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Agreement No. 21-360
AGREEMENT
This AGREEMENT is made and entered into thi ~ day of >Pl::· , 2021, by and
between the COUNTY OF FRESNO, a Pol itical Subdivision of the State of California , hereinafter
referred to as "COUNTY", and Advanced Medical Management Inc., a California corporation , whose
address is 5000 Airport Plaza Dr., Suite 150, Long Beach, CA 90815, hereinafter referred to as
"CONTRACTOR".
WITNESSETH:
WHEREAS , COUNTY and CONTRACTOR entered into Agreement number A -18-584,
dated October 9, 2018 (hereinafter "Original Agreement"), pursuant to which CONTRACTOR
agreed to provide fiscal intermediary services for the COUNTY's Emergency Medical Services Fund
(EMSF); and ,
WHEREAS, the parties desire to execute this Agreement effective retroactive to July 1, 2021
to evidence the intent and actions of the parties for an agreement for fiscal intermediary services for
the COUNTY's EMSF, based on the terms and conditions of the Original Agreement.
NOW, THEREFORE, in consideration of the mutual covenants, terms and conditions herein
contained, the parties agree as follows:
1 . Notwithstanding anything to the contrary in the Original Agreement, the Original
Agreement is attached hereto, as Exhibit A , and incorporated herein as though its terms and
conditions are fully set forth below , and together with the terms and conditions set forth below ,
constitute the entire agreement and understanding between CONTRACTOR and COUNTY
concerning the subject matter hereof for the term hereof, and supersede all previous negotiations ,
proposals, commitments , writings , advertisements, publications and understandings of any nature
whatsoever unless expressly included in and modified by this Agreement.
Ill
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12345678I101112131415161718192021222324252627282. TERM:The term of this Agreement shall commence July 1,2021 and shall continue in fullforce and effect through June 30,2022, This Agreement may be extended for one (1) additionaltwelve (12) month period, upon written approval of both parties no later than thirty (30) days prior tothe first day of the next twelve (12) month extension period. The COUNTY DPH Director or his orher designee is authorized to execute such written approval on behalf of COUNTY based onCO NTRACTO R'S satisfactory performance.3. Section Five (5), Subsections O and P, in the OriginalAgreement, beginning onPage Five (5), Line Two (2) and ending on Page Five (5), Line Five (5) shall be deleted in theirentirety.4. Because this Agreement is effective retroactive to July 1,2021, any services thathave been performed, and for which compensation or reimbursement of expenses has been paid,prior to the execution of this Agreement are hereby approved and ratified by the parties. Except asmodified herein, the terms and conditions of the Original Agreement are ratified and restated hereinin full, and all remaining terms and conditions contained in the Original Agreement, that are notmodified herein, shall remain in fullforce and effect during the term of this Agreement.5. ELECTRONIC SIGNATURE:The parties agree that this Agreement may be executed by electronic signature asprovided in this section. An "electronic signature" means any symbol or process intended by anindividual signing this Agreement to represent their signature, including but not limited to (1) a digitalsignature; (2) a faxed version of an original handwritten signature; or (3) an electronically scanned andtransmitted (for example by PDF document) of a handwritten signature. Each electronic signatureaffixed or attached to this Agreement (1) is deemed equivalent to a valid original handwritten signatureof the person signing this Agreement for all purposes, including but not limited to evidentiary proof inany administrative or judicial proceeding, and (2) has the same force and effect as the valid original-2
1234567BI10111213141516171B19202122232425262728handwritten signature of that person. The provisions of this section satisfy the requirements of CivilCode section 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,part2,Tifle 2.5, beginning with section 1633.1). Each party using a digital signature represents that ithas undertaken and satisfied the requirements of Government Code section 16.5, subdivision (a),paragraphs (1) through (5), and agrees that each other party may rely upon that representation. ThisAgreement is not conditioned upon the parties conducting the transactions under it by electronicmeans and either party may sign this Agreement with an original handwritten signature.iltiltilliltiltiltiltiltiltilliltiltiltillIllllliltiltiltilt-3-
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IN WITNESS WHEREOF , the parties hereto have executed this Agreement as of the day and year
first hereinabove written.
CONTRACTOR: ADVANCED
MEDICAL MA NT,INC.
Mailing Address:
Advanced Medical Management, Inc.
5000 Airport Plaza Drive , Suite 150
Long Beach , CA 90815
FOR ACCOUNTING USE ONLY:
Fund :0130
Subclass : 10000
ORG : 52440200
Account: 7295
COUNTYOF k
Steve Bran u , Chairman of the Board
of Supervisors of the County of Fresno
ATTEST:
Bernice E . Seidel
Clerk of the Board of Supervisors
County of Fresno , State of California
By : _...,._j -'4~==•;__..;:~=c..;;;e~p-,.....tY, ______ _
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A G R E E M E N T
THIS AGREEMENT is made and entered into this 9th day of October, 2018, by
and between the COUNTY OF FRESNO, a Political Subdivision of the State of California,
hereinafter referred to as "COUNTY", and Advanced Medical Management Inc., a California
corporation whose address is 5000 Airport Plaza Dr., Suite 150, Long Beach CA 90815,
hereinafter referred to as "CONTRACTOR".
W I T N E S S E T H:
WHEREAS, COUNTY established the Emergency Medical Services Fund (EMSF)
Program in accordance with California Health and Safety Code Section 1797.98a; and
WHEREAS, a portion of the EMSF is designated as the Physicians’ Allocation; and,
WHEREAS, COUNTY issued Request for Quotation #18-013 for fiscal intermediary
services for the EMSF and CONTRACTOR was the successful bidder; and,
WHEREAS, the parties wish to provide for equitable reimbursement of those providing
EMSF Program services with a minimum of administrative costs; and,
WHEREAS, the parties desire to state their respective rights and responsibilities related
to providing, claiming, and reimbursing EMSF Program services.
WHEREAS, COUNTY wishes to contract with CONTRACTOR for the provision of Fiscal
Intermediary Services for Emergency Medical Services Fund Program services described
herein to the residents of Fresno County; and
WHEREAS, CONTRACTOR is agreeable to the rendering of such services on the terms
and conditions hereinafter set forth:
NOW, THEREFORE, in consideration of the mutual covenants, terms and conditions herein
contained, the parties hereto agree as follows:
1.OBLIGATIONS OF THE CONTRACTOR
A.CONTRACTOR shall provide fiscal intermediary services as outlined in
Exhibit A, attached hereto and by this reference incorporated herein.
2.OBLIGATIONS OF THE COUNTY
Agreement No. 18-584
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A. COUNTY shall provide general oversight of the program including
appropriate financial and contract monitoring and review and analysis of data gathered and
reported.
B. COUNTY shall also provide evaluation and standards assurance of the
program.
3. TERM
The term of this Agreement shall be for a period of three (3) years,
commencing on October 9, 2018 through and including June 30, 2021. This Agreement may be
extended for two (2) additional consecutive twelve (12) month periods upon written approval of
both parties no later than thirty (30) days prior to the first day of the next twelve (12) month
extension period. The Director of the Department of Public Health or his or her designee is
authorized to execute such written approval on behalf of COUNTY based on CONTRACTOR’S
satisfactory performance.
4. TERMINATION
A. Non-Allocation of Funds - The terms of this Agreement, and the services to
be provided hereunder, are contingent on the approval of funds by the appropriating government
agency. Should sufficient funds not be allocated, the services provided may be modified, or this
Agreement terminated, at any time by giving the CONTRACTOR thirty (30) days advance written
notice.
B. Breach of Contract - The COUNTY may immediately suspend or terminate
this Agreement in whole or in part, where in the determination of the COUNTY there is:
1) An illegal or improper use of funds;
2) A failure to comply with any term of this Agreement;
3) A substantially incorrect or incomplete report submitted to the
COUNTY;
4) Improperly performed service.
In no event shall any payment by the COUNTY constitute a waiver by the COUNTY
of any breach of this Agreement or any default which may then exist on the part of the
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CONTRACTOR. Neither shall such payment impair or prejudice any remedy available to the
COUNTY with respect to the breach or default. The COUNTY shall have the right to demand of
the CONTRACTOR the repayment to the COUNTY of any funds disbursed to the CONTRACTOR
under this Agreement, which in the judgment of the COUNTY were not expended in accordance
with the terms of this Agreement. The CONTRACTOR shall promptly refund any such funds upon
demand.
C. Without Cause - Under circumstances other than those set forth above,
this Agreement may be terminated by COUNTY upon the giving of thirty (30) days advance written
notice of an intention to terminate to CONTRACTOR.
5. COMPENSATION/INVOICING: COUNTY agrees to pay CONTRACTOR and
CONTRACTOR agrees to receive compensation as follows:
A. $5.00 per Claim adjudicated by CONTRACTOR from Physicians eligible to
submit claims.
B. Ad hoc reporting, consulting, and other administrative services provided
upon written request of COUNTY shall be subject to a $200/hour fee,
C. The period of July 1, 2018 through June 30, 2019 shall include an
additional Twenty-Five Thousand and 00/100 Dollars ($25,000) lump sum implementation fee
payable to CONTRACTOR.
D. The total of all compensation paid to CONTRACTOR in a given fiscal year,
shall not exceed 9.5 percent of all deposits to and appropriations for the Emergency Medical
Services Fund for each fiscal year. To the extent that the total of all compensation paid is less
than the 9.5 percent maximum, the balance shall remain in the Physicians’ Allocation for
distribution to physicians.
E. For fiscal intermediary services provided by CONTRACTOR in accordance
with the Agreement, COUNTY shall, upon receipt of an appropriate invoice, pay CONTRACTOR
monthly, in arrears.
F. For purposes of reimbursement to CONTRACTOR, a Claim shall be
reimbursed regardless of the adjudication result, including claims that are paid, denied, duplicated,
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and re-submitted.
G. COUNTY shall pay CONTRACTOR quarterly in an amount not to exceed
the share of EMSF revenues received by COUNTY allocated for the reimbursement of physician
claims. Such funds shall be immediately deposited by CONTRACTOR into an interest-bearing
account controlled by CONTRACTOR for reimbursement of Physician Claims received on or after
July 1st of each fiscal year.
H. If CONTRACTOR determines that the fees to maintain an interest-bearing
account exceed the projected interest to be earned, CONTRACTOR shall recommend to
COUNTY that such funds be maintained in a non-interest-bearing account. Approval of the
recommendation shall be at the sole discretion of COUNTY.
I. Upon determination by CONTRACTOR that the account requires additional
funds for reimbursement of claims authorized in accordance with the Agreement, CONTRACTOR
shall submit a supplemental invoice to COUNTY, together with any documentation that may be
required by COUNTY.
J. Monthly, CONTRACTOR shall forward COUNTY an electronic copy of the
most current bank statement(s) and reconciliation with respect to all monies disbursed pursuant to
the Agreement.
K. All billings to COUNTY shall be supported by source documentation
including, but not limited to, provider claims, ledgers, journals, bank statements, canceled checks,
and records of services paid. In support of billing, CONTRACTOR shall submit a Claims
Processed Report in an electronic format acceptable to COUNTY.
L. For the period of October 1, 2018 through June 30, 2019, the amount of
this Agreement shall not exceed One Million Six Hundred Thousand and 00/100 Dollars
($1,600,000.00). The maximum amount for this period is larger than that of subsequent periods
due to COUNTY claims backlog to be resolved by CONTRACTOR during the period.
M. For the period of July 1, 2019 through June 30, 2020 the amount of this
Agreement shall not exceed Five Hundred Thirty Thousand and 00/100 Dollars ($530,000.00).
N. For the period of July 1, 2020 through June 30, 2021 the amount of this
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Agreement shall not exceed Five Hundred Thirty Thousand and 00/100 Dollars ($530,000.00)
O. For the period of July 1, 2021 through June 30, 2022 the amount of this
Agreement shall not exceed Five Hundred Thirty Thousand and 00/100 Dollars ($530,000.00)
P. For the period of July 1, 2022 through June 30, 2023 the amount of this
Agreement shall not exceed Five Hundred Thirty Thousand and 00/100 Dollars ($530,000.00).
Q. The maximum monetary compensation payable under the agreement shall
not exceed Three Million Seven Hundred Twenty Thousand and 00/100 Dollars ($3,720,000) for
the full five (5) year term.
6. INDEPENDENT CONTRACTOR: In performance of the work, duties and
obligations assumed by CONTRACTOR under this Agreement, it is mutually understood and
agreed that CONTRACTOR, including any and all of the CONTRACTOR'S officers, agents, and
employees will at all times be acting and performing as an independent contractor, and shall act in
an independent capacity and not as an officer, agent, servant, employee, joint venturer, partner, or
associate of the COUNTY. Furthermore, COUNTY shall have no right to control or supervise or
direct the manner or method by which CONTRACTOR shall perform its work and function.
However, COUNTY shall retain the right to administer this Agreement so as to verify that
CONTRACTOR is performing its obligations in accordance with the terms and conditions thereof.
CONTRACTOR and COUNTY shall comply with all applicable provisions of
law and the rules and regulations, if any, of governmental authorities having jurisdiction over
matters the subject thereof.
Because of its status as an independent contractor, CONTRACTOR shall have
absolutely no right to employment rights and benefits available to COUNTY employees.
CONTRACTOR shall be solely liable and responsible for providing to, or on behalf of, its
employees all legally-required employee benefits. In addition, CONTRACTOR shall be solely
responsible and save COUNTY harmless from all matters relating to payment of
CONTRACTOR'S employees, including compliance with Social Security withholding and all other
regulations governing such matters. It is acknowledged that during the term of this Agreement,
CONTRACTOR may be providing services to others unrelated to the COUNTY or to this
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Agreement.
7. MODIFICATION: Any matters of this Agreement may be modified from time
to time by the written consent of all the parties without, in any way, affecting the remainder.
8. NON-ASSIGNMENT: Neither party shall assign, transfer or sub-contract this
Agreement nor their rights or duties under this Agreement without the prior written consent of the
other party.
9. HOLD HARMLESS: CONTRACTOR agrees to indemnify, save, hold
harmless, and at COUNTY'S request, defend the COUNTY, its officers, agents, and employees
from any and all costs and expenses, damages, liabilities, claims, and losses occurring or
resulting to COUNTY in connection with the performance, or failure to perform, by
CONTRACTOR, its officers, agents, or employees under this Agreement, and from any and all
costs and expenses, damages, liabilities, claims, and losses occurring or resulting to any person,
firm, or corporation who may be injured or damaged by the performance, or failure to perform,
of CONTRACTOR, its officers, agents, or employees under this Agreement.
10. INSURANCE
Without limiting the COUNTY's right to obtain indemnification from
CONTRACTOR or any third parties, CONTRACTOR, at its sole expense, shall maintain in full
force and effect, the following insurance policies or a program of self-insurance, including but not
limited to, an insurance pooling arrangement or Joint Powers Agreement (JPA) throughout the
term of the Agreement:
A. Commercial General Liability
Commercial General Liability Insurance with limits of not less than Two Million Dollars
($2,000,000.00) per occurrence and an annual aggregate of Four Million Dollars ($4,000,000.00). This
policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including
completed operations, products liability, contractual liability, Explosion-Collapse-Underground, fire legal
liability or any other liability insurance deemed necessary because of the nature of this contract.
B. Automobile Liability
Comprehensive Automobile Liability Insurance with limits of not less than One Million
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Dollars ($1,000,000.00) per accident for bodily injury and for property damages. Coverage should include
any auto used in connection with this Agreement.
C. Professional Liability
If CONTRACTOR employs licensed professional staff, (e.g., Ph.D., R.N., L.C.S.W.,
M.F.C.C.) in providing services, Professional Liability Insurance with limits of not less than One Million
Dollars ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate.
D. Worker's Compensation
A policy of Worker's Compensation insurance as may be required by the
California Labor Code.
CONTRACTOR shall obtain endorsements to the Commercial General Liability
insurance naming the County of Fresno, its officers, agents, and employees, individually and
collectively, as additional insured, but only insofar as the operations under this Agreement are
concerned. Such coverage for additional insured shall apply as primary insurance and any other
insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees shall be
excess only and not contributing with insurance provided under CONTRACTOR's policies herein.
This insurance shall not be cancelled or changed without a minimum of thirty (30) days advance
written notice given to COUNTY.
Within Thirty (30) days from the date CONTRACTOR signs and executes this
Agreement, CONTRACTOR shall provide certificates of insurance and endorsement as stated
above for all of the foregoing policies, as required herein, to the County of Fresno, (Name and
Address of the official who will administer this contract), stating that such insurance coverage have
been obtained and are in full force; that the County of Fresno, its officers, agents and employees
will not be responsible for any premiums on the policies; that such Commercial General Liability
insurance names the County of Fresno, its officers, agents and employees, individually and
collectively, as additional insured, but only insofar as the operations under this Agreement are
concerned; that such coverage for additional insured shall apply as primary insurance and any
other insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees,
shall be excess only and not contributing with insurance provided under CONTRACTOR's policies
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herein; and that this insurance shall not be cancelled or changed without a minimum of thirty (30)
days advance, written notice given to COUNTY.
In the event CONTRACTOR fails to keep in effect at all times insurance
coverage as herein provided, the COUNTY may, in addition to other remedies it may have,
suspend or terminate this Agreement upon the occurrence of such event.
All policies shall be issued by admitted insurers licensed to do business in the
State of California, and such insurance shall be purchased from companies possessing a current
A.M. Best, Inc. rating of A FSC VII or better.
11. AUDITS AND INSPECTIONS: The CONTRACTOR shall at any time during
business hours, and as often as the COUNTY may deem necessary, make available to the
COUNTY for examination all of its records and data with respect to the matters covered by this
Agreement. The CONTRACTOR shall, upon request by the COUNTY, permit the COUNTY to
audit and inspect all of such records and data necessary to ensure CONTRACTOR'S compliance
with the terms of this Agreement.
If this Agreement exceeds ten thousand dollars ($10,000.00), CONTRACTOR
shall be subject to the examination and audit of the Auditor General for a period of three (3) years
after final payment under contract (Government Code Section 8546.7).
12. NOTICES: The persons and their addresses having authority to give and
receive notices under this Agreement include the following:
COUNTY CONTRACTOR
COUNTY OF FRESNO Advanced Medical Management Department of Public Health 5000 Airport Plaza Drive, Suite 150 1221 Fulton Street Long Beach, CA 90815 Fresno, CA 93721
All notices between the COUNTY and CONTRACTOR provided for or
permitted under this Agreement must be in writing and delivered either by personal service, by
first-class United States mail, by an overnight commercial courier service, or by telephonic
facsimile transmission. A notice delivered by personal service is effective upon service to the
recipient. A notice delivered by first-class United States mail is effective three COUNTY business
days after deposit in the United States mail, postage prepaid, addressed to the recipient. A notice
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delivered by an overnight commercial courier service is effective one COUNTY business day after
deposit with the overnight commercial courier service, delivery fees prepaid, with delivery
instructions given for next day delivery, addressed to the recipient. A notice delivered by
telephonic facsimile is effective when transmission to the recipient is completed (but, if such
transmission is completed outside of COUNTY business hours, then such delivery shall be
deemed to be effective at the next beginning of a COUNTY business day), provided that the
sender maintains a machine record of the completed transmission. For all claims arising out of or
related to this Agreement, nothing in this section establishes, waives, or modifies any claims
presentation requirements or procedures provided by law, including but not limited to the
Government Claims Act (Division 3.6 of Title 1 of the Government Code, beginning with section
810).
13. GOVERNING LAW: Venue for any action arising out of or related to this
Agreement shall only be in Fresno County, California.
The rights and obligations of the parties and all interpretation and performance
of this Agreement shall be governed in all respects by the laws of the State of California.
14. DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR is operating as a
corporation (a for-profit or non-profit corporation) or if during the term of the agreement, the
CONTRACTOR changes its status to operate as a corporation.
Members of the CONTRACTOR’s Board of Directors shall disclose any self-
dealing transactions that they are a party to while CONTRACTOR is providing goods or
performing services under this agreement. A self-dealing transaction shall mean a transaction
to which the CONTRACTOR is a party and in which one or more of its directors has a material
financial interest. Members of the Board of Directors shall disclose any self-dealing
transactions that they are a party to by completing and signing a Self-Dealing Transaction
Disclosure Form, attached hereto as Exhibit B and incorporated herein by reference, and
submitting it to the COUNTY prior to commencing with the self-dealing transaction or
immediately thereafter.
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15. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
A. The parties to this Agreement shall be in strict conformance with all
applicable Federal and State of California laws and regulations, including but not limited to
Sections 5328, 10850, and 14100.2 et seq. of the Welfare and Institutions Code, Sections 2.1
and 431.300 et seq. of Title 42, Code of Federal Regulations (CFR), Section 56 et seq. of the
California Civil Code and the Health Insurance Portability and Accountability Act (HIPAA),
including but not limited to Section 1320 D et seq. of Title 42, United States Code (USC) and its
implementing regulations, including, but not limited to Title 45, CFR, Sections 142, 160, 162, and
164, The Health Information Technology for Economic and Clinical Health Act (HITECH)
regarding the confidentiality and security of patient information, and the Genetic Information
Nondiscrimination Act (GINA) of 2008 regarding the confidentiality of genetic information.
Except as otherwise provided in this Agreement, CONTRACTOR, as a
Business Associate of COUNTY, may use or disclose Protected Health Information (PHI) to
perform functions, activities or services for or on behalf of COUNTY, as specified in this
Agreement, provided that such use or disclosure shall not violate the Health Insurance Portability
and Accountability Act (HIPAA), USC 1320d et seq. The uses and disclosures of PHI may not be
more expansive than those applicable to COUNTY, as the “Covered Entity” under the HIPAA
Privacy Rule (45 CFR 164.500 et seq.), except as authorized for management, administrative or
legal responsibilities of the Business Associate.
B. CONTRACTOR, including its subcontractors and employees, shall
protect, from unauthorized access, use, or disclosure of names and other identifying information,
including genetic information, concerning persons receiving services pursuant to this Agreement,
except where permitted in order to carry out data aggregation purposes for health care
operations [45 CFR Sections 164.504 (e)(2)(i), 164.504 (3)(2)(ii)(A), and 164.504 (e)(4)(i)] This
pertains to any and all persons receiving services pursuant to a COUNTY funded program. This
requirement applies to electronic PHI. CONTRACTOR shall not use such identifying information
or genetic information for any purpose other than carrying out CONTRACTOR’s obligations
under this Agreement.
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C. CONTRACTOR, including its subcontractors and employees, shall not
disclose any such identifying information or genetic information to any person or entity, except as
otherwise specifically permitted by this Agreement, authorized by Subpart E of 45 CFR Part 164
or other law, required by the Secretary, or authorized by the client/patient in writing. In using or
disclosing PHI that is permitted by this Agreement or authorized by law, CONTRACTOR shall
make reasonable efforts to limit PHI to the minimum necessary to accomplish intended purpose
of use, disclosure or request.
D. For purposes of the above sections, identifying information shall include,
but not be limited to name, identifying number, symbol, or other identifying particular assigned to
the individual, such as finger or voice print, or photograph.
E. For purposes of the above sections, genetic information shall include
genetic tests of family members of an individual or individual, manifestation of disease or disorder
of family members of an individual, or any request for or receipt of, genetic services by individual
or family members. Family member means a dependent or any person who is first, second, third,
or fourth degree relative.
F. CONTRACTOR shall provide access, at the request of COUNTY, and
in the time and manner designated by COUNTY, to PHI in a designated record set (as defined
in 45 CFR Section 164.501), to an individual or to COUNTY in order to meet the requirements
of 45 CFR Section 164.524 regarding access by individuals to their PHI. With respect to
individual requests, access shall be provided within thirty (30) days from request. Access may
be extended if CONTRACTOR cannot provide access and provides individual with the reasons
for the delay and the date when access may be granted. PHI shall be provided in the form
and format requested by the individual or COUNTY.
CONTRACTOR shall make any amendment(s) to PHI in a designated
record set at the request of COUNTY or individual, and in the time and manner designated by
COUNTY in accordance with 45 CFR Section 164.526.
CONTRACTOR shall provide to COUNTY or to an individual, in a time and
manner designated by COUNTY, information collected in accordance with 45 CFR Section
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164.528, to permit COUNTY to respond to a request by the individual for an accounting of
disclosures of PHI in accordance with 45 CFR Section 164.528.
G. CONTRACTOR shall report to COUNTY, in writing, any knowledge or
reasonable belief that there has been unauthorized access, viewing, use, disclosure, security
incident, or breach of unsecured PHI not permitted by this Agreement of which it becomes aware,
immediately and without reasonable delay and in no case later than two (2) business days of
discovery. Immediate notification shall be made to COUNTY’s Information Security Officer and
Privacy Officer and COUNTY’s DPH HIPAA Representative, within two (2) business days of
discovery. The notification shall include, to the extent possible, the identification of each
individual whose unsecured PHI has been, or is reasonably believed to have been, accessed,
acquired, used, disclosed, or breached. CONTRACTOR shall take prompt corrective action to
cure any deficiencies and any action pertaining to such unauthorized disclosure required by
applicable Federal and State Laws and regulations. CONTRACTOR shall investigate such
breach and is responsible for all notifications required by law and regulation or deemed
necessary by COUNTY and shall provide a written report of the investigation and reporting
required to COUNTY’s Information Security Officer and Privacy Officer and COUNTY’s DPH
HIPAA Representative. This written investigation and description of any reporting necessary
shall be postmarked within the thirty (30) working days of the discovery of the breach to the
addresses below:
County of Fresno County of Fresno County of Fresno
Dept. of Public Health Dept. of Public Health Information Technology Services
HIPAA Representative Privacy Officer Information Security Officer
(559) 600-6439 (559) 600-6405 (559) 600-5800
P.O. Box 11867 P.O. Box 11867 333 W. Pontiac Way
Fresno, CA 93775 Fresno, CA 93775 Clovis, CA 93612
H. CONTRACTOR shall make its internal practices, books, and records
relating to the use and disclosure of PHI received from COUNTY, or created or received by the
CONTRACTOR on behalf of COUNTY, in compliance with HIPAA’s Privacy Rule, including, but
not limited to the requirements set forth in Title 45, CFR, Sections 160 and 164. CONTRACTOR
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shall make its internal practices, books, and records relating to the use and disclosure of PHI
received from COUNTY, or created or received by the CONTRACTOR on behalf of COUNTY,
available to the United States Department of Health and Human Services (Secretary) upon
demand.
CONTRACTOR shall cooperate with the compliance and investigation
reviews conducted by the Secretary. PHI access to the Secretary must be provided during the
CONTRACTOR’s normal business hours, however, upon exigent circumstances access at any
time must be granted. Upon the Secretary’s compliance or investigation review, if PHI is
unavailable to CONTRACTOR and in possession of a Subcontractor, it must certify efforts to
obtain the information to the Secretary.
I. Safeguards
CONTRACTOR shall implement administrative, physical, and technical
safeguards as required by the HIPAA Security Rule, Subpart C of 45 CFR 164, that reasonably
and appropriately protect the confidentiality, integrity, and availability of PHI, including electronic
PHI, that it creates, receives, maintains or transmits on behalf of COUNTY and to prevent
unauthorized access, viewing, use, disclosure, or breach of PHI other than as provided for by this
Agreement. CONTRACTOR shall conduct an accurate and thorough assessment of the potential
risks and vulnerabilities to the confidential, integrity and availaibility of electronic PHI.
CONTRACTOR shall develop and maintain a written information privacy and security program
that includes administrative, technical and physical safeguards appropriate to the size and
complexity of CONTRACTOR’s operations and the nature and scope of its activities. Upon
COUNTY’s request, CONTRACTOR shall provide COUNTY with information concerning such
safeguards.
CONTRACTOR shall implement strong access controls and other security
safeguards and precautions in order to restrict logical and physical access to confidential,
personal (e.g., PHI) or sensitive data to authorized users only. Said safeguards and precautions
shall include the following administrative and technical password controls for all systems used to
process or store confidential, personal, or sensitive data:
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1. Passwords must not be:
a. Shared or written down where they are accessible or
recognizable by anyone else; such as taped to computer screens, stored under keyboards, or
visible in a work area;
b. A dictionary word; or
c. Stored in clear text
2. Passwords must be:
a. Eight (8) characters or more in length;
b. Changed every ninety (90) days;
c. Changed immediately if revealed or compromised; and
d. Composed of characters from at least three (3) of the
following four (4) groups from the standard keyboard:
1) Upper case letters (A-Z);
2) Lowercase letters (a-z);
3) Arabic numerals (0 through 9); and
4) Non-alphanumeric characters (punctuation symbols).
CONTRACTOR shall implement the following security controls on each
workstation or portable computing device (e.g., laptop computer) containing confidential,
personal, or sensitive data:
1. Network-based firewall and/or personal firewall;
2. Continuously updated anti-virus software; and
3. Patch management process including installation of all operating
system/software vendor security patches.
CONTRACTOR shall utilize a commercial encryption solution that has
received FIPS 140-2 validation to encrypt all confidential, personal, or sensitive data stored on
portable electronic media (including, but not limited to, compact disks and thumb drives) and
on portable computing devices (including, but not limited to, laptop and notebook computers).
CONTRACTOR shall not transmit confidential, personal, or sensitive data
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via e-mail or other internet transport protocol unless the data is encrypted by a solution that
has been validated by the National Institute of Standards and Technology (NIST) as
conforming to the Advanced Encryption Standard (AES) Algorithm. CONTRACTOR must apply
appropriate sanctions against its employees who fail to comply with these safeguards. CONTRACTOR
must adopt procedures for terminating access to PHI when employment of employee ends.
J. Mitigation of Harmful Effects
CONTRACTOR shall mitigate, to the extent practicable, any harmful effect
that is suspected or known to CONTRACTOR of an unauthorized access, viewing, use,
disclosure, or breach of PHI by CONTRACTOR or its subcontractors in violation of the
requirements of these provisions. CONTRACTOR must document suspected or known
harmful effects and the outcome.
K. CONTRACTOR’s Subcontractors
CONTRACTOR shall ensure that any of its contractors, including
subcontractors, if applicable, to whom CONTRACTOR provides PHI received from or created
or received by CONTRACTOR on behalf of COUNTY, agree to the same restrictions,
safeguards, and conditions that apply to CONTRACTOR with respect to such PHI and to
incorporate, when applicable, the relevant provisions of these provisions into each subcontract
or sub-award to such agents or subcontractors..
L. Employee Training and Discipline
CONTRACTOR shall train and use reasonable measures to ensure
compliance with the requirements of these provisions by employees who assist in the
performance of functions or activities on behalf of COUNTY under this Agreement and use or
disclose PHI and discipline such employees who intentionally violate any provisions of these
provisions, including termination of employment.
M. Termination for Cause
Upon COUNTY’s knowledge of a material breach of these provisions by
CONTRACTOR, COUNTY shall either:
1. Provide an opportunity for CONTRACTOR to cure the breach
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or end the violation and terminate this Agreement if CONTRACTOR does not cure the breach
or end the violation within the time specified by COUNTY; or
2. Immediately terminate this Agreement if CONTRACTOR has
breached a material term of these provisions and cure is not possible.
3. If neither cure nor termination is feasible, the COUNTY’s Privacy
Officer shall report the violation to the Secretary of the U.S. Department of Health and Human
Services.
N. Judicial or Administrative Proceedings
COUNTY may terminate this Agreement in accordance with the terms and
conditions of this Agreement as written hereinabove, if: (1) CONTRACTOR is found guilty in a
criminal proceeding for a violation of the HIPAA Privacy or Security Laws or the HITECH Act;
or (2) a finding or stipulation that the CONTRACTOR has violated a privacy or security
standard or requirement of the HITECH Act, HIPAA or other security or privacy laws in an
administrative or civil proceeding in which the CONTRACTOR is a party.
O. Effect of Termination
Upon termination or expiration of this Agreement for any reason,
CONTRACTOR shall return or destroy all PHI received from COUNTY (or created or received
by CONTRACTOR on behalf of COUNTY) that CONTRACTOR still maintains in any form, and
shall retain no copies of such PHI. If return or destruction of PHI is not feasible, it shall
continue to extend the protections of these provisions to such information, and limit further use
of such PHI to those purposes that make the return or destruction of such PHI infeasible. This
provision shall apply to PHI that is in the possession of subcontractors or agents, if applicable,
of CONTRACTOR. If CONTRACTOR destroys the PHI data, a certification of date and time of
destruction shall be provided to the COUNTY by CONTRACTOR.
P. Disclaimer
COUNTY makes no warranty or representation that compliance by
CONTRACTOR with these provisions, the HITECH Act, HIPAA or the HIPAA regulations will
be adequate or satisfactory for CONTRACTOR’s own purposes or that any information in
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CONTRACTOR’s possession or control, or transmitted or received by CONTRACTOR, is or
will be secure from unauthorized access, viewing, use, disclosure, or breach. CONTRACTOR
is solely responsible for all decisions made by CONTRACTOR regarding the safeguarding of
PHI.
Q. Amendment
The parties acknowledge that Federal and State laws relating to electronic
data security and privacy are rapidly evolving and that amendment of these provisions may be
required to provide for procedures to ensure compliance with such developments. The parties
specifically agree to take such action as is necessary to amend this agreement in order to
implement the standards and requirements of HIPAA, the HIPAA regulations, the HITECH Act
and other applicable laws relating to the security or privacy of PHI. COUNTY may terminate
this Agreement upon thirty (30) days written notice in the event that CONTRACTOR does not
enter into an amendment providing assurances regarding the safeguarding of PHI that
COUNTY in its sole discretion, deems sufficient to satisfy the standards and requirements of
HIPAA, the HIPAA regulations and the HITECH Act.
R. No Third-Party Beneficiaries
Nothing express or implied in the terms and conditions of these provisions
is intended to confer, nor shall anything herein confer, upon any person other than COUNTY
or CONTRACTOR and their respective successors or assignees, any rights, remedies,
obligations or liabilities whatsoever.
S. Interpretation
The terms and conditions in these provisions shall be interpreted as
broadly as necessary to implement and comply with HIPAA, the HIPAA regulations and
applicable State laws. The parties agree that any ambiguity in the terms and conditions of
these provisions shall be resolved in favor of a meaning that complies and is consistent with
HlPAA and the HIPAA regulations.
T. Regulatory References
A reference in the terms and conditions of these provisions to a section in
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the HIPAA regulations means the section as in effect or as amended.
U.Survival
The respective rights and obligations of CONTRACTOR as stated in this
Section shall survive the termination or expiration of this Agreement.
V.No Waiver of Obligations
No change, waiver or discharge of any liability or obligation hereunder on
any one or more occasions shall be deemed a waiver of performance of any continuing or
other obligation, or shall prohibit enforcement of any obligation on any other occasion.
16.NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR shall not
unlawfully discriminate against any employee or applicant for employment, or recipient of
services, because of race, religious creed, color, national origin, ancestry, physical disability,
mental disability, medical condition, genetic information, marital status, sex, gender, gender
identity, gender expression, age, sexual orientation, military status or veteran status pursuant to
all applicable State of California and Federal statutes and regulation.
17.SEVERABILITY
The provisions of this Agreement are severable. The invalidity or
unenforceability of any one provision in the Agreement shall not affect the other provisions.
18.ENTIRE AGREEMENT: This Agreement constitutes the entire agreement
between the CONTRACTOR and COUNTY with respect to the subject matter hereof and
supersedes all previous Agreement negotiations, proposals, commitments, writings,
advertisements, publications, and understanding of any nature whatsoever unless expressly
included in this Agreement. In the event of any inconsistency in interpreting the documents which
constitute this Agreement, the inconsistency shall be resolved by giving precedence in the
following order of priority: (1) the text of this Agreement (excluding Exhibit "C", the COUNTY'S
Request for Quotation/Proposal No. RFQ 18-013 and the CONTRACTOR'S Quote/Proposal in
response thereto); (2) the COUNTY'S Request for Quotation/Proposal No. 18-013; and (3) the
CONTRACTOR'S quotation/proposal made in response to COUNTY'S Request for
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Quotation/Proposal No. 18-013.]
1 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and
2 year first hereinabove written.
3 COUNTY OF FRESNO
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-i---'--.\-----l-_!..._--=------U-=--~e:.....=..---'--'~::..__ ___ _
Kathy Hegstrom, President
Print Name & Title
5000 Airport Plaza Drive, Suite 150
Long Beach, CA 90815
Mailing Address
FOR ACCOUNTING USE ONLY:
Fund:
Org:
Account:
0130
5244
7295
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ATTEST:
Chaiperson of the Board of
"'l'IW?.l,W<> of the County of Fresno
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno, State of California
By~(',n
Deputy
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EXHIBIT A
I.SCOPE OF WORK
A.Fully adjudicate claims received on a monthly basis received from authorized providers within
forty-five (45) business days after receipt of correctly submitted claims or invoices, and
supporting documentation (when applicable), at the rate specified by the County, and make
other required payments.
B.CONTRACTOR shall continuously provide sufficient staffing including production, supervisory
and management staff to ensure timely and efficient performance of the services herein.
C.Receive, maintain, collect, and account for funds.
D.Review all claims to ensure County responsibility is verified including but not limited to checking
against Medi-Cal eligibility lists and verifying physician efforts to collect payments. Ensure that
the County is the payor of last resort.
E.Apply industry standard procedures for claims review. Request supporting claims
documentation from authorized providers when appropriate. Deny all claims that do not meet
the conditions and requirements for claims submission, processing, and reimbursement.
F.Notify providers in writing of the reason for any denial of a Claim(s).
G.CONTRACTOR shall submit their procedures for claims review to the County within thirty (30)
calendar days of the start of the executed contract.
H.Receive, compile, preserve, and report information and data to the County on a monthly
schedule to be agreed upon between the County and the CONTRACTOR. Reports shall be
provided as a Microsoft Excel spreadsheet or format mutually agreed upon by all parties, and/or
shall be available to the County via a secure web-based reporting tool/portal. General types of
reports for all programs shall include, but not be limited to:
1.Claims Detail Report and Claims Summary Report
2.Claims Status Report and Claims Status Summary Report
3.Fund Reconciliation Report
4.Account Statement
5.Service Utilization Report
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6.Recovery Account Status Report
7.Denial Report
8.Ad-hoc Reports
I.Implement HIPAA compliant encryption security measures for authorized providers to submit
electronic claims data; provide training to providers on those security measures, and ensure
those security measures are adhered to
J.Designate a primary and alternate contact persons dedicated to facilitating communication with
authorized providers submitting claims, County staff, and authorized patient representatives,
and ensure all parties have the relevant phone number and email address.
K.Retain and maintain all records relating to patient care unless Agreement is terminated in which
CONTRACTOR will forward all records to the appropriate vendor or return to COUNTY upon
COUNTY’s instruction.
L.Review and pay claims based on the date services are provided; and in strict accordance with
Maddy Emergency Medical Services Fund requirements enumerated by the State of California
and COUNTY.
M.Authorized providers shall have up to one hundred twenty (120) days of the date of service to
submit claims for services; however, they cannot bill for services prior to ninety (90) days
following the date of service as they must be able to demonstrate, if audited, that they have
made three (3) attempts to collect from the patient and/or other insurance providers and have
been unsuccessful in that collection effort.
N.Pay claims up to the maximum amount an authorized provider may be paid, as specified by law.
At Final Payout, authorized providers are paid at a percentage of Resource Base Relative Value
Scale (RBRVS) determined by the County, or 50% of allowable charges, whichever is less. The
rate shall be based upon the total dollars available divided by the total value of all claims. The
maximum payment limits apply at Final Settlement.
O.If it is determined after March 31st, for each Period that continued payment of the established
RBRVS through June 30th, for each Period, will exceed available Funds, COUNTY may direct
CONTRACTOR to pay Claims up to the amount of remaining available Funds at the presently
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established RBRVS, less estimated administrative costs for CONTRACTOR, COUNTY, and any
other Agreements in support of the EMSF Program; suspend payment of all remaining Claims
submitted through June 30th; or pay those suspended Claims in the following Fiscal Year at the
RBRVS established for that following Fiscal Year. COUNTY shall use best efforts to notify
CONTRACTOR sixty (60) days prior to March 31st if available finds will be exceeded to ensure
timely suspension of claims payment.
P.Final Payout Procedures
1.At Final Payout, if adjustments to reduce the RBRVS were made during the Fiscal Year,
funds shall be first used to pay those Physicians who received payment at an RBRVS
less than that paid to any Physicians at any other time during the Fiscal Year, up to the
maximum RBRVS paid during the year, . Any other remaining Funds shall then be
distributed as provided below.
a)Final Payout is defined as the final reimbursement of Physicians at the close
of a given fiscal year.
2.No later than July 31st following each Period:
a)COUNTY shall perform a final reconciliation of Funds remaining in the EMSF
Trust Fund, CONTRACTOR’s Account, and the Recovery Accounts for the
purpose of determining the amount to distribute to Physicians as Final Pay
after all other obligations provided through this Agreement are met.
b)CONTRACTOR shall report to COUNTY, the value of any pending Claims and
the date the claims are anticipated to be paid
c)COUNTY shall report to CONTRACTOR the Fund balance, if any, to be
distributed through Final Payout. CONTRACTOR shall invoice COUNTY for
this amount, which amount COUNTY shall pay, and CONTRACTOR shall
deposit in the Account. CONTRACTOR shall disburse such Funds, the
balance of all other monies in the Account and any other accounts maintained
for the purposes of the Agreement, and any earned interest, to Physicians in
the manner specified in the Agreement. Funds shall be distributed
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proportionately, based on the dollar amount of Claims submitted and paid to
all physicians and surgeons who submitted qualifying claims during the year,
in accordance with Health and Safety Code Section 1797.98a(d).
d) As recovery funds are received, CONTRACTOR shall deposit any Recovery
Account balance into the Fund.
Q. Complete the Final Settlement process within six months following the end of the fiscal year if
funds remain in the Account, to distribute the balance of the funds proportionate to the claims
paid during the contract period.
R. Maintain a physician registration system acceptable to COUNTY, and only reimburse physicians
that are registered
1. The registration system shall include Conditions of Participation” (COPs) that registered
providers must agree to in order to participate in the EMS Program, and certain of these
COPs may require specific acceptance/agreement by the provider before moving on in
the registration process.
2. Conditions of Participation shall include, at minimum:
a. Services must be provided in a basic or comprehensive general acute care
hospital emergency department.
b. The physician or surgeon may not be an employee of the hospital
c. Reimbursement from the program is sought by the hospital or the hospital’s
designee, as the billing and collection agent for the emergency physician and
surgeon, or an emergency physician group.
d. The physician may not utilize the program if the COUNTY has separately
established any other billing mechanism to permit the physician to bill the
COUNTY for his/her services.
S. Provide directly, or through a County-approved subcontract arrangement, third-party recovery
services to actively pursue reimbursement of claims paid from the Physician Services Account
(PSA) fund that are later determined to be eligible for Medi-Cal, other insurance or third-party
payment. If services are provided directly, CONTRACTOR shall be reimbursed twenty percent
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(20%) of the recovered payments and refunds.
T. Recovery payments and refunds on claims shall be deposited into a recovery account.
U. CONTRACTOR agrees to provide the resources necessary to address any backlog claims
processing or an increased influx of claims within the time periods specified herein.
V. CONTRACTOR shall review Claims and may provide a medical review, as appropriate, in
accordance with its Operations Manual. CONTRACTOR shall keep a copy of its current
Operations Manual at its main facility which shall include CONTRACTOR’s policies and
procedures relating to its operations, including, but not limited to the activities specified herein.
W. CONTRACTOR shall deny all Claims that do not meet the conditions and requirements of the
Agreement and/or state regulations for Claim submission, processing, and reimbursement.
X. CONTRACTOR shall use its best efforts to collect any monies paid, in any form, for
nonreimbursable services or for payment to any Physician or other entity not entitled under the
Agreement to such payment if the result of inaccurate or inappropriate processing by
CONTRACTOR. CONTRACTOR shall send a collection notice to the Physician or other entity. If
the initial notice is not successful, CONTRACTOR shall send a second notice. If the second
notice is unsuccessful CONTRACTOR shall send a third and final notice. Upon becoming aware
that such payments are uncollectible, CONTRACTOR shall submit to COUNTY a plan of
corrective action. Upon review by COUNTY, CONTRACTOR may be subject to disallowances
for said payments.
Y. CONTRACTOR shall make every effort to resolve appeals within forty five (45) days of receipt
through discussion with physician billing staff. For those appeals that cannot be resolved to the
satisfaction of the physician or group, CONTRACTOR shall establish a process by which
physicians or groups may escalate appeals to COUNTY no later than thirty (30) days following
notification of denial. If appeal is not received by COUNTY within this timeframe CONTRACTOR
decision shall be considered final.
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II. MINIMUM STANDARDS
CONTRACTOR shall ensure the following minimum standards are adhered to in the adjudication of
claims.
A. ELIGIBLE SERVICES
Funding Criteria - Reimbursements of physician claims must meet specific criteria, which are
outlined in the California Health and Safety Code and the Welfare & Institutions Code. The
eligibility requirements for the program are as follows:
1. Traffic Fines and Penalties - Emergency services within 48 hours
These funds allow for reimbursement for emergency care prior to stabilization. For the
purposes of reimbursement from this program, the point of stabilization is 48 hours of
continuous service to the patient from the point of emergency department contact or
receipt of transfer. This includes medical screening examinations required by law to
determine whether an emergency condition exists.
2. Emergency Medical Condition - Defined as a medical condition manifesting itself by
acute symptoms of sufficient severity, including severe pain, which in the absence of
immediate medical attention could reasonably be expected to result in any of the
following:
a) Placing the patient's health in serious jeopardy;
b) Serious impairment to bodily functions; or,
c) Serious dysfunction to any bodily organ or part.
3. Location of Service - Emergency medical services must have been provided by a
physician in a general acute care hospital which meets one of the following conditions:
a) The hospital has a permit to provide basic or comprehensive emergency
medical services; or,
b) The hospital has a permit for standby emergency services prior to July 1,
1991 and meets the criteria as a "small and rural hospital" as defined in
Section 124840 of the Health and Safety Code.
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B.PATIENT ELIGIBILITY
Reimbursement under this claiming process shall be limited to services for which the physician,
following reasonable billing efforts has not received any payment from a patient or responsible party,
and the patient does not have health insurance for emergency services and care, cannot afford to pay
for those services, and for whom payment will not be made through any private coverage or by any
program funded in whole or in part by the federal government with the exception of claims submitted for
reimbursement through Section 1011 of the federal Medicare Prescription Drug, Improvement and
Modernization Act of 2003.
These procedures shall not be applied or interpreted so as to prevent a physician from seeking
or accepting payment from a patient or responsible third-party payor, or arranging a repayment
schedule for the costs of services rendered prior to receiving payment from this fund.
C.CLAIM ELIGIBILITY
Physicians must make reasonable efforts to bill for services provided. Claims are eligible for
reimbursement through this fund if all of the following conditions are met:
1.The physician has inquired if there is a responsible third-party source of payment.
2.The physician has billed the patient and, if identified, a responsible third party for
payment of services.
3.The physician has made reasonable efforts to collect payment (the physician's
records should maintain evidence of such effort). For purposes of the PSA,
reasonable efforts shall be defined as one of the following:
a.A period of not less than three (3) months has passed since the initial billing, and
there has been a minimum of three (3) billings by the physician (the three billing
requirement is waived if a billing is returned by postal authorities marked "no
known forwarding address" or "addressee unknown" and the physician made
reasonable efforts to discover a correct billing address); or
b.The physician has received actual notification from the patient or responsible third
party that no payment will be made for the services rendered by the physician.
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4.The physician has not received reimbursement of any portion of the amount billed to
the patient. Deposits for services made by the patient or responsible party are
considered partial payments and result in the service not being eligible for
reimbursement under this program. Deposits for specific services will apply only
towards that specific service and will not affect other claims for different services
for that same patient on different dates.
5.Physicians must stop any current, and waive any future, collection efforts to obtain
reimbursement from the patient, upon receipt of funds from the PSA.
a.If a physician receiving payment under the program is later reimbursed by a patient
or responsible party, the physician shall notify the CONTRACTOR. CONTRACTOR
shall reduce the physician's future payment of claims from the account. In the event
there is not a subsequent submission of a claim for reimbursement within one year,
the physician shall reimburse the account in an amount equal to the amount
collected from the patient or third-party payer, but not more than the amount of
reimbursement received from the account; or, Notify CONTRACTOR of the
payment and, reimburse the account in an amount equal to the amount collected
from the patient or third-party payer, but not more than the amount of the
reimbursement received from the account for that patient's care.
b.In the event the physician receives payment from any source on a claim that has
been submitted to CONTRACTOR, but has not yet been reimbursed from the PSA,
the physician shall contact the CONTRACTOR and request that the claim be
withdrawn from the program.
6.If a pattern of incomplete, ineligible, or unsubstantiated claims is determined by
COUNTY and CONTRACTOR to be continuing, the Physician may be excluded
from submitting future requests for reimbursement.
7.Any refunds or penalties shall be paid to CONTRACTOR and deposited into the
account to fund future payments to physicians.
Exhibit B
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “County”),
members of a contractor’s board of directors (hereinafter referred to as “County Contractor”), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest.”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1)Enter board member’s name, job title (if applicable), and date this disclosure is being made.
(2)Enter the board member’s company/agency name and address.
(3)Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a.The name of the agency/company with which the Corporation has the transaction;
and
b.The nature of the material financial interest in the Corporation’s transaction that the
board member has.
(4)Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5)Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit B
Page 2 of 2
(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to):
(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a):
(5) Authorized Signature
Signature: Date:
COUNTY OF FRESNO
REQUEST FOR QUOTATION
NUMBER: 18-013
FISCAL INTERMEDIARY FOR THE EMERGENCY
MEDICAL SERVICES FUND
Issue Date: October 13, 2017
Closing Date: NOVEMBER 15, 2017 AT 2:00 P.M.
All Questions and Quotations must be electronically submitted on the Bid Page on Public Purchase.
For assistance, contact Darren Howard at Phone (559) 600-7110.
BIDDER TO COMPLETE
Undersigned agrees to furnish the commodity or service stipulated in the attached response at the prices and terms stated in this RFQ.
Bid must be signed and dated by an authorized officer or employee.
Except as noted on individual items, the following will apply to all items in the Quotation Schedule:
•A cash discount of % days will apply. County does not accept terms less than 15 days.
COMPANY
ADDRESS
CITY STATE ZIP CODE
( ) ( )
TELEPHONE NUMBER FACSIMILE NUMBER E-MAIL ADDRESS
SIGNATURE
PRINT NAME TITLE
Purchasing Use: DH:st ORG/Requisition: 56208799 / 5621800305
Exhibit C
Page 1 of 64EXHIBIT C
TABLE OF CONTENTS
PAGE
KEY DATES .................................................................................................................... 3
OVERVIEW ..................................................................................................................... 3
BID INSTRUCTIONS ...................................................................................................... 4
GENERAL REQUIREMENTS & CONDITIONS ............................................................... 5
INSURANCE REQUIREMENTS ................................................................................... 11
PARTICIPATION ........................................................................................................... 12
REFERENCE LIST ........................................................................................................ 13
SCOPE OF WORK ........................................................................................................ 14
COMPLY/NOT COMPLY ............................................................................................... 15
QUOTATION SCHEDULE ............................................................................................. 18
CHECK LIST ................................................................................................................. 19
EXHIBITS ...................................................................................................................... 20
Exhibit C
Page 2 of 64
KEY DATES
RFQ Issue Date: October 13, 2017
Written Questions for RFQ Due: November 1, 2017 at 10:00 A.M.
Questions must be submitted on the Bid Page at Public Purchase.
RFQ Closing Date: November 15, 2017 at 2:00 P.M.
Quotations must be electronically submitted on the Bid Page.
OVERVIEW
The County of Fresno Department of Public Health (DPH) is seeking bids from qualified organizations to
provide Fiscal Intermediary (FI) Services to County Authorized providers for the County of Fresno Physicians
Services Account (PSA) also known as the Maddy Emergency Medical Services Fund. The primary goal of
this program is to provide accurate, timely, efficient, cost effective, and consistent claims processing and
management for FI services.
PSA is responsible for reimbursement of physicians providing medical screening, examination, and
evaluation of a patient in a hospital emergency department to determine if an emergency medical condition
exists and, if so, reimbursement of the care, treatment and/or surgery necessary to stabilize the patient. FI
Services for this program will process payment of claims for physicians for whom no payment has been
made from responsible parties.
Exhibit C
Page 3 of 64
BID INSTRUCTIONS
• Bidders must electronically submit bid package in pdf format, no later than the quotation closing date
and time as stated on the front of this document, to the Bid Page on Public Purchase. The County will
not be responsible for and will not accept late bids due to slow internet connection or incomplete
transmissions.
• Bids received after the closing time will NOT be considered.
• All quotations shall remain firm for 180 days.
• Interpretation: Should any discrepancies or omissions be found in the bid specifications or doubt as to
their meaning, the bidder shall notify the Buyer in writing at once. The County shall not be held
responsible for verbal interpretations. Questions regarding the bid must be received by Purchasing
stated within this document. All addenda issued shall be in writing, duly issued by Purchasing and
incorporated into the contract.
• ISSUING AGENT/AUTHORIZED CONTACT: This RFQ has been issued by County of Fresno,
Purchasing. Purchasing shall be the vendor’s sole point of contact with regard to the RFQ, its
content, and all issues concerning it.
All communication regarding this RFQ shall be directed to an authorized representative of County
Purchasing. The specific buyer managing this RFQ is identified on the cover page, along with his or
her telephone number, and he or she should be the primary point of contact for discussions or
information pertaining to the RFQ. Contact with any other County representative, including elected
officials, for the purpose of discussing this RFQ, its content, or any other issue concerning it, is
prohibited unless authorized by Purchasing. Violation of this clause, by the vendor having
unauthorized contact (verbally or in writing) with such other County representatives, may constitute
grounds for rejection by Purchasing of the vendor’s quotation.
The above stated restriction on vendor contact with County representatives shall apply until the
County has awarded a purchase order or contract to a vendor or vendors, except as follows. First, in
the event that a vendor initiates a formal protest against the RFQ, such vendor may contact the
appropriate individual, or individuals who are managing that protest as outlined in the County’s
established protest procedures. All such contact must be in accordance with the sequence set forth
under the protest procedures. Second, in the event a public hearing is scheduled before the Board of
Supervisors to hear testimony prior to its approval of a purchase order or contract, any vendor may
address the Board.
• APPEALS: Appeals must be submitted in writing within seven (7) working days after notification of
proposed recommendations for award. A “Notice of Award” is not an indication of County’s
acceptance of an offer made in response to this RFQ. Appeals shall be submitted to County of
Fresno Purchasing, 4525 E. Hamilton Avenue 2nd Floor, Fresno, California 93702-4599 and in Word
format to gcornuelle@co.fresno.ca.us. Appeals should address only areas regarding RFQ
contradictions, procurement errors, quotation rating discrepancies, legality of procurement context,
conflict of interest, and inappropriate or unfair competitive procurement grievance regarding the RFQ
process.
Purchasing will provide a written response to the complainant within seven (7) working days unless
the complainant is notified more time is required. If the appealing bidder is not satisfied with the
decision of Purchasing, he/she shall have the right to appeal to the County Administrative Office
within seven (7) working days after Purchasing’s notification; if the appealing bidder is not satisfied
with CAO’s decision, the final appeal is with the Board of Supervisors. Please contact Purchasing if
the appeal will be going to the Board of Supervisors.
Exhibit C
Page 4 of 64
GENERAL REQUIREMENTS & CONDITIONS
LOCAL VENDOR PREFERENCE AND DISABLED VETERAN BUSINESS ENTERPRISE BID
PREFERENCE: The Local Vendor Preference and Disabled Veteran Business Enterprise Preference do
not apply to this Request for Quotation.
DEFINITIONS: The terms Bidder, Proposer, Contractor and Vendor are all used interchangeably and refer
to that person, partnership, corporation, organization, agency, etc. which is offering the quotation and is
identified on page one of this Request For Quotation (RFQ).
INTERPRETATION OF RFQ: Vendors must make careful examination of the requirements, specifications
and conditions expressed in the RFQ and fully inform themselves as to the quality and character of services
required. If any person planning to submit a quotation finds discrepancies in or omissions from the RFQ or
has any doubt as to the true meaning or interpretation, correction thereof may be requested in writing from
Purchasing by November 1, 2017 at 10:00 A.M., cut-off.
Questions must be submitted on the Bid Page at Public Purchase or contact Darren Howard at (559) 600-
7110.
NOTE: Time constraints will prevent County from responding to questions submitted after the cut-off date.
Any change in the Request for Quotation will be made by written addendum issued by the County. The
County will not be responsible for any other explanations or interpretations.
AWARD: Award will be made to the vendor(s) offering the services, products, prices, delivery, equipment
and system deemed to be to the best advantage of the County. The County shall be the sole judge in
making such determination. Award Notices are tentative: Acceptance of an offer made in response to this
RFQ shall occur only upon execution of an agreement by both parties or issuance of a valid written Purchase
Order by Fresno County Purchasing.
RIGHT TO REJECT BIDS: The County reserves the right to reject any and all bids and to waive
informalities or irregularities in bids. Failure to respond to all questions or not to supply the requested
information could result in rejection of your quotation.
CODES AND REGULATIONS: All work and material to conform to all applicable Federal, State, local and
special district building codes, laws, ordinances, and regulations.
TAXES: The quoted amount must include all applicable taxes. If taxes are not specifically identified in the
quotation it will be assumed that they are included in the total quoted.
SALES TAX: Fresno County pays California State Sales Tax in the amount of 7.975% regardless of
vendor's place of doing business.
TAXES, PERMITS & FEES: The successful bidder shall pay for and include all federal, state and local taxes
direct or indirect upon all materials; pay all fees for, and obtain all necessary permits and licenses, unless
otherwise specified herein.
TAXES, CHARGES AND EXTRAS:
A) DO NOT include Federal Excise Tax. County is exempt under Registration No. 94-73-03401-K.
B) County is exempt from Federal Transportation Tax. Exemption certificate is not required where shipping
papers show consignee as County of Fresno.
C) Charges for transportation, containers, packing, etc. will not be paid unless specified in bid.
VENDOR ASSISTANCE: Successful bidder shall furnish, at no cost to the County, a representative to assist
County departments in determining their product requirements.
Exhibit C
Page 5 of 64
MINOR DEVIATIONS: The County reserves the right to negotiate minor deviations from the prescribed
terms, conditions and requirements with the selected vendor.
BIDDERS’ LIABILITIES: County of Fresno will not be held liable for any cost incurred by vendors in
responding to the RFQ.
PRICE RESPONSIBILITY: The selected vendor will be required to assume full responsibility for all services
and activities offered in the quotation, whether or not they are provided directly. Further, the County of
Fresno will consider the selected vendor to be the sole point of contact with regard to contractual matters,
including payment of any and all charges resulting from the contract. The contractor may not subcontract or
transfer the contract, or any right or obligation arising out of the contract, without first having obtained the
express written consent of the County.
PRICES: Bidder agrees that prices quoted are for the contract period, and in the event of a price decline
such lower prices shall be extended to the County of Fresno. Prices shall be quoted F.O.B. destination.
CONFIDENTIALITY: Bidders shall not disclose information about the County's business or business
practices and safeguard confidential data which vendor staff may have access to in the course of system
implementation.
HIPAA: All services performed by vendor shall be in strict conformance with all applicable Federal, State
of California and/or local laws and regulations relating to confidentiality, including but not limited to,
California Civil Code, California Welfare and Institutions Code, Health and Safety Code, California Code of
Regulations, Code of Federal Regulations.
Vendor shall submit to County’s monitoring of said compliance.
Vendor may be a business associate of County, as that term is defined in the “Privacy Rule” enacted by
the Health Insurance Portability and Accountability Act of 1996 (HIPAA). As a HIPAA Business Associate,
vendor may use or disclose protected health information (“PHI”) to perform functions, activities or services
for or on behalf of County as specified by the County, provided that such use or disclosure shall not violate
HIPAA and its implementing regulations. The uses and disclosures if PHI may not be more expansive than
those applicable to County, as the “Covered Entity” under HIPAA’s Privacy Rule, except as authorized for
management, administrative or legal responsibilities of the Business Associate.
Vendor shall not use or further disclose PHI other than as permitted or required by the County, or as
required by law without written notice to the County.
Vendor shall ensure that any agent, including any subcontractor, to which vendor provides PHI received
from, or created or received by the vendor on behalf of County, shall comply with the same restrictions and
conditions with respect to such information.
NEWS RELEASE: Vendors shall not issue any news releases or otherwise release information to any third
party about this RFQ or the vendor's quotation without prior written approval from the County of Fresno.
BACKGROUND REVIEW: The County reserves the right to conduct a background inquiry of each
proposer/bidder which may include collection of appropriate criminal history information, contractual and
business associations and practices, employment histories and reputation in the business community. By
submitting a quotation/bid to the County, the vendor consents to such an inquiry and agrees to make
available to the County such books and records the County deems necessary to conduct the inquiry.
ADDENDA: In the event that it becomes necessary to revise any part of this RFQ, addenda will be provided
to all agencies and organizations that receive the basic RFQ.
Exhibit C
Page 6 of 64
CONFLICT OF INTEREST: The County shall not contract with, and shall reject any bid or quotation
submitted by the persons or entities specified below, unless the Board of Supervisors finds that special
circumstances exist which justify the approval of such contract:
1. Employees of the County or public agencies for which the Board of Supervisors is the governing body.
2. Profit-making firms or businesses in which employees described in Subsection (1) serve as officers,
principals, partners or major shareholders.
3. Persons who, within the immediately preceding twelve (12) months, came within the provisions of
Subsection (1), and who were employees in positions of substantial responsibility in the area of service
to be performed by the contract, or participated in any way in developing the contract or its service
specifications.
4. Profit-making firms or businesses in which the former employees described in Subsection (3) serve as
officers, principals, partners or major shareholders.
5. No County employee whose position in the County enables him to influence the selection of a contractor
for this RFQ, or any competing RFQ, and no spouse or economic dependent of such employee, shall be
employees in any capacity by a bidder, or have any other direct or indirect financial interest in the
selection of a contractor.
INVOICING: All invoices are to be delivered in duplicate to The Department of Public Health, P.O. Box
11867, Fresno, CA 93775-1867. Reference shall be made to the purchase order/contract number and
equipment number if applicable on the invoice.
PAYMENT: County will make partial payments for all purchases made under the contract/purchase order
and accumulated during the month.
CONTRACT TERM: It is County’s intent to contract with the successful bidder for a term of three (3)
years.
RENEWAL: Agreement may be renewed for a potential of two (2) one (1) year periods, based on the mutual
written consent of all parties.
QUANTITIES: Quantities shown in the bid schedule are approximate and the County guarantees no
minimum amount. The County reserves the right to increase or decrease quantities.
ORDERING: Orders will be placed as required by County of Fresno Department of Public Health.
TERMINATION: The County reserves the right to terminate any resulting contract upon written notice.
INDEPENDENT CONTRACTOR: In performance of the work, duties, and obligations assumed by
Contractor under any ensuing Agreement, it is mutually understood and agreed that CONTRACTOR,
including any and all of Contractor’s officers, agents, and employees will at all times be acting and
performing as an independent contractor, and shall act in an independent capacity and not as an officer,
agent, servant, employee, joint venturer, partner, or associate of the COUNTY. Furthermore, County shall
have no right to control or supervise or direct the manner or method by which Contractor shall perform its
work and function. However, County shall retain the right to administer this Agreement so as to verify that
Contractor is performing its obligations in accordance with the terms and conditions thereof. Contractor and
County shall comply with all applicable provisions of law and the rules and regulations, if any, of
governmental authorities having jurisdiction over matters the subject thereof.
Because of its status as an independent contractor, Contractor shall have absolutely no right to employment
rights and benefits available to County employees. Contractor shall be solely liable and responsible for
providing to, or on behalf of, its employees all legally-required employee benefits. In addition, Contractor
shall be solely responsible and save County harmless from all matters relating to payment of Contractor's
employees, including compliance with Social Security, withholding, and all other regulations governing such
matters. It is acknowledged that during the term of the Agreement, Contractor may be providing services to
others unrelated to the County or to the Agreement.
Exhibit C
Page 7 of 64
SELF-DEALING TRANSACTION DISCLOSURE: Contractor agrees that when operating as a corporation
(a for-profit or non-profit corporation), or if during the term of the agreement the Contractor changes its status
to operate as a corporation, members of the Contractor’s Board of Directors shall disclose any self-dealing
transactions that they are a party to while Contractor is providing goods or performing services under the
agreement with the County. A self-dealing transaction shall mean a transaction to which the Contractor is a
party and in which one or more of its directors has a material financial interest. Members of the Board of
Directors shall disclose any self-dealing transactions that they are a party to by completing and signing a
Fresno County Self-Dealing Transaction Disclosure Form and submitting it to the County prior to
commencing with the self-dealing transaction or immediately thereafter.
HOLD HARMLESS CLAUSE: Contractor agrees to indemnify, save, hold harmless and at County's request,
defend the County, its officers, agents and employees, from any and all costs and expenses, damages,
liabilities, claims and losses occurring or resulting to County in connection with the performance, or failure to
perform, by Contractor, its officers, agents or employees under this Agreement and from any and all costs
and expenses, damages, liabilities, claims and losses occurring or resulting to any person, firm or
corporation who may be injured or damaged by the performance, or failure to perform, of Contractor, its
officers, agents or employees under this Agreement.
STANDARD OF PERFORMANCE: All work shall be performed in a good and workmanlike manner.
SAFEGUARDS: The contractor shall provide safeguards, in conformity with all local codes and ordinances
as may be required.
DISPUTE RESOLUTION: The ensuing contract shall be governed by the laws of the state of California.
Any claim which cannot be amicably settled without court action will be litigated in the U.S. District Court for
the Eastern District of California in Fresno, CA or in a state court for Fresno County.
DEFAULT: In case of default by the selected bidder, the County may procure the services from another
source and may recover the loss occasioned thereby from any unpaid balance due the selected bidder, or by
any other legal means available to the County.
Regardless of F.O.B. point, vendor agrees to bear all risks of loss, injury or destruction to goods and
materials ordered herein which occur prior to delivery and such loss, injury or destruction shall not release
vendor from any obligation hereunder
ASSIGNMENTS: The ensuing proposed contract will provide that the vendor may not assign any payment
or portions of payments without prior written consent of the County of Fresno.
ASSURANCES: Any contract awarded under this RFQ must be carried out in full compliance with the Civil
Rights Act of 1964, the Americans With Disabilities Act of 1990, their subsequent amendments, and any and
all other laws protecting the rights of individuals and agencies. The County of Fresno has a zero tolerance
for discrimination, implied or expressed, and wants to ensure that policy continues under this RFQ. The
contractor must also guarantee that services, or workmanship, provided will be performed in compliance with
all applicable local, state, or federal laws and regulations pertinent to the types of services, or project, of the
nature required under this RFQ. In addition, the contractor may be required to provide evidence
substantiating that their employees have the necessary skills and training to perform the required services or
work.
OBLIGATIONS OF CONTRACTOR: Contractor warrants on behalf of itself and all subcontractors
engaged for the performance of the ensuing contract that only persons authorized to work in the United
States pursuant to the Immigration Reform and Control Act of 1986 and other applicable laws shall be
employed in the performance of the work hereunder.
TIE BIDS: With all other factors being equal, the contract shall be awarded to the Fresno County vendor
or, if neither or both are Fresno County vendors, the tied vendors will be granted the opportunity to submit
new bids or the entire bid may be rejected and re-bid. If the General Requirements of the RFQ state that
they are applicable, the provisions of the Fresno County Local Vendor Preference shall take priority over
this paragraph.
Exhibit C
Page 8 of 64
DATA SECURITY: Individuals and/or agencies that enter into a contractual relationship with the County for
the purpose of providing services must employ adequate controls and data security measures, both internally
and externally to ensure and protect the confidential information and/or data provided to contractor by the
County, preventing the potential loss, misappropriation or inadvertent access, viewing, use or disclosure of
County data including sensitive or personal client information; abuse of County resources; and/or disruption
to County operations.
Individuals and/or agencies may not connect to or use County networks/systems via personally owned
mobile, wireless or handheld devices unless authorized by County for telecommuting purposes and provide a
secure connection; up to date virus protection and mobile devices must have the remote wipe feature
enabled. Computers or computer peripherals including mobile storage devices may not be used (County or
Contractor device) or brought in for use into the County’s system(s) without prior authorization from County’s
Chief Information Officer and/or designee(s).
No storage of County’s private, confidential or sensitive data on any hard-disk drive, portable storage device
or remote storage installation unless encrypted according to advance encryption standards (AES of 128 bit
or higher).
The County will immediately be notified of any violations, breaches or potential breaches of security related
to County’s confidential information, data and/or data processing equipment which stores or processes
County data, internally or externally.
County shall provide oversight to Contractor’s response to all incidents arising from a possible breach of
security related to County‘s confidential client information. Contractor will be responsible to issue any
notification to affected individuals as required by law or as deemed necessary by County in its sole
discretion. Contractor will be responsible for all costs incurred as a result of providing the required
notification.
AUDITS AND RETENTION: The Contractor shall maintain in good and legible condition all books,
documents, papers, data files and other records related to its performance under this contract. Such records
shall be complete and available to Fresno County, the State of California, the federal government or their
duly authorized representatives for the purpose of audit, examination, or copying during the term of the
contract and for a period of at least three (3) years following the County's final payment under the contract or
until conclusion of any pending matter (e.g., litigation or audit), whichever is later. Such records must be
retained in the manner described above until all pending matters are closed.
EPAYMENT OPTION: The County of Fresno provides an Epay Program which involves payment of invoices
by a secure Visa account number assigned to the supplier after award of contract. Notification of payments
and required invoice information are issued to the supplier's designated Accounts Receivable contact by e-
mail remittance advice at time of payment. To learn more about the benefits of an Epay Program, how it
works, and obtain answers to frequently asked questions, click or copy and paste the following URL into your
browser: www.bankofamerica.com/epayablesvendors or call Fresno County Accounts Payable, 559-600-
3609.
Exhibit C
Page 9 of 64
BIDDER TO COMPLETE:
SUBCONTRACTORS:
List all subcontractors that would perform work in excess of one/half of one percent of the total amount of
your bid, and state general type of work such subcontractor would be performing. The primary contractor is
not relieved of any responsibility by virtue of using a subcontractor:
Exhibit C
Page 10 of 64
INSURANCE REQUIREMENTS
INSURANCE: Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR or any
third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect, the following
insurance policies or a program of self-insurance, including but not limited to, an insurance pooling
arrangement or Joint Powers Agreement (JPA) throughout the term of the Agreement:
A. Commercial General Liability: Commercial General Liability Insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence and an annual aggregate of Two Million Dollars
($2,000,000). This policy shall be issued on a per occurrence basis. COUNTY may require specific
coverages including completed operations, products liability, contractual liability, Explosion-Collapse-
Underground, fire legal liability or any other liability insurance deemed necessary because of the nature
of this contract.
B. Automobile Liability: Comprehensive Automobile Liability Insurance with limits for bodily injury of not
less than Two Hundred Fifty Thousand Dollars ($250,000.00) per person, Five Hundred Thousand
Dollars ($500,000.00) per accident and for property damages of not less than Fifty Thousand Dollars
($50,000.00), or such coverage with a combined single limit of Five Hundred Thousand Dollars
($500,000.00). Coverage should include owned and non-owned vehicles used in connection with this
Agreement.
C. Professional Liability: If CONTRACTOR employs licensed professional staff, (e.g., Ph.D., R.N.,
L.C.S.W., M.F.C.C.) in providing services, Professional Liability Insurance with limits of not less than One
Million Dollars ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate.
This coverage shall be issued on a per claim basis. Contractor agrees that it shall maintain, at its sole
expense, in full force and effect for a period of three years following the termination of this Agreement,
one or more policies of professional liability insurance with limits of coverage as specified herein.
D. Worker's Compensation: A policy of Worker's Compensation insurance as may be required by the
California Labor Code.
CONTRACTOR shall obtain endorsements to the Commercial General Liability insurance naming the County
of Fresno, its officers, agents, and employees, individually and collectively, as additional insured, but only
insofar as the operations under this Agreement are concerned. Such coverage for additional insured shall
apply as primary insurance and any other insurance, or self-insurance, maintained by COUNTY, its officers,
agents and employees shall be excess only and not contributing with insurance provided under
CONTRACTOR's policies herein. This insurance shall not be cancelled or changed without a minimum of
thirty (30) days advance written notice given to COUNTY.
Within thirty (30) days from the date CONTRACTOR executes this Agreement, CONTRACTOR shall provide
certificates of insurance and endorsement as stated above for all of the foregoing policies, as required
herein, to the County of Fresno, EMS Director, P.O. Box 11867, Fresno, CA 93775-1867, stating that
such insurance coverage have been obtained and are in full force; that the County of Fresno, its officers,
agents and employees will not be responsible for any premiums on the policies; that such Commercial
General Liability insurance names the County of Fresno, its officers, agents and employees, individually and
collectively, as additional insured, but only insofar as the operations under this Agreement are concerned;
that such coverage for additional insured shall apply as primary insurance and any other insurance, or
self-insurance, maintained by COUNTY, its officers, agents and employees, shall be excess only and not
contributing with insurance provided under CONTRACTOR's policies herein; and that this insurance shall not
be cancelled or changed without a minimum of thirty (30) days advance, written notice given to COUNTY.
In the event CONTRACTOR fails to keep in effect at all times insurance coverage as herein provided, the
COUNTY may, in addition to other remedies it may have, suspend or terminate this Agreement upon the
occurrence of such event.
All policies shall be with admitted insurers licensed to do business in the State of California. Insurance
purchased shall be purchased from companies possessing a current A.M. Best, Inc. rating of A FSC VII or
better.
Exhibit C
Page 11 of 64
BIDDER TO COMPLETE THE FOLLOWING:
PARTICIPATION
The County of Fresno is a member of the Central Valley Purchasing Group. This group consists of Fresno,
Kern, Kings, and Tulare Counties and all governmental, tax supported agencies within these counties.
Whenever possible, these and other tax supported agencies co-op (piggyback) on contracts put in place by
one of the other agencies.
Any agency choosing to avail itself of this opportunity, will make purchases in their own name, make
payment directly to the contractor, be liable to the contractor and vice versa, per the terms of the original
contract, all the while holding the County of Fresno harmless. If awarded this contract, please indicate
whether you would extend the same terms and conditions to all tax supported agencies within this group as
you are proposing to extend to Fresno County.
Yes, we will extend contract terms and conditions to all qualified agencies within the Central Valley
Purchasing Group and other tax supported agencies.
No, we will not extend contract terms to any agency other than the County of Fresno.
(Authorized Signature)
Title
Exhibit C
Page 12 of 64
VENDOR MUST COMPLETE AND RETURN WITH REQUEST FOR QUOTATION.
Firm:
REFERENCE LIST
Provide a list of at least five (5) customers for whom you have recently provided similar
products/services. Be sure to include all requested information.
Reference Name: Contact:
Address:
City: State: Zip:
Phone No.: ( ) Date:
Service Provided:
Reference Name: Contact:
Address:
City: State: Zip:
Phone No.: ( ) Date:
Service Provided:
Reference Name: Contact:
Address:
City: State: Zip:
Phone No.: ( ) Date:
Service Provided:
Reference Name: Contact:
Address:
City: State: Zip:
Phone No.: ( ) Date:
Service Provided:
Reference Name: Contact:
Address:
City: State: Zip:
Phone No.: ( ) Date:
Service Provided:
Failure to provide a list of at least five (5) customers may be cause for rejection of this RFQ.
Exhibit C
Page 13 of 64
SCOPE OF WORK
The County of Fresno Department of Public Health (DPH) is seeking proposals from qualified organizations
to provide Fiscal Intermediary (FI) Services to County Authorized providers for the County of Fresno
Physicians Services Account (PSA) also known as the Maddy Emergency Medical Services Fund. The
primary goal of this program is to provide accurate, timely, efficient, cost effective, and consistent claims
processing and management for FI services.
PSA is responsible for reimbursement of physicians providing medical screening, examination, and
evaluation of a patient in a hospital emergency department to determine if an emergency medical condition
exists and, if so, reimbursement of the care, treatment and/or surgery necessary to stabilize the patient. FI
Services for this program will process payment of claims for physicians for whom no payment has been
made from responsible parties.
The current DPH policies and procedures pertaining to this program are included in Exhibit A. These policies
will be revised in consultation with the selected bidder to reflect new practices. Statutory references for the
Maddy Emergency Medical Services Fund are included in Exhibit B.
The approximations described in the table below are based on data at the time of release of this
solicitation, and will vary based on patient need. This information is provided for a twelve (12)
month period and for general information only; it does not constitute any commitment by the
County, nor does it guarantee any amount of dollars to be managed, number of providers, or number of
claims to be processed. Additionally, DPH currently has a backlog of claims similar to the amount described
in the table below. Processing of these claims is ongoing. DPH makes no commitment to the number of
claims that will be outstanding at the start of the eventual agreement for services.
Approximate Number
of Providers
Approximate Number
of Claims Processed
Approximate Claim
Payment
5 15,000 $500,000
The following pages state the specifications and requirements for the services covered under this Request
for Quotation. Bidders are instructed to indicate their compliance or non-compliance with specifications.
Compliance is to be noted by initialing the “Agree” box to the left of the specification. Non-compliance is to be
indicated by initialing the “Disagree” box to the left of the specification. Exceptions may be explained on a
separate page entitled “EXCEPTIONS”. Each exception must appropriately reference the specification by
Item Number. The bidder’s response to County specifications must be submitted as part of his/her quotation.
Exhibit C
Page 14 of 64
COMPLY/NOT COMPLY
Compliance and understanding of the specification is to be noted by marking “COMPLY” on the
line provided to the right of the specification. Non-compliance is to be indicated by marking
“NOT COMPLY” on the line. All non-compliant items must be accompanied by a detailed
statement explaining why they fail to meet the stated specification or requirement.
BIDDER TO COMPLETE THE FOLLOWING: COMPLY/
NOT COMPLY
1. Fully adjudicate claims received from authorized providers within forty-five (45)
business days after receipt of correctly submitted claims or invoices, and
supporting documentation (when applicable), at the rate specified by the County,
and make other required payments
2. Receive, maintain, collect, and account for funds.
3. Review all claims to ensure County responsibility is verified. Ensure that the
County is the payor of last resort.
4. Apply industry standard procedures for claims review. Request supporting claims
documentation from authorized providers when appropriate. Deny all claims that do
not meet the conditions and requirements for claims submission, processing, and
reimbursement.
5. The selected bidder shall submit their procedures for claims review to the County
within thirty (30) calendar days of the start of the executed contract.
6. Receive, compile, preserve, and report information and data to the County on a
schedule to be agreed upon between the County and the selected bidder. Reports
shall be provided as a Microsoft Excel spreadsheet in a format mutually agreed
upon by all parties, and/or shall be available to the County via a secure web-based
reporting tool/portal. General types of reports for all programs shall include, but not
be limited to:
a. Claims Detail Report and Claims Summary Report
b. Claims Status Report and Claims Status Summary Report
c. Fund Reconciliation Report
d. Account Statement
e. Service Utilization Report
f. Recovery Account Status Report
g. Denial Report
h. Ad-hoc Reports
7. Use a Health Insurance Portability and Accountability Act (HIPAA) compliant
automated claims system, and adhere to all Protected Health Information (PHI)
and Personal Identifiable Information (PII) regulations.
8. Implement encryption security measures for authorized providers to submit
electronic claims data; provide training to providers on those security measures,
and ensure those security measures are adhered to.
Exhibit C
Page 15 of 64
BIDDER TO COMPLETE THE FOLLOWING: COMPLY/
NOT COMPLY
9. Designate a primary and alternate contact persons dedicated to facilitating
communication with authorized providers submitting claims, County staff, and
authorized patient representatives, and ensure all parties have the relevant phone
number and email address.
10. Retain and maintain all records relating to patient care for a minimum of seven (7)
years.
11. Review and pay claims based on the date services are provided; and in
accordance with the specific funding source requirements, i.e., claims must be for
emergency services and/or care provided by a physician in a hospital emergency
room setting, and services rendered are within the appropriate time limits.
12. Authorized providers shall have up to four (4) months of the date of service quarter
ending date to submit claims for services; however, they cannot bill for services
prior to ninety (90) days following the date of service as they must be able to
demonstrate, if audited, that they have made three (3) attempts to collect from the
patient and have been unsuccessful in that collection effort.
13. Pay claims up to the maximum amount an authorized provider may be paid, as
specified by law. Authorized providers are currently paid at a percentage of
Resource Base Relative Value Scale (RBRVS) determined by the County, or 50%
of allowable charges, whichever is less. The maximum payment limits apply at
Final Settlement.
14. Request additional funds if the amount of claims received exceeds the amount of
funds initially made available.
15. Conduct the Final Settlement process within sixty (60) days following the end of the
contract year if funds remain in the Account, to distribute the balance of the funds
proportionate to the claims paid during the contract period.
16. Maintain a physician registration system in accordance with county policies, and
only reimburse physicians that are registered. The PSA Program will also provide
“Conditions of Participation” (COPs) that registered providers must agree to in
order to participate in the EMS Program, and certain of these COPs may require
specific acceptance/agreement by the provider before moving on in the registration
process.
17. Provide directly, or through a County-approved subcontract arrangement, third-
party recovery services to actively pursue reimbursement of claims paid from the
PSA fund that are later determined to be eligible for Medi-Cal, other insurance or
third-party payment.
Exhibit C
Page 16 of 64
BIDDER TO COMPLETE THE FOLLOWING: COMPLY/
NOT COMPLY
18. Organization possesses a minimum of five (5) years of experience and expertise
performing services for a California County similar in complexity and scope to the
requested services.
19. Organization agrees to entertain, and accept if feasible, proposals by the County to
add services similar in complexity and scope to the eventual agreement in the
future.
Exhibit C
Page 17 of 64
QUOTATION SCHEDULE
Propose your most competitive Average Cost per Claim for the contract period stated below based on the
equation provided. If awarded a contract, proposed rates will be finalized during contract negotiations.
A claim is defined as any request for payment of a medical service that the FI has to adjudicate (whether it is
approved, denied, incomplete, etc.). The process for one claim includes all administrative and customer
service transactions to process the entire claim, including review, investigation, adjustment (if necessary),
and remittance or denial of the claim. The proposed rate(s) must include all labor, materials, equipment,
insurance coverage, permits, licenses, preparation of all faxed and/or mailed/delivered reports, and all other
fees to provide the services specified in this solicitation; and include the rationale and methodology to justify
the proposed rate(s).
Approximate number of claims processed over 12 month period: 15,000
Total Negotiated Rate: $ (if proposed)
Total Fee-for-Service: $_______________ (if proposed, include all costs you are proposing on a fee-for
service basis. Multiply your per claim rate by the estimated 15,000 claims per year)
Total Other Cost: $_______________ (if proposed)
Please explain “Other”: _______________________________________________________________
Average Cost per Claim*: $_______________
*Average Cost per Claim = the Total of the values entered for Total Negotiated Rate, Total Fee-for-Service,
and Total Other divided by 15,000.
Exhibit C
Page 18 of 64
CHECK LIST
This Checklist is provided to assist the vendors in the preparation of their bid response. Included in this list,
are important requirements and is the responsibility of the bidder to submit with the bid package in order to
make the bid compliant. Because this checklist is just a guideline, the bidder must read and comply with the
bid in its entirety.
Check off each of the following:
1. The Request for Quotation (RFQ) has been signed and completed.
2. Addenda, if any, have been signed and included in the bid package.
3. The completed Reference List as provided with this RFQ.
4. The Quotation Schedule as provided with this RFQ has been completed, price reviewed for
accuracy and any corrections initialed.
5. Indicate all of bidder exceptions to the County’s requirements, conditions and specifications
as stated within this RFQ.
6. The Participation page as provided within this RFQ has been signed and included
7. Bidder to Complete page as provided with this RFQ.
8. Return checklist with RFQ response.
9. Completed RFQ in pdf format, electronically submitted to the Bid Page on Public
Purchase.
Exhibit C
Page 19 of 64
EXHIBITS
A. Fresno County Physician Services Account Reimbursement Claim Procedures
B. California Legislative Information
Exhibit C
Page 20 of 64
Exhibit C
Page 21 of 64
Exhibit C
Page 22 of 64
Exhibit C
Page 23 of 64
Exhibit C
Page 24 of 64
Exhibit C
Page 25 of 64
Exhibit C
Page 26 of 64
Exhibit C
Page 27 of 64
Exhibit C
Page 28 of 64
Exhibit C
Page 29 of 64
Exhibit C
Page 30 of 64
Exhibit C
Page 31 of 64
Exhibit C
Page 32 of 64
Exhibit C
Page 33 of 64
Exhibit C
Page 34 of 64
Exhibit C
Page 35 of 64
Exhibit C
Page 36 of 64
Exhibit C
Page 37 of 64
Exhibit C
Page 38 of 64
Exhibit C
Page 39 of 64
Exhibit C
Page 40 of 64
Exhibit C
Page 41 of 64
Exhibit C
Page 42 of 64
Exhibit C
Page 43 of 64
Code:Select Code Section:
1797.98a.
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HEALTH AND SAFETY CODE - HSC
DIVISION 2.5. EMERGENCY MEDICAL SERVICES [1797 - 1799.207] ( Division 2.5 added by Stats. 1980, Ch. 1260. )
CHAPTER 2.5. The Maddy Emergency Medical Services Fund [1797.98a - 1797.98g] ( Heading of Chapter 2.5
amended by Stats. 1998, Ch. 58, Sec. 2. )
(a) The fund provided for in this chapter shall be known as the Maddy Emergency Medical Services
(EMS) Fund.
(b) (1) Each county may establish an emergency medical services fund, upon the adoption of a resolution by the
board of supervisors. The moneys in the fund shall be available for the reimbursements required by this chapter.
The fund shall be administered by each county, except that a county electing to have the state administer its
medically indigent services program may also elect to have its emergency medical services fund administered by
the state.
(2) Costs of administering the fund shall be reimbursed by the fund in an amount that does not exceed the
actual administrative costs or 10 percent of the amount of the fund, whichever amount is lower.
(3) All interest earned on moneys in the fund shall be deposited in the fund for disbursement as specified in this
section.
(4) Each administering agency may maintain a reserve of up to 15 percent of the amount in the portions of the
fund reimbursable to physicians and surgeons, pursuant to subparagraph (A) of, and to hospitals, pursuant to
subparagraph (B) of, paragraph (5). Each administering agency may maintain a reserve of any amount in the
portion of the fund that is distributed for other emergency medical services purposes as determined by each
county, pursuant to subparagraph (C) of paragraph (5).
(5) The amount in the fund, reduced by the amount for administration and the reserve, shall be utilized to
reimburse physicians and surgeons and hospitals for patients who do not make payment for emergency medical
services and for other emergency medical services purposes as determined by each county according to the
following schedule:
(A) Fifty-eight percent of the balance of the fund shall be distributed to physicians and surgeons for emergency
services provided by all physicians and surgeons, except those physicians and surgeons employed by county
hospitals, in general acute care hospitals that provide basic, comprehensive, or standby emergency services
pursuant to paragraph (3) or (5) of subdivision (f) of Section 1797.98e up to the time the patient is stabilized.
(B) Twenty-five percent of the fund shall be distributed only to hospitals providing disproportionate trauma and
emergency medical care services.
(C) Seventeen percent of the fund shall be distributed for other emergency medical services purposes as
determined by each county, including, but not limited to, the funding of regional poison control centers. Funding
may be used for purchasing equipment and for capital projects only to the extent that these expenditures
support the provision of emergency services and are consistent with the intent of this chapter.
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18-013 EXHIBIT B
Exhibit C
Page 44 of 64
1797.98b.
(c)The source of the moneys in the fund shall be the penalty assessment made for this purpose, as provided in
Section 76000 of the Government Code.
(d)Any physician and surgeon may be reimbursed for up to 50 percent of the amount claimed pursuant to
subdivision (a) of Section 1797.98c for the initial cycle of reimbursements made by the administering agency in
a given year, pursuant to Section 1797.98e. All funds remaining at the end of the fiscal year in excess of any
reserve held and rolled over to the next year pursuant to paragraph (4) of subdivision (b) shall be distributed
proportionally, based on the dollar amount of claims submitted and paid to all physicians and surgeons who
submitted qualifying claims during that year.
(e)Of the money deposited into the fund pursuant to Section 76000.5 of the Government Code, 15 percent shall
be utilized to provide funding for all pediatric trauma centers throughout the county, both publicly and privately
owned and operated. The expenditure of money shall be limited to reimbursement to physicians and surgeons,
and to hospitals for patients who do not make payment for emergency care services in hospitals up to the point
of stabilization, or to hospitals for expanding the services provided to pediatric trauma patients at trauma
centers and other hospitals providing care to pediatric trauma patients, or at pediatric trauma centers, including
the purchase of equipment. Local emergency medical services (EMS) agencies may conduct a needs assessment
of pediatric trauma services in the county to allocate these expenditures. Counties that do not maintain a
pediatric trauma center shall utilize the money deposited into the fund pursuant to Section 76000.5 of the
Government Code to improve access to, and coordination of, pediatric trauma and emergency services in the
county, with preference for funding given to hospitals that specialize in services to children, and physicians and
surgeons who provide emergency care for children. Funds spent for the purposes of this section shall be known
as Richie’s Fund. This subdivision shall remain in effect until January 1, 2027.
(f)Costs of administering money deposited into the fund pursuant to Section 76000.5 of the Government Code
shall be reimbursed from the money collected in an amount that does not exceed the actual administrative costs
or 10 percent of the money collected, whichever amount is lower. This subdivision shall remain in effect until
January 1, 2027.
(Amended by Stats. 2016, Ch. 147, Sec. 2. Effective January 1, 2017.)
(a)Each county establishing a fund, on January 1, 1989, and on each April 15 thereafter, shall report
to the authority on the implementation and status of the Emergency Medical Services Fund. Notwithstanding
Section 10231.5 of the Government Code, the authority shall compile and forward a summary of each county’s
report to the appropriate policy and fiscal committees of the Legislature. Each county report, and the summary
compiled by the authority, shall cover the immediately preceding fiscal year, and shall include, but not be limited
to, all of the following:
(1)The total amount of fines and forfeitures collected, the total amount of penalty assessments collected, and
the total amount of penalty assessments deposited into the Emergency Medical Services Fund, or, if no moneys
were deposited into the fund, the reason or reasons for the lack of deposits. The total amounts of penalty
assessments shall be listed on the basis of each statute that provides the authority for the penalty assessment,
including Sections 76000, 76000.5, and 76104 of the Government Code, and Section 42007 of the Vehicle Code.
(2)The amount of penalty assessment funds collected under Section 76000.5 of the Government Code that are
used for the purposes of subdivision (e) of Section 1797.98a.
(3)The fund balance and the amount of moneys disbursed under the program to physicians and surgeons, for
hospitals, and for other emergency medical services purposes, and the amount of money disbursed for actual
administrative costs. If funds were disbursed for other emergency medical services, the report shall provide a
description of each of those services.
(4)The number of claims paid to physicians and surgeons, and the percentage of claims paid, based on the
uniform fee schedule, as adopted by the county.
(5)The amount of moneys available to be disbursed to physicians and surgeons, descriptions of the physician
and surgeon claims payment methodologies, the dollar amount of the total allowable claims submitted, and the
percentage at which those claims were reimbursed.
(6)A statement of the policies, procedures, and regulatory action taken to implement and run the program
under this chapter.
(7)The name of the physician and surgeon and hospital administrator organization, or names of specific
18-013 EXHIBIT B
Exhibit C
Page 45 of 64
1797.98c.
physicians and surgeons and hospital administrators, contacted to review claims payment methodologies.
(8)A description of the process used to solicit input from physicians and surgeons and hospitals to review
payment distribution methodology as described in subdivision (a) of Section 1797.98e.
(9)An identification of the fee schedule used by the county pursuant to subdivision (e) of Section 1797.98c.
(10)(A) A description of the methodology used to disburse moneys to hospitals pursuant to subparagraph (B) of
paragraph (5) of subdivision (b) of Section 1797.98a.
(B)The amount of moneys available to be disbursed to hospitals.
(C)If moneys are disbursed to hospitals on a claims basis, the dollar amount of the total allowable claims
submitted and the percentage at which those claims were reimbursed to hospitals.
(11)The name and contact information of the entity responsible for each of the following:
(A)Collection of fines, forfeitures, and penalties.
(B)Distribution of penalty assessments into the Emergency Medical Services Fund.
(C)Distribution of moneys to physicians and surgeons.
(b)(1) Each county, upon request, shall make available to any member of the public the report provided to the
authority under subdivision (a).
(2)Each county, upon request, shall make available to any member of the public a listing of physicians and
surgeons and hospitals that have received reimbursement from the Emergency Medical Services Fund and the
amount of the reimbursement they have received. This listing shall be compiled on a semiannual basis.
(Amended by Stats. 2014, Ch. 442, Sec. 5. Effective September 18, 2014.)
(a)Physicians and surgeons wishing to be reimbursed shall submit their claims for emergency services
provided to patients who do not make any payment for services and for whom no responsible third party makes
any payment.
(b)If, after receiving payment from the fund, a physician and surgeon is reimbursed by a patient or a
responsible third party, the physician and surgeon shall do one of the following:
(1)Notify the administering agency, and, after notification, the administering agency shall reduce the physician
and surgeon’s future payment of claims from the fund. In the event there is not a subsequent submission of a
claim for reimbursement within one year, the physician and surgeon shall reimburse the fund in an amount equal
to the amount collected from the patient or third-party payer, but not more than the amount of reimbursement
received from the fund.
(2)Notify the administering agency of the payment and reimburse the fund in an amount equal to the amount
collected from the patient or third-party payer, but not more than the amount of the reimbursement received
from the fund for that patient’s care.
(c)Reimbursement of claims for emergency services provided to patients by any physician and surgeon shall be
limited to services provided to a patient who does not have health insurance coverage for emergency services
and care, cannot afford to pay for those services, and for whom payment will not be made through any private
coverage or by any program funded in whole or in part by the federal government, with the exception of claims
submitted for reimbursement through Section 1011 of the federal Medicare Prescription Drug, Improvement and
Modernization Act of 2003, and where all of the following conditions have been met:
(1)The physician and surgeon has inquired if there is a responsible third-party source of payment.
(2)The physician and surgeon has billed for payment of services.
(3)Either of the following:
(A)At least three months have passed from the date the physician and surgeon billed the patient or responsible
third party, during which time the physician and surgeon has made two attempts to obtain reimbursement and
has not received reimbursement for any portion of the amount billed.
(B)The physician and surgeon has received actual notification from the patient or responsible third party that no
payment will be made for the services rendered by the physician and surgeon.
(4)The physician and surgeon has stopped any current, and waives any future, collection efforts to obtain
18-013 EXHIBIT B
Exhibit C
Page 46 of 64
1797.98e.
reimbursement from the patient, upon receipt of moneys from the fund.
(d) A listing of patient names shall accompany a physician and surgeon’s submission, and those names shall be
given full confidentiality protections by the administering agency.
(e) Notwithstanding any other restriction on reimbursement, a county shall adopt a fee schedule and
reimbursement methodology to establish a uniform reasonable level of reimbursement from the county’s
emergency medical services fund for reimbursable services.
(f) For the purposes of submission and reimbursement of physician and surgeon claims, the administering
agency shall adopt and use the current version of the Physicians’ Current Procedural Terminology, published by
the American Medical Association, or a similar procedural terminology reference.
(g) Each administering agency of a fund under this chapter shall make all reasonable efforts to notify physicians
and surgeons who provide, or are likely to provide, emergency services in the county as to the availability of the
fund and the process by which to submit a claim against the fund. The administering agency may satisfy this
requirement by sending materials that provide information about the fund and the process to submit a claim
against the fund to local medical societies, hospitals, emergency rooms, or other organizations, including
materials that are prepared to be posted in visible locations.
(Amended by Stats. 2005, Ch. 671, Sec. 3. Effective January 1, 2006.)
(a) It is the intent of the Legislature that a simplified, cost-efficient system of administration of this
chapter be developed so that the maximum amount of funds may be utilized to reimburse physicians and
surgeons and for other emergency medical services purposes. The administering agency shall select an
administering officer and shall establish procedures and time schedules for the submission and processing of
proposed reimbursement requests submitted by physicians and surgeons. The schedule shall provide for
disbursements of moneys in the Emergency Medical Services Fund on at least a quarterly basis to applicants who
have submitted accurate and complete data for payment. When the administering agency determines that claims
for payment for physician and surgeon services are of sufficient numbers and amounts that, if paid, the claims
would exceed the total amount of funds available for payment, the administering agency shall fairly prorate,
without preference, payments to each claimant at a level less than the maximum payment level. Each
administering agency may encumber sufficient funds during one fiscal year to reimburse claimants for losses
incurred during that fiscal year for which claims will not be received until after the fiscal year. The administering
agency may, as necessary, request records and documentation to support the amounts of reimbursement
requested by physicians and surgeons and the administering agency may review and audit the records for
accuracy. Reimbursements requested and reimbursements made that are not supported by records may be
denied to, and recouped from, physicians and surgeons. Physicians and surgeons found to submit requests for
reimbursement that are inaccurate or unsupported by records may be excluded from submitting future requests
for reimbursement. The administering officer shall not give preferential treatment to any facility, physician and
surgeon, or category of physician and surgeon and shall not engage in practices that constitute a conflict of
interest by favoring a facility or physician and surgeon with which the administering officer has an operational or
financial relationship. A hospital administrator of a hospital owned or operated by a county of a population of
250,000 or more as of January 1, 1991, or a person under the direct supervision of that person, shall not be the
administering officer. The board of supervisors of a county or any other county agency may serve as the
administering officer. The administering officer shall solicit input from physicians and surgeons and hospitals to
review payment distribution methodologies to ensure fair and timely payments. This requirement may be fulfilled
through the establishment of an advisory committee with representatives comprised of local physicians and
surgeons and hospital administrators. In order to reduce the county’s administrative burden, the administering
officer may instead request an existing board, commission, or local medical society, or physicians and surgeons
and hospital administrators, representative of the local community, to provide input and make recommendations
on payment distribution methodologies.
(b) Each provider of health services that receives payment under this chapter shall keep and maintain records of
the services rendered, the person to whom rendered, the date, and any additional information the administering
agency may, by regulation, require, for a period of three years from the date the service was provided. The
administering agency shall not require any additional information from a physician and surgeon providing
emergency medical services that is not available in the patient record maintained by the entity listed in
subdivision (f) where the emergency medical services are provided, nor shall the administering agency require a
18-013 EXHIBIT BExhibit C
Page 47 of 64
physician and surgeon to make eligibility determinations.
(c) During normal working hours, the administering agency may make any inspection and examination of a
hospital’s or physician and surgeon’s books and records needed to carry out this chapter. A provider who has
knowingly submitted a false request for reimbursement shall be guilty of civil fraud.
(d) Nothing in this chapter shall prevent a physician and surgeon from utilizing an agent who furnishes billing
and collection services to the physician and surgeon to submit claims or receive payment for claims.
(e) All payments from the fund pursuant to Section 1797.98c to physicians and surgeons shall be limited to
physicians and surgeons who, in person, provide onsite services in a clinical setting, including, but not limited to,
radiology and pathology settings.
(f) All payments from the fund shall be limited to claims for care rendered by physicians and surgeons to patients
who are initially medically screened, evaluated, treated, or stabilized in any of the following:
(1) A basic or comprehensive emergency department of a licensed general acute care hospital.
(2) A site that was approved by a county prior to January 1, 1990, as a paramedic receiving station for the
treatment of emergency patients.
(3) A standby emergency department that was in existence on January 1, 1989, in a hospital specified in Section
124840.
(4) For the 1991–92 fiscal year and each fiscal year thereafter, a facility which contracted prior to January 1,
1990, with the National Park Service to provide emergency medical services.
(5) A standby emergency room in existence on January 1, 2007, in a hospital located in Los Angeles County that
meets all of the following requirements:
(A) The requirements of subdivision (m) of Section 70413 and Sections 70415 and 70417 of Title 22 of the
California Code of Regulations.
(B) Reported at least 18,000 emergency department patient encounters to the Office of Statewide Health
Planning and Development in 2007 and continues to report at least 18,000 emergency department patient
encounters to the Office of Statewide Health Planning and Development in each year thereafter.
(C) A hospital with a standby emergency department meeting the requirements of this paragraph shall do both
of the following:
(i) Annually provide the State Department of Public Health and the local emergency medical services agency with
certification that it meets the requirements of subparagraph (A). The department shall confirm the hospital’s
compliance with subparagraph (A).
(ii) Annually provide to the State Department of Public Health and the local emergency medical services agency
the emergency department patient encounters it reports to the Office of Statewide Health Planning and
Development to establish that it meets the requirement of subparagraph (B).
(g) Payments shall be made only for emergency medical services provided on the calendar day on which
emergency medical services are first provided and on the immediately following two calendar days.
(h) Notwithstanding subdivision (g), if it is necessary to transfer the patient to a second facility providing a
higher level of care for the treatment of the emergency condition, reimbursement shall be available for services
provided at the facility to which the patient was transferred on the calendar day of transfer and on the
immediately following two calendar days.
(i) Payment shall be made for medical screening examinations required by law to determine whether an
emergency condition exists, notwithstanding the determination after the examination that a medical emergency
does not exist. Payment shall not be denied solely because a patient was not admitted to an acute care facility.
Payment shall be made for services to an inpatient only when the inpatient has been admitted to a hospital from
an entity specified in subdivision (f).
(j) The administering agency shall compile a quarterly and yearend summary of reimbursements paid to facilities
and physicians and surgeons. The summary shall include, but shall not be limited to, the total number of claims
submitted by physicians and surgeons in aggregate from each facility and the amount paid to each physician and
surgeon. The administering agency shall provide copies of the summary and forms and instructions relating to
making claims for reimbursement to the public, and may charge a fee not to exceed the reasonable costs of
duplication.
18-013 EXHIBIT B
Exhibit C
Page 48 of 64
1797.98f.
1797.98g.
(k) Each county shall establish an equitable and efficient mechanism for resolving disputes relating to claims for
reimbursements from the fund. The mechanism shall include a requirement that disputes be submitted either to
binding arbitration conducted pursuant to arbitration procedures set forth in Chapter 3 (commencing with
Section 1282) and Chapter 4 (commencing with Section 1285) of Part 3 of Title 9 of the Code of Civil Procedure,
or to a local medical society for resolution by neutral parties.
(l) Physicians and surgeons shall be eligible to receive payment for patient care services provided by, or in
conjunction with, a properly credentialed nurse practitioner or physician’s assistant for care rendered under the
direct supervision of a physician and surgeon who is present in the facility where the patient is being treated and
who is available for immediate consultation. Payment shall be limited to those claims that are substantiated by a
medical record and that have been reviewed and countersigned by the supervising physician and surgeon in
accordance with regulations established for the supervision of nurse practitioners and physician assistants in
California.
(Amended by Stats. 2008, Ch. 288, Sec. 2. Effective January 1, 2009.)
Notwithstanding any other provision of this chapter, an emergency physician and surgeon, or an
emergency physician group, with a gross billings arrangement with a hospital shall be entitled to receive
reimbursement from the Emergency Medical Services Fund for services provided in that hospital, if all of the
following conditions are met:
(a) The services are provided in a basic or comprehensive general acute care hospital emergency department,
or in a standby emergency department in a small and rural hospital as defined in Section 124840.
(b) The physician and surgeon is not an employee of the hospital.
(c) All provisions of Section 1797.98c are satisfied, except that payment to the emergency physician and
surgeon, or an emergency physician group, by a hospital pursuant to a gross billings arrangement shall not be
interpreted to mean that payment for a patient is made by a responsible third party.
(d) Reimbursement from the Emergency Medical Services Fund is sought by the hospital or the hospital’s
designee, as the billing and collection agent for the emergency physician and surgeon, or an emergency
physician group.
For purposes of this section, a “gross billings arrangement” is an arrangement whereby a hospital serves as the
billing and collection agent for the emergency physician and surgeon, or an emergency physician group, and
pays the emergency physician and surgeon, or emergency physician group, a percentage of the emergency
physician and surgeon’s or group’s gross billings for all patients.
(Amended by Stats. 1998, Ch. 1016, Sec. 3. Effective January 1, 1999.)
The moneys contained in an Emergency Medical Services Fund, other than moneys contained in a
Physician Services Account within the fund pursuant to Section 16952 of the Welfare and Institutions Code, shall
not be subject to Article 3.5 (commencing with Section 16951) of Chapter 5 of Part 4.7 of Division 9 of the
Welfare and Institutions Code.
(Added by Stats. 1991, Ch. 1169, Sec. 4.)
18-013 EXHIBIT BExhibit C
Page 49 of 64
GOUNTY OF FRESNOREQUEST FOR QUOTATIONNUMBER:18-013FISCAL INTERMEDIARY FOR THE EMERGENCYMEDICAL SERVICES FUNDlssue Date: October 13t 2017Closing Date: NoveueeR 15, 2017 er 2:00 P.M.All Questions and Quotations must be electronically submitted on the Bid Page on Public Purchase.For assistance, contact Darren Howard at Phone (559) 600-7110.BIDDER TO COMPLETEUndersiqned aqrees to furnish the commoditv or service stipulated in the attached response at the prices and terms stated in this RFQ.Bid must be siqned and dated bv an authorized officer or emplovee.Except as noted on individual items, the following will apply to all items in the Quotation Schedule:. A cash discount of0 o/odays will apply. County does not accept terms less than 15 days.Advanced Medical Management, lncCOMPANY5000 AirporlPlaza Drive, Suite 150ADDRESScA 90815( \ 562-766-2006ppew@amm.ccMILE NUMBERE-MAIL ADDRESSSIGNATUREKathryn HegstromPresidentPRINT NAMETITLEPurchasing Use; DH:stORG/Requisition: 56208799 / 5621800305GlPublic\RFQ\FY 2017-18\18-013 Fiscal lntermediary for the Emergency Medical Services Fund\l8-013 Fiscal lntermediary for the Emergency MediælServices Fund.docExhibit C Page 50 of 64
Exhibit C
Page 51 of 64
Advanced Medical Management, Inc. has demonstrated its ability to perform all of the services
requested by Fresno County. Currently AMM performs contracted services for the Orange
County Health Care Agency (“OCHCA”) by functioning as the Fiscal Intermediary for the past
eleven program years (2006-2017) for the Emergency Medical Services Fund Program, Public
Health Program and Correctional Health Services Program and for the past three years for the
Medical Safety Net Program. AMM was also the Fiscal Intermediary for the very large Medical
Services Initiative Program for eight years (2006-2013). During that time, AMM adapted to a
wide array of significant program changes that occurred as well as the quadrupling of the MSI
enrollment and the corresponding increases in volume of work. AMM has not only kept pace
with those changes and increases, but has facilitated and assisted the Program in analyzing the
options and recommending those changes. AMM has worked closely with all other OCHCA
vendors including CCS, NetChemistry, MedImpact, Propharma, RxAmerica, CareMark, Quest
Laboratories and DHS in developing efficient data exchange, cooperative relationships and
enhanced procedures. AMM has adapted to multiple changes in Program and vendor staff
positions while maintaining consistency in technical and administrative contacts internally.
AMM has responded quickly and accurately to unanticipated funding and payment course
corrections and has in many cases been the vehicle of communication for the Program of those
changes to the affected providers. AMM has provided advice and technical experience for the
implementation of provider incentives, capitation methodologies, mandatory referral
authorizations and pharmacy protocols. AMM successfully went through re-negotiation and/or
RFP with all of these programs multiple times and AMM interacts with each of these programs
independently as all have different program personnel and unique processing requirements.
AMM has developed relationships of trust with all OCHCA medical providers and our existing
phone numbers, websites, FTP sites, staff contacts and procedures are familiar to everyone.
AMM has the management information software necessary to keep all of the disparate, vendor
specific OCHCA information managed in one unified and cohesive system. EZ-Cap is a well-
established managed care tool designed specifically to integrate patient, provider, referral
authorization, claims, case management and customer service data. In all of the many and varied
management situations described above, AMM has successfully programmed and processed
Exhibit C
Page 52 of 64
hundreds of thousands of data elements together such that each client is accurately and uniquely
managed.
Advanced Medical Management has also performed the services described in this Fiscal
Intermediary Services RFP for many years and to many non-government agency clients
including Independent Physician Associations (IPA) and Hospitals. For our these clients we
provide many additional services including: eligibility processing, claims receipt, adjudication
and payment services, fund management, financial reporting, referral authorization request
processing, inpatient and outpatient utilization management and case management services.
AMM has been a full service Management Services Organization from 1993 until the present.
We have performed these services concurrently to over 100,000 managed care patients covered
by all of the major health plans in Southern California – past and present – including Aetna,
Anthem Blue Cross, Blue Shield, CalOPTIMA, CareAmerica, Central Health Plan, Cigna,
Community Health Plan of Los Angeles, Easy Choice, FHP, Health Net, LA Care, Maxicare,
MDCare, MetLife, Molina, PacifiCare, SecureHorizons, SCAN, TakeCare, Tower, Universal,
UHP, United Healthcare. We have been audited by those health plans constantly with thousands
of referral authorizations (approved and denied), and tens of thousands of claims (paid and
denied) reviewed and scored. We have also been audited by healthcare consultants and certified
public accounts without sanction or significant negative findings. We have performed these
services for all major product lines including Commercial, Medi-Cal, Covered California,
Healthy Families, Point of Service, Medicare and Cal MediConnect and all of the differing and
changing regulations and standards that have been enforced over twenty-two years. We have
performed those services in Orange, Los Angeles, Riverside, San Bernardino, Santa Clara and
Imperial Counties. We have performed those services in English, Spanish, Korean and
Vietnamese languages. We have performed those services with no change to AMM’s
ownership, upper management personnel, or business strategy. We are confident that no other
applicant proposing to provide these services to the Fresno County can match the variety of
circumstances for which AMM has successfully provided these services.
Exhibit C
Page 53 of 64
AMM is also the Third Party Administrator for the County Medical Services Program (CMSP)
which is a consortium of 35 rural counties in California providing the exact same services as the
OCHCA Medical Safety Net Program. AMM transitioned management of this program from
Anthem Blue Cross effective April 1, 2015.
AMM has been a user of EZ-Cap Benefits Management software since 1995 (22 years). EZ-Cap
is a mainstream benefits management software that is in use by health plans, IPAs, and other
managed care entities nationally. AMM uses the latest 6.5 release of the software which is
written in .NET and has robust user security and role-based user profiles. Each AMM User has a
unique identification number and is assigned to client databases and modules based on their need
to access data. EZ-Cap has an Audit Trail that records the User, Date and Time any claim,
authorization, eligibility or other support table record was changed. AMM actively uses this
feature to control and manage the way claims are queued for processing. At any time a user or
manager can see when a claim was created, modified, adjudicated, paid or denied and by what
user ID.
EZ-Cap is programmed with unlimited Provider Fee Sets, Division of Financial Responsibility
Sets, Benefit Sets and additional technical tables that allow for automatic claims pricing
according to definable rules. Providers with special contracts are programmed with their specific
codes payable at the agreed upon rates but only under the conditions specified in the contract.
AMM maintains hundreds of such provider-specific rules as well as all of the program-specific
rules that control pricing.
AMM also uses the EZ-Cap EDI application which contains standard maps for all HIPAA X12
standard (5010 /5010) file formats as well as EZ-Cap Proprietary Formats (EPFs) for use
submitting authorizations, claims, membership, and paid claims from multiple Trading Partners.
AMM’s network structure allows for the exchange of information between our organization,
providers and health plans without compromising EZ-Cap system security. Within the EZ-Cap
Configuration and Users/Security modules, AMM creates separate user profiles to enable or
disable functionality and viewing of data depending on the user group. AMM network security
requires periodic password changes and locks workstations after 5 minutes of un-use.
Exhibit C
Page 54 of 64
AMM conducts annual HIPAA training of all our employees as well as new hire training and
provide written policies and instructions to employees for handling transactions in
compliance with the law. AMM has secure internet reporting portals for transmitting
information, data and reports to clients and uses two methods for transmitting secure email.
AMM is a Business Associate to all of our contracted clients who are Covered Entities and
we have signed agreements in place to ensure that AMM policies and procedures are
consistent with and maintain the compliance of our clients.
Exhibit C
Page 55 of 64
VENDOR MUST COMPLETE AND RETURN WITH REQUEST FOR QUOTATION.
Firm:
REFERENCE LIST
Provide a list of at least five (5) customers for whom you have recently provided similar
products/services. Be sure to include all requested information.
Reference Name: Contact:
Address:
City: State: Zip:
Phone No.: ( ) Date:
Service Provided:
Reference Name: Contact:
Address:
City: State: Zip:
Phone No.: ( ) Date:
Service Provided:
Reference Name: Contact:
Address:
City: State: Zip:
Phone No.: ( ) Date:
Service Provided:
Reference Name: Contact:
Address:
City: State: Zip:
Phone No.: ( ) Date:
Service Provided:
Reference Name: Contact:
Address:
City: State: Zip:
Phone No.: ( ) Date:
Service Provided:
Failure to provide a list of at least five (5) customers may be cause for rejection of this RFQ.
Exhibit C
Page 56 of 64
VENDOR MUST COMPLETE AND RETURN WITH REQUEST FOR QUOTATION.
Firm:
REFERENCE LIST
Provide a list of at least five (5) customers for whom you have recently provided similar
products/services. Be sure to include all requested information.
Reference Name: Contact:
Address:
City: State: Zip:
Phone No.: ( ) Date:
Service Provided:
Reference Name: Contact:
Address:
City: State: Zip:
Phone No.: ( ) Date:
Service Provided:
Reference Name: Contact:
Address:
City: State: Zip:
Phone No.: ( ) Date:
Service Provided:
Reference Name: Contact:
Address:
City: State: Zip:
Phone No.: ( ) Date:
Service Provided:
Reference Name: Contact:
Address:
City: State: Zip:
Phone No.: ( ) Date:
Service Provided:
Failure to provide a list of at least five (5) customers may be cause for rejection of this RFQ.
Exhibit C
Page 57 of 64
QUOTATION SCHEDULE
Propose your most competitive Average Cost per Claim for the contract period stated below based on the
equation provided. If awarded a contract, proposed rates will be finalized during contract negotiations.
A claim is defined as any request for payment of a medical service that the FI has to adjudicate (whether it is
approved, denied, incomplete, etc.). The process for one claim includes all administrative and customer
service transactions to process the entire claim, including review, investigation, adjustment (if necessary),
and remittance or denial of the claim. The proposed rate(s) must include all labor, materials, equipment,
insurance coverage, permits, licenses, preparation of all faxed and/or mailed/delivered reports, and all other
fees to provide the services specified in this solicitation; and include the rationale and methodology to justify
the proposed rate(s).
Approximate number of claims processed over 12 month period: 15,000
Total Negotiated Rate: $ (if proposed)
Total Fee-for-Service: $_______________ (if proposed, include all costs you are proposing on a fee-for
service basis. Multiply your per claim rate by the estimated 15,000 claims per year)
Total Other Cost: $_______________ (if proposed)
Please explain “Other”: _______________________________________________________________
Average Cost per Claim*: $_______________
*Average Cost per Claim = the Total of the values entered for Total Negotiated Rate, Total Fee-for-Service,
and Total Other divided by 15,000.
Exhibit C
Page 58 of 64
COMPLY/NOT COMPLY
Compliance and understanding of the specification is to be noted by marking “COMPLY” on the
line provided to the right of the specification. Non-compliance is to be indicated by marking
“NOT COMPLY” on the line. All non-compliant items must be accompanied by a detailed
statement explaining why they fail to meet the stated specification or requirement.
BIDDER TO COMPLETE THE FOLLOWING: COMPLY/
NOT COMPLY
1. Fully adjudicate claims received from authorized providers within forty-five (45)
business days after receipt of correctly submitted claims or invoices, and
supporting documentation (when applicable), at the rate specified by the County,
and make other required payments
2. Receive, maintain, collect, and account for funds.
3. Review all claims to ensure County responsibility is verified. Ensure that the
County is the payor of last resort.
4. Apply industry standard procedures for claims review. Request supporting claims
documentation from authorized providers when appropriate. Deny all claims that do
not meet the conditions and requirements for claims submission, processing, and
reimbursement.
5. The selected bidder shall submit their procedures for claims review to the County
within thirty (30) calendar days of the start of the executed contract.
6. Receive, compile, preserve, and report information and data to the County on a
schedule to be agreed upon between the County and the selected bidder. Reports
shall be provided as a Microsoft Excel spreadsheet in a format mutually agreed
upon by all parties, and/or shall be available to the County via a secure web-based
reporting tool/portal. General types of reports for all programs shall include, but not
be limited to:
a. Claims Detail Report and Claims Summary Report
b. Claims Status Report and Claims Status Summary Report
c. Fund Reconciliation Report
d. Account Statement
e. Service Utilization Report
f. Recovery Account Status Report
g. Denial Report
h. Ad-hoc Reports
7. Use a Health Insurance Portability and Accountability Act (HIPAA) compliant
automated claims system, and adhere to all Protected Health Information (PHI)
and Personal Identifiable Information (PII) regulations.
8. Implement encryption security measures for authorized providers to submit
electronic claims data; provide training to providers on those security measures,
and ensure those security measures are adhered to.
Exhibit C
Page 59 of 64
BIDDER TO COMPLETE THE FOLLOWING: COMPLY/
NOT COMPLY
9. Designate a primary and alternate contact persons dedicated to facilitating
communication with authorized providers submitting claims, County staff, and
authorized patient representatives, and ensure all parties have the relevant phone
number and email address.
10. Retain and maintain all records relating to patient care for a minimum of seven (7)
years.
11. Review and pay claims based on the date services are provided; and in
accordance with the specific funding source requirements, i.e., claims must be for
emergency services and/or care provided by a physician in a hospital emergency
room setting, and services rendered are within the appropriate time limits.
12. Authorized providers shall have up to four (4) months of the date of service quarter
ending date to submit claims for services; however, they cannot bill for services
prior to ninety (90) days following the date of service as they must be able to
demonstrate, if audited, that they have made three (3) attempts to collect from the
patient and have been unsuccessful in that collection effort.
13. Pay claims up to the maximum amount an authorized provider may be paid, as
specified by law. Authorized providers are currently paid at a percentage of
Resource Base Relative Value Scale (RBRVS) determined by the County, or 50%
of allowable charges, whichever is less. The maximum payment limits apply at
Final Settlement.
14. Request additional funds if the amount of claims received exceeds the amount of
funds initially made available.
15. Conduct the Final Settlement process within sixty (60) days following the end of the
contract year if funds remain in the Account, to distribute the balance of the funds
proportionate to the claims paid during the contract period.
16. Maintain a physician registration system in accordance with county policies, and
only reimburse physicians that are registered. The PSA Program will also provide
“Conditions of Participation” (COPs) that registered providers must agree to in
order to participate in the EMS Program, and certain of these COPs may require
specific acceptance/agreement by the provider before moving on in the registration
process.
17. Provide directly, or through a County-approved subcontract arrangement, third-
party recovery services to actively pursue reimbursement of claims paid from the
PSA fund that are later determined to be eligible for Medi-Cal, other insurance or
third-party payment.
Exhibit C
Page 60 of 64
BIDDER TO COMPLETE THE FOLLOWING: COMPLY/
NOT COMPLY
18. Organization possesses a minimum of five (5) years of experience and expertise
performing services for a California County similar in complexity and scope to the
requested services.
19. Organization agrees to entertain, and accept if feasible, proposals by the County to
add services similar in complexity and scope to the eventual agreement in the
future.
Exhibit C
Page 61 of 64
Quotation No. 18-013Page 12BIDDER TO COMPLETE THE FOLLOWING :PART¡GIPATIONThe County of Fresno is a member of the Central Valley Purchasing Group. This group consists of Fresno,Kern, Kings, and Tulare Counties and all governmental, tax supported agencies within these counties.Whenever possible, these and other tax supported agencies co-op (piggyback) on contracts put in place byone of the other agencies.Any agency choosing to avail itself of this opportunity, will make purchases in their own name, makepayment directly to the contractor, be liable to the contractor and vice versa, per the terms of the originalcontract, all the while holding the County of Fresno harmless. lf awarded this contract, please indicatewhether you would extend the same terms and conditions to all tax supported agencies within this group asyou are proposing to extend to Fresno County.Yes, we will extend contract terms and conditions to all qualified agencies within the Central ValleyPurchasing Group and other tax supported agencies.No, we will not extendany agency other than the County of Fresno.Presidentcontfacf terms tgI r rt{-' d ll\ "þ" I. \ qJ,-',¡9f*XTitleG:\PUBLIC\RFQ\FY 2017-18\18-013 FISCAL INTERMEDIARY FOR THE EMERGENCY MEDICAL SERVICES FUND\18-OI3 FISCAL INTERMEDIARY FORTHE EMERGENCY MEDICAL SERVICES FUND.DOCExhibit C Page 62 of 64
BIDDER TO COMPLETE:
SUBCONTRACTORS:
List all subcontractors that would perform work in excess of one/half of one percent of the total amount of
your bid, and state general type of work such subcontractor would be performing. The primary contractor is
not relieved of any responsibility by virtue of using a subcontractor:
Exhibit C
Page 63 of 64
CHECK LIST
This Checklist is provided to assist the vendors in the preparation of their bid response. Included in this list,
are important requirements and is the responsibility of the bidder to submit with the bid package in order to
make the bid compliant. Because this checklist is just a guideline, the bidder must read and comply with the
bid in its entirety.
Check off each of the following:
1. The Request for Quotation (RFQ) has been signed and completed.
2. Addenda, if any, have been signed and included in the bid package.
3. The completed Reference List as provided with this RFQ.
4. The Quotation Schedule as provided with this RFQ has been completed, price reviewed for
accuracy and any corrections initialed.
5. Indicate all of bidder exceptions to the County’s requirements, conditions and specifications
as stated within this RFQ.
6. The Participation page as provided within this RFQ has been signed and included
7. Bidder to Complete page as provided with this RFQ.
8. Return checklist with RFQ response.
9. Completed RFQ in pdf format, electronically submitted to the Bid Page on Public
Purchase.
Exhibit C
Page 64 of 64