CTR063729 A2.pdf

CONTRACT AMENDMENT

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530

Phoenix, Arizona 85007

CONTRACT NO.: CTR063729 AMENDMENT NO.: Two (2) Procurement Officer:

Lucas Terry

ARIZONA HEARING AND VISION SCREENING TRAINING PROGRAM

Effective January 1, 2025 it is mutually agreed that the Contract is amended as follows:

1. Pursuant to the Special Terms and Conditions, Provision Three (3), Contract Extension (5 Year Maximum) the Contract is hereby extended through December 31, 2025.

2. Pursuant to the Uniform Terms and Conditions, Provision Five (5), Contract Changes, Section 5.1, the Contract is hereby revised with the following:

2.1 The Scope of Work is revised and replaced.

2.2 The Price Sheet 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 this 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 Procurement Office)

Contractor Signature

Contractor Signature Date

Authorized Signatory’s Name and Title

Arizona Chapter of the American Academy of Pediatrics

Contractor’s Name Chief Procurement Officer Signature or Designee

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

CONTRACT NO.: CTR063729 AMENDMENT NO.: Two (2) Procurement Officer:

Lucas Terry

1. DEFINITIONS

1.1. “ADHS” refers to the Arizona Department of Health Services.

1.2. “BWCH” refers to the Bureau of Women’s and Children’s Health within the Arizona Department of Health

Services.

1.3. “Certification of Completion” refers to an electronic document issued to an individual who has completed the training conducted by the Contractor to become a hearing and/or vision trainer or screener.

1.4. “Contractor” refers to the entity that is awarded funds.

1.5. “Curriculum” refers to the hearing and vision curriculum that was created by the ADHS Sensory Screening Program to train individuals to become ADHS certified trainers or screeners for hearing and/or vision.

1.5.1. The curriculum can be carried out in a variety of formats including in-person, web-based, or a hybrid (combination of in-person and web-based).

1.6. “Database” refers to the Qualtrics system that contains all hearing and vision certifications for trainers and screeners.

1.7. “Fee-based training persons/agencies” refers to an individual or agency who are currently a hearing and/or vision trainer who are conducting training for a fee.

1.8. "FTE" refers to Full Time Equivalent staffing positions.

1.9. “Hearing Screening” refers to the mandated hearing screening that must occur in school-aged children as defined in Arizona Revised Statute. Title 36 - Public Health and Safety Chapter 7.2. - Child Hearing Evaluation and Vision screening Programs Article 1 - Program of Hearing Evaluation Services. And as outlined in Arizona Administrative Code Title 9, Health Services, Chapter 13, Article 1 – Hearing Screening and Vision Screening Rules

1.10. “Hearing and Vision Screening Training Program” refers to the training program that will be carried out by the Contractor to train those who are interested in becoming a certified hearing and/or vision trainer or screener.

1.11. “Hearing & Vision Training Institutes” refers to hearing and vision training that are pre-scheduled and are held in specific regions in Arizona to provide access to individuals living in rural parts of the State. These trainings are held in addition to other training that the Contractor hosts or is requested by a school(s).

1.12. “Instrument-Based Vision Screening Devices” refers to photo screeners or autorefractors.

1.13. “K-12 Instruction” refers to children who are enrolled in a school, accommodation school, charter school and/or private school as defined in A.R.S § 15-101.

1.14. “Master Trainer” refers to an individual who was trained through a contract with the University of Arizona

Maricopa Cooperative Extension through the Train the Trainer (T3) Program Collaborative that trained health care professionals, school personnel and others to be Hearing and/or Vision Trainers.

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

CONTRACT NO.: CTR063729 AMENDMENT NO.: Two (2) Procurement Officer:

1.15. “Otoacoustic Emissions (OAE)” refers to an audiological instrument used to determine the status of an individuals’ cochlear function.

1.16. “Preschool” refers to the instruction preceding kindergarten provided to individuals three to five-year-old (3- 5) through a school.

1.17. "Program Manager" refers to the ADHS Sensory Screening Program Manager.

1.18. “Pure-Tone audiometer” refers to an audiological instrument that is used to perform a three-frequency, pure tone hearing screening on a child.

1.19. “Renewal Certification” refers to an electronic document issued to an individual who has completed the renewal training conducted by the Contractor to become a hearing and/or vision trainer or screener.

1.20. “Screener” refers to an individual qualified to perform a hearing and/or vision screening.

1.21. “Special Education” refers to children as specified in A.R.S. § 15-761.

1.22. “Sub-Contractor” refers to an eligible entity that receives funding through an awardee by partnering in the application and implementing services.

1.22.1. Could include those formerly known as Master Trainers and T3 Trainers or those who are currently fee-based training persons/agencies

1.23. “Training Calendar” refers to a virtual calendar hosted on the ADHS Sensory Screening Program website that will be updated so that the public is aware of upcoming training.

1.24. “T3 Trainer” refers to an individual who was trained through a contract with the University of Arizona Maricopa

Cooperative Extension through the Train the Trainer (T3) Program Collaborative that trained health care professionals, school personnel and others to be Hearing and/or Vision Trainers.

1.25. “Trainer” refers to an individual who:

1.25.1. Has a current certificate of completion, and

1.25.2. Provides classroom instruction and assessment of competency in using audiological and/or vision equipment.

1.26. “Tympanometry” refers to an audiological instrument used to determine the status of an individual’s middle ear.

1.27. “Vision Charts” refers to use of optotype charts (LEA symbols, HOTV letters, and SLOAN letters used in testing distance and near vision acuity.

1.28. “Vision Screening” refers to the mandated vision screening that must occur in school-aged children as defined in Arizona Revised Statute. Title 36 - Public Health and Safety Chapter 7.2. - Child Hearing Evaluation and Vision screening Programs Article 2 – Vision Screening for Children. And as outlined in Arizona Administrative Code Title 9, Health Services, Chapter 13, Article 1 – Hearing Screening and Vision Screening Rules.

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

CONTRACT NO.: CTR063729 AMENDMENT NO.: Two (2) Procurement Officer:

2. BACKGROUND

2.1. Hearing and vision screening is mandated by Arizona Revised Statute (ARS) Title 36 - Public Health and Safety (ARS Title 36) Chapter 7.2 - Child Hearing Evaluation and Vision Screening Programs. Title 9, Health Services, Chapter 13 Department of Health Services- Health Programs Services (Title 9 of the Arizona Administrative Code) outlines the hearing screening rules. Children in public schools, charter schools, and private schools are required to have hearing screenings performed annually. The Hearing Screening Rules also dictate what level of training a person must have to perform the hearing screenings;

2.2. Vision screening legislation Senate Bill (SB 1456) was passed on August 17, 2019. This law requires vision screening of children in Arizona upon initial entry to school as well as not more than two (2) additional grade levels in a district or charter school that provides preschool, special education and/or kindergarten through twelfth (K-12) instruction. The vision screening law is in the ARS which can be found at: ARS §36-899.10.

While Vision Screening rules have not yet been established it is important vision screenings are regularly performed on Arizona school children. Until official rules are in place for vision screening, there are no official guidelines regarding vision training, screening, and reporting of data to the Arizona Department of Health Services (ADHS). Vision issues are the most preventable disabling condition that children experience, according to the American Academy of Pediatrics (AAP). But since young children aren’t able to articulate vision impairments, diagnosis and treatment relies entirely on regular screenings. Early vision screenings are a cost-effective way to identify and treat potential problems, which may lead to delayed sensory and social-emotional development, academic challenges, and permanent loss of vision. The AAP and the Children’s Eye Foundation of American Association for Pediatric Ophthalmology (APPOS) have stated that amblyopia, also known as a lazy eye, is the leading cause of blindness in children which is preventable and that twenty-five percent (25%) of school-aged children have a vision problem that impacts their learning ability. Therefore, until rules are officially in place, ADHS recommends that all school districts or charter schools that provide instruction in preschool, kindergarten, or special education programs and grades one

(1) through twelve (12), or any combination of those programs or grades perform vision screenings.

2.3. From 1998 to 2014 the sensory screening component was provided through a contract with the University of Arizona Maricopa County Cooperative Extension through the Train the Trainer (T3) Program Collaborative that trained health care professionals, school personnel and others to be Trainers. From 2014-2019 the hearing and vision training was maintained within the ADHS’ department, BWCH through a certified, trained employee. In 2020 it was determined that in order to achieve the goal of state-wide training the training component of the program shall be carried out by a community contractor with the capacity to train state-wide to meet the needs of the ADHS Sensory Screening Program and training needs of Arizona schools;

2.4. The ADHS BWCH will fund a state-wide training Contract utilizing the Title V Maternal and Child Block Grant, which aims to reduce infant mortality, the incidence of preventable diseases and handicapping conditions among children, and the need for inpatient and long-term care services and increase the number of children (especially preschool children) appropriately immunized against disease and the number of low income children receiving health assessments and follow-up diagnostic and treatment services. The Contractor shall administer Arizona’s hearing and vision training program. The program will be responsible for maintaining and updating the hearing and vision curriculum (including curriculum used for in-person and eLearning), perform statewide training of screeners and trainers, issue Certificates of Completion and maintain a statewide training calendar in partnership with ADHS, BWCH, Office of Children’s Health.

3. OBJECTIVE

To establish a free statewide hearing and vision screening training program to carry out requirements per Chapter

13. Department of Health Services - Health Program Services, ARTICLE 1. Hearing Screening and prepare for forthcoming rules to carry out ARS §36-899.10 Vision Screening.

https://www.azleg.gov/arsDetail/?title=36 https://azsos.gov/rules/arizona-administrative-code#ID9 https://azsos.gov/rules/arizona-administrative-code#ID9 https://apps.azsos.gov/public_services/Title_09/9-13.pdf https://www.azleg.gov/legtext/54leg/1r/bills/sb1456s.pdf https://www.azleg.gov/viewdocument/?docName=https%3A//www.azleg.gov/ars/36/00899-10.htm https://apps.azsos.gov/public_services/Title_09/9-13.pdf https://apps.azsos.gov/public_services/Title_09/9-13.pdf https://www.azleg.gov/viewdocument/?docName=https%3A//www.azleg.gov/ars/36/00899-10.htm

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

CONTRACT NO.: CTR063729 AMENDMENT NO.: Two (2) Procurement Officer:

Revised 06/24/2024

4. SCOPE OF SERVICE

The Contractor shall perform all activities necessary to maintain curriculum, monitor progress, prepare, facilitate, recruit, and train Trainers and Screeners for the statewide ADHS Sensory Screening Program including, Hearing and Vision Screening as stipulated in the ADHS Sensory Screening Program Policies and Procedures Manual (Link:

https://azdhs.gov/documents/prevention/womens-childrens-health/ocshcn/sensory-screening/sensory-screening- program-policy.pdf) and in compliance with the Chapter 13.

Department of Health Services - Health Program Services, ARTICLE 1. Hearing Screening and forthcoming rules to carry out ARS §36-899.10 Vision Screening.

5. TASKS

The Contractor shall:

5.1. Designate a Program Lead (1.0 FTE) to oversee the activities and tasks of the ADHS Hearing and Vision Training Program;

5.2. Designate a Lead trainer(s) for hearing and vision screening to conduct in-person, web-based and/or hybrid (combination of in-person and web-based) training for trainers and screeners;

5.2.1. Lead Trainer shall meet trainer eligibility requirements as outlined in

Hearing Screening a n d V i s i o n S c r e e n i n g Rules section R9-13-

109. Trainer Eligibility,

5.3. Serve as the hearing and vision trainer for the State of Arizona;

5.4. Review and maintain the ADHS Hearing and Vision curricula annually to ensure curricula are up to date;

5.4.1. Ensure consultation with subject matter experts including licensed audiologist and pediatric ophthalmologists and other relevant community partners with expertise in hearing and vision screening,

5.4.2. Ensure that the curricula are reviewed, evidence-based, and in alliance with national standards, including but not limited to:

5.4.2.1. American National Standards Institute (ANSI);

5.4.2.2. Acoustical Society of America (ASA);

5.4.2.3. American Academy of Audiology;

5.4.2.4. American Academy of Pediatrics (AAP);

5.4.2.5. American Association for Pediatric Ophthalmology and Strabismus

(AAPOS);

https://azdhs.gov/documents/prevention/womens-childrens-health/ocshcn/sensory-screening/sensory-screening-program-policy.pdf https://azdhs.gov/documents/prevention/womens-childrens-health/ocshcn/sensory-screening/sensory-screening-program-policy.pdf https://azdhs.gov/documents/prevention/womens-childrens-health/ocshcn/sensory-screening/sensory-screening-program-policy.pdf https://apps.azsos.gov/public_services/Title_09/9-13.pdf

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

5.4.2.6. National Center for Children's Vision and Eye Health (NCCVEH);

5.4.2.7. American Association of Certified Orthoptists (AACO); and

5.4.2.8. American Academy of Ophthalmology (AAO);

5.4.3. Be responsible for distributing and the printing of any and all materials associated with the ADHS Hearing and Vision curricula (including but not limited to curriculum, handouts, and exams),

5.5. Provide in-person, web-based training, and/or hybrid (combination of in-person and web-based) training options for all hearing and vision screening training based upon the ADHS Hearing and Vision Curricula;

5.5.1. The web-based training requires the participant to demonstrate the hands-on competency portion of the curriculum.

5.5.1.1. Ensure that the prospective screeners have access to demonstrate the hands-on competency by an ADHS certified hearing or vision trainer in order to obtain their certification;

5.5.1.2. The hands-on competency can be conducted in-person or using a virtual platform; and

5.5.1.3. As needed, utilize subcontractors or community partners to assist.

5.6. Adhere to use of subcontractor or community partners requirements:

5.6.1. Obtain pre-approval from ADHS of proposed subcontractor and contract,

5.6.2. Establish a respectful and consistent relationship with the subcontractor,

5.6.3. Monitor the subcontractor through annual site visits,

5.6.4. Provide an annual ethics and conflict of interest training,

5.6.5. Disseminate program information received from ADHS to the subcontractor,

5.6.6. Establish a contract with the subcontractor that outlines the duties and responsibilities for the subcontractor including monthly billing and reporting of deliverables,

5.6.7. Establish a contract with the subcontractor that agrees to follow the

Terms and Conditions and insurance requirements, of this Contract,

5.6.8. Ensure subcontractor is implementing the curriculum with fidelity, HEALTH SERVICES

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5.6.9. Ensure that the subcontractor is providing training free of charge to the public,

5.6.10. Provide supervision of subcontractors to ensure adhesion to the curricula and scope of work.

5.7. All training provided shall be in accordance with the hearing rules and vision as defined in Background section 2.1 and 2.2 mandate;

5.8. The Training Institutes shall be in-person with a virtual option offered as deemed appropriate;

5.9. Conduct Hearing and Vision Training Institutes at a minimum once per quarter in each of the Northern, Central, and Southern regions as outlined in Exhibit Six (6). Including each of the NE, NW, CE, CW, SE, and SW sub-regions (as outlined in Exhibit Six (6) at least annually.

5.9.1. The training shall include:

5.9.1.1. Hearing Training;

5.9.1.1.1. Pure-Tone,

5.9.1.1.2. Oto acoustic Emissions, and

5.9.1.1.3. Tympanometry,

5.9.1.2. Vision Training;

5.9.1.2.1. Vision Charts (LEA symbols, HOTV letters, and

SLOAN letters) used in testing distance and near vision acuity,

5.9.1.2.2. Stereoacuity,

5.10.1.2.3. Color Vision, and

5.10.1.2.4. Instrument-based vision screening devices,

5.9.2. Additional training will be determined between ADHS and the Contractor,

5.10. Incorporate a survey to ensure participant feedback on training institutes;

5.11. Partner with schools/districts or county health departments to identify training spaces for the Hearing & Vision Training Institutes;

5.12. Maintain electronic copies of the sensory training summaries and rosters to submit to ADHS Sensory Screening Program for certification process;

HEALTH SERVICES

OFFICE OF PROCUREMENT

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5.13. Coordinate, perform, and document Training Observations of Hearing & Vision

Trainers who meet the requirements per R9-13-111 and future vision rules (Link:

https://apps.azsos.gov/public_services/Title_09/9- 13.pdf);

5.13.1. Observe new Hearing & Vision Trainers while conducting their first (1st) training session, and

5.13.2. Hold sessions in a classroom setting at a pre-arranged location,

5.14. Maintain an up-to-date statewide training calendar to be shared on the ADHS Sensory Screening Program webpage Link: ADHS - Children and Youth with Special Health Care Needs - ADHS Sensory Screening Program (azdhs.gov);

5.14.1. Shall include the ability for schools and/or child serving agencies to schedule or request a training by the Contractor,

5.15. May reserve audiological and visual equipment through the Sensory Screening Loaner Equipment Program or purchase the necessary equipment for the purpose of carrying out training;

5.15.1. Reservations must be submitted using the Program’s designated booking system,

5.16. Partner with community organizations to provide hearing and vision training for trainers/screeners including initial and renewal certifications, at community events i.e. annual School Nurses Organization of Arizona (SNOA) conference or other ADHS identified conferences not to exceed two (2) per year;

5.17. Develop materials and coordinate outreach to inform schools statewide, community partners, and the Arizona Department of Education (ADE) about the availability of the Sensory Screening Program Training. This includes but is not limited to:

5.17.1. Preschools,

5.17.2. Public,

5.17.3. Private,

5.17.4. Charter schools,

5.17.5. Head Start programs,

5.17.6. First Things First programs, and

5.17.7. Ensure that outreach materials and information reach schools located in rural and underserved parts of the State (i.e., tribal; Title I schools, Part A (Title I) of the Elementary and Secondary Education Act), https://www.azdhs.gov/prevention/womens-childrens-health/ocshcn/index.php#hearing-screening https://www.azdhs.gov/prevention/womens-childrens-health/ocshcn/index.php#hearing-screening https://www.azdhs.gov/prevention/womens-childrens-health/ocshcn/index.php#hearing-screening

HEALTH SERVICES

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5.17.7.1. Outreach materials should include but is not limited to:

5.17.7.1.1. Providing information about future trainings and

other resources about the training institute.

5.18. Meet, at a minimum quarterly up to monthly at the discretion of the Program, with the

ADHS Sensory Screening Program Manager to provide updates, review data, and other items to be identified;

5.19. Prepare Monthly Contractor’s Expenditure Report (CER) and all related documentation detailing services and rates as shown on the contract Price Sheet;

5.20. Participate in an annual site visit with ADHS. This will include ADHS monitoring an in-person training facilitated by the Contractor;

5.21. Include ADHS Sensory Screening Program Manager in all Trainer/Screener mailings and e-mail lists including but not limited to training and marketing materials, correspondence, and notices;

5.22. Provide a written Policy & Procedure demonstrating communication practices including:

5.22.1. Communicate effectively with people who require communication assistance;

5.22.2. Ensure that individuals with a vision, hearing, or speech disability can communicate with, receive information from, and convey information to the Contractor;

5.22.3. Provide or work with a partner to acquire auxiliary aids and services when needed to communicate effectively with people who have communication disabilities;

5.22.4. Consider the nature, length, complexity and context of the communication and the person’s normal methods of communication;

5.22.5. Provide oral translation and interpretation services for English Language

Learners;

5.23. Provide a written Policy & Procedure demonstrating fiscal management;

5.24. Provide a plan outlining policy prohibiting harassment based on race, sexual orientation, gender, gender identity (or expression), religion, and national origin;

5.25. Upon request, provide pandemic plan, ensuring that critical services would continue in the event of a pandemic event;

HEALTH SERVICES

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5.26. Retain an I-9 form on file for any person employed with the Contractor who is funded with any part of funds from this Contract. (if applicable);

5.27. Fidelity in the implementation of the hearing and vision curricula;

5.28. Content for the ADHS Sensory Screening web page shall be updated monthly and provided to Sensory Screening program manager including the current contact and training information to be published on the ADHS Sensory Screening Program website; and

5.29. Work collaboratively with the ADHS Sensory Screening Program Manager for completion of requirements and tasks within stated time frames or a reasonable timely manner.

5.30. Submit for approval a staffing plan detailing the job description and duties of the

Program Lead (1.0 FTE) staff and Lead Trainer and identifying those individuals at the beginning of the contract term and at any time there is a change to the staff members or responsibilities.

5.31. Submit copies of written policies and procedures pertaining to communication, fiscal management, and anti-discrimination standards at the beginning of the contract term and at any time there is a proposed policy change.

5.32. Submit for approval any outreach materials intended for use with community organizations, at community events i.e. annual School Nurses Organization of Arizona (SNOA) conference or other ADHS identified conferences at least 30 days before the printing or publication deadline;

6. REQUIREMENTS

The Contractor shall:

6.1. Comply with the state hearing and vision screening requirements per Chapter 13.

Department of Health Services - Health Program Services, ARTICLE 1. Hearing Screening and forthcoming rules to carry out ARS §36-899.10 Vision Screening and all ADHS Sensory Screening Program Guidelines as outlined in ADHS Sensory Screening Program Policy and Procedure Manual (Link:

https://azdhs.gov/documents/prevention/womens-childrens-health/ocshcn/sensory-screening/sensory- screening-program-policy.pdf) ;

6.2. Perform all activities necessary to maintain curriculum, monitor progress, prepare, facilitate, recruit, and train Trainers and Screeners for the statewide ADHS Sensory Screening Program including, Hearing and Vision Screening as stipulated in the ADHS Sensory Screening Program Policies and Procedures Manual and in compliance with the Chapter 13. Department of Health Services - Health Program https://www.azleg.gov/viewdocument/?docName=https%3A//www.azleg.gov/ars/36/00899-10.htm https://www.azleg.gov/viewdocument/?docName=https%3A//www.azleg.gov/ars/36/00899-10.htm https://azdhs.gov/documents/prevention/womens-childrens-health/ocshcn/sensory-screening/sensory-screening-program-policy.pdf https://azdhs.gov/documents/prevention/womens-childrens-health/ocshcn/sensory-screening/sensory-screening-program-policy.pdf https://azdhs.gov/documents/prevention/womens-childrens-health/ocshcn/sensory-screening/sensory-screening-program-policy.pdf

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Services, ARTICLE 1. Hearing Screening and forthcoming rules to carry out ARS §36-899.10 Vision Screening;

6.3. Retain and manage all required programmatic and fiscal documentation, including but not limited to reports, invoices, backup documentation, to be verified during annual site visit conducted by ADHS Sensory Screening Program Manager;

6.4. Maintain a minimum 1.0 FTE or equivalent to meet statewide capacity; and

6.5. Provide a valid Certificate of Liability Insurance (COI) within five (5) business days of notice of Contract award that includes all the specific types of insurance and other requirements as listed in the Special Terms and Conditions Insurance Provision 19.

ADHS will not be able to issue a Purchase Order for the commencement and continuation of services without a current and valid COI on file with the Procurement Office.

7. DELIVERABLES

7.1. Submit monthly Contractor’s Expenditure Report (CER) and documentation of listed expenses as required by the ADHS Business Finance Office, submitted no later than the close of business on the twenty-first (21st) business day of each month, following the month of service;

7.2. Submit monthly Progress Reports using the most recent template provided by

ADHS, submitted no later than the close of business on the twenty-first (21st) business day of each month, following the month of service;

7.2.1. Monthly Progress Reports shall include information on:

7.2.1.1. Narrative describing program progress including but not limited to:

7.2.1.1.1. Results and accomplishments,

7.2.1.1.2. Implementation challenges,

7.2.1.1.3. Outreach efforts,

7.2.1.1.4. Future plans, and

7.2.1.2. Data, including but not limited to:

7.2.1.2.1. Number of trainings (online/in-person/hybrid)

conducted,

7.2.1.2.2. Number of participants trained, broken down into

categories i.e., hearing, vision, trainer, screener, and

7.2.1.2.3. Updated list of trainers/screeners and their current

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7.2.1.2.4. Results of any participant surveys received.

7.2.2. Any requests to provide additional information on monthly reports will require resubmission of the report for ADHS review within fifteen (15) days of notification;

7.3. Current registry and contact information of all trainers/screeners must be included in the monthly progress report submitted no later than the close of business on the twenty-first (21st) business day of each month, following the month of service;

7.4. Content for the ADHS Sensory Screening web page must be updated the first (1st) of every month and provided to Sensory Screening program manager including the current contact, training information, and any updates to the training calendar to be published on the ADHS Sensory Screening Program website;

7.5. Complete the required information pertaining to the Federal Funding Accountability and Transparency Act (FFATA) as needed, by the fifteenth (15th) of the month following the award;

7.6. Submit a Sensory Training Summary & and Roster to ADHS Sensory Screening Program within five (5) business days of training completion including:

7.6.1. Trainer name,

7.6.2. Trainer contact information (phone number and email address),

7.6.3. Date of training,

7.6.4. Training location,

7.6.5. The completed modules,

7.6.6. Trainee contact information (address, phone number, email address, associated school/agency), and

7.6.7. Trainer signature to verify attendee’s completion of the Hearing/Vision Trainer Training or Hearing/Vision Screener Training,

7.7. Submit an Observation Report for each observation as stipulated in the ADHS

Sensory Screening Program Policy and Procedure Manual, due within five (5) business days of observation;

7.8. Review, sign, and return the site visit monitoring report within 30 calendar days of receipt; and

7.9. Other documentation as requested.

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8. STATE PROVIDED ITEMS

ADHS shall provide:

8.1. The ADHS Sensory Screening Program Policies and Procedures Manual, available from the Arizona Department of Health Services Sensory Screening Program;

8.2. Hearing and Vision Training Curricula;

8.3. Monthly Progress Report forms, electronically;

8.4. Annual Site Visit Report forms, electronically;

8.5. Sensory Training Summary and Roster forms, electronically;

8.6. Observation Report forms, electronically;

8.7. A Contractor’s Expenditure Report (CER) Template, upon execution of the Contract; and

8.8. ADHS logo files (available here for download) and guidance on ADHS Brand Standards.

9. APPROVALS

The following items require review and approval by ADHS

9.1. Monthly CERs and documentation shall be reviewed and approved by ADHS prior to payment;

9.2. Monthly Progress Reports shall be reviewed and approved for finalization by ADHS to monitor implementation of tasks and deliverables;

9.3. Prior to Contractor publishing or recording any marketing, education, or training materials that use the ADHS logo or reference ADHS sponsorship (including but not limited to program materials, brochures, publications, and journal articles), a draft of the material shall first be reviewed and approved by ADHS;

9.4. All marketing or educational materials, promotional items, media or forms, including but not limited to brochures, posters, publications or journal articles developed using funds awarded under this Contract OR are used for the purpose of informing, recruiting or referring eligible participants to services funded under this contract must be approved by the ADHS Program Manager prior to printing, production and distribution by submitting:

9.4.1. A draft of the materials including how the final product is anticipated to appear;

https://azdhs.gov/director/public-information-office/index.php#adhs-logo https://azdhs.gov/documents/director/public-information-office/adhs-brand-standards-guide.pdf https://azdhs.gov/documents/director/public-information-office/adhs-brand-standards-guide.pdf

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

9.4.2. Justification for item;

9.4.3. Details about how the item will be distributed;

9.5. Contractor may purchase audiological and/or visual equipment for the purpose of training. Written approval must be received prior to the utilization of funds for audiological and/or visual equipment. Types of approved equipment may include:

Pure-Tone Audiometers, Otoacoustic Emissions (OAE), Tympanometry, OAE/Tymp combination machines, Optotype charts, Stereoacuity tests, Pseudoisochromatic plates, Autorefractors, and/or Photo screeners;

9.6. Written approvals shall be received prior to utilizing funds for travel; training;

equipment; marketing or education materials; food, program incentives and other items determined by the ADHS in accordance with the state fiscal policy manuals;

9.7. Prior approval to move up to ten percent (10%) of the total budget amount between line items is required Transfer of funds are only allowed between funded line items.

Transfers exceeding ten percent (10%) to a non-funded line item shall require a written Contract amendment; and

9.8. Subcontracts established for consultation to the program or to carry out any of the program deliverables or requirements shall be reviewed and approved by ADHS prior to being executed.

10. NOTICES, CORRESPONDENCE, REPORTS, AND INVOICES

10.1. All notices, correspondences, and reports from the Contractor to ADHS shall be sent electronically via email to sensoryprogram@adhs.gov; and

Arizona Department of Health Services Bureau of Women’s and Children’s Health (BWCH) Sensory Screening Program Manager 150 N. 18th Ave., Suite 320 Phoenix, Arizona 85007 Phone: (480) 271-8832 Email: ashley.neves@azdhs.gov

10.2. CERs and all supporting documentation shall be emailed to: sensoryprogram@adhs.gov;

10.2.1. Contractors CER shall be submitted no later than the twenty-first (21st) of each month reporting on the previous month’s expenses. The Contractor Manager, or Designee, shall approve the CER. Approved CERs shall be paid by the ADHS within thirty (30) days of receipt unless there are additional requested documents required to approve the submitted CER.

10.3. Automated Clearing House

10.3.1. ADHS may pay invoices for some or all Orders through an Automated mailto:sensoryprogram@adhs.gov mailto:ashley.neves@azdhs.gov mailto:sensoryprogram@adhs.gov

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

Clearing House (ACH). In order to receive payments in this manner, the Contractor must complete an ACH Vendor Authorization Form (form GAO-

618) within 30 (thirty) days after the effective date of the Contract. The form is available online at: https://gao.az.gov/sites/default/files/2023-05/GAO- 618.pdf

10.3.2. ACH Vendor Authorization Form shall be emailed to

Vendor.Payautomation@azdoa.gov https://gao.az.gov/sites/default/files/2023-05/GAO-618.pdf https://gao.az.gov/sites/default/files/2023-05/GAO-618.pdf mailto:Vendor.Payautomation@azdoa.gov

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

COST REIMBURSEMENT LINE ITEM BUDGET: CY 2025 (1/1/25-12/31/25)

ACCOUNT CLASSIFICATION AMOUNT

Personnel* $82,880.00

ERE* $18,233.60

Professional & Outside Services* $23,876.38

Travel Expense (In-State) * $500.00

Out of State Travel $0.00

Occupancy* $3,945.80

Operating Expenses/ Other Operating* $1,000.00

Capital Outlay Expense $0.00

Indirect 15% (if authorized) $19,564.22

Other $0.00

TOTAL ANNUAL NOT TO EXCEED $150,000.00

*Indicates Indirect Costs calculation

With prior written approval from the Program Manager, the Contractor is authorized to transfer up to a maximum of ten percent (10%) of the total budget amount between funded line items.

Transfers of funds are only allowed between funded line items. Transfers exceeding ten percent (10%) or to a non-funded line item shall require an amendment.

Authorization for purchase of services under this Contract shall be made only upon ADHS issuance of a Purchase Order that is signed by an authorized agent. The Purchase Order will indicate the Contract number and the dollar amount of funds authorized. The Contractor shall only be authorized to perform services up to the amount on the Purchase Order. ADHS shall not have any legal obligation to pay for services in excess of the amount indicated on the Purchase Order. No further obligation for payment shall exist on behalf of ADHS unless a.) the Purchase Order is modified with an official ADHS Procurement Change Order, and/or b.) an additional Purchase Order is issued for purchase of services under this Contract.

Katie Hobbs | Governor Jennifer Cunico, MC | Director

150 North 18th Avenue, Suite 530, Phoenix, AZ 85007-3247 P | 602-542-1025 F | 602-542-0883 W | azhealth.gov

Health and Wellness for all Arizonans

Memorandum | Office of Procurement

Date: April 10, 2025

To: CTR063729 Procurement File

From: Luca Terry, Senior Procurement Specialist

Regarding: CTR063729 Arizona Hearing and Vision Screening Training Program, Arizona Chapter of the American Academy of Pediatrics

Subject: Contract Amendment Two (2) - Annual Renewal

Contract CTR063729 for the Arizona Hearing and Vision Screening Training Program with Arizona Chapter of the American Academy of Pediatrics (ACAAP) was awarded on December 22, 2022, via a Request for Proposal (RFP). The contract term was for one (1) year with the option to renew annually not to exceed (5) years. On November 26, 2024, the program submitted a procurement request to extend the Contract through December 31, 2025.

Due to an oversight, Amendment Two (2) was sent to the supplier for signature on March 11, 2025, after the Contract expired.

As these services are still needed, and the intent was to extend the Contract timely, it is in the best interest of the State to reinstate this contract and extend it through December 31, 2025.

Prepared by: Lucas Terry, Senior Procurement Officer Date

Approve by: Gina Corwin, Chief Procurement Officer Date

ARIZONA CHAPTER OF THE AMERICAN ACADEMY OF

PEDIATRICS

Unique Entity ID

UV6DNATKXJB6

CAGE / NCAGE

4RZC2

Purpose of Registration

All Awards

Registration Status

Active Registration

Expiration Date

Jun 5, 2025

Physical Address

2600 N Central AVE STE 670

Phoenix, Arizona 85004-1242

United States

Mailing Address

2600 N Central AVE STE 670

Phoenix, Arizona 85004-1242

United States

Business Information

Doing Business as

(blank)

Division Name

(blank)

Division Number

(blank)

Congressional District

Arizona 03

State / Country of Incorporation

Arizona / United States

URL

http://www.azaap.org/

Registration Dates

Activation Date

Jun 7, 2024

Submission Date

Jun 5, 2024

Initial Registration Date

May 29, 2007

Entity Dates

Entity Start Date

Feb 23, 1977

Fiscal Year End Close Date

Dec 31

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

Corporate Entity (Tax Exempt)

Entity Type

Business or Organization

Organization Factors

(blank)

Last updated by Anne Stafford on Jun 05, 2024 at 04:55 PM ARIZONA CHAPTER OF THE AMERICAN ACADEMY OF PEDIATRICS

Dec 05, 2024 07:15:25 PM GMT https://sam.gov/entity/UV6DNATKXJB6/coreData?status=null Page 1 of 2

Profit Structure

Non-Profit Organization

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.

Financial Information

Accepts Credit Card Payments

Yes

Debt Subject To Offset

No

EFT Indicator

CAGE Code

4RZC2

Points of Contact

Electronic Business

Anne Stafford, Chief Executive Officer 2600 N Central AVE

Suite 1610

Phoenix, Arizona 85004

United States

Government Business

Anne Stafford, Chief Executive Officer 2600 N Central AVE

Suite 1610

Phoenix, Arizona 85004

United States

Service Classifications

NAICS Codes

Primary

Yes

NAICS Codes

813920

NAICS Title

Professional Organizations

Disaster Response

This entity does not appear in the disaster response registry.

Last updated by Anne Stafford on Jun 05, 2024 at 04:55 PM ARIZONA CHAPTER OF THE AMERICAN ACADEMY OF PEDIATRICS

Dec 05, 2024 07:15:25 PM GMT https://sam.gov/entity/UV6DNATKXJB6/coreData?status=null Page 2 of 2

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ENTITY INFORMATION

Search Date and Time: 12/5/2024 12:16:08 PM

Entity Details

Entity Name: THE ARIZONA CHAPTER OF THE

AMERICAN ACADEMY OF

PEDIATRICS, I

Entity ID: 08403077

Entity Type: Domestic Nonprofit Corporation Entity Status: Active

Formation Date: 5/22/1998 Reason for Status: In Good Standing

Approval Date: 5/22/1998 Status Date: 5/20/2021

Original Incorporation Date:

5/22/1998 Life Period: Perpetual

Business Type: Health Care and Social Assistance

Last Annual Report Filed: 2024

Domicile State: Arizona Annual Report Due Date: 4/22/2025

Years Due:

Original Publish Date: 6/25/1998

Statutory Agent Information

Name: SPENSERV INC Appointed Status: Active 5/22/1998

Attention:

Address: 2415 E CAMELBACK RD STE 600, PHOENIX, AZ 85016, USA

Agent Last Updated: 5/13/2024 E-mail:

Attention: Mailing Address:Privacy Policy (http://azcc.gov/privacy-policy) ǀ Contact Us (http://azcc.gov/corporations/corporation-contacts)

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Title Name Attention Address Date of Taking Office

Last Updated

Director

REBECCA EGBERT

MD FAAP

2600 N CENTRAL AVE #1610,

PHOENIX, AZ, 85004, Maricopa County, USA

6/2/2016 5/13/2024

President

KRISTINA WILSON

MD MPH FAAP

2600 N CENTRAL AVE #1610,

PHOENIX, AZ, 85004, Maricopa County, USA

6/2/2016 5/13/2024

CEO (Chief Executive Officer)

ANNE STAFFORD

2600 N CENTRAL AVE #1610,

PHOENIX, AZ, 85004, Maricopa County, USA

7/20/2015 5/13/2024

Vice-President Jodi Carter MD

FAAP

2600 N CENTRAL AVE #1610,

PHOENIX, AZ, 85004, Maricopa County, USA

7/1/2020 5/13/2024

Secretary John McGreevy MD

FAAP

2600 N CENTRAL AVE #1610,

PHOENIX, AZ, 85004, Maricopa County, USA

7/1/2020 5/13/2024

County: Maricopa

Principal Information

Address

Attention: Address: 2600 N CENTRAL AVE #1860, PHOENIX, AZ, 85004, USA

County:

Maricopa

Last Updated: 5/13/2024 Privacy Policy (http://azcc.gov/privacy-policy) ǀ Contact Us (http://azcc.gov/corporations/corporation-contacts)

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Entity Principal Office Address

Attention: Address: County: Last Updated:

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