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2nd Amendment 05/19/2004 DANNY L. KOLHAGE CLERK OF THE CIRCUIT COURT DATE: July 15, 2004 TO: Sheila Barker, Director Administrative Services FROM: Maria Z. Fernandez Group Insurance Administrator Pamela G. Hanc~ Deputy Clerk ATTN: At the May 19, 2004, Board of County Commissioner's meeting the Board granted approval and authorized execution of the following: Amendment to the Employee Assistance Program Agreement between Monroe County and Mental Health Care Center of the Lower Keys, Inc. d/b/a Care Center for Mental Health for the Florida Keys Mosquito Control District, a covered entity under the Monroe County Employee Assistance Program, who will no longer be covered effective May 1, 2004. Amendment to Administrative Services Agreement between Monroe County and Acordia National for monthly claim administration fees for the Florida Keys Mosquito Control District (FKMCD). This amendment is required effective May 1,2004 as the FKMCD will no longer be a covered entity under the Monroe County Employee Benefit Plan therefore eliminating the need for administrative fees, except for the handling of run-out claims. /Organ Transplant Network Amendment between Monroe County and MultiPlan, Inc. With the use of global contract rates, savings can range between 30-50% across the spectrum of the eight transplant categories. MultiPlan has credentials the facilities in the network and their outcomes meet or exceed national averages. Enclosed is a duplicate original of each of the above-mentioned for your handling. Should you have any questions please do not hesitate to contact this office. cc: County Administrator w/o documents County Attorney Finance File /' MULTIPLAN, INC. ORGAN TRANSPLANT NETWORK AMENDMENT THIS AMENDMENT, effective upon signature by Client, is by and between MultiPlan, Inc., 115 Fifth Avenue, New York, New York 10003-1004 ("MultiPlan") and Monroe County Board of County Commissioners, located at 1100 Simonton Street, Key West, FL 33040, ("Client"). WHEREAS, the above-named parties entered into a contract, effective January 1, 2003, under which MultiPlan agreed to give Client's Participants access to MultiPlan's Facility Network at MultiPlan's negotiated rates ("the Agreement"); and WHEREAS, MultiPlan has established an Organ Transplant Network composed of Facilities that have agreed to accept a global rate as full reimbursement for organ transplant services provided to Participants of MultiPlan Client that have purchased access MultiPlan's Organ Transplant Network, and; WHEREAS, Client desires to access MultiPlan's Organ Transplant Network in the MultiPlan Program; and THEREFORE, the parties hereby agree to amend the Agreement by adding the following: A. DEFINITIONS The following definitions shall apply for the purposes of this Amendment: 1. Access Fees The rates payable by Client to MPI for access to MPI's Organ Transplant Network, as set forth in paragraph B(7), herein. 2. Benefit Plan A contract, policy, or other document, under which a Client is obligated to provide benefits on behalf of a Participant for transplant services in an amount that meets or exceeds the Contract Rates applicable hereunder. 3. Clean Claim A completed UBF92, or other standard billing form providing the same information. 4. Contract Rates The global rates of reimbursement ("Global Contract Rates"), and other rates of reimbursement for organ transplant and transplant-related health care services rendered to Participants as set forth in MPI's agreement with an MPI Provider. 5. Employee "Employee" includes retirees eligible for coverage under Client's Benefit Program. In the event the Client is a union, all references to "Employee" in this Agreement and its attachments shall be construed to refer to the union member. 6. Market A geographic region defined by MPI for pricing purposes. 7. Savings The difference between the applicable Contract Rate and the MPI Provider's billed charges (excluding surcharges and the cost of personal convenience items). B. RIGHTS AND OBLIGATIONS OF CLIENT 1. Cooperation with Transplant Coordinator Client shall work cooperatively with MultiPlan's Organ Transplant Program Coordinator, Case Managers, and other personnel, and shall comply with the procedures established by MultiPlan for access to the Organ Transplant Network. 2. Participant Enrollment The Client or the Client's Case Manager shall call MultiPlan's Transplant Referral telephone number, 800-239-2745 to initiate the Participant's access to the Organ Transplant Network. Client shall not be entitled to access to the Organ Transplant Program Contract Rates secured by this Agreement unless the Participant is enrolled by MultiPlan in the Organ Transplant Program for each proposed transplant before the transplant is performed. 3. Eligibility Determinations and Verification of Benefits Client shall be soley responsible for making all determinations regarding eligibility and compensability of benefits in connection with this Agreement. Upon receipt of a request from MultiPlan for verification of a Participant's eligibility under MultiPlan's Organ Transplant Program, Client shall forward proof of eligibility and the Participant's program benefits limits to MultiPlan, using the Notification and Benefit Certification form to be provided by MultiPlan. MultiPlan shall transmit this proof to the Provider. 4. Claim Repricing Hospital and/or Client shall forward to MultiPlan all clean claims received for services rendered under the Organ Transplant Program to MultiPlan for repricing. MultiPlan shall return to Client, by mail or facsimile transmission, instructions relating to payment of the claim. 5. Claim Payment Client shall pay all claims for services rendered by providers in MultiPlan's Organ Transplant Network within thirty business days of receipt of the Clean Claim. 6. Explanations of Benefits Client shall indicate clearly on each Explanation of Benefits issued regarding transplant services that Client is accessing MultiPlan's Transplant Network. 7. Network Access Fee Amounts 2 a. Client shall pay MultiPlan Network Access Fee(s) as set forth in the Flat Rate Access Fee Schedule below: Heart $10,000. Lung $10,000. Kidney $ 3,500. Pancreas $ 3,500 Liver $20,000. Bone Marrow Transplants Autologous and PBSC Allogeneic- Matched Related Donor Matched Unrelated Donor $ 5,000. $ 10,000. $ 20,000. b. During the pre-transplant phase, MultiPlan shall invoice Client for an Initial Network Payment of one thousand dollars ($1,000.00), which shall be paid by Client within ten (10) days of the date of the invoice, Following the transplant phase, MultiPlan shall invoice Client for the remaining balance of the total Flat Rate Access Fee, which amount shall be paid by Client within ten (10 ) days of the date of the invoice. In the event that the Participant receives pre-transplant services but does not undergo transplant surgery, Client shall pay MPI for transplant-related services rendered to said Participant the Initial Network Payment of$l,OOO.OO, plus if Client pays percentage of Savings Access Fees under the Agreement to which this Amendment is annexed, Client shall pay Network Access Fees at the percentage rate set forth in the Agreement, or if Client pays capitated Access Fees under the Agreement to which this Amendment is annexed, Client shall pay Network Access Fees of twenty-two percent (22%). 8. Electronic Format Client agrees to use its best efforts to accept electronic invoicing from MPI, on diskette, and to submit payment information to MPI in the same format. Client agrees that the appropriate information systems and/or accounting personnel shall be available to review and implement necessary electronic systems. Client also agrees to explore the feasibility of electronic data interchange as a means of transmitting both claims and financial information. 9. Transplant Services Included in Global Contract Rates The Global Contract Rates negotiated by MultiPlan include, to the extent that they are medically necessary: general nursing care; room and board and all ancillary services; use of intensive or special care facilities; x-ray examination (other than dental x-rays); use of operating room and related facilities; encephalography; drugs, medications, and biologicals; laboratory testing and services; all cardiovascular testing; special tests, when medically necessary; nuclear medicine; physical and rehabilitation therapy; oxygen and oxygen therapy; anesthesia and anesthesia services; intravenous injections and solutions; surgical and medical services provided by Provider; pre- operative care; post-operative care; special duty nursing; short procedure unit services; 3 Monroe County Board of County Commissioner 1100 Simonton Street Key West, FL 33040 BY~ (~ 05/19/2004 SIgnature Date Murray E. Nelson. MaYorffhairm~ Print Name and Title ~ ~ -:::.. :::0 c' : ' c:: 0, I m.... secondary care, including private accommodations in a regular medical/surgical bed not requiring placement in an intensive care unit or other unusually high level of medical and nursing care, inclusive of room and board and all ancillary services, but exclusive of personal comfort and convenience items; and tertiary care, including all items included in secondary care and, in addition, such items and services as are normally and usually provided by Provider in conjunction with care of inpatients in its intensive care unit. However, reference must be had to a specific Provider's MultiPlan Organ Transplant Program contract rates for details regarding the services included in that Provider's rates. 10. Services Not Included in Contract Rates The Global Rates negotiated by MultiPlan do not include: personal comfort or personal convenience items; custodial care; or services which are not necessary to the care or treatment of the illness or illnesses which necessitated the transplant, as determined by Provider's Chief of the Medical Staff, except as incidental to the transplant. 11. Dispute Resolution In the event of a dispute between Client and an MPI Provider regarding a claim or payment for covered services under this Agreement, Client shall notify MPI, in writing, of the dispute within sixty days of receipt of the Clean Claim. Upon request and at no charge, Client shall provide information reasonably necessary for MPI to facilitate resolution of any disputes that arise between Client and an MPI Provider, such as a copy of its benefits and/or utilization programs, and such utilization and/or claims data as MPI may reasonably request. MPI will make its best efforts to assist Client in resolving the dispute with the MPI Provider. If the Client fails to notify MPI of a dispute consistent with this provision, Client may not otherwise dispute the claim(s) at issue. IN WITNESS WHEREOF, the undersigned, duly authorized representatives of the parties, have executed this Amendment. MUL TIPLAN, INC. 115 Fifth Avenue New York, New By: 4 Con .,., - r I" a ." C) ::0 ::::0 rr1 (~ o ':;:0 c:;