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DocuSign Envelope ID: 179DC6FB-73BA-4F64-A513-C8AB2B7D864F <br /> ATTACHMENT B <br /> SCOPE OF WORK <br /> Orange County Department of Social Services <br /> Federal Tax Id. or SSN 56-2460614 <br /> Contract# 68-2043 <br /> A. CONTRACTOR INFORMATION <br /> 1. Contractor Agency Name: Senior Care of Orange County,Inc. <br /> 2. If dr erenl from Contract Administrator Information in General Contract: <br /> Address <br /> Telephone Number: Fax Number: Email: <br /> 3. Name of Program(s):_ Adult Day Health Service <br /> 4. Status: ( )Public (X)Private,Not for Profit { )Private,For Profit <br /> 5. Contractor's Financial Reporting Year July 1,2019 through rune 30,-2020 <br /> B. Explanation of Services to be provided and to whom(include SIS Service Code): The <br /> Contractor will provide Adult Day Health Services(SIS Code 030 and 155 to clients of the <br /> Orange County Department of Social Services. These services will include assistance with <br /> Activities of Daily Living, health monitoring by an RN and thera eutic recreational Programs. <br /> These services will be provided in accordance with provisions set forth in Volume IV of the <br /> Adult and Family Services Manual Chapter H-Adult Day Care Services. The Contractor is <br /> required to meet all goals and outcomes listed in Attachment O. <br /> C. Rate per unit of Service(define the unit): <br /> 1.If Standard Fixed Rate,Maximum Allowable,(See Rates for Services Chart) <br /> Minimum daily rate: 38.921da per client <br /> 2.Negotiated County Rate. <br /> D.Number of units to be provided: <br /> E. Details of Billing process and Time Frames; The Counly will reimburse the Contractor far <br /> services described in this contract up to the budggitga limits of the contract allotment. The <br /> County will reimburse the Contractor at a rate of 38.921da for approved services provided. For <br /> reimbursement,the Contractor must submit an original and two copies of an invoice by the fifth <br /> of the month for the Dreceding month's ex enditures to the designated Coup Administrator. <br /> The County will reimburse the Contractor monthly ul2on receipt of a complete and correctly filed <br /> report. <br /> Contract-Scope of Work(06/04) Page I of 2 <br />