2-DHHS26051 Optometry Services SOW Final.docx

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Optometry Services at USH
Solicitation number
DHHS26051
Issued by
Utah

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This Scope of Work document outlines optometry services to be provided by the Department of Health and Human Services at Utah State Hospital in Provo, Utah. The contract requires the contractor to provide comprehensive optometric services including consultations, diagnostic testing, treatment, and preventative eye care to hospital patients at the Mark I. Payne Medical Services building located at 1300 East Center Street, Provo, UT. Services are to be delivered on a schedule determined by the DHHS Clinical Director, currently scheduled for two times per month to serve approximately 20 patients monthly, though actual service hours may vary based on patient need and DHHS does not guarantee minimum weekly hours. The contractor must notify the DHHS Clinical Director of any planned absences with 60 days' advance notice and immediately report any unforeseen absences due to circumstances such as illness.

The contractor must hold a current Utah optometry license, possess a doctorate of optometry degree, have at least five years of experience as an optometrist, and demonstrate at least one year of direct experience working with mentally ill populations. The contractor is responsible for all optometry management and administrative functions and must maintain consistency in provider assignments to the extent possible. Monthly invoices must be submitted to the DHHS Business Office at statehospitalinvoices@utah.gov and must include service descriptions, dates of service, contract number, invoice number, contractor name, payment address, phone number, and contractor signature. The contractor must execute a Business Associate Agreement in compliance with HIPAA, maintain all records at Utah State Hospital, and submit monthly performance reports documenting the number of patients seen, patients unable to be seen with reasons, and referrals to off-campus providers. DHHS will provide clinic space, telephone access, and computer access to the contractor.

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ATTACHMENT B: SCOPE OF WORK

1.1 Purpose. The purpose of this contract is to provide optometry services to patients at the Department of Health and Human Services, Utah State Hospital. Services must be provided at the Mark I. Payne Medical Services building, 1300 East Center Street, Provo, UT.

Article 2

CONTRACTOR QUALIFICATIONS

2.1 Contractor Qualifications. The Contractor shall have:

(1) a current and valid license to practice optometric medicine issued by the State of Utah, Division of Occupational and Professional Licensing;

(2) a doctorate of optometry degree from an optometric school;

(3) at least five years of experience working as an Optometrist; and

(4) at least one year of experience working directly with the mentally ill.

ARTICLE 3

CONTRACTOR REQUIREMENTS

3.1 Contractor Requirements: The Contractor is responsible for all optometry services at Utah State Hospital, and shall assume management and administrative responsibility for all optometry services. The Contractor shall:

(1) to the extent possible, have the same Optometrist provide services;

(2) provide optometric consultations for all patients as requested by DHHS physicians;

(3) provide diagnostic testing, treatment and preventative services related to eye care to Utah State Hospital patients;

(4)notify the DHHS Clinic Manager of any optometry issue, and document the issue in the electronic chart ("E-Chart"), to which the Contractor will be given access. The DHHS Clinic Manager shall then notify medical and nursing staff of any optometry issue;
(5)ensure records remain at Utah State Hospital;

(6) sign a Business Associate Agreement in compliance with the Health Insurance Portability and Accountability Act of 1996;

(7) see Utah State Hospital patients at times and days determined by the DHHS Clinical Director (currently two times a month/20 patients month). Because service hours are dependent upon need, there may be some weeks where limited services are required. DHHS does not guarantee a minimum number of hours per week. DHHS will provide clinic space, telephone and computer access; and

(8) notify the DHHS Clinical Director or designee of any vacations or other planned time off. Notice must be provided 60 days in advance for the Contractor's absence to establish the Contractor's monthly work schedule. In cases of unforeseen absence due to circumstances (such as illness) the Contractor shall notify the DHHS Clinical Director or designee as soon as possible.

ARTICLE 4

OUTCOMES

4.1 Outcomes. The outcomes of this contract will ensure that patients obtain needed optometry services.

4.2 Performance Measures: The Contractor shall contribute to the following outcomes and report to DHHS the following measures:

(1) Measure: Number of patients seen each month

(2) Measure: Number of patients unable to be seen and the reason

(3) Measure: Number of patients referred to an off-campus provider

4.3 Reporting. The Contractor shall submit monthly reports to the DHHS Clinics Manager or as requested.

Article 5

BILLING REQUIREMENTS

7.1 Invoicing.

(a) The Contractor shall submit monthly invoices for services to the DHHS Business Office, statehospitalinvoices@utah.gov 1300 E Center Street, Provo, UT 84604. The invoice must include:

(1)service description;
(2)dates services rendered;
(3)contract number;
(4)uniquely identifiable invoice number;
(5)Contractor name;
(6)Contractor’s address for payment;
(7)Contractor’s phone number; and
(8)Contractor’s signature.
(b)Invoices submitted without the required information will not be paid and will be returned to the Contractor for revision.
(e)All payments made will be made in the name of the Contractor as it appears on the cover page. Any change must be submitted in writing to the DHHS Administrative Services Director.

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