CSP012396_DAS067_Rev_Contract.pdf

Index No.: DAS067

Eff. Date: 07/01/23

STATE OF OHIO

DEPARTMENT OF ADMINISTRATIVE SERVICES

GENERAL SERVICES DIVISION

OFFICE OF PROCUREMENT SERVICES

4200 SURFACE ROAD, COLUMBUS, OH 43228-1395

MANDATORY USE CONTRACT FOR: BEHAVIORAL HEALTH THIRD-PARTY ADMINISTRATOR

CONTRACT NUMBER: CSP012396 EFFECTIVE DATES: 07/01/23 TO 06/30/26

The Department of Administrative Services has accepted Proposals submitted in response to Request for Proposal (RFP) No.

SRC0000003097 that opened on 08/15/22. The evaluation of the Proposal responses has been completed. The Offeror listed herein has been determined to be the highest ranking Offeror and has been awarded a Contract for the services listed. The respective Proposal response including, Contract Terms & Conditions, any Proposal amendment, special Contract Terms & Conditions, specifications, pricing schedules and any attachments incorporated by reference and accepted by DAS become a part of this Services Contract.

This Requirements Contract is effective beginning and ending on the dates noted above unless, prior to the expiration date, the Contract is renewed, terminated, or cancelled in accordance with the Contract Terms and Conditions.

This Requirements Contract is available to the State Human Resources Division (SHRD), Benefits Administration Services (BAS), of the Department of Administrative Services (DAS) as applicable.

The agency is eligible to make purchases of the contracted services in any amount and at any time as determined by the agency. The State makes no representation or guarantee that department will purchase the volume of services as advertised in the Request for Proposal.

This Requirements Contract and any Amendments thereto are available from the DAS Web site at the following address:

https://procure.ohio.gov/

Eff. Date: 09/01/24

MUTUALLY AGREED TO CLARIFICATIONS / MODIFICATIONS TO THE RFP

Final Clarifications – responses dated 11/28/22

Final Performance Guarantees – response dated 12/14/22

If there are any discrepancies between any of the above documents, the later dated response prevails.

*Effective 09/01/24

The reference to Disability ID cards in Scope of Work Item C. 10 is removed from the Contract.

Scope of Work Item O. “The Ohio Disability Management Program” is removed from the Contract.

The Disability Program Performance Guarantees are removed from the Contract.

*Indicates the mutually agreed upon removal of the Disability Program from the Contract, per amendment 1.

PRICE SCHEDULE

TITLE: BEHAVIORAL HEALTH THIRD-PARTY ADMINISTRATOR

RFP NUMBER: SRC0000003097

UNSPSC: 85101700

Core Fees

*FY 2024

07/01/23 – 06/30/24

*FY 2025

07/01/24 – 06/30/25

*FY 2026

07/01/25 – 06/30/26

Behavioral Health Administration Per Employee Per Month (PEPM) Fee $2.57 PEPM $2.65 PEPM $2.73 PEPM

ABA Management $0.07 PEPM $0.07 PEPM $0.07 PEPM

*Disability Program - effective through 08/31/24 $0.33 PEPM $0.34 PEPM --

Standard Annual Communications Budget (including 1 annual postcard mailer sent to all enrolled employees) $0.07 PEPM $0.07 PEPM $0.07 PEPM

Implementation Services $0.00 $0.00 $0.00

Data Feed to State's Data Warehouse Vendor $0.00 $0.00 $0.00

Data Feed to State's FSA Vendor for Auto-Adjudication $0.00 $0.00 $0.00

Data Feed - inbound or outbound Other State Partners (up to five) $0.00 $0.00 $0.00

Single Sign On to Other State Partners’ Websites (up to five) $0.00 $0.00 $0.00

ID Card Maintenance (for new employees and replacement cards) $0.03 PEPM $0.03 PEPM $0.03 PEPM

ID Card Full Reissue - one time cost $63,000.00 $0.00 $0.00

Tele-Behavioral Health Administration (PEPM) $0.00 $0.00 $0.00

*Total PEPM (excluding ID card full reissue) through 08/31/24 $3.07 PEPM $3.16 PEPM --

*Total PEPM (excluding ID card full reissue) effective 09/01/24 -- $2.82 PEPM $2.90 PEPM

*Indicates an administrative update to correct fiscal year references and the removal of the Disability Program line item from the Price Schedule, effective with all orders issued on or after 09/01/24, per amendment 1.

PRICE SCHEDULE CONTINUED

Additional Fees *FY 2024 07/01/23 – 06/30/24

*FY 2025

07/01/24 – 06/30/25

*FY 2026

07/01/25 – 06/30/26

Optional Buy-Up Behavioral Care Connect $0.00 $0.00 $0.00

Optional Buy-Up Child and Family Behavioral Coaching Month 1 $240, Month 2+ $144

Case Rate

Month 1 $240, Month 2+ $144

Case Rate

Month 1 $240, Month 2+ $144

Case Rate

Ad Hoc Reporting (per hour) $0.00 $0.00 $0.00

Single Sign On with the State’s Intranet $15,000.00 $15,000.00 $15,000.00

Single Sign On (per vendor, over 5) $15,000.00 $15,000.00 $15,000.00

Data Feed (inbound or outbound, over 5 & not including FSA and Data Warehouse vendors) $5,000.00 $5,000.00 $5,000.00

Deep Link into Vendor’s State Specific Portal $0.00 $0.00 $0.00

Adding Logo(s) (State or other vendor partner) to Member ID Card $0.00 $0.00 $0.00

Customer Created App Tools (hourly) $0.00 $0.00 $0.00

Communications Mailings (not including the annual mailer referenced in the Standards Communications Budget) $35,000.00 $35,000.00 $35,000.00

Custom Communications (hourly) $150.00/HR $150.00/HR $150.00/HR

Participation in Onsite Benefit Fairs and/or Open Enrollment Meetings Throughout Ohio as Directed by the State (per event) $0.00 $0.00 $0.00

*Indicates an administrative update to correct fiscal year references, per amendment 1.

CONTRACTOR INDEX

CONTRACTOR AND TERMS: CONTRACT NO: CSP012396

HR00001124 (OHALL)

United Behavioral Health (Optum) TERMS: Net 30 Days 11000 Optum Circle Eden Prairie, MN 55344

Remit to:

Optum Dept. 75897 PO Box 39000 San Francisco, CA 94139

*CONTRACTOR’S CONTACT: Allee Meagher Telephone: 1-414-525-7489 Email: Allee.Meagher@optum.com

SUBCONTRACTOR(S):

Recovery Record

*Indicates an update to the Contractor’s contact information, per amendment 1.

SUMMARY OF AMENDMENTS

Amendment Number

Effective Date Description

1 09/01/24

This amendment is issued to remove the Disability Program from the Contract by mutual agreement, effective 09/01/24. Additionally, this amendment is issued to update the Contract Price Schedule by removing the Disability Program line item, effective with all orders issued on or after 09/01/24, and make an administrative update to correct the fiscal year references. Finally, this amendment is issued to update the Contractor’s contact information.

All other prices, terms and conditions remain unchanged.