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HomeMy WebLinkAbout06-74.doc FEBRUARY 28, 2006 06- 7 4 RESOLUTION (CARRIED 7 -0 LOST LAID OVER WITHDRAWN PURPOSE: APPROVE AMBULANCE AVAILABILITY AGREEMENT I AURORA MEDICAL CENTER OF OSHKOSH, INC. INITIATED BY: OSHKOSH FIRE DEPARTMENT BE IT RESOLVED by the Common Council of the City of Oshkosh that the attached Ambulance Availability Agreement with Aurora Medical Center of Oshkosh, Inc. for ambulance service from Aurora Medical Center - Oshkosh to other facilities is hereby approved and the proper City officials are hereby authorized to execute and deliver the agreement in substantially the same form as attached hereto, any changes in the execution copy being deemed approved by their respective signatures, and said City officials are authorized and directed to take those steps necessary to implement the terms and conditions of the Agreement. Ambulance Availability Agreement This AGREEMENT is made this - day of ,2004, by and between AURORA MEDICAL CENTER OF OSHKOSH, INC., a Wisconsin nonprofit corporation, hereinafter referred to as ("AMCO") and the CITY OF OSHKOSH, a Wisconsin municipality, hereinafter referred to as ("Ambulance Service"). WHEREAS, AMCO operates Aurora Medical Center - Oshkosh, located . on Westhaven Drive in Oshkosh, Wisconsin which from time to time has patients who are in need of transportation by ambulance or specialized medical vehicles to other facilities; WHEREAS, it is in the interests of AMCO and its patients to make certain that medical transportation services are at all times available to patients in need; and WHEREAS, the City of Oshkosh operates an ambulance service which specializes in the transportation of patients with certain medical needs and conditions; and is willing to contract with AMCO to ensure that such transportation services are available to AMCO and its patients upon request by AMCO and on an around-the-clock basis under the terms of this Agreement; NOW, THEREFORE, in consideration of the mutual promises herein contained, it is agreed as follows; 1. PURPOSE. The purpose of this Agreement is to set forth the roles and responsibilities of AMCO and the Ambulance Service relating to the timely and efficient movement of patients from AMCO to other facilities when requested by AMCO. 1 .5 II. AMBULANCE SERVICE RESPONSIBILITIES. 2.1 Ambulance Service agrees to make its transportation services, as requested by AMCO, available to those patients at AMCO who are in need of such transportation. Such transport shall take patients from AMCO to the facility designated in such transport request (this Agreement does not contemplate transporting patients to AMCO and no payments under this Agreement are intended for such purpose). 2.2 Ambulances Service shall ensure that its vehicles and transportation services at all times shall meet the Wisconsin Department of Health and Family Services standards for ambulance service providers. 2.3 Ambulance Service shall maintain all licenses, certificates and approvals, whether State or otherwise, necessary to provide such transportation, and each ambulance shall in addition be equipped in accordance with the Wisconsin Department of Health standards for ambulance service providers. 2.4 Ambulance Service shall respond to all requests for patient transport with appropriate, qualified staff that meets all applicable state and federal licensure requirements. AMCO shall be responsible for providing trained nursing personnel to accompany the patient during transport where the patient's condition requires such level of care, and both parties agree to be available in a reasonable time frame. 2.5 Ambulance Service represents that neither it nor any person providing services to or employed by Ambulance Service has been or shall at any time be suspended or excluded from participation in any state or federally funded health care program. Ambulance Service further agrees to perform any criminal background checks, as required by law, of all Ambulance Service employees who will have any patient contact to ensure that no such employee has been convicted of any serious crime. 2 .5 Ambulance Service shall make the results of such background checks available to AMCO upon request. 2.6 Ambulance Service agrees that it will respond to requests for ambulance services meeting a response time of sixty (60) minutes or less after receipt of a request ninety percent (90%) of the time and shall arrive on time for prescheduled transports not less than ninety percent (90%) of the time. 2.7 The Ambulance Service shall bill each patient's third party payor(s), whenever appropriate, for all services provided to such patient related to a transport under this Agreement from AMCO to the designated facility. In recognition of AMCO's charitable care policy and mission, Ambulance Service agrees not to bill any patient transported at the request of AMCO, where his or her third party payor(s), including but not limited to Medicare, Medicaid and private insurers, deny payment for a transport provided under this agreement on medical necessity grounds, including transports which exceed any distance limitation, however, Ambulance Service is permitted to bill such patients for the same amount as would have been owed to Ambulance Service for co- payment(s) and/or deductible(s) which would have been owed to Ambulance Service had the transport been covered by such third party payor(s). Ambulance Service also agrees to recognize AMCO's charity care policy with respect to transport services provided at the request of AMCO to those patients who do not have any insurance and to bill such patients at an amount appropriate with respect to his or her demonstrated financial need and not to bill an individual without insurance more than the co-payment and deductible, amounts which would have been chargeable to such individual had such individual been covered by Medicare. 3 .5 2.8 Ambulance Service shall conduct quality improvement activities quarterly and report results relevant to AMCO. III. AMCO RESPONSIBILITIES. 3.1 AMCO shall have any patient for whom a pre-scheduled appointment for transportation has been made under this Agreement prepared and ready at the time specified in AMCO's request. This shall include having all necessary documents and forms to be transferred with the patient ready at the specified time of pick up. AMCO will make such request to Ambulance Service as early as feasible in order to help ensure availability. 3.2 AMCO shall assist Ambulance Service in securing billing and insurance information from, or on behalf, ofthe patient(s) to be transported under the terms ofthis Agreement. This includes assisting in obtaining any required or necessary documentation, such as, diagnosis and medical necessity formes) signed by the treating physician (or designee) and the name of the designated AMCO employee responsible to authorize such transportation. 3.4 AMCO shall, when appropriate, effect patient transfer pursuant to AMCO policy and procedure, "Medical Screening and Transfer of Patients To Another Facility" and "Transfer of Patient From ED To Another Facility." Copies ofthese policies and procedures shall be provided to the Ambulance Service by AMCO, as will any subsequent changes in said poJicy and procedure. 3.5 AMCO agrees that all complaints or unusual incidents involving personnel or service of Ambulance Service will be promptly reported to the management personnel of Ambulance Service, and will be described in an incident report detailing the 4 .5 circumstances surrounding the complaint or incident, including the persons or entities involved, date and time of events at issue, and description of events at issue. IV. COMPENSATION AND BILLING 4.1 AMCO shall pay to Ambulance Service a flat fee, on a monthly basis, in the amount of Nine Hundred Dollars ($900.00) per month, to ensure the on-call availability of Ambulance Service and for all services provided to AMCO under this Agreement at the request of AMCO. Under no circumstances shall AMCO be liable to Ambulance Service for any billed amounts for transportation or other services which Ambulance Service is not able to obtain from either the patient or his or her third party payor(s). 4.2 The monthly flat fee shall be payable in arrears on or before the tenth day of a calendar month. 4.3. The flat fee shall be reviewed on an annual basis and adjusted to a fair market value as mutually agreed to by AMCO and Ambulance Service. V. TERM AND TERMINATION. 5.1 Term. This Agreement shall be effective for a term of one year from September 1,2004 through August 31, 2005 and shall be renewed automatically for successive one-year terms unless terminated as hereinafter provided. 5.2 Termination. This Agreement may be terminated by either party upon sixty (60) days prior written notice to the other party given at any time for any or no reason. Notice shall be given to AMCO, at Aurora Health Care, Inc. 3000 West Montana Milwaukee, WI 53215 Attn: Executive Vice President/CFO 5 .5 with copy to: Aurora Medical Center Oshkosh 855 North Westhaven Drive Oshkosh, WI 54904 Attn: Finance and to Ambulance Service, at City of Oshkosh 215 Church Avenue Oshkosh, WI 54903 Attn: VI. CONFIDENTIALITY. Each party agrees to maintain information received in compliance with the Health Insurance Portability and Accountability Act (HIP AA) of 1996. Ambulance Service does employ a designated Privacy Officer for this purpose. VII. ACCESS TO RECORDS. 7.1 To the extent required by law, Ambulance Service agrees to provide, upon written request in accordance with applicable state and federal law, reasonable access to its books and records to the extent necessary for duly authorized representatives of the Comptroller General ofthe United States, the Secretary of the United States Department of Health and Human Services, or the Wisconsin Department of Health and Family Services to evaluate the nature and extent of costs of Medicare and Medicaid reimbursable services provided under this Agreement. Such access shall be allowed for a period of five (5) years after such Medicare and Medicaid reimbursable services are furnished. 7.2 If Medicare or Medicaid reimbursable services provided by Ambulance Service under this Agreement are carried out by means of a subcontract with any 6 .5 organization "related to" Ambulance Service as defined in 42 C.F.R. § 420.301, and such related organization provides services the cost or value of which is Ten Thousand Dollars ($10,000.00) or more over a twelve (12) month period, then Ambulance Service and the related organization will, until the expiration of five (5) years after the furnishing of Medicare or Medicaid reimbursable services pursuant to said subcontract, upon proper request, allow the Comptroller General of the United States, the Secretary of Health and Human Services, the Secretary of the Wisconsin Department of Health and Family Services, and their duly authorized representatives, access to the subcontract and to the related organization's books, documents and records as necessary to certify the nature and extent of costs of Medicare or Medicaid reimbursable services provided under the subcontract. IN WITNESS WHEREOF, the following signatures of the parties by their duly authorized representatives. AURORA MEDICAL CENTER OF OSHKOSH, INc. By: Its: CITY OF OSHKOSH By: Its: 7 .5