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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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MEDICAID SERVICES
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PROVIDER WILL PROVIDE MAINTAIN SUFFICIENT STAFF TO MEET CONTRACTUAL OBLIGATIONS (.5 FTE MEDICAL PROV...
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Cost Reimbursement
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| Major Deliverable: PROVIDER WILL PROVIDE MAINTAIN SUFFICIENT STAFF TO MEET CONTRACTUAL OBLIGATIONS (.5 FTE MEDICAL PROVIDER, .5 FTE CERTIFIED MEDICAL ASSISTANT AND .5 FTE OFFICE ASSISTANT), AND ENSURE STAFF IS APPROPRIATE LICENSED AND CREDENTIALED. |
| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: INVOICE WILL BE SUBMITTED WITH PERSONNEL SUMMARY, REQUESTING REIMBURSEMENT AND ITEMIZE EACH CHARGE REQUESTED FOR REIMBURSEMENT. THE ITEMZATION WILL INCLUDE NAME, JOB TITLE, RATE OF PAY AND TOTAL. |
| Financial Consequences: DEPARTMENT MAY WITHHOLD PAYMENT. FUNDING REDUCTIONS WILL BE PROPORTIONATE TO THE LEVEL OF NON-COMPLIANCE. |
| Source Documentation Page Reference: 10-11 |
| Deliverable Number: |
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MEDICAID SERVICES
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MAKE REFERRALS BASED ON ELIGIBILITY TO VCHD CASE MANAGER. PROVIDER MUST SERVE ALL CLIENTS REFERRED....
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No Cost
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| Major Deliverable: MAKE REFERRALS BASED ON ELIGIBILITY TO VCHD CASE MANAGER. PROVIDER MUST SERVE ALL CLIENTS REFERRED. |
| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: SUBMIT REFERRAL REQUEST/TRACKING FORM (EXHIBIT A) TO VCHD CASE MANAGER. |
| Financial Consequences: DEPARTMENT MAY WITHHOLD PAYMENT. FUNDING REDUCTIONS WILL BE PROPORTIONATE TO THE LEVEL OF NON-COMPLIANCE. |
| Source Documentation Page Reference: 10-11 |
| Deliverable Number: |
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MEDICAID SERVICES
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MAKE APPOINTMENTS AVAILABLE TO CLIENTS REFERRED BY VCHD CASE MANAGER. PROVIDER MUST SERVE ALL CLIEN...
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No Cost
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| Major Deliverable: MAKE APPOINTMENTS AVAILABLE TO CLIENTS REFERRED BY VCHD CASE MANAGER. PROVIDER MUST SERVE ALL CLIENTS REFERRED. |
| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: SUBMIT MONTHLY REPORT OF PATIENTS SEEN (EXHIBIT D). |
| Financial Consequences: DEPARTMENT MAY WITHHOLD PAYMENT. FUNDING REDUCTIONS WILL BE PROPORTIONATE TO THE LEVEL OF NON-COMPLIANCE. |
| Source Documentation Page Reference: 10-11 |
| Deliverable Number: |
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MEDICAID SERVICES
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ENSURE THAT ALL SUPPLIES PURCHASED WILL BE PURCHASED IN ACCORDANCE WITH SCOPE OF WORK AND ALL APPLIC...
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Fixed Fee / Unit Rate
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| Major Deliverable: ENSURE THAT ALL SUPPLIES PURCHASED WILL BE PURCHASED IN ACCORDANCE WITH SCOPE OF WORK AND ALL APPLICABLE STATE AND FEDERAL PROCUREMENT GUIDELINES. (price/encounter) |
| Deliverable Price: $5.07 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: INVOICE WILL BE SUBMITTED WITH SUPPORTING DOCUMENTATION WITHIN 15 DAYS OF MONTH END. |
| Financial Consequences: DEPARTMENT MAY WITHHOLD PAYMENT. FUNDING REDUCTIONS WILL BE PROPORTIONATE TO THE LEVEL OF NON-COMPLIANCE. |
| Source Documentation Page Reference: 10-11 |
| Deliverable Number: |
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MEDICAID SERVICES
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MAINTAIN EXPANDED HOURS OF OPERATION - MONDAY 7P-9P, TUESDAY 7P-9P, WEDNESDAY 5P-9P, THURSDAY 7P-9P,...
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Fixed Fee / Unit Rate
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| Major Deliverable: MAINTAIN EXPANDED HOURS OF OPERATION - MONDAY 7P-9P, TUESDAY 7P-9P, WEDNESDAY 5P-9P, THURSDAY 7P-9P, FRIDAY 4:30P-7P; SATURDAY 9A-12:30P, 1P-5P, EXCLUDING HOLIDAYS, UNLESS OTHERWISE INFORMED 48 HOURS PRIOR TO CLOSURE. ($40/Saturday) |
| Deliverable Price: $40.00 |
| Non Price Justification: |
| Performance Metrics: PROVIDER WILL RECORD AND REPORT CENTER SCHEDULING AND HOURS OF OPERATION MONTHLY. |
| Financial Consequences: DEPARTMENT MAY WITHHOLD PAYMENT. FUNDING REDUCTIONS WILL BE PROPORTIONATE TO THE LEVEL OF NON-COMPLIANCE. |
| Source Documentation Page Reference: 11 |
| Deliverable Number: |
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MEDICAID SERVICES
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MAINTAIN EXPANDED HOURS OF OPERATION - MONDAY 7P-9P, TUESDAY 7P-9P, WEDNESDAY 5P-9P, THURSDAY 7P-9P,...
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Fixed Fee / Unit Rate
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| Major Deliverable: MAINTAIN EXPANDED HOURS OF OPERATION - MONDAY 7P-9P, TUESDAY 7P-9P, WEDNESDAY 5P-9P, THURSDAY 7P-9P, FRIDAY 4:30P-7P; SATURDAY 9A-12:30P, 1P-5P, EXCLUDING HOLIDAYS, UNLESS OTHERWISE INFORMED 48 HOURS PRIOR TO CLOSURE. (EMR License $1132.50/mo, Electric $151/mo) |
| Deliverable Price: $1,283.50 |
| Non Price Justification: |
| Performance Metrics: INVOICE WILL BE SUBMITTED WITH SUPPORTING DOCUMENTATION WITHIN 15 DAYS OF MONTH END. |
| Financial Consequences: DEPARTMENT MAY WITHHOLD PAYMENT. FUNDING REDUCTIONS WILL BE PROPORTIONATE TO THE LEVEL OF NON-COMPLIANCE. |
| Source Documentation Page Reference: 18, 33, 34 |
| Deliverable Number: |
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