IGA AMENDMENT FOR PAYMENT SERVICES C-26-08-011-0-10.PDF

•• Arizona Health Care Cost Conte nment System
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION
DIVISION OF BUSINESS AND FINANCE
INTERGOVERNMENTAL AGREEMENT AMENDMENT
1. AMENDMENT 2. CONTRACT NUMBER: 3. EFFECTIVE DATE OF AMENDMENT: 4. PROGRAM:
YHO8-0073
1 0 C-26-08-011-0-04 July 1,2018 DFSM
5. CONTRACTOR/PROVIDER NAME AND ADDRESS:
Maricopa County on behalf of
Correctional Health Services
234 N. Central, Suite 5000
Phoenix, AZ 85004
6. PURPOSE: To revise rates and extend the term of the agreement for an additional (12) twelve months.
7. The above referenced contract is hereby amended as stated below:
A. Pursuant to Paragraph 6.1, Term of Agreement, the contract term is hereby extended for an additional twelve months
through June 30, 2019.
B. Pursuant to Paragraph 5.7, Administrative Services: Change rates for SFY2019 (July 1, 2018 — June 30, 2019) to the
rates as shown in Attachment A.
8. 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.
IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES IN AGREEMENT.
9 MARICOPA COUNTY on behalf of CORRECTIONAL to. ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
HEALTH SERVICES
SIGNATURE OF AUTHORIZED INDIVIDUAL: SIGNATURE: .
•
_ —
TYPED NAME: TYPED NAME:
STEVE CHUCRI ALICE McLAIN, MBA
TITLE: TITLE:
CHAIRMAN, COUNTY BOARD OF SUPERVISORS PROCUREMENT MANAGER
DATE: DATE:
11. IN ACCORDANCE WITH STATE STATUTES, COUNTY RULES, 12. IN ACCORDANCE WITH § A.R.S/. 11-952, THIS AMENDMENT IS IN PROPER
AND BYLAWS, THIS AGREEMENT HAS BEEN REVIEWED BY THE FORM AND IS WITHIN THE POWER AND AUTHORITY GRANTED TO THE
UNDERSIGNED WHO HAS DETERMINED THAT THIS ADMINISTRATION UNDER § ARE 36-2903 ET SEQ. AND §36-2932 ET SEQ.
AGREEMENT IS IN APPROPRIATE FORM AND IS WITHIN THE
POWER AND AUTHORITY GRANTED TO THE COUNTY.
/A
DATED THIS , DAY — OF , 2018 DATED THIS f DAY OF ,2018
,•,`-
„.. _ ,>-,,'/•-
BY
DEPOT? COUNTY ATTORNEY LEGAL COUNSEL FOR THE ADMINISTRATION
1

AHCCCS YHO8-0073
Administrative Annual Cost Estimates for Amendment 10
Maricopa County Corrections 100% State IGA SFY19 Attachment A
Claims Electronic Paper Total Fund
80% 20% 100%
Estimated total number of claims:
Physician & Emergency Transport/Hospital 21,525 5,525 27,050
DFSM Cost per Claim 2$ 0.61 0.70
OIG Cost per Claim 2 $ 0.15 0.15 •
ISD Cost per Claim 2 $ 1.41 1.41
Concurrent Review Average Cost
Estimated cost per case 3 $ 96.75
Estimated number of HSAG reviews 4 5
Claims Processing costs:
DFSM $13,103.43 $3,886.77 $16,990.20
OIG $3,233.40 $829.94 $4,063.34
ISD $30,350.83 $7,790.40 $38,141.23
State Accounting System Charges @ $0.1350/claim $2,905.01 $745.65 $3,650.66
Total Claims Processing Costs $49,592.67 $13,252.76 $62,845.43
Direct DFSM Labor for MDOC 100% State Claims Processing 5 101,005.54
Direct ISD Labor for MDOC 100% State Claims Processing $14,000.00
Concurrent Review Estimated costs:
Cost for 5 reviews $483.75
Administrative Costs (see detail)
DBF Paper Processing Personnel costs 7 $9,570.86
Postage @ $.0605/claim a $1,636.11
Data Center Charges @ $.4931/claim 9 $13,337.72
OOD @ $.2219/claim $6,003.86
OALS @ $.0851/claim $2,301.78
HRD @ $.0261/claim $624.30
Indirect at 10% $3,347.46
Total Administrative Costs $36,822.09
DIVIS Eligibility Costs
Application Processing Costs - DMS 10 $0.00
Estimated Total Annual Costs for Program $215,156.81
Cost per Claim 11 $7.94
1 Actual number of claims may be higher. Number includes, original, recoupment and adjustment claims.
2 Cost based on actual SFY17 expenditures and actual number of claims processed
3 Average rate per contract. Actual costs will be a strict pass-through based on price negotiated on contract.
4 Actual number may be higher or lower depending on Maricopa Co 100% State Inmate program requirements.
5 Based on estimates of DFSM staff time required to process the claims.
6 Estimate based on 80 hours at a rate of $175 per hour. Will only be billed for actual hours incurred.
7 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 SFY17 costs
DMS Eligibility charges calculated at $100/determlnation. Estimated 0 annual applications/determinations.
11 Cost per claim does not include a cost for concurrent reviews