CTR076899_Contract_Amendment_One__1_.pdf
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- Attached to
- Master Agreement AZ|CTR076899
- Contract number
- CTR076899
- Issued by
- Arizona
About this file
This document is a Contract Amendment issued by the Arizona Department of Economic Security for Contract Number CTR076899, involving Worldwide Travel Staffing. The amendment modifies an existing contract for Nursing and Habilitation Services for Individuals with Intellectual Disabilities, expanding the scope to include services for the Arizona Department of Veterans' Services (ADVS) across four Veterans' Homes located in Maricopa and Pima Counties.
The amendment adds new requirements for the contractor, specifically to provide nursing services and supporting active treatment to residents at the Veterans' Homes. It introduces detailed incident reporting requirements, including the need to submit incident reports through the AHCCCS QM Portal within one business day of occurrence, particularly for sentinel events. The modification outlines specific reporting procedures, references to various medical policy manuals, and establishes communication protocols for reporting critical incidents. All other existing contract terms and conditions remain unchanged, and the amendment will be executed through electronic approval in an application system.
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CONTRACT AMENDMENT
Arizona Department of Economic Security
1789 W Jefferson Street, Mail Drop 1541, Phoenix, AZ 85007
CONTRACT NUMBER: AMENDMENT NUMBER:
CTR076899 One (1)
DESCRIPTION/ LABEL: Nursing and Habilitation Services for Individuals with Intellectual Disabilities at Intermediate Care Facilities and State-Owned Group Homes
CONTRACTOR NAME: Worldwide Travel Staffing
THE ABOVE-REFERENCED CONTRACT IS HEREBY MODIFIED AS FOLLOWS:
1. In accordance with the Uniform Terms and Conditions, Section 5, Contract Changes, the Scope of Work is being revised to add Subsection 2.1.1 as follows:
2.1.1 Provide nursing services at the Arizona Department of Veterans’ Services (ADVS) four (4) Veterans’
Homes (ASVHs) in Maricopa and Pima County. Services include providing healthcare and supporting active treatment services to residents at the Veterans’ Homes.
2. In accordance with the Uniform Terms and Conditions, Section 5, Contract Changes, the Scope of Work is being revised to add Subsection 4.9 as follows:
4.9 Arizona Department of Veterans’ Services (ADVS): provides direct services to Veterans, service members, and their families through several state and federally funded programs and initiatives.
3. In accordance with the Uniform Terms and Conditions, Section 5, Contract Changes, the Scope of Work is being revised to add Subsection 6.14 as follows:
6.14 Provide services to ADVS as defined in the Scope of Work and as further detailed in mutually approved
Task Orders, which shall outline the service requirements, deliverables, timelines, and payment terms.
4. In accordance with the Uniform Terms and Conditions, Section 5, Contract Changes, Section 11 Incident Reporting Requirements is hereby added to the Scope of Work.
11. Incident Reporting Requirements
The Contractor Shall
11.1 Submit Incident Reports as defined in the DDD’s Medical Policy Manual 961, DDD Provider
Manual Chapter 70, and AHCCCS Medical Policy Manual -Chapter 96 as may be amended.
Division Medical Policy Manual 961 Division Provider Manual Chapter 70
AHCCCS AMPM 961
11.1.1 Sentinel Events shall be reported to the Division immediately at 602-375-1403 or 1-855- 375-1403 (phone lines are available 24 hours a day, weekdays, weekends, and holidays) and shall then be submitted via the AHCCCS QM Portal within one (1) business day of the occurrence of the event.
AHCCCS QM Portal Migration User Guide https://des.az.gov/sites/default/files/media/Division_Medical_Policy_Manual_961_Incident_Accident_and_Death_Reporting.pdf?time=1761096186787 https://des.az.gov/sites/default/files/media/DDD_Provider_Policy_Manual_Chapter_70_Qualified_Vendor_Incident_Reporting.pdf?time=1717792726488 https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/900/961.pdf https://docs.google.com/document/d/17V9leTt-Mf9lPUSaOFTqQRz_7jGNutPfKi4m9WcQ6IA/edit?tab=t.0%23heading=h.arsfm1vhtwua
11.1.2 The AHCCCS QM Portal can be accessed through the following links:
AHCCCS QM Portal login page AHCCCS QM Portal FAQ page
11.1.3 The AHCCCS QM Portal User Guides can be found at the links below:
AHCCCS Provider User Guide AHCCCS IAD Submit User Guide AHCCCS Return IAD User Guide AHCCCS Approve IAD User Guide
ALL OTHER REQUIREMENTS, SPECIFICATIONS, AND TERMS AND CONDITIONS REMAIN UNCHANGED
ACKNOWLEDGEMENT AND AUTHORIZATION
This Amendment shall be fully executed by means of electronic approval in APP.
https://qmportal.azahcccs.gov/Account/Login.aspx https://qmportal.azahcccs.gov/Account/Login.aspx https://qmportal.azahcccs.gov/Account/Login.aspx https://qmportal.azahcccs.gov/Account/FAQ.aspx https://qmportal.azahcccs.gov/UserGuides/QuickStart_RegistrationAccountMgmt_Provider.pdf https://qmportal.azahcccs.gov/UserGuides/QuickStart_IAD_Report_Submit.pdf https://qmportal.azahcccs.gov/UserGuides/QuickStart_IAD_Report_Return.pdf https://qmportal.azahcccs.gov/UserGuides/QuickStart_IAD_Report_Approve.pdf
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