CTR070103 Contract Amendment 1.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.: CTR070103 AMENDMENT NO.: ONE (1) Procurement Officer:

NATHANIEL THOMAS

Revised 04/08/2024

Overdose Data to Action in States University of Arizona Center for Rural Health

Effective upon signature by both parties it is mutually agreed that the ISA is amended as follows:

1. Pursuant to the Uniform Terms and Conditions, Provision Twenty-Five (25), Miscellaneous, Section 25.3 the Agreement is hereby revised with the following:

1.1 The Scope of Work is revised and replaced.

1.2 The Price Sheet is revised and replaced.

1.3 Exhibit One (1) is revised and replaced.

ALL CHANGES ARE REFLECTED IN RED

ALL OTHER PROVISIONS SHALL REMAIN IN THEIR ENTIRETY

University 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 __________ 2025 at Phoenix, Arizona

(To be filled out by ADHS Procurement Office)

University Signature

University Signature Date

Authorized Signatory’s Name and Title

University of Arizona

University Name Procurement Officer Signature

3/26/2025

Elisha Johnson, J.D., Sr. Director, Clinical Trials and Contracting

Denel Pickering

Digitally signed by Denel Pickering Date: 2025.04.02 11:51:49 -07'00'

ARIZONA DEPARTMENT

OF HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR070103 AMENDMENT NO.: ONE (1) Procurement Officer:

NATHANIEL THOMAS

Revised 04/08/2024

1. Background

1.1. The Arizona Department of Health Services (ADHS), through the Office of Injury and Violence Prevention (OIVP), administers funding from the Centers for Disease Control and Prevention (CDC) for the Overdose Data to Action (OD2A) Cooperative Agreement. The primary objective of the Overdose Data to Action in States (OD2A-S) initiative is to enhance ADHS’s capacity to track and prevent both nonfatal and fatal overdoses while also identifying emerging drug threats.

1.2. OD2A-S focuses on implementing surveillance strategies and promoting evidence-based interventions designed to immediately reduce overdose morbidity and mortality. The initiative targets opioids, stimulants, and polysubstance use when these substances are used in combination. Central to OD2A-S is a data-to-action framework that emphasizes the utilization of surveillance and other data to inform prevention efforts and policy decisions, with a strong commitment to addressing health equity and disparities.

1.3. ADHS is dedicated to supporting County health departments in the execution of data-driven prevention programs. As part of the OD2A-S priorities, ADHS provides necessary support to participating Counties, which shall engage in activities aligned with the following prevention strategies:

Strategy 7: Public Safety Partnerships/Interventions Strategy 8: Harm Reduction Strategy 9: Community-Based Linkages to Care (LtC)

1.4. The abuse and addiction to opioids represents a significant and complex public health challenge at both national and state levels. Over the past two (2) decades, drug overdose deaths have escalated, becoming the leading cause of injury-related death in the United States. According to CDC data, there were 92,452 overdose deaths reported in 2020, a thirty percent (30%) increase from 71,130 in 2019. Of these deaths, opioids were implicated in 69,031 cases, accounting for seventy-five percent (75%) of all drug overdose fatalities.

1.5. Historically, the opioid epidemic was largely driven by prescription medications. Data from Arizona’s Controlled Substances Prescription Monitoring Program (CSPMP) indicates that in 2019, there were approximately 4.1 million Class II-IV prescriptions written and over 240 million pills dispensed in the State— equating to around thirty-four (34) controlled substance pills for every Arizona resident. However, recent statistics reveal that Arizona ranks twenty-eigth (28th) in opioid prescribing, with 44.1 prescriptions per 100 people, indicating that prescription practices are no longer the primary cause of overdose deaths.

1.6. Currently, the predominant factor in the opioid crisis is the emergence of fentanyl. In 2019, synthetic opioids were responsible for more than 36,000 deaths in the U.S., representing seventy-three percent (73%) of all opioid-related fatalities that year. The majority of these deaths were linked to illicitly manufactured fentanyl, commonly found in counterfeit pills or mixed with other drugs, such as heroin. In Arizona, the presence of fentanyl in overdose cases rose dramatically from nine percent (9%) in 2017 to fifty percent (50%) in 2021.

1.7. Beyond the tragic human toll, the financial implications of opioid misuse are substantial. In 2019 alone, there were 56,623 hospital visits in Arizona related to opioid use, with an average cost of $11,942.00 per visit, resulting in an estimated $676 million in healthcare costs associated with opioids.

ARIZONA DEPARTMENT

OF HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR070103 AMENDMENT NO.: ONE (1) Procurement Officer:

NATHANIEL THOMAS

Revised 04/08/2024

1.8. The escalating addiction rates and overdose deaths, driven by both prescription and illicit opioids, underscore a growing national crisis. Overdose fatalities now rank as the leading cause of preventable injury deaths in the United States, necessitating urgent and effective interventions through initiatives like

OD2A-S.

1.9. University of Arizona Center for Rural Health (UACRH) receives OD2A Cooperative Agreement funds to achieve goals that align with strategies aimed at enhancing surveillance, prevention, and intervention efforts related to overdose deaths. This includes implementing evidence-based practices to reduce opioid and stimulant misuse, improving harm reduction initiatives, fostering community partnerships, and addressing health disparities to ensure equitable access to care and support for affected populations. Through these efforts, UACRH seeks to enhance public health outcomes and ultimately decrease the incidence of both fatal and nonfatal overdoses in the community.

2. Objective

2.1. The objective of this Agreement aims to address the escalating opioid crisis in Arizona by enhancing the capacity of County health departments to implement effective prevention strategies, improve access to overdose prevention tools and treatment options, and strengthen community linkages for individuals with Opioid Use Disorder (OUD). The expected outcomes include reduced opioid misuse, increased retention in care, and improved overall community health and safety.

3. Scope of Service

3.1. The purpose of this Interagency Service Agreement (ISA) is to strengthen clinician and health system management, as well as harm reduction efforts in Arizona to effectively address the opioid crisis. The UACRH will participate in statewide meetings, including the Opioid Clinical Advisory Group and the ASU Medication Assistance Treatment Advisory Group, to foster collaboration among healthcare providers. They will develop and deliver five professional development sessions focusing on the 2022 CDC Opioid Prescribing Guidelines and medications for opioid use disorder (MOUD).

3.2. To improve access to addiction resources, UACRH will maintain a centralized list of non-Medicaid services, update county substance use disorder treatment guides, and create two (2) additional resources for American Indian populations. Coordination with Arizona 2-1-1 will ensure the effective centralization of information. A training and technical assistance plan will be developed to support healthcare organizations in integrating the CDC guidelines into electronic health records (EHRs), with a focus on workflows that promote health equity in prescribing practices.

3.3. In the harm reduction area, the UACRH will identify existing training for community health workers/representatives (CHW/Rs) and deliver at least one training session. They will document current training offerings, update materials to include topics such as fentanyl and social determinants of health, and provide these resources in both English and Spanish. Professional development sessions will also cover naloxone, fentanyl test strips, and other harm reductions strategies.

3.4. Through these comprehensive efforts, the UACRH aims to enhance community response, promote harm reduction, and improve access to care for individuals impacted by substance use disorders.

ARIZONA DEPARTMENT

OF HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR070103 AMENDMENT NO.: ONE (1) Procurement Officer:

NATHANIEL THOMAS

Revised 04/08/2024

4. Requirements

4.1. The University shall designate a point of contact that shall be responsible for maintaining documentation of any Public Service Announcements (PSA) created and placed in the county, regarding opioid misuse prevention.

4.2. Participate in surveys, interviews (remote or face-to-face), and questionnaires developed and disseminated by ADHS’ Evaluation Team or Consultant to collect data and information necessary to assess the state and local progress with meeting grant related goals, objectives, evaluation, and outcomes.

4.3. Receive prior approval before developing or releasing any PSAs or new educational materials.

4.4. Prepare and submit annual budget(s) and work/ action plan(s).

4.5. Prepare and submit quarterly Contractors Expenditures Reports (CERs) and documentation at the end of each quarter.

4.6. Submit quarterly reports to ADHS detailing quarterly progress on grant activities.

4.7. Plan, schedule, and attend onsite/ virtual site visits with ADHS staff, as necessary to meet grant requirements.

4.8. Attend and participate in quarterly Contractor meetings with ADHS.

5. Funding Restrictions

Funds shall not be used for the following:

5.1. Purchasing tents and sleeping bags is not allowable as this is considered housing supplies.

5.2. Promotional items:

5.2.1. Promotional items with logos and website QR codes such as gifts and souvenirs. Items could include water bottles, lip balm, sunscreen, hand sanitizer, tote bag, wrist bands.

5.2.2. Promotional items such as gifts and souvenirs are unallowable. However, advertising costs for the purpose of program outreach and purposes within the scope of the program can be considered allowable.

5.3. Cash as compensation for data collection or using cash for LtC outreach and engagement.

5.4. Funding for data collection or data analysis through Behavioral Risk Factor Surveillance System (BRFSS) or Youth Risk Behavior Surveillance System (YRBS) surveys.

5.5. Funding for neonatal abstinence syndrome (NAS) surveillance, or Hepatitis C/Human Immunodeficiency Virus (HIV) surveillance.

5.6. Funding for wastewater/sewage surveillance.

ARIZONA DEPARTMENT

OF HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR070103 AMENDMENT NO.: ONE (1) Procurement Officer:

NATHANIEL THOMAS

Revised 04/08/2024

5.7. Drug testing for deaths due to motor vehicle crashes.

5.8. Ensuring that PDMPs are easy to access and use by clinicians:

5.8.1. Providing reimbursement/incentives to clinicians.

5.8.2. Providing direct care, e.g., providing care based off Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool or for substance use disorder (SUD)/opioid use disorder (OUD).

5.9. Integrate the PDMP with other health systems data:

5.9.1. Spending beyond twenty percent (20%) of prevention budget on PDMP activities for PDMPs that do not meet the statutory standards as defined in 45 CFR Part 170 [as set forth in 21st Century Cures Act] which includes use of open standards, open architecture, and open application programing interfaces and maintaining bidirectional connections.

5.10. Costs associated with general clinician training/educational activities and clinic-associated items/activities:

5.10.1. Providing financial incentives for clinicians to participate in educational sessions and training activities (e.g., participation in academic detailing, attending seminars, completion of post-session surveys).

5.10.2. Purchasing/leasing furniture.

5.10.3. Purchasing naloxone (e.g., Narcan).

5.10.4. Purchasing syringes (excluding syringes for use with intramuscular naloxone).

5.10.5. Implementing drug disposal (drug disposal programs, drug take back programs, drug drop box, drug disposal bags).

5.10.6. Providing direct patient care.

5.10.7. Conducting HIV, hepatitis B/C, and/or transmitted infection (STI) testing.

5.11. Building and implementing health system capacity including but not limited to screening, diagnosing, connecting to, and supporting trauma-informed longitudinal care for OUD and StUD and support recovery for adults and adolescents:

5.11.1. Fees associated with clinicians obtaining Drug Enforcement Administration (DEA) licensure.

5.11.2. Research – Guidance on how CDC interprets the definition of research in the context of public health can be found at https://www.hhs.gov/ohrp/regulationsand-policy/regulations/45-cfr- 46/index.html.

5.11.3. Direct funding or expansion of the provision of clinical substance abuse treatment.

ARIZONA DEPARTMENT

OF HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR070103 AMENDMENT NO.: ONE (1) Procurement Officer:

NATHANIEL THOMAS

Revised 04/08/2024

5.12. Developing and maintaining Public Health/Public Safety (PH/PS) partnerships or collaboratives at the state level:

5.12.1. Direct patient care for those experiencing disrupted access to prescription opioids or other substances.

5.12.2. Purchase of machines like TruNarc for the purpose of reducing fentanyl exposure among first responders.

5.12.3. Activities without both a public health and public safety component.

5.13. Efforts to improve the sharing, availability, and/or use of data that are not directly related to drug threats, overdose, and associated drivers and harms.

5.14. Implementing evidence-based overdose prevention strategies at the intersection of PH/PS (including LtC and harm reduction):

5.14.1. Purchasing naloxone (e.g., Narcan).

5.14.2. Purchasing syringes (excluding syringes for use with intramuscular naloxone).

5.15. Implementing promising overdose prevention strategies at the intersection of PH/PS.

5.16. Syringe Service Programs (SSPs):

5.16.1. Establishing a new SSP.

5.16.2. Purchasing syringes (excluding syringes for use with intramuscular naloxone).

5.16.3. Implementing drug disposal (drug disposal programs, drug take back programs, drug drop box, drug disposal bags).

5.16.4. Provision of equipment solely intended for illegal drug use such as:

5.16.4.1. Cookers/spoons.

5.16.4.2. Syringes.

5.16.4.3. Pipes.

5.16.5. Procurement of other equipment solely intended for preparing drugs for illegal drug injection such as:

5.16.5.1. Sterile water.

5.16.5.2. Filters.

5.16.5.3. Tourniquets.

ARIZONA DEPARTMENT

OF HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR070103 AMENDMENT NO.: ONE (1) Procurement Officer:

NATHANIEL THOMAS

Revised 04/08/2024

5.16.5.4. Razors.

5.16.5.5. Straws.

5.16.5.6. Plastic cards.

5.16.5.7. Tiny spoons.

5.16.6. Supervised consumption sites (controlled environments that facilitate safer use of illicit drugs by providing medical staff, clean facilities, and education).

5.17. Overdose Education and Naloxone Distribution (OEND):

5.17.1. Distribution of expired naloxone:

5.17.1.1. OD2A funds may not be used to distribute expired naloxone.

5.17.1.2. For guidance on distribution of expired naloxone using non-CDC funds consult with your health department for guidance.

5.17.2. Purchase of naloxone.

5.18. Initiating LtC activities:

5.18.1. Funding or subsidizing rent for individuals linked to treatment.

5.19. Supporting retention in care:

5.19.1. Purchasing and distributing test strips for testing in biological samples for clinical decision-making purposes.

5.19.2. Providing limited, local housing (e.g., 1-2 days in a hotel) while linking individuals to treatment.

5.19.3. Purchasing/leasing furniture.

5.19.4. Purchasing naloxone (e.g., Narcan).

5.19.5. Facilitating and Maintaining Recovery.

5.19.6. Infrastructure costs for educational sessions and trainings (e.g., rent, utilities, etc.).

5.20. Cross category activities:

5.20.1. Funding or subsidizing costs associated with programs other than those specifically targeting overdose prevention (unless to support staff salaries for linkage to treatment, harm reduction, and support services).

ARIZONA DEPARTMENT

OF HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR070103 AMENDMENT NO.: ONE (1) Procurement Officer:

NATHANIEL THOMAS

Revised 04/08/2024

5.20.2. Implementing drug disposal (drug disposal programs, drug take back programs, drug drop box, drug disposal bags).

5.20.3. Direct patient care (e.g., medical provider salaries, the provision of treatment, treatment incentives).

5.20.4. HIV, hepatitis, and/or sexually transmitted infection testing.

6. Tasks

The University shall complete tasks to achieve the following goals under each prevention strategy:

6.1. OD2A-S Prevention Strategy Area 6A: Clinician/Health System Engagement:

6.1.1. Participate in state-wide meetings including the (a) statewide Opioid Clinical Advisory Group, (b) ASU medication assistance treatment advisory group/Echo group, (c) OD2A-S LtC grantee/contractor meetings.

6.1.2. Develop and deliver five (5) professional development content for clinicians, CHW/Rs, and other healthcare professionals on content related to the 2022 CDC Opioid Prescribing Guidelines, integrated services, x-waiver elimination, medications to treat MOUD and others.

6.1.3. Assess, develop, and maintain centralized list of non-Medicaid addiction resources building on existing resources:

6.1.3.1. Update county substance use disorder treatment guides.

6.1.3.2. Develop two more county level substance use treatment resources for American Indian Populations.

6.1.3.3. Meet with Arizona 2-1-1 to coordinate the best way to centralize information.

6.1.4. Develop training and technical assistance plan to support healthcare organizations integrating the CDC Opioid Prescribing Guidelines into the EHRs:

6.1.4.1. Connect with professionals who completed the needs assessment needs assessment to hear more about their integration of prescribing guidelines.

6.1.4.2. Develop workflows and strategies organizations can use to integrate the CDC Opioid Prescribing Guidelines into their EHRs

6.1.4.3. Review the literature regarding ways EHRs can support increasing health equity in prescribing practices.

6.2. OD2A-S Prevention Strategy Area 8. Harm Reduction:

6.2.1. Identify training that exists for CHW/Rs to integrate into healthcare settings and deliver at least one training:

ARIZONA DEPARTMENT

OF HEALTH SERVICES

OFFICE OF PROCUREMENT

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

AGREEMENT NO.: CTR070103 AMENDMENT NO.: ONE (1) Procurement Officer:

NATHANIEL THOMAS

Revised 04/08/2024

6.2.1.1. Meet with groups that offer training to CHW/Rs to document what currently exists in terms of content and modes/methods, and languages.

6.2.2. Update training material to include education about fentanyl, stimulants, and social determinants of health. Provide training materials in English and Spanish.

6.2.3. Develop and provide professional development on naloxone, fentanyl test strips, deterrer bags and other harm reduction resources.

7. State-Provided Items

ADHS will:

7.1. Provide budget, work/ action plan, CER, and quarterly report templates.

7.2. Coordinate quarterly Contractor calls with University staff to facilitate State and county updates, and progress on opioid prevention projects and activities.

7.3. Host an annual meeting for funded agencies and organizations, either face-to-face or virtual.

7.4. Schedule meetings and professional development opportunities with Counties and Universities to provide additional support for the implementation of grant related activities.

7.5. Arizona Opioid Epidemic webpage and Interactive Data Dashboard:

7.5.1. https://www.azdhs.gov/opioid/.

7.6. Arizona Opioid Assistance and Referral (OAR) Line:

7.6.1. https://phoenixmed.arizona.edu/oar.

7.7. CDC Drug Overdose Website:

7.7.1. https://www.cdc.gov/drugoverdose/.

8. Approvals

8.1. Prior to publishing or recording any marketing materials including, but not limited to, brochures, posters, public service announcements, publications, videos, or journal articles which shall be developed and paid using funds awarded under this Agreement, a draft of the marketing material must first be approved by ADHS. The ADHS Communications Director must approve prior to the dissemination of such materials or airing of such announcements.

8.2. With prior written approval from the ADHS Program Manager, the Contractor is authorized to transfer up to a maximum of ten percent (10%) of the total budget amount between 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. The Contractor should reach out to the ADHS Program Manager before the end of the third (3rd) quarter, so that a timely amendment can be processed by ADHS.

ARIZONA DEPARTMENT

OF HEALTH SERVICES

OFFICE OF PROCUREMENT

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

8.3. Requests for publication, student thesis or dissertations based on the work funded by this ISA must be approved in writing, in advance, by the ADHS Principal Investigator. The University shall submit the request to the ADHS Principal Investigator at least forty-five (45) days in advance of the proposed publication date.

ADHS agrees to limit circulation and use of such materials to internal distributions with ADHS and agrees that such distribution will be solely for the purposes of review and comment. ADHS may require additional statements and will provide the statements when needed.

9. Deliverables

The University shall:

9.1. Participate in surveys, interviews (remote or face-to-face), and questionnaires developed and disseminated by ADHS’ Evaluation Team or Consultant to collect data and information necessary to assess the state and local progress with meeting grant related goals, objectives, evaluation, and outcomes.

9.2. Receive prior approval before developing or releasing any PSAs or new educational materials.

9.3. Prepare and submit annual budget(s) and work/ action plan(s).

9.4. Prepare and submit quarterly CERs and documentation at the end of each quarter.

9.5. Submit quarterly reports to ADHS detailing quarterly progress on grant activities.

9.6. Plan, schedule and attend onsite/ virtual site visits with ADHS staff, as necessary to meet grant requirements.

9.7. Attend and participate in quarterly Contractor meetings with ADHS.

9.8. Participate in statewide media/marketing efforts.

9.9. Attend and participate in ADHS’ LtC workgroup.

9.10. Attend and participate in any training, Statewide Contractor’s meetings, or professional development provided by ADHS or its contracted vendors, as necessary.

CDC Overdose Data to Action (OD2A) Grant Deliverables Timeline (September 1 - August 31)

DELIVERABLE TITLE DUE DATE

1st Quarter Survey Completion and CER (September – November) December 31 2nd Quarter Survey Completion and CER (December – February) March 31

3rd Quarter Survey Completion and CER (March – May) June 30 4th Quarter Survey Completion and CER (June – August) September 30

ARIZONA DEPARTMENT

OF HEALTH SERVICES

OFFICE OF PROCUREMENT

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

10. Notices, Correspondence, and Reports

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

Arizona Department of Health Services Elizabeth Markona Opioid Program Administrator 150 N 18th Avenue, Suite 310-B Phoenix, AZ 85007-3242 Email: elizabeth.markona@azdhs.gov

With an email cc: to invoices@azdhs.gov

10.2. Contractor Expenditure Reports (CERs) and documentation from University to ADHS shall be sent to:

Dominic Orso OD2A Program Manager 150 N 18th Ave, Suite 310-B Phoenix, AZ 85007 Email: dominic.orso@azdhs.gov

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

University of Arizona Bridget S. Murphy, DBH, M.Ed.

Assistant Research Professor Mel & Enid Zuckerman College of Public Health & Arizona Center for Rural Health Phone: 520-621-6611 bridget@arizona.edu

ARIZONA DEPARTMENT

OF HEALTH SERVICES

OFFICE OF PROCUREMENT

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

REVISED PRICE SHEET

Cost Reimbursement Annual Price Sheet

ACCOUNT CLASSIFICATION LINE-ITEM TOTAL

Personnel Services* $197,246.00

Employee Related Expenses* $56,035.00

Professional and Outside Services* $71,000.00

Travel* $7,500.00

Occupancy $0.00

Other Operating* $16,045.00

Capital Outlay (Equipment) $0.00

*Indirect Rate and Costs (15%) $52,174.00

TOTAL ANNUAL (NOT TO EXCEED) $400,000.00

The Contractor is authorized to transfer up to a maximum of ten percent (10%) of the total budget amount between line items with the written approval from an ADHS Program Manager.

Transfers exceeding ten percent (10%) or to a non-funded line item shall require an Agreement Amendment.

*Indicated indirect rate calculation.

ARIZONA DEPARTMENT

OF HEALTH SERVICES

OFFICE OF PROCUREMENT

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

Exhibit One (1)