S-44300-00013646 RFP Final combined with attachments~1.pdf

OregonBuys Bid # S-44300-00013646 Medicare Cost Report

STATE OF OREGON

COVER PAGE

OHA – Oregon State Hospital is issuing this Intermediate Procurement under S-44300-00013646 for

MEDICARE COST REPORT

Date of Issue: January 26, 2026 Opening Date: March 2, 2026

Single Point of Contact (SPC): Danielle Pompe, Contracts Specialist 3 Address: 500 Summer Street NE, E-03, Salem, OR 97301

Phone (voice): 971-374-3474

E-mail: danielle.a.pompe@odhsoha.oregon.gov mailto:danielle.a.pompe@odhsoha.oregon.gov

TABLE OF CONTENTS

SECTION 1: GENERAL INFORMATION

1.1 INTRODUCTION

1.2 SCHEDULE

1.3 SINGLE POINT OF CONTACT (SPC)

SECTION 2: AUTHORITY, OVERVIEW, AND SCOPE

2.1 AUTHORITY AND METHOD

2.2 DEFINITION OF TERMS

2.3 OVERVIEW AND PURPOSE

2.4 SCOPE OF WORK/SPECIFICATIONS

SECTION 3: PROCUREMENT REQUIREMENTS AND EVALUATION

3.1 MINIMUM OFFER REQUIREMENTS

3.2 MINIMUM SUBMISSION REQUIREMENTS

3.3 PROCUREMENT PROCESS

3.4 OFFERS CONTENT REQUIREMENTS

3.5 EVALUATION PROCESS

3.6 COST EVALUATION

3.7 NEXT STEP DETERMINATION

3.8 PREFERENCES

3.9 POINT AND SCORE CALCULATIONS

3.10 RANKING OF OFFERORS

SECTION 4: AWARD AND NEGOTIATION

4.1 AWARD NOTIFICATION PROCESS

4.2 SUCCESSFUL OFFEROR SUBMISSION REQUIREMENTS

4.3 CONTRACT NEGOTIATION

SECTION 5: ADDITIONAL INFORMATION

5.1 COMMITMENT TO DIVERSITY, EQUITY, AND INCLUSION

5.2 CERTIFIED FIRM PARTICIPATION

5.3 GOVERNING LAWS AND REGULATIONS

5.4 OWNERSHIP/PERMISSION TO USE MATERIALS

5.5 CANCELLATION OF SOLICITATION; REJECTION OF OFFERS; NO DAMAGES

5.6 COST OF SUBMITTING AN OFFER

5.7 STATEWIDE E-WASTE/RECOVERY PROCEDURE

5.8 RECYCLABLE PRODUCTS

SECTION 6: LIST OF ATTACHMENTS

ATTACHMENT A SAMPLE CONTRACT

ATTACHMENT B DISCLOSURE EXEMPTION AFFIDAVIT

ATTACHMENT C OFFEROR INFORMATION AND CERTIFICATION SHEET

ATTACHMENT D REFERENCE CHECK FORM

ATTACHMENT E COST SHEET

ATTACHMENT F CERTIFIED DISADVANTAGED BUSINESS OUTREACH PLAN

ATTACHMENT G RESPONSIBILITY INQUIRY

SECTION 1: GENERAL INFORMATION

1.1 INTRODUCTION

The State of Oregon, acting by and through the Oregon Health Authority, (“Agency”), is issuing this Request for Proposal for Medicare Cost Reporting in order to comply with the requirements set forth by the Centers for Medicare & Medicaid Services (CMS). Specialized knowledge is required to accurately translate and report the financial information. Due to the complexity of this annual task, OHA seeks professional services through a qualified Certified Public Accounting (CPA) firm to provide this service in order to reduce the risk of erroneous submissions to CMS.

Additional details on the Scope of the goods or services or both are included in the Scope of Work section.

Agency anticipates the award of one Contract from this solicitation. The initial term of the Contract is anticipated to be 5 years with options to renew up to 10 years and a maximum of $249,999.00 Not-to-Exceed (NTE) compensation payable to Contractor.

1.2 SCHEDULE

The table below represents a tentative schedule of events. All times are listed in Pacific Time.

All dates listed are subject to change. N/A denotes that event is not applicable to this solicitation.

Event Date Time

Pre-offer Conference N/A N/A

Questions / Requests for Clarification Due January 30, 2026 3:00 PM

Opening (offer Due) March 2, 2026 3:00 PM

Proposal Review Meeting (approx.) Within two weeks of closing

Issuance of Notice of Award (approx.) Within three days after proposal review Meeting

1.3 SINGLE POINT OF CONTACT (SPC)

The SPC for this solicitation is identified on the Cover Page, along with the SPC’s contact information. Offeror shall direct all communications related to any provision of the solicitation, whether about the technical requirements of the solicitation, contractual requirements, the solicitation process, or any other provision only to the SPC.

SECTION 2: AUTHORITY, OVERVIEW, AND SCOPE

2.1 AUTHORITY AND METHOD

Agency is issuing this solicitation pursuant to its authority under ORS 279A.050, ORS 279A.140 and ORS 413.033.

Agency is using the Intermediate Procurement solicitation method set forth in ORS 279B.070 and OAR 137-047-0270.

2.2 DEFINITION OF TERMS

For the purposes of this solicitation, capitalized words will refer to the following definitions.

2.2.1 General Definitions

Capitalized terms not specifically defined in this document are defined in OAR 125-246- 0110.

Terminology specific to the OregonBuys system may be found at OregonBuys .

2.3 OVERVIEW AND PURPOSE

The State of Oregon, Oregon Health Authority (OHA) on behalf of Oregon State Hospital (OSH) is soliciting for Medicare Cost Reporting that can provide Certified Public Accounting services for (OSH). OSH is the state of Oregon’s largest provider of rehabilitative psychiatric care to patients found guilty except for insanity; unfit to stand trial; civilly committed; or otherwise admitted to

OSH.

Providers of service participating in the Medicare program are required to submit information to achieve settlement of costs relating to health care services rendered to Medicare beneficiaries [42 U.S.C. 1395g (section 1815(a) of the Social Security Act]. Regulations state that cost reports "will be required from providers on an annual basis."[42 C.F.R. §413.20(b)]. When a provider fails to file a timely cost report, all interim payments since the beginning of the cost reporting period can be deemed overpayments. (Provider Reimbursement Manual 15-2 §100)

As a provider of services to Medicare beneficiaries, Oregon State Hospital is seeking to obtain professional Medicare Cost Reporting Services “Services” to comply with the requirements set forth by the Centers for Medicare & Medicaid Services (CMS). Specialized knowledge is required to accurately translate and report the financial information which is extracted and submitted from the Statewide Financial Management Application (SFMA) and the Oregon State Payroll System (OSPS) to CMS on the Medicare Hospital Health Care Complex Cost Report forms (CMS-2552). Due to the complexity of this annual task, OHA seeks professional services through a qualified Certified Public Accounting (CPA) firm to provide this service to reduce the risk of erroneous submissions to CMS.

OHA will issue a Contract, substantially in the form shown in Attachment A “Sample Contract.”

The Contractor awarded a Contract from this RFP will provide Services at the agreed-upon rates specified in the Contract for specific person directed services.

Upon an executed Contract between Contractor and OHA, the Contractor will become enrolled as a Provider for Medicare Cost Reporting.

OHA makes no guarantee of referrals or the amount of Work to be referred to any Provider for Services. Referral is based on the need for specific Contractor.

2.4 SCOPE OF WORK/SPECIFICATIONS

2.4.1 Annual Medicare Cost Reports. Annual Medicare Cost Reports for the Oregon State Hospital are due annually no later than November 20th of each calendar year during the term of the Contract.

2.4.1.1 The Proposer shall be capable of preparing and inputting Agency prepared data into the Contractor’s software program in order to prepare and submit the annual Medicare Hospital Health Care Complex Cost Report forms (CMS 2552-

10) for the Oregon State Hospital.

2.4.1.2 Proposer shall provide forms for data submission as required by CMS.

2.4.1.3 Proposer shall provide copies of the completed Annual Medicare Health Care

Complex Cost Reports in standard electronic cost report (ECR) format, as well as http://arcweb.sos.state.or.us/pages/rules/oars_100/oar_125/125_246.html http://arcweb.sos.state.or.us/pages/rules/oars_100/oar_125/125_246.html https://www.oregon.gov/das/ORBuys/Pages/Index.aspx

PDF format.

2.4.1.4 Proposer shall send and receive copies via Secured File Transfer Portal (SFTP) or similar technology. These deliverables include related schedules and documentation, to be submitted by the Oregon Health Authority (OHA) to the following entities:

• Medicare Fiscal Intermediary (Currently Noridian Healthcare Solutions)

• Oregon Health Authority – Internal Audits Division.

2.4.1.5 Proposer shall provide Prepared-by-Client (PBC) forms to be used by Agency staff to report and submit the necessary financial and statistical information to complete the Annual Medicare Cost Report

2.4.1.6 Proposer shall prepare and input OSH prepared data into Proposer’s cost reporting software program

2.4.1.7 Proposer shall review and provide feedback to client data for reasonableness, completeness, and areas for improvement.

2.4.1.8 Upon completion of the Annual Medicare Cost Report “Report”, Proposer shall evaluate and provide recommendations of OSH’s financial data for future reporting periods.

2.4.1.9 Proposer shall evaluate each hospital location for accuracy in clinical delivery programs and patient population categories (forensic, civil, and geriatric), and organize separate costs for each reportable entity where applicable.

2.4.1.10 Proposer shall provide a wage index review for OSH’s campuses to determine whether the wage index for each hospital location is represented by the currently published IPF PPS rules. The Proposer shall prepare and submit a Report that includes findings of the wage index review.

2.4.1.11 The Report must be reviewed by a Certified Public Accountant (CPA) prior to submission.

2.4.2 Annual Medicare Summary Report “Summary” – The Report is an independent review of OSH’s processes to assess whether the data was accurate and complete for the Cost Reporting Periods covered in this agreement and is due within 45 days after submission and approval of the prepared Report. The Report shall include but not limited to:

2.4.2.1 Summary of key financial ratios applicable to OSH’s financial operations, cost-to-charge ratio, wage ratio, and patient cost per day to confirm sufficiency of data and assist OSH with process improvements.

2.4.2.2 The review will provide OSH with an independent assessment and recommendations with respect to cost report data collection.

2.4.3 Training on Cost Reporting Process – Proposer may be requested to provide training on the cost reporting process, worksheets, and its underlying data to key OSH Staff. The primary point of contact will be OSH’s contract administrator. (Services is on an as needed, ongoing basis)

2.4.3.1 The format of the training is to be decided - either in person at OSH’s Salem Campus, or remotely through electronic means.

2.4.3.2 Training will be presented to individuals with varying understanding and familiarity with the Medicare Cost Report.

2.4.3.3 Proposer shall train and assist OSH Staff in data collection and preparation, noting areas for improvement.

2.4.4 Settlement Audit Review Services - Proposer shall provide ongoing settlement audit review services on an “as needed” basis, as requested by OHA. This includes, but is not limited to:

2.4.4.1 Consultation regarding any settlement audits pertaining to Cost Reports prepared by the Contractor

2.4.4.2 Support regarding any settlement audits pertaining to the Cost Reports prepared by the Proposer.

2.4.5 Additional Services. OSH may wish to expand the scope of work to include but not limited to:

2.4.5.1 Preparation of annual Medicaid Cost Reports.

2.4.5.2 Complete various other accounting functions.

SECTION 3: PROCUREMENT REQUIREMENTS AND EVALUATION

3.1 MINIMUM OFFER REQUIREMENTS

3.1.1 BUSINESS. To be considered for evaluation, Offeror must demonstrate how Offeror meets all of the following business requirements:

3.1.1.1 Proposer’s Key Person(s) must possess current licensure as a Certified Public Accountant.

3.1.1.2 Proposer’s Key Persons resume must show they have a minimum of five years of experience in preparing annual Medicare Cost Reports for Freestanding Psychiatric Hospitals that utilize the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS).

3.1.1.3 Proposer’s Key Persons must have propriety software or system capabilities to prepare and submit the Medicare Cost Report using the standardized electronic cost reporting (ECR) format.

3.1.1.4 Proposer must have 5 years’ experience for similar type services in a State-run Psychiatric Hospital similar to OSH size and complexity.

3.2 MINIMUM SUBMISSION REQUIREMENTS

3.2.1 Offeror Format and Quantity.

Offeror should follow the format and reference the sections listed in the Offeror Content Requirements section. Responses to each section and subsection should be labeled to indicate the item being addressed. Offeror must describe in detail how requirements of this solicitation will be met and may provide additional related information. Cost information must be submitted as a separate electronic file.

Offeror shall submit one electronic copy of its Offer. In addition, if Offeror believes any of its Offer is exempt from disclosure under Oregon Public Records Law (ORS 192.311 through 192.478), Offeror shall complete and submit the Disclosure Exemption Affidavit (Attachment B), and Offeror shall submit a fully redacted version of its Offer, clearly identified as the redacted version.

3.2.2 Authorized Representative.

A representative authorized to bind the Offeror shall sign the Offer. Failure of the authorized representative to sign the Offer may subject the offer to rejection by Agency.

3.3 PROCUREMENT PROCESS

3.3.1 Public Notice

The solicitation, including all Amendments and attachments, are published in the OregonBuys e-procurement system Solicitation documents will not be mailed to prospective Offerors.

Agency shall advertise all Amendments on OregonBuys e-procurement system.

Prospective Offeror is solely responsible for checking OregonBuys to determine whether or not any Amendments have been issued. Amendments are incorporated into the solicitation by this reference.

3.3.2 Questions / Requests for Clarification

All inquiries, whether relating to the solicitation process, administration, deadline or method of award, or to the intent or technical aspects of the solicitation must:

• Be emailed to the SPC

• Reference the OregonBuys bid number

• Identify Offeror’s name and contact information

• Be sent by an authorized representative

• Refer to the specific area of the solicitation being questioned (i.e. page, section and paragraph number); and

• Be received by the due date and time for Questions/Requests for Clarification identified in the Schedule.

3.3.3 Pre-Offer Conference

A pre-submittal conference will not be held for this solicitation.

3.3.4 Offer Submission.

Offeror is solely responsible for ensuring its Offer is received by the SPC in accordance with the solicitation requirements before Opening. Agency is not responsible for any delays in transmission errors or delays or mistaken delivery. All offers must be submitted using the OregonBuys procurement system. Offers submitted by any means not authorized may be rejected.

3.3.5 Submission Options

OregonBuys Electronic Response. Offeror should submit its Offer electronically through OregonBuys. Offeror should follow the procedures outlined in detailed instructions on how to submit an Offer can be found at OregonBuys Vendor Formal Solicitation Response.pdf

The cost sheet must be submitted as a separate electronic response file.

Offeror shall submit its Offer and all other submittal requirements, with Attachment C - Offeror Information and Certification Sheet bearing the Offeror’s authorized representative’s Signature, in one of the following formats: Adobe Acrobat (pdf), Microsoft Word (docx), or Microsoft Excel (xlsx). If Offeror believes any of its Offer is exempt from https://oregonbuys.gov/bso disclosure under Oregon Public Records Law (ORS 192.311 through 192.478), Offeror shall complete and submit the Disclosure Exemption Affidavit (Attachment B). Offeror shall also mark as “Confidential” in OregonBuys all attachments to its Offer that Offeror believes are exempt from disclosure

The Offeror Information and Certification Sheet (Attachment C) must bear the Offeror’s authorized representative’s Signature.

3.3.6 Modification or Withdrawal of Quotes or Offers

Any Offeror who wishes to make modifications to an Offer already received by Agency shall submit its modification in one of the manners listed in the offer Submission Options section and must denote the specific change(s) to the offer submission.

If an Offeror wishes to withdraw a submitted Offer, it shall do so prior to Opening. The Offeror shall submit a Written notice Signed by an authorized representative of its intent to withdraw its Offer in accordance with OAR 125-247-0440. The notice must include the OregonBuys Bid number and be submitted to the SPC.

3.3.7 Offer Opening Date

Offer and all required submittal items must be received by the SPC on or before Opening.

All Offer modifications or withdrawals must be completed prior to Opening.

Offers received after Opening are considered LATE and will NOT be accepted for evaluation. Late Offers will be returned to the respective Offeror or destroyed.

3.3.8 Offer Rejection

Agency may reject an Offer for any of the following reasons:

• Offeror fails to substantially comply with all prescribed solicitation procedures and requirements, including but not limited to the requirement that Offeror’s authorized representative sign the offer.

• Offeror fails to meet the responsibility requirements of ORS 279B.110.

• Offeror has undisclosed liquidated and delinquent debt owed to the State of Oregon or any of its agencies, boards, commissions, departments or divisions.

• Offeror makes any contact regarding this solicitation with State representatives such as State employees or officials other than the SPC or those the SPC authorizes, or inappropriate contact with the SPC.

• Offeror attempts to inappropriately influence a member of the Evaluation Committee.

• Offeror is conditioned on Agency’s acceptance of any other terms and conditions or rights to negotiate any alternative terms and conditions that are not reasonably related to those expressly authorized for negotiation in the solicitation or Amendment.

3.3.9 Opening of Offers

There will be no public Opening of Offers. Offers received will not be available for inspection until after the evaluation process has been completed and the Notice Award is issued. However, Agency will record and make available the identity of all Offerors after Opening.

3.4 OFFERS CONTENT REQUIREMENTS

Offeror must address each of the items listed in this section and all other requirements set forth in this solicitation. Offeror shall describe the Goods to be provided or the Services to be performed or both. An Offer that merely offers to provide the goods or services as stated in this solicitation will be considered non-Responsive to this solicitation and will not be considered further.

3.4.1 Offeror Information and Certification Sheet

The Offeror shall complete and submit the Offeror Information and Certification Sheet (Attachment C).

3.4.2 References

Provide at least 3 references from current or former client firms for similar projects performed for any clients within the last 10 years. References must verify the quality of previous, related Work.

Agency may check to determine if references provided support Offeror’s ability to comply with the requirements of this solicitation. Agency may use references to obtain additional information, break tie scores, or verify any information needed. Agency may contact any reference (submitted or not) to verify Offeror’s qualifications.

Offeror shall send the Reference Check Form (Attachment D) to its references. Reference forms must be completed by the reference, returned to the Offeror and submitted with the Offer prior to opening.

3.4.3 Costs

Submit a detailed Cost Offer (Attachment E) that includes the following items:

3.4.3.1 Proposer’s fees for preparation and completion of the Annual Medicare Cost Reports during the initial term of the Contract. Proposer shall include a single, fully loaded, all-inclusive cost for preparing each report.

3.4.3.2 Proposer’s Not-to-Exceed cost per Fiscal Year for preparation of Annual Summary Report. Proposer shall include a single, fully loaded, all-inclusive cost per fiscal year for preparing this report. Please list the title of each staff person who will perform the work related to the Report

3.4.3.3 Proposer’s hourly rates for performing Settlement Audit Review Services not included in Cost Reporting. Include the position title, and hourly rate of each staff person who will perform the Settlement Audit Review Services described in Section 2, Subsection 2.4.4.

3.4.3.4 Proposer’s Narrative Statement explaining how the Cost Proposal is competitive and cost effective.

3.4.4 Public Record/Confidential or Proprietary Information

All Offers are public record and are subject to public inspection after Agency issues the Notice of the Intent to Award. If an Offeror believes that any portion of its Offer contains any information that is a trade secret under ORS Chapter 192.345(2) or otherwise is exempt from disclosure under the Oregon Public Records Law (ORS 192.311 through 192.478), Offeror shall complete and submit the Disclosure Exemption Affidavit (Attachment B) and a fully redacted version of its Offer.

Offeror is cautioned that cost information generally is not considered a trade secret under Oregon Public Records Law (ORS 192.311 through 192.478) and identifying the Offer, in whole, as exempt from disclosure is not acceptable. Agency advises each Offeror to consult with its own legal counsel regarding disclosure issues.

If Offeror fails to identify the portions of the Offer that Offeror claims are exempt from disclosure, Offeror has waived any future claim of non-disclosure of that information.

3.5 EVALUATION PROCESS

3.5.1 Responsiveness and Responsibility Determination

Offers received prior to Opening will be reviewed for Responsiveness to all solicitation requirements including compliance with Minimum Requirements section and offer Content Requirements section. If the Offer is unclear, the SPC may request clarification from Offeror. However, clarifications may not be used to rehabilitate a non-Responsive Offer. If the SPC finds the Offer non-Responsive, the Offer may be rejected, however, Agency may waive mistakes in accordance with OAR 125-247-0470.

At any time prior to award, Agency may reject an Offeror found to be not Responsible.

3.5.2 Evaluation Criteria

Offers meeting the requirements outlined in the Offer Content Requirements section will be evaluated by an Evaluation Committee. Evaluators will assign a score for each evaluation criterion listed below in this section.

SPC may request further clarification to assist the Evaluation Committee in gaining additional understanding of offers. A response to a clarification request must be to clarify or explain portions of the already submitted Offer and may not contain new information not included in the original Offer.

3.5.2.1 Evaluation Item 1: Knowledge, Experience, Education, and Training (Possible Points 50).

o How well does Proposer’s narrative description of Proposer’s Key Person’s knowledge and experience demonstrate the Proposer’s ability to perform the Work?

o How well does Proposer’s narrative description of Proposer’s Key Persons education and training in the field of accounting, and supporting Key Person resumes, demonstrate the Proposer’s ability to perform the Work?

3.5.2.2 Evaluation Item 2: Available Services (Possible Points 10) o How well does the Proposal identify and describe Proposer’s available services as it applies to this RFP?

3.5.2.3 Evaluation Item 3: Experience and Qualifications (Possible Points 10) o How well does the Proposer’s experience and qualifications identify history of preparing Hospital Cost reports?

3.6 COST EVALUATION (Possible Points 10)

The SPC will conduct the cost evaluation. The SPC will award a score to each Cost Sheet based upon the percentage of the proposed cost as compared to the lowest Offeror’s cost using the following formula:

lowest cost of all Offerors X cost points possible = cost score cost being scored

3.7 NEXT STEP DETERMINATION

Agency may conduct additional rounds of competition if in the best interest of the State.

Additional rounds of competition may consist of, but will not be limited to:

• Establishing a Competitive Range

• Presentations/Demonstrations/Additional Submittal Items

• Interviews

• Best and Final Offers

If Agency elects to conduct additional round(s), Agency shall provide written notice to all Offerors describing the next step. At any time, Agency may dispense with the selected additional round and: (1) issue a Notice of Intent to Award to the highest-ranking Responsible Offeror; or (2) elect to conduct an alternative round of competition; or (3) cancel the solicitation.

3.8 PREFERENCES

3.8.1 Recycled Materials

In comparing Goods from two or more Offerors, if at least one Offeror proposes Goods manufactured with Recycled Materials, and at least 1 Offeror does not, Agency will select the Offeror proposing Goods manufactured from Recycled Materials if each of the conditions specified in ORS 279A.125 (2) exists following any adjustments made to the cost of the Goods according to any applicable reciprocal preference.

3.8.2 Tiebreakers

Oregon Supplies: If Agency receives Offerors identical in cost, fitness, availability and quality and chooses to award a Contract, Agency shall award the Contract in accordance with the procedures outlined in OAR 125-246-0300.

3.9 POINT AND SCORE CALCULATIONS

Points are the total possible value for each section as listed in the table below. Cost points are calculated as stated in the Cost Evaluation section. Points possible are as follows

TOTAL POINTS POSSIBLE: 100

3.5.2.1 Evaluation Item: Knowledge, Experience, Education, and Training

3.5.2.2 Evaluation Item 2: Additional Services 10

3.5.2.3 Evaluation Item 3: Experience and Qualifications 10

3.6 Evaluation Item 4: Cost 30

3.10 RANKING OF OFFERORS

The SPC will total the final average score (calculated by totaling the points awarded by each Evaluation Committee member and dividing by the number of members), together with references, and final price. After each applicable preference has been applied, SPC will determine rank order for each respective Offer and Offeror, with the highest score receiving the highest rank, and successive rank order determined by the next highest score.

SECTION 4: AWARD AND NEGOTIATION

4.1 AWARD NOTIFICATION PROCESS

4.1.1 Award Consideration

Agency, if it awards a Contract, shall award a Contract to the highest-ranking Responsible Offeror(s) based upon the scoring methodology and process described in Section 3. Agency may award less than the full Scope defined in this solicitation.

4.1.2 Notice of Award

Agency will notify all Offerors in Writing that Agency has awarded a Contract to the selected Offeror(s) subject to successful negotiation of any negotiable provisions.

4.2 SUCCESSFUL OFFEROR SUBMISSION REQUIREMENTS

4.2.1 Insurance

Prior to execution of the Contract, the apparent successful Offeror shall secure and demonstrate to Agency proof of insurance coverage meeting the requirements identified in the solicitation or as otherwise negotiated.

Failure to demonstrate coverage may result in Agency terminating Negotiations and commencing Negotiations with the next highest-ranking Offeror. Offeror is encouraged to consult its insurance agent about the insurance requirements contained in Insurance Requirements (Exhibit C of Attachment A) prior to offer submission.

4.2.2 Taxpayer Identification Number

The apparent successful Offeror shall provide its Taxpayer Identification Number (TIN) and backup withholding status on a completed W-9 form if either of the following applies:

• When requested by Agency (normally in an intent to award notice), or

• When the backup withholding status or any other information of Offeror has changed since the last submitted W-9 form, if any.

Agency will not make any payment until Agency has a properly completed W-9.

4.2.3 Business Registry

If selected for award, Offeror shall be duly authorized by the State of Oregon to transact business in the State of Oregon before executing the Contract. The selected Offeror shall submit a current Oregon Secretary of State Business Registry number, or an explanation if not applicable.

All Corporations and other business entities (domestic and foreign) must have a Registered Agent in Oregon. See requirements and exceptions regarding Registered Agents. For more information, see Oregon Business Guide, How to Start a Business in Oregon and Laws and Rules. The titles in this subsection are available at the following Internet site:

http://www.filinginoregon.com/index.htm.

http://www.irs.gov/pub/irs-pdf/fw9.pdf http://www.filinginoregon.com/index.htm

4.3 CONTRACT NEGOTIATION

4.3.1 Negotiation

By submitting an offer, Offeror agrees to comply with the requirements of the solicitation, including the terms and conditions of the Sample Contract (Attachment A), with the exception of those terms reserved for negotiation.

Offeror shall review the attached Sample Contract and note exceptions. Unless Offeror notes exceptions to the terms and conditions identified as negotiable in its Offer, the State intends to enter into a Contract with the successful Offeror substantially in the form set forth in Sample Contract (Attachment A). It may be possible to negotiate some provisions of the final Contract; however, many provisions cannot be changed. Offeror is cautioned that the State of Oregon believes modifications to the standard provisions constitute increased risk and increased cost to the State.

Any Offer that is conditioned upon Agency’s acceptance of any other terms and conditions may be rejected. Any subsequent negotiated changes are subject to prior approval of the Oregon Department of Justice.

Agency will only negotiate the following provisions:

• Term of the contract

• Statement of Work

• Compensation

• Section 14 “Records Maintenance, Access”, subsection a. of the Standard Terms and Conditions

• Exhibit E “Oregon State Hospital Supplemental General Provisions” authorized signer of the parts requiring signature.

In the event that the parties have not reached mutually agreeable terms within 30 calendar days, Agency may terminate Negotiations and commence Negotiations with the next highest-ranking Offeror.

SECTION 5: ADDITIONAL INFORMATION

5.1 COMMITMENT TO DIVERSITY, EQUITY, AND INCLUSION

The State of Oregon is committed to taking active steps toward increasing and promoting diversity, equity, and inclusion values across procurement processes for minority, women, emerging small, and service-disabled veteran owned businesses by reducing barriers to compete for and be awarded state contracts. All interested businesses are encouraged to submit proposals for this contracting opportunity.

5.2 CERTIFIED FIRM PARTICIPATION

Pursuant to Oregon Revised Statute (ORS) Chapter 200, Agency encourages the participation of small businesses, certified by the Oregon Certification Office for Business Inclusion and Diversity (“COBID”) in all contracting opportunities. This includes certified small businesses in the following categories: disadvantaged business enterprise, minority-owned business, woman-owned business, a business that a service-disabled veteran owns or an emerging small business.

Agency also encourages joint ventures or subcontracting with certified small business enterprises. For more information, visit: Business Oregon : Home : State of Oregon or email:

COBID Biz*Biz https://www.oregon.gov/biz/Pages/default.aspx mailto:Biz.COBID@biz.oregon.gov

If the Contract has potential subcontracting opportunities, the successful Offeror may be required to submit a completed Certified Disadvantaged Business Outreach Plan (Attachment F) prior to execution.

5.3 GOVERNING LAWS AND REGULATIONS

This intermediate procurement is governed by the laws of the State of Oregon. Venue for any administrative or judicial action relating to this intermediate procurement, evaluation and award is the Circuit Court of Marion County for the State of Oregon; provided, however, if a proceeding must be brought in a federal forum, then it must be brought and conducted solely and exclusively within the United States District Court for the District of Oregon. In no event shall this Section be construed as a waiver by the State of Oregon of any form of defense or immunity, whether sovereign immunity, governmental immunity, immunity based on the eleventh amendment to the Constitution of the United States or otherwise, to or from any Claim or consent to the jurisdiction of any court.

5.4 OWNERSHIP/PERMISSION TO USE MATERIALS

All Offers submitted in response to this solicitation become the property of Agency. By submitting an Offer in response to this solicitation, Offeror grants the State a non-exclusive, perpetual, irrevocable, royalty-free license for the rights to copy, distribute, display, prepare derivative works of and transmit the Offer solely for the purpose of evaluating the Offer, negotiating a Contract, if awarded to Offeror, or as otherwise needed to administer the intermediate procurement process, and to fulfill obligations under Oregon Public Records Law (ORS 192.311 through 192.478).

5.5 CANCELLATION OF SOLICITATION; REJECTION OF OFFERS; NO DAMAGES.

Pursuant to ORS 279B.100, Agency may reject any or all Offers in-whole or in-part or may cancel this solicitation at any time when the rejection or cancellation is in the best interest of the State or Agency, as determined by Agency. Neither the State nor Agency is liable to any Offeror for any loss or expense caused by or resulting from the delay, suspension, or cancellation of the solicitation, award, or rejection of any Offer.

5.6 COST OF SUBMITTING AN OFFER

Offeror shall pay all the costs in submitting its offer, including, but not limited to, the costs to prepare and submit the offer, costs of samples and other supporting materials, costs to participate in demonstrations, or costs associated with protests.

5.7 STATEWIDE E-WASTE/RECOVERY PROCEDURE

If applicable, Offeror shall include information in its offer that demonstrates compliance with the Statewide E-Waste/Recovery Procedure 107-011-050_PR. Download the procedure by visiting www.oregon.gov/DAS, then enter the procedure number into the search bar, and find the procedure in the search results window.

5.8 RECYCLABLE PRODUCTS

Offeror shall use recyclable products to the maximum extent economically feasible in the performance of the Services or Work set forth in this document and the subsequent Contract.

(ORS 279B.025)

http://www.oregon.gov/DAS

SECTION 6: LIST OF ATTACHMENTS

ATTACHMENT A SAMPLE CONTRACT

ATTACHMENT B DISCLOSURE EXEMPTION AFFIDAVIT

ATTACHMENT C OFFEROR INFORMATION AND CERTIFICATION SHEET

ATTACHMENT D REFERENCE CHECK FORM

ATTACHMENT E COST SHEET

ATTACHMENT F CERTIFIED DISADVANTAGED BUSINESS OUTREACH PLAN

ATTACHMENT G RESPONSIBILITY INQUIRY

Contract Number 000000

ATTACHMENT A

SAMPLE

STATE OF OREGON

PERSONAL/PROFESSIONAL SERVICES CONTRACT

You can get this document in other languages, large print, braille, or a format you prefer free of charge. Contact the Contract Administrator at the contact information found below. We accept all relay calls.

This Contract is between the State of Oregon, acting by and through its Oregon Health Authority, hereinafter referred to as “OHA,” and, Contractor d.b.a. Facility or Assumed Name

Address Address

Attention: (required) Telephone: (required)

Fax: (optional) E-mail address: (required) hereinafter referred to as “Contractor.”

Work to be performed under this Contract relates principally to OHA’s

Oregon State Hospital, hereinafter referred to as OSH (Fill in with name of Office, Program, etc.)

(Insert address) (Insert city, state, zip)

Contract Administrator: (Insert Name) or delegate Telephone: (Required)

E-mail address: (Required)

000000/initials Page 2 of 90 OHA OSH PSK (reviewed by DOJ) Updated: 12/17/2025

1. Effective Date and Duration. This Contract shall become effective on the later of: (I) the last date all required signatures in Section 6., below have been obtained, or (II) [insert start date] provided it is (i) signed by all parties on or before such date, and (ii) when required, approved in writing by the Oregon Department of Justice on or before such date, and (iii) when required, approved in writing by the Oregon Department of Administrative Services. Unless extended or terminated earlier in accordance with its terms, this Contract shall expire on [insert end date]. Contract termination shall not extinguish or prejudice OHA’s right to enforce this Contract with respect to any default by Contractor that has not been cured.

2. Contract Documents.

a. This Contract consists of this document and includes the following listed exhibits which are incorporated into this Contract:

(1) Exhibit A, Part 1: Statement of Work

(2) Exhibit A, Part 2: Payment and Financial Reporting

(3) Exhibit A, Part 3: Special Provisions

(4) Exhibit B: Standard Terms and Conditions

(5) Exhibit C: Insurance Requirements

(6) Exhibit D: Reserved

(7) Exhibit E:

(a) Exhibit E, Part 1: Oregon State Supplemental General Provisions

(b) Exhibit E, Part 2: Oregon State Hospital Confidentiality and Access Agreement (OSH STK 76113)

(c) Exhibit E, Part 3: RESERVED

(d) Exhibit E, Part 4: Oregon State Hospital Policy and

Procedure 5.001, Drug and Alcohol-Free Workplace

(e) Exhibit E, Part 5: RESERVED

(f) Exhibit E, Part 6: RESERVED

(g) Exhibit E, Part 7: RESERVED

(h) Exhibit E, Part 8: RESERVED

(i) Exhibit E, Part 9: Oregon State Hospital Policy and

Procedure 8.007, Identification Badges

(j) Exhibit E, Part 10: RESERVED

(k) Exhibit E, Part 11: RESERVED

(l) Exhibit E, Part 12: Oregon State Hospital Policy and

Procedure 8.027, Weapons on Campus

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(m) Exhibit E, Part 13: Oregon State Hospital Policy and Procedure 8.033, Workplace Violence Prevention

(n) Exhibit E, Part 14: RESERVED

(o) Exhibit E, Part 15: RESERVED

b. This Contract and the documents listed in Section 2., “Contract Documents”, Subsection a. above, shall be in the following descending order of precedence: this Contract less all exhibits, Exhibits B, A, C, and E.

3. Consideration.

a. The maximum, not-to-exceed compensation payable to Contractor under this Contract, which includes any allowable expenses, is $[insert amount]. OHA will not pay Contractor any amount in excess of the not-to-exceed compensation of this Contract for completing the Work and will not pay for Work performed before the date this Contract becomes effective or after the termination or expiration of this Contract. If the maximum compensation is increased by amendment of this Contract, the amendment must be fully effective before Contractor performs Work subject to the amendment.

b. Payments to Contractor shall be subject to ORS 293.462 and shall be made in accordance with the payment schedule and requirements in Exhibit A, Part 2., “Payment and Financial Reporting.”

c. OHA will only pay for completed Work under this Contract. For purposes of this Contract, “Work” means the tasks or services and deliverables accepted by OHA as described in Exhibit A, Part 1, “Statement of Work.”

4. Contractor Determination. In accordance with the State Controller’s Oregon Accounting Manual, policy 30.40.00.104, OHA’s determination is that:

Contractor is a contractor Not applicable

Assistance Listings number(s) of federal funds to be paid through this Contract: N/A

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5. Contractor Information and Certification.

a. Contractor Information. This information is requested pursuant to

ORS 305.385.

PLEASE PRINT OR TYPE THE FOLLOWING INFORMATION

Contractor Name (exactly as filed with the IRS):

Street address:

City, state, zip code:

Email address:

Telephone: ( ) Fax: ( )

Is Contractor a nonresident alien, as defined in 26 U.S.C. § 7701(b)(1), a foreign person, or a foreign entity? (Check one box): YES NO

Business Designation. (Check one box):

Professional Corporation Nonprofit Corporation Limited Partnership Limited Liability Company Limited Liability Partnership Sole Proprietorship Corporation Partnership

Contractor Proof of Insurance. Contractor shall provide the following information upon submission of the signed Contract. All insurance listed herein and required by Exhibit C must be in effect prior to Contract execution.

If Contractor is self-insured for any of the Insurance Requirements specified in Exhibit C of this Contract, Contractor may so indicate by: (i) writing “Self-Insured” on the appropriate line(s); and (ii) submitting a certificate of insurance as required by Exhibit C.

Professional Liability Insurance Company: _____________________________________________

Policy #: ______________________________________________ Expiration Date: ________________

Commercial General Liability Insurance Company: ____________________________________

Policy #: ______________________________________________ Expiration Date: ________________

Automobile Liability Insurance Company: ______________________________________________

Policy #: ______________________________________________ Expiration Date: ________________

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Workers’ Compensation. Does Contractor have any subject workers, as defined in ORS 656.027? (Check one box): YES NO If YES, provide the following information:

Workers’ Compensation Insurance Company: _________________________________________

Policy #: ______________________________________________ Expiration Date: ________________

b. Certification. Without limiting the generality of the foregoing, by signature on this Contract, the undersigned hereby certifies under penalty of perjury that:

(1) Contractor is in compliance with all insurance requirements in Exhibit C of this Contract, and notwithstanding any provision to the contrary, Contractor shall deliver to the OHA Contract Administrator (see page one of this Contract) the required Certificate(s) of Insurance within 30 days of execution of this Contract. By certifying compliance with all insurance as required by this Contract, Contractor acknowledges it may be found in breach of the Contract for failure to obtain required insurance. Contractor may also be in breach of the Contract for failure to provide Certificate(s) of Insurance as required and to maintain required coverage for the duration of the Contract;

(2) Contractor acknowledges that the Oregon False Claims Act, ORS 180.750 to 180.785, applies to any “claim” (as defined by ORS 180.750) that is made by (or caused by) the Contractor and that pertains to this Contract or to the project for which the Contract work is being performed. Contractor certifies that no claim described in the previous sentence is or will be a “false claim” (as defined by ORS 180.750) or an act prohibited by ORS

180.755. The Oregon Attorney General may enforce the

liabilities and penalties provided by the Oregon False Claims Act against the Contractor, in addition to any remedies that may be available to OHA under this Contract;

(3) The undersigned is authorized to act on behalf of Contractor and represents and warrants that Contractor has complied with the tax laws of the State of Oregon and the applicable tax laws of any political subdivision of Oregon. Contractor shall, throughout the duration of this Contract and any extensions, comply with all tax laws of this state and all applicable tax laws of any political subdivision of Oregon. For the purposes of this

000000/initials Page 6 of 90

Section, “tax laws” includes: (i) All tax laws of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of Oregon that applied to Contractor, to Contractor’s property, operations, receipts, or income, or to Contractor’s performance of or compensation for any work performed by Contractor; (iii) Any tax provisions imposed by a political subdivision of Oregon that applied to Contractor, or to goods, services, or property, whether tangible or intangible, provided by Contractor; and (iv) Any rules, regulations, charter provisions, or ordinances that implemented or enforced any of the foregoing tax laws or provisions.

Contractor acknowledges that the Oregon Department of Administrative Services will report this Contract to the Oregon Department of Revenue (DOR). The DOR may take any and all actions permitted by law relative to the collection of taxes due to the State of Oregon or a political subdivision, including (i) garnishing the Contractor’s compensation under this Contract or (ii) exercising a right of setoff against Contractor’s compensation under this Contract for any amounts that may be due and unpaid to the State of Oregon or its political subdivisions for which the DOR collects debts;

(4) The information shown in Section 5.a., “Contractor Information” above is Contractor’s true, accurate and correct information;

(5) To the best of the undersigned’s knowledge, Contractor has not discriminated against and will not discriminate against minority, women or emerging small business enterprises certified under ORS 200.055 in obtaining any required subcontracts;

(6) Contractor and Contractor’s employees and agents are not included on the list titled “Specially Designated Nationals” maintained by the Office of Foreign Assets Control of the United States Department of the Treasury and currently found at: https://www.treasury.gov/resource-center/sanctions/SDN- List/Pages/default.aspx;

https://www.treasury.gov/resource-center/sanctions/SDN-List/Pages/default.aspx https://www.treasury.gov/resource-center/sanctions/SDN-List/Pages/default.aspx

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(7) Contractor is not listed on the non-procurement portion of the General Service Administration’s “List of Parties Excluded from Federal procurement or Non-procurement Programs” currently found at: https://www.sam.gov/SAM;

(8) Contractor is not subject to backup withholding because:

(a) Contractor is exempt from backup withholding;

(b) Contractor has not been notified by the IRS that Contractor is subject to backup withholding as a result of a failure to report all interest or dividends; or

(c) The IRS has notified Contractor that Contractor is no longer subject to backup withholding; and

(9) Contractor’s Federal Employer Identification Number (FEIN) or Social Security Number (SSN) provided to OHA is true and accurate. If this information changes, Contractor shall provide OHA with the new FEIN or SSN within 10 days.

https://www.sam.gov/SAM

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CONTRACTOR, BY EXECUTION OF THIS CONTRACT, HEREBY ACKNOWLEDGES

THAT CONTRACTOR HAS READ THIS CONTRACT, UNDERSTANDS IT, AND

AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS.

CONTRACTOR: YOU WILL NOT BE PAID FOR SERVICES RENDERED BEFORE THE

EFFECTIVE DATE OF THIS CONTRACT.

6. Signatures. This Contract and any subsequent amendments may be executed in several counterparts, all of which when taken together shall constitute one agreement binding on all parties, notwithstanding that all parties are not signatories to the same counterpart. Each copy of the Contract and any amendments so executed shall constitute an original.

Contractor Name By:

Authorized Signature Printed Name

Title Date

State of Oregon, acting by and through its Oregon Health Authority By:

Authorized Signature Printed Name

Title Date

Approved for Legal Sufficiency:

Not Required per OAR 137-045-0030(1)(b) Oregon Department of Justice Date

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EXHIBIT A

Part 1 Statement of Work

(SEE RFP)

(Be specific and complete)

1. Purpose.

2. Services to be Provided. Contractor shall

3. Reporting Requirements.

4. Specifications or Performance Standards. OHA requires that Contractor meets the highest standards prevalent in the industry or business most closely involved in providing the appropriate goods or services.

000000/initials Page 10 of 90

Part 2 Payment and Financial Reporting

1. Payment Provisions.

a. As consideration for the services provided by Contractor during the period specified in Section 1., Effective Date and Duration, of this Contract, OHA will pay to Contractor a maximum not-to-exceed amount as specified in Section 3., Consideration of this Contract, to be paid as follows:

(1)

b. Contractor understands and agrees that this Contract does not provide or guarantee Contractor any minimum amount of work, which is to be provided on an “as-needed” basis.

c. If OHA rejects any work, it shall provide Contractor written notice of rejection that includes an explanation of how the work is deficient.

Contractor shall cure such deficiencies at no cost or expense to OHA and resubmit the deficient work within 14 calendar days of receipt of the notice of rejection, or such longer time as OHA may specify in its notice of rejection. If the work is still deficient, OHA may allow Contractor an additional chance to cure, or may request that OHA declare Contractor in default pursuant to Exhibit B, Section 10.

d. Contractor Invoice. Contractor shall submit monthly invoices for Work performed to OSH’s Accounting Services, either by mail: 2600 Center Street NE, B02-152, Salem, OR 97301 or e-mail:

AccountingOffice.MiscSalem@odhsoha.oregon.gov. Contractor's claims to OHA for overdue payments on invoices are subject to ORS 293.462.

(1) In the upper left hand corner of the invoice the following information must be included: the contract number, the total consideration amount, and the balance prior to current months invoice and the remaining balance of the contract after current invoice charges.

(2) Invoice must include the service date(s), rate(s) charged for service(s), and have a total for all services.

mailto:AccountingOffice.MiscSalem@odhsoha.oregon.gov

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(3) Invoices that do not comply with the format stipulated in d.(1) and d.(2) above may be held up for payment until the proper invoice format is submitted for payment.

2. Travel and Other Expenses. OHA will not reimburse Contractor for any travel or other expenses under this Contract.

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Part 3 Special Provisions

1. Confidentiality of Information.

a. Client Information.

(1) All information as to personal facts and circumstances obtained by the Contractor on the client (“Client Information”) shall be treated as privileged communications, shall be held confidential, and shall not be divulged without the written consent of the client, his or her guardian, or the…