IGA RE EMPOWER PLUS PROGRAM WITH ADHS.PDF

ARIZONA DEPARTMENT OF
8E HEALTH SERVICES
•,,, INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 1740 W. Adams, Room 303
cc 4.4 ''Z DITAT C. US Phoenix, Arizona 85007
E-. (602) 542-1040
(602) 542-1741 Fax
*• * Contract No: ADHS14-052676 Amendment No.1 Procurement Mr. Tracey Thomas Specialist
EMPOWER PLUS
Effective August 1, 2014, it is mutually agreed that the Intergovernmental Agreement referenced is amended as
follows:
1. Pursuant to Terms and Conditions, Provision Six (6), Contract Changes, Item 6.1, Amendments, Purchase
Orders and Change Orders, the Price Sheet of the Agreement is revised and replaced with the Price Sheet of
this Amendment One (1) on page seven (7),
2. Pursuant to Terms and Conditions, Provision Six (6), Contract Changes, Item 6.1, Amendments, Purchase
Orders and Change Orders, Scope of Work, Section 3, Scope of Work, is revised and replaced with the
following:
State trainers shall play a critical role in ensuring that the Empower PLUS curriculum is implemented effectively
and participating programs are supported in their ability to make sustainable policy and practice change.
Trainers will be responsible for the preparation of learning sessions, leading the learning sessions and providing
technical assistance to programs between sessions. Maricopa County Department of Public Health (MCDPH)
shall provide four (4) trainers to facilitate two (2) learning collaboratives in the Phoenix metro area. Additionally,
one (1) additional trainer shall be used for Scope of Work, Tasks, Section 4.1 only.
All other provisions of this agreement remain unchanged.
, CONTRACTOR SIGNATURE
Maricopa County Department of Health Services
Contractor Name Contractor Authorized Signature
4041 North Central Avenue
Address Printed Name
Phoenix Arizona 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 1GA until the IGA has been executed by an authorized ADHS
the State of Arizona. signatory.
State of Arizona
Signed this day of 2014
Signature Date
Printed Name Procurement Officer
RESERVED FOR USE BY THE SECRETARY OF STATE
Attorney General Contract No. P0012014000078, which is an
Agreement between public agencies, has been reviewed pursuant to Under House Bill 2011, A.R.S. § 11-952
A.R.S. § 11-952 by the undersigned Assistant Attorney General, who was amended to remove the requirement
has determined that it is in proper form and is within the powers and
authority granted under the laws of the State of Arizona. that Intergovernmental Agreements be filed
with the Secretary of State.
Signature Date
Assistant Attorney General
Printed Name:
1

Error! Main Document
Only ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
orrAT DEUS AMENDMENT 1740 W. Adams, Room 303
, -......,,, —, Phoenix, Arizona 85007
(602) 542-1040
- (602) 542-1741 Fax
9 Contract No: ADHS14-052676 Amendment No. '1 Procurement Mr. Tracey Thomas Specialist
3. Pursuant to Terms and Conditions, Provision Six (6), Contract Changes, Item 6.1, Amendments, Purchase
Orders and Change Orders, Scope of Work, Section 4, Tasks, is revised and replaced with the following:
4. TASKS
4,1 The Contractor shall, from September 1, 2014 through December 31, 2014:
4.1.1 Continue ECELC implementation with the learning collaborative Cohort One (1) by:
4.1,1.1 Providing technical assistance (TA) with approximately thirteen (13) assigned
programs via on-site visits, telephone support and email support, to support
their ability to make sustainable policy and practice change during the
continuation period,
4.1.1.2 Providing at least one (1) site visit to each program during this period,
4.1.1.3 Assisting in planning, preparation and implementation of Cohort One (1)
reunion event which will last about four (4) hours,
4.1.1.4 Documenting all TA using approved reporting instrument and submit to State
Project Coordinator and Project Evaluation staff (Gretchen Swanson Center
for Nutrition — GWCN), no later than the fifth (5th) working day after each
month end,
4.1.1.5 Submitting monthly summary of TA and other project activity, using approved
reporting instrument to Project Coordinator, no later than the fifth (5th)
working day after each month end, and
4.1.1.6 Submitting monthly invoice to Project Coordinator, no later than the fifth (5th)
working day after each month end.
4.2 The Contractor shall, from September 1, 2014 through September 30, 2015,:
4.2.1 Facilitate successful implementation of the learning collaborative Cohort Two (2)
ECELC by:
4.2,1,1 Co-facilitating five (5) day, eight (8) hour long learning sessions with
approximately ninety (90) representatives from participating ECE programs.
Learning sessions take place approximately every eight (8) weeks between
September and May and should include, but not be limited to the following:
4.2.1.2 Curriculum instruction;
4.2.1.3 Presentation from experts via multimedia or in-person guest speakers;
4.2.1.4 Breakout sessions;
4.2.1.5 Action planning and moderating the sharing of successes and challenges;
and
4.2.1.6 Assignment of curriculum "homework" for participants.
2

Erroll Main Document
r Only,ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
c=" 7. AMENDMENT 1740 W. Adams, Room 303
--. A - rd Phoenix, Arizona 85007
'4:71 (602) 542-1040
(602) 542-1741 Fax
* * Procurement Specialist
Contract No: ADHS14-052676 Amendment No. I Mr. Tracey Thomas
4.2.2 Prepare for learning sessions — with support from State Project Coordinator and
Nemours project staff — by organizing materials, becoming familiar with curriculum
content, identifying state specific information as appropriate and coordinating day of
learning session logistics.
4.2.3 Provide ongoing technical assistance to programs during each Action Period (period
between learning sessions):
4.2.3.1 Provide technical assistance (TA) with approximately thirteen (13) assigned
program per trainer during each Action Period, via on-site visits, telephone
support and email support, to support program's ability to make sustainable
policy and practice change during the project year,
4.2.3.2 Provide at least one site visit to each program during each Action Period,
4.2.3.3 Document all TA using approved reporting instrument and submit to State
Project Coordinator and Project Evaluation Staff (Gretchen Swanson Center
for Nutrition — GVVCN), no later than the fifth (5th) working day after each
month end,
4.2.3.4 Submit Monthly Summary of TA and other project activity, using approved
reporting instrument to Project Coordinator, no later than the fifth (5th)
working day after each month end,
4.2.3.6 Submit Monthly Invoice to Project Coordinator, no later than the 6th working
day after each month end.
4.3 The Contractor shall:
4.3.1 Maintain communication with programs and contribute to overall project reporting;
4.3.2 Assist State Project Coordinator and Nemours project staff with data collection from
participating programs at learning sessions and through the technical assistance process;
4.3.3 Participate in evaluation component of the ECELC project by engaging with Gretchen
Swanson Center for Nutrition (i.e. completion of online surveys, participation in a focus
group, interview, etc.);
4.3.4 Provide feedback and suggestions to Project Coordinator and Nemours staff to improve
the future implementation of learning collaborative sessions;
4.3.5 Contribute to regular project reporting, including but not limited to, simple data collection,
semi-annual reporting, documenting success stories, and, responding to other
information requests;
4.3.6 Receive support from Project Coordinator, BNPA staff, Nemours staff, CDC staff, GWCN
staff and others as made available:
4.3.6.1 Attend in person and participate in trainer preparation meetings, held
approximately five (5) times throughout the project year, prior to each learning
session,
3

Error! IVIain Document
Only.AR1ZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
AMENDMENT 1740W. Adams, Room 303
Phoenix, Arizona 85007
(802) 542-1040
(602) 542-1741 Fax
Contract No: ADHS14-052676 Amendment No. 1 Procurement Mr. Tracey Thomas Specialist
4.3.6.2 Participate in periodic quality improvement group trainer calls, and receive
additional coaching as needed to enhance support provided to participating
programs, and
4.3.6.3 Communicate as needed with State Project Coordinator and Nemours content
experts to expand knowledge to enhance support provided to participating
programs.
4. Pursuant to Terms and Conditions, Provision Six (6), Contract Changes, Item 6.1, Amendments, Purchase Orders
and Change Orders, Scope of Work, Section 5, Reference Materials, is revised and replaced with the following:
5. REFERENCE MATERIALS
5.1 Cohort 2 Empower PLUS+ Trainer Guide (customized version) Hard copy
5.2 Cohort 2 Empower PLUS+ DVD's (or flash drive) (customized version) Hard copy
5.3 Let's Move Child Care
http://vvvvw. healthvkidshealthyfuture. orq/welcom e. htm I
5.4 Preventing Childhood Obesity in Early Care and Education Programs, 2 nd Edition Handbook Hard
copy
5.5 Moving and Dancing Kit Hard copy
5.6 Catching and Throwing Activity Kit Hard copy
5,7 Nutrition Kit Hard copy
5.8 Resource Binder Hard copy
5.9 Choosy Kids — I'm Moving CD Hard copy
5.10 Smart & Tasty CD Hard copy
5.11 CACFP Handbook Hard copy
5.12 Sesame Street Healthy Habits for Life Toolkit Hard copy
5.13 Protective Urges: Working with the Feelings of Parents and Caregiver DVD Hard copy
5.14 Dr. Craft's Active Play DVD & Book Hard copy
5.15 Empower Pack http://www.azdhs.doviempowerpack/
5.16 Empower Guidebook http://www.azdhs.qov/empowerpack/documents/empower-ouidebook.pdf
5,17 Empower Standards http://www.azdhs.goviempowerpack/documents/empower-standards.pdf
5.18 Empower Pack Resources http://www.azdhs.goviempowerpack/resources.htm
5.19 Meals without Squeals Hard copy
4

.._-,
e. Errorl Main Document
INTERGOVERNMENTAL AGREEMENT (GA) OnIy.ARIZONA DEPARTMENT OF
HEALTH SERVICES
AMENDMENT 1740W. Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No ADHS14-052676 Amendment No. 1 Procurement Mr. Tracey Thomas Specialist
5.20 ECELC Resources on ECELC website designated for Trainers
5. Pursuant to Terms and Conditions, Provision Six (6), Contract Changes, Item 6.1, Amendments, Purchase Orders
and Change Orders, Scope-of Work, Section 6, Deliverables, is revised and replaced with the following:
6. DELIVERABLES
The Contractor shall submit to ADHS the following deliverables:
Item Due Date Submission Method
First session to be held by
Learning Session One September 2014 and
through Five (1-5) approximately every eight Electronic (E-mail)
Attendance & Evaluations (8) weeks thereafter
Learning Session Approximately every eight
Preparation Meetings (8) weeks, prior to each Electronic (E-mail)
Attendance learning session
Technical Assistance Monthly, fifth (e) working Electronic (E-mail)
Reports day following month end
Summary of TA Monthly, fifth (5 th) working day Electronic (E-mail)
following month end
Invoice Monthly, fifth (5`m) working day Electronic (E-mail)
following month end
6. Pursuant to Terms and Conditions, Provision Six (6), Contract Changes, Item 6.1, Amendments, Purchase Orders
and Change Orders, Terms and Conditions, Section 18, Health Insurance Portability and'Accountability Act of
1996, is revised and replaced with the following:
Health Insurance Portability and Accountability Act of 1996
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
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
5

Error' Main Document
'3 E 7.7....\\ Only,ARIZONA DEPARTMENT OF
.4 Al111.I INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
Z 5..... AMENDMENT 1740W. Adams, Room 303
E-4 , Phoenix, Arizona 85007
. „ (602) 542-1040
• - (602) 542-1741 Fax
* 4 Procurement Specialist
Contract No: ADHS14 -052676 Amendment No. 1 Mr. Tracey Thomas
and experienced in HIPAA and who has been approved by the ADOA-ASET Arizona State Chief Information
Security Officer and HIPAA Coordinator.
6

Error! Main Document
Only. ARIZONA DEPARTMENT OF
411II INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
AMENDMENT 1740 W. Adams, Room 303
Phoenix, Arizona 85007
t'74 (602) 542-1040
- 1 (602) 542-1741 Fax
Contract No: ADHS14-052676 Amendment No. 1 Procurement Mr. Tracey Thomas Specialist
Revised Price Sheet
Effective August 1, 2014
NUMBER PER
SERVICE BUDGET UNIT RATE TOTAL COST
PERIOD
Learning Session 30 $1200.00 $36,000.00
Technical Assistance/Site Visits 450 $100.00 $45,000.00
Monthly Status Report/Meeting 72 $40.00 $2,880.00
Trainer Preparation Meeting 4 $ 600.00 $ 2,400.00
TOTAL $ 86,280.00
NOTE:
1. The Contractor shall agree that the prices stated in the original Contract shall not be increased in excess of the
maximum percentage of increase, if any, stated on the Pricing Schedule.
7