NURSING DEMONSTRATION PROJECT.PDF

June 12, 2013
Maricopa County Correctional Health Services
3250 West Lower Buckeye Road
Phoenix, AZ 85009
Dear Healthcare Provider:
This Letter Agreement ("Agreement") is entered into by and between Scottsdale Healthcare
Hospitals ("SHC") and (Maricopa County Correctional Health Services "Site") for the clinical
preceptor rotations ("Rotation") for advanced practice nursing students ("APRNs") as part of
the Centers for Medicare and Medicaid Services ("CMS") Graduate Nurse Education
Demonstration Project ("Demonstration Project") being conducted by SHC pursuant to the
Demonstration Agreement between SHC and CMS, a copy of which is attached hereto as Exhibit
hand incorporated herein. Site confirms that it is neither an affiliate of SHC nor a part of the
SHC system.
Pursuant to this Agreement, Site agrees to oversee and carry out the Rotation in accordance
with the terms and conditions of Site's agreement with Northern Arizona University (NAU)
("School") for the clinical training of APRNs, a copy of which is attached hereto as Exhibit B.
The agreement between the School and the Site must be in place prior to a student beginning a
clinical training rotation at the Site. Placement of a student at a Site as part of the
Demonstration Project is subject to prior approval by SHC.
Preceptors who provide services under this Agreement on behalf of Site shall be duly licensed,
and if applicable, certified under Arizona law and shall meet all standards identified by the
Arizona State Board of Nursing. Upon request, Site shall provide SHC with evidence of such
current active license and certification for each Preceptor who provides services under this
Agreement.
In its performance of this Agreement, Site shall be an independent entity and shall not be
considered in any way an employee or agent of SHC. Each party shall be responsible for its
negligent acts or omissions and the negligent acts or omissions of its employees, officers, or
directors to the extent allowed by law.
Site shall invoice SHC for allowable costs incurred in providing clinical training to the APRNs
enrolled in the Demonstration Project on or after August 1, 2012. For those APRNs enrolled in
the Demonstration Project on or after August 1, 2012 who have finished their rotations at Site
prior to Effective Date (as defined below), Site shall invoice SHC for allowable costs incurred in
the training of said APRNs within thirty (30) days of the Effective Date. For those APRNs
enrolled in the Demonstration Project who began but have not completed their rotation(s) at
Site prior to the Effective Date or who have not yet begun their clinical training at Site, Site shall

invoice SHC for allowable costs incurred in the training of the APRNs within thirty (30) days of
the end of each student rotation. All invoices shall be substantially in the form set forth in
Exhibit C attached hereto. Student clinical training hours are subject to verification with the
School. Prior to any payments being made by SHC, Site will need to provide SHC verification of
Site's current Medicare provider based payment status as stipulated in 42 CFR 413.65 and
either a W-9 or Entity Identification Number.
Payments will be made by SHC to Site quarterly. Site will be reimbursed at a rate of $2000.00
per 1.0 Full Time Equivalent ("FTE") student rotation, defined as 300 or more hours per
semester. Reimbursement will be pro-rated based on the clinical hours of training actually
provided by the Site for rotations of less than 300 hours. Notwithstanding anything to the
contrary in the foregoing, Site acknowledges and agrees that there will be no reimbursement
for costs that exceed the annual budgeted amount per FTE student rotation (i.e. $2000.00).
Accordingly, reimbursement per FTE student rotation shall be capped at 300 hour per semester
(cumulative) regardless of where that training is provided. To illustrate, and as an example
only, if the rate for a 1.0 FTE student rotation is $2000 and if during a semester APRN Student A
receives 125 hours of clinical training at Site A, 125 hours of clinical training at Site B, and 125
hours of clinical training at Site C, Site A will be reimbursed for 125 hours of training, or $834;
Site B will be reimbursed for 125 hours of training, or $834; and Site C will be reimbursed for 50
hours of training, or $333.
All payments shall be considered provisional and subject to adjustment in the event adjustment
is necessary as a result of an adverse audit finding against the Site. Site agrees to permit SHC,
its agents and/or federal auditor(s)/official(s) to have access to its records and financial records
as may be necessary. Payment by SHC to Site is contingent on CMS' continued funding of the
Demonstration Project and payment from CMS to SHC for Site's costs. SHC will not be liable for
payment to Site for amounts exceeding reimbursement and/or budget approval by CMS. in
addition, reimbursement is contingent upon appropriate performance by Site, as determined
by SHC in its sole discretion.
This Agreement shall commence on the date countersigned below ("Effective Date") and
terminate on August 1, 2013 ("Initial Term"). Thereafter, this Agreement shall automatically
renew for three (3) successive one (1) year terms (each a "Renewal Term"), unless terminated
by one of the parties. Either party may terminate this Agreement for any reason upon thirty
(30) days advance written notice to the other party.
Any questions regarding the performance of this Agreement should be directed to SHCffis Nurse
Practitioner Liaison, David Smith, ANP-BC, via email graduatenursingeducation@shc.org ,
telephone (480)323-3012, or mail to Nursing Administration, Scottsdale Healthcare, 9003 E.
Shea Blvd., Scottsdale, AZ 85260.
If this letter correctly sets forth your understanding of the terms of this subcontract, please
indicate your agreement to such terms by having this letter countersigned by an appropriate
officer of your organization and returned, along with verification of your current Medicare

provider based payment status and either a W-9 or Entity Identification Number, to Scottsdale
Healthcare Hospitals to the attention of Cathy Collette, as noted on the invoice.
We look forward to working with you.
Sincerely,
k-rakto.m.IL
Melanie Brewer, DNSc, RN, FNP-BC
Director, Arizona Graduate Nurse Education
Demonstration Project
Maricopa County Correctional Health Services
By:
Signature
Printed Name
Title:
Date:

Exhibit A
(Agreement between SHC and CMS)

DEMONSTRATION AGREEMENT
for the
Graduate Nurse Education Demonstration
The statutory authority to conduct this demonstration projeet is provided under Section 5509 of
the Affordable Care Act (ACA). Under this section, the Centers for Medicare and Medicaid
Services (CMS) is required to implement, evaluate, and submit a report to Congress for the
Graduate Nurse Education (ONE) Demonstration (hereinafter "Demonstration"). Five (5)
eligible hospitals and their partner schools of nursing (SONO, partnering hospitals and non-
hospital community-based aura settings (CCSH) will participate In a 4ycur demonstration where
the CMS will reimburse the applicant hospihils the reasonable WM of the clinical training of the
inereased number of advanced practice registered nurses (APRNB) trained. The intent of the
Demonstration is to increase the supply ofAFRNs in order to improve access to health care
professional services for the growing population of Medicare and Medicaid beneficiaries.
Tito Center for Medicare & Medicaid Innovation (CMMI) in the Centers for Medicare &
Medicaid Services (CMS) enters into this demonstration agreement with the Hospital to conduct
the Demonstration according to the terms and conditions agreed upon by both CMS and the
Hospital.
This agreement between CMS and the Hospital is not subject to the Federal Acquisition
Regulation. Nothing in This agreement transfers any right, fitle, or interest in this information to
any party.
Terms and Conditions
K011iiblirli010113g I The Hospital agrees that reimbursement will based on the total reesontible
costs attributed to the incremental increases In APRN FIE enrollees relative to the average
number of APRN graduates in the base enrollment years of 2006.2010.
The Hospital agrees to follow procedures for filing Medicare costs reports as expressed by
current Medicare hospital cost report regulations. lite Hospital agrees to participate in audits
administered by CMS or its designee in order to verify cost amounts for the Demonstration.
The Hospital agrees that CMS is reimbursing only those clinical training costs that arc not
covered by other revenue sources, such as tuition or other funding sources.
If in any given year, the overall expenditures Incurred by the Demonstration across ail sites
exceed the mount appropriated for that year, CMS will make a prorated payment acthistment
across all sites.

Page 2— Demonstration Agreement
higilagiamat. The Hospital agrees to monthly interim payments derived from the projected
budget estimates divided by 12 months for only allowable and reasonable costs incurred for the
provision of °finical training.
These payments will be calculated using the allowable costs derived from the updated budget
estimates and enrollment information that the Hospital agrees to provide to CMS, in the format
CMS stipulates, withinll calendar days of limping to participate in the Demonstration.
rtivment Froctiot CMS requires that the Hospital provide a completed CMS Form 588
payment information form and return it to CMS no later Wm two weeks from the date of
selection/award. The CMS Form 588 can be obtained at the following web address:
hile://www.emmevanntenns1downteadskeyi85Kratf
CMS will use the banking information you provide on this form to establish a vendor account in
our Financial Accounting Control System that will enable CMS to transfer Rinds electronically
from the U.S. Treasury using the ABA routing number to the bank amount you provide.
The Electronic; Funds Transfer (EFT) deposit MI only be made to a checking account; therefore,
to ensure proper payment please make sure to include the checking account and routing numbers
on the payment information form and send either a void check or signed letter from your hank
along with it for verification purposes. CMS will use the Employer Identification Number/Tax
identification Number (EIN/TIN), legal huainess name and address, to identify your organization
within the payment system and to ensure that the payments are directed to the routing
number/ace,ount you specified on the form. Importantly, CMS cannot transfer the monthly
payment without the completed payment informetion form.
Please forward the completed CMS Form 588 with the original "wet" signature using an
eyemighlinat that can be tracked (FerlEx, UPS, etc.) to the following address:
Mr. Edward Derends
Director, Division of Pintmelal Strategies and Evaluation
Mail Stop N3-04-07
Office of Financial Management
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244-1850
partners: The Hospital agrees that each non-hospital CCS is not reimbursed under the provider-
based payment rules as stipulated in 42 CPR 41165, The Hospital agrees to ensure that at least
50% of the clinical training will occur in non-hospital CCSs. The Hospital agrees through its
partner hospitals, SON, and community-based care settings to provide the clinical training
necessary to allow graduating APRN students to be eligible to apply for licensers in the state in
which the SON is accredited.
panternentufiont Within 30 days of the Demonstration Agreement signature, the Hospital
agrees to submit an implementation plan for the Demonstration outlining processes for the
following areas: (a) management and staffing, including information on the roles and

Page 3 — Demonstration Agreement
respnnsibllities of key project personnel (b) implementation sehedulo, (e) student outreach and
recruitment, (d) partner payment processes and distribution schedule, and (e) quality monitoring
and martinet) plans. The implementation plan must be approved by CMS in writing within 60
days of Demonstration Agreement signature. Upon CMS approval, the plan will be Incorporated
into this agreement by reference. The implementation plan may be amended and revised over
the period of performance ofthie Demonstration. CMS may require the Hospital to pnovide the
following information:
• For each annual audit, the Hospital agrees to provide supplemental informetion that
relates to the clinical training and costs that may be beyond the requirements of the
standard costs reports;
• The Hospital agrees to provide CMS and its contractor(e) with documentation upon
request that relates to the cost and clinical training throughout the demonstration
period;
* The Hospital estate to provide CMS and its contractor(s) with a detailed breakdown of
tuition revenues, other 'avenues and Maeda training costs for enrollees in each APRN
program.
The Hospital will notify CMS of any changes it needs to make to its implementation and
operational procedures over the course of the Demonstration by submitting amendments. These
changes are subject to CMS approval. CMS will attempt to respond to a request for modification
of the implementation plan within 10 working days of its receipt but reserves the right to request
an extension, Any amendments or changes to the plan are also incorporated into the agreement
by reference on a prospective basis upon written CMS approval.
Awitird Polo 4: 'The award period Includes a 4.year demonstration period.
)0emonstration Preiraln *difieetinnst if CMS makes any modifioations In the
demonstration rules or operating principles, the project officer will provide written notification
of such mcprlifleations.
lacnortinat The Hospital will submit written operetional progress reports no later than 30 days
from the end of each six (6) months. The report will include information about the
demonstration operational status, FIE number of APRN enrollees, total costs, accomplishments,
conflicts resolved. The report will provide a summary of the Demonstration's activities during
the prior 6 months,
Peconeillatlent Thu Hospital agrees to repay CMS in the event ONE interim payments exeeed
actual reasonable ONE costs, alter audit. Conversely, CMS agrees to pay the Hospital In the
event ONE interim payments are less than actual reasonable ONE costs, after audit, with the
limitation that Demonstration expenditures may not exceed the amount of funds that has been
appropriated in section 5509 of the Affordable Care Act.

Page 4 — Demonstration Agreement
During the demonstration, interim payments will be adjusted for each year based on the actual
reasonable costs incurred in the las( preceding year for which we have data. At the end of the
demonstration, final settlemait of payments will be accomplished via an administrative
adjustment to the payments due from CMS to the Demonstrator, or by other means, at CMS'
election.
gvaluatienr CMS will contract with an independent evaluator to study the design and
Implementation of the demonstration. The Hospital agrees to cooperate with the independent
evaluation contractor by providing requested data to asBBS8 the Impact of the Demonstration and
by allowing for site visits.
Withdrawal; If the Hospital decides to withdraw from the demonstration and terminate this
agreement prior to the end of the demonstration period, it must notify CMS 69 calendar days
before the planned day of withdrawal and termination of this agreement.
Termination) CMS may suspend or terminate this Demonstration in whole or in part at any
time before the date of expiration, CMS will promptly notify the hospitai in writing of the
determination and the reasons for the suspension or termination, and provide the effective date of
termination.
OhnuttVAlterlattro DitillIge Roplutiopt This agreement is subject to the Contract Disputes
Act of 1978, as amended (41 U.S.C. 601..613). Failure of the parties to reach agreement on any
request for equitable adjustment, claim, appeal or action arising under or relating to this
agreement shall be a dispute to be resolved in accordance with the clause at 48 C.F.R. 5.233-1,
Disputes, which is hereby incorporated into this agreement by reference. The Hospital shall
proceed diligently with performance of this agreement, pending final resolution of any dispute
arising under the agreement.
Prior to submitting a claim pursuant to the Contract Disputes Act, the Hospital may request
review by CMS. Request for review should be submitted to the Director of the Center for
Medicare & Medicaid Innovation in writing within 69 days. Upon formal notification of the
final decision of the CMM1 Director, the Hospital will have 30 days to submit its written appeal
to the CMS Administrator, alter which the CMS Administrator will have 60 days to respond.
Nothing in this provision is intended to waive the Hospitals responsibility to comply with the
time limitations in 411 CAR, 52.233-1, Disputes (incorporated by reference) or the Contract
Disputes Act.
United States law will apply to resolve any claim of breach of this agreement,
Changes: Changes in the terms and conditions of this agreement may be made only by written
agreement of the parties.
OrAEL,91121_00 .ece ire. Any inconsistency in this agreement shall be resolved by giving
precedence in the following order:
(a) This Demonstration Agreement

Page 5— Demonstration Agreement
(b) The Hospital's Application
Ihnikruntcvt in the event the Hospital enters into prooettlings relating to bankruptcy, whether
voluntary or involuntary, the Hospital agrees to furnish, by certified mail or electronic commerce
method authorized by the contract, written notification of the bankruptcy to CMS/AMMI. This
notification shall be furnished within 5 days of the initiation of the proceedings relating to
bankruptcy filing. 'Ibis notification shall include the date on which the bankruptcy petition was
filed, the identity of the court in which the bankruptcy petition was filed, and a listing of
Government contract numbers and contracting offices fbr all Government contracts against
which final payment has not been made. This obligation remains in effect until final payment
under this contract.
Alanainad-LbsugutthibnAgrskinnit A representative of the Hospital who GM legally
sign contracts and bind the organization shall sign this agreement below, indicating acceptance
of all provisions contained within this Demonstration Agreement,
MDR. CMS
By: g. 17.( a
Linda M Magni:), Director
Medicare Demonstrations Group
Center for Medicare & Medicaid Innovation
)
By: cr-) 9
[Print Name and Title] 70 Date

Exhibit B
(Agreement between Site and School of Nursing)

Clinical Education Agreement
between
MARICOPA COUNTY
and
Arizona Board of Regents for and behalf of Northern Arizona University,
College of Health and Human Services
Clt,.%3DO7 34)0
The Agreement shall be effective as of 09/01/2013. The parties to this Agreement are
Northern Arizona University with an address of Flagstaff, AZ ("School") and MARICOPA
COUNTY, a political subdivision of the State of Arizona, administered by its
CORRECTIONAL HEALTH SERVICES, with an address of 234 N. Central Ave, Ste 5000,
Phoenix, AZ 85004 ("Clinical Facility")
WHEREAS, School is desirous to provide and design specific clinical experiences with
the assistance of the Clinical Facility (the "Program") for the School's students ("Students") as
part of their overall education; and
WHEREAS, Clinical Facility is desirous of providing clinical training to School's
Students; and
WHEREAS, Clinical Facility is a health care facility which has the resources in
equipment and staff to provide the clinical experiences required by the Program; and
WHEREAS, it is to the benefit of both School and Clinical Facility to cooperate in the
educational preparation of Students, so as to promote excellence in patient care, to ensure
professional competence, and to provide maximum utilization of community resources.
NOW, THEREFORE, IT IS MUTUALLY AGREED that School will place its
students in the Clinical Facility according to the following terms and conditions.
I. Education Program.
1.1 School shall be fully responsible for organizing, establishing and
administering the academic education program.
1.2 The number of Students accepted into the Program and the dates of each
Student's Program experience shall be arranged by mutual agreement between
Clinical Facility and School. All Students shall be subject to Clinical Facility's
standards of admission. In the event it becomes necessary to cancel a reserved
space or change a student assignment, School will immediately notify Clinical
Facility.
1.3 School agrees to designate for participation in the Program only Students
who have completed the necessary training, appropriate prerequisites and didactic
work for the Program, and are in good standing with their respective institutions.
1/15/2013

1.4 School shall advise all Students that they are required to have passed a
physical examination, have all required immunizations including a hepatitis B
series, and, when appropriate for specific rotation, have completed background
studies and drug screening. The Student is responsible for costs for all pre-
rotation screenings (including criminal background reports and drug tests).
School shall also provide Clinical Facility with documentation establishing that
each Student has undergone the appropriate pre-screening and a background
study, and is eligible to have direct contact with hospital patients. School shall
maintain all personnel and academic records relating to Students.
1.5 Clinical Facility agrees:
1.5.1 To provide direct supervision of Students by qualified clinicians
(e.g , psychiatrists, physicians, and psychologists) who are on staff at the
Clinical Facility ("Supervising Clinicians");
1.5.2 That all notes or charting concerning a patient's treatment or
progress; if written by a Student, will be signed by the Student and
countersigned by a Supervising Clinician; and
1.5.3 To complete written evaluations on each Student on forms provided
by School.
1.6 Clinical Facility assumes full responsibility for the care of its patients. It
is understood that School does not derive direct revenue from patient care
activity at Clinical Facility.
2. School's Responsibilities.
2.1 School shall not assign to a Supervising Clinician more than three
Students at any one time during the Program experience.
2.2 School shall notify the Clinical Facility in writing at least thirty days in
advance of its proposed schedule of clinical assignments, and such schedule is
subject to the advance written approval of the Clinical Facility.
2.3 School shall require all Students and any other personnel furnished by
School to comply with all applicable rules, regulations, policies, and procedures
of the Clinical Facility and to maintain the confidentiality of patient information
in accordance with applicable law, as well as the confidentiality of records and
business operations of the Clinical Facility.
2.4 School, after consultation and remediation efforts with Clinical Facility,
shall promptly terminate the assignment of any Student or other employee of the
School for violation of any rule, regulation, policy, or procedure of the Clinical
Facility, breach of confidentiality, or other misconduct.
insnw
2

3. Clinical Facility's Responsibilities.
3.1 Supervising Clinicians will provide instruction and supervision of
Students assigned to the Program, in accordance with Exhibit A and in
accordance with guidelines agreed upon by Clinical Facility and School.
3.2 Clinical Facility will provide a suitable environment for each Student's
clinical experience.
3.3 Clinical Facility shall maintain workers compensation insurance or
funded self-insurance for its employees.
3.4 At all times during the term of this Agreement and any renewal or
extension hereof, Clinical Facility shall, at its own expense, comply with
applicable State and Federal laws and regulations including but not limited to
OSHA standards pertaining to Occupational Exposure to Bloodbome Pathogens
with respect to the School's employees, agents and Student(s) while at the
Clinical Facilities.
33 Clinical Facility shall not disclose any records concerning any Student to
any third party except as required by law or authorized in writing by such Student.
3.6 As an independent contractor of School, Clinical Facility shall, in
accordance with 42 U.S.C. §1395(v)(1)(I) and 42. C.F.R. Part 420, Subpart D
§420.300 et seq., until the expiration of four (4) years after the furnishing of
Medicare reimbursable services pursuant to this Agreement, upon proper written
request, allow the Comptroller General of the United States, the Secretary of
Health and Human Services, and their duly authorized representatives access to
this Agreement and to Clinical Facility's books, documents, and records
necessary to certify the nature and extent of costs of Medicare reimbursable
services provided under this Agreement. None of the duties of Supervising
Clinicians shall be carried out through a subcontract with any other person or
organization.
4. The Parties' Mutual Responsibilities.
4 1 Neither party shall publicize or otherwise disclose the nature or terms of
this Agreement in any manner except as approved in writing by the other party or
required by applicable law.
4.2 Neither School nor Clinical Facility will unlawfully discriminate against
any Student, employee, or patient in the performance of this Agreement.
4.3 School and Clinical Facility shall each designate a coordinator who shall
be reasonably available for consultation with the other respective coordinator
concerning each Student's qualifications, clinical experience performance, and the
curriculum of the clinical experience program.
1/15/2013
3

4.4 At all times during the term of this Agreement, all services shall be
performed in accordance with all applicable standards established by law or
ordinance, or established by the rules and regulations of any federal, state, or local
agency, department, commission, association, or other pertinent governing,
accrediting, or advisory body having the authority to set standards for offices
maintained by health care providers.
4.5 This section intentionally removed due to Arizona Statute §35-154. See
Exhibit A, Indemnification Language far Agreements.
4.6 School shall give at least ten (10) days advance written notice of any
cancellation, non-renewal, or change in limits of the coverage.
4.7 School shall maintain workers' compensation and commercial general
liability insurance or funded self-insurance for its employees.
4.8 School shall be responsible for planning the educational curriculum and
shall maintain appropriate records and reports on each Student's clinical
experience.
4.9 Both parties agree to cooperate with each other and share information in
the event that any investigation is conducted with respect to a Student's
experience or performance at Clinical Facility. Students may be asked to sign a
form granting School. and Clinical Facility permission to share information
relevant to his or her experience or performance.
5. Health Insurance Portability and Accountability Act. Students shall be
instructed by School before beginning the Program concerning the confidentiality of medical
information of Clinical Facility's patients and standard precautions. For purposes of compliance
with the Health Insurance Portability and Accountability Act and associated privacy regulations
("IIIPAA"), Students shall be considered part of Clinical Facility's work force as that term is
defined in H1PAA. to include trainees and students. Students are not considered work force or
employees of Clinical Facility for other purposes, including by and not limited to tax or
employment law. Clinical Facility shall provide the necessary training specific to H1PAA.
6. Policies and Procedure Goyernin2 Students. Students shall be subject to and
follow all Clinical Facility's rules, regulations, policies and procedures, including standard
precautions. Students enrolled in the Program will also be governed in accordance with the
policies and procedures established through School.
7 Termination of Student Experience, Clinical Facility may terminate the
participation of a Student in the Program if the Student's work, conduct or health may, in
Clinical Facility's judgment, have detrimental effect on its patients, staff, or operations. A
Student generally will not be removed from the Program until Clinical Facility has discussed its
concerns with a representative of the School. However, Clinical Facility reserves the right to
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4

take immediate action to suspend a Student's participation in response to concerns of patient care
or the safety and respect of its staff. Clinical Facility shall not be arbitrary or discriminatory in
the exercise of this right.
8. Student Health Insurance and Emerzency Medical Care. Students shall
maintain health insurance throughout the entire term of their participation in the Program.
Students shall be furnished emergency medical care and treatment, if needed, while on duty at
Clinical Facility with the associated expense to be the responsibility of the Student, unless such
medical care or treatment is due to Clinical Facility's intentional acts or omissions.
9. Insurance.
School will provide and maintain insurance as described below:
9.1 Commercial general liability insurance (or completed coverage
under a program of self-insurance) providing coverage on claims
made for occurrences during the term of this Agreement with
limits no less than $2,000,000 per occurrence and $4,000,000
aggregate.
9.2 Professional liability insurance (or comparable coverage under a
program of self-insurance) providing coverage on an "occurrence
basis" for occurrences during the term of this Agreement with
limits no less than $1,000,000 per occurrence and $3,000,000
annual aggregate.
9.3 The insurance required in Section 9.1 above shall be in full force and
effect prior to the arrival of Students at Clinical Facility. The insurance
provider shall endeavor to provide thirty (30) calendar days prior written
notice to Clinical Facility of any modification or termination of insurance.
In the event any "claims made" policy is procured to meet the insurance
requirements hereunder, "tail" coverage shall also be procured for a period
of two (2) years after termination of such policy. To the extent permitted
by School's insurance provider, the general liability insurance shall name
as additional insured, Maricopa County, its directors, subsidiaries,
officers, employees, assigns, agents and board members.
All insurance required herein shall be maintained in full force and effect.
Failure to do so may, at the sole discretion of Clinical Facility, constitute a
material breach of this Agreement.
9.4 School shall provide Clinical Facility with Certificate of Insurance
evidencing the above-stated coverage.
9.5 Clinical Facility shall provide and maintain comprehensive professional
and general liability insurance of not less than $1,000,000 per occurrence
1/15/2013
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and $3,000,000 in the aggregate as well as excess liability insurance of not
less than $1,000,000. A certificate of insurance evidencing such insurance
coverage shall be provided to the School. To the extent permitted by
Clinical Facility's insurance provider, the general liability insurance shall
name as additional insured, Education Management Corporation, its
schools, directors, subsidiaries, officers, employees, assigns, agents and
board members.
10. Independent Contractors. Each party is a separate and independent institution,
and this Agreement shall not be deemed to create a relationship of agency, employment, or
partnership between or among them. Each party understands and agrees that this Agreement
establishes a bona fide training relationship and that the agents, Students, or employees of each
respective party are not employees of agents of the other party.
11. Term. This Agreement shall be effective as of 09/01/2013 and is automatically
renewed for subsequent one year terms for a total of five (5) years, unless terminated as
described in paragraph 12 below.
12. Termination.
12.1 Either party may terminate this Agreement for any reason by giving at
least ninety (90) days written notice to the other party.
12.3 In the event that is Agreement is terminated pursuant to this paragraph, the
parties hereby agree that no Students participating in an ongoing clinical
experience will be denied the opportunity to complete the affiliation, even
when the effective date of termination occurs prior to the completion date
of the clinical experience. In such event, all applicable provisions of this
Agreement, including the right to terminate any Student, pursuant to
Section 7, shall remain in force during the extension period from the
effective date of termination, until the end of the academic term in which
the Student is enrolled.
13. Amendments. This Agreement may be amended from time to time by written
agreement of the parties.
14. Notices. 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
to
1/1512013
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For Program With Copy to: For Clinical Facility:
College of Health & Human If applicable Maricopa County Correctional
Services Health Services
Office of the Dean 234 N Central Ave., Ste. 5000
P.0. Box 15015 Phoenix, AZ 85004
Flagstaff, AZ 86011 Attn: Finance Manager
Phone: (928) 523-4331
15. Use of Names No party shall use the name, logo, or likeness of another party, or
another party's employee or agent in any publicity or advertising material without such other
party's express prior written consent; however, the existence and scope of the Program may be
made know to Students as a means of assistance in completing their training requirements.
16. Assignment. Neither party shall assign all nor part of this Agreement without
the prior written consent of the other party which consent shall not be unreasonably withheld,
provided, however, that this Agreement may be assigned by either party without consent of the
other to an affiliate or to any third party who succeeds to substantially all of its businesses or
assets. In the event of a valid assignment, this Agreement will insure to the benefit of and be
binding upon each party and its respective successors and permitted assigns.
17. Governing Law. This Agreement shall be construed in accordance with the law
of the State of Arizona.
18. Excluded Individual. Each party shall immediately notify the other party in the
event that it becomes an excluded individual from any federal health care program,
19. Enforceability and Waiver. The invalidity or unenforceability of any term or
provision of this Agreement shall in no way affect the validity or enforceability of any other term
or provision. The waiver by a party of a breach of any provision of this Agreement shall not
operate as or be construed as a waiver of any subsequent breach thereof.
20. Non-exclusive Agreement. Each party may enter into similar agreements with
other training institutions, provided that such agreements do not materially interfere with the
ability of each party to carry out its obligations hereunder.
21_ Compliance with Laws. Each party shall comply with all applicable laws,
ordinances, Executive Orders, rules, regulations, standards, and codes of the Federal and State
whether or not specifically referenced herein. Specifically the following apply:
Unless exempted under Federal law, the parties shall not discriminate against any
employee or applicant for employment because of race, age, disability, color, religion, sex or
national origin. The parties shall, to the extent such provisions apply, coimply with Title VI and
VII of the Federal Civil Rights Act; the Federal Rehabilitation Act; the Age Discrimination in
Employment Act; American With Disabilities Act.
1/15/2013
7

22. E-Verification of Employees. School warrants that it's Phoenix Campus is in
compliance with A.R.S. § 41-4401 and further acknowledges that it and its subcontractors, 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, subsection A. School further
acknowledges that a breach of such warranty shall be deemed a material breach of the
Agreement that is subject to penalties up to and including termination of the Agreement.
Further, Clinical Facility retains the legal right to inspect the papers of any contractor or
subcontractor employee who works on the Agreement to ensure that the contractor or
subcontractor is complying with the warranty provided above and that the contractor agrees to
make all papers and employment records of said employee(s) available during normal working
hours in order to facilitate such an inspection.
Nothing herein shall make any contractor or subcontractor an agent or employee of the
contracting government entity.
23. Business in Sudan or Iran. Under A.R.S. §§ 35-391.06 and -393.06, the School
certifies that it does not have scrutinized business operations in either Sudan or Iran.
24. Entire Agreement. This Agreement represents the entire agreement between the
parties with respect to the subject matter hereof, and supersedes all prior agreements and
representations.
25. Authority. The person signing this Agreement warrant that they have full
authority to do so and that their signatures shall bind the parties for which they sign.
—Signatures on following page-
-Remainder left blank intentionally-'-
1/15/2013
S

IN WITNESS WHEREOF, the parties have executed this Agreement as of the respective
dates written below.
Arizona Board of Regents for and on MARICOPA CHAIRMAN OF THE
behalf of Northern Arizona University COUNTY B 0 SUPERVISORS
,
By: vt, /2-k: By:
Name: Laura Huenneke Name: ANDREW KUNASEK
Title: Provost Title: CHAIRMAN BOARD OF SUPERVISORS
Date: i 7 2.0 Date: JAN 3 I 21)13
MARICOPA CLERK OF THE COUNTY
BOARD OF SUPERVISORS
By: By: (.;" 44 14-1---
Name: Name: Ctt.)-c-f ,OCE
Title: Title: V) ---.-Dtt-\-14 C Exx
Date: Date: JAN 31 2013
oroqi3
MARICOPA, COUNTY RISK MANGEMENT
By:
Name:
Title: 64 -0
Date:
ATTORNEY FOR BOARD OF SUPERVISORS
By:
Name: --tsa‘ki it.r; K
Title:
Date:
1/15/2013
9

Exhibit A
indemnification Langua.ge in Agreements
With
The Arizona Board of Regents
For and on Behalf of
Northern Ari7ona University
Northern Arizona University is an institution of higher
edueation, supported by the State of Arizona and govenaod by the
Arizona Board of Regents. University counsel has advised that any
language in an agreement that conarnits the Arizona noard of Regents
to indemnify, hold harmless, or in any way assume a potential
unspecified liability of the contracting party must be stricken. This is
speci .fically prohibited by Arizona Revised Statutes §35-154. This
position is also nupported by Attorney General's Opinion 67-36-L.
The AZ Department of Administration, Risk Management
Section, Insures the University. The State's self-insurance program,
in accordance with Arizona Revised Statutes *41-621 and 622,
provides liability and state-owned property coverage to all Arizona
State agencies, including the universities. AN such, Certificates of
Insurariee will be issued, upon request, for valid -contract's. The
followins language is acceptable and preferred by the 'University:
University shall maintain adequate insurance (through the
State's Risk IVIanagernent Division. which is a self-insurance
program) to cover any liability arasingfrom the ac-is and Oilli.NSi071.7 of
University's agent_g and employees arising out of the performance of
this Agreement. University shall not be responsible for maintaining
insurance coverage for liability arising from the acts and omissions 0)
F'acilities' ernpMyeat or agents.
_Facility shall maintain adequate insurance to cover any
liability arising from the acts and omissions ofFacilittes ' agents and
employees arising out of the performanee of this Agreement. Facility
shall not be responsible for maintaining insurance coverage,for
liability arising from the acts and 07711S,SiOltS of employees of the
University.
1/15/2013
l 0

Exhibit C
Invoice
(Attachment)

INVOICE
Maricopa County Correctional Health Services Date:
3250 West Lower Buckeye Road Invoice
Phoenix, AZ 85009 Tax ID #
Phone Number:
Fax Number:
Bill To:
Scottsdale Healthcare Hospitals
Administration Office
GNE Demonstration Project
c/o: Cathy Collette
9003 E. Shea Blvd.
Scottsdale, Arizona 85260
ROTATION ROTATION NUMBER NUMBER
NAME OF STUDENT SGIOCIL OF NURSING START DATE END DATE OF DAYS OF
00(6000000 000000300 HOURS
TOTAL HOURS:
COMMENTS:
Make all checks payable to:
If you have any question about this invoice, please contact:
Cathy Collette at groduatenursincieducation0shcoro
FOR OFFICE USE ONLY:
Fiscal Year:
Medicare Cost Year:
Quarter: