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HomeMy WebLinkAboutUNINSURED CARE r i. ." '~ AGREEMENT FOR CERTIFIED UNINSURED CARE This Agreement is effective the 1 st day of January 2005 by and between Augusta, Georgia, acting by and through the Augusta-Richmond County Commission (hereinafter referred to as the "County") and Richmond County Medical Society Project Access, Inc. (hereinafter referred to as "Project Access"), upon the terms and conditions set forth below. WITNESSETH: WHEREAS, County and Project Access desire to contract for the provision of certain health care services to the uninsured residen~fRichmond County for calendar year 2005; NOW, THEREFORE, for and in consideration of the promises and covenants contained herein, and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties hereto, intending to be legally bound, do hereby agree as follows. SECTION I. TERM OF AGREEMENT This Agreement shall be for a term beginning January 1, 2005 and continuing until the termination date provided by this Agreement of December 31, 2005. SECTION II. COSTS County shall pay the sum of Four Hundred Thousand Dollars ($400,000.00) for costs necessary for the operation of Project Access, including but no limited to office space, furniture, computer hardware and software, personnel costs and for payment of prescriptions pursuant to Health Care Services as herein provided. SECTION III. PROVISION OF HEALTH CARE SERVICES TO CERTIFIED UNINSUREDS; PAYMENTS BY COUNTY County and Project Access agree to the following terms and conditions for the providing of certain Health Care Services to the uninsured residents of Richmond County beginning July 1, 2002. ~ .' A. Provision of Services Project Access covenants and agrees to provide volunteer physicians to provide clinical care to the certified uninsured residents of Richmond County ("Health Care Services"), in a prompt and proper manner consistent with professional standards and all applicable laws and regulations. Project Access further covenants and agrees to provide ,. , said services to said patients in the same manner and quality as provided to other patients of its members. Proj ect Access reserves the right to deny services to any patient who engages in dangerous or disruptive behavior or who does no abide by the patient rules for participation agreed upon at enrollment into Project Access. B. Certification of Residency In order to receive Health Care Services (as hereinafter defined), a patient or responsible household member must be a resident of Richmond County. Responsible household members are persons legally married (whether by ceremony or common-law) or living in a domestic relationship (as defined in guidelines for purposes of Aid to Families with Dependent Children eligibility), and the legally responsible parents or guardians of children under the age of 18. If there is doubt as to who are the legally responsible parents of children under the age of 18, a copy of the child's birth certificate shall be required to verify parentage. Residency must be confirmed by at least one (1) of the following: a. rent receipts, a lease, or a statement by a rental agency or established real estate business that the patient has resided in the County for at least 6 months; b. a valid Georgia driver's license showing an examination date at least 6 months old and a Richmond County address; c. employment check stubs showing the patient's (or responsible household member's) address or a statement from the patient's (or responsible household member's) employer attesting to residence in Richmond County; d. utility bills or payment stubs in the patient or responsible household member's name; e. a telephone book or city directory listing showing the patient's or responsible household member's name; f. a voter registration card issued at least 6 months before and showing a Richmond County polling place; g. attestations of residency (in the form or affidavits) from the patient and two other people, one of whom must be a minister with a Richmond County congregation or the director of a private relief organization such as the Salvation Army; h. a letter from DF ACS verifying receipt of food stamps from Richmond County DF ACS; or 1. a currently valid Project Access certification card issued under Section C.3 below. No bill for prescriptions for a patient whose residency cannot be verified according to the above requirements shall be submitted to, or paid by, the County. C. Certification of Being Uninsured In order to receive Health Care Services (as hereinafter defined) each patient must be certified as uninsured according to this Agreement. As a preliminary matter, such certification shall confirm that each said patient is with respect to the Health Care Services "self-pay", that is: a. does not have valid health insurance and/or medical payments coverage for the Health Care Service (per diem hospitalization policies shall not be considered health insurance or medical payments coverage, but rather will be included as an asset for purposes of determining resources, and whenever such assets are involved, each inpatient hospitalization will require separate certification); b. does not have Medicare or Medicaid insurance coverage; and c. does not have worker's compensation coverage for the Health Care Service. Unless otherwise disqualified, a patient will be certified as uninsured under this Agreement if the sum of his /her gross income plus other responsible household members' gross income(s) is equal to or less than One Hundred Fifty Percent (150%) of the Federal Poverty Guidelines for the applicable household size, corresponding with the then current Federal Poverty Guidelines. 1. Determination of Gross Income For purposes of this section, gross income means any and all income before deductions, and includes the following: a. wages and salaries before any deductions; b. receipts from self-employment before any deductions, or from an owned farm or business after farm and business deductions; c. public assistance in any form; d. social security payments; e. supplemental security income (SSI); f. unemployment compensation; g. worker's compensations payments; h. veteran's benefits; 1. training stipends; J. alimony payments; k. child support payments; 1. military family allotments; m. regular support from absent family members or persons not living in the household; n. government employee pensions; o. private pensions; p. insurance benefits paid on a regular, annuity-like basis; q. annuity payments; r. dividends, interests, rents royalties, income from estates and trusts; s. union payments or assistance of any kind; and t. any other form of income which results in disposable spending ability (such as student loans used for living expenses). 2. Verification of Gross Income Gross income shall be verified as follows: a. possession of a currently valid Project Access certification card issued under Section C.3 below; or b. for food stamps recipients, gross income shall be determined from DFACS records (unless such records are more than 12 months old); or c. for other than food stamps recipients (or for those whose DF ACS records are more than 12 months old), gross income shall be determined from federal and/or state income tax returns for the immediately preceding year for the patient and all responsible household members and with all children (except those born after the end of the last tax year) accounted for as dependents, with adjustments made to bring figures current; or d. where income tax returns are not available, the patient and all responsible household members shall be required to disclose under oath all income (as defined in this Section II.C.) received in the last 8 weeks from all sources. Income shall be verified according to DF ACS routine standards. Project Access shall require patients to authorize DF ACS to access their income records from the computer records of the Georgia Department of Labor. Any patient refusing to provide such authorization shall not be certified as indigent. Within seven days of its receipt of the authorization, DFACS will notify Project Access if the DOL income exceeds the patient's certified indigency leveL 3. Certification Process All certification cards are to be provided and issued by Project Access. Cards are valid for any Health Care Services event for not more than 90 days immediately following issuance; provided, however, that nothing herein shall obligate either Project Access or County to provide care to such individuals beyond the term of this Agreement. Any individual shall have the right to re-enroll in Project Access. Project Access agrees whenever it learns of a change in status of a patient, or otherwise obtains information suggesting that the certification level of a patient should be changed to take necessary steps to remove such individual from participation in Project Access. D. Health Care Services With the exceptions set out in this Section, Health Care Services includes only those Health Care Services, which are medically necessary, are to be provided to certified uninsured residents of Richmond County pursuant to this Agreement. Prescriptions for the following healthcare services are not covered and shall not be reimbursed by the County: 1. Cosmetic surgery; provided, however, that reconstructive surgery is a covered service. 2. Abortions; provided, however, that an abortion performed when the mother's life is in danger is covered. E. Non-Covered Patients The individuals listed below are not eligible for uninsured care by Project Access: 1. Any person receiving Cancer State Aid except when the program funds are exhausted as to that person or the Health Care Service is not covered by Cancer State Aid. 2. Any veteran eligible for Veteran's Administration assistance for the Health Care Service; 3. Any member ofthe military or any military member's dependent( s). 4. Any person not a resident of Richmond County; provided, however, that the coverage of a person while a resident who later moves away, is not affected by this provision. 5. Any person who, within the last 3 years, was convicted of welfare fraud, entered into a disqualification consent agreement, was determined at an administrative hearing to have committed an intentional welfare program violation, or who waived a disqualification hearing with respect to a charge of welfare fraud or intentional program violation. 6. Any college student who is covered under his/her parent's insurance coverage, or who is provided health care services by the college or institution in which he/she is enrolled; 7. Any transient worker, such as a construction or agricultural worker, who is domiciled outside of Richmond County. 8. Any individual domiciled outside of Richmond County who is present in Richmond County due to participation in a halfway house program or other rehabilitation program. 9. Any illegal alien or illegal immigrant. 10. Any and all inmates whose health costs are covered by the local, state or federal penal institution in which he/she is being housed. F. Payments by County County shall not be responsible for the payment of any prescription costs for any person not certified as an uninsured resident of Richmond County in accordance with this Agreement. G. Cap on Payments Regardless of actual costs and/or charges incurred and billed under this Section II., County shall not payor be required to pay in excess of Four Hundred Thousand . t'. Dollars ($400,000.00) (hereinafter referred to as the "Cap") for operation and/or prescription costs incurred for Health Care Services rendered pursuant to this Agreement. Any sums not expended for operation or for prescription costs shall be reimbursed to County. H. Accountability to County 1. Project Access's accountability to the County shall contain the following information: a. Name of patient; address of each patient; date of each service; the charge for each prescription; and b. A list of the current enrolled uninsured care card holders; and c. A statement signed by Project Access's Executive Director that the accountings comply with this Agreement and that Health Care Services include only individuals enrolled by Project Access. 2. Project Access shall provide county with a reasonable time after a request for a specific account information, but shall furnish at least a quarterly report setting forth the information in paragraph (1) above. SECTIOIN IV. MISCELLANEOUS PROVISIONS A. Amendment This Agreement may be amended only the express written consent and agreement of both parties hereto. B. Sole Agreement This Agreement represents the entire agreement between the parties hereto and supersedes any and all previous written and/or oral agreements or understandings. C. Future Contracts The parties agree that the funding obligations and the descriptions of Health Care Services set forth in this Agreement apply during the term of this Agreement, to-wit: calendar year 2005, only, and that nothing herein shall obligate the County to continue to provide to Project Access the same level of funding for the same services as are set forth herein. " ' . .- . , D. Governing Law This Agreement shall be governed by and construed in accordance with the laws of the State of Georgia. E. Severability In the event any provision of this Agreement is rendered invalid or unenforceable under any law or regulation, or declared null and void by any court of competent jurisdiction, the remainder ofthe provisions of this Agreement shall, subject to this paragraph, remain in full force and effect. F. Waiver Waiver of a breach of any provisions of this Agreement shall not be deemed a waiver of any other breach of the same or different provisions. G. Notices Any notice to be given hereunder by one party to the other shall be effected in writing and may be delivered either by certified U.S. mail with return receipt requested, by regular U.S. mail, properly addressed and postage prepaid, by overnight mail or by hand-delivery to the addresses listed below. Any party may change its address below by written notice given in accordance with this Section. Notices delivered personally shall be deemed received upon actual receipt. Notices mailed shall be deemed received no later than two (2) United States Postal Service business days after the date of such mailing. To Proiect Access: Richmond County Medical Society Project Access, Inc. James Lyle, Executive Director 1054 Claussen Road, Suite 313 Augusta, Georgia 30907 To County: Augusta-Richmond County Commission C/o Administrator 8th Floor - City-County Building (11) 530 Greene Street Augusta, Georgia 30911 .. . '. . IN WITNESS WHEREOF, the parties hereto have set their hands and seals as of the day first above written. f:>c;Js AUGUSTA, GEORGIA by and through the Augusta-Richmond County Commission ~r;;e: Mayor ~ l "'-' 6 [SEAL] RICHMOND COUNTY MEDICAL SOCIETY PROJECT ACCESS, INC. B~ {t. 1~ N e: J es R. Lyle Title: cutIve Dlrec r [SEAL]