AGREEMENT BETWEEN THE COUNTY OF SAN MATEO AND
CALIFORNIA ADVANCED IMAGING MEDICAL ASSOCIATES, INC.

 

THIS AGREEMENT, entered into this _____ day of _______________ , 2007, by and between the COUNTY OF SAN MATEO, hereinafter called "County," and CALIFORNIA ADVANCED IMAGING MEDICAL ASSOCIATES, INC., 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 services such as those provided by Contractor; and

 

WHEREAS, County operates health care facilities collectively known as the “San Mateo Medical Center” (SMMC.)

WHEREAS, it is necessary and desirable that Contractor be retained for the purpose of performing professional radiology and other diagnostic imaging services described for the SMMC; and

WHEREAS, Contractor desires to provide such services all upon the terms and conditions stated below, and this Agreement is entered into for the purpose of defining the parties’ respective rights and responsibilities.

 
 

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

   

1.

Exhibits and Attachments

The following exhibits and attachments are included hereto and incorporated by reference herein:

Exhibit A—Services

Exhibit B—Payments and rates

Exhibit C—Hold Harmless

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 ONE MILLION FOUR HUNDRED AND FOURTEEN THOUSAND AND THREE HUNDRED AND FORTY FIVE DOLLARS, ($1,414,345.00).

 

4.

Term and Termination

Subject to compliance with all terms and conditions, the term of this Agreement shall be from April 1, 2007 through December 31, 2007.

This Agreement may be terminated by Contractor, the CEO of SMMC or his/her designee at any time without a requirement of good cause upon ninety (90) 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 which 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.

   

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 insurance 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 I 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)

Workers’ Compensation . . . . . . . . . . . . . . . . . .

$1,000,000

 

(b)

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

$0

 

(c)

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

$1,000,000/

$3,000,000

       

County and its officers, agents, employees and servants shall be named as additional insured on any such policies of insurance, with the exception of professional liability insurance and workers’ compensation 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 and Other Requirements

A.

Section 504 applies only to Contractor 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.

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.

Compliance with Contractor Employee Jury Service Ordinance

Contractor shall comply with the County Ordinance with respect to provision of jury duty pay to employees and have and adhere to a written policy that provides that its employees shall receive from the contractor, on an annual basis, no less than five days of regular pay for actual jury service in San Mateo County. The policy may provide that employees deposit any fees received for such jury service with the contractor or that the contractor deduct from the employees’ regular pay the fees received for jury service.

   
   
   

13.

Retention of Records, Right to Monitor and Audit

(a) 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.

(b) Reporting and Record Keeping: CONTRACTOR shall comply with all program and fiscal reporting requirements set forth by appropriate Federal, State and local agencies, and as required by the COUNTY.

(c) CONTRACTOR agrees to provide to COUNTY, to any Federal or State department having monitoring or review authority, to COUNTY's authorized representatives, and/or their appropriate audit agencies upon reasonable notice, access to and the right to examine all records and documents necessary to determine compliance with relevant Federal, State, and local statutes, rules and regulations, and this Agreement, and to evaluate the quality, appropriateness and timeliness of services performed.

 

14.

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. In the event that any term, condition, provision, requirement or specification set forth in this body of the Agreement conflicts with or is inconsistent with any term, condition, provision, requirement or specification in any exhibit and/or attachment to this Agreement, the provisions of this body of the Agreement shall prevail. 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.

   

15.

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.

   

16.

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:

    Sang-ick Chang, Interim Chief Executive Officer, SMMC

    222 West 39th Avenue

    San Mateo, CA 94403

    In the case of Contractor, to:

    David S. Marcus, M.D.

    504 Redwood Boulevard, Suite 300

    Novato, CA 94949

 

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

 
 

COUNTY OF SAN MATEO

 
 
 

By:

 

President, Board of Supervisors, San Mateo County

 
 
 

Date:

 

ATTEST:

 
 

By:

Clerk of Said Board

 

David S. Marcus, Vice President, California Advanced Imaging Medical Associates, Inc.

 
 
 
 

Contractor’s Signature

 
 

Date:

 

Long Form Agreement/Non Business Associate v 6/28/06

EXHIBIT A

 

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

    1. Provide Professional Radiology Services in the Division of Radiology, Department of Medicine, including inpatient, outpatient, and emergency care.

    2. Participate in such scheduled coverage of service as is mutually arranged and agreed upon by members of the Department of radiology under the supervision of the Medical Director.

    Contractor shall schedule "On Call," and/or "Emergency Call" status during all other times on Monday through Friday and for twenty-four (24) hours each Saturday, Sunday, or holiday. "On Call" and "Emergency Call" are defined as being available by telephone or pager to the hospital medical staff, nursing supervisor, and administrator on-call as needed. In addition, Contractor must adhere to the guidelines of the San Mateo County Trauma System by being immediately available by phone twenty-four hours a day seven days per week.

    It is expressly understood that Contractor and subcontractors for radiology services, are subject to these conditions, which all will accept scheduling for "On Call" status and that each will be responsible for his/her portion of "On Call" time. All physicians who take calls for Medical Specialty must have San Mateo Medical Center privileges.

    3. Contractor shall participate in utilization review of radiology services to SMMC departments, as requested by the medical staff and administrative staff. Throughout the term of this Agreement, Contractor shall participate monthly in utilization review of radiology services ordered by the Emergency Department. Contractor shall attend and serve without additional compensation on committees responsible for Peer Review activities, Quality Assurance, Utilization Review as outlined in the Medical Staff Bylaws, Rules and Regulations.

    4. Contractor shall participate in such teaching and/or training programs as are, or may be, established by the medical staff at San Mateo Medical Center. Each individual's participation in continuing education is documented and considered at the time of reappointment to the medical staff and/or renewal or revision of individual clinical privileges.

    5. Contractor shall fulfill those requirements for active staff membership set forth in Articles 3 and 4.2 of the San Mateo Medical Center Medical Staff Bylaws, and maintain such active staff status as a condition of the Agreement.

    6. Contractor shall provide Medical Staff administrative support to hospital in meeting radiology standards as defined by Joint Commission, Title 22, and other applicable standards.

    7. Contractor agrees to the following prior authorization protocol for performing off-site services under San Mateo County utilization management.

    a. The services provided must be referred in writing by a member of San Mateo Medical Center’s Medical Staff and authorized by Hospital Administration or Case Management Department. County indigents who present at Contractor's offices without being formally referred by San Mateo Medical Center are expressly excluded from the terms of this Agreement, except those patients who present on an emergency basis who must receive an authorization retrospectively and will be considered on a case-by-case basis.

    b. Contractor shall schedule such services as quickly as is appropriate to the patient's medical condition.

      c. Contractor shall warrant that County will be provided with a written record of the procedures performed and the patient's medical condition within five (5) days of the procedure.

    8. County agrees to maintain the Teleradiology Server Station including all hardware, software and telecommunication linkages required to operate said system.

 

Exhibit-B

 

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

 

    1. Contractor shall be reimbursed in the amount of $1,071,488 to be paid in nine monthly installments of $119,054.22 for radiology and other diagnostic imaging procedures performed.

    2. Contractor shall be reimbursed an additional amount of $243,157 to be paid in nine monthly installments of $27,017.45, which is comprised of $20,767.45 for nighthawk coverage and EMTALA payments, and $6250 for comprehensive administrative direction and medical oversight for all radiology services.

    3. County shall generate and provide to contractor verification reports for RVU unit reconciliation, entitled “Professional Productivity Summary Report” and Professional Productivity Report by RVU” respectively. These reports shall outline Total Facility RVU productivity by radiologist, by CPT code with monthly total and contract year-to-date totals within thirty (30) days of the end of the month.

      a) Total number of professional Relative Value Units (RVUs) according to the Medicare RBRVS system for the current year, listed both individually and in summary, and maintained on a continuous monthly/year-to-date basis;

      b) Sum total of all RVUs for +all radiologists as a group maintained on a continuous monthly/year-to-date basis; and

      c) Sum total of number of CPT codes for all radiologists as a group maintained on a continuous monthly/year-to-date basis; and

      d) Total number of RVU’s according to the Medicare RBRVS system for the current year, listed both individually and in summary, and maintained on a continuous basis.

    4. Such payment shall be based upon the San Mateo GPCI professional fee relative value facility based total units (“Facility Total RVUs”) for the period of April 1, 2006 through March 31, 2007. The total baseline for this period has been prorated and determined as 29,373 for a nine month period. Facility Total RVUs are at an average of $36.46 per unit.

    5. If during the 9 month period of the term of this Agreement the total professional fee RVUs for radiology services rendered by Contractor exceeds the calculated baseline of 29,373 above by more than 5%, County shall reimburse Contractor for the amount in full. Reimbursement for such an adjustment will be made on an annual basis within 90 days from the end of the term of the Agreement. Therefore, if RVU’s for the term of this Agreement exceed 30,842 (29,373 X 1.05) all units over 29,373 shall be paid at 36.46 per unit.

    6. Contractor shall also be reimbursed at the current year Medicare Part B Participating Fee Schedule for San Mateo County for services provided by Contractor at Facilities not operated by County or the San Mateo Medical Center. Contractor shall bill and be paid per CMS coding guidelines. Contractor shall provide a combined billing which details all services performed.

    In the event of the referral of a Medi-Cal pending patient, the County shall have six months to provide proof of eligibility. After this time, if the patient has not been granted Medi-Cal, the Contractor shall be reimbursed at the agreed upon rate. Services to patients determined to be medically indigent adults (MIAs) will be compensated within sixty (60) days of claim.

    Total payment for services under this Agreement will not exceed ONE MILLION FOUR HUNDRED FOURTEEN THOUSAND SIX HUNDRED AND FORTY FIVE DOLLARS ($1,414,645).

    7. CAIMA agreed to renegotiate the existing contract to a flat payment amount with shared risk Relative Value Unit (RVU) component and allows County to monitor productivity based on nationally accepted standards and structured utilization review. Over the next few months, we will review utilization progress and RVU calculations to determine the terms of the future contract.

 
 

EXHIBIT-C

Hold Harmless

 

County shall indemnify and save 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: (A) injuries to or death of any person, including County, its officers, agents, employees, and servants or (B) damage to any property of any kind whatsoever and to whomsoever belonging, (C) any sanctions, penalties, or claims of damages resulting from County’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 Contractor, 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 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 Civil Code.