STATE OF MICHIGAN

ENTERPRISE PROCUREMENT

Department of Technology, Management, and Budget 320 S. Walnut Street 2nd Floor Lansing, MI 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

CONTRACT SUMMARY

Electronic Medical Records (EMR) system, INITIAL EFFECTIVE DATE INITIAL EXPIRATION DATE INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

April 13, 2015 April 12, 2020 5 Months April 11, 2025

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

MINIMUM DELIVERY REQUIREMENTS

P-Card Direct Voucher (PRC) Other Yes No

11801 Domain Blvd, 3rd Floor

Austin TX 78758

Jill Moss

(631) 430-9198 jill.moss@cantatahealth.com

CV0066152

Experience Care Corporation

C O

N

TR

A C

TO

R

Patrick Russell

(517) 648-7767

DTMB

Various Various russellp2@michigan.gov

C ontract

A dm inistrator Program M anagerSTA

TE

Change Notice Number 29

Contract Number MA071B5500090C to

DESCRIPTION OF CHANGE NOTICE

OPTION EXTENSIONLENGTH OF OPTION LENGTH OF EXTENSION REVISED EXP. DATE

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

3 Years April 10, 2028

$1,685,852.40 $120,000.00 $1,805,852.40

DESCRIPTION

Effective 03/25/2025, this Contract is extended for 36 months for the period of 04/11/2025 through 04/10/2028 at a rate of $2,000 per month as previously agreed upon in Change Notice 25.

Additionally, 2-1 year options are added to the contract and is increased by $120,000 to cover costs for the 36 months and 2-1 year options. The revised contract expiration date is 04/10/2028.

All other terms, conditions, specifications, and pricing remain the same. Per contractor and agency agreement, DTMB Central Procurement Services approval, and State Administrative Board approval on 03/25/2030.

AGENCY NAME PHONE EMAIL

DMVA Melissa Velie 517-275-1183 VelieM@michigan.gov

DTMB Jim Coggin 517-243-5265 CogginJ@michigan.gov

Program Managers for

Multi-Agency and Statewide Contracts

CHANGE NOTICE NO. 29 TO CONTRACT NO. MA071B5500090C

CENTRAL PROCUREMENT SERVICES

Department of Technology, Management, and Budget

320 S. WALNUT ST., LANSING, MICHIGAN 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 28 to Contract Number 071B5500090

Various

Sarah Platte jill.moss@cantatahealth.com

Jill Moss

Austin, TX 78758

Experience Care Corporation

CV0066152

(631) 430-9198

11801 Domain Blvd, 3rd Floor

517-219-2406 S

T A

T E

P ro g ra m

M a n a g e r

C o n tra ct

A d m in istra to r

C O

N T R A C T O

R

DTMB

plattes3@michigan.gov

$1,669,852.40

April 13, 2015 May 11, 2024

ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM,

April 12, 2020

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

5 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☒ Yes ☐ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☒ 11, one-month ☐ April 11, 2025

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$22,000.00 $1,691,852.40

Effective 5/3/2024, the parties exercise the remaining 11 months of options and add $22,000.00 to cover the costs of continuing the present level of services. The parties agree that the State may exercise month-to-month options at the rate of $2,000.00 per month thereafter if the State requests this prior to 5/11/2024.

Additionally, an administrative change has been made to fix the starting "Current Value". In CN 27, the "Estimated Aggregate Contract Value" was listed as $1,643,852.40. It should have been $1,669,852.40 and the starting value for Change Notice 28 has been modified to reflect the correct dollar value.

All other terms, conditions, specifications, and pricing remain the same. Per DTMB contractor, agency, DTMB Procurement, and State Administrivia Board approval on 3/31/2015.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

CONTRACT SUMMARY

DMVA

Program Managers for

CHANGE NOTICE NO. 28 TO CONTRACT NO. 071B5500090

Melissa Velie 517-275-1183 VelieM@michigan.govDMVA

Jim Coggin 517-243-5265 CogginJ@michigan.govDTMB

Department of Technology, Management, and Budget

320 S. WALNUT ST., LANSING, MICHIGAN 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 27 to Contract Number 071B5500090

Various

Sarah Platte jill.moss@cantatahealth.com

Jill Moss

Austin, TX 78758

Experience Care Corporation

CV0066152

(631) 430-9198

11801 Domain Blvd, 3rd Floor

517-219-2406 S

T A

T E

P ro g n a g e r

C o n tra ct

A d m in istra to r

C O

N T R A C T O

R

DTMB

plattes3@michigan.gov

$1,639,852.40

April 13, 2015 March 11, 2024

ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM,

April 12, 2020

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

5 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☒ Yes ☐ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☐ ☐ May 11, 2024

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$4,000.00 $1,643,852.40

Effective 3/11/2024, the parties exercise 2, one-month options and add $4,000.00 to cover the costs of continuing the present level of services. The parties agree that the State may exercise month-to-month options at the rate of $2,000.00 per month thereafter if the State requests this prior to 3/11/2024.

All other terms, conditions, specifications, and pricing remain the same. Per DTMB contractor, agency, DTMB Procurement, and State Administrive Board approval on 3/31/2015.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

Program Managers for

CHANGE NOTICE NO. 27 TO CONTRACT NO. 071B5500090

Jim Coggin 517-243-5265 CogginJ@michigan.govDTMB

Department of Technology, Management, and Budget

320 S. WALNUT ST., LANSING, MICHIGAN 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 26 to Contract Number 071B5500090

Various

Sarah Platte scott.schroeder@wellsky.com

Scott Schroeder

Austin, TX 78731

EXPERIENCE CARE CORPORATION

CV0066152

913-307-1000

5900 Balcones Drive, STE 6865

517-219-2406 S

T A

T E

P ro g n a g e r

C o n tra ct

A d m in istra to r

C O

N T R A C T O

R

DTMB

plattes3@michigan.gov

$1,637,852.40

April 13, 2015 February 11, 2024

ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM,

April 12, 2020

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

5 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☒ Yes ☐ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☒ 1 Month ☐ March 11, 2024

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$2,000.00 $1,639,852.40

Effective 1/31/2024, the parties exercise 1, one-month options and add $2,000.00 to cover the costs of continuing the present level of services. The parties agree that the State may exercise month-to-month options at the rate of $2,000.00 per month thereafter if the State requests this prior to 2/11/2024.

Additionally, the State is also updating the Contractor information from Experience Care LLC to Experience Care Corporation (an Affiliate of WellSky Corporation).

All other terms, conditions, specifications, and pricing remain the same. Per DTMB contractor, agency, DTMB Procurement, and State Administrive Board approval on 3/31/2015.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

Program Managers for

CHANGE NOTICE NO. 26 TO CONTRACT NO. 071B5500090

Laura Brancheau 517-335-1334 BrancheauL@michigan.govDTMB

C O

N T R A C T

R

Experience Care, LLC

11801 Domain Blvd, 3rd Floor

Austin, TX 78758

Scott Schroeder

913-307-1000 scott.schroeder@wellsky.com

CV0066152

S T

A T

E

P ro g n a g e r

Various DMVA o n tra ct

A d m in istra to r

Sarah Platte DTMB

517-219-2406 plattes3@michigan.gov

Department of Technology, Management, and Budget

320 S. WALNUT ST., LANSING, MICHIGAN 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 25 to Contract Number 071B5500090

ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM,

INITIAL EFFECTIVE DATE INITIAL EXPIRATION DATE INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

April 13, 2015 April 12, 2020 5 - 1 Year October 11, 2023

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☒ Yes ☐ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☒ 4, one-month ☐ February 11, 2024

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$1,629,852.40 $8,000.00 $1,637,852.40

DESCRIPTION

Effective 11/10/2023, the parties exercise 4, one-month options and add $8,000.00 to cover the costs of continuing the present level of services. The parties agree that the State may exercise month-to-month options at the rate of $2,000.00 per month thereafter if the State requests this prior to 10/11/2023.

The parties also acknowledge that Experience Care, LLC has been purchased WellSky Corporation and will operate as their affiliate under the name Experience Care Corporation. This change is pending in SIGMA and will be completely executed on 11/13/2023.

All other terms, conditions, specifications, and pricing remain the same. Per DTMB contractor, agency, DTMB Procurement, and State Administrative Board approval on 3/31/2015.

mailto:plattes3@michigan.gov

CHANGE NOTICE NO. 25 TO CONTRACT NO. 071B5500090

Program Managers for

Multi-Agency and Statewide Contracts

AGENCY NAME PHONE EMAIL

DMVA Melissa Velie 517-275-1183 VelieM@michigan.gov

DTMB Laura Brancheau 517-335-1334 BrancheauL@michigan.gov mailto:VelieM@michigan.gov mailto:BrancheauL@michigan.gov

Department of Technology, Management, and Budget

320 S. WALNUT ST., LANSING, MICHIGAN 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 24 to Contract Number 071B5500090

Various

Sarah Platte jill.moss@cantatahealth.com

Jill Moss

Austin, TX 78758

Experience Care, LLC

CV0066152

(631) 430-9198

11801 Domain Blvd, 3rd Floor

517-219-2406 S

T A

T E

P ro g n a g e r

C o n tra ct

A d m in istra to r

C O

N T R A C T O

R

DTMB

plattes3@michigan.gov

$1,625,852.40

April 13, 2015 August 11, 2023

ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM,

April 12, 2020

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

5 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☒ Yes ☐ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☒ 2, one month ☐ October 11, 2023

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$4,000.00 $1,629,852.40

Effective 8/10/2023, the parties exercise 2, one-month options and add $4,000.00 to cover the costs of continuing the present level of services. The parties agree that the State may exercise month-to-month options at the rate of $2,000.00 per month thereafter if the State requests this prior to 8/11/2023.

All other terms, conditions, specifications, and pricing remain the same. Per DTMB contractor, agency, DTMB Procurement, and State Administrive Board approval on 3/31/2015.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

Program Managers for

CHANGE NOTICE NO. 24 TO CONTRACT NO. 071B5500090

Department of Technology, Management, and Budget

320 S. WALNUT ST., LANSING, MICHIGAN 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 23 to Contract Number 071B5500090

Various

Sarah Platte jill.moss@cantatahealth.com

Jill Moss

Austin, TX 78758

Experience Care, LLC

CV0066152

(631) 430-9198

11801 Domain Blvd, 3rd Floor

517-219-2406 S

T A

T E

P ro g n a g e r

C o n tra c t

A d m in is tra to r

C O

N T

R A

C T

O R

DTMB

plattes3@michigan.gov

$1,625,852.40

April 13, 2015 June 11, 2023

ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM,

April 12, 2020

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

5 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☒ Yes ☐ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☒ 1 Month ☐ August 11, 2023

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$4,000.00 $1,629,852.40

Effective 6/9/2023, the parties exercise 2, one-month options and add $4,000.00 to cover the costs of continuing the present level of services. The parties agree that the State may exercise month-to-month options at the rate of $2,000.00 per month thereafter if the State requests this prior to 6/11/2023.

All other terms, conditions, specifications, and pricing remain the same. Per DTMB contractor, agency, DTMB Procurement, and State Administrive Board approval on 3/31/2015.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

Program Managers for

CHANGE NOTICE NO. 23 TO CONTRACT NO. 071B5500090

Department of Technology, Management, and Budget

320 S. WALNUT ST., LANSING, MICHIGAN 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 22 to 071B5500090Contract Number

Various

Sarah Platte jill.moss@cantatahealth.com

Jill Moss

Austin, TX 78758

Experience Care, LLC

CV0066152

(631) 430-9198

5900 Balcones Dr, Ste 6865

517-219-2406 S

T A

T E

P ro g n a g e r

C o n tra c t

A d m in is tra to r

C O

N T

R A

C T

O R

DTMB

plattes3@michigan.gov

$1,607,517.20

April 13, 2015 June 11, 2023

ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM,

April 12, 2020

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

5 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☒ Yes ☐ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☐ ☐ June 11, 2023

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$18,335.20 $1,625,852.40

Effective 2/21/2023, the State adds funds in the amount of $18,335.20 to pay for an invoice. This amount reflects the credit of $5,664.80 the State was given by the Contractor on a $24,000.00 invoice.

The State has also made a clerical change to update the Contractor information from Canata Health to Experience Care LLC.

All other terms, conditions, specifications, and pricing remain the same. Per DTMB contractor, agency, and DTMB Procurement approval

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

Program Managers for

CHANGE NOTICE NO. 22 TO CONTRACT NO. 071B5500090

Department of Technology, Management, and Budget

320 S. WALNUT ST., LANSING, MICHIGAN 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 21 to 071B5500090Contract Number

Various

Sarah Platte jill.moss@cantatahealth.com

Jill Moss

Austin, TX 78758

CANTATA HEALTH, LLC

CV0066152

(631) 430-9198

11801 Domain Blvd, 3rd Floor

517-219-2406 S

T A

T E

P ro g n a g e r

C o n tra c t

A d m in is tra to r

C O

N T

R A

C T

O R

DTMB

plattes3@michigan.gov

$1,597,517.20

April 13, 2015 January 11, 2023

ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM,

April 12, 2020

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

5 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☒ Yes ☐ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☒ ☐ June 11, 2023

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$10,000.00 $1,607,517.20

Effective 1/11/2023, the parties exercise 5, one-month option and add $10,000.00 to cover the costs of continuing the present level of services. The parties agree that the State may exercise month-to-month options at the rate of $2,000.00 per month thereafter if the State requests this prior to 1/11/2023.

All other terms, conditions, specifications, and pricing remain the same. Per DTMB contractor, agency, and DTMB Procurement approval.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

Program Managers for

CHANGE NOTICE NO. 21 TO CONTRACT NO. 071B5500090

Department of Technology, Management, and Budget

320 S. WALNUT ST., LANSING, MICHIGAN 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 20 to 071B5500090Contract Number

Various

Sarah Platte jill.moss@cantatahealth.com

Jill Moss

Austin, TX 78758

CANTATA HEALTH, LLC

CV0066152

(631) 430-9198

11801 Domain Blvd, 3rd Floor

517-219-2406 S

T A

T E

P ro g n a g e r

C o n tra c t

A d m in is tra to r

C O

N T

R A

C T

O R

DTMB

plattes3@michigan.gov

$1,593,517.20

April 13, 2015 November 11, 2022

ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM,

April 12, 2020

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

5 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☒ Yes ☐ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☒ 2, one-month options ☐ January 11, 2023

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$4,000.00 $1,597,517.20

Effective 11/7/2022, the parties exercise 2, one-month option and add $4,000.00 to cover the costs of continuing the present level of services. The parties agree that the State may exercise month-to-month options at the rate of $2,000.00 per month thereafter if the State requests this prior to 11/11/2022.

All other terms, conditions, specifications, and pricing remain the same. Per DTMB contractor, agency, and DTMB Procurement approval.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

Program Managers for

CHANGE NOTICE NO. 20 TO CONTRACT NO. 071B5500090

Department of Technology, Management, and Budget

320 S. WALNUT ST., LANSING, MICHIGAN 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 19 to 071B5500090Contract Number

Various

Sarah Platte jill.moss@cantatahealth.com

Jill Moss

Austin, TX 78758

CANTATA HEALTH, LLC

CV0066152

(631) 430-9198

11801 Domain Blvd, 3rd Floor

517-219-2406 S

T A

T E

P ro g n a g e r

C o n tra c t

A d m in is tra to r

C O

N T

R A

C T

O R

DTMB

plattes3@michigan.gov

$1,591,517.20

April 13, 2015 October 11, 2022

ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM,

April 12, 2020

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

5 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☒ Yes ☐ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☒ 1 Month ☐ November 11, 2022

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$2,000.00 $1,593,517.20

Effective 10/07/2022, the parties exercise 1, one-month option and add $2,000.00 to cover the costs of continuing the present level of services. The parties agree that the State may exercise month-to-month options at the rate of $2,000.00 per month thereafter if the State requests this prior to 10/11/2022.

All other terms, conditions, specifications, and pricing remain the same. Per DTMB contractor, aagency, and DTMB Procurement approval.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

Program Managers for

CHANGE NOTICE NO. 19 TO CONTRACT NO. 071B5500090

Department of Technology, Management, and Budget

320 S. WALNUT ST., LANSING, MICHIGAN 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 18 to 071B5500090Contract Number

Various

Sarah Platte jill.moss@cantatahealth.com

Jill Moss

Austin, TX 78758

CANTATA HEALTH, LLC

CV0066152

(631) 430-9198

11801 Domain Blvd, 3rd Floor

517-219-2406 S

T A

T E

P ro g n a g e r

C o n tra c t

A d m in is tra to r

C O

N T

R A

C T

O R

DTMB

plattes3@michigan.gov

$1,589,517.20

April 13, 2015 September 11, 2022

ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM,

April 12, 2020

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

5 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☒ Yes ☐ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☐ ☐ October 11, 2022

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$2,000.00 $1,591,517.20

Effective 09/02/2022, the parties exercise 1, one-month option and add $2,000.00 to cover the costs of continuing the present level of services. The parties agree that the State may exercise month-to-month options at the rate of $2,000.00 per month thereafter if the State requests this prior to 09/11/2022.

All other terms, conditions, specifications, and oricing remain the same. Per DTMB contractor, aagency, and DTMB Procurement approval.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

Program Managers for

CHANGE NOTICE NO. 18 TO CONTRACT NO. 071B5500090

Michael Cooley 517-284-9821 cooleym@michigan.govDTMB

Department of Technology, Management, and Budget

525 W. ALLEGAN ST., LANSING, MICHIGAN 48913

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 10 to 071B5500090Contract Number

Various

Jarrod Barron jill.moss@cantatahealth.com

Jill Moss

Austin, TX 78758

CANTATA HEALTH, LLC

CV0066152

(631) 430-9198

11801 Domain Blvd, 3rd Floor

(517) 249-0406 S

T A

T E

P ro g n a g e r

C o n tra ct

A d m in istra to r

C O

N T R A C T O

R

DTMB

barronj1@michigan.gov

$1,583,517.20

April 13, 2015 July 11, 2021

ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM,

April 12, 2020

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

5 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☒ Yes ☐ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☒ 3 months ☐ October 11, 2021

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$6,000.00 $1,589,517.20

Effective 7/8/2021, the parties exercise a 90-day option and add $6,000.00 to cover the costs of continuing the present level of services. The parties agree that the State may exercise month-to-month options at the rate of $2,000.00 per month thereafter if the State requests this prior to 10/11/2021. All other terms, conditions, specifications, and pricing remain the same. Per DTMB Contractor, agency and DTMB Procurement approval.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

Program Managers for

CHANGE NOTICE NO. 10 TO CONTRACT NO. 071B5500090

Melissa Velie 517-284-5245 VelieM@michigan.govDMVA

Michael Cooley 517-284-9821 cooleym@michigan.govDTMB

Department of Technology, Management, and Budget

525 W. ALLEGAN ST., LANSING, MICHIGAN 48913

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 9 to 071B5500090Contract Number

Jarrod Barron jill.moss@cantatahealth.com

Jill Moss

Austin, TX 78758

CANTATA HEALTH, LLC

(631) 430-9198

11801 Domain Blvd, 3rd Floor

(517) 249-0406 S T A T E

P ro g n a g e r

C o n tra ct

A d m in istra to r

C O

N T R A C T O

R

DTMB

barronj1@michigan.gov

$1,567,033.76

April 13, 2015 April 12, 2021

ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM,

April 12, 2020

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

5 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☒ Yes ☐ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☐ 90 days ☐ July 11, 2021

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$16,483.44 $1,583,517.20

Effective 3/9/2021, the parties exercise a 90-day option and add $16,483.44 to cover the costs of continuing the present level of services, which is the pro-rated 90-day current contract price. The parties agree that the the State may exercise another 90-day option at this price if the State requests this prior to 7/11/2021. All other terms, conditions, specifications, and pricing remain the same. Per DTMB Contractor, agency and DTMB Procurement approval.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

CONTRACT SUMMARY

DMVA

CV0066152

Various

Program Managers for

CHANGE NOTICE NO. 9 TO CONTRACT NO. 071B5500090

Melissa Velie 517-284-5245 VelieM@michigan.gov511

Michael Cooley 517-284-9821 cooleym@michigan.gov171

Department of Technology, Management, and Budget

525 W. ALLEGAN ST., LANSING, MICHIGAN 48913

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 8 to 071B5500090Contract Number boruckir2@michigan.gov

Ralph Borucki

Jarrod Barron greg.leroy@cantatahealth.com

Greg Leroy

Austin, TX 78758

CANTATA HEALTH, LLC

CV0066152

512-663-3362

11801 Domain Blvd, 3rd Floor

(517) 249-0406 S T A T E

P ro g n a g e r

C o n tra ct

A d m in istra to r

C O

N T R A C T O

R

DMVA

517-243-4982

DTMB

barronj1@michigan.gov

$1,501,100.00

April 13, 2015 April 12, 2020

ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM,

April 12, 2020

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

5 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☒ Yes ☐ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☐ ☐ April 12, 2021

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$65,933.76 $1,567,033.76

Effective 3/25/2020, this contract is hereby increased by $65,933.76 for MSP use. All other terms, conditions, specifications and pricing remain the same. Per contractor and agency agreement, and DTMB Procurement approval.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

DocuSign Envelope ID: 423E44AB-8239-4849-B729-F9950313F6EB

Department of Technology, Management, and Budget

525 W. ALLEGAN ST., LANSING, MICHIGAN 48913

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 7 to 071B5500090Contract Number boruckir2@michigan.gov

Ralph Borucki

Jarrod Barron greg.leroy@cantatahealth.com

Greg Leroy

Austin, TX 78758

CANTATA HEALTH, LLC

CV0066152

512-663-3362

11801 Domain Blvd, 3rd Floor

(517) 249-0406 S T A T E

P ro g n a g e r

C o n tra ct

A d m in istra to r

C O

N T R A C T O

R

DMVA

517-243-4982

DTMB

barronj1@michigan.gov

$1,501,100.00

April 13, 2015 April 12, 2020

ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM,

April 12, 2020

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

5 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☒ Yes ☐ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☒ 12 Months ☐ April 12, 2021

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$0.00 $1,501,100.00

Effective 4/1/2021 the State is exercising one option year. The revised contract expiration date is 4/12/2021. The State is also incorporating the attached statement of work that reduces the overall scope of the contract.

All other terms, conditions, specifications and pricing remain the same. Per contractor and agency agreement, and DTMB Procurement approval.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

DocuSign Envelope ID: 08A6EF34-B049-4916-93C8-1EE3B62BD6CEDocuSign Envelope ID: 866D6F59-284D-4938-9E87-A3D7504B4A20

MICHIGAN DEPARTMENT OF TECHNOLOGY,

MANAGEMENT AND BUDGET

IT SERVICES

STATEMENT OF WORK

Project Title:

DMVA –Grand Rapids Home for Veterans and D J Jacobetti Home for Veterans – Limited Access into NetSolutions EMR

Period of Coverage:

April 12, 2020 to April 11, 2021

Requesting Department:

Department of Technology, Management and Budget supporting The Military and Veterans Affairs (DMVA)

Date:

03/17/2020

Agency Business Owner:

Steven Rolston

Phone:

517-242-3862

DTMB Program Manager:

Ralph Borucki

Phone:

517-243-4982

Brief Description of Services to be provided:

Contract 071B5500090 amendment to support the new limited access for both Grand Rapids Home for Veterans and the DJ Jacobetti Home for Veterans within the Cantata NetSolutions application.

BACKGROUND:

NTT DATA Long Term Care Solutions, Inc. (or referred to as “NTT Data”) via Contract 071B5500090 is to provide the Department of Military and Veterans Affairs (DMVA) two Veterans Homes (Grand Rapids Home for Veterans and the D. John Jacobetti Home for Veterans) with a vendor-hosted, web-based Electronic Medical Record (EMR) Software as a Service (SaaS) solution accessed via a web browser referred to as “NetSolutions™”.

Per Contract 071B5500090, Section 1.104 Work and Deliverables G. Supplemental Services allows the Contractor to provide additional software, support and/or services to support the needs of the State.

The Grand Rapids Home for Veterans and D J Jacobetti Home for Veterans is requesting the use of limited user access to the NetSolutions System. This is for the requirement for continuous use for all of the historical data that has been entered into NetSolutions and will be used for reporting and auditing purposes.

Accordingly, NetSolutions™” this will only be a change within the NetSolutions system not allowing for adding or updating any changes. The costs associated with this work request will be only monthly costs and there will not be setup costs associated with the work that needs to be completed.

PROJECT OBJECTIVE:

The purpose of this request is for the Contractor to provide the continue services necessary for both homes to use NetSolutions limited user access interface for historical data at Grand Rapids Home for Veterans and DJ Jacobetti Home for Veterans.

SCOPE OF WORK:

Contractor will create the appropriate limited user access connection. The following are the overview of each point that will be included in the limited user access and monthly fees:

Applications Admit/Discharge/Transfer Accounts Receivable / Billing Care Plan System eDocuments Interdisciplinary Progress Notes (IPN) Point-of-Care Physician Orders with NDC Library eCharting Resident Assessment (MDS 3.0) User Defined Assessments (UDA)

DocuSign Envelope ID: 08A6EF34-B049-4916-93C8-1EE3B62BD6CEDocuSign Envelope ID: 866D6F59-284D-4938-9E87-A3D7504B4A20

See Tasks Section below for further details.

The Contractor and the State will jointly manage this project and will together develop timelines for a Final Project Schedule. The implementation timeline is April 12, 2020.

Payment will be made upon as described within the Payment Schedule Section below. Partial payment is not authorized.

Any change to the scope of effort may result in an adjustment to the price. Contractor will notify DMVA/DTMB as soon as it is known if any change to the scope of effort is required. Any cost impacted changes to this Statement of Work will require a Contract Change Notice executed by Contractor and DTMB Procurement to be effective.

All other terms and conditions per Contract 071B5500090 shall apply.

TASKS:

Contractor Role:

Setup limited user access for the State of Michigan NetSolutions™” that would include the following applications:

• Admit/Discharge/Transfer

• Accounts Receivable / Billing

• Care Plan System

• eDocuments

• Interdisciplinary Progress Notes (IPN)

• Point-of-Care

• Physician Orders with NDC Library

• eCharting

• Resident Assessment (MDS 3.0)

• User Defined Assessments (UDA)

State Role:

• The State will perform the functionality testing of the application prior to the completion of this project.

• The State will provide a single point of contact for project updates to be presented to.

ACCEPTANCE CRITERIA:

Acceptance will be made upon successful setup of NetSolutions™” limited user access for both Grand Rapids Home for Veterans and D.J. Jacobetti Home for Veterans. The State of Michigan, by DMVA and DTMB personnel, then the approval of the DMVA Project Manager. Grand Rapids for Veterans and DJ Jacobetti Home for Veterans will have a period of thirty days following delivery to accept or reject work furnished by Cantata Health, LLC under this work assignment. In the event that such work fails to conform to approved design specifications in any material respect, Grand Rapids for Veterans and DJ Jacobetti Home for Veterans will provide a written rejection of such work detailing any such conformance for Cantata Health’s correction.

Following delivery of the revised work, Grand Rapids for Veterans and DJ Jacobetti Home for Veterans will have an additional period of thirty days to accept same. If the revised work is not accepted by DMVA and DTMB, the State may terminate this agreement for cause.

PAYMENT SCHEDULE:

The compensation for Services delivered under the Statement of Work will be made in accordance with the Payment Schedule below.

Costing for this project is on a fixed price basis.

Deliverables Payment Due Monthly Fee

Setup Limited User Access for both homes to use without interruption.

Upon Acceptance Completion of Testing the interface setup

$0.00

Admit/Discharge/Transfer $201.16 Accounts Receivable / Billing $1,512.37 Care Plan System $472.62 eDocumnets $283.57 Interdisciplinary Progress Notes (IPN) $189.05 Point-of-Care $1,134.28

DocuSign Envelope ID: 08A6EF34-B049-4916-93C8-1EE3B62BD6CEDocuSign Envelope ID: 866D6F59-284D-4938-9E87-A3D7504B4A20

Physician Orders with NDC Library $472.62 eCharting $472.62 Resident Assessment (MDS 3.0) $567.14 User Defined Assessments (UDA) $189.05

Total Cost

$5,494.48

DTMB will pay CONTRACTOR as identified above in the Payment Schedule and receipt of properly completed invoice which shall be submitted to the billing address on the State issued purchase order. DTMB Accounts Payable area will coordinate obtaining Agency and DTMB Project Manager approvals. All invoices should reflect actual work completed by payment date and must be approved by the Agency and DTMB Project Manager prior to payment.

The invoice shall describe a detailed breakdown as set forth in Contract 071B5500090.

Payment shall be considered timely if made by the DTMB within forty-five (45) days after receipt of properly completed invoices.

EXPENSES:

The State will NOT pay for any travel expenses, including hotel, mileage, meals, parking, etc.

PROJECT CONTACTS:

The designated Agency Business Owner is:

Steven Rolston

COO

Michigan Veteran Homes Office: 517-242-3862 RolstonS@michigan.gov

The designated DTMB Program Owner is:

Ralph Borucki State Administrative Manager Department of Technology, Management and Budget (DTMB) Agency Services, Supporting MSP/DMVA Cell: 517.243.4982 BoruckiR2@michigan.gov

AGENCY RESPONSIBILITIES:

See Task Section.

LOCATION OF WHERE THE WORK IS TO BE PERFORMED:

Consultants will work remotely.

EXPECTED CONTRACTOR WORK HOURS AND CONDITIONS:

Normal working hours of 8:00 am to 5:00 pm are to be observed unless otherwise agreed to in writing.

This purchase order is a release from Contract Number 071B5500090. The purchase order, statement of work, and the terms and conditions of Contract Number 071B5500090 constitute the entire agreement between the State and the Contractor.

DocuSign Envelope ID: 08A6EF34-B049-4916-93C8-1EE3B62BD6CEDocuSign Envelope ID: 866D6F59-284D-4938-9E87-A3D7504B4A20

Department of Technology, Management, and Budget

525 W. ALLEGAN ST., LANSING, MICHIGAN 48913

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 6 to 071B5500090Contract Number boruckir2@michigan.gov

Ralph Borucki

Sean Regan greg.leroy@cantatahealth.com

Greg Leroy

Austin, TX 78758

CANTATA HEALTH, LLC

CV0066152

512-663-3362

11801 Domain Blvd, 3rd Floor

(517) 243-8459 S T A T E

P ro g n a g e r

C o n tra ct

A d m in istra to r

C O

N T R A C T O

R

DTMB

517-243-4982

DTMB

regans@michigan.gov

$1,501,100.00

April 13, 2015 April 12, 2020

ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM,

April 12, 2020

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

5 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☒ Other ☒ Yes ☐ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☐ ☐ April 12, 2020

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$0.00 $1,501,100.00

Effective March 4, 2019, the Department of Military and Veteran Affairs is adding the below Statement of Work to provide the supplemental services necessary to setup the NetSolutions to establish an interface with the Therapy vendors application, Optima PT software for D.J. Jacobetti Home for Veterans.

All other terms, conditions, and specifications and pricing remain the same. Per Agency, Contractor and DTMB procurement.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

DocuSign Envelope ID: 45A767AB-D325-41F8-A16A-13E9842F1838

IT SERVICES

STATEMENT OF WORK

Project Title:

DMVA – D.J. Jacobetti Home for Veterans – Interface with Optima Application into NetSolutions EMR

Period of Coverage:

Requesting Department:

Department of Technology, Management and Budget supporting The Military and Veterans Affairs (DMVA)

Date:

12/07/18

Agency Business Owner:

Ryan Engle

Phone:

906-226-3576

DTMB Program Manager:

Ralph Borucki

Phone:

517-243-4982

Brief Description of Services to be provided:

Contract 071B5500090 amendment to support the new interface into Optima for the D.J. Jacobetti Home for Veterans within the Cantata NetSolutions application.

BACKGROUND:

NTT DATA Long Term Care Solutions, Inc. (or referred to as “NTT Data”) via Contract 071B5500090 is to provide the Department of Military and Veterans Affairs (DMVA) two Veterans Homes (Grand Rapids Home for Veterans and the D.J. Jacobetti Home for Veterans) with a vendor-hosted, web-based Electronic Medical Record (EMR) Software as a Service (SaaS) solution accessed via a web browser referred to as “NetSolutions™”.

Effective March 1, 2017, NTT DATA, Inc. assigned this contract to NTT DATA Long Term Care Solutions, Inc., a wholly owned subsidiary. On April 1, 2017, NTT DATA, Inc. divested itself of NTT DATA Long Term Care Solutions, Inc. which has now reformed as an independent organization named CANTATA HEALTH, LLC. The federal employer identification number (FEIN) remains unchanged as 91-0851994. All references to “NTT DATA, Inc.” or “HSD” in the Agreement and its amendment, exhibits and supplements are hereby changed to CANTATA HEALTH, LLC (“CANTATA”) or “Provider.”

Per Contract 071B5500090, Section 1.104 Work and Deliverables G. Supplemental Services allows the Contractor to provide additional software, support and/or services to support the needs of the State.

The D.J. Jacobetti Home for Veterans is requesting the interface with Optima the application that is used by the Therapy vendor at the home. This is for the requirement form CMS for the home’s recent certification for Medicare and Medicaid.

Accordingly, NetSolutions™” this will only be an interface setup costs associated with this work request.

PROJECT OBJECTIVE:

The purpose of this request is for the Contractor to provide the supplemental services necessary to setup the NetSolutions to establish an interface with the Therapy vendors application, Optima PT software for DJ Jacobetti Home for Veterans.

SCOPE OF WORK:

Contractor will create the appropriate interface connection. The following are the overview of each point:

D J Jacobetti Home for Veterans – contact Rehab Optima to activate interface Cantata Health contacts Rehab Optima to request interface credentials Cantata Health delivers license file to D J Jacobetti Home for Veterans Cantata Health set up the sending interface in NetSolutions to Rehab Optima and the MDS Import from Rehab Optima (if included).

Cantata Health schedules the interface activation with Rehab Optima and activate the interface.

The Contractor and the State will jointly manage this project and will together develop timelines for a Final Project Schedule. The estimated implementation project timeline is 4 days from PO issuance.

Payment will be made upon as described within the Payment Schedule Section below. Partial payment is not authorized.

Any change to the scope of effort may result in an adjustment to the price. Contractor will notify DMVA/DTMB as soon as it is known if any change to the scope of effort is required. Any cost impacted changes to this Statement of Work will require a Contract Change Notice executed by Contractor and DTMB Procurement to be effective.

All other terms and conditions per Contract 071B5500090 shall apply.

TASKS:

Contractor Role:

Setup interface with Optima and the State of Michigan NetSolutions™” State Role:

The State will provide a point of contact during this project to provide information on State’s operations, schedules, and existing systems, as reasonably required to accomplish the project objectives.

The State will perform the functionality testing of the application prior to the completion of this project.

The State will provide a single point of contact for project updates to be presented to.

ACCEPTANCE CRITERIA:

Acceptance will be made upon successful setup of NetSolutions™” interface with Optima application and State of Michigan, by DMVA and DTMB personnel, then the approval of the DMVA Project Manager. DJ Jacobetti Home for Veterans will have a period of thirty days following delivery to accept or reject work furnished by Cantata Health, LLC under this work assignment. In the event that such work fails to conform to approved design specifications in any material respect, DJ Jacobetti Home for Veterans will provide a written rejection of such work detailing any such conformance for Cantata Health’s correction. Following delivery of the revised work, DJ Jacobetti Home for Veterans will have an additional period of thirty days to accept same. If the revised work is not accepted by DMVA and DTMB, the State may terminate this agreement for cause.

PAYMENT SCHEDULE:

The compensation for Services delivered under the Statement of Work will be made in accordance with the Payment Schedule below.

Costing for this project is on a fixed price basis.

Deliverables Payment Due Total Cost Onetime Setup fee Upon Acceptance Completion of

Testing the interface setup $135.00

Interface with EMR system and Optima.

Upon Acceptance Completion of Testing the interface setup

$90.00 Per/month

Total Cost Cost to be added to monthly invoice $90.00 Per/month

DTMB will pay CONTRACTOR as identified above in the Payment Schedule and receipt of properly completed invoice which shall be submitted to the billing address on the State issued purchase order. DTMB Accounts Payable area will coordinate obtaining Agency and DTMB Project Manager approvals. All invoices should reflect actual work completed by payment date and must be approved by the Agency and DTMB Project Manager prior to payment.

The invoice shall describe a detailed breakdown as set forth in Contract 071B5500090.

Payment shall be considered timely if made by the DTMB within forty-five (45) days after receipt of properly completed invoices.

EXPENSES:

The State will NOT pay for any travel expenses, including hotel, mileage, meals, parking, etc.

PROJECT CONTACTS:

Ryan Engle Administrator D.J. Jacobetti Home for Veterans Michigan Veteran Health System Cell: 517-331-5375 EngleR3@michigan.gov

The designated DTMB Program Owner is:

Ralph Borucki IT Manager .NET Application Development and Support Department of Technology, Management and Budget (DTMB) Agency Services, Supporting MSP/DMVA Cell: 517.243.4982 BoruckiR2@michigan.gov

AGENCY RESPONSIBILITIES:

See Task Section.

LOCATION OF WHERE THE WORK IS TO BE PERFORMED:

Consultants will work remotely.

EXPECTED CONTRACTOR WORK HOURS AND CONDITIONS:

Normal working hours of 8:00 am to 5:00 pm are to be observed unless otherwise agreed to in writing.

This purchase order is a release from Contract Number 071B5500090. The purchase order, statement of work, and the terms and conditions of Contract Number 071B5500090 constitute the entire agreement

Department of Technology, Management, and Budget

525 W. ALLEGAN ST., LANSING, MICHIGAN 48913

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 5 to 071B5500090Contract Number

SmithD84@michigan.gov

Darlene Smith

Sean Regan Michael Bodenstab

Austin, TX 78758

Cantata Health, LLC

CV0066152

415-307-4450

11801 Domain Blvd, 3rd Floor

(517) 243-8459 S T A T E

P ro g n a g e r

C o n tra ct

A d m in istra to r

C O

N T R A C T O

R

DTMB

517-335-2431

DTMB

regans@michigan.gov

$1,498,580.00

April 13, 2015 April 12, 2020

ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM,

April 12, 2020

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

5 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ Direct Voucher (DV) ☐ Other ☒ Yes ☐ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☐ ☐ April 12, 2020

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$2,520.00 $1,501,100.00

Effective September 10th, 2018, the Department of Military and Veterans Affairs (DMVA) is adding $2,520.00 to setup NetSolutions to handle Medicare and Medicaid billing and documentation for DJ Jacobetti Home for Veterans.

All other terms, conditions, and specifications and pricing remain the same. Per Agency, Contractor and DTMB procurement.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

IT SERVICES

STATEMENT OF WORK

Project Title:

DMVA –D J Jacobetti Home for Veterans – Medicare Medicaid Setup and Training

Period of Coverage:

4 days

Requesting Department:

Department of Technology, Management and Budget supporting The Military and Veterans Affairs (DMVA)

Date:

7/20/18

Agency Business Owner:

Ryan Engle

Phone:

906-226-3576

DTMB Program Manager:

Ralph Borucki

Phone:

517-243-4982

Brief Description of Services to be provided:

Contract 071B5500090 amendment to support the billing and documentation of Medicare and Medicaid for the DJ Jacobetti Home for Veterans within the Cantata NetSolutions application.

BACKGROUND:

NTT DATA Long Term Care Solutions, Inc. (or referred to as “NTT Data”) via Contract 071B5500090 is to provide the Department of Military and Veterans Affairs (DMVA) two Veterans Homes (Grand Rapids Home for Veterans and the D. John Jacobetti Home for Veterans) with a vendor-hosted, web-based Electronic Medical Record (EMR) Software as a Service (SaaS) solution accessed via a web browser referred to as “NetSolutions™”.

Per Contract 071B5500090, Section 1.104 Work and Deliverables G. Supplemental Services allows the Contractor to provide additional software, support and/or services to support the needs of the State.

The D J Jacobetti Home for Veterans is currently in the process of being certified to allow for billing and to electronically submit to the Center for Medicare and Medicaid Services (CMS) and the State of Michigan the required MDS 3.0 file data. This electronic method of submission follows Section 6106 of the Affordable Care Act

(ACA).

Accordingly, NetSolutions™” will need to have setup the billing capability for Medicare and Medicaid. There will also need modifications to the MDS and Point of Care (POC) for MDS submissions to CMS and the State of Michigan.

PROJECT OBJECTIVE:

The purpose of this request is for the Contractor to provide the supplemental services necessary to setup the NetSolutions to handle Medicare and Medicaid billing and documentation for DJ Jacobetti Home for Veterans.

SCOPE OF WORK:

Contractor will create the appropriate Medicare and Medicaid billing capabilities and setup the MDS and Point of Care (POC) modifications to meet the required MDS submittal to CMS and State of Michigan. The following are the overview of each point:

• Set up payors and plans in NetSolutions to handle Medicare and Medicaid skilled nursing facility billing requirements.

• Set up MDS co-relations for MDS submittal to CMS and state.

• Set up additional features of Point of Care.

• Train billing staff on billing functionality of Medicare and Medicaid claims.

See Tasks Section below for further details.

The Contractor and the State will jointly manage this project and will together develop timelines for a Final Project Schedule. The estimated implementation project timeline is 4 days from PO issuance.

Payment will be made upon as described within the Payment Schedule Section below. Partial payment is not authorized.

Any change to the scope of effort may result in an adjustment to the price. Contractor will notify DMVA/DTMB as soon as it is known if any change to the scope of effort is required. Any cost impacted changes to this Statement of Work will require a Contract Change Notice executed by Contractor and DTMB Procurement to be effective.

All other terms and conditions per Contract 071B5500090 shall apply.

TASKS:

Contractor Role:

Setup billing and MDS data that is required for submittal to CMS and the State of Michigan.

1. Medicare and Medicaid billing capability o Medicare payors

Cantata Health responsibilities:

• Set up Medicare A and B payors to follow all CMS requirements for billing.

This includes payor rules, items, rates, and billing specifications. Attached is a Cantata Health internal setup document for Medicare.

o Medicaid

Cantata Health responsibilities:

• Set up Michigan Medicaid payor to follow all requirements for billing. This includes payor rules, items, rates, and billing specifications. Attached is the Michigan Bulletin regarding Medicaid services in state veterans’ homes.

2. MDS and POC modifications o MDS Cantata Health responsibilities:

• Set up MDS correlations o POC

• Set up POC for MDS correlations.

3. Medicare and Medicaid Billing Training

• Train end users on Medicare and Medicaid billing and reporting functionality in NetSolutions:

Review of Profile Information Cash Transactions Ancillary Posting Maintain Status Changes Adjustments Assessment Review/Entry Review Available Reports Census Reconciliation Validate/Balance Data Entry Pre-Billing Verification Calculate/Reset Charges UB Data Entry/Generate Bill Data

Resolve Billing Issues Producing Bills/Statements Audit Process Month End/ Reporting Review Sessions and System Setup Prep/Review for Current Bill Cycle

State Role:

• The State will provide a point of contact during this project to provide information on State’s operations, schedules, and existing systems, as reasonably required to accomplish the project objectives.

• The State will perform the functionality testing of the application prior to the completion of this project.

• The State will provide a single point of contact for project updates to be presented to.

ACCEPTANCE CRITERIA:

Acceptance will be made upon successful setup of Medicare and Medicaid billing and MDS submittal to CMS and State of Michigan, by DMVA and DTMB personnel, then the approval of the DMVA Project Manager. DJ Jacobetti Home for Veterans will have a period of thirty days following delivery to accept or reject work furnished by Cantata Health, LLC under this work assignment.