HIV SURV ADHS AMENDMENT (10).PDF

Maricopa County — Formal (2019-02-27)

Extracted text (via pymupdf_layout) 57481 characters

C-86-13-003-3-10
ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 18th Ave. North
Suite 260
Phoenix, Arizona 85007
(602) 542-1040
Contract No: ADHS17-141746 Amendment No. 3 Procurement Specialist
Bariah Steiner
HIV SURVEILLANCE PROGRAM
Effective upon signature, it is mutually agreed that the Intergovernmental Agreement referenced is amended as follows:
1. Pursuant to Terms and Conditions, Provision Six (6), Contract Changes, Item 6.1, Amendments, Purchase Orders and Change Orders, the Contract
is hereby amended as follows:
1.1. The Scope of Work is amended to include the additional Scope of Work for the Ryan White Part B (RWPB) Services, as detailed by the Health
Resources and Services Administration (HRSA) funding requirements
1.2. The Price Sheet is amended to include the RWPB Services Yearly Budget Cost Reimbursement.
Budget period January 1, 2019 through December 31, 2019
All other provisions of this agreement remain unchanged.
CONTRACTOR SIGNATURE
MARICOPA COUNTY BY AND THROUGH ITS
MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH
Contractor Name Contractor Authorized Signature
4041 N. CENTRAL, SUITE 1400 Bill Gates
Address Printed Name
PHOENIX AZ 85012 Chairman, Board of Supervisors
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 _______________________ 201__
Signature Date
Printed Name Attorney for County Procurement Officer
RESERVED FOR USE BY THE SECRETARY OF STATE
Attorney General Contract No. ADHS17-141746, which is an
Agreement between public agencies, has been reviewed 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
3. Scope of Service
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 HEALTH W. Adams, SERVICES Room 303
AMENDMENT Phoenix, Arizona 85007
SCOPE OF WORK (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS17-141746 Amendment No. 3 Procurement Bariah Steiner Specialist
The Contractor shall:
3.1. Conduct HIV Case Surveillance activities in accordance with the most recent guidelines from CDC
(www.cdc.gov).
3.2. Implement one (1) or more service categories as defined in Exhibit 10, Ryan White Part B Services
Categories, Definitions and Requirements.
3.3. Client services, fiscal and programmatic policies must be compliant with:
3.3.1. HRSA/HIV Aids Bureau (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; and
3.3.2. The most current Arizona Part B Standards of Care posted to
http://azdhs.gov/preparedness/epidemiology-disease-control/disease-integration-
services/index.php#hiv-care-resources-contractors.
3.4. Develop and maintain policies and procedures, to support the Early Intervention Services.
4. Cultural Competency
The Contractor shall:
4.1. Provide culturally competent services, as defined by compliance with the Culturally and Linguistically
Appropriate Services (CLAS) found in Exhibit 4;
4.2. Implement organizational policies that comply with the CLAS standards; and
4.3. Develop a plan, to be approved by ADHS, for enhancement of cultural competency, delivery of services and
staff training.
5. Ryan White Part B Contract Monitoring
5.1. The Program will monitor compliance with and performance under the Terms and Conditions of this
Contract. This includes on-site visits for Contract compliance. There will be at least one (1) scheduled site
visit during each grant year. These visits may be made by the Program at any time during the Contractor’s
normal business hours, announced or unannounced.
5.2. The Contractor shall make available by inspection, and/or by copying, all records and accounts relating to
the work performed or the services provided under this Contract, or for similar work and/or service provided
under other grants, agreements and contracts. The Contractor shall have policies and procedures in place
that allow ADHS, as the funding agency, prompt and full access to financial, programmatic, and records and
documents, as needed, for program and fiscal monitoring and oversight.
5.3. Contractor shall follow and comply with all related corrective action plans and requirements of site visits and
subsequent audits conducted by the Program and its representatives. When monetary penalties are
imposed or unallowable costs determined, the Program will define how repayment will be made to ADHS.
This may include decreasing or withholding the Contractor’s monthly billing or requiring payment to ADHS;
5.4. The Contractor shall submit reports to Program as requested that detail performance and allow review of
budget, cost of services, unit cost methodology and performance outcomes; and
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 HEALTH W. Adams, SERVICES Room 303
AMENDMENT Phoenix, Arizona 85007
SCOPE OF WORK (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS17-141746 Amendment No. 3 Procurement Bariah Steiner Specialist
5.5. At least one (1) Contractor staff member identified as Key Personnel will attend the entirety of all scheduled
Sub-Recipient Monitoring calls.
6. Audit Disallowances
6.1. The Contractor shall, upon written notice, reimburse ADHS for any payments made under this Contract,
which are disallowed, by a Federal or State audit in the amount of the disallowance, as well as court costs
and attorney fees which ADHS incurs to pursue legal action relating to such a disallowance;
6.2. If at any time it is determined by ADHS that a cost for which payment has been made is a disallowed cost,
the Program shall notify the Contractor in writing of the disallowance and the required course of action,
which shall be at the option of the Program either to adjust any future claim submitted by the Contractor by
the amount of the disallowance or to require repayment of the disallowed amount by the Contractor;
6.3. The Contractor shall be responsible for repayment of any and all applicable audit exceptions, which may be
identified by State and Federal auditors of their designated representatives, and reviewed by the
Contractor. The Contractor will be billed by ADHS for the amount of said audit disallowance and shall
promptly repay such audit disallowance within sixty (60) days of said billing.
7. Restrictions on Use of Funds
7.1. The Contractor may not utilize funds made available under this Contract to make payments for any item or
service to the extent that payment has been made, or can reasonably be expected to be made, with respect
to that item or service;
7.1.1. Under any State compensation program, under any insurance policy, or under any Federal, State,
or county health benefits program; or
7.1.2. By an entity that provides health services on a prepaid basis.
7.2. Funds may not be used to purchase or improve (other than minor remodeling) any building or other facility,
or to make cash payments to intended recipients of services as referenced in the Arizona Revised Statutes
(ARS) A.R.S. § 41-2591, R2-7-701 and Code of Federal Regulations, Chapter 1, Subchapter e., Part 31,
and Public Health Service Grants Policy Statement.
7.3. Ryan White funds may only support HIV-related needs of eligible individuals. All activities and expenditures
must reflect an explicit connection between any service supported with Ryan White Act funds and the
intended recipient’s HIV status. The documentation that a service is HIV-related must be made by a medical
provider, must be maintained in the eligible individual’s medical record or in the Ryan White Part B
CAREWare database administered by the Program.
7.4. Contractor is not authorized to provide services anonymously. All services must only be provided to
documented eligible clients as defined in this contract.
7.5. Ryan White funds may not be used to finance the services of lobbyists, fundraisers or grant/proposal
writers, nor to support lobbying, fundraising activities and/or the writing of grant/contract proposals. The
Contractor must have personnel policies and an employee orientation manual that include regulations that
forbid using federal funds to lobby Congress or other Federal personnel.
7.6. The Ryan White Act limits the administrative expenses to not more than ten percent (10%) of the total grant
award. Requests for additional administrative funds may be submitted to the Program, along with support
documents for the administrative costs. The Act defines allowable “administrative activities” to include:
7.6.1. Usual and recognized overhead, including established indirect rates for agencies;
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 HEALTH W. Adams, SERVICES Room 303
AMENDMENT Phoenix, Arizona 85007
SCOPE OF WORK (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS17-141746 Amendment No. 3 Procurement Bariah Steiner Specialist
7.6.2. Management and oversight of specific programs funded under this title; and
7.6.3. Other types of program support such as quality assurance, quality control, and related activities.
8. Staff
8.1. Employ direct service staff who meet the personnel qualifications outlined in the applicable standards of
care published to www.azdhs.gov/preparedness/epidemiology-disease-control/disease-integration-
services/index.php#hiv-care-resources-contractors.
8.2. Notify the Program of staff changes monthly;
8.3. Submit resumes for all new staff to the Ryan White Part B/ADAP Program Director;
8.4. Provide appropriate training for staff conducting direct client services paid for by the Contract.
8.5. All staff shall participate in and complete all training mandated by the Ryan White Part B/ADAP Program
Director. All staff must complete confidentiality or security training annually.
8.6. All mandatory meetings, trainings and/or conferences hosted by the ADHS Ryan White Part B must be
attended by the requested number of staff unless an exemption has been obtained by the Ryan White Part
B/ADAP Program Director in advance. Participating staff are expected to stay for the full duration of the
training or conference unless prior approval has been granted by the Ryan White Part B/Aids Disease
Assistance Program (ADAP) Program Director.
9. Points of Contact
9.1. Dedicate a Project Manager who shall be the primary contact person for the ADHS in discussing work that
needs to be completed. The Contractor shall provide a detailed description of the Project Manager’s
function and how they will accomplish the minimum tasks listed. The Contractor’s Project Manager shall at
a minimum:
9.1.1. Serve as a primary day-to-day contact with the Agency;
9.1.2. Attend, lead, and prepare materials for meetings as requested;
9.1.3. Ensure all necessary operational components are completed;
9.1.4. Troubleshoot and correct problems;
9.1.5. Designate an alternative contact for when the Project Manager is unavailable; and
9.1.6. Assure that the Contractor, as well as any subcontractors, fulfills its duties and responsibilities
under this Contract, and delivers required documents to the ADHS.
9.2. Identify and maintain a Fiscal Contact responsible for ensuring that all Federal and State standards are met
in the record keeping and billing of this program.
9.3. Provide updated contact sheets identifying key contacts for Program Management, Fiscal, ADAP and
Quality Improvement notifications and requests. The updated contact sheets shall be completed on an
annual basis and within thirty (30) days of staff changes.
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 HEALTH W. Adams, SERVICES Room 303
AMENDMENT Phoenix, Arizona 85007
SCOPE OF WORK (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS17-141746 Amendment No. 3 Procurement Bariah Steiner Specialist
9.4. All Contractor programmatic and fiscal communication with ADHS shall be through the Ryan White Part
B/ADAP Program Director or a designee(s) chosen in writing by the Ryan White Part B/ADAP Program
Director and communicated in writing to the Contractor.
10. Clinical Quality Improvement
10.1. The Contractor shall participate in up to two (2) annual, data-driven, quality improvement projects when
requested by the Program. This may include agency specific or multi-agency projects. Participation may
include, but is not limited to, training and implementation of the Plan Do Study Act (PDSA) model,
monitoring, data reporting, and collection of client input.
10.2. The Contractor will use and adhere to the most current Standards of Care for all service categories for
which they are funded. Standards of Care are posted to http://azdhs.gov/preparedness/epidemiology-
disease-control/disease-integration-services/index.php#hiv-care-resources-contractors.
10.3. The Release of Information included in the standard Ryan White application includes client consent to
report client data to County, State, and Federal authorized entities and to view their records as a part of site
visits and quality management review activities.
10.4. The Contractor shall participate in all mandatory Quality Management trainings.
10.5. When requested, Contractor shall participate with a Consumer Satisfaction Survey or Needs Assessments.
11. Data and Information Systems
11.1. The Contractor shall submit Client level data entry to the designated data system (CAREWare) within five
(5) days after the activity. The Contractor shall have staff directly enter Client level data into CAREWare if
other data entry or data upload methods are unavailable.
11.2. CAREWare is used for client level data reporting and monthly billing reports, demographic reports, and
various custom reporting. The Contractor agrees to install, collect, and report all data requested by the
Program via Ryan White Part B CAREWare within thirty (30) days of request by the RWPB. The Contractor
agrees to participate in technical assistance training and/or informational presentations for CAREWare at
various times scheduled during the contract year, as required by the Program;
11.3. The Contractor is responsible for coordinating the installation of the CAREWare software with their internal
information technology staff. CAREWare software is developed by HRSA and requires no licensing fees.
Instructions will be provided by the Program;
11.4. The Contractor shall complete timely review of annual Ryan White Program Services Report (RSR), as
outlined at https://careacttarget.org/category/topics/ryan-white-services-report-rsr. Activities include, but are
not limited to, review of reports, chart reviews to identify missing client data and reporting results. The
Program will provide technical assistance as needed;
11.5. Complete monthly RSR Readiness Reports to ensure data required for RSR reporting is up to date. RSR
Readiness Reports shall include a list of all Ryan White Part B/ADAP clients served in the month by the
Contractor.
11.6. All services provided to eligible Ryan White clients shall be entered into the CAREWare system as a service
in the client’s electronic file. Services shall include the date the service was provided, the service category,
quantity of units, a note describing the service encounter, and the staff member completing the service; and
11.7. ADHS may provide technical assistance to eligible applicants for the implementation, configuration and end
user support for the CAREWare database. In addition, technical assistance is made available to eligible
applicants to integrate CAREWare with proprietary in-house billing systems on an as needed basis to
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 HEALTH W. Adams, SERVICES Room 303
AMENDMENT Phoenix, Arizona 85007
SCOPE OF WORK (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS17-141746 Amendment No. 3 Procurement Bariah Steiner Specialist
minimize data entry efforts needed to report client level demographic and service related data. Utilization of
proprietary in-house billing systems, client databases, and electronic medical records does not replace
required CAREWare data entry and all required Client level data must be entered into CAREWare either by
export or by direct data entry. If a client data export is not working the data must be directly entered into
CAREWare by the Contractor.
12. Use of Subcontractors
12.1. The use of subcontractors and/or consultants for Ryan White Part B funded activities shall be pre-approved
by ADHS Procurement and the Program.
13. Program Marketing Initiatives
13.1. If Contractor markets program services marketing initiatives must promote/incorporate the following
components: Services available, venues/locations, and hours of operation. The Contractor is responsible for
ensuring informed client choice in healthcare program enrollment through the comprehensive and accurate
explanation of all programs available to the client;
13.2. The content of any and all advertising for these services shall be in a format allowed by Local, State and
Federal regulations and shall contain the funding language referenced in this Contract section; and
13.3. Contractor is responsible to ensure that all appropriate program descriptions, including hours and locations,
and any changes related to these services are disseminated to the community and other Ryan White
providers to ensure that clients have access to care. The Contractor shall be able to document and explain
this communication process to the Program upon request.
14. Material Review Acceptance
14.1. The Contractor shall ensure that all materials developed or utilized by the Contractor’s program are
approved by the ADHS prior to use;
14.2. All written materials, websites/internet materials, audiovisual materials, pictorials, questionnaires, survey
instruments, proposed group educational sessions, educational curricula and like materials must be
reviewed and approved by ADHS prior to being put into use. ADHS has established principles on content
for HIV/AIDS materials (see Guidelines for Content below), and requires approval of all applicable materials
prior to their distribution and use in any activities funded in any part with Ryan White funds;
14.3. Guidelines for Content:
14.3.1. Written materials (e.g., pamphlets, brochures, fliers), audiovisual materials (e.g., motion pictures
and video tapes), and pictorials (e.g., posters and similar educational materials using
photographs, or paintings) shall use terms, descriptors, or displays appropriate for the intended
audience to understand;
14.3.2. All materials shall either directly contain a health promotion message, an HIV prevention
message, or inform about functions or events that ultimately promote the same. For example, a
poster advertising a workshop does not need to have a health promotion message as long as the
workshop does;
14.3.3. Materials shall NOT educate on or promote either sexual activity or intravenous substance abuse;
14.3.4. Materials shall not be obscene. ADHS retains the right to define what is obscene on a case by
case basis;
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 HEALTH W. Adams, SERVICES Room 303
AMENDMENT Phoenix, Arizona 85007
SCOPE OF WORK (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS17-141746 Amendment No. 3 Procurement Bariah Steiner Specialist
14.3.5. All current materials which have been produced/approved at the federal level (i.e. CDC, HRSA,
Department of Health and Human Services (DHHS)) do not need to be submitted for prior
approval by ADHS; and
14.3.6. Information shall be accurate, current, and culturally appropriate.
15. Contractors Conducting HIV Testing
15.1. Support Partner Services and Data 2 Care Activities at the Contractor locations providing HIV Testing;
15.2. The Contractors with testing locations shall support current Partner Service or Data 2 Care activities for
persons newly diagnosed with HIV across the County;
15.3. Staff conducting Partner Service or Data 2 Care activities shall participate in an ADHS approved training
prior to start. Staff must comply with Partner Service delivery guidance and requirements from the ADHS
Office of HIV Prevention and HIV Surveillance Program;
15.4. Contractors shall notify HIV Prevention and Care Programs of the staff names and contact information for
staff performing HIV testing. Any staff changes shall be reported on a quarterly basis;
15.5. Any Early Intervention Services or Partners Services activities shall be:
15.5.1. Confidential in all aspects. Programs shall include strict procedures for ensuring privacy,
confidentiality, and security of data;
15.5.2. Timely (i.e. locating and notifying activities are initiated and completed promptly within ADHS-
established timelines) and offered to every client identified by the HIV/STD testing program within
twenty-one (21) days of learning their confirmatory HIV test result;
15.5.3. Appropriately documented in the reporting systems provided by the ADHS HIV/STD Prevention,
Care and Epidemiology programs. All partner counseling sessions shall be in accordance with the
most recent version of the Partner Services guidance issued by the CDC Prevention and
Surveillance branches; and
15.5.4. All HIV positive individuals contacted through RWPB Early Intervention Services shall be entered
into CAREWare. All of these individuals must have a Release of Information completed.
15.6. The roles of County Health Departments and Community Based Organizations differ when conducting
Partner Service or Data 2 Care activities:
15.6.1. County Health Departments may complete all components of Partner Services;
15.6.2. Community Based Organizations are encouraged to engage in partner elicitation activities with
clients testing for HIV. Community Based Organizations may ONLY conduct interviews to solicit
partner information from clients diagnosed with HIV/STDs (new or previously diagnosed) and
solicit partner information. Collected information must be given to the HIV/STD Partner Services
staff at the County Health Department. Community Based Organizations may NOT notify or
locate partners;
15.6.3. Work with community partners and promote integration of partner services into existing services
by ensuring that information about how to access Partner Services is easily accessible by health
care providers in the public and private sectors, Community Based Organizations, and other
agencies diagnosing or providing HIV/STD services;
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 HEALTH W. Adams, SERVICES Room 303
AMENDMENT Phoenix, Arizona 85007
SCOPE OF WORK (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS17-141746 Amendment No. 3 Procurement Bariah Steiner Specialist
15.6.4. When a Health Department does not have staff to complete required HIV Surveillance or HIV
Prevention Activities, a Ryan White Early Intervention Staff member may support these required
HIV Prevention and Surveillance activities on the following conditions;
15.6.4.1. Staff funds shall supplement, not supplant existing efforts;
15.6.4.2. Written approval must be gathered from the ADHS Office Chief of HIV
Prevention, Office of Disease Integration Services HIV Surveillance Program
Manager, and the ADHS Office of Disease Integration and Services Ryan White
Part B/ADAP Program Director. Approval may be collected via email; and
15.6.4.3. Staff shall ensure reporting of HIV/STD positive test results to ADHS according to
current guidelines related to data entry, linkage to care, case closure and
timeliness. Guidelines will be provided by the ADHS HIV/Surveillance Program.
16. Certification of Client Eligibility
16.1. Early Intervention Services (EIS) only providers have limited responsibilities for establishing eligibility. The
Contractor agrees to:
16.1.1. Assist with eligibility submissions for clients seeking Ryan White Part B/ADAP funded services.
Clients enrolled in Ryan White Part B are concurrently enrolled in ADAP. Assistance may include,
but is not limited to, helping clients complete eligibility forms, assisting with an Arizona Medicaid
application, Medicare enrollment including Low Income Subsidy determinations, and/or
communicate Program requests to the client;
16.1.2. Comply with any eligibility policies published to http://azdhs.gov/preparedness/epidemiology-
disease-control/disease-integration-services/index.php#hiv-care-resources-contractors and
mandatory forms at www.azadap.com;
16.1.3. Respond to requests from the ADHS eligibility review team for additional support documentation
and to answer questions related to client applications within three (3) business days;
16.1.4. Confirm and accept client eligibility in approved data systems, such as CAREWare, prior to billing
the Program for Ryan White Part B funded services;
16.1.5. Complete required screening for third party payers prior to billing the Ryan White Part B program
for services;
16.1.6. Contractors are encouraged to have multiple staff with access to approved data systems and
trained on reviewing/submitting eligibility and running eligibility reports. Contractors with more
than four (4) RWPB funded staff must have at least two (2) staff members with access to the
approved data systems;
16.1.7. Act as the primary point of contact for the ADHS eligibility review team, even when the client
submits an application directly to the Program;
16.1.8. Use Program approved, HIPAA compliant data systems and web applications, to send eligibility
referrals and support documents, when submitting applications on behalf of clients;
16.1.9. EIS services are exempt from the eligibility requirements. Prior to entering named EIS client data
into CAREWare a Release of Information (www.azadap.com) must be on file, and the minimum
RSR data entry must be collected;
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 HEALTH W. Adams, SERVICES Room 303
AMENDMENT Phoenix, Arizona 85007
SCOPE OF WORK (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS17-141746 Amendment No. 3 Procurement Bariah Steiner Specialist
16.2. The ADHS eligibility review team will:
16.2.1. Screen all client applications for Part B/ADAP and enroll eligible clients;
16.2.2. Use the Program approved data systems to communicate requests for additional documentation;
16.2.3. Use Program approved data system to post client eligibility status updates;
16.2.4. Review all open applications at least once every three (3) business days; and
16.2.5. Complete medication adherence related improvement projects such as, but not limited to,
monitoring and following up with clients that have not used their ADAP benefit in a six (6) month
period.
16.3. Summary of Client Eligibility Requirements:
16.3.1. HIV diagnosis.
16.3.2. Client lives in the State of Arizona.
16.3.3. Earn less than 400% of the current federal poverty level.
16.3.4. Documented screening and enrollment in the insurance option for which the client is eligible.
Ryan White is the payer of last resort and can pay for services covered by other programs upon
approval.
16.3.5. Clients enrolled in ADAP/ ADAP Assist look-alike program income model services will be
ineligible for all Ryan White Part B/ADAP funded services.
16.3.6. Submission of mandatory Arizona Ryan White and ADAP application in English or Spanish and
required supporting documentation every six (6) months. Support documents include:
16.3.6.1. Documented viral load labs within the past six (6) months;
16.3.6.2. Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid
program, approval or denial for clients under 150% of the federal poverty level;
16.3.6.3. Proof of income;
16.3.6.4. Proof of residency;
16.3.6.5. Proof of insurance (if applicable); and
16.3.6.6. Taxes for clients enrolled in an ADAP-funded Marketplace plan
17. Release of Information
17.1. The Contractor shall secure from all clients provided services under this Contract any and all releases of
information or other authorization requested by the Program. This includes but is not limited to, the Release
of Information included in the application (www.azadap.com), which can be found in the CAREWare client
file for eligible clients. Failure to secure such releases from clients may result in disallowance of all claims
to the Program for covered services provided to eligible individuals.
17.2. The Contractor shall comply with ARS §36-662, access to records. In conducting an investigation of a
reportable communicable disease the department of health services and local health departments may
inspect and copy medical or laboratory records in the possession of or maintained by a health care provider
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 HEALTH W. Adams, SERVICES Room 303
AMENDMENT Phoenix, Arizona 85007
SCOPE OF WORK (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS17-141746 Amendment No. 3 Procurement Bariah Steiner Specialist
or health care facility which are related to the diagnosis, treatment and control of the specific communicable
disease case reported. Requests for records shall be made in writing by the appropriate officer of the
department of health services or local health department and shall specify the communicable disease case
and the patient under investigation.
18. Client Fees and Sliding Fee Policies
18.1. The Contractor shall have billing, collection, co-pay and sliding fee policies and procedures that do not deny
clients services for non-payment, inability to produce income documentation, or require full payment prior to
service, or include any other barriers to service based on ability to pay.
18.2. When the Contractor charges clients for services, all collected fees shall be documented in accordance with
their sliding fee schedule. This fee schedule shall be consistent with current federal guidelines. This fee
schedule must be published and made available to the public. If charging fees, the Contractor shall have a
fee discount policy, sliding fee schedule, and sliding fee eligibility applications. The Contractor shall track
fees charged and paid by clients. The Contractor shall have a fee discount policy that includes client fee
caps, including:
18.2.1. Clear responsibility for annually evaluating clients to establish individual fees and caps;
18.2.2. Tracking of Part B charges or medical expenses inclusive of enrollment fees, deductibles, and co-
payments;
18.2.3. A process for alerting the billing system that client has reached cap and no further charges will be
charged for the remainder of the year;
18.2.4. Documentation of policies, fees, and implementation, including evidence that staff understand
those policies and procedures; and
18.2.5. A process for charging, obtaining, and documenting client charges through a medical practice
information system, manual or electronically. The chart below shall be followed when developing
the fee schedule:
Client Income Fees For Service
Less than or equal to 100% of No fees or charges to be imposed
the official poverty line
Greater than 100%, but not Fees and charges for any calendar year may not
exceeding 200%, of the official exceed 5% of the client’s annual gross income
poverty line
Greater than 200%, but not Fees and charges for any calendar year may not
exceeding 300%, of the official exceed 7% of client’s annual gross income
poverty line
Greater than 300% of the official Fees and charges for any calendar year may not
poverty line exceed 10% of client’s annual gross income
19. Compensation
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 HEALTH W. Adams, SERVICES Room 303
AMENDMENT Phoenix, Arizona 85007
SCOPE OF WORK (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS17-141746 Amendment No. 3 Procurement Bariah Steiner Specialist
19.1. ADHS reserves the right to reallocate funding during the Contract period so that the services provided and
corresponding Contract amount may be decreased or increased, at the discretion of the Program;
19.2. The Program will pay the Contractor on a monthly basis for approved services and expenses and in
accordance with the reimbursement methodology determined by the Program; either fee-for service or cost.
All client level data must be entered into CAREWare, a completed monthly CAREWare eligibility report
must be submitted, and a completed monthly RSR Readiness Report shall be submitted prior to the
Program paying invoices. The total funds paid to the Contractor will be dependent upon the approved
invoice according to the Program. ADHS does not guarantee a minimum payment to the Contractor. The
Program will not reimburse for fee-for-service activities when an appointment is canceled either by the client
or Contractor;
19.3. The Contractor shall notify the Program of any deviations or changes to any budget line of the current
budget in place for this contract within thirty (30) days of such change;
19.4. The Contractor shall be compensated for services provided only by the staff classifications/positions
included/referenced in the current approved budget.
19.5. Unless specifically allowed and referenced elsewhere in this Contract, all services are to be provided at
approved Contractor sites and/or venues. Services provided at non-authorized locations or venues will not
be reimbursed by the Program;
19.6. The Contractor shall provide monthly financial and corresponding programmatic reports per the reporting
schedule to the Program. If the Contractor is not in compliance due to non-performance, submission of
reports after deadlines, insufficient back-up statements or improperly completed forms, the Contractor may
not be reimbursed or reimbursement may be delayed until program compliance issues and any other
related financial consequences are resolved. Instances of non-compliance with billing and reporting
requirements may result in the Program reducing the Contractor’s reimbursement by up to ten percent
(10%) of the corresponding month’s billing; and
19.7. The actual amount of consideration to be paid to the Contractor depends upon the actual hours worked,
services provided and related expenses as stated in the current approved budget or as modified by
Contract Amendment or appropriately executed task order. Any un-obligated balance of funds at the end of
this Contract period shall be returned to the Program in accordance with instruction provided.
20. Adherence to Ryan White Part B Policies
20.1. Contractor shall adhere to all Ryan White Part B Program Policies. Such policies are referenced on
http://azdhs.gov/preparedness/epidemiology-disease-control/disease-integration-services/index.php#hiv-
care-home.and www.azadap.com.
21. Referral Relationships
21.1. Contractors shall have documented evidence to substantiate referral relationships on an ongoing basis
consistent with HRSA guidance regarding “Maintaining Appropriate Referral Relationships” available upon
request;
21.2. The Contractor shall have Letters of Agreement and Memorandums of Understanding (MOUs) to document
referral relationships with key points of entry. Key points of entry include:
21.2.1. Emergency rooms;
21.2.2. Substance abuse and mental health treatment programs;
21.2.3. Detoxification centers;
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 HEALTH W. Adams, SERVICES Room 303
AMENDMENT Phoenix, Arizona 85007
SCOPE OF WORK (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS17-141746 Amendment No. 3 Procurement Bariah Steiner Specialist
21.2.4. Detention facilities;
21.2.5. Sexually Transmitted Disease (STD) Clinics;
21.2.6. Homeless shelters;
21.2.7. HIV counseling and testing sites;
21.2.8. Public health departments;
21.2.9. Health care points of entry specified by eligible areas;
21.2.10. Federally Qualified Healthcare Centers (FQHCs); and
21.2.11. Entities such as Ryan White Part C and D grantees
22. Other Requirements
22.1. Contractor shall respond to all requests for information and documentation within seventy-two (72) hours of
receipt of request;
22.2. Contractor’s service locations shall be accessible by public transportation. If service locations are not
accessible by public transportation, the Contractor shall have policies and procedures in place that describe
how it will provide transportation assistance to clients;
22.3. Contractors providing Medicaid eligible services shall be certified to receive Medicaid payments, or receive
a waiver from the U.S. Secretary of Health and Human Services. The Contractor shall document efforts to
receive certification or waiver, and when certified, maintain proof of certification and file of contracts with
Medicaid insurance companies; and
22.4. Contractor shall follow and maintain compliance with:
22.4.1. The Accounting and Auditing Procedures Manual for Contractors of ADHS Funded Programs
found at https://gao.az.gov/publications/SAAM/;
22.4.2. Office of Management and Budget (OMB) CFR Title 2 – Grants and Agreements, Subtitle A –
Office of Management and Budget Guidance for Grants and Agreements, Chapter II – Office of
Management and Budget Guidance, Part 200 Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards at http://www.ecfr.gov/cgi-bin/text-
idx?tpl=/ecfrbrowse/Title02/2cfr200_main_02.tpl;
22.4.3. Applicable sub grantee responsibilities as outlined in the HRSA/HAB Fiscal Monitoring
Standards), Program Monitoring Standards, and Universal Standards (all found at
https://hab.hrsa.gov/program-grants-management/ryan-white-hivaids-program-recipient-
resources), including compliance with requirements in the following documents;
22.4.4. Ryan White Part B assurances;
22.4.5. HHS Grant Policy Statements (Terms and Conditions);
22.4.6. Notice of Grant Award terms; and
22.4.7. All requirements of the Ryan White HIV/AIDS Treatment Extension Act of 2009, found at
http://www.gpo.gov/fdsys/pkg/PLAW-111publ87/content-detail.html as directed by ADHS. This
will include all applicable quality and program management standards, or performance measures
as required, established and defined by ADHS for the Program.
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 HEALTH W. Adams, SERVICES Room 303
AMENDMENT Phoenix, Arizona 85007
SCOPE OF WORK (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS17-141746 Amendment No. 3 Procurement Bariah Steiner Specialist
23. Tasks
HIV Case Surveillance:
The Contractor shall:
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;
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. HIV Prevention (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.
23.3 Report HIV positive test results to ADHS according to established guidelines;
23.4 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;
23.5 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, earliest lab test dates, AIDS-
defining conditions and travel outside Arizona. When such information cannot be obtained, the Case
Report shall be so annotated;
23.6 Maintain and document an active surveillance system as outlined in the most recent version of the CDC
guidelines for HIV Surveillance and Control;
23.7 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”;
23.8 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”;
23.9 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;
23.10 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;
23.11 Ensure HIV positive individuals to have access to Partner Services staff;
23.12 Ensure that Surveillance Staff are culturally sensitive and acceptable to the affected population;
23.13 Ensure Surveillance Staff complete cases in a timely fashion within ADHS established timelines;
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 HEALTH W. Adams, SERVICES Room 303
AMENDMENT Phoenix, Arizona 85007
SCOPE OF WORK (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS17-141746 Amendment No. 3 Procurement Bariah Steiner Specialist
Participation in Annual HIV March or other month designated by N/A
Symposium, when offered ADHS.
by ADHS OR 4th Sub-
recipient monitoring call
Annual Work Plan April 30th of each year Ryan White Part B/ADAP Program
Director or authorized designee.
Yearly Budget Worksheet December 1st of each year for Ryan White Part B/ADAP Program
and Narrative/justification March 31st year end Director or authorized designee.
Budget Projections Twenty-five (25) days after month of Ryan White Part B/ADAP Program
service/claim. Director or authorized designee.
26. Approvals
ADHS will make payment in accordance to the Terms and Conditions set forth in the Contract.
26.1. The Surveillance Manager in the Office of Disease Integration and Services, or their designee, upon
completion, submission, and approval of all deliverables and reporting requirements will accept the monthly
Contractor Expenditure Report for HIV Surveillance.
26.2. The Ryan White Part B/ADAP Program Director in the Office of Disease Integration and Services, or their
designee, upon completion, submission, and approval of all deliverables and reporting requirements will accept
the monthly Contractor Expenditure Report for the Ryan White Part B program.
26.3. Separate contractor expenditure reports will be submitted for HIV Surveillance and Ryan White part B funding.
26.4. The due date for monthly reports and invoicing for HIV Surveillance is the fifteenth (15th) of the month, following
the month of service.
26.5. The due date for monthly reports and invoicing for Ryan White Part B is the twenty-fifth (25th) of the month
following the month of service.
26.6. ADHS may authorize variations to, and adjust payments for, under and over production of monthly minimum
unit rates, not to exceed the annual contract amount, on a case-by-case basis.
26.7. As appropriate, materials developed or used in HIV Surveillance shall be submitted to and reviewed by the
ADHS HIV Surveillance Program and the Ryan White Part B program.
26.8. Invoices, Payments, and Budgets for Ryan White Part B:
26.8.1. The Contractor shall submit electronically to the Program one (1) legible copy of their detailed
monthly invoice before payment(s) can be made.
26.8.2. Contractor shall submit the invoice packet for services performed on or before the 25th calendar day
following the month in which services were performed.
26.8.3. A complete invoice packet includes:
26.8.3.1. Contractor Expenditure Report signed by the Contractor’s authorized signer;
26.8.3.2. CAREWare Monthly Financial Report showing client and service category details;
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 HEALTH W. Adams, SERVICES Room 303
AMENDMENT Phoenix, Arizona 85007
SCOPE OF WORK (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS17-141746 Amendment No. 3 Procurement Bariah Steiner Specialist
26.8.3.3. CAREWare RSR report demonstrating that there is no missing data. Instructions will be
provided by the Program;
26.8.3.4. CAREWare Eligibility Report demonstrating that all clients billed for Part B in the
corresponding month are eligible. Instructions will be provided by the Program.
26.8.3.5. List of all Ryan White Part B/ADAP clients served by the Contractor during the month.
26.8.3.6. General Ledger or expenditure reports showing cost of operating (includes but not
limited to travel, office supplies, rent, utilities, professional and outside service charges,
etc.) expenses and what percentage of those expenses were paid by the Ryan White
Program or other supporting documentation acceptable to the Program. The General
Ledger or expenditure reports must be accurate as generated by the Contractor’s
financial management system; hand corrections to General Ledgers or expenditure
reports will not be accepted;
26.8.3.7. Program income report detailing all program income collected by the Contractor when
performing services under this award including but not limited to fees
26.8.3.8. Personnel and ERE break-out showing what was paid by the Contractor. Detailed
reports must include staff name, hourly rate, percentage of salary paid (or FTE),
personnel activity logs. Expenses paid by the employee are not reimbursable (i.e. social
security tax, state tax, federal tax, employee portion of benefits, etc.); and
26.8.3.9. Receipts/invoices for all expenses purchased with grant funds during the billing month.
26.8.3.10. Payments are conditioned upon the timely receipt of applicable, accurate and complete
invoice reports and forms submitted by the Contractor. All monthly invoices shall be
supported by auditable documentation, which is determined to be sufficient, competent
evidential matter defined by the Program;
26.8.3.11. The Program will not honor any claim for payment submitted sixty (60) calendar days
after date of service except by written approval of the Ryan White Part B/ADAP Program
Director. The Program will not process any claim for payment for services rendered prior
to the end of the contract period which are submitted sixty (60) calendar days after the
end of the Contract period without approval of Program;
26.8.3.12. The Program will review and may pay claims for services offered in the previous grant
year, based on the claim, client eligibility at the time of service and availability of rebate
funds. Payments for these services shall be at the sole discretion of the Ryan White Part
B/ADAP Program Director and are authorized only by written approval from the Ryan
White Part B/ADAP Program Director;
26.8.3.13. The Ryan White Part B/ADAP Program is the payer of last resort, therefore the
Contractor shall maximize and monitor all other revenue streams including self-pay and
all sources of third party reimbursements. The Contractor shall exhaust self-pay and
third party payments to offset program costs before Ryan White funds are used. The
Contractor shall have policies and procedures documented and in place to determine
and bill these other potential payment sources. These third party payers include but are
not limited to Regional Behavioral Health Authority (RBHA), Medicaid (Arizona Health
Care Cost Containment Services/AHCCCS), Arizona Long Term Care System (ALTCS),
TRICARE, Medicare and private/commercial or other insurance. The Contractor will
determine eligibility of clients and assist with client enrollment whenever feasible;
16

ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 HEALTH W. Adams, SERVICES Room 303
AMENDMENT Phoenix, Arizona 85007
SCOPE OF WORK (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS17-141746 Amendment No. 3 Procurement Bariah Steiner Specialist
26.8.3.14. Payments collected by the Contractor for Ryan White services shall be recorded as
Program Income in the Contractor’s financial management system and deducted from
bills issued to the Program. Any and all program income generated through services
provided to Ryan White Part B/ADAP shall be reported to the Program. Program income
records shall be made available to the Program for assurance that such revenues are
used to support related services. The Contractor shall have policies and procedures for
handling Ryan White revenue including program income;
26.8.3.15. The Contractor shall have policies and staff training on the payer of last resort
requirement and how it meets that requirement.
26.8.3.16. The Contractor shall have written fiscal and general policies and procedures that include
compliance with federal and Ryan White programmatic requirements;
26.8.3.17. The Contractor shall prepare and submit to the Program a budget using the current
Ryan White Part B Program-approved formats at the beginning of each grant year in
accordance with the stated funds allocated. A revised budget may be required when
changes greater than 10% of the contract award are requested. Failure to provide a
required budget or schedule of deliverables within the designated timeframe may result
in termination of the contract;
26.8.3.18. The total administrative costs budgeted; including any federally approved indirect rate
(inclusive of contractor and subcontractor(s)) cannot exceed ten percent (10%) of the
amount of the current grant award, unless there is written approval by the Ryan White
Part B/ADAP Program Director.
26.8.3.19. Contractors requesting use of an indirect rate shall submit a current copy of the HHS-
negotiated, HRSA-approved Certificate of Cost Allocation Plan or Certificate of Indirect
Costs (See HAB Fiscal Monitoring Standards Section A);
26.8.3.20. Contractor shall ensure that all expenditures are in accordance with the current
approved budget. Any expenditure deemed unallowable by the Program is subject to the
Contractor submitting a full reimbursement to the Program;
26.8.3.21. Contractor shall establish and maintain a “Financial Management System” that is in
accordance with the standards required by Federal OMB Circular A-110, Subpart C.
Such system must also account for both direct and indirect cost transactions, reports on
the results of those transactions, are in compliance with the requirements of OMB
Circular A-21 and generally accepted accounting principles;
26.8.3.22. All expenditures and encumbered funds shall be final and reconciled no later than forty –
five (45 days after the close of the grant year;
26.8.3.23. Funds collected by the Contractor in the form of fees, charges, and/or donations for the
delivery of the services provided for herein shall be accounted for separately. Such
fees, charges and/or donations must be used for providing additional services or to
defray the costs of providing these services consistent with the Scope of this Contract.
For audit purposes, the Contractor is responsible for maintaining necessary
documentation to support provision of services.
27. Acceptance)
27.1. Acceptance of the HIV Surveillance CER is signified by signature of the ADHS Surveillance Program Manager
or designee on the CER showing performance is satisfactory for payment.
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C-86-13-003-3-10
ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) 150 18th HEALTH Ave North, SERVICES Suite 260
AMENDMENT Phoenix, Arizona 85007
PRICE SHEET (602) 542-1040
(602) 542-1741 Fax??
Contract No: ADHS17-141746 Amendment No. 3 Procurement Bariah Steiner Specialist
Price Sheet
HIV Surveillance
Cost Reimbursement Line Items Budget Amount
1 Personnel Services $64,600
2 Employee Related Expenses $29,056
3 Professional & Outside Services -0-
4 Travel Expenses $1,500
5 Other Operating Expenses and Supplies $4,500
6 Capital Outlay Expenses $0
7 Other (Indirect Costs) $9,690
Total Contract Amount (not to exceed) $109,346
Ryan White Part B
Cost Reimbursement Line Items Budget Amount
1 Personnel Services $134,500
2 Employee Related Expenses $60,497
3 Professional & Outside Services $0
4 Travel Expenses $500
5 Other Operating Expenses and Supplies $6,500
6 Capital Outlay Expenses $0
7 Other (Indirect Costs) $20,175
Total Contract Amount (not to exceed) $222,172
Budget period January 1, 2019 through December 31, 2019
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