The Department of Human Services, Clarks Summit State Hospital is seeking a contractor to provide Ambulance Services for consumers located at 1451 Hillside Drive Clarks Summit, PA 18411, as described in attached Statement of Work. Anticipated Term of the contract will be January 1, 2022 (or upon full execution of the contract; whichever is later) through December 31, 2023, or two years, with three one-year renewal options. Suppliers must enter firm prices for all contracted years. The contractor is to provide Basic Life Support--BLS and Advanced Life Support--ALS Emergency Transport and Basic Life Support (BLS) Non-Emergency Transport services at Medical Assistance (Medicaid) rates plus an optional percentage of facility gross charges. CSSH will make an all-inclusive payment for all compensable services using the contract rates, which will be based on Commonwealth of PA Medical Assistance Fee Schedule in effect at the time of the service, plus/minus _____ % (bidder inserts rate on MA Rate Certification form). Bidders must bid based on the MA Fee Schedule rates. The fee schedule can be found at: http://www.dhs.state.pa.us/publications/forproviders/schedules/mafeeschedules/outpatientfeeschedule/index.htm The contractor is required to submit the attached MA Rate Acceptance Certification, which also identifies the optional percentage rate you will be requesting if you choose to add a percentage. Please enter your plus/minus% rate on the MA Rate Certification Form. If you choose not to add a percentage, please enter 0% on the MA Rate Certification Form. For purposes of the electronic submission, all responders should bid $1.00 on each MA rate line as this is an estimated spend amount. Invoice prices will be based off the MA Rate Certification Form filled out. All references to a “Purchase Order” in the Standard Terms and Conditions or within the Solicitation documentation shall be substituted with either the term “Contract”, or the phrase “formal written notice to proceed” as appropriate This electronic Invitation for Bid will result in a paper Funds Commitment contract. Bids are due November 22, 2021, 10:00 AM and must be submitted electronically. Late bids will be disqualified. Failure to submit bid as described may result in yours being rejected as a non-responsive bidder. All Questions regarding bidding on this solicitation should be submitted in writing to: [email protected] to Merry Mitchell. The following documents are incorporated by reference: Statement of Work Standard Terms and Conditions DHS Addendum Business Associate Addendum (HIPAA) MA Rate Certification Form Whereas Page--attached is an example of the paper contract that will follow the solicitation to the awarded vendor. Your electronic submission must include the following. Failure to submit all of these items will result in automatic rejection of your bid: 1. Completed IFB. 2. Appropriate responses to all “Mandatory Attributes” contained in the IFB. Your electronic submission should also include the following as attachments. Failure to submit these items may result in the rejection of your bid: Bid Attachment Forms for completion: 1. MA Rate Certification Form 2. Contract Signature Page 3. Lobbying Certification Form 4. A valid license for ambulance services with the bid, as well as a letter stating the qualifications, eligibility, and certifications of all current emergency medical services personnel have been verified. Please note that: The Contractor must submit an updated letter to CSSH every six months thereafter. Quantities listed are estimates and may increase or decrease based on the needs of the facility. Award will be made based on lowest and responsible and responsive bidder.

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