20031202_a

AMENDMENT TO THE AGREEMENT BETWEEN

THE COUNTY OF SAN MATEO AND
SETON MEDICAL CENTER

FOR TERTIARY AND SPECIALTY SERVICES

THIS AGREEMENT, entered into this _ __ day of _________________, 2003, by and between the COUNTY OF SAN MATEO (hereinafter called "County") and SETON MEDICAL CENTER (hereinafter called "Contractor"),

W I T N E S S E T H:

WHEREAS, on September 10, 2002, the parties hereto entered into an agreement (hereinafter referred to as the "Original Agreement") for the furnishing of certain services by Contractor to County as set forth in that Original Agreement; and

WHEREAS, it is now the mutual desire and intent of the parties hereto to amend and clarify that Original Agreement;

NOW, THEREFORE, IT IS HEREBY AGREED between the parties that the Original Agreement is amended as follows:

All references to "San Mateo County General Hospital" are hereby amended to read "San Mateo Medical Center".

Paragraph 4., Hold Harmless, of the Original Agreement is hereby amended to read as follows:

"4.

Hold Harmless

Contractor shall indemnify and save harmless County, its officers, agents, employees, and servants from all claims, suits, or actions of every name, kind and description, brought for, or on account of: (A) injuries to or death of any person, including Contractor, or (B) damage to any property of any kind whatsoever and to whomsoever belonging, or (C) any sanctions, penalties or claims of damages resulting from Contractor's failure to comply with the requirements set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and all Federal regulations promulgated thereunder, as amended, or (D) other loss, cost, including but not limited to that caused by the concurrent active or passive negligence of

County, its officers, agents, employees, or servants, resulting from the performance of any work required of Contractor or payments made pursuant to this Agreement, provided that this shall not apply to injuries or damage for which County has been found in a court of competent jurisdiction to be solely liable by reason of its own negligence or willful misconduct.

The duty of Contractor to indemnify and save harmless as set forth herein, shall include the duty to defend as set forth in Section 2778 of the California Civil Code.

County shall indemnify and hold harmless Contractor, its officers, agents, employees and servants from all claims, suits or actions of every name, kind and description, brought for, or on account of injuries to or death of any person, including County, or damages to property of any kind whatsoever and to whomsoever belonging, including but not limited to the concurrent active or passive negligence of Contractor, its officers, agents, employees and servants, resulting from the performance of any work required of County, provided that this shall not apply to injuries or damage for which Contractor has been found in a court of competent jurisdiction to be solely liable by reason of its own negligence or willful misconduct.

The duty of County to indemnify and save harmless as set forth herein shall include the duty to defend as set forth in Section 2778 of the California Code.

In the event of concurrent negligence of Contractor, its officers and /or employees, and County, its officers, and/or employees, then the liability for any and all claims for injuries or damages to persons and/or property which arise out of the terms and conditions of this Agreement shall be apportioned under the California theory of comparative negligence as established presently, or as may be hereafter modified."

Paragraph 10, Compliance with Applicable Laws, of the original agreement is hereby amended to read as follows:

"10.

Compliance with laws; payment of Permits/Licenses.

All services to be performed by Contractor pursuant to this Agreement shall be performed in accordance with all applicable Federal, State, County, and municipal laws, including, but not limited to, Health Insurance Portability and Accountability Act of 1996 (HIPAA) and all Federal regulations promulgated

thereunder, as amended, and the Americans with Disabilities Act of 1990, as amended, and Section 504 of the Rehabilitation Act of 1973, as amended and attached hereto and incorporated by reference herein as Attachment "I," which prohibits discrimination on the basis of handicap in programs and activities receiving any Federal or County financial assistance. Such services shall also be performed in accordance with all applicable ordinances and regulations, including, but not limited to, appropriate licensure, certification regulations, provisions pertaining to confidentiality of records, and applicable quality assurance regulations.

In the event of a conflict between the terms of this agreement and State, Federal, County, or municipal law or regulations, the requirements of the applicable law will take precedence over the requirements set forth in this Agreement.

Contractor will timely and accurately complete, sign, and submit all necessary documentation of compliance."

Paragraph 13, Term of the Agreement, Part A, of the original agreement is hereby amended to read as follows:

"13.

Term of the Agreement.

A. This Agreement shall be in full force and effect for a period effective January 1, 2002 and terminating June 30, 2003."

Schedule A and Schedule B of the Original Agreement are hereby amended to read as follows:

Schedule A

February 1, 2002 through June 30, 2003

Services

Diagnostic and Tertiary Care Services

A.

In consideration of the payments provided for in Schedule B,

paragraph I, of this Agreement, Contractor shall provide the

full range of its available diagnostic and therapeutic services

on a 24 hour/7days a week basis to medically indigent

patients referred in writing by County, subject to the provision

of Schedule B, paragraph I.

B.

In the event that the patient must be hospitalized in Contractor's facility, Contractor's medical staff shall confer with San Mateo Medical Center medical staff to determine if or when a transfer to San Mateo Medical Center is medically appropriate. Medical records of the patient's stay at Contractor's facility shall accompany the patient.

C.

County shall supply appropriate medical information to Contractor concerning patients referred to Contractor.

D.

The services provided must be referred by a member of the San Mateo Medical Center's medical staff and authorized by the Case Management Department or San Mateo Medical Center Administration. A valid written outside authorized referral form must accompany the patient. Any patients who have not been referred and approved by the County for treatment will be the financial responsibility of Contractor or other third party payor. This includes any patient who arrives directly by ambulance, referred by private physicians, walk-in, and any patient who is awaiting an available bed at San Mateo Medical Center.

E. County indigents who present at Contractor's facility without being referred in writing by San Mateo Medical Center are expressly excluded from the terms of this Agreement. If a County indigent presents at Contractor's facility, Contractor shall contact San Mateo Medical Center's Admitting Department for transfer and/or authorization.

SCHEDULE B

Effective February 1, 2002 - June 30, 2003

Payments

Medical/Surgical/ICU Per Diem

$1,190

Open Heart Surgery Case Rate

$7,083/case up to 3 days

$1,190/day additional days

Outpatient Surgery

126% of the Labor Adjusted San Mateo Medicare ASC Rates

Outpatient Services

105% of the San Mateo Medicare Participating Fee Schedule for "Part B" Services. Services not on the Fee Schedule are to be paid at 60% of billed charges NTE $1640/day *

SNF Per Diem

$537

Biologic and non-biologic implants

Billed at invoice cost

*Provider will bill using CPT coding convention for all

HCFA - Part B services.

In no case will reimbursement be less than 25% of

billed charges.

A. A.

The preceding per diem rates apply to each approved, medically

necessary day of service and includes payment for all services

rendered during the admission including but not limited to: pre-

admission services for provider within 48 hours of admission,

room, board, nursing care, surgery and recovery suites,

equipment, supplies, laboratory, radiology, pharmaceuticals and

The preceding outpatient surgery rates apply to all services

rendered during the surgery including but not limited to: pre-

operative outpatient services within 48 hours of the surgery,

nursing care, surgery and recovery suites, equipment, supplies,

laboratory, radiology, pharmaceuticals and other services

The preceding rates exclude professional services that are not

The preceding rates apply to all authorized services available

from Contractor. Hospital services are described in the hospital

Pre-admission services provided within 72 hours of admission will

be included in the first per diem.

Contractor shall be reimbursed per current HCFA billing

guidelines.

Contractor shall provide a combined billing which details all

services performed and the charges therefore, including hospital-

based physician's fees. All billings will be subject to a utilization

review process prior to payment. A copy of an authorized outside

referral form must accompany all billings.

Contractor shall bill all other payors including, but not limited to,

Medi-Cal outpatients, Medicare outpatients, private insurance

patients and "full pay" patients. County shall bear no financial

responsibility for such patients.

Per Medi-Cal guidelines, as the Provider of Service, Contractor

must complete and submit a Treatment Authorization Request

(TAR) Form 50-1 to the appropriate Medi-Cal field office. County

will provide information on the Outside Referral Form that will

enable Contractor to complete these TARs.

In the event that a patient referral to Contractor by County under this Agreement is subsequently determined to be eligible for third-party payment, Contractor shall claim against third-party payor and County shall bear no financial responsibility for such patient.

In the event of the referral of a Medi-Cal pending patient, the

County shall have six (6) months to provide proof of eligibility.

After this time, the Contractor will be reimbursed at the agreed

upon rate. If patient is subsequently found eligible for Medi-Cal

after payment has been made, San Mateo County General

Hospital will provide proof of retroactive eligibility to Contractor.

Any payment made to Contractor must be reimbursed to San

Mateo County General Hospital within thirty (30) days of such

Notification.

In no event shall total payment exceed $1,049,000.

NOW, THEREFORE, IT IS HEREBY AGREED BY THE PARTIES that the Agreement of September 10, 2002, be amended accordingly.

IN WITNESS WHEREOF, the parties hereto, by their duly authorized representatives, have affixed their hand on the day and year first above written.

COUNTY OF SAN MATEO

By:

Rose Jacobs Gibson

President, Board of Supervisors
San Mateo County

Date:

ATTEST:

By:

Clerk of Said Board

Date: