CHANGE HEALTHCARE INC/MCKESSONS/PST SVS - PROFESSIONAL SERVICE AGREEMENT RMS152526A CONTRACT AWARD SHEET INSTRCUTIONAL GUIDE TO ASSIST YOU WITH THE INFORMATION CONTACINED HEREIN IS AVAILABLE IN THE
PURCHASING SECTION OF OUR WEBPAGE AT:
www.hialeahfl.gov
CITY OF HIALEAH
CONTRACT AWARD
PURCHASING DEPARTMENT
CITY OF HIALEAH CONTRACT: EMERGENCY MEDICAL TRANSPORTATION BILLING
DESCRIPTION: PROFESSIONAL SERVICES AGREEMENT RMS152526
CONTRACT PERIOD: 08/01/2018 – 08/01/2023
SECTION #1 – VENDOR AWARD
Name: CHANGE HEALTHCARE INC/MCKESSONS/PST SERVICES Name:
Contact: Sally Rintoul Contact:
Phone: Phone:
Fax: Fax:
E-mail: sally.rintoul@changehealthcare.com E-mail:
Name: Name:
Contact: Contact:
Phone: Phone:
Fax: Fax:
E-mail: E-mail:
SECTION #2 – AWARD/BACKGROUND INFORMATION/APPLICABLE ORDINANCES/NOTES
CITY COUNCIL APPROVED ON: 10/25/2022, ITEM JJ AMENDED AMOUNT:
RESOLUTION NO: INSURANCE REQUIREMENTS:
ANNUAL CONTRACT AMOUNT: $230,000.00 PERFORMANCE BOND:
APPLICABLE ORDINANCES:
Notes:
SECTION #3 – REQUESTING DEPARTMENT
CITY OF HIALEAH, DEPARTMENT OF FIRE
Contract Administrator: Chief Willians Guerra
Phone: 305-883-6900
SECTION #4 – PROCURING AGENCY
CITY OF HIALEAH, DEPARTMENT OF FIRE
Contract Administrator: Chief Willians Guerra
Phone: 305-883-6900
Prepared by: Marilin Gutierrez
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COUNCIL AGENDA ITEM REQUEST FORMf rrr 9 i 0J? I --
OCT 2 5 2022
This form, Jetter from the department head addressed to the Mayor and City (lotJJ,m.~iAcft?.l,wF ft 95 '--~1v11.:,\7f & BUD
supporting documents are due the Monday of the week prior to the City Council Meet tn ~ET
Date of Request:
Requesting City Department:
Requested Council Meeting
Date :
Action Requested from the
City Council:
Scope of service(s) or
product(s):
Vendor:
Expenditure Amount:
October 14, 2022
Issue a purchase order
D Increase a purchase order
D Award a bid
D Bid No.
D Reject a bid
D Bid No.
D Special Events Permit
D Street Closure
M edical Billing for medical services rendered from Hialeah Fire
Rescue Department and transport to hospital. Also, to facilitate
PEMT and MCO reimbursements
Change Healthcare ln c./M ckesson/PST Services
Funding Source (i.e., account
funding the expenditure):
Purchasing Process:
Total -$230,000.00
Contractual Services Billing -109.2000.522.342
0 Competitive Bidding
0 An exception to competitive bidding applies:
0 Professional services in the nature of
consultants, accountants and attorneys
0 Sole source provider
O Emergency based on object facts
0 Credit facilities
Nmpetitive bidding is not required because the City
is utilizing a bid that has been awarded or under
contract by state, county or other governmental
agencies.
0 Title of state, county or other governmental
agencies contract:
Pie:e:v-back contract exoiration date: August
1,2023
0 Waive Competitive Bidding
D Reason(s) it is not advantageou s to the City to
utilize competitive bidding:
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Signatures:
Department Head
Esteban Bovo, Jr.
Mayor
Carl Zogby
Council President
Monica Perez
Council Vice-President
October 14 , 2022
Mayor Esteban Bovo, Jr.
and City Council Members
50 I Palm A venue
Hialeah, Florida 33010
City of Hialeah
Dear Mayor Bovo & Council members :
Council Members
Bryan Calvo
Vivian Casals-Munoz
Jacqueline Garcia-Roves
Luis Rodriguez
Jesus Tundidor
The C harter of the City of Hialeah states that contracts in amounts greater th an $15,000.00 s ha ll be awarded on
the basis of specifications and formal sealed bids. The Counc il m ay award a contract to the lowest responsible
and responsive bidder, or it may reject a ll bids an d re-adverti se; or it m ay waive competitive bidding when it
finds it to be in the best inte rest of the City.
In accordance with the City of Hial eah Code Section 2-81 8 State, county or other governm e nta l agen cy bids or
contracts: Whenever advantageous to the c ity, t h e c ity may utilize bids that h ave been awarded or under
c ontract by the s tate, county or other governmental agenc ies. If the c ity utilizes state, county or othe r
governmental agency bids, competitive bidding will not be required.
I am re spectfully requ esting your a pproval to create a Purchase Order for Emergency Medical Transportation
Billing with Vendor: Change Healthcare Inc./McKesson/PST Services. Originally ba sed o n Profess ional
Services Agreement RMS 15 2526, d a te d effective September 20, 20 16 effectiv e for an initial term of three (3)
years between C ity of Miami and PST Services LLC (Change Healthcare lnc./McKesson Inc.), m edical billing
services (vendor #23322) and lat e r amended on A ug ust 1, 20 18. T hi s agreeme nt duration of five (5) years (initia l
term of one (I ) year with two (2) options to renew for re newal terms of two (2) years each . PST Services, LLC is
Georgia limited liability company in good standing reg istered to do bus iness in the State of Florida." The amount
s ha ll not exceed $230,000.00, from account 109.2000.522.342 (Contractua l Services Billing).
Your con sideratio n of this request will be g reatly appreciated.
,~,,~,
~lians G u erra
Fire Chief
H ia leah Fire Department
50 1 Palm A venu e, Hi a leah, F lorid a· 33 0 10 -47 19
www.hi a leahfl.gov
/lS 'Lljt Z-
ate
r CHANGE
HEALTHCARE
Memorandum
To: City of Hialeah
From: Melissa Cataldo, Contract Administrator
Date: May 16, 2019
Subject: Amendment Number P201910024672
Enclosed please find two (2) origlnals of Amendment P201910024672 to your August 1, 2018
Professional Services Agreement For Ambulance Bii/ing Services (RMS152526), signed by Change
Healthcare Technology Enabled Services, LLC.
Please execute the two (2) originals and send a fully executed PDF to
TES SerVlcesContraets@changehealthcare.com, for our records. If you have any questions, please feel
free to contact, Sally Rlntoul at Sally.R!ntoul@cbangehealthcare.com.
Thank you for the confidence you have placed In Change Healthcare Technology Enabled Services, LLC.
We value your patronage and look forward to a long and mutually rewarding relationship.
Sincerely,
Melissa catatdo
Technology Enabled Services
Contract Operations
cc: Jeff Wescott
Gregory Arnold
Deb Roberts
Rick Iglesias
Sally Rlntoul
Mauricio Chavez
Ch~mge Healthcare
5995 Windward Pl<WY
Alpharetta, f?A 30005
p 404·!.\38-5555
f 67S-4!i9-0B40
changehealthcare.com
"
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CH~N.GE CONFIDENTIAL AND PROPRIETARY Cllent: Clly of Hialeah
HEALTHCARE Amendment Number: ?201910024672
AMENQMENI
This amendment (the "Amendment") amends the Professional Services Agreement For Ambulance Billing Services
(RMS152526) that became effective on August 1, 2018 (the "Agreement"), between City of Hialeah, a Florida
municipality {"City") and Change Healthcare Technology Enabled Services, LLC ("Contractor") and Is effective as of the
latest dale In the signature block below.
For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree
as follows:
1. Section 5. The Agreement Is amended by deleting Section 5 In Its entirety and Inserting the foltowfng 111 lleu thereof:
5. The first sentence of Paragraph 2 of the Miami Agreement Is hereby amended to read as follows:
"The Agreement shall become effective on August 1, 2018 and shall be for the duration of five (5)
years: lnltlal term of one (1) year with two (2) options to renew for renewal terms of two (2) years each."
2. Exhibit B <Scope of Worl<l. For avoidance of doubt and for clarlflcatlon purposes, City agrees that the following shall
apply to Exhibit B to the Miami Agreement:
> Contractor will begin providing the Services described In this Exhibit B for dates of service of October
1, 2018 and later. Any billing and coding for dates of service prior to October 1, 2018 are the
responslblllty of City.
3. Exhibit B-1 (Statement ofWor!s for Medicaid Publlc Emergency Medical Transportation "PEMT' Services). Section
6.ffimnl. Exhibit B-1 Is amended by adding the followlng new Section 2:
2. Imm.. The term of this Exhibit B-1 will follow the term of the Agreement as amended. Contractor wlll
begin providing the Services set forth In this Exhibit B-1 on August 1, 2018 (the "Exhibit B-1
Commencement Date").
4. El!blblt C-1 (Fee Schedule). The last line oflhe table on Exhibit C;1 (Fee Schedule) Is deleted In Its entirety and the
following Is Inserted In lieu thereof:
! PEMT Services 9%
5. This Amendment may be executed In mulllple counterparts, each of which shall be deemed an original and all of
which together shall be deemed one and the same lnstrumenL
6. Capitalized terms used herein and not otherwise defined have the same meaning as In the Agreement. In the event
any term or condition of this Amendment ls Inconsistent with any tenn or condition of the Agreement, the tenns of
this Amendment will control. Except es stated above, all terms of the Agreement shall remaln In full force and effect.
Contractor and City represent and warrant that they have the full power and authority to enter Into this Amendment,
that there are no restrictions or llmHatlons on their ability to perform under this Amendment, and that the person
execuUng this Amendment has the full power and authority to do so.
IN WITNESS WHEREOF, and In agreement hereto, the parties have .executed this Amendment on the dates set forth
below.
Print Nsme: ----------++-
Tiiie: Mayor
Date:-------------
J)Ogl I •fl
..
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With a co py to:
ity Attorsi.e y
...:ity of Hialeah, FL
City Ha!l -SO I Palm Avenue
4~~ Floor -Law Dept.
Hia leah, FL 33010
Chen&. City or Hialeah
Contract Number. RMS152526
i ! . Th.e pro visions of Paragraphs 24, 25, 28, and 29 of the Miami Agreement are
strickti1 in their e nt irety and the paragraph number is preserved to maintain the sequence in
nl!lrnbet il:.g.
i 2. Any references to the ordinances, resolutions, rules, regulations or policies of the
Ci ty o f Mi ami h the Miami Agreement or Miami RFP shall be amended to make reference to the
c oriespond ing ord inan ces, resolutions, rules, regulations or policies of the City of Hialeah
govem b1g the .san·1e subject matter to the extent an ordinance, resolution, rule, regulation or policy
exists.
: 2. Pa ragraph 3 in the Scope of Work as set forth in Exhibit B to the Miami Agreement
is a~r;en~led to identify fiscal year 2016/2017 as the benchmark year for collection levels .
.:;.. Paragraph 3k in the Scope of Work as set forth in Exhibit B to the Miami Agreement
is a.nen ded by striking the second and third sentence describing the fonnat of incident numbers
and pat i-:im ac c o ur1~ numbers.
5. Pa ragraph S in the Scope of Work as set forth in Exhibit B to the Miami Agreement
Ls ;1rnen::ii:::d to r~pia ce the Fee Schedule with the fee schedule as set forth in Exhibit C-1 to this
11 r -;vTn !ES.S WHER EOF , and intending to be legally bound, CITY and CONTRACTOR, b.y
and :l ro1..igh 'he ir dul y authorized officers or agents, have caused this Agreement to be properly
(::G::rc:ced. .:m the day written on the first page.
By:
ame : Ca~lQS H§..~..n~~9.,~
Title: M_a,._y_o_r __ __,,,_----
Date: 7 J Z,o ._, ) P
4
Client City of Hlalellh
Contract Number. RMS182528
recipients Is currently not allowable under the PEMT Program, should
CMS/ACHA amend the program to include MMA recipients, Contractor shall
be required to expand the services within this agreement to capture cost
associated MMA recipients.
1.2.2. Glty Respons!b!l!ties. City acknowledges and understands that Inaccurate or false
data submissions, even advertent ones, can lead to a talse claim charge or Medicaid
program exclusion. Therefore, City agrees that it will use best efforts to:
(a) Ensure the accuracy of all cost repon data provided by City to Contractor and
provide written certification of the accuracy of such data to Contractor and all
applicable governmental agencies;
(b) Make its internal practices, books and records relating to all cost repon data
provided to Contractor by City available to Contractor to ensure the accuracy of
all such data;
(c) Comply with Contractor policies and procedures for the documentadon of all
cost report data as established and provided to City by Contractor from time to
time; and
(d) Provide Contractor with the following as part of City's request for Supplemental
Payment:
l . An organizational chart of City;
2. An organizational chart of EMS department;
3. Identification of the specific geographic service area covered by the EMS
department;
4. Coples of job descriptions for all staff employed within City's EMS and an
estimated percentage of time spent working for City's EMS department and
for other departments of City's agency;
5. Primary contact person for City; and
6. A signed letter documenting the governmental provider's volwmuy
contribution of non-federal funds. ·
(e) City acknowledges and agrees that Contractor shall be entitled to receive service
fees for Services provided by Contractor under this Agreement even after
expiration or earlier tennination of this Agreement provided that Contractor
provided such services on or before the date of expiration or terminadon of this
Agreement. ln such case, this Agreement may be amended by mutual written
agreement of the Parties hereto.
6
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EXHIBITD
Chant: Cily ol Hiatealt
Contract Number. RMS152628
CERTIFICATE OF LIABILITY INSURANCE
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CHANGE CONFIDENTIAL AND PROPRIETARY caent: cny or Hialeah
HE·ALTHCARE Amendment Number: P201910024872
AMENDMENT
This amendment (the "Amendmenr) amends the Professlonal Services Agreement For Ambulance Billing Services
(RMS152526) that became effective on August 1, 2018 (the "Agreement"), between City of Hlaleah, a Florida
municipality ("City") and Change Healthcare Technology Enabled Services, LLC ("Contractor") and Is effective as of the
latest date In the signature block below.
For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree
as follows: · ·
1. Saction 5. The Agreement Is amended by deleting Section 5 In Its enUrety and Inserting the followlng In lleu thereof:
5. The first sentence of Paragraph 2 of the Miami Agreement Is hereby amended to read as follows:
"The Agreement shall become effecUve on August 1, 2018 and shall be for the duration of five (5)
years: ln!Uel term of one (1) year with two (2) options to renew for renewal terms of two (2) years each."
2. Exhibit B {Scope of Wo£1<). For avoidance of doubt and for clsriflcallon purposes, City agrees that the foll<lJMng shall
apply to Exhibit B to the Miami ~greement
~ Contractor will begin providing the Services described In this Exhibit B for dates of service of October
1, 2018 and later. Any bllDng and coding for dates of service prior to October 1, 2018 are the
responsibility of City.
3. Exhibit B-1 (Statement otWor!s for Mec!lcald Pub~c Emergenoy M&dlca! Transportation •peMr Services). Section
2 /Term\. Exhibit B-1 Is amended by adding the Ollowlng new Section 2:
2. llrm.. The term of this Exhibit B-1 wlll follow the term of the Agreement as amended. Contractor wlU
begin providing the Services set forth In this Exhibit B-1 on August 1, 2018 (the "E>dllblt B-1
Commencement Date").
4. Exhibit C-1 <Fee Schedule\. The last line of the table on Exhibit C-1 (Fee Schedule) Is deleted In Its entirety end the
following is Inserted In lieu thereof:
I PEMT Services 9%
5. This Amendment may be executed In mulUple counterparts, each of which shall be deemed an orig!nal and all of
which together shall be deemed one and the same Instrument.
6. Capl:allzed term s used herein and not otherwise defined have the same meaning as In the Agreement. In the event
any term or condition of this Amendment ls Inconsistent with any term or condition of the Agreement, the terms of
this Amendment will control. Except as stated above, all terms of the Agreement shell remain In full force and effecL
Contractor and City represent and warrant that they have the full power and aulhority to enter Into this Amendment.
that there are no restrictions or llmltaUons on their ablllty to perform under this Amendment, and that the person
e:<ecJting this Amendment has the fUU power and authority to do so.
IN WITNESS WHEREOF, and In agreement hereto, the parties have executed this Amendment on the dates set forth
below. CIT:z1-
By: ----,-+-iM
Prim Name:C,.,,a:.r=..=l"""""--'"""' .............. ......,~_...._
Title: Mayor
Date:-------------
CHANGE~~LTHCARETECHNOLOGYENABLED
SERVIC~S, ,LLC e
By. .J/Jrrlh-f L
Print Name: ('J)1nl>'f1 h-e )<Jc(.
rme: _s"-ljv:......IP....,_.....:C=<..1RJ .......... _..-:? ....... 1'-"~--~'--
oate: -....:..~_,_,./J~<P_,_/ .._./Vj.___ __ _
pogt 1 of I
109 , Fire Rescue Transportation Fund
Account Percent
109.2000 .522342 0 %
CONTRACTUAL SERVICES -BILLING SVCS
(
Total for (2) Operating Expenses
Total expenses 2000 (Fund 109)
FI -Fire
230,000.00
230,000 .00
230,000.00
230,000.00
230,000.00
230,000.00
230,000.00
230,000.00
Fiscal Year: 2023
Expended
0.00
Fund Totals
109
Fire Rescue Transportation Fund $230,000.00 $0.00
Revenue/Expenses Balance: $0.00
I 09 Fire Rescue Transpo11 ati o n Fund
T ri a l Balance -Expenses
Trial Balance -
Encumbered Balance Last Date
0.00 230,000.00 10/1/2022
0.00 230,000.00
0.00 230,000.00
0.00 230,000.00 Expenses
$0.00 $230,000.00
Q ... *
P rin ted : I 0/20/2 022 Page: 2