CS269008_Exhibit_A_Scope_of_Work.pdf

CS269008

EXHIBIT A

SCOPE OF WORK

1. GENERAL SCOPE

Contractor agrees to provide on-call/relief medical care services to the clients of Canyon Springs as requested by the Canyon Springs’ (CS) Contract Manager, ensuring the provision of 24-hour physician coverage, and that clients residing at Canyon Springs receive medical care consistent with their needs, during the Canyon Springs’ physician’s planned absences and needed additional onsite assistance.

Department of Developmental Services (DDS) reserves the right to modify the State’s Scope of Work, as mutually agreed to by the Contractor, to include additional work related to the Scope of Work in the event such work is identified, considered necessary to fulfill program requirements, and funds become available. The State also reserves the right to add additional funds during the term of the agreement. Any changes to the Scope and/or funding must be done in writing as an amendment.

2. CONTRACT MANAGERS

The Contract Managers during the term of this Agreement will be:

Department of Developmental Services Canyon Springs (CS) Health Services Department Office (760) 770-6250

Contractor:

3. LICENSE REQUIREMENT

Contractor must be licensed to practice as a physician in the State of California and must retain such license throughout the term of the contract.

If Contractor subcontracts to another vendor/physician, the subcontractor must meet the provisions outlined in this Scope of Work and Exhibit D “Special Terms and Conditions.”

Additionally, the Contractor (or if Contractor subcontracts to another vendor/physician, the subcontractor) must have a license to practice as a physician free of Administrative Disciplinary Actions, Court Ordered temporarily restrictions or suspensions, Administrative Actions taken by other State or Federal Government, Administrative Citations, Public Letter of Reprimand, Hospital Disciplinary Actions, and Malpractice Settlements as noted by the Medical Board of California.

4. DUTIES

Prior to the physician’s daily rounds, Canyon Springs’ Nursing staff will identify clients requiring physical examination, medical histories to be completed, physician orders to be renewed, and/or other routine medical tasks to be completed as part of the daily rounds. Nursing staff will provide the Contractor with Canyon Springs’ 24-hour record of clients’ new/ongoing physical/medical conditions that should be reviewed/assessed by the Contractor/physician.

Contractor agrees to be physically present at (report to) Canyon Springs when clinically required by regulations to review clinical/medical records; review completed laboratory reports, radiology reports, consultation reports, etc.;

examine clients; and/or sign appropriate orders.

Canyon Springs utilizes a “problem oriented” clinical/medical record format.

Physician’s duties/documentation will be completed consistent with Canyon Springs’ policies and procedures, the Federal Code of Regulations (Title 42) sections 483.400 - 483.480, the California Code of Regulations (Title 22) sections 76000 - 76725, and/or the California Welfare and Institutions Code Section 4500 (the Lanterman Developmental Disabilities Services Act).

Physician Progress Notes shall be completed utilizing the “SOAP,” or “DAP” format.

Contractor shall sign “telephone/verbal” physician orders within forty-eight (48) hours of when the order was made.

Contractor shall complete a “fee-for-service” billing form reflecting the level of service he/she provided/performed and forward the completed forms to Canyon Springs’ Clinical Information Department. A separate “fee-for-service” form shall be completed for each individual client, for each visit/service completed by the Contractor. Canyon Springs’ shall be responsible for submitting the fee-for-service billing information to the Department of Developmental Services’ Client Financial Services department. (Refer to Exhibit D “Special Terms and Conditions” for information regarding the assignment/billing for Medicare/Medi- Cal reimbursable services).

5. SCHEDULING

As scheduled by CS Contract Manager, Contractor agrees to provide medical care service coverage on a 24-hour basis, up to seven (7) days per week or as needed when the CS physician is not available or needs additional assistance.

CS Contract Manager will provide an on-call schedule in advance to the Contractor when coverage or assistance is indicated. Contractor is responsible for notifying the CS Contract Manager in advance of any time periods the Contractor will not be available to provide on-call services. If Contractor is unable to provide the required services on a specific date identified by the CS Contract Manager as a date the Contractor’s services are required, Contractor forfeits reimbursement for that date.

It is anticipated that Contractor’s services will be required for one (1) planned two-week period per calendar year. However, there is no guarantee that Contractor’s services will be required during the term of this Agreement.

During the absence of the CS physician, Contractor will complete daily rounds, lasting approximately two (2) to three (3) hours per day, Monday through Friday, between the hours of approximately 7:00 a.m. to 11:00 a.m. (these hours are flexible upon prior approval by the CS Contract Manager). When on-call, Contractor agrees to be available to respond to phone calls within 15 minutes or personal contact within one (1) hour to calls and/or pages from Canyon Springs’ staff, to diagnose, treat clients, or make referrals to a specialist and/or a higher level of care. Contractor agrees to comply with Canyon Springs’ Administrative Policy #206 “Drug Free Workplace” (a copy of this policy is attached) including, but not limited to, the requirement that an employee who is on duty or on standby for duty is strictly prohibited from (1) using, possessing for any purpose, or being under the influence of any illegal or unauthorized drugs, or other illegal mind-altering substances; and (2) being under the influence of alcohol or legally prescribed drugs to the extent that would hinder the employee’s ability to perform job duties safely, effectively, and efficiently.

Contractor/physician will sign in upon entering Canyon Springs (date and time) and sign out when leaving Canyon Springs (date and time), upon a form provided by the CS Contract Manager.

If requested by a representative (Health Facilities Evaluator or other surveyor) of the Department of Public Health, Licensing and Certification Unit, the Contractor shall make himself/herself available for the required interview.

6. ASSESSMENT

Contractor will provide feedback to Canyon Springs’ physician on services Contractor rendered to clients during the physician’s absence.

7. CONTRACTOR’S ORIENTATION TO CANYON SPRINGS

Within thirty (30) days of the effective date of this agreement, the Contractor will be required to attend approximately eight (8) hours of orientation to Canyon Springs’ policies and procedures including:

• Prevention of Sexual Harassment/Non-Discrimination

• Clients’ Rights

• Health & Safety (Exposure Control Plan; Hazard Communication; Fire Safety; Disaster/Emergency Preparedness)

• Infection Control

• HIPAA/Confidentiality of Client Information & Clinical Record Documentation

• Investigation Process (Client protection; Security Plan; Contraband;

Possession and Use of Fire Arms, Other Lethal Weapons, Destructive Devices; Drug-free Workplace; and Workplace Violence Prevention)

• Client Protection/Abuse Prevention

Canyon Springs will pay the Contractor his/her hourly on-site rate for attendance at this mandatory orientation. If the Contractor subcontracts with another vendor/physician to provide the required services, Canyon Springs will pay the contracted on-site hourly rate for the Subcontractor’s attendance at this mandatory orientation in lieu of the Contractor’s attendance. If the subcontractor changes during the term of the contract, the new subcontractor must complete the mandatory orientation within thirty (30) days and the Contractor will be responsible for payment to the new Subcontractor for his/her attendance at the mandatory orientation. Contractor will not receive payment for time provided for meal breaks during this orientation.

8. TERM OF THIS AGREEMENT

The term of this agreement is July 1, 2026, or when fully executed, whichever is later, through June 30, 2028.