REQUESTS FOR PROPOSALS - Boston Public Health …bphc.org/.../Documents/RFPS/BostonEMSBillingRFP.pdf · 2014-12-01 · BILLING AND COLLECTION SERVICES ... 1.2 PROPOSAL INSTRUCTIONS

REQUESTS FOR PROPOSALS

RFP#15-001 EMERGENCY MEDICAL TREATMENT/TRANSPORT

BILLING AND COLLECTION SERVICES

The Boston Public Health Commission Boston Emergency Medical Services

Effective July 2015

FY '16 Boston EMS Billing RFP 1 of 37

TABLE OF CONTENTS

1.0 INTRODUCTION .................................................................................................................... 3 1.1 BACKGROUND ...................................................................................................................... 3 1.2 PROPOSAL INSTRUCTIONS ................................................................................................ 5 1.3 IMPORTANT DATES ............................................................................................................. 7 1.4 TERMS AND CONDITIONS .................................................................................................. 8 SECTION 2 ................................................................................................................................... 10 2.0 SCOPE OF SERVICES .......................................................................................................... 10 2.1 PROPOSAL CONTENTS ...................................................................................................... 15 SECTION 3 ................................................................................................................................... 19 3.0 SELECTION CRITERIA AND EVALUATION ................................................................... 19 3.1 AWARD AND IMPLEMENTATION ................................................................................... 20 3.2 PEFORMANCE MEASURES ............................................................................................... 21 SECTION 4 ................................................................................................................................... 22

ATTACHMENT A- Cover Page .......................................................................................... 22 ATTACHMENT B- Proposal Checklist ............................................................................... 23 ATTACHMENT C- Business Profile ................................................................................... 24 ATTACHMENT D- Client Summary .................................................................................. 29 ATTACHMENT E- Living Wage………………………………………………………… 30 ATTACHMENT F- Authority…………………………………………………………….. 36 ATTACHMENT G- Pricing………………………………………………………………. 37


SECTION 1

1.0 INTRODUCTION Boston Emergency Medical Services (Boston EMS) is a bureau of the Boston Public Health Commission (BPHC). The BPHC is the local board of health for the City of Boston and a health care provider (a covered entity) as defined under the Health Insurance Portability and Accountability Act (HIPAA). Boston EMS provides and manages the integrated pre-hospital care system for the City of Boston. It is one of the nation’s oldest providers of pre-hospital care, with a history that dates back over one-hundred years. The BPHC, on behalf of Boston EMS, is soliciting proposals from qualified firms (Firms) to provide emergency medical treatment/transport billing, collection, and financial reporting services. This includes complete management of the billing process from the time of the patient care report generation by the responding EMS personnel to account closure. The successful Firm will seek to maximize revenue collection and minimize turnaround time from service provision to payment collection, while providing superior customer service to the patients of Boston EMS and third party payers.

1.1 BACKGROUND Boston EMS responds to over 116,000 incidents per year resulting in over 83,000 transports, making it the largest municipal EMS provider in New England, and one of the busiest EMS services in the country. Boston EMS employs over 320 EMTs and Paramedics, in addition to Supervisor, Command, and Support personnel. During peak periods, the department deploys a minimum of nineteen (19) Basic Life Support (BLS) ambulances and five (5) Advanced Life Support (ALS) ambulances from sixteen (16) stations across the City. Boston EMS personnel also staff the EMS Dispatch Operations Center which is co-located at the City of Boston 9-1-1 Public Safety Answering Point at Boston Police Headquarters. Boston EMS currently charges a base rate of $1,200.00 for BLS (A0429), $1,400.00 for ALS-1 (A0427), and $1,900.00 for ALS-2 (A0433). The mileage charge (A0425) is $22.50 per loaded mile. Currently, the Department does not provide non-emergency inter-facility transport or critical care transport. While Boston EMS’ payer mix and transports by level of service vary from one month to the next, below are recent figures:


30.73%

42.71%

16.70%

9.86%

FY '15 Projected Payer Mix

Medicare

Medicaid

Commercial Insurance

Self‐Pay

91%

8%

0.7%Transports by Level of Service

BLS

ALS

ALS2


1.2 PROPOSAL INSTRUCTIONS

1.2.0 Submission Guidelines

A. Firms that desire to provide services as described in Section 2.0.1 shall submit sealed proposals to: Ms. Andry McFall, Procurement Manager, Boston Public Health Commission, 1010 Massachusetts Avenue, 3rd Floor, Boston, MA 02118. ALL PROPOSALS MUST BE RECEIVED BY January 9, 2015 at 4:00 PM EASTERN STANDARD TIME (EST).

1. Do not bind proposals. Submit one (1) original, ink-signed proposal including appendices, all numbered and unbound (for ease of copying). The PROPOSAL CHECKLIST (Attachment B) contains all of the information required for submission. Appendix G- (Pricing Proposal) shall be included with the proposal, but sealed in a separate envelope.

2. Submit three (3) additional copies of the proposal including appendices.

3. A copy of the proposal and all appendices must also be submitted electronically

on a CD-ROM or thumb drive.

4. Proposal and pricing must be submitted in separately sealed envelopes. Clearly and boldly identify the envelopes with the following: 1) name of the project (“EMERGENCY MEDICAL TREATMENT/TRANSPORT BILLING AND COLLECTION SERVICES”); 2) the name of the Awarding Authority (BPHC/Boston EMS); 3) the name, business address, and business telephone number of the proposer; 4) proposal or pricing.

5. The proposal must be typed and the font should be easily read. All proposals shall

be entitled “EMERGENCY MEDICAL TREATMENT/TRANSPORT BILLING AND COLLECTION SERVICES”.

6. Proposals should be prepared on 8 ½” x 11” letter size paper (preferably recycled)

and printed double-sided.

7. Lengthy and wordy proposals can be difficult to evaluate. As such, proposals should be clear, concise, and address all of the elements outlined in Section 2. Carefully proofread the proposal before submission.

8. Use only the forms attached to the solicitation in Section 4. Complete all spaces

provided and do not leave any blanks. Include “N/A” in any space not needed or used. Do not strike out, line out, white out or erase any information.

9. When completed, check off and sign the PROPOSAL CHECKLIST

(Attachment B) to ensure inclusion of all requested items. Include attachments in the order listed on the checklist.


B. The responsibility for submitting a response to this proposal on or before the stated time

and date will be solely and strictly the responsibility of the proposer. BPHC/Boston EMS will in no way be responsible for delays caused by the United States Postal Service or by any other occurrence. LATE PROPOSALS WILL NOT BE ACCEPTED.

1.2.1 Questions, Clarifications, and Interpretations

A. Each proposer shall thoroughly examine and become familiar with the solicitation. Failure to make such examination will not relieve the proposer from any obligation submitted in its proposal, nor shall it serve as the basis for change orders or equitable adjustments.

B. After careful study of the solicitation and prior to submission, proposers should request clarification in all cases of apparent conflict or confusion. In cases of conflict or confusion where the proposer did not request clarification prior to proposing, proposers shall interpret the solicitation to require the greater quantity, higher quality, most restrictive, and most expensive of the possible interpretations.

C. Proposers shall promptly notify Boston EMS of questions, ambiguities, inconsistencies, errors, or omissions, which they may discover upon examination of the solicitation.

1. Submit written requests for clarification and interpretation via email to Ms. Andry

McFall at [email protected] by December 19, 2014 at 5:00 PM EST.

2. Answers provided by the Procurement Manager, in response to questions by proposers will be posted via written addendum on the Boston Public Health Commission website at http://www.bphc.org on December 26, 2014. Corrections or changes to this document will be made only by addendum. It is the responsibility of proposers to check the website.

3. Clarifications and interpretations offered by Boston EMS in any form other than

formal written addenda shall be invalid.

4. Proposers shall acknowledge addenda in the space provided on the PROPOSAL CHECKLIST (Attachment B). Failure of the proposer to acknowledge addenda in the space provided may cause rejection of the proposal by BPHC/Boston EMS. Failure of a proposer to receive any addenda shall not relieve it from any obligation under its proposal as submitted.


1.3 IMPORTANT DATES Date Activity 11/30/2014 & 12/7/2014 Advertising 12/01/2014 Request for Proposals posted on the BPHC website and available

for pick up at Boston Public Health Commission, 1010 Massachusetts Avenue, Floor 2. Please ask for Ms. Andry McFall, Procurement Manager or contact Ms. McFall at 617 534-9593 or [email protected] to schedule a pick up or request a copy via email.

12/19/2014 Questions in writing due via email by 5:00 PM to Andry McFall at

[email protected] 12/26/2014 Answers to all questions received by proposers will be posted via

written addendum on BPHC website by 5:00 PM. 01/09/2015 Proposals due. Please submit one (1) original and three (3) copies.

Proposal and Pricing must be submitted in separately sealed envelopes and delivered by 4:00 P.M. to the Boston Public Health Commission at 1010 Massachusetts Avenue, 2nd Floor, Boston, MA 02118 ATTN: Procurement. Please clearly mark each envelope with content and the name of the company.

THERE ARE NO EXCEPTIONS TO THE DEADLINE.

02/20/2015 Award notification. In its discretion, Boston EMS may postpone

the award date if additional time is necessary for adequate review of proposals.


1.4 TERMS AND CONDITIONS 1.4.0 Right of Rejection/Cancellation

A. BPHC/Boston EMS reserves the right to reject any or all proposals, without cause, to waive technicalities, or to accept the proposal which, in its sole judgment, best serves the public interest. BPHC/Boston EMS reserves the right to award a contract to the next most qualified proposer if a successful proposer does not execute a contract within sixty (60) days of the Notice of Award. Failure of a selected applicant to satisfactorily negotiate a contract within sixty (60) days may result in the applicant forfeiting its award.

B. BPHC/Boston EMS may, during the proposal review process, or at any time prior to award, cancel this solicitation or reject all proposals, if BPHC/Boston EMS determines such action will best serve the public interest. Notice of the cancellation will be made to the applicants or potential applicants, as appropriate.

C. All proposals shall be valid for one hundred and twenty (120) days beyond the date of submission.

1.4.1 Proposal Withdrawal

A. Any proposal may be withdrawn by mailed written request or faxed written request, prior to the date and time set forth above for the submission of proposals.

B. Withdrawn proposals may be resubmitted until the date and time set forth above for the submission of proposals.

C. No written, oral, or telephone modifications to proposals will be considered after the proposal is received.

1.4.2 Contract Award A. The Contract will be awarded to the most “Most Advantageous Responsible and

Responsive Proposer”. The contract will not considered awarded until BPHC/Boston EMS has issued a written Notice of Award sent by email, first class mail or hand delivered to the address given by the successful proposer on its proposal form. BPHC/Boston EMS reserves the right to award the Contract as it deems appropriate.

B. The “Most Advantageous Responsible and Responsive Proposer” shall mean the Firm

that submits a proposal that best meets the evaluation criteria set forth in this solicitation, and demonstrates the skills, ability, and integrity necessary for faithful performance of the work.

1.4.3 Contract Term

A. The initial Contract Term shall be three (3) years.


B. At BPHC/Boston EMS’ discretion, the Contract may be renewed for two (2) additional

one (1) year periods.

C. At the end of the Contract Term, the Contractor shall agree to facilitate the transfer of all accounts in process/not yet processed to BPHC/Boston EMS or its designated agent. The Contractor will provide the necessary data and account documentation, both hard copy and electronic data in order to facilitate a smooth transition.

1.4.4 Summary of Contract Terms

A. The chosen vendor for this contract will need to execute the Boston Public Health Commission’s contract and associated contract attachments. All of these documents may be viewed on our website in the same location where this RFP is posted. The PDF is labeled “Contract Attachments for Boston EMS Billing Contract.” While those documents do not need to be completed at this time, vendors should review those documents closely and be prepared to be able to comply with their provisions.

B. In addition to the provisions in BPHC’s form contract, any addenda thereto, and the contract attachments, vendors should be aware they will need to comply with the following:

a. The Contractor shall fully comply with applicable Medicare and Medicaid

guidelines. b. HIPAA Compliance

i. The Contractor shall comply with the Administration Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, Public Law, 104-191 and the Health and Human Services regulations implementing the Administrative Simplification and enter into addenda or memorandum of understanding as may be necessary to address the details of such implementation.

ii. The Contractor must demonstrate an active HIPAA Compliance Program. The Contractor shall provide a copy of its HIPAA Compliance Program and provide evidence annually throughout the life of the Contract demonstrating that all staff members involved in the management of the BPHC/Boston EMS account has successfully completed the HIPAA Compliance Training Program.

c. The Contractor shall establish an Identity Theft Prevention Program designed

to ensure compliance with the requirements regarding the prevention, detection and mitigation of identity theft as set forth by the Federal Trade Commission in the Federal Regulations known as the “Red Flag Rules”.

d. Data Security. The Contractor shall ensure that it has policies and processes

in place designed to protect and recover client data from cyber-attack, a network failure, a long term power outage, a fire, a flood and/or a natural


disaster. The Contractor shall provide a system that will ensure a complete and uninterrupted flow of service via back-up systems and a data recovery system should a disaster occur. The Contractor shall provide a copy of the Firm’s policies and procedures for review by BPHC/Boston EMS’ Information Systems Department.

e. The Contractor shall provide evidence that its internet system and electronic

data file transfers and associated billing systems are HIPAA Complaint.

f. The Contractor shall back up computer system data every night and store back-up tapes off-site. Such off-site facility must be HIPAA compliant and proof of such arrangements must be supplied to BPHC/Boston EMS.

g. The Contractor shall be compliant with the National EMS Information System.

C. BPHC reserves the right to add additional and necessary contract provisions during the contract negotiation process.

SECTION 2

2.0 SCOPE OF SERVICES This section outlines the minimum contract requirements for emergency medical treatment/ transport billing, collection, and financial reporting services. The Contractor must assume responsibility for receiving and translating data from BPHC/Boston EMS patient care reports into collectible accounts. This includes locating and billing emergency medical treatment/transport service recipients, individual and/or third party clients, filing and collecting Medicare/Medicaid claims, filing and collecting private insurance claims and processing all payments. The Contractor will be required to collect delinquent accounts, resolve fee related inquires and complaints from emergency medical transport service recipients and provide performance reports as outlined in Section 2.0.2. The Contractor shall be expected to provide analysis and expertise in all issues related to emergency medical treatment/transport billing and collection. Boston EMS is looking for financial analytic expertise, allowing for comprehensive report out on The Contractor shall be available to meet monthly with BPHC/Boston EMS to review performance reports and discuss other pertinent issues. 2.0.0 Billing

A. By the date of implementation, the Contractor shall have an operational and reliable electronic patient care reporting (ePCR) software interface with OPEN Inc., SafetyPAD, ePCR Software. BPHC/Boston EMS shall generate an electronic file for each patient care report to be billed. BPHC/Boston EMS shall make every attempt to generate these files daily. The Contractor must be prepared to receive these files via FTP in an XML format and should demonstrate that it has a secure site to accept such files.


B. It is the responsibility of the Contractor to modify its billing system at its own expense to capture the necessary data generated from the BPHC/Boston EMS ePCR software. BPHC/Boston EMS shall not under any circumstances be required to modify its current system nor shall it authorize the Contractor to make any modifications to BPHC/Boston EMS’ current system in order to satisfy the Contractor’s requirements in response to this solicitation.

C. The Contractor will check diagnosis codes for accuracy before submission and contact

BPHC/Boston EMS with problem codes. The Contractor will be required to assist BPHC/ Boston EMS in maintaining and updating its master diagnosis code table.

D. BPHC/Boston EMS expects that initial invoices will be processed within three (3) business days of the electronic posting of the billing file on the BPHC/Boston EMS secure server.

E. The Contractor shall forward an invoice to each patient within three (3) business days of receiving a billable claim. The invoice shall indicate that BPHC/Boston EMS will bill the patient’s insurance, if applicable, but that the patient is responsible for any unpaid balance.

F. A patient satisfaction survey shall be included in the invoice mailing with a return, postage paid envelope addressed to the Contractor. BPHC/Boston EMS will provide said survey, which is expected to be no more than two single-sided pages in length and of a size not to exceed 8.5” x 11”. The Contractor will be responsible for all costs associated with mailing the survey. The Contractor will review, assess, and report on the results of the patient satisfaction survey. Proposals should also include an option for submission of customer satisfaction survey via on-line form.

G. The Contractor shall prepare invoices according to the following: the rates established by BPHC/Boston EMS, the guidelines and procedures established by BPHC/Boston EMS in conjunction with the Contractor, and all applicable laws, rules and regulations.

H. Invoices for services rendered shall contain the following information:

1. Account Number 2. Invoice Number 3. Date Issued 4. Name of Patient 5. Name of Responsible Party (if different from patient) 6. Complete Patient Address 7. Date of Transport 8. Cost of Transport (including a cost breakdown) 9. Amount Patient Owes (if applicable) 10. Incident Number 11. Toll-free Billing Inquiry Telephone Number (see Section 2.0.1)


I. The Contractor shall file invoices, electronically or by mail, to the appropriate parties including insurance companies, Medicare, Medicaid, and individuals, using a process approved by BPHC/Boston EMS. BPHC/Boston EMS shall approve all forms and correspondence. No changes will be made to the forms or correspondence without prior approval.

J. The Contractor shall conduct any and all follow-up required to obtain the necessary

insurance information to process invoices for payment. The Contractor shall utilize resources available, including links to hospitals and other databases to obtain billing insurance information on private pay patients.

K. The Contractor must provide BPHC/Boston EMS access to all billing and collection data via a web-based secure interface. The Contractor shall provide BPHC/Boston EMS the ability to track individual accounts throughout the billing process, from the electronic posting of the billing file on the BPHC/Boston EMS secure server to receipt of payment.

2.0.1 Collections

A. The Contractor’s collection procedures shall include a 120-day invoicing cycle. After the initial invoice, the Contractor shall forward statements on a thirty (30), sixty (60), ninety (90) and one hundred and twenty (120) calendar day follow up basis with progressive pre-collection language. Boston EMS does not currently use a collection agency for delinquent accounts. The language of the invoices/demands shall be subject to review and approval of BPHC/Boston EMS.

B. The Contractor shall be responsible for follow-up on each medical claim rejected by an

insurance provider (Medicare, Medicaid, commercial carriers, etc.). The Contractor shall be responsible for contacting insurance providers by telephone, mail, electronically and/or fax in order to resolve each rejected claim on a claim-by-claim basis. The Contractor shall be responsible for furnishing insurance providers will all requested patient information, medical information, medical documentation, and resubmission of a rejected claim. On a weekly basis, the Contractor will prepare and deliver a written report to BPHC/Boston EMS for all rejected claims detailing the reason for rejection and provide documentation on each claim resubmitted.

C. The Contractor shall notify BPHC/Boston EMS of any account overpayment within five (5) business days of discovering the occurrence. Notification shall be delivered electronically. The notification shall include the following information: the patient’s name, patient’s address, date of service, incident number, insurance provider, amount to be refunded, name and address of individual/company receiving refund, and reason overpayment occurred. The Contractor shall process all refunds and overpayments in a timely manner in a manner approved by BPHC/Boston EMS.

D. The Contractor shall provide Customer Service Representatives (CSRs), available 8:00

A.M. to 5:00 P.M. EST; Monday through Friday, to assist patients and/or other third party payees in all billing inquires, including requests for statements, in a timely and


courteous manner. Customer calls will be facilitated through an “800” exchange dedicated to Boston EMS. The toll-free number and the Contractor’s website address shall be posted on all communications sent to patients and other third party payees. BPHC/Boston EMS prefers Contractors that have the ability to communicate in multiple languages to serve patients whose primary language is not English.

E. All scripts and protocols for answering and placing telephone calls shall be agreed upon

prior to the commencement of the Contract between the Contractor and BPHC/Boston EMS. A record of telephone calls and contacts shall be maintained and available upon request.

F. The Contractor shall provide BPHC/Boston EMS with a copy of all letters of complaints

within three (3) days of receipt, and indicate what action was taken to achieve an acceptable resolution.

G. The Contractor shall provide patients with online access to their accounts so that they have the ability to review their account information and make secure payments via the Contractor’s website.

H. The Contractor shall have all payments electronically forward to a designated BPHC/Boston EMS bank account. All payments for BPHC/Boston EMS shall be made to a secure lockbox.

2.0.2 Reporting At a minimum and within the time frames specified, the Contractor shall be required to submit the reports detailed below to BPHC/Boston EMS. This list is not all-inclusive and BPHC/Boston EMS reserves the right to change the reporting requirements at any time. The reports described below may be combined if the Contractor believes an alternative format is superior, however all information requested below must be captured. Sample reports should be included with the proposal. The Contractor shall also describe and provide examples of any additional reports it believes may enhance BPHC/Boston EMS’ understanding of the billing and collection process. Daily and monthly reports of the types described below must be provided to the BPHC/Boston EMS. Daily reports should be available within 24 hours and monthly reports should be available by the 10th calendar day of the following month. Reports should be submitted electronically via a secure email delivery system. Reports should be provided in a printer-friendly MS Excel format and/or as PDF documents when requested. The Contractor is also required to submit quarterly and yearly performance reports summarizing the information presented in the monthly reports. Quarterly reports should be available by the 10th calendar day of the subsequent quarter and yearly reports (based on the fiscal year of July 1st through June 30th) should be available by the 10th calendar day of the subsequent year. BPHC/Boston EMS may require additional reports on an as-needed basis. Reports may need to be modified periodically depending on specific issues or needs that arise. The Contractor shall specify the process to add/change or delete specific reports.


A. Weekly Reports

1. Revenue Report: a report showing a list of all transports billed for the previous day and level of service (i.e., BLS, ALS-1, ALS-2). The number of transports should be reconciled with the daily CAD report that will be available from Boston EMS.

2. Unbilled Transports Report: a report showing transports that cannot be billed including the reason the transport cannot be billed, the level of service, and the incident number associated with the unbilled transport.

3. Claims Report: a report showing the number and amount of claims filed with

insurers (e.g., HMO’s, Medicare, Medicaid) including the confirmation information from the insurer acknowledging receipt of the claim.

4. Cash Flow Report: A reconciliation report showing the amount of cash receipts

posted and how the amount ties to the daily bank deposit. Provide an explanation of any cash that is unable to be posted and include the reason.

B. Monthly Reports

1. Monthly Revenue Report: A report showing all revenue for the month broken

down by revenue source (i.e., Insurance, Medicare, Medicaid, Self-pay, etc.).

2. Monthly Transport Report: A report showing all transports billed for the month and the associated collection rate. Analysis should include trend information on total billed and collected transports by month for the year to date as well as comparison to previous year(s). The report shall also summarize instances in which the same patient is transported more than once.

3. Outstanding Accounts Receivable Report: A report of outstanding accounts sorted

by payer and showing four categories of outstanding accounts: 30, 60, 90 and more than 120 outstanding. The report should also show the last day of activity on the account and expected outcome for the account (e.g., collections, free care pool). This report should include a list of all accounts sent to collections for the month.

4. Payer Mix Trend Report: Report that lists by month the payer mix including

Insurance (Medicare, Medicaid, Commonwealth Health, HMO, Workers Comp, etc.), self-pay, and other sources; the number of accounts in each type; and the balances for each type per month compared against trends for previous years.

5. Claims Denied Report: A monthly report of all claims denied broken down by

payer (e.g., HMOs, Medicare, and Medicaid) including the reason for the denial and the current status of the claim.


6. Audit Report of Accounts Changed/Refunded Report: This report tracks changes in type of transport or type of bill for the current month in order to balance against what had been previously reported or billed. For example, if an account is changed from BLS to ALS or a refund is issued, this change would be listed on this report.

C. Quarterly Reports:

1. Annual Revenue Forecast: Project expected revenues for future quarters and the fiscal year.

2. Quarterly Summary: Provide an overview of collections and trends, summarizing the prior quarter. Compare against what was previously forecasted and provide details associated with any variances.

3. Threats and Opportunities: outline any national or local trends in billing and collections that could impact Boston EMS.

D. Annual Report & In-Person Meeting:

1. Reports and report out associated with providing a detailed overview of collections and billing for the prior year.

2. Project revenue for the upcoming year.

3. Outline any issues encountered during the prior year and associated correction actions, as well as potential issues that may be confronted in the next year and associated actions to mitigate such risks.

4. Present local and national trends they impact billing and collections for Boston EMS.

2.1 PROPOSAL CONTENTS 2.1.0 Content and Format Proposals should contain all information outlined in Section 2.1 and should follow the following format:

A. Cover Page: Complete Attachment A. B. Checklist: Complete Attachment B.

C. Table of Contents: Present a clear and comprehensive table of contents outlining the

elements of the proposal by section and by page number.

D. Letter of Transmittal: A brief letter of transmittal is required. Within this letter include statements addressing the following points:


1. The Firm understands the work to be accomplished.

2. That upon award of the Contract, the Firm will commit to perform work within the scheduled time frame.

3. The name of the individuals who will be authorized to make representations on

behalf of the Firm, their titles, addresses, and telephone numbers.

4. The signatory of the transmittal letter has authority to bind the Firm.

E. Description and Qualifications of Firm

1. The Firm shall have at least five (5) years of experience in providing emergency medical transport billing and collection services. Provide a description and history of the Firm and offer evidence of the required experience.

2. Complete Attachment D outlining the number of patients billed and collection

rates for the Firm’s three (3) “largest” clients. The basis for determining the Firm’s “largest” clients shall be based on the number of patients billed.

3. Proposals shall only be accepted from Firms located in the continental United

States that have an established reputation of permanency and reliability in the field of emergency medical transport billing and collection services. Each proposer shall furnish satisfactory evidence of its ability to provide the services as specified.

4. In the space provided in Attachment C, list at least three (3) references for which

the Contractor has performed similar work including the contact name, address, telephone number, and term of the contract. BPHC/Boston EMS reserves the right to contact references other than, and/or in addition to, those furnished by a proposer.

5. The Firm must demonstrate a proven track record of developing, enhancing, and

maintaining effective and functional relationships with hospitals to facilitate the transfer of billing related information. In the space provider in Attachment B, list a minimum of three (3) hospitals with which the Firm currently has such relationships.

6. Provide copies of the Firm’s audited annual financial statements for the last two

years.

7. State the business hours that the Firm is available to clients and patients.

8. List any and all days the Firm is closed during the calendar year.


F. Staff:

1. Provide an organizational chart of the Firm. Include in the chart the names, job titles, and office locations for staff to be assigned to the BPHC/Boston EMS account.

2. Provide resumes for staff members to be assigned to the BPHC/Boston EMS

account and describe relevant experience and credentials. Indicate the staff person who will be primarily responsible for the BPHC/Boston EMS account. The expectation is that this person will be the point of contact for all activities on the account and will be responsible for making sure that all items for the Contract are executed according to the terms established.

3. List any and all staffing changes necessary to accommodate BPHC/Boston EMS

as a client. List the job titles and experience requirements for staff additions, if necessary.

4. Describe in detail and provide policies/procedures that outline how the

BPHC/Boston EMS account shall be monitored to assure maximum productivity of the staff assigned.

5. Indicate how the Firm transitions accounts when a staff member terminates

employment. The Firm shall also indicate how the client is notified of the transition and is assured no interruption of service.

6. Provide the Firm’s established plan or policy to assure no interruption of service

as a result of unusual staff illness/injury/FMLA/turnover/vacation or earned time utilization.

G. Scope of Services:

1. Describe the proposed plan of action for service provisions as identified in Section 2.0. This plan must include a narrative of the overall project strategy, with clearly defined objectives, steps or actions required to accomplish the objectives, and specific time frames for accomplishment. Address all items listed in Section 2.0.

2. Describe the Firm’s approach to maximize collections when it does not have

authorization to use a collection agency.

3. Describe the Firm’s process for handling denial of any claims based on payer mix.

4. Describe and discuss the Firm’s HIPAA Compliance Program.


5. BPHC/Boston EMS requires that multiple letters/invoices be sent requesting payment for transports. Provide sample copies of such letters that the Firm currently sends on behalf of other clients similar in size and scope to BPHC/Boston EMS.

6. Provide copies of the Firm’s standard monthly reports and any other reports that

are prepared for the Firm’s clients.

7. Describe in detail the Firm’s ability to adapt to and comply with the data security and technology requirements outlined in Section 1.4.4.

8. Describe the Firm’s customer service philosophy and provide information on any

policies/procedures and training programs in place that are designed to ensure excellent customer service.

9. Provide a description of the Firm’s current customer complaint and resolution

process.

10. Describe how the Firm will comply with the requirement to provide on-site client training as described in Section 3.1.2.

11. Indicate any exceptions to the required Scope of Services and responsibilities set

forth in Section 2.0.

12. Described any services provided by the Firm that are not covered in Section 2.0, but that would assist BPHC/Boston EMS in enhancing its collections.

H. Legal Disclaimers:

1. Make a statement indicating that the Firm has never lost an account due to

concerns of improper billing practices, accusations or client concerns of fraud as defined by Centers for Medicare and Medicaid Services (CMS) and other applicable Federal or State Authorities.

2. Make a statement indicating that no member of the Firm’s staff has been accused,

disciplined, charged, and/or convicted of fraud, theft, deception, unethical business practices, and/or illegal business practices.

3. List any pending or resolved lawsuits in which the Firm was involved during the

past five (5) years. If the Firm has not been involved in any lawsuits please indicate.

4. Indicate whether or not the Firm has had a contract terminated in the last five (5)

years, and describe the nature and circumstances.


5. Provide a statement explaining any name changes for the Firm in the past five (5) years and current or foreseeable merger or acquisition activity.

6. Discuss the importance of complying with Medicare/Medicaid policies,

procedures, and directives, as well as HIPAA and its regulations. Include a listing of any penalties or findings arising from noncompliance with Medicare/Medicaid or HIPAA and their resolution. If the firm has no penalties/findings, please indicate.

I. Pricing Proposal: A Firm’s pricing proposal is important, however, it will not be the primary factor in the selection process. Proposers may submit any of the pricing options outlined in Attachment G.

SECTION 3

3.0 SELECTION CRITERIA AND EVALUATION 3.0.0 Evaluation Criteria

A. The proposals will be evaluated by a Selection Committee composed of BPHC/Boston EMS staff and other individuals as determined by BPHC/Boston EMS. The Selection Committee will review and rate each proposal based on the criteria outlined below. Each proposal will be reviewed for up to 100 points.

1. Clarity and completeness of the proposal (5 pts).

2. Ability to meet the Scope of Services defined in Section 2.0 (20 pts).

3. Ability to maximize revenue for BPHC/Boston EMS (15 pts).

4. Overall experience of the Firm (10 pts).

5. References from other entities currently using the Firm’s proposed services (10

pts).

6. Proven history of successfully working with EMS services of similar size and scope to Boston EMS (10 pts).

7. Qualifications and expertise of the key personnel to be assigned to the account (10 pts).

8. Financial stability of the Firm (10 pts).

9. Pricing proposal (10 pts).


3.0.1 Selection Process

A. Once each member of the Selection Committee has evaluated each proposal submitted and completed a rating sheet, a composite is developed which indicates the Committee’s collective ranking of the highest rated proposals in descending order. The Selection Committee may request additional submittals and may conduct interviews with only the top ranked Firms. The interview process will take place in two stages consisting of an oral presentation by the Firm followed by a question and answer period conducted by the Selection Committee. The Firms selected to participate in the interview process will be given equal time to make presentations.

B. The Selection Committee shall select one (1) Firm as the “Most Advantageous Responsible and Responsive Proposer”. Information and/or other factors gathered during interviews, negotiations, or any reference checks, in addition to the proposal submitted, shall be utilized in the final award decision.

3.1 AWARD AND IMPLEMENTATION 3.1.0 Award

A. BPHC/Boston EMS will endeavor to negotiate a Contract with the successful proposer within sixty (60) days of the Notice of Award. In the event that a mutually agreeable Contract cannot be negotiated with said Firm, BPHC/Boston EMS will then enter into contract negotiations with the next highest rated Firm, and so on until a mutually agreeable contract can be negotiated.

3.1.1 Implementation

A. The Contract shall commence on July 1, 2015. B. The Contractor will work in conjunction with BPHC/Boston EMS’ current service

provider to ensure a smooth transition. BPHC/Boston EMS’ existing service provider shall be responsible for all billing and collection functions for all accounts with service dates preceding the commencement of the Contract and will process those accounts for up to four (4) months. After four (4) months, BPHC/Boston EMS’s existing service provider shall transfer the remaining accounts to the Contractor.

3.1.2 Training

A. The Contractor will provide training on its billing and collection system to approximately fifteen (15) administrative and management staff. The Contractor shall provide an initial “hands-on” training at the commencement of the Contract Term and shall provide follow-up training upon request. Training dates will be based upon an agreed timeline; Boston EMS will provide final approval of training dates, to ensure adequate attendance.


3.2 PEFORMANCE MEASURES 3.2.0 Performance Measures

A. The collection rates of the Contractor shall be subject to an annual review by BPHC/Boston EMS. The Contractor’s annual collection rate will be compared to the historical average collection rate for BPHC/Boston EMS to determine whether the Contractor is maximizing revenue collection under the Contract.

B. After such annual review, if it is determined by BPHC/Boston EMS that the collection

rate of the Contractor is below the historical average collection rate for BPHC/Boston EMS, the Contractor will be subject to an action plan developed by BPHC/Boston EMS.


SECTION 4 ATTACHMENT A- Cover Page

Legal name of applicant organization: ______________________________________ Address: ___________________________________________________ City, state, zip: ___________________________________________________ Telephone: ___________________________________________________ Fax: ___________________________________________________ FIN#: ___________________________________________________

Proposal for: Emergency Medical Treatment/Transport Billing and Collection Services Authorized Contract Signature person (title) for the agency: ___________________________________________________ Reporting contact: ___________________________________________________ Fiscal contact: ___________________________________________________ Submission of the proposal and signature below indicates the intention of the applicant to comply with the goals, guidelines, and other elements of The Boston Public Health Commission request for proposals. Authorized Signature ________________________________________________ Title __________________________ Date _______________________________


ATTACHMENT B- Proposal Checklist

PROPOSAL CHECKLIST Do not bind proposals. Submit one (1) original, ink-signed proposal including appendices, all numbered and unbound (for ease of copying). In addition, submit three (3) copies of proposal including appendices, and one electronic version. Proposals must include all required information and must follow the format, in the order, outlined below: ________ Cover Page (Attachment A) ________ Proposal Checklist (Attachment B) ________ Items outlined in Section 2.1 ________ Business Profile and References (Attachment C) ________ Billing Information for Three Largest Existing Clients (Attachment D) ________ Living Wage Documents (Attachment E) ________ Certificate of Authority (Attachment F) ________ Pricing (sealed in separate envelope) (Attachment G) Attachments ________ Tax Identification Certificate ________ Certificates of Insurance Failure to submit all of the above information may result in disqualification from the review process. Acknowledgement of addenda appended to the solicitation. ____________________________________________ _________________ Signature Date


ATTACHMENT C- Business Profile

BOSTON PUBLIC HEALTH COMMISSION

Full Legal Name: _________________________________________________________ Place of Business: _________________________________________________________ Contact Person: __________________________ Tel: ___________________________ To the Official, acting in the name and behalf of the Boston Public Health Commission (“BPHC”): A. Summary of Supplies/Services Subject to RFB The undersigned proposes to furnish the specified supplies or services and to perform all work required in the Boston Public Health Commission Request for Proposals, Advertisement, Purchase Description and Specifications and/or other contract documents, titled: ____________________________________________________________________________________ ____________________________________________________________________________________ and dated: ______________, the terms of which are incorporated herein, all of which have been provided by the BPHC. Notice: You must itemize any deviation from original specifications on a separate sheet. Catalogs or brochures will not be accepted as sole compliance with this requirement unless they also include complete technical information. B. References 1. List all contracts for which you have provided goods or services, as the case may be, within the past two (2) years, for work of similar character as required in the Request for Proposals. Attach additional Sheets if necessary. Reference 1 Nature of Contract: ________________________________________________ Company or Entity: ________________________________________________ Contact Name & Phone #: ________________________________________________ Address: ________________________________________________ Contract Term: ________________________________________________ Reference 2 Nature of Contract: ________________________________________________ Company or Entity: ________________________________________________ Contact Name & Phone #: ________________________________________________


Address: ________________________________________________ Contract Term: ________________________________________________ Reference 3 Nature of Contract: ________________________________________________ Company or Entity: ________________________________________________ Contact Name & Phone #: ________________________________________________ Address: ________________________________________________ Contract Term: ________________________________________________ 2. List three hospitals with which you have developed and maintained effective relationships to facilitate the transfer of billing related information. Reference 1 Hospital: ________________________________________________ Contact Name & Phone #: ________________________________________________ Address: ________________________________________________ Reference 2 Hospital: ________________________________________________ Contact Name & Phone #: ________________________________________________ Address: ________________________________________________ Reference 3 Hospital: ________________________________________________ Contact Name & Phone #: ________________________________________________ Address: ________________________________________________ 3. Financial References Name of Bank & Phone #: _________________________________________________ Name of Bank & Phone #: _________________________________________________ Name of Bank & Phone #: _________________________________________________


C. Legal Form of Business Entity The entity submitting this proposal is a/an ______________________________________ (Individual, Partnership, Corporation, Joint Venture, Trust, or specify other). 1. If a Partnership, state the name and residential addresses of all general and limited partners: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 2. If a Corporation, state the following: Corporation is incorporated in the State of _____________________________________ President is ______________________________________________________________ Treasurer is ______________________________________________________________ Address of business is _____________________________________________________ ________________________________________________________________________ 3. If a Joint Venture, state the name and business address of each person, firm or company that is party to the joint venture: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ A copy of the joint venture agreement is on file at ________________________________ and will be delivered to the Official on request. 4. If a Trust, state the name and residential address of each Trustee: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Copies of the trust documents are on file at _____________________________________ and will be delivered to the Official on request. 5. The names and addresses of all persons interested in this proposal as principals other than the undersigned are: ________________________________________________________________________ ________________________________________________________________________


6. If the business is conducted under any title other than the real name of the owner, state the time when, and place where, the certificate required by General Law’s c. 110, sec. 5 was filed: _______________________________________________________________________ D. Taxpayer Identification Number* (the number on the Employer’s Quarterly Federal Tax Return, U.S. Treasury Department Form 941) is: ________________________________________________________________________

*If individual, use Social Security Number: _____________________________________ E. Have been in business under present business name for __________ years. F. Have you or any other principals ever failed to complete any work awarded? ________ If answer is yes, state circumstances: __________________________________________ ________________________________________________________________________ G. Pursuant to M.G.L. c. 62C, sec. 49A, the undersigned certifies that to the best of his/her knowledge and belief all state tax returns have been filed and that all state taxes required under law have been paid. (Notice: The Taxpayer Identification Number may be furnished to the Massachusetts Department of Revenue to determine compliance with the above-referenced law.) H. The undersigned certifies that this proposal has been made and submitted in good faith and without collusion or fraud with any other person. As used in this certification, the word “person” shall mean any natural person, business, partnership, corporation, union, committee, club, or other organization, entity or group of individuals. I. In furtherance of the Mayor’s Executive Order “Minority and Women Business Enterprise Development” dated December 31, 1987 and the Ordinance entitled “Promoting Minority and Women Owned Business Enterprises in the City of Boston” (Ordinances of 1987, Chapter 14), it is understood and agreed by the undersigned, and the undersigned by the execution of this document so certifies, as follows, (1) That the undersigned shall actively solicit proposals for the subcontracting of goods and services from certified minority and women businesses; and (2) That in reviewing substantially equal proposals the undersigned shall give additional consideration to the award of subcontracts to certified minority and women proposers. J. Applicable to any contract which involves costs reimbursable by the U.S. Department of Health and Human Services in which services provided have a value or cost of $10,000 or more over a twelve-month period: Pursuant to the requirements of 42 U.S.C. sec. 1395X(v)(1)(E), as enacted by Public Law 96-499, the undersigned agrees that until the expiration of four (4) years after the furnishing of goods or services, it shall make available the contract, and books, documents and records that are necessary to certify the nature and extent of such costs to the Secretary of the Department of Health and Human Services, or to the Comptroller General, or any of their duly authorized representatives upon written request. If the undersigned carries out any of the duties of the contract through a subcontract, with a value or cost of $10,000 or more over a twelve-month period, with a related organization, such subcontract shall contain a clause to the effect that until the expiration of four (4) years after the furnishing of such goods or services pursuant to such subcontract, the related organization shall make available the subcontract, and books, documents and records of such organization that are necessary to


verify the nature and extent of such costs to the Secretary, or to the Comptroller General, or any of their duly authorized representatives upon written request. The undersigned certifies the accuracy of the information provided herein under the penalties of perjury.

Submitted by: __________________________________

By: __________________________________ (Signature)

Business Address: __________________________________

(Street)

__________________________________ (City, State, Zip Code)

Notice: This Proposal must bear the written signature of the person submitting the proposal. If submitted by an Individual doing business under a name other than his/her own name, the proposal must state the name and the address of the Individual. If submitted by a partnership, the proposal must be signed by a partner designated as such. If submitted by a corporation, trust or joint venture, the proposal must be signed by a duly authorized officer or agent of such corporation, trust or joint venture.


ATTACHMENT D- Client Summary

Billing Information for Three Largest Existing Clients Annual Information

Client One

Client Two

Client Three

Client Name & Location:

Allowable Rates (BLS/ALS1/ALS2):

Client Uses Collection Agency (yes/no):

Payer Charges To:

BLS ALS BLS ALS BLS ALS

# of Patients

Billed

Collection

Rates*

# of Patients

Billed

Collection

Rates*

# of Patients

Billed

Collection

Rates*

# of Patients

Billed

Collection

Rates*

# of Patients

Billed

Collection

Rates*

# of Patients

Billed

Collection

Rates*

Private Insurance

Medicare

Medicaid

Self Pay

Other

Totals

*Percentage of gross billed charges received


Form LW-2

(3/14)

June 2014

JOBS AND LIVING WAGE ORDINANCE

THE LIVING WAGE DIVISION (617) 534-4322

COVERED VENDORS LIVING WAGE AGREEMENT

At the same time the Boston Public Health Commission awards a Service Contract through a

Bid, a Request for Proposal or an Unadvertised Contract, the Covered Vendor must complete this

Form and submit it to the Public Health Commission, agreeing to the following conditions. In

addition, any Subcontractor of the Covered Vendor shall complete this form and submit it to the

Public Health Commission at the time the Subcontract is executed, also agreeing to the following

conditions:

PART I: Covered Vendor (or Subcontractor) Information:

Name of Vendor: ___________________________________________________________

Contact Person: ___________________________________________________________

Address: _________________________________________________________________

Street City State Zip

Telephone #: _____________________________ Fax #: ____________________

E-Mail Address: _______________________________________

PART II: Name of the program or project under which the Contract or Subcontract is

being awarded: __________________________________________________

: _________________________________________________________________

PART III Workforce Profile of Covered Employees paid by the Service Contract or

Subcontract: ____________________________________________________

_________________________________________________________________

A. List all Covered Employees’ job titles with wage ranges (Use additional sheets of paper if

necessary): Identify number of employees in each wage range.

JOB TITLE $13.89 p/h $15.01 p/h

< $13.89 p/h $15.00 p/h -$20.00 p/h > $20.01p/h

B. Total number of Covered Employees: _________

C. Number of Covered Employees who are Boston residents: _________

D. Number of Covered Employees who are minorities: _________

E. Number of Covered Employees who are women: _________


kearney

Typewritten Text

APPENDIX E: LIVING WAGE DOCUMENT

Form LW-2

(3/14)

June 2014

PART IV: Covered Vendor’s Past Efforts and Future Goals (Use additional sheets of

paper if necessary in answering any of these questions):

Describe your past efforts and future goals to hire low and moderate income Boston residents:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Describe your past efforts and future goals to train Covered Employees:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Describe the potential for advancement and raises for Covered Employees:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

What is the net increase and decrease in number of jobs or number of jobs maintained by

classification that will result from the awarding of the Service Contract:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

PART V Service Contracts:

List all Service Subcontracts either awarded or that will be awarded to vendors with funds from

the Service Contract:

SUBCONTRACTOR ADDRESS AMOUNT OF SUBCONTRACT

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________


Form LW-2

(3/14)

June 2014

NOTE: Any Covered Vendor awarded a Service Contract must notify the Contracting

Department with three (3) working days of signing a Service Subcontract with a Vendor.

IMPORTANT: Please print in ink or type all required information. Assistance in

completing this form may be obtained by calling the Living Wage

Administrator, the Living Wage Division of the Boston Public Health

Commission telephone at (617) 534-4322 or your Contracting

Department.

PART VI: The following statement must be completed and signed by an authorized

owner, officer or manager of the Covered Vendor. The signature of an

attorney representing the Covered Vendor is not sufficient:

I, (print or type) _________________________________ (Authorized Representative of the

Covered Vendor) on behalf of (print or type) _________________________________________

(Name of Covered Vendor) hereby state that the above-named, Covered Vendor is committed to

pay all Covered Employees not less than the Living Wage, subject to adjustment each July 1, and

to comply with the provisions of the Boston Jobs and Living Wage Ordinance.

I swear/affirm that the information which I am providing on behalf of Covered Vendor on this

Covered Vendor Agreement is true and within my own personal knowledge. I understand that I

am signing under the pains and penalties of perjury.

________________________________________ ______________________________

Signature Date

________________________________________

Position with Covered Vendor


Form LW-8

(3/14)

July 2008

JOBS AND LIVING WAGE ORDINANCE

THE LIVING WAGE DIVISION (617) 534-4322

VENDORS LIVING WAGE AFFIDAVIT

Any for-profit or any not-for-profit Vendor who employs at least 25 full-time equivalents (FTE)

who has been awarded a Service Contract of $25,000 or more from the Boston Public Health

Commission must comply with the provisions of the Boston Public Health Commission and

Living Wage Ordinance which requires any such Vendors to pay at least the Living Wage

which is $13.89 per hour to any employee who directly expends his or her time on the services

set out in the contract. All Subcontractors whose subcontracts are at least $25,000 are also

required to pay the Living Wage.

If you are bidding on or negotiating a Service Contract that meets the above criteria, you should

submit this Affidavit prior to the awarding of the contract. If you believe that you are exempt

from the Living Wage Ordinance, complete Section 4: Exemption form Living Wage Ordinance,

or if you are requesting a General Waiver, please complete Section 5: General Waiver Reason(s).

WARNING: No Service Contract will be executed until this Affidavit is completed,

signed and submitted to the Contracting Department

IMPORTANT: Please print in ink or type all required information. Assistance in

completing this Form may be obtained by calling or visiting. The Living

Wage Administrator, The Living Wage Division of the Boston Public

Health Commission, telephone: (617) 534-4322, facsimile: (617) 534-

4255, or your Contracting Department.

PART I: VENDOR INFORMATION:

Name of Vendor: ____________________________________________________________

Contact Person: ____________________________________________________________

Address: __________________________________________________________________

Street City State Zip

Telephone #: _____________________________ Fax #: ___________________________

E-Mail Address: ____________________________________________________________

PART II: CONTRACT INFORMATION:

Name of the program or project under which the Contract or Subcontract is being awarded:

______________________________________________________________________________

Contracting Department: ______________________________________________________


Form LW-8

(3/14)

July 2008

Start Date of Contract: _______________ End Date of Contract: _______________

Length of Contract: 1 year 2 years 3 years Other: ______ (years)

PART III: ADDITIONAL INFORMATION:

Please answer the following questions regarding your company or organization:

1. Your company or organization is: check one:

For Profit Not For Profit

2. Total number of “FTE” employees which you employ: __________

3. Total number of employees who will be assigned to work on the above-stated contract:

______

4. Do you anticipate hiring any additional employees to perform the work of the Service

Contract? Yes No

If yes, how many additional F.T.E.s do you plan to hire? __________

PART IV: EXEMPTION FROM BOSTON JOBS AND LIVING WAGE

ORDINANCE:

Any Vendor who qualifies may request and Exemption from the provisions of the Boston Jobs

and Living Wage Ordinance by completing the following:

I hereby request an Exemption from the Boston Jobs and Living Wage Ordinance for the

following reason(s): Attach any pertinent documents to this Application to prove that you are

exempt from the Boston Jobs And Living Wage Ordinance. Please check the appropriate

box(es) below:

The construction contract awarded by the Boston Public Health Commission is subject

to the state prevailing wage law; and

Assistance or contracts awarded to youth programs, provided that the contract is for

stipends to youth in the program. “Youth Program” means any city, state, or federally

funded program which employs youth, as defined by city, state, or federal guidelines,

during the summer, or as part of a school to work program, or in other related seasonal or

part-time program; and

Assistance or contracts awarded to work-study or cooperative educational programs,

provided that the Assistance or contract is for stipends to students in the programs; and

Assistance and contracts awarded to vendors who provide services to the City and are

awarded to vendors who provided trainees a stipend or wage as part of a job training

program and provides the trainees with additional services, which may include but are not

limited to room and board, case management, and job readiness services, and provided

further that the trainees do not replace current City funded positions.

Please give a full statement describing in detail the reasons you are exempt from the Boston Jobs

and Living Wage Ordinance (attach additional sheets if necessary):

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________


Form LW-8

(3/14)

July 2008

PART V: GENERAL WAIVER REASON (S):

I hereby request a General Waiver from the Boston Jobs and Living Wage Ordinance. The

application of the Boston Jobs and Living Wage Ordinance to my (check one):

Service Contract

Subcontract

Violates the following state or federal statutory, regulatory or constitutional provision or

provisions.

State the specific state or federal statutory, regulatory or constitutional provision or provisions,

which make compliance with the Boston Public Health Commission and Living Wage Ordinance

unlawful:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

GENERAL WAIVER ATTACHMENTS:

Please attach a copy of the conflicting statutory, regulatory or constitutional provisions that

makes compliance with this ordinance unlawful.

Please give a full statement describing in detail the reasons the specific state or federal statutory,

regulatory or constitutional provision or provisions makes compliance with the Boston Jobs And

Living Wage Ordinance unlawful (attach additional sheets if necessary):

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

PART VI: VENDOR AFFIDAVIT:

I, ________________________________________________________ a principal officer of the

Covered Vendor certify and swear/affirm that the information provided on this Vendors Living

Wage Affidavit is true and within my own personal knowledge and belief.

Signed under the pains and penalties of perjury.

SIGNATURE: ___________________________________ DATE: ____/_____/______

PRINTED NAME: ____________________________________________________________

TITLE: __________________________________________________________________



kearney

Typewritten Text

APPENDIX F: Certificate of Authority

ATTACHMENT G- Pricing

PRICING PROPOSAL Proposers shall provide a cost effective method of providing emergency medical transport billing, collection, and financial reporting services. In structuring pricing options, proposers should consider the following alternatives: Option 1: Percent of Net Collected Revenue* From To Fee Percentage $ 1 $10,000,000 ____________% $10,000,001 $15,000,000 ____________% $15,000,001 $20,000,000 ____________% $20,000,001 $25,000,000 ____________% More than $25,000,000 ____________% Option 2: Per Claim Inclusive Transaction Fee Transaction Type Per Claim Fee All Claims $_____________ Medicare Claims $_____________ Medicaid Claims $_____________ Private Insurance Claims $_____________ Self Pay $_____________ Option 3: Net Collected Revenue Share Identify percent share of net collected revenue* _____________% *Net Collected Revenue is defined as total collected revenue less refunds.
