CTR066099_Las_Palmas_Assisted_Living_Facility_-_executed.pdf

Direct Contract

Contract No.: CTR066099

Description: Assisted Living Facility

Contract between the Department of Economic Security (the "Department") and Las Palmas Assisted Living Home LLC dba Las Palmas Assisted Living Home (the "Contractor").

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 effective date of last signature and shall terminate on 04/30/2024, 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:

FOR AND ON BEHALF OF THE CONTRACTOR:

Signature of Authorized Individual Signature of Authorized Individual

Typed Name Typed Name

Title Title and Date

Las Palmas Assisted Living Home

Date Contractor

5332 N. Flint Ave.

Contractor Mailing Address

Tucson, AZ 85704 Contractor Mailing Address (cont.)

Maria Mateo Contact Name and Title

(520) 551-0703 laspalmas1621@gmail.com Phone number and Email address

Tracy Chisler

Procurement Manager

7/21/2023

Maria Mateo

Maria Mateo

Maria Mateo Maria Mateo

Maria Mateo Manager 06/19/2023

Table of Contents

CONTRACTOR IS STRONGLY ENCOURAGED TO READ THE ENTIRE CONTRACT.

Table of Contents

Scope of Work ............................................................................................... Error! Bookmark not defined.

Exhibit A - Price Sheet

Exhibit B – Spending Plan

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 – Business Associate Agreement

Attachment 5 - Forced Labor of Ethnic Uyghurs Ban………………………………………………………..…71

Attachment 6 – Affirmation of Central Registry Background Check

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 individuals with a developmental disability receiving services from the Division 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. Service Description

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

3.2. Actual Service Description: Services are provided by Assisted Living Homes licensed by the Arizona

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

3.3. Background: DDD is responsible for administering Arizona Long Term Care Services (ALTCS) to eligible individuals with a developmental disability receiving services from the Division. In collaboration with AHCCCS, DDD contracts with a variety of providers, including Assisted Living Homes, to deliver health care services to eligible individuals, as defined by A.R.S. § 36-2901, et seq.

4. Definitions

4.1. Assisted Living Facility: 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. Title 9, Chapter 10 Article 8 (Sections R9-10).

4.2. Assisted Living Home (ALH): is an ALTCS approved alternative home and community-based setting that provides supervision and coordination of necessary services to ten (10) or fewer residents.

4.3. Assisted Living Center (ALC): is an ALTCS approved alternative home and community-based setting that provides supervision and coordination of necessary services to eleven (11) or more residents as defined in A.R.S. 36-401.

4.4. Division of Developmental Disabilities (DDD): A Division in the ADES that provides services and support for individuals with developmental disabilities and their families also known herein as the Division.

4.5. 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 individuals with a developmental disability receiving services from the Division method of payment.

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

4.7. Support Coordinator: An employee of the DDD who coordinates the implementation of supports and services to meet goals and objectives of the individual with a developmental disability receiving services from the Division. The Support Coordinator also serves as the primary point of contact for the individual with a developmental disability receiving services from the Division and/or their Responsible Person.

4.8. Responsible Person: The parent, legal guardian, or person selected by an individual with a disability receiving services from the DDD who will assist with making decisions.

4.9. 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 the individual with a developmental disability receiving services from the Division (A.A.C. R6-6-101.71 and A.A.C.

Title 9, Chapter 22, Article 10).

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 license issued by ADHS in good standing, as an Assisted Living Home, 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 individuals with a developmental disability receiving services from the Division at the address appearing on the license issued by ADHS.

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

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., DES DDD, 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

5.8. Upon authorization by DDD, only accept or retain an individual with a developmental disability receiving services from the Division who requires continuous nursing services when:

5.8.1. The individual with a developmental disability receiving services from the Division 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.

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 individuals with a developmental disability receiving services from the Division.

5.10. Have household and personal hygiene items available for the individuals with a developmental disability receiving services from the Division.

5.11. Provide laundry services for the individual with a developmental disability receiving services from the

Division.

5.12. Provide transportation for medically necessary appointments and services, and all other reasonable transportation within the community to individuals with a developmental disability receiving services from the Division.

5.13. Participate in the development and review of the planning document for each individual with a developmental disability receiving services from the Division as designated by the DDD.

5.14. Provide services to the individual with a developmental disability receiving services from the Division as indicated in the planning document which meets their medical, physical, and emotional needs.

5.15. Ensure that the individual with a developmental disability receiving services from the Division receives other services authorized by DDD.

5.16. Receive consent/agreement from the Responsible Person, or as directed by a physician prior to changing individual with a developmental disability receiving services from the Division living accommodations.

5.17. Not act as the individual with a developmental disability receiving services from the Division

Representative Payee.

5.18. Maintain a ledger and documentation (e.g., receipts) that accounts for the expenditures of all funds used for the individual with a developmental disability receiving services from the Division with a Representative Payee.

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

5.19. Provide reasonable accommodations and assist, if necessary, to allow the individual with a developmental disability receiving services from the Division to engage in religious or spiritual practices, in accordance with their 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 individuals with a developmental disability receiving services from the Division designated

Support Coordinator immediately if their 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 individual with a developmental disability receiving services from the Division which includes:

5.23.1.1. Their name and AHCCCS Identification Number;

5.23.1.2. Physician's orders;

5.23.1.3. Care plans, including a copy of their 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 their Responsible Person, if applicable;

5.23.1.8. Their 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;

5.23.1.11. Any other documentation applicable to their care; and

5.23.1.12. A log of their personal belongings that is continually updated and available to them, DDD, and their 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 individuals with a developmental disability receiving services from the Division in the Arizona Health Care Cost Containment System Medical Policy Manual in the following ways:

5.24.1. Transporting them to medical appointments,

5.24.2. Accompanying them to medical appointments,

5.24.3. Assisting with personal care needs and,

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

6. Reporting Requirements/Notices:

6.1 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 DDDspecialtycontracts@azdes.gov

6.1 Program Reports:

The Contractor shall submit the following:

6.1.1 An accounting of all expenditures on the Spending Plan (Exhibit B) of the individual with a developmental disability receiving services from the Division to their Representative Payee or designee, if applicable.

6.1.2 Quarterly reports of health care appointments for each individual with a developmental disability receiving services from the Division by July 15th, October 15th, January 15th, and April 15th to the designated Support Coordinator and their Responsible Person. The report shall include:

6.1.2.1 Their Name,

6.1.2.2 Date and time of appointment,

6.1.2.3 Type of appointment,

6.1.2.4 Diagnosis, and

6.1.2.5 After care plan.

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 file:///Users/mariamateo/Desktop/Drafts/DDDspecialtycontracts@azdes.gov

Documents and instructions are available on DDD’s website 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 website 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 DDDspecialtycontracts@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 individual with a developmental disability receiving services from the Division’s acuity level, 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 individual with a developmental disability receiving services from the Division’s share of cost.

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 individual with a developmental disability receiving services from the Division’s share of cost.

7.3 Residential Day

7.3.1 If the individual with a developmental disability receiving services from the Division 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 individual with a developmental disability receiving services from the Division stays for less than one day total, the day of intake shall be considered a full day of services.

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 file://obf-ood/Shared/Procurement_New/03%20PROCUREMENT/DDD/DIRECT%20CONTRACTS/CTR066099-%20Assisted%20Living_Las%20Palmas%20Assisted%20Living%20(Vail)/Drafts/DDDspecialtycontracts@azdes.gov

7.3.3 If on the day of exit, the individual with a developmental disability receiving services from the

Division 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 individual with a developmental disability receiving services from the Division’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 individual with a developmental disability receiving services from the Division’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 primary insurance carrier of the individual with a developmental disability receiving services from the Division.

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.

Exhibit A – Price Sheet

Exhibit A - Price Sheet

Assisted Living Home

Service Rate

Residential Day $0.00

Exhibit B – Spending Plan

Exhibit B – SPENDING PLAN

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) 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 and 36-2901(1).

1.2. “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 DDD/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 amended

1.3. “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.

1.4. “Division of Developmental Disabilities, (DDD)” - the DDD within the ADES is responsible for providing supports and services for eligible members established by A.R.S. Title 36, Chapter 5.1.

1.5. “Encounter” - the record of a care related service submitted to or by the DDD and processed by

AHCCCS that is rendered by an AHCCCS-registered provider to a member who is enrolled with the DDD on the date of service for which the DDD incurs a financial liability (A.AC. R9-22-701).

1.6. “Planning Document” formerly known as Individual 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.

1.7. “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 DDD (A.A.C. R6-6-101.71; A.A.C. Title 9, Chapter 22, Article 10).

1.8. “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

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

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 DDD investigations, including investigations pursuant to A.RS. § 36-557(G)(3) that involve danger to the health and safety of an individual with a developmental disability receiving services from the Division. This includes notification to the DDD of all incidents involving an individual with a developmental disability receiving services from the Division. An incident is defined as an occurrence, which could potentially impact the health and well-being of an individual with a developmental disability receiving services from the Division or community. The process for notifying the DDD of incidents is found in Chapter 6000 (Incident Management) of the ADES/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 ADES, the DDD, the Arizona Department of Health Services (ADHS) and applicable State laws. The Contractor shall, and shall ensure that any subcontractor, comply with all applicable ADES and DDD 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 PCSP team;

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

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

4.3.9. Providing copies of an individual with a developmental disability receiving services from the

Division records, including evaluations and progress reports;

4.3.10. Ensuring that all movement of individuals with a developmental disability receiving services from the Division, except in emergency situations, is coordinated through the planning team.

4.3.11. Credentialing of contractor’s and subcontractor’s staff as required per AMPM 950.

4.4. The terms of this Contract shall be subject to the applicable material terms and conditions of the

Intergovernmental Agreement existing between the ADES and AHCCCS for the provision of covered services under the ALTCS.

4.5. Any changes to Federal and State laws, regulations, or policies; ADES, DDD, or AHCCCS administrative rules, policies, procedures; or to the Intergovernmental Agreement between the DDD and AHCCCS 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 DDD 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 DDD 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 DDD.

4.9. Federal Database Checks.

4.9.1. The DDD 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 DDD 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;

4.9.1.3. And any other such databases that may be prescribed. 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 DDD under this Contract shall comply with 42 C.F.R. § 434.6(b) pertaining to general requirements for all contracts and subcontracts, applicable AHCCCS 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 individuals with a developmental disability receiving services from the Division [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 individual with a developmental disability receiving services from the Division 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 individual with a developmental disability receiving services from the

Division 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 individual with a developmental disability receiving services from the Division 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. Coordination of Benefits; Third Party Liability Determination

5.1. 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 DDD any updates to the individual with a developmental disability receiving services from the Division -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 ADES. Claims by the Contractor shall be submitted to the ADES on Federal government universal claim forms (i.e., CMS 1500, UB- 04, Pharmacy Universal Claim), on the DDD's uniform billing document, or as specified in the Scope http://www.oig.hhs.gov/fraud/exclusions.asp https://oig.hhs.gov/exclusions/ https://www.sam.gov/portal/public/SAM/ of Work. When submitting a claim, the Contractor shall also provide written documentation acceptable to the DDD 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 ADES pays all or a portion of a claim of the Contractor, the Contractor hereby assigns to the ADES all rights it would otherwise have had from the third party or from any other source.

5.2. AHCCCS 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.

6. Enrollment; Disenrollment

6.1. 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 DDD and/or AHCCCS rules and policies.

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

7. Fair Hearings and Service Recipients' Grievances

7.1. For ALTCS-eligible individuals with a developmental disability receiving services from the Division, the system for reviewing and adjudicating grievances shall follow the grievance procedure agreed to by AHCCCS and the ADES in the current AHCCCS/ADES Intergovernmental Agreement and the rules and policies promulgated by AHCCCS and the ADES.

7.2. For non-ALTCS eligible individuals with a developmental disability receiving services from the

Division, the system for reviewing and adjudicating grievances shall follow the grievance procedure as determined under the ADES's rules and policies.

8. Fees and Program Income.

8.1. The Contractor shall not submit a claim, demand, or otherwise collect payment from an individual with a developmental disability receiving services from the Division for ALTCS services in excess of the amount paid to the Contractor by the AHCCCS or the ADES. The Contractor shall not bill or attempt to collect payment directly or through a collection agency from an individual with a developmental disability receiving services from the Division claiming to be ALTCS eligible without first receiving verification from the AHCCCS that they are ineligible for ALTCS on the date of service or that services provided were not ALTCS covered services (A.A.C. R9-22-702).

8.2. The ADES 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 an individual with a developmental disability authorized to receive services from the DDD.

8.3. Individuals with a developmental disability receiving services from the Division or their 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 the individual with a developmental disability receiving services from the Divisions trust fund accounts.

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

9. 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 DDD and to AHCCCS’ Office of the Inspector General (OIG).

10. Monitoring

The DDD may monitor the Contractor, and the Contractor shall cooperate in the monitoring of services, facilities, records, and fiscal practices. The DDD will monitor the Contractor's compliance with the Contract as deemed necessary by the DDD. Monitoring may also be conducted at reasonable times by the individual with a developmental disability receiving services from the Division, their parents, and 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 ADES and DDD policies and procedures regarding evaluation of the quality and impact of Contract services and to establish on-going monitoring of service performance. The DDD reserves the right to monitor the actual provision of services for compliance with the DDD's Programmatic Standards and to conduct investigations in accordance with the DDD's Investigation Standards and to verify staffing levels as authorized by the DDD District Administration.

11. Notices

The Contractor shall notify the DDD, in writing, within 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 DDD shall describe the event or facts that triggered the delivery of the notice.

12. Payments

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

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

12.3. 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 DDD will determine if additional payment is due to the Contractor. Failure to submit information within the 60-day timeline will result in forfeiture of any payment determined appropriate.

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

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

13. Property of the State

13.1. 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.

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

14. Records

14.1. 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.

14.2. In accordance with the Intergovernmental Agreement between the ADES and AHCCCS, the

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

15. Reporting Requirements

15.1. The Contractor shall provide all reports requested by the ADES, the DDD, or AHCCCS and all information from its records relating to the performance of this Contract that the ADES, the DDD, 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.

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

16. Sanctions Against DDD/ADES Resulting from Contractor Action or Inaction

Sanctions imposed against the DDD or the ADES by AHCCCS 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 DDD and/or the ADES.

17. Subcontracts

17.1. Any subcontract that the Contractor enters into shall incorporate by reference this Contract and the AHCCCS/ALTCS Approved Minimum Subcontract Specifications.

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

18. Termination for Any Reason

18.1. In the event the Contract is terminated, in whole or in part, with or without cause, or expires, the Contractor shall assist the DDD in the transition of individuals with a developmental disability receiving services from the Division to one 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:

18.1.1. Notification of subcontractors and individuals with a developmental disability receiving services from the Division.

18.1.2. Facilitating and scheduling of medically necessary appointments for care and services.

18.1.3. Providing all reports set forth in this Contract.

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

18.1.5. If required by the DDD, at the Contractor's own expense, assisting in the training of personnel.

18.1.6. Paying of all outstanding obligations for care rendered to individuals with a developmental disability receiving services from the Division.

18.1.7. Provide financial reports to the DDD until the DDD is satisfied that the Contractor has paid all obligations.

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

18.3. In the event the Contract is terminated in part, the Contractor shall continue the performance of the

Contract to the extent not terminated.

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

19. Utilization Control/Quality Assurance

19.1. The Contractor shall, at all times during the term of this Contract, maintain an internal quality management system approved by the DDD 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 DDD. Contractor requirements shall include, but are not limited to:

19.1.1. Completing statistical or program reports as requested by the DDD;

19.1.2. Complying with any recommendations made by the DDD's Statewide Quality Management

Committee;

19.1.3. Making records available upon request;

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

19.1.5. Providing program information, upon request, to the DDD.

19.2. The Contractor shall cooperate with the DDD and AHCCCS quality management programs and reviews.

20. Contract Void

This Contract is voidable and may be immediately terminated by the ADES/DDD 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 ADES/DDD.

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 the Department for review and approval all reports or publications (written, visual or sound) which are funded or partially funded under this Contract, a minimum of fifteen (15) calendar days prior to public release. All reports and publications whether written, visual or verbal shall contain the following statement:

2.1.1 “This program was funded through a contract with the Arizona Department of Economic Security. Points of view are those of the author and do not necessarily represent the official position or policies of the Department.”

3. Assignment

In addition to the Uniform Terms and Conditions, Section 5.3, the following shall apply:

3.1 Merger, Reorganization or Change of Ownership

3.1.1 A proposed merger, reorganization or change in ownership of the Contractor shall require prior written approval of the Department and may require an assignment of the Contract documented by a Contract Amendment. The Department may terminate this Contract pursuant to the Termination clauses of the Contract, if the Contractor does not obtain prior written approval or the Department determines that the change in ownership is not in the best interest of the State.

3.1.2 This Contract is voidable and subject to immediate cancellation by the Department upon the

Contractor becoming insolvent or filing proceedings in bankruptcy or reorganization under the United States Code or assigning any right(s) or obligations under this Contract without the prior written consent of the Department.

3.1.3 The Contractor shall submit a detailed merger, reorganization and/or transition of ownership plan to the Department, for review at least sixty (60) days prior to the effective date of the proposed change.

4. Audit

In addition to the Uniform Terms and Conditions, Section 3.3, the following shall apply:

4.1 In compliance with the Federal Single Audit Act (31 U.S.C. § 7501-7506 as may be amended), Contractors designated as sub-recipients shall comply with the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards as prescribed in 2 C.F.R.

§ 200.

4.2 Audits of non-profit corporations receiving Federal, or State monies are required pursuant to Federal or State law and shall be conducted as provided in 31 U.S.C. § 7501-7506, and A.R.S. § 35-181.03, as may be amended, and any other applicable statutes, rules, regulations, and standards.

4.3 In accordance with A.R.S. § 35-214, the Contractor shall retain and shall contractually require each subcontractor to retain all data, books, and other records (“records”) relating to this Contract for a period of five (5) years after completion of the Contract, except if subject to Health Insurance Portability & Accountability Act which is six (6) years.