IGA AMENDMENT RE IMMUNIZATION SERVICES WITH ADHS.PDF

Maricopa County — Formal (2014-04-09)

Extracted text (via pymupdf_layout) 20767 characters

ARIZONA DEPARTMENT OF
HEALTH SERVICES
1740 W. Adams, Room 303
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Specialist
Contract No: ADHS13-041805 Amendment No. 1 Jacqueline Ortega-Avila
IMMUNIZATION PROGRAM
Effective January 1, 2014, it is mutually agreed that the Intergovernmental Agreement referenced is amended as
follows:
1. Pursuant to Page Three (3), Terms and Conditions, Provision Four (4), Contract Administration and Operation, Item
(4.12), Scrutinized Businesses, is deleted in its entirety.
2. Pursuant to Page Seven (7), Terms and Conditions, Provision Six (6), Contract Changes, Item (6.1), Amendments,
Purchase Orders and Change Orders; the Contract Price Sheet Effective January 1, 2013 is replaced with the
Revised Price Sheet January 1, 2014 of this Amendment. Pricing will be updated in the ProcureAZ “Items Tab” to
reflect the pricing upon execution of this Amendment.
3. Pursuant to Page Seven (7), Terms and Conditions, Provision Six (6), Contract Changes, Item (6.1), Amendments,
Purchase Orders and Change Orders; the Scope of Services, Provision D, Tasks, of the Contract is hereby revised as
follows:
(CONTINUED ON NEXT PAGE)
ALL OTHER PROVISIONS OF THIS AGREEMENT REMAIN UNCHANGED.
CONTRACTOR SIGNATURE
Maricopa County Department of Public Health
Contractor Name Contractor Authorized Signature
4041 North Central Avenue, #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 has date indicated. The Public Agency is hereby cautioned not to commence
determined that this Intergovernmental Agreement is in proper form and is any billable work or provide any material, service or construction under
within the powers and authority granted under the laws of the State of this IGA until the IGA has been executed by an authorized ADHS
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. P0012012000033, 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 was amended to remove the requirement
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

ARIZONA DEPARTMENT OF
HEALTH SERVICES
1740 W. Adams, Room 303
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Specialist
Contract No: ADHS13-041805 Amendment No. 1 Jacqueline Ortega-Avila
D. Tasks
3. Activity Three (3) Comprehensive Clinic Assessment Software Application (CoCASA)
3.1 Review Spring and Fall CoCASA summary reports provided by AIPO, which provide data analysis of
the immunization rates of children and adolescents immunized at the Contractor’s clinic sites, and
can be used to pinpoint strengths and areas of improvement. Share results with clinic staff to identify.
7. Activity Seven (7) Vaccine Management
7.2 The Contractor shall be responsible for compliance with VFC and VFA storage, handling, and
administration requirements and for preventing any loss or wastage of its vaccine used in clinics,
sites, or other venues to which the Contractor has distributed vaccine.
8. Activity Eight (8) Enrollment in VFC and VFA Programs
8.2 If participating in the Vaccines for Adults (VFA) program, enroll as a VFA provider and comply with
the program requirements as defined in the Arizona VFA Program Provider Enrollment Agreement,
the Arizona VFA operations Guide and AIPO directives on appropriate use of 317 funded vaccine
located at http://azdhs.gov/phs/immunization/vaccines-for-adults program/.
10. Activity Ten (10) Outreach Education
10.1 Utilize and distribute the Arizona Lifetime Immunization Record Card (LIRC), and Vaccine Information
Statements (VIS) and document distribution in the Quarterly Progress Report. May distribute the
Arizona School Immunization Record (ASIR) to County schools if requested. All forms can be
ordered by using Smartworks or by using the Forms Request form located at
http://azdhs.gov/phs/immunization/documents/forms-request.pdf. VISs may also be found at
http://www.immunize/org/vis;
10.2 Distribute “new mother” information/education which will include, but not be limited to, the Arizona
Lifetime Immunization Record Card (LIRC) and a current immunization schedule, located at
http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html, to all birthing centers in the
Contractor’s county and document distribution in the Quarterly Progress Report;
15. Activity Fifteen (15) School/Childcare Immunization Data Reports (IDRs)
15.1 Work directly with schools and childcare facilities to improve compliance with state immunization
requirements as specified by Arizona Revised Statutes and Arizona Administrative Code, and posted
at http://azdhs.gov/phs/immunization/school-childcare/requirements.htm, and the submission of
required reports in the format prescribed by AIPO/ADHS and posted at
http://azdhs.gov/phs/immunization/school-childcare/data-reports.htm. AIPO shall provide the
Contractor with spreadsheets of data reflecting the immunization, exemption and compliance levels of
schools and childcare centers to assist the Contractor in identifying facilities that need assistance.
Work will include on-site visits to provide education and technical assistance.
19. Activity Nineteen (19) (At the Contractor’s Option)
19.1 Conduct one (1) or more site visit(s) to each birthing hospital participating in the Perinatal Hepatitis B
Program. The Contractor should encourage and ensure policies and procedures for maternal
screening, prophylaxis of high-risk infants, and routine immunization of all infants are in place. The
Contractor shall provide professional and parent educational materials and offer educational
programs to labor and delivery and newborn nursery staff. The Contractor shall report the findings of
this visit to AIPO.
2

ARIZONA DEPARTMENT OF
HEALTH SERVICES
1740 W. Adams, Room 303
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Specialist
Contract No: ADHS13-041805 Amendment No. 1 Jacqueline Ortega-Avila
20. Activity Twenty (20) (At the Contractor’s Option)
20.1 Continue to have an Immunization Coalition. The Contractor should ensure that the Immunization
Coalition Executive Committee meets quarterly to assist with the development of the IAP and propose
ways of removing barriers to immunization. The coalition executive committee shall meet at least
semi-annually. At least fifty percent (50%) of the members should represent organizations other than
the County Department of Public Health.
21. Activity Twenty-One (21) Licensed Childcare Facility Assessments
21.1 The Contractor shall assess immunization levels of children attending licensed childcare facilities to
determine if facilities adhere to current state immunization requirements and target immunization
levels (ninety-five percent (95%) in childcare). The Contractor shall employ the following procedure:
21.1.1 By February 15th, the Contractor shall provide to AIPO a spreadsheet listing the childcare
centers that were below ninety-five percent (95%) compliance at the time the IDR was
submitted. The spreadsheet shall contain the number of children enrolled and the number
of children who lacked immunizations required for attendance.
21.1.2 By February 15th, send a follow up letter to all childcare facilities where less than ninety-five
percent (95%) of enrollees listed on the IDRs have completed all immunization required for
attendance. The letter shall require that the facilities refer children for required
immunizations and report the immunizations dates back to the Contractor;
21.1.3 By March 31st, compile and analyze IDR data collected during the current school year and
submit total number and percentages to AIPO. Data submitted shall include all areas of the
IDR;
21.1.4 By September 30th, distribute IDRs to all licensed childcare facilities in the County;
21.1.5 By September 30th, distribute appropriate educational materials, as well as required forms,
in English and Spanish to each child care facility;
21.1.6 By November 15th, collect IDRs from all licensed childcare facilities;
21.1.7 By December 31st, complete follow-up on all incomplete and delinquent childcare facilities.
Mail additional reporting forms to facilities that have not submitted an IDR; and
21.1.8 By December 31st, provide a list of all facilities that failed to submit an IDR to AIPO.
4. Pursuant to Page Seven (7), Terms and Conditions, Provision Six (6), Contract Changes, Item (6.1), Amendments,
Purchase Orders and Change Orders; the Scope of Services, Provision E, Requirements, of the Contract is hereby
revised as follows:
E. Requirements
1. The activities in this Contract shall be performed by the Contractor, or its partners, for the purpose of
increasing immunization coverage levels of children 0-18 years of age and adults 19 years of age and older
in both the public and private sectors of health care. Funds shall be used for immunization related
services and activities and in accordance with any federal and state regulations.
3

ARIZONA DEPARTMENT OF
HEALTH SERVICES
1740 W. Adams, Room 303
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Specialist
Contract No: ADHS13-041805 Amendment No. 1 Jacqueline Ortega-Avila
5. Pursuant to Page Seven (7), Terms and Conditions, Provision Six (6), Contract Changes, Item (6.1), Amendments,
Purchase Orders and Change Orders; the Scope of Services, Provision F, State Provided Items, of the Contract is
hereby revised as follows:
F. State Provided Items
The Arizona Immunization Program Office will provide:
1. CoCASA Summary Report (example) which contains Assessment criteria for children twenty-four to thirty-five
(24-35) months’ old and adolescent reports for children within the thirteen to eighteen (13-18) year old age
cohort.
6. Pursuant to Page Seven (7), Terms and Conditions, Provision Six (6), Contract Changes, Item (6.1),
Amendments, Purchase Orders and Change Orders; the Scope of Services, Provision G, Deliverables, of the
Contract is hereby revised as follows:
G. Deliverables
The Contractor shall:
1. Complete and submit a quarterly Contractor’s Expenditure Report (CER) listing all reports/summaries for
which reimbursement is due within thirty (30) days of the end of the quarter. The Contractor is expected to
use the funds received from the CER for immunization-related services and activities and in accordance with
any Federal and State regulations.
7. Pursuant to Page Seven (7), Terms and Conditions, Provision Six (6), Contract Changes, Item (6.1),
Amendments, Purchase Orders and Change Orders; the Exhibit Two (2), is replaced with the Revised Exhibit Two
(2) of this Amendment.
8. Pursuant to Page Twelve (12), Terms and Conditions, Provision Fifteen (15), Fingerprint and Certification
Requirements/Juvenile Services, is deleted in its entirety.
9. Pursuant to Page Twelve (12), Terms and Conditions, Provision Eighteen (18), Health Insurance Portability and
Accountability Act of 1996 (HIPAA) is revised to read as follows:
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 Strategic
Enterprise Technology (ASET) Office, Statewide Information Security and Privacy Office (SISPO) Chief
Privacy 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
4

ARIZONA DEPARTMENT OF
HEALTH SERVICES
1740 W. Adams, Room 303
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Specialist
Contract No: ADHS13-041805 Amendment No. 1 Jacqueline Ortega-Avila
REVISED EXHIBIT TWO (2)
Fee for Service Definitions
A. Fixed Price
1. Immunization Administration
1.1 "Immunization Visit Fee" is the rate paid to supplement the county-specific administration cost for each
child and/or adult immunization visit. The fee will only be applied to VFC and VFA eligible visits and
should not be used for private insurance visits. Please use ASIIS reports such as the ASIIS Vaccines
for Children Accountability Log, VFC vaccination Breakdown Report, or the Vaccination Total Report as
source documentation when submitting the quarterly Contractor's Expenditure Report (CER).
1.2 "Completions" is the rate paid for each child who completes (receives) four (4) DTaP, three (3) Polio, one
(1) MMR, three (3) Hib, three (3) Hep B, and one (1) Varicella by twenty-four (24) months of age.
Contractor is advised that this immunization completion series is subject to change based on future CDC
and AIPO requirements or recommendations. Please use ASIIS reports such as the ASIIS Completion
Report when submitting the quarterly CER.
2. Perinatal Hepatitis B Case Management
Perinatal Hepatitis B Case Management spans from the mother's initial interview through to completion of all
preventive services for the infant and the household/sexual contacts. It is anticipated that cases should not
take more than eighteen (18) months to complete.
Contract payment for each case will be paid in two increments, depending upon completion of prenatal and
postnatal services:
2.1 "Pre-Natal Management" is the rate paid to include date of initial client interview, identification of
household and sexual contacts, testing and/or immunization of contacts or documentation of previous
services or refusal of services. All services will be reported on the Hepatitis B Line Listing Report, which
shall accompany the quarterly CER.
2. 2 "Post-Natal Management" is the rate paid to include obtaining name of birth hospital, infant' s name,
date of birth (DOB), birth weight, date of administration of HBIG and Hepatitis B # 1, and the name of the
infant's health provider. The rate also includes obtaining subsequent dates for the remaining two (2)
doses of Hepatitis B vaccine as well as the dates and results of post serology follow-up or
documentation of refusal.
Per CDC, guidelines (refer to Hepatitis B Manual identified in Activity 2.1) infants born to HBsAg -
positive mothers should receive Hepatitis # 3 optimally by six (6) months of age (a grace period of two
months is allowed for a "completed series"). Contract payment will only be paid until twelve (12)
months of age. All services will be reported on the Hepatitis B Line Listing Report, w h i c h shall
accompany the quarterly CER.
7