ORDER NO. 16818
CONFIRMATION OF APPROVAL OF A MANDATED PROVIDER AGREEMENT,
BY AND BETWEEN THE SID PETERSON MEMORIAL HOSPITAL AND KERR
COUNTY, TEXAS
On this the 8th day of September 1986, upon motion made by
Commissioner Holland seconded by Commissioner Guthrie
the Court unanimously confirmed approval of a Mandated
Provider Agreement, by and between the Sid Peterson Memorial

Hospital, acting by and through its duly authorized administra-
tor, F. W. Hall, Jr., 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, for Indigent Health Care, as required by the Indigent
Health Care and Treatment Act, to provide certain inpatient and
outpatient mandatory hospital services for its eligible residents.

COMMISSIONERS' COURT MEETING AGENDA REQUEST h
MADE BY: OFFICE:
MEETING DATE: 9_ g_ 86 TIME PREFERRED: A.M. - P. M.
SUBJECT' Confirmation of approval of Agreements between Sid
Peterson Hospital and the doctors on the staff at Sid Peterson
Hospital and Kerr County.
IF PERSONNEL MATTER: NAME OF EMPLOYEE:
WHO WILL SPEAK TO COMMISSIONERS:
THE TIME FOR SUBMITTING THIS REQUEST FOR COURT TO ASSURE THAT THE MATTER IS
POSTED IN ACCORDANCE WITH ARTICLE 6252-17 IS AS FOLLOWS:
* MEETINGS HELD ON SECOND MONDAY OF THE MONTH: 12:00 P.M. PREVIOUS THURSDAY
* MEETINGS HELD ON OTHER DAYS: 12:00 P,M. THREE DAYS BEFORE MEETING DATE.
IF PREFERABLE, AGENDA REQUESTS MAY BE_MADE ON OFFICE STATIONERY WITH THE ABOVE
INFORMATION ATTACHED.
THIS REQUEST RECEIVED BY: *
THIS REQUEST RECEIVED ON: @ A.M. - P.M.
ALL AGENDA REQUESTS WILL BE SCREENED BY THE COUNTY JUDGE'S SECRETARY TO DETER-
MINE I'r' ADEQUATE INFORMATION HAS BEEN PREPARED FQR THE COURT'S FORMAL CONSIDER-
ATION AND ACTION AT TIME OF COURT MEETINGS. YOUR COOPERATION WILL BE APPRECI-
ATED AND CONTRIBUTE TOWARDS YOUR REQUEST BEING ADDRESSED AT THE EARLIEST
OPPORTUNITY.
* PLEASE FURNISH ONE ORIGINAL AND SIX COPIES OF THIS REQUEST
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QRDER N0. 16818
COTIFIRMATIOTd OF APPROVAL OF A
MANDATED PROVIDER AGREEMETdT,
BY AND BETL'TEEN THE SID PETER-
SON P4EMORIAL HOSPITAL AND
RERR COUTITY, TEXAS
9-8-86
VOL. ~, Page 283
AGREEMENT
(HOSPITAL)
This Mandated Provider Agreement is entered into on the
27th day of _ August _„~ 1986, by and between the SID
PETERSON MEMORIAL HOSPITAL, acting by and through its duly
authorized administrator, F. W. HALL, JR. (hereinafter called
"Hospital"), and KERR COUNTY, TEXAS, acting by and through its
duly authorized COUNTY JUDGE,~~ORDON S. MORRISS, as authorized by
the Commissioners Court of Kerr County, Texas (hereinafter called
"County").
WITNESSETH
WHEREAS, County is required by the Indigent Health Care and
Treatment Act (herein "Act") to provide certain inpatient and
outpatient mandatory hospital services for its eligible
residents;
WHEREAS, County desires to insure that County's eligible
residents receive those inpatient and outpatient mandatory
hospital services required by the Act;
WHEREAS, Hospital agrees to provide, or to arrange the
provisions of, those inpatient and outpatient mandatory hospital
services required by the Act for County's eligible residents;
NOW, THEREFORE, in consideration of the mutual covenants
herein contained County hereby designates anal Hospital hereby
agrees to be a Mandated Provider for inpatient and outpatient
mandatory hospital services required by the Act or the Act'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
Hospital shall be the mandated provider of the inpatient and
outpatient mandatory hospital services for County's eligible
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residents, as defined by the Act. Hospital represents it is
duly licensed as a hospital under the laws of the State of
Texas and it is either accredited by the Joint Commission on
Accreditation of Hospitals or certified for the Medicare
program by the Health Care Financing Administration. Unless
otherwise agreed upon, Hospital shall deliver, or arrange to
be delivered, those inpatient and outpatient hospital
services, ordered by a physician, that are considered
mandatory services pursuant to the Act or as defined by the
Department. Such inpatient and outpatient services shall be
provided to eligible residents of County who do not reside
within an area that a public hospital or hospital district
has a legal obligation to serve. County shall require its
eligible residents to obtain inpatient and outpatient
mandatory hospital services from Hospital except in
emergency situations, when medically inappropriate, or when
the service is not available through Hospital. County shall
have the right to require nonmandated hospital providers,
who deliver or will deliver inpatient or outpatient
mandatory hospital services to a patient who is or may be an
eligible resident to transfer the patient to Hospital unless
it is medically inappropriate to do so.
3. COUNTY'S FINANCIAL OBLIGATIONS
County shall reimburse Hospital for inpatient and outpatient
mandatory hospital services provided to eligible residents.
County is obligated to reimburse Hospital For all normal and
reasonable charges of Hospital up to the maximum amount of
reimbursement allowed under the Act. County is not liable
for reimbursement of services which exceed the maximum per
patient limits established by the Act. County shall notify
Hospital before the date on which County anticipates it will
spend ten percent (10~) of the general revenue levy for that
fiscal year. Hospital has no obligation under this
agreement to provide the services covered under this
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Agreement to eligible residents of County when and after
such expenditure level is reached. If Hospital transfers
eligible residents of County for inpatient and outpatient
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mandatory hospital services which Hospital is unable to
provide, County is obligated to reimburse the receiving
hospital at the receiving hospital's payment rate, but not
to exceed the maximum payment of reimbursement allowed under
the Act or established by the Department. Per patient
expenditure limits as established by the Act apply to such
services delivered by the receiving hospital.
4. NOTICE
County shall have the duty and responsibility to post, all
notices concerning the availability of inpatient and
outpatient mandatory hospital services from Hospital.
5. DETERMINATION 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, Hospital shall not provide such
nonemergency services until County has determined
eligibility of the patient, has notified Hospital 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.
County shall provide Hospital with current eligibility forms
and procedures for distribution to applicants.
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.
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_`
6. NOTIFICATION OF PROVISION OF SERVICES
Hospital may deliver emergency services to eligible
residents of County without obtaining County approval.
Hospital must receive written approval from County before
providing nonemergency services.
7. REIMBURSEMENT PROCEDURES
Hospital shall present full charges for inpatient and
outpatient mandatory hospital services provided to eligible
patients to County monthly for patients discharged during
the previous thirty (30) days. County shall reimburse
Hospital within thirty (30) days of presentation of the
charges at the payment rate for inpatient and outpatient
care as determined by 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, Hospital's administrator, one Hospital
Board of Trustee member, County Judge, and one County
Commissioner.
In the case of emergency hospital services rendered to a
patient who is determined in Section 5 not to be eligible
for financial assistance, Hospital shall be financially
responsible for the services rendered to such patient.
Hospital reserves the right to pursue any reasonable
collection effort against such patients.
Hospital shall waive all deposit requirements for eligible
patients, except to the extent such deposits are required by
usual and customary Hospital policies as security for a
person's non-covered charges. Hospital shall have the right
to bill eligible patients for non-covered charges whether
the charges are for excluded services or k>ecause 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
Hospital will notify County if any eligible residents have
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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. Hospital shall
notify County of the amounts received from third party
payors and reimburse County for services and amounts covered
under this Agreement.
9. RECORDS
Hospital will provide County access to all financial records
necessary to document the Hospital's provision of services.
Such access shall be during normal business hours of the
Hospital and shall be preceded by notice from County. Such
notice shall be received by Hospital 24 hours in advance of
such examination. County shall hold all medical records in
strict confidence 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 Hospital prior to
receiving any medical records.
10. TERM AND RENEtiVAL TERMS
The term of this Agreement shall be from September 1 ,
1986 through __August 31`____ 19 87 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 Hospital according to the provisions of this
Agreement for any eligible patient who continues to be
hospitalized past the expiration of this Agreement.
11. TERMINATION AND 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
5

unsuccessful. Upon termination as provided for herein,
neither of the parties shall 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. HOLD 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. Hospital and its medical staff shall retain sole
authority and responsibility for the treatment of eligible
patients of County.
13. ASSIGNMENT
Neither party shall assign this Agreement except with the
prior written consent of the other party.
14. HEADINGS
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.
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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:
Kerr County Judge Administrator
Kerr County Courthouse Sid Peterson Memorial Hospital
Kerrville, Texas 78028 710 Water Street
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
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create nor shall be deemed construed to create any
relationship between County and Hospital 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
Health 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
to be executed by their respective duly authorized
representatives as of the day and year first above written.~~
SID PETERSON MEMORIAL HOSPITAL KERR COU A
c
,s
BY: BY: .~
F. W. HALL, •, GO ON MORRISS,
Administrator Ke r County Judge
PA A
~ %
er Oep~r
~~


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