MIHS IGA ATTACHMENT 1 MENTAL HEALTH 12097-RFP.PDF
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SECTION V ATTACHMENT 1 RYAN WHITE PART A PROGRAM
This Attachment consists of the Maricopa Integrated Health Systems Response to the Maricopa County
Ryan White Part A Program, Request for Proposal 12097-RFP, for Mental Health and Substance Abuse
Services. This portion of the Intergovernmental Agreement shall be a Fee for Service arrangement
utilizing the Arizona Health Care Cost Containment System, Fee for Service rate, in place during the time
the service(s) is/are performed.
Index of Attachments
Attachment 1: consists of the following original documents:
Attachment 1-A: Service Provider Application
Attachment 1-B-1: Budget for Mental Health Services
Attachment 1-B-2: Budget for Substance Abuse Services
Attachment 1-C: Narrative Scope of Work
Attachment 1-D: MIHS Grant Policy and Procedure
Attachment 1-E: MIHS Staff Licenses and Resumes
Attachment 1-F: MIHS References
Attachment 1-G: MIHS Org Chart
SERIAL 12097-RFP
Attachment 1-A
SERVICE PROVIDER APPLICATION
organizafiee: Marioopa Integrated Health System
Adthess: 2601 E Roosevelt St
City: Phcs3rdx State: AZ u p: 85008
Telephone: 602-344-2629
Executive Director/CEO: Betsey Bayless, President end Chief Executive 01Tver
Person completing this fon= shed Tomlin son Contact Telephone: 6°2444-2629
Legal Status I:Nonprofit 501 -C3 jorpomtion LLC EIPartnership Omer Marleopa County Special Health Care
Years in Business 1 33 Years as an °Ma
Maricopa County Valdez. Registration Complete: 'Des ENo Varier Number: w9°°0°774"
Site and Locations where services will be provided under this contract: McDowell Healthcare Center
Service Site Location #1: McDowell Healthcare Center
organizgion: Maricopa County Spedal Health Care Distil dba Maricopa Integrated in
Addiess: 1144 E MoDoviell Road, Suite 300
City: Ph°e1* State: AZ Zip: 85006
Telephone: 60234443550
Service Site Location #2:
Organization:
Addless:
City: State: Zip:
Telephone:
Note: If you propasc mare than two (2) Service Site Locations please include an additional attadiment identifying
those locations.
What Geographic Location(s) do you plan to save (See Exhibit 3)?
MIHS will provide services throughout the entire EMA.
Upon Award of a Ccatract, far this service, it is required that the Contractor shall comply with all Terms and
Conditions of this Solicitation. OM yoir Organization meet and comply with all of the Terms and Conditions at this
time? Yes ar No YES
Can your Organization meet all of the Terms and Conditions at the time of the contract award? Yes or No YES
If your response is yes to this question, please idmtify the Terre and Condition and describe how your Orgardzation
will net the recpurement:
Attachment 1 -B -1
Maricopa County
Ryan White Part A - Budget Documentation
DATE PREPARED 8/16/12
PREPARED BY: Phyllis Hardy
NAME OF ORGANIZATION: Maricopa Integrated Health System
Fed. Employee ID # (FEIN) 86-0830701
DUNS # 186507216
ADDRESS: 2601 E Roosevelt Road
Phoenix, AZ 85008
AUTHORIZED CONTACT Dr. Robert Fromm, Chief Medical Officer
TELEPHONE (602) 344-5503 FAX (60244-5190
E-MAIL robert.fromm@mihs.org
PRIMARY CONTACT
Cheri Tomlinson
TELEPHONE 602-344-2629 FAX 602-344-2633
EMAIL cheri.tomlinson@mihs.org
CONTRACT NUMBER
SERVICE CATEGORY Mental Health Services
BUDGET PERIOD: 31112012 212912013
Start Date End Date
CONTRACT AMOUNT $169,664.16
By submission of this budget, the Provider certifies that they have read the List of Unallowable Costs under
the Ryan White Part A Program and agree to follow the HRSA specific standards related to Unallowable Costs.
In addition, the following documents must be submitted with your budget proposal (Check the appropriate boxes)
;:t applicable, Indirect Cost Proposal is attached [3 Allocation Policy is attached (required)
Cover Page
Effective 3/1/2011
Revised 3/16/2012
Maricopa County
Ryan White Part A Grant
Contractor Budget Summary
Date Prepaied• eigrici2
(Section I)
Organization Maricopa Integrated Health System
Service Category Mental Health Services
Budget Period March 1 2012 Through 21211.'2013
(Section II)
Contract Amount $169,664.16
Operating Expenses Administrative IN:milpfL 1:3Frirct St rm< a guava I lot.t tueve!
FTES 0.00 0.00 0.011
Personnel: Salaries
Personnel: Fringe/Benefits
Subtotal: Peraonnel/Fringe Benefits
Other Operating Expenses
Travel - • . ,
Supplies . - .
,Equipment . - .
_ ....
Contractual
- 32,548.32 32,548.32 _
Program Support .
- -
Other Professional Senrices
- 137,115.84 137,115.84
I Subtotal: Other Operating Expenses I I 169,664.16 I 169,664.16
Total Operating Expenses E7 1 169_,664.16 I 169,664.16 I
(Personnel and Other Direct Costs)
indirect Costs
Enter indirect Cost Rate Providers claiming an indirect cost must submit their most current negotiated indirect costs
(may rot exceed 10% of Direct Costa) rate agreement issued by the cognizant federal agency with their budget.
iTotal Costs of Contract
169,664.1C 169,664.16
(Admin-Parceni of Direct Cost
adifkaaaaTain may not exceed 10% of Deed Casts
CONTRACT BALANCE (Contract Revenue less Total Costs of Contract)
The Contract EllallaCti should equal zero.
Budget Summary
Budget 7erndiate
Effeceve 3/112011
Revised 311612012
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ice
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Description DesentiOop DE430'06011 ' Template
Staffing Elescriptort riemnok.
-
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2 ' 1 11 12 Personnel Effective
1.. 14 1. /7 Budget Revised
TRAVEL 0I0O0P1 Ere., [
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Tneret can be budgeted kettle Dad al slag 'agape and other morel Emaciated with Ryon Wheel Pet A
1 Mlle mg. Waage leig he bJdbeted utPzing Itst stenderd calcuheonol annual toles tor • lull Vele in game tt
the role deternned by your organaahon pe ole e the nontbe, of FT EN budgeted It
provide son, ices under Ibis Wag Enter only the F TE s th.31 NO I travel and provide NalTalleb ihatOlcallort
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Idea - Budget annuat mileage for I FIE
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SUPPLIES Prorates Entry Auto Colculator 1
Dale Prepared; B 116/20121
The supplies line item Is used 10 budget funds for supplies used in the operations Of the Grant.
This category can Include general office supplies and program/medical supplies
1 General Office Supp (Apply al PIE Ratm tram the Budgeted Persormel Page)
Pens, payer toner and general suppfies thal are .10010ton
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am Su Iles leallreoPe frier. Mad Heeilt &arm hlentsi Sere1COS
ai4 ,eeti,e -Description/Cost Allocation Methodology
TOTAL
AdmIn MAKI -Total
SUMMARY [ &Whirl) S' - •
Supplies
Budget Template
Effective 3/112011
Revised 3/16/2012
EQUIPMENT Fmode, ntry jAuW Calculatqn 1 L
Date Prepared'
The equipment line Itern Is budgeted tor equipment purchased or leased in conjunctEon with operations of the grant
Refer Lo your contract terms and cOnditions for requirements related to equipment purchases
ar grantor it ertedp. fronrinon Mikdts, a'aidam taamot Hos
AcImin Dwii Toial
SUMMARY (Emnpmen11
Enwprrwer
Budget Template
Effn-tive 3/V2011
Revile*, 311612012
Contractual I ProMrs Entry Vida Caiculalon
Data Prepared: liftli2D11
Use this form to buclget '7r EdfliSatliNI and COn2raCil1it132f Set.:;•700 1) and lubccelLiSCs ( Section 2) in tnIlr cr. with Operatin g this
Part A grant.
I. Consulting/ Prossional fe Contrast LaborlCierical Support
This budget category I ncliates payments to outsvde consultants. temporary services. professional contract labor and derive suPPori
indicate the curie, hcansesigualifiostions. howl budgeted, quclad tele, dates of service. and a detailed Naitatiyeciustificalion
ol actlyities to be provided
1, Corn .7 giPnutai.rrnn • wine - re't tore..: Sigicisr Ityilusp. I rim ,WrKI 4144 Vern r 111., an - s
ttinosittent Algid% . Slieawl Total Adviiii Admin Rind Service I 1 °deb 4 S.r.ou
Name neditieted v.," I gala ritidilei n HOW 1. •14nm.! I NW* I
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Narrative
Justification
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License* /
qualifications
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Juatilicelun
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Surativer
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.....,.._ ...
t I 1 ,
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qualifications
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I I ((Jr AL : i • . I 32 3.41.S2 i i 12.81/1.22 1
2. Subcontracts
trickede any paymants through subcontracts to provde services under this grant
Each Subcontractor Wed in this section 'who a • ebb mai:bent (not. Vendoi) must candies &Algot using the RWPA laudott tenable
ericopa County RWPA enforce the 10% Nintinistrathie Cost Cap eStablishad by HRSA be finst•bne and lastord ia sub recipient ordities waivin g Ryan WhIlis
Poi A Fords
; sew...111450a
kdersestrectrai gob re Dwra . Adm., . 1 sari be tvx• , Total
Nana or vandal. i 0 IHIri Etudret i Bud.
___ I. I L5 • PDIVIo!
Servic-et.)
Provided
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JurillIcdlon
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—
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SUMMARY u• t•Lf
COntradtral
Budg et Tornotata
Effective 313/201 I
Atarolud 3/16/2012
Contractual- Continuation Page
Dale Prepared: 81161201-21
The Contractual arm OM Is used for consultin g and contraceng to be mated in conjuncuon with operations of the grant.
Use ihn page to 5st Consuhard/Contract Labor and Clerical Support if there a insufficient space on the Contractual Page.
censoungirectessLonst .T.c.nrert LoNwiCinicat SKIVOri
NOWITMALIKI no. t-unirect Lamorn-wrIt-fti J4ippGft Mef1CO9I Inlegtxtad HIIshyst,in Mental Health Services
Coneriatani Hours : ammo fieJrnIn halm ol Seivice
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qualifications
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unifications
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qualifications
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juallikations
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1 fl I S 5 - 5
Licenses /
quelificatIons
Nerraeve
16 i S • • I I S - - I
Licensee /
qualifications
Narrellve
Tim. .
Contractual Continuation
Budget Template
Effective 31112011
Reviled 3/16/2012
Other Program Support [Provider EntrylAuto Calculetron Dale Prepared: 8/1612012
Use this form to budget for other support necessary to provide services under this grant. In the Narrative Justification
describe how the program support wilt be used and also the methodology used to allocate the total or a portion of the total cost
to the grant.
1
Communicationsrfelephunemnieroat Mencups Intaterafred Hoeft System Mental Health Services
Item Amount Narrative/Cost Allocation Methodology
Budnefed
ci
5
TOTAL
211ENNE=11
HOMO SYSiala Menial Health Services
atanittiftlCut SlIncatIon Methodology
2
3
Postime Alaricarge hfferated Ikon System Menteitlealth Services
Item Amount Narrative/Cost Allocation Methodology
Budgeted
thiities are 10D% administrative Rul 6.6.134B;
the epic a Mt raiad Hearth 5ijaLeri Mentor Health Services
Item Amount Narrative/Cost Allocation Methodology
Budgeted
.
I
......... ,, 4 .5 _
J . S .
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TOTAL i - - TOTAL $ .,- . .
a
Other FreW.etr Su Li i adafiCO mad Neigh S am Mental Health Services
Item Narrative/Cost Allocation Methodology 1
....,—
MIIMIIIIIII
ILIMIIMIJIMIESII
-
— - I S - TOTAL _ i $ . ...
Arbein Diieci -Toed
_SUMMAIrr Progrerrl Simeon I • $- • E.' •
Program Support
Budget Template
Effective 3/112011
Revised 3/1672012
unbar Frotessionai Service I nro-Acer Entry 'Auto CAW:4ton j
Dale Prepared.
Use Ole form to budget ke other. professional earecee, euiefistetionting, oIr.n0e, reoUspace, or other professional S•r•C•4
I AudItrAccountingTinence
seinbaissoor tingirinersee allnreseasa iabrallneri Nesbit Sinelem Menial HasSli &HIM.%
• ; ..4 01.114 4,olao -
711, (fdllaitfila Price' of &Poke. Elenitisalein ot I. ryne
Leal Ilatthnef
aruag41
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cat .1K-S7-1
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rfC.TAL ' .
neeureme Perk op. int - Med Hawaii S hue Wentel tes-allia Senaae
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pump • Premium I To Nrebt Da •0 1 011 al smirks
-or 147VII4 .
• I --I . ,.;
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Unit
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.
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Inantedpeoi Silensops Intesienes in-Lim Resole ilesilh serene,
i: n ritee
00:11
Cost Method
Ureol
Rudgia
Juilificafion
TOTAL
4 Other Professional Service
Wm. PseSearionsl Simko Hsi i •u In mod HARM. store lesniai lihoolui benrkee
,.not-.' *Mire 131,01Y11 1.1' . n
lin.- s 110101012 l'f104 Enrage, 14 I pLI0so Intndere
1 St], .tta.114 11117 ItS fie Er=1
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- 11 111.1!0M4I 117,11.5.60-".'.-n
Arienin
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Olhoe Prof Seca
Budget Ternptels
Effectrve 31112011
RevLsed S11a12012
— _.
S, etc.) ,__
(le H .....
I Rate, __
Contracts) Source Rota Fiats Hale
AHCCCS, Mc9,91:Rat--- .____......._
Fee Negotiated
fAHCCCS Al-ICCCt ANCDCS
Only —,
161 85 246 Reimbursement 1
8/16/2612 Service Per 12.;.9,9 - - taro
43.104.96 63,405.60 16.341,60 169,564.16 169.684.18 owe
for Cosi Payment Objective/Activity 46.e _,....,..._ alquld
Fee to — _
Total
Applicable $ 1. * $ 6. $ 5 $
Prepared: Clients Clients Clients (Not Fee 22R-34 ARUM: 264,1E1 27238 ......._ Budgel)
Product/
Deliverable
New Proposed ......... Bk.clort
Dale of Returning Unduplicated Per $ ..s $ $ TWA OrwrIllffinder
Number of Feb 1.4 20 1 57
Measures: of
Number # 12 2I:1 ne O
Jan Ear
Total _.
ta a
Dec
Performance
: 20 ',I . r—T7T-57
Nov
6
Oct — ,.,.. IT 57
Detiverrables 20
Sep —5-Tr
of 20 6 i
Aug 57
Schedule 12 .21 at 6 . ..-.. r
July . 57
...n 20 2f2 5 .,. i
June , 57
,
May lk Fe 232 57-f
Calculation Apr 20 X . 57 i
System
Ault 52 20 2D1 .S 577-
Mar
Health Services. I-
ErVryj of 144 240 240 60 6841
:
PrO‘ide, Integrated Health Number Units ROI:10543d
Mental —1
Maricops Unit = minutes)
Definition unit ! .".1. Aa/1 virdi visa •
Service 1 15 1 - =1 i = • 1 •
(la. tml tam ioSI.
t 1 1., 1 [
.1' ,
Description ami.lon *amalgam aea4,C^ ce.mriblipal. ...__
mesettnitmo win"'
Deliverables t•;•.orchiarric mclloaharanry loacical initial= Socrefi-iiiribndusi toga 101102-inahutuao payelatallalallit mato 45-5511/111ulir .
Service 1+11/10.181er
Name: 9000 lain 20,30 ,,ath —.-
_150 1.•
Category Unit
of Deliverables
Organization CAREWare Name/Code Mann Hail* Hsieh
Service Service meniiiil-tgirri .. TOTAL 3/1/2011 3116/2012
Schedule menial Maloal mom' _ of
1 2 3 4 . 5 6 8 9, .. 14 i
. , .. Schedule Effective Revised
Attachment 1-B-2
Maricopa County
Ryan White Part A - Budget Documentation
DATE PREPARED 8/16/12
PREPARED BY: PhyLlis Hardy
NAME OF ORGANIZATION: Maricopa integrated Health System
Fed. Employee ID # (FEIN) 86-G836701
DUNS # 186507216
ADDRESS: 2601 E Roosevelt Road
Phoenix, AZ 85008
AUTHORIZED CONTACT Betsey Bayless, President and Chief Executive Officer
TELEPHONE 002) 344-5566 FAX_ 002_p44-5190
E-MAIL betsey,bayless@mihs.org
PRIMARY CONTACT
Chen Tomlinson
TELEPHONE 602-344-2629 FAX 602-344-2633
EMAIL cheri.tom[inson@mihs.org
CONTRACT NUMBER
SERVICE CATEGORY Substance Abuse Services
BUDGET PERIOD: 3/1/2012 2i29i2013
Start Date End Date
CONTRACT AMOUNT $17,647.44
By submission of this budget, the Provider certifies that they have read the List of Unallowable Costs under
the Ryan White Part A Program and agree to follow the HRSA specific standards related to Unallowable Costs.
In addition, the following documents must be submitted with your budget proposal (Check the appropriate boxes)
El applicable, Indirect Cost Proposal is attached el Cost Allocation Policy is attached (required)
Cover Page
Effeclive 3/1/2011
Revised 3/16/2012
6
MarIcopa County
Ryan White Part A Grant
Contractor Budget Summary
(Section I) Date Prepared: El1612012
Organization Maricopa Integrated Health System
Service Category Substance Abuse Services
Budget Period March 1, 2012 Through 212912013
(Section II) Contract Amount $17,647.44
Operating Expenses Atiministroko 0.,idge Direct. Service Builest Ttiol Kroger
FTES 00 0.00 0.00
Personnel: Salaries
Personnel: Fringe/Benefits
Subtotal: Personnel/Fringe Benefits
Other Operating Expenses
_
Travel _
• . .
Supplies .
- - _
Equipment . - -
Contractual
- 631.08 631.08_
Program Support .
- -
Other Professional Services
- 17,016.36 17,016.36
Subtotal: Other Operating Expenses 1 74i.44 17,647.44
Total Operating Expenses I 17,647.44 I 17,647.44
(Personnel and Other Direct Costs)
Indirect Costs
Enter Indirect Cost Rate Providers claiming an indirect cost must submit Mei. most current negotiated indirect costs
(may not exceed 10% of Direct Costs} rare agreement issued by the cognizant federal agency with their budget.
'Total Costs of Contract
17,647.44 I 17,647.44
AcImin-Percent of Direct Co(} 0.00%
Administration may not exceed 10% of Direct Costs
CONTRACT BALANCE (Contract Revenue less Total Costs of Contract)
The Contract Balance should equal um.
Budget Summary
Budget Template
Effecove 3/1r2011
Revised 3116/2012
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rial.:1
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, Template
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I
- _ _
---
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3/1/2011 3/16/2012
rourkpurn Desolphan Deatfigiatet Dear.Vital DeserIplion Ditqrririinn nea.owliori Template
Staffing biz-croon
Duw
2 Personnel Effective Revised
1 1 17 Budget
TRAVEL r Pm1•4N Ent,/ 1 Catu,L.DrI
Dela Mewed
Travel [len be budgeted tor Usk met of wan mdeoge are other Irrniassocated Mtn Ryan Whste Pal A.
1 Mk aye 4.4hrage wit be budgeted utilizing the starslard orkulsbOn of snug miles for full time watt person a
the rate determined by your orgeterabon per hole X the number of FTEls) budgeted to
provide services under thts Want Enter only the FTEs that w0 travel and T.00OOO tlaiTelhOM JusUferion
inctudrin who wit travel and why
1.2...encepe 4.4117./son ituk•••••• Abuse Sarno**
Weep RAI
sit A -.....-. IM .... U•i•I
p,,a, Ted Iry I kr,,.. .1 :4 .4 1 . ••I• Piusl lio•h-tarr AesSesse•
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114•Wee•I••• -• e-r sem
'Hots • Budget annum1 rrolleogs for FTE,
2 Ott., Morals Towel t renhe swim Ora Ott)
Rpm Wets Pei A hat determined that sees included In en 0000.0 ere kelnWilee km
al=• 00.mm. 14 rim, IA•r.ais• 100811.111 ow nses, 1....••••• •....mo Banta
Doe, 114;
15..E•11.. Arr.*. •
Cost
Line Item
Cost_
Lino nom
Coat_
Line Item
Direct Service "rceee
fiUld etA Fr? . I
Buckpol Tana.
Efbche 3111221t
Rowed 1100012
SUPPLIES P,ovitler Entry 1Auto Cotulation
Dale Prepared 811612012
The supplies line item is used lo budget funds for supplies used lithe operations of the Grant,
This category can include general office supplies and program/medical supplies
1 Genii-810111cm Supplies: (Apply at FIE Ribo born the Budgeted Personnel Page)
Pens, paper. loner anc genera, Slippires that are ...two; um erotica.
I a Meow - Erie. it Hiatt' S 1 iorkli-Azklatipe Abuso Servicos
Annual 'J. Admin % Owe! 'field
aitiniailiis DrtaarlpelonrC est Attocrlicin Mschadalra21/
Item . Bud :et 0•4
.........._ __ . r t II.
2 5 I _ -- -
3 ', $ • $ - L.-_
4 ......
5 _ 1 . _ ___ ___
TOTAL TOTAL —4- $ I 3 • . 'TOTAL 5 ..... .. .. __________- - ___.-.,..
2 Program Supplies
Program/Medical Supplies are budgeted es 13,tisci Settee
P1.139fl.,15"ipptcs Marleopy Iniewrshicl Fitohn System Substance Abuse Services
Annual
Item _ Eh. JAW Admin • Nanouro Description/Cost Allocation Methodology
3
/41.Pi1n Otirct _ •trial
• ARA& 1 Suklile . . $
Supplies
Budget Template
Effective 31/2011
Revised 3)1612012
EQUIPMENT 1 Prosndol Entry IA.xo Calcular..n I Date
Prepared. 1161201q
The equipment line itern is budgeted for equipment purchased or leased in conjunction with operations ol the grant
Refer to your contract terms and conditions for requirements related to equipment purchases
9. 1M 01,11"ar..t1 W MarinCIP4 idieciretnct Mawlh 5yaLann &Malang. Ktsupa Ewajam,
kilpeNrn Iscps lb! &MO, Fin Ir15 ri l•tis StpuaLanca Abu.. &rakes
Admin Difecc Total
SUMMARY fEildulrimril I. • $ S
Equiprrierd
&pipet TeMplale
Ellwaroa 31112011
Revised 311612012
Contractual flrovaiin Entry 'Auto Calculation
Date Prepared: J" 606:20,A
Use this form to budget for oa iuting end contract Iola& (Seaton 11 end subconliarbl ( Section 2) in 03 ncterxi with operating this Pert A grant.
1. Coneuging/Proleational Contract Labor/Glerlcol Subpar'
Thu balget category includes payments to Outside consultartlb temporary sensor's, prolasalonal swarm( tabor aral clerical support
,ndicate the name, tne,ssiqualificabors, noun budgeted, floated rate. dates of sonvLe and a cletided NarralheeLksleficatran
of oddities to be recioderd
I. Consulli Professional Contract Labor(ClarlcaI Support Mancopa Into • add Health le Substand Abu.. Services
ezineunarri 1 itintnial Quoted i Total Admit, Chines o •
1 Admit, i Oind Service
Nand Iluallqpida eine.* Rate l Budget ; Budget % i Budget • Budget
_, i ha .....I
5:3.4. .11 I 031.06! # 631 08 '. I 8 5 631:
u.... / Ps...on switerie Vole .11.1.• Sr...mr.e.4 h. hilberwhf, r... islotaanni. na...i.....1.h.o.171w0... r.i.I. La, sf is isers• es.% am.. 31.112-.2.05l12
qualifications
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qualifications
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qualifications
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Justification
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qualilications
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Jizettilcation
imatalne Pi s r I' Orval op 1 r ..
toteavvy Pm& blond hp From Cosaationi Continues., e e I
r ( 1' C-Tht.I. e - 1 431 011 i $ 411M
2. Subcontracts
Indult any payments Urowli auboontracta to grotto uroses vide, Ihd grant
Each SUbconbeCtor Fated In this arechoo who lah sub recipient (not a condor) must complete a Budge" using the RATA budget immolate
meticepa county RWPA olK enforce the mi. •drrrverstrve Cost Gap eslabiblierf by HRSA to, fisst-Sne and socaari Ms sub recipient erns* riorteidig Ryon While Art A Funds
2 k. 1....A, K1.. M., h1..1 Me - ghtl K*041117 ha, Bud did 111.1hh.. Serried
beadeade lob to porn irie rer.t TOIrVIEM WA Adman 04..h. n.I 5.......eirm
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• ! 1 NDIV/Ol I
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, TOTAL
Admin 13. 111•4:1 Ole
.5uMPAR1 ..1,, I .1 1
Contractual
Budget. TelrOlaii.
Efface. 1112011
Revised Ina/2012
Contractual- Continuation Page
Dale Prepared 8/16120121
The Contactual Me Item is used for consulting and contracting to be utilized in conjunctrin with operators of the grant
Use the page to tat Consultant/Contract Labor and Ckincal Support if there is insufficient space on the Contractual Page
Gonave rytofeesirr al Como: r. Labor/Clerical Support
ConsultintiPlotessional Cali act LatooniClevicat Support mouldy a Ince atoll ilealthSystam Substance Aquas Services
toes-exult Hour" ' Quoted Admits LI 1 toe. of norvis.
. Budgeted Rite Bud et%
6 I . .-- _ -
LICHISQ17-1
qualifications _
Narrative
7 D. 2. ' .I .
Marian i
quanecations
Harrel/vs'
i
6 !.. $
Licenses I
quallacalions
Narrstnnt
. .
it c $ I 5 E
Licenses I "
queillicatIons
Narrative
10 0 S • 5 - 5.
Licenses I
qualifications
Narrative
1 1 I. 5- I - 1 S
Licenses / --
quellicattodta
Narrativo
12 .1 f - . 5
LIcanses I
qualNicsUons
Narrative
r 1
. $
Licenses I
qualifications .
Narrative
14 • 5 .
Ltcensas 1 '
guanaco/lona
Narrative
1 I. $ - - I. 5 .
Licenses /
qualifications
Narrative i
16 • .
— — Lk —.---1 er 15 .a 1
I
qualincations
Narrative 1
c_ • es=8=r 51217-C.er_r_al 1..1; 84/111.88, ram I .Tf..1 .
Conuachisi Continuation
Budget Template
Elfective 31112011
Named 3/1612012
Other Program Support [Provider EnlrytAuto Calculation'
Date Prepared, 811612012
Use this form to budget for other support necessary to provide services under this grant. In the Narrative Justification
describe how the program support will be used and also the methodology used to allocate the total or a portion of the total cost
to the grant,
1111111•111MMEE111=11
Commurocationsriereahonorntento mancoge Integral ec Health 21 vem Substance Abuse Services
Item
Arnouro Narrative/Cost Allocation Methodology
Buggeted
; 5
TOTAL I ; 5
2
Copy/Duplicating Markup, Intedreted !Health 51riiiirl Substance Abuse Services
Amount
Budgeted Narrative/Cast Allocation MeltiodolegY
1 IIV gireferene.....4•54.61., LimazIzisi
2
TOTAL
3
P01 11. OLINIGAIPa telegratad HUM System Substance Abuse Services
Item Amount
Budgeted Narrative/Cost Allocation Methodology
foiAt - TWA
4
Utilities are 100% administrative f Rub" 0.6.001)
1 111111em spi lf!gr uuIad Heailh Syitim Sian lance Abuse Services
item Antelbel
Budgeted Narrative/Cost Allocation Methodology
.. 1 ...... —...1
" . .... -. —..._.....
$. S .
-1-- 3 — .
--
$
TOTAL i • i - _ $ ..
4
Sear Riparian. Su saga Item iimetfih wag} Substance Abuse Services
NarrativelCost Allocation Methodology
TOTAL TtTAL
"
Program Support
Budget Template
elective 3/1,2011
Revised 3110120 5 2
Utner Protessionai service
Dole Prepared:
Uwe Nis lore ta budget for Other prelessisrial wean sudelersotrnirc. tnatrenok rentleince, or other profesasoriel *emcee
AudItlAtoountIng/Flaarkat
egitirsascsnmimmiteisnes illanorms liii • Idlt ROAM 'dYdIrm JbIIr AA... s•rim.et
OLIAVell
drihuM Elucropeteu • Price af Untie. :Id mr.rIpt 2,1 Ad Sarum
$
1.1 .11, oLl
II untie(
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I tat& 1
ineirrensasosin Wm die; 11..19. iTim $411;WIldldi Aim.. dundoes
• ridor annum IØ1I
K.,. t.r....kro To Eitort of UM.. bI.crlpI1Qri or Strom
.• 4 , I 0
--Firligrar C. . -
i____1111.1
80.0140.1
Ili I tt Vey') oh
, - .7: -_----- • i
trunk fra—r
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MAW
Joallni.lotm
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third
BOOI911
JutrilloIllea
--1,
il'In L — — _-
-
3 Rent/Specs
RerAl AS considered 10044 Administrative
-PrOTAL
4 lather Professional Strides
011.1. PTchlolomood Sono lc* Wed; Ira, refiniWeellis aislem ELAM lump Atm* aids's..
•nriss, i 1,-...m. 12w.1 4.1 .1511.119.
KIM Poo' pied RIAU' 1;411.2Ipldsl .hip,
-.L. ,......... .. , s ttala 3a, SIT.nrcas
i. -...• 3 - S 91 -91 .3 34t
0 c43 Motil.le •Al•AA. ri AInd...I.d. Al YU 411:451 ." Nimes Ad lu4din NA flu Flood ..1.4.44.4,-e, .4 sfar.si MA /A •
U.. 3
13640. 1 ....... ...".--o" . lo. =..........mo um nrsuss ..uuou.ruw, .......1... I. Add Mu didIAMI. I:suldumlol ma
.ilisliihre 144;4 1 ...Audi,
i I • I
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r . I 6
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4 17.1310. L I • a Wan 1 17,11
MEM.
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'
Other Prof. Sled,
Eludgc. Templet.
erroo.arinciii
Ranged 311672012
etc.) ..
(ie S, , •
re) I H Rate, .
Source Rate Rate ROI Rile
Confroc AHCCCS, led
Fee .
Negotta rtkfCCCS AHcdCs AF,C:CCS AHCGCS ,____
Only .. --
12 7 19 Reimbursement
8116/2012 Service Per 1796.04 - - - - _ _ .• . - 1' -
15.851.40 ., 17,647. 17,647_44 iqual
for Con Payment Objective/Activity
Co ahoutd
Fee
Total Elstonc.
Applicable $ S -- $ $ $ $ $ S $
. $
Clients Clients Clients Fee .
Prepared: (Nor Product/ 21?4.34 19S-05 264,10 27215 autIGII)
New Proposed Deliverable
of Returning Unduplicaled Per litzlippl Ch.r4.4.ior
Date S j IMO
Number of Feb I .. 5 , S
Measures: of MI
Number # 0 5 ,
Jan =I E S
Taal
1 C. '
Dec --,.. 6
Performance
0. 0 . I
Nov 5
Oct ,... , 0 6
Deliverables
_ 5
of a I
___,
Schedule .. 0
July — 5
June
- ..
May ...... =
Calculation
System Apr
(I ill
Auto Services Mar
' Health -, --i— I
Entry of 6 60
Abuse Units Proposed ...... - . - ... . -
[Provgder Integrated Number
Substance
Marko's* Unit -- mine,)
Definition unit uail mial salt All/
Service 1 15 % 1 1 I
(Le. wilt. trne. unit, tint
L _...... 1 I 1 I
.F5-
Description seasku, Melton emiluslacon,
ohlairlc craniknotlan ent,d1=Iovanvan.on. iteeDra.
Deliverables by 0:1005-liul1vkamil psuitherail. trgr.ann Obitstrsdritemal mew" 9060-riledlieduei perjeilherapil Mt.:Ora:4 45.51arriaR.ES
Service *glibl•P interview /0-30 couriedum .._____
Name: with '4 with
Category Urill
of CAREWare Name/Code firm, Heap deallt• 11510 Deliverables
Organization Service Service 1 3/1/2011 3116/2012
Schedule Menial merma Mentz! mental TOTAL of
1 , 2 3 4 6 7 a • 12 13 14 15
Schedule Effective Revised
CQM H001 OAMC Retention
Data Scope: Area Agency on Aging/Care Directions
Report Criteria:
Report Start Date: 01/01/2013
Report End Date: 12/31/2013
A service visit must exist during the reporting period to be counted on this report.
H002 - OAMC Retention in Care (Group By): URN (Count):
In Numerator 36.4
Not In Denominator 2359
Not In Numerator 296
Numeric Totals:
3039
Number of Records 3
- Restricted Field (Count is unduplicated across providers)
1/17/2014 1:32:30 PM Pagel Of 1
Attachment 1-C SERIAL 12097-RFP
NARRATIVE
Introduction:
Living For more With than HIV/AIDS 20 years, Maricopa Integrated Health System (MIHS) has provided state-of-the-art care for Persons
McDowell Healthcare Center (PLWHA) (MHCC) at the McDowell Healthcare Center. Dedicated to serving PLWHA, the
care, outpatient mental health, outpatient is substance a comprehensive HIV clinic that offers outpatient ambulatory medical
early intervention services. As both the oldest and largest abuse service, oral health care, laboratory testing services and
County, one in every four PLWHA in Maricopa County chooses provider to of receive HIV primary all or part care of services their health in Maricopa
McDowell rural areas, Healthcare patients Center. Because of the excellent reputation of MHCC in the state, and lack care of providers at the in
abuse services at MTICC. from other The 1vIHCC geographic is also areas of the state seek HIV medical care, mental health and substance
Arizona Board of Regents unanimously approved home an to affiliation the only 11W Women's Clinic in Arizona, In June 2011, the
Arizona — Phoenix (U of A Phoenix). This agreement allows MIHS agreement to become between the primary MIHS and training, the University of
education facility for the U of A Phoenix College of Medicine and enhance our system. research and
1. Description of the Oreanization.
Mills is the logical and appropriate choice to be a RWPA grantee for this comprehensive, coordinated, and
and culturally Part 1), competent the main system medical of and mental oral health care and substance abuse services. MIHS is the grantee for Part C
close partner with Part B. All of these services health care are provider for Part A administered by Maricopa County, and a
care. To show its strong commitment to PLWHA, in provided 1990, M1HS in one dedicated clinic that allows for a full continuum of
address the medical, behavioral and oral health needs of PLWHA. That clinic one is the of its McDowell 11 outpatient clinics to
Center, Healthcare
M1HS since 1991 — First when Ryan White Grantee in Arizona. MIHS has been actively involved in Ryan White Programs
health system, MIHS MIHS has received the the first Ryan White Part C grant in Arizona. As Arizona's largest public
(PLWHA). MIHS has served capability as the largest and healthcare experience to respond to Persons Living with HIV and AIDS
years. Organizational strengths stem from a comprehensive safety healthcare net for Maricopa County residents for over 130
Maricopa Medical Center (MMC), a 351-bed public teaching hospital with delivery a Level system I Trauma incotporating Center; the the
Arizona Bum Center; two psychiatric facilities housing 190 beds for behavioral health services; the
Health Comprehensive Centers (FHCs), Healthcare Center which offers outpatient primary and specialty care; and 11 outpatient Family
extended hours thereby including the comprehensive McDowell Healthcare Center. Two FHCs provide
the largest provider of comprehensive improving access and lowering cost options to Emergency Department visits. MIHS is
adults in Maricopa County, and serves and the coordinated greatest percentage HIV-related of minority medical, behavioral and oral health for
receiving HIV care. MHCC created the only HIV/AIDS Dental Clinic in Arizona individuals in 2000 in Maricopa focused exclusively County
on PLWHA, and provides psychiatric, mental health and substance abuse services focused on HIV care.
Experts in HIV care in HIV in Maricopa Disease. County The McDowell Healthcare Center (MHCC) is recognized as the center for excellence
for adults. MIES' vast experience and includes: is the largest safety net provider offering state-of-the-art HIV medical care
• The MHCC provides a significant proportion of the HIV care in the region, serving one in every
four PLWHA in Maricopa County, with the majority being underservecl, ethnically diverse and
medically needy individuals;
WEIS provides the only comprehensive and seamless continuum of care for adult PLWHA
including outpatient ambulatory care, a Women's HIV Clinic, mental health, substance abuse
services and oral health in one location, with the ability to refer to specialties, sub-specialties and
support services, as well as inpatient services utilizing full access to information through the
system-wide EMR;
• MHCC has participated in HIVQUAL-US since 2004 and repeatedly shows that we are
consistently providing PLWHA with high-quality, cost-effective medical care;
SERIAL 12097-REP
Additional points of entry:
• Public health departments
• Health care points of entry specified by eligible areas
• Federally Qualified Healthcare Centers (FQHCs)
• Entities such as Ryan White Part C and D grantees
1.28 POLICY ON CONFIDENTIALITY:
1.28.1 The Contractor understands and agrees that this Contract is subject to all State and
Federal laws protecting client confidentiality of medical, behavioral health and drug
treatment information.
1.28.2 The Contractor shall establish and maintain written procedures and controls that ensure
the confidentiality of client medical information and records.
1.28.3 The Contractor shall maintain and document employee and direct service provider
training on their organization's policies and procedures related to client confidentiality.
1.28.4 In accordance with Section 318 (e)(5) of the Public Health Service Act [42 U.S.C.
247c(e)(5)i, no information obtained in connection with the examination, care or services
provided to any individual under any program which is being carried out with Federal
monies shall, without such individual's consent, be disclosed except as may be necessary
to provide services to such individual or as may be required by laws of the State of
Arizona or its political subdivisions. Information derived from any such program may be
disclosed (a) in summary, statistical, or other form, or (b) for clinical research purposes,
but only if the identity of the individuals diagnosed or provided care under such program
is not disclosed. The Contractor shall comply with the provisions of A.R.S. § 36-663
concerning HIV-related testing; restrictions; exceptions and A.R.S. § 36-664 concerning
confidentiality; exceptions, in providing services under this Contract.
1.28.5 Confidential communicable disease related information may only be disclosed as
permitted by law, and only consistent with the current Ryan White Part A Program
Policies and Procedures Manual (See Exhibit 2 http://www.rvanwhiteoarta.com
1.29 EQUIPMENT:
1.29.1 All equipment and products purchased with grant funds ,should be American-made.
1.29.2 The title to any and all equipment acquired through the expenditure of funds received
from County shall remain that of the Department of Health and Human Services, Health
Resources and Services Administration. County must specifically authorize the
acquisition of any such equipment in advance. Upon termination of this Contract,
County may determine the disposition of all such equipment.
1.29.3 The Contractor agrees to exercise reasonable control over all equipment purchased with
capital outlay expense Contract funds. All equipment lost, stolen, rendered un-usable, or
no longer required for program operation must be reported immediately to County for
disposition instructions. The Contractor shall report the physical inventory of all
equipment purchased with contract funds within sixty (60) days of receipt of such
equipment.
SERIAL 12097-RFP
Substantial significant growth Growth in in the Services number Received of by PLWHA at MHCC during FY2012. MHCC has realized
health and substance abuse services people has been seeking realized HIV care. An on-going increase in the need for mental
eligible for mental health and substance abuse services over at either the last MHCC, year as well. MI adult clients are potentially
carriers to contracted providers. Many of the newly diagnosed patients corning or by referral into HIV through care have their a insurance need for
mental that has health resulted and substance abuse services based on their dysfunctional life styles, risky behaviors and anxiety
from the diagnosis of HIV infection. Urgent care and crisis services are provided as necessary.
abuse Data compiled services at from March 1, 2012 through June 30, 2012 for PWLHA receiving mental health and substance
patients for both mental MHCC health demonstrate and substance an enormous need in the community for services. Of the 75 unduplicated
were male. These 75 unduplicated patients made abuse 173 services, visits to 63 MHCC percent to were new patients and over 93 percent
abuse counselor. In other words, each patient, on average, visited MI1CC meet for mental with a psychiatrist health and/or or substance
abuse services 2.4 times. The primary diagnoses for those patients receiving mental health services substance were 1)
depressive disorder, 2) associated with HIV disease; 3) major single depressive disorder; 4) generalized anxiety
diagnoses disorder; and were: 5) obsessive-compulsive 1) disorders. For patients receiving substance abuse services, the primary
demographic data pertaining amphetamine to these or related 75 abuse; 2) alcohol abuse; and 3) cannabis abuse. Table 1 shows
unduplicated patients.
Table 1. Demographics of Patients receiving Mental Health and Substance Abuse Services from 03/01/12—
06/30/12.
Unduplicated Description Patients Mental Health Services Substance Abuse Services
First-time Patients 45 65% 2 .' ,6..
Existing Patients 24 35% 4 33% 67%
Male 64 93% 6 100% _
Female 5 7% 0 0%
Number of visits: 11
Visits with Psychiatrist 96 59% 1 _. 9%
Visits with Substance Abuse Counselor 66 41% 10 _L 91%
Maricopa Comprehensive County: Services. MHCC will continue to provide the following services if awarded funding by
counseling to reduce 1) depression, pre-treatment/recovery anxiety and readiness other counseling; 2) harm reduction; 3) mental health
counseling for individuals; and 5) relapse prevention. disorders Mental associated health and with substance substance abuse; 4) outpatient
centered and include Cognitive Behavioral Therapy (CBT) interventions, brief and abuse solution services focused are client-
a interventions large degree and with insight substance oriented abusers. treatment interventions. Motivational Enhancement Therapy (MET) is used to
medication management emphasized as Medications part of a patient's are provided comprehensive by psychiatrists as intervention, with
treatment plan.
2. Personnel Assigned to the Service Category,
MIHS substance Exeniplary abuse therapy Behavioral staff is Health fully committed and Substance Abuse Services Team. The MIHS behavioral health and
their present positions. Carol Olson, M.D., who serves to the as field the of HIV care and many have actively sought out
years of experience in providing behavioral health care. Wendy Chair Watson, of the M.D., Department of Psychiatry, has over 20
M.D., M.P.H., are licensed psychiatrists, while Julie Lankton, LPC, LISAC, provides M.P.H., mental and Joanna health Kowalik, and
substance abuse counseling at MHCC.
and Wendy is in J. the Watson‘M.D.„ process of completing M.P.H. Dr. Wendy Watson, DMG provider, is Board Certified in Adult Psychiatry
serves at the McDowell Healthcare her Center Board specializing Certification in Child and Adolescent Psychiatry, Dr. Watson
MHCC, Dr. Watson worked as a staff Psychiatrist at the in Phoenix psychiatric Veterans care for PLWHA. Prior to her work at
Administration Health Care System,
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2. All direct service providers meet the service category's Standards of Care as defined by the
RWPA Planning Council.
MHCC Behavioral Health Services is licensed as an Outpatient Behavioral Health Clinic through the Arizona
Department of Health Services Division of Assurances and Licensure. It is the orily co-located HIV clinic
providing mental health and substance abuse services, and outpatient ambulatory medical care. MHCC has a
multidisciplinary behavioral health staff -comprised of two 0.4 FTE Psychiatrists and one full-time Licensed
Professional Counselor/Licensed Independent Substance Abuse Counselor. The primary care providers, mental
health and substance abuse clinicians work collaboratively toward a goal of well-being for HIV-positive
individuals who receive services at MHCC. This close relationship assures early i ntervention for medical,
mental health, and/or substance abuse problems, and eliminates potential barriers to the referral process.
Complex co-morbid medical and psychiatric conditions are addressed, including problems with poly-pharmacy
and drug-to-drug interactions. The mental health and substance abuse services clinicians offer counseling and
therapy for HIV-positive people addressing specific issues such as: social and internalized stigmatization,
chronic illness and pain, readjustment of self-image due to health caused changes, changes to employment
status, grief, bereavement and end of life issues. Additional mental health and substance abuse services can
include support for depression, anxiety, psychosis, domestic violence, dementia, sexuality and gender issues,
family dysfunction and stress management.
Patient Assessment. Initial patient status is assessed through a comprehensive psycho-social evaluation
performed by Julie Lankton, LPC, LISAC, who works as both the intake evaluator and the clinic counselor. The
initial assessment includes a basic HIV history, past medical history, notation of medication allergies, family
medical and social history, patient medical and psychosocial history, mental health and substance abuse
assessment. Ms. Lanlcton orders routine baseline HIV laboratory assessments under the direction of the medical
director. Through direct consultation with the medical director at the time of the patient's intake visit tests may
be ordered based on the patient's HIV and medical histories, as well as their current medical and psychosocial
situation. These tests can include resistance testing, HLA-B5701 and CCM prole testing, tests for co-morbid
opportunistic infections, and STD panel, psychiatric medication blood levels and urine drug screening. Since
the entire MTHS system is now utilizing EMIR, any inpatient records from patients recently hospitalized at
Maricopa Medical Center are simultaneously available to the clinicians for review. Further, the clinicians in
both the inpatient and the outpatient MHCC settings work closely together to ensure continuity of care across
both settings, utilizing both telephonic and EMR communication. Patients are then scheduled a follow-up
appointment with their medical provider to review lab results and establish care.
Patients whose initial assessment reveals further need for substance abuse, mental health or other psychosocial
services are routinely given referrals at their initial visit for appropriate services. Ms. Lankton provides on-
going psychotherapy to eligible patients as needed.
All patients are routinely screened for substance use and abuse, whether new, on-going or relapsed. Substance
abusers comprise a considerable proportion of the patients seen at MHCC. Almost all patients who have been in
chemical dependency treatment have relapsed at least once, have been expelled from a program, or ended up
"on the street" again, and have been susceptible to a state of increased vulnerability to continued substance use,
adding to the medication and therapy adherence problems, as well as safe-sex practice inconsistency. Patients
are assessed and receive recommendations at intake from their clinician. Ms. Lankton extends motivation to
these individuals through counseling sessions, and may refer patients for appropriate support and treatment
services (psychiatry, education and/or support groups, case management). Clients who are in need of a
substance withdrawal program are referred to appropriate outside agencies that provide those services.
Counseling and referrals are given for those with substance abuse issues consistent with harm reduction and 12-
step principles. There are numerous referral resources off-site in greater Phoenix including detoxification
centers, residential programs and out-patient services.
Tobacco cessation assessment and intervention is repeatedly offered, with linkage to appropriate tobacco
cessation resources including the Arizona Smokers' Helpline, cessation medications such as Chantix and patient
assistance pharmaceutical programs when needed. Sexual activity is assessed and safer practices are encouraged
using the Prevention for Positives model with both harm and benefit framed messages. To reduce risky sexual
activity, condoms are available on-site at MHCC.
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and at Arizona State University as a Teaching Assistant for the Department of Psychology. Dr. Watson
graduated of Medicine Cum and Laude from Arizona State University with a Bachelor of Science Biology, received her Doctor
Banner Good Sam Masters Hospital in Public in Health from the University of Arizona, fulfilled her Psychiatric Residency at
in June 2010. Dr. Watson's research Phoenix, projects and completed include a Child and Adolescent Psychiatry Fellowship at MIHS
City Adolescent Medicine Clinic and an Internship at Adolescent the Maricopa Drug, County Alcohol Department and Cigarette of Use in an Inner
Diseases. Her many honors include: Sexually Transmitted
• MIHS Child and Adolescent Psychiatry Fellowship Excellence in Psychotherapy Award in 2010;
Banner 2007) Good Sam Psychiatry Residency Program House Officer Educator of the Year (2006 —
awarded by the University of Arizona College of Medicine; and
• University of Arizona College of Medicine
o College of Medicine's Dean's Scholarship,
o Clerkship / Clinical Honors, and
o Basic Science Honors.
Psychiatrist Joanna Kowalik, M.D., M.P.H. Dr. Joanna Kowalilc, DMG provider, is Board Certified as an Adult
Certification and serves as a licensed Psychiatrist at MHCC. Dr. Kowalik is in the process of obtaining Board
Bill Holt Pediatric in Child HIV and Clinic Adolescent at Psychiatry. While MHCC is an adult clinic, we work closely with The
as individually appropriate. Dr. Kowalik's Phoenix Children's additional Hospital to transition adolescents into adult primary care
Student Education, M1HS Desert Vista Behavioral Health responsibilities Center Child include and Adolescent the MIHS Director for Medical
Program faculty, and AriZOna'S Children Association Outpatient Psychiatric Services. Dr. Psychiatry Kowalik Residency also staffs
continuity the Psychiatric of care Consultation-Liaison for patients Service at Maricopa Medical Center (MMC), and thus is able to provide
Master of Public Health—Health admitted to MMC who receive outpatient care at MHCC. Dr. Kowalik holds a
completed a Psychiatric Residency Policy Program and at Administration mms, from the University of Illinois at Chicago,
Fellowship Program at MIES. Her presentations include and Banner graduated Good from Sam the Psychiatry Child and Adolescent Psychiatry
Psychiatry to Medical Students and New Research Poster Session at the 2008 Annual AACAP Grand Rounds: meeting. Teaching Dr.
Kowalik has been honored as the Chief Resident at the MIHS Child and Adolescent Psychiatry Training
Program and received special recognition for her strong organizational skills and leadership in teaching.
Julie Lankton, LPC,LISAC. Julie Lankton is a Licensed Professional Counselor and a Licensed Independent
Substance Abuse Counselor and currently serves as a counselor at the McDowell Healthcare Center. Ms.
MHCC Lankton counselor, provides comprehensive Ms. Lankton assessments to evaluate the complex psycho-social needs of the patients. As a
positive adult patients within an provides interdisciplinary counseling, team social of HIV service intervention and care coordination for HIV-
psychotherapy, Ms. Lankton's objectives are to assist patients with specialists. overall Through adjustment education to their and diagnosis,
of develop life. Ms. empowerment Lankton holds tools a Master to increase of Arts health promoting behaviors, meet treatment goals and enhance quality
Clinical Coursework at Johns Hopkins University. Degree With in Agency over 25 Counseling years of experience and has completed Post Graduate
experience includes serving as a counselor at a mental health center working primarily in the with field, adults Ms. in Lankton's an
outpatient substance abuse treatment program, Family Counselor, Program Coun.selor for adolesce nts in
residential treatment facilities, Social Worker, Behavioral Health Manager working in consultation with
Psychiatry and Behavioral Health staff, and Clinical Supervisor which included planning and development,
trainings and evaluations, and maintaining a clinical caseload.
3. Meet:Ina the Needs of fILWBA.
a. Mental Health and PLWHA.
Mental health disorders are common in the United States. The National Institute for Mental Health
estimates that one in five adults will need mental health treatment in any given year. The number is even
higher in the HIV-positive population. The U.S. Department of Health and Human Services (HRSA) HIV
have Costs symptoms and Services Utilization Study (HCSUS) found that nearly 50 percent of adults being treated for HIV
signs of substance of a psychiatric disorder. HCSUS also found that 19 percent of patients studied showed
abuse, and 13 percent had co-occurring mental illness and substance abuse disorders.
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HRSA states that major depression is the most common mental health disord er among PLWHA. However,
in approximately one-half of PLWHA who have depression, the depression is both undiagnosed and
untreated. Other psychiatric disorders commonly associated with HIV/AIDS include anxiety disorders
such as Post Traumatic Stress Disorder (PTSD), HIV-associated dementia arid substance abuse. Without
appropriate treatment, individuals can experience rapid deterioration in physical and mental health, and are
less likely to be compliant with medication regimens or the use of safe-sex pra ctices. The integration of
medical and behavioral health services improves the overall quality of care received by a client living with
HIV/AIDS.
As people are living longer with HIV, quality of life issues can begin to manifest. Not all medications cross
the blood-brain barrier and, while the plasma HIV-RNA load may decrease and the immune system
function improve, dementia may occur and progress. Many patients are found to experience chronic pain,
which is not necessarily related to a medical problem, but does dramatically i nterfere with their daily
functioning and quality of life. Isolation, linked to the loss of significant others and friends to HIV, is a
growing mental health concern. Mental health and substance abuse treatment issues, if not dealt with
through treatment and therapy, can lead to serious adherence problems and subsequent poor medical
outcomes. The evaluation of individual patients by a licensed clinical psychiatrist, followed by the
combination of pharmaceutical and psychotherapeutic interventions, is more effective than any singular
form of treatment for these disorders.
According to SAMHSA, 11 percent to 18 percent of Arizona residents suffer from serious psychological
distress (SPE)), SPD among youth ages 18-25 years occurs at a rate of 18.34 per 100,000. Many of the
Phoenix EMA's seriously mentally ill are also among the homeless. Fifty-five percent of 'In Care'
PLWHA reports a history of mental/behavioral health issues (i.e., anxiety, depression, and hi-polar disease)
and over 18% report a history of substance abuse.
b. Providing services within the service area.
MIHS will provide mental health and substance abuse services in all seven of the identified RWPA
Planning and Service Areas (PSA). The Phoenix EMA (Maricopa and Pinal counties) encompasses over 66
percent of the state's population. ADHS reports 14,265 PLWHA (March 2011) in Arizona, with over 75
percent of those residing in this service area, with the vast majority residing in Maricopa County. mnis
and MHCC are located in the heart of Phoenix where the vast majority of PLWHA resides. The MHCC is
within walking distance of four major bus routes, and both MHCC and MIHS are within a short walk of
Phoenix Valley Metro Light Rail. This_allows for ease of access to co-located services at the MHCC such
as primary medical care, oral health, EIS, mental health and substance abuse services. Additional
services available at MHCC include the Apothecary Shops and the Southwest Center for HIV/AIDS.
c. Delivering services to special populations.
MIHS is committed to addressing the service needs of individuals who know their HIV status and may not
be receiving primary medical care services, and is dedicated to informing and enabling individuals to
utilize services. Our overarching goal is to eliminate disparities in access and services among the
underserved. MIHS addresses these service needs based on these four guiding principl es:
1. The HIV/AIDS epidemic is growing among traditionally underserved and hard-to-reach
populations. MIHS serves a high percentage of PLWHA who are ethnically diverse (Table 2), are
uninsured and/or live below 100% FPL.
2. The quality of HIV/AIDS therapies can make a tremendous difference in the lives of PLWHA.
The MHCC HIVQUAL review for 2011 shows that 97.1% of all patients eligible for ARV therapy
are taking medications to fight 111V.
3. Changes in the economics of health care are affecting the HIV/AIDS care network. MMS works
with RWPA and RWPB to enroll individuals into the PCIP program; and
4. Outcomes are a critical component of program performance. MIMS believes evaluating outcomes
is critical to measuring program performance, and has demonstrated its commitment to program
performance by being involved in HIVQUAL-US since 2004.
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Needs and Gaps in Services. PLWHA face significant health care challenges and can be
disproportionately impacted when accessing high quality medical care and supportive services. Various
Needs Assessments have been conducted by the Phoenix EMA Planning Council to identify priority service
needs, barriers to care, and gaps in the continuum of care for PLWHA. Results of these client-centered
activities are used to establish service priorities, document the need for specific services, determine barriers
to accessing care, provide baseline data for comprehensive planning, and help providers improve the
accessibility, acceptability and quality of services delivered to PLWHA. In the Phoenix EMA, unmet needs
and gaps in services have been identified by those newly diagnosed and/or out-of-care. Additional effects
of the ongoing recession, cuts to AHCCCS (State of Arizona Medicaid) and state population growth have
greatly impacted care of PLWHA.
Newly Diagnosed The Phoenix EMA Planning Council conducted a 2009 Needs Assessment to learn more
about the unmet needs and gaps in services for the Newly Diagnosed/New to Care. Newly diagnosed
PLWHA ranked their top service needs as: 1) ambulatory outpatient medical care; 2) medication; 3)
medical nutrition therapy; 4) housing assistance; and 5) behavioral health services. When queried about
what would have helped these PLWHA enter care earlier, almost half reported an advocate/peer to
accompany them to their first medical appointment, followed by transportation assistance (27%); more
health education upon testing positive and a peer to talk with (27%); mental health counseling (DM);
and substance abuse counseling (9%). These identified supportive factors were viewed as having speeded
their initial entry into care.
The Out-of-Care (00C). The service gaps listed by the 2008 Phoenix 00C population survey included a
mixture of essential core medical services and supportive services. Housing, transportation, mental health
EMA. and substance A lack of abuse awareness counseling complete the list of services perceived as unavailable by the 00C in the
of exact service location, how to access services and the absence of
funding/insurance were cited as reasons impeding access to care and services.
Many 00C cite drug use as a primary reason for their delay into primary medical care and/or reason for
stopping HIV primary medical care. The crystal methamphetamine problem is recognized as a significant
contributor to increased high risk sexual behaviors and higher rates of HIV and STI transmission,
particularly among MSM. Meth is the drug of choice most frequently reported as used by the 2008 00C
survey respondents: over 32% of the respondents reported regular use of meth. Ten percent of the 00C
survey sample admitted to previous injection drug use (mostly heroin). Both the 2006 and 2008 needs
assessment survey results reveal regular use of meth by the 00C, and is cited as a primary reason for delay
into and/or reason for stopping HIV Outpatient Ambulatory Medical Care (0A.MC).
Effects of the On-going Recession. The on-going effects of the lingering recession combined with the
depth of unemployment have resulted in an increased demand for Ryan White funded services. In addition
to being the Grantee for Parts C and D, MIHS is a Ryan White Part A-funded provider of OAMC, mental
health and outpatient substance abuse services. As individuals have lost their jobs and the insurance
attached to those jobs, many now depend solely upon the Ryan White program to remain in medical care.
There is a high rate of transfers into Ryan White, largely due to the loss of other medical coverage.
Cuts to AMCCCS Create Health Care Struggles for PLIVHA. Arizona is experiencing severe budget
shortfalls and not long ago passed legislation that resulted in the reduction or elimination of health
insurance benefits for many AHCCCS recipients, particularly childless adults. Due to state cuts to
AHCCCS, additional Federal matching Medicaid funds of approximately $1.02 billion were lost. This has
resulted in PLWHA no longer able to enroll in AHCCCS, and those who do not renew timely lose their
AHCCCS benefits, including mental health and substance abuse services. The statewide AHCCCS
population as of July 2012 was nearly 1.3 million (www.azAHCCCS.gov ), with the Phoenix EMA
accounting for nearly 62 percent of those AHCCCS members. Due to these AHCCCS cuts, as many as
1,700 PLWHA in Arizona were deemed eligible to transfer their medical care into the Ryan White
continuum of care. As a result of these cuts, MHCC has realized significant growth in the number of people
seeking HIV care as previously mentioned. MIHS works with patients to complete AHCCCS renewal
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applications timely and we assist individuals applying for Ryan White and ate Pre-Faisting Condition
Insurance Plan (PCIF).
Population Growth Strains Services. The Phoenix EMA has experienced en.orrnous population growth that
is mirrored in the expanding PLWHA population. Twenty-two percent of Arizona's prevalent cases were
diagnosed in another state, leading to an increase in prevalence in Arizona. The number of PLWHA is
increasing at a rate higher than available resources. Foreign migration, primarily from Mexico, but also
from Burma and several African nations, has further strained the existing inf:rastnictare and created
language and cultural barriers unique to the service area. Th e states moderate incidence coupled with
reductions in death rate all contribute to an expanding PLWHA population which threatens to maximally
stretch and exceed all available funds.
Diversity ofPLWHA. MHCC provides services to a PI-WHA population that is highly diverse. Our target
populations are primarily non-White minorities (54.6%), Hispanics (32.2%), males (75.6%) and women
(23.5%). Included in these target populations are individuals that are uninsured, those living below the
Federal Poverty Level (FPL), resettled refugees and those of other language groups. As shown in Table 2,
there are a number of similarities among the populations of the 1_1.S., Arizona, the Phoenix EMA and MUM
Ryan White Part C and Part D patients. However, MHCC exceeds the national norm for the number of
minorities served. While the U.S. population is 15.7% Hispanic, Arizona's population is 30.9% Hispanic.
Hispanics account for 18.3% of PLWHA in the U.S., but are over 25% of PLWHA in the EMA and close
to one-third of all Part C and Part D patients. While Arizona has a relatively small population of Blacks at
3.7%, they comprise 16% of Part C patients and over 23% of Part D patients. On average, minorities
account for 52% of all MHCC patients.
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increase of 116 percent. There are a greater number of females in care at MEHS than in the EMA or the
state due in part to the women-focused care provided at MHCC.
High Levels of Uninsurance. Reports from the U.S. Census Bureau in 201 1 show 19.1 percent of
Arizona's population lacked health coverage, with about one in five residents lacking health coverage.
Only ten states had higher uninsured populations than Arizona. In 2009, the Arizona Republic newspaper
estimated that one in four Phoenix residents lacked health insurance, putting Arizona's largest city among
the bottom of big cities on health coverage. Patients at MIICC in 2011 who had Medicare, Medicaid, other
public or no insurance accounted for 73 percent of those served. As Arizona struggles with cuts to the
Arizona Medicaid (AHCCCS), the number of uninsured patients is expected to rise.
Individuals Who Live Below the FPL As reported in the Arizona Daily Star in September 2010, figures
from the U.S. Census Bureau show that more than one-fifth of Arizonans live in poverty, second only to
Mississippi. Approximately 212 percent of Arizonans live in households that earn less than the FPL,
compared to the national figure of 14.3 percent. The Phoenix area also has a high percentage of persons of
Hispanic/Latino origin living in poverty: the American Community Survey 2005-2009 from the U.S.
Census Bureau reports that 27.7 percent live below the FPL. Sadly, nearly 55 percent of all MHCC patients
live below 100% PPL.
Refugee Resettlement Arizona ranks fourth in the nation for new refugee arrivals. The Arizona Refugee
Resettlement Resources reports that nearly 62,000 refugees have been resettled in Arizona since 1984.
Nearly 80 percent of all resettled refugees are women and children. Seventy-six percent of refugees resettle
in Maricopa County and, of those, 66 percent reside in Central Phoenix where MHCC is located. A large
percentage of immigrants and resettled refugees have come from Somalia, Burundi and, more recently,
Burma. MHCC continues its history of providing culturally and linguistically competent care to all patients,
as discussed in this application.
Other Language Groups. The U.S. Census Bureau Hispanic Population 2010 report states that Arizona
ranks fourth highest in the nation with a'Hispanic/Latino population. Nearly 28 percent of the state's
population five years and older speak a language other than English at home. A recent University of
Arizona Mexican-American Studies and Research Center report found that Hispanic women living in
Border States have a higher risk of contracting HIV than do other Hispanic women due to their lack of
knowledge of HIV/AIDS.
d. Providing culturally and linguistically anDropriate services.
Culturally and Linguistically Appropriate Services (CLAS). MIHS primarily serves patients who speak
English, Spanish and several African languages; however, the predominant non-English language spoken
by our clients is Spanish. The literacy levels of our patients can vary greatly. Even when we meet the
language needs of patients the level of literacy must be considered. MIHS and partners make every effort to
provide patient materials, including Spanish translations, at a 6th grade reading level or lower. MIHS meets
Federal CLAS Standards by providing our patients with translation and interpreting services. As mentioned
above, many of the MHCC staff and clinicians are bilingual in Spanish. For non-Spanish speaking patients
and/or those with limited English skills, staff has access to real-time translation utilizing the phone-based
World Wide interpreters service that is available throughout MIHS including MHCC. Over the past year,
MIHS has contracted for two Cultural Patient Navigators (CHNs) that are well-known and respected in
their communities. Their primary responsibilities include linking medical care to newly diagnosed refugees
at MHCC, and helping refugees remain and/or return to care. The CHNs are fluent in ten languages
including English, Liberian, Va, Miran, Swahili, French, Kirundi, Kimyarwanda, Lingala and Spanish.
We strive to schedule patients with the same provider to provide clinical consistency, thereby reinforcing
trust and respect. Immigrants and refugees are afforded additional privacy measures beyond the usual and
customary privacy practices, depending on their needs and beliefs. Care is taken to protect their privacy and
to meet their needs while being respectful of their cultural and social beliefs. Every attempt is made to work
within appropriate boundaries, to sensitively discuss health topics with the patient, and perhaps most
importantly, to instill and establish a relationship of trust.
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Table 2. Race and ethnicity of target population compared to national, state, and local populations.
2011
ZOO U.S. 2009 .2009 :I'00X t .!,..;-. 20E19 Rtailait 209 MIK 4 ,
rovisiathani Arizona , Ph otai_i r 1 w 1 i , i Aritona rill trial
Pop Watletta EM,‘' 1 Pl.Wil.A4 gm. N
Nal
IIISP Olt':
White g7.3% ILECES 1.1g21.1113X.0111Mi ' '111111. A.° i..ni.
Black* 3.7% -1.4. -. i r..'t u...., 11.1,....y 43' lirii kfligills
AliAZ'Q** 41.1% 1.9% 0.4% .1.3 b.. tik% Li -Ct..
Asian 11101.11 % _ INVINIIIM LS% - .
NII/OP1*** IIM11111.1 4 0.1%
More than one _
race _
Unknown/Not ---
Re i orted _------- rilliF— UM
iiispANic: 17.4%
\lake 114.111.1. NS% 2114% ---- — — 'Marl. IC:77-4.
_ Black ,N OA% 0.M !Mt 1111W0E - -- —11
Al/AN" 03% 0.7% CS% 1111 11111.1.°I., - ,
Asian 0,1% 0.2% 01% __.. ------
NTI/OP1" ' 0.0% CO "44 .., tar
More than one
rare
Unknown/Not '
Re . orted . ' Lgrgglianrlkkall
*Black. or African-American; **American Indian & Alaska Native; ***Native Hawaiian & Other Pacific Islander;
'Population estimates from the U.S. Census Bureau, Statistical Abstract of the United States, 2011; 2Population
estimates from the U.S. Census Bureau, American FactFinder; 3Centers for Disease Control and Prevention,
a. 1 orbiehtl and Mortality Weekly Report, v.60, n.21, June 3, 2011. "Native Hawaiian and Other Pacific Islander"
included with "Asian." "more than one race" is not a reported category. "Hispanic" is not broken down by race;
'Estimates from the Arizona Department of Health Services, HIV Statistics Annual Report, 2011. "Native Hawaiian
and Other Pacific Islander" included with "Asian." "Hispanic" is not broken down by race; 5MIHS System, Ryan
White HIV/AIDS Progam Data Report, 2011.
Eliminate Disparities in Care in Communities of Color. Rates of HIV/AIDS prevalence and emergence
differ sharply between African Americans and other race/ethnicity groups. The emergent HIV/AIDS rate
among African Americans in Arizona is three times more severe than any other raceJethnic group. The
disparity is more pronounced among women than men who are both African America /1, Although HIV has
historically been a disease that predominantly affects males in Arizona, the 2005 —2009 rate of emergent
HIV among African American women was 21% higher than the statewide rate among men. (2010 & 2011
Executive Summaries, ADHS) MIHS has an extensive history in serving communities of color in order to
eliminate disparities in HIV care. For example and as shown in Table 2, while Blacks account for only
4.4% of the population in the Phoenix EMA, they comprised 16.0% of MHCC patients in 2011.
Serving a High Percentage of Women. MHCC continues to see increases in the number of minorities
impacted by HIV/AIDS, especially among female minorities. A goal of MIHS is to increase access to
primary medical care, mental health, substance abuse services and dental care especially for minority
females. To address this goal, MHCC established a Women's Clinic on-site staffed by female health care
providers. Women's Clinic day includes a catered breakfast, women's support groups that include
educational seminars and on-site childcare in collaboration with the Southwest Center for HIV/AIDS. As a
result, the number of women clients at MHCC has steadily increased from 250 in 2004 to 540 in 2010, an
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MIHS is home to the largest teaching hospital in Maricopa County, thereby providing medical
residents with an HIV rotation at MHCC that trains future physicians for this and other
communities regarding care for PLWI1A;
• MINS, as both a teaching hospital and an affiliate of the U of A College of Medicine and District
Medical Group (DMG), supports and encourages patient referrals to and participation in clinical
trials within and outside our system;
• Four MHCC clinicians, two physicians and two nurse practitioners have each been providing full-
time HIV-specialty medical care since the 1980's. All are certified HIV specialists through the
American Academy of HIV Medicine;
Dr. John Post, the founder of the MHCC HIV clinic, has received numerous awards over many
years for his comprehensive and compassionate care, including most recently the 2011 Phoenix
Business Journal Health Care Heroes Award;
• Dr. Ann Khalsa, the clinic's Medical Director, is a nationally recognized HIV specialist and
educator. She has been involved with the Ryan White AIDS Education and Training Center
program since 1990, providing direct full-time clinical preceptorships in HIV for 15 of those
years. She received international recognition at the International AIDS Conference in Mexico City
as one of fifteen recipients of the U.S.-Mexico Border Hero Award;
MIES has an excellent reputation in the medical community as a provider of quality HIV/AIDS
treatment and services, from dedicated and knowledgeable clinicians. This is reflected in the
significant increase in the number of PLWHA we serve. MHCC provided care to 2,594 PLWHA
in 2011, an increase of over 11% from 2010;
• MIHS and MHCC provide culturally sensitive and accessible care. Three of the clinicians are
bilingual in Spanish and on-site translation is always available utilizing bilingual clinic support
staff. MIHS utilizes the telephonic World Wide Interpreter service, through which communication
is possible with our many refugee immigrant patients from locations such as Burma and war-torn
African nations. The MHCC clinic has a program of Cultural Health Navigators who provide an
additional layer of patient support and education;
• MIES has stellar financial systems in place to report and track administrative and clinical data
through an Electronic Medical Record (EMR);
MIHS was recently awarded NCQA certification for a medical home program and is working on a
health exchange to enhance the exchange of information with health providers outside of MIHS;
and
• WEIS has contracts with Magellan and their four Provider Network Organizations (PN0s) with
four additional sites opening later this year.
District Medical Group, District Medical Group (DMG) is the exclusive nonprofit medical provider for MIHS,
and consists of over 350 providers representing all major medical and surgical specialties / subspecialties
including mental health. The mission of DMG is to improve the health and well-being of individuals in Arizona
through an integrated medical group practice based on a balanced program of patient care, education, research
and community service. DMG provides comprehensive physician, allied professional and medical education
services for MIES. DMG is grounded in serving the public by furthering the quality and safety of health care
services through medical education and research, addressing Arizona's needs through training health care
professionals, and improving access to care by means of innovation in the delivery of medical services to all
citizens regardless of circumstance.
The District Medical Group six strategic areas of focus are:
• Clinical Excellence and Community Health: Increase access to health services for the
community and elevate community health care standards.
• Partnership Development: Create effective, synergistic, and sustainable affiliations with
community programs, MIHS and University of Arizona.
• Education and Training: Expand academic programs while maintaining the highest standards of
academic performance and professional competence.
Clinical Research Excellence: Create an institutional culture of exceptional scholarship and
strengthen the competitive quality and reputation of the clinical research enterprise.
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Outstanding Workplace and Operational Excellence: Create a -work environment that fosters
the highest standards of operational performance and fiscal discipline.
Philanthropy and Public Value: Grow philanthropy and effectivel y promote the group's unique
public value.
MIHS Division of Psychiatry. The MIHS Division of Psychiatry is committed to being a leading provider of
behavioral health services in Arizona. The Division is a robust and dynamic group that consists of 25 full-time
adult psychiatrists, seven full-time child psychiatrists, nine full-time psychologists, five nurse practitioners, five
full-time licensed counselors and over 35 part-time staff. The many accomplishments of the Psychiatry
personnel include:
• Having the only HIV mental health and substance abuse clinic co-located with Outpatient
Ambulatory Medical Care (OAMC);
Staffing two acute-care psychiatric hospitals with a total of 190 beds - the largest number of
behavioral health beds in Arizona outside of the Arizona State Hospital;
• Serving as faculty for an Adult Psychiatry Residency Training Program and the only Child
Psychiatry Residency Training Program in Phoenix;
• Operation of their own outpatient psychiatric clinic: Desert Horizons Psychiatric Services;
• Providing full-time psychiatric consultation-liaison services to Maricopa Medical Center,
• Offering an Electroconvulsive Therapy (ECT) service;
• Providing psychiatric and administrative support to community and tribal based clinics, and
residential treatment programs; and
• Providing the Medical Director for the Arizona Department of Economic Security Division of
Developmental Disabilities.
The Division of Psychiatry delivers nearly forty specialty services including, but not limited to:
Adult Psychiatry
Counseling
Medication Management
Pharmacotherapy
Individual Psychotherapy
Psychological Testing
Diagnostic Testing and Assessments
Court Ordered Evaluations and Treatment
Forensic Services
Trauma and Burn Patient Support
Residency Training Programs
DMG Providing Mental Health and Substance Abuse Services According to RWPA Standards. DMG staff
provides mental health and substance abuse services consistent with Maricopa County RWPA Policies and
Procedures, and aligned with service category criteria established by the RWPA Program Planning Council.
These policies include, but are not limited to:
Mental Health..
I. Staff providing treatment are licensed mental health and substance abuse professionals;
2. Communications made on behalf of the patient are documented in the EMR;
3. All activities are directly connected to the HIV-related clinical status of an eligible client;
4. Specific clinical outcomes are measured and reported; and
5. Services promote family/support system stability for coping with the unique challenges posed by
living with HIV/AIDS.
Substance Abuse Services:
In addition to those listed above in mental health, substance abuse services policies and procedures include:
1. Providing assessment, treatment planning, counseling and referral to HIV-infected individuals
with histories of substance abuse; and
SERIAL 12097-RFP
Cultural Competency Training. All staff makes every effort to understand an individual's cultural beliefs
and practices and how they differ from or reflect the cultural group with which the person identifies. To
facilitate efforts to understand the unique cultural beliefs and practices of our patients, cultural competency
training is a mandatory requirement of all MIHS clinical and support staff. MIHS believes that training of
this nature is an integral component of the skill set required for every employee and clinician. In addition to
being a DNV accreditation requirement, MIHS believes that training of this nature is an integral component
of the skill set required for every employee and clinician, Cultural competency awareness training includes:
1) an on-line curriculum that discusses important considerations and questions to ask when working with
patients of diverse backgrounds, and requires a demonstrated 100% proficiency on post-test; 2) an
employee orientation session on cultural diversity; and 3) a clinical orientation session on health literacy. A
variety of methods are used to provide this training, including on-site training from experts in the field.
mrFis' Fulfilling these requirements is part of MIHS employee's annual skills list and performance evaluations. As
patient populations change, the focus of the cultural competency training sessions changes to reflect
the demographic changes of MHCC patients. The MIHS Community Relations Director provides guidance
to the MHCC in the area of language and cultural competency.
MIHS Recognized for CLAS. MB-IS has been recognized locally and nationally as a leader in the provision
of CLAS services to patients. The MIHS Community Relations Director is responsible for directing the
language and cultural competence program. Listed below are some of our accomplishments:
• MU-IS received no deficiencies from the Arizona Medicaid Cultural and Linguistic Competent
Care team;
• In 2004, MBE was part of a leadership team for the Arizona Hispanic Center for Excellence. This
project was awarded $1.5 million from HRSA to improve Latino healthcare;
• Cultural Competence Works, Multicultural program Certificate of Recognition HRSA, 2000 and
HRSA Publication, 2001;
• Community Centered Health Care Certificate of Recognition, American Hospital Association,
2000;
• MIES Customer Service arid Cultural Diversity Program President's Initiative on Race 1998, and
Promising Practices for Racial Reconciliation 1999, The White House;
• Culturally Sensitive Care Committee, Achievement Award, NACo, 1998;
• Spanish Interpreter Pilot Program, NACo Award, 1995; and
• Spanish Language Training for Patient Care, NACo Award, 1993.
The Health Resources and Services Administration (HRSA) envisions optimal health for all, supported by a health
care system that assures access to comprehensive, culturally competent, quality care. To further these aims, the
Department of Health and Human Services (HHS) has promulgated a set of standards that define best practices for
the provision of culturally and linguistically appropriate care. In Table 3, each of the standards is addressed
individually to show how MIHS, in general, and the EM-R, specifically, support the goals of culturally and
linguistically appropriate services. The MHCC follows these same principals.
Table 3. CLAS Standards and Addressing by MIHS.
Standard 1: Health care organizations Both MEETS and MIICC take care to ensure that all patients receive
should ensure that pat ents receive from all health care that is respectful of the cultural health beliefs and
staff members effective, understandable, and preferred language of the patient. For example, with some HIV-
respectful care that is provided in a manner positive refugee women, their cultural and religious beliefs do not
compatible with their cultural health beliefs allow a pelvic examination by male clinicians. To address this and
and practices and preferred language. other issues, MHCC instituted a weekly day-long Women's Clinic
during HIV-positive women are provided medical care by women
clinicians and providers.
1—Sindard 2: Ifealth care organizations Currently, approximately 50% of MHCC staff members are ethnic
I should implement strategies to recruit, retain, or racial minorities. This is only slightly less than the proportion of
and promote at all levels of the organization a racial and ethnic minorities (52°4) who comprise MHCC patients in
SERIAL 12097-RFP
[41M111111 Addressed by mills
diverse staff and leadership that are 2011. Every effort is made to ensur es
representative of the demographic reflective of the patients served at the clinic.
characteristics of the service area.
Standard 3: Health care organizations In accordance with HHS/HRSA and DNV standards, among others,
should ensure that staff at all levels and all MIHS employees (about 4,000 individuals) are required to take
across all disciplines receive ongoing classes concerning, among other topics, both Cultural Diversity and
education and training in culturally and HIV/AIDS.
linguistically appropriate service delivery.
Standard 4: Health care organizations must MTHS has a commitment to provide medical care to all patients,
offer and provide language assistance regardless of which languages are spoken. In 2011, requests at
services, including bilingual staff and MHCC for language interpretation included Spanish, French,
interpreter services, at no cost to each patient Arabic, Vietnamese, other (including several African Languages)
with limited English proficiency at all points and American Sign Language. Interpretation was provided by
of contact, in a timely manner during all certified staff interpreters, Cultural Health Navigators, or a
hours of operation. contracted interpreting service.
Standard 5: Health care organizations must It is standard practice at MTHS and MHCC that all information
provide to patients in their preferred language concerning language assistance services is available in both English
both verbal offers and written notices and Spanish. In house translators are used to translate documents
informing them of their right to receive or, in the alternative, to approve translations from other
language assistance services. organizations. MHIS maintains a contract with an outside provider
to provide translations into languages other than Spanish.
Standard 6: Health care organizations must All MIES personnel who use a language other than English to
assure the competence of language assistance communicate with patients and their families will be tested for
provided to limited English proficient competence in that language. If a patient requests that a family
patients by interpreters and bilingual staff, member or friend act as interpreter, a certified medical interpreter
Family and friends should not be used to will also be present to ensure effective and accurate communication
provide interpretation services (except on to the patieni
request by the patient).
Standard 7: Health care organizations must At both MIHS and MHCC, the most commonly encountered
make available easily understood patient- language outside English is Spanish. As with Standard 5, all
related materials and post signage in the signage posted in any MIEIS facility is posted in both English and
languages of the commonly encountered Spanish.
groups and/or groups represented in the -
service area.
Standard 8: Health care organizations MIHS system-wide policy #01750 S provides the outline for the
should develop, implement, and promote a MIHS program of language and cultural competence. The WEIS
written strategic plan that outlines clear Director of the Community Relations Department is responsible for
goals, policies, operational plans, and the overall implementation and monitoring of the language and
management accountability/oversight cultural competency program.
mechanisms to provide culturally and
linguistically appropriate services.
Standard 9: Health care organizations The MIHS policy on language and cultural competence provides for
should conduct initial and ongoing the periodic creation of a Language Needs Assessment for the
organizational self-assessments of CLAS- population served by the system. The Assessment incorporates
related activities and are encouraged to information on the number, proportion, and frequency of limited
integrate cultural and linguistic competence- English proficient patients may seek medical care from MIHS.
related measures into their internal audits, Data is regularly collected on requests for language services so that
performance improvement programs, patient shifts in interpreting services can be detected early. This on-going
satisfaction assessments, and outcomes-based data collection and early detection is crucial to MIHS' success in
evaluations. providing high-quality medical care to a culturally and linguistically
diverse patient population.
Standard 10: Health care organizations Through the Initial Patient Registration Form, all patients at MHCC
should ensure that data on the individual are asked to provide information on race, ethnicity and language
patient's race, ethnicity, and spoken and needs. This information is collected for inclusion in the patient
Maricopa Integrated Health System
RWPA Outpatient Mental Health and Substance Abuse Services
Solicitation 12097-RFP
Attachment B Service Provider Application
List of HIV/AIDS Grant Funds Addendum
Please list who provides these funds and how long you have been funded:
Service Category Funder Start Date Stop Date
Outpatient/Ambulatory Medical R_,n White Pan A 03/01/1994 I Current
Care Ryan White Part C 01/01/1991 Current
Ryan White Part E) 08/01/1998 Current
Medical Case Management Ryan White Part A — 01-/T4I2011 68/6 1/2-011
Ryan White Part D _08/01/1998 Current
Ryan White Part A 09/01/2007 Current 1
Oral Health Care _Ryan White Part C . 01/01/1991 Current
Ryan White Part D 08/01/1998 Current
Early Intervention Services (RWPA) Ryan White Part A 09/12/2011 Current
Early Intervention Services (MA!) Ryan White Part A 11/22/2011 Current
Early Intervention Services (Part_g Ryan White Part C 01101/1991 Current
Mental Health Services Ryan White Part A 03/01/1994 Current
Ryan White Part C 01/01/1991 Current
Substance Abuse Services, _P.yan Whit L ""irt-t2[ 1 $(1 3/01/1994 Current
Outpatient Ryan White Part C 01/01/1991 _ Current_
Case Management, Non-medical Ryan White Part C 01/01/1991 Current
Ryan White Part 13 04/01/2005 1 03/3112008
Treatment Adherence Services MAC Cosmetics AIDS Fund 10/18/2008 L 0913012009
Boehringer-Ingelheim
Pharmaceuticals 04/07/2008 03/31/2009
HIV Prevention Centers for Disease Control 10/01/2010
& Prevention Current
,—Child Watch Services Ryan White Pan D 08/01/1998 Current
Outreach Services I Ryan White Part D 08/01/1998 Current
Unrestricted Funding Aunt Rita's Foundation 12/01/2005 current
Soroptomist International 09/01/2005 08/31/2010
Attachment 1-D
Maricopa Integrated Health System: Administrative Policy & Procedure
Effective Date: 07/01/2010
Reviewed Dates: 05/02/2011
Revision Dates:
Policy #:
Policy Title: Grant Financial Oversight
Scope: [ 1 District Governance (G)
[ J System-Wide (S)
(1 Division (D)
[ ] Multi-Division (MD)
[X] Department (T)
[ ] Multicepartment (MT)
Signature:
(Narrie -Title, MINS)
Purpose:
The purpose of this policy is to establish consistent grant financial oversight policies and procedures throughout MINS.
Definitions:
Allocable — A cost is allocable to a grant or contract if the cost directly benefits the work done on that project.
Allowable — For a cost to be allowably charged to a grant or contract, it must meet the following requirements:
• It must be allocable to the project;
• It must be reasonable;
• It must be consistently treated like other similar costs;
• It must be allowable under the terms of general federal cost principles, the guidelines of the funding agency and the s
grant Or contract;
Business Objects — The NHS financial reporting and budget system that incorporates the financial data produced in STAR. Business
is a tool to prepare user-friendly financial statements for the operations of the organization including grants. In addition, Business Oh
used to prepare the annual budget for MIHS, including grant budgets.
Catalog of Federal Domestic Assistance (CFDA) — A number assigned to a Federal program in the CFDA.
Central Service Costs — Costs that benefit both grant and non-grant activities for inclusion as part of indirect cost in grants. This alloc
calculated in compliance with OASC-3, A Guide for Hospitals.
Central Service Departments — Department cost centers that support, manage, and maintain TAMS operations (i.e., Administration, Fl
Human Resources, Materials Management, Information Technology, Facilities Management, etc.).
Cost Transfer —Movement of costs between a grant/contract and another grant/contract or a non-sponsored departmental cost center.
Department Overhead — Departmental costs incurred for both grant and non-grant programs.
Grant — A transaction in which an entity transfers cash or other items of value to or incurs a liability for MIHS as a means of sharing
costs or otherwise reallocating resources to the recipients.
Policy # G, S. D. MT, T—Policy Tide Page 1 of 4
Date: 00100 Supersedes: 00/00
For the most current version of this policy, go to the CopaNet and click on the "Policies' tab, then "Policies' then search by name/number.
Grantee - The organization that receives a grant and assumes legal and financial responsibility and accountability both for the awardec
and for the performance of the grant-supported activity.
Grantor Agency — The federal, state, local, or private agency or organization which provides the grant funding and/or grant funding
ON
Indirect Costs — Costs incurred for a common or institution-wide objective that benefits more than one grant or projects. Such costs al
readily assignable to the cost objective specifically benefited.
— Contributions in the form of goods or services rather than cash.
Office of Management and Budget (0Mb') Circular A-87 — This Circular establishes principles and standards for determining
costs for Federal awards carried out through grants, cost reimbursement contracts, and other agreements with State and local
governments and federally-recognized Indian tribal governments (governmental units).
Office of Management and Budget (OMB) Circular A-110 — This Circular sets forth standards for obtaining consistency and uniforinit;
among Federal agencies in the administration of grants to and agreements with institutions of higher education, hospitals, and other no
organizations.
Office of Management and Budget (OMB) Circular A-133 —This Circular is issued pursuant to the Single Audit Act of 1984, P.L. 98-5
the Single Audit Act Amendments of 1996, P.L. 104-156. It sets forth standards for obtaining consistency and uniformity among Fede
agencies for the audit of States, local governments, and non-profit organizations expending Federal awards.
Health and Human Services (IIHS) OASC-3 — OACS-3, A Guide for Hospitals, establishes principles for determining costs applicable
research and development work performed by hospitals in contracts with the Department of Health and Human Services. H-IS is desi;
by the Office of Management and Budget (OMB) as the cognizant federal agency for reviewing and negotiating facility and administn
(indirect) cost rates, fringe benefit rates, special rates as determined to be appropriate, research patient care rates, statewide cost alloca
plans and public assistance cost allocation plans.
Pass-Through Grantor - A non-Federal entity that provides Federal awards to a sub-recipient to carry out a Federal program.
Program Income - Program income is income directly generated from the performance or activities of a sponsored program. Program
applies to federal and non-federal sponsored programs.
Reasonable — A prudent person would have purchased the same item at the same price.
Schedule of Expenditures of Federal Awards (SEFA) —A schedule required to be prepared and audited annually by the Single Audit At
SEFA is compiled by CFDA #, Federal grantor, pass-through grantor (as applicable), and pass-through grantor's contract number.
STAR—The MIHS accounting software system administered by the Finance Department. STAR is the official financial records of M .
Sub-recipient — A non-Federal entity that expends Federal awards received from a pass-through entity to carry out a Federal
program, but does not include an individual that is a beneficiary of such a program. A sub-recipient may also be a recipient of
other Federal awards directly from a Federal awarding agency.
Vendor - A dealer, distributor, merchant, or other seller providing goods or services that are required for the conduct of a
Federal program. These goods or services may be for an organization's own use or for the use of beneficiaries of the Federal
program.
Policy:
The Finance Department will exercise oversight of the financial transactions and status of each grant pursuant to the
requirements of OMB Circular A- 110. The Finance Department will ensure that charges are reasonable and necessary,
allowable under the terms and conditions of the award, are properly allocated to and among multiple awards and funding
sources, limited to funds awarded for the project, prepare and submit required financial reports, and ensure compliance with
federal, sponsor, and other regulations.
Policy # G, S. D, MT, T—Policy Title Page 2 of 4
Date: 00/00 Supersedes: 00/00
For the most current version of tills policy. go to the Copablet and click on the 'Policies' tab, then 'Policies" then search by name/number.
The Finance Department shall also be responsible for contracting with an external audit firm to ensure compliance with the
requirements of OMB Circular A-133 issued pursuant to the Single Audit Act. This responsibility includes the preparation and
annual audit of the Schedule of Expenditures of Federal Awards (SEFA). The Finance Department shall also comply with all
other audit/review requests from the sponsoring agency or its delegate.
The Finance Department also prepares arid negotiates the Federal Indirect Hospital Rate Agreement with the Department of
Health and Human Services, Division of Cost Allocation. M1HS uses the prescribed Medicare Cost Report methodology
contained in the guidelines and cost principles promulgated by the Department of Health and Human Services publication
OASC-3, A Guide for Hospitals, to calculate its indirect costs.
Procedure:
The Finance Department is responsible for setting up grant departments within STAR. Grants whose value is greater than
$100,000 will have be assigned a unique department number. Grants under $100,000 will utilize STAR Entity AC —
Department 8494 — Misc Grants Under $100K for recording their financial transactions unless a separate department number is
requested by the Grants Department.
The Finance Department will record, on a monthly basis, all financial transactions related to a grant, in STAR, Entity AC -
Grants. Where feasible, the payroll subsystem will be used to allocate personnel expenditures to the grant and the accounts
payable subsystem will be used to allocated vendor and other non-personnel costs to the grant. If neither of these subsystems
can be utilized to charge costs to a grant, the Grant Accountant will prepare manual journal entries to allocate allowable costs to
a grant.
Payments in advance will be recorded separately on MINS' balance sheet and reported separately as "restricted for grants" in
the Statement of Net Assets. Interest income associated with advance grants will be remitted back to the grantor as required by
law or retained by the grant for program use if allowed by the grantor.
On a regular basis the Grant Accountant shall:
• Prepare/update an Excel spreadsheet with individual grant activity that reconciles to the STAR department 8494 grand
totals.
• Review and ensure that costs allocated to the other grant departments are appropriate, recorded in the correct period,
and are within the constraints of the overall and line-item budget
• If appropriate, ensure that the payroll distribution reflects the actual work performed as certified in the effort reports
received.
• Reconcile STAR Entity AC balance sheet assets and liabilities.
• Prepared correcting entries and input into STAR.
• Prepare financial reports as required by the M1HS management and grantors.
• Prepare drawdown/reimbursement requests.
The Assistant Controller or Controller is responsible to review and approve all journal entries and drawdown/reimbursement
requests prepared by the Grant Accountant.
In addition to the above, on an annual basis the Grant Accountant shall:
• Prepare a Schedule of Expenditures of Federal Awards (SEFA) in accordance with the Single Audit Act. The Assistant
Controller or Controller reviews the SEFA for completeness arid accuracy.
• Provide documentation, as requested, for the annual A-133 audit.
• Respond to all questions from the external auditors on the annual A-133 audit
On a grant year basis the Grant Accountant shall:
• Ensure the timely closure of the grant as required by the grantor.
• Ensure that all costs allocated to the grant are appropriate and are within the constraints of the overall and line-item
budget.
• Prepare and ensure submission financial reports as required by the grantors. The Assistant Controller or Controller is
responsible for the final review and approval of all grant financial reports.
Policy # G. S. D, MT, T—Policy Title Page 3 of 4
Date: 00100 Supersedes: 00/00
For the most airrent version of InIs policy. go to the CopaNet and click on the 'Policies' tab, then '1 2o4des• then search by name/number.
References:
OMB Circular A-87, OMB Circular A-110, OMB Circular A-133, OASC-3 A Guide for Hospitals, Single Audit Act of 1984
and Amendments of 1996, 45 CFR Part 74, Appendix E-Cost Principles for Hospitals
Policy # G, S, 0, MT, T—Polloy Title Page 4 of 4
Date: 00/00 Supersedes: 00/00
For the most current version of this policy, go Lo the CopeNel and did( on the 'Policies lab, then 'Policies' then search by name/number.
Profile Attachment 1-E
Page 1 of 2
MD PROFILE PAGE
Arizona Medical Board
azmd.gov
Printed on 05/11/12 © 09:12
General Information
Joanna K. Kowalik MD License Number: 35667
570 W Brown Rd License Status: Active
Desert Vista Behavioral Health Licensed Date: 06/19/2006
Mesa AZ 85201 License Renewed: 01/06/2011
Phone: (602) 470-5000v Due to Renew By: 02124/2013
If not Renewed, License Expires: 06/24/2013
Education and Training
Medical School: JAGIELLON IAN UNIV MED COLL, FAG OF MED
KRAKOW,
Poland
Graduation Date: 06/24/1994
Internship: 06/18/2003- 04115/2006 (Psychiatry)
MARICOPA INTEGRATED HEALTH SYSTEM
PHOENIX, AZ
Area of Interest Child and Adolescent Psychiatry (Psychiatry & Neurology)
Area of Interest Psychiatry (ABMS Board Certified)
5/11/2012
Profile Page 2 of 2
The Board does not verify current specialties. For more information please see the American Board of Medical
Specialties website at http://www.abms.org to determine if the physician has earned a specialty certification from this
private agency.
Board Actions
None
A person may obtain additional public records related to any licensee, including dismissed
complaints and non-disciplinary actions and orders, by making a written request to the Board.
The Arizona Medical Board presents this information as a service to the public. The Board
relies upon information provided by licensees to be true and correct, as required by statute. It
is an act of unprofessional conduct for a licensee to provide erroneous information to the
Board. The Board makes no warranty or guarantee concerning the accuracy or reliability of the
content of this website or the content of any other website to which it may link. Assessing
accuracy and reliability of the information obtained from this website is solely the responsibility
of the user. The Board is not liable for errors or for any damages resulting from the use of the
information contained herein.
Please note that some Board Actions may not appear until a few weeks after they are taken,
due to appeals, effective dates and other administrative processes.
Board actions taken against physicians in the past 24 months are also available in a
chronological list.
Credentials Verification professionals, please click here for information on use of this website.
5/11/2012
RECEIVED
CURRICULUM VITAE JUL 2 52012
JOANNA KOWALIK, MD, MPH
CREDENTIALING DEPT.
11018 North I2.th Street • Phoenix. AZ 85020
Phone (602) 327-1995 • E-mail: jkilawok©hotmail.com
EDUCATION
July I, 2006-June 31. 2008 Maricopa Integrated Health Systern, Mesa, AZ
Child & Adolescent Psychiatry Fellowship Program
Graduated June 2008
June 18, 2003-June 30, 2006 MarIcopa Integrated Health System, Mesa, AZ
Psychiatry Residency Program
Graduated June 2006
August 2000-June 2003 University of Illinois at Chicago, Chicago, IL
School of Pubfic Health
Muter of Public Health-Health Poky and Administration
PhD Candidate in Health Information Systems
Nov 1994-Nov I 995 Jagiellonski University, Krakow, Poland
Rydygler General Hospital
Rotating Internship (Internal Medicine, Pediatrics, Surgery)
October 1987-July 1994 Jagiellonsld University Collegium Mediturni
Krakow, Poland
Medical Doctor
EMPLOYMENT
1
June 2008-Present District Medical Group (DMG)
Phoenbc, AZ
Child and Adolescent Psychiatrist
Director for Medical Student Education
Arizona's Children Association Outpatient Psychiatric Services
Desert Vista-Psychiatry/Child and Adolescent Psychiatry Residency Programs
Faculty
MIHS-Consuitation-Liaison Child and Adolescent Psychiatrist
August 2006 —June 2008 Medical Professional Associates (MedPro) of Arizona
Phoenix, AZ
Psychiatrist
MIH5-Inpatient Service and Consuhation Liaison
July 2006 - July 2007 Value Options, Inc.
Phoenkx, AZ
Psychiatrist
Urgent Psychiatric Care: emergency psychiatric evaluations, Court Order
Evaluations
August 2000-June 2003 Rush Presbyterian Medical Center, Chicago, IL
Departrnent of Preventive Medicine/Office of Intellectual Property
Clinical Research Coordinator/Research Consultant
HONORS AND AWARDS
2007 Chief Resident Child & Adolescent Psychiatry Training Program
2008 Special Recognition Award for strong organizational skills and leadership in teaching
BOARD CERTIFICATIONS
2
ABPN Diplornate In the specialty of Psychiatry September 2008
ABPN Part II Child and Adolescent Psychiatry November
2012
MEDICAL LICENSE Arizona Medical License No. 35667
PROFESSIONAL SERVICES
July 2008-Present MINS Department of Psychiatry Research Committee Member
September 201 I-Present MIHS Credendalirtg Committee Member
August 2000-Present American Medical Association
July 2003-Present American Psychiatric Association
May 2004-June 2008 Arizona Psychiatric Society, Executive Member, Member in Training
Representative for the State
July 2006-Present American Academy of Child and Adolescent Psychiatry
July 2003-Present Arizona Chapter of American of Child and Adolescent Psychiatry
August 2000-June 2003 Rush Presbyterian Medical Center, Health Initiative, Volunteer
1995- 2000 American Whole HealthlAllergi & Asthma Center, Oak Park, Illinois;
Observer/Sub-Intern
SCHOL4RY PRESENTATIONS
• Conferences: Banner Good Samaritan Psychiatry Grand Rounds-April 201h. 2011 Teaching
Medical Students Psychiatry to
• New Research Poster Session at the 2008 Annual AACAP meeting Efficacy of Cognitive
Therapy in the Treatment of Pediatric Posttraumatic Stress Disorder-Meta-analysis. Behavioral
• current Conferences: Psychiatry Grand Rounds May 2008: FTSD in children and adolescents: A review of
treatment modalities.
PUBUCATIONS
J Kowallk, j Weller, J Venter, D Drachrnan "r-ognitive Behavioral Therapy far the treatment
Stress Disorder A review rind meta-analysis" Journal of Behavior Therapy of pethavir Posttraumatic
Issue 3(2011), Pages 405-413 and Experimental Psychiatry, Volume 42,
3
i
REFERENCES
1
Available upon request
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State of Arizona
Board of Behavioral Health Examiners
Be It Known That
Julia M. Lankton
Having exhibited to the Board of Behavioral Health Examiners
satisfactory evidence of having met requirements to practice as
prescribed by law, is hereby licensed as a
Licensed Professional Counselor
The Arizona Board of Behavioral Health Examiners hereby grants this
License NumberITC-12890
Under its seal and signatures,
Board Chair Issue Date: January 1, 2008
Expiration Date: December 31, 2013
Julie M. Lankton, LPC, LISAC
P.O. 34177, Phoenix, Arizona 85067
602-281-6254 (home) / 703-901-7722 (mobile)
julielankton@hotmail.com
Current Credentials:
Licensed Professional Counselor, LPC12890: Arizona, issued 12/2007, renew 12/2013
Licensed Independent Substance Abuse Counselor, LISAC11857: Arizona, issued 9/2008,
renew 9/2012
Previous Credentials:
Licensed Professional Counselor, PRC452: District of Columbia, 1996-2008
Nationally Certified Addictions Counselor, NCAC012510, 1996-2010
Certified Addictions Counselor, CAC081082: Virginia, 1994-2010
Education:
Post Graduate Clinical Coursework (28 hours), Johns Hopkins University, 1/1997-8/2002
Master of Arts Degree, Agency Counseling, Appalachian State University, 8/1981-5/1983
Bachelor of Arts Degree, Elementary Education, Rollins College, 9/1976-5/1980
Work Experience:
Maricopa Integrated Health System, Phoenix, Arizona
January 2009-Present
Counselor — Provide counseling, social service intervention and care coordination
for HIV positive adult patients within an interdisciplinary team of HIV specialists.
Provide comprehensive assessments to evaluate the complex psycho-social needs of
the patient. Coordinate with internal/external team members and community referral
sources to address patient needs and improve patient health outcomes. Through
education and psychotherapy assist patient with overall adjustment to the diagnosis,
development of empowerment tools to increase health promoting behaviors, meet
treatment goals and enhance quality of life.
Dynamic Living Counseling, Phoenix, Arizona
March 2007-December 2008
Clinical Supervisor - Responsible for clinical and administrative training and
supervision of counseling staff. Worked with Clinical Director on program
planning and development. Assisted with scheduling of staff as well as trainings
and evaluations. Maintained clinical caseload as needed.
Page 11
Kaiser Permanente Behavioral Health, Fairfax, Virginia & Washington, D.C.
May 1992-March 2007
Behavioral Health Manager (9/2003-3/2007) - Provided leadership, supervision and
management of a Behavioral Health unit and Chemical Dependency service.
Worked in consultation with Psychiatry Chiefs and other Behavioral Health
Managers on program development, case management services, utilization
management processes and referrals to network providers. Responsible for hiring,
training and supervision of staff, completed scheduling and payroll (KRONOS).
Continued to provide direct clinical services, including individual and group
counseling.
Counselor (5/1992-9/2003) - Responsible for clinical services including assessment,
crisis intervention, diagnosis, treatment planning, individual and group counseling
and referrals for chemical dependency/dual disordered clients. Liaison with
psychiatrists, addictionist, internists and ancillary members of treatment team and
community resources.
United Methodist Family Services, Alexandria, Virginia
May 1989 — May 1992
Social Worker - Conducted assessment and referral services for a variety of clients,
provided individual, couples and family counseling. Implemented intake and
aftercare services for adolescent residential program. Facilitated groups for
adolescents and parents. Worked in conjunction with Child Placing Program in
offering pregnancy counseling and adoptions services, including social histories and
home studies.
Straight, Inc., Fairfax, Virginia
August, 1988-May, 1989
Program Counselor Conducted assessments, intakes, individual and group
sessions for adolescents in residential treatment facility. Responsible for treatment
planning, case management, referral and discharge planning. Worked in
conjunction with medical staff to ensure quality of care. Facilitated parent support
groups and education sessions.
Eckerd Family Youth Alternatives, Hendersonville, North Carolina
January 1985 — August 1988
Family Counselor - Participated in all phases of work with the family, youth and
referring agency from intake through residential placement and aftercare,
Facilitated groups and family conferences; worked independently, primarily in the
field.
Page I 2
Partners, Inc., Charlotte, North Carolina
November 1983-January 1985
Volunteer Coordinator — Recruited and trained adult volunteers to mentor
adjudicated adolescents. Interviewed and Assessed referrals from the court system
and matched them with a suitable mentor. Worked closely with juvenile probation
officers. Planned and implemented trainings for volunteers.
Lifetime Fitness, Charlotte, North Carolina
January 1983-January 1984
Assistant Manager — Responsible for hiring, training, scheduling and supervision of
fitness instructor and sales staff, provided customer service, oversaw day to day
operations of facility including accounting/payroll.
References:
Available Upon Request
Page I 3
Wendy Joy Watson, M.D, M.P:M. RECEIVED
30 W. San Juan Avenue • Phoenix, Arizona 85013 • (602) 751-8816 MAR 2 1 2012
wendyjoywatson@hotmail.com
111-11;\4-; DEPT.
EDUCATION
Msricopa Integrated Health System, Mesa, Arizona
Child and Adolescent Psychiatry Fellowship
July 2008— June 2010
Banner Good Samaritan Hospital, Phoenix, Arizona
Psychiatric Residency
June 2005 — June 2008
University of Arizona College of Public Health, Tucson,
Arizona
Masters in Public Health
December 2006
University of Arizona College of Medicine, Tucson, Arizona
Doctor of Medicine
May 2005
Arizona State University, Tempe, Arizona
Bachelor of Science Biology, Cum Laude
May 2000
HON016
Maricopa Integrated Health System, Child and Adolescent
Psychiatry Fellowship
• Excellence in Psychotherapy Award (2010)
Banner Good Samaritan Psychiatry Residency Program
• House Officer Educator of the Year (2006-2007)
awarded by the University of Arizona College of
Medicine, Phoenix Campus Students
University of Arizona College of Medicine
• College of Medicine's Dean's Scholarship
(Full scholarship, 2000-2004)
• Clerkship/Clinical Honors: Subspecialty Surgery, Rural
Health/Family Practice, Psychiatry, Internal Medicine,
Neurology
• Basic Science Honors: Neuroscience, Biochemistry,
Medical and Molecular Genetics, Microbiology,
Pharmacology, Social and Behavioral Science
Arizona State University
• Arizona State University Dean's List 4.0 GPA (1998-
2000)
Maricopa Integrated Health System, Child and Adolescent
Psychiatry Fellowship
• Adolescent Drag, Alcohol and Cigarette Use in an Inner
City Adolescent Medicine Clinic (2010)
University of Arizona Masters in Public Health Program
• Internship at the Maricopa County Department of
Sexually Transmitted Diseases (2005)
• Thesis and Presentation: "HIV Testing Policy in
Maricopa County" (2005,2006)
• Needs Assessments for Pinal County
• Maternal and Child Health (November 2002)
• Senior Transportation for Health Care (July 2002)
Arizona State Univonity
• Department of Psychology Project
Statistical Evaluation of Critical Skills and Thinking
(1998)
tiefiggaStO
Maricopa Integrated Health System, Child and Adolescent
Psychiatry Fellowship
• Chief Resident (2009)
University of Arizona College of Medicine
• Support Groups Leader (2001-2002)
Arizona State University
• Program Coordinator for Adopt-a-School Progam (a
medical education program for underserved children;
1999-2000)
06114TIMAZOTIV Board Certification — American Board of Psychiatrists and
Neurologists, Psychiatry Certificate # 62096 (Certified on
01/14/2011; certificate valid through 12131/2021)
Licensure - Arizona Board of Medical Licensure No. 37763
DEA Registered (Controlled Substance/Regulated Chemical
Registration)
USKLE Parts 1,11 and III (USMLE No. 5-114-875-7)
Basic Life Support (1999-current)
PROVISIONAL
masoottwys American Academy of Child and Adolescent Psychiatry (2009-
current)
Greater Phoenix Chapter of the Arizona Society of Child and
Adolescent Psychiatry (2010 - current)
Maricopa Integrated Health System, Child and Adolescent
Psychiatry Program
Lectures to MIHS Adult Psychiatry Residency "Child and
Adolescent Inpatient Psychiatry", 4 part lecture series
(November — December 2011); "Substance Abuse in
Adolescents" (December 2011)
Greater Phoenix Chapter of the Arizona Society of Child
and Adolescent Psychiatry
Presentation— illicit Drug Use in Adolescents" (November
2010)
Maxicopa Integrated Health System, Child and Adolescent
Psychiatry Fellowship
Presentations — "Enuresis and Encopresis", "Loss and Grief in
Childhood", "Illegal Drug use in Adolescents", "Eating
Disorders in Children and Adolescents"; Child and Adolescent
Psychiatry Class for General Psychiatry Residents (2009-2010)
Presentation — "Adolescent Drug, Alcohol and Cigarette Use in
an Inner City Adolescent Medicine Clinic"; Research
Presentation (June 2010)
Presentation — "Illegal Drug Use in Adolescents", Psychiatric
Grand Rounds (March 2008)
Banner Good Samaritan Psychiatry Residency Program
Presentation "Illegal Drug Use", Surgical Grand Rounds
(December 2007)
Presentation — "Illegal Drugs and Psychiatry", Psychiatric
Grand Rounds (December 2007)
Presentation — "Assessing Capacity for Medical Decision
Making", Internal Medicine Residency Program (June 2007)
Presentation — "IiRr Testing Policies in Psychiatric Settings",
Psychiatric Grand Rounds (May 2007)
University of Arizona College of Medicine
• Rural Health Preceptor Program (lived in Show-Low,
Arizona for three summers working with a Family
Practitioner for underserved, rural population, 2000-
2004)
• Commitment to Underserved People (2000-2003):
- Family Clinic/Refugee Clinic (2000-2003)
- Homeless Shelter Clinic (2001-2002)
- Domestic Abuse Shelter Clinic (2001)
- Med Mentors (mentored at-risk children; 2001)
• Presentation — "Mentoring Underrepresented Medical
Students", STFM Pre-Doctoral Conference (2003)
District Medical Group
• Adult Psychiatrist at the McDowell Healthcare Center
specializing in psychiatric care for patients living with
BIV/ALDS (Augtist 2010— current)
• Child and Adolescent Psychiatrist for the Gila River
Indian Community (August 2010 — current)
• Child and Adolescent Psychiatrist at SCOPES school
based clinic in the Osborn School District (August 2010
— September 2010)
Phoenix Veterans Administration Heath Care System
• Staff Psychiatrist (August 2008— February 2010)
Arizona State University
• Independent Biochemistry Tutor (1999)
• Department of Psychology, Teaching Assistant (1998)
Profile Page 1 of
MD PROFILE PAGE
Arizona Medical Board
azmd.gov
Printed on 04/17/12 it 03:42
General Information
Wendy Joy Watson MD License Number: 37763
570 W. Brown Rd, License Status: Active
Phoenix AZ 85201 Licensed Date: 11/16/2007
Phone: (480) 344-2026Q? License Renewed: 0212512012
Due to Renew By: 02126/2014
If not Renewed, License Expires: 06/26/2014
Education and Training
Medical School: UNIV OF AZ COLL OF MED
Tucson, Arizona
Graduation Date: 05/14/2005
Residency: 06/23/2005 - 11/15/2007 (Psychiatry)
BANNER GOOD SAMARITAN MEDICAL CENTER
PHOENIX , AZ
Area of interest Psychiatry (ABMS Board Certified)
Area of interest Child and Adolescent Psychiatry (Psychiatry & Neurology)
The Board does not verify current specialties. For more information please see the American Board of
Medical Specialties website at http://wvvw.abms.org to determine If the physician has earned a
specialty certification from this private agency.
Board Actions
http://www.aand.gov/g1suiteweb/elients/azbona/Public/Profile.aspx7entID=1637755&licl.. . 4/1712012
Profile Page 2 of 2
None
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12097-RFP
Attachment 1-F
RESPONDENT'S REFERENCES
RESPONDENT SUBMITTING PROPOSAL:
1. COMPANY NAME: Phoenix Children's Hospital
ADDRESS: 1919 E. Thomas Road, Phoenix, AZ 85016
CONTACT PERSON: Jan Piatt, M.D.
TELEPHONE: (602) 202-1260 E-MAIL ADDRESS: iPlatt@phoenixchildrens.org
2. COMPANY NAME: Care Directions @ Area Agency on Aging
ADDRESS: 1366 E. Thomas Road, Suite 200, Phoenix, AZ 85014
CONTACT PERSON: Debby Elliott
TELEPHONE: ( 602) 241-6123 E-MAIL ADDRESS: debby.elliott@aaaphx.org
3. COMPANY NAME: Maricopa County Department of Public Health
ADDRESS: 1645 E. Roosevelt Street, Phoenix, AZ 85006
CONTACT PERSON: Tom Mickey, STD Program Manager
TELEPHONE: (602) 506-6364 E-MAIL ADDRESS: t(nnmickeY@rnail.maricopa.gov
4. COMPANY NAME:
ADDRESS:
CONTACT PERSON:
TELEPHONE: E-MAIL ADDRESS:
5. COMPANY NAME:
ADDRESS:
CONTACT PERSON:
TELEPHONE: E-MAIL ADDRESS:
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