Current through Register Vol. 56, No. 24, December 18, 2024
(a)
Contract eye physicians shall provide the Commission with a copy of his or her
current State of New Jersey medical or optometric license on an annual
basis.
(b) Contract eye physicians
shall provide the Commission with a copy of the face sheet of their malpractice
carrier with expiration date on an annual basis.
(c) Contract eye physicians shall have a
current State of New Jersey W-9 Questionnaire.
(d) Contract eye physicians shall abide by
the eye screening protocols outlined in
N.J.A.C.
10:94-3.7, 3.8, and 3.9, which have been
approved by the agency's medical consultant.
(e) Contract eye physicians shall fill out a
vendor rate schedule every State fiscal year and submit it to the Commission's
Coordinator of Project BEST Services.
1. The
vendor rate schedule shall include the doctor's name, address, agency name,
contract number, Federal I.D. number, medical/optometric license number, and
the date of submission.
i. The rate per
session for general screening shall be $ 300.00 per session.
ii. The rate per session for specialized
screening shall be $ 350.00 per session.
(f) Contract eye doctors shall fill out an
Open Purchase of Service Vendor Agreement (Vendor Agreement) every State fiscal
year and submit it to the Commission's Coordinator of Project BEST Services.
1. The Vendor Agreement shall include the
doctor's name, agency location, contract number, and contract period.
2. The Commission will reimburse contract eye
doctors at the rate specified in the vendor rate schedule at (e)1 above.
i. Reimbursement is subject to legislative
appropriations.
3.
Contract eye doctors are prohibited from imposing a fee on persons served
pursuant to this section, other than those fees described in the New Jersey
Comprehensive Annual Services Program plan.
| OPEN PURCHASE OF SERVICE |
| VENDOR AGREEMENT |
| ON-SITE EYE SCREENING UNIT |
| MIGRANT EYE SCREENING PROGRAM |
| DIABETIC EYE DISEASE DETECTION PROGRAM |
| DOCTOR
___________________________________________________ |
| AGENCY LOCATION
________________________________________ |
| CONTRACT NUMBER
_______________________________________ |
| CONTRACT PERIOD
________________________________________ |
AGREEMENT between the signatory provider (hereinafter
"provider") and the Commission (hereinafter "Commission") for the provision of
services.
The provider hereby agrees to provide services as described
in N.J.A.C. 10:94-3.10 to persons
participating in an eye screening program sponsored by the Commission, and the
Commission agrees to purchase such services under the following terms and
conditions:
1. STATE APPROVAL AND
CERTIFICATION. The provision of services under this Agreement is contingent
upon the Commission's prior evaluation and approval of the operations of the
provider.
2. CONTINUING APPROVAL.
The provider shall comply with all State and/or Federal standards, including
such amended or additional requirements, as may be applicable to the delivery
of services under this Agreement. Provider agrees to comply with all Federal,
State and local laws, rules and regulations including specifically, but not
limited to, the requirements specified for fiscal, life/safety, and program
responsibility, billing, records, controls, reports and monitoring procedures.
In addition, the provider shall provide services to program participants in
accordance with generally accepted standards of professional quality and those
set forth in the Commission's Evaluation Report.
3. DOCUMENTATION, BOOKS, RECORDS AND
ACCOUNTS. The provider shall furnish such documentation at the Commission may
require in order to determine the proper amount of payment. In addition, the
provider shall make available for inspection, its books, records and account to
such parties as the Commission or the Departments of Human Services, Health or
Education. Said books, records, and accounts shall be retained by the provider
in accordance with the requirements of Part 74 of Title 45 of the Code of
Federal Regulations.
4.
NON-DISCRIMINATION. The provider shall make available and provide services
without regard to race, color or national origin. The provider will abide by
the Federal Civil Rights Act of 1964, as amended and the New Jersey Law Against
Discrimination, regulations thereunder, and Section 504 of the Rehabilitation
Act of 1973.
5. DISCLOSURE OF
CLIENT INFORMATION. The provider shall safeguard and treat as confidential,
information concerning persons participating in a Commission sponsored program
in accordance with the requirements of Title 45 of the Code of Federal
Regulations, Section 205.50.
6.
RATE OF PAYMENT. The Commission, upon receipt of proper documentation, shall
pay the provider at the rate specified in the Vendor Rate Schedule of this
agreement and made a part hereof.
7. FEES. The provider will impose no fees on
persons covered under the Agreement other than those described in the New
Jersey Comprehensive Annual Services Program plan.
8. SUBCONTRACTS. Subcontracts permitted by
the Agreement shall be subject to the requirements of this Agreement and the
provider is responsible for the performance of any subcontractor.
9. INDEMNIFICATION. The provider shall be
solely responsible for and shall keep, save and hold the State of New Jersey
harmless from all claims, loss, liability, expenses or damage resulting from
all mental or physical injuries or disabilities, including death to employees
of the provider or recipients of the provider's, or to any other person, or
from any damage to any property sustained in connection with the delivery of
the provider's services which results from any acts or omissions, including
servants or independent contractors, or from the provider's failure to provide
for the safety and protection of its employees, whether or not due to
negligence, fault or default of the provider. The provider's liability under
this Agreement shall continue after the termination of the Agreement with
respect to any liability, loss, expense or damage resulting from acts occurring
prior to termination.
10.
REIMBURSEMENT. Reimbursement by the Commission under this Agreement is subject
to legislative appropriation.
11.
CONFLICT OF LAWS. This Agreement shall be interpreted under the laws of the
State of New Jersey.
12.
SOLICITATION. The provider shall not solicit screening participants for his or
her own practice, nor use Project BEST as a vehicle to procure CBVI services
for his or her own patients.
This Agreement is subject to any amendment, which the Office
of the Attorney General may require as a matter of State Law or State
Policy.
The terms of this Agreement have been read by the person(s)
whose signature are affixed hereto and who have agreed to comply with the
conditions of the Agreement as specified above.
| BY THE PROVIDER | BY THE COMMISSION FOR THE
BLIND |
| & V.I. |
| Signature | Signature/CoordinatorofPrevention
Services |
| OPHTHAMOLOGIST | OPTOMETRIST |
| Title (Circle One) | Date |
| Date | Signature/Fiscal Administrator |
| Date |
