CARE1ST HEALTH PLAN OF ARIZONA A WELLCARE CO. - MOU.PDF
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MEMORANDUM OF UNDERSTANDING
Between
MARICOPA COUNTY AND
Care1st Health Plan of Arizona, a Wellcare Co.
This Memorandum of Understanding (“MOU”) is entered into pursuant to the applicable Arizona Health Care Cost
Containment System (AHCCCS) Contracts with ACC HEALTH PLAN, between Care1st Health Plan of Arizona,
a Wellcare Co. herein referred to as (Care1st) and MARICOPA COUNTY by and through its DEPARTMENT
OF CORRECTIONAL HEALTH SERVICES, herein referred to as (CHS).
Care1st and CHS desire to enter into a MOU to establish a collaborative protocol for effective communication,
coordination, and continuity of care for individuals eligible for services provided by Care1st, whom CHS also serves.
I.
PURPOSE: The purpose of this MOU is to establish a collaborative protocol for effective communication,
coordination, and continuity of care as outlined in AMPM Policy 1020 and 1050 for individuals eligible for
services provided by Care1st, whom CHS also serves. This MOU shall in no way change, modify, or amend
the contract between AHCCCS and Care1st and does not create liability from one party to the other by a
party’s failure to comply with the protocol. Should any information within this MOU conflict with any terms
or conditions within the AHCCCS contract, the AHCCCS contract shall prevail.
II.
DEFINITIONS:
As used throughout this MOU, the following terms shall have the meanings set forth below:
A.
MOU means this document and all attachments and amendments hereto.
B.
County means Maricopa County.
C.
CHS means the Department of CHS.
D.
Criminal Justice Information refers to any confidential information collected by criminal justice
agencies on individuals consisting of identifiable descriptions and notations of arrests, detentions,
indictments, information, or other formal criminal charges, and any disposition arising therefrom,
as well as confidential pre-booking or booking personal identifiable information, including date of
birth, social security number, age, demographic information, projected release dates and release date
information as defined in 5.U.S.C. § 552 and 5 U.S.C. § 552a.
E.
Director means the Director of CHS.
F.
Medical Director means the Medical Director of CHS.
G.
Authorized Use means Protected Health Information (“PHI”) provided by CHS to CARE1ST that
shall be used and/or disclosed only as authorized by law, including, but not limited to, the treatment
of individuals identified as homeless as needed in order to reduce recidivism. Except when otherwise
required by law, disclosures of PHI pursuant to this MOU are subject to a minimum necessary
determination by CHS (45 CFR § 164.502(b)). When reasonable to do so, CHS may rely upon the
representations of CARE1ST as to what information is the minimum necessary for their lawful
purpose (45 CFR § 164.514(d) (3) (iii)). Information regarding substance use or abuse shall not be
disclosed without the express written authorization of the individual.
H.
Health Insurance Portability and Accountability Act (“HIPAA”) refers collectively to the
HIPAA of 1996, codified at 42 U.S.C. § 1320d et seq., and the Health Information Technology for
Economic and Clinical Health Act, enacted as Title XIII of the American Recovery and
Reinvestment Act of 2009, codified at 42 U.S.C. § 17921 et seq., and any current and future
regulations promulgated thereunder, including but not limited to 45 C.F.R. Parts 160 and 164.
I.
Electronic Health Record (“EHR”) refers to the EHR system licensed by the County and
maintained by CHS.
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J.
PHI shall have the same meaning as defined under HIPAA and includes any information about
health status, provision of health care, or any individually identifiable information, including Social
Security Number, Age, Sex, Date of Birth, Patient Identification Number, Medical Record
Documentation either paper or electronic, diagnosis, procedural information, and any other
information directly linked and identifiable to a specific individual under the care, safety, and
medical supervision of CHS.
III.
COLLABORATIVE AGREEMENT BETWEEN CHS AND CARE1ST
A.
Background: The Maricopa County Correctional Health Services (CHS) enhances community
safety by collaborating with AHCCCS, Care1st Health Plan, and its contracted providers to provide
research-based prevention and intervention services. Care1st Health Plan’s contracted providers
deliver a range of health care services and treatment programs for adults and youth with physical
health needs, serious mental illness, and other mental health and/or substance use disorders.
To facilitate the transition of members transitioning out of jails and back into our community,
collaboration between CHS and Care1st Health Plan is critical to reentry activities. Specifically,
Care1st Health Plan will collaborate with CHS to accomplish “reach-in” care coordination for
members who have been incarcerated in the adult correctional system for 20 days or longer and have
an anticipated release date. “Reach-in” care coordination activities shall begin upon knowledge of
a member’s anticipated release date. Care1st Health Plan will collaborate with CHS to identify
justice-involved General Mental Health/Substance Use (GMHSU) members in the adult criminal
justice system with physical and/or behavioral health chronic and/or complex care needs prior to
member’s release.
B.
Data Sharing and Coordination:
Care1st Health Plan and CHS will partner to accomplish the following:
1.
Communicate timely data necessary for coordination of care in conformance with all
applicable administrative orders, state laws, and regulations, 42 CFR Part 2, and HIPAA
requirements that permit the sharing of written, verbal, and electronic information.
2.
Use data-sharing MOUs and administrative orders that permit the sharing of written,
verbal, and electronic information at the time of admission into the facility and at the time
of discharge.
C.
Collaborative Protocols:
When Care1st Health Plan becomes aware that a member is incarcerated and is subject to the
“Reach-In” requirements described above:
1.
The Care1st Health Plan Point of Contact or designee will complete a Justice Transition
Form (JTF) for GMHSU members with designated chronic conditions and send the JTF to
CHS:
a.
CHS will confirm diagnosis/chronic condition in the EHR.
b.
CHS will complete the CHS section of the JTF and return it to Care1st Health Plan
– scan it into the EHR.
2.
If CHS identifies newly diagnosed chronic care conditions, CHS will complete a JTF and
send it to the Care1st Health Plan Point of Contact or designee.
3.
If a member has a diagnosis of HIV+, Medication Assisted Treatment (MAT), or Substance
Use/Misuse, the member’s written consent to release and share information must be
completed and uploaded into The EHR prior to the disclosure of the member’s identifying
information.
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4.
If a member is in jail for 20 days or more, the Care1st Health Plan Point of Contact or
designee will initiate a video or in-person visit with the member.
5.
An Appointment will be made with the member’s Primary Care Physician (PCP) to occur
within 7 days of release.
6.
The Care1st Health Plan Point of Contact or designee will forward to CHS an “Introduction
Letter” via secure email with the following information:
a.
Appointment day/time
b.
Clinic name and location
c.
Health Plan Point of Contact (or designee) contact information
7.
CHS will place this introduction letter into the member’s property which will be provided
upon jail release.
8.
CHS and the Care1st Health Plan Point of Contact or other health staff may coordinate
special needs prior to jail release (such as courtesy release, medical equipment, or specific
medications).
D.
Communication and Problem Resolving:
CHS and Care1st Health Plan will have quarterly steering committee meetings to build and
strengthen relationships and address any problems or conflicts. Additionally, Care1st Health Plan
will identify and extend invitations to CHS to provider-level meetings appropriate for CHS
participation.
Meetings shall include opportunities for agency cross-training and for identifying, communicating
and resolving problems to increase understanding and knowledge of each other's mission, goals
and how, through agency collaboration, members are provided identified services to improve their
health and well-being and reduce recidivism.
Care1st Health Plan and CHS will work together to ensure processes from both agencies are being
practiced. On-going improvement efforts will focus on reducing redundancies and providing
timely, accurate and relevant information to coordinate services and evaluate outcomes of those
services.
Care1st Health Plan and CHS will identify key staff who have the authority to assist with disputes
and find resolutions based on the agreements and best interest of the populations jointly served. If
necessary, this may include the Care1st Health Plan Chief Medical Officer (or designee) and the
CHS Mental Health Director. Meetings shall include opportunities to report identified gaps and
discuss and act on resolutions.
E.
Joint Training Needs: Care1st Health Plan and its contracted providers and CHS will provide
cross-training opportunities as mutually agreeable needs are identified.
IV.
SPECIAL TERMS AND CONDITIONS:
A.
TERM OF MOU: This MOU shall begin upon approval by the Maricopa County Board of
Supervisors and shall terminate October 1, 2024 unless otherwise terminated or amended as
provided herein. By mutual written amendment executed by the Parties’ authorized representatives,
this MOU may be extended for supplemental periods of 12 months, up to maximum of 48 months.
B.
TERMINATION: This MOU may be terminated by either party with prior written notice to the
other party. Such Notice of Termination by CARE1ST shall be effective 20 calendar days after
mailing by certified mail, return receipt requested, to CHS. CHS may terminate this MOU, in whole
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or in part, immediately upon providing either written or verbal notice to CARE1ST when CHS
deems the health or welfare of a patient is endangered. Either party may terminate this MOU
immediately upon providing written or verbal notice when it deems that performance would be in
violation of the law or order of a court of law. For any other cause, CHS may terminate this MOU
upon 20 calendar days after mailing by certified mail, return receipt requested, to CARE1ST.
C.
AMENDMENTS: Any changes to this MOU shall be in writing and signed by both parties.
D.
CARE1ST’s & CHS’ RESPONSIBILITIES: CARE1ST and CHS shall operate in a professional
manner that conforms to all local, state, and federal codes and rules and within the standard of
practice for the scope of each of the parties’ responsibilities. CARE1ST and CHS shall comply with
all federal, state, and local laws, ordinances, rules, and regulations applicable to each party’s
performance under this MOU. There are no financial responsibilities assigned by this MOU; the
MOU is intended to allow CARE1ST and CHS to work together to better address the needs of the
community.
E.
RETENTION OF RECORDS: CARE1ST and CHS shall maintain records and other relevant
documents to this MOU for five years following the termination or expiration of the MOU;
provided, however, if any audit questions are unresolved at the end of that five-year period, all
records and documents relating to such audit questions shall be maintained until those audit
questions are resolved.
F.
NON-DISCRIMINATION: To the extent applicable, CARE1ST, in accordance with A.R.S. § 41-
1461, et seq., shall provide equal employment opportunities for all persons, regardless of race, color,
creed, religion, sex, age, national origin, disability or political affiliation. CARE1ST shall comply
with the Americans with Disabilities Act.
G.
EMPLOYMENT VERIFICATION: To the extent applicable, the parties shall comply with
A.R.S. § 41-4401, all Federal immigration laws and regulations relating to employees, including
compliance with A.R.S. § 23-214, Subsection A.
H.
GOVERNING LAWS: This MOU shall be governed by the laws of the State of Arizona. Any
litigation arising from the MOU, or the performance thereof will be decided in the federal or state
courts of Maricopa County unless otherwise agreed to between the Parties.
I.
INDEMNIFICATION: To the fullest extent permitted by law, each party shall defend, indemnify,
and hold harmless the other party, its agents, representatives, officers, directors, officials, and
employees for, from, and against all claims, damages, losses, and expenses, including, but not
limited to, attorneys’ fees, court costs, expert witness fees, and the cost of appellate proceedings,
relating to, arising out of, or alleged to have resulted from the negligent acts, errors, omissions or
mistakes relating to the performance of this MOU. Each party’s duty to defend, indemnify, and hold
harmless the other party, its agents, representatives, officers, directors, officials, and employees shall
arise in connection with any claim, damage, loss or expense that is attributable to bodily injury,
sickness, disease, death, or injury to, impairment, or destruction of property, including loss of use
resulting therefrom, caused by any negligent acts, errors, omissions or mistakes in the party’s
performance of this MOU including any person for whose acts, errors, omissions or mistakes a party
may be legally liable.
J.
INSURANCE: CARE1ST, at CARE1ST’s own expense, shall purchase and maintain, at a
minimum, the herein stipulated insurance from a company or companies duly licensed by the State
of Arizona and possessing an AM Best, Inc. category rating of B++. In lieu of State of Arizona
licensing, the stipulated insurance may be purchased from a company or companies that are
authorized to do business in the State of Arizona, provided that said insurance companies meet the
approval of the County. The form of any insurance policies and forms must be acceptable to the
County.
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All insurance required herein shall be maintained in full force and effect until all work or service
required to be performed under the terms of the MOU is satisfactorily completed and formally
accepted. Failure to do so may, at the sole discretion of the County, constitute a material breach of
this MOU. In the event that the insurance required is written on a claims-made basis, CARE1ST
warrants that any retroactive date under the policy shall precede the effective date of this MOU, and
either continuous coverage will be maintained or an extended discovery period will be exercised for
a period of two years beginning at the time work under this MOU is completed. CARE1ST’s
insurance will be primary insurance as respects County, and any insurance or self-insurance
maintained by County will not contribute to it.
Any failure to comply with the claim reporting provisions of the insurance policies or any breach of
an insurance policy warranty shall not affect the County’s right to the coverage afforded under the
insurance policies. The insurance policies may provide coverage that contains deductibles or self-
insured retentions. Such deductible and/or self-insured retentions shall not be applicable with respect
to the coverage provided to the County under such policies. CARE1ST shall be solely responsible
for the deductible and/or self-insured retention, and the County, at its option, may require CARE1ST
to secure payment of such deductibles or self-insured retentions by a surety bond or an irrevocable
and unconditional letter of credit.
The insurance policies required by this MOU, except Workers’ Compensation and Errors and
Omissions, shall name the County, its agents, representatives, officers, directors, officials, and
employees as additional insureds. The policies required hereunder, except Workers’ Compensation
and Errors and Omissions, shall contain a waiver of transfer of rights of recovery (subrogation)
against the County, its agents, representatives, officers, directors, officials, and employees for any
claims arising out of CARE1ST’s work or service. If available, the insurance policies required by
this MOU may be combined with Commercial Umbrella Insurance policies to meet the minimum
limit requirements. If a Commercial Umbrella insurance policy is utilized to meet insurance
requirements, the Certificate of Insurance shall indicate which lines the Commercial Umbrella
Insurance covers.
1.
Commercial General Liability: Commercial General Liability (CGL) insurance and, if
necessary, Commercial Umbrella insurance with a limit of not less than $1,000,000 for
each occurrence, $3,000,000 Products/Completed Operations Aggregate, and $3,000,000
General Aggregate Limit. The policy shall include coverage for premises liability, bodily
injury, broad form property damage, personal injury, products and completed operations,
and blanket contractual coverage, and shall not contain any provisions which would serve
to limit third-party action over claims. There shall be no endorsement or modifications of
the CGL limiting the scope of coverage for liability arising from explosion, collapse, or
underground property damage.
2.
Workers’ Compensation: Workers’ Compensation insurance to cover obligations
imposed by Federal and state statutes having jurisdiction of CARE1ST’s employees
engaged in the performance of the work or services under this MOU; and Employer’s
Liability insurance of not less than $1,000,000 for each accident, $1,000,000 disease for
each employee, and $1,000,000 disease policy limit. CARE1ST, its subcontractors, and
sub-subcontractors waive all rights against this MOU and its agents, officers, directors, and
employees for recovery of damages to the extent these damages are covered by the
Workers’ Compensation and Employer’s Liability or Commercial Umbrella Liability
insurance obtained by CARE1ST, its subcontractors, and its sub-subcontractors pursuant
to this MOU.
3.
Professional Liability Insurance: CARE1ST shall maintain Professional Liability
insurance which will provide coverage for any and all acts arising out of the work or
services performed by CARE1ST under the terms of this MOU, with a limit of not less
than $1,000,000 for each claim, and $3,000,000 aggregate claims.
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4.
Sexual Molestation and Physical Abuse: The policy shall be endorsed to include
coverage for sexual molestation and physical abuse at limits not less than $1,000,000.00
per occurrence and $2,000,000.00 aggregate. These limits may be included within a
General Liability policy, Professional Liability policy, or provided by separate
endorsement with its own limits as required. CARE1ST must provide the following
statement on their Certificate(s) of Insurance: “Sexual molestation and physical abuse
coverage is included.” Policies/certificates stating that “Sexual molestation and physical
abuse coverage is not excluded” do not meet this requirement.
5.
Cyber, Network Security, and Privacy Liability: Cyber, Network Security and Privacy
Liability Insurance with a limit of not less than $5,000,000 per occurrence. The policy shall
include, but not be limited to; coverage for all directors, officers, agents, and employees of
CARE1ST, losses with respect to network risks (such as data breaches, unauthorized access
or use, and ID theft of data), invasion of privacy (regardless of the type of media involved
in the loss of private information), crisis management, identity theft response costs, breach
notification costs, credit remediation, and credit monitoring, defense, and claims expenses,
regulatory defense costs plus fines and penalties, cyber extortion, electronic data
restoration expenses (data asset protection), network business interruption, computer fraud
coverage, funds transfer loss, third-party fidelity, theft, no requirement for arrest and
conviction, and loss outside the premises of the named insured.
6.
Certificates of Insurance: Prior to MOU execution, CARE1ST shall furnish the County
with valid and complete certificates of insurance or formal endorsements as required by
the MOU in the form provided by the County, issued by CARE1ST’s insurer(s), as
evidence that policies providing the required coverage, conditions, and limits required by
this MOU are in full force and effect. Such certificates shall identify this contract number
and title. In the event any insurance policy(ies) required by this MOU is (are) written on a
claims-made basis, coverage shall extend for two years past completion and acceptance of
CARE1ST’s work or services and as evidenced by annual Certificates of Insurance. If a
policy does expire during the life of the MOU, a renewal certificate must be sent to the
County 15 calendar days prior to the expiration date. Certificates of Insurance shall identify
Maricopa County as the additional insured/certificate holder as follows:
Maricopa County
c/o Risk Management
201 W Jefferson St., Suite 910
Phoenix, AZ 85003
7.
Cancellation and Expiration Notice: Applicable to all insurance policies required within
the insurance requirements of this MOU, CARE1ST’s insurance shall not be permitted to
expire, be suspended, be canceled, or be materially changed for any reason without 20
calendar days prior written notice to Maricopa County. CARE1ST must provide notice to
Maricopa County within two business days of receipt if they receive notice of a policy that
has been or will be suspended, canceled, materially changed for any reason, has expired,
or will be expiring. Such notice shall be sent directly to the Maricopa County Office of
Procurement Services and shall be mailed or hand delivered to 201 W. Jefferson St., Suite
700, Phoenix, AZ 85003.
K.
EMPLOYMENT: Parties acknowledge that under this MOU, no employee or participant of
CARE1ST is to be considered a County employee and that no rights of County merit, County
retirement, or County personnel rules shall accrue to such individual. CARE1ST shall have total
responsibility for all salaries, wages, bonuses, retirement, withholdings, workman's compensation,
occupational disease compensation, unemployment compensation, other employee benefits, and all
taxes and premiums appurtenant thereto concerning such individuals and shall save and hold County
and CHS harmless with respect thereto.
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L.
NON-JOINT VENTURE: This MOU is not intended to constitute, create, give rise to, or otherwise
recognize a joint venture MOU, partnership or other formal business association or organization of
any kind, and the right and obligations of the Parties shall be only those expressly set forth in this
MOU.
M.
CONFLICTS OF INTEREST: This MOU is subject to the provisions of A.R.S. § 38-511.
N.
ARBITRATION: To the extent applicable, the parties, in accordance with A.R.S. §12-1518, agree
to resolve all disputes arising out of or relating to this MOU through arbitration after exhausting
applicable administrative review except as may be required by other applicable statutes. This
provision does not apply to provider claims disputes or member appeals regarding covered services
provided by CARE1ST.
O.
PUBLIC RECORDS: Notwithstanding any other provision of this MOU to the contrary, CHS is
subject to A.R.S. 39-121 through 39-128 regarding public records. Any provision regarding
confidentiality is limited to the extent necessary to comply with the provisions of Arizona law. The
parties acknowledge that CARE1ST is not a public agency subject to public records laws but is a
private corporation.
P.
CONFIDENTIALITY OF RECORDS:
1.
Neither party shall use or disclose any PHI received from the other in any manner that
would constitute a violation of this MOU or federal or state law. Each party shall take
reasonable measures to ensure that its directors, officers, employees, vendors, contractors,
and agents use or disclose PHI received from the other party in accordance with the
provisions of this MOU and federal and state law. Each party shall implement all
appropriate safeguards reasonably necessary to maintain the confidentiality of the
information accessed through the EHR system.
2.
Information pertaining to substance abuse will only be shared upon obtaining a release of
information from the individual in compliance with 42 CFR Part 2.
3.
Before CARE1ST’s Authorized Users may have access to CHS’ EHR system, CARE1ST’s
Authorized Users will be required to read and agree to the terms of CHS’
user/confidentiality MOU. The parties shall work cooperatively to fulfill this requirement
and return copies of the executed MOUs, as necessary.
4.
CARE1ST and its Authorized Users may be provided with Criminal Justice Information
via the EHR system by CHS for the sole purpose of safely and securely providing and/or
coordinating treatment and/or healthcare services to patients incarcerated in the Maricopa
County Jail. CARE1ST shall not use or disclose Criminal Justice Information for any other
purpose and will treat all Criminal Justice Information as confidential as always required
by state and federal laws and take reasonable measures to maintain the security and
confidentiality of such information. CARE1ST shall instruct its staff concerning the
confidential nature of Criminal Justice Information and the applicable prohibitions against
its use and disclosure.
5.
Reporting of Unauthorized Use or Disclosure of PHI: CHS and CARE1ST shall, within
24 hours of becoming aware or has reason to believe of an unauthorized use or disclosure
of PHI by either organization; or any of its Authorized Users, officers, directors,
employees, vendors, contractors, agents or by a third party. Such notice shall be made to
the following:
MARICOPA COUNTY CORRECTIONAL HEALTH SERVICES (CHS)
Attn: Business Integration Technology (BIT)
Title: Unauthorized Use or Disclosure of PHI
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Address: 234 N Central Avenue, Suite 5350
City, State Zip: Phoenix, AZ 85004
Phone: (602) 506-0897
Emails: CHSBIT@maricopa.gov and CHSHIMTeam@maricopa.gov
Care1st Health Plan of Arizona, a Wellcare Co.
Attn: Johnnie Gasper
Title: Director, Justice and Crisis
Address: 333 E. Wetmore Rd.
City, State Zip: Tucson, AZ 85711
Phone: 520-869-8145
Email: Johnnie.Gasper@azcompletehealth.com
Q.
ASSIGNMENT, DELEGATION, AND EXECUTION:
1.
Neither party may assign this MOU without the express, written, prior consent of both
parties, which shall not be unreasonably withheld or delayed.
2.
This MOU does not imply authority to perform any tasks or accept responsibility.
3.
Sections and other headings contained in this MOU are for reference purposes and shall
not affect in any way the meaning or interpretation of this MOU.
4.
This MOU may be executed in two or more counterparts, each of which shall be deemed
an original, but all of which together shall constitute the same instrument. Faxed, copied,
digital, and scanned signatures are acceptable as original signatures.
5.
This MOU contains the entire understanding of the parties hereto with respect to the
matters covered, and it supersedes all proposals, oral or written, and all other documents
or communications between the parties relative to the subject matter herein covered, unless
such documents or communications are specifically included by reference.
6.
All notices under this MOU given by either party to the other shall be in writing and
shall be delivered in person or sent by U.S. Postal Service, postage prepaid and addressed
to the following individuals:
MARICOPA COUNTY CORRECTIONAL HEALTH SERVICES (CHS)
Attn: Lisa Struble
Title: CHS Department Director
Address: 234 N. Central Avenue, Suite 5000
City, State Zip: Phoenix, AZ 85004
Phone: (602) 350-1745
Email: Lisa.Struble@maricopa.gov
Care1st Health Plan of Arizona, a Wellcare Co.
Attn: Johnnie Gasper
Title: Director, Justice and Crisis
Address: 333 E. Wetmore Rd.
City, State Zip: Tucson, AZ 85711
Phone: 520-869-8145
Email: Johnnie.Gasper@azcompletehealth.com
:
7.
Prior to or simultaneously with the execution of this MOU, CARE1ST shall provide CHS
with proof, satisfactory to the County Attorney, that the individual executing this MOU on
behalf of CARE1ST is legally authorized to bind CARE1ST.
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* Remainder of Page Intentionally Left Blank *
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IN WITNESS WHEREOF, the parties have executed this MOU as of the respective dates written below.
Care1st Health Plan of Arizona, a Wellcare Co.
MARICOPA COUNTY
Authorized Individual:
BOARD OF SUPERVISORS
By:
By:
Name: Johnnie Gasper
Name:
Title: Director of Crisis and Justice System
Title: Chairman, Board of Supervisors
Date: 4/11/2024
Date:
ATTEST:
By:
Name:
Title: Clerk of the Board
Date:
APPROVED AS TO FORM:
By:
Name:
Title: Deputy County Attorney
Date:
DocuSign Envelope ID: 81A22789-2F11-49CC-A9C5-07F5F934DB02
4/12/2024
Davina Bressler