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Deliverable Number
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Commodity/Service Type
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Major Deliverable
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Method of Payment
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Vocational rehabilitation services
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Reemployment Services - Summary of reemployment services; Work products from the requested services ...
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Fixed Fee / Unit Rate
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| Major Deliverable: Reemployment Services - Summary of reemployment services; Work products from the requested services - $84.00 per hour.
Acknowledge the Referral via the Contract Service Module no later than three (3) Business Days as specified.
(Initial contract years; Jan 4, 2024 - Jan 3, 2026) |
| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: The Division will compare the substance of the written report with the records provided to Momentum Healthcare, Inc.
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| Financial Consequences: Acknowledgement of Assignment - Failure to acknowledge the Referral via the Contract Services Module as specified will result in a $25.00 reduction from the initial invoices for that injured employee for each Business Day past the due date until the Referral is acknowledged.
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| Source Documentation Page Reference: pg 52; 2223-03 RCP WC |
| Deliverable Number: |
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Vocational rehabilitation services
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Reemployment Services - Summary of reemployment services; Work products from the requested services ...
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Fixed Fee / Unit Rate
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| Major Deliverable: Reemployment Services - Summary of reemployment services; Work products from the requested services - $84.00 per hour.
Assign the Referral to the Provider and notify the Department of the Provider's name via the Contract Services Module within five (5) Business Days as specified.
(Initial contract years; Jan 4, 2024 - Jan 3, 2026) |
| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: The Division will compare the substance of the written report with the records provided to Momentum Healthcare, Inc.
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| Financial Consequences: Provider Assignment - Failure to assign the Referral to the Provider and notify the Department of the Provider's name via the Contract Services Module as specified will result in a $25.00 reduction from the initial invoice for that injured employee for each Business Day past the due date until the Referral is assigned. |
| Source Documentation Page Reference: pg 52; 2223-03 RCP WC |
| Deliverable Number: |
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Vocational rehabilitation services
|
Reemployment Services - Summary of reemployment services; Work products from the requested services ...
|
Fixed Fee / Unit Rate
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| Major Deliverable: Reemployment Services - Summary of reemployment services; Work products from the requested services - $84.00 per hour.
Completed all services identified on the Referral form as specified.
(Initial contract years; Jan 4, 2024 - Jan 3, 2026) |
| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: The Division will compare the substance of the written report with the records provided to Momentum Healthcare, Inc.
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| Financial Consequences: Report - Initial Report due 45 days/acknowledgement of assignment, Additional Reports due 30 days/thereafter. Failure to completed all services identified on the Referral Form as specified will result in a $75.00 reduction on the invoice for that injured employee.
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| Source Documentation Page Reference: pg 52; 2223-03 RCP WC |
| Deliverable Number: |
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Vocational rehabilitation services
|
Reemployment Services - Summary of reemployment services; Work products from the requested services ...
|
Fixed Fee / Unit Rate
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| Major Deliverable: Reemployment Services - Summary of reemployment services; Work products from the requested services - $84.00 per hour.
Prepare the written Reemployment Services Report and submit it via the Contract Services Module as specified.
(Initial contract years; Jan 4, 2024 - Jan 3, 2026) |
| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: The Division will compare the substance of the written report with the records provided to Momentum Healthcare, Inc.
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| Financial Consequences: Report - Initial Report due 45 days/acknowledgement of assignment, Additional Reports due 30 days/thereafter. Failure to completed all services identified on the Referral Form as specified will result in a $75.00 reduction on the invoice for that injured employee.
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| Source Documentation Page Reference: pg 52; 2223-03 RCP WC |
| Deliverable Number: |
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Vocational rehabilitation services
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Vocational evaluation report - Background, Medical, Educational, Work History, Behavioral Observatio...
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Fixed Fee / Unit Rate
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| Major Deliverable: Vocational evaluation report - Background, Medical, Educational, Work History, Behavioral Observations, Test Results, Transferrable Skills Analysis, Summary - $1,099.00 per vocational evaluation report.
Acknowledge the Referral via the Contract Service Module no later than three (3) Business Days as specified.
(Initial contract years; Jan 4, 2024 - Jan 3, 2026)
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: The Division will compare the substance of the written report with the records provided to Momentum Healthcare, Inc.
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| Financial Consequences: Acknowledgement of Assignment - Failure to acknowledge the Referral via the Contract Services Module as specified will result in a $25.00 reduction from the initial invoices for that injured employee for each Business Day past the due date until the Referral is acknowledged.
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| Source Documentation Page Reference: pg 52; 2223-03 RCP WC |
| Deliverable Number: |
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Vocational rehabilitation services
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"Vocational evaluation report - Background, Medical, Educational, Work History, Behavioral Observati...
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Fixed Fee / Unit Rate
|
| Major Deliverable: "Vocational evaluation report - Background, Medical, Educational, Work History, Behavioral Observations, Test Results, Transferrable Skills Analysis, Summary - $1,099.00 per vocational evaluation report.
Assign the Referral to the Provider and notify the Department of the Provider's name via the Contract Services Module within five (5) Business Days as specified.
(Initial contract years; Jan 4, 2024 - Jan 3, 2026) |
| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: The Division will compare the substance of the written report with the records provided to Momentum Healthcare, Inc.
|
| Financial Consequences: Provider Assignment - Failure to acknowledge the Referral via the Contract Services Module as specified will result in a $25.00 reduction from the initial invoices for that injured employee for each Business Day past the due date until the Referral is acknowledged.
|
| Source Documentation Page Reference: pg 52; 2223-03 RCP WC |
| Deliverable Number: |
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Vocational rehabilitation services
|
Vocational evaluation report - Background, Medical, Educational, Work History, Behavioral Observatio...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Vocational evaluation report - Background, Medical, Educational, Work History, Behavioral Observations, Test Results, Transferrable Skills Analysis, Summary - $1,099.00 per vocational evaluation report.
Prepare the written Vocational Evaluation Report and submit it via the Contract Services Module as specified.
(Initial contract years; Jan 4, 2024 - Jan 3, 2026) |
| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: The Division will compare the substance of the written report with the records provided to Momentum Healthcare, Inc.
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| Financial Consequences: Report - Initial Report due 45 days/acknowledgement of assignment, Additional Reports due 30 days/thereafter. Failure to submit the written reemployment Services Report to the Department as specified will result in a $75.00 reduction from the invoice for each Business Day past the due date until the Report is submitted.
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| Source Documentation Page Reference: pg 52; 2223-03 RCP WC |
| Deliverable Number: |
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