1988-060-RES WHEREAS, the City Council requested to participate in between the Paris-Lamar County Lamar, Texas;
RESOLUTION NO. 88-060
WHEREAS, the City Council
requested to participate in
between the Paris-Lamar County
Lamar, Texas; and
of the City of Paris has been
an Indigent Care Agreement
Health Unit and the County of
WHEREAS, the form of agreement to provide such service
is attached hereto as Exhibit A; NOW, THEREFORE,
BE IS RESOLVED BY THE CITY COUNCIL OF THE CITY OF
PARIS, That the Indigent Care Agreement upon the terms and
conditions stated in the agreement attached hereto as
Exhibit A, between Paris-Lamar County Health Unit and the
County of Lamar is hereby approved and that the Mayor of the
City of Paris, Eric Clifford, be, and he is hereby
authorized and directed to execute on behalf of the City of
Paris the Indigent Care Agreement between Paris-Lamar County
Health Unit and the County of Lamar, Texas, in the form of
Exhibit A attached hereto.
Passed and adopted this 13th day of June, 1988.
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Er~c ~ 0 , ayor
ATTEST:
~~~)~~~~
Mattie unning am, City C er
~-:::::-:>
ttorney
Approved by the Commissioners Court of Lamar County, Texas,
by ption of the above Resolution on the It day of
, 1988, as r ted in Book :111 Page
t e Minutes of said mmis ers Court. ----
, County Judge
Tpx.q~
INDIGENT CARE AGREEMENT
THIS AGREEMENT is entered into on the 25th day
1988, by and between Paris-Lamar County Health Unit
Unit") and Lamar County, a political subdivision of the
Texas (County).
of' May,
("Health
State of
RECITALS
1. The City of Paris (City)/County of Lamar (County) owns
and operates a health facility known as Paris-Lamar County Health
Unit ("The Health Unit").
2. County desires to assure the availability to Eligible
Residents of Health Care. The Health Unit is willing to provide
at the Health Unit, Health Care to Eligible Residents upon the
terms and subject to the conditions set forth herein. It is the
intent of the County to provide by this contract for some of the
health care services that it is required to provide to Eligible
Residents under the provisions of the Indigent Health Care and
Treatment Act, article 4438f, Tex. Rev. Civ. Stat. Ann. (1985),
(the "Act").
Therefore, the parties hereto agree as follows:
Section 1
Definitions.
1.01
Health Care. The Term "Health Care" means any type of
services or products rendered or provided by a health
facility to a person on an outpatient basis, including, but
not limited to, drugs, supplies, laboratory, physician
services and other ancillary services.
Eligible Resident. The term "Eligible Resident" means
any person who (i) is classified by Lamar County as an
indigent, and (ii) is a Resident of Lamar County and does
not reside within an area that a public hospital or hospital
district has a legal obligation to serve. This definition
is adopted solely for purpose of providing Indigent Care
under this Agreement to persons eligible for such services
under the Act and does not constitute a definition of
"Eligible Resident" or "Pauper" for any other purpose.
Persons eligible for Health Care under the Medicaid,
Medicare, or any other gove~nmental program are not Eligible
Residents for the purposes of this Agreement.
Indigent Care. The term "Indigent Care" means
Health Care which under state law is the Responsibility
of Lamar County and is provided to Eligible Residents
who (i) are classified by Lamar County as indigent, and
(ii) are Residents of the County.
1.02
1.03
EXHIBIT A
1.04 Emergency Services. The term "Emergency Services"
means those health services which must be provided
immediately to sustain a person's life, to prevent
serious permanent disfigurement or loss or impairment
of the function of a bodily member or organ, or to
provide for the care of a woman in active labor.
1.05 Resident. The term "Resident" shall have the same
meaning as is set out at section 1.03 of the Act.
1.06 Working Days. The term "Working Days" means normal
working business days, i.e., Monday through Friday of each
calendar week, exclusive of county holidays.
1.07 Mandated Provider. The term "Mandated Provider" means
a provider of Health Care selected by the County that agrees
to provide Indigent Care to Eligible Residents.
1.08 AFDC. The term "AFDC" means the Aid to Families
with Dependent Children program administered by the Texas
Department of Human Services under Chapter 31, Human
Resources Code.
1.09 General Revenue Levy. The term "General Revenue
Levy" means the property taxes imposed by a county that are
not dedicated to the construction and maintenance of
farm-to-market roads or to flood control under Article VIII
Section I-a, of the Texas Constitution, or dedicated to the
further maintenance of the public roads under Article VIII
Section 9, of the Texas Constitution.
1.10 County Auditor. The term "County Auditor" means the
Lamar County Auditor, the person performing the duties of
the County Auditor as provided in article 1645, et seq, Tex.
Rev. Civ. Stat. Ann.
1.11 SSI. The term "SSI" means the Supplemental Security
Income program for the aged, blind and disabled,
administered by the Department of Health and Human Services
under 42 U.S.C.A. 1381 - 1383c (West 1983 and Supp. 1985).
1.12 Eliijibility Document. The term "Eligibility
Document shall mean the identification card, certificate,
or other document issued -by the County to an Eligible
Resident as evidence of that person's eligibility for
Indigent care.
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Section 2
Terms of Agreement.
2.01 Term. The term of this Agreement '. shall
commence on the 25th day of May, 1988, and shall
continue in full force and effect through September 30,
1988. This Agreement may be renewed for a one (1) year
term by County giving written notice at least 90 days
prior to the end of the original term to City and
Health Unit and no objection being delivered to County
on or before 60 days prior to the end of the original
term by City or Health Unit.
2.02 Termination. Either
Agreement by giving sixty
the other party.
party may terminate this
(60) days written notice to
Section 3
Mandated Provider.
The Health Unit agrees that it will be a Mandated
Provider of the County for the purposes of providing
Eligible Residents Indigent Care, that it will provide such
services in accordance with this Agreement, and that it will
comply with all requirements for such provider set out in
the Act and in this Agreement. A copy of the Act as it
currently exists is attached as Exhibit A and is incorp-
orated by reference herein solely for the convenience of the
parties and is not intended to supersede any subseq~ent
amendment to the Act. If an irreconcilable conflict ar~ses
between the Agreement and the Act, then this Agreement shall
control.
Section 4
Order.
Care to be Provided Pursuant to a Physician's
The Health Unit agrees that any services billed to
County under this Agreement will have been medically neces-
sary and provided by, or pursuant to the orders of a physi-
cian licensed by the State of Texas who has stated that the
services were medically necessary. Compliance with this
section will be certified in writing to the County with each
bill for services.
Section 5
Notice Requirements.
The Health Unit agrees to post at the Health Unit all
public notices provided by the County concerning the avail-
ability of mandatory services as required under Section 2.04
of the Act. Provided, however, that if Section 2.04 of the
ct is amended to require additional or different notice, The
Health Unit will post such additional notices as furnished
by County. The Health Unit further agrees to make reason-
able efforts to communicate the contents of the posted and
written individual notices to persons the Health Unit has
reason to believe cannot read the notice.
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Section 6 -- Services to be Provided.
6.01 Provision of Indigent Care.
The HeaLTH Unit agrees that as a Mandated Provider it
shall provide Indigent Care (Health Care) to all
Eligible Residents subject to the terms and conditions
of this Agreement and subject to the exclusions from
and the limitations on health care services listed in
the rules promulgated by the Texas Department of Human
Services (40 Tex. Admin. Code 14.201 and 14.202) as
they currently exist or may hereafter be amended.
6.02 When Services Requested Are Not Covered by this
Agreement.
If a prospective patient requests health care services
that are not covered by this Agreement and claims to be
unable to pay for the services requested, the Health
Unit shall refer the person to the proper MaNDATED
Provider, or the appropriate provider designated by the
County, unless it is medically inappropriate to do so;
any of which shall be at County expense.
Section 7 -- Procedure for Providing Services.
7.01 Non-Emergency Service. The County will make a
determination of the eligibility of prospective
patients to receive Indigent Care under this Agreement
in the case of all requests for non-emergency transfers
to Health Unit. The Health Unit shall not provide non-
emergency Indigent Care to Eligible Residents without
prior approval in writing from the County. Before
providing non-emergency Indigent Care under this
Agreement, the Health Unit shall require the prospec-
tive patient to present a valid Eligibility Document
issued to the prospective patient by the County. The
Health Unit shall not provide non-emergency Indigent
Care under this Agreement unless the prospective
patient presents a valid Eligibility Document and shall
use its best efforts, such as by requesting an addi-
tional source of identification, to verify that the
person present an Eligibility Document or for whom an
Eligibility Document is ~~sented is the person listed
on the document.
(a) Persons With Eli ibilit Documents and Count
PErova . t e prospect~ve pat~ent presents a
valid Eligibility Document and the County has
approved in writing the provision of non-emergency
care to the prospective patient, then the Health
Unit shall provide Indigent Care in accordance
with the provisions of this Agreement and may bill
the County for such services.
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(b) Persons Without Eligibility Documents and County
Approval. If a prospective patient who has not
been approved for services and does not possess an
Eligibility Document requests non-emergency
services but claims to be unable to pay, the
Health Unit shall provide that person with an
application form (which the County will provide to
the Health Unit), shall refer that person to the
County for processing of the application for
assistance, and shall not provide any services
under this Agreement.
7.02 Emergency Services.
(a) Persons with Eligibility Documents. If the
Health Unit provides emergency services to a
patient who possesses an Eligibility Document, the
Health Unit shall use its best efforts, such as by
requesting an additional source of identification,
to verify that the person presenting an Eligibil-
ity Document or for whom an Eligibility Document
is presented is the person listed on the document.
The Health Unit may bill the County for the
emergency services provided in accordance with the
provisions of this Agreement.
Section 8 -- Billing.
8.01 Presentation of Bill. By the tenth working day
after the end of each month during the term of this
Agreement, the Health Unit shall submit to the County
Treasurer of Lamar County, a bill (the "Bill") for
Indigent Care provided to Eligible Residents during
that month. The County shall not be responsible for
payment of Bills presented more than ninety (90) days
after the date of service. The Bill shall be itemized
to identify the Eligibility Document number of each
patient to whom services were provided, the type of
service provided, the date or dates when service was
provided, the Medicaid code number and rate for such
service, and such other information as the County may
from time to time request. Along with each Bill
submitted, the Health Unit shall submit a monthly
activity report reflecEtng services provided by
category on a form provided by the County.
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8.02 Approval of Bill. After review, the County
Judge shall submit his recommendations to the County
Auditor for audit, approval and presentation to the
Lamar County Commissioners Court. The Bill will be
presented at the next regularly scheduled meeting- of
the Commissioners Court after the submission of the
Bill by the County Auditor. Bills submitted shall be
approved by the County Auditor and the Commissioners
Court prior to payment. In the event that any Bills
submitted by the Health Unit to the County should
contain charges which the County believes may not be
eligible for reimbursement, the County shall pay the
portion of the Bill which is not disputed. Payment of
the approved portion of the Bill shall be made within
30 working days of the Commissioners Court meeting at
which payment is approved.
8.03 Disputed Bills. If the County determines, in
good faith, that a patient for whom the Health Unit has
billed County was not an Eligible Resident pursuant to
this Agreement or that services billed are not covered
by this Agreement, the County Judge shall notify the
Health Unit of this determination within thirty (30)
days of presentation of the Bill. - Within twenty (20)
days after the end of each calendar quarter, the City
Manager of the City of Paris, the Administrator of the
Health Unit and the County Judge shall meet to negoti-
ate the amounts in dispute. Amounts agreed upon shall
be presented and paid as provided for in this Section.
Amounts still in dispute thirty (30) days after the
first meeting between the City Manager, Administrator
of the Health Unit and the County Judge shall be
submitted to a vote of the Health Units Board which
decision shall accepted by County and final.
8.04 Disallowance of Bills. Except as provided in
Sections 7, 10 and 11 and except in cases of fraud,
misrepresentation or clerical error, the County shall
have the right to disallow payments to the Health Unit
only if the patient for whom the Health Unit submits a
bill to County is not an Eligible Resident as that term
is defined in this Agreement or if the services
provided are not covered by this Agreement.
Section 9 -- Compensation. '.
9.01
pa~ent Standard for Indi~ent Care. The County
is lia le for paying for Indigent Care Services
provided under this Agreement at 100 percent of the
rates referenced below established by the Department of
Human Services as the payment standard for mandatory
services as set forth in the regulations adopted under
the Act, 40 T.A.C. 14.203:
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(a) The standard of outpatient health care is 100
percent of the Health Unit's interim rate for
allowable services as established by the Depart-
ment of Human Services, multiplied by the. amount
billed by the Health Unit for allowable services.
(b) The payment standard for those laboratory and
x-ray services identified by the Department of
Human Services as the most commonly performed
procedures in the Medicaid Program is 100 percent
of the average Medicaid payment for the procedure.
If a procedure allowed as a mandatory service
under the Act and the regulations promulgated
thereunder is performed that the Department of
Human Services has not so identified, County will
pay 100 percent of the amount billed, if the
provider certifies in writing that the billed
amount is consistent with the amount the provider
charges all other patients for the procedures.
(c) County will reimburse for prescription drugs at an
amount equal to 100 percent of the Redbook whole-
sale price minus 12%, plus the basic dispensing
fee of $2.75 established by the Department of
Human Services.
Provided, however, if the regulations promulgated by
the Department of Human Services for payment of manda-
tory services are changed subsequently to require
additional or different payment standards, such addi-
tional or different standards shall, at the County's
option, be used as the payment standard under this
Agreement.
9.02
County as Payor of Last Resort.
the payor of last resort.
9.03 Third-Party Payors. The Health Unit shall
attempt to ascertain whether a person seeking
Indigent Care at the Health Unit is eligible for
participation in the Medicaid, Medicare. or any
other governmental program or for coverage by any
other third-party payors.
The County is
(a) If it is determined--by the Health Unit that a
patient may reasonable be eligible for such
coverage, then the Health Unit shall direct that
patient to the appropriate agency or to the County
for assistance in preparing and presenting his
application for coverage.
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(b) If a patient is later determined to be eligible
for Medicare, Medicaid, or any other governmental
program, amounts received by the Health Unit from
Medicare, Medicaid, or any other governmental
program for treatment of that patient since the
date of determination shall be returned to the
County to the extent that payments were made from
the County to the Health Unit.
9.04 Limitations on County's Liability for Payment.
(a) The County's liability for payment for Indigent
Care provided by the Health Unit is subject to the
limitations set forth in section 14.204 of the
rules promulgated under the Act, as they now exist
or may hereafter be amended, which include but are
not limited to the provision that County liability
for services is limited to
(1) payment for a total of 30 days cumulative) in
the County fiscal year for Health Unit and/or
skilled nursing facility care, or a com-
bination of both, or a maximum payment of
$30,000 for all mandatory services provided
by all providers to an eligible county-
-resident, whichever comes first;
(2) a maximum liability for all services and
payments to all providers in anyone state
fiscal year equal to ten percent (10%) of the
County's General Revenue Levy; and
(3) payment for nonphysician services to
providers who certify in writing that the
services provided were ordered by a physician
licensed by the State of Texas.
(b) In computing the amounts the Health Unit will bill
County for Indigent Care, the Health Unit may not
include the following:
(1)
any
who
not
amount for services provided
is not an Eligible Resident
covered by this Agreement;
to
for
a person
services
(3)
any amount for services with respect to which
the procedures - set forth in Sections 7-10
were not followed by the Health Unit;
any amounts for services provided by
Health Unit in a period during which
person's Eligibility Document indicates
the person is ineligible for Indigent
and
the
the
that
Care;
(2)
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(4) any amount for services provided to a person
after the County has notified the Health Unit
in writing that such person's Eligibility
Document is no longer valid. If a prospec-
tive patient presents an Eligibility Document
which the Health Unit has been notified by
the County is invalid, the Health Unit shall
request the holder of the Eligibility Docu-
ment to surrender it and shall send any such
surrendered documents to the County.
Section 10 -- Insurance.
The parties agree that the Health Unit shall be an
independent contractor as to this contract and that the
Health Unit shall purchase and maintain such professional
liability insurance as will protect it from any' claims
arising out of an incident to the services provided by or on
behalf of the Health Unit.
Section 11 -- Health Care Policy.
11.01 The Health Unit shall, at the County's option,
request an Eligible Resident receiving- Indigent Care
under this Agreement to contribute a nominal amount, as
defined by the County, toward the cost of Health Care.
However, the Health Unit may not deny or limit
assistance if the Eligible Resident is unable, or
refuses, to make a contribution. Any amount received
from an Eligible Resident shall be remitted to the
County along with the next monthly bill for services
submitted to the County.
11.02 The Health Unit agrees to make available Health
Unit services to all persons without discrimination on
the grounds of race, color, national origin, or creed.
Section 12 -- Transfer.
12.01
an
to
When Health Care is necessary for the treatment of
Eligible Resident, Health Unit may refer the patient
an appropriate Health Care facility.
12.02 Transtortation. Transportation of the patient
to the Hea th Unit shall be-a~ranged by the patient.
Section 13 -- Legal Action.
This Agreement shall not restrict in any way the Health
Unit's right to pursue any recourse it may have, including,
but not limited to, legal action, against any persons who
are not Eligible Residents for amounts owed to the Health
Unit as a result of Health Care provided.
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Section 14 -- Amendment.
This Agreement shall not be amended or modified other
than in a written agreement signed by all parties hereto. .
Section 15 -- Controlling Law.
This Agreement shall
governed by and construed
the State of Texas.
be deemed to be
in accordance with,
made under,
the laws of
Section 16 -- Notices.
All communications provided for hereunder shall be in
writing and shall be deemed to be given when delivered in
person or deposited in the United States Mail, first class,
registered or certified, return receipt requested, with
proper postage prepaid and addressed as follows:
(a) if to the Health Unit, addressed to:
Anthony Bethel, Administrator
Paris - Lamar County Health Unit
740 S.W. 6th Street
Paris, Texas 75460
(b) if to County, addressed to:
Mrs. Latricia A. Miller
County Treasurer
Second Floor
Lamar County Courthouse
Paris, Texas 75460
or to such person
time be specified
Section 20.
at such other address as may from time to
in a notice given as provided in this
Section 17 -- Captions.
The headings to the various sections of this Agreement
have been inserted for convenient reference only and shall
not modify, define, limit, or expand the express provisions
of this Agreement.
Section 18 -- Counterparts.
This Agreen:ent may be executed in counterparts, each of
which, when taken separately, shall be deemed an original.
Section 19 -- Assignability.
Neither this Agreement nor any duties or obligations
hereunder shall be assignable by the Health Unit without the
prior written consent of the County.
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Section 20 -- Obligations as Condition,
All obligations of each party under this Agreement are
conditions to further performance of the other 'party' s
continued performance of its obligation under the Agreement.
Section 21 -- Exclusive Right to Enforce this Agreement.
The County and the Health Unit have the exclusive right
to bring suit to enforce this agreement, and no other party
may bring suit, as a third-party beneficiary or otherwise,
to enforce this Agreement.
Section 22 -- Compliance with Act and Regulations.
The Health Unit agrees to comply with all requirements
of the Act and to cooperate with the County in order to
facilitate the County's compliance with such requirements.
Section 23 -- Review of Indigent Health Care Fund
Expenditure.
The Paris-Lamar County Health Board agrees to provide
review of Indigent Health Care Funds.
IN WITNESS w~REOF, the parties hereto have executed
this Agreement as of the day and year first above written.
PARIS-LAMAR COUNTY HEALTH
UNIT
By
Ann Norment, Chairman
ATTEST:
Dr. Bert Strom, Secretary
CITY OF PARIS
By
Eric Clifford, Mayor
ATTEST:
Mattie Cunningham, City Clerk
APPROVED AS TO FORM:
T. K. Haynes
City of Paris, Attorney
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