CSP020006_Contract_Rev.pdf

Index No.: DOH021

Eff. Date: 04/23/25

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: HEALTHCARE SURVEY CONTRACT FOR BOSC

CONTRACT NUMBER: CSP020006 EFFECTIVE DATES: 05/01/24 TO 06/30/25

* Renewal through 06/30/26

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

SRC0000017136 that opened on 04/12/24. 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 Ohio Department of Health 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/

*Denotes change.

MUTUALLY AGREED UPON CHANGES

*The following amendment items reflects a revision to the Contract to add In-Home Health Assessments:

The Contractor will conduct the agreed upon number of in-home health assessments (HHA) complaint or standard surveys each quarter according to Centers for Medicare and Medicaid Services (CMS) guidelines and the CMS State Operations Manual (SOM). All surveys will be initiated by the (starting) due date specified by the Agency; due dates will be based on the specific due date for the assignment. The Contractor will submit the exit survey according to exit conference guide and submit the completed surveys through iQIES within two business days of exit of survey. The Contractor will enter the findings in iQIES and provide the completed and organized PDF survey packet with supporting documentation within 5 business days of exit.

*Denoted additional services added for In Home Health Assessment surveys with amendment 1, effective 04/23/25, and to repaginate.

*Eff. Date: 04/23/25

*Page 3

COST SUMMARY

Healthcare Survey Contract for BOSC

SRC0000017136

UNSPSC CATEGORY CODE: 85101702 (Health legislation or regulations)

Notes:

• All costs are in U.S. Dollars

• The State is not responsible for any costs not identified.

• There will be no additional reimbursement for travel or other related expenses.

• Contract work will not be performed without a valid purchase order being issued by the Agency.

• Additional Labor Hours must be requested and approved by the Agency prior to the work being performed.

*Denoted additional services added for In Home Health Assessment surveys with amendment 1, effective 04/23/25, and to repaginate.

DESCRIPTION

UNIT OF

MEASURE

(UOM)

COST

PER UNIT

1. Federal nursing home complaint survey, completed according to CMS guidelines and completed and organized PDF survey packet with supporting documentation of the findings that were documented in ASPEN within 5 business days of exit.

Price is per each complaint survey packet completed and received by ODH.

EACH

$ 17,000.00

2. Federal nursing home annual surveys, complete according to CMS guidelines and completed and organized PDF survey packet with supporting documentation of the findings that were documented in ASPEN within 5 business days of exit.

Price is per each annual survey packet completed and received by

ODH.

EACH

$ 45,000.00

3. Optional, Additional Labor Hours for unexpected work needed beyond the stated requirements for survey work. Such additional labor must be needed, requested, and approved including a purchase order issued by the Agency prior to the Contractor performing the work. This is for unusual circumstances not covered by the two line items listed above.

Price is per each hour of labor completed by the Contractor, and will not exceed the stated quantity on the Purchase Order.

HOUR

$ 185.00

*4. In Home Health Assessment surveys, complete according to CMS guidelines and completed and organized PDF survey packet with supporting documentation of the findings that were documented in iQIES within 5 business days of exit.

Price is per each survey packet completed and received by ODH. EACH $ 14,000.00 *

*Eff. Date: 04/23/25

*Page 4

CONTRACTOR INDEX

CONTRACTOR, TERMS, AND SHIPMENT: BID CONTRACT NO.: CSP020006

269154

CertiSurv, LLC TERMS: Net 30 Days 112 W 7th St. Ste C Columbia, TN 38401 DELIVERY: As Specified

CONTRACTOR'S CONTACT: Robert Feurer Telephone: (510) 676-1607

E-mail address: bfeurer@certisurv.com

*Denotes repaginate.

mailto:bfeurer@certisurv.com

SUMMARY OF AMENDMENTS

Amendment

Number Effective

Date Description

1 04/23/25

This amendment is issued to notify that, as a result of mutual agreement between the State of Ohio and the Contractor, this contract is renewed for an additional twelve (12) months, effective 07/01/25 through 06/30/26.

Additionally, this amendment is to add In Home Health Assessments (HHA), effective 04/23/25, and to repaginate.