AGREEMENT BETWEEN MISSOULA COUNTY EMPLOYEE BENEFITS PLAN and MISSOULA CITY-COUNTY HEALTH DEPARTMENT
FOR IMMUNIZATION AND LABORATORY SERVICES
This Agreement is entered into by and between the Missoula County Employee Benefits Plan, hereinafter referred to as "MCEBP" and the Missoula City-County Health
Department, hereinafter referred to as "MCCHD"; with the parties identified as follows:
Organization Name: Missoula County Employee Benefits Plan
Organization Type: Local Government Health and Welfare Plan Sponsored by Missoula County, Montana
Principal Contact: Heidi Fritchen, Plan Administrator
Mailing Address: 200 West Broadway St., Missoula, MT 59802 Telephone Number: 406-523-4876
E-mail Address of Principal Contact: hfritchenmissoulacounty.us Organization Name: Missoula City-County Health Department Organization Type: Political subdivision of the State of Montana Principal Contact: Ellen Leahy, Health Officer/Director
Mailing Address: 301 W. Alder St., Missoula, MT 59802 Telephone Number: 406-258-3882
E-mail Address of Principal Contact: eleahy@missoulacounty.us
1. Purpose: The MCCHD has special expertise and capabilities in immunizations, traveler health consultation, and biological laboratory services. MCEBP desires to enter into an agreement with MCCHD to obtain these services for MCEBP members in return for reimbursement stated within.
2. Recitals:
2.1 Whereas, the MCEBP, originally known as Missoula County Comprehensive Medical Benefits Plan, was formed by resolution of the Board of County
Commissioners effective August 15, 1980 for the purpose of providing accident, hospital, medical, surgical, dental, and optical benefits for employees, retirees and their dependents; and is a self-funded and self-administered government sponsored health and welfare plan, not subject to Employee Retirement Income Security Act (ERISA), 28 U.S.C. §1001 et seq., for which MCEBP provides Plan Administration and Third Party Administration within the Missoula County Office of Risk and Benefits; and,
2.2 Whereas, the Missoula County Commissioners adopted Exhibit 8.26 "Missoula
County Employee Benefits Plan Amendment on September 15, 2015, effective
October 1, 2015, which provides for payment of immunizations at 100% of
allowable; and,
2.3 Whereas, MCCHD provides immunizations, laboratory services, and travel immunization consultation under contracts with public and private insurers and on a self-pay sliding fee scale for required childhood immunizations; and,
2.4 Whereas, both MCEBP and MCCHD, engaging in a third-party payer — provider relationship, must adhere to respective regulatory, contractual, Centers for Disease Control and professional practice guidelines for the provision, billing, and payment of immunization and lab services; and,
2.5 Whereas, both MCEBP and MCCHD are generally administered under the Missoula Board of County Commissioners;
Therefore the parties agree as set forth below:
3. Definitions:
CLEAN CLAIM: A claim that has no defect or impropriety including, but not limited to, any lack of any required substantiating documentation or particular circumstance requiring special treatment that prevents timely payment for the claim.
COVERED PERSON: An employee, retired employee or dependent, who meets eligibility standards, who has completed the enrollment requirement, and for whom an appropriate contribution or payroll deduction has been made for the current month; also, anyone eligible for continued coverage as required by Consolidated Omnibus Budget Reconciliation Act (COBRA), 29 U.S.C. §1161 et seq.
COVERED SERVICES: A health care service to which a covered person is entitled under the terms of the MCEBP.
TRAVEL IMMUNIZATIONS: Japanese Encephalitis, Yellow Fever, Typhoid (both injectable and oral), and pre-exposure Rabies.
4. MCCHD Responsibilities:
4.1 Submit claims and requests for corrections as promptly as possible, preferably within ninety (90) days following the date of service. Claims and requests for corrections submitted after one (1) year will be denied for lack of timely filing.
4.2 Provide covered services to any covered person, no matter where rendered, regardless of race, sex, age, or religion.
4.3 Maintain professional practice licenses in accordance with state law.
4.4 Provide immunizations in accordance with current guidelines of the US
Department of Health and Human Services, Centers for Disease Control and
4.5 Accept reimbursements or balance bill as follows:
a. Immunizations recommended by the Advisory Committee of the
Immunizations Practices of the Center for Disease Control and Prevention at 100% of MCEBP maximum allowable charge.
b. Travel immunizations at 100% of MCCHD charge. These will be billed monthly via paper Health Care Financing Administration (HCFA) forms.
c. Laboratory services recommended by the U.S. Preventive Services Task Force A and B Recommendations at 100% of MCEBP maximum allowable charge.
d. Balance bill or collect payment at the time of service from a covered person for deductible, coinsurance, copay, uncovered services or supplies that exceed MCEBP maximum allowable charge.
5. MCEBP Responsibilities:
5.1 Claims for covered services rendered to a covered person shall be processed as promptly as possible and no later than thirty (30) days following receipt of a clean claim.
5.2 Reconciliation of request for corrections will be processed as promptly as possible preferably within ninety (90) days of request for correction
5.2 An explanation of benefits (EOB) shall be issued to MCCHD. The design of the form must be sufficient to allow MCCHD to clearly identify amounts paid by MCEBP.
5.3 Reimburse MCCHD as follows:
a. Immunizations recommended by the Advisory Committee of the
Immunizations Practices of the Center for Disease Control and Prevention at 100% of MCEBP maximum allowable charge.
b. Travel immunizations at 100% of MCCHD charge. These will be billed monthly via paper HCFA forms. Client names and date of service will be submitted with payment.
c. Laboratory services recommended by the U.S. Preventive Services Task Force A and B Recommendations at 100% of MCEBP maximum allowable charge.
d. Allow MCCHD to balance bill or collect payment at the time of service from a covered person for deductible, coinsurance, copay, uncovered services or supplies that exceed MCEBP maximum allowable charge
5.4 Promote MCCHD travel clinic for covered persons.
5.5 Promote MCCHD as provider of immunizations for MCEBP members.
6. Term and Termination of Agreement:
6.1 This agreement is for a term of five (5) years, effective October 1, 2016.
6.2 This agreement may be terminated by mutual written and signed agreement by both parties.
7. Records:
MCCHD shall maintain sufficient records incident to the performance of this agreement to enable MCEBP to document the performance of the agreement.
MCCHD shall allow access to the records by MCEBP and the County Auditor.
Records shall be retained for at least three (3) years after completion of the agreement.
8. Public Access to Information and Privacy of Health Care Information:
The parties acknowledge that MCEBP and MCCHD are subject to the open meeting and public records provisions of Montana law and the privacy provisions of the Federal Health Care Information Portability and Accountability Act (HIPAA).
9. Compliance with Laws and Non-Discrimination:
MCCHD agrees to comply with all federal, state and local laws, rules and
regulations. In accordance with Montana Code Annotated §49-3-207 , all hiring must be on the basis of merit and qualifications; and there may not be discrimination on the basis of race, color, religion, creed, political ideas, sex, age, marital status, physical or mental disability, or national origin by the persons performing the contract.
10. Controlling Document:
MCCHD and MCEBP agree that the Missoula County Employee Benefits Plan -
Summary Plan Description - July 1, 2016, or subsequent revisions thereof, shall be
the controlling document for eligibility, payment and coverage determinations for
services and supplies to be paid or denied under this agreement.
AGREEMENT BETWEEN MISSOULA COUNTY EMPLOYEE BENEFITS PLAN and MISSOULA CITY-COUNTY HEALTH DEPARTMENT
FOR IMMUNIZATION AND LABORATORY SERVICES
DATED this a(rda y of 1:5kTrr\VIDr t , 2016.
MCCHD: BOARD OF COUNTY COMMISSIONERS
Missoula City-County Missoula County, Montana Health Department
He61th Officer/Director
Date: 2016
MCEBP:
Missoula County Employee Benefits Plan
Chair
issioner
Commissioner
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