Exhibits_A-E.pdf

California Department of Veterans Affairs Agreement Number: 26BS0003 Exhibit A - Scope of Work TBD

TEMPORARY/RELIEF MEDICAL DIRECTOR, PHYSICIAN, AND PHYSICIAN ASSISTANT

1. INTRODUCTION

A. Contractor shall provide temporary/relief services, on an as-needed basis, to the California Department of Veterans Affairs (CalVet). Contractor shall provide services for the benefit and care of residents at the Veterans Home of California – Barstow (Home) located at 100 East Veterans Parkway, Barstow, CA 92311. Contractor shall provide all labor, materials, staff, transportation, license, permits, and every other item of expense necessary, unless otherwise stated, to provide Medical Director, Physician, and Physician Assistant (PA) services. For purposes of this Agreement, the State designee must be a civil service employee. Services shall be provided at the Home, upon request and in compliance with terms of this Agreement.

B. Contracted services shall be used to fill temporary vacancies, substitute for full-time CalVet employees while on extended leave, provide temporary services when appropriate staffing levels cannot be maintained with civil service staff, or when the requested services are not available within state civil service.

C. Provider must be able to perform the tasks associated with providing services under the scope of their license. Contractor agrees that all Providers will be required to render health services as stated below and as required by law on an as-needed basis. Providers will perform services in accordance with federal and state laws and regulations, CalVet policies and procedures, and shall at all times comply with universal safety precautions and maintain CalVet security measures and a safe work environment.

D. Contractor agrees that, unless otherwise stated, all expenses associated with travel to and from the

Veterans Home, lodging, and all training expenses for Providers shall be borne by the Contractor or the Provider and will not be reimbursed separately by CalVet. All services performed outside the scope of this Agreement will be at the sole risk and expense of the Contractor.

E. Contractor is not authorized to deliver or commence performance of services as described in the

Agreement until written approval has been obtained from CalVet Contract Manager, or Designee, and the Contractor has received a copy of an executed contract from CalVet. Any delivery or performance of service commenced prior to the Contractor obtaining all written approvals shall be considered voluntary on the part of the Contractor.

2. CONTRACTOR’S RESPONSIBILITIES

A. Services and all requirements as stated below and as required by law shall be provided by the Contractor for the contracted services, at the request of the Contract Manager, or designee. The services shall include, but are not limited to the following:

1. Contractor must have a minimum number of Providers to adequately provide services who meet the requirements specified in Exhibit A–1, Service Specifications. Contractor must provide the State with proof of any required training, licenses, permits, certifications and any other required documents as stated below and as required by law, for each of the Providers providing services under this Agreement. Services will be performed only by Providers who meet the requirements outlined in this Agreement.

2. The CalVet Contract Manager, or designee, shall approve in advance all required Providers assigned to the Agreement. If any Provider of the Contractor is unable to perform due to illness, resignation, or factors beyond the Contractor’s control, the Contractor shall immediately submit qualifications of proposed substitute Provider to the Home for approval. Failure to do so may be cause for termination of this Agreement. The Home shall be notified of any additions or corrections to the Contractor’s list of prospective Providers at least five (5) working days before the Provider’s start date.

3. The Contractor shall ensure each Provider has an identification badge which includes the name of the Provider, Name of the Contractor (if different), and a photo identification. The badge shall be worn by the Provider at all times while at the Home.

B. Reports

CalVet reserves the right to request Contractor provides reports or information as needed. The reports shall be submitted in electronic format and sent via electronic mail as requested by CalVet. If electronic mail is not available, arrangements will be mutually agreed upon by the Contractor and CalVet Contract Manager or designee.

3. PROVIDER’S QUALIFICATIONS

Provider’s qualifications are noted in Exhibit A–1, Service Specifications.

4. LICENSES, PERMITS, AND CERTIFICATION REQUIREMENTS

Prior to providing services as outlined in this Agreement, Contractor shall ensure that each Provider possess and maintain throughout the term of this Agreement, all licenses, permits, and certification requirements noted in Exhibit A–1, Service Specifications.

5. REQUEST FOR SERVICES

A. Services shall be provided as specified in Exhibit A-1, Service Specifications as scheduled by the Contract Manager or on an as-needed basis, in accordance with CalVet policies and procedures, to ensure the best quality of treatment to meet the needs of residents at the Home.

B. Contractor shall have a telephone number and a contact person available by telephone twenty-four (24) hours per day, seven (7) days per week for the duration of the contract. The initial contact will be by telephone; however, CalVet will make every attempt to follow up with an e-mail.

6. CONTRACTOR’S MINIMUM QUALIFICATIONS

Contractor must employ a Medical Director, Physician(s) and Physician Assistant(s), residing within a 100-mile radius from the Veterans Home of California – Barstow or must have a place of business where a Medical Director, Physician(s), and Physician Assistant(s) employed by the Contractor report to the Contractor’s place of business within a 100-mile radius from the Home. The 100-mile distance limit has been established because the medical providers will be needed within a short period (1 hour or less) after Home staff have contacted the Contractor.

7. RESPONDING TO A REQUEST FOR SERVICES

A. The Contractor shall respond to a request for services within a one (1) hour response time unless otherwise stated by the Home. CalVet may extend the response time at the discretion of the CalVet Contract Manager, or designee, depending upon the urgency of the request for services. The response time shall be included on the request for service. The Contractor shall respond to the Home’s request for services within the stated response time AND submit the following documents:

1. Provider’s current Resume/Curriculum Vitae, which shall include the following information:

a. All education, including name and location of university or college, business, correspondence, trade, or service school; course of study; units completed (semester/quarter); diploma, degree, or certificate obtained; and date completed;

b. All relevant work history, including classification/job title, job duties performed, “to and from” dates (month and year), and any other information necessary to determine qualifications of Providers;

c. Name of organization for which work was performed;

d. Supervisor name and contact information for each job;

e. If the applicant has provided services to CalVet previously, the Provider must include the name of the specific Home, to and from dates of service, and immediate supervisor’s full name and telephone number; and

f. At least two (2) professional references and their contact information.

Note: Contact information shall be current and have a valid telephone number and/or e-mail address.

2. Copies of any current and valid license(s), permits, and/or certification(s) as stated and as required by law. (Refer to Exhibit A-1, Service Specifications, for requirements.)

8. CREDENTIAL VERIFICATION

A. For services provided at a Home, the Contractor must comply with the following credentialing requirements:

1. If the Contractor and/or Provider enter into an Agreement for medical services at the Home, the Contractor and/or Provider shall comply with all CalVet Home credentialing standards, requirements, policies and procedures. Contractor shall provide necessary information for the successful credentialing not less than thirty (30) days prior to the scheduled date of service unless otherwise agreed upon by CalVet. Services cannot start until the credential process and approval is completed by the Home.

2. The Contractor and/or Provider are required to coordinate with the CalVet Contract Manager or designee, to submit documentation for credentialing.

3. The CalVet Contract Manager or designated representative will notify the Provider once credential verification has been completed to arrange for an effective date for the Contractor or Provider to render services at the Home.

4. Contractors providing temporary/relief registry services are responsible for gathering and submitting the completed Credential Verification Packet to the CalVet Contract Manager or designee at the Home where services are to be provided.

9. SCHEDULING

A. Contractor and Provider shall ensure that all ordered services have prior authorization in accordance with the Home and are mutually agreed upon between the CalVet Contract Manager, or designee, and the Contractor.

B. At the time of scheduling, CalVet shall provide the Contractor with an estimated period the Home anticipates the need for contracted services. This will be a good faith estimate based on the circumstances known to CalVet at the time of the request. It is not a guarantee of business, and is subject to change depending on CalVet’s ability to fill staff vacancies and/or the return to work of CalVet staff from long-term leave, and fluctuations in the Resident population. However, CalVet shall endeavor to provide five (5) working day notice prior to cancellation of Provider’s assignment.

C. Contractor shall provide services to Home within twenty-four (24) hours notification by CalVet or as mutually agreed upon between the Home Contract Manager or designee and Contractor. Requests for services shall be for a minimum of two (2) hours. When requesting services, CalVet shall inform the Contractor of 1) the duration of services, 2) the number of staff required, and 3) the length of each shift assignment. If the duration of services must be extended, CalVet shall make every attempt to notify the Contractor not less than twenty-four (24) hours before the end of the current service period. The CalVet Contract Manager, or designee, shall document the request in writing.

D. Providers shall report for beginnings/endings of shifts in accordance with the policies and procedures of the requesting Home.

10. PROVIDER’S RESPONSIBILITIES

Please refer to Exhibit A–1, Service Specifications, for details.

11. CANCELLATION

A. Contractor shall give advanced notice to the CalVet Contract Manager, or designee, prior to cancellation of scheduled clinics/services, if for reasons other than illness, as follows:

1. For scheduled clinics: one (1) week written notice

2. For all other scheduled services: at least twenty-four (24) hour notice

B. CalVet may cancel or change assignments by telephone, before a Contractor’s and/or Provider’s scheduled reporting time.

12. INDEPENDENT CONTRACTOR STATUS

A. The Contractor/Providers shall be considered “Independent Contractors” in relation to CalVet and the State. Therefore, the Contractor/Providers shall not be considered employee(s) of the Home and shall not be entitled to any employee benefits from CalVet or the State including, but not limited to, the following:

1. Premium Pay, Overtime Pay, or Holiday Pay.

2. Medical Insurance.

3. Vacation or Sick Leave.

4. Worker’s Compensation.

5. Other employee benefits.

Note: It is the Contractor’s responsibility to rotate providers if necessary to avoid overtime hours.

13. ORIENTATION/TRAINING

A. Contractor agrees that prior to reporting for work at the Home, all Providers shall complete any required orientation and training to become familiar with the operations of the Home, its medical facilities, Title 22 of the California Code of Regulations, Title 42 of the Code of Federal Regulations, and any other laws or bylaws that may apply to the Home.

B. To maintain continuity of services and ensure safety for all workers, Contractor shall make available to the Home only those Providers who have completed the required orientation and training.

C. Each provider must attend the Home’s orientation. The orientation will take approximately four (4) hours, and Contractor shall be solely responsible for the cost.

14. HEALTH CLEARANCE

A. Contractor shall comply with the Home’s infection control policies and procedures. Initial and annual health clearance to include tuberculosis (TB) screening, Hepatitis B vaccine series offer (initial only) is required by Home policy of all state employees, contract Providers, and volunteers in order to meet state facility licensure requirements.

B. Initial TB screening may include, but not be limited to, 2-step TST/PPD testing and/or X-ray, and TB questionnaire. Annual TB screening may include, but not be limited to, 1-step TST/PPD testing and/or X-ray, and TB questionnaire. The health clearance process must be completed prior to initiation of services or Provider assignment, and within the required timeframe stipulated by the Home for the annual requirement.

C. Pre-employment/pre-assignment and annual health screening performed for Contractor or Contractor’s

Provider will be at the Contractor’s expense.

D. All Providers must show proof of receiving an annual vaccination for influenza (flu). If Provider cannot show proof of receiving the current vaccination, they must sign a declination form and wear a mask while in the Home during the entire duration of flu season.

E. Contractor shall submit medical reports/documentation to the Home’s Ambulatory Care Clinic indicating the individual is cleared to perform their duties and is free of communicable disease. The medical documentation must be submitted prior to initiation of services or Provider assignment, and within the required timeframe stipulated by the Home for the annual requirement.

F. During times of endemic or pandemic (such as COVID-19) or other instances of widespread viral or bacterial infections, additional precautionary infection control steps may be implemented and required by the Home. These may include but are not limited to: wearing CalVet approved masks and/or face shields, extra or special cleanings, social distancing, partitions, adjusted hours, vaccinations, booster shots and obtaining additional clearance certifications that may be required by local, state or federal health authorities. Providers shall comply with the Home’s COVID-19 Mitigation or Infection Control Plan and follow all current COVID-19 guidelines for precautions.

G. Failure to comply with the Home’s infection control policies shall result in immediate Provider suspension, contract suspension or termination. Any suspension will remain in effect until a medical clearance is provided to the Home’s Infection Control Specialist, Contract Manager or designee.

15. BACKGROUND CLEARANCE

A. Background clearance involving fingerprinting is required by Home policy of contract Providers and volunteers prior to assignment to the Home in order to meet state facility licensure requirements. Live- Scan is the only acceptable form of fingerprinting for the Home.

B. Contractor shall coordinate with the Home’s Personnel Office to arrange Live-Scan services. At a minimum, Department of Justice (DOJ) results must show California State level and Federal Bureau of Investigation (FBI) level criminal offender record information (CORI) clearances.

C. The Home’s Personnel Office must receive the Live-Scan results and DOJ clearances prior to approving assignment to the Home.

16. FAILURE TO PERFORM

A. CalVet shall routinely evaluate the work performance of the Contractor and/or Provider to determine if CalVet standards and Departmental/Home policies and procedures are being maintained. Any Contractor, and/or Provider who fail to perform or who are physically or mentally incapable of performing the required duties of this Agreement shall not be permitted to perform service.

B. Failure to provide services on three (3) or more occasions may result in termination of the Agreement.

C. The Home’s Contract Manager, or designee, shall state in writing the reasons the Contractor and/or

Provider did not meet the required policies or standards and submit a copy to the Contractor and to the Contract file. CalVet shall not pay Contractor for any services performed by Contractor and/or Provider which are deemed unacceptable in accordance with the required services contemplated by this Agreement.

17. TRANSITION OF SERVICES

In the event the Contractor has an Agreement from a prior bid for the same services in this Agreement, the State shall pay for services using rate(s) in the prior Agreement for the period of time up to and including the term end date of that Agreement.

The transition period is defined as the time when the new Agreement(s) with new Contractor(s) are approved by the DGS/Office of Legal Services (DGS/OLS), and the Home(s) must begin transition activities such as canvassing the Contractor(s) with new contract(s) and providing Orientation Training, Credential Requirements, Background, or Health Clearances to the new Contractor’s Providers to ensure there is not a break in services. During the transition period, providers working from prior Agreements may continue to provide services based on the Home(s) needs up to the expiration/termination date of the prior Agreements.

18. CONTACT INFORMATION

A. The project representatives during the term of this Agreement will be:

1. CalVet Contract Manager:

Veterans Home of California - Barstow Anthony Pham, SNF Administrator 100 East Veterans Parkway Barstow, CA 92311 Phone: (760) 252-6287 Fax: (760) 252-6333 Anthony.Pham@calvet.ca.gov

2. Contractor Representative:

Name of Contractor Contract Manager and Title Address City, State, and Zip Phone and Fax Numbers E-mail Address

B. Contract Representatives, addresses, and phone/fax numbers may be changed by issuing a 20-day prior written notification and shall not require a formal amendment to this Agreement. The notifying party shall provide complete contact information for the replacement Contract Representative including, name, title, mailing address, phone/fax numbers, and email address. All other changes require a formal written amendment to this Agreement.

mailto:Anthony.Pham@calvet.ca.gov

Exhibit A-1 – Service Specifications TBD

TEMPORARY/RELIEF MEDICAL DIRECTOR, PHYSICIAN, AND PHYSICIAN ASSISTANT

1. PROVIDER’S QUALIFICATIONS

A. Providers assigned to CalVet must have the minimum experience/education/qualifications outlined below:

1. Medical Director

a. Minimum of twelve (12) continuous months of experience within the last three (3) years performing services similar in scope to those defined herein, preferably in a public or private institution.

b. Education: Graduation from a medical school as recognized by the State of California.

c. Is not engaged in or a party to or threatened with any suit, action, proceeding, inquiry, enforcement actions, investigation, claim or demand, or legal or administrative hearing or proceeding, arbitration or other method of settling disputes or disagreements: (i) alleging healthcare fraud or abuse on the part of Physician, Physician’s employees and contractors; of (ii) that could have a material adverse effect on Physician’s ability to perform any or all of its duties and obligations under this Agreement;

d. Is not under suspension or subject to any disciplinary proceedings or other sanctions or penalties

(including but not limited to any administrative sanctions, suspension of payments, civil monetary penalties, or assessments) by any federal or state governmental authority or agency having jurisdiction over the professional activities of Physician, and is not under any formal or informal investigation or preliminary inquiry by any governmental authority or agency for possible suspension, disciplinary action, or other sanction or penalty;

e. Has not been subject to any health care related criminal fine, restitution order, civil judgment, criminal judgment or judgment under the False Claims Act; and

f. Has not been convicted of a criminal offense related to, or has been excluded or debarred from participation in, any federal health care program, as defined at 42 U.S.C. § 1320a-7b(f), including but not limited to the Medicare program or any state Medicaid program. An entity or individual is considered to have been convicted of a criminal offense:

i. When a judgment of conviction has been entered against the individual or entity by a federal, state, or local court, regardless of whether there is an appeal pending or whether the judgment of conviction or other record relating to criminal conduct has been expunged;

ii. When there has been a finding of guilt against the individual or entity by a federal, state, or local court;

iii. When a plea of guilty or nolo contendere by the individual or entity has been accepted by a federal, state, or local court, or

iv. When the individual or entity has entered into participation in a first offender, deferred adjudication, or other arrangement or program where judgment of conviction has been withheld.

2. Physician

a. Minimum of twelve (12) continuous months of experience within the last three (3) years performing services similar in scope to those defined herein, preferably in a public or private institution.

b. Education: Graduation from a medical school as recognized by the State of California.

3. Physician Assistant

a. Minimum of twelve (12) continuous months of experience within the last three (3) years performing services similar in scope to those defined herein, preferably in a public or private institution.

b. Education: Course of study associated with a medical school leading to an academic degree/certificate and practice as a Physician Assistant, as recognized by the State of California.

B. Resident health care is of paramount importance. Accuracy in communications is critical to ensure timely, correct care is provided. Therefore, any Provider(s) providing services through this Agreement must be able to communicate effectively with CalVet.

C. Any Provider(s) who fails to meet the minimum qualifications shall not be permitted to perform service.

The Home’s Contract Manager, or designee, shall state in writing the reason(s) the Provider does not meet minimum qualifications.

2. LICENSES, PERMITS, AND CERTIFICATION REQUIREMENTS

Prior to providing services as outlined in this Agreement, Contractor shall:

A. Ensure that each Provider possess and maintain all current and valid licenses, permits, and certifications throughout the term of this Agreement for each classification noted below:

1. Medical Director:

a. A current and valid license (M.D. or D.O.) recognized by the California Board of Medical Quality Assurance or the California Board of Osteopathic Examiners authorizing the physician’s medical practice in the State of California. Board Certified / Board Eligible in Geriatric Medicine, Internal Medicine, or Family Practice.

b. A current and unrestricted Drug Enforcement Administration (DEA) certificate and shall comply with other applicable requirements set forth in state or federal law or regulations for the Medical Director of a skilled nursing/long term care facility.

c. Comply with California Assembly Bill No. 749, Chapter 586, and be certified by the American

Board of Post-Acute and Long-Term Care Medicine, or an equivalent organization, as a Certified Medical Director.

2. Physician:

A current and valid license recognized by the California Board of Medical Quality Assurance or the California Board of Osteopathic Examiners authorizing the physician’s medical practice in the State of California. Board Certified / Board Eligible in Geriatric Medicine, Internal Medicine, or Family Practice.

3. Physician Assistant:

A current and valid Physician Assistant license recognized by the California Department of Consumer Affairs, Physician Assistant Board.

B. Provide copies of any required license(s), permits, and/or certification(s) for each Provider to the Home’s Contract Manager, or designee, to be kept on file at the Home throughout the term of this Agreement.

Contractor shall ensure that all required licenses, permits, certifications, and any other requirements outlined herein are current and in effect at all times during the term of this Agreement.

C. Provide current/renewed license(s), permit(s), and/or certification(s) to CalVet not less than thirty (30) calendar days prior to their expiration. If, during the course of this Agreement, any of the licenses and/or requirements are found to be inactive or not in compliance, CalVet may withhold payment for services rendered during the expiration period and/or immediately terminate this Agreement.

D. Assume responsibility for verifying, through the appropriate licensing boards, that no current or unresolved adverse actions have been taken by the State licensing authorities against any Provider(s) assigned to CalVet, and that all licenses are active and void of misconduct. CalVet may, at its discretion, verify the current status of Provider(s) assigned.

E. Maintain current Cardiopulmonary Resuscitation (CPR) and Basic Life Support (BLS) certification for each Provider at Contractor’s expense.

3. PROVIDER’S RESPONSIBILITIES

Under the direction of the Home’s SNF Administrator, Contract Manager, or designee, Provider shall provide services as permitted within the scope of practice for Medical Director, Physician and Physician Assistant in accordance with CalVet/Home policies and procedures.

A. Duties/Responsibilities shall include, but are not limited to:

1. Medical Director:

a. Provide clinical oversight and leadership and guidance on clinical and medical care and care coordination.

b. Collaborate with Home’s leadership, staff and other practitioners and consultants to help develop, implement and evaluate resident care policies and procedures that reflect current standards of practice and are consistent with state and federal law and regulation and assist in the development, implementation and monitoring of such policies, including but not limited to:

i. Admission policies

ii. Resident rights

iii. Treatment protocols

iv. Pain management

v. Nutrition and hydration

vi. Skin care and management

vii. UTIs

viii. Weight management

ix. Medication management and gradual dose reduction

x. Infection control practices

c. Perform the direct medical services and functions customary of an Ambulatory Care Clinic (ACC), Intermediate Care Facility (ICF), Skilled Nursing Facility (SNF), and Residential Care Facility for the Elderly (RCFE) medical director as required by federal and state Medicare and Medicaid (Medi-Cal) laws, regulations, rules, and policies, and in compliance with the Home medical care bylaws, rules, and regulations.

d. Provide on-site coverage at the ACC 7:30 a.m. to 5:30 p.m. as needed and part-time in the ICF 7:30 a.m. to 8:00 p.m. when required, and the SNF 7:30 a.m. to 8:00 p.m. when required. On-site coverage in the SNF unit shall be no less than ten (10) hours per month. RCFE coverage is dependent on whether the Home obtains an RCFE license during the course of this contract.

e. Perform all functions associated with the medical care management of resident patients in the ACC, ICF, SNF, and the RCFE. This may include answering and/or returning phone calls while off-site. Each live phone interaction with a CalVet staff member shall be billed in fifteen (15) minute increments, up to forty (40) segments, or ten (10) hours per month using the rate found in Exhibit B. Any calls received above that amount will not be paid separately and are considered part of the provider’s responsibilities. A call log must be kept and attached to provider’s invoice in order to be paid for these off-site interactions.

f. Provide Physician services with emphasis on geriatric medicine.

g. Provide consultation and assessment, treatment plan, and monitoring of response to treatment for each Home resident.

h. Provide administrative review of all Home Policies and Procedures relating to medical care.

i. Provide administrative consultation regarding the Home’s operations issues.

j. Assist with preparations for United States Department of Veterans Affairs (USDVA) and California Department of Healthcare (CDPH) Services surveys and/or resurveys.

k. Perform the physician’s role in admission prescreening and admission physicals.

l. As Medical Director, provide oversight for all Physicians, PAs and NPs.

m. Provide review of referrals by PAs.

n. Provide consultation of clinical services, especially with regard to patient care and management.

o. Perform all medical duties required for health care facilities under Title 22 (22CCR) of the California Codes of Regulations, and Titles 42 and 38 of the Code of Federal Regulations (42CFR and 38CFR).

p. Refer residents of the Home to other appropriate medical contractors only after consultation with the Home Administrator, or designee.

q. Ensure there is a continuity of care for residents of the Home during periods of absence by the Provider. The cross coverage selected by Contractor shall be approved and credentialed in advance by the Home.

r. Comply with the rules and regulations contained in Title 22 (22CCR) of the California Codes of Regulations and the Home Administrative Manual.

s. Shall assist in arranging for continuous physician coverage for medical emergencies.

t. Shall assist in obtaining the services of qualified professionals to serve as consultants to help meet residents’ special needs.

u. Assist the Home in supporting and promoting person-directed care such as the formation of advance directives, end-of-life care, and provisions that enhance resident decision-making including choice regarding medical care options.

v. Help the Home identify, evaluate, address and resolve medical and clinical concerns and issues that affect resident care, medical care or quality of life.

w. Help the Home identify, evaluate, address and resolve issues that are related to the provision of services by physician and other licensed health care practitioners.

x. Provide emergency medical care and oversight in the even that a resident’s attending physician is unavailable.

y. Oversee and coordinate the Home’s medical and clinical care.

z. Assist in evaluating quality of care and performing peer review of physicians and other licensed practitioners.

aa. Ensure that clinical records are accurate, timely and complete.

bb. Help the Home develop and monitor care plans. Intervene as necessary and requested by

CalVet.

cc. Review the monthly drug regimen review report produced by the Pharmacist.

dd. Serve on such committees as appropriate.

ee. Cooperate with the Home’s Quality Assurance Programs and attend QAPI meetings. This may entail maintaining records as specified by CalVet, providing data and reports to assist Home in assessing the status and the impact of such controls and measures, and updating the Home’s quality control measures and utilization review methodology as necessary.

ff. Assist with the remediation of deficient practices identified through the performance of standard or complaint surveys.

gg. Provide and document in-service education for all appropriate personnel of Home regarding various areas of resident care.

hh. Participate in mandatory training, such as annual Compliance Program and HIPAA training and other courses in the Relias or PolicyTech programs.

ii. Provide such services as are reasonably requested by the Home’s Administrator, CalVet Contract Manager, or designee.

jj. Participate in the Home’s Governing Body.

2. Physician:

a. Perform the direct medical services and functions customary of an Ambulatory Care Clinic (ACC), the Elderly (RCFE) Physician as required by federal and state Medicare and Medicaid (Medi-Cal) laws, regulations, rules, and policies, and in compliance with the Home medical care bylaws, rules, and regulations.

b. Provide on-site coverage at the ACC 7:30 a.m. to 5:30 p.m. as needed and part-time in the ICF 7:30 a.m. to 8:00 p.m. when required, and the SNF 7:30 a.m. to 8:00 p.m. when required. RCFE coverage is dependent on whether the Home obtains an RCFE license during the course of this contract.

c. Perform all functions associated with the medical care management of resident patients in the ACC, ICF, SNF and the RCFE. This may include answering and/or returning phone calls while off-site. Each live phone interaction with a CalVet staff member shall be billed in fifteen (15) minute increments, up to forty (40) segments, or ten (10) hours per month using the rate found in Exhibit B. Any calls received above that amount will not be paid separately and are considered part of the provider’s responsibilities. A call log must be kept and attached to the provider’s invoice in order to be paid for these off-site interactions.

d. Provide Physician services with emphasis on geriatric medicine.

e. Provide consultation and assessment, treatment plan, and monitoring of response to treatment

f. Provide administrative review of all Home Policies and Procedures relating to medical care.

g. Provide administrative consultation regarding the Home’s operations issues.

h. Assist with preparations for United States Department of Veterans Affairs and California Department of Healthcare Services surveys and/or resurveys.

i. Perform the physician’s role in admission prescreening and admission physicals.

j. Provide oversight for all PAs and provide review of referrals by PAs.

k. Provide consultation for PAs in providing clinic services, especially with regard to patient care and management.

l. Perform all medical duties required for health care facilities under Title 22 (22CCR) of the California Codes of Regulations, and Titles 42 and 38 of the Code of Federal Regulations (42CFR and 38CFR).

m. Refer residents of the Home to other appropriate medical contractors only after consultation with the Home Administrator, or designee.

n. Ensure there is a continuity of care for residents of the Home during periods of absence by the Provider. The cross coverage selected by Contractor shall be approved and credentialed in advance by the Home.

o. Comply with the rules and regulations contained in Title 22 (22CCR) of the California Codes of Regulations and the Home Administrative Manual.

p. Shall assist in arranging for continuous physician coverage for medical emergencies.

q. Shall assist in obtaining the services of qualified professionals to serve as consultants to help meet residents’ special needs.

3. Physician Assistant:

a. Perform the direct medical services and functions customary of an Ambulatory Care Clinic (ACC), the Elderly (RCFE) Physician Assistant as required by federal and state Medicare and Medicaid (Medi-Cal) laws, regulations, rules, and policies, and in compliance with the Home medical care bylaws, rules, and regulations.

b. Provide on-site coverage at the ACC 7:30 a.m. to 5:30 p.m. as needed and part-time in the ICF 7:30 a.m. to 8:00 p.m. when required, and the SNF 7:30 a.m. to 8:00 p.m. when required. RCFE coverage is dependent on whether the Home obtains an RCFE license during the course of this

c. Perform all functions associated with the medical care management of resident patients in the

ACC, ICF, SNF, and the RCFE.

d. Provide consultation and assessment, treatment plan, and monitoring of response to treatment

e. Work under the supervision of the physician provided by the Contractor / the civil servant physician(s) employed by the Home.

f. Complete admission assessment, history, and physical, in addition to admission orders.

g. Manage Domiciliary, ICF, and SNF resident admissions, to ensure appropriateness and quality of life considerations.

h. Formulate and implement a treatment plan and concurrently initiate discharge planning in conjunction with the utilization management team at the Home.

i. Coordinate and facilitate utilization management with the utilization and case management team at the Home.

j. Adhere to the communication requirements established by the Home.

k. Review appropriateness in level of care (skilled vs. custodial), length of stay, and bed days.

l. Coordinate ancillary services such as pharmacy, rehab, labs, and x-ray.

m. Coordinate appropriate use of specialty consults and referrals.

n. Initiate communication with and inform family members of resident condition and treatment plan, and involve the family in the discharge planning process.

o. Review and discuss resident treatment plan and condition with the utilization management team at the Home.

p. Manage the ordering, timely-completion, and reporting of all resident studies, tests, and procedures, during the course of post-acute stay.

q. Arrange and oversee the use of specialists.

r. Inform or consult with the Home Administrator, CalVet Contract Manager, or designee regarding cases or situations of an unusual administrative or clinical nature.

s. Maintain all medical records in compliance with Home rules and regulations.

t. Discuss findings and recommendations representing trends with the Home Administrator, CalVet

Contract Manager, or designee.

u. Initiate in-house consults for “crisis/emergency care” with the approval of the Home Administrator, CalVet Contract Manager, or designee. Home will initiate emergency care if needed.

v. Provide the customary medical records, including physical, pertinent lab reports, progress reports, and clinical summaries as appropriate. Contractor recommended resident plan of care shall be included in each resident progress report or clinical summary.

w. Be available for telephone consultations with the Home Administrator, CalVet Contract Manager, or designee.

x. Refer residents of the Home to other appropriate medical contractors only after consultation with Administrator or designee.

y. Initiate and participate in Peer Review program.

B. Contractor must currently employ a Medical Director, Physician(s) and Physician Assistant(s), residing within a 100-mile radius from the Veterans Home of California – Barstow or must have a place of business where a Medical Director, Physician(s) and Physician Assistant(s) employed by the Contractor report to the Contractor’s place of business within a 100-mile radius from the Home. The 100-mile distance limit has been established because the medical providers will be needed within a short period (1.5 hours or less) after Home staff have contacted the Contractor.

C. Contractor shall immediately deliver written notice to the Home upon the discovery of any of the following concerning their Providers at the Home:

1. Any action that restricts, suspends, or revokes the registration or license of Provider or his/her DEA certificate;

2. Any felony indictment or conviction of a criminal offense, naming the Provider of the group in which Providers practice (if applicable);

3. Any final non-appealable disciplinary proceeding or action involving Provider before any governmental agency;

4. Any information received by Contractor, Provider or Provider’s group (written or oral) that he, she or it may be under investigation by a state or federal agency for fraud, improper billing, or other reasons that could lead to an indictment, complaint or action prosecuted by a state or federal government or individual acting on behalf of a federal or state program pursuant to 31 U.S.C. § 327 et seq. or any comparable provision of state law;

5. That Provider is excluded, debarred or suspended from participation in any federal health care program, as defined at 42 U.S.C. § 1320a-7b(f), including but not limited to the Medicare program or any state Medicaid program;

6. The imposition of any health care related fines, civil monetary penalties, administrative sanctions, assessments, restitution orders, or other remedies (including, without limitation, any settlements)

Gravina, Kelli@Calvet If this language in Exhibit A gets changed, this language will also need to be changed because it’s a duplicate.

Pham, Anthony@Calvet Agree. We can change it.

Gravina, Kelli@Calvet Stacie- Should this be in Exhibit A or Exhibit A-1?

related to any alleged violation of any law or regulation related to the provision of services hereunder or the billing practices (or any other business, operations or practices) or Contractor or Provider;

7. If Contractor or Provider becomes the subject of, or materially involved in, any investigation, proceeding or disciplinary action before any governmental, professional, licensing board, medical staff, or peer review body, or by a contractor for any state or federal governmental healthcare payment program (such as a Medicare carrier) or any other health care program; or

8. If Contractor or Provider becomes aware of any termination, non-renewal, cancellation or reduction in coverage of any insurance policy required under this Agreement, if not replaced by substantially similar coverage.

D. Shall acknowledge and sign Home policies on Resident Rights, Confidentiality, Discrimination, Sexual

Harassment, and Zero Tolerance of Elder Abuse and other required policies.

E. Sign-in at the front desk when entering the facility and sign-out when leaving, by using the contractor’s binder and shall understand that if this sign-in and sign-out procedure is not followed, the Home may dispute any or all invoices.

F. Provider shall wear an identification badge which includes the name of the Contractor, the Provider’s name, and a photo ID. This badge shall be worn at all times while on grounds of the Veteran’s Home.

G. Provider shall ensure resident medical record information is maintained as “CONFIDENTIAL” and shall be held in trust and confidence. Information shall be used only for the purposes contemplated under this

H. Provider shall obtain the approval and authorization from the primary care physician through the Contract

Manager, or designee, prior to referring resident to other health care/medical vendors/contractors.

Referral shall be made only to those health care/medical vendors/contractors set forth on the Home’s health care/medical vendor/contract list.

I. Prior Authorization Documentation shall include, but is not limited to the following:

1. Veterans Home referral process.

2. Resident progress notes/summary pertinent to reason for referral.

J. Equipment and/or supplies owned or customarily stocked by the Home and which are necessary for services may be used by the Provider. If the lack of equipment and/or supplies creates a limitation to services requested, the Provider shall make a recommendation to the Contract Manager, or designee, identifying equipment or supplies necessary for treatment. The Provider will not procure equipment or supplies and expect reimbursement from the Home/CalVet.

Exhibit B - Budget Detail and Payment Provisions TBD

1. STANDARD BUDGET DETAIL AND PAYMENT PROVISIONS

A. Invoicing and Payment

1. For services satisfactorily rendered, and upon receipt and approval of the invoices, the State agrees to compensate the Contractor for services rendered in accordance with the rates in Exhibit B-1.

2. Invoices shall include the Agreement Number and shall be submitted in not more frequently than monthly in arrears to:

Original Invoice Approval Copy

Department of Veterans Affairs CalVet Accounting Office 1227 “O” Street Room 402 Sacramento, CA 95814

Veterans Home of California – Barstow 100 East Veterans Parkway Barstow, CA 92311

B. Budget Contingency Clause

1. It is mutually agreed that if the Budget Act of the current year and/or any subsequent years covered under this Agreement does not appropriate sufficient funds for the program, this Agreement shall be of no further form and effect. In this event, the State shall have no liability to pay any funds whatsoever to Contractor or to furnish any other considerations under this Agreement and Contractor shall not be obligated to perform any provisions of this Agreement.

2. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this program, the State shall have the option to either cancel this Agreement with no liability occurring to the State, or offer an Agreement amendment to Contractor to reflect the reduced amount.

C. Prompt Payment Clause

Payment will be made in accordance with, and within the time specified in, Government Code, Chapter 4.5, commencing with Section 927.

2. SPECIAL BUDGET DETAIL AND PAYMENT PROVISIONS

A. Submissions of Invoices/Claims

1. All invoices/claims must be completed thoroughly and legibly, with all applicable fields completed.

Invoices/claims that are submitted to the appropriate location but have been altered, or are inaccurate, or do not provide all necessary information will not be accepted and will be returned to the Contractor for correction.

2. Any changes to this provision relating to the invoice/claim submittal process, including but not limited to an address, form, or process change, shall be an administrative change managed through the appropriate designated CalVet office and shall not require a contract amendment.

3. Invoices/claims submitted shall include the following information in order to be considered complete and acceptable for processing, or the invoice/claim will be returned:

a) Contractor’s Company name

b) Contractor’s Company address, phone number and e-mail

c) Date of invoice/claim

d) Invoice/claim number

e) CalVet location where services were performed

Exhibit B - Budget Detail and Payment Provisions TBD

f) Agreement Number

g) Date(s) of Service

h) Total dollar amount being billed

i) First and Last name of Contractor or Provider performing services, if applicable

j) Contractor’s or Provider’s Classification, whichever is applicable

k) When applicable, contractors shall include the following information on the invoice/claim submitted for hourly reimbursement:

1. Hourly Rate

2. Time in and time out

3. Total hours worked

4. Any other information or documentation reasonably required to verify and substantiate the provision of services and the charges for such services.

Exhibit B-1, Rate Sheet TBD

RATE SHEET

The Contractor must be able to provide the services listed below. Subcontractors may be used to comply with this requirement. Subcontractor Agreements may be used to comply with this requirement. Subcontractor(s) information must be identified on Bidder Declaration (GSPD-05-105). If additional Subcontractors are added during the term of the Agreement, an updated GSPD-05-105 must be submitted.

The rates listed below are in effect for the term of the Agreement, including any extension of the term through an amendment.

Description of Service Hourly Rate Medical Director, On-site

Medical Director, Off-site Phone Calls Physician, On-site Physician, Off-site Phone Calls Physician Assistant

Exhibit C, General Terms and Conditions TBD

1. General Terms and Conditions

A. General Terms and Conditions (GTCs)

The (GTCs) are hereby incorporated by reference and made part of this agreement as if attached. hereto.

These documents may also be viewed at the California Department of General Services website:

https://www.dgs.ca.gov/-/media/Divisions/OLS/Resources/GTC-Updates/GTC-225-February- 2025.pdf https://www.dgs.ca.gov/-/media/Divisions/OLS/Resources/GTC-Updates/GTC-225-February-2025.pdf https://www.dgs.ca.gov/-/media/Divisions/OLS/Resources/GTC-Updates/GTC-225-February-2025.pdf

Exhibit D – Special Terms and Conditions TBD

1. EXCISE TAX

The State of California is exempt from Federal Excise Taxes, and no payment will be made for any taxes levied on employees' wages. The State will pay for any applicable State of California or local sales or use taxes on the services rendered or equipment or parts supplied pursuant to this Contract. California may pay any applicable sales or use tax imposed by another state.

2. STATUTORY AND REGULATORY PROVISIONS

A. This Contract shall be governed and construed in accordance with all applicable statutory and regulatory provisions including, but not limited to:

1) Title XVIII of the Federal Social Security Act

2) Title XIX of the Federal Social Security Act

3) Chapters 7 and 8 (commencing with Section 14000), Part 3, Division 9, Welfare and Institutions Code

4) Division 3, Title 22, California Code of Regulations (CCR)

5) Health and Safety Code Section 1340 et seq.

6) All applicable Federal provisions which regulate the administration of health care programs and budget revisions, as contained in the Code of Federal Regulations (CFR), Title 42, and Title 45, Part 74, Title 42 United States Code, Sections 1395 et seq. and 1396 et seq.

7) Sub-chapter 13 (commencing with Section 6800), Chapter 4, Part 1, Title 17, CCR; and

8) All other applicable laws and regulations.

B. Any provision of this Contract in conflict with the applicable laws and regulations is hereby amended to conform to the provisions of those laws and regulations. Such amendment of the Contract shall be effective on the effective date of the statutes or regulations necessitating it, and shall be binding on the parties even though the amendment may not have been reduced to writing and formally agreed upon and executed by the parties. If, due to amendment in laws of regulations, Contractor is unable or unwilling to comply with the provisions of the amendment(s), State or Contractor may terminate this Contract in accordance with the Termination provision of this Contract.

3. EXAMINATION AND AUDIT

A. Contractor shall allow the State and its related entities, the Comptroller General of the United States, Department of Justice (DOJ), and the Bureau of Medi-Cal Fraud, or their duly authorized representatives, to inspect or otherwise evaluate the quality, appropriateness, and timeliness of services performed under this Contract, and to inspect, evaluate, and audit any and all books, records, and facilities maintained by the Contractor and Subcontractors pertaining to services under this…