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HomeMy WebLinkAbout1995-08-07-0900AM-Regular, 11 • d tom' ~ D AA ~ TAT . BRZOS COU NTY ~0+7AZs41 BY BRYAN. TEXAS rLrurY AGENDA C71 6 E I , , t r } t c t c 1 I i BRAZOS COUNTY COMMISSIONERS COURT MEETING THE COMMISSIONERS COURT WILL MEET IN REGULAR SESSION ON MONDAY, AUGUST 7, 1995 AT 9:00 A.M. IN THE COMMISSIONERS' COURTROOM OF THE BRAZOS COUNTY COURTHOUSE, 300 EAST 26TH STREET, SUITE 115, BRYAN, TEXAS. 1. Invocation - Commissioner Norton. 2. Pledge of Allegiance - Commissioner Norton. 3. Citizens input and/or concerns. At this time, the Judge will open the floor to citizens wishing to address the Court on county-related issues not scheduled on the agenda. Please limit subject matters to five minutes. The Commissioners will receive the information, conduct research into the matter, and/or place the matter on a future agenda for discussion. (A recording is made of the meeting; therefore, please give your name and address for the record.) Consider and take action on agenda items 4 - 19: 4. Personnel Change of Status. 5. Payment of claims. 6. Change Order No. 2 for Contract No. BC-95-1, Brazos Center Parking Lot Lighting. 7. Authorization to purchase seven (7) printers and associated components from capital expenditures. 8. Contracts for professional services for Brazos County Indigent Health Care. 9. Request from GTE to place a road bore and parallel installation in the right-of-way of Olympia Buddy Road. Site is located in Precinct 1. 10. Request from GTE for a parallel cable installation in the right-of-way of Thousand Oaks Drive beginning at its intersection with Straub Road extending for a distance of 3,100 feet. Site is located in Precinct 1. 11. Request from GTE for a parallel cable installation in the right-of-way of Schehin Road beginning at its intersection with Parker Lane extending for a distance of 260 feet. Site is located in Precinct 1. 12. The Final Plat of Carter Lake Acres, 15,200 acres, Thomas Caruthers League, A-9, College Station. Site is located in Precinct 1. 13. The Resubdivision of Lot 10, Tabor Ranchettes, 40.45 acres, Francis W. Quota Survey, A-199. Site is located in Precinct 2. i t i I~. k K~ Comtnissioners Court Meeting Agenda, Monday, August 7, 1995 Page Two 14. Permission for Road & Bridge to enter Donnie Williams' property located off Old Bundick Road for the purpose of clearing underbrush from comer of property to create better site distance around curve for the health, safety and welfare of the general public. Site is located in Precinct 2. 15. Permission for Road & Bridge to enter Mrs. Clyde Porterfield's property located off Leonard Road for the purpose of installing new fence around dumpster site for the health, safety and welfare of the general public. Site is located in Precinct 4. 16. Acceptance of Warranty Deed from David R. and Regina Hogan on the expansion and improvements to Cobb Road located in Precinct 3. 17. Acceptance of Warranty Deed from E. C. Lloyd Estate on the expansion and improvements to Cobb Road located in Precinct 3. 18. Acceptance of Warranty Deed from Gerald L. Winn on the expansion and improvements to Cobb Road located in Precinct 3. 19. Budget Amendment No. 94/95.25. 20. Call for citizen input and/or concerns. 21. Adjourn. The building is wheelchair accessible. Handicap parking spaces are available. Any request for sign interpretive services must be made 48 hours before the meeting. To make arrangements, call (409) 361-4102. 7 VOL.. 4 PFA®F, ..Ir:z`:. •.i,'..L.,_ _ - - -•,..a,IL.{_:a......a~a,. ~~sa...: _'t... !..-n..- 6 I t 61 • COMMISSIONERS' COURT REGULAR MEETING AUGUST 7, 1995 A regular meeting of the Commissioners' Court of Brazos' County, Texas was held in the Commissioners' Courtroom in the Courthouse in Bryan, Brazos County, Texas, beginning at 9:00 a.m. on Monday, August 7, 1995, with the following members of the Court present: Alvin W. Jones, County Judge, Presiding; Gary Norton, Commissioner of Precinct 1, Absent; Sandie Walker, Commissioner of Precinct 2, Absent; Randy Sims, Commissioner of Precinct 3; Carey Cauley, Jr., Commissioner of Precinct 4; Mary Ann Ward, County Clerk. The following citizens and officials were in attendance: Bea Green Secretary to Commissioners Susan Gandy Secretary to County Judge John Reynolds Auditor Cheryl Turney Auditor's Office Kay Hamilton Treasurer Richard Vance County Engineer Ralph Jones Jail Administrator Loraine Nichols Personnel Linda Muegge Road & Bridge Marijane Deen CNS Ron Quiran Intern Chip Lambert Bryan/College Station Eagle David Witte McCord Engineering Stan Primus McCord Engineering Mary Lou de Zerega BV Development Council Phyllis Fahlquist LWV The County Judge gave the invocation and led the pledge of allegiance. There was no citizen input and/or concerns. The Court proceeded to consider the change of status of the following employees. NAME DEPARTMENT REASON Beaudreau, Kevin CNS Resignation Pedersen, Patricia CNS New Employee Park, Theron Auditor Resignation Peninger, Lorissa Auditor Transfer I/D Tyler, Karen Road & Bridge Step Increase Villarreal, Victor Road & Bridge Step Increase Drath, Eddie H Road & Bridge Step Increase Nelson, Michael A Road & Bridge. PT/FT Ortiz, Vincente Road & Bridge PT/FT Saxon, Vickie Treasurer Reclassify White, Terri Treasurer Reclassify VOL-XPAQk...j f, f r Commissioners Court meeting August,7, 1995 Commissioner Sims asked the Treasurer if there would be II enough money in the 95/96 budget for the pay increase. She replied there was. On motion by Commissioner Sims, seconded by Commissioner Cauley, the Court voted unanimously to approve the changes as submitted. The Court next considered the following Claims as ~I E1 x~ tracts for mandated health services to be provided to the county's indigent residents, the contracts are between Brazos County and Brazos Valley Development Council and the following providers listed below. The term of the contract will be from September 1, 1995 through August 31, 1996. submitted by the County Treasurer for payment: 95-02730 through 95-02923 On motion by Commissioner Sims, seconded by Commissioner Cauley, the Court voted unanimously to approve the Claims as submitted. The next matter before the Court was Change Order No. 2 for Contract No. BC-95-1, Brazos Center Parking Lot Lighting in the amount of $2,812.01. This was necessary to provide for the change in the foundation design for the parking lot lighting due to -the sandy soil conditions which were discovered after the execution of the Contract. On motion by Commissioner Sims, seconded by Commissioner Cauley, the Court voted unanimously to approve Change Order No. 2 for Contract No. BC-95-1, Brazos Center Parking Lot Lighting. A copy of the change order is attached hereto. The Court next considered authorization to purchase seven (7) printers and associated components from Capital Expen- ditures. These printers are to replace the UNISYS printers for the WIS conversion in the County and Districts Attorney's offices and in the Sheriff's Department. On motion by Commis- sioner Cauley, seconded by Commissioner Sims, the Court voted unanimously to authorize the purchase of the printers at a cost of $3,195.00. The next matter before the Court was approval of Con- _Y A , Commissioners Court meeting August 7, 1995 P. Wuthrich, M.D. James M. Kirby, M.D. R. Alford, M.D. James I. Lindsay, M.D. Anup G. Amin, M.D. Mark B. Lindsay, M.D. H. E. Bohne, M.D. Randall Light, M.D. Brazos Radiology Associates Michael McMahon, M.D. Brazos Family Practice Associates J. C. Lee, M.D. Rudy Briner, M.D. G. M. Montgomery M.D. Bryan Radiology Associates Richard Morgan, M.D. L. W. Coleman, M.D. Steve Opersteny, M.D. Nalini M. Dave, M.D. G. Richardson, M.D. David Doss, M.D. Mark B. Riley, M.D. Joseph Fedorchik, Jr., M.D. Barry Solcher, M.D. Nashi B. Ghattis, M.D. St. Joseph Regional James Giles, M.D. Health Center Karim Haji, M.D. D. M. Stauch, M.D. Stephen S. Tseng, M.D. Barry Veazey, M.D. On motion by Commissioner Sims, seconded by Commissioner Cauley, the Court voted unanimously to enter into contractual agreement with the Brazos Valley Development Council and the previously mentioned providers for professional services with monies to be paid from the county's Indigent Health Care fund. Copies of the contractual agreements are attached hereto. The Court next considered the request from GTE to place a road bore and parallel installation in the right-of-way of Olympia Buddy Road. The site is located in Precinct 1. The County Engineer stated that all appeared to be in order and recommended approval. On motion by Commissioner Sims, seconded by Commissioner Cauley, the Court voted unanimously to approve the request of GTE and authorized the installation. A copy of the request is attached hereto. The Court next considered the request from GTE to place a parallel cable installation in the right-of-way of Thousand Oaks Drive beginning at its intersection with Straub Road extending for a distance of 3,100 feet. The site is located in Precinct 1. The County Engineer stated that all appeared to be in order and recommended approval. On motion by Commis- sioner Sims, seconded by Commissioner Cauley, the Court voted unanimously to approve the request of GTE and authorized the installation. A copy of the request is attached hereto. The Court next considered the request from GTE to place a parallel cable installation in the right-of-way of Schehin Road beginning at its intersection with Parker Lane extending - VOL - - Az i c r s 4 `I r f E~ Commissioners Court meeting August 7, 1995 for a distance of 260 feet. The site is located in Precinct 1. The County Engineer stated that all appeared to be in order and recommended approval. On motion by Commissioner Sims, seconded by Commissioner Cauley, the Court voted unanimously to approve the request of GTE and authorized the installation. A copy of the request is attached hereto. The Court next considered approval of the Final Plat of Carter Lake Acres in Precinct 1. Richard Vance, County 4 Engineer, stated that he had reviewed the plat and recommended the addition of a 10 foot utility easement on all lot lines. On motion by Commissioner Cauley, seconded by Commissioner Sims, the Court unanimously approved the final plat of Carter Lake Acres to include the ten foot utility easements along all lot lines. The Court next considered the resubdivision of Lot 10, Tabor Ranchettes 'in Precinct 2. Richard Vance, County Engineer, stated that he had reviewed the plat and recommended approval. On motion by Commissioner Cauley, seconded by Commissioner Sims, the Court voted unanimously to approve the resubdivision of Tabor Ranchettes. The Court next considered authorizing work outside of county rights-of-way for the health, safety and welfare of the general public. The Road and Bridge Department requested permission to enter the private property of Donnie Williams on old Bundick Road in Precinct 2 to clear under brush from the corner of the property to create a better site distance around a curve. On motion by Commissioner Cauley, seconded by Com- missioner Sims, the Court voted unanimously to authorize the f work. The Court next considered authorizing work outside of county rights-of-ways for the Health, safety and welfare of } the general public. The Road and Bridge Department requested permission to enter the private property of Mrs. Clyde Porterfield on Leonard Road in Precinct 4 to install a new r E fence around a dumpster site. Commissioner Sims asked w4iat pAnE f i t 01 f f i s r' tt i 4 a r 4 Commissioners Court meeting August 7, 1995 kind of fence it would be. Mr. Cauley answered that it would be barbed wire on two (2) sides and hog wire on one (1) side. On motion by Commissioner Cauley, seconded by Commissioner Sims, the Court voted unanimously to authorize the work. The Court next considered acceptance of a Warranty Deed for right-of-way on Cobb Road in Precinct 3 for the expansion and improvement of the road. On motion by Commissioner Sims, seconded by Commissioner Cauley, the Court voted unanimously to authorize the County Judge to accept on behalf of Brazos County a Warranty Deed from David R. and Regina Hogan, land owners on Cobb Road. The Court next considered acceptance of a Warranty Deed for right-of-way on Cobb Road in Precinct 3 for the expansion and improvement of the road. On motion by Commissioner Sims, seconded by Commissioner Cauley, the Court voted unanimously to authorize the County Judge to accept on behalf of Brazos County a Warranty Deed from the E.C. Lloyd Estate, for improvements to Cobb Road. The Court next considered acceptance of a Warranty Deed for right-of-way on Cobb Road in Precinct 3 for the expansion and improvement of the road. On motion by Commissioner Sims, seconded by Commissioner Cauley, the Court voted unanimously to authorize the County Judge to accept on behalf of Brazos County a Warranty Deed from Gerald L. Winn, a land owner on Cobb Road. The Court next considered Budget Amendment #94/95-25, which would reallocate funds budgeted for the Road and Bridge Department to allow payment to the City of College Station for the completion of Graham Road. On motion by Commissioner Sims, seconded by the County Judge, the Court voted unani- mously to approve the budget amendment as submitted, a copy of which is attached hereto. There was no citizen input and/or concerns. The County Judge informed the Court of the following items: ML PAGE ' 1.. w f ~ f•, h• ~ h Commissioners Court meeting August 70' 1995 1. The completed plans for the Juvenile Center are available for viewing in his office. 2. There are also estimates from Cox/Croslin and three (3) alternates. There being no further business to come before the Court, Brazos the meeting was adjourned. 9 i, T U--] c• , The foregoing minutes of the Commissioners Court meeting held August 7, 1995 have been examined and are a ! pproved in c' . open Court this the 30th day of April , 1996 r in Bryan, Brazos County, Texas. ...e.r/ Alvin -W. Jone County Judge Commi on r, Precinct 1 04 r• San ie a er Randy S JAS Commissi a Precinct Commi loner, Precinct 3 Ca 'key ley, Jr. Mary An Ward Commiss over, Prec n 4 County Clerk a r s I 01~ , Ft VO AQ E..~...r,. • . rL I _I. • .Y 11r , • F A.~. •.v~~:rt r..• f.i i,• 1 Q w t I , SOO, McCord Engineering, Inc. August 3, 1995 P. O. Box 10047 u College Station, Texas 77842 s r~ U CHANGE ORDER NO. 2 TO BRAZOS COUNTY CONTRACT NO. BC-95-1 FOR BRAZOS CENTER PARKING LOT LIGHTING ,CONTRACT: Contract date June 20, 1995, between Brazos County and Britt Rice Electric, Inc. REVISIONS: Revise the following construction assembly unit quantities, in Secti8n PL, to reflect revisions in the design of said project made after award of this Contract. The revisions made to the design were to increase the diameter and depth.,of the pole foundations due to the sandy soil conditions which were discovered after the execution of the Contract. Items that were J t C t t i .Y SECTION CONTRACT PRICE CHANGE ORDER #1 REVISED PRICE CHANGE ORDER a1 REVISED PRICE (S) Total, Section 1 1,914.00 1,914.00 1,914.00 Total, Section PL 76,693.00 78,433.00 81,245.01 Total, Section UD 6,410.00 6,410.00 6,410.00 Total, Section UM 7,190.00 7,190.00 7,190.00 Total, Section UR 6,419.00 6,419.00 6,419.00 TOTAL 98,626.00 100,366.00 103,178.01 This change increases the cost of this construction project by $2,812.01, changing the Contract price from $100,366.00 to $103,178.01. APPROVAL RECOMMENDED: McCord Engineering, Inc. B ( S~ Y Date A LJOVAL: Britt Rice, Inc. Brazos County By_7 By Date Da • y Y. . Change Order No. 2 (Cont'd) CHANGE IN CONTRACT PRICE: VOL (a.PAGE rl Page 2 1 _ SPECIFICATIONS 3 7/8" FROM TOP OF - CONCRETE 1 1. •3 spiral, 4" pitch REBAR 2. Four (4) 1" anchor bolt 38" long with 3 7/8" projection from concrete 3. Anchor bolt, 6" thread, top 8" to be galvanized 10" BOLT 4. Anchor bolt to be ' CIRCLE A 328, with eight nuts and eight flat washers I s Six (8) •8 vertical rebar TOP VIEW ance to be 3" min. clearance from all outside surface. ANCHOR BOLTS e. All concrete to be 3.000 P.SJ. grade 1 1/2" SCHEDULE 40 CONDUIT re" FROM GRADE LEVEL ~ a 3811 a . X X - a ~ 3" MIN. CLEARANCE (8) •8 REBAR FROM ALL OUTSIDE SURFACES / 24" ' SIDE VIEW A&CORD ENGINEERING, INC. CON-165 ' no► r..w. a.w s.w m STREET UGKT AND POLE FOUNDATION •O. 0e. 100.7 KT 8 6-3-95 ulte r1--1 s r r .y~y. - •f 'lug 1 1'{ j~ 's J_,Y ~l.a i` . 01 "*I 01 E t SPECIFICATIONS 3 7/8" FROM TOP OF - CONCRETE , t •3 spiral. 4" pitch REBAR 2. Four (4) 1" anchor bolt 36" long with 3 7/8" projections from concrete 3. Anchor bolt. 6" thread. top 6" to be galvanized 11 1/2" BOLT 4. Anchor bolt to be CIRCLE A 326. with eight nuts and eight flat washers TOP VIEW b. Six •8 vertical rebar to be 3" min. clearance from all outside surfaces. ANCHOR BOLTS AC concrete to be 3,000 PSI grade 1 1/2" SCHEDULE 40 CONDUIT r- 6" FROM GRADE LEVEL r _ \ t 24' 1 \`l\ 36„ i~ 3" MIN. CLEARANCE (6) s.8 REBAR << ROM ALL R UTSIDE SURFACES 1 24" ' SIDE VIEW McCORD ENGINEERING, INC. CON-164 rar r..,w aw. w+or STREET LIGHT AND POLE FOUNDATION ►A b,Ow) • or... ww. T..r ~ ,..,,4m 1tT8 8-3'95 , PL-CF-A2 MA C ....~/O ]PAGE - _.V_ .C C.B. ' is ~ _ . _ r r].• a._.. h.n ~...Y ..L +...._.Y►..a..~~S.+r+_i ....t.. ..u. __~_Y+ . _-_r.-..`J_ _ I • 1 ' THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract Is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected county Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and RICHARD ALFORD, M.D., located in BRAZOS County hereinafter "Provider"). RECITALS s WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the states poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS I. "Handbook" shall mean the County Indigent Health Care Program Handbook ti developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. r i 3. "The Act% shall mean the Indigent Health Care and Treatment Act, Texas Revised r Civil Statutes Article 4438 (f). i 4. "Mandated Services" shall mean those services which hospitals and doctors may G provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act 5. "The Program" shall mean the services offered to the Public pursuant to the Act ' 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon j Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has 1 a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (Ist) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. 1 I z z• A 1 J a 1 S. 1 r i e CANCELLATION • This Contract may be canceled by any of the parties )iereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions. exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT •I The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax In-y. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services prodded to a person who is not an Eligible Resident or for services not covered by this Agreement (3) any amounts for services prodded by Prodder in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (4) any amount for services prodded to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (S) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider --VOL....6. PAGE rs-~r <-,w f v,f 1 , j has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBE ITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC sliall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. 5. Maintain this Contract and assist the parties hereto in the operation of the Program 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. S. Maintain data files on clients and billing records to verify the county is in conformity %ith the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Pro%ide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review ovemli Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Act. 3 1• am arm PAGE 7. %rJ • rJ • li7r Is. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18, Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9, 10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County, RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. s RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes ' may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. BELLING The Provider must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of service provided, appropriate CPT-4 code for the service, date of service, the rate for such service and all certificates as described herein, the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time, review the services pro%ided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC VCS PAG3E VJ Y. N. t ~ r4 r I ~T i i C r determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either, party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party, said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Polity Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure , and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% i of its general m-enue tax It%y. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, %iolation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. 5 -VOL .4..PAQE._Z~L- .~4. r -21 N. r. d N e- } f 0I ~01 01 /17' INSURANCE The parties hereto agree that the Provider shall bean independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 RICHARD ALFORD, M.D. 2719 OSLER BLVD, BRYAN, TEXAS, 77802 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement. SEVERABELITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or underfstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein. 4 l a'i I • ~ Y fi K e' i' 4 " 1~ i s i j between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein ASSIGNABILITY I r I t l i t i' Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County, otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DA'T'ED this 1 st day of September, 1993 By. • _ - Q~~ Judge Al Jones BRAZOS VALLEY DEVELOPMENT COUNCIL By: Tom Wilkinson, Jr. PROVIDER By: rd Alford, M.D. • Y J THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and AM/PM CLINICS, located in BRAZOS County hereinafter "Provider"). RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. 3. "The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain.reimbursement therefor from the County pursuant to the Act 5. "The Program' shall mean the services offered to the Public pursuant to the Act. 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernons Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. 1 - VO PAGi F,~x_/_.,r I . i i r t CANCELLATION This Contract may be canceled by any of the partip hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT r. i f• f The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO/100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (100/6) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (S) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider Is 0I has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic. rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. 01 401 RESPONSIBILITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. 5. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. 8. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH. Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Act. 3 -V0 - PAGE 1 5. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,9.9, 10 and I1 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSiBELITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Providers provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. BILLING The Provider must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of senice prodded, appropriate CPT-4 code for the service, date of service, the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time. review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC • '01 1 r. .1,.. ",1. . determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either parry may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The parry seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY r~ The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and condition hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. S r~ _PAOF F i~ r at ..6....t INSURANCE The parties hereto agree that the Provider shall bean independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 RANY CHERIAN, M.D.. 401 SOUTH TEXAS BRYAN, TEXAS, 77803 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement. SEVERABILITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or underfstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein. ' `r y t I I i• f r~ i a • • t U r Ia. ASSIGNABILITY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned " subsidiary or to a corporation with which it may be merged without prior written consent of the County. otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September. 1995 By: Judge Jones BRAZOS VALLEY DEVELOPMENT COUNCIL By: Tom Wilkinson. PROVIDER:, By. ~L Ratty Ch 'a L } 4 ' r• t 4 I r 01 : Y4 t~1 PAGE _ VO I i. I i F. i ~ I r f t e n THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and ANUP G. AMIN, M.D., located in BRAZOS County hereinafter "Provider"). RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health tare in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health pre to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook' shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH' shall mean the Texas Department of Health. 3. "The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. 'Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 3. Mw Program' shall mean the services offered to the Public pursuant to the Act. 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document' shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) option to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renenal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. 1 4 i I ' CANCELLATION v This Contract may be canceled by any of the parties.hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT • The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (100/*) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC ? shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be d confirmed in writing by the BVDC within five (S) working days of the telephone notification, if a prospective patient presents an Eligibility Document which Provider k -VOL---~~PAQE t }r / ~ i t G, t 1 I~ tJ• . has been notified by the BVDC Is Invalid. Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBILITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. S. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. 8. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Act 3 Z, I•, - . t 17, • 15. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9,10 and I I above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. s r 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION ~ The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Providees provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. ■ BILLING t The Provider must, Hithin ninety five (95 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted % ithin the time above specified shall be the responsibility of the Prodder. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of service prodded, appropriate CPT4 code for the service, date of service, the rate for such service and all t certificates as described herein. the BVDC shall, if it determines the person receiving such services %vas an Eligible Resident at that time, review the services prodded, to ascertain and verify that all necessary i certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC a k k~ r ~I r. f determines that the bill should be paid it shall send the bill to the County for final payment If the BVDC determines that • bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question. shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party-, said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (101/6) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tar levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. 5 Q i .i~ rr ` of 4, I J• Yl ~a 1 a INSURANCE The parties hereto agree that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respecm this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such ratite or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET • P.O. DRAWER 4128 BRYAN, TEXAS, 77805 ANUP G. AM1N, M.D. 2716 OSLER BLVD. BRYAN, TEXAS, 77802 • FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any fluther documents which may be necessary to carry out the provisions of this Agreement. SEVERABILITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter t contained herein. There are no representations, agreements, arrangements, or underfstanding, oral or written, ~ between or among the parties hereto, relating to the subject matter of this Agreement. which are not fully expressed, herein. L I• VCS Y A ( E 1 t ASSIGNABILITY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County; otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September. 1995 BRAZOS VALLEY DEVELOPMENT COUNCIL By: .a• a i V0 . k ~4FJ f ~~aJivsa.~~.e ~J 1 • / $ 01 01 91 i S r F r 'r r i- THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and DOUGLAS M. STAUCH, M.D. located in BRAZOS County hereinafter "Provider"). RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health pre. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. . "TDH" shall mean the Texas Department of Health. 3. "The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (1). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 5. "The Program" shall mean the services offered to the Public pursuant to the Act 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) option to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, fate schedules and other requirements which are incorporated herein and trade a part hereof for all purposes. " 1 vol_.~A-pAOe...4tr. a ~ f, r - s r r CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Vrovider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing_ facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County s fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third parry insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (4) any amount for services provided to a person after the County has notified Provider by telephone or in uniting that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (5) working da%s of the telephone notification. If a prospective patient presents an Eligibility Document which Provider ' - V® & ~i r ~ • r 01 i i r 4 ti • ~ . has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic. therapeutic. rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBILITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. 5. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and pa)ment. 8. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County ►►ith information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and %%ith TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County ►►ith all of its responsibilities under the Act. 3 r rr , M 1. i i f F i I IS. Perform all other duties and flrnctions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 1s. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9,10 and i 1 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible eepense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service %%-as prodded. These records shall be made available for inspection and audit by the TDH.. BILLING The Prodder must, vdthin ninety five (93 ) days from the date the Mandated Service is prodded or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Prodder. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, tNpe of service prodded, appropriate CPT-4 code for the service, date of service. the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such scrv-ices was an Eligible Resident at that time, review the services prodded, to ascertain and verify that all necessary certifications have been completed. and that the bill qualifics for payment in all other respects If the BVDC , i VOL-AL- PAGE 1, . , _ _ determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish lp contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. • • APPEAL The Provider and the County shall have the right to submit a dispute invoking household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernons Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall x notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims. demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. S vv PAGE -X? t r- I r t y F - t r ~ J r , t The parties hereto agree that the Provider shall be Art independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 DOUGLAS M. STAUCH, M.D. 1602 ROCK PRAIRIE ROAD COLLEGE STATION. TEXAS, 77840 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any thither documents which may be necessary to carry out the provisions of this Agreement SEVERABILTTY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. INSURANCE h f I 4 ~ i I I F i C t ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or undersstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement. which are not fully expressed herein. VOI~X PAGF , Ilo,,_ - -1 d. I f s. • s Y s n 2 R ~d .r f ASSIGNABILITY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County. otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September. 1995 By. Judge Jones BRAZOS VALLEY DEVELOPMENT COUNCIL By. Tom Wilki 2-~ PROVIDER By: r, 'd, Dou las M. Stauch, M.D. G VOL-J/-k. PAGE • i .....1._ J, 'k THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY. TEXAS, acting by and through Its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and STEPHEN S. TSENG, M.D. located in BRAZOS County hereinafter "Provider"). RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the states poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. 'Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained bX contacting TDH. 2. "TDH' shall mean the Texas Department of Health. 3. "The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. 'Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act 5. "The Program" shall mean the services offered to the Public pursuant to the Act 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on-the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. vol, Z pAQW.4 E~?~ • s • CANCELLATION This Contract may be canceled by any of the partids hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO/100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent cam the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (S) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider 'r VOL V r i r f F L k-- r has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it ftnd shall send any such surrendered documents to the BVDC. t QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic. therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBQ,ITIES OF BVDC f f it BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined iq the Act. including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for trailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. S. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. S. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed. 10. Respond to all and arty inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Act. • E 15. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. , 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8.9, 10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. BILLING The Promider must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted i%ithin the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of service provided, appropriate CPT4 code for the service, date of service, the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC Y VdL,Z _PAOE -~erl--6- determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notio of such rejection to the Provider. Should the Provider wish:to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other parry; said second parry shall then appoint an arbitrator and the two arbitrators s appointed shall appoint , a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned parry, the arbitrator appointed by the first mentioned parry shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The parry seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims. demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and condition hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. S V0 PAGiF ,,.~4.... r 0I 01 01 N i r Y R 7 INSURANCE The parties hereto agree that the Provider shall be An independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77803 STEPHEN S. TSENG, M.D. 2801 E. 29TH STREET BRYAN, TEXAS, 77802 FURTHER ASSURANCES Each patty hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement. SEVERABILITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or underfstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein VOL~PAQE-1!~7 1 • i S ' ASSIGNABQITY t Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County, otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September. 1995 By: Judge Jones 1 BRAZOS VALLEY DEVELOPMENT COUNCIL Tom Wi n, Jr. i• PROVIDER s• By: i Stephen S. Tudg. M.D. i h m.■-L 1 i ,i .r ' r 4 THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and BARRY VEAZEY, M.D. located in BRAZOS County hereinafter "Provider"). RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health rare. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. 3. "The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 5. "The Program" shall mean the services offered to the Public pursuant to the Act 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. , TERM s. • S VOL-~-.d PAGE This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and condition contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. ' 1 CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions. exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for senices not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (S) working da%s of the telephone notification. If a prospective patient presents an Eligibility Document which Provider VOL G--PAGE, ...~e • 01 has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.). in an appropriate facility. RESPONSIBILITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. 5. Maintain this Contract and assist the parties hereto in the operation of the Program 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and pa)menL i. 1 8. Maintain data files on clients and billing records to verify the county is in conformity . with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. h 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. .r 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible e%penses with the appropriate parties. 14. , Assist the County with all of its responsibilities under the Act. 3 VOA--1;,PAQE „ l/_- Is. Perform all other duties and functions neoessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. is. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9,10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. s. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shaU be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Prodder agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Prodder's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH . BILLING The Prodder must. within ninety five (93 ) days from the date the Mandated Service is prodded or ninety five (95) da)•s from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted % ithin the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name. address, social security number, Eligibility Document number of the patient, type of service provided. appropriate CPT4 code for the service, date of service. the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time. review the services prodded, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects if the BVDC voL-6-PAQE.~z a 1. 4 determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider, Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as descnbed below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. • ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned parry, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. U i APPEAL The Provider and the County shall have the right to submit a dispute invoking household residency only to the TDH for resolution. The parry seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (101/6) of the County's general revenue tax levy, its total liability s for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to-any person resulting from any act or omission or negligence on the part of each party hereto. • 5 Vol- Z-PAGE-st~.._. a~; F . INSURANCE The parties hereto agree that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for heroin. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH. in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: i 4 I F BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 BARRY VEAZEY. M.D. 1602 ROCK PRAIRIE ROAD COLLEGE STATION, TEXAS, 77840 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any iinther documents which may be necessary to carry out the provisions of this Agreement. SEVERABILITY In the event that any of the provisions or portions thereof. of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or undersstanding, oral or written, bet% en or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein. VOL.- J(_ --PAOIE .l } -~1~~'..`Y.'.e ~.~'.~~~1 ~Pa~L -'~~:a` t5L'. Y' ~t 1 ,'1l•^ti:•~•1 ~ ~ ~1kAi..i11L ~ L. d ,1 1 ASSIGNABQ.ITY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County; otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September. 1995 By: Judge Al Jones BRAZOS VALLEY DEVELOPMENT COUNCIL t By: Tom Wilkinson. Jr. s PROVIDER: • By. Barry V M.D. i 4 7 S + •i ~y VOL. PAGi A-W-0-000ftS i ! z t I I ■ v i f r t i THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract Is entered Into by and between BRAZOS COUNTY, TEXAS, acting by and througb Its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and PAUL WUTHRICH, M.D., located in BRAZOS County hereinafter "Provider"). RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health 3. "The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 5. '"The Program" shall mean the services offered to the Public pursuant to the Act 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in fora and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate bn the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) option to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. 1 rl VOL PAJME Low, 1 L • CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions. exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS (530,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services prodded to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (S) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider PAGE VOA. - . - - -t, u . , - . - -6-, has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Pmvider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility, RESPONSIBILITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. S. Maintain this Contract and assist the parties hereto in the operation of the Program 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. 8. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff re%ie%v overall Program management and operation. ' 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Ace. 3 VO Z . rPAGE Sri . IM.itL..~~~~r.LL •J4,. 1h r r 11~ • • I 1_ 15. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents, is. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9,10 and I 1 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION i The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. • BILLING The Provider must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of service prodded, appropriate CPT-4 code for the senior, date of service, the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time, review the services prodded, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC VID r ,r . - , . - - - _,_.,_s - - - -----...1.. s, li s t i } l t i t 04 i h determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, arty dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party, said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second parry does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned parry shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to ether said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act. Article 66252-13a Vernon Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. 5 VOL- .r r~ 4 •I 01 •I INSURANCE The parties hereto agree that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE j BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 PAUL W1TI'HRICH, M.D. r 2801 E. 29TH STREET E BRYAN, TEXAS, 77802 r FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement. SEVERABILITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. E ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or underfstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement. which are not fully expressed 1 herein. E a VOL rj Y F f ASSIGNABUXrY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned • subsidiary or to a corporation with which it may be merged without prior written consent of the County, i~ otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September, 1995 By: _ JuSge Al Jet s - BRAZOS VALLEY DEVELOPMENT COUNCIL By: om Willdnso PROVIDER- "By: By: " W Paul Wuthrich, M.D. 7 PAGE • t f ,~di•r.G...`~ciL ..UI'LL ..M.h rs~l~6i!: el~u.. _a A. _ . • ~1 • f . I ~ /1 h h A 01 s THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and HENRY E. BONNE, M.D., located in BRAZOS County hereinafter "Provider"). RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health rare in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. 3. "The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 5. "The Program' shall mean the services offered to the Public pursuant to the Act. i 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to a serve. TERM T This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract Is executed, and shall terminate on the thirty-first (31st) day of August, 19%. The parties shall have, and there is hereby given, three (3) option to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of arty renewal period, upon the same terms and condition contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which am incorporated herein and made a part hereof for all purposes. 1 Vn PAGE . 3..._ 1 ' 41 i i i- I i r, i~ , k . CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Casts in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT f Y F t The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and . (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (101/6) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent cam the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and 2 VOL~_j PAGE 4 r i. IN r •I (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (5) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBILITIES OF BVDC • • BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. • Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. 5. Maintain this Contract and assist the parties hereto in the operation of the Program 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment S. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed 10. Respond to all and any inquiries regarding the Program 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with 7DH Stag rt~view overall Program management and operation. . • 3 • vo PAG E F l 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties r 14. Assist the County with all of its .-,-.bflities under the Act. I5. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9, 10 and I 1 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBQdTY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. .r t .p 4. Provide an audit of the Program as required by state law. S. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. BELLING The Provider must. within ninety five (95 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name. address, social security number. Eligibility Document number of the patient. type of 4 VOL,-~ PAGE • 0i service provided, appropriate CPT4 code for the service, date of service, the rate for such service and all certificates as described herein. the BVDC shall, 5f it determines the person receiving such services was an Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making,such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL 401 The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program INDEMNITY r The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the tams and conditions hereof or the negligent performance of the services stated herein 5 k Vn PAGE of j i r r f F E f , 't i t~ 1, ; i Ir and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. INSURANCE The parties hereto agree that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 HENRY E. BORNE, M.D.. 1602 ROCK PRAIRIE RD. STE. 240 COLLEGE STATION, TEXAS, 77840 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement SEVERABE.ITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or underfstanding, oral or written, 6 11~ i i~ Vn PAGE # 4 , , C7 J • l between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein. ASSIGNABILITY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County, otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September, 1995 By. 7~r Judge ones BRAZOS VALLEY DEVELOPMENT COUNCIL. PROVIDER By. 0~y . Henry E. Bohne, M.D. r 7 ,r Vn PAGE r ,jr , THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract Is entered Into by and between BRAZOS COUNTY, TEXAS, acting by and through Its duly elected county Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and BRAZOS RADIOLOGY ASSOCIATES, located In BRAZOS County hereinafter "Provider"). RECITALS WHEREAS. the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the states poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health cane in Texas through the Counties of the State; and WHEREAS. the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH, 2. "TDH" shall mean the Texas Department of Health. 3. Me Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the AcL 5. "The Program" shall mean the services offered to the Public pursuant to the Act. 6. 'Emergency Services' shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. 'Eligibility Document* shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract Is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given. three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period. upon the same terms and conditions contained herein except for amendments made by the State Department of Human Servicm and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. VOL,.A- PAGE 5•I ` ,v 4 '."'ta"--~~.~-_S..,ra~~ic J 2 ~i'~4:a1.:..vr i.~,tyi(~,: _ .ea , • ! CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. • LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS (S30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services arld payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) arty amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within free (S) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Prodder VOL.A PAG F. r~ ~ has been notified by the BVDC is invalid. Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to Indigents, the Provider must certify that the service %%-as medically necessary and the service was performed for diagnostic. therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBILITIES OF BVDC BVDC will be responsible fqr providing the following services pursuant to this Contract, 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month 3. Assist applicants in completing all necessary forms. 4: Determine the eligibility of each applicant with regard to rdsidency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. 3. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. 8. Maintain data files on clients and billing records to verify the county is in conformity %ith the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed. to. Respond to all and any inquiries regarding the Program. it. Assist the County % ith information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and % ith TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses Aiith the appropriate parties. 14. Assist the County %ith all of its responsibilities under the Act. 3 VO PAGE s' c • f 01 15. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. _t 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. Is. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,9,9,10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. f i 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those indiNiduals it believes may qualify under the Act. The Prodder agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Prodders provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service %%-as prodded. These records shall be made available for inspection and audit by the TDH.. BILLIII G i S • The Provider must, %vithin ninety five (93 ) days from the date the Mandated Service is prodded or ninety five (95) day's from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Prodder. The bill shall be itemized to identify the name, address. social security number, Eligibility Document number of the patient, type of serice prodded, appropriate CPT-4 code for the service. date of service. the rate for such serice and all cenificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time. review the services prodded, to ascertain and verify that all necessary cenifications have been completed. and that the bill qualifies for payment in all other respects If the BVDC i t E R h r+, k ' r t~ i % VOA PAGE owns% r4 i - l r r it determines that the bill should be paid it shall send the bill to the Cotinty for final payment- If the BVDC c'. determines that a bill should not be paid, or the County rejects the some, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shallibe submitted to an arbitration commission as described beldw. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION ' It is hereby agreed that if, at any time hereafter, any dispute. difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, i every such dispute, difference or question, shall be referred to arbitration in the following manner: Either parry may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party, said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second parry does not, within a period of fifteen (15) days after receiving notice from said first mentioned parry, appoint an arbitrator and served written notice thereof upon said first mentioned parry, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and detem-dne the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vemons Texas Civil Statutes. FUNDW; The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be amailable for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims. demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. 5 VOA . PAt E. era:. , i y'- r . r • i i INSURANCE The parties hereto agree that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 BRAZOS RADIOLOGY ASSOCIATES P. O. BOX 3764 BRYAN, TEXAS, 77805 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement. SEVERABILITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT i 3 c 1 This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. Then are no representations, agreements, arrangements, or underfstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein. i v() .PAG s r I r .J "r. rj r N r. T'y 4y H { t~ ys, r r. i i t t I I i ASSIGNABQ.ITY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County, otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September, 1995 By: C4~~ Judge Al Jo BRAZrOS VALLEY DEVELOPMENT COUNCIL By. PR( r k k By: I 7 VOL -PAGE i I I ,t a..f~►..~Y._3.._. v..i...• ~,b]`• a•!.rr•.~_I _ ~ - - •a .!.s3 'k", , ,rt ~ 7` - xonam m cixcnnorsz, m u. ~ - I~r-_ a_'~ James . Campbell, M.D. i THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT f This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and BRAZOS FAMILY PRACTICE ASSOCU►TES., located is BRAZOS County hereinafter "Provider"). t RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health r care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. • 3. "The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). r 4. 'Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 5. 'The Program" shall mean the services offered to the Public pursuant to the Act 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon i Texas Civil Statutes. " 7. 'Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and condition contained herein i, except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a r part hereof for all purposes. VCf PAGE d~ i i i i t• 4 i { r CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT t 4 L ; S t: I t The County shall be responsible for. (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO/100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (S) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider V01. PAGE I • has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it end shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic. rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBILITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and • appeals on the issue of household eligibility. 5. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment } S. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. r 14. Assist the County with all of its responsibilities under the Act. a 3 VCS PAGE, 1 I I s I r f 1 5. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1.3.4,6,8,9, 10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. S. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the AcL The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Providers provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. BILLING The Provider must, %ithin ninety five (93 ) days from the date the Mandated Service is provided or ninety five (93) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted %%ithin the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of service provided, appropriate CPT-4 code for the service, date of service, the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects if the BVDC ,i VO PAGE • determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agrce upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure r and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (101/6) of the County's general revenue tax levy, its total liability . for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 100/6 of its general revenue tar levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims. demands, liabilities or action resulting or alleged to result from the breach. violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. r ~ S VCS PAGE dmm~ 1 f Ir 6 ~I I~ i r I 1 I 1 E I i l r. and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. INSURANCE The parties hereto agree that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to.the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77803 BRAZOS FAMILY PRACTICE ASSOCIATES 1301 MEMORIAL DRIVE - BRYAN, TEXAS, 77802 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement. SEVERABILITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or underfstanding, oral or written, 6 VOLPAGE OOZ.- i .1 .r 'f s r •I. t i v s t h between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully e.~cpressed herein. ASSIGNABILITY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County, otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September, 1993 By: 66 - 4 - Judge Al Jo BRAZOS VALLEY DEVELOPMENT COUNCIL By: ! ~Tom ~ r ' ~Jr~~~ PROVIDER B)r George McIlhaney, M.D,/Presideat Brazos Family Practice Associates VO PAGE i I rZ t I. f , THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAIt ARBITRATION ACT I~ t E t CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through Its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and RUDY BRINER, M.D., located in BRAZOS County hereinafter "Provider"~ RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the states poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health pre. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. 3. "The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 5. "The Program" shall mean the services offered to the Public pursuant to the AcL 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vemons Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. VOL 6 PAGE _ i i • CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided 1 herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-Cmergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. • LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND N01100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tar levy. .r . In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement ' , (3) any amounts for services provided by Provider in a period during which "the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and . f " (4) any amount for services provided to a person after the County has notified Provider by : , - telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be ' confirmed in writing by the BVDC within five (S) working days of the telephone ; ? • notification. If a prospective patient presents an Eligibility Document which Provider . VCDL PAGE it i i 1 l `r C. f E i i ,F r h k E: ~r d ~p F has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender itand shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSEBILITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. 5. Maintain this Contract and assist the parties hereto in the operation of the Program 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. S. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate patties. 14. Assist the County with all of its responsibilities under the Act. 3 VOL-X PAGE Ll 01 a r 1 5. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9, 10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. S. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. r 7. Provide for and assist with the procurement of and payment for additional audit services. i RECORD RETENTION r The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. BILLING The Provider must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above speed shall be the responsibility of the Provider. The bill shall be itemized y to identify the name, address, social security number, Eligibility Document number of the patient, type of a service provided, appropriate CPT4 code for the service, date of service, the rate for such service and all G certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC M PAGE J i• 2,~ i - f determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be ' submitted to an arbitration commission as described below. The County shall pay all uncontested bills within i I thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment. shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon j said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and i his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a i third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district i court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner + aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the !i decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both f patties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL i The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure F j and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. • . FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (101/6) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or action resulting or alleged to result from the breach, violation or non-performance of the tents and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. 5 PAGE VO 0 ~ 91 INSURANCE The parties hereto agree that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule Promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other parry at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 RUDY BRINER, M.D. 1301 MEMORIAL DRIVE BRYAN, TEXAS, 77802 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any Rather documents which may be necessary to carry out the provisions of this Agreement. SEVERABILTTY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT •I This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or undersstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not Rally vgwessed herein. r VOL PAGE ....,e,.,. ~ L ASSIGNABELXrY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County; t otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of f the County. DATED this 1st day of September, 1995 By: Judge Jones BRAZOS VALLEY DEVELOPMENT COUNCEL By: Tom Wilki PROVIDER: By: Rudy Briner. M.D. 7 VOL /0-:'-PAGE f' 6• 3 t 1 0i 01 01 , I , THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT ' CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through Its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and BRYAN RADIOLOGY ASSOCIATES, located in BRAZOS County hereinafter "Provider"). RECITALS ' ` WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the states poor and indigent enacted the indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; - NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. 3. "The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 5. "The Program" shall mean the services offered to the Public pursuant to the Act. ' 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon ; Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (h) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has i a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the r = thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the ' term hereof and of any rener%al period, upon the same terms and condition contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. y V(~ PAGE ± r~ . r t ' I If f Y • f r .C. CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. • RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all prodder, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal )car equal to ten percent (100/*) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Prodder in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (3) any amount for services prodded to a person after the County has notified Prodder by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (S) corking da%s of the telephone notification. If a prospective patient presents an Eligibility Document chich Prodder t VOL. PAGE -4407~2- • 1 has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES • In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBILITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. 5. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment 8. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Pro\ide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Act. 3 PAGC II r i r 1 r i i r ~ e E' I 1 5. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day alter receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9,10 and 1 I above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure intq the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. S. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible rxTense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act The Prodder agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. BILLING The Provider must. within ninety five (95 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address. social security number. Eligibility Document number of the patient, type of service provided, appropriate CPT4 code for the service, date of service. the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC VOL.- 12-PAGE.?-Y..1~ 4 f W . • csY determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below, The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned parry, the arbitrator appointed by the first mentioned parry shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute invoking household residency only to the TDH for resolution. The parry seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section DiNision Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernons Texas Civil Statutes. FUNDING The County shall be responsible for notif ing the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (101/6) of the County's general revenue tax levy, its total liability ~ for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its e_\penditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. 5 vo PAGE rr i t t S ~ 4i r._ . . ~t INSURANCE The parties hereto agree that the Provider shall be In independent contractor and not an agent of the County and that each shalt maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 BRYAN RADIOLOGY ASSOCIATES . P. 0. BOX 5306 BRYAN. TEXAS, 77802 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement. SEVERABILITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or underfstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed 1 herein. I . V0 PAGE f.~L1~J.r.~~. - .i - ~i - to o.t ,.4n..'io.~1ri"~ ~~Ct~ j t ~ ~ i ASSICNABaITY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the Count3r, otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September, 1995 By: Ju ge nes BRAZOS VALLEY DEVELOPMENT COUNCIL, By: Tom Wilk' n, Jr. i PROVIDER: By: -PAJOk Ernest A. Imendorf, M.D. B Ra IA ryas ogy Associates r ' a 1 ~ rY. VOL.--Z PAGE, ! _ f ~k THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through Its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and L W. COLEMAN, M.D., located in BRAZOS County hereinafter "Provider"). RECITALS WHEREAS, the care of this states poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. I t, r i~ c, DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. i t 3. "The Act", shall mean the indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act S. "The Program" shall mean the services offered to the Public pursuant to the Act 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall ha%v, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and condition contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. 1 VO=&"'-PAGE i it t ( r CANCELLATION This Contract may be canceled by any of the partimbereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT t is The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax levy, In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (S) working days of the telephone; notification. If a prospective patient presents an Eligibility Document which Provider Y, VOA PAGE r } , 1 1 t C has been notified by the BVDC is invalid. Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.). in an appropriate facility. RESPONSIBII.ITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act. including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. S. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. 3. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Act 3 dO L /0 PASO E 00 I~ a k r, r• i A •I 13. Perform all other duties and functions necessary to fulfill the requirements as outlined in - the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9,10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. f G 7. Provide for and assist with the procurement of and payment for additional audit services. i RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records Y necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. BILLING The Provider must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not ► , submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of service provided, appropriate CPT-4 code for the service, date of service, the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services v%-as an t1; Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC VO PAGE _,1,64,... 7 I I G. determines that the bill should be paid it shall send the bill to the County fbr final payment. V the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the reftrsal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. i t ARBITRATION It is hereby agreed that if. at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the ` other party, said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed In the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL 5 r• t. t The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252.13a Vcrnons Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (101/6) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program. the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tar levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. i • S VOL. P A G E - A) Y t i 01 5 INSURANCE The parties hereto agree that the Provider shall be pan independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 L. W. COLEMAN, M.D. 2713 OSLER BLVD. BRYAN, TEXAS, 77802 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement. SEVERABILITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or undersstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein. f f; F k t• L VOL`„k_. PAGE LW. C i! f i I. ~r F E ASSIGNABILITY . Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County. otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the county. DATED this Ist day of September, M By. Judge Al Jon BRAZOS VALLEY DEVELOPMENT COUNCIL By: Tom 'I ' n, Jr. PROVIDER By- L. W. Coleman, M. . i z I • 1 ' THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT „ COUNCIL (hereafter "BVDC") and NALINI M. DAVE, M.D., located in BRAZOS County hereinafter "Provider"). RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. 01 DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. 3. 'The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 5. "The Program" shall me9n the services offered to the Public pursuant to the Act. 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) option to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. 1 VdX-~ PAGE Y t f } l l CANCELLATION This Contract may be canceled by any of the parties,hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as tho Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND N01100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tar levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for senices provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (4) any amount for services provided to a person after the County has notified Prodder by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (S) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Prodder VOL----,(. PAGE AO!K. 5 T x x• RESPONSIBILITIES OF BVDC • • k I. f a S I q i N has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.). in an appropriate facility. BVDC sill be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4• Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. i. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. S. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Pro-side information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County % ith information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County %%ith all of its responsibilities under the Act. 3 VOL-12-- PAGE rj 11. 2 c • 13. / Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9,10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBa,ITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Prodder's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. BILLING The Prodder must, % ithin ninety fire (95 ) days from the date the Mandated Service is prodded or'ninety five (95) dais from the date of eligibility of a patient. submit all bills for payment to the BVDC. Bills not submitted % ithin the time above specified shall be the responsibility of the Prodder. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of service provided, appropriate CPT-4 code for the service, date of service. the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services «as an Eligible Resident at that time, review the services prodded. to ascertain and verify that all necessary cenifications have been completed. and that the bill qualifies for payment in all other respects If the BVDC VOL-k. PAGE a- - C, Jam' 11 ' 6 I ~ Q • r~ r determines that the bill should be paid it shall send the bill to the County for final payment. if the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hercallcr, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either parry may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second parry shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. t APPEAL The Providei and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. FUNDING r The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Prodder of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein t and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. r f 'r 5 PAQE,...L~.,, } V0 L A~ L i r f INSURANCE I~ I r ; I I ti c E The parties hereto agree that the Provider shall be ~n independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it. registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77803 NALIM M. DAVE, M.D. 1201 D BRIARCREST BRYAN, TEXAS, 77802 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of thii Agreement. SEVERABQ.ITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements. or underfstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement. which are not fully expressed herein. VO PAG E iii ASSIGNAB11.1TY r 1 Y` F 1 ;w r r r x~ r r` +ll F i Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County. otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September, 1993 By: CAM,=, N-d Judge Al Jones BRAZOS VALLEY DEVELOPMENT COUNCIL By: Tom Wilkinson, Jr. PROVIDER 1 e By: Nalini M. Dave, M.D. 7 VOl.~PAQE,.W-._ f P r G r r Y 5 r t II / . THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and DAVID DOSS, M.D. located in BRAZOS County hereinafter "Provider"). RECITALS WHEREAS, the care of this states poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Caro and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the states indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook' shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TD13" shall mean theTexas Department of Health. 3. 'The Act', shall mean the Indigent Health Can and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services' shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act 5. "The Program" shall mean the services offend to the Public pursuant to the Act. 6. "Emergency Services' shall have the meaning assigned by Article 4438a Vernons Texas Civil Statutes. 7. 'Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent. and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract b executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and then is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. 1 VO PAGE • CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER 0 ~ The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met, These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND N01100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by t all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten r percent (10%) of the County's General Revenue Tax levy. i In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC r shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third parry insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be r confirmed in writing by the BVDC within five (5) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider c i ' r V0 PAGE ~~J y .R i _ u.,.. .-r...-., ~1...~.+... -._~....._.i-~_ t. .t -.._..Sa.i....iaa.r.-~.r ru..}~a. _....~..w. rr,..r. -i..a r_u+ t r ' has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBILTI'IES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to-the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. 5. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. S. Maintain data files on clients and billing records to verify the county is In conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TRH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Act 3 .E VO PAGE 4 ~ . ~ 1 1 • • 01 i Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary .Y r 15. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. . 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9, 10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. i i 7. Provide for and assist with the procurement of and payment for additional audit services. i f RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. BILLING The Provider must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not K submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of service provided, appropriate CPT4 code for the service, date of service, the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services was an certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC VOIL Z - -PAGE • . ~ J 1 , 1 1{ f { determines that the bill should be paid it shall send the bill to the County Ibr final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such i rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to renter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tar levy. Upon depiction of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. VOL PAGE _ .1 01 61 j INSURANCE The parties hereto agree that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature, and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 ' BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 DAVID DOSS, M.D. 1701 BRIARCREST DRIVE BRYAN, TEXAS, 77802 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement. ! SEVERABILITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or understanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein. i i . vo PAGE X10... V4 7 i r i .s ASSIGNABILM ' Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County; otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September, 1995 B)r 64~t;= ak2z- - Judge Al Jones BRAZOS VALLEY p' COUNCIL To nson, Jr. PRO By: aY d• 7 ' PAGE.,... 1 1 ] - ~ ~ asi.Ji1.~'~".". RJR ♦ .;~G.y' ~t Yom: :~'-l^'A 1'f CI''Y~Y.+e Ay ~i . J. •I j r r e 01 r t r Y , THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through Its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and JOSEPH FEDORCHK JR., M.D., located in BRAZOS County hereinafter "Provider"), RECITALS WHEREAS, the can; of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. 3. "The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 5. "The Program" shall mean the services offered to the Public pursuant to the Act. 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernons Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in fora and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. 1 ry V0L-1L.PAGE, i F CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-cmergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges'that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for. (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (101%) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and •I 2 Vn PAGE -J on% ,J • • I , Y (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (5) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. ? QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, r rehabilitative or palliative purposes and famished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBILITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. S. n Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies , e in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. 8. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. a 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. L 12. Monitor the program on a periodic basis to check billing procedures and with TDH 5 Staff review overall Program management and operation. n 3 V O PAGE 4 f V f 1 II f r f' ~C 13. Assist and supervise the reconciling of ineligtble expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Aix. 1S. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9,10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. S. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment fbr legal services as sary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Providers provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided These records shall be made available for inspection and audit by the TDH.. BILLING The Provider must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of 4 bC) PAGE Z4,7. r, f: r; 4 4 1 01- r; i r~ f ~t service provided, appropriate CPT4 code for the service, date of service, the rate for such service and all certificates as described herein. the BVDC shall,'if it determines the person receiving such services was an Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, diff'erence or question, shall be referred to arbitration in the following manner: Either parry may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator In the event that said second parry does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned parry, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernons Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10°/9 of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-Lability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or actions resulting or alleged to result fiom the breach, violation or non-performance of the terms and conditions bend or the negligent performance of the servim stated herein 5 Vn PAGE - - it S r i V r ' t. I 1 a i t E t ' f • I and for any damage to airy person resulting from any act or omission or negligence on the part of each party hereto. INSURANCE The parties hereto agree that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature.. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 JOSEPH FEDORCHIK, JR., M.D. 2801 E. 29TH BRYAN, TEXAS, 77802 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any fWther documents which may be necessary to carry out the provisions of this Agreement. SEVERABUJff In the event that any of the provisions or portions thereof, of this Agreement are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENT= AGREEMENT This Agreement contains the entire understanding between the parties hereW concerning the subject matter contained herein Them are no representations, agreements, arrangements, or underfstanding. oral or written. 6 VOL' PAGE IL 'r. f' rr A 1 F. ti` between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein. ASSIGNABILITY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County; otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September, 1995 By: Judge Al Jon BRAZOS VALLEY DEVELOPMENT COUNCIL By: ' Tom Wilki r. PROVIDER By: h F rchik, Jr., MD. t r ~ .f VO PAGE., A5 j 1 r 4 t I f THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This; Contract It entered Into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and NASHI B. GHATTIS, M.D., located in BRAZOS County hereinafter "Provider"), RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indjgents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFII MONS 1. 'Handbook' shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. ?DH" shall mean the Texas Department of Health. 3. 'The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil ' Statutes Article 4438 (l). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 3. The Program" shall mean the services offered to the Public pursuant to the Act 6. 'Emergency Services" shall have the meaning assigned by Article 4438a Vernons Texas Civil Statutes. 7. 'Eligibility Document' shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to scrve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. VOL-~pAGE-L:94, ~ , s'.~W'L '~'as~' 5 ~ ~ ~.:.'r'..~ ly. .,v.:~'~.~ ~..i~:5l fik ~ 1r.i~ , ~ . i CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of ' such rates shalf be the responsibility of the Provider. • LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing • facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO/100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten . percent (10%) of the County's General Revenue Tax levy. Y In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC t i shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services providod to a person who is not an Eligible Resident or for ' services not covered by this Agreement. ' (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and u Z t ' r VOL. PAGE- a7. ! (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A i telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within rive (S) working days of the telephone ` notification. If a prospective patient presents an Eligibility Document which Provider , has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES P In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBILITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: E 1. Providing of all necessary application forms to potentially eligible individuals. r r 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. f 3. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment 8. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period 9. Provide information to the parties as needed 10. Respond to all and any inquiries regarding the Program, 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to chock billing procedures and with TDH ' Staff review overall Program management and operation. 3 VO PACR. . `r y r J~ • F 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Act. 15. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9, 10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. . Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided These records shall be made available for inspection and audit by the TDH.. BELLING The Provider must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of 1 4 V01- A.PAGE .1. f t to r` U service provided, appropriate CPT4 code for the service. date of service, the rate for such service and all certificates as described herein. the BVDC shall,lif it determines the person receiving such services was an Eligible Resident at that time. review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party, said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (I5) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernons Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program INDEMNITY I The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, violation or j non-performance of the terns and conditions hereof or the negligent performance of the services stated herein i~ S~ V0 % rY C31 61 r and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. INSURANCE The parties hereto agree that the Provider shall be an independent contractor and not an agent of the County , and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77893 NASHI B. GHATTIS, M.D. 1605 ROCK PRAIRIE ROAD #220 COLLEGE STATION, TEXAS, 77840 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement SEVERABILITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. 6 VOL PAGE I 7 VO ' PAGE ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements. or underfstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein. ASSIGNABILITY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County; otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1 st day of September, 1995 QQ~~- By: Judge Al Ones BRAZOS VALLEY D RMENT COUNCIL By. Tom Wilkinson, PROVIDER: n By. N Vi . Ghattis, M.D. ,x ''i t r t i 0~ 01 4 i THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and JAMES GILES, M. D. located in BRAZOS County hereinafter "Prodder"). RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the states poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook 4 developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. 3. "The Act% shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 5. "The Program" shall mean the services offered to the Public pursuant to the Act. 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other } document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for z amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. I I Vol PAGE ..1~ y 1 t ' i l 1 ti i ~I CANCELLATION This Contract may be canceled by any of the partiMhereto upon sixty (60) days written notice as provided herein. ' SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met, These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services, The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total Payment of THIRTY THOUSAND AND N01100 DOLLARS (S30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payrnent to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tar levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (•t) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (S) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider nt_.~44 _PAGE J,04`--- V • has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic. therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBILITIES OF BVDC • r i F BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. 5. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. 8. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Act. 3 VOL b PAGES +Y f I , L , I 1• II tr t t r. Is. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9,10 and 1 I above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as - necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The prodder shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Prodder's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. BILLING The Provider must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient. submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, cape of service provided, appropriate CPT4 code for the service, date of service. the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC VOA PA®E.JAA P i • ~ • n I determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish 3o contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after recei%ing notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. • APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The parry seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section DiNision Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernons Texas Civil Statutes. • r i r FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. M INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims. demands. liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. 5 VOL,~.._. PAGE ....ZJ7 , /r a .7 :S i' V t I i r INSURANCE The parties hereto agree that the Provider shall bean independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects. this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 JAMES GILES, M.D. 1602 ROCK PRAIRIE ROAD COLLEGE STATION, TEXAS, 77840 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement. SEVERABILITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or underfstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein. A 80 PAGE VOA iI i 'I '44, rr:- ...:L ~b! • ..y.^..._ , J soe..~ ' ~ - tJ .~ti• - L. r 4.' I' •uLJt.,~t.ui~L~~ , . t . P. t~ 1. „ •I i 4 1 f Y F i ~i L ASSIGNABaITY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County', otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written oonsent of the County. DATED this 1st day of September, 1995 By. . Judge Al ones BRAZOS VALLEY DEVELOPMENT COUNCIL By: om Wilkinson, )r. PROVIDER: ~j By: mes B. Giles, M.D. lY 1~'- 1 r i 1 t } S • '1 4 i s ,{k V~ PAGE 139' w .r ~ t ~t F' f f t THE CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through Its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and KARIM HAJI, M.D., located in BRAZOS County hereinafter "Provider"), RECITALS WHEREAS, the care of this States poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. ' I DH" shall mean the Texas Department of Health. 3. "The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (fj. 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. S. "The Program" shall mean the services offered to the Public pursuant to the Act. 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card. certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, L, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. 1 r, r i s. CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered. expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. • LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) day's (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 ; DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by r all provider, whichever comes first; and : (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten L percent (100/*) of the County's General Revenue Tar levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC i shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to w receive, assistance for Mandated Services from a third party insurer or under a f` governmental program. ` (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. I " (3) any amounts for services provided by Prodder in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and a~ any amount for services prodded to a person after the Count' has notified Prodder by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be v confirmed in writing by the BVDC within five (S) working days of the telephone , ' 6 notification. If a prospective patient presents an Eligibility Document which Prodder ; r r rt F / VO PAG E 1 t ' f i r 1- V t ....L .r has been notified by the BVDC is invalid. Provider shall-request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBILITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. 5. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. 8. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate patties. 13. Assist the County with all of its responsibilities under the Act. 3 vow-~.sAOV, ~/,z 4 • 1. , , i' a • 01 i i r P S l D i 1 t r• ~a r' .r 15. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9, 10 and I1 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon' request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided, These records shall be made available for inspection and audit by the TDH.. BILLING The Provider must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety five (95) da%s from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identifv the name, address, social security number. Eligibility Document number of the patient, type of service provided, appropriate CPT4 code for the service. date of service, the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time. review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects if the BVDC e Vd PAG E ..L., 7 It i7 • v ~y r r• tffr determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC i~ r ' determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such i rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be subntitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same, ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the ( County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, ! every such dispute, difference or question, shall be referred to arbitration in the following manner: Either ! party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party, said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second parry does not, within a period of fifteen (15) days after receiving notice from said first mentioned parry, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to /1\ the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDR The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernons Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the ~ year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its e-\penditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims. demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. 5 VdL'-~.PAOF 111y[ , l ,f~ 1. . I r~ 01 01 Y ' y r~ r r-- s % INSURANCE The parties hereto agree that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: 4 BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 ' BRYAN, TEXAS, 77805 i• KARIM HAJI, M.D. 2703 OSLER BLVD. BRYAN, TEXAS, 77802 FURTHER ASSURANCES h Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement. 4 SEVERABILITY r. ' In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or underfstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not fWly expressed herein. 4 s t Vn PAGE ~ v .t 'f i q i , h ASSIGNABUM i + Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County. otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September. 1995 i ~ By: ct~~ Z - - Judge Al Jones P BRAZOS VALLEY DEVELOPMENT COUNCIL Itm' Wilkinson, Jr. n, Jr. PPROVI DER: By: x I ' THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through its i duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and JAMES M. KIRBY, M.D., located in BRAZOS County hereinafter "Provider"). RECITALS ` WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health rare. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. 'TDH" shall mean the Texas Department of Health. 3. "The Act", shall mean the indigent Health Care and Treatment Act, Texas Revised Civil r Statutes Article 4438 (f). i 4. "Mandated Services' shall mean those services which hospitals and doctors may provide to indigents and obtain reimbursement therefor from the County pursuant to the Act. 5. "The Program" shall me4n the services offered to the Public pursuant to the Act. 6. 'Emergency Services" shall have the meaning assigned by Article 4438a Vernon s Texas Civil Statutes. J 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. r TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) option to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein ` except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a f part hereof for all purposes. 1 VOL A----PAGE A?. i w Iti I I~ i ' I I~ , ~ . a r s 'Y CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges. that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for. (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or Wiled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND N01100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and - (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and 2 40 PA,V%Ao S. VCS • 1 (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (5) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. • t~ u RESPONSIBILITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. t 2. • Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures.defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. 5. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. 8. Maintain data files on clients and billing records to verify the county is in conformity • with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period 9. Provide information to the parties as needed 10. Respond to all and any inquiries regarding the Program 11. Assist the County with information needed for audit purposes. i 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 3 r VOL. t" ~S I r 13. Assist and supervise the reconciling of ineligible acpenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Act 1s. Perform all other duties and functions necessary to fiM the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9, 10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as Wary 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may quality under the Act The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Providers provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided These records shall be made available for inspection and audit by the TDH.. BILLING The Provider must, within ninety five (93 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of 4 VO -PAGE Z-44P.Lw vJ 4 ' l • 6I service provided, appropriate CPT4 code for the service, date of service, the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shalt arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party-. said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a i third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both ' parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. e FUNDING r The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or anions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein S t VO .PAQF ,_LS re 3 k t T and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. ' INSURANCE The parties hereto agme that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT ' This contract shall be automatically amended by the amendments made to the Act by the State Legislature.. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be v=ted in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, th the other party at the following addresses: BRAZOS COUNTY C BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77843 BVDC r 1706 EAST 29TH STREET P.O. DRAWER 4128 ( BRYAN, TEXAS, 77805 JAMES M. KIRBY, M.D. ' 2801 E. 29TH ST. BRYAN, TEXAS, 77802 t FURTHER ASSURANCES Each party hereto agmes to perform any further acts and to execute and deliver any lhrther documents which may W necessary to carry out the provisions of this Agreement SEVERABILITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or ` invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or undwfstanding, oral or written, 6 VO c JFrbA0F /S 2- a 1 . 1 ~ I f s f l: Y V • between or among the parties hereto, relating to the subject matter of this Agrccnx . which are not frilly expressed herein. • • r t f 1 7 i k k i. f t e z i ASSIGNABILM Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County. otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September, 1995 By: cz~, I "Nudge Al ones BRAZOS VALLEY DEVELOPMENT COUNCIL By; Tom Willd r. PROVIDER: By. James Ikirby, M.D. Vn PAGE... t' i. y L i j Rai S•. ii - r, F r i' r i r i. r r. k THUS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract Is entered Into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and J. C. LEE, M.D., located in BRAZOS County hereinafter "Provider"). RECITALS WHEREAS, the care of this states poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. 3. "The Act% shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 5. 'The Program" shall mean the services offered to the Public pursuant to the Act. 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in fora and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the some terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Senices, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. INSURANCE 1 i l 1 r h • ~J CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT t • The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LL433ELM FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS (530,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third parry insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (3) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider VOL PAGE •4f r i J , 1 t ` .r _ .I 'Zo i has been notified by the BVDC is Invalid. Provider shall.request the holder of the u eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. TJ• QUALIFIED SERVICES r In order to obtain reimbursement for Mandated Services to be provided to Indigents the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician Q413. or D.O.), in an appropriate facility. RESPONSIBILITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. 3. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Pro%rider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment g. Maintain data files on clients and billing records to verify the county is in conformity % ith the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County % ith information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and --rith TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. la. Assist the County % ith all of its responsibilities under the Act. 3 VOL-!---PA0Eja...' - rX F i t t E C ]I F~ Is. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9,10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 3. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. r RECORD RETENTION 3 The provider shall be responsible for record keeping on all services provided to those indiNiduals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the senice was provided. These records shall be made available for inspection and audit by the TDH.. BILLING The Provider must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety five (93) da,.s from the date of eligibility of a patient. submit all bills for payment to the BVDC. Bills not i submitted within the time abov a specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number. Eligibility Document number of the patient, type of service provided, appropriate CPT- code for the service. date of senice, the rate for such senice and all certificates as described herein. the BVDC shall, if it determines the person receiving such services %vas an sl t Eligible Resident at that time. review the services provided. to ascertain and verily that all necessary certifications have been completed. and that the bill qualifies for payment in all other respects If the BVDC VOL, - 44 PAGE 1 i determines that the bill should be paid it shall send the bill to the County for final payment If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second parry does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned parry, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The ProNider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The parry seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH- The office shall conduct a hearing and issue its final decision NvitWn twenty-one (21) days of the date of request The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernons Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total &\penditures for the year on the Program have reached ten percent (101/6) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and agaipst all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each pan hereto, S vow PaaE,.,~4f 41 r~ 01 01 The panics hereto agree that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequat8 liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 J. C. LEE, M.D. P. O. BOX 3505 BRYAN, TEXAS, 77805 f FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may > be necessary to carry out the provisions of this Agreement. SEVERABILITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT 01 • This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or underfstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not tally expressed herein. A C 9 C ASSIGNABILITY rj , r• I t ,r ~.4.4•• ' Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County-, otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this Ist day of September, 1993 By. . Judge Al Jon BRAZOS VALLEY DEVELOPMENT COUNCIL By: Tom Willti r. t• PROVIDER f By: Azzz~ f . J. C. M.D. f c i t 401 THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT ' COUNCIL (hereafter "BVDC") and JAMES L LINDSAY, M.D., located in BRAZOS County hereinafter "Provider"). RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. 3. '"The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). t 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act 5. "The Program" shall mean the services offered to the Public pursuant to the Act f' 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. x 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first i (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) option to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. t ' ? ~ 1 vo PAQK:. C .r 1 1. S I i A• i r CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty '(60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO/100 DOLLARS (S30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not cov eyed by this Agreement. (3) am• amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (a) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in w riting by the BVDC within five (S) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider PAGE VOL 9- i 4 i~ l • has been notified by the BVDC is invalid. Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service Has medically necessary and the service was performed for diagnostic, therapeuticti rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. E • RESPONSIBILITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. S. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services an d review the same to verify that the patient aas an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. t - r 8. Maintain data files on clients and billing records to verify the county is in conformity %%ith the limitations on the amount of money or in hospital care any one indigent may ' recei% a in a one (1) year period. 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 13. Assisi and supervise the reconciling of ineligible expenses with the appropriate parties. 14. e r Assist the County ttith all of Its responsibilities under the Act. 3 VO PAQE . i J I ' i Is. Perform all other duties and functions necessary to Will the requirements as outlined in ' the Act and the TDH Handbook. t 16. Review the eligibility of each household every six (6) months. i 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9, 10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY Y i The County shall be responsible for the following duties and requirements; i ' 1. Provide County funds for the payment of Mandated Services. r2. Provide County funds for the administration of the Program through the BVDC. i3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. r- f 4. Provide an audit of the Program as required by state law. f S. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible &\-pense. 6. Provide for and assist with the procurement of and payment for legal services as I necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. t RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may quality under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was prodded. These records shall be made available for inspection and audit by the TDH.. BILLING The Prodder must. within ninety five (95 ) days from the date the Mandated Senior is provided or ninety five (93) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identifv the name, address. social security number, Eligibility Document number of the patient, type of service prodded, appropriate CPT4 code for the service, date of service, the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time, review the services provided. to ascertain and verify that all necessary centfications have been completed, and that the bill qualifies for payment in all other respects If the BVDC VdL.A ...._P1AQF,...Zg, if f r i.- I • • r determines that the bill should be paid it shall send the bill to the County for final payment. if the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second parry shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned parry, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (IS) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Prodder and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total eependitures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 100/0 of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. l[NDEIINITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the pan of each party hereto. i 1 J 5 vo PAOE. 6 r . t t i. i I 1 • % INSURANCE The parties hereto agree that the Provider shall be en independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities hich ma arise due to the duties and obli tions contracted for herein I i F:• y ga AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH. in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it. registered mail. to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN. TEXAS. 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS. 77805 JAMES I. LINDSAY, M.D. P. 0. BOX 3139 BRYAN, TEXAS, 77803 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any Anther documents which may be necessary to carry out the provisions of this Agreement SEVERABILIITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by. arty court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or »nderfstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein. PAGE 14oA„ 4 5~,~ ii • 1 i • Y ASSIGNABILITY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County; otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September, 1995 By: _ a . 021 Judge Al Jones r 4 i i r~ F t J f i f, r i BRAZOS VALLEY DEVELOPMENT COUNCIL 0-1 By: Tom Wilkinson, J PROVIDER: By: I James I. Lindsay, M.D. 7 vo 6 PAGR b vJ - p t t i l t This Contract is entered Into by and between BRAZOS COUNTY, TEXAS, acting by and through Its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and MARK B. LINDSAY, M.D. located in BRAZOS County hereinafter "Provider"). RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. ' MH" shall mean the Texas Department of Health 3. "The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act 5. "The Program" shall mean the services offered to the Public pursuant to the Act 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in fora and effect for a term of no more than one (1) year commencing on the first (lit) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services. rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. 1 VOL. PAGE *M ~ c THIS CONTRACT 1S SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT 1 R_ A • CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature, The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. • LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and , (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for • services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be ` confirmed in writing by the BVDC within five (5) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider vo PAG1 r~ l L . has been notated by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBaITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. S. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. 8. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed 10. Respond to all and any inquiries regarding the Program. It. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. L 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Act. 3 VO --PAGE-L7-2?- i I I ~r 6 } 1 • i • V ,F 'r r I VOL-4-- PAGE _Zpj' r I Y P .ti 15. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. . 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9, 10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. BILLING The Provider must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of service provided, appropriate CPT4 code for the service, date of service, the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC t . S t determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same. the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the I County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, I every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon E said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL i E The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and condition hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. S VO PAQZ /A.. VI % i i~ t~ N a ''i 01 r •i r f r a f r INSURANCE The parties hereto agree that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other parry at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 MARK B. LINDSAY, M.D. 2725 E. 29TH STREET BRYAN, TEXAS, 77802 FURTHER ASSURANCES Each parry hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement. SEVERABa,ITY In the event that any of the provisions or portions thereof, of this Agreement. are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or underfstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein VOt,~pAQE11,3 a• f; r., i i ASSIGNABILPPY Provider shall have the right to assign this Contract and any of its rights hereunder to "holly owned subsidiary or to a corporation with which it may be merged without prior written eonsen of the County; otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September. 1993 I By. Judge A1Jones f BRAZOS VALLEY DEVELOPMENT COUNCIL By: PRO By: t F f I "()L,-~PAGE ,r ova" d A • • THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT s This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and BRYAN NEUROLOGY SERVICES, located in BRAZOS County hereinafter "Provider"). ` RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. 'TDH" shall mean the Texas Department of Health. 3. "The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 5. "The Program" shall mean the services offered to the Public pursuant to the Act 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. • TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 19%. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requiremeats which are incorporated herein and made a part hered . for all purposes. voll~pAaE..[Zs i i CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LlM1T ON COUNTY'S LIABILITY FOR PAYMENT h~ The County shall be responsible for. (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS (530,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all prmiders in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third parry insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Prodder in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (4) anv amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (5) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider vo PAGE i i , 1 01 3 z has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service %%-as medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility, RESPONSIBILITIES OF BVDC BVDC %ill be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals, 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. S. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment 8. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County AAith information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and vith TDH Staff re%iew overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses %%ith the appropriate parties. 14. Assist the County with all of its responsibilities under the Act. 3 V0 r'd PAGE-1.".. 4 i' 1L• r is. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. Is. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. •BVDC will provide the services designated as numbers 1,3,4,6,8,9,10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. s. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible eepcnse. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service vvas provided. These records shall be made available for inspection and audit by the TDH.. BILLING The Provider must, within ninety five (95 ) days from the date the Mandated Service is provided or.ninety five (93) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of service provided, appropriate CPT4 code for the service, date of service, the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects if the BVDC Vt~ PAOle r j ti , • determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a i third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Prodder and the County shall have the right to submit a dispute invoking household residency only to the TDH for resolution. The parry seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision wvithin twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. FUNDING t The County shall be responsible for notifjing the BVDC and the Provider %,.hen its total expenditures for the year on the Program have reached ten percent (101/6) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. 01.1 VI 5 VOL,~ PAGE -ZZO r~ . I 9t 7 i} . r i / INSURANCE The parties hereto agree that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW i This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES i All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 778Q3 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 RANDALL R. LIGHT, M.D. 1307 MEMORIAL DRIVE BRYAN, TEXAS, 77802 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may } be necessary to carry out the provisions of this Agreement. SEVERABELITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid f by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. I ~y 4 ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or underfstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein. V 0 L--~ PA Q F. -MP I. L a • ASSIGNABILITY • r N Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County, otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September, 1995 By: Judge Al Jone9K BRAZOS VALLEY DEVELOPMENT COUNCIL By: Tom Wilkinson, Jr. PROVIDER: By: 4~~ Randall Light, M.D. Bryan Neurology Services 7 VO PY j i _ _ - _ .tee .-s__. -.~...L _-........-.1~-.. i 1 1 f s' THIS CONTRACT L4 SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT w i CONTRACT Thb Contract is entered Into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and MICHAEL MCMAHON. M.D., located In BRAZOS County hereinafter "Provider"). RECITALS WHEREAS. the cane of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health are. DEFINITIONS 1. 'Handbook' shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. 3. 'The Actshall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services' shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. S. 'The Program' shall mean the services offered to the Public pursuant to the Act. 6. 'Emergency Services' shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on'the first (lot) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, anor the State Legislature with regard to Mandated Services, rate schedules and other requirements which incorporated herein and made a part hereof for all purposes. 1 VD PAGE --"I, f • Y CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER • • The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, t exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county~s fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services- and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third parry insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within rive (5) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider 3 VO PAGE ..L.,~.3 i ' Y has been notified by the BVDC is invalid. Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must eert* that the service was medically necessary and the service was performed for diagnostic, therapeutic. rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSEBELITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. t 5. Maintain this Contract and assist the parties hereto in the operation of the Program. E 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. 8. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Act 3 vo PAQ r, i~ 01 .w _ 15. Perform all other duties and functions necessary to fulfill the requirements as outlined in ; the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9,10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. r RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. . 7. Provide for and assist with the procurement of and payment for additional audit services. ' RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes . ' may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. BILLING The Provider must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety ` five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of " service provided, appropriate CPT4 code for the service, date of service, the rate for such service and all ; r certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary f certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC ' PAU ..~5- r~ _ _ I, E / determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC i? determines that a bill should not be paid, or the Cougty rejects the same, the BVDC shall send notice of such a rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within r thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and. upon making such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned parry, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators i as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district i I court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The parry seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tar levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and agairist all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. 1_~\ 5 V A L. l 5 V0 PAGE i f M 01 •I 91 t INSURANCE The parties hereto agree that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature.. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 r MICHAEL McMAHON, M.D. 1602 ROCK PRAIRIE ROAD COLLEGE STATION, TEXAS, 77840 f FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement. SEVERABILITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be effocted thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or undersstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not idly c: pressod herein. r r 1 V0 PAGE rJ ti r l F r I I I e t ASSIGNABU.rrY Provider shall have the right to assign this Contract and arty of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County. otherwise. this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September. 1995 By: 6&--zqf~ Judge Al Jon BRAZOS VALLEY DEVELOPMENT COUNCIL By: Tom Wilkinson PROVID By: Michael McMahon, M.D. ._8merVe11ey-Ear, Nose dt 'goat 6011,fjeh`.~t MICHAEL F. WMAHON, MW COLLEGE STATION E.N.T 1605 ROCK PRAIRIE RD. COLLEGE STATION, TX 77845 PAQF Vo,_/a `ii~` ` _ •a - '-k.. .'ice 'vr' -1sr `r~ r c s' 01 c f l i i } n i l C r THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and GARY MARK MONTGOMERY, M.D. located in BRAZOS County hereinafter "Provider"). RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health rare in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide hcalth care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. 3. "The Act', shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 3. "The Program" shall mean the services offered to the Public pursuant to the Act. 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) option to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. VOL~PAGE / 49I ~.r f I. ' t t r . r I CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs In excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for. (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO/100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (S) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider Vol. PAGE r~ i • has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBILITIES OF BVDC t BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application fortes to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. • S. Maintain this Contract and assist the parties hereto in the operation of the Program 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for paymerit to the appropriate county for verification and payment. 8. Maintain data files on clients and billing records to verity the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Act. 3 VO PAGE .1 v/ 15. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,9,9, 10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 3. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided These records shall be made available for inspection and audit by the TDH.. BILLING The Provider must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted %ithin the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of service prodded, appropriate CPT4 code for the ser%ice, date of service, the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC VOL 66' PAGE L 12, r V a. dctcrmincs that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the Couqty rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time heralftcr, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. • APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tar levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each parry hereto. • 5 VOL-~PAQE,tf~, INSURANCE The parties hereto agree that the Provider shall be in independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 GARY MARK MONTGOMERY, M.D. 1701 BRIARCREST DRIVE BRYAN, TEXAS, 77802 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement. SEVERABILITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or underfstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not fWly expressed herein. S voL-A4._pAaF,Jfy r~ t c• I " • ASSIGNABILITY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County'. otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September, 1995 By: Judge Al Jon6s ,i 7 1O PAS r • ie. . r BRAZOS VALLEY DEVELOPMENT COUNCIL By: Tom W~ r. THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered Into by and between BRAZOS COUNTY, TEXAS, acting by and through its t duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and RICHARD MORGAN, M.D., located in MADISON County bereinafter "Provider"). RECITALS i i• i i f~ C f ~kk t~ WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "I'DH" shall mean the Texas Department of Health 3. 'The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 M. 4. 'Mandated Services' shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 3. 'The Program" shall mean the services offered to the Public pursuant to the Act 6. 'Emergency Services' shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. i ' 1 QFm p VO JAl. -Lq- _ • j, t CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the rase of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT i i ti 01 E R The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility rare or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS (530,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and . (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) arty amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and . 2 Y , s (4) any amount for services provided to a person after the County has notified provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (5) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic. therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSBELITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. 5. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and paymem a. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 3 s • 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Act. 15. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 1s. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9, 10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate • this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. a Such records shall be retained for at least four (4) years from the date the service was provided These records A shall be made available for inspection and audit by the TDH.. BELLING E The Provider must, within ninety five (93 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of 4 d I- _ r r' R ,l .t r F 3. fI=. f . } G service provided, appropriate CPT4 code for the service, date of service, the rate for such service and all certificates as described herein. the BVDC shall, -if it determines the person receiving such services was an Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure ` and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for farther funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or action resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein 5 Ij vo PAGE.Adw L~z~...#~..•~-s.t-'., sic_..~d...~.r~..c-..~, .i, ~.t~~~ ~ -.s. .`.r,n+ ~ '1 _ i ,/1_\ C ]I i i r, i 1 and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. INSURANCE The parties hereto agree that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77843 RICHARD MORGAN, M.D. P. 0. BOX 697 MADISONVILLE, TEXAS, 77864 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement SEVERABU TTY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTITLE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or underfitanding, oral or wnUM 6 t: VC? PAGE - . r i =~1 _ r_.. _ _ u~_. _ _ N.•+ _.~W r._ .i. .jam........ ....+a.w t I t i• f t i I between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein. I d f i ff, ASSIGNABILPIY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County, otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September, 1995 By. - Judge Al Jon BRAZOS VALLEY DEVELOPMENT COUNCII. By: om Willci r. PROVIDER By: Richard Mor 7 IMAGE r, 1 • i A THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and STEVE OPERSTENY, M. D. located in BRAZOS County hereinafter "Provider"). RECITALS 4 r •I , ti r t WHEREAS, the care of this State's poor and indigent has become a gro«ing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. 3. "The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 5. "The Program" shall mean the services offered to the Public pursuant to the Act. 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and condition contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof, for all purposes. ' 1 vo~.~PAGE. -s r~ - i f i• 1 r' k J t 4 r i CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT i t t i f F The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for. (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (100/6) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: D. (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (3) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (S) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider 1 V0L--~PAQF,..A,0(4 ~r,~ A • has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic. rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBILITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. ! 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant % ith regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and i following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. 5. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same ' to verify that the patient was an Eligible Resident at the time and that the bill qualifies ' in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. S. Maintain data files on clients and billing records to verify the county is in conformity i with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. i 9. Provide information to the parties as needed. r 10. Respond to all and any inquiries regarding the Program. 11. Assist the County % ith information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses %%ith the appropriate parties. i 13. Assist the County with all of its responsibilities under the Act. 3 VO L.--,4~ _PAGE fj r , fi J r t. mow, I Is. Perform all other duties and !unctions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9,10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBQ.ITY OF COUNTY V-0 e: The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 3. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. BILLING The Prodder must, within ninety five (95 ) days from the date the Mandated Service is prodded or ninety fi%e (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Prodder. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of service provided. appropriate CPT4 code for the service, date of service, the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time. review the services prodded, to ascertain and %erify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC V0L---~.PAQF,_A,0k r I iF f• t+ A 7j~ • determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise bcta,ecn the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second parry shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon panics. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either parry, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernons Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider %%hen its total expenditures for the year on the Program have reached ten percent (100/6) of the County's general revenue tar levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tae levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Prodder of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims. demands, liabilities or actions resulting or alleged to result from the breach. violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from'any act or omission or negligence on the pan of each parry hereto. 101 ; 5 PAGE .Jog V 1 U 10 I, 1L I I l ~I t t `r INSURANCE The parties hereto agree that the Provider shall be An independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,, and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shalt be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC " 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 STEVE OPERSTENY, M.D. 1602 ROCK PRAIRIE ROAD COLLEGE STATION, TEXAS, 77840 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any Aluther documents which may be necessary to carry out the provisions of this Agreement. SEVERABULJTX In the event that any of the provisions or portions thereof; of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or underfstanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein. VOPAQE .Ape r i 1e a.- i. r' 1` rr ASSIGNABILITY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County; otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1 st day of September, 1995 By: Judge Al Jon BRAZOS VALLEY DEVELOPMENT COUNCIL. By: Tom Willdnso PROVIDER,, • By: Steve OperstenyD. i M e i:y I I 1 4 i 1 l r I r f f f t, t' k E i i i a THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract b entered Into by and between BRAZOS COUNTY, TEXAS, acting by and through Its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and GEORGE RICHARDSON, M.D. located in BRAZOS County hereinafter "Provider"). RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health taro to the States indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Caro Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. 'TDH" shall mean the Texas Department of Health. 3. "The Act", shall mean the Indigent Health Caro and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act S. 'The Program" shall mean the services offered to the Public pursuant to the Act 6. 'Emergency Services' shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. 'Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminateon the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period. upon the some terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. r I I , i s VOL-06- -,PAGE ff"Em c • CANCELLATION This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT • • The County shall be responsible for: G (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO/100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to ' . receive, assistance for Mandated Services from a third parry insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Provider in a period during which the person's ' Eligibility Document indicates that the person is ineligible for Indigent Care; and t r (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A i. telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (S) working days of the telephone l j notification. If a prospective patient presents an Eligibility Document which Provider i y VOL. .PAGE , d y t i r i• r i } ' QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. r r r t i. i• has been notified by the BVDC is invalid. Provider shall request the holder of the eligibility Document to surrender it-and shall send any such surrendered documents to the BVDC. RESPONSIBILITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. I p 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial f , qualifications pursuant to the procedure and qualifications pursuant to the procedure and j qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and ' appeals on the issue of household eligibility. 5. Maintain this Contract and assist the parties hereto in the operation of the Program. i 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. 8. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. i 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. I1. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Act. 3 • VU r AGE . 1. 1 r I N a{p k • 01 • -J ••,i te r- J 15. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9,10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. • Provide an audit of the Program as required by state law. 3. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. i RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County ` upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. BILLING The Provider must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety K five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient. type of service provided, appropriate CPT-4 code for the service, date of service, the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC VO -PAGE-21-1 , Y e vi t { r J r r E I I~ determines that the bill should be paid it shall send the bill to the'County for final payment, If the BVDC determines that a bill should not be paid, or the Cougty rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if. at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned parry, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either parry, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL FUNDING INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or action resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each parry hereto. The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. , The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. 5 YO PAQEAlq,_ ,t iii I,- 61 1_ INSURANCE The parties hereto agree that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and ` by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 - BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 GEORGE RICHARDSON, M.D. 2801 E. 29TH STREET t BRYAN, TEXAS, 77802 f P - FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may t be necessary to carry out the provisions of this Agreement. SEVERABI.ITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or underfstanding, oral or written, between or among the parties hereto. relating to the subject matter of this Agreement, which are not fully expressed 'z herein. r i VOL- t - 9 . F 4 10 ~ t t_ Iry I L ICI, r t~ ASSIGNABILITY Provider shall have the right to assign this Contract and any of its rights hereunder to a-wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County, otherwise. this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September, 1"S By: -,-I - Judge Jones BRAZOS VALLEY DEVELOPMENT COUNCIL By: Richardson, M.D. 7 VO f • z THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS. acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and MARK B. RILEY, M. D. located in BRAZOS County hereinafter "Provider"). RECITALS i WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the states poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health rare in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. 3. "The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised • Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 5. "The Program" shall mean the services offered to the Public pursuant to the Act 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August. 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. • 1 PAQFk i k 1 e , E CANCELLATION t This Contract may be canceled by any of the parties,hercto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Prodder agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as.such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) day's (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tar levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party insurer or under a governmental program. (2) any amount for services prodded to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) am' amounts for services provided by Prodder in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and (3) any amount for services provided to a person after the County has notified Prodder by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (S) norking days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider Vol. t • ' has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBILITIES OF BVDC BVDC gill be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and I -appeals on the issue of household eligibility. S. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment. to the appropriate county for verification and payment. 8. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the Countywith information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. z s 14. Assist the County %xith all of its responsibilities under the Act. is f 3 h t I e f i i I t iY t is. Perform all other duties and functions necessary to fUlfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. Is. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9,10 and I I above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: h Y 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. S. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Ace. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. BILLING The Provider must, within ninety five (93 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of service provided, appropriate CPT4 code for the service. date of service. the rate for such service and all certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifics for payment in all other respects If the BVDC h • • a determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider % ish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either parry may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned parry, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision % ithin twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernons Texas Civil Statutes. FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY • f A j~ Q :t The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands, liabilities or actions resulting or alleged to result from the breach, violation or non•performnnce of the terms and conditions hereof or the negligent performance of the senices stated herein and for any damage to any person resulting from any act or omission or negligence on the pan of each party hereto. 5 VO PAQk .9 07,/ . i 1 t k i .A- INSURANCE The parties hereto agree that the Provider shall be in independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 MARK B. RELEY, M.D. 1602 ROCK PRAIRIE ROAD COLLEGE STATION, TEXAS, 77840 FURTHER ASSURANCES Each parry hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement. SEVERABILITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or underfstanding, oral or written, i between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein. I VOL~A -PAIDE A, 14 ~J A r~ T 1. 11 ASSIGNAB)TM Provider shall have the right to assign this Contract and airy of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County; otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1 st day of September, 1995 By. . Judge Al Jones R r • i i i r r r i BRAZOS VALLEY DEVELOPMENT COUNCIL By: Tom Wilkins PROVIDER: ~ 0- By: Mark B. Riley, MD. 7 VC) • ~r THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract Is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and BARRY SOLCHER, M.D., located in BRAZOS County hereinafter "Provider") RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the states poor and indigent enacted the indigent Health Care and Treatment Act, providing for indigent health care in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health rare to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. 2. "TDH" shall mean the Texas Department of Health. 3. "The Act', shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act. 3. 'The Program" shall mean the services offered to the Public pursuant to the Act. 6. 'Emergency Services" shall have the meaning assigned by Article 4438a Vernon Texas Civil Statutes. 7, "Eligibility Document" shall mean the Identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) options to renew this Contract for a period of one (1) year in each instances to follow consecutively upon the expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein except for amendments made by the State Department of Human Services, and/or the State Legislature with regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a part hereof for all purposes. i VOL--_.PAGE~ 4.. I i 1 CANCELLATION .l- This Contract may be canceled by any of the parties hereto upon sixty (60) days written notice as provided herein. SERVICES TO BE PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the rase of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. u RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT r~ The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND N01100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and - (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (10%) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third party inst= or under a governmental program (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement (3) any amounts for services provided by Provider in a period during which the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and 2 vo PAQ~~ (4) any amount for services provided to a person after the County has notified Provider by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (S) working days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider has been notified by the BVDC is invalid. Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBILITIES OF BVDC BVDC will be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary foams and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. 3. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment. S. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may receive in a one (1) year period. 9. Provide information to the parties as needed 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 3 Iro P~® iliimmviii;!~ E. r • i • i, 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Act 15. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6) months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 1s. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1.3,4,6,8.9. 10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. • Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. 5. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and make available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Providces provision oft' Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the MR. BELLING The Provider must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Provider. The bill shall be itemized to identify the name, address, social security number, Eligibility Document number of the patient, type of 4 v0L -4 PAGE 7-w f i f r 4 f service provided, appropriate CPT4 code for the service, date of service, the rate for such service and all certificates as described herein. the BVDC shall, If it determines the person receiving such services was an Eligible Resident at that time, review the services provided, to ascertain and verify that all necessary certifications have been completed, and that the bill qualifies for payment in all other respects If the BVDC determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION It is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either parry may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party, said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (15) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner aforesaid shall proceed with all reasonable dispatch to hear and determine the matter In dispute and the decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The parry seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section Division Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. FUNDING M. The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state snatching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 106/0 ; of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County'shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program . i. INDEMNM The parties limo agree to indemnify one another for and hold one another harmless from and against all suits, claims, demands. liabilities or action resulting or alleged to result from the breach, violation or non-performance of the terms and condition hereof or the negligent performance of the services stated herein r" s S ~ s ~J S • t and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. INSURANCE The parties hereto agree that the Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN; TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 BARRY SOLCHER, M.D.. 2901 E. 29TH ST. STE.!l113 BRYAN, TEXAS, 77802 FURTHER ASSURANCES Each party hereto agrees to perform any further acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement. SEVERABILITY In the event that any of the provisions or portions thereof, of this Agreement, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or undersstandin& oral or written, 6 VOL PAGE % I , f F I l between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein. ASSIGNABILITY Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County. otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September, 1995 I By. • Judge Al Jo r t BRAZOS VALLEY DEVELOPMENT COUNCIL By: Tom Wilk' Jr. PROVIDER: A~~ So lcher, MD. VOL-i YAQK,.~. 1 r"~ THIS CONTRACT IS SUBJECT TO ARBITRATION UNDER THE TEXAS GENERAL ARBITRATION ACT CONTRACT This Contract is entered into by and between BRAZOS COUNTY, TEXAS, acting by and through its duly elected County Commissioner's (hereinafter "County"), the BRAZOS VALLEY DEVELOPMENT COUNCIL (hereafter "BVDC") and ST. JOSEPH REGIONAL HEALTH CENTER., located in BRAZOS County hereinafter "Provider" ~ RECITALS WHEREAS, the care of this State's poor and indigent has become a growing problem; and WHEREAS, the 69th Legislature of the State of Texas recognizing the need for improved health care for the State's poor and indigent enacted the Indigent Health Care and Treatment Act, providing for indigent health rare in Texas through the Counties of the State; and WHEREAS, the Counties are required pursuant to this Legislation to contract with local Physicians (M.D. or D.O.) to provide health care to the State's indigents; NOW THEREFORE the parties above stated agree to the following Contract to provide such indigent health care. DEFINITIONS 1. "Handbook" shall mean the County Indigent Health Care Program Handbook developed by the Texas Department of Health and distributed to all Providers, a copy may be obtained by contacting TDH. • 2. "TDH" shall mean the Texas Department of Health 3. "The Act", shall mean the Indigent Health Care and Treatment Act, Texas Revised Civil Statutes Article 4438 (f). 4. "Mandated Services" shall mean those services which hospitals and doctors may provide to Indigents and obtain reimbursement therefor from the County pursuant to the Act, S. "The Program" shall mean the services offered to the Public pursuant to the Act. 6. "Emergency Services" shall have the meaning assigned by Article 4438a Vernon 3 Texas Civil Statutes. " 7. "Eligibility Document" shall mean the identification card, certificate or other document issued by the BVDC as an indigent, and (ii) is a resident of BRAZOS County and does reside within an area that a public hospital or hospital district has a legal obligation to serve. , TERM This Contract shall continue in force and effect for a term of no more than one (1) year commencing on the first (1st) day of September, 1995, or the date upon which this contract is executed, and shall terminate t ? on the thirty-first (31st) day of August, 1996. The parties shall have, and there is hereby given, three (3) : options to renew this Contract for a period of one (1) year in each instance, to follow consecutively upon the r expiration of the term hereof and of any renewal period, upon the same terms and conditions contained herein M, except for amendments made by the State Department of Human Services, and/or the State Legislature with r' regard to Mandated Services, rate schedules and other requirements which are incorporated herein and made a ' ; part hereof for all purposes. e • i. t ,I { 1 ~ v0 PAG IE w r' r ' CANCELLATION i • t may be canceled by any of the parties hereto upon sixty (60) days written notice as provided /,e2imcontrat ~ SERVICES TO B E PERFORMED BY PROVIDER The Provider shall perform only those services which have been declared by the Act to be Mandated Services as set forth in the Handbook. The Provider shall also perform those services which are considered Mandated Services only if certain specified conditions are met. These Mandated Services may be altered, expanded or limited by the TDH through the promulgation of regulations and rules and as the Act may be amended from time to time by the State Legislature. The BVDC shall keep the Provider updated with all additions, exclusions or changes to the Mandated Services. The Provider shall deliver Emergency Services to those indigents who have been determined by the BVDC to be Eligible Residents. Such emergency services may be provided without prior County approval. In the case of non-emergency Mandated Services the Provider shall perform such services only upon presentation by the prospective patient of an Eligibility Document and upon verification that such patient's name appears on the latest computer list of Eligible Residents to be distributed by the BVDC no less than once every six (6) months. RATES FOR REIMBURSEMENT The Provider agrees and acknowledges that it shall be reimbursed for the Mandated Services at the rates established by the TDH for such services as such rates may be amended from time to time Costs in excess of such rates shall be the responsibility of the Provider. LIMIT ON COUNTY'S LIABILITY FOR PAYMENT The County shall be responsible for: (a) a total of thirty (30) days (cumulative) in the county's fiscal year for hospital and/or skilled nursing facility care or a combination of both; or a maximum total payment of THIRTY THOUSAND AND NO1100 DOLLARS ($30,000) for all services provided to any one eligible resident during the County's fiscal year by all provider, whichever comes first; and (b) a maximum liability for all services and payment to all providers in the state's fiscal year equal to ten percent (100/*) of the County's General Revenue Tax levy. In computing the amounts a Provider may bill the County for Indigent care, the Provider and the BVDC shall not include the following: (1) any amount for Mandated Services provided to a person who receives, or is entitled to receive, assistance for Mandated Services from a third parry insurer or under a governmental program. (2) any amount for services provided to a person who is not an Eligible Resident or for services not covered by this Agreement. (3) any amounts for services provided by Prodder in a period during i%hich the person's Eligibility Document indicates that the person is ineligible for Indigent Care; and any amount for services provided to a person after the County has notified Prodder by telephone or in writing that such person's Eligibility Document is no longer valid. A telephone notification that a person's Eligibility Document is no longer valid shall be confirmed in writing by the BVDC within five (S) %%orking days of the telephone notification. If a prospective patient presents an Eligibility Document which Provider Vd PqQjj of , 006 f ~J 01 • b _ has been notified by the BVDC is invalid, Provider shall request the holder of the eligibility Document to surrender it and shall send any such surrendered documents to the BVDC. QUALIFIED SERVICES In order to obtain reimbursement for Mandated Services to be provided to indigents, the Provider must certify that the service was medically necessary and the service was performed for diagnostic, therapeutic, rehabilitative or palliative purposes and furnished by or under the direction of a physician (M.D. or D.O.), in an appropriate facility. RESPONSIBELITIES OF BVDC BVDC % ill be responsible for providing the following services pursuant to this Contract: 1. Providing of all necessary application forms to potentially eligible individuals. 2. Provide intake services in the County at least once a month. 3. Assist applicants in completing all necessary forms. 4. Determine the eligibility of each applicant with regard to residency and financial qualifications pursuant to the procedure and qualifications pursuant to the procedure and qualifications defined in the Act, including but not limited to Sections 1.03 and 1.06. In this capacity the BVDC shall also be responsible for mailing all necessary forms and following all procedures defined in the Handbook with regard to notifications and appeals on the issue of household eligibility. 5. Maintain this Contract and assist the parties hereto in the operation of the Program. 6. Receive all bills submitted by the Provider for payment of services and review the same to verify that the patient was an Eligible Resident at the time and that the bill qualifies in all respects. 7. Send all bills for payment to the appropriate county for verification and payment 8. Maintain data files on clients and billing records to verify the county is in conformity with the limitations on the amount of money or in hospital care any one indigent may ` receive in a one (1) year period. 9. Provide information to the parties as needed. 10. Respond to all and any inquiries regarding the Program. 11. Assist the County with information needed for audit purposes. , 12. Monitor the program on a periodic basis to check billing procedures and with TDH Staff review overall Program management and operation. 13. Assist and supervise the reconciling of ineligible expenses with the appropriate parties. 14. Assist the County with all of its responsibilities under the Act 3 , . • n. VOL-k-- PAGE A-1 31. - i P V 4 t f t .r • ....,.IF, 15. Perform all other duties and functions necessary to fulfill the requirements as outlined in the Act and the TDH Handbook. 16. Review the eligibility of each household every six (6j months. 17. Prepare and distribute to the Provider no less than once every six (6) months a computer list of Eligible Residents. 18. Determination of eligibility not later than the fourteenth (14) day after receiving a completed application form from an applicant including all necessary documentation and verifications. BVDC will provide the services designated as numbers 1,3,4,6,8,9,10 and 11 above to the County when dealing with medical services that have been performed outside the jurisdiction of the respective County. RESPONSIBILITY OF COUNTY The County shall be responsible for the following duties and requirements: 1. Provide County funds for the payment of Mandated Services. 2. Provide County funds for the administration of the Program through the BVDC. 3. Develop a system for the payment of indigent health care services bills or incorporate this billing procedure into the County's established system for paying like bills. 4. Provide an audit of the Program as required by state law. S. Accept ultimate responsibility for payment of services which may be determined through an audit to have been an ineligible expense. 6. Provide for and assist with the procurement of and payment for legal services as necessary. 7. Provide for and assist with the procurement of and payment for additional audit services. - RECORD RETENTION The provider shall be responsible for record keeping on all services provided to those individuals it believes may qualify under the Act. The Provider agrees to maintain and snake available for inspection by the County upon request consistent with personal privacy and subject to the limitation of state law, any and all records necessary to document the Provider's provision off Emergency and Mandated Services to Eligible Residents. Such records shall be retained for at least four (4) years from the date the service was provided. These records shall be made available for inspection and audit by the TDH.. BILLING The Prodder must, within ninety five (95 ) days from the date the Mandated Service is provided or ninety i five (95) days from the date of eligibility of a patient, submit all bills for payment to the BVDC. Bills not submitted within the time above specified shall be the responsibility of the Prodder. The bill shall be ilemized to identify the name, address, social security number. Eligibility Document number of the patient, type of service provided, appropriate CPT-•l code for the sen ice. date of service, the rate for such service and all ' certificates as described herein. the BVDC shall, if it determines the person receiving such services was an Eligible Resident at that time. review the sen ices prodded, to ascertain and verify that all necessary certifications have been completed. and that the bill qualifies for payment in all other respects If the BVDC VD PA®F eX a 1. is t_ C~ determines that the bill should be paid it shall send the bill to the County for final payment. If the BVDC determines that a bill should not be paid, or the County rejects the same, the BVDC shall send notice of such rejection to the Provider. Should the Provider wish to contest the refusal for payment, the dispute shall be submitted to an arbitration commission as described below. The County shall pay all uncontested bills within thirty (30) days of receipt of the same. ARBITRATION it is hereby agreed that if, at any time hereafter, any dispute, difference or question shall arise between the County and the Provider hereto regarding the payment or non-payment of a bill submitted by the Provider, every such dispute, difference or question, shall be referred to arbitration in the following manner: Either party may appoint an arbitrator and, upon making such appointment, shall serve a written notice upon the other party; said second party shall then appoint an arbitrator and the two arbitrators s appointed shall appoint a third arbitrator. In the event that said second party does not, within a period of fifteen (15) days after receiving notice from said first mentioned party, appoint an arbitrator and served written notice thereof upon said first mentioned party, the arbitrator appointed by the first mentioned party shall have power to proceed to arbitrate and determine the question as if he were an arbitrator appointed by both parties or that purpose and his award in writing shall be final and binding upon parties. In the event that both parties appoint arbitrators as aforesaid, the two arbitrators so appointed shall, within fifteen (i5) days after the appointment of the second arbitrator, proceed to appoint a third arbitrator. In the even that said arbitrators are unable to agree upon a third arbitrator, such third arbitrator shall, upon the application of either party, be appointed by a district f court judge for the County of BRAZOS State of Texas. The three arbitrators appointed in the manner a aforesaid shall proceed with all reasonable dispatch to hear and determine the matter in dispute and the 9 decision or award in writing of said arbitrators or a majority of them shall be final and binding upon both parties. The arbitrators are authorized to enter said decision or award in any court having jurisdiction. APPEAL The Provider and the County shall have the right to submit a dispute involving household residency only to the TDH for resolution. The party seeking the resolution shall submit TDH Form 106 and all relevant information regarding the same to the Policy Section DiNision Office of the General Counsel of TDH. The office shall conduct a hearing and issue its final decision within twenty-one (21) days of the date of request. The decision of the Office of the General Counsel may be appealed pursuant to the Administrative Procedure and Texas Register Act, Article 66252-13a Vernon Texas Civil Statutes. S , FUNDING The County shall be responsible for notifying the BVDC and the Provider when its total expenditures for the year on the Program have reached ten percent (10%) of the County's general revenue tax levy, its total liability for the program. Should state matching funds be available for the Program, the County shall notify the BVDC and the Provider of the County's continued participation in the Program subsequent to its expenditure of 10% of its general revenue tax levy. Upon depletion of State funds appropriated for the Program, the County shall notify the BVDC and the Provider of the County's non-liability for further funding of the Program. INDEMNITY The parties hereto agree to indemnify one another for and hold one another harmless from and against all suits. claims. demands, liabilities or actions resulting or alleged to result from the breach, violation or non-performance of the terms and conditions hereof or the negligent performance of the services stated herein and for any damage to any person resulting from any act or omission or negligence on the part of each party hereto. r } S INSURANCE The parties hereto agree that the-Provider shall be an independent contractor and not an agent of the County and that each shall maintain at its own expense, adequate liability insurance to insure against damages and liabilities which may arise due to the duties and obligations contracted for herein. AMENDMENT This contract shall be automatically amended by the amendments made to the Act by the State Legislature,. and by any changes to tthe Mandated Services and fee schedule promulgated by the TDH, in all other respects, this contract may only be amended by the written consent of all the parties hereto. GOVERNING LAW This Agreement shall be executed in and shall be governed by the laws of the State of Texas. NOTICES All notices required to be given hereunder shall be deemed to be duly given by person by delivering such notice or by mailing it, registered mail, to the other party at the following addresses: BRAZOS COUNTY BRAZOS COUNTY COURTHOUSE BRYAN, TEXAS, 77803 BVDC 1706 EAST 29TH STREET P.O. DRAWER 4128 BRYAN, TEXAS, 77805 ST. JOSEPH REGIONAL HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN, TEXAS, 77802 . FURTHER ASSURANCES Each party hereto agrees to perform any futher acts and to execute and deliver any further documents which may be necessary to carry out the provisions of this Agreement SEVERABIITY In the event that any of the provisions or portions thereof, of this Amt, are held to be enforceable or invalid by any court of competent jurisdiction, the validity and enforceability of the remaining provisions or portions thereof shall not be affected thereby. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto concerning the subject matter contained herein. There are no representations, agreements, arrangements, or understanding, oral or written, between or among the parties hereto, relating to the subject matter of this Agreement, which are not fully expressed herein. ASSIGNABI.ITY Vn t t. e f , t ?'J t ti i i I~ I Provider shall have the right to assign this Contract and any of its rights hereunder to a wholly owned subsidiary or to a corporation with which it may be merged without prior written consent of the County,, otherwise, this Contract is not assignable by the Provider or by the BVDC without the prior written consent of the County. DATED this 1st day of September, 1993 By. 64 . Judge ]ones BRAZOS VALLEY DEVELOPMENT COUNCIL By: Tom W' on, ]r. PROVIDER: e, By. Sister Gretchen Kunz, A in' tor' • St. Joseph Regional Health Center 4 f ~ i • r VOL. X-- --PAGE qj BRAZOS COUNTY COMMISSIONERS' COURT ACTION FORM DEPARTMENT Road and Bridge NUMBER 2010 REGULAR X_ SPECIAL DATE OF COURT MEETING: 08/07195 ITEM: Reauest from GTE to glace a road bore and parallel Installation In the right-of- way of Olymola Buddy Road. Site is located in Precinct 1. SOURCE OF FUNDS: N/A 1. PRESENTATION: A) No work will be permitted between from slope and/or bads slope. B) The line shall be installed within 3.5' of and parallel to the right-of-way line. C) If clearing of brush, trees and other obstruction is necessary, it shalt be the Applicant's responsibility to do so and to remove all cleared brush, trees etc. from County right-of-way. 0) Construction shall be in strict conformance to the latest Texas Manual of Uniform Traffic Control Devices for Streets and Highways, published by the Texas Department of Transportation, and all other State and Federal laws governing utility construction. II. ACTION REQUESTED OR ALTERNATIVES: SU MITTED BY: A i . - 1,07 7 Richard F. Vance, P.E. County Engineer CC95-112 AP Comm Approved to Com issioners' Court Date: Alvin . Jones, unty Judge i ~ I a, d I~ 1 VOL ~PAGE al a ~ ~i .r . x GTE] GTE Telephone Operations 01 Central Area Engineering Department 301 Industrial Blvd Bryan, Texas 77803 July 13, 1995 Reply To Bryan, TX ` Richard Vance Brazos County Engineering Office County Engineer 2617 W. Hwy 21 Bryan, Texas 77803 Dear Mr. Vance: Subject: AGRMNTS 24 BURIED CABLE 5416 3F001AR Enclosed are Form ED-135 and work location sketch showing the location of our proposed buried cable line on County roads in Brazos County at College Station, Texas. This work is to be completed on Work Order 3F001AR which is scheduled for August, 1995. If you have any questions concerning this work, please contact Richard Wallace at our office in Bryan, telephone 409-821-4752 within 15 days so that we may explain or modify our proposal, otherwise, it is understood that this proposal is approved. Sincerely, Alan Colley Senior Engineer - OSP AC : cp Attachment •'J A part of GTE Corporation VOI' PAGE J--1!2r. r'! J k I V L ~ M i r t i l ~ . I 1 1 N TO THE COMMISSIONER'S COURT OF BRAZOS COUNTY ATTENTION COUNTY JUDGE: l i I t r GENERAL TELEPHONE NOTICE OF COMMUNICATION COMPANY LINE INSTALLATION July 13, 1995 Formal notice is hereby given that GTE will construct a communication line within the right-of-way of a County Road in Brazos County, Texas as follows: Beginning at the junction of Windy Ryon Road and Olympia Buddy Road, 1565' of buried cable will be placed southeast at 5' within the northeast right-of-way of Olympia Buddy Road and then a bore will be made southwest across Olympia Buddy Road. The'proposed cable will be buried to a minimum depth of 30". The location and description of this line and associated appurtenances is more fully shown by two copies of drawings attached to this notice. The line will be constructed and maintained on the County Road right-of-way in accordance with governing laws. Notwithstanding any other provision contained herein, it is expressly understood that tender of this notice by GTE does not constitute a waiver, surrender, abandonment or impairment of any property rights, franchise, easement, license, authority, permission, privilege or right now granted by law or may be granted in the future and any provision or provisions so con- strued shall be null and void. Construction of this line will begin in August, 1995. GENERAL TELEPHONE COMPANY 5416 3F001AR Alan Coll Senior Engineer - OSP 301 Industrial Blvd Bryan, Texas 77803 i l " t~ t t 4. THE FOLLOWING DOCUMENT IS THE BEST IMAGE POSSIBLE DUE TO THE POOR QUALITY OF THE ORIGINAL , 1 , f I 1 t 1 r , i 1 i r t F f f t I I 1 18 r a . X 15 12 an CLVW" am hr / r Ap 16 as T><arw SUM % % 17 Kid / 23 • N / it an a W*A MIL 21 • ~ • 14n L" / / Tw1► MOOT ' ; r i NN / ♦ / % • iu a , % v • u / 20 / / 7I0 Map" M-Ion / [71T7M mm aw cal" ca no mam" / 9 ,i 1 / ~ wvs rlol / % 6wus cn»7 auw ary nw~o w~a U iluen emm no mo m wlnt T SHEET 4 / ~Isk hpro i o .>~Tl~r+~ N•JgYJ rs.tw 14 , ui.Tn•Ta A+111 u 9" 1 2 % rll L GM 4*DCPT ~PER COUNTY REOUIREKMTS. t. Y o1rIS, Y.[J{ TIM TM w111 I~ 1 r t I ,PA d M CM ter DSI - 4"4 1.41 U Sp[13.0[ W7Tn3 r MIL [1r•11r 0.1x1 [16 F*m IM M , w 1 . I , a ' 1 .mow s A-2 . BRAZOS COUNTY COMMISSIONERS' COURT ACTION FORM DEPARTMENT Road and Bridge NUMBER 2040 REGULAR X_ SPECIAL DATE OF COURT MEETING: 08/07/95 ITEM: Request from GTE for a parallel cable installation in the right-of-way of Thousand Oaks Drive beginning at its intersection with Straub Road extending for a distance of 3,100'. Site is located in Precinct 1. SOURCE OF FUNDS: N/A 1. PRESENTATION: A) No work will be permitted between from slope and/or back slope. B) The line shall be Installed within 3-5 of and parallel to the dght•of-way fine. C) H clearing of brush, trees and other obstruction is necessary, it shall be the Applicant's responsibility to do so and to remove all cleared brush, trees etc. from County right-of-way. D) Construction shall be in strict conformance to the latest Texas Manual of Uniform Traffic Control Devices for Streets and Highways, published by the Texas Department of Transportation, and all other State and Federal laws governing utility construction. II. ACTION REQUESTED OR ALTERNATIVES: SU 1 ED Y: ~1 ichard F. Vance, P.E. County Engineer CC95-113 BY: Commissi r Gary Norton Precinct 1 Approved in Commissioners' Court Date: Al? /49r AIv1n W. Jone(l County Judge VOL fi \ 1 ~1 01 01 .-S GTE GTE Telephone Operations t Central Area Engineering Department 301 Industrial Blvd Bryan, Texas 77803 t July 13, 1995 Reply To Bryan, TX Richard Vance Brazos County Engineering Office County Engineer 2617 W. Hwy 21 Bryan, Texas 77803 Dear Mr. Vance: Subject: AGRMNTS 24 BURIED CABLE 5416 3F001AR Enclosed are Form ED-135 and work location sketch showing the location of our proposed buried cable line on County roads in Brazos County at College Station, Texas. f This work is to be completed on Work Order 3F001AR which is scheduled for August, 1995. If you have any questions concerning this work, please contact Richard Wallace at our office in Bryan, telephone 409-821-4752 within 15 days so that we may explain or modify our proposal, otherwise, it is understood that this proposal is approved. Sincerely, r Alan Colley Senior Engineer - OSP AC:cp Attachment ,y S a C , A part of GTE Corporation VV -Z PA~ s941-1 r i ~Ak j GENERAL TELEPHONE COMPANY NOTICE OF COMMUNICATION LINE INSTALLATION July 13, 1995 TO THE COMMISSIONER'S COURT OF BRAZOS COUNTY ATTENTION COUNTY JUDGE: Formal notice is hereby given that GTE will construct a communication line within the right-of-way of a County Road in Brazos County, Texas as follows: Beginning at the junction of Thousand Oaks Drive and Straub Road, 3100' of buried cable will be placed south and southwest at 5' within the east and southeast right-of-way of Thouand Oaks Drive. The proposed cable will be buried to a minimum depth of 30". The location and description of this line and associated appurtenances is more fully shown by two copies of drawings attached to this notice. The line will be constructed and maintained on the County Road right-of-way in accordance with governing laws. Notwithstanding any other provision contained herein, it is expressly understood that tender of this notice by GTE does not constitute a waiver, surrender, abandonment or impairment of any property rights, franchise, easement, license, authority, permission, privilege or right now granted by law or may be granted in the future and any provision or provisions so con- strued shall be null and void. Construction of this line will begin in August, 1995. GENERAL TELEPHONE COMPANY 5416 3F001AR Colle ~K A Alan Senior Engineer - OSP 301 Industrial Blvd Bryan, Texas 77803 VOL---6,PAGF. -90V I Y t- THE FOLLOWING DOCUMENT IS THE BEST IMAGE POSSIBLE DUE TO THE POOR QUALITY OF THE ORIGINAL r ;L . n 1 . A G t ' t ~ . r R 1 Ir 1 . t ~ .i ' t 'WE MKt'-- L LOCATE CABLE ILA UTILITY LIES PRIOR To COwsTRUCTIOK Y I F j 1 rA.~. ' r I ti i I ` , '~S , il: ti's S +t~ _ .'t. F~.k~ ^`.•,+,«l L+.SJ}..~+'`fn . ~f'Y wW~ItaC.' Y! r _ •1y7~ O•rM•t{r ~1~ rM yrl I~iMiJt ~ ~ 3COf u~M 111-0 • r•7!M W Yr r41y ? r~►t•n~ ~ Ar -W42 N ~1.30 c2us~>s tilt' r•.~r. i • , s ' Irq T1O1gM0 Ort1 ' 1~. 'tr'a+r rr>~ 1 c?~ f L3 • r ire3 /:s r' :1 Gcw" 6Nt neMM• ars , •f \ num if MIS" ows 6V1 fl•usnO OMIT ~y~m'~~ .QLrM C3Lxm tN-MqmIr ~ tnr `l / IOR tA0 r11Q ' i rrarrnG %"a T"Dusm I as / 6-0.0"3 ar C20" C2LJm //0 • f 'f /M/.. all me OQrA •1101 1611 • rrruns 2423-19 , •ff T3 ir [[77~~ra~•EOOl0ir3• / U1J!-0'I0OO / ~ ew3 nwsMo iN~f73 / CS J~~.a,~i CILr1O CrIJSq R SHEET 2 • sit AREA suns: olvlslore•w M•Mt .6w AEKCC.tt• wC. hA) mo-3FRO1 COr1R0. OLVOC% THE FOLLOWING DOCUMENT IS THE BEST IMAGE POSSIBLE DUE TO THE POOR QUALITY OF THE ORIGINAL 1 ' SHEET 1 CW am Gomm / \a~wa w "am lop t ~ / ~S7q f88M rr «n ve / . g wer.. «o t i- .u 2131-22• . g 0 r % % i s' i i i I I ~ 1 f . T M1, y 0- Y I` s C ]I C] t Y t 4 t L BRAZOS COUNTY COMMISSIONERS' COURT ACTION FORM DEPARTMENT Road and Bridge NUMBER 2040 REGULAR XX SPECIAL DATE OF COURT MEETING: 08/07/95 ITEM: Request from GTE for a parallel cable installation in the right-of-way of Schehin Road beginning at Its intersection with Parker Lane extending fora distance of 260'. Site is located in Precinct 1, SOURCE OF FUNDS: N/A 1. PRESENTATION: A) No work will be permitted between from slope and/or back slope. 8) The line shall be Installed within 3-5' of and parallel to the right-of-way line. C) If clearing of brush, trees and other obstruction is necessary, it shall be the Applicant's responsibility to do so and to remove all cleared brush, trees etc. from County right-of-way. D) Construction shall be in strict conformance to the latest Texas Manual of Uniform Traffic Control Devices for Streets and Highways, published by the Texas Department of Transportation, and all other State and Federal laws governing utility construction. II. ACTION REQUESTED OR ALTERNATIVES: SU MITTE BY: dam ichard F. Vance, P.E. County Engineer CC95-114 APPROV,zD BY: CommissiCary Norton Precinct ( Approved in Co issioners' Court Date- A 1-7 -,a -f 'y T + AIvln W. Jones, ounty Judge 14 1 s f 1 t , t VnL. 9' GTE Telephone Operations Central Area Engineering Department 301 Industrial Blvd Bryan, Texas 77803 July 13, 1995 Reply To Bryan, TX Richard Vance Brazos County Engineering Office County Engineer 2617 W. Hwy 21 Bryan, Texas 77803 Dear Mr. Vance: Subject: AGRMNTS 24 BURIED CABLE 5416 3F001AR Enclosed are Form ED-135 and work location sketch showing the location of our proposed buried cable line on County roads in Brazos County at College Station, Texas. This work is to be completed on Work Order 3F001AR which is scheduled for August, 1995. If you have any questions concerning . this work, please contact Richard Wallace at our office in Bryan, telephone 409-821-4752 within 15 days so that we may explain or modify our proposal, otherwise, it is understood that this proposal is approved. Sincerely, '46X LQ Alan Col Senior Engineer - OSP AC:cp Attachment i ' A part of GTE Corporation yO . PA® F. i r ~I 11 i GENERAL TELEPHONE NOTICE OF COMMUNICATION COMPANY LINE INSTALLATION July 13, 1995 i TO THE COMMISSIONER'S COURT OF BRAZOS COUNTY ATTENTION COUNTY JUDGE: Formal notice is hereby given that GTE will construct a communication line within the right-of-way of a County Road in Brazos County, Texas as follows: r Beginning at the junction of Schein Road and Parker Lane, 260' of buried cable will be placed west at 6' within the north right-of-way of Schein Road. The proposed cable will be buried to a minimum depth of 30". The location and description of this line and associated appurtenances is more fully shown by two copies of drawings attached to this notice. The line will be constructed and maintained on the County Road right-of-way in accordance with governing laws. Notwithstanding any other provision contained herein, it is expressly understood that tender of this notice by GTE does not constitute a waiver, surrender, abandonment or impairment of any property rights, franchise, easement, license, authority, permission, privilege or right now granted by law or may be granted in the future and any provision or provisions so con- strued shall be null and void. 6 Construction of this line will begin in August, 1995. r GENERAL TELEPHONE COMPANY 5416 3F001AR r ' Alan Colle Senior Engineer - OSP a 301 Industrial Blvd i Bryan, Texas 77803 VOL j9PAGE qj THE FOLLOWING DOCUMENT IS THE BEST IMAGE POSSIBLE DUE TO THE POOR QUALITY OF THE ORIGINAL opm I' Z Ld I { Y cr I 0- L-346 (PP) --o I 02002595 I y <3F001AR> M8280225 NNNI , { 291 2423.10 10 AKF 25-22 N0. W C21.401-425 :u"alp t:r • 23' s• 1 ~1u1e 1791 ~ I M• ___j~j I 0 AS► 25. W1211811-~ (A6B 242110) 1088' 2423.19 -Cit. F-4.19L - - - - - -k~ - - _ - - C2Ni1.~2S ASP 25.22 4BI•4OS c~el~ei C21,407•497 COO.&25XM* SCHE I N RD C2M I I u1 . or Am ~I ac I N or 4* P~ al N CSI W I ` • VI 1 . ® Sll AREA STATE: TX 61VISIM south con EX0U G%9 REK CO.: 008 i Y.C: 6900 WO NO.s3F0OTAR CONTROL NUMBER: NOTE AREA- TITLE: EUM CS SPRN~1c TAX OSTj 45004 TWPc RNG.: SEC.3 SAL:3-OC OATE: •6/27/95 IRE Y, DATE: CALE:1 too' ORWW pPR PRINT FILE: WP7 Rw Rw 7 OF 7 Er. lo I 4 I y • ti