Program/Project Name: Supplemental Security Income (SSI) Representation Services

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2 Program/Project Name: Supplemental Security Income (SSI) Representation Services 1. TERM This Agreement is effective February 4, 2014 between COUNTY and CONTRACTOR and shall remain in effect until January 31, 2016, unless terminated earlier or otherwise amended. Delegation of authority expires on January 31, SCOPE OF SERVICES CONTRACTOR shall provide a licensed attorney with five (5) years experience in SSI/SSDI representation to oversee the services. All support staff providing services under this RFQ must have a minimum of two (2) years of experience in SSI/SSDI representation and must be supervised by the licensed attorney. A. CONTRACTOR shall have convenient hours at local office. B. CONTRACTOR shall be able to meet at a client s home, if a client is physically unable to travel. C. CONTRACTOR shall accept all SSI/SSDI Advocacy referrals from the COUNTY. D. CONTRACTOR shall maintain a copy of the completed referrals. E. There is no guarantee of a minimum or maximum number of referrals from the COUNTY. F. CONTRACTOR shall maintain monthly contact with active clients after the SSI/SSDI application is submitted and is pending to: I. Monitor client attendance at required psychiatric, medical or Disability Determination Services Division (DDSD) appointments, and II. Determine if the client has received notification of the SSI/SSDI claim determination. G. CONTRACTOR shall schedule a thirty (30) minute interview with each client referred within seven (7) workdays of receiving the completed referral from the COUNTY. The interview will be for completion of the initial SSI/SSDI application forms. H. CONTRACTOR shall document, notify the COUNTY, and discontinue services; if it is determined the client does not appear to have a qualifying disability based on client s self-declaration or CONTRACTORS s evaluation. I. All attempts to contact the client must be documented. J. After three (3) attempts to contact the client have failed, CONTRACTOR shall notify COUNTY Representative of inability to contact client. K. Failure of the client to cooperate with the CONTRACTOR must be documented. L. CONTRACTOR will contact COUNTY after first non-cooperation incident for COUNTY follow-up. M. COUNTY will notify client of cooperation requirements and follow appropriate denial/discontinuance procedures unless client agrees to cooperate immediately and fully with CONTRACTOR. Page 2 of 8

3 N. When appropriate and if necessary, CONTRACTOR shall request records of medical history upon receipt of SSI/SSDI Advocacy Referral. If no medical or psychiatric report exists, CONTRACTOR will in its discretion obtain medical or psychiatric evaluation. O. CONTRACTOR shall assist the client in filing for reconsideration within thirty (30) calendar days when the initial application is denied. P. CONTRACTOR shall be available to represent the client in the appeal process when requested by the client. Q. CONTRACTOR shall make available to the COUNTY, upon request, all records, including client files, relevant to the SSI/SSDI application and advocacy process. R. COUNTY maintains the option to modify the Scope of Services at any time as needed. S. COUNTY will provide CONTRACTOR with an EXCEL spreadsheet. CONTRACTOR will maintain and update the status on all clients referred. The spreadsheet will need to be provided to the COUNTY on a quarterly basis based on the schedule below and will including the following data: I. New Number of Current Referrals II. New Number of initial SSI/SSDI applications completed and filed to date III. Number of Reconsideration filings completed to date IV. Number of Appeal hearing filings completed to date V. Number of Appeal hearings in which the CONTRACTOR provided representation to date VI. Number of Cases closed due to SSI/SSDI Approval or Other terminations to date Note: County has the ability to modify the EXCEL spreadsheet as needed. SCHEDULE QTR FROM TO DUE DATE 1 st January March April 18 2 nd April June July 18 3 rd July September October 17 4 th October December January REFFERAL PROCEDURES A. COUNTY will review the list of pending SSI/SSDI Advocacy referrals and send an Informing Notice to clients regarding a CONTRACTOR contact about their SSI/SSDI application. The CONTRACTOR will be copied via with the Informing Notice, which will contain the client s case information. B. The CONTRACTOR will receive the referral, review, and make contact with the client. Page 3 of 8

4 C. If the client accepts the CONTRACTOR s services, then the CONTRACTOR will schedule an appointment to meet with the client, complete the appropriate documentation, and begin the SSI/SSDI application filing. D. If a client requires a psychological evaluation for his/her SSI/SSDI application, then the CONTRACTOR can refer the client to client s medical provider or may contact the COUNTY to schedule an appointment with the COUNTY s contracted psychological evaluator. E. If the client declines to accept the CONTRACTOR s services, then the CONTRACTOR will the COUNTY indicating the client has declined the CONTRACTOR s offer to assist with the SSI/SSDI application filing. F. The CONTRACTOR will notify the COUNTY of the status of every referral. G. Once the COUNTY receives notice that the client has accepted the CONTRACTOR s services, then the COUNTY will document the case and set a reminder for future date follow-up. If the client has declined the CONTRACTOR s services, then the client will be prioritized to be assigned to a SSI/SSDI Advocate. H. While working with a client, CONTRACTOR will maintain the status of the client s case on an EXCEL spreadsheet provided by the COUNTY. This spreadsheet shall be updated on a monthly basis and will be included in the quarterly report to the COUNTY. 4. TERM AND TERMINATION A. This Agreement may be terminated at any time by either party with 30 days advance written notice. i. Upon termination, CONTRACTOR will continue to work with their existing clients. Clients can choose to change legal representation by way of completing a SSA-1696 form. Those clients returning to the COUNTY can choose to have their case reassigned to another CONTRACTOR or to an SSI/SSDI Advocate. CONTRACTOR will cooperate with the COUNTY and make reasonable efforts to work with the COUNTY to transition cases with least disruption to the client and SSI/SSDI process. B. If CONTRACTOR fails to perform any of the items set forth in Sections 2 or 3 the COUNTY may, at its discretion, stop referring clients to CONTRACTOR until the compliance issues are remedied to the satisfaction of the COUNTY. 5. COMPENSATION TO CONTRACTOR A. Upon an approved claim, the CONTRACTOR will be paid by the Social Security Administration no more than 25 percent of the past-due benefits or $6,000, whichever is less, or the fee as designated by the Social Security Administration. The CONTRACTOR must file either a fee agreement or a fee petition with the Social Security Administration and be authorized by the Social Security Administration for the fee amount between the client and the CONTRACTOR. B. If CONTRACTOR wishes to appeal an Unfavorable Hearing decision to the SSA Appeals Council and/or Federal District Court, then all terms of payment/compensation shall be outlined between CONTRACTOR and client in a Fee Agreement. Page 4 of 8

5 6. CONTRACT REPRESENTATIVES A. CONTRACTOR designates Avi Leibovic, Supervising Attorney as CONTRACTOR s representative for the purpose of performing the services as required by this Contract. Unless otherwise indicated in writing, the above named person has the primary authority and responsibility to carry out this Contract. If the CONTRACTOR s representative is no longer available to manage the services performed under this Contract, CONTRACTOR shall inform the COUNTY in writing and designate a new representative. B. COUNTY designates the Director of Social Services Agency, or designee, as its representative for the purpose of managing the services performed pursuant to this Contract. 7. NOTICES All notices prescribed by this Contract will be in writing and deemed effective if sent by certified mail or registered mail and properly deposited with the United States Postal Service, postage prepaid with return receipt requested and addressed as follows: To COUNTY: To CONTRACTOR: Social Services Agency Bruce Wagstaff, Director 333 West Julian Street San Jose, California Health Advocates, LLC Al Leibovic, President Califa Street Sherman Oaks, CA COUNTY S CONTRACT TRANSITION PROCESS CONTRACTOR agrees to provide all information deemed necessary by the COUNTY for use in subsequent procurement cycles. 9. MODIFICATION This Agreement may be supplemented, amended, or modified only by the mutual agreement of the parties. No supplement, amendment, or modification of this Agreement will be binding on COUNTY unless it is in writing and signed by the COUNTY. 10. NO ASSIGNMENT, DELEGATION OR SUBCONTRACTING WITHOUT PRIOR WRITTEN CONSENT CONTRACTOR may not assign any of its rights, delegate any of its duties or subcontract any portion of its work or business under this Agreement without the prior Page 5 of 8

6 written consent of the COUNTY. No assignment, delegation or subcontracting will release CONTRACTOR from any of its obligations or alter any of its obligations to be performed under the Agreement. Any attempted assignment, delegation or subcontracting in violation of this provision is voidable at the option of the COUNTY and constitutes material breach by CONTRACTOR. As used in this provision, "assignment" and "delegation" means any sale, gift, pledge, hypothecation, encumbrance, or other transfer of all or any portion of the rights, obligations, or liabilities in or arising from this Agreement to any person or entity, whether by operation of law or otherwise, and regardless of the legal form of the transaction in which the attempted transfer occurs. 11. COMPLIANCE WITH ALL LAWS & REGULATIONS CONTRACTOR shall comply with all laws, codes, regulations, rules and orders (collectively, "Regulations") applicable to the services to be provided hereunder. CONTRACTOR s violation of this provision shall be deemed a material default by CONTRACTOR, giving the COUNTY a right to terminate the Agreement. 12. INDEPENDENT CONTRACTOR CONTRACTOR shall perform pursuant to this Agreement as an independent contractor and not as an officer, agent, servant, or employee of the COUNTY. CONTRACTOR shall be solely responsible for the acts and omissions of its officers, agents, employees, contractors, and subcontractors, if any. Nothing herein shall be considered as creating a partnership or joint venture between the COUNTY and the CONTRACTOR. No person performing any services and/or supplying all goods shall be considered an officer, agent, servant, or employee of the COUNTY, nor shall any such person be entitled to any benefits available or granted to employees of the COUNTY. CONTRACTOR is responsible for payment to sub-contractors and must monitor, evaluate, and account for the sub-contractor(s) services and operations. 13. INDEMNITY COUNTY shall not be liable for, and CONTRACTOR shall defend, indemnify and hold harmless COUNTY and the employees and agents of COUNTY (collectively, "COUNTY Parties") against any and all claims, demands, liability, judgments, awards, fines, mechanics' liens or other liens, labor disputes, losses, damages, expenses, charges or costs of any kind or character, including without limitation attorneys' fees and court costs (hereinafter collectively referred to as "Claims"), related to and arising either directly or indirectly from any act, error, omission or negligence of CONTRACTOR or its contractors, licensees, agents, servants or employees, excepting only Claims caused by the sole negligence or willfulness of COUNTY Parties. The CONTRACTOR shall reimburse the COUNTY for all costs, attorneys' fees, expenses and liabilities incurred with respect to any litigation in which the CONTRACTOR is obligated to indemnify, defend and hold harmless the COUNTY under its agreement with the COUNTY. Page 6 of 8

7 14. COOPERATION WITH REVIEW CONTRACTOR shall cooperate with COUNTY s periodic review of CONTRACTOR s performance. CONTRACTOR shall make itself available onsite to review the progress of the project and Agreement, as requested by the COUNTY, upon reasonable advanced notice. CONTRACTOR agrees to extend to the COUNTY or his/her designees and/or designated auditor of the COUNTY, the right to monitor or otherwise evaluate all work performed and all records, including service records and procedures to assure that the project is achieving its purpose, that all applicable County, State, and Federal regulations are met, and that adequate internal fiscal controls are maintained. 15. NON-DISCRIMINATION CONTRACTOR shall comply with all applicable Federal, State, and local laws and regulations, including Santa Clara County s policies, concerning nondiscrimination and equal opportunity in contracting. Such laws include, but are not limited to, the following: Title VII of the Civil Rights Act of 1964 as amended; Americans with Disabilities Act of 1990; The Rehabilitation Act of 1973 ( 503 and 504); California Fair Employment and Housing Act (Government Code et seq.); and California Labor Code 1101 and Contractor shall not discriminate against any employee, subcontractor or applicant for employment because of age, race, color, national origin, ancestry, religion, sex/gender, sexual orientation, mental disability, physical disability, medical condition, political beliefs, organizational affiliations, or marital status in the recruitment, selection for training including apprenticeship, hiring, employment, utilization, promotion, layoff, rates of pay or other forms of compensation. Nor shall CONTRACTOR discriminate in provision of services provided under this contract because of age, race, color, national origin, ancestry, religion, sex/gender, sexual orientation, mental disability, physical disability, medical condition, political beliefs, organizational affiliations, or marital status. CONTRACTOR s violation of this provision shall be deemed a material default by CONTRACTOR giving COUNTY a right to terminate the contract for cause. 16. DEBARMENT CONTRACTOR guarantees that it, its employees, contractors, subcontractors or agents (collectively CONTRACTOR ) are not suspended, debarred, excluded, or ineligible for participation in Medicare, Medi-Cal or any other federal or state funded health care program, if applicable, or from receiving Federal funds as listed in the List of Parties Excluded from Federal Procurement or Non-procurement Programs issued by the Federal General Services Administration. CONTRACTOR must within 30 calendar days advise the COUNTY if, during the term of this Agreement, CONTRACTOR becomes suspended, debarred, excluded or ineligible for participation in Medicare, Medi-Cal or any other federal or state funded health care program, as defined by 42. U.S.C. 1320a- 7b(f), or from receiving Federal funds as listed in the List of Parties Excluded from Federal Procurement or Non-procurement Programs issued by the Federal General Services Administration. Contractor will indemnify, defend and hold the County harmless for any loss or damage resulting from the conviction, debarment, exclusion or ineligibility of the CONTRACTOR. Page 7 of 8

8 17. NON-WAIVER No waiver of a breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement will be effective unless it is in writing and signed by COUNTY. No waiver of any breach, failure, right, or remedy will be deemed a waiver of any other breach, failure, right, or remedy, whether or not similar, nor will any waiver constitute a continuing waiver unless the writing signed by the COUNTY so specifies. 18. GOVERNING LAW, JURISDICTION AND VENUE This Agreement shall be construed and interpreted according to the laws of the State of California, excluding its conflict of law principles. Proper venue for legal actions will be exclusively vested in a state court in the County of Santa Clara. The parties agree that subject matter and personal jurisdiction are proper in state court in the County of Santa Clara, and waive all venue objections. Page 8 of 8