5._Exhibit_A_-_SOW_Sample.pdf

California Department of Corrections and Rehabilitation (CDCR)/ Bid Number: SD24-00021 California Correctional Health Care Services (CCHCS) Exhibit A Scope of Work

Rev. 6/10/2025 Page 1 of 9

PROSTHETIC AND ORTHOTIC SERVICES AND DEVICES

1. Introduction/Services

a. This is a statewide Agreement in which Contractor and/or Provider shall provide on-site Prosthetic and Orthotic Services and Devices on an as-needed basis to patients referred for such health care services from California Department of Corrections and Rehabilitation/California Correctional Health Care Services (CDCR/CCHCS) Institutions.

b. For purposes of this Agreement, “Contractor” is the party hereby contracting with CDCR/CCHCS and who is presumed to be qualified to have an active role under this to provide Prosthetic and Orthotic Services and Devices. Additionally, Contractor is also presumed to have a relationship with other providers for availability purposes in order to provide prosthetic and orthotic services and devices as needed to meet the requirements of this Agreement.

c. For purposes of this Agreement, the term “Provider” shall refer to any Provider who renders prosthetic and orthotic services and devices pursuant to this Agreement, as arranged through and/or associated with Contractor, as Contractor’s employee, independent contractor, and/or sub-contractor. “Provider” includes Contractor with respect to any instance or capacity, in which, Contractor is, or may be, acting as a Prosthetic and Orthotic Services and Devices Provider.

d. Contractor and/or Provider must provide all labor, equipment, supplies, staff, transportation, licenses, permits, certificates, and every other item of expense necessary, or incurred in providing prosthesis services and devices, including any expense anticipated or incurred by Contractor and/or Provider associated with travel to and from an institution. This includes, but is not limited to lodging, food, or any other travel expenses, as well as any expenses associated with work-related training and shall be the sole obligation of Contractor and/or Provider incurring the expense. CDCR/CCHCS has no obligation to pay or reimburse any such expense incurred by Contractor and/or Provider. Any lost/damaged equipment costs due to CDCR/CCHCS negligence will be negotiated with CCHCS Direct Care Contracts Section (DCCS) and in consultation with Contractor and/or Provider.

e. Services shall be provided at the direction of the Institution Chief Executive Officer/Chief Medical Executive (CEO/CME) or designee, and/or facility Associate Director (AD) or designee.

For purposes of this Agreement, CDCR/CCHCS designee must be a civil service employee.

The institution CEO/CME/AD or designee retains professional and administrative oversight for services provided. The responsibility of CDCR/CCHCS to provide prosthetic and orthotic services and devices is limited to those services which are medically necessary to protect life, prevent significant illness or disability, or alleviate severe pain that significantly disables the patient from reasonable independent function, and are supported by outcome data as being effective care.

f. Any service or treatment that is not medically necessary shall safely be deferred until the patient is released from custody. Any service considered under this Agreement is otherwise subject to the prior authorization requirement and all other requirements, processes, and limitations expressed herein, such as the request and scheduling process, and/or other limitations and requirements as imposed by law.

g. Contractor and/or Provider shall perform services pursuant to this Agreement, and in

SAMPLE

CDCR/CCHCS Bid Number: SD24-00021 Scope of Work Exhibit A

Rev. 6/10/2025 Page 2 of 9 accordance with CDCR/CCHCS policies and procedures, and federal and state laws and regulations. Contractor and/or Provider shall, at all times, comply with standard safety precautions and maintain CDCR security measures and a safe work environment.

h. Contractor and/or Provider must possess and maintain throughout the term of this Agreement, valid and unconditional licensure and/or board certification with no pending accusations from the applicable boards by which they are licensed and/or certified to practice in the area of medical specialty.

i. Contractor bears the responsibility for the provision of prosthetic and orthotic services and devices and performing any associated task in a manner consistent with the commonly accepted standard of care. Any and all services performed outside the scope of this Agreement will be at the sole risk and expense of Contractor and/or Provider. CDCR/CCHCS does not assume, agree to, or otherwise accept a duty to defend or indemnify a provider against any civil or criminal action arising out of or in association with this Agreement.

j. Contractor and/or Provider agrees that any excluded health care service or treatment needed for pre-existing conditions shall be provided only in the event that the condition has become exacerbated in such a manner that it poses a significant threat to the patient’s current health and if not treated would result in morbidity and/or mortality. Contractor and/or Provider acknowledges that the health care service or treatment must be recognized as medically necessary.

k. Contractor and/or Provider shall ensure that all ordered health care services and proposed surgical procedures shall be scheduled consistent with the severity of the medical need. Once scheduled, services shall be delivered at the time scheduled, unless unavoidable circumstances occur.

2. Contractor and/or Provider Responsibilities

a. Contractor and/or Provider must provide services to all institutions awarded on Exhibit B-1 – Bid Rate Sheet, and meet the requirements specified in Exhibit A-1 – Service Specifications.

Contractor and/or Provider must provide the State with proof of any required training, licenses, permits, certifications, and any other required documents as stated in Exhibit A-1 – Service Specifications and as required by law. Services will be performed only by Contractor and/or Provider who meet the requirements outlined in this Agreement.

b. Standards of Obligation

(1) Contractors and/or Provider must acknowledge and adhere to the CDCR/CCHCS medical staff bylaws, rules, regulations, policies, and procedures as directed by the institution CEO/CME/AD or designee and comply with universal infection control precautions.

(2) Contractor and/or Provider recognizes that CDCR/CCHCS acts in a fiduciary capacity to the State of California (the State) and that this fiduciary duty extends to the provision and management of medical health care services, mental health care services, and dental services for the patient of the State of California. To assist CDCR/CCHCS in its exercise of this duty, Contractor and/or Provider shall provide high quality services, consistent with the terms and conditions under this Agreement and consistent with established and commonly accepted standards and principles of medical practice. Nothing in this Agreement shall supersede the common law rules for the interpretation of established and commonly accepted standards and principles of medical practice.

Rev. 6/10/2025 Page 3 of 9

c. Reports

CDCR/CCHCS reserves the right to request that Contractor and/or Provider submit electronic reports or information related to this Agreement, as requested. Report submission details, including frequency of requested reports shall be determined by CDCR/CCHCS, upon execution of the Agreement, and in consultation with the Contractor and/or Provider.

CDCR/CCHCS may require reports to include - additional information pertaining to a provider, including, but not limited to, name, social security number, date of birth, etc. Non-compliance may result in termination of the Agreement. The reports shall be submitted by a mutually agreeable timeframe but no later than forty-five (45) calendar days of request.

The reports shall be submitted in a secure HIPAA compliant electronic format (Microsoft Excel 2000 or newer version) and sent via electronic mail (email) to m_ContractSupport@cdcr.ca.gov.

In the event that email is not available the reports can be sent via U.S. Mail to the following address:

California Correctional Health Care Services Attn: Direct Care Contracts Section P.O. Box 588500, Building D Elk Grove, CA 95758

d. Representatives

Contractor is responsible for establishing a designated representative(s) to work with DCCS staff to avoid unreasonable delay in the provision of the services delivered pursuant to this Agreement. Such representative(s) may be changed upon written notice to the other party.

e. Prior Authorization for Treatment

Excluding emergency care services, prior authorization must be obtained in writing from the institution CEO/CME/AD or designee via CDCR/CCHCS Request for Service (RFS), in accordance with CCHCS’ Utilization Management (UM) Plan. Contractor and/or Provider shall complete and return all forms required by CDCR/CCHCS regarding treatment of patient.

Authorization must be documented in the patient’s Electronic Health Record in all cases of essential services as well as any consultations by specialty physicians or diagnostic procedures not specifically stated in a CDCR/CCHCS prior authorization form. Except for emergency care, CDCR/CCHCS shall not render payment for services that do not have prior authorization; and/or if CDCR/CCHCS determined services were not medically necessary or if services were inappropriately delivered.

f. Experimental and Investigational Drugs and Procedures

Contractor and/or Provider shall not perform or administer to any patient any experimental or investigational treatment, therapy, procedure or drug. Any such treatment, unless it is related to specific California legislative provisions, is prohibited under Penal Code, Section 3502, and thus requires prior authorization from the appropriate institution CEO/CME/AD or designee.

Contractor and/or Provider shall perform or administer only those health care services which are recognized as being in accordance with generally accepted professional medical standards, or as being safe and effective for use in the treatment of an illness, injury or condition at issue.

g. Exclusions and Limitations

Rev. 6/10/2025 Page 4 of 9

(1) Contractor and/or Provider agrees that no health care service or treatment shall be provided for those conditions specifically listed in the California Code of Regulations (CCR), Title 15, Division 3, Chapter 2, Subchapter 2, Article 1, Section 3999.200. Contractor and/or Provider may request approval for individual case exceptions for excluded or limited health care service or treatment by seeking prior approval of the institution CEO/CME/AD or designee.

(2) Contractor and/or Provider shall be able to perform the tasks associated with providing the above health care services under the scope of their license and assumes full responsibility for the provision of these services.

h. Required Notices

Except as otherwise provided in this Agreement, any notice required hereunder shall be deemed to be sufficient if sent via email or U.S Mail to CDCR/CCHCS contact information located in Provision 14. If mail via the United States Postal Service is used to give any notice required in this Agreement, notice shall be deemed as given on the day after it is deposited in the United States mail with First Class postage prepaid and addressed to CDCR/CCHCS. Only actual written notice will suffice for the purpose of meeting any notice requirement in this Agreement.

i. Fit Testing

(1) Contractor shall ensure that Provider is in compliance with Title 8 CCR 5144 standards, including providing medical evaluation to determine the provider's ability to use a respirator before the provider is fit tested or required to use the respirator in the workplace. Contractor shall identify a physician or other licensed health care professional (PLHCP) to perform medical evaluations using a medical questionnaire or an initial medical examination that obtains the same information as the medical questionnaire. Contractor shall provide additional medical evaluations if:

(a) provider reports medical signs or symptoms that are related to the ability to use a respirator;

(b) a PLHCP, supervisor, or the respiratory protection program administrator informs the provider that they need to be reevaluated;

(c) information from the respiratory protection program, including observations made during fit testing and program evaluation, indicates a need for provider reevaluation; or

(d) change occurs in workplace conditions (e.g., physical work effort, protective clothing, temperature) that may result in a substantial increase in the physiological burden placed on a provider.

(2) Contractor shall ensure the provider is fit tested with the same make, model, style, and size of respirator that will be used. Provider must be fit tested on a NIOSH-certified N95 respirator annually, within twelve (12) months of the last fit test. Provider shall obtain an additional fit test whenever there is a change or if the contractor or the PLHCP makes visual observations of changes in the provider's physical condition that could affect respirator fit. Such conditions include, but are not limited to, facial scarring, dental changes, cosmetic surgery, or an

Rev. 6/10/2025 Page 5 of 9 obvious change in body weight. Fit testing records must include name of provider, date of testing and respirator(s) make, model, and size, if applicable. Fit testing records must be provided to the CDCR/CCHCS upon request.

(3) Contractor shall provide respiratory protection training to providers annually and more often if necessary.

3. Request for Services

a. Contractor and/or Provider agrees to provide on-site direct health care services as arranged with the institution CEO/CME/AD or designee upon request, in accordance with each institution’s policies and procedures.

b. Contractor shall have a telephone number and email address, as well as a designated representative available by telephone during normal hours of clinic operation for the duration of the Agreement. Clinic hours may vary between the hours of 6:00 a.m. and 5:00 p.m. (PST), Monday through Friday. Telephone answering devices (i.e., message machines) and answering services are not permitted, and their use may be cause for termination of this Agreement. The initial contact will be by telephone; however, CDCR/CCHCS will follow-up with email.

c. The State reserves the right to award multiple Agreements for back-up purposes. When services are needed, CDCR/CCHCS may, at the discretion of the institution CEO/CME/AD or designee, choose one of the options below when contacting Contractors to request services.

(1) The Rank 1 Contractor must be contacted prior to an institution authorization to contact the Rank 2 Contractor, this process continues until the institution has met its needs; or

(2) Institution may contact multiple Contractors in order of the bid matrix as long as this begins with the lowest ranked Contractors (e.g. Ranks 1-3). If the first group of Contractors contacted do not respond within the allotted time as noted in Section 4.a, or if none of the Contractors are able to provide services, the next group of Contractors (e.g. Ranks 4-6) can be contacted. This process will be repeated based on the number of Agreements awarded and start over each time the institution contacts Contractors to request services.

d. Contractor with multiple agreements for the same service and same institution shall be obligated to provide services at the same rates in the primary contract until all the obligations under the primary contract are attained before the secondary or subsequent contract can be in effect. The only exception to this provision occurs when the rate(s) in a subsequent agreement is lower than those of the primary agreement; the State then has the sole right to determine which rate(s) will be applied.

e. Contractor acknowledges that the institution may request for on-site services to be provided at any time, including weekends and holidays.

4. Responding to a Request for Service

a. Contractor shall respond to institution’s request for services within the standard response time of two (2) hours, unless otherwise stated by CDCR/CCHCS. CDCR/CCHCS may extend the response time, at the discretion of the institution CEO/CME/AD or designee, and dependent upon the urgency of the request for services. The response time shall be included on the request for service. CDCR/CCHCS reserves the right to accept a response from other Contractor(s)

Rev. 6/10/2025 Page 6 of 9 after the response time has elapsed.

b. Contractor and/or Provider shall respond to the institution’s request for documentation as part of the request for services, which may include, but not limited to, copies of any current and valid licenses, permits, and/or certifications, unless already on file. A response without the necessary or requested supporting documentation as described above may be deemed as non-responsive and the next ranked Contractor(s) will be contacted.

5. Scheduling

a. Contractor and/or Provider shall ensure that all ordered services have prior authorization in accordance with institution UM and are mutually agreed upon between the institution CEO/CME/AD or designee and Contractor.

b. At the time of scheduling, institutions shall provide Contractor and/or Provider with an estimated period of time the institution anticipates the need for contracted services. This will be a good faith estimate based on the circumstances known to CDCR/CCHCS at the time of the request.

It is not a guarantee of business and is subject to change depending on CDCR’s fluctuations in CDCR patient population. However, CDCR/CCHCS shall endeavor to provide five (5) business days’ notice prior to cancellation of clinics.

c. Contractor shall provide services to the institution at the time mutually agreed upon between the institution CEO/CME/AD or designee and Contractor. Contractor shall provide services at the agreed upon timeframe, regardless of the number of patients scheduled to be evaluated.

6. Overtime Pay Rate Allowances

No overtime pay will be authorized under this Agreement.

7. Holiday Pay Rate Allowances

No holiday pay rate will be authorized under this Agreement.

8. Telephonic Consultations

No telephonic consultations will be authorized under this Agreement.

9. Orientation and Training

At the discretion of each institution, Contractor and/or Provider agrees that prior to reporting to work at the institution, all providers shall complete orientation/training as specified below at Contractor’s sole expense:

a. On-site Institution Orientation/Training

Contractor agrees that all providers shall attend on-site orientation and any other required training (i.e. annual block training and Learning Management System [LMS]) prior to reporting to work at the institution. Orientation/training is designed to assist providers to become familiar with the operations of the institution, its medical facilities, and Title 15 of the CCRs. To maintain continuity of services and ensure safety for all workers, Contractor shall make available to the institution only those providers who have completed the orientation.

Rev. 6/10/2025 Page 7 of 9

b. Self-Certification Orientation Process

This process may be utilized in place of attending an on-site institution orientation based on institution approval. The parties agree that there will be no reimbursement for assigned providers who have been approved to utilize the Self-Certification Orientation Process.

(1) Contractor shall obtain a copy of the Health Care On-Site Contractor’s Orientation Handbook from institution and return the signed copy of the CCHCS Orientation Acknowledgement form once complete.

(2) Contractor shall be responsible for ensuring that all providers complete the orientation and sign the Self-Certification Acknowledgement.

(3) Contractor shall maintain the signed copies (new and renewed) of the CCHCS Orientation Acknowledgement and provide to CDCR/CCHCS upon request.

10. Inspections

Inspections may be carried out by the institution CEO/CME/AD or designee, at various times during the Agreement term to check on the quality and quantity of work and determine acceptability of work performed before Agreement payment will be approved.

11. Failure to Perform

a. CDCR/CCHCS shall routinely evaluate the work performance of Contractor and/or Provider to determine if CDCR/CCHCS standards and departmental/institutional policies and procedures are being met. Any Contractor and/or Provider who fail to perform or who are physically or mentally incapable of performing the required duties as required by this Agreement shall not be permitted to perform service. The institution CEO/CME/AD or designee shall state in writing the reasons Contractor and/or Provider did not meet the required policies or standards and submit a copy to Contractor and to the Contract Support Team at: m_ContractSupport@cdcr.ca.gov

b. CDCR/CCHCS shall not pay Contractor and/or Provider for any services performed by Contractor and/or Provider which are deemed unacceptable in accordance with the required services anticipated by this Agreement.

c. Failure to provide services on three (3) or more occasions may result in termination of the Agreement or the institution not having to contact the first ranked Contractor prior to contacting the other Contractors for the duration of the Agreement term. DCCS Staff Services Manager III (SSMIII) or designee has the sole discretion in this decision.

12. Suspension or Stop Work Notification

a. CDCR/CCHCS may, at any time, issue a written notice to suspend performance or stop work under this Agreement. Upon receipt of said notice, Contractor and/or Provider are to suspend and/or stop all, or any part, of the work called for by this Agreement.

b. Written confirmation of the suspension or stop work notification with directions as to what work (if not all) is to be suspended and how to proceed will be provided within thirty (30) calendar days of the written notification. The suspension or stop work notification shall remain in effect until mailto:m_ContractSupport@cdcr.ca.gov

Rev. 6/10/2025 Page 8 of 9 further written notice is received from CDCR/CCHCS. The resumption of work (in whole or part) will be at the discretion of CDCR/CCHCS and upon receipt of written confirmation.

(1) Upon receipt of a suspension or stop work notification, Contractor and/or Provider shall immediately comply with its terms and take all reasonable steps to minimize or halt the incurrence of costs allocable to the performance covered by the notification during the period of work suspension or stoppage.

(2) Within thirty (30) calendar days of the issuance of a suspension or stop work notification, CDCR/CCHCS shall either:

(a) Cancel, extend, or modify the suspension or stop work notification; or

(b) Terminate the Agreement as provided for in the Right to Terminate clause of the Agreement.

c. If a suspension or stop work notification issued under this clause is cancelled, or the period of suspension or any extension thereof is modified or expires, Contractor and/or Provider may resume work only upon written concurrence of CDCR/CCHCS.

d. If the suspension or stop work notification is cancelled, and the Agreement resumes, changes to the services, deliverables, performance dates, and/or contract terms resulting from the suspension or stop work notification shall require an amendment to the Agreement.

e. If a suspension or stop work notification is not cancelled, and the Agreement is cancelled or terminated pursuant to the provision entitled Right to Terminate, CDCR/CCHCS shall allow reasonable costs resulting from the suspension or stop work notification in arriving at the settlement costs.

f. CDCR/CCHCS shall not be liable to Contractor and/or Provider for loss of profits because of any suspension or stop work notification issued under this clause. For any service by Contractor or its providers provided under this Agreement prior to the effective date of a notice to suspend or stop work, CDCR/CCHCS shall review those services to confirm they meet the terms of the Agreement and shall in good faith make a determination whether payment is warranted.

13. Amendments

The State is executing this Agreement for a period of thirty-six (36) months. CDCR/CCHCS reserves the right to extend the Agreement up to an additional 12 months at the same rates and maximum dollar amount per year as the original Agreement and/or amend to increase funding for additional prosthetic and orthotic services and devices through an amendment signed by both parties. All agreement amendments are subject to satisfactory performance, funding availability and may require approval from the DGS/OLS. Rates submitted in this Agreement shall remain in effect for the term of the Agreement and any amendment to the term of the Agreement.

14. Department of Corrections and Rehabilitation Contact Information

Should questions or problems arise during the term of this Agreement, Contractor should contact the following offices:

Rev. 6/10/2025 Page 9 of 9

a. Billing/Payment Issues:

Goods/Durable Medical Equipment Sacramento Regional Accounting Office Attention: Accounts Payable “A” P.O. Box 187015 Sacramento, CA 95818-7015 Email address: APA.invoices@cdcr.ca.gov

b. Scope of Work/Performance Issues:

Refer to Exhibit G - List of Participating CDCR Institutions for addresses and telephone numbers.

The institution contract liaison can be contacted Monday through Friday from 8:00 a.m. to 4:00 p.m. The institution contract liaison or designee shall pre-arrange all needed services to assure continuity of care.

c. General Agreement Issues:

California Correctional Health Care Services Direct Care Contracts Section - Contract Support Team P.O. Box 588500 Elk Grove, CA 95758 Phone Number: (916) 691-0698 m_ContractSupport@cdcr.ca.gov

SAMPLE

mailto:APA.invoices@cdcr.ca.gov mailto:m_ContractSupport@cdcr.ca.gov