REMEDIES
88
23)
NON-DISCRIMINATION
89
24)
EFFECTIVE DATE
89
25)
INSURANCE
89
26)
DISPUTES
89
27)
RIGHT TO INSPECT PLANT OR PLACE OF BUSINESS
90
28)
INCORPORATION BY REFERENCE
90
29)
COVENANT AGAINST CONTINGENT FEES
90
30)
CHANGES
90
31)
TYPE OF CONTRACT
90
32)
AMERICANS WITH DISABILITIES ACT
90
33)
WARRANTY OF SERVICES
90
34)
NO GUARANTEED QUANTITIES
90
35)
CONFLICT OF INTEREST
90
36)
DISCLOSURE OF CONFIDENTIAL INFORMATION
91
37)
COOPERATION WITH OTHER CONTRACTORS
91
38)
ASSIGNMENT OF CONTRACT AND BANKRUPTCY
91
39)
OWNERSHIP OF INFORMATION AND DATA
91
40)
AHCCCSA RIGHT TO OPERATE CONTRACTOR
91
41)
AUDITS AND INSPECTIONS
92
42)
LOBBYING
92
43)
CHOICE OF FORUM
92
44)
DATA CERTIFICATION
92
45)
OFF SHORE PERFORMANCE OF WORK PROHIBITED
92
46)
FEDERAL IMMIGRATION AND NATIONALITY ACT
93
47)
IRS W-9 FORM
93
48)
CONTINUATION OF PERFORMANCE THROUGH TERMINATION
93
SECTION F: INDEX - PROGRAM REQUIREMENTS AND CONTRACT CLAUSES
94
ATTACHMENT A: MINIMUM SUBCONTRACT PROVISIONS
97
1.
ASSIGNMENT AND DELEGATION OF RIGHTS AND
RESPONSIBILITIES
97
2.
AWARDS OF OTHER SUBCONTRACTS
97
3.
CERTIFICATION OF COMPLIANCE - ANTI-KICKBACK AND LABORATORY
TESTING
97
4.
CERTIFICATION OF TRUTHFULNESS OF REPRESENTATION
97
5.
CLINICAL LABORATORY IMPROVEMENT AMENDMENTS OF 1988
98
6.
COMPLIANCE WITH AHCCCSA RULES RELATING TO AUDIT AND INSPECTION
98
7.
COMPLIANCE WITH LAWS AND OTHER REQUIREMENTS
98
8.
CONFIDENTIALITY REQUIREMENT
98
9.
CONFLICT IN INTERPRETATION OF PROVISIONS
98
10.
CONTRACT CLAIMS AND DISPUTES
98
11.
ENCOUNTER DATA REQUIREMENT
98
12.
EVALUATION OF QUALITY, APPROPRIATENESS, OR TIMELINESS OF SERVICES
98
13.
FRAUD AND ABUSE
99
14.
GENERAL INDEMNIFICATION
99
15.
INSURANCE
99
16.
LIMITATIONS ON BILLING AND COLLECTION PRACTICES
99
17.
MAINTENANCE OF REQUIREMENTS TO DO BUSINESS AND PROVIDE SERVICES
99
18.
NON‐DISCRIMINATION REQUIREMENTS
99
19.
PRIOR AUTHORIZATION AND UTILIZATION MANAGEMENT
100
20.
RECORDS RETENTION
100
21.
SEVERABILITY
100
-4-
22.
SUBJECTION OF SUBCONTRACT
100
23.
TERMINATION OF SUBCONTRACT
100
24.
VOIDABILITY OF SUBCONTRACT
101
25.
WARRANTY OF SERVICES
101
26.
OFF-SHORE PERFORMANCE OF WORK PROHIBITED
101
27.
FEDERAL IMMIGRATION AND NATIONALITY ACT
101
ATTACHMENT B: MINIMUM NETWORK STANDARDS (By Geographic Service Area)
102
ATTACHMENT F: PERIODIC REPORT REQUIREMENTS
106
ATTACHMENT G: AUTO-ASSIGNMENT ALGORITHM
110
ATTACHMENT H (1): ENROLLEE GRIEVANCE SYSTEM STANDARDS AND POLICY
113
ATTACHMENT H(2)
PROVIDER CLAIM DISPUTE STANDARDS AND POLICY
118
ATTACHMENT I: ENCOUNTER SUBMISSION REQUIREMENTS
120
ATTACHMENT L: COST SHARING COPAYMENTS
123
-5-
SECTION B:
CAPITATION RATES
The Contractor shall provide services as described in this contract.
In
consideration for these services, the Contractor will be paid the attached
Contractor specific rates per member per month for the term October 1, 2006
through September 30, 2007.
See attached.
-6-
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
CAPITATION RATE SUMMARY - ACUTE RATES
Phoenix Health Plan
10/1/06-9/30/07
Maternity
TANF
TANF
TANF
TANF
TANF
SSI
SSI
Delivery
MED Hospital
Title XIX and KidsCare Rates;
<1, M/F
1-13, M/F
14-44, F
14-44, M
45+, M/F
w/Med
w/o Med
SFP
Supplement
Non-MED
MED
Supplement
8
Gila/Pinal
$505.20
$111.91
$182.99
$125.65
$348.62
$180.31
$565.41
$17.89
$6,348.42
$415.06
$979.58
$10,372.10
12
Maricopa
$497.71
$110.24