EXECUTIVE DOCUMENT SUIIIIARY _Form.,22, (R101~)DA"'Ai"""",'" InstructionSforcompfetingthe\~VM~~. _ -:. • 1. Plea.. read1he guideHnes on ~!cklof'isWl~ hd "Conua 16. Address: 2.PIease_aJl~DOA 3.CheckaU _ _ apply. 4. For amendments I renewals, atIach original contract:. 5. Attach aMrtional pages if necessary. Family & Social Services Admin Seaetary's 0ftIce 402 W WASHINGTON ST W461 INDIANAPOLIS. IN 48204 I. EnS Number: __ Grant ...... __ Maintenance - _ - Attorney Uoense Agreement _Amendment#l _ _ _ _ __ _MOU _Re~' _ _ _ _ _ __ 25. Tdcphonc #: SVCINC $1,098,000.00 26. Address: NA 485 B01DERVIJOOD IN CARMEL. IN 48032 Year ~20:::':..:' __ S4D OQQOO V.... ~20~1~2_ _ Sl PSB vea, ___ vea, ___ $ QQQQQ • __ Yea _ _ """ _ _ _ _ _ Ne;sotiated X Special PIOCWcment Women: ~NO Minority: X 35. Will die IIttached document involve dab. processing or telecommunications systems(s)1 % % % 33, Is tbcre RencwaI Language in the docwncut? __Other (sp«lfy) % X Womeu: 13. Method of source selection: B~oo __ ~ ~No X Yes 34. Is there a -Termination for ConvaricnQ!:~ clause in the No document? X Yes No Yes: lOT or OeI.cgaIc has signed off 00 contract 36. Statutory Authority (Cite applicable lnmafIQ Of' Federal Codu): NA 37. Dcscriptioo of work andjusti6canon for spending mODe)'. (please giVe a brief dcsCt"lptlon of.he srope o/work Included in this agreemenl.) The oarnraaor wiD provide ovenlllUlllgcmenl. pmjocr leadenhip aDd ~ fur1be lndi_ ~ Heahb lnsurmce ExdIanse l..e\od OaeGrtm AcIi....tti5 38, Justificalion of vendor selection and determination of price rc:asonablmcss: This coatractor hIS worked wilb FSSA in the past pcr{orming c:onsuIting IIIJd projecr: \eada!ibip savice:s, 39. lfthis connact is submitted late, please explain why: (R~quired ifmore than 30 ~ late.) IiomAG 47.0. Approved 57464-Q00 A129-1-29-11-ZN-1758 INDIANA FAMILY AND SOCIAL SERVICES ADMINISTRATION CONTRACT WITH SVC,INC.· CONTRACT NUMBER A129-1-29-11-ZN-1758 This Contract ("this Contract"), entered into by arid between Indiana Family and Social Senilces Administration, 402 West Washington Street, Indianapo~s, Indiana 46204 (the 'State') and the SVC, Inc., 485 Bolderwood Lane, Carmel, Indiana 46032 (the 'Contractor'), is execUted pursuant to the terms and conditions set forth herein. In consideration of those mutual undertaklngs and covenants, the parties agree as follows: 1. Duties of Contractor A. The Contractor shaD provide overallll)anagement, project leadership and support for the ImfJana State-Operated HeaHh Insurance Exchange Level One Grant activities. The specific services to be provided by the Contractor are set forth on Exhibit 1, Scope of Work (the 'Services,) which is attached hereto and incorporated fully herein. B. Non-compliance Remedies It is the State's primary goal to ensure that the Contractor is delivering the scope of work defined and agreed to in this contract. In the event that the Contractor fails to meet performance requirements set forth in the Contrect, the state will provide the ContractOr with a written notice of non-compnance and may require any of the corrective actions or remedies discussed below. The State will provide written notice of non-compliance to the Contractor within fifteen (15) calendar days of the Stale's discovery of such non-compDance. If the State elects not to exercise a corrective action clause contained anywhere in the . Contract this decision must not be construed as a waiver of the State's right to pursue future assessment of that performance requirement and associated damages, including damages that, under the terms of the Contract, may be retroactively assessed. C. Corrective Actions The State may require corrective action(s) when the Contractor tias failed to provide the requested services and deliverableS. The nature of the corrective action(s) will depend upon the nature, severity arid duralion ofthe deficiency, and repeated nature ofthe noncompfiance. The written notice of nOl)-compliance may be instituted in any sequence. and include, but are not fimited to, any of the following: • • Written Warning: The State may Issue a written warning and solicit a response ragarding the Contractor's corrective action. Corrective Action Plan Recommendation: Upon issuance of a written warning. unless otherwise specified in the waming, the Contractor has seven (7) calendar days to submit ~ Corrective Action Plan Recommendation to remedy the breach. The Recommendation must be submitted under the signature of the Contractor's project executive and must be approved by the State. If the Recomme.ndation is not acceptable, the State may provide suggestions arid direction to bring the Contractor into compliance. Page 1 of 18 A 129-1-29-11-ZN-1758 • • • Performance Payment Withhold: In the event that the Contractor cannot develop a Corrective Action Plan Recommendalion that is to the Stale's reasonable satisfaction within fourteen (14) calendar days after issuance of a written warning, the State reserves the right to withhold payments unta Ihe Contractor develops a Corrective Action Plan Recommendation that is accepted by the State. Ceased Payments for Staff Vacancies: It is the State's goal to minimize staff attriIlon rates throughout the project (erm 10 maintain consistency and quality in the Contractor's work product. Wllhin twenty one (21) calendar days from when a team position is vacant, the Contractor shall present at least two (2) qualified candidates for the State to interview and evaluate. These candidates' level of experience and expertise must be equal to or surpass those of the team member they would replace. After the Slate approves of a candidate, the Contractor shall bring the canf-state travei requests must be reviewed by the State for availabtlity of funds and for appropriateness per Circular guidelines.' '. 45. Waiver of.Rights No right confe'ired on' either party under this Contract shall be deemed waived, and no breach of this Contract excused, unless such waiver Is In writing and signed by the party claimed to have waived such right. Neither the State's review, approval or acceptance of, nor payment for, the serviceS required under this Contract shall be construed to operate as a waiver of any rights . under this Contract or of any cause of action arising out of the performance of this Contract, and the Contractor shall be and remain liable to the State in accordance with applicable law for all damages to·the State caused by the Contractor's negligent performance of any of the services furnished under this Contract. . ' . 46. Work Standards The Contractor shall execute its responsibilities by following and applying at all' times the highest professional and technical guideOnes and standards. If the State becomes dissatisfied with.the work product of or the working relationship with those individuals assigned to work on , this Contract; the State may request In writing the replacement of any or all such individuals, and the Contractor shall grant such request. 47. State BOilerplate Afflnnation Clause I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the state's Boilerplate contract clauses (as contained in the 2009 OAG/IDOA Professional SSNices Contract Manual) In any way except for the following' clauses which are named below: 6. Audits-MODIFIED 33. Payments--MODIFIED THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY: LEFT BLANK. Page 17 of 18 A129-1-29-11-ZN-1758 Non-Colluslon and Acceptance The undersigned attests, subject to the penalties for perjury, that he/she Is the Contractor, or that he/she Is the properly authorized raprasentative, agent, member or officer of the Contractor, that he/she has not, nor has any other member, employee, representative, agent or officer of the Contractor, directly or indirectly, to the best ofthe undersigned's knowledge, entered into or offered to enter Into any combination, collusion or agreement to receive or pay, and that he/she has not racelved or paid, any sum of money or other consideration for the execution of this Contract other than that which appears upon the face of this Contract. In Witness Whereof, Contractor and the State have, through their duly authorized representatives, entered Into this Contract. The parties, having read and understood. the foregoing terms of this Contract, do by their respective Signatures dated below hereby agree to the terms thereof. SVC, Inc.: Ices Administration: Dare:,____ ~ ____________________ Department of Admlnlstretion ~~.~C~ioner (for) Date:------~~~~i------1· 20 . \I APPROVED as to Form and Legality: Office of the Attorney General 71=-':;-;-,{-;\-,:""":'f:f-~_ _ _ _....:(for) A"" II , u.. ~bl Gregory F. ZoelleJJijtomey General Date:,____-'-;~~..:....r..------------_ Date: Page 18 of 18 1- "2A -II (for) ,. . ... • ATTACHMENT: AGREEMENT #: AGREEMENT TERM: ATTACHMENT.. DOCUMENT SUMMARY 6/24/2011 VENDOR INFORMATION: LEGAl NAME: A . 29-11-ZN-1758 OS/2312011~12212012 svc, INC. MAIUNG ADDRESS: 485 BOIDERWOOD LN CARMEl, IN 46032 CONTACT NAME:. EMAIL ADDRESS: SEEMAVERMA sverma@$Ydnc.org TELEPHONE NUMBER: (317) 809-8536 (317) .571-8848 . . FAX NUMBER: . DIRECTOR'S NAME:' TELEPHONE NUMBER: SEEMAVERMA (317)809-8536 (317) 571-8848' FAX NUMBER: FSSA CONTRACT CONTACT: . Patton, Joe (317) 233-6468 FID/SSN: PS Vendor ID: XX-XXX9528 000025.7665 CHANGE NUMBER: ORIG FINANCIAl SUMMARY: CLAIMPROGID 29-11-ZN-1758~1 29-11-ZN-1758~2 SERVICE CODE PROGRAM 1677 Health Exchange EFFECTIVE DATES OS/23/2011 ~/30/2011 AWARD AMOUNT $40,000.00 Health Exchange 07/01/2011-05/22/2012 $1,058,000.00 1677 TOTAL DOLLAR AMOUNT: $1,098,000.00 Page lof3 • ATIACHMENT DOCUMENT DETAIL ATIACHMENTi AGREEMENT #: AGREEMENT TERM: 6/24/2011 LEGAL NAME: CLAIM PROGRAM ID: FEDERAL YEAR: EFFECTIVE DATES: EFFECTIVE DATES: SVc, INC. 29-11-ZN-17sa-ol .FY11 2011 OS/23/2011-06/30/2011 OS/23/2011-1)6/30/2011 PSVendarID: 0000257665 CFDA NUMBER: N/A STATE YEAR: STATE YEAR: CLOSE OUT DATE: 2011 2011 08/29/2011 SERVICE INFORMADON: . SERVICE EFF DATES: COMPONENT DESCRIPnON 5/23/2011-6/30/2011 .PS 5/23/11-6[30/11 PROGRAM STAFF A 29-11-ZN-1758 OS/23/2011-05/2212012 1677 HEALTH EXCH PLAN COMPONENT DATES SERVICE TOTAL: Page 2af3 UNITS ACTUAl COST RATE AWARD AMT 1.0000 0.00 40,000.00 ,, • ATTACHMENT DOCUMENT DETAIL ATTACHMENT: AGREEMENT #: AGREEMENT TERM: 6/24/2Dll LEGAL NAME: CLAIM PROGRAM ID: PROGRAM TOTAL: FUND DESCRIpnON: FEDERAL YEAR: EFFEcnvE DATES: EFFEcnvE DATES: SVC, INC. 29-11-ZN-1758-{)2 1,058,000.00 Health Exchange Grant, FY12 2011 07/01/2011-{)S/22/2012 07/01/2011-05/22/2012 SERVICE INFORMAnON: SERVICE EFF DATES: COMPONENT DESCRIPTION .PS PROGRAM STAFF SERVICE TOTAL: 29-11-ZN-1758 . 'OSI23l2011-{)5/2212012 " PS Vendor ID: 0000257665 REGION: StatewIde CFDA NUMBER: N/A STATE YEAR: STATE YEAR: CLOSE OUT DATE: 2012 2012 07/21/2012 1677 HEALTlI EXCH PLAN 7/1/2011-5/22/2012 COMPONENT DATES UNITS 7{01{11-5/22112 ACTUAL COST Page3of3 ~~ RATE AWARO AMT 1.0000 0.00 . 1,058,000.00 Exhibit 1 . A129-1-29-11-ZN-1758 Scope of Work. SVC, Inc., ·Contrector," shall provide overall management, project leadership and support for the Indiana State-Operated HeaHh Insurance Exchange Level One Grant actlvities. The Contrector's scope of work items are listed below: • OVersight and Program Integrity. o Work with the State to establish a communication plan, provide weekly work stream progress reports, provide bi-weekly Exchange progress reports, provide . quarterly progress reports, post public reports, and review project federal financial reports. Confirm quarterly accomplishments. o. Support the following. meetings: govemment updates,. Medicaid integration, IT system work stream iritegratlon. policy work stream Integration, joint strategy, 1001 integration, grant financial review o To ensure the prevention of waste, fraud, and abuse: develop the project schedule, staffing plan, oversee development of govemance model, risk plan, issue plan, and lessons learned documents. Perform stage gate reviews. o Support procurements, working In conjunction with the procurement consultant, Ikaso Consulting o Conduct core area integration meetings. ConSOlidate, analyze, and report on core area project accomplishments and barriers. Working in conjunction with the procurement consultant, lkaso, establish process for performance and success monitoring, financial review and approvel, and grant performance reporting. • Stakeholder Input. Support analysis of Exchange questionnaire data and obtain stakeholder input though meetings with insurers, healthcare providers, consumers and businesses as well as regional meetings • Governance Structure. Provide oversight and direction to Ice Miller to evaluate the governance structure of the Exchange, incorporate Indiana Insurance Market, Inc., and draft governance documents for Indiana Insurance Market, Inc. • Program Integration. Work with the State to develop stretegles for compliance with a "no wrong door policy" and develop detailed process documentation and operating procedures between the Exchange and other subsidy programs. Work with the financial consultant to create detailed standard operating procedure for cost allocation between federal fund streams. . • Financial Management Work with the State to select a qualified financial consuHant. Work with the financial consultant and actuary to develop a funding plan, detailed projected Exchange budget, the financial management staffing plan and the finaricial management system recommendations. • Provide Assistance to Individuals and Small Businesses, Coverage Appeals and Complaints. Work with the State and the business requirements vendor to develop a decision document describing where consumer assistance functions reside. • Develop Business Processes and Requirements for All Exchange Functions to Drive Exchange Design. Work with the State and the selected business requirements Page 1 of2 Exhibit 1 A129-1-29-11-ZN-1758 vendor to develop a business/agency process map. Work with the State to execute the agency process integration and to plan organizational change The roles and responsibilities of key personnel for this scope of work are described below: • Project Director o Be Indiana's Health Care Reform Lead, acting as the Project Director for the Level· One Grant activities. o Represent the Governor's office and be responsible for leading the State's efforts around the reform, coordinating the agenCies, and vendors to lead the Exchange development. He or she wiD have overall responsibility for the grant and will direct and coordinate all Affordable Care Act (ACA) and grant actMties with oversight from the Governor's Office task force. o Provide testimony and respond to media inquiries as needed or as directed by the Office of the Governor. o Supervise the other SVC team members and all vendors on the Level One Grant. . 0 Supervise a!1 resources performing activilies for the Level One Grant. • Project CoordinAtor o Assist the Project Director. . o Conduct research. o Oversee all stakeholders' input. o Support the business requirement team. o Prepare items such as policy papers, reports, state plan amendments, waivers, and PowerPoint presentations for stakeholder meetings under the direction of the Project Director. • Exchange Project Manager o Have primary responsibility for developing the Exchange project plan and assure adherence to timelines. o Provide status reports to the Executive team and identify and create solutions for any lapses in the timelines. o Supervise all Work Stream Project Managers. • Project Assistant o Support the Project Manager. o Work with the agency teams, Indiana Department of Insurance (1001), and Division of Family ResOurces (OFR) to help organize tasks on the agency level. Additions to the Scope of Work The Contractor must receive written approval from the State before commencing work on any task outside of the scope described above. If written approval is not obtained beforehand, the State has the right to decline payment of costs associated with those tasks. Page 2 of2 . Exhibit 2 A129-1·29-11-ZN·1758 Costs Cost Breakdown by Key Personnel Project Director SeemaVerma 1,400 $135.00 $189,000 Project Coordinator Kaitlyn Shaw 1,400 $135.00 $189,000 . Tammy Fisher '2,400 $165.00 $396,000 TBD 2,400 $135.00 $324,000 Project Project Assistant TotaINot·to·Exceed Project Cost Page 1 of 1 $1,098,000