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Home My WebLink AboutMalinowski Consulting, Inc/Fire/28,500/Adl Serv/Preperation of Medical Ambulance Cost ReportsMalinowski Consulting, Inc. Fire Department - 2016 Appropriation #43-404.00; P.O. #24824 Contract Not To Exceed $28,500.00 �a ADDITIONAL SERVICES AMENDMENT TO ✓Ao AGREEMENT FOR PURCHASE OF GOODS AND SERVICES THIS AMENDMENT TO THE GOODS AND SERVICES AGREEMENT ("Agreement") entered into by and between the City of Carmel and Malinowski Consulting, Inc. (the "Vendor"), as City Contract dated February 20, 2013 shall amend the terms of the Agreement by adding the additional services to be provided by Vendor consistent with the Scope of Work attached hereto and incorporated herein as Exhibit "A". Furthermore, the terms of the Agreement shall be amended to include the E -verify requirement as stated in Indiana Code § 22-5-1.7 et seq., which is attached hereto and incorporated herein as Exhibit `tB", as well as the required E -verify Affidavit, attached hereto and incorporated herein as Exhibit "C"t. Also, pursuant to I.C. § 5-22-16.5, Vendor shall certify that in signing this document, it does not engage in investment activities within the Country of Iran. The terms and conditions of the Agreement shall not otherwise be affected by this Additional Services Amendment and shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have made and executed this Amendment as follows: CITY OF CARMEL, INDIANA by and through its Board of Public Works and.Safety By: James Brain d, es'din ffic r Date: Mary Ann rke, Memb r Date: S w E//"/ 01 Lori SWa�s- on ember Date: /I A //,6, jXAContmclsNProf.Svcs & Goods Svcs\Fire Dept12016\MalinoA%Ai Consultin Add? Ston Amcndmetd 5-3.16.doe:5/3/2016 2:12 PMj MALINOWSKI CONSULTING, INC. C�h'�/GLES �/'/,4Ljn/p Printed Name RX - � �-� �'! -, > C-, j -7 Title FID/TIN: Last Four of SSN if Sole Proprietor: // Date: '' 6l/ �, ��C�/ l AONMkO .mulCon Z MALINOWS'KI CONSULTING, INC. April 4, 2016 Chief David'Hahourh City of Carmel — Fire Department 2 Civic SqWe — Station 41 Carmel, IN 46032 Re: Proposal — Dear ChiefHaboush-, Sectio -n 1: 14troduction The purpose of this letter is toprovide the City. of Carmel with a formal proposal. outlining. howmalinowski Consulting, inc-can be of assistance in the area of providing technical expertise in the preparation of a payment adjustment for eligible fee-for-service Medicaid ambulance services. Section 2: Backgkowid The City of Carmel Fire Department, provides ambulance.services in and around Carmel, Indiana: Significant portions ofthose services are provided to. Medicaid participants. Recently Indiana Family and Social Services Administration, Office of MedicaidPolicy and Planning received approval, fora supplemental payr . nent adjustment.toin-state ambulance providers. The.payment adjustment s iintendedto reimburse providers the actual incurred costs of providing ambulance services to eligible Medic i aid. beneficiaries. The payment adjustment is effective for eligible, fee-for-service Medicaid. ambulane I e services provided in 201.5,2oi6 and .2017. SectiOn 3: Objectiv�s The objectives are to: Provide all -necessary documentation.to State and Federal program administrators to clearly document related eligible expenses. • Malice the., process ofpreparing the Ambulance Cost Report as easy as possible. on City employees who can better service the Citizens. Describeffie results of the Ambulance Cost Report to City officials and defend the results to State and .Federal program managers or auditors. SectiOn 4-' SCOPe To achievetbe objectives ofthis service; Malinowski C orsulting will,cover all aspects .cif the Ambulance Cost Report between- the City of Carmel and, the State of Indiana. This will include the following: •Ambulance Cost Report Data Collection:: Manowski Consulting n.g will perform all data 011ectionactivitiesi City'staff will provide direction. as to where the informition can be obtained.. .................... .............. ..................... ............. ............................ ....... .......... � ....... A 75.5 Wo Cannel Drive, Suite 2o3( Cannel, IN 4,6032 EXHIBIT TKL327.8i8,1876 fAX, 877-346.7g86, www malconindiana.c.om CA MEL, INDIANA - PROPOSAL -:MEDICAID AMBuLANCB COST REPORTS 2015-2oi6-2oi 7 Ambulance Cast Report Presentation to City 4ffici0s: After the compilation, of the Ambulance Cost Report, Malinowsla.Consulting will meet with the appropriate City Officials (Fire Chief, Mayor, Deputy Fire. Chief, etc.) to review the results of the analysis, focusing on the recoveries to the City. Delivery and Negotiation with State Officials: All delivery, presentations and negotiations with State agencies is ineluded.in.this service. Audit llefense to federal and State Auditors: In the event that State or Federal auditors have questions regarding how the Ambulance Cost Report was,prepared, Malinowski Consulting is ready to stand completely behind the plan results. Section 5: Approach Tle following approach to this assignment will include:these steps; Schedule: an on-site meeting with .Fire Department to collect ambulance specific data -for the -report. • In cooperation with the Clerk -Treasurer's Office, determine wages and fringe befYef is for the Fire .Department. • Review City expenditureclaims frons"the General and other Funds to ensure the utmost recoveries of eligible supplies and other services and. charges,, • Compile; all data collected. from .various City:departments into, an electronic format that will generate the. appropriate: report that meets.State and Federal. guidelines. • Review the Ambulance Cost Report with City staff to foster an understanding of the _sub bitted document.. Deliver the Ambulance Cost Report to the responsible. State agency contact guaranteeing.receipt of all required: data. • Monitor the. approval and payment process by the State.. • Respond quickly to questions posed the Indiana Family and Social Services Administration, Indiana State Board of Accounts and Federal program managers and auditors. Section 6: Timing The.Ambulance;.Cost Reports will he prepared and submitted to Indiana FSSA by the Federal filing deadline of May 31st; 2o16, 2017 and sol8. Section 7 Staff -Eng Malinowski Consulting will utilize the expertise of our Indiana.based consulting staff. • Charles Malinowsli, President • Barbara Malinowski, Operations Manager • Daniel Vaughn, Consultant Pap 2 XH1131T A 2 4 -Ll CARMItLy INDIANA - PROPOSAL - MEDICAID-AIMBUILANCE COST REPO RTS 2o15 -2o16-_,>017 Section 8: Qualffications The followhig are key qualifications that make Malinowski Consulting uniqpely suited for this assignment: • 23 Indiana Counties and 4 Cities - Medicaid Ambulance Cost Reports,.2ol,1-2015. 21 Indiana Counties - Preparation of County -Wide Cost Allocation Plans for the years; 2005 through 2015. i Indiana City —.Preparation of City -Wide Cost Allocation Plan for 20 ,2.. .54 Judiana Counties - Preparation of Title INT -D Monthly Expenditure Reimbursement claims. for the.years 2004 through 2o -t6. Mali.noi,vski Consultingis -an Lh_diqqg Qo!Toration wxclusively:serving Indiana Local . Government since 2004 with a consultingstaff that is based within Indiana. Section 9: Fees cind.Expenses Our fee for this service, will be $9,,500.00 for eadi:,year the reports are prepared. This fee is fixed. and payment is not contingent upon actual recovery of costs from the Indiana Family and Social Services Administration. • An invoice will be issued.to the City when the City receives "Final Notice of Prograin Reimbutseoietit' from .the Indiana Office of Medicaid Policy and and nd is payable within 45 days. • this feeds inclusive of all services performed,related to this project including: .0 Hata Collection,, o Report Presentation 'to City Officials, 0. Delivery and Negotiation with the Indiana Office of Medicaid Policy Planning: andPlanning:0 Audit defense fees after the "M . nal-Nbtice"has-beenjssued will be billed, at the rate of $i5.00 per hour 7 at the:4iscreti.on of Malcon.. The City will have ultimate approval on accepting the invoice for audit: defense. This invoice: is payable within 45 days. Section 10: closing It has been a- prh4lege: to submit this proposal to the City of Carmel tb'provide for the preparation of the Ambulance Cost Reports: The comprehensive approach outlined above will optimize recoveries from the State and Federal, governments, meet and exceed filing guidelines and substantially enhance the reliability and defense of the Ambulance Cost Report. If this proposal meets with your approval, please have the appropriate City official sign in the acceptance section and return one signed: copy. I Respectfully Charles: 'F..Malinowski President Page 3 EXHIBIT A_ CARMEL, INDLANA - PRoposAL — MEDiwD AsimaANcm COST 'RE R 2 PO TS 2 015-2oi6- 017 ACCEPTANCE This agreement between The City of, Carmel, Indiana and Malinows1d Consulting, Inc. to provide the preparation. of the Medicaid Ambulance Cost Reporting, the years Ended December 31, 2o15 2616 & 2, 017. The fee for this service will be $9,500.00' for each year the reports are Prepared. This f6eds,fixed and payment is not contingent,upon"actual, recovery of costs from the Indiana Family and Social. Services Administration. • An invoice will be issued to the City when the City receives "Final Notice of Program Reirnbursenient" from the Indiana Mee of Medic -aid Policy and Planning and is payable within 45, days. 0 This fee is inclusive of allservices performed related to this project including:. • Data Collection, • Report Presentation to City, Officials, • Delivery and Negotiation with the -Indiana Office of Medicaid Policy and Planning. • Audit defense, fees after the "!,Yn.al Notice" has been issued will be billed at the rate Of -$175.00 per hour at the discretion, of Malcon. The City will have ultimate approval on accepting the invoice for audit defense. This invoice is payabla within 45 days. This agreement shall be in effect from the: date of signature, entered below,, until either party wishes to change the scope of the services or the professional fee. 'Either party may terminate the, agreement Nkrith. a thirty -day, (36)"Altitten n0tiec. The following signatures will be considered as evidence of the acceptance of the above-described,terms. Acceptance by the City of Carmel, Indiana. Name: Title: Fi r it CL I. C S�__ Date of Signature: 't_ z �_ 20/6 For Mallnowski Consulting, Inc. Name: :Charles F. Malinowski Title: President Page 4 EXHIBIT A By: Name: :Charles F. Malinowski Title: President Page 4 EXHIBIT A Malinowski Consulting, Inc. Fire Department - 2016 Appropriation #43-404.00; P.O. #24824 Contract Not To Exceed $28,500.00 EXHIBIT "B" E -verify requirement All terms defined in I.C. § 22-5-1.7 et seq. are adopted and incorporated into this section of the Amendment. Pursuant to I.C. § 22-5-1.7 et seq., Vendor shall enroll in and verify the work eligibility status of all of its newly -hired employees using the E -Verify program, if it has not already done so as of the date of this Addendum. Vendor is further required to execute the attached Affidavit, herein referred to as "Exhibit C", which is an Affidavit affirming that: (i) Vendor is enrolled and is participating in the E -verify program, and (ii) Vendor does not knowingly employ any unauthorized aliens. This Addendum incorporates by reference, and in its entirety, attached "Exhibit C." In support of the Affidavit, Vendor shall provide the City with documentation that it has enrolled and is participating in the E -Verify program. This Agreement shall not take effect until said Affidavit is signed by Vendor and delivered to the City's authorized representative. Should Vendor subcontract for the performance of any work under this Addendum, the Vendor shall require any subcontractor(s) to certify by affidavit that: (i). the subcontractor does not knowingly employ or contract with any unauthorized aliens, and (ii) the subcontractor has enrolled and is participating in the E -verify program. Vendor shall maintain a copy of such certification for the duration of the term of any subcontract. Vendor shall also deliver a copy of the certification to the City within seven (7) days of the effective date of the subcontract. If Vendor, or any subcontractor of Vendor, knowingly employs or contracts with any unauthorized aliens, or retains an employee or contract with a person that the Vendor or subcontractor subsequently learns is an unauthorized alien, Vendor shall terminate the employment of or contract with the unauthorized alien within thirty (30) days ("Cure Period"). Should the Vendor or any subcontractor of Vendor fail to cure within the Cure Period, the City has the right to terminate this Agreement without consequence. The E -Verify requirements of this Agreement will not apply, should the E -Verify program cease to exist. [XAContmclslPraCSm & Goads SvcstFim Dep112016Malinomki Consultin Add? Sees Amendment 5-3-16.dac:5/3/2016 2:12 PM] Malinowski Consulting, Inc. Fire Department - 2016 Appropriation #43404.00; P.O. #24824 Contract Not To Exceed $28,500.00 Exhibit °C1 E -Verify Affidavit Charles F. Malinowski ., being first duly sworn, deposes and says that he/she is familiar with and has personal knowledge of the facts herein and, if called as a witness in this matter, could testify as follows: I am over eighteen (18) years of age and am competent to testify to the facts contained herein. 2. I am now and at all times relevant herein have been employed by Malinowski Consulting, Inc. (the "Company") in the position of President 3. I am familiar with the employment policies, practices, and procedures of the Company and have the authority to act on behalf of the Company. 4. The Employer is enrolled and participates in the federal E -Verify program and has provided documentation of such enrollment and participation to the City of Carmel, Indiana. 5. The Company does not knowingly employ any unauthorized aliens. FURTHER AFFIANT SAYETH NOT. EXECUTED on the 10 day of Y , 20-16 . Ir Printed: Charles F. Malinowski I certify under the penalties for perjury under the la oft nited States of America and the State of Indiana that the foregoing factual statements andref ire do s are true and correct. Printed: Charles F. Malinowski j%3ConnnculPM[Sm d ON& S%=%FIM DcF1120161M3hromki Conmhin Addl Sm Anundnnn 7.2-16.doc51312016 2:12 PMi eri Company ID Number: 630619 To be accepted as a participant In E -Verify, you should only sign the Employer's Section of the signature page. If you have any questions, contact E Verify at 888-464-4218. Employer Maiinowski Consulting, Inc. Charles Malinowski Name (Please Type or Print) dle T� tiectronically Signed1/08/2013 Signature - -- - - ate Department of Homeland Security - Verification Division ame (Please Type or Print) itis Signature — ate Information Required for the E -Verify Program ;Information relating t_y►0 r Compan�l:. Company Namw allnowski Consulting, Inc. Com any Facir Address: 55 West Carmel Drive Suite 203 +Carmel IN 46032 � Company Alternate Address: County or Parish: HAMILTON Employer Identification Number. 2086954N Page 12 of 131 E -Verify MOU for Employer I Revision Date 09/01/09 www.dhs.gov/E-Verify Verif �F. Company ID Number: 630619 North American Industry Charles F Malinowski Classification Systems (317)819-1876 Fax Number: ILII Code: 541 Name: Barbara E Malinowski Administrator. f Number of Employees: 4oyees: i Number of Sites Verified � for. Are you verifying for more than I site? If yes, please provide the number of sites verified for in each State: INDIANA I site(s) Information relating to the Program Administrator(s) for your Company on policy questions or operational problems: Name: Charles F Malinowski Telephone Number: (317)819-1876 Fax Number: E-mail Address: chanes@malconindinno.eom Name: Barbara E Malinowski Telephone Number: (317) 818- 1876 Fax Number: E-mail Address: barbaraQmalconindiana.com Page 13 of 13 1 E -Verify MOU for Employer I Revision Date 09/01/09 www.dhs.gov/E-Verify oj' (� Carmel City INDIANA RETAIL TAX EXEMPT CERTIFICATE NO. 003120155 002 0 Page 1,of 1 PURCHASE ORDER NUMBER JL FEDERAL EXCISE TAX EXEMPT 24824 ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUSTAPPEARON INVOICES,AIP CARMEL, INDIANA 46032-2584 FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL - 1997 VOUCHER, DELIVERY MEMO, PACKING SUPS, SHIPPING LABELS AND ANY CORRESPONDENCE PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 5/3/2016 366749 Recoup Medicaid Fees MALINOWSKI CONSULTING INC Fire Department VENDOR 755 W CARMEL DRIVE STE 203 SHIP 2 Civic Square TO Carmel, IN 46032- CARMEL, IN 46032 - PURCHASE ID BLANKET CONTRACT PAYMENTTERMS FREIGHT 4521 QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Department: 1120 1 Each Send Invoice To: Fire Department 2 Civic Square Carmel, IN 46032 - Account: 43-404.00 Fund: 101 General Fund Recoup Medicaid Fees $9,500.00 Sub Total PLEASE INVOICE IN DUPLICATE $9,500.00 $9,500.00 DEPARTMENT I ACCOUNT I PROJECT I PROJECTACCOUNT AMOUNT PAYMENT $9,500.00 SHIPPING INSTRUCTIONS ' AIP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P,O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN 'SHIP PREPAID. AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN 'C.O.D. SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. *PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL, . 'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY Denise Snyder Steve Engelking TITLE Budget & Accreditation Manager Administration CONTROL NO. 24824 CLERK -TREASURER