ASU AGREEMENT.DOC

Collaboration for Health Screening Exam Program and Nurse Practitioner Educational Experience
Program Agreement
between
Maricopa County
and
Arizona Board of Regents on behalf of Arizona State University
This Agreement, effective as of the last date signed below, is between the Arizona Board of
Regents for and on behalf of College of Nursing and Health Innovation, Arizona State University (“ASU”)
and MARICOPA COUNTY, a political subdivision of the State of Arizona, administered by its HUMAN
SERVICES DEPARTMENT, with an address of 234 N. Central Avenue, Phoenix, Arizona 85004
(“Department”).
WHEREAS, The Maricopa County Human Services Department Head Start Program Zero-Five,
Education Division (HSD) administers the Early Head Start (EHS) Program (serving children 0-3), and the
Head Start (HS) Program (serving children 3-5).
WHEREAS, The EHS/HS Performance Standard 1304.20 requires the EHS/HS programs to
determine children’s health status, to assure children receive age-appropriate preventative health
screening, and to refer for further medical evaluation and treatment as needed.
WHEREAS, As part of its mission and goals, ASU desires to provide practical educational field
experiences for its students while at the same time enhancing ASU’s impact and embeddedness in
Maricopa County, with positive outcomes for the community;
WHEREAS, ASU can further its mission and goals by assisting the Department with its Head Start
program by providing health screening services for the Department to children enrolled in the EHS/HS
Program.
WHEREAS, The purpose of this agreement is to establish a collaboration between the
Department and ASU to provide early childhood screenings for children within the EHS/HS programs
while simultaneous providing real world clinical educational experiences to ASU students.
NOW, THEREFORE, IT IS MUTUALLY AGREED that ASU may place certain students in the
Department Facility according to the following terms and conditions:
1. Definitions
(a) “AHCCCS” means Arizona Health Care Cost Containment System.
(b) “ASU Faculty” means licensed ASU registered nurse practitioner faculty who will be
performing EPSDT physical examinations and supervising Students.
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(c) “Department Facility” the facility to be used for the EPSDT physical exams, which is
provided by the Department and more fully described in Section 4(a)(i).
(d) “Educational Field Experience Program” means the program offered to ASU nurse
practitioner graduate students whereby such students are supervised by an ASU
registered nurse practitioner faculty and interact with patients at the Department
Facility.
(e) “EPSDT” means Early, Periodic, Screening, Diagnosis and Treatment.
(f) “Head Start Nurse” means a Department registered nurse that will be the primary point
of contact and will provide support for the ASU Faculty and Students for the Educational
Field Experience Program and the EHS/HS Programs.
(g) “Medical Home” means a relationship between patient and a primary care provider to
provide accessible, continuous health care for such patient.
(h) “Referral” means a listing of one or more medical/dental providers in the East Valley
who accept AHCCCS and/or provide low or reduced fee services.
(i) “Students” means ASU nurse practitioner graduate students that are licensed registered
nurses that are participating in the Educational Field Experience Program in accordance
with this Agreement.
(j) “Underserved” means those individuals who might experience barriers to obtaining
preventative health care
2. Joint Responsibilities.
(a) The Parties will cooperatively work together to develop monthly schedules setting forth
dates and times whereby ASU Faculty will be present at the Department Facility to
perform EPSDT physical examinations.
(b) ASU Faculty and the Head Start Nurse will review all physical exam findings together so
that referrals and communication with Department support staff can happen. The
Parties shall work to identify children with no Medical Home and/or health insurance so
that referrals to primary care and specialist services can be arranged through the
Medical Service Program.
3. ASU Responsibilities
(a) EPSDT Physical Examination Related Responsibilities - ASU will assist Department’s EHS
and HS programs by providing an ASU Faculty to:
i. perform EPSDT physical examinations at the Department Facility on EHS/HS children
(0-5).
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ii. perform finger sticks for hemoglobin and blood lead testing for children as required
on the EPSDT Periodicity Schedule. (This responsibility may also be performed by
the Department.)
iii. administer Tuberculosis skin test on children as required on the EPSDT Periodicity
Schedule. (This responsibility may also be performed by the Department.)
iv. obtain height, weight and blood pressure on children as required on the EPSDT
Periodicity Schedule. (This responsibility may also be performed by the
Department.)
v. provide information to the Head Start Nurse for referral for further evaluation and
treatment for child, as deemed appropriate.
vi. provide EPSDT physical examination test results to parents at the time of
examination, and to Head Start Nurse.
vii. supervise Students performing or assisting in performing EPSDT physical
examinations.
viii. Timely notify (verbally or in writing) the Department concerning broken or defective
equipment necessary to conduct EPSDT physical examination supplied by the
Department after ASU Faculty becomes aware of such broken or defective
equipment.
(b) Educational Field Experience Program Related Responsibilities
i. ASU shall be responsible for selecting the Students which it deems academically
qualified to participate in the Educational Field Experience Program.
ii. In addition to the specific supervision specified in Section 3(a)(vii) relating to EPSDT
examinations, ASU Faculty shall generally supervise Students as appropriate while
such Students are participating in Educational Field Experience Program at the
Department Facility.
iii. ASU shall be responsible for establishing the educational goals and objectives of the
Educational Field Experience Program.
iv. Student Health Insurance - ASU shall notify Students of Department’s requirement
that Students must obtain and maintain health insurance during their participation
in the Educational Field Experience Program.
v. Termination from Educational Field Experience Program - ASU shall notify Students
that a Student may be dismissed from the Educational Field Experience Program if
the Department deems their behavior or performance to be unacceptable as more
fully described in Section 4(b)(i). Notwithstanding the above, ASU shall also retain
the right to dismiss a Student from the Educational Field Experience Program if ASU
deems Students behavior or performance unacceptable or if they are not in
academic good standing.
(c) The Parties anticipate that only one ASU Faculty will be assigned (as a portion of her/his
ASU job duties) to provide the services identified in Section 3(a) and 3(b)(ii). The Parties
intend to schedule faculty presence at the Department Facility in advance in accordance
with Section 2(a). However, actual presence and the performance of services will be
subject to the reasonable availability of such ASU Faculty, taking into account that
illness, other unplanned events, termination of an ASU Faculty, or fiscal constraints of
the College of Nursing and Health Innovation may affect such availability. ASU shall
provide verbal or written notice as soon as practical in the event that ASU determines or
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discovers that such ASU Faculty will not be available for a scheduled visit to the
Department Facility. Notwithstanding the above, ASU may assign additional faculty at
its sole discretion to perform the above services.
(d) Use, Disclosure, and Safeguarding Patient Information - ASU shall limit its use or
disclosure of any information concerning a patient to whom services are provided to
under this Agreement as required by applicable law. Further, ASU shall abide by any
applicable health care professional standards relating to the use and disclosure of such
information, including standards relating to the safeguarding of such information.
4. Department Responsibilities
(a) Facility Requirements and EPSDT Physical Examination Related Responsibilities - The
Department will:
i. Provide a facility for physical exams services (“Department Facility”) on its property
located at 2150-1 South Country Club Drive; Mesa, Arizona 85210. The Department
Facility shall include rooms equipped with tables and chairs for ASU Faculty,
Students, parents, children and Department staff (if needed) for the exam.
ii. Identify eligible children to receive EPSDT physical examinations on the following
order:
1. Uninsured children that attend one of the Department’s EHS/HS Program;
2. Children that have applied for AHCCCS but have not been approved;
3. Children that have applied for AHCCCS but have documents to provide to
complete application;
4. Children that have applied for AHCCCS but have not been assigned a
Primary Care Provider;
5. Children that are enrolled with AHCCCS but have not been able to see an
AHCCCS provider, or get appropriate services through the AHCCCS provider.
iii. Refer children for EPSDT services for further evaluation and treatment and
coordinate appointments with parents and support staff.
iv. Work with support staff to have parent or legal guardian accompany their child to
the EPSDT physical examination appointment. If parent is unable to attend
appointment, the Department will require that the parent notify Department staff
with a letter stating who may attend the appointment with child.
v. Provide necessary information to the ASU clinical supervisor regarding the insurance
status of child and purpose of the appointment.
vi. Encourage families to arrive promptly for scheduled appointments and to for follow
the prescribed medical instructions.
vii. Provide communication to support staff to provide transportation as needed to
families.
viii. Provide Spanish interpretation for ASU personnel if needed.
ix. Provide all equipment and supplies needed for examinations including, but not
limited to: blood pressure cuff of various pediatric sizes, otoscope, ophthalmoscope,
reflex hammer, scales, stadiometer, stethoscope, lead care machine, hemocue
machine, tongue depressors, and other disposable supplies.
x. Provide the age appropriate EPSDT forms for the documentation of exam.
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xi. Provide Child Plus immunization record and assessments to include hearing, vision,
lead, and TB screening. Provide forms for recording of assessments of the following:
health history, language and speech, fine and gross motor skills, nutrition and the
physical examination and any other documents that may assist the ASU Faculty to
determine child health status.
xii. Receive from ASU Faculty, parents, and others as applicable patient documentation
related to services performed, including completed EPSDT forms. The Department
shall be responsible for maintaining and safekeeping such documentation and
comply with all legal and professional requirements relating to record keeping.
xiii. Provide hearing and vision screening if not already completed.
xiv. Perform finger sticks for hemoglobin and blood lead testing for children as required
on the EPSDT Periodicity Schedule. (This responsibility may also be performed by
ASU Faculty.)
xv. Administer Tuberculosis skin test on children as required on the EPSDT Periodicity
Schedule. (This responsibility may also be performed by ASU Faculty.)
xvi. Obtain height, weight and blood pressure on children as required on the EPSDT
Periodicity Schedule. (This responsibility may also be performed by ASU Faculty.)
xvii. Provide documentation of all completed EPSDT exams if requested by ASU Faculty.
xviii. Provide In-Kind forms for ASU to complete for donation of services.
(b) Educational Field Experience Program Related Responsibilities – The Department will:
i. Allow ASU to conduct an Educational Field Experience Program for its Students. The
Department shall have the right to require withdrawal of any Student in the event
that Student’s behavior or performance is unacceptable for any of the following
reasons: Student’s conduct endangers persons, causes unreasonable risk to
property, is illegal, violates Department policy, or otherwise unreasonably interferes
with the Department’s operations. In the event that Department requires
withdrawal, Department shall immediately notify ASU and the subject Student.
ii. Provide an orientation session for Students upon such Students arrival.
iii. Provide ASU with applicable Department policies to provide to Students.
iv. Generally and reasonably assist and cooperate with ASU to help ensure that
Students’ experiences are safe, productive, and successful.
5. Term. This Agreement shall become effective as of the last date signed below and shall
terminate five (5) years from such effective date, unless terminated as set forth in Section [ 15].
6. Notice. Whenever written notice is required or permitted to be given by any party to the other,
such notice shall have been deemed to have been sufficiently given if personally delivered or
deposited in the United States Mail in a properly stamped envelope, certified or registered mail,
return-receipt-requested, addressed as described below. Each Party may change its designee for
receiving notice, with proper notice of such change.
For ASU For Department:
Academic Contracts Office Maricopa County
College of Nursing and Health Innovation Human Services Department
Arizona State University 234 North Central Avenue,
500 North 3rd Street Suite 3201
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Phoenix, AZ 85004-0698 Phoenix, Arizona 85204
ATTN: Manager, Academic Contracts ATTN: Bruce Liggett, Director
7. Governing Law and Venue. The terms of this Agreement shall be construed in accordance with
Arizona law. Any lawsuit arising out of this Agreement shall be brought in the appropriate court
in Maricopa County, Arizona.
8. Licenses and Compliance with Worker’s Insurance Requirements. Each Party shall, without
limitation, obtain and maintain all licenses, permits and authority necessary to do business,
render services and perform work under this Agreement, and shall comply with all laws
regarding unemployment insurance, disability insurance, and workers’ compensation.
9. Independent Contractor Status. Each Party is an independent contractor in the performance of
all work and the provision of all services under this Agreement. Neither Party shall be
considered an officer, employee, representative, or agent of the other Party.
10. Amendments. All Amendments to this Agreement shall be in writing and signed by authorized
signers for both Parties.
11. Assignment and Subcontracting. No right, liability, obligation or duty under this Agreement may
be assigned, delegated or subcontracted, in whole or in part, by ASU without the prior written
approval of the Contract Administrator. ASU shall bear all liability under this Agreement, even if
it is assigned, delegated, or subcontracted, in whole or in part, unless the Department agrees
otherwise.
12. Availability of Funds. Each Party acknowledges that the other Party’s performance under this
Agreement may be dependent upon funding from the Arizona Legislature or other
governmental source. If the Legislature or other such governmental source fails to appropriate
or otherwise fund the necessary funds for performance of the Agreement, such underfunded
Party may provide written notice of this to the other Party and cancel this Agreement.
13. Disputes. In the event of a dispute arising from this Agreement, the Parties agree to negotiate in
good faith to resolve such dispute. If the dispute cannot be resolved by such negotiations, the
Parties agree that any legal action will be filed in Arizona Superior Court in Maricopa County. In
accordance with ARS 12-1518, the Parties agree to make use of arbitration to the extent that
arbitration is required pursuant to ARS 12-133.
14. Default. This Agreement may be immediately terminated by either Party if the other Party fails
to perform any objective or breaches any obligation under this Agreement.
15. Termination.
(a) This Agreement is subject to cancellation by the either Party in accordance with the
provisions of A.R.S. § 38-511.
(b) Either Party may terminate this Agreement at any time by giving the other Party at least
sixty (60) calendar days prior notice in writing (unless terminated by either Party under
the Availability of Funds provision), except that to the extent a Student is currently
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participating in an educational experience contemplated by this Agreement at the time
of receipt of the termination notice, the Parties shall comply with such applicable
provisions in the Agreement to allow such Student to complete the educational
experience provided such completion does not extend beyond one hundred (120) days
from the date of receipt of such notice.
(c) This Agreement may be terminated by mutual written agreement of the Parties
specifying the termination date therein.
(d) Either Party has the right to terminate this Agreement upon twenty-four (24) hour
notice when such Party determines that the health or welfare of the service recipients
are endangered due to the other Party’s actions or the other Party’s non-compliance
jeopardizes funding source financial participation.
16. Severability. Any provision of this Agreement that is determined to be invalid, void or illegal by a
court shall in no way affect, impair or invalidate any other provision hereof, and the remaining
provisions shall remain in full force and effect.
17. Reciprocal Indemnification. Each Party (as “Indemnitor”) agrees to indemnify, defend, and hold
harmless the other Party (as “Indemnitee”) from and against all claims, losses, liability, costs, or
expenses (including reasonable attorneys’ fees) (hereinafter collectively referred to as “Claims”)
arising out of bodily injury (including death) of any person or property damage, but only to the
extent that such claims, which result in vicarious liability to the Indemnitee, are caused by the
act, omission, negligence, misconduct, or other fault of the Indemnitor, its officers, officials,
agents, employees, or volunteers.
18. Training. The Department may make available to ASU the opportunity to participate in any
applicable training activities conducted by the Department.
19. Lobbying.
(a) No federal appropriated funds have been paid or will be paid by or on behalf of either
Party to any person for influencing or attempting to influence an officer or employee of
any agency, a member of Congress, an officer or employee of Congress, or an employee
of a member of Congress in connection with the awarding of any federal contract, the
making of any federal grant, the making of any federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any federal contract, grant, loan, or cooperative agreement.
(b) If any funds, other than federal appropriated funds, have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a member of Congress, an officer or employee of Congress, or an employee of a
member of Congress in connection with any federal contract, grant, loan or cooperative
agreement, the applicable Party shall complete and submit OMB Form-LLL, titled
"Disclosure of Lobbying Activities," in accordance with its instructions and 31 U.S.C. §
1352.
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20. Political Activity Prohibited. None of the funds, materials, property or services contributed by
the County or ASU under this Agreement shall be used for any partisan political activity, or to
further the election or defeat of any candidate for public office.
21. Rights in Data. The Parties shall have the use of data and reports resulting from this Agreement
without cost or other restriction, except as otherwise provided by law or applicable regulation.
Each Party shall supply to the other Party, upon request, any available information that is
relevant to this Agreement and to the performance hereunder, except as limited by law.
22. Contract Compliance Monitoring. The Department shall monitor ASU's compliance with, and
performance under, the terms of this Agreement. On-site visits for compliance monitoring may
be made by the Department and/or its grantor agencies at any time during ASU's normal
business hours, announced or unannounced. During an on-site visit, ASU shall make all of its
records and accounts related to work performed and services provided under this Agreement
available to the Department for inspection and copying, except as restricted by law.
23. Insurance. The Parties will maintain insurance coverage as set forth below:
(a) School agrees to maintain professional (as appropriate) and general liability coverage
through the State of Arizona Department of Administration Risk Management Division's
program of self-insurance pursuant to ARS 41-621 et. seq., in the minimum amounts of
$2,000,000 per occurrence, $4,000,000 aggregate, for its students, employees, and
agents, participating in this Agreement.
(b) Department shall provide and maintain comprehensive professional and general liability
insurance of not less than $2,000,000 per occurrence and $4,000,000 in the aggregate,
for its employees and agents, participating in this Agreement.
(c) The insurance required in this Section shall be maintained in full force and effect
throughout the term of this Agreement.
(d) Following written request, each Party shall provide the other Party proof of such
insurance within ten days of such request.
24. Nondiscrimination. Each Party, in connection with any service or other activity under this
Agreement, shall not in any way discriminate against any person on the grounds of race, color,
religion, sex, national origin, age, disability, political affiliation, or belief. To the extent that
either Party utilizes subcontractors in the performance of this Agreement, such Party shall
include this clause in all of its Subcontracts related to this Agreement.
25. Equal Employment Opportunity. Each Party shall not discriminate against any employee or
applicant for employment because of race, age, disability, color, religion, sex or national origin.
Each Party, if permitted by law, shall take affirmative action to ensure that applicants are
employed and that employees are treated during employment without regard to their race, age,
disability, color, religion, sex or national origin. Such action shall include, but is not limited to,
the following: employment, upgrading, demotion or transfer, recruitment or recruitment
advertising, lay-off or termination, rates of pay or other forms of compensation, and selection
for training, including apprenticeship. Each Party shall, to the extent such provisions apply,
comply with Title VI and VII of the Civil Rights Act of 1964, as amended (42 U.S.C. §§ 2000a, et
seq.); the Rehabilitation Act of 1973, as amended (29 U.S.C. §§ 701, et seq.); the Age
Discrimination in Employment Act of 1967, as amended (29 U.S.C. §§ 621, et seq.); the
Americans With Disabilities Act of 1990 (42 U.S.C. §§ 12101, et seq.); and Arizona Executive
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Order 2009-09, which mandates that all persons shall have equal access to employment
opportunities.
26. Retention of Records.
(a) This provision applies to all financial and programmatic records, supporting documents,
statistical records and other records of each Party that relate to this Agreement.
Notwithstanding the above, nothing shall require either Party to maintain or provide
access to any records which are subject to a legally recognizable privilege.
(b) Each Party shall retain all records related to this Agreement for six (6) years after final
payment or until after the resolution of any audit questions, which could be more than
six (6) years, whichever is longer. Each Party, federal and State auditors, and any other
persons duly authorized by such Party shall have full access to and the right to examine,
copy and make use of any and all of the records.
27. Property. Any property furnished or purchased by Department pursuant to the terms of this
Agreement shall be utilized, maintained, repaired, and accounted for in accordance with
instructions furnished by the Department, and title to all such property - if still in the possession
of ASU - shall revert to the County upon the expiration or termination of this Agreement, unless
the Contract Administrator determines otherwise. The costs to repair property supplied by ASU
are the responsibility of ASU within the limits budgeted herein. Repair costs beyond the
budgeted amount shall be approved by the Contract Administrator.
28. Immigration Reform and Control Compliance. ASU understands and acknowledges that the
Immigration Reform and Control Act of 1986 (Pub. L. No.99-603) (“IRCA”) may apply to this
Agreement. To the extent applicable, ASU shall comply with the IRCA in performing under this
Agreement and shall grant the County access to inspect its personnel records to verify such
compliance as applicable.
29. Drug Free Workplace Act. ASU shall comply with the Drug-Free Workplace Act of 1988 (41 U.S.C.
§§ 701, et seq.), which requires that contractors and grantees of federal funds must certify that
they will provide drug-free workplaces. This certification is a precondition to receiving a grant or
entering into this Agreement.
30. Governor’s Executive Order No. 88-26. To the extent required by law, ASU shall use the Arizona
Taxonomy of Human Services for reporting and contracting purposes.
31. Employment Disclaimer.
(a) This Agreement is not intended to constitute, create, give rise to, or otherwise recognize
a joint venture agreement, partnership, or other business association or organization of
any kind between the Parties, and the rights and obligations of the Parties shall be only
those expressly set forth in this Agreement.
(b) The Parties agree that no individual performing under this Agreement on behalf of ASU
may be considered a County agent, employee, or representative and that no rights of
County civil service, County retirement, or County personnel rules shall accrue to or
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apply to any such individual. ASU shall have total responsibility for all salaries, wages,
bonuses, retirement, withholdings, workers’ compensation, occupational disease
compensation, unemployment compensation, other employee benefits, and all taxes
and premiums appurtenant thereto concerning such individuals, and Department shall
forward any and all such claims to ASU with respect thereto.
32. Verification Regarding Compliance with A.R.S. Section 23-214 and Federal Immigration laws and
Regulations. By entering into this Agreement, each Party represents and warrants that it is in
compliance with the Immigration and Nationality Act (8 U.S.C. §§ 1101, et seq.) and all other
federal and State immigration laws and regulations related to the immigration status of its
employees. Each Party shall obtain statements from its Subcontractors working under this
Agreement certifying such compliance and shall furnish the statements to the other Party upon
request. These representations and warranties shall remain in effect throughout the term of this
Agreement. Each Party and its Subcontractors working under this Agreement shall also maintain
Employment Eligibility Verification forms (I-9), as required by the U.S. Department of Labor’s
Immigration Reform and Control Act of 1986 (Pub. L. No. 99-603), for all employees performing
work under this Agreement. I-9 forms are available for download at USCIS.GOV. Each Party
agrees to verify employee compliance using the E-verify system and shall keep a record of the
verification for the duration of the employee’s employment or at least three years, whichever is
longer. Each Party warrants that it is in compliance with A.R.S. § 41-4401 (e-verify requirements)
and further represents:
(a) That it and its Subcontractors working under this Agreement, if any, warrant their
compliance with all federal immigration laws and regulations that relate to their
employees and their compliance with A.R.S. § 23-214(A);
(b) That breach of the warranty under subparagraph 1 above shall be deemed a material
breach of this Agreement and the other Party may immediately terminate this
Agreement without liability; and
(c) That the each Party and any contracting government entity retains the legal right to
inspect the papers and employment records of the other Party or Subcontractor
employee who works under this Agreement to ensure that such Party and its
Subcontractor are complying with the warranty provided under subsection 1 above, and
that such Party agrees to make all papers and employment records of said employee(s)
available to the other Party during normal working hours in order to facilitate such an
inspection.
~Signatures on following page~
~Remainder left blank intentionally~
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IN WITNESS WHEREOF, the parties have executed this Agreement as of the respective dates written
below.
THE ARIZONA BOARD OF REGENTS FOR AND ON MARICOPA COUNTY
BEHALF OF ARIZONA STATE UNIVERSITY AND ITS
COLLEGE OF NURSING AND HEALTH INNOVATION
By: ______________________________ By: ________________________________
Name: Teri Britt Pipe, PhD, RN Name:
Title: Dean, College of Nursing and Health Title: Chairman, Board of Supervisors
Innovation
Attested To:
___________________________________
Clerk, Board of Supervisors Date
Approved as to form:
___________________________________
Deputy County Attorney Date
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