The following sections provide guidelines for States wishing to contract with medical providers to perform CEs. This section includes:

• •

  the requirements for contracting out this function.

• •

  the elements of medical provider contracts and,

• •

  a model statement of work and contract language.

DDS must not treat the CE contractors as employees and consider certain factors.

1. 1. 

   Initial proposal provides for:

1. a. 

   Management Summary including general background and organization of the firm, and services to be provided.

2. b. 

   Staffing Types and Qualifications of the physician(s) and other health care practitioners, who:

   • •

     Must meet the licensing or certification requirements of the State (DI 22510.010); and

   • •

     Are not currently excluded, suspended, or otherwise barred from participation in Medicare or Medicaid programs or any other Federal or federally assisted programs.

3. c. 

   Work plans for conducting training in performing CEs and preparing CE reports.

4. d. 

   Experience including a description of any similar contracts or work being performed for other organizations, affiliations and endorsements concerning work in the medical field.

1. 1. 

   Medical Provider means any provider of medical services, including:

   • •

     individual practitioners, such as physicians and psychologists,

   • •

     health care facilities such as group practices, labs, clinics and hospitals, and

   • •

     volume providers.

2. 2. 

   Volume Provider means a provider of medical services that specializes in performing CEs for state agencies and other insurers. Usually, but not necessarily, it includes a provider with estimated annual billings of $150,000 or more.

3. 3. 

   Medical Provider Contract means a formal, written contract between the State and a provider of medical services to perform consultative examinations using physicians and other health care practitioners.