AMENDMENT #3.PDF

-/;!\HCCCS 
• 
Arizona Health Care Cost Containment System 
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 
1. AMENDMENT#: 
2. CONTRACT#: 
3. EFFECTIVE DATE OF AMENDMENT:
4. PROGRAM:
YH16-0018-07 
3 
C-26-19-002-3-02
OCTOBER 1, 2021 
5. CONTRACTOR/PROVIDER NAME AND ADDRESS:
Maricopa County 
c/o Correctional Health Services 
234 N. Central, Fifth Floor, Suite 5000 
Phoenix, AZ 85004 
6. PURPOSE: To revise rates and to revise the terms of this agreement.
1.
THE ABOVE REFERENCED CONTRACT IS HEREBY AMENDED AS FOLLOWS:
DFSM/DMPS 
A. Change rates from Attachment A (SFY21) to the rates as shown in Attachment A (SFY22).
B. Change Quarterly Estimate of State Match Advance Payments from Attachment B (SFY21) to the
Estimates listed in Attachment B (SFY 22).
EXCEPT AS PROVIDED FOR HEREIN, All TERMS AND CONDITIONS OF THE ORIGINAL CONTRACT NOT 
HERETOFORE CHANGED AND/OR AMENDED REMAIN UNCHANGED AND IN FULL EFFECT. 
Electronic Submission: An electronic or portable document file (PDF) copy of this amendment shall serve as the original 
IN WITNESS THEREOF, the parties have executed this Agreement: 
COUNTY: Maricopa 
Signature: ____________ _ 
Printed Name: Jack Sellers
Title: Chairman, Maricopa County Board of 
Supervisors 
Date: _____________ _ 
Arizona Health Care Cost Containment 
System (AHCCCS}: 
Ji/ 
Signature: r,1cu,iit,i,ottc 1Nov8. 2021 IJ;,f! tASTI 
Printed Name: Meggan LaPorte, CPPO, MSW 
Title: Chief Procurement Officer 
Date: __ N_ov_s_,_20_ 2_1 ________ _ 
Page 1 of 4

In accordance with A.R.S. § 11-952, this Agreement 
has been reviewed by the undersigned who has 
determined that this Agreement is in the 
appropriate form and is within the power and 
authority granted to COUNTY. 
COUNTY Attorney 
ATTEST: 
Signature: ____________________________  
Printed Name: Juanita Garza - Interim Clerk of the Board 
Date 
In 
accordance 
with 
A.R.S. § 11-952, 
this 
Agreement is in the proper form and is within the 
power and authority granted to AHCCCS under 
A.R.S. §§ 36-2,903 et seq. and 36-2932 et seq. 
Gregig (Nov 02109:43 MST) 
Legal Counsel for AHCCCS 
Page 2 of 4 
Wayne J. Peck
11/9/2021