New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 94 - PREVENTION SERVICES PROGRAM OF THE COMMISSION FOR THE BLIND AND VISUALLY IMPAIRED
Subchapter 3 - VISION AND EYE SCREENING PROGRAMS
Section 10:94-3.4 - On-Site Eye Screening Program
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The Commission's On-Site Eye Screening Program shall provide free on-site eye screenings to elderly, special needs, minority, and disadvantaged groups at, for example, public housing developments, senior citizen residences, institutionalized care facilities, Federally Qualified Health Centers, special needs schools, and community-based organizations.
(b) Eye screenings shall be given to individuals not under the care of an eye specialist and who have not been examined in more than a year.
(c) The Commission shall be responsible for:
(d) Referral criteria shall be as follows:
(e) Follow-up procedures shall be as follows:
(f) An agreement shall be signed by CBVI and the screening site.
Agreement between | |
_________________________________________ | |
Name of the agency requesting eye health services | |
And | |
NEW JERSEY DEPARTMENT OF HUMAN SERVICES' | |
COMMISSION FOR THE BLIND AND VISUALLY IMPAIRED | |
By accepting this agreement NEW JERSEY DEPARTMENT OF HUMAN SERVICES' COMMISSION FOR THE BLIND AND VISUALLY IMPAIRED agrees to: | |
-- Provide services in the areas of eye health and eye safety by offering vision screenings for adults and children at no cost with a concerted effort to provide these services to historically underserved sectors of the population (low income, elderly, minorities, people with diabetes and individuals with special needs). | |
-- Perform health education and subsequent off-site case management for ongoing applicable vision services. | |
-- Provide a contact person for the purposes of confirming successful client referrals and ensuring collaborative planning and communication between agencies. | |
-- Comply with all the requirements of the Department of Human Services of the State of New Jersey and all other federal, state, and local laws, rules, and regulations, including, but not limited to: confidentiality, federal and state anti-kickback and self referral prohibitions, regulatory and accreditation organizations, relating to the services provided pursuant to this Agreement. | |
By accepting this agreement | |
___________________________________________________________ | |
Name of the agency requesting eye health services agrees to: | |
-- Contract with an eye specialist when mutually agreed for the physical examination portion of the vision/eye screenings for on-site eye screening and diabetic eye disease detection programs. | |
-- Provide a non-smoking physical site to include light controlled quiet room, at least 15 feet long with surge. | |
-- Protected electric outlets, two tables, adequate number of chairs, a sink, a waste basket and convenient parking. | |
-- Perform on-site patient registration for minimum of 30 consumers and provide staff throughout the screening. | |
-- Comply with all the requirements of the Department of Human Services of the State of New Jersey and all other federal, state, and local laws, rules, and regulations, including, but not limited to: confidentiality, federal and state anti-kickback and self referral prohibitions, regulatory and accreditation organizations, relating to the services provided pursuant to this Agreement. | |
-- Comply with the DHS indemnity language: 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. | |
-- Provide a contact person for the purposes of confirming successful client referrals and for ensuring planning and communication between agencies. | |
-- Cancellation must be confirmed at least 2 weeks prior to the scheduled date. | |
This agreement shall be in effect upon signature by both parties until _________________ , unless terminated by either program/institution in accordance with the terms below. | |
This agreement may be modified or amended, at anytime, by mutual written agreement of authorized persons of both programs/institutions. This agreement may be terminated by either program/institution upon written notice given no later than thirty (30) days prior to the termination date. | |
___________________________________________________________ | |
Name of the agency requesting eye health services | |
New Jersey Department of Human | |
Services' Commission for the Blind | |
and Visually Impaired | |
___________________________________________________________ | |
Authorized Signature | Authorized Signature |
___________________________________________________________ | |
Title | Title |
___________________________________________________________ | |
Date | Date |