AGREEMENT BETWEEN THE COUNTY OF SAN MATEO AND The Urban Institute
THIS AGREEMENT, entered into this _____ day of _______________ , 20_____, by and between the COUNTY OF SAN MATEO, hereinafter called "County," and Urban Institute, hereinafter called "Contractor";
W I T N E S S E T H:
WHEREAS, pursuant to Government Code, Section 31000, County may contract with independent contractors for the furnishing of such services to or for County or any Department thereof;
WHEREAS, it is necessary and desirable that Contractor be retained for the purpose of completing a local evaluation of the County’s pilot effort to improve healthcare access.
NOW, THEREFORE, IT IS HEREBY AGREED BY THE PARTIES HERETO AS FOLLOWS:
1.		Exhibits and Attachments
The following exhibits and attachments are included hereto and incorporated by reference herein: Exhibit A—Services Exhibit B—Payments and rates Attachment H—HIPAA Business Associate requirements Attachment I—§ 504 Compliance
2.		Services to be performed by Contractor
In consideration of the payments set forth herein and in Exhibit “B,” Contractor shall perform services for County in accordance with the terms, conditions and specifications set forth herein and in Exhibit “A.”
3.		Payments
In consideration of the services provided by Contractor in accordance with all terms, conditions and specifications set forth herein and in Exhibit "A," County shall make payment to Contractor based on the rates and in the manner specified in Exhibit "B." The County reserves the right to withhold payment if the County determines that the quantity or quality of the work performed is unacceptable. In no event shall the County’s total fiscal obligation under this Agreement exceed THREE HUNDRED FORTY TWO THOUSAND DOLLARS, ($342,000).
4.		Term and Termination
Subject to compliance with all terms and conditions, the term of this Agreement shall be from July 8 2008 through December 31, 2010. This Agreement may be terminated by Contractor, County Manger, or his/her designee at any time without a requirement of good cause upon thirty (30) days’ written notice to the other party. In the event of termination, all finished or unfinished documents, data, studies, maps, photographs, reports, and materials (hereafter referred to as materials) prepared by Contractor under this Agreement shall become the property of the County and shall be promptly delivered to the County. Upon termination, the Contractor may make and retain a copy of such materials. Subject to availability of funding, Contractor shall be entitled to receive payment for work/services provided prior to termination of the Agreement. Such payment shall be that portion of the full payment which is determined by comparing the work/services completed to the work/services required by the Agreement.
5.		Availability of Funds
The County may terminate this Agreement or a portion of the services referenced in the Attachments and Exhibits based upon unavailability of Federal, State, or County funds, by providing written notice to Contractor as soon as is reasonably possible after the county learns of said unavailability of outside funding.
6.		Relationship of Parties
Contractor agrees and understands that the work/services performed under this Agreement are performed as an independent Contractor and not as an employee of the County and that Contractor acquires none of the rights, privileges, powers, or advantages of County employees.
7.		Hold Harmless
Contractor shall indemnify and save harmless County, its officers, agents, employees, and servants from all claims, suits, or actions of every name, kind, and description, brought for, or on account of: (A) injuries to or death of any person, including Contractor, or (B) damage to any property of any kind whatsoever and to whomsoever belonging, (C) any sanctions, penalties, or claims of damages resulting from Contractor’s failure to comply with the requirements set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and all Federal regulations promulgated thereunder, as amended, or (D) any other loss or cost, including but not limited to that caused by the concurrent active or passive negligence of County, its officers, agents, employees, or servants, resulting from the performance of any work required of Contractor or payments made pursuant to this Agreement, provided that this shall not apply to injuries or damage for which County has been found in a court of competent jurisdiction to be solely liable by reason of its own negligence or willful misconduct.
The duty of Contractor to indemnify and save harmless as set forth herein, shall include the duty to defend as set forth in Section 2778 of the California Civil Code.
8.		Assignability and Subcontracting
Contractor shall not assign this Agreement or any portion thereof to a third party or subcontract with a third party to provide services required by contractor under this Agreement without the prior written consent of County. Any such assignment or subcontract without the County’s prior written consent shall give County the right to automatically and immediately terminate this Agreement.
9.		Insurance
The Contractor shall not commence work or be required to commence work under this Agreement unless and until all insurance required under this paragraph has been obtained and such insurance has been approved by Risk Management, and Contractor shall use diligence to obtain such insurance and to obtain such approval. The Contractor shall furnish the Department/Division with certificates of insurance evidencing the required coverage, and there shall be a specific contractual liability endorsement extending the Contractor's coverage to include the contractual liability assumed by the Contractor pursuant to this Agreement. These certificates shall specify or be endorsed to provide that thirty (30) days' notice must be given, in writing, to the Department/Division of any pending change in the limits of liability or of any cancellation or modification of the policy.
(1)			Worker's Compensation and Employer's Liability Insurance The Contractor shall have in effect during the entire life of this Agreement Workers' Compensation and Employer's Liability Insurance providing full statutory coverage. In signing this Agreement, the Contractor certifies, as required by Section 1861 of the California Labor Code, that it is aware of the provisions of Section 3700 of the California Labor Code which requires every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions of the Code, and will comply with such provisions before commencing the performance of the work of this Agreement.
(2)			Liability Insurance The Contractor shall take out and maintain during the life of this Agreement such Bodily Injury Liability and Property Damage Liability Insurance as shall protect him/her while performing work covered by this Agreement from any and all claims for damages for bodily injury, including accidental death, as well as any and all claims for property damage which may arise from contractors operations under this Agreement, whether such operations be by himself/herself or by any sub-contractor or by anyone directly or indirectly employed by either of them. Such insurance shall be combined single limit bodily injury and property damage for each occurrence and shall be not less than the amount specified below.
			Such insurance shall include:
			(a)			Comprehensive General Liability . . . . . . . . . . . . . . . . . .			$1,000,000
			(b)			Motor Vehicle Liability Insurance . . . . . . . . . . . . . . . . . .			$1,000,000
			(c)			Professional Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . .			$1,000,000
County and its officers, agents, employees and servants shall be named as additional insured on any such policies of insurance, which shall also contain a provision that the insurance afforded thereby to the County, its officers, agents, employees and servants shall be primary insurance to the full limits of liability of the policy, and that if the County or its officers and employees have other insurance against the loss covered by such a policy, such other insurance shall be excess insurance only.
In the event of the breach of any provision of this section, or in the event any notice is received which indicates any required insurance coverage will be diminished or canceled, the County of San Mateo at its option, may, notwithstanding any other provision of this Agreement to the contrary, immediately declare a material breach of this Agreement and suspend all further work pursuant to this Agreement.
10.		Compliance with laws; payment of Permits/Licenses
All services to be performed by Contractor pursuant to this Agreement shall be performed in accordance with all applicable Federal, State, County, and municipal laws, ordinances and regulations, including, but not limited to, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and the Federal Regulations promulgated thereunder, as amended, and will comply with the Business Associate requirements set forth in Attachment “H,” and the Americans with Disabilities Act of 1990, as amended, and Section 504 of the Rehabilitation Act of 1973, as amended and attached hereto and incorporated by reference herein as Attachment “I,” which prohibits discrimination on the basis of handicap in programs and activities receiving any Federal or County financial assistance. Such services shall also be performed in accordance with all applicable ordinances and regulations, including, but not limited to, appropriate licensure, certification regulations, provisions pertaining to confidentiality of records, and applicable quality assurance regulations. In the event of a conflict between the terms of this Agreement and State, Federal, County, or municipal law or regulations, the requirements of the applicable law will take precedence over the requirements set forth in this Agreement. Contractor will timely and accurately complete, sign, and submit all necessary documentation of compliance.
11.	Non-Discrimination and Other Requirements
A.	Section 504 applies only to Contractors who are providing services to members of the public. Contractor shall comply with § 504 of the Rehabilitation Act of 1973, which provides that no otherwise qualified handicapped individual shall, solely by reason of a disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination in the performance of this Agreement.
B.	General non-discrimination. No person shall, on the grounds of race, color, religion, ancestry, gender, age (over 40), national origin, medical condition (cancer), physical or mental disability, sexual orientation, pregnancy, childbirth or related medical condition, marital status, or political affiliation be denied any benefits or subject to discrimination under this Agreement.
C.	Equal employment opportunity. Contractor shall ensure equal employment opportunity based on objective standards of recruitment, classification, selection, promotion, compensation, performance evaluation, and management relations for all employees under this Agreement. Contractor’s equal employment policies shall be made available to County of San Mateo upon request.
D.	Violation of Non-discrimination provisions. Violation of the non-discrimination provisions of this Agreement shall be considered a breach of this Agreement and subject the Contractor to penalties, to be determined by the County Manager, including but not limited to
				i)			termination of this Agreement;
				ii)			disqualification of the Contractor from bidding on or being awarded a County contract for a period of up to 3 years;
				iii)			liquidated damages of $2,500 per violation;
				iv)			imposition of other appropriate contractual and civil remedies and sanctions, as determined by the County Manager.
To effectuate the provisions of this section, the County Manager shall have the authority to examine Contractor’s employment records with respect to compliance with this paragraph and/or to set off all or any portion of the amount described in this paragraph against amounts due to Contractor under the Contract or any other Contract between Contractor and County.
Contractor shall report to the County Manager the filing by any person in any court of any complaint of discrimination or the filing by any person of any and all charges with the Equal Employment Opportunity Commission, the Fair Employment and Housing Commission or any other entity charged with the investigation of allegations within 30 days of such filing, provided that within such 30 days such entity has not notified Contractor that such charges are dismissed or otherwise unfounded. Such notification shall include the name of the complainant, a copy of such complaint, and a description of the circumstance. Contractor shall provide County with a copy of their response to the Complaint when filed.
E.	Compliance with Equal Benefits Ordinance. With respect to the provision of employee benefits, Contractor shall comply with the County Ordinance which prohibits contractors from discriminating in the provision of employee benefits between an employee with a domestic partner and an employee with a spouse.
F. E.	The Contractor shall comply fully with the non-discrimination requirements required by 41 CFR 60-741.5(a), which is incorporated herein as if fully set forth.
12.		Compliance with Contractor Employee Jury Service Ordinance
Contractor shall comply with the County Ordinance with respect to provision of jury duty pay to employees and have and adhere to a written policy that provides that its employees shall receive from the contractor, on an annual basis, no less than five days of regular pay for actual jury service in San Mateo County. The policy may provide that employees deposit any fees received for such jury service with the contractor or that the contractor deduct from the employees’ regular pay the fees received for jury service.
13.		Retention of Records, Right to Monitor and Audit
(a) CONTRACTOR shall maintain all required records for three (3) years after the COUNTY makes final payment and all other pending matters are closed, and shall be subject to the examination and/or audit of the County, a Federal grantor agency, and the State of California. (b) Reporting and Record Keeping: CONTRACTOR shall comply with all program and fiscal reporting requirements set forth by appropriate Federal, State and local agencies, and as required by the COUNTY. (c) CONTRACTOR agrees to provide to COUNTY, to any Federal or State department having monitoring or review authority, to COUNTY's authorized representatives, and/or their appropriate audit agencies upon reasonable notice, access to and the right to examine all records and documents necessary to determine compliance with relevant Federal, State, and local statutes, rules and regulations, and this Agreement, and to evaluate the quality, appropriateness and timeliness of services performed.
14.		Merger Clause
This Agreement, including the Exhibits attached hereto and incorporated herein by reference, constitutes the sole Agreement of the parties hereto and correctly states the rights, duties, and obligations of each party as of this document's date. In the event that any term, condition, provision, requirement or specification set forth in this body of the agreement conflicts with or is inconsistent with any term, condition, provision, requirement or specification in any exhibit and/or attachment to this agreement, the provisions of this body of the agreement shall prevail. Any prior agreement, promises, negotiations, or representations between the parties not expressly stated in this document are not binding. All subsequent modifications shall be in writing and signed by the parties.
15.		Controlling Law
The validity of this Agreement and of its terms or provisions, as well as the rights and duties of the parties hereunder, the interpretation, and performance of this Agreement shall be governed by the laws of the State of California.
16.		Notices
		Any notice, request, demand, or other communication required or permitted hereunder shall be deemed to be properly given when deposited in the United State mail, postage prepaid, or when deposited with a public telegraph company for transmittal, charges prepaid, addressed to: In the case of County, to: Srija Srinivasan, Special Assistant to the County Manager County of San Mateo 225 37th Avenue, Room 178 San Mateo, CA 94403 In the case of Contractor, to: Marcus Stevenson, Director of Contracts, Grants, and Pricing The Urban Institute 2100 M Street, NW Washington, DC 20037
IN WITNESS WHEREOF, the parties hereto, by their duly authorized representatives, have affixed their hands.
								COUNTY OF SAN MATEO
								By:
								President, Board of Supervisors, San Mateo County
								Date:
ATTEST:
By:
Clerk of Said Board
The Urban Institute
Contractor’s Signature
Date:
Long Form Agreement/Business Associate v 6/28/06

Exhibit “A”

In consideration of the payments set forth in Exhibit “B”, Contractor shall provide the following services:

I. The Contractor will address eight major research questions:

• What is being done under the Blue Ribbon Task Force pilot (funded through the State Coverage Initiative) to improve access to healthcare and redesign care for clients with chronic illness? What changes have been made to the enrollment and service delivery system for low income adults? • Who is served by the Blue Ribbon Task Force pilot (both the ACE program and the redesigned ambulatory services)? How has the composition of enrollees changed over time? • What services do clients receive? What are the trends over time? • What is the quality of care in clinics that are redesigning their approach to better meet the needs of clients with chronic disease? • Are clients satisfied with the Blue Ribbon Task Force pilot and the services provided? • Are providers and other key stakeholders satisfied with the Blue Ribbon Task Force pilot? • What is the impact of the Blue Ribbon Task Force pilot on access to care and use of medical services? • Does the Blue Ribbon Task Force pilot have an impact on the health status of clients?

II. The Contractor will rely on the following data sources to answer the questions:

Primary Data Collection

• Annual Case Study: Contractor will conduct between 15 and 25 interviews per year with key stakeholders involved in the Blue Ribbon Task Force pilot, representing leadership at the health system, policy and clinic levels. Contractor will work with the County to identify and prioritize individuals to be included in the interviews. Contractor will complete two 4-day Site visits as part of this data collection activity.

Secondary Data Collection

• Automated Clinic Data Analysis: Contractor will work with the County to select existing automated data collected in three study clinics (two County clinics and Ravenswood Family Health Center) that Contractor will receive and analyze.

• Manual Data Collection in Clinics: Contractor will work with the County to select data to be collected manually in three study clinics (two County clinics and Ravenswood Family Health Center) that will be collected by the County

• Health Plan of San Mateo Data Analysis: Contractor will work with the County to define periodic reports, produced by the Health Plan of San Mateo, summarizing administrative data that HPSM will have as the Third Party Administrator for ACE and other programs. Contractor will work with the County to determine the frequency that this data will be provided, with a maximum of two times per year over the two-year study period.

• One-e-App Data Collection and Analysis: Contractor will work with the County to define data from the One-A-App system that will be extracted at regular intervals and provided to the Contractor for analysis. Contractor will work with the County to determine the frequency that this data will be provided, with a maximum of two times per year over the two-year study period.

III. Contractor will investigate these questions through six major components:

1. Task 1: Case Study It will be critical to understand what is actually being done under the Blue Ribbon Task Force Pilot, what changes have been made to the service delivery systems serving low-income adults with chronic health problems, and how key individuals perceive it to be affecting low income adults who are served and their providers. The case study will also explore the services available to low-income uninsured adults and whether that is changing over time. Each year, the Contractor will conduct a comprehensive case study, using semi-structured protocols, in which the Contractor will: • Interview all the key stakeholders in the Blue Ribbon Task Force pilot (list to be developed with the Special Assistant to the County Manager for the Health System Redesign Initiative) • Interview staff of three clinics: one SMMC clinic for which redesign is not yet planned; one SMMC clinic where systems redesign is underway; and Ravenswood. • Observe operations in all three study clinics. Case studies will be conducted each year over the course of the project. The Year One site visit should occur as soon as possible after the contract is signed. That visit will also provide an opportunity to learn about data systems and plan the data collection outlined below. At the end of each round of case study data collection, we will produce a comprehensive case study report.

2. Task 2: Automated Clinic Data Analysis The purpose of this task is to use existing automated clinic data in the three study clinics, in order to develop a profile of low income adults served, their health conditions, and their treatments, and to track changes in these indicators over time. The Contractor will obtain automated data from the clinic data systems at the three study clinics, the two SMMC clinics and Ravenswood. The Contractor will tailor analysis to the different data available at the three clinics, while striving to achieve as much uniformity as possible across clinics and over time. Each year a tracking report will be produced from the findings.

3. Task 3: Manually Collected Data Collection in or about Clinics The purpose of this activity is to use some of the manually-collected data being collected in clinics, and augment or refine the data for the evaluation. The Contractor will work with the County to determine who is collecting the data most relevant to informing the evaluation, in order to systematize the data collected (for example assuring that the same questions are being asked according to the same periodicity, and recorded in a uniform manner) and make sure data are being collected for the individuals of interest to the evaluation (low income adults who are either ACE/WELL enrollees or clients of the three study clinics). Once these data collection procedures are defined and mutually agreed upon, the Contractor will periodically obtain the data in, for example, a spreadsheet form and analyze it for the annual tracking report that also uses the automated clinic data.

4. Task 4: Health Plan Data Analysis The Health Plan of San Mateo is being contracted to administer the care for enrollees in the ACE program and may administer care for other programs of interest. For these enrollees, the HPSM will have complete enrollment and claims/encounter records for all enrollees. The Contractor will work with the County to define key HPSM data of interest and to design periodic reports. The Contractor will obtain and analyze this data for the annual tracking report.

5. Task 5: One-e-App Data Collection and Analysis To obtain impact data (and answer questions such as: “Has the initiative improved access to care? Has the initiative increased appropriate service use?), the Contractor will build on One-e-App data collection by adding some questions to be asked by CAAs at the time of enrollment or renewal. This form of data collection will only address evaluation questions for the WELL and ACE groups, not for the clinic population not enrolled in WELL or ACE, since they are not enrolled through the One-e-App. The Contractor will work with the Special Assistant to the County Manager and other key individuals responsible for collecting One-e-App data to define the number and content of questions. The Contractor will train CAAs in data collection. The Contractor will produce an impact evaluation report at the end of the evaluation that summarizes all impact findings. Interim results will be provided at least once in memo form.

6. Task 6: Dissemination Each year, the Contractor will produce an executive summary of all key findings from the year, to disseminate to evaluation stakeholders in San Mateo County. To reach a wider audience, the Contractor will post the reports described above (annual case study reports; annual monitoring reports; and the impact report) on the Urban Institute web site. The Contractor will also consider creating a shorter brief from each report, and will make conference presentations as appropriate.

IV. Products

The Contractor will provide the following:

• Annual case study report (2 total) • Annual tracking report (clinic and HPSM data) (2 total) • Impact evaluation report (1 report) • Annual “Executive Summary” report summarizing all findings (2 total)

The Contractor will also provide a brief update by March 1, 2009, to inform a formal update to the Blue Ribbon Task Force on Adult Health Care Coverage Expansion and other key stakeholders.

V. Subcontractors

Contractor and its lead evaluators, Embry Howell and Genevieve Kenney, will subcontract with the following:

• Dana Hughes, for $62,577 to assist with the case study, clinic data analysis, and dissemination.

Should the above named individuals no longer work for the listed subcontractor, then the contractor will notify the County within 30 days of this change and will find equally or more qualified alternative(s).

Exhibit “B”

In consideration of the services provided by Contractor in Exhibit “A”, County shall pay Contractor based on the following fee schedule:

I. Payment Schedule

A. Contractor shall be paid a total of $342,000 for the term of the agreement.

B. Contractor shall invoice on a monthly basis. It will submit invoices and progress reports to: County of San Mateo Health Department, Director’s Office ATTN: Srija Srinivasan 225 37th Avenue San Mateo, CA 94403

To constitute a proper invoice, it must be submitted be signed and include the following information and/or attached information: (a) Contract Number; (b) Contractor's name and complete address (c) invoice date; (d) period covered by the invoice; (e) total amount of incurred costs (both for the billing period and cumulatively); (f) indirect costs; (g) fixed fee; (h) total amount invoiced (both for the billing period and cumulatively). Contingent on Contractor meeting targets outlined in the 2-year evaluation schedule.