CTR051841 A6.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.: 6

Procurement Officer

Brandon Durick

HELPERS PROGRAM FOR BEHAVIORAL HEALTH

Effective upon signature of both parties, it is mutually agreed that the Agreement referenced in this Amendment Six (6) amended as follows:

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

1.1. The Scope of Services is revised and replaced.

1.2. The Price Sheet is revised and replaced.

1.3. The Exhibit B is revised and replaced.

ALL CHANGES ARE REFLECTED IN RED

ALL OTHER PROVISIONS SHALL REMAIN IN THEIR ENTIRETY

The University hereby acknowledges receipt and acceptance of the 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 __________ 2024 at Phoenix, Arizona.

(To be filled out by ADHS Procurement Office)

University Signature

University Signature Date

Authorized Signatory’s Name and Title

ARIZONA BOARD OF REGENTS,

UNIVERSITY OF ARIZONA

University’s Name Procurement Officer Signature

Elisha Johnson, JD Sr. Director, Clinical Trials & Contracting

5/1/2024

Jacqueline S.

Ortega-Avila

Digitally signed by Jacqueline S. Ortega-Avila Date: 2024.05.14 10:03:52 -07'00'

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR051841 AMENDMENT NO.: 6

Procurement Officer

Brandon Durick

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.

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.

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR051841 AMENDMENT NO.: 6

2.2.3. Guidance on offering a tobacco cessation group.

2.2.4. Simple client educational handouts to promote cessation.

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

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.

3.4. Work with the Arizona State Hospital and the Arizona Department of Corrections systems to explore possibilities for collaboration on HPBH clinical system intervention initiatives that could possibly include rollout the HPBH program with a minimum of (2-3) programs per agency and provide ongoing development, rollout, and technical support to agency and program staff.

3.5. Coordinate with National Jewish Health to provide to HPBH-participating agencies tracking information on referrals made from participating clinics and programs.

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR051841 AMENDMENT NO.: 6

3.6. 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.

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: baseline clinic program activity reports, quarterly clinic program activity reports, evaluation plan, and site work plans.

4.3. Develop and submit Quarterly reports. Quarterly reports in Year One (1) will be submitted to

ADHS on January 29th, 2021 and April 29th, 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.

4.6. Integration of ASHLine services and referrals into participating agencies and sites (for those that agree); trainings on setting up as a referral site and how to make referrals. Reports back to agency and sites regarding referrals made and utilization of ASHLine services by behavioral health members.

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 ADHS BCDHP, Office of Tobacco, Office Chief.

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

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR051841 AMENDMENT NO.: 6

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, Arizona 85007 Phone: 602.364.0214 Email: emily.carlson@azdhs.gov

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

University of Arizona College of Medicine Department of Family and Community Medicine Violet Perez Siwik, MD, Assistant Professor AHSC, Rm. 4320 Tucson, Arizona 85724-5052 Phone: (520) 694-1613 Email: vsiwik@arizona.edu

University of Arizona College of Medicine Office Department of Family and Community Medicine Valerie Koellisch, Manager, Grants and Contracts Phone: (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, Arizona 85717

6.4. Invoices shall be emailed to: Accounting+InteragencyTransfers@azdhs.gov.

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR051841 AMENDMENT NO.: 6

Procurement Officer

Brandon Durick

REVISED PRICE SHEET

Helpers Program for Behavioral Health April 29th, 2024 – April 28th, 2025

Agreement Expenses Cost

Personnel/ERE $188,557.00 Professional & Outside Services $24,943.00 Other Operating $7,000.00 **Indirect (10%) $24,500.00

TOTAL (NOT TO EXCEED) $245,000.00

**The University 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 agreement 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.: 6

Exhibit B - 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

UEI # QMWUG1AMY65

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; 6/29/2020 - 04/28/2025

Subaward Budget Period Start and End Date: 04/29/2024 - 04/28/2025

Amount of Federal Funds Obligated by this action by the pass-through entity to the subrecipient (this is normally the contract amount): $245,000.00

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR051841 AMENDMENT NO.: 6

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 1,413,252

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 10%

UNIVERSITY OF ARIZONA

Unique Entity ID

C3A1J66ML645

CAGE / NCAGE

1QVT2

Purpose of Registration

All Awards

Registration Status

Active Registration

Expiration Date

Mar 13, 2025

Physical Address

1401 East University Boulevard

Tucson, Arizona 85721-0001

United States

Mailing Address

888 N. Euclid AVE. Room 106

Tucson, Arizona 85721

United States

Business Information

Doing Business as

(blank)

Division Name

The University Of Arizona

Division Number

(blank)

Congressional District

Arizona 07

State / Country of Incorporation

(blank) / (blank)

URL

(blank)

Registration Dates

Activation Date

Mar 15, 2024

Submission Date

Mar 13, 2024

Initial Registration Date

Mar 20, 2002

Entity Dates

Entity Start Date

Feb 5, 1999

Fiscal Year End Close Date

Jan 01

Immediate Owner

CAGE

(blank)

Legal Business Name

(blank)

Highest Level Owner

CAGE

(blank)

Legal Business Name

(blank)

Executive Compensation

Registrants in the System for Award Management (SAM) respond to the Executive Compensation questions in accordance with Section 6202 of

P.L. 110-252, amending the Federal Funding Accountability and Transparency Act (P.L. 109-282). This information is not displayed in SAM. It is sent to USAspending.gov for display in association with an eligible award. Maintaining an active registration in SAM demonstrates the registrant responded to the questions.

Proceedings Questions

Registrants in the System for Award Management (SAM.gov) respond to proceedings questions in accordance with FAR 52.209-7, FAR 52.209-9, or 2. C.F.R. 200 Appendix XII. Their responses are displayed in the responsibility/qualification section of SAM.gov. Maintaining an active registration in SAM.gov demonstrates the registrant responded to the proceedings questions.

Exclusion Summary

Active Exclusions Records?

No

SAM Search Authorization

I authorize my entity's non-sensitive information to be displayed in SAM public search results:

Yes

Entity Types

Business Types

Entity Structure

U.S. Government Entity

Entity Type

US State Government

Organization Factors

(blank)

Profit Structure

(blank)

Last updated by Amorette Rivera on Mar 13, 2024 at 01:46 PM UNIVERSITY OF ARIZONA

May 16, 2024 09:48:15 PM GMT https://sam.gov/entity/C3A1J66ML645/coreData?status=null Page 1 of 2

Socio-Economic Types

Check the registrant's Reps & Certs, if present, under FAR 52.212-3 or FAR 52.219-1 to determine if the entity is an SBA-certified HUBZone small business concern. Additional small business information may be found in the SBA's Dynamic Small Business Search if the entity completed the

SBA supplemental pages during registration.

Government Types

U.S. State Government

Other Entity Qualifiers

Educational Institution

State Controlled Institution of Higher Learning

Financial Information

Accepts Credit Card Payments

Yes

Debt Subject To Offset

No

EFT Indicator

CAGE Code

1QVT2

Points of Contact

Electronic Business

Amorette Rivera 888 N. Euclid AVE. Room 106

Tucson, Arizona 85719

United States

Kirstin Gonzalez 888 N. Euclid AVE. Room 106

Tucson, Arizona 85719

United States

Government Business

Kirstin Gonzalez 888 N. Euclid AVE. Room 106

Tucson, Arizona 85719

United States

Kirstin Gonzalez 888 N. Euclid AVE. Room 106

Tucson, Arizona 85719

United States

Past Performance

Alexis Nasser 888 N Euclid Room 106

Tucson, Arizona 85719

United States

Service Classifications

NAICS Codes

Primary

Yes

NAICS Codes

611310

NAICS Title

Colleges, Universities, And Professional Schools

Disaster Response

This entity does not appear in the disaster response registry.

Last updated by Amorette Rivera on Mar 13, 2024 at 01:46 PM UNIVERSITY OF ARIZONA

May 16, 2024 09:48:15 PM GMT https://sam.gov/entity/C3A1J66ML645/coreData?status=null Page 2 of 2

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