CTR050520-a1.pdf

Contract Amendment State of Arizona Department of Child Safety

Office of Procurement 3003 N. Central St, 20th Fl.

Phoenix, AZ 85012

Contract #:

Amendment #:

ALL OTHER REQUIREMENTS, SPECIFICATIONS, TERMS AND CONDITIONS REMAIN UNCHANGED

This amendment shall be fully executed upon the approval electronically in the state approved e-procurement system by an authorized representative of the Contractor and applied to the contract within the e-procurement system by the Procurement Officer or delegate.

In accordance with contract term and condition, paragraph 9, Amendments, the following clarifications are made in the contract.

1. Throughout the contract delete “DCS/CMDP” and replace with “DCS CHP”.

2. Under Definitions, Contractor, delete “n administrative service organization (ASO)”.

3. Under Definitions, add CSR Service Plan.

4. Under Definitions, Interdisciplinary Care, add “provider” before the second “treatment”.

5. Under Definitions, Integrated Rapid Response, “Virtual Integrated Rapid Response Assessments (e.g.

simultaneous live video with audio) are permitted for exceptional circumstances.”

6. Under Section D, Scope of Work, Purpose, Applicability and Introduction, correct the spelling of Introduction from “Itnroduction” to “Introduction”.

7. Under Section D, Scope of Work, Number 1, Purpose, Applicability and Introduction, second paragraph, add at the beginning “DCS CHP has extensive knowledge of the unique needs of children and youth in the foster care system and experience collaborating with other child serving systems.”

8. Under Section D, Scope of Work, Number 1, Purpose, Applicability and Introduction, second paragraph, second sentence, delete “developing” and replace with “implementing”.

9. Under Section D, Scope of Work, Number 1, Purpose, Applicability and Introduction, second paragraph, third sentence, delete “decision making authority”.

10. Under Section D, Scope of Work, Number 1, Purpose, Applicability and Introduction, second paragraph, third sentence, after “accountability for the” add “provision of”.

11. Under Section D, Scope of Work, Number 1, Purpose, Applicability and Introduction, second paragraph, third sentence, after “accountability for the” add “provision of”.

12. Under Section D, Scope of Work, Number 1, Purpose, Applicability and Introduction, second paragraph, third sentence, after “services” add “to the”.

13. Under Section D, Scope of Work, Number 1, Purpose, Applicability and Introduction, second paragraph, fourth sentence, after “Contractor” add “will be responsible for the administration and provision of integrated physical health and behavioral health services. The Contractor, in close collaboration with DCS CHP, shall provide for the delivery of these integrated services as required by this Contract, including but not limited to, Network Development and Management, Claims/Encounter processing, Utilization Management, Care Management, Care Coordination, Member Services, and Grievance and Appeals (both member and provider). In fulfilling its responsibilities, the Contractor shall collaborate closely with DCS CHP to create a health care delivery system that provides the highest quality of services for Arizona’s children and youth in foster care.”

Office of Procurement 3003 N. Central St, 20th Fl.

Phoenix, AZ 85012

This amendment shall be fully executed upon the approval electronically in the state approved e-procurement system by an authorized representative of the Contractor and applied to the contract within the e-procurement system by the Procurement Officer or delegate.

14. Under Section D, Scope of Work, Number 1, Purpose, Applicability and Introduction, second paragraph, fourth sentence, the newly added language, delete the rest of the paragraph.

15. Under Section D, Scope of Work, Number 1, Purpose, Applicability and Introduction third paragraph, delete in its entirety.”

16. Under Section D, Scope of Work, Number 2, Eligibility Categories, CSR Eligibility, second paragraph, second sentence, delete “DCS/CMDP” and replace with “The Contractor”.

17. Under Section D, Scope of Work, Number 2, Eligibility Categories, CSR Eligibility, third paragraph, second sentence, delete “DCS/CMDP” and replace with “The Contractor”.

18. Under Section D, Scope of Work, Number 9, Scope of Services, third paragraph, delete “October 1, 2020 or at a later date determined by DCS/CMDP” replace with “the go live date of April 1, 2021.”

19. Under Section D, Scope of Work, Number 9, Scope of Services, Children's Rehabilitative Services, second paragraph, delete “DCS/CMDP” and replace with “Contractor”.

20. Under Section D, Scope of Work, Number 9, Scope of Services, Dental Services, third paragraph, first sentence, delete “DCS/CMDP” and replace with “Contractor”.

21. Under Section D, Scope of Work, Number 9, Scope of Services, Dental Services, third paragraph, fifth sentence delete “DCS/CMDP” and replace with “Contractor”.

22. Under Section D, Scope of Work, Number 9, Scope of Services, Dental Services, third paragraph, fifth sentence add “with notification to DCS CHP of the members on the list” after “notice”.

23. Under Section D, Scope of Work, Number 9, Scope of Services, Early and Periodic Screening, Diagnostic and Treatment Services delete “DCS/CMDP” and replace with “Contractor”.

24. Under Section D, Scope of Work, Number 9, Scope of Services, Integrated Rapid Response, after the second sentence insert “Virtual Integrated Rapid Response Assessments (e.g. simultaneous live video with audio) are permitted for exceptional circumstances.”

25. Under Section D, Scope of Work, Number 9, Scope of Services, Covered Services, Post Stabilization

Care, 2nd paragraph, delete “when DCS/CMDP advises the Contractor that” and insert “and”

26. Under Section D, Scope of Work, Number 9, Scope of Services, Covered Services, Post Stabilization Care, Number 1. Delete “DCS/CMDP” and replace with “Contractor”., insert “(Mercy Care) is” after “Contractor’s”.

27. Under Section D, Scope of Work, Number 9, Scope of Services, Covered Services, Post Stabilization

Care, Number 2. Delete “DCS/CMDP” and replace with “Contractor”.

28. Under Section D, Scope of Work, Number 9, Scope of Services, Covered Services, Post Stabilization Care, Number 3. Delete “DCS/CMDP” and “DCS/CMDP will ask the” replace with “Contractor

Office of Procurement 3003 N. Central St, 20th Fl.

Phoenix, AZ 85012

This amendment shall be fully executed upon the approval electronically in the state approved e-procurement system by an authorized representative of the Contractor and applied to the contract within the e-procurement system by the Procurement Officer or delegate.

29. Under Section D, Scope of Work, Number 9, Scope of Services, Covered Services, Post Stabilization Care, 3rd paragraph, insert “(Mercy Care) is” after “Contractor’s

30. Under Section D, Scope of Work, Number 10, Special Healthcare Needs, fourth paragraph, number 1, add at the beginning “Mercy Care’s” and delete “A”.

31. Under Section D, Scope of Work, Number 10, Special Healthcare Needs, fourth paragraph, number 2, add at the beginning “Mercy Care’s” and delete “A”.

32. Under Section D, Scope of Work, Number 11, Behavioral Health Service Delivery, under the paragraph

“The Contractor shall” delete item a and replace with “Follow AHCCCS guidance related to standardized assessment tools for child and adolescent substance abuse.”

33. Under Section D, Scope of Work, Number 11, Behavioral Health Service Delivery, under paragraph “The

Contractor shall require its providers to use:”, number 3.b, delete “CASII” and replace with “CALOCUS or as defined AHCCCS requirement.”.

34. Under Section D, Scope of Work, Number 11, Behavioral Health Service Delivery, under paragraph “The

Contractor shall require its providers to use:”, number 4.a.i., delete “one” and replace with “two”.

35. Under Section D, Scope of Work, Number 11, Behavioral Health Service Delivery, under paragraph “The Contractor shall require its providers to use:”, number 4.a.i., second arrow, add “for behavioral health treatment”.

36. Under Section D, Scope of Work, Number 11, Behavioral Health Service Delivery, under paragraph “The Contractor shall require its providers to use:”, number 4.a.ii., delete “CASII” and replace with “CALOCUS or as defined AHCCCS requirement.”.

37. Under Section D, Scope of Work, Number 11, Behavioral Health Service Delivery, under paragraph “The

Contractor shall require its providers to use:”, number 4.b.i., delete “no more than 1:20, with 1:15 being the desired target.” and (“20”) and replace with “not less than 1:8 and not more than 1:25, with 1:15 being the desired target.” and “25”) respectively.

38. Under Section D, Scope of Work, Number 11, Behavioral Health Service Delivery, under paragraph “The Contractor shall require its providers to use:”, Monitoring, Training and Education, delete “CASII” and replace with “CALOCUS or as defined AHCCCS requirement.”.

39. Under Section D, Scope of Work, Number 16, Written Policies and Procedures, first paragraph, fourth sentence, after “activities” add “and any changes to policy,” and before “review” add “annual”.

40. Under Section D, Scope of Work, Number 17, Member Information, seventh paragraph, delete numbers 1 and 2 and replace with:

1. Member Handbooks,

2. Provider Directories, Office of Procurement 3003 N. Central St, 20th Fl.

Phoenix, AZ 85012

This amendment shall be fully executed upon the approval electronically in the state approved e-procurement system by an authorized representative of the Contractor and applied to the contract within the e-procurement system by the Procurement Officer or delegate.

3. Consent forms,

4. Appeal and Grievance Notices, and

5. Denial and Termination Notices.

41. Under Section D, Scope of Work, Number 22, Quality Management and Performance Improvement, Performance Measures, Operational Performance Measures, Credentialing Standard Performance Measures, Initial, delete “90 days” and replace with “75 days”.

42. Under Section D, Scope of Work, Number 23, Medical Management, High Need/High Cost, fifth paragraph delete “include the training topics identified in APMPM Policy 1060”, and replace with the following:

“Preventing Suicide Among AHCCCS Members: identification of suicide risk using nationally recognized training materials (e.g. SafeTalk).

Social Determinants of Health (SDOH): training requirements in place to educate Contractor staff and providers regarding SDOH support addressing the socioeconomic needs of members.

Quality of care/service concerns: with regard to the appropriate identification and referral of quality of care/service concerns.”

43. Under Section D, Scope of Work, Number 26, Network Development, Transition to Contracted Network delete “10/1/2020”.

44. Under Section D, Scope of Work, Number 26, Network Development Multi-Specialty Interdisciplinary

Clinics, ninth paragraph, delete “DCS/CMDP” and replace with “Contractor”.

45. Under Section D. Scope of Work, Number 29, Primary Care Provider Standards, sixth paragraph, delete and replace with: “The Contractor’s system must be designed to capture and track assignment and/or enrollment in PCP, PDP and BH or integrated health homes. DCS/CHP must have the ability to directly or indirectly change PCP PDP, BH home assignment or enrollment. The Contractor must retain provider assignment historical data, maintain record of changes and have reporting capabilities”.

46. Under Section D, Scope of Work, Number 37, Claims Payment/Health Information System, sixth paragraph, delete in its entirety.

47. Under Section D, Scope of Work, Number 37, Claims Payment/Health Information System, seventh

48. Under Section D, Scope of Work, Number 37, Claims Payment/Health Information System, eighth

Office of Procurement 3003 N. Central St, 20th Fl.

Phoenix, AZ 85012

This amendment shall be fully executed upon the approval electronically in the state approved e-procurement system by an authorized representative of the Contractor and applied to the contract within the e-procurement system by the Procurement Officer or delegate.

49. Under Section D, Scope of Work, Number 50, Compensation, first paragraph, add “This contract is a full risk contract for the Contractor”.

50. Under Section D, Scope of Work, Number 50, Capitation Rate Development, second paragraph, add “Contract is a full risk contract. Contractor shall be responsible for all payments in accordance with the scope of work and receive compensation as per the defined capitation rates and re-insurance for all of CMDP population.”

51. Under Section D, Scope of Work, Number 54, Coordination of Benefits and Third Party Liability, Pay and

Chase, delete “Capped FFS Schedule” and replace with MCO Fee Schedule”.

52. Under Exhibit 1, Member Grievance and appeal system standards, Number 46, fourth sentence, delete “DCS/CMDP within three (3) business days of receipt and DCS/CMDP will forward the request within two (2) additional business days to the AHCCCS OALS” and replace with “AHCCCS or the Office of Administrative Hearing (OAH) within five (5) business days of receipt.”

53. Under Exhibit 2, Provider Claim Dispute Standards, Number 13, delete it its entirety and replace with “If the provider files a written request for hearing related to a Title XIX/XXI claims disputes, the Contractor must ensure that the hearing request and supporting documentation is submitted to AHCCCS or the Office of Administrative Hearings (OAH) within five (5) business days of receipt of the written request for hearing. If the provider files a written request for hearing related to non-Title XIX/XXI claims disputes, the Contractor must ensure that the hearing request and supporting documentation is submitted to the Office of Administrative Hearing.”