“Exhibit A”
In consideration of the payments set forth in Exhibit “B”, Contractor shall provide the following services:
The County of San Mateo Health Care for the Homeless (HCH) Program is contracting with Onsite Health to provide dental services. Onsite Health will provide access to dental health services to at least 424 unduplicated individuals who are homeless in San Mateo County at designated shelters through 84 van services days with a total of 1704 dental visits to be provided. Details of services to be provided include the following:
Treatment Plan Priorities:
Alleviate pain
Restore function
Prevent further disease
Consider esthetic results
Diagnostic and Preventive:
Exam and evaluation
Routine Cleaning
Digital imaging (4 BWS 2 PA)
Digital imaging of problematic area
Fluoride treatment (as recommended)
Dental Education
Sealants (for children)
Palliative treatment for dental pain
Basic Services:
Composite and amalgam fillings(composite anterior, amalgam posterior)
Composite and amalgam fillings (composite anterior, amalgam posterior)
Endodontic (limited to anterior teeth that will not require a crown)
Periodontal scaling and root planning
Repairs of removable appliances
Extractions (basic, soft tissue impacted and some partial bony at treating
dentist’s discretion)
Major Restorative:
Qualification for removal prosthetics: 1) no teeth 2) no posterior occlusion 3) missing front teeth.
Full Dentures – If the arch is edentulous or teeth needing extraction will cause
the arch to become edentulous
Partial Dentures with Metal Frame work - If three (3) or more teeth are missing in
the same posterior quadrant and limited occlusion on the opposing bi-lateral
quadrant.
Acrylic-Base Stay plate (Flipper) – If one (1) to four (4) front teeth are missing or
if the needing of an extraction will cause them to be missing
Referrals:
Form to be completed and submitted with all sections completed
No patient will be seen at SMMC without a referral from Onsite Health
No immediate dentures/stipulates will be delivered by San Mateo Medical Center
OBJECTIVE 1: Provide access to dental health services to at least 424 unduplicated individuals who are homeless in San Mateo County at designated shelters through 84 van service days with a total of 1704 dental visits to be provided.
Outcome Measure 1.A) Each patient will be scheduled for a series of appointments to complete their treatment plan. Contractor shall schedule patients for follow up dental services.
Outcome Measure1.B) Each patient’s progress on their dental plan will be tracked, with a goal to make significant progress in their treatment plans. At least 50% of dental patients will complete their treatment plans within the twenty four month period.
OBJECTIVE 2: Provide comprehensive dental health services (diagnostic and preventive, basis services, and major restorative as outlined above) to 424 individuals who are homeless in San Mateo County, resulting in an improvement in their overall health status.
Outcome 2.A) At least of 85% of the patients will attend their scheduled treatment plan appointments. This shall be accomplished by Onsite Health confirming return appointments.
OBJECTIVE 3: Replace missing teeth with dentures to restore full function, improve self-esteem, and increase employment opportunities up to 60 removal prostheses. (Details for these dental services are included in the “Major Restorative” section above.)
Outcome 3A) All extractions necessary before denture treatment can begin will occur within 3 months of the initial visit. This shall be accomplished by Onsite Health or by immediate referral to San Mateo Medical Center Dental Clinic depending on complexity
Outcome 3.B) 95% of the individuals will complete their denture treatment plan and have dentures delivered within the contract period.
OBJECTIVE 4: Track the percentage of dental patients who complete at least 50% of their dental treatment plan on an annual basis for the HCH QA plan.
RESPONSIBILITIES
Onsite Health is responsible for the following contractual requirements for the HCH Program:
1. A monthly report will be submitted electronically to HCH with each invoice before payment is processed. Onsite Health will collect all demographic information from each homeless individual receiving oral health care during the contract period at the initial encounter on the van. Upon returning to the van for treatment, the date, site of services and type of treatment provided will be collected electronically and included in the monthly report.
2. The dental van will be at a new shelter site every month as indicated on the dental van schedule submitted by Onsite Health and approved by HCH staff.
3. Participate in planning and quality assurance activities such as the following:
a. Create an education and outreach program to inform programs that serve the homeless population how they can access dental services for their clients. Utilize before and after pictures of individuals who received services by Onsite Health along with discussing with clients what procedures are involved and the steps necessary for completing their dental health plan.
b. Create a fact sheet that details the services that are provided by the Onsite Health and how staff of organizations that serve the homeless population can make an appointment for an individual to be seen on the dental van.
c. Collaborate with the program staff of the shelter to assure individuals who are receiving dental health get assistance from shelter staff to complete their dental plan.
d. Evaluate the effectiveness of publishing a quarterly calendar of where the Onsite Health dental van will be located and the impact it has on individuals who are homeless to complete their dental care treatment plan.
4. Participate in HCH Provider meetings and contractor conference calls and/or meetings between Onsite Health and San Mateo Medical Center as scheduled.
5. Participate in community activities that address homeless issues (Homeless One Day Count, Homeless Project Connect, etc).
6. Provide active involvement with the Bureau of Primary Health Care Office of Performance Review Process.
The HCH Program is responsible for the following:
1. Schedule all new patient appointments to be seen on the dental can. Emergency appointments will be worked into the schedule as available and advised by Onsite Health.
2. Review, process and monitor monthly invoices.
3. Review quarterly reports to assure that goals and objectives are being met.
4. Provide direction for data collection processes to Onsite Health.
5. Provide any additional technical assistance to Onsite Health on the HCH Program as needed.
SMMC retains professional and administrative responsibility for the services rendered, however, in no circumstance shall
San Mateo Medical Center be liable for the acts or omissions of Contractor and Contractor is bound in full by the
indemnification language of the Agreement.
Exhibit “B”
In consideration of the services provided by Contractor in Exhibit “A”, County shall pay Contractor based on the following fee schedule:
1. County shall pay Contractor $3,267.50 per dental service day not to exceed 84 days for the period of November 1, 2009 to October 31, 2011. The goal is to serve at least 424 unique homeless individuals and provide 1704 dental visits. A service day is defined as one eight hour time period during which the dental van is providing treatment to patients at a site approved by the SMMC Dental Office.
2. Contractor will invoice the HCH Program by the 10th of the month after rendered services with the number of new unduplicated homeless individuals. Invoices will be approved by the Health Care for the Homeless Program Director.
3. If a scheduled van day is cancelled by Onsite Health and not rescheduled to San Mateo Medical Center’s satisfaction, Onsite Health will forfeit payment for that contract day, resulting in a reduction in the total contract amount.
The term of this agreement is November 1, 2009 to October 31, 2011. Maximum payment for services rendered under this agreement will not exceed TWO HUNDRED SEVENTY-FOUR THOUSAND FOUR HUNDRED SEVENTY DOLLARS ($274,470). Invoices will be approved by the Health Care for Homeless Program Director and paid within 30 days of receipt of invoice.