Arizona Administrative Code › Title 6 - ECONOMIC SECURITY › Chapter 6 - DEPARTMENT OF ECONOMIC SECURITY - DEVELOPMENTAL DISABILITIES › Article 21 - DIVISION PROCUREMENT AND RATE SETTING - QUALIFIED VENDORS › Section R6-6-2104 - Criteria for Qualified Vendor Agreements

Current through Register Vol. 30, No. 28, July 12, 2024
A. To obtain a Qualified Vendor Agreement, an
				applicant shall submit a complete application to the Division that includes:
1. Identification of the services the
				applicant proposes to provide;
2.
				Identification of current and proposed locations at which service,
				administrative, or monitoring activities are conducted;
3. A description of staff qualifications if
				requested by the Division in the Request for Qualified Vendor
				Applications;
4. Corporate
				structure demonstrating ownership and corporate affiliations, if
				applicable;
5. A program plan to be
				included in the Directory of Qualified Vendors in a format prescribed by the
				Division;
6. Assurance that the
				applicant:
a. Holds the appropriate current
				Arizona license or certification to provide developmental disability services,
				and
b. That the license or
				certification is in good standing with the licensing or certification
				organization, or
c. Will possess
				the appropriate license or certification by the time of authorization of
				service;
7. A
				description of the applicant's quality management plan;
8. A declaration of any potential conflict of
				interest with any Division employee;
9. Assurances required by the Division as
				part of the application and documentation to support such assurances, if
				specifically requested by the Division in the Request for Qualified Vendor
				Applications;
10. Certification
				that the submission of the application does not involve collusion or other
				anti-competitive practice; and
11.
				Documentation of financial stability, including:
a. For a Qualified Vendor Agreement for
				services requiring a negotiated rate, the applicant shall submit a program
				budget and a proposed rate. The program budget information shall include:
i. An itemized service budget in a format
				prescribed by the Division;
ii. An
				income statement or statement of revenue by fund source for the applicant's
				current fiscal year to date and for each of the previous three fiscal
				years;
iii. A statement of
				expenditures by fund source for the applicant's current fiscal year to date and
				for each of the previous three fiscal years; and
iv. An audited financial statement or a
				financial audit for the prior fiscal year, if available.
b. For a Qualified Vendor Agreement for
				services that have a published rate, the applicant shall submit its audited
				financial statement for the prior year. In the absence of an audited financial
				statement, the applicant may submit quarterly financial statements for the
				prior year, including revenues and expenditures.
c. Applicants who do not have an audited
				financial statement or quarterly financial statements shall submit a personal
				financial statement of the Director or Chief Executive Officer or if a
				corporation, the corporate business plan.
d. A newly formed corporation shall submit
				the corporate business plan and personal financial statements of the Director
				or Chief Executive Officer.
e.
				Additional financial information may be required by the Request for Qualified
				Vendor Applications.