HomeMy WebLinkAboutItem #06b Approval of Fire-Based EMS Transport Services - Approval of Agreement with Intermedix for Medical Billing Services ocoee
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AGENDA ITEM COVER SHEET
Meeting Date: June 19, 2018
Item # b
Reviewed By:
Contact Name: Fire Chief John Miller Department Directoir
Contact Number: 407-905-3140 City Manager: / / //,
7'/i/
Subject: Fire-Based EMS Transport Services: /
b) Approval of Agreement with Intermedix for Medical Billing Servi es
Background Summary:
Currently, the Ocoee Fire Department (OFD) is part of a two-tiered system for handling EMS patient care and
transports. The City of Ocoee has a contract with American Medical Response (AMR) to transport patients and
bill them for conveyance to the hospital. Over the last several years, the City has evaluated the feasibility of
providing Fire-Based EMS transport, in the interest of Ocoee's citizens and for continuity of patient care. The
Department would like to move forward with transport in January.
Upon adoption of a Rate Resolution (item a), OFD needs to institute a method for collecting fees for transport. It
is proposed that the City enter into an Agreement with American Data Processing, DBA Intermedix, which will
allow OFD to collect revenue to offset the expense of providing such patient transport, and bill for services
rendered. Intermedix has offered to extend the terms of their Agreement with the City of Tamarac, Florida
(Tamarac), to Ocoee (piggyback).
Issue:
Should the Honorable Mayor and City Commission approve entrance into an Agreement with Intermedix,
utilizing the terms of their Agreement with Tamarac, to develop a billing process and to collect funds for
provision of EMS transports?
Recommendations:
Staff recommends approval of the Agreement with Intermedix for medical billing services, utilizing the terms of
their Agreement with Tamarac.
Attachments:
- City of Tamarac, FL Resolution No. R-2016-83 (Agreement with Intermedix)
- City of Tamarac, FL Resolution No. R-2016-121 (Amendment No. 1 to Agreement with Intermedix)
- Proposed Agreement Between the City of Ocoee Fire Department and Intermedix to Piggyback
Agreement with the City of Tamarac, Florida
Financial Impact:
Initially, there will be no financial impact to OFD or the City of Ocoee by contracting with Intermedix to process
billing for EMS transports conducted by the Department. The financial impact will only apply to funds received
subsequent to the billing process. Intermedix charges monthly fees for medical billing services as set forth on
page 2 of the RFP (4.0% of Net Collections, and a flat rate per month of $1,000 for Medicaid accounts, plus
fifteen percent (15%) of Client's revenues for the Florida EMS PEMT-CPE and IGT consulting services, plus
any amounts set forth in any Exhibit.
Type of Item: (please mark with an `x')
Public Hearing For Clerk's Dept Use:
Ordinance First Reading X Consent Agenda
Ordinance Second Reading Public Hearing
Resolution Regular Agenda
X Commission Approval
Discussion&Direction
Original Document/Contract Attached for Execution by City Clerk
Original Document/Contract Held by Department for Execution
Reviewed by City Attorney N/A
Reviewed by Finance Dept. \(a„(ca N/A
Reviewed by 0 N/A
2
AGREEMENT BETWEEN
THE CITY OF OCOEE
FIRE DEPARTMENT
AND
ADVANCED DATA PROCESSING,INC.
FOR MEDICAL BILLING SERVICES
This Agreement is made this 19th day of June, 2018, by and between The City of Ocoee, a municipal corporation
under the laws of the State of Florida, for its Fire Department(hereinafter called"Client"),with principal location at
563 S. Bluford Avenue, Ocoee, FL 34761, and Advanced Data Processing, Inc., dba Intermedix, with principal
location at 6451 N. Federal Hwy., Suite 1000, Fort Lauderdale, FL 33308 (hereinafter called "Intermedix"), for
Ambulance Billing Professional Services.
WHEREAS, Client provides emergency and non-emergency medical services, including ambulance
transport("EMS"), for residents and visitors in its jurisdiction,and charges for such services;and
WHEREAS, Intermedix provides billing, collection and related consulting services and equipment for
localities and other providers of EMS and represents that it has the background and expertise necessary to provide
the automated ambulance billing, insurance services and collection system required by Client, and provides
consulting services for the enrolment in the Florida EMS PEMT (Public Emergency Medical Transports) Medicaid
program, and provide ongoing consulting/costing services for both the Florida CPE (Certified Public Expenditures)
PEMT and the proposed IGT(Intergovernmental Transfer)PEMT which includes Medicaid managed care transports
revenue programs; and
WHEREAS; Intermedix provides services substantially similar to those required by Client to the City of
Tamarac,FL("Tamarac City"),pursuant to an Agreement entitled Agreement for Medical Services and Amendment
No. 1 to Agreement for Medical Billing Services,collectively("Tamarac City Agreement"),resulting from Tamarac
City's Request for Proposal#16-14-R Medical Billing Services("Tamarac City Agreement")incorporated herein by
reference as if fully set forth;and
WHEREAS; Tamarac City and Intermedix have consented to extend the terms of its Tamarac City
Agreement with Intermedix to Client and Client has elected to purchase off the Tamarac City Agreement attached
hereto and incorporated in this Agreement as Exhibit B(Tamarac City Agreement).
NOW THEREFORE,the parties to this Agreement agree to the following terms and conditions:
1. Incorporation by Reference. Tamarac City's Request for Proposal #16-14-R ("RFP") and
Intermedix's proposal response to the RFP, dated June 14, 2016 ("Intermedix Commitments") are incorporated
herein by reference and as if fully set forth.
2. Scope of Services. Intermedix shall perform and carry out Services as specifically described in
City of Tamarac Agreement as specifically described in Exhibit B.
3. Duration of Agreement. The Term of this Agreement for medical billing services shall
commence on this Agreement's Effective Date, January 1, 2019, and follow the Tamarac City Term through
September 30, (the "Initial Term") and shall renew for two (2) additional two (2) renewal options ("Renewal
Terms", collectively, the Initial Term together with any Renewal Terms are the "Term"), unless either party
provides the other party with written notice of termination of this Agreement as provided for in Section 26
(Termination for Cause and Default)and Section 27(Termination for Convenience of City)of the RFP.The Term of
the Florida EMS PEMT-CPE and IGT consulting services shall commence on this Agreement's Effective Date and
follow the term of Amendment No. 1 to the Tamarac City Agreement for three (3) years. All terms and conditions
hereof shall remain in full force and effect during the Term unless this Agreement is amended in writing executed by
each party hereto.
4. Compensation and Methods of Payment. Client will pay Intermedix monthly fees for medical
billing services as set forth in page 2 of the RFP (4.0%) of Net Collections and a flat rate per month of$1,000 per
Page 1 of 10
Medicaid account), plus fifteen percent (15%) of Client's revenues for the Florida EMS PEMT-CPE and IGT
consulting services, plus any amounts set forth in any Exhibit. The $1,000 Medicaid rate will not be activated until
January 1,2019.
5. Notifications. Any notice directed to the parties' legal rights and remedies under this Agreement
will be provided in writing and will reference this Agreement. Such notices will be deemed given if sent by: (i)
facsimile, when complete transmission to the recipient is confirmed by the sender's facsimile machine; (ii)postage
prepaid registered or certified U.S. Post mail, then five (5) working days after sending; or(iii) commercial courier,
then at the time of receipt confirmed by the recipient to the courier on delivery. All notices to a party will be sent to
its address set forth below, or to such other address as may be designated by that party by notice to the other party in
accordance with this Section:
To Client: City of Ocoee, Fire Department
563 S. Bluford Avenue
Ocoee,FL 34761
Attn: John Miller,Fire Chief
Tel:407-905-3140
Fax:407-905-3129
To Intermedix: Intermedix Corporation
6451 N.Federal Hwy., Suite 1000
Fort Lauderdale, FL 33308
Attn: Brad Williams, SVP
Tel: 954-308-8700
Fax: 954-308-8725
6. Confidentiality and HIPAA Business Associate Obligations. Both parties agree to execute a
Business Associate Agreement and agree to the obligations set forth in the BA Agreement attached hereto as Exhibit
A(the"BA Agreement).
IN WITNESS WHEREOF, and intending to be legally bound by this Agreement, City and Intermedix by
their duly authorized officers, has caused these documents to be properly executed the day and year first above
written.
Intermedix: Client:
ADVANCED DATA PROCESSING,INC.,A
SUBSIDIARY OF INTERMEDIX
CORPORATION,a DELAWARE CORPORATION
By:
Name:
Title:
Date:
Page 2 of 10
CITY OF OCOEE, a Florida municipal
corporation
By:
RUSTY JOHNSON
Mayor
Attest:
Melanie Sibbitt, City Clerk
FOR USE AND RELIANCE ONLY BY
THE CITY OF OCOEE, FLORIDA;
APPROVED AS TO FORM AND
LEGALITY this _ day of ,
2018.
SHUFFIELD LOWMAN & WILSON, P.A.
By:
City Attorney
APPROVED BY THE OCOEE CITY
COMMISSION AT A MEETING HELD
ON , 2018, UNDER
AGENDA ITEM NO. .
Page 3 of 10
Exhibit A
Business Associate Agreement
This Business Associate Agreement ("BA Agreement") supplements and is made part of the Underlying
Agreement(as defined below).
This BA Agreement is entered into between The City of Ocoee of Ocoee for its Fire Department.
("Covered Entity") and Advanced Data Processing, Inc., dba Intermedix ("Business Associate"), effective as of the
Effective Date of the Underlying Agreement.
WHEREAS, Covered Entity and Business Associate have entered into, or plan to enter into an Agreement
for Ambulance Billing and Related Professional Services, as of the Effective Date, or other documented
arrangement (the "Underlying Agreement"), pursuant to which Business Associate may provide services for
Covered Entity that require Business Associate to access, create and use Protected Health Information ("PHI")that
is confidential under state and/or federal law; and
WHEREAS, Covered Entity and Business Associate intend to protect the privacy and provide for the
security of PHI disclosed by Covered Entity to Business Associate, or collected or created by Business Associate
pursuant to the Underlying Agreement, in compliance with the Health Insurance Portability and Accountability Act
of 1996, Public Law 104-191 ("HIPAA"), and the regulations promulgated there under, including, without
limitation, the regulations codified at 45 CFR Parts 160 and 164 ("HIPAA Regulations"); the Health Information
Technology for Economic and Clinical Health Act, as incorporated in the American Recovery and Reinvestment Act
of 2009, and its implementing regulations and guidance issued by the Secretary of the Department of Health and
Human Services(the"Secretary") (the"HITECH Act"); and other applicable state and federal laws, all as amended
from time to time, including as amended by the Final Rule issued by the Secretary on January 17, 2013 titled
"Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules under the Health
Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act;
Other Modifications to the HIPAA Rules";and
WHEREAS, the HIPAA Regulations require Covered Entity to enter into an agreement with Business
Associate meeting certain requirements with respect to the Use and Disclosure of PHI, which are met by this
Agreement.
NOW, THEREFORE, in consideration of the mutual promises contained herein and the exchange of
information pursuant to this Agreement,the parties agree as follows:
1. Definitions.
Capitalized terms used herein without definition shall have the meanings ascribed to them in the HIPAA
Regulations or the HITECH Act, as applicable unless otherwise defined herein.
2. Obligations of Business Associate.
a. Permitted Uses and Disclosures. Business Associate shall only Use or Disclose PHI for
the purposes of(i) performing Business Associate's obligations under the Underlying Agreement and as permitted
by this Agreement; or (ii) as permitted or Required By Law; or (iii) as otherwise permitted by this Agreement.
Business Associate shall not Use or further Disclose PHI other than as permitted or required by this Agreement or as
Required By Law. Further, Business Associate shall not Use or Disclose PHI in any manner that would constitute a
violation of the HIPAA Regulations or the HITECH Act if so used by Covered Entity, except that Business
Associate may Use PHI (i) for the proper management and administration of Business Associate; and (ii) to carry
out the legal responsibilities of Business Associate. Business Associate may Disclose PHI for the proper
management and administration of Business Associate,to carry out its legal responsibilities or for payment purposes
as specified in 45 CFR § 164.506(c)(1) and (3), including but not limited to Disclosure to a business associate on
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behalf of a covered entity or health care provider for payment purposes of such covered entity or health care
provider, with the expectation that such parties will provide reciprocal assistance to Covered Entity, provided that
with respect to any such Disclosure either: (i) the Disclosure is Required By Law; or (ii) for permitted Disclosures
when Required By Law, Business Associate shall obtain a written agreement from the person to whom the PHI is to
be Disclosed that such person will hold the PHI in confidence and will not use and further disclose such PHI except
as Required By Law and for the purpose(s) for which it was Disclosed by Business Associate to such person, and
that such person will notify Business Associate of any instances of which it is aware in which the confidentiality of
the PHI has been breached.
b. Creation and Use of De-Identified Data. Business Associate may de-identify any and all
PHI, provided that any process or mechanism used to de-identify the data meets the requirements of 45 C.F.R
164.514(a)-(b). Business Associate may use or disclose (and permit others to use or disclose) such de-identified
data on a perpetual unrestricted basis, but in no case shall Business Associate attempt to run or develop any keys,
codes or algorithms that may be used to re-identify the data.
c. Appropriate Safeguards. Business Associate shall implement administrative, physical
and technical safeguards that(i)reasonably and appropriately protect the confidentiality, integrity and availability of
electronic PHI that it creates, receives, maintains or transmits on behalf of Covered Entity; and (ii)prevent the Use
or Disclosure of PHI other than as contemplated by the Underlying Agreement and this Agreement.
d. Compliance with Security Provisions. Business Associate shall: (i) implement and
maintain administrative safeguards as required by 45 CFR § 164.308, physical safeguards as required by 45 CFR
§ 164.310 and technical safeguards as required by 45 CFR § 164.312; (ii) implement and document reasonable and
appropriate policies and procedures as required by 45 CFR § 164.316; and (iii) be in compliance with all
requirements of the HITECH Act related to security and applicable as if Business Associate were a"covered entity,"
as such term is defined in HIPAA.
e. Compliance with Privacy Provisions. Business Associate shall only Use and Disclose
PHI in compliance with each applicable requirement of 45 CFR§ 164.504(e). Business Associate shall comply with
all requirements of the HITECH Act related to privacy and applicable as if Business Associate were a "covered
entity," as such term is defined in HIPAA. To the extent Business Associate is to carry out one or more of Covered
Entity's obligation(s) under Subpart E of 45 CFR Part 164, Business Associate shall comply with the requirements
of Subpart E that apply to Covered Entity in the performance of such obligation(s).
f. Duty to Mitigate. Business Associate agrees to mitigate, to the extent practicable and
mandated by law, any harmful effect that is known to Business Associate of a Use or Disclosure of PHI by Business
Associate in violation of the requirements of this Agreement.
g. Encryption. To facilitate Business Associate's compliance with this Agreement and to
assure adequate data security, Covered Entity agrees that all PHI provided or transmitted to Business Associate
pursuant to the Underlying Agreement shall be provided or transmitted in a manner which renders such PHI
unusable, unreadable or indecipherable to unauthorized persons, through the use of a technology or methodology
specified by the Secretary in the guidance issued under section 13402(h)(2) of the HITECH Act. Covered Entity
acknowledges that failure to do so could contribute to or permit a Breach requiring patient notification under the
HITECH Act and further agrees that Business Associate shall have no liability for any Breach caused by such
failure.
3. Reporting.
a. Security Incidents and/or Unauthorized Use or Disclosure. Business Associate shall
report to Covered Entity a successful Security Incident or any Use and/or Disclosure of PHI other than as provided
for by this Agreement or permitted by applicable law within a reasonable time of becoming aware of such Security
Incident and/or unauthorized Use or Disclosure (but not later than ten (10) days thereafter), in accordance with the
notice provisions set forth herein. Business Associate shall take (i) prompt action to cure any such deficiencies as
reasonably requested by Covered Entity, and(ii)any action pertaining to such Security Incident and/or unauthorized
Use or Disclosure required by applicable federal and state laws and regulations. If such successful Security Incident
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or unauthorized Use or Disclosure results in a Breach as defined in the HITECH Act, then Covered Entity shall
comply with the requirements of Section 3.b below. The Parties acknowledge and agree that this Section constitutes
notice by Business Associate to Covered Entity of the ongoing existence and occurrence of attempted but
Unsuccessful Security Incidents as defined herein. "Unsuccessful Security Incidents" will include, but not be
limited to, pings and other broadcast attacks on Business Associate's firewall, port scans, unsuccessful log-on
attempts, denials of service and any combination of the above, so long as no such incident results in unauthorized
access,use or disclosure of PHI.
b. Breach of Unsecured PHI. The provisions of this Section 3.b are effective with respect to
the Discovery of a Breach of Unsecured PHI occurring on or after September 23, 2009. With respect to any
unauthorized acquisition, access, Use or Disclosure of Covered Entity's PHI by Business Associate, its agents or
subcontractors, Business Associate shall(i)investigate such unauthorized acquisition, access,Use or Disclosure;(ii)
determine whether such unauthorized acquisition, access, Use or Disclosure constitutes a reportable Breach under
the HITECH Act; and (iii) document and retain its findings under clauses (i) and (ii). If Business Associate
Discovers that a reportable Breach has occurred, Business Associate shall notify Covered Entity of such reportable
Breach in writing within thirty(30)days of the date Business Associate Discovers such Breach. Business Associate
shall be deemed to have discovered a Breach as of the first day that the Breach is either known to Business
Associate or any of its employees, officers or agents, other than the person who committed the Breach, or by
exercising reasonable diligence should have been known to Business Associate or any of its employees, officers or
agents, other than the person who committed the Breach. To the extent the information is available to Business
Associate, Business Associate's written notice shall include the information required by 45 CFR § 164.410(c).
Business Associate shall promptly supplement the written report with additional information regarding the Breach as
it obtains such information. Business Associate shall cooperate with Covered Entity in meeting Covered Entity's
obligations under the HITECH Act with respect to such Breach.
4. Business Associate's Agents. To the extent that Business Associate uses one or more
subcontractors or agents to provide services under the Underlying Agreement, and such subcontractors or agents
receive or have access to PHI, Business Associate shall sign an agreement with such subcontractors or agents
containing substantially the same provisions as this Agreement.
5. Rights of Individuals.
a. Access to PHI. Within ten (10) days of receipt of a request by Covered Entity, Business
Associate shall make PHI maintained in a Designated Record Set available to Covered Entity or, as directed by
Covered Entity,to an Individual to enable Covered Entity to fulfill its obligations under 45 CFR§ 164.524. Subject
to Section 5.b below, (i) in the event that any Individual requests access to PHI directly from Business Associate in
connection with a routine billing inquiry, Business Associate shall directly respond to such request in compliance
with 45 CFR § 164.524; and (ii) in the event such request appears to be for a purpose other than a routine billing
inquiry, Business Associate shall forward a copy of such request to Covered Entity and shall fully cooperate with
Covered Entity in responding to such request. In either case, a denial of access to requested PHI shall not be made
without the prior written consent of Covered Entity.
b. Access to Electronic Health Records. If Business Associate is deemed to use or maintain
an Electronic Health Record on behalf of Covered Entity with respect to PHI, then, to the extent an Individual has
the right to request a copy of the PHI maintained in such Electronic Health Record pursuant to 45 CFR § 164.524
and makes such a request to Business Associate, Business Associate shall provide such Individual with a copy of
the information contained in such Electronic Health Record in an electronic format and, if the Individual so chooses,
transmit such copy directly to an entity or person designated by the Individual. Business Associate may charge a fee
to the Individual for providing a copy of such information, but such fee may not exceed Business Associate's labor
costs in responding to the request for the copy. The provisions of 45 CFR§ 164.524, including the exceptions to the
requirement to provide a copy of PHI, shall otherwise apply and Business Associate shall comply therewith as if
Business Associate were the "covered entity," as such term is defined in HIPAA. At Covered Entity's request,
Business Associate shall provide Covered Entity with a copy of an Individual's PHI maintained in an Electronic
Health Record in an electronic format and in a time and manner designated by Covered Entity in order for Covered
Entity to comply with 45 CFR § 164.524,as amended by the HITECH Act.
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c. Amendment of PHI. Business Associate agrees to make any amendment(s) to PHI in a
Designated Record Set that Covered Entity directs or agrees to pursuant to 45 CFR § 164.526 at the request of
Covered Entity or an Individual, and in the time and manner designated by Covered Entity.
d. Accounting Rights. This Section 5.d is subject to Section 5.e below. Business Associate
shall make available to Covered Entity, in response to a request from an Individual, information required for an
accounting of disclosures of PHI with respect to the Individual, in accordance with 45 CFR§ 164.528, incorporating
exceptions to such accounting designated under such regulation. Such accounting is limited to disclosures that were
made in the six (6) years prior to the request and shall not include any disclosures that were made prior to the
compliance date of the HIPAA Regulations. Business Associate shall provide such information as is necessary to
provide an accounting within ten(10) days of Covered Entity's request. Such accounting must be provided without
cost to the Individual or to Covered Entity if it is the first accounting requested by an Individual within any twelve
(12) month period; however, a reasonable, cost-based fee may be charged for subsequent accountings if Business
Associate informs Covered Entity and Covered Entity informs the Individual in advance of the fee, and the
Individual is afforded an opportunity to withdraw or modify the request. Such accounting obligations shall survive
termination of this Agreement and shall continue as long as Business Associate maintains PHI.
e. Accounting of Disclosures of Electronic Health Records. The provisions of this Section
5.e shall be effective on the date specified in the HITECH Act. If Business Associate is deemed to use or maintain
an Electronic Health Record on behalf of Covered Entity, then, in addition to complying with the requirements set
forth in Section 5.d above, Business Associate shall maintain an accounting of any Disclosures made through such
Electronic Health Record for Treatment, Payment and Health Care Operations, as applicable. Such accounting shall
comply with the requirements of the HITECH Act. Upon request by Covered Entity, Business Associate shall
provide such accounting to Covered Entity in the time and manner specified by Covered Entity and in compliance
with the HITECH Act. Alternatively, if Covered Entity responds to an Individual's request for an accounting of
Disclosures made through an Electronic Health Record by providing the requesting Individual with a list of all
business associates acting on behalf of Covered Entity, then Business Associate shall provide such accounting
directly to the requesting Individual in the time and manner specified by the HITECH Act.
f. Agreement to Restrict Disclosure. If Covered Entity is required to comply with a
restriction on the Disclosure of PHI pursuant to Section 13405 of the HITECH Act,then Covered Entity shall,to the
extent necessary to comply with such restriction, provide written notice to Business Associate of the name of the
Individual requesting the restriction and the PHI affected thereby. Business Associate shall, upon receipt of such
notification, not Disclose the identified PHI to any health plan for the purposes of carrying out Payment or Health
Care Operations, except as otherwise required by law. Covered Entity shall also notify Business Associate of any
other restriction to the Use or Disclosure of PHI that Covered Entity has agreed to in accordance with 45 CFR §
164.522.
6. Remuneration and Marketing.
a. Remuneration for PHI. This Section 6.a shall be effective with respect to exchanges of
PHI occurring six (6) months after the date of the promulgation of final regulations implementing the provisions of
Section 13405(d)of the HITECH Act. On and after such date, Business Associate agrees that it shall not,directly or
indirectly, receive remuneration in exchange for any PHI of Covered Entity except as otherwise permitted by the
HITECH Act.
b. Limitations on Use of PHI for Marketing Purposes. Business Associate shall not Use or
Disclose PHI for the purpose of making a communication about a product or service that encourages recipients of
the communication to purchase or use the product or service, unless such communication: (1) complies with the
requirements of subparagraph (i), (ii) or (iii) of paragraph (1) of the definition of marketing contained in 45 CFR
§ 164.501, and (2) complies with the requirements of subparagraphs (A), (B) or (C) of Section 13406(a)(2) of the
HITECH Act,and implementing regulations or guidance that may be issued or amended from time to time. Covered
Entity agrees to assist Business Associate in determining if the foregoing requirements are met with respect to any
such marketing communication.
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7. Governmental Access to Records. Business Associate shall make its internal practices,books and
records relating to the Use and Disclosure of PHI available to the Secretary for purposes of determining Covered
Entity's compliance with the HIPAA Regulations and the HITECH Act. Except to the extent prohibited by law,
Business Associate agrees to notify Covered Entity of all requests served upon Business Associate for information
or documentation by or on behalf of the Secretary. Business Associate shall provide to Covered Entity a copy of
any PHI that Business Associate provides to the Secretary concurrently with providing such PHI to the Secretary.
8. Minimum Necessary. To the extent required by the HITECH Act, Business Associate shall limit
its Use,Disclosure or request of PHI to the Limited Data Set or, if needed,to the minimum necessary to accomplish
the intended Use, Disclosure or request, respectively. Effective on the date the Secretary issues guidance on what
constitutes "minimum necessary" for purposes of the HIPAA Regulations, Business Associate shall limit its Use,
Disclosure or request of PHI to only the minimum necessary as set forth in such guidance.
9. State Privacy Laws. Business Associate shall comply with state laws to extent that such state
privacy laws are not preempted by HIPAA or the HITECH Act.
10. Termination.
a. Breach by Business Associate. If Covered Entity knows of a pattern of activity or
practice of Business Associate that constitutes a material breach or violation of Business Associate's obligations
under this Agreement,then Covered Entity shall promptly notify Business Associate. With respect to such breach or
violation, Business Associate shall take reasonable steps to cure such breach or end such violation, if possible. If
such steps are either not possible or are unsuccessful, upon written notice to Business Associate, Covered Entity
may terminate its relationship with Business Associate.
b. Breach by Covered Entity. If Business Associate knows of a pattern of activity or
practice of Covered Entity that constitutes a material breach or violation of Covered Entity's obligations under this
Agreement,then Business Associate shall promptly notify Covered Entity. With respect to such breach or violation,
Covered Entity shall take reasonable steps to cure such breach or end such violation, if possible. If such steps are
either not possible or are unsuccessful, upon written notice to Covered Entity, Business Entity may terminate its
relationship with Covered Entity.
c. Effect of Termination. Upon termination of this Agreement for any reason, Business
Associate shall either return or destroy all PHI, as requested by Covered Entity,that Business Associate or its agents
or subcontractors still maintain in any form, and shall retain no copies of such PHI. If Covered Entity requests that
Business Associate return PHI, such PHI shall be returned in a mutually agreed upon format and timeframe. If
Business Associate reasonably determines that return or destruction is not feasible, Business Associate shall
continue to extend the protections of this Agreement to such PHI, and limit further uses and disclosures of such PHI
to those purposes that make the return or destruction of such PHI not feasible. If Business Associate is asked to
destroy the PHI, Business Associate shall destroy PHI in a manner that renders the PHI unusable, unreadable or
indecipherable to unauthorized persons as specified in the HITECH Act.
11. Amendment. The parties acknowledge that state and federal laws relating to data security and
privacy are rapidly evolving and that amendment of this Agreement may be required to ensure compliance with such
developments. The parties specifically agree to take such action as is necessary to implement any new or modified
standards or requirements of HIPAA, the HIPAA Regulations, the HITECH Act and other applicable laws relating
to the security or confidentiality of PHI. Upon the request of Covered Entity, Business Associate agrees to promptly
enter into negotiation concerning the terms of an amendment to this Agreement incorporating any such changes.
12. No Third Party Beneficiaries. Nothing express or implied in this Agreement is intended to confer,
nor shall anything herein confer,upon any person other than Covered Entity, Business Associate and their respective
successors or assigns,any rights,remedies,obligations or liabilities whatsoever.
13. Effect on Underlying Agreement. In the event of any conflict between this Agreement and the
Underlying Agreement,the terms of this Agreement shall control.
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14. Survival. The provisions of this Agreement shall survive the termination or expiration of the
Underlying Agreement.
15. Interpretation. This Agreement shall be interpreted as broadly as necessary to implement and
comply with HIPAA, the HIPAA Regulations and the HITECH Act. The parties agree that any ambiguity in this
Agreement shall be resolved in favor of a meaning that complies and is consistent with such laws.
16. Governing Law. This Agreement shall be construed in accordance with the laws of the State of
Florida.
17. Notices. All notices required or permitted under this Agreement shall be in writing and sent to the
other party as directed below or as otherwise directed by either party, from time to time, by written notice to the
other. All such notices shall be deemed validly given upon receipt of such notice by certified mail, postage prepaid,
facsimile transmission,e-mail or personal or courier delivery:
If to Covered Entity: City of Ocoee, Fire Department
563 S. Bluford Avenue
Ocoee, FL 34761
Attn: John Miller, Fire Chief
Tel: 407-905-3140
Fax:407-905-3129
Email:
If to Business Associate: Intermedix Corporation
6451 N.Federal Highway, Suite 1000
Ft. Lauderdale,FL 33308
Attn: Chief Compliance Officer
Telephone no: 954-308-8700
Facsimile no: 954-308-8725
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Exhibit B
Tamarac City Agreement
Page 10 of 10
TR12821
August 8, 2016
• Page 1
CITY OF TAMARAC, FLORIDA
RESOLUTION NO. R-2016 - 83
A RESOLUTION OF THE CITY COMMISSION OF THE CITY
OF TAMARAC, FLORIDA AUTHORIZING THE !
APPROPRIATE CITY OFFICIALS TO AWARD RFP 16-14R no
"MEDICAL BILLING SERVICES" AND TO EXECUTE AN 6 a
AGREEMENT WITH ADVANCED DATA PROCESSING, INC. m �', o
FOR A PERIOD FROM OCTOBER 1, 2016 THROUGH § o
SEPTEMBER 30, 2021, PROVIDING FOR TWO (2)TWO (2) . m LL Y
YEAR RENEWALS TO PROVIDE FOR THE y o a v
ADMINISTRATION, PROCESSING AND RECEIPT OF y , a a o t .
PAYMENTS ASSOCIATED WITH TRANSPORTING Z ;, co t z g (3
EMERGENCY MEDICAL SERVICE (EMS) PATIENTS ON •Z' it i 1 pit )
BEHALF OF THE CITY OF TAMARAC FIRE RESCUE $ r, ° Ks- �
DEPARTMENT; AUTHORIZING THE CITY MANAGER TO a� m C ` 2 w Ni
EXECUTE THE SUBSEQUENT TWO (2) TWO (2) YEAR 1 8 . 'o' 0
RENEWAL OPTIONS; PROVIDING FOR CONFLICTS; = m 2 § o t=;
PROVIDING FOR SEVERABILITY; AND PROVIDING FOR
AN EFFECTIVE DATE.
WHEREAS, Tamarac Fire Rescue is required to provide basic and
advanced life support services to the citizens and visitors of the City of Tamarac and
to properly invoice and collect fees from the patients who utilize these services;and
WHEREAS, Tamarac Fire Rescue transports an estimated 8,000 patients
per year, which generates an average of approximately $1.9 million in gross
revenue annually; and
WHEREAS,due to the complexity and accounting requirements of collecting
payment from patients,the City has elected to outsource medical billing services to
an experienced and dedicated medical billing agency; and
WHEREAS, On May 25, 2016, the City published a Request For Proposal
(RFP) #16-14R to obtain the services of a qualified firm to process all billing
services for EMS patients, a copy is attached hereto as Exhibit 1; and
TR12821
August 8, 2016
Page 2
WHEREAS, the RFP process was closed on June 14, 2016 and six (6)
proposals were received from six (6) firms; and
WHEREAS, an Evaluation Committee was selected to participate in the
I r evaluation of proposals for selection of a Medical Billing Service consisting of the
Assistant Fire Chief, Fire Division Chief, Financial Services Director, and Fire
Administrative Coordinator; and
-' WHEREAS, on June 23, 2016, the Evaluation Committee discussed the
proposals `strengths and weaknesses and evaluated each proposals based on
•
weighted criteria and scored each proposal firm; and
WHEREAS, a final evaluation matrix attached hereto as Exhibit 2 was
•
finalized with the Evaluation Committee totals and Advanced Data Processing, Inc.
• wasthe highest ranked firm with 393 points of a maximum scoring of 400 points;
and
WHEREAS, Advanced Data Processing, Inc. will charge the City a 4% flat
fee of the net amount collected for non-Medicaid accounts, a flat rate of$1,000 per
month for Medicaid accounts; and
WHEREAS, Advanced Data Processing, Inc. has agreed to the terms and
conditions of RFP #16-14R and the City has executed an Agreement attached
hereto as Exhibit 3; and
WHEREAS, the Fire Chief, Director of Financial Services and Purchasing
and Contracts Manager have determined that it is in the best interest of the City to
award RFP #16-14R to Advanced Data Processing, Inc.; for an initial five (5)year
term effective October 1, 2016 through September 30, 2021 and two (2)additional
two-year renewals upon satisfactory performance and mutual agreement of both
parties; and
o �
TR 12821
August 8, 2016
Page 3
WHEREAS,the City Commission of the City of Tamarac deems it to be in the
best interest of the citizens and residents of the City of Tamarac to award RFP #16-
14R, "Medical Billing Services"and to execute an Agreement with Advanced Data
Processing, Inc. to provide administration, processing and collection of the costs of
transporting EMS patients on behalf of the City of Tamarac Fire Rescue
Department.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF
THE CITY OF TAMARAC, FLORIDA:
SECTION 1: The foregoing "WHEREAS" clauses are hereby ratified and
confirmed as being true and correct and are hereby made a specific part of this
Resolution. The Exhibits attached hereto are incorporated herein and made a
specific part hereof.
SECTION 2: The appropriate City Officials are hereby authorized to award
RFP #16-14R "Medical Billing Services" and to execute an Agreement with
Advanced Data Processing, Inc., attached hereto as Exhibit 3 with an effective date
of October 1, 2016 until September 30, 2021, providing for two(2)additional two(2)
year renewal options to provide administration, processing and receipt of
payments associated with transporting Emergency Medical Service(EMS)patients
on behalf of the City of Tamarac Fire Rescue Department.
SECTION 3: The City Manager is hereby authorized to approve and execute
subsequent two (2) additional two (2) year renewal options as provided for in the
agreement.
SECTION 4: Funding has been included in the proposed FY17 budget in the
appropriate account for $130,000 based on projected revenues for FY17.
SECTION 5: All Resolutions or parts of Resolutions in conflict herewith are
hereby repealed to the extent of such conflict.
TR12821
August 8, 2016
Page 4
SECTION 6: If any clause, section,other part or application of this Resolution
I
is held by any court of competent jurisdiction to be unconstitutional or invalid, in part
or application, it shall not affect the validity of the remaining portions or applications
of this Resolution.
SECTION 7: This Resolution shall become effective immediately upon its
passage and adoption.
PASSED, ADOPTED AND APPROVED this ay- day of/ ' ' . 2016.
-iffitAW
HAR Y RESSLER, MAYOR
ATTEST:
ccitiejet.• /- gill" j i
gr /10 , ''
TRICIA A. TEUFE J, MC RECORD OF COMMISSION VOTE: I
CITY CLERK I
MAYOR DRESSLER I .-
DIST 1: COMM. BUSHNELL d,
DIST 2: COMM. GOMEZ r,
DIST 3: V/M GLASSER Af�,._ •�
DIST 4: COMM. PLACKO r----
PAT
TEUFFEL, CMC
CITY CLERK
I HEREBY CERTIFY that I
have approved this
RESOLUTION as to form.
rf ( 9,4/ .
SA UEL S. Gi4N
CITY ATTORNEY
I
i
TR#12821 -EXHIBIT 1
• REQUEST FOR PROPOSALS
1.1111111111111111
TAMARAC
The City For Your Life
RFP # 16-14 R
• Medical Billing Services
Publish Date: Proposal Due and Opening Date:
05/25/2016 06/14/2016 at 3:00 PM
Pre-Proposal Conference: Where to Deliver Bid
Not Applicable City of Tamarac
Purchasing and Contracts Division
All Questions Due: 7525 NW 88th Ave
Room 108
06/06/2016 by COB Tamarac, FL 33321-2401
City of Tamarac
Purchasing & Contracts Division
7525 NW 88th Avenue
Room 108
(954) 597-3570
For
Fire Rescue Department
L
PURCHASING AND
CONTRACTS DIVISION TA MA RAC
•
Uft
Date: May 27, 2016
REQUEST FOR PROPOSALS
RFP # 16-14 R
ALL QUALIFIED PROPOSERS:
Sealed Proposals, addressed to the Buyer of the City of Tamarac, Broward County,
Florida, will be received in the Purchasing Office, 7525 NW 88th Avenue, Tamarac, •
Florida 33321-2401 until 3:00 PM local time, Tuesday, June 14, 2016 for:
MEDICAL BILLING SERVICES
The City is soliciting proposals on behalf of the Tamarac Fire Rescue Department to
obtain the services of a qualified firm for the administration, processing and collection of
the costs of transporting Emergency Medical Services (EMS) patients. Return One (1)
Original and six (6) copies, as well as a Readable PDF copy on a USB Flash Drive or
CD in an envelope marked with your firm's name and "RFP No. 16-14 - Medical Billing
Services" to the City of Tamarac, Purchasing & Contracts Division, 7525 NW 88th
Avenue, Tamarac, Florida 33321, Attention: Andrew J. Rozwadowski, Senior
111
Procurement Specialist
Sealed Proposals must be received and time stamped in the Purchasing Office, either by
mail or hand delivery, on or before the date and time referenced above. Any
Proposals received after 3:00 p.m. on said date shall not be accepted under any
circumstances.Any uncertainty regarding the time a Proposal is received will be resolved
against the Proposer. Official time will be measured by the time stamp in the Purchasing
Office.
City reserves the right to reject any or all Proposals, to waive any informalities or
irregularities in any Proposals received, to re-advertise for Proposals, to award in whole
or in part to one or more Proposers, or take any other such actions that may be deemed
to be in the best interests of the City.
Proposal documents may be obtained from the Purchasing Office or via the Internet at
http://www.tamarac.org/bids.aspx. For all inquiries, contact the•Purchasing Office via e-
mail
at Andrew.Rozwadowskiacr)tamarac.org or (954) 597-3569.
Andrew J. Rozwadowski
Senior Procurement Specialist
Publish Sun-Sentinel: May 27, 2016
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i
TAMARAC
111110 City of Tamarac Purchasing&Contracts Division
i.
I. INSTRUCTIONS TO OFFERORS Proposal in response to a solicitation. II
it
The terms "Offeror and "Proposer" l
STANDARD TERMS AND CONDITIONS are used interchangeably and have
the same meaning.
RFP 16-14RI
2.3 "Successful Offeror"-the qualified,
f
1. AUTHORITY AND GENERALTERMS AND responsible and responsive Offeror
to whom City (on the basis of City's
CONDITIONS evaluation as hereinafter provided) it
ii
1.1 It is the intent of the City to award the makes an award. ti
rt
proposal to the responsive proposer providing a 2.4 "City" - the City of Tamarac, a
response which is most advantageous to the City. municipal corporation of the State of t
This proposal is issued pursuant to, and governed by Florida. il
the laws of the State of Florida, Article VII "Financial l
Procedures", Section 7.11, "Requirements for Public 2.5 "Proposal Documents" the
Bidding,of the City of Tamarac Charter; and Chapter 6 Request for Proposals, Instructions
ti
"Finance and Taxation", Article V, the Tamarac to Offerors, Offerors Qualifications
Procurement Code. Statement, Non-Collusive Affidavit,
Certified Resolution, Vendor Drug-
1.2 These General Terms and Free Workplace, Offeror's Proposal,
Conditions apply to all offers made to the City Proposal Security and Specifications,
of Tamarac by all prospective Proposers, if any, and the proposed Contract
including but not limited to, Requests for Documents (including all Addenda
• Quotes, Requests for Proposal and Requests issued prior to opening of Proposals).
for Bid. As such the words "bid", "proposal"
and "offer" are used interchangeably in 2.6 "Contractor" the individuals) or
reference to all offers submitted by prospective firm(s) to whom the award is made
Proposers. The City of Tamarac reserves the
right to reject any or all proposals, to waive and who executes the Contract
any informalities or irregularities in any Documents.
proposals received, to re-advertise for 3. SPECIAL CONDITIONS
proposals, to enter into contract negotiations Where there appears to be variances or
with the selected Proposer or take any other conflicts between the General Terms and
actions that may be deemed to be in the best
interest of the City of Tamarac- Any and all Conditions and the Special Conditions and/or
special conditions in this RFP or any sample Scope of Work outlined in this proposal, the
agreement document that may be in variance Special Conditions and/or the Scope of Work
or conflict with these General Terms and shall prevail.
Conditions shall have precedence over these 4. EXAMINATION OF CONTRACT
General Terms and Conditions. If no changes DOCUMENTS AND SITE
or deletions to General Conditions are made in
the Special Conditions, then the General 4.1. Before submitting a Proposal, each
Terms and Conditions shall prevail in their Offeror must carefully review this
entirety. proposal document and any
applicable supplemental material and
2. DEFINED TERMS addenda provided by the City,and in
Terms used in these Instructions to Offerors consideration of federal, state and
are defined as follows: local laws, ordinances, rules and
regulations that may in any manner
2.1 "Offeror" - one who submits a affect cost or performance of the
Proposal in response to a solicitation, work, must carefully compare the
• as distinct from a Sub-Offeror, who
submits a Proposal to the Offeror. Offerors observations in review of
applicable laws with the Proposal
2.2 "Proposer" — one who submits a Documents;and must promptly notify
the Purchasing and Contracts
RFP No. 16-14-Medical Billing Services For Fire Rescue
1
TAMARAC
City of Tamarac Purchasing&Contracts Division •
Manager of all conflicts, errors and (10) calendar days prior to the Proposal
discrepancies,if any, in the Proposal opening date,or prior to the deadline specified
Documents. in the "Schedule of Events" provided herein.
4.2. The Offeror, by and through the Questions received less than ten(10)calendar
submission of a Proposal, agrees days prior to the Proposal opening, or the
that Offeror shall be held responsible deadline specified by the"Schedule of Events'
for having examined the contract herein, whichever is sooner, may not be
documents and supplemental answered. Interpretations or clarifications in
materials; is familiar with the nature response to such questions will be issued in
and extent of the work. the form of a written addendum transmitted via
either fax or email to all parties recorded by
5. OMISSION OF DETAILS/VARIANCES AND the Purchasing Office as having received the
EXCEPTIONS Proposal Documents. The issuance of a
5.1 The apparent silence of the written addendum shall be the only official
requirements as to any detail,or the method whereby such an interpretation or
apparent omission of a detailed clarification will be made.
description concerning any point,
shall be regarded as meaning that7. COSTS AND COMPENSATION
only the best commercial and
professional practice is to prevail 7.1. Costs and compensation shall be
All interpretations of the shown in both unit prices and
specifications shall be made on the extensions whenever applicable, and
basis of this statement. Omission of expressed in U.S. Dollars_ In the
any essential details from these event of discrepancies existing •
specifications will not relieve the between unit prices and extensions
Proposer of supplying such or totals,the unit prices shall govern.
services or product(s)as specified.
7.2. All costs and compensation shall •
5.2 For the purpose of evaluation, the remain firm and fixed for acceptance
Offeror must indicate any variance or for 90 calendar days after the day of
exceptions to the stated the Proposal opening.
requirements, no matter how slight.
Deviations should be explained in 7.3. The price proposal shall include all
detail. Absence of variations and/or franchise fees,royalties,license fees,
corrections will be interpreted to etc., as well as all costs for
mean that the Offeror meets all the transportation or delivery as
requirements in every respect. applicable within the scope of the
solicitation.
6. INTERPRETATIONS AND ADDENDA
If the Offeror is in doubt as to the meaning of 8. PRICES, PAYMENTS, DISCOUNTS &
any of the Proposal Documents, believes that ELECTRONIC PAYMENTS
the General Conditions, Special Conditions
and/or Technical Specifications contain errors, 8.1 Firm Pricing: Prices shall be fixed
contradictions or obvious omissions, or has and firm to the extent required under Special
any questions concerning the information Conditions. In the absence of a reference in
contained in the RFP documents, the Offeror the Special Conditions, prices shall be fixed
shall submit a written request to the City and firm for a period of ninety (90) calendar
days. Payment will be made only after receipt
through the Purchasing Office for interpretation and acceptance of services. Cash discounts
or clarification. Such request must reference may be offered for prompt payment; however, •
RFP name and number, and should be such discounts shall not be considered in
received by the Purchasing Office at least ten determining the lowest net cost for bid
evaluation.
RFP No. 16-14-Medical Billing Services For Fire Rescue
2
1
TAMARAC s
• City of Tamarac Purchasing& Contracts Division
i
submit bids on leases of real property to
public entity,may not be awarded or perform
8.2 Prompt Payment Discounts: work as a contractor,supplier,subcontractor,
Where applicable, offeror is or consultant under a contract with any
encouraged to provide prompt public entity, and may not transact business
payment. If no payment discount is with any public entity in excess of the
offered, the discount shall assume threshold amount provided in Florida
net 30 days. Payment is deemed Statutes §287.017 for Category Two, for a
made on the date of the mailing of period of 36 months from the date of being
the check. All payments shall be placed on the convicted vendor list.
governed by the Local Government 11. CONFLICT OF INTEREST
Prompt Payment Act, F.S. Chapter i
218. The award of any contract hereunder is
r
** ****lMPORTANTNOTEvrw.**** subject to the provisions of Chapter 112,
I.
Florida Statutes. Offerors must disclose with
I
8.3 Payments by Electronic Funds their Proposal the name of any officer,director, I
Transfer: ALL payments by the partner, proprietor, associate or agent who is
City will be made by Direct also an officer or employee of City of Tamarac
•
Deposit (ACH) via electronic or any of its agencies. Further, all Offerors
funds transfer. No paper checks must disclose the name of any officer or •
will be issued after that date.
Vendors must register for direct employee of City who owns, directly or
deposit with the City prior to indirectly, an interest of five percent (5%) or
receiving any payments by more in the Offerors firm or any of its
providing a "City of Tamarac branches or affiliate companies.
• Consent for Direct Deposit"form
(ACH Form) to the City's 12. SUMMARY OF DOCUMENTS TO BE
Financial Services Accounting SUBMITTED WITH PROPOSALS
Division. The form may be The following is a summary of documents
accessed on the City of Tamarac required to be submitted for this proposal.
web-site at Failure to include a technical proposal, cost
http:/lwww.tamarac.orglindex.as proposal, bid surety (if required below), or
px?NID=622. Please contact the any other document that, by its omission,
Purchasing & Contracts Division
at the number shown on this may prejudice the rights of other
solicitation document herein as respondents, may result in immediate
the first point of contact for more rejection of your proposal. Other forms or
information, documents which, by their nature do not
impact price or the Offeror's cost of doing
business should accompany the Proposal;
9. NON-COLLUSIVE AFFIDAVIT but must be provided within three (3)
business days of the City's request to be
Each Offeror shall complete the Non-Collusive considered responsive.
Affidavit form and shall submit the form with 12.1 Technical Proposal&Work Plan
their Proposal. City considers the failure of the
Offeror to submit this document may be cause 12.2 Cost Proposal (See"Proposal Form"
for rejection of the Proposal. herein)
•
10. PUBLIC ENTITY CRIMES 12.3 Proposal price including % to
administer billing and collections
In accordance with Florida Statutes and flat rate per month for
$287.133 (2)(a): A person or affiliate who Medicaid.
has been placed on the convicted vendor list 12.4 Certification Forms
following a conviction for public entity crime
may not submit a bid on a contract to provide 12.5 Offeror's Qualifications Statement
• any goods or services to a public entity, may Form&References
not submit a bid on a contract with a public
entity for the construction or repair of a 12.6 Vendor Drug Free Workplace Form
public building or public work, may not 12.7 Non-Collusive Affidavit Form
RFP No. 16-14-Medical Billing Services For Fire Rescue
3
TAMARAC
City of Tamarac Purchasing&Contracts Division •
12.8 Proof of applicable insurance. include all documents as specified in
12.9 Listing of any Sub-Contractors or the Request for Proposals.
Subcontractors to be utilized. Purchasing and Contracts Division
13. SUBMISSION OF PROPOSALS staff is not responsible for the
premature opening of a Proposal that
13.1 Proposals must be typed or printed in is not property addressed and
ink. Use of erasable ink is not identified.
permitted. All corrections to prices 13.8 In accordance with Florida Statutes,
made by the Offeror should be Chapter §119.07(1) (a) and except
initialed.
as may be provided by other
13.2 All proposals shall be submitted in applicable state and federal law, the
the English language, and pricing Request for Proposals and the
expressed in U.S.Dollars. responses thereto are in the public
domain. However, Proposers are
13.3 Proposals must contain a manual requested to specifically identify in
signature of a corporate officer or the submitted Proposal any financial
designee with the proven authority to information considered confidential
bind the firm in matters of this nature.
The address and telephone number and/or proprietary which may be
considered exempt under Florida
for any communications regarding Statute§119.07(1).
the Proposal must be included.
13.9 All Proposals received from Offerors
13.4 Proposals shall contain an in response to the Request for
acknowledgment of receipt of all Proposals will become the property •
addenda. of City and will not be returned. In
13.5 Proposals by corporations must be the event of Contract award, all
executed in the corporation's legal documentation produced as part of
name by the President or other the Contract shall become the
corporate officer, accompanied by exclusive property of City.
evidence of authority to sign. 13.10 The Proposer preparing a submittal
Evidence of authority shall be in response to this RFP shall bear
provided on the enclosed Certified
all expenses associated with its
Resolution form,or by the company's preparation. The Proposer shall
own Corporate Resolution.
prepare a submittal with the
13.6 Proposals by partnerships must be understanding that no claim for
executed in the partnership name reimbursement shall be submitted
and signed by a partner,whose title to the City for the expense of
must appear under the signature. proposal preparation and/or
presentation.
13.7 Proposals shall be submitted to the
City's Purchasing Office on or before 13.11 Electronic Media Submission: The
the time indicated in the Request for City may require that machine
Proposals. Proposals shall be readable information and data be •
submitted in a sealed envelope provided by the proposing firm as a
(faxed proposals will not be accepted part of its submittal. The proposing
under any circumstances). The firm shall not be liable for claims or
envelope should be dearly marked losses arising out of, or connected
on the exterior with the applicable with, modification by the City, or
solicitation name and number. The anyone authorized by the City, •
envelope should state the name and decline of accuracy or readability of
address of the Offeror and should be data due to storage or obsolescence
RFP No. 16-74-Medical Billing Services For Fire Rescue
4
TAMARAC •
•
Y Purchasing&Contracts Division
Cif of Tamarac
of equipment or software, any use by price, time or changes in the work
the City or anyone authorized by the with the Successful Offeror, and to
City of such data for additions to disregard all nonconforming, non •
•
-
projects except as authorized in responsive, unbalanced or
writing by the proposing firm. conditional Proposals. Proposals will
14. MODIFICATION AND WITHDRAWAL OF be considered irregular and may be
PROPOSALS rejected if they show serious
omissions, alterations in form,
14.1 Proposals may be modified or additions not called for, conditions or
withdrawn by a duly executed unauthorized alterations, or
document signed by a corporate irregularities of any kind.
officer or other employee with 15.2 The Tamarac City Commission
designated signature authority. reserves the right to reject the
Evidence of such authority must Proposal of any Offeror if it believes
accompany the request for that it would not be in its best interest
withdrawal or modification. The of to make an award to that Offeror,
request must be delivered to the whether because the Proposal is not
Purchasing Office at any time prior
to the deadline for submitting responsive,the Offeror is unqualified,
Proposals. Withdrawal of a Proposal of doubtful financial ability, or fails to
meet any other pertinent criteria
will not prejudice the rights of an established by City within the scope
Offeror to submit a new Proposal of the solicitation.
• prior to the Proposal opening date
and time.
14.2 If, within twenty-four (24) hours after 16. QUALIFICATIONS OF PROPOSERS
Proposals are opened, any Offeror 16.1 Proposals will be considered from
files a duly signed,written notice with firms normally engaged in providing
the City's Purchasing Office, and the service requested.The proposing
within five (5) calendar days Firm must demonstrate adequate
thereafter demonstrates to the
reasonable satisfaction of City, by experience, organization, facilities,
clear and convincing evidence, that equipment and personnel to ensure
there was a material and substantial prompt and efficient service to the
City of Tamarac.The City of the City
mistake in the preparation of its of Tamarac will determine whether
Proposal, or that the mistake is the evidence of ability to perform is
clearly evident on the face of the satisfactory and reserves the right to
Proposal, but the intended correct reject proposals where evidence
Proposal is not similarly evident, submitted, or investigation and
Offeror may withdraw its Proposal evaluation,indicates inability of a fine
and any bid security will be returned. to perform.
Thereafter, the Offeror will be
disqualified from further bidding on 16.2 Each Offeror shall complete the
the subject Contract. Offeror's Qualifications Statement
15. REJECTION OF PROPOSALS and submit the form with the
Proposal. Failure to submit the
15.1 To the extent permitted by applicable Offeror's Qualifications Statement
state and federal laws and and the documents required
• regulations, the Tamarac City thereunder may constitute grounds
Commission reserves the right to for rejection of the Proposal.
reject any and all Proposals,to waive 16.3 As a part of the evaluation process,
any and all informalities not involving
RFP No. 16-14-Medical Billing Services For Fire Rescue
5
TAMARAC
City of Tamarac Purchasing&Contracts Division •
the City may conduct a background applicable to Offeror,its employees,
investigation including a criminal agents, or subcontractors, if any,
record check of Proposer's officers with respect to the work and
and/or employees, by the Broward services described herein.
County Sheriffs Office. Proposer's
submission of a proposal 17.2 Offeror shall obtain at Offerors
constitutes acknowledgement of expense all necessary insurance in
and consent to such investigation. such form and amount as required
City shall be the sole judge in by this proposal or by the City's
determining Proposers Risk Manager before beginning
qualifications. work under this Agreement. Offeror
shall maintain such insurance in full
16.4 No proposal shall be accepted from, force and effect during the life of
nor will any contract be awarded to, this Agreement. Offeror shall
any person who is in arrears to City provide to the City's Risk Manager
for any debt or contract, who is a current certificates of all insurance
defaulter, as surety or otherwise, of required under this section prior to
any obligation to City, or who is beginning any work under this
deemed irresponsible for unreliable Agreement.
by City. City will be the sole judge of
said determination. 17.3 Offeror shall indemnify and save
the City harmless from any damage
16.5 The City reserves the right, before resulting to it for failure of either
recommending any award,to inspect Offeror or any Sub-Offeror to obtain
the facilities, and organization or to or maintain such insurance.
take any other action necessary to •
determine ability to perform in 17.4 The following are required types
accordance with the specifications, and minimum limits of insurance
terms and conditions. coverage, which the Offeror agrees
to maintain during the term of this
16.6 Employees of the Proposer shall at contract:
all times be under its sole direction
and not an employee or agent of lasmoraillnommlaI M
the City. The Proposer shall supply ''��'�'r6i�� .y,
competent and physically and
ti
professionally capable employees. •+••+001.rw
The City may require the Proposer .MomsOldrig swum sown
to remove an employee it deems
careless, incompetent, a- --- +W�
w gimme. um **war wombs*
insubordinate or otherwise Ilh.,af aw,i
objectionable. Proposer shall be
responsible to the City for the acts 17.5 Offeror must provide the Cit with
and omissions of all employees evidence ofEfQ
working under its directions. °Claims-Made" forms
are acceptable only for Professional
17. INSURANCE Liability.
17.1 Offeror agrees to, in the
performance of work and services 17.6 The City reserves the right to
under this Agreement, comply with require higher limits depending
all federal,state,and local laws and upon the scope of work under this
Agreement.
regulations now in effect, or
hereinafter enacted during the term 17.7 Neither Offeror nor any Sub-Offeror
of this agreement that are shall commence work under this
RFP No. 16-14-Medical Billing Services For Fire Rescue
6
•
•
TAMARAC
• City of Tamarac Purchasing&Contracts Division
contract until they have obtained all (including economic losses), costs
insurance required under this arising out of any actual or alleged:
section and have supplied the City a). Bodily injury, sickness, disease
with evidence of such coverage in or death, or injury to or destruction
the form of an insurance certificate of tangible property including the
and endorsement. The Offeror will loss of use resulting therefrom, or
ensure that all Sub-Offerors will any other damage or loss arising
comply with the above guidelines out of or resulting, or claimed to
and will maintain the necessary have resulted in whole or in part
coverages throughout the term of from any actual or alleged act or
this Agreement. omission of the Contractor, any
17.8 All insurance carriers shall be rated sub-Contractor, anyone directly or
at least A-VII per Best's Key Rating indirectly employed by any of them,
or anyone for whose acts any of
Guide and shall be licensed to do them may be liable in the
business in Florida. Policies shall performance of the Work; or b).
be"Occurrence"form. Each carrier violation of law, statute, ordinance,
will give the City a sixty (60) day governmental administration order,
notice prior to cancellation. rule, regulation, or infringement of
17.9 The Offeror's liability insurance patent rights by the Contractor in
policies shall be endorsed to add the performance of the Work; or c).
the City of Tamarac as an liens,claims or actions made by the
"additional insured". The Offeror's Contractor or any sub-Contractor
Workers' Compensation carrier will under workers compensation acts;
provide a Waiver of Subrogation to disability benefit acts, other
the City. employee benefit acts or any
• 17.10 The Offeror shall be responsible for statutory bar.Any cost of expenses,
including attorneys fees, incurred
the payment of all deductibles and by the City to enforce this
self-insured retentions. The City agreement shall be borne by the
may require that the Offeror Contractor.
purchase a bond to cover the full
amount of the deductible or self- 18.2 Upon completion of all Services,
insured retention. obligations and duties provided for
17.11 Offeror must provide the City with in this Agreement,or in the event of
evidence of Professional Liability termination of this Agreement for
insurance with, at a minimum, a any reason, the terms and
limit of $1,000,000 per occurrence conditions of this Article shall
and in the aggregate. "Claims- survive indefinitely.
Made" forms are acceptable only
for Professional Liability. 18,3 The Contractor shall pay all claims,
17.12 The Successful Offeror agrees to losses, liens, settlements or
perform the work under the judgments of any nature whatsoever
Contract as an independent in connection with the foregoing
contractor, and not as a indemnifications including, but not
• subcontractor, agent or employee limited to, reasonable attorney's fees
of City. (including appellate attorney's fees)
18. INDEMNIFICATION and costs.
18.1 GENERAL INDEMNIFICATION: 18.4 City reserves the right to select its
Contractor shall, in addition to any own legal counsel to conduct any
other obligation to indemnify the defense in any such proceeding and
City and to the fullest extent all costs and fees associated
permitted by law, protect, defend, therewith shall be the responsibility of
indemnify and hold harmless the
City, their agents, elected officials the Contractor under the
and employees from and against all indemnification agreement. Nothing
claims, actions, liabilities, losses contained herein is intended nor shall
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City of Tamarac Purchasing&Contracts Division .
it be construed to waive City's rights provided for in the Contract
and immunities under the common documents will not result in the
law or Florida Statute 768.28 as breach of any term or provision of,or
amended from time to time. constitute a default under any
indenture, mortgage, contract, or
19. INDEPENDENT CONTRACTOR agreement to which Successful
An Agreement resulting from this solicitation Offeror is a party.
does not create an employee/employer 20.2 Successful Offeror warrants to the
relationship between the Parties. It is the City that it is not insolvent,it is not in
intent of the Parties that the Contractor is an bankruptcy proceedings or •
independent contractor under this receivership, nor is it engaged in or
Agreement and not the City's employee for threatened with any litigation,
any purposes, including but not limited to, arbitration or other legal or
the application of the Fair Labor Standards administrative proceedings or
Act minimum wage and overtime payments, investigations of any kind which
Federal Insurance Contribution Act, the would have an adverse effect on its
Social Security Act, the Federal ability to perform its obligations under
Unemployment Tax Act, the provisions of the the Contract.
Internal Revenue Code, the State Worker's
Compensation Act, and the State 20.3 Successful Offeror warrants to the
Unemployment Insurance law. The City that it will comply with all
Contractor shall retain sole and absolute applicable federal, state and local
discretion in the judgment of the manner and laws, regulations and orders in
means of carrying out Contractor's activities carrying out its obligations under the •
and responsibilities hereunder provided, Contract.
further that administrative procedures 20.4 All warranties made by Successful
applicable to services rendered under any Offeror together with service
potential Agreement shall be those of warranties and guarantees shall run
Contractor,which policies of Contractor shall to City and the successors and
not conflict with City, State, or United States assigns of City.
policies, rules or regulations relating to the
use of Contractor's funds provided for 21. SAFETY STANDARDS
herein. The Contractor agrees that it is a
separate and independent enterprise from The Proposer warrants that the product(s)
supplied to the City shall conform in ail
the City, that it had full opportunity to find respects to the standards set forth in the
other business, that it has made its own Occupational Safety and Health Act of 1970 as
investment in its business, and that it will amended, and shall be in compliance with
utilize a high level of skill necessary to Chapter 442, Florida Statutes as well as any
perform the work. Any potential Agreement industry standards,if applicable.
shall not be construed as creating any joint 22. NON-DISCRIMINATION AND EQUAL
employment relationship between theOPPORTUNITY EMPLOYMENT
Contractor and the City and the City will not
be liable for any obligation incurred by the During the performance of the Contract, the
Contractor, including but not limited to Contractor and its sub-Contractors shall not
unpaid minimum wages and/or overtime discriminate against any employee or
applicant for employment because of race,
premiums. color, sex including pregnancy, religion, age,
national origin, marital status, political
20. WARRANTIES affiliation, familial status, sexual orientation,
gender identity and expression,or disability if
20.1 Successful Offeror warrants to City qualified. The Contractor will take affirmative
that the consummation of the work action to ensure that employees and those of
its sub-Contractors are treated during
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I
4
employment, without regard to their race, document from the City's web-site, or l
color, sex including pregnancy, religion,age, register as a plan holder. All bidders 1
national origin, marital status, political proposers must visit -
affiliation, familial status, sexual orientation, http://www.tamarac.org/bids.aspx, and
gender identity or expression, or disability if select the "NOTIFY ME" icon. This action
qualified. Such actions must include,but not will take the bidder/proposer to the
be limited to, the following: employment, "Notify Me" page, Once on the "Notify
promotion; demotion or transfer; recruitment Me" page, enter the appropriate e-mail
or recruitment advertising, layoff or address to which notifications of
termination; rates of pay or other forms of solicitations and addendums should be
compensation; and selection for training, sent. Bidders and proposers may also
including apprenticeship. The Contractor request notification by text message at
and its sub-Contractors shall agree to post in this time. Upon completion of this
conspicuous places, available to its process, a confirming e-mail will be sent
employees and applicants for employment, to the individual who registered. You
notices to be provided by the contracting must click on the link provided to confirm
officer setting forth the provisions of this registration for solicitation documents
nondiscrimination clause. The Contractor and addendums. Regardless of the
further agrees that he/she will ensure that all means of transmission of an Addendum it
sub-Contractors, if any, will be made aware is the responsibility of the bidder or
of and will comply with this nondiscrimination proposer to insure that they have
clause. received all addendums issued for a
solicitation prior to submitting a
23. CLARIFICATION&ADDENDA response.*''*
Where there appears to be variances or 24. TAXES
• conflicts between the General Terms and
Conditions and the Special Conditions Successful Offeror shall pay all applicable
and/or Scope of Work/Detailed sales, consumer use and other similar taxes
Specifications outlined in this bid,the Special required by law.
Conditions and/or the Scope of
Work/Detailed Specifications shall prevail.
25. PERFORMANCE
The Proposer shall examine all proposal Failure on the part of the Offeror to comply
documents and shall judge all matters with the conditions, terms, specifications and
relating to the adequacy and accuracy of requirements of the proposal shall be just
such documents. If, upon review, any cause for cancellation of the proposal award.
material errors in specifications are found, The City may, by written notice to the
the Proposer shall contact the Purchasing Proposal, terminate the contract for failure to
Office immediately. Any inquires, perform. The date of termination shall be
suggestions, requests concerning stated in the notice. The City shall be the sole
clarification, or requests for additional judge of nonperformance.
information shall be submitted in writing to
the Purchasing and Contracts Manager. 26. TERMINATION FOR CAUSE AND DEFAULT
The City of Tamarac reserves the right to In addition to all other remedies available to
amend this proposal prior to the Proposal the City, this Agreement shall be subject to
due date indicated by written addenda. cancellation by the City for cause,should the
Written addenda shall serve as the sole Successful Offeror neglect or fail to perform
means of clarification. The City shall not be or observe any of the terms, provisions,
responsible for oral interpretations given by conditions, or requirements herein
any City employee or its representative. contained, if such neglect or failure shall
"'* SPECIAL NOTE -- Addendums continue for a period of thirty(30)days after
receipt by of written notice of such neglect or
will only be issued electronically through
failure_
the City's web-site. Vendors will be
notified of the availability of new 27. TERMINATION FOR CONVENIENCE OF
•
solicitations and addendums via e-mail or CITY
text message(per the vendor's choice). It
is essential that all vendors receiving a This Agreement may be terminated by the
bid or proposal either download the City for convenience, upon seven(7)days of
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City of Tamarac Purchasing&Contracts Division
written notice by the City to the Successful service. If the Contractor transfers all public
Offeror for such termination in which event records to the City upon completion of the
the Successful Offeror shall be paid its contract, the Contractor shall destroy any
compensation for services performed to duplicate public records that are exempt or
termination date, including services confidential and exempt from public records
reasonably related to termination. In the disclosure requirements. If the Contractor
event that the Successful Offeror abandons keeps and maintains public records upon
this Agreement or causes it to be terminated, completion of the contract, the Contractor
the Successful Offeror shall indemnify the shall meet all applicable requirements for
city against loss pertaining to this retaining public records. All records stored
termination. electronically must be provided to the City,
28. FUNDING OUT upon request from the City's custodian of
public records in a format that is compatible
This agreement shall remain in full force and with the information technology systems of
effect only as long as the expenditures the City.
provided for in the Agreement have been 29.2 During the term of the contract, the
appropriated by the City Commission of the Contractor shall maintain all books, reports
City of Tamarac in the annual budget for and records in accordance with generally
each fiscal year of this Agreement, and is accepted accounting practices and standards
subject to termination based on lack of for records directly related to this contract.
funding. The Contractor agrees to make such records
available to appropriate City staff for contract
29. RECORDS I AUDITS administration responsibility in regards to, this
agreement. Contract records shall be made
29.1 The City of Tamarac is a public available during normal business hours and in •
agency subject to Chapter 119, Florida Broward, Dade or Palm Beach Counties, and
Statutes. The Contractor shall comply with
Florida's Public Records Law. Specifically, shall include all books of account, reports and
the Contractor shall: records relating to this contract.
30. ASSIGNMENT
29.1.1 Keep and maintain public
records required by the City in order to 30.1 Successful Offeror shall not assign,
perform the service; transfer or subject the Contract or its
rights, title, interests or obligations
29.1.2 Upon request from the therein without City's prior written
City's custodian of public records, provide
the public agency with a copy of the approval.
requested records or allow the records to be 30.2 Violation of the terms of this
inspected or copied within a reasonable time paragraph shall constitute a breach
at a cost that does not exceed the cost
provided in this chapter or as otherwise of the Contract by Successful
provided by law. Offeror and City may, at its
discretion, cancel the Contract. All
29.1.3 Ensure that public records rights, title, interest and obligations
that are exempt or confidential and exempt of Successful Offeror shall
from public records disclosure requirements thereupon cease and terminate.
are not disclosed except as authorized by
law for the duration of the contract term and 31. EMPLOYEES
following completion of the contract if the
contractor does not transfer the records to 31.1 Employees of the Contractor shall at
the City. all times be under its sole direction
and not an employee or agent of the
29.1.4 Upon completion of the City. The Contractor shall supply
contract, transfer, at no cost to the City, all competent and physically capable •
public records in possession of the employees. The City may require the
Contractor, or keep and maintain public Contractor to remove an employee it
records required by the City to perform the deems careless, incompetent,
RFP No. 16-14-Medical Billing Services For Fire Rescue
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illCity of Tamarac Purchasing& Contracts Division
insubordinate or otherwise shows evidence of unbalanced proposal
objectionable. Proposer shall be pricing,such proposal may be rejected.
responsible to the City for the acts
and omissions of all employees 37. INFORMATION REQUESTS AFTER DUE
working under its directions. DATE
31.2 Unauthorized Aliens: The Pursuant to Florida Statute Chapter 119,
employment of unauthorized aliens Section 071 (1), sealed bids or proposals
by any Contractor is considered a received by an agency pursuant to invitations
violation of Section 274A (e) of the to bid or requests for proposals are exempt
Immigration and Nationality Act. If from the provisions of subsection (1) and s.
the Contractor knowingly employs 24(a),Art. I of the State Constitution until such
unauthorized aliens, such violation time as the agency provides notice of a
shall be cause for unilateral decision or intended decision pursuant to F.S.
cancellation of any contract §119.071(1) (b) (2), or within 30 days after
resulting from this RFP. This bid/proposal opening,whichever is earlier.
applies to any sub-contractors used
by the Contractor as well 38. OWNERSHIP OF PRELIMINARY AND
32. TAXES FINAL RECORDS
City of Tamarac is exempt from all All preliminary and final documentation and
The State, and Local taxes. An records shall become and remain the sole
Federal,
exemption certificate will be provided where maintainproperty of theiCity. The awardedtsthereof fiff shally
applicable upon request. original documents for its
records and for its future professional
1111 33. GOVERNING LAW: endeavors and provide reproducible copies
to the City. In the event of termination of the
The laws of the State of Florida shall govern agreement the proposing firm shall cease
this Agreement. Venue shall be Broward work and deliver to the City all documents
County,Florida. (including reports and all other data and
34. FORM ENGAGEMENT LETTER material prepared or obtained by the
awarded firm in connection with the project),
including all documents bearing the
The City may attach as a part of this professional seal of the firm. The City shall,
solicitation, a Form Engagement Letter upon delivery of the aforesaid documents,
document. Proposers shall be responsible for pay the firm and the firm shall accept as full
complying with all of the terms and conditions payment for its services thereunder, a sum
of the Form Agreement document if included of money equal to the percentage of the
herein, except where variant or conflicting work done by the firm and accepted as
language may be included in any Special satisfactory to the City.
Conditions contained herein. Proposers shall
note any deviation or variance with the Form 39. BUDGETARY CONSTRAINTS
Agreement document at the time of bid
submission. In the event the City is required to reduce
35. OTHER GOVERNMENTAL ENTITIES contract costs due to budgetary constraints,
all services specified in this document may
is awarded a contract as a result be subject to a permanent or temporary
Iia Proposer
reduction in budget. In such an event, the
of this RFP, Proposer will, if Proposer has total cost for the affected service shall be
sufficient capacity or quantities available, reduced as required. The Contractor shall
provide to other govemmental agencies, so also be provided with a minimum 30-day
requesting, the products or services awarded notice prior to any such reduction in budget.
in accordance with the terms and conditions of
the Invitation for Bid and resulting contract. 40. CONTINGENT FEES PROHIBITED
Prices shall be F.O.B. Destination to the
• requesting agency. The proposing firm must warrant that it has
36. UNBALANCED PROPOSAL PRICING not employed or retained a company or
person, other than a bona fide employee,
When a unit price proposed has variable or contractor or subcontractor, working in its
estimated quantities, and the proposal
RFP No. 16-14-Medical Billing Services For Fire Rescue
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City of Tamarac Purchasing&Contracts Division
employ, to solicit or secure a contract with Section 6-156.)
the City,and that it has not paid or agreed to
pay any person, company, corporation,
individual or firm other than a bona tide 42. PUBLIC RECORDS
employee, contractor or sub-Contractor,
working in its employ, any fee, commission, CUSTODIAN
percentage, gift or other consideration
contingent upon or resulting from the award IF THE CONTRACTOR
or making of a contract with the City.
HAS QUESTIONS
41. PROHIBITION AGAINST LOBBYING REGARDING THE
During the solicitation of any bid or proposal, APPLICATION OF
any firm and its agents, officers or CHAPTER
employees who intend to submit, or who 119, FLORIDA
have submitted, bids or proposals shall not STATUTES, TO THE
lobby, either individually or collectively, any
City Commission members, candidates for CONTRACTOR'S DUTY TO
City Commission or any employee of the PROVIDE PUBLIC
City. Contact should only be made through
regularly scheduled Commission meetings, RECORDS RELATING TO
or meetings scheduled through the THIS CONTRACT,
Purchasing and Contracts Division for
purposes of obtaining additional or clarifying CONTACT THE
information. Any action, including meals, CUSTODIAN OF PUBLIC
invitations, gifts or gratuities by a submitting
firm, its officers, agents, or employees shall RECORDS AT:
be within the purview of this prohibition and
shall result in the immediate disqualification
of that firm from further consideration. CITY CLERK
During a formal solicitation process, contact 7525 NW 88TH AVENUE
with personnel of any City of Tamarac ROOM 101
employee, officer or elected official other
than the Purchasing and Contracts Manager TAMARAC, FL 33321
or designated representative regarding any (954) 597-3505
such solicitation may be grounds for
elimination from the selection process. CITYCLERK(C TAMARAC.ORG
(Reference: Tamarac Procurement Code
• Remainder of Page Intentionally Blank
RFP No. 16-14-Medical Billing Services For Fire Rescue
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4111 City of Tamarac Purchasing&Contracts Division
REQUEST FOR PROPOSALS
RFP# 16-14 R
Medical Billing Services for Fire Rescue
Definition: A Request for Proposal (REP) is a method of procurement permitting discussions
with responsible offerors and revisions to proposals prior to award of a contract. Proposals will
be opened in private. Award will be based on the criteria set forth herein.
II. INTRODUCTION
The City is soliciting proposals on behalf of the Tamarac Fire Rescue Department to obtain the
services of a qualified firm to administer process and collect the costs of transporting
Emergency Medical Services (EMS) patients.
III. INFORMATION
For information pertaining to this Request for Proposals (RFP), contact Purchasing (954) 597-
3569. Such contact shall be for clarification purposes only. Material changes, if any, to the
scope of services or proposal procedures will be transmitted only by written addendum.
It is preferred that all questions be submitted in writing and submitted via e-mail to
• Andrew.RozwadowskiCc�tamarac.orq
IV. SCHEDULE OF EVENTS
The schedule of events related to this Request for Proposals shall be as follows:
RFP Document issued May 25, 2016
Vendor Questions Due June 06, 2016
Deadline for Receipt of Proposals June 14, 2016
Evaluation of Proposals June 15-20, 2016
Notification of Short-listed Proposers (if applicable) June 21, 2016
Presentations by Short-listed Proposers (if applicable) June 23, 2016
Final Ranking of Firms June 27, 2016
Anticipated Award by the Appropriate City Authority August 24, 2016
All dates are tentative. City reserves the right to change scheduled dates.
•
RFP No. 16-14-Medical Billing Services For Fire Rescue
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City of Tamarac Purchasing&Contracts Division •
V. STATEMENT OF WORK
A. SCOPE OF PROPOSAL
The purpose of this Invitation to Bid Request for Proposals is to obtain the services of a
qualified firm to administer the task of processing, invoicing and collecting the costs for
transporting Emergency Medical Service (EMS) patients on behalf of the City of
Tamarac Fire Rescue Department, in conformity with the requirements contained herein.
The City is seeking a contract for an initial term of five (5) years, with two (2) additional
two-year renewal terms based upon satisfactory performance and mutual agreement of
both parties.
The City of Tamarac provides Basic Life Support (BLS) and Advanced Life Support
(ALS) services to the citizens and visitors of Tamarac, and bills for emergency treatment
rendered by the Fire Rescue Department. Annual transports are estimated to exceed
7,300 per year. Below you will find the current figures:
2013—5881
2014—6592
2015—7211
Charges have been established for Advanced Life Support Transport, Basic Life Support
Transport, mileage and civil assists. The Fire Rescue Department is projecting this fee
structure to result in greater than $2 million in annual gross billings. During the past three
years, collections from Medicaid have been approximately 2% of total collections.
B. SERVICES TO BE PROVIDED
1. Invoice patient and/or other third party responsible for payment of services
rendered in accordance with time frames as stated herein.
2. Collection and generation of any and all insurance forms, filings and record
maintenance.
3. Provide HIPAA privacy practices requirements to all patients transported.
4. Provide and administer a compliance program to ensure compliance with all
State and Federal regulations.
5. Provide the City's Finance Department with all monthly finance, billing and
receivable reports as stated herein.
6. Provide a Customer Service Representative to assist patients and/or other third
party payers in all billing inquiries in a timely fashion as specified herein.
7. Conduct any follow up required to obtain the necessary insurance information to
process invoices for payment.
8. Create yearly revenue projections for budget reporting.
9. Generate quality assurance reports for record completion. •
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11111 City of Tamarac Purchasing&Contracts Division
10. Provide reports and inquires upon request of the city.
C. MINIMUM REQUIREMENTS
1. Successful Proposer shall accept hard copy or electronically transmitted
information.
2. Successful Proposer shall be responsible for invoicing, collection, and generation
of any and all insurance forms, insurance filings, records maintenance, and
preparation of standard and/or custom reports, as requested or required by City.
D. CONTRACTOR RESPONSIBILITIES
1. When preparing invoices, the Successful Proposer shall include the following
information on every invoice:
a. Account number. k'
is
b. Invoice number and date.
c. Name of transported patient.
d. Name of responsible party, if different from patient.
e. Complete patient address.
• f. Date of transport.
g. Location of transport (address or location patient was transported
from).
h. Destination of transport(hospital or other facility).
i. Detailed cost of transport by line item.
•
j. Incident number("Run"number provided by Tamarac Fire Rescue)
2. The invoice will also contain a message stating "This is an invoice for services •
provided by the City of Tamarac". Sample invoices should be included with
proposals.
3. All invoicing and reporting systems shall be computerized. Provide computer
operating system information, hardware configuration and software used.
4. Mail invoices to patients within five (5) business days of receipt of patient
•
information from Tamarac Fire Rescue. This mailing shall include a pre-printed
return payment envelope, with the payment address specified by the City of
Tamarac, however Contractor shall provide multiple platforms for payments, such •
•
as online, IVR, via mail, etc.
5. Second notices shall be sent to patient, in the event of non-response to initial
invoice, at thirty-five day intervals. Third notices shall be sent at sixty-five day
intervals. Provide samples of second and third notices.
• 6. Provide Electronic Claims Processing for Medicare and Medicaid.
7. Mail or electronically process applicable insurance forms to third party payers as •
required or requested by the patient. Either method shall include information on
RFP No. 16-14-Medical Billing Services For Fire Rescue
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City of Tamarac Purchasing&Contracts Division •
where to send payments to City of Tamarac.
8. Post all payments as received by the City's bank through the lock box.
9. Invoice the City on a monthly basis for services rendered based on flat fee for
Medicaid and percentage of other fees collected, as indicated on Price Proposal
page included herein.
10. Respond promptly to all patient requests and inquiries, whether written or verbal.
11. Comply with all applicable Federal, state and local laws as they apply to the
services being provided, such as, but not limited to, the Federal Debit Collection
Practices Law. This further includes all requirements to maintain confidentiality
for all medical and patient information as referenced in state and local laws,
ordinances and/or regulations.
12. Negotiate and arrange modified payment schedules for those individuals unable
to pay the full amount at time of initial billing.
13. Maintain any and all documentation, records and patient information in a safe
and secure manner that will allow inspection and audit by the City of Tamarac or
its agents upon proper notification and within the scope of the awarded Contract.
14. Provide the City with a report of all accounts past due more than 180 days
(except where a modified payment schedule has been arranged), including all
pertinent facts regarding said accounts. •
15. Verify, correct and maintain accurate billing address information for all
transported patients
16. Maintain a working arrangement with all of the Tamarac Fire Rescue-serviced
hospitals wherein said hospitals provide copies of patient run sheets for each
transport to their respective facilities.
17. Support our current citizen's transaction survey process by providing the
necessary monthly data for transport report.
E. RESPONSIBILITIES OF THE CITY OF TAMARAC
1. The City of Tamarac will provide the necessary patient information to the
Successful Proposer on a monthly basis, for all transported patients within the
specified time frame.
2. The City of Tamarac will comply with all Federal, State and local laws, rules and
regulations as applicable to the contracted services.
3. The City of Tamarac will agree to use the Successful Proposer exclusively for the
services specified herein as long as the contract term is current and in force.
4. The City of Tamarac will make every effort to obtain the proper billing address for
all billable patients prior to forwarding said information to the Successful
Proposer.
•
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City of Tamarac Purchasing&Contracts Division
F. DELIVERABLES
1. Distribution of Charges and Collections — This report will track the charges,
payments and financial class mix of all patients for a given month. Provide
sample.
2. Aqed Receivable Report — This report will have outstanding invoices sorted by
date with amounts for thirty days, sixty days and ninety days. This report will
provide totals for these categories.
3. New Charges Alpha Listing — This report lists all invoices alphabetically by
patient name or responsible payer. Provide sample.
4. Monthly Payment Listing - This report lists payment, bad checks, charge offs,
write offs and refunds posted to each patient's account. Provide sample
5. Check Edit Listing - This report lists all patients due refunds as a result of
overpayment of account. Provide sample.
6. Additional reports as required or requested by City.
G. PERFORMANCE SCHEDULE
1. Pricing should reflect costs for services during the initial five (5) year contract
term, from October 1, 2016 to September 30, 2021. The Price Proposal should
reflect the total costs for all services and should detail the different fees for each
service.
2. The Proposer shall include sample invoices and the messages that will be used
on 35- and 65-day notices as part of the submittal. All invoice and notice text,
layout, color of ink and paper stock is subject to approval by City.
VI. PROPOSAL SELECTION
The City Manager will appoint an Evaluation and Selection Committee to review Proposals. The
City reserves the right to select the Proposer who represents the best value, and to accept or
reject any proposal submitted in response to this solicitation. The City's Evaluation and
Selection Committee will act in what they consider to be the best interest of the City and its •
residents.
Price shall not be the sole determining factor for selection, as indicated in the following sectionil
VII. EVALUATION OF PROPOSALS
A. Evaluation Method and Criteria
The Evaluation and Selection Committee will evaluate proposals and, if necessary, any
presentations by short-listed Proposers, and will select the Proposer that best meets the
requirements and criteria of the RFP documents.
The City's evaluation criteria may include, but shall not be limited to, the following:
• 1. Qualifications
a. Verification of availability of qualified personnel.
REP No. 16-14-Medical Billing Services For Fire Rescue
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City of Tamarac Purchasing&Contracts Division110
b. Verification of availability of equipment.
c. Ability to meet set standards.
d. Expertise of staff.
e. Qualifications of the firm.
f. Experience.
g. References from other municipalities providing similar services.
2. Technical
a. Understanding of the requirements.
b. Approach.
c. Technical soundness of the proposal.
d. Proposed scope of work.
3. Financial
a. Cost Effectiveness.
b. Reasonableness of proposed price.
c. Evidence of insurance and/or bonding.
4. Other
a. Location of firm (within Tri-County area of Miami-Dade, Broward and •
Palm Beach Counties).
b. Previous contracting experience with the City, if any.
c. Performance under past contracts with the City, if any.
C. Weighted Criteria
Points will be assigned to each proposal based on the following weighted criteria:
Criteria Maximum Points
1 Expertise/Qualifications 20 points
Experience in Stated Criteria/Medical 20 points
2 Billing
3 Governmental/Municipal Experience 25 points
4 Technology and Equipment Availability 10 points
5 Collection Philosophy 10 points
6 Price 10 points
Location—Office within the Tri-County 5 points
7 Area
These weighted criteria are provided to assist Proposers in the allocation of their
time and efforts during the proposal preparation process. The criteria also guide
the Evaluation Committee during the short-listing and final ranking of proposers
RFP No. 16-14-Medical Billing Services For Fire Rescue
18
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s
S
TAMARAC
• City of Tamarac Purchasing& Contracts Division
t
by establishing a general framework for those deliberations. t
r
Once the Proposals are evaluated, a "short-list" may be selected to make
presentations to the Evaluation and Selection Committee, prior to a
recommendation for award. F
1
D. PRESENTATIONS
The short-listed Proposers may be requested to make presentations to the F
Committee. The City may require additional information after evaluation of the
submittals, and Proposers agree to furnish such information upon the City's
request.
t
E. RIGHT TO REJECT PROPOSALS fi
To the extent permitted by applicable state and federal laws and regulations, City
reserves the right to reject any and all Proposals, to waive any and all informalities I
not involving price, time or changes in the work, and to disregard all nonconforming,
non-responsive, unbalanced or conditional Proposals. Proposals will be considered
irregular and may be rejected if they show serious omissions, alterations in form,
• additions not called for, conditions, unauthorized alterations, or irregularities of any
kind. ii
City reserves the right to reject any Proposal if City believes that it would not be in
its best interest to make an award to a particular Proposer, either because the ri
Proposal is not responsive, the Proposer is unqualified, of doubtful financial ability,
or fails to meet any other pertinent criteria established by City within the scope of
this solicitation.
j
CONTACT WITH PERSONNEL OF THE CITY OF TAMARAC OTHER THAN THE
PURCHASING AND CONTRACTS MANAGER OR DESIGNATED
REPRESENTATIVE REGARDING THEIR REQUEST FOR PROPOSALS MAY BE _
GROUNDS FOR ELIMINATION FROM THE SELECTION PROCESS.
VIII. PROPOSAL COPIES
Return One (1) Original and six (6) copies, as well as a Readable PDF copy on a USB Flash
Drive or CD. in an envelope marked with your firm's name and "RFP No. 16-14 -Medical Billing
Services" to the City of Tamarac, Purchasing & Contracts Division, 7525 NW 88th Avenue, 5
Tamarac, Florida 33321,Attention:Andrew J. Rozwadowski,Senior Procurement Specialist
Any addenda shall become part of this Request of Proposal and the resulting agreement. The
Proposal Form included herein should be signed by an authorized company representative, dated
and returned with the Proposal.
• No negotiations, decisions or actions shall be initiated or executed by the Proposer as a result of
any discussions with any City employee. Only those communications that are issued in writing -
from the Purchasing & Contracts Division may be considered as a duly authorized expression.
RFP No. 16-14-Medical Billing Services For Fire Rescue
19
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TAMARAC
City of Tamarac Purchasing&Contracts Division •
Also, only communications from Proposers that are signed in and in writing will be recognized by
the City as duly authorized expressions on behalf of the Proposer.
CONTACT WITH PERSONNEL OF THE CITY OF TAMARAC OTHER THAN THE
PURCHASING AND CONTRACTS MANAGER OR DESIGNATED REPRESENTATIVE
REGARDING THEIR REQUEST FOR PROPOSALS MAY BE GROUNDS FOR ELIMINATION
FROM THE SELECTION PROCESS.
Remainder of Page Intentionally Blank
40
•
RFP Na 16-14-Medical Billing Services For Fire Rescue
20
TAMARAC
• City of Tamarac Purchasing& Contracts Division
PROPOSAL FORM
RFP 16-14R
MEDICAL BILLING SERVICES
PROPOSAL PRICE
1. Flat Fee Percentage of % to administer billing and collections
2. Flat Rate of$ per month for Medicaid.
is
SUBMITTED BY:
Company Name:
Address:
City: State: Zip:
Telephone: FAX:
Email:
NOTE: To be considered eligible for award, one (1) original copy of this proposal
form must be submitted with the Proposal.
NO BID INDICATION (IF "NO BID" IS OFFERED):
Please indicate reason(s) why a Proposal is not being submitted at this time.
•
RFP No. 16-14-Medical Billing Services For Fire Rescue
21 •
TAMARAC
City of Tamarac Purchasing& Contracts Division
COMPANY NAME: (Please Print):
Phone: Fax:
BEFORE SUBMITTING YOUR PROPOSAL, MAKE SURE YOU...
1. Carefully read the General Terms & Conditions, Special Conditions and the General
Requirements.
2. Provide representative samples of past work/publications printed by your firm.
3 Include a Schedule of Prices as requested on the Proposal Form included herein.
4 References as requested herein.
15. Fill out and sign the Non-Collusive Affidavit and have it properly notarized.
6. Sign the Certification page. Failure to do so will result in your Bid being deemed non-
responsive.
7. Fill out the Offeror's Qualification Statement and Reference Form.
8 Sign the Vendor Drug Free Workplace Form. 1111/
9 Fill out the List of Sub-Contractors or Subcontractors, if applicable.
10 Fill out and sign the Certified Resolution.
n 11 Include all necessary Financial Statements requested.
12 Include proof of insurance.
13 Provide any additional documentation requested within the Proposal Document.
14 Submit ONE (1) Original AND six(6) copies as well as a READABLE PDF copy on a USB
Flash Drive or CD as requested in the Proposal Instructions. Clearly mark the sealed
container with the PROPOSAL NUMBER AND PROPOSAL NAME on the outside of the
package.
Make sure your Proposal is submitted PRIOR to the deadline.
Late Proposals will not be accepted.
Failure to provide the requested attachments may result in your proposal
being deemed non-responsive.
THIS SHOULD BE THE FIRST PAGE OF YOUR PROPOSAL.
•
RFP No. 16-14-Medical Billing Services ForFir-e Rescue
22
TANIARAC
City of Tamarac Purchasing&Contracts Division
REFERENCES
Please list government agencies and/or private firms with whom you have done business during the last five
years:
Your Company Name
Address
City State Zip —— --— -- -- — —._..Phone/Fax
E-mail
Agency/Firm Name:
Address
City State Zip
Phone/Fax
Contact Name
E-mail
Agency/Firm Name:
Address
City State Zip
Phone/Fax
Contact Name
E-mail
Agency/Firm Name:
Address
• City State Zip
Phone/Fax '
Contact Name
E-mail
Agency/Firm Name:
Address
City State Zip
Phone/Fax
Contact Name
E-mail
Agency/Firm Name:
Address
City State Zip
Phone/Fax -
Contact Name -
• E-mail
RFP No. 16-14-Medical Billing Services For Fire Rescue
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TAMARAC
City of Tamarac Purchasing&Contracts Division
411/
CERTIFICATION
THIS DOCUMENT MUST BE SUBMITTED WITH THE PROPOSAL
We(I), the undersigned, hereby agree to furnish the item(s)/service(s)described in the Invitation to
Bid. We (I) certify that we(I) have read the entire document, including the Scope of Work,
Additional Requirements, Supplemental Attachments, Instructions to Proposers, Terms and
Conditions, and any addenda issued.We agree to comply with all of the requirements of the entire
Request for Proposals,
SUBMITTED TO: City of Tamarac
Purchasing and Contracts Manager
7525 NW 88th Avenue
Tamarac, Florida 33321
Indicate which type of organization below:
INDIVIDUAL ❑ PARTNERSHIP ❑ CORPORATION ❑ OTHER❑
If"Other", Explain:
Authorized Signature Company Name
Typed/Printed Name Address
Telephone City, State,ZIP
Fax Federal Tax ID Number
Email address for above signer(if any)
•
RFP No. 16-14-Medical Billing Services For Fire Rescue
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- I
TAMARAC
City• of Tamarac
Purchasing&Contracts Division
CERTIFIED RESOLUTION
I, (Name), the duly elected Secretary of
(Corporate Title), a corporation organized and existing under the laws of
the State of , do hereby certify that the following Resolution was
unanimously adopted and passed by a quorum of the Board of Directors of the said corporation at
•
a meeting held in accordance with law and the by-laws of the said corporation.
"IT IS HEREBY RESOLVED THAT (Name)", the
duly elected (Title of Officer) of
(Corporate Title) be and is hereby authorized to execute
and submit a Bid and/or Bid Bond, if such bond is required, to the City of Tamarac and such other
instruments in writing as may be necessary on behalf of the said corporation; and that the
Bid, Bid Bond, and other such instruments signed by him/her shall be binding upon the said
corporation as its own acts and deeds. The secretary shall certify the names and signatures of
those authorized to act by the foregoing resolution.
The City of Tamarac shall be fully protected in relying upon such certification of the secretary and
shall be indemnified and saved harmless from any and all claims, demands, expenses, loss or
damage resulting from or growing out of honoring, the signature of any person so certified or for
refusing to honor any signature not so certified.
I further certify that the above resolution is in force and effect and has not been revised, revoked or
rescinded.
I further certify that the following are the name, titles and official signatures of those persons
authorized to act by the foregoing resolution.
NAME TITLE SIGNATURE
Given under my hand and the Seal of the said corporation this day of ,20�
(SEAL) By:
Secretary
Corporate Title
NOTE:
The above is a suggested form of the type of Corporate Resolution desired. Such form need
• not be followed explicitly, but the Certified Resolution submitted must clearly show to the
satisfaction of the City of Tamarac that the person signing the Bid and Bid Bond for the
corporation has been properly empowered by the corporation to do so in its behalf.
RFP No. 16-14-Medical Billing Services For Fire Rescue
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TAMARAC
City of Tamarac Purchasing&Contracts Division
PROPOSER'S QUALIFICATION STATEMENT
The Proposer, under oath certifies to the truth and correctness of all statements and of all answers to
questions made hereinafter:
1. If Proposer is a corporation, answer the following:
a) Date of Incorporation: State of Incorporation:
2. If Proposer is operating under a fictitious name, submit evidence of compliance with the Florida
Fictitious Name Statute.
3. How many years has your organization been in business under its present business-name?
a) Under what other former names has your organization operated?
4. List the pertinent experience of the key individuals of your organization (continue on insert sheet, if
necessary).
5. State the name of the individual who will serve as the primary contact for the City: •
6. State the names and addresses of all businesses and/or individuals who own an interest of more
than five percent(5%)of the Proposer's business and indicate the percentage owned of each such
business and/or individual:
7. Has your company ever declared bankruptcy?Yes❑ No❑
If yes, explain:
8. Have you ever received a contract or a purchase order from the City of Tamarac or other
governmental entity?Yes ❑ No❑ If yes, explain: (date, service/project, bid title etc.)
9. Have you ever received a complaint on a contract or bid awarded to you by any governmental
entity? Yes ❑ No❑If yes, explains:
10. Have you ever been debarred or suspended from doing business with any governmental entity?
Yes LI No❑ If yes, explains: •
RFP Na 16-14-Medical Billing Services For Fire Rescue
26
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r-----ter
TAMARAC
41110
City of Tamarac Purchasing&Contracts Division
The Offeror acknowledges and understands that the information contained in response to this
Qualification Statement shall be relied upon by owner in awarding the contract and such
information is warranted by Offeror to be true. The discovery of any omission or misstatement
that materially affects the Offeror's qualifications to perform under the contract shall cause the
owner to reject the proposal, and if after the award, to cancel and terminate the award and/or
contract.
Signature
O
ll
•
RFP No. 16-14-Medical Billing Services For Fire Rescue
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TA MARAC
City of Tamarac Purchasing&Contracts Division
ACKNOWLEDGEMENT
OFFEROR'S QUALIFICATION STATEMENT
State of
County of'
On this the day of , 20_, before me,
the undersigned Notary Public of the State of Florida, personally appeared
And
(Name(s) of individual(s) who appeared before notary)
Whose name(s) is/are Subscribed to within the instrument, and he/she/they acknowledge that
he/she/they executed it.
WITNESS my hand and official seal.
NOTARY PUBLIC, STATE OF FLORIDA
NOTARY PUBLIC
SEAL OF.OFFICE: •
(Name of Notary Public: Print,
Stamp or Type as Commissioned)
❑ Personally known to me, or
0 Produced identification:
(Type of Identification Produced)
❑ DID take an oath, or
❑ DID NOT take an oath
RFP No. 16-14-Medical Billing Services For Fire Rescue
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TAMARAC
•
City of Tamarac _ Purchasing&Contracts Division
NON-COLLUSIVE AFFIDAVIT
State of
)ss.
County of
being first duly sworn deposes and
says that:
1. He/she is the , (Owner, Partner, Officer,
Representative or Agent) of , the Offeror
that has submitted the attached Proposal;
2. He/she is fully informed respecting the preparation and contents of the attached
Proposal and of all pertinent circumstances respecting such Proposal;
3. Such Proposal is genuine and is not a collusive or sham Proposal;
4. Neither the said Offeror nor any of its officers, partners, owners, agents, representatives,
employees or parties in interest, including this affiant, have in any way colluded,
conspired, connived or agreed, directly or indirectly, with any other Offeror, firm, or
• person to submit a collusive or sham Proposal in connection with the Work for which the
attached Proposal has been submitted; or to refrain from bidding in connection with such
Work; or have in any manner, directly or indirectly, sought by agreement or collusion, or
communication, or conference with any Offeror, firm, or person to fix the price or prices
in the attached Proposal or of any other Offeror, or to fix any overhead, profit, or cost
elements of the Proposal price or the Proposal price of any other Offeror, or to secure
through any collusion, conspiracy, connivance, or unlawful agreement any advantage
against (Recipient), or any person interested in the proposed Work;
5. The price or prices quoted in the attached Proposal are fair and proper and are not
tainted by any collusion, conspiracy, connivance, or unlawful agreement on the part of
the Offeror or any other of its agents, representatives, owners, employees or parties in
interest, including this affiant.
Signed, sealed and delivered in the presence of:
By
Witness
Witness Printed Name
Title
•
RFP No. 16-14-Medical Billing Services For Fire Rescue
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TAMARAC
City of Tamarac Purchasing&Contracts Division
ACKNOWLEDGMENT
NON-COLLUSIVE AFFIDAVIT
State of Florida
County of
On this the day of , 20 , before me, the undersigned Notary Public of
the State of Florida, personally appeared
• and
(Name(s)of individual(s)who appeared before notary)
Whose name(s) is/are Subscribed to within the instrument, and he/she/they acknowledge that
he/she/they executed it.
WITNESS my hand
and official seal.
NOTARY PUBLIC, STATE OF FLORIDA
NOTARY PUBLIC
SEAL OF OFFICE: •
(Name of Notary Public: Print,
Stamp, or Type as Commissioned)
❑ Personally known to me, or
❑ Produced identification:
(Type of Identification Produced)
❑ DID take an oath, or 0 DID NOT take an oath
•
RFP No. 16-14-Medical Billing Services For Fire Rescue
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TAMARAC
1 hl L'.
City of Tamarac _ Purchasing&Contracts Division
Preference maybe given to vendors submittinga certification with their bid/proposal lj
lj
certifying they have a drug-free workplace in accordance with Section 287.087, Florida
Statutes. This requirement affects all public entities of the State and becomes effective
January 1, 1991. The special condition is as follows: y
IDENTICAL TIE BIDS-Preference may be given to businesses with drug-free workplace programs.Whenever
two or more bids that are equal with respect to price, quality, and service are received by the State or by any
political subdivision for the procurement of commodities or contractual services, a bid received from a business p
that certifies that it has implemented a drug-free workplace program shall be given preference in the award
process. Established procedures for processing tie bids will be followed if none of the tied vendors have a drug-
free workplace program.In order to have a drug-free workplace program,a business shall:
Publish a statement notifying employees that the unlawful manufacture,
distribution, dispensing, possession, or use of a controlled substance is
prohibited in the workplace and specifying the actions that will be taken against
employees for violations of such prohibition.
1. Inform employees about the dangers of drug abuse in the workplace, the business's
policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation,
and employee assistance programs, and the penalties that may be imposed upon
employees for drug abuse violations. •
• 2. Give each employee engaged in providing the commodities or contractual services that
are under bid a copy of the statement specified in subsection (1).
3. In the statement specified in subsection (1), notify the employees that, as a condition of '
working on the commodities or contractual services that are under bid, the employee will
abide by the terms of the statement and will notify the employer of any conviction of, or
plea of guilty or nolo contendere to, any violation of chapter 893 or of any controlled
substance law of the United States or any state, for a violation occurring in the
workplace no later than five (5) days after each conviction.
4. Impose a section on, or require the satisfactory participation in a drug abuse assistance
or rehabilitation program if such is available in the employee's community, by any
employee who is so convicted.
5. Make a good faith effort to continue to maintain a drug-free workplace through
implementation of this section. As the person authorized to sign the statement, I certify
that this form complies fully with the above requirements.
Authorized Signature Company Name
•
RFP No. 16-14-Medical Billing Services For Fire Rescue
31
TAMARAC
City of Tamarac Purchasing&Contracts Division
SAMPLE FORM AGREEMENT
BETWEEN THE CITY OF TAMARAC
AND
THIS AGREEMENT is made and entered into this_day of , 20. by and
between the City of Tamarac, a municipal corporation with principal offices located at 7525 N.W.
88th Ave., Tamarac, FL 33321 (the"CITY") and , a corporation with
principal offices located at (the "Contractor") to provide
for Medical Billing Services For Fire Rescue.
Now therefore, in consideration of the mutual covenants hereinafter set forth, the City and
Contractor agree as follows:
1. The Contract Documents
The contract documents consist of this Agreement, conditions of Request for
Proposals (RFP) 16-14 R entitled "Medical Billing Services", (General Terms and
Conditions, Instructions to Offerors, and Statement of Work), all addenda issued
prior to, and all modifications issued after execution of this Agreement. These •
contract documents form the Agreement, and all are as fully a part of the
Agreement as if attached to this Agreement or repeated therein.
2. The Work
The Contractor shall perform all work for the City required by the contract documents as
set forth below:
2.1 Contractor shall furnish all labor, materials, and equipment necessary to
administer, process and collect the costs associated with transporting
EMS patients.
2.2 Contractor shall supervise the work force to ensure that all workers
conduct themselves and perform their work in a safe and professional
manner. Contractor shall comply with all OSHA safety rules and
regulations in the operation of equipment and in the performance of the
work, Contractor shall at all times have a competent field supervisor on
the job site to enforce these policies and procedures at the Contractor's
expense.
2.3 Contractor shall provide the City with seventy-two (72) hours written notice
prior to the beginning of work under this Agreement and prior to any
•
RFP No. 16-14-Medical Billing Services For Fire Rescue
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TAMARAC
1110
City of Tamarac Purchasing&Contracts Division
schedule change with the exception of changes caused by inclement
weather.
2.4 Contractor shall comply with any and all Federal, State, and local laws and
regulations now in effect, or hereinafter enacted during the term of this
Agreement, which are applicable to the Contractor, its employees, agents
or subcontractors, if any, with respect to the work and services described •
herein.
3. Insurance
3.1. Contractor shall obtain at Contractor's expense all necessary insurance in such
form and amount as specified by the City's Risk and Safety Manager before
beginning work under this Agreement including, but not limited to, Workers'
Compensation, Commercial General Liability, Automobile Liability and all other
insurance as required by the City, including Medical Malpractice (Errors and
Omission Liability). The Contractor will ensure that all sub-Contractors comply
with the above guidelines and will retain all necessary insurance in force
throughout the terms of this Agreement.
3.2. Contractor shall indemnify and hold the City harmless for any damages resulting •
from failure of the Contractor to take out and maintain such insurance.
Contractor's Liability Insurance policies shall be endorsed to add the City as an •
additional insured. Contractor shall be responsible for payment of all deductibles
and self-insurance retentions on Contractor's Liability Insurance policies.
4. Term
The work to be performed under this Agreement shall be commenced after City
execution of this Agreement. This contract shall be in effect for an initial period of five (5)
years, with two (2) additional two-year renewal terms based upon satisfactory
performance and mutual agreement of both parties
5. Contract Sum
The Contract Sum for the above work is Dollars and cents ( ).
6. Payments
The City shall pay in full the Contract Sum to the Contractor upon completion of the work
listed in Paragraph 2 of this Agreement unless the parties agree otherwise. The City
shall pay the Contractor for work performed subject to the specifications of the job and
subject to any additions and deductions by subsequent change order provided in the
contract documents.All payments shall be governed by the Florida Prompt Payment Act,
F.S., Part VII, Chapter 218.
0 7. Indemnification
•
RFP No. 16-14-Medical Billing Services For Fire Rescue
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•
TAMARAC
City of Tamarac Purchasing&Contracts Division •
7.1 GENERAL INDEMNIFICATION: Contractor shall, in addition to any other
obligation to indemnify the City and to the fullest extent permitted by law, protect,
defend, indemnify and hold harmless the City, their agents, elected officials and
employees from and against all claims, actions, liabilities, losses (including
economic losses), costs arising out of any actual or alleged: a). Bodily injury,
sickness, disease or death, or injury to or destruction of tangible property
including the loss of use resulting therefrom, or any other damage or loss arising
out of or resulting, or claimed to have resulted in whole or in part from any actual
or alleged act or omission of the Contractor, any sub-Contractor, anyone directly
or indirectly employed by any of them, or anyone for whose acts any of them may
be liable in the performance of the Work; or b). violation of law, statute,
ordinance, governmental administration order, rule, regulation, or infringement of
patent rights by Contractor in the performance of the Work; or c). liens, claims or
actions made by the Contractor or any sub-Contractor under workers
compensation acts; disability benefit acts, other employee benefit acts or any
statutory bar. Any cost of expenses, including attorney's fees, incurred by the
City to enforce this agreement shall be borne by the Contractor.
7.2 Upon completion of all Services, obligations and duties provided for in this
Agreement, or in the event of termination of this Agreement for any reason, the
terms and conditions of this Article shall survive indefinitely.
7.3 The Contractor shall pay all claims, losses, liens, settlements or judgments of any
nature whatsoever in connection with the foregoing indemnifications including, but
not limited to, reasonable attorney's fees (including appellate attorney's fees) and
costs.
7.4 City reserves the right to select its own legal counsel to conduct any defense in any
such proceeding and all costs and fees associated therewith shall be the
responsibility of Contractor under the indemnification agreement. Nothing
contained herein is intended nor shall it be construed to waive City's rights and
immunities under the common law or Florida Statute 768.28 as amended from time
to time.
8. Non-Discrimination& Equal Opportunity Employment
During the performance of the Contract, the Contractor shall not discriminate against any
employee or applicant for employment because of race, color, sex, religion, age, national
origin, marital status, political affiliation, familial status, sexual orientation, or disability if
qualified. The Contractor will take affirmative action to ensure that employees are
treated during employment, without regard to their race, color, sex, religion, age, national
origin, marital status, political affiliation, familial status, sexual orientation, or disability if
qualified. Such actions must include, but not be limited to, the following: employment,
promotion; demotion or transfer; recruitment or recruitment advertising, layoff or
termination; rates of pay or other forms of compensation; and selection for training,
including apprenticeship. The Contractor shall agree to post in conspicuous places,
available to employees and applicants for employment, notices to be provided by the •
contracting officer setting forth the provisions of this nondiscrimination clause. The
RFP No. 16-14-Medical Billing Services For Fire Rescue
34
TAMARAC
City of Tamarac Purchasing&Contracts Division
Contractor further agrees that he/she will ensure that Subcontractors, if any, will be
made aware of and will comply with this nondiscrimination clause.
9. Independent Contractor
This Agreement does not create an employee/employer relationship between the
Parties. It is the intent of the Parties that the Contractor is an independent Contractor
under this Agreement and not the City's employee for any purposes, including but not
limited to, the application of the Fair Labor Standards Act minimum wage and overtime
payments, Federal Insurance Contribution Act, the Social Security Act, the Federal
Unemployment Tax Act, the provisions of the internal Revenue Code, the State Worker's
Compensation Act, and the State Unemployment Insurance law. The Contractor shall
retain sole and absolute discretion in the judgment of the manner and means of carrying
out Contractor's activities and responsibilities hereunder provided, further that
administrative procedures applicable to services rendered under this Agreement shall be
those of Contractor, which policies of Contractor shall not conflict with City, State, or
United States policies, rules or regulations relating to the use of Contractor's funds
provided for herein. The Contractor agrees that it is a separate and independent
enterprise from the City, that it had full opportunity to find other business, that it has
made its own investment in its business, and that it will utilize a high level of skill
necessary to perform the work. This Agreement shall not be construed as creating any
• joint employment relationship between the Contractor and the City and the City will not
be liable for any obligation incurred by Contractor, including but not limited to unpaid
minimum wages and/or overtime premiums.
10.Assignment and Subcontracting
Contractor shall not transfer or assign the performance required by this Agreement
without the prior consent of the City. This Agreement, or any portion thereof, shall not be
subcontracted without the prior written consent of the city. •
11. Notice
Whenever either party desires or is required under this Agreement to give notice to any
other party, it must be given by written notice either delivered in person, sent by U.S.
Certified Mail, U.S. Express Mail, air or ground courier services, or by messenger service,
as follows:
CITY
City Manager
City of Tamarac
7525 N.W. 88th Avenue
Tamarac, FL 33321
With a copy to City Attorney at the following address:
• Goren, Cherof, Doody&Ezrol, P.A.
RFP No. 16-14-Medical Bitting Services For Fire Rescue
35
TAMARAC
City of Tamarac Purchasing&Contracts Division
3099 East Commercial Blvd., Suite 200
Fort Lauderdale, FL 33308
CONTRACTOR
12.Termination
12.1 Termination for Convenience: This Agreement may be terminated by the City
for convenience, upon seven (7) days of written notice by the City to Contractor
for such termination in which event the Contractor shall be paid its compensation
for services performed to termination date, including services reasonably related
to termination. In the event that the Contractor abandons this Agreement or
causes it to be terminated, Contractor shall indemnify the city against loss
pertaining to this termination.
•
12.2 Default by Contractor: In addition to all other remedies available to the City, this
Agreement shall be subject to cancellation by the City for cause, should the
Contractor neglect or fail to perform or observe any of the terms, provisions,
conditions, or requirements herein contained, if such neglect or failure shall
continue for a period of thirty (30) days after receipt by Contractor of written
notice of such neglect or failure.
13. Uncontrollable Forces
13.1 Neither the City nor Contractor shall be considered to be in default of this
Agreement if delays in or failure of performance shall be due to Uncontrollable
Forces, the effect of which, by the exercise of reasonable diligence, the non-
performing party could not avoid. The term "Uncontrollable Forces"shall mean any
event which results in the prevention or delay of performance by a party of its
obligations under this Agreement and which is beyond the reasonable control of
the nonperforming party. It includes, but is not limited to fire, flood, earthquakes,
storms, lightning, epidemic, war, riot, civil disturbance, sabotage, and
governmental actions.
13.2 Neither party shall, however, be excused from performance if nonperformance is
due to forces, which are preventable, removable, or remediable, and which the
nonperforming party could have, with the exercise of reasonable diligence,
prevented, removed, or remedied with reasonable dispatch. The nonperforming
party shall, within a reasonable time of being prevented or delayed from
• performance by an uncontrollable force, give written notice to the other party •
RFP No. 16-14-Medical Billing Services For Fire Rescue
36
TAIVIARAC
•
City of Tamarac Purchasing&Contracts Division
describing the circumstances and uncontrollable forces preventing continued
performance of the obligations of this Agreement.
14.Agreement Subject to Funding
This agreement shall remain in full force and effect only as long as the expenditures
provided for in the Agreement have been appropriated by the City Commission of the
City of Tamarac in the annual budget for each fiscal year of this Agreement, and is
subject to termination based on lack of funding.
15.Venue
This Agreement shall be governed by the laws of the State of Florida as now and
hereafter in force. The venue for actions arising out of this agreement is fixed in
Broward County, Florida.
16.Signatory Authority
The Contractor shall provide the City with copies of requisite documentation evidencing
that the signatory for Contractor has the authority to enter into this Agreement.
17.Severability;Waiver of Provisions
• Any provision in this Agreement that is prohibited or unenforceable in any jurisdiction
shall, as to such jurisdiction, be ineffective to the extent of such prohibition or
unenforceability without invalidating the remaining provisions hereof or affecting the
validity or enforceability of such provisions in any other jurisdiction. The non-
enforcement of any provision by either party shall not constitute a waiver of that
provision nor shall it affect the enforceability of that provision or of the remainder of this
Agreement.
18.Merger; Amendment
This Agreement constitutes the entire Agreement between the Contractor and the City,
and negotiations and oral understandings between the parties are merged herein. This
Agreement can be supplemented and/or amended only by a written document executed
by both the Contractor and the City.
19. No Construction Against Drafting Party
Each party to this Agreement expressly recognizes that this Agreement results from the
negotiation process in which each party was represented by counsel and contributed to
the drafting of this Agreement. Given this fact, no legal or other presumptions against
the party drafting this Agreement concerning its construction, interpretation or otherwise
accrue to the benefit of any party to the Agreement, and each party expressly waives the
right to assert such a presumption in any proceedings or disputes connected with,
arising out of, or involving this Agreement.
• 20. PUBLIC RECORDS CUSTODIAN
RFP No. 16-14-Medical Billing Services For Fire Rescue
37
TAMARAC
City of Tamarac Purchasing&Contracts Division •
IF THE CONTRACTOR HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE
CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS
RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF
PUBLIC RECORDS AT:
CITY CLERK
7525 NW 88TH AVENUE
ROOM 101
TAMARAC, FL 33321
(954) 597-3505
C I TY C L E R K@TA MA RAC.O RG
Remainder of Page Intentionally Blank
•
S
RFP No. 16-14-Medical Bitting Services For Fire Rescue
38
TANtARAC•
City of Tamarac Purchasing&Contracts Division
IN WITNESS WHEREOF, the parties have made and executed this Agreement on the
respective dates under each signature. CITY OF TAMARAC, signing by and through its Mayor
and City Manager, and CONTRACTOR, signing by and through by , duly
authorized to execute same.
CITY OF TAMARAC
Harry Dressler, Mayor
Date
3
ATTEST: Michael C. Cernech, City Manager
Patricia A. Teufel, CMC Date:
City Clerk
t
Approved as to form and legal sufficiency:
Date
Samuel S. Goren
ATTEST:
Company Name
(Corporate Secretary) Signature of President/Owner
Type/Print Name of Corporate Secy. Type/Print Name of President/Owner
(CORPORATE SEAL) Date
•
RFP No. 16-14-Medical Billing Services For Fire Rescue
39
TAMARAC
City of Tamarac Purchasing&Contracts Division •
CORPORATE ACKNOWLEDGEMENT
STATE OF •
:SS
COUNTY OF
I HEREBY CERTIFY that on this day, before me, an Officer duly authorized in the State
aforesaid and in the County aforesaid to take acknowledgments, personally appeared
, of
a Corporation, to me known to be the person(s) described in and
who executed the foregoing instrument and acknowledged before me that he/she executed the
same.
WITNESS my hand and official seal this _ day of , 20�
Signature of Notary Public •
State of Florida at Large
Print, Type or Stamp
Name of Notary Public
❑ Personally known to me or
❑ Produced Identification
Type of I,D. Produced
❑ DID take an oath, or
❑ DID NOT take an oath.
•
RFP No. 16-14-Medical Billing Services For Fire Rescue
40
TAMARAC
Ir.
City of Tamarac Purchasing&Contracts Division
APPENDIX A PRICING SCHEDULE
is
RFP No. 16-14-Medical Billing Services For Fire Rescue
41
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0
MEDICAL BILLING SERVICES AGREEMENT
BETWEEN THE CITY OF TAMARAC
AND
ADVANCED DATA PROCESSING, INC. (ADPI)A SUBSIDIARY OF INTERMEDIX
CORPORATION
THIS
THIS AGREEMENT is made and entered into thisQlday of , 2016 by and
between the City of Tamarac, a municipal corporation with princi I offices located at 7525 N.W.
88th Ave., Tamarac, FL 33321 (the "CITY") and_ADVANCED DATA PROCESSING, INC.
(ADPI), a Delaware corporation, duly registered as a Florida Foreign Corporation, with principal
offices located at 6451 N. FEDERAL HIGHWAY SUITE 1000 FORT LAUDERDALE, FL 33308
(the"Contractor")to provide for Medical Billing Services For Fire Rescue.
Now therefore, in consideration of the mutual covenants hereinafter set forth, the City and
Contractor agree as follows:
1. The Contract Documents
The contract documents consist of this Agreement, conditions of Request for Proposals 1
(RFP) 16-14 R entitled "Medical Billing Services", (General Terms and Conditions,.
Instructions to Offerors, and Statement of Work), all addenda issued prior to, and all
modifications issued after execution of this Agreement. These contract documents form
the Agreement, and all are as fully a part of the Agreement as if attached to this
Agreement or repeated therein.
2. The Work
The Contractor shall perform all work for the City required by the contract documents as
set forth below and in RFP#16-14 R:
2.1 Contractor shall furnish all labor, materials, and equipment necessary to
administer, process and collect the costs associated with transporting EMS
patients.
2.2 Contractor shall supervise the work force to ensure that all workers conduct
themselves and perform their work in a safe and professional manner. Contractor
shall comply with all OSHA safety rules and regulations in the operation of
equipment and in the performance of the work. Contractor shall at all times have
a competent field supervisor on the job site to enforce these policies and
procedures at the Contractor's expense.
2.3 Contractor shall provide the City with seventy-two (72)hours written notice prior
to the beginning of work under this Agreement and prior to any schedule change
with the exception of changes caused by inclement weather.
2.4 Contractor shall comply with any and all Federal, State, and local laws and
regulations now in effect, or hereinafter enacted during the term of this
Agreement,which are applicable to the Contractor, its employees, agents or
subcontractors, if any,with respect to the work and services described herein.
3. Insurance
3.1. Contractor shall obtain at Contractor's expense all necessary insurance in such
form and amount as specified by the City's Risk and Safety Manager before
beginning work under this Agreement including, but not limited to, Workers'
Compensation, Commercial General Liability, Automobile Liability and all other
insurance as required by the City, including Medical Malpractice (Errors and
Omission Liability). The Contractor will ensure that all sub-Contractors comply
with the above guidelines and will retain all necessary insurance in force
throughout the terms of this Agreement,
3.2. Contractor shall indemnify and hold the City harmless for any damages resulting
from failure of the Contractor to take out and maintain such insurance.
Contractor's Liability Insurance policies shall be endorsed to add the City as an
additional insured. Contractor shall be responsible for payment of all deductibles
and self-insurance retentions on Contractor's Liability Insurance policies.
4. Term
The work to be performed under this Agreement shall be commenced after City
execution of this Agreement. This contract shall be in effect for an initial period of five(5)
years, with two (2) additional two-year renewal terms based upon satisfactory
performance and mutual agreement of both parties.
6. Contract Sum
The Contract Sum for the above work is outlined in Attachment A.
6. Payments
The City shall pay in full the Contract Sum to the Contractor upon completion of the work
listed in Paragraph 2 of this Agreement unless the parties agree otherwise. The City
shall pay the Contractor for work performed subject to the specifications of the job and
subject to any additions and deductions by subsequent change order provided in the
contract documents.All payments shall be governed by the Florida Prompt Payment Act,
F.S., Part VII, Chapter 218.
7. Indemnification
7.1 GENERAL INDEMNIFICATION: Contractor shall, in addition to any other
obligation to indemnify the City and to the fullest extent permitted by law, protect,
defend, indemnify and hold harmless the City, their agents, elected officials and
employees from and against all claims, actions, liabilities, losses (including
economic losses), costs arising out of any actual or alleged: a). Bodily injury,
sickness, disease or death, or injury to or destruction of tangible property
including the loss of use resulting therefrom, or any other damage or loss arising
out of or resulting, or claimed to have resulted in whole or in part from any actual
or alleged act or omission of the Contractor, any sub-Contractor, anyone directly
or indirectly employed by any of them, or anyone for whose acts any of them may
be liable in the performance of the Work; or b). violation of law, statute,
ordinance, governmental administration order, rule, regulation, or infringement of
patent rights by Contractor in the performance of the Work; or c). liens, claims or
actions made by the Contractor or any sub-Contractor under workers
compensation acts; disability benefit acts, other employee benefit acts or any
statutory bar. Any cost of expenses, including attorney's fees, incurred by the
City to enforce this agreement shall be borne by the Contractor.
7.2 Upon completion of all Services, obligations and duties provided for in this
Agreement, or in the event of termination of this Agreement for any reason, the
terms and conditions of this Article shall survive indefinitely_
7.3 The Contractor shall pay all claims, losses, liens, settlements or judgments of any
nature whatsoever in connection with the foregoing indemnifications including, but
not limited to, reasonable attorney's fees (including appellate attorney's fees) and
costs_
7.4 City reserves the right to select its own legal counsel to conduct any defense in any
such proceeding and all costs and fees associated therewith shall be the
responsibility of Contractor under the indemnification agreement. Nothing
contained herein is intended nor shall it be construed to waive City's rights and
immunities under the common law or Florida Statute 768.28 as amended from time
to time.
8. Non-Discrimination&Equal Opportunity Employment
During the performance of the Contract,the Contractor shall not discriminate against any
employee or applicant for employment because of race, color, sex, religion, age, national
origin, marital status, political affiliation, familial status, sexual orientation, or disability if
qualified. The Contractor will take affirmative action to ensure that employees are
treated during employment, without regard to their race, color, sex, religion, age, national
origin, marital status, political affiliation, familial status, sexual orientation, or disability if •
qualified. Such actions must include, but not be limited to, the following: employment,
promotion; demotion or transfer; recruitment or recruitment advertising, layoff or
termination; rates of pay or other forms of compensation; and selection for training,
including apprenticeship. The Contractor shall agree to post in conspicuous places,
available to employees and applicants for employment, notices to be provided by the
contracting officer setting forth the provisions of this nondiscrimination clause. The
Contractor further agrees that he/she will ensure that Subcontractors, if any, will be
made aware of and will comply with this nondiscrimination clause.
9. Independent Contractor
This Agreement does not create an employee/employer relationship between the
Parties. It is the intent of the Parties that the Contractor is an independent Contractor
under this Agreement and not the City's employee for any purposes, including but not
limited to, the application of the Fair Labor Standards Act minimum wage and overtime
payments, Federal Insurance Contribution Act, the Social Security Act, the Federal
Unemployment Tax Act, the provisions of the Internal Revenue Code,the State Worker's
Compensation Act, and the State Unemployment Insurance law. The Contractor shall
retain sole and absolute discretion in the judgment of the manner and means of carrying
out Contractor's activities and responsibilities hereunder provided, further that
administrative procedures applicable to services rendered under this Agreement shall be
those of Contractor, which policies of Contractor shall not conflict with City, State, or
United States policies, rules or regulations relating to the use of Contractor's funds
provided for herein. The Contractor agrees that it is a separate and independent
enterprise from the City, that it had full opportunity to find other business, that it has
made its own investment in its business, and that it will utilize a high level of skill
necessary to perform the work. This Agreement shall not be construed as creating any
joint employment relationship between the Contractor and the City and the City will not
be liable for any obligation incurred by Contractor, including but not limited to unpaid
minimum wages and/or overtime premiums.
10.Assignment and Subcontracting
Contractor shall not transfer or assign the performance required by this Agreement
without the prior consent of the City. This Agreement, or any portion thereof, shall not be
subcontracted without the prior written consent of the city.
11. Notice
Whenever either party desires or is required under this Agreement to give notice to any
other party, it must be given by written notice either delivered in person, sent by U.S.
Certified Mail, U.S. Express Mail, air or ground courier services, or by messenger service,
as follows:
CITY
City Manager
City of Tamarac
7525 N.W. 88th Avenue
Tamarac, FL 33321
With a copy to City Attorney at the following address:
Goren, Cherof, Doody&Ezrol, P.A.
3099 East Commercial Blvd.,Suite 200
Fort Lauderdale, FL 33308
CONTRACTOR
ADVANCED DATA PROCESSING,INC.
(ADPI)A SUBSIDIARY OF INTERMEDIX
6451 N.FEDERAL HIGHWAY
SUITE 1000
FORT LAUDERDALE,FL 33308
joelportice@intermedix.com
12.Termination
12.1 Termination for Convenience: This Agreement may be terminated by the City
for convenience, upon seven (7) days of written notice by the City to Contractor
for such termination in which event the Contractor shall be paid its compensation
for services performed to termination date, including services reasonably related
to termination. In the event that the Contractor abandons this Agreement or
causes it to be terminated, Contractor shall indemnify the city against loss
pertaining to this termination.
12.2 Default by Contractor: In addition to all other remedies available to the City,this
Agreement shall be subject to cancellation by the City for cause, should the
Contractor neglect or fail to perform or observe any of the terms, provisions,
conditions, or requirements herein contained, if such neglect or failure shall
continue for a period of thirty (30) days after receipt by Contractor of written
notice of such neglect or failure.
13.Uncontrollable Forces
13.1 Neither the City nor Contractor shall be considered to be in default of this
Agreement if delays in or failure of performance shall be due to Uncontrollable
Forces, the effect of which, by the exercise of reasonable diligence, the non-
performing party could not avoid.The term"Uncontrollable Forces"shall mean any
event which results in the prevention or delay of performance by a party of its
obligations under this Agreement and which is beyond the reasonable control of
the nonperforming party. It includes, but is not limited to fire, flood, earthquakes,
storms, lightning, epidemic, war, riot, civil disturbance, sabotage, and
governmental actions.
13.2 Neither party shall, however, be excused from performance if nonperformance is
due to forces, which are preventable, removable, or remediable, and which the
nonperforming party could have, with the exercise of reasonable diligence,
prevented, removed, or remedied with reasonable dispatch. The nonperforming
party shall, within a reasonable time of being prevented or delayed from
performance by an uncontrollable force, give written notice to the other party
describing the circumstances and uncontrollable forces preventing continued
performance of the obligations of this Agreement.
14.Agreement Subject to Funding
This agreement shall remain in full force and effect only as long as the expenditures
provided for in the Agreement have been appropriated by.the City Commission of the
City of Tamarac in the annual budget for each fiscal year of this Agreement, and is
subject to termination based on lack of funding.
15.Venue
This Agreement shall be governed by the laws of the State of Florida as now and
hereafter in force. The venue for actions arising out of this agreement is fixed in
Broward County,Florida.
16.Signatory Authority
The Contractor shall provide the City with copies of requisite documentation evidencing
that the signatory for Contractor has the authority to enter into this Agreement.
17.Severability;Waiver of Provisions
Any provision in this Agreement that is prohibited or unenforceable in any jurisdiction
shall, as to such jurisdiction, be ineffective to the extent of such prohibition or
unenforceability without invalidating the remaining provisions hereof or affecting the
validity or enforceability of such provisions in any other jurisdiction. The non-
enforcement of any provision by either party shall not constitute a waiver of that •
•
provision nor shall it affect the enforceability of that provision or of the remainder of this
Agreement.
18.Merger;Amendment
This Agreement constitutes the entire Agreement between the Contractor and the City,
and negotiations and oral understandings between the parties are merged herein. This
Agreement can be supplemented and/or amended only by a written document executed
by both the Contractor and the City.
19.No Construction Against Drafting Party
Each party to this Agreement expressly recognizes that this Agreement results from the
negotiation process in which each party was represented by counsel and contributed to
the drafting of this Agreement. Given this fact, no legal or other presumptions against
the party drafting this Agreement concerning its construction, interpretation or otherwise
accrue to the benefit of any party to the Agreement, and each party expressly waives the
right to assert such a presumption in any proceedings or disputes connected with,
arising out of, or involving this Agreement.
20. PUBLIC RECORDS CUSTODIAN
IF THE CONTRACTOR HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE
CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS
RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF
PUBLIC RECORDS AT:
CITY CLERK
7525 NW 88TH AVENUE
ROOM 101
TAMARAC, FL 33321
(954) 597-3505
CITYCLERK@TAMARAC.ORG
Remainder of Page Intentionally Blank
IN WITNESS WHEREOF, the parties have made and executed this Agreement on the
respective dates under each signature. CITY OF TAMARAC, signing by and through its Mayor
and City Manager, and CONTRACTOR, signing by and through by cMd th2,.51. CQ-,, duly
authorized to execute same.
C OF TAMARAC
Harry ressler, Mayor
' r�q-l6
Date"41111, 'r
%"A
■ EST: _ icha- . Cemech, City Manager
Patricia A. Teufel, C Date:
City Clerk �����
gi � -> � AR,O,,% Approved as to form and legal sufficiency:
Date4 a 147/10. bi
E.S1 1963 EE Sam el S. Goren
SEAL o
O Advanced Data Processing, Inc.
ATTEST:
7 b C00.\4, Company Name
(Corporate Secretary) ig • ''r sid= -- Kenneth L.Cooke
Leigh, Melissa itle Secretary J'eel Portice, EO
July 26,2016
(CORPORATE SEAL) Date
CORPORATE ACKNOWLEDGEMENT
STATE OF TENNESSEE
COUNTY OF DAVIDSON :SS
I HEREBY CERTIFY that on this day, before me, an Officer duly authorized in the State
aforesaid and in the County aforesaid to take acknowledgments, personally appeared
JOEL PORTICE AND KEN COOKE , of INTERMEDIX CORPORATION
a DELAWARE Corporation, to me known to be the person(s) described in and
who executed the foregoing instrument and acknowledged before me that he/she executed the
same.
WITNESS my hand and official seal this 26thday of JULY , 20 .16
(555, ,
u/a (x)
\, Aw ,ry,,�� Signature of Notary Public State of
Tennessee at Large
E LINDA W. SMITH
Print, Type or Stamp
Name of Notary Public
7'�, ON C04,�`• ® Personally known to me or
❑ Produced Identification
NONE
Type of I.D. Produced
❑ DID take an oath, or
DID NOT take an oath.
TR#12870
October 5, 2016
Page 1
CITY OF TAMARAC, FLORIDA
RESOLUTION NO. R-2016 -
A RESOLUTION OF THE CITY COMMISSION OF THE CITY
OF TAMARAC, FLORIDA AUTHORIZING THE
APPROPRIATE CITY OFFICIALS TO APPROVE AND
EXECUTE AN AMENDMENT TO THE AGREEMENT WITH
ADVANCED DATA PROCESSING, INC. (ADPI)TO PROVIDE
FOR THE ADMINISTRATION, PROCESSING AND
COLLECTION OF ALL COSTS ASSOCIATED WITH
TRANSPORT OF EMERGENCY MEDICAL SERVICES(EMS)
PATIENTS AND MEDICAL BILLING TO INCLUDE EMS
BILLING AND RELATED PROFESSIONAL SERVICES ON
BEHALF OF THE CITY OF TAMARAC FIRE RESCUE
DEPARTMENT FOR A PERIOD OF THREE (3) YEARS
EFFECTIVE UPON EXECUTION OF THE AMENDMENT;
PROVIDING FOR RENEWALS; AND AUTHORIZING THE
CITY MANAGER TO EXECUTE ANY SUBSEQUENT
RENEWAL OPTIONS; PROVIDING FOR CONFLICTS;
PROVIDING FOR SEVERABILITY; AND PROVIDING FOR
AN EFFECTIVE DATE.
WHEREAS,Tamarac Fire Rescue is required to provide basic and advanced
life support services to the citizens and visitors of the City of Tamarac and to
properly invoice and collect fees from the patients who utilize these services; and
WHEREAS, Tamarac Fire Rescue transports an estimated 8,000 patients
per year from which approximately 690 are Medicaid patients; and
WHEREAS, the City Commission of the City of Tamarac awarded an
Agreement for Medical Billing Services to ADPI for a five (5) year term effective
October 1, 2016 through September 30, 2021 via Resolution R-2016-83 at its
meeting of August 24, 2016, a copy of said resolution is on file with the City Clerk;
and
TR#12870
October 5, 2016
Page 2
WHEREAS, the Agency for Healthcare Administration for the State of
Florida sought Federal Authority to amend Title XIX of the Social Security Act which
provides funding for the Medicaid State Plan attached here to as Exhibit "1"; and
WHEREAS, the amendment seeks federal authority to implement a new
reimbursement methodology for certified public expenditures program for
emergency medical transportation services; and
WHEREAS, this program provides supplemental payments for an eligible
Public Emergency Medical Transport (PEMT) entity that meets specified
requirements and provides emergency medical transport service to Medicaid
beneficiaries; and
WHEREAS, Tamarac Fire Rescue provides emergency medical transport
services to a significant number of Medicaid patients annually; and
WHEREAS, Tamarac Fire Rescue is eligible to participate in this program;
and
WHEREAS , supplemental payments are available only for allowable costs
that are in excess of other Medicaid revenue that the eligible PEMT entities received
for emergency medical transportation services to Medicaid eligible recipients; and
WHEREAS,ADPI has evaluated the City's Medicaid transports for calendar
year 2016 and 2017 and has estimated revenue recovery of$104,242 for calendar
year 2016 and $623,611 for calendar year 2017; and
WHEREAS, ADPI is offering the City of Tamarac a flat fee percentage
charge of 15% of the net amount collected for Medicaid accounts; and
WHEREAS, ADPI has proposed Amendment"1"to the current ADPI Billing
Agreement for EMS billing and related professional services attached hereto as
Exhibit "2"; and
TR#12870
October 5, 2016
Page 3
WHEREAS, Amendment "1" is effective for a period of three(3)years which
will coincide with the first three (3) years of the original term of five (5)years of the
term of the existing Agreement, through September 30, 2019; and
WHEREAS,Amendment 1 may be renewed to coincide with the final two(2)
years of the ADPI Agreement through September 30, 2021, and to coincide with the
additional two (2) year renewal terms available for the Agreement with ADPI, and
will allow City staff the opportunity to renegotiate the terms and pricing of
Amendment 1 based on the market conditions in place prior to the execution of the
renewal and upon satisfactory performance and the mutual agreement of both
parties; and
WHEREAS, it is the recommendation of the Director of Financial Services
and the Purchasing and Contracts Manager and the Fire Chief that the City
Commission of the City of Tamarac approve and execute Amendment "1" to the
Agreement with ADPI for three (3) year period effective upon execution of the
Amendment of Services Agreement through September 30, 2019 and allowing for
subsequent renewals for the period of October 1, 2019 through September 30,
2021, as well for any subsequent renewal terms based on any potential re-
negotiation and upon satisfactory performance and mutual agreement of both
parties.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF
THE CITY OF TAMARAC, FLORIDA:
SECTION 1: The foregoing "WHEREAS" clauses are hereby ratified and
confirmed as being true and correct and are hereby made a specific part of this
Resolution. The Exhibits attached hereto are incorporated herein and made a
specific part hereof.
TR#12870
October 5, 2016
Page 4
SECTION 2: The appropriate City Officials are hereby authorized to approve
and execute Amendment"1"to the Agreement with Advanced Data Processing, Inc.
attached hereto as Exhibit "2" with ADPI for the administration, processing and
collection of all EMS patient to include EMS Billing and Related Professional
Services on behalf of the City of Tamarac Fire Rescue Department for a three (3)
year period effective upon execution of the Amendment of Services Agreement
through September 30, 2019 and allowing for subsequent renewals for the period
of October 1, 2019 through September 30, 2021, as well for any subsequent
renewal terms based on any potential re-negotiation and upon satisfactory
performance and mutual agreement of both parties.
SECTION 3: The City Manager is hereby authorized to approve any
subsequent renewals of Amendment "1" to the Agreement with ADPI upon
satisfactory performance, re-negotiation of terms and mutual agreement of both
parties.
SECTION 4: That all Resolutions or parts of Resolutions in conflict herewith
are hereby repealed to the extent of such conflict.
SECTION 5: If any clause, section, other part or application of this Resolution
is held by any court of competent jurisdiction to be unconstitutional or invalid, in part
or application, it shall not affect the validity of the remaining portions or applications
of this Resolution.
TR#12870
October 5, 2016
Page 5
SECTION 6: This Resolution shall become effective immediately upon its
passage and adoption.
PASSED, ADOPTED AND APPROVED this c ''b day of OeV�"`j 2016.
HARit ' ,,
' SLER, MAYOR
ATTEST:
d;Zetztj I 11 /
PATRICIATEU' -L, CMC
CITY CLERK
RECORD OF COMMISSION VOTE:
' MAYOR DRESSLER
DIST 1: COMM. BUSHNELL
DIST 2: COMM. GOMEZ / -
DIST 3: VICE MAYOR GLASSER '
DIST 4: COMM. PLACKO trie../
I HEREBY CERTIFY THAT I HAVE
APPROVED THIS RESOLUTION
AS TO FORM
M1
11; is -wic
SA - L S. GORE ,'
CITY ATTORNEY
TR#12870-Exhibit 1
4"GARF;
y4 RICK SCOTT
GOVERNOR
a ELIZABETH DUDEK
SECRETARY
OF f100'
December 15,2015
Ms. Jackie Glaze
Associate Regional Administrator
Division of Medicaid &Children's Health
Centers for Medicare and Medicaid Services
61 Forsyth Street, Suite 4T20
Atlanta, Georgia 30303-8909
Dear Ms. Glaze:
Enclosed for your consideration is an amendment to our Title XIX Medicaid State Plan. The
Transmittal Number is: FL SPA 2015-014 and the title is: Certified Public Expenditure Program
for Emergency Medical Transportation.
This amendment seeks federal authority to implement a new reimbursement methodology for a
certified public expenditure program for emergency medical transportation services. This
program provides supplemental payments for art eligible Public Emergency Medical
Transportation (PEMT)entity that meets specified requirements and provides emergency
medical transportation services to Medicaid beneficiaries. Supplemental payments provided by
this program are available only for allowable costs that are in excess of other Medicaid revenue
that the eligible PEMT entities receive for emergency medical transportation services to
Medicaid eligible recipients. Eligible PEMT entities must provide certification to the Agency for
Health Care Administration (ANCA)that they have made a total funds expenditure and that the
amount claimed is eligible for federal financial participation (FFP).
•
Thank you for your consideration of this amendment. Please contact April Cook of my staff by
phone at(850)412-4691 or by email at April.Cookaahca.mvflorida.com if you need any
additional information.
Sincerely,
714
Justin M. Senior
Deputy Secretary for Medicaid
JMS/ac
Enclosures: State Plan Documents and Forms
2727 Mahan Drive • Mail Stop #8 5.= Facebook.com/AHCAFIorida
± -�
Tallahassee, FL 32308 s�::_-1 Youtube.com/AHCAFIorida
AHCA.MyFlorida.com it? ;j Twitter.com/AHCA_FL
SlideShare.net/AHCAFIorida
DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
HEALTH CARE FINANCING ADMFNISTRATION 0MB NO.0931 0193
TRANSMITTAL AND NOTICE OF APPROVAL OF I.TRANSMITTAL NUMBER: 2.STATE
STATE PLAN MATERIAL
2015-014 Florida
FOR:HEALTH CARE FINANCING ADMINISTRATION 3.PROGRAM IDENTIFICATION:TITLE XIX OF THE
SOCIAL SECURITY ACT(MEDICAID)
TO:REGIONAL.ADMINISTRATOR 4.PROPOSED EFFECTIVE DATE
HEALTH CARE FINANCING ADMINISTRATION October 1,2015
DEPARTMENT OF HEALTH AND HUMAN SERVICES
5.TYPE OF PLAN MATERIAL(Check One):
❑NEW STATE PLAN ❑AMENDMENT TO BE CONSIDERED AS NEW PLAN AMENDMENT
COMPLETE BLOCKS 6 THRU 10 IF THIS IS AN AMENDMENT(Separate Transmittal for each amendment)
6.FEDERAL STATUTE/REGULATIONCITATIOH: 7.FEDERAL BUDGET IMPACT:(in thousands)
42 CFR 431.53 FFY 2015 2016 $15,000
FFY 2016-2017 $15,000
8.PAGE NUMBER OF THE PLAN SECTION OR ATTACHMENT: 9.PAGE NUMBER OF THE SUPERSEDED PLAN SECTION
New:page 34a-34b of 4.19-B OR ATTACHMENT(If Applicable):
10.SUBJECT OF AMENDMENT: Certified Public Expenditure Program for Emergency Transportation.
11.GOVERNOR'S REVIEW{Check One):
❑GOVERNOR'S OFFICE REPORTED NO COMMENT ®OTHER,AS SPECIFIED:
❑COMMENTS OF GOVERNOR'S OFFICE ENCLOSED Reviewed by the Deputy Secretary for Medicaid
0 NO REPLY RECEIVED WITHIN 45 DAYS OF SUBMITTAL who is the Governor's designee.
12.SIGNATURE Sj4._ ., GiCY OFFICIAL: � 16.RETURN TO:
i�: ` Mr.Justin M.Senior
13.TYPED NAME Deputy Secretary for Medicaid
Mr.Justin M.Senior I Agency for Health Care Administration
14.TITLE; 2727 Mahan Drive,Mail Stop#8
Deputy Secrciary for Medicaid
Tallahassee,FL 32308
15.DATE SUBMITTED: Attention April Cook
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FORM HCFA-179(07-92)
Attachment 4.19-B
SUPPLEMENTAL PAYMENT FOR PUBLICLY OWNED OR OPERATED EMERGENCY MEDICAL
TRANSPORTATION PROVIDERS
This program provides supplemental payments for an eligible Public Emergency Medical
Transportation (PEMT)entity that meets specified requirements and provides emergency
medical transportation services to Medicaid beneficiaries.
Supplemental payments provided by this program are available only for allowable costs that are
in excess of other Medicaid revenue that the eligible PEMT entities receive for emergency
medical transportation services to Medicaid eligible recipients. Eligible PEMT entities must
provide certification to the Agency for Health Care Administration(AHCA)that they have made
a total funds expenditure and that the amount claimed is eligible for federal financial
participation(FFP).
Supplemental payments will be made annually on a State Fiscal Year(SFY)schedule in a lump-
sum basis after the conclusion of the subject SFY but prior to the end of certified forward period,
September 30. Payments will not be paid as individual increases to current reimbursement rates
for specific services.
This supplemental payment program will be in effect beginning October 1, 2015.
A. Definition of a Public Emergency Medical Transportation (PEMT)Entity:
A PEMT entity is determined eligible if it is a county, a city, a healthcare district or Public
Universities in Florida and provides emergency medical transportation services for
Medicaid beneficiaries.
B. Supplemental Payment Methodology:
Supplemental payments provided by this program to an eligible PEMT entity will consist
of FFP for Medicaid uncompensated emergency medical transportation costs based on
the difference between the Medicaid reimbursement amount and the providers actual
cost for providing emergency medical transportation services to eligible Medicaid
recipients.The supplemental payment methodology is as follows:
1. As described in Section C, the expenditures certified by the eligible PEMT entity to
the State will represent the payment eligible for FFP. Allowable certified public
expenditures will determine the amount of FFP claimed.
2. In no instance will the amount certified pursuant to paragraph C.1,when combined
with the amount received for emergency medical transportation services pursuant to
any other provision of this State Plan or any Medicaid waiver granted by the Centers
for Medicare and Medicaid Services exceed 100 percent of the allowable costs for
such emergency medical transportation services.
Amendment:2015-014
Effective: 10/01/15
Supersedes:New
Approved:
34a
Attachment 4.19-B
SUPPLEMENTAL PAYMENT FOR PUBUCLY OWNED OR OPERATED EMERGENCY MEDICAL
TRANSPORTATION PROVIDERS
3. Pursuant to paragraph C.1, the eligible PEMT entity will certify to AHCA, on an
annual basis, the amount of its eligible uncompensated costs for providing
emergency medical transportation services for Medicaid beneficiaries. The
supplemental Medicaid reimbursement received pursuant to this segment of the
State Plan will be distributed in one annual lump-sum payment after submission of
such annual certification.
4. Emergency medical transportation service costs for the subject year that are certified
pursuant to paragraph C.1 will be computed in a manner consistent with Medicaid
cost principles regarding allowable costs, and will only include costs that satisfy
applicable Medicaid requirements.
C. Responsibilities and Reporting Requirements of the eligible PEMT Entity:
An eligible PEMT entity must do all of the following:
1. Certify that the claimed expenditures for emergency medical transportation services
made by the eligible PEMT entity are eligible for FFP.
2. Provide evidence supporting the certification as specified by AHCA.
3. Submit data as specified by AHCA to determine the appropriate amounts to claim as
expenditures qualifying for FFP.
4. Keep, maintain and have readily retrievable, any records required by AHCA or the
Centers for Medicare and Medicaid Services.
D. AHCA's Responsibilities:
1. AHCA will submit claims for FFP for the expenditures for services that are
allowable expenditures under federal law.
2. AHCA will, on an annual basis, submit any necessary materials to the federal
government to provide assurances that FFP will include only those expenditures
that are allowable under federal law.
Amendment:2015-014
Effective:10/01/15
Supersedes:New
Approved:
34b
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01 C 3
Cook April
From: FL-Rules@dos.state.fl,us
Sent Friday, September 25,2015 2:36 PM
To: Cook,April
Subject: Submit Notice in FAR
You have successfully submitted a notice for publication in the Florida Administrative Register on 9/25/2015 2:35:38 PM.
Department:Agency for Health Care Administration
Organization:Medicaid
Notice type:Miscellaneous
Issue:41/188
Once this notice is published you will be able to view it by clicking the following link:
http://www.FLRules.org/gateway/View Notice.asp?id=16535219
You may contact the Florida Administrative Register office at(850)245-6270 for additional information.
@ItsWorkingFL:https://twitter.com/ltsWorkingFL The Department of State is leading the commemoration of Florida's
500th anniversary in 2013. For more information,please go to www.fla500.com.
The Department of State is committed to excellence.Please take our Customer Satisfaction Survey:
http://survey.dosstate.fl.us/index.aspx?email=
Miscellaneous
AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid
State Plan Amendment
The Agency for Health Care Administration (Agency)will be requesting an amendment to the
Florida Medicaid State Plan. The 2015 General Appropriations Act(GM)directed the Agency
to implement a certified public expenditure program for emergency medical services. The
Agency will be seeking federal authority to implement a new reimbursement methodology to
provide supplemental payments for emergency ground and air ambulance transportation
services furnished by government or publicly owned and operated ambulance providers enrolled
in Florida Medicaid. Interested parties may contact the following staff for further information:
Derica Smith, Bureau of Medicaid Policy, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida
32308-5407, telephone: 850-412-4239, e-mail: Derica.smith(q�ahca.myflorida.com.
RICK SCOTT
GOVERNOR
ELIZABETH DUDEK
SECRETARY
FOF1Lo t'
October 23, 2015
Ms. Connie Whidden, MSW
Health Director
Seminole Tribe of Florida
3006 Josie Billie Avenue
Hollywood. FL 33024
Dear Ms. Whidden:
The purpose of this letter is to inform you that the Agency for Health Care Administration
(Agency) intends to submit an amendment to the Title XIX Florida Medicaid State Plan to the
Centers for Medicare and Medicaid Services (CMS). This amendment will seek to implement a
certified public expenditure program for emergency transportation services. The Agency will be
pursuing federal authority to implement a new reimbursement methodology to provide
supplemental payments for emergency ground and air ambulance transportation services
furnished by government or publicly owned and operated ambulance providers enrolled in
Florida Medicaid.
If you would like to make any comments or need additional information, please contact April
Cook of my staff by phone at(850)412-4691 or by e-mail at ADril.Cook@ahca.myflorida.com. If
we don't receive any response from you within 30 days, Florida Medicaid will proceed with the
submission to CMS.
Sincerely,
91/f74,Justin M. nior
Deputy Secretary for Medicaid
JMS/ac
cc: Kathy Wilson, Seminole Health Department
`„e
2727 Mahan Drive • Mail Stop #8 ,44
Facebook.comtAHCAFIorida
Tallahassee, FL 32308 "�+ +� s
• .+r :.� Youtube.comlAHCAFiorida
AHCA.MyFlorida.com Twitter.com/AHCA_FL
SlideShare_net/AHCAFlorida
so,,H AP
a�Q RICK SCOTT
GOVERNOR
ELIZABETH DUDEK
?,17aac
SECRETARY
October 23, 2015
Ms. Cassandra Osceola
Health Director
Miccosukee Tribe of Indians of Florida
P.O. Box 440021, Tamiami Station
Miami, FL 33144
Dear Ms. Osceola:
The purpose of this letter is to inform you that the Agency for Health Care Administration
(Agency) intends to submit an amendment to the Title XIX Florida Medicaid State Plan to the
Centers for Medicare and Medicaid Services (CMS). This amendment will seek to implement a
certified public expenditure program for emergency transportation services. The Agency will be
pursuing federal authority to implement a new reimbursement methodology to provide
supplemental payments for emergency ground and air ambulance transportation services
furnished by government or publicly owned and operated ambulance providers enrolled in
Florida Medicaid.
If you would like to make any comments or need additional information, please contact April
Cook of my staff by phone at (850)412-4691 or by e-mail at April.Cook@ahca.myflorida.com. If
we don't receive any response from you within 30 days, Florida Medicaid will proceed with the
submission to CMS.
Sincerely,
2./-17;Z?
Justin IK Senior
Deputy Secretary for Medicaid
JMS/ac
cc: Denise Ward, Miccosukee Health Department
2727 Mahan Drive • Mail Stop #8 - Facebook.com/AHCAFIorida
Tallahassee, FL 32308 " * `� # ;, Youtube.com/AHCAFIorida
AHCA.MyFlorida.com -. y>' z Twitter.com/AHCA_FL
SlideShare.net/AHCAFIorida
AMENDMENT NO. 1
TO
AGREEENT FOR MEDICAL BILLING SERVICES FOR FIRE RESCUE
71-11S AMEND_ENT NO. 1 the Supplement) is made and entered into this '.. day of October, 2016 (the
-Effective Date") by and between City oI Tamarac, a municipal corporation of the State of Florida :"City", and
Advanced Data Processing, Inc., a subsidiary of Intermiedi_x Corporation,a De'aware corporation Contr tor').
WHEREAS, City and Contractor entered into Ag_ementfor Biding Services for Fire ?esc- ., effective
O-)ctocer!.,201E(the "Agreement");and
WHEREAS, City has requested and Contractor agrees to provide consulting services to City to enroll in the r loinda
EMS PEMT (Public Emergency Medical Transports) Medicaid program, and provide ongoing consulting/costing
se-;ices for both the Florida CPE (Certified Public Expenditures) PEMT and the proposed IOT (intergovernmental
Transfer)PEMT which includes Medicaid managed care rransports revenue programs(the "Consulting Services")for
arm of three('_+)Years from the Effective Date.
VOW THEREFORE,City and Contractor agree to amend the Agreement as follows:
1. New Exhibit 2(CPE-ASPP Program Scope of Consulting Services and Revenue Recognition Process)and
new Exhibit 2-A(Fees)attached herewith are hereby added to the Agreement.
2. Capitalized terms not otherwise defined in this Supplement shall have the meanings ascribed to such terms in
he Agreement. All terms and conditions of the Agreement are hereby ratified and shall remain in full force and effect
except to the extent this Supplement expressly modifies or is inconsistent with the terms and conditions of the
Agreement,in which case the terms of this Supplement shall be controlling.
fIWl-NE'SS Of paHeA rave .;z.,i+.ea Pits Sunplemer! ,II)oye.rlferenced. Agreement ,rfen se as of the
trate.
CITY CON TRACTOR:
CiTY OF TAMAR.Ai. ADVANCED DATA PROCESSING,INC.
a SI BSIDLARTY OF LNTERMM'EDD(
CORPORATION,a DELAWARE
iu?OW
CORDO TIONfro
r'
B /� BY 'e /-.C/..Zi/t;Gi")
Name: ... kkkC( ( C(ViCC..L.\olio II fool Name' .aid W WCk yvtc
Title: L;-� rulta-cr.\ .1.......AAq •<,Title: _f LQ - P{CSIc4-e.,4v —
•
•
+.RN..
C - ►_i I� o
� coat}
PAGE1
Exhibit 2
Description of Consulting Services and Revenue: Recognition Process
• Iarm of,:.lonsuicing Se.,-vices Three years from Amendment No. i Effective Date
• Drafting application materials and responding to requests or additional information necessary for the
provider to gain approval to participate in title :Ambulance Supplemental Payment Programs
• Preparing a fiscal impact study and presenting results to department/state stakeholders to demonstrate
benefits of a Continuing Public Expenditure Program. Medicaid Managed Care supole,mentai
payment, and uninsured CPE iti‘applicable)program to the provider
• Identifying eligible costs and developing appropriate cost allocation methodologies to report only allowable
costs for providing emergency medical services to Medicaid and, as applicable, iiniusured populations
• Preparing the annual Medicaid cost report for EMS on behalf of provider
• Conducting analysis of the Oro.iders financial and billing data in order to prepare and submit annual cos':
reports, the mechanism for providers te receive additional revenue untie! Ambulance Supplemental Payment
Programs
• Providing comprehensive desk review support, including but not limited to conducting reviews of all cost
settlement files,performing detailed analysis of billing reports generated by Medicaid agencies to ensure that
ail allowable charges and payments are encompassed in the calculation of the final settlement, and drafting
letters and providing supporting documentation to meet Medicaid requirements and expedite settlement
• Performing relevant analysis to determine a viable Medicaid managed care supplemental payment
methodology.
• Executing Medicaid managed trite supplemental payment calculations .n adherence with the approved
methodology
• Deter.nining enhanced ,aippleinenh psovH:n -1c7
• I Innaitdial
• charge maste, a. . eitt tiiu: e
• Meeting ,vith the Flu: tic Agent ftc Health are Administration AHCA, and City to turthei develop cci,
supplemental oaymetim prog-,-tin tot teem Medkatu marraged care. an_l 'a-itis:Art(1 par,M1kltttSOlS
• Respond to,and represent City on any AI-{CA or CMS audit,review or communication regarding any PEMT
cost report prepared by Contractor and delivered to ARCA. on behalf of the City.
PAGE 2
Appendix 2-A
FEES
2111 tatvedi,e .realized py the City. from the certified Publio Yxperiditure (CPE) Protiri fcd Emergency Medical
Services anal Medicaid Managed Care Supplemental Payment Program shall be paid in full directly to City. Revenue
realized as a result of the Certified Public Expenditures (CPE) fC Emergency Medical Seat toes (EMS') shall be
,determined Cy the Medicaid cost settlement determited through the Medicaid cost eport.
Revenues realized through the Medtcaid Managed Care Supplemental Payment Program will be defined through an
amendment tb Fourth Modirication of the Agreement upon the approval of the specific methodology successfully
implemented by Contractor and City. Contractor will not receive any compensation with the CPE for Emergency
Medical Set-,ices settlement or Medicaid Managed Care Supplemental Payment-revenues are 7eceiveci by the Cibi.
Contractor will invoice and rectiye revenue upon the receipt of revenue received by City for either iditiativemeaning
revenue does not have to be generated for both the CPE for Emergency Medical Services and the Medicaid Managed
Care Supplemental Payment program, rather revenue simply needs to be generated for either initiative to alloy: the
Contractor to generate invoices. Contractor will invoice City based on the final CPE for Emergency Medical Services
settlement or Medicaid Managed Care Supplemental payments within thirty(30)days of receipt of funds by the City.
City will remit payment to Contractor within thirty(30) days of invoice receipt. Additional revenues generated for the
uninsured patient population, will also be invoiced within thirty (30) days of receipt of revenues by the City. The
contingency fees to be paid associated with the respective successfift implementation and generation of incremental
Medicaid revenues as a result of the CPE for Emergency Medical Services and Medicaid Managed Care Supplemental
Payment programs are fifteen percent i5%)of City revenues.
PAGE 3