MIHS HCH IGA ANCILLARY SVCS.PDF

INTERGOVERNMENTAL AGREEMENT MIHS #:
MARICOPA COUNTY
by and through the
DEPARTMENT OF PUBLIC HEALTH
4041 N. Central Avenue, #1400, Phoenix, Arizona 85012
1. Agreement No: 2. Agreement Type: _Contracted Service
3. Agreement Amount: $100,000.00 per year 4. Purpose: _Ancillary & Specialty Services
5. Start Date: July 1, 2016 6. Expiration Date: June 30, 2021
This Agreement is entered into by and between the Maricopa County Special Health Care District d.b.a. Maricopa
Integrated Health System (MIHS), (referred to herein as “Contractor”), and Maricopa County, by and through its Department of
Public Health (MCDPH) (referred to herein after as “County”). Contractor and the County are collectively referred to herein as
the “Parties” and individually as a “Party.” Contractor, for and in consideration of the covenants and conditions set forth herein,
shall provide and perform the services as set forth below. All rights and obligations of the Parties shall be governed by the
terms of this Agreement, its exhibits, attachments, and appendices, including any subcontracts or amendments as set forth
herein and in:
Section I - General Provisions Section III - Work Statement
Section II - Special Provisions Section IV - Compensation
This Agreement contains all the terms and conditions agreed to by the Parties. No other understanding, oral or otherwise,
regarding the subject matter of this Agreement shall be deemed to exist or to bind the Parties. Nothing in this Agreement shall
be construed as consent to any lawsuit or waiver of any defense in a lawsuit brought against the County or the Contractor in any
State or federal Court.
Legal Notice under this Agreement shall be given by personal delivery or by registered or certified mail, postage prepaid, return
receipt requested, to the addresses set forth below and shall be effective upon receipt by the Party to whom addressed unless
otherwise indicated in the notice.
Notice to Contractor: Managed Care Department Phone 602.344.8140
Address: 2619 E. Pierce Street, First Floor, Phoenix, AZ 85008
Notice to Department: MCDPH Grants/Contract Unit Phone: (602) 372-0675
Address: 4041 North Central Avenue, Ste #1400, Phoenix, Arizona 85012
IN WITNESS WHEREOF, the parties enter into this Agreement:
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT MARICOPA COUNTY BOARD OF SUPERVISORS
d.b.a. MARICOPA INTEGRATED HEALTH SYSTEM.
Signature Signature
Name Name Clint Hickman
Title Title Chairman, Board of Supervisors
Date Date
ATTEST:
Signature
Clerk of the Board
Date
Pursuant to A.R.S. § 11-952, the undersigned public agency Pursuant to A.R.S. § 11-952, the Attorney for the Board of
attorney has determined that this Intergovernmental Agreement Supervisors has determined that this Intergovernmental
is in proper form and is within the powers and authority granted Agreement is within the powers and authority granted under the
under the laws of the State of Arizona. laws of the State of Arizona.
Signature Signature
Attorney for Maricopa County
Date Date
1

SECTION I GENERAL PROVISIONS
1. EFFECT
To the extent the Special Provisions are in conflict with the General Provisions, the
Special Provisions shall control. To the extent the Work Statement(s) and the Special or
General Provisions are in conflict, the Work Statement(s) shall control.
2. DEFINITIONS
As used throughout this Agreement, the following terms shall have the following
meanings:
A. Agreement means this document and all attachments and amendments hereto.
B. Contractor means the person, firm or organization listed on the Cover Page of
this Agreement.
C. County means Maricopa County, Arizona.
D. Department means the Maricopa County Department of Public Health.
E. Funding Source means any federal, State, or private agency funding source,
which may impose conditions on the funding that will be passed on to the
Contractor.
F. Maricopa County Special Health Care District dba Maricopa Integrated
Health System (MIHS) means the Maricopa County Special Health Care District,
including the health care facilities and administrative units operated by it.
G. HCH means the Healthcare for the Homeless Program located within the
Department.
H. Contractor Staff, Employee or Faculty means a person or persons employed
by, contracted with, or retained by the Contractor for the purpose of providing the
services and responsibilities contained in this Contract.
I. HIPAA means the Health Insurance Portability and Accountability Act of 1996
(PL 104-191) and the United States Department of Health and Human Services
(DHHS) final regulations on “Privacy Standards for Individually Identifiable Health
Information”, as amended and clarified from time to time.
3. GENERAL REQUIREMENTS
A. The terms of this Agreement shall be construed in accordance with Arizona law.
Any lawsuit arising out of this Agreement shall be brought in the appropriate
court in Maricopa County.
B. The Contractor shall, without limitation, obtain and maintain all licenses, permits,
and authority necessary to do business, render services, and perform work under
this Agreement, and shall comply with all laws regarding unemployment
insurance, disability, and workers’ compensation.
C. The Contractor is an independent contractor in the performance of work and the
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SECTION I GENERAL PROVISIONS
provision of services under this Agreement and is not to be considered an officer,
employee, or agent of the County.
4. AMENDMENTS
All Amendments to this Agreement must be in writing and signed by authorized persons
for both Parties. All amendments shall clearly state the effective date of the action.
5. ADEQUACY OF RECORDS
If the Contractor's books, records and other documents related to this Agreement are not
sufficient to support and document that allowable services were provided to eligible
clients, the Contractor shall reimburse the County for the services not adequately
supported and documented.
6. RETENTION OF RECORDS
A. This provision applies to all financial and programmatic records, supporting
documents, statistical records, and other records of the County and Contractor
that relate to this Agreement.
B. The County and Contractor shall retain all financial books, records, and other
documents related to this Agreement for five (5) years after final payment or until
after the resolution of any audit questions, which could be more than five (5)
years, whichever is longer. County, federal, or State auditors, and any other
persons duly authorized by the County, shall have full access to and the right to
examine, copy and make use of any and all such financial books, records and
other documents.
7. ASSIGNMENT AND SUBCONTRACTING
No rights, liability, obligations or duties under this Agreement may be assigned,
delegated, or subcontracted without the prior written approval of the County and
Contractor.
8. AUDIT DISALLOWANCES
A. The Contractor shall, upon written demand therefore, reimburse the County for
any payments made under this Agreement that are disallowed, by a federal,
State or County audit in the amount of the disallowance, as well as court costs
and attorney fees the County incurs to pursue legal action relating to a
disallowance.
B. If the County determines that a cost for which payment has been made is a
disallowed cost, the County shall notify the Contractor in writing of the
disallowance and the required course of action, which shall be at the option of
the County either to adjust any future claim submitted by the Contractor by the
amount of the disallowance or to require immediate repayment of the disallowed
amount by the Contractor.
C. The County shall, upon review and agreement of the Parties, remit to the
Contractor any payments determined to have been insufficiently paid, in the
amount of the payment shortfall, as well as court costs and attorney fees the
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SECTION I GENERAL PROVISIONS
Contractor incurs to pursue legal action relating to such short payment.
9. AGREEMENT COMPLIANCE MONITORING
County shall monitor the Contractor's compliance with, and performance under, the
terms and conditions of this Agreement. On-site visits for compliance monitoring may be
made by the County and/or its grantor agencies at any time during the Contractor's
normal business hours, announced or unannounced. During an on-site visit, the
Contractor shall make its records and documents related to work performed or services
provided under this Agreement available to the County for inspection and copying.
10. AVAILABILITY OF FUNDS
A. The provisions of this Agreement relating to the payment for services shall
become effective when funds assigned for the purpose of compensating the
Contractor, as provided herein, are actually available to the County for
disbursement. The Department shall be the sole authority in determining the
availability of funds under this Agreement and the County shall keep the
Contractor fully informed as to the availability of funds. The County shall refer no
clients to Contractor for periods of time for which funding is not available unless
at the discretion of both parties, an alternate source of funds are made available
to continue the medical service.
B. If any action is taken by any State agency, federal department, or any other
agency or instrumentality to suspend, decrease, or terminate its fiscal obligations
under or in connection with this Agreement, the County may amend, suspend,
decrease, or terminate its obligations under or in connection with this Agreement.
If this Agreement is terminated, the County shall be liable for payment only for
services rendered prior to the effective date of the termination, provided that such
services are performed in accordance with the provisions of this Agreement. The
County shall give written notice of the effective date of any suspension,
amendment, or termination under this section at least ten (10) days in advance.
11. CONTINGENCY RELATING TO OTHER CONTRACTS AND GRANTS
A. The Contractor shall, during the term of this Agreement, immediately inform the
County in writing of the award of any other contract or grant where the award of
such contract or grant may affect either the direct or indirect costs being paid or
reimbursed under this Agreement. Failure by the Contractor to notify the County
of such award shall be considered a material breach of this Agreement and the
County may immediately terminate this Agreement without liability.
B. County may request, and the Contractor shall provide within a reasonable time,
not exceeding ten (10) working days, a copy of such other contract or grant,
when, in the opinion of the Department, the award of the contract or grant may
affect the costs being paid or reimbursed under this Agreement.
C. If the County determines that the award to the Contractor of such other contract
or grant has affected the costs being paid or reimbursed under this Agreement,
the County shall prepare an amendment to this Agreement effecting a cost
adjustment. If the Contractor disputes the proposed cost adjustment, the dispute
shall be resolved pursuant to the "Disputes" clause section contained herein.
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SECTION I GENERAL PROVISIONS
12. DEFAULT
For material breach of contractual obligations, or upon the happening of any event which
would jeopardize the ability of the Contractor to perform its contractual obligations, the
County may suspend, modify, or terminate this Agreement immediately upon giving
written notice to the Contractor in the event of non-performance of any stated objectives.
Unless expressly stated otherwise this in this Agreement, such determination will not be
made until such time as the disputes process has been exhausted.
13. TERMINATION
A. Either Party may terminate this Agreement at any time by giving the other Party
at least thirty (30) calendar days prior written notice. The notice shall be given by
personal delivery or by registered or certified mail, postage prepaid, return
receipt requested.
B. This Agreement may be terminated by mutual written agreement of the Parties
specifying the termination date therein.
C. The County may terminate this Agreement upon twenty-four (24) hours notice
when the County deems the health or welfare of a patient is endangered or the
Contractor’s non-compliance jeopardizes funding source financial participation. If
not terminated by one of the above methods, this Agreement will terminate upon
the expiration date of this Agreement as stated on the Cover Page of this
Agreement.
D. Either Party has the right to terminate this Agreement for cause upon fourteen
(14) working days written notice for any of the following reasons:
(1) Breach of this Contract which is not corrected within fourteen (14) working
days after written notice thereof or registered mail, return receipt requested.
(2) Inability to discharge the duties and responsibility under this Contract for
a continual period of 30 days or more.
E. This contract is subject to cancellation in accordance with the provision of A.R.S.
§ 38-511.
14. SEVERABILITY
Any provision of this Agreement that is determined to be invalid, void, or illegal by a
court shall in no way affect, impair, or invalidate any other provision hereof, and the
remaining provisions shall remain in full force and effect.
15. STRICT COMPLIANCE
Acceptance by the County of performance that is not in strict compliance with the terms
of this Agreement shall not be deemed to waive the requirement of strict compliance for
all future performance. All changes in performance obligations under this Agreement
must be in writing and signed by the Parties.
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SECTION I GENERAL PROVISIONS
16. NON-LIABILITY
A. The County and its officers, representatives, agents, and employees shall not be
liable for any act or omission by the Contractor or any subcontractor, employee,
officer, agent, or representative of the Contractor or any subcontractor occurring in
the performance of this Agreement, nor shall they be liable for purchases or
contracts made by the Contractor or any subcontractor in connection with this
Agreement.
B. The Contractor and its officers, representatives, agents, and employees shall not be
liable for any act or omission by the County or any County subcontractor, employee,
officer, agent, or representative of the County or any County subcontractor occurring
in the performance of this Agreement, nor shall they be liable for purchases or
contracts made by the County or any County subcontractor in connection with this
Agreement.
17. INDEMNITY
Each Party (as “Indemnitor”) agrees to indemnify, defend, and hold harmless the other
Party (as “Indemnitee”) from and against all claims, losses, liability, costs, and expenses
(including reasonable attorneys’ fees) (hereinafter collectively referred to as “Claims”)
arising out of bodily injury of any person (including death) or property damage, but only
to the extent that such Claims, which result in vicarious liability to Indemnitee, are
caused by the act, omission, negligence, misconduct, or other fault of Indemnitor, its
officers, agents, employees, or volunteers.
18. COVENANT AGAINST CONTINGENT FEES
The Contractor warrants that no person or entity has been employed or retained to solicit
or secure this Agreement upon an agreement or understanding for a commission,
percentage, brokerage, or contingent fee. For breach or violation of this warranty, the
County may immediately terminate this Agreement without liability.
19. SAFEGUARDING CLIENT INFORMATION
The use or disclosure by any Party of any information concerning an eligible individual
served under this Agreement is directly limited to the performance of this Agreement.
County and Contractor shall safeguard confidential and privileged client and patient
information i.e., medical, financial and patient specific information, and shall only
disclose such information in accordance with all applicable federal, state and local laws,
rules, and/or regulations, including HIPAA. The use or disclosure by any party of any
information concerning a client or patient served under this Agreement or any other
applicable payer contract is directly limited to services under this Agreement subject to
applicable federal, state and local laws, rules and/or regulations. Contractor’s obligation
to maintain the confidentiality of all medical, financial and patient specific information
shall exist after termination or expiration of this Contract. County shall assist Contractor
with regard to Contractors’ obligation to comply with HIPAA.
20. RIGHTS IN DATA
The Parties shall have the use of data and reports resulting from this Agreement without
cost or other restriction, except as otherwise provided herein or by law. Each Party shall
supply to the other Party, upon request, any available information known to the
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SECTION I GENERAL PROVISIONS
supplying Party that is relevant to this Agreement and to the performance hereunder.
21. OWNERSHIP OF INFORMATION
Subject to applicable state and federal laws, rules and regulations, including, without
limitation, those concerning confidentiality of patient records, the Contractor shall have
full and complete ownership rights to and the sole and exclusive right to inspect,
reproduce, duplicate, adapt, distribute, display, disclose and otherwise use all reports,
information, data and material prepared by the Contractor in performance of the
Agreement. County may examine and may receive copies of such information necessary
for County's performance of this Agreement.
22. NON-DISCRIMINATION
The Contractor, in connection with any service or other activity under this Agreement,
shall not in any way discriminate against any person on the grounds of race, color,
religion, sex, national origin, age, disability, affiliation or belief. The Contractor shall
include this clause in all of its subcontracts related to this Agreement.
23. EQUAL EMPLOYMENT OPPORTUNITY
The Contractor shall not discriminate against any employee or applicant for employment
because of race, age, disability, color, religion, sex, or national origin. The Contractor
shall take affirmative action to insure that applicants are employed and that employees
are treated during employment without regard to their race, age, disability, color, religion,
sex, or national origin. Such action shall include, but is not limited to, the following:
employment, upgrading, demotion or transfer, recruitment or recruitment advertising, lay-
off or termination, rates of pay or other forms of compensation, and selection for training,
including apprenticeship. The Contractor shall, to the extent such provisions apply,
comply with Titles VI and VII of the Civil Rights Act of 1964, as amended (42 U.S.C. §§
2000a, et seq.); the Rehabilitation Act of 1973, as amended (29 U.S.C. §§ 701, et seq.);
the Age Discrimination in Employment Act of 1967, as amended (29 U.S.C. §§ 621, et
seq.); the Immigration Reform and Control Act of 1986 (Pub. L. No. 99-603) (“IRCA”);
and Arizona Executive Order 2009-09, which mandates that all persons shall have equal
access to employment opportunities. The Contractor shall also comply with all
applicable provisions of the Americans with Disabilities Act of 1990 (42 U.S.C. §§ 12101,
et seq.).
24. RIGHT OF PARTIAL CANCELLATION
If more than one activity is funded by this Agreement, the County reserves the right to
terminate this Agreement or any part thereof based on the Contractor's failure to perform
any part of this Agreement without impairing, invalidating or canceling the remaining
Work Statement obligations.
25. RIGHT TO EXTEND AGREEMENT
Subject to the availability of funds and acceptable Contractor performance, the
Contractor hereby acknowledges and agrees that the County shall have the right to
extend this Agreement for additional one-year periods, not to exceed a total extended
term of five (5) years, except that the cost will be subject to renegotiation. Any extension
of this Agreement shall be in writing mutually acceptable to the Department and the
Contractor and signed by both Parties.
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SECTION I GENERAL PROVISIONS
26. CERTIFICATION REGARDING DEBARMENT AND SUSPENSION
A. The undersigned, an authorized representative of the Contractor, certifies, to the
best of his or her knowledge and belief, that the Contractor, defined as the
primary participant in accordance with 45 C.F.R. Part 76, and its principals:
1) are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by any federal
department or agency;
2) have not within the 3-year period preceding this Agreement been convicted of
or had a civil judgment entered against them for the commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, State or local) transaction or contract under a public
transaction; violation of federal or State antitrust statues or commission of
embezzlement, theft, forgery, bribery, falsification or destruction of records,
making false statements, or receiving stolen property;
3) are not presently indicted or otherwise criminally or civilly charged by a
government entity (federal, State or local) with the commission of any of the
offenses enumerated in paragraph (2) of this certification; and
4) have not within the 3-year period preceding this Agreement had one or more
public transactions (federal, State or local) terminated for cause or default.
B. If the Contractor is not able to provide this certification, an explanation as to why
shall be attached to this Agreement.
C. The Contractor shall include, without modification, this Paragraph in all lower tier
covered transactions (i.e., transactions with subcontractors) and in all
solicitations for lower tier covered transactions related to this Agreement.
27. E-VERIFICATION OF EMPLOYEES
The Contractor warrants that it is in compliance with A.R.S. § 41-4401 and further
acknowledges:
A. That the Contractor and its subcontractors, if any, warrant their compliance with
all federal immigration laws and regulations that relate to their employees and
their compliance with A.R.S. § 23-214;
B. That a breach of the warranty under subsection A above shall be deemed a
material breach of this Agreement that entitles the County to, among other
things, immediately terminate this Agreement without liability;
C. That the County and any contracting government entity retains the legal right to
inspect the papers of any contractor or subcontractor employee who works on
this Agreement to ensure that the contractor or subcontractor is complying with
the warranty provided under subsection A above and that the contractor agrees
to make all papers and employment records of said employee(s) available during
normal working hours in order to facilitate such an inspection;
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SECTION I GENERAL PROVISIONS
D. That nothing herein shall make any contractor or subcontractor an agent or
employee of the County or contracting government entity.
28. DISPOSITION OF PROPERTY
All property acquired with funds provided for in this agreement shall become the property
of the funding source.
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SECTION II SPECIAL PROVISIONS
1. EFFECT
To the extent that the Special Provisions are in conflict with the General Provisions, the
Special Provisions shall control. To the extent that the Work Statement(s) are in conflict
with the Special or General Provisions, the Work Statement(s) shall control.
2. DISPUTES
Except as otherwise provided by law, or otherwise specifically agreed to by the Parties,
any dispute not involving a question of law arising out of this Agreement that is not
resolved between the Parties within a reasonable time, which shall not exceed 120 days,
shall be resolved as follows:
1. Disputes must be filed with the person administering this Agreement
for the County, if one has been appointed, or, if not, with the Procurement
Officer, within ten (10) days from the date the Contractor knew or should
have known the basis of the dispute.
2. The person administering this Agreement or the Procurement Officer,
as applicable, shall respond in writing to the dispute within fourteen (14)
days.
3. The Contractor may abide by the decision or may appeal the decision
to the Director of the Department within seven (7) days.
4. Any claim or controversy arising out of or in connection with this
Agreement not resolved in accordance with paragraphs 2.A. through 2.C.
above shall be resolved through binding arbitration conducted by a single
arbitrator in accordance with the American Arbitration Association (AAA)
Commercial Arbitration Rules, then in effect, in Phoenix, Arizona;
provided, however, matters that primarily involve Provider's professional
competence or conduct shall not be eligible for arbitration. If possible the
arbitrator shall be an attorney with at least fifteen {15) years of
experience, including at least five (5) years' experience in managed
health care. The parties shall conduct a mandatory settlement conference
at the initiation of arbitration, to be administered by AAA. The arbitrator
shall have no authority to provide a remedy or award damages that would
not be available to such prevailing party in a court of law, nor shall the
arbitrator have the authority to award punitive damages. Each party shall
bear its own costs and expenses, including its own attorneys' fees, and
shall bear an equal share of the arbitrator's and administrative fees of
arbitration. The parties agree to accept any decision by the arbitrator as a
final determination of the matter in dispute, and judgment on the award
rendered by the arbitrator may be entered in any court having jurisdiction.
Arbitration must be initiated within one year of the earlier of the date the
claim or controversy arose, was discovered or should have been
discovered with reasonable diligence; otherwise it shall be deemed
waived. The use of binding arbitration shall not preclude a request for
equitable and injunctive relief made to a court of appropriate jurisdiction.
This Paragraph shall not apply to claims arising from bodily injury, death, or property
damage.
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SECTION II SPECIAL PROVISIONS
3. CHANGES
A. The Department may, at any time, by written order, make changes within the
general scope of this Agreement in any one or more of the following areas:
1. Work Statement activities reflecting changes in funding source or County
regulations, policies, or requirements.
2. Administrative requirements, such as changes in reporting periods,
frequency of reports, or report formats, required by funding source or
County regulations, policies, or requirements.
3. Contractor reimbursement schedules and/or program budgets.
B. The order will not increase or decrease the maximum reimbursable amount to be
paid the Contractor. Additionally, the order will not direct substantive changes in
services to be rendered by the Contractor.
C. Any dispute or disagreement caused by such order shall constitute a "Dispute"
within the meaning of the Disputes Clause of the Special Provisions of this
Agreement and shall be administered accordingly.
4. AUDIT REQUIREMENT
A. If the Contractor expends $500,000 or more in a year in federal awards, the
Contractor shall have a single audit conducted for that year according to the
Single Audit Act of 1984 (Pub. L. No. 98-502) (codified at 31 U.S.C. §§ 7501, et
seq.), and the Single Audit Act Amendments of 1996 (Pub. L. No. 104-156). The
Contractor shall comply with OMB Circulars A-133, A-87, A-102, and A-110, as
applicable. The audit report shall be submitted to the County for review within
nine (9) months following the close of the fiscal year. The Contractor shall take
any necessary corrective action to remedy any material weaknesses and/or
reportable conditions identified in the audit report within six (6) months after the
release date of the report. The County may consider sanctions as described in §
.225 of OMB Circular A-133 for contractors not in compliance with the audit
requirements. All books and records shall be maintained in accordance with
Generally Accepted Accounting Principles (GAAP).
B. The Contractor shall schedule an annual financial audit to be submitted to the
County for review within twelve (12) months following the close of the program’s
fiscal year. Contractor understands that its failure to meet this requirement may
result in the loss of current funding and disqualification from consideration for
future County-administered funding.
C. Comply with the requirement of the Federal Office of Management and Budget
(“OMB”) Circular A-133. The Contractor is responsible for having an audit
performed in accordance with, and when required, by OMB Circular A-133, and
for sending a copy of the report issued as a result of the audit to the County
within thirty (30) days of issuance. The County reserves the right to engage an
auditor, at the Contractor’s expense, to perform an OMB Circular A-133 audit of
the Contractor in the event that the Contractor fails to engage an auditor or the
County rejects or disapproves of the auditor engaged by the Contractor.
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SECTION II SPECIAL PROVISIONS
5. INSURANCE
A. The Contractor shall have in effect at all times during the term of this Agreement
insurance or comparable self-insurance that is adequate to protect the County,
its officers, employees, property, and equipment against the losses set forth
below. The Contractor shall provide the County with a certificate of insurance or
a certified copy of the insurance policy naming the County as an additional
insured, or, if the Contractor is self-insured, shall provide the County with a letter
indicating that it is self-insured.
B. The following types and amounts of insurance are required as minimums:
1. Workers’ compensation and unemployment insurance as required by law.
2. Unemployment insurance as required by Arizona law.
3. Public liability, bodily injury, and property damage policies that insure
against claims for liability for the Contractor’s negligence or maintenance
of unsafe vehicles, facilities, or equipment brought by clients receiving
services pursuant to this Agreement and by lawful visitors of such clients.
The limits of the policies shall not be less than $2,000,000 per occurrence
and $4,000,000 aggregate.
C. Automobile and Truck Liability, Bodily Injury and Property Damages:
1. General liability, each occurrence; $1,000,000
2. Property damage; $1,000,000
3. Combined single limit; $1,000,000
D. Standard minimum deductible amounts are allowable. Any losses applied
against insurance deductible are the sole responsibility of the Contractor.
E. Professional Liability:
1. Insurance for the Contractor and its agents, employees, and other staff
shall be maintained with coverage limits of one million dollars
($1,000,000) per person, three million dollars ($3,000,000) per
occurrence.
2 The Contractor agrees that in the event it, or any of its agents,
employees, and other staff working under this Agreement, is named as a
defendant in litigation, or is identified in a written notice of claim, wherein
professional misconduct is alleged and such allegations arise under the
services or terms of this Agreement, the Contractor will promptly notify
the Department in writing. The duty to notify under this paragraph applies
whether or not the County is alleged to be involved, is named as a party
to the matter, or could be potentially liable as a party.
F. The Contractor shall immediately inform the Department of any cancellation of its
insurance or any decrease in its lines of coverage at least thirty (30) days before
such action takes place.
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SECTION II SPECIAL PROVISIONS
G. In the event the Contractor(s) is/are a public entity, then the Insurance
Requirements shall not apply. Such public entity shall provide a Certificate of
Self-Insurance. If the Contractor(s) is/are a State of Arizona agency, board,
commission, or university, none of the above shall apply.
6. SPECIAL REQUIREMENTS
A. If the use of subcontractors is approved by the County, the Contractor agrees to
use written subcontracts or consultant agreements that conform to federal and
State laws and regulations and the requirements of this Agreement appropriate
to the service or activity covered by the subcontract. These provisions apply with
equal force to the subcontract as if the subcontractor were the Contractor. The
Contractor is responsible for performance under this Agreement whether or not
any subcontractors are used. The Contractor shall submit a copy of each
subcontract to the County upon written request.
7. REPORTING REQUIREMENTS
A quarterly progress report will be submitted on or before the third (3rd) day of the month
following the end of the reporting period. If requested by the County, the Contractor shall
submit annual progress reports.
8. STATUTORY RIGHT OF CANCELLATION FOR CONFLICT OF INTEREST
Pursuant to A.R.S. § 38-511, the County may cancel this Agreement without penalty or
further obligation, within three years after execution of this Agreement, if any person
significantly involved in initiating, negotiating, securing, drafting, or creating this
Agreement on behalf of the County is, at any time while this Agreement or any extension
of this Agreement is in effect, an employee or agent of any other Party to this Agreement
in any capacity or is a consultant to any other Party to this Agreement with respect to the
subject matter of this Agreement. In addition, the County may recoup any fee or
commission paid or due to any person significantly involved in initiating, negotiating,
securing, drafting, or creating this Agreement on behalf of the County from any other
Party to this Agreement arising as the result of this Agreement.
9. POLICY ON CONFIDENTIALITY
The Contractor and the County understand and agree that this Agreement is subject to
all State and federal laws protecting client confidentiality of medical, behavioral health
and drug treatment information.
10. LAWS, RULES AND REGULATIONS
The Contractor and the County understand and agree that this Agreement is subject to
all State and federal laws, rules, and regulations that pertain hereto.
11. SPONSORSHIP ACKNOWLEDGMENT
All promotional materials, brochures, and flyers prepared by the Contractor relating to
this Agreement shall include the following statement, “Sponsored by Maricopa County
Department of Public Health.”
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SECTION III WORK STATEMENT
1. PURPOSE
MIHS shall provide an array of ancillary and specialty services on an outpatient basis
only to clients referred from HCH as part of the Department of Public Health Services.
HCH will not cover the cost for any patients that are hospitalized.
2. REFERRALS
A. MIHS will permit HCH to refer clients to any of its network sites. However, HCH
agrees to work with MIHS in referring clients to sites with sufficient capacity.
B. All HCH patients should have a Referral Form specifying the authorized care
requested. HCH shall fax the referral form, a minimum of 24 hours prior to
patient’s appointment, to 602-344-0748. Should HCH not provide the faxed
referral form and the patient presents for their appointment, MIHS has the option
to reschedule the patient to a later date when the referral from is provided to
MIHS. .
3. RESPONSIBILITIES OF MIHS
Maricopa County Special Health Care District dba Maricopa Integrated Health Systems
(MIHS) shall provide the following services to HCH clients;
A. Access to Patient Records
MIHS will provide HCH access to patient records for utilization review, contract
compliance and quality assurance in conformity with MIHS policies and
procedures.
B. Ancillary Care Services
a. Laboratory Services:
1. Provide full-range of chemistry, microbiology and laboratory services as
ordered by providers at HCH.
2. Transmission of test results to the HCH within standard MIHS turnaround
times for all lab tests.
b. Radiology Services
1. Provide limited radiology services to diagnose factures, respiratory
conditions such as tuberculosis, and digestive complications. In addition,
provide ultrasound, mammography, MRI, CAT, and PET as ordered by
providers at HCH. This agreement includes the reading, interpretation
and consultation of test results.
2. Referred patients shall be able to schedule an appointment for radiology
services according to the following time allowance:
a) Diagnostics: Within a week, exclusive of diagnostic
mammograms, which can be accommodated within a 30 day
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SECTION III WORK STATEMENT
timeframe.
b) Emergency: Within 24 hours
3. Transmission of exam result to the HCH within standard MIHS turnaround
times for all radiology testing, which is normally within 24 hours.
C. Specialty Care Services
Contractor shall provide an array of comprehensive and specialty services as set
forth below (except for professional services provided by and billed by District
Medical Group d.b.a. DMG, which are covered under a separate agreement).
1. Physical Therapy, limited to 15 visits per year per patient, consistent with
AHCCCS benefit guidelines
2. Surgery clinic services (includes Urology, General Surgery, Podiatry,
Neurosurgery, Radiology)
3. Internal Medicine Subspecialty clinic services (includes Rheumatology,
Infectious Disease, Gastroenterology, Nephrology, Neurology, Pulmonology)
4. Cardiology services for referred patients only (includes cardiac stress, EKG
and ECHO testing)
5. Obstetrics and Gynecology (includes colposcopy and reproductive health
services)
6. ENT services
7. Orthopedic services
8. Ophthalmology services
9. Colonoscopy Services
10. Oncology
11. Breast Clinic
12. Pediatrics
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SECTION IV COMPENSATION
1. COMPENSATION
A. MIHS will bill the HCH program employing industry convention billing
documents including UB 04 and CMS 1500 formats, or other approved
successor documents. The bill will identify the following items for each
patient:
1. Date of Service
2. Patient Name
3. Patient Identification Number
4. Date of Birth
5. Sex
6. CPT Code
7. CPT service description
8. ICD9 Code or ICD10 when implemented
9. Billed charge for each service and procedure rendered
2. METHOD OF PAYMENT
A. The County will, within thirty (30) working days from the date of receipt of
Contractor billing statements, process and remit to the Contractor a warrant for
payment up to the maximum total allowable for services provided. Should the
County make a disallowance in the claim, the claim shall be processed for the
reduced amount. If the Contractor protests the amount or the reason for a
disallowance, the protest shall be construed as a dispute concerning a question
of fact within the meaning of the “Disputes” clause of the Special Provisions of
this Agreement.
B. The Contractor understands and agrees that the County will not honor any claim
for payment submitted six (6) months after the date of service unless the claim
was first submitted to another liable primary payer. In such cases, Contractor
shall submit secondary claim to County within sixty (60) days of receipt of
primary payer’s claim determination.
C. The Contractor shall submit monthly invoices to:
Healthcare for the Homeless
Maricopa County Department of Public Health
ATTN: Accounting Specialist
220 South 12th Avenue
Phoenix, AZ 85007
(602) 372-2109
(602) 372-2120
3. REIMBURSEMENT
MIHS will bill AHCCCS for patients who are AHCCCS enrolled prior to invoicing HCH.
HCH shall pay the AHCCCS patient cost share for any AHCCCS covered services. For
patients or services not covered by AHCCCS, the reimbursement to Contractor by HCH
will be as follows:
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SECTION IV COMPENSATION
A. Reimbursement to MIHS will be at 85% of the current Arizona Health Care Cost
Containment System (AHCCCS) fee-for-service rate for Ancillary Care Services in
effect on the date of service, not including any long term or ongoing specialty care.
B. For services not priced by AHCCCS, reimbursement shall be twenty percent (20%)
of Contractor’s billed charges.
C. Any procedure over $5000.00 will require approval of the HCH Clinic Supervisor.
4. NOTICES
Any notice given under this Agreement shall be sent to the attention of the following:
Contractor
Managed Care Department
Maricopa Integrated Health System
2619 E. Pierce Street, 1st Floor
Phoenix, AZ 85008
602-344-1497
Public Health
Grants Supervisor
Grant/Contract Unit
4041 N. Central Ave., Suite 1400
Phoenix, AZ 85012
602-506-1829
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