State of Hawaii Contract for Health and Human Services Competitive Purchase of Services (Contract No. DHS-08-MQD-5129) by and between State of Hawaii Department of Human Services and 'Ohana Health Plans, Inc

 

This Contract, executed on the respective dates indicated below, is effective as of    upon execution   , 20___, between the Department of Human Services/Med-QUEST Division, (Name of state department, agency, hoard or commission) State of Hawai'i ("STATE"), by its Director, Lillian B. Koller (Title of person signing for the STATE) whose address is: 1390 Miller Street Honolulu, Hawaii 96813 and   'Ohana Health Plan, Inc.,  (Name of PROVIDER)("PROVIDER"), a Corporation  (Legal form of PROVIDER i.e., Corporation, Limited Liability Company, etc.) under the laws of the State of Hawaii whose business street address and taxpayer identification numbers are as follows:

Business street address:

Mailing address if different than business street address:

 

Federal employer identification number: ________________

Hawai'i general excise tax number: ____________________

 

 

A.            This Contract is for a competitive purchase of services (a "Competitive POS"), as defined insection 103F-402, Hawai'i Revised Statutes ("HRS"), and Hawai'i Administrative Rules ("HAR") chapter 3-143.

 

B.            The STATE needs the health and human services described in this Contract and its attachments("Required Services") and the PROVIDER agrees to provide the Required Services.

 

AG Form I03F (9/06)

Competitive

 

C.            Money is available to fund this Contract pursuant to:

 

1)  Act SLH/2008,(Identify stale sources) in the amount of $556,287,755.00, (state funding)  or

 

(2) Social Security Act §1903 (Identify federal sources , in the amount of $682,936,471.00,  (federal funding) or both.                                                            

 

D.            The STATE is authorized to enter into this Contract pursuant to:

 

§103F-402HRS     (Legal authority for Contract) 

 

E.           The undersigned representative of the PROVIDER represents, and the STATE relies upon such representation, that he or she has authority to sign this Contract by virtue of (check any or all that apply):

 

£	corporate resolutions  of the  PROVIDER or other authorizing documents  such as partnership resolutions;

 

£	corporate by-laws of the PROVIDER, or other similar operating documents of the PROVIDER, such as a partnership contract or limited liability company operating contract;

 

£	the PROVIDER is a sole proprietor and as such does not require any authorizing documents to sign this Contract;

 

R	other evidence of authority to sign: Contractor's Acknowledgement

 

F.            The PROVIDER has provided a "Certificate of Insurance" to the STATE that shows to the satisfaction of the STATE that the PROVIDER has obtained liability insurance which complies with paragraph1.4 of the General Conditions of this Contract and with any Special Conditions of this Contract.

 

G.            The PROVIDER produced, and the STATE inspected, a tax clearance certificate as required by section 103-53, HRS.

 

NOW, THEREFORE, in consideration of the promises contained in this Contract, the STATE and the PROVIDER agree as follows:

 

1.           Scope of Services. The PROVIDER shall, in a proper and satisfactory manner as determined by the STATE, provide the Required Services set forth in Attachment "1" to this Contract, which is hereby made a part of this Contract, and the Request for Proposals ("RFP"), and the PROVIDER'S Proposal, which are incorporated in this Contract by reference. In the event that there is a conflict among the terms of this Contract, and either the Proposal or the RFP, or both, then the terms of this Contract shall control.

 

AG Form 103 F (9/06)

Competitive

Page 2

 

DOLLARS ($ 1,239,284,226.00), which amount includes all fees and costs incurred and any federal, state and local taxes, at the time and manner set forth in Attachment "3" to this Contract, which is hereby made a part of this Contract.

Notice to the PROVIDER shall be sent to the mailing address as indicated on page 1. A notice shall be deemed to have been received three (3) days after mailing or at the time of actual receipt, whichever is earlier. The PROVIDER is responsible for notifying the STATE in writing of any change of address.

 

AG Form 103F(9/06)

Competitive

Page 3

 

 

CORPORATE SEAL

(if available)

APPROVED AS TO FORM:

 

Deputy Attorney General

AG Form 103F(9/O6)

Competitive

STATE OF HAWAII

CITY & COUNTY OF HONOLULU

 

On this 4th day of  February 2008, before me appeared Lillian B. Koller and Erhardt Preitauer, to me known, to be the person(s) described in and, who, being by me duly sworn, did say that he/she/they is/are the Director of Dpt of Human Services and Executive Director / Asst Secretary of  Ohana Health Plan, Inc. the PROVIDER named in the forgoing instrument, and that he/she/they is/are authorized to sign said instrument on behalf of the PROVIDER, and acknowledges that he/she/they executed said instrument as the free act and deed of the PROVIDER.

AG Form J 03 F (9/06)

Competitive

 

Pursuant to a delegation of the authority by the Director of Human Resources Development, I certify that the services to be provided under this Contract, and the person(s) providing the services under this Contract are exempt from the civil service, pursuant to §76-16, Hawai'i Revised Statutes (HRS).

1 This part of the form may be used by all department heads and others to whom the Director of Human Resources Development (DHRD) has delegated authority to certify §76-16, HRS, civil service exemptions. The specific paragraph(s) of §76-16, HRS, upon which an exemption is based should be noted in the contract file. NOTE: Authority to certify exemptions under §§76-16(2), 76-16(12), and 76-16(15), HRS, has not been delegated; only the Director of DHRD may certify §§76-16(2), 76-16(12), and 76-16( 15) exemptions.

I certify that the services to be provided under this Contract, and the person(s) providing the services under this Contract are exempt from the civil service, pursuant to §76-16, Hawai'i Revised Statutes (HRS).

 

For the purposes of this declaration:

 

"Agency" means and includes the State, the legislature and its committees, all executive departments, boards, commissions, committees, bureaus, offices; and all independent commissions and other establishments of the state government but excluding the courts.

 

"Controlling interest" means an interest in a business or other undertaking which is sufficient in fact to control, whether the interest is greater or less than fifty percent (50%).

 

"Employee" means any nominated, appointed, or elected officer or employee of the State, including members of boards, commissions, and committees, and employees under contract to the State or of the constitutional convention, but excluding legislators, delegates to the constitutional convention, justices, and judges. (Section 84-3, HRS).

 

On behalf of: 'Ohana Health Plan, Inc. (Name of PROVIDER)

1.	PROVIDER £ is*  R  is not a legislator or an employee or a business in which a legislator or an employee has a controlling interest. (Section 84-15(a), HRS).

 

2.

PROVIDER has not been represented or assisted personally in the matter by an individual who has been an employee of the agency awarding this Contract within the preceding two years and who participated while so employed in the matter with which the Contract is directly concerned. (Section 84-15(b), HRS).

 

3.

PROVIDER has not been assisted or represented by a legislator or employee for a fee or other compensation to obtain this Contract and will not be assisted or represented by a legislator or employee for a fee or other compensation in the performance of this Contract, if the legislator or employee had been involved in the development or award of the Contract. (Section 84-14(d), HRS).

 

4.

PROVIDER has not been represented on matters related to this Contract, for a fee or other consideration by an individual who, within the past twelve (12) months, has been an agency employee, or in the case of the Legislature, a legislator, and participated while an employee or legislator on matters related to this Contract. (Sections 84-18(b) and (c), HRS).

 

PROVIDER understands that the Contract to which this document is attached is voidable on behalf of the STATE if this Contract was entered into in violation of any provision of chapter 84, Hawai'i Revised Statutes, commonly referred to as the Code of Ethics, including the provisions which are the source of the declarations

 

__________________

* Reminder to agency: If the "is" block is checked and if the Contract involves goods or services of a value in excess of $10,000, the Contract may not be awarded unless the agency posts a notice of its intent to award it and files a copy of the notice with the State Ethics Commission.  (Section 84-15(a), HRS).

 

AG Form 103F (9/06)

Standards of Conduct Declaration

Competitive

 

Page 7

 

above. Additionally, any fee, compensation, gift, or profit received by any person as a result of a violation of the Code of Ethics may be recovered by the STATE.

 

 

 

 

 

The PROVIDER shall, in proper and satisfactory manner as determined by the STATE, provide the Required Services set forth in RFP-MQD-2008-006 issued October 10, 2007, as amended ("the RFP"), and the PROVIDER'S accepted proposal, both of which are incorporated in this Contract by reference.

 

Revisions to specific provisions in the RFP are set forth below. Additional revisions may be necessary to the contract to comply with conditions imposed by the Centers of Medicare & Medicaid Services (CMS). The PROVIDER agrees to comply with such revisions imposed by CMS.

 

 

Modify the second bullet to read:

 

•   Any date specified by the individual on which appropriate Medicaid eligible expenses were incurred and which is within the immediate thirty (30) days prior to the date of application; or

 

 

Replace the first two paragraphs with the following:

 

Provided the health plan into which the member wants to enroll is not capped, the DHS will allow members to change health plans without cause for the first ninety (90) days from the effective date of enrollment in that health plan.

 

After the initial ninety (90) day grace period, members will be allowed to change health plans only during the annual plan change period, as described in Section 30.560, or as outlined in Section 30.600.

 

 

Modify the 1st paragraph, 2nd second sentence to read:

 

The DHS will process all disenrollment requests submitted orally or in writing by the member or his or her representative.

 

Amend this section to read:

 

The DOH, through its Child and Adolescent Mental Heath Division (CAMHD), will provide acute inpatient psychiatric and outpatient behavioral health services, community crisis management and crisis residential services, intensive family intervention, therapeutic living and therapeutic foster care supports, hospital-based residential treatment, partial hospitalization, respite care and biopsychosocial rehabilitation to children and adolescents age three (3) through age twenty (20) who the DOH determines are in need of intensive mental health services and are determined eligible for the SEBD Program. Additional information on the SEBD program is available in Appendix D,

 

 

Modify the 6th paragraph, 2nd sentence to read:

 

As a part of these monitoring activities, on a monthly basis, the health plan shall submit to the DHS or its designee the following information relevant to its waiting list:

 

Modify the 7th paragraph, 1st sentence to read:

 

For SFY 2009 and SFY 2010, the health plan shall meet with the DHS or its designee on at least a quarterly basis to discuss any issues associated with management of its personal assistance services Level I waiting list.

 

 

Modify the 6th paragraph, 2nd sentence to read:

 

As a part of these monitoring activities, on a monthly basis the health plan shall submit to the DHS or its designee the following information relevant to its waiting list.

 

Modify the 7th paragraph, 1st sentence to read:

 

For SFY 2009 and 2010, the health plan shall meet with the DHS or its designee on at least a quarterly basis to discuss any issues associated with management of its HCBS waiting list.

 

 

Replace this section with the following:

 

In the event a member entering the health plan is receiving medically necessary covered services in addition to or other than prenatal services (see below for members in the second and third trimester receiving prenatal services) the day before enrollment into the health plan, the health plan shall be responsible for the costs of continuation of such medically necessary services, without any form of prior approval and without regard to whether such services are being provided by contract or non-contract providers. The health plan shall provide continuation of such services for the lesser of 1) ninety (90) days for all members receiving HCBS and all children under the age of twenty-one and 2) one-hundred and eighty (180) days for all members living in a nursing facility and all members without a care plan OR until members in these categories have had a HFA from his or her service coordinator, had a care plan developed and has been seen by the assigned POP who has authorized a course of treatment.

 

In the event the member entering the health plan is in her second or third trimester of pregnancy and is receiving medically necessary covered prenatal services the day before enrollment, the health plan shall be responsible for providing continued access to the prenatal care provider (whether contract or non-contract) through the postpartum period.

 

 

Formerly known as SED Serious Emotional Disturbance or SEBD Serious Emotional

Behavioral Disturbance, CAMHD's SEBD program provides an array of services needed

by families to support children and youth with the high-end intensive mental health

support.

 

 

I. CRITERIA 

Children and youth with serious emotional disturbance are individuals who have a Child and Adolescent Functional Assessment Scale (CAFAS) score of 80 or above and currently, or at anytime during the past year, have had a primary DSM-IV Axis I diagnosis.

 

II. EXCLUDED DIAGNOSES

If the diagnoses listed below are the only DSM-IV diagnoses, the child is ineligible for SEBD services. These diagnoses, however, may and often do co-exist with other DSM-IV diagnoses, which make the youth eligible for SEBD services.

 

317     Mild Mental Retardation

318.0  Moderate Mental Retardation

318.1  Severe Mental Retardation

318.2  Profound Mental Retardation

319     Mental Retardation, Severity Unspecified

 

315.0   Reading Disorder

315.1   Mathematics Disorder

315.2   Disorder of Written Expression

315.9 Learning Disorder NOS

 

315.3   Developmental Coordination Disorder

 

315.31 Expressive Language Disorder

315.32 Mixed Receptive-Expressive Language Disorder

315.39 Phonological Disorder

307.0   Stuttering

307.9   Communication Disorder NOS

 

D-24

299.0   Autistic Disorder

299.80 Rett's Disorder

299.10 Childhood Disintegrative Disorder

299.80 Asperger's Disorder

 

 

 

III.       PROVISIONALLY QUALIFIED

 

Children and youth provisionally qualified as SEBD are defined as those:

 

•	Who have a substance abuse condition and are suspected to suffer from a qualifying condition due to their symptoms and functional limitations. These children and youth have ongoing and recent substance abuse, which prevents the clinician from making a definitive qualifying diagnosis.
•	Cases in which the impairment is profound and short-term.

•	Whose degrees of impairment falls mainly within the emotional/self-harm domains that show strong evidence of serious disturbance.

 

 

TIME OF PERFORMANCE

 

The services of the Provider under this Contract shall commence upon execution of the Contract to June 30, 2011. However, performance and payment obligations for each successive fiscal year shall be subject to the availability and appropriation of funds. DHS shall have the option to extend the contract with the Provider for (3) three fiscal years beyond June 30, 2011. Any renewal or extension of the contract will be subject to available funding.

 

Delivery of services to members under this Contract will commence on November 1, 2008.

Attachment 3

 

 

The total compensation of One Billion, Two Hundred Thirty Nine Million, Two Hundred Twenty Four Thousand, Two Hundred Twenty Six Dollars ($1,239,224,226.00) for the period November 1, 2008 to June 30, 2011 will be paid directly to the Provider using HIPAA 834/820 transactions, based on the attached Exhibit A. Performance and payment obligations for each fiscal year shall be subject to the availability and appropriation of funds.

 

 

AG Form 103F (9/06)

General Conditions

Table of Contents

Competitive

 

 

AG Form 103F (9/06)

General Conditions

Table of Contents

Competitive