8-Attachment F - Oxygen Concentrator Reporting Measures Worksheet 1.docx

This is a quarterly reporting measures worksheet for an oxygen concentrator contract between the State of Utah Department of Health and Human Services and a single qualified vendor. The contract, designated BB27-104, is a five-year agreement for the rental of oxygen concentrators, associated equipment, supplies, and maintenance services for eligible Utah Medicaid members statewide. The vendor must provide concentrators and equipment for all enrolled Medicaid members and furnish any additional respiratory equipment ordered by treating practitioners, including ventilators, CPAP, BiPAP, and pulse oximeters, along with sufficient backup and portable oxygen to meet members' medical needs. These additional items are separately reportable with reimbursement based on the Medicaid fee schedule.

The contractor is required to submit monthly-performance reports on a quarterly basis via secure means to the identified oxygen concentrator contract manager. The reporting framework consists of eight performance measures: concentrator and backup oxygen supply information, staff information, incident reporting, concentrator placement, concentrator maintenance, patient satisfaction metrics, telephone response times, and training updates. Reports marked with an asterisk—concentrator and backup oxygen supply information, incident reporting, and concentrator placement—must include minimum necessary Medicaid member information including member name, date of birth, Medicaid identification number, address, and any other required information. The vendor must guarantee pricing for one year, with contract award anticipated for a single responsive and responsible vendor determined by procurement code scoring criteria.