STATEMENT OF WORK
TORRANCE STATE HOSPITAL OUTPATIENT DIALYSIS SERVICES
I. OBJECTIVE
Torrance State Hospital (TSH) located at State Route 1014, Torrance, PA is seeking a Contractor to provide outpatient chronic renal dialysis services. A contract will be awarded to the lowest responsive bidder.
The anticipated contract term is for one (1) year, to begin December 1, 2016 (or upon the completion of all Commonwealth Approvals and full execution of the contract) and will end November 30, 2017, with four (4) one-year renewal at the option of the Commonwealth. Contractor may not begin work until they are in possession of a valid Purchase Order.
II. SCOPE OF WORK
The Contractor will provide dialysis services to consumers of TSH when required at the Contractor’s place of business at scheduled times mutually agreed upon by both parties. For purposes here of “Dialysis Services” shall mean hemodialysis.
The contractor will, in connection with the provision of the dialysis services have the following responsibilities during the Term of this Agreement:
1. Contractor will provide all medications at Medicare rate that are necessary to be given during dialysis and equipment and supplies (collectively, the “Supplies”) necessary and proper for the provision of Dialysis Services.
2. The contractor will provide all drugs and biologicals necessary to administer hemodialysis.
3. Contractor will provide skillful and qualified Clinicians and or Technicians experienced with administering hemodialysis. Clinical personnel must be certified or licensed personnel employed by the Contractor or employees of the Contractor.
4. The Contractor will ensure that adequate supplies and personnel are available to TSH for scheduled hemodialysis treatments.
5. Contractor will provide hemodialysis services to TSH’s consumers pursuant to a written order for such Dialysis Services signed by a nephrologist. The nephrologist must evaluate the consumer at least every 30 day to determine the ongoing suitability of the consumer for dialysis.
6. The Contractor will provide all supplies, equipment and support services necessary for the effective performance of the consumer’s hemodialysis.
7. Contractor will provide pertinent information and or instructions post hemodialysis treatment discharge on TSH’s Consultation Referral/Report.
8. The Contractor may refuse to provide dialysis if the consumer’s physical condition is such that dialyzing that consumer in an out-patient hemodialysis facility may be unsafe, or the consumer’s condition requires care or treatment which cannot be appropriately administered in an out-patient setting. In the case of a medical emergency, the Contractor will call an ambulance. The ambulance service will bill Torrance State Hospital through Torrance’s contract with Mutual Aid Ambulance Service.
III. Torrance State Hospital Responsibilities
Torrance State Hospital shall supply at its cost the following items and services in conjunction with Contractor’s provision of Dialysis Services:
1. TSH shall supply transportation for TSH consumers to and from the Dialysis Clinic.
2. TSH shall supply a nursing staff employee to stay with the consumer during the dialysis procedure.
3. TSH shall evaluate the consumer prior to each transport to the dialysis clinic to ensure that they are medically fit and mentally stable to attend dialysis treatment.
4. Blood banking, laboratory and X-ray services as required for consumer care.
5. Medications not included in the MCR, such as, but not limited to, Epogen, Antibiotics, Activase, Zemplar, Hectoral, Ferrlecit and Venofer.
IV. Contract Monitor
The Contract shall be monitored by Torrance State Hospital’s Chief of Medical Services:
Dr. Alfonso Arevalo
Phone: 724/459-4539
Email:
V. Bid
Payment for all compensable services pertaining to this contract will be made in accordance with the current Federal Medicare Fee Schedule in effect at the time of service. This includes drugs and labs that are bundled into the End State Renal Disease (ESRD) Medicare Rate (MCR); drugs and labs not included in the ESRD MCR will be charged separately at the Medicare Rate for those items.
VI. Payment Provision
All invoices will be approved by the TSH Contract Monitor; the awarded contractor will submit payment at the Medicare Rate for the procedure using the appropriate code. The TSH will provide the necessary billing information as well as completed Medical Necessary Forms.
Invoicing
Invoices must be submitted to:
By US Mail: DHS (Facility/Program)
Commonwealth of Pennsylvania – PO Invoice
PO Box 69180
Harrisburg, PA 17106
By Email
(Invoices Only)
Copies of All Invoices to:
DHS
Torrance State Hospital
PO Box 126
Torrance PA 15779
For a paperless option for the copy, please email:
and cc:
VII. Compliance
Contractor shall comply with all standards of service mandated by Federal, State and Local regulations and laws, as well as the policies and procedures of the Department of Human Services and Torrance State Hospital.
VIII. General Information
The contractor is responsible to carry all necessary insurance and liability coverage to cover this service and provide certification of such insurance.