CTR070044_Contract_Document__part_1__-_signed.pdf

Nila Henson

Procurement Manager

Mar 18, 2024 https://azdesgov.na1.adobesign.com/verifier?tx=CBJCHBCAABAAzxkSuN9q6FwOdkTLxUR2rsx168sOmGu-

Table of Contents

Contract No.: CTR070044

Description: Health Examinations – Consultative Examinations (CE)

Rev. 09-2023, v9

CONTRACTOR IS STRONGLY ENCOURAGED TO READ THE ENTIRE CONTRACT.

Table of Contents

Scope of Work

Exhibit A – Examination Request Form (SAMPLE)

Exhibit B – Claimant Questionnaire

Exhibit C – Standard Operating Procedures for the Oversight of Contractors

Exhibit D – SSA User Guide and Instructions for Send CE Report

Exhibit E – Fee Schedule

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 – Forced Labor of Ethnic Uyghurs Ban

Attachment 5 – Certification of Insurability

Attachment 6 – Facility Location Chart

Attachment 7 – Licensure and Qualifications Statement

Attachment 8 – Fee Schedule Acceptance Statement

Scope of Work

Description: Health Assessment – Consultative Examinations (CE)

1. ADES Mission and Vision Statements

1.1 ADES Mission: To strengthen individuals, families, and communities for a better quality of life.

1.2 ADES Vision: A thriving Arizona.

2. Purpose

2.1 Purpose Statement: The purpose of this agreement is to provide the Disability Determination

Services Administration (DDSA) statewide psychological, somatic, speech and language, and other consultative examination (CE) services to Claimants who have applied for benefits administered through the Social Security Administration and/or the Arizona Health Care Cost Containment System (AHCCCS).

2.2 Legal Authority: A.R.S. § 41-1954(A)(6) provides the Department, the authority to make contracts and incur obligations within the general scope of its activities and operations subject to the availability of funds.

2.3 Projected Utilization: Service provision is on an as needed basis. There is no guarantee of the number of services to be authorized.

2.4 Funding: DDSA is fully funded by the Federal Government Social Security Administration program under Title II and Title XVI.

3. Service Description

3.1 Actual Service Description: Psychological, somatic, speech and language, audiology, and other

Consultative Examinations (CE’s) by a licensed contracted provider to assist DDSA in determining Claimants’ medical eligibility for Social Security Disability benefits. This service does not include “recommended intervention and/or treatment”.

3.2 Background: The Division of Benefits and Medical Eligibility (DBME), Disability Determination

Services Administration (DDSA) is responsible for developing medical evidence and making the medical disability determination for Claimants under the law of the Social Security Administration Disability program. The Social Security Administration (SSA) administers two (2) programs that provide benefits based on disability: the Social Security Disability Insurance program (SSDI, Title II) and the Supplemental Security Income program (SSI, Title XVI). The DDSA is responsible for developing medical evidence and making the medical determination whether the Claimant is or is not disabled or blind under the law.

3.3 Target Population/Service Eligibility: CE services are for Claimants that have applied for Social

Security Disability Benefits. Eligibility for these services is determined in accordance with Title II of the Social Security Act (Act) which authorizes Social Security Disability Insurance (SSDI) Benefits, and Title XVI of the Act authorizes SSI Disability Benefit Payments.

4. Definitions

4.1 Acceptable Medical Source (AMS): Contracted provider that is a licensed physician, license psychologist, licensed optometrists, and other specialties as specified in POMS DI 22505.003.

4.2 Business Day: Monday through Saturday 8:00 am to 6:00 pm, excluding State Holidays

4.3 Claimant: Person who is applying for disability benefits from the DDSA.

4.4 Common Procedural Technology Code (CPT Code): The terms and codes for reporting services and procedures performed by physicians.

4.5 Consultative Examination (CE): Physical or mental examination or test purchased from an Acceptable Medical Source (AMS), at the SSA’s request and expense, to provide evidence for a Claimant’s disability or blindness claim.

4.6 Electronic Records Express (ERE): SSA secure website https://eme.ssa.gov is to offer electronic options for submitting health related records to disability claims.

4.7 Health Assessment H005-BB: A service that provides an assessment of an individual’s physical well-being and medical history to determine and diagnose physical health problems.

4.8 Program Operations Manual System (POMS): The primary source of information used by Social

Security employees to process claims for Social Security benefits for the DDSA claimants.

(http://policy.ssa.gov/poms).

5. General Requirements

The Contractor shall:

5.1 Comply with and meet all applicable provisions of federal, state, and local laws, regulations, policies, and procedures to provide diagnostic services, including without limitations the requirements and standards as follows:

5.1.1 Social l Security Administration Program Operation Manual System:

5.1.2 Standard Operating Procedure for Oversight of Contractors;

5.1.3 Consultative Examinations: A Guide for Health Professionals.

(https://www.ssa.gov/disability/professionals/greenbook/index.htm )

5.2 Attend an orientation meeting with DDSA prior to commencement of services. Orientation shall be held preferably at the Contractor’s location and shall consist of a brief meeting to discuss the DDSA program in areas including, but not limited to, scheduling information, report content, Claimant identification, signature requirement, report submission, rates of payments, Privacy Act information and CE source required referrals.

5.2.1 If travel beyond the standard commute is required to perform the services, the Contractor shall maintain business automobile liability insurance. The Contractor may be reimbursed for mileage, see section 7.4.1.

5.3 Provide CE’s only to referred Claimants, as specified, and authorized by DDSA by way of the

Examination Request Form (Exhibit A).

https://eme.ssa.gov/ http://policy.ssa.gov/poms https://www.ssa.gov/disability/professionals/greenbook/index.htm

5.4 NOTE: Provider is not authorized to conduct in-person treatment of patients without prior authorization, which will be given only upon Provider's showing proof of additional insurance coverages in required minimum amounts.

5.5 DDSA will provide the Examination Request Form to the Contractor via fax or SSA secured website http://eme.ssa.gov one (1) to sixty (60) days prior to the CE service date with the following information:

5.5.1.1 Claimant name;

5.5.1.2 Case number;

5.5.1.3 Date of birth;

5.5.1.4 Social Security number;

5.5.1.5 Date of service;

5.5.1.6 Authorization number;

5.5.1.7 CPT Codes;

5.5.1.8 Payment amount per code.

5.6 Provide services by scheduled appointment.

5.6.1 The Contractor shall notify DDSA within 24 hours if a Claimant cancels an appointment or if a Claimant does not show for a scheduled appointment.

5.6.1.1 The Contractor shall notify DDSA through SSA’s Electronic Records Express

(ERE) website of the cancellation or no-show. Or write cancelled or no-show on the first page of the DDSA’s Examination Request and fax to Phoenix area (866) 502-4266, or Tucson area (866) 820-4378.

5.7 Treat the Claimant with dignity, respect, and provide all services in a culturally relevant and linguistically appropriate for the population to be served.

5.8 Provide services in a manner fitting the profession, free from substantiated Claimant complaints in accordance with POMS DI 39545.375, Claimant Complaints of Consultative Examination (CE) Provider.

5.9 Allow sufficient time for the medical source to complete the Claimants case history and perform the examination, including any needed tests. Allow additional time for ancillary studies, etc. The following minimum scheduling intervals shall be followed:

5.9.1 Psychological examination at least sixty (60) minutes. Additional time may be required depending on the types of psychological tests administered;

5.9.2 Comprehensive psychiatric examination at least forty (40) minutes;

http://eme.ssa.govo/

5.9.3 Comprehensive general medical examination at least thirty (30) minutes;

5.9.4 Comprehensive musculoskeletal or neurological examination at least twenty (20) minutes;

5.9.5 All other examinations at least thirty (30) minutes or in accordance with accepted medical practice.

5.10 Provide a narrative Report of Findings to the DDSA within ten (10) calendar days of the date of service.

5.10.1 Report Findings shall include at a minimum the following:

5.10.1.1 A detailed history of the Claimant;

5.10.1.2 Physical findings of the examination;

5.10.1.3 Findings made from mental health, somatic, speech and language, and other exams;

5.10.1.4 Copies of all reports for ancillary services;

5.10.1.5 Diagnosis and prognosis;

5.10.1.6 Any special information requested.

5.10.2 Revised Reports of Findings related to the services provided may be required if the DDSA determines that the initial CE is incomplete or inconsistent. The re-examination and revised Report of Findings will be provided at no additional cost.

5.10.3 Report of Findings may be dictated through the DDSA’s Medical Transcription Services Contractor as deemed necessary by DDSA at no charge.

5.11 Address concerns DDSA received from Claimants. DDSA regularly surveys Claimants utilizing the sample form provided under Exhibit B Claimant Questionnaire.

5.12 Cooperate with DDSA staff in following the Standard Operating Procedure for the Oversight of Contractors (Exhibit C - Standard Operating Procedure for the Oversight of Contractors), in resolving matters including, but not limited to, complaints from DDSA Claimants, quality, and timeliness of reports on CE findings. DDSA will follow procedures under POMS DI39545.375.

5.13 The electronic signature feature on the Social Security website is an acceptable signature.

Electronically imaged signatures are also acceptable and must be applied by the examining medical source.

5.14 Notify DDSA at least sixty (60) days in advance of the closing of any of its facilities, or if it is purchased or acquired by another company. The Contractor will cooperate with ADES with the assignment of the contract to the new company or the establishment of a new contract if necessary. Contractor is responsible to comply with ADES Special Terms and Conditions, Section 3 Assignment, and Uniform Terms and Conditions and Section 5.3, Assignment and Delegation.

5.15 Notify DDSA no later than one (1) business day of any temporary or unscheduled closures of service facilities that would prevent the Contractor from providing scheduled services to DDSA Claimants.

5.16 Notify DDSA within three (3) business days of receipt of any information related to disciplinary action against the accreditation, certification, license, or registration of the Contractor or an employee.

6. Licensure/Qualifications Requirements

6.1 Be accredited, certified, licensed, or registered, without licensure sanctions or pending sanctions, according to the Arizona State laws including but not limited to as appropriate:

6.1.1 Be licensed in the State of Arizona with the Arizona Board of Psychologist Examiners https://psychboard.az.gov/license/directory-search;

6.1.2 Be licensed in the State of Arizona with the Arizona Department of Health, Speech- Language and Hearing providers https://hsapps.azdhs.gov/ls/sod/SearchProv.aspx?type=AUD;

6.1.3 Be licensed in the State of Arizona with the Arizona Medical Board https://www.azmd.gov/DoctorSearch/DoctorSearch;

6.1.4 Be licensed in the State of Arizona with the Arizona State Board of Nursing https://www.azbn.gov/license-verification.

7. Payment

7.1 The Contractor shall be responsible for all accounting and payroll functions in connection with provided services performed by the Contractor.

7.2 DDSA payment to the Contract is the sole and complete payment for services provided under this Contract. Claimants shall not be charged by other third-party insures, including but not limited to government sources, such as Medicare or Medicaid, for any services rendered.

7.2.1 DDSA will pay only the Contractor for services. The payment is inclusive of the examination performed, case history, and needed tests and including the Report of Findings.

7.2.2 If the Contractor is purchased or combined with another company and the payee for services changes, the Contractor is responsible to comply with the ADES Special Terms and Conditions, Section 3, Assignment, and Uniform Terms and Conditions, Section 5.3, Contract Assignment and provide DDSA with the new payee information at least sixty

(60) days prior to the effective date of the proposed change.

7.3 Payment shall be made in accordance with Exhibit E Fee Schedule, as may be amended, and upon acceptance by the DDSA of a complete and accurate invoice and a corresponding narrative report that meets all reporting requirements.

7.4 All travel expenses shall be related to the services provided and shall be reasonable and necessary. If travel is authorized by DDSA, the Contractor will be reimbursed for the following:

https://psychboard.az.gov/license/directory-search https://www.azmd.gov/DoctorSearch/DoctorSearch https://www.azbn.gov/license-verification

7.4.1 Mileage in accordance with the Arizona Department of Administration (ADOA) General

Accounting Office (GAO), Travel Policy and Arizona State Reimbursement Rates located at https://gao.az.gov/state-arizona-accounting-manual-saam, Section 95 Maximum Reimbursement Rates. Mileage Reimbursement Rates are only applicable to those who procure and maintain Business Automobile Liability. Contractors without Business Automobile Liability shall not drive on behalf of State business.

7.4.2 Lodging in accordance with Exhibit E Fee Schedule.

8. Reporting Requirements

8.1 Financial Reports

8.1.1 Accurately prepare and submit invoices within thirty (30) days following the end of each service month. Failure to submit an invoice within six (6) months of dates of services may result in non-payment for services rendered.

8.1.1.1 Invoice shall include at a minimum, the following:

8.1.1.1.1 Contractor’s name and address;

8.1.1.1.2 Name of the Claimant;

8.1.1.1.3 Case number;

8.1.1.1.4 Date of service were provided;

8.1.1.1.5 Authorization number

8.1.1.1.6 CPT Code;

8.1.1.1.7 Type of services provided;

8.1.1.1.8 Dollar amount billed for each service code.

8.1.2 Invoice shall be emailed to the assigned Fiscal staff member using DDSA’s Examination

Request as the first page to the secured messaging feature on the Electronic Records Express (ERE) secure website.

9. Notices and Correspondence

9.1 The Contractor shall submit the required certificate of insurance and policy endorsements within ten (10) days calendar days of a contract award and shall maintain valid insurance, including policy renewals, on file in the ADES certificate of insurance tracking portal, myCOI.

9.2 Notices, correspondence, reports and invoices from the Contractor to ADES should be sent to:

Arizona Department of Economic Security ATTN: DDSA Fiscal Unit 4000 N. Central Avenue, Suite 1800 Phoenix, AZ 85012 Fax: (602) 532-5567 https://gao.az.gov/state-arizona-accounting-manual-saam

Exhibit A – Examination Request Form (Sample)

Description: Health Assessment – Consultative Examinations (CE)

Exhibit A – Examination Request Form (SAMPLE)

Description: Health Assessment – Consultative Examinations (CE)

Exhibit B - Claimant Questionnaire

Exhibit B – Claimant Questionnaire

Exhibit C - Standard Operating Procedure for the Oversight of Contractors

Description: Health Assessments – Consultative Examinations (CE)

Exhibit C – Standard Operating Procedures for the Oversight of Contractors

Purpose: To standardize the system of oversight of contractors with the Disability Determination Services Administration (DDSA). It operates on a system of checks and balances to afford contractors opportunities to improve upon their actions before elevation of potential contract action. Our intent is to maintain quality and timely services by providing routine feedback to contractors on a regular basis and remediation and training assistance when necessary. This outline addresses the measures and procedures the DDSA will take when customer complaints are received and issues involving quality and timeliness are identified in products and services generated for the DDSA by contractors. Actions are progressive and give the contractor opportunities to receive refreshment training, and a chance to demonstrate improvement or an understanding of the DDSA’s needs. The standard operating procedures also address instances when it appears the CE provider cannot, or will not, provide the DDSA with satisfactory services.

It is important to point out that the Consultative Examination (CE) Management Oversight process as outlined in SSA-POMS and the SSA-SF RDIM A-2018-03 is recognized, followed and consistent with these procedures.

Background: Contractors are recruited, oriented, and trained by AZ DDSA staff. The AZ DDS will routinely review and rate the products and services of contractors to ensure they meet necessary thresholds required for quality, consistency, timeliness, and usefulness. The AZ DDSA established a progressive process consisting of three tiers to address situations when a contractor needs assistance because their product, or service, fails to meet minimum standards for quality, timeliness, consistency, and usefulness.

Notice of a potential egregious action made by the contractor may arise from a customer complaint, incident report, exam or imaging report, survey, etc. For the purpose of this written standard operating procedures, “egregious” is defined as misconduct on part of the vendor. This includes, but is not limited to harassment, abuse, or verbal or written intimidation of claimant. The three-tier process does not address specific procedures of how DDSA handles egregious issues involving claimants due to varied matters and entities that may be involved during an investigation. These events are treated seriously, however, and are handled as required by POMS (Federal guidelines), State employee rules for reporting unusual events and all applicable laws. Management will seek any guidance, if necessary, to comply with all required actions.

Duty to report issues involving vulnerable populations discovered as part of an evaluation will be reported to appropriate authorities and documented by AZ DDSA personnel when it appears imperative, and the contractor did not do so first. If there is a procedural question the AZ DDSA Program Administrator, or at the direction of the AZ DDSA Program Administrator, a member of the Management/Operations team will make the final decision regarding any duty to report issues.

AZ DDS will not curb appointments for non-compliant contractors while DDSA and/or the office of procurement initiates further inquiry and reviews documentation. The PRO and management may reach out to the office of procurement for guidance while making additional attempts to alter contractor practices, behavior or the improvement of products, or services. The office of procurement may intervene or eventually take the lead in communications with the contractor until reaching a conclusive decision about continued services. If there is no change in compliance, the AZ DDSA will defer judgment regarding a contractor’s continued fitness to the office of procurement. The office of procurement will handle communication regarding termination of service due to non-compliance issues.

Process:

Method/Modes of identifying issues and tracking relevant trends:

Monitoring the quality, timeliness, consistency and usefulness of contractor products and services is a program requirement for the DDSA. To help ensure that obligation is met, the Social Security Administration also requires a minimum amount of CE reviews be conducted by DDSA staff annually. Also, if DDSA is notified of a customer complaint through a survey and/or incident report, the Professional Relations Officer (PRO) will reach out to both the customer and contractor in an attempt to resolve the issue and will document the contractor’s file accordingly.

If a trend continues, the tiered process will take place. However, discovery of deficiencies in services, or products, of CE providers can happen at various stages of the assessment process. Medical Consultants (MC’s), Examiners, Unit Supervisors, the PRO and Management all have roles and responsibilities that may lead to the discovery of a deficiency. Deficiencies in the service or products of vendors are not all the same severity and some may require a higher priority resolution than others. Some deficiencies can be identified as in a trend while others appear to be a single anomalous event.

The DDSA has established a progressive three-tier method for addressing trends in poor quality or service, or a lack of timeliness, consistency, and/or usefulness from contractors. While DDSA desires to resolve issues at the lowest level possible, ongoing issues will escalate to the point of possible termination of services if issues with any specific contractor cannot be resolved by the conclusion of the third tier.

Tier I—Initial steps and attempts for remediation, quality improvement or service issue(s) resolution:

Medical consultants will work with the manager and/or the MC unit supervisors to identify specific issues, or trends, in deficiencies involving contractor services, product quality, timeliness, relevance or fitness. The MC supervisors and/or MC’s assemble, tabulate and summarize the results before escalating to the manager in charge of MC’s and PRO for review and/or to the PRO for remedial assistance.

Whether it is an issue that can be remedied with a phone conference, or email, the PRO, MC supervisor, manager, and/or MC will document the concern, the directions given to comply with the program/contract standard, and whether or not the vendor stated they would comply. This documentation will be sent to the vendor by either the PRO, manager, MC, or MC supervisor.

If a larger issue exists and will require training/refresher session:

1. A meeting with a PRO, MC(s), MC supervisor, and/or manager, will take place with the trainer to go over what will be addressed at the session.

2. Along with the trainer (MC or DDSA trainer) a PRO, MC supervisor, MC, or manager will participate in the session with the contractor to provide answers to administrative questions.

3. That PRO, MC supervisor, MC, or manager who participated in the session will write a summary.

4. The PRO, MC supervisor, MC, or manager will send the summary to the contractor along with a survey to gain feedback about the session.

5. No more than six weeks after the date of the training, provided a prohibition of scheduling consultative exams and imaging has not taken place, at least five of the vendor’s CE reports will be pulled and an MC(s) will be asked to review.

Refusal to comply, or declaring a barrier to compliance:

There may be circumstances in which the contractor disagrees with the AZ DDSA regarding specific CE practices or protocols, provision of services, products, or the agency’s description or definition of quality. If the contractor does not want to make the changes to their product or service as requested by DDSA or states a barrier will prevent them from making immediate improvement, they have the opportunity to request administrative review of the alleged non-compliance and the required corrective action. However, such requests must be submitted in writing by the vendor to the Program Administrator and within seven calendar days of first being notified of non-compliance. The PRO should make all expectations clear and provide the contractor with policy references and directives when possible. In the event the contractor still disagrees or refuses to comply with changes or adjustments as directed, the PRO will document all efforts to date and consult with management who may refer the issue to the agency contact at the office of procurement.

Conclusion and follow-up:

It is the agency’s desire and expectation that any contractor participating in a remedial effort improve and maintain quality services to the AZ DDS. There may be times the work products of certain contractors will continue to be monitored to assure continued improvement, or an understanding of the DDS’s needs.

Any vendor with newly discovered quality issues that have not been previously identified or addressed will participate in remedial efforts at the tier one level. This includes vendors that have previously participated in the tier one level remedial function for other issues that have since been resolved.

A contractor whose issue(s) has been resolved but is identified as having a resurgence (within twelve months for product quality) in similar problems, or quality issues in services or products that previously led to a tier one remedial action will be referred for additional remedial actions as described in tier two.

Tier II—Secondary progressive action for lack of demonstrated improvement by contractor:

“Improvement”:

For purposes of this SOP, the definition of improvement is the vendor no longer makes the same errors and submits the product, or completes the service, within compliance of program, or contract, standards after notification from DDSA.

Identification of services/products requiring tier 2 process:

The tier two process begins when a contractor is identified as chronically having the same issues as were addressed in tier one. Identification of relevant issues will be made by routinely monitoring contractor products and/or services and identifying deficiencies as described earlier in this document. When reviewing reports, the PRO, manager, and/or MC supervisors will consider whether there is improvement of issues that were identified at the tier one level. If the PRO, manager, and/or MC supervisor determine no additional action is necessary, the PRO will enter documentation to that effect into the contractor’s file.

The following steps will be taken in the event it appears the contractor is not demonstrating improvement:

If training/refresher session was not completed at tier one, a session will be coordinated with the following steps:

1. A meeting with a PRO, MC supervisor, MC(s), and/or manager, will take place with the trainer to go over what will be addressed at the upcoming session.

2. Along with the trainer (MC or DDSA trainer) a PRO, MC supervisor, MC and/or manager will participate in the session with the vendor to provide answers to administrative questions.

3. The PRO, MC supervisor, MC and/or manager will write up a summary of the meeting.

4. The PRO, MC supervisor, MC and/or manager will send that documentation to the contractor along with a survey to gain feedback about the session.

5. The product will be reviewed four weeks (if high volume vendor), or eight weeks (non-high volume) after training session. MCs from other office will review.

If a training/refresher session did occur at tier one the following steps will take place:

1. PRO, management, and/or MC supervisors review documentation from the first training including the returned survey to make sure no barriers on behalf of DDSA could have prevented the vendor from correcting the error(s).

2. If a second training is not necessary, or of benefit to the vendor’s improvement, PRO or manger will have a documented conversation with the vendor and elevate to the office of procurement. Tier three begins.

If second training/refresher session is necessary, or beneficial to the vendor’s improvement the following steps will take place:

1. A meeting with the PRO, MC supervisor, MC(s), or manager, will take place with the trainer to go over what will be addressed at the session.

2. Along with the trainer (MC or DDSA trainer) a PRO, MC supervisor, MC or manager will participate in the session with the vendor to provide answers to administrative questions.

3. The PRO, MC supervisor, or manager will write up a summary of the meeting.

4. The PRO, MC, MC supervisor, or manager will send the summary to the vendor along with a survey to gain feedback about the session.

5. Reports will be pulled four weeks (if a key or high-volume vendor), or eight weeks (if non-high volume vendor) after the training session. MCs from the other AZ DDSA office will review.

If there has been improvement, no further action will be necessary.

In the event the contractor is still non-compliant with changes or adjustments as directed, the PRO, and if needed, with the help of the MC supervisors, will gather all documented efforts to date and consult with management. The manager may refer the issue to the agency contact at the office of procurement. DDSA will provide the office of procurement a timeline documenting the agency’s efforts/attempts to improve the contractor’s product and/or services.

AZ DDSA will defer to the office of procurement regarding a reduction in appointments for the non-compliant vendor while the office of procurement continues its inquiry and reviews documentation. The office of procurement may intervene or eventually take the lead in communications with the vendor until reaching a conclusive decision about continued services. If there is no change in compliance, the AZ DDSA will defer judgment regarding a contractor’s continued fitness to the office of procurement. The office of procurement will handle all communication regarding termination of service due to non-compliance issues.

Tier III – Final attempt for improvement in the “post formal, procurement action, period”

Once the office of procurement sends the vendor a formal communication regarding their contract, DDSA will review a significant number, if not all, reports submitted by the vendor over a period of 4 weeks. If the contractor has reached tier three of the process not for quality of their reports, but instead due to poor service, or other non-compliant actions, DDSA will monitor and evaluate the vendor for up to 8 weeks depending on the severity of action. The DDS will attempt to identify trends in deficiencies involving services, product quality, timeliness, relevance, or fitness that were previously addressed in tier one and two. If the contractor’s schedule has been reduced per the advisement of the office of procurement, DDSA will communicate the need to increase appointments to be able to review additional reports from this source.

When reviewing reports, the DDS will consider whether issues identified at the tier one and two levels are not as marked, or of a lesser degree than those previously addressed.

If the contractor is not trending toward improvement and remains out of compliance with the program/contract standards, management will elevate the matter to the office of procurement again and request that we stop scheduling appointments with this vendor. The DDS will again submit any additional supporting documentation to the office of procurement.

In tier three, the cycle of reviewing contractor reports, documentation and notifying the office of procurement about compliance issues will continue to cycle beyond the post formal notice and procurement action period until one of the following occurs:

• the contractor’s product improves, and the contractor’s appointments are fully restored

• the office of procurement calls for a cancellation of all appointments

• the contract is severed by the office of procurement, or

• the contract period expires

Exhibit D - SSA User Guide and Instructions for Send CE Report

Exhibit D – SSA User Guide and Instructions for Send CE Report

See attached Exhibit D – SSA User Guide and Instructions for Send CE Report

Exhibit E - Fee Schedule

Exhibit E – Fee Schedule

See attached Exhibit E – Fee Schedule

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 this 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 Acceptance 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 “Contract Amendment” means a written document signed by the Procurement Officer that is issued for the purpose of making changes in the Contract.

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

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

1.6 “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).

1.7 “May” or “may” Indicates something that is not mandatory but permissible.

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

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

1.10 “Should” or “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.

1.11 “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 this Contract documented by a Contract Amendment. The Department may terminate this Contract pursuant to the Termination clauses of this 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 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.

3.2 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.

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 this Contract, except if the Contractor is subject to Health Insurance Portability & Accountability Act of 1996 (Public Law 104-191) in which case such records shall be retained for six (6) years. All records shall be subject to inspection and audit by the State at reasonable times. Upon request by the Department or the Attorney General’s Office, the Contractor shall produce the original of any or all such records.

5. Authorization for Services

5.1 Authorization for performance of services under this Contract shall be made only upon the issuance of a duly authorized Purchase Order (also referred to as “Purchase Authorization” or “Release Order”). The Purchase Order will indicate this Contract number and the dollar amount of funds authorized. The Contractor shall only be authorized to perform services up to the amount on the Purchase Order. The Department shall not have any legal obligation to pay for services in excess of the amount indicated on the Purchase Order.

5.2 No further obligation for payment shall exist on behalf of the Department unless:

5.2.1 The Purchase Order is changed or modified with an official procurement change order, and/or

5.2.2 An additional Purchase Order is issued for purchase of services under this Contract.

6. Certification of Cost or Pricing Data

By submittal of the offer, the Contractor is certifying that, to the best of the Contractor’s knowledge and belief, any cost or pricing data submitted is accurate, complete, and current as of the date submitted or other mutually agreed upon date. Furthermore, the price to the State shall be adjusted to exclude any significant amounts by which the State finds the price was increased because the cost or pricing data furnished by the Contractor was inaccurate, incomplete, or not current as of the date of certification. Such adjustment by the State may include overhead, profit, or fees. The certifying of cost or pricing data does not apply when contract rates are set by law or regulation.

7. Certification Regarding Lobbying

In addition to the Uniform Terms and Conditions, Section 7.11, the following shall apply:

7.1 The Contractor shall comply with P.L. 101-121, Section 319 (31 U.S.C. section 1352) as may be amended, and 29 C.F.R. Part 93 as may be amended which prohibit the use of federal funds for lobbying and which state, in part: Except with the express authorization of Congress, the Contractor, its employees or agents, shall not utilize any federal funds under the terms of this contract to solicit or influence, or to attempt to solicit or influence, directly or indirectly, any member of Congress regarding pending or prospective legislation. Indian tribes, tribal organizations and any other Indian organizations are exempt from these lobbying restrictions with respect to expenditures that are specifically permitted by other federal law.

7.2 The Contractor agrees by submittal of the Certification Regarding Lobbying form, in compliance with 49 C.F.R. Part 20.

8. Code of Conduct

The Contractor shall avoid any action that either creates or result in the appearance of its having:

8.1 Divulging or made an inappropriate use of information gathered or discovered pursuant to the performance of its duties under this Contract;

8.2 Acted on behalf of the State without appropriate authorization;

8.3 Provided favorable or unfavorable treatment to anyone;

8.4 Made a decision on behalf of the State that exceeded its authority, could result in partiality, or have a political consequence for the State;

8.5 Misrepresented or otherwise impeded the efficiency, authority, actions, policies, or adversely affected the confidence of the public or integrity of the State; or

8.6 A loss of impartiality when advising the State.

9. Competitive Bidding

If the Contractor is authorized to purchase the supplies and equipment itemized in this Contract for utilization in the delivery of contract services, this Contractor shall procure all such supplies and equipment at the lowest practicable cost and shall purchase all non-expendable items having a useful life of more than one (1) year and an acquisition cost of $1,000 or more, through generally accepted and reasonable competitive bidding processes. Any procurement in violation of this provision shall be considered a financial audit exception.

10. Compliance with Applicable Laws

In addition to the Uniform Terms and Conditions, Section 7.6, the following shall apply:

10.1 In accordance with A.R.S. § 36-557 as may be amended (Purchase of community developmental disabilities services; application; contracts; limitation), as applicable, all recipients of contract services shall have all of the same specified rights as they would have if enrolled in a service program operated directly by the State.

10.2 The Contractor shall comply with the requirements related to reporting to a peace officer or child protective services incidents of crimes against children as specified in A.R.S. §13-3620 as may be amended.

10.3 The Contractor shall comply with all applicable State and Federal statutes and regulations. This shall include A.R.S. § 23-722.01 as may be amended relating to new hire reporting, A.R.S. § 23-

722.02 as may be amended relating to wage assignment orders to provide child support, and

A.R.S. § 25-535 as may be amended relating to administrative or court-ordered health insurance coverage for children.

10.4 The Contractor shall comply with the Administrative Simplification rules in Title II of the Health

Insurance Portability and Accountability Act of 1996 (P.L. 104-191) and all Federal regulations that are applicable to the operations of the Contractor by the dates required by the implementing Federal regulations as well as all subsequent requirements and regulations as published.

11. Confidentiality

11.1 The Contractor shall observe and abide by all applicable State and Federal statutes, rules and regulations regarding the use or disclosure of information including, but not limited to, information concerning applicants for and recipients of contract services. To the extent permitted by law, the Contractor shall release information to the Department and to the Attorney General's Office as required by the terms of this Contract, by law or upon their request.

11.2 The Contractor shall comply with the requirements of Arizona Address Confidentiality Program, A.R.S. §41-161 et. seq. The Department will advise the Contractor as to applicable policies and procedures the Department has adopted for such compliance.

12. Contract Term and Option to Extend

12.1 The term of the resultant Contract shall be effective the date specified on the Offer and Award or

Signature page and shall remain in effect for two (2) years or as otherwise specified by this Contract, unless terminated, cancelled, or extended as otherwise provided herein.

12.2 The State has no obligation to extend or renew this Contract. However, the State shall have the right, at its sole option, to extend this Contract for an additional two (2) year term and consecutive one (1) year term for a maximum Contract term of five (5) years. In the event that the State exercises such right, all terms, conditions and provisions of the original Contract shall remain the same and apply during the renewal period with the exception of price. The Contractor shall agree that the price stated in the original Contract shall apply unless otherwise allowed.

12.3 Any extension or renewal must be made prior to the end of this Contract period specified in this

Contract.

12.4 The Contractor shall not provide services prior to Contract term commencing or after the termination date of this Contract. There shall be no billable activity outside of this Contract effective dates except as otherwise authorized by the Department in writing.

13. Cooperation with the Department’s Investigation

All Contractors, providers, vendors and volunteers shall cooperate fully and truthfully with any Department investigation, including but not limited to an Investigation by Division or Internal Affairs. Failure to adhere to this condition may result in ADES taking all such actions it deems appropriate, including removal of Contractor personnel and/or witness from working with the Department clients up to termination of this Contract with the Department.

14. Data Sharing Agreement

14.1 When determined by the Department that sharing of confidential data will occur with the Contractor, the Contractor shall complete the ADES Data Sharing Request Agreement and submit the completed Agreement to the ADES Program Designated Staff prior to any work commencing or data shared. A separate Data Sharing Request Agreement shall be required between the Contractor and each DES Program sharing confidential data.

14.2 The Data Sharing Request Agreement is located at: http://des.az.gov/documents-center. In the

“Search” field type “Data Sharing” and click “Apply”. The search will produce the following results:

14.2.1 Document Number J-119-Single (For requests involving a single division or program).

15. Evaluation

15.1 The Department may evaluate, and the Contractor shall cooperate in the evaluation of, contract services. Evaluation may assess the quality and impact of contract services, either in isolation or in comparison with other similar services, and assess the Contractor's progress and/or success in achieving the goals, objectives and deliverables set forth in this Contract.

15.2 As requested by the Department, the Contractor shall participate in third-party evaluations relative to Contract impact in support of Department goals.

16. E-Verify

In addition to the Uniform Terms and Conditions, Section 3.12, the following shall apply:

16.1 The Contractor warrants compliance with all Federal immigration laws and regulations relating to employees and warrants its compliance with Section A.R.S. § 23-214(A) as may be amended.

16.2 A breach of a warranty regarding compliance with Federal and State immigration laws and regulations shall be deemed a material breach of this Contract and the Contractor may be subject to sanctions up to and including termination of this Contract.

16.3 Failure to comply with a State audit process to randomly verify the employment records of contractors and subcontractors shall be deemed a material breach of this Contract and the Contractor may be subject to sanctions up to and including termination of this Contract.

16.4 The Department retains the legal right to inspect the papers of any employee who performs work under this Contract to ensure that the Contractor or subcontractor is complying with the warranty above.

17. Fair Hearings and Service Recipients' Grievances

17.1 The Contractor shall advise all applicants for and recipients of contract services of their right, at any time and for any reason, to present to the Contractor and to the Department any grievances arising from the delivery of contract services, including, but not limited to, ineligibility http://des.az.gov/documents-center determination, reduction of services, suspension or termination of services, or quality of services.

The Department may assert its jurisdiction to hear the grievance or refer the matter to the appropriate authority.

17.2 The Contractor, whenever authorized by law, shall maintain a formal system acceptable to and approved by the Department for reviewing and adjudicating grievances by service recipients or subcontractors arising from this Contract.

18. Federal Immigration and Nationality Act

In addition to the Uniform Terms and Conditions, Section 3.11, the following shall apply:

18.1 By entering into this Contract, the Contractor warrants compliance with the Federal Immigration and Nationality Act (FINA) and all other Federal immigration laws and regulations related to the immigration status of its employees. The Contractor shall obtain statements from its subcontractors certifying compliance and shall furnish the statements to the Procurement Officer upon request. These warranties shall remain in effect through the term of this Contract. The Contractor and its subcontractors shall also maintain Employment Eligibility Verification forms (I-

9) as required by the U.S. Department of Labor's Immigration and Control Act, for all employees performing work under this Contract. I-9 forms are available for download at USCIS.GOV.

18.2 The State may request verification of compliance for any Contractor or subcontractor performing work under this Contract.

19. Fees and Program Income

Unless specifically authorized in this Contract, the Contractor shall impose no fees or charges of any kind upon recipients for contract services.

20. Health Insurance Portability and Accountability Act of 1996 (P. L. 104-191)

20.1 The Contractor warrants that it is familiar with the requirements of HIPAA, as amended and accompanying regulations and will comply with all applicable HIPAA requirements in the course of this Contract.