HomeMy WebLinkAboutMINUTES - 03111997 - C37 TO: BOARD OF SUPERVISORS
FROM: William Walker, M.D. , Health Services Director
By: Ginger Marieiro, Contracts Administrator Contra
`
Costa
DATE: February 27,, 1997 _ County
SUBJECT: Approval of Advice Nurse Services Agreement Format
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I . RECOMMENDED ACTION:
Approve the Advice Nurse Services Agreement format and authorize
the Health Services Director, or his designee (Milt Camhi) , to use
and execute on behalf of the County, this format with various
managed care organizations for the provision, by Contra Costa
Health Plan (CCHP) , of professional Advice Nurse services .
II . FINANCIAL IMPACT:
Revenue generated by these Contracts will be used to offset the
cost of CCHP' s advice nurse services .
III . REASONS FOR RECOMMENDATIONS/BACKGROUND:
The Advice Nurse Program was developed originally to service
members of CCHP and patients of Merrithew Memorial Hospital and
Health Centers . As other counties have developed managed care
plans, each of which has a requirement to provide 24-hour
telephone access to a physician or nurse, CCHP has been actively
marketing Advice Nurse services to them.
On September 7, 1994, the Board of Supervisors authorized the
Health Services Director, or his designee, to execute on behalf of
the County, the first Advice Nurse Services Agreement with Solano
County, and negotiations are currently being completed for the
sale of Advice Nurse Services with Sonoma and San Francisco
counties .
Under the terms of these agreements, CCHP Advice Nurses will
provide the required telephone access, which may include : medical
advice, authorization for emergency services, information about
how to access urgent care services, and information about how to
reach their doctor.
CONTINUED ON ATTACHMENT: YES SIGNATURE: �}
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIG'NATURE(S)
ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
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
OF SUPERVISORS ON THE DATE SHOWN.
Contact: Milt Camhi (313-6004)
CC: Health Services (Contracts) ATTESTED
Risk Management Phil Bate 101',C N of tlie Board of
Auditor-Controller Supervisors and County Administrator
Contractor
M382/7-83 BY DEPUTY
`- Cohtra Costa County
ADVICE NURSE SERVICES CONTRACT
Number: 29-771
1. Contract Identification.
Department: Health Services Department - Contra Costa Health Plan
Subject: Advice Nurse Services
2. Parties. The County of Contra Costa, California (County) , for its Department named
above, and the following named Agency Requiring Service (Plan) mutually agree and
promise as follows:
Agency: SOLANO PARTNERSHIP HEALTHPLAN
Capacity: Public corporation Taxpayer I.D. Not applicable
Address: 421 Executive Court North, Suite A, Suisun City, California 94585
3. Term. The effective date of this Contract is October 1, 1994 and it terminates
September 30, 1996 unless sooner terminated as provided herein.
4. Termination. This Contract may be terminated by either party, at their sole
discretion, upon one hundred and twenty (120) day advance written notice thereof to the
other, or cancelled immediately by written mutual consent.
5. Plan's Obligations. In consideration of County's provision of services as described
below, Plan shall reserve for services hereunder the estimated costs for services and
shall pay County quarterly for services provided hereunder upon submission of a
properly documented demand for payment, in accordance with the per-unit costs expressed
in the Additional Provisions which is attached hereto and incorporated herein by
reference.
6. County's Obligations. County shall provide Advice Nurse Services as set forth in the
attached Additional Provisions. County will bill Plan quarterly as set forth in the
Additional Provisions for the services it performs under this Contract.
7. Indemnification.
A. The Plan shall defend, save harmless and indemnify the County and its officers,
agents and employees from all liabilities and claims for damages for death,
sickness or injury to persons or property, including without limitation all
consequential damages from any cause whatsoever arising from or connected with
the operations or the services of the Plan hereunder, resulting from the conduct,
negligent or otherwise, of the Plan, its agents or employees.
B. The County shall defend, save harmless and indemnify the Plan and its officers,
agents and employees from all liabilities and claims for damages for death,
sickness or injury to persons or property, including without limitation all
consequential damages from any cause whatsoever arising from or connected with
the operations or the services of the County hereunder, resulting from the
conduct, negligent or otherwise, of the County, its agents or employees.
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Contra Costa County
ADVICE NURSE SERVICES CONTRACT
Number• 29-771
8. 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 of agent, servant, employee, partnership, joint venture, or association.
9. Legal Authority. This Contract is entered into under and subject to the following
legal authorities: California Government Code Section 26227.
10. Signatures. These signatures attest the parties' agreement hereto:
COUNTY OF CONTRA COSTA, CALIFORNIA SOLANO PARTNERSHIP HEALTHPLAN
By By
Designee
(Designate official capacity)
Recommended by Department
By
Designee
Approved: County Administrator
By
Designee
Approved: County Counsel
By
Designee
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ADDITIONAL PROVISIONS
Number 29-771
1. Scope of Services. County shall provide after hours Advice Nurse services to Members
of the Solano Partnership Health Plan ("Plan Member(s) ") .
2. County's Obligations. County shall provide the following services:
a. Advice Nurse Services. County shall provide licensed Registered Nurses who have
the experience and qualifications to serve as Advice Nurses, as determined by
County in its sole discretion. County's Advice Nurses will provide the
following services to Plan Members:
(1) Supply information about how to access urgent care services;
(2) Authorize emergency services;
(3) Give medical advice; and
(4) As appropriate, forward a written record of the call to Plan Member's
Primary Care Physician.
b. Hours of Service. County shall provide Advice Nurse services in accordance with
the following schedule:
(1) From 5:00 p.m. to 8:00 a.m. , each Monday through Friday, except for
holidays; and
(2) Twenty-four (24) hours per day on Saturdays, Sundays, and Holidays, not to
exceed a total of thirteen (13) holidays. The thirteen (13) holidays
shall be designated by mutual agreement of County and Agency. It is
understood and agreed that no services will be provided on any holiday
that falls on a weekday and is not one of the thirteen (13) designated
holidays.
C. Telephone Access and Standards.
(1) County shall provide a nationwide, toll-free dedicated telephone number
for Plan Members to call.
(2) County agrees to answer ninety percent (900) of all incoming calls to the
toll-free number within three (3) minutes of the first ring.
d. Brochures. County shall provide Agency with camera-ready artwork for one Member
brochure and one County provider brochure, the contents of which will be mutually
developed and agreed upon by County and Agency.
Initials:
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Plan County
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ADDITIONAL PROVISIONS
Number 29-771
e. Billing for Services. County shall bill Agency quarterly, at the end of each
quarter, for services provided under this Contract.
3. Agency's Obligations.
a. Referral of Plan Members. Agency. shall provide oral and written information to
Plan members regarding the after hours Advice Nurse services and telephone number
which are available pursuant to this Contract.
b. Eligibility List. Agency shall provide to County, in the time, form, and manner
requested by County, current lists of eligible Plan Members.
C. Payment to County. Upon County's written submission of a quarterly invoice in
the time, form, and manner acceptable to Agency and County, Agency shall pay
County at the rate of forty cents (404) each month for each Plan Member who is
included on Plan's Eligible List for a minimum of 18,000 members, regardless of
the number of telephone calls received by County from eligible Plan Members. In
any event, County shall be paid at least $7,200 monthly, or a quarterly payment
of at least $21,600.
County understands and agrees that in the event telephone calls are received from
individuals who are not included on Agency's Eligible List, Agency will not pay
County for any such calls.
4. Reports. The following reports shall be developed and provided in the time, form, and
manner mutually agreeable to County and Agency:
a. Agency shall provide to County monthly Emergency Room and Urgent Care cost and
utilization information for Plan members in the Advice Nurse Program.
b. County shall provide to Agency monthly reports that include information on
average waiting times and data regarding initial intent versus outcome.
5. Advice Nurse Protocols. County shall provide copies of its Advice Nurse Protocols to
Agency for review and approval only. County and Agency agree that the Advice Nurse
Protocols are the property of County. Agency agrees not to duplicate the Protocols and
to return the Protocols to County immediately upon termination of this Contract for any
reason.
Initials:
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Plan County
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ADDITIONAL PROVISIONS
Number 29-771
6. Discrimination Prohibited. County shall not differentiate or discriminate in the
rendering of services hereunder to Plan Members, nor shall County discriminate on the
basis of race, religion, sex, disability, or age. County shall render health services
to Plan Members in the same manner, in accordance with the same standards, and within
the same time availability as offered to all its other patients, except as limited by
existing Medi-Cal Program restrictions.
7. No Reimbursement From State.
a. County and Agency agree to indemnify, defend, and save harmless the State of
California, and their respective officers, agents, and employees from any claims
or losses for materials and/or services rendered by any subcontractor, person,
or firm performing or supplying services, materials, or supplies to County and
Agency in connection with this Contract.
b. County shall hold harmless the State of California, and Plan Members in the event
Agency cannot or will not pay for covered services rendered by County pursuant
to the terms of this Contract.
8. Records. County shall maintain for each Plan Member who receives covered services, a
legible record of services rendered, kept in detail consistent with appropriate
professional practice. County shall maintain such records for at least five years from
the termination date of this Contract.
9. Inspection Rights. County shall make all books and records pertaining to the goods and
services furnished pursuant this Contract, available for inspection, examination, audit
or copying:
a. By Agency's Consultant Team, the State Department of Health Services and the
United States Department of Health and Human Services;
b. At all reasonable times at County's normal place of business or at such other
mutually agreeable location in California;
C. In a form consistent with the general standards applicable to such book or record
keeping; and
d. For at least five (5) years from the termination date of this Contract.
10. Confidentiality of Member Information. Notwithstanding any other provision of this
Agreement, names of persons receiving public social services are confidential and are
to be protected from unauthorized disclosure in accordance with Title 42. CFR. Section
431.300 et seq. and Section 14100.2, Welfare and Institutions Code and regulations
adopted thereunder. For the purposes of this Agreement, all information records, data
and data elements collected and maintained for the operation of the Agreement and
pertaining to Plan Members shall be protected by County and its staff from unauthorized
Initials:
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Plan County
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ADDITIONAL PROVISIONS
Number 29-771
disclosure, as set forth below and in Attachment A (Solano Partnership HealthPlan
Declaration of Confidentiality) which is attached hereto and incorporated herein by
reference.
With respect to any identifiable information concerning a Plan Member under this
Agreement that is obtained by County, County (1) shall not use any such information for
any purpose other than carrying out the express terms of this Agreement, (2) shall
promptly transmit to Plan all requests for disclosure of such information, (3) shall
not disclose, except as otherwise specifically permitted by this Agreement, any such
information to any party other than Plan, the U.S. Department of Health and Human
Services, or the State Department of Health Services without the prior written
authorization of Plan specifying that the information is releasable under Title 42,
CFR, Section 431.300 et seq. and Section 14100.2, Welfare and Institutions Code and
regulations adopted thereunder, (4) shall, at the expiration or termination of this
Agreement, return all such information to Agency or maintain such information according
to written procedures sent to County by Agency.
11. Subcontracts. County shall maintain and make available to Agency, the State Department
of Health Services, and the U.S. Department of Health and Human Services upon request,
all subcontracts of this Contract and shall ensure that all subcontracts are in writing
and require that the subcontractor:
a. Make all books and records pertaining to the goods and services furnished
pursuant to the subcontract available at all reasonable times for inspection,
examination, or copying by Agency, the U.S. Department of Health and Human
Services and the State Department of Health Services; and
b. Retain such books and records at least five (5) years from the termination of the
subcontract.
12. Failure to Meet Obligations. Contract Paragraph 4. (Termination) notwithstanding, in
the event that either Party defaults in the performance of any duties or obligations
hereunder, including the inability or refusal to provide services hereunder, and the
default or breach has not been cured within thirty (30) days of the nondefaulting
Party's giving of written notice of default, specifying the nature of the alleged
default or breach, the nondefaulting Party may give thirty (30) days written notice of
intent to terminate this Contract.
Initials•
Plan County
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ATTACHIIIENT A
SOLANO PARTNERSHIP HEALTHPLAN DECLARATION OF
CONFIDENTLALM
Letter of Authorization Procedures Release/Access of
DHS Computer Files for the Medi-Cal Program
As a condition of obtaining access to information concerning procedures or
other data records utilized/maintained by the Department of Health Services,
County agrees not to divulge any information obtained in the course of
assignment to unauthorized persons receiving Medi-Cal services such that the
persons who receive such services are identifiable.
Access to such data shall be limited to Solano Partnership HealthPlan, Solano
Partnership's fiscal agent, State and Federal personnel who require the
information in the performance of their duties, and to such other as may be
authorized by the Department of Health Services.
County recognizes that unauthorized release of confidential information may
make subject to civil and criminal sanctions pursuant to the provisions of the
Welfare and Institutions Code Section 14100.2.
Signature
Date