HomeMy WebLinkAboutAgreement A-19-411 with Community Medical Centers.pdf
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services, identified in Exhibit 2, to any MISP beneficiaries who do not qualify for Medi-Cal and are in
need of such service/s to avoid suffering or endangerment to life or health in exchange for COUNTY’S
payment under Section 3, Compensation and Invoicing below. CMC, including its affiliated hospitals
and facilities in Exhibit 3, shall not perform any non-emergent comprehensive inpatient hospital services
to any MISP beneficiary until the COUNTY’S Department of Public Health “DPH” Director, or his/her
designee, DPH’s MISP Administrator, or third-party vendor confirms to CMC in writing or through the
COUNTY’S electronic health tracking system (to which CMC shall have read-only access), that such
person is currently enrolled in the COUNTY’S MISP.
B. Standard of Medical Care: CMC, including its affiliated hospitals and facilities in
Exhibit 3, must perform comprehensive inpatient hospital services in Exhibit 2, in accordance with
acceptable medical standards within Fresno County, California.
C. Licenses and Certification: CMC, including its affiliated hospitals and facilities in
Exhibit 3, shall provide only qualified personnel who are credentialed and maintain all required licenses,
certificates and board registrations necessary for the provision of services under this Agreement, for
each particular specialty/area each employee practices, required by the laws and regulations of the
Federal, State of California, and/or local governments, including any other applicable government
agency or non-profit organization, throughout the Term of this Agreement as set forth in Section 4, A,
below.
D. Emergency Care Not Comprehensive Inpatient Hospital Services: CMC,
including its affiliated hospitals and facilities in Exhibit 3, acknowledge and agree that emergency care
means:
1) A medical condition (including emergency labor and delivery) manifesting
itself by acute symptoms of sufficient severity, including sever pain, such that the absence of immediate
medical attention could reasonably be expected to result in any of the following:
a. Placing the patient’s health in serious jeopardy;
b. Serious impairment to bodily functions; or
c. Serious dysfunction to any bodily organ or part.
(Welfare & Institutions Code, §14007.5, subdivision (d); 22 C.C.R. §51056, subdivision (b); 42 U.S.C.
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§1396b, subdivision (v)(3); and 42 C.F.R. §440.255)
In addition, CMC, including its affiliated hospitals and facilities in Exhibit 3, acknowledge and
agree that emergency care is not considered comprehensive inpatient hospital services, identified in
Exhibit 2.
E. Emergency Care Services: CMC acknowledges that it is obligated to provide
emergency care services in accordance with the Emergency Medical Treatment and Active Labor Act
“EMTALA” (42 U.S.C. §1395dd). Separate and apart from CMC’s EMTALA responsibilities, CMC,
including its affiliated hospitals and facilities in Exhibit 3, will only be eligible to receive compensation
from COUNTY for providing emergency care under Section 3, herein:
1) After they first seek reimbursement for individuals who qualify for Medi-Cal
or Restricted Medical;
2) The person who receives emergency care, or the person’s authorized
agent, applies for MISP no later than thirty (30) calendar days from the first date he/she receives the
care (in accordance with the “Certification Period” in the MISP, Exhibit 1; and
3) The COUNTY determines that such person would have qualified as a
MISP beneficiary at the time the emergency care was provided under the eligibility requirements within
Exhibit 1. No authorization is required prior to the provision of emergency care services.
F. Medi-Care/Medi-Cal Certification and Accreditation: CMC, including its affiliated
hospitals and facilities in Exhibit 3, acknowledge that they are certified to participate in the Medicare and
Medi-Cal (MAGI and Non-MAGI) programs under Titles XVIII and XIX of the Social Security Act, and will
continue to participate in the Medicare and Medi-Cal (MAGI and Non-MAGI) programs throughout the
Term set forth under Section 4, A, below. In addition, CMC, including its affiliated hospitals and facilities
in Exhibit 3, acknowledge that they are accredited by the Joint Commission or other widely recognized
accrediting body.
G. Primary Care/Specialty Professional Medical Services: CMC, including its
affiliated hospitals and facilities in Exhibit 3, acknowledge and agree that this Agreement is only for the
provision of Hospital and Clinic Services identified in Exhibit 2, herein, and not for the provision of primary
care or specialty professional medical services. Therefore, no compensation shall be provided to CMC,
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including its affiliated hospitals and facilities in Exhibit 3, for any provision of primary care or professional
medical services under Section 3, below, unless otherwise mutually agreed to in writing by COUNTY’S
DPH Director and CMC as noted in Exhibit 2. Notwithstanding the above, COUNTY recognizes that
CMC does bill for limited professional services provided within the hospital; professional services related
to reading of Electrocardiogram and Pulmonology services. COUNTY will pay for said services, if
provided within the course of receiving covered services at CMC and if billed by CMC.
H. Referral of Primary and/or Specialty Professional Medical Services: To the extent
CMC, or any of its affiliated hospitals in Exhibit 3, determine that an MISP beneficiary needs primary
and/or specialty professional medical service/s that is not specifically noted in Exhibit 2 or has not
specifically been mutually agreed upon prior to provision of said medical service as noted in Exhibit 2,
and is determined to be an MISP covered service, CMC or its affiliated hospitals in Exhibit 3, shall refer
the MISP beneficiary to the appropriate COUNTY MISP-contracted provider group to obtain such
necessary service/s.
I. Facilities: CMC, including its affiliated hospitals and facilities in Exhibit 3, shall, at
their own expense, provide and maintain all necessary facilities to perform the services under this
Agreement. MISP services shall be solely provided at CMC and its affiliated hospitals and facilities in
Exhibit 3, but may be provided at other CMC facilities within Fresno County as determined by CMC and
as agreed upon by the COUNTY’S DPH Director.
J. Outpatient Clinic Facilities: Only to the extent medically necessary, CMC shall
provide, maintain, and make accessible adequate outpatient clinic facilities to MISP beneficiaries.
COUNTY shall compensate CMC for each visit an MISP beneficiary makes to an outpatient clinic facility
in accordance with Section 3 below.
K. Equipment and Supplies: CMC, including its affiliated hospitals and facilities in
Exhibit 3, shall, at their own expense, provide the necessary medical equipment, supplies, and
pharmaceuticals when providing Hospital and Clinic Services, herein, to the extent permitted under
Sections 1, D, and 1, E, above.
L. Financing: Except for compensation under Section 3 below, CMC shall, at their
own expense, be responsible for financing their operation and capital expenses and cash flow
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requirements in providing services herein.
M. No Right to Select MISP Beneficiaries: CMC, including its affiliated hospitals and
facilities in Exhibit 3, shall not have the right to select the persons who may enroll in the COUNTY’S
MISP.
N. Multilingual Services: CMC, including its affiliated hospitals and facilities in
Exhibit 3, shall maintain an appropriate capability for communicating with MISP beneficiaries who are
hearing impaired, non-English speaking and/or limited English speaking to the extent required by law
and to the extent reasonably required to provide such Hospital and Clinic Services.
O. No Treatment Permitted: CMC, including its affiliated hospitals and facilities in
Exhibit 3, shall not provide treatment to any person under this Agreement if such person:
1) Is not a MISP beneficiary;
2) Is not in need of Hospital and Clinic Services, to include emergency care to
avoid suffering or endangerment to his/her life or health, as provided in Exhibit 2;
3) Seeks a medical service that has not been mutually agreed upon in writing
between CMC and COUNTY’S DPH Director, and that is a Medi-Cal covered service; or
4) Seeks a medical service prohibited under the MISP, Exhibit 1.
P. Compliance with Legal Requirements: In providing Hospital and Clinic Services,
as set forth in Exhibit 2, including emergency care as set forth in Sections 1, D and 1, E above, CMC,
and its affiliated hospitals in Exhibit 3, shall provide such services and facilities in accordance with all
applicable laws and regulations of the Federal, State of California and local governments, including, but
not limited to, any binding relevant case law.
2. RESPONSIBILITIES OF COUNTY
A. Administrative Services: Throughout the Term of this Agreement set forth in
Section 4, A, COUNTY will be solely responsible for determining who is eligible to enroll in MISP (see
MISP criteria, Exhibit 1). In doing so, COUNTY shall enroll persons in MISP either through its electronic
health tracking system or through a third-party vendor. COUNTY shall provide CMC, and its affiliated
hospitals in Exhibit 3, with read-only access to its electronic health tracking system, shall provide CMC
with the contact information for the DPH MISP Administrator and/or third-party vendor so that CMC (or
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its affiliated hospitals in Exhibit 3) may verify who is currently enrolled in MISP prior to conducting non-
emergency Hospital and Clinic Services, herein, or after conducting emergency services, herein. For
purposes of this Agreement, COUNTY’S DPH Director, or his/her designee, DPH’s MISP Administrator,
or third-party vendor shall confirm in writing or through the COUNTY’S electronic health tracking system,
to CMC whether a person is currently an MISP beneficiary who would qualify for MISP-covered services
under Exhibit 1.
B. Emergency Care: In the event CMC, or its affiliated hospitals in Exhibit 3,
determine that a person does not qualify for Medi-Cal or Restricted Medi-Cal, but CMC, or its affiliated
hospitals in Exhibit 3, perform emergency care, as defined in Section 1, D above, to such person, CMC
or its affiliated hospitals in Exhibit 3, shall inform COUNTY’S DPH Director, or his/her designee, about
performing such emergency care. In addition, the person receiving such emergency care shall submit
an MISP application to COUNTY within thirty (30) calendar days of the first day he/she receives such
care. COUNTY’S DPH Director, or his/her designee, shall promptly thereafter determine whether such
person would have qualified for MISP (under Exhibit 1) at the time he/she received such emergency
care, COUNTY shall inform CMC in writing and compensate CMC, or its affiliated hospitals under
Exhibit 3, for providing such service in accordance with Section 3 below.
3. COMPENSATION AND INVOICING
A. CMC’s Reimbursement for Comprehensive Inpatient Hospital and Outpatient
Clinic Services:
1) Negotiated Service Rates: For the Term of this Agreement set forth in
Section 4, A, comprehensive inpatient hospital and outpatient clinic services rendered hereunder by
CMC, or its affiliated hospitals under Exhibit 3, to MISP beneficiaries shall be reimbursed according to
the negotiated fee for service rates in Exhibits 4 and 4-A, attached hereto and incorporated by this
reference, herein.
2) Share of MISP Beneficiary Cost will be Deducted: MISP beneficiaries
between the income range of 139% to 224% of the federal poverty level as set forth in the COUNTY’S
MISP, Exhibit 1 and who meet the other MISP eligibility criteria, are permitted to obtain necessary
comprehensive inpatient hospital and outpatient clinic services under the MISP, if they pay for a certain
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share of the cost as set forth in the COUNTY’S MISP (see Pages 5 to 6 in Exhibit 1). CMC, or its
affiliated hospitals in Exhibit 3, shall be responsible to obtain the MISP beneficiaries share of cost, if it
provides comprehensive inpatient hospital and outpatient clinic services to MISP beneficiaries, herein.
COUNTY shall deduct the MISP beneficiaries’ share of cost from invoices provided by CMC, or its
affiliated hospitals in Exhibit 3, under this Agreement.
3) Compensation Contingencies: CMC, and its affiliated hospitals under
Exhibit 3 herein, shall only be entitled to reimbursement for comprehensive inpatient hospital and
outpatient clinic services under these Sections 3, A, 1); 3, A, 2); and 3, A, 3) if:
a. The comprehensive inpatient hospital and outpatient clinic services
provided to MISP beneficiaries are medically necessary to avoid suffering or endangerment to life or
health;
b. Prior to providing comprehensive inpatient hospital and outpatient
clinic services, they are notified by COUNTY in writing or through COUNTY’S electronic health tracking
system that the person to receive such service is enrolled in the MISP and, therefore, qualified to
receive such care; and
c. The MISP beneficiary does not qualify for Medi-Cal.
If prior written authorization for services has been provided by COUNTY to CMC, or other MISP-
contracted provider group, payment shall not be subsequently denied based upon MISP eligibility.
Verification of eligibility in accordance with subsection 3, A, 3), b above is deemed to constitute
authorization to provide services.
B. CMC’s Reimbursement for Emergency Care:
1) Negotiated Service Rates: For the Term of this Agreement set forth in
Section 4, A below, emergency care rendered hereunder by CMC, or its affiliated hospitals under Exhibit
3, to MISP beneficiaries shall be reimbursed according to the negotiated rates in Exhibits 4 and 4-A,
(attached hereto and incorporated by this reference, herein).
2) Share of MISP Beneficiary Cost will be Deducted: MISP beneficiaries
between the income range of 139% to 224%of the federal poverty level (and who meet the other MISP
eligibility criteria) are permitted to obtain emergency care under the MISP if they pay for a certain share
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of the cost as set forth in the COUNTY’S MISP (see Pages 5 to 6 in Exhibit 1). CMC, or its affiliated
hospitals in Exhibit 3, shall be responsible to obtain the MISP beneficiaries share of cost, if it provides
emergency care to MISP beneficiaries, herein. COUNTY shall deduct the MISP beneficiaries’ share of
cost from invoices provided by CMC, or its affiliated hospitals in Exhibit 3, under this Agreement.
3) Compensation Contingencies: CMC, and its affiliated hospitals under
Exhibit 3, herein, shall only be entitled to reimbursement for emergency care under this Section 3, B if:
a. The person who received emergency care, or his/her authorized
agent, applies for MISP no later than thirty (30) calendar days from the first date he/she receives
emergency care (in accordance with the “Certification Period”) in the MISP, Exhibit 1; and
b. The COUNTY determines that such person would have qualified to
enroll in MISP at the time the emergency care was provided under the MISP eligibility requirements in
Exhibit 1.
C. CMC’s Reimbursement for Outpatient Clinic Services: In the event a treating
physician, CMC, or its affiliated hospitals in Exhibit 3, determine that an MISP beneficiary will need to
visit a CMC outpatient clinic facility to obtain medical services herein, COUNTY shall reimburse CMC
according to the negotiated rate identified in Exhibit 4, attached hereto and incorporated by this
reference, herein.
D. Maximum Compensation: In no event shall total compensation and any other
payment for any service performed under this Agreement be in excess of Seven Million, Forty-Three
Thousand, One Hundred Ninety-Six Dollars ($7,043,196) for the entire three (3) year period of this
Agreement. CMC agrees to provide COUNTY with written notice, in accordance with Section 11 below,
when it has expended costs under this Agreement in the amount of eighty-five percent (85%) of the
maximum compensation limit for the base three (3) year period, so that COUNTY may take necessary
action to either amend this Agreement to increase the maximum compensation limits herein or terminate
this Agreement pursuant to Section 4, A, below.
1) If this Agreement is extended for an additional one (1) year period after the
first three (3) years of this Agreement, pursuant to Section 4, A, below, in no event shall total
compensation and any other payment for the services performed under this Agreement be in excess of
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Nine Million, Three Hundred Ninety Thousand, Nine Hundred Twenty-Eight Dollars ($9,390,928) for the
entire four (4) year period of this Agreement. If this Agreement is extended for an additional one (1)
year period after the first three (3) years of this Agreement, pursuant to Section 4, A, below, CMC
agrees to provide COUNTY with written notice, in accordance with Section 11 below, when it has
expended costs under this Agreement in the amount of eighty-five percent (85%) of the maximum
compensation limit for the four (4) year period of the Agreement.
2) If this Agreement is extended for an additional one (1) year period after the
first four (4) years of this Agreement, pursuant to Section 4, A, below, in no event shall total
compensation and any other payment for the services performed under this Agreement be in excess of
Eleven Million, Seven Hundred Thirty-Eight Thousand, Six Hundred Sixty Dollars ($11,738,660) for the
entire five (5) year period of this Agreement. If this Agreement is extended for an additional one (1) year
period after the first four (4) years of this Agreement, pursuant to Section 4, A, below, CMC agrees to
provide COUNTY with written notice, in accordance with Section 11 below, when it has expended costs
under this Agreement in the amount of eighty-five percent (85%) of the maximum compensation limit for
the five (5) year period of the Agreement.
3) If this Agreement is extended for an Additional one (1) year period after
the first five (5) years of this Agreement, pursuant to Section 4, A, below, in no event shall total
compensation and any other payment for the services performed under this Agreement be in excess of
Fourteen Million, Eighty-Six Thousand, Three Hundred Ninety-Two Dollars ($14,086,392) for the entire
six (6) year period of this Agreement. If this Agreement is extended for an additional one (1) year period
after the first five (5) years of this Agreement, pursuant to Section 4, A, below, CMC agrees to provide
COUNTY with written notice, in accordance with Section 11 below, when it has expended costs under
this Agreement in the amount of eighty-five percent (85%) of the maximum compensation limit for the six
(6) year period of the Agreement.
4) If this Agreement is extended for an Additional one (1) year period after
the first six (6) years of this Agreement, pursuant to Section 4, A, below, in no event shall total
compensation and any other payment for the services performed under this Agreement be in excess of
Sixteen Million, Four Hundred Thirty-Four Thousand, One Hundred Twenty-Four Dollars ($16,434,124)
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for the entire seven (7) year period of this Agreement. If this Agreement is extended for an additional
one (1) year period after the first six (6) years of this Agreement, pursuant to Section 4, A, below, CMC
agrees to provide COUNTY with written notice, in accordance with Section 11 below, when it has
expended costs under this Agreement in the amount of eighty-five percent (85%) of the maximum
compensation limit for the seven (7) year period of the Agreement.
5) If this Agreement is extended for an Additional one (1) year period after
the first seven (7) years of this Agreement, pursuant to Section 4, A, below, in no event shall total
compensation and any other payment for the services performed under this Agreement be in excess of
Eighteen Million, Seven Hundred Eighty-One Thousand, Eight Hundred Fifty-Six Dollars ($18,781,856)
for the entire eight (8) year period of this Agreement. If this Agreement is extended for an additional one
(1) year period after the first seven (7) years of this Agreement, pursuant to Section 4, A, below, CMC
agrees to provide COUNTY with written notice, in accordance with Section 11 below, when it has
expended costs under this Agreement in the amount of eighty-five percent (85%) of the maximum
compensation limit for the eight (8) year period of the Agreement.
6) If this Agreement is extended for an Additional one (1) year period after
the first eight (8) years of this Agreement, pursuant to Section 4, A, below,, in no event shall total
compensation and any other payment for the services performed under this Agreement be in excess of
Twenty-One Million, One Hundred Twenty-Nine Thousand, Five Hundred Eighty-Eight Dollars
($21,129,588) for the entire nine (9) year period of this Agreement. If this Agreement is extended for an
additional one (1) year period after the first eight (8) years of this Agreement, pursuant to Section 4, A,
below, CMC agrees to provide COUNTY with written notice, in accordance with Section 11 below, when
it has expended costs under this Agreement in the amount of eighty-five percent (85%) of the maximum
compensation limit for the nine (9) year period of the Agreement.
7) If this Agreement is extended for an Additional one (1) year period after
the first nine (9) years of this Agreement, pursuant to Section 4, A, below,, in no event shall total
compensation and any other payment for the services performed under this Agreement be in excess of
Twenty-Three Million, Four Hundred Seventy-Seven Thousand, Three Hundred Twenty Dollars
($23,477,320) for the entire ten (10) year period of this Agreement. If this Agreement is extended for an
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additional one (1) year period after the first nine (9) years of this Agreement, pursuant to Section 4, A,
below,, CMC agrees to provide COUNTY with written notice, in accordance with Section 11 below, when
it has expended costs under this Agreement in the amount of eighty-five percent (85%) of the maximum
compensation limit for the ten (10) year period of the Agreement.
E. Invoicing: After CMC, or its affiliated hospitals in Exhibit 3, render Hospital and
Clinic Services (or other medical service that has been mutually agreed to in writing by COUNTY’S DPH
Director and CMC as noted in Exhibit 2) to MISP beneficiaries, and meet the contingencies in Sections
3, A – 3, C, herein, to obtain such compensation, CMC, or its affiliated hospitals in Exhibit 3, herein,
shall submit to COUNTY invoices that contain:
1) The Agreement Number assigned by COUNTY to this Agreement;
2) The Account Number, if any, assigned by COUNTY;
3) The date/s of service;
4) Full and complete descriptions of each service provided, as provided in
accordance with industry billing standards;
5) The cost/charge of each service provided per Exhibits 4 and 4-A;
6) The codes utilized to determine services provided;
7) The number of visits to each outpatient clinic, facility and dates of visit, if
any; and
8) The name, date of birth, MISP Number, and current contact information of
the MISP beneficiary who received such services.
Claims shall be submitted to COUNTY electronically or on a UB or HCFA-1500 billing form in
accordance with industry standards.
CMC, or its affiliated hospitals in Exhibit 3, agree to submit invoices/claims to COUNTY for
services referred under this Agreement no later than ninety (90) days after the service was delivered or
ninety (90) days after a MISP beneficiary has been discharged from a CMC facility, whichever is later.
COUNTY agrees to pay CMC, or its affiliated hospitals in Exhibit 3, within forty-five (45) calendar
days after receipt and verification of the invoices from CMC, or its affiliated hospitals in Exhibit 3.
Invoices shall be submitted to County of Fresno, Department of Public Health, P.O Box 11867, Fresno,
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CA 93775, Attention: DPH Director. This Agreement number must appear on all invoices and
correspondence relating to this Agreement.
CMC shall provide COUNTY with CMC’S signed W -9 and CA 590 Forms within thirty (30) days
of the execution of this Agreement so that COUNTY may set up payment mechanism in the COUNTY’S
vendor payment system. CMC shall provide updated Forms annually and/or upon demand as payments
will not be made to CMC if current and correct W -9 and CA 590 Forms are not on file with COUNTY and
said payments will not be considered late if Forms are not received by COUNTY as requested.
Alternatively, COUNTY understands that CMC may not do their own invoicing for services and
CMC agrees that they shall provide COUNTY’S DPH Director, or designee, with the contact information
and signed W-9 and CA 590 Forms of CMC’S billing company within thirty (30) days of the execution of
this Agreement. Should CMC change billing companies during the contract period, CMC shall notify
COUNTY’S DPH Director, or designee, within sixty (60) days of the change and shall provide contact
information and signed W -9 and CA 590 Forms for the new billing company within sixty (60) days of the
change
COUNTY agrees that invoices submitted by CMC, or its affiliated hospitals in Exhibit 3, shall be
presumed to be coded and billed correctly pursuant to the current Medicare regulations and guidance
located at https://www.cms.gov/Medicare/Medicare.html
4. TERM AND TERMINATION
A. Term: This Agreement shall become effective upon execution and shall terminate
at 11:59 p.m. on August 19, 2022.
1) Extension of Agreement: This Agreement may be extended by COUNTY
for up to seven (7) additional, successive twelve (12) month periods upon the same terms and
conditions set forth, herein. Each extension period will be contingent upon both Parties mutual consent
to continue this Agreement for the then successive twelve (12) month extension period at least sixty (60)
calendar days prior to each successive twelve (12) month extension period. The Director of the
Department of Public Health, or his/her designee, is authorized to execute such written approval on
behalf of COUNTY based on CMC’s satisfactory performance.
Notwithstanding anything to the contrary in this Section 4, A, either Party may terminate this
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Agreement in accordance with Section 4, B, below.
B. Termination:
1) Non-Allocation of Funds: The terms of this Agreement, and the services
to be provided thereunder, are contingent on the approval of funds by the appropriating government
agency. Should sufficient funds not be allocated, the services provided may be modified, or this
Agreement terminated, at any time, by giving CMC at least ninety (90) calendar days advance written
notice.
2) Maximum Compensation not Extended: In the event CMC and COUNTY
reach the maximum compensation limits and the COUNTY’S Board of Supervisors affirmatively decides
not to amend the Agreement to extend the maximum compensation limits in Section 3, B, 5) herein,
CMC shall no longer be obligated to provide any service in this Agreement, herein, and may terminate
the Agreement immediately.
3) Suspension: If a substantial part of the services, which CMC has agreed
to provide hereunder, is interrupted due to a catastrophic event beyond the control of CMC, COUNTY
may elect to terminate this Agreement upon ten (10) days prior written notice to CMC.
4) Material Breach of Contract: Either Party may, upon issuing at least a
ninety (90) calendar day prior written notice to the other Party, suspend or terminate this Agreement in
whole or in party, where in the determination of the other Party that there is:
a. An illegal or improper use of funds;
b. A failure to comply with any term of this Agreement;
c. A substantially incorrect or incomplete report submitted to the
COUNTY;
d. Improperly performed service.
However, the defaulting Party shall have forty (40) calendar days from the receipt of notice to
correct the basis for suspension or termination and resolve the dispute in accordance with Section 5
below. If so corrected to the reasonable satisfaction of the non-defaulting Party, this Agreement shall
continue according to the terms and conditions herein.
In no event shall any payment by the COUNTY constitute a waiver by the COUNTY of any
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breach of this Agreement or any default which may then exist on the part of the CMC. Neither shall
such payment impair or prejudice any remedy available to the COUNTY with respect to the breach or
default. The COUNTY shall have the right to demand of CMC the repayment to the COUNTY of any
funds disbursed to CMC under this Agreement, which in the judgment of the COUNTY, were not
expended in accordance with the terms of this Agreement. CMC shall promptly refund any such funds
upon demand.
5) Without Cause: Under circumstances other than those set forth above,
this Agreement may be terminated by either Party upon the giving of ninety (90) calendar days advance
written notice of an intention to terminate to the other Party. Upon termination or expiration of this
Agreement, each Party shall continue to remain liable for their own obligations or liabilities, as indicated
herein, originating prior to termination of this Agreement.
5. AGREEMENT DISPUTE RESOLUTION
If any claim, dispute, or controversy (any or all of which shall be hereinafter referred to as
“dispute”) shall arise between the Parties with respect to making, construction, terms, or interpretation of
this Agreement or any breach thereof, or the rights or obligations of any Party hereto, the Parties shall seek,
in good faith, to informally resolve their dispute/s to the maximum extent possible. If any dispute between
the Parties cannot be resolved informally within twenty (20) calendar days, the Parties may agree to settle
the dispute by nonbinding mediation, unless the Parties mutually agree otherwise. The mediator shall be
mutually selected by the Parties, but in the case of disagreement, the mediator shall be selected by lot from
among two (2) nomination provided by each Party. All costs and fees required by the mediator shall be
split equally by the Parties; otherwise, each Party shall bear its own cost of mediation. If mediation fails to
resolve the dispute within twenty (20) calendar days, each Party reserves the right to resolve the dispute in
any manner provided by law or in equity.
6. MODIFICATION AND ASSIGNMENT
A. Modification: Any matters of this Agreement may be modified from time to time by
the written consent of all Parties without, in any way, affecting the remainder.
B. Non-Assignment: This Agreement is personal in nature and the rights or duties
hereunder shall not be transferred, delegated, or assigned by either Party, without the prior written
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consent of the other Party.
C. Subcontractors: CMC may subcontract the performance of certain services of this
Agreement to other third party agents, only if CMC obtains the prior written approval from COUNTY.
Any subcontractors will be subject to all applicable provisions of this Agreement, and all applicable State
of California and Federal regulations. CMC will be responsible for informing any subcontractors, and
requiring any subcontractors to comply with all the terms and conditions of this Agreement and of all the
Federal and State of California law requirements incorporated herein. CMC shall be responsible to
COUNTY for the performance of any subcontractor. The use of subcontractors by CMC shall not entitle
CMC to any additional compensation or other payment than is provided for under this Agreement.
7. INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by CMC under this
Agreement, it is mutually understood and agreed that CMC, including any and all of CMC's officers, agents,
and employees will, at all times, be acting and performing as an independent contractor, and shall act in an
independent capacity and not as an officer, agent, servant, employee, joint venturer, partner, or associate
of the COUNTY. Furthermore, COUNTY shall have no right to control or supervise or direct the manner or
method by which CMC shall perform its work and function. However, COUNTY shall retain the right to
administer this Agreement so as to verify that CMC is performing its obligations in accordance with the
terms and conditions thereof.
CMC and COUNTY shall comply with all applicable provisions of law and the rules and regulations,
if any, of governmental authorities having jurisdiction over matters the subject thereof.
Because of its status as an independent CMC, CMC shall have absolutely no right to employment
rights and benefits available to COUNTY employees. CMC shall be solely liable and responsible for
providing to, or on behalf of, its employees all legally-required employee benefits. In addition, CMC shall be
solely responsible and save COUNTY harmless from all matters relating to payment of CMC's employees,
including compliance with Social Security withholding and all other regulations governing such matters. It is
acknowledged that during the term of this Agreement, CMC may be providing services to others unrelated
to the COUNTY or to this Agreement.
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8. HOLD HARMLESS:
CMC agrees to indemnify, save, hold harmless, and at COUNTY’S request, defend the
COUNTY, its officers, agents, and employees from any and all costs and expenses (including attorney’s
fees and costs), damages, liabilities, claims, and losses occurring or resulting to COUNTY in connection
with the performance, or failure to perform, by CMC, its officers, agents, or employees under this
Agreement, and from any and all costs and expenses (including attorney’s fees and costs), damages,
liabilities, claims, and losses occurring or resulting to any person, firm, or corporation who may be injured or
damaged by the performance, or failure to perform, of CMC, its officers, agents, or employees under this
Agreement.
COUNTY agrees to indemnify, save, hold harmless, and at CMC’S request, defend CMC, its
officers, agents, and employees from any and all costs and expenses (including attorney’s fees and costs),
damages, liabilities, claims, and losses occurring or resulting to CMC in connection with the performance,
or failure to perform, by COUNTY, its officers, agents, or employees under this Agreement, and from any
and all costs and expenses (including attorney’s fees and costs), damages, liabilities, claims, and losses
occurring or resulting to any person, firm, or corporation who may be injured or damaged by the
performance, or failure to perform, of COUNTY, its officers, agents, or employees under this Agreement.
9. INSURANCE
Without limiting the COUNTY’S right to obtain indemnification from CMC or any third parties,
CMC, at its sole expense, shall maintain in full force and effect, the following insurance policies or a
program of self-insurance, including but not limited to, an insurance pooling arrangement or Joint Powers
Agreement (JPA) throughout the term of the Agreement:
A. Commercial General Liability: Commercial General Liability Insurance with limits of
not less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of Four Million
Dollars ($4,000,000). This policy shall be issued on a “claims made” basis which shall be renewed
annually. In the event that CMC does not continuously maintain a “claims made” policy, CMC will purchase
tail coverage at that time. COUNTY requires specific coverages including completed operations, products
liability, contractual liability, explosion-collapse of a building, and fire legal liability.
///
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B. Automobile Liability: Comprehensive Automobile Liability Insurance with limits of not
less than One Million Dollars ($1,000,000) per accident for bodily injury and for property damages.
Coverage should include any auto used in connection with this Agreement.
C. Professional Liability: If CMC employs licensed professional staff, (e.g., Ph.D., R.N.,
L.C.S.W., M.F.C.C.) in providing services, Professional Liability Insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence, Three Million Dollars ($3,000,000) annual aggregate.
D. Cyber Liability: Cyber Liability Insurance with limits not less than Two Million
Dollars ($2,000,000) per occurrence or claim, Two Million Dollars ($2,000,000) aggregate, subject to the
sub-limits listed below. Coverage shall be sufficiently broad to respond to the duties and obligations as
is undertaken by CMC in this Agreement and shall include, but not be limited to, claims involving
information theft, protected health information breach, regulatory defense and penalties, payment card
liabilities and costs, media liability, damage to or destruction of electronic information, release of private
information, alteration of electronic information, and extortion and network security. The policy shall
provide coverage for breach response costs as well as regulatory fines and penalties as well as credit
monitoring expenses with limits sufficient to respond to these obligations. The parties understand and
agree that CMC’s Cyber Liability Insurance has the following sub-limits; 1) sublimit of $1 Million for
dependent business loss resulting from dependent system failure; 2) sublimit of $100,000 for fraudulent
instruction claims; 3) sublimit of $250,000 for funds transfer fraud claims; 4) sublimit of $250,000 for
telephone fraud claims; and 5) sublimit of $50,000 for criminal reward claims.
E. Worker's Compensation: A policy of Worker's Compensation insurance as may be
required by the California Labor Code.
Additional Requirements Relating to Insurance: CMC shall obtain certificates of insurance for
the Commercial General Liability insurance naming the County of Fresno, its officers, agents, and
employees, individually and collectively, as additional insured, but only insofar as the operations under
this Agreement are concerned. Such coverage for additional insured shall apply as primary insurance
and any other insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees
shall be excess only and not contributing with insurance provided under CMC's policies herein. In the
event that this insurance is cancelled or changed, other than minor changes incidental to a policy
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renewal. CMC will provide written notice to COUNTY within thirty (30) days. Within sixty (60) days from
the date CMC signs and executes this Agreement, CMC shall provide certificates of insurance as stated
above for all of the foregoing policies, as required herein, to the County of Fresno, Department of Public
Health, P.O. Box 11867, Fresno, California 93775, Attention: Contracts Section – 6th Floor, stating that
such insurance coverage have been obtained and are in full force; that such Commercial General
Liability insurance names the County of Fresno, its officers, agents and employees, individually and
collectively, as additional insured, but only insofar as the operations under this Agreement are
concerned; that such coverage for additional insured shall apply as primary insurance and any other
insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees, shall be
excess only and not contributing with insurance provided under CMC's policies herein.
In the event CMC fails to keep in effect at all times insurance coverage as herein provided, the
COUNTY may, in addition to other remedies it may have, suspend or terminate this Agreement upon the
occurrence of such event.
All policies shall be issued by admitted insurers licensed to do business in the State of California,
and such insurance shall be purchased from companies possessing a current A.M. Best, Inc. rating of A
FSC VII or better or covered by a program of self-insurance.
10. AUDITS AND INSPECTIONS
CMC shall, upon three (3) business days’ notice and during business hours, and as often as
the COUNTY may deem necessary, make available to the COUNTY for examination all of its records and
data with respect to the matters covered by this Agreement. CMC shall, upon request by the COUNTY,
permit the COUNTY to audit and inspect all of such records and data necessary to ensure CMC's
compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand Dollars ($10,000.), CMC shall be subject to the
examination and audit of the Auditor General for a period of three (3) years after final payment under
contract (Government Code Section 8546.7).
11. NOTICES
The persons and their addresses having authority to give and receive notices under this
Agreement include the following:
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COUNTY CMC
COUNTY OF FRESNO COMMUNITY MEDICAL CENTERS
Director, County of Fresno Attn: Vicki L. Anderson
Department of Public Health Title: Vice President, Managed Care
P.O. Box 11867 7370 N. Palm
Fresno, CA 93775 Fresno, CA 93711
///
All notices between the COUNTY and CMC provided for or permitted under this Agreement must be
in writing and delivered either by personal service, by first-class United States mail, by an overnight
commercial courier service, or by telephonic facsimile transmission. A notice delivered by personal service
is effective upon service to the recipient. A notice delivered by first-class United States mail is effective
three COUNTY business days after deposit in the United States mail, postage prepaid, addressed to the
recipient. A notice delivered by an overnight commercial courier service is effective one COUNTY business
day after deposit with the overnight commercial courier service, delivery fees prepaid, with delivery
instructions given for next day delivery, addressed to the recipient. A notice delivered by telephonic
facsimile is effective when transmission to the recipient is completed (but, if such transmission is completed
outside of COUNTY business hours, then such delivery shall be deemed to be effective at the next
beginning of a COUNTY business day), provided that the sender maintains a machine record of the
completed transmission. For all claims arising out of or related to this Agreement, nothing in this section
establishes, waives, or modifies any claims presentation requirements or procedures provided by law,
including but not limited to the Government Claims Act (Division 3.6 of Title 1 of the Government Code,
beginning with section 810).
12. RECORDS
A. Upon CMC’s commencement of provision of Hospital and Clinic Services, pursuant
to this Agreement upon execution on August 20, 2019, CMC agrees to document services rendered to
patients in medical records in accordance with all applicable State and Federal laws, rules, and regulations
for services performed at CMC and its affiliated hospitals and facilities. Additionally, to the extent CMC
controls medical health record, CMC agrees to maintain and keep confidential adequate and complete
medical health care records on each MISP beneficiary patient it serves pursuant to any applicable
accreditation standards, State of California and Federal laws and regulations.
B. CMC shall maintain complete and accurate financial records with respect to the
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services rendered herein. All such records shall be prepared in accordance with generally accepted
accounting procedures, shall be clearly identified, and shall be kept readily accessible and available for
inspection, as described in Section 9, Audits and Inspections, herein. All such records shall be retained by
CMC and kept accessible as required by State of California and Federal law.
13. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
A. COUNTY and CMC each consider and represent themselves as covered entities as
defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law 104-191
(HIPAA) and agree to use and disclose Protected Health Information (PHI) as required by law.
COUNTY and CMC acknowledge that the exchange of PHI between them is only for treatment,
payment, and health care operations.
COUNTY and CMC intend to protect the privacy and provide for the security of PHI pursuant to the
Agreement in compliance with HIPAA, the Health Information technology for Economic and Clinical Health
Act, Public Law 111-005 (HITECH), and regulations promulgated thereunder by the U.S. Department of
Health and Human Service (HIPAA Regulations) and other applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require CMC to enter into
a contract containing specific requirements prior to the disclosure of PHI, as set forth in, but not limited to
Title 45, Sections 164.314(a), 164.502(e), and 164.504(e) of the Code of Federal Regulations.
B. CMC shall report to COUNTY, in writing, any knowledge or reasonable belief that
there has been unauthorized access, viewing, use, disclosure, security incident, or breach of unsecured
PHI not permitted by this Agreement of which it becomes aware, immediately and without reasonable delay
and in no case later than two (2) business days of discovery. Immediate notification shall be made to
COUNTY’S Information Security Officer and Privacy Officer and COUNTY’S DPH HIPAA Representative,
within two (2) business days of discovery. The notification shall include, to the extent possible, the
identification of each individual whose unsecured PHI has been, or is reasonably believed to have been,
accessed, acquired, used, disclosed, or breached. CMC shall take prompt corrective action to cure any
deficiencies and any action pertaining to such unauthorized disclosure required by applicable Federal and
State Laws and regulations. CMC shall investigate such breach and is responsible for all notifications
required by law and regulation or deemed necessary by COUNTY and shall provide a written report of the
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investigation and reporting required to COUNTY’S Information Security Officer and Privacy Officer and
COUNTY’S DPH HIPAA Representative. This written investigation and description of any reporting
necessary shall be postmarked within the thirty (30) working days of the discovery of the breach to the
addresses below:
County of Fresno County of Fresno County of Fresno
Dept. of Public Health Dept. of Public Health Internal Services Department
HIPAA Representative Privacy Officer Information Security Officer
(559) 600-6439 (559) 600-6405 (559) 600-5800
P.O. Box 11867 P.O. Box 11867 333 W. Pontiac Way
Fresno, CA 93775 Fresno, CA 93775 Clovis, CA 93612
///
14. GOVERNING LAW
Venue for any action arising out of or related to this Agreement shall only be in Fresno
County, California.
The rights and obligations of the parties and all interpretation and performance of this Agreement
shall be governed in all respects by the laws of the State of California.
15. NON-DISCRIMINATION
During the performance of this Agreement, CMC shall not unlawfully discriminate against
any employee or applicant for employment, or recipient of services, because of race, religious creed,
color, national origin, ancestry, physical disability, mental disability, medical condition, genetic
information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation,
military status or veteran status pursuant to all applicable State of California and Federal statutes and
regulation.
16. DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CMC is operating as a corporation (a for-profit or
non-profit corporation) or if during the term of the agreement, the CMC changes its status to operate as
a corporation.
Members of the CMC’s Board of Directors shall disclose any self-dealing transactions that they
are a party to while CMC is providing goods or performing services under this agreement. A self-dealing
transaction shall mean a transaction to which the CMC is a party and in which one or more of its
directors has a material financial interest. Members of the Board of Directors shall disclose any self -
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dealing transactions that they are a party to by completing and signing a Self-Dealing Transaction
Disclosure Form, attached hereto as Exhibit 5 and incorporated herein by reference, and submitting it to
the COUNTY prior to commencing with the self-dealing transaction or immediately thereafter.
17. SEVERABILITY
The provisions of this Agreement are severable. The invalidity or unenforceability of any
one provision in the Agreement shall not affect the other provisions.
18. SUPERSEDE
This Agreement shall supersede in its entirety and render null and void the Agreement for
Comprehensive Hospital Services, Emergency Care, and Outpatient Clinic Facilities to MISP beneficiaries
between COUNTY and CMC identified as COUNTY Board Agreement No. 14-676, which became
effective November 4, 2014.
19. ENTIRE AGREEMENT
This Agreement constitutes the entire agreement between CMC and COUNTY with
respect to the subject matter hereof and supersedes all previous Agreement negotiations, proposals,
commitments, writings, advertisements, publications, and understanding of any nature whatsoever unless
expressly included in this Agreement.
///
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EXHIBIT 1
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EXHIBIT 2
Hospital and Clinic Services
Emergency Care Services
Comprehensive Inpatient Hospital Services
Outpatient Clinic Services including, but not limited to:
o Laboratory
o Radiology/X-ray
o Home Health
o Pharmacy
o Physical and Occupational Therapy
o Endoscopy
Other services that are Medi-Cal and MISP covered services that are mutually agreed upon between
CMC and the County’s Department of Public Health Director.
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EXHIBIT 3
Participating Affiliated Hospitals and Facilities
Acute Facilities
Fresno Community Hospital & Medical Center
d.b.a. Community Regional Medical Center
2823 Fresno Street Tax I.D. # 94-1156276
Fresno, CA 93724 Medicare # 050060
(559) 459-6000 State License #040000096
Accredited by The Joint Commission NPI # 1104906569
Fresno Community Hospital & Medical Center
d.b.a. Clovis Community Medical Center
2755 Herndon Avenue Tax I.D. # 94-1156276
Clovis, CA 93611 Medicare # 050492
(559) 324-4000 State License # 040000004
Accredited by The Joint Commission NPI # 1316027709
Fresno Community Hospital & Medical Center
d.b.a. Fresno Heart & Surgical Hospital
15 E. Audubon Drive Tax I.D. # 94-1156276
Fresno, CA 93720 Medicare # 050060
(559) 433-8000 State License # 0400000096
Accredited by The Joint Commission NPI # 1104906569
Cancer Service Facilities
Fresno Community Hospital & Medical Center
d.b.a. Community Cancer Institute (Inpatient) Tax I.D. # 94-1156276
2823 Fresno Street Medicare # 050060
Fresno, CA 93721 NPI # 1104906569
(559) 459-6000
Fresno Community Hospital & Medical Center
d.b.a. California Cancer Center Tax I.D. # 94-1156276
785 N. Medical Center Drive West Medicare # 050060
Clovis, CA 93611 NPI # 1104906569
(559) 387-1802
Outpatient Dialysis Service Facilities
Fresno Community Hospital & Medical Center
d.b.a. Community Dialysis Center-Fresno Tax I.D. # 94-1156276
285 N. Fresno Street Medicare # 05-3525
Fresno, CA 93701 NPI #1821179656
(559) 459-3901
Fresno Community Hospital & Medical Center
d.b.a. Community Regional Outpatient Dialysis Center Tax I.D # 94-1156276
215 N. Fresno Street, Suite 150 Medicare # 05-3524
Fresno, CA 93701 NPI # 1497836613
(559) 459-6000
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EXHIBIT 3 (continued)
Participating Affiliated Hospitals and Facilities
Home Health Services
Fresno Community Hospital & Medical Center
d.b.a. Community Home Care Tax I.D. # 94-1156276
1630 E. Shaw Avenue, Suite 172 Medicare #05-7248
Fresno, CA 93710 NPI # 1588745137
(559) 724-4242
Fresno Community Hospital & Medical Center
d.b.a. Community Home Infusion Tax I.D. # 77-0175659 (Home 1630
E. Shaw Avenue, Suite 172 Therapy & Pharmacy)
Fresno, CA 93710 Medicare # 019553002
(559) 724-4242 NPI # 1669553129
Outpatient Imaging Services
Community Regional Medical Center Imaging
2823 Fresno St.
Fresno, CA 93721
(559) 459-2800
Clovis Community Medical Center
2755 E. Herndon Ave.
Clovis, CA 324-4048
Radin Breast Care Center
(559) 324-4444
Fresno Heart & Surgical Hospital
15 East Audubon Drive
Fresno, CA 93720
(559) 433-8000
Infusion Therapy (Outpatient) Facilities
Fresno Community Hospital & Medical Center
d.b.a. Community Ambulatory Infusion Center Tax I.D. # 94-1156276
2335 E. Kashian Lane, Suite 110 Medicare # 050060
Fresno, CA 93701 NPI # 1104906569
(559) 459-6000
Fresno Community Hospital & Medical Center
d.b.a. Infusion Clinic @ Ambulatory Infusion Center-Clovis Tax I.D. # 94-1156276
729 Medical Center Drive, Suite 215 Medicare # 050060
Clovis, CA 93611 NPI # 1104906569
(559) 324-4000
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EXHIBIT 3 (continued)
Participating Affiliated Hospitals and Facilities
Medical Rehabilitation Services Facilities
Fresno Community Hospital & Medical Center
d.b.a. Leon S. Peters Rehabilitation Center (Inpatient) Tax I.D. # 94-1156276
2823 Fresno Street Medicare # 050060
Fresno, CA 93721 NPI # 1679654404
(559) 459-6000
Fresno Community Hospital & Medical Center
d.b.a. Community Outpatient Rehabilitation Center
Outpatient Neurological Training, PT, OT, ST, and Lymphedema Therapy
215 N. Fresno Street, Suite 250 Tax I.D. # 94-1156276
Fresno, CA 93701 Medicare # 050060
(559) 324-4057 NPI # 1104906569
Fresno Community Hospital & Medical Center
d.b.a. Clovis Community Hospital & Medical Center
Outpatient Physical Therapy Tax I.D. # 94-1156276
688 Medical Center Drive, Suite 101 Medicare # 050492
Clovis, CA 93611 NPI # 1316027709
(559) 324-4057
Pharmacy (Off-Site/Outpatient)
Community Health Enterprises
d.b.a. Care Center Pharmacy Tax I.D. # 77-0175659
1570 E. Herndon Avenue Medicare # 0194440002
Fresno, CA 93720 NABP # 05-69042
(559) 437-7370 NPI # 1497813901
Ambulatory Clinic Facilities
Fresno Community Hospital & Medical Center
d.b.a. Deran Koligian Ambulatory Care Center
290 N. Wayte Lane Tax I.D. # 94-1156276
Fresno, CA 93701 Medicare # 050060
(559) 459-4900 NPI # 1104906569
Family HealthCare Network
d.b.a. Deran Koligian Ambulatory Care Center
290 N. Wayte Lane Tax I.D. # 94-2525145
Fresno, CA 93701 Medicare # 921087
(559) 459-4900 NPI # 1225546575
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EXHIBIT 3 (continued)
Participating Affiliated Hospitals and Facilities
Fresno Community Hospital & Medical Center
d.b.a North Medical Plaza
215 N. Fresno Street, Suites 230 & 370 Tax I.D. # 94-1156276
Fresno, CA 93701 Medicare # 050060
(559) 459-4900 NPI # 1104906569
(Services Provided: Diabetes Center and Pediatric Specialty Department ONLY)
Urgent Care/Emergency Room Facilities
Fresno Community Hospital & Medical Center
d.b.a Community Regional Medical Center Tax I.D. # 94-1156276
2823 Fresno Street Medicare # 050060
Fresno, CA 93721 State License # 040000096
(559) 459-6000 NPI # 1104906569
Fresno Community Hospital & Medical Center
d.b.a. Clovis Community Hospital & Medical Center Tax I.D. # 94-1156276
2755 Herndon Avenue Medicare # 050492
Clovis, CA 93611 State License # 040000096
(559) 324-4000 NPI # 1316027709
Subacute Center (Medical Ventilation)
Fresno Community Hospital & Medical Center
d.b.a Community Subacute and Transitional Care Center Tax I.D. # 94-1156276
3003 N. Mariposa St. Medicare # 055258
Fresno, CA 93703 State License # 040000096
(559) 459-1711 NPI # 1104906569
Services may be provided at other CMC facilities within Fresno County as determined by CMC and
agreed upon by the County’s Department of Public Health Director.
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EXHIBIT 4
Reimbursement Schedules for Inpatient Hospital Services, Emergency Care, and Outpatient
Hospital and Clinic Services
Reimbursement Schedule
Participating Affiliated Hospitals and Facilities as stated in Exhibit 3
It is the mutual intent of the contracting parties that the reimbursement be equivalent to 100% of
Medicare allowable. Due to the complexity in administrating reimbursement based upon this
methodology, payment will be made on a percentage of charges basis that equates to CMC’s Medicare
payment percentage. Said percentage of charges will be adjusted on an annual basis to reflect CMC’s
current Medicare payment percentage according to the prior year cost reports and settlements. CMC will
make its best effort to provide an updated worksheet annually by February 15th of each year to reflect
modifications to be effective on March 1st of that year.
Reimbursement:
Percentages below shall be effective August 20th, 2019 – February 2020. Percentages shall be updated
annually and shall be effective on March 1st of each year. Clinic facility and emergency department
facility fees will be paid according to the terms of outpatient services.
Inpatient Services 20.394% of billed charges
Outpatient Services 15.084% of billed charges
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EXHIBIT 4-A
CMC Medicare Acute Prospective Payment System (PPS) Reimbursement
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EXHIBIT 5
Self-Dealing Transaction Disclosure Form
In order to conduct business with the County of Fresno (hereinafter referred to as “County”),
members of a contractor’s board of directors (hereinafter referred to as “County Contractor”), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest .”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member’s name, job title (if applicable), and date this disclosure is being made.
(2) Enter the board member’s company/agency name and address.
(3) Describe in detail the nature of the self -dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which t he Corporation has the transaction;
and
b. The nature of the material financial interest in the Corporation’s transaction that the
board member has.
(4) Describe in detail why the self -dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self -dealing transaction
described in Sections (3) and (4).
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(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to):
(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a):
(5) Authorized Signature
Signature: Date: