ࡱ> { bjbjzz  RINNT(H$ :&(b&b&b&'d) p*oGqGqGqGqGqGqG$NJMVG*''**Gb&b&4jH+++*Rb&b&oG+*oG++o@Bb&p.@J+RA([GH0HA:VM+^VM4BBJVM7C$**+*****GG+***H****VM*********N n:  Request for Quotations Personal Services University Health and Counseling &Testing Center Business Model Consultation Quotations due by: April 29, 2013, at 5:00pm Contact: Michael Eyster Phone: 541-346-8393 Fax: 541-346-8863 Email: meyster@uoregon.edu Department: Student Affairs Address: 6210 University of Oregon, Eugene, OR 97403-6210 Submittal Instructions: Enter the requested information on the Request for Quotations (RFQ) form, print and sign it. Prepare your complete response, including the RFQ form and any additional documents. Submit the complete response via email, facsimile or US mail to the department contact noted above. General Information: The State Board of Higher Education acting by and through the University of Oregon on behalf of the University Health and Counseling & Testing Center (University) is issuing this RFQ for the procurement of personal services as described in the Scope of Work section below. Use this form to submit your signed quotation pursuant to the submittal instructions by the date and time shown above. Additional documents may be included as part of the response, provide all documents in Word format. If you do not use this form your quote may be deemed non-responsive. If you do not sign this Request for Quotations form or submit it to University by the due date and time, your quote will be deemed non-responsive and will not be considered for award. By providing a quote in response to this RFQ, Contractor agrees to the terms and conditions contained in this RFQ and further agrees to the Personal Services Contract Standard Contract Provisions found at  HYPERLINK "http://pcs.uoregon.edu/content/forms" http://pcs.uoregon.edu/content/forms. Any contract resulting from this RFQ will be subject to the Personal Services Contract Standard Contract Provisions. Quotations submitted that contain any exceptions or modification to the terms and conditions contained in this RFQ or the Personal Services Contract Standard Contract Provisions, may be deemed non-responsive by University in its sole discretion. If modifications to the Personal Services Contract Standard Contract Provisions are requested the sections and specific modifications must be provided. Separate terms to replace the Personal Services Contract Standard Contract Provisions in its entirety will not be considered. Quotes submitted in response to this RFQ will be retained by the University for the required retention period and made a part of the file or record that will be open to public inspection. If a response contains any information that is considered a trade secret under ORS 192.501(2), mark each page containing such information with the following legend: TRADE SECRET. The Oregon public records law exempts from disclosure only bona fide trade secrets, and the exemption from disclosure applies unless the public interest requires disclosure in the particular instance. Non-disclosure of documents or any portion thereof or information contained therein may depend on official or judicial determinations made pursuant to law. An entire response to this RFQ marked as trade secret is unacceptable, and all parts of such quote will be deemed available for public disclosure.  FORMCHECKBOX  Insurance Requirements: If checked, the specified insurance is required for any contract resulting from this RFQ. See Attachment D included in this RFQ, Personal Services Contract Insurance Requirements.  FORMCHECKBOX  Additional Terms and Conditions: If checked, this quotation is subject to additional University terms and conditions attached and titled:  FORMTEXT       University Health and Counseling & Testing Center Business Model Consultation Scope of Work: The University of Oregon seeks professional consultation on potential changes to the business model for providing University health and counseling services. Testing services within the Counseling and Testing Center will not be evaluated under this project. Currently the health and counseling services are primarily funded by a segregated health fee charged to all students with minimal user fees for some services. The University currently does not bill insurance companies directly and does not have a mandatory health insurance requirement for students. The consultant will provide information to the University to ensure that all important factors are taken into consideration as the University considers changing the business model to one where University bills insurance companies for services rendered in conformance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and its amendments. An anticipated outcome of this business model is that the University would become less reliant upon the health fee and more reliant on insurance payments to cover the costs of providing health and counseling services. The consultant will provide a written report that: Advises the University on advantages and disadvantages of changing the business model to bill fees-for-service, including directly billing insurance companies. Services to be considered for billing to insurance companies include: medical office visits, immunizations, all clinical procedures, and activities performed in our ancillary services (e.g., lab, x-ray, prescriptions, physical therapy, massage, acupuncture, dental) from the Health Center, and individual and group psychotherapy at the Counseling & Testing Center. Assesses revenue and cost impacts of this business model on service areas of the Health Center and Counseling & Testing Center. Analysis of current income and projections for third party billing/participation. Assessment of financial performance of service areas and funding requirements. Impact on the current cost of office visits and student fees. Identifies costs and fee structure required for implementing fees-for-service business model and for billing and participating with insurance companies. Projects impact of fees-for-service/insurance billing on defined service areas of the Health Center and Counseling & Testing Center; impact on various student populations (e.g., students with SHIP, other insurance, high deductable health plans, uninsured). Identifies options to mitigate access concerns associated with this business model. Identifies changes in policy, practice, staffing and budget that the Health Center and Counseling & Testing Center would have to undergo in order to implement this business model, including: HIPAA compliance (version 5010) Staffing Initial cost of making this change Issues related to compliance, regulations Implications of the current voluntary health insurance policy Anticipated cost of uncompensated care at the Health Center and Counseling & Testing Center Review Oregon Administrative Rules that apply to the Health Center and the Counseling and Testing Center. Propose changes as appropriate. Proposes a billing option for students that maintains student confidentiality. Evaluates scope of services that may be provided to faculty and staff and impact on the Health Center. At present the Health Center is supported by a segregated health fee and user fees-for-service which account for about 80% and 20% of the overall budget, respectively. The consultant is requested to identify the separate conditions under which the Health Center can change the financial mix to 25%, 50%, and 75% fees-for-service revenue. In performing this exercise, the consultant is requested to provide the appropriate fees-for-service schedules, staffing, and policies and procedures to satisfy the three separate financial support scenarios. Similar analysis will be conducted for individual group and psychotherapy at the Counseling and Testing Center. Identifies any specific needs and/or differences that should be taken into consideration regarding the way in which 3rd party billing might be implemented in the Health Center and the way it is implemented in the Counseling and Testing Center. Explore the feasibility and make a recommendation on possible benefits, including economies of scale, to be achieved by the Health Center and the Counseling &Testing Center sharing the insurance billing responsibilities and operations. Advise University on an implementation schedule for a new business model including the 3rd party billing. Identify key benchmarks with target dates. Consulting services will include an initial visit by consultant to University campus to meet with Health Center and Counseling & Testing Center leadership and financial staff, as well as others from the University. The purpose of the visit is to gain a full understanding of current operations as well as a full understanding of the University intent in exploring the business model based upon billing insurance companies. The consultant will make a return visit to University campus to review the report, including findings and recommendations with University leadership. Project to be completed, including final presentation, no later than August 15, 2013. Qualifications: Demonstrated experience in: Consulting with university health centers and counseling centers Creating business and financial models for university health centers and counseling centers Insurance billing as a means to support operations. Submittals: Business name, address, telephone number and email. Responses must include a full description of how responder would approach this project and fully address all system requirements listed in the Scope of Work above. Provide names, titles and qualifications of the key personnel who will be assigned to this project, including subcontractors. Include concise business biographies or resumes of key personnel who will be doing the work described in the response. This information must include their areas of expertise, and their experience with projects of similar scope and nature. Provide sufficient evidence of financial capability to meet the responsibilities to perform the contract which may include balance sheets, income statements, financial statements, independent financial compilation/review or other financial information whereby University can determine responders credit rating or financial capability. It will be at University sole discretion to determine if evidence submitted is sufficient to determine financial capability. University reserves the right to request further information as needed for clarification purposes. Include a detailed description of procedures and other aspects of the working relationship expected between project manager and Universitys representative, as well as any other information deemed necessary for the fulfillment of the awarded contract. Include a description of experience performing projects similar in type and magnitude to the subject of this Alternative Procurement. Include a minimum of three examples. Include a list of three clients and contact information for whom similar projects have been completed by the responder. These clients may be contacted by University for an evaluation and assessment of the responders performance. A proposed timeline with breakdown of time allocated for delivery of all deliverables identified in the Statement of Work above and address ability to meet the requested project completion date of August 15, 2013. An itemized budget of cost estimates for work to be performed to complete the project. The itemized budget must set forth a total price. Provide any other information, documents, or materials you wish. Contractor s Proposed Statement of Work (SOW) Details To streamline the quote and contracting review process, fill in the SOW details below. Project Name:  FORMTEXT       Contractor Full Legal Name:  FORMTEXT       Contract Term:  FORMTEXT       Proposed Start Date:  FORMTEXT       Proposed End Date:  FORMTEXT       Price Quote for Services:  FORMCHECKBOX Fixed Fee:  FORMTEXT        FORMCHECKBOX Variable Fee  Define Structure (ie. Rate per hour or per deliverable):  FORMTEXT       Maximum Not to Exceed: $ FORMTEXT       Deliverables: Contractor will provide to University the following deliverables: No.Description of Deliverables/Tasks/MilestonesResponsible PartyDue Date or Estimated DurationFee/Rate 1. FORMTEXT    FORMTEXT   FORMTEXT   FORMTEXT  2. FORMTEXT    FORMTEXT   FORMTEXT   FORMTEXT  3. FORMTEXT    FORMTEXT   FORMTEXT   FORMTEXT  4. FORMTEXT    FORMTEXT   FORMTEXT   FORMTEXT  5. FORMTEXT    FORMTEXT   FORMTEXT   FORMTEXT  6. FORMTEXT    FORMTEXT   FORMTEXT   FORMTEXT  7. FORMTEXT    FORMTEXT   FORMTEXT   FORMTEXT  8. FORMTEXT    FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT  9. FORMTEXT    FORMTEXT   FORMTEXT   FORMTEXT  10. FORMTEXT    FORMTEXT   FORMTEXT   FORMTEXT   Additional Expenses:  FORMTEXT       FORMTEXT       University Health and Counseling &Testing Center Business Model Consultation Quote for Requested Scope of Work to be Completed by Contractor Check all items applicable to this Request for Quotation:  FORMCHECKBOX  Response/Informal Proposal included with submittal includes the following: X  FORMTEXT Completed Contractor's Proposed Statement of Work (SOW) Details form  FORMCHECKBOX   FORMTEXT [INSERT TYPE OF SUBMITTAL, IE. REFERENCES, QUALIFICATIONS]  FORMCHECKBOX   FORMTEXT [INSERT TYPE OF SUBMITTAL, IE. REFERENCES, QUALIFICATIONS] Contractor Full Legal Name:  FORMTEXT       Address:  FORMTEXT       Email:  FORMTEXT       Phone:  FORMTEXT       Fax:  FORMTEXT       Please indicate your Minority Women or Emerging Small Business (MWESB) Status: Women Owned  FORMCHECKBOX  Self Report  FORMCHECKBOX State Certified #  FORMTEXT       Minority Owned  FORMCHECKBOX  Self Report  FORMCHECKBOX State Certified #  FORMTEXT       Emerging Small Business  FORMCHECKBOX  Self Report  FORMCHECKBOX  State Certified #  FORMTEXT       Contractor agrees to furnish the above according to University s terms, conditions, and specifications. Representations and Warranties. By submitting this quote in response to this RFQ, Contractor represents and warrants that (1) prices quoted shall be firm for three months; (2) Contractor has the power and authority to enter into and perform the contract awarded as a result of this RFQ; (3) The individual signing for Contractor is authorized to execute this quote on behalf of Contractor; (4) Contractor is an independent contractor and not an employee, partner, or agent of University; and (5) Contractors name, as it appears in this quote, is Contractors legal name, as it will appear in the Contractor s W-9, and if Contractor is an entity rather than an individual that the entity named in this quote is validly existing and in good standing. Signature:  FORMTEXT       Print Name:  FORMTEXT       Date:  FORMTEXT        FORMCHECKBOX  No Quote. Date Contacted:  FORMTEXT      Reason:  FORMTEXT       ATTACHMENT D PERSONAL SERVICES CONTRACT INSURANCE REQUIREMENTS (Only complete when insurance is required) During the term of this Contract, Contractor will maintain in full force at Contractors own expense the insurance indicated below and fulfill the following requirements: 1. General Liability Insurance  FORMCHECKBOX  Required by University  FORMCHECKBOX  Not Required by University Contractor will obtain comprehensive general liability insurance with a broad form CGL endorsement or broad form commercial general liability insurance, with a minimum combined single limit of not less than  FORMCHECKBOX  $1,000,000 for each occurrence and $2,000,000 aggregate or  FORMCHECKBOX  $2,000,000 for each occurrence and $5,000,000 aggregate covering bodily injury and property damage, and will include personal and advertising injury liability, products liability, and contractual liability coverage for the indemnity provided under this Contract. It will provide that University and officers and employees are additional insureds but only with respect to the Contractor's services to be provided under this Contract (See Paragraph #4 of this Attachment). 2. Commercial Auto Liability Insurance:  FORMCHECKBOX  Required by University  FORMCHECKBOX  Not Required by University Commercial automobile liability insurance with a minimum combined single limit of $1,000,000 for each accident and $2,000,000 aggregate for bodily injury and property damage, including coverage for owned, hired and non-owned vehicles, as applicable. 3. Professional Liability Insurance: FORMCHECKBOX  Required by University  FORMCHECKBOX  Not Required by University Examples to consider: attorney, physician, dentist, counselor, architects, etc. Professional Liability insurance with a combined single limit, or the equivalent, of not less than  FORMCHECKBOX  $1,000,000 per occurrence and $2,000,000 aggregate or  FORMCHECKBOX  $2,000,000 per occurrence and $5,000,000 aggregate. 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