CONTRACT AMENDMENT

1. AMENDMENT #:

2. CONTRACT #:

YH23-0067

CTR062538

3. EFFECTIVE DATE OF AMENDMENT:

Upon Final Signature

4. PROGRAM:

DGI

5. CONTRACTOR/PROVIDER NAME AND ADDRESS:

Arizona Board of Regents

Acting on Behalf of the Arizona State University (ASU) Office of Research & Sponsored Projects Administration

P.O. Box 876100 Tempe, AZ 85287-6011

To remove and replace the existing SOR III Year 2 Price Sheet and Budget Narrative and Justification for the term September 30, 2023, through September 29, 2024 with the attached.

7. THE ABOVE REFERENCED CONTRACT IS HEREBY AMENDED AS FOLLOWS:

Contract YH23-0067 is hereby amended to remove and replace the existing SOR III Year 2 Price Sheet and Budget Narrative and Justification for the term September 30, 2023, through September 29, 2024 with the attached.

All other portions of the Contract remain in effect.

NOTE: Please sign, date, and return one scanned copy to: Marie Horn, Senior Procurement Specialist at marie.horn@azahcccs.gov

Electronic Submission: An electronic or portable document file (PDF) copy of this amendment shall serve as the original.

8. IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES IN AGREEMENT.

9. NAME OF CONTRACTOR/PROVIDER:

Arizona Board of Regents, Acting on Behalf of the Arizona State University

10. ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM

SIGNATURE OF AUTHORIZED INDIVIDUAL: SIGNATURE:

TYPED NAME:

Kristy Macdonald

TYPED NAME:

Tracey Thomas

ATTEST:

Assistant Director, Research Operations

TITLE:

Procurement Manager

DATE: DATE:

DocuSign Envelope ID: 187BAF59-B37F-4808-8440-AD1D74EFEBAC

12/15/202312/22/2023 mailto:marie.horn@azahcccs.gov

PRICE SHEET

FUNDING / METHOD OF REIMBURSEMENT

SOR III Year 2 September 30, 2023, through September 29, 2024

ASU - SIRC

YH23-0067

ACCOUNT CLASSIFICATION TOTAL AWARD

Personnel $94,294

ERE/Fringe $31,214

Travel Expense $2,369

Equipment $0

Supplies $0

Contractual $0

Other Operating $22,400

Total Direct Charges $150,277

Indirect Charges or Admin (If Authorized)* $66,723

TOTAL $217,000

With prior written approval from the Program Manager, the contractor is authorized to transfer up to a maximum of 10% of the total budget amount between line items. Transfers of funds are only allowed between funded line items. Transfers exceeding 10% or to a non-funded line item shall require an amendment.

All travel related expenditures will require itemized receipts and will not exceed the State allowable rates which can be found at the State of Arizona Accounting Manual (SAAM) https://gao.az.gov/publications/saam

In compliance with 2 CFR Part 200, Grants & Agreements §200.331, Requirements for Pass Thru Entities (subrecipient), the information below is solely to comply with 2 CFR Part 200 and does not reflect the funding amount or period of performance of the contract. Please refer to the Contract & Cost Reimbursement Line-Item Budget for funding amount and Period of Performance.

Grantor: Substance Abuse & Mental Health Services Administration (SAMHSA) Grantee: Arizona Health Care Cost Containment System Grant Name: State Opioid Response III Grant (SOR III)

CFDA: 93.788

Federal Award Identification Number (FAIN)

Award Amount Issue Date Award Period Period of Performance (Project Performance

FFATA

(Y/N)

H79TI085739 $33,080,062 09/05/2023 09/30/23 –

09/29/24

09/30/2022 – 09/29/2024

Y https://gao.az.gov/publications/saam

Budget Narrative and Justification SORIII – Year 2

ASU – SIRC

YH23-0067

September 30, 2022 – September 29, 2023

A. Personnel:

Position (1)

Name (2)

Key Staff (3)

Annual Salary/Rate (3)

Level of Effort (5)

Total Salary Charge to Award

(6)

Principal Investigator Natasha Mendoza Yes $98,428 6.667% $6,562

Co-Investigator Stephanie Lechuga Pena $87,200 6.881% $6,000

Co-Investigator Manuel Cano $85,000 2.353% $2,000

Clinic Coordinator Maria Hanlin $80,945 8% $6,476

Project Manager Elisabeth Williams $70,000 8% $5,600

Research and Evaluation Specialist Trey Jenkins $56,000 25% $14,000

Senior Program Manager Isabel Larsen $83,116.80 5% $4,156

Research Specialist Nika Hernandez $50,000 50% $25,000

Research Specialist Jennifer Martinez-Sanchez $49,000 50% $24,500

TOTAL REQUEST $94,294

JUSTIFICATION:

The Principal Investigator (Mendoza) is responsible for the ASU portion of the SOR project, leading staff efforts in three (3) main areas on the SOR project, expanded technical assistance for recovery residence providers and ongoing medication for opioid use disorder (MOUD) resource dissemination (new curriculum, MOUD pocket guide, MOUD docuseries, etc.), working in collaboration with the Co-Investigator to oversee the new provider survey component.

The Co-Investigator (Lechuga Pena) is responsible for taking the lead on a new survey component aimed at assisting provider perceptions of transitional housing needs among individuals exiting treatment services and working closely with the Principal Investigator and staff to coordinate data collection, reporting and recommendations.

The Co-Investigator (Cano) is responsible for leading the data analysis efforts for the Project MATTRR’s and Recovery Home Academy project, cleaning, analyzing, and reporting on data collected as part of the provider survey, conducting and/or overseeing complex analyses, creating data visualizations, writing clear and concise reports that summarize data analysis findings, collaborating with other members of the research team to ensure that data collection and analysis is conducted in a timely and efficient manner.

The Clinic Coordinator (Hanlin) is responsible for managing the day-to-day logistics and administration of the ECHO program including but not limited to reminder emails to participants, inputting new program registrations, data entry into the ECHO Institute database (iECHO), CME coordination and guest presenter liaising.

The Project Manager (Williams) is responsible for overseeing the management of the program including outreach and recruitment of new Centers of Excellence, planning of annual curricula, participant data collection (post-session and annual surveys), participation in hub team huddles and planning meetings, and quarterly report development.

The Research and Evaluation Specialist (Jenkins) is responsible for serving in a supportive role to the project Principal Investigator and will contribute to the technical assistance (TA) of community partners in housing services (e.g., sober living homes, residential SUD’s treatment), including evaluation of these TA activities.

The Senior Program Manager (Larsen) is responsible for providing overall project administrative support for the Principal Investigator and staff.

The Research Specialist (Hernandez) is responsible for ensuring project logistics are organized and that project reporting is comprehensive and timely and providing support for data collection, analysis, interpretation, and reporting.

The Research Specialist (Martinez-Sanchez) is responsible for assisting project leads in developing a scoping literature review, disseminating findings from project evaluation, supporting Project MATTRR’s curriculum development, and offering coordination support for gap analysis related to housing.

B. Fringe Benefits:

Position (1)

Name (2)

Rate (3)

Total Salary Charged to Award

(4)

Total Fringe Charged to Award

(5)

Principal Investigator Natasha Mendoza 27.10% $6,562 $1,778

Co-Investigator Stephanie Lechuga Pena 27.10% $6,000 $1,626

Co-Investigator Manuel Cano 27.10% $2,000 $542

Clinic Coordinator Maria Hanlin 34.20% $6,476 $2,215

Project Manager Elisabeth Williams 34.20% $5,600 $1,915

Research and Evaluation Specialist Trey Jenkins 34.20% $14,000 $4,788

Senior Program Manager Isabel Larsen 34.20% $4,156 $1,421

Research Specialist Nika Hernandez 34.20% $25,000 $8,550

Research Specialist Jennifer Martinez-Sanchez 34.20% $24,500 $8,379

FEDERAL REQUEST $31,214

JUSTIFICATION: ASU defines fringe benefits as direct costs, estimates benefits as a standard percent of salary applied uniformly to all types sponsored activities, and charges benefits to sponsors in accordance with the Federally negotiated rates in effect at the time salaries are incurred. Benefit costs are expected to increase per year, the rates used in the proposal budget are based on the current Federally negotiated Rate Agreement rate plus annual escalation for out years. Below is a breakdown of the rates used above for FY 23.

Any start date of six months or more into a fiscal year will use the following fiscal year’s rates according to ASU policy.

Employee Related Expenses (ERE) Faculty Staff Post Docs Students RA/TA

Workers Comp Insurance 0.21% 0.21% 0.21% 0.21% 0.21%

Retiree Accumulated Sick Leave 0.35% 0.39% 0.38% 0% 0%

Unemployment Insurance 0.01% 0.04% 0% 0% 0%

FICA Tax 6.52% 6.87% 6.57% 1.31% 0.19%

Combined Retirement 7.36% 9.11% 0% 0% 0%

ASRS Long Term Disability 0.13% 0.15% 0.17% 0% 0%

Group Health Insurance 9.71% 15.05% 15.57% 0% 0%

RATA Health Insurance 0% 0% 0% 0% 9.04%

RATA Dental Insurance 0% 0% 0% 0% 0.07%

Group Dental Insurance 0.07% 0.11% 0.10% 0% 0%

Life/ACC Death/Disability 0.07% 0.08% 0.08% 0% 0%

Dependent Care Flex Spending 0.01% 0.01% 0.01% 0% 0%

Medical Exp Flex Spending 0.02% 0.02% 0.02% 0% 0%

Employee Tuition Reimbursement 0.16% 1.50% 0% 0% 0%

Sabbatical Payments 2.20% 0% 0% 0% 0%

Employee Assistance 0.06% 0.06% 0.06% 0% 0%

Accrued Vacation Payouts 0.20% 0.94% 0.01% 0% 0%

Fertility/Adoption 0.01% 0.01% 0% 0% 0%

Gender Affirming 0.02% 0.02% 0% 0% 0%

Pool Adjustment from FY22 (Over)/Under Recovery

0.03% -0.37% -1.45% 0.10% 1.96%

ERE Total 27.1% 34.2% 21.7% 1.6% 11.5%

C. Travel:

Please note: All travel expenditures will require itemized receipts and will not exceed the State allowable rates which can be found in the State of Arizona Accounting Manual (SAAM) https://gao.az.gov.publications/saam https://gao.az.gov.publications/saam

Purpose (1)

Destination (2)

Item (3)

Calculation (4)

Travel Cost Charged to the Award

(5)

In-State Travel Maricopa County Mileage 398 miles x $0.625 $249

AATOD Conference Las Vegas, NV Lodging $209/night x 1/staff x 5/nights $1,045

AATOD Conference Las Vegas, NV Per Diem $59/day x 1/staff x 6/days $354

AATOD Conference Las Vegas, NV Concur Travel Fee $11

FEDERAL REQUEST $2,369

JUSTIFICATION:

Local travel to conduct project activities, training events, and meetings within the State of Arizona. Local travel is based upon Arizona’s allowable mileage reimbursement rate of .625/mile. Note: Per Diem is a generic term used for budgeting purposes only.

Actual reimbursement is subject to the State of Arizona Accounting Manual (SAAM) travel policy and actual receipts.

Out-of-state travel request is for one (1) staff member to attend the American Association for the Treatment of Opioid Dependence (AATOD) Conference in Las Vegas, Nevada being held May 18-22, 2024. Dr. Mendoza has submitted an abstract to discuss Project MATTRR’s, which will educate providers across the Southwest Region (including AZ) about the impact of technical assistance with medication for opioid use disorder.

D. Equipment:

Item(s) (1)

Quantity (2)

Amount (3)

% Charged to the Award

(4)

Total Cost Charged to the Award

(5)

FEDERAL REQUEST $0

JUSTIFICATION:

E. Supplies (Items costing less than 45,000 per item):

Item(s) (1)

Rate (2)

Cost (3)

FEDERAL REQUEST $0

JUSTIFICATION:

F. Contractual:

COSTS FOR CONTRACTS MUST BE BROKEN DOWN IN DETAIL AND A NARRATIVE JUSTIFICATION PROVIDED. A SEPARATE ITEMIZED BUDGET IS REQUIRED FOR EACH CONTRACTOR. IF APPLICABLE, NUMBER OF CLIENTS SHOULD BE INCLUDED IN THE COSTS.

Name (1)

Service (2)

Rate (3)

Other (4)

Total (5)

FEDERAL REQUEST $0

G. Construction: (NOT ALLOWED)

H. Other: (Include Other Consultants)

Item Rate Cost

Consultants (HUB Team) $2,500 x 7 $17,500

Printing – MOUD and Consumer Guides $2,100 $2,100

Advertising (Facebook & Google) $1,600 $1,600

Shipping (FedEx) for guide mailing $700 $700

AATOD Conference Registration Fee $500/each x 1/staff $500

FEDERAL REQUEST $22,400

Consultants are Hub members who make up the MOUD ECHO and are experts who specialize in prevention, intervention, treatment, harm reduction and/or policy related to the ongoing opioid crisis. Hub teams members meet every other week and facilitate MOUD training to a wide audience of providers every other week via Zoom.

Advertising funds are to promote SOR-related projects including the new MOUD curriculum and emerging Toolkit for recovery residences via paid advertising to increase participation (e.g. Facebook, Google).

AATOD registration for one (1) staff member to attend the conference in Las Vegas, NV May 18-22, 2024.

I. Total Direct Charges:

FEDERAL REQUEST – TOTAL DIRECT CHARGES - $150,277

J. Indirect Cost Rate or Administration (See Footnote below):

Calculation (1)

Revised Total (2)

F&A Costs based on MTCD @ 44.40% Base: $150,277 $66,723

FEDERAL REQUEST $66,723

JUSTIFICATION: Indirect costs are calculated on Modified Total Direct Costs (MTDC) using F&A rates approved by U.S. Department of Health and Human Services (DHHS). The most current rate for on-campus research is 44.4% from FY21 and forward and the rate agreement is dated May 24, 2023. Items excluded from F&A calculation include capital equipment, subcontracts over the first $25,000, tuition remission, participation support, rental/maintenance of off-campus space and patient care fees.

FOOTNOTE:

(1) Please specify whether utilizing indirect or administrative overhead.

(2) For administrative overhead, please provide a justification of costs included in administration.

(3) For indirect costs, please specify if using the de minimis rate or provide a copy of the approved indirect cost agreement. The de minimis rate of 10 percent for non-federal entities is subject to Uniform Guidance, 20 CFR 200.414.

K. Total Project Costs:

FEDERAL REQUEST – TOTAL PROJECT COSTS –

(Sum of Total Direct Costs and Indirect (Or Admin) Costs)

$217,000

L. Budget Summary: (Should include future years, as applicable to the grant, and projected total):

Category Year 1 Year 2* Total Project Costs

Personnel $95,384 $94,294 $189,678

Fringe $30,528 $31,214 $61,742

Travel $2,623 $2,369 $4,992

Equipment $0 $0 $0

Supplies $0 $0 $0

Contractual $0 $0 $0

Other $22,317 $22,400 $44,717

Total Direct Charges $150,852 $150,277 $301,129

Indirect Charges or Administration $66,978 $66,723 $133,698

Total Project Costs $217,830 $217,000 $434,827

*For Requested Future Years

For the proposed programmatic activities listed above, indicate the total number of unduplicated individuals that will be served each grant year and over the entire project period.

Programmatic activities – providing treatment and recovery support services (if not applicable, indicate 0)

Number of Unduplicated Individuals to be Served with Grant Funds

Year 1 9/30/22 – 9/29/23

Year 2 9/30/23 – 9/29/24

TOTAL

Treatment Services 0 0 0

Recovery Support Services 0 0 0

GPRA Target** 0 0 0

**Of those individuals receiving treatment and recovery support services, indicate the total number of individuals who will complete the GPRA Client Outcome Measures. All GPRA intakes must be followed by an interview GPRA follow-up at a minimum 80% rate.

When a provider/agency is solely coordinating, navigating, and/or liaising into non-grant funded treatment and recovery support services, GPRA is not required.

Programmatic activities – providing prevention services (if not applicable, indicate 0)

Number of Unduplicated Individuals to be Served with Grant Funds

Year 1 9/30/22 – 9/29/23

Year 2 9/30/23 – 9/29/24

TOTAL

Prevention Services 0 0 0

Certificate Of Completion Envelope Id: 187BAF59B37F48088440AD1D74EFEBAC Status: Sent

Subject: Complete with DocuSign: YH23-0067 ASU Amend 4

Source Envelope:

Document Pages: 7 Signatures: 1 Envelope Originator:

Certificate Pages: 5 Initials: 0 Marie Horn

AutoNav: Enabled

EnvelopeId Stamping: Enabled

Time Zone: (UTC-07:00) Arizona

801 E. Jefferson St.

Phoenix, AZ 85034 marie.horn@azahcccs.gov

IP Address: 13.86.232.74

Record Tracking Status: Original

12/15/2023 8:46:55 AM

Holder: Marie Horn marie.horn@azahcccs.gov

Location: DocuSign

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System

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Signer Events Signature Timestamp Tracey Thomas

Tracey.Thomas@azahcccs.gov

Procurement Manager

Arizona Health Care Cost Containment System

(AHCCCS)

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Using IP Address: 98.161.254.128

Sent: 12/15/2023 8:48:01 AM

Viewed: 12/15/2023 3:56:33 PM

Signed: 12/15/2023 3:57:02 PM

Electronic Record and Signature Disclosure:

Not Offered via DocuSign kristy Macdonald

Kristy.Macdonald@asu.edu

Assistant Director

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Sent: 12/15/2023 3:57:04 PM

Viewed: 12/18/2023 7:30:28 AM

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Accepted: 6/2/2023 1:53:16 PM ID: 6d0d2da2-7e97-487a-a4a1-b79bab62f508 Company Name: Carahsoft OBO Arizona Health Care Cost Containment System

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BUDGET@azahcccs.gov

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