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Docusign Envelope lDi 1D7E1DA7 4976-488D-9EFo-BEDFgFE584EB <br />review local needs, utilization, and review the desk manualthat outlines the ABCD contractual <br />deliverables and how the Contractor has met or plans to meet those deliverables' <br />E. euarterly, the Contractor must submit a fully completed invoice that correlates with dollar values for <br />completed deliverables outlined in Attachment 2 that includes the following: <br />i. Exhibit templates, which are available on the ABCD website http://abcd-dental'orq/for- <br />coordinators/; <br />ii. Each report must document the status of the SMART goals from the ABCD Action Plan <br />(Attachment 5), detailing specific achievements or ongoing effort; and <br />iii. Reports and billing must be submitted no later than one (1) month after each quarter end <br />date, unless otherwise mutually agreed by both parties' <br />3. Acceptance Criteria <br />i. Contractor may invoice for the deliverables listed below on completion of each <br />deliverable. HCA has the right to withhold payment if the Contractor fails to meet <br />deliverables standards. <br />a. HCA will consider the ABCD Yearty Budget Iool (Attachment 4) complete once HCA <br />confirms receipt of the report containing all required and relevant information. <br />b. HCA will consider the quarterly Community and Provider Outreach and Coordination <br />Care summary to be complete once HCA confirms receipt of the report containing the <br />ABCD euarlerly Community and Provider Outreach and Case Management Repoft <br />(Attachment 2) for the specific quarter; and the ABCD Quartely Outreach and <br />Coordination of Care Report (Attachment 3)' <br />c. HCA will consider the yearly ABCD Action Ptan (Attachment 5) complete once HCA <br />has confirmed receipt of the report containing all required and relevant information <br />completed to HCA reasonable satisfaction' <br />4. Invoicing Schedule <br />The lnvoicing pricing Table below is for FY27 and FY28, and prior fiscal year invoicing schedules are <br />referenced in the prior Contract #K746L Contractor shall invoice HCA once a quarter at the end of each <br />quarter for the amounts listed in the table below: <br />Deliverable Date Due to HGA lnvoice Amount SFY27 lnvoice Amount SFY28 <br />October- Decsmber <br />$1,000.00$1,000.0031-OctCoordinatorAttendance <br />$1,298.00$1,298.00Outreach ReportComm <br />$324.00$324.00Coordinate Care for Patients <br />$500.00$500.00Coalition/Steering Committee Tasks <br />$3,122.00$3,122.0{lJuly - September Total <br />HCA Contract No. K7461-2 PageT of 14