IGA AMENDMENT RE EMERGENCY PREPAREDNESS WITH ADHS.PDF

ARIZONA DEPARTMENT OF
.4.1•Ii. 49-1-kito , INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
/ 1740W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
ftk , (602) 542-1040
(602) 542-1741 Fax
Contract No ADHS12-007891 Amendment No. 8 Procurement Officer:
Ana Shoshtarikj
Emergency Preparedness Program
Effective July 1, 2014, it is mutually agreed that the Intergovernmental Agreement referenced is amended as
follows:
1. Replace Amendment Seven (7) Price Sheet with Price Sheet, page Three (3) of this Amendment Eight (8). The
Total Price Sheet for FY15 is $2,737,151.21.
2. Replace Amendment Seven (7) Attachment A with Attachment A, County Requirements and Deliverables
Document, pages Four (4) through Nineteen (19) of this Amendment Eight (8).
3. Delete in its entirety Contract Terms and Conditions, Provision Eighteen (18), Health Insurance Portability and
Accountability Act of 1996 (HIPAA) and replace with the following:
Continued on next page.
CONTRACTOR SIGNATURE
Maricopa County by and through its
Maricopa County Department of Public Health
Contractor Name Contractor Authorized Signature
4041 N. Central Ave. Suite 1400
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 20
Signature Date
Printed Name Procurement Officer
Attorney General Contract No. P00120143000078, 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
has determined that it is in proper form and is within the powers and
authority granted under the laws of the State of Arizona. Under House Bill 2011, A.R.S. § 11-952
was amended to remove the requirement
that Intergovernmental Agreements be filed
Signature Date
Assistant Attorney General with the Secretary of State.
Printed Name:
Page 1 of 19

ARIZONA DEPARTMENT OF
41.430At HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
'...f.e. :' .• ) (602) 542-1040
(602) 542-1741 Fax
Contract No ADHS12-007891 Amendment No. 8 Procurement Officer:
Ana Shoshtarikj
18. Health Insurance Portability and Accountability Act of 1996
18.1 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.
18.2 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 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.
All other provisions of this agreement remain unchanged.
Page 2 of 19

ARIZONA DEPARTMENT OF
„( 40[4144 INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
, 17401N. Adams, Room 303
e l I! ".— :'- i'' 4l' -' l. --l • AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
%,41tr..woit0 *V". (602) 542-1741 Fax
Contract No: ADHS12-007891 Amendment No. 8 Procurement Ana Shoshtarikj Officer:
PRICE SHEET
Fixed Price July 1, 2014 June 30, 2015
No. Description UOM Amount
1 CDC Deliverables for Public Health Emergency YR $1,937,925.21
Preparedness - PHEP
2 Less charges for CEFO YR - $203,000.00
3 Cities Response Initiative (CRI) YR $1,002,226.00
Total $2,737,161.21
Page 3 of 19

ARIZONA DEPARTMENT OF
401#Milpo, HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W, Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
4- (602) 542-1040
t .4 (602) 542-1741 Fax
Contract No: ADHS12-007891 Amendment No. 8 Procurement Ana Shoshtarikj Officer:
ATTACHMENT A
PUBLIC HEALTH EMERGENCY PREPAREDNESS
COUNTY REQUIREMENTS & DELIVERABLES DOCUMENT
BUDGET PERIOD 3 (BP3)
Period of performance
(July 1, 2014 June 30, 2015)
Page 4 of 19

ARIZONA DEPARTMENT OF
HEALTH SERVICES
*AM Ilk INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
Ar Int. ' AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
N- (602) 542-1741 Fax
Contract No: ADHS12-007891 Amendment No. 8 Procurement Ana Shoshtarikj Officer:
1. INTRODUCTION
1.1 Approaching Budget Period Three (July 1st, 2014 — June 30th, 2015), continuous efforts are made to
expand the preparedness capabilities based on the Five-Year Plan and the Capability Planning Guide
(CPG) data, Based on the above and the guidance set forth by the Center for Disease Control (CDC),
Arizona Department of Health Services (ADHS) has developed the Requirement and Deliverable
Document for Counties. The first section of this document outlines the requirements set forth by CDC
and ADHS that all County partners shall address and ensure are being met in BP3. The section portion
covers the goals, objectives, and outcomes that shall be achieved for each capability within BP3.
Progress shall be measured on these goals and objectives throughout the year through frequent
communication and mid-year report.
1.2 Table One (1) and Attachment B included herein provide additional information for the County partners.
2. PROGRAM REQUIREMENTS
As a recipient of the Public Health Emergency Preparedness (PHEP) funds from the ADHS, Grantee is
required to adhere to Federal and State Grant requirements. Listed below are the Program requirements for
the PHEP grant.
3. MEETINGS
3.1 ADHS Sponsored Grant Meetings (Two (2) events annually)
3.1.1 Semi-annual ADHS sponsored All-Partners Workshop meeting shall be attended,
3,1,2 Regional ADHS sponsored Business Meeting shall be attended. ADHS shall hold one Business
Meeting in each of the four (4) Healthcare Coalition Regions within the State.
3.2 Healthcare Coalition Meeting
3.2.1 Healthcare Coalition meetings shall be attended in the appropriate region. Regions are divided
as following:
3.2.1.1 Northern Region
3.2.1.1.1 County Representatives: Apache County, Coconino County, Navajo
County and Yavapai County.
3,2,1.1.2 Tribal Representatives: Hopi Tribe, Navajo Nation and White Mountain
Apache Tribe.
3.2.1,2 Western Region
3.2.1.2.1 County Representatives: La Paz County, Mohave County and Yuma
County.
3.2.1.2.2 Tribal Representatives: Cocopah Indian Tribe, Fort Mojave Indian Tribe,
Kalbab- Paiute Tribe and Quechan Tribe.
3.2.1.3 Central Region
3.2.1.3.1 County Representatives: Gila County, Maricopa County and Pinal County.
3.2.1.3.2 Tribal Representatives: Gila River Indian Community.
Page 5 of 19

ARIZONA DEPARTMENT OF
4,110I11,-, INTERGOVERNMENTAL AGREEMENT (IGA) 1740W. HEALTH Adams, SERVICES Room 303
AMENDMENT Phoenix, Arizona 85007
..i t (602) 642-1040
(602) 542-1741 Fax
Contract No: ADHS12-007891 Amendment No. 8 Procurement Ana Shoshtarikj Officer:
3.2.1.4 Southeastern Region
3.2.1.4.1 County Representatives: Cochise County, Graham County, Greenlee
County, Pima County and Santa Cruz County.
3.2.1.4.2 Tribal Representatives: Pascua Yaqui Tribe, San Carlos Apache Tribe and
Tohono O'odham Nation.
4, FINANCIAL REQUIREMENTS
4.1 Match Requirement
The PHEP award requires a ten percent (10%) "in-kind' or "soft" match from all the grant participants.
Each recipient shall include in their budget submission the format they shall use to cover the match and
method of documentation. Failure to include the match formula shall preclude funding.
4.2 Inventory
Inventory list shall be provided to ADHS upon request. The Inventory List shall include all capital
equipment.
4.3 Budget Allocation
4.3.1 The budget tool developed by ADHS shall be completed, document signed and returned to
ADHS for review and approval. ADHS will not release funding to the County until the budget has
been approved.
4.3.2 All activities and procurements funded through the PHEP grant shall be aligned with Grantee's
budget/spend plan and work plan which should help reaching the goals and objectives outlined
in this document. Any items and activities that are not specifically tied to the PHEP program
capabilities shall be approved by ADHS before PHEP funds can be utilized on those
activities/items.
4.3.3 Counties shall follow the applicable Office of Management and Budget (OMB) Circulars and Cost
Principles when developing the budget and throughout the period of performance,
4.4 Grant Activity Oversight
4.4,1 PHEP Coordinator shall be appointed by the County on full or part-time basis.
4.4.2 The PHEP Coordinator shall be the main point of contact for ADHS with the County in regards to
the PHEP grant and shall have the responsibility for oversight of all grant related activities.
4.4.3 PHEP Coordinator shall work closely with ADHS to ensure all deliverables and requirements are
met
4.4.4 PHEP Coordinator shall coordinate all activities surrounding any onsite monitoring visits
conducted by ADHS.
4.5 Employee Certifications
4.5.1 PHEP Recipients are required to adhere to all applicable Federal laws and regulations, including
applicable OMB Circulars and semiannual certification of employees who work solely on a single
federal award.
Page 6 of 19

ARIZONA DEPARTMENT OF
.411111114, ,1024v,o, INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
1740 W. Adams, Room 303 i
: ( tC7) AMENDMENT Phoenix, Arizona 55007
4.1titi_# (602) 542-1040
.1: -. (602) 542-1741 Fax
Contract No ADHS12-007891 Amendment No. 8 Procurement Ana Shoshtarikj Officer:
4.5.2 Certification forms shall be prepared semiannually signed by the employee or a supervisory
official who has firsthand knowledge of the work performed by the employee.
4.5.3 Split funded employees are required to maintain Labor Activity Reports (to be provided as
requested). These certification forms shall be retained in accordance with 45 Code of Federal
Regulation, Part 92.42.
4.6 Performance
Failure to meet the deliverables and performance measures described in the Scope of Work shall result
in withholding from a portion of subsequent awards,
5. EXERCISES
5.1 Emergency Operation Coordination
5.1.1 Documentation shall be maintained of all collaborative efforts with local and State emergency
management.
5.1.2 The County PHEP program shall establish and maintain a collaborative working relationship with
emergency management. This shall include but not limited to:
5.1.2.1 Emergency communication plan,
5.1.2.2 Strategies for addressing emergency events, and
5,1.2.3 Consequences management of power failures, natural disasters and other events that
would affect public health.
5.1.3 Jointly participate with emergency management in an ADHS sponsored table top, functional
exercise or other activity.
5.1.4 Provide documentation to support discussion on the order process in WebE0C.
5.2 Multi-Year Training and Exercise Workshop (MYTEP)
5.2.1 Each County shall attend the annual ADHS Training and Exercise Planning Workshop in June,
2015.
5.2.2 Each County shall submit their final training and exercise plans no later than August 1, 2014,
5.2.2.1 Training and exercise plans shall contain proposed events from July 1, 2014 through
June 30, 2019.
5.2.2.2 Plans shall be submitted on the ADHS provided templates.
5.2.2.3 Trainings and exercises shall be gap based. Proposed training and/or exercises shall
be based on an identified gap from a previous exercise, response, risk assessment, or
other documented source.
6. EXERCISE IMPLEMENTATION CRITERIA
6.1 Homeland Security Exercise and Evaluation Program
Page 7 of 19

• ARIZONA DEPARTMENT OF
( V 40-%in,:et ,- INTERGOVERNMENTAL AGREEMENT (1GA) 1740W. HEALTH Adams, SERVICES Room 303
AMENDMENT Phoenix, Arizona 85007
Ait.,. . (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS12 -007891 Amendment No, 8 Procurement Ana Shoshtarill Officer:
Sub-awardees shall conduct preparedness exercises in accordance with the Homeland Security
Exercise and Evaluation Program (HSEEP) fundamentals including:
6.1.1 Exercise Design and Development;
6.1.2 Exercise Conduct;
6.1.3 Exercise Evaluation; and
• 6.1.4 Improvement Planning.
Information on the April 2013 HSEEP guidelines and exercise policy: httos://www.11is.dhs.00v/hseep
6,2 ADHS Coordination
6.2.1 To meet the criteria as a qualified exercise, all PREP sub-awardee exercises shall be
coordinated with ADHS and approved prior to the initial planning meeting. ADHS shall be
continuously updated throughout the remainder of the planning process.
6.2.2 To comply with the exercise implementation criteria, the HSEEP process and guidance shall be
used along with respective templates.
6.3 Healthcare Coalition Exercises
Each Healthcare Coalition (Northern, Central, Western, and Southeastern) shall have an exercise in
BP3 that shall require the County's participation. Date shall be determined.
6.4 At-Risk Individuals
6.4.1 Within each exercise, provisions for the needs of at-risk individuals shall be included.
6.4.2 HPP- PHEP sub-awardees shall report on the strengths and areas for improvement identified
though the coalition based exercise After Action Report and Improvement Plan (AAR/IP).
6.4.3 U.S. Department of Health and Human Services' definition of "at-risk" population is available at
the following website: http://www.phemov/Preparedness/plannind/abc/Pades/at-risk.aspx
6.5 Exemption
County response and recovery operations supporting real incidents could meet the criteria for this
annual exercise requirement if the response was sufficient in scope and the AAR/IPs adequately detail
which PHEP capabilities were tested and evaluated. Such situation shall be addressed on an as-
requested basis.
6.6 Exercise Evaluation Criteria
6.6.1 PHEP exercise shall address Public Health Preparedness (PHP) Capabilities in all qualifying
exercises. If using FEMA Core Capabilities, a cross-walk shall be produced mapping PHP
capabilities with core capabilities.
6.6.2 At a minimum, each County shall demonstrate and validate healthcare coalition participation in
resource and information management as outlined in the HPP-PHEP aligned capabilities.
6,6.2,1 These capabilities are:
Page 8 of 19

ARIZONA DEPARTMENT OF
( .- iki—ox-t-4. ,:t.,10,, INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
g .!"-!•.L" ,_11. 1740 UV, Adams, Room 303
ie. AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
.4kirmv _ 11-0` (602) 542-1741 Fax
Contract No ADHS12-007891 Amendment No. 8 Procurement Officer;
Ana Shoshtarikj
6.6.2.1.1. Capability 3: Emergency Operations Coordination
6.6.2.1,2. Capability 6: Information Sharing.
6.6.3 PHEP Qualifying Exercises:
6.6.3.1 An exercise that meets PHEP-specific qualifying exercise implementation criteria and
the specific HPP evaluation criteria.
'7. INFORMATION SERVICES
7.1 Access to a secure alerting system that at a minimum has the ability to send email, faxes, and phone/
text alerts is required.
7.2 Each County shall provide to ADHS a list of the system(s) that are utilized in EOC operations and for
information sharing during their midyear report.
7.3 Each County shall participate in the Communication Pathway scenarios developed and sent out by
ADHS Information Services Group.
7.4 Each County shall be able to utilize the following Communication systems:
7.4.1 HSP
7.4.2 EMResource,
7.4.3 EMTrack,
7.4.4 ESAR-VHP,
7.4.5 AZHAN,
7.4.6 IRMS,
7.4.7 800 radios, and
7.4,8 WebE0C
7,5 Training on the systems and platforms shall be provided by ADHS as needed.
8. REPORTING
Progress on the deliverables, performance measures, and activities funded through the PHEP grant shall be
reported in a timely manner, ensuring ADHS has adequate time to compile the information and submit to
CDC.
8.1 Mid-Year Report
8.1.1 Mid-Year report templates shall be provided by ADHS in advance of the Due Date.
8.1.1.1 Estimated Due Date is December 2014
8.1,2 CDC Performance Measures templates (if applicable) shall be provided by ADHS in advance of
the Due Date.
Page 9 of 19

ARIZONA DEPARTMENT OF
v-e HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740W. Adams, Room 303
^ Emu AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
iztrinitio4 (602) 542-1741 Fax
Contract No: ADHS12-007891 Amendment No. 8 Procurement Officer:
Ana Shoshtariil
8.1.2.1 Estimated Due Date shall be determined.
8.1.3 Updated Public Health Emergency Contact list shall be provided to ADHS semi-annually. By
each County. The list should include contact information for the primary, secondary, and tertiary
individuals for the Public Health Incident Management System (e.g. Incident Commander,
Operations, etc.) and posted on the Health Services Portal (HSP).
8.1.3.1 The contact information for each individual shall include:
8.1.3.2.1 Individual's name,
8.1.3.2.2 ICS title,
8.1.3.2,3 Non-emergency position title,
8.1.3.2.4 Telephone numbers (Office, Mobile, and Home), and
8.1.3.2.5 Primary email address.
8.2 Annual Report
8.2.1 Annual Report template shall be provided by ADHS in advance of the Due Date.
8.2.1.1 Due Date shall be determined.
8.3 After Action Report/Improvement Plan
8.3.1 Each County shall submit an AAR/IP for any public health emergency exercise or real world
event in which the public health entity participates and has a role.
8.3.2 After a stand-alone DSNS drill, an AAR and an IP shall be provided to the ADHS SNS
Coordinator,
8.3.3 AARs shall be submitted to ADHS within sixty (60) days after the exercise.
8.4 Training Validation Reports
A training validation report shall be provided to ADHS by the end of Budget Period Three (3), using the
ADHS template located in the HSP. This report shall be a summary of trainings actually conducted in
BP3.
9. CAPABILITIES AND COUNTY DELIVERABLES
9.1 CAPABILITY 1: COMMUNITY PREPAREDNESS
Definition: Community preparedness is the ability of communities to prepare for, withstand, and recover
in both the short and long terms from public health incidents. By engaging and coordinating with
emergency management, healthcare organizations (private and community-based), mental/behavioral
health providers, community and faith-based partners, state, local, and territorial, public health's role in
community preparedness is to do the following:
9.1.1 Support the development of public health, medical, and mental/behavioral health systems that
support recovery;
Page 10 of 19

ARIZONA DEPARTMENT OF
..soxx:tpf HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
eSs.e. (602) 542-1040
(602) 642-1741 Fax
, Contract No ADHS12-007891 Amendment No. 8 Procurement Ana Shoshtarikj Officer:
9.1.2 Participate in awareness training with community and faith-based partners on how to prevent,
respond to, and recover from public health incident;
9.1.3 Promote awareness of and access to medical and mental/behavioral health two (2) resources
that help protect the community's health and address the functional needs (i.e., communication,
medical care, independence, supervision, transportation) of at-risk individuals;
9.1.4 Engage public and private organizations in preparedness activities that represent the functional
needs of at-risk individuals as well as the cultural and socio-economic, demographic
components of the community; and
9.1.5 Identify those populations that may be at higher risk for adverse health outcomes
9.2 COUNTY DELIVERABLES
9.2.1 Ensure plans include a jurisdictional risk assessment, utilizing an all-hazards approach with
input and assistance of the following elements:
9.2.1.1 Public health and non-public health subject matter experts; and
9.2.1.2 Existing inputs from emergency management risk assessment data, health department
programs, community engagements, and other applicable sources, that identify and
prioritize jurisdictional hazards and health vulnerabilities
9,3 CAPABILITY 2; COMMUNITY RECOVERY
Definition: Community recovery is the ability to collaborate with community partners, (e.g., healthcare
organizations, business, education, and emergency management) to plan and advocate for the
rebuilding of public health, medical, and mental/behavioral health systems to at least a level of
functioning comparable to pre-incident levels, and improved levels where possible.
9,3,1 This capability supports National Health Security Strategy Objective Eight (8): Incorporate Post-
Incident Health Recovery into Planning and Response. Post-incident recovery of the public
health, medical and mental/behavioral health services, and systems within a jurisdiction is
critical for health security and requires collaboration and advocacy by the public health agency
for the restoration of services, providers, facilities, and infrastructure within the public health,
medical and human services sectors. Monitoring the public health, medical and
mental/behavioral health infrastructure is an essential public health service.
9.4 COUNTY DELIVERABLES
Ensure written plans include processes for collaborating with community organizations, emergency
management, and health care organizations to identify public health, medical, and mental/behavioral
health system recovery needs for the counties identified hazards. Written plans should include the
following elements (either as a standalone Public Health Continuity of Operations plan or as a
component of another plan):
9.4.1 Definitions and identification of essential services needed to sustain agency mission and
operations;
9.4.2 Plans to sustain essential services regardless of the nature of the incident;
9.4.3 Scalable work force reduction; and
Page 11 of 19

ARIZONA DEPARTMENT OF
( 4011-4,. INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
to 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No ADH812-007891 Amendment No, 8 Procurement Ana Shoshtarikj Officer:
9.4.4 Collaborate with ADHS to develop functional exercises in your region to test multiple capabilities
including Recovery.
9.4.4.1 Each County shall participate in a regional focused functional exercise in 8P3. These
exercises shall test your ability to stand up and operate your E0C, recovery operations
shall be included to test plans and processes to support Continuity of Operations Plans.
9.5 CAPABILITY 3: EMERGENCY OPERATIONS COORDINATION
Definition: Emergency operations coordination is the ability to direct and support an event or incident
with public health or medical implications by establishing a standardized, scalable system of oversight,
organization, and supervision consistent with jurisdictional standards and practices and with the
National Incident Management System.
9.6 COUNTY DELIVERABLES
9.6,1 Participate in a Functional Exercise conducted within your respective region.
9.6.1.1 Participate in at least one functional exercise to test their ability to stand up and operate
their EOC during a public health incident.
9.6.2 Maintain documentation of all collaborative efforts with local and State emergency management.
9.6.3 County/Tribal PHEP program must establish and maintain a collaborative working relationship
with emergency management. This must include but not be limited to; Emergency
communication plan, strategies for addressing emergency events, including the management of
the consequences of power failures, natural disasters and other events that would affect public
health,
9.6.4 Jointly participate with emergency management in an ADHS sponsored table top, functional
exercise or other activity
9.6.5 Provide documentation to support discussion on the order process in Web-EOC.
9.7 CAPABILITY 4: EMERGENCY PUBLIC INFORMATION AND WARNING
Definition: Emergency public information and warning is the ability to develop, coordinate, and
disseminate information, alerts, warnings, and notifications to the public and incident management
responders.
9.8 COUNTY DELIVERABLES
9.8.1 Participate in the development of Public Information and Warning messaging during a functional
exercise.
9.8.1.1 When participating in your regionally based functional exercise, work to develop and
disseminate public health messaging and test the communication pathways utilized to
communicate that message to the public.
9.9 CAPABILITY 5: FATALITY MANAGEMENT
Definition: Fatality management is the ability to coordinate with other organizations (e.g., law
enforcement, healthcare, emergency management, and medical examiner/coroner) to ensure the proper
recovery, handling, identification, transportation, tracking, storage and disposal of human remains and
Page 12 of 19

ARIZONA DEPARTMENT OF
ofirkf HEALTH SERVICES
r ah:* INTERGOVERNMENTAL AGREEMENT (IGA) 1740W. Adams, Room 303
AMENDMENT Phoenix, Arizona 86007
* ,,,; , 4. (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHSI2-007891 Amendment No. 8 Procurement Ana Shoshtarikj Officer:
personal effects; certify cause of death; and facilitate access to mental/ behavioral health services to the
family members, responders and survivors of an incident.
9,10 COUNTY DELIVERABLES
9.10.1 Participate in the Fatality Management Workshop held by ADHS,
9.10.1.1 Participate in the Fatality Management workshop conducted by ADHS to gain
additional insight into the State's and other County's capability to manage mass
fatalities and the work each is completing to improve that capability.
9.11 CAPABILITY 6: INFORMATION SHARING
Definition: Information sharing is the ability to conduct multijurisdictional, multidisciplinary exchange of
health-related information and situational awareness data among federal, state, local, territorial, and
tribal levels of government, and the private sector.
9.12 COUNTY DELIVERABLES
9,12.1 Participate in Communication testing scenarios developed and administered by ADHS.
9.12.1.1 Each County should regularly participate in the Communication testing scenarios to
ensure your communication systems and platforms are capable of receiving and
disseminating information from the multiple platforms.
9,13 CAPABILITY 7: MASS CARE
Definition: Mass care is the ability to coordinate with partner agencies to address the public health,
medical, and mental/behavioral health needs of those impacted by an incident at a congregate
location. This capability includes the coordination of ongoing surveillance and assessment to ensure
that health needs continue to be met as the incident evolves.
9.14 COUNTY DELIVERABLES
9.14.1 Review and update County's sheltering plan.
9.14.1.1 County shall review and update their plan to support shelter operations in
coordination with local Emergency Management. Sheltering plans shall incorporate
the needs for At-Risk Individuals and Functional and Access Needs individuals.
9.15 CAPABILITY 8: MEDICAL COUNTERMEASURE DISPENSING
Definition: Medical countermeasure dispensing is the ability to provide medical countermeasures
(including vaccines, antiviral drugs, antibiotics, antitoxin, etc.) in support of treatment or prophylaxis
(oral or vaccination) to the identified population in accordance with public health guidelines and/or
recommendations.
9.16 COUNTY DELIVERABLES (NON-CRI Counties)
9,16,1 Complete a self-assessment of your county's MOM plan.
9.16.1.1 ADHS shall provide self-assessment template to utilize during your review.
9.16.2 Ensure your County's Receipt, Stage, and Store (RSS) site survey information is current and
has been reviewed within the last three (3) years,
Page 13 of 19

ARIZONA DEPARTMENT OF
tIbo," -0017ft INTERGOVERNMENTAL AGREEMENT (IGA) 1740 HEALTH W. Adams, SERVICES Room 303
l 10- t7 AMENDMENT Phoenix, Arizona 85007
SV ' X:- (602) (602) 542-1741 542-1040 Fax
411Wite* Contract No ADHS12-007891 Amendment No. 8 Procurement Officer:
Ana Shoshtarikj
9.16.2.1 Provide ADHS your completed self-assessment template, current MCM plan, and
current RSS site survey as part of the Mid-Year Report.
9.17 CAPABILITY 9: MEDICAL MATERIEL MANAGEMENT & DISTRIBUTION
Definition: Medical materiel management and distribution is the ability to acquire, maintain (e.g., cold
chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g.,
pharmaceuticals, gloves, masks, and ventilators) during an incident and to recover and account for
unused medical materiel, as necessary, after an incident.
9.18 COUNTY DELIVERABLES:
9.18.1 Participate in Inventory Management System quarterly drills.
9.18.2 Cities Readiness Initiative (CR1) Drill Requirement
9.18.2.1 Maricopa County and Pinal County shall conduct at least three (3) different SNS
drills utilizing the templates provided by DSNS/ADHS. An executive summary and an
improvement plan shall be submitted for each drill.
9.18.2.2 Provide ADHS with the drill results by March 30, 2015
9.18.2.3 List of Drills that can be conducted:
9.18.2.3.1 Staff notification, acknowledgement and assembly;
9.18.2.3.2 Site activation: notification, acknowledgement and assembly;
9.18.2.3.3 Facility Setup;
9.18.2.3.4 Pick List Generation;
9.18.2.3.5 Dispensing Throughput; and
9.18.2.3.6 Public Health Decision Making Tool.
9.19 CAPABILITY 10: MEDICAL SURGE
Definition: Medical surge is the ability to provide adequate medical evaluation and care during events
that exceed the limits of the normal medical infrastructure of an affected community. It encompasses
the ability of the healthcare system to survive a hazard impact and maintain or rapidly recover
operations that were compromised.
9.20 COUNTY DELIVERABLES:
9.20.1 Review/update plans.
9.20.1.1 Written plans should include documentation of staff assigned and trained in advance
to fill public health incident management roles as applicable to a given response.
Local Health Departments must be prepared to staff emergency operations centers
at agency and local levels as necessary. (Local Health Departments shall provide a
copy of a PHIMS chart that correlates to the functional drill with local emergency
management and the state).
9.20.2 Crisis Standard of Care (CSC) Workshop.
Page 14 of 19

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS12-007891 Amendment No. 8 Procurement Ana Shoshtarikj Officer;
9.20.2.1 Each County is encouraged to participate in the CSC workshop to provide feedback
and input on the CSC plan,
9.21 CAPABILITY 11: NON-PHARMACEUTICAL INTERVENTIONS
Definition: Non-pharmaceutical interventions (NPI) are the ability to recommend to the applicable lead
agency (if not public health) and implement, if applicable, strategies for disease, injury, and exposure
control. Strategies include the following:
9.21.1 Isolation and quarantine;
9.21.2 Restrictions on movement and travel advisory/warnings;
9.21.3 Social distancing;
9.21.4 External decontamination;
9.21.5 Hygiene; and
9.21.6 Precautionary protective behaviors.
9,22 COUNTY DELIVERABLES:
9.22.1 Collaborate with ADHS to develop or review local health department NPI plans.
9.22.1.1 Written plans should include documentation that identifies public health roles and
responsibilities related to the jurisdiction's identified risks, that was developed in
conjunction with partner agencies (e.g., state environmental health, state
occupational health and safety, and hazard-specific subject matter experts) and
emergency managers. This documentation should identify the protective equipment,
protective actions, or other mechanisms that public health responders shall have to
execute potential roles. Roles for consideration may include the following elements:
9.22.1.1.1 Conducting environmental health assessments;
9.22.1.1.2 Potable water inspections; and
9.22.1.1.3 Field surveillance interviews,
9.22.2 Complete the biannual Performance Measure Report Form.
9.22,2.1 Local Health Department shall complete the biannual performance measure report
form distributed by ADHS for use in identifying gaps in planning and implementation
of interventions in the jurisdiction. Performance measure report information shall be
utilized for mid-year and end-of-year grant reporting for PHEP deliverables.
9.23 CAPABILITY 13: PUBLIC HEALTH SURVEILLANCE AND EPIDEMIOLOGICAL INVESTIGATION
Definition: Public health surveillance and epidemiological investigation is the ability to create, maintain,
support, and strengthen routine surveillance and detection systems and epidemiological investigation
processes, as well as to expand these systems and processes in response to incidents of public
health significance.
9.24 COUNTY DELIVERABLES
Page 15 of 19

ARIZONA DEPARTMENT OF
sompip 111-1111, INTERGOVERNMENTAL AGREEMENT OGA) HEALTH SERVICES
1740 W. Adams, Room 303
, VI AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
tirovifo -.._ (602) 542-1741 Fax
Contract No ADHS12-007891 Amendment No, 8 Procurement Officer:
Ana Shoshtarikj
9.24,1 Participate in State Testing of the Communicable Disease On-Call System.
9.24.1.1 Local Department of Health shall participate in tests of the communicable disease
on-call system, and shall ensure that sufficient staff are identified and trained to
participate in all system tests. Jurisdictions shall complete the disease scenario
evaluation form and return to ADHS.
9.24.2 Enter Information into MEDSIS as Required and Provide ADHS Staff with Current Contact
Information for MEDSIS Liaisons.
9,24.2.1 Arizona utilizes MEDSIS to conduct reportable disease surveillance. Jurisdictions
shall enter information into MEDSIS according to the MEDSIS policies and
procedures. Jurisdictions shall maintain a primary MEDSIS liaison and backup and
notify ADHS of any changes to the liaison roles or their contact information at the
time of the change. MEDSIS liaison responsibilities include requesting/approving
new users and notifying ADHS when users no longer require access. The MEDSIS
liaison shall also participate in the MEDSIS quarterly meetings.
9.24.3 Conduct Outreach to Delayed Reporters.
9.24.3.1 Local Health Department shall conduct outreach to delayed reporters (entities
reporting cases of disease later than timeframes allowed by Arizona Administrative
Code). Delayed reporters can be identified through quarterly timeliness reports
generated by ADHS or county-specific surveillance activities. Report on the
percentage of delayed reporters educated about timeliness of reporting.
9.24,4 Participate in Epidemiology Trainings and Exercises.
9.24.4.1 It is recommended Local Health Department participate in the Epidemiology
Surveillance and Capacity (ESC) meetings (at least ten (10) out of twelve (12)), 'How
to" Presentations (at least eighty percent (80%)) and the Arizona Infectious Disease
Training and Exercise. Attendance shall be monitored by ADHS for use in grant
reporting.
9.24.5 Conduct Investigations of Reported Infectious Diseases and Public Health Incidents.
9.24.5.1 Local Health Departments shall investigate and report cases of infectious disease as
required by Arizona rules and statutes and MEDSIS policies and procedures.
Investigation actions should be documented and include the following as necessary:
case identification, specimen collection, case investigation/characterization, and
control measure implementation. Outbreak investigations should begin within 24hrs
of receipt of report. For outbreak cases with a focused questionnaire, interview shall
be conducted within 48 hours.
9.24.6 Report All Identified Outbreaks Within 24 Hours.
9.24.6.1 Local Health Departments shall report all identified outbreaks to ADHS within 24
hours utilizing the MEDSIS Outbreak Module; include documentation on outbreak
investigation activities as part of jurisdictional mid-year and end-of- year reports to
ADHS. At a minimum, include the following information: Outbreak Name, Date
Reported to Local Health, Morbidity, Type of Setting, and County of Outbreak
Exposure.
9.24.7 Submit Outbreak Summaries to ADHS.
Page 15 of 19

ARIZONA DEPARTMENT OF
omes, HEALTH SERVICES
, INTERGOVERNMENTAL AGREEMENT (IGA) 1740W Adams, Room 303
111W.513 -4'.4.- AMENDMENT Phoenix, Arizona 85007
_. ,i (602) 542-1040
4,41tal;14# 7,/ (602) 542-1741 Fax
Contract No: ADHS12-007891 Amendment No. 8 Procurement Ana Shoshtarikj Officer:
9.24.7.1 Outbreak summaries must be submitted to ADHS utilizing the MEDSIS Outbreak
Module within 30 days of outbreak closure for all outbreaks investigated. Summary
forms must contain all required minimal elements. *(See Appendix 1)
9.24.8 Complete the Monthly Performance Measure Report Form.
9.24.8.1 Local Health Departments shall complete the monthly performance measure report
form distributed by ADHS for use in identifying gaps in timeliness of reporting,
completeness of interviews and monitoring outbreaks in the jurisdiction. Performance
measure report information shall be utilized for mid-year and end-of-year grant
reporting for both PHEP and ELC grant deliverables.
9.24.9 Conduct Epidemiology Program Evaluations.
9.24.9.1 Recommend Local Health Departments participate in regular meetings and/or
conference calls with ADHS regarding evaluation activities by providing feedback
and assisting in the refinement of evaluation questions and determining best
methods for implementation of findings/recommendations.
9.25 CAPABILITY 14: RESPONDER SAFETY AND HEALTH
Definition: The responder safety and health capability describes the ability to protect public health
agency staff responding to an incident and the ability to support the health and safety needs of
hospital and medical facility personnel, if requested.
9.26 COUNTY DELIVERABLES:
9.26.1 Review/update plans to include documentation of the safety and health risk scenarios likely to
be faced by public health responders, based on pre-identified jurisdictional incident risks,
which are developed in consultation with partner agencies.
9.26.1.1 Plans should include documentation that identifies public health roles and
responsibilities related to the jurisdiction have identified risks that were developed in
conjunction with partner agencies and emergency managers. This documentation
should identify the protective equipment, protective actions, or other mechanisms
that public health responders shall have to execute potential roles.
9.27 CAPABILITY 15: VOLUNTEER MANAGEMENT
Definition: Volunteer management is the ability to coordinate the identification, recruitment,
registration, credential verification, training, and engagement of volunteers to support the jurisdictional
public health agency's response to incidents of public health significance.
9.27.1 Review Volunteer Management plans to ensure processes are identified to manage
spontaneous volunteers to include communication pathways, and a method to refer
spontaneous volunteers to other organizations.
Page 17 of 19

ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
1740 W. Adams, Room 303
. AMENDMENT Phoenix, Arizona 85007
kr. (602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS12-007891 Amendment No. 8 Procurement Ana Shoshtarikj Officer:
Table One (1)
DELIVERABLES AT-A-GLANCE
PROGRAM
1 Attend All Partners Meeting
2 Attend ADHS Business Meeting
3 Attend your Region's Healthcare Coalition Meetings
4 Submit Budget and Work Plan
5 Attend Multi-Year Training and Exercise Workshop (MYTEP)
6 Submit Training and Exercise Plan
7 Have or have access to an Alert System
Provide ADHS a list of systems utilized in your EOC and for information sharing
9 Participate in Communication Pathway testing scenarios on a regularly basis
10 Submit Mid-Year and Annual Reports
11 Submit AAR/IPs to ADHS
12 Submit Training Validation Report
COUNTY
13 Participate in a Functional Exercise to test ability to stand up and operate EOC
14 Participate in the Fatality Management Workshop
15 Review and update Mass Care/Sheltering Plans to incorporate additional measures to address At-
Risk and Functional & Access Needs
16 Complete MCM Self-Assessment Tool and Submit MCM Plans to ADHS
17 Review RSS Site Survey and submit to ADHS
18 Participate in quarterly Inventory Management System drills
19 Complete 3 SNS Drills (CR1 Counties — Maricopa and Pinal)
20 Collaborate w/ ADHS on NPI plan reviews and to complete bi-annual performance measure report
21 Participate in Epidemiology Trainings and Exercises
Conduct investigations, report outbreaks, conduct outreach to delayed reporters, submit
22 summaries of outbreaks, complete monthly performance measure report, & enter info into MEDSIS
Page 18 of 19

ARIZONA DEPARTMENT OF
-0-I-..* 0,0-Avy HEALTH SERVICES
• ti v INTERGOVERNMENTAL AGREEMENT (IGA) 1740W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
c4t141411...4y 44 itip 'r _i (602) 542-1040
(602) 542-1741 Fax
Contract No ADHS12-007891 Amendment No. 8 Procurement Ana Shoshtarikj Officer:
ATTACHMENT B
OUTBREAK SUMMARY FORM MINIMAL ELEMENTS
The following elements shall be completed on the ADHS Outbreak Summary Report Form, for the minimal elements
to be considered complete;
1. For CONTEXT:
1.1. County of Exposure;
1.2. Case Information: # primary ill; # susceptible;
1.3. Primary setting of exposure; and
1.4, Could etiology be determined.
2. For INITIATION of INVESTIGATION:
2.1. Date LHD first (1st) notified;
2.2. Date ADHS first (1st) notified; and
2.3. Date Investigation started.
3. For INVESTIGATION METHODS:
3.1. Case Definition: Confirmed case; Probable Case; Suspect case (at least one should be filled out);
12. Other Actions & Investigation methods: Interviewed cases; Interviewed controls; epi studies; traceback;
case/pt samples; environmental samples, environmental health assessment; facility/establishment
investigation (at least one should be filled out);
3.3. Were specimens collected; and
3,4. If yes, what is the confirmed etiology.
4. For INVESTIGATION FINDINGS:
4.1. Were specimens collected;
4.2. If yes, what is the confirmed etiology;
4.3. Signs & Symptoms (at least one (1) filled out); and
4.4. Was a specific contaminated food, water or environmental vehicle/source identified?
5. For DISCUSSION and/or CONCLUSIONS:
5.1. Factors Contributing to an Outbreak: Foodborne; Waterborne; Nosocomial; Person to Person; Zoonotic or
Vector (at least one (/) filled out.)
6. For RECOMMENDATIONS for CONTROLLING DISEASE:
6.1. Outbreak Control section (at least one(1) filled out)
7, For KEY INVESTIGATORS:
7.1, Key Investigator section
Page 19 of 19