CTR076215_Las_Palmas_ALF_2-_Fully_Executed.pdf

Direct Contract

Contract No.: CTR076215

Description: Assisted Living Facility

Rev. 04-2024, v11

Contract between the Arizona Department of Economic Security (the "Department") and Las Palmas Assisted Living 2 LLC (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 5/1/2025 (or date of last signature if the contract is signed after

5/1/2025) and shall terminate on 4/30/2026, 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: LAS PALMAS ASSISTED LIVING

2, LLC.

Signature of Authorized Individual Signature of Authorized Individual

Printed Name Print Name and Title

Title Phone number and Email address

Date Date

Contractor Mailing Address

Contractor Mailing Address (cont.)

Print Owner Name

Phone number and Email address

Saretha Jones

Procurement Manager

04/07/2025

Maria Mateo Maria Mateo Manager

Maria Mateo 520 551-0703 laspalmas1621@gmail.com

Maria Mateo 04/01/2025

Maria Mateo 9443 E 3rd Street Tuson Az, 85710

Maria Mateo 5332 N Flint Ave Tucson, AZ 85704

Maria Mateo Maria Mateo

Maria Mateo 520 551-0703 laspalmas1621@gmail.com https://azdesgov.na1.adobesign.com/verifier?tx=CBJCHBCAABAAadxiC8jS-yh_0TcDZzBrnIkpY34j6ppy

Table of Contents

CONTRACTOR IS STRONGLY ENCOURAGED TO READ THE ENTIRE CONTRACT.

Table of Contents

Scope of Work

Exhibit A – Price Sheet

Exhibit B – Spending Plan

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 – Affirmation of Central Registry Background Checks

Attachment 6 – Facility Location Chart

Attachment 7 – Business Associate’s Agreement

Scope of Work

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.

1.3 DDD Mission: To empower Arizonans with developmental disabilities to lead self-directed, healthy, and meaningful lives.

2. Purpose

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

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

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

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

3. Service Description

3.1 Taxonomy Definition: H004-LG: 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. 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): 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): 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 DDD Members 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 Responsible Person: The parent, legal guardian, or person selected by the DDD Member who will assist with making decisions.

4.8 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 or their Responsible Person.

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 a 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 DDD Members at the address appearing on the ADHS license.

5.4 Be registered with AHCCCS as an Assisted Living Home. https://www.azahcccs.gov/APEP

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

5.5.1 Adhere to the DDD Medical Policy Chapter 1200 Services and Settings, 1230 A Assisted

Living Facilities as may be amended.

5.6 Upon authorization by the DDD, only provide services to the DDD Members who require continuous nursing services when:

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

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

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

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

5.8 Have household and personal hygiene items available for the DDD Members.

5.9 Provide laundry services for the DDD Member as needed.

5.10 Provide transportation for medically necessary appointments and services, and all other reasonable transportation within the community to the DDD Members.

5.11 Participate in the development and review of the planning document for each DDD Member.

5.12 Provide services to the DDD Member as indicated in the planning document which meets their medical, physical, and emotional needs.

5.13 Ensure that the DDD Member receives other services as listed on the service plan.

5.14 Receive consent from the Responsible Person, the DDD Members Support Coordinator or as directed by a physician prior to changing living accommodations for the DDD Member.

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

5.16 Maintain a ledger and documentation (e.g., receipts) that accounts for the expenditures of all funds used for the DDD Member with the Representative Payee.

5.17 Provide reasonable accommodations and assist, if necessary, to allow the DDD Member to engage in religious or spiritual practices, in accordance with their preference.

5.18 Comply with Arizona Administrative Code Title 6, Chapter 6, Article 9 et seq., Managing Inappropriate Behaviors, as may be amended.

5.19 Alert the DDD Members responsible person, and 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.

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

5.21 Maintain the following:

5.21.1 A file for each DDD Member which includes the following but not limited to:

5.21.1.1 The DDD Member’s name;

5.21.1.2 AHCCCS Identification N

5.21.1.3 The Planning document;

5.21.1.4 Physician's orders;

5.21.1.5 Care plans;

5.21.1.6 Treatment records;

5.21.1.7 Medication records;

5.21.1.8 Evaluations;

5.21.1.9 Assessments;

5.21.1.10 Progress reports;

5.21.1.11 The name of the DDD Member’s Responsible Person, if applicable;

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

5.21.1.13 Interactions with other agencies or service providers;

5.21.1.14 Any other documentation applicable to their care; and

5.21.1.15 A log of their personal belongings that is continually updated and available to the DDD Member, Support Coordinator or Member’s Responsible Person upon request.

5.21.2 Provide records that document inspection records and licenses of the facility and all appropriate Contractor personnel.

5.21.2.1 Provide copies of all files to DDD upon request.

5.22 Provide companion care to the DDD Members as designated in the Arizona Health Care Cost Containment System Medical Policy Manual section 1250- H including but not limited to:

5.22.1 Transporting them to medical appointments,

5.22.2 Accompanying them to medical appointments,

5.22.3 Assisting with personal care needs and,

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

5.23 Comply with the Adult Protective Services (APS) Registry requirements pursuant to A.R.S. 46-

459. https://des.az.gov/APSRegistry

5.23.1 Beginning January 1, 2025, owners of residential care institutions, nursing care institutions, and home health agencies, will be required to check for prospective employee on the APS Registry and prohibits the hiring of employees who appear on the Registry (A.R.S. § 46-459).

5.23.2 On or before March 31, 2025, owners of residential care institutions, nursing care institutions or home health agencies must verify that each employee is not on the Adult Protective Services Registry and shall take action to terminate the employment of that employee should they appear on the registry.

5.23.3 Beginning March 31, 2025, annually reverify that each employee is not on the Adult

Protective Services Registry pursuant to Section 46-459.

5.23.3.1 Provide verification of results, upon request by the DDD.

6. Payment Units

6.1 One Unit equals One (1) Residential Day. The Daily Rate is based on the DDD Members acuity level, DDD will pay the portion of the Daily Rate in which DDD is responsible based on the assessed rate minus the DDD Members share of cost.

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

6.3 Residential Day

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

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

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

6.4 The Daily Rate shall include all costs associated with the provision of the service including but not limited to:

6.4.1 Room and board;

6.4.2 Personal hygiene items excluding incontinence supplies;

6.4.3 Transportation;

6.4.4 Staff salaries;

6.4.5 Operating costs;

6.4.6 Licensing;

6.4.7 Materials;

6.4.8 Supplies;

6.4.9 Household items;

6.4.10 Insurance; and

6.4.11 Preparation of billing and reports.

6.4.12 ADES will not pay these, or any other costs, separately.

6.5 Billing

6.5.1 Follow the Complete DDD Billing System Training to obtain a Provider Identification

Number

6.5.2 Contact the DDD Provider Customer Service Unit to schedule training.

DDD Provider Customer Service Unit 1-844-770-9500 option 1 DDDCustomerServiceCenter@azdes.gov

6.5.3 Follow the links below to review the billing instruction for DDD bill claim (Wellsky Claims Processing System);

https://des.az.gov/services/disabilities/developmental-disabilities/current-2-future-initiative/hipaa-tcs

6.5.4 Understand the DDD is not obligated to pay for services provided without prior authorization.

6.5.5 Understand 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

6.5.6 Understand 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.

6.5.7 Understand if a claim does not achieve clean claim status or is not adjusted correctly within twelve (12) months, DES/DDD is not liable for payment.

7. Reporting Requirements

7.1 The Contractor shall submit all notices/correspondence relevant to this contract as directed by

ADES, electronically:

Arizona Department of Economic Security Division of Developmental Disabilities file:///Users/mariamateo/Desktop//C/Users/D003762/Desktop/DDDCustomerServiceCenter@azdes.gov

Contracts Administration DDDSpecialtyContracts@azdes.gov

7.2 Program Reports:

The Contractor shall submit the following:

7.2.1 An accounting of all expenditures on the Spending Plan (Exhibit B) for the DDD Member to their Representative Payee or designee, upon request.

7.2.2 Quarterly reports of health care appointments for the DDD Member by July 15th, October

15th, January 15th, and April 15th to the designated Support Coordinator and their Responsible Person. The report shall include:

7.2.2.1 Their Name,

7.2.2.2 Date and time of appointment,

7.2.2.3 Type of appointment,

7.2.2.4 Diagnosis, and

7.2.2.5 After care plan(s).

7.3 Incident Reporting Requirements

7.3.1 Submit Incident Reports as defined in DDD’s Operations Manual – Chapter 6000 https://des.az.gov/sites/default/files/Provider-Quick-Guide-For-Incident-Reporting.pdf

7.3.1.1 Report all serious immediate notification incidents by calling designated reporting number in quick guide and provide hard copy incident report no later than twenty-four (24) hours following the incident;

7.3.1.2 Report all other normal incidents by close of business day following the incident

8. Notices and Correspondence

8.1 Submit all correspondence and questions regarding the services to:

Residential Provider Network Manager Christine Fennemore Email: cfennemore@azdes.gov

8.2 Submit all questions regarding billing to:

file:///Users/mariamateo/Desktop/cfennemore@azdes.gov

Customer Service Center Tel: 1(844) 770-9500 DDDCustomerService-Providers@azdes.gov

8.3 Submit all correspondence and questions regarding the contract to:

Contracts Administration DDDSpecialtyContracts@azdes.gov

8.4 Submit all correspondence and questions regarding insurance to:

MYCOI

8520 Allison Pointe Blvd Ste 223 PMB 49940 Indianapolis, IN 46250 Email: www.mycoitracking.com Telephone Number: (888) 692-6448 ext. 105

8.4.1 Upon execution of contract, the contractor shall register with www.mycoitracking.com to submit Certificates of Insurance, Accord form and Endorsements within ten (10) business days, as listed in the Special Terms and Conditions.

8.4.1.1 Compliant copies of the contractor’s insurance documents shall be kept on file in the Arizona Procurement Portal.

8.4.1.2 Updated copies of the contractors Certificates of Insurance, Accord form and Endorsements are required to be submitted within ten (10) calendars of expiration/renewal to www.mycoitracking.com.

file:///Users/mariamateo/Desktop//C/Users/D003762/Desktop/DDDCustomerService-Providers@azdes.gov file:///Users/mariamateo/Desktop//C/Users/D003762/Desktop/DDDSpecialtyContracts@azdes.gov file:///Users/mariamateo/Desktop//C/Users/D003762/Desktop/www.mycoitracking.com

Exhibit A – Price Sheet

Exhibit A – Price Sheet

Assisted Living Facility

Service Rate

Residential Day – FOCUS ID 39094 $139.80

Residential Day – FOCUS ID 69 $139.80

Exhibit B - Spending Plan

Exhibit B – Spending Plan

DDD Special Terms and Conditions

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 (DES or Department) Special Terms and Conditions, the following shall apply:

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

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

1.3. “AHCCCS Minimum Subcontract Provisions” - AHCCCS / ALTCS requirements for the Department's contractors and subcontractors providing services to DDD / ALTCS eligible members on the AHCCCS website located at https://www.azahcccs.gov/PlansProviders/HealthPlans/minimumsubcontractprovisions.html

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

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

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

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

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

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

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

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

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

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

3. Certification of Truthfulness of Representation. By signing this Contract, the Contractor certifies the following:

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

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

4. Compliance with Applicable Laws

4.1. The Contractor shall cooperate with all Division investigations, including investigations pursuant to A.RS.

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

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

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

4.3.1. Hiring of ex-offenders;

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

4.3.3. Completing of Fire Risk Profile requirements;

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

4.3.5. Implementing program audit implementation plans;

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

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

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

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

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

4.3.11. 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 Department and AHCCCS for the provision of covered services under the ALTCS.

4.5. Any changes to Federal and State laws, regulations, or policies; Department, Division, or AHCCCS administrative rules, policies, procedures; or to the Intergovernmental Agreement between the Division and 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 Division no later than 120 days prior to any required compliance date if the Contractor is unwilling to or anticipates that it will be unable to comply with any of the requirements of this section.

Receipt by the Division of a notice of anticipated inability or unwillingness to comply as required by this section constitutes grounds for the termination of this Contract.

4.8. By entering into this Contract, the Contractor warrants compliance with the Deficit Reduction Act of 2005

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

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

4.9. Federal Database Checks.

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

4.9.1.1. The List of Excluded Individuals/Entities ("LEIE") no less frequently than monthly

(http://www.oig.hhs.gov/fraud/exclusions.asp),https://oig.hhs.gov/exclusions/ ) or as amended;

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

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

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 Division 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 members [42

C.F.R. § 422.128].

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

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

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

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

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

5. 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 Division any updates to the member-specific third party liability information. The Contractor shall seek payment from Medicare and any other third party up to the amount of liability before submitting a claim to the Department. Claims by the Contractor shall be submitted to the Department on Federal government universal claim forms (i.e., CMS 1500, UB-04, Pharmacy Universal Claim), on the Division's uniform billing document, or as specified in the Scope of Work. When submitting a claim, the Contractor shall also provide written documentation acceptable to the Division as to the amount of the third party payment received or as to the rejection or nonpayment of the claim by the third party. Acceptable written documentation includes, but is not limited to, an "explanation of benefits" form when the third party is an insurance company whose potential liability on the claim arises out of a contract of insurance. To the extent the Department pays all or a portion of a claim of the Contractor, the Contractor hereby assigns to the Department all rights it would otherwise have had from the third party or from any other source.

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 Division 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 members, the system for reviewing and adjudicating grievances shall follow the grievance procedure agreed to by AHCCCS and the Department in the current AHCCCS/DES Intergovernmental Agreement and the rules and policies promulgated by AHCCCS and the Department.

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

8. Fees and Program Income.

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

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

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

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

10. Monitoring

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

11. Notices

The Contractor shall notify the Division, 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 Division shall describe the event or facts that triggered the delivery of the notice.

12. Payments

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

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

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 Division 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 Division or AHCCCS for services provided to ALTCS eligible and/or enrolled individuals and shall comply with encounter reporting and claims submission requirements of the Division and AHCCCS.

12.5. Corrections to claims submitted to the Division in which an underpayment was made due to either billing errors or an error on the part of the Division when paying must be made within a 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 Department within thirty (30) days following termination of the Contract or such longer period as requested by the Department. For purposes of this paragraph, the term "data" shall not include an eligible individual's records.

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 Department and AHCCCS, the

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

15. Reporting Requirements

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

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

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

Sanctions imposed against the Division or the Department 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 Division and/or the Department.

17. Subcontracts

17.1. Any subcontract that the Contractor enters into shall incorporate by reference this Contract and the AHCCCS Minimum Subcontract Provisions.

17.1.1. The following link constitutes requirements for the AHCCCS Minimum Subcontract Provisions.

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

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 Division in the transition of members 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 members.

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

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

18.1.6. Paying of all outstanding obligations for care rendered to members.

18.1.7. Provide financial reports to the Division until the Division 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 Division and in accordance with current applicable AHCCCS rules and policies and Federal rules as specified in the current 42 C.F.R. Part 456 and the AHCCCS Medical Policy Manual, and as implemented by AHCCCS and the Division. Contractor requirements shall include, but are not limited to:

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

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

Committee;

19.1.3. Making records available upon request;

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

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

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

20. Contract Void

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

21. Warranty of Services

In addition to section 56.0 of the Special Terms and Conditions, the following shall apply:

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

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

ADES Special Terms and Conditions

1. Definition of Terms

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

1.1 “Award Date” The date 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 $10,000.00 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. Background Checks for Employment through the Central Registry. If providing direct services to children or vulnerable adults, the following shall apply:

6.1 The provisions of A.R.S. § 8-804 (as may be amended) are hereby incorporated in their entirety as provisions of this Contract.

6.2 The Department will conduct Central Registry Background Checks and will use the information contained in the Central Registry as a factor to determine qualifications for positions that provide direct service to children or vulnerable adults for:

6.2.1 Any person who applies for a contract with this State and that person’s employees;

6.2.2 All employees of a contractor;

6.2.3 A subcontractor of a contractor and the subcontractor’s employees; and

6.2.4 Prospective employees of the contractor or subcontractor at the request of the…