Slide 1

FY 2015 LHD Contracts

Presented by:Tammy Page Janet OverstreetLocal Health Operations Branch

Ron HorsemanAssistant Director,Administration and Financial Management DivisionApril 23, 2014

902KAR 8:170Local health department financial management requirements

Section 7Contracting for servicesThe contract is between the LHD and the Contractor (provider) and should be signed by both parties prior to July 1 each fiscal year to ensure no interruption of services. Technically, if the contract is not signed by July 1 by both parties there is no effective contract in place (902 KAR 8:170, Section 7). Services should only then be provided once both parties have signed the agreement.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.

Personal Service ContractsOne 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).

CH-53M

Local Health DepartmentIndependent Contractor Agreement

Contract RequirementsService TypeContract DescriptionProvider CredentialsScope of WorkCompensation/PaymentBilling ProceduresAmount (#1) and Contract Value (#3)CH-55, if applicableService TypeExamples include, but not limited to:APRN Services,Radiological Services,Lab Services,Interpreter,Physician Services,Administrative Services andCancer, Family Planning, PrenatalContract DescriptionA detailed description of the services is required.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.

CH-55Medicaid Statement of Authorization

For Independent Contractors onlyIf 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, Financial Management, LHD Contracts

CH-55When 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.

CH-55AFM 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.LHD to bill third partyIf 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.LHD billing, continuedIf 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.CH-55The CH-55 can be found on the L drive in the CONTRACTS15 folder.

Onsite/Offsite servicesLHDs 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).

Third Party BillingThe 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).

AR, Financial Management, LHD ContractsThird Party BillingPlease review the WHOLE contract for third party billing language. Whether the contractoris responsible for the TPB MUST BE throughout the contract.

If the language is missing or is inconsistent, the contract will be sent back for a revision.

Third Party BillingIf 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 20101 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, Financial Management, LHD Contracts

Wording/TitlesIn 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.

Example-Refer to page 1 of contractTHIS 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}, 2014.

USE THE TITLES Health Department and Contractor THROUGHOUT THE CONTRACT.Payment InformationWithout 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.

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 = $24,000Payment in #3 cannot exceed $24,00020112$10,00024510$10,000Contract 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 ofthe CH-53M contract, enter the contract number(s), not Cost centers. 20112$10,00024510$10,000Multiple ContractsQuestion 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.Information PagePlease remember to save the information page on the L drivePlease use the information page template or the saved copy on the L drive.LabsThe independent contractor will be responsiblefor billing all third parties for lab services (201 Pathologist and 250 provider numbers).

Examples of 201 provider service:Level IV pathology specimen 88305Level V pathology specimen - 88307

Supplemental ReportingWhen 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.Supplemental ReportingSome 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 Operations (LHO) Branch webpage at http://chfs.ky.gov/dph/info/lhd/LHDforms.htm

and on the L drive located in CONTRACTS 15 folder.

Supplemental ReportingThe overview of Supplemental Services Reporting can be found in the AR, PSRS.

http://chfs.ky.gov/dph/Local+Health+Department.htmProvider numbersOnly use PROVIDER NUMBERS 201-260 for medical services contracts. DO NOT use the 301-315 minor object codes. If the 300 minor object codes are used for medical services (1511030115), the contract will be sent back for revisions.

AR, Financial Management, LHD Contracts260 and 205 provider numbersWhen reporting CPT code W0166, a 260provider number and language is required in thecontract.

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.CH-51Local Health DepartmentEmployment ContractPersonal Service ContractsIf 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.CH-51 RequirementsService typeContract descriptionProvider credentialsScope of workCompensation/PaymentPayment time periodContract valueRetirement issueCH-51Please 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.

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, works1,200 hours or more per year (fiscal or calendar), the LHD would pay into retirement, not the employee.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.

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 #36.Contracting with IndividualsWhile 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 subcontractthe employees services out to other LHDs.

Refer to slide #44 for more information.Contracting with Individuals902 KAR 8:170, Section 7 (4b)Should not substitute for establishing a position

902 KAR 8:160, Section 3, 2dMultiple Agency contractingCH-52 Local Health Department Contract to Provide Services

CH-52A 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, Financial Management, LHD Contracts

CH-52When 2 health departments contract, whoever is requesting the employee should write the contract.

First Party requesting the employee

Health Department supplying the employeePayor Code 8Payor 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.

Payor Code 8Through Payor Code 8 Agreements, LHDs have the ability to negotiate , with public or private entities, higher rates for services, than rates that are listed on the 501 Service File

Negotiated rates 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.

Payor Code 8A 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.HIPAAChanges from the 2013 HIPAA OMNIBUS Final Rule required language changes to Business Associate Agreements. What does that mean? ALL BAAs, whether previously existing or new has to contain the new language. The compliance date was 9/23/13.More information and examples of Business Associates can be found at:http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/businessassociates.htmlPayor Code 8A 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 be setup in Bridge and Portal.

Payor Code 8Contract Codes # should be entered into the CnctC field on PEF entry and P8 should be entered in the over-ride field for each CPT codePayor Code 8Rates 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.

AR, Financial Management, LHD ContractsPayor Code 8P8 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, Financial Management, LHD ContractsPayor Code 8CHFS and DPH have agreed to the provision and payment of DCBS field staff for Hepatitis B and Flu vaccinations for designated First Aid Safety Team FAST employees.

ONLY those DCBS employees designated as FAST employees will be paid.

Payor Code 8Vaccine 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.Payor Code 8DPH 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.Payor Code 8LHDs 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 Physicians Fee Schedule rates should be used.Payor Code 8Contracts 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.Payor Code 8LHDs are to use the CH-52 Fire Commission contracts when contracting to provide Hepatitis B vaccinations to those firefighters approved for the service. DPH encourages ALL LHDs to contract with the Fire Commission for these Hepatitis B services. Health Departments are the ONLY entity that the Fire Commission will reimburse for these services.

Language in the contract should not be changed. LHDs need to fill in their name & address and have LHD & Fire Commission authorized signatures.Payor Code 8Contracts 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.Payor Code 8LHDs 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 agencys cost.

http://kyfirecommission.kctcs.edu/en/Fire_Commission_Programs/Hepatitis_B_Vaccinations.aspx

Payor Code 8Payor Code 8 contracts will not be reviewed by DPH, but we would like for LHDs to save these contracts to the Payor Code 8 Contracts folder on the L-Drive for referencing (if applicable).Payor Code 8For questions concerning Payor Code 8 contracts, hepatitis b or flu CHFS contracted services, contactJanetD.Overstreet@ky.gov

(502) 564-6663, ext. 4120Other Contract Issues

Where are the templates located?The most recent templates are located at:

L:/LHDContracts/CONTRACTS15Why 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.

AmendmentsAmendment templates for the contracts can also be found on the L drive.Administrative ReferenceContract information can be found in the Financial Management Section.When are contracts due?No later than May 1 of each year.

School contracts are due No later than April 30, unsigned.NEW FOLDERA new folder has been created specifically for contracts.

You will now save your contracts at the following address:

L:/LHDContracts/YOUR LHD NAMEHow should the contract be filed?The FINAL FY 14 contract will be saved on the L drive in the health departments Contract14 folder.

Use this as your template for FY15 contracts. Make sure to update the contract number, effective date, and use revised program templates. Once you have completed the contract, save in the L:/LHDContracts/LHD name/Contracts15 and contact Tammy Page via e-mail.

tammy.page@ky.govSaving contractWhen saving the contract on the L drive, name it the contract number. For example, 1511120120.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.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 75.Saving contractThe Contracts15 folder has 2 folders:Contracts $10,000+Contracts less than $10,000Please 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.Saving contractL:/LHDContracts/YOUR LHD NAME/Contracts15

Two folders for saving contracts:Contracts $10,000+Contracts less than $10,000Folder Example

YOU CAN SEPARATE CONTRACTS ACCORDING TO TYPE WITHIN THE FOLDERSNAME ALL CONTRACTS BY NUMBER AND NOT NAMEALL CONTRACTS ARE TO BE SAVED HEREFiling contractsPlease DO NOT e-mail your contracts. If you haveany questions concerning this procedure, feel free to contact me at 502-564-6663, x-4121 or e-mail at tammy.page@ky.gov

Always e-mail when a new contract has been placed on the L drive.Board of Health Member contractsIf 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 $10,000.

902 KAR 8:170, Section 7, (6) (a) 4(b)

Board of Health Member ContractsContracts 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, Financial Management, LHD ContractsBoard of Health Member ContractsPlease refer to the Administrative Reference, 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.RemindersBefore saving the contract to the L drive, check the following:

Minor Object Codes for example, 250 is for labs.

Effective dates for example, July 1, 2014-June 30, 2015.

Payment amounts please refer to earlier slides.CorrectionsWhen 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 FINALDo NotsDo Not include Social Security numbers on the contract.Do Not create a new Contracts folder. Use the Contracts15 folders that have been created by LHO. However, within each folder, you can separate contracts by type. Review slide 76.When new folders are created, it is difficult to find the contracts.Provider NumbersContract provider numbers are assigned by LHO. Contact Tammy Page by e-mail for new provider numbers or to update the provider name.Assigned by LHO ONLY.

AR, Patient Services Reporting System (PSRS), Personal Services Contract & Part-Time Employees table and Independent Contractor Providers tableProvider NumbersWhen 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. Using correct provider numberIf you receive a message when entering services into a PEF, DO NOT use another provider number just to get the service entered.Using the wrong provider number could lead to the loss of federal funding.Contact the Local Health Operations branch at LocalHealth.Helpdesk.@ky.gov for assistance.Contract LayoutI have attempted to clean up some of the contracts. The current contract SHOULD NOT HAVE Rev 2/08 in the left top cornerFinal 08-09 in the right top corner

Please use the FINAL contracts that have been saved in the FY14 folder when creating the FY15 contracts or the templates located on the L drive.Deleted ParagraphContracts 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.)

WebsiteFor information concerning the FY15 contracts, please visit the following website:

http://chfs.ky.gov/dph/2015contracts.htm

and click on 2015 contract information documents on the right.

If all else fails!Contact :Tammy.Page@ky.gov, 502-564-6663, x 4121

Mark.Tibbles@ky.gov ,502-564-6663, x4133

JanetD.Overstreet@ky.gov, 502-564-6663, x. 4120

LocalHealth.HelpDesk@ky.gov