HomeMy WebLinkAbout14504 ORD - 09/13/1978t
� 'jkh:943- 78;1st '�'
AN ORDINANCE
AUTHORIZING THE CITY MANAGER TO EXECUTE A CONTRACT
WITH THE STATE OF TEXAS TO PROVIDE A TITLE XX GRANT
FOR $25,000 RETROACTIVE TO MARCH 1, 1978 AND ENDING
AUGUST 31, 1978 TO PAY FOR A FULL RANGE OF FAMILY
PLANNING SERVICES FOR INCOME ELIGIBLE PARTICIPANTS
SERVED DURING THE GRANT PERIOD, ALL AS MORE FULLY
SET FORTH IN THE CONTRACT, A SUBSTANTIAL COPY OF WHICH
IS ATTACHED HERETO AND MADE A PART HEREOF, MARKED
EXHIBIT "A "; AND DECLARING AN EMERGENCY.
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CORPUS CHRISTI,
TEXAS:
SECTION 1. That the City Manager be and he is hereby authorized
to execute a contract with the State of Texas to provide a Title XX Grant
for $25,000 retroactive to March 1, 1978 and ending August 31, 1978 to
pay for a full range of family planning services for income eligible
participants served during the grant period, all as more fully set forth
in the contract, a substantial copy of which is attached hereto and made
a part hereof, marked Exhibit "A ".
SECTION 2. The necessity to authorize execution of the aforesaid
contract at the earliest practicable date creates a public emergency and an
imperative public necessity requiring the suspension of the Charter rule
that no ordinance or resolution shall be passed finally on the date of its
introduction but that such ordinance or resolution shall be read at three
several meetings of the City Council, and the Mayor having declared such
emergency and necessity to exist, and having requested the suspension of
the Charter rule and that this ordinance be passed finally on the date of
its introduction and take effect and be in full force and effect from and
after its passage, IT IS ACCORDINGLY SO ORDAINED, this the _day of
September, 1978.
ATTEST:
Secretary MAYO ro• em
THE CITY OF CORPUS CH STI, TEXAS
APPROVED:
13th DAY OF SEPTEMBER, 1978:
J. BRUCE AYCOCK, CITY ATTORNEY
By I OfI�P�1Ep
stant City •Aorney O
14504
Texas Department
of Human Resources
STATE OF TEXAS
COUNTY OF TRAVIS
TITLE XX
FAMILY PLANNING CONTRACT NO. 081- 40 -P -00
The Texas Department of Human Resources, hereinafter referred to as the Department, and
CITY OF CORPUS CHRISTI
Form 2034
October 1977
hereinafter referred= to as the Contractor, which has been certified by the Department's Title XIX fiscal
intermediary agent as a Title XIX family planning vendor, do hereby make and enter into this contract,
which constitutes the entire agreement between the Contractor and the Department. '
I.
The Department is the single Texas state agency responsible for administering the public welfare program
under the Social Security Act. Federal law and regulations, as well as State law, in TEX. REV. CIV. STAT.
ANN. art. 695c § 4(12), permit and authorize the Department, subject to certain limitations, to enter
into agreements with public or private agencies for the purposes of providing social and/or other services for
the benefit of eligible individuals. Since the Contractor desires to provide services for the benefit of certain
eligible individuals, as described herein, the Department and the Contractor make this contract.
The parties hereto mutually agree:
A. The scope of the services to be provided by the Contractor and /or subcontracting agency(ies) under this
contract, is limited to those services listed in the Plan of Operation which is attached to this contract
and incorporated into this contract in its entirety by specific reference. Any change, modification, or
amendment thereto, must be made with the prior written approval of the Department except as
otherwise provided in this contract and any such change, modification, or amendment to such Plan of
Operation is not effective until approved by the Department. Such original Plan of Operation together
with any approved amendment as maintained on file by the Department will be considered to be the
controlling instruments in case any disputes arise relative to the wording of any portion of such Plan of
Operation or amendment thereto.
B. Medical and social services under this contract are extended to income eligible individuals. Social
services under this contract are extended to current AFDC and SSI recipients. Services offered to current
AFDC recipients, current SSI recipients, and income eligible individuals must be fully integrated with
those offered to patients not subsidized by the Department.
Z01 ��tr
"1-1
Form 2034
Page 2
C. The basis for payment for services rendered under this contract is indicated in the set fee schedule
included in the aforementioned Plan of Operation. Any Contractor - initiated amendment to the fee
schedule is subject to prior written Department approval. The Department-may revise the fee schedule
by giving the Contractor written notice of such revision.
D. The Department, the Contractor and all subcontractors, if any, will carry out the requirements for the
provision of services as set forth in Chapter II, Title 45 of the Code of Federal Regulations, as amended,
will monitor and conduct fiscal and /or program audits at reasonable times and will provide consultative
and technical assistance for the continuous development of the services contemplated by this contract.
The Department shall have authority to monitor and conduct fiscal and/or program audits of both the
contractor and its subcontractor(s) to the extent of services provided under the terms of this contract
On site visits as well as access at reasonable times to all books and records will be granted State or
Federal auditing agencies, representatives of the United States Department of Health, Education, and
Welfare and/or the Department when it is deemed necessary by the Department for purposes of
inspection, monitoring, auditing, or evaluating said materials.
E. This contract is subject to the availability of State and Federal funds and if such funds become
unavailable, or if the total amount of funds allocated for this contract should become depleted during
any budget period and the Department is unable to obtain additional funds for such purposes, then this
contract will be terminated.
In the event that the Contractor fails to provide services in accordance with the provisions of this
contract, the Department may, upon written notice of default to the Contractor, terminate the whole or
any part of this contract, and such termination shall not be an exclusive remedy but shall be in addition
to any other rights and remedies provided by law or under this contract.
Furthermore, in the event that Federal or State laws or other requirements should be amended or
judicially interpreted so as to render continued fulfillment of this contract, on the part of either party,
substantially unreasonable or impossible, or if the parties should be unable to agree upon any
amendment which would therefore be needed to enable the substanrial continuation of the services
comtemplated herein, then, and in that event, the parties shall be discharged from any further
obligations created under the terms of this contract, except for the equitable settlement of the respective
accrued interests or obligations incurred up to the date of termination.
F. This contract may be cancelled by mutual consent; however, if such mutual consent cannot be attained,
then, and in that event, either party to this contract may consider it to be cancelled by the giving of
thirty (30) days notice in writing to the other party and this contract shall thereupon be cancelled upon
the expiration of such thirty (30) day period.
G. This contract may be renewed and extended by written notice to the Contractor in the form of an
amendment from the Department; such amendment shall state the term and any conditions under
which the contract is to be renewed and extended, and each of such amendments of renewal shall be
incorporated into and become a part of this contract.
,
Form 2034
Page 3
7 -78
The Contractor agrees to, and will require its subcontractor(s) if any, to agree to:
A. Provide services in accordance with the aforementioned Plan of Operation and allow the Department to
monitor same.
B. Provide to the Department, in accordance with the procedures prescribed by the Department, a verified
and proper monthly statement of charges, or certification of expenditures, for services which have been
rendered under this contract.
C. Refrain from entering into any subcontract(s) for services without prior approval or waiver of the right
of approval to subcontract.
All subcontracts, if any, entered into by the Contractor shall be written. Any subcontract entered into
by the Contractor shall be subject to the requirements of Title XX of the Social Security Act, as
amended, and of this contract. The Contractor agrees that it shall be responsible to the Department for
the performance of any subcontractor.
D. Comply with all applicable State licensing requirements and /or Federal certification requirements.
E. Furnish the Department with various statistical reports as required by the Department in the formac
prescribed by the Department.
F. Make available at reasonable times and for reasonable periods those client records, books, and
supporting documents kept current by the Contractor and its subcontractor(s) pertaining to provided
services for purposes of inspection, monitoring, auditing, or evaluating by Department personnel or
their representatives.
G. Participate fully in any evaluation study of this program authorized by the Department.
H. Comply with Department rules and regulations pertaining to hearings concerning applicants for and
recipients of services and to abide by the decisions rendered by the Department in such hearings. The
Contractor shall inform all individuals of their right to such fair hearing.
I. Comply with the Federal Civil Rights Act of 1964, as amended, and TEX. REV. CIV. STAT. ANN.
art. 6252 -16, as amended, and Executive Order No. 11246, entitled "Equal Employment Opportunity"
as supplemented in 41 C.F.R. Part 60, including but not limited to, giving equal opportunity both to
those seeking employment and those seeking services without regard to age, race, color, religion, sex, or
national origin. The Contractor further agrees not to discriminate on the basis of handicap against any
qualified person seeking employment or services.
J. Establish a method to secure the confidentiality of records and other information relating to clients to
accordance with the applicable Federal law, rules, and regulations, as well as the applicable State law and
regulations.
K. Maintain and retain case information concerning those individuals and families who received services
and supporting fiscal documents adequate to ensure that claims for Federal matching funds are in accord
with applicable Federal requirements. Said documents shall be maintained and retained by the
Contractor and all subcontractors, if any, for a period of three (3) years after the date of submission of
the last expenditure report, or until an audit has been concluded, whichever is greater.
Form [034
Page 4
7.78
L. Be primarily responsible for any audit exception or other payment deficiency in the program covered by
this contract which is found to exist after monitoring or auditing by the Department or the United.
States Department of Health, Education, and Welfare, and be primarily responsible for the collection
and proper reimbursement to the Department of any amount paid in excess of the proper billing
amount.
M. Submit billings and statistical documentation as required by the Department by the forty -fifth (45th)
day following the last day of the month in which a service was performed, and in any event, no later
than the ninetieth (90th) day following the last day of the month in which service was provided.
Failure to do so will be considered failure to comply with the contract. Such failure to comply is valid
justification for immediate termination of this contract.
N. Offer family planning services without regard to maternity, marital status, parenthood, or age; with
respect for the dignity of the individual; upon referral from any source including the patient's own
application; on a voluntary basis, ensuring the patient complete choice of provider and choice of
contraceptive method which is medically feasible. Patients may accept or reject contraceptive services
and supplies under this program with complete freedom from coercion or pressure of mind and
conscience. Family Planning services must be provided to minors without the requirement of parental
consent.
O. Use money received through the planned reimbursement mechanism specifically for family planning
services.
P. Accept reimbursement from the Department up to the maximum amount allowed by the Department as
set forth in the Plan of Operation as payment in full for services listed in the Plan of Operation rendered
to individuals eligible under this contract, and to make no charge to the patient, any member of his
family, or to any other source excepting insurance companies for such services.
The Contractor may accept reimbursement from insurance companies, provided that any such
reimbursement received from an insurance company shall be deducted from the amount to be
reimbursed by the Department. The Contractor further agrees to secure agreements to ensure that all
physicians and any others participating in the Contractor's family planning program make no additional
charge to any source other than to the Contractor for covered services rendered to persons eligible under
this contract for such services.
Q. Attempt to serve an increasing number of those estimated to be eligible individuals in the area served
by the agency, through such conveniences as outreach services, child care services, night and weekend
clinics, etc.
R. Abide by Department program guidelines as the Department develops them for purposes of clarifying,
expanding, and improving family planning services.
S. Determine eligibility of individuals according to policies and procedures promulgated by the
Department as set forth in the Plan of Operation.
Form 2034
Page 5
7 -78
IV.
This Article IV is:
Applicable ❑ Inapplicable
The Contractor further agrees:
A. To provide the Department with detailed statements of charges each month developed in the format
prescribed by the Department, and to promptly forward such bill to the Department along with a
statement certifying that the Contractor has provided each and every service for which billing is
rendered.
B. That funds certified by the Contractor for matching purposes in accordance with the terms of this
contract, will be funds which can be used to match Federal funds under the Social Security Act and
appropriate Federal rules and regulations. Records will be maintained to verify the source and amount
of funds certified by the Contractor for matching purposes for a period of three (3) years after
submission of the certification statement, or until an audit has been concluded, whichever is greater.
C. That to reimburse the Department for administrative and other operational costs incurred in procuring
federal funds, the Department shall be entitled to retain from any allowable reimbursement due the
Contractor an amount equal to zero percent ( %) of the total amount
certified to the Department as having been expended.
V.
The Department agrees to:
A. Pay the Contractor 90 % (percent) of the approved monthly billings for services which have been
rendered in accordance with the terms of this contract and its attached set fee schedule.
B. Recognize the fiscal policies and procedures of the Contractor and its subcontractor(s), if any, except
where they are in conflict with Federal and /or State law, policies, rules, and regulations.
C. Perform such evaluation studies that the Department determines to be necessary and report to the
appropriate officers of the Contractor and its subcontractor(s), if any, the preliminary results of the
study before the evaluation is concluded and the findings made a matter of record.
For the faithful performance of the terms of this contract, the parties hereto in their capacities as stated, affix
their signatures and bind themselves effective the 1st day of March t
19 Z$ , and continuing through August 31 , ly 78
TEXAS DEPARTMENT OF HUMAN RESOURCES
BY
Commissioner
Tide
CITY OF CORPUS CHRISTI
Agency Name
BY
R. Marvin Townsend
City Manager
Title
Texas Department
of Human Resources
FAMILY PLANNING CONTRACT
FEE SCHEDULE (Local Match)
Form 2042
April 1978
SERVICE
CODE
FEE
SERVICE
CODE
FEE
OFFICE OR CLINIC VISITS
CONTRACEPTIVE DRUGS AND
Health History and Physical
SUPPLIES
Exam
01
$ 20.00
Creams
35
cost
Follow -up Office Visit
02
8.00
Jellies
36
cost
Follow -up Home Visit Medical
34
10.00
Suppositories
37
cost
Foam
38
cost
LABORATORY
Medication for Vaginal/
PROCEDURES
Cervical Infection
39
cost
Oral Contraceptives
40
cost
Hematocrit
03
3.00
Dispensing Fee, Private
Hemoglobin
04
3.00
Pharmacist. 3 or more cycles
46
$2.50
Urinalysis
05
3.00
Dispensing Fee, Clinic
Papanicolaou Smear
06
7.00
Physician, 3 or more cycles
46
$1.37
Miscellaneous Culture
07
5.00
Diaphragm for Supply
41
cost
Syphilis Serology
08
6.00
Condoms
42
cost
Bacteria Smear
09
5.00
Natural Family Planning
T.B. Skin Test
10
7.50
Supplies
43
cost
Microscopic Analysis -Urine
11
4.00
Sickle Cell Screening
12
3.00
SOCIAL SERVICES: EDUCATION/
Post - prandial Blood Glucose
13
5.00
COUNSELING
Rubella Test
14
8.00
Pregnancy Test
15
8.50
Initial Patient Education
25
$6.00
Blood Type and/or
45
4.50
Post -exam Method Specific
Level
ingLev l
TrConfi
Education/Counseling
26
6.00
Confirmation Test
mats nTest
55
13.50
Follow -up Home Visit, Social
27
7.00
SMA-12 Fasting Level
Problem Counseling
28
10.00
Confirmation Test
56
14.00
Introduction to Family Planning/
Hospital Setting
30
7.00
FAMILY PLANNING SURGERY
Instruction in Natural Family
Planning Methods
47
16.00
Vasectomy
17
160.00
Elective Non- therapeutic
IN- PATIENT HOSPITAL CARE
Hysterectomy
Tuba( Ligation
31
16
240.00
240.00
Complete In- patient Hospital
00
cost
Menstrual Aspiration
48
70.00
Care for Female Sterilization
Max 5 -7
days
CONTRACEPTIVE DEVICES
Post- operative In- patient
Hospital Care, for Menstrual
63
cost -
Insertion of Intrauterine
Aspiration and Vasectomy
Max 5
Device (including the
days
device)
20
25.00
Fitting and furnishing of
TREATMENTOF
diaphragm
21
15.00
COMPLICATIONS
LOCALIZATION OF IUD
Reimbursement for all expenses
44
cost up
actually incurred in the care
to Max.
One X -ray and interpretation
22
24.00
and treatment of complications
$800.00
Two X -rays and interpretation
23
28.00
from family planning surgery
per
Sonography
24
28.00
or IUD insertion
occur-
APPROVED:
APPROVED:
rence
03/01/78
03/01/78
Agency Representative
Date
DHR Representative Date
Texas Department
of Human Resources
Contract No.
081- 40 -P -00
SECTION 1 — Prime Contractor Data
Form 2029
.luly 1978
INFORMATION SHEET
PURCHASE OF SERVICE CONTRACT Region No. County No.
08 178
Legal Name
Effective Date
CITY OF CORPUS CHRISTI
'Contract
March 1, 1978
Commonly Used Name Qf different rom above)
Corpus Christi- Nueces County Department
Contract Termination Date
of Public Health and Welfare Public Health Division
August 31, 1978
Address
I elep one No.
P. 0. Box 9727, Corpus Christi, Texas 78408
(512) 884 -3011
Person Authorized to Sign Contract
Title
Type of Ownership (Cbec one)
R. Mary Townsend
City Manager
®Public ❑Private
Charter No. Employer I.D. No.
Contact Person
Telephone No.
N/A 1 1 -74- 6000 -574 -1
W. R. Metzger, M. D., M.P.H.
(512) 855 -4051
SECTION II — Summary of Pavment
EFFECTIVE PAYMENT DATES
BUDGET NAME
BUDGET
NUMBER
UNIT
RATE
NUMBER
ELIG.UNITS
MAXIMUM
REIMBURSABLE
03 -01 -78 to 08 -31 -78
N/A
25,000:
4
Less fees from eligible clients (unit rate payment only)
1 —
Total Regional Allocation for this contract
1 25,000.
SECTION 111 —Funding
LOCAL FUNDS
$ 2,500 Matching^
N/A Administrative Overhead
$ 2,500 Total Local Fund
$ 2,500.
State Funds -0
Federal Funds 22 500
Contract Total $ 25,000.
Form 2029
Pass 2 of 2
SECTION IV— Service and /or Subcontractor Data (complete a separate sheet (SECTION III) for each different service or for each different
subcontract)
Program Activity Name
'Code
CITY OF CORPUS CHRISTI 591
Service Activity Name Social and Educational Family Planning Services
,Code
Medical F it Plannin Services 16E, 16K
Name of Subwntractin9 Agancy if applicable
Name of Contact Person
N/A
0- 14YRS.
Address of SubcontrN Agency
Telephone No.
/iinng
1. Client categories to be served (check all applicable):
NCurrent AFDC L Other Income Eligible
I@ Current SSl ❑Without Regard to Income
IM MAO Income Eligible M3 Ineligible
2. Total Number of Clients to be Served: ...................... 600 ❑ per day ❑ per week N per month.
3. Number of Eligible Clients to be Served: .................... 600 ❑ per day ❑ per week (9 per month
4. Unit of Service: ....................................................................
5. Number of Units of Service to All Clients: ................................................ .
6. Number of Units of Service to Eligible Clients: ............................................. .
7 A 7 R ICmmnlete nnly if service is children's day care)
ADDRESSES) OF
PROVIDING FACILITY(IES)
HOURS OF
OPERATION
NUMBER OF CHILDREN IN EACH AGE GROUP
0 -2 YRS.
3.5YRS.
6- 14YRS.
0.5YRS.
0- 14YRS.
0- l7YRS.-
1702 Horne Road
Corpus Christi, Texas 78416
8 a.m, to
5 P.M.
FEDERAL FUNDS
22,500
GRAND TOTAL
S 25,000
Also See Attachment
All clinic sites
TOTALS
menmuy, rnysirauy, or emoaonauy nanaicappao
8. Geographic Area Served: Nueces County,
9. Goals (check all applicable): 12. Funding:
®1 ®II j]lll ❑IV ❑V
1Q Source of Federal Funds (check all applicable):
KIxx ❑IV -B
11. Basis of Payment (check one):
❑Fixed Unit Rate of ............................ $ per
❑Cost Reimbursement
Fee Schedule (Local Match)
TOTAL AMOUNT OF
-07
STATE FUNDS
$
MATCH AMOUNT OF
LOCAL FUNDS
2,500
TOTAL AMOUNT OF
FEDERAL FUNDS
22,500
GRAND TOTAL
S 25,000
•' r
Tezes Daa3 tment
of Human Resources
Contract No.
081- 40 -P -00
SECTION I — Prime Cnntramnr Data
INFORMATION SHEET
PURCHASE OF SERVICE CONTRACT
Form 2029
July 1978
Region No. County No.
08 178
Legal Name
Contract Effective Date
CITY OF CORPUS CHRISTI
' March 1, 1978
Commonly Used Name (rf drfferent from abase)
Corpus Christi- Nueces County Department
Contract Termination Date
Public Health and Welfare Public Health Division
August 31, 1978
Address
Telephone No.
P. 0. Box 9727, Corpus Christi, Texas 78408
(512) 884 -3011
Person Authorized to Sign Contract
Title
Type of Ownership (Cbeck one)
R Marvin Townsend
City Manager
®Puhlio OPrivate
Charter No. Employer I,D. No.
Contact Person
Telephone No
N/A 1 -74- 6000 -574 -1
W. R. Metzger, M. D., M.P.H.
, (512) 855 -4051
SECTION 11 — Summary of Pavment
EFFECTIVE PAYMENT DATES
BUDGET NAME
BUDGET
NUMBER
UNIT
RATE
NUMBER
ELIG.UNITS
MAXIMUM
REIMBURSABLE
03 -01 -78 to 08 -31 -78
N/A
25,000. "
State Funds
Federal Funds
22 500
Contract Total
$
25,000.
Less fees from eligible clients (unit rate payment only)
—
Total Regional Allocation for this contract
25,000.
SECTION 111 —
$ 2,500 Matching I '
N/A Administrative Overhead
$ 2,500 Total Local Fund
$
2,500.
-0
State Funds
Federal Funds
22 500
Contract Total
$
25,000.
i•
CORPUS CHRISTI- NUECES COUNTY DEPT OF PUBLIC HEALTH and WELFARE
PUBLIC HEALTH DIVISION
1702 Horne Rd. P.O. Box 9727
Corpus Christi, Texas 78408
ADDRESSES OF PROVIDING FACILITIES
1702 Horne Road, Corpus Christi, Texas
5805 Williams Drive, Corpus Christi, Texas
3204 Highland, Corpus Christi, Texas
3029 Sabinas,.Corpus Christi, Texas
1114 Sam Rankin, Corpus Christi, Texas
1404 Tompkins, Corpus Christi, Texas
614 Horne Road, Corpus Christi, Texas
1456 Waldron, Corpus Christi, Texas
710 East Main, Robstown, Texas
400 East 10th Street, Bishop, Texas
2481 Morgan, Corpus Christi, Texas
2465 Morgan, Corpus Christi, Texas
2606.Hospital, Corpus Christi, Texas
1201 19th Street, Corpus Christi, Texas
HOURS OF OPERATION
8 a.m. - 5 p.m. Mon., Tues., Thur., Fri.
8 a.m. - 9 p.m. Wednesday
8 a.m. - 2 p.m. Mon., Wed., Fri.
8 a.m. - 2 p.m. Monday
8 a.m. - 2 p.m. Tuesday
8 a.m. - 2 p.m. Wednesday
8 a.m. - 2 p.m. Thursday
8 a.m. - 2 p.m. Friday
8 a.m. - 5 p.m. 5 week days
8 a.m. - 5 p.m. 5 week days
11 a.m. - 2 p.m. 1st Wed. each Month
8 a.m. - 5 p.m. 6 week days
8 a.m. - 5 p.m. 6 week days
24 hours a day 7 days a week
9 a.m. - 5 p.m. 5 week days
v
i
Texas Department
of Human Resources
FAMILY PLANNING CONTRACT PROGRAM DESCRIPTION
I. Goals
Form 2040
April 1978
Pursuant to the mandate of PL 93 -647, the Family Planning Program defined
by the terms of this document shall operate toward the achievement of the
following goals:
A. Achieving or maintaining economic self - support to prevent, reduce, or
eliminate dependency.
B. Achieving or maintaining self - sufficiency, including reduction or preven-
tion of dependency.
C. Preventing or remedying neglect, abuse, or exploitation of children and
adults unable to protect their own interests, or preserving, rehabilitating,
or reuniting families.
IL Objectives and Measures
A. To offer social and educational family planning services to 10 cur-
rent recipients of AFDC, SSI, and MAO within the contract period.
B. To offer social and educational family planning services to
600 income eligible persons within the contract period.
C. To offer medical family planning services to 590 income eligible
persons within the contract period.
D. Measure. The number of current recipients and income eligible persons
who receive family planning services within the contract period.
III. Services to be Covered
A. Office or Clinic Visits (Physician Directed)
The Department will provide reimbursement for the following services
and procedures when prescribed, furnished, directed, or supervised by a
physician.
1. Complete Health History and Physical Examination (Code 01) to
consist of:
a. Complete obstetric and gynecologic history (including
menarche, menstrual, gravidity, parity, pregnancy outcomes,
and complications of pregnancy /delivery).
Form 2040
Page 2
b:.'= History- of significant illness - morbidity, hospitalization, and
previous medical care, including particularly information about
thromboembolic disease, hepato -renal disease, breast and
genital neoplasm, diabetic and prediabetic conditions,
cephalgia and migraine, hematologic phenomena, pelvic
inflamatory disease, visual disturbances, and mental depression.
C. History of problems relating to previous contraceptive use.
d. Family, social, physical, and mental health history.
e. • Physical examination. Recommended procedures for examina-
tion should include, but are not limited to:
a. Thyroid palpation
b' Examination of breasts and axillary glands
c. Ausculation of heart and lungs
d. Blood pressure
e. Weight and height
i r f Abdominal examination
g. Pelvic examination
h. Examination of extremities
f. Patient consulation. Consultation includes: ,
a. Instruction of reproductive anatomy and physiology.
b. Overview of available methods of contraception including
consultation on the use of a natural family planning or
rhythm method if chosen by the patient.
g. Duration or frequency
There is a limit of one annual comprehensive examination and
evaluation for each eligible patient per State fiscal year (Sep-
tember 1 through August 31), excepting that a second com-
prehensive examination may be provided where a user of a
temporary contraceptive method elects surgical sterilization, in
which case a second comprehensive examination may be billed.
2. Follow -up Visits
a. There may be follow-up visits (Code 02) or examinations
when medically hecessary including home visits as required.
b. A medical home visit (Code 34) is one made in response to an
acute medical circumstance, requiring a medically- trained pro-
fessional. It must be conducted under the standing orders of a
physician.
.I
' d
Form 2040
Page 3
B. Laboratory Services
1. The following laboratory services are reimbursable as routine pro-
cedures covered under family planning services:
a. Hematocrit (Code 03) and/or hemoglobin (Code 04)
b. Urinalysis (for sugar and protein) (Code 05)
C. Papanicolaou smear (including cervical and vaginal) (Code 06)
d. "''Miscellaneous culture or smear for gonorrhea .(if indicated)
(Code 07)
e. Syphilis serology (if indicated) (Code 08)
f. Bacteria smear (e.g., bacterial study for Trichomoniasis,
Monilia infection, etc.) (Code 09)
g. Triglycerides fasting level confirmation test for patients 40
years of age and over (Code 55).
h. SMA -12 fasting level confirmation test for patients 40 years of
age and over (Code 56).
2. The special laboratory services and procedures noted below will be
covered if needed as a result of positive history or if deemed
medically necessary at the time of examination:
a.' Tuberculosis skin test (Code 10)
b. Microscopic analysis or culture of urine (Code 11)
c. Sickle cell screening (Code 12)
d. Post - prandial blood glucose (blood sugar) (Code 13)
e. Rubella hemaglutination test (antibody screen) (Code 14)
f. Pregnancy testing (Code 15)
g. Blood type and/or Rh factor determination (Code 45)
h. Triglycerides fasting level confirmation test for patients over
40 years of age (Code 55).
i. SMA -12 fasting level confirmation test for patients over 40
years of age (Code 56).
Form 2040
Page 4
3. Duration or Frequency
a. In connection with the annual examination and evaluation, the
procedures listed as routine will be covered immediately.
b. Additional laboratory procedures noted as special will be
covered if indicated as the result of positive history or if
deemed medically necessary at the time of examination by the
attending physician or medical director in charge.
C. The follow -up visits and subsequent laboratory procedures will
be covered if deemed necessary by the attending physician or
medical director and if considered an integral part of family
planning services.
d. These services and procedures must be provided in the context
of medical judgment using policies and practices that con -
stitute high quality family planning services.
C. _ Contraceptive Methods and Devices.
Reimbursement will be made by DHR for these services:
1. Vasectomy (Code lb — Components covered by this fee include
physician services, procedure room, equipment, supplies, anesthesia,
one sperm count, and tissue analysis. If performed in a free - standing
facility, any subsequent hospital charges must be billed to Code 44,
Treatment of Complications. If performed in a hospital- connected
facility, the only specific hospital charges allowed are for Code 53,
Post - Operative In- Patient Hospital Care, except hospital charges for
complications which must be billed to Code 44, Treatment of Com-
plications. Sterilization claims must be accompanied by a written
informed consent document and must comply with Federal steriliza-
tion regulations (45 C.F.R 205.35).
2. Voluntary female sterilization. _
a., Elective, non - therapeutic hysterectomy (Code 31) — The
single surgical component covered by this fee is that of the pri-
mary physician. Hospital charges must be billed to Code 00,
Complete In- Patient Hospital Care, except hospital charges for
complication which must be billed to Code 44, Treatment of
Complications. Sterilization claims must be accompanied by a
written informed consent document and must comply with
Federal sterilization regulations (45 C.F.R. 205.35).
Form 2040
Page 5
A claim for reimbursement of elective, non - therapeutic
hysterectomy must be accompanied by a copy of certification
that three criteria were met: the patient must have specifically
requested this sterilization procedure; the physician must have
certified that the hysterectomy was not for the correction of any
known existing pathology; and the physician must have cer-
tified that hysterectomy (major surgery) was justified over tubal
ligationlresection (minor surgery).
b. Tubal ligation (Code 16) — The single surgical component
covered by the fee is the primary physician. Hospital charges
must be billed to Code 00, Complete In- Patient Hospital Care,
except hospital charges for complication which must be billed
to Code 44, Treatment of Complications. Sterilization claims
must be accompanied by a written informed consent document
and must comply with Federal sterilization regulations
(45 C.F.R. 205.35).
3. :Contraceptive menstrual aspiration (Code 48) — Components
covered by the fee include, physician services, procedure room,
equipment, supplies, anesthesia, and tissue analysis. This procedure
is allowed only prior to the definitive determination of the existence
of pregnancy. Documentation of the uncertain status of pregnancy
must be included in the patients record. If performed in a free-
standing facility, any subsequent hospital charges must be billed on
Code 44, Treatment of Complications. If performed in a hospital
facility, the only hospital charges allowed are Code 53, Post- Opera-
tive In- Patient Hospital Care, except hospital charges for complica-
tion which must be billed to Code 44, Treatment of Complications.
4. Furnishing and insertion of intrauterine (IUD) contraceptive
devices (Code 20).
5. The fitting and furnishing of diaphragms when furnished by the
clinic and not by prescription (Code 21).
6. When furnished by prescription, payment will be made for the
following contraceptive supplies. Cost of supplies is defined as
acquisition price plus 3% for handling and storage.
a. Oral contraceptives (Code 40) and compact containers. In addi-
tion, payment will be made for dispensing oral contraceptives
in quantities of three or more cycles (Code 46).
b. jellies (Code 36), creams (Code 35), foams (Code 38), and
suppositories (code 37).
C. Diaphragms (Code 41).
d. Condoms (Code 42).
Pofm 2040
Page 6
e. Natural family planning supplies (Code 43) (e.g., instruction
books, charts, thermometers).
E Medications for treatment of vaginal/cervical infections (Code
39).
D. Localization of Intrauterine Device (Codes 22, 23 and 24) — Reim-
bursement will be made by DHR for X -rays plus interpretation, and /or
for sonography, to localize an intrauterine device not otherwise detecta.
ble.
E. Social Services Counseling.— These services are generally unavailable
to DHR clients through casework services offered by DHR field staff.
I. Initial Patient Education and Counseling (pre -exam counseling)
(Code 25)
a. - Education of patient concerning the various contraceptive tech-
niques from which the patient may choose a method most per-
sonally suitable.
b. Education of the patient regarding elementary reproductive
anatomy in order to facilitate more effective use of the method
chosen.
C. Allowable as a reimbursable expense once during each period
of active patient status with any one provider agency. A
patients chart must have been closed for at least one year
before this benefit can be billed again for a reactivated patient
with the same agency.
2. Post Exam Specific Education /Counseling on Method Chosen (Code
26)
a. After the patient has been examined by the physician and has
chosen the most personally suitable contraceptive method,
education and counseling are given to the patient about its
proper use, possible side effects, reliability, reversibility, etc.
b. This service will be paid for after an initial exam, annual exam,
or when the patient changes method or experiences difficulty
with a contraceptive method.
3. Follow -up Home Visit, Non Medical (Code 27)
a. Social services home visit follow -up consists of contacting
patients for such reasons as having missed medical appoint-
ments, or for Pap smear results.
Form 2040
Page 7
This service will be paid for as often as the program director
deems it necessary to serve a patient.
C. This benefit includes personal visits only. Telephone and mail
contacts are not included.
4. Problem counseling (Code 28) includes counseling with patients
and referrals to other agencies for such as medical problems, prob-
lem pregnancy assistance, and VD treatment. This service will be
paid for each time it is deemed necessary by the physician. Allowa-
ble once for each counseling session, whether counseling an
individual, a couple, or a large group.
5.. Introduction to family planning /hospital setting (Code 30), consists
of a general overview to an individual of the benefits of family plan-
ning. Allowable only once for each person individually introduced
to family planning within a hospital setting.
6. Instruction in natural family planning methods (Code 47) consists
of two sessions for complete instruction of a couple in one or more
methods of natural family planning (defined as methods for deter-
mining the fertile and infertile periods in a woman's cycle by such
approaches as calendar record keeping, monitoring basal body tem-
perature, and /or analyzing the woman's cervical mucus). This
instruction is allowable as a reimbursable expense once during each
period of active patient status with any single provider agency.
Complete In- patient Hospital Care for Female Sterilization Per-
formed in a Hospital Only (Code 00) — Reimbursement as set forth in
the fee schedule will be made by the Department for all in- patient
expenses actually incurred in the performance of tubal ligations or elec-
tive, non - therapeutic hysterectomies to a maximum of five days of con-
finement for tubal ligations and seven days for hysterectomies. Expenses
incurred in the treatment of complications are not to be included when
billing on this code. A copy of the entire bill must be submitted with the
claim for reimbursement for in- patient care which itemizes in detail the
services rendered. This claim must not be billed separately from the
claim for family planning surgery to which it corresponds. For hospi-
talization on multiple procedures, 65% of the in- patient care must be
charged to non - family planning procedures and 359D to family planning
procedures.
G. Post- operative In- patient Hospital Care for Contraceptive
Menstrual Aspiration and Vasectomy Performed in a Hospital Only
(Code 53) — Reimbursement for all expenses actually incurred for post-
operative care, including bedroom, meals, attendant care, and incidental
services and supplies while recovering post- operatively. At least one
nights stay must have occurred post- operatively. A maximum of five
days confinement is allowed. A copy of the detailed hospital bill must be
submitted which itemizes in detail the services rendered. These services
must not be billed separately from the billing for the surgery to which
they relate. Expenses incurred in the treatment of complications must
not be billed on this code.
form 2040
Page a
H. Treatment of Complications from Family Planning Surgery or IUD
Insertion (Code 44) — Reimbursement will be made by the Depart.
ment for all expenses actually incurred in the care and treatment of com-
plications from family planning surgery (sterilization or contraceptive
menstrual aspiration) or IUD insertion, to the maximum dollar amount
per occurrence as set forth in the fee schedule. An explanation of the
type of complication and circumstances of occurrence of the complica-
tion must accompany such a claim for reimbursement of treatment of
complications. A detailed itemization of services must be attached to the
claims form to document services rendered.
M- %[ e of Tc::as
1Cua11 ty of _ NUECES
An ag: cement bettioc.n —...CITY OF CORPUS CHRISTI
Family 1'lanninr Agency k iiu'cir�ltew rc)'erzccJ Lu l!iq :,gcrc,j _:�;i _T1Ehf0RIAL_riEDICAL
_ C_ENTER _ (hereinafter referred to.as the CO
1: u! :: _•�-�lsiun of certain family planning services.
Ir is hereupon mutually agreed by the parties that the Contractor shall provide undo
thin agrc•eme:nt family planning services according to the terms and conditions Set fi
bloc :n:drr the SOCHOn entitled "Terms and Conditions.," It is also mutually agrees
that Life full compensation shall be as set forth below under Section entitled "Com-
pensation."
Duration and Limitations
The per1cS of this agreement shall-be from 09 -01 -78 to
_ 08 -31 -79 ut
This agreement may be amended or extended by mutua
agreement Of the parties. This - agreement may be terminated by either party with or
without cause after sixty (60) days from the date notice is given to the other party
of the intention to terminate the contract.
Terms and Conditions
The following terms and conditions shall operate for provision ok any and all servic
rendered according to this agreement. The contractor agrees to;
1,. Assure the Agency that all medical services shall be by or under the direction o1
licensed physicians under the laws of the State of Texas. Responsibility for provisi
of medical family planning services is with the Contractor. Any liability for
negligence in administration, of medical services provided herein shall be the sole
responsibility of the Contractor.
2. Provide services in compliance with applicable Federal regulations found in
Chapter I1, Title 45 of Code of Federal Regulations, as amended.
3. Provide to the Agency a verified and proper monthly statement of charges, for*
services which have been rendered under this contract.
4. Submit billings, reports, and statistical documentation, as required by the
- 1,gcncy, by the 30th &.y following the last day of the month in which a service
is performed and in any event, no later than the 45th dsy following the last
day of the month in which service is provided. In the event that the required billin
reporting, and statistical documentation have not been received by-the- 60th day
following the last day of the month in which service is provided, the subcontractor
will be considered to have failed to comply with the contract. Such failure to
comply Is valid justification for immediate termination of this contract.
5. Comply with appropriate State licensing or certification requirements and with
!:ucfi standards as may be prescribed by the Secretary of tice United States Department
of llealth, 1C1111cation, and Welfare. -
6_, comply with the )'cdcral Civil Ri,;hts Act of 19641, as amended, and TEX. REV. CI'
Art. 6252 -16, as amended, Executive order \o. 11246 entitled "Equal
Lm,:loy!,,cnL Opportunity" as supplc;n —Led in 41 C.F.1;. )'art 60, including but not
limited to, giving equal opporLuniLy butte to thoc +e stcl :ing employment and those
seeking services without regard to race, color, religion; sex, or national origin.
'111c Contractor further agrees not to discriminate on the basis of handicap against
.Illy qualified person seeking employment or services.
7. FsLablish a method to secure the confidentiality of records and other informati
relating to clients in accordance with Line applicable Federal laws, rules and regu-
lations, as well as the applicable State laws and rer�ulctions.
8. Offer family planning services without regard to maternity, marital status,
parenthood, or age; with respect for the dignity'of the individual; upon referral
frerni any source including the patient's own application; on a voluntary basis,
ensuring the patient complete choice of provider and choice of contraceptive method
which is medically feasible. Patients may accept or reject contraceptive services
supplies under 'this 'prograin with complete freedom from coercion or pressure of mind
and conscience. Family; :'fanning services must be provided to minors without the
requirement of parental consent.
9. Accept reimbursement -from the contractor Agency up to the maximum amount allowe
by the contractor Agency as set forth in the attached fee schedule as payment in fu
for services rendered to individuals eligible under this contract, and to make no
further charge to the patient, any member of his family, or to any other source.
10. Make available at reasonable times and for reasonable periods those client reco
books, and supporting documents kept current by the contractor pertaining to provides
J services for purposes of inspection, monitoring, auditing, or evaluating-by Departm
perscnnel c_ their rep= ese:tz:iv:s.
Compensation
Co•-.:pensation u:xler this contract: Chai•1 consist of payment to the Contractor by
CITY OF CORPUS CHRISTI Family Planning
/agency; for family planning services according to Lite following schedule:
(Attach the schedule of benefits with payments for each as agreed upon
by the Agency and the Contractor) <.
i
CITY OF CORPUS CHRISTI MEMORIAL MEDICAL,CENTER
(Agency's lame) (Contractor s Name)
Signature , thorized representative) Signature (Auth'orized representat,
W, R. Metzger, M. D., M. P. H. Robert W. Me Cuistion, Pres.
CITY OF CORPUS CHRISTI /MEHORIAL MEDICAL CENTER TITLE XX SERVICE
90% of billed hospital charges for Non - therapeutic Bilateral Tubal Ligation.
Maximum to 5 days.
35% of billed charges less 10% for Non - therapeutic Bilateral Tubal Ligation in conjunc
with a delivery. Maximum to 5 days for Tubal Ligation part of procedures.
TREATMENT OF COMPLICATIONS
Reimbursement for all expenses actually incurred in the care and treatment of
complications from a Bilateral Tubal Ligation and Vasectomy surgery. Cost up to
maximum $680.00 per occurence.
In the event the patient has personal insurance then it is mandatory that the
insurance company be billed first. The City of Corpus Christi may be billed for the
remaining fee not to exceed the allowable billing amount.
Approved
Signature (Authori representative) Signature (Authorized representative)
?O p
t
ji'.;t r of Tc::as
ICuanty of — N UECES
All agrecment betwco.n - CITY OF CORPUS CHRISTI
- - - - -
Fermi ] v Planning Aj;cncy kill retr.:�l t ca referred t.o a:: tie ;.gcnc� j �n.i RADIOLOGY
ASSOCIATES (hereinafter referred to.as the c,)
i,n ;:r,.isiun of certain fmnily planning services.
It is hereupon mutually agreed by the parties that the Contractor shall provide unde
thin nrrvcmrcnt family planning services according to the terms and'condition, set fo
b.lov order the Section entitled "Terns and Conditions.." It is also mutually agreed
that the full compensation shall be as set forth below under Section entitled "Com-
pensation."
Duration and Limitations
Tile perk,:; of this agreement shall-be from 09 -01 -78
_ 08 -31 -79 to
This agreement may be amended or extended by mutual
agreement of the parties. This agreement may be terminated by either party with or
without cause after sixty (60) days from the date notice is given to the other party
of the intention to terminate the contract.
Terms and Conditions
The following terms and conditions shall operate for provision of any and all service
rendered according to this agreement.. The contractor agrees to-
le Assure the Agency that all medical services shall be by or under the direction of
licensed physicians under the laws of the State of Texas. Responsibility for provisi
of medical family planning services is with the Contractor. Any liability for
negligence in administration of medical services provided herein shall be the sole
responsibility of the Contractor_
2. Provide services in compliance with applicable Federal regulations found in
Chapter I1, Title 45 of Code of Federal Regulations, as amended.
3. Provide to the Agency a verified and proper monthly statement of charges, for -
services which have been rendered under this contract.
4. Submit billings, reports, and statistical documentation, as required by the
Agency, by the 30th d :,y following the last day of the month in which a service
is performed and in any event, no later than the 45th d:y following the last
Jay of the month in which service is provided. In the event that the required billing
reporting, and statistical documentation have not been received by,the 60th day
following the last day of the month in which service is provided, the subcontractor
will be considered to have failed to comply with the contract. Such failure to
comply is valid justification for immediate termination of this contract.
5. l:()mply With appropriate State licensing or certification requirements and with
:.uch utandards as may be prescribed by the Secretary of-ti te United States Department
of HPalth, Iiducatiun, and ilelJare.
wlth the Federal (:ivil Pi l,ts Act of 19i,•'i, as amended, and TEX. REV. C1V.
OSTAT. /.1;7., Art. 6252 -16, as nmended, L`Vculive order \o. 11246 entitled "Equal
1'mployn.c•nt Opport "Ili ty° IS cupplc,rcntt(J in 41 c.1 %)% fart 60, including but not
limited to, giving; equal opportunity but), to thoc.c seeking enployncnt and those
scelcing services without regard to race., color, religion; sex, or natidnal origin- '
Jilt Contractor further agrees not to discriminate on the basis of handicap against
any qualified person seeking employment or services.
7. Establish a method to secure the confidentiality of records and other in- foraatior
relating to clients in accordance with the applicable Federal laws, rules and regu-
lations, as well as the applicable State laws and regulations.
8. Offer family planning services without regard to maternity, marital status,
parenthood, or age; iaitfi respect for the dignity'of the individual; upon referral
from any source including the patient's own application; on a voluntary basis,
ensuring the patient complete choice of provider and choice of contraceptive method
which is medically feasible. Patients may accept or reject contraceptive services an
supplies under'tbis- prograit, with complete freedom from coercion or pressure of mind
and conscience. Family: Panning services must be provided to minors without
.Che
requirement of parental consent.
9. Accept reimbursement from the contractor Agency up to the maximum amount allowed
by the contractor Agency as set forth in the attached fee schedule as payment in full
for services rendered to individuals eligible under this contract,- and to make no
further charge to the patient, any member of his family, or to any other source.
10. Make available at reasonable times and for reasonable periods those client record!
Jbooks, and supporting documents kept current by the contractor pertaining to provided
services for purposes of inspection, monitoring, auditing, or evaluatirg-by Departmeal
persc -..e1 c- their rep= es= _tatives.
Compensation
C07-.;1etisation under this contract: ?ial•l consist of payment to the Contractor by
CITY OF CORPUS CHRISTI
Agency; for family pl nning services according to the following schedule: Planning
(Attach the schedule of benefits with payments for each as agreed upon
by tite Agency and the Contractor)
,CITY OF CORPUS CHRISTI a RADIOLOGY ASSOCIATES
(Agency 5 lame)
(Contractor s Name)
Signature- (Aut _ized representative
ignature (Authorized pres ntativc
W. R. Metzger, M. D., M. P. H.
Curtis C. Reemsnyder, M. D.
f �r
CITY OF CORPUS CHRISTI /RADIOLOGY ASSOCIATES
TITLE XX SERVICE
90% of billed charges for X -Ray reading for Non - therapeutic Bilateral Tubal Ligation
patient.
35% of billed charges less 10% for X -Ray reading for Non - therapeutic Bilateral
Tubal Ligation patient in conjunction with a delivery.
In the event the patient has personal insurance then it is mandatory that the
insurance company be billed first. The City of Corpus Christi may be billed for the
remaining fee not to exceed the allowable billing amount.
Approved:
ZV
Signature (AuthorVeY representative)
Date
i
Signature (Autiorize represen tive)
Date
• S131r of Te):a5
1 County of __ NUECES_ --
An ag_ccrient between _ CITY OF CORPUS CHRISTI
Family planning; Agency khurcit:jilect rcJerr,-d i.0 s:: itie Lgenr_ j ::n.i NUECES_COUNTY
MEDICAL EDUCATION FOUNDATION_ (hereinafter referred to.as the Cu- tracttir)
iur Vi >iun of certain family pl: +nning services. "
It is hern.upon mutually agreed by the parties that the Contractor shall provide under
this' agreement family planning services according to the terms and'condition set forth
b0 of -:order the SecH on entitled "Perms and Conditions," It is also mutually agreed
that the full compensation shall be as set forth below under Section entitled "Com-
pensation."
Duration and Limitations
The perk,:; of this agreement shall-be from 09- 01 -78- to
_ 08 -31 -79 This agreement n:av be amended or extended by mutual
agreement of the parties. This agreement may be terminated by either party with or
without cause bfter sixty (60) days from the date notice is given to the other party
of the intention to terminate the contract.
Terms and Conditions
The following terms and conditions shall operate for provision of any and all services
rendcre) according to this agreement. The contractor agrees to:
1. Assure the Agency that all medical services shall be by or under the direction of
licensed physicians under the laws of the State of Texas. Responsibility for provision
of medical family planning services is with the Contractor. Any liability for
negligence in administration of medical services provided herein shall be the sole
responsibility of the Contractor.
2. Provide services in compliance with applicable Federal regulations found in
Chapter II, Title 45 of Code of Federal Regulations, as amended.
3. Provide to the Agency a verified and proper monthly statement of charges, for'
services which have been rendered under this contract.
4. Submit billings, reports, and statistical documentation, as required by the
Agency, by the 30th day following the last day of the month in which a service
is performed and in any event, no later than the _ 45th dcy following the last
day of the month in which service is provided. In the event that the required billing,
reporting, and statistical documentation have not been received by-the 60th day
following the last day of the month in which service is provided, the subcontractor
will be considered to have failed to comply with the contract. Such failure to
comply Is valid justification for immediate termination of this contract.
5. (;nng)ly with appropriate State licensing or certification requirements and with
:.uch utandards as may be prescribed by the Secretary of the United States Department
of 11t•1310h, Education, and Wellare. - _
6. - Comply with Lhe Pcdcral Civil Ri";hts Act of ))i,4, as amcndod, and TEX. P.EV. CIV.
O Lm^lo•'u•ntOppurLun tyl6asasuJ'ilc'ent C>'tcutivc Under ;;o. 11246 entitled "Equal
1 p Yl- Pp L-r1 in 41 (;.1'.1. Part 60, including but not
limited to, giving equal opportunity butte to tho::e seeking employment and those
sc•ckin;,• services wi.thout regard to race, color, religion; sex, or national oriin.
The ConLractor further agrees not to discriminate on g
the basis of handicap against
any qualified person seeking employment or services.
7. Establish a method to secure the confidentiality of records and other information
relating to clients in accordance with Lhe applicable I'rderal laws, rules and regu-
lations, as well as the applicable State laws and regulctions.
B. Offer family planning services without regard to maternity, marital status,
parenthood, or age; with respect for the dignity -of the individual; upon referral
from any source including the patient's own application; on a voluntary basis,
ensuring the patient complete choice of provider and choice of contraceptive method
Which is medically feasible. Patients may accept or reject contraceptive services anc
supplies under this program with complete freedom from coercion or pressure of mind
and conscience. Family T)'fanning services must be provided to minors without
requirement of parental consent. the
9. Accept reimbursement from the contractor Agency up to the maximum amount allowed
by the contractor Agency as set forth in the attached fee schedule as payment in full
for services rendered to individuals eligible under this contract, and to nuke no
further charge to the patient, any member of his family, or to any other source.
C10. Make available at reasonable times and for reasonable periods those client records
book;, and supporting documents kept current by the contractor pertaining to provided
services for purposes of inspection, monitoring, auditing, or evaluating b•
perss -. -e1 oc their S Y Departrznt
Compensation
Co...pC:l:iarlC.l u rder this contract' hall
CITY OF CORPUS CHRISTI consist of payment to the Contractor by
Famil
Atcncy; for family planning services according to the foll cheduley planning
(Attach the schedule of benefits with payments for each as agreed upon
by the Agency and the Contractor)
r
CITY OF CORPUS CHRISTI •.
( Agency s lame)
Signatur����
(Aut orized representative)
W. R. Metzger, M. D., M. p. H.
NUECES COUNTY MEDICAL
EDUCATION FOUNDATION
7, (Contractor s Name)
Signature (Authorized representative)
Leslie S. Archer, M. D. .
1
CITY OF CORPUS CHRISTI /NUECES COUNTY MEDICAL EDUCATION FOUNDATION
TITLE XX SERVICE
In the event the patient has personal insurance then it is mandatory that the
insurance company be billed first. The City of Corpus Christi may be billed for
the remaining fee not to exceed the allowable billing amount of $194.00.
Approved:
',KA77,-w 177.-
Signature (AutVrfized representative)
Date
Signature (Au horized representative)
Date /
Corpus Christi, %4-111�/3 day of
TO THE MEMBERS OF THE CITY COUNCIL
Corpus Christi, Texas
For the reasons set forth in the emergency clause of the foregoing ordinance,
a public emergency and imperative necessity exist for the suspension of the
Charter rule or requirement that no ordinance or resolution shall be passed
finally on the date it is introduced, and that such ordinance or resolution
shall be read at three meetings of the City Council; I, therefore, request
that you suspend said Charter rule or requirement and pass this ordinance
finally on the date it is introduced, or at the present meeting of the City
Council. t
Respectfully,
MAYORpco; Q@
THE CITY OF CORPU CHRISTI, TEXAS
The Charter rule was suspended
Gabe Lozano, Sr.
Bob Gulley
David Diaz
Ruth Gill
Joe Holt
Tony Juarez, Jr.
Edward L. Sample
The above ordinance was passed
Gabe Lozano, Sr.
Bob Gulley
David Diaz
Ruth Gill
Joe Holt
Tony Juarez, Jr.
Edward L. Sample
14504