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Contract #68-1011 <br />Orange Public Transportation -Medicaid <br />• ATTACIBI~NT B <br />SCOPE OF WORK <br />Orange County Department of Social Services <br />Federal Taz Id. or SSN <br />Contract # 68-1011 <br />A. CONTRACTOR INFORMATION <br />1. Contractor Agency Name: Orange Public Transportation <br />2. If different from Contract Administrator Information in General Contract: <br />Address Al Terry <br />600 Highway 86 North, Hillsborough, NC 27278 <br />Telephone Number: (919 245-2002 Fax Number: Email: <br />3. Name of Program (s): Medicaid Transportation Program <br />4. Status: (~ Public ( )Private, Not for Profit ( )Private, For Profit <br />5. Contractor's Financial Reporting Year JulYl, 2007 through June 30, 2008 <br />B. Explanation of Services to be provided and to whom (include SIS Service Code): <br />. The Contractor will provide transportation for eligible Medicaid clients to and from <br />medically necessary appointments. The Contractor is required to meet all goals and <br />outcomes listed in Attachment N. <br />C. Rate per unit of Service (define the unit): <br />1. If Standard Fixed Rate, Maximum Allowable, (See Rates for Services Chart) <br />2. Negotiated County Rate. <br />$12.75/one-way trip <br />• <br />D. Number of units to be provided: <br />E. Details of Billing process and Time Frames; The County will reimburse the Contractor <br />for services described in this contract un to the budt;etarv limits of the contract. allotment. <br />For reimbursement, the Contractor must submit an original and two copies of an invoice <br />by the fifth of the month for the preceding month's expenditures to the designated County <br />Administrator. Expenditures for May and June must be estimated based on average <br />monthly expenditures year-to-date and reported by May 5, 2008. The County will <br />reimburse the Contractor monthl~pon receipt of a complete and correctly filed report. <br />Contract-Scope of Work (06/04) <br />Page 1 of 2 <br />