Ite^ No. 2.19 Consider renewing contracts for Mandated Provider Rgreements between Sid Peterson Memorial Hospital and ~~, Kerr County, and between Sid Peterson Memorial Hospital and all physicians (medical Doctors> on staff at Sid Peterson Memorial Hospital due to expire August 31, 1994 and authorize the County Judge to sign same. ORDER NO.2231 APPROVAL OF RENEWAL OF CONTRACTS FOR MANDATED PROVIDER AGREEMENTS BETWEEN SID PETERSON MEMORIAL HOSPITAL AND KERR COUNTY, RND BETWEEN SID PETERSON MEMORIAL HOSPITAL AND RLL PHYSICIRNS ON STRFF AT SID PETERSON HOSPITAL RND RUTHORIZRTION DF THE COUNTY JUDGE'S SIGNATURE On this the cc^3rd day of Rugust 1994, upon motion made by Commissioner Oehler, seconded 6y Commissioner Lehman, the Court unanimously approved by a vote of 3-0-0, to renew the Mandated Provider Agreements Between Sid Peterson Memorial Hospital and Kerr County as submitted: AGREEMENT (PHYSICIRN - SID PETERSON MEMORIAL HOSPITAL) This Mandated Provider Agreement is entered into on the 31st' day of August, 1994, by and between all Physicians (medical doctors) on staff at SID PETERSON MEMORIAL HOSPITAL as of August 31, 1994, acting by and through their duly authorized. Chief of Staff, J. L. Graham, M. D. (hereinafter called "Physician, whether one or more), and KERR COUNTY, TEXRS,' acting by and through its duly authorized COUNTY JUDGE, W. G. STRCY, 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 (hereinafter called "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 6y the Act; WHEREAS, Physician agrees to provide, or to arrange the provisions of, those mandator^y physician services required by the Rct for County's eligible residents; NOW, THEREFORE, in consideration of the mutual ~~ covenants herein contained, County hereby designates and Physician hereby agrees to be a Mandated Rrovider for mandatory Rhysician services required by the Act or the Rct's regulations to be pr^ovided to County's eligible residents and the parties agree as follows: PRGE .°i.°,0 1. DEFINITIONS ~'~ R11 terms shall be as defined in the'Act and by the TEXRS t DEPARTMENT OF HUMAN SERVICES, thereinafter called "Department") to the extent of the departments rights, responsibilities and powers under the Act. 2. MRNDRTED PROVIDER Physician shall be mandated provider of the mandatory physician services for County~s eligible residents, as defined by the Rct. Rhysician 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 the Health Care Financing Administration. Unless otherwise agreed upon, physician shall deliver, or' arrange to be delivered, physician services that ar'e 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. If Physician transfer' eligible residents of County to 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 Ret or established by the Department. All tr•ansfer-s will be made to contracting physicians if possible. Per patient expenditure limits as established by the Rct apply to such services delivered by the receiving physician. 4. NOTICE County shall have the duty and responsibility to give all notices concerning the availability of mandator-y physician services from Hospital. S. DETERMINRTION OF ELIGIBILITY County shall be responsible for determining whether an applicant is eligible for financial assistance defined by the Rct 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 non- emergency services, Physician shall not provide such non- emergency services until County has determined eligibility of the patient, has notified physician of the eligibility decision RAGE 551 and has approved in writing provision of the _ services. County must determine eligibility services. County must determine eligibility services within fourteen (14) days from the r^eceives a completed application. non-emergency for non-emergency for• non-emergency date County Eligibility requirements and this contract may be notified 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. NOTIFICRTION 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 non-emergency services. 7. REIMBURSEMENT PROCEDURES Physician shall present charges for physician services provided to eligible patients to County monthly. County shall reimburse Rhysician within thirty (30) days of presentation of the charges at the payment rate determined by the Depar^tment. pll payment disputes are to 6e suhmitted 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 Director^ members, County Judge, and one County Commissioner. 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 r^ight to pursue any reasonable collection effort against such patients. Physician shall have the eight 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 pr•avisions of the Rct or payment policies and rates established by the Department. 8. THIRD RRRTY PAYORS Physician will notify County if any eligible residents have access to any others sources of payment for the eligible services provided, but the County shall be responsible for the payment of such eligible services as provided for• herein. Physician shall notify County of the amounts received from third party payor•s and reimburse County far 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 6y notice from County. Such notice shall be received by Physician twenty four (24) hours in advance of such examination. County shall hold all medical r^ecords in strict confidence so as not to violate the physicianlpatient relationship. PRGE 552 County shall obtain a sign authorized medical consent form from the patient, authorizing the release of his/her medical records and provide the same to the Physician prior to receiving any medical records. la. TERM AND RENEWAL TERMS The terms of this Agreement for one (1) year shall begin September 1, 1494 and shall be considered renewed for additional one (1> year terms unless canceled by either party as stated below. County shall reimburse Physician according to the provisions of this Agreement for eligible patient who continues to receive eligible physician services past the expiration of this Agreement. il. TERMINATION RND RIGHT TO CURE Either party may terminate this Agreement upon breach of this Rgreement 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 shall have any further duty or• obligation to the other except for indebtedness due at the the time of termination and indemnification of the other party. 12. HOLD HRRMLESS ^ 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. RSSIGNMENT Neither party shall assign the Rgreement, except with the prior written consent of the other- party, except as provided in Section 5 hereof. 14. HERDINGS Section headings are for convenience of reference only and shall not be used to construe the meaning of any provision to this Rgreement. 15. COUNTERPRRTS This Rgreement 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. OBLIGRTIONS R5 CONDITIONS All obligations of each party to this Rgreement are conditions to further performance of the other party's ~', continued performance of its obligations under the Rgreement. PRGE 553 17. EXCLUSIVE RIGHTS Only the parties to this Agreement have the exclusive right to br-ing 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 Rgreement be invalid or unenfor-ceable, such invalidity or unenforceability shall not affect the validity and enforceability of the remaining portions. 19. LRW This Agreement shall be construed in accordance with the laws of the State of Texas. 2@. AMENDMENT This agreement may not be modified except in writing executed by both parties to this Agreement. 21. NOTICE Rny notices, demands or communications requir^ed, 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 follow: Kerr County Judge Chief of Staff Kerr• County Courthouse Sid Peter^son Memorial Hospital 7@@ Main 71@ Water Street Kerrville, 7x 78@28 Kerrville, Texas 78@28 or such other address and to the attention of such other person is> or officer ts) 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 per-formance under this Rgreement 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 contr-ol of either Party. Either par^ty in such event may terminate this Agreement. 23. RELATIONSHIR OF PARTIES None of the provisions of this Rgreement are intended to create nor shall be deemed construed to create any relationship between County and Physician other than that of independent entities contr-acting with each other- hereunder solely for the purpose of effecting the provisions of this Agr^eement. Neither the parties hereto, or any of their respective officers, directors or employees shall be construed to be the agent, employee or r-e presentative of the other party. PAGE 554 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 6y the Texas Department of Human Services and other applicable local, state and federal laws, r^ules and 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 COUNTY, TEXAS BY:/S/J. L. Graham, M. D. /sJ W. G. Stacy /t/J. L. Graham, M. D. /t/ W. G. Stacy Chief of Staff Kerr County Judge AGREEMENT ISID PETERSON MEMORIAL HOSPITAL) This Mandated Pr^ovider^ Agreement is entered into on the 31 day of August, 1994, by and between SID PETERSON MEMORIAL HOSPITAL, acting by and thr^o ugh it's duly authorized administrator, F. W. Hall, Jr. (hereinafter called "Hospital"), and KERR COUNTY, TEXAS, acting by and through its duly authorized COUNTY JUDGE, W. G. STRCY, as authorized by the Commissioners+ Court of Kerr• County, Texas days. County shall reimburse Hospital within thir-ty t~~) 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 Director 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 ar•e required for 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• because the charges are not payable by County due to provisions of the Act or payment policies and rates established by the Department. PRGE 557 8. THIRD PRRTY F'AYORS Hospital 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 payment of such eligible services as provided for herein. hospital shall notify County of the amounts received from third party payor•s and r•eimbur•se County for services and amounts covered under this Rgreement. 4. RECORDS Hospital will provide County access to all financial recor-ds 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 twenty four (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 hislher medical records and provide the same to the Hospital prior to receiving any medical r•ecards. 10. TERM AND RENEWAL TERMS -- The term of this Rgreement for one (1) year shall begin September 1, 1994 and shall 6e considered renewed for additional one (1) year terms unless canceled by either party as stated below. County shall r•eimbur•se Hospital actor-ding 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 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. 1?. 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. PRGE 558 13. ASSIGNMENT ~~ Neither party shall assign this Rgreement 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 counter•par•ts, each of which shall 6e an original, and all of which shall together constitute ane agreement. 16. OBLIGRTIONS AS CONDITION All obligations of each party to this Rgreement are conditions to fur-they performance of the other party~s continues performance of is obligations under the Rgreement. 17. EXCLUSIVE RIGHTS Only the parties to this Agreement have the exclusive right to bring suit to enforce this Rgreement and no other parties may bring suits as a third party beneficiary, or otherwise, to enforce the Agreement. 18. SEVERANCE Should any part unenforceable, such affect the validity portions. of this Rgreement be invalid or invalidity or unenforceability shall not and enforceability of the remaining 19. LAW This Agreement shall be construed in accordance with the law of the State of Texas. 20. RMENDMENT This Agreement may not be modified except in writing executed by bath par-ties 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 ar- mailed by prepaid certified mail, return receipt requested, addressed as follows: Kerr County Judge Administrator Kerr County Courthouse Sid Peterson Memorial Hospital 700 Main 7i0 Water Street Kerrville, Texas 78028 Ker•r•ville, Texas 78028 or• such other address and to the attention of such other person (s) or officer (s) as either party may designate by i'~ wr-itten notice. PRGE 559 22. FORCE MAJEURE i Neither Party shall be liable nor deemed to be in default for any delay or failure of performance under this Agreement ar other interruption from Acts of God, civil or military authority, acts of public enemy, ware, 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. RELRTIONSHIR 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 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. ~4. ENTIRE AGREEMENT This Agreement supersedes all pr'ior' agreements between the parties with respect to the subject matter thereof. This Agreement is subject to all areas controlled by the Indigent Health Care and Treatment Rct, 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 fir^st above written. SID PETERSON MEMORIRL HOSPITAL KERR COUNTY BY:/s/ F. W. Hall, Jr. /s/ W. G. Stacy /t/ F. W. Hall, Jr. /t/ W. G. Stacy Administrator Kerr County Judge Item No. 2.20 Consider approving Mrs. Edith M. Javens for membership to the Kerr County Child Services Board. ORDER NO. 22232 APPROVAL OF MRS EDITH M. JAVENS FOR MEMBERSHIP TO THE KERR COUNTY CHILD SERVICES BOARD On this the 23rd day of Rugust 1994, upon motion made by Commissioner Oehler, seconded by Commissioner Holekamp, the Court unanimously approved by a vote of 4-0-0, to approve Mrs, Edith M. Javens for membership to the Kerr County Child Services Board as submitted by Peggy Dunbar. PAGE 560