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HomeMy WebLinkAboutFD Ground Emergency Medical Transportation Program Cost Reporting ServicesAGREEMENT FOR PROFESSIONAL SERVICES FOR GROUND EMERGENCY MEDICAL TRANSPORTATION PROGRAM COST REPORTING SERVICES 0e This Agreement is made and entered into this 4 day of 0eJ U�" , 20AA,by and between the CITY OF SAN RAFAEL (hereinafter "CITY"), and PUBLIC CONSULTING GROUP LLC (hereinafter "CONSULTANT"). RECITALS WHEREAS, the CITY has determined that professional services are required for support in preparing Ground Emergency Medical Transportation (GEMT) Program cost reports for fiscal years 2018-19, 2019-20, 2020-21, 2021-22, and half of 2022-23; and WHEREAS, the CONSULTANT has agreed to render such services. AGREEMENT NOW, THEREFORE, the parties hereby agree as follows: PROJECT COORDINATION. A. CITY'S Project Manager. The City Manager is hereby designated the PROJECT MANAGER for the CITY and said PROJECT MANAGER shall supervise all aspects of the progress and execution of this Agreement. B. CONSULTANT'S Project Director. CONSULTANT shall assign a single PROJECT DIRECTOR to have overall responsibility for the progress and execution of this Agreement for CONSULTANT. Marc Staubley is hereby designated as the PROJECT DIRECTOR for CONSULTANT. Should circumstances or conditions subsequent to the execution of this Agreement require a substitute PROJECT DIRECTOR, for any reason, the CONSULTANT shall notify the CITY within ten (10) business days of the substitution. 2. DUTIES OF CONSULTANT. CONSULTANT shall perform the duties and/or provide services as follows: As requested by the PROJECT MANAGER, CONSULTANT shall provide support in preparing the GEMT annual cost report, collect information, address feedback, and provide ongoing support as outlined in the CONSULTANT's "Ground Emergency Medical Transportation (GEMT) Program" proposal, dated July 21, 2022, marked as Exhibit "A," attached hereto, and incorporated herein. 3. DUTIES OF CITY. CITY shall compensate CONSULTANT as provided in Paragraph 4. 4. COMPENSATION. For the full performance of the services described herein by CONSULTANT, CITY shall pay CONSULTANT a contingency fee at a rate of fifteen percent (15%) of the total Medi -Cal Fee - For -Service revenues collected by the CITY based on CONSULTANT's cost reports prepared under this Agreement, as further described in CONSULTANT's "5. Pricing" included in Exhibit "A" attached; but in no event shall the total amount paid to CONSULTANT for services rendered under this Agreement exceed $75,000. CONSULTANT shall not invoice CITY until the CITY receives its Medi -Cal Fee -For - Service revenues that are collected based on CONSULTANT's cost reports, and CONSULTANT submits invoice(s) to the CITY's PROJECT MANAGER detailing the 15% fee contingency calculation. If, as a result of a government audit, a refund is required by CITY, CONSULTANT agrees to return the portion of the compensation fee that was paid on the amount being refunded and will otherwise not be liable for any other costs, fees, expenses, damages, or amounts. If CITY terminates this Agreement for convenience prior to the completion or submission of a cost report, CONSULTANT shall invoice, and CITY shall compensate CONSULTANT, at an hourly rate of $225, in 15 minute increments, for the time CONSULTANT expended in preparing such cost report, provided that CONSULTANT submits invoices documenting actual hours performed on the cost report together with a description of work performed for each hour or portion thereof. If CITY terminates this Agreement for convenience after the submission of a cost report, but prior to payment being received by CITY, the parties agree that the compensation provisions, shall survive termination of the Agreement, and CITY shall timely compensate CONSULTANT pursuant to those provisions set forth herein. TERM OF AGREEMENT. The term of this Agreement shall be for 42 months commencing on the date this Agreement was made and entered into by the parties. Upon mutual agreement of the parties, and subject to the approval of the City Manager the term of this Agreement may be extended for an additional period of up to 12 months. 6. TERMINATION. A. Discretionary. Either party may terminate this Agreement without cause upon thirty (30) days written notice mailed or personally delivered to the other party. B. Cause. Either party may terminate this Agreement for cause upon fifteen (15) days written notice mailed or personally delivered to the other party, and the notified party's failure to cure or correct the cause of the termination, to the reasonable satisfaction of the party giving such notice, within such fifteen (15) day time period. C. Effect of Termination. Upon receipt of notice of termination, neither party shall Revised 7/13/2021 incur additional obligations under any provision of this Agreement without the prior written consent of the other. D. Return of Documents. Upon termination, any and all CITY documents or materials provided to CONSULTANT and any and all of CONSULTANT's documents and materials prepared for or relating to the performance of its duties under this Agreement, shall be delivered to CITY as soon as possible, but not later than thirty (30) days after termination. 7. OWNERSHIP OF DOCUMENTS. The written documents and materials prepared by the CONSULTANT in connection with the performance of its duties under this Agreement, shall be the sole property of CITY. CITY may use said property for any purpose, including projects not contemplated by this Agreement. INSPECTION AND AUDIT. Upon reasonable notice, CONSULTANT shall make available to CITY, or its agent, for inspection and audit, all documents and materials maintained by CONSULTANT in connection with its performance of its duties under this Agreement. CONSULTANT shall fully cooperate with CITY or its agent in any such audit or inspection. 9. ASSIGNABILITY. The parties agree that they shall not assign or transfer any interest in this Agreement nor the performance of any of their respective obligations hereunder, without the prior written consent of the other party, and any attempt to so assign this Agreement or any rights, duties or obligations arising hereunder shall be void and of no effect. 10. INSURANCE. A. Scope of Coverage. During the term of this Agreement, CONSULTANT shall maintain, at no expense to CITY, the following insurance policies: 1. A commercial general liability insurance policy in the minimum amount of one million dollars ($1,000,000) per occurrence/two million dollars ($2,000,000) aggregate, for death, bodily injury, personal injury, or property damage. 2. An automobile liability (owned, non -owned, and hired vehicles) insurance policy in the minimum amount of one million dollars ($1,000,000) per occurrence. 3. If any licensed professional performs any of the services required to be performed under this Agreement, a professional liability insurance policy in the minimum amount of one million dollars ($1,000,000) per occurrence/two million dollars ($2,000,000) aggregate, to cover any claims arising out of the CONSULTANT's performance of services under this Agreement. Where CONSULTANT is a professional not required to have a professional license, CITY reserves the right to require CONSULTANT to provide professional liability insurance pursuant to this Revised 7/13/2021 section. 4. If it employs any person, CONSULTANT shall maintain worker's compensation insurance, as required by the State of California, with statutory limits, and employer's liability insurance with limits of no less than one million dollars ($1,000,000) per accident for bodily injury or disease. CONSULTANT's worker's compensation insurance shall be specifically endorsed to waive any right of subrogation against CITY. B. Other Insurance Requirements. The insurance coverage required of the CONSULTANT in subparagraph A of this section above shall also meet the following requirements: 1. Except for professional liability insurance or worker's compensation insurance, the insurance policies shall be specifically endorsed to include the CITY, its officers, agents, employees, and volunteers, as additional insureds (for both ongoing and completed operations) under the policies. 2. The additional insured coverage under CONSULTANT'S insurance policies shall be "primary and noncontributory" with respect to any insurance or coverage maintained by CITY and shall not call upon CITY's insurance or self-insurance coverage for any contribution. The "primary and noncontributory" coverage in CONSULTANT'S policies shall be at least as broad as ISO form CG20 0104 13. 3. Except for professional liability insurance or worker's compensation insurance, the insurance policies shall include, in their text or by endorsement, coverage for contractual liability and personal injury. 4. By execution of this Agreement, CONSULTANT hereby grants to CITY a waiver of any right to subrogation which any insurer of CONSULTANT may acquire against CITY by virtue of the payment of any loss under such insurance. CONSULTANT agrees to obtain any endorsement that may be necessary to effect this waiver of subrogation, but this provision applies regardless of whether or not CITY has received a waiver of subrogation endorsement from the insurer. 5. If the insurance is written on a Claims Made Form, then, following termination of this Agreement, said insurance coverage shall survive for a period of not less than five years. 6. The insurance policies shall provide for a retroactive date of placement coinciding with the effective date of this Agreement. 7. The limits of insurance required in this Agreement may be satisfied by a combination of primary and umbrella or excess insurance. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary and noncontributory basis for the benefit of CITY (if agreed to in a written contract or agreement) before CITY'S own insurance or self-insurance shall be called upon to protect it as a named insured. 8. It shall be a requirement under this Agreement that any available insurance Revised 7/13/2021 proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be available to CITY or any other additional insured party. Furthermore, the requirements for coverage and limits shall be: (1) the minimum coverage and limits specified in this Agreement; or (2) the broader coverage and maximum limits of coverage of any insurance policy or proceeds available to the named insured; whichever is greater. No representation is made that the minimum Insurance requirements of this agreement are sufficient to cover the obligations of the CONSULTANT under this agreement. C. Deductibles and SIR'S. Any deductibles or self-insured retentions in CONSULTANT's insurance policies must be declared to and approved by the PROJECT MANAGER and City Attorney and shall not reduce the limits of liability. Policies containing any self-insured retention (SIR) provision shall provide or be endorsed to provide that the SIR may be satisfied by either the named insured or CITY or other additional insured party. At CITY's option, the deductibles or self-insured retentions with respect to CITY shall be reduced or eliminated to CITY's satisfaction, or CONSULTANT shall procure a bond guaranteeing payment of losses and related investigations, claims administration, attorney's fees and defense expenses. D. Proof of Insurance. CONSULTANT shall provide to the PROJECT MANAGER or CITY'S City Attorney all of the following: (1) Certificates of Insurance evidencing the insurance coverage required in this Agreement; (2) a copy of the policy declaration page and/or endorsement page listing all policy endorsements for the commercial general liability policy, and (3) excerpts of policy language or specific endorsements evidencing the other insurance requirements set forth in this Agreement. CITY reserves the right to obtain a full certified copy of any insurance policy and endorsements from CONSULTANT. Failure to exercise this right shall not constitute a waiver of the right to exercise it later. The insurance shall be approved as to form and sufficiency by PROJECT MANAGER and the City Attorney. 11. INDEMNIFICATION. A. CONSULTANT shall, to the fullest extent permitted by law, indemnify, release, defend with counsel approved by CITY, and hold harmless CITY, its officers, agents, employees and volunteers (collectively, the "City Indemnitees"), from and against any claim, demand, suit, judgment, loss, liability or expense of any kind, including but not limited to attorney's fees, expert fees and all other costs and fees of litigation, (collectively "CLAIMS"), arising out of CONSULTANT'S performance of its obligations or conduct of its operations under this Agreement. The CONSULTANT's obligations apply regardless of whether or not a liability is caused or contributed to by the active or passive negligence of the City Indemnitees. However, to the extent that liability is caused by the active negligence or willful misconduct of the City Indemnitees, the CONSULTANT's indemnification obligation shall be reduced in proportion to the City Indemnitees' share of liability for the active negligence or willful misconduct. In addition, the acceptance or approval of the CONSULTANT's work or work product by the CITY or any of its directors, officers or employees shall not relieve or reduce the CONSULTANT's indemnification obligations. In the event the City Indemnitees are made a party to any action, lawsuit, or other adversarial proceeding arising from CONSULTANT'S performance of or operations under this Agreement, CONSULTANT shall provide a defense to the City Indemnitees or at CITY'S option reimburse the City Indemnitees their costs of defense, including reasonable attorneys' fees, incurred in defense of such claims. Revised 7/13/2021 B. The defense and indemnification obligations of this Agreement are undertaken in addition to, and shall not in any way be limited by, the insurance obligations contained in this Agreement, and shall survive the termination or completion of this Agreement for the full period of time allowed by law. 12. NONDISCRIMINATION. CONSULTANT shall not discriminate, in any way, against any person on the basis of age, sex, race, color, religion, ancestry, national origin or disability in connection with or related to the performance of its duties and obligations under this Agreement. 13. COMPLIANCE WITH ALL LAWS. CONSULTANT shall observe and comply with all applicable federal, state and local laws, ordinances, codes and regulations, in the performance of its duties and obligations under this Agreement. CONSULTANT shall perform all services under this Agreement in accordance with these laws, ordinances, codes and regulations. CONSULTANT shall release, defend, indemnify and hold harmless CITY, its officers, agents and employees from any and all damages, liabilities, penalties, fines and all other consequences from any noncompliance or violation of any laws, ordinances, codes or regulations. 14. NO THIRD PARTY BENEFICIARIES. CITY and CONSULTANT do not intend, by any provision of this Agreement, to create in any third party, any benefit or right owed by one party, under the terms and conditions of this Agreement, to the other party. 15. NOTICES. All notices and other communications required or permitted to be given under this Agreement, including any notice of change of address, shall be in writing and given by personal delivery, or by email, addressed to the parties intended to be notified. Notice shall be deemed given as of the date of personal delivery, or if emailed, upon the date of sending the email. Notice shall be given as follows: TO CITY's Project Manager: TO CONSULTANT's Project Director: Revised 7/13/2021 Jim Schutz City of San Rafael 1400 Fifth Avenue San Rafael, CA 94901 Email: Jim.schutz@cityofsanrafael.org cityofsanrafael.org Marc Staubley Public Consulting Group LLC 148 State Street Boston, MA 02109 Email: mstaubley@pcgus.com 16. 1NDEPENDENT CONTRACTOR. For the purposes, and for the duration, of this Agreement, CONSULTANT, its officers, agents and employees shall act in the capacity of an Independent Contractor, and not as employees of the CITY. CONSULTANT and CITY expressly intend and agree that the status of CONSULTANT, its officers, agents and employees be that of an Independent Contractor and not that of an employee of CITY. 17. ENTIRE AGREEMENT -- AMENDMENTS. A. The terms and conditions of this Agreement, all exhibits attached, and all documents expressly incorporated by reference, represent the entire Agreement of the parties with respect to the subject matter of this Agreement. B. This written Agreement shall supersede any and all prior agreements, oral or written, regarding the subject matter between the CONSULTANT and the CITY. C. No other agreement, promise or statement, written or oral, relating to the subject matter of this Agreement, shall be valid or binding, except by way of a written amendment to this Agreement. D. The terms and conditions of this Agreement shall not be altered or modified except by a written amendment to this Agreement signed by the CONSULTANT and the CITY. E. If any conflicts arise between the terms and conditions of this Agreement, and the terms and conditions of the attached exhibits or the documents expressly incorporated by reference, the terms and conditions of this Agreement shall control. 18. SET-OFF AGAINST DEBTS. CONSULTANT agrees that CITY may deduct from any payment due to CONSULTANT under this Agreement, any monies which CONSULTANT owes CITY under any ordinance, agreement, contract or resolution for any unpaid taxes, fees, licenses, assessments, unpaid checks or other amounts. 19. WAIVERS. The waiver by either party of any breach or violation of any term, covenant or condition of this Agreement, or of any ordinance, law or regulation, shall not be deemed to be a waiver of any other term, covenant, condition, ordinance, law or regulation, or of any subsequent breach or violation of the same or other term, covenant, condition, ordinance, law or regulation. The subsequent acceptance by either party of any fee, performance, or other consideration which may become due or owing under this Agreement, shall not be deemed to be a waiver of any preceding breach or violation by the other party of any term, condition, covenant of this Agreement or any applicable law, ordinance or regulation. Revised 7/13/2021 20. LIMITATIONS ON LIABILITY; COSTS AND ATTORNEY'S FEES. Neither party shall be liable to the other any incidental, indirect, special, punitive or consequential damages, including but not limited to, such damages arising from any type or manner of commercial, business, or financial loss, even if the other party had actual or constructive knowledge of the possibility of such damages and regardless of whether such damages for foreseeable. Notwithstanding the forgoing, the prevailing party in any action brought to enforce the terms and conditions of this Agreement, or arising out of the performance of this Agreement, may recover its reasonable costs (including claims administration) and attorney's fees expended in connection with such action. Except as expressly provided in this agreement, CONSULTANT does not make any warranty with respect to the contracted services, whether express or implied, and specifically disclaims any implied warranties, whether of merchantability, suitability, fitness for a particular purpose, or otherwise for said contracted services. 21. CITY BUSINESS LICENSE / OTHER TAXES. CONSULTANT shall obtain and maintain during the duration of this Agreement, a CITY business license as required by the San Rafael Municipal Code CONSULTANT shall pay any and all state and federal taxes and any other applicable taxes. CITY shall not be required to pay for any work performed under this Agreement, until CONSULTANT has provided CITY with a completed Internal Revenue Service Form W-9 (Request for Taxpayer Identification Number and Certification). 22. SURVIVAL OF TERMS. Any terms of this Agreement that by their nature extend beyond the term (or termination) of this Agreement shall remain in effect until fulfilled and shall apply to both Parties' respective successors and assigns. 23. APPLICABLE LAW. The laws of the State of California shall govern this Agreement. 24. COUNTERPARTS AND ELECTRONIC SIGNATURE. This Agreement may be executed by electronic signature and in any number of counterparts, each of which shall be deemed an original, but all of which together shall constitute one document. Counterpart signature pages may be delivered by telecopier, email or other means of electronic transmission. [Signatures are on the following page.] Revised 7/13/2021 IN WITNESS WHEREOF, the parties have executed this Agreement as of the day, month and year first above written. CITY OF SAN RAFAEL ,Fim chug City Manag ATTEST: kwL,�; LINDSAY LARA, City Clerk APPROVED AS TO FORM: ROBERT F. EPSTEIN, Revised 7/13/2021 Attorney CONSULTANT By: 4" Name: Marc Staubley, Health Practice Area Director [If CONSULTANT is a corporation, add signature of second corporate officer] By:_ Name: Title: Ej Ground Emergency Medical Transportation (GEMT) Program City of San Rafael July 21, 2022 Attachment A City of San Rafael GEMT,Program and CMS Medicare Cost Survey. Services 1. INTRODUCTION Public Consulting Group (PCG) understands that the City of San Rafael ("City") requests the assistance of a qualified vendor to provide cost report preparation and consulting services for the Medi -Cal Ground Emergency Medical Transportation (GEMT) program, operated by the California Department of Health Care Services. As the leading firm in GEMT reimbursement programs, PCG is well-equipped to provide high-- quality cost reporting services which aim to take the administrative burden away from the provider, increase provider reimbursement, and minimize audit risk. PCG provides unmatched comprehensive cost reporting services PCG's cost report preparation and cost settlement support will allow the City to generate maximum allowable revenue while mitigating audit risk. Through our full-service delivery model, PCG offers cost reporting expertise that optimizes revenue and eliminates the administrative burden on EMS providers. PCG will provide full support to the City throughout the cost reporting process and all state and federal and its. PCG has the knowledge and resources to provide the City of San Rafael with services aimed at increasing revenue forthe City. We provide the full lift associated with developing the cost report, from data collection all the way through compilation of the final report. Additionally, we conduct comparative analyses to identify significant trends in billing and financial data utilizing our web -based cost reporting tool. PCG is the only vendor to offer an online EMS cost reporting system for the use of data aggregation, comprehensive compliance reviews, automated edits checks, and advanced reporting. The use of a system through these programs is vital to help ensure all potential reimbursement is captured and extensively reviewed. PCG is the only vendor to contract directly with state Medicaid agencies to provide EMS supplemental payment program development, oversight and administration, training, and audit support. This gives us a unique advantage and understanding of how the state will be approaching the program and related audits, allowing PCG to better serve our provider clients. PCG is the right choice for the City of San Rafael As a firm dedicated to serving the public sector, PCG understands the fiscal challenges that the City of San Rafael Fire Department faces in serving Californians. We are confident that our team's knowledge, combined with our deep experience and highly successful approach, uniquely qualifies PCG to be the firm that will help the City generate incremental revenue to help alleviate some of the fiscal pressure it is currently facing. 2. COMPANY BACKGROUND AND EXPERIENCE PCG was founded in 1986 with a mission of helping public sector agencies improve operational and managerial performance. Our firm provides industry-leading management consulting and technology to public sectored ucation, health, human services, and other government clients to achieve their performance goals and better serve populations in need. Since 2006, PCG has been working with the provider community to increase Medicaid reimbursement for ambulatory services. Most notably, PCG assisted the State of Texas with the establishment of the first EMS Certified Public Expenditure (CPE) Program in the country and subsequently supported the Commonwealth of Massachusetts with the approval and implementation of an EMS Certified Public Expenditure (CPE) Program in 2013. As the result of our work over the past thirteen years in this arena, PCG has acquired in- depth experience working with fire departments and ambulance service providers to identify reimbursable Public Consulting Group LLC Page 2 Attachment A City of San Rafael GEMT Program and CMS Medicare Cost Survey Services costs and to complete or facilitate the completion of the required annual cost report. More recently, PCG has worked with providers in Washington and Florida to navigate the process cost reporting, revenue maximization, and audits. We currently work with over 550 providers across thirteen states, which provides us with a wide range of experience. Please see Figure 1 below for specific details on PCG's experience in key states. 3. APPROACH PCG Methodology Massachusetts Executive Office of Health & Human Services (EOHHS) appointed PCG to design, obtain federal appra,ral. and implement the CPE Program In 2006, PCG partnered with Austin -Travis County EMS and the State of Texas Health and Human Services Commission (HHSC) to develop the Ambulance Supplemental Payment Program_ ,TEXAS r' Heartliand Human Servkes Floridas Public Emergency Medical Transportation (PEMTi Certified Public Expenditure (CPE) Program vias approved far implementation in 2016 The Washington State Health Care Authority (HCA) gained federal approval for their Ground Emergency Medical Transportation (GENT) Program in July 2017 Washington State Health Care Authority -Developed and facilitated federal approval of State Plan A ni endment -Conducted outreach and facilitated workgroups to inform program development -Created the cost report template, web -based reporting system and training materials -First federally -approved EMS supplemental payment program -Adopted 1115 Waiver that expanded cost settlement to Medicaid Managed Care and the Uninsured -Customized web -based EMS cost reporting tool -Developed web -based cost reporting system for FL -Conducted comprehensive review of programmatic components and developed data request, data review, and QC processes -Created a web -based cost reporting tool for data collection. data review, and enhanced reporting -Shared fiscal impact studies with individual providers to demonstrate the benefits of program participation -Developed cost reporting processes and data analysis tools to ensure compliance and revenue maximization Figure 1: PCG Successes in Key States -Nearly 107 participating providers in FY21 -Generating over $100 million in additional funding to providers since the beginning of the program -More than 70 participating providers -Generated nearly $676 million for Texas providers -Conducted outreach and supported more than 40 providers in the first year of the program -Currently provide service to over 60 EMS providers -Generated more than $190 million for Florida providers since FY17 -Completed FY16 and FY17 cost reports on behalf of more than 60 providers in the program's first reporting period -Generated over $120 million in reimbursement to 90 providers Public Consulting Group LLC Page 3 Attachment A City of San Rafael GEMT Program and CMS Medicare Cost Survey, Seryices PCG's approach to this scope of work is described below. It includes our project management approach, a timeline, milestones and deliverables for the project. This approach is based not only on our successful implementation with other GEMT projects, but also on our process improvement analysis of our past GEMTwork. Phase 1: Project Kickoff and Implementation process as seamless as In this prel iminaryphase, the PCG willworkwith the City toestablish possible. a stakeholder group that will be involved in the cost reporting process. Once the key stakeholders are identified, we will schedule a project kickoff meeting with the appropriate individuals to understand and discuss project expectations and specific roles and responsibilities. This will allow us to further develop our project statement of work and fully refinethe project plan. We will work with the City to form a communication plan to establish protocols and timeframe for future status meetings based on the City's preferences. Lastly, we will provide a data request to the City to begin the process of completing the cost report. The items requestwill include, but is not limited to: • Provider -specific identifier numbers • Computer Aided Dispatch (CAD) Data • Capital Usage • Expenditures for the provider • Employee data • Indirect Cost Rate Proposal • Provider revenue received • Depreciation detail e Billing data The purpose of collecting this data is to determine the allowable costs that are in excess of other Medk Cal revenue that the eligible GEMT entity receives for providing Emergency Medical Transportation services to Medi -Cal recipients. This data will be used to provide the content for the Medi -Cal costreport. Data collection periods forthe f ive (5) cost reports thataredue in 2022/23 are outlined in thetable below. Public Consulting Group LLC Page 4 (12 months) (12 months)' Cost Reporting Period Begins 7/1/2018 7/1/2019 7/1/2020 7/1/2021 7/1/2022 Cost Reporting Period Ends 6/30/2019 6/30/2020 6/30/2021 6/30/2022 12/31/2022 Cost Report p 7/31/2022 7/31/2022 7/31/2022 5/23/2023 Due Date 9/1/2022" 9/15/2022* 10/1/2022 11/30/2022 Public Consulting Group LLC Page 4 Attachment A City of San Rafael GEM T.Pro.gram and CMS Medicare Cost Survey. Services Figure 2: GEMT Cost Report Schedule 'Indicates the extension date grantedbyDHCS to the City of San Rafael Phase 2: Cost Report Preparation This phase will specifically focus on the preparation of the annual cost report as well as any necessary supporting documentation to allow the City to receive supplemental payments. During this phase, we document processes and identify strengths, weaknesses and mitigating controls, proactively offering recommendations for strengthening compliance, especially in relation to California GEMT programmatic regulations. We will leverage our knowledge of state and federal Medicaid billing and reimbursement requirements to make recommendations to the City as the team learns aboutyour data. Additionally, our staff constantly reviews regulations and legislation at both the state and federal levels to ensure its claiming practices are current. Our legal and regulatory staff reviews the Office of Inspector General (OIG), Centers for Medicare and Medicaid Services (CMS), and other audits throughout the nation, some of which result in policy modifications. We will review if any of these reforms could impact the City and make suggestions to enhance procedures, thus proactively addressing the concerns outlined in other audits. The cost report preparation phase of the process involves managing the GEMT pre -cost report submittal process forthe City. This includes: • Collecting provider information securely via electronic submission • Storage of data into ourweb-based cost reporting tool • Reviewing all submitted data to determine eligible costs for reimbursement under the GEMT program • Gaining City sign off during pre -determined status meetings per the communication plan established in the kickoff meeting These items are further outlined below: Collect Provider Information The first step of this process is collecting provider information perthe data request discussed in the kickoff meeting. The transmission, collection and storage of this data in an electronic format has increased the focus and importance of creating appropriate protection and controls for data that is sensitive and/or protected. As a hosted solution provider, we acknowledge and acceptthat itis incumbent on every service provider to enable proper protection and control for the management and safe -keeping of our data, and particularly for the data that we are entrusted to store on behalf of our clients. PCG will take necessary steps to: • Assure appropriate protections and controls are developed and followed; ■ Apply appropriate standards; and • Comply with pertinent regulations governing the access to protected data such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act. We recognize that having a robust security program is critical in minimizing the impact of threats inherent in today's computing environments. We are committed to maintaining a healthy process of periodic audit and review of our program to assure that we are accomplishing our, and the City's goals and objectives in Public Consulting Group LLC Page 5 Attachment A City of San Rafael GEMT Program and CMS Medicare Cost Survey, Services protecting sensitive data, and to assure that the plan evolves to address an ever-changing environment and threat landscape overtime. Once the requested data is received, we will identify the need for any additional data and communicate with the City to ensure a timely completion of the Medi -Cal cost report. When all of the required data is submitted by the City we will provide the City of San Rafael a data summary for approval at a pre- determined status meeting. Afterthe first yearof data collection, PCG will identify any shifts in the data provided in years prior to further ensure the accuracy of the data provided. Review Provider Information Our web -based cost reporting tool is an invaluable resource in performing data validation in real-time, as data is collected. Immediately upon entry, ourteam will be able to identify variances and discuss their acceptance with the City We have the ability to change the allowable variance limits to be aligned with updated guidance from DHCS or the City of San Rafael Fire Department preferences. The web -based tool also allows the team to give the City feedback on how their expenses compare to other providers for benchmarking purposes. The paragraphs below describe this process and further benefits of using this tool. • Benchmarkdata ■ Create an audit trail • Validate data in real-time J Figure 3: PCG's Web -Based Cost Reporting Tod. Once all data is received from the City we will inputthe data into our online tool. As mentioned above, our proprietary system will perform real-time validation checks for quality assurance and accuracy. No other vendor in the country utiles a web -based reporting tool to compile, review, and audit all data components included in the cost report prior to cost report submission. An automated compliance process is essential to ensure the accuracy of all reported financial information. The information collected from the City and stored in this system will be used to satisfy the reporting requirements for all components of the Ground Emergency Medical Transportation (GEMT) Program. Public Consulting Group LLC Page 6 Attachment A City of San Rafael GENT Program. and CMS Medicare Cost Survey Services PCG will communicate with the City of San Rafael Fire Department throughout the data review process with status updates and any clarification questions regarding the data during status meetings for updates. The cost reporting work will focus on compliance and audit risk minimization, ensuring that all included costs meet OMB S u perC i rcu I ar (2 CFR Part 200) req uirem ents and be sufficiently accounted for in auditable financials. After the data is reviewed, we will provide the City with a decision summary for sign off before beginning the process of the cost report preparation. During this p hase, we will draw on our access to and history with EMS providers across the country to provide guidance on necessary determinations such as allowable and shared costs. Our tool, combined with our book of clients across the country allows us to provide the City of San Rafael Fire Department with blinded benchmark data. The City may have an interest in seeing how their cost per transport compares to departments of similar size or with a comparable call volume. We implement year-to-year comparisons of billing and expenditures data and identify any areas in which significant changes occur. Because all data is stored in this system, an audit trail is created as the cost report is completed. In addition to the data trail created in the system, the system captures and stores: • Supporting documentation (including a crosswalk to external files) ■ A crosswalk through allowable cost determination • Notes for any variances identified Because this is created as the cost report is completed, q uestions from D HCS or an audit request will not be a causeforconcern. Wewill havethe information readyto respond to additional req uests without surplus information needed from the City. PCG looks forward to using theweb-based tool, as well as the vast cost report experience mentioned above to assist the City of San Rafael Fire Department in the successful completion of the Medi -Cal Cost Report. Phase 3: Cost Report Submission and Desk Review We accept the full administrative burden of cost report preparation and will ensure the City of San Rafael Fire Department staff is closely involved in the cost report review process before submission to DHCS. We will work towards establishing protocols and processes that the City can easily replicate in generating the information that will ultimately result in the transfer of funds from DHCS. Prepare Cost Report Submission Package We will complete all ten (10) schedules outlined in the Medi -Cal Cost Report in compliance with the format provided by DHCS. This includes using the web -based tool described above to complete the required schedules. A demonstration of the web -based tool will be presented to the City and we will provide a preliminary cost report with anticipated settlement results. Review Cost Report to Identify and Address Audit Risk We will review the cost report and identify all outstanding potential audit risks with the City. Wewill suggest potential remed ies to reduce audit risk and update the cost report accordingly as needed. During this stage, Public Consulting Group LLC Page 7 Attachment A City of San Rafael GEMT Program and CMS Medicare Cost Survey Services we will anticipate any possible question of the cost reported by finalizing notes addressing potential questions or clarifications on the cost report. In addition, we will provide the City with supporting documentation linking the reported data to the documentation delivered during the data collection process. Submit Completed Cost Report Package to DHCS We will supply the City of San Rafael Fire Department with a cost report submission package that includes the completed cost report, supporting documentation of financials, and any additional documentation requested by DHCS. In addition, we will provide an in-depth final report review before submission. This ensures all stakeholders and the individual certifying the report agree with the data as reported and sign off on the cost report before submission. Address Feedback of DHCS Review of Cost Report DHCS's questions and findings will be addressed during the desk review process. This includes d rafting responses, providing supporting documentation and conducting comprehensive billing reconciliations should there be questions regarding the billing data. Leveraging experience responding to agency inquiries regarding EMS Medicaid cost reports in multiple states, we will be able to assist the City of San Rafael Fire Department in swiftly resolving any issues that may arise during D HCS's review of the cost report. We will also be responsible for providing supporting documentation, drafting responses, and undertaking financial accountability during a potential federal audit. We build and maintain a strong collection of supporting files that is well -organized and readily accessible in the event of an audit. We will work closely with the City of San Rafael Fire Department to help maintain the highest levels of compliance and program integrity while maximizing the City's revenue to the greatest extent possible. Ongoing in-depth assessments will be performed and we will work with the City of San Rafael staff to provide status updates and written reports for internal stakeholders. Phase 4: Ongoing Support We will continue to provide ongoing support to the City of San Rafael Fire Department after the completion of the cost report and subsequent reviews. These ongoing tasks include. • Continuing to provide policy updates from DHCS and Centers for Medicare and Medicaid Services (CMS) regarding any updates or changes to the program Communicating any updates f rom DHCS relating to the date of anticipated reimbursement from the GEMT prog ram • Providing auditsupportin theevent of an aud itbythe state, CMS, orthe Officeof Inspector General (OIG) We will also provide the City with additional services aimed at increasing ambulance service revenues. In addition, we provide charge master review services to ensure that the City of San Rafael Fire Department is optimizing charges to drive revenue generation. We understand the political complexities associated with increasing charges and provide the necessary support and analysis to present to stakeholders. 4. PROPOSED STAFF Public Consulting Group's GEMT team includes a qualified and experienced staff of subject matter experts. All members of the PCG team have direct experience with EMS Medicaid reimbursement. No other vendor Public Consulting Group LLC Page 8 Attachment A City of San Rafael GEMT Program and CMS Medicare_Cost Survey Services offers a team with more knowledgeable staff, cost reporting experience and Medicaid experience. We will bring these resources to the full benefit of the City of San Rafael Fire Department cost reporting services. Proposed Staff Bios James Dachos has over 15 years of health care policy and analysis experience and has led PCGs Ambulance Supplemental Payment Program data collection and cost recovery efforts for over 10 years. Mr. Dachos serves as the program director for 11 active Ambulance Supplemental Payment Program initiatives across the country, including Texas, Florida, Washington, Colorado, Oregon, Oklahoma, Maryland, Missouri, Iowa, Illinois, and the District of Columbia. As the program director, Mr. Dachos is directly responsible for the development, design, implementation, cost reporting, and ongoing administration of EMS reimbursement programs. He currently oversees ambulance supplemental payment services for over 550 ambulance providers. Mr. Dachos also oversees the project team dedicated to providing statewide EMS consulting, cost collection, and auditing services on behalf of the State of Colorado. Mr. Dachos has worked closely with state Medicaid departments to design, develop, and gain federal approval for cost -based EMS and school-based services (SBS) programs. He has worked with CMS on behalf of numerous states responding to requests for information pertaining to the State Plan Amendment and other related program components. He has also led comprehensive SBS and Local Health Jurisdiction (LHJ) assessments on behalf of state health departments. Ms. Narode has extensive experience managing statewide projects and comprehensive knowledge on rate setting and rate study projects. Sincejoining PCG, Ms. Narode has supported and led several key initiatives. For the New York State Department of Health School Supportive Health Services Program, Ms. Narode serves as the project manager and assists in reviewing completed Medicaid cost reports to identify possible reporting errors and works closely with Local Education Agencies (LEAs) to ensure that finalized reports are completed accurately and in compliance with all reporting requirements. Ms. Narode serves as the Project Manager on the Florida Public Emergency Medical Transportation (PEMT) program working with over 60 providers on their Medicaid cost reports and also is the Project Director for the Iowa Ground Emergency Medical Transportation (GEMT) program where she oversees a team to assist multiple EMS providers in completing Medicaid cost reports. On behalf of the Wisconsin Department of Health Services, Ms. Narode works hand-in-hand with county -based health service providers to ensure the accuracy and completeness of annual Medicaid cost reports, including conducting trainings and completing comprehensive desk reviews on completed cost reports. Ms. Narode will be the Project Advisor for this program, utilizing her prior experience working in multiple states to maximize Chula Vista Fire Department reimbursement opportunity. Ms. DiCicco has over 12 years of experience working with public sector clients at the federal, state and local levels. She uses innovative ideas, collaborative approaches and change management skills to manage projectsand developnew programs. Ms. DiCicco currently serves as project director for seven Emergency Medical Services (EMS) cost recovery and revenue maximization initiatives which allows her the opportunity to work closely with Medicaid state agencies, lobbyists, state industry associations, and ambulance providers of all sizes. Ms. DiCicco has acquired extensive knowledge of the operations and f inancial health of fire and departments, and is ab leto apply it towards q ualitative and quantitative analysis in orderto create impact solutions for her clients. Additionally, Ms. DiCicco serves as PCG's program director and subject matter expert on CMS' Medicare Ground Ambulance Data Collection System Public Consulting Group LLC Page 9 Attachment A City of San Rafael GEMT Program and CMS Medicare Cost Survey Services ProposedBios (MGADC). Ms. DiCicco will be the Project Manager for this program, utilizing her prior experience working in multiple states to maximize Chula Vista Fire Department reimbursement opportunity. Ms. McDonald has worked with Medicaid and EMS reimbursement for4 years. She has worked as an analyst in Florida, Oklahoma, Missouri, and Texas focusing on Cost Report Compilation and Data Analysis. In these states, she works with fire departments and ambulance providers to design, gain approval for, and implementthe EMS Supplemental Payment Program, a federally approved program that provides additional reimbursement for governmental providers that serve Medicaid patients. She also prepares the annual cost reports, data analysis, and provide comprehensive support throughout the State's desk reviews. Additionally, Ms. McDonald has led and contributed to project initiatives in federal and state compliance, Medicaid billing analysis, Medicaid cost reporting, statewide school-based cost settlement operations and training, process improvement and program management best practices in the state of Wisconsin. Ms. McDonald will utilize her prior experience with completing GEMT cost reports, to compile data and complete the cost report for the Chula Vista Fire Department. Ms. Ray has over four years of experience working with both public and private sector clients and managing portfolios, analyzing provider and client data, and supporting the development of state supplemental payment programs. Ms. Ray currently serves as a business analyst working with governmental ambulance service providers to maximize their fiscal return on Medicaid Fee For Service transports. On each project, she provides detailed cost reporting, data analysis, organization, outreach and stakeholder engagement, implementation planning, and more. Ms. Ray will utilize her prior experience to provide project support in completing the cost reports for Chula Vista Fire Department. 5. PRICING PCG is pleased to offer the above scope of GEMT program services to the City of San Rafael Fire Department at a contingency rate of fifteen percent (15%) per cost report with a total do not exceed of seventy-five thousand dollars ($75,000). This pricing is based off five (5) supplemental payment reimbursement cycles pertaining to additional Medi -Cal Fee -For -Service revenues generated as a result of the program. The City of San Rafael Fire Department will compensate PCG within thirty (30) days of receipt of an invoice. Invoicing will occur only after the City receives its settlement payment(s). Public Consulting Group LLC Page 10 RAP q$C i� � 2 r _ WITH E' CONTRACT ROUTING FORM INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below. TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER: Contracting Department: Fire Project Manager: Thomas Wong Extension: 5360 Contractor Name: Public Consulting Group Contractor's Contact: Sarah Dicicco Contact's Email: sdicicco@pcgus.com ❑ FPPC: Check if Contractor/Consultant must file Form 700 Step RESPONSIBLE DESCRIPTION COMPLETED REVIEWER DEPARTMENT DATE Check/Initial 1 Project Manager a. Email PINS Introductory Notice to Contractor N/A 7/22/2022 b. Email contract (in Word) and attachments to City TW Attorney c/o Laraine.Gittens@cityofsanrafael.org 2 City Attorney a. Review, revise, and comment on draft agreement 7/25/2022 and return to Project Manager 7/25/2022 0 GC b. Confirm insurance requirements, create Job on Department Director PINS, send PINS insurance notice to contractor 9/22/2022 0 _GC_ 3 Approval of final agreement form to send to 0 —DW— Project Manager contractor 4 Forward three (3) originals of final agreement to 10/3/2022 0 contractor for their signature 5 Project Manager When necessary, contractor -signed agreement 0 N/A agendized for City Council approval * *City Council approval required for Professional Services Agreements and purchases of goods and services that exceed Or $75,000; and for Public Works Contracts that exceed $175,000 Click here to Date of City Council approval enter a date. PRINT CONTINUE ROUTING PROCESS WITH HARD COPY 6 Project Manager Forward signed original agreements to City 10/5/22 Attorney with printed copy of this routing form TW 7 City Attorney Review and approve hard copy of signed 10/6/2022 /i► agreement (5�� 8 City Attorney Review and approve insurance in PINS, and bonds 10/6/2022 (for Public Works Contracts) 9 City Manager/ Mayor Agreement executed by City Council authorized /d L official 10 City Clerk Attest signatures, retains original agreement and / �� forwards copies to Project Manager OEM