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Item C03BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: May 15, 2013 Bulk Item: Yes No X Division: Emergency Services Department: Fire Rescue Staff Contact Person: Mary Napoli ext 6010 AGENDA ITEM WORDING: Approval of the first Renewal Agreement between the Board of County Commissioners of Monroe County and the Board of Governors of Fire and Ambulance District 1 with Advanced Data Processing, Inc. (d.b.a. ADPI-Intermedix), effective from June 1, 2013 through May 31, 2014, for ground and air rescue transport billing and related professional services. ITEM BACKGROUND: The original Agreement between the parties provided for a three year term from June 1, 2010 through May 31, 2013 with the option to renew for up to two (2) one-year periods, with approval of the County and the District's governing Board. Staff is requesting approval to exercise the renewal clause for the first one-year period, commencing on June 1, 2013 and ending on May 31, 2014. PREVIOUS RELEVANT BOCC ACTION: On May 19, 2010 the County and the Board of Governors of Fire and Ambulance District 1 entered into a new service agreement with Advanced Data Processing, Inc. (d.b.a. ADPI-Intermedix), with a term beginning June 1, 2010, for ground and air rescue transport billing and related professional services. On February 20, 2013, after issuance of an RFP, the BOCC and the BOG approved the hiring of Jan Purdin d/b/a EMS Billing and Consulting for the purpose of reviewing and making recommendations for improvements to the County's billing and collection practices. That review is still underway. Ms. Purdin is expected to issue a written report within the next month. However, the ADPI contract expires May 31, 2013. In order to ensure that billing continues without interruption, Staff recommends renewal of the agreement. Paragraph 10 of the agreement provides that the County can terminate the agreement on 30 days' written notice to ADPI. CONTRACT/AGREEMENT CHANGES: Contract will be extended and the new expiration date will be May 31, 2014. STAFF RECOMMENDATIONS: Approval. TOTAL COST: 5.50% of ground collections INDIRECT COST: X BUDGETED: Yes X No_ 4.00% of air collections and $11.00 per Medicaid account COST TO COUNTY: % of collections as shown above SOURCE OF FUNDS: Billing Collections REVENUE PRODUCING: Yes _ No X AMOUNT PER MONTH Year APPROVED BY: County Atty OMB/Purchasing _ Risk Management DOCUMENTATION: Included X Not Required DISPOSITION: AGENDA ITEM # Revised 01/09 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract with: ADPI-Intermedix Contract # Effective Date: 06/01 /2013 Expiration Date: 05/31/2014 Contract Purpose/Description: Contract for around and air rescue transport billing and related professional services. Contract Manager: Mary Napoli 6010 Emergency Services / Stop 14 (Name) (Ext.) (Department/Stop #) for BOG meeting on 05/15/2013 Agenda Deadline: 04/30/2013 CONTRACT COSTS Total Dollar Value of Contract: $ 4.00 % of total air Current Year collections and Portion: $ $11.00 per Medicaid Account. Budgeted? Yes® No ❑ Account Codes: 11001 530340 Grant: $ County Match: $ ADDITIONAL COSTS Estimated Ongoing Costs: $ /yr For: (Not included in dollar value above) (eg. maintenance. CONTRACT REVIEW utilities, janitorial, salaries, etc. Changes Date Out Date In Needed R ie Division Director 'y- 3 Yes❑ NoB /� J Risk Management 4-YesE] No LW3d3 M - O.M.B./Purchasing 3 Yes❑ Noa CC# '� '4 a 3113 County Attorney '� 4 'ald�3 Yes[:] NoE/ 4 19 a0/j Comments: OMB Form Revised 2/27.101 MCP #2 RENEWAL AGREEMENT This RENEWAL AGREEMENT dated the / S� day of Rl / . 2013. by and between the Board of County Commissioners and the Board of G6vernors of Fire and Ambulance District 1 of Monroe County, Florida, hereinafter called the "County" and Advanced Data Processing, Inc. dba ADPI- Intermedix, hereinafter called the "Contractor". WITNESSETH WHEREAS, the parties hereto did enter into an agreement dated May, 19, 2010 for rescue ambulance billing and related professional services ("Agreement"), the term of which runs from June L 2010 to May 31, 2013; and WHEREAS, said Agreement provided an option to the County to renew the contract for two additional one year terms; and WHEREAS, the County has elected to exercise said option for the continuation of rescue ambulance billing and related professional services; now therefore IN CONSIDERATION of the mutual convenants and obligations contained herein, the parties agree as follows: 1. The County elects to renew the Agreement for the first one additional year pursuant to Article 1 of the Agreement. 2. The effective date of this amendment is June 1, 2013 and shall extend through May 31, 2014, under the same terms and conditions of the Agreement. 4. All other terms and conditions of the Agreement shall remain in full force and effect. Attest: AMY HEAVILIN, CLERK BOARD OF COUNTY COMMISSIONERS IIn Deputy Clerk MONROE COUNTY ATTORNEY PROVEDilAS 4y" M: fi CYNTHIA L. HALL ASSISFrANT COUNTY ATTORNEY Date_ 4- 2. — X01-3 OF MONROE COUNTY, FLORIDA Mayor/Chairman BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT 1, OF MONROE COUNTY, FLORIDA Mayor/Chairman ADVANCED DATA PROCESSING, INC. d/b/a A edix Print n e and title: 00 O�rJir��n4- '�� K> CERTIFICATE OF LIABILITY INSURANCE DATEI2012 MlYY) 0810212(112 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: it the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Marsh USA Inc. 1560 Sawgrass Corporate Pkwy Suite 300 Sunrise, FL &'1323 Attn:=:Lauderdale.Cer,Requesl@marsh.com F:2'2-94BZ12 CONTACT NAME` PHONE FAX ESE INSURE S AFFORDING COVERAGE NAIC S INSURER A: St. Paul Mercury Insurance Company 24791 101309-GA'WU-PROF-12-'3 INSURED INSURED. Ccrporalio t 6451 North Federal Highway, Suite 1002 INSURER B : Phoenix Insurance Company 25623 INSURER C : NA NA INSURER D : rm4els Property CaSuaty InsJrance Company 36161 Fort Laude-dale, FL 33308 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: ATL-D0298M-09 REVISION NUMBER:2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICAT ED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. II TYPE OF INSURANCE A M SU n POLICY NUMBER MbWDY EFF MMM1D POLICY EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABUTY CLAIMS -MADE FIX ] OCCUR ZLP-10T9311A-12-l3 06130"1012 0613012013 EACH OCCURRENCE S 1.000.000 DAMAGE TO RENTED PREIA. E S 250,Cfl0 MED EXP Any one $ 10,000 PERSONAL &ADV-INJURY E 1,000.000 GENERAL AGGREGATE $ 2,000,1060 GEN'L AGGREGATE LIMIT APPLIES PER X POLIO PRO.LOD PRODUCTS-=MPIOPAGG $ 2,000,000 $ D AUTOMOBILE JXANYAUTO LIABILITY ALL OWNED SCHEDULED AUTCS AUTOS NON-01ANED HIREDAUTOS AUTOS BA IA817433 Owned Como;Coll Ded. $1,000 'red ComPbo6 ilea. $100.'S4x0 0620.2012 06/30/2013 EMI D SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Peraccdenl) S PROPERTY DAMA E e a nD S A X UMBRELLA LIAR EXCESS U1B X OCCJR CLAIMS -MADE ZLP-10T9611A-12-13 06AWC12 13613012013 EACH OCCURRENCE S 5,C00'0C-C AGGREGATE S 5 CO0,000 X DEC RETENTION $10 000 S B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY -LN- — U&1A83727-2-12 _ 06,302012 C6/3012013 X I VAC STATJ- oTH EIR — ——500,t1Q0- .ANY PROPRIE-OR.'PARTNERE'EXECUTIVE OFFICER,TdEM3ER EX CL1)DED? aN (Mandatory In NH) It Yes.desm cnde• DESCRIPTION OF OPERATIONS below N i A .+ E.L. D'SEASE- EA EMPLOYE S ,00.000 E.L D SEASE- POLICY LIMIT s E-000(!0 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) If required by written agreemerl for the Naned Insu-ed's work the Wnrce County Boa d of County Comm ss one-s is ncluded as an additional insured under the general, automobile, and umbrella liability insu-ance L;tKI I1-K3A I t MULUtK Monroe Co inty Board of Conmissioners 490 63rd Street, Suite 170 Maration, FL 33050.1026 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZO REPRESENTATIVE of Marsh USA Inc. Carmen Gordon ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/06) The ACORD name and logo are registered marks Of ACORD CONTRACT BETWEEN THE BOARD OF COUNTY COMMISSIONERS, MONROE COUNTY, FLORIDA AND THE BOARD OF GOVERNORS FIRE AND AMBULANCE DISTRICT 1 OF MONROE COUNTY, FLORIDA AND ADVANCED DATA PROCESSING INC. (DBA ADPI-INTERMEDM FOR GROUND AND AIR RESCUE TRANSPORT BILLING AND RELATED PROFESSIONAL SERVICES THIS CONTRACT, hereinafter "CONTRACT OR AGREEMENT" is made and entered into this 19`' day of May, 2010 by and between the BOARD OF COUNTY COMMISSIONERS and the BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT 1, MONROE COUNTY, a political subdivision of the State of Florida, with principal offices located at 490 63'd Street, Marathon, FL 33050 (the District and Monroe County are hereinafter referred to collectively as the "COUNTY"), and ADVANCED DATA PROCESSING, INC. DBA ADPI-INTERMED]X, hereinafter referred to as "CONTRACTOR": WITNESSETH: WHEREAS, the COUNTY advertised a notice of request for proposals for GROUND AND AIR RESCUE TRANSPORT BILLING; WHEREAS, the successful Respondent was Advanced Data Processing Inc. (DBA ADPI - Intermedix., and; WHEREAS, this CONTRACTOR represents that it is capable and prepared to provide such services, and; WHEREAS, the COUNTY intends to enter into an agreement for the provision of rescue air and ground transport billing and related professional services by the CONTRACTOR to the COUNTY; and, WHEREAS, the CONTRACTOR represents that it is capable and prepared to provide such Services: NOW THEREFORE, in consideration of the promises contained herein, the parties hereto agree as follows: 1. CONTRACT PERIOD AND RENEWAL - The term of this Agreement shall be for a three (3) year term from June 1, 2010 through May 31, 2013, with the option to renew for two (2) additional one year periods at the sole option of COUNTY, subject to cancellation as provided herein. The COUNTY'S performance and obligation to pay under this contract, is contingent upon an annual appropriation by the Board of County Commissioners. 2. SERVICE TO BE PERFORMED BY CONTRACTOR - The CONTRACTOR shall perform the services as specifically stated in the Scope of Services (Attachment A) without requirement for the issuance of any additional work orders. Additional services may be issued in the form of a Work Order. Each Work order will set forth a specific Scope of Services, amount of compensation, deliverables and completion date and shall be subject to the approval of the COUNTY. CONTRACTOR shall perform no additional services until any applicable Work Order is obtained from the COUNTY and countersigned by the CONTRACTOR. 3. COMPENSATION - The CONTRACTOR shall provide to the COUNTY a monthly invoice representing fees for the services provided computed as: A. Five point five zero percent 5.50%) for ground accounts and four point zero per cent (4.00%) for air accounts, of all monies collected by the CONTRACTOR, excluding Medicaid accounts, during the previous month. B. In compliance with Florida Statutes 409.913 (9), the CONTRACTOR shall include in the same invoice an amount of $11.00 per processed Medicaid account for both ground and air accounts providing all billing services related to such accounts processed in the previous month, regardless of whether or not payment was received. C. Price shall include but not be limited to all stationery, fax forms, envelopes, mailings, postage and. telecommunications/phone facilities/charges. D. Ground and Air Rescue Transport Billing shall be invoiced separately. 4. STANDARD OF CARE - CONTRACTOR shall exercise the same degree of care, skill, and diligence in the performance of Services as is ordinarily provided by a professional CONTRACTOR, offering services for local governments in South Florida, under similar circumstances and CONTRACTOR shall, at no additional cost to the COUNTY, re -perform services which fail to satisfy the foregoing standard of care. 5. INDEPENDENT CONTRACTOR - The CONTRACTOR is an independent contractor and not an employee or agent of the COUNTY except that CONTRACTOR shall be authorized as an agent as follows: To the extent necessary to fulfill its billing and collection efforts under this Agreement, the CONTRACTOR is authorized to execute the following types of standard forms and correspondences only: probate filings; letters to patients or their representatives verifying that an account is paid in full; forms verifying the tax-exempt status of the COUNTY; and insurance filings and related forms. The CONTRACTOR has no authority to sign any other document's except as specifically authorized by the COUNTY. CONTRACTOR undertakes performance of the Services as an independent contractor and shall be wholly responsible for the methods of performance. CONTRACTOR shall work closely with the COUNTY in performing Services under this Agreement. The CONTRACTOR shall retain full control over the employment, direction, compensation and discharge of all persons assisting in the performance of service by CONTRACTOR. The CONTRACTOR shall be fully responsible for all matters relating to payment of employees, including compliance with Social Security, withholding tax and all other laws and regulations governing such matters. The CONTRACTOR shall be responsible for its own acts and those of its agents and employees during the term of this contract. The CONTRACTOR shall not receive any the COUNTY benefits, stipend or privileges afforded by the COUNTY employees. 6. COMPLIANCE WITH LAWS - In performance of the Services, CONTRACTOR will comply with applicable regulatory and other applicable requirements including federal, state, and local laws, rules regulations, orders, codes, criteria and standards. 7. ADDITIONAL REQUIRED STATEMENTS/VERIFICATION/AFFADAVITS — Attached hereto and incorporated herein are Attachments B, C, D, E, and F are Non - Collusion Affidavit, Public Entity Crime Statement, Drug Free Workplace Form, Conflict of Interest Clause and Indemnification to Hold Harmless. 8. INSURANCE — During the term of this contract, the CONTRACTOR must keep in force and affect the insurance required by Attachments G. Attachment G is attached and incorporated into this contract. The insurance coverage and conditions afforded by this policy(s) shall not be suspended, voided, canceled or modified, except after thirty (30) days prior written notice by Certified Mail Return Receipt Requested, has been given to the COUNTY department that originated this contract. Certificates of Insurance meeting the specific required provision specified within this Contract/Agreement shall be forwarded to the COUNTY department that originated the contract, and approved prior to the start of any work or the possession of any the COUNTY property or the commencement of services, as application. 9. MONROE COUNTY'S RESPONSIBILITIES — The COUNTY, during the term of this Agreement, shall: A. Supply the electronic "Run Report" to CONTRACTOR with the necessary patient information on a timely basis for those patients that have been transported by Fire -Rescue Services and in sufficient detail to support diagnosis and procedure coding and make reasonable efforts to provide patient demographic information necessary for accurate patient identification including name, address, social security number, date of birth, and telephone number. B. Provide CONTRACTOR with its approved billing policies and procedures including fee schedules and collection protocols. The COUNTY shall be responsible for engaging any third party collection service for uncollectible accounts after CONTRACTOR has exhausted its collection efforts. C. Make reasonable efforts to timely process refunds identified by CONTRACTOR for account overpayments. D. Provide a Lock Box address to CONTRACTOR and will instruct Lock Box to forward all Lock Box documents to CONTRACTOR for processing. E. Provide for CONTRACTOR to have daily bank balance reporting capabilities via internet access with bank. F. Comply and cooperate with CONTRACTOR in all matters to ensure proper compliance with all Federal, State and local laws rules and regulations as applicable to the services being contracted for. 10. TERMINATION OF AGREEMENT - During the time of this Agreement either party may terminate this Agreement for convenience by first giving to other party at least thirty (30) days prior written notice. Upon notice of termination CONTRACTOR shall take all steps necessary to close out any accounts with an open balance and will be responsible for complying with all provisions of this contract until the termination date. CONTRACTOR will not assume new accounts after such notice of termination. CONTRACTOR will be paid for its services through the termination date and CONTRACTOR will not incur any expense after notice of termination except those necessary to properly wind up its obligations under this contract and properly perform this contract. All money received on accounts by CONTRACTOR after the termination date will be forwarded to the COUNTY without regular compensation being paid to the CONTRACTOR. CONTRACTOR will further cooperate with any successor by turning over all records and any other documents or equipment in hard copy to useable electronic format to the COUNTY or the new billing company. CONTRACTOR will pay the COUNTY all funds due and owing to it as the termination of this contract. The provision for CONTRACTOR to turn over documents and to provide all funds due and owing the COUNTY will survive the termination of this contract. In the event the acts constituting default are a violation of law, CONTRACTOR shall be subject to immediate termination. Notwithstanding the provisions above, the COUNTY shall not have any right to cancel this contract without cause. Upon termination, the CONTRACTOR shall submit an invoice(s) to the COUNTY in an amount(s) representing fees for services actually performed or obligations incurred to the date of effective termination for which the CONTRACTOR has not been previously compensated. Upon payment of all sums found due, the COUNTY shall be under no further obligation to the CONTRACTOR, financial or otherwise. 11. NONDISCLOSURE OF PROPRIETARY INFORMATION - CONTRACTOR shall consider all information provided by the COUNTY and all reports, studies calculations, and other documentation resulting from the Contractor's performance of the Services to be proprietary unless such information is available from public sources or is a public record under Florida law. CONTRACTOR shall not publish or disclose proprietary information for any purpose other than the performance of the Services without the prior written authorization of the COUNTY or in response to legal process or orders of a court of competent jurisdiction. Public Access -The County and Contractor shall allow and permit reasonable access to, and inspection of, all documents, papers, letters or other materials in its possession or under its control, which are public records and which are subject to the provisions of Chapter 119, Florida Statutes, and made or received by the County and Contractor in conjunction with this Agreement; and the County shall have the right to unilaterally cancel this Agreement upon violation of this provision by Contractor. 12. UNCONTROLLABLE FORCES - Neither the COUNTY nor CONTRACTOR shall be considered to be in default of this Agreement if delays in or failure of performance shall be due to Uncontrollable Forces, the effect of which, by the exercise of reasonable diligence, the non -performing party could not avoid. The term "Uncontrollable Forces" shall mean any event which results in the prevention or delay of performance by a party of its obligations under this Agreement and which is beyond the reasonable control of the non -performing party. It includes, but is not limited to fire, flood, earthquakes, hurricanes, storms, lightning, epidemic, war, riot, civil disturbance, sabotage, Acts of God and governmental actions. Neither party shall, however, be excused from performance if non-performance is due to forces which are preventable, removable, or remediable and which the non -performing party could have, with the exercise of reasonable diligence, prevented, removed, or remedied with reasonable dispatch. The non -performing party shall, within a reasonable time of being prevented or delayed from performance by an uncontrollable force, give 4 written notice to the other party describing the circumstances and uncontrollable forces preventing continued performance of the obligations of this Agreement. 13. MISCELLANEOUS A. Non Waiver - A waiver by either the COUNTY or CONTRACTOR of any breach of this Agreement shall not be binding upon the waiving party unless such waiver is in writing and duly signed by both parties to this agreement. In the event of a written waiver, such a waiver shall not affect the waiving party's rights with respect to any other or further breach. The making or acceptance of a payment by either party with knowledge of the existence of a default or breach shall not operate or be construed to operate as a waiver of any subsequent default or breach. B. Severability - The invalidity, illegality, or unenforceability of any provision of this Agreement, or the occurrence of any event rendering any portion or provision of this Agreement void or voidable, shall in no way affect the validity or enforceability of any other portion or provision of the Agreement. Any void or voidable provision shall be deemed severed from the Agreement and the balance of the Agreement shall be construed and enforced as if the Agreement did not contain the particular portion or provision held to be void. The parties fiurther agree to reform the Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision. The provisions of this section shall not prevent the entire Agreement from being held void should a provision which is of the essence of the Agreement be determined to be void by a court of competent jurisdiction. C. Political Campaigns - During the term of this Agreement, the CONTRACTOR or any employee or associate, shall not be involved in any political campaign for the COUNTY elective office nor make financial contribution to any such campaign. D. Contractor Records - Contractor shall maintain all books, records, and documents directly pertinent to performance under this Agreement in accordance with generally accepted accounting principles consistently applied. Each party to this Agreement or their authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records purposes during the term of the Agreement and for four years following the termination of this Agreement. If an auditor employed by the County or Clerk determines that monies paid to Contractor pursuant to this Agreement were spent for purposes not authorized by this Agreement, the Contractor shall repay the monies together with interest calculated pursuant to Sec. 55.03, FS, running from the date the monies were paid to Contractor. E. Attorney's Fees and Costs - The County and Contractor agree that in the event any cause of action or administrative proceeding is initiated or defended by any party relative to the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, court costs, investigative, and out-of-pocket expenses, as an award against the non -prevailing party, and shall include attorney's fees, courts costs, investigative, and out-of- pocket expenses in appellate proceedings. Mediation proceedings initiated and conducted pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and customary procedures required by the circuit court of Monroe County. F. Binding Effect - The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of the County and Contractor and their respective legal representatives, successors, and assigns. G. Authority - Each party represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. H. Claims for Federal or State Aid - Contractor and County agree that each shall be, and is, empowered to apply for, seek, and obtain federal and state funds to further the purpose of this Agreement; provided that all such applications, requests, grant proposals, and funding solicitations shall be approved by each party prior to submission. I. Adjudication of Disputes or Disagreements - County and Contractor agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. If the issue or issues are still not resolved to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy as may be provided by this Agreement or by Florida law. J. Cooperation - In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, County and Contractor agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. County and Contractor specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. K. Nondiscrimination - County and Contractor agree that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. County or Contractor agree to comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title VI of the Civil Rights Act of 1964 (PL 88-352) which prohibits discrimination on the basis of race, color or national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC ss. 1681-1683, and 1685- 1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 USC ss. 6101-6107) which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42 USC ss. 690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug abuse patent records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC s. et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC s. 1201 Note), as maybe amended from time to time, relating to nondiscrimination on the basis of disability; 10) Monroe County Code Ch. 13, Art. VI, prohibiting discrimination on the bases of race, color, sex, religion, disability, national origin, ancestry, sexual orientation, gender identity or expression, familial status or age; and 11) any other nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement. L. Covenant of No Interest - County and Contractor covenant that neither presently has any interest, and shall not acquire any interest, which would conflict in any manner or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this Agreement. M. Code of Ethics - County agrees that officers and employees of the County recognize and will be required to comply with the standards of conduct for public officers and employees as delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting employment or contractual relationship; and disclosure or use of certain information. N. No Solicitation/Payment - The County and Contractor warrant that, in respect to itself, it has neither employed nor retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of the provision, the Contractor agrees that the County shall have the right to terminate this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, commission, percentage, gift, or consideration. O. Privileges and Immunities - All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief, disability, workers' compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the County, when performing their respective functions under this Agreement within the territorial limits of the County shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the County. P. Legal Obligations and Responsibilities: Non -Delegation of Constitutional or Statutory Duties - This Agreement is not intended to, nor shall it be construed as, relieving any participating entity from any obligation or responsibility imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the constitutional or statutory duties of the County, except to the extent permitted by the Florida constitution, state statute, and case law. Q. Non -Reliance by Non -Parties - No person or entity shall be entitled to rely upon the terms, or any of them, of this Agreement to enforce or attempt to enforce any third -party claim or entitlement to or benefit of any service or program contemplated hereunder, and the County and the Contractor agree that neither the County nor the Contractor or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the community in general or for the purposes contemplated in this Agreement. R. Attestations - Contractor agrees to execute such documents as the County may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug -Free Workplace Statement. S. No Personal Liability - No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. T. Execution in Counterparts - This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by singing any such counterpart. 14. INTEGRATION AND MODIFICATION - This Agreement is adopted by the COUNTY and CONTRACTOR as a final, complete and exclusive statement of the terms of the Agreement between the COUNTY and CONTRACTOR. This Agreement supersedes all prior agreements, contracts, proposals, representations, negotiations, letters or other communications between the COUNTY and CONTRACTOR pertaining to the Services, whether written or oral. The Agreement may not be modified unless such modifications are evidenced by an amendment in writing signed by both the COUNTY and CONTRACTOR. 15.OWNERSHIP OF DOCUMENTS - CONTRACTOR shall be required to work• in harmony with other CONTRACTOR'S relative to providing information requested in a timely manner and in the specified form. Any and all documents, records, disks, original drawings, or other information shall become the property of the COUNTY upon completion for its use and distribution as may be deemed appropriate by the COUNTY. Failure to turn over such documents within seven () days of when requested may be cause for the COUNTY to withhold any payments due CONTRACTOR or to enforce this clause by legal remedies. 16. NOTICE - Any notice, demand, communication, or request required or permitted hereunder shall be in writing and delivered in person or sent by certified mail, postage prepaid as follows: As to the COUNTY MONROE COUNTY EMERGENCY SERVICES Attention: Fire Chief James Callahan 490 63Td Street Ocean Marathon, F133050 As to CONTRACTOR Advanced Data Processing Inc. (DBA ADPI-INTERMEDDK) 6451 North Federal Highway, Suite 1002 Fort Lauderdale, FL 33308 Notices shall be effective when received at the address specified above. Changes in the respective addresses to which such notice may be directed may be made from time to time by any party by written notice to the other party. Facsimile is acceptable notice effective when received, however, facsimiles received (i.e. printed) after 5:00 p.m. or on weekends or holidays, will be deemed received on the next business day. The original of the notice must additionally be mailed as required herein. Nothing contained in this Article shall be construed to restrict the transmission of routine communications between representatives of CONTRACTOR and the COUNTY. 17. Monroe County's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Board of County Commissioners of Monroe County, Florida. 18. Venue for any litigation arising under this contract must be in a court of competent jurisdiction in Monroe County, Florida. This Agreement is not subject to arbitration. WHEREOF, each party hereto has caused this contract to be executed by ized representative. L. KOLHAGE, CLERK Clerk MON OE COUNTY ATTORNEY A RO D.A T F M: YNTHIA L..HALL ASSIST NT COOUNTYTATTORNEY BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By: �O ayor BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT 1, OFMONROE COUNTY1�" i� By: Mayor/Chairman Advanced Data Processing, Inc. (DB PI�TERMEDIJ) Print&i� and-Title D04 4 Sho 4, on Date: �.z 9 f /D Approved by MONROE COUNTY on Ram 0 2010, Item # ATTACH]MMNTS AND FORMS: Attachment A Scope of Work Attachment B Non -Collusion Affidavit Attachment C Public Entity Crime Statement Attachment D Drug Free Workplace Form Attachment E Lobbying & Conflict of Interest Clause- (Ethics Clause) Attachment F Indemnification and Hold Harmless Attachment G Insurance Documents 10 Attachment A SCOPE OF WORK The CONTRACTOR shall provide the COUNTY with timely and accurate complete medical billing and accounts receivable management services for the COUNTY'S ground and air rescue transport billing services and related professional services in accordance with the responsibilities outlined as follows: 1. Initial Patient Treatment and information A. On a case by case basis, the COUNTY will respond to patients requiring immediate medical treatment and emergency medical transportation services. Upon treating each patient, the COUNTY shall provide the CONTRACTOR with patient information identified on the "Run Report". CONTRACTOR shall be solely responsible for retrieving insurance information and any additional patient information which was not identified on the "Run Report" provided by the COUNTY. CONTRACTOR shall utilize "Run Report" information and any additional information retrieved by CONTRACTOR to file proper patient billing and insurance information. CONTRACTOR shall establish arrangements with hospitals to obtain/verify patient insurance and contact information. CONTRACTOR shall contact the U.S. Post Office's National Change of Address (NCOA) files or other similar services to obtain the correct billing addresses and phone numbers for patients that have left the area, or whom have invalid information. B. CONTRACTOR shall reconcile the number of patients that are transported for emergency medical services with those received. The CONTRACTOR shall report discrepancies to the COUNTY within three (3) business days of receipt. C. As requested by the COUNTY, CONTRACTOR shall provide the COUNTY'S Fire Rescue Services Paramedics Personnel with training on the gathering of necessary information to be adhered on Run Reports for the purpose of assisting CONTRACTOR with the proper submission and processing of patient data. 2. Patient Billins A. CONTRACTOR shall mail an invoice to each patient for emergency transportation service at current rates set forth by the COUNTY as follows: Ground Ambulance: $600.00 for Basic Life Support (BLS) $600.00 for Advance Life Support One (ALSI) $800.00 for Advance Life Support Two (ALS2) $12.00 per mile Air Ambulance: $5500.00 for Air Ambulance Transport Fee $80.00 per mile it B. The aforementioned rates shall be subject to change at the COUNTY'S discretion at any time throughout the term of the agreement; the COUNTY agrees to notify CONTRACTOR a minimum of seven (7) days prior to any rate changes. C. The CONTRACTOR shall provide all self pay patients with a comprehensive statementlinvoice including a courtesy return payment envelope. The front of the statement shall describe all charges and payments. The reverse side of the statement shall have clearly marked entry blocks for information needed to file private insurance claims. CONTRACTOR shall file claims and send an invoice to all self pay patient/payors with return envelope and address as specified by the COUNTY within five (5) days of receipt of incident information. Subsequent invoices to self -pay patient/payor will be sent at thirty-five (35) day intervals, up to a maximum of six invoices. CONTRACTOR shall send one initial statement/invoice to a patient for whom Medicare, Medicaid or private insurance (payor) information is available when an account is filed to the insurance company. These statements will be mailed at 45 days from filing the insurance claim. Thereafter, CONTRACTOR will send a maximum of six invoices to payor. In the course of time that the six invoices are sent to patient/payor and payment in full has not yet been received, CONTRACTOR shall provide follow-up on rejected and inactive claims and establish payor remittance accounts and procedures. In the case of patients for whom payor information is available, CONTRACTOR at that time shall resume sending invoices to patient and shall, within fourteen (14) days of receiving a final decision from the payor, send a maximum of five (5) additional invoices to the patient every thirty-five (35) days thereafter in an attempt to collect the claim. Unless insurance, Medicare, Medicaid or secondary insurance payment is pending, CONTRACTOR shall on a monthly basis send all eligible accounts that have not had activity for 210 days or more from the date of service a Pre - Collection Letter. The Pre -Collection Letter will be provided to the CONTRACTOR by the COUNTY. These accounts have thirty (30) days to. respond to the CONTRACTOR. Once the thirty (30) days have expired, the CONTRACTOR shall send the COUNTY a list of all accounts along with a complete processing history once collection efforts are exhausted. These uncollectible accounts will be forwarded by the CONTRACTOR onto a third party collection agency named by the COUNTY for further attempts at collecting. These accounts sent to the third party collection agency will be sent via a secure site provided by the CONTRACTOR. The CONTRACTOR will continue to work with the third party collection agency on a case by case basis for those accounts requiring additional information. D. CONTRACTOR shall negotiate and arrange modified payment schedules for patients unable to pay the full amount when billed. CONTRACTOR shall not reduce the amount owed and shall not negotiate settlements. All settlement requests shall be forwarded to the COUNTY for review, processing and BOARD approval. 12 E. CONTRACTOR shall process refund requests within the month following an overpayment and provide the COUNTY with documentation substantiating each refund requested. F. Where CONTRACTOR has found no method of payment for a patient after all insurance avenues are exhausted including State Medicaid and local HRS or municipal programs, such cases that cannot be forwarded to the collection agency will be submitted to the COUNTY in writing once a year, for final resolution along with appropriate documentation (i.e. hospital credit status, credit file information, activity file). At the instruction of the COUNTY, CONTRACTOR shall write off any amounts or make any adjustments to a bill, including, but not limited to; patient disputes regarding mileage, special handling charges or the bill in its entirety. G. CONTRACTOR shall provide the COUNTY with real-time read only electronic look -up access of CONTRACTOR'S patient data and billing information system. CONTRACTOR shall provide the facilities to receive patient billing information from the COUNTY electronically. CONTRACTOR- This may be done through email or other method that meets Patient Privacy requirements. H. Via Resolution 152-2009, the COUNTY provides a Trauma Star Air Ambulance Resident Fee Waiver Program, whereby the COUNTY has agreed to accept insurance proceeds as full payment for the air transport using Trauma Star for qualified residents (trauma scene and interfacility transport). CONTRACTOR shall provide all air ambulance accounts with a Trauma Star Air Ambulance Resident Fee Waiver Program application in each monthly statement. This application will be provided to the CONTRACTOR by the COUNTY. The application contains eligibility requirements for the Trauma Star Resident Fee Waiver Program and directs the patient on how to apply. The CONTRACTOR will provide the COUNTY with all completed applications for verification and determination. The COUNTY will notify the CONTRACTOR of the conclusion on all applications. The CONTRACTOR will verify that all billing sources. have been exhausted and then place a hold on all Approved accounts. The CONTRACTOR will adjust balances on these accounts as directed by the COUNTY. I. CONTRACTOR shall not bill Monroe County Sheriff's Office or Monroe County for transportation services rendered via Trauma Star to arrestees, which are arrested for violation of state law or county ordinance, when all other reimbursement sources have been sought since the transportation services are already funded by Monroe County and to bill for such services would be a misuse of time and resources per Resolution #449-2009 approved November 18, 2009. 3. Patient Filing A. CONTRACTOR shall file all insurance claim forms for all patients based upon information received from Run Report and research performed by 13 CONTRACTOR. CONTRACTOR shall provide prompt submission of required paperwork to Medicare, Medicaid, Insurance Companies or Third Party Payers for claims, reviews, resubmission, provider agreements and other as required within 72 hours after receiving the requested "Run Report" from the COUNTY. CONTRACTOR shall submit secondary insurance provider claims after the primary insurance provider has paid within 30 days after receipt of payment from primary insurer. Upon receipt of notice of claim denial, requirement for additional information, Explanation of Benefits reflecting underpayment or other notice requiring submission of documents to the third party provider CONTRACTOR shall within 45 days re -file Medicare, Medicaid, or Insurance claims to obtain payment. CONTRACTOR shall maintain responsibility for obtaining missing or incomplete insurance information. CONTRACTOR shall process all third party reimbursements within one week after receipt of appropriate billing information from primary payor. B. CONTRACTOR shall utilize the most up-to-date knowledge and information with regard to coding requirements and standards and proper preparation of electronic and paper insurance filings to ensure compliance with applicable Federal, State and local regulations. 4. Maintaining Records A. CONTRACTOR shall maintain records in an electronic format that is readily accessible by the COUNTY and meets all federal and state requirements for maintaining patient medical records. B. CONTRACTOR shall maintain appropriate accounting procedures for reconciling all deposits, receivables, billings, patient accounts, adjustments and refunds. C. CONTRACTOR shall facilitate proper security of confidential information and further shred and dispose of materials containing such information. D. CONTRACTOR shall implement and comply with a Compliance Plan consistent with the intent and activities included in the U.S. Office of Inspector General (OIG) Compliance Program Guidance for Third Party Medical Billing Companies 63 FR 70138; (December 18, 1998). E. CONTRACTOR shall retain all accounts for a minimum of twelve (12) months (unless otherwise specified by mutual agreement). F. CONTRACTOR shall ensure that all required documentation and agreements with payors (e.g. Medicare, Medicaid, Champus, etc.) are filed and maintained and that the COUNTY is kept apprised of important changes to industry regulations. G. CONTRACTOR shall be knowledged of different industry insurance plans and shall ensure the COUNTY that every billable claim is pursued accordingly by CONTRACTOR. H. CONTRACTOR shall advise the COUNTY on statutes and industry regulations which would affect emergency transportation service rates. 5. Customer Service: A. CONTRACTOR shall provide a toll free telephone number for patients with CONTRACTOR'S own facilities and workforce. CONTRACTOR'S toll free 14 telephone number must be a dedicated phone number only for accounts from the COUNTY. CONTRACTOR shall provide a designated liaison for patient/payor concerns. B. CONTRACTOR shall conduct all written and verbal communication in the most professional manner. The CONTRACTOR shall never in any way represent them in a way that might be interpreted as intimidating or threatening. C. CONTRACTOR shall respond within three (3) business days of any verbal or written requests made by Patients and/or the COUNTY for information or records. CONTRACTOR shall assist patients that are not able to speak the English language. Difficult calls such as, but not limited to: special insurance issues, taxpayer questions, irate calls shall be handled in a professional manner by a supervisor employed with CONTRACTOR'S firm. D. CONTRACTOR shall provide all customer inquiry services and prepare additional third -party claims or patient payment arrangements based on this information exchange. E. At the COUNTY' S request, CONTRACTOR shall provide survey questionnaires or mail inserts to patients. CONTRACTOR shall mail requested citizen satisfaction surveys. F. CONTRACTOR shall provide for facilities to permit dial -up access to retrieve patient data and billing information. 6. Audits A. CONTRACTOR shall provide access to the COUNTY for all requested information in order for the COUNTY to perform appropriate and periodic audits. The COUNTY will provide CONTRACTOR with reasonable notice for any planned audit and CONTRACTOR shall conduct audit during normal business hours. 7. Monthly Reports Unless otherwise indicated, CONTRACTOR shall provide the following reports on a monthly basis as identified and prescribed by the COUNTY. Monthly reports shall be produced after the month's closing and provided to the COUNTY no later than the tenth of each month. Ground and Air Rescue accounts will be reported separately. A. Ambulance Unit Report: On a monthly basis, CONTRACTOR shall provide a report of number of calls and gross billed by ambulance unit for the current period. B. Ambulance New Billing Report: CONTRACTOR shall produce a report showing all billing (new charges) processed alpha sorted by Last Name and summarized total billing for period. CONTRACTOR shall add column for date received from the COUNTY. C. Ambulance Payment Report: CONTRACTOR shall provide a batch oriented listing of all payments processed including check number and type of payment (self pay, Medicare, Medicaid, private insurance). 15 D. Gross Collection Statistics Summary: CONTRACTOR shall provide a running summary of Interfacility transactions including monthly amount billed, collected, Percentage collected, number of Accounts and Gross Billed. E. Schedule of Transport Charges & Collections: CONTRACTOR shall provide a running month summary of charge, payment and adjustments for the closing month period showing gross and net collection percentages for each period. Information provided shall be for last five fiscal years only. F. Report of Accounts Receivable: CONTRACTOR shall provide a summary for period ending of Accounts Receivable showing gross billing, payments received/processed, reflected write-offs and adjustments, reversals and ending balance. G. Monthly Billing and Collection Summary: CONTRACTOR shall produce a report showing receivables as applied to month running or original billed month. Information provided shall be for last five fiscal years only. H. Insurance Receivable Report: CONTRACTOR shall provide a summary of billed month the number of patient bills having an outstanding insurance balance. This will show the balance and number of bills outstanding by class. I. Collection by Financial Class: CONTRACTOR shall provide a running month summary for the closing month period of collections by Payor Class (Self -Pay, Medicare, Medicaid and Private Insurance). CONTRACTOR shall denote billing numbers for each category and total. Information provided shall be for last five fiscal years only. J. Collection Schedule: CONTRACTOR shall provide a running summary of collected amounts to include monthly, fiscal and cumulative amounts. K. Ambulance Billing Adjustments -Write Offs -Reversals: CONTRACTOR shall provide a running summary showing all adjustments, write-offs and reversals from Medicare, Medicaid and Insurance. L. Report of Accounts Receivable Removed: CONTRACTOR shall provide a report showing Accounts sent to Collections with Original Amount Billed, Payments made, Adjusted Amounts and Balance owed. These accounts will have had'do activity for 12 months or more. This report will only be provided on the months that the CONTRACTOR sent accounts to collections. M. Report by Incident Date: CONTRACTOR shall provide a report by account detail of all accounts outstanding to include Original Amount billed, Adjusted Amount, and Balance due. N. Monthly Refund Schedule: CONTRACTOR shall provide a report by account detail of associated payments reflecting an overpayment and necessary refund to be processed. 0. A ig_ng Report: On a monthly basis, CONTRACTOR shall provide a report which lists patients' accounts receivable amounts by age to alert the COUNTY of any slow paying patients. P. Timeliness of Billing Report: On a monthly basis, CONTRACTOR shall provide a report which lists the number of times invoices were sent to each patient. This 16 report will be used by the COUNTY to verify compliance with Attachment A Section B2 of the Agreement. Q. Air Ambulance Resident Waiver Report: On a monthly basis the CONTRACTOR shall provide a report which lists the air transport accounts that have been approved for the Trauma Star Resident Fee Waiver Program. These accounts will be placed on hold until the COUNTY directs the CONTRACTOR to adjust the balances. 8. Health Insurance Portability and Accountability Act of 1996 (HIPAA) The CONTRACTOR shall comply with the privacy regulations pursuant to Public Law 104-191 of August 21, 1996, known as the Health Insurance Portability and Accountability Act of 1996, Subtitle F — Administrative Simplification, Sections 261, et seq., as amended ("HIPAX), to protect the privacy of any personally identifiable protected health information ("PHI') that is collected, processed or learned as a result of the Billing Services provided hereunder. A. CONTRACTOR shall not use or further disclose PHI except as permitted herein or required by law. B. CONTRACTOR shall use appropriate safeguards to prevent use or disclosure of PHI except as permitted herein. C. CONTRACTOR shall mitigate, to the extent practicable, any harmful effect that is known to CONTRACTOR, its agents or subcontractors of a use or disclosure of PHI by the CONTRACTOR, its agents or subcontractors. D. CONTRACTOR shall report to the COUNTY any use or disclosure of PHI not provided for by this Agreement of which the CONTRACTOR, its agents or subcontractors become aware. E. CONTRACTOR shall ensure that any agents or subcontractors to whom the CONTRACTOR provide PHI or who have access to PHI, agree to the same restrictions and conditions that apply to the CONTRACTOR with respect to such PHI. F. CONTRACTOR shall make PHI available to the COUNTY and to the individual who has a right of access as required under HIPAA within 30 days of the request by the COUNTY regarding the individual. G. CONTRACTOR shall incorporate ally amendments to PER when notified to do so by the COUNTY. H. CONTRACTOR shall provide an accounting of all uses or disclosures of PHI made by the CONTRACTOR its agents or subcontractors as required under the HIPAA privacy rule within sixty (60) days. I. CONTRACTOR shall make their internal practices, books and records relating to the use and disclosure of PHI available to the Secretary of the Department of Health and Human Services for purposes of determining the CONTRACTOR'S, its agents' and subcontractors' and the COUNTY'S compliance with HIPAA. J. CONTRACTOR shall at the termination of the agreement, return or destroy all PHI received from, or created or received by the CONTRACTOR, its agents or 17 subcontractors on behalf of the COUNTY and if return is infeasible, ensure that the protections of this Agreement will extend to such PHI. K. The specific uses and disclosures of PHI that may be made by the CONTRACTOR, its agents or contractors on behalf of the COUNTY include: 1) Preparation of invoices to patients, carriers, insurers and others responsible for payment or reimbursement of the services provided by the COUNTY to its patients. 2) Preparation of reminder notices and documents pertaining to collections of overdue accounts. 3) The submission of supporting documentation to carriers, insurers and other payers to substantiate the health care services provided by the COUNTY to its patients or to appeal denials of payment for same. 4) Other uses or disclosures of PHI as permitted by the HIPAA privacy rule. 5) Mail HIPAA Notice of Privacy Practices to all emergency transport patients within the timeframe allowed under the HIPAA and FD PAA rules. 6) Mail subpoenas, attorney's requests to Fire Rescue immediately upon receipt 9. Lockbox A. The County will provide a Lock Box address to the CONTRACTOR and will instruct Lock Box to forward all Lock Box documents to CONTRACTOR for payment processing. B. Price for services does not include the cost of "Locked -box" service. The COUNTY shall bear the cost of the Locked -box. C. The County will provide the CONTRACTOR access to have daily bank balance reporting capabilities via internet access with Lockbox bank. D. The "Locked -box" service selected shall be at the sole discretion of the COUNTY and shall provide a secure postal address and box for receipt of -all correspondence (especially including all insurance and patient payments, correspondence and benefits determination and denials). The "Locked -box" service will on a daily basis perform the following: 1) Open all mail (except clearly marked returned -mail). 2) Make a copy of every check and attach copy with original document accompanying each check. 3) Deposit all receivables into designated the COUNTY account. 4) Prepare and provide a daily deposit slip totaling and accounting for all receivables deposited for the identified day. 5) Mail (daily) to the CONTRACTOR separated bundles of; copies of checks attached to supporting documents, other correspondence and, returned - mail along with deposit slip. 6) Mail (daily) to the COUNTY copies of checks and daily dOeposit slip. 7) Mail (monthly) to the COUNTY reconciliation of account. 18 E. CONTRACTOR shall maintain daily deposit control sheets and original documentation. �� 10 Attachment B NON- COLLUSION AFFIDAVIT rrn JA city of r-4 t u _ , JA. L- and under penalty of perjury, depose and say that; of the to law on my oath, 1) I am2t ce,,-L,,,1 44, . c cezz ,fin •, the respondent making the Proposal for the project described as follows: �r•t,�JairT Y�i /I1t<c�( 2) The prices in this proposal have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other respondent or with any competitor; 3) Unless otherwise required by law, the prices which have been quoted in this proposal have not been knowingly disclosed by the respondent and will not knowingly be disclosed by the respondent prior to proposal opening, directly or indirectly, to any other respondent or to any competitor; and 4) No attempt has been made or will be made by the respondent to induce any other person, partnership or corporation to submit, or not to submit, a proposal for the purpose of restricting competition; and 5) The statements contained in this affidavit are true and correct, and made with full knowledge that Monroe County relies upon the truth of the statements contained in this affidavit in awarding contracts for said project. STATE OF F/n/Zl-j COUNTY OF &060a,k Signature of Respondent) �/2f/D Date PERSONALLY APPEARED BEFORE ME, the undersigned authority, bdC.( JAu-m art who, after first being sworn by me, (name of individ al signing) affixed his/her signature in the space provided above on this a� day of 20 is n My commdsion expir : 5// z� 2 o 13 NOTARY PUBLIC OMB - MCP FORM #1 20 roY Ile Notary Public State of Fionda Cindy R Gardner �� My Commlasion DD878720 %'for OF Expires 05112i2013 Attachment C PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a proposal on a contract to provide any goods or services to a public entity, may not submit a proposal on a contract with a public entity for the construction or repair of a public building or public work, may not submit proposals on leases of real property to public entity, may not be awarded or perform work as a bidder, supplier, subbidder, or RESPONDENT under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, Florida Statutes, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list." By executing this form, I acknowledge that Vmy company is in compliance with the above. STATEOF plorr'i d Q COUNTY OF &-ooark /11-12 (Signs a of Respondent) � /,z 4 ho Date PERSONALLY APPEARED BEFORE ME, the undersigned authority, 1J0u4 dAAma i who, after first being sworn by me, (name of individual signing) affixed his/her signature in the space provided above on this day of i- , 20 iv Cn � 4 A4-4- My commis ion expires: 5 /11 z-u1 3 NOTARY PUBLIC =oA►sY Pugh Notary Public Slate of Flonda Cindy R Gardner y My Commission DD879720 '40� nod Expires 05/12/2013 21 Attachment D DRUG -FREE WORKPLACE FORM The undersigned Respondent in accordance with Florida Statute 287.087 hereby certifies that: Advanced Data Processing Inc. QBA ADPI Intermedix) (Name of Business) 1. Publishes a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Informs employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug -free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Gives each employee engaged in providing the commodities or contractual services that are under proposal a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notifies the employees that, as a condition of working on the commodities or contractual services that are under proposal, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendre to, any violation of Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Imposes a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who is so convicted. 6. Makes a good faith effort to continue to maintain a drug -free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. al�:!— Respondefits Signature y%y//v Date OMB - MCP FORM #5 22 Attachment E LOBBYING AND CONFLICT OF INTEREST CLAUSE SWORN STATEMENT UNDER ORDINANCE NO.10-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE I A dv c. &A,4 bowi )Li , T 1. warrants that he/it has not employed, retained or otherwise had act on his/its behalf any former County officer or employee in violation of Section 2 of Ordinance No. 10-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 10-1990. For breach or violation of this provision the County may, in its discretion, terminate this contract without liability and may also, in its discretion, deduct from the contract or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee. 1 C-1 /(Signature) Date: 417-0 /11) STATE OF rCIOri d 4- COUNTY OF &VWO-rk PERSONALLY APPEARED BEFORE ME, the undersigned authority, byLjq Sn2m a who, after first being sworn by me, affixed his/her signature (name of individual signing) in the space provided above on this day of , 20 /U . �nR. /z4-"-t VOTARY PTJBLIC My commission expires: t9 //s/;L o i 3 OMB - MCP FORM #4 ae,pY pw� Notary public State of Florida Cindy R Gardner y, My. Commisslon 00079720 "+or n Expires 05112/2013 23 Attachment F MONROE COUNTY, FLORIDA RISK MANAGEMENT POLICY AND PROCEDURES CONTRACT ADMINISTRATION MANUAL Indemnification and Hold Harmless for Other Bidders and Subbidders The Bidder covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners AND Board of Governors for District L its servants, agents and employees from any and all claims for bodily injury (including death), personal injury, and property damage (including property owned by Monroe County) and any other losses, damages, and expenses (including attorney's fees) which arise out of, in connection with, or by reason of services provided by the Bidder or any of its Subbidder(s) in any tier, occasioned by the negligence, errors, or other wrongful act or omission of The Bidder or its Subbidders in any tier, their employees, or agents. In the event the completion of the project (to include the work of others) is delayed or suspended as a result of the Bidder's failure to purchase or maintain the required insurance, the Respondent shall indemnify the County from any and all increased expenses resulting from such delay. The first ten dollars ($10.00) of remuneration paid to the Respondent is for the indemnification provided for above. The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements contained elsewhere within this agreement. Signature ?/2.9�id Date TCS 24 Attachment Cr (1 of 4) INSURANCE REQUIREMENTS FOR CONTRACT GROUND AND AIR RESCUE TRANSPORT BILLNG AND RELATED SERVICES BETWEEN MONROE COUNTY, FLORIDA AND ADVANCED DATA PROCESSING INC. (DBA ADPI-INTERMEDIX) Prior to the commencement of work governed by this contract, the Contractor shall obtain General Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum: • Premises Operations • Products and Completed Operations • Blanket Contractual Liability • Personal Injury Liability • Expanded Definition of Property Damage The minimum limits acceptable shall be: $500,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $250,000 per Person $500,000 per Occurrence $ 50,000 Property Damage An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (12) months following the acceptance of work by the County. The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. GL2 25 Attachment G (2 of 4) PROFESSIONAL LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT GROUND AND AIR RESCUE TRANSPORT BILLNG AND RELATED SERVICES BETWEEN MONROE COUNTY, FLORIDA AND ADVANCED DATA PROCESSING INC. (DBA ADPI-INTERMEDIIQ Recognizing that the work governed by this contract involves the furnishing of advice or services of a professional nature, the Contractor shall purchase and maintain, throughout the life of the contract, Professional Liability Insurance which will respond to damages resulting from any claim arising out of the performance of professional services or any error or omission of the Contractor arising out of work governed by this contract. The minimum limits of liability shall be: $500,000 per Occurrence/$1,000,000 Aggregate PR02 26 Attachment G (3 of 4) VEHICLE LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT GROUND AND AIR RESCUE TRANSPORT BILLNG AND RELATED SERVICES BETWEEN MONROE COUNTY, FLORIDA AND ADVANCED DATA PROCESSING INC. (DBA ADPI-INTERMEDIX) Recognizing that the work governed by this contract requires the use of vehicles, the Contractor, prior to the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum, liability coverage for: • Owned, Non -Owned, and Hired Vehicles The minimum limits acceptable shall be: $300,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $100,000 per Person $300,000 per Occurrence $ 50,000 Property Damage The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. VL2 0M Attachment G (4 of 4) WORKERS' COMPENSATION INSURANCE REQUIREMENTS FOR CONTRACT GROUND AND AIR RESCUE TRANSPORT BILLNG AND RELATED SERVICES BETWEEN MONROE COUNTY, FLORIDA AND ADVANCED DATA PROCESSING INC. (DBA ADPI-INTERMEDIX) Prior to the commencement of work governed by this contract, the Contractor shall obtain Workers' Compensation Insurance with limits sufficient to respond to the applicable state statutes. In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than: $500,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $500,000 Bodily Injury by Disease, each employee Coverage shall be maintained throughout the entire term of the contract. Coverage shall be provided by a company or companies authorized to transact business in the state of Florida. If the Contractor has been approved by the Florida's Department of Labor, as an authorized self -insurer, the County shall recognize and honor the Contractor's status. The Contractor may be required to submit a Letter of Authorization issued by the Department of Labor and a Certificate of Insurance, providing details on the Contractor's Excess Insurance Program. If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be required. In addition, the Contractor may be required to submit updated financial statements from the fund upon request from the County. WC2 28 Attachment G (4 of'4) MONROE COUNTY, FLORIDA Request for Waiver of Insurance Requirements It is requested that the insurance requirements, as specified in the County's Schedule of Insurance Requirements, be waived or modified on the following contract. Contractor: Contract for: Address of Contractor: Phone: Scope of Work: Reason for Waiver: Policies Waiver will apply to: Signature of Contractor: Approved Not Approved Risk Management Date County Administrator appeal: Approved: Not Approved: Date: Board of County Commissioners appeal: Approved: Not Approved: Meeting Date: 29 F.YIYCIVI�SV 2-M-R& CERU C TE OF LOAQOLOTY ON80J ANCE DATE(L9LNJfDLTIYYYY) PRanUCF� 07102(09 Wells Fargo Insurance Services USA, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4401 NOrthslds Pkwy, SWIG 400 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Atlanta, GA 30327-3078 ALTER THE COVERAGE AFFORDED BV Ti9E POLICIES BELOW. 770 850-0050 INSURED INSURERS AFFORDING COVERAGE NAIL III MCI Holdings, LLC INSURERA. St Paul Fire & Marine Insurance Co 24767 Advanced Data Processing, Inc. INSURER a. The Standard Fire Insurance Company 19070 6451 North Federal Highway, Suite 1002 INSURERC: Fort Lauderdale, FL 33308 INSURER D.- :OVERAGES INSURERE. THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH BY PAID CLAIMS. TL NSR TYPE OF INSURANCE I A GENERALLWBILI Y TEOI X COMMERCWL.GENERAL LIABILITY CLAIMS MADE ® OCCUR GEN'L AGGREGATE UMn APPLIES PER: POLICY M M LOC A AUTOMOBILE LIABILITY TE01 X ANY AUTO ALLOWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON.OWNEDAUTOS ANY AUTO DEDUCTIBLE 06/30/09 106130/10 1 EACH 06/30109 _ 106130/10 106 06/30/09 06/30/10 CC), "'. B WOREMPLERS OYERs, ABILeAnoNAxD HCU83240M13609 06130109 06/30/10 EMPLOYERS•uAsuJTY ANY PROPRIETOR/PARTNERIDLECUTLVE OFRCERIMEMSER EXCUIDED? I . daic,i,e under PROV19 NS OTHER DESCRIPTION OF OPERATIONS! LOCATIONY! VEHICLES! EKCWSIONS ADDED 8Y ENGORBI]Ills?IT 18PECUIL PROVISIONS If required by written agreement. the Monroe County Board of County Commissioners is Included as an additional insured under the general, automobile, and umbrella liability Insurance. Monroe County Board of Commissioners 490 63rd Street, Suite 170 Marathon, FL 33050.1026 ACORD 25 (2001/08)1 of 2 #S74963581M7492141 a aeNeEM) INOtL' uMlr $1,000,000 1( BODILY INJURY = (perpa—n) BODILY JURY = �Pu-rMAGE _ AUTO ONLY-EAACCIDENT IS OTHER EAACC = ATO ONLY:THAN U SHOULD ANY OF THE ABOVE DESCRRIED POLICIES BE CANCELLren BEFORE THE EXPIRATION GATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OSUaATNIN OR LIABILITY OF ANY HIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. REPRESENTATIVE i90 a►2. ESE01 0 ACORD CORPORATION 1988