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Deliverable Number
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Commodity/Service Type
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Major Deliverable
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Method of Payment
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4.a.1
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Traditional healthcare services
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Deliverable a. Service Units a. A unit of service is defined as one month of service delivery as des...
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Fixed Fee / Unit Rate
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| Major Deliverable: Deliverable a. Service Units a. A unit of service is defined as one month of service delivery as described. |
| Deliverable Price: $64,092.74 |
| Non Price Justification: |
| Performance Metrics: As evidenced by the monthly invoice and the monthly employee time report. |
| Financial Consequences: 1) In the event staffing levels (5.0 FTE APP’s) are not met, the Department shall deduct a minimum of $500.00 per incident from the monthly invoice amount, this would include TGH staff not attending the clinic with less than 24 hours notice, excluding approved time off, sick leave and family emergency requests (personal and family related).
2) In the event TGH Staff refuse to perform the service to be provided the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
3) In the event EARs or service collection tools are not completed on time the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
4) TGH Staff vacancies: The Department will not reimburse for any TGH staff vacancies upon the date of vacancy. Provider will deduct actual cost of salary and deduct from monthly invoice.
5) If any TGH Staff, tenders their resignation less than one calendar year after returning from training funded by DOH-Hillsborough, the Department shall deduct the total funding provided by the Department for that TGH staff training from the next monthly invoice.
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| Source Documentation Page Reference: 15 |
| Deliverable Number: 4.a.1 |
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4.b.1.
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Traditional healthcare services
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TGH staff shall provide the contract manager, not later than the 15th of each month for the month p...
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Fixed Fee / Unit Rate
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| Major Deliverable: TGH staff shall provide the contract manager, not later than the 15th of each month for the month prior, the EAR for each provider staff and the monthly activity report (See Exhibit Sample). The EAR documentation will demonstrate staffing services (including leave time) were documented and provided. |
| Deliverable Price: $64,092.74 |
| Non Price Justification: |
| Performance Metrics: As evidence by the monthly employee time report (ETR) |
| Financial Consequences: 1) In the event staffing levels (5.0 FTE APP’s) are not met, the Department shall deduct a minimum of $500.00 per incident from the monthly invoice amount, this would include TGH staff not attending the clinic with less than 24 hours notice, excluding approved time off, sick leave and family emergency requests (personal and family related).
2) In the event TGH Staff refuse to perform the service to be provided the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
3) In the event EARs or service collection tools are not completed on time the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
4) TGH Staff vacancies: The Department will not reimburse for any TGH staff vacancies upon the date of vacancy. Provider will deduct actual cost of salary and deduct from monthly invoice.
5) If any TGH Staff, tenders their resignation less than one calendar year after returning from training funded by DOH-Hillsborough, the Department shall deduct the total funding provided by the Department for that TGH staff training from the next monthly invoice. |
| Source Documentation Page Reference: 16 |
| Deliverable Number: 4.b.1. |
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4.b.2.
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Traditional healthcare services
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Provider will provide a monthly invoice and supporting documentation for service provided, including...
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Fixed Fee / Unit Rate
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| Major Deliverable: Provider will provide a monthly invoice and supporting documentation for service provided, including quality improvement projects, research projects, student preceptor projects initiated or completed during the month and any other pertinent activities related to the scope of this contract. |
| Deliverable Price: $64,092.74 |
| Non Price Justification: |
| Performance Metrics: As evidenced by the monthly activity report (MAR) |
| Financial Consequences: 1) In the event staffing levels (5.0 FTE APP’s) are not met, the Department shall deduct a minimum of $500.00 per incident from the monthly invoice amount, this would include TGH staff not attending the clinic with less than 24 hours notice, excluding approved time off, sick leave and family emergency requests (personal and family related).
2) In the event TGH Staff refuse to perform the service to be provided the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
3) In the event EARs or service collection tools are not completed on time the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
4) TGH Staff vacancies: The Department will not reimburse for any TGH staff vacancies upon the date of vacancy. Provider will deduct actual cost of salary and deduct from monthly invoice.
5) If any TGH Staff, tenders their resignation less than one calendar year after returning from training funded by DOH-Hillsborough, the Department shall deduct the total funding provided by the Department for that TGH staff training from the next monthly invoice.
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| Source Documentation Page Reference: 16 |
| Deliverable Number: 4.b.2. |
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4.c.1.
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Traditional healthcare services
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TGH will document in the client medical records (electronically or paper based) and complete other n...
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Fixed Fee / Unit Rate
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| Major Deliverable: TGH will document in the client medical records (electronically or paper based) and complete other necessary documents in accordance with the rules and regulations of the Department. The approved electronic medical record for the Florida Department of Health is HMS (Health Management System) |
| Deliverable Price: $64,092.74 |
| Non Price Justification: |
| Performance Metrics: As evidenced by review of the Health Management System (HMS) |
| Financial Consequences: 1) In the event staffing levels (5.0 FTE APP’s) are not met, the Department shall deduct a minimum of $500.00 per incident from the monthly invoice amount, this would include TGH staff not attending the clinic with less than 24 hours notice, excluding approved time off, sick leave and family emergency requests (personal and family related).
2) In the event TGH Staff refuse to perform the service to be provided the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
3) In the event EARs or service collection tools are not completed on time the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
4) TGH Staff vacancies: The Department will not reimburse for any TGH staff vacancies upon the date of vacancy. Provider will deduct actual cost of salary and deduct from monthly invoice.
5) If any TGH Staff, tenders their resignation less than one calendar year after returning from training funded by DOH-Hillsborough, the Department shall deduct the total funding provided by the Department for that TGH staff training from the next monthly invoice.
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| Source Documentation Page Reference: 16 |
| Deliverable Number: 4.c.1. |
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B.1.a.1
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Traditional healthcare services
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Provider will be responsible for the specific qualifications of the APP furnished through this contr...
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Fixed Fee / Unit Rate
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| Major Deliverable: Provider will be responsible for the specific qualifications of the APP furnished through this contract. |
| Deliverable Price: $64,092.74 |
| Non Price Justification: |
| Performance Metrics: To be verified at the time of employment offered by the Department. |
| Financial Consequences: 1) In the event staffing levels (5.0 FTE APP’s) are not met, the Department shall deduct a minimum of $500.00 per incident from the monthly invoice amount, this would include TGH staff not attending the clinic with less than 24 hours notice, excluding approved time off, sick leave and family emergency requests (personal and family related).
2) In the event TGH Staff refuse to perform the service to be provided the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
3) In the event EARs or service collection tools are not completed on time the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
4) TGH Staff vacancies: The Department will not reimburse for any TGH staff vacancies upon the date of vacancy. Provider will deduct actual cost of salary and deduct from monthly invoice.
5) If any TGH Staff, tenders their resignation less than one calendar year after returning from training funded by DOH-Hillsborough, the Department shall deduct the total funding provided by the Department for that TGH staff training from the next monthly invoice.
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| Source Documentation Page Reference: 14 |
| Deliverable Number: B.1.a.1 |
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B.1.a.2
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Traditional healthcare services
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The TGH staff will provide diagnosis and treatment services to clients of the DOH-Hillsborough progr...
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Fixed Fee / Unit Rate
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| Major Deliverable: The TGH staff will provide diagnosis and treatment services to clients of the DOH-Hillsborough programs. Medical care will include communicable disease medical care and primary care of clients where the DOH-Hillsborough has been identified as primary care Provider. |
| Deliverable Price: $64,092.74 |
| Non Price Justification: |
| Performance Metrics: As evidenced by documentation contained in the Health Management System (HMS) |
| Financial Consequences: 1) In the event staffing levels (5.0 FTE APP’s) are not met, the Department shall deduct a minimum of $500.00 per incident from the monthly invoice amount, this would include TGH staff not attending the clinic with less than 24 hours notice, excluding approved time off, sick leave and family emergency requests (personal and family related).
2) In the event TGH Staff refuse to perform the service to be provided the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
3) In the event EARs or service collection tools are not completed on time the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
4) TGH Staff vacancies: The Department will not reimburse for any TGH staff vacancies upon the date of vacancy. Provider will deduct actual cost of salary and deduct from monthly invoice.
5) If any TGH Staff, tenders their resignation less than one calendar year after returning from training funded by DOH-Hillsborough, the Department shall deduct the total funding provided by the Department for that TGH staff training from the next monthly invoice.
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| Source Documentation Page Reference: 14 |
| Deliverable Number: B.1.a.2 |
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B.1.a.3
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Traditional healthcare services
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The Provider shall provide 5.0 FTE APP (with one of the APP’s serving as administrative lead) Monday...
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Fixed Fee / Unit Rate
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| Major Deliverable: The Provider shall provide 5.0 FTE APP (with one of the APP’s serving as administrative lead) Monday through Friday from 7:00am to 5:00pm for clinic coverage during standard clinic hours. Clinical coverage shall mean rendering appropriate medical care, including but not limited to the Health Management System (HMS) at the DOH-Hillsborough programs for a total of 251 days per calendar year. Standard clinic hours are defined as Monday through Friday 7:00am – 5:00pm and shall exclude official State holidays. Provider will communicate TGH staff leave requests to the contract manager. |
| Deliverable Price: $64,092.74 |
| Non Price Justification: |
| Performance Metrics: Identified upon selection of lead individual. |
| Financial Consequences: 1) In the event staffing levels (5.0 FTE APP’s) are not met, the Department shall deduct a minimum of $500.00 per incident from the monthly invoice amount, this would include TGH staff not attending the clinic with less than 24 hours notice, excluding approved time off, sick leave and family emergency requests (personal and family related).
2) In the event TGH Staff refuse to perform the service to be provided the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
3) In the event EARs or service collection tools are not completed on time the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
4) TGH Staff vacancies: The Department will not reimburse for any TGH staff vacancies upon the date of vacancy. Provider will deduct actual cost of salary and deduct from monthly invoice.
5) If any TGH Staff, tenders their resignation less than one calendar year after returning from training funded by DOH-Hillsborough, the Department shall deduct the total funding provided by the Department for that TGH staff training from the next monthly invoice.
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| Source Documentation Page Reference: 14 |
| Deliverable Number: B.1.a.3 |
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B.1.a.4
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Traditional healthcare services
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Recruitment for vacant positions will be a joint effort between TGH and the Department. TGH will po...
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Fixed Fee / Unit Rate
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| Major Deliverable: Recruitment for vacant positions will be a joint effort between TGH and the Department. TGH will post and advertise for vacant position and the Department will interview and select candidates. Selected candidates will further be screened by TGH staff and on-boarded accordingly. |
| Deliverable Price: $64,092.74 |
| Non Price Justification: |
| Performance Metrics: As evidenced through the recruitment process. |
| Financial Consequences: 1) In the event staffing levels (5.0 FTE APP’s) are not met, the Department shall deduct a minimum of $500.00 per incident from the monthly invoice amount, this would include TGH staff not attending the clinic with less than 24 hours notice, excluding approved time off, sick leave and family emergency requests (personal and family related).
2) In the event TGH Staff refuse to perform the service to be provided the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
3) In the event EARs or service collection tools are not completed on time the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
4) TGH Staff vacancies: The Department will not reimburse for any TGH staff vacancies upon the date of vacancy. Provider will deduct actual cost of salary and deduct from monthly invoice.
5) If any TGH Staff, tenders their resignation less than one calendar year after returning from training funded by DOH-Hillsborough, the Department shall deduct the total funding provided by the Department for that TGH staff training from the next monthly invoice.
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| Source Documentation Page Reference: 14 |
| Deliverable Number: B.1.a.4 |
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B.1.a.5
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Traditional healthcare services
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APP staff leave and training time will be requested at least 5 days in advance and maintained on the...
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Fixed Fee / Unit Rate
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| Major Deliverable: APP staff leave and training time will be requested at least 5 days in advance and maintained on the SCC calendar
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| Deliverable Price: $64,092.74 |
| Non Price Justification: |
| Performance Metrics: Leave requests will be via e-mail. |
| Financial Consequences: 1) In the event staffing levels (5.0 FTE APP’s) are not met, the Department shall deduct a minimum of $500.00 per incident from the monthly invoice amount, this would include TGH staff not attending the clinic with less than 24 hours notice, excluding approved time off, sick leave and family emergency requests (personal and family related).
2) In the event TGH Staff refuse to perform the service to be provided the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
3) In the event EARs or service collection tools are not completed on time the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
4) TGH Staff vacancies: The Department will not reimburse for any TGH staff vacancies upon the date of vacancy. Provider will deduct actual cost of salary and deduct from monthly invoice.
5) If any TGH Staff, tenders their resignation less than one calendar year after returning from training funded by DOH-Hillsborough, the Department shall deduct the total funding provided by the Department for that TGH staff training from the next monthly invoice. |
| Source Documentation Page Reference: 14 |
| Deliverable Number: B.1.a.5 |
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B.1.a.6
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Traditional healthcare services
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Admission to the hospital will be coordinated through the DOH-Hillsborough University of South Flori...
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Fixed Fee / Unit Rate
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| Major Deliverable: Admission to the hospital will be coordinated through the DOH-Hillsborough University of South Florida (USF) Contract to ensure continuity of care. |
| Deliverable Price: $64,092.74 |
| Non Price Justification: |
| Performance Metrics: N/A |
| Financial Consequences: 1) In the event staffing levels (5.0 FTE APP’s) are not met, the Department shall deduct a minimum of $500.00 per incident from the monthly invoice amount, this would include TGH staff not attending the clinic with less than 24 hours notice, excluding approved time off, sick leave and family emergency requests (personal and family related).
2) In the event TGH Staff refuse to perform the service to be provided the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
3) In the event EARs or service collection tools are not completed on time the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
4) TGH Staff vacancies: The Department will not reimburse for any TGH staff vacancies upon the date of vacancy. Provider will deduct actual cost of salary and deduct from monthly invoice.
5) If any TGH Staff, tenders their resignation less than one calendar year after returning from training funded by DOH-Hillsborough, the Department shall deduct the total funding provided by the Department for that TGH staff training from the next monthly invoice.
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| Source Documentation Page Reference: 14 |
| Deliverable Number: B.1.a.6 |
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B.1.a.7
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Traditional healthcare services
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Completion of all state approved forms to include but not limited to EARs, superbill and other servi...
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Fixed Fee / Unit Rate
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| Major Deliverable: Completion of all state approved forms to include but not limited to EARs, superbill and other service collection tools. |
| Deliverable Price: $64,092.74 |
| Non Price Justification: |
| Performance Metrics: Through completion of monthly employee time reports and service collection tools. |
| Financial Consequences: 1) In the event staffing levels (5.0 FTE APP’s) are not met, the Department shall deduct a minimum of $500.00 per incident from the monthly invoice amount, this would include TGH staff not attending the clinic with less than 24 hours notice, excluding approved time off, sick leave and family emergency requests (personal and family related).
2) In the event TGH Staff refuse to perform the service to be provided the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
3) In the event EARs or service collection tools are not completed on time the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
4) TGH Staff vacancies: The Department will not reimburse for any TGH staff vacancies upon the date of vacancy. Provider will deduct actual cost of salary and deduct from monthly invoice.
5) If any TGH Staff, tenders their resignation less than one calendar year after returning from training funded by DOH-Hillsborough, the Department shall deduct the total funding provided by the Department for that TGH staff training from the next monthly invoice.
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| Source Documentation Page Reference: 14 |
| Deliverable Number: B.1.a.7 |
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B.1.a.7
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Traditional healthcare services
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Completion of all state approved forms to include but not limited to EARs, superbill and other servi...
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Fixed Fee / Unit Rate
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| Major Deliverable: Completion of all state approved forms to include but not limited to EARs, superbill and other service collection tools. |
| Deliverable Price: $64,092.74 |
| Non Price Justification: |
| Performance Metrics: Through completion of monthly employee time reports and service collection tools. |
| Financial Consequences: 1) In the event staffing levels (5.0 FTE APP’s) are not met, the Department shall deduct a minimum of $500.00 per incident from the monthly invoice amount, this would include TGH staff not attending the clinic with less than 24 hours notice, excluding approved time off, sick leave and family emergency requests (personal and family related).
2) In the event TGH Staff refuse to perform the service to be provided the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
3) In the event EARs or service collection tools are not completed on time the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
4) TGH Staff vacancies: The Department will not reimburse for any TGH staff vacancies upon the date of vacancy. Provider will deduct actual cost of salary and deduct from monthly invoice.
5) If any TGH Staff, tenders their resignation less than one calendar year after returning from training funded by DOH-Hillsborough, the Department shall deduct the total funding provided by the Department for that TGH staff training from the next monthly invoice.
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| Source Documentation Page Reference: 14 |
| Deliverable Number: B.1.a.7 |
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B.1.b.
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Traditional healthcare services
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All services will be provided at the DOH-Hillsborough designated facilities/locations.
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Fixed Fee / Unit Rate
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| Major Deliverable: All services will be provided at the DOH-Hillsborough designated facilities/locations. |
| Deliverable Price: $64,092.74 |
| Non Price Justification: |
| Performance Metrics: N/A |
| Financial Consequences: 1) In the event staffing levels (5.0 FTE APP’s) are not met, the Department shall deduct a minimum of $500.00 per incident from the monthly invoice amount, this would include TGH staff not attending the clinic with less than 24 hours notice, excluding approved time off, sick leave and family emergency requests (personal and family related).
2) In the event TGH Staff refuse to perform the service to be provided the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
3) In the event EARs or service collection tools are not completed on time the Department shall deduct a minimum of $100.00 per incident from the monthly invoice amount.
4) TGH Staff vacancies: The Department will not reimburse for any TGH staff vacancies upon the date of vacancy. Provider will deduct actual cost of salary and deduct from monthly invoice.
5) If any TGH Staff, tenders their resignation less than one calendar year after returning from training funded by DOH-Hillsborough, the Department shall deduct the total funding provided by the Department for that TGH staff training from the next monthly invoice.
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| Source Documentation Page Reference: 14 |
| Deliverable Number: B.1.b. |
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