CTR051841 A3.pdf

INTERAGENCY SERVICE AGREEMENT (ISA)

AMENDMENT

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

AGREEMENT NO.:

CTR051841 AMENDMENT NO.: 3 Procurement Officer

Karla Varela

Helpers Program for Behavioral Health

Effective upon signature by both parties is mutually agreed that the Agreement referenced in this Amendment Three (3) is amended as follows:

1. Pursuant to the Uniform Terms and Conditions, Provision Twelve (12), Miscellaneous, Section 12.4, the Agreement is hereby amended as follows:

1.1. Scope of work has been revised and replaced as a result of the addition of the unobligated funds and their tasks and deliverables.

1.2. Price Sheet has been revised as a result of the addition of the unobligated funds; and

1.3. Exhibit C has been added.

ALL CHANGES ARE REFLECTED BELOW IN RED.

ALL OTHER PROVISIONS SHALL REMAIN IN THEIR ENTIRETY

Contractor hereby acknowledges receipt and acceptance of above amendment and that a signed copy must be filed with the Procurement Office before the effective date

The above referenced Agreement Amendment is hereby executed this _____ day of __________ 20______ at Phoenix, Arizona

(To be filled out by ADHS Procurement Office)

Contractor Signature

Contractor Signature Date

Authorized Signatory’s Name and Title

Arizona Board of Regents, University of Arizona

Contractor’s Name Procurement Officer Signature

Christopher Balderrama

Digitally signed by Christopher Balderrama Date: 2021.12.22 14:07:22 -07'00'

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

AGREEMENT NO.:

CTR051841 AMENDMENT NO.: 3 Procurement Officer

Karla Varela

SCOPE OF SERVICES

1. Background

1.1. Commercial tobacco use is the most preventable cause of death in the United States, contributing to approximately more than 480,000 deaths annually. State and local tobacco control programs are designed ultimately to help reduce disease, disability, and death related to commercial tobacco use.

1.2. The mission of the Arizona Department of Health Services, Bureau of Chronic Disease and Health

Promotion (ADHS BCDHP), Office of Tobacco is to work with partners to build individual, organizational and community capacities to reduce the impact of commercial tobacco use.

1.3. Persons with serious mental illness or (SMI) or substance use disorder (SUD) have a life expectancy that is twenty-five (25) years shorter than the general population. In Arizona, that disparity in early mortality is even greater – thirty-two (32) years. An important cause of premature mortality is smoking-related chronic diseases such as; chronic obstructive pulmonary disease (COPD), cardiovascular disease, diabetes, and metabolic syndrome.

1.4. In the state of Arizona, about fourteen percent (14%) of the adult population are current smokers, compared to sixteen percent (16%) nationally. This rate is believed to be double for persons with SMI or SUD. Despite the lack of exact figures on smoking in the behavioral health (BH) population in Arizona as a whole, the Arizona Smokers Helpline (ASHLine) reported in 2018, thirty-seven percent (37%) of its clients self-reported having a chronic behavioral health condition.

2. Objective

2.1. The ADHS BCDHP, Office of Tobacco will Contract with The University of Arizona College of Medicine, Department of Family and Community Medicine to implement the Helpers Program for Behavioral Health (Helpers BH), a clinic system intervention designed to shift the cultural milieu of the BH clinic to proactively support tobacco cessation among BH clients. Helpers BH addresses:

2.1.1. Systemic and cultural barriers to tobacco cessation in Behavioral Health,

2.1.2. Motivational approaches to encourage tobacco cessation, and

2.1.3. Modifying the clinical environment to encourage quitting.

2.2. Helpers BH consists of:

2.2.1. Assessment of clinical environmental factors (facility, policies) related to tobacco cessation,

2.2.2. A Helpers BH training that prepares clinic staff to offer brief interventions to support cessation and incorporate cessation into workflow as a billable service,

2.2.3. Guidance on offering a tobacco cessation group,

2.2.4. Simple client educational handouts to promote cessation, and

2.2.5. Assessment of clinic administrative data systems that can be used to monitor impact of Helpers

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

AGREEMENT NO.:

CTR051841 AMENDMENT NO.: 3 Procurement Officer

Karla Varela

BH on client service delivery and outcomes, and technical support to problem solve, maintain clinic staff and leadership engagement.

3. Tasks

The University shall:

3.1. Work with four (4) current behavioral health system partners including; Southeastern Arizona

Behavioral Health Services-La Frontera (SEABHS-La Frontera), Community Organization for Drug Abuse Control (CODAC), La Frontera Arizona, and Marana Health Center (MHC) to:

3.1.1. Update Helpers BH based on feedback from recently completed pilot and implementation sites,

3.1.2. Develop a plan to identify, train, and provide ongoing professional development and technical support, to partner agency staff to serve as site champions,

3.1.3. Expand the Helpers BH program to at least one (1) additional behavioral health clinic site that serves rural, border populations disproportionately impacted by tobacco, and

3.1.4. Evaluate the facilitators and barriers to implementation and larger scaling in other behavioral health systems.

3.2. Identify one (1) – two (2) new counties interested in addressing tobacco use in behavioral health populations and/or other tobacco control priority populations to:

3.2.1. Work with county and local project officers to identify local behavioral health system and/or other community partners, and

3.2.2. Identify and prepare for readiness for implementing Helpers BH in at least two (2) other behavioral health clinics for subsequent grant years.

3.3. Increase the percentage of BH members within participating clinics who receive tobacco cessation-related services, tobacco cessation referrals (e.g. to ASHLine), or cessation medications; and

3.4. Collaborate with BH agencies and payers to identify metrics and sustainable data systems to monitor and assess impact of Helpers BH implementation in increasing delivery of tobacco cessation-related services, including offering of cessation pharmacotherapy.

3.5. From November 1st 2021 to April 28th 2022, the Helpers Program for Behavioral Health (HPBH) will use unobligated funds to:

3.5.1. Increase its reach into an additional two (2) counties in Arizona. Onboard additional behavioral health and Federally Qualified Health Center agencies into the project. Onboarding involves identification of potential agencies, obtaining their commitment, identify participating sites, and obtaining contact information for site supervisors and potential Champions. Program will focus on Behavioral Health and FQHC agencies in Mohave and Santa Cruz counties, along with an additional behavioral health and FQHC agencies in Pima County,

3.5.2. Integrate ASHLine services and referrals into half of the participating sites via the following:

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

AGREEMENT NO.:

CTR051841 AMENDMENT NO.: 3 Procurement Officer

Karla Varela

3.5.2.1. Arrange training on setting up as a referral site and how to make referrals. Helpers will arrange for ASHLine trainers to complete the scheduling and training process with sites. ASHLine will present their own training on how to set up referral site status and make referrals, and

3.5.2.2. Send quarterly reports back to agencies and sites regarding referrals made and utilization of ASHLine services by behavioral health members.

3.5.3. Provide all participating agencies access to existing continuing education webinar series around behavioral health, tobacco use, and connections to COVID-19,

3.5.4. Provide monthly reports to ADHS Program manager detailing activities completed, and

3.5.5. Provide a final project outcome report by May 28th, 2022. The report should include a summary of activities completed, successes, challenges and next steps.

4. Deliverables

The University shall:

4.1. Submit a Contractor Expenditure Report (CER), (see Exhibit A) due fifteen (15) days after month end.

An electronic version will be made available upon request to ADHS BCDHP, Office of Tobacco;

4.2. Develop and submit an Annual Action Plan using standardized processes to include the following items:

4.2.1. Baseline clinic program activity reports,

4.2.2. Quarterly clinic program activity reports,

4.2.3. Evaluation plan, and

4.2.4. Site work plans.

4.3. Develop and submit Quarterly reports. Quarterly reports in Year One (1) will be submitted to ADHS on January 29, 2021 and April 29, 2021. Quarterly reports in subsequent program years will be due thirty

(30) days after the end of each quarter; and

4.4. Develop and submit Evaluation reports including program highlights, successes, challenges, and barriers; Due July 31st of each year, beginning July 31, 2021.

4.5. Unobligated Funds Deliverables

4.2.5. Recruit and engage partners for participation in Year 3; include lists of agencies, sites, and contacts. Will focus on behavioral health and FQHC agencies in Mohave and Santa Cruz counties, along with an additional behavioral health and FQHC agency in Pima County,

4.2.6. Integrate ASHLine services and referrals into participating agencies and sites (for those that agree); provide trainings on setting up as a referral site and how to make referrals. Send reports back to the agency and sites regarding referrals made and utilization of ASHLine services by

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

AGREEMENT NO.:

CTR051841 AMENDMENT NO.: 3 Procurement Officer

Karla Varela behavioral health members, and

4.2.7. Coordinate availability and presentation of webinars to agencies and sites; topics to include tobacco & COVID, along with information of interest specific to site type.

5. Requirements

The University shall meet all of the following requirements:

5.1 Revisions to strategies, evaluation plan, goals, objectives, and timelines shall require approval from the ADHS BCDHP, Office of Tobacco, Office Chief; and

5.2 Staffing changes shall be reported to the ADHS BCDHP, Office of Tobacco within five (5) business days.

6. Notices, Correspondence, Reports and Invoices

6.1. Notices, Correspondence, Reports and Invoices from the University to ADHS shall be sent to:

Arizona Department of Health Services Bureau of Chronic Disease and Health Promotions Attn: Emily Carlson, Office Chief, Tobacco Prevention and Cessation 150 N. 18th Avenue, Suite 310 Phoenix, AZ 85007

6.2. Notices, Correspondence, and Reports from ADHS to the University shall be sent to:

Andy Bernstein, PhD, CPRP Principal Investigator/Program Director Core Faculty, Family Medicine Residency at South Campus Tel: 520-396-4956 Email: andybernstein@arizona.edu

Valerie Koellisch, Manager, Grants and Contracts Department of Family and Community Medicine The University of Arizona College of Medicine Office:

Tel: 520- 626-7823 Fax: 520.626.3976 Email: vkoellisch@arizona.edu

6.3. Payments from ADHS to the University shall be sent to:

University of Arizona Sponsored Projects & Contracting Services P.O. Box 41867 Tucson, AZ 85717

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

AGREEMENT NO.:

CTR051841 AMENDMENT NO.: 3 Procurement Officer

Karla Varela

PRICE SHEET

Year Two (2) 04/29/2021 - 04/28/2022

Contract Expenses Cost

1. Personnel/ERE $173,597

2. Professional & Outside Services $0

3. Travel Expenses $1,000

4. Supplies $25,953

5. Other Operating $0

6. Indirect $19,450

Total (Not to Exceed) $220,000

HPBH Unobligated Funds 11/1/2021 - 04/28/2022

Contract Expenses Cost

1. Personnel/ERE $45,500

2. Professional & Outside Services $0

3. Travel Expenses $0

4. Supplies $0

5. Other Operating $0

6. Indirect $4,500

Total (Not to Exceed) $50,000

Personnel/ERE includes: Funding for FTE increases for project staff; 0.20 to 0.25 FTE for Project Director,

0.5 to 1.0 FTE for Project Coordinator, and 0.5 to 1.0 FTE for a Clinical Research Coordinator to be hired.

The Contractor is authorized to transfer up to a maximum of ten percent (10%) of the total Agreement amount among the categorical line items. Transfers of funds are only allowed among funded line items as detailed in the original ISA. Transfers exceeding ten percent (10%) of the contracted amount, or to non-funded line items, shall require an Agreement Amendment.

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

AGREEMENT NO.:

CTR051841 AMENDMENT NO.: 3 Procurement Officer

Karla Varela

EXHIBIT B

Exhibit - 2 CFR 200.332 § 200.332 Requirements for pass-through entities.

All pass-through entities must:

(a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass-through entity must provide the best information available to describe the Federal award and subaward.

Prime Awardee: Arizona Department of Health Services

DUNS # 804745420

Federal Award Identification (Grant Number): 5 NU58DP006816-02-00

Subrecipient name (which must match the name associated with its unique entity identifier): Arizona Board of Regents, University of Arizona

Subrecipient's unique entity identifier (DUNS #): 80-634-5617

Federal Award Identification Number (FAIN, sometimes it’s the same as the Grant Number): NU58DP006816

Federal Award Date (see the definition of Federal award date in § 200.1 of this part) of award to the recipient by the Federal agency; 06/21/2020

Subaward Period of Performance Start and End Date; 06/29/2020 - 04/28/2025

Subaward Budget Period Start and End Date: 04/29/2021 - 04/28/2022

Amount of Federal Funds Obligated by this action by the pass-through entity to the subrecipient (this is normally the contract amount): $ 220,000.00

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

AGREEMENT NO.:

CTR051841 AMENDMENT NO.: 3 Procurement Officer

Karla Varela

Total Amount of Federal Funds Obligated to the subrecipient by the pass-through entity including the current financial obligation (how much is available for contracts): $1,708,792.00

Total Amount of the Federal Award committed to the subrecipient by the pass-through entity

Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act (FFATA) National and State Tobacco Control Program

Name of Federal awarding agency, pass-through entity, and contact information for awarding official of the Pass-through entity Centers for Disease Control and Prevention

Assistance Listings number and Title; the pass-through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement: 93.387

Identification of whether the award is R&D No

Indirect cost rate for the Federal award (including if the de minimis rate is charged) per § 200.414 26.70%

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

AGREEMENT NO.:

CTR051841 AMENDMENT NO.: 3 Procurement Officer

Karla Varela

EXHIBIT C

Exhibit - 2 CFR 200.332 § 200.332 Requirements for pass-through entities.

All pass-through entities must:

(a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass-through entity must provide the best information available to describe the Federal award and subaward.

Prime Awardee: Arizona Department of Health Services

DUNS # 804745420

Federal Award Identification (Grant Number): 5 NU58DP006816-02-00

Subrecipient name (which must match the name associated with its unique entity identifier): Arizona Board of Regents, University of Arizona

Subrecipient's unique entity identifier (DUNS #): 80-634-5617

Federal Award Identification Number (FAIN, sometimes it’s the same as the Grant Number): NU58DP006816

Federal Award Date (see the definition of Federal award date in § 200.1 of this part) of award to the recipient by the Federal agency; 06/21/2020

Subaward Period of Performance Start and End Date; 06/29/2020 - 04/28/2025

Subaward Budget Period Start and End Date: 11/01/2021 - 04/28/2022

Amount of Federal Funds Obligated by this action by the pass-through entity to the subrecipient (this is normally the contract amount): $ 50,000.00

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

AGREEMENT NO.:

CTR051841 AMENDMENT NO.: 3 Procurement Officer

Karla Varela

Total Amount of Federal Funds Obligated to the subrecipient by the pass-through entity including the current financial obligation (how much is available for contracts): $1,708,792.00

Total Amount of the Federal Award committed to the subrecipient by the pass-through entity

Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act (FFATA) National and State Tobacco Control Program

Name of Federal awarding agency, pass-through entity, and contact information for awarding official of the Pass-through entity Centers for Disease Control and Prevention

Assistance Listings number and Title; the pass-through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement: 93.387

Identification of whether the award is R&D No

Indirect cost rate for the Federal award (including if the de minimis rate is charged) per § 200.414 26.70%