IGA2020-042 A1 MARICOPA COUNTY.PDF
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C-86-21-035-X-01 ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18th Ave Suite 530 Phoenix, Arizona 85007 Amendment Contract No.: Procurement Officer IGA Amendment No: 1 IGA2020-042 Felicia Marquez Title V Maternal and Child Health Healthy Arizona Families 1. Pursuant to the Terms and Conditions, Provision 6, Contract Changes, section 6.1, It is mutually agreed that the Intergovernmental Agreement referenced is amended as follows: 1.1. The Contract No. is revised from IGA2020-042 to CTR055260 due to the Contracts being placed back into the Arizona Procurement Portal; 1.2. The Scope of Work is revised and replaced by the Scope of Work of this Amendment One (1); 1.3. The Price Sheet is revised to include the Price Sheet of this Amendment One (1). 1.4. Attachment H - ADHS Family Planning Policy and Procedure Manual, has been removed. 1.5. Exhibit A has been added. (CONTINUED ON NEXT PAGE) All other provisions of this agreement remain unchanged. Maricopa County , through its Department of Public Health Contractor Name: Authorized Signature 4041 N. Central Avenue, #1400 Jack Sellers Address: Print Name Phoenix Arizona 85012 Chairman, Board of Supervisors City State Zip Title Pursuant to A.R.S. § 11-952, the undersigned public agency attorney has This Intergovernmental Agreement Amendment shall be effective the date determined that this Intergovernmental Agreement is in proper form and is indicated. The Public Agency is hereby cautioned not to commence any billable within the powers and authority granted under the laws of Arizona work or provide any material, service or construction under this IGA until the IGA has been executed by an authorized ADHS signatory. State of Arizona Signature Date Signed this day of 2021. Anne Longo, Attorney for County Print Name Procurement Officer Contract No.: CTR055260, which is an Agreement between public agencies, has been reviewed pursuant to A.R.S. § 11-952 by the undersigned Assistant Attorney, who has determined that it is in proper form and is within the powers and authority granted under the laws of the State of Arizona. Signature Date Assistant Attorney General Print Name ATTEST___________________________________________ Office of the Clerk of the Board Date ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18th Ave Suite 530 Amendment Phoenix, Arizona 85007 Contract No.: Procurement Officer IGA Amendment No: 1 IGA2020-042 Felicia Marquez 1. BACKGROUND: 1.1. The vision of the Arizona Department of Health Services (ADHS) is “Health and Wellness for all Arizonans.” The ADHS conducts a five (5) year statewide needs assessment to examine key health indicators and provide a comprehensive overview of the health of Arizonans. ADHS published the 2019 Arizona State Health Assessment which utilizes an evidence-based public health approach to improve the health and wellness of Arizona residents. This assessment informs other federally funded programs within ADHS that also require statewide needs assessments. One (1) of those programs is the Title V Maternal and Child Health Services Block Grant (hereafter Title V MCH Block Grant) located within the Bureau of Women’s and Children’s Health (BWCH); 1.2. The mission of the BWCH is to “strengthen the family and community by promoting and improving the health status of women, infants, and children.” The BWCH administers the federal Title V MCH Block Grant, other federally funded programs, as well as private, and state supported programs; 1.3. BWCH is responsible for the implementation of the Health Resources and Services Administration (HRSA) funded Title V MCH Block Grant. Established in 1935, in Title V of the Social Security Act, the goal of the Title V MCH Block grant is to improve the health and well-being of America’s mothers, children and families including children with special health care needs by supporting and promoting the development and coordination of systems of care for the MCH population, which are family-centered, community based and culturally appropriate. The Title V MCH Block Grant has five (5) population domains which include: Women/Maternal Health, Perinatal/Infant Health, Child Health, Children with Special Health Care Needs, Adolescent Health. The sixth (6th) domain addresses Cross-Cutting and Systems Building; 1.4. The Title V MCH Block Grant also requires that a five (5) year statewide needs assessment be conducted and submitted as one (1) of the grant deliverables. The purpose of the Title V MCH statewide needs assessment is to identify the priority health needs and issues of Arizona’s maternal and child health populations through a collaborative and systematic data collection and analytic process with stakeholder input. This needs assessment process is guided by eight (8) overarching principles and values that include: 1.4.1. Listen to those who are not traditionally involved, 1.4.2. Learn from community members as well as the MCH Community, 1.4.3. Honor and respect the work that others in the community and state have completed to assess the well-being of Arizona residents, 1.4.4. Assess health disparities across communities including racial, socioeconomic and access, 1.4.5. Use a life course development approach and address social determinants of health as a framework for planning, 1.4.6. Recognize that social, political and economic policies and conditions impact health outcomes, 1.4.7. Value the community as a core partner in public health and work to assure the equity in health, and 1.4.8. Plan, develop and evaluate programs and systems of care which are comprehensive, community-based, culturally competent, coordinated and effective. ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18th Ave Suite 530 Amendment Phoenix, Arizona 85007 Contract No.: Procurement Officer IGA Amendment No: 1 IGA2020-042 Felicia Marquez 1.5. The Title V MCH Block Grant uses a three-tiered National Performance Measurement Framework (Attachment A) which includes National Outcome Measures (NOMs), National Performance Measures (NPMs) and state-initiated Evidence-based or informed Strategy Measures (ESMs). The framework provides flexibility to a state in identifying the best combination of measures to address the MCH priority needs that were identified based on the findings of the Five-Year Needs Assessment (available on the ADHS website: https://www.azdhs.gov/prevention/womens- childrens-health/reports-fact-sheets/index.php#title-v). 2. PURPOSE: The purpose of this IGA is to leverage partnerships between ADHS and Local County Health Departments by providing Title V MCH Block Grant funding to support the implementation of health priorities identified through the Arizona Statewide Needs Assessment and MCH statewide needs assessment. This IGA is intended to provide flexibility to the Local County Health Department to meet the needs of local communities through high impact strategies that align with the 2020-2025 MCH health priorities, the identified national performance measures and administrative functions. 3. OBJECTIVES: 3.1. Counties will implement evidence-based/evidence-informed strategies at the local community level that: 3.1.1. Promote and implement evidence-based or evidence-informed strategies that enhance preventive and primary care services for pregnant women, mothers and infants up to age one (1) for the Women/Maternal and Perinatal Infant population domains, 3.1.2. Promote and implement evidence-based or evidence-informed strategies that enhance preventive and primary care services for the Child Health, Adolescent Health and Children with Special Health Care Needs population domains, 3.1.3. Enhance family, youth, and community engagement for all five (5) population domains in the Title V MCH Block Grant including children and families with special health care needs, and 3.1.4. Promote and implement evidence-based or evidence-informed strategies that enhance cross-cutting and system building infrastructure. 4. SCOPE OF WORK: 4.1. Counties can select to implement strategies within population domains and/or in National Performance Measures. 4.1.1. Population domains include: 4.1.1.1. Women/Maternal Health – women ages eighteen (18) to forty-four (44), before, during, and beyond pregnancy; and across the life course; 4.1.1.2. Perinatal/Infant Health – infants during the time surrounding childbirth, particularly three (3) months before and one (1) year after; 4.1.1.3. Child Health – children one (1) to ten (10) years of age; 4.1.1.4. Adolescent Health – young people ages ten (10) to nineteen (19) years of age; ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18th Ave Suite 530 Amendment Phoenix, Arizona 85007 Contract No.: Procurement Officer IGA Amendment No: 1 IGA2020-042 Felicia Marquez 4.1.1.5. Children/Youth with Special Health Care Needs – children/youth with a diverse range of needs ranging from behavioral and emotional conditions to chronic conditions, to more medically complex health issues; 4.1.1.6. Cross-cutting and Systems Building - priority need such as oral health, access to care, injury prevention, etc. that is related to program capacity and/or systems- building as it applies to all/any of the MCH population domains; or 4.1.1.7. Emerging Issues - projects and/or strategies that become prominent and are unique to a particular County, for example, reassignment of staff to address the COVID-19 pandemic or any other public health emergency, conducting focus groups to determine how to improve services for children/youth with special health care needs, etc. 4.1.2. NPMs selected by the State and identified through the findings of a five (5) year needs assessment include: 4.1.2.1. NPM #1 - Well-woman visits - Percent of women, ages eighteen (18) through forty-four (44), with a preventive medical visit in the past year, and family planning services; 4.1.2.2. NPM #4 Breastfeeding – A) Percent of infants who are ever breastfed and B) Percent of infants breastfed exclusively through six (6) months of age; 4.1.2.3. NPM #6 Developmental Screening - Percent of children, ages nine (9) through thirty-five (35) months, who received a developmental screening using a parent- completed screening tool in the past year; 4.1.2.4. NPM #9 Bullying - Percent of adolescents, ages twelve (12) through seventeen (17), who are bullied or who bully others; 4.1.2.5. NPM #10 Adolescent well visits - Percent of adolescents, ages twelve (12) through seventeen (17), with a preventive medical visit in the past year; 4.1.2.6. NPM #12 Transition - Percent of adolescents with and without special health care needs, ages twelve (12) through seventeen (17), who received services necessary to make transitions to adult health care; and 4.1.2.7. NPM #13 Preventive dental visits for pregnant women, children and adolescents - A) Percent of women who had a dental visit during pregnancy; and B) Percent of children, ages one (1) through seventeen (17), who had a preventive dental visit in the past year. 4.1.3. If strategies selected by the Counties do not align with the State selected NPMs listed above, BWCH in partnership with Counties will develop State Performance Measures (SPMs) as needed to measure priority needs that have not been addressed through the selected NPMs, and 4.1.4. Counties may elect to provide Family Planning Services which would qualify under NPM #1 and the Women/Maternal Health population domain: 4.1.4.1. Implement a clinic based reproductive health program which enhances maternal and child health; ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18th Ave Suite 530 Amendment Phoenix, Arizona 85007 Contract No.: Procurement Officer IGA Amendment No: 1 IGA2020-042 Felicia Marquez 4.1.4.2. Provide accessible, comprehensive education, screening and contraceptive services to underserved individuals of reproductive age; and 4.1.4.3. Adhere to the ADHS Family Planning Policy and Procedure Manual (available on the ADHS website:https://www.azdhs.gov/prevention/womens-childrens- health/womens-health/index.php#family-planning). 4.2. This IGA offers a variety of evidence-based and evidence-based informed strategies designed to promote and positively impact the health status and outcomes of the MCH population in Arizona. Contingent upon available funding, Local County Health Departments are expected to implement at multiple levels, in accordance with local community needs infrastructure activities that integrate and build on each other to optimize the health improvements of the community. Counties have the option to select from a menu of evidence-based/evidence-informed strategies (Attachment B) or to propose their own evidence-based/evidence informed strategies that are identified as a need in their communities; 4.3. MCH has created Skill Sets in each of the NPMs to support implementation and further assist with thinking not only about evidence and strategies to make change but the capacity of the workforce to carry out activities (Attachment B); and 4.4. Where applicable, strategies shall be inclusive of children with special health care needs. Though counties are not required to implement strategies to specifically target this population, strategies designed for children, adolescents, and families assume an integrated approach that includes this population. 5. EVALUATION: 5.1. Performance measures and evaluations allow the counties and ADHS to collaboratively track progress, process indicators, outcomes measures, and impacts. As part of the local evaluation plan, the counties will be responsible for measuring the short term, and intermediate outcomes. Monitoring progress on short-term outcomes provides an opportunity for the counties to make adjustments to strategies to ensure increased long-term impact. ADHS in coordination with the counties will be responsible for measuring the long-term and impact outcomes. Process indicators, outcomes measures, and impacts must clearly relate to the selected strategies and activities identified within each County’s Annual Action Plan; and 5.2. ADHS will provide technical support to counties on selecting the appropriate indicators to measure process and outcomes as they align with the new Title V MCH Priorities and Performance Metrics. 6. APPROVALS: 6.1. The quarterly reports, annual action plans, annual budget workbook, and monthly CERs with receipts supporting expenses billed for in-state and out-of-state travel and equipment purchases of $250 or more, as required and/or requested shall be approved by ADHS prior to payment reimbursement; 6.2. Upon approval of the Action Plan, any changes to the approved activities, or strategies must be resubmitted to ADHS for review and approval prior to implementation; 6.3. Any requests to provide additional information on quarterly reports will require resubmission of the report for ADHS review and approval prior to payment reimbursement; ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18th Ave Suite 530 Amendment Phoenix, Arizona 85007 Contract No.: Procurement Officer IGA Amendment No: 1 IGA2020-042 Felicia Marquez 6.4. Purchases of Capital Equipment (single item purchase of $5,000 or more) will require approval prior to purchasing; 6.5. All marketing materials (the use of ADHS logo, brochures, posters, public service announcements, paid media, videos, etc.) which have been developed, written, published, or recorded by the Counties and paid for with funds from this award must be first approved by ADHS prior to the dissemination of such materials or airing or use of such announcements; 6.6. All County local emerging issues and related supporting documentation must be approved by ADHS prior to implementation; 6.7. Any evaluation or study to be conducted that involves human subjects must be approved by ADHS prior to conducting; and 6.8. Request approval in writing to the MCH HAF IGA Program Manager for purchases of single items of capital equipment at or above the purchase price of five thousand dollars ($5,000.00); 6.8.1. Requests can be made via email and shall include the following information: 6.8.2. Type of equipment requesting to be purchased, 6.8.3. Cost of equipment, and 6.8.4. How the proposed purchase supports the current approved scope of work and annual action plan. 7. TASKS: 7.1. The Local County Health Department Contractor shall for the overall IGA: 7.1.1. Develop and submit an Annual Budget Workbook due January 15th of each year for the following year’s budget period, including the federally approved indirect rate letter, 7.1.2. Develop and implement an Annual Action Plan within the first forty-five (45) days of each budget period, 7.1.3. Implement the selected approved evidence-based and/or evidence-informed strategies outlined in County Action Plans, 7.1.4. Participate in all calls (monthly, bi-monthly, quarterly), technical assistance calls, webinars, meetings, and training, and 7.1.5. Participate in the development of a shared comprehensive evaluation plan and report out on any performance measures related to the implementation of their activities (process and/or intermediate), or as defined by the funding sources. 7.2. Complete tagging and inventory of equipment in compliance with the policy in the State of Arizona Accounting Manual, https://gao.az.gov/sites/default/files/2535%20Stewardship%20190304.pdf; 7.2.1. Submit documents to the MCH HAF Program Manager pertaining to the asset, i.e., receiving papers, invoice, purchase order, receipt, etc., and 7.2.2. Documents shall include the make, model, serial number, and acquisition date of the asset. ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18th Ave Suite 530 Amendment Phoenix, Arizona 85007 Contract No.: Procurement Officer IGA Amendment No: 1 IGA2020-042 Felicia Marquez 7.3. All out-of-state travel shall follow the travel and per diem policies as outlined in the State of Arizona Accounting Manual; 7.3.1. https://gao.az.gov/sites/default/files/5009%20Traveler%20Responsibilities%20Draft%2020 0113.pdf, and 7.3.2. https://gao.az.gov/sites/default/files/5095%20Reimbursement%20Rates%20%20190102% 20a.pdf. 7.4. Food purchases for events are an allowable cost under this grant. Food costs less than $500 per event and cumulative cost less than $5,000 annually do not require prior approval when spent within the State of Arizona Accounting Manual policies; 7.4.1. When food costs exceed the allowable thresholds set forth in the IGA, requests to purchase food shall be required by completing the Request for Purchase of Food form (Attachment F) and submitting to the MCH HAF Program Manager, 7.4.1.1. Requests shall be submitted ten (10) business days prior to needing to purchase food items; 7.4.1.2. Blanket food approval requests can be submitted for approval if multiple events, of the same nature, are reoccurring. The request shall indicate the number of events that will be held during the year and number of people attending; and 7.4.1.3. No food shall be purchased or reimbursed until the form has been approved and signed by the MCH HAF Program Manager. 7.4.2. Purchases shall follow the Food and Beverages policy outlined in the State of Arizona Accounting Manual, https://gao.az.gov/sites/default/files/8010%20Food%20and%20Beverages%20at%20Stat e-sponsored%20Events%20181113.pdf, which includes but is not limited to: 7.4.2.1. Food provided must not exceed the allowable ADHS per person, per diem meal rates. 7.4.3. Justification for providing food at events requires but is not limited to: 7.4.3.1. How providing food serves a valid public purpose and does not violate the “gift clause”, 7.4.3.2. Is an integral part of the function, and 7.4.3.3. Benefits to the community. 7.4.4. A speaker/presentation during the time the meal is provided is required, and 7.4.5. Food provided should be healthy items. Please see the ADHS Healthy Meeting Policy for further guidance on nutritional guidelines for events/meetings: https://azdhs.gov/documents/prevention/nutrition-physical-activity/healthy-meeting policy.pdf. 7.5. Comply with all federal reporting requirements; ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18th Ave Suite 530 Amendment Phoenix, Arizona 85007 Contract No.: Procurement Officer IGA Amendment No: 1 IGA2020-042 Felicia Marquez 7.6. At least one (1) Program Manager or coordinator from each of the MCH HAF IGA programs must be in attendance at the Annual HPHC/MCH HAF IGA Summit; 7.7. Counties implementing Family Planning Programs with MCH HAF IGA funding shall abide by all standards and protocols outlined in the Family Planning Policies & Procedures manual (Available here:https://www.azdhs.gov/prevention/womens-childrens-health/womens- health/index.php#family-planning); and 7.8. County program staff implementing strategies in this IGA will be required to participate in a one- time MCH HAF IGA orientation webinar, date to be determined. 7.9. ADHS will provide: 7.9.1. Review, feedback, and approval of the Annual Action Plan(s) within thirty (30) days of submitting, 7.9.2. Review, feedback, and approval of the annual Budgets Workbooks, CERs and Supporting Documentation within thirty (30) days of submission, 7.9.3. Feedback, technical assistance, and training to support the approved Annual Action Plan(s), Annual Budget, Quarterly Reporting, and Supporting Documentation, 7.9.4. Samples of evidence-based and/or evidence-informed strategies and supporting resources, 7.9.5. A Quarterly Reporting template upon execution of the IGA, 7.9.6. The Annual Action Plan template upon execution of the IGA, 7.9.7. Annual Budget Workbook and CER templates upon execution of the IGA, 7.9.8. Outcome Measures and examples of process, or intermediate performance measures, as needed, 7.9.9. Access to virtual technical assistance and guidance from ADHS staff, Local County Health Department peers/mentors, and subject matter experts related to the strategies for which the County has received funding, and 7.9.10. Coordinate and conduct annual Contractor site visits. 8. STATE PROVIDED ITEMS: 8.1. Attachment A – Maternal and Child Health National Performance Measures Framework; 8.2. Attachment B – Evidence-Based/Evidence-Informed Strategies for MCH Domains; 8.3. Attachment C – Contractor Expenditure Report (CER); 8.4. Attachment D – Financial Supporting Documentation; 8.5. Attachment E – Line Item Budget Move Request; 8.6. Attachment F – Request for Purchase of Food; ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18th Ave Suite 530 Amendment Phoenix, Arizona 85007 Contract No.: Procurement Officer IGA Amendment No: 1 IGA2020-042 Felicia Marquez 8.7. Attachment G – Emerging Issues Approval Process; 8.8. Upon execution of IGA: 8.8.1. Action Plan Template, 8.8.2. Quarterly Report Template, 8.8.3. Contractor Expenditure Report (CER) template, and 8.8.4. Budget Workbook Template. 9. Restrictions: 9.1. Funds cannot be used for any of the following: 9.1.1. Lobbying activities, including the preparation, distribution, or use of any kit, pamphlet, booklet, publication, electronic communication, radio, television, or video presentation designed to support or defeat any proposed or pending regulation, administrative action, or order issued by the executive branch of any State or local government, 9.1.2. Inpatient services, other than inpatient services provided to children with special health care needs or to high-risk pregnancy women and infants and such other inpatient services approved by the Secretary of the Department of Health and Human Services (DHHS), 9.1.3. Cash payments to intended service recipients of health services, 9.1.4. The purchase or improvements of land; the purchase, construction or permanent improvement (other than minor remodeling) of any building or other facility; or the purchase of major medical equipment – unless the ADHS has obtained a waiver from the Secretary of DHHS, 9.1.5. Satisfying any requirements for the expenditure of non-federal funds as a condition for the receipt of federal funds, 9.1.6. Providing funds for research or training to any entity other than a public or non-profit private entity, and 9.1.7. Payment for any item of service (other than an emergency item or service) furnished by or at the medical direction or prescription of an ineligible or uncertified individual or entity. 10. Deliverables: 10.1. Annual Action Plan within the first forty-five (45) days of each budget period; 10.2. Contractor Expenditure Report (CER) to ADHS, due thirty (30) days following each month of services. 10.2.1. Receipts supporting expenses billed for any in-state/out-of-state travel and equipment purchases of $250 or more are to also be submitted, and ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18th Ave Suite 530 Amendment Phoenix, Arizona 85007 Contract No.: Procurement Officer IGA Amendment No: 1 IGA2020-042 Felicia Marquez 10.2.2. Upon request from ADHS, all receipts supporting expenses billed for a selected CER shall be submitted for review. 10.3. Written Quarterly Reports, due thirty (30) days after each quarter end (Q1: July – September; Q2: October – December; Q3: January – March; and Q4: April – June); 10.4. A final CER invoice no later than forty-five (45) days following the end of each contract year; 10.5. Annual Budget Workbook due by January 15th, for the next year’s fiscal period; 10.6. Annual Report forty-five (45) days following the end of each Contract year; and 10.7. Family Planning Programs funded through this IGA will submit monthly data into the Family Planning Database as outlined in the policies and procedures manual. 10.8. Submit monthly CERs (Attachment C) and maintain sufficient documentation in the form of receipts in support of expenses incurred for any purchases that are being claimed for reimbursement or applied as match dollars to a budget (Attachment D), 10.8.1. Supporting documentation shall be kept by the Contractor and does NOT need to be submitted with quarterly CERs with the exception of travel documentation (in-state and out-of-state) and single purchases of equipment exceeding $250, and 10.8.2. Documentation supporting all expenses being billed shall be provided as requested by ADHS. 10.9. Provide the MCH HAF Program Manager with contact information of all program staff funded under this IGA within thirty (30) days of IGA execution to include: 10.9.1. Name, title, email address and phone numbers, 10.9.2. Staff Resumes, and 10.9.3. Program area assigned. 10.10. Submit the MCH HAF Program Manager of all staffing and programmatic changes within fifteen (15) days providing information outlined in 10.8; 10.11. Request to transfer budget amounts between line items, exceeding twenty-five percent (25%) of total annual budget or to a non-funded line item, will require a revised budget be submitted to the MCH HAF Program Manager and a IGA amendment issued by ADHS Procurement; and 10.12. Submit brochures, posters, public service announcements, paid media, videos, sponsorships, etc., to be paid for with funds from this IGA prior to development and use. 11. NOTICES, CORRESPONDENCE, REPORTS, AND INVOICES: 11.1. Notices, correspondence, reports, supporting documentation, and invoices/CERs from the County contractors to ADHS shall be sent to: Alison Lucas MCH HAF Program Manager Arizona Department of Health Services ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18th Ave Suite 530 Amendment Phoenix, Arizona 85007 Contract No.: Procurement Officer IGA Amendment No: 1 IGA2020-042 Felicia Marquez 150 N. 18th Avenue Phoenix, AZ 85007-3242 Email: alison.lucas@azdhs.gov 11.2. Notices, Correspondence, Reports and Payments from ADHS to the Contractor shall be sent to: Contractor Maricopa County Attention Cheryl Bucalo Address 4041 N. central Avenue, #1400 City, State, ZIP Phoenix, Arizona 85012 Phone Fax Email CHERYL.BUCALO@maricopa.gov ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18th Ave Suite 530 Amendment Phoenix, Arizona 85007 Contract No.: Procurement Officer IGA Amendment No: 1 IGA2020-042 Felicia Marquez PRICE SHEET Maricopa County Department of Public Health MCH Healthy Arizona Families IGA Cost-Reimbursement Price Sheet FY22 ACCOUNT CLASSIFICATION LINE ITEM TOTALS $234,630.00 PERSONNEL EXPENSES $101,149.00 EMPLOYEE RELATED EXPENSES $15,000.00 PROFESSIONAL & OUTSIDE SERVICES EXPENSES $2,003.00 TRAVEL EXPENSES $7,411.00 OCCUPANCY EXPENSES $5,094.00 OTHER OPERATING EXPENSES $0.00 CAPITAL OUTLAY EXPENSES $68,674.00 INDIRECT COST EXPENSES (IF AUTHORIZED) TOTAL $433,961.00 The Contractor is authorized to transfer up to a maximum of twenty-five percent (25%) of the total budget amount between line items. Transfers exceeding twenty-five percent (25%) or to a non-funded line item shall require an amendment. 12 ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18th Ave Suite 530 Amendment Phoenix, Arizona 85007 Contract No.: Procurement Officer IGA Amendment No: 1 IGA2020-042 Felicia Marquez EXHIBIT A - 2 CFR 200.332 § 200.332 Requirements for pass-through entities. All pass-through entities must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass- through entity must provide the best information available to describe the Federal award and subaward. Prime Awardee: Arizona Department of Health Services DUNS # 804745420 Federal Award Identification (Grant Number): 1 B04MC40117‐01‐00 Subrecipient name (which must match the name associated with its unique entity identifier): Maricopa County Subrecipient's unique entity identifier (DUNS #): 602062515 Federal Award Identification Number (FAIN, sometimes it’s the same as the Grant Number): B0440117 Federal Award Date (see the definition of Federal award date in § 200.1 of this part) of award to the recipient by the Federal agency; 03/08/2021 Subaward Period of Performance Start and End Date; 07/01/2020-06/30/2025 Subaward Budget Period Start and End Date: 07/01/2021-06/30/2022 Amount of Federal Funds Obligated by this action by the pass- through entity to the subrecipient (this is normally the contract amount): $254,915.67 Total Amount of Federal Funds Obligated to the subrecipient by the pass-through entity including the current financial obligation (how much is available for contracts): $5,570,064.00 Total Amount of the Federal Award committed to the subrecipient by the pass-through entity $433,961.00 Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act (FFATA) Maternal and Child Health Services 13 ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18th Ave Suite 530 Amendment Phoenix, Arizona 85007 Contract No.: Procurement Officer IGA Amendment No: 1 IGA2020-042 Felicia Marquez Name of Federal awarding agency, pass-through entity, and contact information for awarding official of the Pass-through entity Health Resources and Services Administration Assistance Listings number and Title; the pass-through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of 93.994 - Maternal and Child Health Services Block disbursement: Grant to the States Identification of whether the award is R&D No Indirect cost rate for the Federal award (including if the de minimis rate is charged) per § 200.414 14