HomeMy WebLinkAboutReso 1989-15213 RESOLUTION NO. 15213
RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CHULA
VISTA APPROVING A PREFERRED PROVIDER AGREEMENT BETWEEN
THE CITY OF CHULA VISTA AND COMMUNITY HOSPITAL OF CHULA
VISTA, AND AUTHORIZING THE MAYOR TO EXECUTE SAID
AGREEMENT
The City Council of the City of Chula Vista does hereby
resolve as follows:
NOW, THEREFORE, BE IT RESOLVED by the City Council of
the City of Chula Vista that that certain Preferred Provider
Agreement between THE CITY OF CHULA VISTA, a municipal
corporation, and COMMUNITY HOSPITAL OF CHULA VISTA, dated
the 1 day of August , 1989 , a copy of which is
attached hereto and incorporated herein, the same as though fully
set forth herein be, and the same is hereby approved. ~
BE IT FURTHER RESOLVED that the Mayor of the City of
Chula Vista be, and he is hereby authorized and directed to
execute said agreement for and on behalf of the City of Chula
Vista. ~
Presented by Approved as to form by
6003a
ADOPTED AND APPROVED BY THE CITY COUNCIL OF THE CITY OF
CHULA VISTA, CALIFORNIA, this 1 day of AuBust
19 89 , by the following vote, to-wit:
AYES: Councilmen: Malcolm, Moore, McCandliss
NAYES: Coundlmen: None
ABSTAIN: Councilmen: None
AE~NT: Cou~ci~'Den: cox, Nader
STATE OF CALIFORNIA
COUNTY OF SAN DIEGO } ss.
CITY OF CHULA ~STA )
I, JENNIE M. FULASZ, CMC, CITY CLERK of the City of Chulo Vista, California,
DO HEREBY CERTIFY that the above and foregoing is o full, true and correct copy of
RESOLUTION N0.
1521~ ,and that the some has not been amended or repealed.
DATED
city 'Cle,k
CC-660- ~P'l' R-1521,,F
PREFERRED PROVIDER AGREEMENT
THIS PREFERRED PROVIDER AGREEMENT is by and between CITY OF CHULA VISTA
1.1 "Benefit Agreement" means the written or verbal contract entered into between
the City and Its Covered Participants that establishes Cjty's obljlntjon to its Covered Pardci his
for payment for indemnity plan (non-HMO) medical, hospital, and other health care benei i~.
1.2. "Covered Participant" means any per,on who is covered under City's Benefit
Agreement.
'i~ II. HOSPITAL PERFORMANCE PROVISIONS
2.1 Hospital shell provide those serviG'u that h cnstomarlly and nsuaily provides to
~' the pubrio. Hospital airnee (I) to not difrsrentJsta or dlscrlmlnata in the scceu to, treatment of,
!.
or quality of services delivered to Covered Participants on the basis of rare, color, national origin,
' ~;~ sex, lie, rilllion, ancestry, mlrjtal status, laxnil orientation, place of residence, health status, or
source or payment and (2) to render health serv tee to all Covered Participants In the same
. ~. manner, in accordance with the same Itandards and within the same time availability as offered
~ its other patients.
~0 2.2 Exhibit"B", which is the payment provision, shall Indicate whnt lopeSlant
outpatient, emergency tare Ind ph~.'~;;Jlu services, if a y, t~s to be included in the reins o~
;: nv
.~I Exhibit "B", Except ns sfl*irmstively stated in Exhibit "B", Hospital shall not be responsible fo~
nssurinl that Covered Participants will be ibis to obtain physician set ices, Inctudlnl hospital*
besed physician service. The Hospital all*Irma that the dis;ounted retel for Mrvic~ In ;ahibit
· B* ere Thirty-Five Percent (3~%) less thin Ill usual, ress~nsble, customary publishe~: retail ratca
availshie to the general publie for lapaSides servicss; Twenty-Five Percent (2J%) for emergency
room/uutpatjent Mrvicee,
2.3 Teaire percent (129~) of ,tell chlrjol will be dlbltod slainst the Cit of Cllule
Visa Service Account as defined in the Acquisition Alreemwnt IMtwaen the City of C~ula Vista,
Community Hospital of Chula Vista and the California Health Facilities FlnancinI Authority ~ltad
May J, 1989.
2.4 Hospital hereby represents and warrants that it is currenal , lad for the duration
el* thls Agreement Ihell remain: (I) licensed tl I leasial acute cure hospital in accordance with
· ~;ato licensing provisions; (2) accredited by 3CAn, It ar~ (3) certified u I Medicire and Medlcald
p~udd~r.
III. CITY PERFORMANCE PROVISIONS
3.1 City hall provide Hospital with the complete Benefit Agreement and a summary
statement Ol* the Danefit Agreement. City shall provide Hospital with any and all amendm.unt3,
modjfjcatjonl, and revisions to the Benefit Agreement that materially affect this Agreement prior
In the date such amendments, modifications, and revisions become effective.
3.2 City shall supply Covered P~tlclpants with nn Identlfl~tlou card or other ~
of indicting ~ve~lo under the beerat Agreement. City shall aL~ supply with the ~d Of othff
mth~ a phone humor where ell lbllity and ~ve~ge qu~tio~ will h IMweted. !l~plml
rake a remnable effo~ to ~nr~Jm that the individual prosenaSal u Jdend~t~n ~rd b in
fat ~e individ~-wh~nmrap~ln' the identification ~re.'
IV. SERVICE LOCATION
4.1 H~pI~ 0~1 provide health ~re sefflc~ to Covered ~l~n~ within th~
f~llltJ, llst~ h ~xhlblt 'A". H~pl~ IhilJ notary City of lay chani, ~ Exhibit "A' pr~r
their effusive ~.
V. PAYMENT
" ~.! H~plUI s~ll a~pt the amoun~ s~lfied In Exhibit ?, w~h b a~h~ berate
and lnco~m~ heroin. n full ~yment for all health ~re Hff~ mvid~ ~ Cove~
h~cl~n~ In I~rdao~ with the Benefit Alr~ment, except when Hospl~ my bill and
Ju us~ c~rl~ for the p~vbjon of noncovered and not medj~lly n~ Mff~
C~rdlnttlon Of Neefit ~ymen=.
J.2 If a Co~r~ h~lclptnt requesu toryIces from H~ I~ ~t a, not ~
not mediCI n~ under the Deserts Aircement, HOSpI~ ~ entltl~ m enter Jam
alr~ment w~ the Cove~d hrtlclpant to such servlcfi at the H~pI~'s ~en
provide
charges and at the Cover~ hrtjclpant's. not ~e health pins's, exHm.
H~plml m~t a~ept miSsmeat of hnefiu u a ~ndltlon p~ent m CIW's
pa~ont. H~pI~I may u~ I~ cus:oma~ nellsmear form. !r n Covered h~lcl~nt ~fgm
reign a hnefjt claim u~n the H~pl~t's request and Hc:~ml ~ remus ~ hl~vl ~o
h,lcl~nt will not honor the bill, H~pI~ may collect the amounu othe~ d~ f~m Ci~ f~m
the Covered hrtlcJ~nt at the time of servJ~. H~pJUi may a~ cofigt mcon~ for ~ preyblue
of non~vored and not medically n~esmy NffJces at the time of
J.4 Althoulh CI~ ,~Ins the rllht to review aft claim (~oludlnl hNtlen~
ouStlent, emoqency, or othe~jM) on t pre-tdmisdon, concurrent and ,tr~tivo ~b
doermine whether serCJcu re:dared were covered by Iho Benefit Airesmona, Jncludln
rstr~tlve review of whether the ~1co~ were medically nocem~, CI~ aGknowl~lu
aircos that utlllntlon, low and quality alumace determlnttlo~ t~t Hff~ ,ndo~ we~ not
covered or medically ne~sse~ ndor the Benefit Agreement shall not II~t H~pI~'I rJlht
aymont In full union prior to Hospl~l's rendition of such ,rvlcse I) H~pl~ had ~n
~now such nrvJc~ were not co trod or medically necesse~ under the ~noflt Aircement, or
H~pI~ wn nelltied this such sefflcfi ore not covered or medlctll nKmy under the bneflt
Agreement. In no event shall there h a rottencalve denlit of clalml ~or {1 emeqonclse u defin~
~y the Bcoerlt Airsernest or (tl) servl.es rendered for app~ved admln~o~ ~ ~onlt~ of stay.
tl~;l~l t~nowledgos and &~cc~ that Hospital shall not h pild for Jnptt~on~ ~rv~os furnbh~
~t i Pttient's approvod le,gt[. ~. lt~7 or approved extension thereof. Nothinl In this Aimmona
~Jntended to, nor shall ~ construe.. to alter or otherwise restrict II~pittl's rlihl to conduct
own utiljntlon review for I~ own pur~sfi.
VI. BILLINGS
6.1 Hospital shall submit all bills on its customary billing form and use Its customary
h
billing procedures. Btlllnls s all include Identifying patient information, diagnosis, and itemized
records of services end charges even though the only emount due to Hospital by City IS the
payment let forth in this Aircement.
6.2 On a monthly or periodic bale, Hospital will prepare batch billings of all claim
for City Plan Participants; apply the appropriate discounts lad billing/review documentation and
submit to John Hancock for payments. Hospital shill submit its bilh no later than thirty (30) cla)l
· flat the service is rendered or the discharge of the Covered Participants, whichever is later. In
the event Hospital' is'unlble'to'lUbmit bills 'withlt~' the time'specified' ]~ein ~4,:ause of .-*
clrc~mstanee~ beyond its control, the time for submillion of such bill shall bo extended
reasonably necemry from the date such bills would he required to be submitted in the Ib'Jencm
of Inch circusstances.
' 6.3 In the event Clt t, · secondary payor under the !~eneflt Agreement, CItY'I
liability established b the ratel o~thil Aircement shall be reduced In accordance with the
A rowmeat, It shall ~ the raspeosibllity of the Hospital to attempt to collect payment from the
'r~m payor, foliosial the Hospital's customary collection procedure with rapact theram and
~ln~asZree to bill the Hospitol'l then usual char el to the prlmlry payor without being timlaud in
inch collection by the Illtel airled to under t~ Aircement. On the other hand, tf City
prime payor and that1 I, I secondary payor, the Hospital may attempt to collect its usual charles
from ~e secondary payor without beinl limited In such collection by the ratel agreed to under
this Aircement.
6.4 WIthin fifteen (IS) dlys of Clty's receipt of Hospital's corn acted, fully
dcoumonted bill and Ivldence of assignment, Cty I ell pay (or cause to be pa~) or advise
i h
t~'ospital of the reason of n. onpayment of the amount due,
.VII, INDEPENDENT RELA'Y*I~N.S~tP
?.1 NO provision of thll Aircement Is Intended to create nor shall be deemed or
construed to create any relationship between City atad !'!o~pjtnl Other than that of independent
antitint cofitrlctinl with each other hereunder Iolely i'or the purpose of effectinl the provisions
of thil Agreement, Neither of the parties hareto, nor any,of their respective erapie eel, shah he
construed to be the Joint yenCaret, partner, Blast, employee, or representall e of t~e other,
V
Vlll. INS!'ZCTJON Or RECORD~
II.I Hnspltal shell maintain with respect to eech Covered Participant rocelvln hnslth
~aro I hospital medical rece?d In such form, contalnlnl such Information, and pre¶erved ~or su~h
time period(l) u are te~tulrod by the ruler end regulations of Ihe California EMpertment of Heelth,
the fedsad Mcdloare Progr.,,n, and the Joint Commission on Accraditatlon of Hospitals.
8.2 It b understood that the medical records referted to In Section I.! above shell be
and remain the property of Hospital end shall not be removed or transferred from Hospital except
in accordance with applicable California and Federal law and regulationq ~romulpted thereto and
!#.ospiwal rt~l~s and ~.,~gtJl~tlons, In accordance with procedures r~lf~ L~y law, Hospital ihell
parsilt City to In-1~.,ec~ ~.u~ re^ks copies of said records, and shall provide co tel of such recordl
to City upon request, Re,on;able costs incurred by Hospital u · result of suc~ record duplication
shell he dablied to the City of Chain Vilt,~ Ser,~lcw Account.
City or ItS dellafitted represet~tatlve shall havf the right to investlists and audit
whether Itospltal*s bill iccurs,ely refiectl the toryices actually provided, Hospital shall ccoportte
with this audit by maklnl ·vailable Ill necessary filel sad records pertinent to the particular bill(s)
beJnl audited M may be reasonably requested. Any such audit or investigation shall be carried
Out without requlrinl Hospital to reveal any physician-patient confidential information not
otherwise subject to discinsure pursuant to law or the Covered Plrtlclpent'l consent,
IX. PROMOTION AND LISTING OF HOSPITAL
Financial Incentlverfor-Coverad Partlclpunta' to use' HosplUd'under this A~reemnnt b~ ~U
communications from City to iU Covered Participants relurdjnl the Dentfit Alreement.
9.2 Notbin In this A reameat shell prohibit liespiral from appealInS to Covered
Plrtielplnt thf~nlh lnd~' iduld solicitation or lonetel public advertblnl to use Hospital rather thin
other proriders al Ion M City approves the iollcltitlon or edvortblol and any I pljcahle
overnmental approval Ib obtained. To this end, City will off or remnnblo cooperlt~n (c I
~overad Participant millnl Ibtl). ' '*
X. TERM OF AGREEMENT
I0.1 The term of the Alreement shall !~ for one (I) year commenclnl on Aulust I,
1989. This Aircement shall automatically ranaw on I ynr-to-yaar bob, thereafter, unless either
party, with or without cause, lives at lent ninety (~0) days* written notJ~ prior to ~e expiation
or the current tor~ ~a CIty and the H~pjtal airme to meet at lout 120 da~ prior to ~n~ct
urinal rane~l date to fie oilate the term and condjtlo~ of the contact for the foliowJnl
year, AII b~b for neJo~at[n future hospial ~tel and dl~oun~, ~th ~rtlo aim ~
publbhed ratel or area h~pla~l ullnl the rollowtnl key IndJcator~
~m key Indicttuff or ~xHna for Inputlent ~, will Include:
· Hospital ~lly bfflce Rtt~ for Semi Private R~m
o Critical Cart Daily Rata
o O~rstinl R~m * bt Hour ~aJor
~O lndiclton for outpatient ~ro will ~:
o ~ett
o Duelfoe Cherlo for Emerlency R~m Yblt
o Endo~op
o Cardi~ ~t, erlntlon
o Upper O.l. briol
Other oconoml~ or health ~ Jndlcato~ may ~ ipplled u timid u~n by City and
f~m time to time,
10,2 Either party Ihall have the rJlht to terminate thb Alraomont u~n p~vldlnl thl~
(~0) dl riot w~itton notice to the other party ff the ptrl~ ~ * l-~om Inch notl~ b ivan
mtlrJl~ Ernohn toy preytilth or this Altotruant. The p~ ol,2~lnl the rJlht to
rmquJrtd hereby t e ~ Jun. JlrlyJnl iU claim that the other plrty Jl In brotoh of this AIr~meut,
h t~ o
Rmmmd~ of loeb brnch ~jthln twenty (20) days or th receipt or luGh notice ihall ~vi~ thl
Alrmemlnt In trrect for the remalnfnl term ~bJect to in~ other rlahu or tlrmination ~nt~n~
in thll Plralraph or In any other preylain. -~ this Alreement.
10.3 AI or the ~ate er termination or this Aareement, this Aidemoot Ihall
considered or no further force or effect whatsoever and each of the parties Ihall h relieved and
d~chlrlmd therefrom, except that
A. Termination shall have no effect uHn the rlahu and obllSatlonl of t~
pldlel Irlalnl out or any transactions ~currlnS prior to the effective date or such teml~on,
!!. Hospital and City shall remain liable for any obligations or liabilities erblnl
from ectlvltiel cerried on by such party or its cleats, servants. or employees durlnl tl~e period
this^lreemauts,,llhavebee·ina,rect.
....... Cr----ln-throvent-tCovered hrtlcipa·t Is an admitted lapsfleet of'Hospital u .;
of the data of termination of this Aircement, Hospital reimbursement for services rendered durl·l
the period the Covered Participants remains as an admitted Inpatlent of Hospital will c·ntlnuo to
be lover·ca by the applicable term or this Airesmeet. I!·tpltal shell be compensated in
accordance with this Aircement for all health care services rendered by Hospital Io an Covered
!~urticlpant on Iha date of termination of this Agreement and until such time as appropriate
transfer or dischails (or other medically acceptable disposition) of Covered Participant recelvl·l
Jnpatlent services on the date of termination IS completed.
XI. NOTICES
I J.J Any notice required to be liven pursuant to the terms and provisions hereof.
unlell otlterwlse Indicated heroin, ihlll be In wrJtJnl lad shall be sent by certified mall, telurn
receipt re uuntad, postsis prepaid, to the eddielees listed below. Notlcol shall be deemed received
upon recktipS by the addrun~ee.
XII. ~
XII. MODIFICATIONS
IZ, I It Is the ixprell Intention of CIt I·d Hospital that the taros of this lotally
exhibits or Ittachments Ihall comprlre the entire
!ntelretad wrltlnl (the aircement andhall not be lubJsct Io resclss/on, modification, or waiver
Alraemont between the pestles and Jt s all
except u defined in 0, lubtotluent written instrument executed by beth portleg hereto. In
furtherance or this Airearnest. City and Holpi~;~l r~3~,t~i; covenant and request of any reviewgel
tribunal that any claim of runciJslon, modification, or waiver predicated upon any evidence other
than · lubsequent written instrument executed by Ihe parties hornto shell be telaided u void,
XIII. ASSIGNABILITY
13.1 Neither this Aircement nor lny rllht hereunder shall be unsllned, treestarred, or
otherwise conveyed by either part}* without the prior writIon acceptance of the other.
XIV. PARTICIPATION IN ALTERNATIVE HEALTH CARE PROGRAMS
14.1 Nothlnl contained Jn this Agreement shall prevent Hospital from partlclpatln
of contrectJnl with in Insurer, profe.~d preygait Orla·JzltJon, hollth majftanl~ce orllnlse~lo·,
or otherwise entertel Unto contreetl reilt~linl hollth clrl deliver, wi~ ,any other entity. Durin
the term of this Aulreement, howl If, City Ilreun that with Ihe sAcoption of centseta slln~
,~ v v
before Aultlst J. I~, CIt will not contract with Iny hol ltal rovlder of health cite servlcM
that IS physically located ~'~thin the leographic Irel dsrl.e~Pby ]~hlbjt 'C". itsached hereto end
Jncor riled heroin, Jr, durinl the term ~,t this Aircement or any extension thereof, the
Hosp tfmal'l service arel Is expanded, HbtpJtwl :~, a~l have a rJlht of tint rol'usal to be the exeloslvl
prorider of covered services and benefits to p~stisnts within the expanded service area on fermi
no less favorable to City the.". Ire available from other providorl of covered services and bonefie,
If, prior to the expiation of the Nolpltal'l lorries Irel, however City hu executed contracts with
one or more provides of covered services and benefits within the ax ended service area, Hoe Ital
shall have the right to contract with lad to provide covered service and benefits to
within luch Ires on a nonexclusive buts under fermi no luns favorable to Hospital Ihln to thl
other hospital.
XV. INVALIDITY OR UNENFORCEABILITY
I~.j - ~0 ~lnnlldlty or unenForceablllty of a~y terms or ~v~loM he~f
~y a ~t ~e nljd ty or ~nforceablllty of any other term of prov~lon.
XVI. THIRD PARTY BENEFICIARIES
1~.! H~pI~ ~d OIly al~ t~t ~ve.d ~l~l~u ~ whom h.lt~
pmvld~ by H~plml ~d for which H~pI~I Is ~om~nted he.~ndot s~! not
~neflc~l~ of ~,e tlSh~ and oblllatlo~ ~um~ by elthe~ ~tt~ herato.
XVII. BUSINESS INTERRUPTION
I?.1 In t~s event the o~atlo~ of sither ~y*s f~llltl~ ot any subs~n~ ~on '
t~esof m in~uptsd bF ~, flte, i~utt~tlon, ~f troubles, riot, ~e e~men~,
sn of G~, ot, wigout limitinS the fo~ olnll~ any olhet ~a~ ~nd
pmv~n of th~ Agfssmsnl l~t ~ tsndet~ f~npable of ~tfotmn~ s~l ~
XVIII WAIVER
~ve the tlShl to ~rmlna~ ~h~ ASrsement u~n twsntF (20) ~* wrlt~n hotly.
is,l ~e IOr0m~ toleration by either pt~y of def~tJ~ ~omn~ of
provision of Ihb A roemeat shell not ~ ~nstrued ~ a ~;vdf Of oilher tho i
the express conditions which hays ~en trotted in thb AiresmeaL r $ht to ~ormance
XlX. COUNTERPARTS
19,1 ~b Aimsmona may ~ oxeeutod In ~unto~n, ~h of whlgh
d~m~ ~ ~ n otliln~, but ~1 of whlsh loisthor sh~l ~oM~tum ono ud ~o ~o timmeaL
THIS AGREEMENT SHALL BE EFFECTIVE FOR HEALTH CARE SERVICES RENDERED ON OR AFTER AUGUST 1, 1989
COMMUNITY HOSPITAL OF
CHULA VISTA
EXHIBIT "A"
SERVICE LOCATION
l.,ocetion: 751 Medici1 Center Court
Chuls VIsta, CaliFornia 92010
.. MsJllnl Address: Post Office Box 1297
~" Chuls Vista, C,itCornla 92012
EXHIBIT "B"
PAYMENT AND RATE SCHEDULES .~'
For ~e ~ri~ no~ ,~--, H~AL ~M hi it ',~ .~pi d~un~ ~ n pa~ent In
. ....
CITY OF CHUI.A VISTA HTAI, " - " "'
'fide: l~aYo~T ot~the CIty of Cbula Vista
Date of .qipatxtrg 08/0~I89 : : ,.
..... ,.
EXHIBIT "C"
· SERVICES INVENTORY
II ....... Rcpofl Pcrto~ End ............ '
He thC~lmdfutloa ,.Co_,m~u.p,.tCy Ho.a,p,i,tal of Chula .Vista Juner-1989--
~'*i !~! EXHIBIT "D" ~..
SERVICES EXCLUDED FROM CONTRACT ,.
All Physician Professional Fees