1
EXHIBIT 10.12
STATE OF CALIFORNIA
STANDARD AGREEMENT -- APPROVED BY THE --------------------------------------------------
ATTORNEY GENERAL CONTRACT NUMBER XX.XX.
96-26293 00
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TAXPAYER'S FEDERAL EMPLOYER IDENTIFICATION NUMBER
541-000588
THIS AGREEMENT, made and entered into this 1st day of October, 1996, --------------------------------------------------
in the State of California, by and between State of California, through its duly
elected or appointed, qualified and acting
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TITLE OF OFFICER ACTING FOR STATE AGENCY
Chief, Program Support Branch Department of Health Services , hereafter called the State, and
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CONTRACTOR'S NAME
MAXIMUS , hereafter called the Contractor.
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WITNESSETH: That the Contractor for and in consideration of the covenants,
conditions, agreements, and stipulations of the State hereinafter expressed,
does hereby agree to furnish to the State services and materials as follows:
(Set forth service to be rendered by Contractor, amount to be paid Contractor,
time for performance or completion, and attach plans and specifications, if
any.)
ARTICLE I - PREAMBLE
THIS CONTRACT IS ENTERED INTO UNDER THE PROVISIONS OF SECTION 14016.5 ET SEQ.,
WELFARE AND INSTITUTIONS CODE (W&I CODE) AND SB835, AN ACT TO AMEND SECTIONS
14016.5, 14088.05, 14088.22, 14089, 14301, 14304, AND 14408, AND TO ADD SECTIONS
14087.305, 14088.23, AND 14464 TO THE WELFARE AND INSTITUTIONS CODE, RELATING TO
MEDI-CAL.
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APPROVED
/s/ Xxxx Xxxxxxx 10/9/96
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Department of Finance
Budget Division
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CONTINUED ON 33 SHEETS, EACH BEARING NAME OF CONTRACTOR AND CONTRACT NUMBER.
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The provisions on the reverse side hereof constitute a part of this agreement.
IN WITNESS WHEREOF, this agreement has been executed by the parties hereto,
upon the date first above written.
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STATE OF CALIFORNIA CONTRACTOR
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AGENCY CONTRACTOR (If other than an
individual, state whether a
corporation, partnership, etc.)
Department of Health Services MAXIMUS
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BY (AUTHORIZED SIGNATURE) BY (AUTHORIZED SIGNATURE)
/s/ Xxxxxx X. Harley /s/ Xxxxx X. Xxxxxxx
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PRINTED NAME OF PERSON SIGNING PRINTED NAME AND TITLE OF PERSON SIGNING
Xxxxxx X. Xxxxxxxxx Xxxxx X. Xxxxxxx, CEO
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TITLE ADDRESS
Chief, Program Support Branch 0000 Xxxxxxx Xxxx, XxXxxx, XX 00000
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AMOUNT EMCUMBERED BY THIS PROGRAM/CATEGORY (CODE AND TITLE) FUND TITLE DEPARTMENT OF GENERAL SERVICES
DOCUMENT ------------------------------
Loc.Asst.Sect 14157 W & I Code Health Care DEposit USE ONLY
$48,200,000 ----------------------------------------------------------- FORM POLICY BUDGET
--------------------------- (OPTIONAL USE) ------------------------------
PRIOR AMOUNT ENCUMBERED FOR Department of General Services
THIS CONTRACT Xxx.Xxx.Xx. 93778 4260-101-001 & 890
----------------------------------------------------------- APPROVED
$-0- ITEM CHAPTER STATUTE FISCAL YEAR
--------------------------- 0000-000-000 000 0000 96/97
TOTAL AMOUNT ENCUMBERED TO ----------------------------------------------------------- OCT. 10, 1996
STATE OBJECT OF EXPENDITURE (CODE AND TITLE)
$48,200,000 N/A
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I hereby certify upon my own personal knowledge that T.B.A. NO. X.X.XX.
budgeted funds are available for the period and BY /s/ Xxxxx Xxxx
purpose of the expenditure stated above.
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SIGNATURE OF ACCOUNTING OFFICER DATE
/s/ Xxxxxxx Xxxxxx 10/2/96 Ass't Chief Counsel
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[ ] CONTRACTOR [ ] STATE AGENCY [ ] DEPT. OF GEN. SER. [ ] CONTROLLER [ ]
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STATE OF CALIFORNIA
STANDARD AGREEMENT
1. The Contractor agrees to indemnify, defend and save harmless the State, its
officers, agents and employees from any and all claims and losses accruing
or resulting to any and all contractors, subcontractors, material men,
laborers and any other person, firm or corporation furnishing or supplying
work services, materials or supplies in connection with the performance of
this contract, and from any and all claims and losses accruing or resulting
to any person, firm or corporation who may be injured or damaged by the
Contractor in the performance of this contract.
2. The Contractor, and the agents and employees of Contractor, in the
performance of the agreement, shall act in an independent capacity and not
as officers or employees or agents of State of California.
3. The State may terminate this agreement and be relieved of the payment of
any consideration to Contractor should Contractor fail to perform the
covenants herein contained at the time and in the manner herein provided.
In the event of such termination the State may proceed with the work in any
manner deemed proper by the State. The cost to the State shall be deducted
from any sum due the Contractor under this agreement, and the balance, if
any, shall be paid the Contractor upon demand.
4. Without the written consent of the State, this agreement is not assignable
by Contractor either in whole or in part.
5. Time is of the essence in this agreement.
6. No alteration or variation of the terms of this contract shall be valid
unless made in writing and signed by the parties hereto, and no oral
understanding or agreement not incorporated herein, shall be binding on any
of the parties hereto.
7. The consideration to be paid Contractor, as provided herein, shall be in
compensation for all of Contractor's expenses incurred in the performance
hereof, including travel and per diem, unless otherwise expressly so
provided.
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TABLE OF CONTENTS
ARTICLE I PREAMBLE
ARTICLE II - GENERAL TERMS AND CONDITIONS Pg 2
A. GOVERNING AUTHORITIES Pg 2
B. FULFILLMENT OF OBLIGATIONS Pg 2
C. INDEMNIFICATION Pg 3
D. ASSIGNMENT Pg 3
E. INSPECTION RIGHTS Pg 3
F. COMPLIANCE WITH OBLIGATIONS Pg 4
G. DISCRIMINATION COMPLAINTS Pg 5
H. NONDISCRIMINATION CLAUSE AND COMPLIANCE Pg 5
I. AMERICANS WITH DISABILITIES ACT CERTIFICATION Pg 5
J. CONTRACTORS NATIONAL LABOR RELATIONS BOARD
CERTIFICATION Pg 8
K. MINORITY, WOMEN, AND DISABLED VETERAN BUSINESS
ENTERPRISE PARTICIPATION GOALS Pg 6
L. CERTIFICATION OF DRUG-FREE WORKPLACE Pg 6
M. CONSULTANT SERVICES Pg 7
N. NOTICES Pg 8
O. EVALUATION OF CONTRACTORS PERFORMANCE Pg 8
P. RESOLUTION OF DISPUTES Pg 9
Q. PUBLICATION REQUIREMENTS Pg 9
R. COPYRIGHT AND OWNERSHIP OF MATERIALS Pg 10
S. STATE TRADEMARKS AND SERVICE MARKS Pg 12
T. PATENTS Pg 13
U. LIABILITY INSURANCE Pg 15
V. INCORPORATION OF REQUEST FOR PROPOSAL Pg 00
X. XXXXXXXXXXXXX XX XXXXXXXX XX BID Pg 16
X. INCORPORATION OF EXHIBITS Pg 16
Y. CHANGE ORDERS Pg 17
Z. HEALTH CARE OPTIONS Pg 17
AA. CONTRACTOR NAME CHANGE Pg 18
BB. NOVATION Pg 18
ARTICLE III - DUTIES OF CONTRACTOR Pg 19
A. RECORDS ESTABLISHMENT, ACCESS, AND RETENTION Pg 19
B. ACCOUNTING AND AUDITING REQUIREMENTS Pg 19
C. EQUIPMENT Pg 20
D. COMMUNICATION Pg 21
E. PURCHASE ORDERS AND SUBCONTRACTING PROVISIONS Pg 22
F. STANDARDS OF WORK Pg 23
G. PROGRESS REPORTS OR MEETINGS Pg 23
H. STATE APPROVAL OF SUBCONTRACTS Pg 23
I. CONFLICT OF INTEREST - CURRENT AND FORMER STATE
EMPLOYEES Pg 24
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ARTICLE IV - TERM AND TERMINATION Pg 26
A. TERM Pg 26
B. CONTRACT EXTENSION Pg 26
C. CANCELLATION AND AMENDMENT PROVISIONS Pg 26
D. DEPARTMENT TERMINATION Pg 27
ARTICLE V - PAYMENT PROVISIONS Pg 28
A. AMOUNTS PAYABLE Pg 28
B. COSTS REIMBURSABLE Pg 28
C. PAYMENT IN FULL Pg 31
D. CONTRACTOR PAYMENT AND EXPENDITURE PROVISIONS Pg 31
E. MISCELLANEOUS PAYMENT PROVISIONS Pg 33
F. CONTRACT CLOSE-OUT Pg 33
G. CONTRACTS IN EXCESS OF $200,000 Pg 34
H. CONTRACTS FUNDED IN WHOLE OR IN PART BY THE FEDERAL
GOVERNMENT Pg 34
ARTICLE VI - CONFIDENTIALITY Pg 35
EXHIBIT A - TAKEOVER REQUIREMENTS
EXHIBIT B - SCOPE OF WORK
EXHIBIT C - TURNOVER REQUIREMENTS
EXHIBIT D - DEPARTMENT RESPONSIBILITIES
EXHIBIT E - TRAVEL ALLOWANCES AND REIMBURSEMENTS
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WHEREAS, it is the intention of the Department that the Contractor will:
Provide accurate, complete and current information to AFDC and MediCal
applicants and beneficiaries on managed care plans with available capacity,
provide services in the area where the person resides, and in the person's
primary language; and
Educate and inform AFDC and Medi-Cal beneficiaries of the options for obtaining
Medi-Cal services through either enrollment in managed care plans or
fee-for-service Medi-Cal with an emphasis on the benefits and limitations of
increased access to health care services through health care plans; and
Implement the HCO program in a timely and uniform manner in those counties which
will require an HCO program due to new or existing managed care plans in those
counties and future counties designated by the Department without interruption
to County Welfare Departments and/or services AFDC and Medi-Cal beneficiaries;
and,
Conduct all enrollment and disenrollment activities in any County, as
designated by the Department, in a timely and efficient manner; and
Develop and maintain a process to assign AFDC and Medi-Cal beneficiaries, who
have failed to make a timely managed care plan choice or are exempt from
assignment, into an available managed care plan which provides services in an
area where the beneficiary resides; and
Serve as a resource, educate and provide assistance to help enrollees understand
the methods available to resolve issues and problems with their health care
plan; and
WHEREAS, it is in the best interest of all parties to enter into this
contract;
NOW THEREFORE, the contract is entered as follows:
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Article II
ARTICLE II - GENERAL TERMS AND CONDITIONS
A. GOVERNING AUTHORITIES
This contract will be governed and construed in accordance with:
Chapter 7 and 8, Part 3, Division 9, Welfare and Institutions Code;
Division 3, Title 22, California Code of Regulations;
Title 42, Code of Federal Regulations (CFR);
Xxxxx 00, Xxxxxx Xxxxxx Code, Section 1396 et seq.;
Title 45, Code of Federal Regulations, Part 74;
Section 10344, (c)(2), Public Contract Code;
Section 3700, California Labor Code.
All other applicable laws and regulations, and any amendments of, additions
to, or deletions from those laws and regulations.
Any provision of this contract which is in conflict with the above laws,
regulations and federal Medicaid statutes is hereby amended to conform to
the provisions of those laws and regulations. The amendment of the contract
shall be effective on the effective date of the statutes or regulations
necessitating it, and shall be binding on the parties even though such
amendment may not have been reduced to writing and formally agreed upon and
executed by the parties. If, due to amendment in laws and regulations,
Contractor is unable or unwilling to comply with the provisions of the
amendment(s), the Contractor may terminate this contract. The termination
shall become effective on the last day of the second calendar month
following the month in which notice of termination was given.
B. FULFILLMENT OF OBLIGATIONS
No covenant, condition, duty, obligation, or undertaking contained or made
a part of this contract will be waived except by written agreement of the
parties hereto, and forbearance or indulgence in any other form or manner
by either party in any regard whosoever will not constitute a waiver of
covenant, condition, duty, obligation or undertaking to be kept, performed
or discharged by the party to which the same may apply; and, until
performance or satisfaction of all covenants, conditions, duties,
obligations, and undertakings is complete, the other
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party will have the right to invoke any remedy available under the
contract, or under law, notwithstanding such forbearance or indulgence.
C. INDEMNIFICATION
Contractor shall indemnify, defend and hold harmless the State of
California and its agencies, officers, agents and employees from and
against any and all claims and losses accruing or resulting from any and
all contractors, subcontractors, material persons, laborers and any other
person, firm or corporation furnishing or supplying work, services,
equipment, materials, or supplies in connection with the performance of
this agreement, and from any and all claims and losses accruing or
resulting from any person, firm or corporation who may be injured or
damaged by the Contractor in the performance of this agreement. Contractor
agrees to include the State in any consultant or subcontractor agreements
as a named indemnitee. Contractor further agrees to indemnify the State
against all loss incurred by the State as a result of Contractor's failure
to comply with terms and conditions of State of California, Department of
Health Services and other sponsors' administrative requirements including
but not limited to costs expended by Contractor which are determined by the
Federal and State Government to be ineligible for reimbursement.
Contractor, subcontractor, and the agents and employees of the Contractor,
in the performance of this agreement shall act in an independent capacity
and not as officers, employees or agents of the State of California.
D. ASSIGNMENT
Without the written consent of the State, this agreement is not assignable
by the Contractor, either in whole or in part; this agreement shall inure
to the benefit and bind the successors of each of the parties; this
agreement shall be governed by the laws of the State of California as to
interpretation and performance; and no alteration or variation of the terms
of this contract shall be valid unless made in writing and signed by the
parties hereto, and no oral understanding or agreement not incorporated
herein in writing shall be binding on any of the parties hereto. Time is of
the essence in this agreement.
E. INSPECTION RIGHTS
The Contractor will allow the Department, Health and Human Services (HHS),
the Comptroller General of the United States, Department of Justice (DOJ),
Bureau of Medi-Cal Fraud, Department
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of Corporations (DOC), and other authorized state agents or their duly
authorized representatives, to inspect or otherwise evaluate the quality,
appropriateness and timeliness of services performed under this contract,
and to inspect, evaluate and audit any and all books, records, and
facilities maintained by the Contractor and subcontractors, pertaining to
such services at any time during the normal business hours. Books and
records include, but are not limited to, all physical records originated or
prepared pursuant to the performance under this contract including working
papers, reports, financial records and books of account, subcontracts, and
any other documentation pertaining to services rendered. Upon request, at
any time during the period of this contract, the Contractor will furnish
any such records, or copy thereof, to the Department or HHS.
To assure compliance with the contract and for any other reasonable
purpose, the Department and its authorized representatives and designees
will have the right to premises access, with or without notice to the
Contractor. This will include the enrollment form processing facility,
presentation sites, or such other place where duties under the contract are
being performed.
Staff designated by the Department or the State Auditor will have access to
all security areas and the Contractor will provide, and will require any
and all of its subcontractors to provide, reasonable facilities,
cooperation and assistance to Department representative(s) in the
performance of their duties. Access will be undertaken in such a manner as
not to unduly delay the work of the Contractor and/or subcontractor(s).
F. COMPLIANCE WITH OBLIGATIONS
The Contractor is required to comply with all obligations under this
contract. The Department will issue a letter of non-compliance to the
Contractor for any violations, and impose any sanctions allowed by law. The
letter of non-compliance will include the violation, sanctions which may be
imposed, and corrective action required by the Contractor, including time
frames required for said corrective action. Failure to comply with
corrective actions within the specified time frames shall be deemed to be a
subsequent violation. Requests for Extensions of specified time frames must
be submitted in writing to the Departments Contract Manager for approval
prior to the expiration of the time frames.
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G. DISCRIMINATION COMPLAINTS
The Contractor agrees that copies of all grievances received by the
Contractor alleging discrimination against members of MediCal managed care
plans, Medi-Cal applicants or beneficiaries because of race, color, creed,
sex, religion, age, national origin, ancestry, marital status, sexual
orientation, or physical or mental handicap will be forwarded to the
Department for review and appropriate action.
H. NONDISCRIMINATION CLAUSE AND COMPLIANCE
During the performance of this agreement, Contractor and its subcontractors
shall not unlawfully discriminate, harass, or allow harassment, against any
employee, applicant for employment, or beneficiary because of sex, race,
color, ancestry, religious creed, national origin, disability (including
HIV and AIDS), medical condition (i e. cancer), age, marital status, denial
of family and medical care leave and denial of pregnancy disability leave.
Contractor and its subcontractors shall ensure that the evaluation and
treatment of their employees, applicants for employment, and beneficiaries
are free from discrimination and harassment. Contractor and its
subcontractors shall comply with the provisions of the Fair Employment and
Housing Act (Government Code, Section 12900 et seq.), and the applicable
regulations promulgated thereunder (California Code of Regulations, Title
2, Section 7285.0 et seq.). The applicable regulations of the Fair
Employment and Housing Commission implementing Government Code, Section
12990 (a-f), set forth in Chapter 5 of Division 4 of Title 2 of the
California Code of Regulations are incorporated into this agreement by
reference and made a part hereof as if set forth in full. Contractor and
its subcontractor shall give written notice of their obligations under this
clause to labor organizations with which they have a collective bargaining
or other agreement.
Contractor shall include the nondiscrimination and compliance provisions of
this clause in all subcontracts to perform work under this agreement.
I. AMERICANS WITH DISABILITIES ACT CERTIFICATION
The Contractor, by signing this agreement, agrees to fully comply with the
Americans with Disabilities Act (ADA) of 1990, (42 U.S.C. 12101 et seq.),
which prohibits discrimination on the basis of disability, as well as all
applicable regulations and guidelines issued pursuant to the ADA.
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Article II
J. CONTRACTORS NATIONAL LABOR RELATIONS BOARD CERTIFICATION
The Contractor, by signing this agreement, does swear under penalty of
perjury that no more than one final unappealable finding of contempt of
court by a federal court has been issued against the Contractor within the
immediate preceding two (2) year period because of the Contractor's failure
to comply with an order of the National Labor Relations Board (Public
Contracting Code Section 12096).
K. MINORITY, WOMEN, AND DISABLED VETERAN BUSINESS ENTERPRISE PARTICIPATION
GOALS
The Contractor will comply with applicable requirements of California law
relating to Minority/Women/Disabled Veteran Business Enterprises (M/W/DVBE)
commencing at Section 10115 of the Public Contract Code.
L. CERTIFICATION OF DRUG-FREE WORKPLACE
By signing this agreement, Contractor hereby certifies under penalty of
perjury under the laws of the State of California that the Contractor will
comply with the requirements of the Drug-Free Workplace Act of 1990
(Government Code, Section 8350 et seq.) and will provide a drug-free
workplace by taking the following actions:
1. Publishing a statement notifying employees that unlawful manufacture,
distribution, dispensation, possession, or use of a controlled
substance is prohibited and specifying actions to be taken against
employees for violations as required by Government Code, Section
8355(a);
2. Establishing a Drug-Free Awareness Program as required by Government
Code, Section 8355 (b), to inform employees about:
a. The dangers of drug abuse in the workplace;
b. The person's or organization's policy of maintaining a drug-free
workplace;
c. Any available counseling, rehabilitation and employee assistance
programs; and,
d. Penalties that may be imposed upon employees for drug abuse
violations; and
3. Providing, as required by Government Code, Section 8355(c),
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that every employee who performs work under this agreement:
a. will receive a copy of the Contractor's drug-free policy
statement; and
b. will agree to abide by the terms of the Contractor's statement as
a condition of employment under this agreement.
M. CONSULTANT SERVICES
Contractor shall be bound by the following provisions:
1. Contractor is hereby advised of his or her duties, obligations and
rights under Public Contract Code, Sections 10355 through 10382. In
the event of a dispute, the matter shall be settled by an arbitrator
mutually agreed upon by both parties.
2. Contractor's key personnel assigned to perform work under this
agreement and their level of responsibility shall be mutually
acceptable to the State and Contractor.
3. Contractor shall supply to the State one copy of a resume for each
employee, consultant, or employee of a subcontractor who will exercise
a major administrative, policy or consultative role on behalf of the
Contractor.
4. Contractor shall provide a series of progress reports in the manner
stipulated by the State.
5. Upon expiration or cancellation of this agreement, Contractor shall
submit to the State a comprehensive final report and, if required by
the State, schedule a final meeting with the State.
Failure to comply with these requirements may result in suspension of
payment under this agreement or cancellation of this agreement, or both,
and the Contractor may be ineligible for award of any future state
contracts if the State determines that the Contractor:
1. has made a false certification; or
2. violates the certification by failing to carry out the requirements as
noted above.
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N. NOTICES
All notices to be given under this contract will be in writing and will be
deemed to have been given when mailed to the Department or the Contractor:
State Department of Health Services Maximus
Medi-Cal Managed Care Division 0000 Xxxxx Xxxx Xxxxx,
Health Care Options Xxxx Xxxxx 000
000 X Xxxxxx, Xxxx 0000 Xxxxxxxxxx, XX 00000
P.O. Box 942732 Attn: Xxxx Xxxxxxxx
Xxxxxxxxxx, XX 00000-0000 or Xxxxx Xxxxx
Attn: Contract Manager
O. EVALUATION OF CONTRACTORS PERFORMANCE
1. Contractor is hereby notified that its performance under this
agreement will be evaluated within sixty (60) days of the completion
date of this agreement. This evaluation will remain on file with the
Department of General Services. The evaluation will remain on file for
thirty-six (36) months. The evaluation will report:
a. Whether the contracted work or services were completed as
specified in the contract;
b. Whether the contracted work or services met the quality standards
specified in the contract;
c. Whether the contractor fulfilled all the requirements of the
contract, and, if not, in what ways the contractor did not
fulfill the contract;
d. Factors outside the control of the contractor that caused
difficulties in contractor performance;
e. Other information the State may require; and,
f. How the contract results and findings will be utilized to meet
State goals.
2. If the Contractor's performance was judged unsatisfactory in any of
the factors specified in Subsection 1, above, and was not mitigated by
circumstances specified in Subsection 1 4, above, the evaluation shall
be considered unsatisfactory for purposes of Subsections 3 and 4,
below.
3. Contractor is further advised that if the State prepares an
unsatisfactory evaluation under the provisions of Subsection
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2, above, the Contractor shall be notified and sent a copy of the
evaluation within fifteen (15) days of its preparation. The evaluation
shall be placed on file with the Department of General Services. The
Contractor shall have thirty (30) days to send statements to the State
and the Department of General Services defending its performance under
this agreement. These statements shall be filed with the evaluation in
the State's contract file and in the Department of General Service's
files.
4. Contractor evaluations shall remain on file with the State for
thirty-six (36) months.
P. RESOLUTION OF DISPUTES
If the Contractor disputes any action by the Contract Manager arising under
or out of the performance of this agreement, the Contractor shall notify
the Contract Manager of the dispute in writing and request a decision. The
Contract Manager shall issue a decision within thirty (30) days of the
Contractor's notice. If the Contractor disagrees with the Contract
Manager's decision, the Contractor shall submit an appeal to the Chief of
the MediCal Managed Care Division.
The decision of the Contract Manger shall be final and conclusive on the
dispute unless the decision is arbitrary, capricious, or grossly erroneous
or if any determination of fact is unsupported by substantial evidence. The
decision of the Division Chief shall be in writing following an opportunity
for contractor to present documentary evidence and written arguments in
support of the matter.
Q. PUBLICATION REQUIREMENTS
1. Any publication resulting from this project, whether copyrighted or
not, must include an acknowledgement of support by the Department of
Health Services and the State, including a statement similar to "A
partnership program with the Department of Health Services" and
indicating the appropriate agreement number. Except for scientific
articles and papers appearing in scientific journals, materials must
also contain the following disclaimer:
"ANY OPINIONS, FINDINGS, CONCLUSIONS, OR RECOMMENDATIONS EXPRESSED IN
THIS PUBLICATION ARE THOSE OF THE AUTHOR(S) AND DO NOT NECESSARILY
REFLECT THE VIEWS OF THE DEPARTMENT OF HEALTH SERVICES OR THE STATE OF
CALIFORNIA."
2. The State reserves a royalty fee, non-exclusive and
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irrevocable license to reproduce, publish or otherwise use and to
authorize others to use, for State purposes:
a. the copyright in any work developed under this agreement or
subcontract; and
b. any rights of copyright to which a grantee or contractor
purchases ownership with State support.
3. Grantees shall comply with this section and provisions of OMB-Circular
A-110, paragraph 8b, and 13 CFR Part 143.34, to take all necessary and
prudent steps required to protect the federal government's, and the
State of California's license when conveying rights to publishers.
R. COPYRIGHT AND OWNERSHIP OF MATERIALS
1. The term "Work" as used in this Section, Section Q, PUBLICATION
REQUIREMENTS, and Section S, STATE TRADEMARKS AND SERVICE MARKS, means
all writing and printed material including the medium by which it is
recorded or reproduced, photographs, art work, pictorial
reproductions, drawings or other graphic representations and works of
a similar nature, sound recordings, films, tapes, original computer
programs (including executable computer programs and supporting data
in any form) and any other materials or products conceptualized,
developed and/or delivered in the course of or under this agreement.
The "Work" does not include those materials licensed pursuant to
Subsection 3, below.
2. Ownership
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In connection with any and all copyrightable or trademarked Work
developed or created by Contractor or its employees or subcontractors
in the course of performing and creating the Work, it is understood
and agreed that such Work shall be produced as work made for hire when
the Work is within the scope of the definition of work made for hire
in the United States Copyright Act. As such, the copyrights in such
Work shall belong to the State and no further action shall be
necessary to perfect the State's rights in them. In addition,
Contractor shall place or cause to be placed the following legend on
all Work, inserting the year of the Work's creation in the blank
space:
"Copyright @ 199_ by the State of California. All
rights reserved."
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3. Licenses
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For Work(s) requiring the use of copyrighted materials, contractor
shall furnish the names and addresses of all copyright holder(s) or
their agent(s), if any, and the terms of any license(s) or usage
granted, at the time of delivery of the Work. No licensed materials
will be used without prior written permission of the State.
4. Assignment
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If for any reason, the State is not deemed to be the owner of all
right, title and interest in the Work, then Grantee hereby assigns all
such rights to the State, and Grantee shall cause or require its
personnel and subcontractors to assign to Grantee or State, at the
time of creation of the Work, all such rights they may have in the
Work, all without any requirement for further consideration Grantee
shall take such further actions, including the execution and delivery
of instruments of conveyance, as may be appropriate to give full and
proper effect to such assignments.
5. Warranties
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Contractor represents and warrants that:
a. It is free to enter into and fully perform this agreement;
b. It has secured or will secure all rights and licenses necessary
for the production of the Work;
c. Neither the Work nor any of the materials, contained therein, nor
the exercise by the Contractor of the rights granted in this
agreement, will infringe upon or violate the rights or interests
of any person or entity;
d. Neither the Work nor any part of it will;
(1) violate the right of privacy of any person, firm, or
corporation;
(2) constitute a libel or slander against any person, firm or
corporation; or
(3) infringe upon the copyright, literacy, dramatic, statutory
or common law rights of any person, firm or corporation.
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e. It has not granted and shall not grant to any person or
entity any right that would or might derogate, encumber or
interfere with any of the rights granted to the State in
this agreement.
6. Indemnity
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Contractor agrees to indemnify, defend and hold harmless the State and
its licensees and assignees, and their officers, directors, employees,
agents, representatives, successors, from and against all claims,
actions, damages, losses, costs and expenses, including reasonable
attorneys fees; which any of them may sustain because of the use of
the Work and any other materials furnished by Contractor under this
agreement, or because of the breach of any of the representations or
warranties made in this agreement.
7. Notwithstanding the foregoing, any and all licenses granted by the
Contractor to the State pursuant to this section shall only be granted
to the extent that Contractor now has, or prior to the completion of
this agreement, may acquire the right to grant such a license. The
State hereby accepts any and all such licenses granted hereunder. The
State acknowledges that reuse of licensed materials, or use in a
different creative work or format will require renegotiations of use
fees and compensation by the State to the copyright holders. The State
agrees not to use any copyrighted materials outside the scope of the
license as mutually agreed by the State and the Contractor.
S. STATE TRADEMARKS AND SERVICE MARKS
1. Certain trademarks and service marks ("Golden California" and "The
California's" and other logo(s)), as set forth in Exhibit X, State
Trademarks and Service Marks, are the exclusive property of the State
of California, and may not be used alone or in combination with other
words, phrases, logos or marks, without advance written permission
from the State. Form and content of all advertising and promotional
materials, including magazines, require advance written permission of
the State. The trademarks and service marks, "Golden California" and
"The California's", shall be set apart from other text in some
fashion, such as larger type, quotation marks, different colors,
distinctive lettering, as approved in writing by the State. All
trademarks and service marks shall bear the statutory
trademark/service xxxx notice
2. If any State trademarks and service marks are used in the
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Work, the form and content of the Work must be approved by the State
prior to printing. In such case the State shall review all preprinting
proofs, such as blue lines and color keys, prior to printing. The
Contract Manager shall designate one person responsible for reviewing
all such preprinting proofs on behalf of the State.
T. PATENTS
1. The following definition applies to this section: "Subject Invention"
means any invention conceived and first actually reduced to practice
by Contractor in the course of or under the State funded portion of
this agreement (that portion of this agreement for which the
Contractor has invoiced the State and received reimbursement) and
includes any art, method, process, machine, manufacture, design or
composition of matter, or any new and useful improvement thereof, or
any variety of plants or animals, patentable under the patent laws of
the United States of America.
2. Right of Parties
----------------
a. Patent rights for Subject Inventions will be the property of the
Contractor, subject to the State retaining a royalty-free,
non-exclusive, nontransferable, irrevocable license to use or
have practiced for or on behalf of the State of California,
Subject Invention(s) for governmental purposes. The State does
not have the right to sub-license pursuant to any license
obtained pursuant to this agreement Contractor must obtain
agreements to effectuate this clause with all persons or entities
obtaining ownership interest in the patented Subject
Invention(s). Previously documented (whether patented or
unpatented under the patent laws of the United States of America
or any foreign country) inventions and background patents are
exempt from this provision.
b. To the extent permitted by law or overriding obligations of
Contractor, the Contractor agrees to grant the State a
royalty-free, non-exclusive, irrevocable, nontransferable license
to produce, translate, publish, use and dispose of, for or on
behalf of the State of California all copyrightable material
first produced or composed in the performance under the State
funded portion of this agreement. The license described in this
paragraph is limited to governmental purposes, and the State is
precluded from sub-licensing under any license obtained pursuant
to
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this agreement.
3. Disclosure Reporting
--------------------
Except as otherwise provided in Subsection 7.a, below, the Contractor
shall submit a written report to the Contract Manager on each Subject
Invention, specifying the patent(s) applied for, patent(s) issued, and
patent application(s) abandoned by or issued to the Contractor, and/or
to any of the participants.
4. Except in a patent application, the Contractor shall include in any
materials describing the patent mention of the State's role in the
project which resulted in the patent.
5. Reports
-------
The State reserves the right to use and reproduce all reports and data
produced and delivered pursuant to Subsection 6 and all other
reporting and monitoring requirements of this agreement, and reserves
the right to authorize others to use or reproduce such materials. All
reports are to be delivered to the Contract Manager. The State will
withhold from disclosure to the public information disclosing any
Subject Invention for a reasonable time in order for a patent
application to be filed. Furthermore, the State shall not release
copies of any document which is part of an application for a patent
filed with the United States Patent and Trademark Office or with any
foreign patent office.
6. Reporting After Expiration or Cancellation of This Agreement
------------------------------------------------------------
During the period of this agreement and for five (5) years following
the expiration or cancellation of this agreement, Contractor shall
submit an annual written report to the Contract Manager disclosing
the:
a. number of patents applied for on Subject Inventions;
b. number of patents issued on Subject Inventions;
c. number of patents abandoned on Subject Inventions; and
d. commercialization of Subject Inventions and patents. Where a
United States patent has been issued covering a Subject
Invention, a copy of the United States patent shall be provided
with the annual written report. Upon the fifth (5) anniversary
date of the
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cancellation of this agreement, Contractor shall submit a written
report to the Grant Manager summarizing all of the significant
events itemized above that were not previously reported and shall
summarize the Contractor's plans for commercializing all of the
Subject Invention(s) and patent(s) for the next five (5) years.
7. Flow-Through Rights
-------------------
a. The Contractor shall include this section, suitably modified to
identify the parties, in all subcontracts, regardless of tier,
for experimental, developmental, or research work. All such
subcontracts, regardless of tier, shall indicate that the
subcontractor shall be responsible for fulfilling the reporting
requirements to the State.
b. In all subcontracts, at any tier, where paragraph a above
applies, State, subcontractor, and Contractor agree that the
mutual obligations of the parties created by this section
(Section T, Patents) constitute an agreement between the
subcontractor and the State with respect to those matters covered
by this Section.
U. LIABILITY INSURANCE
1. Contractor shall furnish to the State a certificate of insurance
stating that there is Comprehensive General Liability Insurance (CGL)
presently in effect for the Contractor with a Combined Single Limit
(CSL) of not less than five hundred thousand dollars ($500,000) per
occurrence for bodily injury and property liability combined.
2. The Certificate of Insurance will provide:
a. that the insurer will not cancel the insured's coverage without
thirty (30) days' prior written notice to the State;
b. that the State, its officers, agents, employees, and servants are
included as additional insureds but only insofar as the
operations under this contract are concerned; and,
c. that the State will not be responsible for any premiums or
assessments on the policy.
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3. The Certificate of Insurance shall meet such additional standards as
may be determined by the State, either independently or in
consultation with the Department of General Services (DGS), Office of
Insurance and Risk Management (OIRM), as essential for protection of
the State.
4. The insurance will be issued by an insurance company acceptable to the
DGS, OIRM or be provided through partial or total self-insurance
acceptable to the DGS.
5. Contractor agrees that the CGL insurance herein provided for shall be
in effect at all times during the term of this agreement. Contractor
agrees to provide at least thirty (30) days' notice prior to said
expiration date, a new certificate of insurance evidencing insurance
coverage as provided for herein for not less than the remainder of the
term of this contract, or for a period of not less than one year.
6. New Certificates of Insurance are subject to the approval of the DGS
and Contractor agrees that no work or services shall be performed
prior to the giving of such approval. In the event Contractor fails to
keep in effect at all times insurance coverage as herein provided, the
State may, in addition to any other remedies it may have, cancel this
contract upon the occurrence of such event.
V. INCORPORATION OF REQUEST FOR PROPOSAL
The Request for Proposal is not attached hereto, but is expressly
incorporated by reference into this agreement. In the event of conflict or
inconsistency between the terms of this agreement and the Request For
Proposal, this agreement shall be controlling.
W. INCORPORATION OF PROPOSAL OR BID
The Contractor's proposal or bid is not attached hereto, but is expressly
incorporated by reference into this agreement. In the event of conflict or
inconsistency between the terms of this agreement and the Contractor's
proposal or bid, this agreement shall be controlling.
X. INCORPORATION OF EXHIBITS
Exhibits A through E are attached to this agreement and are expressly
incorporated hereto and made a part of this agreement by reference. The
exhibits consist of the following and are as presented in the RFP:
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1. Exhibit-A Takeover Requirements, consisting of 11 pages.
2. Exhibit-B Scope of Work, consisting of 29 pages.
3. Exhibit-C Turnover Requirements, consisting of 4 pages.
4. Exhibit-D Department Responsibilities, consisting of 2 pages.
5. Exhibit-E Travel Allowances and Reimbursements, consisting of 2
pages.
Y. CHANGE ORDERS
The Contractor will make changes requested by the Department. In the case
of mandated changes in policy, regulations, statutes, or judicial
interpretation, the Department may direct the Contractor to immediately
begin implementation of any change by issuing a Change Order. If the
Department issues a Change Order, the Contractor will be obligated to
implement the required changes while the parties negotiate in good faith
relevant to any reimbursement, if applicable.
The Department may, at any time, within the general scope of the contract,
by written notice, issue Change Orders to the Contract. This process will
make use of the following documents:
Medi-Cal Managed Care Division (MMCD) Policy Letters - These documents will
be utilized to notify the Contractor of clarifications made to the Health
Care Options program. These documents will include instructions to the
Contractor regarding implementation. These documents will also be used to
initiate various ongoing changes required to the Contractor throughout the
contract, the performance of which falls within the contract's agreed upon
reimbursement.
Change Orders may also be used by the Department to amend the Contractor's
responsibilities.
Z. HEALTH CARE OPTIONS
The parties recognize that during the life of the contract, the Health Care
Options program will be a dynamic program requiring numerous changes to its
operations and that the scope and complexity of changes will vary widely
over the life of the Contract. The parties agree that the development of a
system which has the capability to implement such changes in an orderly and
timely manner is of considerable importance.
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1. All obligations under this contract or Contract extension will be
terminated after turnover requirements are completed.
2. With respect to any report, invoice, record, paper, document, books of
account, or other contract required data submitted, pursuant to the
requirements of this contract, the Contractor's representative or his
designee will certify under penalty of perjury, that the report,
invoice, record, paper, document, books of account or other contract
required data is current, accurate, complete and in full compliance
with legal and contractual requirements to the best of that
individual's knowledge and belief, unless the requirement for such
certification is expressly waived by the Department in writing.
AA. CONTRACTOR NAME CHANGE
Contractor shall provide a written notice to the State at least 30 days
prior to any changes to the Contractor's current legal name.
BB. NOVATION
If the Contractor proposes any novation of this agreement, the State shall
act upon the proposal within 60 days after receipt of the written proposal.
The State may review and consider the proposal, consult and negotiate with
the Contractor, and accept or reject all or part of the proposal.
Acceptance or rejection may be made orally within the 60-day period, and
confirmed in writing within five days.
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ARTICLE III - DUTIES OF CONTRACTOR
A. RECORDS ESTABLISHMENT, ACCESS, AND RETENTION
1. The Contractor shall maintain such books and records necessary to
disclose how the Contractor discharged its obligations under the
contract. The books and records will disclose the quantity of services
provided under this contract, the quality of those services, the
manner and amount of payment made for those services, the manner in
which the Contractor administered its daily business, and the cost
thereof.
Such books and records shall include, but are not limited to: all
physical records originated or prepared pursuant to the performance
under this contract, including working papers; reports submitted to
the Department; Financial records; and other documentation pertaining
to the services rendered.
These books and records will be maintained for a minimum of five years
from the termination date of this contract, or, in the event the
Contractor has been duly notified that the Department, DHHS, or the
Comptroller General of the United States, or their duly authorized
representatives, have commenced an audit or investigation of the
contract, until such time as the matter under audit or investigation
has been resolved, whichever is later.
2. Contractor shall keep all books and records, accounts and documents
pertaining to this agreement separate from other activities not
related to this agreement. Said records shall be maintained in
California.
B. ACCOUNTING AND AUDITING REQUIREMENTS
1. The Contractor's financial records and books of account shall be
maintained on the accrual basis, in accordance with Generally Accepted
Accounting Principles, which fully disclose the disposition of all
Medi-Cal program funds received.
2. Upon inspection, Contractor shall promptly implement any corrective
measures recommended by the State or Bureau of State Audits regarding
the requirements of this section. Contractor shall be given a
reasonable amount of time to implement said corrective measures.
Failure of Contractor to implement recommended corrective measures
shall result in immediate cancellation of this agreement.
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3. Should an audit by the State or its authorized representatives, result
in disallowance of funds previously reimbursed to Contractor,
Contractor shall reimburse all disallowed funds to the State within
Sixty (60) days of receipt of the demand for reimbursement by the
State. Failure to reimburse the State will result in possible
litigation, with the prevailing party entitled to reasonable
attorney's fees and costs.
C. EQUIPMENT
1. Except as approved by the Department, Contractor shall not use State
funds allocated under this agreement to purchase furniture and
equipment. As used in this Section, "furniture and equipment" means an
article of nonexpendable, tangible personal property having a useful
life of at least one (1) year and a unit acquisition cost of at least
five thousand dollars ($5,000). Purchase of equipment shall comply
with the requirements of Article III, Section E, Purchase Orders and
Subcontracting Provisions.
2. A property identification tag must be placed on all equipment
purchased in whole or in part with State funds within thirty (30) days
of cost reimbursement for such equipment. The property identification
tag, as provided by the Contract Manager, identifies the item as the
property of the State of California, Department of Health Services,
and includes an identification number.
3. Within ninety (90) days of expiration or termination of this
agreement, contractor shall provide the State with an equipment
inventory list which identifies the type of equipment purchased in
whole or in part with State funds, the unit acquisition cost and the
property tag identification number.
4. Contractor is responsible for loss or damage to furniture or equipment
purchased with State funds. Contractor is obligated to keep the
furniture or equipment in good condition, subject to reasonable wear
and tear, and to make all necessary repairs and adjustment, without
qualification, while the furniture or equipment is in the care,
custody and control of the Contractor. The State reserves the right to
be given full and adequate access to the furniture or equipment
purchased with State funds at reasonable times.
5. Lost or stolen property must be reported to the Contract Manager. The
report shall contain a description of the loss or theft, plans to
prevent a reoccurrence, and, in the case
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of theft, a copy of the police report.
6. The State shall retain an ownership interest in furniture or equipment
purchased in whole or in part with State funds. In the event of
expiration or cancellation of this agreement, such furniture or
equipment shall be delivered to the State, unless:
a. this agreement is renewed and the State agrees to the continued
use of the furniture and/or equipment by the Contractor.
b. the State releases its ownership interest in the furniture and
equipment in accordance with State policy.
7. The Contractor is hereby notified that this process is discretionary
and is subject to both State regulations concerning surplus property
and signatory approvals by the Contract Manager and the Department of
Health Services Chief of Administrative Services.
D. COMMUNICATION
1. The designated individual of the State, shall be the Contract Manager
for this agreement. This person shall have overall responsibility to
administer, evaluate and follow-up the work of the Contractor or
consultant during the term of this agreement.
2. All official communication and invoices from the Contractor to the
State, except as provided for in the section on Resolution of
Disputes, shall be directed to the attention of the individual in
subsection 1, above, or other designated individuals of the State at
the following address:
Department of Health Services
Medi-Cal Managed Care Division
Health Care Options Xxxx
000 X Xxxxxx, Xxxx 0000
Xxxxxxxxxx, XX 00000
3. All official communications from the State to the Contractor shall be
directed to the attention of XXXX XXXXXXXX or XXXXX XXXXX, or other
individual designated by the Contractor, at the following address:
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MAXIMUS
0000 XXXXX XXXX XXXXX, XXXXX 000
XXXXXXXXXX, XX 00000
(000) 000-0000
E. PURCHASE ORDERS AND SUBCONTRACTING PROVISIONS
1. Contractor is encouraged to take advantage of vendor discounts
whenever possible and to utilize the services of small, minority,
woman and disabled veteran-owned businesses when subcontracting for
goods or services.
2. Contractor is the responsible authority, without recourse to the
State, regarding the settlement and satisfaction of all contractual
issues arising out of procurements entered into in support of this
agreement.
3. The Contractor is entitled to make use of its own staff and such
subcontractors as are mutually acceptable to the Contractor and the
State. All agreements between the Contractor and the subcontractor are
subject to approval by the Contract Manager.
4. Contractor must obtain prior written approval from the State for any
purchase order or subcontract over five thousand dollars ($5,000) to
be paid for with State funds. Contractor shall include in its request
for authorization, a copy of any subcontract and/or purchase order and
all particulars necessary for the evaluation:
a. the necessity of cost incurred;
b. of the reasonableness of the cost; and
c. that Contractor has either:
(1) obtained three (3) competitive bids;
(2) selected the subcontractor based upon the Contractor's
contracting procedures used for awarding federally-funded
subcontracts; or
(3) has justified why three bids were not obtained.
5. All agreements with subcontractors shall contain all of the following
provisions as are found in this contract:
a. General Provisions
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b. Nondiscrimination Clause Compliance
6. Agreements with subcontractors which involve the expenditure of State
funds in excess of ten thousand dollars ($10,000) shall contain all of
the provisions found in this contract under Record Establishment,
Access and Retention Under Article III, Section A.
7. Agreements with subcontractors, which include consultant services,
shall contain all of the provisions of Article II, Section M,
Consultant Services.
8. Printing and other reproduction work of more than an incidental amount
must be arranged through the State Printer unless the State has
obtained an exemption. Written approval must be obtained from the
Contract Manager prior to undertaking such work.
F. STANDARDS OF WORK
The Contractor agrees that the performance of work and services pursuant to
the requirements of this contract shall conform to high professional
standards.
G. PROGRESS REPORTS OR MEETINGS
1. Contractor shall submit progress reports or attend meetings with state
personnel at least once a month to allow the State to determine if
Contractor is on the right track, whether the project is on schedule,
provide communication to interim findings, and afford occasions for
airing difficulties or special problems encountered so that remedies
can be developed quickly.
2. At the conclusion of this contract, Contractor shall hold a final
meeting with the State during which Contractor shall present its
findings, conclusions, and recommendations. If required by this
contract, Contractor shall submit a comprehensive final report.
H. STATE APPROVAL OF SUBCONTRACTS
The Contractor shall submit any subcontracts to the State for approval
prior to implementation. Upon termination of any subcontract, the state
shall be notified immediately.
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I. CONFLICT OF INTEREST - CURRENT AND FORMER STATE EMPLOYEES
A. Current State Officers and Employees
------------------------------------
1. Contractor shall not utilize in the performance of this contract
any state officer or employee in the state civil service or other
appointed state official unless the employment, activity, or
enterprise is required as a condition of the officer or
employee's regular state employment. Employee in the state civil
service is defined to be any person legally holding a permanent
or intermittent position in the state civil service.
2. If any state officer or employee is utilized or employed in the
performance of this contract, Contractor shall first obtain
written verification from the State that the employment,
activity, or enterprise is required as a condition of the
officer's, employee's, or official's regular state employment and
shall keep said verification on file for three years after the
termination of this contract.
3. Contractor may not accept occasional work from any currently
employed state officer, employee, or official.
4. If Contractor accepts volunteer work from any currently employed
state officer, employee, or official, Contractor may not
reimburse, or otherwise pay or compensate, such person for
expenses incurred, including, without limitation, travel
expenses, per diem, or the like, in connection with volunteer
work on behalf of the Contractor.
5. Contractor shall not employ any state officers, employees, or
officials who are on paid or unpaid leave of absence from their
regular state employment.
6. Contractor or anyone having a financial interest in this contract
may not become a state officer, employee, or official during the
term of this contract. Contractor shall notify each of its
employees, and any other person having a financial interest in
this contract that it is unlawful under Public Contract Code,
Section 10410, for such person to become a state officer,
employee, or official during the term of this contract unless any
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relationship with the Contractor giving rise to a financial
interest, as an employee or otherwise, is first terminated.
7. Occasional or one-time reimbursement of a state employee's travel
expenses is not acceptable.
B. Former State Officers and Employees
-----------------------------------
1. Contractor shall not utilize in the performance of this contract
any formerly employed person of any state agency or department
that was employed under the state civil service, or otherwise
appointed to serve in the state government, if that person was
engaged in any negotiations, transactions, planning, arrangement,
or any part of the decision-making process relevant to the
contract while employed in any capacity by any state agency or
department. This prohibition shall apply for a two-year period
beginning on the date the person left state employment.
2. Contractor shall not utilize within 12 months from the date of
separation of services, a former employee of the contracting
state agency or department if that former employee was employed
in a policy making position in the same general subject area as
the proposed contract within the 12-month period prior to the
employee leaving state service.
C. Failure to Comply with Subparts "A" or "B"
------------------------------------------
If Contractor violates any provision of subparts A or B above, such action
by Contractor shall render this contract void, UNLESS the violation is
TECHNICAL OR NONSUBSTANTIVE.
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ARTICLE IV - TERM AND TERMINATION
A. TERM
The contract will become effective October 1, 1996 and will continue in
full force and effect through September 30, 1999 subject to the provisions
of Article V, Section A, because the State has currently appropriated and
available for encumbrance only funds to cover costs through June 30, 1997.
B. CONTRACT EXTENSION
DHS will have the exclusive option to extend the term of this contract
during the last twelve (12) months of the contract, as determined by the
original termination date or by a new termination date if an extension
option has been exercised. DHS may invoke up to two (2) separate extensions
of one (1) year each. The Contractor will be given at least nine (9)
months' prior written notice of DHS' decision on whether or not it will
exercise this option to extend the contract.
The Contractor will notify DHS of its intent to accept or reject the
extension within five (5) State working days of its receipt of the notice
from DHS.
C. CANCELLATION AND AMENDMENT PROVISIONS
1. No oral understanding or variation of terms of this agreement is valid
unless that understanding or variation has been made in writing and
signed by all parties.
2. The Department may terminate performance of work under this contract
in writing, in whole or in part, for any reason, whenever the
Department determines that termination is in the best interest of the
State, or full funding is not available for all of the project work
outlined in Exhibit B, Scope of Work.
Notification will be given at least sixty (60) days prior to the
effective date of termination, except in cases where the Director
determines the health and welfare of beneficiaries is jeopardized by
continuation of the contract, in which case the contract will be
immediately terminated. Notification will state the effective date of,
and the reason for, the termination.
Should the Department terminate the performance of work under this
contract, payment will be made to the Contractor for any and all work
completed under the terms of this
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contract, and approved by the Department, including withholds, up to
and including the date of termination.
Upon receipt of notice of termination for convenience, the Contractor
will be paid termination costs in accordance with 48 Code of Federal
Regulations (CFR) Section 31.205-42.
3. The Contractor may Default from this contract at any time for good
cause as determined by the Department, by giving written notice to the
Director of the Department. Such notice will be given at least sixty
(60) days prior to the effective date of the default. Notification
will state the effective date of, and the reason for the default. The
Contractor will be responsible for all closing costs associated with
default. Grounds under which a Contractor may default from the
contract are limited to the inability to negotiate reimbursement for
expanded duties as required by the Department and not identified in
the contract.
D. DEPARTMENT TERMINATION
Pursuant to Article IV, Section B, Cancellation and Amendment Provisions,
the Department has the option to void the contract under the 60 day
cancellation clause or to amend this contract to reflect any reduction of
funds.
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Article V
ARTICLE V - PAYMENT PROVISIONS
A. AMOUNTS PAYABLE
The maximum amount payable for the 1996-97 Fiscal Year ending June 30, 1997
will not exceed...................$48,200,000. Any requirement for
performance by DHS and the Contractor for the period subsequent to June 30,
1997 will be dependent upon the availability of future appropriations by
the Legislature for the purposes of this contract. If funds become
available for the purposes of this contract from future appropriations by
the Legislature, the maximum amount payable under this contract in the
1997-98 Fiscal Year ending June 30, 1998, will not exceed $30,720,000. If
funds become available for the purposes of this contract from future
appropriations by the Legislature, the maximum amount payable under this
contract for the 1998-99 Fiscal Year ending June 30, 1999, will not exceed
$30,720,000. The maximum amount payable under this Xxx contract will not
exceed $109,640,000.
B. COSTS REIMBURSABLE
Certain costs incurred by the Contractor in performing responsibilities
under this contract will be cost reimbursed by the Department. They are as
follows:
1. Postage
-------
The Department will reimburse only the actual charges paid for U.S.
Postal rates, common carrier rates and parcel services which includes
folding, stuffing, and posting utilized to mail documents to
beneficiaries, the Department, or to the Federal government and in any
other mailings required by Exhibit B or by the Department upon
request. All other costs associated with postage are excluded. The
exception to this is for zip sorting, the direct costs paid to an
outside mail sorting service, if approved by the Contract manager, in
order to obtain pre-sorting postage services to reduce costs on cost
reimbursable items.
2. Printing
--------
Allowable printing costs refer to those direct costs incurred for the
printing of: Enrollment/Disenrollment forms, informational packets,
Department approved handouts, Department approved plan comparison
charts, envelopes used for mailing and submission of letters and
forms, manuals for the State and Health Care Financing Administration
(HCFA); the printing of beneficiary notices, and additional
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documentation requested by the Department. Reimbursement of printing
costs associated with the production of these forms and documents will
be made by the Department.
The Department will cost reimburse the Contractor for the personnel
time needed to edit the informational packets and manuals as requested
by the Department.
The costs incurred except that cost reimbursable purchases and
subcontracts associated with allowable printing costs will be
reimbursed as provided in Section B.
3. Special Training Sessions
-------------------------
At the direction of the Contract Manager, the Contractor will be
required to conduct special training sessions as discussed in Exhibit
B, Section D.2. The Department will reimburse the Contractor for the
direct cost of training. Travel will be reimbursed at the State rate.
4. Data Center Access
------------------
The implementation of the Health Care Options (HCO) access to Medi-Cal
Eligibility Data System (MEDS) will require the Contractor to
establish an agreement with the Health and Welfare Data Center (HWDC)
for computer access to records contained in MEDs and possibly Fiscal
Intermediary Access to Medi-Cal Eligibility (FAME). The Department
will reimburse only the actual charges incurred by the Contractor for
access to these records, as billed by HWDC, including
telecommunication line charges to utilize MEDS or other eligibility
system. No other costs will be reimbursed.
5. Expenses Related to Expansion Activities
----------------------------------------
The reimbursement of costs incurred in carrying out expansion
activities shall be negotiated in good faith by the parties. These
costs may include, but are not limited to, additional facilities,
equipment, staff, supplies and systems.
6. Office Equipment and Furniture
------------------------------
The Department will reimburse those costs incurred by the Contractor
for equipment, and furniture necessary to perform HCO presentations,
at County and other governmental/non- governmental sites. Such
equipment and furniture will be purchased only after attempts have
been made to acquire the necessary equipment and furniture through
other means, and
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only after receiving prior Department approval and in accordance with
Article III, Section C, Equipment.
7. Facilities
----------
If space is not available at County sites, the Department may
determine that it is necessary to conduct HCO presentations at
non-governmental locations. In that case, the Department will assist
the Contractor in identifying appropriate facilities, and reimburse
any lease or rental payments. The facilities identified above do not
include the Contractor's processing facilities or any other facility
not directly acquired for conducting HCO presentations. All facilities
and lease/rental agreements must be approved by the Department.
It is the intention of the Department to have Departmental staff
located at the Contractor's processing facility. The anticipated
number of staff will be 1-3 persons. Contractor will make available,
space and equipment for Department staff use at the processing
facility. All equipment and furniture for Department staff will be
cost reimbursed with the exception of space.
8. Ad Hoc Reports
--------------
The Department will reimburse the Contractor for time spent
researching and preparing any Ad Hoc Reports requested by the
Department. This does not include monthly reports required under the
Scope of Work, Exhibit B.
9. Travel
------
Travel expenditures necessary to maintain staffing at fixed and
outreach sites, as directed by the Department, will be the
responsibility of the Department, and will be cost reimbursed at the
State rate following guidelines set forth in Exhibit E. Travel
expenditures will be submitted in accordance with staffing and travel
plans provided to and approved by the Contract Manager.
10. Special Projects and Requests
-----------------------------
The Department will reimburse the Contractor for time and expenses
incurred completing any special projects requested by the Department,
and not included in the scope of work as described in Exhibit B.
11. Restrictions on Reimbursable Purchases and Subcontracts
-------------------------------------------------------
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Payment to the Contractor for subcontracts or purchases of cost
reimbursable items or services will be at actual cost to the
Contractor. Such actual cost will consist of the amount charged to the
Contractor for the subcontract or purchase. If the lease or purchase
is from a related entity, payment will be made at the product price.
For only printing, the Contractor will also be paid the other direct
costs associated with subcontracts or purchases.
Under no circumstances will the Department reimburse indirect costs
associated with a subcontractor or purchase of reimbursable items,
services or equipment. This prohibition includes attempts to charge
the Department for overhead and general and administrative expenses as
a percentage of a third party's charges to the Contractor.
C. PAYMENT IN FULL
The payments discussed in this Article constitute payment in full by the
Department for all direct and indirect costs incurred under this contract.
D. CONTRACTOR PAYMENT AND EXPENDITURE PROVISIONS
1. In no event shall the Contractor request reimbursement from the State
for obligations entered into or for costs incurred prior to the
commencement date, or the date of final approval, whichever occurs
later, or after the expiration or cancellation of this agreement.
2. Contractor will submit all invoices after completion of required work.
Invoices will be submitted in arrears by the tenth (1Oth) working day
of the month following the month of service. The invoice shall be in
triplicate and shall be consistent with the amounts in Article VI,
Section C. Requests for reimbursement shall be substantiated by copies
of vendor invoices, time sheets and any other related source
documents. The Contract Manager may require the submittal of any and
all supporting documentation prior to approving invoices for payment.
Each invoice shall contain at least:
a. the contract number and project title;
b. the time period which the invoiced costs were incurred;
c. a statement to the effect that all costs invoiced are eligible
expenses under this agreement and are supported by proper
documentation.
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d. the signature of an authorized representative of the Contractor.
At the request of the Contract Manager, invoices shall be county
specific.
3. In preparing monthly invoices for services provided under this
contract, the Contractor will xxxx the state as follows:
a. For Enrollment/Disenrollment transactions as described in the
RFP, $1.70 for each transaction when the total volume per month
is 0 to 150,000; $0.00 for each transaction over 150,000 and
under 170,001; $0.37 for each transaction over 170,000.
b. For Beneficiary Direct Assistance as described in the RFP, $0.84
per minute for total monthly minutes under 130,000; $0.00 per
minute for each monthly minute over 130,000 and under 160,001;
$0.70 for each monthly minute over 160,000.
c. For each Enrollment Service Representative as described in the
RFP, $5,500.00 per FTE per month when the number of FTE's is less
than 36; $3,700.00 for each monthly FTE which exceeds 35 but is
less than 61; $3,800.00 for each monthly FTE which exceeds 60.
4. The State agrees to make payment as promptly as fiscal procedures
permit, upon receipt of the invoices, subject to approval of the
Contract Manager, and contingent upon satisfactory completion of the
terms of this agreement. The Contract Manager is designated in Article
III, Section D, Communication.
5. "Satisfactory Completion" as used in this agreement, means that
Contractor has completed all terms, conditions and performance of this
agreement for the elapsed portion of the agreement, including but not
limited to:
a. Exhibit A - Takeover Requirements
Exhibit B - Scope of Work, and
Exhibit C - Turnover Requirements; and
b. submittal to the Contract Manager of:
(1) all reports required in this contract; and
(2) invoice(s), with required documentation.
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6. The invoice containing the final costs to be paid by the State shall
be identified as the "final invoice". The final invoice shall be
delivered to the State not more than thirty (30) calendar days after
the expiration or cancellation of this agreement.
7. The Department will withhold 10% of each invoice until the
satisfactory completion of this contract.
8. All payments received under this agreement shall be used solely for
the purpose of providing goods or services under this agreement. The
State shall have final determination of allowable and reimbursable
costs under this agreement. The State may require documentation
substantiating expenses as deemed appropriate by the Contract Manager.
E. MISCELLANEOUS PAYMENT PROVISIONS
1. Travel, subsistence and per diem rates shall not exceed those amounts
paid to State employees as specified in Exhibit F, Travel Allowances
and reimbursements. No reimbursement for travel outside the State of
California shall be allowed without prior written approval by the
Contract Manager.
2. Funds budgeted under this contract may not be used for entertainment
expenses, or for professional dues for the Contractor's staff or
officials.
3. Contractor shall not use State funds allocated under this agreement to
pay for the purchase, construction, renovation, alteration,
improvement, or repair of capital assets, such as real estate and
vehicles.
F. CONTRACT CLOSE-OUT
1. This agreement requires the Contractor to submit to the State
invoices, reports, close-out information and other information at
specified times during the term and following expiration or
cancellation of the agreement. Failure to complete any of these
requirements to the satisfaction of the State is a violation of this
agreement and, as in any violation, the State may take appropriate
action, including the withholding of payment of invoices pursuant to
this Section.
2. If Contractor fails to provide the information specified by this
Section within sixty (60) calendar days after the expiration or
cancellation of this agreement, the State, in
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addition to any other available action to remedy, may deny any unpaid
invoice(s) and the Contractor shall forfeit reimbursement of any costs
incurred and not reimbursed.
G. CONTRACTS IN EXCESS OF $200,000
The Contractor shall give priority consideration in filling vacancies in
positions funded by the agreement to qualified recipients of aid under
Welfare and Institutions Code, Chapter 2, commencing with Section 11200 in
accordance with Welfare and Institutions Code, Article 3.9, commencing with
Section 11349 (Public Contract Code, Section 10353).
H. CONTRACTS FUNDED IN WHOLE OR IN PART BY THE FEDERAL GOVERNMENT
1. It is mutually understood between the parties that this contract may
have been written before ascertaining the availability of
congressional appropriation of funds, for the mutual benefit of both
parties, in order to avoid program and fiscal delays which would occur
if the contract were executed after that determination was made.
2. This contract is valid and enforceable only if sufficient funds are
made available to the State by the United States Government for the
Fiscal Year 1996-97 for the purpose of this program. In addition, this
contract is subject to any additional restrictions, limitations, or
conditions enacted by Congress or any statute enacted by the Congress
which may affect the provisions, terms or funding of this contract in
any manner.
3. It is mutually agreed that if the Congress does not appropriate
sufficient funds for the program, this contract will be amended to
reflect any reduction in funds.
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Article VI
ARTICLE VI - CONFIDENTIALITY
A. Notwithstanding any other provisions of this Contract, names of persons
receiving public social services are confidential and are to be protected
from unauthorized disclosure in accordance with Title 42, CFR, Section
431.300 et seq., and Section 14000.2, Welfare and Institutions Code, and
regulations adopted thereunder. For purposes of this contract, all
information, records, data and date elements collected and maintained for
the operation of the contract and pertaining to Members shall be protected
by the Contractor from unauthorized disclosure.
B. With respect to any identifiable information concerning a Beneficiary under
this contract that is obtained by the Contractor or its subcontractors, the
Contractor (a) shall not use any such information for any purpose other
than carrying out the express terms of this contract, (b) shall promptly
transmit to the Department all requests for disclosure of such information,
(c) shall not disclose except as otherwise specifically permitted by this
contract any such information to any party other than the Department
without the Department's prior written authorization specifying that the
information is releasable under Title 42, CFR, Section 431.300, Welfare and
Institutions Code Section 14100.2, and regulations adopted thereunder, and
(d) shall, at the expiration or cancellation of this contract, return all
information to the Department or maintain such information according to
written procedures sent to the Contractor by the Department for this
purpose.
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EXHIBIT A - TAKEOVER REQUIREMENTS
The Contractor is required to take over the operation of the current HCO Program
according to the requirements of this HCO Request for Proposal (RFP).
A. Takeover Consideration
The Department requires an orderly Takeover that is as transparent as
possible to County Welfare Directors (CWDs), Aid to Families With Dependent
Children (AFDC) and Medi-Cal applicants and beneficiaries, and Medi-Cal
managed care plans in each of the counties designated by the Department.
The Contractor will take all actions required to prepare for operations,
including the identification and rapid resolution of Takeover problems.
Major considerations during Takeover include:
1. The Contractor will have primary responsibility for all technical
processes and products required for the HCO Program implementation.
2. The Contractor will incorporate the appropriate activities and tasks
needed to complete the Proposer Initiated Innovations which have been
approved by the Department.
3. The Contractor will develop and submit to the Department, for written
approval, all policies, procedures, and manuals by the date identified
on the Takeover Phase Schedule.
4. The Contractor will complete all Takeover tasks and activities within
the timeframes established by the Department as specified on the
Takeover Phase Schedule.
5. The Contractor will submit to the Department's HCO Contract Manager, a
Takeover Manual which includes all sections and subsections as
described in this Takeover Section.
B. Takeover Phase Schedule
Following is the Takeover Phase Schedule. The purpose of the Takeover Phase
Schedule is to list the timeframes from the HCO Contract effective date for
the Contractor for major deliverables and milestones. Compliance with this
schedule is mandatory. The Contractor may submit deliverables earlier or
later than the scheduled date if approved, in writing, by the Department.
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Milestone Due Date
--------- --------
Submit Takeover Manual 1 Day
Assemble Interim Management Team 1 Day
Designate Contract Representative 1 Day
Submit Facilities Section 1 Day
Occupy Temporary Facility - Sacramento 1 Day
Takeover Task Plan 1 Week
Takeover Timeline 1 Week
First Weekly Progress Report Due 1 Week
Submit Names & Resumes of Interim Mgmt Team 2 Weeks
Submit Direct Assistance Section 2 Weeks
Submit MEDS Section 3 Weeks
Submit Names & Resumes of Operations Team 4 Weeks
Organizational & Personnel Acquisition Plan 4 Weeks
Operations Training Plan 4 Weeks
Submit Equipment Section 4 Weeks
Department Defines Size of Toll-Free System 4 Weeks
Submit Training Plan to Department 4 Weeks
Submit Forms to State for Approval 4 Weeks
Submit Enrollment/Disenrollment Section 4 Weeks
Implement Security & Confidentiality Reqs. 4 Weeks
Occupy Permanent Facility - Sacramento 4 Weeks
Begin Process Testing 4 Weeks
Assemble Operations Management Team 6 Weeks
Prepared to Begin Direct Assistance Requirement 6 Weeks
Submit Security & Confidentiality Section 8 Weeks
Submit Records Retention Section 8 Weeks
Personnel Hired 8 Weeks
Implement Enrollment/Disenrollment Req. 8 Weeks
Prepared to Start Toll-Free Telephone Services 8 Weeks
Printing and Reproduction Due Date 8 Weeks
Policy and Procedure Section 8 Weeks
Conduct Training to New Staff 8 Weeks
Able to Submit Forms for Reproduction 8 Weeks
Submit Report Distribution List 8 Weeks
Scheduled Walk Through Date 10 Weeks
Able to Submit Proof of Forms 10 Weeks
Update Organization Chart 10 Weeks
Implement Records Retention Requirements 12 Weeks
Takeover Completion 12 Weeks
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C. Takeover Timeline
The Contractor will submit a Takeover Timeline along with the Takeover Task
Plan within one week from the HCO Contract effective date. The Takeover
Timeline will include each Takeover deliverable and milestones included in
the Takeover Task Plan. It will depict the estimated start date and the
deliverable due date for each task.
D. Contractor Transition
The Contractor will prepare and submit to the Department a Takeover Manual
within one day of the Contract effective day. The Takeover manual will
document the progress of the Contractor during the Takeover period.
Throughout the Takeover period deliverables and revisions to existing
sections and subsections will be submitted to the Department for insertion
into the Takeover Manual. This manual will include a section or subsection
for all deliverables and activities as required in the Takeover Section of
this RFP. The Takeover Manual will be submitted in a standard size 3-ring
binder. All updates and deliverables will be submitted to the Department
with replacement page instructions for each attached deliverable to be
inserted in the Takeover Manual. The Contractor is not limited to a maximum
number of binders for the Takeover Manual.
E. Contractor Responsibilities
This sub-section provides the outline of the tasks the Contractor is
required to complete during Takeover. Each of these tasks will result in
milestones and deliverables to the Department and will be included in the
Contractor's Takeover Task Plan.
F. Takeover Task Plant
The objective of the Takeover Task Plan is to specify, in detail, the
Contractor's activities for the duration of the Takeover period. This
includes, but is not limited to, the Contractor's tasks and activities
required to implement the requirements of this RFP and assume the former
Contractor responsibilities (if applicable). This Task Plan will describe
the Contractor's overall plan for undertaking and completing each task and
activity associated with the Takeover phase, as listed on the Takeover
Phase Schedule. The Contractor will submit the Takeover Task Plan Manual to
the Department. The Takeover Task Plan shall be submitted in an organized
format, to be developed by the Contractor and evaluated by the Department
on a pass or fail basis as part of the evaluation phase of this
procurement.
The Takeover Task Plan will include, at a minimum, the following
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items:
1. Milestone/task name;
2. Task description;
3. Deliverable due date;
4. Contractor's primary staff assigned to task;
5. Estimated start date;
6. Estimated hours for Task Completion;
7. Takeover Time Table.
G. Weekly Progress Reporting
Weekly Takeover Status (WTS) Report will include all deliverables and
tasks, the status of all deliverables and tasks and State approval dates,
and will be used by the Contractor and the Department in gauging or
measuring the Contractor's progress during the Takeover Phase, especially
as compared to the Takeover Plan.
The WTS Report will be furnished to the Department weekly and will be
current through Friday of each week. The Contractor will deliver the Weekly
Takeover Status Report to the State by the close of business each Thursday
of the following week. The first WTS Report is due to the Department within
one week from the HCO Contract effective date.
If required by the HCO Contract Manager, the WTS Report will be submitted
not only on hard copy, but also on electronic or magnetic medium in the
format prescribed by the Contract Manager. Two copies, in each specified
medium, will be furnished to the Department. The WTS Report shall be
submitted in an organized format, to be developed by the Contractor and
approved by the Department.
The WTS report will, at a minimum, contain the following information:
1. Task Number. This will be the Task Number the Contractor has assigned
the deliverable or activity.
2. Description. Brief description of the task.
3. Scheduled Due Date. This will be the scheduled due date as originally
provided in the Takeover Task Plan.
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4. Date Delivered. Actual date deliverable was delivered to the
Department for review and approval.
5. Days Late/Early. The number of days the deliverable was delivered
either late (- days) or early (+ days).
6. State Review and Approval Date. The date a letter approving,
disapproving or pending the deliverable is received from the
Department.
7. Status. Approved, disapproved or pending.
8. Date Approved, Disapproved, Pending. The date the Department either
approved, disapproved, or left pending the Deliverable.
9. Final Approval Date. The date the deliverable was approved by the
Department.
10. Resubmission Due Date. If disapproved or left pending, this field will
reflect the new due date set as ten (10) State working days from the
date of the disapproval or left pending status, as dated by the
Department.
11. Date Resubmitted.
12. Days Late/Early. Same definition as item E. above, but relative to
item J. above (the new due date).
13. State Review and Approval Date.
14. Resubmission Status.
15. Date Approved, Disapproved, or Left Pending. The date the Department
approved, disapproved, or left pending the Resubmitted deliverable.
16. Days Late/Early.
17. Remarks. Free-form comment space.
18. Activity Summary. This item will identify those items needing
discussion, action, or which are of concern, as indicated in the
remarks column, for the next Weekly Takeover Status Report.
H. Assemble Management Team
1. The Contractor will assemble an Interim Management Team as part of
Takeover. The Interim Management Team will be
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employed by the Contractor at the beginning of Takeover. By two weeks
from the HCO Contract effective date, the Contractor will submit the
names, resumes, positions, reporting relationships, and functional
responsibilities of the Interim Management Team. The Contractor must
attest to the Department, in writing, that all required functions for
Takeover will be accomplished under the auspices of this Interim
Management Team.
No later than four weeks from the HCO Contract effective date, the
Contractor will submit to the Department for review and approval the
composition, names and resumes of the permanent Management Team for
Operations. The Management Team for Operations will meet all
requirements of Section 18 of the RFP- Contract Requirements,
including qualifications, and will be in place no later than six weeks
from the HCO Contract effective date.
Should the Contractor wish to propose alternatives to the structure of
the permanent Management Team for Operations, any such proposal will
be delivered to the Department at least 60 days prior to such
alteration's anticipated implementation, and approved by the
Department, in writing, at least 30 days prior to implementation.
2. One individual will be designated by the Contractor as the Takeover
Manager. Responsibilities of this person will include ongoing
management of the Takeover period. This manager will be fully
qualified to oversee all Takeover activities.
I. Training
The Contractor will develop materials and courses to provide training. This
training will include an overview of the HCO Contract requirements and will
be provided to both Contractor and State staff. The Contractor will develop
any needed training to ensure successful Takeover, as well as develop and
internally distribute, staff training materials as needed. The Contractor
will schedule and execute all training scheduled for the Takeover Phase in
such a manner as to fully support Takeover tasks and activities and to
ensure full preparedness for the performance of all Contractor
responsibilities, including, but not limited to, those specified in the
Exhibit B - Scope of Work.
1. The Contractor will deliver to the Department for review and approval,
within four weeks from the HCO Contract effective date, an Operations
Training Plan. The Operations Training Section of the Takeover Manual
will include course outlines and schedules for both the Takeover Phase
and all on-going
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courses in the major operational areas to take place during the
Operations Phase of the HCO Contract. The Contractor will provide a
schedule and location of all refresher and on-going training courses.
J. Takeover Organization and Personnel Acquisition
The Contractor will update and submit the Organizational and Personnel
Acquisition Plan Section within four weeks from the HCO Contract effective
date.
K. Personnel Acquisition
The Personnel Acquisition sub-section will describe the method of
recruitment and selection of staff required to prepare the Contractor for
full and on-going operation of the HCO Program. In addition to a narrative
discussion, the Personnel Acquisition sub-section of the Manual will
include the following information:
1. A chart showing the number of staff to be hired or transferred from
previous Contractor by month and classification (hired is defined in
this Section as staff having reported to work);
2. An explanation, including specific actions to be taken, of how the
Contractor will assure the Department that sufficiently experienced
and trained personnel are available to support all Operations
functions without interruption of services to the beneficiaries.
3. A description of alternative actions or contingency plans if the
Contractor is unable to recruit sufficient numbers of adequately
trained staff for each functional, operational area on a timely basis
or if the Contractor's original operational staffing estimates are too
low;
a. A plan for hiring or transferring all specialized
trained/experienced staff, as prescribed in the HCQ Contract.
L. Organizational Structure
The Organizational Structure sub-section of the Contractor's Organization
and Personnel Acquisition Plan Section will provide a complete and detailed
description of the organizational structure to be used by the Contractor.
Additionally, the Organizational Structure sub-section will include the
following:
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1. Organization charts and descriptions showing the location of the HCO
Program in the Contractor's firm, and organization charts and
descriptions for all HCO operational areas. The functional
responsibilities of each organizational unit, the delegation of
responsibilities to each HCO Program organizational unit, organization
decision-making relationships, and unit staffing by classification
will be provided, in addition to those items specified above, for a
comprehensive identification of overall staffing for HCO Program
Operations.
2. Complete job descriptions (specifications) for all classifications
used for senior Managements including job title, functional
responsibilities, and experience requirements.
M. Schedule Execution and Reporting
1. The personnel function is to be established and all hiring completed
to meet all duties and responsibilities as prescribed in the HCO
Program Contract within eight weeks from the HCO Contract effective
date and as reflected in the Contractor's updated Organization and
Personnel Acquisition Section of the Takeover Phase Manual.
2. The Contractor will include the status of hiring and other Takeover
milestones and deliverables as issues reported in the Weekly Takeover
Status Report, or when requested by the Contract Manager.
3. The Contractor will provide to the Department, when and if the
Contractor proposes organizational structure changes during the
Takeover Phase, updates to the Organizational Structure Section of its
Organization and Staffing Manual for Operations. These updates will be
provided to the Department five (5) days prior to such proposed
change(s).
N. Facilities Acquisition and Installation
O. New Facilities
The Contractor will deliver the Facilities Section to the Department within
one day from the HCO Contract effective date, showing the planned usage of
space for the Contractor's operation of the HCO Program, and provision of
space for all equipment.
The Facility Section will include narrative descriptions, supporting
documentation, and an installation schedule for the HCO Program Contract.
The Manual will provide information that includes, but is not limited to:
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1. The extent to which the Contractor's site(s) is/are currently under
lease or ownership or planned to be leased or bought. If the site(s)
is/are currently under lease or ownership, the Contractor will, at a
minimum, provide a guaranteed option on the facility(ies) including
the name, address and telephone number of the leasing or selling agent
for contact by the Department. The Contractor will describe facilities
it currently has in Sacramento for use in the HCO Program Contract and
what facility space, and for what functions, it must obtain and/or
finalize development.
2. A description of the modifications which must be made to the
Sacramento facility(ies), a schedule for completing those
modifications, and the actions taken by the Contractor to ensure that
this schedule is met.
3. Certification that the Contractor has verified that electrical,
telecommunications, and phone services(s) can be provided by the
Contractor facility(ies).
4. Allocated space by function.
5. Accessibility to on-site operations.
6. Access to telephone, and electrical power necessary to be utilized by
the Contractor.
7. Available parking, including State visitor and Disabled Parking
spaces.
P. Permanent Facilities Installation
The Contractor will obtain a permanent facility within a 25-mile radius of
the State Capitol Building to operate the HCO Program, as specified in RFP
Section 12.0, E, Proposer Qualifications. The permanent facility will be
completely operable within four weeks from the HCO Contract effective date.
Until this facility is installed, HCO Takeover activities, including
testing and staff training, will take place within 25 miles of the State
Capitol unless arrangements have been made with the HCO Contract Manager.
All Departmental liaison and planning activities will take place in
Sacramento, unless otherwise agreed to by the Contractor and HCO Contract
Manager.
Q. Existing Sites
The Contractor will include in the Facilities Section the Takeover process
of existing HCO Program sites utilized by the
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former Contractor (if applicable) and/or County Welfare Departments.
The Contractor will include in the Facilities Section a description of all
existing sites and scheduled dates of Takeover (For the locations of
existing sites, see Exhibit 9). These activities will be included in the
Weekly Takeover Work Schedule.
R. Equipment Acquisition and Installation
The Contractor will develop and deliver the Equipment Section of the
Takeover Manual within four weeks from the HCO Contract effective date.
This section will describe the on-site and off-site equipment configuration
required to support the HCO Contract. The manual will describe, but is not
limited to, all processing and telecommunication equipment, and any other
equipment necessary to support the HCO Program. The manual, at a minimum,
will describe:
1. A schematic showing all equipment and communications networks.
2. All equipment, including quantity, model number, and capacity to
support the HCO Program.
S. MEDS
The Contractor will develop and deliver the MEDS Section of the Takeover
Manual within three weeks from the HCO Contract effective date. The MEDS
Section will detail the process to be used to install, and process MEDS
information as provided by the Department. This includes, but is not
limited to, receiving MEDS download tapes and providing MEDS updates in a
format prescribed by the Department, in order to process enrollment and
disenrollment transactions.
T. Toll-Free Telephone Services
The Contractor will include in the Takeover Manual a section which details
the process for implementing the Direct Assistance requirements within two
weeks from the HCO Contract effective date. The Contractor will be prepared
to implement the Customer Assistance toll-free telephone service
capabilities, as directed by the Department, within eight weeks from the
HCO Contract effective date. The Direct Assistance telephone capabilities
include, but are not limited to, toll-free telephone number(s), adequate
number of customer service representatives to respond to conversion and
ongoing operational requirements, language capabilities, timely complaint
resolution, providing specified information to beneficiaries and
applicants, and procedures for
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responding to beneficiary and applicant inquiries.
U. Translation Services
The Contractor will include in the Direct Assistance Section of the
Takeover Manual the process for ensuring that translation services, in
those languages as specified by the Department, are available by the Direct
Assistance implementation date.
V. Printing and Publications
As directed by the Department, the Contractor will perform or arrange to
have performed the requested printing and reproduction within eight weeks
from the HCO Contract effective date. W. Forms
The Contractor will ensure that all forms and documents are in the format,
language, and literacy level specified and approved by the Department. The
Contractor will not submit any forms or documents developed by the
Contractor for printing or reproduction until the final format has been
reviewed and approved by the Department.
X. Policy and Procedures Development
The Contractor will develop and submit to the Department a Policy and
Procedures Section of the Takeover Manual. The Procedure Section will
contain the detailed processes and procedures for all duties, tasks, and
functions described in this RFP. These sub-sections are to be delivered to
the Department within eight weeks from the HCO Contract effective date.
This will include, but is not limited to, the following sub-sections:
1. Scheduling Presentations
2. Security and Confidentiality
3. Monitoring 4. County Performance
5. Assignments
6. Disenrollments
7. Records Retention
8. Communication
9. Direct Assistance
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10. Customer Assistance
11. Problem Resolution
12. Ombudsman
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Maximus Exhibit B
EXHIBIT B SCOPE OF WORK
The Contractor will conduct a program for providing accurate, complete and
current information to persons applying to establish eligibility for AFDC or
Medi-Cal and for existing Medi-Cal beneficiaries, as directed by the Department,
regarding their options for obtaining Medi-Cal services through enrollment in
health care plans or FFS MediCal. The Contractor must provide information on
health care plans that provide services in the geographic areas where the person
resides. Information provided will include whether the health plan has available
capacity and can accommodate the person's primary language. Please refer to
Section 3.7, "Primary Languages For Eligible Beneficiaries By County", for
language needs.
The Contractor will emphasize the benefits and limitations of increased access
to health care services through health care plans and encourage enrollment and
provide enrollment assistance in those plans.
The Contractor will be responsible for enrolling and disenrolling beneficiaries
into and out of managed care plans.
The Contractor will implement the HCO program in a timely and uniform manner in
those counties which will require an HCO program due to new or existing managed
care plans operating in those counties, and any future counties as designated by
the Department. Please see Section 1.3, "HCO Expansion Activities", Section 1.6,
"Existing MediCal Managed Care Arrangements", and 1.7, "Special Project
Activities" of the RFP for a list of the counties requiring an HCO program at
this time.
The Department will provide the Contractor with data files via a direct data
communications link connected to the State's Host computer. The Contractor must
have the capability to transmit and retrieve data files through this mechanism
in a format to be determined by the Department. The Contractor must also have
the capability to evaluate the data received by the Department and identify
changes in a recipients qualifications for managed care plan enrollment, and
take appropriate action. At a minimum, the Department will provide the
Contractor with the following files to assist in processing enrollment and
disenrollment transactions:
HCO New Eligibles File - Daily files which contain new eligibles who have
been designated as potential candidates for managed care enrollment in a
HCO county. This file contains information required for the Contractor to
determine a Medi-Cal recipient's eligibility for participation in a managed
care plan. This file can also be used to transmit enrollment and/or
disenrollment
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transactions to the State Host computer.
HCO Transaction Error Log - Daily files which provide the Contractor with
the status of each enrollment or disenrollment transaction applied to the
MEDS record of a Medi-Cal recipient or managed care plan enrollee in a HCO
county. This file contains information required for the Contractor to
identify and correct errors, and generate appropriate recipient
confirmation mailings.
Quarterly Reconciliation File - A quarterly file which will provide the
Contractor with the current eligibility status of each Medi-Cal recipient
who meets the enrollment criteria in an HCO county. This file contains
information that will allow the Contractor to synchronize its recipient
eligibility files with MEDS.
Changes in policy may constitute the creation of new files or changes to
existing files. The Contractor will be required to modify procedures in an
efficient and timely manner, to accommodate these changes.
The Contractor must also be willing to implement a Dental Managed Care program
with similar scope of work requirements as described in this section and be
willing to enter into good faith negotiations for reimbursement of this work.
In implementing the HCO program, the Contractor is required, at a minimum, to do
the following:
A. Preparation For HCO Presentations
1. The Contractor will make all arrangements necessary to implement the
HCO program. These arrangements will include, but will not be limited
to:
a. Work with the Department in the coordination of a space and
facilities plan, in a County and/or other approved public or
non-public facilities, for group HCO presentations to applicants
and beneficiaries in the mandatory aid codes adapted to each CWDs
intake application and redetermination operation.
b. Schedule group or individual HCO presentations at regular
intervals and at various locations to allow the
applicants/beneficiaries access during the eligibility
determination process.
c. In cooperation with the Department, develop necessary forms and
procedures for the CWDs referral to and documentation of,
applicants and beneficiaries
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attendance at the HCO presentations.
1. The Contractor will submit all proposed procedures and
written materials for use at the HCO presentations, to the
Department for review and approval at least 60 working days
prior to their proposed implementation and distribution,
unless otherwise directed by the Department.
d. Identify and monitor those applicants and beneficiaries who are
required to attend the HCO presentations.
e. Coordinate access to MEDS terminals for the Contractor's
management and other approved personnel.
f. Develop written procedures for researching County MEDS input
conflicts and communicate the results of the research to the
appropriate County staff for correction.
g. Furnish desks, chairs, and access to telephone outlets for
telephones, facsimile equipment and computer modems for use by
Contractor's personnel, in County or other approved public or
non-public facilities where HCO presentations will occur. (The
equipment stated here is only a suggestion). Space size and
availability may vary at County sites where presentations will
occur.
h. Furnish all necessary resources for effective presentations which
include, but are not limited to, office supplies, audio-visual
equipment and visual aids.
i. Hire and train staff, monitor and record staff performance.
2. The Contractor will establish and maintain a system of communication
between Contractor, Contractor's staff, County personnel, Medi-Cal
managed care plans and the Department to assure timely receipt of
eligibility information from MEDS to identify eligible beneficiaries,
timely referral of applicants/beneficiaries to HCO presentations,
timely processing of enrollments/disenrollments, timely updating of
MEDS, a smooth transition to the selected managed care plan from FFS
Medi-Cal and the negotiation of space in County offices. The
Department will assume lead responsibilities for this function.
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B. HCO Presentation
1. The Contractor must provide presentations according to the Departments
specifications.
The HCO presentation will include, but will not be limited to:
a. Information designed to help beneficiaries/applicants understand
how to complete a enrollment form and to assist
applicants/beneficiaries with completion of a enrollment form.
See Exhibit 8, Enrollment Forms.
b. Alternatives for beneficiaries/applicants to receive Medi-Cal
benefits, with an emphasis on the managed care method.
c. A description of the services covered under the Medi- Cal
program.
d. A description of all available managed care plans in areas where
applicants/beneficiaries reside.
e. The zip codes served by each managed care plan in each County.
f. Information in response to managed care plan related questions
which arise during the HCO presentation from
applicants/beneficiaries.
g. Distribution of Department approved health care plan- related
marketing materials (e.g., brochures, pamphlets, etc.) received
from the plans.
h. A description of the beneficiaries enrollment/disenrollment
rights.
2. The Contractor will document the attendance of all applicants and
beneficiaries at the HCO presentation.
3. The Contractor, as directed by the Department, will provide at a
minimum, linguistic services to a population group of mandatory
Medi-Cal eligibles residing in the proposed service area who indicate
their primary language as other than English and who meet a numeric
threshold of 3,000, or a population group of mandatory Medi-Cal
eligibles residing in the proposed service area who indicate their
primary language as other than English and who meet the concentration
standards of 1,000 in a single zip code or 1,500 in two contiguous zip
codes.
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4. The Contractor will ensure non or limited-English speaking applicants
and beneficiaries understand their options and rights. These measures
will include, but not be limited to:
a. Staffing:
1. The Contractor will assess, identify and report the
linguistic capability of interpreters or bilingual employed
staff.
2. Employ or contract with translators or interpreters who are
fluent in English and other languages to meet the linguistic
needs of applicants and beneficiaries.
3. Personnel with a knowledge of the ethnic, cultural, social
and economic compositions of each County's
applicant/beneficiary population. Please refer to Section
3.6, "Ethnic Grouping of Eligible Beneficiaries By County".
4. Consider employing or contracting with qualified, former
AFDC recipients or Medi-Cal beneficiaries, individuals who
possess Medi-Cal eligibility background/experience and
community based organizations.
b. Produce written materials and/or media (e.g., videos/tapes) which
will be made available to assist non-English and limited-English
speaking beneficiaries as specified in Exhibit B and as directed
by the Department.
c. Produce enrollment/disenrollment forms to assist
limited/non-English speaking beneficiaries as specified in
Exhibit B and as directed by the Department.
"See Section 3.7 of the RFP, "Primary Languages of Eligible
Beneficiaries By County".
5. The Contractor will assign personnel to conduct HCO presentations, at
each site, to inform applicants/beneficiaries of their options of
receiving MediCal benefits according to standards developed by the
Department.
Contractor's Staff must provide presentations according to County
intake schedules, policies and procedures and/or arrangements agreed
to between the Contractor and the
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County. The Contractor will consider space and geographic limitations
to determine the most cost effective methods to provide presentations
to the maximum number of beneficiaries. Contractor will monitor
default assignment rates for acceptable levels as determined by the
Department.
6. The Contractor will ensure that back-up personnel is provided in the
event of employee absence to ensure that there is no disruption in HCO
presentations.
7. The Contractor must consistently and effectively conduct HCO
presentations. This may include, but is not limited to:
a. Following the HCO Script.
b. Electronic audio and visual communication mediums.
c. Other enhancements to the HCO presentation.
8. The Contractor will develop and implement a method for evaluating
applicant/beneficiary satisfaction with HCO presentations.
C. Outreach
The Contractor will identify and submit to the Department for approval,
additional locations for presentations, such as community centers,
community meetings, health fairs, Women, Infants and Children (WIC)
nutrition sites, churches and festivals. Further, the Contractor will
schedule HCO presentations outside the normal business hours, 8:00 a.m. to
5:00 p.m., Monday through Friday, as approved by the Department.
The Contractor will submit to the Department for prior approval, a schedule
of all outreach presentations. This schedule will be provided on a biweekly
basis, or as determined by the Department. At a minimum, this schedule will
include:
1. The name of the Enrollment Service Representative (ESR) giving the
presentation.
2. The organization or event served by the presentation, as well as the
location.
3. The date and time of the presentation.
4. Anticipated number of beneficiaries attending.
In addition, the Contractor will provide the Department with a follow-up
report which will be include in the monthly progress
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report.
D. Training
1. The Contractor will develop and conduct initial and ongoing training
programs for the HCO Contractor's staff and monitor staff performance
on a continual basis. The training program will be comprehensive and
ensure that Contractor staff is able to diligently perform the scope
of work in this RFP. Training will include, but will not be limited
to:
a. An overview of the Medi-Cal program;
b. Managed Care and HCO legislation;
c. The development of managed care plans in California;
x. Xxxx training sessions with critiques;
e. Instruction on the completion of the HCO enrollment forms;
f. MEDS inquiry, access and updates;
g. Review of script and informing materials;
h. A review of plans and services available in each County;
i. How to access services in plans/plan grievance processes;
j. Security and confidentiality policies;
k. Cultural and linguistic sensitivity;
l. Customer relations;
m. State enrollment and disenrollment process.
2. The Contractor will develop, and conduct as requested, an HCO
education program for:
a. County Welfare Department staff;
b. Department staff;
c. Consumer advocate groups;
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d. Lawsuit representatives;
e. Medical plan staff;
f. Local officials;
g. Other parties and organizations impacted by the HCO program and
legislation.
E. Enrollment Form Processing
The Contractor will assume responsibility for enrollments in any county, as
designated by the Department.
1. The Contractor will enroll eligible beneficiaries into selected
managed care plans. The enrollment function may include, but is not
limited to:
a. Transmitting enrollment records to the Department in a format
prescribed by the State through methodology proposed by the
Contractor and approved by the Department, utilization of the
"Choice" licensed software available to the Contractor, an/or by
online action thru MEDS.
b. Use MEDS and any other Medi-Cal eligibility verification system
as made available by the Department in the future, to make
corrections to the beneficiary's enrollment information.
c. Complete enrollments within one (1) business day of receiving
notification of eligibility for on-line enrollments or within two
(2) business days for batch enrollments. Batch enrollments are
enrollment forms which are compiled by Contractors staff at
presentation locations and forwarded to the Contractors
processing facilities on a daily basis.
d. Review the HCO enrollment form for accuracy and completeness to
ensure a timely enrollment in the applicant's/beneficiary's
managed care plan of choice.
e. Should the Department determine that enrollment forms currently
submitted to the Department directly by managed care plans are to
be submitted to the Contractor for processing, the Contractor
will assist the managed care plans to ensure enrollment forms are
completed correctly and provide managed care plans with lists of
enrollments successfully processed.
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f. Resolve enrollment problems to ensure enrollment in the selected
managed care plan within the mandated timeframe.
g. Provide lists on a weekly basis, directly to the managed care
plans of those applicants and beneficiaries who have completed an
enrollment form, selected a medical plan and are eligible, or who
are eligible and have been defaulted to a plan through the HCO
program.
2. The Contractor will enroll eligible beneficiaries into selected
managed care plans through the following procedure:
a. Enrollment form is received and sorted.
b. Enrollment form is reviewed. If the form is complete, Contractor
must confirm recipients eligibility for enrollment in health plan
of choice, then process enrollment. If the form is incomplete,
the form is returned to the beneficiary one (1) business day
after processing of the incomplete form, with a letter
identifying areas which are incomplete, and requesting the
beneficiary to complete the enrollment form. The form in reviewed
again upon return, and if complete, enrollment will be processed.
c. Confirmation letter, identifying plan name and effective date of
enrollment is sent to the beneficiary one (1) business day after
enrollment transaction is accepted.
d. If an enrollment form is not completed and returned by the
beneficiary within the established timeframe, a "Notice of Intent
to Assign" letter is sent to remind the beneficiary to complete
and return the enrollment form.
e. If an enrollment form is not received from the beneficiary
following the reminder, the beneficiary is automatically assigned
to a managed care plan. (See Assignment, Sections)
f. When a beneficiary is automatically assigned to a medical plan, a
"Notice of Assignment" letter is sent to the beneficiary.
3. The Contractor may receive documentation or calls from
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beneficiaries indicating they qualify to remain Fee-For- Service as a
result of a medical exemption. Contractor will allow beneficiary to
remain FFS through the exemption period. The Contractor will monitor
these beneficiaries and upon termination of the exemption period,
contact the beneficiary and request an enrollment form be completed.
The Department will publish a list of medical conditions which qualify
the beneficiary for medical exemptions, and will furnish this list to
the Contractor. It will be the Contractors responsibility to track
these beneficiaries and begin the informing process once the exemption
period has expired.
F. Disenrollment Form Processing
The Contractor will assume responsibility for disenrollment in any County
as directed by the Department.
1. The Contractor will disenroll eligible beneficiaries from managed care
plans. This function may include, but is not limited to:
a. Transmitting disenrollment records to the Department in a format
prescribed by the State, through methodology proposed by the
Contractor, utilizing the "Choice" licensed software available to
the Contractor from the Department, and/or by online action thru
MEDS.
b. Use MEDS and any other Medi-Cal eligibility verification system
as made available by the Department or County for corrections to
the beneficiary's disenrollment form information.
c. Complete disenrollment transactions within one (1) business day
of receiving disenrollment forms for on-line disenrollments, or
within two (2) business days for batch disenrollments. Batch
disenrollments are disenrollment forms which are compiled by
Contractors staff at presentation locations and forwarded to the
Contractors processing facilities on a daily basis.
d. Review the HCO enrollment/disenrollment form for accuracy and
completeness to ensure a timely disenrollment from the
beneficiaries' managed care plan.
e. Assist the beneficiary to correct disenrollment form errors.
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f. Resolve disenrollment problems to ensure a timely disenrollment
from the managed care plan.
g. Provide lists on an as requested basis, directly to the managed
care plans of those beneficiaries who have completed a
disenrollment request to be disenrolled from a managed care plan
through the HCO program.
h. Retroactively disenroll beneficiaries who meet the necessary
criteria, as determined by the Department.
i. Should the Department determine that enrollment/disenrollment
forms currently submitted to the Department by managed care plans
are to be submitted to the Contractor for processing, the
Contractor will assist the managed care plans to ensure the
enrollment/disenrollment forms are completed correctly and
provide the plans with a list of disenrollments successfully
processed.
2. The Contractor will disenroll eligible beneficiaries from selected
managed care plans through the following procedure:
a. Disenrollment forms received and sorted.
b. Disenrollment form reviewed for accuracy of information. If form
is complete, Contractor processes disenrollment. If form is
incomplete or incorrect, the form is returned to the beneficiary
within one (1) business day of processing disenrollment request,
with a letter of request to complete the disenrollment form,
specifying the areas which are incomplete or incorrect. The form
is reviewed again upon return, and if complete, disenrollment is
processed.
If enrollment in a MCP is mandatory and if the beneficiary is
disenrolled because the beneficiary has a medical condition which
qualifies the beneficiary to be exempt from enrollment, the
Contractor will verify that a signed exemption form has been
submitted with the disenrollment form.
c. If enrollment is mandatory, the Contractor will ensure the
beneficiary re-enrolls in a MCP by verifying the beneficiary's
selection of a new MCP on the enrollment/disenrollment form.
d. A letter is mailed to the beneficiary, confirming the
disenrollment request.
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e. In GMC, the beneficiary must select a new MCP unless the
beneficiary has a medical condition which qualifies him/her to be
exempt from enrollment. One (1) business day after enrollment
transaction is accepted, a letter is mailed to the beneficiary,
confirming the choice of the new MCP, identifying plan name and
effective date of enrollment.
3. The Contractor will monitor beneficiaries who wish to remain
Fee-For-Service because of a medical condition, and begin the
enrollment process once the exemption period has expired.
The Department will publish a list of medical conditions which qualify
the beneficiary for medical exemptions, and will furnish this list to
the Contractor. It will be the Contractors responsibility to track
these beneficiaries and begin the informing process once the exemption
period has expired.
4. In FFS MCN, the Contractor will be responsible for processing
disenrollments for beneficiaries who submit an exemption form,
self-certifying they are not required to participate in the FFS MCN
program due to a medical condition which qualifies him/her to be
exempt from enrollment.
5. The Contractor will retroactively disenroll beneficiaries which meet
specific criteria as determined by the Department. Retroactive
disenrollments require direct modification to MEDS.
Geographic Managed Care
G. Informing Beneficiaries
When new AFDC beneficiaries appear on MEDS and are eligible for Medi-Cal
benefits, MEDS information tapes will be transmitted to the Contractor
(seven days per week). If the AFDC beneficiary who appears on the MEDS tape
does not have a Medi-Cal enrollment form already on file, the Contractor
will mail an enrollment packet to the beneficiary, unless the beneficiary
is identified as homeless by specific? County P.O. Box addresses on the
MEDS information tapes.
The enrollment packet will be developed by the Department. The Contractor
may be required to develop or edit materials at the discretion and with the
approval of the Department.
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1. The enrollment packet consists of a cover letter, an
information/instruction booklet, a list of assistance telephone
numbers and addresses, a list of plan primary care providers,
plan-paid advertising, plan comparison chart, instructions regarding
plan access problems, an enrollment form and postage paid envelope.
This information will be provided in both English and any additional
primary language indicated on the MEDS form. Once AFDC beneficiaries
receive the enrollment package from the Contractor, they have 30 days
to return the enrollment form specifying their choice for how they
will receive their Medi-Cal benefits. The materials also will advise
them of the availability of a face-to-face presentation and provide
the Contractor's toll-free number to get more information in various
languages.
2. If a beneficiary returns the enrollment form but does not provide all
the needed information, the HCO Contractor will send out a letter one
(1) business day after processing the incomplete form, requesting the
missing information.
3. If the enrollment packet is returned to the HCO Contractor
undelivered, the file will be flagged and no further action is taken
until the Contractor receives a new address notification.
4. If a beneficiary does not respond within ten (10) business days and
the letter has not been returned, a "Notice of Intent to Assign" will
be sent by the HCO Contractor to the beneficiary within one (1)
business day. The "Notice of Intent to Assign" will, at a minimum,
include the following information:
a. Beneficiary's name and address.
b. Name and telephone number of the managed care plan to be
assigned.
c. Reason for intention to assign to a managed care plan.
d. Effective date of assignment.
e. Instructions concerning forms to be completed to prevent
assignment and time frames for completing those forms.
f. Toll-free telephone number and address where the beneficiary can
obtain additional information and complete the enrollment form.
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5. If the beneficiary has not completed an enrollment form within 30 days
from the date that the enrollment packet was mailed; or the
beneficiary attended a face-to-face presentation (whichever occurs
first), the HCO Contractor will assign the beneficiary to a plan and
send a "Notice of Assignment" on the thirty-first (31st) day, which
will include the following information:
a. The effective date of assignment to a plan.
b. The process to use if the assignment is not appropriate or if the
beneficiary wishes to disenroll from the assigned plan.
c. Plan to which beneficiary has been assigned.
d. Toll-free telephone number and address where beneficiary can
receive additional information or assistance.
H. Assignment
The Contractor will develop and maintain procedures for determining which
AFDC applicants have failed to make a choice of Managed Care Plan (MCP)
within the specified period or are exempt from assignment (i.e., have an
existing relationship with a primary care provider certified by that
provider). The Contractor will assign these AFDC applicants to an available
MCP which provides services in the geographic area where the applicant
resides. This assignment system must include, but will not be limited to:
1. Assigning applicants into MCP's, except in those instances where the
applicant meets the criteria exempting the applicant from mandatory
assignment.
2. A method for monitoring/tracking applicant selection in order to
identify applicants that have not selected a MCP within the required
30 days from the day that the enrollment packet was mailed, or, the
beneficiary attended a face- to-face presentation, before assigning
the MCP, if a choice has not been made.
3. Assigning applicants to the various types of managed care models, or
pilot projects.
4. Assigning beneficiaries to the same MCP as other members of the family
group, to the extent possible.
5. Assigning applicants into a MCP in which they are eligible
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to be enrolled. This includes:
a. A MCP which has capacity to accept new patients;
b. A MCP which is within a ten mile radius of where the applicant
resides;
c. A MCP which provides services to those persons in the aid code of
the applicant.
d. A MCP which has language capability to meet the beneficiary's
needs.
Two Plan Model Phase-In
I. Informing Beneficiaries
During the phase-in of the Two-Plan Model, the Department will require the
Contractor to use the HCO process for enrollment of AFDC beneficiaries into
the Local Initiative Plan (LI) and the mainstream plan (MP) when one of the
two plans becomes operational. The process will target AFDC applicants and
beneficiaries in the aid codes identified for mandatory enrollment in the
fully operational Two-Plan Model waiver. During the phase-in period,
participating beneficiaries always have the option of choosing FFS, even if
they are assigned to an MCP because they did not make a choice. When the
Department determines the LI or MP is ready to begin operation, the County
Department of Social Services and the Contractor will be notified. The
County eligibility worker will provide each applicant with a document
explaining what is required and where they need to go for a presentation.
If the AFDC applicant does not attend the Contractor presentation or does
not mail in the Medi-Cal enrollment form, the Contractor will mail the same
enrollment packet to the applicant when the applicant is determined to be
eligible for Medi-Cal. If the beneficiary is identified as homeless by
specific County P.O. Box addresses on the MEDS information tapes, the
Contractor will not mail the enrollment package.
The enrollment packet will be developed by the Department. The Contractor
may be required to develop or edit materials at the discretion and with the
approval of the Department.
1. The enrollment packet will advise them they may attend a face-to-face
presentation or call the Contractor's toll-free number to get more
information. During the phase-in period, beneficiaries will be offered
a choice of enrolling in the
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operational LI or MP, enrolling in an existing HMO or enrolling in a
PCCM plan, or certifying to an existing relationship with a named FFS
provider.
2. If a beneficiary sends in the form, but does not provide all needed
information, the Contractor will send a letter one (1) business day
after the incomplete form has been entered, to that beneficiary
identifying what is still needed.
3. If the enrollment packet is returned to the Contractor undelivered,
the file is flagged and no further action will be taken until the
Contractor receives a new address notification.
4. If a beneficiary does not respond, but the mail was delivered ten (10)
calendar days later, a "Notice of Intent to Assign" will be sent by
the HCO Contractor to the beneficiary. The "Notice of Intent to
Assign" will, at a minimum, include the following information:
a. Beneficiary's name and address.
b. Reason for intention to assign to a managed care plan.
c. Effective date of assignment.
d. Instructions concerning forms to be completed to prevent
assignment and time frames for completing those forms.
e. Toll-free telephone number and address where the beneficiary can
obtain additional information and complete the enrollment form.
5. If the beneficiary has not completed an enrollment form within thirty
(30) calendar days from the date of referral, or date the enrollment
packet is mailed, the Contractor will send a "Notice of Assignment" on
the thirty-first (31st) day which will include the following
information:
a. The effective date of assignment to the managed care plan.
b. The process to use if the assignment is not appropriate or if the
beneficiary wishes to disenroll from the assigned plan.
c. The plan to which beneficiary has been assigned.
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d. Toll-free telephone number and address where beneficiary can
receive additional information or assistance.
J. Assignment
Beneficiaries in mandatory aid codes who attend a presentation or are
mailed notification and do not respond within thirty (30) calendar days,
will be notified in writing one (1) business day after accepted enrollment
transaction, by the HCO Contractor, of their assignment to either the
operational LI or MP and the effective date of that assignment. They also
will be advised by the HCO Contractor, of the process to use if they wish
to disenroll from their assigned plan and enroll in other available plans
(if applicable) or FFS.
Enrollment packets will include a cover letter, an
information/instruction booklet, a list of assistance telephone
numbers and addresses, an enrollment form, plan paid advertising, plan
comparison chart, instructions regarding plan access problems, a list
of plan primary care providers and a postage paid envelope. In
addition to English, materials will also be sent in any primary
language designated on MEDS. The information will identify the
locations of the Contractor where beneficiaries may attend a
presentation explaining the material. If they are unable to attend a
presentation, the material will instruct them to use the toll-free
telephone number to obtain additional information and assistance.
1. If a beneficiary sends in the enrollment form, but does not provide
all needed information, the Contractor will send a letter one (1)
business day after processing incomplete form, identifying what is
still needed.
2. If the mailed enrollment packet is returned to the Contractor
undelivered, the file will be flagged and no further action will be
taken until the Contractor receives a new address notification.
3. If a beneficiary does not respond, but the mail was not returned, ten
(10) business days later, a "Notice of Intent to Assign" will be sent
by the Contractor to the beneficiary within one (1) business day. The
"Notice of Intent to Assign" will, at a minimum, include the following
information:
a. Beneficiaries name and address.
b. Name and telephone number of the managed care plan to
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be assigned.
c. Reason for intention to assign beneficiary to a managed care plan
by default.
d. Effective date of assignment.
e. Instructions concerning forms to be completed to prevent
assignment and time frames for completing those forms.
f. Toll-free telephone number and address where the beneficiary can
obtain additional information and complete the enrollment form.
4. If the beneficiary has not completed an enrollment form within thirty
(30) calendar days from the date of referral, enrollment packet mail
date, or face-to-face presentation, the Contractor will, on the
thirty-first (31st) day, send him/her a "Notice of Assignment" which
will include the following:
a. The effective date of the assignment to the plan.
b. The process to use if the assignment is not appropriate or if
they wish to disenroll from the assigned plan.
c. Plan to which beneficiary has been assigned.
5. Toll-free telephone number where beneficiary can receive additional
assistance. Whether beneficiaries are assigned to a plan or choose a
plan, they are required to receive written notification from the
Contractor of acceptance in a plan. The Contractor's toll-free number
will be included in this letter.
Two Plan Model Full Implementation
K. Informing Beneficiaries
Once the Two-Plan Model is fully operational (i.e., both the LI and the MP
contracts are executed and approved by the Health Care Financing
Administration) in a County, the Department will require the Contractor to
use the HCO process to inform applicants and beneficiaries in the mandatory
aid codes regarding their health care options.
1. Prior to full operation of the Two-Plan Model in a County, the
Department will notify AFDC beneficiaries in mandatory
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aid codes of the transition to full implementation of the waiver. This
notice will also inform beneficiaries of the forthcoming enrollment
packet which will explain their health care options.
a. The notice sent to beneficiaries in mandatory aid codes currently
on FFS will advise them that they must make a choice between the
LI and the MP. If they do not make a choice, they will be
assigned to one of the two plans. FFS no longer will be an
option.
b. The notice sent to beneficiaries in mandatory aid codes currently
enrolled in MCP's other than the LI or MP will advise them that
their MCP will no longer provide services for AFDC beneficiaries
and they must choose between the LI and the MP. If they do not
make a choice, they will be assigned to one of the two plans.
c. The notice sent to beneficiaries in mandatory aid codes currently
enrolled in the LI or MP, or in health plans subcontracting with
the LI or MP, will advise them of the availability of the other
plan. They may choose to disenroll from their existing plan and
enroll in the newly operational plan; however, if they do
nothing, they will remain with their current plan.
2. Prior to full operation, the Contractor will begin mailing out
enrollment packets to AFDC beneficiaries, unless the beneficiary is
identified as homeless by specific County P.O. Box addresses on the
MEDS information tapes. The Contractor will control the issuance of
the mailers with the goal of minimizing confusion to beneficiaries.
The Contractor enrollment package mail-out schedule will take into
consideration the size of AFDC population, whether the LI or MP was
operational during the phase-in period, and the size and number of
MCP's in the County.
The enrollment packet will be developed by the Department. The
Contractor may be required to develop or edit materials at the
discretion, and with the approval, of the Department.
Enrollment packets will include a cover letter, an
information/instruction booklet, a list of assistance telephone
numbers and addresses, an enrollment form, plan paid advertising, plan
comparison chart, instructions regarding plan access problems, a list
of plan primary care providers and a postage paid envelope. In
addition to English, materials will also be sent in any primary
language designated on MEDS. The information will identify the
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locations of the Contractor where beneficiaries may attend a
presentation explaining the material. If they are unable to attend a
presentation, the material will instruct them to use the toll-free
telephone number to obtain additional information and assistance.
a. If a beneficiary sends in the enrollment form, but does not
provide all needed information, the Contractor will send a letter
one (1) day after processing incomplete form, identifying what is
still needed.
b. If the mailed enrollment packet is returned to the Contractor
undelivered, the file will be flagged and no further action will
be taken until the Contractor receives a new address
notification.
c. If a beneficiary does not respond, but the mail was not returned,
ten (10) calendar days later, a "Notice of Intent to Assign" will
be sent by the Contractor to the beneficiary. The "Notice of
Intent to Assign" will, at a minimum, include the following
information:
1. Beneficiaries name and address.
2. Name and telephone number of the managed care plan to be
assigned.
3. Reason for intention to assign beneficiary to a managed care
plan by default.
4. Effective date of assignment.
5. Instructions concerning forms to be completed to prevent
assignment and time frames for completing those forms.
6. Toll-free telephone number and address where the beneficiary
can obtain additional information and complete the
enrollment form.
d. If the beneficiary has not completed an enrollment form within
thirty (30) calendar days from the date of referral, enrollment
packet mail date, or face-to-face presentation, the Contractor
will, on the thirty-first (31st) day, send him/her a "Notice of
Assignment" which will include the following:
1. The effective date of the assignment to the plan.
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2. The process to use if the assignment is not appropriate or
if they wish to disenroll from the assigned plan.
3. Plan to which beneficiary has been assigned.
4. Toll-free telephone number where beneficiary can receive
additional assistance.
Whether beneficiaries are assigned to a plan or choose a plan, they
are required to receive written notification from the Contractor of
acceptance in a plan. The Contractor's toll-free number will be
included in this letter.
L. Assignment
Beneficiaries in mandatory aid codes who attend a HCO presentation or are
mailed notification and do not respond within 30 calendar days, will be
notified on the 31st day by the Contractor in writing of their assignment
to either the LI or MP and the effective date of that assignment. They also
will be advised of the process to use if they wish to disenroll from their
assigned plan and enroll in the other available plan.
When a beneficiary is assigned to a plan, a weighted assignment method will
be used to determine the plan to which assignment will be made. The
following initial beneficiary considerations apply:
1. A beneficiary will only be assigned to an MCP with a primary care
service site in the same ZIP Code as the beneficiary's residence.
2. A beneficiary will be assigned to the same MCP as other members of the
same family group, to the extent possible.
3. Assigning applicants into a MCP in which they are eligible to be
enrolled. This includes
a. A MCP which has capacity to accept new patients;
b. A MCP which provides services to those persons in the aid code of
the applicant.
c. A MCP which has language capability to meet the beneficiary's
needs.
Once the above conditions are met, the LI will be given preference in the
assignment process over the MP. Provided the LI has capacity, all assignments
will be given to the LI until the LI reaches its minimum
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enrollment level, which is established by the Department to provide protection
to the disproportionate share hospital payments in that County. Once the LI has
reached its minimum enrollment level, assignments will be rotated equitably
between the LI and the MP.
The minimum enrollment levels for each County's Local Initiative are described
in the Data and Information Library.
M. Customer Assistance
The Contractor will provide assistance to beneficiaries in using their
health care plan membership, and will assure that this assistance is
readily accessible to beneficiaries. This assistance will emphasize their
rights and responsibilities as health care plan enrollees. The Contractor
will contact involved health care plans, as necessary, and gather all
materials/forms needed to assist beneficiaries. Assistance will include,
but not be limited to:
1. Explaining how health care plans operate and how to use the resources
of the plans. This will include giving them information regarding
completion of applications, and information about the health care plan
grievance process and the appeal process for those who have been
assigned to a health plan.
2. Referring beneficiaries to the appropriate health care plan's
organizational units or staff to resolve enrollment problems.
3. Providing information, as supplied through the Department by health
care plans, to beneficiaries on public transportation available to and
from health care plan service sites.
4. Maintaining toll-free 800 numbers available Monday through Friday,
(excluding holidays) between the hours of 8:00 a.m. and 5:00 p.m.
Pacific Standard Time, for beneficiary questions, inquiries, problems
or concerns. (The rights to use the sequential combinations of numbers
that make up the toll free 1-800 numbers will become/remain property
of the Department.)
The minimum standards for the Call Center are:
a. All calls must be answered within three (3) rings (a call pick-up
system that places the call in queue may be used).
b. No more than one call per operator should be in queue at any
time.
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c. Telephone calls should be of sufficient length to assure adequate
information is gained from and/or imparted to the recipient.
d. The average hold time should be 60 seconds.
e. The average abandon rate should be 5%.
f. The average referral to voice mail should be 2%. This does not
include referrals resulting from ACD options.
g. All voice mail calls should be returned within 24 hours.
h. The average number of blocked calls (i.e., calls receiving a busy
signal) should be no more than 5%.
5. Ensuring accessibility of an interpreter for services to non or
limited English speaking beneficiaries as well as maintaining a TDD
line for the hearing impaired. Contractor will consider cost effective
methodologies for providing translation services, including hiring
bilingual customer service representatives in proportion to
beneficiary language needs. The Department will approve methodologies
utilized by the Contractor.
6. Maintaining sufficient informed staff to respond promptly to
applicant/beneficiary inquiries and/or questions.
7. Documenting the nature of all complaints and attempt to resolve them
within two (2) working days of the Contractor's receipt of the
complaint.
8. Referring issues which are beyond the scope of the Contractor's duties
to the Ombudsman Unit within one (1) working day of receipt from the
beneficiary.
N. Problems Resolution
1. The Contractor will provide assistance to beneficiaries in enrolling
into and using their health care plan. The Contractor will identify
all cases in which an enrollment transaction has not been completed at
least 45 days after the filing of the beneficiary's enrollment form
and for which the Contractor has received no notification from the
Department of any new MED'S eligibility status.
The Contractor will:
a. Investigate each case to determine the cause for
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delay, using County and/or Department resources made available to
them.
b. Inform the County of those enrollment forms and the reasons for
delay, in order to allow the County to correct any MEDS errors.
c. Inform the Department, on a monthly basis, of the number of
errors reported to the County and the elapsed time between the
report to the County and the correction of the problem.
2. The Contractor will report to the County and the Department, MEDS
input errors that prevent beneficiary enrollment into a health care
plan.
3. When a beneficiary calls the Contractor with a problem, the Contractor
may need to forward the beneficiaries problem to the Departments
Ombudsman Unit for resolution. The Contractor will:
a. Investigate the beneficiary's inquiry and determine the nature of
the problem.
b. If the inquiry can be addressed by the HCP through the grievance
or appeal process, refer beneficiary to the HCP.
c. If the problem can be corrected, the appropriate records will be
modified by the Contractor and submitted to the Department.
d. The Contractor will call the beneficiary within 24 hours to
advise him/her of the results of the investigation.
1. The beneficiary will receive follow-up written confirmation
of the results of the investigation.
2. The Department will receive a written Incident Report from
the Contractor.
3. The Plan will receive a phone call from the Contractor.
O. Ombudsman
In the event that referrals to the plan are not successful, or the
complaints cannot be resolved by the Contractor, the Contractor will record
the complaint. The Contractor will advise
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the beneficiary of the date which they can be expected receive a call or an
answer. The Contractor will include this date on a transmittal, and fax it
to the Departments Ombudsman Unit. The Ombudsman Unit will work with the
plan to resolve the complaint within the specified time frame, and fax the
resolved complaint or an extended due date to the Contractor for
communication to the beneficiary. If necessary, the Contractor will provide
all necessary translation services and communication links between the
beneficiary and the Ombudsman unit, as requested by the Department.
P. Monthly Progress Reports
The Contractor will submit monthly progress reports to the Department. The
reports will be prepared to meet the following requirements:
1. The reports are to be submitted in hard copy and as indicated in B
below with all statistical tables in a MS DOS, Lotus 123 WK1
compatible spreadsheet format. All narrative will be submitted in the
American Standard Code II (ASCII) or in WordPerfect 6.0 format.
2. The format for submission of this report will be 3.5" high density,
double sided 1.4MB diskettes or 3.5" double density, double sided
720KB diskettes.
3. Reports will be filed by the tenth working day of the month following
the report month.
4. The Monthly Progress Reports will include, but not be limited to, the
following:
a. Table of Contents
b. Monthly Report Summary
1. Call Center, including total incoming calls; average talk
time; average wait time; abandon rate; voice mail rate;
total provider calls; total outbound calls; total number of
calls.
2. Enrollment Processing, including number of beneficiaries
choosing FFS; Health care plans (by plan); dental plans;
referrals to presentations in counties which use a referral
process; total transactions; assignment.
3. Number of Wetters sent by type.
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4. Number of Disenrollments.
5. Number of Exemptions by each certifying physician.
6. HCO Counseling, including number of presentations; number of
cases; persons represented.
c. HCO Status Reports by County.
Intercounty reports will compare County performance in HCO
presentations, enrollments and disenrollments. Counties will be
summarized by site(s) and overall County total.
1. Total applications completed by case number and number of
persons; total applications granted by case number and number of
persons.
2. Total redetermination by case number and number of persons.
3. A daily and total count of the number of cases referred to HCO
presentations in counties which utilize a referral process and
referral forms.
4. A daily and total count of the number of cases and persons
represented in those cases who actually attended the HCO
presentation.
5. Daily and total summaries of the number of presentations made at
each location and total length of each presentation.
6. A breakdown of the number of persons and percentage who chose
Fee-For-Service. This number is to be separated by new eligibles
and redeterminations.
7. A breakdown of the number of persons and percentage who chose
specific health care plans. This number is to be separated by new
eligibles and redeterminations.
8. Health care plan selection and/or assignment including name of
plan.
9. Total County enrollment.
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10. Total County disenrollment, including name of plan and reason for
disenrollment, including language/ethnicity.
11. Total County default assignments by beneficiaries' language,
ethnicity and zip code
d. Narrative Report, including an overview of current and future
activities, any pertinent information not included in statistical
information and an explanation of variations in the statistical
information.
e. A description of any problems encountered and a proposed corrective
action plan to resolve problems within the scope of the Contractor's
responsibilities. The Department will retain the authority to approve,
deny or amend corrective action plans.
f. Any other reports and information as determined and requested by the
Department such as specialized research reports.
Sample monthly reports are available in the Data and Information Library.
Q. Reports To Managed Care Plans
1. The Contractor will submit lists, on a weekly basis, directly to the
managed care plans regarding those beneficiaries who have been
enrolled in the managed care plan and the PCP selected by the
beneficiary (if applicable) through the HCO program.
2. The reports will include specific information, i.e., beneficiary name,
Social Security Number, address, etc.
3. A copy of the weekly report to the MCPs will be sent to the
Department.
R. Ad Hoc Reports
The Contractor will provide any ad hoc reports as requested, and within the
timeframe designated by, the Department. These reports do not include those
described in Exhibit B, and will be reimbursed as discussed in Section
18.18.8.H of the RFP. The volume of reports varies on a monthly basis.
S. Security and Confidentiality
This section describes the requirement for the Security and
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Confidentiality Plan and Procedures which will be developed and submitted
to the Department and implemented by the Contractor by the contract
effective date.
1. The Contractor will comply with the provisions of the RFP security and
confidentiality requirements from the effective date of the contract
through the end of the contract.
2. The Contractor will permit Department and authorized State and federal
representatives to access any HCO facility, equipment and related
materials covered by the contract. Such access will be at the
discretion of the Contract Manager.
3. The Contractor will provide any security and confidentiality
procedures or related documentation to the Department within one (1)
State workday after receipt of a request from the Contract Manager or
his/her designee. All procedures required in this Section will be
developed and formally submitted to the Contract Manager for review
and written approval prior to implementation.
4. The Contractor will establish a security and confidentiality training
program as part of the Security and Confidentiality Plan and
Procedures specifically designed for all levels of Contractor staff.
All persons having responsibility for the handling or processing of,
or the exposure to, confidential data will participate. Such training
will occur within two (2) weeks of the Department's approval of the
training program. Once fully established and presented, an annual
orientation program will be maintained to ensure a continual awareness
of security and confidentiality requirements. Additionally, new
employees will receive security and confidentiality training within
one (1) week of their start date before they are given exposure to the
confidential data. Included in the training will be fire and safety
training. The training will cover a full range of security and
confidentiality concerns, including, but not limited to:
a. Definition of confidential data and examples of the various
types.
b. Federal and State law pertaining to confidential data.
c. The staffs' ongoing responsibility to ensure that unauthorized
disclosure does not occur, with practical and realistic examples
as to how such disclosure can occur and what can be done by all
staff to minimize or preclude the occurrence of unauthorized
disclosure.
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d. The training must deal with both manual and automated processes
and the procedures which have been devised to protect these
processes.
5. The Contractor will see that the contents of this Section are included
in the standard language of any subcontract entered into to perform
work arising from or related to this contract.
6. Upon request from the Contract Manager, the Contractor will submit
documentation acceptable to the Department to demonstrate compliance
with security and confidentiality requirements and will certify, in
writing, that all RFP requirements of this Section have been and will
continue to be met throughout the life of the contract.
7. The Contractor will develop, implement and maintain a Department
approved Security Plan and Procedures which provide adequate physical
and system security for the HCO Program.
All Contractor facilities associated with this contract will be
addressed in the Security Plan. Facilities will include, but are not
limited to, the equipment room; software and data libraries;
supervisor area; job entry area; enrollment and disenrollment form
processing area: mail room; computer terminals; Customer Service
telephone room; junction boxes; and HCO presentation sites. It will
also include transportation and data holding resources used by the
Contractor throughout the term of the contract and the facilities
which handle both enrollment and disenrollment information.
8. All Contractor facilities will be secured so that only authorized
persons, including persons designated by the Contract Manager, are
permitted entry into the facility and that such persons are restricted
to areas where they are permitted access. Access control requirements
will include, but not be limited to:
a. Contractor staff will be familiar with and adhere to the written
security policy.
b. Facility entry and control points will be guarded or locked at
all times. Control points should be established for each of the
following: entrances to the processing facility where both
enrollments and disenrollments are processed; service entrances;
loading platforms; garage entrances;
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equipment/facilities; and secondary entrances.
c. The Contractor's processing facility will be a secured building,
providing segregated areas which contain confidential
information. There will be no access to unauthorized personnel in
these segregated areas.
d. The Contractor will have available and furnish to the Department
as a part of the Security and Confidentiality Plan and
Procedures, a current list of all authorized staff and their
levels of access. Upon change of duty or termination of
Contractor staff from work under or arising from this contract,
access authority for that staff member will be removed.
e. The entry and exit of visitors and messengers will be logged by
visitor name, agency represented, date and time of arrival and
departure, and name of individual to whom visit is made.
Identification credentials of all visitors will be checked.
Visitors will be badged and escorted to their destination by a
Contractor employee.
f. Passwords will be required to access MEDS and "Choice" system, if
utilized.
g. Procedures for the handling, packaging and transportation of
confidential information or resources will be developed,
submitted to and approved by the Department, and will ensure
against unauthorized access.
h. The equipment room/facilities will be locked at all times.
i. During non-working hours, the facility will be protected against
intrusion with an appropriate surveillance alarm extended to a
staffed monitoring center.
j. The Contractor will establish and maintain internal security
procedures and put safeguards in place to protect against
possible collusion between Contractor employees and providers or
others.
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Maximus Exhibit C
EXHIBIT C TURNOVER REQUIREMENTS
The objective of the turnover period is to ensure an orderly transfer of the
Health Care Options contract from the Contractor to the successor Contractor at
the end of the contract, or upon termination of the Contract. Turnover
activities will begin as early as six (6) months prior to the end of the
Contract. If the Department exercises its option to extend this Contract all
Turnover activities will be delayed for a commensurate period of time.
Given the uncertainties associated with the turnover period that will occur at
the end of this Contract, the Contractor will be flexible to changing
requirements.
A. Turnover Support Services
Turnover support services will begin 6 months prior to the end of the
contract period. The purpose of these services will be to assist the
Department in the Contract procurement process and provide support in the
transfer of records and operations .
All information provided by the Contractor will be accompanied by a letter,
signed by the responsible authority, attesting to the accuracy, currency
and completeness of the material(s) supplied.
Three months prior to the end of the Contract, the Contractor will provide
an updated and detailed description of the methodology that will be
utilized by the Contractor to ensure the complete review, certification,
and acceptance of all Contractor's documentation provided to the Department
for transfer to the successor Contractor.
The Contractor will supply any other information or data deemed necessary
by the Department to effect a smooth turnover to a successor Contractor.
B. Turnover Work Plan
The objective of the Turnover Work Plan is to identify requirements
necessary to complete the Contract expiration/termination process, transfer
the Health Care Options process from the current Contractor to the
successor Contractor at the end of this contract and describe in detail,
the Contractor's proposed activities for the duration of the Contract.
Turnover activities will begin 6 months prior to the end of the Contract.
If the Department exercises its option to extend this Contract, all
Turnover activities will be delayed for a commensurate period of time. The
Turnover Work Plan will
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include, but is not limited to the Contractor s turnover activities as
follows
l. Descriptions of the turnover activities identified as major tasks and
minor tasks to be performed during Turnover period.
2. A proposed schedule for the occurrence of all turnover tasks and
services to be performed.
3. Proposed schedules and staff allocations, by classification, for all
turnover activities, including narrative descriptions.
4. A detailed description of the procedures that will be utilized by the
Contractor to ensure an acceptable transfer of the Contractor's
records retention responsibilities to the successor Contractor.
5. A detailed description of the means by which the Contractor will
support the Department, during Turnover, with documentation, software,
and any other resources required to complete a test of the successor
Contractor's operation of the HCO program. This will include
descriptions of the tasks necessary to perform operational test runs.
6. A detailed description of the Contractor's activities during the
turnover including a schedule of reports, files, and data that will be
provided to the successor Contractor and a schedule demonstrating the
proposed sequential organization of the transfer(s).
The Department will review the Turnover Work Plan to determine if all
the Turnover requirements are adequately and appropriately detailed
and sufficiently covered, by the Contractor, prior to giving final
written Department approval to the Turnover Work Plan.
C. Turnover Preparation
The objective of the turnover preparation is to schedule activities to
ensure the Department's procurement and the successor Contractor's takeover
schedule will not in any way disrupt the Health Care Options contract
activities. Turnover preparation activities will begin 6 months prior to
the end of the Contract. During this turnover preparation period, the
Contractor will provide the Department with a schedule of hands-on training
for designated successor Contractor's staff on equipment and records being
turned over.
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D. Processing
The Contractor's obligations and liabilities will be as follows:
1. The Contractor will remain responsible for performing all contractual
obligations until the close of the contract or as requested by the
Department for phase-down period.
2. The Contractor will keep the beneficiary history file operative and
current until the expiration of the contract.
3. The Contractor will develop a report describing, at the lowest level
of detail understandable to the lay person, work in progress to be
transferred to the successor Contractor.
4. Additional Contractor responsibilities during turnover will include:
a. Maintain staffing consistent with workload during the turnover by
encouraging and/or providing incentives for staff retention.
b. In conjunction with the successor Contractor, hold job seminars
with the Contractor's employees to encourage employees to accept
employment with the successor Contractor, thereby enhancing the
continuity of Health Care Options.
E. Contract Closeout
Following the operations phase of the contract, the Contractor will perform
the following activities:
1. Transfer all records to the successor Contractor. This physical
transfer will be in an orderly and efficient manner, and in full
compliance with the security and confidentiality provisions of this
contract. The Contractor will transfer to the successor Contractor, in
covered boxes, all unprocessed documents along with transmittal sheets
indicating the contents of each box, the type(s) of document(s)
contained in each box, the exact status of each document, and the
remaining activities to be performed for each document. This transfer
will be accomplished with no disruption in services to users,
including but not necessarily limited to provision of records
retention services, during execution of the transfer. This transfer
will be completed in accordance with the Departments phase-down plan,
will be executed no later than the last day of the contract period,
and will include but not be limited
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to the following:
a. Enrollment forms
b. Disenrollment forms
c. Inquiries and correspondence
d. Appeals
e. Returned mail
f. Logs and correspondence for special review
g. All other related documents and records as identified by the
Department or the Contractor throughout contract closeout.
2. The Department may perform a final audit of all contract-related
documentation in preparation for Federal or State conducted audits of
the Contract.
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EXHIBIT D DEPARTMENT RESPONSIBILITIES
In discharging its obligations under the resulting contract, the Department will
perform the following duties:
A. Comply with provisions of the Request for Proposal and the Contractor's
approved Technical Proposal.
B. Make appropriate payments for work performed by the Contractor as specified
in the contract.
C. Designate the Department staff, also referred to as the Health Care Options
(HCO) contract manager, who will act as a single source liaison or contact
within the Department for all HCO related matters.
D. Provide and maintain liaison duties between the Contractor and the County
Welfare Departments.
E. Provide and maintain liaison duties between the Contractor and the Managed
Care Plans (MCP).
F. Provide the Contractor with a sufficient number of "Medi-Cal Choice"
booklets and enrollment forms.
G. Ensure each County Welfare Department's compliance in referrals of Medi-Cal
applicants and beneficiaries to the Contractors representatives.
H. Provide necessary access to the County Welfare Department's Medi-Cal
Eligibility Data System (MEDS).
I. Evaluate and approve or disapprove all training materials and training
courses the Contractor proposes to use to perform the implementation and
continuous training requirements for the Contractor's staff.
In the event the Department does not approve the training plan or
materials, the Department will direct the Contractor to make appropriate
modifications to make the material acceptable.
J. Notify the Contractor of the addition of new MCPs or termination of
existing plans.
K. Provide to the Contractor, a list of beneficiary categories to be exempted
from assignment to health care plans.
L. Provide to the Contractor written procedures for handling assignment and
appeals.
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M. Specify content and format for reports to be prepared by the Contractor
relative to assignment.
N. Provide to the Contractor data files (see Section 9.0), in a jointly
approved format, listing beneficiaries who have become eligible for
Medi-Cal in aid categories and areas in which Medi-Cal health care plans
are available.
O. Inform the Contractor of any changes in any health care plan listings of
available clinic/office/hospital locations and information regarding public
transportation to and from clinics/offices/hospitals, language capabilities
and any extra services offered by the health care plan as this information
becomes available.
P. Provide the Contractor with all the approved marketing materials developed
by he MCPs which may be provided to the applicant or beneficiary with the
enrollment packet or during the HCO presentation.
Q. Provide the Contractor with a detailed list of all primary CWD intake
offices where the Contractor will be required to maintain staff and the
addresses and County contacts for each primary location.
R. Provide the Contractor with complete and current information on program
content, regulations, policies, procedures, and guidelines affecting
performance under this contract.
S. Provide the Contractor with approved zip codes by MCP.
T. Provide printed materials to be distributed by the Contractor in
appropriate languages, as required by the Department.
U. Approve all audio, visual, and~printed materials developed by the
Contractor for distribution to the applicant or beneficiary, and used in
any presentation discussing the HCO program.
V. Approve the "Conflict of Interest Disclosure Statement" and the "Conflict
of Interest Avoidance Plan" developed by the Contractor.
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Department of Health Services EXHIBIT E
Contract Management Unit
SHORT-TERM TRAVEL REIMBURSEMENT INFORMATION
EFFECTIVE JULY 1, 1993
1. The following rate policy is to be applied for reimbursing the travel
expenses of persons under contract:
a. Short Term Travel is defined as a 24-hour period and less than 31
consecutive days. Starting time is ether one hour prior to takeoff
time or from the time a person leaves his or her home, whichever is
earlier.
b. Contractors on travel status for more than one 24-hour period and less
than 31 consecutive days may claim a tractional pan of a period of
more than 24 hours. Consult the chart appearing on page 2 of this
bulletin to determine the reimbursement allowance.
(1) Lodging: Statewide Rate (no receipts) $24.99
Statewide Rate (with receipts) Actual costs
up to $79.00 plus tax.
Reimbursement for actual lodging expenses exceeding the above
amounts may be allowed with the advance written approval of the
Deputy Director of the Department of Health Services or his or
her designee. Receipts are required.
(2) Meals/Supplemental Expenses (with or
without.receipts):
Breakfast $5.50 Dinner $17.00
Lunch 9.50 Incidentals 5.00
c. Out-of-state travel may only be reimbursed if such travel has been
stipulated in the contract and has been approved in advance by the
program with which the contract is held. For out-of-state travel,
contractors may be reimbursed actual lodging expenses, supported by a
receipt and may be reimbursed for meals and supplemental expenses each
24-hour period computed at the rates listed in b(2) above.
d. In computing allowances for continuous periods of travel of less than
24 hours, consult the chart appearing on page 2 of this bulletin.
e. No meal or lodging expenses will be reimbursed for any period of
travel that occurs within normal working hours.
2. If any of the reimbursement rates stated herein change by law, an amendment
to the contract must be entered into to incorporate the new rates. The
effective date of any new rates will be determined by the effective date of
the contract amendment.
3. For transportation expenses, the contractor must retain receipts for
parking; taxi, airline, bus, or rail tickets; car rental; or any other
travel receipts pertaining to each trip for attachment to an invoice as
substantiation for reimbursement. Reimbursement may be requested for
commercial carrier fares; private car mileage; parking fees; bridge tolls;
taxi, bus, or streetcar fares; and auto rental fees when substantiated by a
receipt.
4. Note on Use of Autos: if a Contractor uses his or her car for
transportation, the rate of pay will be 24 cents per mile. If, however, the
contractor Claims that his or her actual cost is over 24 cents per mile,
the contractor may Claim up to 30 cents per mile provided the Contractor
types on an invoice and Certifies the following: "I certify that the actual
cost of operating my vehicle was equal to or greater than the rate I have
claimed." If a contractor uses his or her car in lieu of air fare, the air
coach fare will be the maximum paid by the state. The contractor must
provide a cost comparison upon request by the state. Gasoline and routine
automobile repair expenses are not reimbursable. Amounts Claimed in excess
of 24 cents per mile may be reported to the Internal Revenue Service.
5. The contractor may be required to furnish details surrounding each period
of travel. Travel detail may include but not be limited to: departure and
return times, destination points, miles driven, mode of transportation etc.
6. Contractors are to consult with the program with which the contract is held
to obtain specific invoicing procedures.
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SHORT-TERM TRAVEL REIMBURSEMENT GUIDE
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IF LENGTH OF TRAVEL IS IF THIS CONDITION EXISTS CONTRACTOR MAY CLAIM
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Less than 24 hours Travel period began at Breakfast
least one hour before
the regularly scheduled
work day began.
Example: A contractor may claim breakfast if,
during a period of travel, he or she begins their
travel at 7:00 a.m. or earlier and their normal
working day was scheduled to begin at 8:00 a.m.
Less than 24 hours ----------------------- No lunch
Less than 24 hours Travel period ends at Dinner
least one hour after the
regularly scheduled work
day ends.
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24 hours A contractor is on Breakfast, lunch, and
travel status for a full dinner
24-hour period
(determined begin and
end times).
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Last fractional part of Return at or after 9:00 Breakfast
more than 24 hours a.m.
Example: If a contractor returns the last day of a
trip of more than 24 hours at or after 9:00 a.m.,
a breakfast allowance may be claimed.
Last fractional part of Return at or after 2:00 Lunch
more than 24 hours p.m.
Example: If a contractor returns the last day of a
trip of more than 24 hours at or after 2:00 p.m.,
a lunch allowance may be claimed.
Last fractional part of Return at or after 2:00 Dinner
more than 24 hours p.m.
Example: If a contractor returns the last day of a
trip of more than 24 hours at or after 7:00 p.m.,
a dinner allowance may be claimed.
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