A1_CTR077220_Steadfast_Renovations_LLC__2025.10.29.pdf
PDF 183 KB Posted
- Attached to
- Master Agreement AZ|CTR077220
- Contract number
- CTR077220
- Issued by
- Arizona
About this file
This is a Contract Amendment (Amendment Number One) issued by the Arizona Department of Economic Security for Contract Number CTR077220 with Steadfast Renovations LLC. The amendment modifies the existing Home Modifications contract between the state and the contractor.
The amendment removes and replaces Section 1.12 (Incident Reporting Requirements) in its entirety. Under the revised requirements, the contractor must submit incident reports as defined in the Division for Developmental Disabilities (DDD) Medical Policy Manual 961, the DDD Provider Manual Chapter 70, and the AHCCCS Medical Policy Manual Chapter 961, as may be amended. Sentinel events must be reported to the Division immediately by telephone at 602-375-1403 or 1-855-375-1403 (available 24 hours daily, including weekends and holidays) and subsequently submitted via the AHCCCS QM Portal within one business day of occurrence. The amendment provides reference links to the AHCCCS QM Portal login and user guides. All other requirements, specifications, and terms and conditions of the original contract remain unchanged. The amendment was executed through electronic approval in the state's APP system.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
CONTRACT AMENDMENT
Arizona Department of Economic Security
1789 W Jefferson Street, Mail Drop 1541, Phoenix, AZ 85007
CONTRACT NUMBER: AMENDMENT NUMBER:
CTR077220 One (1)
DESCRIPTION/ LABEL: Home Modifications
CONTRACTOR NAME: Steadfast Renovations LLC
THE ABOVE REFERENCED CONTRACT IS HEREBY MODIFIED AS FOLLOWS:
In accordance with the Uniform Terms and Conditions, Section 5, Contract Changes, Exhibit A, Section 1.12. Incident Reporting Requirements are being removed in their entirety and replaced as follows:
1.12 Incident Reporting Requirements
The Contractor Shall:
1.12.1 Submit Incident Reports as defined in the DDD’s Medical Policy Manual 961, DDD Provider Manual Chapter70 and AHCCCS Medical Policy Manual -Chapter 961 as may be amended.
Division Medical Policy Manual 961 Division Provider Manual Chapter 70
AHCCCS AMPM 961
1.12.1.1 Sentinel events shall be reported to the Division immediately at 602-375-1403 or 1-855- 375-1403 (phone lines are available 24 hours a day, weekdays, weekends and holidays) and must then be submitted via the AHCCCS QM Portal within one (1) business day of the occurrence of the event.
AHCCCS QM Portal Migration User Guide
1.12.1.2 The AHCCCS QM Portal can be accessed through following links:
AHCCCS QM Portal login page AHCCCS QM Portal FAQ page
1.12.1.3 The AHCCCS QM Portal User Guides can be found at the links below:
AHCCCS PROVIDER USER GUIDE
AHCCCS IAD Submit User Guide AHCCCS Return IAD User Guide AHCCCS Approve IAD User Guide
ALL OTHER REQUIREMENTS, SPECIFICATIONS, AND TERMS AND CONDITIONS REMAIN UNCHANGED
ACKNOWLEDGEMENT AND AUTHORIZATION
This Amendment shall be fully executed by means of electronic approval in APP.
https://des.az.gov/sites/default/files/media/Division_Medical_Policy_Manual_961_Incident_Accident_and_Death_Reporting.pdf?time=1761096186787 https://des.az.gov/sites/default/files/media/DDD_Provider_Policy_Manual_Chapter_70_Qualified_Vendor_Incident_Reporting.pdf?time=1717792726488 https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/900/961.pdf https://docs.google.com/document/d/17V9leTt-Mf9lPUSaOFTqQRz_7jGNutPfKi4m9WcQ6IA/edit?tab=t.0%23heading=h.arsfm1vhtwua https://qmportal.azahcccs.gov/Account/Login.aspx about:blank https://qmportal.azahcccs.gov/UserGuides/QuickStart_RegistrationAccountMgmt_Provider.pdf https://qmportal.azahcccs.gov/UserGuides/QuickStart_RegistrationAccountMgmt_Provider.pdf https://qmportal.azahcccs.gov/UserGuides/QuickStart_IAD_Report_Return.pdfhttps:/qmportal.azahcccs.gov/UserGuides/QuickStart_IAD_Report_Approve.pdf https://qmportal.azahcccs.gov/UserGuides/QuickStart_IAD_Report_Approve.pdf
File details come from the government source that posted it. Updated .