HomeMy WebLinkAboutMINUTES - 02091993 - 1.32 r i
TO: B ARD OF SUPERVISORS Contra
FROM:
Mark Finucane, Health Services Director Contra
By: Elizabeth A. Spooner, Contracts Administrator
Costa
DATE: January 25, 1993 County
SUBJECT: Approval of Contract #23-063-6: with HHL Financial Services, Inc.
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION '
I. RECOMMENDED ACTION:
Approve and authorize the Chair, Board of Supervisors, to execute on
behalf of the County, Contract #23-063-6 with HHL Financial Services,
Inc. for the period January 1, 1993 through December 31, 1993 for
consultation and technical assistance with regard to Medi-Cal
eligibility, collection issues, and administrative appeals.
II. FINANCIAL IMPACT:
The Contractor is paid on a commission basis only for amounts it
collects on inpatient and outpatient Medi-Cal claims.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
Since 1984 the Department has contracted with HHL Financial Services,
Inc. to provide financial consulting services with regard to Medi-Cal
eligibility, claims, and administrative appeals. Standard Contract
#23-063-6 continues the Contractor's services through December 31,
1993 .
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMME JAON OF BOARD CI&MMITTEE
APPROVE OTHER
SIGNATURE(S)
ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
X UNANIMOUS (ABSENT ) I HEREBY CERTIFY THAT THIS IS A TRUE
AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
Contact: Patrick Godley (370-5007) OF SUPERVISOR ON THE DATE SHOWN.
CC: Health Services (Contracts) ATTESTED a Zo
Risk Management Phil Batchelor,Clerk of the card Of
Auditor—Controller Supervisors and County Administrator
Contractor
ell
M382/7-99 BY DEPUTY
G'ontra Costa County 1 -3Z Number 23-063-6
Standard Form 1/87 STANDARD CONTRACT Fund/Org # as coded
(Purchase of Services) Account # 2861
1. Contract Identification. Other #
Department: Health Services - (Office of the Director/Finance)
Subject: Consultation and technical assistance with regard to Medi-Cal eligibility
and collection issues and administrative appeals
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: HHL Financial Services, Inc.
Capacity: Delaware Corporation Taxpayer ID #11-2915581
Address: 6180 Laurel Canyon. Boulevard, North Hollywood, California 91609-7081
Mailing Address: P.O. Box 7081, North Hollywood, California 91609-7081
3. Term. The effective date of this Contract is January 1. 1993 and it terminates
December 31. 1993 unless sooner terminated as provided herein.
4. Payment Limit. County's total payments to Contractor under this Contract shall not
exceed $ Not Applicable.
5. County's Obligations. County shall make to the Contractor those payments described in
the Payment Provisions attached hereto which are incorporated herein by reference,
subject to all the terms 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 (if any) attached hereto, which are incorporated herein by reference.
8. Project. This Contract 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 AuthoritX. This Contract is entered into under and subject to the following legal
authorities: California Government Code Sections 26227 and 31000.
10. Signatures. These signatures attest the parties' agreement hereto:
COUNTY OF CONTRA COSTA, CALIFORNIA
ATTEST: Phil Batchelor, Clerk of the Board
BOARD OF SUPERVISORS--, of Su rvisors and County Administrator
By /� BY
Chairman/Designee Ireputy
� CONTRACTOR
By By
(Designate business capacity A) (Designate business capacity B)
Note to Contractor: For corporations (profit or nonprofit) , the contract must be signed by
two officers. Signature A must be that of the president or vice-president and Signature .B
must be that of the secretary or assistant secretary (Civil Code Section 1190 and
Corporations Code Section 313) . All signatures must be acknowledged as set forth on page two.
SERVICE PLAN
Number 23-063-6
1. Independent Status. Contractor is an independent contractor and County shall
neither direct nor have control over Contractor, Contractor's activities, or the methods and
details by which Contractor fulfills his/her obligations under this Contract. In providing
services hereunder, Contractor shall work cooperatively with County's Health Services
Director, or his designee (Chief Finance Officer) .
2. County's Activity Support. County shall provide for Contractor certain office
space, clerical support, office supplies and services, materials, equipment, facilities, and
assistance as may be mutually determined to be necessary to support Contractor's activities
hereunder, but excluding the use of County cars.
3. Progress Reports. Contractor shall submit monthly Progress Reports, written or
oral, upon request .to the County's Health Services Director, or his designee, detailing
Contractor's accomplishments in providing services hereunder.
4. Service Activities. Contractor shall provide consultation and technical
assistance to County's Health Services Department with regard to certain finance issues as
set forth below:
a. Program Eligibility for Indigent. At County's request, Contractor shall
assist County in obtaining Medi-Cal, Medically Indigent Adult (MIA) , and/or California
Children's Services (CCS) program eligibility for patients who have been designated by County
as pending Medi-Cal or cash accounts. Generally, these patients are those who have failed
to provide County with proof of eligibility for the month(s) of service, and/or have failed
to cooperate with the County Department of Social Services or CCS in obtaining Medi-Cal, MIA,
or CCS coverage.
b. TAR Appeals. Wherever medically or administratively justified, Contractor
shall file administrative appeals on Treatment Authorization Requests (TAR'S) and Extensions
denied by the State of California Medi-Cal Field Services office(s) .
C. Medi-Cal Claim Reprocessing and Appeals. Upon County's request,
Contractor shall diligently process and pursue any inpatient and outpatient Medi-Cal claims
billed and unpaid problem accounts through the State's Medi-Cal administrative appeals
process. Such problem accounts may include any claim(s) billed to the Medi-Cal Fiscal
Intermediary. Contractor shall be solely responsible for said appeals, and County shall
provide Contractor with necessary information to carry out its responsibility. Upon County's
request, Contractor shall make available to County all correspondence between Contractor and
the State of California and the State's Medi-Cal fiscal intermediary regarding billing claims
referred to Contractor for administrative appeals services hereunder. Contractor shall be
responsible for photocopying documents necessary for such appeals.
d. Workshops. Contractor provide regular workshops to educate County-selected
personnel on Medi-Cal billing procedures, admitting and collection techniques.
e. Telephone Consultation. Contractor shall provide off-site consultation via
an accounts receivable telephone "hotline" .
f. Third Party Sources of Payment. On any County-referred account which does
not qualify for Medi-Cal, MIA, and/or CCS benefits, Contractor shall make its best efforts
to identify and recover other sources of payment which may include, but not be limited to,
Victims of Crime, Workers Compensation, third-party liability, and commercial insurance.
Initials: c tv�S
I Count} DeDt Contractor
Contra•'Costa County _ Standard Form 1/87
APPROVALS/ACKNOWLEDGEMENT
Number 23-063-6
APPROVALS
RECOMMENDED BY DEPARTMENT FORM APPROVED
By By
of-signee
APPROVED: COUNTY ADMINISTRATOR
By W
ACKNOWLEDGEMENT
State of California ACKNOWLEDGEMENT (By Corporation,
Partnership, or Individual)
County of •�/SC-�1�s3
The person(s) signing above 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)
0 INES WEBER Notary Public/Deputy County Clerk \
Comm.#968148
v ti L NOTARY PUBLIC.CALIFORNIgQ
LOS ANGELES COUNTY ()
r o MY Comm.EMpues Jury 20,19961 —2-
-- i
Cont a� Costa, County PAYMENT PROVISIONS Standard Form 6/90
(Fee Basis Contracts)
Number 23-063-6
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
[ ] b. $ per unit, as defined in the Service Plan, or
[ J c. $ after completion of all obligations and conditions herein.
[R] d. As set forth in Paragraph 7. (Payment and Reimbursement) of the attached Service
Plan which is incorporated herein by reference.
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 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. (Payment Amounts) above.
3. Penalty for Late Submission. 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
prejudiced, 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 'refs-ed 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 i_tEgr ze' 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 30 days of demand 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.
Initials:
Colm..ty Dept Contractor
SERVICE PLAN.
Number 23-063-6
Contractor shall return to County all accounts which it identifies as self-pay accounts so
that County may assign such accounts to a collection agency.
g. Collection of Accounts. County shall, at its discretion and in a timely
fashion, assign to Contractor" certain accounts as prescribed in the attached
Inpatient/Outpatient Medi-Cal Bulletin No. 59 (Exhibit A) , which is incorporated herein by
reference. County.shall immediately notify Contractor of each collection received directly
by County from the debtor when such collection was of a delinquent bill, claim, or account
previously assigned to Contractor for collection.
(1) Uncollectible Accounts. Contractor shall submit to the Health
Services Director or his designee a monthly written report in the form and manner required
by County which identifies all claims or accounts which Contractor deems to be uncollectible
and which includes a brief statement of the reasons why such items are considered to be
uncollectible. All such accounts shall be returned to County, and Contractor shall have no
rights to a commission for any sums thereafter collected upon these accounts. In the event
that Contractor makes a recommendation to County for reactivation of an account which it
previously identified as uncollectible and which it had therefore returned to County, County
may once again assign said account to Contractor. Contractor shall be entitled to its
commission for any sums thereafter collected upon such reassigned accounts.
(2) Reassigned Accounts and Legal Action by County. In the event that
County and Contractor mutually agree that it is in the best interest of County for County to
initiate a suit or other legal process with respect to an account, Contractor shall return
said account to County for this purpose. In the event that Contractor returns to County such
an account, the account or claim shall not be considered an uncollectible account, and
Contractor shall be entitled to its commission on the account collected as a result of County
action, less expenses of collection and attorney fees of County.
(3) Compromise Settlement or Cancellation of Indebtedness. If Contractor
determines that the collection or enforcement of a claim would result in undue hardship to
the debtor or his dependents, or that for some reason of law or fact County's right to
recover is in doubt, Contractor shall report such facts to the Health Services Director or
his designee. If County determines that the collection or enforcement of a claim would
result in undue hardship to the debtor or his dependents, or that for some reason of law or
fact County's right to recover is in doubt, County shall report to its Board of Supervisors
through the County Auditor-Controller with a recommendation for a compromise settlement or
cancellation of the indebtedness. Contractor's commission in such case shall be based upon
the amount accepted by County in full satisfaction of the obligation, provided, however, that
if the Board of Supervisors decides that it is in the best interest of County to cancel said .
claim, in its entirety, Contractor shall not be entitled to payment of. any fees or commission
from County.
h. Attorney Lien Project. County shall refer to Contractor, attorney lien
requests or subpoena tecums received on accounts for an inpatient stay with a balance of
$1,000.00 or more. County shall also supply Contractor with an accounts receivable balance
for outpatient services related to the attorney request or subpoena duces tecum so that the
lien is filed for the total charges.
i. Control of Accounts and Reports. Contractor shall maintain a control
account of County-assigned accounts, which is separate from all of its other accounts and
shall bill responsible parties for the full amount owed on each County-assigned account.
Initials: U J�
2 Cour:ty Dept Contractor
I
SERVICE PLAN
Number 23-063-6
All reports and information provided by Contractor under the terms of this
Contract become the property of County.
j . Maintenance and Examination of Agency Records. Contractor shall maintain
accurate, current books of accounts in accordance with generally accepted standards of good
accounting practice. Such books of account shall consist of primary and subsidiary records,
which shall be maintained for a period of four years. The County Auditor-Controller, without
advance notice, shall be permitted to examine the records, books, and other data in the
possession of Contractor pertaining to the collection of accounts assigned under the terms
of this Contract.
k. Financial Consultation. Contractor shall provide any additional financial
consulting services which may be requested by Country.
5. Pro iect Managers.
a. Contractor's Project Manager. Subject to the initial and continuing
approval of the Health Services Director or his designee, Contractor shall designate from
Contractor's staff a Project Manager to lead and coordinate Contractor's financial services
as described in this Contract. Contractor's Project Manager shall be responsible for the
timely accomplishment of all activities assigned hereunder.
b. County's Project Manager. The Health Services Director, or his designee,
shall designate a County Project Manager to oversee County's activities under this Contract.
County does not anticipate assigning any of its employees to assist Contractor on a full-time
basis. However, at the discretion of County's Project Manager, County personnel shall be
available to Contractor to provide necessary input and assistance in answering questions and
to provide necessary liaison between County and Contractor.
6. Access to County's Records. As deemed necessary for the provision of services
hereunder, County shall provide Contractor access to the following:
a, Patient Financial File, as available, for purposes of determining the
financial status, billing, and follow-up activities related to the account.
b. Medical records, as available, for purposes of determining and verifying
dates of patient service and other medical information required for the administrative
appeals process referred to in Paragraph 4. (Service Activities) above.
C. Hospital computer system for data inquiry purposes.
d. Remittance Advice files and other necessary data, as available, in manual
or computer form.
e. Various operational/administrative records and statistics of County's
Health Services operations.
Contractor's access to said information shall be limited to those patient
accounts which County has referred to Contractor for services. Contractor shall not publish
or disseminate such information without prior written approval of County. In any event,
Contractor shall maintain the confidentiality of all patient records and information in
accordance with all applicable State Federal laws and regulations.
Initials:
3 Cmz;ty Dept Cortrz,.c*_or
SERVICE PLAN
Number 23-063-6
Contractor shall promptly return to County in the same conditions and order
in which it was originally received all materials provided to it by County as set forth
above.
7. PayMel2t and Reimbursement. In consideration for the services it provides under
this Contract, Contractor shall receive payment from County at the rate of twenty-three
percent (23%) of the amounts collected on inpatient and outpatient claims, and twenty-seven
percent (27%) of the amounts collected as a result of all levels of administrative appeals
and/or legal action with the State's Medi-Cal Fiscal Intermediary, State Department of Health
Services and the Board of Control, plus any costs and disbursements advanced by Contractor.
For purposes of calculating Contractor's fee, said "amounts collected" shall exclude any and
all amounts paid to County as "disproportionate share payment adjustments" through AB-4563,
AB-.4523, SB-1255, SB-855, AB-3139, or any subsequent legislation modifying or replacing these
regulations.
Contractor shall not charge County for the off-site accounts receivable telephone "hotline" ,
billing and collection workshops, and monthly progress reports which it provides for County
under this Contract.
a. Settlement Statements. Contractor shall submit to the Health Services
Director or his designee on County-approved forms a monthly settlement statement which
itemizes showing the total receipts collected for each account for the preceding month.
These settlement statements shall include:
(1) The total amount of collections received.
(2) All costs advanced by Contractor.
(3) The amount of the commission payable to Contractor for its
collection service.
(4) The total amount of collections to which County is entitled under
this Contract, i.e. , the amount collected and transmittable by
Contractor, less Contractor's commission.
b. Payment to Contractor.
(1) Subject to the Payment Provisions of this Contract, Health Services
Department shall authorize payment to Contractor for services delivered to and accepted by
County within thirty (30) days of receipt by County.
(2) County shall pay to Contractor the sum of the fees and commissions
described in Paragraph 7. , subparagraph a. , above, not later than ten (10) days after receipt
of a settlement statement acceptable to County.
C. Reimbursement to County. Contractor hereby agrees that any payment made
by County to Contractor for inpatient services originally approved by Medi-Cal as a result
of Contractor's services, which is later disallowed in a State audit, shall be repaid to
County by Contractor. Any refund payment which Contractor owes to County is due and payable
by Contractor upon Contractor's receipt of an itemized invoice from County indicating the
specific nature and amount of the audit disallowance(s) and affirming County's intention to
Initials: Q00 px� -
4 CoUAY Leet Contactor
SERVICE PIAN
Number 23-063-6
immediately repay such disallowance(s) to Medi-Cal. In the event that Contractor fails to
reimburse County, County may, at its discretion, deduct such amount from future payments to
Contractor.
8. 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 in the 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 be 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 may be authorized by the Board of Supervisors or by law to
receive such views.
Initials:
5 Comty Dent Contractor
P:Xtlll511 A
a :• ore a �
v ma =REM
tul CAI
r
May 1983•
Medical Services Bulletin No. 64 Long Term Care Bulletin No. 41
Inpatient/Outpatient Bulletin No. 59. Vision Care Bulletin No. 40
Allied Health Services Bulletin No. 50 Pharmacy Bulletin No. 78
Claims inquiries and Appeals Criteria for
Timely Submission and Fallow-up
CSC is strictly adhering to the following guidelines for timely
submission and follow-up of claims inquiries and appeals :
o Initial Claims Inquiry to Request Denial Reconsideration
or Adjustments
r
For this purpose , a Claims Inquiry Form (CIF 60-1) must
be submitted within 60 days of the date of the Explana-
tion of Benefits (EOB) or Remittance Advice (RA) on
which the claim in question was either paid or denied .
o Follow-up Inquiry
If the initial inquiry (CIF) is not responded to within
60 days, the provider should review the information on
the initial CIE for accuracy by referring to the follow-
ing checklist "Reasons for No Response to CIFs ." If an
obvious error is noted on the initial CII', a new CIF
should be prepared and submitted with all appropriate
corrections and documentation attache3 (including a
photocopy of the original CIF) .
If no error can be found on the initial CIF, photocopy
the initial CIF and all attachments, write "SECOND
REQUEST" on the CIF copy, date , and mail to : ,
Computer Sciences Corporation
P.O. Box 15000
Sacramento, CA 95813
ATTN: Claims Research - 2nd Request CIFs
ALL PROVIDER, BULLETIN -2- MAY 1923
o Appeals Process
If no response is received within 90 days of the second
CIF submission , providers may file a first level appeal
as detailed -in the provider manuals . ,
o Claim Tracer as Proof of Timely Billing
If a claim in question has not been paid , denied , or
(AFTER 45 DAYS FROM DATE OF MAILING TO CSC) is not
appearing as suspended on the most current EOB/RA, you
should sLtl;�ar•acer�eguest (CIF 60-1) . This claim
tracer may assist you in documenting timely submission
of your claim to CSC. To document timely submission ,
the tracer must be received by CSC within the same
"two-month from end of service month" billing limitation
as the original claim.
The only acceptable documentation to verify timely
submission of claims is a copy of an EOB/RA, RTD, or a
tracer response letter . Any of these documents contain-
-g
in a__CCN or CRN__with a Julian date falling within the
-
two-month limitation for the claims in question will
verify timely submission .'
o Claim Tracer for Status of a Claim
A tracer request (CIF inquiring on the status of claim)
may be submitted any time within the system-available 15
months of processed claim history. Information on
claims processed more than 15 months ago is not avail-
able . DO NOT SUBMIT TRACER REQUESTS ON CLAIMS KNOWN TO
HAVE BEEN PAID, DENIED, OR ARE APPEARING AS SUSPENDED ON
THE MOST RECENt EOB/RA.
o Separate Forms for Different Inqui-ry Requests
Since the inception of version 4 of. the Claims Inquiry
Form (September 1981) it has become apparent that pro-
viders have experienced difficulty meeting the require-
ments for different types of inquiries on _or)e ,inquiry
form. This has resulted in incorrect processing of some
requests .
Therefore , CSC recommends that each type of request
(denial reconsideration, adjustment, tracer) be com-
pleted on separate Claims Inquiry Forms. NOTE: Denial
reconsideration and adjustment requests on Hospital
Inpatient and Medicare Crossover Claims must be on
separate inquiry forms and are limited to one claim
(Claim Control Number) per inquiry form.
ALL PROVIDER BULLETIN -3- MAY 1983
REASONS FOR NO RESPONSE TO CIFs
1. Correct Provider Number -- Verify that you entered your
provider number accurately and completely.
rwvvw�nco.
2. Claim type -- Verify that you checked the correct claim type .
f5I CLAIM TYPE
CHECK ONE Boz ONLY
a, fu 01- 30-1 Claim form
❑0'14ARfAACV ITAL
11 OUTPATIENTICLINIC 02— 25-1 Claim form
02
0 03- 16-1 Claim form
LTCPHYSICIAN/
LJ ALLIEp 04- 15-1 Claim form
M 07 05- 40-1 Claim form
�IN ENT VISION 47- 45-1 Claim fcrm
3. Patient 's Medi-Cal ID No . -- Be sure that the ID number is 14
digits and matches the ID number printed on the EOB/RA, even
if the number on the EOB/RA is incorrect . (Example: The
claim is denied 001 or 002 because the ID number on the
initial claim was " incorrect . Enter the incorrect ID number
from the EOB/RA, explain in the Remarks area that the correct
ID number is ana 'attach a corrected billing -
with POE or copy o ID card to the CIF. )
4. Claims Control Number (CCN) -- Verify that the Claim Control
Number contains 13 digits and matches the Claim Control
Number from the EOB/RA. If this is left blank the inquiry
will be conbidered a tracer request .
a) When inquiring on a claim that appeared on the EOB/RA as
denied on more than one occasion , use the CCN from the
most res.en-t denial .
b) When requesting an adjustment to a paid:. claim that has
already been adjusted one or more times, use the CCN from
the payment (positive) line of the most recent adjust-
ment. Do not use a CCN from a denial on an adjustment
request .
ALL PROVIDER BULLETIN -4- MAY 1983
5. Date of Service, Proc/Mod/Drug Code , Amount Billed are only
necessary to fill in on tracer requests (see All Provider
Bulletin, September 1981, for instructions) .
6. On all inquiries submitted , copies of any previous inquiries
or correspondence should be included in order to,:document
timely initial inquiry and timely - follow-up.
Contra .Costa,County Standard Form 1/87
GENERAL CONDITIONS
(Purchase of Services)
1. Compliance with Law. Contractor shall be subject to and comply with all Federal,
State and local laws 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. Inspection. Contractor's performance, place of business and records pertaining to
this Contract are subject to monitoring, inspection, 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 business records 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 available 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 costs 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
years after the furnishing of services pursuant to such subcontract, the 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 subcontractor 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 the preparation of each such document or written
report. This section shall apply only if the payment limit under this Contract exceeds
$5,000.
1
I �
Contra Costa `County Standard Form 1/87
GENERAL CONDITIONS
(Purchase of Services)
5. Termination.
a. Written Notice. This 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.
C. Cessation of Funding. Notwithstanding Paragraph 5.a. above, in the event
that Federal, State, or other non-County funding for this Contract ceases, this Contract is
terminated without notice.
6. Entire Agreement. 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 Specifications for 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.
8. Modifications and Amendments.
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 any required State or Federal approval.
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. Disputes. Disagreements between the County and Contractor concerning the meaning,
requirements, or performance of this Contract shall be subject to final determination in
writing by the 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.
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Contra Costa County Standard Form 1/87
GENERAL 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.
12. No Waiver by County. Subject to Paragraph 9. (Disputes) of these General
Conditions, inspections or approvals, or statements by 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 performance,
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 Contractor 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 making, 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.
lb. 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 Contract will be confidential, and will not be open
to examination for any purpose not directly connected with the administration of such
service.
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GENERAL 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 claims 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. Liability 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 or 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 liability and worker's compensation insurance as
required herein no later than the effective date of this Contract. If the Contractor 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 at any time during the term of this
Contract, then Contractor shall provide (a) current certificate(s) of insurance.
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 specified coverage.
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Contra Costa County Standard Form 1/87
GENERAL CONDITIONS
(Purchase of Services)
20. 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. 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 or 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 may be 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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