20040727_a

AGREEMENT BETWEEN THE COUNTY OF SAN MATEO AND

SETON MEDICAL CENTER

THIS AGREEMENT, entered into this _____ day of _______________ , 2004, by and between the COUNTY OF SAN MATEO, SAN MATEO MEDICAL CENTER, hereinafter called "County," and SETON MEDICAL CENTER, hereinafter called "Contractor";

W I T N E S S E T H:

WHEREAS, pursuant to Government Code, Section 31000, County may contract with independent contractors for the furnishing of such services to or for County or any Department thereof;

WHEREAS, it is necessary and desirable that Contractor be retained for the purpose of providing diagnostic and therapeutic services not available at San Mateo Medical Center as described in Schedule A.

NOW, THEREFORE, IT IS HEREBY AGREED BY THE PARTIES HERETO AS FOLLOWS:

1.

Exhibits.

The following exhibits are attached hereto and incorporated by reference herein:

Exhibit A—Services

Exhibit B—Payments and rates

Attachment I—§504 Compliance

2.

Services to be performed by Contractor.

In consideration of the payments set forth herein and in Exhibit “B,” Contractor shall perform services for County in accordance with the terms, conditions and specifications set forth herein and in Exhibit “A.”

3.

Payments.

In consideration of the services provided by Contractor in accordance with all terms, conditions and specifications set forth herein and in Exhibit "A," County shall make payment to Contractor based on the rates and in the manner specified in Exhibit "B." The County reserves the right to withhold payment if the County determines that the quantity or quality of the work performed is unacceptable. In no event shall the County’s total fiscal obligation under this Agreement exceed $600,000.

The maximum County obligation specified in paragraph A is based on projected utilization. If utilization exceeds projections and the County maximum obligation is expended prior to the termination or expiration of this Agreement, Contractor may discontinue services. County may, at its discretion, agree to an amendment whereby its maximum obligation is increased in consideration of Contractor’s provision of services that are necessitated by changed projections or increased utilization.

Contractor shall submit an invoice for services to County for payment in accordance with the provisions of Schedule B. All invoices must be submitted to: San Mateo County General Health Center, 222 West 39^th Avenue, San Mateo, CA 94403, Attn.: Case Management Department. County shall not be obligated to pay Contractor for the services covered by any invoice if Contractor presents the invoice to County more than one hundred eighty (180) days after the date Contractor renders the services or after eligibility has been determined, whichever is later, or more than ninety (90) days after this Agreement terminates, whichever is earlier. Any tracers or appeals must be submitted to County within two hundred and seventy (270) days after the date Contractor renders the services. County shall not be obligated to respond to any tracers or appeals submitted by Contractor for services rendered to patients without an authorized referral form. County shall pay Contractor for services within forty-five (45) days after receipt of approved billing.

4.

Term and Termination.

Subject to compliance with all terms and conditions, the term of this Agreement shall be from July 1, 2004 through June 30, 2005.

This Agreement may be terminated by Contractor, the Chief Executive Officer of San Mateo Medical Center, or his/her designee at any time without a requirement of good cause upon thirty (30) days’ written notice to the other party.

In the event of termination, all finished or unfinished documents, data, studies, maps, photographs, reports, and materials (hereafter referred to as materials) prepared by Contractor under this Agreement shall become the property of the County and shall be promptly delivered to the County. Upon termination, the Contractor may make and retain a copy of such materials. Subject to availability of funding, Contractor shall be entitled to receive payment for work/services provided prior to termination of the Agreement. Such payment shall be that portion of the full payment that is determined by comparing the work/services completed to the work/services required by the Agreement.

5.

Availability of Funds.

The County may terminate this Agreement or a portion of the services referenced in the Attachments and Exhibits based upon unavailability of Federal, State, or County funds, by providing written notice to Contractor as soon as is reasonably possible after the county learns of said unavailability of outside funding.

6.

Relationship of Parties.

Contractor agrees and understands that the work/services performed under this Agreement are performed as an independent Contractor and not as an employee of the County and that Contractor acquires none of the rights, privileges, powers, or advantages of County employees.

7.

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, (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) any other loss or 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.

8.

Assignability and Subcontracting.

Contractor shall not assign this Agreement or any portion thereof to a third party or subcontract with a third party to provide services required by contractor under this Agreement without the prior written consent of County. Any such assignment or subcontract without the County’s prior written consent shall give County the right to automatically and immediately terminate this Agreement.

9.

Insurance.

The Contractor shall not commence work or be required to commence work under this Agreement unless and until all insurance required under this paragraph has been obtained and such insurance has been approved by Risk Management, and Contractor shall use diligence to obtain such issuance and to obtain such approval. The Contractor shall furnish the Department/Division with certificates of insurance evidencing the required coverage, and there shall be a specific contractual liability endorsement extending the Contractor's coverage to include the contractual liability assumed by the Contractor pursuant to this Agreement. These certificates shall specify or be endorsed to provide that thirty (30) days' notice must be given, in writing, to the Department/Division of any pending change in the limits of liability or of any cancellation or modification of the policy.

(1)

Worker's Compensation and Employer's Liability Insurance. The Contractor shall have in effect during the entire life of this Agreement Workers' Compensation and Employer's Liability Insurance providing full statutory coverage. In signing this Agreement, the Contractor certifies, as required by Section 1861 of the California Labor Code, that it is aware of the provisions of Section 3700 of the California Labor Code which requires every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions of the Code, and it will comply with such provisions before commencing the performance of the work of this Agreement.

(2)

Liability Insurance. The Contractor shall take out and maintain during the life of this Agreement such Bodily Injury Liability and Property Damage Liability Insurance as shall protect him/her while performing work covered by this Agreement from any and all claims for damages for bodily injury, including accidental death, as well as any and all claims for property damage which may arise from contractors operations under this Agreement, whether such operations be by himself/herself or by any sub-contractor or by anyone directly or indirectly employed by either of them. Such insurance shall be combined single limit bodily injury and property damage for each occurrence and shall be not less than the amount specified below.

Such insurance shall include:

(a)

Comprehensive General Liability . . . . . . . . . . . . . . .

$5,000,000

(b)

Motor Vehicle Liability Insurance . . . . . . . . . . . . . . .

$ -0-

(c)

Professional Liability . . . . . . . . . . . . . . . . . . . . . . . . .

$5,000,000

County and its officers, agents, employees and servants shall be named as additional insured on any such policies of insurance, which shall also contain a provision that the insurance afforded thereby to the County, its officers, agents, employees and servants shall be primary insurance to the full limits of liability of the policy, and that if the County or its officers and employees have other insurance against the loss covered by such a policy, such other insurance shall be excess insurance only.

In the event of the breach of any provision of this section, or in the event any notice is received which indicates any required insurance coverage will be diminished or canceled, the County of San Mateo at its option, may, notwithstanding any other provision of this Agreement to the contrary, immediately declare a material breach of this Agreement and suspend all further work pursuant to this Agreement.

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.

11.

Non-Discrimination.

A.

Section 504 applies only to Contractors who are providing services to members of the public. Contractor shall comply with § 504 of the Rehabilitation Act of 1973, which provides that no otherwise qualified handicapped individual shall, solely by reason of a disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination in the performance of this Agreement.

B.

General non-discrimination. No person shall, on the grounds of race, color, religion, ancestry, gender, age (over 40), national origin, medical condition (cancer), physical or mental disability, sexual orientation, pregnancy, childbirth or related medical condition, marital status, or political affiliation be denied any benefits or subject to discrimination under this Agreement.

C.

Equal employment opportunity. Contractor shall ensure equal employment opportunity based on objective standards of recruitment, classification, selection, promotion, compensation, performance evaluation, and management relations for all employees under this Agreement. Contractor’s equal employment policies shall be made available to County of San Mateo upon request.

D.

Violation of Non-discrimination provisions. Violation of the non-discrimination provisions of this Agreement shall be considered a breach of this Agreement and subject the Contractor to penalties, to be determined by the County Manager, including but not limited to

i)

termination of this Agreement;

ii)

disqualification of the Contractor from bidding on or being awarded a County contract for a period of up to 3 years;

iii)

liquidated damages of $2,500 per violation;

iv)

imposition of other appropriate contractual and civil remedies and sanctions, as determined by the County Manager.

To effectuate the provisions of this section, the County Manager shall have the authority to examine Contractor’s employment records with respect to compliance with this paragraph and/or to set off all or any portion of the amount described in this paragraph against amounts due to Contractor under the Contract or any other Contract between Contractor and County.

Contractor shall report to the County Manager the filing by any person in any court of any complaint of discrimination or the filing by any person of any and all charges with the Equal Employment Opportunity Commission, the Fair Employment and Housing Commission or any other entity charged with the investigation of allegations within 30 days of such filing, provided that within such 30 days such entity has not notified Contractor that such charges are dismissed or otherwise unfounded. Such notification shall include the name of the complainant, a copy of such complaint, and a description of the circumstance. Contractor shall provide County with a copy of their response to the Complaint when filed.

E.

Compliance with Equal Benefits Ordinance. With respect to the provision of employee benefits, Contractor shall comply with the County Ordinance, which prohibits contractors from discriminating in the provision of employee benefits between an employee with a domestic partner and an employee with a spouse.

F. E.

The Contractor shall comply fully with the non-discrimination requirements required by 41 CFR 60-741.5(a), which is incorporated herein as if fully set forth.

12.

Retention of Records.

Contractor shall maintain all required records for three (3) years after the County makes final payment and all other pending matters are closed, and shall be subject to the examination and/or audit of the County, a Federal grantor agency, and the State of California.

13.

Merger Clause.

This Agreement, including the Exhibits attached hereto and incorporated herein by reference, constitutes the sole Agreement of the parties hereto and correctly states the rights, duties, and obligations of each party as of this document's date. Any prior agreement, promises, negotiations, or representations between the parties not expressly stated in this document are not binding. All subsequent modifications shall be in writing and signed by the parties.

14.

Controlling Law.

The validity of this Agreement and of its terms or provisions, as well as the rights and duties of the parties hereunder, the interpretation, and performance of this Agreement shall be governed by the laws of the State of California.

15.

Notices.

Any notice, request, demand, or other communication required or permitted hereunder shall be deemed to be properly given when deposited in the United State mail, postage prepaid, or when deposited with a public telegraph company for transmittal, charges prepaid, addressed to:

In the case of County, to:

San Mateo Medical Center

Attn: Linda Wallach

222 W. 39^th Avenue

San Mateo, CA 94403

In the case of Contractor, to:

Daughters of Charity Health System

c/o Seton Medical Center

1900 Sullivan Avenue

Daly City, CA 94015



IN WITNESS WHEREOF, the parties hereto, by their duly authorized representatives, have affixed their hands.



Seton Medical Center	COUNTY OF SAN MATEO


By:	By:
J. Marc Golan Chief Financial Officer DCHS Bay Area	Mark Church President, Board of Supervisors San Mateo County

Date:	Date:



ATTEST:


By:
Clerk of Said Board



















Revised 6/03
Long Form Agreement/Non Business Associate


Exhibit “A”

In consideration of the payments set forth in Exhibit “B”, Contractor shall provide the following services:

I.		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/7 days 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 specifically referred by a member of San Mateo Medical Center’s medical staff and approved by San Mateo Medical Center Administration on a referral form provided by County and will accompany the patient.

		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.

		F.	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.









Exhibit “B”
I.		In consideration of the services provided by Contractor in Exhibit “A”, County shall pay Contractor based on the following fee schedule:

				Seton Medical Center
				Inpatient and O/P Services Contract Rates
				for San Mateo Medical Center

Effective:					07/01/04


1.			Medical/Surgical/ICU Bed				$1,190		Per Diem

2.			Inpatient Cardiac Procedures/Surgery						See attached rate sheet

3.			Outpatient Cardiac Procedures						100% Medicare APC

4.			Brachytherapy				$15,000		Case Rate
							Seeds:		Invoice Cost

5.			Lithotripsy				Phased:		$2,023
							Single:		$4,041
							Bilateral:		$6,070

6.			MRI (excludes Gadolinium)						Medicare APC Fee Schedule
7.			Radiation Therapy					Medicare APC Fee Schedule
8.			O/P Renal Dialysis			Per Run:		Medicare Fee Schedule
						Epoitin:		Medicare Fee Schedule

9.			Laboratory					Medicare APC Fee Schedule

10.			Galadium					Invoice Cost

11.			AICD					Invoice Cost

12.			Implants					Invoice Cost

13.			O/P Surgery O/P Urology Surgery O/P Urology Cardiac Procedure					100% Medicare APC 100% Medicare APC 100% Medicare APC

14.			O/P- All Other Services					50% of Charges NTE $1,500 per day


Notes:					Rates are exclusive of Professional Services and separately paid for by SMMC. Medicare rate will be current fee schedule at time service is provided.

		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 24 hours of admission, room, board, nursing care, surgery and recovery suites, equipment, supplies, laboratory, radiology, pharmaceuticals and other services incidental to the admission.

		B.	The preceding outpatient surgery rates apply to all services rendered during the surgery including but not limited to: pre-operative outpatient services within 24hours of the surgery, nursing care, surgery and recovery suites, equipment, supplies, laboratory, radiology, pharmaceuticals and other services incidental to the surgery.

	C.		The preceding rates exclude professional services that are not billed under the Contractor's TIN. Laboratory rates will be understood to mean lab services associated with referred patients as well as lab specimen referrals for which no advance case management paperwork will be required.

	D.		The preceding rates apply to all authorized services available from Contractor. Hospital services are described in the hospital services inventory attached as Exhibit I.

		E.	Pre-admission services provided within 72 hours of admission will be included in the first per diem.

		F.	Contractor shall be reimbursed per current HCFA billing guidelines.

	G.		Per diem rates exclude hospital-based physician fees.

	H.		The services provided must be referred by a member of San Mateo Medical Center's medical staff and authorized by the Case Management Department or Hospital Administration. A valid outside authorized referral form must accompany the patient.

	I.		Contractor shall provide a combined billing which details all services performed and the charges therefore, excluding 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.

	J.		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.

		K.	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.

		L.	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.

	M.		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 Medical Center will provide proof of retroactive eligibility to Contractor. Any payment made to Contractor must be reimbursed to San Mateo Medical Center within thirty (30) days of such notification.

		The term of this agreement is July 1, 2004 to June 30, 2005. In no event shall total payment exceed $600,000.

RATE SHEET

DRG

Description

Case Rate

104

Cardiac valve procedure with cardiac cath

54,642

105

Cardiac valve procedure without cardiac cath

39,699

106

Coronary bypass with PTCA

50,887

107

Coronary bypass with cardiac cath

36,818

108

Other cardio thoracic procedures

37,439

109

Coronary bypass without PTCA or cardiac cath

27, 210

110

Major cardiovascular procedures with cc

28,182

111

Major cardiovascular procedures without cc

16,807

115

Perm cardiac pacemaker implant w/AMI, heart failure or shock

23,565

116

Other Perm card pacemaker implant or PTCA with coronary artery stent implant

15,780

117

Cardiac pacemaker revision except devise replacement

9,125

118

Cardiac pacemaker devise replacement

10,727

124

Circulatory disorders exc AMI with card cath & complex diag

9,856

125

Circulatory disorders exc AMI with card cath without complex diag

7,414

514

Cardiac Defibrillator Implant w Cardiac Cath (no longer valid)

515

Cardiac Defibrillator Implant without Cardiac Cath

34,571

516

Percutaneous Cardiovascular Proc with AMI

18,647

517

Perc Cardio Proc with Coronary Artery Stent without AMI

14,898

518

Perc Cardio Proc without Coronary Artery Stent or AMI

11,826

526

Percutaneous Cardiovascular Proc W Drug Eluting Stent W AMI

21,316

527

Percutaneous Cardiovascular Proc W Drug Eluting Stent without AMI

17,327

535

Cardiac Defibrillator Implant with Cardiac Cath with AMI/HF/SHOCK

59,500

536

Cardiac Defibrillator Implant with Cardiac Cath without AMI/HF/SHOCK

45,252


AGREEMENT BETWEEN THE COUNTY OF SAN MATEO AND SETON MEDICAL CENTER

THIS AGREEMENT, entered into this _____ day of _______________ , 2004, by and between the COUNTY OF SAN MATEO, SAN MATEO MEDICAL CENTER, hereinafter called "County," and SETON MEDICAL CENTER, hereinafter called "Contractor";

W I T N E S S E T H:

WHEREAS, pursuant to Government Code, Section 31000, County may contract with independent contractors for the furnishing of such services to or for County or any Department thereof;

WHEREAS, it is necessary and desirable that Contractor be retained for the purpose of providing diagnostic and therapeutic services not available at San Mateo Medical Center as described in Schedule A.


NOW, THEREFORE, IT IS HEREBY AGREED BY THE PARTIES HERETO AS FOLLOWS:

1.		Exhibits.
The following exhibits are attached hereto and incorporated by reference herein: Exhibit A—Services Exhibit B—Payments and rates Attachment I—§504 Compliance

2.		Services to be performed by Contractor.
In consideration of the payments set forth herein and in Exhibit “B,” Contractor shall perform services for County in accordance with the terms, conditions and specifications set forth herein and in Exhibit “A.”

3.		Payments.
In consideration of the services provided by Contractor in accordance with all terms, conditions and specifications set forth herein and in Exhibit "A," County shall make payment to Contractor based on the rates and in the manner specified in Exhibit "B." The County reserves the right to withhold payment if the County determines that the quantity or quality of the work performed is unacceptable. In no event shall the County’s total fiscal obligation under this Agreement exceed $600,000.

The maximum County obligation specified in paragraph A is based on projected utilization. If utilization exceeds projections and the County maximum obligation is expended prior to the termination or expiration of this Agreement, Contractor may discontinue services. County may, at its discretion, agree to an amendment whereby its maximum obligation is increased in consideration of Contractor’s provision of services that are necessitated by changed projections or increased utilization.

Contractor shall submit an invoice for services to County for payment in accordance with the provisions of Schedule B. All invoices must be submitted to: San Mateo County General Health Center, 222 West 39^th Avenue, San Mateo, CA 94403, Attn.: Case Management Department. County shall not be obligated to pay Contractor for the services covered by any invoice if Contractor presents the invoice to County more than one hundred eighty (180) days after the date Contractor renders the services or after eligibility has been determined, whichever is later, or more than ninety (90) days after this Agreement terminates, whichever is earlier. Any tracers or appeals must be submitted to County within two hundred and seventy (270) days after the date Contractor renders the services. County shall not be obligated to respond to any tracers or appeals submitted by Contractor for services rendered to patients without an authorized referral form. County shall pay Contractor for services within forty-five (45) days after receipt of approved billing.

4.		Term and Termination.
Subject to compliance with all terms and conditions, the term of this Agreement shall be from July 1, 2004 through June 30, 2005. This Agreement may be terminated by Contractor, the Chief Executive Officer of San Mateo Medical Center, or his/her designee at any time without a requirement of good cause upon thirty (30) days’ written notice to the other party. In the event of termination, all finished or unfinished documents, data, studies, maps, photographs, reports, and materials (hereafter referred to as materials) prepared by Contractor under this Agreement shall become the property of the County and shall be promptly delivered to the County. Upon termination, the Contractor may make and retain a copy of such materials. Subject to availability of funding, Contractor shall be entitled to receive payment for work/services provided prior to termination of the Agreement. Such payment shall be that portion of the full payment that is determined by comparing the work/services completed to the work/services required by the Agreement.

5.		Availability of Funds.
The County may terminate this Agreement or a portion of the services referenced in the Attachments and Exhibits based upon unavailability of Federal, State, or County funds, by providing written notice to Contractor as soon as is reasonably possible after the county learns of said unavailability of outside funding.

6.		Relationship of Parties.
Contractor agrees and understands that the work/services performed under this Agreement are performed as an independent Contractor and not as an employee of the County and that Contractor acquires none of the rights, privileges, powers, or advantages of County employees.

7.		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, (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) any other loss or 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.

8.		Assignability and Subcontracting.
Contractor shall not assign this Agreement or any portion thereof to a third party or subcontract with a third party to provide services required by contractor under this Agreement without the prior written consent of County. Any such assignment or subcontract without the County’s prior written consent shall give County the right to automatically and immediately terminate this Agreement.

9.		Insurance.
The Contractor shall not commence work or be required to commence work under this Agreement unless and until all insurance required under this paragraph has been obtained and such insurance has been approved by Risk Management, and Contractor shall use diligence to obtain such issuance and to obtain such approval. The Contractor shall furnish the Department/Division with certificates of insurance evidencing the required coverage, and there shall be a specific contractual liability endorsement extending the Contractor's coverage to include the contractual liability assumed by the Contractor pursuant to this Agreement. These certificates shall specify or be endorsed to provide that thirty (30) days' notice must be given, in writing, to the Department/Division of any pending change in the limits of liability or of any cancellation or modification of the policy.

(1)			Worker's Compensation and Employer's Liability Insurance. The Contractor shall have in effect during the entire life of this Agreement Workers' Compensation and Employer's Liability Insurance providing full statutory coverage. In signing this Agreement, the Contractor certifies, as required by Section 1861 of the California Labor Code, that it is aware of the provisions of Section 3700 of the California Labor Code which requires every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions of the Code, and it will comply with such provisions before commencing the performance of the work of this Agreement.

(2)			Liability Insurance. The Contractor shall take out and maintain during the life of this Agreement such Bodily Injury Liability and Property Damage Liability Insurance as shall protect him/her while performing work covered by this Agreement from any and all claims for damages for bodily injury, including accidental death, as well as any and all claims for property damage which may arise from contractors operations under this Agreement, whether such operations be by himself/herself or by any sub-contractor or by anyone directly or indirectly employed by either of them. Such insurance shall be combined single limit bodily injury and property damage for each occurrence and shall be not less than the amount specified below.

			Such insurance shall include:
			(a)		Comprehensive General Liability . . . . . . . . . . . . . . .		$5,000,000
			(b)		Motor Vehicle Liability Insurance . . . . . . . . . . . . . . .		$ -0-
			(c)		Professional Liability . . . . . . . . . . . . . . . . . . . . . . . . .		$5,000,000

County and its officers, agents, employees and servants shall be named as additional insured on any such policies of insurance, which shall also contain a provision that the insurance afforded thereby to the County, its officers, agents, employees and servants shall be primary insurance to the full limits of liability of the policy, and that if the County or its officers and employees have other insurance against the loss covered by such a policy, such other insurance shall be excess insurance only.

In the event of the breach of any provision of this section, or in the event any notice is received which indicates any required insurance coverage will be diminished or canceled, the County of San Mateo at its option, may, notwithstanding any other provision of this Agreement to the contrary, immediately declare a material breach of this Agreement and suspend all further work pursuant to this Agreement.

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.

11.	Non-Discrimination.
A.	Section 504 applies only to Contractors who are providing services to members of the public. Contractor shall comply with § 504 of the Rehabilitation Act of 1973, which provides that no otherwise qualified handicapped individual shall, solely by reason of a disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination in the performance of this Agreement.
B.	General non-discrimination. No person shall, on the grounds of race, color, religion, ancestry, gender, age (over 40), national origin, medical condition (cancer), physical or mental disability, sexual orientation, pregnancy, childbirth or related medical condition, marital status, or political affiliation be denied any benefits or subject to discrimination under this Agreement.
C.	Equal employment opportunity. Contractor shall ensure equal employment opportunity based on objective standards of recruitment, classification, selection, promotion, compensation, performance evaluation, and management relations for all employees under this Agreement. Contractor’s equal employment policies shall be made available to County of San Mateo upon request.
D.	Violation of Non-discrimination provisions. Violation of the non-discrimination provisions of this Agreement shall be considered a breach of this Agreement and subject the Contractor to penalties, to be determined by the County Manager, including but not limited to
				i)		termination of this Agreement;
				ii)		disqualification of the Contractor from bidding on or being awarded a County contract for a period of up to 3 years;
				iii)		liquidated damages of $2,500 per violation;
				iv)		imposition of other appropriate contractual and civil remedies and sanctions, as determined by the County Manager.

To effectuate the provisions of this section, the County Manager shall have the authority to examine Contractor’s employment records with respect to compliance with this paragraph and/or to set off all or any portion of the amount described in this paragraph against amounts due to Contractor under the Contract or any other Contract between Contractor and County.

Contractor shall report to the County Manager the filing by any person in any court of any complaint of discrimination or the filing by any person of any and all charges with the Equal Employment Opportunity Commission, the Fair Employment and Housing Commission or any other entity charged with the investigation of allegations within 30 days of such filing, provided that within such 30 days such entity has not notified Contractor that such charges are dismissed or otherwise unfounded. Such notification shall include the name of the complainant, a copy of such complaint, and a description of the circumstance. Contractor shall provide County with a copy of their response to the Complaint when filed.

E.	Compliance with Equal Benefits Ordinance. With respect to the provision of employee benefits, Contractor shall comply with the County Ordinance, which prohibits contractors from discriminating in the provision of employee benefits between an employee with a domestic partner and an employee with a spouse.
F. E.	The Contractor shall comply fully with the non-discrimination requirements required by 41 CFR 60-741.5(a), which is incorporated herein as if fully set forth.

12.		Retention of Records.
Contractor shall maintain all required records for three (3) years after the County makes final payment and all other pending matters are closed, and shall be subject to the examination and/or audit of the County, a Federal grantor agency, and the State of California.

13.		Merger Clause.
This Agreement, including the Exhibits attached hereto and incorporated herein by reference, constitutes the sole Agreement of the parties hereto and correctly states the rights, duties, and obligations of each party as of this document's date. Any prior agreement, promises, negotiations, or representations between the parties not expressly stated in this document are not binding. All subsequent modifications shall be in writing and signed by the parties.

14.		Controlling Law.
The validity of this Agreement and of its terms or provisions, as well as the rights and duties of the parties hereunder, the interpretation, and performance of this Agreement shall be governed by the laws of the State of California.

15.		Notices.
Any notice, request, demand, or other communication required or permitted hereunder shall be deemed to be properly given when deposited in the United State mail, postage prepaid, or when deposited with a public telegraph company for transmittal, charges prepaid, addressed to: In the case of County, to: San Mateo Medical Center Attn: Linda Wallach 222 W. 39^th Avenue San Mateo, CA 94403 In the case of Contractor, to: Daughters of Charity Health System c/o Seton Medical Center 1900 Sullivan Avenue Daly City, CA 94015

DRG	Description	Case Rate

104	Cardiac valve procedure with cardiac cath	54,642
105	Cardiac valve procedure without cardiac cath	39,699
106	Coronary bypass with PTCA	50,887
107	Coronary bypass with cardiac cath	36,818
108	Other cardio thoracic procedures	37,439
109	Coronary bypass without PTCA or cardiac cath	27, 210
110	Major cardiovascular procedures with cc	28,182
111	Major cardiovascular procedures without cc	16,807
115	Perm cardiac pacemaker implant w/AMI, heart failure or shock	23,565
116	Other Perm card pacemaker implant or PTCA with coronary artery stent implant	15,780
117	Cardiac pacemaker revision except devise replacement	9,125
118	Cardiac pacemaker devise replacement	10,727
124	Circulatory disorders exc AMI with card cath & complex diag	9,856
125	Circulatory disorders exc AMI with card cath without complex diag	7,414
514	Cardiac Defibrillator Implant w Cardiac Cath (no longer valid)
515	Cardiac Defibrillator Implant without Cardiac Cath	34,571
516	Percutaneous Cardiovascular Proc with AMI	18,647
517	Perc Cardio Proc with Coronary Artery Stent without AMI	14,898
518	Perc Cardio Proc without Coronary Artery Stent or AMI	11,826
526	Percutaneous Cardiovascular Proc W Drug Eluting Stent W AMI	21,316
527	Percutaneous Cardiovascular Proc W Drug Eluting Stent without AMI	17,327
535	Cardiac Defibrillator Implant with Cardiac Cath with AMI/HF/SHOCK	59,500
536	Cardiac Defibrillator Implant with Cardiac Cath without AMI/HF/SHOCK	45,252

Exhibits.

Services to be performed by Contractor.

Term and Termination.

Availability of Funds.

Relationship of Parties.

Hold Harmless.

Assignability and Subcontracting.

Insurance.

Compliance with laws; payment of Permits/Licenses.

Non-Discrimination.

The Contractor shall comply fully with the non-discrimination requirements required by 41 CFR 60-741.5(a), which is incorporated herein as if fully set forth.

Retention of Records.

Merger Clause.

Controlling Law.

Notices.

Seton Medical Center

See attached rate sheet

100% Medicare APC

50% of Charges NTE $1,500 per day

Medicare rate will be current fee schedule at time service is provided.

RATE SHEET