AMD RE PROVIDER AGREEMENT WITH MIHS DBA MHP.PDF

AMENDMENT
Between
MARICOPA INTEGRATED HEALTH SYSTEMS dba MARICOPA HEALTH PLAN
&
MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH dba MARICOPA COUNTY
DEPARTMENT OF HEALTH SERVICES
dba PUBLIC HEALTH CLINICAL SERVICES
Whereas, Maricopa Integrated Health System dba Maricopa Health Plan (MHP), an Arizona non-profit corporation, on
behalf of themselves and their Affiliates and Maricopa County Department of Public Health dba Maricopa County
Department of Health Services dba Public Health Clinical Services (Provider), previously entered into an Agreement
and;
Whereas, the Arizona Health Care Cost Containment System (AHCCCS) has modified the reimbursement methodology
for AHCCCS registered Federally Qualified Health Centers/ Rural Health Center’s (FQHC/RHC’s).
Now, therefore, it is agreed that said Agreement is amended as set forth below, and effective April 1st, 2015 and or the
date set forth by AHCCCS, all other provisions of said Agreement being confirmed and remaining in effect as long as not
inconsistent with this Amendment.
It is hereby agreed that the following be amended to the Agreement including all Exhibits and Amendments:
FQHC/RHC Reimbursement. Effective April 1st, 2015 and or the date set forth by AHCCCS and after, for AHCCCS and
its contracted Managed Care Organizations (MCOs) will begin paying the all-inclusive per visit PPS rate on a per claim
basis, replacing the current method of reimbursing claims by the capped fee-for-service fee schedule and annually
reconciling to the PPS rate.
Reimbursement will pay at 100% (one hundred percent) of the prevailing AHCCCS all-inclusive per visit PPS rate
on a per claim basis. A service which is provided incident to another service, whether or not on the same day or
at the same location, is considered to be part of the visit and is not reimbursed separately. If something less
than the PPS rate is used to report billed charges, the AHCCCS “lesser of” reimbursement policy will prevail and
cause the claim to be paid a rate less than the PPS rate.
MHP confirms that its claims processing systems shall be ready to process claims in accordance with AHCCCS’
FQHC/RHC based pricing system on April 1st, 2015 and or the date set forth by AHCCCS. In the event that MHP is unable
to process claims according to the new methodology on April 1st, 2015 and or the date set forth by AHCCCS, both parties
agree to revert to the previous reimbursement structure for a period not to exceed 90 days at which time MHP will
manually process claims according to the FQHC/RHC pricing methodology provided by AHCCCS.
All other terms and conditions of the Agreement shall remain in effect.

In Witness Whereof, the parties hereto have entered into this Amendment as of the effective date set forth above.
MARICOPA INTEGRATED HEALTH SYSTEMS Maricopa County Department of Public Health dba
dba MARICOPA HEALTH PLAN Maricopa County Department of Health Services
dba Public Health Clinical Services
Signature: Signature:
Name: James V Stover Name: Steve Chucri
Title: Chief Executive Officer Title: Chairman, Maricopa County Board of Supervisors
Date: Date:

C-86-06-052-2-05 ATTACHED TO AND A PART OF
Amendment to Provider Agreement
Maricopa integrated Health Systems dba
Maricopa Health Plan
IN WITNESS WHEREOF, the parties agree to enter into this Contract and its
Amendments:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Attorney for Maricopa County
Date