Ariz. Admin. Code § R6-6-2104 - Criteria for Qualified Vendor Agreements

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.

B. The Division shall consider the following factors in determining if an applicant is a Qualified Vendor and eligible to enter into a Qualified Vendor Agreement:

1. Ability of the applicant to meet the need for services based on performance, including compliance with licensing and certification requirements; program monitoring, agreement monitoring, or contract monitoring reports; and corporate or individual experience providing community developmental disability services or similar services in Arizona and in other states;

2. Whether the applicant has met the requirements of the Qualified Vendor application process;

3. Whether the application is consistent with the Division's network development plan or other documentation of projected service need;

4. Financial stability of the applicant as demonstrated by the financial information provided in the application;

5. The rate proposal for a negotiated rate agreement; and

6. Any other criteria deemed relevant by the Division and included as part of the Request for Qualified Vendor Applications.

C. The Division shall document the results of its evaluation of the applications in the Division agreement file.

Notes

Ariz. Admin. Code § R6-6-2104

New Section made by exempt rulemaking at 9 A.A.R. 170, effective February 1, 2003 (Supp. 03-1). Amended by exempt rulemaking at 9 A.A.R. 4656, effective October 9, 2003 (Supp. 03-4).