104BusinessContinuity RecoveryPlan.Pdf Form

AHCCCS CONTRACTOR OPERATIONS MANUAL CHAPTER 100 - ADMINISTRATION

Page 104-1 of 4 104 – BUSINESS CONTINUITY AND RECOVERY PLAN

EFFECTIVE DATE: 10/01/04, 10/01/12, 06/01/14, 07/01/16

REVISION DATE: 01/01/11, 09/27/12, 05/29/14, 02/04/16

STAFF RESPONSIBLE FOR POLICY: DHCM OPERATIONS

I. PURPOSE

This Policy applies to Acute Care, ALTCS/EPD, CRS, DCS/CMDP (CMDP), DES/DDD (DDD), and RBHA Contractors. AHCCCS requires in contract that each of its Contractors have a Business Continuity and Recovery Plan. The purpose of this Policy is to outline the required components of the Business Continuity and Recovery Plan. Refer to the Resources section of this Policy for additional information in developing an emergency management plan.

II. DEFINITION

ADMINISTRATIVE SERVICES SUBCONTRACTS

An agreement that delegates any of the requirements of the contract with AHCCCS, including, but not limited to the following:

1. Claims processing, including pharmacy claims,
2. Credentialing, including those for only primary source verification (i.e. Credential Verification Organization).
3. Management Service Agreements;
4. Service Level Agreements with any Division or Subsidiary of a corporate parent owner;

5. DDD acute care subcontractors. Providers are not Administrative Services Subcontractors.

   CONTINUITY OF OPERATIONS PROGRAMS (COOP) An effort within the individual executive departments and agencies to ensure that essential functions continue to be performed during a wide range of emergencies.

   III. POLICY

   AHCCCS is mandated to provide health care benefits to its members. In order to provide benefits, the Contractor must be able to recover from any disruption in services as quickly as possible. This recovery can be accomplished by the development of a Business Continuity and Recovery Plan that contains strategies for recovery. The Business Continuity and Recovery Plan is part of the Federal Government’s Continuity of Operations Programs (COOP) requirements.

AHCCCS CONTRACTOR OPERATIONS MANUAL CHAPTER 100 - ADMINISTRATION

Page 104-2 of 4 A. CONTRACTOR RESPONSIBILITIES

The Contractor shall develop and maintain a Business Continuity and Recovery Plan which assures AHCCCS that the provision of covered services will occur as stated in contract
[42 CFR 438.207 and 42 CFR 438.208]. A comprehensive summary of the Contractor’s Business Continuity and Recovery Plan must be evaluated, updated and submitted with Attachment A, as specified in Contract, Section F, Attachment F3, Contractor Chart of Deliverables and RBHA Contract, Exhibit-9, Deliverables. The summary shall be no longer than five pages and shall address all Business Continuity and Recovery Plan requirements outlined below.

B. BUSINESS CONTINUITY AND RECOVERY PLAN REQUIREMENTS

1. The Business Continuity and Recovery Plan (Plan) shall be reviewed and tested at least annually to manage unexpected events that may negatively and significantly impact the ability to deliver services to members and must be updated as needed by the Contractor.

2. The Contractor shall ensure that all staff are trained and familiar with the Plan.

3. The Plan must be specific to the Contractor’s operations in Arizona and reference local resources. Generic Plans which do not reference operations in Arizona and the Contractor’s relationship to AHCCCS are not acceptable.

4. The Plan shall contain a listing of key customer priorities and key factors that could cause disruption and timelines for when Contractors will be able to resume critical customer services when a disruption occurs.

   These priorities include but are not limited to: Providers receipt of prior authorization approvals and denials, members receiving transportation, and timely claims payments.

   The Contractor shall also include any additional priorities as identified by the Contractor to be critical key priorities or factors.

5. The Plan shall contain specific timelines for resumption of services as well as the percentage of recovery at certain hours, and the key actions required meeting those timelines.

   Example: Telephone service restored to prior authorization unit within four hours, to Member Services within 24 hours, to all phones in 24 hours.

6. The Plan shall contain, at a minimum, planning and training for: a. Electronic/telephonic failure,
   b. Complete loss of use of the main site and any satellite offices in and out of State, c. Loss of primary computer system/records, d. Extreme weather conditions,

AHCCCS CONTRACTOR OPERATIONS MANUAL CHAPTER 100 - ADMINISTRATION

Page 104-3 of 4 e. How the Contractor will communicate with AHCCCS during a business disruption.
(The name and phone number of a specific contact in the Division of Health Care Management is preferred). The Plan must direct the Contractor staff to contact AHCCCS Security at 602-417-4888 in the event of a disruption outside of normal business hours, and f. Periodic testing, at least annually. Results of the test shall be documented.

7. The Contractor shall designate a staff person as Business Continuity Planning Coordinator and furnish AHCCCS with contact information as part of the Plan.

8. The Contractor shall require Administrative Services Subcontractors to develop and maintain a Business Continuity and Recovery Plan.

   IV. RESOURCES

   The Federal Emergency Management Agency (FEMA) has a website which contains additional information on Business Continuity Planning, including checklists for reviewing a Plan.
   AHCCCS encourages the Contractor to use relevant parts of these checklists in the evaluation and testing of its own Business Continuity Plan. The Contractor can also reference the Arizona Division of Emergency Management and the Ready websites for supplementary information.
   Links to these websites are provided below.

   • Federal Emergency Management Agency (FEMA) • Arizona Division of Emergency Management • Ready.gov

   V. REFERENCES

   • Acute Care Contract, Section D • ALTCS/EPD Contract, Section D • CRS Contract, Section D • DCS/CMDP Contract, Section D • DES/DDD Contract, Section D • Contract, Section F, Attachment F3, Contractor Chart of Deliverables • RBHA Contract, Scope of Work • RBHA Contract, Exhibit 9-Deliverables • Attachment A, Business Continuity and Recovery Plan Checklist • 42 CFR 438.207
   • 42 CFR 438.208

AHCCCS CONTRACTOR OPERATIONS MANUAL CHAPTER 100 - ADMINISTRATION

Page 104-4 of 4 ATTACHMENT A, BUSINESS CONTINUITY AND RECOVERY PLAN CHECKLIST

SEE THE ACOM WEBPAGE FOR ATTACHMENT A OF THIS POLICY