CTR061468 Contract Amendment No. 1_ Executed.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.: CTR061468 AMENDMENT NO.: ONE (1) Procurement Officer:

Selena Leon

UNIVERSITY OF ARIZONA RURAL TRANSFER LINE

Effective upon final signature by both parties, it is mutually agreed that the Agreement referenced in this Amendment is revised as follows:

1. Pursuant to the Uniform Terms and Conditions, Provision Two (2) Renewal of Agreement, the Contract is extended for one (1) year through June 30, 2024.

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

2.1. Scope of Services is revised and replaced;

2.2. Price Sheet is revised and replaced; and

2.3. Exhibit B - 2 CFR 200.332 is revised and replaced.

ALL CHANGES ARE REFLECTED 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 Contract 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, on behalf of the University of Arizona Contractor’s Name Procurement Officer Signature

04/26/2023

Elisha Johnson, Director, Clinical Trials and Contracting

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR061468 AMENDMENT NO.: ONE (1) Procurement Officer:

Selena Leon

SCOPE OF SERVICES

1. Purpose

1.1. The Arizona Department of Health Services (ADHS) receives funding from the Center for Disease Control and Prevention to enhance the State’s ability to rapidly respond to public health emergencies and to address COVID-19 related health disparities. The American Rescue Plan Act of 2021 provides additional relief to address the continued impact of the health disparities within jurisdictions and the Coronavirus Disease 2019 (COVID-19) pandemic on the public health system. These funds are used to support the development and implementation of Tasks in this Scope of Work;

1.2. ADHS will continue to prepare for and respond to all types of public health emergencies such as emerging infectious diseases, natural and/or manmade disasters, and other threats. Funding provided will be used to build existing capabilities and bridge preparedness gaps across the health care system. Lessons learned from real-world responses such as COVID-19, and other exercises will guide Arizona’s health care system preparedness efforts and improve resiliency for the whole community; and

1.3. Intended outcomes are to reduce health disparities and expand infrastructure support for populations at higher risk and that are underserved, including racial and ethnic minority groups and people living in rural communities. Activities align with the Arizona Health Improvement Plan (AzHIP) priorities, specifically in support of Pandemic Recovery & Resiliency goal to rebuild a stronger system to support health and the Rural & Urban Underserved vision of understanding and addressing health disparities uniquely impacting rural and underserved Arizonans.

2. Scope of Services

The Contractor (Center for Toxicology, Pharmacology, Education and Research (CTPER)) shall:

2.1. Pilot a statewide rural transfer center for hospitals seeking to transfer patients out of their facilities;

2.2. Host at least quarterly statewide meetings for participating sending hospitals in order to fine tune the function, data collection and reports in the statewide rural transfer center;

2.3. Prepare algorithms and protocols needed to rapidly stand up the Arizona Surge Line from this statewide rural transfer center;

2.4. Attend the annual Public Health Preparedness Community Conference (PCC) and provide information and or training (handouts, PowerPoints, etc.) to healthcare system partners on what resources Poison Control can provide to assist in response activities during a public health emergency related to hospital surge;

2.5. Prepare a budget and work plan according to deliverables contained in the Grant Guidance Document and accomplish activities in the approved budget and work plan;

2.6. Prepare and forecast future costs for annual budgets, expansion to behavioral health transfers, subscription models; and

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR061468 AMENDMENT NO.: ONE (1) Procurement Officer:

Selena Leon

2.7. Explore future funding sources for years 2 and 3 of potential function.

2.8. Visit at least 50% of the participating sending hospitals, to establish rapport and gain insight into enhancement of interhospital transfers.

2.9. Temporarily expand services as requested by the Department to manage surge.

3. Financial Requirements

Regardless of funding allocation for each Budget Period (BP), participants are expected to continue towards the completion of the deliverables as outlined.

4. Inventory

4.1. Provide a complete annual inventory report to include all capital equipment above the $5,000 thresholds that was procured with this grant funding; and

4.2. Inventory list shall be provided to ADHS within ten (10) days of request.

5. Budget and Work Plan

5.1. Budgets along with a work plan shall be completed and submitted to ADHS after Contractor signature;

5.2. The budget and work plan need to be reviewed and approved by ADHS before funding is released;

5.3. Upon approval of the Contractor’s budget and work plan by ADHS, invoice shall be submitted to ADHS and payment will be processed;

5.4. Activities and procurements funded through the this grant funding shall be aligned with the budget/spend plan and work plan; and

5.5. Progress reports at the 6th month shall be submitted with supporting documentation to ADHS.

6. Reporting Deliverables

6.1. Submit quarterly progress information on the deliverables, performance measures and financial expenditures through the COVID-19 Public Health Workforce Supplemental Grant:

6.1.1. Quarterly Reporting: Progress Update and CER (Expenditure Report) - email to antonio.hernandez@azdhs.gov (followed by a conference call to brief on the report) example of the reporting schedule e.g. 2022-2023:

6.1.1.1. Q1 July - September (Report Due First week of October);

6.1.1.2. Q2 October - December (Report Due First week of January);

6.1.1.3. Q3 January - March (Report Due First week of April); and

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR061468 AMENDMENT NO.: ONE (1) Procurement Officer:

Selena Leon

6.1.1.4. Q4 April - June (Report Due First week of July).

6.1.2. The end-year program update and expense report, covering April 1, 2023 to October 31, 2023, will be due no later than November 30, 2023;

6.1.3. Scheduled quarterly calls with ADHS staff member to review progress of the transfer line activity;

6.1.4. The summary of transfer-related data and steering committee meetings from the statewide transfer center pilot; provided each quarter;

6.1.5. The protocols, budget and sample algorithms in order to stand up the Arizona Surge Line rapidly, in case of emergency, by the end of the second quarter, March 31, 2023;

and

6.1.6. Forecasted future costs for annual budgets, expansion to behavioral health transfers, subscription models, by the end of the second quarter, March 31, 2023.

6.2 Update or provide a certificate of Insurance (COI), which conforms to the Special Terms and Conditions, within ten (10) days of Contract award. A purchase order will not be issued without a current and valid COI on file.

7. Grant Activity Oversight

The sub-recipient shall cooperate with ADHS coordination in completing on-site visits or monitoring activities based on the guidance set forth by the ASPR.

8. Performance

8.1. Failure to meet the performance measures or deliverables may result in a reduction or withholding subsequent awards; and

8.2. Upon approval of the Contractor’s invoice by ADHS, payment will be processed

9. Notices, Correspondences, Report and Invoices

9.1. Notices, correspondence, and reports from the University to ADHS shall be sent to:

Arizona Department of Health Services Antonio Hernandez, Community Partner Liaison 150 N. 18th Avenue Suite 150 Phoenix, AZ 85007 Telephone: (602) 763-1774 Email: antonio.hernandez@azdhs.gov

9.2. Quarterly Invoices shall be submitted to invoices@azdhs.gov.

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR061468 AMENDMENT NO.: ONE (1) Procurement Officer:

Selena Leon

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

Steve Dudley, PharmD, DABAT Director Arizona Poison and Drug Information Center 1295 N. Martin Avenue P.O. Box 210202

a. Tucson, AZ 85721-0202

(526) 626-6239 dudley@pharmacy.arizona.edu

9.4. Send Duplicate Copy to:

Darrell Thomson, Director of Operations Center for Toxicology Pharmacology Education and Research 475 N. 5th Street Phoenix, AZ 85004 Phone: (602) 827-2111 d13thomson@arizona.edu

Pamela Teague, Accountant pteague@arizona.edu

9.5. Payments from ADHS to the University shall be sent to: (University to complete if different from above)

University of Arizona Sponsored Projects Services PO Box 41867 Tucson, AZ 85717 Phone: 520-626-6000 Fax: 520-626-4137 Email: sponsor@email.arizona.edu

ARIZONA DEPARTMENT

OF HEALTH SERVICES

OFFICE OF

PROCUREMENT

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

AGREEMENT NO.: CTR061468 AMENDMENT NO.: ONE (1) Procurement Officer:

Selena Leon

PRICE SHEET

July 1, 2022 to June 30, 2023

Fixed Price DESCRIPTION PERIODS: UOM AMOUNT

Initial start up costs upon execution of the Agreement: computers, monitors, headsets, space furnishings, phone expansion, and EMR licensing and initial set-up

1 Invoice $284,000.00

Monthly invoices with supporting documentation to support costs incurred up to amount indicated

11 Month $141,333.00

Final invoice with supporting documentation to support costs incurred up to amount indicated

1 Month $141,337.00

Visit at least 50% of the participating sending hospitals, to establish rapport and gain insight into the enhancement of inter-hospital transfers.

1 Invoice $10,000.00

Temporarily expand services as requested by the Department to manage the surge.

1 Invoice $118,000.00

TOTAL AMOUNT $2,108,000.00

ARIZONA DEPARTMENT

OF HEALTH SERVICES

OFFICE OF

PROCUREMENT

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

AGREEMENT NO.: CTR061468 AMENDMENT NO.: ONE (1) Procurement Officer:

Selena Leon

PRICE SHEET (CONTINUED)

FOR BUDGET PURPOSES

Service Notes Start Up + Year 1 Cost Software Highmor web-based EMR and

ToxSentry local backup for 24/7 capabilities

$250,000

Budget Justification:

Highmor web-based EMR, data storage, SQL server, 24/7 support and administrative training.

ToxSentry modified to provide fail-safe service due to provide 24/7 operations due lack of offline capabilities currently available on Highmor.

Phone Five9 $30,000 Budget Justification:

Phones

Additional licenses Billing for call time

Staffing Phone Coverage– EMCTs, Cross-trained Poison Control Staff for 24/7/365 coverage

$700,000

Admin Oversight – Daily Operations, Analytics, Executive Oversight, Reporting, IT

$650,000

Clinical Oversight – On-call provider and toxicologist

$100,000

Budget Justification:

Minimum of 10 FTEs required for appropriate 24/7/365 coverage.

Designated Poison Control staff will be cross-trained and provide emergency fill coverage when required.

Blackbox will provide daily operations, analytic and executive oversight as well as initial and continuing staff training and reporting.

Poison Control (CTPER) will provide continuing staff training and clinical oversight for toxicological based transfers to provide support for supporting hospital as well as attend all required conferences and meetings to present on findings and progress.

CTPER will also provide technical support for all software and hardware needed for the transfer line.

Equipment and Supplies Encrypted computers, monitors, headsets $30,000

Budget Justification:

Encrypted computers, monitors, headsets, and other necessary office and administrative accessories

Space Rented space to physically house agents

$40,000

Budget Justification:

Current space restraints do not allow the addition of the required staff and equipment to operate the transfer line.

Additional space will be rented out to perform necessary operations.

Indirects (10%) $180,000 Total $1,980,000

ARIZONA DEPARTMENT

OF HEALTH SERVICES

OFFICE OF

PROCUREMENT

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

AGREEMENT NO.: CTR061468 AMENDMENT NO.: ONE (1) Procurement Officer:

Selena Leon

EXHIBIT B - 2 CFR 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 # QMWUG1AMYF65

Federal Award Identification (Grant Number): 1 NU90TP922172-01-00

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

Subrecipient's unique entity identifier (UEI#): ED44Y3W6P7B9

Federal Award Identification Number (FAIN, sometimes it’s the same as the Grant Number): NU90TP922172

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; 05/19/2020

Subaward Period of Performance Start and End Date; 07/01/2021–06/30/2023

Subaward Budget Period Start and End Date: 07/01/2021–06/30/2023

Amount of Federal Funds Obligated by this action by the pass-through entity to the subrecipient (this is normally the contract amount): $1,280,000.00

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): $1,980,000.00

Total Amount of the Federal Award committed to the subrecipient by the pass-through entity $1,980,000.00

Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act (FFATA)

Cooperative Agreement for Emergency Response:

Public Health Crisis Response – 2018: COVID-19 Crisis Funding for Workforce Development

Name of Federal awarding agency, pass-through entity, and contact information for awarding official of the Pass-through entity CDC

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:

93.354 – Cooperative Agreement for Emergency Response – Public Health Crisis Response - 2018

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

See Budget: 10% included as part of fixed price budget