HomeMy WebLinkAboutMINUTES - 10041994 - 2.1 Pr/ 'I
TO: BOARD OF SUPERVISORS
A
FROM: Mark Finucane, Health Services Director >t� Contra
Costa
DATE October 3, 1994 County
r
SUB.IECT: Increased Hospital Choice for East and West County Poor Patients
SPEI IC RBQUEST(S)OR RBCOMMBmATK)N(S)&BACKGROUND AND JUSTWICATION
RECOMMENDATION:
(1) AUTHORIZE the Health Services Director or his designee to execute a Contract with Brookside
Hospital to provide for hospital services for Contra Costa Health Plan and Basic Adult Care program
referred patients, at an all inclusive rate per day and outpatient visit. Staff or other privileges accorded
county-employed physicians under such contract shall be limited solely to those privileges necessary for
them as county physicians to provide medical care to Contra Costa Health Plan and Basic Adult Care
program members.
(2) AUTHORIZE the Health Services Director or his designee to execute a Contract with Delta
Memorial Hospital to provide for inpatient hospital services for Contra Costa Health Plan and Basic Adult
Care program referred patients, at an all inclusive rate per day and outpatient visit. Staff or other
privileges accorded county-employed physicians under such contract shall be limited solely to those
privileges necessary for them as county physicians to provide medical care to Contra Costa Health Plan
and Basic Adult Care program members.
BACKGROUND:
On August 16, 1994 your Board' authorized the Health Services Director to execute contracts with Delta
and Brookside,Hospitals to enhance the access to hospital care for poor patients who reside in the east
and west regions of Contra Costa County.
The authorization included a maximum contract payment limit of$750,000 for Brookside and $500,000 for
Delta.
During contract negotiations with both institutions the maximum payment limit became problematic due
to: (1) The contract term and; (2) the potential for substantial growth in the Contra Costa Health Plan
and resulting need for inpatient services, created by implementation of the States two-plan Medi-Cal
model, which could have a material effect on the need for inpatient hospital services.
Accordingly, a revised payment method, utilizing an all inclusive rate per inpatient day; a five year contract
term; and a sixty (60) day cancellation provision, with no maximum payment limit, where agreed upon.
CONTINUED ON ATTACHMENT: YES SIGNATURE
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE _OTHER
SIGNATURE(S):
ACTION OF BOARD ON OCT 0 4 19% APPROVED AS RECOMMENDED OTHER _
DEFERRED to October 7 , 1994 , at 9 : 00 A.M.
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
x UNANIMOUS (ABSENT-----) AND CORRECT COPY OF AN ACTION TAKEN
T` AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
Contact Person: OLDT 0 4 1994
CC: County Administrator ATTESTED
Health Services PHIL BATCHELOR, CLERK OF THE BOARD OF
SUPERVISORS AND COUNTY ADMINISTRATOR
Brookside Hospital
Delta Memorial Hospital
,DEPUTY
2
FISCAL RVIPACT:
The net cost to the County, if any, is a variable and dependent upon the following factors:
(1) Health Plan Growth: Increased growth in the Health Plan due to an expanded provider
network, i.e., Brookside and Delta would be a positive factor: and increase of 1,000 Medi-Cal members
would result in approximately $1.1 million in gross revenue expenditures for inpatient care rendered in
Non-County facilities would range from $250,000 - $350,000 with the net differential available for
outpatient and physician services.
(2) Patient Choice: The number of patients electing to utilize Brookside or Delta versus Merrithew
is unknown. In the event there is no Health Plan growth and patient volume declines at Merrithew the
cost to the County is the difference between the Hospital Contract rate and the variable cost savings at
Merrithew. The range for the increased cost/exposure to the County is approximately$350,000- $650,000.
TO: BOARD OF SUPERVISORS
FROM: Mark Finucane, Health Services Director
M
DATE: October 3, 1994
SUBJECT: Increased Hospital Choice for East and West County Poor Patients
SPEUM REOUEST(S)OR RECOMMENDATKW(S)&BACKGROUND MID JUSTWKA- TXM
RECOMMENDATION:
(1) AUTHORIZE the Health Services Director or his designee to execute a Contract with Brookside
Hospital to provide for hospital services for Contra Costa Health Plan and Basic Adult Care program
referred patients, at an all inclusive rate per day and outpatient visit. Staff or other privileges accorded
county-employed physicians under such contract shall be limited solely to those privileges necessary for
them as county physicians to provide medical care to Contra Costa Health Plan and Basic Adult Care
program members.
(2) AUTHORIZE the Health Services Director or his designee to execute a Contract with Delta
Memorial Hospital to provide for inpatient hospital services for Contra Costa Health Plan and Basic Adult
Care program referred patients, at an all inclusive rate per day and outpatient visit. Staff or other
privileges accorded county-employed physicians under such contract shall be limited solely to those
privileges necessary for them as county physicians to provide medical care to Contra Costa Health Plan
and Basic Adult Care program members.
BACKGROUND:
On August 16, 1994 your Board authorized the Health Services Director to execute contracts with Delta
and Brookside.Hospitals to enhance the access to hospital care for poor patients who reside in the east
and west regions of Contra Costa County.
The authorization included a maximum contract payment limit of$750,000 for Brookside and$500,000 for
Delta.
During contract negotiations with both institutions the maximum payment limit became problematic due
to: (1) The contract term and; (2) the potential for substantial growth in the Contra Costa Health Plan
and resulting need for inpatient services, created by implementation of the States two-plan Medi-Cal
model, which could have a material effect on the need for inpatient hospital services.
Accordingly, a revised payment method, utilizing an all inclusive rate per inpatient day; a five year contract
term; and a sixty (60) day cancellation provision, with no maximum payment limit, where agreed upon.
CONTINUED ON ATTACHMENT: YES SIGNATURE
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMI`TTEE
APPROVE OTHER
SIGNATURE(S):
ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
UNANIMOUS (ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
Contact Person:
CC: County Administrator ATTESTED
Health Services SUPERVISORS
BATCHELOR, CLERK OF THE BOARD OF
SUPERVISORS AND COUNTY ADMINISTRATOR
Brookside Hospital
Delta Memorial Hospital
BY DEPUTY
� � ,; ! Date:
REQUEST TO SPEAK FOAM
(Two [2] Minute Limit)
Complete this form and place it in the box near the speakers' rostrum before addressing the Board.
Name: Phone:
Address: City: "//
I am speaking for: yself OR ❑ Organization:
NAME OF ORGANIZATION
CHECK ONE:
# 4
El wish to speak on Agenda Item
Az
My comments will be: ❑ General [<For ❑ Against
❑ I wish to speak on the subject of:
❑ 1 do not lh to speak but leave these comments for the Board to consider:
fi:v
0 rre,c-
Contra Costa County Number 27-110
Standatd .Form 1/87 STANDARD CONTRACT Fund/Org #
t
i, (Purchase of Services) Account #
1. Contract Identification. Other # .
Department: Health Services - Contra Costa Health Plan (CCHP)
Subject: East County Inpatient Hospital Services (medical, surgical, obstetric,
burn, intensive care, cardiac care, physical therapy, skilled nursing) and
OutpatientN (emergency, specialty, ancillary) services for CCHP Members.
2. Parties. The County of Contra Costa, California (County), for its Department named
above, and the following named Contractor mutually agree and promise as follows:
Contractor: DELTA MEMORIAL HOSPITAL (hereinafter referred to as "Hospital")
Capacity: Not-For-Profit Acute Care Hospital Taxpayer ID #94-1552887
Address: 3901 Lone Tree Way, Antioch, California 94509
3. Term. The effective date of this Contract is September 27. 1994 and it terminates
Sevtember 26. 199.9 unless sooner terminated as provided herein.
4. Payment Limit. County's total payments to Contractor under this Contract shall not
exceed knot apvlicable�.
5. County's Obligations. uCounty shall make to the Contractor those payments described in
the Payment Provisionsattached hereto which are incorporated herein by reference,
subject to all the to is and conditions contained or incorporated herein.
6. Contractor's Obligations. Contractor shall provide those services and carry out that
work described in the Service Plan attached hereto which is incorporated herein by
reference, subject to all the terms and conditions contained or incorporated herein.
7. General and Special Conditions. This Contract is subject to the General Conditions and
Special Conditions attached hereto, which are incorporated herein by reference.
8. Pro.-ect. This Contracts implements in whole or in part the following described Project,
the application and approval documents of which are incorporated herein by reference:
Not applicable.
9. Legal Authority. This Contract is entered into under and subject to the following
legal authorities: 42 U.S.C. 1396, et seq. ; 42 U.S.C. 300e; 42 U.S.C. 1395; Welfare
and Institutions Codel;Division 9, Section 14000, et seq. ; Health and Safety Code,
Division 2, Sections 13,140-1399.65; California Cove rnment'Code Sections 25209.6, 26227,
and 31000. li
10. Signatures. These signatures attest the parties' agreement hereto:
COUNTY OF CONTRA COSTA. CALIFORNIA
h ATTEST: Phil Batchelor, Clerk of the Board
BOARD OF SUPERVISORS of Supervisors and County Administrator
By By
Chairman/Designee Deputy
CONTRACTOR
By By
(Designate business capacity A) (Designate business capacity B)
Note to Contractor: For corporation (profit or nonprofit), the contract Must be sig.ed b7
a —.r M that of the nresident or viee-nreaident amd Sieaature E east be that of the secretary or
_ Y
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Contra Costa County Standard Form 1/87
APPROVAIS/ACKNOWLEDGEMENT
Number __27-110
APPROVALS
RECOMMENDED BY DEPARTMENT FORD APPROVED
a
By ji By
Designee F
N
APPROVED: COUNTY ADMINISTRATOR
By
i
F
C
ACKNOWLEDGEMENT
State of California N ACKNOWLEDGEMENT (By Corporation,
*` Partnership, or Individual)
County of
I
The person(s) signing abo�e for Contractor, personally known to me in the individual or
business capacity(ies) stated, or proved to me on the basis, of satisfactory evidence to
be the stated individual or the representatives) of the partnership or corporation
named above in the capacity(ies) stated, personally appeared before me today and
acknowledged that he/she/they executed it, and acknowledged to me that the partnership
named above executed it or acknowledged to me that the corporation named above executed
it pursuant to its bylaws or a resolution of its board of directors. -
Dated:
[Notarial Seal]
Notary Public/Deputy County Clerk
r2_
i
Contra Costa County PROVISIONS Standard Form 6/90
(Fee Basis Contracts)
Number 27-110
1. Payment Amounts. Subject to the Payment Limit of this Contract and subject to the
following Payment Provisions, County will pay Contractor the following fee as full
compensation for all services, work, expenses or costs provided or incurred by
Contractor:
[Check one alternative only.]
[ ] a. $ monthly, or
11
[ ] b. $ per unit, as defined in the Service Plan, or
[ ] c. $ after completion of all obligations and conditions herein.
[S] d. As set forth in Article IV (Compensation) of the Service Plan.
2. Payment Demands. Contractor shall submit written demands. Said demands shall be made
on County Demand Form D-15 and in the manner and form prescribed by County. Contractor
shall submit said demands for payment no later than 30 days from the end of the month
in which the contract 1'services upon which such demand is based were actually rendered.
Upon approval of said payment demands by the head of the County Department for which
this Contract is made, or his designee, County will make payments as specified .in
Paragraph 1. (PaymentlAmounts) above.
3. Penalty for Late Su bm ssion. When Contractor fails to submit to County a timely demand
for payment as specified in Paragraph 2. (Payment Demands) above, and as a result of
Contractor's late submission the County is unable to obtain reimbursement from the
State of California or otherwise; to the extent the County's recovery of funding is
pfejudiced, County shall not pay Contractor for such services, even though such
services were fully provided.
4. Right to Withhold. County has the right to withhold payment to the Contractor when,
in the opinion of the County expressed in writing to the Contractor, (a) the
Contractor's performance, in whole or in part, either has not been carried out or is
insufficiently documented, (b) the Contractor has neglected, failed or refused to
furnish information or to cooperate with any inspection, review or audit of its
program, work or records, or (c) Contractor has failed to sufficiently itemize or
document its demand(s) for payment.
5. Audit Exceptions. Contractor agrees to accept'responsibility for receiving, replying
to, and/or complying with any audit exceptions by appropriate County, State or Federal
audit agencies occurring as a result of its performance of this Contract. Contractor
also agrees to pay to the County within 90 days ofdemand by County the full amount of
the County's obligation, if any, to the State and/or Federal government resulting from
any audit exceptions, � to the extent such are attributable to the Contractor's failure
to perform properly any of its obligations under this Contract.
11
Initials:
Contractor County Dept.
I'
SERVICE FLAW
Number 27-110
ARTICLE I
DEFINITIONS
The following terms have the following meanings:
a. "Member" means a subscriber or enrolled dependent eligible for CCHP benefits.
b. *Subscriber- means an individual who has qualified and enrolled in CCHP under the
provisions of an applicable CCHP benefits agreement, including the CCHP agreements to provide
services to Medi-Cal and Medicare beneficiaries, and the Contra Costa County Basic Adult Care
program beneficiaries.
C. "Authorization" is the approval and authorization by CCHP, or a physician group,
or utilization review organization authorized by CCHP, to provide authorization for the
.provision by Hospital of hospital services. Such approval shall be requested and provided
pursuant to the authorization procedures established from time to time by CCHP.
d. "Prior Authorization" is authorization provided prior to the provision of
hospital services and is required for all hospital services, as indicated in paragraph i. ,
Article I, except emergency services.
e. "Copayments" are charges which are the responsibility of the member, and which
are to be collected by Hospital from the member at the time of the provision of hospital
services. CCHP will notify Hospital as to the copayment amounts by category of member which
are to be collected by Hospital and such copayments shall be in addition to the compensation
paid to Hospital by either CCHP or IPA. CCHP will, in advance of the effective date, notify
Hospital as to changes in the copayment schedule.
f. "Covered Services" are the health care benefits and related services which a
member is entitled to receive as a member of CCHP under the applicable CCHP individual,
employer group, Medi-Cal, or Medicare benefit agreements, or the Contra Costa County Basic
Adult Care program.
9- "Non-Covered Services" are any services which are not Covered Services.
h. "Emereency Services" are medically necessary Covered Services required by a
medical condition manifesting itself by acute symptoms of sufficient severity (including
severe pain) such that the absence of immediate medical attention could reasonably be
expected to result in: [i] placing the member's health in serious jeopardy; [ii] serious
impairment to bodily functions; [iii] serious dysfunction of any bodily organ or part.
In respect to Medicare or Medi-Cal members, Emergency Services also includes any other
services defined as emergency services under those programs.
i. "HosRital Services- are those Covered Services which the Hospital is.licensed to
provide and customarily provides to its patients. Without limiting the foregoing, Hospital
Services includes all room and meals, nursing care, dietitian, intensive care services,
operating and special treatment rooms, surgical and anesthetic supplies, blood transfusions,
Iniftals* :
Contractor County Dept.
SERVICE PIAN
Number 27-110
all devises and equipment, hospital ancillary services, including laboratory, pathology and
radiology, and all drugs (including take-home drugs) which are supplied by and used in the
Hospital.
J. "Inpatient Services" are Covered Hospital Services provided to the member who
is admitted to Hospital as a registered bed patient in accordance with the Authorization
required hereunder with the expectation of staying overnight and is receiving Hospital
Services which are ordered by, and under the direction of, a physician, podiatrist, or oral
surgeon, with appropriate medical staff membership and clinical privileges at Hospital.
k. "moi" is an independent practice association or medical group which has entered
into a services agreement with CCHP to provide services to Members who select or are assigned
to a primary care physician affiliated with such IPA.
1. "Outpatient Services" are Covered Hospital Services which are not Inpatient
Services and which are provided to a Member in accordance with the Authorization required
hereunder. Outpatient Services include services provided at Hospital as well as at any
other facility or location owned or operated by Hospital.
M. "Medically Necessary" means a service or supply ordered by a participating
physician which is commonly and customarily recognized as appropriate in the treatment of a
member's diagnosed illness or injury. The decision as to whether a service or supply is
Medically Necessary for the purposes of payment by CCHP rests with CCHP's Grievance Review
Committee.
n. "Plan Physician(s)" means a person who has a Doctor of Medicine or Doctor of
Osteopathy degree, a license to practice medicine in the State of California, and membership
on CCHP I&-`medical staff or is a participant in IPA. Also referred to as "Qualified
Physician(s)".
o. "Hospital Physician(s)" means a person who has a Doctor of Medicine degree, a
license to practice medicine in the State of California, and membership, or limited
membership, as provided in Article II paragraph h. (Staff Privileges) below, on Hospital's
medical staff.
P. -Attending Physician(s)" means Plan Physicians, including residents, who are
also Hospital Physicians and who are responsible for the physician professional care of a
particular member (but may be a non-plan physician when requested by CCHP for a specific
member's illness) .
q. *BAC* means former Medi-Cal medically indigent adult eligibles who have been
certified by the County as meeting the requirements for the County's Basic Adult Care
Program.
Y. "Hospital Based Physicians" means physicians such as pathologists,
anesthesiologists, radiologists, and Emergency Room physicians, who are regular salaried
staff members of Hospital, who are not County-employed physicians providing medical care to
CCHP and BAC program members pursuant to this Contract, and whose professional fees have been
included in Hospital's per diem payment at any time in the year preceding execution of this
Contract.
Initials:
2 Contractor County Dept.
SERVICE PIAN
Number 27-110
ARTICLEII
HOSPITAL OBLIGATIONS
a. Hospital Services. Hospital shall provide to Members requesting from, or
referred to, Hospital all Medically Necessary Hospital Services. Except when such services
are Emergency Services, Prior Authorization for such services must first be obtained by
Hospital as described in Article 1, paragraph d.
b. Standard of Ca're and Non-Discrimination. Hospital shall comply with all
applicable federal and state laws, licensing requirements, and professional standards, and
shall provide its services in accordance with generally accepted hospital practices and
standards prevailing in' Contra Costa County at the time of treatment.
Hospital shall not discriminate against Members on the basis of race, color, creed, religion,
sex, sexual preference, national origin, health status, income, or status as a Member of
CCHP. Hospital shall make its services available to Covered Persons in the same manner, in
accordance with the same standards, and with the same availability, as to its other patients.
C. Licensure and Accreditation. Hospital shall be, and remain, licensed by the
State of California, Accredited by Joint Commission on the Accreditation of Healthcare
Organizations (JCAHO), and certified under Title XVIII and XIX of the Social Security Act.
d. Copayments/Charges to Members. Hospital shall collect applicable Copayments from
Members upon the provision of Hospital Services.
e. -_-.No Billinp,/Collections. With the exception of Copayments and charges for Non
Covered Services delivered on a fee-for-service basis, Hospital shall in no event, including
without limitation non-payment by CCHP (or IPA), insolvency of CCHP (or IPA), or breach of
this Agreement (or an agreement between Hospital and an IPA), bill, charge, collect a
deposit, or attempt to bill, charge, collect or receive any form of payment from any Member
for Hospital Services. Hospital shall not maintain any action at law or in equity against
any Member to collect sums owed to Hospital by either CCHP or an IPA. Upon notice of any
such charge, CCHP may take all appropriate action consistent with the terms of this Agreement
to eliminate such charges, including without limitation, termination of this Agreement.
Hospital shall return to the Member upon CCHP*s demand, all sums collected from the Member
other than applicable Copayments/deductibles, and charges for Non Covered Sex-vices.
f. Service Authorizations. Hospital shall comply with the Authorization
requirements of CCHP, including all requirements for Prior Authorization. CCHP shall set
forth its Prior Authorization requirements in either its Operations Manual or by written
notices to Hospital. in the case of Emergency Services, Hospital shall obtain the_
Authorizationof CCHP as soon as possible, but in no event later than 24 hours after any
admission ("Notification Period"). If such Notification Period ends on a weekend or
holiday, the Notification Period shall be extended to 5 p.m. on the next occurring non-
holiday weekday. If such Service Authorization is obtained, CCHP shall pay for all Covered
Services, including emergency services rendered to Member. County shall reimburse Hospital
for all emergency services rendered to a Member and required under State and Federal Law.
All such payments and reimbursements are 'subject to the limitation set forth in Article IV.
b,* (Per Diems) .
Initials:
3 Contractor County Dept.
y
C
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SERVICE PLAN
i'
al Number 27-110
g. Utilization Rev ew/0uality Assurance Programs. Hospital shall participate in
and cooperate with CCHP's utilization review program and quality assurance programs. In any
case, Hospital shall allow access to CCHP patients and records for utilization review and
quality assurance review by (a) County-designated CCHP representative(s). CCHP shall provide
to Hospital existing guidelines and protocols for such programs prior to execution of this
Agreement.
P
h. Staff Privileges, Hospital shall arrange appropriate staff privileges or other
appropriate access to qualified physicians or physicians who otherwise provide services to
CCHP members. Notwithstanding anything else to the contrary in this agreement, the only
staff privileges or other access this agreement gives County-employed physicians are those
privileges or that access necessary to treat CCHP and BAC program members when County-
employed physicians are acting in their capacity as County-employed physicians. Such
physicians shall meet the reasonable standards established by the Hospital medical staff and
the bylaws, regulations, and1rules of the Hospital.
i. Medi-Cal/Medicare Requirements. Hospital shall:
[i] Comply with Title VI of the Civil Rights Act of 1964, Section 504 of the
Rehabilitation Act of 1973, and the Age Discrimination Act of 1975;
[ii] Not employ or contract with, directly or indirectly, entities or
individuals excluded from participation in Medicare or Medicaid for the provision of health
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care, utilization review, medical social work, or administrative services in respect to
Members; F'
Iiii] Not condition treatment or otherwise discriminate on the basis of whether
a Member las executed an advance directive;
[iv] Comply with any other governmental requirements and rules imposed upon
hospitals which provide services to Medicare or Medi-Cal beneficiaries.
[v] Provide to�the California Department of Health Services ("DHS") , HCFA, and
other State and Federal agencies, such data, information, reports, and access which is
required to be provided by State or Federal regulations or any contract between CCHP and DHS
or CCHP and HCFA.
J. Grievance Procedure.. Hospital shall cooperate with CCHP in identifying,
processing, and resolving all Member complaints and grievances pursuant to CCHP's grievance
procedures.
E
k. Insurance. Hospital shall self-insure or secure and maintain from an insurance
company approved to conducti business in the State of California, and acceptable to CCHP,
professional and general liability insurance with limits of coverage reasonably, considered
to be adequate for the risk Iinsured against. Hospital shall provide memorandum copies of
all of its pertinent insurance policies, together with certificates of insurance therefore
to CCHP and shall obligate the carrier of each such insurance policy to give CCHP written
notice by registered mail at! least thirty days prior to cancellation or other termination of
such policy.
Initials:
4 Contractor County Dept.
li
SERVICE PIAN
Number 27-110
Throughout the term of this contract, CCHP shall maintain, at CCHP's sole cost and expense,
policies of self-insurance providing coverage for CCHP's general liability and professional
liability in the minimum amount of $1,000,000 per claim as may be necessary to protect CCHP
or CCHP's employees, agents, or representatives in the discharge of its or their
responsibilities and obligations under this contract.
1. Service Exceptions. Notwithstanding the provisions of paragraph II. a.
(Hospital Services), Hospital may on an occasional and intermittent basis, elect not to
provide Inpatient Hospital Services to High Cost elective admissions provided that:
ji] Hospital timely notifies CCHP of its election on a case by case basis and
in accordance with mutually agreed notification protocols;
[ii] Such el
ectlion is based solely on the costs of the required Inpatient
Hospital Services, and is not in breach of the non-discrimination
requiremeni ts of Section II. , b. (Standard of Care and Non-Discrimination).
[iii] The health care needs of the CCHP member are not such that the time
required to secure an alternate provider could adversely affect the
member's health.
1, High Cost Cases. As used herein, "High Cost" refers to an elective
admission where the reasonably-anticipated cost to Hospital of providing Inpatient Services
to such patient will exceed the amount payable by CCHP to Hospital hereunder (including Stop
Loss) by a factor of ten.
Nothing herein shall authorize Hospital to transfer or refuse to provide services to a
patient admitted to Hospital or requesting services on an emergency basis.
If Hospital determines to voluntarily limit or discontinue any services, it will provide CCHP
with written notice of such action at least sixty days in advance of such limitation or
discontinuation. If Hospital must involuntarily limit or discontinue any services, it will
provide CCHP with written notice as soon as possible upon Hospital learning of the limitation
or discontinuation. HospitIal shall have no obligation to provide such services (except to
the extent provided on a newly limited basis) after the effective date of the limitation or
discontinuance.
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2. Hospital Beds. The Hospital shall not be responsible to admit any CCHP
enrollee for inpatient services under this contract if such admission would be in excess of
the then-existing capacityor capability of Hospital, taking into account, among other
factors, occupied beds, pre 11 admissions, and availability of qualified personnel.
Hospital's capacity and capability hereunder shall be determined on a service-by-service
basis (e.g. , the then-existing capacity or then-existing capability of the intensive care
service shall be determined separately from acute/medical/surgical capacity or capability) .
In the event Hospital lacks capacity or capability to admit a CCHP enrollee for inpatient
services, upon stabilization of the enrollee and in accordance with applicable California and
federal laws, he or she may upon direction from CCHP, be transported to Merrithew Memorial
Hospital or to another hospital designated by CCHP.
Initials:
!' 5 Contractor County Dept.
i�
SERVICE PW
Number 27-110
M. Service AdditionsL Hospital shall, in addition to all other services provided
hereinunder, provide such additional services, such as translator services, to CCHP members
who are patients of Hospital to the extent such services are required by the rules and
regulations of the Medi-Cal program and/or the contract between DHS and CCHP. Hospital
shall receive advance written notice in the event new services are required.
ARTICLE III
CCHP OBLIGATIONS
a. Payment of ComiDe cation. CCHP shall compensate Hospital for the provision of
Hospital Services to Members in accordance with the provisions of Article IV of this
Agreement.
b. Identification Cards and Verification. CCHP may issue identification cards to
Members. Production of such identification card shall be indicative of a person's status
as a Member, but shall not beft conclusive of such status. At Hospital's request, CCHP shall
provide Hospital with on-line computer access to membership information to verify Member
status. CCHP shall provide a sample of such identification card to Hospital upon execution
of this Contract. Pursuant oto verification of Member status by CCHP, Hospital is entitled
to receive compensation for services rendered to the Member from the County.
C. Directory. CCHPmay develop a directory of participating hospitals, physicians,
and IPAs to be distributed to Members. Hospital agrees that its name, address, and phone
number ma7_ be included in said directory (and any related marketing material) . Hospital
agrees that in the event this Agreement is terminated, or the listing information is or
becomes incorrect or incomplete, CCHP will have no obligation to correct, delete, or update
such listing information until such time as CCHP, in its sole discretion, issues a new
directory.
CCHP will send a written copy of the information to be included in the Plan Directory or
related marketing materialsi to Hospital at least twenty (20) working days in advance of
publication. If the Plan has not received corrections within twenty (20) working days, they
may publish without formal approval from Hospital. CCHP shall provide to Hospital a copy of
all such material.
d. Operations Manual. CCHP may develop and provide to Hospital an Operations Manual
which sets forth CCHP's administrative requirements for participating health care providers.
CCHP may modify this operations Manual from time to time by written notice to Hospital.
Changes in this Manual with which Hospital is expected to comply will be noticed to Hospital
at least 30 days in advance of the change. In the event of a conflict between the
Operations Manual and this Contract, this Contract shall prevail.
e. Administrative Functions. CCHP shall perform all necessary administrative,
accounting, enrollment, and other functions appropriate for the administration of its health
care service plans. CCHP shall notify Hospital in writing thirty (30) days prior to any
administrative changes which may affect the terms and conditions of this Contract.
Initials:
6 Contractor County Dept.
SERVICE PLAN
Number 27-110
ARTICLE IV
COMPENSATION
AL. Compensation. ISubject to the provisions of this Contract, CCHP shall pay
Hospital the following compensation:
jil Inpatient Services, As full payment for all Covered Hospital Services
which are Inpatient Services provided by Hospital to eligible Members (which are the
financial responsibility of CCHP hereunder), other than Copayments and Stop Loss, and as to
which Hospital (except for Emel rgency Services) has received Prior Authorization in accordance
with CCHP procedures, CCHP shall pay Hospital for such services.. at the payment rates set
forth in Attachment B attached, reduced by applicable Copayments: The rates set forth in
Attachment B shall be effective until such time as modified by the written agreement of the
parties.
[ii] Outpatient� Services. As full payment for all Covered Hospital Services
which are Outpatient Services,, including outpatient surgery, provided by Hospital to eligible
Members (which are the financial responsibility of CCHP hereunder) other than Copayments, and
as to which Hospital (except for Emergency. Services) has received Prior Authorization in
accordance with CCHP procedures, CCHP shall pay Hospital for such services at the payment
rates set forth in Attachmen t B reduced by applicable Copayments. The rates set forth in
Attachment B shall be effective until such time as modified by the written agreement of the
parties. Notwithstanding such rates, in no event will CCHP be obligated to compensate
Hospital more than Hospital would have been compensated under the applicable per them rates
if such services were provided to the Member as an inpatient.
Hospital acknowledges that CCHP may enter into capitated services agreements with one or more
IPAs pursuant to which the �IPA will be financially responsible to pay Hospital for its
provision of certain professional services and certain other Outpatient Services provided by
Hospital to Members assigned or selecting such IPA. CCHP shall notify Hospital of such
contract(s) and which Outpatient Services and/or professional services are the financial
responsibility of such IPA(s) . Until such time as CCHP executes an agreement with IPA for
Covered Services, CCHP agrees to compensate Hospital for such services. Thereafter, and
when Hospital and IPA have agreed to an acceptable rate of payment, Hospital agrees to look
only to IPA for the payment �of such services, except for Copayments.
b. Per Diems. Attachment B sets forth the per them amounts which CCHP will
compensate Hospital pursuant to Article IV. , paragraph a. (Compensation) for its provision
of Inpatient Services. Inrespect to such per diems:
i.
[i] The per diem payment rates will be paid for each day a Member occupies an
inpatient acute care bed at 12.00 midnight, or where the Member is admitted with the
expectation of staying overnight and is subsequently discharged within the same day, if the
Member has not otherwise been an inpatient within twenty four hours of this admission for the
same diagnosis.
[ii] CCHP shall pay a single per them for Inpatient Services provided to a
mother and a normal newbornj and shall continue to pay a single per them where either mother
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or the newborn remains in the Hospital after the other has been discharged. CCHP shall pay
separate per diems for a mother and a newborn when the Hospital provides Inpatient Services
to both and the newborn requires -care in the Hospital's Neonatal Level II Nursery.
[iii) Hospital Services provided to the Member within twenty four hours prior to
admission as an inpatient, ifs related to the condition for which the Member was admitted,
shall be included in and compensated by the first day's per diem and neither CCHP nor IPA
shall be obligated to otherwise compensate Hospital for its services provided to such Member
within such 24 hour period.
[iv] Transportation services required for treatment of the patient following
authorized admission as an inpatient at Hospital until discharge are included in the per diem
and are Hospital's financial �responsib£lity. However, transportation services to another
facility for services not provided by Hospital are not the responsibility of Hospital.
[v] CCHP shall "compensate Hospital at the lowest per diem rate applicable to
the services provided to a Member if it is determined that the more intensive services
provided to the Member were :;Medically Unnecessary. Medically Necessary is defined in
Article I. , paragraph m. ("Me'dically Necessary").
C. Stop Loss. CCHPI shall provide stop loss protection to Hospital as set forth in
Attachment B. Hospital shall, within sixty days of the provision of services, provide all
billings/charges to CCHP necessary for CCHP to calculate the amount of Stop Loss payable.
Billings to support Stop Loss;claims shall include the same forms and documentation required
for standard bills for service.
d. Coordination of Benefits. In:the event that CCHP is not the primary payor for
Hospital:Services, Hospital shall not make any demand for payment from CCHP pursuant to this
Agreement until all primary sources of payment ("Primary Payor") have been pursued and it is
determined that full payment cannot be obtained. For purposes of this provision, full
payment shall be the amount ;payable by CCHP pursuant to paragraph a. Article IV (and the
applicable per diem or outpatient compensation set forth in Attachment B). In the event the
primary payor pays less than said amount, CCHP's obligation is limited to the difference
between the amount so paid and the amount otherwise payable by CCHP under this Contract. If
Hospital has not received payment from such primary payor within one hundred and eighty days
of its submission of its fully-completed claim, Hospital may demand payment of any amounts
owed by CCHP under this Contract. Upon payment of such claim by CCHP, Hospital shall assign
all of its rights to payment from primary payor to CCHP and shall cooperate with CCHP in
obtaining payment from said primary payor. Hospital shall identify for CCHP such primary
payors and execute and deliver to CCHP any liens, assignments, or other documents as CCHP may
reasonably request. In the event that Hospital receives payment from the primary payor
after claiming and accepting'[payment from CCHP, Hospital shall, to the extent of such primary
payor payment, reimburse CCHP for its payment to Hospital.
e. Non-Covered Services. Hospital shall not bill or collect from a.Member any
charges in connection with health care services, even though those services are Non-Covered
Services, unless Hospital has obtained a written acknowledgement of financial responsibility
from the Member or the Member's legal representative prior to the time that such services are
provided to the Member. Hospital shall be entitled to bill the Member or other responsible
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party directly on the basis of customary charges for services rendered which are Non Covered
Services provided Hospital hai obtained such a written acknowledgement.
f. Denial of Paymentland Retroactive Additions/Deletions.
[i] CCHP may deny payment for:
[a] All Non . Emergency Services for which the required Authorization
(described in Article III paragraph f. (Service Authorization) form was not obtained prior
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to rendering such services; or
[b] Services claimed as Emergency Services which are determined not to
,have been Emergency Services. P, Such denial shall not create any liability on the part of the
Member, and Hospital shall neither bill nor collect from the Member any charges in connection
with such services.
[ii] CCHP shall be financially responsible for Covered Services provided by
Hospital to a retroactively canceled Member, provided that Hospital provides to CCHP
satisfactory evidence that it has unsuccessfully sought payment for all such charges from the
patient or the person having legal responsibility for such patient through two billing cycles
immediately following notice of retroactive cancellation.
[iii] In the event that Covered Services which are CCHP's financial
responsibility hereunder have been provided by Hospital to a retroactively added Member, CCHP
shall compensate Hospital for' such services at the rate set forth in Attachment B hereto.
[iv] In the event Hospital is unable to obtain verification after documenting
all reasonable efforts to obtain authorization, Hospital may proceed to deliver medically
necessary Covered Services to, eligible Members.
9. Payment --Date. For those Hospital Services which are CCHP's financial
responsibility hereunder, CCHP shall pay Hospital's uncontested claims for Hospital Services
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within forty-five days of receipt of the proper billing forms as described in Payment
Provisions, Paragraph 1. (Payment Amounts).
h. Hospital-Based Physicians. The compensation rates paid to Hospital hereunder
include payment for the inpatient and outpatient services of Hospital Based Physicians as
defined in Article 1, Paragraph r. ("Hospital Based Physicians") .
ARTICLE V
RECORDS. REPORTS, AND INSPECTIONS
a. Disclosures. Hospital
ospital shall notify CCHP immediately in writing upon the
occurrence of any of the following events:
[i] Hospital's` license to operate as an acute care facility or its Joint
Commission Accreditation or its certification under Title XVIII or XIX of the Social Security
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SERVICE PLAN
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Act is suspended, revoked, ; terminated, or subjected to terms of probation or other
restriction;
Iii] Hospital'sj'Iiability insurance is canceled, terminated, not renewed, or
materially modified; 8
[iii] Hospital learns, or reasonably should know, that it has become a defendant
in a negligence action filed by a Member or is required or agrees to pay damages in any such
.action by way of judgement or settlement;
[iv] An act of nature or any event occurs which substantially interrupts all or
a portion of Hospital's facilities or which has a materially adverse effect on Hospital's
ability to perform its obligations hereunder;
[v] A petitionil is filed to declare Hospital bankrupt or for reorganization
under the bankruptcy laws of the United States or a receiver is appointed over all or any
portion of the Hospital's assets, or the Hospital fails to pay when due any obligation under
any of its bond agreements;
[vi] Any other situation arises which could reasonably be expected to materially
affect Hospital's ability to carry out its obligations under this Agreement.
b. Medical Records. Hospital shall maintain the usual and customary records for
Members in the same manner as for other patients of Hospital. Hospital shall comply with
all privacy and confidentiality requirements imposed by Federal and State law. Subject to
such requirements, such records shall, on request, be made available to CCHP and its
designated agents. Without limiting the foregoing, Hospital shall, subject to such privacy
and confidentiality laws:
[i] Provide to CCHP copies of Member medical and payment records that are in
the custody of Hospital;
[ii] Allow CCHP authorized personnel access to such records on the Hospital's
premises during its regular "business hours;
[iii] Transmit Member's medical records information by telephone to CCHP for
purposes of Authorization or other CCHP quality and utilization management activities;
[iv] Upon reasonable request, provide copies of a Member's medical record to any
CCHP physician treating such member.
C. Disclosure to Peer Review Organization. Hospital shall furnish to the Peer
Review Organization ("PRO")` under contract to HCFA on-site access to or copies of patient
care records and other pertinent data, and permit the PRO or its subcontractor. to examine
Hospital operations and records as necessary for the PRO to carry out its functions under
applicable Federal law.
d. Government Required Information. Hospital shall supply CCHP with periodic
reports and information pertaining to services provided by Hospital to Members, on such forms
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SERVICE PLAN
Number 27-110
and within such times as CCHP shall require through its Operations Manual; and which will
enable CCHP to meet all Federal and State reporting requirements.
e. Site Evaluations and Inspections. To the extent required by law or by CCHP's
agreements with Medi-Cal or Medicare, Hospital agrees to permit Government Officials to
conduct periodic site evaluations and .inspections of Hospital's facilities and records and
shall correct, as may be required by law, any deficiencies in Hospital's facilities or
records as determined by suchevaluations and inspections.
ARTICLE VI
MISCELLANEOUS PROVISIONS
a. Partial Invalidity. If for any reason any provision of this Agreement is held
invalid, the remaining provisions shall remain in full force and effect unless the absence
of the invalid provision materially alters the intent of this Agreement.
b. Waiver of Breach The waiver of any breach of this Agreement by either party
shall not constitute a continuing waiver of any subsequent breach of either the same or any
other provisions of this Agreement.
C. Amendments. Unless otherwise specifically provided herein, this Agreement may
be amended only by mutual,f, written consent of CCHP's and Hospital's duly authorized
representatives.
d...� Entire Agreement+. This Contract, along with the Operations Manual and CCHP
written notices, as such Manual and notices are amended from time to time, constitutes the
entire understanding between the parties relating to the subject matter hereof and supersedes
any prior agreements between the parties, except those agreements described in Exhibit B
hereto. All Exhibits and Schedules referenced in this Contract and attached hereto are
incorporated hereiin by refernce.
e. No Volume Guarantee. CCHP does not represent, warrant, or covenant any minimum
volume of patients or Members to Hospital.
f. Non-Exclusivitv.^ This Agreement is non-exclusive and each party shall have at
all times the right to enter into agreements comparable to this Agreement with other persons
or entities.
g. Captions. The captions contained herein are for reference purposes only and
shall not affect the meaning of this Agreement.
h. Confidentiality,) Except as ordered by a Court, each party shall not disclose
the financial provisions of, this Agreement without the prior written consent of the other
party. Notwithstanding theu foregoing a party may disclose such financial provisions to its
auditors and to such governmental agencies as may be required by its rules and regulations.
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SPECIAL CONDITIONS
Number 27-110
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1. Contra Costa Health Tian subcontract Requirements. This Contract is subject to the Contra
Costa Health Plan Subcontract Requirements (Attachment A) which is attached hereto and
incorporated herein by reference.
2. Demands for Payment. Payment Provisions, Paragraph 2 (Payment Demands) is hereby
rescinded and replaced with anew paragraph to read as follows:
*2. Billin¢ Fq ns. Hospital shall bill CCHP on a periodic basis in a manner and on
such forms as are reasonably acceptable to CCHP and Hospital. Such for shall be the
equivalent of UB-92 or o1ne providing equivalent information with complete CPT-4 or ICD-i
coding, CCHP's authorization number, and the Member's subscriber number, submitted in
accordance with CCHP's directions and that do not involve coordination of payment, third
party liability or subrogation. CCHP shall advise Hospital of any objections to the
claim or request additional information within thirty (30) days upon receipt of the
claim. When Hospital has submitted a complete claim as defined above, CCHP shall be
responsible for payment within forty-five (45) days.*
3. Termination. General� Condition Paragraph 5. (Termination) is hereby rescinded and
replaced with. a new paragraph� to read as follows:
*5. Termination.
a. Termination without Cause. Either party may terminate this Agreement without
cause by giving to the other party at least sixty (ba) calendar days advance
written notice ofltermination.
b. Termination for Cause. Subject to the Cure Period set forth in paragraph c.
(Notice and Cure I Period), below, either party may terminate this Agreement for
material cause after written notice as set forth below. The following shall
constitute a mateirial cause for termination:
[i] By Hospital:
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[a] In the event that CCHP fails to pay Hospital the compensation
due to Hospital for an uncontested claim hereunder within forty-
five days of any such payment's due date.
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[b] A petition is filed to declare CCHP bankrupt, or for
reorganization, under the bankruptcy laws of the United States,
or a receiver is appointed over all or any portion of CCHP's
1' assets, which is not withdrawn within thirty days 'thereafter.
[c] I CCHP breaches any material term, covenant, or condition of this
a
Agreement.
[d] CCHP is not in compliance with a regulatory financial reserve
requirement.
[e] The State gives CCHP notice of determination, allegation, or
contention that CCHP is not in compliance with a financial
reserve requirement.
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x SPECIAL CONDITIONS
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Number—_21-110
[f� In the event CCHP's agreement for reinsurance is canceled or not
renewed.
[ii] By CCHP:
[aIn the event CCHP reasonably determines, after consulting with
Hospital, that Hospital is likely to be financially unable to
provide its Hospital Services in a competent and timely manner.
[b] A petition is filed to declare Hospital bankrupt, or for
P reorganization, under the bankruptcy laws of the United States,
or a receiver is appointed over all or any portion of Hospital's
assets, which is not withdrawn within thirty days thereafter.
[c] i' Hospital substantially fails to* meet the licensure and
professional standards set forth in this Agreement.
[d] f Hospital breaches any material term, covenant, or condition of
this Agreement.
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Notwithstanding any provision of Paragraph d. (Effect of Termination) below
to the contrary, CCHP may immediately terminate this Agreement in the event
that Hospital is excluded from participation in Medicare or Medicaid.
C. Notice andl' Cure Period. A party seeking to terminate this agreement for
material breach shall notify the other party in writing of the nature of the breach
and the other party shall have thirty days from the receipt of such notice to cure
or otherwise eliminate such cause. In the event that the other party does not
remedy the breach, this Agreement shall terminate at the end of the thirty day
period.
d. Effect of Termination. As of the date of termination, this Agreement shall
be considered of 11 no further force or effect whatsoever, and each of the parties
shall be relieved and discharged herefrom, except that:
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[i] Term ination shall not affect any rights or obligations hereunder which
have previously accrued, or shall hereafter arise with respect to any
occurrence prior to termination, and such rights and obligations shall
continue to be governed by the terms of this Agreement.
[ii] Hosp4 tal shall, at CCHP's option, continue to render inpatient Hospital
Services to eligible Members after the termination of this Agreement
at the current rates set forth in this Agreement until such time as:
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[a] Appropriate discharge or transfer of Members receiving Inpatient
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Services at the date of termination is achieved, or
[b] '; An alternate source of payment for such services, acceptable to
Hospital has been found.
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SPECIAL CONDITIONS
Number 27-110
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[iii] The following provisions of this Contract shall survive the Termination
of this Contract: Payment Provisions, Paragraph 5 (Audit Exceptions);
ServiIce Plan Article II. , paragraph e. (No Bill ing\Collections) and
Article V. , Paragraph b. (Medical Records); and General Conditions
Paragraphs 3. (Records), 16. (Confidentiality), and 18.
(Indemnification)."
4. Entire Agreement. Genera l Conditions Paragraph 6. (Entire Agreement) is hereby rescinded
11
and replaced with a new paragraph to read as follows:
II
06. Entire A,greement�, This Agreement, along with the Operations Manual and CCHP
written notices, as such Manual and notices are amended from time to time, constitutes
the entire understanding between the parties relating to the subject matter hereof."
5. Disputes. General Conditions Paragraph 9. (Disputes) is hereby deleted.
6. No Waiver by County. General Conditions Paragraph 12. (No Waiver by County) is hereby
rescinded and replaced by a new paragraph to read as follows:
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012. No Waiver. Inspections or approvals, or statements by any officer, agent or
employee of either parity indicating the other party's performance or any part thereof
complies with the requirements of this Contract, or acceptance of the whole or any part
of said performance, or payments therefore, or any combination of these acts, shall not
relieve the parties' obligation to fulfill this Contract as prescribed; nor shall either
party be thereby estopped from bringing any action for damages or enforcement arising
from any failure to comply with any of the terms and conditions of this Contract."
7. Indemnification. General Conditions Paragraph 18. (Indemnification) is hereby rescinded
and replaced with a new section to read as follows:
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018. indemnification. The Contractor shall defend, indemnify, save, and hold harmless
the County and its officers and employees from all liabilities and claims for sickness,
death, or injury to person(s) or property, including without limitation all consequential
damages, from any cause whatsoever arising directly or indirectly from or connected with
the operations or services of the Contractor or its agents or employees. The County
shall defend, save harmless and indemnify the Contractor and its officers, agents and
employees from all liabilities and claims for damages for death, sickness or injury to
persons or property arising from or connected with the operations or the services of the
County hereunder, resulting from the conduct of the County, its agents or employees."
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B. Insurance. General Conditions Paragraph 19. (Insurance) is hereby rescinded and replaced
with new paragraphs to read as follows:
"19. Insurance.
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a. Contractor's Insurance. During the entire term of this Contract and any
extension or modification thereof, the Contractor shall keep in effect insurance
policies, meeting the following insurance requirements unless otherwise expressed
in these Special Conditions:
(1) Liability Insurance. The Hospital shall provide malpractice insurance
and comprehensive liability insurance, including coverage for owned vehicles,.each
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SPECIAL CONDITIONS
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Number 27-110
with a minimum combined single limit coverage of $5,000,000 for all damages,
including consequential damages, due to bodily injury, sickness or disease, or
death to any persron or damage to,or destruction of property, including the loss of
use thereof, arising from the act or omission of Hospital, its directors, officers,
employees, and agents.
(2) Workers Compensation. The Hospital shall provide workers'
compensation insurance coverage for its employees.
(3) Certificate of Insurance. The Hospital shall provide the County with
a certificate(s)� of insurance evidencing liability and workers' compensation
insurance as required herein no later than the effective date of this Contract.
If the Hospital should renew the insurance policy(ies) or acquire either a new
insurance policy(ies) or amend the coverage afforded through an endorsement to the
policy(ies) at any time during the term of this Contract, then Hospital shall pro-
vide (a) current�icertificate(s) of insurance.
(4) Additional Insurance Provisions. The Hospital agrees to provide the
County not less than thirty (30) days written notice prior to any material change
or cancellation of insurance coverage.
b. County's Insurance. Throughout the term of this Contract, County shall
maintain, at County's sole cost and expense, policies of self-insurance providing
coverage for County's general liability and professional malpractice liability in
the minimum amount of $1,000,000 per claim as may be necessary to protect County
or County's employees, agents or representatives in the discharge of its or their
responsibilities and obligations under this Contract."
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9, NotIces. General Conditions Paragraph 20. (Notices) is hereby amended to read as follows:
020. Notices. All notices provided for by this Contract shall be in writing and may be
delivered by deposit � in the United States mail, postage prepaid, return receipt
requested. Notices to 'the County shall be addressed to the head of the County Department
for which this Contract is made. Notices to the Contractor shall be addressed to the
Contractor's address designated herein. The effective date of notice shall be the date
of deposit in the mails or of other delivery."
h
10. Primacy of General Conditions. General Conditions Paragraph 21. (Primacy of General
Conditions) is hereby amended to read as follows:
021. Primacy of General Conditions. Except for Special Conditions which modify and
expressly 'supersede General Conditions, the Special Conditions (if any) and Service Plan
do not limit any term :of the General Conditions."
11. Possessory Interest. General Conditions Paragraph 23. (Possessory Interest) is hereby
deleted in its entirety. f
12. CoP3XiQhts and Rights In Data. General Conditions Paragraph 25. (Copyrights and Rights
in Data is hereby deleted in its entirety.
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SPECIAL CONDITIONS
G
Number_ 27-110
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13. Endorsements. Contractor shall not in its capacity as a contractor with Contra Costa
County publicly endorse or oppose the use of any particular brand name or commercial product
without the prior approval of the Board of Supervisors. In its County contractor capacity,
Contractor shall not publicly attribute qualities or lack of qualities to a particular brand
name or commercial product inIthe absence of a well-established and widely-accepted scientific
basis for such claims or without the prior approval of the Board of Supervisors. In its County
contractor capacity, Contractor shall not participate or appear in any commercially-produced
advertisements designed to promote a particular brand name or commercial product, even if
Contractor is not publicly endorsing a product, as long as the Contractor's presence in the
advertisement can reasonably The interpreted as an endorsement of the product by or on behalf
of Contra Costa County. Notwithstanding the foregoing, Contractor may express its views on
products to other contractors, the Board of Supervisors, County officers, or others who maybe
authorized by the Board of Supervisors or by law to receive such views.
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ATTACEDMVT A
CONTRA COSTA HEALTH PLAN SUBCONTRACT REQUIREMENTS
Number: 27-110
Pursuant to State Department of Health/County Contract #88-94695 (County #29-609-35),
effective January 1, 1989, (or the latest revision) Article X, Subcontracts; requirements of
the Waxman-Duffy Prepaid Health Plan Act, (1972) and Knox-Keene Health Care Service Plan Act
of 1975; Federal Regulations: 42 CFR 431.504; State Law: W&I Code, Section 14452; State
Regulations: Title 22, CCR, Section 53250, the following subcontract requirements are
incorporated into the contract referenced by number above:
1. Contractor shall ibe subject to and comply with all Federal, State, and local laws
and regulations and contractual obligations incumbent upon the County under County Contract
029-609-35 and any subsequent amendment thereto.
2. A Contractor prodding any basic health care service to Contra Costa Health Plan
members (Plan members) shall meet all of the requirements of Chapters 3 and 4, Subdivision
1, Division 3, Title 22, C.AJC. (commencing with Section 51001) which relate to the services
the Contractor provides. This specifically includes the requirements of Title 22, C.A.C.
Section 53250(e), a copy of which is attached hereto and incorporated herein by reference as
Exhibit A.
3. Contracts shallibe public records on file with the State Department of Health
Services. The names of the officers and owners of the Contractor, stockholders owning more
than ten percent of the stock issued by the Contractor, and major creditors holding more than
five percent of the debt of �the Contractor are:
Qwners/Officers
Stockholders owning more than 10% of stock:
Creditors holding more than�5% of debt:
4. County and Contractor agree that Contractors compensation hereunder shall not be
based in any way on a percentage of the County's compensation from the State Department of
Health Services; this agreement does not preclude the establishment of Contractor's rate
based on capitation payments pursuant to Welfare and institutions Code Section 14453.
5. Contractor agrees to submit reports or abstracts of treatment records in relation
to Plan members, as appropriate and required by County.
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6. Contractor will allow inspection, examination, or copying of financial books and
records relating to Plan members, subscribers or Plan services by the County, the State
Department of Health Services, the State Department of Corporations, the U.S. Department
Health and Human Services, or their duly authorized representatives. Such books and records
shall be made available at all reasonable times at the Contractor's place of business; in a
form maintained in accordance with general standards, for a term of at least five years from
the close of State's fiscal!. year in which this Contract is in effect.
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ATTACHMENT A
CON-MA ICOSTA HEALTH PIAN SUBCONTRACT REQUIREMENTS
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7. Contractor shall not make assignment and/or delegation of this Contract unless
it has obtained prior written approval of the other party, the County, and State Department
of Health Services.
S. Contractor will hold harmless both the State and Plan members in the event the
County cannot or will not pay for services performed for Plan members pursuant to this
Contract.
9. Contractor will notify the Department of Health Services and Commissioner of
Corporations in the event this Contract is amended or terminated. Notice is considered given
when deposited in the U.S1,. Registered Mail, first class postage prepaid, addressed as
follows:
Organized Health ServicesiHMO Unit Department of Corporations
Department of Health Services 600 South Commonwealth
714 P Street Los Angeles, California 90005
Sacramento, California 95814
10. Nondiscrimination Reouirements.
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a. Nondiscrimination Clause (OCP-1) .
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(1) During the performance of this Contract, Contractor and its
subcontractors shall not unlawfully discriminate against any employee or applicant for
employment because of racell religion, color, national origin, ancestry, physical handicap,
medical condition, marital status, age (over 40) or sex. Contractor and subcontractors shall
insure $at the evaluation and treatment of their employees and applicants for employment are
free from such discrimination. Contractors and subcontractors shall comply with the
provisions of the Fair Employment and Housing Act (Government Code, Section 12900 et seq.)
and the applicable regulations promulgated thereunder (California Code of Regulations, Title
2, Section 7285.0 et seq.) iThe applicable regulations of the Fair Employment and Housing
Commission implementing Government Code, Section 12990, set forth in Chapter 5 of Division
4 of Title 2 of the California Code of Regulations are incorporated into this Contract by
reference and made a part hereof as if set forth in full. Contractor and its subcontractors
shall give written notice of their obligations under this clause to labor organizations with
which they have a collective bargaining or other agreement.
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(2) This Contractor shall include the nondiscrimination and compliance
provisions of this clause in all subcontracts to perform work under this Contract.
b. Nondiscriminatory Services. The Contractor will not discriminate against
Contra Costa Health Plan members, subscribers or eligible beneficiaries because of race,
color, creed, religion, ancestry, marital status, sexual orientation, national origin, age,
sex, or physical or mental i, handicap in accordance with Title VI of the Civil Rights Act of
1964, 42 USC Section 2000d rules and regulations promulgated pursuant thereto, or as
otherwise provided by law or regulation.
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ATTACHMENT A
CONTRA�COSTA HEALTH PIAN SUBCONTRACT REQUIREMENTS
C. DiscriminationCogr plaints. The Contractor agrees that copies of all
grievances alleging discrimination against Contra Costa Health Plan members or eligible
beneficiaries because of race, color, creed, sex, religion, age, national origin, ancestry,
marital status, sexual orientation, or physical or mental handicap shall be forwarded to the
Health Services Director for review and appropriate action.
11. Confidentialit.l. Contractor agrees to comply with all applicable State or
Federal statutes or regulations respecting confidentiality, including but not limited to, the
identity of persons served under this Contract, their records, or services provided them, and
assures that:
a. All records concerning any individual made or kept by Contractor relating
to services provided under this Contract will be confidential, and will .not be open to
examination for any purpose not directly connected with the administration of such service.
b. No person will publish or disclose any list of persons receiving services,
except as may be required in the administration of such service.
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EYE BIT A
TITLE 22 MEDICAL ASSISTANCE PROGRAM Sectioa 53250
(Register 82. No. 39--5725-82 (p, 1300.39)
(e) Each subcontract shall contain:
(1) The subcontractor's agreement to make all of its books and records,
pertaining to the goods and services furnished under the terms of the
subcontract, available Ifor inspection, examination or copying:
(A) By the Department, the United States Department of Health and Human
Services and the Department of Corporations.
(B) At all reasonable times at the subcontractor's place of business,
or at such other mutually agreeable location in California.
(C) In a form maintained in accordance with the general standards
applicable to such book or record keeping.
(D) For a term of�� at least five years from the close of the fiscal year
in which the subcontract was in effect.
(2) Full disclosure of the method and amount of compensation or other
consideration to be received by the subcontractor from the plan.
(3) Subcontractor's agreement to maintain and make available to the
Department, upon request, copies of all sub-subcontracts and to ensure that
all sub-subcontracts are in writing and require that the subcontractor:
(A) Make all applicable books and records available at all reasonable
times for inspection, examination or copying by the Department.
(B) Retain such books and records for a term of at least five years
from the close of they fiscal year in which the sub-subcontractor is in
effect.
(4) Subcontractor's agreement to notify the Department in the event the
agreement with the Contractor is amended or terminated. Notice to the
Department is considered given when properly addressed and deposited in the
United States Postal PService as first-class registered mail, postage
attached.
(5) Subcontractor's agreement that assignment or delegation of the
subcontract shall be void unless prior written approval is obtained from the
Department in those instances where prior approval by the Department is
required.
(6) Subcontractor's agreement to hold harmless both the State and plan
members in the event the plan cannot or will not pay for services performed
by the subcontractorpursuant to the subcontract.
NOTE: Authority cited: Section 14312, Welfare and Institutions code
Reference Section 14452, Welfare and Institutions Code.
HISTORY
1. Repealer ands new section filed 7-5-78, effective thirtieth day
thereafter (Register 78, No. 27) .
2. Amendment of I subsection (g) (16) and new subsection (g) (17) filed
10-20-78, effective thirtieth day thereafter (Register 78, No. 42) .
3. Amendment filed 12-30-81; effective thirtieth day thereafter
(Register 82, No. 1) .
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Contra Costa County ', Standard Form V87
GENMAL CONDiT D
i
(Purchase of Services)
1. Com2liance with Law. Contractor shall be subject to and comply with all Federal, State and local
taws and regulations applicable with respect to its performance under this Contract, including but not
limited to, licensing, employment and purchasing practices; and wages, hours and conditions of
employment, including nondiscrimination.
2. Lns
Xgdjon. Contractor's performance, place of business and records pertaining to this Contract
are subject to monitoring, vnspection, review and audit by authorized representatives of the County, the
State of California, and the United States Government.
3. Records. Contractor shall keep and make available for inspection and copying by authorized
representatives of the County, the State of California, and the United States Government, the
Contractor's regular businessrecords and such additional records pertaining to this Contract as may be
required by the County.
a. Retention of Records. The Contractor shall retain all documents pertaining to this Contract
for five years from the date of submission of Contractor's final payment demand or final Cost Report;
for any further period that is required by law; and until all Federal/State audits are complete and
exceptions resolved for this contract's funding period. Upon request, Contractor shall make these records
available to authorized representatives of the County, the State of California, and the United States
Government.
b. Access to Books and Records of Contractor. Subcontractor. Pursuant to Section 1861(v)(1)
of the Social Security Act, and any regulations promulgated thereunder, Contractor shall, upon written
request and until the expiration of four years after the furnishing of services pursuant to this Contract,
make avallable to the Secretary of Health and Human Services or to the Comptroller General, or any of
their duly authorized representatives, this Contract and books, documents, and records of Contractor
that are necessary to certify the nature and extent of all cons and charges hereunder.
Further, if Contractor carries out any of the duties of this Contract through a subcontract with a value
or cost of $10,000 or more over a twelve-month period, such subcontract shall contain a clause to the
effect that upon written request and until the expiration of four yearn after the furnishing of services
pursuant to such subcontract,Ithe subcontractor shall make available, to the County,to the Secretary or
to the Comptroller General, or any of their duly authorized representatives, the subcontract and books,
documents, and records of the'isubcontractor that are necessary to verify the nature and extent of all costs
and charges thereunder.
This special condition is in addition to any and all other terms regarding the maintenance or retention
of records under this Contract and is binding on the heirs, successors, assigns and representatives of
Contractor:
4. Reporting Requirements. Pursuant to Government Code Section 7550, Contractor shall include
in all documents or written reports completed and submitted to County in accordance with this Contract,
a separate section listing the "numbers and dollar amounts of all contracts and subcontracts relating to
We prepat`ation oC each such document or written report. This section shall apply only-if the payment
limit under this Contract exceeds $5,000. -
G
Contra Costa County Standard Form LW
GENERAL CONDMONS
(Purchase of Services)
5. Termination.
i.
a. Written Notice. is Contract may be terminated by either party, at their sole discretion,
upon thirty-day advance written notice thereof to the other,and may be cancelled immediately by written
mutual consent.
b. Failure to Perform. The County, upon written notice to Contractor, may immediately
terminate this Contract should`the Contractor fail to perform properly any of its obligations hereunder.
In the event of such termination, the County may proceed with the work in any reasonable manner it
chooses. The cost to the County of completing Contractor's performance shall be deducted from any sum
due the Contractor under this) Contract, without prejudice to the County's rights otherwise to recover
its damages.
i.
C. Cessation of Funding. Notwithstanding Paragraph 5.a. above, in the event that Federal,
State, or other non-County fu'ading for this Contract ceases, this Contract is terminated without notice.
6. Entire AQr Bement. This Contract contains all the terms and conditions agreed upon by the parties.
Except as expressly provided herein, no other understanding, oral or otherwise, regarding the subject
matter of this Contract shall be deemed to exist or to bind any of the parties hereto.
7. Further Snecirications foI!. r Operating Procedures. Detailed specifications of operating procedures
and budgets required by this Contract, including but not limited to, monitoring, evaluating, auditing,
billing, or regulatory changes, may be developed and set forth in a written Informal Agreement between
the Contractor and the County. Such Informal Agreements shall be designated as such and shall not be
amendments to this Contract except to the extent that they further detail or clarify that which is already
required hereunder. 'Such Informal Agreements may not enlarge in any manner the scope of this
Contract, including any sums of money to be paid the Contractor as provided herein. Informal
Agreements may be approved and signed by the head of the County Department for which this Contract
is made or his designee.
S. Modifications and Amelndments.
p
a. General Amendments. This Contract may be modified or amended by a written document
executed by the Contractor and the Contra Costa County Board of Supervisors or, after Board approval,
by its designee, subject to anyC required State or Federal approval.
I
b. Administrative Amendments. Subject to the Payment Limit, the Payment Provisions and
the Service Plan may be amended by a written administrative amendment executed by the Contractor
and the County Administrator or his designee, subject to any required State or Federal approval,
provided that such administrative amendments may not materially change the Payment Provisions or the
Service Plan.
9. utes. Disagreements between the County and Contractor concerning the meaning,
requirements, or.pefinal determination in writing by
The
rformancei of this Contract shall be subject to
head of the County Department for which this Contract is made or his designee or in'accordance with
the applicable procedures (if any) required by the State or Federal Government.
L.
Contra Costa County Standard Form 1/87
CzENERAL CONDITIONS
(Purchase of Services)
10. Choice of Law and Personal Jurisdiction.
a. This Contract is made in Contra Costa County and shall be governed and construed in
accordance with the laws of the State of California.
b. Any action relating to this Contract shall be instituted and prosecuted in the courts of
Contra Costa County, State of California.
11. Conformance with Federal and State Regulations and Laws. Should Federal or State regulations
or laws touching upon the subject of this Contract be adopted or revised during the term hereof, this
Contract shall be deemed amended to assure conformance with such Federal or State requirements.
L. No Waiver by County. Subject to Paragraph 9. (Disputes) of these General Conditions, inspections
or approvals, or statements byil any officer, agent or employee of the County indicating the Contractor's
performance or any part thereof complies with the requirements of this Contract, or acceptance of the
whole or any part of said perfo1rmance, or payments therefor, or any combination of these acts, shall not
relieve the Contractor's obligation to fulfill this Contract as prescribed; nor shall the County be thereby
estopped from bringing any action for damages or enforcement arising from any failure to comply with
any of the terms and conditions of this Contract.
13. Subcontract and Assignment. This Contract binds the heirs, successors, assigns and
representatives of Contractor. The Contractor shall not enter into subcontracts for any work
contemplated under this Contract and shall not assign this Contract or monies due or to become due,
without.the prior written consent of the County Administrator or his designee, subject to any required
State or Federal approval.
14. Independent Contra cto `Status. This Contract is by and between two independent contractors and
is not intended to and shall not be construed to create the relationship between the parties of agent,
servant, employee, partnership,joint venture or association.
15. Conflicts of Interest. Contractor, its officers, partners, associates, agents, and employees, shall
not make, participate in ma king, or in any way attempt to use the position afforded them by this
Contract to influence any governmental decision in which he or she knows or has reason to know that
he or she has a financial interest under California Government Code Sections 87100; et seq., or
otherwise.
16. Confidentiality. Contractor agrees to comply and to require its officers, partners, associates,
agents and employees to comply with all applicable State or Federal statutes or regulations respecting
confidentiality, including but not limited to, the identity of persons served under this Contract, their
records, or services provided them, and assures that:
a. All applications and records concerning any individual made or kept by Contractor or any
public officer or agency in connection with the administration of or relating to services provided under
this Contita will be-confidential, and will not be open to examination for any purpose not directly
connected with the administration of such service.
h _
Contra Costa County Standard Form 1Ig7.
fiENIERAL CONDITIONS
(Purchase of Services)
b. No person will publish or disclose or permit or cause to be published or disclosed, any list
of persons receiving services, except as may be required in the administration of such service. Contractor
agrees to inform all employees, agents and partners of the above provisions, and that any person
knowingly and intentionally disclosing such information other than as authorized by law may be guilty
of a misdemeanor.
17. Nondiscriminatory Services. Contractor agrees that all goods and services under this Contract
shall be available to all qualified persons regardless of age, sex, race, religion, color, national origin, or
ethnic background, or handicap, and that none shall be used, in whole or in part, for religious worship
or instruction.
18. Indemnification. The Contractor shall defend,indemnify,save,and hold harmless the County and
its officers and employees from any and all claims, costs and liability for any damages, sickness, death,
or injury to person(s) or property, including without limitation all consequential damages, from any cause
whatsoever arising directly or indirectly from or connected with the operations or services of the
Contractor or its agents, servants, employees or subcontractors hereunder, save and except claims or
litigation arising through the sole negligence or sole willful misconduct of the County or its officers or
employees. Contractor will reimburse the County for any expenditures, including reasonable attorneys'
fees, the County may make by reason of the matters that are the subject of this indemnification, and if
requested by the County will defend any clairns or litigation to which this indemnification provision
applies at the sole cost and expense of the Contractor.
19. Insurance. During the entire term of this Contract and any extension or modification thereof, the
Contractor shall keep in effect insurance policies meeting the following insurance requirements unless
otherwise expressed in the Special Conditions:
a. Mability Insurance. The Contractor shall provide comprehensive liability insurance,
including coverage for owned and non-owned automobiles, with a minimum .combined single limit
coverage of$500,000 for all damages, including consequential damages, due to bodily injury, sickness or
disease, or death to any person or damage to or destruction of property, including the loss of use thereof,
arising from each occurrence. Such insurance shall be endorsed to include the County and its officers
and employees as additional insureds as to all services performed.by Contractor under this agreement.
Said policies shall constitute primary insurance as to the County, the State and Federal Governments,
and their officers, agents, and employees, so that other insurance policies held by them br their self-
insurance program(s) shall not be required to contribute to any loss covered under the Contractor's
insurance policy or policies.
b. Workers' Compensation. The Contractor shall provide workers' compensation insurance
coverage for its employees.
C. Certificate of Insurance, The Contractor shall provide the County with (a) certificate(s)
of insurance evidencing Iiability and worker's compensation insurance as required herein no later than
the effective date of this Contract. If the Contractor should renew the insurance policyCies) or acquire
either a new mm,—nce policy(ies) or amend the coverage afforded through an endorsement to the policy
at any time during the term of this Contract, then Contractor shall provide (a) current cert icaate(s) of .
insurance.
Contra Costa County Standard Form U87
SEVERAL CONDMONS
(Purchase of Services)
d. Additional Insurance Provisions. The insurance policies provided by the Contractor shall
include a provision for thirty (30) days written notice to County before cancellation or material changes
of the above speed coverage.
20. Noti . All notices provided for by this Contract shall,be in writing and may be delivered by
deposit in the United States mail, postage prepaid. Notices to the County shall be addressed to the head
of the County Department for which this Contract is made. Notices to the Contractor shall be
addressed to the Contractor's address designated herein. The effective date of notice shall be the date
of deposit in the mails or of other delivery, except that the effective date of notice to the County shall be
the date of receipt by the head of the County Department for which this Contract is made.
21. Primacy of General Conditions. Except for Special Conditions which expressly supersede General
Conditions, the Special Conditions (if any) and Service Plan do not limit any term of the General
Conditions.
22. Nonrenewal. Contractor understands and agrees that there is no representation, implication, or
understanding that the services provided by Contractor under this Contract will be purchased by County
under a new contract following expiration of termination of this Contract, and waives all rights or claims
to notice or hearing respecting any failure to continue purchase of all or any such services from
Contractor.
23. Possessory Interest. If this Contract results in the Contractor having possession of, claim to or
right to the possession of land or improvements, but does not vest ownership of the land or improvements
in the same person, or if this Contract results in the placement of taxable improvements on tax exempt
land (Revenue & Taxation Code Section 107), such interest or improvements may represent a possessory
interest subject to property tax, and Contractor maybe subject to the payment of property taxes levied
on such interest. Contractor agrees that this provision complies with the notice requirements of Revenue
& Taxation Code Section 107.6, and waives all rights to further notice or to damages under that or any
comparable statute.
24. No Third-Party Beneficiaries. Notwithstanding mutual recognition that services under this
Contract may provide some aid or assistance to members of the County's population, it is not the
intention of either the County or Contractor that such individuals occupy the position of intended third-
party beneficiaries of the obligations assumed by either party to this Contract.
25. Copyrights and Rights in Data. Contractor shall not publish or transfer any materials produced
or resulting from activities supported by this agreement without the express written consent of the County
Administrator. If any material is subject to copyright, the County reserves the right to copyright such
and the Contractor agrees not to copyright such material. If the material is copyrighted, the County
reserves a royalty-free, nonexclusive, and irrevocable license to reproduce, publish, and use such
materials, in whole or in part, and to authorize others to do so.
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SUMMARY OF THE PROCEEDINGS
BEFORE THE BOARD OF SUPERVISORS OF
CONTRA COSTA COUNTY
MEETING IN ALL ITS CAPACITIES
PURSUANT TO ORDINANCE CODE SECTION 24-20402
FRIDAY, OCTOBER 7t 1994, 9 A.M.
DETERMINATION ITEM NO. 2.1 (October 4, 1994 Agenda)
APPROVED the recommendations of the Medical Director on increased
health care access for East and West County poor patients, which
included approval of contracts with Brookside Hospital and Delta
Memorial Hospital (Ayes: 1,2,3,4,5) ; AUTHORIZED the Ad Hoc
Committee to discuss pertinent issues with the Los Medanos
Hospital Board and receiver including relief of the bonded
indebtedness of Hospital District taxpayers, and authorizing the
Committee to hire consultants at reasonable cost to acquire
information deemed necessary for longterm health care options
(Ayes: 1,2,3 ,4,5) ; and AUTHORIZED the contracting with an
outside hospital consultant to provide the Board with a cost-
benefit analysis of the identifiable options for replacing
Merrithew Memorial Hospital (Ayes: 1,3,4,5; Noes: none; Abstain