25WS0022_-_Exhibit_A-1.pdf

California Department of Veterans Affairs Agreement Number: 25WS0022 Exhibit A-1 – Service Specification TBD

DIAGNOSTIC SERVICES:

RADIOLOGY, ULTRASOUND AND PHLEBOTOMY/LABORATORY SERVICES

1. PROVIDER’S QUALIFICATIONS

A. Providers assigned to CalVet must have the minimum experience/education outlined below:

1. Radiology Technician:

a. Minimum of twelve (12) continuous months of experience within the last five (5) years performing services similar in scope to those defined herein, preferably in a public or private institution.

b. Education: Graduation from an approved Radiology Technician program.

2. Ultrasound Technician:

3. Licensed Laboratory & Phlebotomist:

b. Education: Graduation from an approved laboratory and phlebotomist program.

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(s) who fails to meet the minimum qualifications shall not be permitted to perform service.

The Home’s Contract Manager, or designee, shall state in writing the reason(s) the Provider does not meet minimum.

2. LICENSES, PERMITS, AND CERTIFICATION REQUIREMENTS

Prior to providing services as outlined in this Agreement, Contractor shall:

A. Ensure that each Provider possess and maintain all current and valid licenses, permits, and certifications throughout the term of this Agreement for each classification noted below:

1. Licensed Radiologist:

a. A current and valid license issued by American Registry of Radiologic Technologists (AART) in order to practice Radiology Technician services in the State of California.

b. Provider must be linked to Medicare, MediCal / DentiCal, and all other applicable insurance vendors.

2. Ultrasound Technician:

a. Provider must be linked to Medicare, MediCal / DentiCal, and all other applicable insurance

3. Licensed Laboratory & Phlebotomist:

a. A current and valid license issued: Clinical Laboratory Improvement Amendments (CUA) Certification, and the Phlebotomy Technician Certification (CPT) for the phlebotomists, in order to practice laboratory and phlebotomy services in the State of California.

b. Provider must be linked to Medicare, MediCal / DentiCal, and all other applicable insurance

c. Contractor shall maintain or subcontract with a laboratory licensed by the California Department of Health Services. Contractor, including Subcontractors, responsible for discharging the Contractor's duties and obligations, under this Contract, shall hereby attest that all licenses, registrations, and/or certifications are and will remain current throughout the term of this Contract.

B. Ensure all licenses, permits, and certification requirements are verified and current throughout the term of this Agreement. Maintain all appropriate licensing for physicians affiliated with Contractor, including but not limited to: most recent survey report with corrections, and Licenses.

C. Ensure services be provided in accordance with Medicare and Medi-Cal Standards, requirements and reimbursement schedules as set forth in Title XVIII 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 and under the general direction of the Home CMO or designee.

D. Guarantee licenses will include, but not limited to: Radiology Technician license, Radiologist License, California Radiology license and Clinical Laboratory Improvement Amendments (CUA) Certification, and the Phlebotomy Technician Certification (CPT) for the phlebotomists. Survey reports shall be available for review. Prior to providing services specified in this Agreement, Contractor or Contractor’s Provider shall possess and maintain throughout the term of this Agreement, all licenses, permits, and certification requirements. Contractor must provide the State with proof of any required training, licenses, permits, certifications and any other required documents as stated below and as required by law, for each of the Providers providing services under this Agreement. Contractor shall abide by all the applicable rules and regulations as depicted by the Department of Health and Human Services.

E. Contractor, including Subcontractors, responsible for discharging the Contractor’s duties and obligations, under this Contract, shall hereby attest that all licenses, registrations, and/or certifications are and will remain current throughout the term of this Contract.

F. Further attest that no restrictions or probationary actions have been levied against its practice as licensed under the laws of the State of California. Contractor shall routinely monitor and report to the Clinical Administrator or designee the status of its medical and professional staff’s licenses, certifications, and/or registrations to ensure that they are current and that said personnel are in compliance with Medicare, Medi-Cal, and/or State of California licensing and/or registration restrictions.

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

H. 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(s) assigned to the Home, and that all licenses are active and void of misconduct. The Home may, at its discretion, verify the current status of Provider(s) assigned.

I. Provide copies of any required license(s), permits, and/or certification(s) for each Provider to the Home’s Contract Manager, or designee, to be kept on file at the Home throughout the term of this Agreement.

Contractor shall ensure that all required licenses, permits, certifications, and any other requirements outlined herein are current and in effect at all times during the term of this Agreement.

J. Provide current/renewed license(s), permit(s) and/or certification(s) to CalVet not less than thirty (30) calendar days prior to their expiration. 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.

K. Contractor will supply references including but not limited to, company references within California from a licensed skilled nursing facility with more than five (5) years of experience. References for the Radiologist, Ultrasound Technician, Radiology Technician and Laboratory/Phlebotomist Technician within California from a licensed skilled nursing facility with more than five (5) years of experience.

L. Maintain current Cardiopulmonary Resuscitation (CPR) and Basic Life Support (BLS) certification for each Provider at Contractor’s expense.

3. PROVIDER’S RESPONSIBILITIES

Under the direction of the Home’s SNF Administrator, Contract Manager, or designee, Provider shall provide services as permitted within the scope of practice for Radiology, Ultrasound and Phlebotomy/Laboratory Services in accordance with CalVet/Home policies and procedures.

A. Duties/Responsibilities shall include, but are not limited to:

1. The Radiology Technician shall:

a. Provide on-site radiology services, per physician orders for residents of the Home, Monday through Friday between 8:00 AM and 5:00 PM, excluding State holidays. Services shall be provided at the Home’s Clinic or at bedside.

b. Provide pre and post-procedure instructions and communicate it with MD/Nursing staff.

c. Ensure Radiology Services shall be performed by a California licensed radiology technician, and interpreted by a duly licensed and California Board Certified Radiologist.

d. Ensure Radiology services shall include, but not limited to the following:

1. Chest

2. Abdominal films

3. Extremities

4. Spine

5. Pelvis

6. Facial bones

7. Skull

8. Rib series

2. The Ultrasound Technician shall:

a. Provide ultrasound services, per physician orders for residents of the Home, Monday through

Friday between 8:00 AM and 5:00 PM, excluding State holidays. Services shall be provided at the Home’s Clinic or at bedside.

b. Convey any dye allergies to Physician/Nursing staff. Pre-consent must be signed prior to invasive procedures. Contractor shall provide pre and post-procedure instructions and communicate it with Physician/Nursing staff.

c. Ensure ultrasound services are inclusive of, but not limited to the following:

1. Cardiac ultrasound

2. Doppler ultrasound

3. Echocardiogram

4. Thyroid ultrasound

3. The Phlebotomist and Laboratory Technician shall:

a. Provide on-site phlebotomy and laboratory services for clinical laboratory diagnostic services per physician orders for residents of the Home Monday through Friday between 5:00 AM (before breakfast) and 5:00 PM, excluding State holidays. Services shall be provided at the Home's Clinic or at bedside.

b. Collect, pickup, and deliver all specimens collected at the Home to contractor’s duly authorized laboratory the same morning to ensure specimens remain viable. Contractor must notify the License Vocational Nurse (LVN) or Registered Nurse (RN) on the unit if unable to collect specimen at any given time. Contractor shall communicate results for morning phlebotomy specimens on the same day and before 2:00 PM.

c. Non-blood specimens collected by the Home's nursing staff shall be done prior to routine phlebotomy hours as defined above, and shall be picked up by the phlebotomist the same day throughout respective locations at the Home with results to be available within 24 hours or sooner. All routine tests ordered after the routine phlebotomy business hours will be performed the next business day. Results shall be communicated to the Home immediately upon availability.

d. Not determine whether any resident or any laboratory test for a particular resident is a covered service by an applicable third-party payer. Therefore, Contractor shall not be held financially responsible for tests which a third-party payer may determine medically unnecessary, not a covered service, or were unauthorized by the third-party payer Reports.

e. Maintain a primary business office within a thirty (30) mile radius of the California Department of Veterans Affairs (CALVET) facility located in West Los Angeles (WLA). The Contractor agrees to provide the necessary services promptly and efficiently, ensuring that the proximity allows for timely communication and laboratory services.

f. Provide laboratory services, inclusive of the following test results, but not limited to:

1. Basic Metabolic

2. Comp Metabolic

3. Lipid Panel

4. CBC w/Diff

5. Ferritin

6. Folate

7. Hemoglobin

8. Iron, Total

9. Iron (TIBC)

10. PSA, Total

11. PT/INR

12. Influenza

13. TSH 3rd Gen

14. UA w/Microscopy

15. Vit B12

16. Vil D, 25-0H

17. Urine's Culture

18. Venipuncture

g. Furnish all supplies required to collect samples that the Contractor is collecting firsthand.

h. When samples are Quantity Not Sufficient (QNS) or are lost; the Contractor shall phone to notify the Home as soon as it is discovered.

i. Immediately telephone and/or fax directly to the Home all results that fall into "Panic Values" as defined by Contractor.

j. Perform repeat determinations at no charge on the same or second specimen when results appear to be inconsistent with clinical evaluation of patients.

k. Provide patient and Antiprogram reports via Email and Fax or a printable equivalent on their HIPAA-compliant website each day, and a workload analysis report each month and annually.

Electronic protected health information (ePHI) must be encrypted (preferably password protected pdf) when leaving trusted internal environment. Must meet HIPAA Security Rule (HSR) referenced in 45 CFR Part 160 and Subparts A and C of Part 164. Please reference NIST Special Publication 800-14, Generally Accepted Principles and Practices for Securing Information Technology Systems and NIST Special Publication 800-33. Contractor that provides this information agrees to implement reasonable and appropriate security measures to protect the information.

l. Ensure information access management, access control, security awareness training, security incident procedures, and devices and media controls. The web portal must be IAW California Government Code §11135(d), which requires that all electronic and information technology developed or purchased by the State of California Government is accessible to people with disabilities. Web based interface/portal would be Ideal for any access to documents.

B. Diagnostic Reports – Radiology

1. Contractor shall provide diagnostic imaging interpretation and administrative services including quality assurance, facilitation of timely reports, equipment oversight, and radiation safety expertise.

2. Contractor shall dictate a report for each examination or procedure. The report shall include the following:

a. Examination Date

b. Patient follow-up care

c. Results of the report, including the findings and the area(s) examined, and the final diagnosis.

3. Routine consultation notes will be communicated by fax to the ordering unit of the Home within 24 hours.

4. All critical findings and the doctor’s report shall be sent by phone or fax to the Contract Manager, or designee within one (1) hour to ensure resident receives the appropriate quality of care. Additionally, as soon as a critical value is noted, the contractor shall call the Home’s ordering unit and notify a Nurse or MD. All tests ordered by the Specialist shall have the Primary Care Provider at the Home as a recipient of the test results.

C. Diagnostic Reports – Ultrasound

1. Contractor shall provide diagnostic imaging interpretation and administrative services including quality assurance, facilitation of timely reports, equipment oversight, and radiation safety expertise.

2. Routine consultation notes will be communicated by fax to the ordering unit of the Home within 24

3. All critical findings and the doctor’s report shall be sent by phone or fax to the Contract Manager, or designee within one (1) hour to ensure resident receives the appropriate quality of care. Additionally, as soon as a critical value is noted, the contractor shall call the Home’s ordering unit and notify a Nurse or MD. All tests ordered by the Specialist shall have the Primary Care Provider at the Home as a recipient of the test results.

D. Diagnostic Reports – Laboratory and Phlebotomy

1. Contractor shall provide laboratory results and administrative services including quality assurance, facilitation of timely reports, and equipment oversight.

2. Routine consultation notes will be communicated by fax to the ordering unit of the Home within 24

3. All critical findings and the doctor's report shall be sent by phone or fax to the Contract Manager, or designee within one (1) hour to ensure resident receives the appropriate quality of care. Additionally, as soon as a critical value is noted, the contractor shall call the Home's ordering unit and notify a Nurse or Physician. All tests ordered by the Specialist shall have the Primary Care Provider at the Home as a recipient of the test results.

E. Set-Up Fee

Set-up fee includes all necessary items/materials to set up for an Radiology, Phlebotomy, and/or Ultrasound at the Home. Set-up fee shall be reimbursed once per procedure.

F. Transportation Fee

Contractor will be reimbursed a transportation fee for transporting portable Radiology, Phlebotomy, and/or Ultrasound equipment to the Home, where portable Radiologys, Phlebotomy, and/or Ultrasounds are taken. Contractor shall be paid only a single transportation payment for each trip to the Home, per resident.

G. After Hours Services for Residents

Contractor shall be available after business hours seven (7) days a week on the order of a duly licensed and authorized Home provider. After-hour services are outside of the hours of Monday through Friday 8:00 a.m. – 5:00 p.m., and include State holidays. After-hour fee may be charged once per trip.

H. Home Staff (Laboratory Services only)

Employee labs shall be completed for the Hepatitis Vaccine Titers and any other vaccine titers as needed.

Employee labs will be called in 24 hours in advance and scheduled during business hours between 08:00

AM - 05:00 PM.

I. STAT Services for Residents (Radiology only)

1. Contractor shall be available for emergency response 24 hours a day, seven (7) days a week on the order of a duly licensed and authorized Home provider.

2. STAT Radiology orders require results within four (4) hours. Contractor shall honor STAT orders when requested by provider order. Emergency response time for arrival for STAT services at the Home shall be within two (2) hours of the initial contact of the Contractor by the Home. Results must be communicated to an LVN or an RN of the Home’s ordering Unit where the result originated.

3. STAT fee may be charged once per patient per visit.

J. STAT Services for Residents (Laboratory and Phlebotomy only)

1. STAT orders require results within four (4) hours. Contractor shall honor STAT orders when requested by provider order. Emergency response time for arrival for STAT services at the Home shall be within two (2) hours of the initial contact of the Contractor by the Home. A STAT draw call with lab processing is defined as a call requiring the phlebotomist to arrive to perform a draw, and results provided to the Home within two (2) hours. Results must be communicated to an LVN or an RN of the Home's ordering Unit where the Lab result originated.

2. STAT non-blood test orders require arrival for specimen pick up within two (2) hours and results communicated to the Home immediately upon availability.

3. STAT fee may be charged once per patient per visit.

K. Employee (Radiology only)

Contractor shall provide employee/volunteer/intern/registry staff/vendor chest Radiology service for Tuberculosis (TB) evaluation as requested by the Contract Manager or designee. Contractor shall respond to Employee Chest Radiology requests even if it is not bundled with any resident Radiology procedures. The Home will attempt to schedule Employee Chest Radiology service along with Resident Radiology service but is not guaranteed. Results must be submitted to CalVet West Los Angeles clinic NO LATER THAN 3 days after the procedure.

L. Home Staff Laboratory Services

Employee labs shall be completed for the Hepatitis Vaccine Titers and any other vaccine titers as needed. Employee labs will be called in 24 hours in advance and scheduled during business hours between 08:00 AM - 05:00 PM.