HomeMy WebLinkAboutDoc 386 - EMS Acct Svs IGA - SRSD - SpringfieldDeschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 -Fax (541) 385-3202 -www.deschutes.org
AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of July 10,2013
DATE: June 26,2013
FROM: Angie Powers, Admin. Assistant Sunriver Service District 541-593-4640
TITLE OF AGENDA ITEM:
Consideration of Board Signature to the EMS Account Services Intergovernmental Agreement Between
the City of Springfield and the Sunriver Service District Fire Department renewal.
PUBLIC HEARING ON THIS DATE? No.
BACKGROUND AND POLICY IMPLICATIONS:
This intergovernmental agreement needs to be renewed. The Deschutes County Board of
Commissioners approved the Sunriver Service District's EMS Account Services IGA with the City of
Springfield, under Order No. 2007-141, on July 25, 2007. The current agreement expires on June 30,
2013, and as such is in need of renewal. The agreement renewal (with expiration date of June 30, 2015)
was signed by Fire Chief Art Hatch on June 19,2013 and by Brian Evanoff of the City of Springfield
on June 12,2013. The IGA renewal is in need of approval by the Sunriver Service District Governing
Body.
FISCAL IMPLICATIONS:
None.
RECOMMENDATION & ACTION REQUESTED:
Please sign two original copies of the Deschutes County Board of Commissioners signature approval
page.
ATTENDANCE: None.
DISTRIBUTION OF DOCUMENTS:
Please send one copy to: (or/j ina I) fThe City of Springfield
Attn: Jana Sorenson/Brian Evanoff -Springfield Fire and Life Safety
225 Fifth Street
Springfield, OR 97477
Please send one copy to: (Or J j JOn.;;) I) I
The Sunriver Service District
Attn: Angie Powers IP.O. Box 2108 f tSunriver, OR 97707
EMS ACCOUNT SERVICES INTERGOVERNMENTAL AGREEMENT
Contract #332
This Agreement is entered into by and between the City of Springfield, an Oregon municipal corporation, hereinafter
referred to as "Springfield"" and Sunriver Service District Fire Department, an Oregon municipal corporation, on
behalf of its ambulance service, hereinafter referred to as "client:
RECITALS
A. ORS 190.010 provides that units of local govemment may enter into agreements for the performance of any
and all functions and activities that any party to the agreement, its officers, or agents have authority to
perform.
B. Provision of services for the remuneration specified in this Agreement will mutually benefit the parties to it.
C. Timely and accurate billing, collection, and patient account services for ambulance services are high
priorities for both client and Springfield.
D. Client desires to enter into an Agreement with Springfield whereby Springfield will provide billing, collection,
and patient account services on behalf of client for all billable patients serviced by the clienfs Emergency
Medical Services system.
E. Springfield is willing to fumish ambulance billing, collection, and patient account services to client according
to the terms and conditions set forth herein.
AGREEMENT
NOW, THEREFORE, in consideration of the above recitals and the covenants contained herein, the parties hereby
agree as follows:
1. Springfield Services to be Provided. Springfield agrees to provide the services described in EXHIBIT A,
which is attached hereto and made a part hereof.
2. Client Responsibilities. Client agrees to perform the obligations and pay for the services performed by
Springfield in the manner and at the rate described in EXHIBIT B, which is attached hereto and made a part
hereof.
3. Contract Duration. This Agreement shall commence on July 1, 2013 and shall continue until June 30,
2015 unless modified, or terminated as provided herein.
4. Representatives. Each party shall appoint a Contract Representative to represent the party for the purpose
of giving or receiving any notices provided for in this Agreement and to perform such other functions as are
set forth in this Agreement and the Exhibits hereto. The initial Contract Representatives are named in
EXHIBIT D, which is attached hereto and made a part hereof. A party may change its Contract
Representative by notifying the other party in conformance with the provisions of paragraph 8. Client shall
appoint an Ambulance Service Representative to perform the Ambulance Service functions stated on
EXHIBIT B. The initial Ambulance Service Representative named on EXHIBIT D may be changed in the
same way that Contract Representatives are changed. One person may serve in both representative
capacities, if that person meets the qualifications to perform both functions.
5. Status. In providing services specified in this Agreement (and any associated services), both parties are
public bodies and maintain the public body status as specified in ORS 30.260. Both parties understand and
acknowledge that each retains all immunities and privileges granted them by the Oregon Tort Claims Act
(ORS 30.260 through 30.300) and any and all other statutory rights granted as a result of their status as
local public bodies.
6. Indemnification. To the extent allowed by the Oregon Constitution and the Oregon Revised Statutes, each
of the parties hereto agrees to defend, indemnify, and save the other harmless from any claims, liability or
damages including attorney fees ariSing out of any error, omission or act of negligence on the part of the
indemnifying party, its officers, agents, or employees in the performance of this agreement.
7. Assignment. Neither party shall assign this contract in whole or in part, or any right or obligation
hereunder, without the other party's written approval.
8. Notices. Any notices permitted or required by this contract shall be deemed given when personally
delivered or upon deposit in the United States mail, postage fully prepaid, certified, and return receipt
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requested, addressed to the representative designated in EXHIBIT D. Either party may change its address
by notice given to the other in accordance with this paragraph.
9. Integration. This Agreement embodies the entire agreement of the parties. There are no promises, terms,
conditions, or obligations other than those contained herein. This contract shall supersede all prior
communications, representations, or agreements, either oral or written, between the parties. This contract
shall not be amended except in writing, signed by both parties.
10. Interpretation. This Agreement shall be governed by and interpreted in accordance with the laws of the
state of Oregon.
11. Modification. This Agreement or any of its Exhibits may be modified at any time by mutual consent of
parties. No change or modification of this Agreement or any of its Exhibits shall be valid or binding upon the
parties hereto unless such a change or modification is in writing Signed by all the parties hereto.
12. Termination. Upon 180 days prior written notice delivered to the persons designated in EXHIBIT D, either
party, without cause, may terminate its participation in this Agreement.
13. Obligations upon Termination. Except for Default pursuant to paragraph 14, upon termination, Springfield
shall continue to perform all services set forth in EXHIBIT A for all ambulance incidents occurring prior to the
termination date. After termination, Springfield shall have no obligation to render further services for client
except that Springfield shall continue to forward payments received on client's accounts to client.
14. Default. In the event that client shall fail to comply with any term or condition or fulfill any obligation of this
Agreement, Springfield may terminate the Agreement upon 14 days written notice to client's Contract
Representative. Springfield shall tum over to client all receipts, books, accounts, and records in the
possession of Springfield that relate solely to billing accounts received from client. In such event, Springfield
shall have no obligation to render further services to client except that Springfield shall continue to forward
payments received on client's accounts to client. The provisions of paragraph 13 shall apply in connection
with an Agreement termination made under this provision.
15. Waiver and Breach. The waiver by either party of any breach or violation of any provision of this
Agreement shall not be deemed a waiver of such term or condition in the future.
16. Attorney Fees. In the event of any action to enforce or interpret this Agreement, the prevailing party shall
be entitled to recover from the losing party such additional sums as the court may adjudge for reasonable
attorney fees plus all costs and disbursements at trial, on any appeal, or upon review.
17. Notice of Adverse Action. Each party shall notify the other in writing, within five days of receiving any
written or oral notice of any adverse action naming or otherwise involving the other.
18. Severability. Invalidation of any term or provision herein by judgment or court order shall not affect any
other provision, which shall remain in full force and effect.
19. Force Majeur. Neither party to this Agreement shall be held responsible for delay or default caused by fire,
riot, acts of God, and/or war that are beyond that party's reasonable control. Client may terminate this
Agreement upon written notice after determining such delay or default will reasonably prevent successful
performance of the Agreement.
20. Exhibits. Each Exhibit, if any, to this Agreement is made a part of this Agreement as though set forth fully
herein. Any provision of any Exhibit that is in conflict with any provision of this Agreement shall take
precedence and supersede the conflicting provision of this Agreement.
BY THE SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE BELOW, EACH PARTY ACKNOWLEDGES THAT
HE/SHE HAS READ THIS AGREEMENT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND
CONDITIONS.
IN WITNESS WHEREOF, THE PARTIES HERETO HAVE EXECUTED THIS AGREEMENT.
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C332 -EMS Account Services Intergovernmental Agreement-SUnriver SeMce District FD Expires; June 30, 2015
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SUNRIVER SERVICE DISTRICT FIRE
DEPARTM NT: CITY OF SPRINGFIELD, OREGON:
Title t&S6 rn~
Date Date
R-'i . t
,..vrVtl-/0---·/O . (3 b
P OVED
DATED this ___ Day of _ _____2013.
BOARD OF COUNTY COMMISSIONERS OF
DESCHUTES COUNTY , OREGON, ACTING AS
THE GOVERNING BODY OF THE SUNRIVER
SERVICE DISTRICT.
ALAN UNGER, Chair
TAMMY BANEY, Vice Chair
ATTEST: ANTHONY DEB ONE, Commissioner
Recording Secretary
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EMS Account Services Intergovernmental Agreement
EXHIBIT A
Springfield Services. Springfield agrees to perform the following services:
1. Perform billing and collection services under this Agreement on behalf of and in the best interests of client
according to the policies, rates, schedules, and instructions established by client.
2. Bill patients and/or insurance companies after receipt of completed patient billing information from client.
Assist patients in the preparation of forms that are required by their insurance companies.
3. Appeal denials from non-commercial payors based upon medical necessity when documentation supports
the need for services rendered by client.
4. Refer delinquent patient accounts to a collection agency, as appropriate.
5. Accept patient payments made with a VISA, MasterCard, Discover, or American Express credit cards.
6. Allow patients to pay their bills in installments.
7. Transfer all funds collected on client accounts, whether received within the Agreement period or thereafter,
to client after the month-end posting has been completed, according to the payment disposition instructions
established by client. The transfer of funds shall consist of all monies received by Springfield on account of
ambulance services provided by client, excluding any sums overpaid by the customer or third party payer
that Springfield shall refund.
8. Springfield shall put clienfs billing data on the same computer as its own billing data and shaJi take all
reasonable precautions to protect said data. Springfield shall not be responsible for loss of client's data, or
any damages or loss to client resulting from said loss of data, if that loss of data results from circumstances
beyond Springfield's control.
9. Provide the following data on a monthly basis:
9.1. Amount billed (categorized by non-member and member)
9.2. Number of patients billed (categorized by non-member and member)
9.3. Amount collected (categorized by non-member, member, and collection recovery)
9.4. Amount of write-downs and write-offs
9.5. Refunds made for overpayments
9.6. Other adjustments
9.7. Accounts receivable balance
10. Cooperate in the development or alteration of mutually acceptable billing and coJlection policies, procedures,
practices, or forms.
11. Assist client in the formulation of ambulance rate structures and fees.
12. Assist client in the analysis and development of managed healthcare and facilities contracts.
13. Meet with client's deSignated representatives to discuss problems and performance as needed.
14. Provide mutually agreed upon training to appropriate field and administrative staff regarding the gathering of
necessary information and proper completion of run reports. Training expenses to be reimbursed by client
including: lodging, mileage, per diem, and instructor fee.
15. Provide additional services for special purposes, or for work outside the nonnal scope of this Agreement.
Client will pay an agreed upon fee for such services, as mutually agreed upon in advance of the work
performed.
16. Attend Board or Council meetings as requested. Mileage and per diem to be reimbursed by client.
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EMS Account Services Intergovernmental Agreement
EXHIBITB
Client Payments and Obligations. Client agrees to make payment and perform as follows:
1. Establish the policies, rates, schedules, and instructions for the billing of patients and the disposition of
payments received for Springfield to use when providing services. Client may modify or revoke its po~cies,
rates, schedules, and instructions, at its discretion.
1.1. Client agrees that the policies, instructions, rates, schedules, and payment disposition for
Springfield to use when providing services shall be made in good faith and shall comply with all
applicable laws, rules, and regulations.
1.2. Client shall negotiate in good faith any impact that modifications or revocations may have on
Springfield's ability to provide the services listed in EXHIBIT A or upon the price per patient billed
as listed in EXHIBIT B, paragraph 12.
1.3. Client will notify Springfield prior to adoption of any rate, schedule, or policy changes as they may
have an impact on Springfield's ability to provide the services listed in EXHIBIT A.
1.4. Client will notify Springfield of all electronic payments made directly to client by month end each
month.
1.5. Client will notify Springfield upon receipt of any other direct payments by client.
2. Provide Springfield, in a mutually acceptable format, the necessary information and proper documentation
required to prepare and reach final adjudication of patient claims, to include:
2.1. Ensuring that all ambulance service incident reports use mutually agreed upon report forms and
are completed according to the instructions of Springfield.
2.2. Obtaining appropriate patient encounter, demographic, financial, and insurance information as
required to process patient account.
2.3. Obtaining an appropriate patient or patient representative Signature for all billable patients in a
mutually acceptable form or format. Springfield shall not be held responsible for billing or
collections on accounts without aforementioned signature.
2.4. Obtaining a signed Physician Certification Statement (PCS) of Medical Necessity for non
emergency services as required. Springfield shall not be held responsible for billing or collections
on accounts without aforementioned PCS.
2.5. Providing indication of the ambulance membership status of billable patients to ensure that member
patients are billed according to their membership terms of agreement.
2.6. Forwarding reports and other billing information forms to Springfield in a timely manner.
2.7. Both parties agree that Springfield will make reasonable efforts to verify and/or obtain information
needed to process patient accounts; however, Springfield is not responsible for errors or omissions
when relying on information provided by client.
2.8. Client is responsible for maintaining all patient medical care reports per OAR 333-250-0045. Client
will make reports available to Springfield for billing purposes. Client is responsible for maintaining
all patient-related information, forms, or records (as needed) per applicable OAR's.
3. DeSignate a single person in an administrative pOSition to receive and evaluate all complaints by client's
officials and employees regarding Springfield's performance under this Agreement, and share the
information with the appropriate Springfield Representative in a timely manner.
4. Refer all citizen inquiries regarding their accounts to Springfield.
5. Cooperate to the greatest extent possible with Springfield in its efforts to perform the services described in
EXHIBITA.
6. Provide Springfield, annually, the client's current Ambulance Service License issued by the Oregon Health
Division.
7. Meet with Springfield's designated representatives to discuss problems and performance as needed.
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8. Cooperate in the development or alteration of mutually acceptable billing and collection policies, procedures,
practices, or fonns.
9. Permit Springfield to review and comment on any contract or agreement that client may enter into that could
affect ambulance fees, charges, or billing and collection practices. Negotiate in good faith any impact that
the above-mentioned contracts or agreements may have on Springfield's ability to provide the services listed
in EXHIBIT A or upon the price per patient billed as listed in EXHIBIT B. paragraph 12.
10. Obtain prior insurance authorization for non-emergency ambulance transfers, if required.
11. If desired, provide, at client's expense. a local telephone number or toll-free long distance number that will
automatically forward calls to the Springfield Account Services office.
12. Pay Springfield for services rendered according to the following schedule:
12.1. For monthly patient account services provided, the amount per patient billed on behalf of client as
follows:
Ambulance Dates of Service Per Patient Billed Amount
July 1,2013 through June 30,2015 .................................. $38.00
12.1.1. Amount due for monthly services rendered by Springfield will be invoiced monthly.
Invoices will be sent to dient as soon as possible after month-end patient statistics have
been computed and will list the number of patients billed and the amount due to
Springfield.
12.2. Pay Springfield for any additional services for special purposes, or for work outside the nonnal
scope of this Agreement. Client will pay an agreed upon fee for such services, as mutually agreed
upon in advance of the work performed.
12.3. Reimburse Springfield for training requested for appropriate field and administrative staff regarding
the gathering of necessary infonnation and proper completion of run reports. Training expenses to
be reimbursed by dient including: lodging, mileage, per diem, and instructor fee.
12.4. Reimburse Springfield for mileage and per diem, as appropriate, for attendance at client's Board or
Council meetings at the request of client.
12.5. Other than the fees and charges for services rendered as described in this Agreement. Springfield
shall have no financial interest in, nor is its compensation related to, the amounts billed andlor
collected on behalf of dient. regardless of whether amounts were actually collected.
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EMS Account Services Intergovernmental Agreement
EXHIBITC
Health Insurance Portability and Accountability Act Requirements. Springfield agrees that it will carry out its
obligations to client under this agreement in compliance with the privacy and security regulations pursuant to Public
Law 104-191 of August 21,1996, known as the Health Insurance Portability and Accountability Act of 1996, Subtitle F
-Administrative Simplification, Sections 261, et seq., as amended rHIPAN).
Springfield agrees it will protect the confidentiality, integrity, and security of any personally identifiable protected
health information ("PHI") that is collected, processed or leamed as a result of the services provided to client by
Springfield, including any such information stored and transmitted electronically, referred to as electronic protected
health information re-PHI").
1. Springfield agrees that it will:
1.1. Not use or further disclose PHI except as permitted under this Agreement or required by law;
1.2. Use appropriate safeguards to prevent use or disclosure of PHI except as permitted by this
Agreement;
1.3. To mitigate, to the extent practicable, any harmful effect that is known to Springfield of a use or
disclosure of PHI by Springfield in violation of this Agreement.
1.4. Report to client any use or disclosure of PHI not provided for by this Agreement of which
Springfield becomes aware;
1.5. Ensure that any agents or subcontractors to whom Springfield provides PHI, or who have access to
PHI, agree to the same restrictions and conditions that apply to Springfield with respect to such
PHI;
1.6. Make PHI available to client and to the individual who has a right of access as required under
HIPM within 30 days of the request by client to the individual;
1.7. Incorporate any amendments to PHI when notified to do so by client;
1.8. Provide an accounting of all uses or disclosures of PHI made by Springfield as required under the
HIPM privacy rule within 60 days;
1.9. Make its intemal practices, books and records relating to the use and disclosure of PHI available to
the Secretary of the Department of Health and Human Services for purposes of determining
Springfield's and clienfs compliance with HIPM;
1.10. At the termination of this Agreement, retum or destroy all PHI received from, or created or received
by Springfield on behalf of client. and if return is infeasible, the protections of this agreement will
extend to such PHI.
2. The specific uses and disclosures of PHI that may be made by Springfield on behalf of client include:
2.1. The preparation of invoices to patients, carriers, insurers and others responsible for payment or
reimbursement of the services provided by client to its patients;
2.2. Preparation of reminder notices and documents pertaining to collections of overdue accounts;
2.3. The submission of supporting documentation to carriers, insurers and other payers to substantiate
the health care services provided by client to its patients or to appeal denials of payment for same.
2.4. Uses required for the proper management of the Springfield as a business associate.
2.5. Other uses or disclosures of PHI as permitted by HIPM Privacy Rule.
3. Springfield agrees to assume the following obligations regarding electronic Protected Health Information (e
PHI):
3.1. Springfield agrees to implement administrative, physical and technical safeguards that reasonably
and appropriately protect the confidentiality, integrity and availability of the e-PHI that it creates,
receives, maintains or transmits on behalf of client.
3.2. Springfield will ensure that any agent, including a subcontractor, to whom it provides e-PHI that
was created, received, maintained or transmitted on behalf of client agrees to implement
reasonable and appropriate safeguards to protect the confidentiality, security, and integrity of e
PHI.
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C332 -EMS Account Services Intergovemmental Agreement -Sunriver Service District FD Expires: June 30, 2015
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3.3. Springfield agrees to alert client of any security incident (as defined by the HIPAA Security Rule)
which it becomes aware, and the steps it has taken to mitigate any potential security compromise
that may have occurred, and provide a report to client of any loss of data or other information
system compromise as a result of the incident.
4. Notwithstanding any other provisions of this Agreement. this Agreement may be terminated by client, in its
sole discretion, if client determines that Springfield has violated a term or provision of this Agreement
pertaining to client's obligations under the HIPAA privacy or security rules, or if Springfield engages in
conduct which would, if committed by client, would result in a violation of the HIPAA privacy or security rules
by client.
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EMS Account Services Intergovernmental Agreement
EXHIBIT 0
Representatives. As provided in paragraph 5, the following individuals are the designated representatives to
perfonn the functions set forth in this Agreement.
1. Springfield Contract Representative
Brian Evanoff. Administrative Services Bureau Manager
Springfield Fire and Life Safety
225 North Fifth Street
Springfield OR 97477
Phone: 541-736-1019 FAX: 541-726-2297
e-mail: bevanoff@springfield-or.gov
2. Client Contract Representative
Contact Tille
Agency
Address
Phone FAX
3. Client Ambulance Service Representative
Contact TItle
City State Zip
Phone FAX
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C332 . EMS AccOunt Selvices Intergovernmental Agreement:: Sunriver Service District FD Expires: June 30, 2015
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