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AGREEMENT
(SID PETERSON MEMORIAL HOSPITAL)
This Mandated Provider Agreement is entered into on the 26th day of June, 2002, by and
between SID PETERSON MEMORIAL HOSPITAL, acting by and through its duly authorized
CHIEF EXECUTIVE OFFICER or designee (hereinafter called "Hospital"), and KERR COUNTY,
TEXAS, acting by and through its duly authorized COUNTY JUDGE, as authorized by the
Commissioner's 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 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 provision 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 and 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 in the Act and by the TEXAS DEPARTMENT OF HUMAN
SERVICES, (hereinafter called "Department") to the extent of the department's rights,
responsibilities and powers under the Act.
2. MANDATED PROVIDER
Hospital shall be a mandated provider of the inpatient and outpatient mandatory hospital
services for County's eligible program by the Center for Medicare and Medicaid Services. 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 is 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 non-mandated 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 that exceed the maximum per patient limits established by the Act. County
shall notify Hospital before the date on which County anticipates it will spend eight percent (8%) of the
general revenue levy for that fiscal year. If Hospital transfers eligible residents of County for inpatient and
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outpatient 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
that identify persons as eligible residents.
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.
6. NOTIFICATION OF PROVISION OF SERVICES
Hospital may deliver emergency or non-emergency services to eligible residents of County
without obtaining County approval. The Hospital will provide notification by mail.
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 Chief Executive Officer or
designee, 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 are 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.
8. THIRD PARTY PAYORS
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 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, in accordance with Hospital policy. 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 his/her medical records and provide the same to the Hospital prior to receiving any
medical records.
10. TERM AND RENEWAL TERMS
The term of this Agreement for one (1) year shall begin July 1, 2002 and shall automatically
renew for additional one (1) year terms. Either party may cancel this agreement with ninety (90)
days prior written notice. 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 ninety (90)
days prior written notice, provided the breaching party has been notifed 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.
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. EXLUSIVE 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. Jurisdiction for any dispute under this agreement will be with the
appropriate courts of Kerr County, Texas.
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
certifed mail, return receipt requested, addressed as follows:
Kerr County Judge	Chief Executive Officer
Kerr County Courthouse	Sid Peterson Memorial Hospital
700 Main St.	710 Water St.
Kerrville, Texas 78028	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
pertormance 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 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
Patrick Murray, CEO
R COUNTY, EXAS
' red Henn ke, aunty Judge
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