NOTICE OF REQUEST FOR PROPOSAL SOLICITATION # YH19 …

1 NOTICE OF REQUEST FOR PROPOSAL . SOLICITATION # YH19-0001. AHCCCS COMPLETE CARE CONTRACT FOR CONTRACTORS. SECTION A: SOLICITATION AND OFFER PAGE. Chief Procurement Officer Meggan Harley, CPPO, MSW. Chief Procurement Officer Telephone: (602) 417-4538. AHCCCS E-Mail: 701 E. Jefferson, MD5700 Issue Date: November 2, 2017. Phoenix, Arizona 85034. LOCATION: ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION (AHCCCS). Procurement Office (First Floor). 701 E. Jefferson, MD 5700. Phoenix, AZ 85034. DESCRIPTION: AHCCCS COMPLETE CARE PROGRAM CONTRACT FOR CONTRACTORS. PROPOSAL DUE DATE: January 25, 2018 AT 3:00 ARIZONA TIME. A Pre- PROPOSAL Prospective Offerors' Conference has been scheduled for Wednesday, November 8, 2017 starting at 9 Arizona Time. The Conference will be held in the following location: AHCCCS.

2 Gold Room, Third Floor 701 E. Jefferson Street Phoenix, AZ 85034. QUESTIONS CONCERNING THIS SOLICITATION SHALL BE SUBMITTED TO THE PROCUREMENT OFFICER NAMED. ABOVE, IN WRITING, VIA E-MAIL, AS SPECIFIED IN SECTION H, INSTRUCTIONS TO OFFERORS. QUESTIONS MUST. BE SUBMITTED ON THE RFP YH19-0001 QUESTIONS AND RESPONSE TEMPLATE LOCATED IN THE BIDDERS'. LIBRARY. ANSWERS TO QUESTIONS WILL BE POSTED IN THE AHCCCS WEBSITE IN THE FORM OF A SOLICITATION . AMENDMENT FOR THE BENEFIT OF ALL POTENTIAL OFFERORS. In accordance with 36-2906, which is incorporated herein by reference, competitive sealed Proposals will be received by AHCCCS in accordance with the instructions in this SOLICITATION document until the time and date cited. Proposals received by the correct time and date will be opened and the name of each Offeror will be publicly read.

3 Proposals must be in the actual possession of AHCCCS on or prior to the time and date in accordance with the instructions in this SOLICITATION document. Late Proposals shall not be considered. All Proposals must be typewritten. Additional instructions for preparing a PROPOSAL are included in this SOLICITATION document. Persons with a disability may REQUEST a reasonable accommodation, such as a sign language interpreter, by contacting the person named above. Requests should be made as early as possible to allow time to arrange the accommodation. OFFERORS ARE STRONGLY ENCOURAGED TO CAREFULLY READ THE ENTIRE SOLICITATION . CONTRACT/RFP NO. YH19-0001. OFFER. The undersigned Offeror hereby agrees to provide all services in accordance with the terms and requirements stated herein, including all exhibits, amendments, and final PROPOSAL revisions (if any).

4 Signature also certifies Small Business Status. NPI No. (optional) For clarification of this offer, contact: Name: Federal Employer Identification No.: Title: Dun and Bradstreet (DUN) No. Phone: E-Mail Address: Company Name Signature of Person Authorized to Sign Offer Address Printed Name City State Zip Title CERTIFICATION. By signature in the Offer section above, the Offeror certifies: 1. The submission of the offer did not involve collusion or other anti-competitive practices. 2. The Offeror shall not discriminate against any employee or applicant for employment in violation of Federal Executive Order 11246, State Executive Order 2009-09 or 41-1461 through 1465. 3. The Offeror has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted offer.

5 Failure to provide a valid signature affirming the stipulations required by this clause shall result in rejection of the offer. Signing the offer with a false statement shall void the offer, any resulting contract and may be subject to legal remedies provided by law. 4. The Offeror __ __ _ is / _____ is not a small business with less than 100 employees or has gross revenues of $4 million or less. 5. The Offeror is in compliance with 18-132 when offering electronics or information technology products, services, or maintenance; and 6. The Offeror certifies that it is not debarred from, or otherwise prohibited from participating in any contract awarded by federal, state, or local government. ACCEPTANCE OF OFFER (to be completed by AHCCCS). Your offer, including all exhibits, amendments and final PROPOSAL revisions (if any), contained herein, is accepted.

6 The Contractor is now bound to provide all services listed by the attached Contract and based upon the SOLICITATION , including all terms, conditions, specifications, amendments, etc., and the Contractor's Offer as accepted by AHCCCS. The Contractor is cautioned not to commence any billable work or to provide any material or service under this Contract until Contractor receives written NOTICE to proceed. This Contract shall henceforth be referred to as Contract No. _____YH19-0001 _____. Award Date: _____. _____. MEGGAN HARLEY, AHCCCS Chief Procurement Officer 2 of 311. CONTRACT/RFP NO. YH19-0001. TABLE OF CONTENTS. SECTION A: SOLICITATION AND OFFER SECTION B: CAPITATION RATES AND CONTRACTOR SPECIFIC 8. SECTION C: DEFINITIONS ..9. PART 1. DEFINITIONS PERTAINING TO ALL AHCCCS CONTRACTS.

7 9. PART 2. DEFINITIONS PERTAINING TO ONE OR MORE AHCCCS CONTRACTS .. 29. SECTION D: PROGRAM REQUIREMENTS .. 39. 1. PURPOSE, APPLICABILITY AND INTRODUCTION .. 39. 2. ELIGIBILITY CATEGORIES .. 42. 3. ENROLLMENT AND DISENROLLMENT .. 44. 4. ANNUAL AND OPEN ENROLLMENT CHOICE .. 49. 5. MEMBER AND PEER INVOLVEMENT AND PARTICIPATION .. 49. 6. AUTO-ASSIGNMENT ALGORITHM .. 50. 7. ACCOMODATING AHCCCS 51. 8. TRANSITION ACTIVITIES .. 52. 9. SCOPE OF SERVICES .. 55. 10. SPECIAL HEALTH CARE NEEDS .. 76. 11. BEHAVIORAL HEALTH SERVICE DELIVERY .. 79. 12. AHCCCS GUIDELINES, POLICIES AND MANUALS .. 89. 13. MEDICAID SCHOOL BASED CLAIMING .. 89. 14. PEDIATRIC IMMUNIZATIONS AND THE VACCINES FOR CHILDREN 90. 15. STAFFING 91. Key Staff Positions .. 92. 16. WRITTEN POLICIES AND PROCEDURES.

8 100. 17. MEMBER INFORMATION .. 101. 18. 104. 19. CULTURAL COMPETENCY .. 105. 20. MEDICAL RECORDS .. 105. 21. ADVANCE 106. 22. QUALITY MANAGEMENT AND PERFORMANCE IMPROVEMENT .. 108. 23. MEDICAL 118. 3 of 311. CONTRACT/RFP NO. YH19-0001. 24. TELEPHONE PERFORMANCE 125. 25. GRIEVANCE AND APPEAL SYSTEM .. 125. 26. NETWORK DEVELOPMENT .. 127. 27. PROVIDER AFFILIATION 133. 28. NETWORK 133. 29. PRIMARY CARE PROVIDER STANDARDS .. 134. 30. MATERNITY CARE PROVIDER REQUIREMENTS .. 136. 31. REFERRAL MANAGEMENT PROCEDURES AND STANDARDS .. 136. 32. APPOINTMENT STANDARDS .. 137. 33. FEDERALLY QUALIFIED HEALTH CENTERS AND RURAL HEALTH CLINICS .. 138. 34. PROVIDER MANUAL .. 139. 35. PROVIDER 139. 36. 140. 37. CLAIMS PAYMENT/HEALTH INFORMATION SYSTEM .. 144. 38. SPECIALTY CONTRACTS .. 149.

9 39. HOSPITAL SUBCONTRACTING AND REIMBURSEMENT .. 149. 40. RESPONSIBILITY FOR NURSING FACILITY REIMBURSEMENT .. 150. 41. INCENTIVES/PAY FOR 150. 42. MATERIAL CHANGE TO BUSINESS OPERATIONS .. 151. 43. PERFORMANCE BOND OR BOND SUBSTITUTE .. 152. 44. AMOUNT OF PERFORMANCE 153. 45. ACCUMULATED FUND DEFICIT .. 153. 46. ADVANCES, EQUITY DISTRIBUTIONS, LOANS AND INVESTMENTS .. 153. 47. FINANCIAL VIABILITY STANDARDS .. 154. 48. AFFILIATED CORPORATION .. 156. 49. CHANGE IN CONTRACTOR ORGANIZATIONAL STRUCTURE .. 156. 50. 156. 51. CAPITATION ADJUSTMENT .. 166. 52. MEMBER BILLING AND LIABILITY FOR PAYMENT .. 167. 53. REINSURANCE .. 168. 54. COORDINATION OF BENEFITS AND THIRD PARTY LIABILITY .. 172. 55. 177. 4 of 311. CONTRACT/RFP NO. YH19-0001. 56. MEDICARE SERVICES AND COST SHARING.

10 177. 57. MARKETING .. 178. 58. CORPORATE COMPLIANCE .. 178. 59. RECORD RETENTION .. 185. 60. SYSTEMS AND DATA EXCHANGE REQUIREMENTS .. 186. 61. ENCOUNTER DATA 190. 62. ENROLLMENT AND CAPITATION TRANSACTION UPDATES .. 192. 63. PERIODIC REPORTING REQUIREMENTS .. 193. 64. REQUESTS FOR INFORMATION .. 193. 65. DISSEMINATION OF INFORMATION .. 194. 66. READINESS REVIEWS .. 194. 67. MONITORING AND OPERATIONAL REVIEWS .. 194. 68. ADMINISTRATIVE ACTIONS .. 195. 69. CONTINUITY OF OPERATIONS AND RECOVERY PLAN .. 196. 70. MEDICARE REQUIREMENTS .. 197. 71. PENDING ISSUES .. 199. 72. VALUE-BASED PUCHASING .. 201. SECTION E: CONTRACT TERMS AND 204. 1. ADVERTISING AND PROMOTION OF 204. 2. APPLICABLE LAW .. 204. 3. ARBITRATION .. 204. 4. ASSIGNMENT AND DELEGATION .. 204. 5. ASSIGNMENT OF CONTRACT AND BANKRUPTCY.