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• Submit a detailed initial data request to the City of Santa Ana at project commencement to include <br />items that CMS requires agencies to track and submit. <br />• Review data received for the following areas as required by CMS: Organizational Characteristics, <br />Service Area, Emergency Response Time, Ground Ambulance Service Volume, Service Mix, Labor <br />Costs, Facilities Cost, Vehicle Costs, Equipment and Supply Costs, Other Applicable Costs, and <br />Revenues. <br />• Analyze data received and develop customized technical work -papers and data summaries that <br />prepare for efficient and effective submission of information into CMS' required survey format. <br />Perform any cost calculations or data calculations needed to generate outcomes supporting the <br />survey submittal. <br />• Consult with CMS representatives to discuss submittal requirements and options on City of Santa <br />Ana's behalf, if needed. <br />Completion of Data Review and Analysis by NBS assumes the City of Santa Ana has tracked all required <br />service characteristics in accordance with the Medicare Ground Ambulance Data Collection Instrument for <br />a continuous 12-month period. <br />TASK 2. PREPARATION OF COST SURVEY FOR SUBMISSION AND APPROVAL <br />NBS will prepare the required forms for submission to CMS via the survey instrument for the survey's <br />reporting period. <br />• Schedule a conference call to review data analysis, findings, and submittal preparation. Provide <br />opportunity for the City of Santa Ana to review forms and request revisions. Include one round of <br />revisions if necessary. <br />• NBS will become the "Submitter" for the City of Santa Ana. NBS will obtain its own log -in <br />information from CMS. The City of Santa Ana will become the "Certifier." <br />TASK 3. PROVIDE AUDIT SUPPORT <br />Should the City of Santa Ana require support from NBS during CMS's review process, NBS will provide up to <br />four (4 hours) of support to answer auditor questions, clarify supporting documentation, and discuss <br />alternatives, as required. <br />PROJECiTEAM <br />The following provides an overview of professional staff that would be assigned to this project, as well as <br />their roles and responsibilities. <br />NICOLE KISSAM, DIRECTOR <br />Nicole Kissam will direct the ongoing administration of the project, including contracting, quality control of <br />deliverables, and management support to the project team. Ms. Kissam is also interchangeable with Ms. <br />Huerta as a consulting expert and will provide senior -level technical analysis as warranted throughout the <br />project. <br />ANNIY6.RSARV Page 2 <br />V1NBS <br />