Current through Register Vol. 56, No. 18, September 16, 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 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
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 |
