26-27047_RFP_Consulting_Cardiologist.pdf

Department of Health Care Access and Information RFP # 26-27047 Cardiology Consultant

REQUEST FOR PROPOSAL

Notice to Prospective Proposers Cardiology Consultant

RFP No. 26-27047

October 22, 2026 You are invited to review and respond to this Request for Proposal (RFP), entitled RFP #26- 27047, for a Consulting Cardiologist. In submitting your proposal, you must comply with the instructions found herein. Failure to comply with any of the requirements may result in rejection of your proposal. By submitting a bid, you agree to all terms stated in this RFP and within your bid submission.

Note that all agreements entered into with the State of California will include by reference General Terms and Conditions downloaded at Internet site listed under Standard Contract Language. If you do not have Internet access, a hard copy can be provided by contacting the person listed on page eight.

https://www.dgs.ca.gov/ols/resources/page-content/office-of-legal-services-resources-list-folder/standard-contract-language Please be aware that the entirety of your response to this request is a matter of public record.

This solicitation is published online in the California State Contracts Register at:

https://caleprocure.ca.gov/pages/Events-BS3/event-search.aspx To ensure receipt of any addenda that may be issued, and answers to questions posed, interested parties must either register online or frequently check the solicitation page. Registration page can be found at: https://caleprocure.ca.gov/pages/ The Department of Health Care Access and Information (HCAI) deadline for receipt of proposal submission is November 27, 2026, no later than 5:00 p.m. PDT. All late bids will be rejected and returned to the proposer. Proposals must be received on or before the date and time specified herein (See Section 4.A: Key Action Dates, for Proposal submission details).

In the opinion of the Department of Health Care Access and Information (HCAI), this RFP is complete and without need of explanation. However, if you have questions, notice any discrepancies or need any clarifying information, please contact the below listed Contract Analyst.

*Please note: No verbal information given will be binding upon the state, unless such information is issued in writing as an official addendum to this RFP. A response to all questions received by the date provided will be added to the Cal e-Procure solicitation page.

Quica Teames, Contract Analyst Department of Health Care Access and Information

2020 West El Camino Avenue, Suite 1000 Sacramento, CA 95833

(916) 319-8871 pcs@hcai.ca.gov https://www.dgs.ca.gov/ols/resources/page-content/office-of-legal-services-resources-list-folder/standard-contract-language https://www.dgs.ca.gov/ols/resources/page-content/office-of-legal-services-resources-list-folder/standard-contract-language https://caleprocure.ca.gov/pages/Events-BS3/event-search.aspx https://caleprocure.ca.gov/pages/ mailto:pcs@hcai.ca.gov

Table of Contents Section Page

1. Purpose and Description of Services

2. Contractor Tasks and Responsibilities

3. Minimum Qualifications

4. Proposal Requirements and Information

A. Key Action Dates B. HCAI Project Contact C. Submission of Proposal D. Evaluation and Selection Process E. Tax Delinquent Status Verification F. Award and Protest G. Disposition of Proposals H. Agreement Execution and Performance

5. Preference Programs A. Small Business Preference B. DVBE Participation Goals C. Programs Requirements and Incentives

6. Required Attachments

1. Required Attachment Check List

2. Proposal/Proposer Certification Sheet

3. Bidder Declaration (DGS PD 05-105)

4. Cost Worksheet

5. Commercial Useful Function (CUF)

6. Payee Data Record (STD 204)

7. Contractor's Certification Clauses (CCC-307)

8. Darfur Contracting Act Vendor Certification (DGS PD 1)

9. Confidentiality Statement

10. Insurance Requirement

11. Sample Standard Agreement

Exhibit A – Scope of Work Exhibit B – Budget Detail and Payment Provisions

i. Exhibit B1 – Cost Worksheet Exhibit C – Special Terms and Conditions Exhibit D – Data Confidentiality and Privacy (Personal Information Exhibit E – Data Security Standards

1. Purpose and Description of Services The Department of Health Care Access and Information (HCAI), Healthcare Analytics Branch (HAB), seeks consulting cardiologist services to assist California Cardiovascular Outcomes Reporting Program (CCORP). The mandate for this program is outlined in Health and Safety Code (HSC) § 128745-128750 and requires HCAI to publish risk-adjusted outcomes reports annually for the approximately 124 California licensed hospitals that perform CABG surgery.

The primary data source for these reports is clinical data submitted by hospitals to CCORP using an online reporting tool, Cardiac Online Reporting for California (CORC). Most of the data elements collected by CCORP draw on a subset of data elements collected by the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD). More information on data collected is available on HCAI website at:

https://hcai.ca.gov/data/submit-data/coronary-artery-bypass-grafts/. HCAI seeks a cardiologist to provide consultation on the STS ACSD and CCORP data elements and interpretation of patient medical record information.

Contract Term: The contract term will be from December 18, 2026, or upon approval, through December 17, 2029.

2. Contractor Tasks and Responsibilities:

Contractor shall provide consultation to HAB staff within three days of request. HAB staff will submit questions regarding clinical risk factors via phone or email and provide the necessary documentation for contractor to respond. Most staff questions will occur primarily during the twice-yearly data submissions periods – including one month before and up to one month after the following due dates for hospital data submission of September 28 and March 31 of each year. HCAI may extend the due dates as necessary.

Consultation will be primarily during the data submission periods, but will also be requested throughout the year, with an estimated need of 60 to 80 hours annually.

Consultation will be in the following areas:

A. Provide interpretation of the STS ACSD and CCORP clinical data element definitions as applied to decisions made about specific cardiac surgical cases. STS ACSD and CCORP data element information can be found at https://www.sts.org/research-data/registries/resources-data-managers#adult-cardiac-surgery-database and https://hcai.ca.gov/data/submit-data/coronary-artery-bypass-grafts/#data-resources.

B. Assess, interpret, and evaluate operative reports and other medical records documentation submitted to HCAI by hospitals and surgeons.

C. Provide clinical perspective as needed for statistical modeling development for outcomes.

D. Assist HAB staff with questions from medical chart auditors and other cardiologists, as needed, in the subject matter listed above in (1) through (3).

E. Assist HAB with other cardiac clinical questions and/or information as needed.

F. As available, attend up to two Clinical Advisory Panel meetings annually. Participation may be virtual to provide guidance and clarification to panel regarding cardiac data element coding practices, data analysis, and risk-adjusted model building, and other issues identified by HCAI.

G. Provide program recommendations to HCAI when appropriate.

https://hcai.ca.gov/data/submit-data/coronary-artery-bypass-grafts/ https://www.sts.org/research-data/registries/resources-data-managers#adult-cardiac-surgery-database https://www.sts.org/research-data/registries/resources-data-managers#adult-cardiac-surgery-database https://hcai.ca.gov/data/submit-data/coronary-artery-bypass-grafts/#data-resources https://hcai.ca.gov/data/submit-data/coronary-artery-bypass-grafts/#data-resources

Consultant will provide the following training:

A. Provide an annual focused instructional training session on CCORP data element definitions for the independent audit team prior to their reabstraction of patient records for a sample of hospitals. This training may be virtual for up to two hours and will take place in August or September of each year.

B. When a major CCORP version change is implemented, create up to two 90-minute training videos explaining the data element definitions and providing clinical interpretation and examples.

C. When a major CCORP version change is implemented, conduct up to two virtual live 60-minute questions and answer sessions with CCORP data abstractors on data element definitions.

Contractor Deliverables Contractor is responsible for the following:

A. Provide responses to questions on data element questions and coding for complex CABG cases from HAB staff. May be via email, phone, or in person.

B. Provide input and edits on CCORP training materials. May be via email, phone, or in person.

C. Provide training virtual (via recorded video or live webinar).

D. Provide adequate proof of compliance with HCAI Background Check Policy for contractors who will have access to medical information pursuant to HSC §127011.

State Responsibilities HCAI/HAB is responsible for the following:

A. Provide the contractor with data/documentation required to complete tasks.

B. Provide technical format for training videos and webinars.

3. Minimum Qualifications Bid Submissions that do not meet minimum requirements will be rejected.

A. Bidder must have a current California medical license (in good standing).

B. Bidder must provide documentation of board certification in Cardiology, Cardiovascular

Disease, Interventional Cardiology, or Cardiovascular Surgery—including but not limited to Thoracic, Cardiac, Vascular, or Cardiothoracic Surgery.

C. Bidder must have a minimum of three years reviewing medical record documentation (must be referenced in curriculum vitae (CV)).

D. Bidder must have a minimum of two years of experience with interpreting data elements for submission to STS National Database, National Cardiovascular Data Registry (NCDR), or relevant clinical registry (must be referenced in CV).

4. Desired Qualifications Bidder shall have minimum of two years of experience interpreting and clarifying common cardiac/medical terms for data managers or data abstractors such as Endocarditis, Cerebrovascular Disease, Carotid Stenosis, Liver Disease, Peripheral Artery Disease, Heart Failure, New York Heart Association Classification, Cardiogenic Shock, Cardiac Arrhythmia, Number of Diseased Vessels, Left Main Stenosis, and Mitral Valve Regurgitation.

5. Proposal Requirements and Information A. Key Action Dates

Release of RFP October 22, 2026 RFP written questions due to HCAI October 29, 2026, 5:00 p.m. PDT HCAI written response to questions if any November 2, 2026, 3:00 p.m. PDT RFP Response Due Date November 27, 2026, 5:00 p.m. PDT

Notice of Intent to Award December 11, 2026, 5:00 p.m. PDT Contract Effective Date December 18, 2026

Proposers are advised that this schedule is for planning purposes only. All questions regarding this RFP must be brief, in writing and submitted by email to the project contact identified in Section 4.B: HCAI Project Contact below by October 29, 2026, at 5:00 p.m., PDT. Responses to questions received will be posted to Cal e-Procure’s solicitation page and provided to all responsive proposers within two (2) business days.

B. HCAI Project Contact:

Quica Teames Procurement and Contracting Services

Office of Administrative Services 2020 West El Camino, 10th Floor

Sacramento, CA 95833 pcs@hcai.ca.gov

C. Submission of Proposal:

1) All proposals must be emailed to pcs@hcai.ca.gov by the date and time shown in

Section 4.A: Key Action Dates.

2) All proposals shall include the documents identified in Section 6.1, as identified in

Required Attachment Checklist (see page 11). Proposals that do not include the Required Attachments and Attachment 1 – Required Attachment Checklist shall be deemed non-responsive and will be rejected.

3) All documents requiring a signature must bear an original signature by a person authorized to bind the proposing firm.

4) Proposals must be submitted for the performance of all the services described herein.

Any deviation from specifications will not be considered and will cause a proposal to be rejected.

5) A proposal may be rejected if it is conditional or incomplete, or if it contains any alterations of form or other irregularities of any kind. The State may reject any or all proposals and may waive an immaterial deviation in a proposal. The State's waiver of an immaterial deviation shall in no way modify the RFP document or excuse from full compliance with all requirements if awarded the agreement.

6) Costs incurred in developing proposals and in anticipation of award of the agreement are entirely the responsibility of the proposer and shall not be charged to the State of California.

7) An individual who is authorized to bind the proposal contractually shall sign the Proposal/Proposer Certification Sheet (Attachment 2). The signature shall indicate the title or position that the individual holds in the firm. An unsigned proposal may be rejected.

mailto:analyst@hcai.ca.gov mailto:pcs@hcai.ca.gov

8) A proposer may modify a proposal after its submission by withdrawing its original proposal and resubmitting a new proposal prior to the proposal submission deadline.

Proposal modifications offered in any other manner, oral or written, or submitted after the proposal’s submission deadline, will not be considered.

9) A proposer may withdraw its proposal by submitting a written withdrawal request to the HCAI, signed by the contractor or an authorized agent. A proposer may thereafter submit a new proposal prior to the proposal submission deadline. Proposals may not be withdrawn without cause subsequent to proposal submission deadline.

10) HCAI may modify the RFP prior to the date fixed for submission of proposals by the issuance of an addendum to all parties who received a proposal package.

11) HCAI reserves the right to reject all proposals. HCAI is not required to award an agreement.

12) Before submitting a response to this solicitation, proposers should review, correct all errors and confirm compliance with the RFP requirements.

13) If contractor requires on-site inspection of the premises, please contact the PCS Analyst.

14) HCAI does not accept alternate contract language from a prospective contractor. A proposal with such language will be considered a counter proposal and will be rejected. The State’s General Terms and Conditions (GTC) are not negotiable.

15) No oral understanding or agreement shall be binding on either party.

D. Evaluation and Selection Process:

1) At the time of bid opening, each bid will be checked for the presence or absence of required information in conformance with the submission requirements of this RFP.

2) The State will evaluate each bid to determine its responsiveness to the published requirements.

3) Award, if made, will be to the lowest responsive, responsible bidder.

I.RFP responses that meet administrative requirements for a complete response will be considered "responsive.'

II.Contractors that meet the qualification expectations and can be reasonable assumed as capable of performing the requested scope of work activities will be considered “responsible”.

Consideration will be given to the criteria outlined in the following table, with Credentials and Experience Assessment Criteria to demonstrate success with SOW activities and Cost being equally weighted factor:

Assessment and Selection Criteria Item Rating Credentials and Experience Assessment Criteria

1. Bidder must have a current California Medical License (in good standing)

2. Bidder must have board certification in Cardiology, Cardiovascular Disease, Interventional Cardiology, or Cardiovascular Surgery—including but not limited to Thoracic, Cardiac, Vascular, or Cardiothoracic Surgery.

3. Bidder must provide curriculum vitae

4. Bidder must have a minimum of three years’ experience reviewing medical record documentation

5. Bidder mut have a minimum of two years’ experience with interpreting data elements for submission to STS National Database, NCDR, or relevant clinical registry

6. Bidder Declaration (STD 843)

7. Payee Data Record (STD 204)

8. Proof of Insurance

9. One (1) electronic copy of the complete response

50 points

Cost Assessment Criteria Cost Worksheet – Attachment B1 50 points

Total Possible Points MAXIMUM 100 POINTS

E. Tax Delinquent Status Verification Effective July 1, 2012, Public Contract Code 10295.4 requires state agencies to verify the tax delinquent status of bidders responding to state solicitations.

1) At the time of bid evaluation, prior to contract award and execution, the State will verify all bidders and identified subcontractors as not listed as tax delinquent by the Franchise Tax Board and the Board of Equalization. Any bidder or subcontractor listed as tax delinquent shall result in a bid rejection and will not be considered for contract award. Bidders wanting further clarification can refer to the statute above or to the web sites listed below for additional information.

a) CA Department of Tax and Fee Administration – Top 500 Sales Tax and Use Delinquencies

b) Franchise Tax Board – Top 500 Delinquent Taxpayers

F. Award and Protest

1) Notice of Intent to Award shall be posted at HCAI, 2020 West El Camino Ave., Sacramento, 95833, 8th Floor, for five (5) State business days after awarding the agreement.

2) Proposers have the right to protest the award of the HCAI agreement subject to the following grounds, processes and procedures: If any proposer, prior to the award of Agreement, files a full and complete written statement specifying the grounds for the protest with HCAI, Procurement and Contract Services, and DGS, Office of Legal Services on the grounds that,

a) HCAI failed to correctly apply the standards for reviewing the format requirements or evaluating the proposals as specified in the request for proposal.

b) HCAI used the evaluation and selection procedure in this RFP but failed to follow the methods for evaluating and scoring the proposals specified in the request for proposal.

HCAI used the evaluation and selection procedure in this RFP but is proposing to award the contract to a bidder other than the bidder given the highest score by the state agency evaluation committee.

The Agreement shall not be awarded until either the protest has been withdrawn, or the State has decided the matter. The initial protest must be submitted to:

Department of Health Care Access and Information

Procurement and Contract Services Office of Administrative Services

2020 West El Camino Avenue, Suite 1000 Sacramento, California 95833 Telephone: (916) 326-3600

It is suggested that you submit any protest by certified or registered mail.

c) Within five (5) days after filing the initial protest, the protesting contractor shall file with the Department of General Services (DGS) and the awarding agency a detailed written statement specifying the grounds for the protest. The written protest must be sent to the Department of General Services, Office of Legal Services, 707 Third Street, 7th Floor, Suite 7-330, West Sacramento, California 95605. A copy of the detailed written statement should be mailed to the awarding agency. It is suggested that you submit any protest by certified or registered mail.

http://www.cdtfa.ca.gov/taxes-and-fees/top500.htm http://www.cdtfa.ca.gov/taxes-and-fees/top500.htm https://www.ftb.ca.gov/about-ftb/newsroom/top-500-past-due-balances/corporate-income-tax-list.html

d) DGS Office of Legal Services shall assign a Hearing Officer to determine the outcome of the dispute and notify parties to the protest.

e) All protests related to this RFP will be handled in accordance with the State Contracting Manual Volume 1, Chapter 6.

f) No award shall be made until this protest is resolved.

G. Disposition of Proposals

1) Upon proposal opening, all documents submitted in response to this RFP will become the property of the State of California and will be regarded as public records under the California Public Records Act (Government Code Section 6250 et seq.) and subject to review by HCAI.

2) Proposal packages may be returned only at the contractor's expense unless such expense is waived by the awarding agency.

H. Agreement Execution and Performance

1) Performance of the contract shall begin when the agreement is fully executed. Should the contractor fail to commence work at the agreed upon time, HCAI, upon five (5) calendar days written notice to the contractor, reserves the right to terminate the agreement. In addition, the contractor shall be liable to HCAI for the difference between contractor’s proposal price and the actual cost of performing work by the second lowest contractor or by another contractor.

2) All performance under the agreement shall be completed on or before the termination date of the agreement.

6. Preference Programs A. Small Business Bid Preference (Gov. Code, § 14835):

A non-small business prime contractor who uses certified small business subcontractors for at least 25% of its net bid price is eligible for a bid preference of five percent (5%) of the lowest responsible bid that does not involve a certified small business. A prime contractor who is a small business is eligible for the five percent bid preference. The application of a bid preference does not impact the bid pricing for inclusion into the contract. The preference shall be applied to bids at evaluation to determine a lowest evaluated bid for award.

B. DVBE Participation Goals (Pub. Contract Code, § 10115 et seq.)

Per SCM Vol. 1, Ch. 8.17, all competitive solicitations must contain a DVBE incentive if the solicitation included the DVBE program requirement, unless an exemption for the incentive is approved. Competitive solicitations exempted from the DVBE program requirement may include the DVBE incentive.

For more information: SCM Vol. 1, Ch. 8 https://www.dgs.ca.gov/PD/Services/Page-Content/Procurement-Division-Services-List- Folder/Certify-or-Re-apply-as-Small-Business-Disabled-Veteran-Business- Enterprise?search=apply%20for%20small%20business

C. Program Requirements and Incentives (Gov. Code, §§ 14600, 14615; Cal. Code Regs, tit. 2, § 1896.99.100):

The DVBE Program requirement for this solicitation has been waived; however, the DVBE Incentive still applies. For information about the DVBE Program and Incentive:

https://www.dgs.ca.gov/PD/About/Page-Content/PD-Branch-Intro-Accordion- List/OSDS/OSDS?search=small%20business%20outreach%20program https://www.google.com/url?sa=i&source=web&rct=j&url=https://www.dgs.ca.gov/-/media/Divisions/OLS/Resources/SCM-VI---04-2026-Update/CH8-2026.pdf&ved=2ahUKEwjHib7Yi6OVAxUvHzQIHa67DxAQy_kOegoIAggACAIICxAC&opi=89978449&cd&psig=AOvVaw1bftqcnQ-VoH4Kw74ypd-S&ust=1782500966196000 https://www.google.com/url?sa=i&source=web&rct=j&url=https://www.dgs.ca.gov/-/media/Divisions/OLS/Resources/SCM-VI---04-2026-Update/CH8-2026.pdf&ved=2ahUKEwjHib7Yi6OVAxUvHzQIHa67DxAQy_kOegoIAggACAIICxAC&opi=89978449&cd&psig=AOvVaw1bftqcnQ-VoH4Kw74ypd-S&ust=1782500966196000 https://www.google.com/url?sa=i&source=web&rct=j&url=https://www.dgs.ca.gov/-/media/Divisions/OLS/Resources/SCM-VI---04-2026-Update/CH8-2026.pdf&ved=2ahUKEwjHib7Yi6OVAxUvHzQIHa67DxAQy_kOegoIAggACAIICxAC&opi=89978449&cd&psig=AOvVaw1bftqcnQ-VoH4Kw74ypd-S&ust=1782500966196000 https://www.google.com/url?sa=i&source=web&rct=j&url=https://www.dgs.ca.gov/-/media/Divisions/OLS/Resources/SCM-VI---04-2026-Update/CH8-2026.pdf&ved=2ahUKEwjHib7Yi6OVAxUvHzQIHa67DxAQy_kOegoIAggACAIICxAC&opi=89978449&cd&psig=AOvVaw1bftqcnQ-VoH4Kw74ypd-S&ust=1782500966196000 https://www.dgs.ca.gov/PD/About/Page-Content/PD-Branch-Intro-Accordion-List/OSDS/OSDS?search=small%20business%20outreach%20program https://www.dgs.ca.gov/PD/About/Page-Content/PD-Branch-Intro-Accordion-List/OSDS/OSDS?search=small%20business%20outreach%20program

7. Required Attachments The Attachments set forth in Attachment 1, herein (including Attachment 1, itself) shall be attached to the bid. Bids failing to include Attachments shall be deemed non-responsive and will be rejected.

ATTACHMENT 1

REQUIRED ATTACHMENT CHECK LIST

Proposer Name: ___________________________________________ A complete proposal or proposal package will consist of the items identified below.

Complete this checklist to confirm the items in your proposal. Place a check mark or “X” next to each item that you are submitting to the State. For your proposal to be responsive, all required attachments must be returned. This checklist should also be returned with your proposal package.

ATTACHMENT ATTACHMENT NAME/DESCRIPTION

Attachment 1 Required Attachment Check List

Attachment 2 Proposal/Proposer Certification Sheet

Attachment 3 Bidder Declaration (GSPD-05-105)

Attachment 4 Cost Worksheet

Attachment 5 Commercially Useful Function Questionnaire

Attachment 6 Payee Data Record (STD 204)

Attachment 7 Contractor Certification Clauses

Attachment 8 Darfur Contracting Act Vendor Certification

Attachment 9

Documentation of Board Certification in Cardiology, Cardiovascular Disease, Interventional Cardiology, or Cardiovascular Surgery—including but not limited to Thoracic, Cardiac, Vascular, or Cardiothoracic Surgery.

Attachment 10 Curriculum Vitae

Attachment 11 Confidentiality Statement

Attachment 12 Insurance Requirement

Attachment 13 Sample Standard Agreement

*Will be incorporated into final Agreement.

Do not return the RFP pages 1 through 10.

ATTACHMENT 2

PROPOSAL/PROPOSER CERTIFICATION SHEET

This Proposal/Contractor Certification Sheet must be signed and returned along with all the “required attachments” as an entire package with one (1) original proposal with original signatures plus three (3) copies. The proposal must be transmitted in a sealed envelope in accordance with RFP instructions.

Place all required attachments behind this certification sheet.

1) The signature affixed hereon and dated certifies compliance with all the requirements of this proposal document. The signature below authorizes the verification of this certification.

An Unsigned Proposal/Proposer Certification Sheet May Be Cause for Rejection

1. Company Name 2. Telephone Number

2a. Fax Number

3. Address

Indicate your organization type:

4. Sole Proprietorship 5. Partnership 6. Corporation Indicate the applicable employee and/or corporation number:

7. Federal Employee ID No. 8. California Corporation No.

9. Indicate applicable license and/or certification information:

10. Contractor’s Name (Print) 11. Title

12. Signature 13. Date

14. Are you certified with the Department of General Services, Office of Small Business and Disabled Veteran Business Enterprise (DVBE) Services (OSDS) as:

a. California Small Business b. Disabled Veteran Business Enterprise Yes No Yes No

If yes, enter certification number: If yes, enter certification number:

NOTE: A copy of your Certification should be included if either of the above items is checked “Yes”.

Date application was submitted to OSDS, if an application is pending:

Completion Instructions for Proposal/Proposer Certification Sheet Complete the numbered items on the Proposal/Proposer Certification Sheet by following the instructions below.

Item Number

Instructions

1, 2, 2a, Must be completed. These items are self-explanatory.

Check if your firm is a sole proprietorship. A sole proprietorship is a form of business in which one person owns all the assets of the business in contrast to a partnership and corporation. The sole proprietor is solely liable for all the debts of the business.

5 Check if your firm is a partnership. A partnership is a voluntary agreement between two or more competent persons to place their money, effects, labor, and skill, or some or all of them in lawful commerce or business, with the understanding that there shall be a proportional sharing of the profits and losses between them. An association of two or more persons to carry on, as co-owners, a business for profit.

Check if your firm is a corporation. A corporation is an artificial person or legal entity created by or under the authority of the laws of a state or nation, composed, in some rare instances, of a single person and his successors, being the incumbents of a particular office, but ordinarily consisting of an association of numerous individuals.

7 Enter your federal employee tax identification number.

Enter your corporation number assigned by the California Secretary of State’s Office. This information is used for checking if a corporation is in good standing and qualified to conduct business in California.

9 Complete, if applicable, by indicating the type of license and/or certification that your firm possesses and that is required for the type of services being procured.

10, 11, 12, 13

Must be completed. These items are self-explanatory.

If certified as a California Small Business, place a check in the “Yes” box, and enter your certification number on the line. If certified as a Disabled Veterans Business Enterprise, place a check in the “Yes” box and enter your service code on the line. If you are not certified to one or both, place a check in the No” box. If your certification is pending, enter the date your application was submitted to

OSBCR.

ATTACHMENT 3

BIDDER DECLARATION (GSPD05-105)

All bidders must complete the Bidder Declaration Form (GSPD05-105) and include it with the bid response.

The Bidder Declaration Form (GSPD05-105) is available at the following website:

https://www.documents.dgs.ca.gov/dgs/fmc/gs/pd/gspd05-105.pdf https://www.documents.dgs.ca.gov/dgs/fmc/gs/pd/gspd05-105.pdf

ATTACHMENT 4

COST WORKSHEET

FY CARDIOLOGIST

CONSULTATION SERVICES PRICE HOURS SUM TOTAL

26/27 Cardiologist Consultation Services $________ 80 $__________

27/28 Cardiologist Consultation Services $________ 60 $__________

28/29 Cardiologist Consultation Services $________ 60 $__________

TOTAL $__________

ATTACHMENT 5

COMMERCIALLY USEFUL FUNCTION QUESTIONNAIRE

State of California – Health and Human Services Agency Department of Health Care Access and Information

COMMERCIALLY USEFUL FUNCTION QUESTIONNAIRE

HCAI-AD-159 (Rev 10/2021)

BUSINESS NAME

“DOING BUSINESS AS” (DBA) NAME OSDS REF # (CURRENTLY CERTIFIED FIRMS ONLY)

COMMERICALLY USEFUL FUNCTION (CUF)

All certified Small Business (SB), Microbusiness (MB), and/or Disabled Veteran Business Enterprise (DVBE) vendors (contractors, subcontractors, or suppliers) must meet commercially useful function requirements under Government Code Section 14837(d)(4) and Military and Veterans Code Section 999(b)(5)(B).

Answer the following questions as they apply to the vendor that is fulfilling a contract or purchase order.

Mark all that apply: DVBE Small Business Micro Business 1 Vendor is responsible for the execution of a distinct element of the work of the contract or purchase order?

Yes* No

2 Vendor will carry out its obligation on a contract or purchase order by actually performing, managing, or supervising the work involved?

Yes* No

3 Vendor will perform work on a contract or purchase order that is normal for its business, services and functions?

Yes* No

4 Vendor is responsible, with respect to products, inventories, materials, and supplies required for the contract, for negotiating price, determining quality and quantity, ordering, installing, if applicable, and making payment?

Yes* No

5a Is the vendor subcontracting? Yes No* Go to 5b Skip 5b

5b Is the vendor further subcontracting a portion of the work that is greater than what is to be expected by normal industry practices?

Yes No*

Please note: to be considered compliant, a vendor must meet all five criteria.

Responses that meet the requirements of the government code criteria are marked with an asterisk (*).

Vendor’s Certification I, the Vendor certify under penalty of perjury under the laws of the State of California that my company is in compliance with all five of the criteria listed above.

Buyer’s Certification I, the Buyer certify that I have performed a CUF evaluation and the vendor is in compliance with all five of the criteria listed above.

ATTACHMENT 6

PAYEE DATA RECORD (STD 204)

All bidders must complete the Payee Data Record (STD 204) and include it with the bid response.

The Payee Data Record (STD 204) is available at the following website:

https://www.documents.dgs.ca.gov/dgs/FMC/PDF/Std204.pdf https://www.documents.dgs.ca.gov/dgs/FMC/PDF/Std204.pdf

ATTACHMENT 7

CONTRACTOR CERTIFICATION CLAUSES

All bidders must complete the Contractor Certification Clauses Form (CCC - 04/2017) and include it with the bid response. The Contractor Certification Clauses form (CCC - 04/2017) is available at the following website:

https://www.dgs.ca.gov/-/media/Divisions/OLS/Resources/CCC- 042017.pdf?la=en&hash=4DE3E4DC414511AE378794200BA43EBF91C758EE https://www.dgs.ca.gov/-/media/Divisions/OLS/Resources/CCC-042017.pdf?la=en&hash=4DE3E4DC414511AE378794200BA43EBF91C758EE https://www.dgs.ca.gov/-/media/Divisions/OLS/Resources/CCC-042017.pdf?la=en&hash=4DE3E4DC414511AE378794200BA43EBF91C758EE

ATTACHMENT 8

DARFUR CONTRACTING ACT VENDOR CERTIFICATION (DGS PD 1)

All bidders must complete the Darfur Contracting Act Vendor Certification form and include it with the bid response.

The Darfur Contracting Act Vendor Certification form is available at the following website:

https://www.documents.dgs.ca.gov/dgs/FMC/GS/PD/PD_1.pdf https://www.documents.dgs.ca.gov/dgs/FMC/GS/PD/PD_1.pdf

ATTACHMENT 11

CONFIDENTIALITY STATEMENT

As an authorized representative and/or corporate officer of the company named below, I agree that all persons employed by this company will adhere to the following policy:

All information belonging to the Department of Health Care Access and Information (HCAI) or its affiliated agencies is considered sensitive and/or confidential and cannot be disclosed to any person or entity that is not expressly approved to participate in the work required to execute this Contract without written approval from HCAI Management.

I certify that I will keep all project information, including information concerning the planning, processes, development, or procedures of the Project, confidential and secure. I will not copy, give, or otherwise disclose such information to any other person not authorized under this contract. I will sign and abide by any Security and Confidentiality Statement deemed necessary by HCAI for the Project. I understand that the information to be kept confidential includes, but is not limited to, systems specifications, administrative requirements, terms and conditions, concepts and discussions, as well as written and electronic materials.

I further understand that if I leave this project before it ends, I must still keep all project information confidential and release all data and information to HCAI. I agree to follow any instructions provided by the Project relating to the confidentiality of project information.

I fully understand that any unauthorized disclosure I make may be basis for civil or criminal penalties. I agree to advise HCAI’s Information Security Officer (ISO) (iso@hcai.ca.gov) immediately in the event of an unauthorized disclosure, inappropriate access, misuse, negligence, theft or loss of data as well as any compromise of any system used by the contractor related to work performed for HCAI.

I warrant that if my company is awarded this contract, it will not enter into any agreements or discussions with a third party concerning such materials prior to receiving written confirmation and approval from the State of California to do so.

All materials provided for this Project, except where explicitly stated will be promptly returned or destroyed, as instructed by an authorized HCAI representative. If the materials are destroyed and not returned, a letter attesting to their complete destruction which certifies the destruction procedures must be sent to the HCAI’s ISO before payment can be made for services rendered. In addition, all copies or derivations, including any working or archival backups of the information, will be physically and/or electronically destroyed within five (5) calendar days immediately following either the end of the contract period or the final payment, as determined by HCAI.

I agree that my company's confidentiality obligations hereunder will be continuing and will survive expiration or termination of this contract.

All personnel assigned to this project shall be provided a Confidentiality Statement and will be expected to sign and return it to ISO before beginning work on this project.

Any contractor receiving an account from HCAI shall be required to complete Security Awareness training provided by HCAI.

(Signature of representative) (Date)

(Print name of representative) (Print name of company) mailto:iso@hcai.ca.gov

ATTACHMENT 12

INSURANCE REQUIREMENTS

The Grantee is required to maintain insurance for the term of the Agreement as outlined below.

1. Grantee shall without expense to HCAI maintain at all times during the term of the Agreement, a valid certificate of Commercial General Liability Insurance with the following requirements:

A. Evidence of insurance shall be of a form and content acceptable to HCAI.

B. The certificate of insurance shall be issued by an insurance company, or be provided through partial or total self-insurance, acceptable to HCAI.

C. The certificate of insurance shall state an amount of Commercial General Liability of no less than $1,000,000 per occurrence for bodily injury and property damage liability combined.

D. The certificate of insurance shall provide that the insurer shall not cancel the insured’s coverage without thirty (30) days prior written notice to the state.

E. The general liability certificate of insurance shall provide that HCAI, and its employees are included as additional insured.

F. The certificate of insurance shall meet such additional standards as may be determined by

HCAI.

2. Grantee shall without expense to HCAI maintain at all times during the term of the Agreement, Automobile Liability insurance with limits not less than $500,000.00.

3. Grantee shall without expense to HCAI maintain at all times during the term of the Agreement, Professional Liability Insurance covering any damages caused by a negligent error, act or omission with limits not less than $1,000,000.00 per claim and $1,000,000.00 policy aggregate.

4. Grantee shall without expense to HCAI maintain at all times during the term of the Agreement, Workers Compensation and Employers’ Liability Insurance. In lieu of this insurance requirement, Grantee agrees to indemnify and hold harmless HCAI and its employees from any claims, expenses, causes of action, lawsuits, damages, and liabilities for any work-related injuries suffered by Grantee or any employees of Grantee during performance of services under this Agreement.

5. In the event the required insurance coverage lapses, expires, or is canceled at any time or times during the term of the Agreement, Grantee shall provide upon receipt new certificate of insurance evidencing insurance coverage as provided for herein for not less than the remainder of the term of the Agreement, or for a period of not less than one (1) year. Grantee agrees that no work or services shall be performed without the required insurance coverage noted above. In the event Grantee fails to keep current and in effect at all times, insurance coverage as noted above, the state may, in addition to any other remedies, terminate the Agreement.

All certificates of insurance shall clearly indicate HCAI #26-27047 and be submitted to: The

Department of Health Care Access and Information Office of Health Care Affordability

Attn.: TBD 2020 West El Camino Avenue, Ste. 1000

Sacramento, CA 95833

ATTACHMENT 13

SAMPLE STANDARD AGREEMENT

SAMPLE

EXHIBIT A

SCOPE OF WORK

1. The Contractor, [Contractor Name], shall provide to the Department of Health Care Access and

Information (HCAI) complex clinical consultation to professional staff specific for mandated work related to the California Cardiovascular Outcomes Reporting Program (CCORP).

2. Period of Performance The maximum term of this agreement shall be from November 27, 2026, through July 31, 2029, during regular business hours defined as Monday through Friday, between 8:00 a.m. and 5:00 p.m.

(excluding State holidays).

3. Background The CCCORP is a mandatory program that collects, evaluates, and publishes risk-adjustment outcomes reports for CABG surgeries in California. The program requires the consulting services of a cardiologist who has clinical understanding of the Society of Thoracic Surgeons (STS) data elements.

4. The project representatives during the term of this Agreement shall be:

State Agency:

HCAI

Contractor:

Name: Shannon Conroy, PhD, MPH Name:

Phone: (916) 326-3885 Phone:

Email: shannon.conroy@hca.ca.gov Email:

Direct all inquiries concerning the terms and conditions of this agreement to:

State Agency:

HCAI

Contractor:

Section:

Healthcare Analytics Branch Attention:

Shannon Conroy, PhD, MPH

Attention:

Address:

2020 West El Camino Avenue Sacramento, CA 95833

Address:

Phone: (916) 326-3885 Phone:

Email: shannon.conroy@hcai.ca.gov Email:

5. Contractor Tasks and Responsibilities Contractor shall provide consultation to HAB staff within three days of request. HAB staff will submit questions regarding clinical risk factors via phone or email and provide the necessary documentation for contractor to respond. Most staff questions will occur primarily during the twice-yearly data submissions periods – including one month before and up to one month after CABG data is due from hospitals. The due dates for hospital data submission are September 28 and March 31 of each year. HAB may extend the due dates as necessary.

Consultation will be primarily during the data submission periods, but will also be requested throughout the year, with an estimated need of 60 to 80 hours annually.

SAMPLE

mailto:shannon.conroy@hca.ca.gov mailto:shannon.conroy@hcai.ca.gov

Consultation will be in the following areas:

A. Provide interpretation of the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery

Database (ACSD) and CCORP clinical data element definitions as applied to decisions made about specific cardiac surgical cases. STS ACSD and CCORP data element information can be found at https://www.sts.org/research-data/registries/sts-national-database#adult-cardiac-surgery-database.

B. Assess, interpret, and evaluate operative reports and other medical records documentation submitted to HCAI by hospitals and surgeons.

C. Provide clinical perspective as needed for statistical modeling development for outcomes.

D. Assist HAB staff with questions from medical chart auditors and other cardiologists, as needed, in the subject matter listed above in (1) through (3).

E. Assist HAB with other cardiac clinical questions and/or information as needed.

F. As available, attend up to six Clinical Advisory Panel Meetings. Participation may be virtual to provide guidance and clarification to panel regarding cardiac data element coding practices, data analysis, and risk-adjusted model building, and other issues identified by HCAI.

G. Provide program recommendations to HCAI when appropriate.

6. Consultant will provide the following training:

A. Provide an annual focused instructional training on CCORP data element definitions for the independent audit team prior to their re-abstraction of patient records for a sample of hospitals.

This training may be virtual for up to two hours and will take place in July, August, or September of each year.

B. When a major CCORP version change is implemented, create up to two 90-minute training videos explaining the data element definitions and providing clinical interpretation and examples.

C. When a major CCORP version change is implemented, conduct up to two virtual live 60-minute questions and answer sessions with CCORP data abstractors on data element definitions.

Contractor Deliverables

7. Contractor is responsible for the following:

A. Provide responses to questions from HAB staff. May be via email, phone, or in person.

B. Provide input and edits on CCORP training materials. May be via email, phone, or in person.

C. Provide training virtual (via recorded video or live webinar).

D. Provide adequate proof of compliance with HCAI Background Check Policy for contractors who will have access to medical information pursuant to HSC §127011

8. State Responsibilities

HCAI/HAB is responsible for the following:

A. Provide the contractor with data/documentation required to complete tasks.

B. Provide technical format for training videos and webinars.

SAMPLE

https://www.sts.org/research-data/registries/sts-national-database#adult-cardiac-surgery-database https://www.sts.org/research-data/registries/sts-national-database#adult-cardiac-surgery-database

9. Work Order Authorization (WOA) Process:

A. Definitions - In addition to the definitions set forth in Paragraph 1 of the General Provisions, the following terms and conditions shall apply to this Agreement:

1) “Acceptance” or “Accepted” means a written notice from the State to the Contractor that

WOA services and/or work products have satisfied the acceptance criteria.

2) “Business Days” means all weekdays on which the State is open to the public to conduct business.

B. Each and every WOA shall be in writing and signed by the Contractor and State prior to beginning work under such WOA. Each WOA shall describe the services and/or work products to be developed, applicable due dates, acceptance criteria, staff resources, total number of hours, and total fixed price cost. The Contractor shall demonstrate to the State how the staff hours and costs to complete the work were calculated, including providing, upon State request, documentation supporting those calculations (e.g., hours and costs). Upon request by the State, the Contractor shall submit a completed draft WOA to the State, using the State provided WOA template, within five (5) calendar days, or as otherwise agreed to by the State. Upon receipt of a completed draft WOA from the Contractor, the State will provide written notice to the Contractor of its acceptance or rejection of the completed draft WOA within ten (10) calendar days. If the WOA is rejected, the State shall notify the Contractor of the reasons why it was rejected, and the Contractor shall correct the deficiencies and resubmit within the timeframe provided by the State.

C. The total cost set forth in a WOA shall be a fixed price for all the services and work products in that WOA.

D. A WOA may be amended only in writing by mutual consent of both parties. If at any time the Contractor anticipates the level of effort to complete a WOA will be greater than as described in the executed WOA, the Contractor shall immediately notify the State. If the State agrees that additional effort and time is warranted, the WOA will be amended to reflect the agreement of both parties.

E. The State, in its sole discretion, may unilaterally terminate a WOA at any time by providing three

(3) Business Days’ written notice to the Contractor. The Contractor shall be paid the reasonable costs incurred for Accepted work products and/or services rendered up to termination of the WOA, as determined by the State.

F. Each WOA shall be incorporated into and become a part of this Agreement. In no event shall a WOA be deemed a separate contract.

10. Acceptance Criteria It shall be the State’s sole determination as to whether a deliverable has been successfully completed and acceptable to the State. There must be a signed Acceptance document for each deliverable before invoices can be processed for payment.

Acceptance criteria for deliverables shall consist of the following:

A. Deliverables are completed as specified and approved.

B. All deliverables must be in a format that can be used by HCAI.

If a deliverable is not Accepted, HCAI shall provide the rationale for non-acceptance in writing within fourteen (14) business days of receipt of the deliverable or upon completion of the applicable acceptance testing period.

EXHIBIT B

BUDGET DETAIL AND PAYMENT PROVISIONS

1. Invoicing and Payment

A. For services satisfactorily rendered and on receipt and approval of the invoices, HCAI agrees to compensate Contractor, for actual expenditures incurred in accordance with the rates specified herein, which is attached hereto as Exhibit B and made a part of this Agreement. The rates are based on the Cost Proposal Work Sheet submitted in the contractor’s proposal. Invoices shall be submitted no more than monthly, in arrears, and shall provide supporting documentation properly detailing all charges, expenses, direct, and indirect costs. All invoices submitted by Contractor must identify this Agreement No. 26-27047. Any invoices submitted without the above referenced information may be returned to Contractor for further reprocessing.

B. Invoices must be provided to HCAI, submitted on contractor’s letterhead and signed by an authorized representative. Each invoice must include:

1) Agreement Number 26-27047

2) Time period covered by the invoice

3) Itemized expenses (including applicable sub-contractor services and travel expenses)

C. Invoices shall be submitted not more frequently than monthly in arrears to:

Department of Health Care Access and Information

Office of Technology Services OISProcurement@hcai.ca.gov 2020 West El Camino Avenue

Sacramento, CA 95833 D. Final invoice will not be authorized for payment until HCAI has received and approved the final file.

2. Budget Contingency Clause

A. It is mutually agreed that if the budget act of the current year and/or any subsequent years covered under this agreement does not appropriate sufficient funds for the program, the agreement shall be of no further force and effect. In this event, the State shall have no liability to pay any funds whatsoever to Contractor or to furnish any other considerations under this agreement and contractor shall not be obligated to perform any provisions of the agreement.

If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this program, the State shall have the option to either cancel this agreement with no liability occurring to the State or offer an agreement amendment to contractor to reflect the reduced amount.

3. Prompt Payment Clause Payment will be made in…