fy 2014 lhd contracts

Ron HorsemanAssistant Director,

Administration and Financial Management DivisionApril 21, 2015

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902KAR 8:170Local health department financial management

requirements

Section 7Contracting for services

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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. Services should only then be provided once both parties have signed the agreement.

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

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CH-53M

Local Health DepartmentIndependent Contractor Agreement

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Contract RequirementsService TypeContract DescriptionProvider CredentialsScope of WorkCompensation/PaymentBilling ProceduresAmount (#1) and Contract Value (#3)CH-55, if applicable

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CH-55Medicaid Statement of Authorization

For Independent Contractors only – CH-53M

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.

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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.

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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.

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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.

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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.

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Payment InformationWithout an amendment, total payments (CH-53M) can be 20% greater than thetotal contract (amount listed in #1).

(1)This Payment made under the terms of each section of this contract shall not exceed: Contract Section # Amount 20112 $10,000

24510 $10,000

(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 $24,000

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Multiple ContractsQuestion – Can a contract have more than one provider number?

Answer – Yes. One provider can have numerous numbers. For example, a contract can have the following numbers:

201, 215, 245, 250, 260

Each new section must have a third party billing sentence.

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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

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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.

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Supplemental ReportingSome of those services include: mammograms, breast ultrasounds, paps, HPV tests, Lead tests, etc. The Supplemental Reporting document (CH-47) is to be usedto 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

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

http://chfs.ky.gov/dph/Local+Health+Department.htm

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Provider 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.

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260 and 205 provider numbersCPT Code W0166 – 260 provider numberAnesthesia CPT Codes – 205 provider number

Examples of contract language can be found on the L drive.

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CH-52Local Health Department Contract

to Provide Services

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CH-52A CH-52 was created by DPH to provide a standardized

template that local health departments may use to 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.

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CH-52When 2 health departments contract,

whoever is requesting the employee should write the contract.

First Party – requesting the employee

Health Department – supplying the employee

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Payor 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.

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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 (exceptions: KDPH/KDCBS Hep B agreement, KY Fire Commission, and Jail contracts involving incarcerated individuals)

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.

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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.

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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, have 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

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Payor 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.

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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 code.

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Payor 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.

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Payor 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.

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Payor 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 First Aid Safety TeamSafety Team – ““FAST”FAST” employees.

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

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Payor Code 8Vaccine administration Vaccine administration will be $22.00$22.00;

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.

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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.

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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 Physician’s Fee Schedule rates should be used.

https://www.healthcare.gov/incarcerated-people/

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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.

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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 DPH encourages ALL LHDs to contract with the Fire encourages ALL LHDs to contract with the Fire Commission for these Hepatitis B services. Commission for these Hepatitis B services.

Health Departments are the ONLY entity that the Fire Health Departments are the ONLY entity that the Fire Commission will reimburse for these services.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.

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Payor Code 8Contracts should be completed prior 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 andand in Bridge.

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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.

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

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Payor Code 8Vaccine administration Vaccine administration rate is determined by the

LHO Branch using the AMA Code Manager software. The current rate is $23.00 (already set in the 501 Service File and updated annually); 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 vaccine for this project is approved.

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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 Payor Code 8 Contracts folder on the L-DriveL-Drive for referencing (if applicable).

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Payor Code 8For questions concerning Payor Code 8 contracts, hepatitis b or flu CHFS contracted services, contactJanetD.Overstreet@ky.gov

(502) 564-6663, ext. 4120

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CH-51Local Health Department

Employment Contract

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Personal 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.

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CH-51 RequirementsService typeContract descriptionProvider credentialsScope of workCompensation/PaymentPayment time periodContract valueRetirement issue

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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, works 1,200 hours or more per year (fiscal or calendar), the LHD would pay into retirement, not the employee.

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1,200 hours, cont.ALL RETIREES returning to work at an agencyshould check with the KRS before entering into acontract to protect their retirement benefits.

Entering into the contract too early could jeopardize their retirement.

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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.

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Employee ContractingContract employees are hired on a CH-51 contract with one health department.

If the individual is working at more than one LHD, one LHD should contract with the employee andsubcontract the employee’s services out to other LHDs.

Refer to slide #22 for more information.

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Employee Contracting902 KAR 8:170, Section 7 (4b)Should not substitute for establishing a merit position

902 KAR 8:160, Section 3, 2dMultiple Agency contracting

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Employee Contracting• Post open employee contract positions

(Suggested for full time openings)• Complete application process• Send application to Local Health Personnel

and/or Program Lead at Department for Public Health for program specific qualifying

• Obtain all contract employee signatures for required documents

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Other Contract Issues

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TemplatesThe most recent templates for contracts, amendments and information page are located at:

L:/LHDContracts/CONTRACTS16

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Administrative ReferenceContract information can be found in the Financial Management Section.

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When are contracts due?No later than May 1 of each year.

School contracts are due No later than April 30, unsigned.

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How should the contract be filed?The FINAL FY 15 contract will be saved on the L drive in the health departments Contract15 folder.

Use this as your template for FY16 contracts. Make sure to update the contract number, effective date, and use revisedprogram templates. Once you have completed the contract,save in the L:/LHDContracts/LHD name/Contracts16 and contact Tammy Page via e-mail.

tammy.page@ky.gov

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Saving contractWhen saving the contract on the L drive, name it the contract number. For example, 1611120120.doc would be the correct way to save the contract.

DO NOT include the word “FINAL”. DO NOT save the contract as the name.

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Filing 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.

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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 table

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Provider NumbersThere are 2 types of provider numbers assigned/setup by LHO.

The first 5 digits of the contract are as follows:16 – Fiscal Year000 – HID #

Administrative Reference, Financial Management, Page 16 of 58.

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CH-51 and CH-52Digits 6-7 represent the Employee class categories (MO) for payroll

contract expenditures. General Classification Codes are listed in the PSRS.

Digits 8-10 represent the individual portion of the Employee Class ID# (ID).

Employee class ID# for each employment contractor must be assigned by the Local Health Operations Branch.

Provider number 16000K130016 Fiscal Year

000 HID #

K1 Employee Provider Class No.

300 Individual number

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CH-50, CH-53M, CH-54, CH-58 Digits 6-8 represent the minor object code for independent

contracts. Digits 9-10 represent the individual portion of the Contract Class

ID# (ID). Provider number 1600026004

16 Fiscal year000 HID #260 Independent Contractor MOC04 Individual number

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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)

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Board of Health Member ContractsContracts exceeding $10,000 must be approvedby the Commissioner of the Department for Public Health. A letter or justification indicatingthe necessity and rationale for contracting with a board member must be submitted to the Commissioner of DPH with the proposed contract.

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Board of Health Member ContractsPlease contact Dr. Connie White, Deputy Commissioner of Department for Public Health for additional questions.

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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.

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WebsiteFor information concerning the FY16 contracts, please visit the following website:

http://chfs.ky.gov/dph/info/lhd/2016+Contract+Information+and+Documents.htm

and click on “2016 contract information documents” on the right.

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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