CSP900620_A4.pdf

Index No.: LDC112 Contract No.: CSP900620 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. 4

TO: LIMITED DISTRIBUTION - OHIO DEPARTMENT OF MEDICAID AND OHIO DEPARTMENT OF MENTAL

HEALTH AND ADDICTION SERVICES

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

SUBJECT: CONTRACT FOR PRE-ADMISSION SCREENING AND RESIDENT REVIEW (PASRR) FOR INDICATIONS

OF SERIOUS MENTAL ILLNESS (SMI) LEVEL II ASSESSMENTS AND SELECT DETERMINATIONS

Attached are pages 1, 3 and 5 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 24 months, effective 07/01/25 through 6/30/27.

Also, this amendment is issued to add Virtual Rate Pricing to the pricelist, effective with all orders 07/01/25.

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):

256991 Maximus US Services, Inc.

1600 Tysons Blvd McLean, VA 22102 hunterfede@maximus.com

Eff. Date: 07/01/25

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: PRE-ADMISSION SCREENING AND RESIDENT REVIEW (PASRR) FOR INDICATIONS OF SERIOUS MENTAL ILLNESS (SMI) LEVEL II ASSESSMENTS AND SELECT DETERMINATIONS

CONTRACT NUMBER: CSP900620 EFFECTIVE DATES: 07/01/19 TO 06/30/21

* Renewal through 06/30/27

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

CSP900620 that opened on 09/14/18. 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 Medicaid and the Ohio Department of Mental Health and Addiction Services 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 contract renewal through 06/30/27 per amendment 4.

COST SUMMARY FORM

RFP Title Pre-Admission Screening and Resident Review (PASRR) for Indications of Serious Mental Illness (SMI) Level II

Assessments and Select Determinations

RFP Number: CSP900620 Index Number: LDC112

UNSPSC CATEGORY CODE: 85000000

OAKS

ID Number

Work Description

Cost

Routine Assessments

35409

Completed (PAS and RR) - (Pre-Admission Screening and Resident Review)

$ 397.33 Each

35410

Withdrawn – Administrative Tasks Performed – Partially Assessed

$ 246.85 Each

35411

Withdrawn - Administrative Tasks Performed – Not Assessed

$ 54.65 Each

37982

Desk-Based Evaluations

$ N/A

None

Cancelled – No Administrative Tasks Performed

Non-reimbursable

Expedited Assessments

35412

SMI - (Serious Mental Illness)

$ 515.04 Each

35413

SMI/DD (Dual Assessment) - (Serious Mental Illness/Developmental Disabilities)

$ 543.69 Each

35414

Categorical – Emergencies

$ 99.55 Each

PASRR Determinations

35415

Issue SMI Determinations on Weekends and Holidays - (Serious Mental Illness)

$ 82.95 Each

37490

Delivery Confirmation Mail

$ 13.75 Each

The Contract pricing shown above is all inclusive. Initial development, on-going and future IT support is to be included in the individual cost lines.

* Virtual Rate Pricing

* Completed (PAS and RR) – Pre-Admission $348.20 Each

* Completed (PAS and RR) – Resident Review $348.20 Each

* Expedited SMI (Serious Mental Illness) $451.36 Each

All costs are in U.S. Dollars.

The State is not responsible for any costs not identified.

There are no additional reimbursements for travel or other related expenses.

* Indicates adding line items for Virtual Rates effective with all orders on or after 07/01/25, per amendment 4.

SUMMARY OF AMENDMENTS

Amendment Number

Effective Date Description

4 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 24 months, effective 07/01/25 through 06/30/27. Also, this amendment is issued to add Virtual Rate Pricing to the pricelist, effective with all orders 07/01/25.

All other prices, terms and conditions remain unchanged.

3 07/01/23

This amendment is issued to reflect the contract assignment from Ascend Management Innovations, Inc. to Maximus US Services, Inc., effective with all orders on or after 07/01/23, and 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. Also, this amendment is issued to indicate an updated pricelist.

Additionally, this amendment is issued to notify of an update to the agencies to which this contract is available, to indicate an updated Contract Number, to indicate an updated Contract Index Number, to include updated language regarding the Prohibition of the Expenditure of Public Funds for Offshore Services, effective with all orders on or after 07/01/23, and to repaginate.

All other prices, terms and conditions remain unchanged.

2 07/01/21

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 07/01/21 through 06/30/23. All other prices, terms and conditions remain unchanged.

03/13/20

This amendment is issued to add line items, for Desk-Based Evaluations and Delivery Confirmation Mail. All other prices, terms and conditions remain unchanged.