HomeMy WebLinkAbout20152066.tiff RESOLUTION
RE: APPROVE FIRST 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 First 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, 2015, and continuing until July 22, 2016,
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 First 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 agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 13th day of July, A.D., 2015.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COL , RADO
ATTEST: ;� (( )d„odteA) t� kf7�ye/A-
Barbara Kirkmeyer, hair
Weld Co ty Clerk to the Boar.
Mike Freeman, Pro-Tern
BY: �� _�_.�- ►i__, .. ..�:�J`_.
Deputy CI-,'k to the =•gr EXCUSED
♦ �.:;�.► ""vr�Sean P. Conway
APP' • , DA • R
Ju i . Coz d
C•u . ttorney
Steve Moreno
Date of signature: /
2015-2066
C'c f!L (57/TG) 13//z. H L0047
�18i,� Memorandum
-- '' �! r r
TO: Barbara Kirkmeyer, Chair
U N Board of County Commissioners
FROM: Mark E.Wallace, MD, MPH,
Executive Director
Department of Public Health& Environment
DATE: July 8,2015
SUBJECT: Banner-North Colorado Medical Center
Imaging Contracts for Diagnostic
Imaging/Radiology
Enclosed for the Board's review and approval are two contracts between Banner Health (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).
With the approval of the Board, the Weld County Department of Public Health & Environment
would like to continue two separate contracts entered into with Banner with an effective date of
July 21, 2014, 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. These include the Tuberculosis Control and Women's Wellness Connection
programs. Specific services will include mammograms, ultrasounds, and two-view chest x-rays.
WCDPHE will reimburse Banner for the technical services at the current Medicare rate in effect
at the time the services are performed. Each one-year continuation contract has a new effective
date of July 21, 2015, and upon mutual written agreement may be extended for additional one
year terms.
I recommend approval of these Banner-North Colorado Medical Center Imaging contracts for
diagnostic imaging/radiology services.
2015-20666)
FIRST AMENDMENT TO
DIAGNOSTIC SERVICES AGREEMENT
(FOR WOMEN'S WELLNESS CONNECTION PROGRAM)
(Banner Health Contract Number 0314-03-43839 Al)
THIS FIRST AMENDMENT TO SERVICES AGREEMENT (this "Amendment") is made
and entered into as of the signature dates set forth below, to be effective as of July 21, 2015 (the
"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").
WITNESSETH:
WHEREAS, Banner and WCDPHE are parties to that certain Services Agreement dated
effective as of July 21, 2014, (the "Agreement"), pursuant to which WCDPHE desires to engage
Banner to provide the technical component of the diagnostic imaging/radiology services for the
Designated Patient(s)of the Program,as more particularly described therein;and
WHEREAS,in accordance with the terms and conditions hereof,the parties desire to amend
the Agreement to extend the term of the Agreement.
NOW, THEREFORE, for and in consideration of the mutual covenants and promises
contained herein,the receipt and sufficiency of which are hereby acknowledged, it is understood and
agreed upon by the parties hereto as follows:
1. Amendment of the Agreement.
a. Section 3.1 of the Agreement is hereby amended to extend the term of the Agreement for
a period of one(1)year commencing as of the Effective Date and continuing until July
20,2016, subject to earlier termination as provided in the Agreement.
b. "Schedule B",the Sample Voucher to the Agreement shall be deleted and replaced with
"Schedule B",Radiology Service Voucher,as provided by WCDPHE,a copy of which is
attached hereto.
c. The Agreement is hereby amended to add"Attachment A",as provided by WCDPHE,a
copy of which is attached hereto.
2. Agreement Effective. Except as otherwise expressly provided herein,all terms and conditions
of the Agreement shall remain unmodified and in full force and effect.
Weld County Dept of Public Health and Environment Women's Wellness Connection Program 0314-03-43839A1(060215)gs.doc Page 1/6
020/J-02°66 6>
3. Precedence of Amendment. In the event of a conflict between the terms and conditions of
this Amendment and the terms and conditions of the Agreement, the terms and conditions of this
Amendment shall govern and control.
4. Capitalized Terms. All capitalized terms used in this Amendment and not otherwise defined
herein shall have the meaning ascribed to such terms in the Agreement.
5. Incorporation. This Amendment shall be attached to, and made a part of,the Agreement.
6. Counterparts. This Amendment may be executed in one or more copies or counterparts,each
of which when signed shall be an original, but all of which together shall constitute one instrument.
IN WITNESS WHEREOF, the parties hereto have executed this Amendment, individually
or by signature of their duly authorized representative, as of the signature dates set forth below, to be
effective as of the Effective Date.
BANNER: WCDPHE:
Banner Health Weld County Department of Public Health
d/b/a North Color do Medical Center and Environment
By: u 4O ,
By:
Name: Rick Sutton
Name: Dr. Mark Wallace
Title: Chief Executive Officer
Title: Director
Date: 71f 13 2015
Date: JUL
ATTACHMENTS:
*The following forms shall be attached separately hereto and incorporated by reference:
"Schedule B": Radiology Service Voucher
and
"Attachment A"
"Schedule B"
Weld County Dept of Public Health and Environment Women's Wellness Connection Program 0314-03.43839A1(060215)gs.doc Page 2/6 / )
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First Amendment to Diagnostic Services Agreement
with Banner Health - TB Program
ATTEST: BOARD OF COUNTY COMMISSIONERS
Weld C u ty e o 1;O44 4 WELD COUNTY, COLO DO
BY: ..1 �� 46724141Ut-
-w.
Deputy Cle to the Bo`I'rj � arbara Kirkmeyer, hair JUL 1 3 2015
VED AS TO FU R ( PPROVED AS TO TANCE:
;IA
Controller / 'Jf� j Elected Official or Department Head
APPROVE AS TO FORM: /4/A,
ft. Director of General Services
ounty Attorney/Y
Radiology Service Voucher
See attached.
Weld County Dept of Public Health and Environment Women's Wellness Connection Program 0314-03-43839A1(060215)gs.doc Page 3/6
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 North 17th Avenue
r / Greeley,CO 80631 1?'tl0bileHealtII
www.weldhealth.org ID 0
lteelh Adreleldrallon Pubic Neale& Eav bonm.Mpl NeaNh Caaimu.ieallon, lnten9ency Preparedness
VNat Records CNticalSontew Santee& Ndueaton&Fleming &tampons,
Tele:970.304-6410 Tele:970.304.6420 Tele:970304-6415 Tele:970304-6470 Tel.:970 14.6420
Fat:970304.6412 Fax:970-3044416 Fax:970,3046411 blot:970.304.6452 Fat 970.304-6469
Our visage:Tensaw with the communities we nave,wows waking to make Weld County the healthier place to live,Wm,walk ern phy.
Radiology Service Voucher
This voucher is for those who are confirmed as eligible for:
Este,upon es pars las personas que son coryirmalas elegible pare&:
❑ Women's Wellness Connection Program* 0 TB Program
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
llegar a su cita por favor presente este cup6n y afros docwnentas necesarios entregados a ustat pars asegurar la factwacion
apropiada. Su cita es programada en:
0 Summit View Medical Commons ❑ North Colorado Medical Center
200170th Avenue,Greeley,CO 80634 1801 16th Street,Greeley,CO 80631
(970)395-2500 (970)352-4121
Appointment date/time:
Fecha de la cita
Patient's name: Patient's date of birth:
Nombre del paciente Fecha de nacinriento
*Covered service for this visit:
Servicla cablerto pars esta die All other services will need prior authorization.
Todes otros serviclas se requierea autarkeddapr via.
NOTE:This voucher expires 30 days after date of issue.
Issue date: Initials:
Please bill Weld County as an insurance:
Weld County Department of Public Health
Attn:Contract Billing
1555 North 17th Avenue
Greeley,CO 80631
If
I you have any questions or need to reschedule,please call(970)304-6420.
Si usted tiene alguna pregunta o tiene que cancelar la cita,porfavorManse(970)304-642(1.
Revised 05!2015
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ATTACHMENT A
Public Contracts for Services C.R.S.§8-17.5-101. Contractor certifies,warrants,and agrees that it
does not knowingly employ or contract with an illegal alien who will perform work under this
contract. Contractor 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 State of Colorado program established pursuant to
C.R.S.§8-17.5-102(5)(c). Contractor 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 Contractor that the subcontractor shall not knowingly employ or contract with an
illegal alien to perform work under this Agreement.Contractor shall not use E-Verify Program or
State of Colorado program procedures to undertake pre-employment screening or job
applicants while this Agreement is being performed. If Contractor obtains actual knowledge
that a subcontractor performing work under the public contract for services knowingly employs
or contracts with an illegal alien Contractor shall notify the subcontractor and County within
three(3)days that Contractor has actual knowledge that a subcontractor is employing or
contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not
stop employing or contracting with the illegal alien within three(3)days of receiving
notice. Contractor shall not terminate the contract if within three days the subcontractor
provides information to establish that the subcontractor has not knowingly employed or
contracted with an illegal alien. Contractor 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 Contractor participates in the State of Colorado
program,Contractor shall,within twenty days after hiring a new employee to perform work
under the contract,affirm that Contractor has examined the legal work status of such employee,
retained file copies of the documents,and not altered or falsified the identification documents
for such employees. Contractor shall deliver to County,a written notarized affirmation that it
has examined the legal work status of such employee,and shall comply with all of the other
requirements of the State of Colorado program. If Contractor fails to comply with any
requirement of this provision or of C.R.S.§8-17.5-101 et seq.,County,may terminate this
Agreement for breach,and if so terminated,Contractor shall be liable for actual and
consequential damages.
Except where exempted by federal law and except as provided in C.R.S.§24-76.5-103(3),if
Contractor receives federal or state funds under the contract,Contractor must confirm that any
individual natural person eighteen(18)years of age or older is lawfully present in the United
States pursuant to C.R.S.§24-76.5-103(4),if such individual applies for public benefits provided
under the contract. If Contractor operates as a sole proprietor,it hereby swears or affirms
under penalty of perjury that it:(a)is a citizen of the United States or is otherwise lawfully
present in the United States pursuant to federal law,(b)shall produce one of the forms of
identification required by C.R.S.§24-76.5-101,et seq.,and(c)shall produce one of the forms of
identification required by C.R.S.§24-76.5-103 prior to the effective date of the contract.
Governmental Immunity:No term or condition of this contract 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.
No Third Porte 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.
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.
Execution of this Agreement by County does not create an obligation on the part of County to expend
eachsucceeding year.
n not otherwise appropriated in fu funds o y
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