Exhibit 10.9
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ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
DIVISION OF BUSINESS AND FINANCE
SECTION A: CONTRACT AMENDMENT
1. AMENDMENT #
2. CONTRACT#:
3. EFFECTIVE DATE OF AMENDMENT:
4. PROGRAM
7
YH14-0001-07
October 1, 2014
DHCM-ACUTE
5. CONTRACTOR NAME AND ADDRESS:
Health Choice Arizona
410 N. 44th Street, Suite 900
Phoenix, AZ 85008
6. PURPOSE: To renew the contract for the period October 1, 2014 through
September 30, 2015 and to amend Sections B, Capitation Rates and Contractor
Specific Requirements, C, Definitions, D, Acute Care Program Requirements, E,
Contract Terms and Conditions, and F, Attachments.
7. THE ABOVE REFERENCED CONTRACT IS HEREBY AMENDED AS FOLLOWS:
•
Section B, Capitation Rates and Contractor Specific Requirements
Section B, Capitation rates adjusted for the period October 1, 2014 through
September 30, 2015.
•
Section C, Definitions
•
Section D, Acute Care Program Requirements
•
Section E, Contract Terms and Conditions
•
Section F, Attachments
Refer to the individual Contract sections for specific changes.
Note: Please sign, date and return executed file by E-Mail to: Meggan Harley at
, Contracts Manager, AHCCCS Contracts & Purchasing and
Julie Ambur, Contracts and Policy Administrator, at ,
Division of Health Care Management.
8. EXCEPT AS PROVIDED FOR HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL
CONTRACT NOT HERETOFORE CHANGED AND/OR AMENDED REMAIN UNCHANGED AND IN FULL
EFFECT.
IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES IN AGREEMENT
9. SIGNATURE OF AUTHORIZED
REPRESENTATIVE: /s/ MIKE UCHRIN
10. SIGNATURE OF AHCCCS
CONTRACTING OFFICER: /s/ MICHAEL VEIT
TYPED NAME: MIKE UCHRIN
TYPED NAME: MICHAEL VEIT
TITLE: CHIEF EXECUTIVE OFFICER
TITLE: CONTRACTS AND PURCHASING ADMINISTRATOR
DATE: 9/8/14
DATE: August 25, 2014
TABLE OF CONTENTS
SECTION A: CONTRACT AMENDMENT
1
SECTION B: CAPITATION RATES AND CONTRACTOR SPECIFIC REQUIREMENTS
5
SECTION C: DEFINITIONS
6
PART 1.
DEFINITIONS PERTAINING TO ALL AHCCCS CONTRACTS
6
PART 2.
DEFINITIONS PERTAINING TO ONE OR MORE AHCCCS CONTRACTS
21
SECTION D: ACUTE CARE PROGRAM REQUIREMENTS
29
1.
PURPOSE, APPLICABILITY, AND INTRODUCTION
29
2.
ELIGIBILITY CATEGORIES
30
3.
ENROLLMENT AND DISENROLLMENT
32
4.
ANNUAL AND OPEN ENROLLMENT CHOICE
34
5.
RESERVED
34
6.
AUTO-ASSIGNMENT ALGORITHM
34
7.
AHCCCS MEMBER IDENTIFICATION CARDS
35
8.
MAINSTREAMING OF AHCCCS MEMBERS
35
9.
TRANSITION ACTIVITIES
36
10.
SCOPE OF SERVICES
37
11.
SPECIAL HEALTH CARE NEEDS
47
12.
BEHAVIORAL HEALTH SERVICES
48
13.
AHCCCS GUIDELINES, POLICIES AND MANUALS
51
14.
MEDICAID SCHOOL BASED CLAIMING
51
15.
PEDIATRIC IMMUNIZATIONS AND THE VACCINES FOR CHILDREN PROGRAM
51
16.
STAFF REQUIREMENTS AND SUPPORT SERVICES
52
17.
WRITTEN POLICIES AND PROCEDURES
57
18.
MEMBER INFORMATION
57
19.
SURVEYS
59
20.
CULTURAL COMPETENCY
59
21.
MEDICAL RECORDS
59
22.
ADVANCE DIRECTIVES
60
23.
QUALITY MANAGEMENT AND PERFORMANCE IMPROVEMENT
61
24.
MEDICAL MANAGEMENT
67
25.
TELEPHONE PERFORMANCE STANDARDS
69
26.
GRIEVANCE SYSTEM
69
27.
NETWORK DEVELOPMENT
70
28.
PROVIDER AFFILIATION TRANSMISSION
72
29.
NETWORK MANAGEMENT
72
30.
PRIMARY CARE PROVIDER STANDARDS
73
31.
MATERNITY CARE PROVIDER STANDARDS
74
32.
REFERRAL MANAGEMENT PROCEDURES AND STANDARDS
75
33.
APPOINTMENT STANDARDS
75
34.
FEDERALLY QUALIFIED HEALTH CENTERS AND RURAL