Download MOU final draft with UCDHS eye center CLB Edits 4-16

MEMORANDUM OF UNDERSTANDING
This Memorandum of Understanding is made July 1, 2012 by and between UC Davis
Student Health and Counseling Services (UCD SHCS) at the Davis campus and the Eye
Center at the UC Davis Health System (EC UCDHS) and sets forth the relationship and
obligations relating to provision for optometry services provided by EC UCDHS to
UCD SHCS patients at the UC Davis Student Health and Wellness Center.
Recitals
Whereas UCD SHCS and the EC at UCDHS are both owned and operated by the Regents of
the University of California and
Whereas UCD SHCS is operated for the purpose of providing highly accessible and
affordable excellent health care to their patients, and
Whereas EC UCDHS is a top-rated provider of vision care, operated for the purpose of
providing excellent health care to their patients, and
Whereas UCD SHCS seeks to fulfill its mission by providing access to optometric services
for UCD SHCS patients, and
Whereas the EC UCDHS seeks to serve the needs of the campus student population, and
Whereas UCD SHCS and the EC UCDHS seek to maximize the efficient use of University
resources by intra-campus cooperation in meeting the needs and mission of these
respective campus entities and the goals and objectives of UC.
Now, therefore, UCD SHCS and the EC UCDHS agree as follows:
1. Responsibilities of UCD SHCS:
a) In consultation with EC UCDHS, site shall determine the type and scope of services
that may be provided at UCD SHCS by EC UCDHS.
b) UCD SHCS shall designate an on-site liaison as a point-of-contact to coordinate the
delivery of optometric services by EC UCDHS and the UCD SHCS business and
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facility operational needs on optometry service-days. Initially, for set up of the
clinic, this shall be Cheryl Boney, Director of Administrative Services. Once
implementation of the clinic begins, this shall be Sandy Santiago, Director of Clinical
Support Services.
c) UCD SHCS shall provide and maintain facilities, including security, sufficient and
appropriate to delivering optometric services.
d) UCD SHCS shall supply the necessary staff support for the scheduling, reception,
clinical record keeping, collection of co-payments, ordering and dispensary
management for UCD SHCS patients.
e) UCD SHCS shall be responsible for all costs involved in the set up and daily
operations of the optical dispensary including, but not limited to, optical displays,
inventory, optical supplies, ophthalmic products, labor, etc.
2. Responsibilities of EC UCDHS:
a) EC UCDHS shall appoint a member of its faculty to be responsible for delivery of
optometric services. Initially, this shall be Dr. Barnett. When Dr. Barnett is not
available, EC UCDHS will provide a substitute member of its faculty to be
responsible for delivery of optometric services. It is the intention of UCDHS to
quickly establish a rotation of optometrists that are credentialed at SHCS in order
to provide a seamless system of clinical care.
b) EC UCDHS shall be solely responsible for the general conduct of its staff while
assigned to the UCD SHCS facility. General conduct shall be in conformance with the
UCD SHCS facility’s policies, rules and regulations while at the UCD SHCS facility.
c) EC UCDHS shall provide refractory and contact lens fitting and follow up services
within the mutually agreed on scope of services. Refer to Attachment I for Scope of
Services.
d) EC UCDHS shall ensure that staff complete all required UCD SHCS administrative
and clinical training programs and participate in quality assurance activities to
ensure that compliance and accreditation standards are met.
e) EC UCDHS will provide optometric services at the UCD SHCS Student Health and
Wellness facility on days to be mutually agreed upon by UCD SHCS and EC UCDHS.
Initially this will be two days per week to commence on or before July 1, 2012.
f) EC UCDHS optometrists shall participate in the delivery of optometric services. EC
UCDHS optometrists shall be duly licensed and in good standing with the California
State Board of Optometry and within EC UCDHS.
g) EC UCDHS shall provide on-call ophthalmology consultation to EC UCDHS, as
necessary.
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h) EC UCDHS’s staff will be present for service-days, between the hours of 8:00 a.m. to
5:00 p.m. in order to provide optometric services as necessary. Service-days and/or
service may be expanded, by mutual agreement, based upon increased UCD SHCS
patient demand for vision services.
i) EC UCDHS care providers shall produce letters, reports, or documents regarding
patient care for the patient’s file, referring doctor, rehabilitation counselor, or
similar purpose.
j) EC UCDHS staff will document clinical services in Point and Click, the UCD SHCS
electronic health record. UCDHS will then transfer notes from Point and Click via
mutually agreed on method, to its own EMR for the purpose of creating its own
patient file and for the purpose of patient billing.
k) EC UCDHS will supply equipment and supplies (including DPAs—diagnostic
pharmaceutical agents) as necessary to deliver optometric services. This will
include, but not be limited to: all equipment, such as power chair and stand,
phoropter and slit lamp, hand-held ophthalmoscope, binocular indirect and assorted
lenses, and lens sets. EC UCDHS will be responsible for the maintenance, repair and
replacement of equipment as necessary to deliver optometric services. EC UCDHS
will be responsible to ensure that purchase, storage, and administration of DPAs will
comply with all clinical and legal standards and all UCD SHCS program
pharmaceutical policies and procedures. These will be provided at no cost to the
UCD SHCS.
l) EC UCDHS will provide, at no charge, their expertise and assistance to UCD SHCS in
setting up an optical shop that will coordinate with the clinical services. This
expertise may include, but not be limited to: design of optical shop, vendor
selection, inventory management, ordering, and billing.
m) EC UCDHS shall provide all information and documentation required for UCD SHCS
to credential EC UCDHS optometrist(s) per UCD SHCS accrediting body guidelines.
n) EC UCDHS shall conduct annual chart review of records provided by EC UCDHS
optometrist(s) to ensure high quality optometric services.
3. Mutual Considerations:
a) Patient files shall be the property of UCD SHCS. EC UCDHS shall have the right to
access and duplicate any individual charts or records of patients receiving
optometric services provided by EC UCDHS which are (1) necessary to assist in the
defense of any malpractice or similar claim; (2) relevant to any disciplinary action
or substantive adverse event; (3) for educational or research purposes and/or (4)
billing purposes. Such inspection and/or duplication shall be permitted and
conducted pursuant to commonly acceptable federal, state, and local laws. Files
shall be retained at UCD SHCS.
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b) EC UCDHS, in partnership with UCD SHCS, will provide and/or participate in quality
improvement activities involving vision care services, including but not limited to:
peer review, medical record completion review, patient safety, accreditation
preparedness, etc.
4. Business and Operations Plan:
EC UCDHS shall retain all revenue from the provision of optometric services including
but not limited to, reimbursement of claims, co-payments, and cash payments.
UCD SHCS shall retain all revenue deriving from the sales of eyeglasses, contact lenses,
and other ophthalmic products at UCD SHCS optical dispensary.
UCD SHCS shall collect co-payments for optometric services provided by EC UCDHS
using the EC UCDHS National Provider Identification (NPI) number. EC UCDHS shall
cooperate in these processes by accurately completing entries in the EHR (electronic
health record) system used by UCD SHCS and related linked websites of insurers
covering patients served by UCD SHCS (such as VSP or EyeMed).
UCD SHCS will transfer copayments to EC UCDHS at least quarterly via intercampus
transfer of funds within the UC accounting system.
EC UCDHS will be responsible for all other billing and collection services.
It is mutually agreed upon by both parties that after one year (or on any other mutually
agreed upon point of time) the financial performance of both the clinic and the optical
shop will be shared between both parties so as to negotiate mutually beneficial financial
terms beyond the scope of this initial agreement.
EC UCDHS will be responsible for all clinical expenses related to providing optometric
services at the UCD SHCS.
Operations:
Initially two service days per week, starting on or before July 1, 2012. The initial
service providers will consist of one optometrist and one EC UCDHS health
assistant. A maximum of 20 patients per day will be scheduled for the initial
services team. Services shall be provided on a year-round basis. Service-days
and/or service participants will be expanded, by mutual agreement, as UCD
SHCS patient demand for vision services increases.
Fees:
EC UCDHS, in collaboration with UCD SHCS, will determine mutually agreeable
fees for services.
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UCD SHCS and EC UCDHS must mutually approve waiver of fees for any service.
a) EC UCDHS may request waiver of fees for clinical educational purposes.
b) UCD SHCS may request waiver of fees for patient hardship or other similar
purpose but is responsible for any “means testing” or similar testing of
qualification for financial hardship.
5. Term
The term of this Memorandum of Understanding shall become effective upon
final execution of this agreement and shall continue in effect for a maximum of
five (5) years, through June 30, 2017 or until earlier terminated.
6. Termination
Termination Without Cause: Notwithstanding any other provision to the contrary,
either party upon ninety days (90 days) prior written notice to the other party may
terminate this Memorandum of Understanding without cause at any time.
7. General Terms
a) Professional and general liability insurance coverage for these activities is provided
and governed by University policy, especially Business & Finance Bulletins (BUS-) 9,
63 and 75.
b) Disputes under any business agreement among the parties shall be resolved
amicably and with mediation involving a third party from within the University, if
necessary.
c) The term of a business agreement concluded from this memorandum of
understanding shall begin on July 1, 2012 as mutually agreed and will continue
thereafter until terminated, for any reason, by either party upon thirty (30) days
advance written notice to the other.
d) Any notice required to be given pursuant to this letter of intent shall be in writing
and shall be served by personal service or first class mail. When served by first class
mail, service shall be conclusively deemed effective three (3) days after deposit
thereof in the United States mail, postage prepaid, addressed to the party to whom
such notice is to be given as herein provided:
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Notice to EC UCDHS shall be addressed and mailed as follows:
Mark J. Mannis, M.D., F.A.C.S.
Professor and Chair
Department of Ophthalmology & Vision Science
UC Davis Health System Eye Center
4860 Y St., Suite 2400
Sacramento, CA 95817
Notice to the UCD SHCS shall be addressed and mailed as follows:
Michelle S. Famula M.D.
Executive Director, Student Health and Wellness
One Shields Avenue
University of California, Davis
Davis, CA 95616
WHEREFORE, the parties have executed this Memorandum of Understanding as set
forth below:
Mark J. Mannis, M.D., F.A.C.S
Professor and Chair
Department of Ophthalmology
& Vision Science
UC Davis Health System Eye Center
4860 Y St., Suite 2400
Sacramento, CA 95817
Michelle S. Famula M.D.
Executive Director
Student Health and Wellness
University of California, Davis
One Shields Avenue
Davis, CA 95616
Date:
Date:
Attachment I: Scope of Services
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Attachment I
UC DAVIS STUDENT HEALTH AND COUNSELING SERVICES
OPTOMETRY SCOPE OF PRACTICE
I.
The practice of optometry includes the prevention and diagnosis of disorders and
dysfunctions of the visual system, and the treatment and management of certain
disorders and dysfunctions of the visual system, as well as the provision of
rehabilitative optometric services, and is the doing of any or all of the following:
(A)
(B)
(C)
(D)
(E)
II.
The examination of the human eye or eyes, or its or their appendages, and
the analysis of the human vision system, either subjectively or objectively.
The determination of the powers or range of human vision and the
accommodative and refractive states of the human eye or eyes, including the
scope of its or their functions and general condition.
The prescribing or directing the use of, or using, any optical device in
connection with ocular exercises, visual training, vision training, or
orthoptics.
The prescribing of contact and spectacle lenses for, or the fitting or
adaptation of contact and spectacle lenses to, the human eye, including lenses
that may be classified as drugs or devices by any law of the United States or
of this state.
The use of topical pharmaceutical agents for the purpose of the examination
of the human eye.
An optometrist who is certified by California law to use therapeutic pharmaceutical
agents to diagnose and treat the human eye or eyes, or any of its or their
appendages may do so at U.C. Davis Student Health and Counseling Services under
direct supervision of or in consultation with University of California Davis Medical
Center (UCDMC) Ophthalmology for the following conditions:
(A)
(B)
(C)
Infections of the anterior segment and adnexa (e.g., conjunctivitis,
blepharitis).
Ocular allergies of the anterior segment and adnexa.
Non-vision threatening corneal surface disease and dry eyes.
In any condition in which the diagnosis is unclear, in which there the potential for
vision threatening disease, or there is a lack of response to initial therapy, the
optometrist must obtain immediate consultation with the supervising
ophthalmologist and/or refer the patient to the community ophthalmologist for
continuing care.
In any case where an optometrist consult with an ophthalmologist, the optometrist
shall maintain in the patient’s Electronic Health Record (EHR) the information
provided to the ophthalmologist, the ophthalmologist's response, and any other
relevant information. Upon the consulting ophthalmologist's request and with the
patient's consent, the optometrist shall furnish a copy of the record to the
ophthalmologist.
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III.
The optometrist will initiate immediate/urgent referral to UCDMC or community
ophthalmologist for any condition causing a sudden painful, often red eye, with
reduced vision (e.g., acute glaucoma, corneal ulcer, traumatized eye, herpetic eye
disease, scleritis, orbital cellulitis, etc.), conditions causing sudden and profound
visual loss with or without pain (e.g., diabetic eye disease, retinal artery or vein
occlusion, retinal detachment, ischemic optic neuropathy, wet macular
degeneration, etc.), and conditions with gradual painless vision loss (e.g., cataract,
macular degeneration, diabetic retinopathy, glaucoma, compressive optic
neuropathy, etc.
Any immediate/urgent referral by the optometrist to UCDMC or community
ophthalmologist will be documented in the patient’s EHR.
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