ORDER NO. 19697 ADOPTION OF DIAGNOSTIC RELATED GROUP tDRG) PAYMENT STANDARDS FOR INPATIENT HOSPITAL BILLS FDR INDIGENT HEALTH CARE PATIENTS, SUBJECT TO APPROVAL OF THE THIRD PARTY CONTRACT BY THE COUNTY ATTORNEY On this the 9th day of August 1990, came on to be considered by the Court the adoption of Diagnostic Related Group (DRG) payment standards for Indigent Health Care. Upon motion made by Commissioner Morgan, seconded by Commissioner Holekamp, with Commissioner's Morgan, Holekamp and Baldwin voting "AYE", and Judge Edwards voting "NAY", said motion to adopt Diagnostic Related Group tDRG) payment standards for inpatient hospital bills for Indigent Health Care patients in Kerr County, Texas, effective September 1, 1990 thru August 31, 1991, and subject to the approval of the third party contract by the County Attorney, was approved by a majority vote. TO: Members of the Commissioner's Court FROM: Stan Reid, Assistant County Attorney DATE: August 28, 1990 RE: Third Party Administration Contract As you requested, I have reviewed the above-referenced contract. I cannot approve the contract as it was submitted to me by the Court. The Court should not sign the agreement because it contains a "hold harmless and indemnity" clause. Such a clause creates a debt not contemplated to be satisfied out of current revenues and is therefore in violation of Article XI, §7 of the Texas Constitution. Tommie has a contract prepared in which that provision has been struck through. Finally, Judge Edwards has pointed out that the provision which guarantees essentially an 8% savings is not specific enough as to what constitutes "savings" since the agency guidelines save us, as I understand it, 9% anyway. If that clause is of concern to the court it should be clarified. If the clause is of no concern, it should be deleted. know. If you desire for me to do anything further, please let me id ~ ~ ~ Ry-Ron I ~..:. _. THIRD PARTY ADMINISTRATOR ADMINISTRATIVE SERVICE AGREEMENT IMPLEMENTING THE INDIGENT HEALTH CARE AND TREATMENT ACT OF 1985 (S.B.1) Kerr County acting by and through its Commissioners' Court, hereinafter referred to as "County", and Ry/Ron Inc. dba/THIRD PARTY ADMINISTRATOR of Houston, Texas, hereinafter referred to as "Administrator", do hereby enter into the following agreement to implement the Indigent Health Care and Treatment Act of 1985 (S.B.1), hereinafter referred to as "Act". The County agrees to employ Administrator to furnish services necessary to administer certain aspects of the Act. The Administrator agrees to provide such services in accordance with the terms of this agreement, hereinafter set forth. I. SCHEDULE & SERVICES It is understood and agreed that the County will compensate the Administrator in the following manner: A $500.00 upon the execution of this agreement, plus, B. A monthly fee will be payable promptly on or after the second Monday of the month. The monthly fee shall be 4% of Claims Paid. It is understood and agreed that the Administrator will provide the following services to the County: A. Approve claims in accordance with the Act's Standards. B. Administrator agrees to annual audit based on Exhibit 'A" attached. C. Maintenance of all Medical Records a. Maintain files on an active basis for five years. b. Maintain individual case files and individual provider file cumulative claims total and generate monthly reports data for the Department of Human Services, the providers of the County. c. Provide prepared checks for providers. d. Provide check register containing appropriate information to the County Auditor. e. All records available for review and audit by County on TDHS. D. Payr a. b. c. d. e. f. g• h. i. nent Services and Reports Claims matched with medical file. Payment according to benefits of Act. Written explanation of benefit payments submitted with each check. Issuance of checks. Disperse checks according to County's rules for such payment. Monthly and annual medical utilization summary. Will not pay the costs of a health care service that is in excess of payment standards for that service established by TDHS under Section 1.06 of the Act. Monthly report showing benefits paid year-to-date by month. Supply necessary claim forms to County, if needed. Provide verification and documentation to the County that shows expenditures to eligible residents so the County can request assistance from TDHS. 13105 Northwest Freeway Suite 580 Houston, Texas 77040 (713) 690-0044 Fax (713) 939-1957 ©~ © Ry-Ron I-_ ,,. THIRD PARTY ADMINISTRATOR j. Match claims with payment schedule as outlined in (b.) above and verify that care rendered by provider is consistent with reasonable medical qre was provided and if not, tend to not make payment of claims. k. Provide instant inquiry by hospitals and providers during normal working hours. 1. Coordinate benefits with other benefit programs and third party liability coverage, i.e., automobile liability. E. Reports to County The reports are composed of two parts: Standard Reports and Management Information Reports. Standard Reports are designed to analyze plan performance payment history and monthly transaction volume. The Management Reports cover cost containment analysis, loss reporting, and benefit utilization. STANDARD REPORTS Monthly Check Register Coverage Analysis Report MANAGEMENT REPORTS (YEAR-END) Hospitalization Utilization Statistics Diagnosis Reporting Claim Payment Analysis Benefit Utilization Analysis Provider Comparison Analysis Average Length of Stay (by diagnosis and hospital) II. TRAINING It is understood and agreed that the County will pay $250.00 per individual trained by the Administrator at their training school, if such is desired by the County. III. POSTAGE AND CHECK FORMAT It is understood and agreed that the Administrator will pay for all postage required to transmit claims, records and checks to the County. The County will pay for any and all other postage. Should the County not elect to use Administrator's checks the County will provide printed checks compatible with Administrator's computer hardware at the County's expense. IV. PERIOD OF CONTRACT It is understood and agreed that this agreement shall be in effect from the date of execution of this document through the following August 31st, and renewable for succeeding periods, such periods being from September 1st of a calendar year and through August 31st of the second following year, unless the County or Administrator gives written notice to the other, at least ninety (90) days prior to the end of any such period, that this Agreement is to be terminated at the end of any such period. If no such written agreement is received by either party the contract will continue in force for another period. If no such written agreement is terminated, the Administrator will process all claims during the contracted experience period at the percentage fee rate set forth hereinbefore. After all claims are processed the Administrator will promptly deliver all records, reports and documents relating to the County's obligations under the Act to the County. 13105 Northwest Freeway Suite 580 Houston, Texas 77040 (713) 690-0044 Fax (713) 939-1957 ®~ ~ Ry-Ron I _.. ~. THIRD PARTY ADMINISTRATOR V. DISPUTES In the event a dispute arises between TPA and a provider as to a claim, the dispute shall be resolved by the Commissioner's Court of Kerr County, Texas. VI. MISCELLANEOUS The time for performance by Administrator of any term, condition or covenant of this Description shall be deemed extended by time lost due to delays resulting from Acts of God, strikes, shortages of any materials, computer breakdowns, civil riots, national or labor restrictions by governmental authority, any other cause not within the control of Administrator., with a maximun of thirty (30) days. ADMINISTRATOR DOES NOT INSURE OR UNDERWRITE THE LIABILITY OF THE COUNTY UNDER THE COUNTY'S BENEFITS PLAN. THE COUNTY RETAINS THE ULTIMATE RESPONSIBILITY FOR PAYMENT OF CLAIMS UNDER TTS BENEFIT PLAN AND ALL EXPENSES INCIDENTAL TO SUCH BENEFIT PLAN EXCEPT AS EXPLICITLY ASSUMED BY ADMINISTRATOR IN THIS DESCRIPTION. other persons directly engaged or retained by Administrator to discharge its obligations under '~ent are made parties to any judicial or administrative proceeding which arises against th ty, the County will provide legal defense and pay any judgement or award granted, except tnafter provided. The County shall have control of any defense or settlement of such claim ministrator agrees to offer all reasonable cooperation to the County in connection with suc a or settlement. It is understood and agreed that the y is not responsible to defend any suit brought against the Administrator on the ground a Administrator's willful misconduct or negligence. The County shall also not be liable for ount of any judgement award which was the direct consequence of Administrator's willful uct or negligence. Administrator will within ten (10) days, after knowledge of such suit, notify It is understood and agreed that this agreement shall be governed by, and shall be construed in accordance with the laws of the State of Texas. It is understood and agreed that this agreement constitutes the entire contract between all parties hereto, and no modification or amendment of this agreement shall be valid unless made in writing and signed by all the parties hereto. VII. GUARANTEE OF SAVINGS TPA provides a guarantee to Counties that have a minimum of $100,000 per plan year in paid claims. We guarantee that the savings achieved through our audit program will equal at least two (2) times the total administration fees paid for that period. The "savings" figure will be the sum of all disallowed charges not deemed payable under the County Program. Should the savings be less than the minimum stated above then TPA will refund the difference to the County. Such refund will be within sixty (60) days of the end of the twelve (12) month accounting period. VIII. TERMINATION It is understood and agreed that this agreement shall terminate on the earliest of: A. The date specified with respect to which there has been written notice of termination as provided for hereinbefore; B. Any other date determined by agreement by the County and Administrator. 13105 Northwest Freeway Suite 580 Houston, Texas 77040 (713) 690-0044 Fax (713) 939-1957 ~ ©0 Ry-Ron I_~~ :. ~~ THIRD PARTY ADMINISTRATOR C. County shall have the right and option to terminate this agreement for any reason or no reason at all providing Administrator has at least ninety (90) days notice prior to the date of such termination. In the event that the contract is terminated, any and all claim files in possession of Administrator shall remain, as between the parties hereto, the sole property of the County. In the event that the Engagement is terminated by either County or Administrator shall be delivered to the County within ten (10) days following such termination. It is understood and agreed that if the Administrator performs any service pursuant to this agreement following termination hereof, Administrator will be entitled to the fees or other charges on the same basis as if the agreement had continued in effect until such services were performed, provided such services were performed at the request of the County. In WITNESS WHEREOF, the parties hereto have caused this agreement to be executed in duplication by their respective officers duly authorized to do this _ _ day of 13105 Northwest Freeway Suite 580 Houston, Texas 77040 (713) 690-0044 Fax (713) 939-1957 ~ ©© Ry-Ron i~ ~. THIRD PARTY ADMINISTRATOR EXHIBIT "A" AUDIT PROCEDURE AGREEMENT Pursuant to the Administration Contract, the County has on thirty (30) days written notice requested Contract Administrator to allow the County or its authorized agent to inspect or audit ail records and files maintained by the Contract Administrator in accordance with the following procedures: A. The Audit and/or inspection of records shall be made by County or TDHS, a financial officer of County, a member of a firm of independent public accountants, or an individual Certified Public Accountant. B. The audit and/or inspection of records shall be conducted during normal business hours at the office of the Contract Administrator between 9:00 A.M. and 5:00 P.M., Monday through Friday. C. The County shall be liable for alt fees to be charged by Auditor. D. The Auditor shall meet jointly andlor separately with an officer of the Contract Administrator at the conclusion of the audit: a. To discuss the results of the audit. b. To discuss any significant recommendation by the Auditor. E. The Auditor agrees not to disclose any proprietary and confidential information used in the business of the Contract Administrator to which the Auditor has had access pursuant to the inspection and/or audit of the record files maintained by the Contract Administrator. 13105 Northwest Freeway Suite 580 Houston, Texas 77040 (713) 690-0044 Fax (713) 939-1957 ©©~ Ry-Ron I.__.y. THIRD PARTY ADMINISTRATOR sY: ~ I C NTY'JUDGE ATTEST: l~%a"` COUNTY CLERK DATED AT this ___. day of _ RY-RON, INC. BY: TITLE: 13105 Nortfiwest Freeway Suite 580 Houston, Texas 77040 (713) 690-0044 Fax (713) 939-1957 ~4 c~~r~a~~ ~~a~~~ COUNTY COMMISSIONER -PRECINCT 1 700 MAIN STREET KERRVILLE, TEXAS 78028 512 257-2617 ~~ ~ ~-~ ~-`~~,~ y_i- vo z~-...- s'~~-fi COMMISSIONERS' COURT AGENDA REQUEST • PLEASE FURNISH ONE ORIGINAL AND SEVEN COPIES OF THIS RE~UEST.AND DOCUMENTS 10 BE REVIEWED BY 1HE COURT. MAUL= BY: ~~~ OFF ICE: ~' ~ /~~'z-~~"r MEETING DATE: ~U TIME PREFERRED: ESTIMAI-ED LENGTH OF PRESENTATION: IF PERSONNEL MATTER -NAME OF EMPLOYEE: NAME OF PERSON ADDRESSING THE COURT: Time for submitting this request for Court to assure that the matter Is posted in accordance with Article 6252- 17 is as fol lows: • Meetings held on second Monday: 12:00 P. M. previous Wednesday • Meetings held on Thursdays: 5:00 P. M. previous Thursday. If preferable, Agenda Requests may be made on office stationery with the above Inforrnatlon attached. TI-IIS REQUEST RECEIVED BY: ~ ~~~ ` ~-''`-Q `~~-`~ THIS REQUEST RECEIVED ON: ,~i C~S'O @ U `~ U '4'u'' I All Agenda Requests well be screened by the County Judge's OfFice to determine If adequate Information has been prepared for the Court's formal consideration and action at time of Court meetings. Your cooperation will be appreciated and contribute towards your request being addressed at the earliest opportunity. i i~ I U February 7, 1990 Gordon Morgan Kerr County Commissioner P.O. Box 362 Kerrville, Texas 78029 RE: Indigent Health Care Dear Mr. Morgan: This office has analyzed 20 in-patient bills incurred in Sid Peterson Hospital. The interim rate payment and DRG payment method were applied with the assumption that each patient was an eligible indigent for the days confined. Results are as follows: Total Billed $76,690.20 Interim Rate Payment $62,119.06 DRG Payment $52,878.24 This method shows a potential savings of 15a for in-patient bills. Please feel free to call and discuss this further at your convenience. Sincerely, <_~` ,~.~!~~ Alice Peairson IHC Audit Manager AP:prm cc: Cathy Horgan THIRD PARTY ADMINISTRATORS P.O. BOx 45f?2 NOUST~fJ, 1FYAS 77?_1(} ~' ~2 1F1 ~ 713-640{?04A 1'IIIR Y.~~RTI' t1Di1II1VI~. L RL1TOIt~ t ADMINISTRATIVE SER~TlCE AGREH~Nt' '~ I[~IGQ~TP BE~1i~~I CARE ALGID TRFA'Ii~NP ALT OF 1965 (S.B.1) Kerr County acting by and through its Commissioners' Court, hereinafter referred to as "County", and Ry/Ron Inc. dba/THIRD PARTY ADMINISTRATORS of Houston, Texas, hereinafter referred to as "Administrator", do hereby enter into the following agreement to implement the Indigent Health Care and Treatment Act of 1985 (S.B.1), hereinafter referred to as "Act". The County agrees to employ Ac'trninistrator to furnish services necessary to administer certain aspects of the Act. The Administrator agrees to provide such services in accordance with the terms of this agreement, hereinafter set forth. I. SCHIDL]LE & SERVICES It is understood and agreed that the County will compensate the Administrator in the following manner: A. $1,50~.0PJ upon the execution of this agreement, plus, B. A monthly fee will be payable promptly on or after the second Monday of the month. The monthly fee shall be 4$ of Claims Paid. It is understood and agreed that the Administrator will provide the following services to the County: A. Approve claims in accordance with the Act's Standards. B. Admdnistrator agrees to annual audit based on Exhibit "A" attached. C. Maintenance of all Medical Records a. Maintain files on an active basis for five years. b. Maintain individual case files and individual provider file cumulative claims total and generate monthly reports data for the Department of Human Services, the providers of the County. ' c. Provide prepared checks for providers. d. Provide check register containing appropriate information to the County Auditor. e. All records available for review and audit by Oounty on TDHS. D. Payment Services and Reports a. Claims matched with medical file. b. Payment according to benefits of Act. Written explanation of benefit payments submitted with each check. c. Issuance of checks. d. Disperse checks according to County's rules for such payment. e. Monthly and annual medical utilization summary. f. Will not pay the costs of a health care service that is in excess of payment standards for that service established by TDHS under Section l.PJ6 of the Act. ~ ~ ~. ~ 1311th \~n•ilur~~st F'r~~~~~~~a~~ ~uit~~ :58f) Hrn~~ton, 1t~~1s 770-1O (713) (iS)Ih00-}.~ 'I'II IIt- P.1 II 'P 1" :1I)lI1 \'I~_1'R.1`1'Oliti pg.2 g. Monthly report showing benefits paid year-to-date by month. h. Supply necessary claim forms to bounty, if needed. i. Provide verification and documentation to the Bounty that shows expenditures to eligible residents so the County can request assistance from TDHS. j. Match claims with payment schedule as outlined in (b.) above and verify that care rendered by provider is consistent with reasonable medical care was provided and if riot, tend to not make payment of claims. k. Provide instant inquiry by hospitals and providers during normal working hours. 1. Coordinate benefits with other benefit programs and third party liability coverage, i.e., auton~bile liability. E. Reports to County The reports are arnposed of two parts: Standard Reports and Management Information Reports. Standard Reports are designed to analyze plan performance payment history and monthly transaction volume. The Management Reports Dover cost containment analysis, loss reporting, and benefit utilization. STADIDARD REPORTS Monthly Check Register Coverage Analysis Report MANAGEN~r REPORTS YEAR-ENID Hospitalization Utilizatirn Statistics Diagnosis Reporting Claim Payment Analysis Benefit Utilization Analysis Provider CatQarison Analysis Average Length of Stay (by diagnosis and hospital) II. TRAINING It is understood and agreed that the County will pay $250.QX~ per individual trained by the Administrator at their training school, if such is desired by the County. III. POSTAGE AMID CHECK EjORMAT It is understood and agreed that the Administratar will pay for all postage rec~iired to transmit claims, recards and checks to the County. The County will pay for any and all other postage. Should the County not elect to use Administrator's checks the County will provide printed checks catpatible with Administrator's oanputer hardware at the County's expense. TIIIII~ I'~t Ii'1'1" :1I)~IINI ~I'II~1'l'OIi~+ pg.3 IV. PERIOD OF OONTRACT It is understood and agreed that this agreement shall be in effect frcm the date of execution of this document through the following August 31st, and renewable for succeeding periods, such periods being fmn September 1st of a calendar year and through August 31st of the secazd following year, unless the County or Ar.~ninistrator gives written notice to the other, at least ninety (98) days prior to the end of any such period, that this Agreement is to be terminated at the end of any such period. If no such written agreement is received by either party the contract will continue in force for another period. If no such written agreement is terminated, the Administrator will process all claims during the contracted experience period at the percentage fee rate set forth hereinbefore. After all claims are processed the Administratar will prc~tly deliver all records, reports and documents relating to the County's obligations under the Act to the County. V. DISPUTES Tn the event a dispute arises between TPA and a provider as to a claim, the dispute shall be resolved by the Cacmissioner's Court of Kerr county, Texas. VI. MISCELLANDOiJS The time for performance by Administrator of any term, condition or covenant of this Description shall be deemed extended by time lost due to delays resulting fran Acts of God, strikes, shortages of any materials, computer breakclowr~s, civil riots, national or labor restrictions by governmental authority, any other cause not within the control of AcbnisListratar. ADMINISTRAZC3R DOES NOT INSURE OR UNDERWRITE THE LIABILITY OF ~ COUi~TPY UNDER THE COUNTY'S BENEFITS PLAN. THE OOUNTY RETAINS THE ULTIMATE RESPONSIBILITY ~R PAYMYM~NNr OF CLAIMS UNDER ITS BENEFIT PLAN AMID ALL EXPENSES INCIDENTAL TO SUCfi BEIQEF'IT PLAN F~CCEPT AS F~LICITLY ASSL~ BY ADbIINISTRATOR IN THIS DESCRIPTI~T. It is understood and agreed that in the event that Administratar or any of its directors, officers, employees or other persons directly engaged or retained by Administrator to discharge its obligations under this agreement are made parties to any judicial or administrative proceeding which arises against the County, the County will provide legal defense and pay any judgement or award granted, except as hereinafter provided. The County shall have control of any defense or settlement of such claim and Administrator agrees to offer all reasonable cooperation to the County in connection with such defense or settlement. It is understood and agreed that the County is not responsible to defend any suit brought against the Ac3 v . c~ c .r! 3 ~ ~t . (.Gv J~ Ui , I J r c 7Js..1(~ ,f~, ~ ~7 (J . (31 ~ d.c~o ~ U,00 U a () l) {~ 0.00 ~ 106. ].0 ~ 0,00 :~ (? . U U ~X> 0 . U 0 'G 0 . U (? ~ a,ao {); O , O U ~ 0.00 ~ a.ad ~> d , c) o ~ 1,U0 ~ U.00 1~ U.UU ~ U.00 ~ O.OG ~ U,OU `~ U,0() `~ 0.00 ~> o,()o ~ O.UO ,,,,rra~utt BII,L~IG (N0~ INTF,xc+~*+ 76,690.20 TOTEM CAST 62,119.06 IN'I'ERl SAVINGS botto ~ line Do11 ~ ~''''' ~ ~°~ 3l ~~ PERSON ,HOSp~AL TOTAL DRG $~ 76,690.20 gAVINGS TOTAL 56,562.94 ~ ~J Q e DRGINGS 20,127.26126.24a1a1 ~./~ p _~ , ~ SA a~"~~ adjusted =~1,pp o~Q Qp - g,pp0.pp arrY saved 30 83' a$proximately 200} Third Pariy Costs 4 /o ° ervices 3 513.32 Th Utilize Thlyd Pte' 4 513.32 adjusted = .s-~'" To additional cost -•~--' Belated - Gr°up billingl RG _ Dia~nostlc ~ approx. 5p% total no refundl D e tearly dismissal ies to in'Pa~ent casts o y stay tim ApPI of hospital total amount regardless _ Pay _- F~CTS_ l Do DRG at no cast. ;id Peterson Hosplta ouble checks IHC b~~s D ~~°~ Third Park ~ ~ `~ continue Kathy s services Necessa~ to TIC P~~ 76,6.20 23 81$.96131.04%1 ~~~. ' ~' ,~