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FY 2014 LHD Contracts FY 2014 LHD Contracts Presented by: Tammy Page Janet Overstreet Local Health Operations Branch Ron Horseman Assistant Director, Administration.

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Presentation on theme: "FY 2014 LHD Contracts FY 2014 LHD Contracts Presented by: Tammy Page Janet Overstreet Local Health Operations Branch Ron Horseman Assistant Director, Administration."— Presentation transcript:

1 FY 2014 LHD Contracts FY 2014 LHD Contracts Presented by: Tammy Page Janet Overstreet Local Health Operations Branch Ron Horseman Assistant Director, Administration and Financial Management Division 1

2 902KAR 8: KAR 8:170 Local health department financial management requirements Section 7 Contracting for services 2

3 902KAR 8:170, Section 7, (6)4.b A contract shall not be entered into with a local health department employee or local board of health member, unless authorized in writing by the Department for Public Health, and except for medical or professional services under $10,000. 3

4 902KAR 8:170, Section 7 (10) 902KAR 8:170, Section 7 (10) All local health department contracts and amendments are subject to review by the Department for Public Health. Emphasizing ALL contracts are subject to review. 4

5 FY13 most common problems Reporting CPT codes under the wrong provider number, Using wrong rate sheet for KWCSP, Not identifying what Family Planning services the contract is for (example: for onsite midlevel clinician or higher to perform family planning clinical services at LHD; for midlevel clinician or higher to insert methods not provided on site or perform sterilization procedures; or outpatient surgery center or hospital for pre-op, OR, and post-op care for sterilizations). Not listing specific contract language needed for procedures and rates for Family Planning services (example: not including the federal sterilization form requirement language in a contract for sterilization procedures. Including language in the contract that is listed as instructions for the LHD and should not be included in the contract, Using language from previous versions of the Administrative Reference (AR) and/or the Core Clinical Service Guidelines (CCSG) - previously the Public Health Practice Reference (PHPR). References to the PHPR will need to be changed to the CCSG. Specific prenatal services not identified, Contracts did not include the language listed as Required Language, Statements singling out any group and/or race. 5

6 Personal Service Contracts Personal Service Contracts One of the powers of local health departments is to contract for services of a professional or technical nature not available through the local health department merit system. The two types of personal service contracts are Payroll/Employment (CH-51) and Independent Contracts (CH-53M). 6

7 CH-53M Local Health Department Independent Contractor Agreement 7

8 Contract Requirements Service Type Contract Description Provider Credentials Scope of Work Compensation/Payment Billing Procedures Amount (#1) and Contract Value (#3) CH-55, if applicable 8

9 Service Type Examples include, but not limited to: APRN Services, Radiological Services, Lab Services, Interpreter, Physician Services, Administrative Services and Cancer, Family Planning, Prenatal 9

10 Contract Description A detailed description of the services is required. 10

11 Provider Credentials Example: Dr. Jones is a licensed physician in the state of Kentucky. Credentials will be kept on file and updated on a yearly basis or as changes arise. 11

12 CH-55 Medicaid Statement of Authorization CH-55 Medicaid Statement of Authorization For Independent Contractors only If the Contractor is performing services ON-SITE and the LHD will bill Medicaid on behalf of the Contractor, the CH-55 is required and shall be attached to the CH- 53M. The contract would have an “N” at the top of page 1. AR, Volume 1, Financial Management, LHD Contracts 12

13 CH-55 When the Contractor signs the CH-55, they are allowing the LHD to bill Medicaid for the services they provide. This authorization from the Contractor should help prevent duplicate payments due to the health department and provider both billing Medicaid for the same services. 13

14 CH-55 CH-55 AFM strongly recommends if the Contractor is a Medicaid provider, that the Contractor bill for the services performed OFF-SITE. The CH-55 is NOT required. 14

15 LHD to bill third party If the LHD contracts with a Contractor and the LHD will be the third party biller: This includes patients that are provided services by the Contractor at the contractor site, who have insurance, Medicaid, Medicare, etc. (with the exception of Lab services). For CPT codes not listed on the DPH Medicaid Preventive Fee Schedule, the LHD will not receive payment from Medicaid. 15

16 LHD billing, continued If there possibly will be CPT codes not billable by LHDs to Medicaid or other third party plans, the LHD should not agree to bill on behalf of the contractor. If the LHD is responsible for billing the third party payors, the contractor should not bill third party payors. 16

17 CH-55 The CH-55 can be found on the L drive in the CONTRACTS14 folder. 17

18 Onsite/Offsite services LHDs who have a Contractor come on-site to deliver services and the LHD is responsible for the third party billing, but the Contractor does their own third party billing for services not provided at the LHD, those LHDs would need two (2) provider numbers. For example, a provider number is needed if the health department is responsible for the billing when a doctor performs services onsite (20111). Another provider number is needed if the same contractor is responsible for the billing if a service is performed offsite (20112). 18

19 Third Party Billing The contract MUST include a “Y” or “N” at the top of the page AND language IN the contract stating who is responsible for the Third Party Billing (TPB). See example on next slide. AR, Volume 1, Financial Management, LHD Contracts 19

20 Third Party Billing If “Y” is marked at the top of the page – If “N” is marked at the top of the page - State in the contract “The contractor will be responsible for billing all third parties”. State in the contract “The contractor will not be responsible for billing all third parties”. 20

21 Third Party Billing Third Party Billing Please review the WHOLE contract for third party billing language. Whether the contractor is responsible for the TPB MUST BE CONSISTENT throughout the contract. If the language is missing or is inconsistent, the contract will be sent back for a revision. 21

22 Third Party Billing If there is more than one contract included with the lead contract, TPB language is required for every contract number. For example, if the contract includes numbers and 21501, a sentence is required concerning TPB responsibility under EACH contract number. Each sentence must correspond to the “Y” or “N” at the top of the page. AR, Volume 1, Financial Management, LHD Contracts 22

23 Wording/Titles Wording/Titles In the CH-53M template, the parties to the contract are identified as “Health Department” and “Contractor”. To make the contract enforceable, the body of the contract should refer to the parties identified as Health Department and Contractor. See example on next slide. 23

24 Example- Refer to page 1 of the contract THIS CONTRACT, between Health Department (Health Department) Address City, State, Zip Code and Contractor's Name (Contractor) Address City, State, Zip Code is effective {date } and ends {No later than June 30}, USE THE TITLES “Health Department” and “Contractor” THROUGHOUT THE CONTRACT. 24

25 Example Dr. Smith agrees to furnish the ABC Health Department copies of the prenatal office visit records. WRONG The Contractor agrees to furnish the Health Department copies of the prenatal office visit records. RIGHT 25

26 Payment Information Without an amendment, total payments (CH-53M) can be 20% greater than the total contract. See example on next slide. Refer to last page of CH-53M template. 26

27 Example ( 1)This Payment made under the terms of each section of this contract shall not exceed: Contract Section # Amount ( 2) For the services described in this contract, the Health Department agrees to pay the Contractor in the following manner, within 90 days, payable upon receipt of appropriate billing. (3) The total payments made under the terms of this contract shall not exceed $24,000 ($10,000+ $10,000) x 1.2 = $24,000 Payment in #3 cannot exceed $24, $10, $10,000

28 Contract Numbers (1)This Payment made under the terms of each section of this contract shall not exceed: Contract Section # Amount When entering the information in #1 on the last page the CH-53M contract, enter the contract number(s), not Cost centers. Refer to example above $10, $10,000

29 Multiple Contracts Question – Can there be more than one contract with the same contractor? Answer – Yes. The health department will have a lead contract and the others will be attached. Third party billing language must be included for EACH contract. See previous slides concerning third party billing. 29

30 Information Page Please remember to save the information page on the L drive. Please use the information page template or the saved copy on the L drive. 30

31 Labs Labs The independent contractor will be responsible for billing all third parties for lab services (201 and 250 provider numbers). 31

32 Supplemental Reporting Supplemental Reporting When the contracted provider bills third party payors, there are some services that DPH requests LHDs to report through the Supplemental Reporting System to attain necessary federal & state data information. 32

33 Supplemental Reporting Some of those services include: mammograms, breast ultrasounds, paps, HPV tests, Lead tests, etc. The Supplemental Reporting document (CH-47)is to be used to report these services. It can be found on the Local Health webpage at and also on the L drive located in CONTRACTS14 folder. 33

34 Supplemental Reporting Supplemental Reporting The overview of Supplemental Services Reporting can be found in the AR, Volume II, PSRS. 34

35 Provider numbers Only use PROVIDER NUMBERS for medical services contracts. DO NOT use the minor object codes. If the 300 minor object codes are used for medical services ( ), the contract will be sent back for revisions. AR, Volume 1, Financial Management, LHD Contracts 35

36 202 Provider number When requesting a 202 provider number, the OB/GYN should be Board Certified. 36

37 260 and 205 provider numbers 260 and 205 provider numbers When reporting CPT code W0166, a 260 provider number and language is required in the contract. When reporting anesthesia codes, a 205 provider number and language is required in the contract. The language for the contract can be found on the L drive. 37

38 CH-51 Local Health Department Employment Contract 38

39 Personal Service Contracts Personal Service Contracts If a full-time contract with an individual (CH-51) is submitted, and the services are available through the LHD Merit system, the contract will not be reviewed and the health department will be instructed to obtain the services through the LHD Merit System. 39

40 CH-51 Requirements Service type Contract description Provider credentials Scope of work Compensation/Payment Payment time period Contract value Retirement issue 40

41 CH-51 Please remember to mark whether the employee is___or is not___ receiving retirement benefits on the last page of the contract. Review example below. The Employee certifies that he/she is ___ or is not ___ receiving any retirement benefits from the Kentucky State Employees Retirement System or any other retirement system supported either fully or partially by the Commonwealth of Kentucky. 41

42 Can Contract Employees work more than 1,200 hours? YES: With the approval of DPH, per 902 KAR 8:170 Section 7, 4(c). Retirement and insurance may impact the cost to LHD and employee. If a retiree that participates in KRS, were to average more than 1,200 hours per year (fiscal or calendar), the LHD would pay into retirement, not the employee. 42

43 1,200 hours, cont. 1,200 hours, cont. ALL RETIREES returning to work at an agency should check with the KRS before entering into a contract to protect their retirement benefits. Entering into the contract too early could jeopardize their retirement. 43

44 1,200 hours, cont. 1,200 hours, cont. If an employee works 1,200 or more hours per year or a pattern of 100 hours per month is established, the agency will be responsible for retirement and insurance benefits. Please remember to mark whether the employee is receiving retirement benefits or not on the last page of the CH-51 contract as shown on slide #41. 44

45 Contracting with Individuals Contracting with Individuals While the conservative method to contract with an individual is to use the CH-51, Employment Contract, employees should not contract with more than one LHD. If the individual is working at more than one LHD, one LHD should contract with the employee and subcontract the employee’s services out to other LHDs. 45

46 Employment Agency Contracting Contracting available for positions that work between hours per calendar or fiscal year Positions would provide services for the health departments as agreed upon in a CH53-M contract with the employment agency 46

47 Contracting with Individuals 902 KAR 8:170, Section 7 (4b) Should not substitute for establishing a position 902 KAR 8:160, Section 3, 2d Multiple Agency contracting 47

48 CH-52 Local Health Department Contract to Provide Services 48

49 CH-52 CH-52 A CH-52 was created by DPH to provide a standardized template that local health departments may use enter into a contract with a public or private entity to provide needed health services. CH-52 is used for agreements between LHDs & Boards of Education, Payor Code 8 agreements and contracts between 2 LHDs. Contracts initiated by a First Party may be used; however, any required language must be included in the contract and the expiration date should end on June 30 of each year. AR, Volume 1, Financial Management, LHD Contracts 49

50 Payor Code 8 Payor Code 8 Agreements should be between the LHD and a public or private entity. Payor Code 8 Agreements should never be with an individual, unless they are the public or private entity. Through Payor Code 8 Agreements, LHDs have the ability to negotiate rates for services with the public or private entity; However, Negotiated rates, may be more, but should not be less than the DPH rate listed on the 501 Service File in the “Other” field. Rates should cover the direct and indirect cost of the service. 50

51 Payor Code 8 A HIPAA Business Associate Agreement (BAA) shall accompany the initial Payor Code 8 Agreement or an agreement initiated by a First Party. Payor Code 8 Agreements shall be completed on a fiscal year basis; after the initial BAA, another would not need to be completed unless there are significant material changes. 51

52 Payor Code 8 A Payor Code 8 Agreement or other agreement shall be completed prior to providing services. LHDs should assign and set-up a Contract Code for each entity with whom they have a Payor Code 8 Agreement.. This would include other agreement formats initiated by a First Party. Contract codes have to built in Bridge and Portal. Contract Codes should be entered into the “CnctC” field on PEF entry and “P8” should be entered in the over-ride section for each CPT code. 52

53 Payor Code 8 Rates negotiated by the LHDs that are “higher” than the system assigned rates may be over-ridden without submitting a request to AFM for approval. A rate is required for services rendered and an appropriate audit trail should be documented. Invoices shall not be setup as “0”. Nor should LHDs use nominal fee rates. P8 Contractors should be treated as third party payers and the expectation would be they are charged at 100% of the cost (direct and indirect) of the service. AR, Volume 1, Financial Management, LHD Contracts 53

54 Payor Code 8 CHFS and DPH have agreed to the provision and payment of DCBS field staff for Hepatitis B and Flu vaccinations for designated “first responders”. (First Aid Safety Team – FAST employees) ONLY those DCBS employees designated as “FAST” employees will be paid. Vaccine administration will be $22.00 (already set in 501 Service File); however the actual vaccine should be charged at the cost the LHD purchased the vaccine. Over-rides for making changes to the LHD cost of the Hep B or Flu vaccine for this project is approved. DPH will provide quarterly payments to LHDs after validating services reported; DPH will bill CHFS/DCBS annually. LHDs will use Payor Code 8, Contract Code 701, for reporting these services; if not reported correctly LHDs may not receive timely payment for services provided. 54

55 Payor Code 8 LHDs may contract with Jails through P8 contracts to provide services to incarcerated individuals. KRS 441 provides information regarding the responsibility of jails to provide access to and payment for “necessary care” for prisoners. KY Medicaid Physician’s Fee Schedule rates should be used. Contracts for services provided to Jail employees should be treated the same as contracts with other public or private entities. A sample CH-52 Jail contract (with language for services provided to incarcerated individuals) is available. 55

56 Payor Code 8 LHDs are to use the CH-52 Fire Commission contracts when contracting to provide Hepatitis B vaccinations to those firefighters approved for the service. Language in the contract should not be changed. LHDs need to fill in their name & address and have LHD & Fire Commission authorized signatures. Contracts should be completed prior to providing the Hepatitis B vaccination services. LHDs will setup their own P8 contract code number. This needs to be done in CMS Portal and in Bridge. LHDs should submit the Fire Commission Hepatitis B Voucher along with their billing document to the Fire Commission. However, the LHD will not receive payment from the Fire Commission unless a valid Contract is on file. Vaccine administration is $22. Charges for the hepatitis b vaccine should be listed on the encounter at the agencies cost. 56

57 Payor Code 8 Save ALL Payor Code 8 contracts in the Payor Code 8 contracts folder. 57

58 Payor Code 8 DPH contact for the DCBS flu or hepatitis b services: ◦ Janet Overstreet ◦ KY Dept. for Public Health ◦ 275 E. Main St., HS 1 WB ◦ Frankfort, KY ◦ (502) , ext

59 Other Contract Issues Other Contract Issues 59

60 Where are the templates located? The most recent templates are located at: L:\LHDBudgets\CONTRACTS14 60

61 Why are there shaded areas in the templates? The shaded areas need to be filled in by the health department. They contain reminders and suggestions for wording and/or content. 61

62 Amendments Amendment templates for the contracts can also be found on the L drive. 62

63 CH-53M Amendment When completing an amendment for the CH-53M, use the amount in #1 on the last page of the contract. Refer to the CH-53M template $10,000 This Payment made under the terms of each section of this contract shall not exceed: Contract Section # Amount Contract Section # Amount

64 CH-53M Amendment All other terms and conditions of the contract except as modified above are hereby ratified and confirmed. The period within the current fiscal year in which services are to be performed under this amendment is from {Enter Date} to {Enter Date}. Net Increase in Contract {$5,000}Net Decrease in Contract {Enter Dollars} Revised Contractual Total {$15,000} 64

65 Administrative Reference Administrative Reference Contract information can be found in Volume 1, Financial Management Section 65

66 When are contracts due? No later than May 1 of each year. School contracts are due No later than April 30, unsigned. 66

67 How should the contract be filed? The FINAL FY 13 contract will be saved on the L drive in the health departments Budget13 folder, Contracts13 folder. Use this as your template for FY14 contracts. Make sure to update the contract number, effective date, and use revised program templates. Once you have completed the contract, save in the Budget14 folder, Contracts14 folder and contact Tammy Page via . 67

68 Saving contract Saving contract When saving the contract on the L drive, name it the contract number. For example, doc would be the correct way to save the contract. DO NOT include the word “FINAL”. DO NOT save the contract as the name. For example, Dr. Jones contract.doc is not the correct way. 68

69 What if my contract is less than $10,000? ALL contracts are subject to review. Save the contracts in the appropriate folder. See example on slide

70 Less than $10,000 contract Contracts that are less than $10,000 were reviewed for FY13. 70

71 Saving contract Saving contract The Contracts14 folder has 2 folders: Contracts $10,000+ Contracts less than $10,000 Please inform all those involved in the contract process where the contracts need to be saved. DO NOT save anywhere else. Worth repeating – Save by contract number, not provider name 71

72 Saving contract L:\LHDBudgets\YOUR LHD NAME\Budget14\Contracts14 Two folders for saving contracts: Contracts $10,000+ Contracts less than $10,000 72

73 Folder Example 73 YOU CAN SEPARATE CONTRACTS ACCORDING TO TYPE WITHIN THE FOLDERS NAME ALL CONTRACTS BY NUMBER AND NOT NAME ALL CONTRACTS ARE TO BE SAVED HERE

74 Filing contracts Filing contracts Please DO NOT your contracts. If you have any questions concerning this procedure, feel free to contact me at , x-4121 or at Always when a new contract has been placed on the L drive. 74

75 Board of Health Member contracts If a contracting medical professional is a governing board of health member, then an automatic exception to the conflict of interest provision of the contract policies is made if the annual amount will not exceed $10, KAR 8:170, Section 7, (6) (a) 4(b) 75

76 Board of Health Member Contracts Contracts exceeding $10,000 must be approved by the Commissioner of the Department for Public Health. A letter or justification indicating the necessity and rationale for contracting with a board member must be submitted to the Commissioner of DPH with the proposed contract. AR, Volume 1, Financial Management, LHD Contracts 76

77 Board of Health Member Contracts Please refer to the Administrative Reference, Volume 1, Financial Management, LHD Contracts and 902 KAR 8:170, Section 7,6. Please contact Dr. Connie White, Deputy Commissioner of Department for Public Health for additional questions. 77

78 Reminders Before saving the contract to the L drive, check the following: Minor Object Code – for example, 250 is for labs. Effective dates – for example, July 1, 2013-June 30, Payment amounts – please refer to earlier slides 78

79 Corrections Corrections When making corrections, please replace the old contract with the corrected contract. There should only be ONE copy of each contract on the L drive. DO NOT keep the original and a revised version of the contract on the L drive. NEVER save the contract as “FINAL” 79

80 HIPAA HIPAA All contracts continue to have the HIPAA language. However, be sure to have a Business Associate Agreement completed with ALL vendors. If you completed a BAA last year, it is not required that you do a new BAA. Exemptions would be independent medical contractors who already are HIPAA covered entities. Examples include custodial services, auditors, physicians, hospitals, etc. 80

81 Do Nots Do Not include Social Security numbers on the contract. Do Not create a new Contracts folder. Use the Contracts14 folders that have been created by LHO. However, within each folder, you can separate contracts by type. Review slide 72. When new folders are created, it is difficult to find the contracts. 81

82 Provider Numbers Provider Numbers Contract provider numbers are assigned by LHO. Contact Tammy Page by for new provider numbers or to update the provider name. Assigned by LHO ONLY. AR, Volume II, Patient Services Reporting System (PSRS), Personal Services Contract & Part-Time Employees table and Independent Contractor Providers table 82

83 Provider Numbers When requesting a provider number, DO NOT assume that I will look for the contract on the L drive. It is up to the LHD to inform LHO when a contract has been saved on the L drive. 83

84 Using correct provider number If you receive a message when entering services into a PEF, DO NOT use another provider number just to get the service entered. Contact the Help Desk at Using the wrong provider number could lead to the loss of federal funding. 84

85 Contract Layout I have attempted to “clean up” some of the contracts. The current contract SHOULD NOT HAVE Rev 2/08 in the left top corner Final in the right top corner Please use the FINAL contracts that have been saved in the FY13 folder when creating the FY14 contracts or the templates located on the L drive. 85

86 Deleted Paragraphs Contracts of $10,000 or greater shall not become effective until the Department for Public Health has reviewed the contract as evidenced by the signature of an authorized officer of the Department for Public Health on the attached Contractor Information Page. (ALL contracts regardless of amount are to be maintained by the health department.) The Contractor, and all its agents, employees and subcontractors, shall adhere to and comply with any and all applicable requirements of Section 114 of the Fair and Accurate Credit Transactions Act of 2003 (15 U.S.C. 1681m (e)); the administrative regulations promulgated thereto, including but not limited to 16 C.F.R. Part 681 (the “Red Flags Rule”); and any written identity theft prevention program developed and implemented by the Local Heath Department and/or the Kentucky Department for Public Health. Additionally, the Contractor shall indemnify and hold harmless the Local Heath Department, the Kentucky Department for Public Health, and their agents, representatives, officers, directors, employees, insurers, successors, and assigns from and against any and all expenses, costs (including attorneys’ fees), causes of action, liability, loss and/or damages suffered or incurred by any of them, that results from or arises out of any acts, errors, or omissions of the Contractor, or its agents, employees, or subcontractors, that violate Section 114 of the Fair and Accurate Credit Transactions Act of 2003; any administrative regulations promulgated thereto, including but not limited to the Red Flags Rule; or any written identity theft prevention program developed and implemented by the Local Heath Department or the Kentucky Department for Public Health. 86

87 Website For information concerning the FY14 contracts, please visit the following website: and click on “2014 contract information documents” on the right. 87

88 If all else fails! Contact Tammy Page and/or Janet Overstreet at Option 1 or 88


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