Free Declaration - District Court of Arizona - Arizona

EXHIBIT 18 TO SUPPLEMENTAL DECLARATION OF ELLEN KATZ

Case 2:03-cv-02506-EHC

Document 138-4

Filed 03/10/2008

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Contract No. YH03-0032

ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION DIVISION OF BUSINESS AND FINANCE CONTRACT AMENDMENT

1. AMENDMENT NO: 5 4.

2. CONTRACT NO.: YH03-0032 ADHS # HS461371

3.

EFFECTIVE DATE OF AMENDMENT: July 1, 2006

4. PROGRAM DHCM

CONTRACTOR'S NAME AND ADDRESS: Arizona Department of Health Services Children's Rehabilitative Services 150 North 18th Avenue, Suite 330 Phoenix, AZ 85007

6. PURPOSE OF AMENDMENT: To amend Sections B, D and E and Attachments B and F. 7. THE CONTRACT REFERENCED ABOVE IS AMENDED AS FOLLOWS: A. CHANGES IN REQUIREMENTS: In accordance with Section E, Paragraph 30, "Changes", various changes in contract requirements are indicated in this contract restatement. By signing this contract amendment, the Contractor is agreeing to the terms of the contract as amended.

B.

NOTE: Please sign and date both and then return one to:

Michael Veit, MD 5700 AHCCCS Contracts and Purchasing 701 E Jefferson Street Phoenix AZ 85034

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: 10. SIGNATURE OF AHCCCSA CONTRACTING OFFICER:

TYPED NAME: KAREN BOSWELL TITLE: PROCUREMENT ADMINISTRATOR

MICHAEL VEIT

CONTRACTS & PURCHASING ADMINISTRATOR

DATE:

DATE:

Case 2:03-cv-02506-EHC

Document 138-4

Filed 03/10/2008

CYE 07 CRSA Renewal July 1, 2006

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DEFINITIONS

Contract No. YH03-0032

MEDICAID

A Federal/State program authorized by Title XIX of the Social Security Act, as amended, which provides Federal matching funds for a state-operated medical assistance program for specified populations. Title XIX Waiver member whose family income is more than 100% of the Federal Poverty Level (FPL) and has family medical expenses that reduce income to or below 40% of the FPL. MEDs may have a categorical link to a Title XIX category; however, their income exceeds the limits of the Title XIX category. Medicare Part D is the Prescription Drug Coverage option available to Medicare beneficiaries, including those also eligible for Medicaid. Medications that are available under this benefit will not be covered by AHCCCS post January 1, 2006. There are certain drugs that are excluded from coverage by Medicare, and will continue to be covered by AHCCCS. Those medications are barbiturates, benzodiazepines, and over the counter medication as defined in the AMPM. Prescription medications that are covered under Medicare, but are not on a Part D Health Plan's formulary are not considered excluded drugs, and will not be covered by AHCCCS. Those covered services provided by qualified service providers within the scope of their practice to prevent disease, disability and other adverse health conditions or their progression or to prolong life. A Federal program authorized by Title XVIII of the Social Security Act, as amended. For this contract, a person eligible for AHCCCS who is enrolled with a contractor. The written determination by the Contractor concerning an appeal. AHCCCSA's Prepaid Medical Management Information System. Medically necessary services, related to an emergency medical condition, provided after the member's condition is sufficiently stabilized so that the member could alternatively be safely discharged or transferred to another location. 42 CFR 438.114(a) A Medicaid eligible recipient who is not enrolled with an acute care/ALTCS contractor [42 CFR 438.10(a)]. An individual who meets the requirements of ARS § 36-2901, and who is responsible for the management of the member's health care. A PCP may be a physician defined as a person licensed as an allopathic or osteopathic physician according to ARS Title 32, Chapter 13 or Chapter 17 or a practitioner defined as a physician assistant licensed under ARS Title 32, Chapter 25, or a certified nurse practitioner licensed under ARS Title 32, Chapter 15. A person or entity that subcontracts with CRSA, or its delegate, to provide AHCCCS covered services directly to members. State Children's Health Insurance Program under Title XXI of the Social Security Act. The Arizona version of SCHIP is referred to as "KidsCare." See "KIDSCARE." See "COVERED SERVICES." Members with special health care needs are those members who have serious and chronic physical, developmental or behavioral conditions, and who also require medically necessary health and related services of a type or amount beyond that required by members generally. All CRS recipients are considered to be members with special health
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MEDICAL EXPENSE DEDUCTION (MED)

MEDICARE PART D EXCLUDED DRUGS

MEDICALLY NECESSARY SERVICES MEDICARE MEMBER NOTICE OF APPEAL RESOLUTION PMMIS POST STABILIZATION SERVICES POTENTIAL ENROLLEE PRIMARY CARE PROVIDER/ PRIMARY CARE PRACTITIONER (PCP) PROVIDER SCHIP SCOPE OF SERVICES SPECIAL HEALTH CARE NEEDS

CYE `07 CRSA Renewal July 1, 2006

Case 2:03-cv-02506-EHC

Document 138-4

Filed 03/10/2008

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DEFINITIONS
care needs. STATE STATE FISCAL YEAR (FY) SUBCONTRACT The State of Arizona.

Contract No. YH03-0032

The budget year-State fiscal year: July 1 through June 30. An agreement entered into by CRSA with a provider of health care services who agrees to furnish covered services to members, or with a marketing organization, or with any other organization or person who agrees to perform any administrative function or service for CRSA specifically related to fulfilling CRSA's obligations to AHCCCSA under the terms of this contract. (1) A person, agency or organization to which CRSA has contracted or delegated some of its management functions or responsibilities to provide covered services to its members; or (2) A person, agency or organization with which a fiscal agent has entered into a contract, agreement, purchase order or lease (or leases of real property) to obtain space, supplies, equipment or services provided under the AHCCCS contract. An individual, entity or program that is or may be liable to pay all or part of the medical cost of injury, disease or disability of an AHCCCS applicant or member, as defined in R9-22-1001. The resources available from a person or entity that is, or may be, by agreement, circumstance or otherwise, liable to pay all or part of the medical expenses incurred by an AHCCCS applicant or member, as defined in R9-22-1001.

SUBCONTRACTOR

THIRD PARTY

THIRD PARTY LIABILITY

TITLE XIX MEMBER A member eligible for Federally funded Medicaid programs under Title XIX of the Social Security Act including those eligible under the 1931 provisions of the Social Security Act, Sixth Omnibus Budget Reconciliation Act (SOBRA), Supplemental Security Income (SSI), SSI-related groups, Title XIX Waiver groups, Medicare Cost Sharing groups, Breast and Cervical Cancer Treatment program and Freedom to Work. TITLE XIX WAIVER MEMBER All MED (Medical Expense Deduction) members, and adults or childless couples at or below 100% of the Federal Poverty Level who are not categorically linked to another Title XIX program. This would also include Title XIX linked individuals whose income exceeds the limits of the categorical program.

TITLE XXI MEMBER See "KIDSCARE."

[END OF DEFINITIONS]

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CYE `07 CRSA Renewal July 1, 2006

Case 2:03-cv-02506-EHC

Document 138-4

Filed 03/10/2008

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