REQUEST FOR PROPOSALS 1105-002
REFERENCE LABORATORY AND PHLEBOTOMY SERVICES
2028 E. Ben White Blvd. Suite 400 Austin TX 78741
Purchasing@communitycaretx.org
REQUEST FOR PROPOSALS: RFP 1105-002
REFERENCE LABORATORY AND PHLEBOTOMY SERVICES
RFP NUMBER:
1105-002
RFP TITLE:
REFERENCE LABORATORY AND PHLEBOTOMY SERVICES
RFP START DATE:
May 31, 2011
RFP END DATE:
Presentation/Interviews will be week of July 11, 2011
QUESTIONS DUE:
June 15, 2011 2:00 pm central time
RESPONSES DUE:
June 17, 2011
RFP CONTACT:
KAREN BITZER, PURCHASING MANAGER
PURCHASING@COMMUNITYCARETX.ORG
Description:
Interested firms are invited to conduct a presentation and submit to an interview in accordance with the
instructions in this Request for Proposals (RFP) No. 1105-002.
Call to set presentation time by 2pm June 16, 2011.
Presentations to be the week of July 11, 2011.
CommUnityCare intends to award a base three (3) year contract with three (3) one (1) year options to
renew.
REQUEST FOR PROPOSALS: RFP 1105-002
REFERENCE LABORATORY AND PHLEBOTOMY SERVICES
TABLE OF CONTENTS
1.0
INTRODUCTION
3
2.0
PROPOSAL SUBMISSION REQUIREMENTS, CONTENT AND FORMAT
3
3.0
ADMINISTRATIVE PROPOSAL INFORMATION
4
4.0
SCOPE OF WORK
6
5.0
EVALUATION PROCESS AND CRITERIA
13
EXHIBIT A: AVERAGE ANNUAL TEST QUANITIES
16
EXHIBIT B: CRITICAL VALUES
38
EXHIBIT C: PHLEBOTOMIST AND COURIER LOCATIONS AND HOURS
40
EXHIBIT D: TERMS AND CONDITIONS
41
EXHIBIT E: BUSINESS ASSOCIATE AGREEMENT
46
EXHIBIT F: CONFLICT OF INTEREST FORM
52
EXHIBIT G: PROPOSER QUESTIONNAIRE
55
CommUnityCare RFP 1105-001
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1.0
INTRODUCTION.
1.1 CommUnityCare invites qualified entities to provide a presentation that clearly outlines how they
can meet and/or exceed the expectations in the Statement of Work, Section 4.0, to provide
reference laboratory and phlebotomy services at CommUnityCare. CommUnityCare currently has
Lab Corp Services as its vendor.
1.2 Central Texas Community Health Centers d/b/a “CommUnityCare” is a 501(c)(3) non-profit
organization providing healthcare services to underinsured and uninsured residents of Travis and
surrounding counties. CommUnityCare was formerly a department of the City of Austin,
transitioning to a non profit status on March 1, 2009. CommUnityCare has nineteen clinic locations,
four dental locations and one pharmacy and two administration locations. These sites are located
throughout the City of Austin and Travis County. Services provided are comprehensive primary care
including pediatrics, behavioral health services, and dental care. CommUnityCare also provides
healthcare services to persons affected by Acquired Immune Deficiency Syndrome (“AIDS”) and
Human Immune-deficiency Virus (“HIV”), and care for the homeless at the Austin Resource Center
for the Homeless. CommUnityCare provides services to people who are eligible for Medicaid,
Medicare, Children’s Health Insurance Program (“CHIP”) or the Travis County Healthcare District
Medical Assistance Program (“MAP”). Funding is also provided by grants received from federal,
state and local governments; service revenue received from patients and other medical insurance
and aid providers; and the Travis County Healthcare District (“CentralHealth”). CommUnityCare, a
501 (c) 3 nonprofit corporation and CentralHealth, a local governmental entity are joint holders of
the Federally Qualified Health Center status that allows the clinics operated by CommUnityCare to
receive an enhanced level of Medicaid reimbursement.
2.0
PROPOSAL SUBMISSION REQUIREMENTS, CONTENT AND FORMAT.
2.1 Proposers must call 512-978-9059 by 3pm Thursday June 16, 2011 to set an appointment time for
the week of July 11, 2011.
2.2 Each Proposer will be given a 2 hour time slot in order to present their proposal and answer any
questions that might arise.
2.3 Responses to the RFP must be submitted in several parts as set forth below.
2.3.1
Presentation:
2.3.1.1 Proposer to bring all necessary electronic devices (if any) as required for their
presentation.
2.3.1.2 Proposer to supply twelve (12) paper copies of presentation.
2.3.1.3 Proposer should provide a presentation and proposal that addresses how
Proposer will meet and/or exceed expectations listed in the Scope of Work,
Section 4.0 and Cost Schedule for services to be paid for by CommUnityCare.
2.3.1.4 Topics of presentation should be presented in this order:
2.3.1.4.1
Introductions
2.3.1.4.2
Corporate history/profile (be sure to include, but not limited to:
company size, market share, local business locations, 2008 – 2010
financial statements and annual reports, etc.)
2.3.1.4.3
Corporate philosophies (customer service, employee retention,
etc.)
2.3.1.4.4
Corporate corrective action policies
2.3.1.4.5
Then specifically address how the Proposer would transition and
manage each of these following topics:
2.3.1.4.5.1 IT Topics – Emphasis on Bi-Directional interface with Next
Gen Electronic Medical Records.
2.3.1.4.5.2 Phlebotomist Management
2.3.1.4.5.3 Equipment & Supply Management
2.3.1.4.5.4 Courier Service
CommUnityCare RFP 1105-001
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2.3.1.4.5.5
2.3.1.4.5.6
2.3.1.4.5.7
2.3.1.4.5.8
2.3.1.4.5.9
2.3.2
2.3.3
Test Response Times
Utilization Reporting
Education and In-Service Training
Billing – To include ABM waiver and claim denial process
Compliance – Must include QI plan and communication
plan of issues and problems with customers.
2.3.1.4.6
Cost Schedule – CommUnityCare is willing to hear proposals
based on either cost by test, by capitated account or other pay
structure as recommended.
2.3.1.4.7
Why CommUnityCare should choose your Company
2.3.1.4.8
Allow time for questions and answers
Completed Forms: Proposer provides one (1) original signed copy of the following
documents to the Purchasing Manager or her designee on the day of the Presentation:
2.3.2.1 Completed Exhibit E: Business Associate Agreement
2.3.2.2 Completed Exhibit F: Conflict of Interest
2.3.2.3 Completed Exhibit G: Proposer Questionnaire
Prior Performance Evaluation: Have three (3) previous clients complete the Prior
Performance Form (pages 57 and 58) and have client return completed forms directly to
Purchasing Manager at 512-901-9707 or electronically to
purchasing@communitycaretx.org. Copies of the evaluations will be provided to
Evaluation Team members by Purchasing Manager.
2.4 CommUnityCare anticipates the following schedule and milestones for this RFP. These dates are for
general information only and are subject to change.
3.0
Event
Date
RFP distribution to entities
June 27, 2011
Questions for clarification due from entities
June 15, 2011, 2pm
Responses to entities’ questions issued
June 17, 2011
Proposal due date
Week of July 11, 2011
Target date for completion of review of proposals
July 18, 2011
Contract Award Announcement
July 19 , 2011
Commencement of contract work/transition
August 20, 2011
ADMINISTRATIVE PROPOSAL INFORMATION.
3.1 A Proposer is advised to read the entire RFP (all documents) to determine all requirements.
CommUnityCare reserves the right to reject a submittal that does not contain all information
required by this RFP or is otherwise non-responsive, as determined by CommUnityCare in its sole
discretion.
3.2 The final contract will contain:
 This RFQ to include Exhibits: A Average annual test quantities, B Critical Values, C
Phlebotomist & Courier Times and Locations and D Terms and Conditions;
 The completed Exhibits E Business Associate Agreement, F Conflict of Interest and G
Proposer Questionnaire;
 The Proposal and any additional documents submitted; and
 (if necessary) Exhibit H: Best and Final Offer reflecting negotiated changes agreed upon
between Proposer and CommUnityCare.
3.3 CommUnityCare reserves the right to:
 Reject any or all submittals and discontinue the RFQ process without obligation or liability to
any respondent;
 Waive any defect, irregularity, or informality in any submittal;
CommUnityCare RFP 1105-001
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







Accept a submittal other than the lowest-price submittal;
Award a contract initial submittal received without discussions or requests for best and final
offers;
Request additional information; or clarification from Proposers, which information may vary
by Proposer;
Request Best and Final Offers from any or all Proposers;
Accept submittals from one or more entity;
Procure the services in whole or in part by other means;
Award more than one contract; and
Not award any contract
3.4 Cost of Developing Proposals: All costs related to the preparation of the proposals and any related
activities are the sole responsibility of the Proposer. CommUnityCare assumes no liability for any
costs incurred by Proposer throughout the entire selection process.
3.5 Proposal Ownership: All proposals, including attachments, supplementary materials, addenda, etc.,
shall become the property of CommUnityCare and will not be returned to Proposer.
3.6 Proposal Disclosure: Submittals/Responses will be opened so as to avoid disclosure of the contents
to competing entities or individuals. To the extent allowed by law, submittals/responses will be kept
confidential during the process of negotiation. After a contract is awarded, the submittals/responses
will be presumed to be public information under the Texas Public Information Act unless the Office
of the Attorney General determines otherwise.
3.6.1
If an entity believes that any of its submitted response to the RFP is exempted from
disclosure under the Texas Public Information Act, the entity must mark that portion or
portions as "confidential." Upon receiving a request for information related to a
submitted response to the RFP, CommUnityCare will submit to the Office of the
Attorney General only that information that an entity has marked "confidential." That
information will remain confidential only if so determined by the Office of the Attorney
General.
3.7 Proposal Clarifications/Questions: Contacting CommUnityCare staff may result in disqualification
from consideration for contract award for this RFP. The sole point of contact for inquiries is
CommUnityCare’s Purchasing Manager at purchasing@communitycaretx.org. Entities may make
written inquiries concerning this solicitation in order to obtain clarification of the requirements.
Inquiries must be submitted electronically via email to purchasing@communitycaretx.org no later
than the date and time outlined in the submittal instructions. Questions received by this deadline
and corresponding answers will be emailed to all Proposers.
3.7.1
All entities are expected to carefully examine the RFP documents. Any ambiguities or
inconsistencies should be brought to the attention of the Purchasing Manager. It is
CommUnityCare’s intent that all information necessary to complete a response is
included in this RFP. It is the responsibility of an interested entity to obtain clarification
of any information contained herein that is not fully understood.
3.7.2
Any entity, by and through the submission of a Proposal, agrees to be held responsible
for: (1) examining the RFP (including Exhibits and amendments) and all referenced
material; (2) becoming familiar with the nature and scope of the services required by
CommUnityCare; and (3) identifying any local conditions, administrative rules, or other
factors that may impact the timeline for completion of the services.
3.7.3
CommUnityCare is responsible for interpretation of the wording of this RFP. Its staff will
not give verbal answers to inquiries regarding the RFP contents. Any verbal statement
regarding the RFP prior to the award shall be considered non-binding. The only formal
interpretation of the RFP will be made by RFP amendment or addendum issued by the
Purchasing Manager. A copy of such amendment or addendum will be emailed to all
CommUnityCare RFP 1105-001
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Proposers.
3.8 Proposals must be valid and proposed fees and hourly rates must be firm and guaranteed for 360
days from the RFP Due Date.
3.9 Negotiations. The Purchasing Manager shall participate in all negotiations. Discussions may be
conducted with responsible Proposers who submit proposals to the RFP determined to be
reasonably susceptible of being selected for award. Those Proposers will be accorded fair and equal
treatment with respect to any opportunity for discussion and revision of submittals. Proposers may
be required to submit additional data and/or clarify previously-submitted information during the
process of any negotiations. Revisions and supplements to proposals/responses may also be
permitted after submission and before award for the purpose of obtaining best and final offers.
CommUnityCare reserves the right to negotiate the price and any other term with any, all, or none
of the Proposers. Any oral negotiations must be confirmed in writing prior to an award.
3.10 Deviations. Requirements stated in this RFP will become part of the contract resulting from this RFP
unless the Proposer requests a deviation. All requests for deviations from these requirements must
be specifically defined by the Proposer in the response to the RFP. If accepted, the deviation
becomes part of the contract. CommUnityCare reserves the right to modify the requirements of this
RFP.
3.11 Protests. Protests before award must be submitted in writing to the Purchasing Manager not later
than six (6) calendar days after proposal/submittal opening, and protests after award must be
submitted within ten (10) calendar days after award by CommUnityCare. The Purchasing Manager
shall rule on the protest in writing within ten (10) calendar days from date of receipt. Any appeal of
the Purchasing Manager's decision must be made within ten (10) calendar days after receipt thereof
and submitted to the Purchasing Manager, who shall present the matter for final resolution to the
CEO or his designee. Appellant shall be notified of the time and place the appeal is to be heard by
CommUnityCare and afforded an opportunity to present evidence in support of the appeal.
CommUnityCare’s decision is final.
4.0
SCOPE OF WORK:
4.1 Required Tests
4.1.1
CommUnityCare requires the availability of all standard reference laboratory tests,
including a TAST and HPV marker on abnormal Pap smears.
4.1.2
For any new test not listed in Attachment A or any modifications to tests
CommUnityCare shall negotiate pricing and amend the Contract in writing.
4.1.3
Contractor shall use critical values as determined by CommUnityCare and as exhibited in
Attachment B. Contractor may only add, delete or otherwise adjust values upon the
written consent of the CommUnityCare Medical Director.
4.2 Locally owned/operated Draw Stations
4.2.1
Contractor is required to have draw stations in Travis County and preferably near
CommUnityCare locations. Contractor’s draw stations also should be accessible by
public transportation and to persons with disabilities in accordance with the American
with Disabilities Act (ADA).
4.2.2
Contractor shall employ pathologists to make a medical interpretation and/or diagnosis
regarding the medical significance of anatomical specimens and provide written
communication to the referring Provider.
4.2.3
Contractor shall have a pathologist available via telephone during regular work hours
CommUnityCare RFP 1105-001
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(8am to 5pm), seven (7) days a week for consultation with the referring Provider
regarding pathology questions relevant to patient diagnosis and treatment.
4.3 Onsite Phlebotomists – at CommUnityCare locations
4.3.1
Contractor will provide certified phlebotomists employed directly by Contractor (no subcontractors) to provide phlebotomy services at CommUnityCare locations. Times and
locations as exhibited in Attachment C.
4.3.1.1 Phlebotomists shall hold a current State Phlebotomy Certification and take
required training/courses to maintain certification.
4.3.1.2 Each individual assigned to CommUnityCare will sign a Confidentiality
Statement. The Statement must be signed before a person can enter premises
to work.
4.3.1.3 CommUnityCare reserves the right to require the immediate removal of any
phlebotomist from CommUnityCare’s premises’ without having to give reason.
Contractor shall provide a different phlebotomist for that location within one
(1) day and provide temporary coverage until coverage can be placed.
4.3.1.4 Contractor will not hire a CommUnityCare employee within one (1) year from
the time that employee’s employment with CommUnityCare has ended.
4.3.2
Phlebotomy Duties:
4.3.2.1 Drawing and collecting all tests (blood and urine) to be transported to
Contractor’s reference laboratory or other labs as requested.
4.3.2.2 Processing all specimens being transported to the reference laboratory, DSHS
or other reference laboratory as requested by CommUnityCare staff.
4.3.2.3 Every specimen shall be marked with
4.3.2.3.1
Name of patient
4.3.2.3.2
Date of birth
4.3.2.3.3
Date and time of test
4.3.3
Maintain a log of specimens sent to the reference laboratory to include patient first and
last name, date of birth, test requested and date of test
4.3.3.1 Will review log daily for appropriate turn around time of test results
4.3.4
Report any tests not following the appropriate turn-around time to clinic manager or
designee.
4.3.5
Follow infection control guidelines as specified by local, state, federal, industry and/or
Joint Commission.
4.3.6
Maintain stock/inventory or supplies needed to collect reference laboratory specimens
to be sent to Contractor for processing based on requirements specified by local, state,
federal, industry and/or Joint Commission.
4.3.7
Ensure patients are prepared for collection of specimens (i.e. fasting, not taking
medications, etc.).
4.3.8
Ensure correct insurance is entered into system.
CommUnityCare RFP 1105-001
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4.3.9
Work with clinic staff to ensure that patients are seen in a timely manner.
4.3.10
Be flexible in schedule to ensure that patients are seen before breaks begin.
4.3.11
All phlebotomists will be bilingual in Spanish/English.
4.3.12
Dress Code – Phlebotomists will follow CommUnityCare’s current dress code policy.
Policy to be provided at time of contract award.
4.3.13
Code of Conduct – Phlebotomist will follow CommUnityCare’s Code of Conduct. Codes
to be provided to each Phlebotomist upon initial assignment to CommUnityCare and as
the Code is updated.
4.3.14
Employee Health – Phlebotomists will comply with CommUnityCare’s Employee Health
policy. Policy to be provided at time of contract award.
4.3.15
Time Tracking – Phlebotomists will sign in and sign out (to include unpaid lunch times) at
every location each individual is assigned to. If Contractor has electronic time tracking
system, a weekly report sent to the Regional Clinic Administrators (RPA) and Accounts
Payable Person may be accepted in place of signature sheets (at CommUnityCare’s
discretion only).
4.3.16
Back-up plan for late or absent Phlebotomists – If the personnel provided by the
Contractor is/are more than twenty (20) minutes late for work, the Contractor shall
provide staffing within one (1) hour. Late or absent phlebotomists will call Contractor,
not Clinic, and inform them as soon as possible. Contractor will contact clinic personnel
to explain coverage issues. CommUnityCare will NOT be responsible for reporting
late/absent phlebotomists to Contractor.
4.3.16.1 Phlebotomist billing for late or absent – CommUnityCare will not be billed for
late or absent personnel. Excessive tardiness or absenteeism can result in
CommUnityCare requesting the removal of the Phlebotomist from the account.
4.3.16.2 Phlebotomist Billing Holiday Pay – CommUnityCare will only pay Holiday Pay
(one and one-half base rate) for CommUnityCare Holidays scheduled to work.
4.3.16.3 Phlebotomist Billing Overtime – CommUnityCare will not schedule a
Phlebotomist to work more than 40 hours per week. If a phlebotomist works
more than forty hours in a week, the overtime rate will be the responsibility of
the Contractor and the cost will not be passed on to CommUnityCare.
4.3.16.4 Phlebotomist Training – CommUnityCare will not be billed for any training
times.
4.4 Equipment and Supplies
4.4.1
Contractor shall install and maintain dedicated communication lines and ports following
mandated HIPAA security guidelines and shall provide a direct computer interface with
each site by installing, at no expense to CommUnityCare, a personal computer, modem,
monitor and printer with the following capabilities:
4.4.1.1 On-line test ordering, including label printing, results inquiry and results
reporting via read-only screen or direct print out.
4.4.1.2 On-line test catalog with interpretive information for all tests available.
4.4.1.3 Ability to hold test results for twelve (12) months after result reporting.
CommUnityCare RFP 1105-001
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4.4.1.4 Ability to produce referred tests management reports, including, but not
limited to: generation of a list of tests not yet reported, all tests sent for a
specified time period and critically high results for a given day.
4.4.1.5 Laboratory system interface adhering to the standard of the American Society
for Testing and Materials (ASTM).
4.4.1.6 An electronic mailbox system allowing for exchange of messages with
personnel.
4.4.1.7 A security system providing user-specified ability to limit access to confidential
information and control of who has authority to enter data and receive results.
4.4.1.8 Web-based access to lab test results for CommUnityCare personnel.
4.4.2
Contractor shall maintain the computer equipment and software with no charge to
CommUnityCare (including Software Upgrades).
4.4.3
Contractor shall provide laboratory requisition forms. Requested forms should be
delivered within one business day of request.
4.4.4
Contractor shall provide supplies for those tests being performed under this Agreement,
including but not limited to: specimen tubes, culture and transport media, pap supplies,
parasite/stool containers, vacutainers, needles, safety syringes and all necessary
supplies required for performing phlebotomy and transporting specimens to the
Contractor in a manner that meets local, state, federal, industry and Joint Commission
standards and regulations.
4.4.4.1 New equipment and/or supplies must first be approved by Contract Manager
BEFORE use in ANY CommUnityCare facility.
4.4.5
Contractor shall provide information sheets that list the Contractor’s drawing stations
(not located within a CommUnityCare clinic) with directions and maps.
4.4.6
Contractor shall provide Lock Boxes for the storage of specimens and reports for each
CommUnityCare clinic in a manner that meets local, state, federal, industry and Joint
Commission standards and regulations.
4.4.7
Contractor shall provide and properly maintain biohazard waste boxes and their
disposal of their medical waste in the laboratory areas only in accordance with local,
state, federal, industry and Joint Commission standards and regulations.
4.4.8
Contractor shall provide to each CommUnityCare location, a copy of the reference
laboratory manuals (aka Collection Manual) and addenda as changes are made, for
information relating to tests available and requirements for collection.
4.4.8.1 An online test directory will be available daily for list of tests available.
4.5 Courier Service
4.5.1
Contractor shall provide a no cost courier service to include the pick up, transport and
delivery of specimens in a HIPAA compliant manner. The regular schedule is described
in Attachment C. Courier will be able to come on property with Contractor ID to pick up
specimens.
4.6 Results Delivery System
4.6.1
CommUnityCare RFP 1105-001
Contractor shall, at no cost to CommUnityCare, provide, install, and maintain equipment
Page 9 of 58
and software necessary to support a system for delivery of test results provided by
Contractor laboratory services. Contractor shall provide printers, dedicated phone lines
for printers, and necessary supplies for maintenance of printers at no cost to
CommUnityCare for the purpose of reporting lab test results. Equipment installed will
remain the property of the Contractor and will not be used for any other purpose.
Result files must be:
4.6.1.1 Download capable from the internet via a secure connection (HTTPS/SSL);
4.6.1.2 Order upload capable from the internet via secure connection;
4.6.1.3 Available in both PDF and HL7 compliant pip-delimited format or XML; and
4.6.1.4 Order uploads accepted via HL7 compliant XML order.
4.6.2
Technical Support – Results delivery system must include technical support to assist
with an integration project so CommUnityCare Electronic Medical Record Software can
dynamically upload and download order and result data at no cost to CommUnityCare.
4.6.3
Computer Log-in Support – Contractor shall provide lab computer support and log-in
support for computer result delivery system 24 hours a day 7 days per week.
4.7 Timelines for Test
4.7.1
STAT tests shall be picked up within one (1) hour from the time of phone notification to
Contractor by CommUnityCare. Results shall be completed and reported in two (2)
hours from time of pick-up for a total of three (3) hours from the time of notification.
Requesting provider will provide contact information with each request, including after
hours contact information.
4.7.2
Routine tests shall be reported via electronic interface no later than the close of
business the next working day.
4.7.3
Non - Routine tests shall be reported via electronic interface no later than ten (10)
business days.
4.7.4
Critical Abnormal Results: All critical abnormal results will be called immediately to the
referring Provider, as denoted specifically to the Contractor in writing by the Provider,
unless otherwise specified. If the critical abnormal result is identified after
CommUnityCare’s close of business (4:45 pm), the Contractor shall report to the afterhours triage nurse, unless the referring Provider has given a phone number where
he/she may be reached after hours. In such case, Contractor shall notify the referring
Provider immediately at the designated phone number.
4.7.5
Longer testing times: Longer testing for all sites may be necessary for certain tests.
Time frames necessary will be as agreed upon during the bid process.
4.8 Utilization Reports
4.8.1
Contractor shall provide a monthly encounter data report: name of client (last/first),
patient ID number, IDC – 9 diagnosis code, requesting provider, location of service,
contract price for each test, payer and payer ID number, ordering physician’s name
(last/first) and NPI.
4.8.2
Contractor shall provide a monthly clinic and/or program area, as required by
CommUnityCare, volume activity report: patient’s full name (last/first), date of birth,
date of service, CPT code for test service, test service price, contract file number,
number of tests performed by clinic and/or by program area.
CommUnityCare RFP 1105-001
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4.8.3
Contractor shall provide a monthly Provider Activity Report: the number and type of
laboratory tests by site and physician.
4.8.4
Contractor shall provide a monthly Utilization Report: name of patient (last/first),
patient ID number, DOB, date of service, location of service, test results and ordering
physician’s name (last/first).
4.8.5
Contractor shall provide a quarterly Error Rate Report.
4.8.6
Contractor shall provide a quarterly Payer Source Activity Reports:
4.8.6.1 The total number and type of laboratory test, type of test by diagnosis.
4.8.6.2 Type of diagnosis and provider/physician
4.8.6.3 Type of test by payer and associated costs
4.8.6.4 List of denials by site, ICD9 and Provider.
4.9 Education and In-Service Training
4.9.1
Contractor shall provide education and in-service training as deemed necessary by
CommUnityCare.
4.10 Billing
4.10.1
The Contractor is solely responsible for billing applicable Medicare, Medicaid Managed
Care Companies, and commercial health coverage insurers for services provided
hereunder. The Contractor is solely responsible for entering into agreements with those
insurance providers.
4.10.2
Contractor is not allowed to bill or contact a patient directly.
4.10.3
CommUnityCare shall pay the Contractor for each test conducted for patients eligible
for Travis County Healthcare District Medical Assistance Program (MAP), is a
CommUnityCare sliding-fee patient, is a CommUnityCare employee or a potential
CommUnityCare employee (pre-employment drug screening), or has insurance or grant
funding through other local, state or federal entities that CommUnityCare has
contracted with.
4.11 Compliance: To ensure the quality and quantity of work completed by the Contractor meets the
minimum requirements set forth by CommUnityCare in the Scope of Work. Also, to ensure that
CommUnityCare is providing all the tools and opportunities for the Contractor to provide the work
as requested.
4.11.1
Contractor shall have electronic interface with CommUnityCare’s EMR within twelve
(12) months from beginning of contract.
4.11.1.1 Immediately, Contractor to have web-based, HIPAA compliant reporting site
until electronic interface completely functional.
4.11.2
Error rate in test results must remain below 2% of total reportable results.
4.11.3
Participation in Contract Compliance:
4.11.3.1 Monthly Contract Compliance Survey: A monthly survey will be issued from the
Purchasing Department to the Contract Manager, the Nurse Managers, the
Clinic Managers, the IT Department, and the person(s) assigned to receive the
CommUnityCare RFP 1105-001
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reports. The survey will be limited to no more than ten (10) questions
pertaining to work related questions referring to section 4.0 – 4.15 (excluding
4.3.2). Questions can change month to month, but will be limited to the Scope
of Work. If Contractor scores less than 98%, the Purchasing Department will
alert the Contractor. The Contractor will prepare a statement of explanation
and a corrective action plan. If the Contractor fails to correct problem or If the
Contractor scores less than 98% two (2) times in a rolling six (6) month period
of time, CommUnityCare reserves the right to request remedial action up to
and including notice to terminate and/or monetary compensation (depending
on severity of non-compliance with Scope of Work).
4.11.3.2 Quarterly Survey: The Purchasing Department will send a survey to Contractor
on a quarterly basis. The survey will be limited to no more than ten (10)
questions pertaining to CommUnityCare’s ability to fulfill obligations under
4.16. Questions can change month to month, but will be limited to the Scope
of Work. Contractor will return survey within fifteen (15) business days. Any
unsatisfactory findings will be addressed and agreed to between
CommUnityCare and Contractor.
4.11.3.3 Quarterly Phlebotomy Management Survey: A quarterly survey will be issued
from the Purchasing Department to the clinic, nurse and business office
managers. The survey will be limited to no more than ten (10) questions
pertaining to the phlebotomists work habits, work attitude, attendance and
other work related questions referring to section 4.3. Questions can change
month to month, but will be limited to the Scope of Work. If a phlebotomist
scores less than 95%, the Purchasing Department will alert the phlebotomy
contract supervisor. A memo of explanation and a corrective action plan will
be submitted to the Purchasing Department. If the corrective action plan is not
completed in the specified time or if the same phlebotomist scores less than
95% two (2) times in a rolling six (6) month period of time, CommUnityCare
may require the immediate removal of the phlebotomist.
4.11.3.4 Semi Annual Self Audit: Checklists have been developed to help Contractor
document compliance with each contract element, including attachments and
any amendments. Mark each element as C (Compliant), PC (Partially
Compliant), NC (Not Compliant), NE (Not Evaluated), provide supporting
evidence and comments. For any areas identified as partially or non-compliant,
Contractor will provide a “Proposed Corrective Action Plan” to correct
deficiencies noted. The written proposed Corrective Action Plan (if needed)
should: clearly identify:
4.11.3.4.1
A description of the specific deficiencies, if any were found;
4.11.3.4.2
What actions are proposed to correct each deficiency;
4.11.3.4.3
The contract person that CommUnityCare should use for followup contact; and
4.11.3.4.4
The date by which deficiencies will be corrected.
4.12 Corrective Actions
4.12.1
CommUnityCare RFP 1105-001
Failure to adequately perform any of the services as defined in 4.0 or any amendments
will result in corrective action. Issues of Contractor non-compliance will be addressed in
the following manner:
Page 12 of 58
4.12.1.1 Contract Manager will inform the Contractor of the problem, and seek
resolution by a mutually agreed upon date.
4.12.1.2 If the issue is not resolved, the Purchasing Manager will notify the Contractor in
writing documenting the failure to resolve by the agreed upon deadline.
4.12.1.3 If the Contractor makes insufficient effort to communicate and resolve the
issue, the Contract Manager will communicate failure to resolve to the
Purchasing Manager. As a final step the Purchasing Manager will issue a letter
notifying the Contractor of the intent to terminate the contract if the problem
is not resolved by a specific deadline. Letter will be sent regular or certified U.S.
Postal Service mail requiring a signed return receipt.
4.13 Licensure
4.13.1
Contractor agrees to maintain for the duration of the contract period all licenses
necessary to lawfully perform the services covered by this contract.
4.13.2
Contractor business and professional licenses will be requested and shall remain on file
in the Purchasing Manager’s office throughout the entire contract term.
4.13.3
Contractor further agrees to advise CommUnityCare immediately in writing of any
limitation, cancellation, or other termination of any license.
4.14 Insurance
4.14.1
Contractor shall maintain the following minimum per occurrence insurance coverage,
and $3,000,000.00 aggregate liability coverage, throughout the life of the contract:
4.14.1.1
4.14.1.2
4.14.1.3
4.14.1.4
4.14.2
General Liability
$1,000,000.00
Occurrence Liability
$1,000,000.00
Personal Injury
$1,000,000.00
Workers compensation $100,000.00
Said coverage will continue throughout the term of the contract. A copy of the
Certificate of Insurance shall be maintained, by the Purchasing Manager, throughout the
life of the contract. The successful bidder shall have the insurance carrier send the
Certification prior to initiation of the contract. The Contractor through the insurance
company must agree to notify CommUnityCare immediately in writing of any limitation,
modification, cancellation, or other termination of such insurance coverage.
4.15 HIPAA Compliance: Contractor and their employees are bound by HIPAA to refrain from disclosing
names and information about CommUnityCare’s patients.
4.15.1
The Vendor must sign a Business Associate Agreement (Attachment E).
4.15.2
Each phlebotomist will sign a Confidentiality Agreement prior to providing services.
Agreements are to be maintained by Proposer’s supervisor managing phlebotomists,
but CommUnityCare reserves the right to request access to verify agreements with one
(1) hour notice.
4.15.3
Proposer to provide annual comprehensive HIPAA training for Phlebotomists assigned to
CommUnityCare. Access to training records to be presented within one (1) hour of
request to verify training.
4.15.3.1 CommUnityCare must approve program annually.
4.15.4
CommUnityCare RFP 1105-001
Review of Confidentiality Agreements and training records to be a standard part of
Page 13 of 58
CommUnityCare’s monthly audit.
4.16 CommUnityCare’s Responsibilities
5.0
4.16.1
A Contract Manager will be assigned to be the Point of Contact in managing this
Contract.
4.16.2
Contract Manager will provide contact information for after-hours notification of Critical
Abnormal Results.
4.16.3
Contract Manager will provide contact information for CommUnityCare’s recipient of
reports.
4.16.4
CommUnityCare will provide proper patient information in a timely manner in order for
Contractor to properly bill for services.
4.16.5
CommUnityCare will provide a list of what insurance and grant coverages will be paid
for by CommUnityCare as changes occur.
4.16.6
CommUnityCare will provide updated Immunization, Dress Code and Code of Conduct
policies if changes are made.
4.16.7
CommUnityCare will host a monthly meeting for discussion of issues or for training time.
CommUnityCare’s Contract Manager and two (2) providers will be required to attend.
The Contractor must have the Contract Manager and the Phlebotomist supervisor
present.
EVALUATION PROCESS AND CRITERIA:
5.1
The following Evaluation Process will be used for this solicitation:
5.1.1
Presentation Evaluation. The evaluation committee will evaluate and score
presentations and proposals using the evaluation criteria identified in 5.2.
5.1.2
Negotiations/Best and Final Offer. A Proposer/Respondent may be required to submit a
Best and Final Offer that documents all of the results from negotiations. The Best and
Final Offer, if requested, will be the basis for the final determination of contract award
to the Respondent. Any Best and Final Offer, as well as the entire Submittal, will become
part of the contract.
5.2 The following Evaluation Criteria and Scoring Matrix will be used:
5.2.1
A weighted scoring method will be used.
5.2.1.1 Each Evaluator will score Proposer on a scale of 1 – 10 (10 being the best) for
each topic listed below.
5.2.1.2 The Purchasing Manager or her designee will total all the score cards for each
topic.
5.2.1.3 The Purchasing Manager or her designee will multiply each total score by the
weighted percentage listed in the matrix below.
5.2.1.4 The Proposer with the highest score will be the first choice for CommUnityCare
to enter into negotiations with or accept the Proposal as is.
Area of Evaluation
IT Topics
Onsite Phlebotomist Management
Onsite Equipment & Supplies
Management
Courier Service
CommUnityCare RFP 1105-001
%
20
20
5
5
Page 14 of 58
Test Response Times
Utilization Reports
Education and In-Service Training
Billing
Compliance/HIPAA
Cost
Prior Past Performance
Corporate Experience
Creativeness, Responsiveness, and
Technical Approach of presentation
Total
Licensure (Yes/No)
Insurance (Yes/No)
5
5
5
5
5
10
5
5
5
100
5.3 Any contract award resulting from this RFP will be based upon the most responsive submittal that is
the most advantageous to CommUnityCare over the life of the project in terms of the evaluation
criteria specified as determined by CommUnityCare in its sole discretion.
5.4 The Proposal must be limited to those matters sufficient to define the entity's offer and to provide
an adequate basis for CommUnityCare’s evaluation of the response to the RFP.
CommUnityCare RFP 1105-001
Page 15 of 58
Exhibit A: Average Annual Test Quantities
Description
# of Genotyping Targets
% CD 3 Pos. Lymph.
% CD 4 Pos. Lymph.
% CD 8 Pos. Lymph.
% Free PSA
17-OH Progesterone
1-Methyl-histidine,Pl
3-Methyl-histidine,Pl
3-OH-Dodecanoylcarnit.,C12-OH
3-OH-Hexadecanoylcarn.,C16-OH
3-OH-Hexadecenoyl.,C16:1-OH
3-OH-Hexanoylcarnitine C6-OH
3-OH-Linoleylcarnit.,C18:2-OH
3-OH-Oleylcarnitine,C18:1-OH
3-OH-Tetradecanoylcarn.,C14-OH
3-OH-Tetradecenoyl.,C14:1-OH
3TC [Lamivudine, Epivir]
5' Nucleotidase
5-HIAA, Urine
5-HIAA, Urine, 24hr
5-HIAA,Qn,Random,Ur
A/G Ratio
a-Aminoadipic acid,Pl
a-Amino-N-butyric acid,Pl
ABO Grouping
Abs. CD 8 Suppressor
Absolute CD 3
Absolute CD 4 Helper
Abstinence Period
ACE
Acetaminophen
Acetone
Acetone, Urine
Acetylcarnitine, C:2
Acetylcarnitine,Quantitative,P
AChR Binding Abs, Serum
AChR Blocking Abs, Serum
AChR Modulating Ab
Act.Prt.C Resist.
ACTH, Plasma
Actin (Smooth Muscle) Antibody
ADDEND
Additional Information
Additional Information:
Additional Markers
Additional Test(s) Requested
ADEQ
ADH
ADV [Adefovir, Hepsera]
Aerobic Bacterial Culture
Aerobic Culture
AFB Cult/Smear, Broth, Suscep
AFB Culture and Smear,Broth
AFP MoM
AFP Value
CommUnityCare RFP 1105-001
Count
1
5220
5288
5288
15
19
11
11
2
2
2
2
2
2
2
2
16
4
7
5
2
28959
11
11
47
5289
5221
5289
6
10
10
1
9
2
2
4
4
4
7
21
285
4
2
2
2
126
13119
4
16
438
1
15
19
1468
1459
Page 16 of 58
AFP, Serum, Tumor Marker
Alanine (a-Alanine),Pl
Albumin
Albumin, Serum
Albumin, U
Aldolase
Aldosterone
Aldosterone U,Random
Aldosterone,U, Timed
Alkaline Phosphatase, S
Alpha 2-Macroglobulins, Qn
Alpha-1-Antitrypsin, Serum
Alpha-1-Globulin
Alpha-1-Globulin, U
Alpha-2-Globulin
Alpha-2-Globulin, U
Alprazolam
Alprazolam (GC/MS)
Alprazolam (Xanax)
Alprazolam Confirm
ALT (SGPT)
ALT (SGPT) P5P
AMBIGU
AMEND
Amikacin
Amiodarone, Serum
Amitriptyline/Nortriptyline
Ammonia, Plasma
Ammonia, Urine
Ammonium acid urate
Amobarbital
Amphetamine
Amphetamine (GC/MS)
Amphetamine GC/MS Conf
Amphetamine Screen, Urine
Amphetamines
Amphetamines Screen, Blood
Amylase Urine
Amylase, Serum
Amyloid Beta-Protein
ANA Direct
Anaerobic Culture
Androstenedione
Anserine,Pl
Antibody Id. #1
Antibody Id. #2
Antibody Screen
Anticardiolipin Ab, IgA
Anticardiolipin Ab, IgA, Qn
Anticardiolipin Ab, IgG
Anticardiolipin Ab, IgM
Anticardiolipin Ab,IgA,Qn
Anticardiolipin Ab,IgG,Qn
Anticardiolipin Ab,IgM,Qn
Anti-Centromere B Antibodies
Antichromatin Antibodies
Anti-DNA (DS) Ab Qn
Antiglomerular BM Ab, Qn
Anti-Jo-1
Antimicrobial Susceptibility
CommUnityCare RFP 1105-001
713
11
377
32303
236
10
44
1
1
32213
37
73
377
236
377
236
16
2
1
2
32510
37
14
2
1
1
8
241
5
5
15
36
3
29
1078
50
48
1
6063
1
1456
8
3
11
58
58
2893
1
49
1
1
4
64
65
142
140
215
1
140
2098
Page 17 of 58
Antimyeloperoxidase (MPO) Abs
Antinuclear Antibodies, IFA
Antiparietal Cell Antibody
Antiphosphatidylserine IgG
Antiphosphatidylserine IgM
Antiproteinase 3 (PR-3) Abs
Antiprothrombin Antibody, IgG
Antiprothrombin Antibody, IgM
Antiribosomal P Antibodies
Antiscleroderma-70 Antibodies
Antistreptolysin O Ab
Anti-striation Abs
Antithrombin Activity
Antithrombin Antigen
Antithyroglobulin Ab
Apolipoprotein A-1
aPTT
aPTT 1:1 Mix Saline
aPTT 1:1 Normal Plasma
APTT 1:1 NP
aPTT 1:1 NP Incub. Mix Ctl
aPTT 1:1 NP Mix, 60 Min,Incub.
APTT 1:1 Saline
Arginine,Pl
Array Type
Arsenic, Blood
Asparagine,Pl
Aspartic acid,Pl
Aspergillus flavus
Aspergillus fumigatus
Aspergillus niger
AST (SGOT)
Atypical pANCA
B Cells
B pertussis IgG Ab
B pertussis IgM Ab
B. henselae IgG
B. henselae IgM
B. quintana IgG
B. quintana IgM
Bacteria
B-Alanine,Pl
B-Aminoisobutyric acid,Pl
Bands
Barbiturate
Barbiturates
Barbiturates By TLC
Barbiturates Screen
Barbiturates Screen, Blood
Barbiturates Screen, Urine
Baso (Absolute)
Baso(Absolute)
Basos
Benzodiazepines
Benzodiazepines Screen, Blood
Benzodiazepines Screen, Urine
Benzoylecgonine
Benzoylecgonine (GC/MS)
Benzoylecgonine GC/MS Conf
Beta Globulin
CommUnityCare RFP 1105-001
13
5
4
1
1
13
1
1
2
146
15
5
13
12
60
37
746
1
1
1
1
1
1
11
1
16
11
11
6
6
6
32510
16
2
2
1
1
1
1
1
6488
11
11
68
919
18
9
1
48
158
25753
10
25764
1087
48
158
5
29
119
377
Page 18 of 58
Beta Globulin, U
Beta Strep Gp A Culture
Beta-2 Glycoprotein I, IgA
Beta-2 Glycoprotein I, IgG
Beta-2 Glycoprotein I, IgM
Beta-2 Microglobulin, Serum
Bile Acids
Bili, Indirect, Neo
Bilirubin
Bilirubin, Direct
Bilirubin, Direct, Neonatal
Bilirubin, Indirect
Bilirubin, Total
Bilirubin, Total, Neonatal
Biological Indicators, Sterile
Biotinidase Activity
Blast
Blastomyces Abs, Qn, DID
Blasts/blast like cells
Blood Culture, Routine
Blood Grouping
Body Fluid Culture, Sterile
Body Surface Area
Bone Fraction:
Bordetella parapertussis DNA
Bordetella pertussis DNA
Brucella Antibody IgG, EIA
Brucella Antibody IgM, EIA
Brushite
B-Type Natriuretic Peptide
BUN
BUN/Creatinine Ratio
Butalbital
Butalbital (GC/MS)
Butalbital GC/MS Conf
C difficile Toxins A+B, EIA
C difficile, Cytotoxin B
C. trachomatis, NAA, Pharyn
C1 Esterase Inhibitor, Serum
CA 125 in the Presence of HAMA
Ca hydrogen phos.
Ca oxalate dihydrate
Ca oxalate monohydr.
Caffeine By TLC
Calcitonin, Serum
Calcitriol(1,25 di-OH Vit D)
Calcium bilirubinate
Calcium carbonate
Calcium Oxalate
Calcium phosphate
Calcium, Ionized, Serum
Calcium, Serum
Calcium, Urine
Calcium, Urine 24hr
Campylobacter Culture
Cancer Antigen (CA) 125
Cannabinoid
Cannabinoid Screen, Blood
Cannabinoid Screen, Urine
Cannabinoids
CommUnityCare RFP 1105-001
236
770
1
1
1
3
87
1
7560
3872
769
11
32241
1167
0
1
2
6
68
69
2742
6
106
28
2
2
1
1
5
159
33846
33849
15
3
7
168
1
2
2
1
5
5
5
9
3
235
5
5
5
5
185
33862
60
51
309
29
1144
48
158
1
Page 19 of 58
Carbamazepine By TLC
Carbamazepine(Tegretol), S
Carbon Dioxide, Total
Carboxy THC
Carboxy THC (GC/MS)
Carboxy THC GC/MS Conf
Carnosine,Pl
Carotene, Beta
Cast Type
Casts
CBC
CCP Antibodies IgG/IgA
CD4/CD8 Ratio
CD4:CD8
CEA
Cellular Material
Ceruloplasmin
Chain-of-Custody Protocol
Chlamydia Competition Rflx
Chlamydia DNA Probe w/Rflx
Chlamydia trachomatis Culture
Chlamydia trachomatis, NAA
Chlamydia, Nuc. Acid Amp
Chloride Urine
Chloride, Serum
Chloride, Urine
Cholesterol
Cholesterol, Total
Chromium, Blood
Chromogranin A
Chromosome Microarray
Chromosome-Routine
CICD-9
Cimetidine
Ciprofloxacin
Citric Acid (Citrate)
Citric Acid(Citrate)
Citric Acid, U, 24hr
Citric Acid, Urine
Citrulline,Pl
CK-BB
CK-MB
CK-MM
Clarithromycin
Clarity, Fluid
Class Description
CLHIST
Clinical Diagnosis
Clonazepam
Clonazepam (Klonopin),Serum
Clonazepam Confirm
Clostridium difficile Culture
Clue Cell Exam
CMV Ab, IgG (Cytomegalovirus)
CMV Ab, IgM Cytomegalovirus
CMV PCR
CMV Quant DNA PCR (Plasma)
CMV Quant DNA PCR (Urine)
Cobalt, Blood
Cocaine
CommUnityCare RFP 1105-001
9
172
33795
13
45
171
11
1
6485
6485
2
72
5289
2
21
5
130
1
6
146
27
17278
5
6
33795
7
5
27866
0
1
1
24
7981
9
1
5
5
2
2
11
19
19
19
1
7
60
78
2
14
2
2
2
3338
3
3
2
28
3
0
14
Page 20 of 58
Cocaine (GC/MS)
Cocaine (Metab)
Cocaine (Metab.)
Cocaine (Metab.) Screen, Urine
Cocaine (Metabolite)
Cocaine + Metab. Screen, Blood
Cocaine + Metabolite
Coccidioides Abs, Qn, DID
Codeine
Codeine (Free)
Codeine (GC/MS)
Codeine By TLC
Codeine Confirm
Codeine GC/MS Conf
Color
Color, Fluid
COMM
Complement C2
Complement C3, Serum
Complement C4, Serum
Complement, Total (CH50)
Composition
Concentration
Coombs Titer #1
Coombs Titer #2
Coombs', Direct
Copper, Serum
Copper, Urine
Copper,Urine 24 Hr
Copper/Crt Ratio
Coproporphyrin
Coproporphyrin (CP) I
Coproporphyrin (CP) III
Corrected Report Comment
Cortisol
Cortisol - AM
Cortisol - PM
Cortisol #1 (Base)
Cortisol #2
Cortisol,F,ug/24hr,U
Cortisol,F,ug/L,U
Coxsackie A16 IgG
Coxsackie A16 IgM
Coxsackie A24 IgG
Coxsackie A24 IgM
Coxsackie A7 IgG
Coxsackie A7 IgM
Coxsackie A9 IgG
Coxsackie A9 IgM
C-Peptide, Serum
CPT
C-Reactive Protein, Cardiac
C-Reactive Protein, Quant
Creat Clr (Corr.)
Creatine Kinase,Total,Serum
Creatine, Serum
Creatine,24-hr Ur
Creatine,U,mg/dL
Creatinine
Creatinine Clearance
CommUnityCare RFP 1105-001
1
7
1040
158
1
48
24
6
263
2
3
9
9
11
5
7
13119
1
30
28
2
5
5
58
58
2
1
1
1
1
1
2
2
80
16
63
3
3
3
13
13
1
1
1
1
1
1
1
1
40
484
5
423
106
716
1
1
1
1
108
Page 21 of 58
Creatinine(Crt),U
Creatinine, Random U
Creatinine, Serum
Creatinine, Ur 24hr
Creatinine, Urine
Creatinine, Urine 12hr
Creatinine/Protein Ratio
Cryoglobulin %
Cryoglobulin, Ql, Serum, Rflx
Cryptococcus Ag Titer
Cryptococcus Antigen, Serum
Cryptosporidium Detection
Cryptosporidium Smear,Stool
Crystal Type
Crystal,Synovial/Joint Fl
Crystals
Cyclospora Smear, Stool
Cyclosporine, LC-MS/MS
Cystathionine,Pl
Cysticercosis (Taenia solium)
Cystine
Cystine, Urine
Cystine,Pl
Cytomegalovirus (CMV) Culture
Cytoplasmic (C-ANCA)
D001-IgE D pteronyssinus
D002-IgE D farinae Mite
Date/Time #1
Date/Time #2
Date/Time #3
D-Dimer
Deamidated Gliadin Abs, IgA
Deamidated Gliadin Abs, IgG
Decanoylcarnitine, C10
Decenoylcarnitine, C10:1
Dehydroepiandrosterone (DHEA)
Dermatophyte Only, Culture
Desalkylflurazepam
DHEA-Sulfate
DIA MoM
DIA Value
DIAG
DIAGN
Diazepam
Differential Comment
Differential Comments:
Digoxin, Serum
Dihydrotestosterone
Diltiazem
Dilute Prothrombin Time(dPT)
Diphenhydramines
Director Review
Director Review:
Dodecanoylcarnitine, C12
Dodecenoylcarnitine, C12:1
Dopamine
Dopamine, Ur, 24hr
Dopamine, Urine
Doxepin
dPT Confirm Ratio
CommUnityCare RFP 1105-001
1
8
33999
199
5451
1
1
1
13
3
26
1
10
6485
7
6485
2
16
11
2
5
6
11
3
16
44
46
1
1
1
24
236
83
2
2
7
1
1
62
1468
1459
2
13209
1
12
1
54
8
8
3
9
1
25
2
2
1
9
10
8
3
Page 22 of 58
Dried Blood
dRVVT
dRVVT Confirm
DRVVT Confirm Seconds
dRVVT Mix
DRVVT Ratio
DRVVT Screen Seconds
DSR (By Age) 1 IN
DSR (Second Trimester) 1 IN
E coli Shiga Toxin EIA
E001-IgE Cat Hair/Dander,Stan
E002-IgE Dog Epithelia
EBV Ab VCA, IgG
EBV Ab VCA, IgM
EBV Early Antigen Ab, IgG
EBV Nuclear Antigen Ab, IgG
EER Osmotic Fragility
eGFR
eGFR AfricanAmerican
Endomysial Antibody IgA
Eos
Eos (Absolute Value)
Eos (Absolute)
Eosinophil Count, Nasal
Eosinophil, Urine
Eosinophils, Fluid
Ephedrines
Epinephrine
Epinephrine, U, 24hr
Epinephrine, Urine
Epithelial Cells
Epithelial Cells (non renal)
Epithelial Cells (renal)
Epstein-Barr DNA Quant, PCR
Epstein-Barr Virus Real Time
Erythromycin
Erythropoietin
Estim. Avg Glu (eAG)
Estimated CHD Risk
Estradiol
Estriol, Serum
Estrogens, Total
Estrone, Serum
Ethambutol
Ethanol
Ethanol U, Quan
Ethanol, Urine
Ethchlorvynol
ETV [Entecavir, Baraclude]
F001-IgE Egg White
F002-IgE Milk (Cow)
F004-IgE Wheat
F007-IgE Oat
F008-IgE Corn
F009-IgE Rice
F013-IgE Peanut
F014-IgE Soybean
F026-IgE Pork
F027-IgE Beef
F052-IgE Chocolate/Cocoa
CommUnityCare RFP 1105-001
5
61
3
1
6
1
1
1465
1467
310
46
44
11
7
10
10
2
33882
33882
148
25764
10
25753
1
7
7
9
1
9
10
1
6488
6485
1
1
8
21
12947
1
26
2
13
2
1
15
18
9
10
16
3
29
29
1
29
1
29
29
28
28
29
Page 23 of 58
F075-IgE Egg (Yolk)
F201-IgE Pecan Nut
F245-IgE Egg, Whole
Factor II, DNA Analysis
Factor IX Activity
Factor IX Antigen
Factor V Activity
Factor V Leiden
Factor VII Activity
Factor VIII Activity
Factor X Activity
Fat,(Fecal Lipids)Qn
Fats, Neutral
Fats, Total
FDIAG
FDP, Plasma
Fecal Reducing Substances
Fecal Weight (Total)
Fentanyl
Fentanyl (GC/MS)
Fentanyl GC/MS
Fentanyl Screen, Urine
Ferritin, Serum
Fibrinogen Activity
Fibrosis Score
Fibrosis Scoring:
Fibrosis Stage
FISH(W/o Cell Cult.)
FISH-Multiprobe-Subtelomere
Flurazepam
Flurazepam Confirm
Folate (Folic Acid), Serum
Fragile X DNA
Free T4 by Dialysis/Mass Spec
Free Testosterone(Direct)
Free Thyroxine Index
Fructosamine
FSH
Fungus (Mycology) Culture
Fungus Stain
FX02-IgE Fish/Shell Mix
G002-IgE Bermuda Grass
G006-IgE Timothy
G008-IgE Bluegrass, Kentucky
G010-IgE Johnson Grass
G017-IgE Bahia Grass
G-6-PD, Blood
G-6-PD, Quant
GAD-65
g-Aminobutyric acid,Pl
Gamma Globulin
Gamma Globulin, U
Gastrin, Serum
Gating Strategy
GC Culture Only
Genital Culture, Routine
Genotype Assay
Gestational Diabetes Screen
GGT
Giardia lamblia Ag, EIA
CommUnityCare RFP 1105-001
1
1
28
4
1
2
2
9
1
16
2
1
22
22
484
1
1
1
13
9
12
97
1980
7
37
37
37
1
1
15
1
1401
9
2
1931
4
19
516
75
27
28
44
4
42
44
44
1644
1644
2
11
377
236
3
2
31
49
3
3016
5602
14
Page 24 of 58
Globulin, Total
Glucagon, Plasma
Glucose
Glucose - 1 hour
Glucose - 2 hour
Glucose - 3 hour
Glucose - Fasting
Glucose, 1 1/2 hour
Glucose, 1 hour
Glucose, 1/2 hour
Glucose, 2 hour
Glucose, 3 hour
Glucose, 4 hour
Glucose, 5 hour
Glucose, 6 hour
Glucose, Body Fluid
Glucose, Fasting
Glucose, Plasma
Glucose, Serum
Glucose, Two-Hour Postprandial
Glutamic acid,Pl
Glutamine,Pl
Glutarylcarnitine, C5-DC
Glutethimide
Glutethimide By TLC
Glycine,Pl
Gonococcus, Nuc. Acid Amp
gp120 Ab
gp160 Ab
gp40 Ab
gp41 Ab
Gram Stain Evaluation
Gram Stain Result
Granulocytes
Graph
GROSS
GROSSD
Growth Hormone, Serum
H. pylori Breath Test
H. pylori IgG, Abs
H. pylori Stool Ag, EIA
H. pylori, IgA ABS
H.pylori, IgM ABS
Haptoglobin
HBsAg Confirmation
HBsAg Screen
HBV as Copies/mL
HBV as IU/mL
HBV DNA, Qualitative PCR
HBV Drug Resist
HBV Drug Resistance Mutation
HBV Drug Resistance Mutations
HBV Genotype
hCG MoM
hCG Value
HCG, Beta Chain, Quant, S
hCG,Beta Subunit,Qnt,Serum
hCG,Beta Subunit,Qual,Serum
HCV Ab
HCV Genotype
CommUnityCare RFP 1105-001
28959
1
7560
30
30
30
30
583
584
583
584
584
583
583
583
1
584
2704
33476
533
11
11
2
1
9
11
5
363
363
363
363
1
7
2
2
80
483
4
314
1168
271
17
17
53
144
7958
163
162
3
33
8
8
4
1468
1459
1
444
242
1846
5
Page 25 of 58
HCV IU log10
HCV log10
HCV Quant (IU/mL)
HCV RNA (International Units)
HDL Cholesterol
Head Def,%
Hematocrit
Hemoglobin
Hemoglobin (Hgb) Solubility
Hemoglobin A1c
Hemoglobin A2, Qn
Hep A Ab, IgM
Hep A Ab, Total
Hep B Core Ab, IgM
Hep B Core Ab, Tot
Hep B Surface Ab
Hep Be Ab
Hep Be Ag
Hep C Virus Ab
Hepatitis B Quantitation
Hepatitis C Genotype
Hepatitis C Quantitation
Hepatitis C RNA-PCR
Heptacarboxyl (7-CP)
Hereditary Hemochromatosis
Hexacarboxyl (6-CP)
Hexadecanoylcarnitine, C16
Hexadecenoylcarnitine,C16:1
Hexagonal Phase Phospholipid
Hexagonal Phospholipid Neutral
Hexanoylcarnitine, C6
Hgb A
Hgb A2
Hgb C
Hgb F
Hgb Fetal
Hgb S
Hgb Solubility
Hgb Variant
High Risk HPV in situ Hybrid.
Histidine,Pl
Histo/Cyto Correlation
Histoplasma Abs, Qn, DID
Histoplasma Antigen
HIV 1/O/2 Abs, Qual
HIV 1/O/2 Abs-Index Value
HIV DNA PCR
HIV GenoSure
HIV-1 RNA by PCR
HIV-2 Immunoblot
HLA Class 1 Antibody
HLA-B27
Homocyst(e)ine, Plasma
Homocystine,Pl
HPV ASR
HPV, high-risk
HPV, low-risk
HSV 1 IgG, Type Spec
HSV 1/2 PCR
HSV 2 IgG, Type Spec
CommUnityCare RFP 1105-001
479
725
479
18
22778
5
33766
32605
47
12948
1
657
2876
2162
4497
4704
1898
1903
3472
7
401
718
133
2
11
2
2
2
8
1
2
1546
1545
1546
1545
1
1546
1545
1546
1
11
2
6
22
14640
14640
2
7
105
1
4
6
16
11
285
5439
45
54
1
83
Page 26 of 58
HSV Culture Without Typing
HSV Culture/Type
HSV I/II IgG
HSV, IgM I/II Combination
Hydrocodone
Hydrocodone (GC/MS)
Hydrocodone Confirm
Hydrocodone GC/MS Conf
Hydromorphone
Hydromorphone (GC/MS)
Hydromorphone Confirm
Hydromorphone GC/MS Conf
Hydroxylysine,Pl
Hydroxyproline,Pl
I100-IgE Cockroach,American
Ia/IIa Antibody
Ib/IX Antibody
IFE Interpretation:U
IFE Result, Cryoprecipitant
IgE Alternaria Alternatea
IgE American Cockroach
IgE Bermuda Grass
IgE Cat Dander
IgE Cladosporium Herbarum
IgE Cockroach
IgE Codfish
IgE Dog Dander
IgE Dust Mite, D. Farinae
IgE Egg White
IgE Elm, White
IgE Johnson Grass
IgE Meadow Grass,Kentucky Blue
IgE Milk, Cow's
IgE Mountain Juniper
IgE Oak, White
IgE Peanut
IgE Ragweed, Common
IgE Rough Marshelder
IgE Soybean
IgE Walnut Tree
IgE Wheat Food
IgG P18 Ab.
IgG P23 Ab.
IgG P28 Ab.
IgG P30 Ab.
IgG P39 Ab.
IgG P41 Ab.
IgG P45 Ab.
IgG P58 Ab.
IgG P66 Ab.
IgG P93 Ab.
IgG, Subclass 1
IgG, Subclass 2
IgG, Subclass 3
IgG, Subclass 4
IGLBP
IgM P23 Ab.
IgM P39 Ab.
IgM P41 Ab.
IIb/IIIa Antibody
CommUnityCare RFP 1105-001
196
18
81
35
243
41
9
156
243
38
9
114
11
11
44
4
4
5
1
2
2
2
2
2
1
1
2
2
1
2
2
2
1
2
2
1
2
2
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
5283
1
1
1
4
Page 27 of 58
Imipramine/Desipramine
Immature Cells
Immature Grans (Abs)
Immature Granulocytes
Immotile
Immunofixation Result, Serum
Immunofixation Result, Urine
Immunoglobulin A, Qn, Serum
Immunoglobulin E (IgE)
Immunoglobulin E, Total
Immunoglobulin G, Qn, Serum
Immunoglobulin M, Qn, Serum
INR
Insulin
Insulin (Fasting)
Insulin Antibodies
Insulin Dep Diabetes
Insulin-Like Growth Factor I
Intestinal Frac.:
Intrinsic Factor Abs, Serum
Iron Bind.Cap.(TIBC)
Iron Saturation
Iron, Serum
Iso/Butyrylcarnitine, C4
Isoleucine,Pl
Isopropanol
Isopropanol, Urine
Isospora Smear, Stool
Isovaleryl-/2-Methylbutyry.C5
Itraconazole
Itraconazole Comment
Itraconazole Level
IU log10
Kappa:Lambda
Ketone Bodies, Serum
Ketones
LAC Interpretation
Lactic Acid, Plasma
Lamotrigine, Serum
LDH
LDL Chol. (Direct)
LDL Cholesterol Calc
LDL/HDL Ratio
Lead, Blood
Lead, Blood (Adult)
Lead, Blood (Pediatric)
Leptospira Ab, IgM by Dot Blot
Leucine,Pl
Levetiracetam, S
LGLs
LH
Linezolid
Lining Cells, Synovial
Linoleylcarnitine, C18:2
Lipase, Serum
Liquefaction Time
Lithium (Eskalith), Serum
Liver Fraction:
Liver-Kidney Microsomal Ab
log 10
CommUnityCare RFP 1105-001
8
22842
22837
22837
5
9
3
351
1
23
24
27
1602
89
1
1
1461
18
28
5
2402
2402
7598
2
11
1
9
10
2
2
1
1
3
2
5
7560
1
8
14
5289
30
22775
68
14
7
1407
1
11
59
2
515
1
7
2
798
5
180
28
1
5
Page 28 of 58
log10 CMV Qn DNA Pl
log10 HIV-1 RNA
Lopinavir Level
Lopinavir, HPLC
Lorazepam
Lorazepam Confirm
Low Risk HPV in situ Hybrid.
Lower Respiratory Culture
Lyme Ab IgM Interp., EIA
Lyme Ab Interp.,EIA
Lyme Disease Ab, Quant, IgM
Lyme IgG WB Interp.
Lyme IgG/IgM Ab
Lyme IgM WB Interp.
Lymphocytes
Lymphocytes, Fluid
Lymphs
Lymphs (Absolute)
Lysine,Pl
M001-IgE Penicillium notatum
M002-IgE Cladosporium herbaru
M003-IgE Aspergillus fumigatu
M004-IgE Mucor racemosus
M006-IgE Alternaria tenuis
M010-IgE Stemphylium botryosu
Macro Type 1
Macro Type 2
Macrophages
Magnesium ammon phos
Magnesium, Serum
Magnesium, Ur(24 Hr)
Magnesium, Urine
MATER
MCH
MCHC
MCV
MDMA
Megakaryocytes
Meperidine
Meperidine Screen, Urine
Meprobamate
Mercury, Blood
Metamyelocytes
Metaneph/Creat Ratio
Metanephrine, Pl
Metanephrine, U,24hr
Metanephrine, Ur
Methadone
Methadone (Dolophine), Serum
Methadone (GC/MS)
Methadone By TLC
Methadone GC/MS Conf
Methadone Screen, Urine
Methamphetamine
Methamphetamine (GC/MS)
Methamphetamine GC/MS Conf
Methanol
Methanol, Urine
Methionine,Pl
Methylmalonic Acid, Serum
CommUnityCare RFP 1105-001
17
106
2
9
14
1
1
15
3
4
3
1
6
1
2
7
25764
25763
11
44
44
44
44
46
44
19
19
7
5
285
5
5
484
28202
28202
28202
1
68
10
95
10
14
68
5
6
10
15
34
2
4
9
24
607
35
2
8
1
9
11
21
Page 29 of 58
Metoprolol
Microalb/Creat Ratio
Microalbumin, Urine
Microalbumin,mg/day
MICROD
MICROS
Microscopic Examination
Microsporidia Stain
Midazolam
Midazolam Confirm
Midpiece Defect, %
Miscellaneous Problem
Mitochondrial (M2) Antibody
Mono Qual W/Rflx Qn
Mono Titer
Monocytes
Monocytes(Absolute)
Mononucleosis Test, Qual
Monosodium Urate
Morphine
Morphine (Free)
Morphine (GC/MS)
Morphine By TLC
Morphine Confirm
Morphine GC/MS Conf
Motility
Moxifloxacin
M-Spike
M-Spike, %
M-Spike, mg/24 hr
Mucus Threads
Multiple Gestation
Mumps Abs, IgG
Mumps Antibodies, IgM
Mycophenolic Acid
Mycophenolic Acid Glucuronide
Myelocytes
Myoglobin, Serum
N gonorrh. Competition Rflx
N. gonorrh. DNA Probe w/Rflx
N. gonorrhoeae, NAA, Pharyn
Necroinflamm Activity Scoring:
Necroinflammat Activity Grade
Necroinflammat Activity Score
Neisseria gonorrhoeae, NAA
Neutrophils
Neutrophils (Absolute)
Neutrophils Absolute
Newberyite
NGI HBV UltraQual
NGI HCV LiPA Genotype
Nicotine By TLC
Nidus
Nitrite, Urine
NK Cells
No Aptima Swab Received
No Bacterial Swab Trans Rec'd
No Clean Vial Stool Received
No Genprobe Received
No Micro Specimen Received
CommUnityCare RFP 1105-001
8
4495
6313
1
481
88
7574
2
2
1
6
47
181
33
1
25766
25763
34
5
263
2
14
9
9
48
5
1
377
236
7
6487
1461
52
2
6
6
68
1
6
145
2
37
37
37
17276
25764
25753
10
5
2
1
9
5
7561
2
1
3
1
2
1
Page 30 of 58
No Micro Urine Received
No O+P Trans Containers Rec'd
No Stool Culture Transport Rcd
No Test Indicated Stool
Noramiodarone,S
Nordiazepam
Nordiazepam (GC/MS)
Nordiazepam Confirm
Nordiazepam GC/MS Conf
Norepinephrine
Norepinephrine, Ur
Norepinephrine,U,24h
Normal Morphology, %
Normetanephr.,U,24h
Normetanephrine, Pl
Normetanephrine, Ur
Nortriptyline (Aventyl), Serum
NRBC
NTI Aptima Swab
NTI for Aptima Urine
NTI Formalin Vial
NTI PVA Vial
NTI Urine Culture Transport
NTI Viral Transport
Nucleated Cells, Synovial Fld
O+P Exam, PVA Only
Occult Blood
Occult Blood, Stool #1
Occult Blood, Stool #2
Occult Blood, Stool #3
Occult Blood, Stool, Guaiac
Octanoylcarnitine, C8
Octenoylcarnitine, C8:1
OH-Alprazolam
OH-Alprazolam GC/MS Conf
Oleylcarnitine, C18:1
Opiate Screen, Urine
Opiates
Opiates As Class
Opiates Screen, Blood
Organic Acid Interpretation
Organism ID, Mycobacteria
Organism Identification, Yeast
Ornithine,Pl
OSBR Risk
1 IN
Osmolality
Osmolality (Calc)
Osmolality, Serum
Osmolality, Urine
Osmotic Fragility
Other Microsc. Observations
Other, Lineage Uncertain
Ova + Parasite Exam
Oxalates, Urine
Oxalates, Urine 24hr
Oxazepam
Oxazepam (GC/MS)
Oxazepam Confirm
Oxazepam GC/MS Conf
Oxcarbazepine
CommUnityCare RFP 1105-001
64
3
15
17
1
76
2
1
9
1
10
9
5
10
6
15
1
24949
6
5
1
1
77
2
7
2
7560
1
1
1
1
2
2
59
11
2
158
1423
9
48
8
2
1
11
1466
24
1
5
31
2
5
68
482
7
2
76
6
1
50
1
Page 31 of 58
Oxycodone
Oxycodone (GC/MS)
Oxycodone Confirm
Oxycodone/Oxymorph
Oxycodone/Oxymorphone, Urine
Oxymorphone
Oxymorphone (GC/MS)
Oxymorphone Confirm
P E Interpretation, S
P E Interpretation, U
p18 Ab
p24 Ab
p31 Ab
p51 Ab
p55 Ab
p65 Ab
Pancreatic Amylase, S
Parasite Exam, Blood
Parasite ID, Worm
Parvovirus B19, IgG
Parvovirus B19, IgM
PCR Amplification + Detection
Pentacarboxyl (5-CP)
Pentazocine By TLC
Pentobarbital
PERFOR
Perinuclear (P-ANCA)
pH
pH, 24 Hr Urine
pH, Stool
pH, Urine
Phencyclidine
Phencyclidine GC/MS Conf
Phencyclidine Screen, Blood
Phencyclidine Screen, Urine
Phenmetrazine By TLC
Phenobarbital
Phenobarbital GC/MS Conf
Phenobarbital, Serum
Phenothiazines
Phenotype
Phenotype % of Total
Phentermine By TLC
Phenylalanine,Pl
Phenylpropanolamine
Phenytoin
Phenytoin (Dilantin), Serum
Phenytoin, Free, Serum
Phosphoethanolamine,Pl
Phosphorus, Serum
Phosphorus, Urine
Phosphorus, Urine 24hr
Phosphoserine,Pl
PICD-9
Pinworm Prep - Enterobius
Platelet Neutralization
Platelets
Plt Count, Citrated Bld
PLTs
Polys, Fluid
CommUnityCare RFP 1105-001
13
2
10
69
160
13
3
10
373
1
363
363
363
363
363
363
21
1
1
4
4
341
2
9
15
13209
16
7565
5
1
484
936
6
48
158
9
15
5
38
9
2
2
9
11
9
1
371
77
11
5690
7
2
11
1871
13
1
28268
48
231
7
Page 32 of 58
Potassium, Heparin Plasma
Potassium, Serum
Potassium, Urine
Prealbumin
Pregnancy Test, Urine
Primidone, Serum
Profile Performed
Progesterone
Prolactin
Proline,Pl
Promyelocytes
Propionylcarnitine, C3
Propoxyphene
Propoxyphene Metab
Propoxyphene or Meta
Propoxyphene or Metab GC/MS
Propoxyphene or Metab. GC/MS
Propoxyphene Screen, Urine
Prostate Specific Ag, Serum
Prot,24hr calculated
Protein
Protein C Antigen
Protein C-Functional
Protein S, Free
Protein S, Total
Protein S-Functional
Protein, Total, Serum
Protein,Total,Urine
Protein/Creat Ratio
Prothrombin Time
Protoporphyrin
PSA, Free
PTH Related Peptide
PTH, Intact
PTT-LA
PTT-LA Mix
Q Fever Phase I
Q Fever Phase II
QC REV
QFT Positive Criteria
QFT TB Ag minus Nil Value
QuantiFERON Incubation
QuantiFERON Mitogen Value
QuantiFERON Nil Value
QuantiFERON TB Ag Value
QuantiFERON TB Gold
Quinine
RA Latex Turbid.
Rapidly Progressive
RBC
RBC Morphology
RBC, Fluid
RDW
RECOMM
REFLEX
Reflex Criteria
Renin Activity, Plasma
Renin, Plasma
Request Problem
Reticulocyte Count
CommUnityCare RFP 1105-001
1
34063
16
14
4
2
2
12
658
11
68
2
458
11
14
10
14
158
1834
192
7560
17
16
18
18
16
32366
685
237
1602
1
15
3
366
79
8
1
1
1944
388
387
386
387
388
388
387
9
709
5
34921
1
7
28202
314
7416
7
35
9
1083
633
Page 33 of 58
Retroviral Genotype
Review:
Rh Factor
Rh Factor (D)
RIBA Result
Rifampin
RMSF, IgG, EIA
RNA, b-DNA, Quant
RNP Antibodies
Rotavirus Ag, EIA
RPR
RPR, Quant
RPR, Quant.
RSV Ag, EIA
Rubella Antibodies, IgG
Rubella Antibodies, IgM
Rubeola Ab, IgG, EIA
Rubeola Antibodies, IgM
Salicylate
Salivary Amyl. Calc.
Salivary Amylase, S
Salmonella/Shigella Screen
Sample Isolation performed at:
Sarcosine,Pl
Saturation Ratios
Secobarbital
Sedimentation Rate-Westergren
Serial Monitoring
Serine,Pl
Serotonin, Serum
Sex Horm Binding Glob, Serum
Shell
Silver, Serum/Plasma
Sjogren's Anti-SS-A
Sjogren's Anti-SS-B
Sluggish
Smear Review
Smith Antibodies
Smith/RNP Antibodies
SMN1:
SMN2:
Sodium acid urate
Sodium, Serum
Sodium, Urine
SOURCE
Specific Gravity
SPECTY
Sperm
Spironolactone
Spotted Fever Group IgG
Spotted Fever Group IgM
Staining Method
Stearoylcarnitine, C18
Strep Gp B Cult/DNA Probe
Strep Gp B Cult/Probe+Rflx
Strep Gp B Susceptibility
Streptomycin
Struvite
Sulfate, Urine
Surface Crystals
CommUnityCare RFP 1105-001
1
5
45
2744
17
1
1
1
213
5
17787
19
592
1
4110
4
51
1
10
3
18
309
145
11
5
15
2177
13
11
1
2
5
1
215
215
5
2
213
2
3
3
5
33804
30
90
7672
2
1973
8
1
1
2
2
2157
21
4
1
5
6
5
Page 34 of 58
Susceptibility, Aer + Anaerob
T Cells
T pallidum Ab (FTA-Ab)
T pallidum Ab(TP-PA)
T. Chol/HDL Ratio
T001-IgE Maple/Box Elder
T006-IgE Cedar, Mountain
T007-IgE Oak, White
T008-IgE Elm, American (White
T015-IgE Ash, White
T020-IgE Mesquite
T041-IgE Hickory, White
T061-IgE Sycamore, American
T070-IgE White Mulberry
T18 (By Age)
T18 Risk
T211-IgE Sweet Gum
T3 Uptake
T-3 Uptake, Neonatal
T4,Free (Direct)
T4,Free(Direct)
Tacrolimus (FK506), Blood
-Tacrolimus (FK506), Blood
Tacrolimus by Immunoassay
Tailpiece Defect, %
Tandem-R Ostase
Taurine,Pl
TEB [Telbivudine, Tyzeka]
Temazepam
Temazepam Confirm
Testosterone, Serum
Tetradecadienoylcarnit.,C14:2
Tetradecanoylcarnitine, C14
Tetradecenoylcarnitine,C14:1
THC
THC (GC/MS)
Theophylline, Serum
Threonine,Pl
Thrombin Time
Thyroglobulin, Qn.
Thyroid Peroxidase (TPO) Ab
Thyroid Stim Immunoglobulin
Thyrotropin Receptor Ab, Serum
Thyroxine (T4)
Thyroxine Binding Globulin
TNF [Tenofovir, Viread]
Topiramate, Serum
Total Motile
Tox Request Problem
Toxoplasma gondii Ab,IgG,Qn
Toxoplasma gondii Ab,IgM,Qn
Tramadol
Tramadol (GC/MS)
Tramadol Screen, Urine
Transferrin
Trazodone
Treponema pallidum Antibodies
Triamterene
Triazolam
Triazolam Confirm
CommUnityCare RFP 1105-001
3
2
3
252
5
44
44
44
44
42
42
44
2
44
1436
1419
44
81
1
162
4934
9
2
2
6
3
11
16
15
1
399
2
2
2
13
7
5
11
4
21
258
62
5
14
2
16
16
5
4
1650
6
14
4
94
11
8
372
13
14
1
Page 35 of 58
Trich vag by NAA
Trichomonas
Trichomonas Culture
Trichomonas Exam
Tricyclics
Tricyclics By TLC
Triglycerides
Triiodothyronine (T3)
Triiodothyronine, Free, Serum
Triiodothyronine,Free,Serum
Trimethoprim
Troponin I
Tryptophan,Pl
TSH
t-Transglutaminase (tTG) IgA
t-Transglutaminase (tTG) IgG
Typhus Fever Group IgG
Typhus Fever Group IgM
Tyrosine,Pl
uE3 MoM
uE3 Value
UIBC
Upper Respiratory Culture
Urea Nitrogen, U
Uric acid
Uric acid dihydrate
Uric Acid, Serum
Uric Acid, Urine
Uric Acid, Urine 24hr
Urinalysis Reflex
Urine Culture, Routine
Urine Volume
Urine Volume (Preservative)
Urine-Color
Urobilinogen,Semi-Qn
Uroporphyrins (UP)
Valine,Pl
Valproic Acid (Depakote),S
Varicella Zoster IgG
Varicella-Zoster Ab, IgM
VDRL Titer
VDRL, Serum
Venipuncture
Venlafaxine
Verapamil
Viability
Viral Culture, General
Viral Culture,Rapid,Varicella
Virtual Phenotype
Viscosity
Vit. B1, Plasma
Vitamin A, Serum
Vitamin B12
Vitamin B6
Vitamin C
Vitamin D, 25-Hydroxy
Vitamin E(Alpha Tocopherol)
VLDL Cholesterol Cal
VMA, Random Urine
VMA, Urine
CommUnityCare RFP 1105-001
3
6485
809
3338
1
1
27508
6
38
988
8
19
11
17926
324
85
1
1
11
1468
1459
2402
45
1
10
5
5849
17
11
3121
9231
5
5
7560
7560
2
11
260
63
11
1
1
1
8
8
7
1
1
1
5
2
4
1405
6
6
1558
3
22774
4
3
Page 36 of 58
VMA, Urine, 24hr
VMA/Crt, Random U
von Willebrand Factor (vWF) Ag
vWF Activity
W001-IgE Ragweed, Short/Commo
W006-IgE Mugwort
W009-IgE Plantain, English
W014-IgE Pigweed, Rough
W015-IgE Lenscale
W018-IgE Sheep Sorrel(Dock)
W020-IgE Nettle
WBC
WBC Esterase
Western Blot Interp:
White Blood Cells
White Blood Cells (WBC), Stool
Yeast
Yeast Exam
Zinc, Plasma or Serum
total
CommUnityCare RFP 1105-001
3
4
13
13
46
2
44
44
42
44
44
34919
7560
363
1
260
6485
3338
4
2055298
Page 37 of 58
Calcium
Exhibit B: Critical Values
Critical Value List for David Powell Clinic (DPC)
DPC Internal
LabCorp
Abnormal
Critical Call
None
>12.0
Glucose
< 60 or > 450
< 60 or > 450
Potassium
< 3.0 or > 6.0
< 3.0 or > 6.0
Sodium
< 130 or > 150
< 125 or > 150
CO2
< 17*
< 17*
Creatinine
> 2.5*
No
ALT
> 200
>500
AST
> 200
>500
WBC
< 1.5
<0.5
ANC
< 600
<400
Hgb
< 6.9
<6.5
Plt
< 20,000
<10,000
RPR
> 1:4 or first positive RPR
None
> 2.5 x ULN
> 2.5 x ULN
Cultures
All positive cultures
Positive Blood Cultures
PT/INR
All PT/INR results
>3.5
STAT Labs
All STAT labs
All STAT labs
Drug Levels
All drug levels
None
Any abnormal urinalysis
None
Lactic acid
Urinalysis
Critical Value List for all CommUnityCare Clinics (not DPC)
Lab Test
Bilirubin (total)
0.1-14
BUN
6-22
Calcium
8.5-10.6
Creatinine
0.7-1.6
Glucose-fasting
65-110
Potassium
3.5-5.0
Sodium
135-145
CommUnityCare RFP 1105-001
Normal Value
Critical Value
> 5.0 Adults
> 15.0 Peds
> 50 Adults
> 30 Peds
< 7.5
> 12.0
> 6.0 Adults
> 2.0 Peds
< 60
> 450
< 3.0
> 6.0
< 125 Adults
Page 38 of 58
< 120 Peds
> 150 All
Above Therapeutic Range
Therapeutic Drugs
Urinalysis:
RBC
Cultures
CBC
WBC
Hematocrit
Hemoglobin
Platelets
INR
Pap Smears
Endometrial Biopsies
Cervical Biopsies and ECC
CommUnityCare RFP 1105-001
Gross Hematuria
1+Occult blood if not on menses
All Positive
5.0-10.0
Male 40-54
Female 37-47
Male 14-18
Female 12-16
150- 450
< 2.5
> 15.0 non-pregnant adult
> 25 pregnant female
< 20% and > 65%
< 20% and > 65%
< 7.5 Adults
< 8.5 Peds
< 50,000 Adults
< 100,000 Peds
> 1 Million All
> 3.5
All Class III and IV
All abnormal
CIN III or greater
Page 39 of 58
Exhibit C: Phlebotomist and Courier locations and hours
CommUnityCare RFP 1105-001
Page 40 of 58
Exhibit D:
General Terms and Conditions
ACCEPTANCE: Contractor’s written acceptance, commencement of work, shipment, or partial delivery of any item
or service called for under this Contract shall constitute acceptance by the Contractor of this Contract and its
Terms and Conditions.
ASSIGNMENT: CommUnityCare may assign any of its obligations under this Contract. Contractor may assign any of
its rights or obligations under this Contract only with the prior written consent of CommUnityCare. No official,
employee, representative, or agent of CommUnityCare has the authority to approve any assignment under this
Contract unless that specific authority is expressly granted by CommUnityCare’s Board of Directors. The terms,
provisions, covenants, obligations and conditions of this Contract are binding upon and inure to the benefit of the
successors-in-interest and the assigns of the parties to this Contract if the assignment or transfer is made in
compliance with the provisions of this Contract.
COMPLIANCE WITH FEDERAL, STATE, AND LOCAL LAWS. Each party shall provide the services and activities to be
performed under the terms of this Purchase Contract in compliance with the Constitutions of the United States
and Texas and with all applicable federal, state, and local orders, laws, regulations, rules, policies, and
certifications governing any activities undertaken during the performance of this Purchase Contract, including, but
not limited to: Title VI of the Civil Rights Act of 1964, as amended; Section 504 of the Rehabilitation Act of 1973
(29 U.S.C. Section 794); and the Americans With Disabilities Act of 1990, Public Law 101-336 [S.993] (“ADA”). No
party shall discriminate against any employee, applicant for employment, or plan participant based on race,
religion, color, gender, national origin, age, or handicapped condition. In performance of all services and activities
under this Contract, each party will comply with applicable state and federal licensing and certification
requirements, health and safety standards, and regulations prescribed by the U. S. Department of Health and
Human Services, the Texas Department of State Health Services, or any other state regulatory agency.
CONTRACT CONSTRUCTION: Provisions, words, phrases, and statutes, whether incorporated by actual use or by
reference, shall be applied to this contract in accordance with Texas Government Code, Sec 312.002 and 312.003.
For purposes of this solicitation and any resulting award, the following words or phrases shall have the meanings
indicated: (i) CommUnityCare – Central Texas Community Health Centers d/b/a CommUnityCare; (ii) Board of
Directors – CommUnityCare’s Board of Directors, the governing body of CommUnityCare; (iii) Seller/Contractor– a
person or firm receiving award of a contract from CommUnityCare; and (iv) Subcontractor–a person or firm doing
business with a contractor.
COVENANT AGAINST CONTINGENT FEES: Seller warrants that no persons have or selling agency has been retained
to solicit this Contract upon an understanding for a commission, percentage, brokerage, or contingent fee,
excepting bona fide employees or bona fide established commercial selling agencies maintained by Contractor to
secure business. For breach or violation of this warranty, CommUnityCare shall have the right to terminate this
Contract without liability or, in its discretion and as applicable, to add to or deduct from the contract price or
otherwise recover the full amount of such commission, percentage, brokerage, or contingent fee.
DESCRIPTION OF SUPPLIES: Any catalog or manufacturer’s reference used in describing any item in this Contract is
merely descriptive and not restrictive, unless otherwise noted, and is used to indicate type and quality of material.
The term “or equal,” if used, identifies commercially-produced items that have the essential performance and
salient characteristic of the brand name stated in the item description. Seller certifies that any substitute brand
supplied hereunder matches the performance and salient characteristics of the item called for in this Contract and
agrees to replace it in the event that it does not conform as determined by CommUnityCare in its sole discretion.
All supplies or equipment shall be the latest-improved, new model meeting specification in current production at
the time of delivery and shall be delivered completely assembled, adjusted, serviced, and ready for use. Seller
warrants that all applicable patents and copyrights that may exist on items sold hereunder have been adhered to
and agrees to hold CommUnityCare harmless and defend CommUnityCare against any infringement claim.
CommUnityCare ACCESS AND AUDIT: During the term of this Contract and for a period of four (4) years following
termination of this Contract, CommUnityCare maintains the right to review and audit any of the books and records
of Contractor relating to Contractor's performance and receipt of payments under this Contract. CommUnityCare
may conduct its review or audit through its own employees, agents, or representatives or through independent
external auditors or representatives or through independent external auditors or representatives retained by
CommUnityCare RFP 1105-001
Page 41 of 58
CommUnityCare. CommUnityCare will conduct such review or audit upon reasonable notice to the Contractor, at
its own expense, and during regular business hours. The records shall be retained beyond the fourth year if an
audit is in progress, the findings of a completed audit have not been resolved satisfactorily, or litigation involving
this Contract is not finally resolved.
ENTIRETY OF AGREEMENT AND MODIFICATION: All oral and written agreements between the parties to this
Contract relating to the subject matter of this Contract that were made prior to the execution of this Contract have
been reduced to writing and are contained in this Contract. This Contract may be amended only by an instrument
in writing that is signed by both parties. Amendments to this Contract shall be effective as of the date stipulated
therein. Contractor acknowledges that no CommUnityCare officer, agent, employee, or representative has any
authority to amend this Contract unless expressly granted that specific authority by CommUnityCare Board of
Directors.
FOB POINT, INSPECTION, AND ACCEPTANCE: Final inspection and acceptance of any goods or services delivered or
performed hereunder shall be made at final destination by the CommUnityCare. CommUnityCare reserves the
right to reject all items not in conformance with applicable specifications, and Seller assumes the costs associated
with such nonconformance. An itemized packing list, bearing purchase, delivery, and/or contract number shall be
attached to the outside of every shipping container delivered under this instrument. Delivery of all goods or
services shall be free on board (FOB) to final destination as outlined herein unless otherwise required by
CommUnityCare.
FORCE MAJEURE: Neither CommUnityCare nor Contractor will be deemed to have breached this Contract or be
held liable for any failure or delay in the performance of all or any portion of its obligations under this Contract if
prevented from doing so by a cause or causes beyond its control. Without limiting the generality of the foregoing,
such causes include acts of God or the public enemy, fires, floods, storms, earthquakes, riots, strikes, boycotts,
lock-outs, wars and war operations, acts of terrorism, restraints of government, power or communications line
failure or other circumstances beyond such party’s control, or by reason of the judgment, ruling, or order of any
court or agency of competent jurisdiction, or change of law or regulation (or change in the interpretation thereof)
subsequent to the execution of this Contract.
GOVERNING LAW AND VENUE: The laws of the State of Texas (without giving effect to its conflicts of laws
principles) govern all matters arising out of or relating to this Contract and all transactions it contemplates,
including, without limitation, its validity, interpretation, construction, performance, and enforcement. Venue for
any dispute arising out of this Contract is in Travis County, Texas.
INSURANCE: INSURANCE: Contractor shall maintain the following minimum per occurrence insurance coverage,
and $3,000,000.00 aggregate liability coverage, throughout the life of the contract:
General Liability
$1,000,000.00
Occurrence Liability
$1,000,000.00
Personal Injury
$1,000,000.00
Workers compensation
$100,000.00
Said coverage will continue throughout the term of the contract. A copy of the Certificate of Insurance shall be
maintained, by the Purchasing Manager, throughout the life of the contract. The successful bidder shall have the
insurance carrier send the Certification prior to initiation of the contract. The Contractor through the insurance
company must agree to notify CommUnityCare immediately in writing of any limitation, modification, cancellation,
or other termination of such insurance coverage.
LEGAL CONSTRUCTION: If one or more of the provisions contained in this Contract shall for any reason be held to
be invalid, illegal, or unenforceable in any respect, such invalidity, illegality, or unenforceability shall not effect any
other provision hereof, and this Contract shall be construed as if such invalid, illegal, or unenforceable provision
had never been contained herein.
NONDISCRIMINATION AND STATUS: Seller certifies that it is a duly qualified, capable and otherwise eligible
business entity, it is not in receivership and does not contemplate same and it has not filed for bankruptcy.
CommUnityCare RFP 1105-001
Page 42 of 58
NOVATION AND CHANGE OF NAME AGREEMENTS: Seller is responsible for the performance of this Contract. If
Seller experiences a change of name or change of ownership, Seller shall notify CommUnityCare immediately. No
change in the obligation of or to the Seller will be recognized until it is approved by CommUnityCare.
TERMINATION FOR FAULT: If either party defaults in the performance of its obligations (including compliance with
any covenants) under this Contract and such default is not cured within thirty (30) days of the receipt of written
notice thereof, then the non-defaulting party shall have the right (in addition to any other rights that it may have)
by further written notice to terminate the Contract on any future date that is not less than thirty (30) days from
the date of that further notice.
TERMINATION FOR CONVENIENCE: In addition to, and without restricting any other legal, contractual, or equitable
remedies otherwise available, either party may terminate the Contract without cause by giving the other party at
least thirty (30) days written notice.
TERMINATION FOR GRATUITIES: CommUnityCare may terminate this Contract if it is found that gratuities of any
kind, including entertainment or gifts, were offered or given by the Contractor or any agent or representative of
the Contractor to any CommUnityCare official or employee with a view toward securing favorable treatment with
respect to this Contract. If this Contract is terminated by CommUnityCare pursuant to this provision,
CommUnityCare shall be entitled, in addition to any other rights and remedies, to recover from the Contractor at
least three times the cost incurred by Contractor in providing the gratuities.
TERMINATION FOR FUNDING OUT: Despite anything to the contrary in this Contract, if, during budget planning and
adoption, CommUnityCare fails to provide funding for this Contract for the following fiscal year, CommUnityCare
may terminate this Contract after giving Contractor thirty (30) days written notice that this Contract is terminated
due to the failure to fund it.
INVOICES: For purposes of complying with prompt payment standards, time does not begin unless or until all
billing instructions have been complied with and proper delivery or performance has been made satisfactorily
approved, whichever is later. CommUnityCare has twenty-one (21) days after the date CommUnityCare receives
the invoice in which to notify Contractor of an error in the invoice. A complete and acceptable invoice will contain:
i.
Line item descriptions of goods or services delivered
a. Location of goods or services delivery
b. Date of goods or services delivery
ii.
A unique invoice number
iii.
Reference the Purchase Order Number issued
a. The Contractor will ensure that each invoice contains a unique identifying number and that it
also reflects the correct Purchase Order Number if applicable. The invoice will also contain a
remittance section containing the date of service, the total amount due and the remittance
address.
b. Paper invoices should be mailed to CommUnityCare, P.O. Box 17366 Austin, TX 78760.
c. Invoices will be paid within 30 days after receiving a correct invoice.
d. The invoice should reflect prorated billing for all services that are performed for less than the
entire month covered by the invoice. Prorated bills shall note the ending and/or beginning date
of the new or changed service. The method used by the Contractor to calculate prorated bills is
subject to the approval of the Purchasing Manager.
PAYMENTS: Payment shall be made by check or electronic transfer of funds upon satisfactory delivery and
acceptance of all items or services and submission of a proper invoice. For purposes of payment discounts, time
will begin upon satisfactory delivery of goods or services or submission of a proper invoice, whichever is later. No
partial payments shall be accepted.
CONFLICT OF INTEREST: Before contract can begin and then annually, Contractor will complete a Conflict of
Interest Form and return to PURCHASING@COMMUNITYCARETX.ORG or fax to 512-978-9001.
WARRANTY: Implied warranties notwithstanding, Seller warrants to CommUnityCare that all items delivered and
all services rendered under this Purchase Contract will conform to the specifications, drawings, or other
descriptions furnished or incorporated by reference in this Contract, will be of merchantable quality, good
CommUnityCare RFP 1105-001
Page 43 of 58
workmanship, and free from any defects. Seller further agrees to provide copies of applicable warranties to
CommUnityCare. Return of merchandise not meeting applicable warranties or specifications shall be at Seller’s
expense.
FRAUD,WASTE AND ABUSE. Contractor agrees to report the existence (or apparent existence) of fraud, waste, or
abuse related to HHS funds by calling the OIG hotline at 1-800-HHS-TIPS (1-800-447-8477) or TTY at 1-800-3774950; by fax at 1-800-223-8164; by e-mail at HHSTips@oig.hhs.gov; or by mail at Office of the Inspector General,
Department of Health and Human Services, Attn: HOTLINE, 330 Independence Avenue, SW, Washington, DC 20201.
Fraud, Waste and abuse includes, but is not limited to, embezzlement, misuse, or misappropriation of HHS funds or
property, and false statements, whether by organizations or individuals. Examples are theft of grant funds for
personal use; suing funds for non-grant-related purposes; theft of federally owned property or property acquired or
leased under a grant; charging inflated building rental fees for a building owned by the recipient; submitting false
financial reports; and submitting false financial data in bids submitted to the recipient (for eventual payment under
the grant).
CODE OF CONDUCT. Employees, volunteers, contractors and members of the Governing Board of CommUnityCare
share the vision to provide primary health care, education, and preventive services to clients in the service area.
The goal and purpose of the Code of Conduct is to maintain the integrity of CommUnityCare as a reliable
healthcare provider and integral part of the community we serve. Compliance with the Code of Conduct simply
means that we “do the right thing” and the Code is our guide toward that end. Our policies and procedures are
written and implemented in compliance with the regulations and standards of health care, which essentially are
“the right thing.” Contractor’s commitment to the CommUnityCare vision, mission and values to ethical conduct
and to servicing others with your special and unique talents will help CommUnityCare success in meeting the
health needs of our community and patients.
VISION: Improve the health of the community by increasing access to the best care possible.
MISSION: We will work with the community as peers with open eyes and a responsive attitude to provide the right
care, at the right time, at the right place.
GOALS:
1. Spread the word through consistent communication that gives the right information to the right people at
the right time.
2. Develop a care model that meets the needs of the community.
3. Support our target population through integrated services across the continuum of care.
4. Establish a flexible infrastructure to support our growing needs.
5. Use technological resources efficiently to meet our data needs and provide optimal care.
6. Hire and retain the right people for the right job by providing resources, recognition and appreciation.
CORE VALUES:
RESPECT – We treat our patients and peers with dignity and embrace diversity.
INTEGRITY – We are honest and sincere, doing what is right, not what is expedient.
DEPENDABILITY – We are accountable and strive to exceed expectations.
TEAMWORK – We work together, promote cooperation and value the opinions of patients and peers.
QUALITY – We strive for excellence in all that we do.
CONDUCT:
1. BE HONEST
2. FOLLOW APPLICABLE POLICIES AND PROCEDURES WHILE ACTING ON BEHALF OF COMMUNITYCARE
3. KEEP ACCURATE AND TIMELY RECORDS
4. PROTECT COMMUNITYCARE ASSETS
5. RESPECT CLIENTS AND STAFF RIGHTS
6. DO NOT ACCEPT GIFTS OR GRATUITIES
7. DO NOT OFFER, SOLICIT OR ACCEPT BRIBES OR KICKBACKS
8. AVOID CONFLICT OF INTEREST
9. MAINTAIN A STANDARD OF CONDUCT THAT DOES NOT TOLERATE ANY CONDUCT THAT INTERFERES WITH
OPERATIONS, DISCREDITS COMMUNITYCARE, AND/OR IS OFFENSIVE TO OR HARMS PATIENTS,
COWORKERS, CONTRACTORS OR OTHER INDIVIDUALS.
10. REPORT VIOLATIONS
CommUnityCare RFP 1105-001
Page 44 of 58
HOLIDAY SCHEDULE: Administrative offices and regular clinics will be closed the following dates:
Holiday
New Year’s Day
Memorial Day
Independence Day
Labor Day
Thanksgiving Day
Christmas
CommUnityCare RFP 1105-001
Date
January 1
Last Monday in May
July 4
First Monday in September
Fourth Thursday and Friday in November
December 25
Page 45 of 58
Exhibit E:
BUSINESS ASSOCIATE AGREEMENT
BY AND BETWEEN
CENTRAL TEXAS COMMUNITY HEALTH CENTERS D/B/A COMMUNITYCARE
AND
_______________________________
This Business Associate Agreement (the “Agreement”) is effective as of the date of last signature (“Effective Date”) by and between
Central Texas Community Health Centers, d/b/a CommUnityCare (“Covered Entity”) and _________________. on behalf of itself
and its Affiliates (“Business Associate”).
RECITALS
WHEREAS, Covered Entity has engaged Business Associate to perform services or provide goods, or both;
WHEREAS, Covered Entity possesses Individually Identifiable Health Information that is protected under HIPAA (as
hereinafter defined), the HIPAA Privacy Regulations (as hereinafter defined), the HIPAA Security Regulations (as hereinafter defined),
and the HITECH Standards (as hereinafter defined) and is permitted to use or disclose such information only in accordance with such
laws and regulations;
WHEREAS, Business Associate may receive such information from Covered Entity, or create and receive such information on
behalf of Covered Entity, in order to perform certain of the services or provide certain of the goods, or both; and
WHEREAS, Covered Entity wishes to ensure that Business Associate will appropriately safeguard Individually Identifiable
Health Information;
NOW THEREFORE, Covered Entity and Business Associate agree as follows:
1.
Definitions. The parties agree that the following terms, when used in this Agreement, shall have the following meanings,
provided that the terms set forth below shall be deemed to be modified to reflect any changes made to such terms from
time to time as defined in the HIPAA Privacy Regulations, the HIPAA Security Regulations, and the HITECH Standards.
a. “Breach” shall mean the acquisition, access, use, or disclosure of Protected Health Information in a manner not permitted
under 45 C.F.R. Part 164, Subpart E (the “HIPAA Privacy Rule”) which compromises the security or privacy of the Protected
Health Information. “Breach” shall not include:
(1) Any unintentional acquisition, access, or use of Protected Health Information by a workforce member or person
acting under the authority of Covered Entity or Business Associate, if such acquisition, access, or use was made in
good faith and within the scope of authority and does not result in further use or disclosure in a manner not
permitted under the HIPAA Privacy Rule; or
(2) Any inadvertent disclosure by a person who is authorized to access Protected Health Information at Covered
Entity or Business Associate to another person authorized to access Protected Health Information at Covered
Entity or Business Associate, respectively, or Organized Health Care Arrangement in which Covered Entity
participates, and the information received as a result of such disclosure is not further used or disclosed in a
manner not permitted under the HIPAA Privacy Rule; or
(3) A disclosure of Protected Health Information where Covered Entity or Business Associate has a good faith belief
that an unauthorized person to whom the disclosure was made would not reasonably have been able to retain
such information.
b. “Business Associate” means, with respect to a Covered Entity, a person who:
(1) on behalf of such Covered Entity or of an organized health care arrangement in which Covered Entity
participates, but other than in the capacity of a member of the workforce of such Covered Entity or arrangement,
performs, or assists in the performance of:
CommUnityCare RFP 1105-001
Page 46 of 58
a) a function or activity involving the use or disclosure of Individually Identifiable Health Information,
including claims processing or administration, data analysis, processing or administration, utilization
review, quality assurance, billing, benefit management, practice management, and repricing; or
b) any other function or activity regulated by the HIPAA Privacy Regulations or HIPAA Security
Regulations; or
(2) provides, other than in the capacity of a member of the workforce of such Covered Entity, legal, actuarial,
accounting, consulting, Data Aggregation, management, administrative, accreditation, or financial services to or for
such Covered Entity, or to or for an organized health care arrangement in which Covered Entity participates, where
the provision of the service involves the disclosure of Individually Identifiable Health Information from such
Covered Entity or arrangement, or from another Business Associate of such Covered Entity or arrangement, to the
person.
c. “Covered Entity” means a health plan, a health care clearinghouse, or a health care provider who transmits any health
information in electronic form in connection with a transaction covered by the HIPAA Privacy Regulations and HIPAA
Security Regulations.
d. “Data Aggregation” means, with respect to PHI created or received by a Business Associate in its capacity as the Business
Associate of a Covered Entity, the combining of such PHI by the Business Associate with the PHI received by the Business
Associate in its capacity as a Business Associate of another Covered Entity, to permit data analyses that relate to the health
care operations of the respective Covered Entities.
e. “Electronic Protected Health Information” or “Electronic PHI” means Protected Health Information that is transmitted by
or maintained in electronic media as defined in the HIPAA Security Regulations.
f. “HIPAA” means the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191.
g. “HIPAA Privacy Regulations” means the regulations promulgated under HIPAA by the United States Department of Health
and Human Services to protect the privacy of Protected Health Information, including, but not limited to, 45 C.F.R. Part 160
and 45 C.F.R. Part 164, Subpart A and Subpart E.
h. “HIPAA Security Regulations” means the regulations promulgated under HIPAA by the United States Department of
Health and Human Services to protect the security of Electronic Protected Health Information, including, but not limited to,
45 C.F.R. Part 160 and 45 C.F.R. Part 164, Subpart A and Subpart C.
i. “HITECH Standards” means the privacy, security and security Breach notification provisions applicable to a Business
Associate under Subtitle D of the Health Information Technology for Economic and Clinical Health Act (“HITECH”), which is
Title XIII of the American Recovery and Reinvestment Act of 2009 (Public Law 111-5), and any regulations promulgated
thereunder.
j. “Individually Identifiable Health Information” means information that is a subset of health information, including
demographic information collected from an individual, and;
(1) is created or received by a health care provider, health plan, employer, or health care clearinghouse; and
(2) relates to the past, present, or future physical or mental health or condition of an individual; the provision of
health care to an individual; or the past, present, or future payment for the provision of health care to an
individual; and
a) that identifies the individual;
b) or with respect to which there is a reasonable basis to believe the information can be used to identify
the individual.
k. “Protected Health Information” or “PHI” means Individually Identifiable Health Information transmitted or maintained in
any form or medium that (i) is received by Business Associate from Covered Entity, (ii) Business Associate creates for its
own purposes from Individually Identifiable Health Information that Business Associate received from Covered Entity, or (iii)
CommUnityCare RFP 1105-001
Page 47 of 58
is created, received, transmitted or maintained by Business Associate on behalf of Covered Entity. Protected Health
Information excludes Individually Identifiable Health Information in education records covered by the Family Educational
Rights and Privacy Act, as amended, 20 U.S.C. § 1232g, records described at 20 U.S.C. § 1232g(a)(4)(B)(iv), and employment
records held by the Covered Entity in its role as employer.
l. Any terms capitalized, but not otherwise defined, in this Agreement shall have the same meaning as those terms have
under HIPAA, the HIPAA Privacy Regulations, the HIPAA Security Regulations, and the HITECH Standards.
2.
Status of Parties. Business Associate hereby acknowledges and agrees that Covered Entity is a Covered Entity and that
Business Associate is a Business Associate of Covered Entity.
3.
Permitted Uses and Disclosures.
a. Performance of Services. Business Associate may use and disclose PHI in connection with the performance of the services
if such use or disclosure of PHI would not violate HIPAA, the HIPAA Privacy Regulations, or the HITECH Standards if done by
Covered Entity or such use or disclosure is expressly permitted under Section 3(b) or 3(c) of this Agreement.
b. Proper Management and Administration. Business Associate may use PHI for the proper management and administration
of Business Associate in connection with the performance of services described in Exhibit A attached to this Agreement and
as permitted by this Agreement. Business Associate may disclose PHI for such proper management and administration of
Business Associate only with the prior consent of Covered Entity. Any such disclosure of PHI shall only be made if Business
Associate obtains reasonable assurances from the person to whom the PHI is disclosed that: (1) the PHI will be held
confidentially and used or further disclosed only as required by law or for the purpose for which it was disclosed to the
person; and (2) Business Associate will be notified by such person of any instances of which it becomes aware in which the
confidentiality of the PHI has been breached.
c. Other Permitted Uses. Unless otherwise limited herein, the Business Associate may also: (1) perform Data Aggregation for
the Health Care Operations of Covered Entity; (ii) may use, analyze, and disclose the PHI in its possession for the public
health activities and purposes set forth at C.F.R. § 164.512(b); and (iii) de-identify any and all PHI provided that Business
Associate implements de-identification criteria in accord with 45 C.F.R. §164.514(b).
4.
Nondisclosure.
a. As Provided In Agreement. Business Associate shall not use or further disclose PHI except as permitted or required by this
Agreement.
b. Disclosures Required By Law. Business Associate shall not, without the prior written consent of Covered Entity, disclose
any PHI on the basis that such disclosure is required by law without notifying Covered Entity so that Covered Entity shall
have an opportunity to object to the disclosure and to seek appropriate relief. If Covered Entity objects to such disclosure,
Business Associate shall refrain from disclosing the PHI until Covered Entity has exhausted all alternatives for relief.
Business Associate shall require reasonable assurances from persons receiving PHI in accordance with Section 3(b) hereof
that such persons will provide Covered Entity with similar notice and opportunity to object before disclosing PHI on the
basis that such disclosure is required by law.
c. Additional Restrictions. If Covered Entity notifies Business Associate that Covered Entity has agreed to be bound by
additional restrictions on the uses or disclosures of PHI pursuant to HIPAA, the HIPAA Privacy Regulations or the HITECH
Standards, Business Associate shall be bound by such additional restrictions and shall not disclose PHI in violation of such
additional restrictions.
5.
Safeguards, Reporting, Mitigation and Enforcement.
a. Safeguards. Business Associate shall use any and all appropriate safeguards to prevent use or disclosure of PHI otherwise
than as provided by this Agreement. Business Associate further agrees to use appropriate administrative, physical and
technical safeguards to protect the confidentiality, integrity and availability of any Electronic PHI in accordance with the
HIPAA Security Regulations (after the compliance date of the HIPAA Security Regulations) and the HITECH Standards.
b. Business Associate’s Agents. Business Associate shall ensure that any agents, including subContractors, to whom it
provides PHI agree in writing to be bound by the same restrictions and conditions that apply to Business Associate with
respect to such PHI; provided, however, that Business Associate shall not disclose or provide access to PHI to any
subContractor or agent without the prior written consent of Covered Entity.
c. Reporting. Business Associate shall report immediately to Covered Entity any use or disclosure of PHI in violation of this
Agreement or applicable law of which it becomes aware. Business Associate further agrees to report immediately to
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Covered Entity any security incident (as defined by the HIPAA Security Regulations, as amended) on or after the compliance
date of the HIPAA Security Regulations of which it becomes aware. In addition, Business Associate shall immediately report
to Covered Entity any Breach consistent with the regulations promulgated under HITECH by the United States Department
of Health and Human Services at 45 C.F.R. Part 164, Subpart D.
d. Mitigation. Business Associate shall have procedures in place to mitigate, to the maximum extent practicable, any
deleterious effect from any use or disclosure of PHI in violation of this Agreement or applicable law.
e. Sanctions. Business Associate shall have and apply appropriate sanctions against any employee, subContractor or agent
who uses or discloses PHI in violation of this Agreement or applicable law.
f. Covered Entity’s Rights of Access and Inspection. From time to time upon reasonable notice, or upon a reasonable
determination by Covered Entity that Business Associate has breached this Agreement, Covered Entity may inspect the
facilities, systems, books and records of Business Associate to monitor compliance with this Agreement. The fact that
Covered Entity inspects, or fails to inspect, or has the right to inspect, Business Associate’s facilities, systems and
procedures does not relieve Business Associate of its responsibility to comply with this Agreement, nor does Covered
Entity’s (1) failure to detect or (2) detection of, but failure to notify Business Associate or require Business Associate’s
remediation of, any unsatisfactory practices constitute acceptance of such practice or a waiver of Covered Entity’s
enforcement or termination rights under this Agreement. The parties’ respective rights and obligations under this Section
5(f) shall survive termination of the Agreement.
g. United States Department of Health and Human Services. Business Associate shall make its internal practices, books and
records relating to the use and disclosure of PHI, and the security of Electronic PHI, available to the Secretary of the United
States Department of Health and Human Services (“HHS”) for purposes of determining Covered Entity’s compliance with
the HIPAA Privacy Regulations, the HIPAA Security Regulations, and the HITECH Standards after the compliance dates,
respectively, of these regulations and standards; provided, however, that Business Associate shall immediately notify
Covered Entity upon receipt by Business Associate of any such request for access by the Secretary of HHS, and shall provide
Covered Entity with a copy thereof as well as a copy of all materials disclosed pursuant thereto. The parties’ respective
rights and obligations under this Section 5(g) shall survive termination of the Agreement.
6.
Obligation to Provide Access, Amendment and Accounting of PHI.
a. Access to PHI. Business Associate shall make available to Covered Entity such information as Covered Entity may require
to fulfill Covered Entity’s obligations to provide access to, and copies of, PHI in accordance with HIPAA, the HIPAA Privacy
Regulations, and the HITECH Standards.
b. Amendment of PHI. Business Associate shall make available to Covered Entity such information as Covered Entity may
require to fulfill Covered Entity’s obligations to amend PHI in accordance with HIPAA, the HIPAA Privacy Regulations and the
HITECH Standards. In addition, Business Associate shall, as directed by Covered Entity, incorporate any amendments to
Covered Entity’s PHI into copies of such information maintained by Business Associate.
c. Accounting of Disclosures of PHI. Business Associate shall make available to Covered Entity such information as Covered
Entity may require to fulfill Covered Entity’s obligations to provide an accounting of disclosures with respect to PHI in
accordance with HIPAA, the HIPAA Privacy Regulations, and the HITECH Standards. Business Associate shall make this
information available to Covered Entity upon Covered Entity’s request.
d. Forwarding Requests From Individual. In the event that any individual requests access to, amendment of, or accounting
of PHI directly from Business Associate, Business Associate shall within two (2) days forward such request to Covered Entity.
Covered Entity shall have the responsibility of responding to forwarded requests. However, if forwarding the individual’s
request to Covered Entity would cause Covered Entity or Business Associate to violate HIPAA, the HIPAA Privacy
Regulations, or the HITECH Standards, Business Associate shall instead respond to the individual’s request as required by
such law and notify Covered Entity of such response as soon as practicable.
7.
Compliance with HITECH Standards. Notwithstanding any other provision in this Agreement, no later than
February 17, 2010, unless a separate effective date is specified by law or this Agreement for a particular requirement (in
which case the separate effective date shall be the effective date for that particular requirement), Business Associate shall
comply with the HITECH Standards, including, but not limited to: (i) compliance with the requirements regarding minimum
necessary under HITECH § 13405(b); (ii) requests for restrictions on use or disclosure to health plans for payment or health
care operations purposes when the provider has been paid out of pocket in full consistent with HITECH § 13405(a); (iii) the
prohibition of sale of PHI without authorization unless an exception under HITECH § 13405(d) applies; (iv) the prohibition
CommUnityCare RFP 1105-001
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on receiving remuneration for certain communications that fall within the exceptions to the definition of marketing under
45 C.F.R. § 164.501 unless permitted by this Agreement and Section 13406 of HITECH; (v) the requirements relating to the
provision of access to certain information in electronic access under HITECH § 13405(e); (vi) compliance with each of the
Standards and Implementation Specifications of 45 C.F.R. §§ 164.308 (Administrative Safeguards), 164.310 (Physical
Safeguards), 164.312 (Technical Safeguards) and 164.316 (Policies and Procedures and Documentation Requirements); and
(vii) the requirements regarding accounting of certain disclosures of PHI maintained in an Electronic Health Record under
HITECH § 13405(c).
8.
Material Breach, Enforcement and Termination.
a. Term. This Agreement shall be effective as of the Effective Date, and shall continue until the Agreement is terminated in
accordance with the provisions of Section 8(b) or the contractual relationship between the parties terminates.
b. Termination. Covered Entity may terminate this Agreement:
(1) immediately if Business Associate is named as a defendant in a criminal proceeding for a violation of HIPAA, the
HIPAA Privacy Regulations, the HIPAA Security Regulations, or the HITECH Standards;
(2) immediately if a finding or stipulation that Business Associate has violated any standard or requirement of
HIPAA, HITECH or other security or privacy laws is made in any administrative or civil proceeding in which Business
Associate has been joined; or
(3) pursuant to Sections 8(c) or 9(b) of this Agreement.
c. Remedies. If Covered Entity determines that Business Associate has breached or violated a material term of this
Agreement, Covered Entities may, at its option, pursue any and all of the following remedies:
(1) exercise any of its rights of access and inspection under Section 5(f) of this Agreement;
(2) take any other reasonable steps that Covered Entity, in its sole discretion, shall deem necessary to cure such
breach or end such violation; and/or
(3) terminate this Agreement immediately.
If Business Associate determines that Covered Entity has breached or violated a material term of this Agreement, Business
Associate may, at its option, pursue any and all of the following remedies:
(1) take any reasonable steps that Business Associate, in its sole discretion, shall deem necessary to cure such
breach or end such violation; and/or
(2) terminate this Agreement immediately.
d. Knowledge of Non-Compliance. Any non-compliance by Business Associate with this Agreement or with HIPAA, the HIPAA
Privacy Regulations, the HIPAA Security Regulations, or the HITECH Standards automatically will be considered a breach or
violation of a material term of this Agreement if Business Associate knew or reasonably should have known of such noncompliance and failed to immediately take reasonable steps to cure the non-compliance.
e. Reporting to United States Department of Health and Human Services. If Covered Entity’s efforts to cure any breach or
end any violation are unsuccessful, and if termination of this Agreement is not feasible, Covered Entity shall report Business
Associate’s breach or violation to the Secretary of HHS, and Business Associate agrees that it shall not have or make any
claim(s), whether at law, in equity, or under this Agreement, against Covered Entity with respect to such report(s). If
Business Associate’s efforts to cure any breach or end any violation are unsuccessful, and if termination of this Agreement
is not feasible, Business Associate shall report Covered Entity’s breach or violation to the Secretary of HHS, and Covered
Entity agrees that it shall not have or make any claim(s), whether at law, in equity, or under this Agreement, against
Business Associate with respect to such report(s)
f. Return or Destruction of Records. Upon termination of this Agreement for any reason, Business Associate shall return or
destroy all PHI; except that Business Associate may retain such records as necessary for purposes of their rights, if any, to
conduct audits related to such records, to utilize such records in connection with an audit of Business Associate, and/or to
CommUnityCare RFP 1105-001
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retain records in accordance with their records retention policies and/or obligations. If Business Associate retains such
records, it shall continue to extend the protections of this Agreement to such information and limit further use and
disclosure of such PHI.
g. Injunctions. Covered Entity and Business Associate agree that any violation of the provisions of this Agreement may cause
irreparable harm to Covered Entity. Accordingly, in addition to any other remedies available to Covered Entity at law, in
equity, or under this Agreement, in the event of any violation by Business Associate of any of the provisions of this
Agreement, or any explicit threat thereof, Covered Entity shall be entitled to an injunction or other decree of specific
performance with respect to such violation or explicit threat thereof, without any bond or other security being required and
without the necessity of demonstrating actual damages. The parties’ respective rights and obligations under this Section
8(g) shall survive termination of the Agreement.
h. Indemnification. Business Associate shall indemnify, hold harmless and defend Covered Entity from and against any and
all claims, losses, liabilities, costs and other expenses resulting from, or relating to, the acts or omissions of Business
Associate in connection with the representations, duties and obligations of Business Associate under this Agreement. The
parties’ respective rights and obligations under this Section 8(h) shall survive termination of the Agreement.
9.
Miscellaneous Terms.
a. State Law. Nothing in this Agreement shall be construed to require Business Associate to use or disclose PHI without a
written authorization from an individual who is a subject of the PHI, or written authorization from any other person, where
such authorization would be required under state law for such use or disclosure.
b. Amendment. Covered Entity and Business Associate agree that amendment of this Agreement may be required to ensure
that Covered Entity and Business Associate comply with changes in state and federal laws and regulations relating to the
privacy, security, and confidentiality of PHI, including, but not limited to, changes under the HIPAA Privacy Regulations, the
HIPAA Security Regulations, and the HITECH Standards. Covered Entity may terminate this Agreement upon 30 days written
notice in the event that Business Associate does not promptly enter into an amendment that Covered Entity, in its sole
discretion, deems sufficient to ensure that Covered Entity will be able to comply with such laws and regulations. This
Agreement may not otherwise be amended except by written agreement between both parties.
c. No Third Party Beneficiaries. Nothing express or implied in this Agreement is intended or shall be deemed to confer upon
any person other than Covered Entity and Business Associate, and their respective successors and assigns, any rights,
obligations, remedies or liabilities.
d. Ambiguities. The parties agree that any ambiguity in this Agreement shall be resolved in favor of a meaning that complies
and is consistent with applicable law protecting the privacy, security and confidentiality of PHI, including, but not limited to,
HIPAA, the HIPAA Privacy Regulations, the HIPAA Security Regulations, and the HITECH Standards.
e. Primacy. To the extent that any provisions of this Agreement conflict with the provisions of any other agreement or
understanding between the parties, this Agreement shall control with respect to the subject matter of this Agreement.
f. Ownership of PHI. As between Covered Entity and Business Associate, Covered Entity holds all right, title and interest in
and to any and all PHI received by Business Associate from, or created or received by Business Associate on behalf of,
Covered Entity, and Business Associate does not hold, and will not acquire by virtue of this Agreement or by virtue of
providing any services or goods to Covered Entity, any right, title or interest in or to such PHI or any portion thereof. Except
as specified in Section 3(c) above or as otherwise agreed to in writing by both parties, Business Associate shall have no right
to compile and/or distribute any statistical analysis or report utilizing such PHI, any aggregate information derived from
such PHI, or any other health and medical information obtained from Covered Entity.
IN WITNESS THEREROF, the parties hereto have duly executed this Agreement as of the Agreement Effective Date.
BUSINESS ASSOCIATE
_____________________________
Signature
_______________________________
Date
CommUnityCare RFP 1105-001
Page 51 of 58
Exhibit F:
Conflict of Interest Form
CommUnityCare STATEMENT OF DISCLOSURE OF CONFLICT OF INTERESTS
Name
Position/Title ------------------------------------------Date of Submission--------------------------------------Introduction and Purpose
This Statement of Disclosure shall be completed by:
• Each member of the governing body (Executive Committee Member or
Director) of CommUnityCare;
• Each member of a standing or ad hoc committee of a governing body of
CommUnityCare
• Each member of the medical staff of CommUnityCare
• Each officer of CommUnityCare (as well as persons with similar powers, responsibilities, or
positions);
• Each physician serving on a standing or ad hoc committee of CommUnityCare that had direct or
indirect responsibility for making recommendations which may impact purchasing decisions;
• Each Contractor providing goods and services to CommUnityCare or any of its departments; and
• Each employee of CommUnityCare designated by the President and Chief Executive Officer of
CommUnityCare or designated by the CommUnityCare Corporate Compliance Officer.
PLEASE COMPLETE FORM, SIGN AND RETURN TO:
Purchasing Division
CommUnityCare
15 Waller Street 5th Floor
Austin, TX 78702
Phone: 512-978-9059
Fax: 512-901-9707Questionnaire
Please answer the following questions to the best of your knowledge. Please print your responses and do
not leave any questions blank.
1) Do you, a member of your family, or an entity in which you hold an interest (other than an interest of 1%
or less in a publicly traded corporation), either own an interest in, or have an employment or other financial
arrangement with, any business or entity that conducts or seeks to conduct business or is or could be in
competition, directly or indirectly, with CommUnityCare?
Yes ( ) No ( ) If yes, describe: ----------------2) Have you, a member of your family, or an entity in which you hold an interest (other than an interest of
1% or less in a publicly traded corporation), received any compensation, whether it be salary, sales
commission, revenue, or return on investment, which was directly or indirectly derived as a result of
business with CommUnityCare (excluding your regular employee compensation from CommUnityCare)?
Yes ( ) No ( ) If yes, describe:
CommUnityCare RFP 1105-001
Page 52 of 58
3) Have you, a member of your family, or an entity in which you hold an interest (other than an interest
of 1% or less in a publicly traded corporation), received from any business, entity or other outside person
that conducts business with, seeks to do business with, or is or could be a competitor of CommUnityCare,
any one-time gift or favor in excess of Fifty Dollars ($50.00) in value, or multiple gifts or favors with a
cumulative value in excess of Two Hundred Fifty Dollars ($250.00) in a year? For this purpose, please list
vendor paid travel, gifts or other business courtesies with an aggregate value in excess of $250 per year.
Yes ( ) No ( ) If yes, describe:
_
4) Do you or a member of your family serve as a director, trustee, officer or in any other fiduciary or key
employee capacity for a non-[Company] corporation, partnership, or other business entity or organization
that conducts or seeks to conduct business or that is or could be in competition, directly or indirectly, with
[Company]?
Yes ( ) No () If yes, describe (including name of entity, title and nature of the entity's b u s i n e s s :
5) Are you, a member of your family, or an entity in which you hold an interest (other than an
interest of 1% or less in a publicly traded corporation), engaged in any other activities which could
be regarded as a potential conflict of interest with CommUnityCare?
Yes ( ) No ( ) If yes, describe:
_
6) To the best of your knowledge, did you or a member of your family, or an entity in which you hold an
interest (other than an interest of 1% or less in a publicly traded corporation), benefit during the fiscal
year, from any transaction involving CommUnityCare as a result of information or advice furnished by
you either directly or indirectly?
Yes ( ) No ( ) If yes, describe:
Signature Statement
I have read the CommUnityCare Conflict of Interest Policy, and I understand and acknowledge its
requirements. I agree to comply with the CommUnityCare Conflict of Interest Policy. I will deal honestly,
fairly and with integrity in all matters related to CommUnityCare and will not use my position or knowledge
gained to the detriment of CommUnityCare or to my personal benefit or the benefit of a member of my
family or an entity in which I hold an interest. I hereby agree to report immediately in writing to the
CommUnityCare Corporate Compliance Officer any new situation with the potential for a Conflict of Interest
which may develop before the completion of my next annual Statement of Disclosure. The answers above
are true and accurate to the best of my knowledge as of the date of this disclosure.
Name (please print or type)
Title:
Signature: Date:
CommUnityCare RFP 1105-001
Page 53 of 58
2011 DISCLOSURE FORM
ADDENDUM BUSINESS
COURTESIES/GIFTS
If you answered "yes" to question number 3 on the CommUnityCare 2011 Disclosure Form:
Please describe below any business curtsies or gifts (other than business meals) that you have
accepted from vendors, sales representatives, suppliers or other persons or entities who do
business with or seek to do business with CommUnityCare (or its subsidiaries). Include anything
received in the past 12 months.
You may estimate the date received and the value.
NAME:
_
Item
Cash: (Please list all payments and nature
of
payment ....such as
consultingfee,
Gift
certificateetc.)
or other cash
honorarium,
equivalent:
(Please list each item)
Tickets to sporting event: (please
describe
each type of event, #of ackets, etc.)
Other Vendor paid entertainment:
(please describe each event, #of
tickets,
Vendor etc.)
paid travel expenses: (please
Approx.
Date
Est.
Value
Name of Vendor/Sales Rep./Supplier, etc.
describe type of travel, pwy;ose, etc.
Other Vendor Gifts or Courtesies
(Please describe)
Signature
CommUnityCare RFP 1105-001
Date
Page 54 of 58
Exhibit G: Proposer Questionnaire
General Information:
Complete (Legal) Name of Proposer:
Proposer Tax Identification Number:
Business Address:
Telephone Number:
Type of Organization:
Individual
Partnership
Corporation
Association
Other (please describe)
If incorporated, state of incorporation:
Date organization was formed (month/year):
Describe Proposer’s organization/locations (include the physical address, size/services provided for headquarters
and any branch locations that will provide services/support outlined in this RFQ):
Please certify the following by placing an “X” in the appropriate column:
Certification
Yes
No
Is Proposer currently in the process of filing for bankruptcy?
Has Proposer filed for bankruptcy within the past five (5) years?
Does the Proposer owe taxes to the Travis County Healthcare District?
Is the Proposer currently under suspension or debarment as defined under 15 C.F.R. Part 26 by
any governmental entity (local/state/federal government)?
Do you acknowledge that if the Proposer is currently under suspension or debarment, its
submission may not be considered?
Individual authorized to bind Proposer to contract:
Name/Title:
Telephone:
E-Mail:
Signature: ___________________________________________________________________________________
Point-of-contact information for this solicitation (if different from authorized individual):
Name/Title:
Telephone:
E-Mail:
Proposer HUB Declaration – This is not a prequalification, but can be used as a tiebreaker for the evaluation
phase.
Is your Proposer certified as a HUB or an MBE/WBE/DBE source?
If yes, please attach your HUB certification.
Yes
Contract Terms and Conditions
CommUnityCare RFP 1105-001
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No
The contract terms and conditions identified in the RFP will form part of the contract resulting from this RFP.
Please identify whether there are any requested exceptions or deviations to the stated contract terms and
conditions.
I do not request any exceptions or deviations to the stated contract terms.
I request the following exceptions or deviations to the stated contract terms.
Business Associate Agreement
The Business Associate Agreement identified in the RFP will form part of the contract resulting from this RFP.
Please identify whether there are any requested exceptions or deviations to the stated Business Associate
Agreement.
I do not request any exceptions or deviations to the stated contract terms.
I request the following exceptions or deviations to the stated contract terms.
Insurance:
Do you have the types and limits of insurance described in the RFP?
Yes
No
Past Performance Client Survey Information: Past performance information will be collected on all Proposers.
Proposers are required to identify and submit at least three (3) of their best projects. Proposers will be required to
send out Performance Evaluation Surveys to each of their clients.
Please provide your client with the Performance Evaluation Letter and Survey attached herein (pages 60 and 61),
and request that your client submit the completed survey to Purchasing Division, at (Fax) 512-978-9001 or (e-mail)
purchasing@communitycaretx.org.
Proposers are solely responsible for making sure their clients return the Performance Evaluation Surveys to
CommUnityCare. CommUnityCare reserves the right to verify any information submitted in this process. Such
verification may include, but is not limited to, speaking with current and former clients, review of relevant client
documentation, site-visitation, and other independent confirmation of data.
CommUnityCare WILL NOT ACCEPT CLIENT SURVEYS SENT TO THE PROCUREMENT DIVISION FROM THE
OFFICE OF THE PROPOSER. SURVEYS MUST BE SENT TO THE PROCUREMENT DIVISION DIRECTLY FROM
YOUR CLIENT’S OFFICE(S).
CommUnityCare RFP 1105-001
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REQUEST FOR PROPOSALS 1105-002
REFERENCE LABORATORY AND PHLEBOTOMY SERVICES
2028 E. Ben White Blvd. Suite 400 Austin TX 78741
Purchasing@communitycaretx.org
PRIOR PERFORMANCE EVALUATION
To:
Phone:
Fax:
E-mail:
Subject: Performance Evaluation of _____________________________________
Number of pages including cover: 2
To Whom It May Concern:
CommUnityCare has implemented a process that collects past performance information pursuant to the
submittal of responses to this Request for Proposal (RFP) No. 1105-002 entitled “REFERENCE
LABORATORY AND PHLEBOTOMY SERVICES”. The information will be used to assist CommUnityCare in
the evaluation of proposals received in response to the RFP.
The company listed in the subject line has chosen to participate in this RFP. They have listed you as a
past client for which they have provided services. Both the company and CommUnityCare would greatly
appreciate you taking a few minutes of your time to complete the accompanying questionnaire.
Please review all items in the following document and answer the questions to the best of your
knowledge. If you cannot answer a particular question, please leave it blank. Please return this
questionnaire to Karen Bitzer by July 1, 2011 via fax: 512-901-9707; or e-mail
purchasing@communitycaretx.org.
Thank you for your time and effort,
Karen Bitzer MPA MA
Purchasing Manager
CommUnityCare
15 Waller St. 5th Floor
Austin, TX 78702
512-978-9061 office
512-978-9001 fax
www.CommUnityCaretx.org
CommUnityCare RFP 1105-001
Page 57 of 58
REQUEST FOR PROPOSALS 1105-002
REFERENCE LABORATORY AND PHLEBOTOMY SERVICES
2028 E. Ben White Blvd. Suite 400 Austin TX 78741
Purchasing@communitycaretx.org
PRIOR PERFORMANCE EVALUATION
Reference Name/Title:
Company Name:
Contact Phone:
Contact Email:
Project Information
Reference Rating Questions:
On a scale of 1 to 10, with 10 being completely satisfied and 1 being completely unsatisfied, how would you
rate the following?
Item
They were successful in meeting my performance
requirements.
How would you rate the Proposer’s quality or work?
How would you rate the Proposer’s overall service
quality?
How would you rate the Proposer’s cost for services
provided?
How would you rate your satisfaction with the
Proposer’s response when issues or problems
associated with the work were identified?
1 - 10
N/A
Item
Would you recommend them to us?
Yes
No
Is there anything else that comes to mind that you think would be helpful to the team evaluating the proposal
such as complaints, problems, or favorable performance?
When completed, please fax to 512-901-9707 or email to purchasing@communitycaretx.org.
CommUnityCare RFP 1105-001
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