HomeMy WebLinkAboutIL022 Interlocal Agreement INTERLOCAL AGREEMENT
PROVIDING AMBULANCE SERVICE
THIS AGREEMENT is made to be effective as of the 1st day of Jannary2007 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 35.23.4%and City of Anacortes Ordinance 13.54
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 and other areas where the City is contracted to
provide service.
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:
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 and other areas the City is contracted to provide service.
1.2 Definitions.
1.2.1. Emergency ALS STAT 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.
1.2.2. Routine MS 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.
1.2.3. Emergency Response- Response to a 911 request for Prehospital service
to provide immediate medical aid to a patient when time and level of
supervision could be critical factors in well-being of patient.
1.2.4. Ambulance/Emergency Service- all ambulance service including
emergency response, emergency ALS transfer,and routine ALS or BLS
transfers.
1.2.5. 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.
1.2.6. 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.
1.2.7. BLS- Basic Life Support- Personnel certified at least at the EMT B 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.
1.2.8. Pre-Hospital- Routine or emergency response and care provided to
patients before being admitted to a hospital.
Section 2: Administration
2.1 The ambulance/emergency service to be provided under this Agreement shall
be coordinated bythe 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
policy/procedures 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.
2.3 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.
Section 3: Responsibilities of the City
3.1 The City shall provide full-time emergency response service as defined herein.
3.2 The City's dispatch service shall be responsible for providing dispatch services
for the City's ambulance service only. The 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 911-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
required to be provided bythe City 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 for ALS interfacility transfers
when available.
Section 4: Responsibilities of the District
4.1 The District shall pay a sum each month 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.
43 The District shall be responsible for billing individnals for ambulance service
provided bythe City under this Agreement. The documentation of ambulance
service provided shall be submitted to the District bythe 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 individnais receiving such supplies based upon documentation of the use
of such supplies submitted to the District by the City. This documentation shall be
submitted to the District by the City 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
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 monthly installments.
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.
Section 7: Review,Modification,Termination, Effective Date,and Duration
7.1 This Agreement is subject to review 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 shall automatically renew for additional one-year terms unless
either party provides the other with written notice of its intent to modify the
Agreement,including the suggested changes.
7.4 Either party may terminate this Agreement without cause at anytime on ninety(90)
days written notice to the other party.
Section 8: Organized Health Care Arrangement.
8.1 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.
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.
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:
Att.Fire Chief
City of Anacortes
P.O.Box 547
Anacortes,WA 98221
Att.District Superintendent and CEO
Skagit County Public Hospital District No.2
Island Hospital
1211 -24th Street
Anacortes,WA 98221
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.
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
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.
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
to J
CITY OF ANACORTES,WASHINGTON
By:
H. Dean Maxwell, M or
ITj 2S1d7
Date
ATTEST:
4's 4 (-)
Wanda Phillips, City Clerk reasurer
i/ atf/o
Date
APPENDIX A (EXAMPLE ONL})
ISLAND HOSPITAL
Ambulance Department
Reconciliation
YTD 12/31/05
Actual YTD
Description 12/31/2005
Ambulance Revenue-Inpatient 9,195
Deductions from Revenue-
Inpatient Actual (5,675)
Total Ambulance revenue $ 1,169,725
Deductions from Revenue (34.9%) (408,234)
Net Ambulance revenue 765,011
Direct Expenses (157,318)
Indirect expenses (56,817)
Total Expenses (214,135)
Net Income Amount paid to City $ 550,876
Indirect Cost Summary:
Total
Dept Allocation Allocated
Indirect Cost Departments Expense Method Cost
Human Resources 468,759 %of FTE's 0.38% 1,782
Patient Accounts N/A 4%of Gross Revenue 1,178,920 47,157
Materials Management 371,201 %Supply Cost 0.23% 859
Finance 395,492 %of Salary Expense 0.57% 2,256
Laundry&Linen N/A $2.50 per transfer 1,905 4,763
56,817
Calculations:
Human Resources Ambulance FTE =1.33
Total FTE's =349.8
1.33/349.80 =.0038
Patient Accounts Ambulance Billings =$1,078,920
Ambulance Supplies =
Materials Management $19,694
Total IH Supplies =
$8,511,782
19694/8511782=.0023
Ambulance Salaries =
Finance $108,953
Total IH Salaries =
$19,097,808
108953/19097808 =
.0057
Ambulance Runs
Laundry&Linen =1,905
1905 X$2.5 =$4,763
APPENDIX B
JOINT NOTICE OF PRIVACY PRACIIC ES
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 tecliniria.nt 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 bya 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
121124th 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
121124th 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 US. 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(onlyto 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