AHCCCS - HOSPITALIZATION - EXECUTED - C-26-19-002-3-00.PDF

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INTERGOVERNMENTAL AGREEMENT
FOR AHCCCS INMATE HOSPITALIZATION
_ YH16-0018-07

This Intergovernmental Agreement (“Agreement”) is entered into by and between Maricopa County,
on behalf of Correctional Health Services, a political subdivision of the State of Arizona, and the
Arizona Health Care Cost Containment System (“AHCCCS”), and shall be effective October 1, 2018,
and terminated pursuant to the terms set forth in this agreement.

RECITALS

WHEREAS, AHCCCS is duly authorized to execute and administer Agreements under A.R.S. §§ 36-2903
et seq., 36-2932 et seq. and 11-952; and

WHEREAS, Maricopa County is duly authorized to enter into this Agreement under A.R.S. § 11-952; and

WHEREAS, Maricopa County and AHCCCS are authorized by A.R.S. § 11-951 et seq. to enter into

Intergovernmental Agreements for cooperative action pertaining to reimbursement or advancements
of funds for services performed; and

WHEREAS, Maricopa County and AHCCCS wish to enter into this Agreement in order to establish
procedures to permit AHCCCS to pay for Medical services that qualify for Federal Financial Participation
(FFP) provided to Inmates of the County jail detention facilities or other penal facilities.

WHEREAS, Maricopa County is responsible for the oversight, management and the provision of
healthcare services to detainees in the custody of the Sheriff's Department and utilizes outside
healthcare vendors for the provision of healthcare services; and

WHEREAS, the medical services program in the Maricopa County Jail is administered by the Maricopa
Health & Social Services and is a Covered Entity for purposes of compliance with the Health Insurance
Portability and Accountability Act (HIPAA); and

WHEREAS, Maricopa Health & Social Services has been designated by the County as a health care
component consistent with 45 CFR 164.105(a)(2)(iii)(D).

NOW, THEREFORE, Maricopa County and AHCCCS (collectively, the “Parties”), pursuant to the above
and in consideration of the matters hereinafter set forth, do mutually agree as follows:

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801 East Jefferson, Phoenix, AZ 85034 » PO Box 25520, Phoenix, AZ 85002 * 602-417-4000 » www.azahcccs.gov

Page 1 of 22

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AGREEMENT

1. DEFINITIONS Unless otherwise defined in this Agreement, all terms shall have the same meaning as set
forth in Title 36 of the Arizona Revised Statutes.

1.1.

1.2.

1.3.

1.4.

1.5.

1.6.

1.7.

1.8.

1.9.

1.10.

1.11.

1.12.

1.13,

1.14.

AAC: Arizona Administrative Code
ADES: Arizona Department of Economic Security

AGREEMENT: This document, together with any and all attachments, appendices, exhibits,
schedules and future amendments as agreed to by the Parties.

AHCCCS: Arizona Healthcare Cost Containment System
AHCCCS PROVIDER MANUAL: The Fee-for-Service Provider Manual promulgated by AHCCCS.

The AHCCCS Provider Manual is available online at:
http://www.azahcccs.gov/commercial/ProviderBilling/manuals/FFSProviderManual.aspx

APPLICANT: A person who submits, or whose authorized representative submits a written,
completed, signed, and dated eligibility application for AHCCCS benefits.

ARS: Arizona Revised Statutes

CFR: United States Code of Federal regulations, the official compilation of Federal rules and
requirements.

.CLEAN CLAIM: Clean claim means one that can be processed without obtaining additional

information from the provider of the service.

CORRECTIONAL HEALTH ELIGIBILITY COORDINATOR: A person designated by the County to
coordinate and initiate the eligibility process for hospitalized inmates.

CMS: Centers for Medicare and Medicaid Services, a Federal agency within the U.S.
Department of Health and Human Services.

CMS-37: A report providing the State estimate of the quarterly award from the Federal
government.

DAY: A calendar day, unless specified otherwise.

DOCUMENTATION: Copies of evidence that support an Applicant’s eligibility determination.
Documentation includes, but is not limited to, any of the following: birth certificates, death
certificates, court orders, insurance policies, pay stubs, award letters, medical bills, expenses,
letters and responses from collateral sources, Applicant’s authorization to share the eligibility
information and Maricopa County or AHCCCS’ entries in case records.

Page 2 of 22

1.15.

1.16.

1.17.

1.18.

1.19.

1.20.

1.21.

1,22.

EMERGENCY MEDICAL SERVICES: Services provided to treat a medical condition manifesting
itself by acute symptoms of sufficient severity, including severe pain that the absence of
immediate medical attention could. reasonably be expected to result in any of the following:

1.15.1. labor and delivery; :

1.15:2. placing the patient’s health in serious jeopardy
1.15.3. serious impairment to bodily functions; or
1.15.4. serious dysfunction of any bodily organ or part.

EXPARTE INMATE ELIGIBILITY DETERMINATION: A determination of Inmate eligibility made

by AHCCCS after the person is released from a jail, detention facility or other penal facility and is
no longer an Inmate at the time of the eligibility determination.

FEDERAL EMERGENCY SERVICES PROGRAM (FESP): A Federal emergency services program
covered under AAC R9-22-217, to treat an emergency medical condition for an Applicant who is
determined eligible under A.R.S § 36-2903.03(D).

FFP: Federal Financial Participation refers to the Federal matching rate that the Federal
government makes to the Title XIX program portion of AHCCCS, which are the monies that
AHCCCS can claim from CMS for the Federal share of AHCCCS Program service and
administration costs.

IBNR: Incurred But Not Reported claims refers to claims with dates of service within the
effective dates of this Agreement.but which have not been invoiced or recorded in the AHCCCS
claims system.

IMD: Institution for Mental Disease as defined in 42 CFR 435.1010.

INMATE: A person, either adult or juvenile, who is living in a County jail, detention facility; or
other penal facility, or in a Medical Institution where but for an illness or an injury, the person
would be living in a County jail or detention facility or other penal facility, and who may be
eligible for FFP payment as determined by AHCCCS.

INPATIENT: As it relates to an inmate, is a_patient who has been admitted to a Medical
Institution as.an inpatient as defined in 42 CFR 435.1010. An Inpatient is a patient who has
been admitted to a Medical Institution as an inpatient in a non-secure ward on
recommendation of a physician or dentist and who:

1.22.1. | Receives room, board and professional s services in the institution for a 24 hour period
or longer; or

1.22.2. . Is expected by the institution to receive room, board and professional services in the
institution for a twenty-four (24) hour period or longer even though it later develops
that the patient dies, is discharged or is transferred to another facility and does not
actually stay in the institution for twenty-four (24) hours.

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1.23.

1.24,

1.25.

1.26.

1.27.

1.28.

1.29.

1.30.

1.31,

1.32.

'
MEDICAL INSTITUTION: Any facility, including IMDs providing FFP qualifying services, that is
engaged in the delivery of health care services and is authorized to do so by the state in which
those services are delivered. Medical Institution means an institution that:

1.23.1. Is organized to provide medical care, including medical, surgical, psychiatric, nursing
and convalescent care;

1.23.2, | Has the necessary professional personnel, equipment, and facilities to manage the
medical, nursing, and other health needs of patients on a continuing basis in
accordance with accepted standards;

1.23.3. Is authorized under State law to provide medical care;

1.23.4. _ Is staffed by professional personnel who are responsible to the institution for

. professional medical and nursing services. The services must include adequate and
continual medical care and supervision by a physician; registered nurse or licensed
practical nurse supervision and services and nurses’ aid services, sufficient to meet
‘nursing care needs; and a physician’s guidance on the professional aspects of
operating the institution; and

1.23.5. Services are rendered on a non-secure ward.

MEDICAL SERVICES: Services provided by a medical provider in the community, including

Medical Institution. Medical Services includes, but is not limited to, medical, surgical,

psychiatric, diagnostic, and specialty physician services.

MEMBER: An Inmate who qualifies for Title XIX coverage.

PROVIDER: Any individual or entity that is engaged in the delivery of health care services and
that is authorized to do so by the state in which those services are delivered.

RECIPIENT: A person who has been determined eligible to receive AHCCCS benefits.
REVIEW: An analysis of all factors affecting a family’s or person’s eligibility.
STATE: The State of Arizona.

STATE MATCH: The percentage of payment for health services usually paid by the State; but
under this contract paid to the State by County to qualify for FFP.

SUBCONTRACT: Any contract or agreement between Maricopa County and a third party to
provide, or be accountable for providing a service.

TITLE XIX: That section of the Social Security Act that authorizes the Medicaid Program.

Page 4 of 22

PURPOSE OF THIS AGREEMENT

The purpose of this Agreement is for Maricopa County and AHCCCS to jointly develop, and mutually
agree upon, an eligibility application and determination process that complies with both Federal and
State laws, regulations, rules and appropriate CMS approval, and to adjudicate and pay claims for
covered services provided to Members in accordance with Federal and State laws, regulations, and
rules. This Agreement is entered into pursuant to A.R.S. § 36-2903 to provide AHCCCS with the
appropriate State Match in order to pay for Medical Services that qualify for FFP provided to Inmates
who qualify for Title XIX while they are an inpatient in a non-secure ward of a Medical Institution. It
‘also provides AHCCCS with the funds to pay for administrative costs associated with this Agreement.

TERM
3.1.

4.2.

"4,3.

This Agreement is effective October 1, 2018 and shall remain in effect for an initial term of five
(5) years, with the possibility of additional extensions of five years each or any portion thereof
through an amendment executed by the parties, unless terminated pursuant to the terms and
conditions of this Agreement. Any material change to this Agreement shall be through an
amendment and shall become effective on the date executed by the parties.

Eligibility Requirements and Application Process:

When required to determine a non-citizen’s eligibility for the FES only, the disability
determination will be made by ADES, Disability Determination Services Administration (DDSA),
pursuant to an agreement between AHCCCS and ADES, for an additional cost to the COUNTY as
set forth in Attachment A to this Agreement.

Claims Processing And Payment:

4.2.1. AHCCCS Administration and Maricopa County will jointly develop and riutually agree

upon a claims processing and payment process that complies with both Federal and
State laws, regulations, and rules; and is not in conflict with the provisions of this
contract.

4.2.2. AHCCCS will process and pay clean claims in accordance with AHCCCS policies and
procedures.

Mutual Data Exchange:

Subject to the confidentiality rules specified in AAC R9-22-512, 42 CFR Part 431, Subpart F, and
45 CFR, Parts 160 and 164. AHCCCS and Maricopa County will timely provide to each other any
information that may be required for program administration. Upon the request of either
party, AHCCCS and Maricopa County will meet to address any issues regarding the transmission
of information, identify corrective actions required, and monitor the effectiveness of the
corrective actions. Maricopa County and AHCCCS will cooperate with all parties in the
corrective actions. Maricopa County and AHCCCS will cooperate with all parties In the
determination of an Applicant’s eligibility for the Program, including supplying any needed
information. AHCCCS and Maricopa County shall provide the information to each other ina
timely manner. :

Page 5 of 22

44.

AHCCCS Rights and Obligations:

4.4.1. Eligibility Decision:

4.4.2.

4.4.3.

4.4.1.1. AHCCCS / ADES shall-determine the eligibility of Inmates who apply for Title
XIX while an Inpatient in an acute hospital and not in a separate county or
contracted hospital unit that houses only county/state inmates.. An eligibility
determination for non-citizens who do not qualify for full Medical Services
will be completed when the services qualify under A.R.S § 36-2903.03 (D) as
an emergency service and when required, Maricopa County agrees to pay the
cost of any DDSA determination in the amount set forth in Attachment A of
this Agreement. The eligibility determination may also include an Ex Parte
Inmate Eligibility Determination when appropriate. Maricopa County is not
financially liable for an Ex Parte Eligibility Determination.

4.4.1.2. AHCCCS/ADES shall contact Maricopa County, as appropriate and consistent
with applicable privacy laws, to obtain additional information required to
complete an Applicant’s application and to determine the person’s ongoing
eligibility.

4.4.1.3. AHCCCS/ADES shall issue a decision notice to the Applicant and a copy to
Maricopa County in accordance with the confidentiality rules of Title XIX.

Payment for Services in Agreement:

Payments made to AHCCCS by Maricopa County pursuant to this Agreement are
conditioned upon the availability of Maricopa County funds authorized for expenditure
in the manner and for the purpose(s) stated herein. AHCCCS is not liable for any
purchases of subcontracts entered into by Maricopa County in anticipation of such
funding. AHCCCS is not responsible for any payments to a Medical Institution or
Provider for claims submitted under this Agreement if Maricopa County has not -
provided the State Match for such payments.

Notwithstanding the provisions of the terms and conditions “Amendments” section of
this Agreement (2.0), AHCCCS and Maricopa County agree that changes in the claims
processing and payment procedures that do not have a monetary effect may be made
from time to time by mutual written agreement of the Assistant Director of AHCCCS and
Maricopa County. Such changes shall become effective and binding without execution
of an amendment to this Agreement.

AHCCCS Payment Recoupment from Medical Institutions and Providers:

4.4.3.1. AHCCCS shall require Medical institutions and Providers submitting claims to
reimburse AHCCCS upon demand or AHCCCS shall deduct from future
payments to the Medical Institutions or Providers any amount:

4.4,3.1.1. © Received by a Medical Institution or Provider from AHCCCS for

Agreement services that have been inaccurately reported or
paid or are found to be for an excluded service; or

Page 6 of 22

‘
4.4.3.1.2. Paid by AHCCCS for which a Medical Institution’s or Provider’s
books, records, and other documents are not sufficient to clearly
confirm that those amounts were used by the Medical
Institution or Provider to perform billed services; or

4.4.3.1.3. Identified as a questioned cost as the result of a financial
management review or audit.

4.4.3.2. For purposes of this Agreement only, Maricopa County is responsible to
reimburse AHCCCS for payments for services rendered that are not eligible
for Federal Financial Participation (FFP) if AHCCCS is unable to recoup
payments from the Medical Institutions or Providers. Maricopa County is not
responsible for services where AHCCCS failure to recoup payments from
Medical Institutions and Providers is due to AHCCCS’ negligence or
inattention.

4.4.3.3. If an Inmate is not AHCCCS eligible, and if Maricopa County is legally required
to pay the medical expenses for the Inmate, Maricopa County shall pay
Medical Institutions or Providers for services rendered if AHCCCS has
recouped funds. This section does not obligate Maricopa County to pay a
Medical Institution or Provider in excess of the terms of a contract between
Maricopa County and a Medical Institution or Provider, or, where there is no
contract, the actual cost of care.

4.4.4. Monitoring:
AHCCCS shall monitor services covered by this Agreement that are provided by any
Medical Institution, Provider, or any Provider subcontractor to ensure compliance with
the AHCCCS Provider Manual.

4.4.5. Visitation, Inspection and Copying:
After the date of this Agreement, all related Maricopa County contracts with Medical
Institutions, Providers and Providers’ subcontractors shall require that the Medical
Institution’s, Provider’s or a subcontractor’s facilities, services, books, accounts, reports,
files, and other records directly related to this Agreement shall be subject at all
reasonable times to visitation, inspection, and copying by AHCCCS and any other
appropriate agent of State or Federal government for five (5) years after completion of ©
this Agreement. Such records shall be available at the Medical Institution’s, Provider's,
or a subcontractor’s offices or shall be produced at the AHCCCS main office or any other
office designated by AHCCCS.

4.5. COUNTY’s Rights and Obligations

4.5.1. Application for Title XIX:

4.5.1.1. Maricopa County shall appoint a Correctional Health Eligibility Coordinator to
assist Inmates who potentially qualify for Title XIX coverage while an Inpatient
in an acute hospital, with the AHCCCS application process. Before assisting an
individual with the application process, Maricopa County shall obtain the

Page 7 of 22

4.5.1.2,

4.5.1.3,

4.5.1.4,

4.5.1.5,

k
Inmates’ authorization to apply for AHCCCS in accordance with AAC R9-22-
1406. :

The Correctional Health Eligibility Coordinator shall obtain. the Applicant’s
authorization for AHCCCS to release eligibility information to Maricopa
County and Maricopa County shall maintain the confidentiality of the
Applicant's records in accordance with AAC.R9-22-512.

The Correctional Health Eligibility Coordinator shall attempt to obtain the
required Documentation to establish eligibility for the budget month and to
assist the AHCCCS Administration or the ADES in obtaining any information
required for the Inmate’s ongoing eligibility.

When authorized by an Inmate to assist with the application, the Correctional
Health Eligibility Coordinator shall take the application and obtain the
Applicant's signature in the month of the hospital stay. The completed
application, all verification and Documentation will be submitted to AHCCCS
during the first week of the month following the month of application. For
cases in which additional time is needed to collect appropriate verification
and/or Documentation, the Correctional Health Eligibility Coordinator will
submit the application as soon as the Documentation is complete, but no
later than the 15" of the month following the month of application. The
month of application is the month in which the inpatient service is received
and the appropriate party signs the application.

The Correctional Health Eligibility Coordinator will not submit an application

‘on inmates that are treated in the secure ward of the hospital. If the inmates

were treated in both the secure and non-secure ward of the hospital the
Correctional Health Eligibility Coordinator will identify those secure days on
the application to ensure the eligibility segment identifies them as non-
eligible.

4.5.2. Advance payment for Medical Services and Administrative Costs by the COUNTY:

4.5.2.1.

Quarterly estimates of the State Match payments for program services will be
determined based on the prior year’s dollar value of claims and any additional
information provided by Maricopa County. For the initial year of the
Agreement, Maricopa County must provide an estimate of the number of
paper claims, electronic claims and applications to be processed as well as an
estimate of the dollar value of claims to be paid. The quarterly estimates will
be documented on Attachment B of this Agreement. Based on these
estimates, Maricopa County shall make an advance payment to AHCCCS of

‘the estimated amount on or before the last business day of the first month of

each quarter. AHCCCS may request additional State Match funds for program
services to be advanced more frequently than quarterly to‘address an
increase in the volume of claims or dollar value of claims to be processed.

Page 8 of 22

4.5.3.

4.5.2.2.

4.5.2.3.

4.5.2.4,

4.5.2.5.

The State Match for. the administrative costs of this Agreement per
application or claim is estimated to be as shown in Attachment A. Any
changes to the estimated State Match for the administrative costs may only
be assessed by written agreement of the Parties.

AHCCCS will calculate a quarterly invoice for the State Match of the
administrative fees of this Agreement based on the actual costs, number of
electronic claims, paper claims and applications processed for the quarter.
The quarterly invoice will be emailed to Maricopa County by the last business
day of the month following the end of the quarter. The quarterly
administrative fees owed to AHCCCS will be deducted from the amount
Maricopa County has on deposit. If sufficient funds are not on deposit,
Maricopa County will pay AHCCCS for the remainder of the administrative
fees so that AHCCCS will receive the monies due within thirty (30) days of the
invoice date.

AHCCCS shall deposit the quarterly advance payments made by Maricopa
County into a separate account (the State Match Fund). All funds in the State
Match Fund are the property of Maricopa County until withdrawn by AHCCCS
to pay the State Match ona claim or administrative fees. AHCCCS will inform
Maricopa County of the State Match Fund balance as of the end of each
quarter in a report received with the quarterly administrative fees invoice.
This report will be emailed by the last business day of the month following
the end of the quarter.. Notwithstanding the previous sentence, AHCCCS will
immediately inform Maricopa County if, at any time, the State Match Fund
contains less than twenty five percent (25%) of the quarterly estimate of the
State Match advance payments for program services documented on
Attachment B of this Agreement. In the event the State Match Fund falls
below twenty five percent (25%) of the quarter estimate of the State Match
advance payments for program services documented on Attachment B of
this Agreement, Maricopa County shall pay into the State Match Fund
sufficient money to increase the Fund to the quarterly estimate of the State
Match documented in Attachment B. Any amount in the State Match Fund
that is not expended at the end of a quarter shall be applied to the advance
payment for the subsequent quarter, and AHCCCS shall reduce the estimate
for the subsequent quarter by such amount. If at any time this Agreement is
terminated by either party, any money remaining in the State Match Fund
shall be returned to Maricopa County after the claim submission deadline, as
of the date of termination.

Maricopa County shall bear the administrative cost of any appeal process
requested by the COUNTY of deferred or disallowed claims.

AHCCCS Recoupment from Maricopa County: In the event CMS modifies its

methodology for allocating FFP, Maricopa County shall be responsible for the Federal
portion of deferred or disallowed claims and any interest charged thereon pursuant to
42 CFR 433.38, subject to the payment limitations in listed in this agreement in Section

4.4.3.2.

Page 9 of 22

5. GENERAL FINANCIAL RESPONSIBILITIES

5.1.

5.2.

5.3. °

‘5.4,

5.5.

‘Quarterly Program Expenditure estimates:

Maricopa County shall submit to AHCCCS a quarterly estimate of expenditures to be used for
the development of the CMS-37. The estimates shall be submitted to AHCCCS thirty (30) days
after the end of each quarter unless otherwise determined by Federal requirements.

AHCCCS Reporting:
5.2.1.. Quarterly Expenditures Report. AHCCCS will submit to Maricopa County reports that
show actual quarterly program expenditures made pursuant to this Agreement.
Each report shall detail the amount expended of State Match funds provided by
Maricopa County and the matching FFP funds, and the administrative fees AHCCCS
charged to Maricopa County. The expenditure reports shall be submitted by the last
. business day of the month following the end of each quarter.

5.2.2. Claims Paid Report. AHCCCS will provide a report to Maricopa County reporting the
claims paid by AHCCCS. The report will be produced weekly, monthly or quarterly if
necessary depending on the frequency of claims paid.

AHCCCS Annual Reconciliation with the COUNTY: .
5.3.1. In the Quarterly Expenditure Report dated June 30" of each State fiscal year,
AHCCCS will provide to Maricopa County the actual amounts claimed and paid on an
annual basis under this Agreement. This report shall also show any and all amounts
paid in advance using estimate reports.

5.3.2. AHCCCS will reconcile the actual amounts paid against Maricopa County‘s AHCCCS
estimates and advanced payments for the twelve month period of the state fiscal
year. This reconciliation shall be completed within ninety (90) days of the end of the
state fiscal year. ©

5.3.3. Ifany monies are due Maricopa County, these will be applied to the next quarterly
payment. , ;

Insufficient Appropriation

If at any time during the term of the Agreement, Maricopa County determines that the money
Maricopa County budgeted to meet its obligations under this Agreement is insufficient,
Maricopa County shall notify AHCCCS in writing and shall include in the notice
recommendations as to the resolution of the shortage.

Unused Funds

After the close of each State of Arizona fiscal year and the administrative adjustment period,
upon request of the COUNTY, any funds remaining in the State Match Fund, shall be returned to
Maricopa County. It is understood that if any valid IBNR claim appears after funds are returned
to Maricopa County, the COUNTY i is still responsible for payment within the terms of this
Agreement.

Page 10 of 22

6.

5.6,

5.7.

NOTICES
Any notices or correspondence rela

Maricopa County Annual Budget Submissions

Maricopa County shall provide AHCCCS with projected: funding requirements for this Agreement
by July 31 of each new fiscal year to allow AHCCCS to request the appropriate amount of

Federal authority.

Maricopa County Budget Revisions

Any revisions to expenditure projections shall be expeditiously forwarded to AHCCCS as soon as
the need for revision becomes known to Maricopa County in order for AHCCCS to adjust the

Federal cash projections to CMS.

respectively as follows:

6.1.

6.2.

AHCCCS

Procurement and Contracts:

Melannie Rustein, Sr. Procurement Specialist
701 East Jefferson St., MD 5700

Phoenix, AZ 85034

Phone: 602-417-4408

Email: Melannie.Rustein@azahcccs.gov

Eligibility Determination:

Joni Shipman, Assistant Director, Division of Member Services
801 E. Jefferson St., MD2500

Phoenix, AZ 85034

Phone: 602-417-7631

E-Mail: Joni.Shipman@azahcccs.gov

Claims Processing and Payment:

Lisa DeWitt, Third Party Accounts Manager-DFSM/Claims
701 E. Jefferson St., MD8500

Phoenix, AZ 85034

Phone: 602-417-4771

E-Mail: Lisa. DeWitt @azahcccs.gov

Maricopa County

Cody Johnson

Finance Manager .
Maricopa County Correctional Health Services
234 N. Central, Fifth Floor, Suite 5000
Phoenix, AZ 85004

602-506-1070
Johnsonco22@mail.maricopa.gov

Page 11 of 22

ted to this-Agreement shall be sent to the parties or their designees

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1.0

2.0

3.0

4.0

5.0

6.0

7.0

TERMS AND CONDITIONS

ADA .

The Parties must comply with all applicable provisions of the Americans with Disabilities Act (Public
Law 101-336, 42 U.S.C. 12101-12213) and all applicable federal regulations under the Act, including
28 CFR Parts 35 and 36.

Amendments

2.1 Any amendment to this Agreement must be in writing and signed by both parties.

2.2 Amendments signed by each of the parties and attached hereto are hereby adopted by
reference as a part of this Agreement, from the effective date of the amendment, as if fully
set out herein. .

2.3 All requests for additional services shall be in writing and signed by both parties.

2.4 An amendment shall not be necessary when completing a change of contact person, change
of key personnel, change of address, change of signatory or other non- material changes to
this Agreement.

Arbitration and Disputes

In accordance with ARS § 12-1518, the parties agree to resolve all disputes arising out of or relating
to this agreement through arbitration, after exhausting applicable administrative review except as

may be required by other applicable statutes. The laws of the State shall govern any interpretation

of this Agreement and the venue shall be in Maricopa County, Arizona.

Assignment and Delegation

This Agreement may not be assigned by any party without the prior written consent of the other
parties. If consent to an assignment is obtained, this Agreement is binding on the successors and
assigns of the parties to this Agreement.

Compliance with Laws, Rules and Regulations

AHCCCS, the COUNTY and their subcontractors must comply with all applicable Federal and State
laws, rules, regulations, standards and Executive Orders, without limitation to those designated
within this Agreement. The laws and regulations of the State of Arizona govern the rights of the
Parties, the performance of this Agreement, and any disputes arising from the Agreement. Any
action relating to this Agreement must be brought by arbitration to the extent required by A.R.S. §
12-1518 or in an appropriate court. Any arbitration award will be enforced in an appropriate court.

E-Verify Requirement
In accordance with ARS § 41-4401, all parties warrant compliance with all Federal immigration laws

and regulations relating to.employees and warrants its compliance with A.R.S. § 23-214, Subsection
A.

Execution in Counterparts / Electronic Documents

71 This Agreement may be executed in one or.more counterparts, each of which shall be
deemed to be an original but all of which together shall constitute one and the same
document. |

7.2 Facsimile signatures, electronic signatures and signatures transmitted by email after having

been scanned shall be accepted as originals for the purposes of this Agreement.

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Page 12 of 22

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9.0

10.0

11.0

12.0

TERMS AND CONDITIONS

Federal Immigration and Nationality Act
The parties shall ensure compliance with the Federal Immigration and Nationality Act (FINA) and all

‘other Federal immigration laws and regulations related to the immigration status of its employees

to include but.not-limited to sub-contractors. All services under this. Agreement shall be performed
within the borders of the United States. :

Fraud and Abuse

9.1 It shall be the responsibility of AHCCCS and to Maricopa County report all cases of
suspected fraud and abuse by subcontractors, members or employees. AHCCCS and
Maricopa County shall provide written notification of all such incidents to the Contracting
Officer.

9.2 As stated in A.R.S. § 13-2310, incorporated herein by reference, any person who knowingly
obtains any benefit by means of false or fraudulent pretenses, representations, promises or
material omissions is guilty of a class 2 felony.

9.3 AHCCCS and Maricopa County are required to research potential overpayments identified
’ by a fraud and abuse investigation or audit conducted by AHCCCS or Maricopa County After
conducting a cost benefit analysis to determine if such action is warranted, the Parties
should attempt to recover any overpayments identified due to erroneous, false or
fraudulent billings.

Health Insurance Portability and Accountability Act (HIPAA) of 1996
The parties certify that each is familiar with the requirements of HIPAA, as amended by the Health
Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009, and

, accompanying regulations and will comply with all applicable HIPAA requirements in the course of

this Agreement. The parties warrant that each will cooperate in the course of performance of the
Agreement so that the parties will be in compliance with HIPAA, including cooperation and
coordination with the Arizona Strategic Enterprise Technology (ASET), Statewide Information
Security and Privacy Office (SISPO) Chief Privacy Officer and HIPAA Coordinator and other
compliance officials required by HIPAA and its regulations. Maricopa County will sign any
documents that are reasonably necéssary to keep AHCCCS in compliance with HIPAA, including, but
not limited to, business associate agreements.

Insurance

The parties acknowledge that they are self-insured pursuant to statutory authority. The parties
agree that the general liability coverage afforded by the self-insurance programs is sufficient to -
meet the purposes of this Agreement. :

Liability :

The parties shall each be responsible for any and all liability for their own negligence arising from
the Agreement and each shall bear all costs for their own defense of any litigation to the extent
allowed by law.

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POT area rere re ra eee esse ede ee HH SEED OOO EEB EEE SEHR EO OR ESHA LEH OEHEDOHESEOHED ED OEE EEE DE SEED OSES OE DEDEDE HEE HDDS SESE ED

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TERMS AND CONDITIONS

Non-Conforming Performance

Either party’s failure to insist on strict performance of any term or condition of the Agreement shall
not be deemed a waiver of that term or condition even if the party accepting or acquiescing in the
nonconforming performance knows of the nature of the performance and fails to object to it.

No Joint Venture
Nothing in this Agreement is intended to create a joint venture between the Parties and it will not
be so construed. Neither AHCCCS’ nor Maricopa County employees will be considered officers,

agents or employees of the other or be entitled to receive any employment-related fringe benefits
from the other.

No Third Party Beneficiaries
Nothing in the provisions of this IGA is intended to create duties or obligations to or rights in third
parties not Parties to this IGA or effect the legal liability of either Party to the IGA.

Records and Audit

Under A.R.S. § 35-214 and A.R.S. § 35-215, the parties agree to retain and shall contractually require
each subcontractor to retain all data and other records (“records”) relating to the acquisition and
performance of the Agreement for a period of five (5) years after the completion of the

Agreement. All records shall be subject to inspection and audit by the State and where applicable
the Federal Government at reasonable times. Upon request, the parties will produce a legible copy
of any or all such records.

Severability

If any provision of this Agreement or the application thereof to any circumstance shall be invalid or
unenforceable to any extent, it is the intention of the parties that the remainder of the Agreement
and the application of such provision to other circumstances shall not be affected thereby and shall
be enforced to the greatest extent permitted by law.

Termination

Either party may terminate this Agreement upon thirty (30) working days written notice to the
other party. Termination will be without further obligation or penalty and will be effective upon
receipt, unless specified otherwise.

Cancellation for Conflict of Interest.

This IGA is subject to cancellation for conflict of interest pursuant to ARS § 38-511, the pertinent
provisions of which are:incorporated into this IGA by reference.

Page 14 of 22

SIGNATURE PAGE

‘

IN WITNESS THEREOF, the parties have executed this Agreement:

COUNTY: Maricopa-Copnty

AHCCCS

RAGS

Signature:

Printed Name: Steve Churcri

5 t
Signature: Yt- AZ
7

Printed Name: Alice McLain, MBA

Title: Chairman, County Board of Supervisors

Title: Procurement Manager

OCT 1.0 2018

Date: {

bate: 10 [8 |

Shofd et 1 0 201

In accordance with A.R.S. § 11-952, this Agreement -has
been reviewed by the undersigned who has determined
that this Agreement is in the appropriate form and is
within the power and authority granted to COUNTY.

Legal Counsel for Maricopa County

In accordance with A.R.S, § 11-952, this Agreement is
jn the proper form and is within the power and
authority granted to AHCCCS under A.R.S. §§ 36-2903
et seq. and 36-. 2932 et seq.

oe < LAL ice WA

fegal Counsel for AHCCCS

Page 15 of 22 ,

ATTACHMENT A
YH16-0018-04

AHCCCS
Admin istrative Ar n

i] Cost Estim

Claims

Estimated total number of claims:
Physician & Emergency Trans port/Hospital

,

‘FSM Cost per Claim_

‘Estimated ¢ cost pé
Estimated number of HSAG reviews

“Total Claims Processing Costs

Direct DFSM Labor for Maricopa ‘Co Medicaid Claims Processing :

LN NON.

ein

3

Average Cost
$

Electronic Paper Total Fund
93% | 8% 100%
300° | 4,000 |
i

96.75

25 i

$2,252.39

State
Share
50% |

$1,231.72 |

| Federal

Share
50%

‘Direct ISD Labor for Maricopa Co Medicaid Claims Processing |

‘Concurrent Review E: Estimated ¢ ost

Cost for 2 reviews

‘Admit istrative Costs (see detail)

_ DBF Paper Processing Personnel costs
' Postage @ $.0605/claim

Data Center Charges @ $.4934/claim

OALS @ $.0851/claim
HRD @ $.0261/claim
| Indirect at 10%
‘Total DBF Administrative Costs

DMs Eligibility Costs
Application Processing Costs - DMS

‘Estimate

| Total Annual Costs for Program

($555.80. | $300.43 |
"$5,217.10 $5 $2,820.05 2,82
$499.35 : $539.84 i $269.92 $269.92 |
$8,524.64 $719.60 | $9,244.24! $4,622.12! $4,622.12 |
5 ~ $0,00 | $0.00 $0.00
[6 $3,500.00 $3,500.00
i "$193.50 $96.75 «$98.75,
H id | |
7 | 8 7,649.00) $3,824.50 $3,824.50 |
8 i $241.94! $120.97! $120.97 |
8, ! $1,972.30 | i
$887.82; $443.5 ;
$340.38! $170.19) $170.19
$92.32; $46.16 $46.16 |
i i $1,118.38/ $659.19! $559.19 |
i : ($12,302.44! $6,151.07 | $6,151.07 |
! i 7 fi
"0. : $12,000.00 { $6,000.00 }

$6,000.00 :

$40,739.88 | $20,369.94 | $20,369.94 |

Page 16 of 22

ATTACHMENT A
YH16-0018-04

1 Actual number of claims may be higher. Number includes, original, recoupment and adjustment claims.
: . . . ~ }

? Cost based on actual SFY 17 expenditures and actual number of claims processed H
3 Average rate per | contract. Actual costs w ill bea strict pass-through based on price negotiated on new contract.
-4 Actual number may be higher or lower depending on Maricopa County Medicaid Inmate program requirements,

* Based on estimates of DFSM staff time required to pr
° Estimate based on 40 hours at a rate of $175 per hour. wil only be billed for actual hours incurred, H
‘7 Based on estimates of DBF staff time required to monitor funding activity and process payments.

b Postage based on average cost per claim times number of claims. : i
i Data Center charges calculated based on average SFY 17 costs :
*° DMS Eligibility charges calculated at $100/determination. Estimated 120 annual applications/determinations.

11 Cost per claim does not include a cost for concurrent review s

Page 17 of 22

ATTACHMENT B
YH16-0018-07

AHCCCS ©
~ Quarterly Estimate of State Match Advance Payments for Program Services

Maricopa County Medicaid Eligible FFS Project IGA SFY19

Estimate of Annual Dollar Value of Claims Paid 1s 2,173,000.00
Average Federal Financial Participation Rate a cee el "79.91%
\Estimate of State Match Payments for Program Services for Current Year |S 436,664.35

!

Quarterly Estimate of State Match Advance Payments for Program Services to AHCCCS Ss 109,166.00 |

Page 18 of 22

1.

BUSINESS ASSOCIATE ADDENDUM
Amended 2016

This Addendum is made part of this Contract between the Arizona Health Care Cost Containment
System ("AHCCCS") and the Contractor, referred to as “Business Associate” in this Addendum.

AHCCCS and Business Associate agree that the underlying Contract shall comply with the Administrative
Simplification requirements of the Health Insurance Portability and Accountability Act of 1996
("HIPAA"), as set forth in Title 45, Parts 160 and 164 of the Code of Federal Regulations (the "CFR"), as
amended. In the event of conflicting terms or conditions, this Addendum shall supersede the underlying
Contract.

DEFINITIONS.

The following terms used in this Addendum shall have the same meaning as those terms in the HIPAA
rules set forth in Title 45, Parts 160 and 164 of the CFR: Breach, Data Aggregation, Designated Record
Set, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices,
Protected Health Information, Required by Law, Secretary, Security Incident, Subcontractor,
Unsecured Protected Health Information, and Use. ,

OBLIGATIONS AND ACTIVITIES OF BUSINESS ASSOCIATE
Business Associate agrees to:

2.1, Not use or disclose protected health information (“PHI”) other than as permitted or required
by this Addendum or as required by law;

2.2. Use appropriate safeguards, and comply with Subpart C of 45 CFR Part 164 with respect to
electronic PHI, to prevent use or disclosure of protected health information other than as
provided for by this Addendum;

2.3. Report to AHCCCS any use or disclosure of PHI not provided for by this Addendum of which it
becomes aware, including breaches of unsecured protected health information as required at
45 CFR §164.410, and any security incident of which it becomes aware in the following ‘
manner; :

2.3.1. Reporting. Business Associate shall report to AHCCCS any use or disclosure of PHI
that is not authorized by the Contract, by law, or in writing by AHCCCS. Business
Associate shalt make an initial report to the AHCCCS Privacy Official not more than
twenty-four (24) hours after Business Associate learns of such unauthorized use or
disclosure. The initial report shall include all of the following information to the
extent known to the Business Associate at the time of the initial report:

A. Adescription of the nature of the unauthorized use or disclosure, including
the number of individuals affected by the unauthorized use or disclosure;
A description of the PHI used or disclosed;

C. The date(s) on which the unauthorized use or disclosure occurred;
-D. The date(s) on which the unauthorized use or disclosure was discovered;

2

Page 19 of 22

2.4.

2.5,

2.6.

2.7.

2.8.

E. Identify the person(s) who used or disclosed the PHI in an unauthorized
manner; ; ;

F. Identify the person(s) who received PHI disclosed in an unauthorized
manner; : .

G. Adescription of actions, efforts, or plans undertaken by the Business
associate to mitigated the harm of the unauthorized disclosure;

H. A description of corrective actions undertaken or planned to prevent future
similar unauthorized use or disclosure;

I. An’assessment of whether a breach, as defined in 45 CFR 164.402, including,

if necessary, an assessment of the probability of harm, and

J. Such other information, as may be reasonably requested by the AHCCCS

Privacy Official.

’ Business Associate shall provide AHCCCS with supplemental reports promptly as
new information becomes available, as assessments.and action plans are
developed, and as action plans are implemented. In any event, Business Associate
shall provide a comprehensive written report including all of the information listed
above no later than twenty (20) days after discovery of the unauthorized use or
disclosure.

2.3.2. Mitigation. Business Associate agrees to mitigate, to the extent practicable, any
harmful effect that is known to’ Business Associate of a use or disclosure of PHI by
Business Associate in violation of the requirements of the Contract.

2.3.3. Sanctions. Business Associate shall have and apply appropriate sanctions against
any employee, subcontractor or agent who uses or discloses AHCCCS PHI in
violation of this Addendum or applicable law.

In accordance with 45 CFR §164.502(e)(1)(ii) and §164.308(b)(2), if applicable, ensure that
any subcontractors that create, receive, maintain or transmit.PHI on behalf of the Business
Associate agree to the same restrictions, conditions and requirements that apply to the
Business Associate with respect to such information;

Make available PHI in a designated record set to AHCCCS as necessary to satisfy AHCCCS’
obligations under 45 CFR §164.524;

Make any amendment(s) to PHI in a designated record set as directed or agreed.to by
AHCCCS pursuant to 45 CFR §164.526, or take other measures as necessary to satisfy
AHCCCS’ obligations under 45 CFR §164.526; ; :

Maintain and make available the information required to provide an Accounting of
Disclosures to AHCCCS as necessary to satisfy AHCCCS’ obligations under 45 CFR §164.528;

To the extent Business Associate is to carry out one of more of AHCCCS’ obligations under
Subpart E of 45 CFR Part 164, comply with the requirements of Subpart E that apply to

AHCCCS in the performance of such obligation(s); and

Page 20 of 22