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HomeMy WebLinkAbout07/03/2023 Item 016 MOHAVE COUNTY REQUEST FOR BOARD ACTION FORM FORMAL ACTION 0 FROM: Chad Kingsley, Director, Department of Health CONSENT XX CONTACT/EXT: Chad Kingsley Ext. 4313 RESOLUTION 0 DATE: June 5, 2023 OTHER Q BOS MEETING DATE: 71- 3 INFORMATION ONLY 0 SUMMARIZE THE ISSUE & DESIRED ACTION CLEARLY/ATTACH BACKUP MATERIAL: To request Mohave County Board of Supervisors' approval for the renewal of the agreement for immunization billing services between Mohave County Department of Public Health (MCPDH) and The Arizona Partnership of Immunization (TAPI). Approval of this agreement continues to allow TAPI to coordinate billing services on MCDPH's behalf so MCDPH can be compensated for childhood immunization services provided to health plan members. MCDPH will receive payment for appropriately billed services provided to privately insured clients and clients listed to be on the Arizona State Medicaid Program Arizona Health Care Cost Containment System (AHCCCS), Marketplace Exchange, and other insurance systems. RECOMMENDED MOTION: Approve the renewal of the agreement for Immunization billing services between Mohave County Department of Public Health and The Arizona Partnership of Immunization. ATTACHMENTS: Contract Reviewed and Approved By: County Attorney Human Resources[:] Finance County Manager Board Action Taken: Approved as Requested No Action TakenO Disapproved Continued to E:j Approved with the following changes: Acknowledged receipt and referred to: Filing Information and Retrieval rr�� Filed Bid Filed Agreement d— BOS Resolution Filed Yearly Correspondence Filed Petition Filed Dedication Filed Land Sold Filed Land Acquired Filed Franchise ID Resolution Filed Improvement District Filed Other Date Routed:lnf n /,� :77 l� L ,1 0-� . Additional Infor a n`' /J )(yC W�-e- xC: Pk"LJ-JL � �� ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18"Ave Suite 530 Amendment Phoenix,Arizona 85007 F f Contract No.: CTR055215 IGA Amendment No: 3 Procurement Officer Hana Hehman SCOPE OF WORK 1. BACKGROUND 1.1 Centers for Disease Control and Prevention Public Health Emergency Preparedness (PHEP) Grant The Arizona Department of Health Services(ADHS),through the Bureau of Public Health Emergency Preparedness (PHEP), has been working with Arizona Counties and Tribes to improve the preparedness of each community in the event of any public health emergency. Most of these projects were funded by grants from the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS). and 1.2 Workforce Development Grant ADHS is tasked with overseeing the CDC Workforce Development Crisis Emergency Cooperative Agreement to address the need to establish,expand,and sustain a public health workforce to support COVID-19 prevention, preparedness, response, and recovery initiatives, including school-based health programs. Funding for this initiative comes from the CDC Workforce Development Crisis Emergency Cooperative Agreement. 2. OBJECTIVE 2.1 Centers for Disease Control and Prevention Public Health Emergency Preparedness (PHEP) Grant This Agreement is intended to improve upon the process. Nothing in this Agreement is meant to supplant or in any other way discourage existing planning and coordination between County and Tribal Health Departments. This Agreement is designed to increase participation in the ongoing development of the State and County Health Preparedness Infrastructure through the CDC Public Health Preparedness Cooperative Agreement with the ADHS; 2.2 Workforce Development Grant(if applicable) The goal of this project will be utilizing grant funds to establish, expand, train and sustain the public health workforce to support COVID-19 prevention, preparedness, response, and recovery initiatives, including school-based health programs. ADHS will be working with each jurisdiction on the school- based initiatives that are separate and in addition to their funding amounts through a partnership with the Department of Education. ADHS stakeholders are essential in providing support to the healthcare delivery system across Arizona. Sub-recipients of CDC Workforce Development Crisis Emergency funds are expected to strengthen and enhance jurisdictional COVID-19 prevention, preparedness, response, and recovery initiatives, including public health workforce development needs and school-based health programs. Grant related activities should be completed over a two (2) year period and fall within the following four(4) main strategies: 2.2.1 Hiring of additional public health staff to sustain ongoing COVID-19 response and recovery initiatives, 2.2.1.1 The costs, including wages and benefits, related to recruiting, hiring and training of individuals to serve as: 2.2.1.1.1 Professional or clinical staff, including public health physicians and 2 ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18"Ave Suite 530 Amendment Phoenix,Arizona 85007 � f Contract No.: CTR055215 IGA Amendment No: 3 Procurement Officer Hana Hehman nurses (other than school-based staff); mental or behavioral health specialists to support workforce and community resilience; social service specialists; vaccinators; or laboratory scientists or technicians, 2.2.1.1.2 Disease investigation staff, including epidemiologists; case investigators; contact tracers; or disease intervention specialists, 2.2.1.1.3 Program staff, including program managers; communications and policy staff; logisticians; planning and exercise specialists; program evaluators; pandemic preparedness and response coordinators to support the current pandemic response and identify lessons learned to help prepare for possible future disease outbreaks; health equity officers or teams; data managers, including informaticians, data scientists, or data entry personnel; translation services; trainers or health educators; or other community health workers, 2.2.1.1.4 Administrative staff, including human resources personnel; fiscal or grant managers; clerical staff; staff to track and report on hiring under this cooperative agreement;or others needed to ensure rapid hiring and procurement of goods and services and other administrative services associated with successfully managing multiple federal finding streams for the COVID-19 response, and 2.2.1.1.5 Any other positions that may be required to prevent, prepare for, and respond to COVID-19. 2.2.1.2 Purchase of equipment and supplies necessary to support the expanded workforce including personal protective equipment, equipment needed to perform the duties of the position, computers, cell phones, internet costs, cybersecurity software, and other costs associated with support of the expanded workforce (to the extent these are not included in recipient indirect costs). 2.2.2 Augment the public health workforce pipeline to improve the ability to sustain COVID-19 recovery initiatives and prepare for future responses, 2.2.3 Develop or enhance training programs for new and/or existing public health staff supporting COVID-19 preparedness, response, and recovery efforts, and 2.2.4 Retain existing public health staff through various initiatives to ensure continued COVID- 19 preparedness, response, and recovery efforts. 3. TASKS 3.1 Centers for Disease Control and Prevention Public Health Emergency Preparedness (PHEP)Grant: The Subrecipient shall: 3.1.1 Appoint a PHEP Coordinator, or other staff member, responsible for overseeing all grant related activities, budgets, and reports, 3 ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18"Ave Suite 530 Amendment Phoenix,Arizona 85007 Contract No.: CTRO55215 IGA Amendment No: 3 Procurement Officer Hana Hehman 3.1.2 Participate in Public Health Preparedness Regional Healthcare Coalition meetings and conference calls held in Subrecipient's regional communities as appropriate. Attend and participate in the respective regional Integrated Preparedness Planning Workshop (IPPW) meeting, 3.1.3 Review the attached ADHS PHEP Grant Deliverables(Exhibit B)document and use for grant reference, and 3.1.4 Review and update, in writing, the Subrecipient's PHEP and Response Plans according to the timeframes identified under this ADHS PHEP Grant Deliverables document: 3.1.4.1 Develop or update mutual aid agreements with other jurisdictions, in accordance with the approved Subrecipient's Public Health Emergency Preparedness and Response Plan. 3.2 Medical Electronic Disease Surveillance and Intelligence System (MEDSIS): The Subrecipient shall: 3.2.1 Participate in ADHS-coordinated workgroups for MEDSIS enhancements to include Tribal communities (if applicable)and Electronic Laboratory Reporting (ELR)capabilities, 3.2.2 Participate in epidemiology specific trainings,workshops, or conferences provided by ADHS or an ADHS recognized training session (if applicable), 3.3 Public Health Emergency Exercises: The Subrecipient shall: 3.3.1 Participate in required ADHS led statewide/regional public health exercises, 3.4 ADHS shall: Monitor the expenditure of funds for the reports submitted. If there are any reports that are not submitted on or before the appropriate submission date, the Subrecipient could be subject to a potential reduction in funds, or loss of funds for the following year: 3.4.1 Expenditures that are not on an approved budget or approved redirection may not be eligible for reimbursement from ADHS. 4. FINANCIAL REQUIREMENTS 4.1 For Centers for Disease Control and Prevention Public Health Emergency Preparedness (PHEP) Grant: 4.1.1 The Subrecipient shall participate in match requirement: 4.1.1.1 The PHEP award required a ten percent (10%) "in-kind" or "soft" match from all Subrecipients. Each Subrecipient must include in their budget submission, the format they shall use to cover the match and method of documentation. Failure to include the match formula shall preclude funding.ADHS may not award a Contract 4 ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18"Ave Suite 530 Amendment Phoenix,Arizona 85007 Contract No.: CTR055215 IGA Amendment No: 3 Procurement Officer Hana Hehman under this program unless the Subrecipient agrees that,with respect to the amount of the cooperative agreement allocated by ADHS, the Subrecipient shall make available non-federal contributions in the amount of ten percent(10%)[one dollar ($1) for each ten dollars ($10) of federal funds provided in the cooperative agreement)of the award, whether provided through financial or direct assistance. Match may be provided directly or through donations from public or private entities and may be in cash or in kind, fairly evaluated, including plant, equipment or services; 4.1.1.2 Amounts provided by the federal government or services assisted or subsidized to any significant extent by the federal government may not be included in determining the amount of such non-federal contributions. Documentation of match, including methods and sources, must be included in sub-recipient budget each budget period, include calculations for both financial assistance and direct assistance, follow procedures for generally accepted accounting practices, and meet audit requirements; 4.1.1.3 Direct Costs Show the direct costs by listing the totals of each category, including salaries and wages, fringe benefits, consultant costs, equipment, supplies, travel, other, and contractual costs. Provide the total direct costs within the budget; and 4.1.1.4 Indirect Costs To claim indirect costs up to the state's approved rate, the Subrecipient must have a current approved indirect cost rate agreement established with the applicable federal agency. A copy of the most recent indirect cost rate shall be submitted to ADHS with the signed Agreement. Indirect cost percentage cannot exceed the current ADHS rate without an approved indirect cost rate agreement. If the Subrecipient does not have an approved federal indirect cost rate agreement, costs normally identified as indirect costs (overhead costs) can be budgeted and identified as direct costs and a default indirect percentage of 10% may be used. 4.1.2 Inventory Upon request, the Subrecipient shall provide an inventory list to ADHS. The inventory list shall include all equipment purchased. Items over$5,000 will require an ADHS asset tag. 4.1.3 Budget Allocation and Work Plan 4.1.3.1 The Subrecipient shall complete the budget tool provided by ADHS, and return to ADHS for review and approval. Funding may not be released until the budget has been approved by ADHS; and 4.1.3.2 All activities and procurements funded through the PHEP grant shall be aligned with the budget/spend plan and work plan. These tools shall help the Subrecipient to reach the goals and objectives outlined in the ADHS PHEP Grant Deliverables document. 4.1.4 Conduct Financial accounting, auditing and reporting consistent with the ADHS Accounting 5 ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18"Ave Suite 530 Amendment Phoenix,Arizona 85007 Contract No.: CTR055215 IGA Amendment No: 3 Procurement Officer Hana Hehman and Auditing Procedures Manual, which can be found at https://drive.google.com/file/d/l 5mO7JShrS9VFfgaCXhlmhthgsv74yM9M/view, 4.1.5 Prepare monthly Contractor Expenditure Reports (CERs)with supporting documentation by the established due dates identified by ADHS. Failure to accomplish monthly financial reports within specified time frames, without prior coordination of ADHS program leadership, could result in a reduction or loss of grant funding in subsequent years, and 4.1.6 Expanded Authority: ADHS is permitted the following expanded authority in the administration of the award. Carryover of unobligated balances from one (1) budget period to a subsequent budget period. Unobligated funds may be used for purposes within the scope of the project as originally approved: 4.1.6.1 2022-2023 Budget Period Four (4) PHEP funds may be applied to approved Subrecipient expenses incurred up to and including June 30, 2024; and 4.1.6.2 Workforce Development funds, if applicable, may be applied to approved Subrecipient expenses incurred up to and including June 30, 2024. 4.2 For Workforce Development Grant(if applicable) Regardless of funding allocation for each Budget Period (BP), participants are expected to continue their best efforts towards the completion of the reporting requirements as outlined in Section 6.2. 4.2.1 Match 4.2.1.1 No match is required for these funds. 4.2.2 Inventory 4.2.2.1 When requested by ADHS, Subrecipient shall provide a complete annual inventory report to include all capital equipment above the five-thousand ($5,000) threshold. 4.2.3 Budget Allocation and Work Plan 4.2.3.1 Annual budgets and work plans will be reviewed and approved by ADHS before funding is released. 5. GRANT ACTIVITY OVERSIGHT FOR WORKFORCE DEVELOPMENT GRANT(if applicable) ADHS shall monitor the expenditure of funds for the reports submitted. If there are any reports that are not submitted on or before the appropriate submission date, the Subrecipient could be subject to a potential reduction in funds, or loss of funds for the following year. Expenditure that are not on an approved budget or approved redirection may not be eligible for reimbursement from ADHS. Failure to meet the performance measures or deliverables may result in a reduction or withholding subsequent awards. 6 ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18"Ave Suite 530 Amendment Phoenix,Arizona 85007 Contract No.: CTR055215 IGA Amendment No: 3 Procurement Officer Hana Hehman 6. DELIVERABLES 6.1 PHEP Grant 6.1.1 Provide to ADHS the primary and secondary contact information for its public health incident command team, as part of the mid-year report due by December 31 St, 6.1.2 Provide annually twenty-four (24) hours a day/seven (7) days a week/three hundred sixty- five (365) days a year, public health emergency contact number for its Public Health Department or a designated health emergency contact person and within ten (10) days of any changes, 6.1.3 Upon activation of the Subrecipient's Health Emergency Operations Center,the Subrecipient shall provide the primary and secondary contact information for its public health incident command team, 6.1.4 Submit by June 111 an annual spending plan using the budget tool supplied by ADHS for the completion of the work plan to meet selected deliverables, 6.1.5 Submit monthly expenditure reports to the ADHS PHEP Grant Coordinator by the last day of the following month and include all supporting documents, receipts and reports necessary to back up the expenditures, 6.1.6 Submit a mid-year Report, utilizing the templates provided, to the ADHS PHEP Grant Coordinator; the report will include progress toward the completion of identified work plan activities and outcome for the budget period. The semi-annual report is due no later than January 31st, and 6.1.7 Submit an End of Year Report, utilizing the templates provided, to the ADHS PHEP Grant Coordinator; the report will include a narrative that describes the final progress toward the completion of the planned activities and outcomes. Challenges and barriers that prevented the completion of the activities is also required. The End of Year report is due no later than September 15th following the end of the budget period. 6.2 Workforce Development Grant (if applicable) Report progress on the activities within approved workplans, spending reports, progress on hiring goals and priorities shall be reported in a timely manner to ensure ADHS has adequate time to compile the information and prepare it for submission at the federal level. Sub- recipient is also responsible to report on diversity, equity, and inclusion plan metrics; 6.2.1 Progress report — submit status update on meeting hiring goals and diversity, equity and inclusion (DEI) metrics. Progress reports are due every six(6) months: 6.2.1.1 The period July 1, 2023—November 30, 2023 is due December 31, 2023; and 6.2.1.2 The period December 1, 2023—May 31, 2024 is due June 30, 2024; 6.2.2 End-of-Program Report (dates covered: July 1, 2021-June 30, 2024)- submit final report on overall workplan activities, hiring goals, and DEI metrics. ADHS shall send out the End-of- Program report template in advance of the due date—August 25, 2024, and 7 ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18"Ave Suite 530 Amendment Phoenix,Arizona 85007 Contract No.: CTR055215 IGA Amendment No: 3 Procurement Officer Hana Hehman 6.2.3 The Subrecipient shall prepare monthly CERs with supporting documentation by the established due dates identified by ADHS. Failure to accomplish monthly financial reports within specified time frames, without prior coordination of ADHS program leadership, could result in a reduction or loss of grant finding in subsequent years. 7. NOTICES, CORRESPONDENCE, REPORTS, INVOICES/CERs AND PAYMENT 7.1 Notices, Correspondence and Reports from the Subrecipient to ADHS shall be sent to: Arizona Department of Health Services Public Health Emergency Preparedness 150 North 181h Avenue, Suite 150 Phoenix, Arizona 85007 7.1.1 The PHEP grant email address is: phepchp(a)azdhs.gov 7.1.2 The Workforce Development Grant email address is: wfdgrant(Oazdhs.gov 7.2 Automated Clearing House ADHS may pay invoices for some or all Orders through an Automated Clearing House (ACH). In order to receive payments in this manner, the Subrecipient 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://grants.az.gov/sites/default/files/GAO- 618%20ACH%20Authorization%20Form%20101019.pdf. 7.2.1 ACH Vendor Authorization Form shall be emailed to Vendor.Payautomation(a�azdoa.gov 7.3 Notices, Correspondence and Payments from the ADHS to the Subrecipient shall be sent to: Mohave County Department of Public Health Attn: Chad Kingsley 700 W. Beale Street Kingman, AZ 86401 Phone: (928)753-0774 x 4313 Email: kingscC@mohave.gov 8 i ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES _ 150 1811 Ave Suite 530 Amendment Phoenix,Arizona 85007 Contract No.: CTR055215 IGA Amendment No: 3 Procurement Officer Hana Hehman PRICE SHEET PHEP GRANT Budget Period Five (5) Cost Reimbursement Description Amount Funds to enhance current PHEP activities per the deliverables in the attached ADHS PHEP Grant Deliverables document and upon ADHS $273,889.00 approval of monthly Contractor Expenditure Reports (CER's). TOTAL (NOT TO EXCEED) $273,889.00 9 ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES 150 18`h Ave Suite 530 Amendment Phoenix,Arizona 85007 Contract No.: CTR055215 IGA Amendment No: 3 Procurement Officer Hana Hehman Exhibit A Exhihit-2 CFR 200-332 §tuu.g32 Requircmcntk fur pak%-through entitic%. LIt la% -through cntitie%muwt (a)Enure that escn suhaward is clearh identified to the%uhrecipient a%a suhauard and include%the foll4 sing information at the time of the%uliatsard and if nn%of the%c data clenwnts change,include the changes in%uh+equent ruhaaard modification.When some of this information i%not m ailahk,the pain+-through entit%must prat ide the he%t information a%uilahle to de%critic the Federal a«ard and%uhaward. Prinz Assardect Ariruna Ih•partment of itralth Scn•icc% t'F.Is QMW It'Gl.X%IYFb.; Feder al Award Identification i Grant Nurrt*rP NU90TP922004 Subrecipent name(Mfnch must match lhs name assoaated Mohave County wth its unique entity 4"tifier) Subreapient's unique entity identifier(DUNS tr) V35YJGS4W9Y 1 Federal Award ldentdication Number(FAIN NU90TP922004 sometimes it s the same as the Grant Number) Federal Award Date(see the definition of Federal award date in§200 t of INS pan)of award to the TB D recipient by the Federal agency. Subaward Period of Performance Start and End Date. 7/0112019-6/30/2024 Subaward Budget Period Start and End Date 7/01/2023-6/30/2024 Amount of Federal Funds Obligated by this action by the pass-through entity to the subrecipient(this is 3$27 (} normally the contract amount) /I 889 Q0 Total Amount of Federal Funds obligated to the subreuptent by the pass-through entity induding the current financial obligation(tow much is available $8,0(J9,605,00 for contracts) Total Amount of the Federal Award committed to the Q 1 2,895,655.00 subreuptent by the pass-through entity �D Federal award project description,as required to be responsive to the Federal Funding Accountability Public Health Emergency Preparedness and Transparency Act(FFATAi Name of Federal awarding agency,pass-through entity"and contact information for awarding official Centers for Disease Control and Prevention of the Pass-through entity Assistance Listings number and Title the pass- through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of 93.069 disbursement Identification of whether the award is R&D 0 Yes O No Indirect cost rate for the Federal award(including the de minimis rate is charged)per§200,414 10 1"J-�-J ARIZONA DEPARTMENT 01 OF HEALTH SERVICES Bureau of Public Health Emergency Preparedness Exhibit B GRANT DELIVERABLES Project Period: 2019-2024 Budget Period 5 PERIOD OF PERFORMANCE (July 1 , 2023 - June 30, 2024) Table of Contents INTRODUCTION 3 FEDERAL REQUIREMENTS FOR ADHS 5 Project Period Requirements for ADHS (2019-2024) 5 Funding Restrictions 5 LOCAL PROGRAM REQUIREMENTS 7 Meetings 7 Exercise Planning and Conduct 7 Health Care Coalition 8 Plans, Training, and Exercise Implementation Criteria 9 INFORMATION SERVICES 9 REPORTING 10 Mid-Year Report 10 Annual Report (End of Year) 10 Planning, Training, and Exercise Deliverables 10 STRATEGIES AND ACTIVITIES 13 Domain Strategy 1: Strengthen Community Resilience 13 Domain Strategy 2: Strengthen Incident Management 16 Domain Strategy 3: Strengthen Information Management 17 Domain Strategy 4: Strengthen Countermeasures and Mitigation 18 Domain Strategy 5: Strengthen Surge Management 22 Domain Strategy 6: Strengthen Biosurveillance 25 PHEP Deliverables(July 1,2023—June 30,2024) Page 2 of 26 INTRODUCTION The Grant Guidance Deliverable document was developed based, in part, on information set forth in the Centers for Disease Control and Prevention's Office of Public Health Preparedness and Response funding opportunity announcement 2019-2024 -PHEP Cooperative Agreement CDC-RFA-TP19-1901 and continuation guidance from the CDC. During this five year project period, the Arizona Department of Health Services and sub-recipients (tribal and county health departments) will increase or maintain their levels of effectiveness across the six key preparedness domains to achieve a prepared public health system. The six preparedness domains are: 1. Strengthen Community Resilience • Capability 1: Community Preparedness • Capability 2: Community Recovery 2. Strengthen Incident Management • Capability 3: Emergency Operation Coordination 3. Strengthen Information Management • Capability 4: Emergency Public Information and Warning • Capability 6: Information Sharing 4. Strengthen Countermeasures and Mitigation • Capability 8: Medical Countermeasure Dispensing and Administration • Capability 9: Medical Materiel Management and Distribution • Capability 11: Non-Pharmaceutical Interventions • Capability 14: Responder Safety and Health 5. Strengthen Surge Management • Capability 5: Fatality Management • Capability 7: Mass Care • Capability 10: Medical Surge • Capability 15:Volunteer Management 6. Strengthen Biosurveillance • Capability 12: Public Health Laboratory Testing PHEP Deliverables(July 1,2023—June 30,2024) Page 3 of 26 . Capability 13: Public Health Surveillance and Epidemiological Investigation PHEP Deliverables(July 1,2023—June 30,2024) Page 4 of 26 FEDERAL REQUIREMENTS FOR ADHS Project Period Requirements for ADHS (2019-2024) • One fiscal preparedness tabletop exercise once during the five-year period (completed in November 2021) • One MCM distribution full-scale exercise once during the five-year period (completed in November 2019) • One MCM dispensing full-scale exercise or one mass vaccination full-scale exercise (one POD in each CRI local planning jurisdiction will be exercised) (completed in November 2019) • Complete two table top exercises (TTX) every five years. One TTX to demonstrate readiness for an anthrax scenario and one to demonstrate a pandemic response scenario. • Complete one functional exercise every five years that focuses on the vaccination of at least one critical workforce group to demonstrate readiness for a pandemic response scenario. (satisfied by COVID response) • Complete one full scale exercise every five years to demonstrate operational readiness for a pandemic response scenario. (satisfied by COVID response) Funding Restrictions Funding restrictions that will be considered for workplan and budget development: • May not use funds for research. • May not use funds for clinical care except as allowed by law. • May not use funds for construction or major renovations. • May use funds only for reasonable program purposes, including personnel, travel, supplies, and services. • Generally, recipients may not use funds to purchase furniture or equipment. Any such proposed spending must be clearly identified in the budget. • Reimbursement of pre-award costs generally is not allowed, unless the CDC provides written approval to ADHS on behalf of the sub- recipient. • Other than for normal and recognized executive-legislative relationships, no funds may be used for: o publicity or propaganda purposes, for the preparation, distribution, or use of any material designed to support or defeat the enactment of legislation before any legislative body o the salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or Executive order proposed or pending before any legislative body PHEP Deliverables(July 1,2023—June 30,2024) Page 5 of 26 • See Additional Requirement (AR) 12 for detailed guidance on this prohibition and additional guidance on lobbying for CDC recipients. • The direct and primary sub-recipient in a cooperative agreement program must perform a substantial role in carrying out project outcomes and not merely serve as a conduit for an award to another party or provider who is ineligible. General Restrictions • May supplement but not supplant existing state or federal funds for activities described in the budget. • Payment or reimbursement of backfilling costs for staff is not allowed. • None of the funds awarded to these programs may be used to pay the salary of an individual at a rate in excess of Executive Level II or $189,600 per year. • Funds may not be used to purchase or support (feed) animals for labs, including mice. • Funds may not be used to purchase a house or other living quarters for those under quarantine. Rental may be allowed with approval from the CDC OGS. Passenger Road Vehicles • Funds cannot be used to purchase over-the road passenger vehicles. • Funds cannot be used to purchase vehicles to be used as means of transportation for carrying people or goods, such as passenger cars or trucks and electrical or gas-driven motorized carts. • Can (with prior approval) use funds to lease vehicles to be used as means of transportation for carrying people or goods, e.g., passenger cars or trucks and electrical or gas- driven motorized carts during times of need. • Additionally, PHEP grant funds can (with prior approval) be used to make transportation agreements with commercial carriers for movement of materials, supplies and equipment. There should be a written process for initiating transportation agreements (e.g., contracts, memoranda of understanding, formal written agreements, and/or other letters of agreement). Transportation agreements should include, at a minimum: o Type of vendor o Number and type of vehicles, including vehicle load capacity and configuration o Number and type of drivers, including certification of drivers o Number and type of support personnel o Vendor's response time o Vendor's ability to maintain cold chain, if necessary to the incident o This relationship may be demonstrated by a signed transportation agreement or documentation of transportation planning meeting with the designated vendor. All documentation should be available to the CDC project officer for review if requested. PHEP Deliverables(July 1,2023—June 30,2024) Page 6 of 26 Transportation of Medical Materiel • PHEP funds may be used (with approved budget) to procure leased or rental vehicles for movement of materials, supplies and equipment. • PHEP funds may be used (with approved budget) to purchase material-handling equipment (MHE) such as industrial or warehouse-use trucks to move materials, such as forklifts, lift trucks, turret trucks, etc.Vehicles must be of a type not licensed to travel on public roads. • PHEP funds may be used (with approved budget) to purchase basic (non-motorized) trailers with prior approval from the CDC OGS. Procurement of Food and Clothing • Funds may not be used to purchase clothing such as jeans, cargo pants, polo shirts,jumpsuits, sweatshirts, or T-shirts. Purchase of vests to be worn during exercises or responses may be allowed. • Generally, funds may not be used to purchase food. Vaccines • Contact ADHS with vaccine requests in support of an activity. LOCAL PROGRAM REQUIREMENTS Meetings 1. ADHS Grant Meetings a. Attend annual Preparedness Community Conference (PCC) b. Attend annual Integrated Preparedness Plan Workshop (IPPW) c. Participate in ADHS Jurisdictional Risk Assessment Review and Analysis or equivalent Exercise Planning and Conduct 1. Local jurisdictions are encouraged to conduct preparedness exercises in accordance with Homeland Security Exercise and Evaluation Program (HSEEP) fundamentals including: a. Exercise design and development b. Exercise conduct c. Exercise evaluation d. Improvement planning PHEP Deliverables(July 1,2023-June 30,2024) Page 7 of 26 e. More information and templates are available at: https://www.azdhs.gov/preparedness/emergency- preparedness/index.php#training-exercise-resources Health Care Coalition 1. As core members of the Arizona Coalition for Healthcare Emergency Response (AzCHER), full participation in the AzCHER meetings, exercises, and drills in your respective regions is required. Northern Region • County Representatives:Apache County, Coconino County, Navajo County, and Yavapai County • Tribal Representatives: Hopi Tribe, Navajo Nation and White Mountain Apache Tribe Western Region • County Representatives: La Paz County, Mohave County, and Yuma County • Tribal Representatives: Cocopah Indian Tribe, Colorado River Indian Tribes, Fort Mojave Indian Tribe, Kaibab-Paiute Tribe and Quechan Tribe Central Region • County Representatives: Gila County, Maricopa County, and Pinal County • Tribal Representatives: Gila River Indian Community and Salt River Pima-Maricopa Indian Community Southern Region • County Representatives: Cochise County, Graham County, Greenlee County, Pima County and Santa Cruz County • Tribal Representatives: Pascua Yaqui Tribe, San Carlos Apache Tribe, and Tohono O'odham Nation PHEP Deliverables(July 1,2023—June 30,2024) Page 8 of 26 Plans, Training, and Exercise Implementation Criteria Training and exercises should be gap based and linked to the CDC PHEP Domains. Proposed training and exercises will be based on identified gaps from previous exercises, real-world responses, risk assessments (e.g.JRA, CPG, CAWP,THIRA), or other documented sources. 1. Program Requirements A. Sub-recipient PHEP programs should establish and maintain a collaborative working relationship with emergency management. This will include, but not be limited to; emergency communication planning, strategies for addressing emergency events, the management of the consequences of power failures, natural disasters and other events that would affect public health. B. Sub-recipient PHEP programs should maintain documentation of all collaborative efforts with local and state emergency. management C. Sub-Recipients should participate in ADHS sponsored tabletops, functional exercises, or other activities. 1. ADHS Coordination: Collaborate with ADHS throughout the planning process. 2. At-Risk Individuals: Local jurisdictions will include provisions for the needs of at-risk individuals within each exercise. PHEP local jurisdictions will report on the strengths and areas for improvement identified though the coalition-based exercise After Action Reports and Improvement Plans (AARs/IPs).To learn more about the U.S. Department of Health and Human Services' definition of"at-risk" population visit this website: http://www.phe.ciov/Preparedness/planning/abc/Pages/at-risk.aspx. D. Evaluation 1. PHEP-funded exercises will address and list applicable Public Health Emergency Preparedness (PHEP) Capabilities in all qualifying exercises. A qualifying exercise is one that meets PHEP-specific implementation criteria as described in the grant. 2. Exemption:A sub-recipient's response and recovery operations supporting real-world incidents could meet the criteria for an exercise requirement if the response was sufficient in scope and the AARs/IPs adequately detail which PHEP capabilities were evaluated. This will be addressed on an as-requested basis. INFORMATION SERVICES 1. Local jurisdictions will have or have access to a secure alerting system that at a minimum has the ability to send email, and phone/text alerts. PHEP Deliverables(July 1,2023—June 30,2024) Page 9 of 26 ADHS will provide training on the information systems and platforms as needed and/or requested. Examples of systems: EMResource, ESAR-VHP, AzHAN, iCAM, etc. REPORTING Progress on the deliverables, performance measures, and activities funded through the CDC grant will be reported as requested and in a timely manner to ensure ADHS has adequate time to compile the information and submit to the CDC. Mid-Year Report a. Mid-year reports are expected in advance of the due date determined by ADHS. Mid-year report templates are integrated within the sub-recipient workplan templates. b. Update jurisdictional points of contact twice during each budget period (July 1 and December 31), or as changes occur, to facilitate time-sensitive, accurate information sharing within the local jurisdictions and between ADHS and the sub-recipients. Annual Report (End of Year) a. Annual reports are expected in advance of the due date determined by ADHS. End-of-year report templates are integrated within the sub-recipient workplan templates. Planning, Training, and Exercise Deliverables ProgramDate Applies To Comments Participation in a Regional Integrated Once annually All PHEP • PHEP Coordinator and/or Preparedness Plan Workshop (IPPW) Sub-Recipients designee Attend Annual Preparedness Once annually All PHEP • PHEP Coordinator and/or a Community Conference (PCC) Sub-Recipients designee PHEP Deliverables(July 1,2023—June 30,2024) Page 10 of 26 • The IPP consists of three parts: o Narrative All PHEP o Training schedule Sub-Recipients o Exercise schedule Complete a Final Integrated Annually as part of the Workplan • Covering the time period from Preparedness Plan (IPP) submittal for the next budget July 1, 2022 to June 30, 2025 period. • Upload to the ADHS AZ-PIRE website: https://sites.cioogle.com/azdhs.ci ov az- ire • Template and HSEEP guidelines All PHEP can be found on the ADHS AZ- After Action Reports/Improvement Per HSEEP, within 120 days of Sub-Recipients PIRE website: Plans (AARs/IPs) exercise conduct https://sites.gooclle.com/azdhs.q ov/az-pi re Sharing of Core Plans with ADHS, if any: • Emergency Response Plan • Emergency Response toolkits and resources are • Pandemic Response All PHEP located at: • Fatality Management All plans to be completed Sub-Recipients https://www.azdhs.gov/prepared • Medical Countermeasures Receipt and made available by the and Dispensing end of the five-year project ness/emergency- preparedness/#erp-home • Continuity of Operations period. • Plans should be uploaded to the • Medical Surge respective sub-recipient page on • Mass Care the ADHS AZ-PIRE website: PHEP Deliverables(July 1,2023-June 30,2024) Page 11 of 26 https:Hsites.google.com/azdhs.g ov az- ire PHEP Deliverables(July 1,2023—June 30,2024) Page 12 of 26 STRATEGIES AND ACTIVITIES Domain Strategy 7: Strengthen Community Resilience Community resilience is the ability of a community, through public health agencies, to develop, maintain, and utilize collaborative relationships among government, private, and community organizations to develop and utilize shared plans for responding to and recovering from disasters and public health emergencies. Associated Capabilities • Capability 1: Community Preparedness • Capability 2: Community Recovery Domain Activity: Determine the Risks to the Health of the Jurisdiction Deliverable plies To Due Date Conduct public health jurisdictional risk assessment (JRA) or equivalent, in Conduct a JRA and report All PHEP Once every five collaboration with HPP, to identify potential hazards, vulnerabilities, and risks results to ADHS. Sub-Recipients years from the within the community that relate to the public health, medical, and date of the last mental/behavioral health systems and the access and functional needs of at- Provide a copy of their JRA JRA (or risk individuals. report or equivalent (even if equivalent) outdated). ADHS recommends a collaborative and flexible risk assessment process that includes input from existing hazard and vulnerability analysis conducted by emergency management, AzCHER and other health care organizations, as well as other community partners and stakeholders. Jurisdictions should analyze JRA results, and use diverse data sources such as the HHS Capabilities Planning Guide (CPG), previous risk assessments, jurisdictional incident AARs/IPs, site visit observations,jurisdictional data from the National Health Security Preparedness Index, and other jurisdictional priorities and strategies, to help determine their strategic priorities, identify program gaps, and, ultimately prioritize preparedness investments. PHEP Deliverables(July 1,2023-June 30,2024) Page 13 of 26 Domain Activity: Ensure HPP Coordination (Health Care System) The purpose of this collaboration is to ensure a shared approach to delivering Local Jurisdictions must All PHEP End of the Project public health services alongside health care services to mitigate the public participate in one ADHS- Sub-Recipients Period, June 30, health consequences of emergencies. PHEP resources cannot be used to sponsored statewide full-scale 2024. supplant HPP programmatic activities. However, there are areas where exercise, OR coordinated planning and collaboration between the programs are beneficial, including exercising and training. Participate/conduct a regional full-scale exercise, OR Jurisdictions must participate in one statewide or conduct one regional full- scale exercise (FSE) within the five-year project period. Exercises must include ADHS may consider a real- participation from, at a minimum, hospitals and/or hospital systems, world response as an emergency management agencies, and emergency medical services (EMS). acceptable substitute Domain Activity: Plan for the Whole Community Working in collaboration with HPP, continue to build and sustain local health After Action Reviews, planning All PHEP June 30, 2024 department and community partnerships to ensure that activities have the document, or real-world widest possible reach with the strongest possible ties to the community. events may provide evidence Sub-Recipients Coordination with local stakeholders to review collaboration efforts with local of a whole community agencies they represent; and approach when planning, • Engage with key community partners who have established relationships training and exercising with diverse at-risk populations, to include mental/behavioral health and annually. pediatric populations. • Local jurisdictions are encouraged to address family reunification plans for schools and child care centers. Plan for individuals with disabilities and others with access and functional needs. Use a flexible approach to define populations at risk to jurisdictional threats and hazards. Address a broad set of common access and functional needs using the Communication, Maintaining Health, Independence, Services and Support, and Transportation (CMIST) framework. PHEP Deliverables(July 1,2023—June 30,2024) Page 14 of 26 Identify individuals with access and functional needs that may be at risk of being disproportionately impacted by incidents with public health consequences. Examples of populations with access and functional needs include, but are not limited to, children, pregnant women, postpartum and lactating women, racial and ethnic minorities, older adults, persons with disability, persons with chronic disease, persons with limited English proficiency, persons with limited transportation, persons experiencing homelessness, and disenfranchised populations. Domain Activity: Focus on Tribal Planning and Engagement Deliverable Due Date Support the engagement between county and tribal public health Annual documentation of All PHEP June 30, 2024 departments in a meaningful and mutually beneficial way to ensure that all collaborative efforts to ensure Sub-Recipients community members are fully and equally served, while also recognizing the appropriate efforts are made inherent responsibility of those nations to support their members in a to develop public health culturally appropriate manner. preparedness and response capability. May be included in regular workplan reports. PHEP Deliverables(July 1,2023—June 30,2024) Page 15 of 26 Domain Strategy 2. Strengthen Incident Mono ement Incident management is the ability to activate, coordinate, and manage public health emergency operations throughout all phases of an incident through use of a flexible and scalable incident command structure that is consistent with the NIMS and coordinated with the jurisdictional incident, unified, or area command structure. Associated Capability • Capability 3: Emergency Operations Coordination Domain Activity:Activate and Coordinate Public Health Emergency Operations Deliverable Applies To Due Date Maintain a current COOP plan that includes the following elements. Development or All PHEP June 30, 2024, • Definitions, identification, and prioritization of essential services needed to update/review of the Sub-Recipients uploaded to the sustain public health agency mission and operations; Continuity of Operations Plan Plans Library • Procedures to sustain essential services regardless of the nature of the folders on the incident (all-hazards planning); ADHS AZ-PIRE • Positions, skills, and personnel needed to continue essential services and website functions (human capital management); • Identification of public health agency and personnel roles and responsibilities in support of ESF #8; • Scalable workforce in response to needs of the incident; • Limited access to facilities due to issues such as structural safety or security concerns; Broad-based implementation of social distancing policies; • Identification of agency vital records (such as legal documents, payroll, personnel assignments)that must be preserved to support essential functions or for other reasons; • Alternate and virtual work sites; • Devolution of uninterruptible services for scaled down operations; • Reconstitution of uninterruptible services; and • Cost of additional services to augment recovery. PHEP Deliverables(July 1,2023—June 30,2024) Page 16 of 26 Domain Strategy • • • •n Management Information management is the ability to develop and maintain systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, and warnings using a whole community approach. It also includes the ability to exchange health information and situational awareness with federal, state, local, territorial, and tribal governments and partners. Associated Capabilities • Capability 4: Emergency Public Information and Warning • Capability 6: Information Sharing Domain Activity: Coordinate Information Sharing Deliverable Applies To Due Date Have or have access to communication systems that maintain or improve 1. Testing of All PHEP 1. Once Annually reliable, resilient, interoperable, and redundant information and communication Sub-Recipients communication systems and platforms. platforms. Such systems, whether they are internally managed or externally hosted on shared platforms, must be capable of supporting syndromic surveillance, integrated surveillance, active and/or passive mortality surveillance, public health registries, situational awareness dashboards, and other public health and preparedness activities. Have plans in place that identify redundant communication platforms (primary and secondary) and a cycle of maintenance and testing of these platforms annually. Domain Activity: Coordinate Emergency Information and Warning Ensure that communication plans, if any, have processes for coordinating All PHEP 1. As changes in public messaging during infectious disease outbreaks and information sharing Sub-Recipients personnel regarding monitoring and tracking of cases of persons under investigation to occur ensure maximum coordination and consistency of messaging. PHEP Deliverables(July 1,2023—June 30,2024) Page 17 of 26 Domain Strategyr • -r r • rr • Countermeasures and mitigation is the ability to distribute, dispense, and administer medical countermeasures (MCMs) to reduce morbidity and mortality and to implement appropriate non-pharmaceutical and responder safety and health measures during response to a public health incident. Associated Capabilities • Capability 8: Medical Countermeasure Dispensing and Administration • Capability 9: Medical Materiel Management and Distribution • Capability 11: Non-pharmaceutical Interventions • Capability 14: Responder Safety and Health Domain Activity: Develop and Test MCM Distribution, Dispensing, and Vaccine Deliverable Applies To Due Date Administration Plans Plans that address MCM distribution, dispensing, and vaccine administration Development, update/review All PHEP June 30, 2024, plans through development, training, exercising, and evaluating these MCM of Medical Countermeasures Sub-Recipients uploaded to the plans. Managing access to, and administration of, countermeasures and plans Plans Library ensuring the safety and health of clinical and other personnel are important folder on the priorities for preparedness and continuity of operations. ADHS AZ-PIRE website Domain Activity: Demonstrate Operational Readiness for Pandemic Response For pandemic preparedness planning, all sub-recipients are encouraged to Pandemic Response plans All PHEP June 30, 2024, collaborate with their respective immunizations programs to develop, maintain, should provide evidence of Sub-Recipients uploaded to the PHEP Deliverables(July 1,2023—June 30,2024) Page 18 of 26 and exercise pandemic plans to prevent, control, and mitigate the impact of collaboration with respective Plans Library pandemic on the public's health and to help meet pandemic vaccination goals immunization programs. If a folder on the for the general population. jurisdiction does not have an ADHS AZ-PIRE immunization program then website provide evidence of collaboration with county/state level programs. Domain Activity: Participate in ORRs The Operational Readiness Review will focus on all 15 preparedness capabilities Continue to collect and CRI Jurisdictions June 30, 2024 to include pandemic response planning and response elements. The CDC has provide data for the Only expanded the ORR to include a comprehensive evaluation of planning and Operational Readiness Review operational readiness based on elements across all 15 public health preparedness and response capabilities. Domain Activity: Ensure Safety and Health of Responders Local jurisdictions should assist, train, and provide resources necessary to Evidence should demonstrate All PHEP June 30, 2024 protect public health first responders, to include volunteers performing as the assistance with personal Sub-Recipients public health first responders, critical workforce personnel, and critical protective equipment (PPE), infrastructure workforce from hazards during response and recovery MCMs, workplace violence operations. training, psychological first aid training, and other resources specific to an emergency that would PHEP Deliverables(July 1,2023—June 30,2024) Page 19 of 26 protect responders and health care workers from illness or injury at the state and local levels.This may include developing clearance goals for contaminated areas based on guidance from a committee of subject matter experts. Domain Activity:Coordinate Non-pharmaceutical Interventions Coordinate with and support partner agencies to plan and implement non- Plans, if any, should All PHEP Sub- End of Project pharmaceutical interventions (NPIs) by developing and updating plans for document applicable Recipients Period, June 30, isolation, quarantine, temporary school and child care closures and dismissals, jurisdictional, legal, and 2024. mass gathering (large event) cancellations and restrictions on movement, regulatory authorities including border control measures, in applicable jurisdictions. NPIs may reflect necessary for implementation routine and incident-specific situations. of NPIs, and; Delineate roles and responsibilities of health, law enforcement, emergency management, chief executive, and other relevant agencies and partners, and; Define procedures, triggers, and necessary authorizations to implement NPIs, whether addressing individuals, groups, facilities, animals, food products, public works/utilities, or travelers PHEP Deliverables(July 1,2023—June 30,2024) Page 20 of 26 passing through ports of entry, and; Determine occupational and exposure prevention measures, such as decontamination or evacuation strategies. PHEP Deliverables(July 1,2023—June 30,2024) Page 21 of 26 Domain Strategy 5: Strengthen Surge Management Surge management is the ability to coordinate jurisdictional partners and stakeholders to ensure adequate public health, health care, and behavioral services and resources are available during events that exceed the limits of the normal public health and medical infrastructure of an affected community. This includes coordinating expansion of access to public health, health care and behavioral services; mobilizing medical and other volunteers as surge personnel; conducting ongoing surveillance and public health assessments at congregate locations; and coordinating with organizations and agencies to provide fatality management services. Associated Capabilities • Capability 5: Fatality Management • Capability 7: Mass Care • Capability 10: Medical Surge • Capability 15: Volunteer Management Domain Activity: Coordinate Activities to Manage Public Health and Medical Deliverable Applies To Due Date Surge Coordinate with emergency management, and other relevant partners and At minimum, local All PHEP June 30, 2024 stakeholders to assess the public health and medical surge needs of the jurisdictions should have Sub-Recipients affected community. written plans in place that clearly define the public health roles and responsibilities during surge operations and outline procedures on how public health will engage the health care system to provide and receive situational awareness throughout the surge event. PHEP Deliverables(July 1,2023—June 30,2024) Page 22 of 26 Domain Activity: Coordinate Public Health, Health Care, Mental/Behavioral Health, and Human Services Needs during Mass Care Operations Local jurisdictions should coordinate with key partner agencies to address, At minimum, these plans All PHEP June 30, 2024 within congregate locations (excluding shelter-in-place locations), the public should address procedures on Sub-Recipients health, health care, mental/behavioral health, and human services needs of how ongoing surveillance and those impacted by an incident. In collaboration with ESF#8 partners, health public health assessments will care, emergency management, and other pertinent stakeholders, local be coordinated to ensure that jurisdictions should develop, refine, or maintain written plans that identify the the public health, health care, public health roles and responsibilities in supporting mass care operations. mental/behavioral health and human services needs of those impacted by the incident continue to be met while at congregate locations; and procedures to support or implement family reunification, including any special considerations for children. Domain Activity: Coordinate with Partners to Address Public Health Needs during Fatality Management Operations Coordinate with and support partner agencies to address fatality management Development, update/review All PHEP June 30, 2024, needs resulting from an incident of Fatality Management plan Sub-Recipients uploaded to the Plan Library In collaboration with jurisdictional partners and stakeholders, local jurisdictions folder on the should conduct the following activities. ADHS AZ-PIRE website Coordinate with subject matter experts and cross-disciplinary partners and stakeholders to clarify, document, and communicate the public health agency role in fatality management, based on jurisdictional risks, incident needs, and partner and stakeholder authorities. PHEP Deliverables(July 1,2023—June 30,2024) Page 23 of 26 The public health agency role may include supporting: o Recovery, preservation, and release of remains, o Identification of the deceased, o Determination of cause and manner of death, including whether disaster- related o Provision of mental/behavioral health assistance, and o Plans to include culturally appropriate messaging around handling of remains. o The coordination with community partners, including law enforcement, emergency management, and medical examiners or coroners to ensure proper tracking, transportation, handling, and storage of human remains and ensure access to mental and behavioral health services for responders and families impacted by an incident. o Have procedures in place to share information with fatality management partners, including fusion centers or comparable centers and agencies, emergency operations centers, and epidemiologist(s), to provide and receive relevant surveillance information that may impact the response. PHEP Deliverables(July 1,2023—June 30,2024) Page 24 of 26 Domain Strategy .:Strengthen Biosurveillance Biosurveillance is the ability to conduct rapid and accurate laboratory tests to identify biological, chemical, radiological, and nuclear agents; and the ability to identify, discover, locate, and monitor- through active and passive surveillance - threats, disease agents, incidents, outbreaks, and adverse events, and provide relevant information in a timely manner to stakeholders and the public. Associated Capabilities • Capability 12: Public Health Laboratory Testing • Capability 13: Public Health Surveillance and Epidemiological Investigation Domain Activity: Conduct Epidemiological Surveillance and Investigation Deliverable Applies To Due Date Local jurisdictions should continue to create, maintain, support, and strengthen 1. Provide evidence to show All PHEP June 30, 2024 routine surveillance and detection systems and epidemiological processes. that you have or have Sub-Recipients access to trained personnel Local jurisdictions should evaluate surveillance and epidemiological to manage and monitor investigation outcomes to identify deficiencies encountered during responses routine jurisdictional to public health threats and incidents and recommend opportunities for surveillance and improvement. epidemiological investigation systems. Conduct border health surveillance activities (where applicable). Support surge The focus on cross-border preparedness reinforces public health whole requirements in response community approach, which is essential for local-to-global threat risk to threats to include management and response to actual events regardless of source or origin. supporting populations at risk of adverse health outcomes as a result of the incident. 2. Have procedures in place to establish partnerships, to conduct investigations, and share information with PHEP Deliverables(July 1,2023—June 30,2024) Page 25 of 26 other governmental agencies and partner organizations. Local jurisdictions located on the United States- Mexico border should conduct activities that enhance border health, particularly regarding disease detection, identification, investigation, and preparedness and response activities related to emerging diseases and infectious disease outbreaks whether naturally occurring or due to bioterrorism. PHEP Deliverables(July 1,2023—June 30,2024) Page 26 of 26 MOHAVE COUNTY REQUEST FOR BOARD ACTION FORM FORMAL ACTION Q FROM: - Denise Burley, Director, Departm nt of Health CONSENT Q CONTACT/EXT: Denise Burley Ext. 431 RESOLUTION Q DATE: February 9, 2022 OTHER Q BOS MEETING DATE: February 22, 2022 INFORMATION ONLY Q SUMMARIZE THE ISSUE & DESIRED ACTION CLEARLYIATTACH BACKUP MATERIAL: Approve the Business Associate Agreement (BAA) between Mohave County and The Arizona Partnership for Immunizations(TAPI) as a third-party biller for the health department's Childhood Immunization clinics by sharing patients' billing and insurance information via limited access to the Nursing division's electronic health record (EHR) website. The BAA outlines the strict and limited access to patients' insurance billing information TAPI will be granted, as specified under HIPAA law. TAPI has been providing third-party insurance billing services for Mohave County Department of Public Health (MCDPH) since 2013 and manages insurance billing for nine other Arizona county health departments. Currently, all MCDPH patient insurance and billing information is sent to TAPI monthly via a large electronic file; retrieving insurance billing information directly from the EHR will allow for a more secure and efficient means of accessing the required data. RECOMMENDED MOTION: Approve the Business Associate Agreement (BAA) between Mohave County and The Arizona Partnership for Immunizations (TAPI)as a third-party biller for the health department's Childhood Immunization clinics by sharing patients' billing and insurance information via limited access to the Nursing division's electronic health record (EHR) website. The BAA outlines the strict and limited access to patients' insurance billing information TAPI will be granted, as specified under HIPAA law. Reviewed and Approved By: County Attorney Human Resources 0 Finance County Manager Board Action Taken: Approved as Requested El No Action Taken Disapproved Continued to 0 Approved with the following changes: Acknowledged receipt and referred to: Filing Information and Retrieval Filed Bid Filed Agreement BOS Resolution Filed Yearly Correspondence Filed Petition Filed Dedication Filed Land Sold Filed Land Acquired Filed Franchise ID Resolution Filed Improvement District Filed Other Date Routed: Additional Information: XC: BUSINESS ASSOCIATE AGREEMENT WHEREAS, Mohave County (hereafter "COUNTY") entered into this Agreement on behalf of which is a "Covered Entity" as defined in 45 CFR §160.103; and, WHEREAS, COUNTY has determined that The Arizona Partnership for Immunizations (hereafter "TAPI" or "CONTRACTOR") is a "Business Associate" of the COUNTY as defined in 45 CFR §160.103; and, WHEREAS, the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, require that an agreement be entered into specifying the ways in which [CONTRACTOR] is permitted to use and disclose protected health information which is provided by COUNTY; NOW, THEREFORE, [CONTRACTOR] agrees to comply with and be bound by the following Business Associate Agreement provisions: 1. Definitions Terms used, but not otherwise defined in this Agreement shall have the same meaning as those terms in 45 CFR Parts 160 and 164 as currently drafted or subsequently amended. 1.1. "Business Associate" means The Arizona Partnership for Immunizations (TAPI), also referred to as CONTRACTOR. 1.2. "Covered Entity" means COUNTY'S, Mohave County Health Department. 1.3. "HIPM Rules" means the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164. 1.4. "HITECH" means the provisions of the Health Information Technology for Economic and Clinical Health Act enacted on February 17, 2009 as Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act of 2009 (ARRA) (PL 111-5). 1.5. "Individual"has the same meaning as the term "individual" in 45 CFR §164.501 and shall include a person who qualifies as a personal representative in accordance with 45 CFR §160.103. 1.6. "Minimum necessary" means the standard as set forth in 45 CFR §164.502(b). 1.7."PHI" means "protected health information" as the term is used in 45 CFR 164.501, limited to the information created or received by the Business Associate from or on behalf of the Covered Entity. 1.8."Privacy Rule" means the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164. 1.9."Security Rule" means the Security Standards for the Protection of Electronic Protected Health Information at 45 CFR part 164,subpart C. 2. Permissive uses of PHI by Business Associate 2.1.Services. Except as otherwise specified herein, Business Associate may make only those uses of PHI necessary to perform its obligations under the Agreement provided that such use or disclosure would not violate the HIPAA Rules if done by the Covered Entity. All other uses not authorized by this Agreement are prohibited, unless agreed to in writing by COUNTY. 2.2.Activities. Excepts as otherwise limited in this Agreement, Business Associate may: 2.2.1. Use the PHI for the proper management and administration of the Business Associate and to fulfill any present or future legal responsibilities of Business Associate provided that such uses are permitted under State and Federal confidentiality laws. 2.2.2. Disclose the PHI to a third party for the proper management and administration of the Business Associate, provided that: 2.2.2.1. Disclosures are required by law; or 2.2.2.2. Business Associate obtains reasonable assurances from the third party that the PHI will remain confidential and not be used or further disclosed except as required by law or for the purpose for which it was disclosed to that third party and the third party notifies the Business Associate of any instances of which it is aware in which the confidentiality of the PHI has been breached. 3. Obligations of Business Associate with respect to PHI 3.1.With regard to use and disclosure of PHI provided by Covered Entity, Business Associate agrees-not-to use or-further disclose PHIother an as permitte ort—r - -- required by this Agreement or as required by law. 3.2.With regard to use and disclosure of PHI provided by Covered Entity, Business Associate further agrees to: 3.2.1. Use appropriate safeguards to prevent use or disclosure of PHI other than as provided for by this Agreement; 3.2.2. Mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of PHI by Business Associate in violation of the requirements of this Agreement; 3.2.3. Report to Covered Entity, in writing, any use or disclosure of PHI not permitted or required by this Agreement of which it becomes aware within fifteen(15)days of Business Associate's discovery of such unauthorized use or disclosure; 3.2.4. Ensure that any agent, including a subcontractor, to whom Business Associate provides PHI agrees in writing to the same restrictions and conditions on use and disclosure of PHI that apply to Business Associate; 3.2.5. Make available all records, books, agreements, policies and procedures relating to the use or disclosure of PHI to the Secretary of HHS for purposes of determining compliance with the HIPAA Rules, subject to applicable legal privileges; 3.2.6. Make available, within seven (7) days of a written request, to Covered Entity during normal business hours at Business Associate's offices all records, books, agreements, policies and procedures relating to Business Associate's use or disclosure of PHI to enable Covered Entity to determine Business Associate compliance with the terms of this Agreement; 3.2.7. Provide access to PHI to the Covered Entity or the individual to whom PHI relates at the request of and in the time and manner chosen by Covered Entity or the Individual to meet the requirements of 45 CFR § 164.524; 3.2.8. Make any amendment(s) to PHI that Covered Entity directs pursuant to 45 CFR §164.526; 3.2.9. Provide, within fifteen (15) days of a written request, to Covered Entity such information as is requested by Covered Entity to permit Covered S -- -- -----Entity to respond-to-a-request-by-an individual-for-an-accounting-of-the--- disclosures of the individual's PHI in accordance with 45 CFR §164.528; and 3.2.10.Disclose to subcontractors, agents or other third parties, and request from Covered Entity, only the minimum PHI necessary to perform or fulfill a specific function required or permitted under the Agreement. 3.3.With regard to securing PHI provided by Covered Entity, Business Associate agrees to comply with the requirements for Business Associates established by the HIPAA Rules and such modifications or additions to the Security Rule as may be established by the Secretary of the U.S. Department of Health and Human Services related to the HIPAA Rules. 4. Term and Termination 4.1.Term. This Agreement shall become effective when signed by all parties and shall continue in effect until all obligations of the Parties have been met, unless the Agreement is terminated as provided in this Agreement. 4.2.Termination by County. The County may terminate this agreement at any time. 4.2.1. Upon COUNTY'S knowledge of a material breach or violation of the terms of this Agreement by Business Associate COUNTY, in its sole discretion, may: 4.2.1.1. Immediately terminate the Agreement; or, 4.2.1.2. Provide Business Associate with an opportunity to cure the breach or violation within the time specified by COUNTY. If Business Associate fails to cure the breach or end the violation within the time specified by COUNTY, then COUNTY will either: 4.2.1.2.1. Terminate the Agreement, or 4.2.1.2.2. If COUNTY determines termination is not feasible, report the breach or violation to the Secretary ofHHS. 4.3.Effect of Termination 4.3.1. Upon termination of the Agreement, for any reason, Business Associate agrees to return or destroy all PHI, if it is feasible to do so, and retain no 's -- copies thereof. Return or destruction shall-occur within 60 days of the --- termination of the Agreement. Business Associate shall, upon return or destruction of PHI, provide written attestation to COUNTY that all PHI held by Business Associate has been returned to COUNTY or has been destroyed. 4.3.2. Business Associate further agrees to recover any PHI in the possession of its subcontractors, agents or third parties to whom Business Associate has provided PHI and return or destroy such PHI within the 60 days after termination of the Agreement. Business Associate shall, upon return or destruction of PHI, provide written attestation to COUNTY that all PHI held by Business Associate has been returned to COUNTY or has been destroyed. 4.3.3. Ifreturn or destruction of PHI is not feasible, Business Associate shall: 4.3.3.1. Notify Covered Entity in writing of the specific reasons why the Business Associate has determined it is infeasible to return or destroy the PHI; 4.3.3.2. Agree to extend any and all protections, limitations, and restrictions contained in this Agreement to Business Associate use, disclosure, security, breach notification and enforcement of any PHI retained after the termination of this Agreement; and 4.3.3.3. Agree to limit any further uses and disclosures to those allowed under the HIPAA Rules for the purposes that make the return or destruction of PHI infeasible. 4.3.4. If it is not feasible for Business Associate to obtain PHI in the possession of a subcontractor, agent, or third party to whom Business Associate has provided PHI, Business Associate shall: 4.3.4.1. Provide a written explanation to the Covered Entity why the PHI cannot be obtained; 4.3.4.2. Require the subcontractor, agent, or third party to agree, in writing, to extend any and all protections, limitations, and restrictions contained in this Agreement to the subcontractor's, agent's, or third parry's use and disclosure of any PHI retained after the termination of this Agreement; and -- 4.3A.3.--_-Require-the-subcontractor;-agent—, or third party agree in wrtm*g, ---- to limit any further uses and disclosures to those allowed under the HIPAA Rules for the purposes that make it infeasible for the Business Associate to obtain the PHI. 5. Miscellaneous 5.1.Survival. All terms of this Agreement that are necessary to carry out the intents and purposes of this Agreement, including but not limited to Sections 2.1 and 4.3, shall survive the Termination of this Agreement. 5.2.Superseding Effect. Should the terms of this Agreement conflict with the terms of the Agreement, the terms providing for more stringent protections of PHI shall apply. Additionally, nothing contained in this Agreement shall be held to vary, alter, waive or extend any of the terms, conditions, provisions, or limitations of 45 CFR Parts 160 and 164. Signatures to Follow APPROVALS By the signatures below of their duly authorized officials, the parties agree to, and accept, the terms of this Agreement. Mohave County, Arizona, a political Contractor subdivision of the State of Arizona By: By: Ronald Gould,Chairman Patty Gast, Program Manager-Billing and Funding Mohave County Board of Supervisors The Arizona Partnership for Immunization Date: Date: This Agreement has been reviewed by the undersigned counsel who have determined that it is in appropriate form and within the powers and authority granted to each counsel's respective Party. Attorney for Mohave County Mohave County Public Health Department Matthew J. Smith Mohave County Attorney B �, � �� By: Tyler er, Deputy County Attorney Denise Burley, Director Date: ?-- /,,_e2— z2 Date: Attestation By: Ginny Anderson, Clerk Mohave County Board of Supervisors TAPI-THE ARIZONA PARTNERSHIP for IMMUNIZATION-COST RECOVERY PROGRAM-BILLING PROJECT: (County) CONTRACTOR: TAPI-The Arizona Partnership for Immunization AMOUNT: 20%of reimbursements received from insurance companies for billing diagnostic services; 40%of reimbursement for immunization administration fees and vaccine profit FUNDING: Mohave County Public Health Department. THIS CONTRACT is entered into between The Arizona Partnership for Immunization (hereinafter"TAPI"), a corporate nonprofit of the State of Arizona, and Mohave County Public Health Department (hereinafter "Department"). WITNESSETH WHEREAS, Department operates vaccination clinics on behalf of the County; x And Whereas, Department requires the services of a contractor(TAPI) qualified to coordinate billing services in order for Department to be compensated for Immunization services provided to health plan members; and, WHEREAS,TAPI is qualified and willing to provide such services; and, WHEREAS, pursuant to Department,TAPI is the vendor qualified to perform said services. Now,THEREFORE,the parties hereto agree as follows: ARTICLE I-TERM AND EXTENSION/RENEWAL This Contract, as awarded by Department, shall commence upon the date of execution. The contract period shall be one year from the date of execution. Either party may terminate this Contract by providing written notification of their intent to terminate a minimum of sixty days in advance of such termination. The contract will automatically renew annually unless prior written notification of intent to terminate this contract is provided by either party a minimum of sixty (60) days prior to the annual renewal date. The parties may renew this Contract a total of four additional times at one-year periods. Any modification or extension of the Contract termination date shall be by formal written amendment executed by the parties hereto.Amendments to the Contract must be approved by both parties, before any work or deliverables under the Amendment commences. This Agreement is subject to the provisions of A.R.S. § 38-511. 1 Ta pi2015 ARTICLE II-SCOPE A. Billing: This agreement will establish a program operated by TAPI to coordinate billing for public health programs so that counties and Department can be compensated for services to health plan members. TAPI will ensure that the health plans have claims data records for their clients. Department will receive payment for appropriately billed services provided to privately insured clients and clients listed to be on the Arizona State Medicaid Program Arizona Health Care Cost Containment System (AHCCCS), Marketplace Exchange, and other insurance systems. B.TAPI will: 1. Coordinate contracts for public health services billing with each commercial and public health plan. If Department holds its own contracts with insurance companies, TAPI may use those contracts to secure reimbursement. 2. Coordinate process for reimbursement of services provided to clients with commercial and public insurance plan coverage. 3. Communicate with Arizona Department of Health Services (ADHS) programs to ensure necessary financial collaboration. 4. Use safeguards to ensure data is Health Insurance Portability and Accountability Act (HIPAA) compliant and patient data protected. 5. Make available support equipment recommendations based on industry standards. 6. Offer education services on claims processed for Department programs when requested. 7. Offer general billing and programmatic education and updates to Department staff as needed and requested. 8. For the billing process TAPI will: I. Process claims on behalf of Department, by using its own billing (practice management) system or by becoming a user in the Department practice management system. TAPI may use a 3 d party contractor to assist with processing high volumes of claims or with interfacing with Department's electronic health record system or practice management system. ll. Communicate information for each individual health plan III. Receive payment for submitted claims or, in the case where Department holds its own contracts,ensure payment is directed to Department's TIN. IV. Reimburse Department for a portion of the claims payments received on a monthly basis,when TAPI receives the payments. In the case where Department 2 Tapi2015 receives payments under its own TIN, TAP[ will invoice Department for TAPI's portion of monthly insurance revenue. C. Department will: 1. Use a standard billing encounter or superbill form or electronic document which conforms to regulatory billing requirements. 2. All billing and demographic records of the health plan members will be sent to TAPI for processing using electronic submission of claims to health plans for payment, unless paper HCFA 1500s are required by the payer. 3. Train staff to verify clients' insurance at the clinics or program sites using online real time insurance eligibility tool,which will be provided by TAPI or the Department. 4. Provide TAPI the cost for services and private stocks of supplies and materials to aid in analysis of billing program reimbursement sufficiency and effectiveness. The exact data to be provided and timing will be mutually agreed upon by both TAPI and Department. ARTICLE III-PAYMENT In consideration of this contract,TAPI agrees to pay Department as follows: BILLING:TAPI will receive 40%of all immunization administration fees and 40%of any profits for vaccines, after Department has been reimbursed for its vaccine cost. For all other clams, TAPI will receive 20%of the reimbursement paid for administration, evaluation and management, and any other services; as well as 20% of claims paid for private stock items, such as materials reimbursement. This percentage covers TAPI's costs for billing,accountability reports,contracting and advocacy activities. Over time the payment methodology will be revised,once sufficient volumes of billing are available to enable an accurate revenue and expense projection to ensure that both TAPI and Department's cost are covered. All changes in percentage will be done through an amendment to this contract in writing and signed by both parties. ARTICLE IV-INSURANCE TAPI shall obtain and maintain at its own expense, during the entire term of this contract the following type(s) and amount(s)of insurance: A. Commercial General Liability in the amount of$1,000.000.00 combined,single limit Bodily injury and Property Damage, $2,000,000.00 aggregate. Department and Mohave County is to be named as an additional insured for all operations performed within the scope of the agreement between Department and TAPI. 3 Tapi2015 B. Commercial or Business automobile liability coverage for owned, non-owned and hired vehicles used in the performance of this agreement with limits in the amount of $1,000.000.00 combined single limit or $1,000.000.00 Bodily injury and $1,000.000.00 Property Damage and $2,000,000.00 aggregate. C. If this agreement involves professional services, professional liability insurance in the amount of$1,000.000.00; and, D. If required by law, workers' compensation coverage including employees' liability coverage. ARTICLE V-INDEMNIFICATION TAPI shall indemnify,defend,and hold harmless Department, its officers,employees and agents from and against any and all suits,actions, legal administrative proceedings,claims or demands and costs attendant thereto, arising out of any act, omission, fault or negligence by TAPI, its agents, employees, or anyone under its direction or control or on its behalf in connection with performance of this contract. TAPI warrants that all products and services provided under this contract are non-infringing. TAPI will indemnify, defend and hold harmless Department from any claim of infringement arising from services provided under this contract or from provision, license, transfer or use for their intended purpose of any products provided under this Contract. ARTICLE VI-COMPLIANCE WITH LAWS TAPI shall comply with all federal, state, and local laws, rules, regulations, standards and executive orders,without limitation to those designated within this contract.The laws and regulations of the State of Arizona shall govern the rights of the parties,the performance of this contract, and any disputes arising hereunder. Any action relating to this contract shall be brought in a court of the State of Arizona in Maricopa County. Any changes in the governing laws, rules, and regulations during the terms of this contract shall apply, but do not require an amendment. ARTICLE VII-INDEPENDENT CONTRACTOR The status of TAPI shall be that of an independent contractor. Neither TAPI, its officers, agents or employees shall be considered an employee of Department, or be entitled to receive any employment- related fringe benefits under any merit system now in place or to be created during the length of this contract.TAPI shall be responsible for payment of all federal, state and local taxes associated with the compensation received pursuant to this contract and shall indemnify and hold Department harmless 4 Tapi2015 from any and all liability which Department may incur because of TAPI's failure to pay such taxes.TAPI shall be solely responsible for program development and operation. ARTICLE VIII-SUBCONTRACTOR TAPI will be fully responsible for all acts and omissions of any subcontractor and of persons directly or indirectly employed by any subcontractor and of persons for whose acts any of them may be liable to the same extent that TAPI is responsible for the acts and omissions of persons directly employed by it. Nothing in this contract shall create any obligation on the part of County of Mohave to pay or see to the payment of any money due any subcontractor,except as may be required by law. ARTICLE IX-ASSIGNMENT TAPI retains its right to assign its rights of this contract, in whole or in part,without any prior written approval of Department. Approval may be withheld at the sole discretion of TAPI, provided that such approval would not seek to harm Department or its parent or affiliates, in which case approval shall not be unreasonably withheld. ARTICLE X-HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY(HIPAA) The parties acknowledge that Department's Immunization Program is a "covered entity" as defined in 45 CFR 160.103 of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and provides protected health information or PHI (as defined by HIPAA)to TAPI as a Business Associate (as defined by HIPAA).The Business Associate Agreement entered into in February,2022 between TAPI and Department is adopted and part of this Contract, and TAPI must comply with the provisions contained therein. ARTICLE XI-LEGAL ARIZONA WORKERS ACT COMPLIANCE TAPI hereby warrants that it will at all times during the term of this Contract comply with all federal immigration laws applicable to TAPI's employment of its employees, and with the requirements of A.R.S., 23-214 (A) (together the State and Federal Immigration Laws").TAPI shall further do its best to ensure that each subcontractor who performs any work for TAPI under this contract likewise complies with the State and Federal Immigration Laws. 5 Ta pi2015 ARTICLE XII-SCRUTINIZED BUSINESS OPERATIONS 1. 4TAP1 and Department hereby certify that neither party will employ the use of goods or services produced by the forced labor of ethnic Uyghurs in the People's Republic of China pursuant to A.R.S. §35-394. 2. If this contract exceeds$100,000, and parties employ ten or more employees,then both parties certify it is not currently engaged in, and agrees for the duration of this Contract, not to engage in a boycott of goods or services from Israel pursuant to A.R.S. §35-393.01. 3. The submission of a false certification may result in action up to and including termination of this contract. ARTICLE XIII-ENTIRE AGREEMENT This document constitutes the entire agreement between the parties pertaining to the subject matter hereof,and all prior or contemporaneous agreements and understandings, oral or written, are hereby suspended and merged herein.This Contract may be modified, amended, altered or extended only by a written amendment signed by the parties. 6 Tapi2015 c •: a 3 ; v -n v c o u O �o c � v o a o a v M z °1 N v � m o a O .b Z)J (i Z ai E J E Q) VI o a Q E w m Z Q F L II vC o NJ� L. 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