ADHS IGA AMENDMENT.PDF

C-86-18-051-3-02
ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT HEALTH SERVICES
150 North 18 th Avenue, Suite 280
Phoenix, Arizona 85007
(602) 542-1040
Contract No: ADHS18-188819 Amendment No. 1 Procurement Specialist
Bariah Steiner
Ryan White Part B and HIV Prevention - Maricopa
Effective upon signature, it is mutually agreed that the Intergovernmental Agreement referenced is amended as follows:
1. Pursuant to the Terms and Conditions, Section Six (6), Contract Changes, Item 6.1, Amendments, Purchase Orders and Change
Orders, the Agreement is hereby amended to include the following:
1.1. The Price Sheet is revised and replaced with the Price Sheet in this Amendment One (1);
1.2. The Objective, Scope of Work, and Tasks are revised to include the Ryan White Part B funding requirements in this
Amendment One (1); and
1.3. The Agreement is revised to include Exhibit A in this Amendment One (1).
All other provisions of this agreement remain unchanged.
CONTRACTOR SIGNATURE
Maricopa County
Contractor Name Contractor Authorized Signature
4041 N. Central Ave., Suite 1400 Bill Gates
Address Printed Name
Phoenix AZ 85012 Chairman
City State Zip Title
CONTRACTOR ATTORNEY SIGNATURE This Intergovernmental Agreement Amendment shall be effective the
Pursuant to A.R.S. § 11-952, the undersigned public agency attorney date indicated. The Public Agency is hereby cautioned not to commence
has determined that this Intergovernmental Agreement is in proper any billable work or provide any material, service or construction under
form and is within the powers and authority granted under the laws of this IGA until the IGA has been executed by an authorized ADHS
the State of Arizona. signatory.
State of Arizona
Signed this ______ day of _______________________ 2019
Signature Date
Printed Name Procurement Officer
Pursuant to A.R.S. § 11-952 by the undersigned Assistant Attorney
General, 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
Printed Name:
ATTEST:________________________________________________
Office of the Clerk of the Board

INTERGOVERNMENTAL AGREEMENT (IGA) ARIZONA DEPARTMENT OF
HEALTH th SERVICES
AMENDMENT 150 North 18 Avenue, Suite 280
SCOPE OF WORK Phoenix, Arizona 85007
(602) 542-1040
Contract No: ADHS18-188819 Amendment No. 1 Procurement Bariah Steiner Specialist
2. Objective
2.1. The Contract aims to support the end of HIV in Arizona through the funding of authorized Ryan White
services for eligible clients. Key objectives include:
2.1.1. Increased knowledge of HIV status among persons at risk for HIV;
2.1.2. Increased participation in HIV partner services among persons newly diagnosed with HIV;
2.1.3. Increased access to care for persons living with diagnosed HIV infection; and
2.1.4. Improved health outcomes for persons living with diagnosed HIV infection, including achieving viral
suppression.
2.2. County Health Departments may receive funding to fill gaps in surveillance (ADHS Office of Disease
Integration and Services) and activities. These activities must be coordinated and approved by the respective
program. Key objectives include:
2.2.1. Submission of one hundred percent (100%) Office of Disease Integration Services reports within
thirty (30) days of completed activities;
2.2.2. Representation of at least one staff member at any Office of Disease Integration Services trainings;
and
2.2.3. Completion of partner elicitation, location and notifications for at least ninety percent (90%) of all
newly diagnosed clients. Activities must meet Office of Disease Integration Services qualifications.
4. Scope of Work
4.5. SERVICES
The Contractor shall:
4.5.1. Implement one (1) or more service categories as defined by the most current Ryan White Part
B Services Categories, Definitions and Requirements:
4.5.1.1. Services to be delivered shall meet definitions and requirements;
4.5.1.2. Client services, fiscal and programmatic policies must be compliant with:
4.5.1.2.1. HRSA/HAB Part B Program Monitoring, Fiscal and Universal
Monitoring Standards located at: https://hab.hrsa.gov/program-grants-
management/ryan-white-hivaids-program-recipient-resources.
4.5.1.2.2. The most current Arizona Part B Standards of Care posted to
http://azdhs.gov/preparedness/epidemiology-disease-control/disease-
integration-services/inde.xphp#hiv-care-resources-contractors
4.5.2. Develop and maintain policies and procedures, to support the service categories being
proposed for funding; and
4.5.3. Focus the delivery of early intervention services HIV testing on the following target
populations:
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INTERGOVERNMENTAL AGREEMENT (IGA) ARIZONA DEPARTMENT OF
HEALTH th SERVICES
AMENDMENT 150 North 18 Avenue, Suite 280
SCOPE OF WORK Phoenix, Arizona 85007
(602) 542-1040
Contract No: ADHS18-188819 Amendment No. 1 Procurement Bariah Steiner Specialist
4.5.3.1. Men who have Sex with Men (MSM);
4.5.3.2. Latinos of all genders;
4.5.3.3. American Indians of all genders;
4.5.3.4. Transgender Persons and Latino Men who have Sex with Men (MSM),
especially youth; Latinos of all genders; American Indians of all genders;
injection drug users; and
4.5.3.5. Injection Drug Users.
4.6. CULTURAL COMPETENCY
The Contractor shall:
4.6.1 Provide culturally competent services, as defined by compliance with the CLAS
(Culturally and Linguistically Appropriate Services);
4.6.2 Implement organizational policies that comply with the CLAS standards; and
4.6.3 Develop a plan, to be approved by ADHS, for enhancement of cultural competency,
delivery of services and staff training.
5. Tasks
5.23. HIV Case Surveillance:
The Contractor shall:
5.23.1 Conduct HIV Case Surveillance activities in public and private sectors with regard to all persons
newly diagnosed with HIV in Maricopa County. These programs should address all steps of HIV
case surveillance.
5.23.2 Cross-jurisdictional case investigations will be assigned for HIV Surveillance (chart reviews, data
entry) activities to the county in which the client was tested or treated. ADHS Ryan White Part
B/ADAP Partner Services activities will be conducted by the County Health Department in which the
client is resident. This information will be communicated in a timely manner to the resident county
electronically using PRISM and other means.
5.23.3 Report HIV positive test results to ADHS on a monthly basis in the template provided in Exhibit A.
5.23.4 Report HIV negative test results to ADHS on a quarterly basis in the template provided in Exhibit A.
5.23.5 Confirm the diagnosis of each reported case of AIDS or HIV infection in compliance with the most
recent version of the CDC guidelines for HIV Surveillance.
5.23.6 Obtain medical, laboratory and other information to complete the CDC HIV/AIDS Reporting System
(HARS) Confidential Case Report Form in both the adult and pediatric CDC forms as appropriate
and the ADHS HIV/AIDS supplemental report form. Information may be obtained, when necessary
by direct interview with the reported individual. Contractor shall pay particular attention to risk, race,
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INTERGOVERNMENTAL AGREEMENT (IGA) ARIZONA DEPARTMENT OF
HEALTH th SERVICES
AMENDMENT 150 North 18 Avenue, Suite 280
SCOPE OF WORK Phoenix, Arizona 85007
(602) 542-1040
Contract No: ADHS18-188819 Amendment No. 1 Procurement Bariah Steiner Specialist
earliest lab test dates, AIDS-defining conditions and travel outside Arizona. When such information
cannot be obtained, the Case Report shall be so annotated.
5.23.7 Maintain and document an active surveillance system as outlined in the most recent version of the
CDC guidelines for HIV Surveillance and Control.
5.23.8 Complete the HIV Testing History section, which include the data fields: “Date of First Positive,”
“Ever Tested Negative,” “Number of Negative Tests,” “Date of Last Negative,” “Ever Had Previous
Positive Test,” “Ever Taken ARVs,” and “ARV Use Dates”.
5.23.9 Forward completed case reports for ADHS review. Activities shall be summarized in the monthly
statistical reports and at the end of the reporting year. All HIV Case Reports shall be forwarded to
ADHS in envelopes marked “Confidential”.
5.23.10 Maintain documentation of Quality Assurance actions taken and shall include any deficiencies
identified and any corrective action steps taken. This documentation shall be maintained for ADHS
review. Observation by ADHS staff of field activities may occur as part of a site visit review.
5.23.11 Maintain an Active Surveillance System whereby sentinel hospitals, clinics and physicians are
contacted on a regular basis regarding new and/or updated reports of HIV infection. The Contractor
shall be familiar with and be able to explain, as necessary, case reporting procedures, including
Arizona State Law and Arizona Administrative Code requirements, to prospective reporting sources
in the Contractor’s jurisdiction.
5.23.12 Ensure HIV positive individuals to have access to Partner Services staff.
5.23.13 Ensure that Surveillance Staff are culturally sensitive and acceptable to the affected population.
5.23.14 Ensure Surveillance Staff complete cases in a timely fashion within ADHS established timelines.
5.23.15 Have on-going communication with ADHS Ryan White Part B/ADAP staff.
5.23.16 Attend weekly telephonic or in-person meetings with ADHS Ryan White Part B/ADAP staff.
5.24 Testing, Partner Services and Linkage to Care
The Contractor shall:
5.24.1 Ensure that all clients who receive a preliminary positive HIV test performed by MCDPH also receive
a confirmatory test result.
5.24.2 Ensure that all clients who are identified as HIV infected are linked to HIV care within five (5)
business days of confirmatory diagnosis.
5.24.3 Ensure that all clients who are identified as HIV infected be offered partner services, including a
client interview for gathering information about locating and notifying partners of possible exposure
and offering testing.
5.24.4 Provide HIV prevention services for all high risk negative individuals identified. Prevention services
must include providing information regarding pre-exposure prophylaxis (PrEP), eligibility for PrEP,
and PrEP navigator information.
4

INTERGOVERNMENTAL AGREEMENT (IGA) ARIZONA DEPARTMENT OF
HEALTH th SERVICES
AMENDMENT 150 North 18 Avenue, Suite 280
SCOPE OF WORK Phoenix, Arizona 85007
(602) 542-1040
Contract No: ADHS18-188819 Amendment No. 1 Procurement Bariah Steiner Specialist
5.24.5 Distribute condoms/safer sex materials to MCDPH STD Clinic clients and for members of the public
and promote condom use.
5.24.6 Attain a one percent (1%) positivity rate.
5.24.7 Comply with program reporting requirements defined by ADHS.
5.24.8 Submit client-level data using mechanisms specified by ADHS and maintain capacity to implement
client-level data collection and data entry
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INTERGOVERNMENTAL AGREEMENT (IGA) ARIZONA HEALTH DEPARTMENT SERVICES OF
AMENDMENT 150 North 18 th Avenue, Suite 280
PRICE SHEET Phoenix, Arizona 85007
(602) 542-1040
Contract No: ADHS18-188819 Amendment No. 1 Procurement Bariah Steiner Specialist
Price Sheet
Maricopa County Department of Public Health
Ryan White Part B Price Sheet
Cost Reimbursement Line Items Budget Amount
1. Personnel Services – Core $298,800
2. Employee Related Expenses – Core $168,999
3. Personnel Services – Admin $162,200
4. Employee Related Expenses – $ 85,590
Admin
5. Professional & Outside Services $0
6. Travel Expenses 5,500
7. Other Operating Expense $15,054
8. Capital Outlay Expense $0
9. Other (Indirect Costs) $85,257
Total Ryan White Part B Amount $821,400
HIV Prevention Price Sheet
Cost Reimbursement Line Items Budget Amount
1. Personnel Services $0
2. Employee Related Expenses $0
2. Professional & Outside Services $0
3. Travel Expenses $0
4. Other Operating Expense $240,000
5. Capital Outlay Expense $0
6. Other (Indirect Costs) $0
Total HIV Prevention Amount $240,000
Total Budget Amount $1,061,400
ITEMIZED SERVICE BUDGET (ISB) RESTRICTIONS:
With prior written approval from the ADHS Ryan White Part B/ADAP Program Director, the
Contractor is authorized to transfer up to a maximum of ten percent (10%) of the total
Agreement amount among the categorical line items. Transfers of funds are only allowed among
funded line items as detailed in the original ISB. Transfer exceeding ten percent (10%) of the
Agreement amount, or to a non-funded line item, shall require a written Amendment.
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Negative Test Results Quarterly Reporting Variables Exhibit A Pt 1
Client Acct #
Session Date
CDI Assigned
County of Residence
Zip Code of Residence
Birth Year
Ethnicity
Race
Assigned Sex at Birth
State of Residence
Current Gender Identity
Previous HIV Test
Test Election
Specimen Collection Date
Result Provided Test Type
Test Result - Final Determination
Lab-Based Test Result
Heard of PrEP?
Currently Taking Daily PrEP?
Used PrEP in Last 12 Months?
Risk for HIV Infection?
PrEP Education & Readiness Assessment Completed?
Demonstrate a Desire/Ability to take PrEP?
Referral to a PrEP Navigator?
Referral to a PrEP Prescriber?
Tested for Co-Infections?

Syphilis Test?
Syphilis Test Result
Gonorrhea Test?
Gonorrhea Test Result
Chlamydia Test?
Chlamydia Test Result
Hep C Test?
Hep C Test Result
Ever had a Positive HIV Test?
Date of First Positive Test
Sex w/Male in Last 5 Years
Sex w/Female in Last 5 Years
Sex w/Transgender in Last 5 Years
Injected Drugs or Substances in Last 5 Years
Heard of PrEP? Currently Taking Daily PrEP?
Used PrEP in Last 12 Months?
Risk for HIV Infection?
PrEP Education & Readiness Assessment Completed?
Demonstrate a Desire/Ability to take PrEP?
Referral to a PrEP Navigator?
Referral to a PrEP Prescriber?
Health Benefits Navigation and Enrollment Screened Provided/Referred
Evidence-Based Risk Reduction Intervention Screened Provided/Referred
Behavioral Health Services Screened Provided/Referred
Social Services Screened Provided/Referred

Positive Test Results Monthly Reporting Variables Exhibit A Pt 2
Client Acct #
eHARS State Number
eHARS City/County Number
Session Date
CDI Assigned
Birth Year
Ethnicity
Race
State of Residence
Assigned Sex at Birth
Current Gender Identity
County of Residence
Zip Code of Residence
Sex w/Male in Last 5 Years
Sex w/Female in Last 5 Years
Sex w/Transgender in Last 5 Years
Injected Drugs or Substances in Last 5 Years
Previous HIV Test
Test Election
Specimen Collection Date
Result Provided
Test Type
HIV Test Result
Confirmatory Test Result - Final Determination
New or Previous Diagnosis?
Seen a Provider in the Last Six Months for HIV Treatment?
Attend an HIV Medical Care Appointment After Positive Test?
Date of Medical Care Appointment
Ever had a Positive HIV Test?

Date of First Positive HIV Test
Provided Individualized Behavioral Risk-Reduction Counseling?
Contact Information Provided for Partner Services?
Most Severe Housing Status in Last 12 months
Is the Client Pregnant?
In Prenatal Care?
Screened for Need for Perinatal HIV Service Coordination?
Need Perinatal HIV Service Coordination?
Referred for Perinatal HIV Service Coordination?
PRISM Number
Partner Services Interview?
Date of Interview
Tested for Co-Infections?
Syphilis Test?
Syphilis Test Result
Gonorrhea Test?
Gonorrhea Test Result
Chlamydia Test?
Chlamydia Test Result
Hep C Test?
Hep C Test Result
Navigation Services for Linkage to Medical Care
Screened for Need
Provided/Referred Linkage to Medical Care Screened
Provided/Referred Medication Adherence Support Screened
Provided/Referred Health Benefits Navigation and Enrollment Screened
Provided/Referred Evidence-Based Risk Reduction Intervention Screened
Provided/Referred Behavioral Health Services Screened
Provided/Referred Social Services Screened Provided/Referred