HomeMy WebLinkAboutIL021 Interlocal Agreement AGREEMENT BETWEEN ISLAND HOSPITAL AND CITY OF ANACORTES POLICE DEPARTMENT
This Hospital Participation Agreement(hereinafter referred to as"Agreement") is made and entered into by and between
the City of Anacortes Police Department(hereinafter referred to as "Agency")and island Hospital (hereinafter referred to
as"Hospital").
The purpose of this agreement is to establish the rates and terms for financial reimbursement from the Agency to the
Hospital for the provision of medical services provided to individuals in custody.
In performance of their respective duties and obligations hereunder, Agency and Hospital and their respective employees
and agents, are at all times acting and performing as independent contractors and neither party, nor their respective
employees and agents, shall be considered the partner, agent, servant, employee of or joint venturer with the other party.
The parties acknowledge and agree that neither Hospital nor Agency will be liable for the activities of the other nor the
agents and employees of the other, including but not limited to, any liabilities, losses, damages, suits, actions, fines,
penalties, claims or demands of any kind or nature by or on behalf of any person, party or governmental authority.
Hospital agrees to provide or arrange for medical and related health care services (hereinafter referred to as"Hospital
Services") to individuals in custody of law enforcement(hereinafter referred to as "Individuals").
The Hospital will seek and accept assignment of benefits. Hospital may bill the Agency only for charges or services
verified as not covered by another primary payer; or after the primary health plan payment for any balance due only for
applicable plan co-payments and/or deductibles.
Arresting Agency agrees to pay the Hospital for services provided to arrestees within 30 days of receipt of invoice in
accordance with the rates defined on attachment A.
The term of this Agreement shall commence on April 1, 2009.
Either party may terminate this Agreement without cause at any time by providing to the other party ninety(90) days prior
written notice of termination.
In the event of a breach of this Agreement by either party, the non-breaching party may terminate this Agreement by
giving thirty(30)days notice to the breaching party. Notice shall specify in detail the nature of the alleged breach. If the
breach is not cured within a thirty(30) day period, then the date of termination shall be that date set forth in the notice of
termination.
LAW ENFORCEMENT AGENCY:
By:Q
Print Name; joARre. ,3 -w 5
Title: /-Mce
Date: 3`.2�4Y
HOSP IAL
By:
Print Name: PE`
Title: '—
Date: '' w 16 ( i
ATTACHMENT A:
HOSPITAL REIMBURSEMENT
ISLAND HOSPITAL
I. HOSPITAL INPATIENT AND OUTPATIENT REIMBURSEMENT:
Hospital agrees to accept a 20% discount from standard billed charges for inpatient services and a 20% discount from
standard billed charges for outpatient services as full compensation for services provided.
ATTACHMENT B:
HEIRARCHY OF FINANCIAL RESPONSIBILITY
Pursuant to RCW 70.48.130 Emergency or necessary medical and health care for confined person — Reimbursement
procedures— Conditions —Limitations.
1) individuals health or auto insurance
2) DSHS/Medicaid when patient is covered/eligible
3) State—for individuals held in a jail and are accused of either escaping from a state facility or committing an
offense in a state facility.
4) Law enforcement agency that made arrest