AHCCCS AMENDEMENT AGENDA C-26-08-011-0-13.PDF

YAHCCCS

~ Arizona Health Care-Cost Containment System

INTERGOVERNMENTAL AGREEMENT

1. Amendment | 2. CONTRACT NUMBER:

AMENDMENT
3. EFFECTIVE DATE OF AMENDMENT: 4, PROGRAM:
July 1, 2021 DFSM

13 YHO8-0073

C-26-08-011-0-13

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, 2022.

B. Pursuant to Paragraph 5.7, Administrative Services: Change rates for SFY2022 (July 1, 2021 —June 30,
2022) to the rates as shown in Attachment A.
C. Updated Section 8.1 with: This Amendment is subject to cancelation pursuant to A.R.S 38-511.

These rates will remain the same until otherwise updated.

NOTE: Please return scanned copy to: Toni Cota, Procurement Specialist at: anntonio.cota@ozahcces.gov

unchanged and in full effect.

8. Except as provided for herein, all terms and conditions of the original contract not heretofore changed and/or amended remain

In witness whereof the parties hereto sign their names in agreement.

9. Maricopa County on behalf of Correctional Health
Services

10. Arizona Health Care Cost Containment System

SIGNATURE OF AUTHORIZED INDIVIDUAL:

SIGNATURE:

lle _.

Meggan LaPorte (Sep 30, 2021 12:03 PDT)

TYPED NAME: TYPED NAME:
Meggan LaPorte, MSW, CPPO
TITLE: TITLE:
Chairman, County Board of Supervisors Chief Procurement Officer
DATE: DATE:
Sep 30, 2021

11. In accordance with state statutes, county rules, and bylaws,
this agreement has been reviewed by the undersigned who
has determined that this agreement is in appropriate form and
is within the power and authority granted to the county.

12. In accordance with § A.R.S, 11-952, this amendment is in proper form and
is within the power and authority granted to the administration under §
ARS. 36-2903 et seq. and §36-2932 et seq.

Dated this > SF ayer CF, Z S 2021 Dated this_29th day of September _ 2021
x ;
BY. “ Ae UE ra

Reptity County Attomey

Legal counsel for the administration

Attachment A

AHCCCS Amendment 13 - YH08-0073
Administrative Annual Cost Estimates for
Maricopa County Corrections 100% State IGA SFY22 - Contract C-26-0-011-0-13

Claims Electronic Paper Total Fund
65% 35% 100%
Estimated total number of claims:
Physician & Emergency Transport/Hospital 1 12,300 6,750 19,050
DFSM Cost per Claim 2¢§ 068 § 0.79
OIG Provider Enrollment Cost per Claim 2¢§ 0.15 $ 0.15
2
$

4.67
—

Lele
Concurrent Review Average Cost
Estimated cost per case 3 g§ 127.95
Estimated number of HSAG reviews ‘ . 4

ES

Claims Processing costs:

DFSM $8,389.62 $5,320.49 $13,710.14
OIG Provider Enrolment $1,863.07 $1,022.42 $2,885.49
ISD $20,524.96 $11,263.70 $31,788.66
State Accounting System Charges @ $0.1974/claim $2,428.59 $4,332.76 $3,761.35
Total Claims Processing Costs $33,208.24 $18,939.37 $52,145.61
Direct DFSM Labor for MDOC 100% State Claims Processing 8 100,943.94
Direct ISD Labor for MDOC 100% State Clalms Processing 6 $14,000.00
Concurrent Review Estimated costs:
Cost for 4 reviews $511.80
Administrative Costs (see detail)
DBF Paper Processing Personnel costs 7 $ 9,268.35
Postage @ $.0545/claim . . $1,039.09
Data Center Charges @ $.7366/claim 8 $14,032.62
OOD @ §.3104/claim $5,908.06
OALS @ $.0860/claim $1,638.62
HRD @ $.0263/claim $500.53
TIBCO @ $.0852/claim $1,622.83
Indirect at 10% $3,401.01
Total Administrative Costs $37,411.14
DMS Eligibility Costs
Application Processing Costs - DMS $0.00
Estimated Total Annual Costs for Program $205,012.46
Cost per Claim

‘Achual number of claims may be. higher. Number includes, original, recoupment and adjustment claims.
? Cost based on actual expenditures and actual number of claims processed

* Average rate per contract. Actual costs will be a strict pass-through based on price negotialed on contract.
* Actual number may be higher or lawer depending on MDOG 100% Stale program requirements.

* Based on estimates of DFSM staff time required fo process the clans.

* 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 ime required to monitor funding activity and process payments.

* Postage based on average cost per claim times number of claims.

° Data Center charges calculated based on average costs

** DMS Eligibility charges calculated al $108/detemnination, Estimated 0 annual appkcations/determinations.

AHCCCS DBF 9/23/2021 3:08PM CAUserslamcotalDesktop\Contracts of Task Orders\YH08-0073 MDOC 100% Rate SFY22xisx