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Backup Documents 12/13/2016 Item #16E2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT T pgg ;„ f THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATUREW 5� Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the Cotetile a no later than Monday preceding the Board meeting. FF **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures.dates.and/or information needed. If the docPn al -te . J� c .a exception of the Chairman's signature.draw a line through routing lines 41 through#2,complete the checklist,and forward' otinty orney•f ice. Routed by Procurement Services to the Office Initials Date Following Addressee(s) (In routing order) , 1. Risk Risk Management ita•4144(/ 2. CountyAttorney Office CountyAttorney Office frei/9/S 3. BCC Office Board of County Commissioners 'Q b,-,\ \rk 1- / v�\kE\kc 4. Minutes and Records Clerk of Court's Office IC (al t61 tk7 ,fi 5. Return to Procurement Services Division Procurement Services Contact: Viviana Giarimoustas PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary V.>v Giari oustas for Rhonda Bums Phone Number 239-252-8375 Procurement Staff Contact and Date Agenda Date Item was 12/13/2016 ✓ Agenda Item Number 16E2 t.------ Approved by the BCC Type of Document Contract Number of Original 2 Attached Documents Attached PO number or account N/A Solicitation/Contract 12-5854/Naples number if document is Number/Company Physician Hospital ,...- to .to be recorded Name INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A" in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature? Sci.ltl VG Wilt 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be VG signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the N/A document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's VG signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip tea-- 4 should be provided to the County Attorney Office at the time the item is input into SIRE. 1, // Some documents are time sensitive and require forwarding to Tallahassee within a certain 114/.4- v time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on the date above and all changes made VG � y i during the meeting have been incorporated in the attached document.The County " Attorney's'Office has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the BCC,all changes directed by the BCC have been made,and the document is ready for the ' s ;,° _ Chairman's signature. I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12 16E2 MEMORANDUM Date: December 15, 2016 To: Viviana Giarimoustas for Rhonda Burns Procurement Services From: Teresa Cannon, Deputy Clerk Minutes & Records Department Re: Amendment to Contract #12-5854 "Managed Care Service Agreement" Contractor: Naples Physician Hospital Organization, Inc. Attached is a copy of the document referenced above, (Item #16E2) approved by the Board of County Commissioners on Tuesday, December 13, 2016. The original has been held by the Minutes and Records Department as part of the Board's Official Record. If you have any questions, please contact me at 252-8411. Thank you. Attachment 16E 2 AMENDED AND RESTATED MANAGED CARE SERVICE AGREEMENT WITH NAPLES PHYSICIAN HOSPITAL ORGANIZATION,INC.,d/b/a COMMUNITY HEALTH PARTNERS, MANAGED CARE SERVICE AGREEMENT#12-5854 This AMENDED AND RESTATED MANAGED CARE SERVICE �A"G'REEMENT (the "Amended and Restated Agreement")effective as of the 3 veday of Y\veJ� , 2016 , (the "Effective Date"), is entered into by and between Naples Physician Hospital Organization, Inc. d/b/a Community Health Partners("CHP" or"Contractor")and Collier County,Florida, a political subdivision of the State of Florida("County"). WITNESSETH: WHEREAS, Contractor and County entered into that certain Managed Care Service Agreement # 12-5854 dated March 13, 2012 ("Agreement#12-5854"), whereby Contractor agreed to provide group health insurance plan case management services; and WHEREAS, Contractor and County desire to amend Agreement # 12-5854 to extend the term thereof at the same rates and to revise the scope of work to remove those services described as the Smartchoice Program, Health Advocacy Program and the Workcare Program, which services were separately solicited in 2016,are now provided for under Contract Numbers 16-6614 and 16-6646; and WHEREAS, Contractor has as its primary objective arranging for the delivery or provision of certain Managed Care Services, Utilization Review Services and Case Management Services through a cost effective,coordinated,and integrated health care delivery system;and WHEREAS, the County has adopted a self-insured employee benefit plan for the provision of Health Care Benefits,Managed Care Program and Utilization Review Program to Plan Members;and WHEREAS, the County, a self-insured employer, is ultimately responsible for payment of Health Care Benefits, Managed Care Program, Utilization Review Program, Case Management Program in accordance with the terms and conditions of this Amended and Restated Agreement;and WHEREAS, the County desires to increase control over the cost of providing Health Care Benefits to Plan Members and enters into this Amended and Restated Managed Care Agreement to arrange for CHP, through CHP Providers, to render Managed Care Program(s) to Plan Members in conjunction with County's various Benefit Programs;and WHEREAS,the Parties desire that the entire original Agreement#12-5854 is hereby amended in its entirety and superseded by this Amended and Restated Agreement. NOW, THEREFORE, for and in consideration of the mutual covenants contained in this Amended and Restated Agreement,the parties agree as follows: ARTICLE I DEFINITIONS For purposes of this Amended and Restated Agreement, the following terms shall have the meaning ascribed thereto: 1.1 Agreement. This Managed Care Agreement. Page 1 10/26/16 ti. / 16E2 1.2 Benefit Program. The County's self insured employee benefit plans covered under this Agreement,as amended from time to time. 1.3 Medical Emergency. The sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity which, if not immediately diagnosed and treated, could reasonably be expected to result in serious physical impairment to a bodily function, or serious and permanent dysfunction of any body, organ or body part, or to cause other serious medical consequences which include placing a Plan Member's health in permanent jeopardy. 1.4 CHP Hospital. Any hospital facility that has contracted as an independent contractor with CHP to provide certain Health Benefit Plan to Plan Members. 1.5 CHP Physician. A physician who has contracted as an independent contractor with CHP. 1.6 CHP Provider. A CHP Physician,CHP Hospital,and any licensed health care facility or professional,who or which has entered into a written agreement with CHP. 1.7 Plan Benefits. Those inpatient and outpatient services that are ordered for Plan Members by physicians and other licensed health care providers,covered under a Benefit Program. 1.8 Plan Member. Any person who has elected to receive health care benefits from or through County's Benefit Program and who is eligible to receive Plan Benefits under the Utilization Review,Managed Care portion of the Benefit Program included in this Agreement. ARTICLE II PROVISION OF SERVICES 2.1 UTILIZATION MANAGEMENT PROGRAM Community Health Partner's Utilization Management Program shall use nationally recognized guidelines to determine the appropriateness of medical services as well as the delivery setting and length of stay for inpatient hospital and MRI/CT services only. The appropriateness guidelines have been developed to create practice pathways that integrate with procedures that require precertification. Community Health Partners will be responsible for: • Maintaining a local telephone line and an out of area toll free telephone line for enrollees of the County's Benefit Plan to call for Precertification of defined procedures and medical services. This may include non-emergent inpatient hospital confinements, outpatient hospital services, surgeries, diagnosis testing and/or medical procedures. • Providing Utilization Management service that will be available during standard business days, Monday through Friday 8:00 am through 5:00 pm EST. Voice mail messaging will be available during non-business hours/days,and calls will be returned on the next business day. • Responding to Utilization Management requests for the medical services within twenty-four (24) hours of the request verbally when all necessary medical information and eligibility status is provided. Written confirmation of the decision will be mailed within the next business day of the decision. Page 2 10/26/16 16E2 • Providing retrospective process of emergent admissions. • Performing concurrent review and assist with discharge planning. • Providing Precertification forms. • Assisting County to determine the medical services and procedures that are to be included in the Utilization Management Program. • Providing analysis and reports of the Utilization Management Program. Standard reporting of authorizations and Denials by CPT codes. • Providing Precertification information to the County's claim administrator via email or fax. CHP will coordinate with claim administrator the assignment of authorization numbers. • Following CHP Grievance Procedure process that does not include medical services excluded by the benefit plan. • Providing Nurse and Physician review as necessary. • Providing Pharmacy over rides for PPI's only and Pharmacy utilization reports. • Providing basic Case Management. • Providing basic Benefit Verification and Eligibility Information. • Precertification process will not include any medical services requested or begun prior to the effective date of this Agreement.CHP will not handle overlap Precertification processing. The County will be responsible for: • Providing written notification to their Benefit Plan enrollees of the Utilization Management Program and the requirements of this program. • Providing up to date enrollment eligibility information to CHP online. • Assisting CHP with the integration of the Utilization Management Program with the County's claim administrator. • Distributing the Precertification forms as necessary to enrollees. 2.2 LARGE CASE MANAGEMENT Community Health Partners will be responsible for: • Case managing catastrophic chronic and acute illness. • Case managing transplants, inclusive of negotiating rates, all authorizations, working with in-house case management with discharge planning, i.e.home health,DME,Rehab services,etc. Page 3 10/26/16 6E 2• The CHP Case Manager will use claims data to determine which members can most benefit from e program. Members will be selected by high cost and high complexity diagnoses. Need for out-of- network services will also be a factor. • The CHP Case Manager will attempt to negotiate rates for all services not available within the CHP network, or the employer's national network. This service will be provided only with the written approval of the employer's reinsurer when applicable. • Determining inappropriate Emergency Room utilization of members that have had (3) or more emergency room visits per calendar year. The ICD-9 codes will be reviewed, and members with inappropriate ER use will be contacted by the case manager. The case manager will encourage the member to establish with a participating Primary Care Physician. County will be responsible for: • Encouraging their enrollees to participate in the Large Case Management Program. • Assisting with the notification to employees about the Large Case Management Program. • Providing Preventative Benefits to help identify potential health problems early. • Facilitating the production of monthly claims data files to the Large Case Management program. 2.3 MANDATORY CASE MANAGEMENT Community Health Partners(CHP)will be responsible for: • Monitoring a Covered individual's emerging risk, a condition or diagnosis that may be potentially significant by utilizing several different methods such as Verisk Medical Intelligence, Notification request,Pharmacy and TPA reports. • CHP Registered Nurse Case Managers communicating on a weekly basis until less intensity is needed as determined by the Case Manager or the Covered Person is dis-enrolled from program. • Communicating with individuals in the form of letters,phone calls, face to face meeting or encrypted email. 2.4 County Representations and Warranties. For purposes of CHP Providers compliance with Rule 4-153, Florida Administrative Code, County represents and warrants that its Benefit Programs are completely and fully self-insured,except for any reinsurance or similar form of stop-loss insurance. 2.5 Grievances. Any complaints received by County or its claims administrator with respect to the provision of the Managed Care Program by CHP shall be forwarded to CHP and shall be submitted for resolution in accordance with CHP's patient grievance resolution procedures attached hereto as Exhibit 1. 2.6 Force Majeure. Neither CHP, any CHP Provider, nor County shall be liable or deemed to be in default for any delay or failure in performance under this Agreement or other interruption of service or employment deemed resulting, directly or indirectly, from acts of nature, civil or military authority, acts of public enemy, war, accidents, fires, explosions, employee strikes or work interruptions, Page 4 10/26/16 ,r ., 16E2 earthquakes, floods, hurricane, failure of transportation or any similar or dissimilar cause beyond the reasonable control of such party. 2.7 Managed Care and Utilization Review Requirements. The County shall provide CHI' copies of the Utilization Review and Managed Care requirements and other conditions to be followed by CHP and Plan Members with respect to providing Managed Care Services under a particular Benefit Program. To the extent of any conflict between the terms of this Agreement and such policies the Plan Benefits shall govern if the Plan Benefits address the specific conflict and if not the terms of this Agreement shall govern provided, however, that in no event shall this Agreement amend the Benefit Program. 2.8 Review Board. The County and CHP shall actively participate in a review board and work toward creating equitable methods to measure outcomes of the CHP Managed Care Programs and utilization strategies that have an impact on medical costs. 2.10 Notification of Claims Payment Administrator. Upon execution of this Agreement, the County shall provide CHP with written notification of its designated third party administrator, if any, and shall thereafter provide CHP with written advance notice ninety(90)days prior to any changes. 2.11 Program Fees. The County shall choose the Managed Care Program(s) and pay CHP the fees for each program chosen as listed on Schedule 4.7 as compensation for each Managed Care Program CHP provides. ARTICLE III TERM AND TERMINATION 3.1 Term. The term of the Agreement shall be for twelve(12)months from January 1, 2017 to December 31,2017. The County Manager, or his designee,may, at his discretion,extend the Agreement under all of the terms and conditions contained in this Agreement for up to one hundred and eighty (180) days. The County Manager, or his designee, shall give CHP written notice of the County's intention to extend the Agreement term prior to the end of the Agreement term then in effect. 3.2 Termination With Cause. If either party materially breaches this Agreement (the "Breaching Party")the other party(the "Non-Breaching Party") shall have the right to give the Breaching Party written notice of the alleged breach and the Breaching Party shall have thirty (30) days following receipt of such notice to cure the breach to the reasonable satisfaction of the Non-Breaching Party. If the breach is not cured to the reasonable satisfaction of the Non-Breaching Party within the thirty (30) day period the Non-Breaching Party shall have the right to immediately terminate this Agreement. 3.3 Obligations After Termination; Continuation of Care. Termination of the Agreement shall not affect the rights, obligations and liabilities of the parties arising out of transactions occurring prior to termination. Termination of this Agreement shall be without the consent of or notice to any Plan Member or any other third party. Upon the termination of this Agreement for any reason or cause,CHP shall cooperate with County by taking reasonable and medically appropriate measures to assure the assumption of Managed Care Services to Plan Members. CHP shall be compensated for such services in accordance with the terms of this agreement. CHP shall furnish any information and take any action including, without limitation, continuing to provide Managed Care Services, for up to thirty(30)days,as the County may reasonably request in order to effectuate an orderly and systematic termination of CHP duties and activities under this Agreement and the transfer of obligations. Page 5 10/26/16 16E 2 ARTICLE IV GENERAL PROVISIONS 4.1 Relationship of Parties. The County and CHP acknowledge that CHP is an independent contractor. 4.2 Recitals. Each of the recitals set forth above are true and correct and are incorporated into and made part of this Agreement by reference. 4.3 Limitation of Assignment. This Agreement shall not be assigned by either party without the prior express written consent of the other party. 4.4 Binding on Successors in Interest. To the extent permitted by this Agreement, the provisions of and obligations arising under this Agreement shall extend to, be binding upon, and inure to the benefit of the successors and assigns of CHP and the County. 4.5 Severability; Changes in Law. If any part of this Agreement is determined to be invalid, illegal, inoperative or contrary to law or professional ethics, the part shall be reformed, if possible, to conform to law and ethics; the remaining parts of this Agreement shall be fully effective and operative to the extent reasonably possible. If any restriction contained in this Agreement is held by any court to be unenforceable and unreasonable, a lesser restriction shall be enforced in its place and the remaining restrictions shall be enforced independently of each other. 4.6 Conformance With Law. Each party agrees to carry out all activities undertaken by it pursuant to this Agreement in conformance of all applicable federal, Florida and local laws, rules and regulations. 4.7 Time of the Essence. Time shall be of the essence with respect to each and every term, covenant,and condition of this Agreement. 4.8 Attorney Fees. In the event of any action,dispute, litigation or other proceeding relating to or in connection with this Agreement, each party shall be responsible for their own fees, costs, and expenses of counsel incurred in connection with that action,dispute,litigation or other proceeding. 4.9 Entire Agreement/Amendments. This Agreement supersedes all previous Managed Care Service contracts and constitutes the entire agreement between the parties relating to the subject matter of this Agreement. Oral statements or prior written materials not specifically incorporated in this Agreement shall not be of any force and effect. In entering into and executing this Agreement,the parties rely solely upon the representations and agreements contained in this Agreement. Except as otherwise expressly provided in this Agreement to the contrary, no changes in or additions to this Agreement shall be recognized unless and until made in writing and signed by an authorized officer or agent of CHP and County. 4.10 Governing Law. This Agreement has been executed and delivered and shall be construed and enforced in accordance with the laws of the State of Florida excluding and without application of any choice of law principles except to the extent pre empted by federal law. Any action brought by the parties whether at law or in equity shall be commenced and maintained and venue shall properly be in Collier County, Florida. The parties knowingly, intentionally and irrevocably waive any claim that any suit, action or proceeding brought in Collier County, Florida has been brought in an inconvenient forum. Each party further waives all rights to any trial by jury in all litigation relating to or arising out of this Agreement. Page 6 10/26/16 0 16E 2 4.11 Waiver of Breach. No provision of this Agreement shall be deemed waived unless evidenced by a written document signed by an authorized officer or agent of CHP and the County. The waiver by either party of a breach or violation of any provision of this Agreement shall not operate as, or be construed to be, a waiver of any subsequent breach of the same or other provision of this Agreement unless specifically provided for in the written instrument consenting to the waiver. 4.12 Paragraph and Other Headings. The section and other headings contained in this Agreement are for reference purposes only and shall not affect in any way the meaning or interpretation of this Agreement. 4.13 Gender and Number. When the context of this Agreement requires, the gender of all words shall include the masculine, feminine, and neuter, and the number of all words shall include the singular and plural. 4.14 Execution. This Agreement and any amendments may be executed in multiple originals, each counterpart shall be deemed an original, but all counterparts together shall constitute one and the same instrument. 4.15 Additional Assurances. The provisions of this Agreement are self-operative and do not require further agreement by the parties; provided, however, at the request of either party,the other shall execute, except as otherwise provided in this Agreement, any additional instruments and take any additional acts as may be reasonably necessary to effectuate this Agreement. 4.16 Construction. This Agreement shall be construed without regard to any presumption or other rule requiring construction against the party causing this Agreement to be drafted. 4.17 Authority. Each signatory to this Agreement represents and warrants that he possesses all necessary capacity and authority to act for, sign, and bind the respective entity on whose behalf he is signing. 4.18 Notice. Any notice given pursuant or relating to this Agreement shall be given by United States mail, postage prepaid, certified or registered mail, return receipt requested, hand delivery, or overnight delivery, and delivered to the addressee at the following address unless otherwise changed in accordance with the provisions of this Section: To Community Health Partners: To Board of County Commissioners,Collier 851 5th Ave N Suite 201 County,Florida Naples,Florida 34102 3311 Tamiami Trail East Attention: Contracting Dept. Naples,FL 34112 Attention: Risk Management Department 4.19 Cumulative Remedies. Remedies provided for in this Agreement shall be in addition to and not in lieu of any other remedies available to either party and shall not be deemed waivers or substitutions for any action or remedy the parties may have under law or in equity. 4.20 Marketing and Promotion. The County and CHP each reserve the right to and control of its name, symbols, trademarks, logos and service marks presently existing or established in the future. The County agrees that CUP may use its name in any publication listing the names of managed care programs and health benefit plans with which CHP contracts. Except as provided in this Section,the use of any written promotional documents, publicity, media advertising, or any other materials for public disclosure carrying the name, trademark, service mark, or a pictorial likeness of either party shall require the prior written consent of the other party. Page 7 10/26 0/26 /16 '► 16E2 4.21 Confidentiality. The County and CHP shall take all reasonable precautions to maintain the confidentiality of this Agreement and any related information provided to or discovered and shall not disclose this Agreement, the terms thereof, or such other information to any party other than a party directly involved in the transaction contemplated by this Agreement. Confidentiality is subject to Chapter 119, Florida Statutes, also known as the Public Records Law, including specifically those contractual requirements at F.S. § 119.0701(2)(a)-(b)as stated as follows: IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: Communication and Customer Relations Division 3299 Tamiami Trail East, Suite 102 Naples, FL 34112-5746 Telephone: (239) 252-8383 The Contractor must specifically comply with the Florida Public Records Law to: 1. Keep and maintain public records required by the public agency to perform the service. 2. Upon request from the public agency's custodian of public records, provide the public agency with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. 3. Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the Contractor does not transfer the records to the public agency. 4. Upon completion of the contract, transfer, at no cost, to the public agency all public records in possession of the Contractor or keep and maintain public records required by the public agency to perform the service. If the Contractor transfers all public records to the public agency upon completion of the contract, the Contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Contractor keeps and maintains public records upon completion of the contract, the Contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the public agency, upon request from the public agency's custodian of public records, in a format that is compatible with the information technology systems of the public agency. 4.22 Coordination of Defense of Claims. The County and CHP shall promptly notify the other of any claims or demands asserted by third parties that arise under or related to this Agreement. The parties shall make all reasonable efforts, consistent with advice of counsel and the requirements of the respective insurance policies and carriers,to coordinate and assist in the defense of all claims in which the other party is either a named defendant or has a substantial possibility of being named. This Section shall survive termination or expiration of this Agreement. 4.23 Compliance with Laws and Regulation. In the event any applicable federal, state, or local law or any regulation, order or policy issued under such law is changed (or any judicial interpretation thereof is developed or changed) in a way which will have a material adverse effect on the Page 8 10/26/16 ti.' 16E2 practical realization of the benefits anticipated by one or both parties to this Agreement, the adversely affected party shall notify the other party in writing of such change and the effect of the change. The parties shall enter into good faith negotiations to modify this Agreement to compensate for such change. If an agreement is not reached within thirty (30) days of such written notice; the Agreement may be terminated by either party. 4.24 Insurance. CHP shall provide insurance to County as follows: A. Commercial General Liability: Coverage shall have minimum limits of$300,000 Per Occurrence, $2,000,000 aggregate for Bodily Injury Liability and Property Damage Liability. This shall include Premises and Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. B. Workers' Compensation: Insurance covering all employees meeting Statutory Limits in compliance with the applicable state and federal laws. C. Professional Liability: Shall be maintained by CHP to ensure its legal liability for claims arising out of the performance of professional services under this Agreement. Special Requirements: Collier County Government shall be listed as the Certificate Holder and included as an Additional Insured on the Comprehensive General Liability Policy. Current, valid insurance policies meeting the requirement herein identified shall be maintained by CHP during the duration of this Agreement. Renewal certificates shall be sent to the County ten(10)days prior to any expiration date. CHP shall insure that all sub Contractors comply with the same insurance requirements that is required to meet. The same CHP shall provide County with certificates of insurance meeting the required insurance provisions. **** Page 9 10/26/16 • 1 6 E 2 IN WITNESS WHEREOF, the parties have caused this Agreement to be duly executed as of the Effective Date. BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY,FLORIDA ATTEST: lee..., Dwight E.Brock,Clerk of Courts CD� By: By: 1.� Print Name:,-,v-tckVwS.Q Dated *L I.= 6Ii k Title: C vor-\n�a - (SEMt fb Chairman'sDate: Iz�V \ In sl r ,,nre!e/, ppr ved as to Fo 10 < d, egality: 1 i f -_'.------------ IV ott R.Teach, Deputy County Attorney NAPLES PHYSICIAN HOSPITAL RGANIZATION,INC.d/b/a COMMUNITY HEALTH PARTNERS ATTEST: Y: h, IA Ar ` B '' Vf,. olff, la,Co-Chairman orporate Secre A Date: I" a- I (P 1 I\DCO k Print Name 'AZ / By: (� Kevin Cooper,Co-Chairman Date: II --c gv ((il Item# i 6 ea , Agenda 102013'1b Date Date ',LI d(0/0" i Rec'd 32-0,15—N4LZI'\1 01 Page 10 Deputy Clerk �`m➢iL`� 10/26/16 16E2 SCHEDULE 4.7 PROGRAM FEES Board of County Commissioners,Collier County,Florida shall pay Community Health Partners monthly the fees listed below for the Managed Care Programs that are indicated as purchased.The fee(s)shall be paid upon receipt of a proper invoice and in accordance with Chapter 218,Florida Statutes,also known as the"Local Government Prompt Payment Act."Fees to be disbursed to: Community Health Partners 851 Fifth Avenue N. Suite 201 Naples,FL 34102 Utilization Management/Case Management Fee: CHP Utilization Review Management program with Large Case Management/Care Coordination including Maternity Management $2.60 per employee per month Page 11 10/26/16 ?a PHYSI-6 t ALC-ClR' X DATE /DD/YYYY) 4.----. (MM CERTIFICATE OF LIABILITY INSURANCE 1MM/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTNAME:ACT William H. Kuhlman,CPCU,ARM Insurance and Risk Management PHONEFAX Services,Inc. IA/c,No.Extl:239-649-1444 (A/C,No): 239-649-7933 8950 Fontana Del Sol Way#200 ADDRESS: Naples,FL 34109-4374 William H.Kuhlman,CPCU,ARM INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Hartford Casualty Insurance INSURED Naples Physician Hospital INSURER B:FCCI Insurance Company 10178 Organization,Inc. INSURER C:Darwin Select Insurance Co. 24319 851 5th Avenue North,#201 Naples, FL 34102 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSD SUBRDPOLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DDlYYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR X 21SBABV904101/01/2016 01/01/2017 DAMAGE TO RENTED PREMISES(Ea occurrence) $ 300,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2000 000 (Ea accident) _ A ANY AUTO 21SBABV9041 01/01/2016 01/01/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE 21SBABV9041 01/01/2016 01/01/2017 AGGREGATE $ DED X RETENTION$ 10000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY X STATUTE X ER Y/N B ANY PROPRIETOR/PARTNER/EXECUTIVE 001 WC16A73097 01/01/2016 01/01(2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Professional Liab 03043578 01/01/2016 01/01/2017 Gen Agg 4,000,000 Claims Made Occur 4,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Collier County Government is listed as Additional Insured with 30 Days Notice of Cancellation as respects to General Liability. CERTIFICATE HOLDER CANCELLATION COLLCI8 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier CountyGovernment THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 3327 Tamiami Trail East • Naples,FL 34112 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Detail by Entity Name Page 1 of 4 Florida Department of State Divisions OF CORP 1TIO E 2 i- r fI syr .✓af /Pi i'lv-tairg 1,„„,....----"- -----,„,...--,-.4-1,,,,,„, 4IF SS€ii,,Eaf(,.;it g 1 rq- P 3fi• ,,,‘0,,, Department of State / Division of Corporations / Search Records / Detail By Document Number/ Detail by Entity Name Florida Not For Profit Corporation NAPLES PHYSICIAN HOSPITAL ORGANIZATION, INC. Filing Information Document Number N93000005824 FEI/EIN Number 65-0531134 Date Filed 12/30/1993 State FL Status ACTIVE Last Event CANCEL ADM DISS/REV Event Date Filed 10/31/2008 Event Effective Date NONE Principal Address 851 FIFTH AVE. N STE.201 NAPLES, FL 34102 Changed:03/19/2004 Mailing Address 851 FIFTH AVE. N STE.201 NAPLES, FL 34102 Changed: 04/12/2012 Registered Agent Name&Address COMMUNITY HEALTH PARTNERS 851 FIFTH AVE N 201 NAPLES, FL 34102 Name Changed: 04/12/2012 Address Changed: 04/12/2012 Officer/Director Detail Name&Address Title Director Cooper, Kevin, Esq. \7 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 12/14/2016 Detail by Entity Name Page 2 of 4 6E 2 851 FIFTH AVE. N 1 STE. 201 NAPLES, FL 34102 Title D Talano, James MD 851 Fifth Ave North STE 201 NAPLES, FL 34102 Title D Lewis,John MD 851 FIFTH AVE. N STE. 201 NAPLES, FL 34102 • Title D PARSONS, GARY MD 851 FIFTH AVE. N STE. 201 NAPLES, FL 34102 Title D Kamerman, Max MD 851 FIFTH AVE. N STE. 201 NAPLES, FL 34102 Title D WOLFF, BRIAN MD 851 FIFTH AVE. N • STE. 201 NAPLES, FL 34102 Title Director Statfeld, Robert, Dr. 851 FIFTH AVE. N STE. 201 NAPLES, FL 34102 Title Director Perez-Trepichio,Alejandro MD 851 FIFTH AVE.N STE. 201 NAPLES, FL 34102 http://search.sunbiz.org/Inquiry/CorporationSearch/S earchRe sultDetail?inquirytype=Entit... 12/14/2016 Detail by Entity Name Page 3 of 4 iiE2 Title Director Alessi,Albert MD 851 FIFTH AVE. N STE.201 NAPLES, FL 34102 Title Director Riley, Michael 851 FIFTH AVE. N STE.201 NAPLES, FL 34102 Title Director Dutcher, Phil 851 FIFTH AVE. N STE. 201 NAPLES, FL 34102 Annual Reports Report Year Filed Date 2015 04/23/2015 2015 11/24/2015 2016 Q2/05/2016 Document Images 02/05/2016--ANNUAL REPORT View image in PDF format 11/24/2015--AMENDED ANNUAL REPORT View image in PDF format 04/23/2015--ANNUAL REPORT View image in PDF format 02/27/2014—AMENDED ANNUAL REPORT View image in PDF format 01/10/2014--ANNUAL REPORT View image in PDF format 01/25/2013--ANNUAL REPORT View image in PDF format 04/12/2012--ANNUAL REPORT View image in PDF format 01/06/2011--ANNUAL REPORT View image in PDF format 02/17/2010—ANNUAL REPORT View image in PDF format 04/28/2009--ANNUAL REPORT View image in PDF format 10/31/2008—REINSTATEMENT View image in PDF format 04/23/2007--ANNUAL REPORT View image in PDF format 03/13/2006--ANNUAL REPORT View image in PDF format 02/03/2005--ANNUAL REPORT View image in PDF format 03/19/2004—ANNUAL REPORT View image in PDF format 04/17/2003—ANNUAL REPORT View image in PDF format 03/13/2002--ANNUAL REPORT View image in PDF format 03/01/2001--ANNUAL REPORT View image in PDF format 03/27/2000—ANNUAL REPORT View image in PDF format 03/29/1999—ANNUAL REPORT View image in PDF format 02/06/1998--ANNUAL REPORT View image in PDF format http://search.sunbiz.org/Inquiry/CorporationSearch/S earchRe sultDetail?inquirytype=Entit... 12/14/2016 Detail by Entity Name Page 4 of 4 03/10/1997—ANNUAL REPORT View image in PDF format 04/22/1996--ANNUAL REPORT View image in PDF format 06/23/1995—ANNUAL REPORT View image in PDF format Florida Department of State,Division of Corporations • http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 12/14/2016