5-Attachment C - Scope of Work.docx

SCOPE OF WORK

Article 1

BACKGROUND

1.1 Background. The Utah Department of Health and Human Services, Utah State Developmental Center (“DHHS/USDC”) currently runs approximately 10,000 prescriptions (new and existing) per week. The purpose of this contract is to provide pharmacy services for individuals at DHHS/USDC. The size and type of population served at DHHS/USDC is subject to change as the State of Utah’s needs change.

Article 2

CONTRACTOR QUALIFICATIONS

2.1 Qualifications. The Contractor shall:

(1) maintain a current professional license to conduct pharmaceutical services in the State of Utah;

(2) be a Medicaid provider with an active NPI (National Provider Identifier) number;

(3) maintain the ability to bill all types of Medicaid, Medicare and private Insurance; and

(4) have the ability to send and receive messages in the National Council for Prescription Drug Programs (“NCPDP”) format directly between DHHS/USDC and the pharmacy, not using a third-party information network exchange platform.

Article 3

SERVICE REQUIREMENTS

3.1 Prescription Ordering. The Contractor shall:

(1) prepare prescription orders off site and deliver them to the requesting DHHS facility within 24 hours of receiving the prescription order;

(2) be able to receive prescriptions sent by DHHS practitioners and nurses seven days a week;

(3) contact DHHS/USDC within one hour of receiving the order for non-formulary drugs or drugs ordered with possible interaction or medical concerns;

(4) obtain pre-authorization from Part D Medicare and Medicaid or private insurance for medications that require pre-authorization at the time DHHS places the prescription order;

(5) contact the ordering provider for further guidance If medication is unauthorized;

(6) be available for emergency consultations by phone 24 hours a day, seven days a week, including holidays;

(7) maintain a formulary accessible by both the Contractor and DHHS medical staff;

(8) maintain the ability to handle Statum (STAT) prescription orders and refills to the medication dispensing machine within four hours (antibiotics must be delivered within one hour); and

(9) provide an interactive interface to communicate with DHHS/USDC’s E-Chart and the Contractor’s computer application.

3.2 Prescription Fulfillment. The Contractor shall:

(1) make scheduled hand-deliveries at least twice per week;

(2) make unscheduled hand-deliveries as required by DHHS, which may be required multiple times per day;

(3) ensure regular hand-delivered intervals happen at least twice per week or more often if required by DHHS;

(4) deliver all medications directly to each building;

(5) provide medication supplies to patients of DHHS using the FastPack EXP 320 robot packing system or similar packet system with a complete label including: (A) name of Individual; (B) building; (C) apartment number; (D) medication; and (E) dosing Instructions, including date and time;

(6) provide a maximum seven day supply to each patient at one time, as medication requirements change frequently, and anything more results in wasted time and materials;

(7) ensure daily medication changes are reflected in the next day's packet fulfillment;

(8) accept the return of any unused medications and issue a credit to DHHS for unused or unopened medications within 30 days of receiving the unused medication;

(9) educate DHHS medical staff, as requested, on drugs and pharmacy matters; and

(10) provide at least one dedicated pharmacy technician with no less than two years’ experience in the pharmaceutical field, to coordinate between the remote pharmacy and DHHS, and who can be available on-site as requested, with responsibilities of the pharmacy technician including:

(A) working with DHHS providers to ensure prescribed drugs are on the formulary;

(B) coordinating interaction between the pharmacy and DHHS, including screening all faxes and keeping a record of previous communications;

(C) ensuring the technological interface between DHHS and the Contractor is working; and

(D) ensuring the medication dispensing machine is fully stocked and functional.

3.3 Medication Dispensing Machine. The Contractor shall:

(1) provide and be responsible for fixing and maintaining any problems that arise with a secure automated inventory and medication dispensing machine;

(2) ensure the machine is stocked with medications as defined by DHHS;

(3) ensure the specified drugs are available from the machine within 15 minutes of prescription request; and

(4) monitor and maintain inventory levels and expiration dates independently from USDC.

3.4 Emergency Kits. The Contractor shall:

(1) provide one Basic Emergency Kit for each residential building at USDC, and at least one Advanced Emergency Kit for each practitioner;

(2) ensure the Kits contain medications and supplies as defined by USDC;

(3) stock and maintain each Kit, and replace expired medication;

(4) restock items within 24 hours of being reported to the Contractor;

(5) fill and deliver after-hour prescriptions not found in the Basic Emergency Kit or Advanced Emergency Kits, to the DHHS/USDC campus within four hours of prescription request, with the exception to this rule being that any antibiotics must be restocked or delivered within one day; and

(6) be responsible for any after-hours or delivery costs, at no additional charge to DHHS.

Article 4

INFORMATION TECHNOLOGY REQUIREMENTS

4.1 DHHS/USDC Information Technology Requirements. DHHS/USDC will use the NCPDP Script pharmacy interface to:

(1) initiate a request for a new prescription;

(2) initiate a request to cancel or discontinue a prescription that has already been transmitted;

(3) notify the pharmacy about admission, discharge, transfer and leave, manually or electronically;

(4) modify the prescription order and notify the pharmacy; and

(5) send a refill request, manually or electronically.

4.2 Contractor Information Technology Requirements. The Contractor shall:

(1) use the NCPDP Script pharmacy interface to:

(A) initiate a notification of a dispensed, not dispensed, or partially dispensed prescription as requested;

(B) discontinue an order as requested; and

(C) enter a new order as requested;

(2) allow direct submission of NCPDP messages rather than going through a third-party health information network for non-controlled substance RX Orders, with the potential to move to a third-party health information network in the future for submitting all RX orders, including controlled substances;

(3) back up all patient data consistent with industry best practices;

(4) acknowledge medical data is the property of DHHS, and shall be returned to DHHS at the end of this contract in a usable format;

(5) ensure all data, including backups, are stored within the United States and must be encrypted at rest and in transit;

(6) ensure all appropriate measures are taken to ensure data has been deleted from the Contractor's systems after the contract has ended and, if requested, provide a copy of the data to DHHS in a usable format;

(7) allow Utah State Division of Technology Services personnel to inspect, at any time, any I.T. device accessing State secured data;

(8) be subject to device inspection that may include a detailed review of any file, Informational assets, or data storage media installed or connected to the Information technology device in question; and

(9) follow all terms and conditions of the IT General Provisions as outlined in Attachment A.

Article 5

QUARTERLY REVIEWS

5.1 Quarterly Reviews.

(a) With input from DHHS practitioners, the Contractor shall review the drug regimen of each client at least quarterly, including for control of inappropriate behavior for their effectiveness in changing targeted behavior or symptoms, untoward side effects, and contraindications for continued use. The Contractor shall report any irregularities in clients’ drug regimens to the prescribing practitioner.

(b) DHHS will make blood test results and electronic health charts available to the Contractor for review. The Contractor shall inform the practitioners of any deviations from protocol or other noted concerns. The Contractor shall conduct the review using guidelines established by DHHS practitioners in collaboration with the Contractor.

Article 6

BILLING AND PAYMENT

6.1 Billing and payment.

(a) The Contractor shall bill all medications directly to private insurance providers, Medicaid or Medicare (referred to collectively herein as third-party insurers), except for DHHS patients who have no insurance. The Contractor shall contact the ordering practitioner before dispensing medication when a drug is not covered by third-party insurers. The Contractor shall provide over-the-counter or other medications excluded from coverage by third-party insurers and bill DHHS for the National Average Drug Acquisition Cost (NADAC) 2026 Affordable Care Act Federal Upper Limits (FUL) or TrumpRx pricing, whichever is lower. Comment by Kainoa Willing: “OTC” is not mentioned anywhere else in the SOW, so there’s no need to define it.

(b) Except as described otherwise in this subsection, The Contractor shall be responsible for all costs associated with "Filled-too-soon" rejections by third-party insurers. If authorized by a DHHS/USDC practitioner, DHHS will reimburse such costs and pay the National Average Drug Acquisition Cost (NADAC) 2026 Affordable Care Act Federal Upper Limits (FUL) or TrumpRx pricing, whichever is lower.

(c) The Contractor shall be responsible for the cost of drugs that are rejected by third-party insurers that do not meet the third-party insurer's formulary requirements, unless the Contractor has notified the DHHS prescribing practitioner in advance of the prescription being filled and the DHHS prescribing practitioner has approved its use or changed to a different formulary drug.

Article 7

ADMINISTRATIVE REQUIREMENTS:

7.1 Contractor Training Requirements. The Contractor shall:

(1) train its employees assigned to work at DHHS on the following topics prior to working on DHHS premises:

(A) the most current DHHS Provider Code of Conduct, as found on the DHHS website;

(B) the most current DHHS Adult Protective Services and mandatory reporting requirements of Utah Code § 62A-3-305; and

(C) other training as required by DHHS;

(2) ensure on-site employees complete the following DHHS-provided training: (A) Security Awareness; (B) Respect in the Workplace; and (C) Privacy Awareness; and

(3) oversee the training of its employees and monitor performance to achieve and sustain compliance with DHHS policies and regulations.

7.2 Background Screening. The Contractor shall comply with the background screening requirements in Utah Code §26B-2-120 and Utah Administrative Code R501-14. The pharmacy technician(s) must pass a background check before working at DHHS. The Contractor shall cover all costs associated with the background check(s).

7.3 HIPAA Business Associates Agreement. The Contractor shall sign and comply with HIPAA and the attached DHHS/USDC HIPAA Business Associate Agreement.

Article 8

OUTCOMES

8.1 Routine Medications.

(a) Outcome: All routine medications are delivered in a timely and accurate manner.

(b) Measure: The Contractor shall maintain 95% accuracy in initial fulfillment and 100% accuracy when corrections are needed.

(c) Reporting: DHHS/USDC will survey nurses yearly to ensure compliance.

8.2 Emergency Medications.

(a) Outcome: Emergency medications are available at DHHS/USDC for immediate clinical use.

(b) Measure: The Contractor shall ensure 100% availability of emergency medications at DHHS/USDC.

(c) Reporting: DHHS/USDC will conduct a yearly spot check of Medication E-kits to verify stock levels, integrity, and expiration dates. DHHS/USDC will conduct an annual Medical Staff Survey to assess the ease of access and perceived availability of emergency medications during critical incidents.

8.3 Cost Efficiency.

(a) Outcome: Maximum cost efficiency is achieved.

(b) Measure: The Contractor shall exhaust all insurance options before seeking reimbursement from DHHS.

(c) Reporting: DHHS/USDC will perform monthly audits of Contractor invoices to verify that all third-party billing opportunities have been fully utilized.