ATT D Sample Contract.docx.pdf

SAMPLE CONTRACT DOH24-029C

DOH RFP#24-029C Page 1 of 10

ATTACHMENT D SAMPLE CONTRACT

10/1/2023

CONTRACT NUMBER:

SUB-RECIPIENT

YES NO

FFATA FORM REQUIRED

YES NO

THIS AGREEMENT is made by and between the State of Washington Department of Health, hereinafter referred to as DOH, and the party whose name appears below, hereinafter referred to as Contractor.

CONTRACTOR NAME and ADDRESS:

UBI:

PURPOSE:

IT IS MUTUALLY AGREED THAT:

STATEMENT OF WORK: The Contractor shall provide all the necessary personnel, equipment, materials, goods, and services and otherwise do all things necessary for or incidental to the performance of the work as described in Exhibit A, attached hereto, and incorporated herein.

PERIOD OF PERFORMANCE: Subject to its other provisions, the period of performance under this contract shall be from through unless sooner terminated as provided herein. Any work done outside of the period of performance shall be provided at no cost to DOH.

DEPARTMENT OF ENTERPRISE SERVICES APPROVAL: This contract may be required to be filed with the Department of Enterprise Services (DES) for approval under the provisions of Chapter 39.26 RCW. No contract or amendment required to be so filed is effective and no work thereunder shall be commenced, nor payment made therefore until ten (10) working days following the date of filing, and, if required, until approved by DES. In the event DES fails to approve the contract or amendment, the contract shall be null and void.

FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA): If checked above, this contract is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act). The purpose of the Transparency

Act is to make information available online so the public can see how federal funds are spent.

To comply with the act and be eligible to enter into this contract, your organization must have a Unique Entity Identifier (UEI) number. A UEI number provides a method to verify data about your organization.

If you do not already have one, you may receive a UEI number free of charge by contacting System for

Award Management (SAM) at SAM.GOV.

https://sam.gov/content/home

DOH RFP#24-029C Page 2 of 10

ATTACHMENT D SAMPLE CONTRACT

10/1/2023

Information about your organization and this contract will be made available on www.USASpending.gov by DOH as required by P.L. 109-282. DOH’s form, Federal Funding Accountability and Transparency Act

Data Collection Form, is considered part of this contract and must be completed and returned along with the contract.

CONSIDERATION: The maximum consideration available under this contract shall not exceed $ without a properly executed written amendment signed by representatives of both parties authorized to do

so. Consideration includes but is not limited to all taxes, fees, surcharges, etc.

Source of Funds:

Federal: $ State: $ Other: $ TOTAL: $

Contractor agrees to comply with all applicable rules and regulations associated with these funds.

Unless otherwise indicated in this contract, any State funds which are unexpended as of June 30th will not be available for carry over into the next State fiscal year (July – June).

INVOICES AND PAYMENT: Contractor will submit invoices to the DOH Project Manager for all amounts to be paid. Invoices must reference this contract number and provide detailed information as requested. All invoices must be approved by DOH prior to payment; approval will not be unreasonably withheld. DOH will authorize payment only upon satisfactory completion and acceptance of deliverables and for allowable costs as outlined in the statement of work and/or budget. DOH will return all incorrect or incomplete invoices and will not pay for services that occur outside the period of performance. The

Contractor will not invoice for services if they are entitled to payment, have been, or will be paid by any other source for that service.

DOH will issue payment within 30 days of receiving a correct and complete invoice and approving the deliverable(s). DOH must receive correct and complete invoices within 60 days of the contract expiration date. Late invoices will be paid at the discretion of DOH and are contingent upon the availability of funds.

Failure to submit a properly completed IRS form W-9 may result in delayed payments.

GOVERNANCE: In the event of an inconsistency in this contract, unless otherwise provided herein, the inconsistency shall be resolved by giving precedence in the following order:

A. Federal statutes and regulations B. State statutes and regulations

C. Contract amendments.

D. The contract (in this order)

1. Primary document (document that includes the signature page)

2. Statement of Work (Exhibit A)

3. Standard/General Terms and Conditions (Exhibit B)

4. Special Terms and Conditions (Exhibit C if used)

5. RFX and bidder’s response

UNDERSTANDING: This contract, including referenced exhibits, attachments and documents included herein by reference, contains all the terms and conditions agreed upon by the parties. No other understandings, oral or otherwise, regarding the subject matter of this contract shall exist or bind any of the parties hereto.

https://www.usaspending.gov/Pages/default.aspx

DOH RFP#24-029C Page 3 of 10

ATTACHMENT D SAMPLE CONTRACT

10/1/2023

APPROVAL: This contract shall be subject to the written approval of DOH Contracting Officer and shall not be binding until so approved. Only the Contracting Officer or his/her designee, by written delegation made prior to action, shall have the expressed, implied, or apparent authority to alter, amend, modify, or waive any clause or condition of this contract. Furthermore, any alteration, amendment, modification, or waiver of any clause or condition of this contract is not effective or binding unless made in writing and signed by the Contracting Officer.

IN WITNESS WHEREOF: DOH and the Contractor have signed this contract.

This contract has been approved as to form by the attorney general.

CONTRACTOR SIGNATURE

{{SigB_es_:signer1:signatureblock}}

DATE

{{Dte_es_:signer1:date}}

PRINT OR TYPE NAME

TITLE

{{*Ttl_es_:signer1:title}}

DOH CONTRACTING OFFICER SIGNATURE

{{Sig_es_:signer2:signature}}

DATE

{{Dte_es_:signer2:date}}

EXHIBIT A

STATEMENT OF WORK

DOH CONTRACT TBD

CARE A VAN MOBILE HEALTH SERVICES

CONTRACTOR- TBD

DOH RFP#24-029C Page 4 of 10

10/1/2023

PURPOSE:

DOH entered into this Contract as the result of RFP DOH24-029C and the Contractor’s Bid Response.

(a) DOH incorporated by reference RFP DOH24-029C, including all Amendments and Attachments.

(b) DOH incorporates by reference the Contractor’s written response, including any written appendixes to

RFP DOH24-029C.

BACKGROUND:

To address the inequity of health services in marginalized communities, DOH recommends continued investments into our mobile health services and expand the scope beyond COVID-

19 vaccines to address health concerns brought on or exacerbated by the pandemic and respond to future emergencies. To provide clinicians for vaccination efforts and other public health initiatives, as needed. The Washington State Department of Health (DOH) will contract with Contractor(s) to provide all-inclusive mobile healthcare services, in response to requests submitted by community partners and Local Health Jurisdictions

(LHJs) and Tribes. Services at each clinic may include COVID-19 vaccinations, other vaccines for adults, preventative health screenings, health education and information, and/or other vaccines for children. The Contractor shall respond to as many Care-a-Van events as possible and shall invoice DOH twice a month, due by the 10th and 25th of each month for all events that occurred in the prior payment period.

SCOPE OF WORK:

The Contractor shall recruit and provide fully trained, appropriately licensed, and qualified personnel, including but not limited to, Registration/Screener, Vaccine Reconstitution/Preparer, Vaccinator, Medical Observer, and Float/Lead to physically interact with patients and accompanying individuals at the sites, as approved by DOH.

TASKS:

The Contractor shall:

1. Coordinate with DOH and LHJs to set up and administer mobile health clinics in agreed-upon areas.

2. Coordinate with DOH and LHJs to provide vaccine administration for homebound individuals, adult family homes, and long-term care facilities at the direction of the Department of Health

3. Maintain enrollment in Childhood Vaccine Program and Adult Vaccine Program with DOH and meet all requirements and recommendations as outlined in the provider agreement.

4. Provide standing orders for all vaccines offered at mobile health clinics.

5. Provide staff for all healthcare services in accordance with agreed-upon staffing models.

6. Staff mobile health clinics no longer than 12-hours long, 7 days a week, if needed. Clinic hours fall between 7:00 AM to 9:00 PM daily time frame.

7. Provide necessary vehicles and equipment, to transport vaccination teams and all necessary supplies to and from multiple vaccination sites.

8. Purchase and provide all necessary syringes, personal protective equipment (PPE), and supplies for vaccinations and agreed upon healthcare services.

DOH CONTRACT TBD

DOH RFP#24-029C Page 5 of 10

10/1/2023

9. Purchase and provide commercial vaccines for adults that do not qualify for the Adult Vaccine Program with Department of Health. Contractor is responsible for collecting insurance information and billing insurance for reimbursement of vaccine. When appropriate vendor will bill insurance for administration costs. Any administration costs billed to insurance are to be deducted from invoices.

10. Provide necessary technology and office supplies, including tablets, Mobile Hot Spot, tables, chairs, pop-up tents, and water.

11. Equip each mobile team with a Basic Life Support (BLS) Kit to include Epinephrine/Adrenalin, Diphenhydramine, AED, and related supplies per Washington State recommendations.

12. Adhere to infection control and organizational methods that comply with the Center for Disease

Control and Prevention (CDC) guidance for planning vaccination clinics held at satellite, temporary, or off-site locations to ensure a safe clinic.

13. Ensure staff work within their defined scope of practice as defined in the Revised Code of

Washington (RCW) and the Emergency Use Authorization (EUA) issued by the Food and Drug

Administration (FDA).

14. Support DOH and the LHJs in the safety of the clinics, including monitoring for, responding to, and reporting any safety concerns or adverse events during mobile health clinics.

15. Comply with all components of the Health Insurance Portability and Accountability Act (HIPAA) for confidentiality.

16. By the 10th and 25th of each month, provide a report to the Contract Manager for the previous performance periods clinics, detailing the date, clinic partner/location, number of contracted staff, number and type of vaccines administered (commercial and CVP/AVP doses), total number of clients served, time on site, and general remarks regarding the clinic.

17. Within 30 days of contract end, provide a final evaluation report tracking number of clinics, hours, and number of staff available at each clinic, and the number and type of vaccinations provided.

METHOD OF ACCOUNTABILITY:

The DOH Contract Manager will schedule weekly meetings with Contractor to manage contract deliverables and provide input for locations and number of mobile clinics to be coordinated. Collaboration with the LHJ will be done jointly between Contractor and DOH Contract Manager.

PERIOD OF PERFORMANCE:

The period of performance is on or about July 1, 2024, through June 30, 2025, with the option to extend the contract if needed.

DOH CONTRACT TBD

DOH RFP#24-029C Page 6 of 10

10/1/2023

CONSIDERATIONS:

Total consideration payable to Contractor for satisfactory performance of the work under this

Contract is up to a maximum of Final amount TBD, including any and all expenses, and shall be based on the attached, TBD.

Rates payable to Contractor. Consideration shall be payable in accordance with the applicable hourly rates, subject to the Rates set forth in Budget Rate Sheet and the actual hours of scheduled Services provided.

BUDGET RATE SHEET:

VACCINE PROVIDERS

NOT TO EXCEED HOURLY

RATES.

Physicians $114.59

Registered Nurses $57.70

Nurse Practitioners $77.80

Licensed Practical and Licensed Vocational Nurses $35.50

CNA/MHT with experience $27.99

Medical Assistant $38.57

Physicians Assistants $80.82

Emergency Medical Technicians and Paramedics $48.83

Note* The Not to Exceed hourly rates are based on the Authorized Federal Supply Schedule for Professional &

Allied HealthCare Staffing Services.

The above rates cover all Services. No additional charges of Shift Differential Rates, Weekend Rates, Weekend

Call Rates, Callback Hour Rates, Holiday Premium Rates are allowed.

Rates shown exclude lodging and transportation charges. The contractor will be reimbursed for travel to not exceed the maximum allowable per diem in accordance with OFM:

https://www.ofm.wa.gov/sites/default/files/public/resources/travel/colormap.pdf.

https://www.ofm.wa.gov/sites/default/files/public/resources/travel/colormap.pdf

DOH RFP#24-029C Page 7 of 10

10/1/2023

STAFFING MODELS AND CRITERIA:

Below are the staffing models and criteria to determine which model should be used for CAV events, DOH will work with the Contractor to determine the appropriate staffing model. All staffing models need to be pre-approved by DOH for each assigned event. During times of increased response there may be a need to increase staffing. Staffing needs outside of the scope of models outlined in this section be mutually agreed upon by vendor and DOH.

2-STAFF MODEL CRITERIA

• 1-10 attendees are expected by the requestor.

• Long Term Facility Care (10 or less residents), Home Visit, Adult Family Homes

• Offering 2 or fewer services (e.g., COVID-19 vaccinations and health screenings)

Registration/Screener (Prep Mod) Lay person, NAC OR MA-C, MA-R, EMT, RN

Vaccinator/Pharmacy MA-C, MA-R, EMT, Paramedic, RN, PA

4- STAFF MODEL CRITERIA

• Number of attendees expected / number of clinic hours = up to 15

(Example: 50 expected attendees/4hr clinic= 12.5 expected attendees/hr. This would meet the criteria of “up to 15”.)

• A total of 11-50 attendees are expected by the requestor.

• Care-a-Van will be the only vendor at the event that is open to the public.

• Offering 2 or fewer services (e.g., COVID-19 vaccinations and health screenings)

• CAV has provided services in the past with this requestor and fewer than 15 people were served at the most recent clinic.

Registration/Screener (Prep Mod) Lay person, NAC OR MA-C, MA-R, EMT

Registration/Screener (Prep Mod) Lay person, NAC OR MA-C, MA-R, EMT

Vaccinator MA-C, MA-R, EMT, Paramedic, RN, PA

Pharmacy MA-C, MA-R, EMT, Paramedic, RN, PA

5-STAFF MODEL CRITERIA

• Number of attendees expected / number of clinic hours = up to 25.

• A total of 51-75 attendees are expected by requestor.

• Multiple vendors will be attending the event that is open to the public.

• Offering 3 or more services/vaccines

• Serving mainly children or people who are homeless, drug-affected, or are experiencing severe mental illness or disability.

DOH RFP#24-029C Page 8 of 10

10/1/2023

• CAV has provided services in the past with this requestor and fewer than 25 people were served at the most recent clinic. However, there is good reason to believe that there will be an increase in attendance at the upcoming event (e.g. new vaccine being offered, better weather conditions, or additional services provided).

Registration/Screener (Prep Mod) Lay person, NAC OR MA-C, MA-R, EMT

Registration/Screener (Prep Mod) Lay person, NAC OR MA-C, MA-R, EMT

Vaccinator MA-C, MA-R, EMT, Paramedic, RN, PA

Medical Observer MA-C, MA-R, EMT, NAC, Paramedic, RN, PA

Float/Lead/Pharmacy MA-C, MA-R, EMT, Paramedic, RN, PA

8-STAFF MODEL

Criteria (Multiple criteria may need to be selected)

• Number of attendees expected / number of clinic hours = over 26

• A total of 100 or more people expected by requestor.

• Multiple vendors will be attending the event that is open to the public.

• Offering 4 or more services

• Serving mainly children or people who are homeless, drug-affected, or are experiencing severe mental illness or disability.

Registration/Screener (Prep Mod) Lay person, NAC OR MA-C, MA-R, EMT

Registration/Screener (Prep Mod) Lay person, NAC OR MA-C, MA-R, EMT

Registration/Screener (Prep Mod) Lay person, NAC OR MA-C, MA-R, EMT

Vaccinator MA-C, MA-R, EMT, Paramedic, RN, PA

Scribe Lay person, NAC OR MA-C, MA-R, EMT

Vaccinator MA-C, MA-R, EMT, Paramedic, RN, PA

Medical Observer MA-C, MA-R, EMT, Paramedic, RN, PA

Float/Lead/Pharmacy MA-C, MA-R, EMT, Paramedic, RN, PA

The staffing model can be adjusted for special circumstances and will be reviewed jointly by the contractor and CAV managers.

For clinics where the primary services offered, expected greater than 50%, are childhood vaccines (CVP) the following staffing models will be used. As with other clinic staffing models, must be mutually agreed upon by vendor and DOH.

Staffing Models for Childhood Vaccine Clinics:

• CVP 5 Person staff + DOH Registration: Registration, Subject Matter Expert (RN), Vaccinator, Medication Manager, Observation. Throughput is 4 patients per hour.

DOH RFP#24-029C Page 9 of 10

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• CVP 6 Person Staff + DOH Registration: Registration, Subject Matter Expert (RN), Consult

(RN), Vaccinator, Medication Manager, Observation. Throughput is 6 patients per hour.

• CVP 7 Person Staff + DOH Registration: Registration, Subject Matter Expert (RN) x2, Vaccinator x 2, Medication Manager, Observation. Throughput is 8 patients per hour.

• CVP 10 Person Staff + DOH Registration: Registration, Subject Matter Expert (RN) x2, Consult (RN) x2, Vaccinator x 2, Medication Manager x2, Observation. Throughput is 12 patients per hour.

• CVP 13 Person Staff+ DOH Registration: Registration, Subject Matter Expert (RN) x3, Consult (RN) x3, Vaccinator x 3, Medication Manager x2, Observation. Throughput is 18 patients per hour.

Contractor’s Personnel Duties may include, but are not limited to, the following:

COORDINATOR/AGENCY REPRESENTATIVE

• Point of Contact within contracted company/organization

FLOAT/LEAD

• Provide clinical information to recipients of healthcare services.

• Administer vaccines for recipients.

• Monitor safety of the administration of vaccines by those not comfortable/have limited experience with intradermal and subcutaneous injections.

• Provide epinephrine as needed for anaphylaxis.

• Summon additional help by calling advanced life support (ALS) ambulance transport, if needed.

VACCINATOR

• Follow CDC Vaccine administration recommendations found at this link: Vaccine

Administration Route and Site | CDC

• Work with a team of clinical and support staff to administer vaccines.

• Give vaccinations to clients.

• Care for individuals who have adverse side effects from vaccines.

• Manage inventory of vaccines.

• Adapt to change and adjust plans to thrive in a dynamic community healthcare setting.

• Professionally interact with healthcare professionals and patients.

REGISTRATION/SCREENER

• Assist in onsite set-up of mobile health clinic, including establishing an efficient registration process and flow, specific to each service site.

• Review current patient data in WAIIS to ensure correct vaccines are administered.

• Engage directly with residents and staff to ensure they are correctly entered in the system;

collect information to ensure appropriate data processing and sharing of results.

• Ensure that patient information is entered into WAIIS within 72 hours of mobile health clinic.

• Screen for and collect insurance information for vaccinations.

https://www.cdc.gov/vaccines/hcp/admin/administer-vaccines.html https://www.cdc.gov/vaccines/hcp/admin/administer-vaccines.html

DOH RFP#24-029C Page 10 of 10

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• Provide information regarding vaccination program, including an explanation of the process and answers to frequently asked questions.

• Ensure staff and resident information is matched to their paperwork and electronic registration software.

• Respond to customer inquiries and complaints; research problems; resolve and reconcile discrepancies; prepare documents to adjust and correct when errors are detected; and refer customer service requests to appropriate personnel for disposition and/or follow-up as required.

• Update and maintain accurate account information and customer records in systems by inputting new information and changes as needed; maintain statistical records and generate reports as required.

• Follow all safety protocols, wear assigned PPE, and decontaminate workstation as required.

• Perform other duties as assigned.

MEDICAL OBSERVER

• Observe recipients for adverse reactions to vaccine and provide general first aid for staff, volunteers, and recipients as needed; this needs medical oversight.

• Oversee the patient and observe for 15 minutes or 30 minutes, based on history of anaphylaxis or side effects.

• Administer epinephrine as needed for anaphylaxis, summon for additional help by calling

ALS ambulance transport, if needed

TRAINING

Follow CDC Vaccine administration recommendations found at these links: Vaccine

Administration Route and Site | CDC and You Call the Shots: Vaccines Web-based

Training Course | CDC

SCHEDULE

Contractor shall staff the mobile teams to the best of their ability in accordance with DOH needs and in consideration of staff availability, including but not limited to flexible 12-hour shifts, 7 days a week. Shift hours to fall within 7:00 AM to 11:00 PM daily time frame.

COMMUNICATION

Contractor shall attend and actively participate (on-site or remotely via telephone or web conference call) in the planning, status, and performance review meetings conducted or as otherwise established by the DOH. The contractor shall adopt and adapt to any concerns or recommendations of the DOH Contract Manager or designee within the scope of this contract.

https://www.cdc.gov/vaccines/hcp/admin/administer-vaccines.html https://www.cdc.gov/vaccines/hcp/admin/administer-vaccines.html https://www.cdc.gov/vaccines/ed/youcalltheshots.html https://www.cdc.gov/vaccines/ed/youcalltheshots.html