ORDER NO. 16891
APPROVAL OF MANDATED PROVIDER AGREEMENT BY AND BETWEEN
STEPHEN L. SMITH, D. O. AND KERR COUNTY, TEXAS, REGARDING
INDIGENT HEALTH CARE
On this the 14th day of October 1986, upon motion made by
Commissioner Holland seconded by Commissioner Guthrie ,
the Court unanimously approved a MANDATED PROVIDER AGREEMENT
by and between STEPHEN L. SMITH, D.O., hereinafter called
"Physician", whether one or more, and KERR COUNTY, TEXAS,
acting by and through its duly authorized COUNTY JUDGE,
GORDON S. MORRISS, as authorized by the Commissioners' Court
of Kerr county, Texas (hereinafter called "County"), regarding
Indigent Health Care and Treatment Act, effective from October
1st, 1986 through October 1, 1987.
!~I'I(Y::: C:C'(:f GLK~DL~F3 _ ,-8G
AGREEMENT
(PHYSICIAN - GENERAL)
Ttlis Mandated Provider Agreement is entered into on the
1st day of October _, 1986, by and between
STEPHEN L. SMITH, D.O.
(hereinafter called "Physician", whether one or more), and KERR
COUN`PY, `PEXAS, acting by and through its duly authorized COUNTY
JUDGI?, GORDON S. MORRISS, as authorized by the Commissioners
Court of Kerr County, Texas (hereinafter called "County").
WITNESSETii
S4[IEREAS, County is required by the Indigent Health Care and
Treatment Act (herein "Act") to provide certain Physician
services for its eligible residents;
WHEREAS, County desires to insure that County's eligible
residents receive those mandatory physician services required by
the Act;
'r1HEREAS, Physician agrees to provide, or to arrange the
provisions of, those mandatory physician services required b~y the
Act for County's eligible residents;
NOW, THEREFORE, in consideration of the mutual covenants
Herein contained County hereb~~ designates and Physician hereby
agrees to be a Mandated Pro~~ic::i far mandatory physician services
required by the Act or ±tle 11ct's regulations to be provided to
County's eligible residents and the parties agree as follows:
1. DEFINITIONS
All terms shall be as defined by the Act and by the TEXAS
DEPARTMENT OF HUMAN SERVICES, (herein "Department") to the
extent of the departments rights, responsibilities and
powers under the Act.
2. MANDATED PROVIDER
Physician shall be a mandated provider of the mandatory
i~hysician services for County's eligible residents, as
defined by the Act. Physician represents that Physician is
duly licensed as a Medical Doctor under the laws of the
State of Texas and is certified for the Medicare program by
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the Health Care Financing Administration. Unless otherwise
agreed upon, Physician shall deliver, or arrange to be
~3elivered, Physician services that are considered mandatory
services pursuant to the Act or as defined by the
Department. Such services shall be provided to eligible
residents of County who do not reside within an area that a
public physician or physician district has a legal
obligation to serve. County shall require its eligible
residents to obtain mandatory physician services from
contracting Physicians except in emergency situations, or
when medically inappropriate.
3. COUNTY'S FINANCIAL OBLIGATIONS
County shall reimburse Physician for physician services
provided to eligible residents. County will reimburse
Physician for all normal and reasonable charges for mandated
services up to the maximum amount of services and
reimbursement allowed under the Act. County is not liable
for reimbursement of services which exceed the maximum per
patient limits established by the Act. Physician has no
obligation under this agreement to provide the services
covered under this Agreement to eligible residents of County
when and after such expenditure level is reached. If
Physician transfers eligible residents of County to a
noncontracting physician for physician services which
physician is unable to provide, County is obligated to
reimburse the receiving physician at the receiving
physicians payment rate, but not to exceed the maximum
payment of reimbursement allowed under the Act or
established by the Department. All transfers will be made
to contracting physicians if possible. Per patient
expenditure limits as established by the Act apply to such
services delivered by the receiving physician.
4. NOTICE
..
County shall have the duty and responsibility to give all
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r,~'14Y; ; : c'C(~/Gf:K/UL/t3~ ~ ~'-t3G
~iotices concerning the availability of mandatory physician
services from Hospital.
5. UIaTFRMINATION OF ELIGIBILITY
County shall be responsible for determining whether an
applicant is eligible for financial assistance defined by
the Act and shall provide eligible residents with documents
and/or cards which identify persons as eligible residents.
In the case of a patient who may be eligible seeking
nonemergency services, Physician shall not provide such
nonemergency services until County has determined
eligibility of the patient, has notified Physician of the
eligibility decision and has approved in writing provision
of the nonemergency services. County must determine
eligibility for nonemergency services within fourteen days
from the date County receives a completed application.
Eligibility requirements and this contract may be modified
at any time by County to reflect any statutory changes in
County's indigent care obligations. Residency disputes
shall be resolved by the Department.
6. C70TIFICATION OF PROVISION OF SERVICES
Physician may deliver emergency services to eligible
residents of County without obtaining County approval.
Physician must receive written approval from County before
providing nonemergency services.
7. REIMBURSEMENT PROCEDURES
Physician shall present charges for physician services
provided to eligible patients to County monthly. County
shall reimburse Physician within thirty (30) days of
presentation of the charges at the payment rate determined
key the Department. All payment disputes are to be submitted
for binding resolution to a panel consisting of a Hospital
medical staff member who did not attend the patient,
iiospital's administrator, one Hospital Board of Trustee
member, County Judge, and one County Commissioner.
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,'1PE3YS . CCC/GEK~DL/~-27-86
In the case of emergency physician services rendered to a
patient who is determined in Section 5 not to be eligible
for financial assistance, Physician shall be financially
responsible for the services rendered to such patient.
Physician reserves the right to pursue any reasonable
collection effort against such patients.
Physician shall have the right to bill eligible patients for
non-covered charges whether the charges are for excluded
services or because the charges are not payable by County
due to provisions of the Act or payment policies and rates
established by the Department.
8. THIRD PARTY PAYORS
Physician will notify County if any eligible residents have
access to any other sources of payment for the eligible
services provided, but County shall be responsible for the
full payment of such eligible services. Physician shall
notify County of the amounts received from third party
payors and reimburse County for services and amounts covered
under this Agreement.
9. RECORDS
Physician will provide County access to all financial
records necessary to document the Physician's provision of
services. Such access shall be during normal business hours
of the Physician and shall be preceded by notice from
County. Such notice shall be received by Physician 24 hours
in advance of such examination. County shall hold all
medical records in strict confide ,~ ~~ so as not to violate
the physician/patient relationship.
County shall obtain a signed authorized medical consent form
from the patient, authorizing the release of his/her medical
records and provide the same to the Physician prior to
receiviny any medical~..records.
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fill; .~'~'~'/~~I;h/I)I~/is--;?.a-24h -
10. `I'I:RM AND RENEWAL TERMS
The term of this Agreement shall be from October 1,
c October 1 87 ,
1 ~f36 through ~____-__„_ 19 This Agreement
may be renewed for additional one (1) year terms by written
agreement of the parties at least thirty (30) days prior to
the expiration of the original or any renewal term. County
shall reimburse Physician according to the provisions of
this Agreement for any eligible patient who continues to
receive eligible physician services past the expiration of
this Agreement.
11. TERMINATION RND RIGHT TO CURE
Either party may terminate this Agreement upon breach of
this Agreement with thirty (30) days prior written notice,
provided the breaching party has been notified thirty (30)
days prior to the termination notice and efforts to resolve
the matter to the terminating party's satisfaction are
unsuccessful. Upon termination as provided for herein,
neither of the 'parties shal l have any further duty or
obligation to the other except for indebtedness due at the
time of termination and indemnification of the other party.
12. BOLD HARMLESS
Each party agrees to indemnify and hold harmless the other
party and its employees against and from all claims and
actions brought by third parties against the other party on
account of willful, intentional, negligent or illegal
conduct, omissions or bad faith of the party, its agents or
employees. Physician shall retain sole authority and
responsibility for the services rendered to eligible
patients of County.
13. ASSIGNMENT
Neither party shall assign this Agreement except with the
prior written consent of the other party, except as provided
in section 5 hereof.
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1 ~~ . HEADIN(i:i
Section headings are for convenience of reference only and
shall not be used to construe the meaning of any provision
to this Agreement.
15. COUNTERPARTS
This Agreement may be executed in any number of
counterparts, each of which shall be an original, and all of
which shall together constitute one agreement.
16. OBLIGATIONS AS CONDITION
All obligations of each party to this Agreement are
conditions to further performance of the other party's
continued performance of its obligations under the
Agreement.
17. EXCLUSIVE RIGHTS
Only the parties to this Agreement have the exclusive right
to bring suit to enforce this Agreement and no other parties
may bring suits as a third party beneficiary, or otherwise,
to enforce the Agreement.
18. SEVERANCE
Should any part of this Agreement be invalid or
unenforceable, such invalidity or unenforceability shall not
affect the validity and enforceability of the remaining
portions.
19. LAW
This Agreement shall be construed in accordance with the
laws of the State of Texas.
20. AMENDMENT
This Agreement may not be modified except in writing
executed by both parties to this Agreement.
21. NOTICE
Any notices, demands or communications required, permitted
or desired to be given hereunder shall be deemed effectively
given when personally delivered or mailed by prepaid
certified mail, return receipt requested, addressed as
follows:
6

Kerr County Judge
Kerr County Courthouse
Kerrville, Texas 78028
or such other address and to the attention of such other
person(s) or officer(s) as either party may designate by
written notice.
22. FORCE MAJEURE
Neither Party shall be liable nor deemed to be in default
for any delay or failure of performance under this Agreement
or other interruption from Acts of God, civil or military
authority, acts of public enemy, war, accidents, fires,
explosions, earthquakes, floods, failure of transportation,
strikes, or other work interruptions by either Party's
employees or agents, or any similar or dissimilar cause
beyond the reasonable control of either Party. Either party
in such event may terminate this Agreement.
23. RELATIONSHIP OF PARTIES
None of the provisions of this Agreement are intended to
create nor shall be deemed construed to create any
relationship between County and Physician other than that of
independent entities contracting with each other hereunder
solely for the purpose of effecting the provisions of this
Agreement. Neither the parties hereto, or any of their
respective officers, directors or employees shall be
construed to be the agent, employee or representative of the
other party.
24. ENTIRE AGREEMENT
This Agreement supersedes all prior agreements between the
parties with respect to the subject matter hereof. This
Agreement is subject to all areas controlled by the Indigent
Hea 1 th Care and Treatment Act, as it may be amended, and by
the Texas Department of Human Services and other applicable
local, state and federal laws, rules or regulations.
IN WITNESS WHEREOF, the Parties have caused this Agreement
7

to bc~ executed	by	their	respective	duly	authorized
representatives as	of	the day	and year first	above	written ~
PHYSICIAN KERB CO ~S
\c ~ ,~--_
BY. ~ r ~i '1 ~ ~ Bf'
~` G N MORRISS,
/ Ke County Judge
PATRICIA DYE '~ '~- ~
,~CkrA County Court. Ken Counq, ~s J, ~ /
,~ ~ r ~_


ORDER N0. 16891
APPROVAL OF MANDATED PROVIDER AGREEMENT BY AND BETWEEN
STEPHEN L. SMITH, D. 0. AND KERB COUNTY, TEXAS, REGARDING
INDIGENT HEALTH CARE
On this the 14th day of October 1986, upon motion made by
Commissioner Holland seconded by Commissioner Guthrie .
the Court unanimously approved a MANDATED PROVIDER AGREEMENT
by and between STEPHEN L. SMITH, D.O., hereinafter called
"Physician", whether one or more, and KERR COUNTY, TEXAS,
acting by and through its duly authorized COUNTY JUDGE,
GORDON S. MORRISS, as authorized by the Commissioners' Court
of Kerr county, Texas (hereinafter called "County"), regarding
Indigent Health Care and Treatment Act, effective from October
1st, 1986 through October 1, 1987.

pRDER Np, 16691
PROVIDER
MANDATED
AppRpVAL OF AT1D BET~dEET3
Ei'"~NT BY p .
AGpgEN L. SMITH, D.
STE AND REGARDING
E T~ HEA~H' CARE
7:ERINDIG
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