HomeMy WebLinkAbout20240432.tiffRESOLUTION
RE: APPROVE AGREEMENT CONCERNING SURGICAL SERVICES FOR WOMEN'S
WELLNESS CONNECTION PROGRAM AND AUTHORIZE CHAIR TO SIGN - BANNER
MD ANDERSON
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 Concerning Surgical
Services for the Women's Wellness Connection Program between the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Department of Public Health and Environment, and Banner MD Anderson, commencing upon full
execution of signatures, 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 Concerning Surgical Services for the Women's
Wellness Connection Program between the County of Weld, State of Colorado, by and through
the Board of County Commissioners of Weld County, on behalf of the Department of Public Health
and Environment, and Banner MD Anderson, 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 21st day of February, A.D., 2024.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST:
Kevin D. Ross, Chair
Weld County Clerk to the Board
Perry L. Buck, Pro-Tem
BY:
Deputy Clerk to the Board
Mike Freeman
APPROVED AS TO FORM:
Scott K. James
County Attorney
Date of signature:
Lori Saine
2024-0432
H L0057
Cbn4Ya c±lam T78x1
BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS -AROUND TITLE: Banner MD Anderson Surgical Services Agreement
DEPARTMENT: PUBLIC HEALTH AND ENVIRONMENT DATE: January 19, 2024
PERSON REQUESTING: Jason Chessher, Executive Director
Shaun May, Public Health Services Director
Brief description of the problem/issue:
For the Board's review and approval is a contract renewal between Banner MD Anderson and the Board of
County Commissioners of Weld County for the use and benefit of the Weld County Department of Public
Health and Environment (WCDPHE).
The Women's Wellness Connection (WWC) program requires certain surgical services to be provided to
patients that qualify for the WWC program. Exhibit A lists the types of services to be provided and the 2023
Colorado Medicare reimbursement rates. Exhibit B is the consultation voucher. The Weld County Department
of Public Health and Environment (WCDPHE) seeks approval for this agreement with Banner MD Anderson to
ensure that our qualified patients have timely access to the surgical services needed.
This agreement would be effective for one (1) year from the date of execution, and then after that this
agreement shall renew on a yearly basis for up to three (3) more years unless terminated sooner in
accordance with the terms of this agreement. Activities will be conducted by current staff; no additional FTE is
being requested.
What options exist for the Board?
Consequences: If the Board declines to approve this agreement, the WCDPHE will not be able to
provide optimal care for our patients. This will result in greater challenges for us to assist qualified
patients at increased risk of breast and cervical cancer with connecting with a surgeon.
Impacts: With approval of the Board, the WCDPHE will be able to connect our qualified WWC patients
with Banner MD Anderson resulting in improved health outcomes and increased customer service.
Costs (Current Fiscal Year I Ongoing or Subsequent Fiscal Years): This is a no -cost agreement
with Banner MD Anderson. The cost of the services provided by Banner MD Anderson will be invoiced
and paid by WCDPHE. The Colorado Department of Public Health and Environment (CDPHE)
Women's Wellness Connection program will reimburse the WCDPHE. A list of the surgical services to
be provided and their associated cost is listed in Appendix A.
Recommendation: I recommend approval of this agreement with Banner MD Anderson.
Support Recommendation Schedule
Place on BOCC Agenda Work Session Other/Comments:
Perry L. Buck, Pro -Tern
Mike Freeman
•
2024-0432
2/2 I LOp��
Scott K. James
Kevin D. Ross , Chair
Lori Seine
Cheryl Hoffman
From:
Sent:
To:
Cc:
Subject
Approve - thanks!
Scott James
Monday, January 22, 2024 8:44 AM
Cheryl Hoffman
Esther Gesick
Re: New Banner MD Anderson Surgical Agreement
Scott K. James
Weld County Commissioner, District 2
1150 O Street, P.O. Box 758, Greeley, Colorado 80632
970.336.7204 (Office)
970.381.7496 (Cell)
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or
entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you
have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any
disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by
anyone other than the named recipient is strictly prohibited.
On Jan 22, 2024, at 8:36 AM, Cheryl Hoffman <choffman@weld.gov> wrote:
Hi Scott,
Here's #4 of 7.
Do you approve of placement on the BOCC agenda after your review?
Thanks.
Cheryl L. Hoffman
Deputy Clerk to the Board
1150 O Street/P.O. Box 758
Greeley, CO 80632
Tel: (970) 400.4227
choffman@weld.gov
From: Karla Ford <kfordAtweld.gov>
Sent: Sunday, January 21, 2024 1:35 PM
To: Cheryl Hoffman <choffmania0weld.lov>
Subject: New Banner MD Anderson Surgical Agreement
Karla Ford R
Office Manager, Board of Weld County Commissioners
1150 O Street, P.O. Box 758, Greeley, Colorado 80632
:: 970.336-7204 :: kfordeweldgov.corn :: www.weldgov.com :.
'Visase note my working hours are Monday -Thursday 7:OOa.m. 5:OOp.m."
<image003.jpg>
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed
and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please
immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of
this communication or any attachments by anyone other than the named recipient is strictly prohibited.
From: Jason Chessher <ichessheriweld.eov>
Sent: Friday, January 19, 2024 10:19 AM
To: Karla Ford <kford@weld.gov>
Cc: Holly Smith <hsmithgaweld.gov>; Shaun May <smay@weld.gov>; Bill Fritz <bfritz@weld.gov>
Subject: Banner MD Anderson Surgical Agreement
PA #3
Jason Chessher
Executive Director
Weld County Department of Public Health & Environment
1555 N 17. Ave, Greeley, CO 80631
970-400-2293
<image001. png><image002.png>
<Banner MD Anderson Surgical Subcontractor Pass Around.doc><2024 Surgical Subcontractor.pdf>
2
AGREEMENT CONCERNING SURGICAL SERVICES BETWEEN WELD COUNTY
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT AND BANNER MD ANDERSON
THIS AGREEMENT is made and entered into the 219k -day of 2024, by and
between Banner MD Anderson (SUBCONTRACTOR) and Weld County, State Colorado, by
and through the Board of County Commissioners of Weld County, on behalf of the Weld County
Department of Public Health and Environment ("WCDPHE").
BACKGROUND INFORMATION
WHEREAS, WCDPHE requires certain surgical services, to be provided to patients who
qualify for the Women's Wellness Connection program ("WWC"); and
WHEREAS SUBCONTRACTOR has the necessary credentials and the appropriate
personnel to provide the Services in the State of Colorado, and to provide such Services to patients
who qualify for the WWC program ("WWC patients");
WHEREAS WCDPHE would like SUBCONTRACTOR to provide Services, and
SUBCONTRACTOR is willing and able to provide such Services to eligible WWC patients
consistent with the terms and conditions hereinafter set forth.
NOW THEREFORE, for and in consideration of the covenants, conditions, agreements, and
stipulations hereinafter expressed, the parties do hereby agree as follows:
1. Recitals. The above set forth recitals are hereby incorporated as though set forth herein
verbatim.
2. Term ofAgreement. This Agreement shall be effective for one (1) year from the date of
final execution by the Board of Weld County Commissioners. At the end of the initial one-year
period, this Agreement shall automatically renew on a yearly basis for up to three (3) more years,
unless sooner terminated by notice from either party in accordance with Section 10, Termination,
of this Agreement.
3. Termination ofAgreement. Either party may terminate this Agreement with or without
cause upon thirty (30) days written notice to the other party, such notice to be given pursuant to the
provisions contained in this Agreement. Ifthis Agreement is so terminated, WCDPHE shall pay
that compensation to SUBCONTRACTOR which duly reflects the amount not previously
reimbursed for actual Services rendered to WWC patients under the terms and provisions of this
Agreement by SUBCONTRACTOR during the term of this Agreement, and pursuant to the terms
and provisions of this Agreement.
4. Services to be Provided by WCDPHE. WCDPHE agrees to provide the following
services pursuant to this Agreement, concerning WCDPHE clients who are referred or authorized to
receive Services from SUBCONTRACTOR:
1
(a) Referrals. All referrals and authorizations for Services to WWC patients will be
coordinated through WCDPHE and the WCDPHE designated coordinator. WCDPHE shall provide
all information necessary to ensure patients are identified correctly as being participants in the
WWC Program when presenting for Services at SUBCONTRACTOR.
(b) Eligibility for Services. WCDPHE will determine a patient's eligibility for Services
prior to referral of such patient to SUBCONTRACTOR. SUBCONTRACTOR will confirm
eligibility status with WCDPHE, in the event of any question concerning such status. In addition,
the parties acknowledge that the patients receiving Services have authorized WCDPHE to monitor
or audit the Services being provided to them by SUBCONTRACTOR.
(c) Vouchers. At the time of registration at SUBCONTRACTOR facility and prior to
performing Services, SUBCONTRACTOR will require patients to present a WCDPHE WWC
voucher in substantially the form of Exhibit B, which is attached hereto and incorporated herein by
reference.
5. Compensation. In consideration for the Services to be provided by SUBCONTRACTOR
as set forth in this Agreement, WCDPHE agrees to pay SUBCONTRACTOR the following:
(a) Funding and Rates for Services. Within thirty (30) days of receipt of
SUBCONTRACTOR s invoice, WCDPHE shall pay SUBCONTRACTOR for Services (as defined herein)
in accordance with the reimbursement rates set forth in the current WWC rate sheet attached hereto and
incorporated herein as Exhibit A. If the WWC rate sheet is modified at any time during the term of this
Agreement, WCDPHE shall notify SUBCONTRACTOR immediately of such change, and in any case, no later
than thirty (30) days after such change, giving Notice as provided for in this Agreement.
(b) Billing. SUBCONTRACTOR will provide to WCDPHE on a monthly basis, a
summary of Services rendered to WWC patients referred or authorized by WCDPHE to receive
such Services. The summary will include the following information: patient name, date of
birth, and date of service. SUBCONTRACTOR will provide in a timely manner any additional
information which may be required by WCDPHE in processing the billing information.
(c) 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 the overpayment or
underpayment within ninety (90) days of such payment and provides documentation
substantiating such claim. Such requests for payment adjustment must be answered within thirty
(30) calendar days of receipt.
(d). Paying Adjustments. If the parties determine that WCDPHE has underpaid
SUBCONTRACTOR, WCDPHE shall pay the underpaid amount to SUBCONTRACTOR within fourteen
(14) calendar days of such determination. If the parties determine that WCDPHE has overpaid
SUBCONTRACTOR, SUBCONTRACTOR shall reimburse WCDPHE for the overpayment
within fourteen (14) days of said determination.
2
(e) Payment Final. Except for those payment disputes that have been submitted to a
court of law or in accordance with this section, all payments shall be final.
(f) 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 SUBCONTRACTOR unless SUBCONTRACTOR expressly permits WCDPHE to do so
in writing.
6. SUBCONTRACTOR Responsibilities. SUBCONTRACTOR agrees to provide the
following services and be responsible for the following:
(a) Services. SUBCONTRACTOR agrees to provide certain Surgical services as
specifically set forthonthecurrent WWC rate sheet, Exhibit B. SUBCONTRACTOR shall submit
invoices on a monthly basis to WCDPHE, 1555 North 1.I h Avenue, Greeley, Colorado 80631, for
Services provided under this Agreement.
(b) Timely Clinical Services Report. SUBCONTRACTOR shall use best efforts to return
a clinical services report within one (1) week of the date of service to allow WCDPHE to report
required information to the State of Colorado. Any disclosure of information will be in
compliance with federal and state law. In the event of a contradiction between this Agreement and
federal and state law, federal and state law shall govern the release of any confidential information.
(c) No Additional Fees Shall be Paid. SUBCONTRACTOR shall not bill additional
fees to the WWC patient for those Services covered under the approved WWC codes for the fiscal
year 2024.
7. Records. The relevant records of SUBCONTRACTOR shall be complete and available
for audit ninety (90) days after final payment for any Services provided pursuant to this
Agreement and shall be retained and available for audit purposes for at least five (5) years after
such final payment. The parties agree to the additional following provisions concerning records:
(a) Medical Records. Medical records for the Services provided pursuant to this
Agreement will be maintained at SUBCONTRACTOR, but WCDPHE personnel will have access
to such files at all reasonable times during regular business hours.
(b) Financial Records. WCDPHE shall have access to the financial records kept by
SUBCONTRACTOR with respect to the Services provided by SUBCONTRACTOR pursuant to
this Agreement at all reasonable times during regular business hours.
(c) Confidentiality. Each party agrees to keep any and all records and information
confidential, and to comply with the privacy obligations applicable to them under the Health
3
Insurance Portability and Accountability Act of 1996 and the regulations issued pursuant thereto, as
amended (42 USC 1320d and 45 CFR 160.101, et. seq.) ("HIPAA") and to comply with all other
laws and regulations concerning the confidentiality of such records. The parties agree to execute a
Business Associate Agreement pursuant to HIPAA requirements, if such an agreement is indicated.
8. Errors, Acts, and Omissions.
(a) WCDPHE. WCDPHE agrees it shall be liable for any claims, costs and
expenses, arising from or out of any alleged negligent act or omission of WCDPHE or its agents or
employees in the performance or lack of performance of its obligations under this Agreement. This
section shall survive termination of this Agreement.
(b) SUBCONTRACTOR. SUBCONTRACTOR agrees it shall be liable for any
claims, costs and expenses, arising from or out of any alleged negligent act or omission of
SUBCONTRACTOR or its agents or employees in the performance or lack of performance of
its obligations under this Agreement. This section shall survive termination of this Agreement.
9. No Federal Exclusion. WCDPHE hereby represents and warrants that WCDPHE is not,
and at no time has been, excluded from participation in any federally funded health care program,
including Medicare and Medicaid. WCDPHE hereby agrees to immediately notify
SUBCONTRACTOR of any threatened, proposed, or actual sanction or exclusion from any
federally funded health care program, including Medicare and Medicaid. Such notice shall contain
reasonably sufficient information to allow SUBCONTRACTOR to determine the nature of any
sanction. In the event that WCDPHE is excluded from participation in any federally funded health
care program during the term of this Agreement, or if, at any time after the effective date of this
Agreement, it is determined that WCDPHE is in breach of this Section, this Agreement shall, as of
the effective date of such exclusion or breach, automatically terminate.
SUBCONTRACTOR hereby represents and warrants that SUBCONTRACTOR is not, and
at no time has been, excluded from participation in any federally funded health care program,
including Medicare and Medicaid. SUBCONTRACTOR hereby agrees to immediately notify
WCDPHE of any threatened, proposed, or actual sanction or exclusion from any federally funded
health care program, including Medicare and Medicaid. Such notice shall contain reasonably
sufficient information to allow SUBCONTRACTOR to determine the nature of any sanction. In
the event that SUBCONTRACTOR is excluded from participation in any federally funded health
care program during the term of this Agreement, or if, at any time after the effective date of this
Agreement, it is determined that SUBCONTRACTOR is in breach of this Section, this Agreement
shall, as of the effective date of such exclusion or breach, automatically terminate.
4
10. General Provisions.
(a) Section Headings. The headings ofsections in this Agreement are for reference
only and shall not affect the meaning of this Agreement.
(b) Parties' Relationship. The parties to this Agreement intend that the relationship
between them contemplated by this Agreement is that of independent entities working in mutual
cooperation. No employee, agent, or servant of one party shall be or shall be deemed to be an
employee, agent, or servant of another party to this Agreement.
(c) No Waiver of Immunities. Notwithstanding any other provision contained herein,
WCDPHE specifically does not waive any immunities to which it may be entitled by statute or
otherwise, including, without limitation, the Colorado Governmental Immunity Act.
(d) Non -Assignment. This Agreement shall not be assigned, delegated, or transferred
by either party without the prior written consent of the other party. Notwithstanding any provision
ofthis Agreement to the contrary, SUBCONTRACTOR shall have the right to assign or otherwise
transfer its interest under this Agreement to any "related entity." For the purposes of this section, a
related entity shall be deemed to include a parent or subsidU, of SUBCONTRACTOR, any entity
that acquires all or substantially all of SUBCONTRACTOR assets or operations relating to this
Agreement, and the surviving entity of any merger or consolidation involving
SUBCONTRACTOR. Any assignment to a related entity shall not require the consent or approval
of WCDPHE in order to be effective.
(e) Notices. Any notice or other communication provided for in this Agreement shall be
in writing and shall be served by personal delivery, confirmed facsimile, or by certified mail, return
receipt requested, postage prepaid, at the addresses set forth in this Agreement, until such time as
written notice of a change is received from the party wishing to make a change of address. Any
notice so mailed and any notice served by personal delivery or confirmed facsimile shall be deemed
delivered and effective on the date of delivery if the notice is personally served or served by
facsimile, or on the third business day following the date ofmailing if the notice is mailed by
certified mail.
Banner MD Anderson: Banner MD Anderson
1800 15th Street 210
Greeley, Colorado 80631
WCDPHE: Weld County Department of Public Health and Environment
c/o Bill Fritz
1555 N. 17`h Avenue
Greeley, Colorado 80631
FAX: (970) 304-6412
(f) No Waiver ofAttorney-Client Privilege. Neither party waives the attorney -client,
5
the accountant -client, or any other legal privilege by virtue of this Agreement.
(g) Change in Law. If there is a change in any federal or state law, regulation or
rule that affects this Agreement or the activities of either party under this Agreement, or any
change in the judicial or administrative interpretation of any such law, regulation, or rule, and
either party reasonably believes in good faith that such change shall have a substantial adverse
effect on such party's business operations or its rights or obligations under this Agreement, then
such party may, upon written notice, require the other party to enter into good faith negotiations
to renegotiate the terms of this Agreement. If(a) the parties are unable to reach an agreement
concerning the modification of this Agreement within the earlier of(i) forty-five (45) days
after the date of the notice seeking renegotiation or (ii) the effective date of the change, or (b)
the change is effective immediately, then either party may immediately terminate this
Agreement upon written notice of such termination to the other party.
(h) Binding Effect. This Agreement shall be binding upon, and shall inure to the
benefit of, the parties hereto and their successors and permitted assignees.
(i) Unforeseen Circumstances. In the event that SUBCONTRACTOR does not have
proper facilities to treat patients or in the event of circumstances beyond their reasonable control
such as a major disaster, epidemic, war, complete or partial destruction of facilities, disability of
a significant number of personnel or significant labor disputes, SUBCONTRACTOR shall
provide health services to patients to the extent possible according to its best judgment or
limitations of such facilities and personnel as are then available, but SUBCONTRACTOR shall
have no liability or obligation for delay or failure to provide or arrange for such services.
U) Ethical Business Practices. WCDPHE and SUBCONTRACTOR understand and
agree that all obligations under this Agreement shall be conducted in accordance with all applicable
laws and regulations. In addition, WCDPHE and SUBCONTRACTOR understand and agree that
all business operations will be conducted in accordance with applicable business and ethical.
standards.
(k) Governing Law. This Agreement shall be governed under the laws of the State
of Colorado, and any relevant Federal law.
(1) Medical Practices. WCDPHE and SUBCONTRACTOR understand and agree that
all obligations concerning medical practices under this Agreement shall be conducted in
accordance with the applicable standards of care within the community.
(m) Confidential Information. During the term of this Agreement and at all times
thereafter, WCDPHE and SUBCONTRACTOR shall ensure that WCDPHE and
SUBCONTRACTOR, and their directors, officers, employees, contractors and agents hold the
other party's Confidential Information in the strictest confidence and in accordance with state and
federal law. "Confidential Information" shall include without limitation all information and
records whether oral or written or disclosed prior to or subsequent to the execution of this
Agreement regarding the following:
6
the following: patients, utilization review, quality assessment, finances, volume ofbusiness,
methods ofoperation, trade secrets, contracts and prices and price -related information. To the
extent allowed by Law, each party shall return or destroy, as directed by the disclosing party, all
Confidential Information received from the other party following termination ofthis Agreement for
any reason. The parties agree that disclosure of party's Confidential Information other than in
accordance with this Section or applicable federal or state Law shall cause irreparable injury to
such party, and that the injured party shall be entitled to injunctive reliefto prevent the other party's
breach ofthis Section. Notwithstanding any provision contained herein to the contrary,
SUBCONTRACTOR acknowledges that WCDPHE is a department ofWeld County Government,
and as such, is subject to the Colorado Open Records Act, which would most likely recognize this
Agreement and its accompanying records, among other things, as open records.
(n) Modification and Breach. This Agreement contains the entire Agreement and
understanding between the parties to this Agreement and supersedes any other agreements
concerning the subject matter ofthis transaction, whether oral or written. No modification,
amendment, novation, renewal, or other alteration ofor to this Agreement and the attached exhibits
shall be deemed valid or ofany force or effect whatsoever, unless mutually agreed upon in writing
by the undersigned parties. No breach ofany term, provision, or clause ofthis Agreement shall be
deemed waived or excused, unless such waiver or consent shall be in writing and signed by the
party claimed to have waived or consented Any consent by any party hereto, or waiver of a breach
by any other party, whether express or implied, shall not constitute a consent to, waiver of or
excuse for any other different or subsequent breach.
(o) Severability. If any term or condition of this Agreement shall be held to be invalid,
illegal, or unenforceable, this Agreement shall be construed and enforced without such a provision,
to the extent this Agreement is then capable of execution within the original intent ofthe parties.
(p) Funding. No portion ofthis Agreement shall be deemed to create an obligation on
the part ofthe County of Weld, State of Colorado, or WCDPHE to expend funds not otherwise
appropriated during the term of this Agreement.
(q) No Third -Party Enforcement. No portion of this Agreement shall be deemed to
constitute a waiver of any immunities the parties or their officers or employees may possess, nor
shall any portion of this Agreement be deemed to have created a duty of care with respect to any
person not a party to this Agreement.
It is expressly understood and agreed that enforcement of the terms and conditions of this
Agreement, and all rights ofaction relating to such enforcement, shall be strictly reserved to the
undersigned parties, and nothing contained 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
ofthe undersigned parties that any entity other than the undersigned parties receiving Services or
benefits under this Agreement shall be deemed an incidental beneficiary only.
7
(r) Conflict of Interest. No officer, member, director, or employee of WCDPHE or
SUBCONTRACTOR and no member of their governing bodies shall have any pecuniary
interest, direct or indirect, in the approved Agreement or the proceeds thereof
(s) Non -Exclusive Agreement. This Agreement is not exclusive. Accordingly,
either SUBCONTRACTOR or WCDPHE shall have the right to enter into one or more
agreements relating to the same or similar matters as are covered by this Agreement, and
execution by either party of such agreements shall not constitute a breach ofthis Agreement.
IN WITNESS WHEREOF, the parties have hereunto set their hands and seals on the
dates stated below:
BANNER MD ANDERSON:
Name:
Title: _
Date:
ATTEST.
BY:
DATE:
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
020 ���-
Exhibit A
Medicare Rates and CPT Codes - Updated June 2023 (updates in Bold)
Cancer Prevention and Early Detectoo Program/Women's Wellness Connection Clinical Services
Reimbursable Services and Procedures for June 30, 2023 to June 29, 2024
Listed below are allowable procedures and the corresponding CPT codes for use in the Cancer Prevention and
Connection (WWC) Clinical Services program. These rates are based on information found on the Centers for
https://www.cros.gov/medicare/physician-fee-schedule/search/overview. Rates are incorporated into the program's
Early Detection (CPED)/Women's Wellness
Medicare and Medicaid website,
Bundled Payment System (BPS) at the
and to aid in negotiating subcontracts.
of the breast and cervix may be eligible
Lead for approval of any codes not on this
beginning of each fiscal year. Codes are provided to show what services are covered through WWC Clinical Services
Reimbursement for treatment services is not allowed. Additional CPT codes related to cancer screening and diagnostics
for reimbursement through the CPED/WWC Clinical Services program. Please contact your CDPHE Organizational
list.
CPT CODES
OFFICE VISITS
End
Notes
2023 CO
Rates
2023 Prof 12023 Tech
(26) (TC)
99202
New patient; expanded history, exam, straightforward decision -making; 15-29 minutes
$74.40
99203
New Patient; detailed history, exam, straightforward decision -making; 30-44 minutes
$114.59
99204
New Patient; comprehensive history, exam, moderate complexity decision -making; 45-59 minutes
1
$169.84
99205
New patient; comprehensive history,
p p exam, high complexity decision -making; 60-74 minutes
1
$224.00
99211
Established patient; evaluation and management, may not require presence of physician; presenting
problems are minimal
$24.19
99212
Established patient; history, exam, straightforward decision -making; 10-19 minutes
$58.20
99213
Established Patient; expanded history, exam, straightforward decision -making; 20-29 minutes
$92.52
99214
Established Patient; detailed history, exam, moderately complex decision -making; 30-39 minutes
$130.73
99385
Initial comprehensive preventive medicine evaluation and management; history,
p p g ry, examination,
counseling and guidance, risk factor reduction, ordering of appropriate immunizations and lab
procedures; 18 to 39 years of age
2
intentionally
left blank
99386
Same as 99385, but 40 to 64 years of age
2
intentionally
left blank
99387
Same as 99385, but 65 years of age or older
2
intentionally
left blank
99395
Periodic comprehensive preventive medicine evaluation and management; history, examination,
counseling and guidance, risk factor reduction, ordering of appropriate immunizations and lab
procedures; 18 to 39 years of age
2
intentionally
left blank
1
99396
Same as 99395 but 40 to 64 years of age
2
intentionally
left blank
ht
(d
99397
Same as 99395, but 65 years of age or older
2
intentionally
left blank
CPT CODES
BREAST SCREENING AND DIAGNOSTIC SERVICES
End
Notes
2023 CO
Rates
2023 Prof
(26)
2023 Tech
(TC)
76098
Radiological examination, surgical specimen
$44.10
$15.37
$28.74
76641
Ultrasound, complete examination of breast including axilla, unilateral
$109.12
$35.55
$73.57
76642
Ultrasound limited examination of breast including axilla, unilateral
3
$89.62
$33.13
$56.49
76942
Ultrasonic guidance for needle placement, imaging supervision and interpretation
3
$60.46
$30.66
$29.80
19000
Puncture aspiration of cyst of breast
$106.66
19001
Puncture aspiration of cyst of breast, each additional cyst, used with 19000
$26.77
19100
Breast biopsy, percutaneous, needle core, not using imaging guidance
$1.57.03
19101
Excision Procedures on the Breast
$341.80
19120
Excision of cyst, fibroadenoma or other benign or malignant tumor, aberrant breast tissue, duct lesion,
nipple or areolar lesion; open; one or more lesions
$534.05
19125
Excision of breast lesion identified by preoperative placement of radiological marker; open; single
lesion
$587.57
19126
Excision of breast lesion identified by preoperative placement of radiological marker, open; each
additional lesion separately identified by a preoperative radiological marker
$158.37
19081
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous;
stereotactic guidance; first lesion
7
$532.20
19082
Breast biopsy, with placement oflocalization device and imaging of biopsy specimen, percutaneous;
stereotactic guidance; each additional lesion
7
$414.74
19083
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous;
ultrasound guidance; first lesion
7
$532.74
19084
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous;
ultrasound guidance; each additional lesion
7
$408.93
19085
Breast biopsy, with placement oflocalization device and imaging of biopsy specimen, percutaneous;
magnetic resonance guidance; first lesion
7
$821 20
19086
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous;
magnetic resonance guidance; each additional lesion
7
$640.86
19281
Placement of breast localization device, percutaneous; mammographic guidance; first lesion
8
$253.73
19282
Placement of breast localization device, percutaneous; mammographic guidance; each additional
lesion
8
$181.22
19283
Placement of breast localization device, percutaneous; stereotactic guidance; first lesion
8
$274.20
19284
Placement of breast localization device, percutaneous; stereotactic guidance; each additional lesion
8
$203.19
19285
Placement of breast localization device, percutaneous; ultrasound guidance; first lesion
8
$395.45
19286
Placement of breast localization device, percutaneous; ultrasound guidance; each additional lesion
8
$325.91
19287
Placement of breast localization device, percutaneous; magnetic resonance guidance; first lesion
8
$683.08
19288
Placement of breast localization device, percutaneous; magnetic resonance guidance; each additional
lesion
8
$530.47
10021
Fine needl a aspiration without imaging guidance, first lesion
$105.75
10004
Fine needle aspiration biopsy without imaging guidance, each additional lesion
$51.92
10005
Fine needle aspiration biopsy including ultrasound guidance first lesion
$141.13
10006
Fine needle aspiration biopsy including ultrasound guidance, each additional lesion
$61.31
10007
Fine needle aspiration biopsy including fluoroscopic guidance, first lesion
$312.29
10008
Fine needle aspiration biopsy including fluoroscopic guidance, each additional lesion
$150.10
10009
Fine needle aspiration biopsy including CT guidance, first lesion
$459.72
10010
Fine needle aspiration biopsy including CT guidance, each additional lesion
$250.62
10011
Fine needle aspiration biopsy including MRI guidance, first lesion
9
(see end note)
10012
Fine needle aspiration biopsy including MRI guidance, each additional lesion
9
(see end note)
88172
Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine
adequacy of specimen(s), first evaluation episode
$57.49
$35.51
$21.98
88177
Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine
adequacy of specimen(s), each separate additional evaluation episode
$30.23
$21.69
$8.54
88173
Cytopathology, evaluation of fine needle aspirate; interpretation and report
$168.51
$69.94
$98.57
88305
Surgical pathology, gross and microscopic examination
$74.12
$37.20
$36.92
88307
Surgical pathology, gross and microscopic examination; requiring microscopic evaluation of surgical
margins
$304.31
$82.27
$222.04
400
Anesthesia for procedures on the integumentary system, anterior trunk, not otherwise specified.
Medicare Base Units = 3
14
(see end note)
i
77053
Mammary ductogram or galactogram, single duct
$56,12
$17.43
$38.70
77046
Magnetic resonance imaging (MRI), breast, without contrast, unilateral REQUIRES WWC
PREAPPROVAL.
6
$232.92
$69.78
$163.15
77047
Magnetic resonance imaging (MRI), breast, without contrast, bilateral REQUIRES WWC
PREAPPROVAL.
6
$241.15
$77.29
$163.86
77048
Magnetic resonance imaging (MRI), breast, including CAD, with and without contrast, unilateral
REQUIRES WWC PREAPPROVAL.
6
$370.54
$101.53
$269.01
77049
Magnetic resonance imaging (MRI), breast, including CAD, with and without contrast, bilateral
REQUIRES WWC PREAPPROVAL.
6
$377.98
$111.10
$266.88
77063
Screening digital breast tomosynthesis, bilateral (3D mammography)
4
$54.96
$29.34
$25.62
77065
Diagnostic Mammography, unilateral, includes CAD
$132.1.2
$38.99
$93.14
77066
Diagnostic Mammography, bilateral, includes CAD
$166.70
$47.95
$118.76
77067
Screening Mammography, bilateral
$135.40
$36.93
$98.48
G0279
Diagnostic digital breast tomosynthesis, unilateral or bilateral (diagnostic 3D mammography)
5
$54.96
$29.34
$25.62
Various
To include any pre -operative testing procedures medically necessary for the planned surgical
procedure (e.g., complete blood count, urinalysis, pregnancy test, pre -operative CXR, etc.)
88164
Cytopathology (conventional Pap test), slides cervical or vaginal reported in Bethesda System,
manual screening under physician supervision
$17.31
88165
Cytopathology (conventional Pap test), slides cervical or vaginal reported in Bethesda System,
manual screening and rescreening under physician supervision
$42.22
88141
Cytopathology (conventional Pap test), cervical or vaginal, any reporting system, requiring
interpretation by physician
$23.71
88142
Cytopathology (liquid -based Pap test) cervical or vaginal, collected in preservative fluid, automated
thin layer preparation; manual screening under physician supervision
$20.26
88143
Cytopathology, cervical or vaginal, collected in preservative fluid, automated thin layer preparation;
manual screening and rescreening under physician supervision
$23.04
88174
Cytopathology, cervical or vaginal, collected in preservative fluid, automated thin layer preparation;
screening by automated system, under physician supervision
$25.37
88175
Cytopathology, cervical or vaginal, collected in preservative fluid, automated thin layer preparation;
screening by automated system and manual rescreening, under physician supervision
$26.61
87624
Human Papillomavirus (HPV) high -risk types
10
$35.09
87625
Human Papillomavirus, types 16 and 18 only
10
$40.55
57452
Colposcopy of the cervix
$131.49
57454
Colposcopy of the cervix, with biopsy and endocervical curettage
$174.03
57455
Colposcopy of the cervix, with biopsy
$166.88
57456
Colposcopy of the cervix, with endocervical curettage
$157.57
57460
Colposcopy with loop electrode biopsy(s) of the cervix Requires WWC Preapproval Unless Done
After HSIL or AIS Pap test.
$330.48
57461
Colposcopy with loop electrode Ionization of the cervix Requires WWC Preapproval unless done
after HSIL or AIS Pap test.
$367.49
57500
Cervical biopsy, single or multiple, or local excision of lesion, with or without fulguration (separate
procedure) Use this code for cervical polyp removal
$162.00
57505
Endocervical curettage (not done as part of a dilation and curettage)
$163.43
57520
Conization of cervix, with or without fulguration, with or without dilation and curettage, with or
without repair; cold knife or laser
11
$367.29
57522
Loop electrode excision procedure
11
$314.92
58100
Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical
dilation, any method (separate procedure). Only for diagnostic purposes following AGC Pap.
$105.41
58110
Endometrial sampling (biopsy) performed in conjunction with Colposcopy (List separately in addition
to code for primary procedure). Only for diagnostic purposes following AGC Pap.
$50.81
88305
Surgical pathology, gross and microscopic examination
$74.12
$37.20
$36.92
88331
Pathology consultation during surgery, first tissue block, with frozen section(s), single specimen
$105.74
$62.06
$43.68
88332
Pathology consultation during surgery, each additional tissue block, with frozen section(s)
$56.93
$30.68
$26.25
88341
Inununohistochemistry antibody slide
$90.51
$28.24
$62.27
88342
Immunohistochemistry antibody slide
$104.79
$34.78
$70.01
88360
Morphometric analysis, tumor immunohistochemistry, pre specimen; manual
$123.78
$41.67
$82.11
88361
Morphometric analysis, tumor immunohistochemistry, pre specimen; using computer -assisted
technology
$123.63
$43.65
$79.97
99070
Supplies
included
provided)
and
with
materials (except
the office visit
spectacles), provided
or other services rendered
by the
physician over and above those usually
(list drugs, trays, supplies, or materials
Various
Pre -operative testing;
necessary for the planned
CBC,
urinalysis,
surgical
pregnancy test, etc. These procedures should be medically
procedure.
D.
Lod
21)23
( 0
2023 1'rrol. .
21)23 *tech
',Rates
(2.6)
(
1*( )
4UU
Anesthesia for procedures on the integumentary system, anterior trunk, not otherwise specified
99156
10-22 minutes for individuals
5 years or older
$75.64
99157
For each additional
15 minutes
12
$62.27
'CERVICAL
O!)
PATHOLOGY FOR BOTH BREAST ;AND CANCER SCREENING AND
-
End
2023 CO
2023 Prof
2023 Tech
- - • - - -- - .
Notes
Rates
(26)
(TC-')
87426
COVID-19 infectious agent detection by nuclei acid DNA or RNA: amplified probe
technique
15
$35.33
87635
COVJD-19 infectious agent antigen detection by immunoassay technique; qualitative or
semiquantitative
15
$51.31
88365
In situ hybridization (eg,FISH), per specimen; initial single probe stain procedure
$189.83
$43.05
$146.78
88 364
In situ hybridization
(eg,FISH), per specimen; each additional single probe stain procedure
$143.58
$34.07
$108.51
88366
In situ hybridization (eg,FISH), per specimen; each multiplex probe
stain procedure
$293.45
$61.98
$231.46
88367
Morphometric analysis, in situ hybridization,
stain procedure
computer -assisted, per specimen, initial
single probe
$119.34
$33.32
$86.02
88373
Morphometric analysis, in situ hybridization,
stain procedure
computer -assisted, per specimen, each additional probe
$71.70
$25.09
$46.66
88374
Morphometric analysis, in situ hybridization, computer -assisted, per specimen, each multiplex stain
procedure
$320.07
$42.62
$277.45
88368
Morphometric analysis, in situ hybridization, manual, per specimen, initial single probe
procedure
stain
$149.27
$41.63
$107.64
88369
Morphometric analysis, in situ hybridization,
procedure
manual, per specimen, each additional
probe
stain
$128.28
$33.01
$95.27
88377
Morphometric analysis, in situ hybridization, manual, per specimen, each multiplex
stain procedure
$417.83
$63.61
$354.22
Various
Pre -operative testing; CBC, urinalysis, pregnancy test, etc. These
necessary for the planned surgical procedure.
procedures should
be medically
CPT CODES U!ICAi
R
_
,LLADIED
ant.
/\ny
Treatment of breast carcinoma in situ,
cancer.
breast cancer, cervical intraepithelial neoplasia and cervical
77061,
77062
Breast tomosynthesis, as screening, diagnostic,
approved for coverage by CPED/WWC.
unilateral/bilateral. These procedures have not been
C.
13
87623
Human Papillomavirus,
low -risk types
END NOTES FOR WWC CLINICAL SERVICES
1
A11 consultations should be billed through the standard "new patient" office visit CPT codes 99202-99205 Consultations billed as 99204 or 99205 must meet
the criteria for these codes These codes (99204-99205) are typically not appropriate for CPED/WWC screening visits However, they may be used when
provider spends extra time to do a detailed risk assessment
2
The 9938X codes shall be reimbursed at or below the 99203 rate, and 9939X codes shall be reimbursed at or below the 99213 rate The type and duration of
office visits should be appropriate to the level of care needed to accomplish screening and diagnostic follow-up within the CPED/WWC While some
programs may need to use 993XX-series codes, Preventive Medicine Evaluation visits are not covered by Medicare and not appropriate for the CPED/WWC
3
Fora bilateral breast ultrasound, a modifier 50 may be added to either 76641 or 76642 to indicate a bilateral procedure The Medicare Physician Fee Schedule
assigns a "1" bilateral indicator to both CPT codes 76641 and 76642 which means that Medicare will allow 150 percent of the standard reimbursement rate
4
List separately in addition to code for primary procedure 77067
5
List separately m addition to 77065 or 77067
6
Breast MRI can be reimbursed by them conjunction with a mammogram when a client has a BRCA gene mutation a first -degree relative who is a BRCA
carrier, or a lifetime risk of 20% or greater as defined by risk assessment models such as BRCAPRO that depend largely on family history Breast MRI also
can be used to assess areas of concern on a mammogram, or to evaluate a client with a history of breast cancer after completing treatment Breast MRI should
never be done alone as a breast cancer screening tool Breast MRI cannot be reimbursed to assess the extent of disease in a women who has just been newly
diagnosed with breast cancer in order to determine treatment
7
Codes 19081-19086 are to be used for breast biopsies that include image guidance, placement of localization device, and imaging of specimen These codes
should not be used in conjunction with 19281-19288
8
Codes 19281-19288 are for image guidance placement of localization device without image -guided biopsy These codes should not be used in conjunction
with 19081-19086 '
9
For CPT 10011 use the reimbursement rate for CPT code 10009 For CPT 10012 use the reimbursement rate for CPT code 10010
10
HPV DNA testing is not a reimbursable test for women under 30 years of age
11
A LEEP or comzation of the cervix, as a diagnostic procedure, may be reimbursed based on ASCCP recommendations Pre -approval of this procedure for
reimbursement is required A LEEP or comzation of the cervix as a treatment procedure cannot be reimbursed by CDPHE
12
Example If procedure is 50 minutes, code 99156+(99157 x 2) No separate charge allowed ifprocedure
<10 minutes
13
These procedures have not been approved for coverage by Medicare Please see code 77063 as the approved code for screening digital breast tomosynthesis
bilateral 3D mammography
14
The carrier specific Medicare anesthesia conversion rates are available here https //www cros gov/Center/Provider-Type/Anesthesiologists-Center html
Medicare's methodology for the payment of anesthesia services are outlined in the Medicare Claims Processing Manual, Chapter 12, pages 99-107, available
here http //www cros hhs gov/manuals/downloads/c1m104c12 pdf
15
States have received federal funding and test kits for free COVD-19 testing These were specifically provided so that uninsured people could get free testing
Since WWC/CPED is payor of last resort, this should be the first resource for any COVID-19 testing required by a provider prior to any procedure When
testing cannot be covered by those resources for reasons such as the free testing only be administered to people who are symptomatic, then WWC/CPED can
cover the required COVID-19 antigen testing If your organization pays for COVID testing, your organization should be able to track all tests results and link
them to an actual screening or diagnostic procedure if the COVID-19 testis negative If the COVID-19 test is positive, your organization will need to have a
plan for following up to make sure the required procedure gets done at a later date
.
dCOUNTY
:'rl
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 North 17th Avenue, Greeley, CO 80631 www.weldhealth.org
Consultation Voucher
This voucher is for the following patient who has been confirmed as eligible for:
Este cupon es para las personas que son conJrmadas elegible para:
Women's Wellness Connection Program
Patient: Please present this voucher, as well as any other paperwork given to you, as you arrive for your
appointment to ensure proper billing. Your appointment is scheduled at:
Al llegar a su cita por favor presente este cupon y otros documentos necesarios entregados a usted, para asegurar la
facturacion apropiada. Sac cita es programada en:
Banner MD Anderson Cancer Center
1801 16th Street
Greeley, CO 80631
970-810-3894
970-810-3897 Fax
Appointment date/time:
Fecha de la cita
Patient's name:
Summit Pathology
5802 Wright Drive
Loveland, CO 80538
970-212-0518
970-267-6941 Fax — Attn : Andrea
Patient's Date of Birth:
Fecha de nacimiento
Nombre del paciente
Covered service for this visit:
Servicio cubierto para esta cita
*All other services will require prior authorization.
Todos otros servicios se requieren autorizacion previa.
NOTE: This voucher expires 60 days after date of issue.
Issue date:
Authorized Signature:
Service Provider: please bill Weld County as an insurance for the above listed service only:
Weld County Department of Public Health
Attn: Contract Billing
1555 North 17th Avenue, Greeley, CO 80631
If you have any questions or need to reschedule, please call (970) 304-6420.
Si usted tiene alguna pregunta o tiene que cancelar la cita, por favor Ilame (970) 304-6420.
Health Administration
Vital Records
Tele: 970-304-6410
Fax: 970-304-6412
Public Health &
Clinical Services
Tele: 970-304-6420
Fax: 970-304-6416
Environmental Health
Services
Tele: 970-304-6415
Fax: 970-304-6411
Communication,
Education & Planning
Tele: 970-304-6470
Fax: 970-304-6452
Emergency Preparedness
& Response
Tele: 970-304-6470
Fax: 970-304-6452
Public Health
Contract Form
Entity Information
Entity Name" Entity ID*
BANNER MD ANDERSON SURGICAL @00048010
Q New Entity?
Contract Name" Contract ID
BANNER MD ANDERSON SURGICAL SERVICES 7787
AGREEMENT
Contract Status
CTB REVIEW
Contract Lead
BFRITZ
Contract Lead Email
bfritz@weld.gov;Health-
Contracts@weld.gov
Contract Description *
BANNER MD ANDERSON SURGICAL SERVICES AGREEMENT
Contract Description 2
Contract Type" Department
AGREEMENT HEALTH
Amount*
$1.00
Renewable
YES
Automatic Renewal
YES
Grant
IGA
Department Email
CM-Health@weldgov.com
Department Head Email
CM-Health-
DeptHead@weldgov.com
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
DGOV.COM
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Parent Contract ID
Requires Board Approval
YES
Department Project #
Requested BOCC Agenda Due Date
Date* 01 /25/2024
01/29/2024
Will a work session with BOCC be required?*
NO
Does Contract require Purchasing Dept. to be
included?
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts
are not in OnBase
Contract Dates
Effective Date
Termination Notice Period
Contact Information
Contact Info
Review Date *
11/01/2026
Renewal Date*
02/01/2027
Committed Delivery Date Expiration Date
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head
JASON CHESSHER
DH Approved Date
02/09/2024
Final Approval
BOCC Approved
BOCC Signed Date
BOCC Agenda Date
02/21/2024
Finance Approver
CHERYL PATTELLI
Legal Counsel
BRUCE BARKER
Finance Approved Date Legal Counsel Approved Date
02/09/2024 02/12/2024
Tyler Ref #
AG 022124
Originator
BFRITZ
Hello