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Arizona Health Cure Cost Containment 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 9 C-26-08-011-0-04 July 1, 2017 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, 2018. B. Pursuant to Paragraph 5.7, Administrative Services: Change rates for SFY2017 (July 1, 2017— June 30, 2018) 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 10. ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM CORRECTIONAL 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 WI H § ARS. 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 § A.R.S 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. DATED THIS DAY OF ,2018 DATED THIS DAY OF ,2018 ,.— BY "'• -.. DEPUTY COUNTY ATTORNEY LEGAL COUNSEL FOR THE AD ISTRATION — 1 AHCCCS YHO8-0073 Administrative Annual Cost Estimates for Amendment 9 Maricopa County Corrections 100% State IGA SFY18 Attachment A Claims Electronic Paper Total Fund 77% 23% 100% Estimated total number of claims: Physician & Emergency Transport/Hospital 17,450 5,250 22,700 Drsm Cost per Claim 2 $ 0.70 OIG Cost per Claim 2 $ 0.15 ISD Cost per Claim 2 $ 1.41 Concurrent Review Average Cost Estimated cost per case 3 $ 96.75 Estimated number of HSAG reviews 4 5 Claims Processing costs: DFSM $10,622.76 $3,693.31 $14,316.07 OIG $2,621.27 $788.63 $3,409.90 ISD $24,604.97 $7,402.64 $32,007.61 State Accounting System Charges @ $0.1350/claim $2,355.05 $708.54 $3,063.59 Total Claims Processing Costs $40,204.05 $12,593.12 $52,797.17 Direct DFSM Labor for MDOC 100% State Claims Processing 5 101,077.53 Direct ISD Labor for MDOC 100% State Claims Processing 6 $14,000.00 Concurrent Review Estimated costs: Cost for 5 reviews $483.75 Administrative Costs (see detail) DBF Paper Processing Personnel costs 7 $9,706.97 Postage @ $.0605/claim 8 $1,373.00 Data Center Charges @ $.4931/claim 9 $11,192.84 Indirect at 10% $970.70 Total DBF Administrative Costs $23,243.51 DIM Eligibility Costs Application Processing Costs - DMS 10 $0.00 Estimated Total Annual Costs for Program $191,601.96 Cost per Claim 11 $8.42 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 new contract. a 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. 8 Postage based on average cost per claim times number of claims. 9 Data Center charges calculated based on average SFY17 costs 15 DMS Eligibility charges calculated at $100/determination. Estimated 0 annual applications/determinations. 11 Cost per claim does not include a cost for concurrent reviews