Swvc Optometry Services

PROJECT STATEMENT and SCOPE OF WORK

FOR OPTOMETRY SERVICES FOR

THE PENNSYLVANIA DEPARTMENT OF MILITARY AND VETERANS AFFAIRS

SOUTHWESTERN VETERANS’ CENTER

I. Objectives.

A. General. The Department of Military and Veterans Affairs (DMVA) is seeking to award a purchase order (PO) for the provision of Optometry Services at Southwestern Veterans’ Center (SWVC) in accordance with this Project Statement.

B. Specific. SWVC is located at 7060 Highland Drive, Pittsburgh, PA 15206.

The PO will cover all optometry services in accordance with this Project Statement. These services will be all-inclusive and on an as-needed basis for all SWVC residents. All services shall be billed against resident insurance. Compliance with contract specifications will be under the direction of Southwestern Veterans’ Center Deputy Commandant, Director of Nursing, or designee.

C. DMVA Contracting Officer. The DMVA Contracting Officer responsible for the solicitation and PO award is:

Kayla Brill, Purchasing Supervisor

Procurement & Contracting

Bldg. 0-47

Fort Indiantown Gap

Annville, PA 17003-5002

Phone: 717-861-6400

Fax: 717-861-2932

Email: kbrill@pa.gov

Method of Award and Term of PO. DMVA shall award the PO to the lowest responsive quote. In order to be deemed responsive, the bidder must be able to perform the required services as outlined in the project statement and in accordance with the terms and conditions.

It is DMVA’s intent to establish a one-year term with four, one-year renewal options in accordance with the terms and conditions of the contract. The term of the PO shall commence on the executed effective date and shall end on the expiration date identified on the PO. Services shall begin as specified in the project statement or notice to proceed letter, whichever is the later. DMVA reserves the right, upon written notice to the awarded contractor, to extend the term of the PO or any part of the PO for up to 90 days under the same terms and conditions.

II. Minimum Qualification Requirements.

A. Contractor Experience. The Awarded Contractor shall directly provide all optometry services to residents of SWVC.

B. The Awarded Contractor shall provide proof of a minimum 5 years’ experience in optometry services.

C. The Awarded Contractor shall provide a current license to practice optometry with the Commonwealth of Pennsylvania.

D. The Awarded Contractor shall provide the facility with a practitioner license number, expiration date, and if appropriate, Drug Enforcement Agency (DEA) number.

E. The Awarded Contractor shall be an independent contractor and not an employee of the Commonwealth of Pennsylvania.

F. The Awarded Contractor shall at all times in the performance of this contract, render professional services in accordance with SWVC policies, procedures, rules, and standards.

G. The Awarded Contractor shall be in compliance with all Federal, State, and Local Laws and Regulations.

H. The Awarded Contractor shall submit pricing for all line items/services requested by DMVA.

III. Project Statement.

A. Contractor Services. The awarded contractor shall provide optometry services under the direction of SWVC Deputy Commandant, Director of Nursing, or designee.

The awarded contractor shall provide services on a monthly basis.

The awarded contractor shall provide a routine eye examination, screening and subsequent referral of those residents who require medical care by an Ophthalmologist.

The awarded contractor shall provide a selection of materials, dispense, adjust, and make minor optical repairs. All frames are to be labeled with residents names.

The awarded contractor shall provide services during normal working hours either at the awarded contractor’s designated location or resident’s bedside. Scheduling of visits will be coordinated between SWVC staff and the awarded contractor. Facility shall provide sufficient staff to transport and maintain all residents during visit. By mutual agreement with the awarded contractor, SWVC may modify the specified hours of service to meet the facility’s needs.

The awarded contractor shall invoice each resident visit separately according to the bid price for an examination plus the itemized cost of materials such as frames, lenses, etc. See “Billing” section.

The awarded contractor shall be located within a five (5) mile radius of facility, insuring accessibility and convenience of service.

The awarded contractor shall be able to perform services on residents at SWVC as directed by the attending physician. Consult reports will be provided showing the care/plan of care received, provided by the awarded contractor within 2 business days.

The awarded contractor shall furnish all supplies and equipment necessary to perform these services as outlined in the Scope of Work at no additional charge to DMVA.

B. Off-site services. The awarded contractor’s facility shall be accessible by ramps and/or elevators for residents that require wheelchairs.

The awarded contractor’s facility shall be located within a five (5) mile radius of SWVC.

The awarded contractor shall complete the “Certification of Medical Necessity” and forward it to the Facility Deputy Commandant and/or the Director or Nursing for approval prior to treatment if ambulatory services are required.

Southwestern Veterans’ Center shall provide transportation of residents to the Awarded Contractor’s facility.

C. Emergency Services. Prior to treatment of any optometry emergencies, the facility must complete the “Certification of Medical Necessity” and forward it to the Facility Deputy Commandant, Director of Nursing and/or designee so they can determine if emergency service(s) are required.

The awarded contractor shall respond to any emergency within twenty-four (24) hours after approval has been provided and initial call to the awarded contractor from the facility.

D. Residents Option of Services. Each resident of SWVC reserves the right to accept or reject participation in the optometry services offered under the Awarded Contract. The residents or residents’ families may choose to obtain these services from another contractor at their own discretion and expense.

Resident(s) may, at their own expense, seek private treatment by an Optometrist of their choice. If a resident seeks private treatment, the facility must ensure the resident is provided with transportation to an optometrist of their choice. The facility will provide transportation with a ten (10) mile radius for exams and/or emergency treatments. The resident will be responsible to pay for transportation over ten (10) miles from the facility where the resident resides.

E. Compliance. All services and supplies provided must be compliant with the most current applicable Federal, State, and Local, Standards, Laws, Guidelines, Licensure Requirements, and Regulations (Requirements). In any event where the awarded contractor creates a scenario where the contracting agency is found to be out of compliance with any Requirements the awarded contractor will be liable and responsible for any damages suffered by DMVA. All non-compliance issues must be addressed and resolved by the awarded contractor within (48) forty-eight hours of notification to the awarded contractor. It is the awarded contractor’s responsibility to ensure they are complying with all Requirements, including any updates throughout the duration of the contract, regardless of being provided them specifically by DMVA.

F. Hours of Operation. The awarded contractor shall perform optometry services within normal business hours. Emergency or special requests may be performed outside of normal business hours. All work performed outside of normal business hours must be pre-approved by the SWVC Deputy Commandant, Director of Nursing, or designee. Normal business hours for these services are Monday – Friday from 8:00 am through 4:00 pm.

G. Final Inspection. DMVA reserves the right to conduct a final inspection and acceptance test of all work or deliverables acquired under this PO.

H. Background Checks Restrictions. The awarded contractor’s employees, contractors, or resources shall not be employable by DMVA if they have been found guilty of abuse, neglect, exploitation, misappropriation of property or mistreatment by a court of law, or have had a finding entered into the Pennsylvania nurse aide registry or any State registry if applicable, concerning abuse, neglect, exploitation, mistreatment of residents or misappropriation of resident property, or have disciplinary action in effect against his/her professional license by at state licensure body as a result of finding of abuse, neglect, exploitation, mistreatment of residents or misappropriation of resident property. DMVA has the right to review each individuals background check on a case-by-case basis for any other infractions.

I. Confidentiality. The Awarded Contractor shall maintain as confidential all information relating to the policies and procedures and records of the Veterans Homes, including all resident medical records and maintain such records in a secured locked fashion and in compliance with the Health Insurance Portability and Accountability Act (HIPAA). The awarded contractor will be required to adhere to the requirements of the Business Associate Agreement (see attached).

J. Medical Screening The awarded contractor will have staff complete the following prior to the provision of services: Contractor/Vendor TB Screening Attestation, The HealthCare Personnel (HCP) Baseline Individual Tuberculosis (TB) Risk Assessment, Initial Tuberculosis (TB) Signs & Symptoms questionnaire, as well as, TB Testing if not completed within the past twelve (12) months.   

The awarded contractor will present proof for all staff assigned to the SVH of having received a complete two-step PPD (purified-protein-derivative) tuberculin skin test (TST) with negative/no reaction result completed within the past twelve (12) months or a negative Interferon Gamma Release Assay (IGRA) blood test (examples: QuantiFERON / T-spot). A single negative IGRA test done within the prior 12 months will be accepted. 

  

TST (Tuberculin Skin Test). 

If the individual has had only one TST in the past 12 months, that test would be considered the first of the two-step process, the second step being the repeat TST test. 

If an individual has not had a TB test within the last twelve months or has never had a TB test and TST is being done for the first time, the 2 step TST protocol shall be followed. 

Contractors with a newly positive TB Test result will complete a symptom evaluation, TB Signs & Symptoms Questionnaire, and be referred to the local County Health Department (DOH) and potential restriction from the SVH.  

Contractors with a known history of positive TB Testing; a past chest x-ray, applicable clearance from County DOH or Primary Care Provider (PCP), and symptom evaluation, TB Signs & Symptoms Questionnaire, must be submitted to the SVH prior to rendering services.   

Contractors assigned to the SVH must complete a TB Signs & Symptoms Questionnaire annually.  If symptomatic screening is positive at any time, the contractor is required to follow the direction of the SVH Infection Preventionist in relation to further testing and screening, potential follow up with local Department of Health and potential restriction from the SVH.  

It is the awarded contractor’s responsibility to ensure the SVH is provided with the most current documentation throughout the term of the agency contract.  

Failure to provide the required documentation will be interpreted as the awarded contractor not complying with the Terms and Conditions of the agency contract.

K. Infection Control. – The awarded contractor must comply with all Commonwealth of PA infection control requirements, Centers for Disease Control and Prevention (CDC) guidance, and COVID-19 guidelines for the duration of the contract period.

L. Ongoing Screenings.  The Awarded Contractor is responsible for providing required information, Provider Screening for Exclusion from Participation in Federal Health Care Programs Contractor Attestation to comply with the Medical Assistance Bulletin No. 99-11-05 (attached).  This attestation must be provided directly to the Veterans’ Home upon hiring or assigning individuals to the Veterans’ Home and monthly thereafter.  In the event one of the Awarded Contractor’s employees or their subcontracted employees, are identified, it is the Awarded Contractor’s responsibility to suspend the individual from the Veterans’ Home immediately and ensure the proper levels of care continue to be met with an appropriate, equivalent substitution. It is the Contractor’s responsibility to make sure that the Veterans’ Home is provided with this documentation throughout the term of the Contract. Failure to provide the required documentation will be interpreted as the Awarded Contractor not complying with the Terms and Conditions of the Contract.

M. Facility Security Procedures. Each time the awarded contractor’s employees provide services for DMVA, they will be required to sign in at the security desk at the main entrance of the facility, obtain contractor identification badges, and report to DMVA POC, prior to the provision of services under this PO. Upon completion of the services, the awarded contractor’s employees must return to the security desk, sign out, and return all badges issued to them. For the Veterans Homes, any medical providers or individuals providing services directly to residents will be required to punch in and out at a time clock or access device. The awarded contractor shall follow all required security procedures of each location within the facility in addition to any other pertinent identification or requirements as deemed necessary by DMVA. Particularly sensitive areas may require DMVA staff to accompany the awarded contractor’s employees. These procedures may vary from work location to work location and must be adhered to. If requested by the facility designee, the awarded contractor shall provide paperwork for facility designee to sign verifying satisfactory services have been provided.

N. Facility Policies and Procedures. The awarded contractor’s employees providing services at the DMVA location shall follow all policies and procedures of the location(s). The awarded contractor may obtain a copy of all policies and procedures from the Program Office POC.

O. Annual Training of Contracted Staff: All awarded contractors, contractor personnel, and subcontractors that encounter residents during the performance under their contract at a Veterans Homes shall complete annual training.  The training will consist of safety topics, emergency preparedness, residents’ rights, abuse, infection control, reporting, incidents, HIPAA, and compliance.  The approximate length of all combined trainings is estimated at no more than 2 hours per person. The cost associated with the annual trainings shall be included in contract amount and shall not be billed separately.

P. Service Deficiencies. DMVA will notify awarded contractor verbally and in writing of any unsatisfactory services rendered. The awarded contractor shall correct the deficiency within the timeframe as specified by DMVA after such notification. If service deficiencies are ongoing and documented, DMVA will issue a Cure letter to the awarded contractor stating the ongoing deficiencies, with a requirement that the awarded contractor submit a formal Plan of Corrective Action for resolution of the deficiency issues, as specified in the letter. The formal Plan of Correction must be submitted to DMVA with in ten (10) calendar days of the date on the Cure letter. Ongoing service deficiencies that are not resolved may result in termination of the contract.

Q. DMVA Payment Authorization. For all services provided under the Contract, DMVA reserves the right to authorize the Veterans Home to pay for the services provided.  The awarded contractor shall bill DMVA and DMVA shall pay for services with DMVA payment authorization.  DMVA shall provide pre-authorization in writing to the awarded contractor prior to the provision of services. The awarded contractor shall provide an itemized invoice by resident for all services billed to DMVA.

R. Insurance Billing – Resident Pay, non-Enhanced Veterans Reimbursement (EVR). The awarded contractor shall bill Medicare and other third-party payers for services provided.  The awarded contractor shall bill Medicaid, when participating.  The awarded contractor is required to make a good faith effort to obtain reimbursement from third-party insurance and Medicaid if the awarded contractor is participating.  The awarded contractor shall send all remaining bills directly to the resident for payment. The awarded contractor shall agree to direct billing for all services and procedures provided, as follows: Medicare, Primary Insurance, Medical Assistance, Supplemental Insurance (Medicare deductible/co-insurance), lastly the Resident. The awarded contractor shall accept the insurer’s Usual, Customary and Reasonable (UCR) rates as the acceptable rate for the service provided. The resident shall not be responsible to pay the difference between the UCR and the awarded contractor’s rate for a given service. DMVA shall not cover any outstanding costs or expenses associated with the provision of services under this contract.  

S. Insurance Billing – DMVA Payor of Last Resort. The awarded contractor is required to have a provider number and bill Medicare, Medicaid, and other third-party payers that provide coverage for any resident.  With respect to services rendered to residents who are Medicare, Medicaid, or third-party insurer beneficiaries, the awarded contractor shall bill the insurer.  All bills for cost-sharing amounts must be sent directly to the Veterans Home.  The awarded contractor cannot bill the residents or their families for any cost-sharing amounts.  The Veterans Home will reimburse the awarded contractor without limitation for all cost sharing amounts owed up to the UCR rate, when required by regulation.  The awarded contractor is required to make a good faith effort to obtain reimbursement from third party insurance.  The awarded contractor shall agree to direct billing for all services and procedures provided to residents by adhering to the following terms and order of payers for allowable charges:  Medicaid, Medicare, Insurance, Supplemental Insurance, Veterans Homes.  The awarded contractor shall accept the insurer’s Usual, Customary and Reasonable (UCR) rates as the acceptable rate for the service provided. Neither DMVA nor the resident shall be responsible to pay the difference between the UCR and the awarded contractor’s rate for a given service. The Veterans Home will be payer of last resort for any/all co-pay & deductible amounts and for uninsured residents up to the Medicare/Medicaid, UCR rates. Requests for submission of any necessary corrections or waiver appeals must be submitted by the awarded contractor within seventy-two (72) hours of request. The Veterans Home shall provide the awarded contractor with updated resident insurance information as changes occur. The awarded contractor shall make all corrections to rejected claims; assist with waiver appeals, and correction of billings. The awarded contractor shall provide an itemized invoice for services based on the PO. The awarded contractor shall bill for services when completed, not to exceed thirty (30) days from date of service. Insured and uninsured residents shall be invoiced and billed separately.  The awarded contractor shall provide individual invoices for all cost sharing amounts (co-pays and deductibles) to the Veterans Home for reimbursement as they occur. Invoice backup shall be in the form of an itemized spreadsheet detailing the medical specialty service, a copy of the explanation of benefits (EOB), from the awarded contractor and below fields provided on-site and off-site at the Veterans Home.  The awarded contractor shall provide billing reports to the Veterans Home, as requested 

T. Billing and Invoicing Requirements. The awarded contractor is required to have a provider number and bill Medicare, Medicaid, and other third-party payers that provide coverage for any resident. With respect to services rendered to residents who are Medicare, Medicaid, or third-party insurer beneficiaries, the awarded contractor shall bill the insurer. All bills for cost-sharing amounts must be sent directly to the Veterans Home. The awarded contractor cannot bill the residents or their families for any cost-sharing amounts. The Veterans Home will reimburse the awarded contractor without limitation for all cost sharing amounts owed up to the UCR rate. The awarded contractor is required to make a good faith effort to obtain reimbursement from third party insurance.

The awarded contractor shall agree to direct billing for all services and procedures to residents by adhering to the following terms and order of payers:

a. Primary Insurance (if applicable)

b. Medicare

c. Supplemental Insurance (Medicare deductible/co-insurance only)

d. Medical Assistance (deductible/co-insurance only)

e. Veterans’ Home as payer of last resort

The awarded contractor shall accept the insurer’s Usual, Customary and Reasonable (UCR) rates as the acceptable rate for the service provided. Neither DMVA nor the resident shall be responsible to pay the difference between the UCR and the awarded contractor’s rate for a given service. The Veterans Home will be payer of last resort for any/all co-pay & deductible amounts and for uninsured residents up to the Medicare/Medicaid, UCR rates. Requests for submission of any necessary corrections or waiver appeals must be submitted by the awarded contractor within seventy-two (72) hours of request. The Veterans Home shall provide the awarded contractor with updated resident insurance information as changes occur.

The awarded contractor shall make all corrections to rejected claims; assist with waiver appeals, and correction of billings.

The awarded contractor shall provide an itemized invoice for services based on the PO. The awarded contractor shall bill for services when completed, not to exceed thirty (30) days from date of service. Insured and uninsured residents shall be invoiced and billed separately.

The awarded contractor shall provide individual invoices for all cost sharing amounts (co-pays and deductibles) to the Veterans Home for reimbursement as they occur.

The awarded contractor shall submit a copy of all invoices and backup to the remit to address:

Southwestern Veterans Home, 7060 Highland Dr, Pittsburg, PA 15206

Invoice backup shall be in the form of an itemized spreadsheet detailing the medical specialty service, a copy of the explanation of benefits (EOB), from the awarded contractor and below fields provided on-site and off-site at the Veterans Home.

a. Contract Number;

b. Medical Services’Location (including on-site at the Veterans Home);

c. Resident Name, Service Provided, CPT Code and Level of Care (LOC); skill andnon-skilled (for cost reporting purposes);

d. Date of Service;

e. Description of Services (all and multiple/resident) provided by Specialty;

f. Procedure Code as listed on Fee Schedule; EOB; and

g. Total Cost.

The awarded contractor shall provide the following reports to the Veterans Home as requested in the timelines listed in this section. The reports must contain at a minimum the requirements described and shall be sent to the accountant or designee at the Veterans Home.

U. Reporting Requirements. The Awarded Contractor shall supply current copies of required current licensure, current certification, relevant education, training and experience, current competence, and a statement that the individual is able to perform the services that he or she is applying to provide in the Commonwealth of Pennsylvania, as specified in the Statement of Work and/or the Terms & Conditions. This documentation must be provided to Barbara Klucinec at bklucinec@pa.gov at SWVC. The awarded contractor shall mail, fax, or hand deliver copies of all necessary information to the Veterans’ Home where services are to be provided within the timeframe as designated in the Statement of Work. It is the awarded contractor’s responsibility to make sure the Veterans’ Home is provided with the most current documentation throughout the term of the contract. Failure to provide the required documentation will be interpreted as the Contractor not complying with the Terms and Conditions of the contract.

V. Removal of Contractor Personnel. The POC or designee reserves the right to direct the awarded contractor to permanently remove any contractor personnel from duty under the PO when the performance does not meet the standards outlined in these Specifications or when DMVA determines that it is in the best interest of the Commonwealth to have the personnel removed. The POC or designee shall notify the awarded contractor in writing of the reason(s) the removal of contracted personnel is required. Removal of contractor personnel will not relieve the awarded contractor of any performance requirements under the PO or create an entitlement of the contractor to receive an equitable payment adjustment. The awarded contractor shall not, without the POC or designee’s consent, assign a permanently removed individual to DMVA at any time. 

W. Laws/Statutes/Acts/Etc. (as applicable)

Stark Law. The awarded contractor shall comply with the Physician Self-Referral Law [42 U.S.C. § 1395nn] (Stark Law).

Anti-Kickback Statute. The awarded contractor shall comply with the Anti-Kickback Statute [42 U.S.C. § 1320a-7b].

False Claims Act. The awarded contractor shall comply with the False Claims Act [31 U.S.C. § § 3729-3733].

Exclusion Statute. The awarded contractor shall comply with the Exclusion Statute [42 U.S.C. § 1320a-7].

Annual Checks. The awarded contractor shall ensure all contract staff who will have contact with residents complete the following checks annually:

• The Pennsylvania Department of Human Services Medicheck (Precluded Providers) List

• The Office of Inspector General, U.S. Department of Health and Human Services Exclusion Database Check

• The U.S. Department of Health and Human Services National Practitioners Data Bank Check

• Background Check Certification Form

The awarded contractor shall immediately report to DMVA any individual that does have a clean check and remove them from providing services to DMVA. The awarded contractor shall provide certifications that the checks have been completed upon request by DMVA.

X. Estimated Quantities. DMVA quantities listed in the Purchase Order are considered estimated.

Y. Like Services/Increase and Decrease Quantities. The DMVA Reserves the right to add like services or supplies to the contract not listed in the original solicitation or contract if a need arises. The awarded contractor will be notified in writing when services or supplies have been added. DMVA reserves the right to increase and decrease quantities resulting from variations between any estimated quantities in the Contract and actual quantities. 

Z. Qualification/Scope of Work Changes.  The DMVA reserves the right to change qualifications and/or scope of work items to enhance the success of the service.

AA. Contacts. The awarded contractor shall provide all required documentation throughout the term of the executed PO to the SWVC POC:

Barbara Klucinec, Procurement Specialist

Department of Military & Veterans Affairs

Southwestern Veterans’ Center

7060 Highland Drive

Pittsburgh PA 15206

Telephone: 412-665-6766

Email Address: bklucinec@pa.gov

Invoices:

Accounting Department

Southwestern Veterans’ Center

7060 Highland Drive

Pittsburgh PA 15206

Telephone: 412-665-6760