CTR070152 Contract Amendment 2.pdf

INTERGOVERNMENTAL AGREEMENT (IGA)

Amendment

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N. 18th Ave., Suite 530 Phoenix, Arizona 85007

Contract No.: CTR070152 IGA Amendment No: 2 Procurement Officer:

Nathaniel Thomas

Revised 05/29/2024

CDC Overdose Data to Action - OD2A-S Navajo County

It is mutually agreed that the Intergovernmental Agreement referenced is amended as follows:

1. Pursuant to Terms and Conditions, Provision Six (6) Contract Changes, subsection 6.1 Amendments, the Contract 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 of this agreement remain unchanged.

Navajo County Public Health Services

Contractor Name: County Authorized Signature

117 E. Buffalo St.

Address: Print Name

Holbrook AZ 86025 City State Zip Title and Date

Pursuant to A.R.S. § 11-952, the undersigned public agency attorney has determined that this Intergovernmental Agreement is in proper form and is within the powers and authority granted under the laws of Arizona.

This Intergovernmental Agreement Amendment shall be effective the date indicated. The Public Agency is hereby cautioned not to commence any billable work or provide any material, service or construction under this IGA until the IGA has been executed by an authorized ADHS signatory.

State of Arizona

Signature Date Signed this day of 2025.

Print Name Procurement Officer

Contract No.: CTR070152, which is an Agreement between public agencies, has been reviewed pursuant to A.R.S. § 11-952 by the undersigned Assistant Attorney, who has determined that it is in proper form and is within the powers and authority granted under the laws of the State of Arizona.

Signature Date

Assistant Attorney General Print Name

Alice Perepech Digitally signed by Alice Perepech DN: cn=Alice Perepech, o=Arizona Attorney General's Office, email=Alice.Perepech@azag.gov, c=US Date: 2025.04.11 10:48:30 -07'00'

Nathaniel Thomas

Digitally signed by Nathaniel Thomas Date: 2025.04.11 13:51:49 -07'00'

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 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 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.

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. Navajo County Public Health Services District (NCPHSD) receives Overdose Data to Action (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, NCPHSD 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 IGA, led by the NCPHSD, is to strengthen public safety partnerships, promote harm reduction, and establish community-based LtC to combat opioid misuse and overdose. NCPHSD shall ensure public safety representation on the Navajo County Overdose Fatality Review team, fostering collaboration between health and safety agencies to improve overdose prevention efforts. Additionally, NCPHSD shall provide training to public safety agencies on naloxone administration, encouraging broader participation in Naloxone Leave-Behind Programs to support those affected by overdose.

3.2. NCPHSD shall advance harm reduction through comprehensive education initiatives, increasing community access to naloxone and training on its proper use. Working with the Arizona Department of Health Services (ADHS) to provide naloxone, NCPHSD shall track its usage across the County, helping to monitor the program's effectiveness. Educational materials and media campaigns shall be developed to raise awareness on harm reduction strategies, emphasizing safe practices and overdose prevention.

3.3. To enhance community-based LtC, NCPHSD shall collaborate with local correctional facilities, schools, and businesses. These partnerships shall enable NCPHSD to connect individuals to resources and support systems that facilitate retention in care and access to necessary treatment options. Through these coordinated strategies, NCPHSD aims to strengthen community partnerships, promote harm reduction, and improve access to care for individuals impacted by opioid and substance use disorders in Navajo County.

4. REQUIREMENTS

4.1. The County shall designate a point of contact that shall be responsible for maintaining documentation of any public service announcements (PSAs) 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 cannot 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/HIV surveillance.

5.6. Funding for wastewater/sewage surveillance.

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)/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 human immunodeficiency Virus (HIV), hepatitis B/C, and/or sexually 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 Stimulant Use Disorder (StUD) and support recovery for adults and adolescents:

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

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

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,

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.

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 – OD2A funds may not be used to distribute expired naloxone -

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).

5.20. Facilitating and Maintaining Recovery.

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

5.21. Cross category activities:

5.21.1. 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).

5.21.2. Implementing drug disposal (drug disposal programs, drug take back programs, drug drop box,

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

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

6. TASKS

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

6.1. Public Safety Partnerships: Developing or maintaining strong public health and public safety partnerships.

6.1.1. Ensure Navajo County Overdose Fatality Review team has public safety representatives on the team.

6.1.2. Train public safety agencies on naloxone usage and encourage participation in Naloxone Leave

Behind Programs.

6.2. Harm Reduction: Dissemination of education and communication materials and media to community members.

6.2.1. Increase Naloxone training and tracking of usage (with Naloxone provided by ADHS).

6.3. Community-Based LtC: LtC that support retention in care.

6.3.1. Partnerships with corrections, schools, and businesses.

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 County 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 to provide additional support for the implementation of grant related activities.

7.5. Arizona Opioid Epidemic Webpage and Interactive Data Dashboard:

7.5.1. azhealth.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, PSAs, publications, videos, or journal articles which will 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 County 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 County 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.

8.3. Requests for publication, student thesis or dissertations based on the work funded by this IGA must be approved in writing, in advance, by the ADHS Principal Investigator. The County 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 County 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 Contractors Expenditures Reports (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

10. Notices, Correspondence, and Reports

10.1. Notices, correspondence and reports from the County 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

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

Arizona Department of Health Services 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 County shall be sent to:

Navajo County Public Health Services District Amy Stradling Outreach & Education Division Manager 600 North 9th Place Show Low, AZ 85901 Phone: (928) 532-6050 EXT 5522 Email: Amy.stradling@navajocountyaz.gov

COST REIMBURSEMENT

Revised Annual Price Sheet

ACCOUNT CLASSIFICATION LINE-ITEM TOTALS

Personnel Services* $62,973.00

Employee Related Expenses* $12,342.00

Professional and Outside Services $0.00

Travel* $2,818.00

Occupancy $0.00

Other Operating* $1,448.00

Capital Outlay (Equipment) $0.00

*Indirect Rate and Costs (0.5%) $437.00

TOTAL ANNUAL (NOT TO EXCEED): $80,000.00

*Indicated indirect rate calculation

**The County 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.

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N. 18th Ave., Suite 530 Phoenix, Arizona 85007

Contract No.: CTR070152 IGA Amendment No: 2 Procurement Officer:

Nathaniel Thomas

Exhibit One (1) – 2CFR 200.332( )

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N. 18th Ave., Suite 530 Phoenix, Arizona 85007

Contract No.: CTR070152 IGA Amendment No: 2 Procurement Officer:

Nathaniel Thomas

COUNTY OF NAVAJO

Unique Entity ID

FH3HTA8K5456

CAGE / NCAGE

37ET7

Purpose of Registration

All Awards

Registration Status

Active Registration

Expiration Date

Jun 28, 2025

Physical Address

100 E Code Talkers DR

Holbrook, Arizona 86025-3479

United States

Mailing Address

Navajo County Finance

PO Box 668

Holbrook, Arizona 86025-3479

United States

Business Information

Doing Business as

(blank)

Division Name

Navajo County Government

Division Number

Congressional District

Arizona 02

State / Country of Incorporation

(blank) / (blank)

URL

http://www.navajocountyaz.gov

Registration Dates

Activation Date

Jul 2, 2024

Submission Date

Jun 28, 2024

Initial Registration Date

Mar 14, 2005

Entity Dates

Entity Start Date

Mar 21, 1895

Fiscal Year End Close Date

Jun 30

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 Local Government

Organization Factors

(blank)

Profit Structure

(blank)

Last updated by Jackie Walker on Jun 28, 2024 at 05:39 PM COUNTY OF NAVAJO

Feb 25, 2025 05:13:31 PM GMT https://sam.gov/entity/FH3HTA8K5456/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. Local Government

County

Financial Information

Accepts Credit Card Payments

Yes

Debt Subject To Offset

No

EFT Indicator

CAGE Code

37ET7

Points of Contact

Electronic Business

JAYSON VOWELL, Finance Director P.O. Box 668

Holbrook, Arizona 86025

United States

Government Business

JAYSON VOWELL, Finance Director PO Box 668

Holbrook, Arizona 86025

United States

Service Classifications

NAICS Codes

Primary

Yes

NAICS Codes

921110

NAICS Title

Executive Offices

921120 Legislative Bodies

921130 Public Finance Activities

922110 Courts

922120 Police Protection

922130 Legal Counsel And Prosecution

922140 Correctional Institutions

922150 Parole Offices And Probation Offices

922190 Other Justice, Public Order, And Safety Activities

923110 Administration Of Education Programs

923120 Administration Of Public Health Programs

Disaster Response

This entity does not appear in the disaster response registry.

Last updated by Jackie Walker on Jun 28, 2024 at 05:39 PM COUNTY OF NAVAJO

Feb 25, 2025 05:13:31 PM GMT https://sam.gov/entity/FH3HTA8K5456/coreData?status=null Page 2 of 2

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