HomeMy WebLinkAboutPROJECT ACCESS
Augusta Richmond GA
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AUGUSTA-RICHMOND COUNTY COMMISSION
JAMES B. WALL
CITY A TIORNEY
LEE BEARD
TOMMY BOYLES
ULMER BRIDGES
ANDY CHEEK
BOBBY G, HANKERSON
WILLIAM D. KUHLKE, JR,
WM, "WILLIE" H, MAYS, III
STEPIIEN E. SHEPARD
MARION WILLIAMS
BOB YOUNG
Mayor
P,O, Box 2125
454 GREENE STREET
AUGUSTA, GA 30903
Bus, (706) 821-2488
FAX No: (706) 722-5984
E-MAIL: JWALL@CO.RICHMOND.GA.US
GEORGE R. KOLB
Administrator
RICHARD L. COLCLOUGH
Mayor Pro Tem
May 20, 2002
Ms. Lena BOlmer
,Clerk, Commission
8th Floor, City-County Bldg.
Augusta, GA 30911
RE: Project Access Agreement
Our File No. AR-75-011-02
Dear Lena:
I enclose herewith the original of the Project Access Agreement to be included in
the City's permanent files.
By carbon copy oftlus letter, I am forwarding a copy of same to Donna Williams
in order for payment to be made as provided in the Agreement.
With best personal regards, I am
Yours very truly,
~
James B. Wall /~
JBW/sjp
Enclosure
cc: Mr. Jerry Peloquin
Ms. Donna Williams
.".~
AGREEMENT FOR CERTIFIED
UNINSURED CARE
This Agreement is effective the 1 st day of January, 2002, 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 residents of Richmond County for calendar year 2002;
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 bOlmd, do hereby agree as
follows.
SECTION I.
TERM OF AGREEMENT
This Agreement shall be for a tenn beginning January 1, 2002 and continuing until the
termination date provided by this Agreement of December 31, 2002.
SECTION II. COSTS
County shall pay the stun of Four Hundred Thousand Dollars ($400,000.00) for costs
necessary to begin the operation of Project Access, including but not limited to office space,
furniture, computer hardware and software, personnel costs ("Start Up Costs") and for payment
of prescriptions pursuant to Health Care Services as herein provided. One payment of Two
Hundred Thousand Dollars ($200,000.00) shall be made upon execution of the Agreement and
the balance of Two Hundred Thousand Dollars ($200,000.00) shall be paid July 1,2002.
SECTION III. PROVISION OF HEALTH CARE SERVICES TO CERTIFIED
UNINSUREDSj PAYMENTS BY COUNTY
County and Project Access agree to the following tenns and conditions for the providing
of certain Health Care Services to the uninsured residents of Richmond County beginning July 1,
2002 and continuing until December 31, 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
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in the same manner and quality as provided to other patients of its members. Project Access
reserves the right to deny services to any patient who engages in dangerous or disruptive
behavior or who does not 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 a responsible household
member's) address or a statement from the patient's (or a responsible household member's)
employer attesting to residence in Richmond County;
d. utility bills or payment stubs in the patient or a 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 of 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 Almy;
h. a letter from DF ACS verifying receipt of food stamps from Richmond
County DF ACS; or
1. a cun"ently valid Project Access certification card issued under Section C.3
below.
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No bill for prescriptions for a patient whose residency cannot be certified 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 Service "self-pay", that is
a. does not have valid health insurance and/or medical payments coverage
for the Health Care Service (per diem hospitalization reimbursement 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 workers' 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 fann 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. workers' compensation payments;
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h. veterans's benefits;
1. training stipends;
J. alimony payments;
k. child support payments;
1. military fanlily 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
1. any other fornl 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 stamp recipients, gross income shall be determined from
DF ACS records (unless such records are more than 12 months old); or
c. For other than food stamp recipients (or for those whose DFACS
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
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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. lncome 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, DF ACS 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 Service 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
health care 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 perfonned 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 program
funds are exhausted as to that person or the Health Care Service is not covered by Cancer State
Aid.
2.
the Health Care Service;
Any veteran eligible for Veterans' Administration assistance for
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3. Any member of the 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 progran1
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 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 Dollars
($400,000.00) (hereinafter referred to as the "Cap") for start up costs and/or prescription costs
incurred for Health Care Services rendered pursuant to this Agreement. Any sums not
expended for start up costs or for prescription costs shall be reimbursed to County.
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I. 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 within a reasonable time after
a request for a specific account information, but shall fumish at least
quarterly a report setting forth the infonnation in paragraph (1) above.
SECTION IV. MISCELLANEOUS PROVISIONS
A. Amendment
This Agreement may be amended only by 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 2002, 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.
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,,'
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 of the provisions of this Agreement shall, subject to this paragraph, remain in full
force and effect.
F. Waiver
Waiver of a breach of any provision 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 celiified 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 Project Access:
Richmond County Medical Society Project Access, Inc.
Jerry Peloquin, Executive Director
1054 Claussen Rd.
Suite 307
Augusta, Georgia 30907
To County:
Augusta-Richmond County Commission
c/o Administrator
8th Floor - City-County Building (11)
530 Greene Street
Augusta, Georgia 30911
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IN WITNESS WHEREOF, the parties hereto have set their hands and seals as of the day
first above written.
AUGUSTA, GEORGIA by and through the
Augusta-Richmond County Commission
:1!!LqJ~
[SI2AL]
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I,.:
RICHMOND COUNTY MEDICAL SOCIETY
PROJECT ACCESS, INe.
By:
Name:
Title:
[SEAL]
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