IGA AMD RE NURSE FAMILY PARTNERSHIP WITH ADHS.PDF

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 1740 W. Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Officer:
Contract No: ADHS12-023419 Amendment No. 3
Sue-Anne Tan
Nurse Family Partnership
Effective January 1, 2015, it is mutually agreed that the Agreement referenced is amended as follows:
1. The Price Sheet of Amendment Two (2) is replaced with the revised Price Sheet of this Amendment Three (3). The
Agreement Item Pricing shall be revised in ProcureAZ to align with available funding upon execution of this
Amendment Three (3). The Agreement line item pricing total is increased from $1,594,246.13 to $2,384,820.57 to
support the expansion of Nurse Family Partnership Home Visiting Services based on the following line item
changes:
1.1 Personnel increased by $289,776.70 for a total of $929,874.10. Additional staff is needed for the expansion;
1.2 ERE increased by $92,842.59 for a total of $305,165.35 due to additional staff;
All other provisions of this Agreement remain unchanged.
CONTRACTOR SIGNATURE
Maricopa County Department of Public Health
Contractor Name Contractor Authorized Signature
4041 N. Central Ave.
Address Printed Name
Phoenix AZ 85012
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 Under House Bill 2011, A.R.S. § 11-952
has determined that it is in proper form and is within the powers and
authority granted under the laws of the State of Arizona. was amended to remove the requirement
that Intergovernmental Agreements be filed
with the Secretary of State.
Signature Date
Attorney General Office:
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ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 1740 W. Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Officer
Contract No: ADHS12-023419 Amendment No. 3
Sue-Anne Tan
1.3 Professional and Outside Services increased by $311,359.00 for a total of $804,174.00. Maricopa County
Department of Public Health subcontracts to South West Human Development for additional services funded
through this grant. Additional funding is needed to support that subcontract;
1.4 Travel increased by $5,400.00 for a total of $27,300.00. The expansion of service area has increased the
amount of travel for Nursing Family Partnership nurses;
1.5 Occupancy Expense increased by $3,000.42 for a total of $13,600.00 to support the expansion of Nurse
Family Partnership Home Visiting Services;
1.6 Other Operating Expenses increased by $23,362.00 for a total of $83,750.00. Additional staff needs
additional telephones, office supplies, printing, copying, and program materials;
1.7 Capital Outlay Expense in now funded for the amount of $6,000.00. Additional staff needs additional office
equipment; and
1.8 Indirect (if authorized) increased by $58,833.73 for a total of $214,957.12 due to additional Staff.
2. Pursuant to Scope of Work, Provision A, Definitions, the following definition is added:
“MCDPH” refers to Maricopa County Department of Public Health.
3. Pursuant to Scope of Work, Provision A, Definitions, the following definition is deleted in its entirety:
“State Nurse Consultant” refers to the position of State Nurse Consultant as outlined by NFP NSO.
4. Pursuant to Scope of Work, Provision D, Scope of Work, the Second (2nd) paragraph is deleted in its entirety and
replaced with the following language:
Target Community Health Analysis Areas under this agreement include: Camelback East, Alhambra, Central
City, Glendale Central, Mesa East, Mesa West, Avondale, Estrella, Glendale North, Glendale West, and
Surprise. Additional Community Health Analysis Areas can be included under this agreement when decided
upon by ADHS prior to implementation and based on the needs assessment.
5. Pursuant to Scope of Work, Provision E, Tasks, the following tasks are revised to read as follows:
1.10. Estimating and tracking the number of families served monthly and annually;
1.11. Minimizing the attrition rates for participants enrolled in the program by maintaining no more than thirty-five
percent (35%) attrition;
1.12. Estimating a timeline to reach maximum caseload in each location and maintaining program capacity no less
than eighty percent (85%);
2.10. Identifying and recruiting participants, maintaining program goal of no less than eighty-five percent (85%)
capacity; and
2.14. Minimizing the attrition rates for participants enrolled in the program by maintaining no more than thirty-five
(35%) attrition.
6. Pursuant to Scope of Work, Provision E, Tasks, Section Five (5), is hereby deleted in its entirety.
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ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 1740 W. Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Officer
Contract No: ADHS12-023419 Amendment No. 3
Sue-Anne Tan
7. Pursuant to Scope of Work, Provision G, Reference Documents, Item Three (3) is revised to read as follows:
3. Data Plan.
8. Pursuant to Scope of Work, Provision H, Approvals, Item six (6) has been added:
6. Contractor shall acquire approval from ADHS before any expansion to any new sites or expansion of existing
sites.
9. Pursuant to Scope of Work, Provision I, Deliverables, Item 2.1 is revised to read as follows:
2.1 Monthly invoices are due within twenty-one (21) days following the end of the service month to the Program
Manager; and
10. Pursuant to Scope of Work, Provision I, Deliverables; Section 3.1 is deleted in its entirety and replace with the
following:
3.1 Monthly Progress Reports are due within twenty-one (21) days following the end of the month to the Program
Manager using the ADHS form provided and must include:
3.1.1 Caseload Capacity Information
3.1.1.1 Continuing families from previous month,
3.1.1.2 Active Families,
3.1.1.3 New families enrolled,
3.1.1.4 Closed families,
3.1.1.5 Home Visits,
3.1.1.6 Active Home Visitors,
3.1.1.7 Capacity percentage,
3.1.1.8 Attrition percentage, and
3.1.1.9 Annual numbers for federal fiscal year for total number of families served and closed
families;
3.1.2 Closure Reasons for families that disengaged from the program during the reporting month;
3.1.3 Identify specific referrals to other services;
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ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 1740 W. Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Officer
Contract No: ADHS12-023419 Amendment No. 3
Sue-Anne Tan
3.1.4 Provide narrative reporting
3.1.4.1 Recruitment successes and challenges including efforts to increase capacity if not reaching
program goal of eighty-five percent (85%),
3.1.4.2 Family retention successes and challenges including efforts to decrease family attrition if
over thirty-five percent (35%),
3.1.4.3 Staff recruitment and retention, and
3.1.4.4 Staff Training and Supervision.
11. Pursuant to Scope of Work, Provision I, Deliverables; Section 3.2 is deleted in its entity.
12. Pursuant to Scope of Work, Provision I, Deliverables; Section 3.3 is revised to read as follows:
3.2 The name, phone numbers, and resume of program staff if replaced, within twenty-one (21) days of hire.
13. Pursuant to Scope of Work, Provision J, Notices, Correspondence and Reports, Section One (1), has been revised
to read as follows:
1. Notices, correspondence, reports and invoices from the Contractor to ADHS shall be sent to:
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
14. Pursuant to Terms and Conditions, Provision Seven (7), Risk and Liability, Section 7.3 Indemnification – Patent
and Copyright, is hereby deleted in its entirety.
15. Pursuant to the Terms and Conditions, Provision Eighteen (18), Health Insurance Portability and Accountability Act
of 1996 of the IGA is hereby replaced with the following language:
18. 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.
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
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ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 1740 W. Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Officer
Contract No: ADHS12-023419 Amendment No. 3
Sue-Anne Tan
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.
16. Provision Twenty (20), Authorization for Provision of Services, is hereby added to the Terms and Conditions of the IGA:
20. Authorization for Provision of Services
Authorization for purchase of services under this Agreement shall be made only upon ADHS issuance of a
Purchase Order that is signed by an authorized agent. The Purchase Order will indicate the Agreement
number and the dollar amount of funds authorized. The Contractor shall only be authorized to perform
services up to the amount on the Purchase Order. ADHS shall not have any legal obligation to pay for
services in excess of the amount indicated on the Purchase Order. No further obligation for payment 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 Agreement.
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ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 1740 W. Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Officer
Contract No: ADHS12-023419 Amendment No. 3
Sue-Anne Tan
Price Sheet
As of January 1, 2015
Maricopa County Community Health Services
Cost reimbursement line item budget
ACCOUNT CLASSIFICATION AMOUNT
Personnel $929,874.10
ERE $305,165.35
Professional & Outside Services $804,174.00
Travel Expense $27,300.00
Occupancy Expense $13,600.00
Other Operating Expense $83,750.00
Capital Outlay Expense - Computers $6,000.00
Indirect Cost $214,957.12
TOTAL $2,384,820.57
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 a Contract Amendment.
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