Item C58
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BOARD OF COUNTY COMl\1ISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: September 19 & 20.2001
Division: Administrative Services
Bulk Item: Yes ~ No
Department: Group Insurance
AGENDA ITEM WORDING: Approval to renew contract with the' KEYS PHYSICIAN
HOSPITAL ALLIANCE (KPHA) for the employer-provider network and utilization review and
case manaeement services for the county's employee benefit plan effective 10/0112001 throueh
09/30/2002.
ITEM BACKGROUND: This is the third and final renewal of the contract which expires
September 30. 2001. The County continues to review the Group Benefits Proeram and currently
are out for RFP.
PREVIOUS REVELANT BOCC ACTION: Approved throueh RFP in 1999. First contract
vear (1999-2000) was approved at the BOCC meetine of 09/08/99: second year (2000-2001)
approved at the 09/20/2000 BOCC meetine.
CONTRACT/AGREEMENT CHANGES: Renew contract for FY 2001-2002 with no chanee in
the contract terms.
STAFF ~COMMENDATIONS: Approval
TOT ALCOST: $23.500.00
BUDGETED: Yes -X.. No
COST TO COUNTY: $23.500.00
REVENUE PRODUCING: Yes
No-X AMOUNTPERMONTH_ Year
APPROVED BY: County Atty _ OMB/Purchasing _ Risk Management_
DIVISION DIRECTOR APPROVAL: j?- ~ J~~ .
James L. Roberts
DOCUMENTATION:
Included '\...
To Follow_
Not Required_
DISPOSITION:
AGENDAITEM#~'
Revised 2/27/01
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MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract #
Contract with: Keys Physician-Hospital Effective Date: 10/0112001
Alliance
Expiration Date:09/3012001
Contract Purpose/Description:Third year renewal for the employer-provider network and
utilization review and case management for the county's employee benefit plan.
Contract Manager: Sheila A. Barker
(Name)
4462
(Ext. )
Management Services
(Department)
for BOCC meeting on September 19 &20. Agenda Deadline: September 5. 2001
2001
CONTRACT COSTS
Total Dollar Value of Contract: $23.500.00 Current Year Portion: $
Budgeted? Yes[g] No 0 Account Codes: 502-08002-530310-_
Grant: $ -_-_
County Match: $ -_-_
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ADDITIONAL COSTS
Estimated Ongoing Costs: $_/yr For:
(Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.)
CONTRACT REVIEW
Date Out
Date In
Division Director
'1- i.-"I
Risk Management
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RENEWAL AGREEMENT
This renewal agreement is entered into by and between Board of County Commissioners of
Monroe County, Florida; 5100 College Road, Room 215; Key West, Florida 33040 (hereafter Employer)
and the Keys Physician-Hospital Alliance; P.O. Box 9107; Key West, Florida 33040 (hereafter KPHA).
WHEREAS, on October 1,2000, the Employer and KPHA entered into an agreement (hereafter
the original agreement) whereby the KPHA performs Utilization Review and Case Management Services
and provides an Employer-Provider Network for the Employer's employee welfare benefit plan; and
WHEREAS, the current contract will expire on September 30,2001 and the Employer desires to
extend the original agreement for another year, therefore, the parties agree as follows:
(1) The KPHA fee will remain the same for the year: Utilization Review fees will continue at
$1.35 per employee, per month; and Case Management fees will continue at $55.00 per
hour on an as needed basis.
(2) The Participating Provider Compensation clause will be amended so that all claims for
covered services, whether payable by the Employer or a Covered Person will receive a
discount between 5% and 25%. The discount rate and applicable period will be
determined through joint agreement of the KPHA and the County Administrator or his
designee and communicated jointly to Acordia National for implementation.
(3) In all other respects the terms and conditions of the original agreement remain in full force
and effect.
(4) This third one-year renewal term will commence immediately upon the expiration of the
current contract. Therefore this renewal will become effective October 1, 2001, and will
expire September 30, 2002.
IN WITNESS WHEREOF, the parties hereto have executed this Renewal Agreement this
, 2001.
day of
ATTEST: DANNY L. KOLHAGE, CLERK
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By
By
Mayor/Chairman
Deputy Clerk
WITNESS:
KEYS PHYSICIAN-HOSPITAL ALLIANCE
STEPHEN KRA THEN, DO
By
By
Witness
President
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RENEWAL AGREEMENT
This renewal agreement is entered into by and between Board of County Commissioners of Monroe
County, Florida; 5100 College Road, Room 215; Key West, Florida 33040 (hereafter Employer) and the
Keys Physician-Hospital AllianGe; P.O. Box 9107; Key West, Florida 33040 (hereafter KPHA).
WHEREAS, on October 1, 1999, the Employer and KPHA entered into an agreement (hereafter
the original agree~ent) whereby the KPHA performs Utilization Review and Case Management Services
and provides an Employer-Provider Network for the Employer's employee welfare benefit plan; and
WHEREAS, the current contract will expire on September 30, 2000 and the Employer desires to
extend the original agreement for another year, therefore, the parties agree as follows:
(1) The KPHA fee will remain the same for the year: Utilization Review fees will continue at
$1.35 per employee, per month; and Case Management fees will continue at $55.00 per
hour on an as needed basis.
(2) The Participating Provider Compensation clause will be amended so that all claims for
covered services, whether payable by the Employer or a Covered Person will receive a
discount between 5% and 25%. The discount rate and applicable period will be determined
through joint agreement of the KPHA and the County Administrator or his designee and
communicated jointly to Acordia National for implementation.
(3) In all other respects the terms and conditions of the original agreement remain in full force
and effect.
(4) This first one-year renewal term will commence immediately upon the expiration of. .the
current contract. Therefore this renewal will become effective October 1, 2000, and will
of
By.
BOARD OF COUNTY COMMISSIONERS
OFM~rR~ECOUNT~LORIDA
B~Jv...:lt f/J/U~
~OrlChairman
WITNESS:
KEYS PHYSICIAN-HOSPITAL ALLIANCE
By ~d~- t(~'l.-
Witness
STEPHEN
By
President
EMPLOYER-PROVIDER NElWORK
AND
UTILIZATION REVIEW AND CASE MANAGEMENT SERVICES
AGREEMENT
THIS AGREEMENT is entered into as of this first day of OCTOBER 1999 by and
between Keys Physician-Hospital Alliance ("KPHA") and the County of Monroe
("County"), hereon referred to as "Employer".
RECITALS
WHEREAS, the KPHA has established a. network of participating health care
providers, which providers, pursuant to the terms and conditions of provider agreements
with KPHA, have agreed"to deliver medica1.services in a cost" effective manner to persons
covered under the health benefit plans and policies of Employer.
WHEREAS, KPHA has agreed to provide utilization review" and case management
services to Employer and personnel, dependents, Cobra beneficia{ies and eligible retirees
covered under the health benefit plans and policies of Employer.
WHEREAS, Employer administers the health care benefit plans and has the express
authority, by signing this Agreement, to bind the Employer to all of the terms and conditions
of this Agreement.
WHEREAS, Employer desires and agrees to offer KPHA Provider Network to
persons covered under the Employers health benefits plans;
Now, THEREFORE, the parties agree as follows:
1. RECITALS. The foregoing recitals are hereby incorporated by reference and
made a substantive part hereof
2. LIST OF P ARTICIP A TING PROVIDERS. KPHA shall provide Employer
with a list of Participating Providers, to include hospitals, physicians, dentists, pharmacies,
and other ancillary health services, and shall provide Employer with periodic updates of the
Network roster of Participating Providers from time to time. Such updates will be at least
semi-annually and in such a printed format as distributable to persons covered under the
Employers health benefits plans.
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OUT-OF COUNTY PROVIDERS. KPHA agrees to negotiate and contract with
"Dimension Network" in Dade County for discounted fee arrangements with physicians,
hospitals, and other ancillary health services as needed for the benefit of the Employer. If the
"Dimension Network" is not utilized, or becomes unacceptable to the" Employer, KPHA will
propose other alternative arrangements for such out of county services.
3. UTILIZATION MANAGEMENT AND QUALITY ASSURANCE. KPHA shall
provide for Employer Utilization Review services to include
. Review of inpatient admissions and of continued hospital stay
· Discharge planning
· Data collection and reporting
. Review of supportive or treatment services
. Review of office visits, ambulatory surgery and diagnostic or other outpatient
seMces
. Review of billing practices and appropriateness of charges of network providers
· Large Case Management services
The monthly capitation fee for such services will be $1.35 per employee per month. This fee will
be payable by the County to KPHA by the 20th of each month beginning on the 20th day of
October, 1999. The number of enrollees will be determined on the 1st business day of each
month.
KPHA shall provide for Large Case Management services for a fee of $55.00 per hour on an as-
needed basis.
Large Case Management services shall be pre-approved by the County on a case by case basis
and billings for such fees incurred shall be provided monthly with details of all charges.
Utilization Review and Large Case Management services will be performed according to pre-set
protocols developed in conjunction with the claims administrators (Acordia National's) standards
and will be documented in the claims administrators computer system.
4. WELLNESS PROGRAMS AND OTHER EDUCATIONAL SERVICES. KP.HA
shall design and implement with the coordination of Employer's staff, the Worksite Wellness
Program and other similar services to the Employer and Covered Persons to promote healthy
lifestyles and preventative health care. The Worksite Wellness Program will include, at no
additional charge to Employer or Covered Persons, a health risk assessment for each employee
and may include, for a charge by a Participating Provider, Health Physical Packages. Health Fair
coordination and implementation and other services as negotiated deemed to promote healthy
lifestyles and preventative health care may also be included in this service.
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5. PARTICIPATING PROVIDER COMPENSATION. Employer shall compensate
Participating Providers for covered services minus any plan participant responsibilities.
Employer has the responsibility for implementation of the applicable claims payment submitted
by Participating Providers for services rendered or for any billing or other function related to the
health care services provided by Participating Providers to Covered Persons. All claims for
covered services, whether payable by the Employer or a Covered Person will receive a 5%
discount. This discount will be rescinded if an appropriately documented and non-contested
claim is not paid to the Participating Provider within thirty (30) days of being received by the
claims administrator (Acordia National).
PROVIDER REIMBURSEMENT TERMS. KPHA guarantees that the Participating
Provider's physician Usual Customary and Reasonable (UCR) and hospital charges will not
change during the term of one year. Thereafter, KPHA agrees to provide a ninety (90) day
notification in the event of a charge increase. UCR and hospital charges will be based upon "the
Medicode database." The above agreed upon discount will be applied to the billed charge, not to
exceed the UCR charge for a service.
KPHA further agrees that no other self-insured employer contracting with KPHA will be
provided with better overall terms than what is being here agreed. If however better terms are
provided to another self-insured employer contracting with KPHA, such terms will also be
extended to the Employer.
6. COVERED PERSON IDENTIFICATION. Employer shall supply Covered Persons
with identification cards or other means of identification which clearly identifies KPHA, reflects
the Covered Person's coverage under the applicable Employers health benefit plan, and reflects
the Covered Person's eligibility to receive services from Participating Providers in accordance
with the terms of this Agreement. Employer shall also provide such other services as may be
required in order for Participating Providers promptly to verify the status of individuals as
Covered Persons, the terms of the Covered Person's health care benefits, including but not
limited to the applicable terms of coverage, deductible status and co-insurance.
7. NETWORK EXCLUSIVITY. During the course of the agreement Employer agrees not
to participate or enter agreements to utilize other provider networks other than that. agreed upon
with KPHA and the Employer. Employer during the term of this Agreement shall not seek to
negotiate with individual network members for care or services outside of contractual provisions
without prior notification to KPHA.
8. " BOOKS AND RECORDS. KPHA shall make available to claims administrator
(Acordia National) all records and other data relating to both the network and utilization review
and case management services for the purpose of periodic audits of KPHA's services.
Information/data will be maintained, as required, to assure confideIitiality and compliance with
all applicable regulations.
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9. RESPONSmILITY FOR HEALTH CARE SERVICES. Employer agrees that KPHA
shall not have any responsibility or liability for any act, omission, or decision related to medical
services rendered by Participating Providers to a Covered Person.
10. TERM. This Agreement shall continue in effect for one (1) year from the date first
above written. Thereafter, the Agreement shall renew for two (2) consecutive one (1) year terms.
KPHA agrees to provide the Employer with at least ninety (90) days written notice of the intent
to tenninate, non-renew, or amend this Agreement. The Employer agrees to provide KPHA with
at least ninety (90) days written notice of the intent to terminate or non-renew this agreement.
Any modification of the terms of this agreement may occur upon the mutual agreement of the
parties.
KPHA agrees to negotiate in good faith a partial risk sharing arrangement for the first renewal of
this contract.
BREACH AND CURE. Notwithstanding the foregoing, this Agreement may be
tenninated by either party upon a material breach of this Agreement by the other party, providing
that the breaching party does not cure the breach within thirty (30) days following receipt of a
written notice from the non-breaching party specifying the nature of the breach and requesting
that it be cured.
11. GENERAL PROVISIONS.
A. THIRD PARTIES: The terms and provisions of this Agreement are for the
benefit of the parties hereto and are not intended to provide any other person with any right or
cause of action on account thereof
B. NOTICES: Any notice required to be given pursuant to the terms and provisions
thereof shall be in writing and shall be hand-delivered, with return receipt thereof, or sent by
certified or registered mai~ return receipt requested and first-class postage prepaid to the
addresses as follows:
Employer:
County of Monroe
Manager- Employee Benefits
Public Service Building
5100 College Road, Stock Island
Key West, Fl33040
KPHA:
Keys Physician-Hospital Alliance
c/o Lower Florida Keys Physician Hospital Organization, Inc.
P.O. Box 9107
Key West, Florida 33041-9107
Attn.: Ronald Bierman, Secretary
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c. ASSIGNMENT: This Agreement may not be assigned, subcontracted,
delegated, transferred by either party without the express written consent of the other party, and
any attempted assignment, subcontract, delegation or transfer shall be void.
D. INDEPENDENT CONTRACTORS: None of the provisions of this Agreement
are intended to create, nor shall be deemed to, or construed to create any relationship between
KPHA and Employer other than that of independent entities contracting with each other
hereunder solely for the purposes of effecting the provisions of this Agreement. Neither of the
parties hereto, nor any of their respective officers, directors, or employees shall be construed to
be the agent, employee, or representative of the other.
E. GOVERNING LAW: This Agreement shall be governed in all respects by the
laws of the State of Florida without regard to Florida's choice of law statutes or decisions. Any
action by any party, whether at law or in equity, relating to this Agreement shall be commenced
and maintained, and venue shall be proper, only in Monroe County, Florida.
F. ORDINANCE 10-1990: KPHA warrants that it has not employed, retained or
otherwise had acted on his behalf any former County officer subject to the prohibition in Sec. 2
of Ordinance no. 10-1990 or any County officer or employee in violation of sec. 3 of Ordinance
10-1990, and that no employee or officer of the County had any interest, financially or otherwise,
in KPHA except for such interest, permissible by law and fully disclosed by affidavit attached
hereto. For breach or violation of this paragraph, the County may, in its discretion, terminate this
agreement without liability and may also, in its discretion, deduct from the contract or purchase
price, or otherwise recover, the full amount of any fee, commission, percentage, gift or
consideration paid to the former County officer or employee.
G. CONFLICT OF INTEREST: KPHA assures the County that to the best of its
knowledge information and belief, the signing of this agreement does not create conflict of
interest.
H. OWNERSHIP OF INFORMA nON: All Utilization Review and Case
Management documents which are prepared in the performance of this agreement are to be, and
shall remain, the property of the County and shall be transferred to the County or to a
replacement Utilization Review/Case Management service provider upon request and no later
than thirty (30) days after termination of this agreement. Any patient identifying information
shall not be disclosed without written consent of the patient.
1. INSURANCE REOUIREMENTS: KPHA is required to maintain the types of
insurance identified in Attachment A.
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J. SEVERABILITY: If any provision of this Agreement is held to be illegal,
invalid, or unenforceable, under present or future laws effective during the term hereof, such
provision shall be fully severable. In such event, this Agreement shall be construed and enforced
as if the illegal invalid or unenforceable provision had never been a part hereof, and the
remaining provisions shall remain in full force and effect unaffected by such severance- provided
that if the illegal, invalid or unenforceable provision is material to the overall purpose and
operation of this Agreement, then this Agreement shall terminate upon the severance of such
provision.
K. COUNTERPARTS: This Agreement and any amendment hereto may be
executed in multiple originals, all counterparts together constituting one and the same
instrument.
L. ENTIRE AGREEMENT: This Agreement, along with its exhibits, contains all
the terms and conditions agreed upon by the parties hereto regarding the subject matter of this
Agreement and supersedes any prior Agreements, promises, negotiations, or representations
either oral or written, relating to the subject matter of this Agreement. "
M. HOLD HARMLESS: KPHA shall indemnify and hold the County harmless
from and against any and all losses, penalties, damages, professional fees, including attorney fees
and all costs oflitigation and/or judgment arising out of any willful misconduct or negligent act,
error or omission of KPHA incidental to the performance of this agreement or work performed
thereunder. This indemnity shall extend to amounts the County becomes legally obligated to pay
and shall be limited by any sovereign immunity limit applicable to the underlying claim plus
costs of litigation.
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Employer:
Board of County Commissioners
" of Monroe County, Florida
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By:
Its: Mo.1Dt'{ Cf,,4.iIi"M",.,
I
::~s PhYSiCian-H~
Its: ~-esrb~~T-
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