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HomeMy WebLinkAboutContracts & Agreements_44-1990_CCv0001.pdf PREFERRED PROVIDER REFERRAL AGREEMENT TS AGREEMENT is made and this entered into I I Ist day of September 1990 , between the CITY OF REDLANDS ( "City ) , an CARTER HOSPITAL OF REDLANDS, through its Hospital and Counseling Centers ( "Provider" ) . A. Provider operates facilities authorized to provide inpatient and outpatient psychiatric and substance abuse treatment services . B. City desires to refer, on a non-exclusive basis , employees and eligible dependents (also referred to as "Datients" and "clients" ) to Provider for psychiatric and substance abuse treatment services . C. Provider and amity desire to establish a consistent referral process to ensure quality and continuity of care and to provide mechanisms for cost and treatment accountability for employees and eligible dependents referred by City to Provider for psychiatric and substance abuse treatment services . NOW, THEREFORE, the parties agree as follows : A. PROVIDER agrees : 1 . To provide outpatient psychiatric and substance abuse treatment services to employees and dependents referred by City. 2 . To secure the patient ' s consent- to release information to city 3 . To advise City of new treatment locations, and changes in current locations and identify primary contact in each facility. 4 . To maintain during the term of this aqreement all governmental licenses, permits, authorizations and approvals; maintain accreditation by the joint Commission on Accred-itat-lon of Healthcare Organizations; and maintain adequate general liability and professional liability insurance . 5 . Provider agrees to accept payment due under this Agreement as payment in full for outpatient services . Refer to attached "Schedule Of Feesm . B. CILTY agrees : 1 . To retain the right to identify the treatment resources to be used for each referral and is not bound to refer anyone to Provider . 2 . To provide information to its referring offices on their responsibilities under this agreement including pre-treal[-ment notifications, discharge planning, and billing. 3. To have its staff Provide information to Provider to assist in assessment , treatment and aftercare of the referred employee and/or eligible dependent s ) . 4 . To encourage -family members , whenever possible, to become involved in the treatment process . 5 . To maintain the confidentiality of the referred employee/family member by obtaining a release of L information from the individual prior to refer,-al . C. CITY and PROVIDER mutually agree as follows: 1 . The term of this agreement shall be for one (1 ) year expiring on September 1 1991 . 2. The terms of this agreement include as follows: (a) The agreement may be terminated in general o.- with respect to a specific Provider facility by either party upon thirty ( 30 ) days written notice to the other party without- cause. (b] in the event any one 04:, the Provider 's facilities ' license is revoked or insurance cancelled, this agreement, as it applies to the facility in question, will be terminated effective the date of revocation or cancellation. pct in the event this agree tent is t-erminated for any reason specified above, Provider will continue to provide covered services to clients who are outpatlents as of the date of termination until those clients are transferred to another provider or discharged. - 2 (d) In the event item (c) above should occur, City is obligated to pay for PI-ovider 's services I until 1C h e time of client 's transfer or d4-Lscharge . 3. During the term of the agreement , compensation due to Provider shall be paid to Provider in a timely fashion so that each payment is received by Provider no later than thirty ( 30) days after receipt of the UB-8/2 by City. In the event Provider does not receive payment within thirty ( 30) days after the receipt of a claim by City, Provider should be entitled to receive as payment for any such claim its usual and customary billed charges . 4 . If City' s benefits change at any time during the course of this agreement, Provider has the right to renegotiate the payment provision with City. city agrees to riotify Provider of any proposed changes n i .L its benefit plan by providing Provider sixty (60) days written notice -prior to the effective date of change in the benefit plan, 5 . This agreement represents the entire understanding between City and Provider and no representations, inducements or agreements, oral or otherwise, between the Parties not contained in this agreement shall be in any force or effect , 6 . r.rhis agreement may not be modified, changed or terminated, in whole or in part, in any manner other than by an agreement in writing duly signed by both parties . THIIS AGREEMENT has been executed on the date above written by the persons authorized to act in the respective parties ' names . ocity" "Provider" CITY OF REDLANDS CHARTER HOSPITAr OF REDL NDS y$ BV: -Litle: MAYOR Title: Administrator 3 T2CO�--HT ER H 5P-I�TAE IAND CHARTER HOSPITAL OF REDLANDS SCHEDULE OF FEES Proposed Actual Charge Individual Therapy $60 .00 $75 .04 Family Thera 444 $85 .00 Group Therapy $34 .00 $30 .00 ADDITIONAL SERVICES INITIAL ASSESSMENT FREE 24-HOUR CRISIS NE: 844 533-4673 SEMINAR WORKSHOPS a . e: "Drugs And Alcohol In The Workplace" ; "Stress Management" ) 1714 Barton Road a Redlands, California 442373 o (714) 793-4333 A member of the Charter Medical Corporation family of quality health care facilities.