000170
PSC-HHS-000171
PSC-HHS-000172
and administrative systems are evaluated for necessary updates and changes based on the best
available clinical evidence, advances in systems management theory research, auditing and
monitoring techniques, and regulatory/medical/legal changes. PPLM developed its proprietary
Health Center Log System software to track clients from registration through completion of their
visits, allowing PPLM to set goals for staff efficiency at each point of the client visit. Throughput
time is monitored to establish goals for particular visit types and to ensure that staff are providing
consistent, efficient high-quality care. EHRs are also improving the quality of client care,
enabling clients to be seen at any PPLM health center, facilitating chart review and reporting,
and allowing for the capture of population-based data to improve services and identify trends.
PPLM health centers utilize a collaborative team approach that includes physicians, Advance
Practice Clinicians (NPs, nurse midwives, and PAs), RNs, and other staff who provide medical
services. New staff attend multiple days of orientation and in-service training, referred to as New
Hire Orientation and Jumpstart 1 & 2, as part of their onboarding process. During their
introductory period, staff receive trainings on topics including: Introduction to Title X;
Mandatory Reporting Laws; Human Trafficking; Services to Minors State and Federal Laws;
HIPAA: Protecting Patient Privacy; Medical Records Documentation; Birth Control Methods
and Contraceptive Efficacy including understanding client preference, ease of use and side effect
profile; and STDs.
In addition to this basic training, licensed staff undergo a period of supervised practice. To
ensure ongoing clinical quality, PPLM performs periodic chart audits using both PPLM designed
audits as well as (b) (4)
used by PPFAs (b) (4)
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follow-up, colposcopy, and breast mass referral. PPLM supplements use of the (b) (4)
tool with
PPLM specific audit points determined by the Medical Director, Patient Services Director, and
the Manager of Quality Assurance based on areas identified for improvement of client care. One
of PPLMs goals is to revisit the (b) (4)
G.
Financial Management
1.
PPLM is committed to efficiently and effectively using public funds. PPLM collects fees for
family planning services from third party payers when applicable. PPLM receives reimbursement
for its family planning services by private insurance companies, Medicaid, Medicaid managed
care programs, state subsidized plans, the Massachusetts DPH, and clients.
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PSC-HHS-000175
Cost Analysis
PPLM analyzes cost of service by allocating costs to CPT codes. This includes analyzing the cost
of direct labor based on visit length; direct materials used based on actual usage; and overhead
and malpractice based on the appropriate relative value unit component promulgated by
Medicare. The cost per CPT code is multiplied by the visit volume and compared to the total
health center cost to validate the process. Charges are reviewed annually and updated as needed.
Clients receive a bill for services rendered at the end of their appointment. When considering
charges to minors, the following conditions are taken into account.
If the minor is not emancipated and confidentiality of services is not a concern, the
familys income is considered in determining the charge. If, however, the minor does not
know his/her familys income, PPLM assigns an estimated income to determine charges.
58
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All clients with insurance are counseled that an explanation of benefits from the insurance
company may be sent to the insured. If the client is concerned about confidentiality, s/he is
advised that confidentiality is not assured when using insurance and clients have the option to
self-pay. Clients also sign an insurance waiver acknowledging they may receive a bill for
services if their insurance plan denies their claim for services.
2.
PPLMs Board of Directors annually hires an independent accounting firm to audit PPLMs
financial records as of the June 30 fiscal year-end, in compliance with OMB Circular A-133.
(b) (4)
audit, the auditor reports the results to the Finance and Audit Committee of PPLMs Board. The
most recent A-133 financial audit for PPLM was completed in November 2014, and covers the
time period of July 1, 2013 to June 30, 2014 which encompasses the previous Title X grant
awarded to PPLM. It has been approved by the PPLM Board of Directors on December 2, 2014
and submitted to the Federal Audit Clearinghouse.
3.
which is
designed to meet the many insurance needs of the affiliates. (See Appendix Q: Summary of
Insurance Coverage).
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Upload #4
Applicant:
Application Number:
FPH2015007161
Project Title:
Status:
Awarded
Document Title:
Form Attachments-V1.1.pdf
PSC-HHS-000180
ATTACHMENTS FORM
Instructions: On this form, you will attach the various files that make up your grant application. Please consult with the appropriate
Agency Guidelines for more information about each needed file. Please remember that any files you attach must be in the document format
and named as specified in the Guidelines.
Important: Please attach your files in the proper sequence. See the appropriate Agency Guidelines for details.
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PSC-HHS-000181
(b) (4)
(b) (4)
PSC-HHS-000182
(b) (4)
(b) (4)
(b) (4)
PSC-HHS-000183
PSC-HHS-000184
PSC-HHS-000185
PSC-HHS-000186
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PSC-HHS-000189
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(b) (4)
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PSC-HHS-000193
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PSC-HHS-000194
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PSC-HHS-000195
(b) (4)
(b) (4)
(b) (6)
(b) (6)
(b) (6)
(b) (4)
(b) (6)
(b) (6)
PSC-HHS-000196
(b) (6)
(b) (6)
(b) (6)
(b) (4)
(b) (6)
(b) (4)
(b) (6)
(b) (6)
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PSC-HHS-000197
(b) (4)
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PSC-HHS-000198
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(b) (4)
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PSC-HHS-000199
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(b) (4)
PSC-HHS-000200
(b) (4)
(b) (4)
(b) (6)
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(b) (4)
PSC-HHS-000201
(b) (6)
(b) (6)
(b) (6)
(b) (4)
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PSC-HHS-000202
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PSC-HHS-000203
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PSC-HHS-000204
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PSC-HHS-000205
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(b) (6)
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PSC-HHS-000206
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PSC-HHS-000207
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PSC-HHS-000208
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PSC-HHS-000209
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(b) (4)
PSC-HHS-000215
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PSC-HHS-000218
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