CTR062093Contract_Amendment_2.pdf

Contract Amendment

Arizona Department of

Administration

State Procurement Office 1802 West Jackson Street, Number 100 Phoenix, AZ 85007

CTR062093 (Contract Copy CTR067877) Contract Amendment No. 2

Workers’ Compensation Fee Schedule Development and

Consultation

Supplier: Fair Health Inc.

This Contract Amendment Number 2, executed in accordance with Special Terms and Conditions Section 3.2 Contract Extensions and Section 5.1, Amendments, is hereby modified to extend the current term of the contract and to add to the Scope of Work additional requirements.

1. Term of contract is hereby extended from September 13, 2024 to September 12, 2025 and;

2. Summary for Cost and Program Timeline Values to be modify to reflect no dates for the phases listed under Timeline. The new phases to read as follows:

o Phase 1 – 6 months prior to the effective date of the Fee Schedule update o Phase 2 – 3 months prior to the effective date of the Fee Schedule update o Phase 3 – 1 month prior to the effective date of the Fee Schedule update o Phase 4 – 1 month after the effective date of the Fee Schedule update

3. Pricing Fee Schedule Table is hereby modified to delete column addressing the required due dates. New table to read as follows:

1 Required Item

Phase 1 – Preliminary Planning (6 months prior to the effective date of the Fee Schedule update)

1 EA $4,200.00

2 Required Item

Phase 2 – Delivery of the Initial Updated Fee Schedule Documents (3 months prior to the effective date of the Fee

Schedule update)

1 EA $9,500.00

3 Required Item

Phase 3 – Initial Posting of the Updated Fee Schedule for Public Review and Commission Approval (1 month prior to the effective date of the Fee Schedule update)

1 EA $9,500.00

4 Required Item

Phase 4 – Close Out, Best Practices, Plan for Next Cycle (1 month after the effective date of the Fee

Schedule update)

1 EA $850.00

5 Hourly Consultation Fee 1 Hourly $290.00

4. Section 3 Scope of Services, specifically section the Section 3.1.1 which reads “Develop Fee Schedules for nine separate sections of the updated Fee Schedule. To accomplish this the contractor agrees to deliver services consistent with industry best practices and will:” is hereby modified to read:

3.1.1 Develop Fee Schedules for ten separate sections of the updated Fee Schedule. To accomplish this the contractor agrees to deliver services consistent with industry best practices and will:

5. Section 3, Scope of Work is hereby amended to add the following section Sections 3.1.7, 3.1.8 and 3.19 which read:

3.1.7 Assign values to the HCPCS table based on the reimbursement values published by CMS in the most current Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule.

3.1.8 Calculate reimbursement values in each section using conversion factors designated by the ICA.

3.1.9 Review and provide suggestions for updates to the thirteen sections of the Fee Schedule Guidelines.

RECITALS

The State and Supplier entered into that certain agreement title Master Service Agreement effective as of September 13, 2022 pursuant to which Supplier is to provide Workers’ Compensation Bill Review Services.

THEREAFTER, contract amendment No. 1 to extend on the initial term of the contract to September 13 , 2024 was executed on September 13, 2023.

ALL OTHER REQUIREMENTS, SPECIFICATIONS, TERMS AND CONDITIONS REMAIN UNCHANGED

This amendment shall be fully executed upon the electronic approval in the State e-Procurement system by an authorized representative of the Contractor and applied to the contract in the State e-Procurement system by the Procurement

Officer or delegate.

Available online at app.az.gov Page | 1