25WS0022_-_Exhibit_A.pdf

California Department of Veterans Affairs Agreement Number: 25WS0022 Exhibit A - Scope of Work TBD

DIAGNOSTIC SERVICES

RADIOLOGY, ULTRASOUND, AND PHLEBOTOMY/LABORATORY

1. INTRODUCTION/SERVICES

A. Contractor shall provide Radiology, Ultrasound and Phlebotomy/Laboratory Services, as specified, to the

California Department of Veterans Affairs (CalVet) for the benefit and care of the Veterans Home Residents. Contractor shall provide services at the Veterans Home, (Home), located at 11500 Nimitz Ave., Los Angeles, CA 90049. Contractor shall provide all labor, materials, staff, transportation, license, permits and every other item of expense necessary to perform services, unless otherwise stated. Services shall be provided at the Home under the direction of the Contract Manager or designee; or at the Contractor’s place of business upon request and in compliance with the terms of this agreement. For purposes of this Agreement the State designee must be a civil service employee.

B. All work shall be coordinated and approved by Contract Manager or designated representative.

Contractor shall provide routine services to the Home as needed Monday through Friday between 8:00 AM and 5:00 PM, excluding State holidays. For after hours, emergency, or STAT services (for radiology purposes only), Contractor shall be available 24 hours a day, seven (7) days a week on the order of a duly licensed and authorized Home provider. Any and all services performed outside the scope of this Agreement or not approved by the Contract Manager, or designated representative, will be at the sole risk and expense of the Contractor.

C. Contractor/Provider must 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.

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

E. Contractor’s main address/location shall be located within a 30-mile radius of the CalVet, West Los Angeles Home.

F. The Contractor is not authorized to deliver or commence performance of services as described in the agreement until written approval has been obtained from 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. MINIMUM QUALIFICATIONS

A. 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.

B. Any Provider who fails to meet the qualifications shall not be permitted to perform service. The Contract Manager, 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 identified as not meeting the qualifications.

C. Contractor must have a minimum number of Providers to adequately provide services to the Home, who meet the requirements specified in this Agreement.

3. CONTRACTOR’S RESPONSIBILITIES

A. Services and all requirements as stated below and as required by law shall be provided by the Contractor, at the request of the Chief Medical Officer (CMO), Contract Manager, or designee.

B. Services shall include but are not limited to:

1. Contractor must have a minimum number of Providers to adequately provide services who meet the requirements specified in Exhibit A–1, Service Specifications. 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. Services will be performed only by Providers who meet the requirements outlined in this Agreement.

2. The Contract Manager, or designee, shall approve in advance all required Provider assigned to the

Agreement. If any Provider of the Contractor is unable to perform due to illness, resignation, or factors beyond the Contractor’s control, the Contractor shall immediately submit qualifications of proposed substitute Provider to the Home for approval. The Home shall be notified of any additions or corrections to the Contractor’s list of prospective Providers at least five (5) working days before the Provider’s start date.

3. The Contractor shall ensure each Provider has an identification badge which includes the name of the Provider, Name of the Contractor (if different), and a photo identification. The badge shall be worn by the Provider at all times while at the Home.

4. Contractor shall meet every other month with the Contract Manager or designee via phone conference or in person to discuss performance and current issues that needed any follow up.

5. Contractor shall maintain for each resident, who has received medical services under this Contract, a legible, detailed medical record consistent with good medical and professional practices. Medical records shall permit effective internal professional review and external medical audit processes facilitating an adequate follow-up treatment and all supporting documentation required by Federal and State Medicare and Medi-Cal laws, regulations, rules, and policies. Medical records shall be maintained in accordance with Title 22, CCR, Sections 53284 and 53861, and reflect all aspects of patient care, including ancillary services.

6. Contractor shall provide CalVet users login activity upon requested within seven (7) days.

7. Contractor shall provide training of Home staff on the use of the solution.

8. Contractor shall provide at least three (3) user names and passwords and the user password can be reset by the user at any time.

9. Equipment and/or supplies owned or customarily stocked by the Home and which are necessary for therapeutic services may be used by the Provider. If the lack of equipment and/or supplies creates a limitation to services requested, the Provider shall make a recommendation to the Contract Manager, or designee, identifying equipment or supplies necessary for treatment. The Provider will not procure equipment or supplies and expect reimbursement from the Home/CalVet.

C. Timeframe requirements and services shall be noted in Exhibit A–1, Service Specifications.

D. Contractor shall have a telephone number and a contact person available by telephone 24 hours a day, seven (7) days a week for the duration of the contract.

E. Contractor and Provider shall ensure that all ordered services have prior authorization in accordance with the Home and are mutually agreed upon between the CMO, Contract Manager, or designee and the Contractor.

F. Contractor shall obtain from the Home staff the policies and procedures regarding the identification of the

Skilled Nursing Facility covered stays and identification time frames. The Home shall provide Contractor with information on the tests requisitions that identify patients as SNF residents under Medicare Part A-covered stays to enable Contractor to bill in compliance with applicable laws and regulations.

G. 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/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.

I. Contractor/Provider shall obtain the approval and authorization from the Home’s primary care physician through the CMO, Skilled Nursing Facility (SNF) Administrator, Contract Manager, or designee, prior to referring resident to other health care/medical vendors/contractors. Referral shall be made only to those health care/medical vendors/contractors set forth on the Home’s health care/medical vendor/contract list.

Prior Authorization Documentation shall include, but is not limited to the following:

1. Veterans Home referral process

2. Resident progress notes/summary pertinent to reason for referral

3. Provider order

J. Reports

1. After the initial consultation, the contractor shall send all critical findings and the doctor’s report to the

Home within two (2) hours to ensure the resident receives the appropriate quality of care. Information may be transmitted by phone or fax to the Primary Care Provider, Contract Manager, or designee.

All tests ordered by the Specialist shall have the Primary Care Provider at the Home as a recipient of the test results. Routine consultation notes will be communicated by fax to the Home within 72 hours.

2. CalVet reserves the right to request Contractor provides additional reports or information as needed.

The reports shall be submitted in electronic format and sent via electronic mail as requested by CalVet. If electronic mail is not available, arrangements will be mutually agreed upon by the Contractor and CalVet Contract Manager or designee.

4. CONTRACTOR/PROVIDER’S QUALIFICATIONS

A. Contractor/Providers must have the required licenses, insurance, permits, and/or certifications noted in

Exhibit A-1, Service Specifications.

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

CMO, SNF 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 identified as not meeting the qualifications.

5. LICENSES, PERMITS, AND CERTIFICATION REQUIREMENTS

A. 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 noted in Exhibit A–1, Service Specifications.

B. 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.

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

6. HEALTH & SAFETY

A. During times of pandemic (such as COVID-19) or other instances of widespread viral or bacterial infections, additional precautionary infection control steps may be implemented and required by the Home. These may include, but are not limited to: wearing CalVet approved masks and/or face shields, extra or special cleanings, social distancing, partitions, adjusted hours and obtaining additional clearance certifications that may be required by local, state or federal health authorities.

B. Providers shall comply with the Home’s COVID-19 Mitigation Plan and follow all current COVID-19 guidelines for precautions.

7. BUILDING SECURITY

The Contractor shall ensure each Provider has an identification badge which includes the name of the Provider, Name of the Contractor (if different), and a photo identification. The badge shall be worn above the waist by the Provider at all times while at the Home. Providers shall sign in and out at the main lobby, as required upon entering the Home. The Contractor/Provider shall follow all requirements indicated by the Home for visitor sign in/out procedures, authorized parking lots, security and reporting. Providers shall wear the Home issued visitor I.D. badge.

8. INDEPENDENT CONTRACTOR STATUS

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

State. Therefore, the 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

5. Other employee benefits

9. CONTACT INFORMATION

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

1. CalVet Representative/Contract Manager:

Veterans Home of California - West Los Angeles

TBD

11500 Nimitz Avenue Los Angeles, CA 90049

2. Contractor Representative:

TBD

B. Project Representatives, addresses, and phone/fax numbers may be changed by issuing a 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.