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HomeMy WebLinkAboutMINUTES - 09011998 - C71-C75 TO: BOARD OF SUPERVISORS e. ;71 FROM: William Walker, M.D. , Health Services Director ~a. ';t Contra By: Ginger Marieiro, Contracts Administrator Costa MATE: August 13, 1998 County SUBJECT: Approval of Standard Agreement (Amendment) x#29-765-4 with the State of California Major Risk Medical Insurance Board for the Access for In I Program SPECIFIC:REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDED ACTION: Approve and authorize the Health Services Director, or his designee (Milt Camhi) , to execute on behalf of the County, - Standard Agreement' (Amendment) #29-765--4, with the State of California Major Risk Medical Insurance Board, effective June 30, 1998, to extend term of the Agreement through June 30, 1999 and increase the Total Payment Limit by $50, 000, from $136, 875 to $186, 875, for County' s participation in the Access for Infants & Mothers (AIM) Program. FISCAL IMPACT: The State of California Major Risk Medical Insurance Board is allocating funds, not to exceed $50, 000 for the Fiscal. Year 1998/99, for the County' s participation in the AIM Program. Total revenue to the County will depend entirely upon enrollment volume . No County, match is required. The California Major Risk Medical Insurance Board requires that this Contract be a confidential document for one year and requires that the fiscal provisions attachment remain confidential for a' period of four' years. BACKGROMM/'REASON(S) FOR RECOMMENDATIONS) The County has participated in the State-funded AIM', Program since' January 1992 . This Program provides increased access to maternity, delivery and infant care services for low income women who have neither Medi-Cal nor private health insurance coverage . Under this Agreement, the Contra Costa Health Plan ' (Health Plan) ' provides comprehensive medical care during a woman' s' pregnancy and delivery, and for sixty days post-partum. The AIM Program also provides comprehensive medical care to the baby during its first two years of life . Approval of Standard Agreement (Amendment) ##29-765-4 :will allow the Health Plan to continue participating in the AIM Program through June 30, 1999 . CO TINUED ON ATTACHMENT' Ir SIGNATURE RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE _„_OTHER I &kei& ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT 1 AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED P S HELOR,CLEE�K OF T OARC1 OF SUPERVISORS AND COUNTY ADMINISTRATOR Contact Pet 41 Camhi. (313-6004) CC: State of Calif Mayr Risk Ins Bd Health Service Dept (Contracts) -----• ,D UTY r TO: BOARD OF SUPERVISORS w*� 'William Walker, M.D. , Hea h Servi�ce�sceo ,�' FROM: By: Ginger Marieiro, Contracts Administrator ., Contra Costa DATE: August 18, 1998 County Approval of Standard. Agreement (Amendment) #29-488-8 with the SUBJECT= State Department of Alcohol and Drug Programs SPECIFIC REQUEST(S)OR RECOMMENDATION(S)a BACKGROUND AND JUSTIFICATION RECObDI ED ACTION: Approve and authorize the Health Services Director, or his designee (Chuck Deutschman) , to execute on behalf of the County, Standard Agreement (Amendment) #29-488-8 (State #NNNA 07-94, A-8) with the State Department of Alcohol and Drug Programs, effective July 1, 1997, to receive State General Funds and Federal Block Grant allocations to fund approximately 77W of County's Community Substance Abuse services. FINANCIAL IMPACT: Funding under this Agreement is summarized below: State General Funds $ 2,644,442 Federal Block Grants 5,808,893 Federal Drug Medi-Cal Funds ' 1.119,232 TOTAL $ 9,572,567 This Amendment represents changes in funding over the previous Agreement as follows: State General Funds $ No change Federal Block Grants (185,000) Federal Drug Medi-Cal Funds 33,556 TOTAL $(151.444) The decrease in Federal funding represents a roll-over of e $1.50,000 Federal .Block Grant and $35,000 of Mentor Initiative funds from fiscal year 1997-98 to fiscal year 1998-99. The required County match remains unchanged from the prior agreement. REASONS FOR RECO MXMWATION9/BACKGROUND: Under the State Department of Alcohol and Drug Programs regulations and the court order of Sobky V. Smoley, counties are required to contract with the State to provide substance abuse and Drug/Medi-Cal services. The above amounts represent the final amendment of the contract with the State for fiscal year 1997-98 to provide those services. Three (3) copies of the certified/sealed Board Order should be returned to the Health Services Contracts and Grants Unit for submission to the State. CONTINUEDON A TC IG ATUR RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE ,,,_,,,OTHER SIGNA U q ACTION OF BOARD ON � .�" APPROVED AS RECOMMENDED R VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE -- UNANIMOUS (ABSENT 1 AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED PHIL BATC ELOR,CLERK OF TH BOAR©OF SUPERVISORS AND COUNTY ADMINISTRATOR Contact Penson: Chuck Deutschman (313-6350) CC: Health Services (Contracts) State Dept. of Alcohol and Drug BY DEPUTY TO: BOARD OF SUPERVISORS FROM: William Walker, M.D. , e�al dector Contra By: Ginger Marieiro, Contracts Administrator DATE: August 18, 1998 6X, Costa County SUBJECT, Approval of Agreement #26-023-62 with the U.S. Depar ent of Veterans Affairs SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDED ACTION: Approve and authorize the Health Services Director, or his designee (Frank Puglisi, Jr. ) , to execute on behalf of the County, Agreement #26-023-62 (Federal #V612P-6153) , with the U.S. Department of Veterans Affairs, Northern California Health Care System (VANCHCS) , for the period from July 1, 1998 through September 30, 1998 . FINANCIAL IMPACT: VANCHCS will pay County a fee for service in accordance with the fee schedules incorporated in the Contract . There are no unit price increases over the prior Agreement. REASONS FOR RECOMMENDATIONS/BACKGROUND: For many years the County and U.S. Department of Veterans Affairs has maintained a mutual sharing agreement which has made available to the County specialized medical services not otherwise available due to lack of resources, equipment, and personnel . These services included specialized laboratory testing, radiology services, nuclear medicine studies, CT scans, MRI ' s, dermatology, gastroenterology, urology, audiology and speech, and ophthalmology services . The County provided Emergency Room treatment and inpatient care, including certain ancillary services, for VA- referred patients . The VA recently informed the Department that hereinafter they will separate those services they "buy" and "sell" into individual documents in an effort to simplify, as well as expedite, the processing of future agreements. Under the terms of this Agreement, Contra Costa Regional Medical Center will provide Emergency Services and Inpatient Medical and Surgical Services to patients referred by VANCHCS. The Contract documents have always been prepared by the Veterans Administration and require final approval from the Department of Veterans Affairs in Washington, D.C. j CONTINUED ON ATTACHME T: -IV RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE _X APPROVE —OTHER ACTION OF BOARD ON APPROVED AS RECOMMENDED VOTE Of SUPERVISORS I �,/ I HEREBY CERTIFY THAT THIS IS A TRUE _60�60� UNANIMOUS (ASSENT AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ASSENT: _ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED,,''e HIL BATCHELOR,CLERK O BOARD OF Contact Person: Frank Puglisi (370-5100) SUPERVISORS AND COUNTY ADMINISTRATOR CC: Health Services(Contracts) Risk Management Auditor Controller BY DEPUTY Contractor SOLICITATIC}N/CC}N T RACTIORDER FOR COMMERCIAL ITEMS 1.REQUISITION NUMBER PAGE I. OF OFFEROR TO COMPLETE BLOCKS 12,I?,23,24,&30 W CONTRACT NO. 3.AWARDTFFECTIVE 4 ORDER NUMBER 5.SOLICITATION NUMBER 6.SOLICITATION ISSUE V612P-6153 DATE 7/1/98 N/A DATE 3133198 7.FOR.SOLICITATION a,NAME b.TELEPHONIE NliMBER/Va Caltaa+Ca tst S.OFFER DUE DATE/ INFORMATION CALL: Karen E.Pridmore, Contracting Officer (925)372-2046 LOCAL TIME 9. ISSUED BY CODE 612/90C 10. THIS ACQUISITION IS 11,DELIVERY FOR FOB 12_DISCOUNT TERMS DESTINATION UNLESS Department of Veterans Affairs UNRESTRICTED BLOCK IS MARKE-1) Northern California Health Care System SET ASIDE 100 i FOR SEE SCHEDULE Acquisition&Materiel Management Service QSMALL BUSINESS 13a,THIS CONTRACT IS A RATED ORDER UNDER DPAS f 15 CFR 740) 2300 Contra Costa Blvd., Suite 440 SMALL DISADv,BUSINESS N/A Pleasant Hill, CA 94523 g(A) 138 RATING N/A SIC: 8062 14, METHOD OF SOLICITATION NIA SIZE STANDARD $5.0 Mil E3PFQ 131FB [)RFP 15.DELIVER TO CODE 36.ADMINISTERED BY CODE Sarre as Block 9 Same as Block 9 17A.CONTRACTORI CODE FACILITY i 8A. PAYMENT WILL BE MADE BY CODE 612/04 OFFEROR CODE Contra Costa Regional Medical Center(CCRMC) Chief,Fiscal Service(04) 2500 Alhambra Avenue VA Northern California Health Care Svstem Martinez, CA 94553 2300 Contra Costa Blvd., Suite 440 Pleasant Hill,CA 94523 "' 2, .. 6Telephone No. (925)370-5130 ri 18 b.SUBMIT INVOICES TO ADDRESS SHOWNTN BLOCK 18a UNLESS BLOCK BELOW 17b.CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 1S CHECKED SEE ADDENDUM 19 20 21 22 23 24 ITEM NO. SCHEDULE OF SUPPLIES/SERVICE QUANTITY # UNIT UNIT PRICE AMOUNT 1 See Attached Schedule tR7T4C"X d17Flt It}.VAL SF?EE73,4S A'e"CESS.3RY) 25.ACCOUNTING AND APPROPRIATION DATA 20.TOTAL AMOUNT AWARD(FOR GOVT USEONL3) 27a.SOLICITATION INCORPORATES BY REFERENCE FAR 52.212.1. FAR 52.212.3 AND 52.212.5 ARE ATTACHED ADDENDA 71 ARE L7ARE NOT ATTACHED. 27b.CON T RACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.2124 FAR 52.'.12-5 IS ATTACHED ADDENDA .ARE [] ARE NOT ATTACHED 28.CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN i(one) COPIES 29 AWARD OF CONTRACT, REFERENCE OFFER TO ISSUING OFFICE CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET DATED YOUR OFFER ON SOLICITATION(BLOCK Z FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO 5) INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH THE TERMS AND CONDITIONS SPECIFIED HEREIN, HEREIN,IS ACCEPTED AS TO ITEMS: 30a. SIGNATURE OF OFFEROR ICONTRACTOR 31A.UNITED STATES OF AMERICA(SIGNATUREOF CONTRACTING OFFICER) 30b.NAME AND TITLE OF SIGNER(TYPE OR PRINT) 30c,DATE SIGNED 31 b.NAME OF CONTRACTING OFFICER(TYPE OR PRINT) 31c.DATE SIGNED Karen E.Pridmore 32a.QUANTITY IN COLUMN 21 HAS BEEN 33.SHIP NUMBER 34 VOUCHERNUMBER 35,AMOUNT VERIFIED CORRECT FOR F1 RECEIVED INSPECTED 7, ACCEPTED AS CONFORMS TO THE PARTIAL FINAL CONTRACT.EXCEPT AS NOTED 32b-SIGNATURE OF AUTHORIZED GOVT,REPRESENTATIVE 32C.DATE 36.PAYMENT 37.CHECK NUMBER COMPLETE PARTIAL FINAL 38.S/R ACCOUNT NUMBER 39 SIR VOUCHER NUMBER 40.PAID BY 414.I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a.RECEIVED BY IPRIA'11 41b SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c DATE 42b,RECEIVED AT(LOC4TICW6 42c.DATE RECD(7-7:M k-DD) 42d.TOTAL CONTAINERS AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 1449 (10-95) Prescribed by GSA-FAR(48 CFR)53.212 FEE SCBEDULE July 1, 1998 through September 30, 1998 7�77 escription Est, Unit Total Cost Qty. Cost EMERGENCY ROOM VISITS 1. Use of treatment room 100 ! 68.00 ( 6,800.00 2. Laboratory Services { a.. CBC j 50 j 26.00 . 1,300.00 i b. Chem Panel (7) i 50 58.00 2,900.00 (1) PT 25 18.00 ' 450.00 (2) PTT 25 86.00 2,150.06- d. Blood Gases (ABG) 25 86.00 2,150.00 e. LFTs (1) SGOT 10 E2O.00 200.00 (2)T Bili 10 20.00 ' 200.00 (3) Alk Phos 10 24.00 1 240.00 J 3. EKG 50 j 83.00 4,150.00 4. Radiology { a. CXR f 10 134.00 { 1,340.00 b. Long bone film., survey 5 j 328.00 1,540.00 c. KUB 5 91.00 455.00 d. Ultrasound(Abd/Pelvic) 5 382.00 1,910.00 5. Professional Component a.. Brief(ER) 60 38.00 j 2,280.00 b. Detailed (ER) 40 105.00 4,200.00 6. ; Cast Room 5 109.00 545.00 7. Pharmacy (average visit) 80 28,00 2,248.00 ' 8. ; GI Lab (Scopes) 4 j 433,00 ! 1,732.00 9. j Central Supply (average visit) 100 , 13.00 1,300.00 ' Ill'rPATIENT CARE I0. Hospital Days a. Routine (medical) (Daily Per Diem Rate) 180 j 623:00 ' 112,140.00 b. Intensive Care(Daily Per Diem Rate) 20 1.971.00 39,420.00 c. Operating Room (2-3 cases per month) (1) OR Time (Hourly Rate) 24 436.00 . 10,464.00 (2) Recovery Room(Hourly Rate) 24 301.00 ' 7,224.00 (3) Anesthesiology Time (Hourly Rate) 24 276.00 6,624.00 d. Pharmacy(average visit) 200 153.00 30,600.00 e. Central Supply(average visit) 200 161.00 ' 32,200.00 f. CT Scan (7.1 per Stereotactic Thalamotomy(per slice) j 25 60.50 1,512.50 Estimated Total , $278,374.50-1 F. ESTIMATEDLTANTITIES: All quantities listed are estimates only. The Government is not obligated to any specified amount of products and/or services, but shall be obligated to provide payment in full for all items/services requested and received in the quality and quantity requested. 2 DESCRIPTION OF SERVICES Enhanced Use Sharing Agreement between Contra Costa Regional Medical Center(CCRMC), 2500 Alhambra Avenue,Martinez, California and.VA Northern California Health Care System (VANCHCS), 2300 Contra Costa Blvd., Suite 440, .Pleasant Hill, California. A. SCOPE OF CONTRACT The Contractor shall provide Emergency Services and Inpatient Medical and Surgical Services to patients referred by the VA Northern California Health Care System (hereinafter referred to as "VANCHCS" or "VA"), 150 Muir Road, Martinez, California, as specified herein at the prices identified in the Fee Schedule. All services shall be provided at the Contractor's place of business. This contract shall cover emergency cases referred by VA. Elective and non-emergency cases may be referred or transferred to VA medical facilities when available and when deemed medically appropriate by a VA physician. B. EMERGENCY SERVICES: 1. General: The Contractor shall provide a full range of Emergency Services to patients referred by a VA Telecare Nurse or VA Attending.Physician, as described herein, at the prices specified in Section B. a. Emergency room services provided to patients referred by VA will include,but not be limited to, all services necessary for treatment of the patient's condition (i.e., EKG, radiology,professional services, lab testing, casting, central sterile supply, etc.). C. INPATIENT SERVICES: 1. The Contractor shall provide hospital inpatient services to patients referred by VA who cannot be stabilized for transfer to a VA facility or when it is determined in the best interest ofthe patient by the VA attending physician. 2. Professional Component: VA physicians with clinical privileges at the Contractor's facility will accompany the patient to the Contractor's facility and will provide the professional component of necessary medical-surgical services. In such cases the Contractor shall invoice the VA for use of the Contractor's Surgical Facilities, Support Staff, and Ancillaries at the rates identified in the Fee Schedule. 3. Inpatient Per Diem Rates. The contract per diem rates for Inpatient Services',specified in the Fee Schedule shall be all-inclusive of institutional and ancillary fees necessary for treatment of the patient's condition, with the exception of those items listed separately in the Fee Schedule under"Inpatient Services." 4. Patient Transfers: As soon as patients are stabilized, they may be transferred to VA or other lower level of care for continuing care. Patient transfers will be coordinated by the VA Clinical Transfer Coordinator and Social Work Service staff working with the Contractor's discharge planner. 5. Written consent for treatment shall be obtained by the Contractor. The VA will assist in contacting the next of kin for consent in cases where the patient is incompetent or unable to sign the consent. 6. The VA Surgery Program Coordinator will provide the patient with specific written instructions pertaining to admission to the Contractor's facility. 3 7. The Contractor shall ensure advance directives are completed for all patients admitted for treatment. E. REFERRALS: 1. Patients referred for treatment during normal working hours(between 7:30 a.m. and 5:00 p.m.) Monday through Friday, will be referred by a VA Attending Physician at the VA Outpatient Clinic (VA OPC) or the VA Center for Rehabilitation and Extended Care(CREC), 150 Muir Road, Martinez, California. Patients referred for services after normal working hours, on weekends and Federal holidays will be referred for treatment by the VA Telecare Nurse or VA Attending physician or CLEC`staff. 2. 'Verification of Referral: The Contractor shall be responsible for verifying referral by obtaining a written referral from the VA Telecare Nurse, VA Attending Physician or other VA authorizing authority prior to treatment of the patient. 3. Written authorizations will be made on VA Form 10-7078 which will be faxed to the Contractor by the VA Fee Services Coordinator. 4. Patient Records: When patients are referred for treatment after hours,on weekends or Federal holidays, the VA Telecare Nurse or CREC staff will have access to computerized portions of the VA patient record. Available documents that are necessary for emergency treatment of the patient will be faxed to the Contractor by the Telecare Nurse or CREC staff at the time of treatment. When patients are referred by a VA Attending Physician for hospital admission, the VA Surgery Coordinator shall ensure that copies of all necessary patient records and/or lab results are forwarded to the Contractor's facility prior to hospital admission. F. OTHER CONTRACT REQUIREMENTS: 1. When patients are referred for treatment after hours,the Contractor shall obtain written authorization from VA prior to treating the patient. If a patient presents to the Contractor's facility for treatment without prior authorization,the Contractor will be required to contact VA and verify authorization prior to treatment. 2. Transportation: The patient or VA will be responsible for transportation of patients to and from. the Contractor's medical facility. 3. Pre-procedure/Pre-operative testing. The VA will be responsible for ensuring pre-procedure or pre-operative tests required by the Contractor are completed, and results forwarded to the Contractor for all patients who are seen at the VA prior to admission to the Contractor's facility, 4. Patient Follow-up: The VA Telecare Nurse(s)or VA Clinical Coordinator will be responsible for patient follow-up, requesting copies of emergency room records, and scheduling patients for follow-up outpatient appointments within the VA. 5. For patients referred.by VA who expire, the Contractor shall immediately notify the VA Attending Physician or VA Medical Officer on Duty (MOD) with an explanation of the circumstances and probable cause of death. All pertinent medical records described above will be furnished to the VA within 48 hours of patient's expiration. The Contractor shall notify the Medical Examiner when required by law to do so. 4 G. REPORTS: 1. Within forty-eight(48)hours of emergency treatment or discharge of patient referred by VA; the Contractor will complete a handwritten discharge summary report which will be immediately forwarded to the VA Attending Physician and one copy shall be faxed to the location of VA patient's follow-up care (i.e., VA or VA contract facility). 2. A complete dictated, discharge summary and other necessary billing documents shall be submitted with the final invoice for services as follows: Description Copies Date Due Patient Identification Patient Discharge Summary 1 At time of billing or within Patient Name fourteen(14) days of discharge UB 92/HCFA 1500 1 At time of billing Patient Name 2. The medical records shall include, but not be limited to: emergency treatment and testing, admission history and physical, operative and procedure reports, anesthesia records, post-anesthesia care records,biopsy and pathology reports,recent laboratory and EKG,product information about any implanted devices, and all clinical progress notes for the course of the patient's hospitalization and/or treatment. 3. Each page of the discharge summary report, chart notes or other written medical records shall be annotated with the patient's full name. H QUALITY ASSURANCE A_ND QUALITY MONITORING: I. Services provided under this contract shall be subject to quality management standards as established by the VA, consistent with the standards published by the Joint Commission for Accreditation of Healthcare Organizations (JCAHO). The Contractor shall develop and maintain QI/QA Programs in accordance with JCAHO policies. 2. All information required by the FDA for the tracking of devices implanted during surgery will be included in the patient's record upon transfer. 3. The Contracting Officer or designee is authorized to review,by on-site survey or through review of records or other reasonable manner, the quality of care rendered under the contract, to include,the Contractor's facility,patient records or pertinent documentation. The Contractor shall furnish and maintain adequate medical records to reflect accuracy with respect to claims submission, as well as quality and appropriateness of care. All records of medical and surgical services, supplies and business records shall be subject to review by the Contracting Officer or designee. 4. Quality of Patient Care: The Contractor and its employees and subcontractors shall provide patients referred by VA under this contract the same level of care as provided to other patients receiving care in the Contractor's facility. VA patients will be included as a subset in all appropriate facility performance improvement or quality management or continuous monitoring. Monitoring will include but not be limited to, infection control, mortality, morbidity,blood usage evaluations, drug use evaluations, physician profiles, utilization and admission appropriateness and length of stay. 5 I. CONTRACTOR/SUBCONTRACTOR QVALIFICA'T`IONS; 1. In order to furnish services under this contract, the Contractor and its subcontractors, must be accredited by the Joint Commission for Accreditation of Healthcare Organizations(JCAHO). The Contractor and its subcontractors shall follow all JCAHO policies, procedures and protocols when performing services under this contract. 2. The Contractor shall develop and maintain written policies and procedures for credentialing, certification and continuing education for employees and/or subcontractors providing services under this agreement in accordance with JCAHO requirements. 3. All services under this agreement shall be provided by competent, qualified and experienced health care professionals who are licensed or certified in a State, Territory or Commonwealth of the United States or District of Columbia for their specialty. The qualifications of such personnel shall be subject to review by the VA Chief of Staff and approval by the VA Facility Director and/or Contracting Officer. 4. All professional staff assigned to the care of patients referred by VA under this contract shall be state licensed and board eligible or certified by the appropriate medical/professional standards. I TERMINATION OF SERVICES: VA reserves the right to discontinue services being furnished by the Contractor at any time when it is determined by VA to be in the best interest of the patient or the VA. K. CONTRACT MODIFICATIONS: 1. The services described herein may be changed by written modification to this contract. The modification will be prepared by VA Contracting Officer and,prior to becoming effective, shall be signed by the Contractor and the VA Contracting Officer. 2. Any change in physician providers, or the availability or Contractor's ability to provide a service will be reported via telephone to the VA Chief of Staff's Office through the Contracting Officer at the VA immediately. L. TERINI OF CONTRACT. This contract is effective for the period from July 1, 1998 through September 30, 1998. No services shall be performed by the Contractor or its subcontractors, after the expiration date of the contract until written notification is received from the Contracting Officer. The contract is subject to the availability of VA funds. The contract may be terminated by either party within 30 calendar days prior written notice. M. PERSONNEL POLICY: 1. The Contractor and its subcontractors shall be responsible for protecting the personnel furnishing services under this contract. The parties agree that such personnel shall not be considered VA employees for any purpose and shall be considered employees of the Contractor. To carry out this responsibility, the contractor and its subcontractors shall provide the following for these personnel: 1)worker's compensation, 2)professional liability insurance, 3) health examinations, 4) income tax withholding, 5)social security payments. 6 2. It is understood that services furnished under this contract may be required on holidays and weekends. All services shall be furnished at the.prices specified in the Fee Schedule of this contract. N. INVOICE SUBMISSION AND PAYMENT: I. Invoices shall be submitted by the Contractor to the VA at time of discharge, on UB 92 (for hospital services) and HCFA 1500 (physician component) if any. All invoices submitted shall be for the actual services provided. Invoices will be verified for accuracy by VA Fee Services Coordinator prior to payment. Each invoice must contain (at a minimum)the following information: a. Patient name, Social Security Number, Address b. Date(s)services were provided C. Description and level of services provided d. Itemized unit cost for services provided(in accordance with Section B) e. Total Cost f. Contract Number g. Authorization h. Remittance Address 2. Invoices shall be submitted to the following address: Payment Processing(136/04V) VA Northern California Health Care System (VANCHCS) 2300 Contra Costa Blvd., Suite 440 Pleasant Hill, CA 94523 3. All payments will be processed in accordance with the Payments Clause. 4. Payments made by VA under this contract, shall constitute the total cost for services rendered. No charges will be billed by the Contractor or its subcontractors to the patient, the patient's family, private insurer, or Medicare, (unless the patient is Medicare and not authorized for payment by VA), unless and until specific prior written authorization is obtained from VA. 52.212-4 CONTRACT TERMS AND CONDITIONS--COMMERCIAL ITEMS (MAY 1997) (a) Inspection/Acceptance. The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or re-performance of nonconforming services at no increase in contract price. The Government must exercise its post-acceptance rights (1)within a reasonable time after the defect was discovered or should have been discovered; and(2)before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item. (b) Assignment. The Contractor or its assignees rights to be paid amounts due as a result of performance of this contract, may be assigned to a bank, trust company, or other financing institution, including any Federal lending agency in accordance with the Assignment of Claims Act(31 U.S.C. 3727). (c) Changes. Changes in the terms and conditions of this contract may be made only by written agreement of the parties. (d) Disputes. This contract is subject to the Contract Disputes Act of 1978, as amended (41 U.S.C. 601- 7 613). Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at FAR 52.233-1, Disputes, which is incorporated herein by reference. The Contractor shall proceed diligently with performance of this contract, pending final resolution of any dispute arising under the contract. (e) Definitions. The clause at FAR 52.202-1,Definitions, is incorporated herein by reference. (f) Excusable delays. The Contractor shall be liable for default unless nonperformance is caused by an occurrence beyond the reasonable control of the Contractor and without its fault or negIi,gence such as, acts of God or the public enemy, acts of the Government in either its sovereign or contractual capacity, fires, floods, epidemics,quarantine restrictions, strikes,unusually severe weather,and delays of common carriers. The Contractor shall notify the Contracting Officer in writing as soon as it is reasonably possible after the commencement of any excusable delay, setting forth the full particulars in connection therewith., shall remedy such occurrence with all reasonable dispatch, and shall promptly givewritten notice to the Contracting Officer of the cessation of such occurrence. (g)Invoice. The Contractor shall submit an original invoice and three copies (or electronic invoice, if authorized,) to the address designated in the contract to receive invoices. An invoice must include-- (!)Name and address of the Contractor; (2) Invoice date.- (3) ate;(3) Contract number, contract line item number and, if applicable, the order number; (4) Description, quantity, unit of measure, unit price and extended price of the items delivered; (5) Shipping number and date of shipment including the bill of lading number and weight of shipment if shipped on Government bill of lading; (6)Terms of any prompt payment discount offered; (7)Name and address of official to whom payment is to be sent; and (8)Name, title, and phone number of person to be notified in event of defective invoice. Invoices will be handled in accordance with the Prompt Payment Act(31 U.S.C. 3903)and Office of Management and Budget(OMB) Circular A-125, Prompt Payment. Contractors are encouraged to assign an identification number to each invoice. (h) Patent indemnity. The Contractor shall indemnify the Government and its officers. employees and agents against liability, including costs, for actual or alleged direct or contributory infringement of, or inducement to infringe, any United States or foreign patent, trademark or copyright, arising out of the performance of this contract, provided the Contractor is reasonably notified of such claims and proceedings. (i)Payment. Payment shall be made for items accepted by the Government that have been delivered to the delivery destinations set forth in this contract. The Government will make payment in accordance with the Prompt Payment Act (31 U.&C. 3903)and Office of Management and Budget(COMB) Circular Aw 125, Prompt Payment. Unless otherwise provided by an addendum to this contract, the Government shall make payment in accordance with the clause at FAR 52.232-33,Mandatory Information for Electronic Funds Transfer Payment, which is incorporated herein by reference. In connection with any discount offered for early payment, time shall be computed from the date of the invoice. For the purpose of computing the discount earned, payment shall be considered to have been made on the date which appears on the payment check or the specified payment date if an electronic funds transfer payment is made. 8 }) Risk of loss.Unless the contract specifically provides otherwise, risk of loss or damage to the supplies provided under this contract shall remain with the Contractor until, and shall pass to the Government upon: (1)Delivery of the supplies to a carrier, if transportation is f.o.b. origin; or (2)Delivery of the supplies to the Government at the destination specified in the contract, if transportation is f.o.b. destination. (k)Taxes. The contract price includes all applicable Federal, State, and local taxes and duties. (1)Termination for the Governments convenience. The Government reserves the right to terminate this contract, or any part hereof, for its sole convenience. In the event of such termination, the Contractor shall immediately stop all work hereunder and shall immediately cause any and all of its suppliers and subcontractors to cease work. Subject to the terms of this contract, the Contractor shall be paid a percentage of the contract price reflecting the percentage of the work performed prior to the notice of termination,plus reasonable charges the Contractor can demonstrate to the satisfaction of the Government using its standard record beeping system, have resulted from the termination. The Contractor shall not be required to comply with the cost accounting standards or contract cost principles for this purpose. This paragraph does not give the Government any right to audit the Contractors records. The Contractor shall not be paid for any work performed or costs incurred which reasonably could have been avoided. (m) Termination for cause. The Government may terminate this contract,or any part hereof, for cause in the event of any default by the Contractor, or if the Contractor fails to comply with any contract terms and conditions, or fails to provide the Government, upon request, with adequate assurances of future performance. In the event of termination for cause, the Government shall not be liable to the Contractor for any amount for supplies or services not accepted, and the Contractor shall be liable to the Government for any and all rights and remedies provided by law. If it is determined that the Government improperly terminated this contract for default, such termination shall be deemed a termination for convenience. (n) Title. Unless specified elsewhere in this contract, title to items furnished}under this contract shall pass to the Government upon acceptance; regardless of when or where the Government takes physical possession. (o) Warranty. The Contractor warrants and implies that the items delivered hereunder are merchantable and fit for use for the particular purpose described in this contract. (p) Limitation of liability. Except as otherwise provided by an express or implied warranty, the Contractor will not be liable to the Government for consequential damages resulting from any detect or deficiencies in accepted items. (q)Other compliances. The Contractor shall comply with all applicable Federal. State and local laws, executive orders, rules and regulations applicable to its performance under this contract. (r)Compliance with laws unique to Government contracts. The Contractor agrees to comply with 31 U.S.C. 1352 relating to limitations on the use of appropriated funds to influence certain Federal.contracts; 18 U.S.C. 431 relating to officials not to benefit; 40 U.S.0 327, et seq., Contract Work Hours and Safety Standards Act; 41 U.S.C. 5 i-58, Anti-Kickback Act of 1986; 41 U.S.C. 251 related to whistle blower protections; and 49 U.S.0 40118, Fly American. (s) Order of precedence. Any inconsistencies in this solicitation or contract shall be resolved by giving 9 precedence in the following order: (1)the schedule of supplies/services; (2)the Assignments, Disputes, Payments, Invoice, Other Compliances, and Compliance with Laws Unique to Government Contracts paragraphs of this clause; (3) the clause at 52.212-5-, (4)addenda to this solicitation or contract, including any license agreements for computer software; (5)solicitation provisions if this is',a solicitation; (6)other paragraphs of this clause; (7)the Standard Form 1449; (8)other documents,exhibits, and attachments, and (9)the specification. (End of clause) ADDENDUIVI TO FAR 52.212-4 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998) This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es): Federal Acquisition Regulations (FAR): http://www.glq;t.ggyif I Veterans Affairs Acquisition Regulations (VAAR): ht p.//wwvsr,va,gov/oa&mmlvaar (End of clause) Clause Description Date 52.215-18 ORDERING (OCT 1995) 52.216-19 ORDER LIMITATIONS OCT 1995 (Note: there are no minimums or maximums applicable to this contract) 52.216-21 REQUIREMENTS (OCT 1995) --ALTERNATE I APR 1984, 52.217-8 OPTION TO EXTEND SERVICES AUG 1989 52.224-1 PRIVACY ACT NOTIFICATION APR 1984 52,224-2 PRIVACY ACT APR 1984 52.232-18 AVAILABILITY OF FUNDS APR 1984 52.232-33 MANDATORY INFORMATION FOR ELECTRONIC FUNDS AUG 1996 TRANSFER PAYMENT 52.233-2 SERVICE OF PROTEST (AUG 1996) 852.203-70 ETHICS IN DOVER--W, Ei�TT ACT APR 1984 852.21E-70 .ESTIMATED QUANTITIES FOR REQUIREMENTS CONTRACTS APR 1984 852.233-70 PROTEST CONTENT JUN 1987 852.237-70 CONTRACTOR RESPONSIBILITIES APR. 1984 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE OCT 1996 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS APR 1984 852.270-4 COMMERCIAL ADVERTISING NOV 1984 852.271-70 NONDISCRIMINATION IN SERVICES PROVIDED APR 1984 BENEFICIARIES 10 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (AUG 1996) (a) The Contractor agrees to comply with the following FAR clauses, which are incorporated in this contract by reference, to implement provisions of law or Executive orders applicable to acquisitions of commercial items: (1) 52.222-3, Convict Labor(E.O. 11755); and (2)52.233-3, Protest After Award(31 U.S.0 3553). (b)The Contractor agrees to comply with the FAIT clauses in this paragraph(b) which the contracting officer has indicated as being incorporated in this contract by reference to implement provisions of law or executive orders applicable to acquisitions of commercial items or components: (Contracting Officer shall check as appropriate.) ✓ (1) 52.203-6, Restrictions on Subcontractor Sales to the Government, with Alternate I(41 U.S.C. 2538 and 10 U.S.C. 2402). ✓ (2) 52.203-10, Price or Fee Adjustment for Illegal or Improper Activity(41 U.S.C.423). ✓ (3) 52.219-8, Utilization of Small Business Concerns and Small Disadvantaged Business Concerns (15 U.S.C. 637(d) (2) and(3)); �V _ (4) 52.219-9, Small, Small Disadvantaged and Women-Owned Small Business Subcontracting Plan (15 U.S.C. 637(d)(4)); NIA (5)52.219-14, Limitation on Subcontracting(I5 U.S.C. 637(a)(14)). ✓ (6) 52.222-26, Equal Opportunity(E.O. 11246). (7) 52.222-35, Affirmative Action for Special Disabled and Vietnam Era Veterans (38 U.S.C. 4212). ✓ (8) 52.222-36, Affirmative Action for Handicapped. Workers(29 U.S.C. 793). ✓ (9) 52.222-37, Employment Reports on Special Disabled Veterans and Veterans of the Vietnam Era (38 U.S.C. 4212). NIA (10) 52.225-3, .Buy American Act--Supplies (41 U.S.C. 10). N/A (11) 52.225-9, Buy American Act--Trade Agreements Act--Balance of Payments Program (41 U.S.C. 10, 19 U.S.C. 2501-2582). N/A (12) Reserved. NIA (13) 52.225-18, European Union Sanctions for End Products (E.O. 12849). N/A (14) 52.225-19, European Union Sanctions for Services(E.O. 12849). N/A (15)(i) 52.225-21, Buy American Act--North American Free Trade Agreement Implementation Act--Balance of Payments Program (41 U.S-C 10, Pub. L. 103-187). NIA (I5)(ii) Alternate I of 52.225-21. NIS X16)52.239-1, Privacy or Security Safeguards (5 U.S.C.)552a). NIA (17)52.247-64, Preference for Privately Owned U.S.-Flag Commercial Vessels (46 U.S.C. 1241). (This acquisition is being conducted under N/A delegation of GSA's exclusive procurement authority for FIP resources. The specific GSA DPA case number is NIA). (c) The Contractor agrees to comply with the FAR clauses in this paragraph(c), applicable to commercial services, which the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of lav or executive orders applicable to acquisitions of commercial items or components: (Contracting Officer check as appropriate) N/A (1) 52.222-41, Service Contract Act of 1965,As amended(41 U.S.C. 351, et seq.). N/A (2) 52.222-42, Statement of Equivalent Rates for Federal Hires (29 U.S.C'„ 206 and 41 U.S.C. 351, et seq.). NIA (3) 52.222-43, Fair Labor Standards Act and Service Contract Act--.Price Adjustment(Multiple Year and Option Contracts) (29 U.S.C. 206 and 41 U.S.C. 351,et seq.). N/A (4)52.222-44,Fair Labor Standards Act and Service Contract Act--Price Adjustment(29 U.S.C. 206 and 41 U.S.C. 351,et seq.). N/A (5) 52.222-47, SCA Minimum Wages and Fringe Benefits Applicable to Successor Contract Pursuant to.Predecessor Contractor Collective Bargaining Agreement(CBA) (41 U.S.C. 351, et seq.). (d)Comptroller General Examination of Record. The Contractor agrees to comply with the provisions of this paragraph (d) if this contract was awarded using other than sealed bid, is in excess of the simplified acquisition threshold, and does not contain the clause at 52.215-2,Audit and Records--Negotiation. (1)The Comptroller General of the United States, or an authorized representative of the Comptroller General, shall have access to and right to examine any of the Contractor's directly pertinent records involving transactions related to this contract (2)The Contractor shall make available at its offices at all reasonable times the records, materials, and other evidence for examination, audit, or reproduction. until 3 years after final payment under this contract or for any shorter period specified in FAR Subpart 4.7, Contractor Records Retention, of the other clauses of this contract. If this contract is completely or partially terminated, the records relating to the work terminated shall be made available for 3 years after any resulting final termination settlement. Records relating to appeals under the disputes clause or to litigation or the settlement of claims arising under or relating to this contract shall be made available until such appeals, litigation, or claims are finally resolved. (3) As used in this clause. records include books, documents, accounting procedures and practices, and other data, regardless of type and regardless of form. This does not require the Contractor to create or maintain any record that the Contractor does not maintain in the ordinarycourse of business or pursuant to a provision of law. (e)Notwithstanding the requirements of the clauses in paragraphs (a), (b), (c) or(d) of this clause, the Contractor is not required to include any FAIL clause, other than those listed below (and as may be required by an addenda to this paragraph to establish the reasonableness of prices under fart 15), in a subcontract for commercial items or commercial components-- (1) 52.222-26, Equal Opportunity(E.O. 11246); (2) 52.222-35, Affirmative Action for Special Disabled and Vietnam Era Veterans(38 U.S.C. 2012(a)); and (3) 52.222-36, Affirmative Action for Handicapped Workers(29 U.S.C. 793). (4) 52.247-64, Preference for Privately Owned U.S.-Flagged Commercial Vessels (46 U.S.C. 1241) (flow down not required for subcontracts awarded beginning May 1, 1996), (End of clause) 12 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS COMMERCIAL ITEMS (JAN 1997) (a).Definitions. As used in this provision: Emerging small business means a small business concern whose size is no greater than 50 percent of the numerical size standard for the standard industrial classification code designated. Small business concern means a concern, including its affiliates,that is independently owned and operated, not dominant in the field of operation in which it is bidding on Government contracts, and qualified as a small business under the criteria in 13 CFR Part 121 and size standards in this solicitation. Small disadvantaged business concern means a small business concern that-- (1)Is at least 51 percent unconditionally owned by one or more individuals who are both socially and economically disadvantaged, or a publicly owned business, having at least 51 percent of its stock unconditionally owned by one or more socially and economically disadvantaged individuals, and (2)Has its management and daily business controlled by one or more such individuals. This term also means a small business concern that is at least 51 percent unconditionally owned by an economically disadvantaged Indian tribe or Native Hawaiian organization, or a publicly owned business having at least 51 percent of its stock unconditionally owned by one or more of these entities, which has its management and daily business controlled by members of an economically disadvantaged Indian tribe or Native Hawaiian organization and which meets the requirements of 13 CFR Part 124. Women-owned small business concern means a small business concern-- (1)'Which is at least 51 percent owned by one or more women or, in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more women; and (2) Whose management and daily business operations are controlled by one or more women. Women-owned business concern means a concern which is at least 51 percent owned by one or more women; or in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more women; and whose management and daily business operations are controlled by one or more women. (b) Taxpayer identification number(TIMI)(26 U.S.C. 6050M). (1) Taxpayer Identification Number(TIN). TIN: TIN has been applied for. TIN is not required because: Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of trade or business in the U.S. and doses not have an office or place of business or a fiscal paying agent in the U.S.; Offeror is an agency or instrumentality of a foreign government; Offeror is an agency or instrumentality of a Federal, state. or local government, Other. State basis. (2) Corporate Status. 13 Corporation providing medical and health care services, or engaged in the billing and collecting of payments for such services, Other corporate entity; Not a corporate entity: Sole proprietorship Partnership Hospital or extended care facility described in 26 CFR 501(c)(3)that is exempt from taxation under 26 CFR 501(a). (3)Common Parent. Offeror is not owned or controlled by a common parent. Name and TIN of common parent: Name: TIN (c)Offerors must complete the following representations when the resulting contract is to be performed inside the United States, its territories or possessions, Puerto.Rico, the Trust Territory of the Pacific Islands, or the District of Columbia. Check all that apply. (1) Small business concern. The offeror represents as part of its offer that it( ) is, { ) is not a small business concern. (2) Small disadvantaged business concern. The offeror represents that it( ) is, ( } is not a small disadvantased business concern. (3) Women-owned small business concern. The offeror represents that it{ ) is, ( } is not a women-owned small business concern. 'dote: Complete paragraphs(c)(4)and (c)(5)only if this solicitation is expected to exceed the simplified acquisition threshold. (4) Women-owned business concern. The offeror represents that it( } is, ( } is not, a women- owned business concern. (5)Tie bid priority for labor surplus area concerns. If this is an invitation for bid, small business offerors may identify the labor surplus areas in which costs to be incurred on accountof manufacturing or production (by offeror or first-tier subcontractors)amount to more than 50 percent of the contract price: (6) Small Business Size for the Small Business Competitiveness Demonstration Program and for the Targeted Industry Categories under the Small Business Competitiveness Demonstration Program. [Complete prily if the offeror has represented itself to be a small business concern under the size standards for this solicitation. (i) (Complete only for solicitations indicated in an addendum as being set-aside for emerging small businesses in one of the four designated industry groups(DIGS).)The offeror represents as part of its offer that it( ) is, ( )is not an emerging small business. (ii)Offeror represents as follows: 14 (A)Offeror's number of employees for the past 12 months(check the Employees column if size standard stated in the solicitation is expressed in terms of number of employees); or (B)Offeror's average annual gross revenue for the last 3 fiscal years (check the Average Annual Gross Number of Revenues column if size standard stated in the solicitation is expressed in terms of annual receipts) (Check one of the following): Number of`EmplQvees Average Annual Gross Revenues 50 or fewer $1 million 51-100 $1,000,001 - $2 million _ 101-250x2,000,001 - $3.5 million 251-500 _-_ $3,500,001 - $5 million 501-750 $5,000,001 - $10 million 751-1,000 $10,000,001 _ $17 million Over 1,000 Over$17 million (d) Certifications and representations required to implement provisions of ExecutiveOrder 11246-- (1) Certification of non-segregated facilities. (Applies only if the contract amount is expected to exceed$10,000)-- By submission of this offer, the offeror certifies that it does not and will not maintain or provide for its employees, any facilities that are segregated on the basis of race, color,religion, or national origin because of habit, local custom, or otherwise and that it does not and will not permit its employees to perform their services at any location where segregated facilities are maintained. The offeror agrees that a breach of this certification is a violation of the Equal Opportunity clause in the contract. (2) Previous Contracts and Compliance. The offeror represents that-- (i) It( ) has, ( )has not, participated in a previous contract or subcontract subject either to the Equal Opportunity clause of this solicitation, the clause originally contained in Section 310 of Executive Order 10325, or the clause contained in Section 201 of Executive Order 11114; and (ii) It( ) has, ( ) has not, filed all required compliance reports. (3)Affirmative Action Compliance. The offeror represents that-- (i) It( )has developed and has on file, ( )has not developed and does not have on file, at each establishment, affirmative action programs required by rules and regulations of the Secretary of Labor(41 CFR Subparts 60-1 and 60-2), or (ii) 1t ( ) has not previously had contracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor. (e) Certification Regarding Payments to Influence Federal Transactions (31 U.S.C. 13512). (Applies only if the contract is expected to exceed$100,000.) By submission of its offer. the offeror certifies to the best of its knowledge and belief that no Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress or an employee of a Member of Congress on his or her behalf in connection with the award of any resultant contract. 15 (f)Buy American Act--Trade Agreements--Balance of Payments Program Certificate. (Applies only if FAR clause 52.225-9, Buy.American Act--Trade Agreement--Balance of Payments Program, is included in this solicitation.) (1)The offeror hereby certifies that each end product, except those listed in paragraph (f)(2) of this provision,is a domestic end product(as defined in the clause entitled "Buy American Act--Trade Agreements Balance of Payments Program")and that components of unknown origin have been considered to have been trained, produced, or manufactured outside the United States, a designated country, a North American Free Trade Agreement(NAFTA)country, or a Caribbean Basin country, as defined in section 25.401 of the Federal Acquisition Regulation. (2)Excluded End Products: (List as necessary) Line item No. Country of origin (3)Offers will be evaluated by giving certain preferences to domestic end products,designated country end products, NAFTA country end products, and Caribbean Basin country end products over other end products. In order to obtain these preferences in the evaluation of each excluded end product listed in paragraph(f)(2)of this provision, offerors must identify and certify below those excluded end products that are designated or NAFTA country end products, or Caribbean Basin country end products. Products that are not identified and certified below will not be deemed designated country end products, NAFTA country end products, or Caribbean Basin country end products. Offerors must certify by inserting the applicable line item numbers in the following: (i)The offeror certifies that the following supplies qualify as "designated or NAFTA country end products" as those terms are defined in the clause entitled "Buy American Act--Trade Agreements-- Balance of Payments Program:" (Insert line item numbers) (ii) The offeror certifies that the following supplies qualify as "Caribbean Basin country end products" as that term is defined in the clause entitled "Buy American Act--Trade Agreements--Balance of Payments Program": nsert line item numbers) (4)Offers will be evaluated in accordance with FAR Part 25. (g)(1) Buy American Act--North American Free Trade Agreement Implementation Act--Balance of Payments Program. (.Applies only if FAR clause 52.225-21, Buy American Act--North American Free Trade Agreement Implementation Act--Balance of Payments Program, is included in this solicitation.) (i) The offeror certifies that each end product being offered, except those listed in paragraph (g)(1)(ii) of this provision, is a domestic end product(as defined in the clause entitled"Buy American Act--North American Free Trade Agreernent Implementation Act-Balance of Payments Program," and that components of unknown origin have been considered to have been mined,produced,or manufactured outside the United States. (ii)Excluded End Products: (List as necessary) Line item No. Country of origin (iii) Offers will be evaluated by giving certain preferences to domestic end products or NAFTA country end products over other end products. In order to obtain these preferences in the evaluation of each excluded end product listed in paragraph (g)(1)(ii)of this provision, offerors must identify below those excluded end products that are NAFTA country end products. Products that are not identified and certified below will not be deemed NAFTA country end products. The offeror certifies that the following supplies qualify as "NAFTA country end product" as that term is defined in the clause entitled "Buy American Act-North American Free Trade Agreement Implementation Act-Balance'of Payments Program": (Insert line item numbers) (iv) Offers will be evaluated in accordance with FAR.Part 25 of the Federal Acquisition Regulations. In addition, if the solicitation is for supplies for use outside of the United States, an evaluation factor of 50 percent will be applied to offers of end products that are not domestic or NAFTA country end products. (2)Alternate L If Alternate I to the clause at 52.225-21 is included in this solicitation, substitute the following paragraph(g)(1)(iii) for paragraph (g)(1)(iii)of this provision; (g)(1)(iii) Offers will be evaluated by giving certain preferences to domestic end products or Canadian end products over other end products. In order to obtain these preferences in the evaluation of each excluded end product listed in paragraph(b)of this provision,offerors must identify and certify below those excluded end products that are Canadian end products. Products that are not identified and certified below will not be deemed Canadian end products. The offeror certifies that the following supplies qualify as "Canadian end products" as that term is defined in the clause entitled "Buy American Act--North American Free Trade Agreement Implementation Act--Balance of Payments Program:" (Insert line item numbers). (h) Certification Regarding Debarment, Suspension or Ineligibility for Award(Executive Order 12549). The offeror certifies, to the best of its knowledge and belief, that-- (1) The offeror and/or any of its principals ( ) are, ( )are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency, and (2) ( ) Have, ( ) have not, within a three-year period preceding this offer, been convicted of or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a Federal, state or local government contract or subcontract: violation of Federal or state antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, snaking false statements, tax evasion, or receiving stolen property; and ( } are, ( } are not presently indicted for, or otherwise criminally or civilly charged by a Government entity with, commission of any of these offenses. (End of Provision) 17 - --------- TO: -_.-TO: BOARD OF SUPERVISORS i.� ,--'' ;. CONTRA o` , COSTA Sara Hoffman ',� =-� COUNTY Senior Deputy County Administrator r DATE: September 1, 1998 SUBJECT: Grant Proposal for the Service Integration Program - Bay Point Works SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION RECOMMENDATI N(S►:►: APPROVE and AUTHORIZE the County Administrator, or designee, to apply for a grant from the John Muir/Mt. Diablo Community Health Benefit Corp. in the amount of$75,000 for Bay Point Works. FINANCIAL, IMPACT: Supplements available Federal, State and County funding to support employment and resource services in the communities of Bay Point by $75,000.00 in the coming year. BACKGROUNDIREASON'(S) FOR I;tECO ENDATIONf S) Existing resources available to the community of Bay Point in the area of employment are limited by categorical funding streams that often restrict eligibility based on income or other exclusive criteria. In addition, resources are not available to fill service gaps and forge links among existing services to create a seamless employment and support services system. This grantwill support services to (1) provide the types of supports and services needed by all unemployed and underemployed individuals, but not sufficiently covered by other existing sources; and (2) build indigenous community capacity to provide comprehensive community-wide oymenp services over the long-term. CONTINUED ON ATTACHMENT: _'SBS SIGNATURE: -Y--RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BO MMITTEE APPROVE OTHER SIGNATURES): ,/7 ACTION OF BOARD ON APPROVED AS RECOMMENDED ---40TIHEW VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A UNANIMOUS(ABSENT TRUE AND CORRECT COPY OF AN AYES: NOES: ACTION TAKEN AND ENTERED ABSENT: ABSTAIN: ON MINUTES OF THE 80ARD OF SUPERVISORS N THE DATE SHOWN. Contact:Sara Hot6nan,335-1080 ATTESTEQ I � E ,. P C#I CLERK OF THE BOARD OF SUPERVISORS A COUNTY ADMINISTRATOR cc:CAO . r r 4 o BOARD OF SUPERVISORS Centra FROM: John Cullen,Director 'rOSt Social Service Department ' County DATE: August 18, 1998 r ` SUBJECT: Approve aced Authorize the Chair,Board of Supervisors to sign the Authorization to Bind Corporation or Government agency and Authorize the Director,Office on Aging (AAA)to Submit a Proposal to the California Dept.of Aging for the Multipurpose Senior Services Program(MSSP)and sign appropriate RFP Attachments SPECIFIC REOUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION REC OMMFNIIA', LOhl: .Approve and Authorize the Chair, Board of Supervisors to sign the Authorization to Bind Corporation or Government Agency and Authorize the Director, Office on Aging or his designee to submit a proposal for $1,185,634 and sign appropriate attachments. The proposal is for provision of case management services to persons age 65+who are Contra Costa County residents. Upon receipt and approval by the County Counsel or Contracts Administrator Authorize the Director, Office on Aging to sign the California.Department of Aging Standard MSSP Agreement. The contract term for the Multipurpose Senior Services Program (MSSP)will be January 1, 1999 through June 30, 2000. EINANCIAL IMPACT: The MSSP Grant will not cover all required staff costs. Available Federal and State revenue will be used to cover any costs not covered by MSSP funding. B CKGRD ND: The Office on Aging is requesting Board of Supervisors approval to submit a proposal for Multipurpose Senior Services Program(MSSP)in the amount of$1,185,634 and for the term January 1, 1999 through June 30, 2000.. This program provides case management on a countywide basis for Contra Costa County residents age 65+who are eligible for Medi-Cal and certifiable for skilled nursing facility care. The:purpose of this program is to provide case management services so eligible clients age 65+can safely stay at home and avoid institutionalization. MSSP will provide case management for client assessment,care planning, service arranging and client monitoring through a team of health and social service professionals. The MSSP project will greatly enhance AAA's current case management services. �9 ', CONTINUED ON ATTACHMENT: v. YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR -RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURES ACTION OF BOARD ON '" ,. $ APPROVED AS RECOMMENDED VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN; OF SUPERVISORS ON THE DATE SHOWN. ATTESTED Contact: Sharon Johnson X 3-1711 PHIL BATCHELOR,CLERK OF THE BOARD OF CC: CAO PERVISORS AND COUNTY ADMINISTRATOR a Auditor-Controller Office on Aging DEPUTY sr= Attachment a It E Authorization to Bind Corporation or Government Agency The Board of Directors/Supervisors of the Counter of co r_ra Cast , in a duty executed meeting held on sp , g and where a quorum was present resolved to authorize: NAME: Robert Sessler TITLE: Director , Office on Agin (AAA) to submit and sign a Proposal in Response to Request for Proposal # ms-!ii for the MSSP Case Management Project, and to sign and negotiate any contract that may result from said proposal. In addition, we authorize: NAME. Tai ^h^chi TITLE: Fiscal Division Mana&er to sign invoices applicable to any such contract. The undersigned hereby affirms that the statements contained in the application package are true and complete to the best of the Proposer's knowledge and accepts, as a condition of a contract/grant award, the obligation to comply with the applicable state and federal requirements, policies, standards and regulations. The undersigned recognizes that this is a public document and open to public inspection. F �� Board Chairperson: sN Date. 11 4 If the Contractor is a local govemment entity, a copy of the resolution, order, motion, or ordinance must accompany this form. if the Contractor is a nonprofit corporation, proof of incorporation and nonprofit status must accompany this form.