1. Ron Horseman Assistant Director, Administration and Financial Management Division April 21, 2015

2. 2 902KAR 8:170 Local health department financial management requirements Section 7 Contracting for services

3. 3 The contract is between the LHD and the Contractor (provider) and should be signed by both parties prior to July 1 each fiscal year to ensure no interruption of services. Technically, if the contract is not signed by July 1 by both parties there is no effective contract in place. Services should only then be provided once both parties have signed the agreement.

4. 4 902KAR 8:170, Section 7 (10) All local health department contracts and amendments are subject to review by the Department for Public Health.

5. 5 CH-53M Local Health Department Independent Contractor Agreement

6. 6 Contract Requirements Service Type Contract Description Provider Credentials Scope of Work Compensation/Payment Billing Procedures Amount (#1) and Contract Value (#3) CH-55, if applicable

7. 7 CH-55 Medicaid Statement of Authorization For Independent Contractors only – CH-53M If the Contractor is performing services ON-SITE and the LHD will bill Medicaid on behalf of the Contractor, the CH-55 is required and shall be attached to the CH-53M. The contract would have an “N” at the top of page 1.

8. 8 CH-55 When the Contractor signs the CH-55, they are allowing the LHD to bill Medicaid for the services they provide. This authorization from the Contractor should help prevent duplicate payments due to the health department and provider both billing Medicaid for the same services.

9. 9 CH-55 AFM strongly recommends if the Contractor is a Medicaid provider, that the Contractor bill for the services performed OFF-SITE. The CH-55 is NOT required.

10. 10 LHD to bill third party If the LHD contracts with a Contractor and the LHD will be the third party biller: This includes patients that are provided services by the Contractor at the contractor site, who have insurance, Medicaid, Medicare, etc. (with the exception of Lab services). For CPT codes not listed on the DPH Medicaid Preventive Fee Schedule, the LHD will not receive payment from Medicaid.

11. 11 LHD billing, continued If there possibly will be CPT codes not billable by LHDs to Medicaid or other third party plans, the LHD should not agree to bill on behalf of the contractor. If the LHD is responsible for billing the third party payors, the contractor should not bill third party payors.

12. 12 Payment Information Without an amendment, total payments (CH-53M) can be 20% greater than the total contract (amount listed in #1). ( 1)This Payment made under the terms of each section of this contract shall not exceed: Contract Section # Amount 20112$10,000 24510$10,000 (3) The total payments made under the terms of this contract shall not exceed $24,000 ($10,000+ $10,000) x 1.2 = $24,000 Payment in #3 cannot exceed $24,000

13. 13 Multiple Contracts Question – Can a contract have more than one provider number? Answer – Yes. One provider can have numerous numbers. For example, a contract can have the following numbers: 201, 215, 245, 250, 260 Each new section must have a third party billing sentence.

14. 14 Labs The independent contractor will be responsible for billing all third parties for lab services (201 “Pathologist” and 250 provider numbers). Examples of 201 provider service: Level IV pathology specimen – 88305 Level V pathology specimen - 88307

15. 15 Supplemental Reporting When the contracted provider bills third party payors, there are some services that DPH requests LHDs to report through the Supplemental Reporting System to attain necessary federal & state data information.

16. 16 Supplemental Reporting Some of those services include: mammograms, breast ultrasounds, paps, HPV tests, Lead tests, etc. The Supplemental Reporting document (CH-47) is to be used to report these services. It can be found on the Local Health Operations (LHO) Branch webpage at http://chfs.ky.gov/dph/info/lhd/LHDforms.htm

17. 17 Supplemental Reporting The overview of Supplemental Services Reporting can be found in the AR, PSRS. http://chfs.ky.gov/dph/Local+Health+Department.htm

18. 18 Provider numbers Only use PROVIDER NUMBERS 201-260 for medical services contracts. DO NOT use the 301-315 minor object codes. If the 300 minor object codes are used for medical services (1511030115), the contract will be sent back for revisions.

19. 19 260 and 205 provider numbers CPT Code W0166 – 260 provider number Anesthesia CPT Codes – 205 provider number Examples of contract language can be found on the L drive.

20. 20 CH-52 Local Health Department Contract to Provide Services

21. 21 CH-52 A CH-52 was created by DPH to provide a standardized template that local health departments may use to enter into a contract with a public or private entity to provide needed health services. CH-52 is used for agreements between LHDs & Boards of Education, Payor Code 8 agreements and contracts between 2 LHDs. Contracts initiated by a First Party may be used; however, any required language must be included in the contract and the expiration date should end on June 30 of each year.

22. 22 CH-52 When 2 health departments contract, whoever is requesting the employee should write the contract. First Party – requesting the employee Health Department – supplying the employee

23. 23 Payor Code 8 Payor Code 8 Agreements should be between the LHD and a public or private entity. Payor Code 8 Agreements should never be with an individual, unless they are the public or private entity.

24. 24 Payor Code 8 Through Payor Code 8 Agreements, LHDs have the ability to negotiate, with public or private entities, higher rates for services, than rates that are listed on the 501 Service File (exceptions: KDPH/KDCBS Hep B agreement, KY Fire Commission, and Jail contracts involving incarcerated individuals) Negotiated rates should not be less than the DPH rate listed on the 501 Service File in the “Other” field. Rates should cover the direct and indirect cost of the service.

25. 25 Payor Code 8 A HIPAA Business Associate Agreement (BAA) shall accompany the initial Payor Code 8 Agreement or an agreement initiated by a First Party. Payor Code 8 Agreements shall be completed on a fiscal year basis; after the initial BAA, another would not need to be completed unless there are significant material changes.

26. 26 HIPAA Changes from the 2013 HIPAA OMNIBUS Final Rule required language changes to Business Associate Agreements. What does that mean? ALL BAAs, whether previously existing or new, have to contain the new language. The compliance date was 9/23/13. More information and examples of Business Associates can be found at: http://www.hhs.gov/ocr/privacy/hipaa/understanding/cove redentities/businessassociates.html

27. 27 Payor Code 8 A Payor Code 8 Agreement or other agreement shall be completed prior to providing services. LHDs should assign and set-up a Contract Code for each entity with whom they have a Payor Code 8 Agreement. This would include other agreement formats initiated by a First Party. Contract codes have to be setup in Bridge and Portal.

28. 28 Payor Code 8 Contract Codes # should be entered into the “CnctC” field on PEF entry and “P8” should be entered in the “over-ride” field for each CPT code.

29. 29 Payor Code 8 Rates negotiated by the LHDs that are “higher” than the system assigned rates may be over-ridden without submitting a request to AFM for approval. A rate is required for services rendered and an appropriate audit trail should be documented. Invoices shall not be setup as “0”. Nor should LHDs use nominal fee rates.

30. 30 Payor Code 8 P8 Contractors should be treated as third party payers and the expectation would be they are charged at 100% of the cost (direct and indirect) of the service.

31. 31 Payor Code 8 First Aid Safety Team“FAST” CHFS and DPH have agreed to the provision and payment of DCBS field staff for Hepatitis B and Flu vaccinations for designated First Aid Safety Team – “FAST” employees. “FAST” ONLY those DCBS employees designated as “FAST” employees will be paid.

32. 32 Payor Code 8 Vaccine administration $22.00 Vaccine administration will be $22.00; however, the actual VACCINE should be charged at the cost the LHD purchased the vaccine. Over-rides for making changes to the LHD cost of the Hep B or Flu vaccine for this project is approved.

33. 33 Payor Code 8 DPH will provide quarterly payments to LHDs after validating services reported; DPH will bill CHFS/DCBS annually. LHDs will use Payor Code 8, Contract Code 701, for reporting these services; if not reported correctly LHDs may not receive timely payment for services provided.

34. 34 Payor Code 8 LHDs may contract with Jails through P8 contracts to provide services to incarcerated individuals. KRS 441 provides information regarding the responsibility of jails to provide access to and payment for “necessary care” for prisoners. KY Medicaid Physician’s Fee Schedule rates should be used. https://www.healthcare.gov/incarcerated-people/

35. 35 Payor Code 8 Contracts for services provided to Jail employees should be treated the same as contracts with other public or private entities. A sample CH-52 Jail contract (with language for services provided to incarcerated individuals) is available.

36. 36 Payor Code 8 DPH encourages ALL LHDs to contract with the Fire Commission for these Hepatitis B services. LHDs are to use the CH-52 Fire Commission contracts when contracting to provide Hepatitis B vaccinations to those firefighters approved for the service. DPH encourages ALL LHDs to contract with the Fire Commission for these Hepatitis B services. Health Departments are the ONLY entity that the Fire Commission will reimburse for these services. Health Departments are the ONLY entity that the Fire Commission will reimburse for these services. Language in the contract should not be changed. LHDs need to fill in their name & address and have LHD & Fire Commission authorized signatures.

37. 37 Payor Code 8 completed prior Contracts should be completed prior to providing the Hepatitis B vaccination services. and LHDs will setup their own P8 contract code number. This needs to be done in CMS Portal and in Bridge.

38. 38 Payor Code 8 LHDs should submit the Fire Commission Hepatitis B Voucher along with their billing document to the Fire Commission. However, the LHD will not receive payment from the Fire Commission unless a valid Contract is on file. http://kyfirecommission.kctcs.edu/en/Fire_Commissi on_Programs/Hepatitis_B_Vaccinations.aspx http://kyfirecommission.kctcs.edu/en/Fire_Commissi on_Programs/Hepatitis_B_Vaccinations.aspx

39. 39 Payor Code 8 Vaccine administration Vaccine administration rate is determined by the LHO Branch using the AMA Code Manager software. The current rate is $23.00 (already set in the 501 Service File and updated annually); however, the actual Vaccine should be charged at the cost the LHD purchased the vaccine. Over-rides for making changes to the LHD cost of the Hep B vaccine for this project is approved.

40. 40 Payor Code 8 Payor Code 8 Contracts folder L-Drive Payor Code 8 contracts will not be reviewed by DPH, but we would like for LHDs to save these contracts to the Payor Code 8 Contracts folder on the L-Drive for referencing (if applicable).

41. 41 Payor Code 8 For questions concerning Payor Code 8 contracts, hepatitis b or flu CHFS contracted services, contact JanetD.Overstreet@ky.gov (502) 564-6663, ext. 4120

42. 42 CH-51 Local Health Department Employment Contract

43. 43 Personal Service Contracts If a full-time contract with an individual (CH-51) is submitted, and the services are available through the LHD Merit system, the contract will not be reviewed and the health department will be instructed to obtain the services through the LHD Merit System.

44. 44 CH-51 Requirements Service type Contract description Provider credentials Scope of work Compensation/Payment Payment time period Contract value Retirement issue

45. 45 Can Contract Employees work more than 1,200 hours? YES: With the approval of DPH, per 902 KAR 8:170 Section 7, 4(c). Retirement and insurance may impact the cost to LHD and employee. If a retiree that participates in KRS, works 1,200 hours or more per year (fiscal or calendar), the LHD would pay into retirement, not the employee.

46. 46 1,200 hours, cont. ALL RETIREES returning to work at an agency should check with the KRS before entering into a contract to protect their retirement benefits. Entering into the contract too early could jeopardize their retirement.

47. 47 1,200 hours, cont. If an employee works 1,200 or more hours per year or a pattern of 100 hours per month is established, the agency will be responsible for retirement and insurance benefits.

48. 48 Employee Contracting Contract employees are hired on a CH-51 contract with one health department. If the individual is working at more than one LHD, one LHD should contract with the employee and subcontract the employee’s services out to other LHDs. Refer to slide #22 for more information.

49. 49 Employee Contracting 902 KAR 8:170, Section 7 (4b) Should not substitute for establishing a merit position 902 KAR 8:160, Section 3, 2d Multiple Agency contracting

50. 50 Employee Contracting Post open employee contract positions (Suggested for full time openings) Complete application process Send application to Local Health Personnel and/or Program Lead at Department for Public Health for program specific qualifying Obtain all contract employee signatures for required documents

51. 51 Other Contract Issues

52. 52 Templates The most recent templates for contracts, amendments and information page are located at: L:/LHDContracts/CONTRACTS16

53. 53 Administrative Reference Contract information can be found in the Financial Management Section.

54. 54 When are contracts due? No later than May 1 of each year. School contracts are due No later than April 30, unsigned.

55. 55 How should the contract be filed? The FINAL FY 15 contract will be saved on the L drive in the health departments Contract15 folder. Use this as your template for FY16 contracts. Make sure to update the contract number, effective date, and use revised program templates. Once you have completed the contract, save in the L:/LHDContracts/LHD name/Contracts16 and contact Tammy Page via e-mail. tammy.page@ky.gov

56. 56 Saving contract When saving the contract on the L drive, name it the contract number. For example, 1611120120.doc would be the correct way to save the contract. DO NOT include the word “FINAL”. DO NOT save the contract as the name.

57. 57 Filing contracts Please DO NOT e-mail your contracts. If you have any questions concerning this procedure, feel free to contact me at 502-564-6663, x-4121 or e-mail at tammy.page@ky.gov Always e-mail when a new contract has been placed on the L drive.

58. 58 Provider Numbers Contract provider numbers are assigned by LHO. Contact Tammy Page by e-mail for new provider numbers or to update the provider name. Assigned by LHO ONLY. AR, Patient Services Reporting System (PSRS), Personal Services Contract & Part-Time Employees table and Independent Contractor Providers table

59. 59 Provider Numbers There are 2 types of provider numbers assigned/setup by LHO. The first 5 digits of the contract are as follows: 16 – Fiscal Year 000 – HID # Administrative Reference, Financial Management, Page 16 of 58.

60. 60 CH-51 and CH-52 Digits 6-7 represent the Employee class categories (MO) for payroll contract expenditures. General Classification Codes are listed in the PSRS. Digits 8-10 represent the individual portion of the Employee Class ID# (ID). Employee class ID# for each employment contractor must be assigned by the Local Health Operations Branch. Provider number 16000K1300 16Fiscal Year 000HID # K1Employee Provider Class No. 300Individual number

61. 61 CH-50, CH-53M, CH-54, CH-58 Digits 6-8 represent the minor object code for independent contracts. Digits 9-10 represent the individual portion of the Contract Class ID# (ID). Provider number 1600026004 16Fiscal year 000HID # 260Independent Contractor MOC 04Individual number

62. 62 Board of Health Member contracts If a contracting medical professional is a governing board of health member, then an automatic exception to the conflict of interest provision of the contract policies is made if the annual amount will not exceed $10,000. 902 KAR 8:170, Section 7, (6) (a) 4(b)

63. 63 Board of Health Member Contracts Contracts exceeding $10,000 must be approved by the Commissioner of the Department for Public Health. A letter or justification indicating the necessity and rationale for contracting with a board member must be submitted to the Commissioner of DPH with the proposed contract.

64. 64 Board of Health Member Contracts Please contact Dr. Connie White, Deputy Commissioner of Department for Public Health for additional questions.

65. 65 Corrections When making corrections, please replace the old contract with the corrected contract. There should only be ONE copy of each contract on the L drive. DO NOT keep the original and a revised version of the contract on the L drive.

66. 66 Website For information concerning the FY16 contracts, please visit the following website: http://chfs.ky.gov/dph/info/lhd/2016+Contract+Information+and+Documents.htm and click on “2016 contract information documents” on the right.

67. 67 If all else fails! Contact : Tammy.Page@ky.gov, 502-564-6663, x 4121 Mark.Tibbles@ky.gov,502-564-6663, x4133 JanetD.Overstreet@ky.gov, 502-564-6663, x. 4120 LocalHealth.HelpDesk@ky.gov