3-DHHS26065 Optometry Services SOW Final.docx

20 KB Posted

Attached to
Optometry Services at Utah State Hospital
Solicitation number
DHHS26065
Issued by
Salt Lake County, Salt Lake City, Utah

About this file

Written by GovTribe AI ·

This is a Scope of Work document for the Department of Health and Human Services, Utah State Hospital, outlining the requirements for optometry services to be provided at the Mark I. Payne Medical Services building in Provo, Utah. The contract requires a licensed optometrist with a doctorate degree, at least five years of optometry experience, and a minimum of one year working with mentally ill populations to provide comprehensive eye care services including consultations, diagnostic testing, treatment, and preventative care. The optometrist must maintain consistency in service delivery to the extent possible, ensure the same provider delivers services regularly, and coordinate with the DHHS Clinical Director regarding scheduling, which is currently set at two times per month serving approximately 20 patients monthly. The contractor is required to provide 60 days' advance notice for planned absences and immediate notification for unforeseen circumstances. Records must remain on-site, and the contractor must execute a Business Associate Agreement compliant with HIPAA requirements.

The contractor shall submit monthly invoices to the DHHS Business Office containing required information including service descriptions, dates rendered, contract number, invoice number, contractor name, address, phone number, and signature. Monthly performance reports must document 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 for electronic chart documentation. Compensation structure and specific contract term details are not specified in this document. The contract guarantees no minimum hours per week, with service hours dependent upon patient need, though specific wage rates or payment amounts are not outlined in the scope of work.

View the file

Other files

File Type Posted
2-Form 1 IRS Form W-9.pdf PDF
5-Form 2b Conflict of Interest Certification UGE.pdf PDF
8-DHHS Client Service Terms.docx DOCX document
6-AAA DHHS BAA Template 8.14.2023.docx DOCX document
1-DHHS26065 IFB Optometry Services at USH.docx DOCX document
7-Form 2a Conflict of Interest Disclosure Statement.pdf PDF
9-DHHS26065 Submission Instructions.docx DOCX document
4-DHHS26065 Cost Proposal Form.doc DOC document

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

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.

File details come from the government source that posted it. Updated .