AMD 1 RE HYPERTENSION AND DIABETES WITH ADHS.PDF

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT(IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Agreement No: ADHS16-113997 Amendment No. 1 Procurement Officer:
Russell Coplen
HYPERTENSION AND DIABETES SYSTEM OF CARE
Effective upon signature, it is mutually agreed that the Agreement referenced above is amended as follows:
1. Pursuant to Terms and Conditions, Provision 6. Contract Changes, Section 6.1 Amendments, Purchase Orders and
Change Orders, the Agreement Scope of Services is revised as follows:
1.1. Provision Two (2) Scope of Work, shall be replaced with the following:
The Contractor shall:
2.1 Implement a hypertension and diabetes system of care program. During the implementation of this
program, the Contractor shall partner with a community health center(s) to bring CHWs into the
healthcare team; and provide feedback to primary care physicians on the compliance of their patients.
Through this program, a patient that is at risk of, or has been diagnosed with hypertension or diabetes
(and pre-diabetes) will be enrolled into an educational hypertension/diabetes treatment and monitoring
program utilizing a community health worker system to ensure solid communication and follow-up
between the patient and the rest of the healthcare team. Additional referral requirements will be
followed as they apply to the specific patient’s needs, resources, and availability. Examples of these
programs are: Diabetes Self-Management Education Programs, Chronic Disease Self-Management
Programs, clinic, hospital or community-based support networks, etc.
Continued on next page.
CONTRACTOR SIGNATURE
Maricopa County by and through its,
Maricopa County Dept. of Health
Contractor Name Contractor Authorized Signature
4041 N. Central Ave. Clint L. Hickman
Address Printed Name
Phoenix AZ 85012 Chairman, Maricopa County 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
has determined that this Intergovernmental Agreement is in proper form commence any billable work or provide any material, service or
and is within the powers and authority granted under the laws of the construction under this IGA until the IGA has been executed by an
State of Arizona. authorized ADHS signatory.
State of Arizona
Signed this _________ day of _________________________ 2016
Signature Date
Printed Name Procurement Officer
Attorney General Contract No. P0012014000078, which is an
Agreement between public agencies, has been reviewed pursuant to
A.R.S. § 11-952 by the undersigned Assistant Attorney General, who
has determined that it is in proper form and is within the powers and
authority granted under the laws of the State of Arizona.
Signature Date
Assistant Attorney General
Printed Name:
ATTEST:
Page 1 of 2
__________________________________________________
Clerk of the Board Date

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT(IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Agreement No: ADHS16-113997 Amendment No. 1 Procurement Officer:
Russell Coplen
1.2. Provision three (3) Objectives is revised with the following:
3.1 Through this funding, the Contractor shall develop or improve a system of care that includes the
following by June 30, 2016:
3.1.1 Development of a CHW program with clinician oversight; within a community health clinic
setting whose patient and potential-patient census includes a majority of patients from the
following high-risk populations groups:
3.1.1.1 African American Women
3.1.1.2 Hispanic males;
3.1.1.3 Asian/Pacific Islanders; and
3.1.1.4 American Indians.
1.3. Provision Three (3) Objectives is revised as follows;
1.3.1. Delete sections: 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 3.10, and 3.11.
1.4. Provision Five (5) Deliverables and Delivery Schedule is revised as follows:
1.4.1. Delete sections: 5.1.1 and 5.1.2.
Page 2 of 2