HomeMy WebLinkAbout20172021RESOLUTION
RE: APPROVE THIRD AMENDMENT TO DIAGNOSTIC SERVICES AGREEMENT FOR
TUBERCULOSIS CONTROL PROGRAM AND AUTHORIZE CHAIR TO SIGN -
BANNER HEALTH, DBA NORTH COLORADO MEDICAL CENTER
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 the Third Amendment to the Diagnostic
Services Agreement for the Tuberculosis Control Program 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 the Banner Health, dba North
Colorado Medical Center, commencing July 21, 2017, and ending July 20, 2018, with further
terms and conditions being as stated in said amendment, and
WHEREAS, after review, the Board deems it advisable to approve said amendment, 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 Third Amendment to the Diagnostic Services Agreement for the
Tuberculosis Control Program 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 Human Services, and the Banner Health, dba North Colorado Medical Center, and hereby is,
approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said amendment.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 10th day of July, A.D., 2017.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLOR/DO
ATTEST:4O(; ..fddo4k
Weld County Clerk to the Board
Steve Moreno, Pr
o -Tern
ro-Tern
Sean
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e Freeman
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Date of signature: Q? 15117
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arbara Kirkmeyer,
2017-2021
HL0048
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Memorandum
TO: Julie A. Cozad, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH
Executive Director
Department of Public Health & Environment
DATE: July 5, 2017
SUBJECT: Banner -North Colorado Medical Center
Imaging Contracts for Diagnostic
Imaging/Radiology
Enclosed for the Board's approval are two contracts between Banner Health/North Colorado
Medical Center (Banner/NCMC) and the County of Weld, by and through the Board of
Commissioners of Weld County, on behalf of the Weld County Department of Public Health and
Environment (WCDPHE).
The Health Department is requesting approval to continue two separate contracts with
Banner/NCMC to provide the technical component of diagnostic imaging/radiology services (the
taking of x-rays) to designated eligible patients referred to Banner/NCMC by the Health
Department. Specific services will include mammograms, ultrasounds, and two -view chest x-rays
and will cover patients in the Tuberculosis Control and Women's Wellness Connection programs.
Each one-year continuation contract has a new term of July 21, 2017, through July 20, 2018, and
upon mutual written agreement may be extended for additional one year terms.
Both contracts were approved for placement on the Board's agenda via pass -around memo dated
June 30, 2017. I recommend approval of these two imaging contracts with Banner Health.
2017-2021
DocuSign Envelope ID: C28E6B19-15B6-456C-ABC6-AE9966032683
THIRD AMENDMENT TO DIAGNOSTIC SERVICES AGREEMENT
(BH Contract Number 0314-0343839 A3)
THIS THIRD AMENDMENT TO DIAGNOSTIC SERVICES AGREEMENT (FOR WOMEN'S WELLNESS CONNECTION
PROGRAM) ("Third Amendment") is made and entered into as of the signature dates set forth below, to be effective
as of July 21, 2017 ("Effective Date") by and between Banner Health, an Arizona nonprofit corporation, d/b/a North
Colorado Medical Center ("Banner") and the County of Weld, State of Colorado, by and through the Board of
Commissioners of Weld County, on behalf of the Weld County Department of Public Health and Environment
("WCDPHE"). Banner and WCDPHE may collectively be referred to as the Parties.
RECITALS:
A. Banner and WCDPHE are parties to that certain Agreement dated July 21, 2014, as amended from time to
time (as amended, the "Agreement"), wherein Banner provides diagnostic/imaging radiology services to
patients qualified for certain health services programs ("Designated Patients") through WCDPHE, as more
particularly described therein.
B. The Parties desire to extend the term of the Agreement.
C. The Parties desire to evidence this modification to the Agreement by execution of this Third Amendment.
NOW THEREFORE, the Parties agree as set forth below:
1. Amendment of Agreement. Section 3 (Term and Termination) of the Agreement is hereby amended to
extend the term of the Agreement for a period of one (1) year as of the Effective Date above and continuing through
July 20, 2018, subject to earlier termination as provided in Section 3 of the Agreement.
2. Agreement Effective. Except as amended by this Third Amendment, the Agreement attached hereto and
hereby made a part of this Third Amendment shall remain in full force and effect.
3. Precedence of Amendment. In the event of a conflict between the terms and conditions of this Third
Amendment and the terms and conditions of the Agreement, the terms and conditions of this Third Amendment
shall govern and control.
4. Capitalized Terms. All capitalized terms used in this Third Amendment and not otherwise defined herein
shall have the meaning ascribed to such terms in the Agreement.
5. Incorporation. This Third Amendment shall be attached to, and made a part of, the Agreement.
This Third Amendment will not be in effect until signed by both Parties.
Banner Health, an Arizona nonprofit
corporation, d/b/a North Colorado
Medical Center
By:
o A. Karsten
ts: Chief Executive Officer - NOCO
Signature Date :
SVW June 2017
0314-03-43839 A3
Weld County Department of Public Health and
Environment, by and through the Weld County
Board of Commissioners
Its: Chair, County C
Signature Date : July 10, 2017
1
DocuSign Envelope ID: DC15F30E-2281-44CB-961E-A65FC631DA9A
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
155.5 North 17th Avenue, Greeley, CO 80631 ww-w.weldhealth.orq
EXHIBIT B
Radiology Service Voucher
This voucher is for the following patient who has been confirmed as eligible for:
Este cupon es porn las personas que son canfirmadas elegible para:
Women's Wellness Connection Program
TB Program ZIKA OB Ultrasound
Patient: Please present this voucher, as well as any other paperwork given to you, as you arrive for your
radiology appointment to ensure proper billing. Your appointment is scheduled at:
ll llegar a su cita par Javor presence este cupon y otros docurnentos necesarios entregados a usted para asegurar la
fcecturacion apropiada. Su eau es progrconada en:
Summit View Medical Commons
2001 706 Avenue, Greeley, CO 80634
(970) 810-6070
North Colorado Medical Center
1801 16th Street, Greeley, CO 80631
(970) 810-4121
Appointment date/time: Patient's Date of Birth:
Fecho de la alto Fecha de nacimiento
Patient's name: _
Nambre del paciente
Covered service for this visit:
Servicio cubierto para esta cita
*AII 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 1 7th Avenue, Greeley, CO 80631
If you have any questions or need to reschedule, please call (970) 304-6420.
.Si usted tiene algana pregunta o tiene (pre cancelar la cita, par favor llame (970) 304-6420.
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