HomeMy WebLinkAboutIL019 Interlocal Agreement INTERLOCAL AGREEMENT
PROVIDING AMBULANCE SERVICE (Clarification)
THIS AGREEMENT is made to be effective as of the 1st day of January 2004, between
the City of Anacortes,Washington("the City"), a municipal corporation, and Skagit
County Public Hospital District No. 2, ("the District"), d/b/a Island Hospital, a municipal
corporation.
RECITALS
1. The City has the power under RCW 35.23.456 to authorize the operation of
municipally owned ambulances, which may serve the City and may serve
surrounding areas for emergencies. The City has been providing emergency medical
services to the City and surrounding areas.
2. The District has the authority under RCW 70.44.060 to provide ambulance service
within its boundaries. The District owns ambulances and related equipment and has
been providing ambulance service within its boundaries.
3. The City and the District have studied jointly and have been acting jointly to furnish
ambulance service to the area encompassed within the District, including that area
within the corporate limits of the City.
4. A cooperatively managed ambulance service is necessary to promote and protect the
public health, safety and general welfare of the area encompassed within the District
and the City and will permit the most efficient and effective use of mutual resources.
5. The City and the District are authorized to enter into an agreement for joint or
cooperative action to serve and benefit their constituents.
6. The City and the District have been parties to a similar inter-local agreement since
March of 1987.
NOW, THEREFORE, in consideration of the foregoing and the mutual promises contained
herein, the mutual benefits to be derived, and the public interest to be served, it is agreed as
follows:
1 Section 1. Service to be Provided and Definitions
1.1 Full-time ambulance emergency service shall be provided within the area
encompassed by the District, including that area within the corporate limits
of the City.
1.2 Definitions.
1.2.1 (a) Emergency ALS Transfer- Unscheduled inter-facility transport
of a patient for the purpose of rendering immediate medical aid
to the patient when time and level of supervision are critical
factors in well-being of patient.
(b) Routine ALS or BLS transfers-Non-emergency scheduled
transport of a patient to or from hospital or to or from other
health care facilities, including physician offices.
(c) Emergency Response- Response to a 911 request for prehospital
work to provide immediate medical aid to a patient when time
and level of supervision could be critical factors in well-being of
patient.
(d) Ambulance/Emergency Service- all ambulance service
including emergency response, emergency ALS transfer, and
routine ALS or BLS transfers.
(e) Medical Service Officer-An officer within the structure of the
fire department that has primary responsibilities for the
operational supervision of the District and City ambulance
services.
(f) ALS -Advanced Life Support-Paramedic level service
initiating care and treatment involving intravenous fluids,
cardiac drugs, advanced airway techniques, and cardiac
monitoring within the scope of practice dictated by Skagit
County ALS Protocols.
(g) BLS-Basic Life Support-Personnel certified at least at the First
Responder level by the State of Washington to provide basic
initial evaluation, care, and stabilization until the patient is
transferred to a higher standard of care.
(h) Pre-Hospital -Routine or emergency response and care provided
to patients before being admitted to a hospital.
2 Section 2. Administration
2.1 The ambulance/emergency service to be provided under this Agreement
shall be coordinated by the Fire Chief for the City of Anacortes.
2.2 The Medical Services Officer appointed by the Fire Chief shall be
responsible for overseeing the coordination of the ambulance emergency
service with each party being responsible for overseeing the internal
operation of the service they are providing under this Agreement. The
operation and management of the ambulance/emergency service shall be
conducted in accordance with written protocols for ambulance service to be
established by the Medical Services Officer after receiving the advice and
assistance of the Local Training and Supervising Physician as appointed by
the Skagit County Medical Program Director. The Medical Services Officer
shall be responsible for making reports and recommendations to the Fire
Chief on the following matters: the nature and extent of the
ambulance/emergency service; financial implications of operating the
service; funding options available for the service; and budgets for the
service.
3 Section 3.Responsibilities of the City
3.1 The City shall provide full-time emergency response service as defined
herein. The City shall provide backup transfer services whenever hospital
personnel are unavailable and between 5:00 P.M. and 8:00 A.M., Monday
through Thursday.
3.2 The City's dispatch service shall be responsible for providing dispatch
services for the City's ambulance service only. District shall provide
dispatch service for transfers involving its ambulance.
3.3 Except as provided in Section 5 of this Agreement, the City shall fund and
pay the expense of providing ambulance service required to be provided by
the City under this Agreement from whatever sources the City Council of
the City deems appropriate.
3.4 The City shall establish and maintain a budget for the ambulance service
and shall establish in that budget the manner of financing for the ambulance
service.
3.5 The City shall be responsible for the purchase,operating, and maintenance
of the ambulances and associated equipment needed to provide the
ambulance service the City is required to provide under this Agreement.
3.6 The City agrees to provide mutual aid to the District and the District agrees
to provide mutual aid to the City when necessary.
4 Section 4. Responsibilities of the District
4.1 The District shall pay a sum each year to the City for ambulance service.
This sum is to be calculated and paid in accordance with the terms of
Section 5 of this Agreement and as further described in Appendix A. These
payments by the District shall constitute the District's sole obligation to pay
the City for providing ambulance service under this Agreement.
4.2 The City shall set all rates for ambulance service provided under this
Agreement. The City shall notify the District in writing at least ten (10)
days before the effective date of any proposed rate change.
4.3 The District shall be responsible for billing individuals for ambulance
service provided by the City under this Agreement. The documentation of
ambulance service provided shall be submitted to the District by the City
within twenty-four(24)hours of each instance of providing ambulance
service under this Agreement. Documentation should include basic
information required to bill patient as established by the Hospital Patient
Accounts Department.
4.4 The District shall provide the necessary laundry service, first aid supplies,
oxygen, and other similar operational supplies needed for the ambulance
service. These supplies shall be provided at the District's cost for such
supplies and the District shall bill individuals receiving such supplies based
upon documentation of the use of such supplies submitted to the District by
the City. The City shall submit this documentation to the District within
twenty-four(24)hours of the use of such supplies.
4.5 The District shall be responsible for the collection of all payments for
ambulance services rendered and supplies provided and shall be entitled to
retain all such payments which are collected, subject to paragraph 5.1
herein.
4.6 The District shall provide personnel for routine transfers after having
consulted with the Medical Services Officer.
4.7 The District shall be primarily responsible to provide routine transfer
services from 8:00 A.M. to 5:00 P.M. Monday through Thursday and 24
hours on Friday, Saturday, and Sunday of each week. If District personnel
are not available,the City shall provide back-up transfer services.
5 Section 5. Payments Due to the City from the District
5.1 The basic method of payment to be followed by the District will be to pay
to the City moneys remaining after having deducted necessary costs from
acquired revenues. For the purpose of this Agreement"necessary costs"
shall be defined as contractual allowances, accounts payable,bad debts,
salary for billers' and ambulance drivers and benefits,maintenance,repairs,
and replacement for the District's ambulance, supplies and applicable
overhead. Costs for replacement or substantial repair of District's
ambulance shall be amortized over the estimated useful life of the
ambulance or the repairs in accordance with generally accepted accounting
principals.
5.2 Amounts paid to the City and applicability of the existing formula thereto
will be reassessed by the parties on an annual basis.
5.3 Payments shall be made in quarterly installments on the following dates:
March 30th, June 30th, September 30th, and December 30th.
6 Section 6. District Boundary Changes
6.1 The City shall not be obligated to provide ambulance service to areas
annexed to the District after the effective date of this Agreement unless the
City agrees in writing to serve such areas.
7 Section 7. Review,Modification,Termination, Effective Date, and Duration
7.1 This Agreement is subject to review and approval each year on or before
the December 31st anniversary.
7.2 No amendment or modification of this Agreement, including any additions
or deletions, shall be effective unless approved and executed by the parties
in the same form and manner as, and subject to the remaining provisions of,
this Agreement.
7.3 This Agreement is effective as of the day and year first written above and
shall continue in full force and effect until December 31, 2004. This
Agreement shall automatically renew for additional one-year terms unless
either party provides the other with ninety(90)days written notice of its
intent not to renew the Agreement.
7.4 Either party may terminate this Agreement without cause at any time on
ninety(90) days written notice to the other party.
8 Section S. Organized Health Care Arrangement.
As of the adoption of this inter-local agreement, the city and district acknowledge
the creation of an "Organized Health Care Arrangement", (OCHA)between the
District and City, under the privacy regulations promulgated pursuant to the Health
Insurance Portability and Accountability Act of 1996 ("HIPAA"),42 U.S.C.
§1320d r. The District's hospital shall include the city ambulance service in the
District's "joint privacy notice" for all patients delivered to or transported from the
District's hospital by the City ambulance service (See Appendix B). The City has
promulgated this arrangement through passage of City of Anacortes Resolution
#1655.
9 Section 9. Disposition of Assets Upon Termination.
9.1 Should this Agreement be terminated or not renewed, ownership of all
assets owned by the City shall remain with the City. All assets owned by
the District shall remain with the District.
10 Section 10. Notice
10.1 All notices and payments relating to this Agreement shall be made at the
following addresses,unless the other party is otherwise previously notified
in writing:
Attn. Fire Chief
City of Anacortes
P.O. Box 547
Anacortes, WA 98221
Attn. District Superintendent and CEO
Skagit County Public Hospital District No. 2
Island Hospital
1211 24th Street
Anacortes, WA 98221
11 Section 11.Non-Assignability
11.1 This Agreement shall insure to the benefit of and be binding upon the
successors and assigns of the parties, and is not intended to confer rights or
benefits upon any third parties. This Agreement may not be assigned by
either party without prior written consent of both the parties. Any attempt to
assign or transfer any of the rights,duties or obligations of this Agreement
without such consent is void.
12 Section 12. Duty Created
12.1 Nothing herein contained shall create any duty on the part of the City or
District to any particular person or individual but only to each other and the
public at large.
13 Section 13. Severability
13.1 If any term or condition of this Agreement or application thereof to any
person or circumstances is held invalid, such invalidity shall not effect other
terms, conditions or applications of this Agreement, which can be given
effect without the valid term, condition or application.
14 Section 14. Integration
14.1 This Agreement is a complete and exclusive settlement of the agreement
between the parties and supersedes all proposals or prior agreements, or
written, and all other communications between the parties relating to the
subject matter of this Agreement.
EXECUTED at Anacortes, Washington to be effective as of the day and year first above
written.
SKAGIT COUNTY PUBLIC HOSPITAL
DISTRICT NO.2, d/b/a HOSPITAL
Vincent C. Oliver
Superintendent and Chief Executive Officer
a.\%. d`k
Date
Not required
Secretary of the Board of Commissioners
CITY OF ANACORTES,WASHINGTON
By: i'r lq
H. Dean Maxwell, Mayor
a1s /by
Date
ATTEST:
orge t Ian, ny lerk Treasurer
Date
APPENDIX A (EXAMPLE ONLY)
YTD 11/30/03
Total
Dept Allocation Allocated
Indirect Cost Departments Expense Method Cost
Human Resources 387,485 % of FTE's 0.41% 1,579
Patient Accounts 835,715 Gross Revenue 4.0% 33,428
Materials Management 319,632 % Supply Cost 0.27% 873
Finance 402,210 % of Salary Expense 0.58% 2,347
Laundry&Linen N/A $2.50 per transfer 318 795
64,095
Calculations:
Human Resources Ambulance FTE= 1.33
Total FTE's =326.33
1.33/326.33=. 0041
Ambulance Billings =
Patient Accounts $835,715
X 4% =33,428
Ambulance Supplies =
Materials Management $16,496
Total III Supplies =
$6,041,254
16,496/6,041,254=. 0027
Ambulance Salaries =
Finance $90,730
Total IH Salaries =
$15,545,358
90,730/15,545,358=.0058
Laundry & Linen Ambulance Transfers =318
318 X $2.5 =$795
APPENDIX B
JOINT NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION. PLEASE REVIEW IT CAREFULLY.
Island Hospital respects your privacy. It is required to maintain the privacy of your
health information and to provide you with a notice ("Notice") of its legal duties
and privacy practices. We understand that your personal health information is
very sensitive. Island Hospital will not use or disclose your health information
except as described in this Notice. We will not disclose your information to others
unless you tell us to do so, or unless the law authorizes or requires us to do so. This
Notice applies to all of the medical records generated by Island Hospital and its
personnel,volunteers, students and trainees. This Notice also applies to other
health care providers that come to Island Hospital to care for patients, such as
physicians,physician assistants, therapists, and other health care providers who are
not employed by Island Hospital, such as ambulance services and emergency
medical technicians who may have brought you to the Hospital, unless those other
providers give you their own Notice that describes how they will protect your
medical information. The Hospital and these other health care providers work
together to provide you with care and they will share your health information with
each other as necessary to care for you,to obtain payment for that care, or for
health care operations purposes, such as quality assessment and utilization review.
The law protects the privacy of the health information we create and obtain in
providing our care and services to you. For example, your protected health
information includes your symptoms,test results, diagnoses, treatment, health
information from other providers, and billing and payment information relating to
these services. Federal and state law allows us to use and disclose your protected
health information for purposes of treatment and health care operations. State law
requires us to get your authorization to disclose this information for payment
purposes.
Examples of Use and Disclosures of Protected Health Information for
Treatment, Payment, and Health Operations
For treatment:
• Information obtained by a nurse, physician, or other member of our health care
team will be recorded in your medical record and used to help decide what care
may be right for you.
• We may also provide information to others providing you care. This will help
them stay informed about your care.
For payment:
• We request payment from your health insurance plan with your consent. Health
plans need information from us about your medical care. Information provided
to health plans may include your diagnoses, procedures performed, or
recommended care.
For health care operations:
• We use your medical records to assess quality and improve services.
• We may use and disclose medical records to review the qualifications and
performance of our health care providers and to train our staff
• We may contact you to remind you about appointments and give you
information about treatment alternatives or other health-related benefits and
services.
• We may contact you to raise funds.
• We may use and disclose your information to conduct or arrange for services,
including:
• medical quality review by your health plan;
• accounting, legal,risk management, and insurance services;
• audit functions, including fraud and abuse detection and compliance
programs.
Your Health Information Rights
The health and billing records we create and store are the property of Island
Hospital. The protected health information in it,however, generally belongs to
you. You have a right to:
• Receive, read, and ask questions about this Notice;
• Ask us to restrict certain uses and disclosures. You must deliver this request in
writing to us. We are not required to grant the request except as to physicians
who previously treated you. But we will comply with any request granted;
• Request and receive from us a paper copy of the most current Notice of Privacy
Practices for Protected Health Information("Notice");
• Request that you be allowed to see and get a copy of your protected health
information. You may make this request in writing. We have a form available
for this type of request.
• Have us review a denial of access to your health information—except in certain
circumstances;
• Ask us to change your health information. You may give us this request in
writing. You may write a statement of disagreement if your request is denied.
It will be stored in your medical record, and included with any release of your
records.
• When you request, we will give you a list of disclosures of your health
information. The list will not include disclosures made for purposes of
treatment, payment or health care operations, disclosures you authorized,
disclosures to you, incidental disclosures, disclosures to family or other persons
involved in your care, disclosures to correctional institutions, and law
enforcement in some circumstances, disclosures of limited data set information
or disclosures for national security. You may receive this information without
charge once every 12 months. We will notify you of the cost involved if you
request this information more than once in 12 months.
• Ask that your health information be given to you by another means or at
another location. Please sign, date, and give us your request in writing.
• Cancel prior authorizations to use or disclose health information by giving us a
written revocation. Your revocation does not affect information that has
already been released. It also does not affect any action taken before we have
it. Sometimes, you cannot cancel an authorization if its purpose was to obtain
insurance.
For help with these rights during normal business hours, please contact:
Kathy McDermott,Privacy Officer
Island Hospital
1211 24th Street
Anacortes,WA 98221
(360) 299-4202
Our Responsibilities
We are required to:
• Keep your protected health information private;
• Give you this Notice;
• Follow the terms of this Notice.
We have the right to change our practices regarding the protected health
information we maintain. If we make changes,we will update this Notice
and place the updated notice on our website. You may receive the most
recent copy of this Notice by calling and asking for it or by visiting our
Admitting or Medical Records departments to pick one up.
To Ask for Help or Complain
If you have questions, want more information, or want to report a problem
about the handling of your protected health information, you may contact:
Kathy McDermott, Privacy Officer
Island Hospital
1211 24th Street
Anacortes,WA 98221
(360) 299-4202
If you believe your privacy rights have been violated, you may discuss your
concerns with any staff member. You may also deliver a written complaint
to Kathy McDermott, Privacy Officer, at Island Hospital. You may also file
a complaint with the U.S. Secretary of Health and Human Services.
We respect your right to file a complaint with us or with the U.S. Secretary
of Health and Human Services. If you complain, we will not retaliate
against you.
Other Disclosures and Uses of Protected Health Information
Notification of Family and Others
• Unless you object, we may release health information about you to a
friend or family member who is involved in your medical care. We may
also give information to someone who helps pay for your care. We may
tell your family or friends your condition and that you are in a hospital.
In addition, we may disclose health information about you to assist in
disaster relief efforts.
• Information may be provided to people who ask for you by name. We
may use and disclose the following information in a hospital directory:
. your name,
• location,
• general condition, and
. religion(only to clergy).
You have the right to object to this use or disclosure of your information. If
you object,we will not use or disclose it.
We may use and disclose your protected health information without your authorization as
follows:
• With Medical Researchers—if the research has been approved and has
policies to protect the privacy of your health information. We may also share
information with medical researchers preparing to conduct a research project.
• To Funeral Directors/Coroners consistent with applicable law to allow them
to carry out their duties.
• To Organ Procurement Organizations (tissue donation and transplant) or
persons who obtain, store, or transplant organs.
• To the Food and Drug Administration (FDA)relating to problems with food,
supplements, and products.
• To Comply With Workers' Compensation Laws—if you make a workers'
compensation claim.
• For Public Health and Safety Purposes as Allowed or Required by Law:
• to prevent or reduce a serious, immediate threat to the health or safety of
a person
• or the public.
• to public health or legal authorities
• to protect public health and safety
• to prevent or control disease, injury, or disability
• to report vital statistics such as births or deaths.
• To Report Suspected Abuse or Neglect to public authorities.
• To Correctional Institutions if you are in jail or prison, as necessary for your
health and the health and safety of others.
• For Law Enforcement Purposes such as when we receive a subpoena, court
order, or other legal process, or you are the victim of a crime.
• For Health and Safety Oversight Activities. For example,we may share
health information with the Department of Health.
• For Disaster Relief Purposes. For example, we may share health information
with disaster relief agencies to assist in notification of your condition to family
or others.
• For Work-Related Conditions That Could Affect Employee Health. For
example, an employer may ask us to assess health risks on a job site.
• To the Military Authorities of U.S. and Foreign Military Personnel. For
example,the law may require us to provide information necessary to a military
mission.
• In the Course of Judicial/Administrative Proceedings at your request, or as
directed by a subpoena or court order.
• For Specialized Government Functions. For example, we may share
information for national security purposes.
Other Uses and Disclosures of Protected Health Information
• Uses and disclosures not in this Notice will be made only as allowed or
required by law or with your written authorization.
Web Site
• We have a Web site that provides information about us. For your benefit, this
Notice is on the Web site at this address: www.islandhospital.org.
Effective Date: 4/14/2003