Slide 1FY 2015 LHD Contracts Presented by: Tammy Page Janet Overstreet Local Health Operations Branch Ron Horseman Assistant Director, Administration and Financial Management Division April 23, 2014
902KAR 8:170
Section 7
Contracting for services
The 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.
review.
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).
CH-53M
CH-55, if applicable
APRN Services,
Radiological Services,
Lab Services,
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-55
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.
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.
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.
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.
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.
CH-55
The CH-55 can be found on the L drive in the CONTRACTS15 folder.
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).
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).
Third Party Billing
party billing language. Whether the contractor
is responsible for the TPB MUST BE
throughout the contract.
contract will be sent back for a revision.
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 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/Titles
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 contract
THIS CONTRACT, between
and Contractor's Name
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.
(CH-53M) can be 20% greater than the
total contract.
page of CH-53M template.
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 $24,000
20112
$10,000
24510
$10,000
of this contract shall not exceed:
Contract Section # Amount
 
When entering the information in #1 on the last page of
the CH-53M contract, enter the contract number(s), not
Cost centers.
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 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.
Labs
for billing all third parties for lab services
(201 “Pathologist” and 250 provider numbers).
Examples of 201 provider service:
Level IV pathology specimen – 88305
Level V pathology specimen - 88307
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.
Supplemental Reporting
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
Supplemental Reporting
Reporting can be found in the AR, PSRS.
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
AR, Financial Management, LHD Contracts
260 and 205 provider numbers
When reporting CPT code W0166, a 260
provider number and language is required in the
contract.
number and language is required in the contract.
The language for the contract can be found on
the L drive.
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.
CH-51 Requirements
Service type
Contract description
Provider credentials
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.
to protect their retirement benefits.
Entering into the contract too early could jeopardize
their retirement.
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.
page of the CH-51 contract as shown on slide #36.
Contracting with Individuals
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.
Refer to slide #44 for more information.
Contracting with Individuals
Should not substitute for establishing a position
902 KAR 8:160, Section 3, 2d
Multiple Agency contracting
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, Financial Management, LHD Contracts
CH-52
When 2 health departments contract, whoever is requesting the employee should write the contract.
First Party – requesting the employee
Health Department – supplying the employee
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.
Payor Code 8
Through 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 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.
HIPAA
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.html
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 be setup in Bridge and Portal.
Payor Code 8
Contract Codes # should be entered into the “CnctC” field on PEF entry and “P8” should be entered in the “over-ride” field for each CPT code
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.
AR, Financial Management, LHD Contracts
Payor Code 8
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, Financial Management, LHD Contracts
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 Aid Safety Team – “FAST” employees.
ONLY those DCBS employees designated as “FAST” employees will be paid.
Payor Code 8
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.
Payor Code 8
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.
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.
Payor Code 8
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.
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. 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 8
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.
Payor Code 8
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 agency’s cost.
Payor Code 8
Payor 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 8
For questions concerning Payor Code 8 contracts, hepatitis b or flu CHFS contracted services, contact
The most recent templates are located at:
L:/LHDContracts/CONTRACTS15
The shaded areas need to be filled in by the
health department. They contain reminders
and suggestions for wording and/or
content.
Amendments
Amendment templates for the contracts can also be found on the L drive.
Administrative Reference
Contract information can be found in the Financial Management Section.
When are contracts due?
School contracts are due No later than April 30,
unsigned.
You will now save your contracts at the following address:
L:/LHDContracts/YOUR LHD NAME
How 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.
When 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.
ALL contracts are subject to review.
Save the contracts in the appropriate folder.
See example on slide 75.
Saving contract
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.
Saving contract
Contracts $10,000+
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
Filing contracts
any questions concerning this procedure, feel free
to contact me at 502-564-6663, x-4121 or e-mail at
on the L drive.
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
$10,000.
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.
Please 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.
Reminders
Before 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.
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”
Do Nots
Do 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 Numbers
Contract 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.
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.
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.
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 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 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 Paragraph
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.)
Website
contracts, please visit the following website:
documents” on the right.
If all else fails!