HomeMy WebLinkAboutC2005-477 - 8/30/2005 - ApprovedDEPARTMENT OF STATE HF. ALTH SERVICI~
1 lllO WEST 49TH STRlr. F.T
AUSTIN, TEXAS 78756-3199
· ~T.x I F ¢ ~F '1E,X A,~
~ '01 :¥: Y OF 1R~ VIS
DSRS D~xur, mt No. 746000Y/41,~
~Chan~ ~ No. 07
'i'l~e I_~.~artn-n-m of Stale Health Se~ico,. herelrmfter re£en'cd to n~ RECI.IVING AGE.NCY. did he~tofo~ ~ into · co.i~ ,,ct in
~,fing w~m CORPUS CHRI~TI-~ COUNTY ~IBLIC IlEAl .TH DIb-I'RICT ICITY~ he~nm'~' ~ lo ~
PERI~RMI~G AGt-~NCY. Th~ p~nie~ fl~m~ now a~,!~ m ~nemi ~uch coolr~l atmchn~nt(~) a~ follow~:
SLTbOdARY OF TRANSACTION:
\I-FN() 0-<'- CHS TFTI_E .LX
All term,, atxl ~..)r~ltttom, m)l r~.rcb¥ an~mdLxl remain tn lull fim.'e ',md
F. XI .('l "l-El) IN l)l 'PI.IC'ATF. ORIGINAL',; ON Till-'. DATES SHO~, N.
PERFORMING XGENCY:
RECEIVING AGFANCY:
CORPUS CHRIb'I'I-NUECES COUNTY PUBLIC
HEALTH DISTRICT (CITY~
,Sigg~ person autb~zed It) ~,ignl
DEPARTMENT OF ~TATI~ HEALTH ~VlCl~
~Silpmtur~ of [~rson .mllorized m si~n)
Bt* Bumette. Director
.__ Clignt ~'i,.'e~, Contr~'tina Unit
~Name aM Title}
· H:RF-ORMINO ^{3F_A"qCY Dh,..x~tm'. ~f d~ffcrem ....
I'n,tn i,emm m,lM-rizrd tn ~lgn Contric~
20O5-477
r-or ~/monm,/ 01i/30~
Rea026415
IISH%
DETAII. S OF A I'TACHMENTS
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(~)IAL IIS/~ I ~ Slate
,,.4(' ('HS/I II XX 09R}l/O.a i 12131/~i Slate93.66'v 1267~.81.00
] IS] IS I)ocurrmin N,, 7460005.741 .,~.'~O5
CI~nL, o: No. 07
Dimct
Totil Almunt
0.00 22,.~00.(10
0.00
0,00 306,2'74,00
0.00 126,281.110
$ 0.00 S617,360.00
' I ~.nck', ,,I ['unds arc intm:al~l b.~ a number from ]he Catalog of Federal IX)rne~uc A~a,stunc~ (CF'DA), if ~oplicab~ REFER TO
I.H itl ;FT! ,;El 'TION OF .&.NY Y}/.RO AMOUNt' .-VI-I'A('I IMENT [:OR DETAII_q.
Cover Page 2
DOCITME.NT NO. 7'460005741A-2005
ATTACHMENT NO. 04C
PERF~)RMING AGENCY: CORPUS CHRISTI-NL'ECES COUNTY PUBLIC I--~-ALTH
DISTRICT (CITY)
RECEIVING AGENCY PROGRAM: COMMUNITY HEALTH SERVICF_3
I'ERM: Sq:~ember01._-q3(~4 FHRU: I)ecember 31. _2005
Il is mutually u _grt~-d__ by 'and between the contracting parties to amend the conditiona of
Documem No. 7460005741A2005 -(MB ua written below. All other conctitiona not hereby
amended are to remain in full force and effect.
'gECT1ON I. SCOPE OF WORK. sixth paragraph, is mplac.~d with ~ following:
PERI:~ORMANCE
I'be following performance me. asurea will be used to asaeua, in part, th~ PERFORMING
AGENCY'S eff~tiveness in imaviding thc sm-vices deascribea:l in thia eontn~ Aaaeh~t,
~,,ith~mt waiving the enforceability of any of the terms of the contract.
PERFORMING AGENCY shall provide family planning mexlical t, en'vicea to 902
unauplicated clients who live or rex~ve services in the following county(ies)/ama:
Nucces. The aervices shall be providexl to the clients in the followin~ poi~lmion
categories und in the following numbera:
~.'ategory N umbg'r of Clicnta
Wom~n 19 and Un&'r 199
Women ~ to 34 622
Wo~r~n 35 and Over 72
Mules 9
'1 otal Family Planning Chents 902
SF~_-'TIOIX I. SCOPE OF WORK is revised to include the following:
PERFORMING AGENCY' shall perform no elective abortion proced_ ,~es, shall neither {xmtract
wah nor provide funda to uny individual or entity for the perfo,-,imnce of elective abortions, and
shall submit no clmms to RECEIVING AGENCY for reimbursement of direct or i~ costa
t,ncludmg overhead, rent, phones, and utilities) of abortion proeedm~.
ATTACHMENT · Pag~ I
II PERFX}RMING AGENCY is affiliated with an entity that l:erforma elective abortion
orocedure, or affihated ~th un entil.~ Ihut perfo,.,~ cie:clive abortions at any time al,wing ~
ecrm o] Lhl,; Ct)l'ltr"dtt.
PERFORMING AGENCY and ~ts abortion-,aervi_oes__ affilia~ must be
legally .separate corporations, with 8~pal~te articlea of incorpormion and
separ, ffe b~law.,, If PERFORMING AGENCY is a StRt~ Or Ioc.~l
govcrnm~t-ai entity, the abortion-services affiliate mu~t be a legally
separule organization with a separate governing structure.
PERFORMING AGENCY and ils abortion-servtces affilim'e mu~t have
easily distinguishable names.
PERFORMING AGENCY and its abortion-service~ m'~fili~t,~ muat have
separate, 'tmards of directors or governing bodies which meet separately
and maintain separate rcctwcLs.
PERFORMING AGENCY may not transfer any funds dialxibuted under
RECEIVING AGENCY Strategy B. 1.3 to its abortion-services affiliate.
PERFORMING AGENCY must assure that its affiliated entity apportions
fmr ,,slue Ior uny shured expenses or cosls (including overhead, rent,
ph~n'g,s, equipment, and utilities) in uccordance with generally accepted
~:counting principles.
PERFORMING AGENCY shall assure thai. any person employed part-
time by PERFORMING AGENCY and by its abortion-aendce~__ affiliate
shall contemlx}raneously rnaJnlain accurate lime records, similm' to time
records maintained by attorneys, though not nece..qatily by means of an
uutomatic recording device such as u "time clock", that clearly reflect the
work perfoi,ed for each employer.
if PKR/~RMING AGENCY and ils abortion-services affiliate are Ioc. al~
us. the same phys,cal locution, PERFORMING AGENCY shall asauxe that
the existence and ~pu:rute nature of the affiliate relationship ia clearly
reflected by appropriate signage in areas accessible to the public.
PERFORMING AGENCY and ils abortion-services affiliam mu~t eamh
maintain records adequme to show compliance with th~ foregoing
req u~remem:~.
'4F.f'-FION II. SPECIAL PROVISIONS is r~vised to include the following:
RECEIVING AGENCY ..:,hall include ,n any Iinancial u.dits of state fimds received by
PERIaORMING AGENCY under this attachment a review to en~ure compliance with the
requirements of I~-partmenl of State Heallh S~'rvices Rider 30, General Appmpriationa A~, 79th
l~g~slalurc
A'ITACt-IMENT - Page 2
SF_X?TION !]. SPECIAL PROVISIONS. page 3. Te~ma ami Comlitlom of Pa]~ne~t Article,
· hird i~ragraph, is r~l~-ed with the folh~wing paragraph:
BILLING REQUIREMENTS
PERFORMING AGENCY' shall bill RECEIVING AGENCY for allowable s~'vieea provid~ m
Idle XX eligible clients. PERFORMING AGENCY shall submit to RF_.L-2EIVING AGENCY all
allowable services ptovicled to Title XX eligible clients during the claim period indicated on
hmlling form. Requests for payment shall be submitted to the Texas Medicaid and l-lmtlll~gare
Partnership (TMHP) From September I. 2005, through De~ember 31, 2~05, in a
campaliblc with the Compass 21 billing system by the 60th day aftea' the dam on which ~'vieea
..~.el'e pi'or id~2[ or Ih~ date of uny third party insurance Explanation of Benefits fo, m. Apoeada
mu.st Ix~ sabmirtmt within 60 days of rejection, and all requests for payment shall be m~itl~d
,x mthm 60 days of the end ,ff thc Attachment t~H,,. Claims shall be submitted truing an approved
:laim Io,,,~ thru follow.,, the RF. CEIVING AGENCY Contract Mmmgeanent Branch billing
~pec,fitat-,)ns which may be ,,b~uined From RECEIVING AGENCY'S Contn~ ~t
Branch
Generul P, ovisions. Child Abu~ Reporting R_equlr~n~nt~ Article, flint sentm~., is mpla~d in
PERFORMING AGENC'~ is required to comply with this article only aa rel~.tnt to ~ervice~
provided under the following Attachments: Human lmmunodeficiency Virus and Sexually
Transmittc'd Diseaz~'s (all dirt-ca client cure ~rvices for HIV and other sex-ally han~uitted
dmeaa~s lundod under the Ryan White CARE Act Title Il or general revenue), Title V Family
Planning tCHS/FEE-FP). Title X Family Planning (CHS/'rITI .E X), Title XX Family Plamfing
,CHS/'ITI_XXL I:¥imury Health Care (CHS/PHCL Title V Maternal and Child Health
,CHS/FEF.), Spec,al Supplemental Nutrition Program for Women, Infants, and Cl'dld~a
. NSS/WIt '-CARD,. and the Sen'ices Delivery Integrution project (SDI/FFS).
Geuerai Pmviskms. Tertm and C. ondlflom of Payment Article, im revised to include the
I,,llow~ng
Funds made available in thc initial contra:t term of September 1. 2004 I~rough Augtm 31, 2005
must be b.,~d for services peff~n'rned on or after September I, _'2004 through Augu~ 31, 2005.
· -~ny funds thul are not expended for .,~--rvicea performed during that period are not available for
,,ervlceS p~'rt'orlTled al:ter August 31. 2005. PERFORMING AGENCY sl~ll sub,fit all claims
.md supporting documentation {'or dales of service between September 1, 2004 and Augu~ 31,
2005 to RF~-'EIVING AGENCY no Islet than September 30. 2005.
Funds rnad~ available by this contracl amendment for the period of September 1, 2005 tl'mmx~
[~x:emb~ 31. _-~05 must be used For serx. icea perlbrmed on or after Sepmmber 1, 2005 thmagh
I)o:emho 31. _'2005. Any ftmds thru are not expended for services performed during that period
are no~ .~vailable PERFORMING AGENCY .;hall submil all claim~ and supporting
ATFACHMENT - Page 3
documcntulion lot clatcs of service between Septcmber I, _-'~}05 and Dect, mber 31, 200S to
RECEIVING AGENCY no later Ihun February 28. 2006.
SEX.' rlON lit. BUDGET i.~ repla:cd with Ihe following:
SECTION III. BUDGET:
PERFORMING AGENCY shall -dhere to the current schedule of allowable services and ral:s as
referenced in SECTION II. SPECIAl. PROVISIONS. us amended and a:p~oved by the
RECEIVING AGENCY.
To~al payments will no~ cx:_?ed $ l ~.~.281.00.
ATTACHMENT - Pag~ 4