IGA RE DENTAL SEALTH WITH ADHS.PDF

INTERGOVERNMENTAL AGREEMENT (IGA) ARIZONA DEPARTMENT OF
HEALTH SERVICES
150 North 18th Avenue, Suite 260
CONTRACT No.: ADHS18-175153 Phoenix, Arizona 85007
Project Title: ORAL HEALTH DENTAL SEALANT SERVICES Begin Date: January 01, 2018
Geographic Service Area: MARICOPA COUNTY PUBLIC HEALTH Termination Date: December 31, 2022
Arizona Department of Health Services has authority to contract for services specified herein in accordance with A.R.S. §§ 11-951, 11-952, 36-
104 and 36-132. The Contractor represents that it has authority to contract for the performance of the services provided herein pursuant to:
X Counties: A.R.S. §§ 11-201, 11-951, 11-952 and 36-182.
Indian Tribes: A.R.S. §§ 11-951, 11-952 and the rules and sovereign authority of the contracting Indian Nation.
School Districts: A.R.S. §§ 11-951, 11-952, and 15-342.
City of Phoenix: Chapter II, §§ 1 & 2, Charter, City of Phoenix.
City of Tempe: Chapter 1, Article 1, §§ 1.01 & 1.03, Charter, City of Tempe.
Amendments signed by each of the parties and attached hereto are hereby adopted by reference as a part of this Contract, from the effective
date of the Amendment, as if fully set out herein.
Arizona Transaction (Sales) Privilege: FOR CLARIFICATION, CONTACT:
Federal Employer Identification No.: 86-6000472 Name: Cheryl Rentscheler and Toby Urvater
Tax License No.: 07-290-681-D Phone: (602) 506-6886 and (602) 506-6853
Contractor Name: Maricopa County by and through its FAX No: (602) 506-6885
Maricopa County Public Health
Address: 4041 North Central Avenue., Suite 1400 E-mail: cherylrentscheler@mail.maricopa.gov
Phoenix, Arizona 85012
CONTRACTOR SIGNATURE: This Contract shall henceforth be referred to as
The Contractor agrees to perform all the services set forth in the Contract No.: ADHS18-175153. The Contractor is hereby
Agreement and Work Statement. cautioned not to commence any billable w ork or provide any
material, service or construction under this Contract until
Contractor receives a fully executed copy of the Contract.
State of Arizona
Signature of Person Authorized to Sign Date
Signed this day of , 20_____
Steve Chucri, Chairman, Maricopa County Board of Supervisors
Print Name and Title
Procurement Officer
CONTRACTOR / ATTORNEY SIGNATURE: Attorney General Contract, No. P0012014000078, w hich is an
Agreement betw een public agencies, has been review ed pursuant to
Pursuant to A.R.S. § 11-952, the undersigned Contractor’s A.R.S. § 11-952 by the undersigned Assistant Attorney General, who
Attorney has determined that this Intergovernmental Agreement is has determined that it is in the proper form and is w ithin the pow ers
in proper form and is w ithin the pow ers and authority granted granted under the law s of the State of Arizona to those parties to the
under the law s of Arizona. Agreement represented by the Attorney General.
The Attorney General, BY:
Signature of Person Authorized to Sign Date
Signature Date
Assistant Attorney General:
Print Name and Title
ATTESTl
___________________________________________________
Clerk of the Board Date Page 1 of 24

CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS18-175153 TERMS AND CONDITIONS
1. DEFINITION OF TERMS. As used in this Contract, the terms listed below are defined as follows:
1.1 “Attachment” means any document attached to the Contract and incorporated into the Contract.
1.2 “ADHS” means Arizona Department of Health Services.
1.3 “Budget Term” means the period of time for which the contract budget has been created and during which
funds should be expended.
1.4 “Change Order” means a written order that is signed by a Procurement Officer and that directs the
Contractor to make changes authorized by the Uniform Terms and Conditions of the Contract.
1.5 “Contract” means the combination of the Uniform and Special Terms and Conditions, the Specifications and
Statement or Scope of Work, Attachments, Referenced Documents, any Contract Amendments and any
terms applied by law.
1.6 “Contract Amendment” means a written document signed by the Procurement Officer and the Contractor
that is issued for the purpose of making changes in the Contract.
1.7 “Contractor” means any person who has a Contract with the Arizona Department of Health Services.
1.8 “Cost Reimbursement” means a contract under which a contractor is reimbursed for costs, which are
reasonable, allowable and allocable in accordance with the contract terms and approved by ADHS.
1.9 “Days” means calendar days unless otherwise specified.
1.10 “Fixed Price” establishes a set price per unit of service. The set price shall be based on costs, which are
reasonable, allowable and allocable.
1.11 “Gratuity” means a payment, loan, subscription, advance, deposit of money, services, or anything of more
than nominal value, present or promised, unless consideration of substantially equal or greater value is
received.
1.12 “Materials” unless otherwise stated herein, means all property, including but not limited to equipment’s,
supplies, printing, insurance and leases of property.
1.13 “Procurement Officer” means the person duly authorized by the State to enter into and administer Contracts
and make written determinations with respect to the Contract.
1.14 “Purchase Order” means a written document that is signed by a Procurement Officer, that requests a
vendor to deliver described goods or services at a specific price and that, on delivery and acceptance of the
goods or services by ADHS, becomes an obligation of the State.
1.15 “Services” means the furnishing of labor, time or effort by a Contractor or Subcontractor.
1.16 “Subcontract” means any contract, express or implied, between the Contractor and another party or
between a subcontractor and another party delegating or assigning, in whole or in part, the making or
furnishing of any material or any service required for the performance of this Contract.
1.17 “State” means the State of Arizona and/or the ADHS. For purposes of this Contract, the term “State” shall
not include the Contractor.
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ADHS18-175153 TERMS AND CONDITIONS
2. CONTRACT TYPE.
This Contract shall be:
X FIXED PRICE
3. CONTRACT INTERPRETATION.
3.1. Arizona Law. The law of Arizona applies to this Contract including, where applicable, the Uniform
Commercial Code as adopted by the State of Arizona.
3.2. Implied Contract Terms. Each provision of law and any terms required by law to be in this Contract are a
part of this Contract as if fully stated in it.
3.3. Contract Order of Precedence. In the event of a conflict in the provisions of the Contract, as accepted by
the State and as they may be amended, the following shall prevail in the order set forth below:
3.3.1. Terms and Conditions;
3.3.2. Statement or Scope of Services;
3.3.3. Attachments; and
3.3.4. Referenced Documents.
3.4. Relationship of Parties. The Contractor under this Contract is an independent Contractor. Neither party to
this Contract shall be deemed to be the employee or agent of the other party to the Contract.
3.5. Severability. The provisions of this Contract are severable. Any term or condition deemed illegal or invalid
shall not affect any other term or condition of the Contract.
3.6. No Parole Evidence. This Contract is intended by the parties as a final and complete expression of their
agreement. No course of prior dealings between the parties and no usage of the trade shall supplement or
explain any terms used in this document.
3.7. No Waiver. Either party’s failure to insist on strict performance of any term or condition of the Contract shall
not be deemed a waiver of that term or condition even if the party accepting or acquiescing in the
nonconforming performance knows of the nature of the performance and fails to object to it.
3.8. Headings. Headings are for organizational purposes only and shall not be interpreted as having legal
significance or meaning.
4. CONTRACT ADMINISTRATION AND OPERATION.
4.1. Term. As indicated on the signature page of the Contract, the Contract shall be effective as of the Begin
Date and shall remain effective until the Termination Date.
4.2. Contract Renewal. This Contract shall not bind, nor purport to bind, the State for any contractual
commitment in excess of the original Contract period. The term of the Contract shall not exceed five years.
However, if the original Contract period is for less than five years, the State shall have the right, at its sole
option, to renew the Contract, so long as the original Contract period together with the renewal periods does
not exceed five years. If the State exercises such rights, all terms, conditions and provisions of the original
Contract shall remain the same and apply during the renewal period with the exception of price and Scope
of Work, which may be renegotiated.
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4.3. New Budget Term. If a budget term has been completed in a multi-term Contract, the parties may agree to
change the amount and type of funding to accommodate new circumstances in the next budget term. Any
increase or decrease in funding at the time of the new budget term shall coincide with a change in the
Scope of Work or change in cost of services as approved by the Arizona Department of Health Services.
4.4. Non-Discrimination. The Contractor shall comply with State Executive Order No. 2009-09 and all other
applicable Federal and State laws, rules and regulations, including the Americans with Disabilities Act.
4.5. Records and Audit. Under A.R.S. § 35-214 and A.R.S. § 35-215, the Contractor shall retain and shall
contractually require each subcontractor to retain all data and other records (“records”) relating to the
acquisition and performance of the Contract for a period of five years after the completion of the Contract.
All records shall be subject to inspection and audit by the State and where applicable the Federal
Government at reasonable times. Upon request, the Contractor shall produce a legible copy of any or all
such records.
4.6. Financial Management. For all contracts, the practices, procedures, and standards specified in and
required by the Accounting and Auditing Procedures Manual for the ADHS funded programs shall be used
by the Contractor in the management of Contract funds and by the State when performing a Contract audit.
Funds collected by the Contractor in the form of fees, donations and/or charges for the delivery of these
Contract services shall be accounted for in a separate fund.
4.6.1. Federal Funding. Contractors receiving federal funds under this Contract shall comply with the
certified finance and compliance audit provision of the Office of Management and Budget (OMB)
Circular A-133, if applicable. The federal financial assistance information shall be stated in a
Change Order or Purchase Order.
4.6.2. State Funding. Contractors receiving state funds under this Contract shall comply with the certified
compliance provisions of A.R.S. § 35-181.03.
4.7. Inspection and Testing. The Contractor agrees to permit access, at reasonable times, to its facilities.
4.8. Notices. Notices to the Contractor required by this Contract shall be made by the State to the person
indicated on the signature page by the Contractor, unless otherwise stated in the Contract. Notices to the
State required by the Contract shall be made by the Contractor to an ADHS Procurement Officer, unless
otherwise stated in the Contract. An authorized ADHS Procurement Officer and an authorized Contractor
representative may change their respective person to whom notice shall be given by written notice, and an
amendment to the Contract shall not be necessary.
4.9. Advertising and Promotion of Contract. The Contractor shall not advertise or publish information for
commercial benefit concerning this Contract without the prior written approval of an ADHS Procurement
Officer.
4.10. Property of the State.
4.10.1. Equipment. Except as provided below or otherwise agreed to by the parties, the title to any and all
equipment acquired through the expenditure of funds received from the State shall remain the
property of the State by and through the ADHS and, as such, shall remain under the sole direction,
management and control of the ADHS. When this Contract is terminated, the disposition of all such
property shall be determined by the ADHS. For Fixed Price contracts, when the Contractor
provides the services/materials required by the Contract, any and all equipment purchased by the
Contractor remains the property of the Contractor. All purchases of equipment need to be reported
to the ADHS Office of Inventory Control.
4.10.2. Title and Rights to Materials. As used in this section, the term “Materials” means all products
created or produced by the Contractor under this Contract, including, but not limited to: written and
electronic information, recordings, reports, research, research findings, conclusions, abstracts,
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results, software, data and any other intellectual property or deliverables created, prepared, or
received by the Contractor in performance of this Contract. Contractor acknowledges that all
Materials are the property of the State by and through the ADHS and, as such, shall remain under
the sole direction, management and control of the ADHS. The Contractor is not entitled to a patent
or copyright on these Materials and may not transfer a patent or copyright on them to any other
person or entity. To the extent any copyright in any Materials may originally vest in the Contractor,
the Contractor hereby irrevocably transfers to the ADHS, for and on behalf of the State, all
copyright ownership. The ADHS shall have full, complete and exclusive rights to reproduce,
duplicate, adapt, distribute, display, disclose, publish, release and otherwise use all Materials. The
Contractor shall not use or release these Materials without the prior written consent of the ADHS.
When this Contract is terminated, the disposition of all such Materials shall be determined by the
ADHS. Further, the Contractor agrees to give recognition to the ADHS for its support of any
program when releasing or publishing program Materials.
4.10.3. Notwithstanding the above, if the Contractor is a State agency, the following shall apply instead: It
is the intention of ADHS and Contractor that all material and intellectual property developed under
this Agreement be used and controlled in ways to produce the greatest benefit to the parties to this
Contract and the citizens of the State of Arizona. As used in this paragraph, “Material” means all
written and electronic information, recordings, reports, findings, research information, abstracts,
results, software, data, discoveries, inventions, procedures and processes of services developed by
the Contractor and any other materials created, prepared or received by the Contractor and
subcontractors in performance of this Agreement. “Material” as used herein shall not include any
pre-existing data, information, materials, discoveries, inventions or any form of intellectual property
invented, created, developed or devised by Contractor (or its employees, subcontractors or agents)
prior to the commencement of the services funded by this Agreement or that may result from
Contractor’s involvement in other service activities that are not funded by the Agreement.
4.10.4. Title and exclusive copyright to all Material shall vest in the State of Arizona, subject to any rights
reserved on behalf of the federal government. As State agencies and instrumentalities, both ADHS
and Contractor shall have full, complete, perpetual, irrevocable and non-transferable rights to
reproduce, duplicate, adapt, make derivative works, distribute, display, disclose, publish and
otherwise use any and all Material. The Contractor’s right to use Material shall include the following
rights: the right to use the Material in connection with its internal, non-profit research and
educational activities, the right to present at academic or professional meetings or symposia and
the right to publish in journals, theses, dissertations or otherwise of Contractor’s own choosing.
Contractor agrees to provide ADHS with a right of review prior to any publication or public
presentation of the Material, and ADHS shall be entitled to request the removal of its confidential
information or any other content the disclosure of which would be contrary to the best interest of the
State of Arizona. Neither party shall release confidential information to the public without the prior
expressly written permission of the other, unless required by the State public records statutes or
other law, including a court order. Each party agrees to give recognition to the other party in all
public presentations or publications of any Material, when releasing or publishing them.
4.10.5. In addition, ADHS and Contractor agree that any and all Material shall be made freely available to
the public to the extent it is in the best interest of the State. However, if either party wants to
license or assign an intellectual property interest in the material to a third-party for monetary
compensation, ADHS and Contractor agree to convene to determine the relevant issues of title,
copyright, patent and distribution of revenue. In the event of a controversy as to whether the
Material is being used for monetary compensation or in a way that interferes with the best interest
of the state or ADHS, then the Arizona Department of Administration shall make the final decision.
Notwithstanding the above, “monetary compensation’ does not include compensation paid to an
individual creator for traditional publications in academia (the copyrights to which are Employee-
Excluded Works under ABOR Intellectual Property Policy Section 6-908C.4.), an honorarium or
other reimbursement of expenses for an academic or professional presentation, or an unprofitable
distribution of Material.
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4.11. E-Verify Requirements In accordance with A.R.S. § 41-4401, Contractor warrants compliance with all
Federal immigration laws and regulations relating to employees and warrants its compliance with Section
A.R.S. § 23-214, Subsection A.
4.12. Federal Immigration and Nationality Act The Contractor shall comply with all federal, state and local
immigration laws and regulations relating to the immigration status of their employees during the term of the
Contract. Further, the Contractor shall flow down this requirement to all subcontractors utilized during the
term of the Contract. The State shall retain the right to perform random audits of Contractor and
subcontractor records or to inspect papers of any employee thereof to ensure compliance. Should the State
determine that the Contractor and/or any subcontractors be found noncompliant, the State may pursue all
remedies allowed by law, including, but not limited to; suspension of work, termination of the Contract for
default and suspension and/or debarment of the Contractor.
5. COSTS AND PAYMENTS.
5.1. Payments. Payments shall comply with the requirements of A.R.S. Titles 35 and 41, net 30 days. Upon
receipt and acceptance of goods or services, the Contractor shall submit a complete and accurate
Contractor’s Expenditure Report for payment from the State within thirty (30) days, as provided in the
Accounting and Auditing Procedures Manual for the ADHS.
5.2. Recoupment of Contract Payments.
5.2.1. Unearned Advanced Funds. Any unearned State funds that have been advanced to the Contractor
and remain in its possession at the end of each budget term, or at the time of termination of the
Contract, shall be refunded to the ADHS within forty-five (45) days of the end of a budget term or of
the time of termination.
5.2.2. Contracted Services. In a fixed price contract, if the number of services provided is less than the
number of services for which the Contractor received compensation, funds to be returned to the
ADHS shall be determined by the Contract price. Where the price is determined by cost per unit of
service or material, the funds to be returned shall be determined by multiplying the unit of service
cost by the number of services the Contractor did not provide during the Contract term. Where the
price for a deliverable is fixed, but the deliverable has not been completed, the Contractor shall be
paid a pro rata portion of the completed deliverable. In a cost reimbursement contract, the ADHS
shall pay for any costs that the Contractor can document as having been paid by the Contractor
and approved by ADHS. In addition, the Contractor will be paid its reasonable actual costs for work
in progress as determined by Generally Accepted Accounting Procedures up to the date of contract
termination.
5.2.3. Refunds. Within forty-five (45) days after the end of each budget term or of the time of termination
of the Contract, the Contractor shall refund the greater of: i) the amount refundable in accordance
with paragraph 4.2.1, Unearned Advanced Funds; or ii) the amount refundable in accordance with
paragraph 5.2.2, Contracted Services.
5.2.4. Unacceptable Expenditures. The Contractor agrees to reimburse the ADHS for all Contract funds
expended, which are determined by the ADHS not to have been disbursed by the Contractor in
accordance with the terms of this Contract. The Contractor shall reimburse ADHS within 45 days of
the determination of unacceptability.
5.3. Unit Costs/Rates or Fees. Unit costs/rates or fees shall be based on costs, which are determined by ADHS
to be reasonable, allowable and allocable as outlined in the Accounting and Auditing Procedures Manual for
the ADHS.
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5.4. Applicable Taxes.
5.4.1. State and Local Transaction Privilege Taxes. The State of Arizona is subject to all applicable state
and local transaction privilege taxes. Transaction privilege taxes apply to the sale and are the
responsibility of the seller to remit. Failure to collect taxes from the buyer does not relieve the seller
from its obligation to remit taxes.
5.4.2. Tax Indemnification. The Contractor and all subcontractors shall pay all federal, state and local
taxes applicable to its operation and any persons employed by the Contractor. Contractor shall
require all subcontractors to hold the State harmless from any responsibility for taxes, damages and
interest, if applicable, contributions required under Federal, and/or state and local laws and
regulations and any other costs, including transaction privilege taxes, unemployment compensation
insurance, Social Security and Worker’s Compensation.
5.4.3. I.R.S. W9 Form. In order to receive payment under any resulting Contract, the Contractor shall
have a current I.R.S. W9 Form on file with the State of Arizona.
5.5. Availability of Funds for the Next Fiscal Year. Funds may not be presently available for performance under
this Contract beyond the first year of the budget term or Contract term. The State may reduce payments or
terminate this Contract without further recourse, obligation or penalty in the event that insufficient funds are
appropriated in the subsequent budget term. The State shall not be liable for any purchases or
Subcontracts entered into by the Contractor in anticipation of such funding. The Procurement Officer shall
have the discretion in determining the availability of funds.
5.6. Availability of Funds for the Current Contract Term. Should the State Legislature enter back into session
and decrease the appropriations through line item or general fund reductions, or for any other reason these
goods or services are not funded as determined by ADHS, the following actions may be taken by ADHS:
5.6.1. Accept a decrease in price offered by the Contractor;
5.6.2. Reduce the number of goods or units of service and reduce the payments accordingly;
5.6.3. Offer reductions in funding as an alternative to Contract termination; or
5.6.4. Cancel the Contract.
6. CONTRACT CHANGES.
6.1. Amendments, Purchase Orders and Change Orders. This Contract is issued under the authority of the
Procurement Officer who signed this Contract. The Contract may be modified only through a Contract
Amendment, Purchase Order and/or Change Order within the scope of the Contract, unless the change is
administrative or otherwise permitted by the Special Terms and Conditions. Changes to the Contract,
including the addition of work or materials, the revision of payment terms, or the substitution of work or
materials, directed by an unauthorized State employee or made unilaterally by the Contractor are violations
of the Contract and of applicable law. Such changes, including unauthorized Contract Amendments,
Purchase Orders and/or Change Orders, shall be void and without effect, and the Contractor shall not be
entitled to any claim under this Contract based on those changes.
6.2. Subcontracts. The Contractor shall not enter into any subcontract under this Contract without the advance
written approval of the Procurement Officer. The subcontract shall incorporate by reference all material and
applicable terms and conditions of this Contract.
6.3. Assignments and Delegation. The Contractor shall not assign any right nor delegate any duty under this
Contract without the prior written approval of the Procurement Officer. The State shall not unreasonably
withhold approval.
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7. RISK AND LIABILITY.
7.1. Risk of Loss. The Contractor shall bear all loss of conforming material covered under this Contract until
received and accepted by authorized personnel at the location designated in the Purchase Order, Change
Order or Contract. Mere receipt does not constitute final acceptance. The risk of loss for nonconforming
materials shall remain with the Contractor regardless of receipt.
7.2. Mutual Indemnification. Each party (as “indemnitor”) agrees to indemnify, defend and hold harmless the
other party (as “indemnitee”) from and against any and all claims, losses, liability, costs or expenses
(including reasonable attorney’s fees) (hereinafter collectively referred to as “claims”) arising out of bodily
injury of any person (including death) or property damage, but only to the extent that such claims, which
result in vicarious/derivative liability to the indemnitee, are caused by the act, omission, negligence,
misconduct, or other fault of the indemnitor, its officers, officials, agents, employees or volunteers.
7.3. Force Majeure.
7.3.1. Liability and Definition. Except for payment of sums due, neither party shall be liable to the other
nor deemed in default under this Contract if and to the extent that such party’s performance of this
Contract is prevented by reason of force majeure. The term “force majeure” means an occurrence
that is beyond the control of the party affected and occurs without its fault or negligence. Without
limiting the foregoing, force majeure includes acts of God; acts of the public enemy; acts of
terrorism; war; riots; strikes; mobilization; labor disputes; civil disorders; fire; flood; lockouts;
injunctions-interventions not caused by or resulting from the act or failure to act of the parties;
failures or refusals to act by government authority not caused by or resulting from the act or failure
to act of the parties; and other similar occurrences beyond the control of the party declaring force
majeure, which such party is unable to prevent by exercising reasonable diligence.
7.3.2. Exclusions. Force Majeure shall not include the following occurrences:
7.3.2.1. Late delivery of Materials caused by congestion at a manufacturer’s plant or elsewhere, or
an oversold condition of the market;
7.3.2.2. Late performance by a subcontractor unless the delay arises out of a force majeure
occurrence in accordance with this force majeure term and condition; or
7.3.2.3. Inability of either the Contractor or any subcontractor to acquire or maintain any required
insurance, bonds, licenses or permits.
7.3.3. Notice. If either party is delayed at any time in the progress of the work by force majeure, the
delayed party shall notify the other party in writing of such delay, as soon as is practicable and no
later than the following working day of the commencement thereof, and shall specify the causes of
such delay in such notice. Such notice shall be delivered or mailed certified-return receipt and shall
make a specific reference to this article, thereby invoking its provisions. The delayed party shall
cause such delay to cease as soon as practicable and shall notify the other party in writing when it
has done so. The time of completion shall be extended by Contract Amendment for a period of
time equal to the time that the results or effects of such delay prevent the delayed party from
performing in accordance with this Contract.
7.3.4. Default. Any delay or failure in performance by either party hereto shall not constitute default
hereunder or give rise to any claim for damages or loss of anticipated profits if, and to the extent
that, such delay or failure is caused by force majeure.
7.4. Third Party Antitrust Violations. The Contractor assigns to the State any claim for overcharges resulting
from antitrust violations to the extent that those violations concern materials or services supplied by third
parties to the Contractor for or toward the fulfillment of this Contract.
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8. DESCRIPTION OF MATERIALS. The following provisions shall apply to Materials only:
8.1. Liens. The Contractor agrees that the Materials supplied under this Contract are free of liens. In the event
the Materials are not free of liens, Contractor shall pay to remove the lien and any associated damages or
replace the Materials with Materials free of liens.
8.2. Quality. Unless otherwise modified elsewhere in these terms and conditions, the Contractor agrees that, for
one year after acceptance by the State of the Materials, they shall be:
8.2.1. Of a quality to pass without objection in the Contract description;
8.2.2. Fit for the intended purposes for which the Materials are used;
8.2.3. Within the variations permitted by the Contract and are of even kind, quantity, and quality within
each unit and among all units;
8.2.4. Adequately contained, packaged and marked as the Contract may require; and
8.2.5. Conform to the written promises or affirmations of fact made by the Contractor.
8.3. Inspection/Testing. Subparagraphs 8.1 through 8.2 of this paragraph are not affected by inspection or
testing of or payment for the Materials by the State.
8.4. Compliance With Applicable Laws. The Materials and services supplied under this Contract shall comply
with all applicable federal, state and local laws, and the Contractor shall maintain all applicable license and
permit requirements.
8.5. Survival of Rights and Obligations After Contract Expiration and Termination.
8.5.1. Contractor’s Representations. All representations and warranties made by the Contractor under
this Contract in paragraphs 7 and 8 shall survive the expiration or termination hereof. In addition,
the parties hereto acknowledge that pursuant to A.R.S. § 12.510, except as provided in A.R.S. §
12-529, the State is not subject to or barred by any limitations of actions prescribed in A.R.S. Title
12, Chapter 5.
8.5.2. Purchase Orders and Change Orders. Unless otherwise directed in writing by the Procurement
Officer, the Contractor shall fully perform and shall be obligated to comply with all Purchase Orders
and Change Orders received by the Contractor prior to the expiration or termination hereof,
including, without limitation, all Purchase Orders and Change Orders received prior to but not fully
performed and satisfied at the expiration or termination of this Contract.
9. STATE’S CONTRACTUAL REMEDIES.
9.1. Right to Assurance. If the State, in good faith, has reason to believe that the Contractor does not intend to,
or is unable to, perform or continue performing under this Contract, the Procurement Officer may demand
in writing that the Contractor give a written assurance of intent to perform. Failure by the Contractor to
provide written assurance within the number of Days specified in the demand may, at the State’s option, be
the basis for terminating the Contract.
9.2. Stop Work Order.
9.2.1. Terms. The State may, at any time, by written order to the Contractor, require the Contractor to
stop all or any part of the work called for by this Contract for a period up to ninety (90) Days after
the order is delivered to the Contractor, and for any further period to which the parties may agree.
The order shall be specifically identified as a stop work order issued under this clause. Upon
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receipt of the order, the Contractor shall immediately comply with its terms and take all reasonable
steps to minimize the incurrence of costs allocable to the work covered by the order during the
period of work stoppage.
9.2.2. Cancellation or Expiration. If a stop work order issued under this clause is canceled or the period of
the order or any extension expires, the Contractor shall resume work. The Procurement Officer
shall make an equitable adjustment in the delivery schedule or Contract price, or both, and the
Contract shall be amended in writing accordingly.
9.3. Non-exclusive Remedies. The rights and remedies of ADHS under this Contract are not exclusive, and
ADHS is entitled to all rights and remedies available to it, including those under the Arizona Uniform
Commercial Code and Arizona common law.
9.4. Right of Offset. The State shall be entitled to offset against any sums due the Contractor in any Contract
with the State or damages assessed by the State because of the Contractor’s non-conforming performance
or failure to perform this Contract. The right to offset may include, but is not limited to, a deduction from an
unpaid balance and a collection against the bid and/or performance bonds. Any offset taken for damages
assessed by the State shall represent a fair and reasonable amount for the actual damages and shall not
be a penalty for non-performance.
10. CONTRACT TERMINATION.
10.1. Cancellation for Conflict of Interest. Pursuant to A.R.S. § 38-511, the State may cancel this Contract within
three (3) years after Contract execution without penalty or further obligation if any person significantly
involved in initiating, negotiating, securing, drafting or creating the Contract on behalf of the State is, or
becomes at any time while the Contract or an extension of the Contract is in effect, an employee of or a
consultant to any other party to this Contract with respect to the subject matter of the Contract. The
cancellation shall be effective when the Contractor receives written notice of the cancellation, unless the
notice specifies a later time. If the Contractor is a political subdivision of the State, it may also cancel this
Contract as provided in A.R.S. § 38-511.
10.2. Gratuities. The State may, by written notice, terminate this Contract, in whole or in part, if the State
determines that employment or a Gratuity was offered or made by the Contractor or a representative of the
Contractor to any officer or employee of the State for the purpose of influencing the outcome of the
procurement, securing the Contract or an Amendment to the Contract, or receiving favorable treatment
concerning the Contract, including the making of any determination or decision about Contract
performance. The State, in addition to any other rights or remedies, shall be entitled to recover exemplary
damages in the amount of three times the value of the Gratuity offered by the Contractor.
10.3. Suspension or Debarment. The State may, by written notice to the Contractor, immediately terminate this
Contract if the State determines that the Contractor or its subcontractor has been debarred, suspended or
otherwise lawfully prohibited from participating in any public procurement activity, including but not limited
to, being disapproved as a subcontractor of any public procurement unit or other governmental body.
10.4. Termination Without Cause.
10.4.1. Both the State and the Contractor may terminate this Contract at any time with thirty (30) days’
notice in writing specifying the termination date. Such notices shall be given by personal delivery or
by certified mail, return receipt requested.
10.4.2. If the Contractor terminates this Contract, any monies prepaid by the State, for which no service or
benefit was received by the State, shall be refunded to the State within 5 days of the termination
notice. In addition, if the Contractor terminates the Contract, the Contractor shall indemnify the
State for any sanctions imposed by the funding source as a result of the Contractor’s failure to
complete the Contract.
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10.4.3. If the State terminates this Contact pursuant to this Section, the State shall pay the Contractor the
Contract price for all Services and Materials completed up to the date of termination. In a fixed
price contract, the State shall pay the amount owed for the Services or Materials by multiplying the
unit of service or item cost by the number of unpaid service units or items. In a cost reimbursement
contract, the ADHS shall pay for any costs that the Contractor can document as having been paid
by the Contractor and approved by ADHS. In addition, the Contractor will be paid its reasonable
actual costs for work in progress as determined by GAAP up to the date of termination. Upon such
termination, the Contractor shall deliver to the ADHS all deliverables completed. ADHS may
require Contractor to negotiate the terms of any remaining deliverables still due.
10.5. Mutual Termination. This Contract may be terminated by mutual written agreement of the parties
specifying the termination date and the terms for disposition of property and, as necessary, submission of
required deliverables and payment therein.
10.6. Termination for Default. The State reserves the right to terminate the Contract in whole or in part due to
the failure of the Contractor to comply with any material obligation, term or condition of the Contract, to
acquire and maintain all required insurance policies, bonds, licenses and permits, or to make satisfactory
progress in performing the Contract. In the event the ADHS terminates the Contract in whole or in part as
provided in this paragraph, the ADHS may procure, upon such terms and in such manner as deemed
appropriate, Services or Materials, similar to those terminated, and Contractor shall be liable to the ADHS
for any excess costs incurred by the ADHS in obtaining such similar Services or Materials.
10.7. Continuation of Performance Through Termination. Upon receipt of the notice of termination and until the
effective date of the notice of termination, the Contractor shall perform work consistent with the
requirements of the Contract and, if applicable, in accordance with a written transition plan approved by the
ADHS. If the Contract is terminated in part, the Contractor shall continue to perform the Contract to the
extent not terminated. After receiving the notice of termination, the Contractor shall immediately notify all
subcontractors, in writing, to stop work on the effective date of termination, and on the effective date of
termination, the Contractor and subcontractors shall stop all work.
10.8. Disposition of Property. Upon termination of this Contract, all property of the State, as defined herein, shall
be delivered to the ADHS upon demand.
11. ARBITRATION.
Pursuant to A.R.S. § 12-1518, disputes under this Contract shall be resolved through the use of arbitration when
the case or lawsuit is subject to mandatory arbitration pursuant to rules adopted under A.R.S. § 12 -133.
12. COMMUNICATION.
12.1. Program Report. When reports are required by the Contract, the Contractor shall provide them in the
format approved by ADHS.
12.2. Information and Coordination. The State will provide information to the Contractor pertaining to activities
that affect the Contractor’s delivery of services, and the Contractor shall be responsible for coordinating
their activities with the State’s in such a manner as not to conflict or unnecessarily duplicate the State’s
activities. As the work of the Contractor progresses, advice and information on matters covered by the
Contract shall be made available by the Contractor to the State throughout the effective period of the
Contract.
13. CLIENT GRIEVANCES.
If applicable, the Contractor and its subcontractors shall use a procedure through which clients may present
grievances about the operation of the program that result in the denial, suspension or reduction of services
provided pursuant to this Contract and which is acceptable to and approved by the State.
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14. SOVEREIGN IMMUNITY.
Pursuant to A.R.S. § 41-621(O), the obtaining of insurance by the State shall not be a waiver of any sovereign
immunity defense in the event of suit.
15. FINGERPRINT AND CERTIFICATION REQUIREMENTS/JUVENILE SERVICES.
15.1. Paid and Unpaid Personnel. Pursuant to A.R.S. § 36-425.03, the Contractor shall ensure that all paid and
unpaid personnel who are required or are allowed to provide Services directly to juveniles have obtained
fingerprint clearance cards in accordance with A.R.S. § 41-1758 et. seq.
15.2. Costs. The Contractor shall assume the costs of fingerprint certifications and may charge these costs to its
fingerprinted personnel.
16. ADMINISTRATIVE CHANGES.
The Procurement Officer, or authorized designee, reserves the right to correct any obvious clerical, typographical
or grammatical errors, as well as errors in party contact information (collectively, “Administrative Changes”), prior
to or after the final execution of a Contract or Contract Amendment. Administrative Changes subject to
permissible corrections include: misspellings, grammar errors, incorrect addresses, incorrect Contract
Amendment numbers, pagination and citation errors, mistakes in the labeling of the rate as either extended or
unit, and calendar date errors that are illogical due to typographical error. The Procurement Office shall
subsequently send to the Contractor notice of corrections to administrative errors in a written confirmation letter
with a copy of the corrected Administrative Change attached.
17. SURVIVAL OF TERMS AFTER TERMINATION OR CANCELLATION OF CONTRACT.
All applicable Contract terms shall survive and apply after Contract termination or cancellation to the extent
necessary for Contractor to complete and for the ADHS to receive and accept any final deliverables that are due
after the date of the termination or cancellation.
18. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA).
18.1. The Contractor warrants that it is familiar with the requirements of HIPAA, as amended by the Health
Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009, and accompanying
regulations and will comply with all applicable HIPAA requirements in the course of this Contract.
Contractor warrants that it will cooperate with the Arizona Department of Health Services (ADHS) in the
course of performance of the Contract so that both ADHS and Contractor will be in compliance with HIPAA,
including cooperation and coordination with the Arizona Department of Administration-Arizona Strategic
Enterprise Technology (ADOA-ASET) Office, the ADOA-ASET Arizona State Chief Information Security
Officer and HIPAA Coordinator and other compliance officials required by HIPAA and its
regulations. Contractor will sign any documents that are reasonably necessary to keep ADHS and
Contractor in compliance with HIPAA, including, but not limited to, business associate agreements.
18.2. If requested by the ADHS Procurement Office, Contractor agrees to sign a “Pledge To Protect Confidential
Information” and to abide by the statements addressing the creation, use and disclosure of confidential
information, including information designated as protected health information and all other confidential or
sensitive information as defined in policy. In addition, if requested, Contractor agrees to attend or
participate in HIPAA training offered by ADHS or to provide written verification that the Contractor has
attended or participated in job related HIPAA training that is: (1) intended to make the Contractor proficient
in HIPAA for purposes of performing the services required and (2) presented by a HIPAA Privacy Officer or
other person or program knowledgeable and experienced in HIPAA and who has been approved by the
ADOA-ASET Arizona State Chief Information Security Officer and HIPAA Coordinator.
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19. COMMENTS WELCOME.
The ADHS Procurement Office periodically reviews the Uniform Terms and Conditions and welcomes any
comments you may have. Please submit your comments to: ADHS Procurement Administrator, Arizona
Department of Health Services, 150 North 18th Avenue, Suite 260, Phoenix, Arizona 85007.
20. DATA UNIVERSAL NUMBERING SYSTEM (DUNS) REQUIREMENT.
For federal funding, pursuant to 2 CFR 25.100 et seq., no entity (defined as a Governmental organization, which
is a State, local government, or Indian tribe; foreign public entity; domestic or foreign nonprofit organization;
domestic or foreign for-profit organization; or Federal agency, but only as a subrecipient under an award or
subaward to a non-Federal entity) may receive a subaward from ADHS unless the entity provides its Data
Universal Numbering System (DUNS) Number to ADHS.
21. THE FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA OR TRANSPARENCY
ACT - P.L.109-282, AS AMENDED BY SECTION 6202(A) OF P.L. 110-252), FOUND AT
HTTPS://WWW.FSRS.GOV/
If applicable, the Contractor/Grantee shall submit to ADHS via email the Grant Reporting Certification Form. This
form and the instructions can be downloaded from the ADHS Procurement website at
http://www.azdhs.gov/operations/financial-services/procurement/index.php#ffata and must be returned to the
ADHS by the 15th of the month following that in which the award was received. The form shall be completed
electronically, and submitted using the steps outlined in the Grant Reporting Certification Form Instructions to the
following email address: ADHS_Grant@azdhs.gov. All required fields must be filled including Top Employee
Compensation, if applicable. Completing the Grant Reporting Certification Form is required for compliance with
the Office of Management and Budget (OMB), found at http://www.whitehouse.gov/omb/open. Failure to timely
submit the Grant Reporting Certification Form could result in the loss of funds. This requirement applies to all
subcontractors/sub-awardees utilized by the Contractor/Grantee for amounts exceeding $30,000.00 during the
term of the Award.
22. CONTRACTING; PROCUREMENT; INVESTMENT; PROHIBITIONS.
22.1. A public entity may not enter into a contract with a company to acquire or dispose of services,
supplies, information technology or construction unless the contract includes a written certification that
the company is not currently engaged in, and agrees for the duration of the contract to not engage in,
a boycott of Israel.
22.2. A public entity may not adopt a procurement, investment or other policy that has the effect of inducing
or requiring a person or company to boycott Israel.
22.3. Contractor hereby certifies that it is not currently engaged in, and will not for the duration of this Contract
engage in, a boycott of Israel as defined by A.R.S. § 35-393.01. Violation of this certification by Contractor
may result in action by the State up to and including termination of this Contract.
23. TECHNOLOGY REPLACEMENT.
In any event where product is discontinued, no longer available or technically inferior to newly developed product,
the Contractor shall provide an equivalent replacement model at no additional cost and shall honor the original
contract terms.
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1. BACKGROUND:
1.1. The mission of the Arizona Department of Health Services (ADHS) Office of Oral Health (OOH) is to promote
oral health for the well-being of all Arizona residents. The United States Surgeon General’s report in the
year 2000 identified dental caries (tooth decay) as one of the most common childhood chronic diseases.
Tooth decay is also one of the most common preventable diseases seen in children, preventable through
preventive dental services such as the use of fluoride and the application of dental sealants.
1.2. Children who are at greatest risk for caries are those from low income and minority populations and are least
likely to have access to dental care. The American Academy of Pediatric Dentistry and the American Dental
Association recommends the first dental visit occur no later than twelve (12) months of age. Children can get
cavities as young as twelve (12) to eighteen (18) months, which can cause pain and prevent them from
being able to eat, speak, sleep, and learn properly. Children do not lose all their baby teeth until they are
about twelve (12) to thirteen (13) years old. Of the decay found in children’s teeth, approximately ninety
percent (90%) occurs in tooth surfaces with pits and fissures, and almost two-thirds are found in the chewing
surfaces alone. Tooth decay can often be reversible or arrested in the earliest stages through a variety of
proven preventive methods. Once the decay progresses and the longer the decay remains untreated, it
becomes more difficult and costly to repair. As a result, early intervention and prevention is easier for both
the child and the dental professional, less expensive, and more successful than treatment at a later time.
1.3. Health education and promotion can be an important piece of any public health initiative as many low income
people do not understand the importance of seeking care or preventive services. The knowledge that tooth
decay is a transmissible disease caused by bacteria or that simple behavior changes can limit the risk of
decay, is not widespread among the general population, let alone low income people. According to the
National Institute of Dental and Craniofacial Research National Institutes of Health (NIDCR-NIH) fewer than
one-quarter of U.S. adults know that dental sealants prevent dental decay. Collaborative efforts with
agencies or groups such as Head Start centers, Women Infant and Children (WIC) centers or coalition
groups can play a significant role in improving the education and awareness of community members.
1.4. National objectives help guide States in promoting health and wellness through such guidelines as the
Healthy People 2020 oral health objectives. These objectives include:
1.4.1. OH–2: Reduce the proportion of children with untreated dental decay in their primary teeth.
1.4.2. OH–7: Increase the proportion of children, adolescents, and adults who used the oral health care
system.
1.4.3. OH–8: Increase the proportion of low-income children and adolescents who received any preventive
dental service during the past year.
1.4.4. OH–9: Increase the proportion of school-based health centers with an oral health component that
includes dental sealants, dental care and topical fluoride.
1.4.5. OH–10: Increase the proportion of local health departments that have oral health prevention or care
programs.
1.4.6. OH–12: Increase the proportion of children and adolescents who have received dental sealants on
one or more of their molar teeth.
1.5. Prevention services provided through collaboration with the OOH can help to address some, if not all of the
above mentioned oral health objectives. Some of the services may include (but not be limited to)
implementation of a dental sealant program, fluoride varnish program, or an early childhood oral health
program.
1.6. The Arizona School-based Sealant Program is a school-based preventive dental program targeting schools
with greater than fifty percent (50%) of the children participating in the free and reduced school meal
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program. Second and sixth grade children without private dental insurance are eligible to participate.
Children in other grades may receive services upon determination by OOH. Children shall have parental
consent and a clinical need for sealants. Screenings, sealants, and/or fluoride varnish are provided by OOH
trained dentists, Affiliated Practice (AP) dental hygienists, dental hygienists, and dental assistants. OOH
training ensures specified guidelines are used to ensure successful sealant retention. Additionally, every
effort is made to ensure that participating children receive information and referral to establish a dental home
in or near their community.
1.7. Pit and fissure sealants, defined as plastic (resin) coatings applied to susceptible tooth surfaces, are an
evidence-based preventive service, and have been approved and recommended for use for many years by
professional health associations and public health agencies. The purpose of sealants is to prevent the
growth of bacteria present in the pits and grooves of molar teeth, which lead to the breakdown of tooth
structure, resulting in decay. When properly placed, dental sealants can prevent up to seventy percent
(70%) of tooth decay on the chewing surfaces of first and second permanent molar teeth.
1.8. Fluoride varnish application is a safe, cost-effective procedure to prevent tooth decay. Bacteria that build up
on tooth surfaces produce acids that de-mineralize enamel. Left unchecked, the bacteria continue to destroy
tooth structure. Fluoride varnishes are applied directly to the tooth surface and provide immediate "re-
mineralization", interfere with bacterial build- up, and reduce acid production. According to an Association of
State and Territorial Dental Directors (ASTDD) Research Brief (2007.) http://www.astdd.org/state-of-the-
science/ studies on fluoride varnish have demonstrated that at least two (2) fluoride applications per year for
a period of two (2) years are necessary to demonstrate effective reductions in tooth decay. Fluoride varnish
is an adjunct to community water fluoridation. Children may receive fluoride varnish application after sealant
application as part of the school-based dental sealant program, consistent with Medicaid reimbursement
policies, which may be subject to change.
1.9. Community health assessments are included in the core set of population-based elements outlined as
essential in all communities by the Essential Public Health Services Work Group, (1994)
http://www.cdc.gov/nphpsp/essentialServices.html. Periodic dental surveys and data gatherings are
conducted by OOH to determine the oral health status of Arizona’s children and for reporting and monitoring
Healthy People 2020 Objectives. Numerous screeners are needed to participate in various surveys which
follow strict calibration set on national standards. Such calibration training would be provided by OOH for
each type of survey.
1.10.OOH uses a community-based approach and will target children at higher risk for dental caries, operate
efficiently, ensure quality, and maximize the use of public funding to meet these objectives.
2. OBJECTIVE:
2.1. To reduce dental decay in primary and permanent teeth in children;
2.2. Provide dental sealants and fluoride varnish to at-risk children;
2.3. Monitor oral health status of children;
2.4. Assist children in obtaining dental care;
2.5. Provide educational training for children, teachers, parents, health professionals; and
2.6. Provide technical assistance on dental public health issues.
3. SCOPE OF SERVICES:
The Contractor shall provide the services necessary to promote oral health and provide OOH authorized
preventive dental services. Provision of each type of preventive service will be based on availability of funding
and at the discretion of OOH. Services shall include those necessary to coordinate and implement the Arizona
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School-based Sealant Program using portable equipment, OOH approved dental sealant materials, and following
the protocols outlined in the Arizona School-based Sealant Program Manual
http://www.azdhs.gov/phs/owch/ooh/schools/sealant.htm. At the request of the Chief of the Office of Oral Health,
the Contractor shall provide services necessary to coordinate and implement a Fluoride Varnish Program using
materials and protocols outlined by OOH. At the request of the OOH, the Contractor shall provide services
necessary to gather data for dental surveys following strict calibration in accordance with training provided by the
OOH.
4. TASKS:
The Contractor shall provide:
4.1. Coordination/Administration
4.1.1. Distribute, collect, and analyze annual school applications for Arizona School-based Sealant
Program in accordance with Arizona School-based Sealant Program Provider Manual guidelines
(reference Provision Seven (7) Reference Documents);
4.1.2. Coordinate preventive dental services with OOH identified school and community sites;
4.1.3. Procure and manage dental supply inventory. Dental sealant material shall have American Dental
Association (ADA) seal of acceptance and/or comply with Center for Disease Control (CDC)
guidelines;
4.1.4. Monitor equipment, maintain an inventory list, provide maintenance and perform basic repairs;
4.1.5. Assure instrument sterilization;
4.1.6. Provide clerical procedures, including but not limited to:
4.1.6.1. Maintaining program schedules to include school screening and application dates,
4.1.6.2. Maintaining inventories of supplies and equipment,
4.1.6.3. Planning as related to the dental sealant and/or fluoride varnish program,
4.1.6.4. Preparing and submitting accurate and complete records of program activities, and
4.1.6.5. Preparing and submitting accurate and complete forms and reports required by OOH;
4.1.7. Develop, solicit, and maintain program provider contracts and provide a copy of each contract to
OOH;
4.1.8. Notify ADHS in writing within thirty (30) days of any change in personnel;
4.1.9. Maintain a current Provider List to include name, address, phone number, and license number of
each provider, and submit to OOH once each year thirty (30) days prior to beginning the program
each school year;
4.1.10. Maintain files containing the following information for each provider and staff member:
4.1.10.1. Arizona current licenses to practice dentistry or dental hygiene,
4.1.10.2. Resumes or curriculum vitae,
4.1.10.3. Certificates for dental assisting, or affiliated practice (AP), if applicable,
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4.1.10.4. A copy of the Standing Orders of the Affiliated Practice, if applicable,
4.1.10.4.1. A Standing Order is an agreement that the Dentist and hygienist signs which
allows the Affiliated Practice hygienist or Dental Hygienist to screen and
diagnose sealants without the dentist being present.
4.1.10.4.2. An Affiliated Practice (hygienist) is allowed to provide dental screenings
without a dentist present.
4.1.10.5. Current CPR certificate,
4.1.10.6. Copy of fingerprint clearance,
4.1.10.7. Malpractice insurance; including, but not limited to, sexual molestation and abuse
coverage,
4.1.10.8. Copy of Arizona Driver’s License,
4.1.10.9. Signed confidentiality agreement from all dentists, hygienists, and dental assistants
providing service in the sealant program to comply with Health Insurance Portability and
Accountability Act (HIPAA),
4.1.10.10. Provide the date and verification of most recent in-service training for all individuals
providing service in the sealant and/or fluoride varnish program,
4.1.10.11. Provide other insurance and documentation as needed,
4.1.10.12. Provide storage of the above mentioned documents must follow HIPAA compliance and
be available for audit by ADHS Sealant Program Manager or designated person,
4.1.10.13. Coordinate the collection of all information required by Arizona Health Care Cost
Containment System (AHCCCS) and AHCCCS health plans for enrollment of dentists
and/or Affiliated Practice dental hygienists into the program. This AHCCCS Provider
Information shall be submitted to OOH thirty (30) days prior to a dentist and/or AP dental
hygienist providing service in the sealant program. The information shall include the
following:
4.1.10.13.1. State of Arizona Substitute W-9 & Vendor Authorization form;
4.1.10.13.2. Completed AHCCCS Provider Registration form;
4.1.10.13.3. Completed AHCCCS Provider Participation Agreement;
4.1.10.13.4. Completed AHCCCS Group Authorization form;
4.1.10.13.5. Copy of Drug Enforcement Administration (DEA) Card; and
4.1.10.13.6. Social Security number.
4.1.10.14. Coordinate training for preventive dental program providers, at a minimum annually,
4.1.10.15. Assure that all employed and contracted preventive dental program providers complete
any ADHS required training prior to providing services, and receive annual training on
program updates and reviews. Reimbursement to the program provider for attending
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training is the responsibility of the contractor and should be considered part of the unit
price,
4.1.10.16. Prepare and submit OOH preventive dental program Data Forms as contained in the
Arizona Dental Sealant Provider Training Manual (reference Provision Seven (7)
Reference Documents) after completion of each school or community site which may
include the following:
4.1.10.16.1. School application forms;
4.1.10.16.2. Completed Preventive Dental Program Consent/Health History Forms;
4.1.10.16.3. Encounter Forms using standard protocols; and
4.1.10.16.4. Completed Summary Forms.
4.1.10.17. Ensure all children screened are provided information regarding AHCCCS health plans
as provided by AHCCCS and receive appropriate dental referral,
4.1.10.18. Assure accurate data collection and reporting, using standard guidelines as stated in the
Arizona Dental Sealant Provider Training Manual (see H. Reference Documents),
4.1.10.19. Correct and return forms deemed unacceptable by OOH, within ten (10) calendar days of
receipt by the Contractor,
4.1.10.20. Prepare and submit an Annual Activity Plan to include:
4.1.10.20.1. A list of schools and/or community sites to be scheduled for screenings,
fluoride varnish, and/or sealant placement; and
4.1.10.20.2. A schedule of any in-service trainings and/or scheduled quality assurance
checks;
4.1.10.21. Prepare and submit a Monthly Activity Report to include:
4.1.10.21.1. The number of children by site who received preventive dental services in
the previous month, outlining which type of service was received; and
4.1.10.21.2. Quality Assurance activities, including a training attendance list;
4.1.10.22. Prepare and submit a Contractor's Expenditure Report (CER) and supporting documents,
provided by OOH, to be signed by the Chief of the Office of Oral Health or designee
before submitting to ADHS Accounting Office for payment. Payment shall be made in
monthly payments based on the number of hours screened (for specified survey
activities), the number of children treated, or the service provided multiplied by the
contract rate. Payment for the number of children sealed shall be based on the number of
approved sealant encounter forms received by OOH during the month that indicates
sealants were placed. A month shall be defined as a calendar month, e.g. March 1st –
March 31st,
4.1.10.23. Utilize the OOH Quality Assurance Plan, or, develop or update, and implement, a Quality
Assurance (QA) Plan to include:
4.1.10.23.1. Sealant retention, goal of eighty-five percent (85%) or better;
4.1.10.23.2. Infection control, OSHA compliant;
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4.1.10.23.3. QA monitoring forms;
4.1.10.23.4. Schedule of QA checks and equipment maintenance;
4.1.10.23.5. Equipment Maintenance log;
4.1.10.23.6. Protocol to be followed if acceptable performance measures are not being
met;
4.1.10.23.7. Training agenda; and
4.1.10.23.8. Other topics determined necessary by ADHS and/or the Contractor.
4.1.10.24. Prepare and submit an Annual Report to include:
4.1.10.24.1. Identification of any barriers, or recommendations for, achieving program
goals;
4.1.10.24.2. Annual budget narrative and justification of expenditures by January 15th
of each year; and
4.1.10.24.3. A summary of the progress made toward accomplishing the tasks set forth
in the Quality Assurance Plan.
4.2. Dental Assistant(s) shall:
4.2.1. Transport equipment and supplies;
4.2.2. Provide chair-side dental assisting;
4.2.3. Record dental findings as instructed by dentists and dental hygienists;
4.2.4. Adhere to infection control protocols;
4.2.5. Educate clients and families; and
4.2.6. Distribute referral and health insurance information.
4.3. Dental Hygienist(s), Public Health or Affiliated Practice Dental Hygiene (s) shall:
4.3.1. Follow standing orders as provided by affiliated practice agreement
4.3.2. Transport equipment and supplies;
4.3.3. Collect oral health data using OOH standardized protocol;
4.3.4. Provide OOH authorized dental prevention services;
4.3.5. Apply dental sealants and/or fluoride varnish;
4.3.6. Adhere to infection control protocols;
4.3.7. Educate clients and families;
4.3.8. Distribute referral and health insurance information; and
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4.3.9. Provide program consultation, as requested.
4.4. Dentist(s) shall:
4.4.1. Serve as affiliated practice dentist if applicable;
4.4.2. Transport equipment and supplies;
4.4.3. Collect oral health data using OOH standardized protocol;
4.4.4. Provide OOH authorized dental prevention services;
4.4.5. Adhere to CDC infection control protocols;
4.4.6. Educate clients and families;
4.4.7. Distribute referral and health insurance information;
4.4.8. Provide program consultation, as requested;
4.4.9. Maintain AHCCCS enrollment; and
4.4.10. Provide standing orders for public health dental hygienists to apply sealants and fluoride varnish to
children enrolled in the program.
5. REQUIREMENTS:
The Contractor shall:
5.1. Maintain confidentiality
5.1.1. All data, forms, and supporting documentation for the program-related activities shall remain the
ownership of ADHS;
5.1.2. All materials containing information that could identify an individual shall be kept confidential
including but not limited to, paper, electronic documents, databases, and audio/visual tapes;
5.1.3. Confidential information shall be kept in an inaccessible location at all times except when being
worked on during business hours;
5.1.4. Confidential information shall not be released to or discussed with anyone other than authorized
individuals;
5.1.5. All confidential information shall be disposed of by either shredding or incineration; and
5.1.6. All employees and subcontractors must sign a confidentiality form to be kept on file for the duration
of their affiliation with the Contractor.
5.2. Obtain approval from OOH for any marketing, educational, and/or referral materials to be used in the
program.
5.3. Adhere to the policies and procedures as set forth in the appropriate dental prevention program Provider
Manual/Protocol (reference Provision Seven (7) Reference Documents).
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CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
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5.4. Utilize all dental prevention program forms as provided by OOH. No alterations shall be permitted without
authorization from OOH Prevention Program Manager or designated person.
5.5. Ensure correspondence with schools, parents, and/or partners (including, but not limited to, county
governments, sub-recipients and other agencies) includes the following statement: “The Arizona School-
based Sealant Program is funded by the Arizona Department of Health Services, Office of Oral Health”.
5.6. Special Programmatic Requirements
5.6.1. Schools shall be chosen on the basis of participation: and prioritized from highest to lowest. There
shall be a minimum of fifty (50) children with signed consent forms to schedule the school for a
screening. At least twenty-five (25) children shall be eligible for sealants. Any services provided to
schools with fewer than fifty (50) signed consents shall be approved by the Chief of the Office of
Oral Health prior to providing services.
6. STATE PROVIDED ITEMS:
OOH will provide:
6.1. Dental Prevention Program Provider Manual/ Protocol for each provider as related to each prevention
program the provider is participating;
6.2. Expenditure Report (CER);
6.3. Master copies of forms, report templates, protocols, and polices required to be used in the particular
prevention Program;
6.4. Portable dental equipment, unless provided by the Contractor. All portable equipment are to be returned in
working condition, to OOH upon termination of contract.
6.5. Sealant Program Guidelines and Communications Manual;
6.6. Market the Arizona School-based Sealant Program and/or other dental prevention programs to qualified
sites.
6.7. Provide a list of eligible sites;
6.8. Monitor sealant retention results;
6.9. Provide annual sealant retention checklist to Contractor;
6.10. Provide standardized training for program implementation and data collection;
6.11. Provide periodic Technical Assistance Meetings for Contractors;
6.12. Conduct random quality assurance checks, including site visits; and
6.13. Ensure dental providers are linked to appropriate health plans.
7. REFERENCE DOCUMENTS:
7.1. Arizona Sealant Program Provider Manual (reference Provision Six (6) State Provided Items);
7.2. ADHS Fluoride Varnish Program protocol (reference Provision Six (6) State Provided Items);
7.3. ADHS Surveillance protocol (reference Provision Six (6) State Provided Items);
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CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
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7.4. ADHS Education protocol (reference Provision Six (6) State Provided Items);
7.5. OOH Guidelines and Communications Manual; and
7.6. OOH Waterline Testing Manual.
8. APPROVALS:
8.1. The Chief of the Office of Oral Health or designated Program Manager shall have the final approval of all
items submitted by the Contractor.
9. DELIVERABLES:
Any required lists or reports may be submitted electronically. Any correspondence including Protected Health
Information (PHI) shall adhere to HIPAA security rules.
The Contractor shall submit:
9.1. A Provider List, due ten (10) days after Arizona School-based Sealant Program provider training;
9.2. AHCCCS Provider Information, due thirty (30) days prior to a dentist/AP dental hygienist providing service in
the Arizona School-based Sealant Program;
9.3. Data Forms within ten (10) business days after completion of each school or community site;
9.4. Monthly Activity Reports by the tenth (10th) business day of the following month to include:
9.4.1. Health fairs attended;
9.4.2. Community outreach activities; and
9.4.3. List of schools included on CER.
9.5. Monthly Planning Reports by the twenty-fifth (25th) of each month for the upcoming month;
9.6. Quality Assurance Plan along with Annual Report, due thirty (30) days after the end of each school year;
9.7. Completed Expenditure Report (CER) with supporting documents due by the fifteen (15th) of the month
following the calendar month that the services were provided;
9.8. Annual Report within thirty (30) days after the end of each Contract year;
9.9. Copies of school applications to OOH within thirty (30) days of receipt. Copies may be transmitted
electronically, or hard copies are also acceptable; and
9.10. The contractor shall submit a log to the OOH within thirty (30) days of a completed Waterline test.
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CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
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10. NOTICES, CORRESPONDENCE, REPORTS, AND INVOICES
10.1. Notices, Correspondence, Reports and Invoices/CER’s from the Contractor to ADHS shall be sent to:
Arizona Department of Health Services
Bureau of Women’s and Children’s Health (BWCH)
Office of Oral Health
150 North 18th Avenue, Suite #320
Phoenix, Arizona 85007
Phone: (602) 364-1431
Email: polar.akoi@azdhs.gov
10.2. Invoices shall be emailed to: invoices@azdhs.gov
10.3. Notices, Correspondence, Reports and Payments from ADHS to the Contractor shall be sent to:
Maricopa County Public Health Department
Maricopa County Public Health
Attn: Cheryl Rentscheler
4041 North Central Avenue, Suite #1400
Phoenix, Arizona 85012
Phone: (602) 506-6886
Fax: (602) 506-6885
Email: cherylrentscheler@mail.maricopa.gov
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CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS18-175153 PRICE SHEET
ORAL HEALTH DENTAL SEALANT SERVICES
LINE DESCRIPTION OF SERVICE UOM TOTAL
ITEM
1 DENTAL SEALANT SERVICES Sealant Applied Per Child $75.00
Total cost per sealant to include the following:
• Sealant dental staff and services including travel, supplies,
training, indirect/direct costs.
• Administrative personnel coordination of Sealant program and
participation in an External Advisory Group.
• Cost of Dentist providing standing orders for public health
hygienist.
2 FLUORIDE VARNISH SERVICES Per Fluoride Application $8.00
3 ORAL HEALTH DATA COLLECTION, DENTAL HYGIENIST Per Hour Per Provider $30.00
4 ORAL HEALTH DATA COLLECTION, DENTAL ASSISTANT Per Hour Per Provider $18.00
5 COST EFFECTIVENESS EVALUATION Each $13,324.00
CUSTOMER SATISFACTION SURVEY AND ASSESSMENT
6 RESULTS Each $13,324.00
7 PROGRAM IMPLEMENTATION ANALYSIS AND ASSESSMENT Each $13,324.00
Authorization for Provision of Services:
Authorization for purchase of services under this Contract shall be made only upon ADHS issuance of a Purchase
Order that is signed by an authorized agent. The Purchase Order will indicate the Contract number and the dollar
amount of funds authorized. The Contractor shall only be authorized to perform services up to the amount of the
Purchase Order. No further obligation shall exist on behalf of ADHS unless:
a) The Purchase Order is changed or modified with an official ADHS Procurement Change Order, and/or
b) An additional Purchase Order is issued for purchase of services under this Contract.
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