11._Exhibit_A.pdf

California Department of Veterans Affairs Agreement Number: 23VS0018 Exhibit A - Scope of Work TBD

MEDICAL TRANSPORTATION SERVICES -

EMERGENCY/ NON-EMERGENCY BASED AND ADVANCED LIFE SUPPORT

1. INTRODUCTION/SERVICES

A. Contractor shall provide medical transportation services to the California Department of Veterans Affairs

(CalVet) for the benefit and care of residents of the Veterans Home of California-Ventura (Home) located at 10090 Telephone Road Ventura, CA 93004. Contractor shall provide all labor, vehicles, materials, staff, license, permits and every other item of expense necessary to perform services, unless otherwise stated to provide emergency based and advanced life support based medical transportation services.

Services shall be provided at the Home, upon request and in compliance with the terms of this Agreement.

B. Contractor shall perform services under the scope of their license and in accordance with federal and state laws and regulations as well as CalVet policies and procedures.

C. Any and all services performed outside the scope of this Agreement shall be at the sole risk and expense of the Contractor.

D. Contractor is not authorized to deliver or commence performance of services as described in the

Agreement until written approval has been obtained from the CalVet Contract Manager and the Contractor has received an executed contract from CalVet. Any delivery or performance of service commenced prior to the Contractor obtaining all written approvals shall be considered voluntary on the part of the Contractor.

2. CONTRACTOR RESPONSIBILITIES

The Contractor shall provide medical transportation services- emergency based and advanced life support on an as-needed basis to include the following:

A. Services and all requirements as stated herein and as required by law shall be provided by the Contractor, at the request of the Chief Physician, Contract Manager, or designee.

B. Contractor shall meet the requirements and have the ability to adequately provide services to the Home’s residents. Contractor may use Providers to perform services who meet the requirements specified in this Agreement. Contractor must provide the State with proof of any required training, licenses, permits, certifications and any other documents required by law including documents for each Provider performing services under this Agreement.

C. Services shall include but are not limited to:

1. Contractor shall provide advanced life support ambulance transportation to local and other medical facilities as deemed necessary. (Advanced Life Support is defined as one paramedic and one Emergency Medical Technician Paramedic who can provide advanced life support care, pain medication, advanced Airway management, and cardiac monitoring. It is the 911 level of service or when requesting transportation to an Emergency Department)

2. Contractor shall provide non-emergency advanced life support transportation within sixty (60) minutes of request.

3. Services shall be available twenty-four (24) hours per day, seven (7) days per week.

4. Ambulance medical transportation services shall be provided in accordance with Medicare and Medi- Cal ambulance health care standards.

5. Contractor shall provide health care services to Home residents in accordance with Medicare and

Medi-Cal standards, requirements, and reimbursement schedules set forth in Title XVII and Title XIX of the Federal Social Security Act; Title 22, Division 3, of the California Code of Regulations (CCR);

and Home bylaws, policies, and procedures under the general direction of the Home Clinical Administrator or designee. Contractor is responsible to ensure medical necessity for all tests they order.

6. Contractor shall provide the minimum pre-hospital emergency care personnel per ambulance as required by the Ventura County Division of Emergency Medical Services Ambulance Ordinance.

7. Contractor shall provide space within the transport vehicle for attendants from CalVet Home, such as a registered nurse or physician, if necessary.

D. Authorizations:

1. Contractor shall not be reimbursed for health care services provided without prior authorization, excluding medically necessary emergency care (911 system). For the purposes of this Agreement, any request through the 911 system by a State employee shall be deemed medically necessary emergency care. A 911 call by a non-State employee, if deemed not medically necessary by the Home, will be the responsibility of the caller to pay (See also D.3.).

2. Contractor shall obtain any applicable and/or required prior authorizations, including from Medicare, Medi-Cal, Partnership Health, Tricare for Life, United Healthcare, AARP, Blue Shield/Blue Cross, Aetna, Humana, ChampVA, and any other applicable insurances.

3. Services not authorized by the Home Chief Physician & Surgeon, primary care provider, or designee shall not be subject to reimbursements by CalVet.

a. Contractor shall not transfer residents to any facility or provider without prior authorization from the Home primary care physician, Chief Physician & Surgeon, or designee and provision of a prior authorization number.

b. Contractor shall obtain the approval and authorization of the Home residents’ primary care physician and/or the Home Chief Physician & Surgeon prior to referring residents to other health care/medical vendors/contractors. Referral shall be made to only those health care/medical vendors/contractors set forth on the Home’s Preferred Provider Referral List.

c. Prior authorization documentation shall include, but not limited to, the following:

1) Veterans Home Referral Form;

2) Prior Authorization Number;

3) Physician Consultation Form;

4) Resident Progress Notes; and

5) Laboratory and X-rays (if applicable).

E. Claims:

1. Contractor shall verify Medicare and Medi-Cal eligibility for Home resident who are the Contractor’s patient.

2. Contractor shall clear the Medi-Cal share-of-cost, when applicable, and submit proof of clearance with the claim for those residents with Medi-Cal share-of cost remaining for the date of service.

3. Contractor shall submit claim to the Home no later than sixty (60) days after date of service.

Contractor shall write off any claims submitted more than sixty (60) days past date of service.

4. Contactor shall attempt to receive payment from Veterans Administration (VA), private insurances, and from any benefit entitled to the resident patient. Contractor shall recognize CalVet as the last resort for payment.

F. Contractor shall accept and treat residents who do not have medical insurance, exhausted their

Medicare/Medi-Cal benefits, or who are not Medicare/Medi-Cal eligible in accordance with Medicare/ MediCal health care standards and reimbursement schedules.

G. Contractor/Provider shall ensure resident medical record information is maintained as “CONFIDENTIAL” and shall be held in trust and confidence. Information shall be used only for the purposes contemplated under this contract.

H. Contractor shall ensure that during periods of Contractor’s absence, such as vacation or other absences, there is another service provider who will provide the same service, thereby providing continuity of care for the Home residents.

I. Contractor shall provide weekly reports to the Home (recipients shall be determined by Contract Manager) that include case number; date and time of ambulance dispatch; address/location ambulance dispatched to; resident/patient age, primary and secondary impression; response and transport modes (e.g. lights, siren); disposition (e.g. treated, transported emergency room); place/location resident/patient transported to.

3. CONTRACTOR/PROVIDER QUALIFICATIONS

A. Contractor/Providers shall have the required licenses, insurance, permits, and/or certifications required to provide services under this Agreement.

B. Resident health care is of paramount importance. Accuracy in communications is critical to ensure timely, correct care is provided. Therefore, any Provider(s) providing services through this Agreement must be able to communicate effectively with CalVet.

C. Any Provider who fails to meet the qualifications shall not be permitted to perform service. The Home’s

Chief Physician & Surgeon, Skilled Nursing Facility Administrator, Contract Manager, or designee, shall state in writing the reason(s) the Provider does not meet qualifications. After notification of failure to meet qualifications has been provided, CalVet shall not pay the Contractor for additional services performed by Provider identified as not meeting the qualifications.

4. LICENSES, PERMITS, AND CERTIFICATION REQUIREMENTS

A. Prior to providing services specified in this Agreement, Contractor/Provider shall possess and maintain throughout the term of this Agreement, all licenses, permits, and certification requirements.

B. Contractor shall provide Emergency Medical Technicians (EMTs) licensed by the State of California and Department of Consumer Affairs. EMTs must possess a current, valid, Basic Cardiopulmonary Life Support certificate. Paramedics must possess all license and certification required by the Napa County EMS Agency.

C. If during the course of this Agreement, any of the licenses and/or requirements are found to be inactive or not in compliance, CalVet may withhold payment for services rendered during the expiration period and/or immediately terminate this Agreement.

D. Contractor shall assume responsibility for verifying, through the appropriate licensing boards, that no current or unresolved adverse actions have been taken by the State licensing authorities against any Provider providing services under this Agreement, and that all licenses are active and void of misconduct.

CalVet may, at its discretion, verify the current status of Contractor/Providers.

5. INDEPENDENT CONTRACTOR STATUS

A. Contractor/Providers shall be considered “Independent Contractors” in relation to CalVet and the State.

Therefore, Contractor/Providers shall not be considered employee(s) of the Home and shall not be entitled to any employee benefits from the CalVet or the State including, but not limited to, the following:

1. Premium Pay, Overtime Pay, or Holiday Pay;

2. Medical Insurance;

3. Vacation or Sick Leave;

4. Worker’s Compensation; and

5. Other employee benefits.

6. CONTACT INFORMATION

A. The project representatives during the term of this Agreement will be:

1. CalVet Home Representative/Contract Manager:

Veterans Home of California - Ventura

TBD

10090 Telephone Road Ventura, CA 93004 Phone: TBD Fax: TBD

TBD

2. Contractor Representative:

TBD

B. Project Representatives, addresses, and phone/fax numbers may be changed by issuing a twenty (20)-day prior written notification and shall not require a formal amendment to this Agreement. The notifying party shall provide complete contact information for the replacement Project Representative including, name, title, mailing address, phone/fax numbers, and email address. All other changes require a formal written amendment to this Agreement.