AMENDMENT RE NICP COMMUNITY HEALTH NURSING WITH ADHS.PDF

461;v4N, ARIZONA DEPARTMENT OF
HEALTH SERVICES
CONTRACT AMENDMENT 1740 W. Adams, Room
) 303
Phoenix, Arizona 85007
. . {602) 542-1040
Procurement Specialist
Contract No: ADHS14-074958 Amendment No: 1 Sue-Anne Tan
HRPPIN1CP Community Health Nursing Services
Effective July, 1, 2015, It is mutually agreed that the Contract referenced is amended as follows:
1, Pursuant to Uniform Terms and Conditions, Provision Five (5), Contract Changes, Item 5.1, Amendments, the
current Line Item Pricing of the Contract is replaced with the revised Line Item Pricing of this Amendment One (1).
The Contract Item Pricing shall be revised in ProcureAZ to align with the available funding upon execution of this
Amendment One (1).
2, Delete in its entirety, Special Terms and Conditions, Provision Twenty (20), Health Insurance Portability and
Accountability Act of 1996 (HIPAA) and replace with the following:
20. Health Insurance Portability and Accountability Act of 1996 (HIPAA)
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.
Continued on next page
Contractor hereby acknowledges receipt and acceptance of The above referenced Contract Amendment is hereby
above amendment and that a signed copy must be filed with executed this day of , 2015 at
the Procurement Office before the effective date Phoenix, Arizona
Signature / Date
Authorized Signatory's Name and Title: Procurement Officer
Contractor's Name:
Maricopa County Public Health
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*MOO ARIZONA DEPARTMENT OF
HEALTH SERVICES
'Av ,-,.!-- I CONTRACT AMENDMENT 1740 W . Adams, Room
CI t;:7V v 303
Phoenix, Arizona 85007
(602) 542-1040
Procurement Specialist
Contract No: ADHS14-074958 Amendment No: 1 Sue-Anne Tan
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: (I) intended to make the Contractor proficient in HI PAA 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.
All other provisions shall remain in their entirety.
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ARIZONA DEPARTMENT OF
CONTRACT AMENDMENT HEALTH SERVICES
1-4V2— . 1740 W , Adams, Room
,pLi .'d• 303
Phoenix, Arizona 85007
(602) 542-1040
Procurement Specialist
Contract No: ADHS14-074958 Amendment No: 1 Sue-Anne Tan
HRPP/N1CP Community Health Nursing Services
As of July 1 , 2015
MARICOPA COUNTY PUBLIC HEALTH
Line Item Pricing
Type of Unit Rate per Unit Unit of Measure
Regular Home Visit $250.00 Per visit
Out of Town Home Visits $250.00 Per visit
Out of County Home Visits $250.00 Per visit
Interim Local Home Visits $205.00 Per visit
Shadowing Local Home Visits $100.00 Per visit
Family Local Home Visits $205.00 Per visit
Multi-Disciplinary Staffing Local Home Visits $205.00 Per visit
NICP / Other Sponsored Training - Local Per $205.00 Per Day
Person / Per Day
NICP / Other Sponsored Training - Non-Local $205.00 Per Day
Per Person / Per Day
Newborn Screening Follow-up Visit $250.00 Per Visit
Low Risk Letter - Price p/Ietter $20.00 Each
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