request for qualifications and proposals lea medi-cal ... · notice is hereby given that the orange...

ORANGE UNIFIED SCHOOL DISTRICT

REQUEST FOR QUALIFICATIONS AND PROPOSALS

LEA Medi-Cal Billing Option (LBO) And

Medi-Cal Administrative Activities (MAA) Program

RFQP No. 2021-0001

Qualifications and Proposals Due No Later Than: July 16, 2020 at 4:00 pm

Submissions and Information Contact: Kathleen Arciniega

Purchasing and Contracts Supervisor Orange Unified School District

Purchasing Department 726 W. Collins Avenue

Orange, CA 92867 Phone: (714) 628-4440

E-Mail: [email protected]

From the period beginning on the date of the issuance of this RFQP and ending on the date of the award of the Contract, no Proposer, person, or entity, submitting in response to this RFQP, nor any officer, employee, representative, agent, or consultant representing such Proposer shall contact through any means or engage in any discussion regarding this RFQP, the evaluation or selection process/or the award of the Contract with any member of the District, Board of Education, representatives, agents, selection members, or any member of a District Citizens' Oversight Committee, other than the individual(s) specifically named herein. Any such contact shall be grounds for the disqualification of the Proposer submitting a response.

Orange Unified School District RFQP 2021-0001 Medi-Cal LEA Billing of 22

REQUEST FOR QUALIFICATIONS AND PROPOSALS

RFQP No. 2021-0001

LEA Medi-Cal Billing Option (LBO) And

Medi-Cal Administrative Activities (MAA) Program

Qualifications and Proposals Due No Later Than: NOTICE IS HEREBY GIVEN that the Orange Unified School District, County of Orange, California, (“District”), acting by and through its Governing Board, is requesting qualifications and proposals from interested firms LEA Medi-Cal Billing Option (LBO) and Medi-Cal Administrative Activities (MAA) Program. It is the intention of the District to identify a list of high quality firms that can provide full service Medi-Cal Billing and Medi-Cal Administrative Activities Services. The District intends on hiring one (1) firm to assist with preparation and electronic submission of LEA Medi-Cal billing claims, and provide professional services necessary to implement said program. Proposer must be authorized to do business in the State of California. The due date and time for the receipt of sealed qualifications and proposals is up to, but not later than 4:00 p.m. on July 16, 2020, at the Purchasing Department, 726 West Collins Avenue, Orange, California, 92867. RFI Documents will be available at no charge beginning June 25, 2020, on the District’s website at www.orangusd.org/bid_list. Please direct any inquiries or questions to the attention of Kathleen Arciniega, Purchasing and Contracts Supervisor via email at [email protected]. General information regarding the District is available via www.orangeusd.org. The right is reserved by the District to reject any or all qualifications and proposals, to waive any irregularities or informalities not affected by law, to evaluate the qualifications and proposals submitted and to award the Contract(s) according to the qualification(s) and proposal(s) which best serves the interests of said District. Publication: Orange City News Publication Dates: June 25, 2020 and July 2, 2020

http://www.orangusd.org/bid_list

mailto:[email protected]

http://www.orangeusd.org/


TABLE OF CONTENTS

ARTICLE DESCRIPTION PAGE Legal Notice – Request for Qualifications and Proposals Revised Legal Notice – Request for Qualifications and Proposals 2 Table of Contents 3 General District Information 4 Purpose and Intent 4 Tentative Timeline 5 Questions, Addenda, and Clarifications 5 Withdrawal of Qualifications and Proposals 5 Term and Extension 5 Instructions 6 Limitations 7 Non-Discrimination 7 Indemnification 7 Insurance Requirements 7-9 Restrictions on Lobbying and Contacts 9 Oral Communications not Binding 9 District Right to Terminate Contract 9 Non-Appropriation of Funds 10 Compliance with Applicable Laws 10 No Public Opening 10 Summary Scope of Services To Be Provided 11 Qualifications Questionnaire 12 General Instructions to Proposers 13 Qualifications and Proposal Format 14 Qualifications and Proposal Components 15-16 Evaluation and Selection 17 Evaluation Criteria 18 Evaluation of Proposals 18 Selection 19

APPENDIX (Located After Articles Above, Beginning on Page 21) EXHIBIT

District Purchasing Department Site Map (Location for Submittal of Qualifications and Proposals to District) A Proposer Certification and Acknowledgement of Addenda B Non-Collusion Declaration C Criminal Background and Fingerprinting Certification D Cost Proposal and Fee Schedule Worksheets E Sample Proposed Agreement F

END OF TABLE OF CONTENTS


GENERAL DISTRICT INFORMATION

Orange Unified School District (“District”) is a public school district headquartered in Orange, California. Orange USD serves the cities of Orange and Villa Park, the unincorporated land of Silverado, and parts of Anaheim, Garden Grove, Santa Ana, and an unpopulated area of Yorba Linda. Its student enrollment is approximately 30,000 students for grades K-12. The District operates 3 pre-schools, 27 elementary, 5 middle (including 2 Charter schools), 4 high schools, a continuation high school, a K-8 math and science magnet school and two special schools. Twenty-one of its thirty-eight schools have been recognized as California Distinguished Schools. In 1953, the citizens of the area voted to form a “unified” school district, combining the original five elementary districts with the high school district into one unified district, now known as the Orange Unified School District.

Additionally, information regarding advertised RFP’s, RFQ’s, IFB’s (“Invitation for Bid”), online vendor registration to participate in informal quotations, and how to do business with the District, can be obtained by visiting the District’s website at https://www.orangeusd.org/departments/business-services/purchasing/bids

PURPOSE AND INTENT

The District anticipates Medi-Cal billing services to begin in September 2020. The selected firm will be responsible for minimizing income lost for 2018-2019 and 2019-2020 Cost and Reimbursement Comparison Schedule (“CRCS”) using the District’s data, as well as collecting, analyzing, and tracking data for preparation of CRCS’s for subsequent years.

The Local Educational Agency (LEA) Medi-Cal Billing Option Program was established in 1993 in conjunction with the California Department of Education (CDE). The program provides the federal share of reimbursement for health assessment and treatment services for Medi-Cal eligible children and family members within the school environment. It is authorized under California's Welfare and Institutions Code §14132.06. Reimbursement is based upon a "fee-for-service" model. More information regarding the LEA Medi-Cal Billing Option Program is available at the California Department of Health Care Services’ website: <http://www.dhcs.ca.gov/provgovpart/Pages/LEA.aspx>. Interested firms are asked to submit a proposal that clearly specifies the areas where services will be provided, provides a schedule of rates, and addresses the information requested in the General Instructions. At minimum, the services to be provided shall include: • Assistance with start-up documentation and implementation to secure maximal funding. • Training and follow-up on receipt of information of District personnel • Claims preparation and submission of CRCS • Management of reports and program analysis. • Audit support and preparedness

http://en.wikipedia.org/wiki/Public_school_(government_funded)

http://en.wikipedia.org/wiki/School_district

http://en.wikipedia.org/wiki/Orange,_California

http://en.wikipedia.org/wiki/Orange,_California

http://en.wikipedia.org/wiki/Villa_Park,_California

http://en.wikipedia.org/wiki/Silverado,_California

http://en.wikipedia.org/wiki/Anaheim,_California

http://en.wikipedia.org/wiki/Garden_Grove,_California

http://en.wikipedia.org/wiki/Santa_Ana,_California

http://en.wikipedia.org/wiki/Yorba_Linda,_California

http://en.wikipedia.org/wiki/Elementary_school

http://en.wikipedia.org/wiki/Middle_school

http://en.wikipedia.org/wiki/High_school

http://en.wikipedia.org/wiki/Continuation_high_school

http://en.wikipedia.org/wiki/California_Distinguished_School

http://en.wikipedia.org/wiki/California_Distinguished_School

https://www.orangeusd.org/departments/business-services/purchasing/bids

https://www.orangeusd.org/departments/business-services/purchasing/bids

http://leginfo.legislature.ca.gov/

http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=14132.06

http://www.dhcs.ca.gov/provgovpart/Pages/LEA.aspx


TENTATIVE TIMELINE

The anticipated schedule for completion of this RFQP is shown below. Dates are subject to change:

Milestone Date RFQP Advertised June 25 2020 & July 2, 2020 RFQP Posted to Website June 25, 2020 Proposer Deadline for Questions/Clarifications July 10, 2020 Qualifications and Proposals Due July 16, 2020 Interviews/Presentations July 21, 2020 Notice of Intent to Award to Selected Firm(s) July 22, 2020 Award of Contract by Authorization of the Board of Education August 13, 2020

Notice of Award and Contract Issuance to Firm(s) August 17, 2020

QUESTIONS, ADDENDA, AND CLARIFICATIONS If it becomes necessary for the District to revise any part of this RFQ&P, or to provide clarification or additional information after the response documents are released, a written Addendum will be sent to each recipient of record of the original RFQ&P, It shall be the sole responsibility of the proposers to inquire of the District as to any Addenda or Clarifications issued. All Addenda issued shall become part of the RFQ&P.

Questions or comments regarding this RFQ&P (except to inquire about the number of Addenda

issued) must be in writing and received no later than date and time (Pacific Standard Time) specified in the Article entitled “TENTATIVE TIMELINE”.

WRITTEN QUESTIONS ARE TO BE E-MAILED TO THE DISTRICT’S CONTACT REPRESENTATIVE STATED IN THIS RFQ&P.

WITHDRAWAL OF QUALIFICATIONS AND PROPOSALS Proposers may withdraw their qualifications and proposal, by written request at any time prior to the scheduled closing time for receipt of proposals stated in this RFQ&P. To withdraw your proposal, contact the District representative stated in this RFQ&P. TERM AND EXTENSION(S) The District’s intent is to award an initial one (1) year contract; with two (2) optional annual renewal terms; however, please include fully burdened price proposals on an annual basis for a potential maximum contract of five (5) years. Pricing is to remain firm for the first three (3) years. Written requests for price increases, if approved in writing by the District, for subsequent contract renewal years, will not exceed the percentage change listed in the Consumer Price Index (CPI) for the Los Angeles area for the calendar year ending on December 31st preceding the renewal year. The awarded contractor is responsible for requesting all price increases in writing thirty (30) business days prior to expiration of contract. Price increases shall not be automatically made. If the District determines a price decrease may be applicable as a result of industry trends, thirty (30) business days prior to expiration of contract, the District will contact awarded contractor in writing to request a price decrease negotiation meeting. By submitting qualifications and a proposal, the awarded contractor agrees that it is willing to provide such contract extensions under these terms if requested by the District, at the District’s sole discretion.


Future contracts and/or renewals will be at the sole discretion of the District. Refer to Articles entitled “Background”, “Term and Extensions”, and “Qualifications and Proposal Components” for additional information. INSTRUCTIONS All proposals shall be submitted in the format specified by the District as defined in this RFQ&P. Qualifications and proposal shall be submitted in a sealed envelope, no later than the due date and time specified in this RFQ&P. It is the sole responsibility of the person submitting the qualifications and proposal to see that it is delivered on time. Proposals received after the due date and time will be returned to the provider unopened. Qualifications and proposals submitted by any other means will not be accepted. The selection process will include a screening review and evaluation of qualifications and proposals and background investigation by District staff members and an interview process. The time clock in the District Purchasing Department will be used as the official time. SEALED PROPOSALS WILL BE RECEIVED AT THE FOLLOWING LOCATION, NOT LATER THAN THE DATE AND

TIME (PACIFIC STANDARD TIME) AS SPECIFIED IN THE ARTICLE ENTITLED “TENTATIVE TIMELINE FOR RFQ&P PROCESS”:

Kathleen Arciniega

Purchasing & Contracts Supervisor Orange Unified School District

Purchasing Department 726 W. Collins Avenue

Orange, CA 92867 Phone: (714) 628-4440 Fax: (714) 532-8054

E-Mail: [email protected] District office hours are Monday through Friday, 8:00 a.m. to 4:30 p.m. Orange Unified School District shall not be responsible for, nor accept as a valid excuse for a late proposal delivery, any delay in mail service or other method of delivery used by the Proposer. QUESTIONS REGARDING THIS PROPOSAL SHOULD BE SUBMITTED TO KATHLEEN

ARCINIEGA, PURCHASING & CONTRACTS SUPERVISOR, VIA E-MAIL AT THE CONTACT INFORMATION LISTED ABOVE.

Kathleen Arciniega is the identified District contact for this RFQ&P

Refer to “Restrictions on Lobbying and Contacts” for further information All materials received as part of this solicitation become the property of the District and shall be considered public record. The cost to prepare and submit the proposals is at the sole expense of each firm. Proposal will not be returned. Responses should be complete and provide an insightful, straightforward, and concise overview of the capabilities of your firm. Responses may be rejected if not prepared in the format described, or if submitted without all required information and signatures. The District’s Request for Qualifications and Proposals (RFQ&P), and the Proposer's response, will be incorporated into the Agreement as Exhibits and/or by reference; however, the terms and conditions of the District’s Agreement takes precedence. Collectively, these documents shall be referred to as “Contract Documents” whether stated or not. The use of the word “Agreement” and “Contract” may be used interchangeably, and have the same meaning, whether stated or not.


LIMITATIONS This RFQ&P is neither a formal request for bids, nor an offer by the District to contract with any party responding to this RFQ&P. The District makes no representation that participation in the RFQ&P process will lead to an award of contract or any consideration whatsoever. The District shall in no event be responsible for the cost of preparing a response to this RFQ&P. The awarding of any contract(s) for services on the Project(s), if at all, is at the sole discretion of the District. The District reserves the right to reject any and all proposals and to waive informalities and minor irregularities in any proposal reviewed. The District may reject any proposal that does not conform to the instructions herein. Additionally, the District reserves the right to negotiate all final terms and conditions of any preliminary Agreement entered into with the architectural firm(s). The District makes no representations that any contract will be awarded to any respondent. NON-DISCRIMINATION The District hereby notifies all respondents that it will affirmatively insure that, in any contract entered into pursuant to this advertisement, minority business enterprises will be afforded full opportunity to submit its response to this RFQ&P and no respondent will be discriminated against on the grounds of race, color, sex, age, ancestry, religion, marital status, national origin, medical condition or physical disability, or sexual orientation on consideration for the award. INDEMNIFICATION The Contractor shall indemnify, pay for the defense of, and hold harmless District and its Board of Education, officers, agents and employees of and from any and all liabilities, claims, debts, damages, demands, suits, actions and causes of actions of whatsoever kind, nature or sort which may be incurred by reason of Contractor’s negligence, recklessness, or willful acts and/or omission in rendering any services hereunder. Contractor shall assume full responsibility for payments of federal, state and local taxes or contributions imposed or required under the social security, Workers' Compensation or income tax law, or any disability or unemployment law, or retirement contribution of any sort whatever, concerning Contractor or any employee and shall further indemnify, pay for the defense of, and hold harmless District of and from any such payment or liability arising out of or in any manner connected with Contractor’s performance under this Agreement. INSURANCE REQUIREMENTS Prior to execution of a contract and commencement of any work, selected firm(s) will be required to provide certificate(s) of insurance, naming the District as an additional insured, for the following levels of coverage. • Commercial General Liability: $1,000,000 per occurrence, and $3,000,000 general aggregate

for bodily injury, personal injury and property damage. • Automobile Liability:

a. Commercial: $2,000,000 Combined Single Limit for owned, hired and

non-owned auto

b. Personal: Transportation vehicles, not utilized for business that are driven onto and parked on school property California State minimum requirements for private passenger vehicles: $15,000 injury/death to one person


$30,000 injury/death to more than one person $5,000 damage to property

• Errors and Omissions: All professionals and firms shall carry, or agree to obtain prior to

the commencement of architectural work for the District, an amount of Errors and Omissions Insurance sufficient to provide adequate protection to the District given the anticipated scope and volume of work to be assigned to the professional or firm by the District which should meet at a minimum the requirements established by OPSC as follows:

Architect: $1,000,000 per occurrence, $2,000,000 aggregate

Sub-Contractors: $1,000,000 • Workers’ Compensation: As required by the State of California1

Part A: Statutory Requirements Part B: Employer’s Liability: $1,000,000 per injury, $1,000,000 per disease, and $1,000,000 aggregate

For all insurance coverage provided by the Contractor, the following terms apply:

A. Any deductibles, or self-insured retentions, shall be declared in writing to the District; District approval is required

for any amounts over $25,000. B. Insurance shall be placed with California admitted insurers with a current A.M. Best Company rating of “no less

than A” unless otherwise approved by the District. The State Compensation Fund of California is acceptable for Workers’ Compensation insurance.

C. Workers’ Compensation and Employer’s Liability policies shall contain a Waiver of Subrogation.

D. General Liability and Automobile Liability policies are to contain, or be endorsed to contain, the following

provisions:

i. Contractor agrees to defend, indemnify, save and hold harmless, the Orange Unified School District (District), its officers, agents, representatives, employees, and Board of Education, and provides named additional insured endorsements for the District, its officers, agents, representatives, employees, and Board of Education. They are to be covered as insured with respect to: liability arising out of activities performed by, or on behalf of, the Contractor, products and completed operations of the Contractor, premises owned, occupied or used by the Contractor, or automobiles owned, leased, hired, or borrowed by the Contractor. The coverage shall contain no special limitations on the scope of protection afforded to the District, its subsidiaries, officials, employees, and the Board of Education.

ii. For any claims related to the services, the Contractor’s insurance coverage shall be primary insurance with

respect to the District, its subsidiaries, officials, employees, and the Board of Education. Any insurance or self-insurance maintained by the District, its subsidiaries, officials, employees, and the Board of Education shall be excess of the Contractor’s insurance and shall not contribute to it.

iii. Each insurance policy required by this clause shall be endorsed to state that coverage shall not be suspended,

voided, cancelled by either party, reduced in coverage or in limits, except after a thirty (30) day prior written notice by certified mail, return receipt requested, has been given to the District.

1 If the Contractor is a sole proprietor with no employees, proof of Workers’ Compensation and insurance coverage will not be required.


The Contractor shall furnish the District original endorsements affecting coverage required by this clause. The endorsements are to be signed by a person authorized by that insurer to bind coverage on its behalf. All endorsements are to be received and approved by the District before work commences. RESTRICTIONS ON LOBBYING AND CONTACTS From the period beginning on the date of the issuance of this RFQ&P and ending on the date of the award of the contract, no person, or entity submitting in response to this RFQ&P, nor any officer, employee, representative, agent, or Contractor representing such a person or entity shall contact through any means or engage in any discussion regarding this RFQ&P, the evaluation or selection process/or the award of the contract with any member of the District, Board of Education, or Evaluation Committee, other than the individual specifically named herein. Any such contact shall be grounds for the disqualification of the entity submitting a response. ORAL COMMUNICATIONS NOT BINDING

Oral conversations or agreements with any official, employee, contractor, or agent of the District will in no manner alter, affect, modify, or change any term, condition, instruction, specification, spreadsheet or requirement of this RFQ&P. Oral communications between any representative of the District and any proposer will not be considered binding or enforceable on the District, nor shall any written communication by any district representative other than authorized District personnel listed in this RFQ&P defined herein who releases Addenda to this RFQ&P or communicates any other official correspondence. There are no understandings, agreements, or representations not specified in this RFQ&P. All documents forming a part of this RFQ&P are executed by the District and are contained in this RFQ&P. DISTRICT RIGHT TO TERMINATE CONTRACT If the Contractor refuses or fails to prosecute the services, work, or any separable part thereof with such diligence as will insure its completion within the time specified or any extension thereof, or fails to complete said work within such time, or if the Contractor should be adjudged as bankrupt, or if the Contractor should make a general assignment for the benefit of its creditors, or if a receiver should be appointed on account of Contractor’s insolvency, or if Contractor should persistently or repeatedly refuse or should fail, except in cases for which any extension of time is provided, to comply with contracted services, supply enough properly skilled workmen, proper materials to complete the work in time specified, or if Contractor should fail to make prompt payment to any subcontractors or for material or labor, or persistently disregards laws, ordinances or instruction of the District, or otherwise be guilty of a substantial violation of any provision of the contract, or if Contractor or its subcontractors should violate any of the provisions of this contract, then the District may, without prejudice to any other right or remedy, serve written notice upon the Contractor of its intention to terminate this contract, such notice to contain the reasons for such intention to terminate, and unless within ten (10) days after the service of such notice such condition shall cease or such violation shall cease and satisfactory arrangements for the correction thereof be made, this contract shall upon the expiration of said ten (10) days, cease and terminate. In such case, Contractor shall not be entitled to receive any further payment until work is finished. The foregoing provision is in addition to and not in limitation of any other rights or remedies available to the District. NON-APPROPRIATION OF FUNDS Contractor/Carrier agrees that if funds are not appropriated or are otherwise not available to District for all or a portion of the Services due to regulatory changes or program cancellation (“Non-Appropriation”), District may, upon thirty (30) days written Notice to Contractor/Carrier, terminate the resultant Agreement or specific Service(s) under the resultant Agreement. District may so terminate without any liability (including any liability for cancellation or termination or underutilization charges that might otherwise apply).


COMPLIANCE WITH APPLICABLE LAWS

All Proposals must be submitted, filed, made, and executed in accordance with Applicable Laws, whether or not such Applicable Laws are expressly referred to in the RFQ&P Documents. NO PUBLIC OPENING Proposals will not be opened publicly, however a list of the names and companies submitting qualification and proposal packages will be available within a reasonable time after the submittal deadline. Proposals will be made public and may be inspected one day following the District’s issuance of Notice(s) of Intent to Award. An appointment with the District contact is required due to the volume of documents that may be involved in the request and staffing availability.

Thank You for Your Participation!


SUMMARY SCOPE OF WORK AND SERVICES TO BE PROVIDED

The scope of work may include, but is not limited to, the following:

The Orange Unified School District is soliciting proposals for our current Local Education Agency Medi-Cal Billing Option Program and Medi-Cal Administrative Activities (MAA) Program beginning with minimizing revenue lost in the 2018-19 fiscal year.

The Local Education Agency (LEA) Medi-Cal Billing Option Program is a fee-for-service program authorized by state and federal governments. In 1986, Congress authorized schools to bill the Medicaid (note: in California, Medicaid is called Medi-Cal) program for some health related services. Services reimbursed by Medi-Cal currently include certain health services for all students in the district as well as specific services for students with disabilities. The health related services for students with disabilities include both assessment and the treatment(s) specified on a student’s Individual Education Program (IEP) including audiology, counseling, nursing services, occupational therapy, physical therapy, speech therapy, and transportation related to these services. Medi-Cal regulations set the same high professional standards for school-based providers as providers who work in hospitals, rehabilitations centers, and other settings.

As per the Individuals with Disabilities Education Act (IDEA) regulations, school districts provide all required services as specified on a child’s IEP at no cost to parents. However, school districts can be reimbursed for a percentage of the cost of those services from the federal government’s Medicaid program which increases the ability to provide health related services for all students.

The Medi-Cal Administrative Activities (MAA) Program allows school districts and county offices to be reimbursed federal dollars for costs incurred while performing certain administrative activities. Employees record the time worked on these activities for one week each quarter, and then a claim is submitted based on the activities performed.

Administrative activities that facilitate enrollment into Medi-Cal and assisting students and families to access Medi-Cal services may include:

• Outreach - Providing Medi-Cal information to students and their families. Initial referral of students to medical services.

• Facilitating Applications - Referring or assisting families with the Medi-Cal application.

• Monitoring, Coordination, or Referral to Medi-Cal covered services - Such as speech, occupational therapy, physical therapy, counseling, and any follow-up on these issues.

• Arranging Transportation to medical services within the community or IEP services at the school site.

• Translation - Arranging or providing translation for medical services, e.g. speech, counseling.

• Program Planning, Policy Development & Interagency Coordination - Developing strategies to improve the delivery or coordination of medical services.

Allowable costs may include the salaries and benefits of the staff performing the activities, applicable operating expenses, and appropriate overhead expenses. MAA is a Federal Financial Participation (FFP) program, which requires a non-federal match. Approved MAA costs are reimbursed at fifty percent (50%) and revenue is unrestricted.


SCOPE OF SERVICES I. Implementation:

a. Will work with Client to assess program potential, establish provider and site databases for effective service tracking, and provide implementation training to Client program coordinator(s). This implementation process will be designed to identify areas of reimbursement and to facilitate an effective partnership between Client and SCCOE.

II. Training and Materials:

a. Will provide training to Client’s program coordinator(s) and healthcare providers as part of the initial contract implementation and at least annually thereafter. Training will include the following subject areas: DHCS audit requirements for Client’s LEA billing program; all necessary information and procedures for submitting Client billing data and “best practices” to implement and maintain an optimized, audit-ready program.

b. Will provide Client personnel with all necessary training materials including a proprietary “Coordinator’s Handbook” containing a detailed review of the rules and regulations governing the LEA billing program. At Client’s request, will also make available its proprietary “provider forms” for use in documenting the delivery of healthcare services (available in paper and electronic versions).

III. Claims Preparation and Submission:

a. Eligibility: Upon the commencement of LEA Billing Services under this Agreement and quarterly thereafter during the Term of the Agreement, agency will use its proprietary algorithms and know-how to determine Medi-Cal eligibility and identify Medi-Cal numbers within limits imposed by the DHCS and county governments. Eligibility match information will be retained by the agency and will be used solely to provide services hereunder subject to all the confidentiality provisions provided in the Agreement.

b. Claim Submittal: Will make reasonable efforts to submit each Medi-Cal claim within thirty (30) days of receipt from Client of all information necessary for processing that claim. Will also make reasonable efforts to bill retroactive claims existing at the commencement of this Agreement so as to minimize revenue lost due to Medi-Cal’s one (1) year billing limit.

c. Review and Submittal: Will monitor the submittal and payment process, review denials, suspensions, and holds, as reported by DHCS, and make reasonable efforts to resolve any challenges Client reimbursement claim.

IV. Management of Reports and Program Analysis:

a. Will provide Client with periodic management reports using provider, procedure, and/or site parameters. The frequency of such reports will be determined by mutual agreement, but in any event shall occur no less frequently than quarterly.

V. Coordination with Client:

a. Information Sharing: Will provide Client with information regarding program policy, interpretation of policy, and regulatory updates as applicable. Quarterly “Bulletins” will be provided to Client’s coordinator(s) to ensure timely communication about program changes and updates to the systems and processes.

b. Support: Will provide a “Client Care Center” available for the use of Client’s program Coordinator(s) and accessible via toll-free phone and email. A Help Desk will be available to Client program coordinator(s) and participants utilizing web-based software, accessible by toll-free phone during regular business hours and by email.

c. Audit and Site Visit Support: Will provide Client personnel with training on audit requirements and program compliance. In the event of a program audit or review, agency will assist in preparing for and responding to the audit to the extent permitted by DHCS and or any other auditing party.


VI. Technology and Software:

a. Will make available its proprietary web-based software to assist Client in effective management of program participation.

VII. Cost and Reimbursement Comparison Schedule (CRCS) Services:

a. Will prepare the annual CRCS Workbook in accordance with the claim guidelines approved by DHCS, based on information supplied by Client for each fiscal year, in accordance with the terms of the Agreement. Client will have final approval over the CRCS Workbook submission prepared by the agency.

VIII. MAA Billing Services: All services described below will be provided in accordance with and to the extent allowed by the California Department of Health Care Services (DHCS) Medi-Cal Administrative Activities (MAA) Plan.

a. MAA Program Consulting Services: Will work with Client to assess program potential, and establish an optimized claim plan, which consists of review and analysis of all program participants and their fiscal eligibility. Ongoing consultation will be designed to identify areas of reimbursement and to facilitate Client’s full participation in the MAA program.

b. Training: Will provide training to Client’s program coordinator(s). Training will include the following subject areas: DHCS audit requirements for Client’s MAA program; information and procedures for submitting MAA fiscal information, and “best practices” to implement and maintain an optimized, audit-ready program.

c. Information Sharing: Will provide Client with information regarding program policy, interpretation of policy, and regulatory updates as applicable. Quarterly “Bulletins” will be provided to Client’s coordinator(s) to ensure timely communication about program changes and updates to systems and processes. Will provide Client personnel with training on audit requirements and program compliance, and will perform “compliance reviews” to assist the Client in maintaining audit records. In the event of a program audit or review, agency will assist in preparing for and responding to the audit to the extent permitted by DHCS and/or any other auditing party.

d. Supplemental Support: Will provide a “Client Care Center” available for the use of Client’s program coordinator(s) and accessible by toll-free phone during regular business hours and by email. A Help Desk will be available to Client program coordinator(s) and staff utilizing the agency’s web-based software, accessible by toll-free phone during regular business hours and by email.

e. Technology and Software: Will make available, as applicable, its proprietary web- based software to assist Client in effective program participation

The current District enrollment for students who may receive services reimbursable under the MAA program for 2019-20 is as follows:

• 23,838.71 District estimated 2019-20 P2 ADA for K-12

• 3757 Special Education students

• 11,308 students enrolled in the Free and Reduced Lunch Program

END OF SUMMARY SCOPE OF SERVICES TO BE PROVIDED


QUALIFICATIONS QUESTIONNAIRE Please provide responses to the following questions, as well as details to offer a comprehensive representation of your company and its services.

1. Provide an overview of the services you provide related to the LEA Medi-Cal Billing Option (LBO) Program.

2. Provide an overview of the services you provide related to Medi-Cal Administrative Activities (MAA).

3. Provide a complete description of the cost of your services. Please provide a breakdown of fees for the LBO

and MAA programs separately. Proposer is not required to offer both programs. Identify any extra charges for materials, training or additional services.

4. Does your company supply all needed forms and supplies for providers?

5. Does your company utilize the internet for logging and documentation purposes? Is your software

compatible with other databases? If so, what programs is the software compatible with?

6. Does your billing system allow for bulk billing of daily treatments from our providers? Also, can our providers create student groups in the system to allow for a more efficient billing process?

7. How will your company support the District during the event of an audit?

8. Does your company return its portion of fees in the event of an audit finding?

9. Who will train our participants? Do you have designated staff to provide the training? How many staff

members does your company employ that are devoted to Medi-Cal Direct Billing Option issues?

10. Can your company process mandated reports and invoices for our district? (Ex. CRCS, MAA Invoices, etc.) If so, what are the associated fees for this preparation?

11. Will your company review documentation received from District employees for errors?

12. What is the time line to get supporting documentations in to your company for billing?

13. Can your company provide a detailed summary of providers who submitted billing on a monthly summary?

Please provide a sample.

14. Can your company provide detailed reports of billing separated by provider type or other detail? Please provide a sample.

15. What is your firm’s ability to remain current with changes in the law or proposed changes from the

Department of Health Services, including your method for communicating relevant changes to the District and how soon will we be notified of changes?

16. Where is your company located? Provide the name of the person that would be the lead to the District, their

hours, phone number, and website. What is your turn around time for responding to messages?

17. At this time, our intentions are to hire consultants with a clerical component. Tell us how you would assist us with the transition?

18. How does the Proposer protect confidential student data?


GENERAL INSTRUCTIONS TO PROPOSERS 1. General Information

All responses shall conform to instructions provided in this Request for Qualifications and Proposals (RFQ&P) document.

2. Deadline for RFQ&P Submittal

Proposers must submit all required documents prior to the deadline. All qualifications and proposals shall be complete and final with no additional information required after the close of the submittal date, unless specifically requested by the District. Responses received after the deadline will be returned unopened as not meeting the RFQ&P requirements.

3. No Request for Preparation Cost of Qualifications and Proposal The District shall not, under any circumstance, be liable for any pre-contractual expenses incurred by

potential contractors, and potential contractors shall not include any such expenses as part of their proposal response for this RFQ&P. Pre-contractual expenses are defined as any expenses incurred by a potential contractor in: (1) preparing its qualifications and proposal in response to this RFQ&P; (2) submitting that qualifications and proposal to the District; (3) negotiating with the District any matter related to this RFQ&P, including a possible contract; or (4) engaging in any other activity prior to the effective date of award, if any, of a contract resulting from this RFQ&P.

4. Proposer Qualifications

Any individual firm submitting qualifications and a proposal must be able to provide evidence that the individual or firm and its personnel carrying out the responsibilities have expertise and experiences in all areas identified in this RFQ&P.

Supplementary Materials

5. Proposals should be accompanied by brochures and product cut sheets providing technical specifications for all services and systems described in this RFQ&P. If the literature differs in any manner from the systems and equipment being proposed, the differences must be fully clarified and explained.

6. References – MUST BE INCLUDED

Before awarding any contract, the District will require Proposer’s to submit additional evidence of qualifications, in particular California, TK-12, Local Educational Agencies. (LEA) This evidence will support qualifications as well as relevant experience and skills of the Proposer.

7. Timeline for Work and Transition Plan

Based on the District’s Transition Plan, please provide a timeline stating number of days that services will be operational from date of order. Refer to Article entitled “Qualifications and Proposal Format” for placement of this information in Proposer’s response submittals.

END OF GENERAL INSTRUCTIONS TO PROPOSERS


QUALIFICATIONS AND PROPOSAL FORMAT

Proposers responding to this RFQ&P must follow the format below. Submitted printed materials must be in bound 8-1/2” x 11” format. Refer to Qualifications and Proposal Components, for number of printed copies, and digital submittal. Qualifications and proposals should be organized by section in the following manner and limited to the following number of pages for each section. Do not exceed page limits. All references to page number requirements are single sided. Refer to Article entitled “Qualifications and Proposal Components” for information regarding submittal detail for each Proposer Submittal Section listed below.

SECTION DESCRIPTION MAX PAGES

1 Table of Contents As Required for Proposer Submittals

2 Cover Letter 2

3 Relevant Qualifications/Experience 4

4 Qualifications Questionnaire (Refer to Section 3 for Details) 2

5 Operational Timeline for Services As Required for Complete Explanation

6 References 1

7 Proposal and Fee Schedule 3

8 Proposer Certification and Acknowledgement of Addenda Use Enclosed Exhibit

9 Non-Collusion Declaration Use Enclosed Exhibit

10 Criminal Records Certification Use Enclosed Exhibit

11 Proposer Supplementary Materials (if any) List as Exhibit

END OF QUALIFICATIONS AND PROPOSAL FORMAT


QUALIFICATIONS AND PROPOSAL COMPONENTS Proposers shall provide one (1) original, five (5) copies, and one (1) digital copy, on a readable device such as a USB for your RFQ&P Response. Proposers content and sequence of the qualifications and proposal will be as follows:

1. Table of Contents (maximum pages as required for Proposer submittals):

2. Cover Letter (maximum of two (2) pages):

Provide/Include at a minimum:

a. A brief statement of interest and summary of relevant qualifications to engage in a professional relationship with the Orange Unified School District.

b. The following statements:

“The [firm’s name] received a copy of the standardized Agreement for Services used by the Orange Unified School District, including the indemnity provisions and all liability insurance provisions contained therein. If given the opportunity to contract with the District, the [firm’s name] has no substantive objections to the use of these Agreements.”

"I certify that I have read the attached RFQ&P and accompanying instructions and that I am authorized to commit the firm to the proposal submitted.”

c. The following information:

i. Firm Name ii. Address iii. Vendor SPIN Number iv. Name of Contact Person v. Phone Number vi. E-Mail Address vii. Year Firm was Established viii. Number of Employees ix. Website x. Signature of Principal xi. Corporate Seal xii Is the company private or publicly traded

The emphasis of your qualifications and proposal should be on completeness, adherence to directions and format requirements, brevity, and clarity of content.

3. Qualifications Questionnaire (maximum of two (2) pages):

4. Scope of work (maximum pages as required for a complete explanation of this requirement)

5. References (maximum of one (1) page):

Provide a list of references that include at least three (3) previous California K-12 public schools with similar size and scope to the one being proposed for this District project. List must include the following information for each contract: a. Client Name b. Address c. Contact Name and Telephone Number


d. Dates of Service and Completion e. Description of Service and size f. Contract Amount

7. Proposal plus Fee Schedule (maximum of three (3) pages):

Proposer is requested to submit a proposal to furnish all of the labor, materials, and other related items required for the performance of the contract resulting from this RFQ&P, on a fully-burdened labor rate basis. Be as thorough and specific as possible as this may form the basis of any contract for services that may be presented by the District. Proposal and Fee Schedule Worksheets have been included to assist Proposer’s with this information, and are included as Exhibits at the end of this RFQ&P. Fee Proposal and Fee Schedule shall be based on work and services stipulated in the Article entitled “Summary Scope of Work and Services.” Include one-time and monthly recurring costs, including all applicable taxes and surcharges.

Proposal costs and fees should reflect the following scenarios: The District’s intent is to award an initial one (1) year contract; with two (2) optional annual renewal terms; however, please include fully burdened price proposals on an annual basis for a potential maximum contract of five (5) years. Pricing is to remain firm for the first three (3) years. Written requests for price increases, if approved in writing by the District, for subsequent contract renewal years, will not exceed the percentage change listed in the Consumer Price Index (CPI) for the Los Angeles area for the calendar year ending on December 31st preceding the renewal year. The awarded contractor is responsible for requesting all price increases in writing thirty (30) business days prior to expiration of contract. Price increases shall not be automatically made. If the District determines a price decrease may be applicable as a result of industry trends, thirty (30) business days prior to expiration of contract, the District will contact awarded contractor in writing to request a price decrease negotiation meeting.

By submitting qualifications and a proposal, the awarded contractor agrees that it is willing to provide such contract extensions under these terms if requested by the District, at the District’s sole discretion.

Future contracts and/or renewals will be at the sole discretion of the District. Refer to Articles entitled “Background”, “Term and Extensions”, and “Qualifications and Proposal Components” for additional information.

8. Proposer Certification and Acknowledgement of Addenda (use Exhibit document) 9. Non-Collusion Declaration (use Exhibit document) 10. Certification by Contractor of Criminal Records Check (use Exhibit)

Pursuant to Education Code 45125.1, complete, sign, and date the enclosed form AB 1610, 1612, and 2102. Refer to Appendix, included as an Exhibit with this RFQ&P.

14. Supplementary Materials (if any)

Proposals should be accompanied by brochures and product cut sheets providing technical specifications for all services and systems described in this RFQ&P. If the literature differs in any manner from the systems and equipment being proposed, the differences must be fully clarified and explained.

END OF QUALIFICATIONS AND PROPOSAL COMPONENTS


EVALUATION AND SELECTION

EVALUATION OF PROCESS Submittals will be reviewed for responsiveness and evaluated pursuant to objective criteria, with particular attention to, without limitation, each Proposer’s qualifications and demonstrated competence in providing like services as well as completeness, adherence to directions and format requirements, brevity, and clarity of content. After the submittals are evaluated and/or ranked, the District, at its sole discretion, may elect to schedule interview(s) with the top Proposer(s). The District may elect to interview one or more Proposer. During contract negotiations, if the District is unable to negotiate successfully a satisfactory Agreement(s) with terms and conditions the District determines to be fair and reasonable, the District may then commence negotiations with the best qualified Proposer(s) in sequence until an Agreement is reached, or determination is made to reject all submittals. The Evaluation Committee intends to recommend the most qualified Proposer(s) to the District’s Board of Education regarding candidate(s). After selection and authorization by the Board, staff will issue a Notice of Award to awarded firm(s). It is the intent of the District to award one or more contracts as the result of this RFQ&P; however, the District reserves the right to apportion the requirements of this RFQ&P among multiple firms if this is determined to be in the District's best interests. No minimum amount of Work is guaranteed. Proposers should refer to “Summary Scope of Work and Services to be Provided” regarding proposed Work. Final selection of a Proposer, terms and conditions of any and all Agreements and authority to proceed with services shall be at the discretion of the District. A commitment will be made to the firm(s) offering the most advantageous proposal. Although cost is a significantly weighted factor, the District shall not be obligated to accept the lowest priced proposal, but will make an award in the best interest of the District after all factors have been evaluated.

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EVALUATION CRITERIA

CRITERIA EVALUATION WEIGHT FACTORS

Proposal Price and Fee Schedule 30%

Qualifications 15%

Understanding and Ability to Service District Needs and Objectives 20%

Satisfaction of Previous Clients, including any Experience with Orange Unified School District 10%

Proposer’s Experience 20%

Completeness and Responsiveness to the District’s RFQ&P 5%

TOTAL: 100% EVALUATION OF PROPOSALS Evaluation of proposals will be based on the following minimum criteria:

a. Proposal Price and Fee Schedule b. Qualifications & availability of key team members c. Demonstrated understanding and ability to service the District’s needs and objectives. d. Experience in performance of comparable work and/or services e. Satisfaction of previous clients including:

i. Prior favorable experience with District ii. Timeliness of work and ability of the firm to meet schedules

iii. Ability to work as a team iv. Accountability and willingness to take ownership of mistakes

f. Completeness and Responsiveness to the District’s RFQ&P The Evaluation Committee will contact and evaluate the firm’s references, contact any representative to clarify any response, contact any current or previous users of the firm’s services, solicit information from any available source concerning any aspect of a proposal, and review any information deemed pertinent to the evaluation process.


SELECTION Discussions may, at the District’s sole option, be conducted with responsible representatives who submit proposals determined to be reasonably probable of being selected for an award. Discussions may be for the purpose of clarification to assure full understanding of, and responsiveness to, the solicitation requirements. Firms shall be given fair and equal treatment with respect to any opportunity for discussion and written revision of proposals. Revisions may be permitted after submission, and before award for obtaining best and final proposals. In conducting discussions, the District will not disclose information derived from proposals submitted by competing firms. Selection of qualified firm(s) will be based on the criteria listed above as well as quality and completeness of submitted proposal, understanding of objectives, project approach, experience and expertise with public agencies and similar types of efforts, current and past performance as evidenced by current/former clients and references. Additional questions may be asked of firms and interviews may be conducted. Firms awarded contracts will be expected to sign the District’s Agreement for Services.

END OF EVALUATION AND SELECTION

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APPENDIX

EXHIBIT EXHIBIT DESCRIPTION

A District Purchasing Department Site Map (Location for Submittal of Qualifications and Proposals to District)

B Proposer Certification and Acknowledgement of Addenda C Non-Collusion Declaration D Criminal Background and Fingerprinting Certification E Cost Proposal and Fee Schedule Worksheets F Sample Agreement

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