CSP900620_LDC112_Contract_Rev.pdf

Index No.: LDC112 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.

* Index No.: LDC112 Eff. Date: 07/01/23

MUTUALLY AGREED UPON CLARIFICATIONS / MODIFICATIONS TO THE RFP

* PROHIBITION OF THE EXPENDITURE OF PUBLIC FUND FOR OFFSHORE SERVICES

No State Cabinet Agency, Board or Commission will enter into any contract to purchase services provided outside of the United States or that allows State data to be sent, taken, accessed, tested, maintained, backed-up, stored, or made available remotely outside (located) of the United States, unless a duly signed waiver from the State has been attained.

Notwithstanding any other terms of this Contract, the State reserves the right to recover any funds paid for services the Contractor performs outside of the United States for which it did not receive a waiver. The State does not waive any other rights and remedies provided to the State in the Contract.

Further, no State agency, board, commission, State educational institution, or pension fund will make any purchase from or investment in any Russian institution or company. Notwithstanding any other terms of this Contract, the State reserves the right to recover any funds paid to Contractor for purchases or investments in a Russian institution or company in violation of this paragraph. The provisions of this paragraph will expire when the applicable Executive Order is no longer effective.

The Contractor must complete the Contractor/Subcontractor Affirmation and Disclosure Form (https://procure.ohio.gov/pdf/EO2022-02D/04-Affirmation%20and%20Disclosure%20Form_3-4-22.pdf) affirming the Contractor understands and will meet the requirements of the above prohibition. During the performance of this Contract, if the Contractor changes the location(s) disclosed on the Affirmation and Disclosure Form, Contractor must complete and submit a revised Affirmation and Disclosure Form reflecting such changes.

* Indicates updated contract index number and to add the MUTUALLY AGREED UPON CLARIFICATIONS / MODIFICATIONS TO THE RFP for the Prohibition of the Expenditure of Public Funds for Offshore Services to the contract, per amendment 3.

https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.com%2Fv3%2F__https%3A%2Fnam11.safelinks.protection.outlook.com%2F%3Furl%3Dhttps*3A*2F*2Fprocure.ohio.gov*2Fpdf*2FEO2022-02D*2F04-Affirmation*2520and*2520Disclosure*2520Form_3-4-22.pdf%26data%3D05*7C01*7Cpzipperer-davis*40carestar.com*7C14e64c91626c447194d508da23d1211f*7C97949c389d76437188b278d5c33b4e88*7C1*7C0*7C637861678555466720*7CUnknown*7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0*3D*7C3000*7C*7C*7C%26sdata%3DAVuQHWdW3*2B8b9OeMhx0lgh0JB820niXbuV3e*2FFGeMSA*3D%26reserved%3D0__%3BJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUl!!ADJM6pxZfkrGng!WXH1-0dh0eQMkG7ITbo6N-xRTHt1UUIXntvp-MPmhqYX6FWCzHcdDwBGZuZmv4Z1Kip5Wv5aBQfzbDnwXBqOYWM8vNRO9gR98v4%24&data=05%7C01%7CShaun.Roderer%40das.ohio.gov%7C4308aa72380b4e31391a08da70010150%7C50f8fcc494d84f0784eb36ed57c7c8a2%7C0%7C0%7C637945447041394408%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=CCJ37aKIwq6xEijXPr6bvv6BshvnonxtIqADuwvWDNc%3D&reserved=0

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.

* Index No.: LDC112

* Eff. Date: 07/01/23

* Page 4

* CONTRACTOR INDEX

CONTRACTOR AND TERMS: * CONTRACT NO: CSP900620-2

256991 Maximus US Services, Inc.

1600 Tysons Blvd McLean, VA 22102

Remit to Address: TERMS: Net 30 Days

256991 Maximus US Services, Inc.

1600 Tysons Blvd McLean, VA 22102

CONTRACTOR’S CONTACT: Mr. Hunter Fede Telephone: 1-615-473-4554 Fax: 1-615-771-1813 Email: hunterfede@maximus.com

*Indicates updated contract index number, indicates repagination, and indicates contract assignment from Ascend Management Innovations LLC to Maximus US Services Inc, effective with all orders placed on or after 07/01/23, per amendment 3.

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.

* Indicates updated contract index number and indicates repagination, per amendment 3.