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HomeMy WebLinkAboutMINUTES - 09011998 - C116-C120 TO: BOARD OF SUPERVISORS FROM: William Walker, M.D. , Health Services Director CiC)C1tCc By: Ginger Marieiro, Contracts Administrator August 18, 1998 Costa DATE: County SUBJECT: Approval of Contract #26-250-3 with Preferred Staffing Incorporated SPECIFIC REQUEST(S)OR RECOMMENDA7tON(S)&BACKGROUND AND JUSTIFICATION REC9 MZ1gMIOH(S) Approve and authorize the Health Services Director, or his designee, (Frank Puglisi, Jr. ) to execute on behalf of the County, Contract #26-250-3 with Preferred Staffing Incorporated, in the amount of $75,000, for the period from August 1, 1938 through July 31, 1999, to provide nursing registry services at Contra Costa Regional Medical Center and Health Centers. FISCAL IMPACT: This contract is included in the Health Services Department Enterprise I budget for FY 1998-99. BACKGROUNDIREASON(S) FOR RECOMMENDATION(8) For several years the County has contracted with nursing registries to provide temporary licensed nursing personnel to assist Contra Costa Regional Medical Center and the Contra Costa Health Centers during peak loads, temporary absences, and ,emergency situations. There continues to be a nationwide nursing shortage, and in spite of persistent efforts to recruit nurses, the Department has experienced difficulty in filling vacant positions. Therefore, the Department has had to rely heavily on the registry services in order to provide quality nursing care for patients. On October 31, 1997, the Board of Supervisors approved Contract #26-260--2 with Preferred Staffing, Inc. for the period From August 1, 1997 through July 31, 1998 to provide nursing care for County's patients. Approval of Contract ,#26--250-3 will allow the Contractor to continue providing services through July 31, 1999. CONTINUED ON ATTACHMENT: SIGNATURE RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATII'RE(S),;_ ! '] ACTION OF BOARD ON4 193$ APPROVED AS RECOMMENDED X 1� VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS (ABSENT l l AND CORRECT COPY of AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED ., , PHI[SA HELOR,CLERK OF T E BOARD OF Contact Person: Frank F'ugliai, Jr. (370-5100) SUPERVISORS AND COUNTY ADMINISTRATOR CC: Health SeMces(Contracts) Risk Management Auditor Controller BY�r, ..rr�tn / �?- DEPUTY Contractor r TO: BOARD OF SUPERVISORS FROM: William Walker, M.D. , Health Services Director `_= Contra By: Ginger Marieiro, Contracts Administrator Costa DATE: August 1.8, 1998 County SUBJECT: Approval of Agreements with the U.S. Department of Veterans Affairs SPECIFIC REQUEST(S)OR RECOMMENDATION(S)4 BACKGROUND AND JUSTIFICATION RECOMMENDER ACTiCN: Approve and authorize the Health Services Director, or his designee (Frank Puglisi, Jr. ) , to execute on behalf of the County, the following Agreements with the U.S. Department of Veterans Affairs Northern California Health Care System (VANCHCS) for the period from July 1, 1998 through. September 30, 1998, for provision of specialized medical services : County # VA # Service ##26-343 V612P-6151 Ophthalmology ##26-344 V612P-6152 Speech Pathology/Audiology #26-345 V612P-6150 Neurology FINANCIAL IMPACT: This Contract is funded in the Health Services Department' s Enterprise I Budget . Under the term of the agreements VANCHCS will be paid a fee for each service in accordance with the fee schedules which are incorporated in the Contract . The services provided for the County' s patients under this Contract are billable to patients and third party payors . REASONS FOR RECOMMENDATIONSI$ACKGRO : For many years the County and U. S. Department of Veterans Affairs has maintained a mutual sharing agreement which has made available to the County specialized medical services not otherwise available due to lack of resources, equipment, and personnel. These services ;included specialized laboratory testing, radiology services, nuclear medicine studies, CT scans, MRI' s, dermatology, gastroenterology, urology, audiology and speech, and ophthalmology services. The County provided Emergency Room treatment and inpatient care, including certain ancillary services, for VA-referred patients . The VA recently informed the Department that hereinafter they will use separate agreements for services provided to the County'. Under the terms of the Agreements listed above, VANCHCS will provide specialized services to patients referred for treatment by Contra Costa Regional Medical Center physicians. The Contract documents have always been prepared by the Veterans Administration. CONTINUED ON ATT AC S SIG AT R :. RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE ®OTHER E ACTION OF BOARD ON SeptCtter I, 1 APPROVED AS RECOMMENDED X U VOTE OF SUPERVISORS XI HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT lrle ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: -ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED FHICBkTCAELOR,CLERK OF TH BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR ContactF�erson: Frank Puglisi, Jr. (370-5100) CC: Health Services(Contracts) Risk Management Auditor Controller BY �. , DEPUTY Contractor CONTRACT AWARD FOR SELLING HEALTHCARE SERVICES t.R.EQL1€smm NUMBER PACE I OF CON''AACTOR TO COMPLE':E BLOCKS 12, 17,23,24,&30 2.CONTRACT NO. 3.A WARD/EFFECTtVE 4.ORDER NUMBER 5.SOL CITATION NUMBER 6.SOLICITATION ISSUE V612P-6151 DATE 7/l/98 NIA DATE 7/1/98 7.FOR a.NAME Karen E. Pridmore,Contract Specialist b-TE EPHO vE NUMBER rN cot;r c'ulral S,OF€ER DUE DATE( N/A INFORMATION CALL: 1 1 (925)372-2046 1 LOCAL TIME 9, ISSUED BY CODE 10. THIS ACQUISITION IS N/A i I.DELIVERY FOR FOB 12:DISCOUNT TERMS DESTINATION UNLESS Department of Veterans Affairs 6a 1 UNRESTRICTED BLOCK IS MARKED N/A Northern California Health Care System(VANCHCS) SET ASIDE %POR []SEE SCHEDULE' 2300 Contra Costa Blvd., Suite 440 [7 SMALL BUSINESS Lj Iia.THIS CONTRACT IS A RATED ORDER UNDER DPAS(I5 CFR 700) Pleasant Hill, CA 94523 ❑SMALL DISADV.BUSINESS `Vr/A Q 8(A) 13B.RATING N/A SIC: 14 METHOD OF SOLICITATION NIA SIZE STANDARD: ©gFQ [1IFB ORFP 15.DELIVER TO CODE 16.ADMINISTERED BY CODE N/A Same as Block 9 CONT CT COD 'ACiLITY• IBA. PAYMENT WILL BE MADE BY CODE C' COSItT a Costa Regional .Me f Center(CCRMC) 25413 Alhambra Avenue Same as Block 17A Martinez, CA 94553 TELEPHONE NO.(925)370-5130 Fax (925)370-5138 N/A 18-b.SUBMIT INVOICES TO.ADDRESS SHOWN IN BLOCK ISa UNLESS BLOCK BELOW 7b,CHECK IF REMMANCE IS DIFFERENT AND PUT SUCH ADDRESS TN OFFER IS CHECKED (� SEE ADDENDUM NIA 19 20 21 22 23 24 ITEM NO, SCHEDULE OF SUPPLIES SERVICE QUANTITY UNIT UNIT PRICE AMOUNT VANCHCS will provide Ophthalmology Services to CCRMC in accordance with the attached terms/conditions. /.{77:iCtf,iDD1T;t3,V,4L 5HEE?S.tS.YiCESSARY} 25.ACCOUNTING AND APPROPRIATION DATA j 26.TOTAL.AMOUNT AWARD(FOR GOVT.USECINL)9 Authorities: Enhanced Healthcare Resources Sharing Authority VHA Directive 97-015,dated 3/12/97 17 27a.SOLICITATION INCORPORATES BY REFERENCE FAR 52,212-i.52.:12-4 FAR 52.212.3 AND 52.212.5 ARE ATTACHED.ADDENDA 7 ARE 17 ARE NOT ATTACHED. 270. CONTRACT PEE SCHEDULE.TERMS AND CONDITIONS AND ADDENDA1 ARE 11ARE NOT ATTACtfED 28.CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETUR,ti OR 2(TWO) COPIES 5 AWARD OF CONTRACT. REFERENCE OFFER TO ISSUING OFFICE. CONTRACTOR AGREES TO THE TERMS AND CONDITIONS SET FORTH HEREIN. DATED YOUR OFFER ON SOLICITATION(BLOCK OR OTHER WISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO 11 5),INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH THE TERMS AND CONDITIONS SPECIFIED HEREN, HEREIN.IS ACCEPTED AS TO ITEMS: 30a. SIGNATURE OF CONTRACTOR 3IA.UNITED STATES OF AMERICA(SIGNATURE'LSF'CON?'RACTINGOFFICER) Sob.NAME AND TITLE.OF SIGNER(TYPE OR PRINT) 30c DATE SIGNED 3 i h.NAME OF CONTRACTING OFFICER.(TYPE OR PRIM ) 3Ic.DATE SIGNED Karen E. Pridmore 32a,QUANTITY IN COLUMN 21 HAS BEEN N/A 33,SHIP NUMBER 34.VOUCHER NUMBER 35.AMOUNT VERIFIED CORRECfFOR RECEIVED Q INSPECTED Cf ACCEPTED AS CONFORMS TO THE PARTIAL FINAL CONTRACT.EXCEPT AS NOTED 320,SIGNATURE OF AUTHORIZE+'?GOVT.REPRESFN[AFIVE 32C.DATE 36.PAYMENT 37.CHECK NUMBER COMPLETE PARTIAL FINAL 39.SJR ACCOUNT NUMBER 39 SiR VOUCHER NUMBER 40,PAIR BY 41a.1 CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a.RECEIVED BY(PIUV7) 41b.SIGNATURE AND TITLE OF CERTIFYIN,OFFICER 41c,DATE 42b.RECEIVED AT UOC 4710113 42a.DATE RECD M/MM DD) 42d.TOTAL CONTAINERS 7f7/98 Contract Award Form•VANCHCS(612/900) _ Opthalmology Services Page 2 FEE SCHEDULE A. July 1, 1998 through September 30, 1998 Item# Description Est. Cost per Estimated Qty. procedure total cost VA PROVIDED SERVICES I. Colorvision Testing 2 -T- 22.00 44.00 2. Comprehensive Eye Exam 3 216.00 648.00 3. External Photography 5 54.00 270.00 4. Flourescein Angiography 8 173.00 1,384.00 5. Flourescein Angiography Printing 12 34.00 408.00 6, Fundus Photography 30 66.00 1,980.00 7. Ophthalmology O/R Assistant Fee 3 417.00 1,251.00 8. ; Slit Lamp Photography 6 52.00 312.00 9. Ultrasound A or B Scan 15 154.00 2,310.00 j 10. Visual Field Test 18 109.00 ; 1,962.00 11. Medical Media Slides (per slide) 13 5.001 65.00 USE OF EQUIPMENT AND SPACE 12, Comprehensive Eye Exam 3 216.00 ' 648.00 13. Endolaser 2 188.00]- 376.00 14. Intermediate Eye Exam 6 139.00 j $34.00 15. Keratometry 15 ' 39.00 585.00 16. Laser Treatment and/or Croypexy 12 396.00 4,752.00 17. Scleral Buckle 1 j 1,255.00 1,255.00 18. i Vitrectomy 1 j 1,527.00 1,527.00 19. Vitrectomy and Lensectomy 1 1,527.00 ' 1,527.00 20. Vitrectomy and Scleral Buckle 1 I 1952f.-OO-T- 1,527.00 21. Vitrectomv/Scleral Buckle/Lensectomy 1 1,527.00 1,527.00 Estimated Total $25,192.00 Estimated Quantities: The quantities (number of procedures) identified above is an estimate only based on the projected number of procedures to be performed during the contract period. The I estimate will not be construed to imply that CCRMC guarantees any specific number of procedures. CCR-,MC will be obligated to make payment only for those procedures actually performed by VANCHCS. __ _... Opthalmology Services Pagel TERMS AND CONDITIONS for contract to provide OPTHALMOLOG'Y SERVICES AND USE OF EQUIPMENT AND SPACE The Department of Veterans Affairs,Northern California Health Care System (VANCHCS or VA) will provide Opthalmology Services and use of Opthalmology Equipment and Space as described herein to Contra Costa Regional Medical Center(CCRMC), 2500 Alhambra Avenue, Martinez, California. All services will be provided at the prices in the Fee Schedule contained herein and in accordance with the terms and conditions of this contract. A. SCOPE OF SERVICES 1. VA PROVIDED SERVICES: VANCHCS will provide the Opthalmology Services as identified in the Fee Schedule as "VA Provided Services" to CCRMC patients, referred for treatment by CCR.MC physicians. All such services will be provided at the VANCHCS Outpatient Clinic, 150 Muir Road, Martinez, California. a. VA Provided Services will be performed utilizing VANTCHCS physicians, technologists, and support staff, using VANCHCS space, equipment, and supplies. 2. USE OF SPACE AND EQUIPMENT: VANCHCS will provide use of Ophthalmology Equipment and Space to CCRMC physicians for performing the procedures identified in the Fee Schedule identified as "Use of Equipment and Space." CCRMC physicians shall perform such procedures on CCRMC patients only. a. Prior to performing services for CCRMC patients at the VA Outpatient Clinic, CCRMC physicians shall undergo a VA Credentialing process, and must be granted VA clinical privileges. 3. VANCHCS will maintain utilization review and quality assurance programs to ensure the necessity, appropriateness and quality of care provided to CCRMC patients receiving treatment under this contract. 4. All services provided by VANCHCS under this contract will be provided in an economical and efficient manner consistent with professional standards of medical care generally accepted in the medical community, and in accordance with VANCHCS and Joint Commission of Healthcare Organizations (JCAHO)accreditation standards. 5. VANCHCS will not discriminate in the treatment of CCRMC patients, except as otherwise specified in this agreement. 6. To preclude the possibility of denying or delaying the care and treatment of eligible veterans, VANCHCS will provide outpatient services to CCRMC patients, only to the extent there will be no reduction in service or delay in treatment to veterans. 7. Referrals will be made in accordance with the referral procedures identified in Attachment A-1 of this agreement. Opthalmology Services Page 4 8. Work hours/days: a. Hours/Days: VANCHCS will accept referrals for Ophthalmology Services provided herein, Monday through Friday during normal work hours(between 7:30 a.m. and 4:30 p.m), Monday through Friday, excluding Federal holidays as identified below. b. Holidays: Federal holidays observed by VANCHCS are as follows: New Year's Day, Presidents Day, Martin Luther King's Birthday, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving, Christmas. 9. worts: a. Reports for services provided by VANCHCS physicians and staff, to CCRMC patients under this contract,will be generated by VANCHCS Ophthalmology staff. Copies of such reports will be forwarded to the CCRMC, within 3 working days after completion of services. Such reports shall be forwarded to CCRMC by VANCHCS staff/courier at the expense of VANCHCS. 10. Transportation: Transportation for all CCRMC referred to the VANCHCS OPC for treatment, shall be arranged in accordance with CCRMC policies. All such transportation costs shall be the responsibility of CCRMC or the patient. 11. Eligibility for treatment.- CCRMC patients presenting to the VANCHCS OPC without prior authorization by a CCRMC physician will not be treated. 12. Emergency Treatment: In the event patients experience a life-threatening emergency while being treated at VANCHCS OPC,necessary immediate life support will be provided, and VANCHCS will activate the 911 system. The attending VANCHCS OPC physician will immediately contact the CCRMC referring physician. If the CCRMC patient requires transportation by ambulance, VANCHCS OPC may make ambulance arrangements, but CCRMC shall be responsible for payment of all invoices for such transportation. 13. Physical Assistance/Translating: CCRMC inpatients or outpatients requiring physical assistance shall be accompanied by a CCRIvIC nurse or other medical staff qualified to meet the needs of patient. Patients requiring translation must be accompanied by a CCRMC staff member, relative or friend who is capable of providing patient assistance. 14. Medical Records: a. Patient records for services provided by VANCHCS under this contract shall be governed by the Privacy Act, Title 5 U.S.C. 552x. In addition, for the purposes of VANCHCS' records access and patient confidentiality this contract shall also be subject to Title 38 U.S.C. 5701, 5705, and 7362. Therefore, CCR.MC may have access, as would other appropriate components of VANCHCS, to patient medical records, including patient treatment records pertaining to drug and alcohol abuse, HIV, and sickle cell anemia, to the extent necessary to perform its contractual responsibilities. However, like other components of the Department of Veterans Affairs, and notwithstanding any other previsions of the contract, CCRIMC is restricted from making disclosures of VANCHCS records, or information contained in such records, to which it may have access, except to the extent that CCRMC has received explicit disclosure authority from VANCHCS. CCRMC is subject to the same penalties and liabilities for unauthorized disclosures of such records as VANCHCS. 9thalmola v Services Pa e 5 b. The records referred to herein, shall be and remain the property of VANCHCS, and shall not be removed or transferred from VANCHCS except in accordance with U.S.C. 551a(Privacy Act), 38 U.S.C. 5741 (Confidentiality of Claimants Records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 {Confidentiality of Medical (duality Assurance Records, 38 U.S.C. 7332 (Confidentiality of Certain Medical Records) and federal laws,rules and regulations. Subject to applicable federal confidentiality or privacy laws, CCRMC or their designated representatives of federal regulatory agencies having jurisdiction over CCRMC, may have access to VANCHCS' records,at VANCHCS' place of business on request during normal business hours,to inspect and review and make copies of such records. B. LIABILITY a. Tort Claims against the government under this contract shall be filed in accordance with the Federal Tort Claims Act, 28 U.S.C.2671-2680. b. Liability for damages resulting from the official conduct of VANCHCS' independent contractors or subcontractors performing services under this contract, shall be covered by their own liability or professional liability insurance. Such damages might include, but are not limited to medical malpractice damages for personal injury or death and damage resulting from negligent. b. CCRMC Physician Malpractice Insurance Coverage: MMH physicians will not be considered VA employees when providing medical services at the VA Outpatient Clinic,but shall be considered to be employees of CCRMC, and as such, CCRMC will assume full responsibility. All CCIZ2MC physicians are either covered by their own malpractice insurance, or covered through the County's self-insured malpractice program. The County will assume all liability for physicians who carry medical malpractice insurance, in the event the physician's malpractice insurance is canceled. VANCHCS shall be held harmless for any malpractice exposure arising through the furnishing of services by CCRMC physicians under this agreement. C. PRIORITY FOR VETERANS 1. VANCHCS reserves the right to deny provision of service to patients referred for treatment under this contract where space or service is unavailable, or if provision of service to such patients would deny or delay care to eligible veterans. VANCHCS agrees to notify CCRMC of any changes in availability of services specified in this contract. 2. Determinations by VANCHCS concerning the availability of services and resources to be provided by the VANCHCS pursuant to this contract are conclusive,binding on the parties to this contract and non-reviewable. The decision of VANCHCS not to provide any service or resource called for by this contract because of its unavailability does not constitute a breach of the contract and is not considered a cause for termination of the contract in whole or in part. D. CONTRACT MODIFICATIONS 1. Any oral statement or representation by any representative of the Government, changing or supplementing the contract or any condition thereof, is unauthorized and shall confer no right upon CCRMC or obligation upon VANCHCS. Furthermore,no interpretation of any provision of the contract, including applicable performance requirements, shall be binding on the VANCHCS unless furnished or agreed to, in writing,by the VANCHCS Contracting Officer or his/her designated representative. 2. The services described herein may be changed by written modification to this contract. The modification shall be prepared by the VANCHCS Contracting Officer. All modifications shall be in _...... __ ...... . . 012thalmolo Services Wage 6 writing and, except for termination, shall have the written consent of both, an authorized representative of CCRMC and the VANCHCS Contracting Officer. E. TERM OF THE CONTRACT I. Contract Term: This contract shall be effective for the period July 1, 1998 through September 30, 1998. 2. Termination: The contract may be terminated by either party subject to a thirty(30)day written notice to the other party. In such cases, CCRMC will be responsible for payment for all services rendered prior to termination, and no further liability will exist on the part of VANCHCS after said date of termination. F. PAYMENT 1. Payment of sums due the VANCHCS under this agreement shall be made by CCRMC monthly in arrears. 2. VANCHCS will invoice CCRMC, on VA{optional Form 1114, Bill for Collection, for services provided in accordance with the Fee Schedule contained herein. 3. Each invoice rendered by VANCHCS to CCRMC will contain the following: a. Date(s)the services were performed. b. Name of patient. C. Social Security Account Number or Patient ID Number. d. Type of services provided(identified by appropriate CPT Code) e. Unit cost of services provided. f. Total cost of services provided. 4. CCRTMC shall forward payment for services rendered under this contract to the address identified in Block 1$(a), Page I of this contract. 5. Notwithstanding any other provision of this contract, unless paid within 30 calendar days from the date of receipt of the first written demand, all amounts that become payable by CCRMC to the VANCHCS under this contract shall bear simple interest, at the rate which has been established by the Secretary of the Treasury as provided in Section 12 of the Contract Disputes Act of 1978 (Public Law 95-563), from the date of first written demand, until paid. 6. Restrictions on Third Party Billing. a. VANCHCS will not be responsible for invoicing any third party for services provided under this agreement, nor will VANCHCS be responsible for collecting co-payments from CCRMC patients. b. VANCHCS hereby agrees, that in no event, including,but not limited to, nonpayment by CCRW, CCRMC's insolvency, or breach of this Agreement, will VANCHCS bill, charge,collect a deposit from, seek compensation,remuneration, or reimbursement from, or have any recourse against a CCRMC patient or persons other than CCRMC acting on a patient's behalf for services provided pursuant to this agreement. VANCHCS agrees that this provision will survive the termination of this Agreement,regardless of the cause, giving rise to termination and will be thalmology Services Papze 7 construed to be for the benefit of the patient, and this provision supersedes any oral',or written contrary agreement now existing or hereafter entered into between VANCHCS and CCRMC patients or persons acting on their behalf. G. DISPUTES 1. All disputes arising or relating to this contract shall be resolved in accordance with the following: a. As used herein, "claim,,,means a written demand or assertion by one of the parties seeking as a legal right, the payment of money, adjustment or interpretation of contract terms, or other relief,arising or relating to this contract. b. Any controversy or claim arising out of or relating to this contract on behalf of CCRMC shall be presented initially to the VANCHCS Contracting Officer for consideration. The VANCHCS will furnish a written reply on the claim to CCRMC. c. In the event the parties cannot amicably resolve the matter, any controversy or claim arising out of or relating to this contract, or breach thereof, shall be settled by arbitration at the Department of Veterans Affairs(VA)Board of Contract Appeals in accordance with procedures set forth in the Alternative Means of Dispute Resolution, VA Directive 7433 and Administrative Disputes Resolution Act of 1996, and judgment upon any award rendered by the Arbitrator(s)may be entered into any Court having jurisdiction thereof. d. Any claim by CCRMC must be presented no later than 30 calendar days after cancellation or final expiration of the contract, whichever occurs earlier, otherwise CCRMC forfeits its right(s) to relief. H. GOVERNING LAW Notwithstanding any other parts of this contract, this contract shall be governed, construed, andenforced in accordance with Federal law. I. COMMERCIAL ADVERTISING CCRMC shall not advertise or use any marketing material, logos, trade names, service marks, or other material belonging to the Department of Veterans Affairs or VANCHCS without the consent of VANT CHCS. J. VANCHCS REPRESENTATIVES 1. VANCHCS will assign a Contracting Officer who will be authorized to act on behalf of VANL CHCS in the following capacity: Make changes to the contract provisions, including changes involving increases or decreases in contract price, and no cost changes, making changes to the scope of the contract, requiring extras other than stated in the contract, extending the time established in the contract,terminating the contract,requiring extras other than stated in the contract, extending the time established in the contract, terminating the contract in whole or in part, or conducting price or cost negotiations for proposed contract changes. A VANCHCS Contracting Officer is the only official who can bind the VANCHCS. 2. The Contracting Officer reserves the right to designate representatives to act for him/her in furnishing technical guidance and advice, or to generally oversee the technical aspects of the services provided under this contract. Such designation will be in writing and will define the scope and limitations Opthalmology Services Page8 of the designee's authority. A copy of the designation will be furnished to CCRMCupon contract award. K. AUTHORITIES This contract is a Sharing Agreement awarded pursuant to 38 U.S.C. 8153. L. RELATIONSHIP BETWEEN THE PARTIES The relationship of the parties to this Agreement is not and shall not be construed or interpreted to be a partnership,joint venture or agency. The relationship of the parties is an independent contractor relationship. Qpthahnology Services Page.9 ATTACHMENTA-1 REFERRAL/SCIUDULLNG PROCEDURES The following procedures will be used for scheduling CCRMC outpatients to be treated at the VANCHCS OPC. A. Patient Scheduling/Reserving se of space, 1. Patients referred for treatment by physicians of CCRMC, or physicians interested in reserving use of space and equipment will call the VANCHCS Eye Clinic at(25) 372-2600, to schedule an appointment/reserve space/equipment. 2. As soon as possible after scheduling their appointment,patients will call the VANCHCS,Medical Administration Service at(800) 382-8387,to be registered into the VA DHCP computer system, or patients may present themselves at the V,4"NCHCS,OPC, Main Reception for registration, a minimum of thirty(30)minutes prior to appointment time. 3. The patient will check-in at VANCHCS, QPC, Reception C for check-in at the appointed time. CONTRACT AWARD FOR SELLING HEALTHCARE SERVICES 1.REQUISITION NUMBER PAGE 1 OF 8 CONTRACTOR TO COMPLETE BLOCKS 12,I7,23,24,Sc 30 ?.CONTRACT NO. 3.AWARDIE;=FECTIVE 4.ORDER NUMBER 5.SOLICITATION NUMBER 6.SOLICITATION ISSUE V612P-6152 DATE 7/1/9$ NIA DATE 7/1/9$ 7.FOR a. NAME Karen E. Pridemore, Contract Speecialist b.TELEPHONE NUMBERx.Cot,rcr cu ty INFOR�I.ATION CALL. (925)372-2046 S.DEFER DUE DATE N/A §. ISSUED BY CODE LOCAL`MME10. THIS ACQUISITION IS N/A I I.DELIVERY FOR.FOB 12.DISCOUNT TERMS DESTINATION UNLESS Department of Veterans Affairs ❑ UNRESTRICTED BLOCK IS MARKED N/A Northern California Health Care System(VANCHCS) C-SETASIDE %FOR [:]SEE SCHEDULE 2300 Contra Costa Blvd., Suite 440 QSMALL BUSINESS 13a.THIS CONTRACT ISA RAPED ORDER UNDER DPAS(1 S CFR 700) Pleasant Hill,CA 94523 E]SMALL DISADV BUSINESS N/A Q S(A) 13B.RATING N/A S.C. 14 METHOD OF SOLICITATION N/A SIZE STANDARD: OR.FQ ®IFB ©RFP 15.DELIVER TO CODE 16.ADMINISTERED BY CODE N/A Same as dock 9 4Lk ACT CO .FACILITY I8A. PAYMENT WILL BEMADE BY CODE CE ntra s�aRe Iona icai enter(CCRMC) - 2500 Alhambra.Avenue Same as Block 17A Martinez, CA 94553 2 ro .. z , m.3 TELEPHON£NO.(925)370-5130 Fax (925)370-513$ N/A 18 b.SUBMIT INVOICES TO ADDRESS SHOWN RI BLOCK 183 UNLESS BLOCK BE!OW CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER IS CHECKED SEE ADDENDUM N/A 19 20 11 22 23 1 24 ITEM NO. SCHEDULE OF SUPPLIES,SERVICE QUANTITY UNIT j UN`1TPRICE AMOUNT VANCHCS will provide Audiology and Speech Pathology Services to CCRMC in accordance with the attached terms/conditions. + aCr.,DDI'U0,v.4LSHEETSASNECESS.4erl 25.ACCOUNTING AND APPROPRIATION DAi A j 16.TOTAL AMOUNT AWARD{FOR GOVT.USE ONLY) Authorities: Enhanced Healthcare Resources Sharing Authority VHA Directive 97-015,dated 3/12/97 I J '7a.SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1.52,_'i2-4 FAR 52.212-3 AND 52.112-5 ARE ATTACHED.ADDENDA MARE ARE NOT ATTACHED. 27b. CONTRACT FEE SCHEDULE,TERMS AND CONDITIONS AND ADDENDA [E� ARE L_I ARE NOT ATTACHED, 23.CDN"FRACTOR IS REQUIRED TO SIQN THIS DOCUMENT AND RETURN OR 2(TWO) COPIES 29 A WARD OF CONTRACT, REFERENCE OFFER TO ISSUING OFFICE. CONTRACTOR AGREES TO THE TERMS AND CONDITIONS SET FORTH HEREIN.. DATED YOUR OFFER ON SOLICITATION(BLOCK. 17 OR OTHER WISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO ® 5).INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH THE TERMS AND CONDITIONS SPECIFIED HEREIN, HEREIN,IS ACCEPTED AS TO ITEMS: 3033 SIGNATURE OF CONTRACTOR 31 A.UNITED STATES OF AMERICA(SIGNATURE OF CONTRACTING OFFICER) Sob.NAM E AND TITLE OF SIGNER(TYPE OR PRINT) 3oc.DATE SIGNED 31b.NAME OF CONTRACTING OFFICER(TYPE OR PRINT) 31 c.DATE SIGNED Karen E. Pridmore 32a.QUANTITY IN COLUMN 21 HAS BEEN N/A 37,SHIP NUMBER 34,VOUCHER NUMBER 35.AMOUNT VERIFIED CORRECT FOR 17 RECEIVED INSPECTED ® ACCEPTED AS CONFORMS TO THE PARTIAL FINAL CONTRACT.EXCEPT AS NOTED 32b.SIGNATURE OF AUTHORIZED GOVT.REPRESENTATIVE 32C.DATE 36.PAYMENT 37.CHECK NUMBER COMPLETE PARTIAL FINAL 38.S/R ACCOUNT NUMBER 3§.SIR VOUCHER NUMBER 40.PAID BY ala.I CERTIFY THIS ACCII,NT IS CORRECT AND PROPER FOR PAYMENT ata.RECEIVED BY(PRIN7) 41b.SIGNATURE AND"TITLEOFCERTIFYING OFECER 41c.DATE 42b.RECEIVED AT(LOC'.4TION) 42e.DATE RECD(YY/MM/DD) 42ci.TOTAL CONTAINERS 7/7/98 Contract Award Forth-VANCHCS(612/90C) _. _. _ Audiology&Speech Pathology Services Page 2 FEE SCHEDULE A. July 1, 1998 through September 30, 1998 Item# , Description Est. Cost per Estimated Qty. procedure total cost Audiology/Speech Pathology Services 1. Speech-Language Evaluation 6 519.00 3,114.00 2. Speech-Language Pathology Group Treatment 26 104.00 2,704.00 ' 3. Speech-Language Treatment 56 1 225.00 12,600.00 Estimated Total $18,418.00 Estimated Quantities: The quantities (number of procedures)identified above is an estimate only based on the projected number of procedures to be performed during the contract period. The estimate will not be construed to imply that CCRMC guarantees any specific number of procedures. CCRPMC will be obligated to mare payment only for those procedures actually performed by VANCHCS. Audiology&Speech Pathology Services Page 3 TERMS AND CONDITIONS for contract to provide AUDIOLOGY AND SPEECH PATHOLOGY SERVICES The Department of Veterans Affairs,Northern California Health Care System(VANI CHCS or VA)will provide Opthalmology Services and use of Audiology and Speech Pathology Services,as described herein to Contra Costa Regional Medical Center(CCRMC), 2500 Alhambra Avenue, Martinez, California. All services will be provided at the prices in the Fee Schedule contained herein and in accordance with the terms and conditions of this contract. A. SCOPE OF SERVICES 1. VANCHCS will provide Audiology and Speech Pathology Services as identified in the Fee Schedule to CCRMC patients,referred for treatment by CCRMC physicians. All such services will be provided at the VANCHCS Outpatient Clinic, 150 Muir Road,Martinez, California. 2. All services will be performed utilizing VANCHCS physicians, technologists, and support staff, using VANCHCS space, equipment, and supplies. 3. VANCHCS will maintain utilization review and quality assurance programs to ensure the necessity, appropriateness and quality of care provided to CCRMC patients receiving treatment under this contract. 4. All services provided by VANCHCS under this contract will be provided in an economical and efficient manner consistent with professional standards of medical care generally accepted in the medical community, and in accordance with VANCHCS and Joint Commission of Healthcare Organizations (JCAHO) accreditation standards. 5. VANCHCS will not discriminate in the treatment of CCRMC patients, except as otherwise specified in this agreement. 6. To preclude the possibility of denying or delaying the care and treatment of eligible veterans, VANCHCS will provide outpatient services to CCRMC patients, only to the extent there will be no reduction in service or delay in treatment to veterans. Referrals will be made in accordance with the referral procedures identified in Attachment A-1 of this agreement. 8. Work hours/days. a. Hours/Days: VANCHCS will accept referrals for services provided herein, Monday through Friday during normal work hours(between 7:30 a.m. and 4:30 p.m.), Monday through Friday,excluding Federal holidays as identified below. b. Holidays: Federal holidays observed by VANCHCS are as follows: New Year's Day, Presidents Day, Martin Luther King's Birthday, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving, Christmas. Audiology&Speech Pathology Services Page 4 9. Reports: a. Reports for services provided by VANCHCS physicians and staff, to CCRMC patients under this contract, will be generated by VANCHCS staff. Copies of such reports will be forwarded to the CCRMC, within 3 working days after completion of services. Such reports shall be forwarded to CCRMC by VANCHCS staff/courier at the expense of VANCHCS. 10. Transportation: Transportation for all CCRMC referred to the VANCHCS OPC for treatment, shall be arranged in accordance with CCR�'MC policies. All such transportation costs shall be the responsibility of CCRMC or the patient. 11. Eligibihi y for treatment: CCRMC patients presenting to the VANCHCS OPC without prior authorization by a CCRMC physician will not be treated. 12. fmergency Treatment: In the event patients experience a life-threatening emergency while being treated at VANCHCS OPC, necessary immediate life support will be provided,and VANCHCS will activate the 911 system. The attending VAT CHCS OPC physician will immediately contact the CCRMC referring physician. If the CCRMC patient requires transportation by ambulance, VAINCHCS OPC may make ambulance arrangements, but CCRMC shall be responsible for payment of all invoices for such transportation. 13. Plsysieal Assistance/Translating CCRMC inpatients or outpatients requiring physical assistance shall be accompanied by a CCRMC nurse or other medical staff qualified to meet the needs of patient. Patients requiring translation must be accompanied by a CCRMC staff member, relative or friend who is capable of providing patient assistance. 14. Medical Records: a. Patient records for services provided by VANCHCS under this contract shall be governed by the Privacy Act, Title 5 U.S.C. 552a. In addition, for the purposes of VANCHCS' records access and patient confidentiality this contract shall also be subject to Title 38 U.S.C. 5701, 5705, and 7302. Therefore, CCRMC may have access, as would other appropriate components of VANCHCS, to patient medical records, including patient treatment records pertaining to drug and alcohol abuse,HIV, and sickle cell anemia, to the extent necessary to perform its contractual responsibilities. However, like other components of the Department of Veterans Affairs, and notwithstanding any other provisions of the contract, CCRMC is restricted from making disclosures of VANCHCS records, or information contained in such records, to which it may have access, except to the extent that CCRMC has received explicit disclosure authority from VANCHCS. CCRMC is subject to the same penalties and liabilities for unauthorized disclosures of such records as VANCHCS. b. The records referred to herein, shall be and remain the property of VANCHCS, and shall not be removed or transferred from VANCHCS except in accordance with U.S.C. 551a(Privacy Act), 38 U.S.C. 5701 (Confidentiality of Claimants Records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records, 38 U.S.C. 7332(Confidentiality of Certain Medical Records) and federal laws,rules and regulations. Subject to applicable federal confidentiality or privacy laws, CCRMC or their designated representatives of federal regulatory agencies having jurisdiction over CCRMC, may have access to VANCHCS' records, at VANCHCS' place of business on request during normal business hours, to inspect and review and make copies of such records. _... ._. ... ...... _.. . .1111. .. _ _ . ........ ..... .. ........_.. ............ Audiology&Speech Pathology Services Page 5 B. LIABILITY a. Tort Claims against the government under this contract shall be filed in accordance with the Federal Tort Claims Act, 28 U.S.C. 2671-2680. b. Liability for damages resulting from the official conduct of VANCHCS' independent contractors or subcontractors performing services under this contract, shall be covered by their own liability or professional liability insurance. Such damages might include, but are not limited to medical malpractice damages for personal injury or death and damage resulting from negligent. C. PRIORITY FOR VETERANS 1. VANCHCS reserves the right to deny provision of service to patients referred for treatment under this contract where space or service is unavailable, or if provision of service to such patients would deny or delay care to eligible veterans. VA1NT CHCS agrees to notify CCRIVIC of any changes in availability of services specified in this contract. 2. Determinations by VANCHCS concerning the availability of services and resources to be provided by the VANCHCS pursuant to this contract are conclusive,binding on the parties to this contract and non-reviewable. The decision of VANCHCS not to provide any service or resource called for by this contract because of its unavailability does not constitute a breach of the contract and is not considered a cause for termination of the contract in whole or in part. D. CONTRACT MODIFICATIONS 1. Any oral statement or representation by any representative of the Government, changing or supplementing the contract or any condition thereof, is unauthorized and shall confer no right upon CCRMC or obligation upon VANCHCS. Furthermore, no interpretation of any provision of the contract, including applicable performance requirements, shall be binding on the VANCHCS unless furnished or agreed to, in writing, by the VANCHCS Contracting Officer or his/her designated representative. 2. The services described herein may be changed by written modification to this contract. The modification shall be prepared by the VANCHCS Contracting Officer. All modifications shall be in writing and, except for termination, shall have the written consent of both, an authorized representative of CCR.MC and the VANCHCS Contracting Officer. E. TERM OF THE CONTRACT 1. Contract Term: This contract shall be effective for the period July 1, 1998 through September 30, 1998. 2. Termination: The contract may be terminated by either party subject to a thirty(30)day written notice to the other party. In such cases, CCRMC will be responsible for payment for all services rendered prior to termination, and no further liability will exist on the part of VANCHCS after said date of termination. __...... .. ....... .. ...... ............................................ . _....__. ._.... _... _. ........ .. _.............. Audiology&Speech Pathology Services Page 6 E. PAYMEItiT 1. Payment of sums due the VANCHCS under this agreement shall be made by CCRMC monthly in arrears. 2. VANCHCS will invoice CCRMC, on VA Optional Form 1114, Bill for Collection, for services provided in accordance with the Pee Schedule contained herein. 3. Each invoice rendered by VANCHCS to CCRMC will contain the fallowing: a. Date(s) the services were performed. b. Name of patient. C. Social Security Account Number or Patient ID Number. d. Type of services provided(identified by appropriate CPT Code) e. Unit cost of services provided. f Total cost of services provided. 4. CCRMC shall forward payment for services rendered under this contract to the address identified in Block 18(a),Page 1 of this contract. 5. Notwithstanding any other provision of this contract, unless paid within 30 calendar days from the date of receipt of the first written demand, all amounts that become payable by CCRMC to the VANCHCS under this contract shall bear simple interest, at the rate which has been established by the Secretary of the Treasury as provided in Section 12 of the Contract Disputes Act of 1978 (Public Law 95-563), from the date of first written demand, until paid. 6. Restrictions on Third Parry Billing, a. VANCHCS will not be responsible for invoicing any third party for services provided under this agreement, nor will VANCHCS be responsible for collecting co-payments from CCRIMC patients. b. VANCHCS hereby agrees, that in no event, including, but not limited to, nonpayment by CCRMC, CCRMC's insolvency, or breach of this Agreement, will VANCHCS bill, charge, collect a deposit from, seek compensation,remuneration, or reimbursement from, or have any recourse against a CCRMC patient or persons other than CCR.ML C acting on a patient's behalf for services provided pursuant to this agreement. VANCHCS agrees that this provision will survive the termination of this Agreement,regardless of the cause, giving rise to termination and will be construed to be for the benefit of the patient, and this provision supersedes any oral or written contrary agreement now existing or hereafter entered into between VANCHCS and CCRMC patients or persons acting on their behalf. G. DISPUTES 1. All disputes arising or relating to this contract shall be resolved in accordance with the following: a. As used herein, "claim," means a written demand or assertion by one of the parties seeking as a legal right, the payment of money, adjustment or interpretation of contract terms, or other relief,arising or relating to this contract. Au!jiology&Speech Pathology Services Page 7 b. Any controversy or claim arising out of or relating to this contract on behalf of CCRMC shall be presented initially to the VANCHCS Contracting Officer for consideration. The VANCHCS will furnish a written reply on the claim to CCRMC. c. In the event the parties cannot amicably resolve the matter, any controversy or claire arising out of or relating to this contract, or breach thereof, shall be settled by arbitration at the Department of Veterans Affairs (VA)Board of Contract Appeals in accordance with procedures set forth in the Alternative Means of Dispute Resolution, VA Directive ',433 and Administrative Disputes Resolution Act of 1996, and judgment upon any award rendered by the Arbitrator(s)may be entered into any Court having jurisdiction thereof. d. Any claim by CCRMC must be presented no later than 30 calendar days after cancellation or final expiration of the contract, whichever occurs earlier, otherwise CCRMC forfeits its right(s)to relief. H. GOVERNING LAW Notwithstanding any other parts of this contract, this contract shall be governed, construed, and enforced in accordance with Federal law. 1. COMMERCIAL ADVERTISING CCRMC shall not advertise or use any marketing material, logos, trade names, service marks, or other material belonging to the Department of Veterans Affairs or VANCHCS without the consent of VANCH CS. J. VANCHCS REPRESENTATIVES 1. VANCHCS will assign a Contracting Officer who will be authorized to act on behalf of VANCHCS in the following capacity: Make changes to the contract provisions, including changes involving increases or decreases in contract price, and no cost changes, making changes to the scope of the contract, requiring extras other than stated in the contract, extending the time established in the contract, terminating the contract,requiring extras other than stated in the contract, extending the time established in the contract, terminating the contract in whole or in part, or conducting price or cost negotiations for proposed contract changes. A VANCHCS Contracting Officer is the only official who can bind the VANCHCS. 2. The Contracting Officer reserves the right to designate representatives to act for him/her in furnishing technical guidance and advice, or to generally oversee the technical aspects of the services provided under this contract. Such designation will be in writing and will define the scope and limitations of the designee's authority. A copy of the designation will be furnished to CCRMC upon contract award. K. AUTHORITIES This contract is a Sharing Agreement awarded pursuant to 38 U.S.C. 8153. L. RELATIONSHIP BETWEEN THE PARTIES The relationship of the parties to this Agreement is not and shall not be construed or interpreted to be a partnership,joint venture or agency. The relationship of the parties is an independent contractor relationship. Audiology&Speech Pathology Services Pale 8 ATTACHMENT A-1 REFERRAL/SCHEDULING PROCEDURES The following procedures will be used for scheduling CCRMC outpatients to be treated at the VANCHCS OPC. A. Patient Scheduling,/Reserving use of space: 1. Patients referred for treatment by physicians of CCRMC, or physicians interested in reserving use of space and equipment will call the VANCHCS Audiology and Speech Pathology Department at25 372-2670, to schedule an appointment. 2. As soon as possible after scheduling their appointment, patients will call the VANCHCS, Medical Administration Service at(800) 382-8387,to be registered into the VA DHCP computer system,or patients may present themselves at the VANCHCS, OPC, Main Reception for registration, a minimum of thirty (30) minutes prior to appointment time. 3. The patient will check-in at VANCHCS, OPC, Reception C for check-in at the appointed time. _. ......... ......... ......... ... ................_...... ......... ......... ......... ......... ......... ......... _ _. . . . ......... ......... ......... ......... ......... .......... ......................................................................... 777-777T AWJARD FOR SELLING HEALTHCARE SERVICES 1.REQUISITION NUMBER PAGE I OF 8 COMTRACTOR TO COMPLETE BLOCKS 12,17,23,24,&30 2.CONTRACT NO. Y C t1 3.A WARDIEFFECTIVE 4.ORDER NUMBER 5.SOLICITATION NUMBER 6.SOLICITATION ISSUE Y V 12rt�-6 t 5 V DATE 7/l/98 N/A DATE 7/10/98 7.FORa.NAME Karen E.Pridmore Specialist b.TELEPHONE NUMBER(Na ColMcr Carrs) 8.OFFER DUE DATPJ IN- FORMCALL: 'Contract (925)372-2046 LOCAL TIME 4_ ISSUED BY CODE 10. THIS ACQUISITION IS NIA 11.DELIVERY FOR FOB 12.DISCOUNT TERMS DESTINATION UNLESS Department of Veterans Affairs © UNRESTRICTED BLOCK IS MARKED N/A Northern California Health Care System(VANCHCS) ❑SETASIDE %FOR E]SEE SCHEDULE 2300 Contra Costa Blvd., Suite 440 ®SMALL BUSINESS 13a.THIS CONTRACT iS A RATED ORDER UNDER DPAS(15 CFR 700) Pleasant Hill,CA 94523 E]SMALL DISADV.BUSINESS N/A ®9(A) 13B.RATING N/A SIC: 14. METHOD OF SOLICITATION NSA SIZE STANDARD: ORFQ ©IFS aRFP 15.DELIVER TO CODE 16.ADMINISTERED BY CODE N/A Same as Block 9 17A.CONTRACTOR CODE FACILITY 18A. PAYMENT WILL BE MADE BY CODE CODE Contra Costa Regional Medical Center(CCRMC) 2500 Alhambra Avenue Same as Block ISA Martinez, CA 9455326 - 345 TELEPHONE NO.(925)370-5130 Fax (925)370-5138 N/A 18.b,SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW 17b.CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER iS CHECKED ® SEE ADDENDUM NIA 19 20 21 22 23 24 ITEM NO. SCHEDULE OF SUPPLIES/SERVICE QUANTITY UNIT UNIT PRICE AMOUNT VANCHCS will provide Neurology Services to CCRMC in accordance with the attached terms/conditions. (,47T.4CHADDITIONAL SHEE-TS.4SNECESSRRr 25.ACCOUNTING AND APPROPRIATION DATA 26.TOTAL AMOUN T AWARD(FOR GOVT.USE UNLIT Authorities: Enhanced Healthcare Resources Sharing Authority VHA Directive 97-015;dated 3/12/97 27a.SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1,52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED.ADDENDA ARE 0 ARE NOT ATTACHED. ® 27b. CONTRACT FEE SCHEDULE.TERMS AND CONDITIONS AND ADDENDA ®ARE[] ARE NOT ATTACHED. 28.CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN OR 2(TWO) COPIES 29 AWARD OF CONTRACT, REFERENCE OFFER TO ISSUING OFFICE. CONTRACTOR AGREES TO THE TERMS AND CONDITIONS SET FORTH HEREIN.. DATED YOUR OFFER ON SOLICITATION(BLOCK OR OTHER WISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO 5).INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH THE TERMS AND CONDITIONS SPECIFIED HEREIN, HEREIN,IS ACCEPTED AS TO ITEMS: 30a. SIGNATURE OF CONTRACTOR 31A.UNITED STATES OF AMERICA(SIGNATURE OF CONTRACTING OFFICER) 30b.NAME AND TITLE OF SIGNER(TYPE OR PRINT) 30c.DATE SIGNED 3Ib.NAME OF CONTRACTING OFFICER(TYPE OR PRINT) 31 c.DATE SIGNED Karen E. Pridmore 32a.QUANTITY IN COLUMN 21 HAS BEEN N/A 33.SHIP NUMBER 34.VOUCHER NUMBER 35.AMOUNT VERIFIED CORRECT FOR RECEIVED INSPECTED [:] ACCEPTED AS CONFORMS TO THE PARTIAL FINAL CONTRACT,EXCEPT AS NOTED 32b.SIGNATURE OF AUTHORIZED GOVT,REPRESENTATfVE 32C,DATE 36.PAYMENT 37.CHECK NUMBER COMPLETE PARTIAL FINAL 38.SIR ACCOUNT NUMBER 39.SIR VOUCHER NUMBER 40,PAID BY 41 a.I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a.RECEIVED BY(PRINT) 41b.SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c DATE 42b,RECEIVED AT(LOCATION) 42c.DATE RECD(YY/MM/DD) 42d.TOTAL CONTAINERS 7/7199 Contract Award Form-VANCHCS(612i9OC) . ......... ........ . ... ........ ............. ................. .._... ......... ......._. ..... . .......... ............ ......._.... .. .............................. Neurology Services Page 2 FEE SCHEDULE A. July 1, 1998 through August 30, 1998 Item# CPT Description f Est. Cost per Estimated Code Qty. procedure total cost 1. 95950 124-Hour Ambulatory EEG Monitoring 10 97.97 i $979.70 f Estimated Total $979.70 Estimated Quantities: The quantities(number of procedures)identified above is an estimate only based on the projected number of procedures to be performed during the contract period. The estimate will not be construed to imply that CCRMC guarantees any specific number of procedures. CCRMC will be obligated to make payment only for those procedures actually performed by VANCHCS. i ......... ._............11.1.1 _ ___ ..... ....... ....... ......... __............ ......1111 ... ......... ......... ......... ... ........ ........... Neurology Services Page 3 TERMS AND CONDITIONS for contract to provide NEUROLOGY SERVICES The Department of Veterans Affairs,Northern California Health Care System(VANCHCS)will provide Nuclear Medicine Services as described herein to Contra Costa Regional Medical Center(CCRMC), 2500 Alhambra Avenue,Martinez, California. All services will be provided at the prices in the Fee Schedule contained herein and in accordance with the terms and conditions of this contract. A. SCOPE OF SERVICES 1. VANCHCS will provide Neurology Services as specified herein to patients referred for treatment by CCRMC physicians. Services provided by VANCHCS will be 2. VANCHCS will perform 24-Hour Ambulatory EEG Monitoring at the VANT CHCS Outpatient Clinic (OPC),Neurology Department, 150 Muir Road, Martinez, California at the prices set forth in the Fee Schedule, and as otherwise described herein. 3. Services provided by VANCHCS under this contract will be performed utilizing VANCHCS physicians, technologists,and support staff,using VANCHCS space,equipment, and supplies. 4. VANCHCS will maintain utilization review and quality assurance programs to ensure the necessity, appropriateness and quality of care provided to CCRMC patients receiving treatment under this contract. 5. All services provided by VANCHCS under this contract will be provided in an economical and efficient manner consistent with professional standards of medical care generally accepted in the medical community,and in accordance with VANCHCS and Joint Commission of Healthcare Organizations (JCAHO)accreditation standards. 6. VANCHCS will not discriminate in the treatment of CCRMC patients, except as otherwise specified in this agreement. 7. To preclude the possibility of denying or delaying the care and treatment of eligible veterans, VANCHCS will provide outpatient services to CCRMC patients, only to the extent there will be no reduction in service or delay in treatment to veterans. 8. Referrals will be made in accordance with the referral procedures identified in Attachment A-1 of this agreement. 9. Work hoursldays: a. Hours/13cz� VANCHCS will accept referrals for Neurology Services provided herein, Monday through Friday during normal work hours(between 7:30 a.m. and 4:30 p.m;),Monday through Friday, excluding Federal holidays as identified below. b. Ho days: Federal holidays observed by VANCHCS are as follows: New Year's Day, Presidents Day,Martin Luther King's Birthday, Memorial Day,Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving, Christmas. Neurology Services Page 4 10. Re tarts: a. 24-Hour REG Monitoring: Upon completion of the test, the recording will be previewed by a VANCHCS EEG Technician, and formally reviewed by a VANCHCS Encephalographer. b. Reports for services provided under this contract will be generated by VANCHCS Neurology staff. Two copies of such reports will be forwarded to the CCRMC, EEG/Cardiology Department within 3 working days after completion of services. Such reports shall be forwarded to CCRTMC by VANCHCS staff/courier at the expense of VANCHCS. 11. Transportation: Transportation for all CCRTMC referred to the VANCHCS OPC for treatment, shall be arranged in accordance with CCRMC policies. All such transportation costs shall be the responsibility of CCRMC or the patient. 12. Ali ibility_fbr treatment: CCRMC patients presenting to the VANCHCS OPC without prior authorization by a CCR-MC physician will not be treated. 13. Emergency Treatment: In the event patients experience a life-threatening emergency while being treated at VANCHCS OPC,necessary immediate life support will be provided, and VANCHCS will activate the 911 system. The attending VANCHCS OPC physician will immediately contact the CCRMC referring physician. If the CCRMC patient requires transportation by ambulance,VANCHCS OPC may make ambulance arrangements,but CCRIMC shall be responsible for payment of all invoices for such transportation. 14. Physical Assistance/Translating: CCRTMC inpatients or outpatients requiring physical assistance shall be accompanied by a CCRMC nurse or other medical staff qualified to meet the needs of patient. Patients requiring translation must be accompanied by a CCRMC staff member, relative or friend who is capable of providing patient assistance. 15. Medical Records: a. Patient records for services provided by VANCHCS under this contract shall be governed by the Privacy Act, Title 5 U.S.C. 552a. In addition, for the purposes of VANCHCS' records access and patient confidentiality this contract shall also be subject to Title 38 U.S.C. 5701, 5705, and 7362. Therefore, CCRMC may have access,as would other appropriate components of VANCHCS, to patient medical records, including patient treatment records pertaining to drug and alcohol abuse, HIV, and sickle cell anemia, to the extent necessary to perform its contractual responsibilities. However, like other components of the Department of Veterans Affairs, and notwithstanding any other provisions of the contract, CCRMC is restricted from making disclosures of VANCHCS records, or information contained in such records, to which it may have access, except to the extent that CCRMC has received explicit disclosure authority from VANCHCS. CCRMC is subject to the same penalties and liabilities for unauthorized disclosures of such records as VANCHCS. b. The records referred to herein, shall be and remain the property of VANCHCS, and shall not be removed or transferred from VANCHCS except in accordance with U.S.C. 551a(Privacy Act), 38 U.S.C. 5701 (Confidentiality of Claimants Records),5 U.S.C. 552(FOIA),38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records, 38 U.S.C. 7332(Confidentiality of Certain Medical Records)and federal laws,rules and regulations. Subject to applicable federal confidentiality or privacy laws,CCRMC or their designated representatives of federal regulatory agencies having jurisdiction over CCRMC,may have access to VANCHCS'records,at VANCHCS'place of business on request during normal business hours, to inspect and review and make copies of such records. _.._..... _........ ....__... .. ........ ....................................................... ...... __..... ___ ............ . ..._. ......... Neur&logy Services pale-5 B. LIABILITY a. Liability for damages resulting from the official conduct of VANCHCS employees shall be governed by applicable federal laws,rules and regulations. Tort Claims against the Government for services provided under this contract,shall be filed in accordance with the Federal Tort Claims Act,28 U.S.C. 2671-2680. b. Liability for damages resulting from the official conduct of VANCHCS' independent contractors or subcontractors shall be covered by their own liability or professional liability insurance. c. 24-Hour Ambulatory EEC Monitoring Equipment: Equipment utilized to perform this procedure will remain the property of VANCHCS. Should the equipment fail to be returned by the patient or CCRMC, or if it is returned damaged, CCRI�IC will be held responsible for the repair or replacement of the equipment. C. PRIORITY FOR VETERANS 1. VANCHCS reserves the right to deny provision of service to patients referred for treatment under this contract where space or service is unavailable, or if provision of service to such patients would deny or delay care to eligible veterans. VANCHCS agrees to notify CCRMC of any changes in availability of services specified in this contract. 2. Determinations by VANCHCS concerning the availability of services and resources to be provided by the VANCHCS pursuant to this contract are conclusive,binding on the parties to this contract and non-reviewable. The decision of VANCHCS not to provide any service or resource called for by this contract because of its unavailability does not constitute a breach of the contract and is not considered a cause for termination of the contract in whole or in part. D. CONTRACT MODIFICATIONS 1. Any oral statement or representation by any representative of the Government, changing or supplementing the contract or any condition thereof, is unauthorized and shall confer no right upon CCRMC or obligation upon VANCHCS. Furthermore,no interpretation of any provision of the contract, including applicable performance requirements, shall be binding on the VANCHCS unless furnished or agreed to, in writing,by the VAINCHCS Contracting Officer or his/her designated representative. 2. The services described herein may be changed by written modification to this contract. The modification shall be prepared by the VANCHCS Contracting Officer. All modifications shall be in writing and, except for termination, shall have the written consent of both,an authorized representative of CCRMC and the VANCHCS Contracting Officer. E. TERM OF THE CONTRACT 1. Contract Term: This contract shall be effective for the period July 1, 1998 through August 30, 1998, unless sooner terminated by either party. 2. Termination: The contract may be terminated by either party subject to a written notice to the other party. In such cases, CCRMC will be responsible for payment for all services rendered prior to termination, and no further liability will exist on the part of VANCHCS after said date of termination. _.._.... _........ ....... .. 1111 ...... .. ........ ........ _...... ....... 1...._111. _. . ................... - N ology Services Page 6 F. PAYMENT 1. Payment of sums due the VANCHCS under this agreement shall be made by CCRMC monthly in arrears. 2. VANCHCS will invoice CCRMC, on VA Optional Form 1114,Bill for Collection, for services provided in accordance with the Fee Schedule contained herein. 3. Each invoice rendered by VANCHCS to CCRMC will contain the following: a. Date(s)the services were performed. b. Name of patient. C. Social Security Account Number or Patient 1D Number. d. Type of services provided(identified by appropriate CPT Code) e. Unit cost of services provided. f. Total cost of services provided. 4. CCR.TMC shall forward payment for services rendered under this contract to the address identified in Block 18(a), Page 1 of this contract. 5. Notwithstanding any other provision of this contract, unless paid within 30 calendar days from the date of receipt of the first written demand,all amounts that become payable by CCRMC to the VANCHCS under this contract shall bear simple interest,at the rate which has been established by the Secretary of the Treasury as provided in Section 12 of the Contract Disputes Act of 1978 (Public Law 95- 563), from the date of first written demand, until paid. 6. Restrictions on Third Party Billing: a. VANCHCS will not be responsible for invoicing any third party for services provided under this agreement,nor will VANCHCS be responsible for collecting co-payments from CCRMC patients. b. VANCHCS hereby agrees, that in no event,including,but not limited to nonpayment by CCRTMC, CCRMC's insolvency, or breach of this Agreement,will VANCHCS bill,',charge, collect a deposit from,seek compensation, remuneration, or reimbursement from, or have any recourse against a CCRMC patient or persons other than CCRMC acting on a patient's behalf for services provided pursuant to this agreement. VANCHCS agrees that this provision will survive the termination of this Agreement, regardless of the cause, giving rise to termination and will be construed to be for the benefit of the patient, and this provision supersedes any oral or written contrary agreement now existing or hereafter entered into between VANCHCS and CCRTMC patients or persons acting on their behalf. G. DISYUTES 1. All disputes arising or relating to this contract shall be resolved in accordance with the following: a. As used herein, "claim,"means a written demand or assertion by one of the parties seeking as a legal right,the payment of money,adjustment or interpretation of contract terms, or other relief,arising or relating to this contract. b. Any controversy or claim arising out of or relating to this contract on behalf of CCRMC shall be presented initially to the VANCHCS Contracting Officer for consideration. The VANCHCS will _. .... _.........._. . .... .. _. ....... ........ ............................................ ......... _........ ... . .. ........ ..........._...__. _.. ......._. Neurology Services — Page 7 furnish a written reply on the claim to CCRMC. c. In the event the parties cannot amicably resolve the matter, any controversy or claim arising out of or relating to this contract, or breach thereof, shall be settled by arbitration at the Department of Veterans Affairs (VA)Board of Contract Appeals in accordance with procedures set forth in the Alternative Means of Dispute Resolution,VA Directive 7433 and Administrative Disputes Resolution Act of 1996, and judgment upon any award rendered by the Arbitrator(s)may be entered into any Court having jurisdiction thereof. d. Any claim by CCRMC must be presented no later than 30 calendar days after cancellation or final expiration of the contract, whichever occurs earlier,otherwise CCRMC forfeits its right(s)to relief. H. GOVERNING LAW Notwithstanding any other parts of this contract, this contract shall be governed,construed, and enforced in accordance with Federal law. I. COMMERCIAL ADVERTISING CCRMC shall not advertise or use any marketing material, logos, trade names, service marks, or other material belonging to the Department of Veterans Affairs or VANCHCS without the consent of VANI TCHCS. J. VANCHCS REPRESENTATIVES 1. VANCHCS will assign a Contracting Officer who will be authorized to act on behalf of VANCHCS in the following capacity: Make changes to the contract provisions, including changes involving increases or decreases in contract price,and no cost changes, making changes to the scope of the contract,requiring extras other than stated in the contract, extending the time established in the contract, terminating the contract,requiring extras other than stated in the contract, extending the time established in the contract, terminating the contract in whole or in part, or conducting price or cost negotiations for proposed contract changes. A VANCHCS Contracting Officer is the only official who can bind the VANCHCS. 2. The Contracting Officer reserves the right to designate representatives to act for him/her in furnishing technical guidance and advice,or to generally oversee the technical aspects of the services provided under this contract. Such designation will be in writing and will define the scope and limitations of the designee's authority. A copy of the designation will be furnished to CCRMC upon contract award. K. AUTHORITIES This contract is a Sharing Agreement awarded pursuant to 38 U.S.C. 8153. L. RELATIONSHIP BETWEEN THE PARTIES The relationship of the parties to this Agreement is not and shall not be construed or interpreted to be a partnership,Joint venture or agency. The relationship of the parties is an independent contractor relationship. ......... ._..._ . ................ ................._......_........_._... ......... ....._._. Ne ology Services Page 8 ATTACHMENT A-1 REE`ERRALISCHEDULING PROCEDURES The following procedures will be used for scheduling CCRMC outpatients to be treated at the VANCHCS OPC. A. 24-Hour EEG Monitoring 1. Patients referred for treatment by physicians of CCRMC will call the VANCHCS Neurodiagnostic Lab (925) 372-2056, to schedule an appointment. 2. As soon as possible after scheduling their appointment,patients will call the VAT CHCS, Medical Administration Service at(800)382-8387,to be registered into the VA DHCP computer system, or patients may present themselves at the VANCHCS, OPC, Main Reception for registration,a minimum of thirty(30)minutes prior to appointment time. 3. The patient will check-in at VANCHCS, OPC, Reception C for check-in at the appointed time. 4. The patient will be connected to VANCHCS-owned ambulatory EEG equipment and released with instruction to return in 24 hours(or a specified number of days), so that the equipment can be removed. 5. The recording will be previewed by the VA EEG technician and formally by a VANCHCS Encephalographer. ......... ......... _.._._.. .. ......... ........ . .._..._.. ..... ........ ........ ........ ....... ....... ... ... ......... ........ ......... ........................... . TO:., BOARD OF SUPERVISORS ° William Walker, M.D. , ealth Services Director Contra By: Ginger Marieiro, Contracts Administrator DATE:: August 18, 1998 Costa SUBJECT: Approval of Sharing Agreement V612P with the U.S. Department' of Veterans Affairs SPECIFIC REQUEST(st OR RECOMMENDATtON(S)&BACKGROUND AND JUSTIFICATION RECUMMENDEA ACTION: Approve and authorize the Health Services Director, or his;, designee (Frank Puglisi, Jr. ) , to execute on behalf of the County, Sharing Agreement V612P (County #26-346) , with the U.S. Department of Veterans Affairs Northern California Health Care System' (VANCHCS) for the period from August 1, 1998 through July 31, 1999, for provision of Nuclear Medicine Services. ' FINANCIAL IMPACT: This Contract is funded in the Health Services Department ' s ' Enterprise I Budget . Under the term of the agreement VANCHCS ' will be paid a fee for each service in accordance with the attached fee schedule, which is incorporated in the Contract . The services provided for the County' s patients under this Contract are billable to patients and third party ;payors. REASONS FOR RECOMMENDATIONS/BACKGROUND: For many years the County and U.S. Department of Veterans Affairs ' has maintained a mutual sharing agreement which has made available to the County specialized medical services not otherwise available ' due to lack of resources, equipment, and personnel . These , services included specialized laboratory testing, radiology', services, nuclear medicine studies, CT scans, MRI ' s, dermatology, gastroenterology, urology, audiology and speech, and ophthalmology services . The County provided Emergency Room treatment and inpatient care, including certain ancillary services, for VA- referred patients. The VA recently informed the Department that hereinafter they will use separate agreements for services provided to the County. ' Under the terms of this Sharing Agreement #26-346, VANCHCS (under the auspices of the VANCHCS Nuclear Regulatory Commission License) will provide a full range of Nuclear Medicine Services to County' s patients at the VA Outpatient Clinic in Martinez and/or the Contra Costa. Regional Medical Center' s Nuclear Medicine Department . The Contract documents have always been prepared by the Veterans Administration. CONTINUED ON A C N .SIGNATURE' .. RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER ACTION OF BOARD ON SqteTbW11 1998 APPROVED AS RECOMMENDEDX N! VOTE OF SUPERVISORS X UNANIMOUS (ABSENT I } I HERESY CERTIFY THAT THIS 1S A TRUE AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED ' , A t . PHIL I3AT ELOR,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR COntaCt P "k istlgl :3i. Jr. (313-53.00) CC: Health Services(Contracts) Risk Management Auditor Controller BY --' DEPUTY Contractor MITRACT AWARD FOR SELUNG HEALTHCARE SERVICES 1.REQUISITION NUMBER PAGE 1 OF 19 CONTRACTOR TO COMPLETE BLOCKS 12,17,23,24,a 30 i.CONTRACT NO. 3.AWRRD EFFECTNE 4.ORDER NUIvD9ER 5_SOLICITATION NUMBER fi.SOLICITATION ISSUE SJIp DATE /A DATE 7/7/98 7.FOR a.NAME.Karen E. Pridmore,Contract Specialist h.TELEPHONE NUMBER C.11-,Ca t,I 8 OFFER DUE DATE/ INFORMATION CALL: (925)372-2046 LOCAL TIME 9. ISSUED BY CODE 10. THIS ACQUISITION IS N/A i t.DELIVERY FOR FOB I?.DISCOUNT TERMS DESTINATION UNLESS Department of Veterans Affairs UNRESTRICTED BLOCK IS MARKED N/A Northern California Health Care System(VANCHCS) ❑SET ASIDE 4S.FOR [3 SEE SCHEDULE 2300 Contra Costa Blvd., Suite 440 ©SMALL BUsrsESs Iia.THIS CONTRACT IS A RATED ORDER UNDER DPAS(IS CFR 700) Pleasant Hill,CA 94523 SMALL DISADV.BUSINESS N/A 8(A) 13B.RATING N/A SIC: 14 METHOD OF SOLICITATION N/A SIZE STANDARD []RFQ 01FB ©RFP 15.DELIVER TO CODE16.ADMINISTERED BY CODE N/A Same as Black 9 17A.CC7NTRAC,`DR CODE1. FACILITY €8A.CODE PAYMENT WILL BE MAD£B5' CODE _.,. Contra Costa Regional Medical Center(CCRMC) 2500 Alhambra Avenue Same as Black 17A Martinez, CA 9455326 . 0 346 TELEPHONE NO.(925)374-5138 N/ Min SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BEW 17b.CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER LOIS CHECKED � SEE ADDENDUM N/A 19 20 21 22 1 23 24 ITEM NO. SCHEDULE OF SUPPLIES/SERVICE QUANTITY UNIT UNIT PRICE AMOUNT VANCHCS will provide Nuclear l Medicine Services to CCRL C in accordance with the terms and conditions contained herein. (A7,4CH ADDITIONAL SHEET.4S NECESsr RY) 25.ACCOUNTING AND APPROPRIATION DATA 26.TOTAL AMOUNT AWARD("FOR GOVT CISEONLY) Authorities: Enhanced Healthcare Resources Sharing Authority VHA Directive 97-015,dated 3/12/97 27a SOLICITATION INCORPORATES BY REFERENCE FAR 52,212.1.52.212-4. FAR 52.1-12-3 AND 52.2.12-5 ARE ATTACHED.ADDENDA n A ARE NOT ATTACHED. ' ® 27b CONTRACT FEE SCHEDULE,TERMS AND CONDITIONS AND ADDENDA ARE[] ARE NOT ATTACHED. 28.CONTRACTOR IS REQUIRED TO SIGN TIIl5 DOCUNIENT AND RETURN OR 2(c WO) COPIES 29 AWARD OF CONTRACT; REFERENCE OFFER TO ISSUING OFFICE CONTRACTOR AGREES TO THE TERMS AND CONDITIONS SET FORTH HEREIN., DATED YOUR OFFER ON SOLICITATION(BLOCK OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO 5).INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH THE TERMS AND CONDITIONS SPECIFIED HEREIN, HEREIN.IS ACCEPTED AS TO ITEMS: 30a. SIGNATURE OF CONTRACTOR 3IA.UNITED STATES OF AMERICA(SIGNATURE OF CONTRACTING OFFICER) Sob.NAME AND TITLE OF SIGNER(TYPEOR PR NT} 30c.DATE SIGNED 3 ib.NAME OF CONTRACTING OFFICER(TYPE OR PRINT) 31c.DATE SIGNED 32a.QUANTITY IN COLUMN 2I HAS BEEN N/A FOR 33.SHIP NUMBER 34.VOUCHER NUMBER 35.AMOUNT RlFIF.D CORRECT FOR RECEIVED INSPECTED L,7 ACCEPTED AS CONFORMS TO THE PARTIAL FINAL CONTRACT.EXCEPT AS NOTED 32b.SIGNATURE OF AUTHORIZED GOVT REPRESENTATIVE 32C.DATE 36,PAYMENT 37.CHECK NUMBER COMPLETE PARTIAL FINAL 38.S/R ACCOUNT NUMBER 39.SIR VOUCHER NUMBER 40.PAID BY 41 a.I CERTIFY THIS ACCOUNT IS CORRECT,AND PROPER FOR PAYMENT 42a.RECEIVED BY tPRINI) 41b SIGNATURE AND TITLE OF CERTIFYING OFFICER 41 c.DATE 42b.RECEIVED AT(LGC4TION) 42c.DATE REC'D(YY/MWDD) 42d.TOTAL CONTAINERS 7/7198 Contract Award Form-VANCHCS(612/90C) Table o}Contents SECTION/DESCRIPTION PAGE(S) CONTRACT AWARD .FOIL.SELLING HEALTHCARE SERVICES 1 FEE SCHEDULE A. .Base Period 7/1/98 - 6/30/99 2 B. Option Year 1 7/1/99 - 6/30/00 5 C. Option Year 2 7/l/00 - 6/30/01 8 TERMS AND CONDITIONS A. Scope of Services 11 B. Outpatient Services Provided at VANCHCS OPC 11 C. Inpatient Services Provided at CCRMC 12 D. Liability for Damages 13 E. Other Contract Requirements 14 F. Priority for Veterans 16 G. Contract Modifications 16 H. Term of the Contract 16 1. Payment 17 J. Disputes 18 K. Governing Law 18 L. Commercial Advertising 18 M. VANCHCS Representatives 18 N. Authorities 19 O. Relationship Between the Parties 19 NRC LICENSE AGREEMENT Attachment A-1 REFERRAL/SCHEDULING PROCEDURES Attachment A-2 Nuclear Medicine Services Page 2 -- FEE SCHEDULE A. BASE PERIOD: 7/1/98 -6/30/99 PROCEDURES CPT Est. Unit Est. Unit Item# Cade Description Qty. Price Total Price Qty. Price Total Price 1 76075 Bone Density 25 174 4,347 0 189 0 2 78006 Thyroid U&S 1-131 2 151 302 2 164 329 3 78007 Thyroid U&S 1-123 85 162 13,733 9 176 1,.581 4 78011 Thyroid Scan Tc99m Plow 0 150 0 0 163 0 5 78018 Cancer Survey 0 334 0 0 363 0 6 78018 WB Thyroid Scan(M1BI) 0 334 0 0 1 363 0 7 78070 Parathyroid Scan 0 137 0 0 149 0 8 78122 RSC Mass 0 260 0 0 283 0 9 78195 Lymph Scan 2 270 540 0 294 0 10 78205 Hemangioma Scan SPECT(wf78202) 0 343 0 0 373 0 11 78205 Liver/Spleen Scan SPECT 0 343 0 0 373 0 12 78215 Liver/Spleen Scan Planar 13 179 2,324 1 194 194 13 78220 HIDA 33 218 7,201 4 237 949 14 78223 HIDA w/EF 0 238 0 0 259 0 15 78258 Esoph. Motility 0 193 0 0 210 0 16 78262 Gastric Reflex 0 257 0 0 1 280 0 17 78254 Gastric Empty 21 258 5,412 2 1 280 560 18 78270 Schillings, Stage I 0 91 0 0 99 0 19 78271 Schillings, Stage 11 and 111 0 96 0 0 1041 0 20 78278 GI Bleed 0 309 C. 0 336 0 21 78290 Meckels 0 197 0 0 214 0 22 78305 Sone, Ltd 0 238 0 0 258 0 23 78306 Sane, WB 2731 270 73,737 30 294 8,808 24 78315 Bone, Ltd w/Plow 4 305 1,220 0 332 0 25 78315 Bone, WB w/Flow 0 305 0 0 332 0 26 78460 Persantine Myov Planar* 0 243 0 0 264 0 27 78460 Treadmill Myov Planar* 0 243 0 0 264 0 28 78460 Dobutamine Ti-201 Planar* 0 243 0 0 264 0 29 78460 24 hr TI-201 Planar(Addlt.) 0 175 0 0 190 0 30 78461 Planar Persantine TI-201* 0 384 0 0 418 0 31 78461 Planar Myov Rest 0 316 0 0 343 0 32 78464 SPECT addit.TL-201 0 425 0 0 462 0 33 78464 Treadmill Myov SPECT* 0 493 0 0 536 0 34 78464 Persantine Myov SPECT* 0 493 0 0 536 0 35 78464 24 hr TL-201 SPECT 0 425 0 0 462 0 36 78465 Thallium Treadmill Test* 89 754 67,066 9 819 7,372 37 78465 SPECT Rest TL-201 0 685 0 0 745 0 38 78465 SPECT Dobutamine TL-201* 0 754 0 0 819 0 39 78465 SPECT Persantine TL-201* 199 754 149,956 22 1 819 18,020 40 78456 PYP Myocardial Infarction Planar 0 177 0 0 193 0 41 78469 PYP Myocardial Infarction Scan 0 321 0 0 349 0 42 78472 GWMS 5 340 1,700 1 369 369 43 78473 Exercise GWMS* 0 577 0 0 627 0 44 78481 GWMS w/ 1st Pass 0 326 0 0 3541 0 45 78483 Ex GWMS w/1st Pass* 0 558 0 0 606 0 Nuclear Medicine Services Page 3 ---------- EEE SCHEDULE A. SASE PERIOD: 711!98 -6130/99 PROCEDURES CPT Est. Unit Est. Unit Item# Code Description Qty. Price Total Price Oty. Price Total Price 46 78580 Lung Perfusion 0 220 0 0 240 0 47 '78580 Luna Quantification 0 220 0 0 240 0 48 78585 Lung V/Q 49 352 17,272 5 383 1,916 49 78594 Lung Vent(addit.) 0 285 0 0 310 0 50 78606 Cerebral Flow and Scan 0 235 0 0 256 0 51 78630 Cisternogram 0 297 0 0 323 0 52 78650 CSF Leak Study 0 272 0 0 296 0 53 78707 RenaiScan 25 286 7,140 3 310 931 54 78707 Lasix Renal(Incl Lasix) 0 304 0 0 330 0 55 78709 Captopril penal(inc Captopril) 0 304 0 0 330 0 56 78800 Octreoscan Ltd 2 view 0 213 0 0 232 0 57 78800 Oncoscint Ltd 2 view 0 213 0 0 232 0 58 78801 Ga-67 Ltd 0 263 0 0 286 0 59 78802 Ga-67 WB 16 333 5,333 2 362 725 60 78802 Octreoscan WB 0 333 0 0 362 0 61 78802 Oncoscint WB 0 333 0 0 362 0 62 78803 Ga-67 SPECT 0 399 0 0 433 0 63 78803 Octreoscan SPECT 0 399 0 1 0 433 0 64 78803 Oncoscint SPECT 0 399 0 0 433 0 65 78805 In-111 WBC Ltd 0 218 0 0 237 0 66 78806 In-111 WBC WB 12 378 4,535 1 411 411 67 78806 In-111 WBC SPECT(addit) 0 378 0 0 411 0 68 79000 Hyperthyroid Therapy Initial 18 249 4,476 2 270 541 69 79001 Hyperthyroid Therapy Additional 0 133 0 0 144 0 70 79030 Thyroid Therapy-Ablation 0 268 0 0 291 0 71 79035 Thyroid Therapy Cancer 0 295 0 0 321 0 72 79100 P-32 Therapy 0 217 0 0 236 0 73 79401 Sr-89 Therapy 0 0 0 0 0 0 74 78890 Computer Processing (<313 min) 0 0 0 0 0 0 75 78891 Computer Processing (>30 ruin) 0 0 0 0 0 0 PROCEDURES SUBTOTAL $366,293 $42,704 TOTAL(OUTPATIENT AND INPATIENT) $408,997 'Includes 93016&93018 Nuclear Medicine Services Page 4 FEF SCHEDULE A. SASE PERIOD: 7/1/98 -6130/99 iSOTOPESFSUPPLIES Est. Unit Item# Ref# Description (CPT/HCPCS) Qty. Price Total Price 76 00001 78990 A4641 Tc99m MAG3 28 160 4,480 77 00002 78990 A4641 Tc99m MAA 54 20 1,080 78 00003 78990 A4641 Tc99m SC 38 20 760 79 OU,004 78990 A4641 Tc99m DTPA 0 50 0 80 00005 78990 A4641 Tc99m Choletec 37 50 1,850 81 00006 78990 A4641 1123 200 uCi 94 81 7,614 82 00007 78990 A4641 1-131(1-5 mCi) 20 80 1,600 83 00008 78990 A4641 1-131(ea addl rnQ) 20 10 200 84 00009 78990 A4641 IN-111 DTPA(1 vi) 0 500 0 85 00010 78990 A4641 IN-111 WBC(per labeling) 13 400 5,200 86 00011 78990A4641 Xenon (10mCi/vi) 54 20 1,080 87 00012 78990 A4641 Ga67(6 mCi) 18 94 1,692 88 00013 78990 A4641 Rubratope(4 kts) 3 150 450 89 00014 78990 A4641 Uitratag(1 kt) 0 69 0 90 00015 78990 A4641 Otreoscan/dose 0 1,188 0 91 00016 78990 A4641 Tc04(30 mCi) 0 10 0 92 00017 78990 A4641 Bulk Tc04 0 23 0 93 00018 78990 A4641 Prostascint 0 1,490 0 - 94 00019 78990 A4641 Tc99m CEA 0 1,381 0 95 00020 78990 A4642 Oncoscint 0 1,313 0 98 G0021 78990 A9502 Tc99m Myoview 0 85 0 97 00022 78990 A9503 Tc99m MDP 3071 31 9,517 98 00023 78990 A9505 TL-201 (3 mCi) 319 53 16,907 99 00024 78990 A9600 5-89 Chloride(4 mCi) 0 2.850 0 100 00025 JO 150 Adenosine(6 mg) 0 25 0 101 00026 J0280 Aminophylline(to 250 mg) 398 2 796 102 00027 J1246 Persantine(10 mg) 221 93 20,553 103 0002.8 J1550 Dobutamine (250 mg) 0 23 0 104 00029 Dobutamine back 0 0 0 105 00030 CCK 6 63 378 ISOTOPES/SUPPLIES SUBTOTAL $73,779 Med-Image System 1 18,000 $18,000 BASE PERIOD-GRAND TOTAL (Outpatlentllnpatient/lsotopes) $426,997 ?nuclear Medicine Services Page 5 EEE SCHEDULE B. OPTION 1: 711!93 - 6/30100 PROCEDURES CPT Est. Unit Est. It item# Code Description Qty. Price Total Price Qt Price Total Prue 1 76075 Bone Density 25 178 4,461 0 194 0 2 78006 Thyroid U 1-131 2 155 310/ 2 168 337 3 78007 Thyroid U&S 1-123 8s 166 14,0;x'1 9 180 1,618 4 78011 1 Thyroid Scan Tc99m Flow 0 154 0 0 167 0 5 78018 Cancer Survey 0 342 j` 0 0 371 0 6 78018 W8 Thyroid Scan(MIBI) 0 342 0 0 371 0 7 78070 Parathyrold Scan 0 140/ 0 0 152 0 8 78122 RBC Mass 0 267 0 0 289 0 9 78195 Lymph Scan 2 ;277 554 0 301 0 10 78205 Hemangioma Scan SPECT(w/78202) 0 352 0 0 382 0 11 78205 Liver/Spleen Scan SPECT 0 352 0 0 382 0 12 78215 Liver/Spleen Scan Planar 13 183 2,384 1 199 199 13 78220 HIDA 33 224 7,389 4 243 972 14 78223 HIDA w/EF 0 244 0 0 265 0 15 78258 Esoph. Motility 0 198 0 0 215 0 16 78262 Gastric Reflex 0 264 0 0 287 0 17 78264 Gastric Empty 21 264 5,553 2 287 574 18 78270 Schillings,Stage 1 0 93 0 0 101 0 19 78271 Schillings, Stage II and 111 0 98 0 0 107 0 20 78278 GI Bleed 0 317 0 0 344 0 21 78290 Meckels 0 262 0 0 219 0 22 78305 Bone,Ltd 0 244 0 0 265 0 23 178306 Bone,WB 2731 277 75,661 30 301 9,019 24 178315 Bone, Ltd w/Flow 4 1 3131 1,252 0 340 0 25 178315 Bone, WB w/Flow 0 313 0 0 340 0 26 1 78460 Persantine Myov planar* 0 249 0 0 270 0 27 178460 Treadmill Myov Planar* 0 249 0 0 270 0 28 1 78460 Dobutamine TI-201 Planar* 0 249 0 0 270 0 29 78460 24 hr T1-201 planar(Addit.) 0 179 0 0 194 0 30 78461 Planar Persantine TI-201` 0 1 394 0 0 428 0 31 78461 Planar Myov Rest 0 324 0 0 352 0 32 78464 SPECT addit.TL-201 0 436 0 0 473 0 33 78464 Treadmill Myov SPECT* 0 506 0 0 549 0 34 78464 Persantine Myov SPECT* 0 506 0 0 549 0 35 78464 24 hr TL-201 SPECT 0 436 0 0 473 0 36 78465 Thallium Treadmill Test* 89 773 68,815 9 839 7,549 37 78465 SPECT Rest TL-201 0 703 0 0 763 .0 38 78465 SPECT Dobutamine TL-201* 0 773 0 0 839 0 39 78465 SPECT Persantine TL-201* 199 773 153,868 22 839 18,452 40 78466 PYP Myocardial infarction Planar 0 182 0 0 197 0 41 78469 PYP Myocardial Infarction Scan 0 330 0 0 358 0 42 78472 GWMS 5 349 1,744 1 378 378 43 78473 Exercise GWMS* 0 592 0 0 642 0 44 78481 GWMS w/ 1 st Pass 0 334 0 0 362 0 45 178483, Ex GWMS w/1st Pass* 0 572 0 0 621 0 Nuclear Medicine Services Page 6 - -- FEE SCHEDULE B. OPTION 1: 7/1/99 6/30/00 PROCEDURES CPT Est. Unit Est. Chit Item# Code Description Qty, Price Total Price Qty. Price Total Prue 46 78580 Lung Perfusion 0 226 0 0 245 0 47 78580 Lung Quantification 0 226 0 0 j 245 0 48 78585 Lung V/Q 49 362 17,722) 5 392 1,962 49 78594 Lung Vent(addit.) 0 292 0 0 317 0 50 78606 Cerebral Flow and Scan 0 242 0 0 262 0 51 78630 Cisternogram 0 305 0 0 331 0 52 78650 CSF Leak Study 0 279 0 0 303 0 53 78707 Renal Scan 25 293 7,326 3 318 054 54 78707 Lasix Renal (Incl Lasix) 0 312 0 0 338j 0 55 78709 Captopril Renal(inc Captopril) 0 312 0 0 338 0 56 78800 Octreoscan Ltd 2 view 0 219 0 0 237 0 57 78800 Oncoscint Ltd 2 view 0 219 0 0 237 0 58 78801 Ga-67 Ltd 0 270 0 0 293 0 59 78802 Ga-67 WB 16 342 5,472 2 371 742 60 78802 Octreoscan WB 0 342 0 0 371 0 61 78802 Oncoscint WB 0 351 0 0 371 0 62 78803 Ga-67 SPECT 0 409 0 0 444 0 63 78803 Octreoscan SPECT - 0 409 0 0 444 0 64 78803 Oncoscint SPECT 0 409 0 0 444 0 65 78805 In-111 WBC Ltd 0 223 0 0 242 0 66 78806 in-111 WBC WB 12 388 4,653 1 421 421 67 78806 In-111 WBC SPECT(addit) 0 388 0 0 421 0 68 79000 Hyperthyroid Therapy Inibai 18 255 4,592 2 277 553 69 79001 Hyperthyroid Therapy Additional 0 136 0 0 148 0 70 79030 Thyroid Therapy-Ablation 0 275 0 0 298 0 71 79035 Thyroid Therapy Cancer 0 303 0 0 329 0 72 79100 P-32 Therapy 0 222 0 0 241 0 73 79401 Sr-89 Therapy 0 0 0 0 0 0 74 78890 Computer Processing (<30 min) 0 0 0 0 0 0 75 78891 Computer Processing(>30 min) 0 0 0 0 1 0 0 PROCEDURES SUBTOTAL $375,848 $43,729 TOTAL (OUTPATIENT AND INPATIENT) $419,577 'Includes 93016&93018 Nuclear Medicine Services Page 7 FEE SCHEDULE B. OPTION 1: 7/1/99 - 6/30/00 ISOTOPESISUPPLIES Est. Unit Item# Ref# Description(CPT/HCPCS) Qty. Price Total Price 76 100001 78990 A4641 Tc99m MAG3 28 1651 4,614 77 00002 78990 A4641 Tc99m MAA 54 21 1,112 78 100003 78990 A4641 Tc99m SC 38 21 783 79 00004 78990 A4641 Tc99m DTPA 0 52 0 80 00005 78990 A4641 Tc99m Choletec 37 52 1,906 81 00006 78990 A4641 1-123 200 uCi 94 83 7,842 82 00007 78990 A4641 1-131(1-5 mCi) 20 82 1,548 83 00008 78990 A4641 1-131(ea addl mCi) 20 10 206 84 00009 78990 A4641 IN-111 DTPA(1 vi) 0 515 0 85 00010 78990 A4641 IN-111 WBC (per labeling) 13 412 5,356 86 00011 78990 A4641 Xenon (10mCi/vi) 54 21 1,112 87 00012 78990 A4641 Ga67(6 mCi) 18 97 1,743 88 00013 78990 A4641 Rubratope (4 kts) 3 155 464 89 00014 78990 A4641 Ultratag (1 kt) 0 71 0 90 00015 78990 A4641 Otreoscanldose 0 1,224 0 91 00016 78990 A4641 Tc04 (30 mCi) 0 10 0 92 00017 78990 A4641 Bulk Tc04 0 24 0 93 00018 78990 A4641 Prostascint 0 1,535 0 94 00019 78990 A4641 Tc99m CEA 0 1,422 0 95 00020 78990 A4642 Oncoscint 0 1,352 0 96 00021 78990 A9502 Tc99m Myoview 0 88 0 97 00022 78990 A9503 Tc99m MDP 307 32 9,803 98 00023 78990 A9505 TL-201 (3 mCi) 319 55 17,414 99 00024 78990 A9600 5-89 Chloride(4 mCi) 0 2,936 0 100 00025 J0150 Acenosine(6 mg) 0 26 0 101 00026 J0280 Aminophylline (to 250 mg) 398 2 820 102 00027 J1245 Persantine(10 mg) 221 46 10,243 103 00028 J1550 Dobutamine(250 mg) 0 23 0 104 00029 Dobutamine Pack 0 0 0 105 00030 CCK 6 65 389 ISOTOPES SUBTOTAL $65,455 OPTION YEAR 1 -GRAND TOTAL (Outpatient/inpatientilsotopes) $485,033 __ Nuclear Medicine Services Page 8 FEE SCHEDULE C. OPTION 2: 7/1100 - 6/30/01 PROCEDURES GPT Est. Unit Est. Unit item# Code Description Qty- Price Tats[Price Qty. Price Total Price 1 76075 Bane Density 25 183 4,574 0 198 0 2 78006 Thyroid U&S 1-131 2 159 318 2 172 345 3 78007 Thyroid U&S 1-123 85 170 14,4491 9 184 1,656 4 78011 Thyroid Scan T c99rn Plow 0 158 0 0 171 0 5 78018 Cancer Survey 0 351 0 0 380 0 6 78018 WB Thyroid Scan (MIBI) 0 351 0 0 380 0 7 78070 Parathyroid Scan 0 144 0 0 156 0 8 78122 RBC Mass 0 273 0 0 296 0 9 78195 Lymph Scan 2 284 568 0 308 0 10 78205 Hemangioma Scan SPECT{w178202} 0 361 0 0 390 0 11 78205 Liver/Spleen Scan SPECT 0 361 0 0 390 0 12 78215 Liver/Spleen Scan Planar 13 188 2,445 1 204 204 13 78220 HIDA 33 230 7,577 4 249 994 14 78223 HIDA wt EF 0 251 0 0 271 0 15 78258 Esoph. Motility 0 203 0 0 220 0 16 78262 Gastric Reflex 0 271 0 0 293 0 17 78264 Gastric Empty 21 271 5,694 2 294 587 18 78270 Schillings, Stage 1 0 96 0 0 104 0 19 78271 Schillings, Stage 11 and 111 0 101 0 0 109 0 20 78278 Gl Bleed 0 325 0 0 352 0 21 78290 Meckels 0 207 0 0 224 0 22 78305 jBone, Ltd 0 250 0 0 271 0 23 78306 1 Bone,WB 273 284 77,585 30 308 9,230 24 78315 Bane, Ltd w/Plow 4 321 1,284 0 348 0 25 78315 Bone, WB w/Flow 0 321 0 0 348 0 26 78460 Persantine Myov Planar* 0 256 0 0 277 0 27 78460 Treadmill Myov Planar* 0 256 0 0 277 0 28 78460 Dobutamine TI-201 Planar* 0 256 0 0 277 0 29 78460 24 hr TI-201 Planar{Addit.} 0 184 0 0 199 0 30 78461 Planar Persantine TI-201` 0 404 0 0 438 0 31 1 78461 Planar Myov Rest 0 332 0 0 360 0 32 78464 SPECT addit.TL-201 0 447 0 j 0 484 0 33 78464 Treadmill Myov SPECT` 0 519 0 0 562 0 34 78464 Persantine Myov SPECT* 0 519 0 0 562 0 35 78464 24 hr TL-201 SPECT 0 447 0 0 484 0 36 78465 Thallium Treadmill Test* 89 793 70,565 9 858 7,726 37 78465 SPECT Rest TL-201 0 721 0 0 780 0 38 78465 SPECT Dobutamine TL-201* 0 793 0 0 858 0 39 78465 SPECT Persantine TL-201' 199 793 157,780 22 858 18,885 40 78466 PYP Myocardial infarction Planar 0 186 0 0 202 0 41 78469 PYP Myocardial Infarction Scan 0 338 0 0 366 0 42 78472 GWMS 5 358 1,788 1 387 387 43 78473 Exercise GWMS* 0 607 0 0 657 0 44 78481 GWMS w/ 1st Pass 0 343 0 0 371 0 45 78483 ,Ex GWMS w11 st Pass* 0 587 0 0 635 0 Nuclear:Medicine Services Pae 9 FEESCHEDULE C. OPTION 2: 7/1/00 -6/30101 PROCEDURES CPT Est, unit Est. Unit item# Code Description Qty. Price Total Prig Qty. Pricy Total Price 46 78580 Lung Perfusion 0 232 0 0 251 0 47 78580 Lugg Quantification 0 232 0 0 251 0 48 78585 Lung V/Q 49 371 18,173 5 402 2,008 49 78594 Lung Vent(addit.) 0 300 0 0 324 0 50 78606 Cerebral Flow and Scan 0 248 0 0 268 0 51 78630 Cistemogram 0 312 0 0 338 0 52 78650 CSF Leak Study 0 '286 0 0 310 0 53 78707 Renal Scan 25 300 7,512 3 325 976 54 78707 Lasix Renal(Incl Lasix) 0 320 0 0 3461 0 55 78709 Captopril Renal (inc Captopril) 0 320 0 0 346 0 56 78800 (Octreoscan Ltd 2 view 0 224 0 0 243 0 57 78800 Oncoscint Ltd 2 view 0 224 0 0 243 0 58 78801 Ga-67 Ltd 0 277 0 0 300 0 59 78802 Ga-67 WB 16 351 5,611 2 380 759 60 178802 Octreoscan WB 0 351 0 0 380 0 61 178802 Oncoscint WB 0 351 0 0 380 0 62 78803 Ga-67 SPECT 0 413 0 0 454 0 63 78803 octreoscan SPECT 0 419 0 0 454 0 64 78803 Oncoscint SPECT 0 419 0 0 454 0 65 78805 In-111 WBC Ltd 0 229 0 0 248 0 66 78806 In-111 WBC WB 12 398 4,771 1 430 430 67 178806 in•111 WBC SPECT(addit) 0 398 0 0 430 0 68 1 79000 Hyperthyroid Therapy initial 18 262 4,709 2 283 566 69 179001 Hyperthyroid Therapy Additional 0 140 0 0 151 0 70 1 79030 Thyroid Therapy-Ablation 0 282 0 0 305 0 71 79035 Thyroid Therapy Cancer 0 311 0 0 336 0 72 79100 P-32 Therapy 0 228 0 0 247 0 73 79401 Sr-89 Therapy 0 0 0 0 0 0 74 78890 Computer Processing (<30 min) 0 0 0 0 0 0 75 178891 Computer Processing (>30 min) 0 0 0 0 0 0 PRtOCEDURES SUBTOTAL $385,404 $44,754 TOTAL(OUTPATIENT AND INPATIENT) $430,157 Includes 93016&93018 Nuclear Medicine Services Pae 10 FEE SCHEDULE C. OPTION 2: 711104 - 6130101 ISt3TOPESfSUPPL1ES Est. Unit Item# Ref# Description(CPTIHCPCS) Qty. Price Total Price 76 00001 78990 A4641 Tc99m MAG3 28 170 4,749 77 00002 78990 A4641 Tc99m MAA 54 21 1,145 78 00003 78990 A4541 Tc99m SC 38 21 806 79 00404 78990 A4641 Tc99m DTPA 0 53 0 80 00005 78990 A4641 Tc99m Choletec 37 53 1,961 81 00006 78990 A4641 1-123 200 uCi 94 86 8,071 82 00007 78990 A4641 1-131(1-5 mCi) 20 85 1,696 83 00008 78990 A4641 1-131(ea addl mCi) 20 11 212 84 00009 78990 A4641 I N-1 TT DTPA(1 vi) 0 530 0 85 100010 78990 A4641 1N-111 WBC(per labeling) 13 424 5,512 86 100011 78990 A4641 Xenon(10mCi/vi) 54 21 1,145 87 00012 78990 A4641 Ga67(6 mCi) 18 100 1,794 88 00013 78990 A4641 Ru#ratope(4 kts) 3 159 477 89 00014 78990 A4641 Ultratag (1 kt) 0 73 0 90 0{1015 78990 A4641 Otreoscan/dose 0 1,259 0 91 00016 78990 A4641 Tc©4 (30 mCi) 0 11 0 92 00017 78990 A4641 Bulk Tc04 0 24 0 93 04018 78990 A4641 Prostascint 0 1,579 0 94 00(319 78990 A4641 Tc99m CEA 0 1,464 0 95 100020 78990 A4642 Oncoscint 0 1,392 0 96 100021 78990 A9502 Tc99m Myoview 0 90 0 97 100022 78990 A9503 Tc99m MDP 307 33 10,088 98 100023 78990 A9505 TL-201 (3 mCi) 3191 56 17,921 99 00024 78990 A9600 S-89 Chloride(4 mCl) 0 3,021 0 100 00025 J0150 Adenosine(6 mg) 0 27 0 101 00026 J0280 Aminophylline(to 250 mg) 3981 2 844 102 00027 J1245 Persantine(10 mg) 2211 48 10,542 103 f00028 J1550 Dobutamine(250 mg) 0 24 0 104 00029 Dobutamine Pack 0 0 0 105 00030 CCK 6 67 401 ISOTOPES SUBTOTAL $67,362 OPTION YEAR 2-GRAND TOTAL (Outpatientlinpatientllsotopes) $497,519 GRAND TOTAL (BASE PERIOD, OPTION 1 &2) $1,409,549 Nuclear Medicine Services Pae 11 TERMS AND CONDITIONS FOR CONTRACT TO PROVIDE NUCLEAR MEDICINE SERVICES The Department of Veterans Affairs, Northern California Health Care System (VANCHCS) will provide Nuclear Medicine Services as described herein to Contra Costa Regional Medical Center (CCRMC), 2500 Alhambra Avenue, Martinez, California. All services will be provided at the prices in the Fee Schedule contained herein and in accordance with the terms and conditions of this contract. A. SCOPE OF SERVICES 1. VANCHCS will provide the fail range of outpatient Nuclear Medicine Services to patients referred for treatment by CCRMC physicians. All Nuclear Medicine Services provided under this contract will be provided under the auspices of the VANCHCS Nuclear Regulatory Commission(NRC) License, which shall be incorporated as a part of this contract as Attachment A-1. 2. Nuclear Medicine Services will be provided by VANCHCS at the following locations. a. Services will be provided to CCRMC outpatients at the VANCHCS Outpatient Clinic (OPC), 150 Muir Road, Martinez, California. b. Services will be provided to CCRMC inpatients and outpatients, and VANCHCS outpatients and inpatients as described herein, at CCRMC, 2500 Alhambra Avenue, Martinez, California, B. OUTPA'T'IENT SERVICES PROVIDED AT VANCHCS OUTPATIENT CLINIC 1. VANCHCS will furnish the full range of Nuclear Medicine Outpatient Services as described herein, at the VANCHCS Outpatient Clinic (VANCHCS OPC), Nuclear Medicine Service, 150 Muir Road, Martinez, California, to patients referred for treatment by CCRMC physicians. 2. The outpatient procedures identified in the Fee Schedule, will be performed by VA1+CHCS physicians and technologists, using VANCHCS space, equipment, and supplies. 3, VANCHCS will maintain utilization review and quality assurance programs to ensure the necessity, appropriateness and quality of care provided to CCRMC patients receiving treatment under this contract. 4. All outpatient services provided by VANCHCS will be provided in an economical and efficient manner consistent with professional standards of medical care generally accepted in the medical community, and in accordance with VANCHCS accreditation standards. 5. VANCHCS will not discriminate in the treatment of CCRMC patients, except as otherwise specified in this agreement. Nuclear Medicine Services Pae 12 6. To preclude the possibility of denying or delaying the care and treatment of eligible veterans, VANCHCS will provide outpatient services to CCRMC patients, only to the extent there will be no reduction in service or delay in treatment to veterans. 7. Referrals will be made in accordance with the referral procedures identified in Attachment A-2 of this agreement. C. INPATIENT/OUTPATIENT SERVICES PROVIDED AT CCRMC 1. VANCHCS will furnish services as specified in the Fee Schedule, to CCRMC inpatients and outpatients when necessary, using CCRMC space and equipment at CCRMC, 2500 Alhambra Avenue,Martinez, California. 2. The Nuclear Medicine Department at CCRMC, consisting of the Imaging Room#3511 and Radiopharmacy and Room#3511, will be operated by the VANCHCS Nuclear:Medicine Department. In order to maintain appropriate licensing and accreditation by NRC, VANCHCS shall be granted exclusive administrative and operational control of this space, to include the direction and supervision of all personnel performing nuclear medicine studies and/or administering of radiopharmaceuticals under the contract. For the purposesof this contract, such space shall be considered to be under federal (VANCHCS)jurisdiction. 3. Administration of radioactive materials by VANCHCS in the Nuclear Medicine Department at CCRMC, will be accomplished under the VANCHCS Nuclear Regulatory Commission (NRC) licensing authority. Therefore, any personnel administering, or supervising the administration of isotopes to patients in the Nuclear Medicine Department at CCRMC, shall be in one of the following categories: a. Physicians - shall be listed on the VANCHCS NRC license. b. Technologists - shall be listed as a credentialed technologist on the VANCHCS, Nuclear Medicine, departmental roster. 4. Facilities Support: CCRMC will be responsible for all costs associated with the maintenance of the equipment and space used by VANCHCS at CCRMC. CCRMC will also be responsible for furnishing any utilities necessary for operation of the equipment and VANCHCS' uninterrupted use of the space and equipment. 5. Radiation SaLm: a. VANCHCS Radiation Safety Officer and Radiation Safety Committee will oversee Radiation Safety at VANCHCS OPC and CCRMC,Nuclear Medicine Departments during the term of this contract. VANCHCS will be responsible for all decommissioning activities at the CCRMC Nuclear/Medicine Department in accordance with NRC decommissioning requirements contained in 10 CRP, Parts 20 and 30. Nuclear Medicine Services Pae 13 b. CCRMC shall ensure that its staff and contractors, to include housekeeping, maintenance, engineering, security, and other personnel, will follow VANCHCS radiation safety guidance when in Nuclear Medicine Department at CCRMC, specifically when in the Nuclear Medicine Imaging Room or Radiopharmacy. b. Work hoursldays: a. Hourslbays: VANCHCS will make available a Nuclear Medicine Technologist and a Nuclear Medicine Physician to perform Nuclear Medicine inpatient procedures at CCRMC during normal work hours (between 7:30 a.m. and 5:00 p.m.), Monday through Friday, excluding Federal holidays as identified below. b. Call Back Services: If call back services are required during normal work hours, a VANCHCS Tecl-urologist or Physician will provide such services at CCRMC. After hours call back services will be the responsibility of CCRMC. Outpatient studies to be performed at CCRMC will need approval by the VANCHCS Nuclear Medicine Staff. c. Holida s: Federal holidays observed by VANCHCS are as follows: New Year's Day, Presidents Day, Martin Luther King's:Birthday, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans Day,Thanksgiving, Christmas. 7. Provision os�t�plies/radiopharmaceuticals: VANCHCS will provide all supplies and radiopharmaceuticals necessary for the performance of the procedures listed in the Fee Schedule, at CCRMC. S. Administrative support: VANCHCS will be responsible for transcription, filing and documentation of treatment for procedures performed at CCRMC. E. LIABILITY FOR DAMAGES 1. Liability for damages resulting from the official conduct of VANCHCS employees shall be governed by applicable federal laws, rules and regulations. Liability for damages resulting from the official conduct of VANCHCS' independent contractors or subcontractors shall be covered by their own liability or professional liability insurance. Such damages might include,but are not limited to, damage to or loss of equipment, accidents involving radioactive materials, damage to or loss of property, medical malpractice damages for personal injury or death and damage resulting from negligent management of the CCRMC nuclear medicine program. 2. Liability for damages resulting from the official conduct of CCRMC employees shall be governed by applicable state and local laws, rules and regulations and such damages will be covered by CCRMC's professional liability insurance. Liability for damages resulting from the official conduct of CCRMC independent contractors or subcontractors shall be covered by their own liability or professional liability insurance. Such damages might include, but are not limited to, damage to or loss of equipment, damage to or loss of property, medical malpractice damages for personal injury or death and damage resulting from negligence of CCRMC employees or subcontractors while in the Nuclear Medicine Department at CCRMC. Nuclear Medicine Services Page 14 3. The parties agree to meet and confer in good faith to resolve any disputes that may arise as a result of damages for which the cause or liability for such damages cannot be determined. F. OTHER CONTRACT REQUIREMIENTS 1, No ShowslAp2ointment Cancellation: If a patient does not show for a scheduled appointment, or cancels the appointment within too short a time frame (causing perishable items to require destruction), VANCHCS will invoice CCRMC for the actual cost of those perishable items that must be destroyed. 2. Efports: VANCHCS Nuclear Medicine Physicians will dictate reports, and VANCHCS transcription staff will prepare transcribed reports of patient studies performed at the VANCHCS UPC or at CCRMC. 3. Films: a. Copies of films (bone scans only) will be provided by VANCHCS for all CCRMC outpatients. I b. Inpatient films, will be maintained in the CCRMC Radiology File Room, or in the patient's chart. 3, Procedure Turn-around-time: Transcribed reports for CCRIMC patients will be available from the VANCHCS central transcription area within 8 hours of completion of procedures, performed during regular work hours. When necessary transcribed reports for"Stat"patients will be faxed to CCRMC within 2 hours of completion. 4. Courier Service: CCRMC will provide regular courier service, to pick-up reports of outpatient procedures performed at the VANCHCS UPC. If reports are required by CCRMC prior to pick up by courier, CCRMC will contact the VANCHCS Nuclear Medicine Department to request that copies of reports be faxed to CCRMC. 5. Medical StqffMembership/Courtesy Privileges: a, VANCHSC Nuclear Medicine physicians, and other VANCHCS personnel will be privileged by VANCHCS for all procedures and medical care performed within the Nuclear Medicine Department at CCRMC as well as at the VANCHCS UPC, Martinez. b. VANCHCS physicians will secure courtesy staff privileges at CCRMC for care provided outside of the CCRMC Nuclear Medicine Department; for example, ordering pregnancy tests and chest x-rays. 6, Transportation: Transportation for all CCRMC referred to the VANCHCS UPC for outpatient treatment, shall be arranged in accordance with CCRMC policies. All such transportation costs shall be the responsibility of CCRMC. =Nuclear Medicine Services Pae 15 7. El ibility for treatment: CCRMC patients presenting to the VANCHCS OPC without prior authorization by a CCRMC physician will not be treated. 8. Emergency Treatment. a. Patients treated at VANCHCS OFC: In the event patients experience a life-threatening emergency while being treated at VANCHCS OPC,necessary immediate life support will be provided, and VANCHCS will activate the 911 system. The attending VANCHCS OPC physician will immediately contact the CCRMC referring physician. If the CCRMC patient requires transportation by ambulance, VANCHCS OPC may make ambulance arrangements, but CCRMC shall be responsible for payment of all invoices for such transportation. b. Patients treated at CCRMC: In the event patients experience a life'-threatening emergency while being treated in the Nuclear Medicine Department at CCRMC, standard hospital code procedures shall be followed. 9. Phvsical AssistancetTranslating: CCRMC inpatients or outpatients requiring physical assistance shall be accompanied by a CCRMC nurse or other medical staff qualified to meet the needs of patient. Patients requiring translation must be accompanied by a CCRMC staff member, relative or friend who is capable of providing patient assistance. 10. 'Jedical Records: a. Patient records for services provided by VANCHCS under this contract shall be governed by the Privacy Act, Title 5 U.S.C. 552a. In addition, for the purposes of VAlNCHCS' records access and patient confidentiality this contract shall also be subject to Title 38 U.S.C. 5701, 5705, and 7362. Therefore, CCRMC may have access, as would other appropriate components of VANCHCS, to patient medical records including patient treatment records pertaining to drug and alcohol abuse, HIV, and sickle cell anemia,to the extent necessary to perform its contractual responsibilities. However, like other components of the Department of Veterans Affairs, and notwithstanding any other provisions of the contract, CCRMC is restricted from making disclosures of VANCHCS records, or information contained it such records, to which it may have access, except to the extent that CCRMC has received explicit disclosure authority from VANCHCS. CCRMC is subject to the same penalties and liabilities for unauthorized disclosures of such records as VAT CHCS. b. The records referred to herein, shall be and remain the property of VANCHCS, and shall not be removed or transferred from VANCHCS except in accordance with U.S.C. 551 a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of Claimants Records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 570:5 (Confidentiality of Medical {:duality Assurance Records, 38 U.S.C. 7332 (Confidentiality of Certain Medical Records) and federal laws, rules and regulations. Subject to applicable federal confidentiality or privacy laws, CCRMC or their designated representatives of federal regulatory agencies having jurisdiction over CCRTMC, may have access to VANCHCS' records, at VANCHCS' place of business on request during normal business hours, to inspect and review and make copies of such records. " Nuclear Medicine Services Pae 16 11. Imaging Equipment Ownership: CCRMC agrees to make a one-time lump sum payment, as identified in the Fee Schedule contained herein, to VANCHCS, for purchase of a computerized imaging system that will be used by VANCHCS, to transfer images between facilities when providing services under this contract. Upon completion of the contract, VA will retain complete ownership of such equipment, at no additional cost to VA or CCRIMC. F. PRIORITY FOR VETERANS a. VANCHCS reserves the right to deny provision of service to patients referred for treatment under this contract where space or service is unavailable, or if provision of service to such patients would deny or delay care to eligible veterans. VANCHCS agrees to notify CCRMC of any changes in availability of services specified in this contract. b. Determinations by VANCHCS concerning the availability of services and resources to be provided by the VANCHCS pursuant to this contract are conclusive, binding on the parties to this contract and non-reviewable. The decision of VANCHCS not to provide any service or resource called for by this contract because of its unavailability does not constitute a breach of the contract and is not considered a cause for termination of the contract in whole or in part. G. CONTRACT MODIFICATIONS 1. Any oral statement or representation by any representative of the Government, changing or supplementing the contract or any condition thereof, is unauthorized and shall confer no right upon CCRMC or obligation upon VANCHCS. Furthermore, no interpretation of any provision of the contract, including applicable performance requirements, shall be binding on the VANCHCS unless furnished or agreed to, in writing, by the VANCHCS Contracting Officer or his/her designated representative. 2. The services described herein may be changed by written modification to this contract. The modification shall be prepared by the VANCHCS Contracting Officer. All modifications shall be in writing and, except for termination, shall have the written consent of bath, an authorized representative of CCRIVIC and the VANCHCS Contracting Officer. H. TERM OF THE CONTRACT 1. Contract Term: This contract will take effect on the"effective date"set forth in Block 31(c), Page 1, Solicitation/Contract/Order for Commercial Items of this contract and as set forth in the Fee Schedule. The contract will continue for a period of one(1) year from the date of contract award or until terminated. 2. Otp ions: The contract contains four one-year options for renewal at the prices specified in the Fee Schedule. Options may be exercised solely at the discretion of VANCHCS, and such options will be exercised in accordance with FAR Clause 52.217-9. The exercising of options under this contract will be done by written modification to the contract. Prior to becoming effective, the modification must be signed by an authorized representative of CCRMC and the VANCHCS Contracting Officer. Nuclear Medicine Services Pae 17 3. Termination: The contract may be terminated by either party subject to a one-hundred twenty(120) day written notice to the other party. In such cases, CCRMC will be responsible for payment for all services rendered prior to termination, and no further liability will exist on the part of VANCHCS after said date of termination. 4. Right afFirst Refusal: If CCRMC decides for any reason, to solicit a new contract prior to expiration of, or termination of this agreement, VANCHCS shall be granted First Right of Refusal to provide Nuclear Medicine Services to CCRMC under such an agreement. I. PAYMENT 1. Payment of sums due the VANCHCS under this agreement shall be made by CCRMC monthly in arrears. 2. VANT CHCS will invoice CCRMC, on VA Optional Form 1114, Bill for Collection, for services provided in accordance with the Fee Schedule contained herein. 3. Each invoice rendered by VANCHCS to CCRMC will contain the following: a. Date(s) the services were performed. b. Name of patient. c. Social Security Account Number or Patient ID Number. d. Type of services provided (identified by appropriate CPT Code) e. Unit cost of services provided. f Total cost of services provided. 4. CCRMC shall forward payment for services rendered under this contract to the address identified in Block 18(a), Page 1 of this contract. 5. Notwithstanding any other provision of this contract, unless paid within 30 calendar days from the date of receipt of the first written demand, all mounts that become payable by CCRMC to the VANCHCS under this contract shall bear simple interest, at the rate which has been established by the Secretary of the Treasury as provided in Section 12 of the Contract Disputes Act of 1978 (Public Law 95-563), from the date of first written demand, until paid. 6. Restrictions on Third Party Billing. a. VANCHCS will not be responsible for invoicing any third party for services provided under this agreement, nor will VANCHCS be responsible for collecting co-payments from CCRMC patients. b. VANCHCS hereby agrees, that in no event, including, but not limited to, nonpayment by CCRMC, CCRMC's insolvency, or breach of this Agreement, will VANCHCS bill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against a CCRMC patient or persons other than CCRMC acting on a patient's behalf for Nuclear Medicine Services Pae 18 services provided pursuant to this agreement. VANCHCS agrees that this provision will survive the termination of this Agreement, regardless of the cause, giving rise to termination and will be construed to be for the benefit of the patient, and this provision supersedes any oral or written contrary agreement now existing or hereafter entered into between VANCHCS and CCRMC patients or persons acting on their behalf. J. DISPUTES 1. All disputes arising or relating to this contract shall be resolved in accordance with the following: a. As used herein, "claim,"means a written demand or assertion by one of the parties seeking as a legal right, the payment of money, adjustment or interpretation of contract terms, or other relief, arising or relating to this contract. b. Any controversy or claire arising out of or relating to this contract on behalf of CCRMC shall be presented initially to the VANCHCS Contracting Officer for consideration. The VANCHCS will furnish a written reply on the claim to CCRMC. c. In the event the parties cannot amicably resolve the matter, any controversy or claim arising out of or relating to this contract, or breach thereof, shall be settled by arbitration at the Department of Veterans Affairs (VA) Board of Contract Appeals in accordance with procedures set forth in the Alternative Means of Dispute Resolution, VA Directive 7433 and Administrative Disputes Resolution Act of 1996, and judgment upon any award rendered by the Arbitrator(s) may be entered into any Court having jurisdiction thereof: d. Any claim by CCRMC must be presented no later than 30 calendar days after cancellation or final expiration of the contract, whichever occurs earlier, otherwise CCRMC forfeits its right(s) to relief K. GOVERNING LAW Notwithstanding any other parts of this contract, this contract shall be governed, construed, and enforced in accordance with Federal law. L. COMMERCIAL ADVER'T'ISING CCRMC shall not advertise or use any marketing material, logos, trade names, service marks, or other material belonging to the Department of Veterans Affairs or VANCHCS without the consent of VA`�,`CHCS. M. VANCHCS REPRESENTATIVES 1. VANCHCS will assign a Contracting Officer who will be authorized to act on behalf of VANCHCS in the following capacity: Make changes to the contract provisions, including changes involving increases or decreases in contract price, and no cost changes, making changes Nuclear Medicine Services Page 19 to the scope of the contract, requiring extras other than stated in the contract, extending the time established in the contract, terminating the contract,requiring extras other than stated in the contract, extending the time established in the contract, terminating the contract in whole or in part, or conducting price or cost negotiations for proposed contract changes. A VANTCHCS Contracting Officer is the only official who can bind the VANCHCS. 2. The Contracting Officer reserves the right to designate representatives to act for him/her in furnishing technical guidance and advice, or to.generally oversee the technical aspects of the services provided under this contract. Such designation will be in writing and will define the scope and limitations of the designee's authority. A copy of the designation will be furnished to CCRMC upon contract award. N. AUTHORITIES This contract is a Sharing Agreement awarded pursuant to 38 U.S.C. 8153. O. RELATIONSHIP BETWEEN THE PARTIES The relationship of the parties to this Agreement is not and shall not be construed or interpreted to be a partnership,joint venture or agency. The relationship of the parties is an independent contractor relationship. ,* UNMED STATES iCLEAR REGULATORY COMMISSION wREGION IV � Walnut Creek Field Office 1450 Marla Lane, Suite 300 AT TACHMEYT A-1 Walnut Creek,C &o+mia 94596--5868 Page 1 of 9 ;QEC 17 07 Department of Veterans Affairs Northern California Health Care System „ ATTN: John E. Hempel Acting Director 2300 Contra Costa Blvd., Suite 440 ` Pleasant Hili, California 94525-3951 U.BJECT. LICENSE AMENDMENT Please find enclosed amendment 77 to License No. 04-02955-02. You should review this license carefully and be sore that you understand all conditions. If you have any questions, please contact me at 510-975-0245. NRC expects licensees to conduct their programs with meticulous attention to detail and a high standard of compliance. Because of the serious consequences to employees and the public which can result from failure to comply with NRC requirements, you must conduct your program involving radioactive materials in accordance with the conditions of your NRC license, representations made in your license application, and NRC regulations. In particular, note that you must. 1. Operate in accordance with NRC regulations 10 CPR Part 19, "'Notices, Instructions and Reports to Workers: Inspection and Investigations," 10 CFR Part 20, "Standards for Protection Against Radiation," and other applicable regulations. 2. Possess radioactive material only in the quantity and farm indicated in your license. 3. Use radioactive material only for the purpose(s) indicated in your license. 4. Notify NRC in writing of any change in mailing address Ino fee required if the location of radioactive material remains the same). 5. Request and obtain written NRC consent before transferring your license or any right thereunder, either voluntarily or involuntarily, directly or indirectly, through transfer of control of your license to any person or entity. A transfer of control of your license includes not only a total change of ownership, but also a change in the controlling interest in your company whether it is a corporation, ',partnership, or other entity. to addition, appropriate license amendments must be requested and obtained for any other planned changes in your facility or program that are contrary to your license or contrary to representations made in your license application, as well as supplemental correspondence thereto, which are incorporated into your license. A license fee may be charged for the amendments if you are not in a fee- exempt category. Department of Veterans Affairs -2- N. Calif. Health Care System 6. Maintain in a single document decommissioning records that have been certified for completeness and accuracy listing all the following items applicable to the license: Onsite areas designated or formerly designated as restricted areas as defined in 1-0 CFR 20.3(a){14) or 20.1003. • Onsite areas, other than restricted areas, where radioactive materials in quantities greater than amounts listed in Appendix C to 10 CFR 20.1001-20.2401 have been used, possessed, or stored. • Onsite areas, other than restricted areas, where .spills or other unusual occurrences involving the spread of contamination in and around the facility, equipment, or site have occurred that required reporting pursuant to 10 CFR 30.50(b}(1) or ibl(4), including areas where subsequent cleanup procedures have removed the contamination. Specific locations and radionuclide contents of previous and Current burial areas within the site, excluding radioactive material with half-lives of 10 days or less, depleted uranium used only for shielding or as penetrators in unused munitions, or sealed sources authorized for use at temporary job sites. * Location and description of all contaminated equipment involved in licensed operations that is to remain onsite: after license termination. 7. Submit a complete renewal application with proper fee, or termination request at least 30 stays before the expiration date on your license. You will receive a reminder notice approximately 90 days before the expiration date. Possession of radioactive material after your license expires is a violation of NRC regulations. 8. Request termination of your license if you plan to permanently discontinue activities involving radioactive material. You will be periodically inspected by NRC. Failure to conduct your program in accordance with NRC regulations, license conditions, and representations made in your license application and supplemental correspondence with NRC will result in enforcement action against you. This could include issuance of a notice of violation; imposition of a civil Department of Veterans Affairs -3- N. Calif. health Care System penalty; or an order suspending, modifying, or revoking your license as specified'in the "General Statement of Policy and Procedure for NRC Enforcement Actions" (Enforcement Policy), 60 FR 34381, June 30, 1995. Thank you for your cooperation. Sincerely, . r .lames L. Montgomery Senior Health Physicist Materials Branch Docket: 030-01223 License: 04-02956-02 Control: 572555 Enclosures: As stated cc w/enclosure: Charles Barnett, M.D. Nuclear Medicine Dept. 150 Muir road Martinez, California 94553 ..........a4 > i W »,('.0 i slid sat fir,_� .riCi iAt ut'(JAt tat ,r, — �[+'tai {Yr �ltt-l*r �1r.<' 'Esc< gar.; ,.. ,w.-.«. >au- -s=l"s�.r IK( )rt vu )x+ W uec�7[r 1Yr S* Yr NRC l=C7RM 374 s.NUCLEAR REGULATORY COMMISSION PAGE. � IT•g+> 77" PACES e`niimen`�NST;` MATERIALS LICENSE Pursuant to the Atomic Enemy Act of 1954.as amended,the Entergy Reorganization Act of 1974(public Law 93438),and Title 10,Code of Federal Regulations.Chapter 1.Pans 30,3 t.32,33,34.35,36,39.40.and 70,and in reliance on statements and representations heretofore made by the licensee,a license is hereby issued authorizing the licensee to receive,acquire,possess,and transfer byproduct,source,and special nuclear material designated below; to use such material for the purposes?and at the place(s)designated below; to deliver or transfer such material to persons authorized to receive it in accordance with the regulations of the applicable Part(s).This license shall be deemed to contain the conditions specified in Section 183 of the Atomic Energy Act of 1954,as amended, and is subject to all applicable rules, regulations, and orders of the Nuclear Regulatory Commission now or hereafter in effect and to any conditions specified below. „ - Licenser; In accordance with letter dated September 12, 1997, 1 Department of Veterans Affairs 3.LicenseNumber 04-02956_02 is amended Northern California Health Care System in its entirety to read as' follows: " z. 2300 Contra Costa Blvd., Suite. 440 i Pleasant Hill , California 94523-3961 4.Expiration Date May 31, 2002 5. Docket or 030-01223 Reference No. t 6. Byproduct,Source,and/or 7.Chemical and/or Physical 8. Maximum Amount that Licensee Special Nuclear Material Form May Possess at Any One Time < Under This License i A. Any byproduct A. Any A. As needed material identified radiopharmaceutical in 10 CFR 35.100 identified in 10 CFR 35.100 B. Any byproduct B. Any B. As needed material identified radiopharmaceutical in 10 CFR 35.200 identified in 10 CFR 35.200 C. Any byproduct C. Any C. 3.3 curies (no Material identified radiopharmaceutical single container to in 10 CFR 35.300 identified in exceed 300 10 CFR 35.300 millicuries) D. Cesium-137 D. Sealed source D. 100 millicuries contained in J. L. Shepherd & ; Associates model 28-5 single source beam calibrator E. Iodine-131 E. Iodide E. 20 millicuries F. Iodine-125 F. Any F. 100 millicuries G. Rubidium=-86 C. Any G. 10 millicuries H. Hydrogen-3 H. Prelabeled organic H. 200 millicuries chemicals I. Carbon-14 I. Any 1. 100 millicuries µ J: Phosphorus-32 J. Any J. 60 millicuries NAC FORM 374A U.S.NUCI'=AR REGULATORY COMIMSSION PAGE 2 OF � PAGES (7- ) se NunIbCr 02956-02 MATERIALS LICENSE Docket or R� '=`(� � SUPPLEMENTARY SHEET Amendment No. 77 K. Chromium-51 K. Any K. 60 -millicuries L. Sulfur-35 L. Any L'. 40 millicuries rK M. Technetium-99m M. Any M 200 millicuries N. Calcium-45 N. Any N. 40 millicuries 0. Chlorine-36 0. Any 0 40 millicuries 9. Authorized. use A. Medical use described in 10 CFR 35.100. B. Medical use described in 10 CFR 35.200. C. Medical use described in 10 CFR 35.300. D. Standard for instrument calibration. E. through 0. In vitro studies; animal studies. O 10. A. Licensed material may be used at the licensee's facilities located at the Department of Veterans Affairs Northern California System of Clinics, 150 Muir Read, Martinez, California. B. Licensed material identified in items 6.A, 6.8 and 6.0 may also be used at the Contra Costa Regional Medical Center, Rooms 3510 and 3511, 2500 Alhambra Avenue, Martinez, California. For item 6.0 material , no single patient dose shall exceed 33 millicuries. 11. The Radiation Safety Officer for this license is Charles A. Barnett, M.D. i J f 1 '1 ,nm ax TWK—Ir ry YV Ir nr }�(i m nr ry Tv ry 7r 7v Trt nr "r 71" 1TT S (9RC FORM 374A U.S.NUC;EAR REGULATORY COMOSSION PAGE 3 7the ; PAGES bby� Licrnse NnsU4—Uz956-02 MATERIALS LICENSE Doc s or rt�mSUPPLEMErNTARY SHEET Amendment No. 7712. Licensed material listed in Item 6 above is authorized for use by, ar u supervision of, Ahe following individual(s) for the materials and uses indicated: Authorized Users Material and Use Mukesh J. Joshi , M.D. 10 CFR 35.100, 35.200, 35.300 In vitro studies animal studies Albert Weinshelbaum, M.O. 10 CFR 35.100, 35.200, 35.300 In vitro studies • animal studies Charles A. Barnett, M.D. 10 CFR 35.100, 35.200, 35.300 In vitro studies animal studies Paul A. Farrar, M.D. 10 CFR 35.100, 35.200, 35.300 In vitro studies animal studies Ildiko Sandford, M.D. In vitro studies animal studies Robert Noth, M.D. In vitro studies animal studies Edwin M. Leidholdt, Ph.D In vitro studies, Cesium 137 for instrument calibration Ingrid Kwee, M.D. In vitro studies animal studies Robert J. Liebig, M.D. 10 CFR 35.100 and 35.200 a 13. In addition to the possession limits in Item 8, the licensee shall further restrict the possession of licensed material to quantities below the minimum limit specified P in 10 CFR 30.35(d) for establishing decommissioning financial assurance. E E � E y�y� �. E 1NRC FORM 37dA , U.S.NUC,^an REGULATORY COMMISSION PACE 4 of 6 PJu3ES L'+rxrut`""�-02956-02 � r A x MATERIALS LICENSE or RgwC17 SUPPLEMENTARY SKEET x Amendment No. 77 14. - The licensee is authorized to hold radioactive material with a' physical half-Iife of less than 65 days for decay-in-storage before disposal in ordinary trash provided: , A. Radioactive waste to be disposed of in this manner shape held for decay a minimum of 10 half-lives. B. Before disposal as ordinary trash, byproduct material shall be' surveyed at the container surface with the appropriate survey meter set on its most sensitive scale and with no interposed shielding to determine that its radioactivity ' cannot be distinguished from background. All radiation labels shall be removed or obliterated. C. A record of each disposal permitted under this License Condition shall be retained for three years. The record must include the date of disposal , the date on which the byproduct materiae was placed in storage, the radionuclides ' disposed, the survey instrument used, the background dose rate, the dose rate measured at the surface of each waste container, and the name of the individual who performed the disposal . 15. A. Sealed sources and detector cells shall be tested for leakage and/or contamination at intervals not to exceed 6 months or at such other intervals as specified by the certificate of registration referred to in 10 CFR 32.210. B. Notwithstanding Paragraph A of this Condition, sealed sources designed to emit alpha particles shall be tested for leakage and/or contamination at intervals not to exceed 3 months. C. In the absence of a certificate from a transferor indicating that a leak test has been made within 6 months prior to the transfer, a sealed source or detector cell received from another person shall not be put into use until tested. D. Sealed sources need not be leak tested if: (i) they contain only hydrogen-3; or (ii) they contain only a radioactive gas; or (iii) the half-life of the isotope is 30 days or less; or (iv) they contain not more than 100- microcuries of beta and/or gamma emitting material or not more than 10 microcuries of alpha emitting material; it *—m Tut 7F Tv m nct FF'm mr-w m m m err NRC FORM 374A U.S.NUCl c 4R REGULATORY COMMISSION PAGE � OF � PAGES a-s.rLkmv N"��U,956-02 MATERIALS LICENSE Docket or SUPPLEMENTARY SHEET Amendment No. 77 15. (Continued) (v) they are not,,designed to emit alpha particles, are in storage, and are not being used. However, when they are removed from storage for use or- transferred to another person, and have not been tested within the required leak test interval , they shall be tested before use or transfer. No sealed source or detector cell shall be stored for a period of more than 10 years without being tested for leakage and/or contamination. E. The leak test shall be capable of detecting the presence of 0.005 microcurie of radioactive material on the test sample. If the test reveals the presence of 0.005 microcurie or more of removable contamination, a report shall be filed with the U.S. Nuclear Regulatory Commission in accordance with 10 CER 30(b)(2) , and the source shall be removed immediately from service and decontaminated, repaired, or disposed of in accordance with Commission regulations. The report shall be filed within 5 days of the date the leak test result is known with the U.S. Nuclear Regulatory Commission, Region 1Y, 611 Ryan Plaza Drive, Suite 400, Arlington, Texas 76011, ATTN: Director, Division of Nuclear Materials Safety. The report shall specify the source involved, the test results, and corrective action taken. F. Tests for leakage and/or contamination shall be performed by the licensee or by other persons specifically licensed by the Commission or an Agreement State to Perform such services. 16. The licensee shall conduct a physical inventory every three (3) months to account for all sources and/or devices received and possessed pursuant to 10 CFR 35.57, and every six (6) months for all other sources and or devices. 17. The licensee is authorized to transport licensed material only in accordance with the provisions of 10 CFR Part 71, "Packaging and Transportation of Radioactive Material". 18. Sealed sources containing licensed material shall not be opened or sources removed from source holders by the licensee. a � LiI7.�L�m TSC m TSC-m m m m � ,.� •.• ,•-• ••. .�, ••. •,.• .... -... — __ __ _._ .... .,.. .... .... _.. .._. --'' .tcc uc.sic. � 1 U.S.NUC7 REGULATORY COMMISSION �aMx7aa pace � OF 6 pates (7-94) Lirewtou r-02956-02 MATERIALS LICENSE afelet or a15V SUPPLEMENTARY SHEET Amendment No. 77 i f x i _19. Except as specifically provided otherwise in this license, the licensee shall conduct its program in accordance with the statements, representations, and procedures contained in the documents, including any enclosures, listed below, except for minor changes in the medical use radiation safety procedures as provided in 10 CFR 35.31. The Nuclear Regulatory Commission's regulations shall govern unless the statements, representations, and procedures in the licensee's application and correspondence are more restrictive than the regulations. J� A. Application dated Marcel 5, 1991 B. Letter dated January 30, 1992 C. Letter dated February 26, 1992, except Item 10.16 D.* Letter dated March 10, 1992 E. Letter dated March 23, 1992 F. Letter dated April 29, 1992 G. Letter dated May 7, 1992 H. Letter dated May 29, 1992 I. Letter dated June 12, 1992 J. Letter received September 2, 1992 K. Letter dated November 24, 1992 L. Letter dated July 12, 1993 M. Letter dated January 10, 1994 N. Letter dated October 18, 1993 0. Letter dated February 28, 1994 P. Letter dated October 14, 1994 Q. Letter dated March 6, 1995 R. Letter dated August 1, 1995 S. Letter dated February 14, 1996 T. Letter dated September 30, 1996 U. Letter dated March 28, 1997 V. Letter dated April 28, 1997 W. Letter dated June 23, 1997 X. Letter dated September 12, 1997 Y. Letter dated November 25, 1997 FOR THE U.S. NUCLEAR REGULATORY COMMISSION f DEC 17 V9!7 Date g erza s rant Region IV, WCFO Walnut Creels, California 94596 rq ir- r t.e ATTACHMENT A-2 Page I of I REFERRAL/SCHEDULING PROCEDURES The following procedures will be used for scheduling CCRMC outpatients to be treated at the y VANCHCS OPG-as well as CCRMC inpatients and outpatients to be treated at CCRMC by VANCHCS. 1. CCRMC Department of Radiology will call the VANCHCS Nuclear Medicine Department at (925) 372-2124, to schedule CCRMC patients for inpatient or outpatient procedures as listed in the Fee Schedule contained herein. a . "Routine" inpatient studies shall be: (1) scheduled at least one day in advance (2) performed between the hours of 8:00 a.m. and 12:00 p.m. b. "Stat"inpatient studies: shall be: (1) scheduled as soon as requirement is known (2) will be performed by 5:00 p.m. the same day request is made if VANCHCS is notified within a timely manner 2. Once appointment has been made with VAIINCHCS, CCRMC will notify the patient of the appointment date and time. Prior to the appointment time, CCRMC will fax a written referral to the VANCHCS Nuclear Medicine Department. 3. When CCRMC inpatients are referred for procedures, CCRMC shall inform. the VANCHCS Nuclear Medicine Department of the patient's condition. This notification shall be made prior to the appointment time. 4. CCRMC inpatients shall bring an inpatient chart when presenting for treatment at the CCRMC Nuclear Medicine Department or VANCHCS OPC. VANCHCS staff will document services provided in the inpatient chart. _.. _... _......_. _._.. .. .. .. ........... . ..... .._... .......... ........................................... TO: BOARD OF SUPERVISORS FROM: William Walker, M.D. , Health Services Director ` Contra By: Ginger Marieiro, Contracts Administrator Costa DATE: August: 18, 1998 County SUBJECT: Approval of Contract Amendment Agreement #24-941-1 with True to Life Chi.1dran ' s Services SPECIFIC REQUEST($)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION(S) : Approve and authorize the Health Services Director, or his designee (Donna Wigand) , to execute on behalf of the County, Contract Amendment Agreement #24-941.-1 with True to Life Children' s Services, effective March 9, 1998 to amend Contract #24-941, to remedy the mutual mistake of the County and Contractor and to accurately reflect the intent of the parties. FISCAL IMPACT: Funding for this Contract is included in the Health Services Department ' s budget, and the source of funding is County/Realignment 100. . BACKGROUND/REASON(S) FOR RECOMMENDATION(S) : On May 12, 1998, the Board of Supervisors approved. Contract #24-941 with True to Life Children' s Services, for the period from March 9, 1998 through June 30, 1998, for the provision of intensive day treatment and mental health services for severely emotional Disturbed Children (SED) . True to Life Children' s Services is an alternative to hospitalization at State hospitals . ' Due to the mutual mistake of the parties, the Contract did not accurately reflect the intent of the parties which was that the Contract Payment Provisions include two separate rates, as follows : $137 per day for Medi-Cal beneficiaries and $91 per day for non Medi-Cal clients . Approval of Contract Amendment Agreement #24-941.-Twill reform the Contract to remedy the mutual mistake of the County and the Contractor, and to accurately reflect the intent of the parties, so that the Contractor can be properly reimbursed for services provided to County' s patients . CONTINUED N TTAC MENT: YF S SIGNATUR gL��-.e.4-2-!" RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER ACTION OF BOARD ON__ _ SePtWiEr 1, 19% APPROVED AS RECOMMENDED X VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT � I AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED PHIL BA CHELOR,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR Contact Person: Donna Wigand (313-6411) CC: Health Services(Contracts) Risk Management Auditor ControllerBY � � - DEPUTYContractor F: REMISED Azo TO: BOARD OI' SUPERVISORS '�✓�Cltra FROM: John Cullen, Director r Social Service Department ` - � : Costa _• August 18, 1998 Countyfir. �` !LATE: ,rrA itt APPROVE and AUTHORIZE the Social Service Director, or designee, to EXECUTE Contract SUBJECT:#21-443-1 with Mr. Paul Buddenhagen for technical assistance, and program monitoring and evaluation services. SPECIFIC REOUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: APPROVE and AUTHORIZE the Social Service Director, or designee, to EXECUTE Contract #21-443-1 with Mr. Paul Buddenhagen for the period of October 1, 1998 through September 30, 1999 in the amount of$52,000 for technical assistance, and program monitoring and evaluation services for Child Welfare programs. FINANCIAL IMPACT: The $52,000 of funding for Contract #21-443-1 is divided among three different funding sources: the Federal Family Preservation and Support Program; the Kinship Support Services Program grant, awarded in accordance with the provisions of AB 1193, Chapter 794, Statutes of 1997; and the Child Welfare Services Administrative allocation. The total County allocated share is 3% ($1,560), with State and Federal allocated share at 97% ($50,440). CHILI?REN'S IMPACT STATEMENT: The work to be completed under this contract will expand the development of the Federal Family Preservation and Support Program and the State Family Preservation Program in this county so that kinship care can be strengthened and the interests of children and their extended families will be enhanced. In this respect, this contract is directly applicable to all 5 community outcomes because the basic protection of children is essential to ensuring: 1) Children Ready for and Succeeding in School; 2) Children and Youth Healthy and Preparing for Productive Adulthood; 3) Families that are Economically Self Sufficient; 4) Families that are Safe, Stable and Nurturing; and 5) Communities that are Safe and provide a High Quality of Life for Children and Families. (continued) CONTINUED ON ATTACHMENT: YES SIt.,NAYURE: `�-', '_AAA'_ .:_RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF 130ARD COMMITTEE APPROVE OTHER SIGNATURE(SS: .)o_� ACTION OF BOARD ON_ September . 1298 — --APPROVED AS RECOMMENDED _zY� gum VOTE OF SUPERVISORS 1 HEREBY CERTIFY THATTHIS IS A TRUE _K-UNANIMOUS(ASSENT NnnP ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED r Contact: PHIL SAT HELOR,CLERK OF THE BOARD OF Cc: Contact: Dr'3nna Fabella, 313-1583 SUPERVISORS AND COUNTY ADMINISTRATOR SOCIAL SERVICE (CONTRACTS UNIT) COUNTY ADMINISTRATOR AUDITOR-CONTROLLER BY_ --•'� '" DEPUTY CONTRACTOR page 2 BACKGROUND/SUMMARY: During the past several years contracted Child Welfare Service programs, which enhance the core mandated services, grew substantially both in terms of the number of community-based providers and in terms of the availability of allocated funding. The services funded under Contract #21443- 1 will be an expansion of existing technical assistance, and program monitoring and evaluation services which have reached their capacity. The services delivered under this contract will assist SSD staff in developing and improving community needs assessment, identifying and establishing measurable program outcomes, managing the public bid process, managing contractors, and evaluating contractor performance.