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CONTRACT PURSUANT TO RFP SERIAL 13126 -RFP This Contract is entered into this 26th day of March, 2014 by and between Maricopa County (“County”), a political subdivision of the State of Arizona, and Phoenix Indian Medical Center, HIV Center of Excellence, an Arizona corporation (“Contractor”) for the purchase of Outpatient Ambulatory Medical Care Services for the Phoenix Eligible Metropolitan Area Ryan White Part A Program. 1.0 CONTRACT TERM: 1.1 This Contract is for a term of five (5) years, beginning on the 1st day of April, 2014 and ending the 31st day of March, 2019. 1.2 The County may, at its option and with the approval of the Contractor, renew the term of this Contract up to a maximum of five (5) additional years, or other specified length options, (or at the County’s sole discretion, extend the contract on a month-to-month bases for a maximum of six (6) months after expiration). The County shall notify the Contractor in writing of its intent to extend the Contract term at least thirty (30) calendar days prior to the expiration of the original contract term, or any additional term thereafter. 2.0 PAYMENTS: 2.1 As consideration for performance of the duties described herein, County shall pay Contractor the sum(s) stated in Exhibit “B”. 2.2 Payment shall be made upon the County’s receipt of a properly completed invoice. Invoices shall contain the following information: Contract number, purchase order number, item numbers, description of supplies and/or services, sizes, quantities, unit prices, extended totals and any applicable sales/use tax. 2.3 INVOICES: 2.3.1 The Contractor shall submit electronically to the Administrative Agent one (1) legible copy of their detailed monthly invoice before payment(s) can be made. 2.3.2 Contractor will submit the invoice packet for services performed on or before the fifteen (15th) calendar day following the month in which services were performed. 2.3.3 The invoice must include the requirements as outlined in the Ryan White Part A’s current policies and procedures manual. 2.3.4 Contractors providing medical services are required to utilize the Health Care Form 1500 (HCF-1500), Uniform Billing 92 (UB-92) or other standardized medical claim forms as agreed to with the Administrative Agent, and to submit these to the Ryan White Part A Program in addition to the other required invoice reports and forms. 2.3.5 Problems regarding billing or invoicing shall be directed to the County as listed on the Purchase Order. SERIAL 13126-RFP 2.3.6 Payment shall be made to the Contractor by Accounts Payable through the Maricopa County Vendor Express Payment Program. This is an Electronic Funds Transfer (EFT) process. After Contract Award the Contractor shall complete the Vendor Registration Form located on the County Department of Finance Vendor Registration Web Site (www.maricopa.gov/finance/vendors). 2.3.7 EFT payments to the routing and account numbers designated by the Contractor will include the details on the specific invoices that the payment covers. The Contractor is required to discuss remittance delivery capabilities with their designated financial institution for access to those details. 3.0 DUTIES: 3.1 The Contractor shall perform all duties stated in Exhibits “B & C” and the budget’s schedule of deliverables for that grant year and/or as directed by the current Ryan White Part A policies and procedures manual or as otherwise directed in writing by the Procurement Officer. 3.2 The Contractor shall perform services at the location(s) and time(s) stated in this application, the current approved work plan or as otherwise directed in writing, via contract amendment and/or task order from the Administrative Agent. 3.3 During the Contract term, County shall provide Contractor’s personnel with adequate workspace for consultants and such other related facilities as may be required by Contractor to carry out its contractual obligations. 4.0 TERMS and CONDITIONS: 4.1 PRICE ADJUSTMENTS: 4.1.1 Any request for a fee adjustment must be submitted sixty (60) days prior to the current Contract anniversary date. Requests for adjustment in cost of labor and/or materials must be supported by appropriate documentation. If County agrees to the adjusted fee, County shall issue written approval of the change. The reasonableness of the request will be determined by comparing the request with the AHCCCS fee schedule or by performing a market survey. 4.2 INDEMNIFICATION: 4.2.1 To the fullest extent permitted by law, Contractor shall defend, indemnify, and hold harmless County, its agents, representatives, officers, directors, officials, employees and volunteers from and against all claims, damages, losses and expenses, including, but not limited to, attorney fees, court costs, expert witness fees, and the cost of appellate proceedings, relating to, arising out of, or alleged to have resulted from the negligent acts, errors, omissions, mistakes or malfeasance relating to the performance of this Contract. Contractor’s duty to defend, indemnify and hold harmless County, its agents, representatives, officers, directors, officials, employees and volunteers shall arise in connection with any claim, damage, loss or expense that is caused by any negligent acts, errors, omissions or mistakes in the performance of this Contract by the Contractor, as well as any person or entity for whose acts, errors, omissions, mistakes or malfeasance Contractor may be legally liable. 4.2.2 The amount and type of insurance coverage requirements set forth herein will in no way be construed as limiting the scope of the indemnity in this paragraph. 4.2.3 The scope of this indemnification does not extend to the sole negligence of County. 4.3 INSURANCE REQUIREMENTS: 4.3.1 The Contractor shall have in effect at all times during the term of this Contract insurance SERIAL 13126-RFP which is adequate to protect Maricopa County, its officers and employees, participants and equipment funded under the Contract against such losses as are set forth below. The Contractor shall provide County with current documentation of insurance coverage by furnishing a Certificate of Insurance or a certified copy of the insurance policy naming Maricopa County as an additional insured. 4.3.2 The following types and amounts of insurance are required as minimums: 4.3.2.1 Worker's Compensation as required by Arizona law; and employer’s liability insurance with $1,000,000 per accident, $1,000,000 per disease and $1,000,000 per limit disease. 4.3.2.2 Unemployment Insurance as required by Arizona law. 4.3.2.3 Commercial general liability insurance the limits of the policies shall not be less than $2,000,000.00 per occurrence, $4,000,000 general aggregate, $2,000,000 products completed operations aggregate. 4.3.3 Automobile and Truck Liability, Bodily Injury and Property Damages: 4.3.3.1 Combined single limit; $1,000,000.00 4.3.4 Standard minimum deductible amounts are allowable. Any losses applied against insurance deductibles are the sole responsibility of the Contractor. 4.3.5 Professional Liability Insurance; $2,000,000.00 per occurrence or claim and $4,000,000 aggregate. 4.3.6 The Contractor will immediately inform the Director of any cancellation of its insurance or any decrease in its lines of coverage at least thirty (30) days before such action takes place. 4.3.7 Certificates of Insurance. 4.3.7.1 Prior to commencing work or services under this Contract, Contractor shall have insurance in effect as required by the Contract in the form provided by the County, issued by Contractor’s insurer(s), as evidence that policies providing the required coverage, conditions and limits required by this Contract are in full force and effect. Such certificates shall be made available to the County upon ten (10) business days. BY SIGNING THE AGREEMENT PAGE THE CONTRACTOR AGREES TO THIS REQUIREMENT AND FAILURE TO MEET THIS REQUIREMENT WILL RESULT IN CANCELLATION OF CONTRACT. 4.3.7.1.1In the event any insurance policy (ies) required by this Contract is (are) written on a “claims made” basis, coverage shall extend for two (2) years past completion and acceptance of Contractor’s work or services and as evidenced by annual Certificates of Insurance. 4.3.7.1.2If a policy does expire during the life of the Contract, a renewal certificate must be sent to County fifteen (15) days prior to the expiration date. 4.3.8 Cancellation and Expiration Notice. Insurance required herein shall not be permitted to expire, be canceled, or materially changed without thirty (30) days prior written notice to the County. 4.4 NOTICES: All notices given pursuant to the terms of this Contract shall be addressed to: SERIAL 13126-RFP For County: Maricopa County Office of Procurement Services ATTN: Contract Administration 320 West Lincoln Street Phoenix, Arizona 85003-2494 For Contractor: Phoenix Indian Medical Center, HIV COE ATTN: Adrian Bizardi 4212 North 16th Street Phoenix, AZ 85016 4.5 REQUIREMENTS CONTRACT: 4.5.1 Contractor signifies its understanding and agreement by signing this document that this Contract is a requirements contract. This Contract does not guarantee any purchases will be made (minimum or maximum). Orders will only be placed when County identifies a need and issues a purchase order or a written notice to proceed. 4.5.2 County reserves the right to cancel purchase orders or notice to proceed within a reasonable period of time after issuance. Should a purchase order or notice to proceed be canceled, the County agrees to reimburse the Contractor for actual and documented costs incurred by the Contractor. The County will not reimburse the Contractor for any avoidable costs incurred after receipt of cancellation, or for lost profits, or shipment of product or performance of services prior to issuance of a purchase order or notice to proceed. 4.5.3 Contractor agrees to accept written cancellation of purchase orders. 4.6 TERMINATION: 4.6.1 Either party may terminate this Contract at any time with thirty (30) days prior written notice to the other party. Such notice shall be given by personal delivery or by Registered or Certified Mail. 4.6.2 This Contract may be terminated by mutual written agreement of the parties specifying the termination date therein. 4.6.3 County may terminate this Contract upon twenty-four (24) hours notice when County deems the health or welfare of a patient is endangered or Contractor non-compliance jeopardizes funding source financial participation. If not terminated by one of the above methods, this Contract will terminate upon the expiration date of this Contract as stated on the Cover Page. 4.7 TERMINATION FOR DEFAULT: County may suspend, modify or terminate this Contract immediately upon written notice to Contractor in the event of a non-performance of stated objectives or other material breach of contractual obligations; or upon the happening of any event, which would jeopardize the ability of the Contractor to perform any of its contractual obligations. 4.8 TERMINATION BY THE COUNTY: If the Contractor should be adjudged bankrupt or should make a general assignment for the benefit of its creditors, or if a receiver should be appointed on account of its insolvency, the County may terminate the Contract. If the Contractor should persistently or repeatedly refuse or should fail, SERIAL 13126-RFP except in cases for which extension of time is provided, to provide enough properly skilled workers or proper materials, or persistently disregard laws and ordinances, or not proceed with work or otherwise be guilty of a substantial violation of any provision of this Contract, then the County may terminate the Contract. Prior to termination of the Contract, the County shall give the Contractor fifteen- (15) calendar day’s written notice. Upon receipt of such termination notice, the Contractor shall be allowed fifteen (15) calendar days to cure such deficiencies. 4.9 STATUTORY RIGHT OF CANCELLATION FOR CONFLICT OF INTEREST: Notice is given that pursuant to A.R.S. §38-511 the County may cancel this Contract without penalty or further obligation within three years after execution of the contract, if any person significantly involved in initiating, negotiating, securing, drafting or creating the contract on behalf of the County is at any time while the Contract or any extension of the Contract is in effect, an employee or agent of any other party to the Contract in any capacity or consultant to any other party of the Contract with respect to the subject matter of the Contract. Additionally, pursuant to A.R.S §38-511 the County may recoup any fee or commission paid or due to any person significantly involved in initiating, negotiating, securing, drafting or creating the contract on behalf of the County from any other party to the contract arising as the result of the Contract. 4.10 OFFSET FOR DAMAGES; In addition to all other remedies at law or equity, the County may offset from any money due to the Contractor any amounts Contractor owes to the County for damages resulting from breach or deficiencies in performance under this contract. 4.11 ADDITIONS/DELETIONS OF SERVICE: The County reserves the right to add and/or delete products and/or services provided under this Contract. If a requirement is deleted, payment to the Contractor will be reduced proportionately to the amount of service reduced in accordance with the proposal price. If additional services and/or products are required from this Contract, prices for such additions will be negotiated between the Contractor and the County. 4.12 RELATIONSHIPS: In the performance of the services described herein, the Contractor shall act solely as an independent contractor, and nothing herein or implied herein shall at any time be construed as to create the relationship of employer and employee, partnership, principal and agent, or joint venture between the District and the Contractor. 4.13 USE OF SUBCONTRACTORS: The use of subcontractors and/or consultants shall be pre-approved by the County. If the use of subcontractors is approved by County, the Contractor agrees to use written subcontract/consultant agreements which conform to Federal and State laws, regulations and requirements of this Contract appropriate to the service or activity covered by the subcontract. These provisions apply with equal force to the subcontract as if the subcontractor were the Contractor referenced herein. The Contractor is responsible for Contract performance whether or not subcontractors are used. The Contractor shall submit a copy of each executed subcontract to County within fifteen (15) days of its effective date. 4.13.1 All subcontract agreements must provide a detailed scope of work, indicating the provisions of service to be provided by both the Contractor and Subcontractor. 4.13.1.1 All subcontract agreements must include a detailed budget, identifying all administrative and direct service costs as defined in the Budget, Revenues and Expenditures section. SERIAL 13126-RFP 4.13.1.2 All subcontract agreements must document the qualifications and ability to provide services by the subcontracting agency. 4.13.1.2.1 The Contractor agrees to include in any subcontracts a provision to the effect that the subcontractor agrees that County shall have access to the subcontractor’s facilities and the right to examine any books, documents and records of the subcontractor, involving transactions related to the subcontract and that such books, documents and records shall not be disposed of except as provided herein. 4.13.1.2.2 The Contractor shall not enter into a subcontract for any of the work contemplated under this Agreement except in writing and with prior written approval of the County. Such approval shall include the review and acceptance by the County of the proposed sub-contractual arrangement between the Contractor and the subcontractor. 4.14 AMENDMENTS: All amendments to this Contract shall be in writing and approved/signed by both parties. Maricopa County Office of Procurement Services shall be responsible for approving all amendments for Maricopa County. 4.15 ACCESS TO AND RETENTION OF RECORDS FOR THE PURPOSE OF AUDIT AND/OR OTHER REVIEW: 4.15.1 In accordance with section MCI 367 of the Maricopa County Procurement Code the Contractor agrees to retain all books, records, accounts, statements, reports, files, and other records and back-up documentation relevant to this Contract for six (6) years after final payment or until after the resolution of any audit questions which could be more than six (6) years, whichever is latest. The County, Federal or State auditors and any other persons duly authorized by the Department shall have full access to, and the right to examine, copy and make use of, any and all said materials. 4.15.2 If the Contractor’s books, records , accounts, statements, reports, files, and other records and back-up documentation relevant to this Contract are not sufficient to support and document that requested services were provided, the Contractor shall reimburse Maricopa County for the services not so adequately supported and documented. 4.15.3 If at any time it is determined by the County that a cost for which payment has been made is a disallowed cost, the County shall notify the Contractor in writing of the disallowance. The course of action to address the disallowance shall be at sole discretion of the County, and may include either an adjustment to future claim submitted by the Contractor by the amount of the disallowance, or to require reimbursement forthwith of the disallowed amount by the Contractor by issuing a check payable to Maricopa County 4.16 PUBLIC RECORDS: All Offers submitted and opened are public records and must be retained by the Records Manager at the Office of Procurement Services. Offers shall be open to public inspection after Contract award and execution, except for such Offers deemed to be confidential by the Office of Procurement Services. If an Offeror believes that information in its Offer should remain confidential, it shall indicate as confidential, the specific information and submit a statement with its offer detailing the reasons that the information should not be disclosed. Such reasons shall include the specific harm or prejudice which may arise. The Records Manager of the Office of Procurement Services shall determine whether the identified information is confidential pursuant to the Maricopa County Procurement Code. SERIAL 13126-RFP 4.17 AUDIT DISALLOWANCES: 4.17.1 The Contractor shall, upon written demand, reimburse Maricopa County for any payments made under this Contract, which are disallowed, by a Federal, State or Maricopa County audit in the amount of the disallowance, as well as court costs and attorney fees which Maricopa County incurs to pursue legal action relating to such a disallowance. 4.17.2 If at any time it is determined by County that a cost for which payment has been made is a disallowed cost, County shall notify the Contractor in writing of the disallowance and the required course of action, which shall be at the option of County either to adjust any future claim submitted by the Contractor by the amount of the disallowance or to require repayment of the disallowed amount by the Contractor. 4.17.3 The Contractor shall be responsible for repayment of any and all applicable audit exceptions, which may be identified by County, State and Federal auditors of their designated representatives, and reviewed by the Contractor. The Contractor will be billed by the County for the amount of said audit disallowance and shall promptly repay such audit disallowance within 60 days of said billing. 4.18 CONTRACT COMPLIANCE MONITORING: 4.18.1 County shall monitor the Contractor's compliance with, and performance under, the terms and conditions of this Contract. On-site visits for Contract compliance monitoring may be made by County and/or its grantor agencies at any time during the Contractor's normal business hours, announced or unannounced. The Contractor shall make available for inspection and/or copying by County, all records and accounts relating to the work performed or the services provided under this Contract, or for similar work and/or service provided under other grants and contracts. 4.18.2 The Contractor shall have policies and procedures in place that allow the County as the funding agency prompt and full access to financial, program and management records and documents as needed for program and fiscal monitoring and oversight. 4.18.3 Contractor shall follow and comply with all related corrective action plans and requirements of site visits and subsequent audits conducted by County and its representatives. When monetary penalties are imposed or unallowable costs determined, the County will define how repayment will be made to the County. This may include decreasing or withholding the Contractor’s monthly billing or requiring payment to the County. 4.18.4 The Contractor shall submit reports to County as requested that detail performance and allow review of budget, cost of services and unit cost methodology. 4.19 AVAILABILITY OF FUNDS: 4.19.1 The provisions of this Contract relating to payment for services shall become effective when funds assigned for the purpose of compensating the Contractor as herein provided are actually available to County for disbursement. The Director shall be the sole judge and authority in determining the availability of funds under this Contract and County shall keep the Contractor fully informed as to the availability of funds. 4.19.2 If any action is taken by any State Agency, Federal Department or any other agency or instrumentality to suspend, decrease, or terminate its fiscal obligations under, or in connection with, this Contract, County may amend, suspend, decrease, or terminate its obligations under, or in connection with, this Contract. In the event of termination, County shall be liable for payment only for services rendered prior to the effective date of the termination, provided that such services are performed in accordance with the provisions of this Contract. County shall give written notice of the effective date of any SERIAL 13126-RFP suspension, amendment, or termination under this section, at least ten (10) days in advance. 4.20 RESTRICTIONS ON USE OF FUNDS: 4.20.1 The Contractor shall not utilize funds made available under this Contract to make payments for any item or service to the extent that payment has been made, or can reasonably be expected to be made, with respect to that item or service: 4.20.1.1 Under any State compensation program, under any insurance policy, or under any Federal, State, or county health benefits program; or 4.20.1.2 By an entity that provides health services on a prepaid basis. 4.20.2 Funds shall not be used to purchase or improve (other than minor remodeling) any building or other facility, or to make cash payments to intended recipients of services as referenced in the Arizona Revised Statutes (ARS) A.R.S. § 41-2591, R2-7-701 and Code of Federal Regulations, Chapter 1, Subchapter e., Part 31, and Public Health Service Grants Policy Statement. 4.20.3 The federal Office of General Counsel and County emphasize that Ryan White Act funds may only support HIV-related needs of eligible individuals. All activities and expenditures must reflect an explicit connection between any service supported with Ryan White Act funds and the intended recipient’s HIV status. 4.20.4 Contractor is not authorized to provide services anonymously, unless specifically approved for the service category in which the Contractor is providing services. All services must only be provided to documented eligible clients as defined in this contract. 4.20.5 Ryan White funds shall not be used to finance the services of lobbyists, fundraisers or grant/proposal writers, nor to support lobbying, fundraising activities and/or the writing of grant/contract proposals. The Contractor shall have personnel policies and an employee orientation manual that include regulations that forbid using federal funds to lobby Congress or other Federal personnel. 4.20.6 The Ryan White Act limits the administrative expenses to not more than 10% of the total grant award. The Act defines allowable “administrative activities” to include: 4.20.6.1 Usual and recognized overhead, including established indirect rates for agencies; 4.20.6.2 Management and oversight of specific programs funded under this title; and 4.20.6.3 Other types of program support such as quality assurance, quality control, and related activities.” 4.21 CONTINGENCY RELATING TO OTHER CONTRACTS AND GRANTS: 4.21.1 The Contractor shall, during the term of this Contract, immediately inform County in writing of the award of any other contract or grant where the award of such contract or grant may affect either the direct or indirect costs being paid/reimbursed under this Contract. Failure by the Contractor to notify County of such award shall be considered a material breach of the Contract and County shall have the right to terminate this Contract without liability. 4.21.2 County may request, and the Contractor shall provide within a reasonable time, a copy of any other contract or grant, when in the opinion of the Director, the award of the other contract or grant may affect the costs being paid or reimbursed under this Contract. 4.21.3 If County determines that the award to the Contractor of such other Federal or State contract or grant has affected the costs being paid or reimbursed under this Contract, County shall prepare a Contract Amendment effecting a cost adjustment. If the Contractor protests the proposed cost adjustment, the protest shall be construed as a dispute within the meaning of the "Disputes" clause contained herein. SERIAL 13126-RFP 4.22 SEVERABILITY: The invalidity, in whole or in part, of any provision of this Contract shall not void or affect the validity of any other provision of this Contract. 4.23 STRICT COMPLIANCE: Acceptance by County of performance not in strict compliance with the terms hereof shall not be deemed to waive the requirement of strict compliance for all future performance obligations. All changes in performance obligations under this Contract must be in writing. 4.24 NON-LIABILITY: Maricopa County and its officers and employees shall not be liable for any act or omission by the Contractor or any subcontractor, employee, officer, agent, or representative of Contractor or subcontractors occurring in the performance of this Contract, nor shall they be liable for purchases or Contracts made by the Contractor in anticipation of funding hereunder. 4.25 RIGHT OF PARTIAL CANCELLATION: If more than one service category is funded by this Contract, Maricopa County reserves the right to terminate this Contract or any part thereof based upon the Contractor’s failure to perform any part of this contract without impairing, invalidating or canceling the remaining service category obligations as stated in the current schedule of deliverables. 4.26 RIGHTS IN DATA: The County shall own have the use of all data and reports resulting from this Contract without additional cost or other restriction except as provided by law. Each party shall supply to the other party, upon request, any available information that is relevant to this Contract and to the performance hereunder. 4.27 INTEGRATION: This Contract represents the entire and integrated agreement between the parties and supersedes all prior negotiations, proposals, communications, understandings, representations, or agreements, whether oral or written, express or implied. 4.28 VERIFICATION REGARDING COMPLIANCE WITH ARIZONA REVISED STATUTES §41- 4401 AND FEDERAL IMMIGRATION LAWS AND REGULATIONS: 4.28.1 By entering into the Contract, the Contractor warrants compliance with the Immigration and Nationality Act (INA using e-verify) and all other federal immigration laws and regulations related to the immigration status of its employees and A.R.S. §23-214(A). The contractor shall obtain statements from its subcontractors certifying compliance and shall furnish the statements to the Procurement Officer upon request. These warranties shall remain in effect through the term of the Contract. The Contractor and its subcontractors shall also maintain Employment Eligibility Verification forms (I-9) as required by the Immigration Reform and Control Act of 1986, as amended from time to time, for all employees performing work under the Contract and verify employee compliance using the E-verify system and shall keep a record of the verification for the duration of the employee’s employment or at least three years, whichever is longer. I-9 forms are available for download at USCIS.GOV. 4.28.2 The County retains the legal right to inspect contractor and subcontractor employee documents performing work under this Contract to verify compliance with paragraph 4.20.1 of this Section. Contractor and subcontractor shall be given reasonable notice of the County’s intent to inspect and shall make the documents available at the time and date specified. Should the County suspect or find that the Contractor or any of its subcontractors SERIAL 13126-RFP are not in compliance, the County will consider this a material breach of the contract and may pursue any and all remedies allowed by law, including, but not limited to: suspension of work, termination of the Contract for default, and suspension and/or debarment of the Contractor. All costs necessary to verify compliance are the responsibility of the Contractor. 4.29 CONTRACTOR LICENSE REQUIREMENT: 4.29.1 The Respondent shall procure all permits, insurance, licenses and pay the charges and fees necessary and incidental to the lawful conduct of his/her business, and as necessary complete any required certification requirements, required by any and all governmental or non-governmental entities as mandated to maintain compliance with and in good standing for all permits and/or licenses. The Respondent shall keep fully informed of existing and future trade or industry requirements, Federal, State and Local laws, ordinances, and regulations which in any manner affect the fulfillment of a Contract and shall comply with the same. Contractor shall immediately notify both Office of Procurement Services and the using agency of any and all changes concerning permits, insurance or licenses. 4.29.2 Respondents furnishing finished products, materials or articles of merchandise that will require installation or attachment as part of the Contract, shall possess any licenses required. A Respondent is not relieved of its obligation to posses the required licenses by subcontracting of the labor portion of the Contract. Respondents are advised to contact the Arizona Registrar of Contractors, Chief of Licensing, at (602) 542-1525 to ascertain licensing requirements for a particular contract. Respondents shall identify which license(s), if any, the Registrar of Contractors requires for performance of the Contract. 4.30 CERTIFICATION REGARDING DEBARMENT AND SUSPENSION 4.30.1 The undersigned (authorized official signing for the Contractor) certifies to the best of his or her knowledge and belief, that the Contractor, defined as the primary participant in accordance with 45 CFR Part 76, and its principals: 4.30.1.1 are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal Department or agency; 4.30.1.2 have not within 3-year period preceding this Contract 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 public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; 4.30.1.3 are not presently indicted or otherwise criminally or civilly charged by a government entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (2) of this certification; and 4.30.1.4 have not within a 3-year period preceding this Contract had one or more public transaction (Federal, State or local) terminated for cause of default. 4.30.2 Should the Contractor not be able to provide this certification, an explanation as to why should be attached to the Contract. 4.30.3 The Contractor agrees to include, without modification, this clause in all lower tier covered transactions (i.e. transactions with subcontractors) and in all solicitations for lower tier covered transactions related to this Contract. SERIAL 13126-RFP 4.31 INFLUENCE As prescribed in MC1-1202 of the Maricopa County Procurement Code, any effort to influence an employee or agent to breach the Maricopa County Ethical Code of Conduct or any ethical conduct, may be grounds for Disbarment or Suspension under MC1-902. An attempt to influence includes, but is not limited to: 4.31.1 A Person offering or providing a gratuity, gift, tip, present, donation, money, entertainment or educational passes or tickets, or any type valuable contribution or subsidy; 4.31.2 That is offered or given with the intent to influence a decision, obtain a contract, garner favorable treatment, or gain favorable consideration of any kind. If a Person attempts to influence any employee or agent of Maricopa County, the Chief Procurement Officer, or his designee, reserves the right to seek any remedy provided by the Maricopa County Procurement Code, any remedy in equity or in the law, or any remedy provided by this contract. 4.32 GOVERNING LAW: This Contract shall be governed by the laws of the state of Arizona. Venue for any actions or lawsuits involving this Contract will be in Maricopa County Superior Court or in the United States District Court for the District of Arizona, sitting in Phoenix, Arizona 4.33 LAWS, RULES AND REGULATIONS: The Contractor understands and agrees that this Contract is subject to all State and Federal laws, rules and regulations that pertain hereto. 4.34 ANTI-KICKBACK REGULATIONS: 4.34.1 If the Contractor is a Medicare/Medicaid provider, it shall maintain a Corporate Compliance Plan. 4.34.2 The Contractor shall maintain Personnel Policies, Code of Ethics or Standards of Conduct, Bylaws and Board policies that include ethics standards or business conduct practices. 4.34.3 The Contractor shall maintain documentation of any employee or Board member violations of Code of Ethics/Standards of Conduct, and complaints of violations and resolution. 4.34.4 The Contractor’s Code of Ethics/Standards of Conduct shall include: • Conflict of interest • Prohibition on use of provider property, information or position without approval or advance personal interest • Fair dealing: Contractor engages in fair and open competition • Confidentiality • Protection and use of company assets • Compliance with laws, rules, regulations • Timely and truthful disclosure of significant accounting deficiencies and non- compliance 4.34.5 The Contractor shall have adequate policies and procedures to discourage soliciting cash or in-kind payments for: • Awarding contracts • Referring clients • Purchasing goods of services • Submitting fraudulent billings SERIAL 13126-RFP 4.34.6 The Contractor shall have employee policies that discourage: • Hiring persons with a criminal record • Hiring persons being investigated by Medicare/Medicaid • Large signing bonuses 4.35 ORDER OF PRECEDENCE: In the event of a conflict in the provisions of this Contract and Contractor’s license agreement, if applicable, the terms of this Contract shall prevail. 4.36 INCORPORATION OF DOCUMENTS: The following are to be attached to and made part of this Contract: 4.36.1 Exhibit A, Service Provider Application; 4.36.2 Exhibit B, Pricing/RWPA Price Sheet; 4.36.3 Exhibit C, Scope of Work. SERIAL 13126-RFP EXHIBIT A SERVICE PROVIDER APPLICATION SERIAL 13126-RFP SERIAL 13126-RFP EXHIBIT B PRICING & BUDGET FORM DATE PREPARED 1/15/14 PREPARED BY: Adrian Bizardi, Grants Manager NAME OF ORGANIZATION: Phoenix Indian Medical Center, HIV Center of Excellence Fed. Employee ID # (FEIN) 86-0212139 DUNS # 364268581 ADDRESS: 4212 North 16th Street Phoenix, AZ 85016 AUTHORIZED CONTACT Stephanie Markman, MD Chief COE (Acting) TELEPHONE 602-263-1200 FAX 602-263-1618 E-MAIL stephanie.markman@ihs.gov PRIMARY CONTACT Stephanie Markman, MD Chief COE (Acting) TELEPHONE 602-263-1200 FAX 602-263-1618 EMAIL stephanie.markman@ihs.gov CONTRACT NUMBER Serial 13126-RFP SERVICE CATEGORY Outpatient Ambulatory Medical Care Service BUDGET PERIOD: 3/1/2014 2/28/2015 Start Date End Date CONTRACT AMOUNT $150,150.00 SERIAL 13126-RFP Date Prepared: 1/15/2014 (Section I) Organization Phoenix Indian Medical Center, HIV Center of Excellence Service Category Outpatient Ambulatory Medical Care Service Budget Period 3/1/2014 Through 2/28/2015 (Section II) Contract Amount $150,150.00 Administrative Total Budget Operating Expenses Budget Direct Service Budget FTES 0.00 0.69 0.69 Personnel: Salaries $ - $ 95,481.15 $ 95,481.15 Personnel: Fringe/Benefits - 28,548.86 28,548.86 Subtotal: Personnel/Fringe Benefits - 124,030.02 124,030.02 Other Operating Expenses Travel - - - Supplies - 459.98 459.98 Equipment - - - Contractual - - - Program Support - 25,660.00 25,660.00 Other Professional Services - - - Subtotal: Other Operating Expenses - 26,119.98 26,119.98 Total Operating Expenses - 150,150.00 150,150.00 (Personnel and Other Direct Costs) Indirect Costs - - Enter Indirect Cost Rate Providers claiming an indirect cost must submit their most current negotiated indirect costs (may not exceed 10% of Direct Costs) rate agreement issued by the cognizant federal agency with their budget. Total Costs of Contract - 150,150.00 150,150.00 (Admin-Percent of Direct Costs) 0.00% Administration may not exceed 10% of Direct Costs CONTRACT BALANCE (Contract Revenue less Total Costs of Contract) $ 0.00 *The Contract Balance should equal zero. SERIAL 13126-RFP Personnel All staff paid in full or part from this Ryan White Part A grant are to be listed in the following chart. Date Prepared: 1/15/2014 1 Staffing Provider Entry Auto Calculation Fringe Benefit Rate 29.90% Staffing Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Benefits Annual Hourly Salary Applied to Applied to grant Job Status % Applied as Gross Admin Gross Admin Direct Service Direct Service Position Title Last Name Hours % RWPA FTE Rate grant per FTE per FTE A, D or A/D Administrative Salary Benefits Salary Benefits 1 Physician Bloomquist 2080 35.00% 0.3500 $88.24 $ 64,238.72 $ 19,207.38 D - - $ 64,238.72 $ 19,207.38 The HIV Physician will provide comprehensive primary medical services to the HIV + American Indian / Alaska Niatve (AI / AN) individuals of all ages with a full sprectrum of primary care, health and supportive services in a professional, culturally sensitive and competent manner. A licensed physician will provide primary care services in a team-based model that focuses on evaluation and management and treatment for HIV infected individuals in accordance with the Standards of Care. List Benefit Categories and %; ( this table w ill not print) 2 Pharmacist Huentelman 2080 14.00% 0.1400 $50.61 $ 14,737.63 $ 4,406.55 D - - $ 14,737.63 $ 4,406.55 (R) Benefits The HIV Clinical Pharmacist will provide comprehensive pharmaceutical care services to the HIV + American Indian / Alaska Native (AI / AN) individuals of all ages with a full spectrum of medication management including side effects, drug interaction, adherence counseling and labatory interpretations in a professional, culturally sensitive and competent manner. Benefits Name Percent FICA 7.65% 3 HIV Nurse Smith 2080 10.00% 0.1000 $51.80 $ 10,774.40 $ 3,221.55 D - - $ 10,774.40 $ 3,221.55 Federal Tax 10.95% The HIV Nurse will provide comprehensive medical nursing services to the HIV + American Indian / Alaska Native (AI / AN) individuals of all ages with a full sprectrum of primary health care and supportive services in a professional, culturally sensitive and competent manner. State Tax 2.70% Health Ins 3.70% 4 HIV Nurse Peters 2080 10.00% 0.1000 $27.55 $ 5,730.40 $ 1,713.39 D - - $ 5,730.40 $ 1,713.39 Retirement 3.60% The HIV Nurse will provide comprehensive medical nursing services to the HIV + American Indian / Alaska Native (AI / AN) individuals of all ages with a full sprectrum of primary health care and supportive services in a professional, culturally sensitive and competent manner. Life Insurance 1.30% 5 0.0000 $ - $ - - - $ - $ - Description TOTAL 29.90% 6 0.0000 $ - $ - - - $ - $ - Description 7 0.0000 $ - $ - - - $ - $ - Description 8 0.0000 $ - $ - - - $ - $ - Description Subtotal Personnel 0.69 $ 95,481.15 $ 28,548.86 $ - $ - $ 95,481.15 $ 28,548.86 Subtotal from Personnel Continuation Sheet 0.00 $ - $ - $ - $ - $ - $ - TOTAL Personnel 0.69 $ 95,481.15 $ 28,548.86 $ - $ - $ 95,481.15 $ 28,548.86 (Admin) 0.00 FTE Percent Admin 0% (Direct Service) 0.69 FTE Percent Direct 100% Total 0.69 FTE 100% SERIAL 13126-RFP 2 Staffing Continuation Sheet ( Page 2 of 2) Provider Entry Auto Calculation Date Prepared: 1/15/2014 Staffing Continuation Sheet ( Page 2 of 2) Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Annual Hourly Salary Applied to Benefits Applied to Job Status % Applied as Gross Admin Gross Admin Direct Service Direct Service Position Title Last Name Hours % RWPA FTE Rate grant per FTE grant per FTE A, D or A/D Administrative Salary Benefits Salary Benefits 9 0.0000 $ - $ - - - $ - $ - Description 10 0.0000 $ - $ - - - $ - $ - Description 11 0.0000 $ - $ - - - $ - $ - Description 12 0.0000 $ - $ - - - $ - $ - Description 13 0.0000 $ - $ - - - $ - $ - Description 14 0.0000 $ - $ - - - $ - $ - Description 15 0.0000 $ - $ - - - $ - $ - Description 16 0.0000 $ - $ - - - $ - $ - Description 17 0.0000 $ - $ - - - $ - $ - Description Subtotal to Page 1 0.00 $ - $ - - - $ - $ - SERIAL 13126-RFP TRAVEL Provider Entry Auto Calculation Date Prepared: 1/15/2014 Travel can be budgeted for the cost of staff mileage and other travel associated with Ryan White Part A. 1 Mileage Mileage will be budgeted utilizing the standard calculation of # of monthly miles for a full time staff person x12 months x the rate per mile used by your organization x the number of FTE(s) budgeted who will travel to provide services under this grant. Enter only the FTEs that will travel and provide a Narrative Justification including who will travel and why. Mileage Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Mileage Rate FTE Monthly Miles Annual Miles Total Budgeted (Per 1 Admin Direct Svc Narrative Justification FTE)* Applied to Grant Budget 1 Admin 0 $ - $ - $ - 2 Direct Svc 0 $ - $ - TOTAL 0 0 $ - $ - $ - $ - (Total Miles applied to this grant) *Note - Budget monthly mileage for 1 FTE. This is a revision to prior year budget templates. 2 Other Allowable Travel ( car rental, parking, fees, etc.) Ryan White Part A has determined that costs included in this section are Administrative Costs. Other Allowable Travel Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Dates Total Admin Direct Svc Narrative Justification of Travel Budget 1 Cost $ - $ - 0 Line Item 0 2 Cost $ - $ - 0 Line Item 0 3 Cost $ - $ - 0 Line Item 0 $ - $ - - $ - Admin Direct Service Total SUMMARY (Travel) $ - $ - $ - SERIAL 13126-RFP SUPPLIES Provider Entry Auto Calculation Date Prepared: 1/15/2014 The supplies line item is used to budget funds for supplies used in the operations of the Grant. This category can include general office supplies and program/medical supplies 1 General Office Supplies: (Apply an FTE Ratio from the Budgeted Personnel Page) Pens, paper, toner and general supplies that are used to run an office. General Office Supplies Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Annual % Admin % Direct Total Narrative Description/Cost Allocation Methodology Item Budget 0% 100% 100% 1 Office Supply $ 459.98 $ - $ 459.98 $ 459.98 Misc Office supply - Paper, Folders, Pens & printer ink cartridges 2 $ - $ - $ - $38.33 x 12 months 3 $ - $ - $ - 4 $ - $ - $ - 5 $ - $ - $ - $ - $ - $ - TOTAL $ - $ 459.98 TOTAL $ 459.98 2 Program Supplies Program/Medical Supplies are budgeted as Direct Service. Program Supplies Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Annual Item Admin Direct Narrative Description/Cost Allocation Methodology Budget 1 $ - $ - 2 $ - 3 $ - 4 $ - 5 $ - $ - TOTAL $ - $ - TOTAL $ - Admin Direct Total SUMMARY ( Supplies) $ - $ 459.98 $ 459.98 SERIAL 13126-RFP EQUIPMENT Provider Entry Auto Calculation Date Prepared: 1/15/2014 The equipment line item is budgeted for equipment purchased or leased in conjunction with operations of the grant Refer to your contract terms and conditions for requirements related to equipment purchases Equipment less than $5,000 Equipment less than $5,000 - includes computers, fax machines, shredders, and other equipment less than $5,000 to be used in the operations of this grant. Equipment less than $5,000 Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Item Admin Direct Total Narrative Description/Cost Allocation Methodology Budgeted Service 1 $ - 2 $ - 3 $ - 4 $ - 5 $ - $ - TOTAL $ - $ - TOTAL $ - Equipment $5,000 or greater Equipment $5,000 or greater Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Item Admin Direct Total Narrative Description/Cost Allocation Methodology Budgeted Amount Amount 1 $ - 2 $ - 3 $ - 4 $ - TOTAL $ - $ - TOTAL $ - Admin Direct Total SUMMARY (Equipment) $ - $ - $ - SERIAL 13126-RFP Contractual Provider Entry Auto Calculation Date Prepared: 1/15/2014 Use this form to budget for consulting and contract labor (Section 1) and subcontracts ( Section 2) in conjunction with operating this Part A grant. A copy of the fully executed contract covering the dates of service is required for each subcontract listed in this section. 1. Consulting/Professional Contract Labor/Clerical Support This budget category includes payments to outside consultants, temporary services, professional contract labor and clerical support. Indicate the name, licenses/qualifications, hours budgeted, quoted rate, dates of service, and a detailed Narrative/Justification of activities to be provided. 1. Consulting/Professional Contract Labor/Clerical Support Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Dates of Service Consultant Annual Quoted Total Admin Admin Direct Service Name Budgeted Hours Rate Budget Budget % Budget Budget 1 $ - $ - $ - Licenses / qualifications Narrative/ Justification 2 $ - $ - $ - $ - Licenses / qualifications Narrative/ Justification 3 $ - $ - $ - $ - Licenses / qualifications Narrative/ Justification 4 $ - $ - $ - $ - Licenses / qualifications Narrative/ Justification 5 $ - $ - $ - $ - Licenses / qualifications Narrative 6 $ - $ - $ - $ - Licenses / qualifications Narrative/ Justification Consulting/ Prof./ Clerical Sup. Page 1 SUBTOTAL $ - $ - $ - Consulting/ Prof./ Clerical Sup. From Contractual Continuation Page SUBTOTAL $ - $ - $ - TOTAL $ - $ - $ - SERIAL 13126-RFP 2. Subcontracts Include any payments through subcontracts to provide services under this grant. Each Subcontractor listed in this section who is a sub recipient (not a vendor) must complete a Budget using the RWPA budget template. Maricopa County RWPA will enforce the 10% administrative Cost Cap established by HRSA for first-line and second line sub recipient entities receiving Ryan White Part A Funds. 2. Subcontracts Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Subcontractor Sub recipient Admin Direct Service Total Admin Dates of Service Name or Vendor Budget Budget Budget % of Direct 1 $ - #DIV/0! Service(s) Provided Narrative/ Justification 2 $ - #DIV/0! Service(s) Provided Narrative/ Justification 3 $ - #DIV/0! Service(s) Provided Narrative/ Justification TOTAL - - - Admin Direct Total SUMMARY Contractual $ - $ - $ - SERIAL 13126-RFP Contractual- Continuation Page Date Prepared: 1/15/2014 The Contractual line item is used for consulting and contracting to be utilized in conjunction with operations of the grant. Use this page to list Consultant/Contract Labor and Clerical Support if there is insufficient space on the Contractual Page. Consulting/Professional Contract Labor/Clerical Support Consulting/Professional Contract Labor/Clerical Support Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Dates of Service Consultant Hours Quoted Total Admin Admin Direct Service Budgeted Rate Budget Budget % Budget 6 $ - $ - $ - Licenses / qualifications Narrative 7 0 $ - $ - $ - Licenses / qualifications Narrative 8 0 $ - $ - $ - Licenses / qualifications Narrative 9 0 $ - $ - $ - Licenses / qualifications Narrative 10 0 $ - $ - $ - Licenses / qualifications Narrative 11 0 $ - $ - $ - Licenses / qualifications Narrative 12 0 $ - $ - $ - Licenses / qualifications Narrative 13 $ - $ - $ - $ - $ - Licenses / qualifications Narrative 14 0 $ - $ - $ - Licenses / qualifications Narrative 15 0 $ - $ - $ - Licenses / qualifications Narrative 16 0 $ - $ - $ - Licenses / qualifications Narrative Consulting/ Prof./ Clerical Sup. Subtotal to Page 1 TOTAL - - $ - SERIAL 13126-RFP Other Program Support Provider Entry Auto Calculation Date Prepared: 1/15/2014 Use this form to budget for other support necessary to provide services under this grant. In the Narrative Justification describe how the program support will be used and also the methodology used to allocate the total or a portion of the total cost to the grant. 1 Communications/Telephone/Internet mmunications/Telephone/Internet Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Servi Item Total Narrative/Cost Allocation Methodology Amount Admin Direct Budgeted 0% 100% $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL $ - $ - TOTAL $ - 2 Copy/Duplicating Copy/Duplicating Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Item Amount Admin Direct Total Narrative/Cost Allocation Methodology Budgeted 0% 100% 1 Program Brochures $ - $ - 2 Other Copying/Duplicating $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL $ - $ - TOTAL $ - SERIAL 13126-RFP 3 Postage Postage Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Item Amount Admin Direct Total Narrative/Cost Allocation Methodology Budgeted 0% 100% $ - $ - $ - $ - $ - $ - TOTAL $ - $ - TOTAL $ - 4 Utilities Utilities are 100% administrative. (Ruling 6.6.B05) Utilities Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Item Amount Admin Direct Total Narrative/Cost Allocation Methodology Budgeted $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL - - TOTAL $ - 4 Other Program Support Other Program Support Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Item Admin Direct Total Narrative/Cost Allocation Methodology Extenal Labs $ 500.00 $ - $ 25,000.00 $ 25,000.00 Ext Labs $2,083.33 per mo x 12 months Lab Draw Fees $ - $ - $ 660.00 $ 660.00 Lab Draw s $10 x 66 Lab Draw s $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL $ - $ 25,660.00 TOTAL $ 25,660.00 Admin Direct Total SUMMARY Program Support $ - $ 25,660.00 $ 25,660.00 SERIAL 13126-RFP Other Professional Service Provider Entry Auto Calculation Date Prepared: 1/15/2014 Use this form to budget for other professional services; audit/accounting, insurance, rent/space, or other professional services. 1 Audit/Accounting/Finance Audit/Accounting/Finance Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Vendor Hours Quoted Total Dates Admin Direct Service Description of Service Name Budgeted Price* Price of Service a $ - $ - Cost Method Used Budget Justification b $ - $ - Cost Method Used Budget Justification c $ - $ - Cost Method Used Budget Justification TOTAL - $ - SERIAL 13126-RFP 2 Insurance Insurance Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Vendor Annual Percent Total Dates Admin Direct Service Description of Service Name Premium To grant Grant of Service a $ - $ - $ - Cost Method Used Budget Justification b $ - $ - $ - Cost Method Used Budget Justification c $ - $ - $ - Cost Method Used Budget Justification TOTAL $ - $ - 3 Rent/Space Rent is considered 100% administrative Rent/Space Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Vendor Annual Percent Total Dates Admin Direct Service Description of Service Name Rent to Grant Grant of Service $ - a $ - $ - Cost Method Used Budget Justification TOTAL $ - $ - SERIAL 13126-RFP 4 Other Professional Service Other Professional Service Phoenix Indian Medical Center, HIV Center of Excellence Outpatient Ambulatory Medical Care Service Vendor Hours Quoted Total Admin Admin Direct Service Description of Service Name Budgeted Price* Price Budget % a $ - $ - $ - Cost Method Used Budget Justification b $ - $ - $ - Cost Method Used Budget Justification c $ - $ - $ - Cost Method Used Budget Justification $ - TOTAL $ - $ - $ - Admin Direct Total SUMMARY Other Prof. Svc $ - $ - $ - SERIAL 13126-RFP Schedule of Deliverables Provider Entry Auto Calculation Date Prepared: 1/15/2014 Organization Name: nix Indian Medical Center, HIV Center of Excel Performance Measures: Service Category Outpatient Ambulatory Medical Care Service Number of New Clients 15 Number of Returning Clients 70 Total # of Unduplicated Clients 85 Fee for Service Only Schedule of Deliverables ( Not Applicable to Cost Reimbursement Contracts) Service Unit CAREWare Fee Source (ie Definition Number of Proposed Fee Total Payment Per Service Unit Service Description Mar Apr May June July Aug Sep Oct Nov Dec Jan Feb AHCCCS, I H S, 1 unit = Units Per Product/ Objective/Activity Name/Code Negotiated Rate, etc.) (i.e. 15 minutes) Proposed Deliverable 1 OP Visits Primary Medical Visits 1 unit = $330 377 34 34 34 34 34 34 34 34 34 35 35 35 $ 330.00 $ 124,410.00 2 Lab Draw s Patient Lab Draw s 1 unit = $10 66 6 6 6 6 6 6 5 5 5 5 5 5 $ 10.00 $ 660.00 3 - $ - 4 - $ - 5 - $ - 6 - $ - 7 - $ - 8 - $ - 9 - $ - 10 - $ - 11 - $ - 12 - $ - 13 - $ - 14 - $ - 15 - $ - TOTAL 443 40 40 40 40 40 40 39 39 39 40 40 40 $ 125,070.00 Total Budget $ 150,150.00 Over/(Under Budget) $ (25,080.00) Balance should equal zero SERIAL 13126-RFP Fee for Service Only Example ( Not Applicable to Cost Reimbursement Contracts) Service Unit CAREWare Number Definition 1 Proposed Fee Per Total Payment Per Fee Source (ie AHCCCS, I H Service Unit Service Description of Units Mar Apr May June July Aug Sep Oct Nov Dec Jan Feb unit = (i.e. Product/ Objective/Activity S, Negotiated Rate, etc.) Name/Code Proposed 15 minutes) Deliverable Face to face medical FMCM case management Assessment assessment. 1 unit = 15 minutes 1,128 94 94 94 94 94 94 94 94 94 94 94 94 $ - $ - Food boxes Food box 1 unit = 1 food box 3,396 283 283 283 283 283 283 283 283 283 283 283 283 $ - $ - H0004 Ind Individual counseling Counseling session 1 unit = 15 minutes 6,900 600 600 600 600 500 600 600 600 600 400 600 600 $ 16.76 $ 115,644.00 AHCCCS Rate SERIAL 13126-RFP EXHIBIT C SCOPE OF WORK 1.0 SCOPE OF WORK: 1.1 PURPOSE OF THE PROGRAM, AUTHORITY AND BACKGROUND: The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act was first enacted in 1990 and amended in 1996, 2000, 2006 and 2009. Currently, the Act was reauthorized in 2009 and is called the Ryan White HIV/AIDS Treatment Extension Act of 2009. The authority for this grant program is the Public Health Service Act Section 2603, 42 USC 300ff-13. The U.S. Department of Health and Human Services (DHHS) administers the Part A program through the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB), Division of Service System (DSS). The entire CARE Act may be accessed at http://hab.hrsa.gov/abouthab/legislation.html. Part A funds provide direct financial assistance to Eligible Metropolitan Area (EMAs) that have been the most severely affected by the HIV epidemic. Formula and supplemental funding components of the grant assist EMAs in developing or enhancing access to a comprehensive continuum of high quality, community-based care for low-income individuals and families with HIV disease. A comprehensive continuum of care includes primary medical care, HIV-related medications, mental health treatment, substance abuse treatment, oral health and case management services that assist PLWH/A (People Living with HIV/AIDS) in accessing treatment of HIV infection that is consistent with Public Health Service (PHS) Treatment Guidelines (current treatment guidelines are available at www.AIDS info.nih.gov). Comprehensive HIV/AIDS care beyond these core services also includes access to other health services (e.g. home health care, nutritional, and rehabilitation service). In addition, this continuum of care may include supportive services that enable individuals to access and remain in primary medical care (e.g. outreach, transportation, and food services). Part A supplemental funds have been awarded since fiscal year (FY) 1999 under the Minority AIDS Initiative (MAI) to improve the quality of care and health outcomes in communities of color disproportionately impacted by the HIV epidemic. Funds are to initiate, modify, or expand culturally and linguistically appropriate HIV care services for disproportionately impacted communities of color. Following Congressional intent, MAI funds must be used to expand or support new initiatives consistent with these goals. MAI funds are subject to special conditions of award, and providers of services funded with MAI funds must document their use separately from other Part A funds. Progress reports must be provided in a beginning of year, Mid-Year Progress Report, and end-of-fiscal year Final Progress Report. This information reported is used to monitor: 1. Compliance with the MAI Condition of Award and related requirements; 2. Progress in meeting planned objectives; 3. Potential grantee technical assistance needs; 4. Type and quantity of services delivered and demographics of clients served, and; 5. Improvements in access and health outcomes being achieved through these services. In preparing all responses to this Request for Proposal (RFP), applicant should consider how efforts at the local level are consistent with the Ryan White HIV/AIDS Treatment Extension Act of 2009 which emphasizes the use of funds to address the service needs of “individuals who know their HIV status and are not receiving primary medical care services and for informing individuals of and enabling the individuals to utilize the services, giving particular attention to eliminating disparities in access and services among affected subpopulations and historically underserved communities” Section 2602 (b)(4)(D)(i). Additionally, applicants should consider the impact of the epidemic within the Phoenix EMA, which consists of Maricopa and Pinal counties. Several studies are available for applicants to review including: SERIAL 13126-RFP 1. 2006 Hispanic PLWH/A Needs Assessment 2. 2006 African American PLWH/A Needs Assessment 3. 2006 PLWH/A Out of Care Needs Assessment 4. 2006 Pinal County Needs Assessment 5. Phoenix EMA 2006-2009 Comprehensive Plan All reports can be viewed at the Phoenix EMA Ryan White Planning Council's website at: http://www.ryanwhiteparta.com Moreover, in developing your application you should consider the HIV/AIDS Bureau (HAB) Guiding Principles indicated below that have significant implications for HIV/AIDS care services planning. 1. The HIV/AIDS epidemic is growing among traditionally underserved and hard-to-reach populations; 2. The quality of emerging HIV/AIDS therapies can make a difference in the lives of people living with HIV disease; 3. Changes in the economics of health care are affecting HIV/AIDS care network; and 4. Outcomes are a critical component of program performance. All CARE Act funded projects in any service category must participate in the existing community- based continuum of care. This concept requires that services in a community must be organized to respond to the individual’s or family’s changing needs, in order to reduce fragmentation of care. For the Phoenix EMA to achieve this intent as required by HRSA guidance funded providers will be required to attend meetings sponsored by the Phoenix EMA Ryan White Planning Council and other management and technical assistance meetings deemed mandatory by Maricopa County Ryan White Part A Program. Lastly, Part A funds must be used in a manner consistent with current and future HRSA policies as developed by the Division of Services Systems, HIV/AIDS Bureau. These policies can be reviewed on the HAB website at http://hab.hrsa.gov. 1.2 THE PHOENIX EMA RYAN WHITE PLANNING COUNCIL: The Phoenix EMA Ryan White Planning Council (PC) is a planning body required under the Part A authorization. The Maricopa County Board of Supervisors serves as the Chief Elected Official for the Planning Council. Membership of the PC must be reflective of the epidemic within the Phoenix EMA and includes representatives from a variety of specific groups such as providers of housing and homeless shelters, HIV prevention services, representatives of individuals who were formerly Federal, State or local prisoners released from the custody of the penal system and had HIV disease on the date released, other mandated entities and interested advocates. The PC establishes service priorities, allocates Part A funds, develops a comprehensive plan, and addresses the efficiency of the grantee’s administrative mechanism for rapidly contracting out funds to service providers. The PC establishes Directives for service categories that are additional requirements that must be incorporated into the program plan along with applicable Standards of Care. These Directives are discussed under the service category description and should also guide prospective applicants in the development of goals objectives and a work plan. 1.3 ADMINISTRATIVE AGENT AND QUALITY MANAGEMENT: Part A funds are awarded to the chief elected official (CEO). The CEO retains ultimate responsibility for submitting grant applications, ensuring that funds awarded are used appropriately, and complying with reporting or other requirements. Most CEOs delegate day-to- day responsibility for administering their Part A award to a health related department within the jurisdiction. SERIAL 13126-RFP For the purposes of this section, the CEO of the EMA has delegated this responsibility to the Ryan White Part A Program within Maricopa County Department of Business Strategies and Health Care Programs. Administrative activities under the authority of the Administrative Agent include: Routine grant administration and monitoring activities, including the development of applications for funds, the receipt, monitoring and disbursal of program funds, the development and establishment of reimbursement and accounting systems, the preparation of routine programmatic and financial reports, compliance with grant conditions and audit requirements/promulgation of policies and procedures and continuous quality improvement initiatives. All activities associated with the grantee’s contract award procedures, including the development of requests for proposals, contract proposal review activities, negotiation and awarding of contracts, monitoring of contracts through telephone consultation, written documentation or onsite visits, reporting on contracts, and funding reallocation activities. The administrative agent will conduct site visits with service providers to monitor program and fiscal compliance with contracts, and to ensure adherence to the EMA’s Standards of Care as developed by the PC. The lead agency (Contractor) agrees to include in any subcontracts a provision to the effect that the subcontractor agrees that Maricopa County Ryan White Part A Program shall have access to the subcontractor’s facilities and the right to examine any books, documents, and records of the subcontractor, involving transactions related to the subcontract. Additionally, client charts, care/treatment plans, eligibility requirements, etc shall be available for inspection. The Administrative Agent will also provide technical assistance and training that providers may be required to attend. The CARE Act requires the establishment of quality management program and quality service indicators for all Part A programs to ensure that persons living with HIV disease receive those services and that the quality of those services meet certain criteria, specifically Standards of Care and the Public Health Services treatment guidelines. The Maricopa County Ryan White Part A Program has established a Quality Management Program to assess all services funded under Ryan White Part A Program and to achieve the goals set forth in the CARE Act. All funded programs are subject to quality management reviews and technical assistance. All agencies must be able to demonstrate that health and support services supported by Part A funds are consistent with PHS treatment guidelines and the Standards of Care as established by the Planning Council. All funded providers will be asked to submit quality management plans to reflect how providers are ensuring quality services. 1.4 CONTRACTOR ELIGIBILITY: Eligible contractor’s include public or non-profit health and social services providers, and other non-profit community organizations, medical care providers, community-based organizations, HIV/AIDS service organizations, academic entities, and city, county, state, federal governmental units. The CARE Act Amendments of 1996 provide for contracting with for-profit entities under certain limited circumstances. Specifically, the amendments allow Part A funds to be used to provide direct financial assistance through contracts with private for-profit entities if such entities are the only available provider of quality HIV care in the area (Sec 2604(b) (2) (A); Section 2631(a) (1). Contractors are prohibited from serving as conduits to pass on their awards to for- profit entities. To better serve Persons Living with HIV/AIDS (PLWHA) within the EMA, the Maricopa County Ryan White Part A Program reserves the right, at its discretion, to issue multiple contracts within a service category pursuant to this Request for Proposal. SERIAL 13126-RFP All services must be directed to enhance the delivery of services to persons living with HIV, and, in limited, restricted instances, their families. These funds may not be used for prevention services. Joint proposals from coalitions of agencies and organizations are allowable. However, if a lead agency (prime contractor) is proposing to sub-contract with another agency to perform more than 50% of the deliverables, the proposal must provide sufficient information regarding the qualifications of the sub-contracting agency. In all cases, a lead agency (as prime contractor) must be identified. All proposals in response to this RFP which include the use of subcontractors must be submitted by a lead agency, with the approach to use the subcontractor(s) clearly outlined in their proposal. All providers must have documented evidence to substantiate referral relationships on an ongoing basis. All officers must submit any written agreements with other organizations/entities that serve the community of persons living with HIV and are 1) service providers and/or 2) points of entry or access to HIV services. All officers’ are strongly encouraged to include copies of such agreements, detailing each agencies/organization’s roles and responsibilities, with each application. The use of subcontractors and/or consultants must be pre-approved by the Maricopa County Ryan White Part A Program. If approved, the Contractor agrees to use written agreements which conform to Federal and State laws, regulations and requirements of this proposal appropriate to the service or activity defined by this RFP. These provisions apply with equal force to the subcontract as if the subcontractor were the contractor referenced herein. The Contractor is responsible for the performance of this contract regardless of whether or not a subcontract is used. The lead agency (Contractor) will submit a copy of each executed subcontract to the RWPA within fifteen (15) days of its effective date. All proposals in response to this RFP which include the use of subcontractors must clearly state and document the details of the subcontract agreement. This will include a scope/intent of work for both the lead agency and all subcontracts proposed. The scope of the proposal must clearly identify the services to be provided by all parties for the proposal. Additionally, all subcontract agreements proposed must include a detailed budget and narrative, identifying all administrative costs, as defined in the “Administrative Costs” section of this RFP. Subcontracts will be restricted to no more than ten percent of the budget proposed. 1.5 COMPENSATION: 1.5.1 The County reserves the right to reallocate funding during the contract period so that the services provided and corresponding contract amount may be decreased or increased, via contract amendment or Task Order, at the discretion of the County. 1.5.2 County will pay the Contractor on a monthly basis for approved services and expenses and in accordance with the reimbursement methodology determined by the County’s Administrative Agent; either fee-for service or cost. The total funds paid to the Contractor will be dependent upon the approved invoice according to the Administrative Agent. County does not guarantee a minimum payment to the Contractor. County will not reimburse for fee-for-service activities when an appointment is canceled either by the client or Contractor. 1.5.3 The Contractor understands and agrees to notify the County of any deviations or changes to any budget line of the current budget in place for this contract within 30 days of such change. 1.5.4 The Contractor shall be compensated for services provided only by the staff classifications/positions included/referenced in the current approved budget. 1.5.5 Unless specifically allowed and referenced elsewhere in this contract, all services are to be provided at approved Contractor sites and/or venues. Services provided at non- authorized locations or venues will not be reimbursed by the County. SERIAL 13126-RFP 1.5.6 The Contractor shall provide monthly financial and corresponding programmatic reports per the reporting schedule to the County. If the Contractor is not in compliance due to non-performance, submission of reports after deadlines, insufficient back-up statements or improperly completed forms, the Contractor may not be reimbursed or reimbursement may be delayed until program compliance issues and any other related financial consequences are resolved. Furthermore, instances of non-compliance with billing and reporting requirements may result in the County reducing the Contractor’s reimbursement by up to 10% of the corresponding month’s billing. Billing forms and instructions are included in the current Ryan White Part A Program Policies and Procedures Manual refer to http://www.ryanwhiteparta.com 1.5.7 The actual amount of consideration to be paid to the Contractor depends upon the actual hours worked, services provided and related expenses as stated in the current approved budget or as modified by contract amendment or appropriately executed task order. Any un-obligated balance of funds at the end of this Agreement period will be returned to the County in accordance with instruction provided. 1.6 INVOICES AND PAYMENTS: 1.6.1 The Contractor shall submit electronically to the Administrative Agent one (1) legible copy of their detailed monthly invoice before payment(s) can be made. 1.6.2 Contractor shall submit the invoice packet for services performed on or before the fifteenth (15th) calendar day following the month in which services were performed. 1.6.3 The invoice shall include the requirements as outlined in the Ryan White Part A’s current policies and procedures manual. 1.6.4 Contractors providing medical services are required to utilize the Health Care Form (HCF-1500) Uniform Billing (UB-92) or other standardized medical claim forms as agreed to with the Administrative Agent, and to submit these to the Ryan White Part A Program in addition to the other required invoice reports and forms. 1.7 METHOD OF PAYMENT: 1.7.1 Subject to the availability of funds, County will, within sixty (60) business days from the date of receipt of the documents enumerated herein, process and remit to the Contractor a warrant for payment up to the maximum total allowable for services provided or work performed during the previous month. Payment may be delayed or reduced if invoices are in non-compliance due to late submission, improperly completed or missing documentation/information or for other contract non-compliance occurring in the related grant year. Other non-compliance issues that may delay or reduce payments can be related to any contractual issue, and may not necessarily be related to the bill itself. Should County make a disallowance in the claim, the claim shall be processed for the reduced amount. If the Contractor protests the amount or the reason for a disallowance, the protest shall be construed as a dispute concerning a question of fact within the meaning of the "Disputes" clause of the Special Provisions of this Contract. 1.7.1.1 The Contractor understands and agrees that County will not honor any claim for payment submitted 60 calendar days after date of service. The Contractor understands and agrees that County will not process any claim for payment for services rendered prior to the end of the contract period which are submitted sixty (60) calendar days after the end of the contract period without approval of County. 1.7.1.2 Payments made by County to the Contractor are conditioned upon the timely receipt of applicable, accurate and complete invoice reports and forms submitted by the Contractor. All monthly invoices must be supported by auditable documentation, which is determined to be sufficient, competent evidential matter defined by the County. SERIAL 13126-RFP 1.7.1.3 The Contractor understands and agrees that Ryan White Part A Program is the payer of last resort, and shall maximize and monitor all other revenue streams including self-pay and all sources of third party reimbursements. The Contractor understands and agrees that all self-pay and third party payments must be exhausted to offset program costs before Ryan White funds are used. The Contractor must have policies and procedures documented and in place to determine and bill these other potential payment sources. These third party payers include but are not limited to Regional Behavioral Health Authority (RBHA), Medicaid (Arizona Health Care Cost Containment Services/AHCCCS), Arizona Long Term Care System (ALTCS), TRICARE, Medicare and private/commercial or other insurance. The Contractor will determine eligibility of clients and assist with client enrollment whenever feasible. Payments collected by the Contractor for Ryan White services must be recorded as Program Income in the Contractor’s financial management system and deducted from bills issued to the County. Program income records must be made available to the County for assurance that such revenues are used to support related services. The Contractor shall have policies and procedures for handling Ryan White revenue including program income. 1.7.1.4 The Contractor shall have policies and staff training on the payer of last resort requirement and how it meets that requirement. 1.7.1.5 Payment shall be made to the Contractor by Accounts Payable through the Maricopa County Vendor Express Payment Program. This is an Electronic Funds Transfer (EFT) process. After Contract Award the Contractor shall complete the Vendor Registration Form located on the County Department of Finance Vendor Registration Web Site (http://www.maricopa.gov/Finance/Vendors.aspx). 1.7.1.6 EFT payments to the routing and account numbers designated by the Contractor will include the details on the specific invoices that the payment covers. The Contractor is required to discuss remittance delivery capabilities with their designated financial institution for access to those details. 1.8 BUDGET, REVENUES AND EXPENDITURES: 1.8.1 The Contractor shall have written fiscal and general policies and procedures that include compliance with federal and Ryan White programmatic requirements. 1.8.2 The Contractor shall prepare and submit to County a budget using the current Ryan White Part A Program-approved formats at the beginning of each grant year in accordance with the stated funds allocated on the most recently issued task order. If the task order is increased or decreased at any time throughout the duration of the grant year, a revised budget may be required. Failure to provide a required budget or schedule of deliverables within the designated timeframe may result in termination of the contract. 1.8.2.1 The total administrative costs budgeted; including any federally approved indirect rate (inclusive of contractor and subcontractor(s)) cannot exceed 10% of the amount of the current grant award. Any amount of administrative expenditures in excess of 10% will not be reimbursed. 1.8.2.2 Contractor agrees that all expenditures are in accordance with the current approved budget. Any expenditure deemed unallowable by the Administrative Agent is subject to the Contractor submitting a full reimbursement to the County. 1.8.2.3 Contractor agrees to establish and maintain a “Financial Management System” that is in accordance with the standards required by Federal OMB Circular A- SERIAL 13126-RFP 110, Subpart C. Such system must also account for both direct and indirect cost transactions, reports on the results of those transactions, are in compliance with the requirements of OMB Circular A-21 and generally accepted accounting principles. 1.8.2.4 All expenditures and encumbered funds shall be final and reconciled no later than 45 days after the close of the grant year. 1.8.2.5 Funds collected by the Contractor in the form of fees, charges, and/or donations for the delivery of the services provided for herein shall be accounted for separately. Such fees, charges and/or donations must be used for providing additional services or to defray the costs of providing these services consistent with the Schedule of Deliverables of this Contract. As applicable, the Contractor agrees to include, in the underlying budget, the amount of projected revenue from client fees. The amount of funds collected from client fees shall be reported by Contractor in the Monthly invoice by discrete service. For audit purposes, the Contractor is responsible for maintaining necessary documentation to support provision of services. 1.9 AMENDMENTS: All amendments to this Contract must be in writing and signed by both parties. All amendments shall clearly state the effective date of the action. 1.10 TASK ORDERS: Contractor shall not perform a task other than those found/defined in the contract award document. Task Orders may be issued by the Administrator of this contract. Task Orders will be communicated via written document and shall include, but is not limited to: budget amount, reference to special conditions of award, and any special service and reporting requirements. Amended Task Orders can be issued at any time during the grant year. Both parties shall sign a new or amended Task Order. 1.11 CHANGES: 1.11.1 The Maricopa County Ryan White Part A Program, with cause, by written order, may make changes within the general scope of this Contract in any one or more of the following areas (Also see AMENDMENTS & TASK ORDER SECTIONS): 1.11.1.1 Schedule of deliverables activities reflecting changes in the scope of services, funding source or County regulations, 1.11.1.2 Administrative requirements such as changes in reporting periods, frequency of reports, or report formats required by funding source or County regulations, policies or requirements, and/or, 1.11.1.3 Contractor fee schedules, reimbursement methodologies and/or schedules and/or program budgets. Examples of cause would include, but are not limited to: non-compliance, under performance, service definition changes, reallocations or other directives approved by the Planning Council, or any other reason deemed necessary by the Administrative Agent. 1.11.2 Such order will not serve to increase or decrease the maximum reimbursable amount to be paid to the Contractor. Additionally, such order will not direct substantive changes in services to be rendered by the Contractor. SERIAL 13126-RFP 1.11.3 Any dispute or disagreement caused by such written order shall constitute a "Dispute" within the meaning of the Disputes Clause found within this Contract and shall be administered accordingly. 1.12 AUDIT REQUIREMENTS: 1.12.1 If the Contractor expends $500,000 or more from all contracts administered and/or funded via County, and/or receives $500,000 or more per year from any federal funding sources, the Contractor will be subject to Federal audit requirements per P.L. 98-502 "The Single Audit Act." The Contractor shall comply with OMB Circulars A-128, A- 110, and A-133 as applicable. The audit report shall be submitted to the Maricopa County Internal Audit Department of Public Health for review within the twelve months following the close of the fiscal year. The Contractor shall take any necessary corrective action to remedy any material weaknesses identified in the audit report within six months after the release date of the report or by a date defined by the Internal Audit Department. Maricopa County may consider sanctions as described in OMB Circular A-128 for contractors not in compliance with the audit requirements. All books and records shall be maintained in accordance with Generally Accepted Accounting Principles (GAAP). 1.12.2 The Contractor shall schedule an annual financial audit to be submitted to County for review within twelve months following the close of the program’s fiscal year. Contractor understands that failure to meet this requirement may result in loss of current funding and disqualification from consideration for future County-administered funding. 1.12.3 The Contractor shall have and make available to County financial policies and procedures that guide selection of an auditor, based on an Audit Committee for Board of Directors (if Contractor is a non-profit entity). 1.12.4 The Contractor shall also comply with the following OMB Circulars as applicable to its organizations business status: 1.12.4.1 A-102 Uniform Administrative Requirements for Grants to State and Local Government. 1.12.4.2 A-110 Uniform Administrative Requirements for Grants and Agreement with Institutions of Higher Education, Hospitals and other non-profit organizations. 1.12.4.3 A-122 Cost Principles for Non-Profit Organizations. 1.12.4.4 A-87 Cost Principles for State and Local Governments. 1.12.4.5 A-21 Cost principles for Education Institutions. 1.13 SPECIAL REQUIREMENTS: 1.13.1 The Contractor shall adhere to all applicable requirements of the Ryan White HIV/AIDS Treatment Extension Act of 2009 and/or current authorized or reauthorized Ryan White HIV/AIDS Act. 1.13.2 The Contractor shall participate in provider technical assistance meetings and/or teleconference calls that will be scheduled by the Administrative Agent throughout the year. 1.13.3 The Contractor shall retain the necessary administrative, professional and technical personnel for operation of the program. 1.13.4 The Contractor agrees to maintain adequate programmatic and fiscal records and files including source documentation to support program activities and all expenditures made under terms of this agreement as required. 1.13.5 Contractor agrees to install and utilize the CAREWare client level reporting software system as described in the current Ryan White Part A Program Policies and Procedures Manual. There are no licensing costs associated with the use of CAREWare, however, SERIAL 13126-RFP the provider is required to pay for the cost related to installing and configuring internal firewall devices to gain access to the CAREWare database. These expenses can be reimbursed by Ryan White if included in the current approved budget. 1.14 RELEASE OF INFORMATION: 1.14.1 The Contractor agrees to secure from all clients provided services under this contract any and all releases of information or other authorization requested by County. Each client file documenting the provision of Part A services must contain a current Administrative Agent authorized release form signed and dated by the client or client’s legal representative. Failure to secure such releases from clients may result in disallowance of all claims to County for covered services provided to eligible individuals. If service to anonymous clients is specifically allowed and approved by the County according to the current Ryan White Part A policies and procedures manual or otherwise stated in writing by the Administrative Agent, this provision does not apply. 1.14.2 The Contractor agrees to comply with ARS §36-662, access to records. In conducting an investigation of a reportable communicable disease the department of health services and local health departments may inspect and copy medical or laboratory records in the possession of or maintained by a health care provider or health care facility which are related to the diagnosis, treatment and control of the specific communicable disease case reported. Requests for records shall be made in writing by the appropriate officer of the department of health services or local health department and shall specify the communicable disease case and the patient under investigation. 1.15 CERTIFICATION OF CLIENT ELIGIBILITY: 1.15.1 The Contractor agrees to determine and certify eligibility all clients seeking services supported by Ryan White funds, according to the requirements detailed in of the Eligibility section of the current Ryan White Part A Program Policies and Procedures Manual. 1.15.2 The Contractor agrees to have billing, collection, co-pay and sliding fee policies and procedures that do not deny clients services for non-payment, inability to produce income documentation, or require full payment prior to service, or include any other barriers to service based on ability to pay. 1.15.3 If the Contractor charges clients for services, the Contractor agrees to charge and document client fees collected in accordance with their sliding fee schedule. This fee schedule shall be consistent with current federal guidelines. This fee schedule must be published and made available to the public. If charging fees, the Contractor must have a fee discount policy, sliding fee schedule, and sliding fee eligibility applications. The Contractor must track fees charged and paid by clients. The Contractor must have a fee discount policy that includes client fee caps, including: 1.15.3.1 Clear responsibility for annually evaluating clients to establish individual fees and caps. 1.15.3.2 Tracking of Part A charges or medical expenses inclusive of enrollment fees, deductibles, and co-payments. 1.15.3.3 A process for alerting the billing system that client has reached cap and no further charges will be charged for the remainder of the year. 1.15.3.4 Documentation of policies, fees, and implementation, including evidence that staff understand those policies and procedures. 1.15.3.5 Contractor must have a process for charging, obtaining, and documenting client charges through a medical practice information system, manual or electronically. The chart below must be followed when developing the fee schedule. SERIAL 13126-RFP Fees For Service Client Income Less than or equal to 100% of the No fees or charges to be imposed official poverty line Greater than 100%, but not exceeding Fees and charges for any calendar year may not 200%, of the official poverty line exceed 5% of the client’s annual gross income Greater than 200%, but not exceeding Fees and charges for any calendar year may not 300%, of the official poverty line exceed 7% of client’s annual gross income Greater than 300% of the official Fees and charges for any calendar year may not poverty line exceed 10% of client’s annual gross income 1.16 QUALITY MANAGEMENT: 1.16.1 The Contractor will participate in the Quality Management program as detailed in the current Ryan White Part A Program Policies and Procedures Manual. (http://www.maricopa.gov/publichealth/Services/RyanWhite/publications.aspx) (See Exhibit2 Ryan White Part A Program Policies and Procedures). 1.16.2 The Contractor will utilize and adhere to the most current Standards of Care as developed by the Phoenix Eligible Metropolitan Area Planning Council. 1.16.3 The Contractor will develop and implement an agency-specific quality management plan for Ryan White Part A-funded services. The Contractor will conduct Quality Improvement projects at the agency level utilizing the Plan-Do-Check-Act (PDCA) model. 1.16.4 The Contractor will participate in cross-cutting Quality Improvement projects and report data per the timeline established with the County. Additionally, the Contractor will report quality outcome measures established by the County per the reporting schedule. 1.16.5 The Contractor will participate in the Quality Management activities of the Clinical Quality Management Committee as requested by the County. 1.16.6 The Contractor will conduct and provide documentation of quality assurance and improvement activities, including maintenance of client satisfaction surveys and other mechanisms as designated by the County. 1.16.7 The Contractor will maintain a comprehensive unduplicated client level database of all eligible clients served as well as demographic and service measures required and submit this information in the format and frequency as requested by the County. The County will make available to the Contractor software for the collection of this information (CAREWare). 1.16.8 The Contractor will maintain consent to serve forms signed by the clients to gain permission to report their data to County, State and Federal authorized entities and to view their records as a part of site visits and quality management review activities. 1.16.9 The Contractor will participate in Quality Management trainings sponsored by the County which are deemed mandatory. The Contractor understands that non-participation in these types of activities may result in non-compliance with the Standards of Care as mandated by the Ryan White Act. Further, such non-participation in Quality Management trainings could result in prompting a performance monitoring site visit. SERIAL 13126-RFP 1.17 REPORTING REQUIRMENTS: 1.17.1 The Contractor agrees to submit monthly invoices as defined in the Invoice and Payments section. 1.17.2 The Contractor agrees to submit any administrative, programmatic, quality and/or fiscal reports requested and at the due date defined by the Administrative Agent. 1.17.3 The Contractor agrees to comply with and submit annual and semi-annual client-level and provider-level data as required by HRSA by the due date(s) defined by the Administrative Agent. 1.17.4 The Contractor agrees to comply with ARS § 36-621, reporting contagious diseases. Any employee, subcontractor or representative of the Contractor providing services under this contract shall follow the requirements of this law. Specifically, a person who learns that a contagious, epidemic or infectious disease exists shall immediately make a written report of the particulars to the appropriate board of health or health department. The report shall include names and residences of persons afflicted with the disease. If the person reporting is the attending physician he shall report on the condition of the person afflicted and the status of the disease at least twice each week. 1.18 PROGRAM MARKETING INITIATIVES: 1.18.1 When issuing statements, press releases and/or Internet-based or printed documents describing projects, programs and/or services funded in whole or in part with Ryan White Part A funds, the Contractor shall clearly reference the funding source as the federal Department of Health and Human Services, Health Resources and Services Administration, the Ryan White HIV/AIDS Treatment Extension Act of 2009 (or current authorized or reauthorized name of Act), and Maricopa County Ryan White Part A Program. Such references to funding source must be of sufficient size to be clear and legible. 1.18.2 Contractor is responsible for advertising Ryan White Part A-funded services. Such advertisement is to promote/incorporate the following components: Services available, venues/locations, and hours of operation. The content of any and all advertising for these services must be in a format allowed by Local, State and Federal regulations and shall contain the funding language referenced in this contract section. 1.18.3 Contractor is responsible to ensure that all appropriate program descriptions, including hours and locations, and any changes related to these services are disseminated to the community and other Ryan White providers to ensure that clients have access to care. The Contractor shall be able to document and explain this communication process to the Administrative Agent upon request. 1.19 OTHER REQUIREMENTS: 1.19.1 Contractor shall comply with all policies and procedures as defined in the current Ryan White Part A Policies and Procedures Manual. 1.19.2 Contractor will maintain discrete client files for all individuals served and will secure the necessary releases of information to allow for review of all pertinent client information by employees of County and/or their designated representatives. 1.19.3 Contractor shall respond to all requests for information and documentation solicited by County when they are submitted in writing no later than 72 hours of receipt of request. 1.19.4 Contractor shall participate with a standardized anonymous Consumer Satisfaction Survey issued to all program participants, at least once during the contract year. The survey and procedure is included in the Ryan White Part A Program Policies and Procedures Manual. Refer to http://www.ryanwhiteparta.com SERIAL 13126-RFP 1.19.5 Contractor’s service locations shall be accessible by public transportation. If service locations are not accessible by public transportation, the Contractor shall have policies and procedures in place that describe how it will provide transportation assistance to clients. 1.19.6 Contractors providing Medicaid eligible services shall be certified to receive Medicaid payments, or receive a waiver from the U.S. Secretary of Health and Human Services. The Contractor shall document efforts to receive certification or waiver, and when certified, maintain proof of certification and file of contracts with Medicaid insurance companies. 1.20 SAFEGUARDING OF CLIENT INFORMATION: The use or disclosure by any party of any information concerning an eligible individual served under this Contract is directly limited to the performance of this Contract. 1.21 NON-DISCRIMINATION: The Contractor, in connection with any service or other activity under this Contract, shall not in any way discriminate against any patient on the grounds of race, color, religion, sex, national origin, age, or handicap. The Contractor shall include a clause to this effect in all Subcontracts inuring to the benefit of the Contractor or County. 1.22 EQUAL EMPLOYMENT OPPORTUNITY: 1.22.1 The Contractor will not discriminate against any employee or applicant for employment because of race, age, handicap, color, religion, sex, or national origin. The Contractor will take affirmative action to insure that applicants are employed and that employees are treated during employment without regard to their race, age, handicap, color, religion, sex, or national origin. Such action shall include, but not be limited to the following: employment, upgrading, demotion or transfer, recruitment or recruitment advertising, lay-off or termination, rates of pay or other forms of compensation, and selection for training, including apprenticeship. The Contractor shall to the extent such provisions apply, comply with Title VI and VII of the Federal Civil Rights Act; the Federal Rehabilitation Act; the Age Discrimination in Employment Act; the Immigration Reform and Control Act of 1986 (IRCA) and Arizona Executive Order 99.-4 which mandates that all persons shall have equal access to employment opportunities. The Contractor shall also comply with all applicable provisions of the Americans with Disabilities Act of 1990. 1.22.2 The Contractor will operate under this agreement so that no person otherwise qualified is denied employment or other benefits on the grounds of race, color, sex, religion, national origin, ancestry, age physical or mental disability or sexual orientation except where a particular occupation or position reasonably requires consideration of these attributes as an essential qualification for the position. 1.23 CULTURAL COMPETENCY: 1.23.1 The Contractor shall meet and comply with applicable standards of the federal Culturally and Linguistically Appropriate Services (CLAS) standards The Contractor shall develop and implement organizational policies that comply with these standards. 1.23.2 The Contractor shall recognize linguistic subgroups and provide assistance in overcoming language barriers by the appropriate inclusion of American Sign Language and languages of clients accessing care. 1.24 RYAN WHITE CAREWARE DATA BASE: 1.24.1 RWPA requires the installation and utilization of HRSA-supplied Ryan White CAREWare software. CAREWare is used for client level data reporting and monthly SERIAL 13126-RFP billing reports, demographic reports, and various custom reporting. The Contractor agrees to install, collect, and report all data requested by the RWPA via RYAN WHITE CAREWare within 60 days of request by the RWPA. The Contractor agrees to participate in technical assistance training and/or informational presentations for CAREWare at various times scheduled during the contract year. 1.24.2 The Contractor is responsible for coordinating the installation of the CAREWare software with their internal information technology staff. CAREWare software is developed by HRSA and requires no licensing fees. The Contractor will be responsible for the cost of Virtual Provider Network (VPN) cards for each user within their organization. 1.24.3 The Ryan White Part A office will provide technical assistance to eligible applicants for the implementation, configuration and end user support for the CAREWare database. In addition, technical assistance is made available to eligible applicants to integrate CAREWare with proprietary in-house billing systems on an as needed basis to minimize data entry efforts needed to report client level demographic and service related data. 1.25 IMPROPRIETIES AND FRAUD: 1.25.1 The contractor shall notify the Ryan White Part A Program in writing of any actual or suspected incidences of improprieties involving the expenditure of CARE Act funds or delivery of services. This will include when potential or current clients receive services, or attempt to receive services, for which they are ineligible. Notification is also required whenever acts of indiscretion are committed by employees that may be unlawful or in violation of this contract. Notification to the Ryan White Part A Program shall occur in writing within 24 hours of detection. 1.25.2 The Federal Department of HHS Inspector General maintains a toll-free hotline for receiving information concerning fraud, waste, or abuse under grants and cooperative agreements. Such reports are kept confidential and callers may decline to give their names if they choose to remain anonymous. Office of Inspector General TIPS HOTLINE P. O. Box 23489 Washington, D. C. 20026 Telephone: 1-800-447-8477 (1-880-HHS-TIPS) 1.25.3 The Contractor shall be responsible for any loss of funds due to mismanagement, misuse, and/or theft of such funds by agents, servants and/or employees of the Contractor. 1.26 ADHERENCE TO RYAN WHITE PART A POLICIES: 1.26.1 Contractor shall adhere to all Ryan White Part A Program Policies. Such policies are referenced in the Ryan White Part A Program Policies and Procedures Manual (See Exhibit 2 http://www.ryanwhiteparta.com 1.27 REFERRAL RELATIONSHIPS: 1.27.1 Contractors must have documented evidence to substantiate referral relationships on an ongoing basis consistent with HRSA guidance regarding “Maintaining Appropriate Referral Relationships” available from the RWPA upon request. 1.27.2 The Contractor shall have letters of agreement and Memorandums of Understanding (MOUs) to document referral relationships with key points of entry. Key points of entry include: • Emergency rooms • Substance abuse and mental health treatment programs SERIAL 13126-RFP • Detox(ification) centers • Detention facilities • Sexually Transmitted Disease (STD) Clinics • Homeless shelters • HIV counseling and testing sites Additional points of entry: • Public health departments • Health care points of entry specified by eligible areas • Federally Qualified Healthcare Centers (FQHCs) • Entities such as Ryan White Part C and D grantees 1.28 POLICY ON CONFIDENTIALITY: 1.28.1 The Contractor understands and agrees that this Contract is subject to all State and Federal laws protecting client confidentiality of medical, behavioral health and drug treatment information. 1.28.2 The Contractor shall establish and maintain written procedures and controls that ensure the confidentiality of client medical information and records. 1.28.3 The Contractor shall maintain and document employee and direct service provider training on their organization’s policies and procedures related to client confidentiality. 1.28.4 In accordance with Section 318 (e)(5) of the Public Health Service Act [42 U.S.C. 247c(e)(5)], no information obtained in connection with the examination, care or services provided to any individual under any program which is being carried out with Federal monies shall, without such individual’s consent, be disclosed except as may be necessary to provide services to such individual or as may be required by laws of the State of Arizona or its political subdivisions. Information derived from any such program may be disclosed (a) in summary, statistical, or other form, or (b) for clinical research purposes, but only if the identity of the individuals diagnosed or provided care under such program is not disclosed. The Contractor shall comply with the provisions of A.R.S. § 36-663 concerning HIV-related testing; restrictions; exceptions and A.R.S. § 36-664 concerning confidentiality; exceptions, in providing services under this Contract. 1.28.5 Confidential communicable disease related information may only be disclosed as permitted by law, and only consistent with the current Ryan White Part A Program Policies and Procedures Manual (See Exhibit 2 http://www.ryanwhiteparta.com 1.29 EQUIPMENT: 1.29.1 All equipment and products purchased with grant funds should be American-made. 1.29.2 The title to any and all equipment acquired through the expenditure of funds received from County shall remain that of the Department of Health and Human Services, Health Resources and Services Administration. County must specifically authorize the acquisition of any such equipment in advance. Upon termination of this Contract, County may determine the disposition of all such equipment. 1.29.3 The Contractor agrees to exercise reasonable control over all equipment purchased with capital outlay expense Contract funds. All equipment lost, stolen, rendered un-usable, or no longer required for program operation must be reported immediately to County for disposition instructions. The Contractor shall report the physical inventory of all equipment purchased with contract funds within sixty (60) days of receipt of such equipment. SERIAL 13126-RFP NARRATIVE Executive Summary The Mission of the Phoenix Indian Medical Center is to offer quality health care that is uniquely suited to American Indians and Alaskan Natives (AI/AN) and to be the health home for AI/ANs. The Phoenix Indian Medical Center (PIMC) is a Joint Commission-accredited urban hospital and ambulatory care center. PIMC is the largest hospital component of the Phoenix Area Indian Health Service (IHS), with a staff of over one thousand. In addition to primary care services for central Arizona, it serves as a referral and specialty center for a tri-state area for IHS with a catchment area of over 350,000 AI/ANs. PIMC provides a comprehensive range of services including anesthesiology, pediatrics, internal medicine, surgery, obstetrics and gynecology, family practice, emergency medicine, ophthalmology, optometry, podiatry, pathology and clinical laboratory medicine, radiology, psychiatry, psychology, physical therapy, and dental services. Subspecialty services include endocrinology, oncology, HIV management, ENT, and others. The population served has a high rate of co-morbid conditions including Alcohol and Drug Abuse/Dependence, obesity, and diabetes. The Medical Center relies on AHCCCS, Medicare, and private insurance billing and collections for almost 60% of its operating budget, and the rest is from annual congressional appropriations. Introduction The Phoenix metropolitan area has one of the largest and most rapidly growing American Indian and Alaska Native (AI/AN) populations of any metropolitan area in the United States. As with all people, AI/AN people have been touched by the Human Immunodeficiency Virus (HIV) epidemic. Nationally, AI/AN populations rank third, behind Black and Hispanic populations, in HIV infection rate by ethnicity. In response to this need, the Planning Council and the Phoenix Eligible Metropolitan Area (EMA) Ryan White Title 1 Grantee has excelled and even gained national recognition as one of the most progressive bodies in seeking inclusion, gathering data, and allocating resources to better address the needs of HIV infected individuals among this unique population The following narrative is provided to communicate how the Phoenix Indian Medical Center proposes to continue to work with the Phoenix Ryan White Title 1 grantee via the SERIAL13126-RFP to help address the service needs of AI/AN people infected with HIV who know their HIV status and provide them with Primary Medical Care services in an culturally appropriate IHS setting. In concert with the Phoenix Ryan White Title 1 grantee, PIMC seeks to help eliminate disparities in access and services among this important, diverse and historically underserved community. As a service provider for HIV services to the largest proportion of AI/AN people of any provider in the Phoenix EMA, we feel that improving delivery of core services will increase the proportion of AI/AN people in care who are receiving and appropriately adhering to life-saving therapy. We are able to deliver culturally-sensitive care and have access to a full range of interpreter services and/or traditional practitioners, as needed. Early intervention integrating medical, behavioral, and traditional Native American healing concepts are an integral part of the program. Services will include, but are not limited to: • Diagnostic and therapeutic care across the continuum of HIV disease • Early intervention and risk assessment • Prescribing and managing medication therapy to include adherence issues. This will include access to antiretroviral and other drug therapies, including prophylaxis and treatment of opportunistic infections and combination antiretroviral therapies. • Education and counseling on health issues • Continued care and management of chronic conditions • Referral to and provision of HIV-related specialty care • Diagnostic testing- laboratory and radiology • Mental Health and Substance abuse treatment and referral • HIV and STD Prevention • HIV testing and counseling • Technical assistance, provider training and replication to other IHS and tribal care settings. • Expert consultation via IHS HIV Telehealth Collaborative • Community outreach and education • Provider training in collaboration with AIDS Education and Training Center (AETC) SERIAL 13126-RFP The guide for many of these services will be the Standards of Care as established by the Phoenix Ryan White Title 1 and the Planning Council Primary HIV Medical Care which are consistent with Public Health Service guidelines. Systems such as the electronic health record and HIV Management System have been deployed at PIMC to help track, guide, remind, and improve care. A key aspect of the clinic at PIMC is involvement of a pharmacist with skills and knowledge in not only safe pharmacy practice, but in attaining access to medications through AHCCCS, private insurance and through the Ryan White AIDS Drug Assistance Program (ADAP). As mentioned earlier, PIMC represents a major service provider for AI/AN people in the Phoenix EMA. As such, it is a key point of entry to the health care system for AI/AN people living with HIV. Work Statement To meet the service plan as described above, we will provide comprehensive Outpatient Ambulatory Medical Care Services. Professional diagnostic and therapeutic services shall be provided by a licensed physician, a pharmacist, clinical nurse specialists (RN/Case managers), a health specialist and a psychiatrist. The medical provider and pharmacist are credentialed through the American Academy of HIV Medicine. PIMC will provide primary care services in a team-based model that focuses on evaluation; management and treatment for HIV infected individuals in accordance with standards of care. Primary Medical Care Services are per visit and is based on the current AHCCCS rate for one visit. Laboratory and radiology services are billed on a cost basis. Performance will be measured through medical record review for attainment of the Standards of Care. This will be facilitated by use of the electronic health record, HIV Management System, CADR reports and program review by the grantee. Schedule of deliverables Implementation of the work plan will begin immediately. Funding will be used to assure engagement of clients and to expand services as required by patient care volume through the use of both employees and contractor staffing (if needed) models per established human resource processes at PIMC. Information systems and documentation procedures are largely in place, with the implementation of CAREware. HIV Care and Treatment Recognizing a growing need to respond to people with HIV, PIMC established of the HIV Center of Excellence (HIV COE) in the fall of 1996. The goal of the HIVCOE is to provide the highest quality of culturally competent HIV services for AI/ANs. This includes HIV medical treatment, behavioral health services and HIV prevention. The mission of the HIV COE is to increase services, access, disease management and patient care for AI/ANs living with HIV through a culturally competent and comprehensive HIV health care delivery system. The HIV COE program is proud to be seen as a leader in health care management for AI/AN people with HIV/AIDS. The HIV COE has been able to develop a model health delivery system that provides its clients with a wide range of medical and support services that respect and attempt to blend traditional healing beliefs with the latest advances in medical technology. Today the HIV COE has a dedicated HIV specialized physician, a part-time (0.1 FTE) HIV specialized Physician, pharmacist director (Acting), two nurse specialists/HIV case managers, one health specialist and one Psychiatrist. Patients may receive medical outpatient care, adherence clinic, mental health, substance abuse, laboratory, radiology, transportation, and medical specialty services on-site at PIMC. Our Quality Management program includes the HIV Management System reports and internal quality reports base on the HIVQUAL model, as well as on site review for quality of care by the Ryan White Services team. Our electronic computerized HIV Management System assures reliability in patient care and follow-up and to create quality performance reporting upon demand. Marketing Plan The goal is to implement a comprehensive marketing plan involving community planning efforts and outreach programs to identify and enroll eligible participants throughout the Phoenix Service Unit. The development and implementation of the PIMC policy and procedures will assure compliance with all requirements of the Ryan White CARE Act, including determination of the patient’s medical, income and residence requirements; confidentiality provisions and audit/accounting standards and controls. The marketing of the HIV COE Program will be done through networking and attendance at local and statewide meetings or conferences, a PIMC HIV COE brochure and through the PIMC HIV COE Website. 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