HomeMy WebLinkAbout20173967.tiffRESOLUTION
RE: APPROVE THIRD AMENDMENT TO DIAGNOSTIC SERVICES AGREEMENT FOR
WOMEN'S WELLNESS CONNECTION 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 a Third Amendment to the Diagnostic
Services Agreement 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 Weld County Department of Public Health and Environment, and Banner Health,
dba North Colorado Medical Center, commencing July 21, 2017, and continuing until 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
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 Weld County
Department of Public Health and Environment, and Banner Health, dba North Colorado Medical
Center, be, 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 27th day of November, A.D., 2017, nunc pro tunc July 21, 2017.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLQRADO
ATTEST:datA0) �' jCld4;e1
Weld County Clerk to the Board
BY:
APP
oun y "orney ,I XCUSED
Date of signature: ('a( 1 ( (1
Gc'• 1 -IL C TG)
0% / ( •/ ( 8'
u le A. Cozad, Chair
EXCUSED
Steve Moreno, Pro-Tem
Sean P. Conway
Barbara Kirkmeyer
2017-3967
HL0049
ID /5
Memorandum
TO: Julie A. Cozad, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH
Executive Director
Department of Public Health & Environment
DATE: November 21, 2017
SUBJECT: Banner Health/North Colorado Medical
Center WWC Imaging Contract Amendment
Enclosed for the Board's review and approval is an amended contract 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).
With the approval of the Board, Banner/NCMX is requesting to amend our FY17-18 Women's
Wellness Connection (WWC) imaging/radiology contract that was executed on July 10, 2017, to
provide the technical component of diagnostic imaging/radiology services to designated eligible
patients referred to Banner/NCMC by the Health Department.
Changes to the contract occur in section 1, Amendment of the Agreement, with the addition of
three subsections, A, B and C:
• Subsection A. designates the new contracted provider of the professional component (the
reading of images) as Radiology Imaging Associates (RIA);
• Subsection B. adds language regarding the use of a Radiology Service Voucher and the
responsibilities of both parties regarding the provision of and reimbursement for the
imaging services;
• Subsection C. adds language regarding the reference document that will be used (the
predetermined, allowable CPT codes for the Women's Wellness Connection program) to
establish the fee reimbursement schedule associated with the services provided by
Banner/NCMC.
These are clerical changes and things that have historically occurred in our ongoing contracts,
but they have not been specifically listed in the annual contract renewals. Furthermore, the
contract term will remain as originally agreed from July 21, 2017, through July 20, 2018, and upon
mutual written agreement may be extended for additional one year terms.
The agreement was approved for placement on the Board's agenda via pass -around dated
November 20, 2017. I recommend approval of this contract amendment with Banner Health.
tIta-1
2017-3967
Cheryl Hoffman
From:
Sent:
To:
Cc:
Subject:
Attachments:
Tanya Geiser
Monday, November 27, 2017 10:55 AM
Cheryl Hoffman; Skye Thomas
Esther Gesick
RE: Banner Health-NCMC WWC Imaging Contract Amendment
Contract ID 1556 -20173967 -Third Amendment Diagnostic Services Agreement -
Womens Wellness Connection.pdf
Hello, we would happily accept the offer of assistance from Esther. That seems to really expedite the signing of the
contract. Thank you for this offer.
From: Cheryl Hoffman
Sent: Monday, November 27, 2017 10:52 AM
To: Skye Thomas <sthomas@co.weld.co.us>; Tanya Geiser <tgeiser@weldgov.com>
Cc: Esther Gesick <egesick@weldgov.com>
Subject: Banner Health-NCMC WWC Imaging Contract Amendment
Good morning, Skye and Tanya,
The above referenced contract amendment was approved by the BOCC at this morning's hearing. Esther has her
monthly luncheon meeting with the NCMC Board of Trustees today and would be glad to take it with her to that
meeting to leave it for Margo to sign. Would that be okay with you or would you rather handle it through your
office? Just let me know.
Thanks!
Cheryl Hoffman
Deputy Clerk to the Board
Weld County Clerk to the Board Office
1150 O Street
Greeley, CO 80631
970.400.4227
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.
1
THIRD AMENDMENT TO DIAGNOSTIC SERVICES AGREEMENT
(BH Contract Number 0314-03-43839 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 modify certain provisions and to extend the term of the Agreement.
C. The Parties desire to evidence these modifications to the Agreement by execution of this Third Amendment.
NOW THEREFORE, the Parties agree as set forth below:
1. Amendment of Agreement.
a. Paragraph 5 in the RECITALS of the Agreement is hereby deleted in its entirety and replaced as
follows:
"WHEREAS, WCDPHE has a separate agreement with Radiology Imaging Associates ("RIA") to
provide the professional component of diagnostic imaging/radiology services for Designated
Patients at Banner; and"
b. Section 1.1 (Provision of Services) of the Agreement is hereby deleted in its entirety and replaced
as follows:
"1.1 Provision of Services. Upon presentation of Radiology Service Voucher as set forth on
("Schedule B"), attached hereto and incorporated herein by this reference, and if required, an
order of an appropriately licensed physician (employed or otherwise contracted to provide
services to WCDPHE), Banner shall provide the technical component of such diagnostic
imaging/radiology services (the "Technical Services") to Designated Patients as set forth and in
accordance with the current Women's Wellness Connection Medicare and Medicaid rates. Banner
shall supply all qualified personnel, materials and equipment necessary to provide the Technical
Services."
c. "Schedule A" of the Agreement is hereby deleted in its entirety and replaced with a new "Schedule
A", which lists the CPT Codes for the Women's Wellness Connection. "Schedule A" is attached
hereto and incorporated herein to the Agreement by this reference.
d. Sections 3 and 3.1 (Term and Termination) and (Term) 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 Sections 3 and 3.1
of the Agreement.
SVW July 2017
0314-03-43839
1
,to/7
2
AEtreeme nt Effect;ve 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
shaft 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.
K 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
/
Margo A. Karsten
its: Chief Executive Officer - NOCO
Signature Date
SVW July 2017
0374-03-43839
-`x-717.
Weld County Department of Public Health and
Environment, by and through the Weld County
Board of Commissioners
Signature Date N0V 2 7 2017
2
020/7 -96' 7
"SCHEDULE A"
CPT Codes for Women's Wellness Connection Program
See attached.
SVW July 2017
0314-03-43839
3
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH/BANNER
CPT CODES
ECTION CLINICAL SERVICES
WOMEN'S WELLNESS CO
REIMBURSABLE SERVICES AND PROCEDURES AT THE MEDICARE RATE
END
i NOTES
END
NOTES
^
^
co
co
00
0O
0O
0O
O,
ON
rn
rn
OFFICE VISITS
New Patient; detailed history, exam, straightforward decision -making; 30 minutes
New Patient; comprehensive history, exam, moderate complexity decision -making; 45 minutes
Established Patient; detailed history, exam, moderately complex decision -making; 25 minutes
Established Patient; expanded history, exam, straightforward decision -making; 15 minutes
BREAST SCREENING AND DIAGNOSTIC SERVICES
Radiological examination, surgical specimen
Ultrasound, complete examination of breast including axilla, unilateral
Ultrasound, limited examination of breast including axilla, unilateral
Ultrasonic guidance for needle placement, imaging supervision and interpretation
Puncture aspiration of cyst of breast
Puncture aspiration of cyst of breast, each additional cyst, used with 19000
Breast biopsy, percutaneous, needle core, not using imaging guidance
Excision of cyst, fibroadenoma or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion; open; one or more
lesions
Excision of breast lesion identified by preoperative placement of radiological marker; open; single lesion
Excision of breast lesion identified by preoperative placement of radiological marker, open; each additional lesion separately identified by a
preoperative radiological marker
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; stereotactic guidance; first lesion
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; stereotactic guidance; each additional lesion
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; ultrasound guidance; first lesion
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; ultrasound guidance; each additional lesion
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; magnetic resonance guidance; first lesion
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; magnetic resonance guidance; each additional
lesion
Placement of breast localization device, percutaneous; mammographic guidance; first lesion
Placement of breast localization device, percutaneous; mammographic guidance; each additional lesion
Placement of breast localization device, percutaneous; stereotactic guidance; first lesion
Placement of breast localization device, percutaneous; stereotactic guidance; each additional lesion
W
E'" A
Or O
C, V
99203
99204
99214
99213
CPT
CODE
00
Cr,
O
--
V
'C
76642
I 76942
O
O
O
ON
.-o
O
O
ON
O
-•
CT
-
O
-
ON
O
N
-
Cr,
V1
N
O�
skc
N
Q�
^-
00
OOi
19082
19083
19084
00
OO,
00
0ON
^
00
N
N
0O
N
r•1
0O
N
'Cr
0O
a,
ar
ar
C
0
cn
CO
C 0
O
C '.—,
.O
co
0 U
0 ^ L 0
0 CO U V
cal
cn U CO
T.. 70
4:. CU 9 C
0A 0u
U is
U 'O
C C
9900
CO 0 •U U
C C a)
O b co CO
7 C 5 5
0 0 0 0
a) a) a) a)
to.§BCC)
to w U
C
U N G) N •O
CO 0. 0. 0. b0D
U U U Ul op
0
C
O
0 b 'C -O0
C O C O O 5
co N N N O
N
N L
0 0 0 0 0
O
CO as ta'A 5
a)
.o 0 a a) .
.0 , °-
(4.-. C w w 2
0 0 0 0 C 0
a) a0 a) a)a) a 0
592P5
c
0:1 act act UN
a a a. a a.
00
N
O
co
00
C'
h
00
C'
00
00
N
O
N
0
U
.b
C
00
C
CO
0
'a
a)
a)
a)
C
a)
.9
N
0
0
9
'U
a)
a 5 c)
0 „.0
U
COct E
CO CO
U U
E0
G CO
w
0
U' O
Q)
d COC
O C
>, >
b U
o C)
CU 0.
.... c
o
O Q, CO
y O
CO U
0 o E
V, o 0
0
O.
b i C
.... d C C
.5 - c0 co
.5
a g
Aa U 0
^o -d o o 0
a) N C �_
C C O iO
a) C U U_
w 5 5 ;�
O0'0 "v ,a
0 o O Q
co
N y 00 b0
O .C
0 0 o. o.
0u
CO 9cd 9 .5
Q., a.,.0 ,U C
V, 2 `n o
UUcr)v)v,
00
00
N
00
00
Len
00
00
00
h
00
00
0
N
O
0
0
D
.OO
N
h
h
N
N
I I
•
Q
C4 0
U
Ua
w
U
N
0.
54 r�T1 CY
O
4444
obid t°
0 0
U
SO
o o ❑❑o U
CU 0I)p S ai b N
C r0
g • 3 3 .5 0
o 00 .
9
oSco
S
og
0. Q CO C
ozzz
a{..�' U
cn
aQo
eh
V'1
h
00
N
h
h
Cr.
len
h
h
h
h
h
b
Nh
h
h
N
h
N
CO
C
0
:�.
Cd
C
b
C
a
0
if
N
a)
0
412
c.)
a
.2
an
CU
0
CO
O
C
00
W
DIAGNOSTIC SERVICES
CERVICAL SCREE
U
i 0
g -CO 5
C
• U C C
>, ,5 9
O. a-) c 5
"0 U
5 COg cc
ag
OA
CD
C MI rn
0 5 b
U CIA 2
O co
a) •i 9
'0 O OA _O O
g Z5 yC S CO
5 .5 a " ''
s U .o• O
C q• a) CO 00 OCA
-o0 9 . •m
—
o U z o a)
CO m •F..3., 5 CO t0.
C C 5 U z
CO N
co S C C
9 9 v 2 ° '.cv
v
0 aa) = a. Vii, a
cc � O CO 2 i
V) V) .4. .D CL t), 0.
y aj N
O >, et a) `�
N 5 5 .5 •c
{� [g a) '�7 +'
5 .5 >,
T1 ^O `n yU, CO CO CO
t 't .5 00 a o o 0
aO O o .� N o
. n.
eat
`" 0 tf d d
C .5 °' = CO
co
O > > a)
>
N cd C 'CO 5 a) co N
U „Uy > 0 CO y CO
o n a n
0 a) ° .5 .5 .5
b b U C a-) 0
_ +, o ,� +�
U E
N .0) N N
4-, .-. .--": U 0 0
a) t71
N
O, Cl. a, cd cd a)
a a
C
. ,y 0 CO U c.. CO 1-,
> Oi
o o
n 9¢• `° a'7)
U > > 9 C .0 N U U �>,
C C _O - > 0.
0 0 00 0 •Q' G co a y 4.
o .N o C o O C O C
O >, 00 0 0° CO aa)i 0 00 0 0
0 o , aa)i 0 0 'c) 0 a') 0 4 0
is >, ,nzt U 0 U y U o. U cCV U a V 2
00
00
In
00
00
00
00
00
00
00
00
r--
00
CO
h
N
00
00
0.a
CO
"51
N
00
In
h
00
v
U
N
In
N
In
I
7�r
U
U
O
'O
0
b
CO
CO
OO 0
0
-0 ..0
.0 .CO
'3 3
a) a)
0 U
1
0 0
a a
U UO
cn
0 A.
0
U
trn
N
0
U
V1
V1
N
In
a)
N
CO
C
U
as
U
a)
U
0
C
a)
U
a)
w
0
0 O
O
0.
U U
VD 0
N N
In In
cen
a)
cc
V)
O
U
a)
C
0
CO
a)
C
CO
0.
cu
15
a
O
•
O
as
a
Q
O
CLINICAL SERVICES AND PROCEDURES SPECIFICALLY NOT ALLOWED
END NOTES FOR WWC CLINICAL SERVICES
All consultations should be billed through the standard "new patient" office visit CPT codes 99203 or 99204. Consultations billed as 99204 must meet the CPT coding
guidelines for this code. CPT code 99204 is not appropriate for WWC screening visits.
The type and duration of office visits should be appropriate to the level of care necessary for accomplishing screening and diagnostic follow-up. Reimbursement rates
should not exceed those published by Medicare. While the use of 993XX-series codes may be necessary in some programs, the 993XX Preventive Medicine Evaluation
visits themselves are not appropriate for WWC programs. 9938X codes shall be reimbursed at or below the 99203 rate, and 9939X codes shall be reimbursed at or below
the 99213 rate.
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:'; wV4 .cros.hh gov_manuals;downloads'clm 104c 12.pdf
This charge should be used with caution to ensure programs do not reimburse for supplies, the cost of which, has already been accounted for in another clinical charge.
Breast MRI can be reimbursed in 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 20-25% or greater as defined by risk assessment models such as BRCAPRO that are largely dependent on family history. Breast MRI can also be used to better
assess areas of concern on a mammogram or for evaluation of a client with a past history of breast cancer after completing treatment. Breast MRI should never be
Colposcopy with loop electrode conization of the cervix Requires WWC Preapproval unless done after HSIL or AIS Pap test.
Cervical biopsy, single or multiple, or local excision of lesion, with or without fulguration (separate procedure) Use this code for cervical polyp
removal
Endocervical curettage (not done as part of a dilation and curettage)
Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold
knife or laser
Loop electrode excision procedure
Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure). Only for
diagnostic purposes following AGC Pap.
Endometrial sampling (biopsy) performed in conjunction with colposcopy (List separately in addition to code for primary procedure). Only for
diagnostic purposes following AGC Pap.
Surgical pathology, gross and microscopic examination
Pathology consultation during surgery, first tissue block, with frozen section(s). single specimen I
Pathology consultation during surgery, each additional tissue block, with frozen section(s)
Immunohistochemistry antibody slide
lmmunohistochemistry antibody slide
Supplies and materials (except spectacles), provided by the physician over and above those usually included with the
office visit or other services rendered (list drugs, trays, supplies, or materials provided)
Pre -operative testing; CBC, urinalysis, pregnancy test, etc. These procedures should be medically necessary for the planned surgical procedure.
Any I Treatment of breast cancer, cervical intraepithelial neoplasia and cervical cancer.
77061,
77062,
77063, Breast tomosynthesis, unilateral/bilateral.
and
G0279
I 87623 I Human Papillomavirus, low -risk types I
N
kn
0
N
kn
0
l�
kn
0
l�
,n
N
N
kn
58100
58110
88305
88331
I 88332
V'
0
L 88342
99070
Various
CPT
CODES
—
N
r�
V'
•,fl ro o .'. ,n .. y
° a 00
-O � O
>C
W •.. ° °
S O N 'b N
N
3 = o �y
CD LA 5
o 'O 0 v N 'yv1
0 OU '.0 V]0 ca
coU
N
U
o
U .O
C O ai N
U U
Uc .a •cn N .C74 c".
V1 G .c .71 N
a 0 aE w
a�
w .o
O O U 0 N
tab
a by -0
y N N
4.
ali L 0
a ro N 'b O
4.
a> oo O O
an '0 oo a o L
O 0 CU 0 H .C
O .N a b a)
y O_ N ,.n O b
o ..O s`n. ro .fir OU
o ;b 5 ° .a)0.B. ro
O a)9 0 .a .. o
ro a Si 3 E
ro y -Na.)
U
ro . N ct c
'b n. 5 ro " 5
O .C N. 'd
).. C.) _ O). U N
a N
.a) S V .45.
U (i) N ❑ K N
N N UO 'V
E,O O T.)Q. 1. J
ro
a ft
O U O O
C.) b N cri O ,� ,..C y L
t2 U ti 3 v y
O O b' w O 4)
-Cif ,..., fl
'b ..0G a c
m °' b'v an
•N E c 5 .
C .a t .C
O cd .0 U
'D O Q N U U �O
N N
d) a:), o\ O .5 cd F N
w 4.) N U) N of)a>�tl U vi
o � U a) O a.` �C0 Zwri
� t• '~ 2 o
.o U f Lt. cci .G 12i 8
0O
O,
O
Hello