7747.03-RICHTER-CONTRACT+DELIVERABLES+FEES-9.9.21.pdf

WISCONSIN DEPARTMENT OF CORRECTIONS

Governor Tony Evers / Secretary Kevin A. Carr

3099 E. Washington Ave. PO Box 7925 Madison, WI 53707 Phone: (608) 240-5000 doc.wi.gov

CO N T R A C T

Services: Optometry Services for the Department of Corrections Division of Adult Institutions, Bureau of Health Services.

Contract Period: The Contract shall commence and be effective April 1, 2021 through March 31, 2024 with one 3-year renewal term option by mutual agreement between the Provider and the Department of Corrections

Provider: Richter Professional Services, Inc.

Reference Number: General Waiver: KHA7747

Contract Number: 410008-W21-ELB7747-GEN-03

I. DEFINITIONS:

Agency: Office, department or agency or other body in state government created by the constitution or any law, including the legislature and the courts but not including an authority.

Provider: Successful vendor awarded the Contract.

County: A region created by territorial division for the purpose of local government.

DAI: Division of Adult Institutions administers all adult state correctional incarceration facilities with administrative offices at DOC Central Offices, 3099 E Washington Ave., Madison, WI 53704.

DOA: Department of Administration has statutory authority [WI Stats. Chapter 16] to define, regulate and delegate all aspects of procurement of services and commodities for state agencies.

DOC: Wisconsin Department of Corrections also referred to as the department or the DOC headquartered at

DOC Central Offices, 3099 E Washington Ave., Madison, WI 53704.

PIOC: Person under the custody or supervision of the Wisconsin Department of Correction.

Prison: A correctional institution where persons are confined after being convicted of a crime.

State: State of Wisconsin.

Subprovider: Subprovider is a person who is awarded a portion of an existing Contract by a principal or general

Provider.

Third Party: Refers to a person or entity who is not a party to this Contract.

DocuSign Envelope ID: 664FB54F-6676-4C69-ABB5-5277778BF7D2

II. PARTIES TO THE CONTRACT

A. This contractual agreement (“Contract”) is entered into between the State of Wisconsin Department of

Corrections, whose principal business address is 3099 East Washington Ave., P.O. Box 7925, Madison, WI

53707-7925, (the “DOC”), and

Richter Professional Services, Inc., whose principal business address is 811 Cattail Ct., Plymouth, WI 53073-

49976 (the Provider).

B. The DOC employee responsible for administration of this Contract will be Michael Rivers (“Contract

Administrator”) whose principal business address is DOC Central Office. In the event that the Contract

Administrator is unable to administer this agreement, DOC will contact Provider and designate a new Contract

Administrator.

C. The Contract Administrator for Richter Professional Services, Inc., is James Richter, whose principal business address is the Provider’s principal business address.

III. CONTRACT AUTHORITY

This Contract is entered under the authority of Wis. Stats.16.75 and Wis. Adm. Code Chapter Adm 10.

IV. SCOPE OF CONTRACT AND STATEMENT OF DELIVERABLES

A. The Provider will deliver comprehensive eye examination and fitting services (the “Service”) to be delivered as per specifications in the contract.

B. This Contract detail for providing Service hereunder is specified in Attachment A which is attached hereto and incorporated herein by reference.

V. CONTRACT DOCUMENTS

Form DOA-3054 (“Standard Terms and Conditions”) and Form DOA-3681 (“Supplemental Standard Terms and

Conditions for Procurement of Services”) are incorporated into this Contract by reference. To the extent that any term or condition set forth in either Form DOA-3054 or Form DOA-3681 differs or conflicts with this Contract, the term, condition, or Contract provision determined by the DOC to be the more favorable to the DOC in any given situation shall govern and control. Copies of Forms DOA-3054 and DOA-3681 are available upon request from the DOC or the State of Wisconsin Bureau of Procurement.VI

VI. CONTRACT REVISIONS/ADDENDUMS

Any subsequent revisions or addendums to this Contract must be in writing and signed by both parties.

VII GENERAL SERVICE PROVISIONS

A. Provider may not subcontract, refer to outside/community resources, or assign any part or obligations of this

Contract without the prior written consent of DOC. If DOC approves, Provider is responsible for having subcontracts in place to provide service to the subcontracted agencies under this Contract. Provider retains responsibility for fulfillment of all terms and conditions of this Contract when it enters into subcontractual agreements.

B. This Contract and the performance of the parties' obligations hereunder will be governed by and construed and enforced in accordance with the laws of the State of Wisconsin, other than any conflict-of-law’s provisions thereof that would otherwise require the application of the law of any other jurisdiction. Provider consents to personal jurisdiction in the State of Wisconsin. The venue for any action hereunder shall be in Dane County, Wisconsin.

C. No waiver by either party of any default hereunder shall be deemed as a waiver of any prior or subsequent default of the same or other provisions of this Contract.

D. If any provision hereof is held invalid or unenforceable by a court of competent jurisdiction, such invalidity shall not affect the validity or operation of any other provision and said provision shall continue to apply to the extent allowed by said court or, if not so allowed, be deemed severed from this Contract entirely.

E. Providers are prohibited from responding to legal or legislative matters as a representative of DOC. All legal or legislative inquires requiring a response by DOC are to be referred to DOC Secretary’s Office in a timely manner for an appropriate response.

F. The parties hereto agree that Provider, its officers, agents, and employees, in the performance of this Contract shall act in the capacity of an independent Provider and not as an officer, employee, or agent of DOC. Provider agrees to take such steps as may be necessary to ensure that each of its Subproviders will be deemed to be an independent Provider and will not be considered or permitted to be an agent, servant, joint venturer, or partner of

DOC. Furthermore, neither DOC nor Provider will represent itself as the agent or legal representative of the other or as partner or joint venturers for any purpose whatsoever, and neither shall have any right to create or assume any obligations of any kind, express or implied, for or on behalf of the other in any way whatsoever.

G. Any and all notices or other communications necessary or desirable to be given hereunder will be deemed given and received when personally delivered, delivered prepaid same-day or overnight delivery service, proof of delivery requested, or deposited in U.S. certified or registered mail, postage prepaid, return receipt requested, addressed as follows and by email:

(i) If to DOC:

Department of Corrections, DOC

Contract Administrator: Michael Rivers

Email address: michael.rivers@wisconsin.gov

(ii) If to Provider:-

Attention: James Richter, O.D.

Company: Richter Professional Services, Inc.

Email address: jamesrichter1948@gmail.com

VIII PAYMENT TERMS AND INVOICING

A. Payments for Services: Provider will be paid in accordance with the fee schedule incorporated as Attachment B of this Contract. Provider agrees to enter claim information into DOC’s Third-Party Administrator’s (TPA) online portal. The TPA shall accept and pay claims which meet all PHI and electronic claims and remittance processing requirements of HIPAA (i.e. the 837 and 835 compliant transactions) and any amendment. Such payment shall be made within thirty (30) days after entering claim information into the TPA’s portal. In the event

Provider does not receive payment from DOC within 30 days of filing a complete and accurate claim, (averaged over a FY quarter) Provider will be paid an additional 1% per month per prompt pay statute. A good faith dispute may create an exception for prompt payment. The Provider payments are payment for performing optometric medical services for a PIOC.

B. Timeliness of Claims Filing. All claims for payment for medical services rendered by Provider shall be submitted in accordance with CMS Medicare guidelines within one hundred and eighty-three (183) days of the later of, date-of-service, or notification from DOC that DOC is liable for care provided as a primary or secondary payer or receipt of primary payer’s remittance advice. Any claim submitted pursuant to this Contract which is not submitted within that time frame shall not be eligible for payment under this Contract; unless such requirement is waived in writing by DOC. OC shall pay Provider for all valid outstanding claims according to the terms of section VIII A.

C. Payment in Full. Unless payment is available from another source, Provider shall accept payment for medical services performed for DOC, in accordance with Attachment B, as payment in full.

D. Refunds. DOC shall have the right to request a refund for an overpayment, provided, however, that such request shall be made by DOC within three (3) months of DOC’s payment of such claim and such request is accompanied by sufficient documentation to establish the accuracy of DOC’s claim for entitlement to a refund providing claim is not under dispute. DOC may recoup past erroneous payments from future payments. Provider represents that, in the event of an overpayment by DOC, Provider shall promptly initiate the refund. If refund not paid within 30 days from DOC’s valid request for a refund, then DOC or its DOC designee may recoup from future payments.

E. Appeals and Claims Resubmissions. If DOC or its designee processes a claim that results in partial or no payment, Provider is entitled to appeal the denial. Appeal requests shall be submitted with supporting documentation no more than one (1) year from date of receipt of the denial by Provider. Claim resubmissions shall be submitted within one (1) year from the filing of the original claim(s). Payer shall respond to an appeal or claim resubmission within thirty (30) days of Provider’s filing of the appeal or resubmission. If additional payment is warranted, such payment shall be paid within thirty (30) days of determination.

mailto:jamesrichter1948@gmail.com

IX REPORTING AND AUDITING

A. Provider shall comply with the reporting and auditing requirements of DOC including, without limitation, the requirement that Provider retain all documents applicable to the Contract for a period of not less than six (6) years after the final Contract payment is made. Any required reports shall be forwarded to the Contract Administrator according to the schedule of DOC. If Provider does not submit the forms as required, DOC may cease all payments for Services to Provider under this Contract.

B. DOC may require, at its discretion that Provider provide an audit covering all DOC funds paid pursuant to the

Contract. In the event that Provider fails to comply with a DOC audit request including all follow-up requests for information pertaining to said audit, DOC reserves the right to conduct an independent audit and DOC’s costs for completing the same will be charged back to Provider. Provider agrees to retain and make available to DOC all program and fiscal records until the audit and, if necessary, subsequent audit resolution processes have been completed.

C. Provider agrees to inform DOC within three (3) working days of any inquiry from outside entities regarding a participant, former participant or the program provided under this Contract. This includes requests for information from the media, legislature, local officials, neighbors and participant's family members. Nothing in this Contract prohibits the Provider from freely communicating with any entity regarding the program or participants to the extent allowed by confidentiality requirements.

X RECORDS

A. Provider shall maintain such records as are required by State and Federal law and shall comply with all applicable confidentiality laws and requirements pertaining to said records and the information contained therein.

B. Provider will allow inspection of records and programs, insofar as is permitted by State and Federal law, by representatives of DOC and its authorized agents, and Federal agencies, in order to confirm Provider's compliance with the specifications of this Contract.

Worker’s Compensation Statutory Requirements

$100,000 each accident

$500,000 disease-policy liability limit

$100,000 disease-policy liability limit for each employee

Commercial General Liability $1,000,000 each occurrence of bodily injury and property damage

$1,000,000 general aggregate, including product liability and completed operations

Automobile Liability (covering all owned, non-owned and hired vehicles)

$1,000,000 per occurrence combined single limit for liability and property damage

Professional Liability (medical malpractice)

$2,000,000 per occurrence * **

$2,000,000 aggregate

C. Provider agrees to retain and make available to DOC all program and fiscal records until the audit and subsequent audit resolution processes have been completed.

D. To ensure confidentiality of records and safeguard access to these records, Provider must maintain secure data protocols for current and closed PIOC records.

E. Provider agrees to have a written policy on confidential destruction of care records.

XI INSURANCE RESPONSIBILITY

Throughout the term of this contract and any renewal periods, the Provider shall maintain insurance in the types and with the limits outlined below. Policies must be issued with a 30-day cancellation notice, by an insurance company licensed to do business in the State of Wisconsin with a minimum AM Best Company rating of A-, and signed by an authorized agent. The Provider shall provide a Certificate of Insurance to the Contract Manager, prior to the contract start date or the commencement of services.

Additional Insured: The Provider shall add the “State of Wisconsin, its officers, employees and agents” as an additional insured under the commercial general, automobile and professional liability policies.

The certificate holder: Wisconsin Dept. of Corrections

3099 E. Washington Ave.

Madison, WI 53707

Prior to the expiration date of each policy, the Provider will provide a renewal certificate evidencing continued insurance coverage. Renewal certificates may be emailed to DOCPurchasingHelpDesk@Wisconsin.gov. Please reference the solicitation number or contract number in your email.

** If the professional maintains all or a portion of the Professional Liability insurance coverage, the Provider shall ensure that the professional maintains the coverage throughout the term of the contract and any renewal periods.

The Provider shall ensure that the DOC receives an insurance certificate from the professional that indicates the limit of insurance provided.

Provider staff covered by the Injured Patients and Families Compensation Fund, as outlined in Wisconsin Statute

655, shall provide evidence of statutorily mandated professional liability (medical malpractice) insurance coverage in the amount of $1,000,000 for each occurrence incident and $3,000,000 for all occurrences in one year, as well as proof of participation in Injured Patients and Families Compensation Fund.

XII BACKGROUND CHECKS OF PROVIDER’S STAFF AND APPLICANTS

A. The Provider shall not employ a person who is on active probation, parole, extended supervision, lifetime supervision or an PIOC who is supervised by Intensive Sanctions for any position where the primary duties and responsibilities involve contact or work with PIOCs or involves access to a PIOC’s records or funds.

Provider shall implement policies and procedures to ensure that job applicants and its staff shall be dealt with as follows:

1. For a job applicant who has a pending criminal charge: Where the circumstances of said criminal charge substantially relate to the circumstances of a particular job or licensed activity, the applicant will not be hired for that job

2. For a staff member who has a pending criminal charge: Where the circumstances of said criminal charge substantially relate to the circumstances of the current job or required licensure, the staff member will not be retained in that particular job; and

*These limits may be met by coverage maintained by the Provider or the professional or a combination of coverage maintained by each.

mailto:HelpDesk@Wisconsin.gov

3. For a job applicant who is convicted of a criminal offense or other offense: Where the circumstances of said conviction of a criminal or other offense that substantially relate to the circumstances of a particular job or required licensure, the applicant will not be hired for that job;

4. For a staff member who is convicted of a criminal offense: Where the circumstances of said conviction of a criminal or other offense that substantially relate to the circumstances of the current job or licensed activity, the staff member will not be retained in that particular job; and

5. For a job applicant who is required to use an Ignition Interlock Device (IID): Where the circumstances of a court ordered requirement substantially relate to the circumstances of a particular job or licensed activity, a job applicant will not be hired for that job;

6. For a staff member who is required to use an Ignition Interlock Device (IID): Where the circumstances of a court ordered requirement substantially relate to the circumstances of a particular job or required licensure, the staff member will not be retained in that particular job.

B. In compliance with the Prison Rape Elimination Act, the Provider shall implement policies and procedures for its staff or job applicants who may have contact with PIOCs or juveniles that include the following items. The DOC shall not enlist the facility-based services of any Provider or Provider staff who:

1. Has engaged in sexual abuse in a confinement facility;

2. Has been convicted of engaging or attempting to engage in nonconsensual sexual activity in the community; or

3. Has been civilly or administratively adjudicated to have engaged in activity described above. The

Provider shall consider incidents of sexual harassment when determining whether to assign anyone to that particular job. See 28 C.F.R. § 115.17 (applying to adult prisons and jails); 28 C.F.R. § 115.217

(applying to community confinement facilities); and 28 C.F.R. § 115.317 (applying to juvenile facilities).

C. Provider shall immediately notify the Contract Administrator via email upon discovery of any criminal charge pending or criminal conviction against the Provider or the Provider’s current staff, and the DOC retains the right to bar that person’s entry into its facilities and/or access to DOC records. DOC reserves the right to request reassignment of any existing staff/employee of the Provider meeting any of the above qualifications so that they are not providing direct services to DOC PIOCs and or having direct access to DOC records.

D. Provider shall verify compliance with this entire section and paragraphs above by filing a “Contractor Compliance

Agreement” form (DOC-2818) with the DOC every 12 months within 30 days of each contract year or date previously determined if already on file with DOC Purchasing Services.

XIII FRATERNIZATION

The Provider agrees to have a written policy on fraternization which includes the following:

1. Prohibiting certain relationships and conduct between Provider's employees, adult and juvenile PIOCs, and their relatives. This must also be substantially equivalent to DOC's policy as expressed in Executive Directive

16, August 2004 -Revised January 2019. A copy of Executive Directive 16 may be obtained from the DOC

Contract Administrator.

2. The policy shall provide for the following definitions

a. Employee- definition must be consistent with DOC’s definition of employee

b. Relationship

c. PIOC

d. Social Media

e. Sexual Contact

f. Sexual Intercourse

g. Sexual Misconduct.

3. A statement detailing prohibited relationships.

4. A statement detailing prohibited sexual conduct.

5. The duty of an employee to inform Provider of unplanned contacts with PIOCs.

6. A statement that Provider-directed contacts or those which are part of the employee's job requirements are exempt from the policy.

7. An exception procedure policy and approval process to be carried out by Provider.

8. A provision requiring a signed standard employee statement is kept in the personnel file for every Provider employee. The statement attests that the employee has read and received a copy of the Provider’s policy on fraternization.

9. DOC may request copies of or to inspect the original signed employee statements of a Provider upon request.

XIV TERMINATION / CANCELLATION:

This Contract may be terminated or cancelled under any of the conditions included in this Section.

A. TERMINATION FOR CONVENIENCE

DOC may terminate the Contract at any time, without cause and without penalty, by delivering thirty (30) days’ written notice to the Provider.

The Provider may terminate by providing one hundred and twenty (120) days’ written notice to DOC.

In the event of a termination for convenience, the Provider shall be entitled to receive compensation for completed services rendered under the Contract.

B. TERMINATION FOR CAUSE

If the Provider breaches this Contract, the DOC shall provide the Provider written notice of the breach and a time period (not less than 30 days) to cure. The notice of breach and opportunity to cure may be waived at DOC’s discretion for repeated breaches and may result in immediate termination of the Contract.

The Provider may terminate this Contract, with cause, by notifying DOC in writing within thirty (30) days after the Provider becomes aware of the DOC’s alleged noncompliance to the contract. The notice shall include a complete description of the noncompliance. If the DOC does not, within forty-five (45) days after its receipt of the Provider’s notice, either (1) effect a cure or (2) develop and diligently proceed with a plan to cure the noncompliance, then the Provider may terminate the Contract by providing DOC written notice ninety (90) days in advance of the intended date of termination.

C. CONTRACT CANCELLATION

1 DOC reserves the right to cancel this Contract in whole or in part without penalty, and without notice, if the Provider:

a. Files a petition in bankruptcy, becomes insolvent, or otherwise takes action to dissolve as a legal entity;

b. Makes an assignment for the benefit of creditors;

c. Fails to maintain and keep in force all required insurance, permits and licenses as provided in this

Contract;

d. Fails to maintain the confidentiality of the DOC’s information that is considered to be Confidential

Information; or

e. Performs in a manner that threatens the health or safety of a State employee, PIOC, citizen, or customer.

2 DOC reserves the right to cancel this Contract in whole or in part without penalty, with 30 days’ written notice, if the Provider:

a. Fails to follow the sales and use tax certification requirements of s. 77.66 of the Wisconsin Statutes;

b. Incurs a delinquent Wisconsin tax liability;

c. Fails to submit a non-discrimination or affirmative action plan as required;

d. Fails to follow the non-discrimination or affirmative action requirements of subch. II, Chapter 111 of the Wisconsin Statutes (Wisconsin’s Fair Employment Law); or

e. Becomes a state or federally debarred Provider.

XV EXECUTED CONTRACT TO CONSTITUTE ENTIRE AGREEMENT

A. The contents of this contract (including all attachments) and the bid of the successful bidder, and additional terms agreed to, in writing, by DOC and the Provider shall become part of the contract.

B. The following priority for contract documents will be used if there are conflicts or disputes:

State of Wisconsin standard and supplemental terms and conditions

Final Signed Contract including amendments

Attachment A - Statement of Deliverables

Attachment B – Fee Schedule

Other exhibits/attachments

XVI CONFIDENTIALITY

A. All confidential health, mental health, drug and alcohol information or educational information reviewed and collected in connection with this contract shall be handled by the Provider in a manner consistent with the applicable state and federal confidentiality laws.

B. Provider acknowledges that some of the data and documentation it may become privy to in the performance of this contract is of a confidential nature. Provider shall make all reasonable efforts to ensure that it or its employees and Subproviders do not disseminate such confidential information without the Purchaser’s prior permission and in a manner that complies with all applicable confidentiality laws and requirements.

C. Provider or its employees may have direct or indirect contact with PIOCs, staff, or other parties. All services provided to PIOCs are confidential in nature. Provider shall make all reasonable efforts to ensure that it or its employees and Subproviders do not disseminate such confidential information, including but not limited to identity of PIOCs or services being received. Provider must have a policy regarding ethics and confidentiality for their staff to follow.

D. Provider or its employees and Subproviders will not reuse, sell, or make use in any format the data researched or compiled for this contract for any venture, profitable or not, outside this contract.

E. Provider agrees to observe complete confidentially with respect to all aspects of any confidential information, proprietary data and/or trade secrets and any parts thereof, whether such contents are the

State's or the manufacturer's, proposer's, or distributor's whereby Provider or any Provider's personnel may gain access while engaged by the State or while on State premises.

F. The restrictions herein shall survive the termination of this contract for any reason and shall continue in full force and effect and shall be binding upon the Provider or its agents, employees, successors, assigns, Subproviders, or any party claiming an interest in this contract on behalf of or under the rights of Provider following any termination. Provider shall advise all Provider's agents, employees, successors, assigns and

Subproviders which are engaged by the State of the restrictions, present and continuing, set forth herein.

Provider shall defend and incur all costs, if any, for actions that arise as a result of noncompliance by

Provider, its agents, employees, successors, assigns and Subproviders regarding the confidentiality restrictions herein.

XVIII PRISON RAPE ELIMINATION ACT (PREA)

A. All Provider staff shall prevent, detect and respond to sexual abuse and sexual harassment in accordance with the

Federal Prison Rape Elimination Act of 2003 and the DOC’s Executive Directive 72 [Sexual Abuse and Sexual

Harassment in Confinement (PREA)].

B. The DOC shall provide training to the Provider staff, in accordance with the type of service and level of contact they have with PIOCs or juveniles, on the DOC’s zero-tolerance policy as it relates to the sexual abuse and sexual harassment. The DOC shall, additionally, provide training to the Provider on their responsibilities under DOC’s sexual abuse and sexual harassment prevention, detection and response policies and procedures. The Provider staff shall acknowledge and certify to the DOC through signature or electronic verification that they understand the training they received. See 28 C.F.R. §§ 115.32 and 115.332.

C. If the Provider staff is the first to respond to an allegation of sexual abuse, the responder shall request that the alleged victim not take any actions that could destroy physical evidence, and then notify DOC security staff. See

28 C.F.R. §§ 115.64 and 115.364.

D. The Provider staff shall notify the DOC immediately of any knowledge, suspicion or information regarding an incident of sexual abuse or sexual harassment that occurred in a facility, whether or not it is part of DOC; any incidents of retaliation against PIOCs, juveniles or Provider staff who reported such an incident; and/or any

Provider staff neglect or violation of responsibilities that may have contributed to an incident or retaliation. The

Provider staff shall report this information immediately to a DOC supervisory staff member who is not the subject of the allegation, unless reporting to such a person compromises the safety of the alleged victim, witness (es) and/or reporter. In those instances, the Provider staff shall report this information immediately via email to

DOCSECOSOPREAInvestigations@wisconsin.gov and follow-up with a phone call to the DOC PREA Office at

(608)240-5000. See 28 C.F.R. §§ 115.61 and 115.361.

E. The Provider staff shall comply with any applicable mandatory child abuse or vulnerable adult reporting laws. See

28 C.F.R. §§ 115.61 and 115.361.

F. The Provider staff shall not reveal any information related to a sexual abuse or sexual harassment report to anyone other than to the DOC supervisor, investigators and designated officials. Such information shall be limited to information necessary to make treatment, investigation and other security and management decisions. Medical and mental health practitioners shall be required to report sexual abuse and to inform PIOCs or juveniles of the practitioner’s duty to report, and the limitations of confidentiality, at the initiation of services. See 28 C.F.R. §§

115.61 and 115.361.

G. If the DOC has reason to believe that a sexual abuse or sexual harassment incident as defined by PREA has occurred or to ensure compliance with PREA standards, it shall have immediate access to the relevant Provider records as defined by DOC.

H. If a Provider staff is the alleged perpetrator of sexual abuse, the Provider and/or DOC shall immediately remove that individual from any position that has PIOC or juvenile contact within DOC-funded operations pending an investigation. The individual may not return to any position that has PIOC or juvenile contact within DOC-funded operations until DOC has reviewed investigation materials and authorized return to work. A Provider staff who engages in sexual abuse shall be prohibited from contact with PIOCs and juveniles; they shall be reported to law enforcement agencies, unless the activity was clearly not criminal, and to relevant licensing bodies. In the case of any other violation of DOC sexual abuse or sexual harassment policy by a Provider staff, DOC shall take appropriate remedial measures, and shall consider whether to prohibit the Provider staff’s further contact with

PIOCs or juveniles. See 28 C.F.R. §§ 115.77 and 115.377.

XIX CONCEALED CARRY

Provider is prohibited under Executive Directive 80, signed October 31, 2011 from possession of any weapon by

Provider's employees while providing services to DOC PIOCs.

In WITNESS THEREOF, the undersigned authorized officers have subscribed their names on behalf of the parties to this

Contract.

Provider's Authorized Representative Date

Name: James Richter, O.D.

Title: President

Kevin A. Carr, Secretary Date

WI Department of Corrections

9/3/2021

9/9/2021 mailto:DOCSECOSOPREAInvestigations@wisconsin.gov

Attachment A

Statement of Deliverables

Richter Professional Services

Type and Quality of Service. Provider shall deliver Optometry Health Services within the usual and customary range of its personnel, to PIOCs. Provider shall not be required to provide any services to PIOCs that are otherwise not provided to other patients. It is further understood that the purpose of this Contract is to provide DOC with access to the specialized services of Provider for its PIOCs.

Provider shall perform Optometry Health Services to PIOCs in a manner similar to that provided any other patient, recognizing that services can vary based on the forensic requirements imposed by DOC and the safety needs of Provider’s staff and other persons. When DOC-mandated security precautions are incompatible with providing a service in a medically appropriate manner, Provider reserves the right to decline to provide the service after consultation with DOC medical personnel. Nothing in the Contract shall be construed to be a commitment by Provider to give PIOCs priority or a preference over other patients.

Licensed/Good Standing. Provider shall at all times during the term of the Contract assure that it or each Physician and other healthcare provider maintain WI state licensure and, when appropriate, specialty certification. In the event of any reduction, suspension, restriction, lapse, revocation, or other loss of any such licensure or certification, Provider shall notify DOC of such reduction, suspension, restriction, lapse, revocation, or other loss by telephone and in writing within ten (10) business days following the date such notice was received. However, in no event will a PIOC be treated by a provider with a restricted license.

Authority. Provider shall, and hereby does, represent and warrant, that it has full legal power and authority, to bind its physicians and other providers to the provisions hereof.

Referrals. In transferring or referring PIOCs for diagnosis or treatment, Provider shall use reasonable efforts, to the extent consistent with professionally recognized standards of care and the best interests of the PIOC, refer only to other DOC-identified participating professionals participating hospitals, and other participating providers. Physician shall use reasonable efforts in every instance to exercise a preference for the most cost-effective available option that provides a comparable level of quality in the diagnosis and treatment of PIOCs under this Contract, consistent with professionally recognized standards of care and the best interests of the PIOC.

PIOC Complaints. Provider shall inform the responsible DOC Nursing Coordinator of any complaints received from

PIOCs. Results of Provider’s review will be shared with the Nursing Coordinator who will work with the Provider to: (a) assess and provide information from the DOC; b) work with Provider to prevent actions(s) or circumstance(s) from recurring; and (c) if appropriate, notify the claimant of the general nature of the action taken.

Outpatient Scheduling. Outpatient services requested from Provider shall be scheduled by the DOC by calling and scheduling appointments in advance. Provider will schedule requested outpatient visits as soon as appointment times are available, consistent with its normal scheduling practices for all patients.

Electronic Medical Record. Provider agrees to work with DOC in integrating the PIOC’s electronic medical record information making it available at sites in DOC.

Quality of Care Issues. Provider agrees that quality of care issues which arise will be referred by the DOC Medical

Director to the Provider’s Medical Director for review.

Inspection. Provider shall permit representatives of DOC’s clinical and quality assurance staff, or their designees, upon prior written notice to Provider of not less than five (5) working days, to review any and all operational phases of the delivery of covered services by Provider staff practitioners to inmates, including access to an inmate’s clinical records as maintained by the Provider and as authorized by inmate.

Data Ownership. Provider agrees that inmate medical information collected by Provider is owned by the Department of

Corrections and will return available data back to the DOC in a format acceptable to DOC at the time of contract termination.

Attachment B

Fee Schedule

Richter Professional Services, INC.

Provider shall be paid the rates listed below for the CPT codes listed.

Any claims for CPT codes not on the list below will be denied and reviewed after the fact to consider reimbursement.

New patient eye exam codes 92002 and 92004 may only be billed for services provided at Jackson Correctional and

Stanley Correctional Institutions (JCI & SCI).

WIDOC Optometry Fee Schedule 8/4/2021

CPT Description

Approved

Rates

76514 Corneal pachymetry $11.01

92002 New patient eye exam, intermediate $64.48

92004 New patient eye exam, comprehensive $119.90

92012 Established patient eye exam, intermediate $68.18

92014 Established patient eye exam, comprehensive $98.88

92015 Refraction $28.56

92071 Contact lens fitting, ocular surface disease $48.86

92072 Contact lens fitting, keratosis $94.79

92083 Visual field examination $26.42

92133 OCT, optic nerve $21.29

92134 OCT, retina $24.68

99211 Optometric assistant visit, optometrist not present $15.48

99212 E&M, level 2 $44.17

99213 E&M, level 3 $75.98

99214 E&M, level 4 $109.86

99241 Face-to-face discussion with patient present $43.39

99339 Review records of offsite visit & enter note in Cerner, patient not present $28.55