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Home My WebLink AboutResolution - 4648 - Agreement- Sisters Of Saint Joseph Of Texas- Health Care Services For Employees - 10_20_1994Resolution No. 4648 October 20, 1994 Item #18 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock BE and is hereby authorized and directed to execute for and on behalf of the City of Lubbock a Hospital Service Agreement and all related documents by and between the City of Lubbock and Sisters of Saint Joseph of Texas dba St. Mary of the Plains Hospital and Rehabilitation Center, St. Mary Imaging Center and St. Mary Surgicenter for Health Care Services for City of Lubbock employees, which contract is attached hereto, which shall be spread upon the minutes of the Council and as spread upon the minutes of this Council shall constitute and be a part of this Resolution as if fully copied herein in detail. Passed by the City Council this ATTEST: i etty A Johnson, C-5# Secretary APPROVED AS TO CONTENT: 20th day of October 1994. --)Z� aylle� Mary AndrOvs, Director of Human Resources APPROVED AS TO FORM: Assistant City Attorney DG V : dp\G Acodocv\SntMary.Rn October 12, 1994 Resolution No. 4648 October 20, 1994 Item #18 HEALTHCARE SERVICES AGREEMENT This Agreement is entered into this 1st day of October, 1994 by and between the City of Lubbock, Texas ("Payor") and Sisters of Saint Joseph of Texas dba St. Mary of the Plains Hospital and Rehabilitation Center, Lubbock Texas and St. Mary Imaging Center and St. Mary Surgicenter ("Providers"). WHEREAS, in response to a request for proposal by Payor and a second request for a non-exclusive network, Providers submitted a bid for health care services; and WHEREAS, Providers own and operate a licensed acute health care facility, family healthcare centers and outpatient diagnostic and surgery centers and desire to make its facilities and services available to Payor; and WHEREAS, Payor and Providers, as parties to this agreement desire to establish a relationship to ensure their mutual success and to define their respective rights and responsibilities to each other; NOW THEREFORE, in consideration of the mutual covenants, terms and conditions herein contained, it is agreed by and between the parties hereto as follows: Definition: As used herein, the term "Covered Persons" means a beneficiary of the Health Benefit Plan for the employees of the City of Lubbock (or any successor plan). I. INPATIENT AND OUTPATIENT PROVIDER SERVICES Providers agree to render to Covered Persons inpatient and outpatient hospital services, including Emergency Room and St. Mary Family Healthcare Center services for group health and workers' compensation as listed in Exhibit A for diagnosis, testing, and treatment of a medical condition, less any applicable co - payments and deductibles, and not including uncovered or medically unnecessary services. Rates are contingent upon the Providers, including University Medical Center and Methodist Hospital Lubbock, being the exclusive service providers for "Covered Persons" in Lubbock and as such, Payor agrees to not enter into similar discount arrangements with other acute care hospitals, psychiatric hospitals, outpatient diagnostic and surgery centers in the Lubbock, Texas market without the Provider's prior written consent. H. DESCRIPTION OF SERVICES A. Services to be provided must be medically necessary. B. Nothing in this Agreement shall require Providers to provide any services which would cause Providers to violate its ethical and/or religious beliefs. Such services would include but not be limited to abortions not necessary to remedy a life -threatening condition of the mother, sterilizations, in vitro -fertilization and euthanasia. C. The rate structure set forth in this Agreement for Providers services shall not include any physician professional fees; provided, however, that the rates set forth herein shall include those physician professional fees billed by Providers on UB-82 forms submitted to Payor. M. VERIFICATION OF BENEFITS, PAYMENT OF CLAIMS A. Payor shall provide Providers with a list of employee benefits provided under the employee benefit plan covered by this Agreement including a list of all co-insurance and deductible requirements of this benefit plan. B. Payor shall provide identity cards to all Covered Persons in the plan. Each card shall identify the name and telephone number of the entity responsible for treatment benefits verification, treatment authorization and utilization review. C. Providers shall contact Payor's designated claims management agent orally to verify the Covered Person's plan benefits and to obtain an authorization for the treatment prescribed by the Covered Person's attending physician. D. Providers shall bill and collect from the Covered Person all co -payments, deductibles and charges for noncovered and medically unnecessary services. E. Providers shall submit proper documentation to Payor's designated claims management agent on a timely basis. The Payor, through its designated claims management agent, shall make payments to the Providers within thirty (30) calendar days from the receipt of a "clean claim". A "clean claim" is defined as a claim for authorized services rendered to Covered Persons that includes the necessary details relating to the illness, accident or other coverage the patient may have. IV. TERM A. This contract shall commence October 1, 1994, and continue until September 30, 1995. B. This contract is valid for one year, and at the end of this term, then and only then will the Payor accept any offer of an HMO product to the employees of Payor by the participating hospitals. V. CONFIDENTIALITY All parties agree to keep the contents of this Agreement and the rate structure confidential to the extent permitted by the Texas Open Records Laws (Chapter 552 Texas Government Code). Any breach of this confidentiality will be cause for immediate termination of this Agreement. IN V4TNESS WHEREOF, the undersigned parties have executed this Agreement as of year first written above. Title: David R. Langston Date: October 20, 1994 APPROVED AST CONTENT: G Director of uman Resources APPROVED AS TO FORM: Assistant City Attorney ST. Y HOSPITA ST. MARY IMAGING CENTER Title:` d �"��0 Title: Date: ST. MAARR�Y SURGICENTER By: (J- Title: �r2 A,1111 J Date: Date: 1 d 111 *1- SISTERS OF SAINT JOSEPH OF TEXAS By: Title:�'�'�� Date: ld/y'/y-11-- Page 1 of 3 EXHIBIT A RATES FOR SERVICES HOSPITAL: St. Mary of the Plains Hospital PAYOR: City of Lubbock FOR: Group Health and Workers' Compensation CONTRACT PERIOD: October 1, 1994 through September 30,1995 with the providers being St. Mary Hospital, University Medical Center and Methodist Hospital. At the end of this term, then and only then can the participating hospitals offer an HMO product to the City of Lubbock employees Description Payment Method Rate 1. Inpatient Services: A. Adult and pediatric, medical or surgical services : Per Diem 1100 B. Obstetrical and neonatal services: 1. Maternity, uncomplicated vaginal delivery: Per Diem S 1140 2. Maternity, cesarean section: Per Diem 1200 3. Neonatal intensive care services: Per Diem 2200 4. Boarder Baby: Per Diem 345 C. Adult medical/surgical intensive care, pediatric intensive care, coronary care unit services: Per Diem 2160 D. Inpatient cardiovascular services: 1. Cardiovascular surgery (DRG 104-111): Per Diem 2900 2. Cardiac catheterization (DRG 124-125) Per Diem S 1630 3. PTCA/arthrectomy (DRG 112): % Charges 65% RATES FOR SERVICES HOSPITAL: St. Man+ of the Plains Hospital PAYOR: City of Lubbock FOR: Group Health and Workers' Compensation CONTRACT PERIOD: October 1, 1994 through September 30, 1995 with the providers being St. Mary Hospital, University Medical Center and Methodist Hospital. At the end of this term then and only then can the participating hospitals offer an HMO product to the City of Lubbock employees. Description Payment Method Rate E. Psychiatric services (see note): 1. Acute Inpatient: Per Diem S 695 2. Partial Hospitalization: Per Diem S 320 F. Chemical dependency services (see note): 1. Chemical dependency/ alcohol recovery services: Per Diem 575 2. Detoxification: 3. Partial Hospitalization: G. Physical rehabilitation services: H. Sidlled nursing care: Per Diem S 650 Per Diem S 320 Per Diem S 700 Per Diem S 360_ II. Inoatl___ent Stop -Loss: For services provided to any Covered Person during an inpatient admission for which Hospitals' usual and customary charges at rates then in effect exceed $25,000, Payor agrees to reimburse Hospitals at the rate of sixty-five percent (65%) of covered charges for all services rendered during such admission. III. Outpatient Hospital Services A. St. Mary Hospital % Charges 70 % B. St. Mary Family Healthcare Centers % Charges 70% C. St. Mary Imaging Center % Charges 75 % D. St. Mary SurgiCenter % Charges 75% Important Note: St- Mary provides the full range of adult mental health and adult chemical dependency services, both on an inpatient and partial hospitalization basis. 'Iberefore, no other hospital should be contracted with to provide these services. Page 3 of 3 EXHIBIT A RATES FOR SERVICES HOSPITAL: St. Mary of the Plains Hospital PAYOR: City of Lubbock FOR: Group Health and Workers' Compensation CONTRACT PERIOD: October 1. 1994 through September 30, 1995 with the provide being St. Ma!y Hospital, University Medical Center and Methodist Hospital. At the end of this term, then and only then can the participating hospitals offer an HMO product to the Ci!X of Lubbock employees. DRG• Code Description 104 Cardiac Valve Procedures with Cardiac Catheterization 105 Cardiac Valve Procedures without Cardiac Catheterization 106 Coronary Bypass with Cardiac Catheterization 107 Coronary Bypass without Cardiac Catheterization 108 Other Cardiothoracic Procedures 110 Major Cardiovascular Procedures with Cardiac Catheterization 111 Major Cardiovascular Procedures without Cardiac Catheterization 112 Percutaneous Cardiovascular Procedures 124 Circulatory Disorders except Acute Myocardial Infarction with Cardiac Catheterization and Complex Diagnosis 125 Circulatory Disorders Except Acute Myocardial Infarction with Cardiac Catheterization without Complex Diagnosis `DRG - Diagnostic Related Grouping