Direct Contract

.titMt Contract No.: CTR059105 n F P -� KT �I F :-; T OF

ECONOMlC SECURITY

Description: Assisted Living Facility lour r.mnu Fvr .I Scrongt·r .lruond

Contract between the Department of Economic Security (the "Department") and Marshall Home for Men, Inc (the "Contractor").

WHEREAS the Contractor is:

[ ] a Non-profit Organization as defined in Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards as prescribed in 2 C.F.R. § 200;

[] a For-profit Organization; and

WHEREAS the Department is duly authorized to execute and administer contracts under A.R.S. § 41-1954;

THEREFORE; the Department and Contractor agree to abide by all the terms and conditions set forth in this Contract.

Contract Term: This contract shall be 05/01/2022 and shall terminate on 04/30/2023, unless extended in accordance with the Special Terms and Conditions.

BY SIGNING THIS FORM ON BEHALF OF THE CONTRACTOR, THE SIGNATORY CERTIFIES HE/SHE HAS THE AUTHORITY TO BIND THE CONTRACTOR TO THIS CONTRACT.

FOR AND ON BEHALF OF THE

ARIZONA DEPARTMENT OF ECONOMIC SECURITY:

Signature of Authorized Individual

Typed Name

Title

Date

FOR AND ON BEHALF OF THE CONTRACTOR:

Typed Name

Title

Contractor Mailing Address

Contractor Mailing Address (cont.)

K\""��\� u ...... _\ ➔r-,.J.o Contact Name and Title 7

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Phone number and Email address x

Tracy Chisler

Procurement Manager

3/21/2022

Table of Contents

Contract No.: CTR059105

Description: Assisted Living Facility

CONTRACTOR IS STRONGLY ENCOURAGED TO READ THE ENTIRE CONTRACT.

Table of Contents

Scope of Work

Exhibit A - Rate Sheet

Exhibit B - Level of Care

Exhibit C - 1250-H

DDD Special Terms and Conditions

ADES Special Terms and Conditions

Uniform Terms and Conditions

Attachment 1 - Certification Regarding Lobbying

Attachment 2 - Participation in Boycott of Israel

Attachment 3 - Certification Regarding: Debarment, Suspension, Ineligibility and Voluntary Exclusion

Attachment 4 - Contractor Facility Location Chart

Attachment 6 - Central Registry

Scope of Work

1. Arizona Department of Economic Security (ADES) Mission and Vision Statement

1.1 ADES Mission: The Arizona Department of Economic Security makes Arizona stronger by helping

Arizonans reach their potential through temporary assistance for those in need, and care for the vulnerable.

1.2 ADES Vision: All Arizonans who qualify receive timely ADES services and achieve their potential.

1.3 DDD Mission: The Division of Developmental Disabilities empowers individuals with developmental disabilities to lead self-directed, healthy, and meaningful lives.

2. Purpose of Contract

2.1. Purpose Statement: This service provides continuous residential care to eligible Division of

Developmental Disabilities (DDD) Members to assure a safe and healthy living environment that meets the physical needs of members.

2.2. Legal Authority: A.R.S. § 41-1954(A)(6) provides ADES, hereafter referred to as the Department, the authority to contract and incur obligations within the general scope of its activities and operations.

2.3. Projected Utilization: Service provision is on an as needed, if needed, basis. ADES makes no guarantee of the number of payment units to be authorized.

3. Definitions

3.1. Assisted Living Facility: Means a residential care institution that provides supervisory care service, personal care services or direct care services on a continuing basis. All approved residential settings in this category are required to meet ADHS licensing criteria as defined in A. A.C R9-10 Article 8.

Assisted Living Home (ALH) 10 or fewer residents and Assisted Living Center (ALC) 11 or more residents.

3.2. Representative Payee: Is appointed to accept disability or Social Security payments on behalf of someone incapable of managing their benefits

3.3. Members: Are individuals who have autism, cerebral palsy, epilepsy or a cognitive disability or children under the age of six (6) years old that are at risk of having a developmental disability who are eligible for and authorized to receive services from DDD.

3.4. Pre-Admission Screening and Resident Review (PASRR): A federally mandated multi-level screening process which applies to all applicants and residents of Medicaid certified nursing homes, regardless of the member's method of payment.

3.5. Support Coordinator: An employee of the DDD who coordinates the implementation of the DDD

Member’s appropriate supports and services to meet goals and objectives of the DDD Member. The

Support Coordinator also serves as the primary point of contact for the DDD Member and/or their

Responsible Person.

3.6. Third Party Liability: The resources available from a person or entity that is or may be, by agreement, circumstances, or otherwise, liable to pay all or part of the medical expenses incurred by a DDD

Member (A.A.C. R6-6-101.71 and A.A.C. Title 9, Chapter 22, Article 10).

4. Service Description

4.1. Arizona Taxonomy Definition: A residential care facility that provides supervisory care services, personal care services or directed care services on a continuing basis to eleven or more residents as defined by A.R.S. § 36-401.

4.2. Actual Service Description: Services are provided by Assisted Living Facility licensed by the Arizona

Department of Health Services (ADHS) and registered with the Arizona Health Care Cost Containment

System (AHCCCS).

4.3. Background: DDD is responsible for administering Arizona Long Term Care Services (ALTCS) to eligible DDD Members. In collaboration with AHCCCS, DDD contracts with a variety of providers, including Assisted Living Centers, to deliver health care services to eligible individuals, as defined by

A.R.S. § 36-2901, et seq.

5. General Requirements

The Contractor shall:

5.1. Provide all services in a culturally relevant and linguistically appropriate manner for the population to be served.

5.2. Possess a current license issued by ADHS, as an Assisted Living Center, in accordance with the Arizona

Administrative Code (A.A.C.) Title 9, Chapter 10, Article 8, Assisted Living Facilities, as may be amended.

5.3. Provide services to DDD Members at the address appearing on the license issued by ADHS.

5.4. Be registered with AHCCCS as an Assisted Living Center.

5.5. Comply with all rules and requirements set forth in the A.A.C. Title 9, Chapter 10, Article 8, Assisted

Living Facilities, as may be amended.

5.6. Provide services in accordance with A.R.S. Title 36, Chapter 5.1 et seq., State Department of

Developmental Disabilities, as may be amended.

5.7. Adhere to all applicable Policies and Procedures of ADES and DDD (available at https://des.az.gov/services/disabilities/developmental-disabilities/policies-and-rules, as may be amended.

5.8. Upon authorization by DDD, only accept or retain a DDD Member who requires continuous nursing services when:

5.8.1. The DDD Member is under the care of a licensed hospice service agency; or

5.8.2. The continuous nursing services are provided by a private duty nurse.

https://des.az.gov/services/disabilities/developmental-disabilities/policies-and-rules

5.9. Ensure that a Registered Nurse, or a Licensed Practical Nurse working under the supervision of a

Registered Nurse, licensed in accordance with A.R.S., Title 32, Chapter 15 et seq., governing Nursing, provides skilled nursing services to DDD Members.

5.10. Have household and personal hygiene items available for the DDD Member’s use.

5.11. Provide laundry services for the DDD Member.

5.12. Provide transportation for medically necessary appointments and services, and all other reasonable transportation within the community.

5.13. Provide treatment to the DDD Member as indicated in the Individual Support Plan (ISP), which meets the

DDD Member’s medical, physical, and emotional needs.

5.14. Participate in the development and review of the DDD Member’s planning document (e.g., Individual

Support Plan).

5.15. Ensure that the DDD Member receives other services authorized by DDD.

5.16. Receive consent/agreement from the Responsible Person, or as directed by a physician prior to changing a DDD Member’s living accommodations.

5.17. Not act as the DDD Member’s Representative Payee.

5.18. Maintain a ledger and documentation (e.g., receipts) that accounts for the expenditures of all DDD

Member funds used for members with a representative payee.

5.19. Provide reasonable accommodations and assist if necessary, to allow the DDD Member to engage in religious or spiritual practices, in accordance with the member’s preference.

5.20. Comply with Arizona Administrative Code Title 6, Chapter 6, Article 9 et seq., Managing Inappropriate

Behaviors, as may be amended.

5.21. Alert the DDD Member’s designated Support Coordinator immediately if the DDD Member’s health status unexpectedly changes. If the Support Coordinator is not available, notify DDD Health Care Services at

602-771-8080.

5.22. Participate in discharge planning following the process specified in DDD’s Policy and Procedures Manual.

5.23. Maintain the following:

5.23.1. A file for each DDD Member which includes:

5.23.1.1. DDD Member’s name and AHCCCS Identification Number;

5.23.1.2. Physician's orders;

5.23.1.3. Care plans, including a copy of the Member’s DDD planning document;

5.23.1.4. Treatment records;

5.23.1.5. Medication records;

5.23.1.6. Evaluations and assessments;

5.23.1.7. The name of the DDD Member’s Responsible Person;

5.23.1.8. The DDD Member’s designated Support Coordinator’s name and contact information;

5.23.1.9. Progress reports;

5.23.1.10. Interactions with other agencies or service providers relative to the DDD Member;

5.23.1.11. Any other documentation applicable to the care of the DDD Member; and

5.23.1.12. A log of personal belongings of the DDD Member that is continually updated and available to DDD, the DDD Member, and the DDD Member’s Responsible Person upon request.

5.23.2. Records that document inspections and licenses of the facility and all appropriate Contractor personnel.

5.23.3. Provide copies of all files to DDD upon request.

5.24. Provide companion care to DDD Members in accordance with Exhibit C, 1250-H in the Arizona Health

Care Cost Containment System Medical Policy Manual in the following ways:

5.24.1. Transporting members to medical appointments,

5.24.2. Accompanying members to medical appointments,

5.24.3. Assisting with members personal care needs and,

5.24.4. Supervising members during appointments that a medical practitioner is unable to provide.

6. Reporting Requirements/Notices:

The Contractor shall submit the following items and all notices/correspondence relevant to this contract as directed by ADES, electronically or by mail to:

Arizona Department of Economic Security Division of Developmental Disabilities Contracts Administration

Mail Drop 2HC3

1789 W Jefferson St., Phoenix, AZ 85007 dddcontractsmanager@azdes,gov

6.1. Program Reports: The Contractor shall submit the following:

mailto:dddcontractsmanager@azdes,gov

6.1.1. A monthly accounting of all expenditures of the DDD Member to the DDD Member’s

Representative Payee, if applicable.

6.1.2. A report of each DDD Member’s health care appointments quarterly by July 15, October 15, January 15, and April 15 to the designated Support Coordinator and the DDD Member’s

Responsible Person.

6.2. Financial Payments: Payment will be made by ADES when billing is submitted through one of the following methods:

6.2.1. Billing Electronically or via 837 or 837P - Payment will be made by ADES when billing is submitted using the Division’s approved methods for electronic payment processing. Provider Billing

Documents and instructions are available on DDD’s web site at https://des.az.gov/services/disabilities/developmental-disabilities/vendors-providers/rates-authorizations-billing

6.2.2. Billing Paper Claims: Paper claims shall be submitted on approved HCFA-1500, ADA or Uniform

Billing Documents (UBD forms). All forms must be original (photocopies and faxes will not be accepted). Provider Billing Documents, instructions and submittal address are available on

DDD’s web site at https://des.az.gov/services/disabilities/developmental-disabilities/vendors-providers/rates-authorizations-billing

6.3. Incident Reports

6.3.1. Incident reports shall be submitted to DDD as stated on the Quick Guide to Incident Reporting available at: https://des.az.gov/sites/default/files/Provider-Quick-Guide-For-Incident-

Reporting.pdf

6.4. Contractor Facility License: Contractor shall maintain current facility license issued by ADHS, as an

Assisted Living Center to DDD, in accordance with the A.A.C. Title 9, Chapter 10, Article 8, Assisted

Living Facilities, as may be amended.

6.4.1. Submit Contractor facility license to DDD Contracts prior to contract renewal.

Arizona Department of Economic Security

Division of Developmental Disabilities

Contracts Administration dddcontractsmanager@azdes,gov

6.5. Certificate of Insurance: Current certificates of insurance, as required in the ADES Special Terms and

Conditions shall be on file with ADES throughout each contract term.

7. Payment

7.1. One Unit equals One (1) Residential Day. The Daily Rate is based on the DDD Member’s acuity, see

Exhibit B Levels of Care. DDD will pay the portion of the Daily Rate in which DDD is responsible based on the assessed rate minus the DDD Member’s share of cost.

https://des.az.gov/services/disabilities/developmental-disabilities/vendors-providers/rates-authorizations-billing https://des.az.gov/services/disabilities/developmental-disabilities/vendors-providers/rates-authorizations-billing https://des.az.gov/services/disabilities/developmental-disabilities/vendors-providers/rates-authorizations-billing https://des.az.gov/services/disabilities/developmental-disabilities/vendors-providers/rates-authorizations-billing https://des.az.gov/sites/default/files/Provider-Quick-Guide-For-Incident-Reporting.pdf https://des.az.gov/sites/default/files/Provider-Quick-Guide-For-Incident-Reporting.pdf mailto:dddcontractsmanager@azdes,gov

7.2. One Unit equals One (1) Residential Day including Incontinence Supplies. DDD will pay the portion of the Daily Rate in which DDD is responsible based on the assessed rate minus the DDD Member’s share of cost.

7.3. Residential Day

7.3.1. If the DDD Member is receiving services at 11:59 PM on any day, that day shall be considered a full day of services.

7.3.2. If the DDD Member stays for less than one day total, the day of intake shall be considered a full day of services.

7.3.3. If on the day of exit, the DDD Member leaves prior to 11:59 PM, no part of that day shall be counted, unless it is also the day of intake.

7.4. The Daily Rate shall be all inclusive. ADES will not pay these, or any other costs, separately. The costs associated with the service include but are not limited to:

7.4.1. Room and board;

7.4.2. Personal hygiene items excluding incontinence supplies;

7.4.3. Transportation;

7.4.4. Staff salaries;

7.4.5. Operating costs;

7.4.6. Licensing;

7.4.7. Materials;

7.4.8. Supplies;

7.4.9. Household items;

7.4.10. Insurance; and

7.4.11. Preparation of billing and reports.

7.5. Billing Instructions.

7.5.1. The Contractor shall bill ADES when:

7.5.1.1. The DDD Member’s primary insurance carrier denies payment, or any portion of the payment to the Contractor, as indicated on the Explanation of Benefits (EOB) form; or

7.5.1.2. The Contractor receives payment from a third-party payer in an amount that meets or exceeds the amount authorized. The Contractor shall report the provision of service on the claim document showing no amount due from DDD.

7.5.1.3 The DDD Member’s primary insurance carrier denies payment, or any portion of the payment to the Contractor, as indicated on the EOB form.

7.5.2. Payment will only be made by ADES upon receipt of a complete and accurate Clean Claim, in accordance with A.R.S. § 20-3101, for;

7.5.2.1. Services provided, that includes a copy of the EOB from all Third Party Liability (TPL) insurance carriers.

7.5.2.2. Services provided that includes a copy of the EOB from the DDD Member’s primary insurance carrier.

7.5.3. DDD is not obligated to pay for services provided without prior authorization. An initial claim for services must be received by DDD no later than six (6) months from the date of service, unless the claim involved retro eligibility. Claims initially received beyond the six (6) month time frame, except claims involving retro-eligibility, will be denied. If a claim is originally received within the six (6) month time frame, the Contractor will have up to twelve (12) months from the date of service or sixty (60) days from the date of the recoupment to correctly resubmit the claim in order to achieve clean claim status or to adjust a previously processed claim, unless the claim involves retro-eligibility. If a claim does not achieve clean claim status or is not adjusted correctly within twelve (12) months, DDD is not liable for payment.

Exhibits

Exhibit A - Rate Sheet

Assisted Living Facility

Service Effective Date Rate

Residential Day – Focus ID 101987 May 01, 2022 $93.99

Exhibit B - Level of Care Attachment 01

LEVELS OF CARE

Assisted Living Center

Acuity determinations are based on the AHCCCS/ALTCS Uniform Assessment Tool matrix which describes characteristics of DDD Members in each level of care. Information is gathered through the Division’s assessment of the member, interview with assisted living facility staff or the individual(s) most knowledgeable of the DDD Member’s health care needs.

LEVEL 1

MEMBER HAS THREE OR MORE

OF THE FOLLOWING:

LEVEL 2

MEMBER HAS FOUR OR

MORE OF THE FOLLOWING:

LEVEL 3

MEMBER HAS FIVE OR

MORE OF THE FOLLOWING:

BATHING,

DRESSING,

GROOMING

Independent or may participate in care, but requires assistance with bathing, and/or grooming

Requires moderate assistance with bathing, dressing and/or grooming.

Requires maximum assistance with bathing, dressing, and/or grooming.

FEEDING/EATING

Independent or requires minimum set up/prompting assistance with feeding/eating.

Requires moderate assistance with feeding/eating.

Requires maximum assistance with feeding/eating (for example, tube feeding).

MOBILITY

Independent or requires minimum or stand by assistance to move from one location to another with or without assistive devices.

Requires moderate assistance to move from one location to another with or without assistive devices.

Requires maximum assistance to move from one location to another with or without assistive devices.

TRANSFERRING

Can transfer to some or all surfaces independently. Requires the assistance of no more than one person to transfer form one surface to another with or without assistive devices.

Requires hands-on physical guidance or assistance of one person for all transfers with or without assistive devices. The member may participate by being able to bear weight and pivot.

Requires assistance of two or more people to be physically lifted or moved from one surface to another with or without assistive devices

BOWEL/BLADDER

Continent or occasional incontinent (less than seven times per week) of bowel and/or bladder, or may be continent at times with a training program.

Moderately (daily but some control) incontinent of bowel and/or bladder.

Totally incontinent of bowel and/or bladder, receives scheduled toileting on a daily basis to avoid incontinence and/or receives care of a catheter or ostomy.

ORIENTATION/

BEHAVIOR

Requires no intervention or requires minimum staff intervention for episodes of confusion, memory deficits, impaired judgment, or agitation. May require temporary (24 hours or less) restraints to control a behavioral or medical problem and restraints for personal safety.

Requires moderate staff intervention. May have periodic emotional or mental disturbances, including combativeness.

Requires maximum staff intervention. May be disoriented, confused, combative, withdrawn, or depressed. May need restraints (physical/chemical) for personal safety or protection of others).

MEDICAL

CONDITION

Stable, with no or some routine nursing/medical monitoring and care.

Conditions require more frequent monitoring to maintain stability (for example, unstable hypertension needing frequent assessment and medication adjustment).

Conditions require intense professional intervention to maintain stability (for example, unstable diabetes, coma, terminal medical condition).

MEDICAL/NURSING

TREATMENTS

None or routine, such as range of motion and injections, as well as routine medication administration and routine catheter care.

Skilled nursing treatment in addition to routine medication administration (such as a treatment for skin condition).

Relatively complex, with more than one professional or technical treatment, such as IV therapy, tube or parenteral feeding, care of recent wound, care of infected or stage 4 decubitus, deep suctioning or an extension rehab regime.

Exhibit C - 1250-H

DDD Special Terms and Conditions

1. Definition of Terms

In addition to the terms and conditions defined in the Uniform Terms and Conditions and the Arizona Department of Economic Security (ADES or Department) Special Terms and Conditions, the following shall apply:

1.1. Arizona Health Care Cost Containment System (AHCCCS) - The Arizona Medicaid Program established in Arizona Revised Statutes (A.R.S.) § 36-2903.

1.2. Arizona Health Care Cost Containment System Administration (AHCCCSA or Administration) - (as defined in A.R.S. § 36-2901(1)

1.3. AHCCCS/Arizona Long Term Care Services (ALTCS) - Approved Minimum Subcontract Specifications

- The AHCCCS minimum requirements for the Department's contractors and subcontractors providing services to members eligible for DD/ALTCS and/or receiving Title XIX (ALTCS) funds, available on the AHCCCS website located at https://www.azahcccs.gov/PlansProviders/HealthPlans/minimumsubcontractprovisions.html or as

1.4. Arizona Long Term Care System (ALTCS) - The program under AHCCCS that delivers long term, acute, behavioral health care and case management services to eligible members, as established by A.R.S. § 36- 2932.

1.5. Division of Developmental Disabilities, (Division or DDD) - The division within the Department responsible for providing supports and services for eligible members established by A.R.S. Title 36, Chapter 5.1.

1.6. Encounter - The record of a care related service submitted to or by the Division and processed by AHCCCS that is rendered by an AHCCCS-registered provider to a member who is enrolled with the Division on the date of service for which the Division incurs a financial liability (A.AC. R9-22-701)

1.7. Planning Document (formerly Individual Service/Support Plan (ISP) - A written statement of services to be provided to a member with developmental disabilities including habilitation goals and objectives and a listing of the services, if any, the member is authorized to receive. The Planning Document incorporates and replaces the Individual Support Plan, the Individual Program Plan, the placement evaluation, the individualized service program plan, and the service program plan used in A.RS. § 36- 557 (as may be amended). The planning document incorporates the Individual Family Service Plan (IFSP), as defined in Chapter 4004-A of the DES/DDD Operations Policy Manual, as well as a Person Centered Plan, which describes the type, frequency, and duration of the services and supports needed to achieve the appropriate outcomes for a member.

1.8. DDD Member - A person who is authorized by the Division to receive services.

1.9. Third Party Liability - The resources available from a person or entity that is or may be, by agreement, circumstances, or otherwise, liable to pay all or part of the medical expenses incurred by a member authorized to receive services from the Division (A.A.C. R6-6-101.71; A.A.C. Title 9, Chapter 22, Article 10).

https://www.azahcccs.gov/PlansProviders/HealthPlans/minimumsubcontractprovisions.html

1.10. Third Party Payer - Any individual, entity, or program that is or may be liable to pay all or part of the medical cost of injury, disease, or disability of a member authorized to receive services from the Division (A.A.C. R6- 6-101.72).

2. Certification of Compliance - Anti-Kickback and Laboratory Testing

By signing this Contract, the Contractor certifies that it has not engaged in any violation of the Medicare Anti- Kickback statute [42 United States Code (U.S.C.) §§ 1320a - 7b] or the "Stark I" and "Stark II" laws governing related-entity referrals [(Public Law (P.L.) 101- 239 and P.L. 101-432] and compensation there from. If the Contractor provides laboratory testing, it certifies that it has complied with 42 C.F.R § 411.350-389 and has sent to AHCCCS simultaneous copies of the information required by that rule to be sent to the Centers for Medicare and Medicaid Services (42 U.S.C. §§ 1320a-7b; P.L. 101-239 and P.L. 101-432; 42 C.F.R. § 411.361).

3. Certification of Truthfulness of Representation

By signing this Contract, the Contractor certifies the following:

3.1. That all representations set forth herein are true to the best of its knowledge; and

3.2. That it will maintain all representations, comply with all covenants, and perform all duties throughout the term of the Contract.

4. Compliance with Applicable Laws

4.1. The Contractor shall cooperate with all Division investigations, including investigations pursuant to A.R.S. § 36-557(G)(3) that involve danger to the health and safety of a member. This includes notification to the Division of all incidents involving a member. An incident is defined as an occurrence, which could potentially impact the health and well-being of a member enrolled with the Division or community. The process for notifying the Division of incidents is found in Chapter 6000 (Incident Management) of the DES/DDD Operation Policy Manual.

4.2. The Contractor shall comply with all applicable Federal and State laws, rules, regulations and policies, including, without limitation, Title XIX of the Social Security Act, the Omnibus Budget Reconciliation Act of 1981 (P.L. 97-35), Title 42 of the C.F.R., and Title 45 C.F.R., Parts 74 and 96. If the Contractor receives Title XX funds, the Contractor shall comply with The Arizona Title XX Social Services Plan and Section 2352, Title XX Block Grants, of the Omnibus Budget Reconciliation Act of 1981.

4.3. The Contractor and any subcontractor shall comply with all applicable licensure, certification, and registration standards established by the Department, the Division, AHCCCSA, the Arizona Department of Health Services (ADHS) and applicable State laws. The Contractor shall, ensure that any subcontractor, comply with all applicable Department and Division administrative rules, policies, procedures, service standards, guidelines, and other authorities (regardless of whether specifically cited in this Contract) that relate to the Contractor's services, operations, or business including, but not limited to:

4.3.1. Hiring of ex-offenders;

4.3.2. Fingerprinting of contractor's and subcontractor's staff;

4.3.3. Completing of Fire Risk Profile requirements;

4.3.4. Reporting of unusual incidents involving children and/or adults;

4.3.5. Implementing program audit implementation plans;

4.3.6. Participating as a member of the planning (i.e. Planning Document) team;

4.3.7. Complying with all policies, procedures, and instructions regarding planning documents;

4.3.8. Submitting to the Division's Support Coordinator copies of required documentation;

4.3.9. Providing copies of a member's records, including evaluations and progress reports;

4.3.10. Ensuring that all movement of members, except in emergency situations, is coordinated through the planning team.

4.4. The terms of this Contract shall be subject to the applicable material terms and conditions of the Intergovernmental Agreement existing between the Department and AHCCCSA for the provision of covered services under the ALTCS.

4.5. Any changes to Federal and State laws, regulations, or policies; Department, Division, or AHCCCS administrative rules, policies, procedures; or to the Intergovernmental Agreement between the Division and AHCCCSA effective during the term of this Contract shall apply to this Contract.

4.6. The Contractor shall comply with the Occupational Safety and Health Administration (OSHA) regulations regarding blood borne pathogens (29 C.F.R. § 1910.1030).

4.7. The Contractor shall comply with the requirements of the Health Insurance Portability and Accountability Act of 1996 (P.L 104-191) and all applicable implementing Federal regulations. The Contractor shall notify the Division no later than 120 days prior to any required compliance date if the Contractor is unwilling to or anticipates that it will be unable to comply with any of the requirements of this section. Receipt by the Division of a notice of anticipated inability or unwillingness to comply as required by this section constitutes grounds for the termination of this Contract.

4.8. By entering into this Contract, the Contractor warrants compliance with the Deficit Reduction Act of

2005 (P.L 109-171). Any Contractor that receives at least $5,000,000 in Medicaid payments annually shall establish written policies for all employees (including management), and for all employees of any subcontractor or agent of the subcontractor, providing detailed information about false claims, false statements, and whistleblower protections under applicable Federal and State fraud and abuse laws.

These written policies shall include a specific discussion of the foregoing laws and detailed information regarding the Contractor's policies and procedures for detecting and preventing fraud, waste, and abuse, as well as the rights of employees to be protected as whistleblowers. In addition, the Contractor shall establish a process for training, and train, existing staff and new hires on false claims, false statements, and whistleblower protections under applicable Federal and State fraud and abuse laws and the Contractor's policies and procedures for detecting and preventing fraud, waste, and abuse, and the rights of employees to be protected as whistleblowers. All training must be conducted in a manner that can be verified by the Division.

4.9. Federal Database Checks

4.9.1. The Division will not and the Contractor shall not employ or contract with any individual who has been debarred, suspended or otherwise lawfully prohibited from participating in any public procurement activity or from participating in non- procurement activities under regulations issued under Executive Order 12549 or under guidelines implementing Executive Order 12549 [42 C.F.R. § 438.610(a) and (b), 42 C.F.R. § 1001. 1901(b), 42 C.F.R. § 1003.)]. The Division is obligated under 42 C.F.R. §§ 455.434 and 455.436 to screen all Contractors and the Contractor is obligated to screen all employees, contractors, and/or subcontractor employees to determine whether any of them have been excluded from participation in Federal health care programs by checking the following Federal databases:

4.9.1.1. The List of Excluded Individuals/Entities ("LEIE") no less frequently than monthly(http://www.oig.hhs.gov/fraud/exclusions.asp), https://oig.hhs.gov/exclusions/ ) or as amended;

4.9.1.2. The System for Award Management ("SAM") no less frequently than monthly

(https://www.sam.gov/portal/public/SAM/) or as amended; and

4.9.1.3. And any other such databases that may be prescribed.

4.9.2. The Contractor shall maintain the Federal Database Check results and any related forms or documents in a confidential file for five (5) years after termination of the Agreement.

4.10. The Contractor and any subcontractor providing services to the Division under this Contract shall comply with 42 C.F.R. § 434.6(b) pertaining to general requirements for all contracts and subcontracts, applicable AHCCCSA rules, and applicable provisions of Federal law and regulations.

4.11. The Contractor shall comply with federal and state law on advance directives for adult members [42

C.F.R. § 422.128].

4.12. The Contractor, acting within the lawful scope of its practice, is not prohibited or otherwise restricted from advising or advocating, on behalf of a member who is the Contractor's patient, for [42 C.F.R. § 438.102]:

4.12.1. The member's health status, medical care or treatment options, including any alternative treatment that may be self-administered [42 C.F.R. § 438.102(a)(i))];

4.12.2. Any information the member needs in order to decide among all relevant treatment options;

4.12.3. The risks, benefits, and consequences of treatment or non-treatment; and

4.12.4. The member's right to participate in decisions regarding his or her behavioral health care, including the right to refuse treatment, and to express preferences about future treatment decisions [42 C.F.R. § 438.102].

5. Contract Changes

In addition to the Uniform Terms and Conditions, Section 5 the following shall apply:

5.1. The Contractor shall not terminate the operations of the nursing care institution without the prior written consent of the Department during the term of this Contract.

http://www.oig.hhs.gov/fraud/exclusions.asp https://oig.hhs.gov/exclusions/ https://oig.hhs.gov/exclusions/ https://www.sam.gov/portal/public/SAM/

6. Coordination of Benefits; Third Party Liability Determination

6.1. The Contractor shall establish and maintain a third-party payor identification process that identifies Medicare and all other third-party liability coverage. The Contractor shall report to the Division any updates to the member-specific third-party liability information. The Contractor shall seek payment from Medicare and any other third party up to the amount of liability before submitting a claim to the Department. Claims by the Contractor shall be submitted to the Department on Federal government universal claim forms (i.e., CMS 1500, UB-04, Pharmacy Universal Claim), on the Division's uniform billing document, or as specified in the Scope of Work. When submitting a claim, the Contractor shall also provide written documentation acceptable to the Division as to the amount of the third-party payment received or as to the rejection or nonpayment of the claim by the third party. Acceptable written documentation includes, but is not limited to, an "explanation of benefits" form when the third party is an insurance company whose potential liability on the claim arises out of a contract of insurance.

To the extent the Department pays all or a portion of a claim of the Contractor, the Contractor hereby assigns to the Department all rights it would otherwise have had from the third party or from any other source.

6.2. AHCCCSA rules apply to the coordination of benefits under this Contract (refer to the AHCCCS

Contractor Operations Manual at ( https://www.azahcccs.gov/shared/ACOM/) or as amended

7. Enrollment; Disenrollment

7.1. Procedures for enrollment of a member in Contractor services and termination of enrollment with the Contractor shall be in accordance with this Contract and all applicable Division and/or AHCCCSA rules and policies.

7.2. AHCCCS is responsible for enrollment, re-enrollment and disenrollment of the ALTCS covered population.

8. Fair Hearings and Service Recipients' Grievances

8.1. For ALTCS-eligible members, the system for reviewing and adjudicating grievances shall follow the grievance procedure agreed to by AHCCCSA and the Department in the current AHCCCSA/DES Intergovernmental Agreement and the rules and policies promulgated by AHCCCSA and the Department.

8.2. For non-ALTCS eligible members, the system for reviewing and adjudicating grievances shall follow the grievance procedure as determined under the Department's rules and policies.

9. Fees and Program Income

9.1. The Contractor shall not submit a claim, demand, or otherwise collect payment from a member for ALTCS services in excess of the amount paid to the Contractor by the AHCCCSA or the Department.

The Contractor shall not bill or attempt to collect payment directly or through a collection agency from a member claiming to be ALTCS eligible without first receiving verification from the AHCCCSA that the member was ineligible for ALTCS on the date of service or that services provided were not ALTCS covered services (A.A.C. R9-22- 702).

https://www.azahcccs.gov/shared/ACOM/

9.2. The Department will be responsible for collecting Client Share of Cost as specified in A.A.C. R6-6-1201 el seq. The Contractor may not collect this amount from a member authorized to receive services from the Division.

9.3. Members or members' representative shall be assessed a cost sharing requirement as applicable in the form of a co-payment for certain medical services (A.A.C. R9-22- 711). The Contractor shall provide reasonable assistance to facilitate payment of this charge from member (a.k.a. client) trust fund accounts.

10. Fraud and Abuse

If the Contractor discovers, or is made aware, that an incident of suspected fraud or abuse has occurred or been alleged, the Contractor shall immediately report the incident or allegation to the Division and l to AHCCCS’ Office of the Inspector General (OIG).

11. Levels of Service

In addition to ADES Special Terms and Conditions Section 26 the following shall apply:

11.1. The Division has the authority, after considering the ISP and other evaluations, to make any change in a member’s residential placement or any other determinations regarding the services authorized for the member subject to grievance and appeal rights provided by law to the member. Except in emergency need situations, requests by the Contractor to change a member’s residential placement require a minimum of sixty (60) days prior written notice to the Division.

12. Monitoring

The Division may monitor the Contractor, and the Contractor shall cooperate in the monitoring of services, facilities, records, and fiscal practices. The Division will monitor the Contractor's compliance with the Contract as deemed necessary by the Division. Monitoring may also be conducted at reasonable times by members, parents, and member' representatives, by representatives of the Developmental Disabilities Advisory Council, and by other recognized, on-going advocacy groups for persons with developmental disabilities. The Contractor shall adhere to all Department and Division policies and procedures regarding evaluation of the quality and impact of Contract services and to establish on-going monitoring of service performance. The Division reserves the right to monitor the actual provision of services for compliance with the Division's Programmatic Standards and to conduct investigations in accordance with the Division's Investigation Standards and to verify staffing levels as authorized by the Division District Administration.

13. Notices

In addition to Uniform Terms and Conditions Section 3.5 and ADES Special Terms and Conditions Section 30, the following shall apply:

13.1. The Contractor shall notify the Division, in writing, within twenty-four (24) hours of the incident if the

Contractor fails to so maintain any representation, comply with any covenant, or perform any duty as provided in this contract, or (ii) Contractor receives notice or becomes aware of a claim or cause of action that would, if valid and enforceable against the Contractor, violate any provision in this contract or have a material effect on the Contractor's business. The notice to the Division shall describe the event or facts that triggered the delivery of the notice.

14. Payments

In addition to Uniform Terms and Conditions Section 4.1 and ADES Special Terms and Conditions Section 34, the following shall apply:

14.1. The Division is not obligated to pay for services provided without prior authorization. Claims for covered services shall be initially received by the Division not later than six (6) months after the last date of service shown on the claim. Except as provided by A.R.S. § 36-2904(G), a claim shall not be considered for payment unless it is received by the Division as a clean claim not later than twelve (12) months after the last date of service shown originally on the claim.

14.2. The effective date of receipt of the claim is the date the Division actually receives the claim. Only claims received by the Division in accordance with the provisions of this section will be considered for payment.

14.3. Any payment reconciliation shall be submitted in writing, complete with all backup documentation, no later than sixty (60) days from Contract termination date (whether in whole or in part) or date of contract extension. The Division will determine if additional payment is due to the Contractor. Failure to submit information within the sixty (60) day timeline will result in forfeiture of any payment determined appropriate.

14.4. The Contractor shall obtain any necessary authorization from the Division or AHCCCSA for services provided to ALTCS eligible and/or enrolled individuals and shall comply with encounter reporting and claims submission requirements of the Division and AHCCCS.

14.5. Corrections to claims submitted to the Division in which an underpayment was made due to either billing errors or an error on the part of the Division when paying must be made within a twelve (12) month period of time following delivery of service. Underpayment billing corrections will not be considered beyond twelve (12) months from service delivery.

15. Property of the State

15.1. The Federal and State governments reserve a royalty-free, nonexclusive, and irrevocable license to reproduce, publish, or otherwise use and to authorize others to use for Federal or State government purposes such materials, reports, data or information system, software, documentation, and manuals.

15.2. At the termination of this Contract, the Contractor shall make available all such materials, reports, data, and information to the Department within thirty (30) days following termination of the Contract or such longer period as requested by the Department. For purposes of this paragraph, the term "data" shall not include an eligible individual's records.

16. Records

In addition to Uniform Terms and Conditions Section 3.1 and ADES Special Terms and Conditions Section 40,

16.1. The Contractor shall maintain books and records relating to covered services and expenditures. The

Contractor shall comply with all specifications for record keeping established by AHCCCS. All books and records shall be maintained to the extent and in such detail as required by AHCCCS Rules and policies. Records shall include but not be limited to financial statements, records relating to the quality of care, medical records, prescription files and other records specified by AHCCCS.

16.2. In accordance with the Intergovernmental Agreement between the Department and AHCCCS, the

Contractor shall make available upon request, of the Department or AHCCCS, a description of its patient, medical, dental, and cost recordkeeping system.

17. Reporting Requirements

In addition to ADES Special Terms and Conditions Section 42, the following shall apply:

17.1. The Contractor shall provide all reports requested by the Department, the Division, or AHCCCS and all information from its records relating to the performance of this Contract that the Department, the Division, or the AHCCCS may reasonably require. The Contractor reporting requirements hereunder may include, but are not limited to, timely and detailed utilization statistics, information, and reports.

17.2. All records or other documentation supplied to the Division by the Contractor shall contain the Contract number and name of the entity and be submitted to the person designated by the Division.

18. Sanctions Against Division/Department Resulting from Contractor Action or Inaction

Sanctions imposed against the Division or the Department by AHCCCSA in accordance with applicable AHCCCS rules, policies, and procedures that would not have been imposed but for the action or inaction of one or more Contractors will be assessed against the Contractor based on the percentage of the Contractor's contribution to the sanction imposed against the Division and/or the Department.

19. Subcontracts

In addition to Uniform Terms and Conditions Section 5.2 and ADES Special Terms and Conditions Section 38,

19.1. Any subcontract that the Contractor enters into shall incorporate by reference this Contract and the

AHCCCS/ALTCS Approved Minimum Subcontract Specifications.

19.2. No subcontract terminates the legal responsibility of the Contractor to assure that all activities under the Contract are carried out.

20. Termination for Any Reason

In addition to ADES Special Terms and Conditions Section 43 the following shall apply:

20.1. In the event the Contract is terminated, in whole or in part, with or without cause, or expires, the Contractor shall assist the Division in the transition of members to one (1) or more other providers in a manner that ensures the health and safety of the member. Such assistance and coordination shall include but shall not be limited to:

20.1.1. Notification of subcontractors and members;

20.1.2. Facilitating and scheduling of medically necessary appointments for care and services;

20.1.3. Providing all reports set forth in this Contract;

20.1.4. If required by the Division, extending its performance until suitable arrangements are made by the Division for continuation of services from one or more other providers;

20.1.5. If required by the Division, at the Contractor's own expense, assisting in the training of personnel;

20.1.6. Paying of all outstanding obligations for care rendered to members; and

20.1.7. Provide financial reports to the Division until the Division is satisfied that the Contractor has paid all obligations.

20.2. All reports in this section shall be due on the fifth (5th) day of each succeeding month for the prior month.

20.3. In the event the Contract is terminated in part, the Contractor shall continue the performance of the Contract to the extent not terminated.

20.4. The Contractor shall promptly supply all information necessary for the reimbursement of any outstanding Medicaid claims.

21. Utilization Control/Quality Assurance

21.1. The Contractor shall, at all times during the term of this Contract, maintain an internal quality management system approved by the Division and in accordance with current applicable AHCCCS rules and policies and Federal rules as specified in the current 42 C.F.R. Part 456 and the AHCCCS Medical Policy Manual, and as implemented by AHCCCS and the Division. Contractor requirements shall include, but are not limited to:

21.1.1. Completing statistical or program reports as requested by the Division;

21.1.2. Complying with any recommendations made by the Division's Statewide Quality Management

Committee;

21.1.3. Making records available upon request;

21.1.4. Allowing persons authorized by the Division access to program areas at any hours of the day or night as deemed appropriate by the Division; and

21.1.5. Providing program information, upon request, to the Division.

21.2. The Contractor shall cooperate with the Division and AHCCCS quality management programs and reviews.

22. Void of Contract

This Contract is voidable and may be immediately terminated by the Department upon the Contractor becoming insolvent or filing proceedings in bankruptcy or reorganization, or upon assignment or delegation of the Contract without prior written approval from the Department.

23. Warranty of Services

In addition to ADES Special Terms and Conditions Section 55 the following shall apply:

23.1. The Contractor, by execution of this Contract, warrants that it has the ability, authority, skill, expertise and capacity to perform the services specified in this Contract.

23.2. The Contractor shall, and ensure that and any subcontractor shall, submit the most recent ADHS licensure review, copies of substantiated complaints, and other pertinent information that is available and considered to be public information from oversight agencies.

ADES Special Terms and Conditions

1. Definition of Terms

In addition to the Uniform Terms and Conditions, Section 1, the following shall apply:

1.1 “Award Date” The date the Contract is executed by the Department. This may or may not be the same date as the “Effective Date” which is the date specified on the Offer and Award or Signature

Page.

1.2 “Client Specific Referral” Services or activities for which a referral has been made for a client by an authorized representative of the Department.

1.3 “Department” The Arizona Department of Economic Security (ADES), unless otherwise indicated.

1.4 “Effective Date” The date the Contractor is to start delivering services. The Effective Date is specified on the Offer and Award or Signature Page.

1.5 “Equipment” All vehicles, furniture, machinery, electronic data processing (EDP) equipment, software and all other equipment costing $5,000.00 or more, including all normal and necessary expenses incurred to make the equipment ready for its intended use (e.g., taxes, freight, installation, assembly and testing charges, etc.), and with a useful life of greater than one (1) year. Equipment as used herein does not include real property (e.g., land, building, structures, or facilities’ improvements).

1.6 “May” Indicates something that is not mandatory but permissible.

1.7 “Purchase Order” also known as “Purchase Authorization” or “Release Order” is an authorized document to procure goods or services.

1.8 “Shall, Must” Indicates a mandatory requirement. Failure to meet these mandatory requirements may result in the rejection of a proposal as non-responsive.

1.9 “Should” Indicates something that is recommended but not mandatory. If the Contractor fails to provide recommended information, the State may, at its sole option, ask the Contractor to provide the information.

1.10 “Vulnerable adult” An individual who is eighteen (18) years of age or older who is unable to protect himself from abuse, neglect or exploitation by others because of a physical or mental impairment.

Vulnerable adult includes an incapacitated person as defined in A.R.S. §14-5101.

2. Advertising, Publishing and Promotion of Contract

In addition to the Uniform Terms and Conditions, Section 3.6, the following shall apply:

2.1 The Contractor shall provide to…