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HomeMy WebLinkAbout2014-11-24 15-017 ORDERCOUNCIL ACTION Item No. 15-017 Date: November 24, 2014 Item/Subject: ORDER, Authorizing the City Manager to Execute a Memorandum of Understanding with the University of Massachusetts Medical School. Responsible Department: Health and Community Services Commentary: This Order will authorize the City Manager to execute a memorandum of understanding with the University of Massachusetts Medical School to bill insurance on behalf of the Public Health and Community Services Department Travel & Infectious Disease Program for reimbursement of administrative costs associated with public vaccine clinics. The State of Maine Immunization Program has arranged for the University of Massachusetts Medical School to act as a third -party vendor for public health entities so that insurance claims can be made. This agreement would be of no cost to the City of Bangor. As a fee for service, the University of Massachusetts Medical School would receive 20% of approved and paid claims. The agreement would be subject to an annual renewal by both parties. This was reviewed and recommended for approval by the Government Operations Committee on November 17, 2014. Manager's Comments: Associated Information: Order Budget Approval: Legal Approval: Introduced for X Passage _First Reading Referral Department Head C-2-21 VV - U&'// City Manager Page _of_ Finance Director Solicitor 15-017 NOVEMBER 24, 2014 Assigned to Councilor Civiello CI`T'Y OF BANGOR (TITLE.) ORDER, Authorizing the City Manager to Execute a Memorandum of Understanding with the University of Massachusetts Medical School. BY THE CITY COUNCIL OF THE CITY OF BANGOR: BE IT ORDERED, that the City Manager is hereby authorized to enter into a Memorandum of Understanding with the University of Massachusetts Medical School to act as a third -party vendor for the Public Health & Community Services Department Travel & Infectious Disease Program. IN CITY COUNCIL NOVEMBER 24, 2014 MOTION MADE AND SECONDED FOR PASSAGE PASSED CITY CLERK 15-017 NOVEMBER 24, 2014 Memorandum To: Government Operations Committee From: Patty Hamilton, Director of Health & Community Services Date: November 13, 2014 Re: Flu Clinic Reimbursement PH&CS, Travel Health & Infectious Disease program has been working with the State Immunization program to provide flu shots in school settings for several years now. We vaccinate teachers, parents and siblings at these 'school located clinics'. Research shows that by providing vaccines in school settings more children are immunized resulting in fewer missed days of work for parents, fewer missed days of school for children and an overall decrease in circulating flu in the community. We participate in the Universal Vaccination program meaning we receive 'free' vaccine from the state of Maine for this purpose and are required to provide vaccines free of charge to children up to age 19. Receiving free vaccine does not however mean there are no costs associated with providing the service. To help cover costs such as staff time, supplies and disposal we are allowed to ask for a $10.00 administration fee. Although we have been fairly successful this is not a reliable way to recoup our expenses. We have had on-going discussions with State of Maine Immunization program staff about the barrier of cost to us to continue to offer this service. In response the state began conversations with the University Of Massachusetts Medical School who has for several years acted as a third party vendor in Massachusetts for entities like ours to recoup vaccine expenses. Signing this MOU would allow us to go through this vendor and have them act as a clearing house for insurance claims for vaccine administration from public clinics. This would allow us a more stable revenue stream and over time would enable us to more accurately budget for this program. This agreement would be no cost to the City of Bangor. The University of Massachusetts Medical School would receive 20% of approved claims. The legal department has reviewed the MOU and recommended a yearly MOU vs. an automatic renewal and the University has agreed and made this change. 15-017 NOVEMBER 24, 2014 Agreement By and Between XXX (Public Clinic) and the University of Massachusetts Medical School This Agreement is entered into as of September 1, , by and between (hereinafter referred to as the "Public Clinic"), located at and the University of Massachusetts Medical School, located at 529 Main Street, Charlestown, MA (hereinafter referred to as "UMMS"). UMMS makes available to Public Clinics services related to collecting reimbursement that may be available for the vaccines that Public Clinics administer to patients. The available reimbursement sources may be: commercial health insurers and Medicare Part B. Public Clinic provides and administers vaccines ("Vaccine Administration") for which certain payers have agreed to provide payment ("Payer(s)"). Payers include Insurers and Medicare as those terms are defined below: A. Certain commercial health insurers ("Insurers") that have agreed to provide payment to Maine public clinics for Vaccine Administration and to use UMMS as a clearinghouse to facilitate such payment. B. The federal Medicare Part B Program ("Medicare"). Public clinics that participate in the Medicare Part B Program are eligible to receive payment from the Medicare Part B Program for Vaccine Administration, in accordance with Medicare Part B Program requirements. UMMS has agreed to act as a clearinghouse for claims for Vaccine Administration from Public Clinics. The parties hereto agree as follows: Section I. Pavers The responsibilities of the parties set forth in this Agreement will apply to the claims for Vaccine Administration by the Public Clinic with respect to only those Payers checked below ("Claims"): A. F-1 Insurers: Commercial health insurers that have agreed to provide payment to Maine Public Clinics and to use UMMS as a clearinghouse to facilitate such payment. Certain Insurers may require different or additional terms and conditions than those set forth in this Agreement. If that is the case, such terms and conditions will be set forth in either a written amendment to this Agreement signed by Public Clinic and UMMS or a separate agreement signed by Public Clinic and UMMS. B. El Medicare: Public Clinics that participate in the Medicare Part B Program are eligible to receive payment from the Medicare Part B Program for Vaccine Administration, in accordance with Medicare Part B Program requirements. Pagel of 8 15-017 NOVEMBER 24, 2014 Section II. UMMS Services A. UMMS: General Responsibilities The following services will be provided to Public Clinic by UMMS with respect to Claims for all Pavers checked in Section I, above. UMMS will: 1. Provide training material to Public Clinic regarding all data requirements necessary to prepare and submit Claims, including the Health Screen and Permission Form (attached hereto as Exhibit #1). The Health Screen and Permission Forms are updated annually, and UMMS will provide Public Clinic with current forms in a timely manner. 2. Collect the Health Screen and Permission Form and other data for Claims for Vaccine Administration by Public Clinic. 3. Verify eligibility of individuals receiving Vaccine Administration in the plan identified Health Screen and Permission Form in section 10 titled Health Insurance. 4. Prepare and submit Claims for payment of Vaccine Administration for individuals UMMS has determined to be eligible in a particular plan sponsored by a Payer, pursuant to Section I, above. 5. Attempt to resubmit and reprocess any rejected or denied Claims at the discretion of UMMS only. 6. In the event that third -party liability coverage is identified, UMMS will attempt to submit the Claim to the appropriate payer or return the Claim to Public Clinic, as appropriate. 7. Reconcile Claims and provide a report to Public Clinic that includes a summary of paid and denied Claims. 8. UMMS will not be responsible for unreimbursed/denied Claims. B. UMMS: Payer -Specific Responsibilities 1. Insurers: UMMS will provide the following services for Claims to "Insurers" if that box is checked in Section I.A. above: a. Submit Claims for Vaccine Administration defined in Exhibit #2 attached hereto, entitled Vaccine Administration for Insurers, to Insurers for complete Health Screen and Permission Forms received by UMMS for services provided by Public Clinic for individuals UMMS has determined to be eligible for coverage by Insurer. When additional Insurers agree to provide payment for Vaccine Administration, UMMS will provide Public Clinic notification of such agreement, including which Vaccine Administration services the additional Insurer will cover. b. Receive payment from Insurers on behalf of Public Clinic for Claims approved for payment by the Insurers ("Insurer Approved Claim(s)"). Page 2 of 8 15-017 NOVEMBER 24, 2014 c. Make payment to Public Clinic in an amount equal to the amount received by UMMS for Insurer Approved Claims less a fee of 20% per Insurer Approved Claim paid to UMMS by Insurers. 2. Medicare: UMMS will provide the following services for Claims to "Medicare" if that box is checked in Section I.C, above: a. Assist Providers with the acquisition of a National Provider Identifier ("NPP') if the Provider does not have an active NPI. b. Assist the Provider with the completion of the CMS 855B Medicare Enrollment Application for Clinics, Group Practices, and Certain Other Suppliers. c. Review the Medicare Enrollment Application to ensure that all sections have been properly completed and executed. d. Submit Claims for payment of Vaccine Administration of Influenza and Pneumococcal vaccines for individuals UMMS has determined to be eligible for Medicare. e. Accept payment for Medicare claims that have been approved for payment by Medicare ("Medicare Approved Claims") according to the method checked below: 0 UMMS will offset the amounts to UMMS for Medicare Approved Claims under the agreement by offsetting the amounts UMMS owes to Public Clinic for Insurer Approved Claims pursuant to Section II.B.1.c, above. UMMS reserves the right to withhold payment for Insurer Approved Claims until UMMS has been compensated for 20% of the Medicare Approved Claims; OR UMMS will submit an invoice to the Public Clinic for 20% of the Medicare Approved Claims per the 835 and paper remittance advices. Section III. Responsibilities of Public Clinic A. Public Clinic: General Responsibilities: Public Clinic is responsible for the following activities with respect to Claims for Vaccine Administration for all Pavers checked in Section I, above ("Claims"). Public Clinic will: 1. Within thirty (30) calendar days after Vaccine Administration, submit the Health Screen and Permission Forms to UMMS for each Patient and each Member in electronic or paper form. Health Screen and Permission Forms must be completed in entirety to ensure approval of Claims by Payers. 2. Obtain copies of patient insurance cards, whenever possible, and attach them to the Health Screen and Permission Form when submitted to UMMS. Page 3 of 8 15-017 NOVEMBER 24, 2014 3. Submit a copy of the invoice for all privately purchased vaccines related to the Claims. 4. Sort and batch the Health Screen and Permission Forms and related documents by Insurer, if possible. 5. Maintain originals of the Health Screen and Permission Form and copies of related documents submitted to UMMS. 6. Submit copies of completed Health Screen and Permission Forms to UMMS via • Paper sent by certified U.S. Postal Service mail or some other delivery service/system by which shipments may be tracked: To: University of Massachusetts Medical School Center for Health Care Financing 529 Main Street, 3rd Floor Charlestown, MA 02129 ATTN: Holly Oldham B. Public Clinic: Payer -Specific Responsibilities 1. Insurers: If the box for "Insurers" is checked in Section I.A, above, Public Clinic will: a. Enroll and maintain enrollment in the Maine Department of Public Health (MDPH) Vaccine Program. b. Enter all vaccination information into the Maine Immunization Information System (MIIS) as required by MDPH. 2. Medicare: If the box for "Medicare" is checked in Section I.C, above, Public Clinic will: a. Submit a complete CMS 855B application to the appropriate Medicare billing intermediary as directed by UMMS. b. Submit all other documents as required by Centers for Medicare & Medicaid Services (CMS) to obtain and maintain the Medicare Provider number. c. Pay Medicare any enrollment or revalidation fees as required by CMS d. Ensure that the individual responsible for authorizing the CMS 855B application supplies his/her Social Security Number. e. Ensure that the individual responsible for authorizing the CMS 855B application signs and dates the application. f. Provide UMMS with authorization to transmit electronic Claims in 837 files and to access all 835 remittance advices from the Medicare intermediary upon enrollment. If Medicare is not Page 4 of 15-017 NOVEMBER 24, 2014 able to conduct electronic transactions, Public Clinic will authorize UMMS to roster bill and to receive remittance advices. g. Maintain an active Medicare Provider number for the dates of service applicable to each Health Screen and Permission Form submitted to UMMS. h. Pay UMMS 20% of Medicare Approved Claims for invoices properly submitted to UMMS per Section II.B.3.e. Section IV. Public Clinic Representation and Warranty Public Clinic hereby agrees, represents and warrants that it shall accept as final payment in full for Vaccine Administration the amount paid to UMMS by the Payers less a fee of 20% per Payer Approved Claim by all Payers, and that Payers, if applicable, shall have no further liability for that Claim. Public Clinic further represents that it shall not charge, collect a deposit from, seek compensation, remuneration or reimbursement from eligible patients, or have any recourse against anyone other than the Payers for Vaccine Administration. The provisions of this Agreement shall survive termination of this Agreement and shall be construed to be for the benefit of the eligible patient. Section V. Confidentiality UMMS acknowledges that, in the performance of services under this Agreement it shall comply with all applicable federal and state law relating to confidentiality and the security of data, including the Privacy, Security, Breach Notification and Enforcement Rules at 45 CFR Part 160 and Part 164, promulgated pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology Economic and Clinic Health Act (HITECH) provisions in Title XIII of the American Recovery and Reinvestment Act of 2009, and M.G.L. Chapter 93H. Section VI. Recordkeepin2 UMMS shall maintain all records required by law and shall additionally maintain all records, books, files and other data in sufficient detail as to properly substantiate claims made for Payer reimbursement on behalf of the Public Clinic. Section VII. Taxpayer Identification Number and Form W-9 Certification Public Clinic will sign and submit to UMMS a University of Massachusetts substitute W-9 Form provided by UMMS. Section VIII. Term of Agreement This Agreement commences on September 1, 2014 and ends on June 30, 2015. Page 5 of 8 15-017 NOVEMBER 24, 2014 Section IX. Integration This Agreement constitutes the entire agreement of the parties with respect to the subject matter hereof, including all attachments hereto, and supersedes all prior agreements, representations, negotiations, and undertakings not set forth or incorporated herein. Section X. Contact Information Inquiries relating to this agreement should be directed to the following individuals: For UMMS: University of Massachusetts Medical School Center for Health Care Financing 529 Main Street, 3`a Floor Charlestown, MA 02129 Mary Fontaine (800) 890-2986 Vaccine.Reimbursement@umassmed.edu For Public Clinic: Provider Name: Address: Address Line 2: City/State/Zip:_ Phone Number: E-mail: IN WITNESS THEREOF, the parties hereto execute this Agreement as of the date first written above: Public Clinic: Signature Print Name: Print Title: UMMS: Signature: Marc A. Thibodeau Executive Director, Center for Health Care Financing Commonwealth Medicine, UMMS Page 6 of 8 15-017 NOVEMBER 24, 2014 Exhibit #1 INFLUENZA, 'VACCINE .HEALTA SCREEN & PERT►IISSION FORM .1 NPL I `FullName: Date of Birth; Age:'; Gender: SchoolName: Street Address: Tawi-Xity: Zip Code: Daytime Phore: .Grade:: Teacher: SchoolAdministrative Unit (District) '.,Please muxs &e foDm+�g.queitions about &e penon named above. C-o=na&, may be wrillm on the'back ;of this Sohn. -)MS NO 1) Does this:personhave`asevere .(life-1hieaterang)allergb toeggs? 2) Hasihispersonevei•hada'severe-reactiontoaninfhienzai•�i intlYpast? Kyou ansuW*d 'jos U any quer — l-3,'plue see yna he&Wum provider fai jfttivucbi4fimi 4} "Has this.personreceivedanyotl�rvaccinatiominthe past4weeks;bri5'notfeelingwell? If yes, Type' of vaccine ]date 5) Does thispersonhave long=tetmhealthproblems; aUergies, asthma.orwheezingprioblems, or.onloxjg termaspirintreatcnent?.' ' &) Does this,personhave aweakenedimrmure system;orcome inclose contactvnthsome(mewho has a, to 10)'Is this person inmredby MaineCare (Medreaid)? MaineCare ID 0 10) HealthInsurance: Name of Company. ID Number: Croup m miber: ,Subscriber Name Subscnber.DateofBirth 11) Doctor's Name: CPhor:e Nuriiber: PERMISSION TO VACCINATE >Iwas gi' acopyof'th%`Infbitenz;VaccineInformationStatemerds,Ihave read themorhadthem explained tome and I understand the benefits and risks of the I46nza vaccine . ..I give-perrti ssion for a record of this.vaccinationto be entered into Abe ImmPact.P;egistry. ( give, permission'for.information to be used to bill IdaineCaie or private insurance for thd'cost of pmyuiuig the vaccine > .I give my consent for thi,. persontioeceive the most appmpriate vaccine, as deterininedbythe healthcare clinic �, A Ifmychild refiises,to receive the injectionanddoesnot have.anyofthe corditiaais #4-7lis ted above; you have my permission to, give the nasal flu mist. I give permkFionfor the f luvaccim tbbe gk"to tbepersonnmrredabove bysigmbchelow. Sigtra aeofpareirtorguai�dnv►ifpersuntbbevaecioraiedisarrifmoiorSig ti"bfadi tobevacchudiA Printed Name, of Parent or'Guaidian: FOR OFFICE USE ONLY: Bate Dose, Vacdne Lot Nimi]ber :Dose Sigrt ium wid U_ of .:Body Route VIS date Adrlmuftaed 1rl8nrlfattlQ� VOlIQM1e 'Vatd7r�(R' Site' v IM single dme O M Britt csei O 7cemesd 'Mkie CDC -W10114 Page 7 of 8 Vaccine Administration for Insurers Administration 15-017 NOVEMBER 24, 2014 • Administration of influenza virus (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) for individuals ages 6 months and older enrolled in any Insurer's health plan, including Medicare Advantage. • Administration of influenza virus by intranasal for individuals ages 6 months and older enrolled in any Insurer's traditional health plan only. Provision of Privately Purchased Influenza and Pneumococcal Vaccine (Payment is not available for State -provided free flu vaccine.) • Influenza virus vaccine, trivalent or quadrivalent, split virus, preservative -free, for intramuscular use, administered to individuals ages 19 and older enrolled in any Insurer's health plan, including Medicare Advantage. • Influenza virus vaccine, quadrivalent, live, for intranasal use, administered to individuals ages 19 and older enrolled in any Insurer's traditional health plan onlv. • Influenza virus vaccine, trivalent or quadrivalent, split virus, intramuscular use, administered to individuals ages 19 and older enrolled in any Insurer's health plan, including Medicare Advantage. 0 Influenza virus vaccine, split virus, preservative -free, for intradermal use, administered to individuals ages 19 and older enrolled in any Insurer's traditional health plan only. • Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content for intramuscular use administered to individuals of any age enrolled in any Insurer's health plan, including Medicare Advantage. 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