SUP-22-8125-B Contract - Essentia - Signed.pdf
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- Attached to
- Student Health Services for UW-Superior
- Contract number
- SUP-22-8125-B
- Issued by
- Wisconsin
About this file
This is a state contract (Contract Number RFB SUP-22-8125-B) between the University of Wisconsin and Essentia Health-Superior Clinic & Hospital for student health services at UW-Superior. The contract was executed on July 1, 2021, following a Request for Bid process dated June 2, 2021, with Essentia Health providing services under Lots One and Three of the original RFB.
The contract covers comprehensive medical and psychiatric services with detailed pricing schedules. Lot One includes standard medical services with CPT codes ranging from basic nursing visits at $50.00 to comprehensive new patient visits at $321.00, along with various laboratory tests and diagnostic services priced between $4.00 and $60.00, including COVID-19 detection tests. Lot Three covers psychiatric services billed at hourly rates: initial evaluation visits at $200/hour, follow-up visits and consultations at $150/hour, half-hour consultations at $75/hour, and designated hours/no-shows at $150/hour. The contract allows for telehealth services as a substitute for face-to-face services when agreed upon by the University, and includes a pricing schedule (Schedule 1) that is incorporated as part of the binding agreement.
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| File | Type | Posted |
|---|---|---|
| SUP-22-8125-B Contract - Douglass County - Signed.pdf |
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Text version
CONTRACT
CONTRACT NUMBER: RFB SUP-22-8125-B
COMMODITY OR SERVICE: Student Health Services for UW-Superior
This Agreement is entered into between the University of Wisconsin, hereinafter referred to as the "University", and Essentia Health-Superior Clinic & Hospital.
Whereas the University issued a Request for Bid (RFB) dated June 2, 2021; and
Whereas the University wishes to award a contract pursuant to that process; and
Whereas Essentia Health-Superior Clinic & Hospital wishes to provide product and services requested in Lots One and Three of the RFB.
NOW, THEREFORE, in consideration of the mutual promises, covenants, and agreements hereinafter set forth, Essentia Health-Superior Clinic & Hospital and the University do hereby agree as follows:
1. Essentia Health-Superior Clinic & Hospital agrees to supply such commodity or service of Lot One and Lot Three in accordance with the terms, conditions, and specifications of the RFB, and Essentia Health-Superior Clinic & Hospital response signed and dated June 15, 2021. The RFB and response are incorporated and made a part of this contract.
2. Both parties agree to be bound the Pricing Schedule incorporated as Schedule 1 and attached hereto.
3. If agreed to by the University, tele-health services may be provided in substitution of face-to-face services.
4. In the event of any inconsistency in this Contract, the inconsistency shall be resolved in the following order of precedence:
a. Official Purchase Orders and any Contract Amendments.
b. The Terms and Conditions of RFB SUP-22-8125-B, dated June 2, 2021.
c. The specific terms and conditions stated herein.
d. Essentia Health-Superior Clinic & Hospital response to the RFB, signed and dated June 15, 2021.
5. This Agreement may be amended only by written agreement of both parties.
For: University of Wisconsin For: Essentia Health-Superior Clinic &
Hospital
Signature: Signature:
Name: Name:
Title: Title:
Date: Date:
DocuSign Envelope ID: F4074907-1AD6-4489-951F-7C9C1128204C
Tammy Kritzer
7/1/2021 | 3:31 PM CDT
SVPProcurement Specialist
Mike Morris
7/1/2021 | 3:34 PM CDT
Schedule 1 – Pricing Schedule
Lot One:
CPT Code Description Billable Fee
99202 New, Expanded Problem Focused $ 116.00
99203 New, Detailed $ 168.00
99204 Problem visit, New Patient $ 258.00
99205 Problem visit, New Patient (60 min) $ 321.00
99211 Established, Minimal (Nursing) $ 50.00
99212 Established Problem Focused $ 68.00
99213 Established, Expanded Problem Focused $ 114.00
99214 Established, Detailed $ 168.00
99215 Established, Comprehensive $ 224.00
99384 New Patient, under age 18 $ 209.00
99385 New Patient, age 18-39 $ 203.00
99386 New Patient, age 40-64 $ 236.00
99394 Established Patient, under age 18 $ 179.00
99395 Established Patient, age 18-39 $ 183.00
99396 Established Patient, age 40-64 $ 195.00
81001 U/A Complete $ 9.00
81003 U/A Minor $ 5.00
86308 Mono Spot $ 6.00
86592 PR (VDRL) test $ 5.00
87081 Standard Throat Culture (Strep Screen) $ 11.00
87086 Urine Culture (with colony count) $ 13.00
87088 Urine Culture (commercial kit) $ 13.00
87210 Wet Mount $ 4.00
87340 Hepatitis B Surface Antigen $ 6.50
87880 Rapid Throat Culture (Rapid Strep) $ 30.00
U0003 Covid-19 Detection Test (DNA or RNA) $ 60.00
Lot Three:
Description Billable Fee
Psychiatric Office Visit - initial evaluation visit $ 200/hour
Psychiatric Office Visit - follow-up visit $ 150/hour
Consultation $ 150/hour
1/2 hour Consultation $ 75/hour
Designated Hours and No Shows $ 150/hour
Unfilled $ 150/hour
DocuSign Envelope ID: F4074907-1AD6-4489-951F-7C9C1128204C
| 2021-07-01T13:34:09-0700 | |
| Digitally verifiable PDF exported from www.docusign.com |
File details come from the government source that posted it. Updated .