II.



SERVICE AGREEMENT
BETWEEN
UNIVERSITY or WISCONSIN, STATE LABORATORY or HYGIENE
AND STATE or MONTANA
DEPARTMENT or PUBLIC HEALTH AND HUMAN SERVICES

STATE OF MONTANA DEPARTMENT OF PUBLIC HEALTH AN HUMAN SERVICES (hereinafter
has requested newborn screening testing services from the University of Wisconsin, State
Lab oratory of Hygiene (hereinafter WSLH). The WS LH agrees to provide this service based upon the

following understanding and terms.
agrees to:

1.

4.

Ship testing specimens along with demographic information by an express courier
delivery service and pay the expense incurred. Specimens for same day processing are
due by11 :00 am CST, Monday through Saturday.

Notify Montana medical centers of test results that are generated by the WSLH and
provide followup of abnormal results as appropriate. In case of abnormal results
requesting a repeat newborn screen by the repeat specimen will be sent to WSLH
for analysis and will bear the courier charge for sending the samples. The repeat
testing will be done at no charge. I

Pay invoice for tests performed within 90 days of invoice date, at the agreed
upon rates, in US dollars. The fees listed below are the rates to be paid for specimens
received by on or after 7,11! 15 (the effective date).

Assume all liability for, and agree to indemnify, defend, and hold WSLH harmless for any
liability, costs or damages arising from test results timely reported to that are not
reported to the medical center or physician re questing the test in an appropriate manner,
or not appropriately followed up, or where there is a failure to treat the patient
appropriately, or where the patient specimen is improperly handled by the
medical center, or physician requesting the test, or the courier or delivery service.
Provide WSLH ninety (90) days advance written notice of intent to terminate this
agreement. 

WSLH agrees to:

1 

Test newborn samples received from for the newborn screening disorders
requested as part of the routine newborn screening workload. Test results are available
within 72 hours of receipt before 11:00 am CST Monday to Saturday.

Post reports on the WSLH secure web server within 24 hours of completion of all testing.
Provide authorization to staff to access the reports.

Notify of abnormal ?ndings onthe same day, and the laboratory reports with
abnormal test results will be clearly identi?ed and include follow-up recommendations.
Provide DPI-II-IS with a invoice listing the date of service, patient name and
testing fee. 

Provide DPH HS ninety (9 0) days advance written notice of intent to terminate this
agreement.

WSLH will provide 180 days written noti?cation of changes to the agreed upon
fee schedule and agrees not to increase fees for at least three (3) years from the effective
date of this agreement.

 

 

IV.

8. WSLH will engage in interoperability and electronic data exchange activitieswith
which over time will allow electronic ordering and result reporting through a
secure LIMS interface. - - -

WSLH and agree to the following fee schedule:

 

Unit Price 

 

 

 

 

 

 

 

 

 

 

 

 

Item Description

Disorder Panel Identified by Tandem Mass Spectrometry 13.00 -
Acylcarnitine Profiles
Aminoacidopathies Disorder Panel Identi?ed by Tandem Mass 5.20
Spectrometry
Biotinidase De?ciency Testing 2.60
Congenital Adrenal erplasia Testing 5. 20
Hemoglobinopathies, HPLC 12.00
Severe Combined Immunode?ciency Disorder, TREC 6.00
For WSLH: For DPI-I HS:

Date Date Lf-?g?j;
Charles Brokepp, Todd Harwell, MPH
Director Administrator

Montana, Department of Public Health and
Human Services

Wisconsin State Laboratory Hygiene