R-97-06-12-11F - 6/12/1997 RESOLUTION NO. R-97-06-12-11 F
WHEREAS, the City of Round Rock desires to retain health care
insurance for City Employees, and
WHEREAS, Columbia/St . David' s Healthcare System, L.P. , has
submitted an agreement to provide said insurance, and
WHEREAS, the City Council desires to enter into said
agreement with Columbia/St . David' s Healthcare System, L.P. , Now
Therefore
BE IT RESOLVED BY THE COUNCIL OF THE CITY OF ROUND ROCK,
TEXAS,
That the Mayor is hereby authorized and directed to execute on
behalf of the City an agreement with Columbia/St. David' s
Healthcare System, L. P. for health care insurance for City
Employees, a copy of said agreement being attached hereto and
incorporated herein for all purposes.
RESOLVED this 12th day of June, 1997 .
64 1 A'
CHARLES CULIPE15199R, Mayor
City of Round Rock, Texas
ATTEST:
J&NNE LAND, City Secretary
R:\WPDOCS\RBSOLUTI\RS70612P.WPD/Bcg
EMPLOYER AGREEMENT
BETWEEN
COLUMBIA/ST. DAVID'S HEALTHCARE SYSTEM, L.P. dba
COLUMBIA ST. DAVID'S HEALTH NETWORK
AND
CITY OF ROUND ROCK,TEXAS
rr �v
This Agreement is made and entered into on this !0&— day of O1997,
effective December 1, 1996(the "Effective Date")by and between Columbia/ .David's Healthcare
System,L.P.,dba Columbia St.David's Health Network("Health Network"), a Texas corporation,
and The City of Round Rock, Texas ("Employer").
WHEREAS,Employer desires to make available to its employees,their dependents and other
eligible Beneficiaries appropriate, cost effective medical, hospital and other health care services
through Employer's health benefits program which Employer offers to its eligible employees,their
dependents, and other eligible beneficiaries; and
WHEREAS,Employer exercises discretionary authority or control respecting management
of the Plan in that Employer has authority to appoint the Plan administrator and/or to amend or
terminate the Plan; and
WHEREAS, Health Network arranges directly and indirectly with physicians,other licensed
health care practitioners,hospitals and health care facilities to provide health care services to eligible
Beneficiaries of employers and other entities with whom Health Network has entered into
agreements; and
WHEREAS,Employer desires to offer the option of participating in Health Network's system
of health care providers to its eligible employees and other covered persons;
NOW, THEREFORE, in consideration of the premises and mutual covenants herein
contained,the parties agree as follows:
I.
DEFINITIONS
1.1 "Beneficiary" means any person eligible to receive covered services for which a
health care Payor has a legal obligation to pay for or indemnify under a Payor Agreement and Plan.
1.2 "Complete Claim" means a written request for payment for Covered Services
submitted by a Participating Provider or its designee or agent to a Payor,which is accurate,complete
and in the form reasonably required by Payor, and as to which there is no material issue regarding
the Payor's responsibility for payment.
1.3 "Co-payment" means a payment which may be collected directly from a Beneficiary
in accordance with the terms of this Agreement and applicable Payor Agreement and Plan.
1.4 "Coordination of Benefits"means those provisions by which Participating Physicians,
Hospital or Payor on an individual or collective basis,seek to recover costs incidental to an episode
of sickness or accident by a Beneficiary,which costs may be covered by one or more Payors,subject
to any limitations preventing such recovery.
1.5 "Covered Services"means those medical services and health care services,which are
medically necessary,provided to a Beneficiary for which payment or reimbursement is authorized
pursuant to a Payor Agreement and Plan and which are rendered in conformity with the applicable
Utilization Review Program.
1.6 "Designated Claims Agent" means an entity or organization (including an insurer
performing administrative services only) that is responsible through a contract with the Plan of
Employer for the administration or payment of claims under the Plan.
1.7 "Employer" means The City of Round Rock, Texas, with offices located in Round
Rock, Texas.
1.8 "Medically Necessary"means the medical or surgical treatment which a Beneficiary
requires as determined by one or more Participating Providers in accordance with accepted medical
and surgical practice and standards prevailing at the time of treatment and in conformity with the
professional and technical standards adopted by the Plan.
1.9 "Normal Charges" means a Participating Provider's actual and full charge for a
service, based upon professional fees that are usual, customary and consistent with community
standards or based upon hospital or facility standard charges,as adjusted from time to time by the
Participating Providers and before any discount granted by reason of this Agreement.
1.10 "Participating Hospital"means any hospital which satisfies such participation criteria
as may be established by Health Network and which has entered into an agreement directly or
indirectly with Health Network to provide Covered Services to Beneficiaries.
1.11 "Participating Physician" means any physician who satisfies such participation
criteria as may be established by Health Network and who has entered into an agreement directly
or indirectly with Health Network to provide Covered Services to Beneficiaries.
1.12 "Participating Provider" means a participating hospital, clinic, other health facility,
Participating Physician, health professional, or other medical provider, which has entered into an
agreement with Health Network to provide Covered Medical Services to Beneficiaries and is
licensed as that term is defined in the Texas Medical Practice Act or is otherwise licensed or
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authorized to provide health care services in the State of Texas; and is defined in Attachment E
hereto.
1.13 "Payor"means(I)an insurance company,a multi-employer trust,or a union trust fund
which has entered into an agreement with an Employer to assume, in whole or in part,the actuarial
risk of,and to make payment for, Covered Services provided to Beneficiaries of an Employer,or(ii)
a self-insured Employer which assumes the actuarial risk of,and has entered into an agreement with
an organization to coordinate, administer, and to make payment for, Covered Services provided to
Beneficiaries of an Employer, but does not mean a federal or state government agency or a charity
program.
1.14 "Payor Agreement" means an agreement directly or indirectly between a Payor and
Health Network where the Payor agrees to pay for or indemnify Covered Services arranged for by
Health Network provided to a Beneficiary.
1.15 "Plan"means an agreement which identifies health care services which are Covered
Services and the terms and conditions upon which a Payor will pay for or indemnify a Beneficiary
for such Covered Services.
1.16 "Provider Agreement"means any agreement for the provision of health care services
to Beneficiaries which is entered into by Health Network directly or indirectly with any Participating
Provider.
1.17 "Utilization Management" or"Utilization Review" means a program for reviewing
and making determination regarding whether a service provided or to be provided to a Beneficiary
by a Participating Provider is Medically Necessary and provided at the most appropriate level of care
in a timely and cost efficient manner.
II.
OBLIGATIONS OF NETWORK
2.1 Arranging for Covered Services. Health Network shall directly or indirectly arrange
for, enter into, maintain, and enforce Provider Agreements with Participating Providers in the
Service Area. If Employer has a reasonable basis for dissatisfaction with the services of any
Participating Provider,Employer shall so notify Health Network and thereafter Health Network shall
in good faith,consult with Employer in determining what action,if any,should be taken with respect
to such Participating Provider.
2.2 Requirements for Provider Agreements. All Provider Agreements for which Health
Network has arranged,directly or indirectly,and which have been entered into prior to the execution
of this Agreement shall be considered to meet the requirements of this Section. Health Network
shall to include provisions in Provider Agreements by which the respective Participating Providers
agree to (I) comply with all applicable laws, regulations, and ordinances; (ii) provide Covered
3
Services to Beneficiaries; (iii) cooperate and comply with the Utilization Review program of
Employer; (iv) accept the attached applicable Participating Provider Compensation Exhibit as the
full amount that Employer is obligated to pay Participating Providers, as set forth in Attachment A
hereto,which is incorporated herein by this reference; (v)not bill or collect from Beneficiaries any
amount other than: (a) deductibles,coinsurance or copayments required by the Plan to be paid by
the Beneficiaries and(b)fees or charges for services that are not Covered Services; (vi)not waive
the payment by Beneficiaries of any deductible or copayment required to be paid by the Beneficiary
for Covered Services; (vii) assist, if appropriate, with the coordination of benefits; (viii) upon
termination or suspension of the Provider Agreement, continue to provide Covered Services to a
Beneficiary who is under active treatment until the episode of illness, injury or other debilitation
requiring the provision of Covered Services is completed, responsibility for such treatment is
assumed by another participating Provider, or the patient ceases to be eligible as a Beneficiary,
which ever occurs first; (ix) upon termination of the Provider Agreement, use its best efforts to
transfer care of Beneficiaries to other Participating Providers as soon thereafter as practicable; (x)
maintain either(a)hospital,medical or other professional liability insurance,as applicable,which
is consistent with the minimum standards as established by Health Network, if such coverage is
reasonably available,or(b)other equivalent financial responsibility as approved by Health Network
and such other terms and conditions as may be agreed upon by the parties from time to time.
2.3 Medical Records. Health Network shall,directly or indirectly,require Participating
Providers to maintain complete and professionally adequate medical records to the extent necessary
for continuity of care and to provide such documents and records, including all writings,
transcriptions and tapes of any description,to Health Network,and/or any applicable federal, state
or local regulatory agency as may be necessary for compliance with the provisions of federal, state,
or local law,to conduct Utilization Management/Review,or for compliance with the obligations of
this Agreement, for the period of time required by all applicable federal, state and local laws,but in
no event for less than two(2)years from the date the record is created.
2.4 Liability Insurance or Financial Responsibility. The Health Network shall maintain
a policy of liability insurance applicable to this Agreement and covering the Health Network's
responsibilities hereunder, in such form as shall be acceptable to Employer. Upon written request
of Employer, the Health Network shall provide Employer with a memorandum copy of such
insurance or evidence of such other financial responsibility.
2.5 Suits and Other Actions. Health Network shall, directly or indirectly, require
Participating Providers to give prompt written notice to Health Network whenever they become
aware that a Beneficiary or other person has filed a claim or given written notice of intent to
commence any suit or other action against Employer,the Plan,Health Network, or a Participating
Provider in connection with this Agreement. Health Network shall notify Employer promptly
whenever it becomes aware of any such claim or notice of intent to commence a suit or other action.
Failure to notify Employer as required by this Section 2.5 and State and Federal Law shall relieve
Employer of any obligation it may have to indemnify Health Network.
4
2.6 Roster of Participating Providers. Health Network shall provide to Employer and
keep current a roster of the names and office or business address of all Participating Providers that
have contracted to provide Covered Services. Such roster shall be amended as may be necessary
from time to time,but not less often than quarterly.
2.7 Health Network Indemnification of Employer. Health Network acknowledges and
agrees that Employer and the Plan have no responsibility or liability for the organization,
administration, and operation of Health Network, including the contracting for Participating
Providers. Health Network agrees, to the extent of Health Network's responsibility, to indemnify
and hold Employer and the Plan harmless from any and all damages, claims and reasonable
expenses, including attorneys' fees and court costs incurred in defending any action seeking the
award of such damages or claims, arising out of any error or omission of Health Network, or its
agents or employees, in performing Health Network's duties under this Agreement. Health
Network's agreement to indemnify and hold harmless with respect to liability alleged against
Employer or the Plan based on Health Network's performance under this Agreement shall not extend
to damages, claims or liabilities arising in the paying or denying payment of claims for Covered
Services.
2.8 Access and Availability of Participating Provider Services. In no event shall this
Agreement be construed to guarantee the availability to Beneficiaries of a particular service or of a
certain number of beds at a Participating Hospital, nor to grant priority to Beneficiaries over other
patients in instances where the demand for services or beds exceeds the number of services or beds
available. Neither Health Network nor Participating Hospitals shall be liable to Employer or Plan
or Beneficiaries in connection with any participating Hospital's inability to provide a service to a
Beneficiary or in connection with any Participating Hospital's decision, under the circumstances
described above,not to admit Beneficiaries. Health Network makes no warranty,express or implied,
as to the availability of or access to services that Beneficiaries seek from participating Providers.
In the event a Beneficiary cannot obtain services from a participating Provider,Health Network shall
not be responsible for any portion of the costs relating to such services that are obtained from a non-
Participating Provider.
III.
OBLIGATIONS OF EMPLOYER
3.1 Plan Marketing and Administration. Employer shall be responsible for design,
development, marketing and administration of the Plan. However, pursuant to the terms of this
Agreement the parties agree that the Plan shall be as described in Attachment B hereto. The parties
shall agree on a mutually acceptable procedure for verifying and identifying Beneficiaries; however,
Employer or its designee shall be responsible for ultimate determinations of eligibility. At all times
when this Agreement is in effect, Employer shall use its best efforts to keep its Beneficiaries
informed of the availability of and the financial benefits of utilizing Participating Providers.
Employer agrees to make available to all Beneficiaries any marketing and promotional brochures,
5
or other literature supplied to Employer by Health Network. Participating Providers may obtain
verification of a Covered Person's eligibility for Covered Services by calling Employer's Claim
Administrator at a telephone number to be supplied by Employer prior to the effective date of this
Agreement. Participating Provider shall be paid pursuant to Section 3.2, for Covered Services
provided to patients who are identified or verified by Employer as Covered Persons (even if
information provided by Employer is erroneous)until:
(a) notification of noncoverage is provided by the Employer; and
(b) Alternative coverage has been arranged or a medically acceptable transfer or other
disposition of the patient has been made.
3.2 Compensation of Participating Providers. Employer agrees to cause the Plan or the
Designated Claims Agent to pay claims in accordance with the terms and conditions of this
Agreement and the Plan and of the Participating Provider Compensation Exhibit set forth in
Attachment A hereto. Employer agrees to cause the Plan or the Designated Claims Agent to (I)to
determine that a claim is not a Complete Claim and to request any information from Participating
Provider necessary to make such claim a Complete Claim within an average twenty(20) days from
receipt of a claim from Participating Provider or its designee or agent,for Covered Services provided
to a Beneficiary,and(ii)to make claim payments within an average of twenty(20)days from receipt
of a Complete Claim. Employer agrees to cause the Plan or the Designated Claims Agent to apprise
Participating Provider, on request, of the status of any such claim, and to endeavor to resolve
promptly any claim that is determined not to be a Complete Claim. Employer agrees that a
Participating Hospital may submit claims for payment on a UB-92 and a Participating Provider may
submit claims for payment on a"superbill" or HCFA 1500 forms. All claims will be mailed directly
to the Plan or the Designated Claims Agent for payment. Health Network may review claims to
initially assess whether the claim is in the prescribed form and contains necessary information. All
claims processing functions will be performed by Employer, the Plan or the Designated Claims
Agent.
3.3 Claims Data. Employer agrees to provide (or have the Plan's Designated Claims
Agent provide)to Health Network on a timely basis the claims data reasonably necessary to produce
management reports in a format mutually acceptable to both parties' data systems.
3.4 Compensation for Continuation of Services. Employer agrees to cause the Plan to
continue to pay each Participating Provider for Covered Services rendered after the termination of
this Agreement to Beneficiaries under Section 2.2 (viii) and (ix) hereof in accordance with the
applicable Participating Provider Compensation Exhibit.
3.5 Certification of Number of Employ. Employer shall provide Health Network with
certification as to the number of employees in the Plan. Such certification shall be provided at the
time this Agreement becomes effective and monthly thereafter.
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3.6 Health Network Access Fee. Employer shall pay a fee to Health Network for
arranging pursuant to this Agreement for a system of Providers to provide Covered Services to
Beneficiaries in the Service Area. The fee shall be paid in accordance with Attachment C hereto
which is incorporated herein by this reference.
3.7 Employer Utilization Management Program.
3.7.1 Employer may perform its own Utilization Management Program or employ
a Utilization Management vendor to perform the program. Health Network
shall require Network Participating Providers to comply wi mployer's
Utilization Management Program, as described in Attachment D hereto,to
the extent of Providers' scope of licensure.
3.7.2 Utilization Review shall be performed (a) during normal business office
hours,(b)after prior notice to Network Participating Providers, and (c)in a
manner limited to the authorized scope of Utilization Review.
3.7.3 Information obtained by Utilization Review should not be released to third
parties absent Network Participating Providers'prior consent.
3.7.4 Employer shall assure that an adequate appeal process is available to
Beneficiaries to contest denial of payment as a result of Utilization Review.
3.7.5 Network Participating Providers may contest any denial of payment as a
result of Utilization Review.
3.8 Liability Insurance or Financial Responsibility. Employer shall maintain a policy of
liability insurance applicable to this Agreement and covering Employer's activities and
responsibilities hereunder, in an amount not less than required by Community Standards and State
and Federal Law. Upon written request by Health Network,Employer shall provide Health Network
with a memorandum copy of such insurance or evidence of such other financial responsibility and
shall obligate its carrier or other individual or entity having financial responsibility to give a
minimum of twenty(20)days prior written notice to Health Network of any material adverse change
in Employer's coverage.
3.9 Suits and Other Actions. Employer shall notify and shall cause the Plan and
Designated Claims Agent to notify Health Network in writing promptly whenever it becomes aware
of any claims or notice of intent to commence a suit or other action against Employer, Health
Network, the Designated Claims Agent, or a Participating Provider in connection with this
Agreement. Failure to notify Health Network as required by this Section 3.9 and State and Federal
Law shall relieve Network of any obligation it may have to indemnify employer.
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3.10 Release of Records. Employer agrees to obtain the consent of Beneficiaries as legally
required for any release of health care information by Participating Providers to Employer,the Plan,
or the Designated Claims Agent pursuant to the delivery of Covered Services, or for the release of
health care information by Employer, the Plan, or the Designated Claims Agent. Any medical
records to which Health Network,Employer,the Plan,the Designated Claims Agent or their agents,
or Participating Providers have access pursuant to this Agreement shall be kept confidential in
accordance with applicable law.
3.11 Reference to Employer. Employer agrees that Health Network may refer to Employer
or the Plan in informing Participating Providers and potential Participating providers about the
organizations, funds, and employers participating in the Health Network's programs.
3.12 Regulation under ERISA. In the event Employer or the Plan is regulated under
ERISA, Employer agrees that Health Network shall not be responsible for complying with any
requirements of ERISA imposed on Employer or the Plan. Health Network will reasonably
cooperate with Employer or the Plan by furnishing such material or information as it has access to
and control of,in accordance with applicable federal and state law and the provisions of Section 2.3
and Section 3.10 herein,to aid Employer or the Plan in meeting ERISA reporting requirements. It
is agreed that Health Network is not, and will not be designated or deemed, the administrator or
named fiduciary of the Plan for the purposes of ERISA and any applicable state legislation of a
similar nature. Employer shall indemnify and hold Health Network harmless in connection with any
responsibility, obligation, suits, proceedings, or inquiries arising under the Employee Retirement
Income Security Act of 1974 ("ERISA") or any applicable state legislation of similar nature as a
result of this Agreement where such responsibilities,obligations,suits,proceedings,or inquiries are
applicable to Employer.
3.13 Employer Indemnification of Health Network. Employer agrees, to the extent of its
responsibility,to indemnify and hold Health Network harmless from any and all damages, claims,
and reasonable expenses,including attorneys'fees and court costs incurred in defending any action
seeking the award of such damages or claims, arising out of any error or omission of Employer,or
its agents or employees, in performing its duties under this Agreement.
IV.
TERM AND TERMINATION OF AGREEMENT
4.1 Term. This Agreement shall remain in force and effect for an initial term of twelve
months,commencing on the Effective Date described herein, and expiring on November 30, 1997.
This Agreement may be renewed for three(3)ladditional periods of time not to exceed twelve (12)
months for each renewal, providing Employer and Health Network agree in writing.
4.2 Continuation of Covered Services. In the event of termination of this Agreement,
Health Network shall continue to arrange for the provision of Covered Services in accordance with
the applicable Participating Provider Compensation Exhibit for each Beneficiary, unless otherwise
8
directed by Employer or the Plan,until the first of the following occurs: (I)the expiration of twelve
(12) months following the date of termination of this Agreement; or (ii) Employer or Health
Network notifies the other party that alternative coverage arrangements have been made with respect
to the Beneficiaries for whom such arrangements have been made for which written consent has been
obtained from the Beneficiaries. The parties agree that nothing in this Agreement authorizes any
Participating Provider to abandon any Beneficiary who is a patient.
4.3 Insolvency. This Agreement may be terminated immediately byleither party by
giving written notice of such termination to theleither party if the either party shall be adjudicated
bankrupt, become insolvent, have a receiver of its assets or property appointed or make a general
assignment for the benefit of creditors, or institute or cause to be instituted any proceeding in
bankruptcy or reorganization or rearrangement of its affairs.
4.4 Material Breach. This Agreement may be terminated immediately by either party by
giving written notice of such termination to the other party if the other party to this Agreement
materially breaches this Agreement,and the breaching party fails to take reasonable steps to cure the
breach,or a plan for cure is not agreed to by the parties,within a period of thirty (30)days after the
breaching party receives written notice specifying the nature of the breach and requesting that it be
cured.
4.5 Material Adverse Change in Insurance Coverage or Financial Responsibility. This
Agreement may be terminated immediately by Employer, upon a material adverse change in the
status of the insurance coverage or financial responsibility, as applicable, of Health Network such
that the insurance coverage or financial responsibility, as applicable, no longer meets the
requirements of this Agreement;and by Health Network upon a material adverse change in the status
of Employer's insurance coverage or financial responsibility, as applicable, such that the insurance
coverage or financial responsibility no longer meets the requirements of this Agreement.
4.6 Termination With or Without Cause. This Agreement may be terminated with or
without cause by either party upon ninety(90)days'written notice.
4.7 Obligations After Termination. Following the effective date of termination of this
Agreement,the provisions of this Agreement shall be of no further force or effect, except that each
party to this Agreement shall remain liable for any obligations or liabilities arising from activities
carried on by such party prior to the effective date of termination,and the provisions hereof relating
to confidentiality of and access to medical records, proprietary information, and continuation of
services shall survive termination of the Agreement.
9
V.
MISCELLANEOUS
5.1 Health Network Not Emplaer,Guarantor.Underwriter or Third Party Administrator.
Health Network is neither implicitly nor explicitly,an insurer,guarantor,indemnifier, or third party
administrator as defined in the Texas Insurance Code,Article 21.07-6,or underwriter of Employer's
or the Plan's responsibility to provide benefits to Employer's employees,their dependents, and other
Beneficiary's claim for benefits under the Plan shall not be an obligation of Health Network. Health
Network shall,however,cooperate with Employer or the Plan by furnishing such non-confidential
material or information as it has available in connection with the defense of any such action.
5.2 Duty to Defend and Hold Harmless. Any obligations of either Employer or Health
Network herein to defend, indemnify, and hold the other harmless from damages, expenses, and
costs arising from legal actions or investigations shall inure also to the respective employees,agents,
directors, and officers of Employer or Health Network acting pursuant to or in furtherance of this
Agreement who become subject to or are witnesses in legal actions or investigations regarding this
Agreement.
5.3 Provider-Patient Relationship. Participating Providers are exclusively responsible
for the maintenance of the Participating Provider-patient relationship with Beneficiaries and are
solely responsible to such persons for all health care services. Nothing contained herein shall be
construed to create any liability on the part of any Participating Provider arising as the result of
health care services rendered by the other Participating Providers. To the extent that Employer or
the Plan or an agent of either conducts its own Utilization Review Program or is involved directly
or indirectly in any activity which affects the manner or delivery of services rendered to
Beneficiaries by Participating Providers,Employer covenants and agrees to defend, indemnify, and
hold Health Network harmless from damages, expenses, and costs arising from legal actions or
investigations in connection with such activities.
5.4 Entire Agreement. This Agreement and all attachments and other documents
furnished pursuant to this Agreement and expressly made a part hereof shall constitute the entire
agreement relating to the subject matter hereof between the parties hereto. Each party acknowledges
that no representation,inducement,promise or agreement has been made,orally or otherwise,by the
other party, or anyone acting on behalf of the other party,unless such representation, inducement,
promise or agreement is embodied in this Agreement,expressly or by incorporation.
5.5 Amendments.
5.5.1 Amendments in Writing. Except as otherwise provided in this Agreement,
no amendment to this Agreement shall be valid unless it is in writing and signed by an authorized
officer of both parties.
10
5.5.2 Compliance with Applicable Laws. Notwithstanding any other provision of
this Section 5.5, either party may propose to amend this Agreement if necessary to comply with
applicable federal, state or local laws and regulations. Such amendments shall be effective thirty
(30) days after written notification to the other party, which shall be deemed to have accepted all
such amendments fifteen (15) days after notice, unless said other party provides a written
notification of any objection to any such amendment within such fifteen (15) day period. If the
parties are unable to agree upon the proposed amendment,either party may terminate this Agreement
immediately upon written notice to the other party.
5.6 Governing Law and Performance of Contract. The validity and interpretation of this
Agreement, and the rights and obligations of the parties hereunder, shall be governed by the laws
of the State of Texas and, if any provision of this Agreement is held to be invalid, void or
unenforceable,the remaining provisions shall nevertheless continue in full force and effect. This
contract is performable in Williamson and Travis Counties, and either of the said countiesishall be
the exclusive venue for any litigation, special proceeding,or other proceeding as between the parties
that may be brought, or arise out of, in connection with, or by reason by this Agreement.
5.7 Third Party Beneficiaries. The obligations of each party to this Agreement shall
insure solely to the benefit of the other party,and no Beneficiary or other person or entity shall be
a third party beneficiary of this Agreement.
5.8 Notices. Any notice or other communication made or contemplated by this
Agreement to be in writing shall be deemed to have been received by the party to whom it is
addressed on the date indicated on the certified mail return receipt or one (1) business day after
delivered to Federal Express or similar overnight delivery service and addressed as follows:
If to Employer:
City of Round Rock,Texas
MO(ijod ROCK,N
Attention: fSoNlud j`1wiwer
If to Health Network:
Columbia/St. David's Health Network
1800 San Jacinto Center
98 San Jacinto Boulevard
Austin, Texas 78701
Attn: Director, Provider Sponsored Networks
11
or to such other address of which the receiving party has given written notice pursuant to this Section
5.8, which address may be changed from time to time by written notice in accordance hereunder.
5.9 Assignment/Subcontracting. This Agreement may be assigned by either party only
with the prior written consent of the other party, and any assignment attempted without such prior
consent shall be null and void. It is expressly agreed, however,that Health Network may contract
with other entities in order to arrange for the provision of Covered Services in the Service Area,
including entities which may in their own names contract with Participating Providers for the
provision of covered Services pursuant to this Agreement.
5.10 Independent Contractors. None of the provisions of this Agreement are intended to
create, nor shall be deemed or construed to create, any relationship between Employer or Health
Network other than that of independent entities contracting with each other hereunder solely for the
purpose of effecting the provisions of this Agreement. Neither of the parties hereto,nor any of their
respective employees,contractors,or agents, shall be construed to be the agent,partner,co-venturer,
employee, or representative of the other.
5.11 Rights Concerning Propriety Information. Health Network and Employer each
acknowledge that the other party has developed certain symbols,trademarks, service marks,designs,
data processes,plans,procedures and information(the "Proprietary Information"), all of which are
proprietary information and trade secrets of such other party.
5.12 Remedies/Waiver of Breach. Pursuit of any aforementioned remedies provided in
this Agreement shall not preclude pursuit of any other remedies herein provided or any other
remedies provided by law,nor shall pursuit of any remedy herein provided constitute a forfeiture or
waiver of any obligation of the defaulting party hereunder or of any damages accruing by reason of
the violation of any of the terms, provisions, and covenants herein contained. No waiver of any
violation shall be deemed or construed to constitute a waiver of any other violation or breach of any
of the terms,provisions,and covenants herein contained and forbearance to enforce one or more of
the remedies herein provided upon an event of default shall not be deemed or construed to constitute
a waiver of such default.
5.14 Further Acts and Documents. Each of the Parties hereto hereby agree to execute and
deliver such further instrument and do such further acts and things as may be necessary or desirable
to carry out the purposes of this Agreement.
5.15 Severability. In the event any provision of this Agreement is held to be invalid,
illegal, or unenforceable for any reason and in any respect, such invalidity, illegality, or
unenforceability shall in no event affect,prejudice, or disturb the validity of the remainder of this
Agreement,which shall be in full force and effect, enforceable in accordance with its terms.
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5.16 Legal Fees and Costs. In the event either party elects to incur legal expenses to
enforce or interpret any provision of this Agreement,the prevailing party will be entitled to recover
such legal expenses, including without limitation, attorney's fees including any fee incurred on
appeal,costs and necessary disbursements, in addition to any other relief to which such party shall
be entitles.
5.17 Exclusive Agreement in Service Area. Unless otherwise agreed to by the parties,
Employer agrees it shall not contract with any third party for the provision of Covered Services
described in this Agreement in the metro Austin area during the Term of this Agreement. The
parties hereto agree that Health Network shall not be precluded from entering into agreements to
provide the types of services set forth herein to other entities,persons or organization.
5.18 Confidentiality of Contract Terms. Facility,Employer and Plan recognizes the terms
of this Agreement are confidential and agree not to divulge in any manner the terms of this
Agreement to any outside parties except to the extent required by applicable State and Federal Law.
5.19 Force Majeure. Neither party shall be liable nor deemed to be in default for any delay
or failure to perform under this Agreement deemed to result, directly or indirectly, from any cause
beyond the reasonable control of either party, including without limitation, Acts of God, civil or
military authority, acts of public enemy,fires, floods, strikes or regulatory delay or restraint.
5.20 Gratuities/Bribes. The City may,by written notice to Vendor,cancel this Agreement
without liability to Vendor if it is determined by the City that gratuities or bribes in the form of
entertainment,gifts,or otherwise,were offered or given by Vendor,or its agent or representative to
any City officer, employee or elected representative with respect to the performance of this
Agreement. In addition, Vendor may be subject to penalties stated in Title 8 of the Texas Penal
Code.
5.21 Right to Assurance. Whenever one Party to this Agreement in good faith has reason
to question the other Party's intent to perform, the questioning Party may demand that the other
Party give written assurance of their intent to perform. In the event that a demand is made and no
assurance is given within five(5)days,the demanding party may treat this failure as an anticipatory
repudiation of this Agreement.
5.22 Multiple Counterparts. This Agreement may be executed in multiple counterparts,
any one of which shall be consider an original of this instrument, all of which, when taken together
shall constitute one and the same instrument.
IN WITNESS WHEREOF,the parties hereto have caused this Agreement to be executed in
multiple originals by their duly authorized officers, all as of the day and year first above written.
13
EMPLOYER: CITY OF ROUND ROCK,TEXAS
By: l.��Tl7�� C�u�,�EPi°��2 . /��yoe
HEALTH NETWORK: COLUMBIA/ST.DAVID'S HEALTHCARE SYSTEM,L.P.,
dba COLUMBIA/ST. DAVID'S HEALTH NETWORK
4By: i aschal
President
14
EMPLOYER AGREEMENT
ATTACHMENT A
COMPENSATION 12/1/96 THROUGH 2/28/97:
Trilled PHO Providers: Physician Compensation is based on the fee schedule currently
administered by Employer's claims administrator,for the TriMed Physician Hospital Organization.
Any CPT Codes which do not currently have a discounted rate assigned to it,will be paid at 80%
of billed charges.
Round Rock Hospital: Hospital compensation rates are based on the fee schedule currently
administered by Employer's claims administrator, for Round Rock Hospital.
Columbia St.David's Health Network Providers(for services not available through a TriMed
PHO Provider): Physician or Facility compensation will be a 80%of billed charges.
Columbia St. David's Health Network Mental Health Providers: Provider compensation is
based on the fee schedule currently administered by Employer's claims administrator.
COMPENSATION EFFECTIVE 3/1/97:
Physician Compensation is based on specific discounts currently in place assigned to each
CPT Code. Individual codes are subject to periodic adjustments. Sample fees are attached. Any
CPT Codes which do not currently have a discounted rate assigned to it,will be paid at 80%of billed
charges.
Hospital compensation rates are attached.
15
Columbia St. David's Health Network
Sample Physician Reimbursement
EFFECTIVE 3/1/97
MEDICAL
Office Visits- New Codes Fee
99203 Office Visit, New Patient-Level 3 $67.80
99204 Office Visit, New Patient-Level 4 $92.80
99205 Office Visit, New Patient-Level 5 $122.25
99213 Office Visit, Established Patient-Level 3 $46.00
99214 Office Visit, Established Patient- Level 4 $66.00
99215 Office Visit, Established Patient-Level 5 $96.17
Inpatient Visits-New Codes
99222 Hospital, Initial- Level 2 $116.93
99223 Hospital, Initial-Level 3 $140.79
99231 Hospital, Subsequent-Level 1 $41.37
99232 Hospital, Subsequent-Level 2 $61.97
99233 Hospital, Subsequent-Level 3 $83.56
99291 Critical Care, First Hour $141.57
Emergency Visits-New Codes
99282 Emergency Room Visit-Level 2 $49.00
99283 Emergency Room Visit-Level 3 $69.00
99284 Emergency Room Visit- Level 4 $110.00
Consults-New Codes
99244 Office Consultation -Level 4 $140.95
99253 In Patient Consultation, Initial- Level 3 $116.99
99254 In Patient Consultation, Initial-Level 4 $146.97
99255 In Patient Consultation, Initial-Level 5 $188.73
Sample Laboratory Fees
81002 Routine Urine Analysis $5.91
82270 Test Feces For Blood $9.06
82948 Stick Assay Of Blood Glucose $6.70
84703 Assay Gonadotropin $18.31
85014 Hematocrit $5.83
85018 Hemaglobin, Colorimetric $6.35
85651 RBC Sedimentation Rate $10.88
CARDIOLOGY
Medicine Codes
92982 Single Vessel, Percutaneous Transluminal Coronary Angioplasty $3,936.00
93000 Electrocardiogram,with Interpretation and Report $61.22
93010 Electrocardiogram, Interpretation and Report Only $22.34
93015 Cardiovascular Stress Test, Utilizing Treadmill Bicycle $212.24
93503 Right Heart Catheterization Only,Placement of Flow Directed Catheter $2,014.35
93526 Combined Right Heart Catheterization and Retrograde Left Heart Cath $4,067.44
93547 Combined Left Heart Catheterization,Selective Coronary Angiography $1,448.67
(When 93510 Combined With 93543&93545)
Columbia St David's Health Network
Sample Physician Reimbursement, Page 2
CARDIOLOGY, Medicine Codes, cont.
93548 Combined Left Heart Catheterization,Selective Coronary Angiography, $1,766.68
Aortic Root Aortography
93549 Combined Right&Left Catheterization,Selective Coronary Angiography& $1,908.01
Selective Left Ventricular Angiography
(When 93547 Combined With Right Heart Catheterization)
CARDIOLOGY
Surgery Codes
33010 Periocardiocentesis, Initial $196.17
33011 Periocardiocentesis, Subsequent $196.17
33210 Insertion of Temporary Pacemaker $470.14
33971 Removal Intra Aortic Balloon $713.34
36489 Central Venous Catheter, Percutaneous $211.42
36620 Intra-Aterial Line, Percutaneous $119.67
36800 Quinton Catheter $270.70
SURGERY
Dermatology
11100 Biopsy of Skin $52.49
11401 Removal of Lesion,Trunk, Limbs .6 to 1.0 cm $57.97
11402 Removal of Lesion, Trunk, Limbs 1.1 to 2.0 cm $82.52
11441 Removal of Lesion, Face.6 to 1.0 cm $98.93
11750 Escision of Nail, Partial or Complete $177.78
12001 Simple Repair of Wound, Trunk, Limbs, Under 2.5 cm $75.75
17000 Destruction of One Lesion-Face $41.30
17100 Destruction of One Lesion-Skin $37.86
17340 Cryotherapy $41.19
ENT
30140 Submucous Resection Turbinate, Partial or Complete $508.26
30420 Rhinoplasty, Including Major Septal Repair $2,336.20
30520 Septoplasty $1,097.02
42820 Removal of Tonsils&Adenoids, Under 12 $573.44
42826 Removal of Tonsils&Adenoids, Over 12 $623.31
69210 Removal of Impacted Cerumen $32.34
69436 Tympanostomy, General Anesthesia $333.10
69631 Tympanoplasty Without Mastoidectomy or $1,723.32
Ossicular Chain Reconstruction
GASTROENTEROLOGY
43235 Upper Gastrointestinal Endoscopy $504.49
43239 Upper Gastrointestinal Endoscopy With Biopsy $547.79
45300 Proctosigmoidoscopy; Diagnostic $84.05
45330 Sigmoidoscopy, Disgnostic $126.38
45378 Colonoscopy, Fiberoptic, Beyond Splenic Flexure, Diagnostic $567.22
45380 Colonoscopy, Fiberoptic, Beyond Splenic Flexure, With Biopsy $626.02
45385 Colonoscopy, Fiberoptic, Beyond Splenic Flexure, $741.91
For Removal of Polypoid Lesion(s)
Columbia St. David's Healt4 Network
Sample Physician Reimbursement,Page 3
GENERAL SURGERY
19120 Excision of Breast Cyst $487.12
19240 Mastectomy, Modified Radical $1,857.84
32480 Partial Removal of Lung $2,407.54
33405 Replacement of Aortic Valve $4,640.89
33510 Coronary Bypass, One Artery $4,532.96
33511 Coronary Bypass,Two Arteries $4,856.74
33512 Coronary Bypass,Three Arteries $5,180.53
33513 Coronary Bypass, Four Arteries $5,504.31
33514 Coronary Bypass, Five Arteries $5,828.10
44140 Partial Colectomy With Anastomosis $1,846.77
44950 Appendectomy $778.35
46260 Hemorrhoidectomy $1,046.21
47600 Cholecystectomy $1,162.81
47605 Cholecystectomy With Cholangiography $1,310.21
47610 Cholecystectomy With Exploration of Common Duct $1,637.76
49505 Repair Inguinal Hernia, Over Age 5 $696.05
49560 Repair Ventral Henia $941.71
NEUROSURGERY
63005 Relieve Spinal Cord Pressure, Except for Spondylolisthesis $2,364.70
63030 Laminotomy Wrth Decompression of Nerve Root(s), $2,587.79
One Interspace, Lumbar
63042 Laminotomy With Decompression of Nerve Root(s), $2,719.16
Exploration, Lumbar
64721 Neurolysis, Carpal Tunnel $871.60
OPTHALMOLOGY
66983 Intracapsular Cataract Extraction $1,359.39
66984 Extracapsual Cataract Extraction $1,359.39
67036 Vitrectomy $2,141.16
67228 Destruction of Extensive or Progressive $734.11
Retinopathy, Photocoagulation
67312 Strabismus Surgery,Two Muscles $1,101.17
ORTHOPEDICS
20610 Arthrocentesis, Major Joint or Bursa $59.59
24538 Treat Humerous Fracture $802.51
25605 Treat Fractured Radius/Ulna $448.78
26605 Treal Metacarpal Fracture $222.92
27130 Total Hip Replacement $3,380.77
27425 Lateral Retinacular Release $1,024.70
27447 Total Knee Replacement $3,398.49
27780 Treatment of Tibula Fracture $178.34
27818 Treatment of Ankle Fracture $579.59
28292 Correction of Bunion $800.00
28296 Correction of Bunion With Metatarsal Osteotomy $932.00
29870 Arthroscopy, Knee, Diagnostic $544.92
29875 Arthroscopy, Knee, Synovectomy, Limited $1,121.90
29877 Arthroscopy, Knee, Debridement/Shaving of Articular Cartilage $1,121.90
29881 Arthroscopy, Knee,With Meniscectomy $1,121.90
29882 Arthroscopy, Knee, With Meniscus Repair $1,402.38
Columbia St. David's Health Network
Sample Physician Reimbursement, Page 4
PLASTIC SURGERY
11602 Excision, Malignant Lesion,Trunk, Arms, or Legs; 1.1 to 2.0 cm $159.57
11762 Reconstruction of Nail Bed With Graft $445.84
12011 Simple Repair of Face;2.5 cm or Less $83.33
12052 Repair Face, Ear, Lids, etc; 2.6 to 5.0 cm $181.80
13131 Complex Repair of Face; 1.1 to 2.5 cm $242.41
15100 Split Graft, Trunk, Scalp,Arms, Legs, Hands and/or Feet; $462.09
Up to 100 sq cm
19318 Reduction Mammaplasty $1,605.02
UROLOGY
51840 Vesicourethropexy;Simple $1,016.16
52000 Cystourethroscopy $160.66
52281 Cystourethroscopy,With Calibration and/or Dilation, $230.69
With or Without Meatotomy and Injection Procedure
52601 Transurethral Resection of Prostate $1,503.58
55250 Vasectomy $256.69
OB/GYN
49000 Exploratory Laparotomy $818.88
54150 Circumcision; Newborn $57.89
57410 Pelvic Exam Under Anesthesia $116.72
57452 Colposcopy $125.23
57454 Colposcopy With Biopsy $158.40
57520 Conization of Cervix $655.64
58120 D & C $305.31
58140 Removal of Uterus Lesion(s) $915.94
58150 Total Hysterectomy $1,297.58
58260 Vaginal Hysterectomy,With or Without Removal of $1,716.07
Tube(s) and Ovary(ies)
58600 Ligation or Transextion of Fallopian Tube(s) $909.13
58605 Ligation or Transection of Fallopian Tube(s), Postpartum $676.86
58720 Removal of Ovary(ies)/Tube(s), Partial or Complete $1,160.06
58740 Lysis of Adhesions $932.20
58980 Laparoscopy, Diagnostic $610.62
58982 Laparoscopy, Surgical With Fulguration of Oviducts $763.28
58983 Laparoscopy, Surgical With Fulguration of Oviducts by Device $786.80
58985 Laparoscopy With Lysis of Adhesions $806.28
58990 Hysteroscopy, Diagnostic $543.76
OBSTETRICS
59400 Global Care,Vaginal Delivery $1,397.18
59510 Global Care, C-Section $1,947.13
Columbia St. Mvid's Health Network
Sample Physician Reimbursement, Page 5
BEHAVIORAL HEALTH
Psychiatry
90801 Diagnostic Interview $139.67
90825 Evaluation of Hospital Records $142.51
90843 Individual Psychotherapy $63.84
20-30 minutes
90844 Individual Psychotherapy $103.91
45-50 minutes
90847 Family Psychotherapy $89.07
90853 Group Psychotherapy $44.53
Psychology
90801 Diagnostic Interview $125.00
90830 Psychological Testing $98.00
90843 Individual Psychotherapy $57.00
20 -30 minutes
90844 Individual Psychotherapy $85.00
45-50 minutes
90847 Family Psychotherapy $80.00
45-50 minutes
90853 Group Psychotherapy $40.00
Social Work-LMSW-ACP
90801 Diagnostic Interview $83.00
90843 Individual Psychotherapy $40.00
20-30 minutes
90844 Individual Psychotherapy $70.00
45-50 minutes
90847 Family Psychotherapy $75.00
45-50 minutes
90853 Group Psychotherapy $40.00
Assumed number of minutes:
90801 50.0
90825 50.0
90843 25.0
90844 50.0
90847 50.0
90853 1.5 hours
Columbia St David's Health Network
Sample Physician Reimbursement, Page 6
RADIOLOGY Fee
Global Professional Technical
70220 X-Ray Exam of Sinuses $84.49 $31.97 $52.52
71010 X-Ray Exam of Chest, Single View $33.79 $14.08 $19.71
71020 X-Ray Exam of Chest, Two Views $52.52 $21.34 $31.18
72050 X-Ray Exam of Spine $88.23 $31.25 $56.98
72100 X-Ray Exam of Lumbar, Limited $52.34 $20.62 $31.72
72110 X-Ray Exam of Lumbar, Complete $90.69 $36.28 $54.41
73610 X-Ray Exam of Ankle $47.13 $16.83 $30.30
73630 X-Ray Exam of Foot $48.50 $19.76 $28.74
74240 X-Ray Exam of Upper Gastrointestinal Trac 5140.39 $68.48 $71.91
74270 X-Ray Exam of Colon, Barium Enema $154.09 $68.48 $85.61
74400 X-Ray Exam of Urinary Tract $133.54 $47.94 $85.60
s
COLUMBIA ST. DAVID'S HEALTH NETWORK
CITY OF ROUND ROCK
PROVIDER REIMBURSEMENT EFFECTIVE 3/1/97
All physicians, facilities and other health care specialists providing services for St. David's Health Network will be
reimbursed per the fee schedule,with the following exceptions:
PHYSICIAN TAX 1D# REIMBURSEMENT
John Bagwell 74-2608688 90%of billed charges
Jack Bissett 74-2608688 90%of billed charges
Dwight DuBois 74-2608688 90%of billed charges
Charles Brown 74-2489189 90%of billed charges
Robert Patterson 74-2489189 90%of billed charges
Byron Dean Elliot 74-2489189 90%of billed charges
Mark Peters 74-2489189 90%of billed charges
Timothy Harstad 74-2489189 90%of billed charges
Byron Darby 74-2489189 90%of billed charges
Shannon Cox 74-2577054 90%of billed charges
David Duhon 74-2675706 90%of billed charges
(Also Sleep Disorders Center of Central Texas)
J. Lowell Haro 74-2693390 90% of billed charges
James Sconecipher 74-2693390 90%of billed charges
Brian Sayers 74-2479343 90%of billed charges
Jay Shapiro 74-2653601 90%of billed charges
John Williams 74-2653601 90% of billed charges
Kaylen Silverberg 74-2182813 90% of billed charges
Thomas Vaughn 74-2182813 90% of billed charges
Bruce Turner 74-2377027 90% of billed charges
Shivers Cancer Centers 74-1715889 90% of billed charges
Austin EEG and Neuroscience Lab 74-2006091 90%of billed charges
Christopher House 74-2522713 90%of billed charges
Austin Cancer Center 74-2734906 90% of billed charges
Central Texas Oncology Associates 74-1984725 90% of billed charges
Peoples' Community Clinic 237-08-7608 Billed Charges
Anesthesiology $45 Per Unit
Vivek Mahendru 74-2744963 $50 per unit
All Providers For DME, Supplies, Reports, HCPCs codes etc. 90%of Billed Charges
For those CPT Codes which do not have a fee 80% of Billed Charges
Spccrcim bsc-Novcmbcr 26, 1996
COLUMBIA ST. DAVID'S HEALTH CARE SYSTEM, L.P.
City of Round Rock
Facility Reh nbursement Schedule
EFFECTIVE 311/97
This reimbursement schedule includes the following Columbia/St. David's Healthcare System facilities:
Austin Diagnostic Medical Center St David's Pavilion
Round Rock Hospital Columbia Home Care Lifeway
South Austin Medical Center St David's Physical Therapy and Spine Center
St. David's Hospital St David's Behavioral Health Care Center
St. David's Rehabilitation Center& Bailey Square Surgical Center
Skilled Nursing Facility Oakwood Surgery Center(Opening 2/97)
03/01/97
Columbia/St. David's
I. INPATIENT SERVICES Reimbursement
Per Diem Rates:
Medical $900
Surgical $1,000
ICU/CCU/PICU/NICU III $1,200
Obstetrics:
Vaginal Delivery
1 Day --
2 Day $1,700 (1 -2 days)
3 Day S2,175 (3 day)
Each Additional Day $475
Vaginal Delivery w/Tubal
1 -2 Days $2,000
3 Day $2,475
Each Additional Day $475
C-Section, up to 3 days $2,700
Each Additional Day S475
Boarder Baby $250
NICU 1 $650
NICU II $875
Flat Rates:
Cardiac Catheterization
Inpatient S4,100 flat rate
Outpatient S2,500 flat rate
_Discount Rates:
MDC 25 (HIV) 35% discount off
Including DRG's 488-490 billed charges
Transplants 35% discount off
billed charges
City of Round Rock Reimbursement
Page Two
03/01/97
Columbia/St. David's
Reimbursement
II. OUTPATIENT SERVICES
impatient Services 35% discount off
All outpatient services, including surgery, billed charges
emergency room and observation stays:
III. REHABILITATION SERVICES
Inpatient Rehab Services $775 per diem
Subacute Rehab. Services $600 per diem
Outpatient Day Programs $475 per diem
Outpatient Physical/Occupational Therapy $110 per visit
Skilled Nursing Facility Services $450 per diem
Exclusions
In addition to above rates
Dialysis, Special Beds, 35%discount off
Hyperbaric Services - billed charges
V. BEHAVIORAL HEALTH CARE SERVICES
Psychiatric Intensive Care/Delox. $500 per diem
Inpatient Psych $425 per diem
Partial Day Hospital $215 per diem
Intensive Outpatient Program $85 per diem
Exclusions
In addition to above rates 35% discount off
ECT, Psych Testing/Evaluation billed charges
Ill. OTHER
In addition to reimbursement for inpatient or outpatient medical,
surgical, rehabilitation or behavioral health services as identified above:
Prosthetics, artificial limbs, implants, IOL, 30%discount off
Pacemakers, durable medical equipment billed charges
human tissue, blood and blood products
MRIs (technical only) $675
CTs (technical only) $425
High-Cost Drugs, Chemo,,TPA, 30% discount off
TPN > $150.00: billed charges
Lithotripsy $4,900 flat rate
All inpatient or outpatient services (including 35% discount off
emergency room) not billed on a case or flat rate billed charges
City of Round Rock Reimbursement
Page Three
03/01/97
Columbia/St. David's
Reimbursement
VI. HOME HEALTH CARE
Services. Per Visit
RN High Tech $72
RN $68
LVN $55
Home Care Aide $32
Physical Therapist $78
Occupational Therapist $78
Speech Therapist $78
Medical Social Worker $78
Registered Dietitian $78
Services. Per Hour'
RN High Tech $35
RN $33
LVN $27
Home Care Aide $14
'Hourly Rates: Billed after two(2) hours with a minimum of four(4) hours.
High-tech includes OB/GYN, infusion therapy and pediatric nursing visits.
Holiday Rate: Billed at time and one-half for the following holidays: New Year's Eve, New
Year's Day, Easter Sunday Memorial Day, Independence Day, Labor Day,Thanksgiving Day,
Christmas Eve, and Christmas Day.
VII. MISCELLANEOUS
Stop Loss.
When total case charges equal or exceed $35,000, facility will be reimbursed at 65%of
billed charges from the first dollar.
Rate Increases:
All case rates shall be increased by a rate equal to the increase in the Regional Consumer
Price Index for the 12 month period from the effective date of this agreement annually
throughout the term of the agreement.
EMPLOYER AGREEMENT
ATTACHMENT B
EMPLOYER'S PLAN DOCUMENT-Attach a copy of Employer's Plan document which describes
the benefits available to the members covered under the plan.
16
EMPLOYER AGREEMENT
ATTACHMENT C
Columbia St. David's Health Network and EMPLOYER agree that no Health Network
Access Fee will be charged pursuant to this agreement.
17
EMPLOYER AGREEMENT
ATTACHMENT D
EMPLOYER'S UTILIZATION MANAGEMENT PROGRAM -Attach a copy of the Utilization
Review Program which describes the UM requirements for Network Participating Providers.
18
EMPLOYER AGREEMENT
ATTACHMENT E
PARTICIPATING PROVIDERS
EFFECTIVE 12/1/96 THROUGH 2/28/97:
All Members of the TriMed Physician Hospital Organization, including Round Rock Hospital
and Ancillary Providers.
Specialist(non-Primary Care Providers), Facility and Ancillary Members of the Columbia St.
David's Health Network, for care not available through a TriMed PHO Provider.
Mental Health Providers, including Psychiatrists,Psychologists and Social Workers who are
Members of the Columbia St. David's Health Network.
EFFECTIVE 3/1/97:
All providers of the Columbia St. David's Health Network.
DATE: June 10. 1997
SUBJECT: City Council Meeting, June 12, 1997
ITEM: 11. F. Consider a resolution authorizing the Mayor to execute an agreement with
Columbia/St. David's Healthcare System, L.P. as health care providers for the City's
self-funded health plan.
STAFF RESOURCE PERSON: David Kautz
STAFF RECOMMENDATION:
Columbia/St. David's Healthcare System, which includes Round Rock Hospital, arranges directly
and indirectly with physicians, other licensed health care practitioners, hospitals and health care
facilities to provide health care services to the City.
Fees for these services are negotiated between Columbia/St. David's and the City and are
included in the City's health plan budget.