COMMISSIONER OF ADMINISTRATION As delegated to Office of State Procurement Print Name: Xxxxxx Xxxxxxxxx Signature: Original signed Title: AMS Date: 8/3/2017 Attachment A – Work Plan Contractor shall hire, train, and make available qualified personnel to perform and administer vocational rehabilitation services. Contractor shall conduct background checks using primary sources on all personnel authorized to provide direct services or transport persons served under this contract. When transportation is provided for persons served under this contract, Contractor shall maintain current records of driving licenses and satisfactory driving history of drivers. Contractor shall provide for the integrity and security of its information assets including, but not limited to, each automated system, electronic file, database or paper file, by establishing appropriate internal policies and procedures for preserving the integrity and security of the personal information of individuals served. Contractor shall work collaboratively as part of the team with VRS staff in providing services that are part of the person’s served Employment Plan. Contractor shall develop and share detailed written information outlining the procedure for notifying VRS and the person or their guardian regarding their acceptance for services listed in Attachment B, Fee-for-Service Rate Schedule. The written information, at a minimum, should include: (a) start date notification, (b) intake process and location, (c) orientation to the Contractor, (d) service planning and delivery, (e) monitoring of service provided, (f) communication and progress reports, (g) service exit or termination. Contractor shall provide the most effective mode(s) of communication to all populations without charge to VRS or persons served. Contractor shall provide Interpreter services for all services in Attachment B, Fee-for-Service Rate Schedule, and Performance Based Agreement (PBA) for Placement and Retention Services as referenced at xxxxx://xx.xxx/deed/job- seekers/disabilities/partners/. Contractor is responsible for all necessary interpreting costs. Contractors need to notify VRS on the same day that the scheduled service(s) is cancelled in order to receive the cancellation fee. Documentation (phone calls, emails, report writing, case notes) time is built into the fee structure and rates, therefore is not billable. VRS expects all documentation be provided in accessible format whenever possible. Attachment B-1 – Fee-for-Service Rate Schedule Contractor: Allina Health dba Courage Xxxxxx Rehabilitation Institute SWIFT Vendor Number: 0000000000 Referral Contact(s) and phone number(s): Xxxxxxxx Xxx (Vocational Services): 000-000-0000 Xxxx Xxxxxxx (Vocational Services): 000-000-0000 Driver Assessment and Training: 000-000-0000(phone)/000-000-0000(fax) Effective Date: 10/19/2018 Service Title Fee Unit Placement and Retention Services under a Performance Based Agreement (PBA) See Performance Based Agreement (PBA) for Placement and Retention Services as referenced at xxxxx://xx.xxx/deed/job- seekers/disabilities/partners/ Yes No Occupational Communication Specialist Services (OCSS) Differential for PBA $400 Each Cancellation Fee $100 Day, if notified less than 2 business days prior to appointment for Rehabilitation Technology Assessments/training or Vocational Evaluation appointment $150 Day, if notified less than 4 business days prior to Work Evaluation appointment $100 Fee, if notified less than 1 business day prior to Post Secondary Navigation of Career Navigation appointment Service Title Fee Unit Employment Supports/Job Coaching for Short Term Job Supports $75 Hour Informational Interviews $100 Hour Intake (Not Applicable to PBA) $85 Each Intake – Extended Employment $85 Each Job Seeking Skills Training $600 Each On-the-Job Evaluation $120 Hour Postsecondary Supports (Remedial Training or Services) $120 Hour Work/Vocational Evaluation $400 Day $100 Each Staffing $2,500 Each 4 week in house work evaluation $1,000 Cancellation fee through 1st week of Service $1,500 Cancellation fee through 2nd week of Service $2,000 Cancellation fee through 3rd week of Service $120 Hour $80 Hour Vocational Evaluation $500 Day of Vocational Evaluation (off site, 7 county metro area) Driver and assessment training services have fees that are negotiated for each year of the contract and are set forth in a separate fee schedule below: Service Title Fee: 2018 Fee: 2019 Fee: 2020 Fee: 2021 Fee: 2022 Unit Rehabilitation (Assistive) Technology Assessments $400 $400 $400 $400 $400 Day $150 $150 $150 $150 $150 Per Hour of Consultation Driver Comprehensive Evaluation $426 $439 $452 $466 $479 Each Sedan Evaluation $559 $576 $593 $611 $629 Each Van Evaluation Post Vehicle Equipment Assessment $331 $341 $351 $362 $373 Each Post Vehicle Modification Assessment $404 $416 $428 $442 $454 Each: 2 Hour Sedan Lesson $560 $576 $594 $612 $630 Each: 2 Hour Van Lesson Rehabilitation (Assistive) Technology Training $100 $100 $100 $100 $100 Per Hour $150 $150 $150 $150 $150 Per Hour if Community Based $202 $208 $214 $221 $227 Per Hour for Sedan Lesson $280 $288 $297 $306 $315 Per Hour for Van Lesson State Road Test $404 $416 $428 $442 $454 Each: 2 Hour Sedan Lesson $560 $576 $594 $612 $630 Each: 2 Hour Van Lesson Attachment B – Fee-for-Service Rate Schedule Contractor: Allina Health Systems dba Sister Xxxxx Rehabilitation Institute SWIFT #:0000000000 Referral Contact(s) and phone number(s): Intake Coordinator: Xxxxxxxx Xxx, 000-000-0000 Supervisor: Xxxx Xxxxxxx, 000-000-0000 Effective Date: 8/3/2017 Service Title Fee Unit Placement and Retention Services under a Performance Based Agreement (PBA) See PerformancEe Based Agrexement (PpBA) for Pliacemrent aend Retention Services as referenced at xxxxx://xx.xxx/deed/job- seekers/disabilities/partners/ Yes No d Service Title Fee Unit Cancellation Fee Expire $100 $150 $100 d Day, if notified less than 2 business days prior to appointment for Rehabilitation Technology Assessments or Vocational Evaluation appointment Day, if notified less than 4 business days prior to Work Evaluation appointment Fee, if notified less than 1 business day prior to Postsecondary Navigation or Career Navigation appointment Employment Supports/Job Coaching for Short Term Job Supports $75 Hour Informational Interviews (Transition/Youth Pre-ETS) $100 Hour Intake (Not Applicable to PBA) $85 Client Intake – Extended Employment $85 Client Job Seeking Skills Training $600 Each On-the-Job Evaluation $120 Hour Postsecondary Supports (Remedial Training or Services) $120 Hour Rehabilitation (Assistive) Technology Assessments $400 $150 Day Hour of consultation Rehabilitation (Assistive) Technology Training $100 $150 Hour Hour in community Service Title Fee Unit Work/Vocational Evaluation Expire $400 $100 $2,500 $1,000 $1,500 $2,000 $120 d$80 $500 Day Staffing - Each 4 weeks, in-house work evaluation Cancellation fee through 1st week of service Cancellation fee through 2nd week of service Cancellation fee through 3rd week of service Hour of Career Navigation Hour of Vocational Evaluation Day of Vocational Evaluation (off site, 7 county metro area) Attachment C
