CSP022430_Amendment_3.pdf

Index No.: DOH117 Contract No.: CSP022430 Eff. Date: 7/01/25

STATE OF OHIO

DEPARTMENT OF ADMINISTRATIVE SERVICES

GENERAL SERVICES DIVISION

OFFICE OF PROCUREMENT SERVICES

4200 SURFACE ROAD, COLUMBUS, OH 43228-1395

AMENDMENT FOR CHANGE

AMENDMENT NO. 3

TO: LIMITED DISTRIBUTION - OHIO DEPARTMENT OF HEALTH

FROM: KATHLEEN C. MADDEN, DIRECTOR, DEPARTMENT OF ADMINISTRATIVE SERVICES

SUBJECT: CONTRACT FOR INDEPENDENT INFORMAL DISPUTE RESOLUTION (IIDR) SERVICES

Attached are pages 1 through 4 to this contract. Remove these pages from the existing contract and replace with the attached pages on the effective date.

As a result of mutual agreement between the State of Ohio and the Contractor, this amendment is issued to renew the subject contract an additional twenty-four (24) months, effective July 1, 2025 through June 30, 2027.

Additionally, this amendment is issued to update the cost end date, revise Contractor’s contact person and contact information as well as updating the Summary of Amendments page.

All other prices, terms and conditions remain unchanged.

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

http://www.ohio.gov/procure

Affected Contractor(s):

0000307957 iMPROve Health 625 Kenmoor Ave., Suite 350

PMB 47995

Grand Rapids, MI 49546 bbrokmeyer@improve.health

Eff. Date: 07/01/25 Page No.: 1

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: INDEPENDENT INFORMAL DISPUTE RESOLUTION (IIDR) SERVICES

CONTRACT NUMBER: CSP022430 EFFECTIVE DATES: 05/16/22 TO 06/30/23

* Renewal through 06/30/27

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

SRC0000002641 that opened on 04/08/22. 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 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:

www.ohio.gov/procure

*Indicates a twenty-four (24) month renewal, effective July 1, 2025 through June 30, 2027

COST SUMMARY FORM

Independent Informal Dispute Resolution (IIDR) Services

CSP022430

UNSPSC CATEGORY CODE: 80120000

DESCRIPTION

UNIT OF

MEASURE

COST PER UNIT

(Contract Inception through *6/30/27)

Flat fee for each IIDR recommendation and report.

Each $120.00

Hourly fee for review of a deficiency by a:

Licensed Social Worker

Hourly $120.00

Life Safety Code Professional

Nursing Professional

Pharmacist

Physician

Hourly $200.00

Registered Dietician

All costs must be in U.S. Dollars.

The State will not be responsible for any costs not identified.

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

*Indicates update to cost end date

CONTRACTOR INDEX

CONTRACTOR AND TERMS: BID CONTRACT NO.: CSP022430

0000307957 iMPROve Health TERMS: Net 30 625 Kenmoor Ave., Suite 350

PMB 47995

Grand Rapids, MI 49546

CONTRACTOR’S CONTACT:

*Bailey Brokmeyer *Office: (248) 465-1035 *E-mail: bbrokmeyer@improve.health

*Indicates change to contact person and contact information mailto:bbrokmeyer@improve.health

SUMMARY OF AMENDMENTS

Amendment

Number Effective

Date Description

*3 07/01/25

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 twenty-four

(24) months, effective 07/01/25 through 06/30/27. Additionally, this amendment is issued to update the cost end date, revise Contractor’s contact person and contact information as well as updating the Summary of Amendments page. All other prices, terms and conditions remain unchanged.

2 07/01/24

This amendment is issued to notify of an assignment from Michigan Peer Review Organization to Improve Health, effective 7/1/24. Additionally, this amendment is issued to update the Contract Number to CSP022430, revise Contractor’s business name, address, contact information as well as the Contractor’s OAKS ID number and to update the Summary of Amendments page. All other prices, terms and conditions remain unchanged.

1 07/01/23

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 twenty-four

(24) months, effective 07/01/23 through 06/30/25. Additionally, this amendment is issued to add the Summary of Amendments.

*Indicates update to the Summary of Amendments page