IGA AMD RE BNPA WIC BFPC FMNP WITH ADHS.PDF

Maricopa County — Formal (2014-11-05)

Extracted text (via pymupdf_layout) 11116 characters

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Sr. Procurement Specialist
Contract No: ADHS14-053007 Amendment No. 1
Mr. Tracey Thomas
BNPA – WIC, BFPC and FMNP
Effective October 1, 2014 it is mutually agreed that the Intergovernmental Agreement referenced is amended as
follows:
1. The WIC Price Sheet from the original Agreement is hereby replaced with the revised WIC Price Sheet of this
Amendment number One (1). The total of the Revised WIC Price Sheet is decreased from $10,828,155.00 to
$10,374,785.00 due to the following line item changes:
1.1 Personnel Costs / Salary decreased by $162,715.00 for a total of $5,093,411.00 due to decreased caseload
assigned and reducing staff.
1.2 ERE decreased by $100,025.00 for a total of $2,247,905.00 due to decrease in personnel.
1.3 Professional and outside services decreased by $25,000.00 for a total of $32,000.00 due to adjusted expenses
to stay within the decreased budget.
1.4 Travel decreased by $9,400.00 for a total of $35,900.00 due to adjusted expenses to stay within the decreased
budget.
Continued on next page
CONTRACTOR SIGNATURE
Maricopa County Department of Public Health
Contractor Name Contractor Authorized Signature
4041 North Central Avenue, Suite 1400
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 IGA 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
has determined that it is in proper form and is within the powers and was amended to remove the requirement
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:
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Error! Main Document
Only.ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
AMENDMENT 1740 W. Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS14-053007 Amendment No. 1 Procurement Specialist
Mr. Tracey Thomas
1.5 Occupancy Expense decreased by $33,207.00 for a total of $674,593.00 due to closing and moving two (2)
clinics.
1.6 Other Operating Expense decreased by $80,895.00 for a total of $141,035.00 due to adjusted operating
expenses to stay within the budget.
1.7 Indirect decreased by $62,635.00 for a total of $1,232,778.00 due to decrease in overall funding.
1.8 Registered Dietitian increased by $20,507.00 for a total of $917,162.00 due to increase of merit and living cost.
2. The BFPC Price Sheet from the original Agreement is hereby replaced with the revised BFPC Price Sheet of this
Amendment number One (1). The total of the Revised BFPC Price Sheet remains the same, $475,000.00, however
there are changes in the individual line items as following:
2.1 Personnel decreased by $2,194.00 for a total of $264,860.00.
2.2 ERE decreased by $289.00 for a total of $131,281.00.
2.3 Professional and outside services decreased by $6,722.00 for a total of $1.00 due to removal of language line
as Peer Counselors are all bi-lingual.
2.4 Travel Expense increased by $9,820.00 for a total of $11,820.00 due to space restrictions at clinics, staff are not
in dedicated space at each clinic and must travel around the county in order to provide services.
2.5 Other Operating Expenses increased by $104.00 for a total of $5,800.00.
2.6 Capital Outlay Expense increased by $1.00 for a total of $1.00 to allow move between line items.
2.7 Indirect Cost decreased by $720.00 for a total of $61,237.00.
3. Replace in its entirety, Special Terms and Conditions, Provision Seventeen (17), Health Insurance Portability and
Accountability Act of 1996 with the following:
17. Health Insurance Portability and Accountability Act of 1996
17.1 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.
17.2 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
Page 2 of 5

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS14-053007 Amendment No. 1 Sr. Procurement Specialist
Mr. Tracey Thomas
PRICE SHEET
October 1, 2014 to September 30, 2015
WIC Services
WIC Services Amount
Account Classification
Personnel $5,093,411.00
Employee Related Expenses $2,247,905.00
Professional & Outside Services $32,000.00
Travel Expense $35,900.00
Occupancy Expenses $674,593.00
Other Operating Expenses $141,035.00
Capital Expenditures $1.00
Indirect Cost $1,232,778.00
RD Supplement $917,162.00
Total $10,374,785.00
Breastfeeding Peer Counseling Services
Account Classification Amount
Personnel $264,860.00
Employee Related Expenses $131,281.00
Professional & Outside Services $1.00
Travel Expense $11,820.00
Occupancy Expenses $0.00
Other Operating Expenses $5,800.00
Capital Expenditures $1.00
Indirect Costs $61,237.00
Total $475,000.00
Farmer’s Market Nutrition Program Services
March 1, 2015 to September 30, 2015
Estimated Number
Type of Service Unit Rate Unit of Measure
of Participants
WIC FMNP Check
$1.25 WIC Participant AS NEEDED
Issuance
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ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS14-053007 Amendment No. 1 Sr. Procurement Specialist
Mr. Tracey Thomas
Additional Terms and Conditions:
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 funded line items except for Registered Dietitian
Expenses. 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. The Registered Dietitian line item is meant to
fund additional Registered Dietitian position(s) to meet high risk counseling requirements.
Authorization for purchase of services under this Contract shall be made only upon ADHS issuance of a Purchase
Order that is signed by an authorized agent. The Purchase Order will indicate the Contract 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 modified with an official ADHS Procurement Change Order, and/or b.) an additional Purchase Order is
issued for purchase of services under this Contract.
ADHS reserves the right to adjust awards given to local agencies depending on federal dollars received.
Adjustments will be at the discretion of ADHS.
Additional WIC Program:
Should additional administrative monies become available through state or federal grants, ADHS may increase
the purchase order to increase the number of participants served and increase the total of this contract.
The assigned caseload for FFY 2015 is: 68,500
Additional Breastfeeding Peer Counseling Program:
Allowable costs for the Peer Counseling Program include compensation for peer counselors and designated peer
counselor managers/coordinators, and related costs such as training and training materials; telephone expenses
for participant contacts (including pager, cell phones and answering machines); travel for training and home and
hospital visits; recruitment of peer counseling staff; and the purchase of demonstration materials (e.g., breast
pumps for demonstration purposes, videos). Out of state travel must be pre-approved by ADHS. Items and
materials for distribution to WIC participants (e.g. breast pumps, breastfeeding aids, written materials) are not
allowable costs.
Farmer’s Market Nutrition Program:
If funding for additional FMNP checks becomes available and the contract budget (as shown on the Contract Price
Sheet) has been fully expended, Contractor may choose whether or not to distribute the additional checks with no
increase in the contract budget.
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