Fillable Printable Minimum Subcontract Provisions Altcs

Minimum Subcontract Provisions Altcs

MINIMUM SUBCONTRACT PROVISIONS

ALTCS/EPD and DES/DDD Contractors

10/01/14

MINIM U M S U BCONTR A CT P RO V I SI O NS

For the sole pur pose of this Attac hment, the f ollowing definitions apply:

“Subcontract” means any Contract between the AHCCCS Contractor and a third party for the performance of

any or all services or requirements specified under the Contractor’s Contract with AHCCCS.

“Subcontractor” means any third party with a Contract with the Contractor for the provision of any or all

services or requir ements specif ied under the Contract or’s Contract with AHCCCS.

Subcontractors who provide services under the AHCCCS Long Term Care Programs, including ALTCS/EPD

and DES/DDD must comply with the following applicable rules and statutes:

• ALTCS - Arizona Administrative Code (A.A.C.) Title 9, Chapter 28. AHCCCS statutes for long term

care are generally found in Arizona Revised Statue (A.R.S.) Title 36, Chapter 29, Article 2.

• Medicare Cost Sharing - A.A.C. Title 9, Chapter 29 (for Acute) and A.A.C. Title 9, Chapter 29 (for

ALTCS).

• DES/DDD - A.A.C. Title 9, Chapter 22, 28, and 33. AHCCCS statutes for DDD are generally found

in A.R.S. Title 36, Chapter 5.1 and § 36-2932.

All statutes, rules and regulations cited in this attachment are listed for reference purposes only and are not

intended to be all inclusive.

MINIMUM SUBCONTRACT PROVISIONS

ALTCS/EPD and DES/DDD Contractors

10/01/14

The following provi sions must be r eferenced and com pli ance require d in every Subcontr act .

1. ASSIG NM ENT AN D DELEG ATIO N OF RIG HTS A ND RES PONS IBI LITI ES

No payment due the Subcontractor under this subcontract may be assigned without the prior approval of the

Contractor. No assignment or delegation of the duties of this subcontract shall be valid unless prior written

approval is received from the Contractor. (A.A.C. R2-7-305)

2. AWAR DS O F O THER S U BCONTRA CT S

AHCCCS and/or the Contractor may undertake or award other contracts for additional or related work to the

work performed by the Subcontractor and the Subcontractor shall fully cooperate with such other contractors,

subcontractors or state employees. The Subcontractor shall not commit or permit any act which will interfere

with the performa nce of w ork by any ot her contractor, s ubcontractor or state employ ee. (A.A.C. R2-7-308)

3. CERTIF ICA TIO N OF CO MPLI AN CE – ANTI-KI C K BA CK A ND L A BO R AT O RY T ESTING

By signing this subcontract, the Subcontractor certifies that it has not engaged in any violation of the Medicare

Anti-Kickback statute (42 USC §§1320a-7b) or the “Stark I” and “Stark II” laws governing related-entity

referrals (P L 101-239 and PL 101-432) and compensation there from. If the Subcontractor provides laboratory

testing, it certifies that it has complied with 42 CFR 411.361 and has sent to AHCCCS simultaneous copies of the

information required by that rule to be sent to the Centers for Medicare and Medicaid Services. (42 USC

§§1320a-7b; PL 101-239 and PL 101-432; 42 CFR 411.361)

4. CERTIFICATION OF TR UTHF ULNE SS OF REPR ESE NTATI O N

By signing this subcontract, the Subcontractor certifies that all representations set forth herein are true to the best

of its knowledge.

5. CLINI C AL L A B O R ATORY IM P RO V EM E NT AMEND M E NTS O F 1988

The Clinical Labora tory Improvement Amendment (CLIA) of 1988 requires laboratories and other facilities that

test human specimens to obtain either a CLIA Waiver or CLIA Certificate in order to obtain reimbursement from

the Medicare and Medicaid (AHCCCS) programs. In addition, they must meet all the requirements of 42 CFR

493, Subpart A.

To comply with these requirements, AHCCCS requires all clinical laboratories to provide verification of CLIA

Licensur e or Certificate of Waiver during the provider registr ation process. Failure to do so shall result in either a

termination of an active provider ID number or denial of initial registration. These requirements apply to all

clinical laboratories.

Pass-through billing or other similar activities with the intent of avoiding the above requirements are prohibited.

The Contractor may not reimburse providers who do not comply with the above requirements. (CLIA of 1988; 42

CFR 493, Subpart A)

6. COMPLI A NCE WITH AHCC CS RU LES RE LATI NG TO AUDIT AN D INSPE CTIO N

The Subcontractor shall comply with all appl icable A HCCCS Rules and Audit Guide relating to the audit of the

Subcontractor's records and the inspection of the Subcontractor's facilities. If the Subcontractor is an inpatient

facility, the Subcontractor shall file uniform reports and Title XVIII and Title XIX cost reports with AHCCCS.

A.R.S. §41-2548; 45 CF R 74.48 (d)

MINIMUM SUBCONTRACT PROVISIONS

ALTCS/EPD and DES/DDD Contractors

10/01/14

7. COMPLI A NC E WITH L A WS A ND O TH ER R EQUIREMEN TS

The Subcontractor shall comply with all federal, State and local laws, rules, regulations, standards and executive

orders governing performance of duties under this subcontract, without limitation to those designated within this

subcontract. [ 42 CF R 434.70] [42 CF R 438.6(l) ]

8. CONFI DENT IALI TY RE QUI REM ENT

The Subcontractor shall safeguard confidential information in accordance with Federal and State laws and

regulations, including but not limited to, 42 CFR Part 431, Subpart F, A.R.S. §§36-107, 36-2903 (for Acute), 36-

2932 (for ALTCS), 41-1959 and 46-135, the Health Insurance Portability and Accountability Act (Public Law

107-191 Statutes 1936), 45 CFR Parts 160 and 164, and AHCCCS Rul es.

9. CONF LI C T I N I NTERPR ET ATI O N O F PROV I SI O NS

In the event of any conflict in interpretation between provisions of this subcontract and the AHCCCS Minimum

Subcontract Provisi ons, the latter shall take prec edence.

10. CONTRACT CLAIMS AND DISPUTES

Contract claims and disputes arising under A.R.S. Title 36, Chapter 29 shall be adjudicated in accordance with

AHCCCS Rules, A.R.S. §36-2901 et seq. ( for Acute ) and A.R.S. §36-2931 et seq. (for AL TCS).

11. ENCO UNT ER DAT A REQ UIRE MENT

If the Subcontractor does not bill the Contractor (e.g., Subcontractor is capitated), the Subcontractor shall submit

encounter data t o the Contractor i n a form accept able to AHCCCS.

12. EVALUA TIO N O F QUALI TY, A PP RO P RIA TE NES S, O R TIME LI N ESS O F S ERV I C ES

AHCCCS or the U.S. Department of Health and Human Services may evaluate, through inspection or other

means, the quality , appropriateness or timelines s of servic es perform ed under this subcontract .

13. FRAU D AND AB USE

If the Subcontractor discovers, or is made aware, that an incident of suspected fraud or abuse has occurred, the

Subcontractor must report the incident to AHCCCS, Office of the Inspector General (AHCCCS-OIG)

immedi ately within one busi ness day and to the prime Contract or.

14. GENERAL INDEMNIFICATION

The parties to th is Contract agree that AHCCCS shall be indemnified and held harmless by the Contractor and

Subcontractor for the vicarious liability of AHCCCS as a result of entering into this Contract. However, the

parties further agree that AHCCCS shall be responsible for its own negligence. Each party to this Contract is

responsible for its own negligence.

15. INSURANCE

[This provision applies only if the Subcontr actor provi des services directly to AHCCCS members]

The Subcontractor shall main tain for the duration of this subcontract a policy or policies of professional liability

insurance, comprehensive general liability insurance and automobile liability insurance in amounts that meet

Contractor’s requirements. The Subcontractor agrees that any insurance protection required by this subcontract,

or otherwise obtained by the Subcontractor, shall not limit the responsibility of Subcontractor to indemnify, keep

and save harmless and defend the State and AHCCCS, their agents, officers and employees as provided herein.

MINIMUM SUBCONTRACT PROVISIONS

ALTCS/EPD and DES/DDD Contractors

10/01/14

Furthermore, the Subcontractor shall be fully responsible for all tax obligations, Worker's Compensation

Insurance, and all other applicable insurance coverage, for itself and its employees, and AHCCCS shall have no

responsibility or liability for any such taxes or insurance coverage. (45 CFR Part 74) The requirement for

Worker’s Compensation Insurance doesn’t apply when a Subcontractor is exempt under A.R.S. §23-901, and

when such Subcontractor executes the appropriate waiver (Sole Proprietor/Independent Contractor) form.

16. LIMI TA TI O NS ON BIL LI NG A ND CO L L E CTI O N P RA CTICES

Except as provided in federal and state law and regulations, the Subcontractor shall not bill, or attempt to collect

payment from a person who was AHCCCS eligible at the time the covered service(s) were rendered, or from the

financially responsible relative or representative for covered services that were paid or could have been paid by

the System.

17. MAIN TE N AN CE O F REQUIR EMENTS TO DO BUSI NESS AN D P RO V I DE SERV I CES

The Subcontractor shall be registered with AHCCCS and shall obtain and maintain all licenses, permits and

authority necessary to do business and render service under this subcontract and, where applicable, shall comply

with all law s regarding s afety, unemployment insurance, disabi lity i nsurance and wor ker's com pensati on.

18. NON-DISC RIMI NATI ON REQ UI REME NTS

The Subcontractor shall comply with State Executive Order No. 99-4, which mandates that all persons,

regardless of race, color, religion, gender, national origin or political affiliation, shall have equal access to

employment opportunities, and all other applicable Federal and state laws, rules and regulations, including the

Americans with Disabilities Act and Title VI. The Subcontractor shall take positive action to ensure that

applicants for employment, employees, and persons to whom it provides service are not discriminated against

due to race, creed, color, religion, sex, national origin or disability. (Federal regulations, State Executive order

# 99-4)

19. PRIOR AU THO RIZ ATI ON AN D U TI LIZATI O N MANAG EMENT

The Contractor and Subcontractor shall develop, maintain and use a system for Prior Authorization and

Utilization Review that is consistent with AHCCCS Rules and the Contractor’s policies.

20. RECO RDS RET ENT ION

The Subcontractor shall maintain books and records relating to covered services and expenditures including

reports to AHCCCS and working papers used in the preparation of reports to AHCCCS. The Subcontractor shall

comply with all specifications for record keeping established by AHCCCS. All books and records shall be

maintained to the extent and in such detail as required by AHCCCS Rules and policies. Records shall include but

not be limited to financial statements, records relating to the quality of care, medical records, prescription files

and other records specified by AHCCCS.

The Subcontractor agrees to make available at its office at all reasonable times during the term of this Contract

and the period set forth in the following paragraphs, any of its records for inspecti on, audit or reproduction by any

authorized representative of AHCCCS, State or Federal government.

The Subcontractor shall preserve and make available all records for a period of five years from the date of final

payment under this Contract unless a longer period of time is required by law. For retentio n of patient medical

records, the subcontractor shall ensure compliance with A .R.S. §12-2297 which provides, in part, that a health

care provider shall retain patient medical records according to the following:

1. If the patient is an adult, the provider shall retain the patient medical records for at least six years after the

last date the adult patient received medical or health care services from that provider.

MINIMUM SUBCONTRACT PROVISIONS

ALTCS/EPD and DES/DDD Contractors

10/01/14

2. If the patient is under 18 years of age, the provider shall retain the patient medical records either for at least

three years after the child's eighteenth birthday or for at least six years after the last date the child received

medical or health care services from that provider, whichever date occurs later.

In addition, the Subcontractor shall comply with the record retention periods specified in HIPAA laws and

regulations, including, but not limited t o, 45 CFR 164.530(j)( 2).

If this Contract is completely or partially terminated, the records relating to the work terminated shall be

preserved and made available for a period of five years from the date of any such termination. Records which

relate to grievances, disputes, litigation or the settlement of claims arising out of the performance of this Contract,

or costs and expenses of this Contract to which exception has been taken by AHCCCS, shall be retained by the

Subcontractor for a period of five years after the date of final disposition or resolution thereof unless a longer

period of time i s r equired by law. (45 CF R 74.53; 42 CF R 431.17; A.R.S. §41-2548)

21. SEVERABILITY

If any provision of these standard subcontract terms and conditions is held invalid or unenforceable, the

remaini ng provisions shall continue valid and e nforcea ble to the full extent permitted by law.

22. STANDARDS OF CONDUCT

The subcontractor will perform services for members consistent with the proper and required practice of

medicine and must adhere to the customary rules of ethics and conduct of its appropriate professional

organization including, but not limited to, the American Medical Association and other national and state

boards and associations or health care professionals to which they are subject to licensing, certification, and

control.

23. SUBJ EC TI O N O F S UBCO NT RA CT

The terms of this subcontract shall be subject to the applicable material terms and conditions of the Contract

existing betwe en the Contractor and AHCC CS for t he provi sion of covered servi ces.

24. TERMINATION OF SUBCONTRACT

AHCCCS may, by written notice to the Subcontractor, terminate this subcontract if it is found, after notice and

hearing by the State, that gratuities in the form of entertainment, gifts, or otherwise were offered or given by the

Subcontractor, or any agent or representative of the Subcontractor, to an y officer o r e mplo yee of the S tate w ith a

view towards securing a Contract or securing favorable treatment with respect to the awarding, amending or the

making of any determinations with respect to the performance of the Subcontractor; provided, that the ex istence

of the facts upon which the state makes such findings shall be in issue and may be reviewed in any competent

court. If the subcontract is terminated under this section, unless the Contractor is a governmental agency,

instrume ntality or subd ivision thereof, AHCCCS shall be entitled to a penalty, in addition to any other damages

to which it may be entitled by law, and to exemplary damages in the amount of three times the cost incurred by

the Subcontractor in providing any such gratuities to any such officer or employee. [A.A.C. R2-5-501; A.R.S.

§41-2616 C.; 42 CFR 434.6, a. (6)]

25. VOI DABI LI T Y O F SUBC O NT RA CT

This subcontract is voidable and subject to immediate termination by AHCCCS upon the Subcontractor

becoming insolvent or filing proceedings in bankruptcy or reorganization under the United States Code, or upon

assignment or delegation of the subcontract without AHCCCS’ pri or w ritte n approval.

MINIMUM SUBCONTRACT PROVISIONS

ALTCS/EPD and DES/DDD Contractors

10/01/14

26. WARRANTY OF SERVICES

The Subcontractor, by execution of this subcontract, warrants that it has the ab ility, authority, skill, expertise and

capacity to perform the services specified in this Contract.

27. OFF-SHORE PERFORMANCE OF WORK PROHIBITED

Due to security and identity protection concerns, direct services under this Contract shall be performed within

the borders of the United States. Any services that are described in the specifications or scope of work that

directly serve the State of Arizona or its clients and may involve access to secure or sensitive data or personal

client data or development or modification of software for the State shall be performed within the borders of the

United States. Unless specifically stated otherwise in spec ifications, this definition does not apply to indirect or

“overhead” services, redundant back-up services or services that are incidental to the performance of the

Contract. This provision applie s to work per formed by s ubcontractors at all tiers.

28. FEDERAL IMMIGRATION AND NATIONALITY ACT

The Subcontractor shall comply with all federal, state and local immigration laws and regulations relating to

the immigration status of their employees during the term of the Contract. Further, the Subcontractor shall flow

down this requirement to all subcontractors utilized during the term of the Contract. The State shall retain the

right to perform random audits of Contractor and subcontractor records or to inspect papers of any employee

thereof to ensure compliance. Should the State determine that the Contractor and/or any subcontractors be

found noncompliant, the State may pursue all remedies allowed by law, including, but not limited to;

suspension of work, termination of the Contract for default and suspension and/or debarment of the Contractor.

MINIMUM SUBCONTRACT PROVISIONS

ALTCS/EPD and DES/DDD Contractors

10/01/14

Complian ce with the Federal Immig ration and Nationality Act (F INA) and All Other Federa l Immigra tion

Laws and Regulations related to Immigration Status of its Employees:

By entering into the Contract, the subcontractor warrants compliance with the Federal Immigration and

Nationality Act (FINA) and all other Federal immigration laws and regulations related to the immigration

status of its employees. The subcontractor shall obtain statements from any of its subcontractors certifying

compliance and shall furnish the statements to the Procurement Officer, upon request. These warranties shall

remain in effect through the term of the Contract. The subcontractor and its subcontractors shall also maintain

Employment Eligibility Verification forms (I-9) as required by the U.S. Department of Labor’s Immigration

and Control Act, for all employees performing work under the Contract. I-9 forms are available for download

at USACIS.GOV.

The State may request verification of compliance for any subcontractor or its subcontractor performing work

under the Contract. Should the Contractor suspect or find that the subcontractor or any of its subcontractors

are not in compliance, the Contractor may pursue any and all remedies allowed by law, including, but not

limited to: suspension of work, termination of the Contract for default, and suspension and/or debarment of the

subcontractor. All costs necessary to verify compliance are the responsibility of the subcontractor.

Compliance Requirements for A.R.S. §41-4401, Gover n ment Procur e ment: E-Verify Requirement

The subcontractor warrants compliance with all Federal immigration laws and regulations relating to

employees and warrants its compliance with Section A.R.S. §23-214, Subsection A. (That subsection reads:

“After December 31, 2007, every employer, after hiring an employee, shall verify the employment eligibility

of the employee through the E-Verify program.”)

A breach of a warranty regarding compliance with immigration laws and regulations shall be deemed a

material breach of the Contract and the subcontractor may be subject to penalties up to and including

termination of the Contract.

Failure to comply with a State or Contractor audit process to randomly verify the employment records of

subcontractors and any of its subcontractors shall be deemed a material breach of the Contract and the

subcontractor may be subject to penalties up to and including termination of the Contract.

The State Agency and Contractor retains the legal right to inspect the papers of any employee who works on

the Contract to ensure that the contractor or subcontractor is complying with the warranty.