YH16-0018-07 MARICOPA COUNTY INMATE HOSPITALIZATION IGA-AMEND 1.PDF

AHCCCS
Arizona Health Care Cost Containment System
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT
1. AMENDMENT #: 2. CONTRACT #: 3. EFFECTIVE DATE OF AMENDMENT: 4. PROGRAM:
YH16-0018-07
1 C-26-19-002-3-01 OCTOBER 1, 2019 DFSM/DMS
5. CONTRACTOR/PROVIDER NAME AND ADDRESS:
Maricopa County Correctional Health Services
234 N. Central, Fifth Floor, Suite 5000
Phoenix, AZ 85004
6. PURPOSE: To revise rates.
1. THE ABOVE REFERENCED CONTRACT IS HEREBY AMENDED AS FOLLOWS:
A. Change rates from Attachment A (SFY18) to the rates as shown in Attachment A (SFY20).
B. Change Quarterly Estimate of State Match Advance Payments from Attachment B (SFY18) to the
Estimates listed in Attachment B (SFY 20).
2. EXCEPT AS PROVIDED FOR HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL CONTRACT NOT
HERETOFORE CHANGED AND/OR AMENDED REMAIN UNCHANGED AND IN FULL EFFECT.
Electronic Submission: An electronic or portable document file (POE) copy of this amendment shall serve as the original
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IN WITNESS THEREOF, the parties have executed this Agreement:
COUNTY: Arizona Health Care Cost Containment
System (AHCCCS):
Signature: Signature:
Printed Name: Bill Gatesi Printed Name: Meggan LaPorte, CPPO, MSW
Title: Chairman, Maricopa County Board of Title: Chief Procurement Officer
Supervisors
Date: Date:
A'TTEST:
Signature:
Printed Name: Fran McCarroll - Clerk of the Board Date
In accordance with A.R.S. § 11-952, this Agreement In accordance with A.R.S. § 11-952, this
has been reviewed by the undersigned who has Agreement is in the proper form and is within the
determined that this Agreement is in the power and authority granted to AHCCCS under
appropriate form and is within the power and A.R.S. §§ 36-2903 et seq. and 36-2932 et seq.
authority granted to COUNTY.
COUNTY Attorney
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AHCCCS YH16-0018-07
Administrative Annual Cost Estimates for C-26-19-002-3-01
Maricopa County Medicaid Eligible Inmates FFS Project IGA SFY20 Attachment A
Amendment 1
State Federal
Claims Electronic Paper Total Fund Share Share
98% 2% 100% 50% 50%
Estimated total number of claims:
Physician & Emergency Transport/Hospital 3,883 97 3,980
DFSM Cost per Claim 2$ 0.62 0.71
OIG Provider Enrollment Cost per Claim 2$ 0.14 0.14
ISD Cost per Claim 2$ 1.51 1.51
Concurrent Review Average Cost
Estimated cost per case 3 $ 121.86
Estimated number of HSAG reviews 4 2
Claims Processing costs:
DFSM $2,402.29 $69.35 $2,471.64 $1,235.82 $1,235.82
OIG ProNider Enrollment $533.47 $13.33 $546.80 $273.40 $273.40
ISO $5,877.14 $146.80 $6,023.94 $3,011.97 $3,011.97
State Accounting System Charges @ $0.1723/claim $669.12 $16.70 $685.82 $342.91 $342.91
Total Claims Processing Costs $9,482.02 $246.18 $9,728.20 $4,864.10 $4,864.10
Direct DFSM Labor for MDOC Medicaid Claims Processing $0.00 $0.00 $0.00
Direct ISO Labor for MDOC Medicaid Claims Processing 6 $7,000.00 $3,500.00 $3,500.00
Concurrent Review Estimated costs:
Cost for 2 reviews $243.72 $121.86 $121.86
Administrative Costs (see detail)
DBF Paper Processing Personnel costs 7 $ 7,671.44 $3,835.72 $3,835.72
Postage @ $.0410/claim $163.22 $81.61 $81.61
Data Center Charges @ $.7366/claim $2,931.76 $1,465.88 $1,465.88
000 @ $.2819/claim $1,122.12 $561.06 $561.06
OALS @ $.0782/claim $311.22 $155.61 $155.61
HRD @ $.0239/claim $95.06 $47.53 $47.53
TECO @ $.2866/claim $1,140.50 $570.25 $570.25
Indirect at 10% $1,343.54 $671.77 $671.77
Total Administratiw Costs $ 14,778.86 $ 7,389.43 $ 7,389.43
DMS Eligibility Costs
Application Processing Costs - DMS 10 $2,000.00 $1,000.00 $1,000.00
Estimated Total Annual Costs for Program $33,750.78 $16,875.39 $16,875.39
Cost per Claim 11 $8.43 $4.21 $4.21
Actual number of claims may be higher. Number includes, original, recoupment and adjustment claims,
2 Cost based on actual SFY 18 expenditures and actual number of claims processed
Average rate per contract. Actual costs w ill be a strict pass-through based on price negotiated on contract.
'Actual ouster may be higher or low er depending on Maricopa Co Medicaid Innate program requirements.
5 Based on estimates of DFSM staff time required to process the claims.
6 Estimate based on 40 hours at a rate of $175 per hour. only be billed for actual hours incurred.
Based on estimates of DBF staff time required to monitor funding activity and process payments.
Postage based on average cost per claim times number of claims.
9 Data Center charges calculated based on average SFY18 costs
DMS Bigibility charges calculated at $100/deterrnination. Estimated 20 annual applications/deterninations.
11 Cost per claim does not include a cost f or concurrent review s
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ATTACHMENT B
YH16-0018-07
C-26-19-002-3-01
Amendment 1
AHCCCS
Quarterly Estimate of State Match Advance Payments for Program Services
Maricopa County Medicaid Eligible FFS Project IGA SFY20
Estimate of Annual Dollar Value of Claims Paid $ 2,370,000.00
Average Federal Financial Participation Rate 80.01%
Estimate of State Match Payments for Program Services for Current Year $ 473,763.00
Quarterly Estimate of State Match Advance Payments for Program Services to AHCCCS $ 118,441.00
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