CTR077216_Contract_Documents__ADL_Solutions.pdf

CTR077216

July 1, 2025

5th June 25

Solicitation Requirements Request for Proposal (RFP)

Solicitation No.: BPM006728

Description: Home Modification Services

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Table of Contents

Section Page

Scope of Work

DDD Special Terms and Conditions

ADES Special Terms and Conditions

Uniform Terms and Conditions

Exhibit A – DDD Home Modification Procedures

Exhibit B - RSA Home Modifications Procedures

Exhibit C - DDD Home Modification Service Project Specification and Price Sheet (PSPS)

Exhibit D - RSA Home Modification Request for Project Pricing

Exhibit E – DDD Home Modification Service Notice of Selection

Exhibit F – Contractor Code of Conduct

Exhibit G – DDD Home Modification Non-Selection Notice

Exhibit H – RSA Home Modification Project Completion Report https://app.az.gov/

Scope of Work

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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: To provide the Arizona Department of Economic Security (ADES), the Division of

Developmental Disability (DDD) and the Division of Employment and Rehabilitation Services (DERS), Rehabilitation Service Administration (RSA) programs with service for Home Modifications. The Department is seeking a registered licensed Contractor to provide Home Modification Statewide to a home of the eligible individuals with disabilities to increase the individual’s ability to function with greater independence.

2.2 Legal Authority:

2.2.1 DDD: A.R.S. § 41-2580 provides the Department the authority to contract and meet obligations within the general scope of its activities and operations. A.R.S. § 41-1954 A.6 provides ADES the authority to contract and incur obligations within the general scope of its activities and operations.

2.2.2 DERS: ADES is authorized to administer the Vocational Rehabilitation program pursuant to A.R.S. § 41-1954 (A) (1) (d). RSA is authorized to provide this service under Rehabilitation Act of 1973, as amended (29 U.S.C. 723(a); 709(c), 721(a)(6) and 723 (b) and 34 CFR 361.48 and

361.49 Scope of Vocational Rehabilitation Services for Individuals and Groups of Individuals with Disabilities), and A.R.S. § 23-503.1, Duties and Powers of Vocational Rehabilitation Division (i.e. Administration). RSA is authorized to purchase this service through the RSA Fee Schedule in accordance with Arizona Revised Statute 41-1954 H.

2.3 Projected Awards: It is the intent of ADES to make multiple awards when determined to be in the best interest of the State.

2.4 Projected Utilization: Service provision is on an as needed basis. ADES makes no guarantee of the projected utilization of services. Each Home Modification Project will require a competitive bid request by the Division.

3. Service Description

3.1 Taxonomy Definition: Home Modification/Adaptation H028-HJ: A service that provides for alterations to a home to assist the individual to continue to reside in the property.

3.2 Actual Service Description: Home Modification services based on assessment completed by DDD or RSA. Home Modification may include but not limited to, the installation of ramps, widening of doorways, lowering of sinks and countertops, installation of grab bars, and curb-less showers. Contractor will work with the Division at no cost to the eligible individual who resides in a home, mobile home, apartment, and other similar shelter that is owned, rented, leased or occupied.

Athena Begay Highlight

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3.3 Background:

3.3.1 DDD Background: The Division provides a variety of services to eligible individuals with developmental disabilities enrolled in the ALTCS Program, including services that assist in making an individual’s home more accessible. In accordance with AHCCCS Medical Policy Manual (AMPM) Ch. 1200 and DDD Medical Policy Manual Ch. 1200, the Division’s Home Modification services are intended to make appropriate and cost effective medically necessary home modifications in order to meet the DDD Member’s medical and accessibility needs throughout all regions in Arizona.

3.3.2 DERS Background: RSA: Home modifications include adaptations, changes, and/or modifications of features to a clients’ home to accommodate their disability related needs necessary for achievement of their employment and/or independent living goal.

4. Definitions

4.1 Arizona Department of Economic Security (ADES): Is a state agency that provides protective and assistance services to Arizona’s children, adults, and families through a broad range of programs.

4.2 Arizona Health Care Cost Containment System (AHCCCS): Arizona’s Medicaid agency that offers health care programs to serve Arizona residents: https://www.azahcccs.gov/

4.3 Business Day(s): normally means any day except a legal holiday. It may also mean a business day of operation, any of the days ADES operates from Monday through Friday from 8 am to 5 pm.

4.4 Calendar Day(s): refers to the total number of days on a calendar, including weekends and holidays.

4.5 Certified Environmental Access Consultant (CEAC): is responsible for the entirety of the Home Modification Project including but not limited to the initial assessments, drafts the PSPS, completes solicitations, reviews bids, awards projects, installations deficiencies, project completeness, and warranty claims.

4.6 Clean Claim: Means written or electronic claim for health care services or benefits that may be processed without obtaining additional information, including coordination of benefits information, from the health care provider, the enrollee or a third party, except in cases of fraud. (A.R.S. §20- 3101).

4.7 Completion Date: The date specified by the Division on the Project Specification and Pricing Sheet and the Resolution Plan, in which all work on a Home Modification Project shall be completed, including all cleanup and the removal of all Contractor’s property and debris from the residence.

4.8 Contractor Personnel: Any of the Contractor’s employees providing services under the Contract.

4.9 Division of Developmental Disabilities, (DDD): A Division in the Department of Economic Security serving individuals with developmental disabilities.

4.10 DDD Member: An individual who has been determined to be eligible by the Division to receive services from the Division.

4.11 Evaluating Therapist: Professional responsible for determining home modification requirements for the RSA Client.

https://www.azahcccs.gov/

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4.12 Home: A residential dwelling that is owned, rented, leased, or occupied by a member, including a house, a mobile home, apartment, or other similar shelter

4.13 Home Modification Project: A home modification service authorized by the ADES based on the needs of an eligible member/client and the assessment completed by a Home Modification Specialist/Coordinator.

4.14 Home Modification Specialist, (CEAC): An employee of the Division and a member of the Home Modification Unit who has a certification as a Certified Environmental Access Consultant (CEAC). The Home Modification Specialist completes assessments and oversees the DDD Member’s Home Modification Project. The Home Modification Specialist verifies job completeness, installation deficiencies, and warranty claims.

4.15 Home Modification Unit: A unit within DDD responsible for assessing a DDD Member’s residence, to assist in determining if a modification is warranted, preparing the initial Project Specification and Pricing Sheet, assigning and managing projects, and approving all Contractor work. The Home Modification Unit functions as the Contractor’s main point of contact throughout a Home Modification Project.

4.16 Legally Responsible Person: The parent or guardian of a developmentally disabled minor or a developmentally disabled adult; or a developmentally disabled adult who is a DDD Member for whom no guardian has been appointed.

4.17 Monitoring: The process of observing, evaluating, analyzing, conducting a follow-up Home visit and documenting results via on-site-review of the modifications specified on the PSPS. A Monitoring will occur after completion of the project and may occur while the modifications are being performed, and when a concern is identified by a Member/responsible person (up to two years from completion date for all materials and workmanship or as provided by the manufacturer, whichever is greater and two (2) years for all equipment or as provided by the manufacturer, whichever is greater).

4.18 Notice of Selection: The formal notification by the DDD that the Contractor has been selected to perform a specific Home Modification Project identified by a DDD Project Number, specified as Exhibit E.

4.19 Price Sheet: A document that is a section of the PSPS containing any and all costs or expenses identified and covered under the project specifications during the period of the work assignment. The Home Modification Specialist will provide the PSPS to the contractor who will review, complete cost estimate, then submit to the Home Modification Unit via email or fax

4.20 Project Specification and Price Sheet (PSPS): A document, sent by the DDD, as Exhibit C, as may be amended, with a list of tasks to be completed by the Contractor within the scope of the Home Modification Project. It may contain requirements, measurements, descriptions, photographs, special instructions, etc.

4.21 Rehabilitation Services Administration (RSA): Helps individuals with disabilities achieve their goals for employment and independence.

4.22 Request for Project Pricing (RFPP): A request sent by DDD via email to Contractors with the Exhibit C attached. The email will have specific instructions detailing Price Sheet submission due dates and submission procedures for each Home Modification Project which must be followed by the contractor.

4.23 Resolution Plan: A document outlining a resolution to areas of concern identified during a Monitoring visit after the completion of a Home Modification Project and when a concern is reported to the Home Modification Unit by a Member/Responsible person.

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4.24 Responsible Adult: An adult; over the age of eighteen (18) years, designated by the Legal Responsibly Person.

4.25 Return to State: The process of restoring the home to the original condition that existed prior to the renovation when the landlord/property owner requires such after the Member has vacated the property.

4.26 RSA Home Modification Coordinator: An employee with RSA who provides ongoing technical assistance and consultation to DES/RSA staff, clients, and vendors regarding the assessment, purchase, construction/installation, and follow-up of home modification services for RSA clients.

4.27 RSA Home Modification Request for Project Pricing: A document, sent by the RSA, as Exhibit D, as may be amended, which includes both a ‘Project Information’ section completed by the RSA Home Modification Coordinator and a ‘Project Pricing Proposal’ section to be completed by the contractor to describe the scope of the Home Modification Project. The scope should include make, model, materials, photographs, material cost, labor cost, total project pricing, estimated timeframe and any additional contractor notes.

4.28 RSA Informed Choice: A decision-making process in which the RSA client analyzes relevant information and selects, with the assistance of their VR counselor, vocational goals, intermediate objectives, services, and service providers.

4.29 RSA Planning Team: includes the Client, VR Counselor, Evaluating Therapist and Home Modification Coordinator responsible for assessing the Client's residence, to assist in determining if a home modification is warranted. The Home Modification Coordinator functions as the Contractor’s main point of contact throughout a Home Modification Project, including selection of the Contractor, Project Specifications, and approving work to be completed for the Home Modification Project.

4.30 State Holidays: Per Arizona Revised Statues (A.R.S.) Title 1, Chapter 3, State of Arizona observed holidays include New Year’s Day, Martin Luther King Jr. Day, Presidents Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving Day, and Christmas Day.

4.31 Subcontractor Personnel: A contract between the contractor and another party or between a subcontractor delegated or assigned to provide any service or any material required for the performance of the contract.

5. General Requirements

The Contractor shall:

5.1 Have experience providing accessible Home Modification remodeling to a home of individuals with disabilities or for a person aging in place.

5.2 Comply with and meet all applicable provisions of Federal, State, and Local laws and local building codes., Regulations, Policies, and Procedures to provide Home Modification Services, including without limitations the requirements and standards as follows:

5.2.1 Arizona Revised Statute (A.R.S.) Title 32, Chapter 10 as amended and Arizona Administrative

Code (AAC), Title 4, Chapter 9; as amended.

5.2.2 The Occupational Safety & Health Administration (OSHA) Standard Title 29, Subtitle B, Chapter XVII, Part 1926, Subpart Z, et seq., as amended, regarding Toxic and Hazardous Substances, and all State and local requirements.

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5.3 Comply with AHCCCS requirements for professional licensure, certification, or registration.

5.3.1 Obtain and maintain a valid AHCCCS Provider Identification Number under Provider Type 44:

Environmental (LTC); as amended in Chapter 600, Subsection 610. Please follow the following link:

https://www.azahcccs.gov/APEP

5.4 Maintain active license(s) and certificate(s) in good standing with all applicable State and local licensing and regulatory boards and agencies. The ADES reserves the right to request any of the aforementioned information at any time, see Section 8 - Licensure/Qualification Requirements.

5.5 Complete all work by the Completion Date, unless an extension is approved in writing and will communicate any issues with the Home Modification Specialist/Coordinator that hinder the completion of the Home Modification Project by the agreed to date.

5.6 Understand that ADES will not be responsible for reimbursing the Contractor for non-refundable materials purchased, without prior written approval, in the event a Home Modification Project is canceled or assigned to another Contractor.

5.7 Be responsible for providing detailed information regarding material and labor expenses incurred for services provided to allow the Home Modification Project Specialist/Coordinator to determine a prorated amount to be paid for services completed in the event that the Home Modification Project must be reassigned to another Contractor.

5.8 Accept all costs for unauthorized work performed, not within the scope of the Project Specifications and/or change order, not addressed in the Exhibit C PSPS, and/or Exhibit D, and will be responsible to bring the residence to its original state. This includes any repairs, damages, removal, restoration and alterations.

5.9 Accept all costs incurred for increased cost of unauthorized materials, equipment, or installations used to complete the Home Modification Project.

5.10 Refrain from accepting requests for additional upgrades to materials and/or equipment used to complete specified Home Modifications that result in an increase in the project’s cost.

5.11 Obtain any municipal licenses and/or permits that are required to perform the requested Home Modification Project when preparing pricing submittals.

5.12 Verify resources, staffing, materials, and availability prior to submitting a completed Price Sheet, Exhibit C - PSPS/ Exhibit D- RSA Home Modification Request for Project Pricing, as may be amended.

5.13 Ensure the ability to meet the project requirements and deadlines as identified in the Exhibit C - PSPS/ Exhibit D- RSA Home Modification Request for Project Pricing before submitting a completed Price Sheet.

5.14 Supply all labor, supervision, materials, supplies, tools, transportation, equipment and incidentals required to complete the project.

https://www.azahcccs.gov/APEP

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5.15 Contractor Staffing Responsibility

5.15.1 Require all personnel to wear an identification badge, uniform or clothing with the Contractor’s or the Subcontractor’s name to identify themselves to individuals at the DDD Member’s or RSA Client’s residence.

5.15.2 Prohibit any person from the work site that is not employed by the Contractor or Subcontractor.

5.15.3 Provide Member, Client and Responsible Person operating instructions, copy of owner manuals, and manufacturer warranty information regarding the safe operation and maintenance of all equipment or building features installed.

5.15.4 Ensure all personnel and subcontractors have the required licensing to perform each Home

Modification Project.

5.15.5 Use of a Subcontractor

5.15.5.1 Act as the single point of contact for ADES with the Contractors’ Subcontractors for the services described in this RFP.

5.15.5.2 Accept that ADES will hold Subcontractors to the same Contract terms and performance standards as the Contractor.

5.15.5.3 Accept that ADES will hold the Contractor exclusively accountable for Subcontractor performance and compliance.

5.15.5.4 Ensure any subcontracts contain all appropriate flow-down provisions and requirements expressed in this RFP and in the resulting Contract, including but not limited to insurance, confidentiality and nondisclosure.

5.15.5.5 Submit a formal written request to the Procurement Office prior to adding a subcontractor to the contractor in accordance with the Special Terms and Conditions, Section 45.

5.16 Work Site Responsibility

5.16.1 Immediately stop all work and contact the designated Home Modification Project Specialist/

Coordinator in the event asbestos, lead or any other hazardous materials are suspected or encountered at the project location:

5.16.1.1 Provide safety measures as appropriate (e.g., seal off or cover suspected areas), until inspection and testing can be completed as required, and will only resume work upon notification from the Home Modification Project Specialist/Coordinator.

5.16.2 Perform work in a manner that minimizes disruption to the normal day-to-day routines of the member/client.

5.16.3 Take reasonable measures to minimize noise and ensure the construction area is sealed to prevent dust migration throughout the residence.

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5.16.4 Remove the Contractor’s and Subcontractor(s) property and remaining materials, as applicable, from the residence upon completion of the Home Modification Project site.

5.16.5 Refrain from disposal of trash and debris in the member’s/client’s waste receptacle. Ensure all trash and debris generated by the Home Modification Project is cleaned up and removed from the property at the end of each workday.

5.16.6 Obtain owner’s permission prior to using any area of the property for preparation, storage or demolition.

5.16.7 Ensure all areas of the owners’ property used during preparation or demolition is restored to its pre-construction state.

5.16.8 Ensure all areas of the owners’ property and the surrounding area is protected from overspray and debris by using tarps or similar means to maintain property and landscape integrity.

5.16.9 Repair or replace at the Contractor’s expense, any damage to the member/client, responsible persons owned or controlled real or personal property, and the property of any other party when the damage is the result of the Contractor’s or Subcontractor’s action.

5.16.10 Be responsible for the replacement costs of all materials, equipment, and devices lost, stolen, or damaged during the course of the Home Modification Project and shall not be billed to the ADES. Report incident to the Home Modification Specialist/Coordinator.

5.16.11 Be responsible for any cost associated with the loss, theft, or damage for any material prior to and including installation. The Division and member/homeowner shall not be liable for loss or cost of said items. Report incident to the Home Modification Specialist/Coordinator.

5.17 Changes, Correction & Deficiency

5.17.1 Contact the Home Modification Specialist/Coordinator immediately in the event the Contractor discovers an unforeseen condition; and/or for any request(s) made by the DDD Member/Responsible Person or RSA Client to deviate from the Project Specifications and/or change order, not addressed in the Exhibit C PSPS, and/or Exhibit D that may result in an alteration of the Home Modification Project.

5.17.2 Submit photographs and any additional information as requested by the Home Modification Specialist/Coordinator in the event of an change order and unforeseen conditions is discovered such as installation corrections, deficiencies, adjustments or additional details.

5.17.3 Request prior approval from the Home Modification Project Specialist/Coordinator before altering or deviating from the Exhibit C/D, change orders, and unforeseen conditions.

5.18 Hazardous Materials and Substance

5.18.1 Immediately stop all work and notify the Home Modification Specialist/Coordinator in the event asbestos, lead or any other hazardous materials and substance are suspected or encountered.at the project location.

5.18.2 Remove all personnel and request residents to leave home, until the remediation team can complete an inspection and testing.

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5.18.3 Be directed by the Home Modification Specialist/Coordinator to hire a AZROC licensed contractor for hazardous materials and substance when the Contractor/Subcontractor is not licensed, specified in Section 8.2.

6. DDD Home Modification Requirements

6.1 Ensure all special instructions on the Exhibit A - DDD Home Modification Procedure are followed and to utilize Exhibit C - Project Specification and Price Sheet (PSPS) are identified and followed as designated by the Home Modification Specialist.

6.2 Request written authorization from the DDD Home Modification Unit prior to implementing any changes or substitutions of the Exhibit C - Project Specification and Price Sheet.

7. RSA Home Modification Requirements

7.1 Perform work on each project, collaborating with the RSA Home Modification Coordinator at the beginning, middle and end points of the project, according to the Exhibit B - RSA Home Modification Procedures, without defects and conforms with established professional industry standards.

7.2 Understand that RSA reserves the right to award a project based on RSA Informed Choice and/or bids submitted by various Contractors. Prior to starting the project, the Contractor shall do a walkthrough of the home, utilizing Exhibit D - RSA Home Modification Request for Project Pricing as a guide, and contact the Home Modification Coordinator for any questions and/or clarifications.

8. Warranty The Contractor shall

8.1 Warranty all equipment for one (1) year from the Home Modification Project completion date, or as provided by the manufacturer, whichever is greater.

8.2 Warranty all materials and workmanship for two (2) years from the Home Modification Project completion date, including all work performed by the Contractor Personnel or as deemed by the AZ Registrar of Contractors (AROC).

8.3 Make arrangements with the DDD Member, RSA Client or Legally Responsible Person to perform the warranty service.

9. Licensure/Qualification Requirements

The Contractor shall;

9.1 Have a valid Arizona Registrar of Contractors (AZROC) licenses, type B-, B-1, B- 2, B-3, KB-1, KB-2, R-61, or CR-61 and bonded, meeting all applicable State and local laws, regulations, and codes for which can be verified. License and bond must be current and in good standing with AZROC. The (AZROC) license is located at the following link: https://roc.az.gov/license-classifications

9.1.1 B: General Residential Contractor

9.1.2 B-1: General Commercial Contractor

9.1.3 B-2: General Small Commercial Contractor

https://roc.az.gov/license-classifications

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9.1.4 B-3: General Remodeling and Repair Contractor

9.1.5 KB-1 Dual Building Contractor

9.1.6 KB-2; Dual Residential and Small Commercial

9.1.7 R-61: Carpentry, Remodeling and Repairs

9.1.8 CR-61; Carpentry, Remodeling and Repairs

9.2 Ensure compliance when encountering Asbestos and Lead abatement regulations set forth in the Environmental Protection Agency (EPA) Title 40 Code of Federal Regulations (CFR) Appendix C to Subpart E of Part 763—Asbestos Model Accreditation Plan (MAP) and the EPA National Emissions Standards for Hazardous Air Pollutants (NESHAP) found in Title 40 Code of Federal Regulations (CFR) Part 61, Subpart M, Asbestos NESHAP as adopted per Title 18 Chapter 2 Section 1101 (A)(8) of the Arizona Administrative Code (AAC).

9.2.1 Submit proof of Asbestos Certification (held by Contractor or Subcontractor) prior to the abatement process.

9.2.2 Submit proof of Lead Certification (held by Contractor or Subcontractor) prior to the abatement process.

9.2.3 Submit proof of training and accreditations set forth in the EPA requirements for the Renovation, Repair and Painting (RRP) program.

10. Performance Measures/Evaluation/Standards

10.1 The Department will monitor performance of the selected Contractor by the Contractor’s adherence to the following measures:

10.1.1 DDD Performance Measure

10.1.1.1 95% of projects completed by the project completion date;

10.1.1.2 95% of project start dates and estimated completion dates will be reported to the

Home Modification Unit by the required timeline as identified on the Exhibit E - Notice of Selection letter;

10.1.1.3 95% of project completion dates will be reported to the Home Modification Unit within three (3) days from the date the project is completed;

10.1.1.4 95% of projects, provide email confirmation of the Exhibit E - Notice of Selection Letter within one (1) Business Day of receipt.

10.1.1.5 95% of projects completed with zero deficiencies as determined by Monitoring visits.

10.1.2 DERS Performance Measure

10.1.2.1 95% of projects completed within the contractor estimated timeframe specified in Exhibit D, unless an exception is given by the Division.

10.1.2.2 95% percent meeting Exhibit H - Completion Report.

11. Reporting Requirements

11.1 Follow EXHIBIT A – DDD Home Modification Procedures, Section 1, Subsection 1.11.

11.2 Follow Exhibit B - RSA Home Modification Procedures, Section 4, RSA Reporting Requirements.

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11.3 Incident Report

11.3.1 Follow EXHIBIT A – DDD Home Modification Procedures, Section 1, Subsection 1.12.

12. Payment Unit/ Payment for Services

12.1 Complete and submit the document Exhibit’s C/D upon written ADES’ acceptance of each Division.

Contractor shall submit a complete and accurate invoice for each project awarded.

12.2 Pricing submittals are inclusive of all costs associated with the delivery of the service on Exhibit C/D, including direct and indirect services, staff time, participation at staffing meetings, travel time, mileage, administrative costs, including insurance and all overhead. ADES shall not pay separately for these or any other costs.

12.3 Follow Exhibit A – DDD Home Modification Procedures, Section 2.1 Rates.

13. Invoicing and Billing

13.1 Maintain complete and accurate accounting records that substantiate all charges.

13.2 Within thirty (30) days of receipt and acceptance of Services, Contractor shall submit to ADES a complete and accurate invoice for payment.

13.3 In accordance with A.R.S. Titles 35 and 41, ADES payments are due to the Contractor within thirty (30) days upon receipt of an accurate and complete invoice.

13.4 Contractor invoices shall include the following for each Division invoices:

13.4.1 Follow the Invoicing in Exhibit A – DDD Home Modification Procedures, Section 2, Subsection 2.2.

13.4.2 Follow Exhibit B - RSA Home Modifications Procedures, Section 5, RSA Billing & Invoicing

Instructions.

14. Notices and Correspondence

14.1 Submit all correspondence and questions regarding the contract to:

Division of Developmental Disabilities Contracts Administration DDDSpecialtyContracts@azdes.gov

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

mailto:DDDSpecialtyContracts@azdes.gov

DDD Special Terms and Conditions

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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 (AHCCCSA or Administration)” (as defined in A.R.S. § 36-2901(1).

1.3. “AHCCCS/Arizona Long Term Care Services (ALTCS) Approved Minimum Subcontract Specifications” - The AHCCCS minimum requirements for the Department's contractors and subcontractors providing services to members eligible for DD/ALTCS and/or receiving Title XIX (ALTCS) funds, available on the AHCCCS website located at https://www.azahcccs.gov/PlansProviders/HealthPlans/minimumsubcontractprovisions.html or as amended

1.4. “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” - An individual who has been determined to be eligible by the Division to receive services from the Division.

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).

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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, AHCCCSA, 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;

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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 AHCCCSA 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 AHCCCSA 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:

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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 AHCCCSA 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. AHCCCSA 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 https://app.az.gov/ http://www.oig.hhs.gov/fraud/exclusions.asp https://oig.hhs.gov/exclusions/ https://www.sam.gov/portal/public/SAM/ https://www.azahcccs.gov/shared/ACOM/

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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 AHCCCSA 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 AHCCCSA and the Department in the current AHCCCSA/DES Intergovernmental Agreement and the rules and policies promulgated by AHCCCSA 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 AHCCCSA 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 AHCCCSA 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.

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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 AHCCCSA 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…