ADHS FOR NURSE FAMILY PRTNRSHP AMD 4 (09).PDF

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 North 18th Avenue, Suite 280
Phoenix, Arizona 85007
(602) 542-1040
C-86-12-082-3-09 (602) 542-1741 Fax
Procurement Officer:
Contract No: ADHS12-023419 Amendment No. 4
Russell Coplen
Nurse Family Partnership
Effective July 1, 2016, it is mutually agreed that the Agreement referenced is amended as follows:
1. Pursuant to the Terms and Conditions, Section 6, Contract Changes, Amendments, Purchase Orders and
Change Orders, Section 6.1, the Scope of Work is revised and replaced with the Scope of Work of this
Amendment Four (4).
2. Pursuant to the Terms and Conditions, Contract Changes, Section 6, Amendments, Purchase Orders and
Change Orders, Section 6.1, the Price Sheet is revised and replaced with the Price Sheet of this Amendment
Four (4). Payments from ADHS to the Contractor shall be sent to the “Remit To” Address listed on the
Contractor’s ProcureAZ vendor profile.
All other provisions shall remain in their entirety.
CONTRACTOR SIGNATURE
Maricopa County by and through the
Maricopa County Department of Public Health
Contractor Name Contractor Authorized Signature
4041 N. Central Ave. Suite 1400 Clint Hickman
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 Procurement Officer
Attorney General Contract No. P0012014000078, which is an RESERVED FOR USE BY THE SECRETARY OF STATE
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
Attorney General Office:
ATTEST:____________________________________
Page 1 of 14

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 North 18th Avenue, Suite 280
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS12-023419 Amendment No. 4 Procurement Officer
Russell Coplen
Nurse Family Partnership- Maricopa County
Scope of Work
1. Definitions
1.1. “ADE” refers to the Arizona Department of Education.
1.2. “ADES” refers to Arizona Department of Economic Security.
1.3. “ADHS” refers to the Arizona Department of Health Services.
1.4. “ADHS Evaluators” refers to the internal and external evaluators working for ADHS on the Maternal, Infant,
and Early Childhood Home Visiting Program (MIECHV).
1.5. “AZETO” refers to the Arizona Efforts to Outcomes; Efforts to Outcomes is the Arizona Coordinated Home
Visitation Data Management System.
1.6. “Benchmark” for the purpose of this document means the Benchmarks laid out by Health Resources
Service Administration (HRSA) in the Supplemental Information Request and further clarified in the Updated
Plan. This definition includes any updates HRSA makes to these Benchmarks. This includes all the
constructs which are parts of the Benchmarks.
1.7. “Community Health Analysis Area (CHAA)” A geographical unit of measurement identified by the Arizona
Department of Health Services Bureau of Public Health Statistics for disease surveillance and built from US
2000 Census Block Groups. See fuller description in the Needs Assessment found in Reference
Documents.
1.8. “Capacity” for the purpose of this document is defined by the federal funder as the total number of families
that can be served at any point and time by a Local Implementing Agency and is determined by the number
of contracted Family Support Specialists or Home Visitors.
1.9. “CQI” refers to Continuous Quality Improvement.
1.10. “FTE” refers to Full Time Equivalent staffing positions.
1.11. “HRSA” refers to Health Resources and Services Administration.
1.12. “IALT” refers to Interagency Leadership Team.
1.13. “LIA” refers to the Local Implementing Agency(ies) in which the Maricopa County Department of Public
Health contracts to for the implementation and delivery of services of the Nurse Family Partnership program
with Maternal, Infant and Early Childhood Home Visiting grant funding.
1.14. “MCDPH” refers to Maricopa County Department of Public Health.
1.15. “MIECHV” refers to Maternal, Infant and Early Childhood Home Visiting.
1.16. “Model” refers to the Nurse Family Partnership model as outlined by Nurse Family Partnership.
1.17. “NFP” refers to Nurse Family Partnership.
1.18. “Program Manager” refers to the ADHS Maternal, Infant, and Early Childhood Home Visiting Program
Manager.
Page 2 of 14

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 North 18th Avenue, Suite 280
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS12-023419 Amendment No. 4 Procurement Officer
Russell Coplen
1.19. “Site” refers to a location offering Nurse Family Partnership under this contract.
1.20. “Updated Plan” refers to the State Updated Plan and any of its updates.
1.21. “Target CHAAs” are the CHAAs outlined in this contract for receiving services and additional CHAAs as
approved by the Program Manager and ADHS.
1.22. “Task Force” refers to the Early Childhood Home Visiting Task Force.
2. Background
2.1. The Arizona Department of Health Services (ADHS) Bureau of Women's and Children's Health (BWCH)
supports efforts to improve the health of Arizona women and children. Within BWCH, the Office of
Children's Health supports the increased focus within the state and nation on the importance of early
childhood programs. It also supports enhanced integration of existing children’s programs both within the
Arizona Department of Health Services and among other state and federal agencies and our outside
partners. The Office of Children’s Health within the Bureau administers the Affordable Care Act (ACA)
Maternal, Infant and Early Childhood Home Visiting federal grant funded by Health Resources and Services
Administration (HRSA). The Maternal, Infant and Early Childhood Home Visiting Program (MIECHV) is
funded entirely through federal funds.
2.2. The goal of the Maternal, Infant and Early Childhood Home Visiting Program is to deliver evidence based
home visiting models to communities identified to be at risk through the Needs Assessment developed as a
requirement for the grant. HRSA commissioned a study by Mathematic to determine which models of home
visiting were considered evidence based. Based on these findings, HRSA determined which models would
be eligible for funding. It was then up to the states to determine which of the evidence based models fit their
needs.
2.3. In October 2009, the Arizona Early Childhood Development and Health Board, also known as First Things
First, along with ADHS, the Arizona Department of Economic Security (DES), and the Arizona Department
of Education (ADE) and community providers of home visiting services convened an Early Childhood Home
Visiting Task Force (Task Force).
2.4. The purpose of the Task Force was to define a system-wide strategy for the future development and
delivery of quality home visiting services throughout Arizona. After several focused meetings, the Task
Force produced a plan, titled The Vision for Early Childhood Home Visiting Services in Arizona. The Plan
hoped to provide a pathway for delivery of consistent, high quality home visiting services in the context of
Arizona’s statewide early childhood development and health system.
2.5. While the Task Force was a start for Arizona; when the ACA Maternal, Infant and Early Childhood Home
Visiting statute was passed, the ADHS called together the state agencies that provide early childhood home
visiting to begin work on the grant opportunity. Included in this group was representation from the Title V
agency and the state’s Single State Agency for Substance Abuse, which are housed within ADHS; the
state’s Head Start Collaboration Director, the Arizona Department of Education; the state’s Title II agency,
the Arizona Department of Economic Security; which serves as the state’s child care and child welfare
agency; the Intertribal Council of Arizona (ITCA) and senior management from Arizona’s Early Childhood
Development and Health Board. This group is now referred to as the Inter Agency Leadership Team
(IALT). These agencies are Early Childhood Comprehensive System stakeholders as well and several
members serve on Project LAUNCH’s State Advisory Council.
2.6. The IALT committed to work together on the process of developing a statewide system of evidence based
home visiting. This collaborative decision making guided the needs assessment process, the development
Page 3 of 14

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 North 18th Avenue, Suite 280
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS12-023419 Amendment No. 4 Procurement Officer
Russell Coplen
of the Updated Plan and built on the earlier plan for early childhood home visiting in a concerted effort to
best serve the most at risk families of Arizona. This agreement seeks to implement the actions and
measures discussed in the Updated Plan and subsequent grant applications.
2.7. The evidence based models chosen for implementation as part of this plan were Healthy Families and
Nurse Family Partnerships. Once a community is selected by the IALT to receive evidence based home
visiting, a meeting is held in the local community, At the meeting the community has input and in fact
makes the decision on which model will be implemented based on the their needs and resources. In the
target CHAAs in Maricopa, the local communities chose to implement Healthy Families and Nurse Family
Partnership. This contract covers the implementation of Nurse Family Partnership in target areas of
Maricopa.
3. Objective
To provide evidence based home visiting services through the Nurse Family Partnership model to eligible women in
Maricopa County and to evaluate the process and outcome of the implementation of the model.
4. Scope of Work
4.1. The Contractor shall assume the responsibility for the provision of a home visitation program delivering the
Nurse Family Partnership model to pregnant women and young children in targeted communities. Based on
the potential volume of women to be enrolled, the contractor shall partner with Southwest Human
Development, the other authorized provider of NFP in Maricopa County, to implement this program. The
Contractor shall also collect and report all required data, including but not limited to, the requirements
outlined in the Updated State Plan and subsequent grant applications. The Contractor shall also participate
in ongoing evaluation, monitoring, and CQI activities through the ADHS evaluator. This agreement is funded
through the Affordable Care Act Maternal, Infant and Early Childhood Home Visiting grant awarded to
ADHS through HRSA.
4.2. Target CHAAs under this agreement include: Camelback East, Alhambra, Central City, Glendale Central,
Mesa East, Mesa West, Avondale, Estrella, Glendale North, Glendale West, and Surprise. Additional
CHAAs can be included under this agreement when decided upon by ADHS prior to implementation and
based on the needs assessment.
5. Tasks
The Contractor shall:
5.1. Develop an updated implementation plan within forty-five (45) days of contract execution. The plan shall
include, but not limited to activities or strategies and schedules for:
5.1.1. Working with the national model developer and a description of the technical assistance and
support to be provided through the national model;
5.1.2. Recruiting, hiring, and retaining appropriate staff for all positions including number of positions to be
hired;
5.1.3. Ensuring high quality clinical supervision and reflective practice for all home visitors and
supervisors;
5.1.4. Obtaining the curriculum or other materials needed to implement the NFP with fidelity;
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ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 North 18th Avenue, Suite 280
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS12-023419 Amendment No. 4 Procurement Officer
Russell Coplen
5.1.5. Providing initial and ongoing training and professional development activities including a description
of how and what type of training will be provided by or through the Contractor and/or the model
developer;
5.1.6. Identifying, screening, and recruiting participants;
5.1.7. Conducting individualized assessments of participant families including a description of what
assessments will be used and how services will be provided in accordance with those individual
assessments;
5.1.8. Assuring that services will be provided on a voluntary basis;
5.1.9. Assuring that priority will be given to serve eligible participants who:
5.1.9.1. Have low incomes,
5.1.9.2. Are pregnant women who have not attained age twenty-one (21),
5.1.9.3. Have a history of child abuse or neglect or have had interactions with child welfare
services,
5.1.9.4. Have a history of substance abuse or need substance abuse treatment,
5.1.9.5. Are users of tobacco products in the home,
5.1.9.6. Have, or have children with, low student achievement,
5.1.9.7. Have children with developmental delays or disabilities, and
5.1.9.8. Are in families that include individuals who are serving or have formerly served in the
armed forces, including such families that have members of the armed forces who have
had multiple deployments outside of the United States;
5.1.10. Estimating and tracking the number of families served monthly and annually;
5.1.11. Minimizing the attrition rates for participants enrolled in the program by maintaining no more than
35% attrition;
5.1.12. Estimating a timeline to reach maximum caseload in each location and maintaining program
capacity no less than 85%;
5.1.13. Operationalizing the coordination between the proposed home visiting program(s) and other
existing programs and resources in those communities, especially regarding health, mental health,
early childhood development, substance abuse, domestic violence prevention, child maltreatment
prevention, child welfare, education, and other social and health services;
5.1.14. Establishing a system of referrals for families with identified needs, including follow up to ensure
referred services were received;
5.1.15. Developing, maintaining and updating a list of collaborative public and private partners;
5.1.16. Monitoring data for quality;
Page 5 of 14

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 North 18th Avenue, Suite 280
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS12-023419 Amendment No. 4 Procurement Officer
Russell Coplen
5.1.17. Measuring family satisfaction with visits;
5.1.18. Participating in the MIECHV CQI committee;
5.1.19. Anticipating challenges to maintaining quality and fidelity, and responding to the issues identified;
5.1.20. Describing data collection instruments, data entry, management of case notes, and data quality
assurance process; and
5.1.21. Working with ADHS evaluation team in the external evaluation of the MIECHV program in Arizona.
5.2. Implement the Nurse Family Partnership model and provide home visits:
5.2.1. Implement the plans referenced above, reporting progress and any changes to ADHS as discussed
in the reporting section below;
5.2.2. Ensure program implementation and set-up period in new areas does not exceed ninety (90) days;
5.2.3. Work with the national model developer(s) to ensure fidelity to the model;
5.2.4. Provide NFP in accordance with the specifications of the national model;
5.2.5. Maintain NFP accreditation;
5.2.6. Recruit, hire, train, and retain appropriate staff for all positions;
5.2.7. Ensure high quality clinical supervision and reflective practice for all home visitors and supervisors;
5.2.8. Obtain the curriculum or other materials needed;
5.2.9. Provide initial and ongoing training and professional development activities to the local
implementing agencies, or obtained from the national model developer;
5.2.10. Identify and recruit participants, maintaining program goal of no less than 85% capacity. Caseload
capacity total for this contract is 300 with 187 caseload capacity for MCDPH and 113 caseload
capacity for LIA;
5.2.11. Conduct individualized assessments of participant families and provide services in accordance with
those individual assessments;
5.2.12. Provide services to eligible families on a voluntary basis;
5.2.13. Ensure priority will be given to serve eligible participants who:
5.2.13.1. Have low incomes,
5.2.13.2. Are pregnant women who have not attained age twenty-one (21),
5.2.13.3. Have a history of child abuse or neglect or have had interactions with child welfare
services,
5.2.13.4. Have a history of substance abuse or need substance abuse treatment,
Page 6 of 14

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 North 18th Avenue, Suite 280
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS12-023419 Amendment No. 4 Procurement Officer
Russell Coplen
5.2.13.5. Are users of tobacco products in the home,
5.2.13.6. Have, or have children with, low student achievement,
5.2.13.7. Have children with developmental delays or disabilities, and
5.2.13.8. Are in families that include individuals who are serving or have formerly served in the
armed forces, including such families that have members of the armed forces who have
had multiple deployments outside of the United States;
5.2.14. Minimize the attrition rates for participants enrolled in the program by maintaining no more than
35% attrition;
5.2.15. Coordinate the proposed home visiting program(s) and other existing programs and resources in
those communities, especially regarding health, mental health, early childhood development,
substance abuse, domestic violence prevention, child maltreatment prevention, child welfare,
education, and other social and health services;
5.2.16. Develop partnerships with above mentioned entities;
5.2.17. Establish a list of collaborative public and private partners;
5.2.18. Provide referrals to community resources for families with identified need(s);
5.2.19. Collect data, provide data to ADHS Evaluation team, and participate in CQI including but not limited
to:
5.2.19.1. Enter into a Data Sharing Agreement with ADHS to provide needed data,
5.2.19.2. Track that referred services were received or document the reason why the services
were not received,
5.2.19.3. Collect all data as required by ADHS for this program as per the Updated State Plan and
any revised plans (including data and evaluation plans developed for the MIECHV
program) and submit all data to the ADHS evaluation team and when applicable to cross
site evaluation team,
5.2.19.4. Measure client satisfaction with home visiting service,
5.2.19.5. Participate in CQI committee,
5.2.19.6. Work with ADHS Evaluators to modify data collection forms or provide additional
information to capture all required data including benchmarks and demographics required
for the MIECHV program, and
5.2.19.7. Ensure that all of the Program forms and visit notes are kept in a locked location and are
transported in a locked file.
5.3. Meet program and reporting requirements including but not limited to:
5.3.1. Be responsive and ensure timely response to ADHS Program Managers and Evaluators to any
request for clarification, documentation, reports and/or any questions regarding program
implementation and evaluation;
Page 7 of 14

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 North 18th Avenue, Suite 280
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS12-023419 Amendment No. 4 Procurement Officer
Russell Coplen
5.3.2. Ensure that all required staff attend ADHS sponsored meetings, trainings, and conference calls
and/webinars as directed;
5.3.3. Provide additional information and data when requested by the Program Manger or by the
Evaluators in the format and medium requested;
5.3.4. Submit invoices for services on a monthly basis;
5.3.5. Submit required reports on a monthly basis (see Deliverables) in compliance with federal reporting
requirements;
5.3.6. When providing services in a community also served by other home visiting services, the
Contractor shall work with the other home visiting programs to ensure that client is enrolled in the
program that best meets their needs and that there are selection criteria and standardized
processes for referring families from one program to another;
5.3.7. If the Contractor/subcontractor has another Contract, Grant, or Subcontract that administers and/or
provides a similar home visiting program in the targeted service area or adjoining service areas,
they must provide a detailed description of the other funded programs including staffing, funding
source and clearly identify how the program(s) will not duplicate services and/or home visiting
services to the targeted communities that are being proposed through the ADHS Home Visiting
Program. It will also state how the two (2) separate funding sources will be tracked; and
5.3.8. The Contractor agrees will provide a written plan to ADHS about how the contractor has divided
work with the Sub-Contractors, and which entity will be serving which areas.
5.4. Complete contract monitoring of each LIA biannually that includes the following components:
5.4.1. Programmatic Quality Assurance:
5.4.1.1. Submission of completed and accurate monthly reports SEE EXHIBIT A,
5.4.1.2. Ensure high quality clinical supervision and reflective practice for home visitors and
supervisors is provided in accordance with model requirements,
5.4.1.3. Ensure all LIA sites are utilizing a model approved curriculum;
5.4.1.4. Ensure home visitors are receiving model-specific initial and ongoing training as required
by the national model developers and DCS CA,
5.4.1.5. Ensure enrolled clients are appropriately identified, screened, and consent forms, if
applicable, are signed and on file,
5.4.1.6. LIA site supervisors and/or an individual identified by the site supervisor to participate in
monthly CQI calls and reporting, and
5.4.1.7. Ensure all LIA sites maintain fidelity to the model.
5.4.2. Administrative Quality Assurance:
5.4.2.1. Completion of annual inventory with items reported to ADHS,
Page 8 of 14

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 North 18th Avenue, Suite 280
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS12-023419 Amendment No. 4 Procurement Officer
Russell Coplen
5.4.2.2. I-9 forms on file for all program staff,
5.4.2.3. Data is entered and cleaned in accordance with this contract,
5.4.2.4. Trainings paid for with MIECHV funded receive prior approval from ADHS,
5.4.2.5. Materials created utilizing MIECHV funding are pre-approved prior to production and
include the ADHS Logo, Strong Families AZ Logo, and funded by language accordingly,
and
5.4.2.6. Written copy of a pandemic plan.
5.4.3. Fiscal Quality Assurance:
5.4.3.1. Examine a sample of expenditures incurred during a quarter of the federal fiscal year to
ensure all purchases are allowable in accordance to the MIECHV grant,
5.4.3.2. LIA sites requiring an audit report must retain and submit a copy of the audit report on an
annual basis to the MIECHV Program Manager,
5.4.3.3. Appropriate back up documentation for invoices provided, and
5.4.3.4. Timely submission of invoices.
5.5. Provide a copy of policies and procedures for contract monitoring compliance.
5.6. LIA Site Supervisors or site identified individual to participate in statewide CQI committee including
attendance in monthly meetings, reporting, and projects as requested.
6. Deliverables
The Contractor shall deliver to ADHS:
6.1. Implementation Plan:
6.1.1. An updated implementation plan is due to ADHS by the end of the first forty-five (45) days of
contract execution; and
6.1.2. Changes to the implementation plan need to reported to the Program Manager and approved
before being implemented.
6.2. Monthly Invoices:
6.2.1. Monthly invoices are due within twenty-one (21) days following the end of the service month to the
program manager; and
6.2.2. Include all information as directed by Program Manager on invoices. For staff training beyond what
is required by the model, documentation of attendance shall be provided including a Certificate of
Attendance and copy of e-mail prior approval from ADHS.
Page 9 of 14

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 North 18th Avenue, Suite 280
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS12-023419 Amendment No. 4 Procurement Officer
Russell Coplen
6.3. Monthly Progress:
6.3.1. Monthly Progress Reports due within twenty-one (21) calendar days following the end of the month
using the ADHS form provided;
6.3.2. Monthly progress reports that shall include a brief narrative of key achievements and any issues
with funded sites. The monthly report should outline successes and challenges including, but not
limited to:
6.3.2.1. Current number of active families,
6.3.2.2. Current number of outreach families,
6.3.2.3. Number of new families enrolled during the reporting month,
6.3.2.4. Number of families to disengage in service during the reporting month,
6.3.2.5. Total number of home visits,
6.3.2.6. Number of MIECHV funded FTE home visitors, supervisors, and other staff currently
employed and number of vacancies,
6.3.2.7. Reason for families to disengage in services,
6.3.2.8. Sources referrals are received from and conversion to enrollment,
6.3.2.9. Referral to other community services, and
6.3.2.10. Narratives on:
6.3.2.10.1. Family recruitment and retention success and challenges;
6.3.2.10.2. Staff recruitment;
6.3.2.10.3. Staff training and supervision; and
6.3.2.10.4. Community Collaboration and Outreach.
6.3.3. The name, phone numbers, and resume of program staff if replaced, within twenty-one (21) days of
hire.
6.4. Annual Reports:
6.4.1. An annual report at time specified in the reporting plan shall include:
6.4.1.1. Update on work-to-date with national model developer(s) and a description of the
technical assistance and support provided to-date through the national model(s),
6.4.1.2. Based on the timeline provided in Updated State Plan, an update on securing curriculum
and other materials needed for the home visiting program,
6.4.1.3. Update on training and professional development activities obtained from the national
model developer, or provided by the State or the implementing local agencies,
Page 10 of 14

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 North 18th Avenue, Suite 280
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS12-023419 Amendment No. 4 Procurement Officer
Russell Coplen
6.4.1.4. Update on staff recruitment, hiring, training, and retention for all positions including
subcontracts,
6.4.1.5. Update on participant recruitment and retention efforts,
6.4.1.6. Family satisfaction with visit information,
6.4.1.7. Status of home visiting program caseload within each at-risk community,
6.4.1.8. Update on the coordination between home visiting program(s) and other existing
programs and resources in those communities including but not limited to: health, mental
health, early childhood development, substance abuse, domestic violence prevention,
child maltreatment prevention, child welfare, education, and other social and health
services, and
6.4.1.9. A discussion of challenges, both experienced and anticipated, to maintaining quality and
fidelity of each home visiting program, and the response to the issues identified.
6.5. Data
6.5.1. Contractor shall supply data to the ADHS evaluator and any cross site evaluation team within the
timeframe outlined in the data and evaluation plans and latest revisions thereof. This includes all
individual-level benchmarks, demographic and service-utilization data on the participants in the
program, which shall at least meet the federal requirements for individual-level data including, but
not limited to:
6.5.1.1. Family’s participation rate in the home visiting program, including but not limited to,
number of sessions/number of possible sessions and duration of sessions,
6.5.1.2. Demographic data for the participant child(ren), pregnant woman, expectant father,
parent(s), or primary caregiver(s) receiving home visiting services including: child’s
gender, age of all (including age in month for child) at each data collection point and
racial and ethnic background of all participants in the family,
6.5.1.3. Participant child’s exposure to languages other than English, and family linguistic
isolation,
6.5.1.4. Which, if any, priority populations the child or family belongs to,
6.5.1.5. Family socioeconomic indicators, including but not limited to, family income and
employment status,
6.5.1.6. Referrals made,
6.5.1.7. Referred services were received and, if not, what was the barrier and are the next steps,
6.5.1.8. Information required and identified in the benchmark section of the Updated Plan and
latest revisions thereof, the data and evaluation plans, and federal reporting
requirements, and
6.5.1.9. Additional information as requested by the federal funder.
Page 11 of 14

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 North 18th Avenue, Suite 280
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS12-023419 Amendment No. 4 Procurement Officer
Russell Coplen
6.6. Contractor shall ensure that the MIECHV funded NFP sites under this contract supply data to the AZETO
within two weeks of data collection.
6.7. Contractor shall ensure that the MIECHV funded NFP sites clean data in accordance with the most current
cleaning schedule.
6.8. Contractor shall provide a copy of all sub-recipient contracts for MIECHV funded NFP sites;
6.9. Contractor shall provide a copy of all annual site reviews for MIECHV funded NFP sites;
6.10. Contractor shall provide a copy of biannual contract monitoring summaries; and
6.11. Contractor shall annually submit the Federal Funding Accountability and Transparency Act of 2006 (FFATA)
report within forty-five (45) days of purchase order execution.
7. Requirements
The Contractor shall:
7.1. Be able to become an authorized NFP site within 90 days of the contract becoming effective, this includes
meeting all requirements from the national Nurse Family Partnership office for becoming an authorize NFP
site and maintaining authorization; and
7.2. Meet all requirements of NFP to implement the model with fidelity and ensure fidelity to the model is
maintained.
8. Approvals
8.1. Monthly Contractor’s Expenditure Report (invoice/CER) shall be approved by ADHS prior to payment.
8.2. Monthly Report.
8.3. All marketing or educational materials, and promotional items, media or forms including, but not limited to,
brochures, posters, publications or journal articles developed using funds awarded under this Contract shall
be approved by ADHS Program Manager prior to printing.
8.3.1. All marketing or educational materials shall bear the following “Funded in part by the Bureau of
Women’s and Children’s Health as made available through the Arizona Department of Health
Services, through the DHHS Maternal, Infant and Early Childhood Home Visiting Program.
8.4. This program is fully funded by Federal funds so the HHS Appropriation Act requirements shall be followed.
The HHS Appropriations Act requires that when issuing statements, press releases, requests for proposals,
bid solicitations, and other documents describing projects or programs funded in whole or in part with
Federal money, all grantees receiving Federal funds, including but not limited to, State and local
governments, shall clearly state the percentage of the total costs of the program or project which will be
financed with Federal money, the dollar amount of Federal funds for the project or program, and percentage
and a dollar amount of the total costs of the project or program that will be financed by non-governmental
sources.
8.5. Contractor shall acquire approval from ADHS before any expansion to any new sites or expansion of
existing sites.
Page 12 of 14

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 North 18th Avenue, Suite 280
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS12-023419 Amendment No. 4 Procurement Officer
Russell Coplen
9. Reference Documents
The following documents are available from ADHS:
9.1. Supplemental Information Report;
9.2. Arizona’s Maternal, Infant and Early Childhood Updated Plan;
9.3. Data Plan; and
9.4. Forms (data and report forms as referenced above upon completion by ADHS, subject to updating).
10. Notices, Correspondence and Reports
10.1. Notices, correspondence, reports and invoices from the Contractor to ADHS shall be sent to:
Jessica Stewart
Arizona Department of Health Services
Maternal, Infant and Early Childhood Home Visiting Program Manager
150 North 18th Avenue, Suite 320
Phoenix, Arizona. 85007-3242
Phone: 602-364-1441
Email: Jessica.stewart@azdhs.gov
10.2. Notices, Correspondence and Payments from ADHS to the Contractor shall be sent to:
Tracy Sloat, Nurse Manager, OFH
Maricopa County Department of Public Health
4041 N Central Ave, Suite 700
Phoenix, Arizona 85012
Phone: 602-506-0610
Fax: 602-506-6896
Email: tracysloat@mail.maricopa.gov
With a copy to:
Katherine Mason, Grant/Contract Specialist
Maricopa County Department of Public Health
4041 N Central Ave, Suite 1400
Phoenix, Arizona 85012
Phone: 602-372-0674
Fax: 602-506-6885
Email: dianecox@mail.maricopa.gov
Email: erikmiller@mail.maricopa.gov
Page 13 of 14

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 North 18th Avenue, Suite 280
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS12-023419 Amendment No. 4 Procurement Officer
Russell Coplen
PRICE SHEET
MIECHV Program, Nurse Family Partnership
October 1, 2016 to April 30, 2017
Cost Reimbursement Price Sheet
ACCOUNT CLASSIFICATION AMOUNT
Personnel $432,029.50
ERE $150,338.56
Professional & Outside Services $351,458.33
Travel Expense $10,791.67
Occupancy Expense $15,673.00
Other Operating Expense $11,112.50
Capital Outlay Expense-computers $291.67
Indirect (if authorized) $102,327.67
TOTAL $1,074,022.90
With prior written approval from the Program manager, the Contractor is authorized to transfer up to a maximum
of ten percent (10%) of the total budget amount between line items. Transfers of funds are only allowed between
funded line items. Transfers exceeding ten percent (10%) or to a non-funded line item shall require an
Amendment.
Page 14 of 14