Nurse Advice and Triage Services

Description

Addendum 1/ Amendment 2: Added March 18, 2020 •Acknowledgement of Addendum 1/ Amendment 2 prerequisite has been added to the prerequisites page. •Addendum 1 added to the Buyer Attachments tab containing the following: SCOPE OF SERVICES Description of Services: the following change has been made Delete: The telephone-based service shall be accredited by the Utilization Review Accreditation Commission (URAC).  Replace: At time of contracting proposer must provide documentation to show they are accredited or certified to provide the requested services. Please review addendum 1 in the Buyer Attachments page for detailed information. _____________________________________ Amendment 1: Added March 12, 2020 The following change has been made to the Pre-proposal Conference: Please note that the in person pre-proposal conference has been canceled. We will still hold the optional pre-proposal conference today March 12, 2020 at 2:00 pm via telephone only. Please call into the pre-proposal conference using the below information: •Address: meet.google.com/wiy-gqqf-dwv •Phone Number: (442) 273-0466 PIN: 621 159# Attendance is: Optional _____________________________________ PRE-PROPOSAL CONFERENCE:  There will be a pre-proposal conference for this sourcing event on Thursday, March 12th at 2:00PM. The pre-proposal conference will be held in Conference Room 511 on the fifth floor of the Gladys McCoy Building, 619 NW 6th Ave, Portland, OR 97209. Proposers will also have the ability to call into the pre-proposal conference using the below information: •Address: meet.google.com/wiy-gqqf-dwv •Phone Number: (442) 273-0466 PIN: 621 159# Attendance is: Optional Please allow yourself extra time for parking and to check in with the security guard.  SERVICE DESCRIPTION, FUNDING AND CONTRACTING INFORMATION  PURPOSE AND OVERVIEW  The Multnomah County Health Department (MCHD) Integrated Clinical Services (ICS) Division is seeking Proposers from whom it may purchase nurse advice and triage services. Services are to be provided to Multnomah County clients outside of normal business hours, including weekends and observed MCHD holidays, during planned or unplanned clinic closures, and as needed during other times. Services are intended to assist clients served by the MCHD clinics when MCHD clinics are not accessible. This service is a requirement for federally qualified health centers (FQHC). The specific requirement is described in detail by the Bureau of Primary Health Care within the Health Resources and Services Administration (HRSA), part of the U.S. Department of Health and Human Services. This service has been previously established and operating at Multnomah County for many years. The successful Proposer will provide specially trained, Utilization Review Accreditation Commission (URAC) accredited nurses using a call center software platform that supports medical triage. Registered nurses will have proof of active registration in the State of Oregon and proof of annual renewal.  Major service components include: •Dedicated toll free phone number and ability to connect with MCHD’s phone system  •Custom greeting and optional Interactive Voice Response (IVR) menu   •24/7 access to registered nurses for medical triage and health questions   •24/7 access to service personnel for non-clinical questions and administrative assistance   •Prompt and timely reporting and quality assessment and quality control capabilities   •Multiple language translation services  INTRODUCTION AND PROGRAM HISTORY MCHD has operated Oregon’s largest FQHC since 1977. MCHD operates health centers across Multnomah County, Oregon’s most populous county that includes the City of Portland. MCHD serves approximately 60,000 patients annually through the following services: •7 primary care health centers providing primary care, behavioral health, radiology, laboratory, and prenatal services; •1 specialty health center serving clients with HIV/AIDS; •8 school-based health centers providing primary care and behavioral health services to school-aged children on school sites; •6 dental clinics providing preventive and comprehensive dental and oral health services; and •A School Community Oral Health program placing sealants in elementary and middle schools MCHD’s clinical services currently use the following electronic health record platforms and value partners with familiarity and experience with these platforms:   •Medical: OCHIN Epic Health Record/Epic Practice Management   •Dental: OCHIN Epic Health Record/Epic Wisdom •Pharmacy: Cerner, Note: As of May 2020 Pharmacy will  transition to a new platform PioneerRx GOALS, VALUES AND OTHER IMPORTANT CONSIDERATIONS Integrated Clinical Services (ICS) values are aligned with the Quadruple Aim:   •Patient Experience: Person-Centered and Culturally Relevant •Better Health Outcomes: Quality and Safety •Care Team Experience: Engaged, Expert, Diverse Workforce •Lower Costs: Fiscally Sound and Accountable Important considerations for Proposers include: •Flexibility: Health care reform is a major influencer of Multnomah County’s services. As such, we seek Proposers who will partner with us as our services expand or change in size and/or scope and as our service hours/days change over time.   •Technology: Multnomah County seeks Proposers who value and use technology in innovative ways in support of health care services. Technology and familiarity with electronic health record systems will continue to drive improvements, and we value Proposers who use technological innovation in their work or who have experience documenting in electronic health record systems.   •Scope of Advice and Triage Services: At minimum, Multnomah County expects Proposers to provide medical, dental and behavioral nurse advice and triage services in accordance with our clinical protocols to be developed collaboratively.   •Language Translation Services: Proposers shall have experience and expertise in handling high volume translation needs.   •Low-Income Clients:  Successful Proposer will have experience and expertise in serving low income clients and/or will have familiarity serving FQHCs or safety net clinic systems. TARGET POPULATION SERVED  MCHD serves approximately 60,000 low-income clients per year in its primary care health centers, school based health centers and dental clinics. Approximately half of the clients served are children or adolescents age 18 and younger.  Nearly 85% are at or below 200% of the Federal Poverty Level (FPL), with over 65% at or below 100% of FPL. Clients served are generally on Oregon Health Plan (Medicaid) or lack health insurance.  MCHD serves clients of many races and ethnicities that require language translation services. Successful Proposer shall provide translation services in multiple languages. A few of the more common languages are: •English •Spanish •Russian •Chinese-Cantonese •Somali •Arabic •Vietnamese •Karen •Burmese •Nepali FUNDING  Funding sources include fee revenue, grants and Multnomah County General Fund. Funding of the work described in this Request for Proposal (RFP) is not guaranteed. Fluctuations in funding year to year should be expected. The County cannot assure that any particular level of work will be assigned and the contract will permit the County to add or remove work as necessary depending on availability of funding. SCOPE OF SERVICES Description of Services: Proposer shall provide all personnel including labor, supervision and management, facilities, materials, equipment and services for the provision of all after hours nurse advice and triage services described in this RFP. All nurses providing advice and triage services shall be a registered nurse (RN) with a current and unrestricted license(s) as required by the Oregon State Board of Nursing; This is a requirement of Oregon’s Board of Nursing. The telephone-based service shall be accredited by the Utilization Review Accreditation Commission (URAC). The service will provide clinical assessment and appropriate level of care support services for established clients of MCHD health centers.  Services shall include telephone nurse advice and triage services, processing, administration and management, data collection, quality reporting and financial administration/reporting. Expected level of service should be aligned with industry standard. This description is not intended to be all-inclusive, but rather as the minimum service standard. Description of Assigned Personnel:   •Proposer shall not employ persons on this Contract if such employee is identified to the Proposer as a potential threat to the health, safety, security, and/or general well being of the facility and its population.   •Proposer shall provide initial and monthly updated lists of Proposers employees’ names and position titles.   •Proposer shall not employ any person who is an employee of MCHD if the employment of that person would create a conflict of interest as determined by the County Attorney.   •All Proposers employees shall conduct themselves in a professional, courteous manner. The selection, assignment, reassignment, transfer, supervision, management, and control of Proposers employees in performance of services shall be the responsibility and prerogative of the Proposer; however, Proposer shall comply with the requirements set forth in this RFP including health center regulations concerning conduct of employees as referenced herein.   •Proposer shall employ and maintain a technically trained and experienced workforce. Proposers personnel shall be responsible for providing a staff of competent professional RNs that have a current, unrestricted license(s) as required by the Oregon State Board of Nursing who have a minimum of three years experience in nurse triage related experience.   •RNs shall be fully trained to manage patient calls per protocols, maintain call/patient records, provide feedback to clinics/providers as requested, provide back-up and support for internal personnel, provide feedback to program and medical management, and maintain appropriate nursing skills. Proposer must ensure that RNs are trained and practice within the Nursing Scope of Practice as defined by the Oregon State Board of Nursing.  •The County highly desires that the Proposer have English and Spanish speaking staff available at all times. However, all Proposer employees shall fluently read, understand, speak, and write in English. For language other than English , Proposer shall provide interpretation services as needed.   •All services will be performed in the US, and all personnel assigned to receive and make calls shall legally able to work in the US.  •Proposer will ensure that there is no break in service except for those circumstances or reasons beyond Proposer's control, including, without limitation, acts of God or of the public enemy, flood, storm, strikes, regulatory delay or restraint. Management: Proposer shall have a manager RN available with overall responsibility for all clinical functions, quality improvement monitoring, directing workflow of staff, monitoring staff productivity, conducting staff performance evaluations, staff scheduling, reviewing calls for use of protocols, adequacy, and accuracy of documentation, acting as a resource for caregivers and multidisciplinary team members, quality of service, quality assurance,  staff competency, clinical problem resolution, development and maintenance of relationships with physicians and other healthcare providers, and program representation to organizational management and related departments. This manager RN shall meet all State of Oregon licensure requirements. Proposer Point of Contact (POC): Proposer shall provide a POC that shall be responsible for the overall performance of the services. Proposer shall designate the POC in writing, to MCHD POC before the contract start date. An alternate may be designated, but the Proposer shall identify those times when the alternate shall be the primary POC. Proposer POC or the alternate shall be available via pager or mobile phone, 24-hours per day, 7 days a week. Call Volume, Response and Call Back Time: Historic volume is approximately 200-400 calls per month. The volume could vary depending on the time of year and public health concerns such as an outbreak. A small number of calls will be for information only, or closed due to screening and will not require an RN. All others will follow clinical protocols and guidelines.  Proposer shall answer patient calls in the order they are received with an average answer time within 30 seconds. Proposer will give every caller an approximation of their expected wait time to receive a call back from RN.  All patients shall speak immediately to a staff member or be called back within an average of 30 minutes from the patient's original call to the service. The callbacks will be prioritized based upon urgency with urgent calls being immediately connected to a RN. At least two attempts will be made to reach a patient before a Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant message is left on the patient's voice mail. Quality Assurance Program: Proposer shall implement a quality control program to ensure performance is in accordance with the scope of work. Proposer and MCHD shall co-develop this plan and expect that it will be incorporated into the resulting contract. Complaints: Complaints by MCHD personnel, validated through the MCHD POC, shall be reported in writing to the Proposer for action and may constitute failure to perform. Patients may also be a source of legitimate complaints that constitute a failure to perform. Validated complaints will be addressed through a mutually agreed upon action plan by the MCHD and the Proposer.  Hours of Service and Operations: The services are required for after hours, weekends, observed MCHD holidays and when health centers are otherwise closed (example: inclement weather, staff meetings, etc.). Hours of service may change over time but generally are the following:   •Weekdays: Evenings, from 5:00 p.m. to 8:00 a.m. the following day.   •Weekends: Friday evening, from 5:00 p.m. to 8:00 a.m. on the following Monday.   •Holidays: If a holiday falls on a weekday, from 5:00 p.m. on the day preceding the holiday to 8:00 a.m. on the weekday following the holiday. Multnomah County health centers are currently closed on the following holidays:  New Year’s Day;  Martin Luther King, Jr. Day;  Presidents Day;  Memorial Day;  Independence Day;  Labor Day;  Veterans Day;  Thanksgiving Day;  Christmas Day; and  Any other holiday declared by the President of the United States, Governor of Oregon, or Multnomah County Board of Commissioners.   •Inclement Weather Closures: As communicated to Proposer  (often on short notice.)   Other unplanned closures or emergencies (often on short notice.)   •Staff Meetings and Trainings: As communicated to Proposer (generally planned with at least 3 days notice.)   •Other: As communicated to Proposer •Gaps in Service: Proposer shall ensure that phones are continuously staffed with trained personnel. No gaps in Proposer coverage of services are permissible except as noted elsewhere.   •Calls When Health Centers are Open: MCHD may forward triage calls during regular business hours when health centers are open when prearranged through the POC and Proposer.   •Crises: These services are designated as essential services for performance during crisis of any kind. Continuation of essential services during a crisis is critical in the provision of these services. Proposer shall develop a contingency plan for tasks designated as essential to provide reasonable assurance of continuation of services during a crisis and inclement weather conditions. This plan shall be incorporated into the resulting contract.  Clinical Protocols and Guidelines: All calls shall be answered using nationally recognized and physician approved clinical protocols and guidelines for symptom-based calls. MCHD shall have direction, approval and input into how calls are answered. MCHD personnel will coordinate any customization to standardized protocols and guidelines. Customized protocols will be provided to MCHD personnel by the Proposer and will clarify points of contact. Screening Protocol: With each call, Proposer shall ask if the caller is enrolled in an MCHD health center. If the answer is yes and verified by Proposer, the Proposer will follow established and agreed upon protocols. With each MCHD health center beneficiary call, the Proposer will ask if the patient is a current patient of an MCHD health center. If the answer is yes, the Proposer will verify by collecting the following information: patients name, date of birth, telephone number including area code, address, MCHD health center name, primary care provider name when known, and MCHD patient identification number when known.  Proposer will recite the following script to callers who are not enrolled in an MCHD health center: “We are unable to provide medical advice to callers who are not Multnomah County Health Department clients. If this is a medical emergency, please hang up and call 911. If this is a mental health emergency, please hang up and call 503-988-4888. If you need other medical advice, please call your last provider or clinic for help.”  Dental Calls: RN shall respond to calls from clients who are seeking dental advice using the agreed upon MCHD protocol and guideline for dental emergency protocol: Prescription Refill Procedure: Proposer will follow the following procedure for prescription refills. For medication refills, RN will confirm if the medicine is needed prior to the next clinic day and ensure the patient has called pharmacy if there are any refills on record. If no refill on file, medical provider or dental provider approval will be sought. RN will take a verbal order from a medical provider or dental provider. RN will read back confirmation to the prescribing medical provider or dental provider, and call in the prescription to the appropriate pharmacy as identified by the prescribing medical provider or dental provider. The RN will then document in the triage report the following information (which may be changed at any time by MCHD personnel):   •Presenting problem/nursing assessment   •Prescription called in by (Provider name)   •Date/time ordered   •Item   •Dosage   •Frequency   •Provider name HIV Calls: RN shall respond to calls from clients of Multnomah County’s HIV Health Services Center (sometimes called HIV Clinic or Health Services Center by obtaining the following information (which may be changed at any time by MCHD personnel):   •Name of provider   •Last health center visit   •Next health center visit   •Most recent CD4 count and viral load   •Current medications   •Has client started any new medications? If so, which ones?   •Previous serious illnesses associated with HIV/AIDS   •If and when last hospitalized   •Has this symptom or problem occurred before? If so, when? If a client who is served by Multnomah County’s HIV Health Services Center asks to speak with an after hours provider, the RN will refer the client as instructed by MCHD.Mental Health Calls: For calls from Multnomah County clients or family members asking for the mental health after-hours provider, the RN shall take the name of the client/caller and/or family member, specific concern, location of the client, and phone number where the client/caller and/or family member can be reached. The after-hours MCHD provider shall be contacted by RN immediately, and/or an agreed upon MCHD protocol used. Nurse Standing Orders: The provision of Nurse Standing Orders shall be within the Oregon State Board of Nursing requirements. Emergency Contraceptive Calls: RNs shall refer these calls to the after-hours provider as informed. The MCHD provider will call in a prescription, and RN will document referral in triage report. MCHD clients are not to be referred to their health center.Calls from Emergency Rooms: The RN shall document calls regarding MCHD clients in the triage report, including the nature of the visit, disposition of patient, and whether follow-up at an MCHD health center is recommended. The RN shall contact after-hours MCHD provider only if requested by the emergency room physician or personnel.Critical Lab Calls: The RN shall refer all critical labs that are called in from the lab services Proposer to the after-hours MCHD provider. Agreed upon protocols will be established.Medical Emergencies: The RN will ascertain the location of the client as is routine with all calls. The client will be instructed to hang up and dial 911 immediately. If 911 is unavailable or availability is unknown, the client will be instructed to hang up and dial 0 for the operator. If the client is unable to dial 0, the RN will keep the client on the line and establish contact with the operator to initiate emergency medical services for the client’s location. Once contact is made between the client and emergency medical service assistance, the RN will hang up and document in triage report.Translation Services: Proposer shall make available translation services for all languages spoken by MCHD health center clients. Approximately one-third of MCHD health center clients speak Spanish as a primary language. Immediate Spanish translation services are required each and every call as this service may be provided through a three-way conference call between the client, RN and interpreter.Error Calls: For telephone calls received by Proposer in error, Proposer shall make its best effort to forward or route calls to the correct parties, in accordance with the telephone directory provided by MCHD and other tools or research engines available to Proposer. If there is an immediate need for assistance, Proposer will refer caller to the 211 information line at 503-222-5555.Information Requests:  Requests for health information, medication information or other information that the RN would normally not provide in the judgment of MCHD alone, Proposer will document the request and send the request  to MCHD for follow-up the next business day as instructed by MCHD.Contacting Health Center Providers and Staff: Where the Proposer’s nationally recognized and physician approved clinical protocols and guidelines for symptom based calls indicate, the Proposer shall call or page the health center’s on-call provider•Contacting the After-Hours MCHD Provider: Calls will be routed to the On-Call Provider based on protocols supplied by MCHD after award of the Contract. There is a single After-Hours Physician and a single After-Hours Dentist available at all times. No medical or dental specialist including pediatrics and mental health providers are available during the provision of these services.  â€¢Contact Information: Pager and cell phone numbers will be provided to the Proposer by MCHD. MCHD will give the Proposer schedules of On-Call Providers by the 20th of the preceding month with updates submitted as needed.  â€¢Contacting the After-Hours Physician: If the MCHD After-Hours Physician does not call the Proposer back within fifteen (15) minutes, the first step will be to re-page the After-Hours Physician, ensuring that the proper number is dialed. If the MCHD After-Hours Physician does not call the Proposer back after an additional 15 minutes, Proposers registered nurse will attempt to call the After-Hours Physician’s cell phone or home phone. If the MCHD After-Hours Physician does not respond after this (a total of 30 minutes), Proposers registered nurse will contact the back-up MCHD After-Hours Physician.  â€¢Information Provided to On-Call Provider: When the MCHD After-Hours Physician returns Proposers registered nurse call, Proposers registered nurse will give the patient’s name, age, the specific concern, the patient’s location and phone number and, if applicable, the name of the family member and that person’s phone number. Patients or family members are not, under any circumstances, to be referred or directly connected to MCHD After-Hours Physician. The After-Hours Physician will contact the patient and/or family member.  â€¢Pager and Cell Phone Numbers: MCHD POC will provide a list of pager and cell phone numbers to the Proposer for all After Hours Physicians prior to the start of provision of services. The MCHD POC will provide new numbers to the Proposer prior to use if the information changes.•On-Call Point of Contact (POC): MCHD will provide a list of providers who are on call (After-Hours Physicians), including provider names, and days and times of assignment. MCHD will provide the roster to the Proposer by the 20th day of the preceding month. There may be circumstances where the on-call schedule will change with short notice or no notice. Proposer will be provided changes to the roster as soon as changes are received.  â€¢List of Providers: A current list of MCHD Health Department providers by assigned MCHD will be provided to the Proposer prior to the start of provision of services. The POC will provide changes to the provider roster prior to changes taking effect whenever staffing changes.  â€¢MCHD Point-of-Contact (POC): The POC will be assigned. Calls requiring necessary follow-up from the MCHD POC, Primary Care team, Dental team, MCHD Medical Director, or MCHD Dental Director shall be identified by the Proposer in daily individual triggered triage reports and daily summary reports that list all patients by acuity.  â€¢Quality Assurance Personnel (QAP): MCHD will provide the names and contact information for the QAP. Designated QAP will accomplish inspection and acceptance of services according to requirements of this Contract and Performance Plan.  â€¢Provider Education: MCHD shall be responsible for educating its physicians and its other providers about the services. MCHD shall instruct the physicians and other providers to direct concerns regarding the protocols and other issues to the Physician Advisory Committee (PAC).  â€¢Community Resource Information: MCHD shall provide information regarding community resources and other referral information so that Proposers RNs can refer patients when appropriate.  â€¢Follow-Up Services: The parties agree that all follow-ups deemed appropriate for Proposers registered nurse triage telephone calls will be the sole responsibility of MCHD. Proposer shall not be responsible for follow-up after providing the call detail report to MCHDCall Documentation and Distribution: Information regarding calls to the Proposer shall be entered into an individual patient document with information concerning the assessment made, resolution, and/or further action needed from MCHD. Call information shall be sent electronically in a secure manner to MCHD’s POC daily.Privacy and Protection of Patient Information:•Proposers employees shall abide by the Patient Privacy Act 1974 and the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  â€¢Proposer shall provide patient information only to its employees, Proposers and subContractors having a need to know such information in the performance of their duties.  â€¢All individuals performing Services for MCHD shall be required to complete HIPAA Act of 1996 Privacy Rule training, and will be held accountable for complying with MCHD specific health information privacy policies and procedures. All individuals answering calls as Proposers employees are required to complete HIPAA training provided by the Proposer. Training shall be completed successfully prior to start of the provision of Services. Proposer is required to maintain proof of completion of training for all staff employed by the Proposer or supporting work for this contract.  â€¢Patient medical information or lists and/or names of patients shall not be disclosed to or revealed in any way for any use outside MCHD without prior written permission by the MCHD POC. Patient lists shall be treated as privileged information. Lists and names of patients shall not be disclosed or revealed in any way for use outside MCHD.FISCAL REQUIREMENTS County fiscal compliance reviews/audits will be conducted to ensure that financial records, systems, and procedures conform to Generally Accepted Accounting Principles and are in compliance with all County and State audit and accounting requirements.Proposers who are Sub recipients of Federal Funding and rely on County contracts for 40% or more of their revenue are considered high risk and may be subject to additional monitoring requests including, but not limited to, submission of quarterly financial statements.REPORTING Proposer System Requirements: Proposer shall utilize a computer software program that collects data and collate calls by type of call received and information delivered. A summary of individual patient calls from the previous day and each individual patient's triage documentation shall be provided to the MCHD POC for distribution within MCHD by 8:00 a.m. Pacific Standard Time the following day that MCHD centers are open. This communication shall be in a written format to facilitate follow-up with the Primary Care nurses, dental staff and health center teams as appropriate. All written documentation and submittal shall be fully HIPAA compliant.Call Detail Report Requirements: Proposers registered nurse will obtain information on each RN triage telephone call and submit a "Call Detail Report" to a designated MCHD fax number or e-mail address. The information obtained and submitted shall include the following: â€¢Date â€¢Primary symptom/duration â€¢Time of call•Allergies â€¢Patient name â€¢Current Medications â€¢Patient Date of Birth â€¢Pertinent surgical history â€¢Relationship of caller to the Patient â€¢Nursing assessment â€¢Telephone number for follow up â€¢Protocol Guideline(s) used â€¢Patient Address â€¢Disposition recommendation â€¢Reason for disposition â€¢Health Department Medical Record Number (MRN) (if known) â€¢Patient/caller understanding â€¢MCHD Health Center patient is enrolled at â€¢ER caller intends to go to (if applicable) â€¢Primary care provider•Registered Nurse operator â€¢Patient/caller intended action â€¢Nursing notes The Call Detail Reports shall be transmitted with a cover sheet that summarizes the total number of calls and a breakdown by RN advice/triage, abandoned and non-eligible calls.Call Statistics Reporting: The Proposer shall submit to MCHD POC monthly status reports no later than the 10th working day of each month. These reports shall include comprehensive analyses of all activity to include at a minimum:•Daily Triggered Triage Report  â€¢Daily Patient Call Summary Report, sorted by acuity, including Disposition Recommendation  â€¢Monthly Phone Statistics Report including, call volume, hold times, abandonment rates (secure email)  â€¢Monthly Billing Invoice including, standard reports and language line detailQuality Assurance and Peer Review Reporting: Proposer will establish a quality control program based on a combination of physician and peer reviews to ensure appropriate triage protocols are used, patient calls are responded to in a timely manner and customers are satisfied with the services received. The method of measuring service satisfaction will be provided to MCHD POC with a quarterly Quality Peer Review Summary Report within 10 days of the end of each quarter (fiscal year quarters). The report will provide, at a minimum:   •The number of phone calls monitored, and will answer the following questions:   •Was it answered timely?   •Was the appropriate protocol used?   •Were the appropriate instructions (disposition) provided to the patient?   •Was the patient satisfied with the service received? The quality assurance reporting shall include: call quality data for RNs, weekly call volume by RN, percentage of calls that underwent quality assurance review, scoring results by RN, basic call handling error rate and percentage of RNs in compliance with quality goals. These reports shall be submitted on a frequency determined by MCHD but not less than quarterly. Records and Records Maintenance: Proposer shall be responsible for creating and maintaining records which are specifically cited in this contract. (The "records" being referenced pertain to any record created using data that is being collected from each patient to include but not limited to status reports and database participation.) If requested by MCHD, Proposer shall provide the original record or a reproducible copy of any such record within five (5) working days of receipt of the request. Record and maintain a copy of all service calls within its software system for seven (7) years and within the telephone recording system for a period of thirty (30) days. If any litigation, review, claim or audit is started before the expiration as indicated above, the records shall be retained until all litigation, reviews, claims or audit findings involving the records have been resolved.PERFORMANCE MEASURES/PERFORMANCE CONTRACTING Successful Call: Proposer shall direct an appropriate disposition for the patient's symptoms or complaints based on the nationally recognized, physician approved protocol. As an example, a successful call contains the following components:  â€¢The number of phone calls monitored, and will answer the following questions:  â€¢Was it answered timely?  â€¢Was the appropriate protocol used?  â€¢Were the appropriate instructions (disposition) provided to the patient?  â€¢Was the patient satisfied with the service received?Procedural Guidance: Proposers employees shall perform services compatible with a nationally recognized nurse triage protocol. Proposer can propose new services to the MCHD POC, who will coordinate internally with MCHD. New services shall not be introduced without prior written approval from MCHD.Performance Evaluation: Performance of the service will be evaluated to determine whether or not it meets the performance requirements of the contract. Failure to meet the performance objective thresholds may result in inability to invoice for specific services. The objectives are as follows: # Performance Objective Performance Threshold 1 Respond to calls within specified parameters on a monthly basis Respond within 30 seconds (Accuracy: 80% for all calls) 2 RN call back: response is made within specified parameters on a monthly basis Average call returned within 30 minutes or less 3 Patient triage documentation provided to MCHD no later than 8:00 a.m. Pacific Standard Time on the next duty day Accuracy: 100% 4 Direct appropriate disposition for patient symptoms/complaints based on protocol on a quarterly basis Accuracy: 100% 5 No downtime/break in Proposers service on a quarterly basis Accuracy: 100% 6 No more than two validated patient complaints per month Accuracy: 95% CONTRACT NEGOTIATION The County will initiate contract negotiations with the responsive and responsible Proposer with the highest scoring proposal. Multnomah County may, at its option, elect to negotiate general contract terms and conditions, services, pricing, implementation schedules, and such other terms as the County determines are in the County’s best interest. If negotiations fail to result in a contract, the County reserves the right to terminate the negotiations and initiate contract negotiations with the next highest scoring responsive and responsible Proposer. This process may continue until a contract agreement is reached.CONTRACT AWARD Multnomah County strongly encourages the participation of Minority-Owned, Women-Owned, and Emerging Small Businesses and Organizations in providing these services. Through this RFP process, the County is seeking to award one contract. Award, as determined by the County, will be made to the responsible Proposer whose Proposal the County determines is most advantageous to the County based on the evaluation process and evaluation factors described in this RFP. The County reserves the right to select a Proposer who submitted a proposal scoring fewer points than a higher scoring proposal based on the Proposer’s ability to best meet the County’s programmatic needs. If a Proposer who has submitted a proposal that has scored fewer points is recommended for selection, the Board of County Commissioners must approve the award.CONTRACT TERM Fixed term.  The contract term shall be five (5) years.The effective date of the resulting contract shall be approximately May 1, 2020 with an end date of April 30, 2025.COMPENSATION AND METHOD OF PAYMENT Payment will be made to the Proposer  within thirty (30) calendar days after receipt of invoice. Payment terms are net 30 days after receipt of an accurate and acceptable invoice.COOPERATIVE PURCHASING Not applicable for these servicesINSURANCE REQUIREMENTS Proposer awarded a Contract as a result of this RFP and the follow on allocation process will be required to provide the insurance described in Exhibit 2 of the Multnomah County Services Contract located in the Buyer Attachments page. The table below states the minimum insurance required of a Proposer to provide this service. Additional insurance coverage may be required depending on the key features of service delivery chosen by the Proposer. Final insurance requirements will be subject to negotiation between, and mutual agreement of, the parties prior to contract execution and recorded in Exhibit 2 of the contract. The minimum insurance coverage stated below supersede requirements listed in Exhibit 2 of the Sample Contract where they are different. Minimum insurance requirements: Type of Insurance  Amount Per Occurrence Aggregate Professional Liability                $2,000,000   $5,000,000 Commercial Gen Liability     $2,000,000   $3,000,000 Commercial Auto Liability    N/A   N/A Workers Compensation            Required           MINIMUM REQUIREMENTS At the time of proposal submission, Proposer must meet the following minimum requirements. Failure to provide any of the required documents or meet any of the below requirements shall result in rejection of the proposal. The Proposal response must be received by Multnomah County Purchasing no later than 4:00 P.M. local Portland time on the proposal submission deadline. Proposer Representations and Certifications  Proposer must certify that they agree to the Proposers Representation and Certification terms in the Pre-requisite page of the Sourcing Event. At the time of Contracting, Proposer must meet the following minimum requirements. Failure to provide any of the required documents or meet any of the below requirements shall result in cancellation of the contract Proposer must be legal entities, currently registered to do business in the State of Oregon (per ORS 60.701). Proposer must submit verification that all insurance requirements are met. Proposer must have a completed Pre-Award Risk Assessment if federal funds are used for this Sourcing Event. (See Procedural Instructions in the Buyer Attachments page of this Sourcing Event) All nurses providing advice and triage services shall be a registered nurse (RN) with a current and unrestricted license(s) as required by the Oregon State Board of Nursing.

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