HomeMy WebLinkAbout20142410.tiff RESOLUTION
RE: APPROVE AGREEMENT FOR PROVISION OF CERTAIN MEDICAL DIAGNOSTIC
SERVICES AND AUTHORIZE CHAIR TO SIGN - FORT COLLINS RADIOLOGIC
ASSOCIATES, PC, DBA ADVANCED MEDICAL IMAGING CONSULTANTS, PC
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with an Agreement for the Provision of Certain
Medical Diagnostic Services between the County of Weld, State of Colorado, by and through the
Board of County Commissioners of Weld County, on behalf of the Weld County Department of
Public Health and Environment, and Fort Collins Radiologic Associates, PC, dba Advanced
Medical Imaging Consultants, PC, commencing July 21, 2014, and ending one year thereafter,
with further terms and conditions being as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Agreement for the Provision of Certain Medical Diagnostic Services
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Weld County Department of Public Health and
Environment, and Fort Collins Radiologic Associates, PC, dba Advanced Medical Imaging
Consultants, PC, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 4th day of August, A.D., 2014, nunc pro tunc July 21, 2014.
BOARD OF COUNTY COMMISSIONERS
WELD//COUNTY, COLORADO
ATTEST: W �C jes;ok �o s Rademacher, &'
Douglas Rademacher, Chair
Weld County Clerk to the Board
ES La%XCUSED
�Z.rbara Kirkmeyer, Pro-Tem
� ,_ �ti.. . ► .r
D ' ty Clerk t• the Bo. } ' ° J CUSED
an P. Conway
,9i
AP A ORM: � urre
Mike Fre n
oun ttorney
//z William . Garcia
Date of signature:
/ at H.C-rG)
`-f 0 0�8� B/4 2014-2410HL0044
1861 Memorandum
i TO: Douglas Rademacher, Chair
_G O U N T Y Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH,
Executive Director
Department of Public Health & Environment
DATE: July 31, 2014
SUBJECT: Contract with Advanced Medical Imaging
Consultants
Enclosed for Board review and approval is a contract between the Weld County Department of
Public Health and Environment and Fort Collins Radiologic Associates, PC d/b/a Advanced
Medical Imaging Consultants, PC.
With the approval of the Board, the Weld County Department of Public Health & Environment
will enter into a contract with AMIC to provide the professional component of diagnostic
imaging/radiology services (the reading of x-rays) provided to designated eligible patients. The
Health Department has four programs that will utilize these services. These include the
Tuberculosis Control, Family Planning, Women's Wellness Connection and Susan G. Komen
Foundation programs. Specific services will include the reading of mammograms, ultrasounds,
hysterosalpingograms, and two-view chest x-rays. WCDPHE will reimburse AMIC for the
professional services at the current Medicare rate in effect at the time the services are
performed. This contract has an effective date of July 1, 2014, and shall renewal automatically
for successive one-year terms following the initial expiration of the contract.
This contract was approved for placement on the agenda by the Board via pass-around dated
July 22, 2014.
I recommend approval of this contract for radiology services with Advanced Medical Imaging
Consultants, PC.
AGREEMENT BETWEEN THE WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT, BY AND
THROUGH THE BOARD OF COMMISSIONERS FOR WELD COUNTY, COLORADO, AND FORT COLLINS
RADIOLOGIC ASSOCIATES, PC, DBA ADVANCED MEDICAL IMAGING CONSULTANTS PC, FOR THE PROVISION
OF CERTAIN MEDICAL DIAGNOSTIC SERVICES
This AGREEMENT is dated July 21, 2014, and is between Weld County Department of Public Health & Environment("WCDPHE"), by
and through the Board of County Commissioners of Weld County,CO, ("County"),and Fort Collins Radiologic Associates, PC,dba
Advanced Medical Imaging Consultants, PC("Provider").
RECITALS
WHEREAS, WCDPHE provides women's health care services; and
WHEREAS, WCDPHE receives grant funding from organizations affiliated with Susan G. Komen for the Cure ("Komen") and
Women's Wellness Connection ("W WC") intended to provide access to breast health services for qualifying women;and
WHEREAS, WCDPHE receives grant funding from the State of Colorado to provide screening Chest X-rays for diagnosis and
treatment of tuberculosis;and
WHEREAS,WCDPHE receives grant funding from the State of Colorado to provide family planning services;and
WHEREAS, WCDPHE desires to enter into this Agreement with Provider, in accordance with which Provider will offer breast
health services to qualifying women in return for payment at agreed upon rates from WCDPHE;and
WHEREAS, WCDPHE desires to enter into this Agreement with Provider, in accordance with which Provider will offer Chest X-
rays to qualifying members of the community in return for payment at agreed upon rates from WCDPHE;and
WHEREAS, WCDPHE desires to enter into this Agreement with Provider, in accordance with which Provider will offer
hysterosalpingograms for family planning purposes to qualifying members of the community in return for payment at agreed upon
rates from WCDPHE;and
WHEREAS, no payments in any amount arising from or related to this Agreement shall be made with funds derived from
Medicare, Medicaid,or any other federal or state government program;and
WHEREAS, no remuneration shall be provided to WCDPHE or to Provider in return for, or based upon the volume or value of,
patient referrals;and
WHEREAS, WCDPHE has no ownership interest in, or financial arrangement with Provider other than as set forth in this
Agreement;and
WHEREAS the purpose of this Program is to assure that qualifying patients have access to medically necessary breast health
in services and can obtain those services in a manner that preserves and enhances their
services, Chest X-rays, and Family Planning se c
Y
dignity.
Page I of 9
NOW,THEREFORE, in consideration of the foregoing and of the mutual promises and covenants contained herein,and incorporating
the above Recitals as if fully set forth herein,the Parties agree as follows:
Term,Termination,and Rights Upon Termination of this Agreement
1.1. Effective Date & Term. This Agreement shall be effective as of July 21, 2014, and shall remain in effect for an Initial
Term of one year thereafter.
1.2. Renewal. This Agreement shall automatically renew for successive one-year terms commencing at the expiration of
the Initial Term. The renewal shall be on the same terms and conditions as described herein.
1.3. Termination. Either Party may terminate this Agreement with or without cause upon sixty (60) days written notice to
the other party. Said notice shall be deemed received by the other party within four(4) days of the postmarked date if
the notice is sent by registered mail,return receipt requested.
II. Obligations of the Parties
2.1. WCDPHE Obligations
WCDPHE shall provide Komen, WWC, TB Chest X-ray or Family Planning qualifying patients with orders for care
clearly marked "Komen Referral," "WWC Referral,"'TB Chest Referral," or "Family Planning Referral." The
referring WCDPHE Health Center and the WCDPHE billing address shall be identified in the orders. WCDPHE shall
pay Provider in accordance with the reimbursement rates set forth in Exhibit A, attached hereto and incorporated
herein by reference,for services provided to Komen and WWC, Exhibit B,attached hereto and incorporated herein
by reference, for TB Chest qualified patients, and Exhibit C, attached hereto and incorporated herein by reference,
for Family Planning qualified patients. WCDPHE shall pay Provider within 90 days of receiving Provider's properly
prepared bill, so long as Provider has transmitted to WCDPHE a clinical services report regarding the patient during
such 90-day period.
2.2. Provider Obligations
a. Provider agrees to offer the following services to qualified patients:
• Breast screening and breast diagnostic imaging.
• 1 or 2 view Chest X-rays (please see Exhibit B for a list of covered codes) Hvsterosalpingograms for Family
Planning(please see Exhibit C for list of covered codes).
b. Upon reasonable advance notice to and prior written approval by WCDPHE, Provider may use sub-providers to
perform any or all professional and technical components of the services addressed in this Agreement.
c. Provider shall submit bills on a monthly invoice for qualified patients. Billings shall be submitted to Weld County
Department of Public Health& Environment at 1555 North 17`h Avenue,Greeley,CO 80631 within one hundred
twenty(120) days of the date of service. WCDPHE may, in its discretion, decline payment of bills submitted more
than 120 days following the date of service.
d. Provider shall accept those fees paid by WCDPHE for those services set forth in Exhibit A, Exhibit B,and Exhibit C as
payment in full and shall not bill fees in any amount for those services to any qualified patient.
e. Except in cases of medical emergency, if Provider determines that a qualified patient requires services that are not
set forth in Exhibit A, Exhibit B, or Exhibit C, Provider shall contact the Director of Administrative Services. Should
WCDPHE agree to provide payment for those additional services, Provider shall bill WCDPHE at rates not to exceed
the then current Medicare rates for all components of those services. Should WCDPHE decline to provide
payment, Provider agrees to offer its services directly to the qualified patient at rates no greater than the then
current Medicare rates.
Page 2 of 9
III. Insurance
3.1 County and Provider shall each maintain medical professional liability insurance coverage,with policy limits not less than
$3,000,000 per occurrence and $5,000.000 annual aggregate, throughout the term, and every renewal term, of this
Agreement.
3.2 Neither party to this Agreement shall be liable for any negligent or wrongful acts, either of commission or omission,
chargeable to the other, unless such liability is imposed by law. This Agreement shall not be construed as seeking either
to enlarge or diminish any obligation or duty owed by one party to the other or to a third party. No term or condition of
this Agreement shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights,
benefits, protections or other provisions,of the Colorado Governmental Immunity Act§§24-10-101 et seq., as applicable
now or hereafter amended.
IV. Identification of Patients under This Agreement and HIPAA Business Associate Addendum
4.1 WCDPHE is solely responsible for determining that a patient is qualified for Komen, WWC, TB Chest X-ray or Family
Planning funded services prior to referring that patient to Provider. Provider is entitled to rely upon WCDPHE's
determination that each referred patient is qualified to receive Komen, WWC,TB Chest X-ray or Family Planning funded
services.
4.2 The Parties to this Agreement agree to comply with the additional terms to this Agreement contained in Exhibit D
HIPAA Business Associate Addendum, attached hereto and incorporated herein.
V. Overpayments or Underpayments
5.1 Request for Adjustment of Payment. Either Party shall be entitled to request an adjustment of payment if it notifies the
other Party in writing of an overpayment or underpayment and provides documentation substantiating such claim.
Such requests for payment adjustment must be answered within thirty(30)calendar days of receipt.
5.2 The Parties agree to work cooperatively and in good faith to attempt to resolve issues concerning this Agreement on an
informal basis within thirty (30) calendar days of the first notification of such dispute. If any payment dispute remains
unresolved at the end of the 30-day period,either party may seek relief in a court having jurisdiction thereof.
5.3 Paying Adjustments. If the Parties determine that WCDPHE has underpaid Provider, WCDPHE shall pay the underpaid
amount to Provider within fourteen (14) calendar days of that determination. If the Parties determine that WCDPHE
has overpaid Provider, Provider shall reimburse WCDPHE for the overpayment within 14 days of that determination.
5.4 No Offsets or Deductions without Permission. Take-backs, offsets, and deductions, as commonly used in the health
care industry, are expressly prohibited. In no event shall WCDPHE offset overpayments against, or deduct
overpayments from, any other payments it owes to Provider unless Provider expressly agrees, in writing, to such an
arrangement.
VI. General Provisions
6.1 Provisions Separable. The provisions of this Agreement are independent of and separable from each other, and no
provision shall be affected or rendered invalid or unenforceable by virtue of the fact that for any reason any other or
others of them may be invalid or unenforceable in whole or in part.
6.2 Compliance with Law. Provider shall strictly comply with all applicable federal and State laws, rules and regulations in
effect or hereafter established, including without limitation, laws applicable to discrimination and unfair employment
practices.
6.3 Fund Availability. Financial obligations of the County payable after the current fiscal year are contingent upon funds for
that purpose being appropriated, budgeted and otherwise made available. By execution of this Agreement,the County
does not warrant that funds will be available to fund this Agreement beyond the current fiscal year.
Page 3 of 9
6.4 Public Contracts for Services, C.R.S. §8-17.5-101. Provider certifies, warrants, and agrees that it does not knowingly
employ or contract with an illegal alien who will perform work under this contract and will confirm the employment
eligibility of all employees who are newly hired for employment in the United States to perform work under this
Agreement, through participation in the E-Verify program of the Department program established pursuant to C.R.S.
§8-17.5-102(5)(c). Provider shall not knowingly employ or contract with an illegal alien to perform work under this
Agreement or enter into a contract with a subcontractor that fails to certify with Provider that the subcontractor shall
not knowingly employ or contract with an illegal alien to perform work under this Agreement. Provider (a) shall not
use E-Verify Program or Department program procedures to undertake pre-employment screening or job applicants
while this Agreement is being performed,(b)shall notify the subcontractor and Weld County within three(3)days that
Provider has actual knowledge that a subcontractor is employing or contracting with an illegal alien and (c) shall
terminate the subcontract if a subcontractor dues not stop employing or contracting with the illegal alien within three
(3) days of receiving notice, and (d) shall comply with reasonable requests made in the course of an investigation,
undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Provider
participates in the Department program, Provider shall deliver to County, a written notarized affirmation that the legal
work status of such employee has been examined, and Provider shall comply with all of the other requirements of the
Department program. If Provider fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq.,
Weld County, may terminate this Agreement for breach, and if so terminated, Provider shall be liable for damages.
6.5 Employee Financial Interest/Conflict of Interest. C.R.S. §§24-18-201 et seq. and §24-50-507: The signatories to this
Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest
whatsoever in the service or property which is the subject matter of this Agreement. Provider has no interest and shall
not acquire any interest direct or indirect, that would in any manner or degree with the performance of Provider's
services and Provider shall not employ any person having such known interests. During the term of this Agreement,
Provider shall not engage in any in any business or personal activities or practices or maintain any relationships which
actually conflict with or in any way appear to conflict with the full performance of its obligations under this Agreement.
Failure by Provider to ensure compliance with this provision may result, in Weld County's sole discretion,in immediate
termination of this Agreement
6.6 Waiver of Breach. The failure of WCDPHE or Provider to object to or to take affirmative action with respect to any
conduct of the other which is a breach of this Agreement shall not be construed as a waiver of that breach or of any
prior or future breaches of this Agreement.
6.7 Entire Agreement. This Agreement together,with its Exhibits,constitute the entire understanding of the parties to this
Agreement regarding the subject matter addressed herein, and supersedes all prior proposals, representations,
communications, negotiations, and agreements between the parties as to that subject matter,whether oral or written.
6.8 Assignment. This Agreement may not be assigned, delegated, or transferred by either Party without the prior written
consent of the other Party.
6.9 Independent Contractors. Provider shall perform its duties hereunder as an independent contractor and the
relationship between County and Provider shall not be an employer-employee relationship nor a partnership or joint
venture. Provider shall be solely responsible for its acts and those of its agents and employees for all acts performed
pursuant to this Agreement. Neither Provider nor any agent or employee of Provider shall be deemed to be an agent or
employee of County. Provider and its employees and agents are not entitled to unemployment insurance or workers'
compensation benefits through County and County shall not pay for or otherwise provide such coverage for Provider or
any of its agents or employees. Unemployment insurance benefits will be available to Provider and its employees and
agents only if such coverage is made available by Provider or a third party. Provider shall pay when due all applicable
taxes, employment, income, or otherwise, incurred pursuant to this Agreement. Provider shall not have authorization,
express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this
Agreement. Provider shall have the following responsibilities with regard to workers' compensation and
unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and
unemployment compensation insurance in the amounts required by law and (b) provide proof thereof when requested
to do so by County.
Page 4 of 9
6.10 Amendment. This Agreement may not be amended or changed in any of its provisions except by a subsequent written
agreement signed by duly authorized representatives of the County and Provider.
6.11 No Third Party Beneficiary Enforcement. It is expressly understood and agreed that the enforcement of the terms and
conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the
undersigned Parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any
other person not included in this Agreement. It is the express intention of the undersigned Parties that any entity
other than the undersigned Parties receiving services or benefits under this Agreement shall be an incidental
beneficiary only.
6.12 Notices. Any notices of other communications required or contemplated under the provisions of this Agreement,
excluding billings, clinical services reports, and proposed updates to Exhibits A, B, or C, shall be in writing and delivered
in person, evidenced by a signed receipt, or mailed by certified mail, return receipt requested, postage prepaid, to the
addresses indicated below or to such other persons or addresses as WCDPHE and Provider may provide by notice to
the other. The date of the notice shall be the date of delivery if the notice is personally delivered or the third business
day following the date of mailing if the notice is mailed by certified mail.
6.13 Address for Notices. Any Notices for Provider shall be mailed to:
Advanced Medical Imaging Consultants,PC
ATTN: Stan Podolski, III,CPA, CIA, CHBME
Chief Executive Officer
2008 Caribou Drive
Fort Collins,CO 80525
Any notices for WCDPHE shall be mailed to:
Weld County Department of Public Health&Environment
ATTN: Tanya Geiser
Director of Administrative Services
1555 North 17`h Avenue
Greeley, CO 80631
6.14 Governing Law. This Agreement shall be governed under the laws, and rules and regulations established pursuant
thereto, of the State of Colorado, and any relevant federal law. Specifically, all parties agree to comply with any
Federal or State laws or regulations regarding the exchange of protected health information.
6.15 Contacts. The contact person for any questions or inquiries for WCDPHE shall be:
Kimberly Senn
Clinical Service Manager
The contact person for any questions or inquiries for Provider shall be:
Trina Buxton Flores
Managed Care Contract Administrator
970-266-4467
t.flores@advmedimaging.com
IN WITNESS WHEREOF,the parties have executed this Agreement personally or by their duly authorized representatives as of
and to be effective as of July 21,2014.
Page 5 of 9
FORT COLLINS RADIOLOGIC ASSOCIATES, P.C.,
d/b/a Advanced Medical Imaging Consultants, PC
2008 Caribou Drive
Fort Collins,CO 80525
��►'i
Stan '••• - i, Ill
Title: Chief Executive Officer
Date: 7/.1O- v/
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH& ENVIRONMENT
1555 North 17`h Avenue
Greeley,CO 80631
Attn: Tanya Geiser
Douglas Radee, acher
Title:Chair,Weld County Board of County Commissioners
Date: AUG 0 4 2014
Page 6 of 9
0,76/4/- cP'Y/D
Exhibit A—Current Year Colorado Medicare rates based on the facility rate as determined annually by CMS.
Page 7 of 9
Exhibit B—
Current Year Colorado Medicare rates based on the facility rate as determined annually by CMS.
71010
71020
Page 8 of 9
Exhibit C—
Current Year Colorado Medicare rates based on the facility rate as determined annually by CMS.
74740-26
58340
Page 9 of 9
EXHIBIT D
HIPAA BUSINESS ASSOCIATE ADDENDUM
This Business Associate Addendum ("Addendum") is a part of the Agreement to which
this Addendum is attached as Exhibit D between the Weld County Department of Health and
Environment, by and through the Board of Weld County Commissioners ("Covered Entity" or
"CE"), and Fort Collins Radiologic Associates, PC, dba Advanced Medical Imaging Consultants,
PC ("Associate"). Unless the context clearly requires a distinction between the Agreement
document and this Addendum, all references herein to "the Agreement" or "this Agreement"
include this Addendum.
RECITALS
A. CE wishes to disclose certain information to Associate pursuant to the terms of the
Agreement, some of which may constitute Protected Health Information("PHI") (defined
below).
B. CE and Associate intend to protect the privacy and provide for the security of PHI
disclosed to Associate pursuant to this Agreement in compliance with the Health
Insurance Portability and Accountability Act of 1996, 42 U.S.C. § 1320d— 1320d-8
("HIPAA") as amended by the American Recovery and Reinvestment Act of 2009
("ARRA")/HITECH Act (P.L. 111-005), and its implementing regulations promulgated
by the U.S. Department of Health and Human Services, 45 C.F.R. Parts 160, 162 and 164
(the "HIPAA Rules") and other applicable laws, as amended.
C. As part of the HIPAA Rules, the CE is required to enter into a written agreement
containing specific requirements with Associate prior to the disclosure of PHI, as set
forth in, but not limited to, Title 45, Sections 160.103, 164.502(e) and 164.504(e) of the
Code of Federal Regulations ("C.F.R.") and contained in this Addendum.
The Parties agree as follows:
1. Definitions.
a. Except as otherwise defined herein, capitalized terms in this Addendum shall have
the definitions set forth in the HIPAA Rules at 45 C.F.R. Parts 160, 162 and 164, as amended.
In the event of any conflict between the mandatory provisions of the HIPAA Rules and the
provisions of this Agreement, the HIPAA Rules shall control. Where the provisions of this
Agreement differ from those mandated by the HIPAA Rules, but are nonetheless permitted by
the HIPAA Rules, the provisions of this Agreement shall control.
b. "Protected Health Information" or"PHI" means any information, whether oral or
recorded in any form or medium: (i) that relates to the past, present or future physical or mental
condition of an individual; the provision of health care to an individual; or the past, present or
future payment for the provision of health care to an individual; and (ii)that identifies the
Page 1 of 9
Colorado Model BA Provision and
Addendum For New or Amended Contracts
Rev. May 2013
individual or with respect to which there is a reasonable basis to believe the information can be
used to identify the individual, and shall have the meaning given to such term under the HIPAA
Rules, including, but not limited to, 45 C.F.R. Section 164.501.
c. "Protected Information" shall mean PHI provided by CE to Associate or created
received, maintained or transmitted by Associate on CE's behalf. To the extent Associate is a
covered entity under HIPAA and creates or obtains its own PHI for treatment, payment and
health care operations, Protected Information under this Agreement does not include any PHI
created or obtained by Associate as a covered entity and Associate shall follow its own policies
and procedures for accounting, access and amendment of Associate's PHI.
d. "Subcontractor" shall mean a third party to whom Associate delegates a function,
activity, or service that involves CE's Protected Information, in order to carry out the
responsibilities of this Agreement.
2. Obligations of Associate.
a. Permitted Uses. Associate shall not use Protected Information except for the
purpose of performing Associate's obligations under this Agreement and as permitted under this
Addendum. Further, Associate shall not use Protected Information in any manner that would
constitute a violation of the HIPAA Rules if so used by CE, except that Associate may use
Protected Information: (i) for the proper management and administration of Associate; (ii) to
carry out the legal responsibilities of Associate; or(iii) for Data Aggregation purposes for the
Health Care Operations of CE. Additional provisions, if any, governing permitted uses of
Protected Information are set forth in Attachment A to this Addendum. Associate accepts full
responsibility for any penalties incurred as a result of Associate's breach of the HIPAA Rules.
b. Permitted Disclosures. Associate shall not disclose Protected Information in any
manner that would constitute a violation of the HIPAA Rules if disclosed by CE, except that
Associate may disclose Protected Information: (i) in a manner permitted pursuant to this
Agreement; (ii) for the proper management and administration of Associate; (iii) as required by
law; (iv) for Data Aggregation purposes for the Health Care Operations of CE; or(v) to report
violations of law to appropriate federal or state authorities, consistent with 45 C.F.R. Section
164.502(j)(1). To the extent that Associate discloses Protected Information to a third party
Subcontractor, Associate must obtain, prior to making any such disclosure: (i) reasonable
assurances through execution of a written agreement with such third party that such Protected
Information will be held confidential as provided pursuant to this Addendum and only disclosed
as required by law or for the purposes for which it was disclosed to such third party; and that
such third party will notify Associate within two (2) business days of any breaches of
confidentiality of the Protected Information, to the extent it has obtained knowledge of such
breach. Additional provisions, if any, governing permitted disclosures of Protected Information
are set forth in Attachment A.
c. Appropriate Safeguards. Associate shall implement appropriate safeguards as are
necessary to prevent the use or disclosure of Protected Information other than as permitted by
this Agreement. Associate shall comply with the requirements of the HIPAA Security Rule at 45
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Colorado Model BA Provision and
Addendum For New or Amended Contracts
Rev. May 2013
C.F.R. Sections 164.308, 164.310, 164.312, and 164.316. Associate shall maintain a
comprehensive written information privacy and security program that includes administrative,
technical and physical safeguards appropriate to the size and complexity of the Associate's
operations and the nature and scope of its activities. Associate shall review, modify, and update
documentation of, its safeguards as needed to ensure continued provision of reasonable and
appropriate protection of Protected Information.
d. Reporting of Improper Use or Disclosure. Associate shall report to CE in writing
any use or disclosure of Protected Information other than as provided for by this Agreement
within five (5) business days of becoming aware of such use or disclosure.
e. Associate's Agents. If Associate uses one or more Subcontractors or agents to
provide services under the Agreement, and such Subcontractors or agents receive or have access
to Protected Information, each Subcontractor or agent shall sign an agreement with Associate
containing the same provisions as this Addendum and further identifying CE as a third party
beneficiary with rights of enforcement and indemnification from such Subcontractors or agents
in the event of any violation of such Subcontractor or agent agreement. The Agreement between
the Associate and Subcontractor or agent shall ensure that the Subcontractor or agent agrees to at
least the same restrictions and conditions that apply to Associate with respect to such Protected
Information. Associate shall implement and maintain sanctions against agents and
Subcontractors that violate such restrictions and conditions and shall mitigate the effects of any
such violation.
f. Access to Protected Information. If Associate maintains Protected Information
contained within CE's Designated Record Set, Associate shall make Protected Information
maintained by Associate or its agents or Subcontractors in such Designated Record Sets
available to CE for inspection and copying within ten (10) business days of a request by CE to
enable CE to fulfill its obligations to permit individual access to PHI under the HIPAA Rules,
including, but not limited to, 45 C.F.R. Section 164.524. If such Protected Information is
maintained by Associate in an electronic form or format, Associate must make such Protected
Information available to CE in a mutually agreed upon electronic form or format.
g. Amendment of PHI. If Associate maintains Protected Information contained
within CE's Designated Record Set, Associate or its agents or Subcontractors shall make such
Protected Information available to CE for amendment within ten (10) business days of receipt of
a request from CE for an amendment of Protected Information or a record about an individual
contained in a Designated Record Set, and shall incorporate any such amendment to enable CE
to fulfill its obligations with respect to requests by individuals to amend their PHI under the
HIPAA Rules, including, but not limited to, 45 C.F.R. Section 164.526. If any individual
requests an amendment of Protected Information directly from Associate or its agents or
Subcontractors, Associate must notify CE in writing within five (5) business days of receipt of
the request. Any denial of amendment of Protected Information maintained by Associate or its
agents or Subcontractors shall be the responsibility of CE.
h. Accounting Rights. If Associate maintains Protected Information contained
within CE's Designated Record Set, Associate and its agents or Subcontractors shall make
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Colorado Model BA Provision and
Addendum For New or Amended Contracts
Rev. May 2013
available to CE within ten (10) business days of notice by CE, the information required to
provide an accounting of disclosures to enable CE to fulfill its obligations under the HIPAA
Rules, including, but not limited to, 45 C.F.R. Section 164.528. In the event that the request for
an accounting is delivered directly to Associate or its agents or Subcontractors, Associate shall
within five (5) business days of the receipt of the request forward it to CE in writing. It shall be
CE's responsibility to prepare and deliver any such accounting requested. Associate shall not
disclose any Protected Information except as set forth in Section 2(b) of this Addendum.
i. Governmental Access to Records. Associate shall keep records and make its
internal practices, books and records relating to the use and disclosure of Protected Information
available to the Secretary of the U.S. Department of Health and Human Services (the
"Secretary"), in a time and manner designated by the Secretary, for purposes of determining
CE's or Associate's compliance with the HIPAA Rules. Associate shall provide to CE a copy of
any Protected Information that Associate provides to the Secretary concurrently with providing
such Protected Information to the Secretary when the Secretary is investigating CE. Associate
shall cooperate with the Secretary if the Secretary undertakes an investigation or compliance
review of Associate's policies, procedures or practices to determine whether Associate is
complying with the HIPAA Rules, and permit access by the Secretary during normal business
hours to its facilities, books, records, accounts, and other sources of information, including
Protected Information, that are pertinent to ascertaining compliance.
j. Minimum Necessary. Associate (and its agents or subcontractors) shall only
request, use and disclose the minimum amount of Protected Information necessary to accomplish
the purpose of the request, use or disclosure, in accordance with the Minimum Necessary
requirements of the HIPAA Rules including, but not limited to 45 C.F.R. Sections 164.502(b)
and 164.514(d).
k. Data Ownership. Associate acknowledges that Associate has no ownership rights
with respect to the Protected Information.
1. Retention of Protected Information. Except upon termination of the Agreement as
provided in Section 4(d) of this Addendum, Associate and its Subcontractors or agents shall
retain all Protected Information throughout the term of this Agreement and shall continue to
maintain the information required under Section 2(h) of this Addendum for a period of six (6)
years.
m. Associate's Insurance. Associate shall maintain insurance to cover loss of PHI
data and claims based upon alleged violations of privacy rights through improper use or
disclosure of PHI. All such policies shall meet or exceed the minimum insurance requirements
of the Agreement (e.g., occurrence basis, combined single dollar limits, annual aggregate dollar
limits, additional insured status and notice of cancellation).
n. Notice of Privacy Practices. Associate shall be responsible for reviewing CE's
Notice of Privacy Practices, available on CE's external website, to determine any requirements
applicable to Associate per this Agreement.
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o. Notification of Breach. During the term of this Agreement, Associate shall notify
CE within two (2) business days of any suspected or actual breach of security, intrusion or
unauthorized use or disclosure of PHI and/or any actual or suspected use or disclosure of data in
violation of any applicable federal or state laws or regulations. Associate shall not initiate
notification to affected individuals per the HIPAA Rules without prior notification and approval
of CE. Information provided to CE shall include the identification of each individual whose
unsecured PHI has been, or is reasonably believed to have been accessed, acquired or disclosed
during the breach. Associate shall take (i) prompt corrective action to cure any such deficiencies
and (ii) any action pertaining to such unauthorized disclosure required by applicable federal and
state laws and regulations.
p. Audits, Inspection and Enforcement. Within ten (10) business days of a written
request by CE, Associate and its agents or subcontractors shall allow CE to conduct a reasonable
inspection of the facilities, systems, books, records, agreements, policies and procedures relating
to the use or disclosure of Protected Information pursuant to this Addendum for the purpose of
determining whether Associate has complied with this Addendum; provided, however, that: (i)
Associate and CE shall mutually agree in advance upon the scope, timing and location of such an
inspection; and (ii) CE shall protect the confidentiality of all confidential and proprietary
information of Associate to which CE has access during the course of such inspection. The fact
that CE inspects, or fails to inspect, or has the right to inspect, Associate's facilities, systems,
books, records, agreements, policies and procedures does not relieve Associate of its
responsibility to comply with this Addendum, nor does CE's (i) failure to detect or(ii) detection,
but failure to notify Associate or require Associate's remediation of any unsatisfactory practices,
constitute acceptance of such practice or a waiver of CE's enforcement rights under the
Agreement.
q. Safeguards During Transmission. Associate shall be responsible for using
appropriate safeguards, including encryption of PHI, to maintain and ensure the confidentiality,
integrity and security of Protected Information transmitted pursuant to the Agreement, in
accordance with the standards and requirements of the HIPAA Rules.
r. Restrictions and Confidential Communications. Within ten (10) business days of
notice by CE of a restriction upon uses or disclosures or request for confidential communications
pursuant to 45 C.F.R. Section 164.522, Associate will restrict the use or disclosure of an
individual's Protected Information. Associate will not respond directly to an individual's
requests to restrict the use or disclosure of Protected Information or to send all communication of
Protect Information to an alternate address. Associate will refer such requests to the CE so that
the CE can coordinate and prepare a timely response to the requesting individual and provide
direction to Associate.
3. Obligations of CE.
a. Safeguards During Transmission. CE shall be responsible for using appropriate
safeguards, including encryption of PHI, to maintain and ensure the confidentiality, integrity and
security of Protected Information transmitted pursuant to the Agreement, in accordance with the
standards and requirements of the HIPAA Rules.
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b. Notice of Changes. CE maintains a copy of its Notice of Privacy Practices on its
website. CE shall provide Associate with any changes in, or revocation of, permission to use or
disclose Protected Information, to the extent that it may affect Associate's permitted or required
uses or disclosures. To the extent that it may affect Associate's permitted use or disclosure of
PHI, CE shall notify Associate of any restriction on the use or disclosure of Protected
Information that CE has agreed to in accordance with 45 C.F.R. Section 164.522.
4. Termination.
a. Material Breach. In addition to any other provisions in the Agreement regarding
breach, a breach by Associate of any provision of this Addendum, as determined by CE, shall
constitute a material breach of this Agreement and shall provide grounds for immediate
termination of this Agreement by CE pursuant to the provisions of the Agreement covering
termination for cause, if any. If the Agreement contains no express provisions regarding
termination for cause, the following terms and conditions shall apply:
(1) Default. If Associate refuses or fails to timely perform any of the
provisions of this Agreement, CE may notify Associate in writing of the non-performance, and if
not promptly corrected within the time specified, CE may terminate this Agreement. Associate
shall continue performance of this Agreement to the extent it is not terminated and shall be liable
for excess costs incurred in procuring similar goods or services elsewhere.
(2) Associate's Duties. Notwithstanding termination of this Agreement, and
subject to any directions from CE, Associate shall take timely, reasonable and necessary action
to protect and preserve property in the possession of Associate in which CE has an interest.
(3) Compensation. Payment for completed supplies delivered and accepted
by CE shall be at the Agreement price. In the event of a material breach under paragraph 4a, CE
may withhold amounts due Associate as CE deems necessary to protect CE against loss from
third party claims of improper use or disclosure and to reimburse CE for the excess costs
incurred in procuring similar goods and services elsewhere.
(4) Erroneous Termination for Default. If after such termination it is
determined, for any reason, that Associate was not in default, or that Associate's action/inaction
was excusable, such termination shall be treated as a termination for convenience, and the rights
and obligations of the parties shall be the same as if this Agreement had been terminated for
convenience, as described in this Agreement.
b. Reasonable Steps to Cure Breach. If CE knows of a pattern of activity or practice
of Associate that constitutes a material breach or violation of the Associate's obligations under
the provisions of this Addendum or another arrangement and does not terminate this Agreement
pursuant to Section 4(a), then CE shall take reasonable steps to cure such breach or end such
violation.. If CE's efforts to cure such breach or end such violation are unsuccessful, CE shall
either (i)terminate the Agreement, if feasible or (ii) if termination of this Agreement is not
feasible, CE shall P report Associate's breach or violation to the Secretary of the Department of
P
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Health and Human Services. If Associate knows of a pattern of activity or practice of a
Subcontractor or agent that constitutes a material breach or violation of the Subcontractor's or
agent's obligations under the written agreement between Associate and the Subcontractor or
agent, Associate shall take reasonable steps to cure such breach or end such violation, if feasible.
c. Judicial or Administrative Proceedings. Either party may terminate the
Agreement, effective immediately, if(i) the other party is named as a defendant in a criminal
proceeding for a violation of the HIPAA Rules or other security or privacy laws or (ii) a finding
or stipulation that the other party has violated any standard or requirement of the HIPAA Rules
or other security or privacy laws is made in any administrative or civil proceeding in which the
party has been joined.
d. Effect of Termination.
(1) Except as provided in paragraph (2) of this subsection, upon termination
of this Agreement, for any reason, Associate shall return or destroy all Protected Information that
Associate or its agents or Subcontractors still maintain in any form, and shall retain no copies of
such Protected Information. If Associate elects to destroy the PHI, Associate shall certify in
writing to CE that such PHI has been destroyed.
(2) If Associate believes that returning or destroying the Protected
Information is not feasible, Associate shall promptly provide CE notice of the conditions making
return or destruction infeasible. Associate shall continue to extend the protections of Sections
2(a), 2(b), 2(c), 2(d) and 2(e) of this Addendum to such Protected Information, and shall limit
further use of such PHI to those purposes that make the return or destruction of such PHI
infeasible.
5. Injunctive Relief. CE shall have the right to injunctive and other equitable and legal
relief against Associate or any of its Subcontractors or agents in the event of any use or
disclosure of Protected Information in violation of this Agreement or applicable law.
6. No Waiver of Immunity. No term or condition of this Agreement shall be construed or
interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protection,
or other provisions of the Colorado Governmental Immunity Act, CRS 24-10-101 et seq. or the
Federal Tort Claims Act, 28 U.S.C. 2671 et seq. as applicable, as now in effect or hereafter
amended.
7. Limitation of Liability. Any limitation of Associate's liability in the Agreement shall be
inapplicable to the terms and conditions of this Addendum.
8. Disclaimer. CE makes no warranty or representation that compliance by Associate with
this Agreementor the HIPAA Rules will be adequate or satisfactory for Associate's own
purposes. Associate is solely responsible for all decisions made by Associate regarding the
safeguarding of PHI.
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9. Certification. To the extent that CE determines an examination is necessary in order to
comply with CE's legal obligations pursuant to the HIPAA Rules relating to certification of its
security practices, CE or its authorized agents or contractors, may, at CE's expense, examine
Associate's facilities, systems, procedures and records as may be necessary for such agents or
contractors to certify to CE the extent to which Associate's security safeguards comply with the
HIPAA Rules or this Addendum.
10. Amendment.
a. Amendment to Comply with Law. The parties acknowledge that state and federal
laws relating to data security and privacy are rapidly evolving and that amendment of this
Addendum may be required to provide for procedures to ensure compliance with such
developments. The parties specifically agree to take such action as is necessary to implement the
standards and requirements of the HIPAA Rules and other applicable laws relating to the
confidentiality, integrity, availability and security of PHI. The parties understand and agree that
CE must receive satisfactory written assurance from Associate that Associate will adequately
safeguard all Protected Information and that it is Associate's responsibility to receive satisfactory
written assurances from Associate's Subcontractors and agents. Upon the request of either party,
the other party agrees to promptly enter into negotiations concerning the terms of an amendment
to this Addendum embodying written assurances consistent with the standards and requirements
of the HIPAA Rules or other applicable laws. CE may terminate this Agreement upon thirty (30)
days written notice in the event (i) Associate does not promptly enter into negotiations to amend
this Agreement when requested by CE pursuant to this Section, or (ii) Associate does not enter
into an amendment to this Agreement providing assurances regarding the safeguarding of PHI
that CE, in its sole discretion, deems sufficient to satisfy the standards and requirements of the
HIPAA Rules.
b. Amendment of Attachment A. Attachment A may be modified or amended by
mutual agreement of the parties in writing from time to time without formal amendment of this
Addendum.
11. Assistance in Litigation or Administrative Proceedings. Associate shall make itself, and
any Subcontractors, employees or agents assisting Associate in the performance of its obligations
under the Agreement, available to CE, at no cost to CE up to a maximum of 30 hours, to testify
as witnesses, or otherwise, in the event of litigation or administrative proceedings being
commenced against CE, its directors, officers or employees based upon a claimed violation of
the HIPAA Rules or other laws relating to security and privacy or PHI, except where Associate
or its Subcontractor, employee or agent is a named adverse party.
12. No Third Party Beneficiaries. Nothing express or implied in this Agreement is intended
to confer, nor shall anything herein confer, upon any person other than CE, Associate and their
respective successors or assigns, any rights, remedies, obligations or liabilities whatsoever.
13. Interpretation and Order of Precedence. The provisions of this Addendum shall prevail
over any provisions in the Agreement that may conflict or appear inconsistent with any provision
in this Addendum. Together, the Agreement and this Addendum shall be interpreted as broadly
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as necessary to implement and comply with the HIPAA Rules. The parties agree that any
ambiguity in this Agreement shall be resolved in favor of a meaning that complies and is
consistent with the HIPAA Rules. This Agreement supercedes and replaces any previous
separately executed HIPAA addendum between the parties.
14. Survival of Certain Agreement Terms. Notwithstanding anything herein to the contrary,
Associate's obligations under Section 4(d) ("Effect of Termination") and Section 12 ("No Third
Party Beneficiaries") shall survive termination of this Agreement and shall be enforceable by CE
as provided herein in the event of such failure to perform or comply by the Associate. This
Addendum shall remain in effect during the term of the Agreement including any extensions.
15. Representatives and Notice.
a. Representatives. For the purpose of the Agreement, the individuals identified
elsewhere in this Agreement shall be the representatives of the respective parties. If no
representatives are identified in the Agreement, the individuals listed below are hereby
designated as the parties' respective representatives for purposes of this Agreement. Either party
may from time to time designate in writing new or substitute representatives.
b. Notices. All required notices shall be in writing and shall be hand delivered or
given by certified or registered mail to the representatives at the addresses set forth below.
Weld County Department of Public Health&Environment
ATTN: Tanya Geiser
Director of Administrative Services
1555 N. 17th Avenue
Greeley, CO 80631
Advanced Medical Imaging Consultants,PC
ATTN: Stan Podolski, III,CPA, CIA, CHBME
Chief Executive Officer
2008 Caribou Drive
Fort Collins,CO 80525
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ATTACHMENT A
This Attachment sets forth additional terms to the HIPAA Business Associate
Addendum, which is part of the Agreement to which the Addendum is attached as Exhibit D
between the Weld County Department of Health and Environment by and through the Board of
Weld County Commissioners ("Covered Entity" or "CE") and Fort Collins Radiologic
Associates, PC, dba Advanced Medical Imaging Consultants, PC ("Associate")and is effective as
of (the "Attachment Effective Date"). This Attachment may be
amended from time to time as provided in Section 10(b) of the Addendum.
1. Additional Permitted Uses. In addition to those purposes set forth in Section 2(a) of the
Addendum, Associate may use Protected Information as follows:
2. Additional Permitted Disclosures. In addition to those purposes set forth in Section 2(b)
of the Addendum, Associate may disclose Protected Information as follows:
or agents of
that the following subcontractors
3. Subcontractors . The parties acknowledge
( ) g
Associate shall receive Protected Information in the course of assisting Associate in the
performance of its obligations under this Agreement:
4. Receipt. Associate's receipt of Protected Information pursuant to this Agreement shall be
deemed to occur as follows, and Associate's obligations under the Addendum shall commence
with respect to such PHI upon such receipt:
5. Additional Restrictions on Use of Data. CE is a Business Associate of certain other
Covered Entities and, pursuant to such obligations of CE, Associate shall comply with the
following restrictions on the use and disclosure of Protected Information:
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6. Additional Terms. [This section may include specifications for disclosure format,
method of transmission, use of an intermediary, use of digital signatures or NCI, authentication,
additional security of privacy specifications, de-identification or re-identification of data and
other additional terms.]
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Memorandum
1861
TO: Susan Brown, Clerk to the Board
COUNTY J FROM: Tanya Geiser
Department of Public Health & Environment
DATE: July 31, 2014
SUBJECT: Contract Routing Request
The following contracts have been approved for placement on the Board's meeting agenda for
the Board's final approval and the Chair's signature. We would like to have these items placed
on the Board's agenda for Monday, August 4, 2014.
NEW BUSINESS: RECEIVED
2 Originals: Advanced Medical Imaging Consultants, PC JUL 3 1 2014
Originals: WELD COUNTY
COMMISSIONERS
Originals:
Originals:
CONSENT AGENDA: \c)S
Originals:
2c\(\ i\fr
Originals:
Originals:
Originals:
Once signed by the Chair, please return the original, signed contracts to my attention.
If you have any questions, or if you require anything further in this regard, please let me know. I
can be reached at Extension 2122 or via email.
As always, thank you for all of your help with processing our contracts.
2014-2410
BOARD OF COUNTY COMMISSIONERS
PASS-AROUND REVIEW/WORK SESSION REQUEST
RE: Advanced Medical Imaging Consultants Contract for Diagnostic Imaging/Radiology
DEPARTMENT: PUBLIC HEALTH & ENVIRONMENT DATE: July 22, 2014
PERSON REQUESTING: Mark E. Wallace, MD, MPH, Executive Director
Brief description of the problem/issue:
Enclosed for the Board's review and approval is a contract between Fort Collins Radiologic
Associates, PC, dba Advanced Medical Imaging Consultants PC (AMIC) and the County of Weld, by
and through the Board of Commissioners for Weld County, on behalf of the Weld County
Department of Public Health and Environment (WCDPHE).
With the approval of the Board, the Weld County Department of Public Health & Environment will
enter into a contract with AMIC to provide the professional component of diagnostic
imaging/radiology services (the reading of x-rays) provided to designated eligible patients. The
Health Department has four programs that will utilize these services. These include the Tuberculosis
Control, Family Planning, Women's Wellness Connection and Susan G. Komen Foundation
programs. Specific services will include the reading of mammograms, ultrasounds,
hysterosalpingograms, and two-view chest x-rays. WCDPHE will reimburse AMIC for the
professional services at the current Medicare rate in effect at the time the services are performed.
This contract has an effective date of July 1, 2014, and shall renewal automatically for successive
one-year terms following the initial expiration of the contract.
Weld County Assistant County Attorney,Brad Yatabe, has reviewed this contract and has
determined that the terms are acceptable.
What options exist for the Board? (Include consequences, impacts, costs, etc. of options)
Declining these contracts will increase the costs for these services to "fee for service" rates which
would be cost prohibitive and add to the net county cost of providing these services to eligible
patients.
Approving the contract will allow WCDPHE to pay for the professional component of diagnostic
imaging/radiology at current year Medicare rates.
Recommendation: I recommend approval of this contract with Advanced Medical Imaging
Consultants PC.
Approve Schedule
Recommendation Work Session Other/Comments:
Douglas Rademacher,Chair
Barb Kirkmeyer, Pro-Tern
Sean P. Conway
Mike Freeman
William F. Garcia
/Y— 4/7O
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