CIGNA
CONTRACTS
OLSTEN HEALTH SERVICES
NATIONAL PRICING AREA DESIGNATION
AREA I AREA II AREA III
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EXCEPTIONS EXCEPTIONS
DISTRICT OF COLUMBIA ARIZONA ALABAMA
CALIFORNIA SAN DIEGO, CA AREA I ARKANSAS
LOS ANGELES, CA AREA I IDAHO
ORANGE COUNTY AREA I ILLINOIS CHICAGO, IL AREA II
SAN FRANCISCO, CA AREA I INDIANA INDIANAPOLIS, IN AREA II
VENTURA COUNTY AREA I IOWA
SANTA BARBARA, CA AREA I KENTUCKY
RICHMOND, CA AREA I LOUISIANA NEW ORLEANS, LA AREA II
SAN JOSE, CA AREA I MAINE
SAN LEANDRO, CA AREA I MICHIGAN SOUTHFIELD, MI AREA II
SAN MATEO, CA AREA I ANN ARBOR, MI AREA II
SANTA ROSA, CA AREA I DETROIT, MI AREA II
LAKE ELSINORE, CA AREA I MINNESOTA ST. PAUL, MN AREA II
SAN BERNARDINO, CA AREA I MISSISSIPPI
SAN LUIS OBISPO, CA AREA I MISSOURI KANSAS CITY, MO AREA II
COLORADO ST. LOUIS, MO AREA II
CONNECTICUT STAMFORD, CT AREA I MONTANA
DANBURY, CT AREA I NEBRASKA
WETHERSFIELD, CT AREA I NEW HAMPSHIRE
STRATFORD, CT AREA I NORTH CAROLINA CHARLOTTE, NC AREA II
HAMDEN, CT AREA I NORTH DAKOTA
DELAWARE OHIO
FLORIDA SOUTH CAROLINA
GEORGIA SOUTH DAKOTA
KANSAS TENNESSEE
MARYLAND BALTIMORE, MD AREA I VIRGINIA ALEXANDRIA, VA AREA I
TOWSON, MD AREA I RETRON, VA AREA II
MASSACHUSETTS SPRINGFIELD, MA AREA III FAIRFAX COUNTY, VA AREA I
GREENFIELD, MA AREA III RICHMOND, VA AREA II
PITTSFIELD, MA AREA III VIRGINIA BEACH, VA AREA II
NEVADA NORFOLK, VA AREA II
NEW JERSEY NORTHERN, NJ AREA I SUFFOLK, VA AREA II
JERSEY CITY, NJ AREA I HAMPTON, VA AREA II
UNION, NJ AREA I WEST VIRGINIA
NEW MEXICO WYOMING
NEW YORK LONG ISLAND AREA I
FIVE BOROUGHS AREA I
WESTCHESTER COUNTY AREA I
ROCKLAND AREA I
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
TEXAS
UTAH
VERMONT
WASHINGTON
WISCONSIN
OLSTEN HEALTH SERVICES
NETWORK PRICING AREA DESIGNATION
AREA I AREA II AREA III
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EXCEPTIONS EXCEPTIONS
California Arizona Alabama
Colorado Arkansas
District of Columbia Connecticut Idaho
Delaware Illinois CHICAGO, IL AREA II
Florida Indiana INDIANAPOLIS, IN AREA II
Georgia Iowa
Kansas Kentucky
Maryland TOWSON, MD Area I Louisiana
Massachusetes GREENFIELD, MA Area III Maine
PITTSFIELD, MA Area III Michigan
SPRINGFIELD, MA Area III Minnesota ST. PAUL, MN Area II
Nevada Mississippi
New Jersey EATONTOWN, NJ Area I Missouri KANSAS CITY, MO Area II
JERSEY CITY, NJ Area I Montana
TOMS RIVER, NJ Area I Nebraska
UNION, NJ Area I New Hampshire
New Mexico North Carolina CHARLOTTE, NC Area II
New York LONG ISLAND & Area I North Dakota
FIVE BOROUGHS Area I Ohio
WESTCHESTER COUNTY Area I Oklahoma
Oregon South Carolina
Pennsylvania South Dakota
Rhode Island Tennessee
Texas Virginia ALEXANDRIA, VA Area I
Utah RESTON, VA Area II
Vermont West Virginia
Washington Wyoming
Wisconsin
TABLE OF CONTENTS
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I. DEFINITIONS..........................................................................................4
II. PARTIES' OBLIGATIONS.................................................................................8
A. Services....................................................................................8
B. Reporting/Data Access......................................................................13
C. Compensation, and Billing..................................................................15
D. Records....................................................................................17
E. Participant Grievance......................................................................18
F. Insurance and Liability....................................................................18
G. Indemnification............................................................................19
H. Inspections................................................................................20
I. Performance Guarantees.....................................................................20
J. Representations............................................................................20
K. Best Rate Guarantee........................................................................20
L. State Specific Provider Agreement Requirements.............................................21
III. MISCELLANEOUS OBLIGATIONS...........................................................................21
A. Independent Contractor Relationship........................................................21
B. Term of Agreement..........................................................................21
C. Termination................................................................................22
D. Rights and Obligations Upon Termination....................................................23
E. Assignment and Delegation of Duties........................................................24
F. Use of Name................................................................................24
G. Interpretation.............................................................................24
H. Amendment..................................................................................24
I. Program Attachments and Exhibits...........................................................25
J. Entire Contract............................................................................25
K. Notice.....................................................................................25
L. Enforceability and Waiver..................................................................25
M. Regulatory Approval........................................................................26
N. Dispute Resolution.........................................................................26
O. Third Party Beneficiaries..................................................................26
PROGRAM ATTACHMENTS
A. HMO PROGRAM ATTACHMENT
Exhibit A.1 Capitation Rates
Exhibit A.2 Tocolytic Rates
Exhibit A.3 FFS Reimbursement Schedule - Home Medical Equipment
Exhibit A.4 Home Medical Equipment Capitation Rates
Exhibit A.5 Utilization Management Standards
Exhibit A.6 HMO Program Requirements
B. PPO PROGRAM ATTACHMENT
Exhibit B.1 FFS Reimbursement Schedule - Home Health
Exhibit B.2 FFS Reimbursement Schedule - Home Infusion
Exhibit B.3 FFS Reimbursement Schedule - Home Medical Equipment
Exhibit B.4 FFS Reimbursement Schedule - Tocolytics
Exhibit B.5 PPO Program Requirements
C. INDEMNITY PROGRAM ATTACHMENT
Exhibit C.1 FFS Reimbursement Schedule - Home Health
Exhibit C.2 FFS Reimbursement Schedule - Home Infusion
Exhibit C.3 FFS Reimbursement Schedule - Home Medical Equipment
Exhibit C.4 FFS Reimbursement Schedule - Tocolytics
Exhibit C.5 Indemnity Program Requirements
D. MEDICARE RISK PROGRAM ATTACHMENT
Exhibit D.1 Capitation Rates
Exhibit D.2 Tocolytic Rates
Exhibit D.3 FFS Reimbursement Schedule - Home Medical Equipment
Exhibit D.4 Home Medical Equipment Capitation Rates
Exhibit D.5 Medicare Risk Program Requirements
E. MEDICAID RISK PROGRAM ATTACHMENT
Exhibit E.1 Capitation Rates
Exhibit E.2 Tocolytic Rates
Exhibit E.3 FFS Reimbursement Schedule - Home Medical Equipment
Exhibit E.4 Home Medical Equipment Capitation Rates
Exhibit E.5 Medicaid Risk Program Requirements
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EXHIBITS
I. Participating CIGNA Subsidiaries and Affiliates
II. Participating Olsten Subsidiaries and Affiliates
III. Information Required For Complete Order
IV. Exclusions From Home Care Services
V. Home Infusion Therapy Drugs and Medications
VI. Credentialing/Recredentialing Requirements
VII. Required Encounter Data Elements
VIII. Subcontractor Payment
IX. Performance Guarantees
X. National Home Health Exclusivity: Exclusions
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NATIONAL HOME CARE PROVIDER AGREEMENT
PARTIES
THIS AGREEMENT is by and between CIGNA Health Corporation, for and on behalf of
its wholly-owned subsidiaries and affiliates listed on Exhibit I (individually
and collectively, "CIGNA"), and Kimberly Home Health Care, Inc., D/B/A Olsten
Kimberly QualityCare, for and on behalf of its wholly-owned subsidiaries and
affiliates listed on Exhibit II (individually and collectively, "Provider"), and
is entered into as of January 1, 1996 (the "Effective Date").
PURPOSE
CIGNA contracts directly or indirectly with Payors, employers, individual
insurers, sponsors and others, to provide, insure, arrange for or administer the
provision of health care services;
CIGNA contracts with physicians, hospitals and other health care practitioners
and entities, to provide, arrange for or administer, at predetermined rates, the
delivery of such health care services;
CIGNA and Provider desire to enter into this Agreement relating to certain
health care services for individuals;
In consideration of the mutual promises herein, the parties agree as follows:
I. DEFINITIONS
Defined terms are set forth herein and in the Program Attachments.
COINSURANCE means a payment that a Participant is required to make to a
Participating Provider for Covered Home Care Services under a Service Agreement,
which is calculated as a percentage of the contracted reimbursement rate of such
services, or, if reimbursement is on a basis other than a fee-for-service amount
(i.e. capitation), as a percentage of the fee schedule set forth in the PPO
Program Attachment to this Agreement or some other fee schedule agreed upon by
the parties during implementation of this Agreement.
COMPLETE ORDER means all information and physician orders, to the extent
applicable, reasonably required by Provider and/or any applicable Subcontractor
in order to provide or arrange for Covered Home Care Services. Provider shall
have received a Complete Order if Provider has received the information
delineated in Exhibit III which is applicable and Provider and any applicable
Subcontractor has received a physician order, to the extent applicable.
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COPAYMENT OR DEDUCTIBLE means a payment that a Participant is required to make
to a Participating Provider under a Service Agreement, which is calculated as a
fixed dollar payment.
COVERED HOME CARE SERVICES means those Home Care Services which are Covered
Services and which are not among the list of excluded services delineated in
Exhibit IV.
COVERED SERVICES means those health care services which are Medically Necessary
provided to a Participant in accordance with a Service Agreement.
EMERGENCY means an illness or accident in which the onset of symptoms is both
sudden and so severe as to require immediate medical or surgical treatment. This
includes accidental injuries or medical emergencies of a life-threatening nature
or when serious impairment of bodily functions would result if treatment were
not rendered immediately.
EXPERIMENTAL means medical, surgical or other healthcare procedures and
treatments which are experimental or investigational as determined by a CIGNA
Medical Director in accordance with consensus derived from peer review medical
and scientific literature and the practice of the national medical community,
including 1) any procedures or treatments which are not recognized as conforming
to accepted medical practice; 2) any procedures or treatments in which the
scientific assessment of the techniques or its application for a particular
condition has not been completed or its effectiveness has not been established;
and 3) any procedure or treatments for which the required approval of the
applicable governmental agency has not been granted at the time the services are
rendered.
HOME CARE SERVICES means Home Health Services, Home Infusion Therapy Services,
Home Medical Equipment. and Tocolytic Services, as defined below, currently
normally and appropriately provided, in a home setting (except that Home
Infusion Therapy Services include those services also currently normally and
appropriately provided in an ambulatory setting, and Home Medical Equipment
includes medical equipment irrespective of setting but exclusive of equipment to
be used primarily in an inpatient facility setting, except in preparation for
hospital discharge, or equipment to be used primarily in an outpatient facility
setting, except in preparation for the transition of care to the home setting,
or which would normally be provided by any such facility), subject to the
conditions and limitations of this Agreement:
HOME HEALTH SERVICES means those services, supplies, drugs/medications
(limited to topical agents for wound care) and equipment ordered by a
physician for a Participant who is home bound due to a disabling
condition and who requires skilled care or ordered by a physician for a
Participant for whom such services, supplies, drugs/medications and
equipment are appropriately provided in a home setting, including but
not limited to: skilled nursing services rendered by a registered
professional nurse, licensed practical nurse or licensed vocational
nurse; home health aide services; physical, occupational, speech and
respiratory therapy; dietary and nutri-
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tional services; medical social services; family caregiver training and
education; consumable medical supplies and durable medical equipment
administered or used in the course of rendering skilled or unskilled
services; and prescribed drugs and medications (limited to topical
agents for wound care).
HOME INFUSION THERAPY SERVICES means intravenously administered,
subcutaneously or self-injected drugs and medications prescribed by a
physician for a Participant (including all services and supplies
necessary for such administrations), which are administered in an
ambulatory setting where the close supervision of a physician in person
is not required, including but not limited to those drugs and
medications listed on Exhibit V. Home Infusion Therapy Services do not
include those medications which are provided under a Participant's
prescription drug benefit program such as oral, rectal, ophthalmic,
subdermal, sublingual and topical agents, self-injected medications
which are covered under a Participant's prescription drug benefit
program (such as anti-diabetic agents and certain subcutaneous
mediations) and medications not generally considered home infusion
therapy (such as skeletal muscle relaxants, anti-psychotics,
anti-convulsants, diagnostic agents, vaccines and hormones (except
growth hormone)). Home Infusion Therapy Services include blood
products, such as anti-hemphil factors, whole blood and platelets, only
to the extent such products are appropriately provided in a home or
Provider infusion site setting.
HOME MEDICAL EQUIPMENT means medical equipment ordered or prescribed by
a physician for a Participant (including all services, training,
supplies, maintenance and repairs necessary for use of such equipment)
including but not limited to: durable medical equipment, respiratory
therapy equipment, and oxygen.
TOCOLYTIC SERVICES means those services, supplies, drug/medications and
equipment ordered by a physician for a Participant who is deemed to be
at high risk for preterm labor. Such services may include but are not
limited to home uterine monitoring, whether the Participant is on oral
or infused tocolytic medications or on no medication at all, skilled
nursing services rendered by a registered professional nurse, family
caregiver training and education; consumable medical supplies and
durable medical equipment administered or used in the course of
rendering services, and prescribed drugs and medications.
MEDICALLY NECESSARY means services or supplies which, under the provisions of
this Agreement, are determined, under utilization Management, to be (i)
appropriate and necessary for the symptoms, diagnosis or treatment of the
medical condition; (ii) provided for diagnosis or direct care and treatment of
the medical condition; (iii) within standards of good medical practice within
the organized medical community; and (iv) not primarily for the convenience of
the Participant, the Participant's physician, another provider or CIGNA. Covered
Services must be Medically Necessary.
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NETWORK MANAGER means that individual or individuals designated by Provider as
Provider's central point of contact.
PARTICIPANT means any individual, or eligible dependent of such individual,
whether referred to as "Insured," "Subscriber," "Member," "Participant,"
"Enrollee," "Dependent" or otherwise, who is eligible for Covered Services
pursuant to a Service Agreement.
PARTICIPATING PROVIDER means a hospital, a physician or any other health care
practitioner or entity that has a direct or indirect contractual arrangement
with CIGNA to provide Covered Services (including Provider's Subcontractors).
PAYOR means CIGNA or such other entity which, pursuant to a Service Agreement,
funds, administers, offers or insures Covered Services and which has agreed to
act as Payor in accordance with a Service Agreement.
PROGRAM means the Health Maintenance Organization (HMO), Preferred Provider
Organization (PPO) Indemnity or other types of health care or administrative
services which are provided by or arranged by CIGNA or CIGNA Affiliates and
which are specifically described in applicable Program Attachments and Program
Requirements.
PROGRAM REQUIREMENTS means the rules and procedures that establish conditions to
be followed by Participating Providers with respect to Programs, and which are
attached to applicable Program Attachments.
QUALITY MANAGEMENT means the processes established and operated by CIGNA or its
designee relating to the quality of Covered Services.
ROUTINE means conditions which cannot otherwise be classified as STAT or Urgent.
SERVICE AGREEMENT means those agreements among CIGNA and an employer, insurer,
labor union, trust or other organization or entity, or an individual, that
specifies services to be provided to or for the benefit of, or arranged for or
reimbursed to or for the benefit of Participants, the terms and conditions under
which those services are to be provided or reimbursed, and is consistent with
applicable Program Requirements.
SERVICE AREA means all respective geographic areas in which CIGNA provides or
arranges for its HMO, PPO, Medicare Risk and Medicaid Risk Programs.
STAT means Emergency conditions.
SUBCONTRACTOR means a duly licensed and qualified provider of Covered Home Care
Services: (a) contractually engaged by Provider to fulfill some of Provider's
obligations under this Agreement; (b) who or which has satisfied applicable
credentialing criteria as set forth in
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Exhibit VI; (c) who or which both CIGNA and Provider have agreed may render
Covered Home Care Services pursuant to this Agreement; and (d) who or which has
agreed with Provider to be subject to the requirements of this Agreement to the
extent applicable.
URGENT means conditions requiring prompt response time as determined by the
Participant's physician.
UTILIZATION MANAGEMENT means the processes to review usage of Covered Services
provided or to be provided to Participants which identify and promote the
efficient and effective use of Covered Services in accordance with Program
Requirements.
II. PARTIES' OBLIGATIONS
A. SERVICES
1. Provider, Provider's Subcontractors and CIGNA shall act in accordance
with the terms of this Agreement, including its Program Attachments and
applicable Program Requirements. The compensation set forth in this
Agreement shall be payment in full for all Covered Home Care Services
provided to Participants pursuant to this Agreement.
2. Except with respect to the Indemnity, PPO, Medicare or Medicaid
Programs in instances where Provider has not received a referral,
Provider will be responsible for the coordinated delivery of all
Covered Home Care Services to CIGNA Participants in the Service Area,
whether these services are rendered directly by Provider or by
Provider's Subcontractors. To enable Provider to fulfill such
responsibilities, CIGNA shall communicate referrals for Covered Home
Care Services to the Network Manager. Further, CIGNA shall deliver to
Provider a listing of Participating Providers and Participants and
regularly update such listings in accordance with the procedures set
forth in section II.A.10. below.
3. Provider and its Subcontractors shall render Covered Home Care Services
with the same standard of care, skill and diligence customarily used by
similar providers in the community in which such services are rendered.
Provider and its Subcontractors shall render Covered Home Care Services
in the same manner, in accordance with the same standards, and with the
same availability, as offered to other patients. Provider and its
Subcontractors shall not differentiate or discriminate in the treatment
of any Participant because of race, color, national origin, ancestry,
religion, sex, marital status, sexual orientation, age, health status,
handicap or source of payment.
4. Provider, Subcontractors and CIGNA shall be bound by and comply with
the provisions of applicable state and federal laws and regulations,
credentialing and recreden-
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tialing requirements of the National Committee for Quality Assurance
("NCQA") or of another appropriate accrediting body designated by
CIGNA, and applicable Program Requirements.
5. Provider shall maintain and ensure (with respect to its respective
personnel), and shall require Subcontractors to maintain and ensure
(with respect to its respective personnel), that all personnel which
render Covered Home Care Services maintain all licenses, accreditations
and certifications required in order to perform Covered Home Care
Services hereunder and any other obligations set forth herein. Evidence
of applicable licensure, accreditation or certification shall be
submitted to CIGNA upon request. Upon request by CIGNA, Provider shall
submit a photocopy or comprehensive letter validating the following
information, if applicable, concerning any of Provider's employees,
Subcontractors, or Subcontractor's employees involved in rendering
services to Participants hereunder:
(a) nursing license or appropriate professional
certification or licensure;
(b) valid state driver's license;
(c) proof of automobile insurance coverage;
(d) employment history;
(e) CPR certification.
Provider will ensure (with respect to its respective personnel), and
shall require Subcontractors to ensure (with respect to its respective
personnel), that the skill level of the personnel utilized to render
Covered Home Care Services under this Agreement is appropriate for the
particular Covered Home Care Service rendered.
6. Provider and its Subcontractors shall comply with the requirements of,
and shall participate in, CIGNA's Quality Management and Utilization
Management programs. Such participation shall include, but not be
limited to, participation in CIGNA's Quality Management and Utilization
Management meetings as required.
7. Except with respect to the Indemnity, PPO, Medicare or Medicaid
Programs in instances where Provider has not received a referral,
Provider will provide, arrange through its Subcontractors to provide,
or, if rendered by another provider, be financially responsible for all
Covered Home Care Services required by Participants in each Service
Area. Prior to the start date with respect to each Service Area: (a)
Provider shall obtain CIGNA's approval of Provider's list of
participating home care providers (which may include both Provider
affiliates and Subcontractors) who will render Covered Home Care
Services under this Agreement; (b) Provider shall satisfy CIGNA that it
has established a home care services network adequate in size,
composition and distribution to accommodate the Covered Home Care
Services required by Participants; (c) the parties shall agree upon a
plan to ensure appropriate and sensitive transitioning
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of Participants already receiving Covered Home Care Services such that
there is no disruption of care which would be detrimental to such
Participants; and (d) the parties shall be satisfied that adequate
management systems are in place. CIGNA's financial obligations for
payment of Covered Home Care Services rendered hereunder shall not
commence with respect to a Service Area until the agreed upon start
date for such Service Area. Provider shall not eliminate or change
Subcontractors or a Provider location without sixty (60) days' prior
written notice to CIGNA, except to the extent Provider is required to
do so for cause and, in any such case, Provider shall notify CIGNA of
such change as soon as practicable.
8. Provider shall maintain binding agreements with each of its
Subcontractors requiring Subcontractors to comply with all of the terms
and conditions of this Agreement to the extent applicable. The form of
Provider's standard Subcontractor agreement and any material subsequent
amendments thereto must be approved in advance by CIGNA. Each of such
agreements shall include, among other things, the following:
a. A Participant hold harmless provision satisfactory to CIGNA,
consistent with applicable law and which provides, among other
things, that in no event, including but not limited to
nonpayment by Provider, Provider's insolvency or breach of
Provider's agreement with the Subcontractor, shall
Subcontractors bill, charge, collect a deposit from, seek
compensation, remuneration or reimbursement from or have any
recourse against Participant, Payor (if Payor has made
payments in accordance with this Agreement) or parties other
than Provider for Covered Home Care Services provided pursuant
to this Agreement;
b. a provision obligating Subcontractors to notify CIGNA
immediately of any significant payment defaults by Provider
relating to services rendered hereunder provided that such
notification shall only be required after Provider has failed
to cure such default within the applicable 15 day cure period;
c. with respect to Covered Home Care Services reimbursed on a
capitated basis, a provision obligating Subcontractors to
continue to render Covered Home Care Services for the period
of time for which Provider has received Capitation Payments
hereunder notwithstanding Provider's failure to pay
Subcontractor;
d. with respect to all Covered Home Care Services, a provision
obligating Subcontractors, in the event of Provider's
significant payment default as described in Section II.A.8.b
above and at CIGNA's option, to continue rendering Covered
Home Care Services hereunder so long as payments due
Subcontractors for Covered Home Care Services rendered after
notification to CIGNA of such payment default and CIGNA's
exercise of such option are made directly to Subcontractors by
Payor and until a date specified by CIGNA but no later than
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120 days after CIGNA's exercise of such option. Subcontractors
shall agree that any such payments during such time period
shall be made, at CIGNA's election, either in accordance with
the reimbursement terms set forth in Subcontractors'
agreements with Provider or in accordance with the
reimbursement rates set forth in the PPO Program Attachment to
this Agreement;
e. with respect to Covered Home Care Services referred to
Provider, a provision obligating Subcontractors to submit
requests for payment to Provider and not to CIGNA and
f. any other provisions required by applicable law or regulation
or, with respect to the Medicare or Medicaid Risk Program, by
HCFA.
To the extent required by applicable laws, regulations or the
applicable governmental authority, including but not limited to HCFA,
or in the event of Provider's significant payment default to
Subcontractor(s), upon request, Provider shall make available to CIGNA
and to any applicable regulatory authority making such request a copy
of each of its provider agreements with Subcontractors.
9. Provider agrees that each Provider location and each Subcontractor will
be credentialed and recredentialed in accordance with the procedures
set forth in Exhibit VI of this Agreement.
10. CIGNA shall establish a system of Participant identification, and
communicate to Participants and Participating Providers appropriate
sections of this Agreement, including sections related to coordination
with the Network Manager. Prior to the start date at each Service Area,
CIGNA shall deliver to Provider a complete listing of all Participants
by Program for which Covered Home Care Services are to be available and
will subsequently provide weekly updates of Participant additions and
deletions in standard CIGNA format. CIGNA shall also deliver to
Provider prior to the start date at a Service Area a listing of all
current Participating Providers by Program and will subsequently
provide weekly updates of Participating Provider additions and
deletions in standard CIGNA format. Provider will establish or delete
the Participating Provider status of such Providers within five (5)
business days of notification.
11. Provider shall maintain qualified and experienced personnel, including
a registered pharmacist and IV specialty nurse or certified registered
nurse on call on a 24-hour per day, seven day per week basis to respond
to emergencies and questions (including, but not limited to,
consultations on IV therapies and instructions regarding the use of
Home Medical Equipment) as they pertain to Covered Home Care Services
provided to Participants by Provider or Subcontractor pursuant to this
Agreement.
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12. Provider shall deliver Covered Home Care Services to Participants
within twenty-four (24) hours of receiving a Routine Complete Order or
at the time such services are requested delivered, whichever is later,
within four (4) hours for Urgent Complete Orders or at the time such
services are requested delivered, whichever is later, and within two
(2) hours for STAT Complete Orders. In those instances where the
Covered Home Care Service referred to Provider is to be rendered by a
Subcontractor, Provider shall immediately notify the Subcontractor of
the referral and, to the extent applicable, the Subcontractor shall
immediately attempt to make contact with the referring physician and
immediately return phone calls from the referring physician in order to
confirm the physician order.
13. Provider shall provide or arrange for the following services with
respect to Participants receiving Covered Home Care Services:
(a) training and education;
(b) family orientation;
(c) family/caregiver training, if required;
(d) instructional literature; and
(e) oxygen patient assessments, if required.
These services shall not be to the exclusion of any other services set
out in this Agreement or any other services customarily incident to the
rendering of Covered Home Care Services.
14. Provider shall provide or arrange for Home Medical Equipment in good
working order and condition and ensure that Home Medical Equipment has
been properly cleaned and disinfected between uses. Provider shall
provide or arrange for at Provider's expense all necessary on-site
maintenance and/or repair for Home Medical Equipment (including
provision of all necessary puts, mechanisms and devices) in order to
maintain the Home Medical Equipment in good condition and working
order. Provider shall provide or arrange for twenty-four (24) hour per
day, seven (7) day per week maintenance and repair service, provided
however, that Provider may elect to pick up the Home Medical Equipment
needing maintenance and/or repair and replace it with Home Medical
Equipment in operable condition, rather than repair the Home Medical
Equipment immediately.
15. Provider shall maintain or arrange for the maintenance of an accurate
inventory of solutions, medications, drugs, Home Medical Equipment and
ancillary supplies for each Participant and shall make these inventory
records available to CIGNA upon request.
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16. Provider shall ensure that its facilities and employees, and require
that the facilities and employees of its Subcontractors, maintain a
neat, clean and professional appearance at all times.
17. Provider will dedicate on a full-time basis (and part-time, as
required) the services of appropriate personnel to coordinated the
implementation of this Agreement on both local and national levels, and
to manage the day-to-day work relationship with CIGNA. Provider will
meet with designated CIGNA personnel upon request to review Provider
performance, Participant utilization and quality improvement
initiatives.
18. Provider will educate CIGNA case managers and CIGNA discharge planners
on the capabilities of home care providers. Provider will identify
potential home care candidates as early as possible in the hospital
stay and prepare for the discharge. CIGNA and Provider acknowledge that
none of the activities of their respective personnel described in this
section will substitute for the discharge planning obligations imposed
on Participating Hospitals by Medicare and/or Medicaid.
19. Provider will meet with CIGNA on at least a quarterly basis to assist
CIGNA in staying abreast of innovations in home care services
(including drug protocols) and to assure that these services are being
appropriately applied to Participants.
20. Provider will dedicate personnel to travel to any Service Area location
or to CIGNA Health Corporation's home office on twenty-four hours'
notice to resolve CIGNA's repeated dissatisfaction with Provider. Said
personnel will include at least one officer of Olsten Kimberly
QualityCare.
21. Provider will provide a home care coordinator who shall be a registered
nurse in each CIGNA healthplan location in which there are a combined
minimum of 75,000 Participants in the HMO, Medicare and Medicaid
Programs and, in those healthplan locations in which there are less
than 75,000 such Participants, in each region where there are a
combined minimum of 75,000 such Participants. Such regions will be
defined and mutually agreed upon by both parties during the
implementation process. Costs for such staffing are included in the
rates set forth in the exhibits to the Attachments to this Agreement.
B. REPORTING/DATA ACCESS
1. Provider's compensation for the reports, studies, information exchanges
and data access delineated in this section II.B and associated exhibits
is fully incorporated in the rates and/or fee schedules defined in each
Program Attachment and associated exhibits attached hereto. Provider
shall receive no additional compensation for the reports,
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studies, information exchanges and data access delineated in this
section II.B and associated exhibits.
2. Provider agrees to collect data for each data element listed in Exhibit
VII.
3. Provider agrees to provide CIGNA with reports in a form, a format and
in frequencies mutually determined by the parties during the
implementation process. Said reports shall be consolidated reports,
incorporating all data from Provider and its Subcontractors.
4. Provider agrees to provide CIGNA, on a quarterly basis, a listing of
Home Medical Equipment currently in use by Participants in each
Program, including the number of months Participants have had the Home
Medical Equipment.
5. Provider will conduct quality assurance studies (including both
clinically-based studies and process improvement initiatives) on
Participants on a quarterly basis, and report to CIGNA the results of
such studies each quarter. CIGNA may conduct home care service
satisfaction surveys on Participants, Participating Providers and CIGNA
personnel and will supply Provider with the results of any such
satisfaction surveys. The format of the quality assurance surveys shall
be mutually developed by the parties. The format of the home care
service satisfaction surveys, will be developed by CIGNA with input
from Provider.
6. Provider agrees to furnish ad hoc reports to CIGNA upon reasonable
request by CIGNA to an individual designated by Provider. Provider
agrees to provide most simple ad hoc reports requested within 2 to 5
working days.
7. Provider agrees to allow CIGNA electronic access to utilization data on
Participants as needed and as technologically feasible. Provider shall
work in good faith to assure that such access is technologically
feasible and shall make any reasonable capital expenditures necessary
to enhance its systems in order to enable such access by April 1, 1997.
8. Provider agrees to share with CIGNA all on-line data and all
information relating to Participants, including but not limited to,
intake, patient status, utilization, outcomes, clinical records,
billing and cost information, subject to any applicable confidentiality
obligations and as technologically feasible. Provider agrees to work in
good faith to assure that such access is technologically feasible and
shall make any reasonable capital expenditures necessary to enhance its
system in order to enable such access by April 1, 1997.
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9. Provider agrees to provide on-line access to Gold Standard forms and
HEAT system screens describing information about Participants and
caregivers as required by CIGNA, subject to the obligation to maintain
the confidentiality of such forms and screens as set forth in Section
II.D.5. of this Agreement.
10. The parties acknowledge and agree that all of the data, information,
studies and reports relating to Participants and referenced in this
Section II.B.2. or elsewhere in this Agreement:
a. shall be jointly owned by CIGNA and Provider;
b. with respect to such data, information, studies and reports
which identify the other party, Participants or parties with
whom CIGNA has Service Agreements by name, shall not be used,
disclosed or sold by either party (unless such identity shall
have been deleted) except as otherwise agreed. This provision
shall not apply:
(i) to the extent the use or disclosure of such data,
information, studies, or reports is required to
fulfill obligations hereunder, obligations to
Participants and parties with whom CIGNA has Service
Agreements or any other obligation imposed by law; or
(ii) with respect to usage of such data, information,
studies and reports for internal measurement
purposes.
This provision shall survive the termination of this Agreement and
shall not prohibit disclosures by either party to its subsidiaries or
affiliates. Upon request by CIGNA and free of charge, Provider will
provide CIGNA with copies of all materials sold by Provider to third
parties containing such data, information, studies and reports.
11. Provider agrees that all electronic data which Provider is required to
maintain and/or permit access to under this Agreement shall include the
century (MMDDCCYY) and that, by December 31, 1999, all system logic
used by Provider with regard to all of such data shall be century
compliant (i.e. 19xx can roll correctly to 20xx).
C. COMPENSATION AND BILLING
1. CIGNA will compensate Provider for Covered Home Care Services rendered
to Participants in accordance with this Agreement. Specific
compensation arrangements and rates for each Program are delineated in
the applicable Program Attachments and in the exhibits associated with
such Program Attachments. Provider will look solely to CIGNA, and not
to the parties with whom CIGNA has Service Agreements, for com-
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pensation for such Covered Home Care Services, excluding any
Copayments, Deductibles or Coinsurance due from Participants. CIGNA
represents that payments made hereunder shall be made by CIGNA either
for or on behalf of full service health maintenance organizations or a
licensed insurance company or relate to services which are referenced
in reports filed by full service health maintenance organizations with
applicable regulatory authorities.
2. Provider shall comply with the limitations on billing Participants as
set forth in the Agreement and applicable Program Attachments.
3. Provider may bill an individual directly for any services provided
following the date the individual ceases to be a Participant. CIGNA has
no obligation under this Agreement to pay for services rendered to
individuals who no longer are Participants. This provision shall not be
construed to relieve CIGNA of its obligation to notify Provider when an
individual ceases to be a Participant as set forth in Section II.A.10.
of this Agreement.
4. Provider will be responsible for all compensation to its Subcontractors
for Covered Home Care Services provided to Participants under this
Program. Subcontractors shall be reimbursed for Covered Home Care
Services rendered in accordance with the requirements set forth in
Exhibit VIII. CIGNA will not accept billing from, or directly
reimburse, any Subcontractor or any other home care agency for Covered
Home Care Services rendered to Participants under this Agreement. CIGNA
will only accept billing for Covered Home Care Services from either of
Provider's two centralized Provider billing locations unless otherwise
agreed by CIGNA.
5. Provider shall grant CIGNA reasonable access during regular business
hours to all records maintained respecting payments received by
Provider and, to the extent required by any applicable laws,
regulations or the applicable governmental authority, including but not
limited to HCFA, by Subcontractors for the rendering of Covered Home
Care Services during the term of this Agreement. CIGNA shall have the
right to conduct periodic audits of such records to determine if
amounts have been properly paid to Provider under this Agreement. CIGNA
shall present Provider with the results of any such audits, and any
amounts determined to be due and owing as a result of such audits shall
be promptly paid, or, at the option of the party to whom such amounts
are owed, offset against amounts due and owing by such party hereunder.
This provision shall survive the termination of the Agreement.
6. CIGNA shall notify Provider of any applicable limitations on coverage
for Covered Home Care services to Participants under specific Programs.
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7. With respect to the PPO and Indemnity Programs, the parties agree to
work in good faith toward the implementation of regional
fee-for-service rates with respect to Home Health Services in lieu of
the composite rate structure set forth in the PPO and Indemnity Program
Attachments. Any such regional fee-for-service rates must be revenue
neutral and shall only be effective upon amendment to this Agreement.
This provision shall not be construed to require CIGNA to incur
significant expenditures in order to enable CIGNA to administer such
regional fee-for-service rates.
8. Provider agrees that the reimbursement rates set forth in the PPO
Program Attachment shall also apply with respect to any Home Care
Services referred to Provider which are not Covered Home Care Services
and which are rendered by Provider or its Subcontractors to
Participants and that Provider shall accept such rates as payment in
full from such Participants.
D. RECORDS
1. CIGNA, Provider and Subcontractors agree that clinical records of
Participants and any other records containing individually identifiable
information relating to Participants shall be regarded as confidential,
and each shall comply with all applicable federal and state laws and
regulations regarding such records. This provision shall survive the
termination of this Agreement.
2. Provider and Subcontractors shall maintain and furnish such records and
documents as may be required by applicable laws, regulations and
Program Requirements. CIGNA, Provider and Subcontractors shall
cooperate with each other to facilitate the information and record
exchanges necessary for CIGNA's or Provider's conduct of Quality
Management, Utilization Management, peer review, or other programs
required for CIGNA's or Provider's operations related to performance
under this Agreement.
3. Provider and Subcontractors shall provide CIGNA, its designee and duly
authorized third parties, including, but not limited to, applicable
governmental regulatory agencies, with reasonable access during regular
business hours to specified clinical, medical and other records
relating to Covered Home Care Services rendered to Participants under
this Agreement, subject to applicable confidentiality obligations. Such
access shall be provided within the time frames specified by the
governmental regulatory authority requesting such access or, if such
access is requested by CIGNA only, upon reasonable notice by CIGNA.
This provision shall survive the termination of this Agreement.
4. CIGNA shall be responsible for obtaining Participant's consent to the
release of medical record information by Provider or its Subcontractors
for the purposes stated in this section.
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5. The parties acknowledge that, as a result of this Agreement, each may
have access to certain trade secrets and other confidential and
proprietary information of the other. Each party shall hold such trade
secrets and other confidential and proprietary information, including
the terms and conditions of this Agreement, in confidence and shall not
disclose such information, either by publication or otherwise, to any
person or use such information without the prior written consent of the
other party except as may be required by law and except as may be
required to fulfill the rights and obligations set forth in this
Agreement. This provision shall survive the termination of this
Agreement.
E. PARTICIPANT GRIEVANCE
Provider and Subcontractors shall cooperate with CIGNA in the
implementation of its Participant grievance procedure and shall assist
CIGNA in taking appropriate corrective action. CIGNA shall make the
final determination under such grievance procedure. CIGNA shall provide
Provider with a copy of its Participant grievance procedure and shall
notify Provider of any material changes to such procedure.
F. INSURANCE AND LIABILITY
1. Throughout the term of this Agreement, Provider shall maintain at its
expense general and professional liability coverage of at least
$2,000,000 per claim/$5,000,000 aggregate and shall require its
Subcontractors to maintain general and professional liability coverage
of at least $1,000,000 per claim/$3,000,000 aggregate. Provider shall
give CIGNA certificates of insurance evidencing such coverage upon
request. Provider shall give CIGNA thirty (30) days' prior written
notice of cancellation, modification or termination of its insurance.
Provider shall require its Subcontractors to give Provider thirty (30)
days' prior written notice of cancellation, modification or termination
of such insurance, and Provider shall notify CIGNA of any such
cancellation, modification or termination upon receipt of notification
from its Subcontractor. Provider shall give CIGNA prompt written notice
of any material claims or claims for which NCQA guidelines recommend
disclosure against Provider's or Subcontractor's liability coverage.
2. In connection with any complaint or investigation with or by any
licensing or regulatory authority, peer review organization, hospital
committee, or other committee, organization or body which by law
regulates the Provider's or Subcontractor's quality of medical care
which complaint or investigation directly or indirectly evaluates or
focuses on the quality of care provided by Provider or Subcontractors
at locations providing or contemplated to provide services hereunder:
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a. prior to April 1, 1996, Olsten shall notify CIGNA of any such
complaint or investigation which is material and which
occurred within the 2 year period preceding the Effective Date
and shall provide an explanation of the status or resolution
of such investigation or complaint; and
b. during the term of this Agreement, Provider shall notify CIGNA
immediately upon becoming aware of the initiation of any such
complaint or investigation which is material.
G. INDEMNIFICATION
1. Each party agrees to indemnify, defend and hold harmless the other, its
agents and employees from and against any and all liabilities, causes
of action, penalties, losses and expenses of any nature, including but
not limited to court costs and reasonable attorney fees, including but
not limited to bodily injury, death, personal injury, property damage
or other damages, arising out of its negligence or willful misconduct
in connection with its performance under this agreement, except to the
extent that the liability results from the negligence or willful
misconduct of the other party, its agents or its employees.
2. Notice. The party seeking indemnification ("Indemnitee") shall
promptly, and within 15 days after notice to it (notice to Indemnitee
with respect to third-party claims being the filing of any legal
action, receipt of any claim in writing, or similar form of actual
notice) of any claim as to which it asserts a right to indemnification,
notify the party or parties from whom indemnification is sought
("Indemnitor") of such claim. Indemnitee shall set forth in such notice
the section of this Agreement under which the indemnification is
claimed, factual support and information regarding the claim, and the
amount of such claim. The failure of Indemnitee to give such notice
under this Section shall not relieve Indemnitor from any liability that
it may have pursuant to this Agreement except to the extent the failure
to give such notice within such time shall have been prejudicial to it,
and in no event shall the failure to give such notice relieve
Indemnitor from any liability it may have other than pursuant to this
Agreement.
3. Third-Party Claims. If any claim for indemnification by Indemnitee
arises out of a claim for monetary damages by a person other than
Indemnitee, Indemnitor may, by written notice to Indemnitee, undertake
to conduct any proceedings or negotiations in connection therewith or
necessary to defend Indemnitee and take all other steps or proceedings
to settle or defeat any such claims or to employ counsel to contest any
such claims; provided, however, that Indemnitor shall reasonably
consider the advice of Indemnitee as to the defense of such claims, and
Indemnitee shall have the right to participate, at its own expense, in
such defense, but control of such litigation and set-
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tlement shall remain exclusively with Indemnitor. Indemnitee shall
provide all reasonable cooperation in connection with any such defense
by Indemnitor. Counsel and auditor fees, filing fees, and court fees in
all proceedings, contests, or lawsuits with respect to any such claim
or asserted liability shall be borne by Indemnitor. To the extent that
Indemnitor undertakes the defense of such claim by written notice to
Indemnitee and diligently pursues such defense at its expense,
Indemnitee shall be entitled to indemnification hereunder only to the
extent that such defense is unsuccessful as determined by a final
judgment of a court of competent jurisdiction or to the extent
Indemnitor acknowledges liability and/or agrees to make payment to the
third party pursuant to a settlement agreement between the Indemnitor
and the third party relating to such claim.
H. INSPECTIONS
Upon reasonable notice and at reasonable hours, CIGNA or its agents may
inspect Provider's or any Subcontractor's premises and operations to
ensure that they are adequate to meet Participants' needs.
I. PERFORMANCE GUARANTEES
Provider shall perform its obligations under this Agreement in
accordance with the standards set forth in Exhibit IX. In the event
that Provider fails to achieve a performance standard set forth in
Exhibit IX, the amounts due Provider as set forth in the Program
Attachments of this Agreement shall be reduced in accordance with the
formula set forth in Exhibit IX.
J. REPRESENTATIONS
CIGNA makes no representations or guarantees concerning the number of
Participants it can or will refer to Provider under this Agreement.
Notwithstanding the foregoing, subject to the exclusions and
limitations set forth in Exhibit X and, with respect to the HMO,
Medicare Risk, Medicaid Risk and PPO Programs only, CIGNA agrees that,
during the term of this Agreement, it shall not contract with any third
party for the provision of the Covered Home Care Services which are the
subject of this Agreement in those Service Areas for which Provider
shall have commenced rendering Covered Home Care Services under this
Agreement and for which all transitioning care has been completed. This
provision shall not prohibit or restrict CIGNA from contracting with
others with regard to services which Provider does not provide or
arrange for or services, which are not included within the scope of
this Agreement.
CIGNA shall cause its affiliate Intracorp to refer to Provider all
CIGNA Indemnity Program Participants referred to or identified by
Intracorp to utilize Covered Home
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Care Services when the utilization review/case management contract
applicable to the Participant is between CIGNA and the party with which
CIGNA has the Service Agreement.
K. BEST RATE GUARANTEE
Provider warrants that the rates, terms and benefits granted by
Provider as set forth in this Agreement, viewing the package of
services hereunder as a whole, are equivalent to, or better than, the
rates, terms, benefits being offered by Provider to any company in any
area which is contained within or overlaps a CIGNA Service Area which
purchases services similar to those provided under this Agreement,
viewing the package of such services as a whole. If Provider, during
the term of this Agreement, enters into agreements with any other
company which provides greater benefits or more favorable terms or
rates with respect to like obligations of Provider and like rights of
CIGNA, viewing the package of services provided hereunder as a whole,
Provider shall notify CIGNA immediately upon consummation of such
agreement and at least 30 days prior to the effective date of such
agreement. This Agreement shall thereupon be deemed automatically
amended to provide the same advantages to CIGNA. This provision shall
be enforceable to the extent permitted by applicable law.
L. STATE SPECIFIC PROVIDER AGREEMENT REQUIREMENTS
The parties agree to amend this Agreement and Provider shall amend its
contracts with its Subcontractors to the extent necessary to articulate
any provider contract requirements absent from this Agreement or
Provider's agreements with its Subcontractors and required by
applicable law, regulation or the applicable regulatory authority,
including but not limited to, HCFA.
III. MISCELLANEOUS OBLIGATIONS
A. INDEPENDENT CONTRACTOR RELATIONSHIP
1. This Agreement is not intended to create nor shall be construed to
create any relationship between CIGNA and Provider other than that of
independent persons or entities contracting for the purpose of
effecting provisions of this Agreement. Neither party nor any of their
representatives shall be construed to be the agent, employer, employee
or representative of the other.
2. Nothing in this Agreement, including Provider's and Subcontractor's
participation in the Quality Management and Utilization Management
process, shall be construed to interfere with or in any way affect
Provider's or Subcontractor's obligation to exercise independent
medical judgement in rendering health care services to Participants,
and
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CIGNA agrees to adhere to its obligations to Participants under its
Service Agreements.
B. TERM OF AGREEMENT
This Agreement shall begin on January 1, 1996 and shall continue
through December 31, 1998 and then from year to year thereafter, unless
terminated as set forth below.
C. TERMINATION
1. For Cause. Provider or CIGNA may terminate this Agreement at any time
for cause. Cause for termination includes, but is not limited to, the
following:
a. Significant failure of CIGNA to make required compensation
payments to Provider. Only Provider may terminate pursuant to
this subsection.
b. Failure of either party to comply with applicable laws or
regulations.
c. Habitual neglect or continued failure by either party to
perform its duties under this Agreement.
d. Material breach of this Agreement by either party.
e. Failure by Provider to maintain licenses required to perform
its duties under this Agreement.
f. Failure of CIGNA to maintain licenses or certifications
required to operate in conformity with this Agreement,
g. Failure of Provider to maintain required liability coverage
protection.
h. Material adverse change in financial condition or insolvency
of either party.
i. Any material misrepresentation or falsification of any
information supplied by Provider for consideration by CIGNA in
Provider's becoming a Participating Provider.
Any occurrence under paragraphs (e) through (i) above shall be grounds
for immediate termination. Termination for any other reason set forth
above shall be upon thirty (30) days' prior written notice by the
terminating party, provided that the non-terminating party will have
the opportunity to cure the breach or occurrence within the thirty-day
period.
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2. Without Cause. Commencing eight (8) months after the Effective Date,
this Agreement may be terminated at any time without cause or prejudice
upon one hundred and twenty (120) days' prior written notice by either
party.
3. Termination of Subcontractors. Upon reasonable request by CIGNA,
Provider shall prohibit a Subcontractor or Provider location from
continuing to provide services to Participants under this Agreement.
Provider shall take such action within 30 days of the receipt of
CIGNA's request, unless CIGNA requests immediate action.
4. Termination for Nonpayment of Subcontractors by Provider. Provider
shall promptly notify CIGNA in the event that Provider is in
significant default of its obligations to any Subcontractor with
respect to services rendered hereunder. If Provider fails to cure such
default within 15 days of receipt of notice of the default from the
respective Subcontractor, CIGNA may elect to terminate this Agreement
effective on a date determined by CIGNA which date shall be no earlier
than 30 days but not later than 120 days after CIGNA's notification to
Provider of its election to terminate pursuant to this provision.
During the time between CIGNA's election to terminate and CIGNA's
designated effective date of termination, CIGNA may elect to direct any
and all payments due Provider for services rendered hereunder by
Subcontractors directly to Subcontractors. Such payments shall be made,
at CIGNA's election, either in accordance with the reimbursement
arrangements set forth in Provider's provider agreements with its
Subcontractors or in accordance with the reimbursement rates set forth
in the PPO Program Attachment to this Agreement. CIGNA's payment
obligations to Provider hereunder shall be reduced to the extent of
such payments.
5. Termination of Individual Program Attachments. Program Attachments may
be terminated individually by amendment as provided in Section III.H.
of this Agreement. Termination of any individual Program Attachment
will not have the effect of terminating the entire Agreement and all
remaining Sections and Program Attachments of the Agreement will remain
in full force.
6. Termination Due To Material Issues Arising During Implementation. If,
during the implementation of this Agreement but prior to the start date
at any Service Area, a material issue or issues arise between the
parties relating to the parties' obligations under this Agreement which
issue(s) the parties are unable to resolve, either party may terminate
this Agreement upon 60 days, prior written notice to the other party,
provided that this Agreement shall not terminate if the parties resolve
such material issue(s) within such 60 days. The parties agree to use
best efforts to resolve any such material issue within such 60-day
period.
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D. RIGHTS AND OBLIGATIONS UPON TERMINATION
Upon termination of this Agreement for any reason, the rights of each
party hereunder shall terminate, except as otherwise provided in the
Agreement including any Program Attachment. Any such termination,
however, shall not release Provider or its Subcontractors or CIGNA from
obligations under this Agreement prior to the effective date of
termination.
E. ASSIGNMENT AND DELEGATION OF DUTIES
Neither CIGNA nor Provider may assign duties, rights or interests under
this Agreement unless the other party shall so approve by written
consent, provided, however, that any reference to CIGNA or Provider
herein shall include any successor in interest and that CIGNA or
Provider may assign its duties, rights and interests under this
Agreement in whole or in part to its wholly owned subsidiaries or
affiliates under common control or may delegate any and all of its
duties in the ordinary course of business, but in any such case the
respective party to this Agreement shall remain bound by its
obligations and liabilities hereunder.
F. USE OF NAME
Provider and Subcontractors agree that Provider's and Subcontractors'
name, office telephone number, address, specialty, and professional
certification may be included in literature distributed to existing or
potential a) Participants; b) Participating Providers; c) Payors; d)
parties with Service Agreements; and e) brokers, provided that such
literature does not utilize Provider's name in a form materially
different from the form approved by Provider and that such literature
does not materially misrepresent the nature and scope of the services
rendered by Provider hereunder. With respect to such literature, CIGNA
agrees to direct its sales offices to utilize the approved form of
Provider's name and to describe the services rendered by Olsten
hereunder in a manner consistent with an approved description of such
services. Provider's or Subcontractors' use of CIGNA's name or CIGNA
Affiliate's name, or any other use of Provider's or Subcontractors'
name by CIGNA shall require written approval, which approval shall not
be unreasonably withheld.
G. INTERPRETATION
The validity, enforceability and interpretation of this Agreement shall
be governed by any applicable federal law and by the applicable laws of
the State of Connecticut.
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H. AMENDMENT
1. CIGNA may amend this Agreement and Program Attachments by providing
prior written notice to Provider. Failure of Provider to object in
writing to any such proposed amendment within sixty (60) days following
receipt of notice shall constitute Provider's acceptance thereof.
Notification to CIGNA of rejection of any proposed amendment means that
this Agreement shall remain in force without the proposed amendment.
2. In the event that a change in state or federal law or regulation should
materially adversely affect either party, the affected party shall
notify the other, and both parties agree to negotiate in good faith to
amend the Agreement accordingly, while at the same time trying to
preserve the economic expectations of the parties to the greatest
extent possible under these new circumstances. If the parties cannot
agree to amend the Agreement, the affected party may terminate this
Agreement pursuant to the Without Cause termination provision set forth
in Section III.C.2. The provisions of this paragraph shall not in any
way limit the parties' rights under other termination provisions of
this Agreement.
3. Except as provided above, amendments to this Agreement shall be agreed
to in advance in writing by CIGNA and Provider.
I. PROGRAM ATTACHMENTS AND EXHIBITS
The Program Attachments and Exhibits hereto are a part of this
Agreement and their terms shall supersede those of other parts of this
Agreement in the event of a conflict.
J. ENTIRE CONTRACT
This Agreement together with all Program Attachments contains all the
terms and conditions agreed upon by the parties, and supersedes all
other agreements, expressed or implied regarding the subject matter.
K. NOTICE
Any notice required hereunder shall be in writing and shall be sent by
United States certified or registered mail, postage prepaid, to the
following individuals at the following addresses: John Perlstein, CIGNA
Health Corporation, 900 Cottage Grove Road, Bloomfield, CT 06002; and
Robert Fusco, President, Kimberly Home Health Care, Inc., 175 Broad
Hollow Road, Melville, NY 11747. A copy of any such notice to Provider
shall be sent to: Kimberly Home Health Care, Inc., 175 Broad Hollow
Road, Melville, NY 11747, Attention: Law Department.
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A copy of any such notice to CIGNA will be sent to: CIGNA Health
Corporation, 900 Cottage Grove Road, Bloomfield, CT 06002, Attention:
Legal Division, W-26.
L. ENFORCEABILITY AND WAIVER
The invalidity and nonenforceability of any term or provision of this
Agreement shall in no way affect the validity or enforceability of any
other term or provision. The waiver by either party of a breach of any
provision of this Agreement shall not operate as or be construed as a
waiver of any subsequent breach thereof.
M. REGULATORY APPROVAL
In the event that CIGNA or Provider has not been licensed or has not
received any applicable regulatory approval for use or implementation
of this Agreement prior to the execution of this Agreement, this
Agreement shall be deemed to be a binding letter of intent with respect
to the state(s) in which such licensure or approval has not been
received. In such event, the Agreement shall become effective in such
state(s) on the date that such regulatory approval or licensure is
obtained. If CIGNA or Provider is unable to obtain such licensure or
approval in any such state(s) after due diligence or if the respective
party subject to such licensure or approval reasonably determines that
obtaining such licensure or approval shall be unduly burdensome, CIGNA
or Provider, as the case may be, shall notify the other party and both
parties shall use best efforts to work to modify this Agreement to the
extent necessary to comply with applicable regulatory requirements
while at the same time preserving the economic expectations of the
parties to the extent possible.
N. DISPUTE RESOLUTION
1. The parties agree to meet and confer in good faith to resolve any
problems or disputes that may arise under this Agreement. The parties
agree to fully utilize, and to comply with, the procedures delineated
in applicable Program Requirements in attempting to resolve categories
of disputes specified in such Program Requirements.
2. If the dispute is not resolved through the aforementioned processes and
to the extent permitted by law, the matter in controversy shall be
submitted to the National Health Lawyers' Association Alternative
Dispute Resolution Service in New York, New York. Both parties
expressly covenant and agree to be bound by the decision of that
dispute resolution entity as final determination of the matter in
dispute. Each party shall assume its own costs, but shall share the
cost of the resolution entity equally. Judgment upon the award rendered
by the resolution entity may be entered in any court having
jurisdiction.
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O. THIRD PARTY BENEFICIARIES
This Agreement is not intended to and shall not confer any rights to
any person or entity not a party to this Agreement except that the
Participant hold harmless provisions in the Attachments to this
Agreement are intended for the benefit of Participants.
[REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK]
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In WITNESS WHEREOF, the parties hereto have executed and delivered this
Agreement as of the date below.
CIGNA HEALTH CORPORATION
DATE: By:
----------------------------------
W. Allen Schaffer, MD
President
- ------------------------------ CIGNA Health Corporation
900 Cottage Grove Road
Bloomfield, CT 06002
KIMBERLY HOME HEALTH CARE, INC.
DATE: By:
----------------------------------
Robert Fusco
President
- ------------------------------ Kimberly Home Health Care, Inc.
D/B/A Olsten Kimberly QualityCare
175 Broad Hollow Road
Melville, NY 11747
-------------------------------------
Federal Tax Identification Number
-28-
NATIONAL HOME CARE PROVIDER AGREEMENT
EXHIBIT I.
PARTICIPATING CIGNA SUBSIDIARIES AND AFFILIATES
Connecticut General Life Insurance Company
CIGNA HealthCare of Arizona, Inc.
Arizona Health Plan, Inc.
CIGNA HealthCare of California, Inc.
CIGNA HealthCare of Colorado, Inc.
CIGNA HealthCare of Connecticut, Inc.
CIGNA HealthCare of Delaware, Inc.
CIGNA HealthCare of Illinois, Inc.
CIGNA HealthCare of Florida, Inc.
CIGNA HealthCare of Georgia, Inc.
CIGNA HealthCare of Kansas/Missouri, Inc.
CIGNA HealthCare of Louisiana, Inc.
CIGNA HealthCare of North Louisiana, Inc.
CIGNA HealthCare MidAtlantic, Inc.
CIGNA HealthCare of Massachusetts, Inc.
CIGNA HealthCare of St. Louis, Inc.
CIGNA HealthCare of Northern New Jersey, Inc.
CIGNA HealthCare of New Jersey, Inc.
Lovelace Health System, Inc.
CIGNA HealthCare of New York, Inc.
CIGNA HealthCare of North Carolina, Inc.
CIGNA HealthCare of Ohio, Inc.
CIGNA HealthCare of Oklahoma, Inc.
CIGNA HealthCare of Pennsylvania, Inc.
CIGNA HealthCare of Tennessee, Inc.
CIGNA HealthCare of Texas, Inc.
CIGNA HealthCare of Utah, Inc.
CIGNA HealthCare of Virginia, Inc.
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NATIONAL HOME CARE PROVIDER AGREEMENT
EXHIBIT II.
PARTICIPATING OLSTEN SUBSIDIARIES AND AFFILIATES
Kimberly Home Health Care, Inc.
Olsten Certified Healthcare Corp.
Olsten Flying Nurses Corp.
Olsten Services of New York, Inc.
Olsten Home Healthcare, Inc.
New York Healthcare Services, Inc.
QC Medi - New York, Inc.
Quality Care - USA, Inc.
-30-
NATIONAL HOME CARE PROVIDER AGREEMENT
EXHIBIT III.
INFORMATION REQUIRED FOR COMPLETE ORDER
Requested start of care ("SOC")/Actual SOC date (actual if current client)
Last Name, First Name, MI, Phone #
Address where service is to be rendered
Facility, Facility Discharge Date
Facility Name, Phone #
Date of Birth/Age, Sex, SS#, Marital Status
Ordering Physician, Phone #
Home Care Personnel (specify. type)
Home Medical Equipment
Infusion Product
All pertinent diagnoses and/or surgical procedures with onset and/or
exacerbation dates
Allergies (Infusion Therapy)
Specific Orders/Treatment: (note: Subcontractor must contact physician and/or
physician's agent directly to obtain/validate all orders)
Has client taken ordered drug(s) before.? Y, N, comment
Venous/other access established? Y, N, if Yes, date placed, type ordered, gauge
if applicable (1st Dose)
Anaphylaxis Order - Y, not applicable (1st Dose)
Anaphylaxis medications/dosage/route (1st Dose)
Primary Plan, ID#
-31-
NATIONAL HOME CARE PROVIDER AGREEMENT
EXHIBIT IV.
EXCLUSIONS FROM HOME CARE SERVICES
Home Care Services do not include:
1. the prenatal risk assessment, counseling and education
services provided by Tokos, Inc. or others to Participants.
2. those Home Care Services where the provision of such Home Care
Services in the home setting (or ambulatory setting, with
respect to Home Infusion Therapy) would be unsafe for the
Participant or Provider personnel.
3. assistance in the activities of daily living including but not
limited to eating, bathing, dressing or other custodial or
self-care activities, homemaker services, and services
primarily for rest, domiciliary or convalescent care.
4. care required to be rendered in a skilled nursing facility or
other medical facility except in preparation for the
transition of care into the home setting. This exclusion shall
not be interpreted to exclude care required to be rendered in
a residential facility where the residential facility is the
permanent home of the Participant.
5. care covered under a Participant's mental health benefit
program
6. hospice care to the extent such care requires a hospice
license or certification to deliver or the Participant is
admitted to a hospice facility and the service is covered as
part of a hospice program. This exclusion shall not be
interpreted to exclude those services which are normally
provided in a home care setting by an entity not required to
be licensed or certified as a hospice and which happen to be
rendered to a Participant who is terminally ill, which
services include but are not limited to, medical social work
services.
7. Experimental services.
-32-
NATIONAL HOME CARE PROVIDER AGREEMENT
EXHIBIT V.
HOME INFUSION THERAPY DRUGS AND MEDICATIONS
DRUG BILLING
DRUG/THERAPY DESCRIPTIONS BRAND NAMES CLASSIFICATION* UNITS
- ------------------------- ----------- -------------- -----
ANTIHISTAMINE DRUGS
Diphenhydramine Hydrochloride Benadryl Ancillary x mg
ANTI-INFECTIVES
AMINOGLYCOSIDES
Amikacin Sulfate Amikin Anti-Infectives x mg
Gentamicin Sulfate Garamycin Anti-Infectives x mg
Kanamycin Sulfate Kantrex Anti-Infectives x mg
Netilmicin Netromycin Anti-Infectives x mg
Tobramycin Sulfate Nebcin Anti-Infectives x mg
ANTIFUNGAL AGENTS
Amphotericin B Fungizone Anti-Infectives x mg
Fluconazole Diflucan Anti-Infectives x mg
CEPHALOSPORINS
Cefamandole Nafate Mandol Anti-Infectives x.x gm
Cefazolin Sodium Ancef/Kefzo1 Anti-Infectives x.x gm
Cefonicid Sodium Monocid Anti-Infectives x.x gm
Cefoperazone Sodium Cefobid Anti-Infectives x.x gm
Cefotaxime Sodium Claforan Anti-Infectives x.x gm
Ceftazidime Ceptaz/Fortaz/Tazidime Anti-Infectives x.x gm
Cefizoxime Sodium Cefizox Anti-Infectives x.x gm
Ceftriaxone Sodium Rocephin Anti-Infectives x.x gm
Cefuroxime Sodium Zinace/Kefurox Anti-Infectives x.x gm
MISCELLANEOUS B-LACTAMS
Aztreonam Azactam Anti-Infectives x.x gm
Cefmetazole Sodium Zefazone Anti-Infectives x.x gm
Cefotetan Disodium Cefotetan Anti-Infectives x.x gm
Cefoxiten Sodium Mefoxin Anti-Infectives x.x gm
Imipenam and Cilastatin Sodium Primaxin Anti-Infectives x.x gm
CHLORAMPHENICOL
Chloramphenicaol Chloromycetin Anti-Infectives x.x gm
MACROLIDES
Erythromycin Lactobionate Erythrocin Anti-Infectives x.x gm
PENICILLINS
Penicillin G Potassium Penicillin Anti-Infectives x Million Uni
Penicillin V Potassium Penicillin Anti-Infectives x Million Uni
Methicillin Sodium Staphcillin Anti-Infectives x.x gm
Nafcillin Sodium Unipen Anti-Infectives x.x gm
Oxacillin Sodium Bactocil Anti-Infectives x.x gm
Ampicillin Sodium Omnipen Anti-Infectives x.x gm
Ampicillin Sodium and Sulbactam Sodium Unasyn Anti-Infectives x.x gm
Mezlocillin Sodium Mezlin Anti-Infectives x.x gm
Piperacillin Sodium Pipracil Anti-Infectives x.x gm
Piperacillin Sodium and Tazobactam Sodium Zosyn Anti-Infectives x.x gm
Ticarcillin Disodium Ticar Anti-Infectives x.x gm
Ticarcillin Disodium and Clavulanate Potassium Timentin Anti-Infectives x.x gm
-33-
DRUG BILLING
DRUG/THERAPY DESCRIPTIONS BRAND NAMES CLASSIFICATION* UNITS
- ------------------------- ----------- -------------- -----
MISCELLANEOUS ANTIBIOTICS
Clindamycin Hydrochloride Cleocin Anti-Infectives x mg
Vancomycin Hydrochloride Lyphocin/Vancocin Anti-Infectives x.x gm
ANTIVIRALS
Acyclovir Zovirax Anti-Infectives x mg
Foscarnet Sodium Foscavir Anti-Infectives x mg
Ganciclovir Sodium Cytovene Anti-Infectives x mg
Zidovudine Retrovir Anti-Infectives x mg
QUINOLONES
Ciprofloxicin Lactate Cipro Anti-Infectives x mg
Ofloxacin Floxin Anti-Infectives x mg
MISCELLANEOUS ANTI-INFECTIVES
Metronidazole Hydrochloride Flagyl Anti-Infectives x.x mg
Pentamidine Isoethionate Pentam Anti-Infectives x mg
Trimetrexate Glucuronate Neutrexin Anti-Infectives x mg
ANTINEOPLASTIC AGENTS
Cyclophosphamide Neosar/Cytoxan Chemotherapy x mg
Fluorouracil 5FU/Florouracil Chemotherapy x mg
Interferon Alfa 2A Roferon Ancillary Ancillary x Million Uni
Interferon Alfa 2b Intron A Ancillary x Million Uni
Interferon Alfa n3 Alferon-N Ancillary x Million Uni
Interferon Beta Betaseron Ancillary x.x mg
Methotrexate Sodium Mexate/MTX Chemotherapy x mg
AUTONOMIC DRUGS
SYMPATHOMIMETICS
Dobutamine Hydrochloride Dobutrex Inotropic x mg
Epinephrine Epinephrine Ancillary x IU
BLOOD DERIVATIVES
Fresh Frozen Plazma FFP Blood x unit
Platelet Concentrate Platelets Blood x unit
Whole Blood Whole Blood Blood x unit
BLOOD FORMATION AND COAGULATION
ANTIANEMIA DRUGS
Epoetin Alfa Procrit/Epogen Ancillary x Units
IRON PREPARATIONS
Iron Dextran INFed Ancillary x mg
ANTICOAGULANTS
Enoxaprin Sodium Lovenox Ancillary x mg
Heparin Sodium Heparin Ancillary x Units
ANTIHEPARIN AGENTS
Protamine Sulfate Protamine Ancillary x mg
HEMOSTATICS
ANTIHEMOPHILIC FACTOR VIII (RECOMBINANT)
Antihemophilic Factor VIII (Recombinant) Recombinate Factor VIII x Units
Antihemophilic Factor VIII (Recombinant) Kogenate Factor VIII x Units
Antihemophilic Factor VIII (Recombinant) Bioclate Factor VIII x Units
Antihemophilic Factor VIII (Recombinant) Helixate Factor VIII x Units
ANTIHEMOPHILIC FACTOR VIII (MONOCLONAL)
Antihemophilic Factor VIII (Monoclonal) Hemofil-M Factor VIII x Units
Antihemophilic Factor VIII (Monoclonal) Monoclate P Factor VIII x Units
Antihemophilic Factor VIII (Monoclonal) A.R.C. Method M Factor VIII x Units
-34-
DRUG BILLING
DRUG/THERAPY DESCRIPTIONS BRAND NAMES CLASSIFICATION* UNITS
- ------------------------- ----------- -------------- -----
ANTIHEMOPHILIC FACTOR VIII (OTHER)
Antihemophilic Factor VIII (Other) Koate HP Factor VIII x Units
Antihemophilic Factor VIII (Other) Humate-P Factor VIII x Units
Antihemophilic Factor VIII (Other) Alphanate Factor VIII x Units
ANTIHEMOPHILIC FACTOR IX (MONOCLONAL/HIGH PURITY)
Antihemophilic Factor IX (Monoclonal/High Purity) Mononine Factor IX x Units
Antihemophilic Factor IX (Monoclonal/High Purity) Alphanate SD Factor IX x Units
Antihemophilic Factor IX (Other) Koyne-80 Factor IX x Units
Antihemophilic Factor IX (Other) Profilnine-HT Factor IX x Units
Antihemophilic Factor IX (Other) Proplex T Factor IX x Units
Antihemophilic Factor IX (Other) Bebulin VH Factor IX x Units
ANTI-INHIBITOR COMPLEX
Anti-Inhibitor Complex Autoplex T Ancillary x Units
Anti-Inhibitor Complex FEIBA-VH Ancillary x Units
HEMATOPOIETIC AGENTS
Epoetin Alfa Epogen/Procrit Ancillary x Units
Filgrastim (G-CSF) Neupogen Ancillary x mg
Sargramostim (GM-CSF) Leukine Ancillary x mg
THROMBOLYTIC AGENTS
Urokinase Abbokinase Ancillary x Units
CENTRAL NERVOUS SYSTEM AGENTS
OPIATE AGONISTS
Hydromorphone Hydrochloride (Continuous PCA) Dilaudid Pain x mg
Morphine Sulfate (Continuous PCA) Morphine Pain x mg
OPIATE ANTAGONISTS
Naloxone Hydrochloride Narcan Ancillary x mg
BENZODIAZEPINES
Diazepam Hydrochloride Valium Ancillary x mg
Lorazepam Hydrochloride Ativan Ancillary x mg
ELECTROLYTIC, CALORIC, & H2O BALANCE
ACIDIFYING AGENT
Ammonium Chloride Ammonium Chloride Ancillary x mEq
ALKALINIZING AGENTS
Sodium Acetate Sodium Acetate Ancillary x mEq
Sodium Bicarbonate Sodium Bicarbonate Ancillary x mEq
REPLACEMENT PREPARATIONS
Calcium Salts Calcium Salts Ancillary x mEq
Electrolyte Solutions with Hydration Hydration w/Electrolytes Hydration x Liter
Potassium Supplements Potassium Supplements Ancillary x mEq
Sodium Chloride Sodium Chloride Ancillary x mEq
CALORIC AGENTS
Amino Acid Injection Amino Acid Injection Ancillary x.x gm
Dextrose Dextrose Ancillary x.x gm
Fat Emulsions Fat Emulsions Ancillary x.x gm
TPN TPN TPN x.x Liter
TPN with Lipids TPN with Lipids TPN x.x Liter
Enteral Formulae: Semi-Synthetics Enteral Formulae Enteral x calorie
Enteral Formulae: Natural Intact Protein/Protein Isolates Enteral Formulae Enteral x calorie
Enteral Formulae: Calorically Dense Intact Protein/Isolates Enteral Formulae Enteral x calorie
Enteral Formulae: Hydrolized Protein/Amino Acids Enteral Formulae Enteral x calorie
Enteral Formulae: Defined Formulae for Special Needs Enteral Formulae Enteral x calorie
-35-
DRUG BILLING
DRUG/THERAPY DESCRIPTIONS BRAND NAMES CLASSIFICATION* UNITS
- ------------------------- ----------- -------------- -----
Enteral Formulae: Modular Components Enteral Formulae Enteral x calorie
Enteral Formulae: Standard Nutrients Enteral Formulae Enteral x calorie
DIURETICS
Bumetanide Bumex Ancillary x mg
Furosemide Lasix Ancillary x mg
Mannitol Mannitol Ancillary x mg
IRRIGATING SOLUTIONS
Sodium Chloride Solution Sodium Chloride Solution Ancillary x.x Liter
Sterile Water Solution Sterile Water Solution Ancillary x.x Liter
ENZYMES
Alph 1 Antitrypsin Prolastin Alpha 1 Antitrypsin x mg
Aglucerase Ceredase Ceredase x mg
Aglucerase Cerezyme Cerezyme x mg
GASTROINTESTINAL DRUGS
ANTIEMETICS
Granisetron Hydrochloride Kytril Ancillary x mg
Ondansetron Hydrochloride Zofran Ancillary x mg
Prochlorperazine Edisylate Compazine Ancillary x mg
Thiethylperazine Malate Torecan Ancillary x mg
Trimethobenzamide Tigan Ancillary x mg
MISCELLANEOUS GI DRUGS
Cimetidine Hydrochloride Tagamet Ancillary x mg
Famotidine Hydrochloride Pepcid Ancillary x mg
Metoclopramide Hydrochloride Reglan Ancillary x mg
Ranitidine Hydrochloride Zantac Ancillary x mg
HEAVY METAL ANTAGONISTS
Deferoxamine Mesylate Desferal Chelation x mg
HORMONES AND SYNTHETIC SUBSTITUTES
ADRENALS
Dexamethasone Phosphate Decadron Ancillary x mg
Hydrocortisone Sodium Succinated A-Hydrocort/Solu-Cortef Steroid x mg
Methylprednisolone Sodium Succinate A-Methapred/Solu-Medrol Steroid x mg
HUMAN GROWTH HORMONE
Growth Hormone Humetrope Growth Hormone x mg
Growth Hormone Protropin Growth Hormone x mg
ANTIDIABETIC AGENTS
INSULINS
Human Insulin Humulin/Novolin Ancillary x Vials
SERUMS, TOXOIDS, AND VACCINES
SERUMS
Immune Globulin, IV Gammar/Sandimune/etc. Immune Globulin, IV x.x gm
VITAMINS & TRACE ELEMENTS
Vitamin C Vitamin C Ancillary x mg
Vitamin K Vitamin K Ancillary x mg
Multivitamin Preparation Multivitamin Preparation Ancillary x vials
Trace Elemental Metals Trace Elemental Metals Ancillary x mg
* Ancillary drugs are covered under Home Infusion Therapy only in
conjunction with a primary therapy unless otherwise stated.
-36-
The above list of drugs and medications is an illustrative list of drugs and
medications and is not intended to be all inclusive.
-37-
NATIONAL HOME CARE PROVIDER AGREEMENT
EXHIBIT VI.
CREDENTIALING/RECREDENTIALING REQUIREMENTS
8. Provider shall be responsible for credentialing and recredentialing of
all Provider locations and all Subcontractors.
9. Provider's credentialing/recredentialing criteria shall, at a minimum,
satisfy NCQA standards or the standards of another appropriate
accrediting body designated by CIGNA, and the standards established by
CIGNA. CIGNA reserves the right to disapprove, terminate or suspend the
participation of any of Provider's locations or Subcontractors if they
do not meet CIGNA's requirements.
10. Provider shall review and externally verify the credentials of every
Provider location and every Subcontractor at least once every two
years, or more frequently if required by NCQA or other applicable
accrediting body.
11. Provider shall provide CIGNA with a summary of the credentials of each
Provider location and each Subcontractor in a format acceptable to
CIGNA and such other information as may reasonably be requested by
CIGNA from time to time.
12. Provider shall require Subcontractors to represent and warrant that the
information contained in their applications for participation is true
and accurate and to agree to notify Provider promptly of any material
change in the information on such application. Provider shall, in turn,
immediately notify CIGNA of all of such changes.
13. CIGNA may audit Provider's credentialing/recredentialing activities,
including Provider's credentialing/recredentialing files. If CIGNA
determines that Provider cannot meet its credentialing obligations set
forth herein, CIGNA may elect to assume responsibility for such
activities. If CIGNA elects to assume responsibility for such
activities, the parties agree to renegotiate the rates set forth in
this Agreement to the extent necessary, and Provider shall cooperate
and provide to CIGNA any information necessary to perform such
activities.
-38-
NATIONAL HOME CARE PROVIDER AGREEMENT
EXHIBIT VII.
REQUIRED ENCOUNTER DATA ELEMENTS
Provider (including Provider's Subcontractors) shall provide CIGNA with the
following standard data elements for each service encounter with respect to
Covered Home Care Services rendered under this Agreement:
a. Patient name
b. CIGNA Patient ID No.
c. Healthplan Identifier
d. Group Number
e. Date of Service
f. Primary and Secondary ICD-9 Codes
g. CPT-4, and HCPCS Codes
h. Charge to CIGNA
i. Usual Charge
j. Service Provided
k. Service Description
l. Drug supplied including NDC
m. Usual Drug Charge
n. Equipment Provided
o. Equipment Description
p. Usual Equipment Charge
q. Referring Physician Name
r. Referring Physician License No.
s. Referring Facility
t. Place of Service
u. CIGNA Program (e.g. Indemnity, PPO)
v. Revenue codes
w. any other data element agreed upon by the parties during
implementation or during the term of the Agreement.
-39-
NATIONAL HOME CARE PROVIDER AGREEMENT
EXHIBIT VIII.
SUBCONTRACTOR PAYMENT
-40-
Provider shall pay Subcontractors for Covered Home Care Services rendered
hereunder in accordance with this Exhibit and the terms of the Agreement.
14. Provider shall pay Subcontractors for Covered Home Care Services
rendered hereunder in accordance with the payment administration
standards agreed upon during implementation and any other standards set
forth in applicable laws and regulations. Provider agrees to reimburse
Subcontractors for Covered Home Care Services within thirty (30) days
of receipt of a properly completed request for payment for Covered Home
Care Services and receipt of payment from CIGNA. CIGNA may withhold all
or a portion of Provider's Capitation Payments if Provider repeatedly
fails to reimburse Subcontractors on a timely basis. Provider's
obligations with regard to payment for Covered Home Care Services
rendered hereunder shall survive the termination of this Agreement with
respect to any Covered Home Care Services rendered by Subcontractors
during the term of this Agreement and with respect to any Covered Home
Care Services Provider is obligated by this Agreement to provide or
arrange for after termination of this Agreement.
15. With reasonable notice, Provider agrees to allow CIGNA representatives
to conduct on-site reviews of Provider's payment administration
facilities. Such reviews shall be for the sole purpose of evaluating
Provider's performance of its payment responsibilities under this
Agreement, including, but not limited to, ascertaining the quality and
timeliness of Provider's payment processing. Provider agrees to correct
any deficiencies detected during such reviews within sixty (60) days of
CIGNA's submission of a written report detailing such deficiencies.
16. Provider shall be responsible for the production of all applicable tax
reporting documents (e.g., 1099s) for Subcontractors. Such documents
shall be produced in a format and within the timeframes set forth in
applicable state and federal laws and/or regulations.
17. CIGNA shall produce explanations of benefits for both Provider and
Participants. Provider shall produce explanations of benefits for
Subcontractors. Such explanations of benefits shall be in a format and
contain data elements acceptable to CIGNA.
18. Providers shall develop and deliver training programs for
Subcontractors which outline Provider's billing and reimbursement
processes. Under no circumstances shall Subcontractors submit bills to
CIGNA for Covered Home Care Services referred to Provider. Provider
shall make best efforts to ensure that Subcontractors avoid submitting
such requests for payment.
19. CIGNA or Payor shall have final decision making authority with regard
to all Participant benefit determinations made hereunder.
MCR 13
[THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK]
MCR 14
NATIONAL HOME CARE PROVIDER AGREEMENT
EXHIBIT IX.
PERFORMANCE GUARANTEES
* Confidential Treatment Requested
YEAR 1 YEARS 2 & 3
Standard of Standard of
Areas of Performance Performance
Performance Achieved Risk Achieved Risk
- ------------------------------------ ------------------ ------------------- ------------------- -------------------
I. Risk
Patient Satisfaction <90% * * *
CIGNA Satisfaction. <90% * * *
Physician Satisfaction <90% * * *
Turnaround times for >24 Hours * * *
Routine services
Turnaround times for >4 Hours * * *
Urgent services
Turnaround times for >2 Hours * * *
STAT services
Ability to supply all IV <100% * * *
medications as needed
Guarantee of availability of Home <100% * * *
Medical Equipment
II. Lower Priority Risk: * * *
Guarantee of Home <100% * * *
Medical Equipment rental equipment
in good condition
No bills from Subcontractors re: <95% * * *
Covered Home Care
Services referred to Provider
- ------------------------------------ ------------------ ------------------- ------------------- -------------------
- ------------------------------------ ------------------ ------------------- ------------------- -------------------
Total Potential Risk * * *
- ------------------------------------ ------------------ ------------------- ------------------- -------------------
The above turnaround times commence to run as of the time of receipt by
Provider of a Complete Order and are subject to the terms and conditions set
forth in Section II.A.12. of the Agreement. To assess annual performance in each
of the above categories, four consecutive quarterly audits will be conducted and
averaged to determine whether the standard has been attained. CIGNA will compile
these results and calculate the resulting payment (if any) that is due from
Provider.
NATIONAL HOME CARE PROVIDER AGREEMENT
EXHIBIT X.
NATIONAL HOME HEALTH EXCLUSIVITY: EXCLUSIONS
CIGNA's agreement not to contract with any other third party for the
provision of Covered Home Care Services with respect to its HMO, Medicare Risk,
Medicaid Risk and PPO Programs, as more particularly set forth in Section II. J.
of the Agreement, shall not apply with respect to the following:
1) Covered Home Health Services delivered or arranged for by Lovelace
Health Systems, Inc.;
2) Covered Home Care Services delivered or arranged for by CIGNA
HealthCare of Texas, Inc. in its Dallas, Texas service area;
3) Covered Home Care Services delivered under CIGNA's current and future
capitation contracts with Participating Providers or delivered under
CIGNA's current and future contracts with preferred provider
organizations, where such contracts include Covered Home Care Services
as just one of a number of different types of health care services to
be delivered or arranged for thereunder.
The parties understand and agree that CIGNA may elect at any time to
have those services referenced in items 1 through 3 above provided or arranged
for by Provider pursuant to the terms and conditions of this Agreement at the
applicable rates in effect at the time of such election.
HMO PROGRAM ATTACHMENT
TO NATIONAL HOME CARE PROVIDER AGREEMENT
PURPOSE
The terms and provisions of this HMO Program Attachment and the
Agreement are applicable to Covered Home Care Services rendered in accordance
with a Service Agreement which is consistent with the HMO Program. The HMO
Program includes CIGNA's commercial HMO and FlexCare products.
IV DEFINITIONS
CAPITATION PAYMENT means a periodic payment for Covered Home Care
Services which is made to Provider, at the rates set forth in Exhibits A.1, A.2
and A.4, for each Participant who is a member of Provider's Patient Panel.
MEDICAL DIRECTOR means a physician designated by CIGNA to manage
Quality Management and Utilization management responsibilities, or that
physician's designee.
PATIENT PANEL means those Participants who have designated or have
otherwise been assigned to Provider as the primary source for Covered Home Care
Services pursuant to a Service Agreement for which Provider will receive a
global Capitation Payment for Covered Home Care Services rendered.
PRIMARY CARE PHYSICIAN means a physician duly licensed to practice
medicine who is a Participating Provider with CIGNA to provide Covered Services
in the fields of general medicine, internal medicine, family practice or
pediatrics, and who has agreed to provide primary care physician services to
Participants in accordance with HMO Program Requirements.
V PARTIES' OBLIGATIONS
A. Services
1. Provider shall provide, arrange for or, if rendered by another
provider, be financially responsible for all Covered Home Care Services
that are required by Participants in Provider's Patient Panel in
accordance with the terms of this Agreement, this HMO Program
Attachment and HMO Program Requirements. Provider shall accept the
compensation set forth in Exhibits A.1, A.2 and A.3 or A.4, whichever
is applicable, of this Program Attachment as payment in full for such
services.
2. A CIGNA Participating Physician or CIGNA will notify Provider's Network
Manager of each referral for Covered Home Care Services for
Participants in its Patient Panel. Provider will provide or arrange for
all Medically Necessary Covered Home Care Services for all such
HMO 1
Participants, in accordance with the authorization and Utilization Management
procedures set forth in Section II.D. below.
Provider and CIGNA will jointly develop clinical pathways to establish a plan of
treatment for more difficult Participant cases requiring Covered Home Care
Services.
Provider shall be financially responsible for all out-of-network claims for
Covered Home Care Services rendered to Participants, whether the result of an
affirmative opt-out decision or noncompliance by the Participant or physician in
the selection of home care provider.
B. Compensation and Billing
HMO 2
1. By the 15th day of each month or within 5 days of receipt of the
reports specified in Sections II.B.2. and II.B.3 of the Agreement,
whichever is later, Provider shall receive a Capitation Payment for
each Participant in Provider's Patient Panel in accordance with the
rates set forth in Exhibit A.1. The Capitation Payment shall be
compensation in full for all Covered Home Care Services provided to
Participants in Provider's Patient Panel, except as set forth in
section II.B.2. and II.B.3. below. Provider is required to deliver the
reports delineated in Sections II.B.2. and II.B.3. of the Agreement by
the tenth day of each calendar month, reflecting activity for the month
preceding the prior month. The obligation to deliver such reports shall
not apply until 2 months following the date that the format of the
reports is agreed upon by the parties. CIGNA may elect to withhold all
or a portion of Provider's Capitation Payment until such reports are
received, except with respect to payments due in the first two months
of this Attachment.
2. Each Service Area may elect to compensate Provider for those Tocolytic
Services which are Covered Home Care Services either on a capitated or
fee-for-service basis in accordance with the rates set forth in Exhibit
A.2.
3. Home Medical Equipment which is a Covered Home Care Service shall at
first be compensated in accordance with the fee-for-service rates set
forth in Exhibit A.3. At any time during the term of this Agreement,
CIGNA may elect to reimburse Provider for Home Medical Equipment in
accordance with the Capitation Payment rates set forth in Exhibit A.4.
Such rates shall be effective on the first day of the month following
receipt of notification of such election by Provider from CIGNA.
4. Commencing on the Effective Date and for the first year of this
Agreement, the Capitation Payment rates set forth in the Exhibits to
this Attachment will be reduced by 2.5%. This amount represents the
estimated amount needed to fund claims for Covered Home Care Services
rendered to Participants by other providers for which Provider is
obligated hereunder (the "Out-Of-Network Claims Fund"). CIGNA shall
process and pay all of such claims on behalf of Provider from such fund
in accordance with the Participant's Service Agreement. At the end of
the first year of this Agreement and at the end of each year
thereafter:
a. the parties shall reconcile the Out-Of-Network Claims
Fund for the preceding year with the actual amount
paid by CIGNA to other providers during the preceding
year for Covered Home Care Services rendered to
Participants for which Provider is obligated
hereunder (the "Out-Of-Network Claims Experience").
Any amount owing will be collected through an
appropriate credit or charge to the following year's
Capitation Payment rates based on the number of
Participants as of January 1 and prorated over 12
months; and
b. the parties shall reestablish the percentage amount
by which the Capitation Payment rates for the
following year are to be reduced to fund the
Out-Of-Network Claims Fund. Such percentage amount
shall be calculated based upon the preceding year's
Out-of-Network Claim Experience.
HMO 3
Upon termination of this Agreement, the parties shall reconcile the
Out-Of-Network Claims Fund with the Out-Of-Network Claims Experience from the
date of the last reconciliation through the date of termination and any amount
determined to be due and owing shall be paid by the owing party within 120 days
of the date of termination. CIGNA will provide Provider with quarterly
statements delineating the Out-Of-Network Claims Fund and the Out-Of-Network
Claims Experience, and, upon reasonable notice, Provider may conduct reasonable
audits of CIGNA's records relating to such amounts paid.
HMO 4
5. Any retroactive adjustment made to Provider's Capitation Payments
shall be based on the same methodology as is used in CIGNA Service
Agreements. CIGNA shall fully apprise Provider in writing of all such
applicable methodologies. Any adjustment shall be made in subsequent
Capitation Payments. CIGNA will be able to make retroactive adjustments
to capitation fees paid based on eligibility adjustments up to 180 days
after a Participant's eligibility has changed. In those instances where
a Participant has been retroactively deleted and has received services
from Provider after the effective date of a deletion but prior to CIGNA
informing Provider of such deletion, Provider or Subcontractor may bill
participant for such services rendered.
6. With respect to Participants added to or deleted from Provider's
Patient Panel after the 1st day of the month, the following rules shall
apply.
a. if the Participant is added to Provider's Patient
Panel on or before the 15th day of the month, a full
month's Capitation Payment will be due for that
Participant for that month. There will be no
Capitation Payment due for Participants added after
the 15th day of the month; and
b. A full month's Capitation Payment will be due for the
month of termination of a Participant if the
Participant terminates after the 15th day of the
month. If the Participant terminates on or before the
15th day of the month, no Capitation Payment will be
due for the month of termination.
7. Provider agrees that the rates set forth in Exhibits A.1, A.2, A.3 and
A.4 are all-inclusive for Covered Home Care Services and that no
additional charges for any additional or ancillary items, supplies or
services including, but not limited to, in-hospital assessments or
pre-nursing assessments, travel time, nursing services, training
services, equipment delivery, maintenance and repair, equipment service
contracts, after-hours delivery or other charges will be billed to or
reimbursed by CIGNA.
8. Provider guarantees that the Capitation Payment rates set forth in this
Attachment are effective for three years from the Effective Date of
this Agreement. Additionally, Provider guarantees that the Home Medical
Equipment fee-for-service rates set forth in Exhibit A.3 are effective
until such time as CIGNA elects to reimburse Provider for such services
on a capitated basis in accordance with Exhibit A.4 or 3 years,
whichever is earlier. Notwithstanding the foregoing, the parties agree
to meet to discuss adjustment to the Capitation Payment rates should
any of the following circumstances occur during the term of this
Attachment:
a. treatments, products, supplies or equipment which are
excluded from Covered Home Care Services for HMO
Program Participants as of the Effective Date on the
basis that they are considered Experimental are no
longer considered Experimental and become a Covered
Home Care Service for such Participants.
HMO 5
b. shifts in treatment sites for Covered Home Care Service therapies
occurring after the Effective Date result in a material change to the
services which are Covered Home Care Services for HMO Program
Participants.
c. material changes are made to HMO Program Participants' Service
Agreements after the Effective Date such that there is a material
change to those Home Care Services which are Covered Home Care Services
for such Participants.
d. a change in the number of HMO Program Participants serviced under the
capitation arrangements described in item 3 of Exhibit X. to the
Agreement occurring after the Effective Date of this Agreement results
in a material change in HMO Program Participant volume under this
Agreement which has a material financial impact on Provider. CIGNA
agrees to notify Provider of any capitation arrangements described in
item 3 of Exhibit X to the Agreement entered into after the Effective
Date which will result in the elimination of Provider's entire HMO
Program Patient Panel in a particular healthplan location or which will
result in a material reduction in the number of HMO Program
Participants in Provider's entire HMO Program Patient Panel. This
notification obligation shall only apply to the extent that the
department at CIGNA's home office primarily responsible for CIGNA's
relationship with Provider has received notice of such capitation
arrangements.
Any such adjustment of Capitation Payment rates shall only be made to
the extent required to address the change in costs directly resulting from the
above changed circumstance.
9. Any amendment of Capitation Payment rates shall be in accordance with
the Amendment provisions of this Agreement.
10. All capitation rates include the cost of routine lab specimen
collection by a nurse and delivered to a laboratory specified by CIGNA
provided that Provider and such laboratory can reach a reasonable
accommodation with respect to the logistics of such collection and
delivery and with respect to the provision of applicable laboratory
supplies.
C. Financial Reports
1. Provider represents and warrants that the information provided by
Provider to CIGNA in its response to CIGNA's request for proposal is,
to the best of its knowledge, true and accurate.
2. Provider shall provide CIGNA with the following financial reports on a
timely basis: 1) Provider's annual audited financial reports,
including, but not limited to, Provider's audited annual income
statement and balance sheet; 2) quarterly financial reports including
an income statement, balance sheet and any other reports identifying
payments made to Subcontractors in the preceding quarter and the
incurred but not reported claims as of the end of the preceding quarter
in sufficient detail to determine if payments have been made in
accordance
HMO 6
with this Agreement and applicable law; and 3) any financial reports
required by applicable regulatory authorities.
3. Provider shall notify CIGNA immediately of any of Provider's known
significant payment defaults and shall provide CIGNA with copies of
notifications of significant payment defaults received by Provider with
respect to any of Provider's Subcontractors, provided that such notice
shall not be required if Provider cures the default within 15 days of
notification of the default. At the end of each quarter, Provider's
chief financial officer or another individual acceptable to CIGNA shall
provide CIGNA with a signed certification to the effect that there are
no known payment defaults with respect to any of Provider's creditors.
Provider agrees to provide CIGNA with copies of all auditors letters
normally provided to Provider's lenders relating to Provider's
compliance with the terms and conditions of its loan agreements with
such lenders.
D. Utilization Management
1. The CIGNA Participating Physician or CIGNA shall notify Provider's
Network Manager of each referral for Covered Home Care Services to
Participants in Provider's Patient Panel.
2. For Covered Home Care Services ordered by a physician, Provider and/or
Subcontractor will work with that referring physician to assess the
patient's appropriateness for Home Care Services. Any patients which
Provider determines to be medically inappropriate for Covered Home Care
Services will be reported to CIGNA for evaluation and final
determination. Where CIGNA assesses Covered Home Care Services to be
appropriate for the patient, Provider and Participating physician will
develop a care plan, including definition of treatment goals and
outcomes and the identification of the resources necessary for
implementation.
3. Provider will provide or arrange for the Covered Home Care Services
necessary to carry out the care plan, provided that neither Provider
nor Subcontractors shall be obligated to provide services where the
provision of services in the home setting (or ambulatory setting with
respect to Home Infusion Therapy) would be unsafe to the Participant or
Provider or Subcontractor personnel. Provider will monitor the services
rendered under the care plan in accordance with Utilization Management
criteria and procedures mutually agreed upon by both parties,
including, but not limited to, the Milliman and Robertson Home Care and
Case Management guidelines set forth in Exhibit A.5.
HMO 7
E. Assignment and Identification of Participants
1. Provider shall comply with the requirements of and shall participate in
CIGNA's procedures with respect to the assignment and identification of
Participants as outlined in HMO Program Requirements.
2. CIGNA will deliver Participant identification information to Provider
in accordance with section II.A.10 of the Agreement.
F. Coordination of Benefits
1. CIGNA, and Provider shall cooperate to exchange information relating to
coordination of benefits with regard to any Participant for whom
Provider is providing or arranging services.
2. Certain claims for services rendered to Participants are claims for
which another payor may be primarily responsible under coordination of
benefit rules. Provider may bill such claims to the primary payor and
shall comply with the primary payor's billing rules, including, but not
limited to, any of the primary payor's limitations on billing
Participants.
3. When Payor is other than primary under applicable coordination of
benefits rules, Payor shall nor be obligated to pay any amounts in
addition to the capitation amounts paid pursuant to this Agreement and
Provider and its Subcontractors shall reimburse any CIGNA Copayments,
Coinsurance or Deductibles collected from Participants upon request by
CIGNA or the Participant. In the event that Provider or its
Subcontractors fail to reimburse such amounts, CIGNA shall have the
right to deduct any such amounts from any amounts payable under this
Agreement.
4. When CIGNA or its designated Payor is primary under applicable
coordination of benefits rules, Provider shall consider the
compensation set forth in this Attachment as payment in full for
Covered Home Care Services rendered to Participants and shall not seek
additional reimbursement from any secondary payors.
G. Reimbursement of Expenditures
CIGNA, shall be entitled to recover from Provider any reasonable expenditure
made, or recover any reasonable cost incurred, including, but not limited to,
any reasonable administrative costs (except with respect to the administrative
costs incurred in processing out-of-network claims as described in Section
II.B.4. of this Attachment), in providing or arranging for any Covered Home Care
Services for which Provider was obligated hereunder but did not so provide. An
amount sufficient to compensate for such expenditures and costs may be deducted
from any payments due to Provider under this Agreement. Except with
HMO 8
respect to Emergency or Urgent situations or with respect to
out-of-network claims which are the result of an affirmative opt out
decision or non-compliance by the Participant or physician in the
selection of home care provider, prior to incurring any such
expenditures, CIGNA shall notify Provider and allow Provider a
reasonable opportunity to cure its failure to provide the particular
service. CIGNA shall provide Provider with written notice and full
disclosure of costs incurred prior to any such deduction. This
provision shall survive the termination of this Agreement.
H. Limitations on Billing Participants
1. Provider hereby agrees that in no event, including, but not limited to
non-payment by CIGNA, CIGNA's insolvency or breach of this Agreement,
shall Provider bill, charge, collect a deposit from, seek compensation,
remuneration or reimbursement from, or have any recourse against
Participants or persons other than CIGNA for Covered Home Care
Services. This provision shall not prohibit collection of any
applicable Copayments, Deductibles or Coinsurance billed in accordance
with the term of a Service Agreement.
2. Provider further agrees that this provision shall survive the
termination of this Agreement regardless of the cause giving rise to
such termination and shall be construed to be for the benefit of
Participants and that this provision supersedes any oral or written
agreement to the contrary now costing or hereafter entered into between
Provider and the Participant or persons acting on the Participant's
behalf.
3. Any modification, additions, or deletion to the provisions of this
clause shall become effective on a date no earlier than fifteen (15)
days after the applicable state regulatory agency has received written
notice of such proposed changes.
4. When Provider has been notified in advance that a particular service is
not Medically Necessary, Provider and its Subcontractors shall not
charge Participants for such services unless, in advance of the
provision of such services, the Participant is notified that the
services are not covered and the Participant acknowledges in writing
that he or she shall be responsible for payment of charges for such
services.
VI. RIGHTS AND OBLIGATIONS UPON TERMINATION
A. UPON TERMINATION OF THIS AGREEMENT, PROVIDER AND SUBCONTRACTORS SHALL
CONTINUE TO PROVIDE COVERED HOME CARE SERVICES FOR SPECIFIC CONDITIONS
FOR WHICH A PARTICIPANT WAS UNDER PROVIDER'S OR SUBCONTRACTOR'S CARE AT
THE TIME OF SUCH TERMINATION SO LONG AS PARTICIPANT RETAINS ELIGIBILITY
UNDER A SERVICE AGREEMENT, UNTIL THE EARLIER OF COMPLETION
HMO 9
OF SUCH SERVICES, CIGNA'S PROVISION FOR THE ASSUMPTION OF SUCH TREATMENT BY
ANOTHER PROVIDER, OR THE EXPIRATION OF TWELVE (12) MONTHS. CIGNA, SHALL
COMPENSATE PROVIDER FOR COVERED HOME CARE SERVICES PROVIDED TO ANY SUCH
PARTICIPANTS AT THE FEE-FOR-SERVICE RATES SPECIFIED IN THE PPO PROGRAM
ATTACHMENT TO THIS AGREEMENT.
B. PROVIDER HAS NO OBLIGATION UNDER THIS AGREEMENT TO PROVIDE SERVICES TO
INDIVIDUALS WHO CEASE TO BE PARTICIPANTS.
[THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK]
HMO 10
HMO PROGRAM ATTACHMENT
EXHIBIT A.1
CAPITATION RATES
HMO 11
CIGNA HEALTHCARE
EXHIBIT A(1) -- OLSTEN KIMBERLY QUALITYCARE
HOME CAPITATION RATES -- NON-MEDICARE/NON-MEDICAID
HEALTHPLAN SITE NON-MEDICARE/NON-MEDICAID
- ---------------------------------------------------------- --------------------------------------------------------
Alabama *
- ---------------------------------------------------------- --------------------------------------------------------
Arizona *
- ---------------------------------------------------------- --------------------------------------------------------
Arkansas *
- ---------------------------------------------------------- --------------------------------------------------------
California *
- ---------------------------------------------------------- --------------------------------------------------------
Colorado *
- ---------------------------------------------------------- --------------------------------------------------------
Connecticut *
- ---------------------------------------------------------- --------------------------------------------------------
Delaware *
- ---------------------------------------------------------- --------------------------------------------------------
District of Columbia *
- ---------------------------------------------------------- --------------------------------------------------------
Florida *
- ---------------------------------------------------------- --------------------------------------------------------
Georgia *
- ---------------------------------------------------------- --------------------------------------------------------
Idaho *
- ---------------------------------------------------------- --------------------------------------------------------
Illinois *
- ---------------------------------------------------------- --------------------------------------------------------
Indiana *
- ---------------------------------------------------------- --------------------------------------------------------
Iowa *
- ---------------------------------------------------------- --------------------------------------------------------
Kansas *
- ---------------------------------------------------------- --------------------------------------------------------
Kentucky *
- ---------------------------------------------------------- --------------------------------------------------------
Louisiana *
- ---------------------------------------------------------- --------------------------------------------------------
Lovelace *
- ---------------------------------------------------------- --------------------------------------------------------
Maine *
- ---------------------------------------------------------- --------------------------------------------------------
Maryland *
- ---------------------------------------------------------- --------------------------------------------------------
Massachusetts *
- ---------------------------------------------------------- --------------------------------------------------------
Michigan *
- ---------------------------------------------------------- --------------------------------------------------------
Minnesota *
- ---------------------------------------------------------- --------------------------------------------------------
Mississippi *
- ---------------------------------------------------------- --------------------------------------------------------
Missouri *
- ---------------------------------------------------------- --------------------------------------------------------
Montana *
- ---------------------------------------------------------- --------------------------------------------------------
Nebraska *
- ---------------------------------------------------------- --------------------------------------------------------
Nevada *
- ---------------------------------------------------------- --------------------------------------------------------
New Hampshire *
- ---------------------------------------------------------- --------------------------------------------------------
New Jersey *
- ---------------------------------------------------------- --------------------------------------------------------
New Mexico (except Lovelace) *
- ---------------------------------------------------------- --------------------------------------------------------
New York *
- ---------------------------------------------------------- --------------------------------------------------------
North Carolina *
- ---------------------------------------------------------- --------------------------------------------------------
North Dakota *
- ---------------------------------------------------------- --------------------------------------------------------
Ohio *
- ---------------------------------------------------------- --------------------------------------------------------
Oklahoma *
- ---------------------------------------------------------- --------------------------------------------------------
Oregon *
- ---------------------------------------------------------- --------------------------------------------------------
Pennsylvania *
* Confidential Treatment Requested
CIGNA HEALTHCARE
EXHIBIT A(1) -- OLSTEN KIMBERLY QUALITYCARE
HOME CAPITATION RATES -- NON-MEDICARE/NON-MEDICAID
HEALTHPLAN SITE NON-MEDICARE/NON-MEDICAID
- ---------------------------------------------------------- --------------------------------------------------------
Rhode Island *
- ---------------------------------------------------------- --------------------------------------------------------
South Carolina *
- ---------------------------------------------------------- --------------------------------------------------------
South Dakota *
- ---------------------------------------------------------- --------------------------------------------------------
Tennessee *
- ---------------------------------------------------------- --------------------------------------------------------
Texas *
- ---------------------------------------------------------- --------------------------------------------------------
Utah *
- ---------------------------------------------------------- --------------------------------------------------------
Vermont *
- ---------------------------------------------------------- --------------------------------------------------------
Virginia *
- ---------------------------------------------------------- --------------------------------------------------------
Washington *
- ---------------------------------------------------------- --------------------------------------------------------
West Virginia *
- ---------------------------------------------------------- --------------------------------------------------------
Wisconsin *
- ---------------------------------------------------------- --------------------------------------------------------
Wyoming *
- ---------------------------------------------------------- --------------------------------------------------------
(1) Prices effective 1/1/96 through 12/31/98.
(2) Above prices exclude Home Medical Equipment.
* Confidential Treatment Requested
HMO PROGRAM ATTACHMENT
EXHIBIT A.2
TOCOLYTIC RATES
CIGNA HEALTHCARE
EXHIBIT A(4) -- OLSTEN KIMBERLY QUALITYCARE
TOCOLYTIC RATES - NON-MEDICARE/NON-MEDICAID
HMO CAPITATION RATE FOR HEALTHPLANS ELECTING CAPITATION:
$0.11 PER MEMBER PER MONTH
FEE FOR SERVICES (FFS) RATES FOR HEALTHPLANS ELECTING FFS:
(1)
SERVICE PER DIEMS
- ---------------------------------------------------------- --------------------------------------------------------
Level I Monitoring *
- ---------------------------------------------------------- --------------------------------------------------------
Level II Monitoring *
- ---------------------------------------------------------- --------------------------------------------------------
Level III Monitoring *
* Confidential Treatment Requested
(1) Per Diems include ALL costs -- including, but not limited to, all
nursing required, telephonic monitoring, family caregiver training and
education, durable medical equipment administered or used in the course
of rendering services, medical supplies, disposables, pumps, drugs and
medications, general and administrative expenses, etc.
(2) Prices effective 1/1/96 through 12/31/98.
HMO 10
HMO PROGRAM ATTACHMENT
EXHIBIT A.3
FFS REIMBURSEMENT SCHEDULE - HOME MEDICAL EQUIPMENT
CIGNA HEALTHCARE
EXHIBIT A(3) -- OLSTEN KIMBERLY QUALITYCARE
HMO FEE SCHEDULE -- HOME MEDICAL EQUIPMENT -- NON-MEDICARE
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- -------- ----------------------------------------------------------- -------- ------
E0100 CANE *
E0105 QUAD CANE/3PRONG/FIXED ADJ *
E0110 FOREARM CRUTCH/PAIR/FIXED/ADJ *
E0111 FOREARM CRUTCH/EACH *
E0112 UNDERARM CRUTCH/WOOD/PAIR/FIXED/ADJ *
E0113 UNDERARM CRUTCH/WOOD/EACH/FIXED/ADJ *
E0114 UNDERARM CRUTCH/ALUM/PAIR/FIXED/ADJ *
E0116 UNDERARM CRUTCH/ALUM/EACH/FIXED/ADJ *
E0130 WALKER/RIGID/FIXED/ADJ *
E0135 WALKER/FOLDING/FIXED/ADJ *
E0141 WALKER/RIGID/WHEELED *
E0142 WALKER/RIGID/WHEELED/SEAT *
E0143 WALKER/FOLDING/WHEELED *
E0145 WALKER/WHEELED W/SEAT & CRUTCH ATT. *
E0146 WALKER/WHEELED W/SEAT *
E0147 WALKER/HD/MULTI BRAKE/VARI-TENSION *
E0153 PLATFORM ATTACHMENT/FOREARM CRUTCH *
E0154 WALKER PLATFORM ATTACHMENT ONLY *
E0155 WHEEL ATTACH/RIGID PICKUP WALKER *
E0156 SEAT ATTACHMENT WALKER *
E0157 CRUTCH ATTACHMENT/WALKER/EA *
E0158 LEGAL EXTENSIONS FOR WALKER *
E0160 SITZ BATH/PORT/FIT COMMODE *
E0161 SITZ BATH/PORT/FITS COMMODE/W/FAUCETT *
E0163 COMMODE/CHAIR STATIONARY FIXED ARMS *
E0164 COMMODE/CHAIR MOBILE FIXED ARMS *
E0165 COMMODE/CHAIR STATIONARY/DETACH ARMS *
E0166 COMMODE/CHAIR MOBILE/DETACH ARMS *
E0167 PAIL OR PAN FOR USE W/COMMODE CHAIR *
E0176 AIR PRESS. PAD/CUSH. NON-POSITIONING *
E0177 H2O PRESS. PAD/CUSH. NON-POSITIONING *
E0178 GEL PRESS. PAD/CUSH. NON-POSITIONING *
E0179 DRY PRESS. PAD/CUSH. NON-POSITIONING *
E0180 PRESSURE PAD/ALTERNATING W/PUMP * *
E0181 PRESSURE PAD/ALTERNATING/W/PUMP/HD * *
E0182 PUMP FOR ALTERNATING PRESSURE PAD * *
E0184 DRY PRESSURE MATTRESS *
E0185 GEL PRESSURE PAD FOR MATTRESS *
E0186 AIR PRESSURE MATTRESS *
E0187 WATER PRESSURE MATTRESS *
E0188 SYNTHETIC SHEEP SKIN PAD *
E0189 LAMB WOOL, SHEEP SKIN PAD/ANY SIZE *
E0191 HEAT/ELBOW/PROTECTOR/EA *
E0192 LOW PRESSURE & POS. EQUALIZATION * *
* Confidential Treatment Requested
HMO 11
CIGNA HEALTHCARE
EXHIBIT A(3) -- OLSTEN KIMBERLY QUALITYCARE
HMO FEE SCHEDULE -- HOME MEDICAL EQUIPMENT -- NON-MEDICARE
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- -------- ----------------------------------------------------------- -------- ------
E0193 LOW AIR LOSS-BED MATTRESS REPLACEMENT *
E0194 AIR FLUIDIZED BED *
E0195 REPLACEMENT PAD/ALTERNATING PRESS *
E0196 GEL PRESSURE MATTRESS *
E0197 AIR PRESSURE PAD FOR MATTRESS *
E0198 WATER PRESSURE PAD FOR MATTRESS *
E0199 DRY PRESSURE PAD FOR MATTRESS *
E0210 PAD, ELECTRIC, HEAT, STANDARD *
E0215 PAD, ELECTRIC, MOIST HEAT *
E0237 H2O CIRC. HEAT PAD W/PUMP * *
E0238 PAD, HEAT PAD, NON-ELECTRIC, MOIST *
E0243 TOILET RAIL, EACH *
E0244 RAISED TOILET SEAT *
E0245 TUB STOOL OR BENCH W/O BACK *
E0246 TRANSFER TUB RAIL ATTACHMENT *
E0249 PAD FOR WATER CIRCULATING HEAT UNIT *
E0250 BED/FH/SR/MATT * *
E0251 BED/FH/SR/W/O MATT * *
E0255 BED/VH/HI-LOW/SR/MATT * *
E0256 BED/VH/HI-LOW/SR/W/O MATT * *
E0260 BED/SEMI-ELEC/SR/MATT * *
E0261 HOSPITAL BED/VARI HGHT/SR/W/O MATT * *
E0265 BED/FULL-ELEC/SR/MATT * *
E0266 BED/FULL-ELEC/SR/W/O MATT * *
E0271 MATTRESS/INNER SPRING *
E0272 MATTRESS/FOAM RUBBER *
E0274 OVERBED TABLE * *
E0275 BED PAN/STD METAL OR PLASTIC *
E0276 BED PAN/FRACTURE/METAL OR PLASTIC *
E0280 BED CRADLE, ANY TYPE *
E0290 BED/F/W/O SR/MATT * *
E0291 BED/F/W/O SR/W/O MATT * *
E0292 BED/VH/HI-LO/W/O SR/MATT * *
E0293 BED/VH/HI-LO/W/O SR/W/O MATT * *
E0294 BED/SEMI-ELEC/W/O SR/MATT * *
E0295 BED/SEMI-ELEC/W/O SR/W/O MATT * *
E0296 BED/FULL-ELEC/W/O SR/W/O MATT * *
E0297 BED/FULL-ELEC/W/O SR/MATT * *
E0325 URINAL/MALE/JUG-TYPE/ANY MATERIAL *
E0326 URINAL/FEMALE/JUG-TYPE/ANY MATERIAL *
E0425 STATIONARY GAS SYS. PURCH * *
E0430 O2 GAS SYS/PORT/ACCESS/PURCH * *
E0431 O2 GAS SYS/PORT/ACCESS/RENTAL *
E0434 O2 LIQUID/PORT/ACCESS/RENTAL *
* Confidential Treatment Requested
CIGNA HEALTHCARE
EXHIBIT A(3) -- OLSTEN KIMBERLY QUALITYCARE
HMO FEE SCHEDULE -- HOME MEDICAL EQUIPMENT -- NON-MEDICARE
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- -------- ----------------------------------------------------------- -------- ------
E0435 O2 LIQUID SYS/PORT/ACCESSORIES/PURCH *
E0439 STATIONARY LIQUID SYSTEM/RENTAL *
E0440 STATIONARY LIQUID SYSTEM/PURCHASE *
E0442 O2 CONTENTS/LIQUID/PER UNIT *
E0444 PORTABLE O2 CONTENTS/LIQUID/1 LB. *
E0450 VOLUME VENTILATOR/STAT OR PORT * *
E0452 INTERMITTENT ASSIST DEVICE/BIPAP/TU * *
E0453 THERAPEUTIC VENT FOR <12 HRS./DAY * *
E0460 NEG PRESSURE VENT/PORT/STATIONARY * *
E0480 PERCUSSOR/ELEC OR PNEUMATIC HOME * *
E0500 IPPB MACHINE/ALL TYPES * *
E0550 HUMIDIFIER/DURABLE/FOR IPPB OR O2 * *
E0555 HUMIDIFIER/REUSE/PLASTIC OR GAS *
E0565 COMPRESSOR/BEDSIDE CONTINUOUS * *
E0570 NEBULIZER W/COMP IE/PULMO-AIDE *
E0575 NEBULIZER/ULTRASONIC, HD CONTIN. USE * *
E0585 NEBULIZER W/COMPRESSOR & HEATER * *
E0600 SUCTION PUMP/HOME USE/PORTABLE * *
E0601 CONT AIRWAY PRESSURE DEVICE/CPAP * *
E0607 HOME BLOOD GLUCOSE MONITOR * *
E0608 APNEA MONITOR * *
E0620 SEAT LIFT CHAIR/MOTORIZED * *
E0621 SLING/SEAT FOR PATIENT LIFT *
E0630 PATIENT LIFT/HYDRAULIX W/ST OR SLN * *
E0650 PNEUMATIC COMP/LYMPH EDEMA PUMP * *
E0651 PNEUMATIC COMP/LYMPH PUMP/NON GRAD * *
E0652 PNEUMATIC COMP/LYMPH PUMP/CAL GRAD * *
E0655 PNEUMATIC APPLIANCE/HALF ARM *
E0660 PNEUMATIC APPLIANCE/FULL LEG *
E0665 PNEUMATIC APPLIANCE/FULL ARM *
E0666 PNEUMATIC APPLIANCE/HALF LEG *
E0667 PNEUMATIC APP/USED W/SEG COMP/LEG *
E0720 TENS/2 LEAD * *
E0730 TENS/4 LEAD * *
E0745 NEUROMUSCULAR STIM/ELECTRIC SHOCK * *
E0776 IV POLE * *
E0840 CERVICAL TRACTION FRAME/HEADBOARD *
E0850 CERVICAL TRACTION STAND FREE STANDING *
E0860 OVERDOOR CERVICAL TRACTION * *
E0870 EXTREMITY TRACTION/FOOTBOARD/BUCKS * *
E0880 EXTREMITY TRACTION/FREE STANDING * *
E0890 PELVIC TRACTION/FOOTBOARD * *
E0900 PELVIC TRACTION/FREE STANDING * *
E0910 TRAPEZE BAR ATTACHED TO BED * *
* Confidential Treatment Requested
CIGNA HEALTHCARE
EXHIBIT A(3) -- OLSTEN KIMBERLY QUALITYCARE
HMO FEE SCHEDULE -- HOME MEDICAL EQUIPMENT -- NON-MEDICARE
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- -------- ----------------------------------------------------------- -------- ------
E0920 FRACTURE FRAME/ATT'D TO BED W/WEIGHTS * *
E0930 FRACTURE FRAME/FREE STANDING W/WEIGHTS * *
E0935 KNEE CPM PER DAY *
E0940 TRAPEZE BAR/FREE STANDING W/BAR * *
E0942 CERVICAL HEAD HARNESS/HALTER *
E0946 FRACTURE FRAME DUAL W/CROSS BARS *
E0951 LOOP HEEL/EACH *
E0952 LOOP TOE/EACH *
E0953 PNEUMATIC TIRE/EACH *
E0954 SEMI PNEUMATIC CASTER/EACH *
E0958 W/C ATTACH TO CONVERTER TO 1 ARM DRIV *
E0959 AMPUTEE ATTACHMENT *
E0961 W/C BRAKE EXTENSION *
E0962 1" CUSHION FOR WHEELCHAIR *
E0963 2" CUSHION FOR WHEELCHAIR *
E0964 3" CUSHION FOR WHEELCHAIR *
E0965 4" CUSHION FOR WHEELCHAIR *
E0966 HOOK ON HEAD REST EXT. *
E0967 WC HANDRIMS WITH 8 VERT TIPS PAIR *
E0968 COMMODE SEAT/WHEELCHAIR *
E0969 NARROWING DEVICE/WHEELCHAIR *
E0970 #2 FOOTPLATES/EXC FOR ELEC LEG REST *
E0971 ANTI-TIPPING DEVICE FOR WHEELCHAIR *
E0972 TRANSFER BOARD/WHEELCHAIR *
E0973 ADJ HGHT/DETACH ARMS/DESK FULL M/C *
E0974 GRADE AID FOR WC *
E0975 REINFORCED SEAT UPHOLSTERED *
E0976 REINFORCED BACK W/O UPHOLSTERY *
E0977 WEDGE CUSHION/WHEELCHAIR *
E0978 WC SAFETY BELT/AIRLINE BUCKLE *
E0979 WC SAFETY BELT/VELCRO CLOSURE *
E0980 SAFETY VEST/WHEELCHAIR *
E0990 ELEVATING LEG REST/EACH *
E0991 UPHOLSTERY SEAT *
E0992 SOLID SEAT INSERT *
E0993 BACK/UPHOLSTERY *
E0994 ARM REST/EACH *
E0995 CALF REST/EACH *
E0996 TIRE/SOLID/EACH *
E0997 CASTER W/ FORK/EACH *
E0998 CASTER W/O FORK/ EACH *
E0999 PNEUMATIC TIRE WITH WHEEL *
E1000 TIRE PNEUMATIC CASTER *
E1001 WHEEL/SINGLE *
* Confidential Treatment Requested
CIGNA HEALTHCARE
EXHIBIT A(3) -- OLSTEN KIMBERLY QUALITYCARE
HMO FEE SCHEDULE -- HOME MEDICAL EQUIPMENT -- NON-MEDICARE
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- -------- ----------------------------------------------------------- -------- ------
E1030 WC/FA REMOVABLE FOOTRESTS * *
E1031 ROLLABOUT CHAIR * *
E1050 FULL RECLINE/FIXED ARMS/DELR/WC * *
E1060 FULL RECLINE/DETACH ARMS/DELR * *
E1065 POWER ATTACH TO CONVERT WC TO POWER * *
E1070 FULL RECLINE/DA/SDFR * *
E1083 HEMI WC/FA/ELR * *
E1084 HEMI WC/DA/SDFR * *
E1085 HEMI WC/FA/SDFR * *
E1086 W/C STANDARD HEMI DA SDFR * *
E1087 W/C HI STRENGTH LT WT FA ELR * *
E1088 W/C HI STRENGTH LT WT DA ELR * *
E1089 W/C HI STRENGTH FA SDFR * *
E1090 W/C HI STRENGTH LT WT RA SDFR * *
E1091 YOUTH WHEELCHAIR, ANY TYPE * *
E1092 W/C HD WIDE DA ELR * *
E1093 W/C HD WIDE DA FR * *
E1100 SEMI RECLINING W/C FA ELR * *
E1110 WC SEMI-RECLINING/DA OR ELR * *
E1130 WC STANDARD FA/SDFR * *
E1140 WC STANDARD DA/SDFR * *
E1150 WC STANDARD DA/ELR * *
E1160 WC STANDARD FA/ELR * *
E1170 AMPUTEE WC FA/ELR * *
E1171 AMPUTEE WC FA W/O SDFR OR ELR * *
E1172 AMPUTEE WC DA W/O SDFR OR ELR * *
E1180 AMPUTEE WC DA/SDFR * *
E1190 AMPUTEE WC DA/ELR * *
E1195 HEAVY DUTY WC FA/ELR *
E1200 AMPUTEE WC FA/SDFR *
E1210 MOTORIZED WC FA/ELR *
E1211 MOTORIZED WC DA/ELR *
E1212 WC/MOTORIZED/FFLA/SDFR *
E1213 MOTORIZED WC DA/SDFR *
E1240 WC LIGHTWEIGHT DA/ELR * *
E1250 WE LIGHTWEIGHT FA/SDFR * *
E1260 WC LIGHTWEIGHT/DA/SDFR * *
E1270 WC LIGHTWEIGHT FA/ELR * *
E1353 REGULATOR, FOR PURCHASED TANK *
E1355 TANK STAND/RACK *
E1372 EXTERNAL HEATER IMMERSION FOR NEB * *
E1375 PORTABLE NEB W/SMALL COMP./LTD. FLOW *
E1377 COMPRESSOR, LIGHT DUTY ADJ. PRESSURE * *
E1378 O2 CONCENTRATOR/HI HUMID/=488 CU FT. * *
* Confidential Treatment Requested
CIGNA HEALTHCARE
EXHIBIT A(3) -- OLSTEN KIMBERLY QUALITYCARE
HMO FEE SCHEDULE -- HOME MEDICAL EQUIPMENT -- NON-MEDICARE
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- -------- ----------------------------------------------------------- -------- ------
E1379 O2 CONCENTRATOR/HI HUMID/=732 CU FT. * *
E1380 O2 CONCENTRATOR/HI HUMID/=976 CU FT. * *
E1381 O2 CONCENTRATOR/HI HUMID/=1220 CU FT. * *
E1382 PULSE OXIMETER CONT/OVERNOC INCL.PROVE * *
E1383 O2 CONCENTRATOR/HI HUMID/=1708 CU FT. * *
E1384 O2 CONCENTRATOR/HI HUMID/=1952 CU FT. * *
E1385 OXYGEN ANALYZER * *
E1400 OXYGEN CONCENTRATOR 2 LITER * *
E1401 O2 CONCENTRATOR BETWEEN 2L & 4L * *
E1402 O2 CONCENTRATOR BETWEEN 3L & 4L * *
E1403 O2 CONCENTRATOR BETWEEN 4L & 5L * *
E1404 O2 CONCENTRATOR OVER 5L @ 85% CONC * *
E1405 O2 & H20 ENRICHING SYS/HTD DELIVERY * *
E1406 O2 & H20 ENRICHING SYS/NON HTD DELIVERY * *
(1) HME PROVIDED TO PATIENTS OTHER THAN LISTED ABOVE WILL BE BILLED AT A
30% DISCOUNT FROM PROVIDER'S USUAL AND CUSTOMARY CHARGE.
(2) SPECIAL ORDER, CUSTOM WHEELCHAIRS WILL BE DISCONTINUED 20% FROM
MANUFACTURERS' SUGGESTED RETAIL.
* Confidential Treatment Requested
HMO PROGRAM ATTACHMENT
EXHIBIT A.4
HOME MEDICAL EQUIPMENT CAPITATION RATES
- -------------------------------------------------------------------------------------------------------------------
CIGNA HEALTHCARE
EXHIBIT A(4) -- OLSTEN KIMBERLY QUALITYCARE
HME CAPITATION RATES -- NON-MEDICARE/NON-MEDICAID
- -------------------------------------------------------------------------------------------------------------------
HEALTHPLAN SITE NON-MEDICARE/NON-MEDICAID
- ---------------------------------------------------------- --------------------------------------------------------
Alabama *
- ---------------------------------------------------------- --------------------------------------------------------
Arizona *
- ---------------------------------------------------------- --------------------------------------------------------
Arkansas *
- ---------------------------------------------------------- --------------------------------------------------------
California *
- ---------------------------------------------------------- --------------------------------------------------------
Colorado *
- ---------------------------------------------------------- --------------------------------------------------------
Connecticut *
- ---------------------------------------------------------- --------------------------------------------------------
Delaware *
- ---------------------------------------------------------- --------------------------------------------------------
District of Columbia *
- ---------------------------------------------------------- --------------------------------------------------------
Florida *
- ---------------------------------------------------------- --------------------------------------------------------
Georgia *
- ---------------------------------------------------------- --------------------------------------------------------
Idaho *
- ---------------------------------------------------------- --------------------------------------------------------
Illinois *
- ---------------------------------------------------------- --------------------------------------------------------
Indiana *
- ---------------------------------------------------------- --------------------------------------------------------
Iowa *
- ---------------------------------------------------------- --------------------------------------------------------
Kansas *
- ---------------------------------------------------------- --------------------------------------------------------
Kentucky *
- ---------------------------------------------------------- --------------------------------------------------------
Louisiana *
- ---------------------------------------------------------- --------------------------------------------------------
Lovelace *
- ---------------------------------------------------------- --------------------------------------------------------
Maine *
- ---------------------------------------------------------- --------------------------------------------------------
Maryland *
- ---------------------------------------------------------- --------------------------------------------------------
Massachusetts *
- ---------------------------------------------------------- --------------------------------------------------------
Michigan *
- ---------------------------------------------------------- --------------------------------------------------------
Minnesota *
- ---------------------------------------------------------- --------------------------------------------------------
Mississippi *
- ---------------------------------------------------------- --------------------------------------------------------
Missouri *
- ---------------------------------------------------------- --------------------------------------------------------
Montana *
- ---------------------------------------------------------- --------------------------------------------------------
Nebraska *
- ---------------------------------------------------------- --------------------------------------------------------
Nevada *
- ---------------------------------------------------------- --------------------------------------------------------
New Hampshire *
- ---------------------------------------------------------- --------------------------------------------------------
New Jersey *
- ---------------------------------------------------------- --------------------------------------------------------
New Mexico (except Lovelace) *
- ---------------------------------------------------------- --------------------------------------------------------
New York *
- ---------------------------------------------------------- --------------------------------------------------------
North Carolina *
- ---------------------------------------------------------- --------------------------------------------------------
North Dakota *
- ---------------------------------------------------------- --------------------------------------------------------
Ohio *
- ---------------------------------------------------------- --------------------------------------------------------
Oklahoma *
- ---------------------------------------------------------- --------------------------------------------------------
Oregon *
- ---------------------------------------------------------- --------------------------------------------------------
* Confidential Treatment Requested
HMO 12
- -------------------------------------------------------------------------------------------------------------------
CIGNA HEALTHCARE
EXHIBIT A(4) -- OLSTEN KIMBERLY QUALITYCARE
HME CAPITATION RATES -- NON-MEDICARE/NON-MEDICAID
- -------------------------------------------------------------------------------------------------------------------
HEALTHPLAN SITE NON-MEDICARE/NON-MEDICAID
- ---------------------------------------------------------- --------------------------------------------------------
- ---------------------------------------------------------- --------------------------------------------------------
Pennsylvania *
- ---------------------------------------------------------- --------------------------------------------------------
Rhode Island *
- ---------------------------------------------------------- --------------------------------------------------------
South Carolina *
- ---------------------------------------------------------- --------------------------------------------------------
South Dakota *
- ---------------------------------------------------------- --------------------------------------------------------
Tennessee *
- ---------------------------------------------------------- --------------------------------------------------------
Texas *
- ---------------------------------------------------------- --------------------------------------------------------
Utah *
- ---------------------------------------------------------- --------------------------------------------------------
Vermont *
- ---------------------------------------------------------- --------------------------------------------------------
Virginia *
- ---------------------------------------------------------- --------------------------------------------------------
Washington *
- ---------------------------------------------------------- --------------------------------------------------------
West Virginia *
- ---------------------------------------------------------- --------------------------------------------------------
Wisconsin *
- ---------------------------------------------------------- --------------------------------------------------------
Wyoming *
- ---------------------------------------------------------- --------------------------------------------------------
(1) Prices effective 1/1/96 through 12/31/98.
(2) Above prices have NO exclusions for home medical equipment.
* Confidential Treatment Requested
HMO PROGRAM ATTACHMENT
EXHIBIT A.5
UTILIZATION MANAGEMENT STANDARDS
Refer to Milliman and Robertson Health Care Management Guidelines, Volume 4,
Home Care and Case Management, as revised or supplemented.
HMO 13
HMO PROGRAM ATTACHMENT
EXHIBIT A.6
HMO PROGRAM REQUIREMENTS
This highlights the essential features of CIGNA's HMO Program Requirements for
Provider. Provider must follow Program Requirements in order to receive payment
for services rendered to Participants hereunder. Participants must also follow
applicable Program Requirements in order to receive benefits.
HMO 14
VII. PARTICIPANT IDENTIFICATION
1. Participants must present an HMO ID card to Provider or Subcontractor
at the time of service.
2. The ID card itself does not guarantee eligibility. Provider or
Subcontractor should verify Participant eligibility with CIGNA.
VIII. COMPENSATION AND BILLING
1. Encounter data will contain all of the required data elements of a paid
claim and will reflect services rendered to CIGNA Participants either
by Provider directly or through Subcontractors.
2. For Covered Home Care Services rendered by Provider or Subcontractors
to Participants out-of-network (i.e., Participant failed to obtain
Participating Primary Care Physician authorization), Provider shall
bill CIGNA electronically in a format acceptable to CIGNA. Such claims
must be sent to the centralized billing location designated by CIGNA.
3. Provider's Subcontractors may not bill CIGNA directly for Covered Home
Care Services referred to Provider under any circumstances.
4. Provider and Subcontractors shall not bill Participants for Covered
Home Care Services rendered. For in-network Covered Home Care Services,
Provider or Subcontractors will collect from or bill to Participant any
applicable Copayments. For out-of-network Covered Home Care Services
rendered by Provider or Subcontractors, Deductibles and Coinsurance
should be billed to the Participant following the receipt of the
Explanation of Benefits (EOB) letter from CIGNA.
5. Questions concerning the payment of individual claims should be
directed to CIGNA.
IX. REFERRALS/PRIOR AUTHORIZATION
1. Provider and Subcontractors must communicate and collaborate with the
Participant's Primary Care Physician in the management of the
Participant's care.
X. DISPUTE RESOLUTION
1. Disputes arising with respect to the performance or the interpretation
of this Agreement shall be submitted to the Healthplan Medical Director
for review and resolution. If Provider is not satisfied with the
resolution, Provider may submit the matter to the National Medical
Director, CIGNA Health Corporation. The National Medical Director or
his designee will review the matter and may seek written statements
from the Healthplan Medical Director, Provider, Subcontractors, and
others as appropriate. The decision of the National Medical Director
will be binding on CIGNA and Provider if the resolution is accepted by
Provider.
HMO 15
2. If the parties are unable to resolve the dispute through the
aforementioned process, the parties shall resolve the dispute in
accordance with the dispute resolution procedures outlined in Section
III.N. of the Agreement.
HMO 16
PPO PROGRAM ATTACHMENT
TO NATIONAL HOME CARE PROVIDER AGREEMENT
PURPOSE
The terms and provisions of this PPO Program Attachment and the Agreement are
applicable to Covered Home Care Services rendered in accordance with a Service
Agreement which is consistent with the PPO Program. The PPO Program includes
CIGNA'S PPO and Gatekeeper PPO products.
XI PARTIES' OBLIGATIONS
A. Services
Provider shall provide or arrange for all Covered Home Care Services that are
ordered or prescribed by a physician for Participants and referred to Provider
in accordance with the terms of this Agreement, this PPO Program Attachment and
applicable PPO Program Requirements.
B. Compensation and Billing
1. Provider's reimbursement for Covered Home Care Services shall be based
upon the fees set forth in Exhibits B.(1)-(3), less applicable
Copayments, Deductibles and Coinsurance. Provider guarantees that the
rates set forth in Exhibits B.(1)-(3) are effective for a period of
one year from the Effective Date. For the second year of this
Agreement, such rates will be increased by the lesser of 50% of the
annual national Consumer Price Index-Medical Component, or comparable
successor measure, established as of October 1, 1996 or 4%. For the
third year of this Agreement, the rates will be increased by the
lesser of 50% of the annual national Consumer Price Index-Medical
Component, or comparable successor measure, established as of October
1, 1997 or 4%.
2. Provider shall submit claims for Covered Home Care Services under this
Program Attachment and receive payment for valid claims according to
the following:
a. Provider shall submit claims electronically, to the
extent technologically feasible, for reimbursement for
all Covered Home Care Services within ninety (90) days of
the date those services are rendered or, if Payor is the
secondary payor with regard to the claim, within ninety
(90) days of the date Payor is determined to be secondary.
Claims will be submitted in accordance with the rates set
forth in the Exhibits attached hereto and in accordance
with the requirements mutually agreed upon by the
parties during implementation of this Agreement.
PPO 1
Claims received after this ninety (90) day period may
be denied for payment. Provider shall submit claims to the
location described in PPO Program Requirements. Provider
agrees to work in good faith to assure that claims can be
submitted to CIGNA electronically and shall make any
reasonable capital expenditures necessary to enhance its
systems in order to enable such submission by April 1, 1997.
b. If a claim meets the above-referenced mutually
agreed upon requirements, any amount owing under this
Agreement shall be paid within thirty (30) days after
receipt, unless additional required information is requested
within the thirty (30) day period, or unless the claim
involves coordination of benefits, except as otherwise
provided for in this Program Attachment.
3. CIGNA shall deduct any Copayments, Deductibles, or Coinsurance required
by the Service Agreement from payment due to Provider. Deduction for
the Copayment, Deductible, or Coinsurance shall be determined on the
basis of rates set forth in this Attachment.
4. Provider's reimbursement as set forth herein shall be payment in full
for Covered Home Care Services rendered by Provider and Subcontractors
pursuant to this Agreement, except for Copayments, Deductibles and
Coinsurance.
5. When Provider has been notified in advance that a particular service is
not Medically Necessary, Provider and its Subcontractors shall not
change the Participant for such service unless, in advance of the
provision of such service, Provider or Subcontractor has notified the
Participant that the service is not covered and the Participant
acknowledges in writing that he or she shall be responsible for payment
of charges for such services.
6. Provider will look solely to CIGNA and Subcontractors will look solely
to Provider for compensation for Covered Home Care Services except for
Copayments, Deductibles or Coinsurance. Provider agrees that whether or
nor there is any unresolved dispute for payment, that under no
circumstances will Provider or its Subcontractors directly or
indirectly make any charges or claims, other than for Copayments,
Deductibles or Coinsurance against any Participants or their
representatives for Covered Home Care Services and that this provision
survives termination of this Agreement for services rendered prior to
such termination. Except for the collection of Copayments, Deductibles
or Coinsurance, only those services that are not Covered Home Care
Services may be billed directly to Participants, subject to limitations
listed above. This paragraph is to be interpreted for the benefit of
Participants and does not diminish the obligation of CIGNA to make
payments to Provider according to the terms of this Agreement.
7. All rates include the cost of routine lab specimen collection by a
nurse and delivered to a laboratory specified by CIGNA provided that
Provider and such laboratory can reach a reasonable accommodation with
respect to the logistics of such collection and delivery and with
respect to the provision of applicable laboratory supplies.
8. For patients receiving two or more therapies on the same day, Provider
will receive the highest applicable per diem for the first therapy. For
most therapies, this per diem will include drugs as per the fee
schedule. For each additional therapy except for parenteral, enteral
and IV push/IM/SQ injections, Provider will receive $30 for each
therapy, plus AWP less the applicable discount. Parenteral, enteral and
IV push/IM/SQ injections will be paid in the usual manner.
C. COORDINATION OF BENEFITS
1. Certain claims for services rendered to Participants are claims for
which another payor may be primarily responsible under coordination of
benefit rules. Provider shall bill such claims to the primary payor
when information regarding such primary payor is available, or upon
CIGNA's request and shall comply with the primary payor's billing
rules, including, but not limited to, any of the primary payor's
limitations on billing Participants.
2. When CIGNA or CIGNA's designated Payor is primary under applicable
coordination of benefits rules, CIGNA shall pay benefits as set forth
in this Agreement without regard to the obligations of any secondary
payor.
3. When CIGNA or CIGNA's designated Payor is determined to be secondary to
any other payor including Medicare, CIGNA will pay no greater amount
than the difference between the amount payable to Provider by the
primary payor and the amount for Covered Home Care Services owing
under this Agreement. CIGNA shall not be liable for any amount unless
CIGNA has received Provider's claim for such secondary payment within
90 days of the date when CIGNA is determined to be secondary.
D. Utilization Management/Cost Containment
PPO 2
1. Provider shall evaluate whether each Participant order or prescription
it receives for Covered Home Care Services under this Program are
Medically Necessary, utilizing Utilization Management guidelines
mutually developed by the parties, including, but not limited to, the
Milliman and Robertson Home Care and Case Management Guidelines set
forth in Exhibit A.5 to the HMO Program Attachment.
2. Provider will notify CIGNA's Intracorp subsidiary of each referral it
receives for Covered Home Care Services and will coordinate with
Intracorp in the provision of case management and concurrent inpatient
utilization review services to Participants under this Program. The
parties will determine the specific roles and responsibilities of
CIGNA, Provider and Intracorp with respect to Utilization Management
during the implementation process.
3. CIGNA will review claims submitted for Covered Home Care Services by
Provider and Subcontractors under this Program to assure that all
billed services were Medically Necessary, based on utilization review
criteria mutually developed by both parties. If an individual at
Intracorp (or its successor function) identified by CIGNA certifies to
Provider the Medical Necessity of a particular service in advance of
the provision of such service, CIGNA shall not retrospectively deny
payment for such service on the basis of Medical Necessity.
4. Where CIGNA determines billed services not to be Medically Necessary
and denies payment, Provider may appeal the payment denial in
accordance with the appeal procedures described in the Program
Requirements to this Program Attachment.
XII RIGHTS AND OBLIGATIONS UPON TERMINATION
This Agreement provides for an alternative method of payment of Provider
charges incurred by the Participant during the existence of this Agreement. It
is not a contract for the provision of service to the Participant. Termination
of this Agreement terminates the alternative method of payment with regard to
services provided after the date of termination. Termination of this Agreement
should in no way be construed as affecting any Provider's relationship with the
patient other than removing this alternative payment system.
[REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK]
PPO 3
PPO PROGRAM ATTACHMENT
EXHIBIT B.1
FFS REIMBURSEMENT SCHEDULE -- HOME HEALTH
- -------------------------------------------------------------------------------------------------------------------
CIGNA HEALTHCARE
EXHIBIT B(1) -- OLSTEN KIMBERLY QUALITYCARE
PPO FEE SCHEDULE -- HOME HEALTH
- -------------------------------------------------------------------------------------------------------------------
(1) (2)
VISIT HOURLY
SERVICE RATE RATE
- ----------------------------------------------------------- --------------------------- ---------------------------
RN -- High Tech * *
- ----------------------------------------------------------- --------------------------- ---------------------------
RN * *
- ----------------------------------------------------------- --------------------------- ---------------------------
LPN * *
- ----------------------------------------------------------- --------------------------- ---------------------------
LPN -- High Tech * *
- ----------------------------------------------------------- --------------------------- ---------------------------
Home Health Aide * *
- ----------------------------------------------------------- --------------------------- ---------------------------
Physical Therapy *
- ----------------------------------------------------------- --------------------------- ---------------------------
Physical Therapy Assistant *
- ----------------------------------------------------------- --------------------------- ---------------------------
Occupational Therapy *
- ----------------------------------------------------------- --------------------------- ---------------------------
Occupational Therapy Assistant *
- ----------------------------------------------------------- --------------------------- ---------------------------
Speech Therapy *
- ----------------------------------------------------------- --------------------------- ---------------------------
Medical Social Work *
- ----------------------------------------------------------- --------------------------- ---------------------------
Phelebotomist * *
- ----------------------------------------------------------- --------------------------- ---------------------------
Respiratory Therapy *
- ----------------------------------------------------------- --------------------------- ---------------------------
Registered Dietician *
- ----------------------------------------------------------- --------------------------- ---------------------------
Companion * *
- ----------------------------------------------------------- --------------------------- ---------------------------
Live-In *
- ----------------------------------------------------------- --------------------------- ---------------------------
(1) Visits are defined as two (2) hours or less in duration.
(2) Hourly rate for visits exceeding two (2) hours in duration, starting with hour 3.
(3) We do not reimburse for travel time, weekend, holiday or evening differentials.
(4) Above prices have NO exclusions.
(5) For home health services not on fee schedule, 70% of Provider's usual and customary
charge will apply.
(6) Prices effective 1/1/96 through 12/31/96.
* Confidential Treatment Requested
PPO 4
PPO PROGRAM ATTACHMENT
EXHIBIT B.2
FFS REIMBURSEMENT SCHEDULE -- HOME INFUSION
EXHIBIT B(2) -- OLSTEN KIMBERLY QUALITYCARE
PPO FEE SCHEDULE -- HOME INFUSION
(1) (2) (3)
PER DIEMS
PER DIEMS PER DIEMS DRUGS FOR MULTIPLE DRUGS
INCLUDING EXCLUDING % OFF THERAPIES % OFF
SERVICE DRUGS DRUGS AWP (EXCL. DRUGS) AWP
- -------------------------------------- --------- --------- ----- ------------- -----
Total Parenteral Nutrition * * * * *
Enteral Nutrition * * * * *
Anti-Infective Infusion * * * * *
Chemotherapy (Continuous or Bolus) * * * * *
Pain Management * * * * *
Hydration Therapy * * * * *
Chelation Therapy * * * * *
Inotropic Therapy * * * * *
Anticoagulation * * * * *
Methylprednisolone * * * * *
Immunoglobulin (4) * * * * *
Specialty-Dosed IV Therapies (5) * * * * *
Ceradase/cerazyme (6) * * * * *
IV Push/IM/SQ Injections (7) * * * * *
(1) Per Diems under column 1 include ALL costs-- including, but not limited
to, cost of drugs, facility overhead, supplies, delivery, professional
labor including compounding and monitoring, all nursing required,
maintenance of specialized catheters, equipment/patient supplies,
disposables, pumps, general and administrative expenses, etc.
(2) Per Diems under column 2 are only for those specific therapies for
which a per diem inclusive of drugs cannot be provided. For such
therapies, the quoted per diems plus * will apply, with the only
exception being Ceradase/Cerazyme which shall be paid at its applicable
per diem plus AWP with no discount.
(3) For patients receiving two or more therapies on the same day, Provider
will receive the highest applicable per diem for the first therapy. For
most therapies, this per diem will include drugs as per the fee
schedule above. For each additional therapy except for parenteral,
enteral and IV Push/IM/SQ injections, Provider will receive $30 for
each therapy, plus AWP less the applicable discount for those drugs
used in the additional therapies. Parenteral, enteral and IV Push/IM/SQ
injections will be paid in their usual manner.
(4) The per diems for Immunoglobulin do not include drugs. As a single
therapy, Immunoglobulin will be paid at $ per diem plus *.
(5) The per diems for Specialty-Dosed IV Therapies do not include drugs. As
a single therapy, a Specialty-Dosed Therapy will be paid at *.
(6) The per diems for Ceradase/Cerazyme do not include drugs. As a single
therapy, Ceradase or Cerazyme will be paid at * with no discount.
(7) The per diems for IV Push/IM/SQ Injections do not include drugs. IV
Push/IM/SQ Injections will be paid at *.
(8) The per diem rate shall only be charged for those days the Participant
receives medication.
(9) Prices effective 1/1/96 through 12/31/96.
(10) For home infusion pharmaceuticals not listed on fee schedule *, will
apply.
* Confidential Treatment Requested
PPO 5
PPO PROGRAM ATTACHMENT
EXHIBIT B.3
FFS REIMBURSEMENT SCHEDULE -- HOME MEDICAL EQUIPMENT
CIGNA HEALTHCARE
EXHIBIT B(3) -- OLSTEN KIMBERLY QUALITYCARE
PPO FEE SCHEDULE -- HOME MEDICAL EQUIPMENT
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ----- --------------------------------------------------------- -------- ------
E0100 CANE *
E0105 QUAD CANE/3PRONG/FIXED ADJ *
E0110 FOREARM CRUTCH/PAIR/FIXED/ADJ *
E0111 FOREARM CRUTCH/EACH *
E0112 UNDERARM CRUTCH/WOOD/PAIR/FIXED/ADJ *
E0113 UNDERARM CRUTCH/WOOD/EACH/FIXED/ADJ *
E0114 UNDERARM CRUTCH/ALUM/PAIR/FIXED/ADJ *
E0116 UNDERARM CRUTCH/ALUM/EACH/FIXED/ADJ *
E0130 WALKER/RIGID/FIXED/ADJ *
E0135 WALKER/FOLDING/FIXED/ADJ *
E0141 WALKER/RIGID/WHEELED *
E0142 WALKER/RIGID/WHEELED/SEAT *
E0143 WALKER/FOLDING/WHEELED *
E0145 WALKER/WHEELED W/SEAT & CRUTCH ATT. *
E0146 WALKER/WHEELED W/SEAT *
E0147 WALKER/HD/MULTI BRAKE/VARI-TENSION *
E0153 PLATFORM ATTACHMENT/FOREARM CRUTCH *
E0154 WALKER PLATFORM ATTACHMENT ONLY *
E0155 WHEEL ATTACH/RIGID PICKUP WALKER *
E0156 SEAT ATTACHMENT WALKER *
E0157 CRUTCH ATTACHMENT/WALKER/EA *
E0158 LEG EXTENSIONS FOR WALKER *
E0160 SITZ BATH/PORT/FIT COMMODE *
E0161 SITZ BATH/PORT/FITS COMMODE/W/FAUCETT *
E0163 COMMODE/CHAIR STATIONARY FIXED ARMS *
E0164 COMMODE/CHAIR MOBILE FIXED ARMS *
E0165 COMMODE/CHAIR STATIONARY/DETACH ARMS *
E0166 COMMODE/CHAIR MOBILE/DETACH ARMS *
E0167 PAIL OR PAN FOR USE W/COMMODE CHAIR *
E0176 AIR PRESS. PAD/CUSH. NON-POSITIONING *
E0177 H20 PRESS. PAD/CUSH. NON-POSITIONING *
E0178 GEL PRESS. PAD/CUSH. NON-POSITIONING *
E1079 DRY PRESS, PAD/CUSH. NON-POSITIONING *
E0180 PRESSURE PAD/ALTERNATING W/PUMP * *
E0181 PRESSURE PAD/ALTERNATING/W/PUMP/HD * *
E0182 PUMP FOR ALTERNATING PRESSURE PAD * *
E0184 DRY PRESSURE MATTRESS *
E0185 GEL PRESSURE PAD FOR MATTRESS *
E0186 AIR PRESSURE MATTRESS *
E0187 WATER PRESSURE MATTRESS *
E0188 SYNTHETIC SHEEP SKIN PAD *
E0189 LAMP WOOL, SHEEP SKIN PAD/ANY SIZE *
E0191 HEAT/ELBOW/PROTECTOR/EA *
E0192 LOW PRESSURE & POS. EQUALIZATION * *
* Confidential Treatment Requested
PPO 6
CIGNA HEALTHCARE
EXHIBIT B(3) -- OLSTEN KIMBERLY QUALITYCARE
PPO FEE SCHEDULE -- HOME MEDICAL EQUIPMENT
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ----- --------------------------------------------------------- -------- ------
E0193 ILOW AIR LOSS-BED MATTRESS REPLACEMENT *
E0194 AIR FLUIDIZED BED *
E0195 REPLACEMENT PAD/ALTERNATING PRESS *
E0196 GEL PRESSURE MATTRESS *
E0197 AIR PRESSURE PAD FOR MATTRESS *
E0198 WATER PRESSURE PAD FOR MATTRESS *
E0199 DRY PRESSURE PAD FOR MATTRESS *
E0210 PAD, ELECTRIC, HEAT, STANDARD *
E0215 PAD, ELECTRIC, MOIST HEAT *
E0237 H2O CIRC. HEAT PAD W/PUMP * *
E0238 PAD, HEAT PAD, NON-ELECTRIC, MOIST *
E0243 TOILET RAIL, EACH *
E0244 RAISED TOILET SEAT *
E0245 TUB STOOL OR BENCH W/O BACK *
E0246 TRANSFER TUB RAIL ATTACHMENT *
E0249 PAD FOR WATER CIRCULATING HEAT UNIT *
E0250 BED/FH/SR/MATT * *
E0251 BED/FH/SR/W/O MATT * *
E0255 BED/VH/HI-LOW/SR/MATT * *
E0256 BED/VH/HI-LOW/SR/W/O MATT * *
E0260 BED/SEMI-ELEC/SR/MATT * *
E0261 HOSPITAL BED/VARI HGHT/SR/W/O MATT * *
E0265 BED/FULL-ELEC/SR/MATT * *
E0266 BED/FULL-ELEC/SR/W/O MATT * *
E0271 MATTRESS/INNER SPRING *
E0272 MATTRESS/FOAM RUBBER *
E0274 OVERBED TABLE * *
E0275 BED PAN/STD METAL OR PLASTIC *
E0276 BED PAN/FRACTURE/METAL OR PLASTIC *
E0280 BED CRADLE, ANY TYPE *
E0290 BED/F/W/O SR/MATT * *
E0291 BED/FH/W/O SR/W/O MATT * *
E0292 BED/VH/HI-LO/W/O SR/MATT * *
E0293 BED/VH/HI-LO/W/O SR/W/O MATT * *
E0294 BED/SEMI-ELEC/W/O SR/MATT * *
E0295 BED/SEMI-ELEC/W/O SR/W/O MATT * *
E0296 BED/FULL-ELEC/W/O SR/W/O MATT * *
E0297 BED/FULL-ELEC/W/O SR/MATT * *
E0325 URINAL/MALE/JUG-TYPE/ANY MATERIAL *
E0326 URINAL/FEMALE/JUG-TYPE/ANY MATERIAL *
E0425 STATIONARY GAS SYS. PURCH * *
E0430 O2 GAS SYS/PORT/ACCESS/PURCH * *
E0431 O2 GAS SYS/PORT/ACCESS/RENTAL *
E0434 O2 LIQUID/PORT/ACCESS/RENTAL *
* Confidential Treatment Requested
CIGNA HEALTHCARE
EXHIBIT B(3) -- OLSTEN KIMBERLY QUALITYCARE
PPO FEE SCHEDULE -- HOME MEDICAL EQUIPMENT
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ----- --------------------------------------------------------- -------- ------
E0435 O2 LIQUID SYS/PORT/ACCESSORIES/PURCH *
E0439 STATIONARY LIQUID SYSTEM/RENTAL *
E0440 STATIONARY LIQUID SYSTEM/PURCHASE *
E0442 O2 CONTENTS/LIQUID/PER UNIT *
E0444 PORTABLE O2 CONTENTS/LIQUID/1 LB. *
E0450 VOLUME VENTILATOR/STAT OR PORT * *
E0452 INTERMITTENT ASSIST DEVICE/BIPAP/TU * *
E0453 THERAPEUTIC VENT FOR <12 HRS./DAY * *
E0460 NEG PRESSURE VENT/PORT/STATIONARY * *
E0480 PERCUSSOR/ELEC OR PNEUMATIC HOME * *
E0500 IPPB MACHINE/ALL TYPES * *
E0550 HUMIDIFIER/DURABLE/FOR IPPB OR O2 * *
E0555 HUMIDIFIER/REUSE/PLASTIC OR GAS *
E0565 COMPRESSOR/BEDSIDE CONTINUOUS * *
E0570 NEBULIZER W/COMP IE/PULMO-AIDE *
E0575 NEBULIZER/ULTRASONIC, HD CONTIN. USE * *
E0585 NEBULIZER W/COMPRESSOR & HEATER * *
E0600 SUCTION PUMP/HOME USE/PORTABLE * *
E0601 CONT AIRWAY PRESSURE DEVICE/CPAP * *
E0607 HOME BLOOD GLUCOSE MONITOR * *
E0608 APNEA MONITOR *
E0620 SEAT LIFT CHAIR/MOTORIZED * *
E0621 SLING/SEAT FOR PATIENT LIFT *
E0630 PATIENT LIFT/HYDRAULIX W/ST OR SLN * *
E0650 PNEUMATIC COMP/LYMPH EDEMA PUMP * *
E0651 PNEUMATIC COMP/LYMPH PUMP/NON GRAD * *
E0652 PNEUMATIC COMP/LYMPH PUMP/CAL GRAD * *
E0655 PNEUMATIC APPLIANCE/HALF ARM *
E0660 PNEUMATIC APPLIANCE/FULL LEG *
E0665 PNEUMATIC APPLIANCE/FULL ARM *
E0666 PNEUMATIC APPLIANCE/HALF LEG *
E0667 PNEUMATIC APP/USED W/SEG COMP/LEG *
E0720 TENS/2 LEAD * *
E0730 TENS/4 LEAD * *
E0745 NEUROMUSCULAR STIM/ELECTRIC SHOCK * *
E0776 IV POLE * *
E0840 CERVICAL TRACTION FRAME/HEADBOARD *
E0850 CERVICAL TRACTION STAND FREE STANDING *
E0860 OVERDOOR CERVICAL TRACTION * *
E0870 EXTREMITY TRACTION/FOOTBOARD/BUCKS * *
E0880 EXTREMITY TRACTION/FREE STANDING * *
E0890 PELVIC TRACTION/FOOTBOARD * *
E0900 PELVIC TRACTION/FREE STANDING * *
E0910 TRAPEZE BAR ATTACHED TO BED * *
* Confidential Treatment Requested
CIGNA HEALTHCARE
EXHIBIT B(3) -- OLSTEN KIMBERLY QUALITYCARE
PPO FEE SCHEDULE -- HOME MEDICAL EQUIPMENT
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ----- --------------------------------------------------------- -------- ------
E0920 FRACTURE FRAME/ATT'D TO BED W/WEIGHTS * *
E0930 FRACTURE FRAME/FREE STANDING W/WEIGHTS * *
E0935 KNEE CPM PER DAY *
E0940 TRAPEZE BAR/FREE STANDING W/BAR * *
E0942 CERVICAL HEAD HARNESS/HALTER *
E0946 FRACTURE FRAME DUAL W/CROSS BARS *
E0951 LOOP HEEL/EACH *
E0952 LOOP TOE/EACH *
E0953 PNEUMATIC TIRE/EACH *
E0954 SEMI PNEUMATIC CASTER/EACH *
E0958 W/C ATTACH TO CONVERTER TO 1 ARM DRIV *
E0959 AMPUTEE ATTACHMENT *
E0961 W/C BRAKE EXTENSION *
E0962 1" CUSHION FOR WHEELCHAIR *
E0963 2" CUSHION FOR WHEELCHAIR *
E0964 3" CUSHION FOR WHEELCHAIR *
E0965 4" CUSHION FOR WHEELCHAIR *
E0966 HOOK ON HEAD REST EXT. *
E0967 WC HANDRIMS WITH 8 VERT TIPS PAIR *
E0968 COMMODE SEAT/WHEELCHAIR *
E0969 NARROWING DEVICE/WHEELCHAIR *
E0970 #2 FOOTPLATES/EXC FOR ELEC LEG REST *
E0971 ANTI-TIPPING DEVICE FOR WHEELCHAIR *
E0972 TRANSFER BOARD/WHEELCHAIR *
E0973 ADJ HGHT/DETACH ARMS/DESK FULL M/C *
E0974 GRADE AID FOR WC *
E0975 REINFORCED SEAT UPHOLSTERED *
E0976 REINFORCED BACK W/C UPHOLSTERY *
E0977 WEDGE CUSHION/WHEELCHAIR *
E0978 WC SAFETY BELT/AIRLINE BUCKLE *
E0979 WC SAFETY BELT/VELCRO CLOSURE *
E0980 SAFETY VEST/WHEELCHAIR *
E0990 ELEVATING LEG REST/EACH *
E0991 UPHOLSTERY SEAT *
E0992 SOLID SEAT INSERT *
E0993 BACK/UPHOLSTERY *
E0994 ARM REST/EACH *
E0995 CALF REST/EACH *
E0996 TIRE/SOLID/EACH *
E0997 CASTER W/ FORK/EACH *
E0998 CASTER W/O FORK/EACH *
E0999 PNEUMATIC TIRE WITH WHEEL *
E1000 TIRE PNEUMATIC CASTER *
E1001 WHEEL/SINGLE *
* Confidential Treatment Requested
CIGNA HEALTHCARE
EXHIBIT B(3) -- OLSTEN KIMBERLY QUALITYCARE
PPO FEE SCHEDULE -- HOME MEDICAL EQUIPMENT
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ----- --------------------------------------------------------- -------- ------
E1030 WC/FA REMOVABLE FOOTRESTS * *
E1031 ROLLABOUT CHAIR * *
E1050 FULL RECLINE/FIXED ARMS/DELR/WC * *
E1060 FULL RECLINE/DETACH ARMS/DELR * *
E1065 POWER ATTACH TO CONVERT WC TO POWER * *
E1070 FULL RECLINE/DA/SDFR * *
E1083 HEMI WC/FA/ELR * *
E1084 HEMI WC/DA/SDFR * *
E1085 HEMI WC/FA/SDFR * *
E1086 W/C STANDARD HEMI DA SDFR * *
E1087 W/C HI STRENGTH LT WT FA ELR * *
E1088 W/C HI STRENGTH LT WT DA ELR * *
E1089 W/C HI STRENGTH FA SDFR * *
E1090 W/C HI STRENGTH LT WT RA SDFR * *
E1091 YOUTH WHEELCHAIR, ANY TYPE * *
E1092 W/C HD WIDE DA ELR * *
E1093 W/C HD WIDE DA FR * *
E1100 SEMI RECLINING W/C FA ELR * *
E1110 WC SEMI-RECLINING/DA OR ELR * *
E1130 WC STANDARD FA/SDFR * *
E1140 WC STANDARD DA/SDFR * *
E1150 WC STANDARD DA/ELR * *
E1160 WC STANDARD FA/ELR * *
E1170 AMPUTEE WC FA/ELR * *
E1171 AMPUTEE WC FA W/O SDFR OR ELR * *
E1172 AMPUTEE WC DA W/O SDFR OR ELR * *
E1180 AMPUTEE WC DA/SDFR * *
E1190 AMPUTEE WC DA/ELR * *
E1195 HEAVY DUTY WC FA/ELR *
E1200 AMPUTEE WC FA/SDFR *
E1210 MOTORIZED WC FA/ELR *
E1211 MOTORIZED WC DA/ELR *
E1212 WC/MOTORIZED/FFLA/SDFR *
E1213 MOTORIZED WC DA/SDFR *
E1240 WC LIGHTWEIGHT DA/ELR * *
E1250 WC LIGHTWEIGHT FA/SDFR * *
E1260 WC LIGHTWEIGHT/DA/SDFR * *
E1270 WC LIGHTWEIGHT FA/ELR * *
E1353 REGULATOR, FOR PURCHASED TANK *
E1355 TANK STAND/RACK *
E1372 EXTERNAL HEATER IMMERSION FOR NEB * *
E1375 PORTABLE NEB W/SMALL COMP./LTD. FLOW *
E1377 COMPRESSOR, LIGHT DUTY ADJ. PRESSURE * *
* Confidential Treatment Requested
CIGNA HEALTHCARE
EXHIBIT B(3) -- OLSTEN KIMBERLY QUALITYCARE
PPO FEE SCHEDULE -- HOME MEDICAL EQUIPMENT
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ----- --------------------------------------------------------- -------- ------
E1378 O2 CONCENTRATOR/HI HUMID/=488 CU FT. * *
E1379 O2 CONCENTRATOR/HI HUMID/=732 CU FT. * *
E1380 O2 CONCENTRATOR/HI HUMID/=976 CU FT. * *
E1381 O2 CONCENTRATOR/HI HUMID/=1220 CU FT. * *
E1382 PULSE OXIMETER CONT/OVERNOC INCL.PROVE * *
E1383 O2 CONCENTRATOR/HI HUMID/=1708 CU FT. * *
E1384 O2 CONCENTRATOR/HI HUMID/=1952 CU FT. * *
E1385 OXYGEN ANALYZER * *
E1400 OXYGEN CONCENTRATOR 2 LITER * *
E1401 O2 CONCENTRATOR BETWEEN 2L & 4L * *
E1402 O2 CONCENTRATOR BETWEEN 3L & 4L * *
E1403 O2 CONCENTRATOR BETWEEN 4L & 5L * *
E1404 O2 CONCENTRATOR OVER 5L @ 85% CONC * *
E1405 O2 & H20 ENRICHING SYS/HTD DELIVERY * *
E1406 O2 & H20 ENRICHING SYS/NON HTD DELIVERY * *
(1) HME PROVIDED TO PATIENTS OTHER THAN LISTED ABOVE WILL BE BILLED *
DISCOUNT FROM PROVIDER'S USUAL AND CUSTOMARY CHARGE.
(2) SPECIAL ORDER, CUSTOM WHEELCHAIRS WILL BE * FROM MANUFACTURERS'
SUGGESTED RETAIL.
* Confidential Treatment Requested
PPO PROGRAM ATTACHMENT
EXHIBIT B.4
FFS REIMBURSEMENT SCHEDULE -- TOCOLYTICS
CIGNA HEALTHCARE
EXHIBIT B(4) -- OLSTEN KIMBERLY QUALITYCARE
PPO FEE SCHEDULE -- TOCOLYTICS
-------------------------------------------
(1)
SERVICE PER DIEMS
------- ---------
Level I Monitoring *
Level II Monitoring *
Level III Monitoring *
* Confidential Treatment Requested
(1) Per Diems include ALL costs -- including, but not limited to, all
nursing required, telephonic monitoring, family caregiver training and
education, durable medical equipment administered or used in the course
of rendering services, medical supplies, disposables, pumps, drugs and
medications, general and administrative expenses, etc.
(2) Prices effective 1/1/96 through 12/31/98.
PPO 7
PPO PROGRAM ATTACHMENT
EXHIBIT B.5
PPO PROGRAM REQUIREMENTS
This highlights the essential features of CIGNA's PPO Program Requirements for
Provider. Provider must follow Program Requirements in order to receive payment
for services rendered to Participants hereunder. Participants must also follow
applicable Program Requirements in order to receive benefits.
VIII PARTICIPANT IDENTIFICATION
1. Participants must present a PPO ID card to Provider or Subcontractor at
the time of service.
2. The ID card itself does not guarantee eligibility. Provider or
Subcontractor should verify Participant eligibility with CIGNA.
XIV COMPENSATION AND BILLING
1. Claims must be clearly identified as "CIGNA PPO" and sent to the
centralized billing location designated by CIGNA.
2. Provider's Subcontractors may not bill CIGNA directly for Covered Home
Care Services referred to Provider under any circumstances.
3. Provider and Subcontractors must not bill Participants for Covered Home
Care Services rendered. Provider or Subcontractor will collect from or
bill to Participant any applicable Copayments. Deductibles and
Coinsurance should be billed to the Participant following the receipt
of the Explanation of Benefits (EOB) letter from CIGNA.
4. Questions concerning the payment of individual claims should be
directed to CIGNA.
XV DISPUTE RESOLUTION
1. CIGNA and Provider agree to meet and confer in good faith to resolve
any problems or disputes that may arise under this PPO Program.
2. If the parties are unable to resolve the dispute through the
aforementioned process, the dispute shall be resolved in accordance
with the dispute resolution procedures set forth in Section III.N. of
the Agreement.
PPO 8
INDEMNITY PROGRAM ATTACHMENT
TO NATIONAL HOME CARE PROVIDER AGREEMENT
PURPOSE
The terms and provisions of this Indemnity Program Attachment and the Agreement
are applicable to Covered Home Care Services rendered in accordance with a CIGNA
Service Agreement which is consistent with the Indemnity Program.
XVI PARTIES' OBLIGATIONS
A. Services
Provider shall provide or arrange for all Covered Home Care Services
that are ordered or prescribed by a physician for Participants and
referred to Provider in accordance with the terms of this Agreement,
this Indemnity Program Attachment and applicable Indemnity Program
Requirements.
B. Compensation and Billing
1. Provider's reimbursement for Covered Home Care Services shall be based
upon the fees set forth in Exhibits C.(1)-(3), less applicable
Copayments, Deductibles and Coinsurance. Provider guarantees that the
rates set forth in Exhibits C.(1)-(3) are effective for a period of one
year from the Effective Date. For the second year of this Agreement,
such rates will be increased by the lesser of 50% of the annual
national Consumer Price Index-Medical Component, or comparable
successor measure, established as of October 1, 1996 or 4%. For the
third year of this Agreement, the rates will be increased by the lesser
of 50% of the annual national Consumer Price Index-Medical Component,
or comparable successor measure, established as of October 1, 1997 or
4%.
2. Provider shall submit claims for Covered Home Care Services under this
Program Attachment and receive payment for valid claims according to
the following:
a. Provider shall submit claims electronically to the extent
technologically feasible for reimbursement for all Covered
Home Care Services within ninety (90) days of the date those
services are rendered or, if Payor is the secondary payor with
regard to the claim, within ninety (90) days of the date Payor
is determined to be secondary. Claims will be submitted in
accordance with the rates set forth in the Exhibits attached
hereto and in accordance with the requirements mutually agreed
upon by the parties during implementation of this Agreement.
Claims received after this ninety (90) day period may be
denied for payment. Provider shall
IND 1
submit claims to the location described in Indemnity Program
Requirements. Provider agrees to work in good faith to assure that
claims can be submitted electronically to CIGNA and shall make any
reasonable capital expenditures necessary to enhance its systems in
order to enable such submission by April 1, 1997.
b. If a claim meets the above-referenced mutually agreed upon
requirements, any amount owing under this Agreement shall be paid
within thirty (30) days after receipt, unless additional required
information is requested within the thirty (30) day period, or unless
the claim involves coordination of benefits, except as otherwise
provided for in this Program Attachment.
3. Payor shall deduct any Copayments, Deductibles, or Coinsurance required
by the Service Agreement for payment due to Provider. Deduction for the
Copayment, Deductible, or Coinsurance shall be determined on the basis
of the rates set forth in this Attachment.
4. Provider's reimbursement as set forth herein shall be payment in full
for Covered Home Care Services rendered by Provider and Subcontractors
pursuant to this Agreement, except for Copayments, Deductibles and
Coinsurance.
5. Provider will look solely to CIGNA and Subcontractors will look solely
to Provider for compensation for Covered Home Care Services except for
Copayments, Deductibles or Coinsurance. Provider agrees that whether or
not there is any unresolved dispute for payment, that under no
circumstances will Provider or its Subcontractors directly or
indirectly make any charges or claims, other than for Copayments,
Deductibles or Coinsurance against any Participants or their
representatives for Covered Home Care Services and that this provision
survives termination of this Agreement for services rendered prior to
such termination. Except for the collection of Copayments, Deductibles
or Coinsurance, only those services that are not Covered Home Care
Services may be billed directly to Participants, subject to limitations
listed above. This paragraph is to be interpreted for the benefit of
Participants and does not diminish the obligation of CIGNA to make
payments to Provider according to the terms of this Agreement.
6. When Provider has been notified in advance that a particular service is
not Medically Necessary, Provider and its Subcontractors shall not
charge the Participant for such service unless, in advance of the
provision of such service, Provider or Subcontractor has notified the
Participant that the service is not covered and the Participant
acknowledges in writing that he or she shall be responsible for payment
of charges for such services.
7. All rates include the cost of routine lab specimen collection by a
nurse and delivery to a laboratory specified by CIGNA provided that
Provider and such laboratory can reach a reasonable accommodation with
respect to the logistics of such collection and delivery and with
respect to the provision of applicable laboratory supplies.
IND 2
8. For patients receiving two or more therapies on the same day, Provider
will receive the highest applicable per diem for the first therapy. For
most therapies, this per diem will include drugs as per the fee
schedule. For each additional therapy except for parenteral, enteral
and IV push/IM/SQ injections, Provider will receive for each therapy,
plus AWP less the applicable discount. Parenteral, enteral and IV
push/IM/SQ injec,tions will be paid in the usual manner.
C. Coordination of Benefits
1. Certain claims for services rendered to Participants are claims for
which another payor may be primarily responsible under coordination of
benefit rules. Provider shall bill such claims to the primary payor
when information regarding such primary payor is available, or upon
CIGNA's request and shall comply with the primary payor's billing
rules, including, but not limited to, any of the primary payor's
limitations on billing Participants.
2. When CIGNA or CIGNA's designated Payor is primary under applicable
coordination of benefits rules, CIGNA shall pay benefits as set forth
in this Agreement without regard to the obligations of any secondary
payor.
3. When CIGNA or CIGNA's designated Payor is determined to be secondary to
any other payor including Medicare, CIGNA will pay no greater amount
than the difference between the amount payable to Provider by the
primary payor and the amount for Covered Home Care Services owing under
this Agreement. CIGNA shall not be liable for any amount unless CIGNA
has received Provider's claim for such secondary payment within 90 days
of the date when CIGNA is determined to be secondary.
D. Utilization Management/Cost Containment
1. Provider shall evaluate whether each Participant order or prescription
it receives for Covered Home Care Services under this Program are
Medically Necessary, utilizing Utilization Management guidelines
mutually developed by the parties, including, but not limited to, the
Milliman and Robertson Home Care and Case Management Guidelines set
forth in Exhibit A.5 to the HMO Program Attachment.
2. Provider will notify CIGNA's Intracorp subsidiary of each referral it
receives for Covered Home Care Services and, for those Participants
whose Service Agreements contain Intracorp utilization management, will
coordinate with Intracorp in the provision of case management and
concurrent inpatient utilization review services to Participants under
this Program. The parties shall determine the specific roles and
responsibilities of CIGNA, Provider and Intracorp with respect to
Utilization Management during the implementation process.
3. Where CIGNA determines billed services not to be Medically Necessary
and denies payment, Provider may appeal the payment denial in
accordance with the appeal procedures described in the Program
Requirements to this Program Attachment. If an appropriate individual
at
IND 3
Intracorp (or its successor function) identified by CIGNA certifies to Provider
the Medical Necessity of a particular service in advance of the provision of
such service, CIGNA shall not retrospectively deny payment for such service on
the basis of Medical Necessity.
XVII RIGHTS AND OBLIGATIONS UPON TERMINATION
This Agreement provides for an alternative method of payment of Provider charges
incurred by the Participant during the existence of this Agreement. It is not a
contract for the provision of service to the Participant. Termination of this
Agreement terminates the alternative method of payment with regard to services
provided after the date of termination. Termination of this Agreement should in
no way be construed as affecting any Provider's relationship with the patient
other than removing this alternative payment system.
[REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK]
IND 4
INDEMNITY PROGRAM ATTACHMENT
EXHIBIT C.1
FFS REIMBURSEMENT SCHEDULE -- HOME HEALTH
CIGNA HEALTHCARE
EXHIBIT C(1) -- OLSTEN KIMBERLY QUALITYCARE
INDEMNITY FEE SCHEDULE -- HOME HEALTH
-------------------------------------------
(1) (2)
VISIT HOURLY
SERVICE RATE RATE
------- ---- ------
RN-- High Tech * *
RN * *
LPN * *
LPN-- High Tech * *
Home Health Aide * *
Physical Therapy * *
Physical Therapy Assistant * *
Occupational Therapy * *
Occupational Therapy Assistant * *
Speech Therapy * *
Medical Social Work * *
Phelebotomist * *
Respiratory Therapy * *
Registered Dietician * *
Companion * *
Live-In * *
(1) Visits are defined as two (2) hours or less in duration.
(2) Hourly rate for visits exceeding two (2) hours in duration, starting
with hour 3.
(3) We do not reimburse for travel time, weekend, holiday or evening
differentials.
(4) Above prices have NO exclusions.
(5) For home health services not on fee schedule, * Provider's usual and
customary charge will apply.
(6) Prices effective 1/1/96 through 12/31/96.
* Confidential Treatment Requested
IND 5
INDEMNITY PROGRAM ATTACHMENT
EXHIBIT C.2
FFS REIMBURSEMENT SCHEDULE -- HOME INFUSION
EXHIBIT C(2) -- OLSTEN KIMBERLY QUALITYCARE
INDEMNITY FEE SCHEDULE -- HOME INFUSION
- -----------------------------------------------------------------------------------------------------------------
(1) (2) (3)
PER DIEMS
FOR MULTIPLE
PER DIEMS PER DIEMS DRUGS THERAPIES DRUGS
INCLUDING EXCLUDING % OFF (EXCL. % OFF
SERVICE DRUGS DRUGS AWP DRUGS) AWP
------- --------- --------- ----- ------------ -----
Total Parenteral Nutrition * * * * *
Enteral Nutrition * * * * *
Anti-Infective Infusion * * * * *
Chemotherapy (Continuous or Bolus) * * * * *
Pain Management * * * * *
Hydration Therapy * * * * *
Chelation Therapy * * * * *
Inotropic Therapy * * * * *
Anticoagulation * * * * *
Methylprednisolone * * * * *
Immunoglobulin (4) * * * * *
Specialty-Dosed IV Therapies (5) * * * * *
Ceradase/cerazyme (6) * * * * *
IV Push/IM/SQ Injections (7) * * * * *
(1) Per Diems under column 1 include ALL costs -- including, but not
limited to, cost of drugs, facility overhead, supplies, delivery,
professional labor including compounding and monitoring, all nursing
required, maintenance of specialized catheters, equipment/patient
supplies, disposables, pumps, general and administrative expenses, etc.
(2) Per Diems under column 2 are only for those specific therapies for
which a per diem inclusive of drugs cannot be provided. For such
therapies, the quoted per diems plus * will apply, with the only
exception being Ceradase/Cerazyme which shall be paid at its applicable
per diem plus AWP with no discount.
(3) For patients receiving two or more therapies on the same day, Provider
will receive the highest applicable per diem for the first therapy. For
most therapies, this per diem will include drugs as per the fee
schedule above. For each additional therapy except for parenteral,
enteral and IV Push/IM/SQ injections, Provider will receive * for each
therapy, plus AWP less the applicable discount for those drugs used in
the additional therapies. Parenteral, enteral and IV Push/IM/SQ
injections will be pain in their usual manner.
(4) The per diems for Immunoglobulin do not include drugs. As a single
therapy, Immunoglobulin will be paid at *.
(5) The per diems for Specialty-Dosed IV Therapies do not include drugs. As
a single therapy, a Specialty-Dosed Therapy will be paid.
(6) The per diems for Ceradase/Cerazyme do not include drugs. As a single
therapy, Ceradase or Cerazyme will be paid at * per diem plus AWP
with no discount.
(7) The per diems for IV Push/IM/SQ Injections do not include drugs. IV
Push/IM/SQ Injections will be paid* .
(8) The per diem rate shall only be charged for those days the Participant
receives medication.
(9) Prices effective 1/1/96 through 12/31/96.
(10) For home infusion pharmaceuticals not listed on fee schedule, * will
apply.
* Confidential Treatment Requested
IND 6
INDEMNITY PROGRAM ATTACHMENT
EXHIBIT C.3
FFS REIMBURSEMENT SCHEDULE -- HOME MEDICAL EQUIPMENT
CIGNA HEALTHCARE
EXHIBIT C(3) -- OLSTEN KIMBERLY QUALITYCARE
INDEMNITY FEE SCHEDULE -- HOME MEDICAL EQUIPMENT
- ---------------------------------------------------------------------------------------------------------------
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ---------------------------------------------------------------------------------------------------------------
E0100 CANE *
E0105 QUAD CANE/3PRONG/FIXED ADJ *
E0110 FOREARM CRUTCH/PAIR/FIXED/ADJ *
E0111 FOREARM CRUTCH/EACH *
E0112 UNDERARM CRUTCH/WOOD/PAIR/FIXED/ADJ *
E0113 UNDERARM CRUTCH/WOOD/EACH/FIXED/ADJ *
E0114 UNDERARM CRUTCH/ALUM/PAIR/FIXED/ADJ *
E0116 UNDERARM CRUTCH/ALUM/EACH/FIXED/ADJ *
E0130 WALKER/RIGID/FIXED/ADJ *
E0135 WALKER/FOLDING/FIXED/ADJ *
E0141 WALKER/RIGID/WHEELED *
E0142 WALKER/RIGID/WHEELED/SEAT *
E0143 WALKER/FOLDING/WHEELED *
E0145 WALKER/WHEELED W/SEAT & CRUTCH ATT. *
E0146 WALKER/WHEELED W/SEAT *
E0147 WALKER/HD/MULTI BRAKE/VARI-TENSION *
E0153 PLATFORM ATTACHMENT/FOREARM CRUTCH *
E0154 WALKER PLATFORM ATTACHMENT ONLY *
E0155 WHEEL ATTACH/RIGID PICKUP WALKER *
E0156 SEAT ATTACHMENT WALKER *
E0157 CRUTCH ATTACHMENT/WALKER/EA *
E0158 LEG EXTENSIONS FOR WALKER *
E0160 SITZ BATH/PORT/FIT COMMODE *
E0161 SITZ BATH/PORT/FITS COMMODE/W/FAUCETT *
E0163 COMMODE/CHAIR STATIONARY FIXED ARMS *
E0164 COMMODE/CHAIR MOBILE FIXED ARMS *
E0165 COMMODE/CHAIR STATIONARY/DETACH ARMS *
E0166 COMMODE/CHAIR MOBILE/DETACH ARMS *
E0167 PAIL OR PAN FOR USE W/COMMODE CHAIR *
E0176 AIR PRESS. PAD/CUSH. NON-POSITIONING *
E0177 H2O PRESS. PAD/CUSH. NON-POSITIONING *
E0178 GEL PRESS. PAD/CUSH. NON-POSITIONING *
E0179 DRY PRESS. PAD/CUSH. NON-POSITIONING *
E0180 PRESSURE PAD/ALTERNATING W/PUMP * *
E0181 PRESSURE PAD/ALTERNATING/W/PUMP/HD * *
E0182 PUMP FOR ALTERNATING PRESSURE PAD * *
E0184 DRY PRESSURE MATTRESS *
E0185 GEL PRESSURE PAD FOR MATTRESS *
E0186 AIR PRESSURE MATTRESS *
E0187 WATER PRESSURE MATTRESS *
E0188 SYNTHETIC SHEEP SKIN PAD *
E0189 LAMB WOOL, SHEEP SKIN PAD/ANY SIZE *
E0191 HEAT/ELBOW/PROTECTOR/EA *
E0192 LOW PRESSURE & POS. EQUALIZATION * *
* Confidential Treatment Requested
CIGNA HEALTHCARE
EXHIBIT C(3) -- OLSTEN KIMBERLY QUALITYCARE
INDEMNITY FEE SCHEDULE -- HOME MEDICAL EQUIPMENT
- ---------------------------------------------------------------------------------------------------------------
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ---------------------------------------------------------------------------------------------------------------
E0193 LOW AIR LOSS-BED MATTRESS REPLACEMENT
E0194 AIR FLUIDIZED BED *
E0195 REPLACEMENT PAD/ALTERNATING PRESS *
E0196 GEL PRESSURE MATTRESS *
E0197 AIR PRESSURE PAD FOR MATTRESS *
E0198 WATER PRESSURE PAD FOR MATTRESS *
E0199 DRY PRESSURE PAD FOR MATTRESS *
E0210 PAD, ELECTRIC, HEAT, STANDARD *
E0215 PAD, ELECTRIC, MOIST HEAT *
E0237 H2O CIRC. HEAT PAD W/PUMP * *
E0238 PAD, HEAT PAD, NON-ELECTRIC, MOIST *
E0243 TOILET RAIL, EACH *
E0244 RAISED TOILET SEAT *
E0245 TUB STOOL OR BENCH W/O BACK *
E0246 TRANSFER TUB RAIL ATTACHMENT *
E0249 PAD FOR WATER CIRCULATING HEAT UNIT *
E0250 BED/FH/SR/MATT * *
E0251 BED/FH/SR/W/O MATT * *
E0255 BED/VH/HI-LOW/SR/MATT * *
E0256 BED/VH/HI-LOW/SR/W/O MATT * *
E0260 BED/SEMI-ELEC/SR/MATT * *
E0261 HOSPITAL BED/VARI HGHT/SR/W/O MATT * *
E0265 BED/FULL-ELEC/SR/MATT * *
E0266 BED/FULL-ELEC/SR/W/O MATT * *
E0271 MATTRESS/INNER SPRING *
E0272 MATTRESS/FOAM RUBBER *
E0274 OVERBED TABLE * *
E0275 BED PAN/STD/METAL OR PLASTIC *
E0276 BED PAN/FRACTURE/METAL OR PLASTIC *
E0280 BED CRADLE, ANY TYPE *
E0290 BED/F/W/O SR/MATT * *
E0291 BED/FH/W/O/SR W/O MATT * *
E0292 BED/VH/HI-LO/W/O/SR/MATT * *
E0293 BED/VH/HI-LO/W/O/SR/W/O/MATT * *
E0294 BED/SEMI-ELEC/W/O/SR/MATT * *
E0295 BED/SEMI-ELEC/W/O/SR/W/O/MATT * *
E0296 BED/FULL-ELEC/W/O/SR/W/O/MATT * *
E0297 BED/FULL-ELEC/W/O/SR/MATT * *
E0325 URINAL/MALE/JUG-TYPE/ANY MATERIAL *
E0326 URINAL/FEMALE/JUG-TYPE/ANY MATERIAL *
E0425 STATIONARY GAS SYS. PURCH * *
E0430 O2 GAS SYS/PORT/ACCESS/PURCH * *
E0431 O2 GAS SYS/PORT/ACCESS/RENTAL *
E0434 O2 LIQUID/PORT/ACCESS/RENTAL *
* Confidential Treatment Requested
CIGNA HEALTHCARE
EXHIBIT C(3) -- OLSTEN KIMBERLY QUALITYCARE
INDEMNITY FEE SCHEDULE -- HOME MEDICAL EQUIPMENT
- ---------------------------------------------------------------------------------------------------------------
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ---------------------------------------------------------------------------------------------------------------
E0435 O2 LIQUID SYS/PORT/ACCESSORIES/PURCH *
E0439 STATIONARY LIQUID SYSTEM/RENTAL *
E0440 STATIONARY LIQUID SYSTEM/PURCHASE *
E0442 O2 CONTENTS/LIQUID/PER UNIT *
E0444 PORTABLE O2 CONTENTS/LIQUID/1 LB. *
E0450 VOLUME VENTILATOR/STAT OR PORT * *
E0452 INTERMITTENT ASSIST DEVICE/BIPAP/TU * *
E0453 THERAPEUTIC VENT FOR <12 HRS. DAY * *
E0460 NEG PRESSURE VENT/PORT/STATIONARY * *
E0480 PERCUSSOR/ELEC OR PNEUMATIC HOME * *
E0500 IPPB MACHINE/ALL TYPES * *
E0550 HUMIDIFIER/DURABLE/FOR IPPB OR O2 * *
E0555 HUMIDIFIER/REUSE/PLASTIC OR GAS *
E0565 COMPRESSOR/BEDSIDE CONTINUOUS * *
E0570 NEBULIZER W/COMP IE/PULMO-AIDE *
E0575 NEBULIZER/ULTRASONIC, HD CONTIN. USE * *
E0585 NEBULIZER W/COMPRESSOR & HEATER * *
E0600 SUCTION PUMP/HOME USE/PORTABLE * *
E0601 CONT AIRWAY PRESSURE DEVICE/CPAP * *
E0607 HOME BLOOD GLUCOSE MONITOR * *
E0608 APNEA MONITOR *
E0620 SEAT LIFT CHAIR/MOTORIZED * *
E0621 SLING/SEAT FOR PATIENT LIFT *
E0630 PATIENT LIFT/HYDRAULIX W/ST OR SLN * *
E0650 PNEUMATIC COMP/LYMPHEDEMA PUMP * *
E0651 PNEUMATIC COMP/LYMPH PUMP/NON GRAD * *
E0652 PNEUMATIC COMP/LYMPH PUMP/CAL GRAD *
E0655 PNEUMATIC APPLIANCE/HALF ARM *
E0660 PNEUMATIC APPLIANCE/FULL LEG *
E0665 PNEUMATIC APPLIANCE/FULL ARM *
E0666 PNEUMATIC APPLIANCE/HALF LEG *
E0667 PNEUMATIC APP/USED W/SEG COMP/LEG *
E0720 TENS/2 LEAD * *
E0730 TENS/4 LEAD * *
E0745 NEUROMUSCULAR STIM/ELECTRIC SHOCK * *
E0776 IV POLE * *
E0840 CERVICAL TRACTION FRAME/HEADBOARD *
E0850 CERVICAL TRACTION STAND FREE STANDING *
E0860 OVERDOOR CERVICAL TRACTION * *
E0870 EXTREMITY TRACTION/FOOTBOARD/BUCKS * *
E0880 EXTREMITY TRACTION/FREE STANDING * *
E0890 PELVIC TRACTION/FOOTBOARD * *
E0900 PELVIC TRACTION/FREE STANDING * *
E0910 TRAPEZE BAR ATTACHED TO BED * *
* Confidential Treatment Requested
CIGNA HEALTHCARE
EXHIBIT C(3) -- OLSTEN KIMBERLY QUALITYCARE
INDEMNITY FEE SCHEDULE -- HOME MEDICAL EQUIPMENT
- ---------------------------------------------------------------------------------------------------------------
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ---------------------------------------------------------------------------------------------------------------
E0920 FRACTURE FRAME ATT'D TO BED W/WEIGHTS * *
E0930 FRACTURE FRAME/FREE STANDING/W/WEIGHTS * *
E0935 KNEE CPM PER DAY *
E0940 TRAPEZE BAR/FREE STANDING W/BAR * *
E0942 CERVICAL HEAD HARNESS/HALTER *
E0946 FRACTURE FRAME DUAL W/CROSS BARS *
E0951 LOOP HEEL/EACH *
E0952 LOOP TOE/EACH *
E0953 PNEUMATIC TIRE/EACH *
E0954 SEMI PNEUMATIC CASTER/EACH *
E0958 W/C ATTACH TO CONVERTER TO 1 ARM DRIV *
E0959 AMPUTEE ATTACHMENT *
E0961 W/C BRAKE EXTENSION *
E0962 1" CUSHION FOR WHEELCHAIR *
E0963 2" CUSHION FOR WHEELCHAIR *
E0964 3" CUSHION FOR WHEELCHAIR *
E0965 4" CUSHION FOR WHEELCHAIR *
E0966 HOOK ON HEAD REST EXT. *
E0967 WC HANDRIMS WITH 8 VERT TIPS PAIR *
E0968 COMMODE SEAT/WHEELCHAIR *
E0969 NARROWING DEVICE/WHEELCHAIR *
E0970 #2 FOOTPLATES/EXC FOR ELEC LEG REST *
E0971 ANTI-TIPPING DEVICE FOR WHEELCHAIR *
E0972 TRANSFER BOARD/WHEELCHAIR *
E0973 ADJ HGHT/DETACH ARMS/DESK FULL M/C *
E0974 GRADE AID FOR WC *
E0975 REINFORCED SEAT UPHOLSTERED *
E0976 REINFORCED BACK/WC/UPHOLSTERY *
E0977 WEDGE CUSHION/WHEELCHAIR *
E0978 WC SAFETY BELT/AIRLINE BUCKLE *
E0979 WC SAFETY BELT/VELCRO CLOSURE *
E0980 SAFETY VEST/WHEELCHAIR *
E0990 ELEVATING LEG REST/EACH *
E0991 UPHOLSTERY SEAT *
E0992 SOLID SEAT INSERT *
E0993 BACK/UPHOLSTERY *
E0994 ARM REST/EACH *
E0995 CALF REST/EACH *
E0996 TIRE/SOLID/EACH *
E0997 CASTER W/FORK/EACH *
E0998 CASTER W/O FORK/EACH *
E0999 PNEUMATIC TIRE WITH WHEEL *
E1000 TIRE PNEUMATIC CASTER *
E1001 WHEEL/SINGLE *
* Confidential Treatment Requested
CIGNA HEALTHCARE
EXHIBIT C(3) -- OLSTEN KIMBERLY QUALITYCARE
INDEMNITY FEE SCHEDULE -- HOME MEDICAL EQUIPMENT
- ---------------------------------------------------------------------------------------------------------------
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ---------------------------------------------------------------------------------------------------------------
E0130 WC/FA REMOVABLE FOOTRESTS *
E0131 ROLLABOUT CHAIR * *
E1050 FULL RECLINE/FIXED ARMS/DELR/WC * *
E1060 FULL RECLINE/DETACH ARMS/DELR * *
E1065 POWER ATTACH TO CONVERT WC TO POWER * *
E1070 FULL RECLINE/DA/SDFR * *
E1083 HEMI WC/FA/ELR * *
E1084 HEMI WC/DA/SDFR * *
E1085 HEMI WC/FA/SDFR * *
E1086 W/C STANDARD HEMI DA SDFR * *
E1087 W/C HI STRENGTH LT WT FA ELR * *
E1088 W/C HI STRENGTH LT WT DA ELR * *
E1089 W/C HI STRENGTH FA SDFR * *
E1090 W/C HI STRENGTH LT WT RA SDFR * *
E1091 YOUTH WHEELCHAIR, ANY TYPE * *
E1092 W/C HD WIDE DA ELR * *
E1093 W/C HD WIDE DA FR * *
E1100 SEMI RECLINING W/C FA ELR * *
E1110 WC SEMI-RECLINING/DA OR ELR * *
E1130 WC STANDARD FA/SDFR * *
E1140 WC STANDARD DA/SDFR * *
E1150 WC STANDARD DA/ELR * *
E1160 WC STANDARD FA/ELR * *
E1170 AMPUTEE WC FA/ELR * *
E1171 AMPUTEE WC FA W/O SDFR OR ELR * *
E1172 AMPUTEE WC DA W/O SDFR OR ELR * *
E1180 AMPUTEE WC DA/SDFR * *
E1190 AMPUTEE WC DA/ELR *
E1195 HEAVY DUTY WC FA/ELR *
E1200 AMPUTEE WC FA/SDFR *
E1210 MOTORIZED WC FA/ELR *
E1211 MOTORIZED WC DA/ELR *
E1212 WC/MOTORIZED/FFLA/SDFR *
E1213 MOTORIZED WC DA/SDFR *
E1240 WC LIGHTWEIGHT DA/ELR * *
E1250 WC LIGHTWEIGHT FA/SDFR * *
E1260 WC LIGHTWEIGHT/DA/SDFR * *
E1270 WC LIGHTWEIGHT FA/ELR * *
E1353 REGULATOR, FOR PURCHASED TANK *
E1355 TANK STAND/RACK *
E1372 EXTERNAL HEATER IMMERSION FOR NEB * *
E1375 PORTABLE NEB W/SMALL COMP/LTD. FLOW *
E1377 COMPRESSOR, LIGHT DUTY ADJ. PRESSURE * *
E1378 O2 CONCENTRATOR/HI HUMID/=488 CU FT. * *
* Confidential Treatment Requested
CIGNA HEALTHCARE
EXHIBIT C(3) -- OLSTEN KIMBERLY QUALITYCARE
INDEMNITY FEE SCHEDULE -- HOME MEDICAL EQUIPMENT
- ---------------------------------------------------------------------------------------------------------------
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ---------------------------------------------------------------------------------------------------------------
E1379 O2 CONCENTRATOR/HI HUMID/=732 CU FT. * *
E1380 O2 CONCENTRATOR/HI HUMID/=976 CU FT. * *
E1381 O2 CONCENTRATOR/HI HUMID/=1220 CU FT. * *
E1382 PULSE OXIMETER CONT/OVERNOC INCL PROVE * *
E1383 O2 CONCENTRATOR/HI HUMID/=1708 CU FT. * *
E1384 O2 CONCENTRATOR/HI HUMID/=1952 CU FT. * *
E1385 OXYGEN ANALYZER * *
E1400 OXYGEN CONCENTRATOR 2 LITER * *
E1401 O2 CONCENTRATOR BETWEEN 2L & 4L * *
E1402 O2 CONCENTRATOR BETWEEN 3L & 4L * *
E1403 O2 CONCENTRATOR BETWEEN 4L & 5L * *
E1404 O2 CONCENTRATOR OVER 5L@ 85% CONC * *
E1405 O2 & H2O ENRICHING SYS/HTD DELIVERY * *
E1406 O2 & H2O ENRICHING SYS/NON HTD DELIVERY * *
(1) HME PROVIDED TO PATIENTS OTHER THAN LISTED ABOVE WILL BE BILLED AT A *.
(2) SPECIAL ORDER, CUSTOM WHEELCHAIRS WILL BE DISCOUNTED * SUGGESTED
RETAIL.
* Confidential Treatment Requested
INDEMNITY PROGRAM ATTACHMENT
EXHIBIT C.4
FFS REIMBURSEMENT SCHEDULE - TOCOLYTICS
CIGNA HEALTHCARE
EXHIBIT C(4) - OLSTEN KIMBERLY QUALITYCARE
INDEMNITY FEE SCHEDULE - TOCOLYTICS
--------------------------------------------------------
(1)
SERVICE PER DIEMS
------- ---------
Level I Monitoring *
Level II Monitoring *
Level III Monitoring *
(1) Per Diems include ALL costs--including but not limited to all nursing
required, telephonic monitoring, family caregiver training and
education, durable medical equipment administered or used in the course
of rendering services, medical supplies, disposables, pumps, drugs and
medications, general and administrative expenses, etc.
(2) Prices effective 1/1/96 through 12/31/98.
* Confidential Treatment Requested
INDEMNITY PROGRAM ATTACHMENT
EXHIBIT C.5
INDEMNITY PROGRAM REQUIREMENTS
This highlights the essential features of CIGNA's Indemnity Program
Requirements for Provider. Provider must follow the Program
Requirements in order to receive payment for services rendered to
Participants hereunder. Participants must also follow applicable
Program Requirements in order to receive benefits.
XVIII PARTICIPANT IDENTIFICATION
1. Participants should present a CIGNA Indemnity ID cud to Provider or
Subcontractor at the time of service.
2. The ID card itself does not guarantee eligibility. Provider or
Subcontractor should verify Participant eligibility with CIGNA.
XIX COMPENSATION AND BILLING
1. Claim must be clearly identified as "CIGNA Indemnity" and sent to the
centralized billing location designated by CIGNA.
2. Provider's Subcontractors may not bill CIGNA directly for Covered Home
Care Services referred to Provider under any circumstances.
3. Provider and Subcontractors must not bill Participants for Covered Home
Care Services rendered. Deductibles and Coinsurance should be billed to
the Participant following the receipt of the Explanation of Benefits
(EOB) letter from CIGNA.
4. Questions concerning the payment of individual claims should be
directed to CIGNA.
XX DISPUTE RESOLUTION
1. CIGNA and Provider agree to meet and confer in good faith to resolve
any problems or disputes that may arise under this Indemnity program.
2. If the parties are unable to resolve the dispute pursuant to the
aforementioned process, the dispute shall be resolved in accordance
with the dispute resolution procedures set forth in Section III.N. of
the Agreement.
IND 9
MEDICARE RISK PROGRAM ATTACHMENT
TO NATIONAL HOME CARE PROVIDER AGREEMENT
(CAPLTATION)
PURPOSE
The terms and provisions of this Medicare Risk Program Attachment and
the Agreement are applicable to Covered Home Care Services rendered in
accordance with a Service Agreement which is consistent with the
Medicare Risk Program.
XXI DEFINITIONS
CAPITATION PAYMENT means a periodic payment for Covered Home Care
Services made to Provider, at the rates set forth in Exhibits D.1, D.2
and D.4, for each Medicare Contract Participant who is a member of
Provider's Medicare Patient Panel.
MEDICAL DIRECTOR means a physician designated by CIGNA to manage
Quality Management and Utilization Management responsibilities, or that
physician's designee.
MEDICARE CONTRACT PARTICIPANT means a Medicare eligible individual who
is eligible for Covered Home Care Services under a Service Agreement
and for whom CIGNA receives a capitation payment from the Health Care
Financing Administration ("HCFA") under a risk arrangement. For
purposes of this Attachment only, all references to Participants in the
Agreement shall mean Medicare Contract Participants.
MEDICARE PATIENT PANEL means those Medicare Care Participants who have
designated or have otherwise been assigned to Provider as the primary
source for Covered Home Care Services pursuant to a Service Agreement
for which Provider will be reimbursed on a capitated basis for Covered
Home Care Services rendered by Provider or Subcontractors.
PRIMARY CARE PHYSICIAN means a physician duly licensed to practice
medicine who is a Participating Provider with CIGNA to provide Covered
Services in the field of general medicine, internal medicine, family
practice or pediatrics, and who has agreed to provide primary care
physician services to Medicare Contract Participants in accordance with
Medicare Risk Program Requirements.
XXII PARTIES' OBLIGATIONS
A. Services
1. Provider shall provide or arrange for all Covered Home Care Services
referred to Provider that are required by Medicare Contract
Participants In Provider's Medicare Patient Panel in accordance with
the terms of this Agreement, this Medicare Risk Program Attachment and
MCR 1
Medicare Risk Program Requirements. Provider shall accept the
compensation set forth in Exhibits D.1, D.2 and D.3 or D.4, whichever
is applicable, of this Program Attachment as payment in full for such
services.
2. A CIGNA Participating Physician or CIGNA will notify Provider's Network
Manager of each referral for Covered Home Care Services for Medicare
Contract Participants in its Medicare Patient Panel. Provider will
provide or arrange for all Medically Necessary Covered Home Care
Services for all such Medicare Contract Participants, in accordance
with the authorization and Utilization Management procedures set forth
in Section II.D. below.
3. Provider and CIGNA will jointly develop clinical pathways to establish
a plan of treatment for more difficult Medicare Contract Participant
cases requiring Covered Home Care Services.
B. Compensation and Billing
1. By the 15th day of each month or within 5 days of receipt of the
reports specified in Sections II.B.2. and II.B.3. of the Agreement,
whichever is later, Provider shall receive a Capitation Payment for
each Medicare Contract Participant in Provider's Medicare Patient Panel
in accordance with the rates set forth in Exhibit D.1. The Capitation
Payment shall be compensation in full for all Covered Home Care
Services provided by Provider or Subcontractors to Medicare Contract
Participants in Provider's Medicare Patient Panel, except as set forth
in sections II.B.2. and II.B.3. below. Provider is required to deliver
the reports delineated in Sections II.B.2. and II.B.3. of the Agreement
by the tenth day of each calendar month, reflecting activity for the
month preceding the prior month. The obligation to deliver such reports
shall not apply until 2 months following the date that the format of
the reports is agreed upon by the parties. CIGNA may elect to withhold
all or a portion of Provider's Capitation Payment until such reports
are received, except with respect to payments due in the first two
months of this Attachment.
2. Each Service Area may elect to compensate Provider for those Tocolytic
Services which are Covered Home Care Services either on a capitated or
fee-for-service basis in accordance with the rates set forth in Exhibit
D.2.
3. Home Medical Equipment which is a Covered Home Care Service shall at
first be compensated in accordance with the fee-for-service rates set
forth in Exhibit D.3. At any time during the term of this Agreement,
CIGNA may elect to reimburse Provider for Home Medical Equipment in
accordance with the Capitation Payment rates set forth in Exhibit D.4.
Such rates shall be effective on the first day of the month following
receipt of notification of such election by Provider from CIGNA.
4. Any retroactive adjustment made to Provider's Capitation Payments shall
be based on the same methodology as is used in CIGNA Service
Agreements. CIGNA shall fully apprise Provider in advance in writing of
all such applicable methodologies. Any adjustment shall be
MCR 2
made in subsequent Capitation Payments. CIGNA will be able to make
retroactive adjustments to capitation fees paid based on eligibility
adjustments up to 180 days after a Medicare Contract Participant's
eligibility has changed. In those instances where a Medicare Contract
Participant has been retroactively deleted and has received services
from Provider after the effective date of a deletion but prior to CIGNA
informing Provider of such deletion, Provider or Subcontractor may bill
the new provider of medical services for such participant for such
services rendered.
5. With respect to Medicare Contract Participants added to or deleted from
Provider's Patient Panel after the 1st day of the month, the following
rules shall apply:
a. If the Medicare Contract Participant is added to
Provider's Patient Panel on or before the 15th day of
the month, a full month's Capitation Payment will be
due for that Medicare Participant for that month.
There will be no Capitation Payment due for Medicare
Contract Participants added after the 15th day of the
month; and
b. A full month's Capitation Payment will be due for the
month of termination of a Medicare Contract
Participant if the Medicare Contract Participant
terminates after the 15th day of the month. If the
Medicare Contract Participant terminates on or before
the 15th day of the month, no Capitation Payment will
be due for the month of termination.
6. Provider agrees that the rates set forth In Exhibits D.1, D.2, D.3 and
D.4 are all-inclusive for Covered Home Care Services and that no
additional charges for any additional or ancillary items, supplies or
services including, but not limited to, in-hospital assessments or
pre-nursing assessments, travel time, nursing services, training
services, equipment delivery, maintenance and repair, equipment
service, contracts, after-hours delivery or other charges will be
billed to or reimbursed by CIGNA.
7. Provider guarantees that the Capitation Payment rates set forth in this
Attachment are effective for three years from the Effective Date of
this Agreement. Additionally, Provider guarantees that the Home Medical
Equipment fee-for-service rates set forth in Exhibit D.3 are effective
until such time as CIGNA elects to reimburse Provider for such services
on a capitated basis in accordance with Exhibit D.4 or 3 years,
whichever is earlier. Notwithstanding the foregoing, the parties agree
to meet to discuss adjustment to the Capitation Payment rates should
any of the following circumstances occur during the term of this
Attachment:
a. treatments, products, supplies or equipment which are
excluded from Covered Home Care Services for Medicare
Contract Participants as of the Effective Date on the
basis that they are considered Experimental are no
longer considered Experimental and become a Covered
Home Care Service for such Participants.
MCR 3
b. shifts in treatment sites for Covered Home Care
Service therapies occurring after the Effective Date
result in a material change to the services which are
Covered Home Care Services for Medicare Contract
Participants.
c. material changes are made to Medicare Contract
Participants' Service Agreements after the Effective
Date such that there is a material change to those
Home Care Services which are Covered Home Care
Services for such Participants.
d. a change in the number of Medicare Contract
Participants serviced under the capitation
arrangements described in item 3 of Exhibit X. to the
Agreement occurring after the Effective Date of this
Agreement results in a material change in Medicare
Contract Participant volume under this Agreement
which has a material financial impact on Provider.
CIGNA agrees to notify Provider of any capitation
arrangements described in Item 3 of Exhibit X to the
Agreement entered into after the Effective Date which
will result in the elimination of Provider's entire
Medicare Patient Panel in a healthplan location or
will result in a material reduction to the total
number of Medicare Contract Participants in
Provider's entire Medicare Patient Panel. This
obligation to notify shall only apply to the extent
that the department at CIGNA's home office primarily
responsible for CIGNA's relationship with Provider
has received notice of such capitation arrangements.
Any such adjustment of Capitation Payment rates shall only be made to
the extent required to address the change in costs directly resulting from the
above changed circumstance.
8. Any amendment of Capitation Payment rates shall be in accordance with
the Amendment provisions of this Agreement.
9. All capitation rates include the cost of routine lab specimen
collection by a nurse and delivered to a laboratory specified by CIGNA
provided that Provider and such laboratory can reach a reasonable
accommodation with respect to the logistics of such collection and
delivery and with respect to the provision of applicable laboratory
supplies.
C. Financial Reports
1. Provider represents and warrants that the information provided by
Provider to CIGNA in its response to CIGNA's request for proposal is,
to the best of its knowledge, true and accurate.
2. Provider shall provide CIGNA with the following financial reports on a
timely basis: 1) Provider's annual audited financial reports,
including, but not limited to, Provider's audited annual income
statement and balance sheet; 2) quarterly financial reports including
an income statement, balance sheet and any other reports identifying
payments made to Subcontractors in the preceding quarter and the
incurred but not reported claims as of the end of the
MCR 4
preceding quarter in sufficient detail to determine if payments have
been made in accordance with this Agreement and applicable law; and 3)
any financial reports required by applicable regulatory authorities.
3. Provider shall notify CIGNA immediately of any of Provider's known
significant payment defaults and shall provide CIGNA with copies of
notifications of such payment defaults received by Provider, with
respect to any of Provider's Subcontractors, provided that such notice
shall not be required if Provider cures the default within 15 days of
notification of the default. At the end of each quarter, Provider's
chief financial officer or another individual acceptable to CIGNA shall
provide CIGNA with a signed certification to the effect that there are
no known payment defaults with respect to any of Provider's creditors.
Provider agrees to provide CIGNA with copies of all letters normally
provided by auditors to Provider's lenders relating to Provider's
compliance with terms and conditions of loan agreements with such
lenders.
D. Utilization Management
1. The CIGNA Participating Physician or CIGNA shall notify Provider's
Network Manager of each referral for Covered Home Care Services to
Medicare Contract Participants in Provider's Medicare Patient Panel.
2. For Covered Home Care Services ordered by a physician, Provider and/or
Subcontractor will work with that referring physician to assess the
patient's appropriateness for Covered Home Care Services. Any patients
which Provider determines to be medically inappropriate for Covered
Home Care Services will be reported to CIGNA for evaluation and final
determination. Where CIGNA assesses Covered Home Care Services to be
appropriate for the patient, Provider and Participating Physician will
develop a care plan, including definition of treatment goals and
outcomes and the Identification of the resources necessary for
implementation.
3. Provider will provide or arrange for the Covered Home Care Services
necessary to carry out the care plan provided that neither Provider nor
its Subcontractors shall be obligated to render services where the
provision of services in the home setting (or ambulatory setting with
respect to Home Infusion Therapy) would be unsafe to the Participant or
Provider or Subcontractor personnel. Provider will monitor the services
rendered under the care plan in accordance with Utilization Management
criteria and procedures mutually agreed upon by both parties,
including, but not limited to, the Milliman and Robertson Home Care and
Case Management guidelines set forth in Exhibit A.5 to the HMO Program
Attachment.
E. Assignment and Identification of Participants
MCR 5
1. Provider shall comply with the requirements of and shall participate
in CIGNA's procedures with respect to the assignment and identification
of Medicare Contract Participants as outlined in Medicare Risk Program
Requirements.
2. CIGNA will deliver Medicare Contract Participant identification
information to Provider in accordance with section II.A.10 of the
Agreement.
F. Coordination of Benefits
1. CIGNA and Provider shall cooperate to exchange information relating to
coordination of benefits with regard to any Medicare Contract
Participant for whom Provider is providing or arranging services.
2. Certain claim for services rendered to Medicare Contract Participants
are claims for which another payor may be primarily responsible under
coordination of benefit rules. Provider may bill such claims to the
primary payor and shall comply with the primary payor's billing rules,
including, but not limited to, any of the primary payor's limitations
on billing Participants.
3. When Payor is other than primary under applicable coordination of
benefits rules, Payor shall not be obligated to pay any amounts in
addition to the capitation amounts paid pursuant to this Agreement and
Provider and Its Subcontractors shall reimburse any CIGNA Copayments,
Coinsurance or Deductibles collected from Medicare Contract
Participants upon request by CIGNA or the Medicare Contract
Participant. In the event that Provider or its Subcontractors fail to
reimburse such amounts, CIGNA shall have the right to deduct any such
amounts from any amounts payable under this Agreement.
4. When CIGNA or its designated Payor is primary under applicable
coordination of benefits rules, Provider shall consider the
compensation set forth in this Attachment as payment in full for
Covered Home Care Services rendered to Medicare Contract Participants
and shall not seek additional reimbursement from any secondary payors.
G. Reimbursement of Expenditures
CIGNA shall be entitled to recover from Provider any reasonable expenditure
made, or recover any reasonable cost incurred, including, but not limited to,
any reasonable administrative costs, in providing or arranging for any Covered
Home Care Services for which Provider was obligated hereunder but did not so
provide. An amount sufficient to compensate for such expenditures and costs may
be deducted from any payments due to Provider under this Agreement. Except with
respect to Emergency or Urgent situations or
MCR 6
with respect to out-of-network claims which are the result of an affirmative opt
out decision or non-compliance by the Participant or physician in the selection
of home care provider, prior to incurring any such expenditures, CIGNA shall
notify Provider and allow Provider a reasonable opportunity to cure its failure
to provide the particular service. CIGNA shall provide Provider with written
notice and full disclosure of costs incurred prior to any such deduction. This
provision shall survive the termination of this Agreement.
H. Limitations on Billing Participants
1. Provider hereby agrees that in no event, including, but not limited to
non-payment by CIGNA, CIGNA's insolvency, or breach of this Agreement,
shall Provider bill, charge, collect a deposit from, seek compensation,
remuneration or reimbursement from, or have any recourse against
Medicare Contract Participants or persons other than CIGNA for Covered
Home Care Services. This provision shall not prohibit collection of any
applicable Copayments, Deductibles or Coinsurance.
2. Provider further agrees that this provision shall survive the
termination of this Agreement regardless of the cause giving rise to
such termination and shall be construed to be for the benefit of
Medicare Contract Participants and that this provision supersedes any
oral or written agreement to the contrary now existing or hereafter
entered into between Provider and the Medicare Contract Participant or
persons acting on the Medicare Contract Participant's behalf.
3. Any modification, additions, or deletion to the provisions of this hold
harmless clause shall become effective on a date no earlier than
fifteen (15) days after: (1) the applicable state regulatory agency has
received written notice of such proposed change and (2) HCFA's
Secretary has approved in writing such proposed change.
4. When Provider has been notified in advance that a particular service is
not Medically Necessary, Provider and its Subcontractors shall not
charge Medicare Contract Participants for such services unless, in
advance of the provision of such services, the Medicare Contract
Participant is notified that the services are not covered and the
Medicare Contract Participant acknowledges in writing that he or she
shall be responsible for payment of charges for such services.
I. Identification of Special Status Medicare Contract Participants
MCR 7
Provider shall use best efforts in identifying to CIGNA all patients that
qualify for additional compensation through HCFA and the Medicare Risk Program.
In particular, instances involving end stage renal patients, hospice care,
skilled nursing facilities and institutionalized Medicare Contract Participants
will be closely monitored.
J. Medicare Contract Participants' Financial Responsibility
1. CIGNA will maintain a listing of Covered Services, Copayments,
Deductibles and Coinsurance for each Service Agreement under which a
Medicare Contract Participant is enrolled. CIGNA will maintain
operational policies and procedures related to its Medicare Risk
Programs.
2. Provider and Subcontractors shall collect any applicable Copayment
amounts indicated on the Medicare Contract Participant's ID Card at the
time of services. Deductibles and Coinsurance amounts, if any, shall be
billed to the Medicare Contract Participant following receipt of an
explanation of benefits.
3. Provider and Subcontractors shall provide notice to Medicare Contract
Participants of the Participants personal financial obligation for
payment of non-Covered Services prior to service delivery.
K. Provider Incentive Arrangements
1. CIGNA shall have the right to review and disclose to applicable
regulatory authorities to the extent required by applicable laws or
regulations any agreements between Provider and others relating to
Medicare Contract Participants which contain an incentive arrangement.
2. The terms of this Agreement may be renegotiated if the aforementioned
incentive arrangements place Provider or its Subcontractors at
"substantial financial risk" as defined by applicable laws and
regulations with respect to provider incentive plans.
L. Provider Contracts With Subcontractors
Each of Provider's provider contracts with Subcontractors shall comply with all
HCFA requirements relating to such contracts and shall acknowledge CIGNA as a
third party beneficiary to such contracts
M. Compliance With Medicare Risk Requirements
MCR 8
Provider and its Subcontractors shall cooperate and comply with all applicable
statutory, regulatory and HCFA requirements relating to Medicare Contract
Participants including, but not limited to, requirements relating to Peer Review
Organization reviews and audits and Medicare appeals processes. Provider and its
Subcontractors will cooperate and participate in CIGNA's efforts to comply with
applicable statutory, regulatory and HCFA requirements relating to Medicare
Contract Participants to the extent reasonably requested by CIGNA.
N. Notification Of Complaints, Investigations, Litigation
Provider shall notify CIGNA immediately of any known advocacy group actions or
investigations of services or care rendered by Provider or its Subcontractors
under this Agreement.
O. Records
Provider and Subcontractors shall maintain, in a manner which facilitates
regulatory review, and provide CIGNA and HCFA with access to any books, records
and documentation relating to services rendered to Medicare Contract
Participants under this Agreement and any other records requested by HCFA or
CIGNA to assure financial solvency and health care delivery capability and to
investigate complaints and grievances. Access to such books, records and
documentation shall be provided within the timeframes specified by HCFA or, if
access is requested by CIGNA only, upon reasonable notice by CIGNA.
P. Internal Grievance Policy, Medicare Appeals Process and Denial Letters
Prior to execution of this Agreement, Provider shall provide CIGNA with a copy
of its internal grievance policy and
MCR 9
procedures, a copy of its Medicare appeals policy and procedures and a copy of
its service and/or payment denial letters. Provider shall make no material
change to such policies, procedures and denial letters without the prior written
consent of CIGNA.
XXIII TERMINATION
A. NOTWITHSTANDING THE TERMINATION PROVISIONS SET FORTH IN THE
AGREEMENT, THIS MEDICARE RISK PROGRAM ATTACHMENT MAY ONLY BE
TERMINATED AS FOLLOWS:
1. With or without cause, upon one hundred twenty (120)
days' prior written notice by either party;
2. Immediately by CIGNA if CIGNA reasonably determines
that continuation of the terms of this Medicare Risk
Program Attachment may negatively impact the care
rendered to Medicare Contract Participants;
3. By CIGNA in the event that the risk arrangement
between CIGNA and HCFA is terminated or not renewed
by HCFA effective on the date of such termination or
nonrenewal and as to the Service Area affected by the
nonrenewal or termination only.
B. UPON TERMINATION OF THIS AGREEMENT, PROVIDER AND ITS
SUBCONTRACTORS SHALL CONTINUE TO PROVIDE COVERED SERVICES FOR
SPECIFIC CONDITIONS FOR WHICH A MEDICARE CONTRACT PARTICIPANT
WAS UNDER PROVIDER OR ITS SUBCONTRACTOR'S CARE AT THE TIME OF
SUCH TERMINATION SO LONG AS MEDICARE CONTRACT PARTICIPANT
RETAINS ELIGIBILITY UNDER A SERVICE AGREEMENT, UNTIL THE
EARLIER OF COMPLETION OF SUCH SERVICES, CIGNA'S PROVISION FOR
THE ASSUMPTION OF SUCH TREATMENT BY ANOTHER PHYSICIAN, OR THE
EXPIRATION OF TWELVE (12) MONTHS. PROVIDER SHALL BE
COMPENSATED FOR COVERED SERVICES PROVIDED TO ANY SUCH MEDICARE
CONTRACT PARTICIPANT IN ACCORDANCE WITH THE FEE-FOR-SERVICE
REIMBURSEMENT RATES SET FORTH IN THE PPO PROGRAM ATTACHMENT TO
THIS AGREEMENT.
C. PROVIDER SHALL HAVE NO OBLIGATION UNDER THIS AGREEMENT TO
PROVIDE SERVICES TO INDIVIDUALS WHO CEASE TO BE MEDICARE
CONTRACT PARTICIPANTS.
[REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK]
MCR 10
MEDICARE RISK PROGRAM ATTACHMENT
EXHIBIT D.1
CAPITATION RATES
CIGNA HEALTHCARE
EXHIBIT D(1) -- OLSTEN KIMBERLY QUALITYCARE
HMO CAPITATION RATES -- MEDICARE
-------------------------------------------
HEALTHPLAN SITE MEDICARE
--------------- --------
Alabama *
Arizona *
Arkansas *
California *
Colorado *
Connecticut *
Delaware *
District of Columbia *
Florida *
Georgia *
Idaho *
Illinois *
Indiana *
Iowa *
Kansas *
Kentucky *
Louisiana *
Lovelace *
Maine *
Maryland *
Massachusetts *
Michigan *
Minnesota *
Mississippi *
Missouri *
Montana *
Nebraska *
Nevada *
New Hampshire *
New Jersey *
New Mexico (except Lovelace) *
New York *
North Carolina *
North Dakota *
Ohio *
Oklahoma *
Oregon *
* Confidential Treatment Requested
CIGNA HEALTHCARE
EXHIBIT D(1) -- OLSTEN KIMBERLY QUALITYCARE
HMO CAPITATION RATES -- MEDICARE
HEALTHPLAN SITE MEDICARE
--------------- --------
Pennsylvania *
Rhode Island *
South Carolina *
South Dakota *
Tennessee *
Texas *
Utah *
Vermont *
Virginia *
Washington *
West Virginia *
Wisconsin *
Wyoming *
* Confidential Treatment Requested
(1) Prices effective 1/1/96 through 12/31/98.
(2) Above prices exclude Home Medical Equipment.
MEDICARE RISK PROGRAM ATTACHMENT
EXHIBIT D.2
TOCOLYTIC RATES
CIGNA HEALTHCARE
EXHIBIT D(2) - OLSTEN KIMBERLY QUALITYCARE
TOCOLYTIC RATES - MEDICARE
HMO CAPITATION RATE FOR HEALTHPLANS ELECTING CAPITATION:
$0.11 PER MEMBER PER MONTH
FEE FOR SERVICES (FFS) RATES FOR HEALTHPLANS ELECTING FFS:
----------------------------------------------------------
(1)
SERVICE PER DIEMS
------- ---------
Level I Monitoring *
Level II Monitoring *
Level III Monitoring *
(1) Per Diems include ALL costs--including but not limited to all nursing
required, telephonic monitoring, family caregiver training and
education, durable medical equipment administered or used in the course
of rendering services, medical supplies, disposables, pumps, drugs and
medications, general and administrative expenses, etc.
(2) Prices effective 1/1/96 through 12/31/98.
* Confidential Treatment Requested
MEDICARE RISK PROGRAM ATTACHMENT
EXHIBIT D.3
FFS REIMBURSEMENT SCHEDULE - HOME MEDICAL EQUIPMENT
CIGNA HEALTHCARE
EXHIBIT D(3) - OLSTEN KIMBERLY QUALITYCARE
HMO FEE SCHEDULE - HOME MEDICAL EQUIPMENT - MEDICARE
<Table>
<Caption>
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ----- ----------- -------- ------
E0444 PORTABLE O2 CONTENTS/LIQUID/1 LB. * *
E0450 VOLUME VENTILATOR/STAT OR PORT * *
E0452 INTERMITTENT ASSIST DEVICE/BIPAP/TU * *
E0453 THERAPEUTIC VENT FOR <12 HRS DAY * *
E0460 NEG PRESSURE VENT/PORT/STATIONARY * *
E0480 PERCUSSOR/ELEC OR PNEUMATIC HOME * *
E0500 IPPB MACHINE/ALL TYPES * *
E0550 HUMIDIFIER/DURABLE/FOR IPPB OR 02 * *
E0555 HUMIDIFIER/REUSE/PLASTIC OR GAS *
E0565 COMPRESSOR/BEDSIDE CONTINUOUS * *
E0570 NEBULIZER W/COMP IE/PULMO-AIDE *
E0575 NEBULIZER/ULTRASONIC, HO CONTIN. USE * *
E0585 NEBULIZER W/COMPRESSOR & HEATER * *
E0600 SUCTION PUMP/HOME USE/PORTABLE * *
E0601 CONT AIRWAY PRESSURE DEVICE/CPAP * *
E0607 HOME BLOOD GLUCOSE MONITOR * *
E0608 APNEA MONITOR * *
E0620 SEAT LIFT CHAIR/MOTORIZED *
E0621 SLING/SEAT FOR PATIENT LIFT *
E0630 PATIENT LIFT/HYDRAULIX W/ST OR SLN * *
E0650 PNEUMATIC COMP/LYMPHEDEMA PUMP * *
E0651 PNEUMATIC COMP/LYMPH PUMP/NON GRAD * *
E0652 PNEUMATIC COMOP/LYMPH PUMP/CAL GRAD * *
E0655 PNEUMATIC APPLIANCE/HALF ARM *
EO660 PNEUMATIC APPLIANCE/FULL LEG *
EO665 PNEUMATIC APPLIANCE/FULL ARM *
EO666 PNEUMATIC APPLIANCE/HALF LEG *
EO667 PNEUMATIC APP/USED W/SEG COMP/LEG *
EO720 TENS/2 LEAD * *
E0730 TENS/4 LEAD * *
E0745 NEUROMUSCULAR STIM/ELECTRIC SCHOCK * *
E0776 IV POLE * *
E0840 CERVICAL TRACTION FRAME/HEADBOARD *
EO850 CERVICAL TRACTION STAND FREE STANDING *
EO860 OVERDOOR CERVICAL TRACTION * *
E0870 EXTREMITY TRACTION/FOOTBOARD/BUCKS * *
E0880 EXTREMITY TRACTION/FREE STANDING * *
E0890 PELVIC TRACTION/FOOTBOARD * *
E0900 PELVIC TRACTION/FREE STANDING * *
E0910 TRAPEZE BAR ATTACHED TO BED * *
E0920 FRACTURE FRAME ATTD TO BED W/WEIGHTS * *
E0930 FRACTURE FRAME/FREE STANDING/W/WEIGHTS * *
E0935 KNEE CPM PER DAY *
E0940 TRAPEZE BAR/FREE STANDING W/BAR * *
E0942 CERVICAL HEAD HARNESS/HALTER *
EO946 FRACTURE FRAME DUAL W/CROSS BARS *
EO951 LOOP HEEL/EACH *
EO952 LOOP TOE/EACH *
E0953 PNEUMATIC TIRE/EACH *
</Table>
- ---------------
* Confidential Treatment Requested
EXHIBIT D(3) - OLSTEN KIMBERLY QUALITYCARE
HMO FEE SCHEDULE - HOME MEDICAL EQUIPMENT - MEDICARE
<Table>
<Caption>
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ----------------------------------------------------------------------------------------
E1091 YOUTH WHEELCHAIR, ANY TYPE * *
E1092 W/C HD WIDE DA ELR * *
E1093 W/C HD WIDE DA FR * *
E1100 SEMI RECLINING S/C FA ELR * *
E1110 WC SEMI-RECLINING/DA OR ELR * *
E1130 WC STANDARD FA/SDFR * *
E1140 WC STANDARD DA/8DFR * *
E1150 WC STANDARD DA/ELR * *
E1160 WC STANDARD FA/ELR * *
E1170 AMPUTEE WC FA/ELR * *
E1171 AMPUTEE WC FA W/O SDFR OF ELR * *
E1172 AMPUTEE WC DA W/O SDFR OR ELR * *
E1180 AMPUTEE WC DA/SDFR * *
E1190 AMPUTEE WC DA/ELR * *
E1195 HEAVY DUTY SC FA/ELR *
E1200 AMPUTEE WC FA/SDFR *
E1210 MOTORIZED WC FA/ELR *
E1211 MOTORIZED WC DA/ELR *
E1212 WC/MOTORIZED/FFLA/SDFR *
E1213 MOTORIZED WC DA/SDFR *
E1240 WC LIGYHTWEIGHT DA/ELR * *
E1250 WC LIGHTWEIGHT FA/SDFR * *
E1260 WC LIGHTWEIGHT/DA/SDFR * *
E1270 WC LIGHTWEIGHT FA/ELR * *
E1353 REGULATOR, FOR PURCHASED TANK *
E1355 TANK STAND/RACK *
E1372 EXTERNAL HEATER IMMERSION FOR NEB * *
E1375 PORTABLE NEB W/SMALL COMP/LTD, FLOW *
E1377 COMPRESSOR, LIGHT DUTY ADJ. PRESSURE * *
E1378 O2 CONCENTRATOR/H1 HUMID/=488 CU FT. * *
E1379 O2 CONCENTRATOR/H1 HUMID/=732 CU FT. * *
E1380 O2 CONCENTRATOR/H1 HUMID/=976 CU FT. * *
E1381 O2 CONCENTRATOR/H1 HUMID/=1220 CU FT. * *
E1382 PULSE OXIMETER CONT/OVERNOC INCL PROV * *
E1383 O2 CONCENTRATOR/H1 HUMID/=1708 CU FT. * *
E1384 O2 CONCENTRATOR/H1 HUMID/=1952 CU FT. * *
E1385 OXYGEN ANALYZER * *
E1400 OXYGEN CONCENTRATOR 2 LITER * *
E1401 O2 CONCENTRATOR BETWEEN 2L & 4L * *
E1402 O2 CONCENTRATOR BETWEEN 3L & 4L * *
E1403 O2 CONCENTRATOR BETWEEN 4L & 5L * *
E1404 O2 CONCENTRATOR BETWEEN 5L @ 85% CONC * *
E1405 O2 & H2O ENRICHING SYS/HTD DELIVERY * *
E1408 O2 & H2O ENRICHING SYS/NON HTD DELIVERY * *
</Table>
1) HME PROVIDED TO PATIENTS OTHER THAN LISTED ABOVE WILL BE BILLED AT A *
DISCOUNT FROM PROVIDER'S USUAL AND CUSTOMARY CHARGE.
2) SPECIAL ORDER, CUSTOM WHEELCHAIRS WILL BE DISCOUNTED * FROM MANUFACTURERS'
SUGGESTED RETAIL.
* Confidential Treatment Requested.
01/24/96
MEDICARE RISK PROGRAM ATTACHMENT
EXHIBIT D.4
HOME MEDICAL EQUIPMENT - CAPITATION
EXHIBIT D(4)-ESTEN KIMBERLY QUALITYCARE
HME CAPITATION RATES - MEDICARE
Healthplan Bldg Medicare
- --------------- --------
Alabama *
Arizona *
Arkansas *
California *
Colorado *
Connecticut *
Delaware *
District of Columbia *
Florida *
Georgia *
Idaho *
Illinois *
Indiana *
Iowa *
Kansas *
Kentucky *
Louisiana *
Lovelace *
Maine *
Maryland *
Massachusetts *
Michigan *
Minnesota *
Mississippi *
Missouri *
Montana *
Nebraska *
Nevada *
New Hampshire *
New Jersey *
New Mexico (except Lovelace) *
New York *
North Carolina *
North Dakota *
Ohio *
Oklahoma *
Oregon *
Pennsylvania *
Rhode Island *
South Carolina *
South Dakota *
Tennessee *
Texas *
Utah *
Vermont *
Virginia *
Washington *
West Virginia *
Wisconsin *
Wyoming *
(1) Prices effective 1/1/98 through 12/31/98.
(2) Above prices have NO exclusions for home medical equipment.
* Confidential Treatment Requested.
MEDICARE RISK PROGRAM ATTACHMENT
EXHIBIT D.5
MEDICARE RISK PROGRAM REQUIREMENTS
This highlights the essential features of CIGNA's Medicare Risk Program
Requirements for Provider. Provider must follow the Program Requirements in
order to receive payment for services rendered to Medicare Contract
Participants. Medicare Contract Participants must also follow applicable Program
Requirements in order to receive benefits.
I. MEDICARE CONTRACT PARTICIPANT IDENTIFICATION
1. Medicare Contract Participants must present a Medicare Risk Program ID
card to Provider or Subcontractor at the time of service.
2. The ID card itself does not guarantee eligibility. Provider or
Subcontractor should verify Medicare Contract Participant eligibility
with CIGNA.
II. COMPENSATION AND BILLING
1. Encounter data will contain all of the required data elements of a paid
claim and will reflect services rendered to Medicare Contract
Participants either by Provider directly or through Subcontractors.
2. Provider's Subcontractors may not bill CIGNA directly for Covered Home
Care Services referred to Provider rendered to Medicare Contract
Participants under any circumstances.
3. Provider and Subcontractors must not bill Medicare Contract
Participants for Covered Home Care Services rendered. Provider or
Subcontractor will collect from or bill to Medicare Contract
Participant any applicable Copayments.
4. Questions concerning the payment of individual claims should be
directed to CIGNA.
III. ROLES AND RESPONSIBILITIES
1. Provider or Subcontractor must communicate and collaborate with the
Medicare Contract Participant's Primary Care Physician in management of
the Participant's care.
IV. DISPUtE RESOLUTION
1. Disputes arising with respect to the performance or the interpretation
of this Agreement shall be submitted to the Healthplan Medical Director
for review and resolution. If Provider is not satisfied with the
resolution, Provider may submit the matter to the National Medical
Director, CIGNA Health Corporation. The National Medical Director or
his designee will review the matter and may seek written statements
from the Healthplan Medical Director, Provider, Subcontractor and
others as appropriate. The decision of the National Medical Director
will be binding on CIGNA and Provider if the resolution is accepted by
Provider.
2. If the parties are unable to resolve the dispute through the
aforementioned process, the parties shall resolve the dispute pursuant
to the dispute resolution procedures set forth in Section III.N. of the
Agreement.
MCR 13
MEDICAID RISK PROGRAM ATTACHMENT
TO NATIONAL HOME CARE PROVIDER AGREEMENT
(CAPITATION)
PURPOSE
The terms and provisions of this Medicaid Risk Program Attachment and the
Agreement are applicable to Covered Home Care Services rendered in accordance
with a Service Agreement which is consistent with the Medicaid Risk Program.
I. DEFINITIONS
CAPITATION PAYMENT means a periodic payment for Covered Home Care Services made
to Provider, at the rates set forth in Exhibits E.1, E.2 and E.4, for each
Medicaid Participant who is a member of Provider's Medicaid Patient Panel.
MEDICAL DIRECTOR means a physician designated by CIGNA to manage Quality
Management and Utilization Management responsibilities, or that physician's
designee.
MEDICAID PARTICIPANT means a Medicaid eligible individual who is eligible for
Covered Home Care Services under a Service Agreement and for whom CIGNA receives
a capitation payment from a state governmental authority under a risk
arrangement. For purposes of this Attachment only, all references to
Participants in the Agreement shall mean Medicaid Participants.
MEDICAID PATIENT PANEL means those Medicaid Participants who have designated or
have otherwise been assigned to Provider as the primary source for Covered Home
Care Services pursuant to a Service Agreement for which Provider will be
reimbursed on a capitated basis for Covered Home Care Services rendered by
Provider or Subcontractors.
PRIMARY CARE PHYSICIAN means a physician duly licensed to practice medicine who
is a Participating Provider with CIGNA to provide Covered Services in the field
of general medicine, internal medicine, family practice or pediatrics, and who
has agreed to provide primary care physician services to Medicaid Participants
in accordance with Medicaid Risk Program Requirements.
II. PARTIES' OBLIGATIONS
A. SERVICES
1. Provider shall provide or arrange for all Covered Home Care Services
referred to Provider that are required by Medicaid Participants in
Provider's Medicaid Patient Panel in accordance with the terms of this
Agreement, this Medicaid Risk Program Attachment and Medicaid Risk
Program Requirements. Provider shall accept the compensation set forth
in Exhibits E.1, E.2 and E.3 or E.4, whichever is applicable, of this
Program Attachment as payment in full for such services rendered by
Provider and Subcontractors.
2. A CIGNA Participating Physician or CIGNA will notify Provider's Network
Manager of each referral for Covered Home Care Services for Medicaid
Participants in its Medicaid
MCD 1
Patient Panel. Provider will provide or arrange for all Medically
Necessary Covered Home Care Services for all such Medicaid
Participants, in accordance with the authorization and Utilization
Management procedures set forth in Section II.D. below.
3. Provider and CIGNA will jointly develop clinical pathways to establish
a plan of treatment for more difficult Medicaid Participant cases
requiring Covered Home Care Services.
B. COMPENSATION AND BILLING
1. By the 15th day of each month or within 5 days of receipt of the
reports specified in Sections II.B.2. and II.B.3. of the Agreement,
whichever is later, Provider shall receive a Capitation Payment for
each Medicaid Participant in Provider's Medicaid Patient Panel in
accordance with the rates set forth in Exhibit E.1. The Capitation
Payment shall be compensation in full for all Covered Home Care
Services provided by Provider or Subcontractors to Medicaid
Participants in Provider's Medicaid Patient Panel, except as set forth
in Sections II.B.2. and II.B.3. below. Provider is required to deliver
the reports delineated in Sections II.B.2. and II.B.3. of the Agreement
by the tenth day of each calendar month, reflecting activity for the
month preceding the prior month. The obligation to deliver such reports
shall not apply until 2 months following the date that the format of
the reports is agreed upon by the parties. CIGNA may elect to withhold
all or a portion of Provider's Capitation Payment until such reports
are received, except with respect to payments due in the first two
months of this Attachment.
2. Each Service Area may elect to compensate Provider for those Tocolytic
Services which are Covered Home Care Services either on a capitated or
fee-for-service basis in accordance with the rates set forth in Exhibit
E.2.
3. Home Medical Equipment which is a Covered Home Care Service shall at
first be compensated in accordance with the fee-for-service rates set
forth in Exhibit E.3. At any time during the term of this Agreement,
CIGNA may elect to reimburse Provider for Home Medical Equipment in
accordance with the Capitation Payment rates set forth in Exhibit E.4.
Such rates shall be effective on the first day of the month following
receipt of notification of such election by Provider from CIGNA.
4. Any retroactive adjustment made to Provider's Capitation Payments shall
be based on the same methodology as is used in CIGNA Service
Agreements. CIGNA shall fully apprise Provider in advance in writing of
all such applicable methodologies. Any adjustment shall be made in
subsequent Capitation Payments. CIGNA will be able to make retroactive
adjustments to capitation fees paid based on eligibility adjustments up
to 180 days after a Medicaid Participant's eligibility has changed. In
those instances where a Medicaid Participant has been retroactively
deleted and has received services from Provider after the effective
date of a deletion but prior to CIGNA informing Provider of such
deletion, Provider or Subcontractor may bill the new provider of
medical services to the participant for such service rendered.
5. With respect to Medicaid Participants added to or deleted from
Provider's Patient Panel after the 1st day of the month, the following
rules shall apply:
MCD 2
a. If the Medicaid Participant is added to Provider's Patient
Panel on or before the 15th day of the month, a full month's
Capitation Payment will be due for that Medicaid Participant
for that month. There will be no Capitation Payment due for
Medicaid Participants added after the 15th day of the month;
and
b. A full month's Capitation Payment will be due for the month
of termination of a Medicaid Participant if the Medicaid
Participant terminates after the 15th day of the month. If
the Medicaid Participant terminates on or before the 15th day
of the month, no Capitation Payment will be due for the month
of termination.
6. Provider agrees that the rates set forth in Exhibits E.1, E.2, E.3 and
E.4 are all-inclusive for Covered Home Care Services and that no
additional charges for any additional or ancillary items, supplies or
services including, but not limited to, in-hospital assessments or
pre-nursing assessments, travel time, nursing services, training
services, equipment delivery, maintenance and repair, equipment service
contracts, after-hours delivery or other charges will be billed to or
reimbursed by CIGNA.
7. Provider guarantees that the Capitation Payment rates set forth in this
Attachment are effective for three years from the Effective Date of
this Agreement. Additionally, Provider guarantees that the Home Medical
Equipment fee-for-service rates set forth in Exhibit E.3 are effective
until such time as CIGNA elects to reimburse Provider for such services
on a capitated basis in accordance with Exhibit E.4 or 3 years,
whichever is earlier. Notwithstanding the foregoing, the parties agree
to meet to discuss adjustment to the Capitation Payment rates should
any of the following circumstances occur during the term of this
Attachment:
a. treatments, products, supplies or equipment which are excluded
from Covered Home Care Services for Medicaid Participants as
of the Effective Date on the basis that they are considered
Experimental are no longer considered Experimental and become
a Covered Home Care Service for such Participants.
b. shifts in treatment sites for Covered Home Care Service
therapies occurring after the Effective Date result in a
material change to the services which are Covered Home Care
Services for Medicaid Participants.
c. material changes are made to Medicaid Participants' Service
Agreements after the Effective Date such that there is a
material change to those Home Care Services which are Covered
Home Care Services for such Participants.
d. a change in the number of Medicaid Risk Program Participants
serviced under the capitation arrangements described in item 3
of Exhibit X. to the Agreement occurring after the Effective
Date of this Agreement results in a material change in
Medicaid Risk Program Participant volume under this Agreement
which has a material financial impact on Provider. CIGNA
agrees to notify Provider of any capitation arrangements
described in item 3 of Exhibit X occurring after the Effective
Date which will result in the elimination of Provider's entire
Medicaid Patient Panel in a particular healthplan location or
which will result in a material reduction in the total number
of Medicaid Participants
MCD 3
in Provider's entire Medicaid Patient Panel. This obligation
to notify shall only apply to the extent that the department
at CIGNA's home office location primarily responsible for
CIGNA's relationship with Provider is notified of such
capitation arrangements.
Any such adjustment of Capitation Payment rates shall only be made to
the extent required to address the change in costs directly resulting
from the above changed circumstance.
8. Any amendment of Capitation Payment rates shall be in accordance with
the Amendment provisions of this Agreement.
9. All capitation rates include the cost of routine lab specimen
collection by a nurse and delivered to a laboratory specified by CIGNA
provided that Provider and such laboratory can reach a reasonable
accommodation with respect to the logistics of such collection and
delivery and with respect to the provision of applicable laboratory
supplies.
C. FINANCIAL REPORTS
1. Provider represents and warrants that the information submitted to
CIGNA by Provider in its response to CIGNA's request for proposal is,
to the best of its knowledge, true and accurate.
2. Provider shall provide CIGNA with the following financial reports on a
timely basis: 1) Provider's annual audited financial reports,
including, but not limited to, Provider's audited annual income
statement and balance sheet; 2) quarterly financial reports including
an income statement, balance sheet and any other reports identifying
payments made to Subcontractors in the preceding quarter and the
incurred but not reported claims as of the end of the preceding quarter
in sufficient detail to determine if payments have been made in
accordance with this Agreement and applicable law; and 3) any financial
reports required by applicable regulatory authorities.
3. Provider shall notify CIGNA immediately of any of Provider's known
significant payment defaults and shall provide CIGNA with copies of
notifications of significant payment defaults received by Provider,
with respect to any of Provider's Subcontractors, provided that such
notice shall not be required if Provider cures the default within 15
days of notification of the default. At the end of each quarter,
Provider's chief financial officer or another individual acceptable to
CIGNA shall provide CIGNA with a signed certification to the effect
that there are no known payment defaults with respect to any of
Provider's creditors. Provider agrees to provide CIGNA with copies of
all letters normally provided by auditors to Provider's lenders
relating to Provider's compliance with the terms and conditions of loan
agreements with such lenders.
D. UTILIZATION MANAGEMENT
1. The CIGNA Participating Physician or CIGNA shall notify Provider's
Network Manager of each referral for Covered Home Care Services to
Medicaid Participants in Provider's Medicaid Patient Panel.
2. For Covered Home Care Services ordered by a physician, Provider and/or
Subcontractor will work with that referring physician to assess the
patient's appropriateness for Covered Home
MCD 4
Care Services. Any patients which Provider determines to be medically
inappropriate for Covered Home Care Services will be reported to CIGNA
for evaluation and final determination. Where CIGNA assesses Covered
Home Care Services to be appropriate for the patient, Provider and
Participating Physician will develop a care plan, including definition
of treatment goals and outcomes and the identification of the resources
necessary for implementation.
3. Provider will provide or arrange for the Covered Home Care Services
necessary to carry out the care plan provided that neither Provider nor
Subcontractors shall be obligated to provide services where the
provision of services in the home setting (or ambulatory setting with
respect to Home Infusion Therapy) would be unsafe to the Participant or
Provider or Subcontractor personnel. Provider will monitor the services
rendered under the care plan in accordance with Utilization Management
criteria and procedures mutually agreed upon by both parties,
including, but not limited to, the Milliman and Robertson Home Care and
Case Management guidelines set forth in Exhibit A.5 to the HMO Program
Attachment.
E. ASSIGNMENT AND IDENTIFICATION OF PARTICIPANTS
1. Provider shall comply with the requirements of and shall participate in
CIGNA's procedures with respect to the assignment and identification of
Medicaid Participants as outlined in Medicaid Risk Program
Requirements.
2. CIGNA will deliver Medicaid Participant identification information to
Provider in accordance with section II.A.10 of the Agreement.
F. COORDINATION OF BENEFITS
1. CIGNA and Provider shall cooperate to exchange information relating to
coordination of benefits with regard to any Medicaid Participant for
whom Provider is providing or arranging services.
2. Certain claims for services rendered to Medicaid Participants are
claims for which another payor may be primarily responsible under
coordination of benefit rules. Provider may bill such claims to the
primary payor and shall comply with the primary payor's billing rules,
including, but not limited to, any of the primary payor's limitations
on billing Participants.
3. When Payor is other than primary under applicable coordination of
benefits rules, Payor shall not be obligated to pay any amounts in
addition to the capitation amounts paid pursuant to this Agreement and
Provider and its Subcontractors shall reimburse any CIGNA Copayments,
Coinsurance or Deductibles collected from Medicaid Participants upon
request by CIGNA or the Medicaid Participant. In the event that
Provider or its Subcontractors fail to reimburse such amounts, CIGNA
shall have the right to deduct any such amounts from any amounts
payable under this Agreement.
4. When CIGNA or its designated Payor is primary under applicable
coordination of benefits rules, Provider shall consider the
compensation set forth in this Attachment as payment in full for
Covered Home Care Services rendered to Medicaid Participants and shall
not seek additional reimbursement from any secondary payors.
MCD 5
G. REIMBURSEMENT OF EXPENDITURES
CIGNA shall be entitled to recover from Provider any reasonable
expenditure made, or recover any reasonable cost incurred, including,
but not limited to, any reasonable administrative costs, in providing
or arranging for any Covered Home Care Services for which Provider was
obligated hereunder but did not so provide. An amount sufficient to
compensate for such expenditures and costs may be deducted from any
payments due to Provider under this Agreement. Except with respect to
Emergency or Urgent situations or with respect to out-of-network claims
which are the result of an affirmative opt out decision or
non-compliance by the Participant or physician in the selection of home
care provider, prior to incurring any such expenditures, CIGNA shall
notify Provider and allow Provider a reasonable opportunity to cure its
failure to provide the particular service. CIGNA shall provide Provider
with written notice and full disclosure of costs incurred prior to any
such deduction. This provision shall survive the termination of this
Agreement.
H. LIMITATIONS ON BILLING PARTICIPANTS
1. Provider hereby agrees that in no event, including, but not limited to
non-payment by CIGNA, CIGNA's insolvency or breach of this Agreement,
shall Provider bill, charge, collect a deposit from, seek compensation,
remuneration or reimbursement from, or have any recourse against
Medicaid Participants or persons other than CIGNA for Covered Home Care
Services. This provision shall not prohibit collection of any
applicable Copayments, Deductibles or Coinsurance.
2. Provider further agrees that this provision shall survive the
termination of this Agreement regardless of the cause giving rise to
such termination and shall be construed to be for the benefit of
Medicaid Participants and that this provision supersedes any oral or
written agreement to the contrary now existing or hereafter entered
into between Provider and the Medicaid Participant or persons acting on
the Medicaid Participant's behalf.
3. Any modification, additions, or deletion to the provisions of this hold
harmless clause shall become effective on a date no earlier than
fifteen (15) days after the applicable regulatory agency has received
written notice of such proposed change and, if required, approved in
writing such proposed change.
4. When Provider has been notified in advance that a particular service is
not Medically Necessary, Provider and its Subcontractors shall not
charge Medicaid Participants for such services unless, in advance of
the provision of such services, the Medicaid Participant is notified
that the services are not covered and the Medicaid Participant
acknowledges in writing that he or she shall be responsible for payment
of charges for such services.
I. IDENTIFICATION OF SPECIAL STATUS MEDICAID PARTICIPANTS.
Provider shall use best efforts in identifying to CIGNA all patients
that qualify CIGNA for additional compensation under the applicable
governmental authority's Medicaid Risk program. In particular,
instances involving end stage renal patients, hospice care, skilled
nursing facilities and institutionalized Medicaid Participants will be
closely monitored.
MCD 6
J. MEDICAID PARTICIPANTS' FINANCIAL RESPONSIBILITY
1. CIGNA will maintain a listing of Covered Services, Copayments,
Deductibles and Coinsurance for each Service Agreement under which a
Medicaid Participant is enrolled. CIGNA will maintain operational
policies and procedures related to its Medicaid Risk Programs.
2. Provider and Subcontractors shall collect any applicable Copayment
amounts indicated on the Medicaid Participant's ID Card at the time of
services. Deductibles and Coinsurance amounts, if any, shall be billed
to the Medicaid Participant following receipt of an explanation of
benefits.
3. Provider and Subcontractors shall provide notice to Medicaid
Participants of the Participant's personal financial obligation for
payment of non-Covered Services prior to service delivery.
K. PROVIDER INCENTIVE ARRANGEMENTS
1. CIGNA shall have the right to review and disclose to applicable
regulatory authorities to the extent required by applicable laws or
regulations any agreements between Provider and others relating to
Medicaid Participants which contain an incentive arrangement.
2. The terms of this Agreement may be renegotiated if the aforementioned
incentive arrangements place Provider or its Subcontractors at
"substantial financial risk" as defined by applicable laws and
regulations with respect to provider incentive plans.
L. PROVIDER CONTRACTS WITH SUBCONTRACTORS
Each of Provider's provider contracts with Subcontractors shall comply
with all applicable regulatory requirements relating to such contracts
and shall acknowledge CIGNA as a third party beneficiary to such
contracts.
M. COMPLIANCE WITH MEDICAID REQUIREMENTS
Provider and its Subcontractors shall cooperate and comply with all
applicable statutory, regulatory and HCFA requirements relating to
Medicaid Participants including, but not limited to, any requirements
relating to Peer Review Organization reviews and audits and Medicaid
appeals processes. Provider and its Subcontractors will cooperate and
participate in CIGNA's efforts to comply with applicable statutory,
regulatory and HCFA requirements relating to Medicaid Participants to
the extent reasonably requested by CIGNA.
N. NOTIFICATION OF COMPLAINTS, INVESTIGATIONS, LITIGATION
Provider shall notify CIGNA immediately of any known advocacy group
actions or investigations of services or care rendered by Provider or
its Subcontractors under this Agreement.
MCD 7
O. RECORDS
Provider and Subcontractors shall maintain, in a manner which
facilitates regulatory review, and provide CIGNA, HCFA and other
applicable governmental authorities with access to any books, records
and documentation relating to services rendered to Medicaid
Participants under this Agreement and any other records requested by
HCFA, other applicable governmental regulatory authorities or CIGNA to
assure financial solvency and health care delivery capability and to
investigate complaints and grievances. Access to such books, records
and documentation shall be provided within the timeframes specified by
HCFA or the applicable governmental authority or, if access is
requested by CIGNA only, upon reasonable notice by CIGNA.
P. INTERNAL GRIEVANCE POLICY, MEDICAID APPEALS PROCESS AND DENIAL LETTERS
Prior to execution of this Agreement, Provider shall provide CIGNA with
a copy of its internal grievance policy and procedures, a copy of its
Medicaid appeals policy and procedures and a copy of its service and/or
payment denial letters. Provider shall make no material change to such
policies, procedures and denial letters without the prior written
consent of CIGNA.
Q. ADDITIONAL APPLICABLE REGULATORY REQUIREMENTS
The parties understand that additional statutory and regulatory
requirements not already specified in this Agreement may apply. Both
parties agree to satisfy their respective obligations to comply with
such statutory and regulatory requirements and to amend this Attachment
to reflect such requirements to the extent necessary.
III. TERMINATION
A. Notwithstanding the termination provisions set forth in the Agreement,
this Medicaid Risk Program Attachment may only be terminated as
follows:
1. With or without cause, upon one hundred twenty (120) days' prior
written notice by either party;
2. Immediately by CIGNA if CIGNA reasonably determines that continuation
of the terms of this Medicaid Risk Program Attachment may negatively
impact the care rendered in Medicaid Participants;
3. By CIGNA in the event that the risk arrangement between CIGNA and the
applicable governmental regulatory authority is terminated or not
renewed by the regulatory authority effective on the date of such
termination or nonrenewal and as to the Service Area affected by the
nonrenewal or termination only.
B. Upon termination of this Agreement, Provider and its Subcontractors
shall continue to provide Covered Services for specific conditions for
which a Medicaid Participant was under Provider or its Subcontractor's
care at the time of such termination so long as Medicaid Participant
retains eligibility under a Service Agreement, until the earlier of
completion of
MCD 8
such services, CIGNA's provision for the assumption of such treatment
by another physician, or the expiration of twelve (12) months. Provider
shall be compensated for Covered Services provided to any such Medicaid
Participant in accordance with the fee-for-service reimbursement rates
set forth in the PPO Program Attachment.
C. Provider shall have no obligation under this Agreement to provide
services to individuals who cease to be Medicaid Participants.
[REMAINDER OP THIS PAGE IS INTENTIONALLY LEFT BLANK]
MCD 8
MEDICAID RISK PROGRAM ATTACHMENT
EXHIBIT E.1
CAPITATION RATES
MCD 9
MEDICAID RISK PROGRAM ATTACHMENT
EXHIBIT E.1
CAPITATION RATES
MCD 9
EXHIBIT E(1) -- STEN KIMBERLY QUALITYCARE
HMO CAPITATION RATES -- MEDICAID
HEALTHPLAN SITE MEDICAID
--------------- --------
Alabama *
Arizona *
Arkansas *
California *
Colorado *
Connecticut *
Delaware *
District of Columbia *
Florida *
Georgia *
Idaho *
Illinois *
Indiana *
Iowa *
Kansas *
Kentucky *
Louisiana *
Lovelace *
Maine *
Maryland *
Massachusetts *
Michigan *
Minnesota *
Mississippi *
Missouri *
Montana *
Nebraska *
Nevada *
New Hampshire *
New Jersey *
New Mexico (except Lovelace) *
New York *
North Carolina *
North Dakota *
Ohio *
Oklahoma *
Oregon *
Pennsylvania *
Rhode Island *
South Carolina *
South Dakota *
Tennessee *
Texas *
Utah *
Vermont *
Virginia *
Washington *
West Virginia *
Wisconsin *
Wyoming *
(1) Prices effective 1/1/96 through 12/31/98.
(2) Above prices exclude Home Medical Equipment.
* Confidential Treatment Requested.
MEDICAID RISK PROGRAM ATTACHMENT
EXHIBIT E.2
TOCOLYTIC RATES
CIGNA HEALTHCARE
EXHIBIT E(2) - OLSTEN KIMBERLY QUALITYCARE
TOCOLYTIC RATES - MEDICAID
HMO CAPITATION RATE FOR HEALTHPLANS ELECTING CAPITATION:
$0.11 PER MEMBER PER MONTH
FEE FOR SERVICES (FFS) RATES FOR HEALTHPLANS ELECTING FFS:
<Table>
<Caption>
(1)
SERVICE PER DIEMS
------- ---------
Level I Monitoring *
Level II Monitoring *
Level III Monitoring *
</Table>
(1) Per Diems include ALL costs-including but not limited to all nursing
required, telephonic monitoring, family caregiver training and education,
durable medical equipment administered or used in the course of rendering
services, medical supplies, disposables, pumps, drugs and medications, general
and administrative expenses, etc.
(2) Prices effective 1/1/96 through 12/31/98.
* Confidential Treatment Requested.
MCD 10
MEDICAID RISK PROGRAM ATTACHMENT
EXHIBIT E.3
FFS REIMBURSEMENT SCHEDULE - HOME MEDICAL EQUIPMENT
CIGNA HEALTHCARE
EXHIBIT E(3) - OLSTEN KIMBERLY QUALITYCARE
HMO FEE SCHEDULE - HOME MEDICAL EQUIPMENT - MEDICAID
<Table>
<Caption>
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ---- ----------- -------- ------
E0444 PORTABLE O2 CONTENTS/LIQUID/1 LB. * *
E0450 VOLUME VENTILATOR/STAT OR PORT * *
E0452 INTERMITTENT ASSIST DEVICE/SIPAP/TU * *
E0453 THERAPEUTIC VENT FOR <12 HRS. DAY * *
E0460 NEC PRESSURE VENT/PORT/STATIONARY * *
E0480 PERCUSSOR/ELEC OR PNEUMATIC HOME * *
E0500 PPS MACHINE/ALL TYPES * *
E0550 HUMIDIFIER/DURABLE/FOR PPB OR O2 * *
E0555 HUMIDIFIER/REUSE/PLASTIC OR GAS * *
E0565 COMPRESSOR/BEDSIDE CONTINUOUS * *
E0570 NEBULIZER W/COMP IE/PULMO-AIDE * *
E0575 NEBULIZER/ULTRASONIC HD CONTIN. USE * *
E0585 NEBULIZER W/COMPRESSOR & HEATER * *
E0600 SUCTION PUMP/HOME USE/PORTABLE * *
E0601 CONT AIRWAY PRESSURE DEVICE/CPAP * *
E0607 HOME BLOOD GLUCOSE MONITOR * *
E0608 APNEA MONITOR *
E0620 SEAT LIFT CHAIR/MOTORIZED * *
E0621 SLING/SEAT FOR PATIENT LIFT * *
E0630 PATIENT LIFT/HYDRAULIX W/ST OR SLN * *
E0650 PNEUMATIC COMP/LYMPHEDEMA PUMP * *
E0651 PNEUMATIC COMP/LYMPH PUMP/NON GRAD * *
E0652 PNEUMATIC COMP/LYMPH PUMP/CAL GRAD * *
E0655 PNEUMATIC APPLIANCE/HALF ARM * *
E0660 PNEUMATIC APPLIANCE/FULL LEG * *
E0665 PNEUMATIC APPLIANCE/FULL ARM * *
E0666 PNEUMATIC APPLIANCE/HALF LEG * *
E0667 PNEUMATIC APPLIANCE W/LEG COMP/LEG * *
E0720 TENS/2 LEAD * *
E0730 TENS/4 LEAD * *
E0745 NEUROMUSCULAR STIM/ELECTRIC SHOCK * *
E0778 IV POLE * *
E0840 CERVICAL TRACTION FRAME/HEADBOARD * *
E0850 CERVICAL TRACTION STAND FREE STANDING * *
E0860 OVERDOOR CERVICAL TRACTION * *
E0870 EXTREMITY TRACTION/FOOTBARD/BUCKS * *
E0880 EXTREMITY TRACTION/FREE STANDING * *
E0880 PELVIC TRACTION/FOOTBAND * *
E0900 PELVIC TRACTION/FREE STANDING * *
E0910 TRAPAZE BAR ATTACHED TO BED * *
E0920 FRACTURE FRAME ATT'D TO BED W/WEIGHTS * *
E0930 FRACTURE FRAME/FREE STANDING/W/WEIGHTS * *
E0935 KNEE CPM PER DAY * *
E0940 TRAPEZE BAR/FREE STANDING W/BAR *
E0942 CERVICAL HEAD HARNESS/HALTER * *
E0945 FRACTURE FRAME DUAL W/CROSS BARS * *
E0951 LOOP HEEL/EACH * *
E0952 LOOP TOE/EACH * *
E0953 PNEUMATIC TIRE/EACH * *
</Table>
* Confidential Treatment Requested
MCD 11
MEDICAID RISK PROGRAM ATTACHMENT
EXHIBIT E-4
HOME MEDICAL EQUIPMENT - CAPITATION
EXHIBIT E(4) OLSTEN KIMBERLY QUALITYCARE
HME CAPITATION RATES - MEDICAID
<Table>
<Caption>
HEALTHPLAN SITE MEDICAID
--------------- --------
Alabama *
Arizona *
Arkansas *
California *
Colorado *
Connecticut *
Delaware *
District of Columbia *
Florida *
Georgia *
Idaho *
Illinois *
Indiana *
Iowa *
Kansas *
Kentucky *
Louisiana *
Lovelace *
Maine *
Maryland *
Massachusetts *
Michigan *
Minnesota *
Mississippi *
Missouri *
Montana *
Nebraska *
Nevada *
New Hampshire *
New Jersey *
New Mexico (except Lovelace) *
New York *
North Carolina *
North Dakota *
Ohio *
Oklahoma *
Oregon *
Pennsylvania *
Rhode Island *
South Carolina *
South Dakota *
Tennessee *
Texas *
Utah *
Vermont *
Virginia *
Washington *
West Virginia *
Wisconsin *
Wyoming *
</Table>
(1) Prices effective 1/1/96 through 12/31/98.
(2) Above prices have NO exclusions for home medical equipment.
* Confidential Treatment Requested.
MCD 12
MEDICAID RISK PROGRAM ATTACHMENT
EXHIBIT E.5
MEDICAID RISK PROGRAM REQUIREMENTS
This highlights the essential features of CIGNA's Medicaid Risk Program
Requirements for Provider. Provider must follow the Program Requirements in
order to receive payment for services rendered to Medicaid Participants.
Medicaid Participants must also follow applicable Program Requirements in order
to receive benefits.
I. PARTICIPANT IDENTIFICATION
1. Medicaid Participants must present a Medicaid Risk Program ID card to
Provider or Subcontractor at the time of service.
2. The ID card itself does not guarantee eligibility. Provider should
verify Medicaid Risk Participant eligibility with CIGNA.
II. COMPENSATION AND BILLING
1. Encounter data will contain all of the required data elements of a paid
claim and will reflect services rendered to CIGNA Medicaid Participants
either by Provider directly or through Subcontractors.
2. Provider's Subcontractors may not bill CIGNA directly for Covered Home
Care Services referred to Provider under any circumstances.
3. Provider and Subcontractors must not bill Medicaid Participants for
Covered Home Care Services rendered. Provider or Subcontractor will
collect from or bill to Medicaid Participant any applicable Copayments.
4. Questions concerning the payment of individual claims should be
directed to CIGNA.
III. ROLES AND RESPONSIBILITIES
1. Provider must communicate and collaborate with the Medicaid
Participant's Primary Care Physician in management or the Medicaid
Participant's care.
IV. DISPUTE RESOLUTION
1. Disputes arising with respect to the performance or the interpretation
of this Agreement shall be submitted to the Healthplan Medical Director
for review and resolution. If Provider is not satisfied with the
resolution, Provider may submit the matter to the National Medical
Director, CIGNA Health Corporation. The National Medical Director or
his designee will review the matter and may seek written statements
from the Healthplan Medical Director, Provider, Subcontractors and
others as appropriate. The decision of the National Medical Director
will be binding on CIGNA and Provider if the resolution is accepted by
Provider.
MCD 13
2. If the parties are unable to resolve the dispute through the
aforementioned process, the dispute shall be resolved pursuant to the
dispute resolution procedures set forth in Section III.N. of the
Agreement.
MCD 14
CIGNA
CONTRACTS
(AMENDMENTS)
AMENDMENT TO NATIONAL HOME CARE PROVIDER AGREEMENT
THIS AMENDMENT to that certain National Home Care Provider
Agreement between CIGNA Health Corporation ("CIGNA") and Kimberly Home Health
Care, Inc. d/b/a Olsten Kimberly QualityCare ("Kimberly") dated as of January
1, 1996 (the "Agreement") is entered into as of October 1, 1996.
PURPOSE
CIGNA and Kimberly entered into the Agreement, by which
Kimberly provides or arranges for the provision of certain health care
services;
CIGNA and Kimberly have determined that each desires to amend
certain provisions of the Agreement;
In consideration of the mutual promises herein, the parties
agree as follows:
1. Capitalized items not defined herein shall
have the same meaning as set forth in the Agreement, provided that
"CIGNA" shall mean CIGNA Health Corporation, for and on behalf of its
wholly-owned subsidiaries and affiliates listed on Exhibit I to the
Agreement, individually and collectively, and "Kimberly" shall mean
Kimberly Home Health Care, Inc., for and on behalf of its wholly-owned
subsidiaries and affiliates listed on Exhibit II to the Agreement,
individually and collectively.
2. CIGNA will promptly review those cases in
which Kimberly has provided or arranged for the provision of services
at the request of CIGNA which Kimberly believes did not constitute
Covered Home Care Services under the HMO, Medicare Risk and Medicaid
Risk Program Attachments to the Agreement ("Out-of-Benefit Services").
If CIGNA agrees with Kimberly's conclusion, CIGNA shall reimburse
Kimberly as follows:
a) For Out-of-Benefit Services provided during the period from
January 1, 1996 through September 30, 1996, Kimberly shall be
reimbursed at the lesser of (i) Kimberly's actual
out-of-pocket expenditures for such Out-of-Benefit Services;
or (ii) the cost of such Out-of-Benefit Services based upon
the Fee Schedules attached as Exhibits B(1), (2) and (3) to
the PPO Program Attachment to the Agreement, less applicable
Copayments, Deductibles and Coinsurance;
-2-
b) For Out-of-Benefits Services provided on or after October 1,
1996, Kimberly shall be reimbursed based upon the Fee
Schedules attached as Exhibits B(1), (2) and (3) to the PPO
Program Attachments to the Agreement in effect at the time of
service, less applicable Copayments, Coinsurance and
Deductibles; and
c) Notwithstanding the foregoing, no additional reimbursement
shall be made with respect to claims previously processed by
CIGNA.
3. Effective October 1, 1996, the Capitation
Payment Rates set forth in Exhibits A.1., D.1., and E.1., to the HMO,
Medicare Risk and Medicaid Risk Program Attachments to the Agreement,
respectively, are each increased by $.06. The parties agree that the
increased capitation amounts for the months preceding April, 1997 will
be paid to Kimberly over the course of 4 months starting in April,
1997 with reimbursement taking the form of increased capitation
amounts over such 4 month period. The additional capitation amounts
owed for the period October 1, 1996 through December 31, 1996 due to
the capitation increase described herein shall be calculated in
accordance with the CIGNA membership as of December 31, 1996.
4. Effective October 1, 1996, the Capitation
Payment Rates set forth in Exhibits A.1, D.1., and E.1 to the HMO,
Medicare Risk and Medicaid Risk Program Attachments to the Agreement,
respectively, will no longer constitute payment to Kimberly for
Antihemophilic Factors VIII (Recombinant, Monoclonal and Other) and IX
(Monoclonal/High Purity and Other) Ceredase/Cerazyme. Payment for said
items which are Covered Home Care Services will be based on the PPO
Fee Schedule attached as Exhibit B(2) to the PPO Program Attachment to
the Agreement in effect at the time of service.
5. Footnote 10 on the PPO Fee Schedule
attached as Exhibit B(2) to the PPO Program Attachment to the
Agreement, and footnote 10 on the Indemnity Fee Schedule attached as
Exhibit C(2) to the Indemnity Program Attachment to the Agreement are
each hereby amended by adding the following phrase to the end of said
Footnotes:
"..., except that the price for Antihemophilic Factors VIII
(Recombinant, Monoclonal and Other) and IX (Monoclonal/High
Purity and Other) will be AWP less 20%"
6. Effective October 1, 1996, (a) the PPO Fee
Schedule attached as Exhibit B(2) to the PPO Program Attachment to the
Agreement, and the Indemnity Fee Schedule attached as Exhibit C(2) to
the Indemnity Program Attachment to the Agreement are each increased
by 5%; and (b) the PPO Fee Schedule attached as Exhibit B(1) to the
PPO Program Attachment to the Agreement, and the Indemnity Fee
-3-
Schedule attached as Exhibit C(1) to the Indemnity Program Attachment
to the Agreement are deleted in their entirety and replaced by
Exhibits B(1) and C(1), attached hereto, respectively. Notwithstanding
the foregoing, the fee schedule changes described in this provision
shall not apply to claims previously processed by CIGNA. The fee
schedule changes set forth in this provision are in lieu of the
increase that would have been applied to said Schedules for the second
year of the Agreement, as described in Section I.B.1. of the PPO
Program Attachment to the Agreement and Section I.B.1 of the Indemnity
Program Attachment to the Agreement.
7. Effective October 1, 1996, CIGNA and
Kimberly will share the cost of any Spell of Illness, as that term is
defined by HCFA, for any HMO, Medicare Risk or Medicaid Risk
Participant for whom the cost of providing Covered Home Care Services
exceeds $25,000 in a calendar year. Kimberly shall be solely
responsible for the initial $25,000 of cost of Covered Home Care
Services for the Participant's Spell of Illness. For any costs of
Covered Home Care Services incurred in a calendar year for the
Participant's Spell of Illness which exceed that $25,000 threshold,
Kimberly shall be responsible for 40% and CIGNA shall be responsible
for 60%. For the initial period October 1, 1996 through December 31,
1996, the calculation of Covered home Care Services for the calendar
year will include Covered Home Care Services provided hereunder since
January 1, 1996; provided, however, that CIGNA's obligation to fund
amounts in excess of the $25,000 threshold as described above shall
only apply to claims for Covered Home Care Services incurred on or
after October 1, 1996. For the purposes of this paragraph 7, "cost" is
defined as the lesser of (i) Kimberly's actual out-of-pocket
expenditures for Covered Home Care Services for such Spell of Illness,
or (ii) the applicable Fee Schedules from the Agreement, less
applicable Copayments, Deductibles and Coinsurance. When Kimberly
becomes aware of a Participant whose Spell of Illness Kimberly
reasonably expects to generate costs of $25,000 or more in a calendar
year, Kimberly will notify in writing the Medical Director of the
CIGNA health plan in which the Participant is enrolled of that
expectation, and will send a copy of that notification to Dr. Manuel
Selva of CIGNA's Managed Care Operations, 900 Cottage Grove Road,
Hartford, CT 06152-1136.
8. Kimberly agrees to waive its rights under
Section III.C.2. of the Agreement, entitled "Termination Without
Cause," and agrees that only CIGNA may terminate "without cause" in
accordance with the terms of Section III.C.2. of the Agreement.
9. Pursuant to the Agreement, Kimberly is
financial responsible to reimburse CIGNA for the amounts paid by or
through CIGNA for Covered Home Care Services to providers others than
Kimberly or its Subcontractors for Participants in CIGNA's HMO,
Medicare Risk and Medicaid Risk Programs. To the extent that said
obligation exceeds five percent (5%) of the total amounts paid by
CIGNA for Covered Home Care Services under the Agreement, the parties
agree to discuss possible adjustments to that obligation. This
provision shall not affect the parties' rights and obligations under
Section II.B.4. of the HMO Program Attachment to the Agreement.
10. Except as modified herein, all other terms
and provision of the Agreement shall remain in full force and effect.
-4-
IN WITNESS WHEREOF, the parties hereto have executed and
delivered this Amendment as of the date below.
CIGNA HEALTH CORPORATION
DATE: By:
-------------------------- ----------------------------------------
KIMBERLY HOME HEALTH CARE, INC.
DATE: By:
-------------------------- ----------------------------------------
-5-
CIGNA HEALTH CARE
HOME HEALTH CARE
PROPOSED FEE SCHEDULE
VISITS
DISCIPLINE AREA I AREA II AREA III
RN * * *
LPN * * *
HHA * * *
COMPANION * * *
MSW * * *
THERAPIES * * *
PTA's/OTA's * * *
PHLEBOTOMISTS * * *
HOURLY
DISCIPLINE AREA I AREA II AREA III
RN * * *
LPN * * *
HHA * * *
COMPANION * * *
PHLEBOTOMISTS * * *
* Confidential Treatment Requested.
-6-
AMENDMENT TO
NATIONAL HOME CARE PROVIDER AGREEMENT
This Amendment is entered into this 1st day of January, 1998 by and
between CIGNA Health Corporation for and on behalf of certain of its
subsidiaries and affiliates ("CIGNA"), and Kimberly Home Health Care, Inc.
d/b/a Olsten Health Services, for and on behalf of certain of its subsidiaries
and affiliates ("Provider").
WITNESSETH:
WHEREAS, the Parties entered into a National Home Care Provider
Agreement (the "Agreement") dated January 1, 1996, for Provider to provide
certain services to CIGNA nationwide, and now desire to change payment rates in
the Medicare Risk Program Attachment of the Agreement from Capitation Payment
Rates to Fee-for-service Payment Rates.
NOW THEREFORE, CIGNA and Provider agree hereto as follows:
1. This Amendment shall be effective as of January 1, 1998.
2. The Agreement is hereby amended by deleting Exhibit B.1 of
the PPO Program Attachment and replacing it with new Exhibit
B.1 of the same name attached hereto.
3. Unless otherwise amended by this Amendment or amendments with
earlier effective dates, all other terms and conditions of
the Agreement, including the Program Attachments and the
Exhibits attached thereto shall remain the same and in full
force and effect. To the extent that the provisions in the
Agreement or in any amendments with earlier effective dates
conflict with the terms of this Amendment, the terms in this
Amendment shall supercede and control.
4. Capitalized terms not defined herein but defined in the
Agreement shall have the same meaning as defined in the
Agreement.
WHEREFORE, the Parties hereto execute this Amendment as of the date first
written above.
CIGNA HEALTH CORPORATION KIMBERLY HOME HEALTH CARE, INC.,
D/B/A OLSTEN HEALTH SERVICES
By: By:
------------------------------------ -----------------------------
Title: Title:
--------------------------------- --------------------------
Date: Date:
---------------------------------- ---------------------------
OLSTEN HEALTH SERVICES NETWORK
EXHIBIT B.1, PAGE 2 OF 2: TRADITIONAL HOME HEALTH ZONE RATES
EFFECTIVE DATE: JANUARY 1, 1998 - JANUARY 31, 1999
RATE RATE
STATE AREA DESIGNATION
Alabama LOW 3
Alaska HIGH 1
Arizona MEDIUM 2
Arkansas LOW 3
California HIGH 1
Colorado MEDIUM 2
Connecticut MEDIUM 2
Delaware LOW 3
District of Columbia HIGH 1
Florida MEDIUM 2
Georgia MEDIUM 2
Hawaii HIGH 1
Idaho LOW 3
Illinois HIGH 1
Indiana LOW 3
Iowa LOW 3
Kansas LOW 3
Kentucky LOW 3
Louisiana MEDIUM 2
Maine LOW 2
Maryland MEDIUM 2
Massachusetts HIGH 1
Michigan LOW 3
Minnesota LOW 3
Mississippi LOW 3
Missouri MEDIUM 2
Montana LOW 3
Nebraska LOW 3
Nevada LOW 3
New Hampshire LOW 3
New Jersey MEDIUM 2
New Mexico LOW 3
New York MEDIUM 2
North Carolina MEDIUM 2
North Dakota MEDIUM 2
Ohio MEDIUM 2
Oklahoma LOW 3
Oregon MEDIUM 2
Pennsylvania MEDIUM 2
Rhode Island MEDIUM 2
South Carolina LOW 3
South Dakota LOW 3
Tennessee MEDIUM 2
Texas HIGH 1
Utah MEDIUM 2
Vermont LOW 3
Virginia MEDIUM 2
Washington MEDIUM 2
West Virginia LOW 3
Wisconsin LOW 3
Wyoming LOW 3
AMENDMENT TO
NATIONAL HOME CARE PROVIDER AGREEMENT
This Amendment is entered into this 1st day of March, 1998 by and
between CIGNA Health Corporation, for and on behalf of certain of its
subsidiaries and affiliates ("CIGNA"), and Kimberly Home Health Care, Inc.,
d/b/a Olsten Health Services, for and on behalf of certain of its subsidiaries
and affiliates ("Provider").
W I T N E S S E T H :
WHEREAS, the Parties entered into a National Home Care Provider
Agreement (the "Agreement") dated January 1, 1996, for Provider to provide
certain services to CIGNA nationwide, and now desire to change payment rates in
the Medicare Risk Program Attachment of the Agreement from Capitation Payment
Rates to Fee-for-service Payment Rates.
NOW THEREFORE, CIGNA and Provider agree hereto as follows:
1. This Amendment shall be effective March 1, 1998.
2. The Agreement is hereby amended by deleting the existing
Medicare Risk Program Attachment to the Agreement and
replacing it with the new Medicare Risk Program Attachment of
the same name attached hereto.
3. The Agreement is hereby amended by deleting Exhibits D.1, D.2,
D.3, D.4 and D.5 of the Medicare Risk Program Attachment and
replacing them with new Exhibits D.1, D.2, D.3, D.4 and D.5
attached hereto.
4. Unless otherwise amended by this Amendment or amendments with
earlier effective dates, all other terms and conditions of the
Agreement, including the Program Attachments and the Exhibits
attached thereto, shall remain the same and in full force and
effect. To the extent that the provisions in the Agreement or
in any amendments with earlier effective dates conflict with
the terms of this Amendment, the terms in this Amendment shall
supercede and control.
5. Capitalized terms not defined herein but defined in the
Agreement shall have the same meaning as defined in the
Agreement.
WHEREFORE, the Parties hereto execute this Amendment as of the date first
written above.
CIGNA HEALTH CORPORATION KIMBERLY HOME HEALTH CARE, INC.,
D/B/A OLSTEN HEALTH SERVICES
By: By:
--------------------------------- ---------------------------------
Title: Title:
------------------------------ ------------------------------
Date: Date:
------------------------------- -------------------------------
-1-
MEDICARE RISK PROGRAM ATTACHMENT
TO NATIONAL HOME CARE PROVIDER AGREEMENT
(FEE FOR SERVICE)
PURPOSE
The terms and provisions of this Medicare Risk Program Attachment and
the Agreement are applicable to Covered Home Care Services rendered in
accordance with a Service Agreement which is consistent the Medicare Risk
Program.
II. DEFINITIONS
MEDICAL DIRECTOR means a physician designated by CIGNA to manage
Quality Management and Utilization Management responsibilities, or that
physician's designee.
MEDICARE CONTRACT PARTICIPANT means a Medicare eligible individual who
is eligible for Covered Home Care Services under a Service Agreement and for
whom CIGNA receives a capitation payment from the Health Care Financing
Administration ("HCFA") under a risk arrangement. For purposes of this
Attachment only, all references to Participants in the Agreement shall mean
Medicare Contract Participants.
MEDICARE PATIENT PANEL means those Medicare Contract Participants who
have designated or have otherwise been assigned to Provider as the primary
source for Covered Home Care Services pursuant to a Service Agreement for which
Provider will be reimbursed on a Fee for Service basis for Covered Home Care
Services rendered by Provider or Subcontractors.
PRIMARY CARE PHYSICIAN means a physician duly licensed to practice
medicine who is a Participating Provider with CIGNA to provide Covered Services
in the field of general medicine, internal medicine, family practice or
pediatrics, and who has agreed to provide primary care physician services to
Medicare Contract Participants in accordance with Medicare Risk Program
Requirements.
III. PARTIES' OBLIGATIONS
A. SERVICES
1. Provider shall provide or arrange for all Covered Home Care
Services referred to Provider that are required by Medicare Contract
Participants in Provider's Medicare Patient Panel in accordance with the terms
of this Agreement, this Medicare Risk Program Attachment and Medicare Risk
Program Requirements. Provider shall accept the compensation set forth in
Exhibits D.1, D.2, D.3 and D.4 of the Agreement, whichever is applicable, as
payment in full for such services.
-1-
2. A CIGNA Participating Physician or CIGNA will notify
Provider's Network Manager of each referral for Covered Home Care Services for
Medicare Contract Participants in its Medicare Patient Panel. Provider will
provide or arrange for all Medically Necessary Covered Home Care Services for
all such Medicare Contract Participants, in accordance with the authorization
and Utilization Management procedures set forth in Section II.D. below.
3. Provider and CIGNA will jointly develop clinical pathways
to establish a plan of treatment for more difficult Medicare Contract
Participant cases requiring Covered Home Care Services.
B. COMPENSATION AND BILLING
1. Provider's reimbursement for Covered Home Care Services
shall be set at the fees set forth in Exhibits D.1, D.2, D.3 and D.4, less
applicable Copayments, Deductibles and Coinsurance. Provider guarantees that the
rates set forth in Exhibits D.1, D.2, D.3 and D.4 are effective through January
31, 1999. Rates for years following that year shall be identical to the rates
set forth in the unified fee schedules (Schedules I, II and III) that shall be
effective February 1, 1999.
2. Provider shall submit claims for Covered Home Care Services
under this Program Attachment and shall be entitled to receive payment for valid
claims according to the following:
a. Provider shall submit claims electronically,
to the extent technologically feasible, for
reimbursement for all Covered Home Care
Services within ninety (90) days of the date
those services are rendered or, if Payor is
the secondary payer with regard to the
claim, within ninety (90) days of the date
Payor is determined to be secondary. Claims
will be submitted in accordance with the
rates set forth in the Exhibits attached
hereto and in accordance with the
requirements mutually agreed upon by the
parties during implementation of this
Agreement. Claims received after this ninety
(90) day period may be denied for payment.
Provider shall submit claims to the location
described in PPO Program Requirements.
Provider agrees to work in good faith to
assure that claims can be submitted to CIGNA
electronically and shall make any reasonable
capital expenditures necessary to enhance
its systems in order to enable such
submission by April 1, 1997.
-2-
b. If a claim meets the above-referenced
mutually agreed upon requirements, any
amount owing under this Agreement shall be
paid within thirty (30) days after receipt,
unless additional required information is
requested within the thirty (30) day period,
or unless the claim involves coordination of
benefits, except as otherwise provided for
in this Program Attachment.
3. CIGNA shall deduct any Copayments, Deductibles, or
Coinsurance required by the Service Agreement from payment due to Provider.
Deduction for the Copayment, Deductible, or Coinsurance shall be determined on
the basis of rates set forth in this Attachment.
4. Provider's reimbursement as set forth herein shall be
payment in full for Covered Home Care Services rendered by Provider and
Subcontractors pursuant to this Agreement, except for Copayments, Deductibles
and Coinsurance.
5. When Provider has been notified in advance that a
particular service is not Medically Necessary or is not a Covered Service,
Provider and its Subcontractors shall not charge the Participant for such
service unless, in advance of the provision of such service, Provider or
Subcontractor has notified the Participant that the service is not a Covered
Service and the Participant acknowledges in writing that he or she shall be
responsible for payment of charges for such service.
6. Provider will look solely to CIGNA and Subcontractors will
look solely to Provider for compensation for Covered Home Care Services except
for Copayments, Deductibles or Coinsurance. Provider agrees that whether or not
there is any unresolved dispute for payment, under no circumstances will
Provider or its Subcontractors directly or indirectly make any charges or
claims, other than for Copayments, Deductibles or Coinsurance, against any
Participants or their representatives for Covered Home Care Services, and that
this provision survives termination of this Agreement for services rendered
prior to such termination. Except for the collection of Copayments, Deductibles
or Coinsurance, only those services that are not Covered Home Care Services may
be billed directly to Participants, subject to limitations listed above. This
paragraph is to be interpreted for the benefit of Participants and does not
diminish the obligation of CIGNA to make payments to Provider according to the
terms of this Agreement.
7. All rates include the cost of routine lab specimen
collection by a nurse and delivered to a laboratory specified by CIGNA (provided
that Provider and such laboratory can reach a reasonable accommodation with
respect to the logistics of such collection and delivery and with respect to the
provision of applicable laboratory supplies).
-3-
8. For patients receiving two or more therapies on the same
day, Provider will receive the highest applicable per diem for the first
therapy. For most therapies, this per diem will include drugs as per the fee
schedule. For each additional therapy (except for parenteral, enteral and IV
push/IM/SQ injections) after the first therapy, Provider will receive the per
diems indicated in Exhibit D.2 for multiple therapies, plus AWP less the
applicable discount. Parenteral, enteral and IV push/IM/SQ injections will be
paid for at the applicable per diem.
C. FINANCIAL REPORTS
1. Provider represents and warrants that the information
provided by Provider to CIGNA in its response to CIGNA's request for proposal
is, to the best of its knowledge, true and accurate.
2. Provider shall provide CIGNA with the following financial
reports on a timely basis: (1) Provider's annual audited financial reports,
including, but not limited to, Provider's audited annual income statement and
balance sheet; (2) quarterly financial reports including an income statement,
balance sheet and any other reports identifying payments made to Subcontractors
in the preceding quarter and the incurred but not reported claims as of the end
of the preceding quarter in sufficient detail to determine if payments have been
made in accordance with this Agreement and applicable law; and (3) any financial
reports required by applicable regulatory authorities.
3. Provider shall notify CIGNA immediately of any of
Provider's known significant payment defaults and shall provide CIGNA, with
copies of notifications of such payment defaults received by Provider, with
respect to any of Provider's Subcontractors, provided that such notice shall not
be required if Provider cures the default within 15 days of notification of the
default. At the end of each quarter, Provider's chief financial officer or
another individual acceptable to CIGNA shall provide CIGNA with a signed
notification to the effect that there are no known payment defaults with respect
to any of the Provider's creditors. Provider agrees to provide CIGNA with copies
of all letters normally provided by auditors to Provider's lenders relating to
Provider's compliance with terms and conditions of loan agreements with such
lenders.
D. UTILIZATION MANAGEMENT
1. The CIGNA Participating Physician or CIGNA shall notify
Provider's Network Manager of each referral for Covered Home Care Services to
Medicare Contract Participants in Provider's Medicare Patient Panel.
2. For Covered Home Care Services ordered by a physician,
Provider and/or Subcontractor will work with that referring physician to assess
the patient's appropriateness
-4-
for Covered Home Care Services. Any patients which Provider determines to be
medically inappropriate for Covered Home Care Services will be reported to CIGNA
for evaluation and final determination. Where CIGNA assesses Covered Home Care
Services to be appropriate for the patient, Provider and Participating Physician
will develop a care plan, including definition of treatment goals and outcomes
and the identification of the resources necessary for implementation.
3. Provider will provide or arrange for the Covered Home Care
Services necessary to carry out the care plan provided that neither Provider nor
its Subcontractors shall be obligated to render services where the provision of
services in the home setting (or ambulatory setting with respect to Home
Infusion Therapy) would be unsafe to the Participant or Provider or
Subcontractor personnel. Provider will monitor the services rendered under the
care plan in accordance with Utilization Management criteria and procedures
mutually agreed upon by both parties, including, but not limited to, the
Milliman and Robertson Home Care and Case Management guidelines set forth in
Exhibit A.5 to the HMO Program Attachment.
E. ASSIGNMENT AND IDENTIFICATION OF PARTICIPANTS
1. Provider shall comply with the requirements of and shall
participate in CIGNA's procedures with respect to the assignment and
identification of Medicare Contract Participants as outlined in Medicare Risk
Program Requirements.
2. CIGNA will deliver Medicare Contract Participant
identification information to Provider in accordance with section II.A.10 of the
Agreement.
F. COORDINATION OF BENEFITS
1. CIGNA and Provider shall cooperate to exchange information
relating to coordination of benefits with regard to any Medicare Contract
Participant for whom Provider is providing or arranging services.
2. Certain claims for services rendered to Medicare Contract
Participants are claims for which another payor may be primarily responsible
under coordination of benefit rules. Provider may bill such claims to the
primary payor and shall comply with the primary payor's billing rules,
including, but not limited to, any of the primary payor's limitations on billing
Participants.
3. When Payor is other than primary under applicable
coordination of benefits rules, Payor shall not be obligated to pay any amounts
in addition to the capitation amounts paid pursuant to this Agreement and
Provider and its Subcontractors shall reimburse any CIGNA Copayments,
Coinsurance or Deductibles collected from Medicare Contract Participants upon
request by CIGNA or the Medicare Contract Participant. In the event that
Provider
-5-
or its Subcontractors fail to reimburse such amounts, CIGNA shall have the right
to deduct any such amounts from any amounts payable under this Agreement.
4. When CIGNA or its designated Payer is primary under
applicable coordination of benefits rules, Provider shall consider the
compensation set forth in this Attachment as payment in full for Covered Home
Care Services rendered to Medicare Contract Participants and shall not seek
additional reimbursement from any secondary payors.
G. REIMBURSEMENT OF EXPENDITURES
CIGNA shall be entitled to recover from Provider any
reasonable expenditure made, or recover any reasonable cost
incurred, including, but not limited to, any reasonable
administrative costs, in providing or arranging for any
Covered Home Care Services for which Provider was obligated
hereunder but did not so provide. An amount sufficient to
compensate for such expenditures and costs may be deducted
from any payments due to Provider under this Agreement. Except
with respect to Emergency or Urgent situations or with respect
to out-of-network claims which are the result of an
affirmative opt out decision or non-compliance by the
Participant or physician in the selection of home care
provider, prior to incurring any such expenditures, CIGNA
shall notify Provider and allow Provider a reasonable
opportunity to cure its failure to provide the particular
service. CIGNA shall provide Provider with written notice and
full disclosure of costs incurred prior to any such deduction.
This provision shall survive the termination of this
Agreement.
H. LIMITATIONS ON BILLING PARTICIPANTS
1. Provider hereby agrees that in no event, including, but not
limited to non-payment by CIGNA, CIGNA's insolvency or breach of this Agreement,
shall Provider bill, charge, collect a deposit from, seek compensation,
remuneration or reimbursement from, or have any recourse against Medicare
Contract Participants or persons other than CIGNA for Covered Home Care
Services. This provision shall not prohibit collection of any applicable
Copayments, Deductibles or Coinsurance.
2. Provider further agrees that this provision shall survive
the termination of this Agreement regardless of the cause giving rise to such
termination and shall be construed to be for the benefit of Medicare Contract
Participants and that this provision supersedes any oral or written agreement to
the contrary now existing or hereafter entered into between Provider and the
Medicare Contract Participant or persons acting on the Medicare Contract
Participant's behalf.
-6-
3. Any modification, additions, or deletion to the provisions
of this hold harmless clause shall become effective on a date no earlier than
fifteen (15) days after: (1) the applicable state regulatory agency has received
written notice of such proposed change and (2) HCFA's Secretary has approved in
writing such proposed change.
4. When Provider has been notified in advance that a
particular service is not Medically Necessary, Provider and its Subcontractors
shall not charge Medicare Contract Participants for such services unless, in
advance of the provision of such services, the Medicare Contract Participant is
notified that the services are not covered and the Medicare Contract Participant
acknowledges in writing that he or she shall be responsible for payment of
charges for such services.
I. IDENTIFICATION OF SPECIAL STATUS MEDICARE CONTRACT PARTICIPANTS
Provider shall use best efforts in identifying to
CIGNA all patients that qualify for additional compensation
through HCFA and the Medicare Risk Program. In particular,
instances involving end stage renal patients, hospice care,
skilled nursing facilities and institutionalized Medicare
Contract Participants will be closely monitored.
J. MEDICARE CONTRACT PARTICIPANTS' FINANCIAL RESPONSIBILITY
1. CIGNA will maintain a listing of Covered Services,
Copayments, Deductibles and Coinsurance for each Service Agreement under which a
Medicare Contract Participant is enrolled. CIGNA will maintain operational
policies and procedures related to its Medicare Risk Programs.
2. Provider and Subcontractors shall collect any applicable
Copayment amounts indicated on the Medicare Contract Participant's ID Card at
the time of services. Deductibles and Coinsurance amounts, if any, shall be
billed to the Medicare Contract Participant following receipt of an explanation
of benefits.
3. Provider and Subcontractors shall provide notice to
Medicare Contract Participants of the Participant's personal financial
obligation for payment of non-Covered Services prior to service delivery.
K. PROVIDER INCENTIVE ARRANGEMENTS
1. CIGNA shall have the right to review and disclose to
applicable regulatory authorities to the extent required by applicable laws or
regulations any agreements between Provider and others relating to Medicare
Contract Participants which contain an incentive arrangement.
-7-
2. The terms of this Agreement may be renegotiated if the
aforementioned incentive arrangements place Provider or its Subcontractors at
"substantial financial risk" as defined by applicable laws and regulations with
respect to provider incentive plans.
L. PROVIDER CONTRACTS WITH SUBCONTRACTORS
Each of Provider's provider contracts with
Subcontractors shall comply with all HCFA requirements
relating to such contracts and shall acknowledge CIGNA as a
third party beneficiary to such contracts.
M. COMPLIANCE WITH MEDICARE RISK REQUIREMENTS
Provider and its Subcontractors shall cooperate and
comply with all applicable statutory, regulatory and HCFA
requirements relating to Medicare Contract Participants
including, but not limited to, requirements relating to Peer
Review Organization reviews and audits and Medicare appeals
processes. Provider and its Subcontractors will cooperate and
participate in CIGNA's efforts to comply with applicable
statutory, regulatory and HCFA requirements relating to
Medicare Contract Participants to the extent reasonably
requested by CIGNA.
N. NOTIFICATION OF COMPLAINTS, INVESTIGATIONS, LITIGATION
Provider shall notify CIGNA immediately of any known
advocacy group actions or investigations of services or care
rendered by Provider or its Subcontractors under this
Agreement.
O. RECORDS
Provider and Subcontractors shall maintain, in a
manner which facilitates regulatory review, and provide CIGNA
and HCFA with access to any books, records and documentation
relating to services rendered to Medicare Contract
Participants under this Agreement and any other records
requested by HCFA or CIGNA to assure financial solvency and
health care delivery capability and to investigate complaints
and grievances. Access to such books, records and
documentation shall be provided within the timeframes
specified by HCFA or, if access is requested by CIGNA only,
upon reasonable notice by CIGNA.
P. INTERNAL GRIEVANCE POLICY, MEDICARE APPEALS PROCESS AND DENIAL
LETTERS
Prior to execution of this Agreement, Provider shall
provide CIGNA with a copy of its internal grievance policy and
procedures, a copy of
-8-
its Medicare appeals policy and procedures and a copy of its
service and or payment denial letters. Provider shall make no
material change to such policies, procedures and denial
letters without the prior written consent of CIGNA.
IV. TERMINATION
A. Notwithstanding the termination provisions set forth in the
Agreement, this Medicare Risk Program Attachment may only be
terminated as follows:
1. With or without cause, upon one hundred twenty (120)
days' prior written notice by either party;
2. Immediately by CIGNA if CIGNA reasonably determines
that continuation of the terms of this Medicare Risk
Program Attachment may negatively impact the care
rendered to Medicare Contract Participants;
3. By CIGNA in the event that the risk arrangement
between CIGNA and HCFA is terminated or not renewed
by HCFA effective on the date of such termination or
nonrenewal and as to the Service Area affected by the
nonrenewal or termination only.
B. Upon termination of this Agreement, Provider and its
Subcontractors shall continue to provide Covered Services for
specific conditions for which a Medicare Contract Participant
was under Provider or its Subcontractor's care at the time of
such termination so long as Medicare Contract Participant
retains eligibility under a Service Agreement, until the
earlier of completion of such services, CIGNA's provision for
the assumption of such treatment by another physician, or the
expiration of twelve (12) months. Provider shall be
compensated for Covered Services provided to any such Medicare
Contract Participant in accordance with the fee-for-service
reimbursement rates set forth in the PPO Program Attachment to
this Agreement.
C. Provider shall have no obligation under this Agreement to
provide services to individuals who cease to be Medicare
Contract Participants.
[REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK]
-9-
CIGNA HEALTHCARE
OLSTEN HEALTH SERVICES NETWORK
EXHIBIT D.1: PAGE 1 OF 2, TRADITIONAL HOME HEALTH MEDICARE RISK FEE SCHEDULE
EFFECTIVE DATE: MARCH 1, 1998 - JANUARY 31, 1999
- -------------------------------------------------------------------------------------------------------------------
THE FOLLOWING TRADITIONAL HOME HEALTH SERVICES HAVE BOTH VISIT AND HOURLY RATES.
- -------------------------------------------------------------------------------------------------------------------
Notes 1, 2, 3, 4, 6 and 7 apply AREA 1 AREA 2 AREA 3
------------------------ ----------------------- ------------------------
VISIT HOUR VISIT HOUR VISIT HOUR
- ----------------------------------------- ----------- ------------ ----------- ----------- ----------- ------------
HOME HEALTH AIDE * * * * * *
- ----------------------------------------- ----------- ------------ ----------- ----------- ----------- ------------
LVN/LPN * * * * * *
- ----------------------------------------- ----------- ------------ ----------- ----------- ----------- ------------
LVN/LPN - HIGH TECH * * * * * *
- ----------------------------------------- ----------- ------------ ----------- ----------- ----------- ------------
RN * * * * * *
- ----------------------------------------- ----------- ------------ ----------- ----------- ----------- ------------
RN HIGH TECH * * * * * *
- ----------------------------------------- ----------- ------------ ----------- ----------- ----------- ------------
- -------------------------------------------------------------------------------------------------------------------
THE FOLLOWING TRADITIONAL HOME HEALTH SERVICES HAVE VISIT ONLY RATES.
- -------------------------------------------------------------------------------------------------------------------
Notes 1, 3, 4 and 5 apply AREA 1 AREA 2 AREA 3
----------------------- ----------------------- -----------------------
VISIT HOUR VISIT HOUR VISIT HOUR
- ------------------------------------------- ----------- ----------- ----------- ----------- ----------- -----------
DIETITIAN * * * * * *
- ------------------------------------------- ----------- ----------- ----------- ----------- ----------- -----------
MEDICAL SOCIAL WORKER * * * * * *
- ------------------------------------------- ----------- ----------- ----------- ----------- ----------- -----------
OCCUPATIONAL THERAPIST * * * * * *
- ------------------------------------------- ----------- ----------- ----------- ----------- ----------- -----------
OCCUPATIONAL THERAPIST AST. * * * * * *
- ------------------------------------------- ----------- ----------- ----------- ----------- ----------- -----------
PHLEBOTOMIST * * * * * *
- ------------------------------------------- ----------- ----------- ----------- ----------- ----------- -----------
PHYSICAL THERAPIST * * * * * *
- ------------------------------------------- ----------- ----------- ----------- ----------- ----------- -----------
PHYSICAL THERAPIST AST * * * * * *
- ------------------------------------------- ----------- ----------- ----------- ----------- ----------- -----------
RESPIRATORY THERAPIST * * * * * *
- ------------------------------------------- ----------- ----------- ----------- ----------- ----------- -----------
SPEECH THERAPIST * * * * * *
- ------------------------------------------- ----------- ----------- ----------- ----------- ----------- -----------
- -------------------------------------------------------------------------------------------------------------------
THE FOLLOWING TRADITIONAL HOME HEALTH SERVICE ARE PRICED ON A PER EACH BASIS.
- -------------------------------------------------------------------------------------------------------------------
Notes 3, 4 and 5 apply AREA 1 AREA 2 AREA 3
------------------------ ----------------------- ------------------------
EACH EACH EACH
- ----------------------------------------- ------------------------ ----------------------- ------------------------
LIVE IN (Per Diem) * * *
- ----------------------------------------- ------------------------ ----------------------- ------------------------
NOTES:
1. Visits are defined as two (2) hours or less in duration (EXCEPT MATERNAL CHILD HEALTH VISITS,
WHICH HAVE NO MAXIMUM DURATION).
2. Hourly rate for visits exceeding two (2) hours in duration, starting with hour 3.
3. CIGNA does not reimburse for travel time, weekend, holiday or evening differentials.
4. Above prices have no exclusions.
5. For home health services not on fee schedule * of Provider's usual and customary charge will apply.
6. Respiratory therapist visit and hourly utilization/costs to be reported with HME/RT.
7. RN High Tech Infusion visit and hourly utilization/costs to be reported with HIT.
-1-
- -----------------------------------------------------------------------------------------------------------
OLSTEN HEALTH SERVICES NETWORK
EXHIBIT B.1, PAGE 2 OF 2: TRADITIONAL HOME HEALTH ZONE RATES
EFFECTIVE DATE: JANUARY 1, 1998 - JANUARY 31, 1999
- -----------------------------------------------------------------------------------------------------------
RATE RATE
STATE AREA DESIGNATION
- ------------------------------------- ---------------------------------- ----------------------------------
Alabama LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
Alaska HIGH 1
- ------------------------------------- ---------------------------------- ----------------------------------
Arizona MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
Arkansas LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
California HIGH 1
- ------------------------------------- ---------------------------------- ----------------------------------
Colorado MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
Connecticut MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
Delaware LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
District of Columbia HIGH 1
- ------------------------------------- ---------------------------------- ----------------------------------
Florida MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
Georgia MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
Hawaii HIGH 1
- ------------------------------------- ---------------------------------- ----------------------------------
Idaho LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
Illinois HIGH 1
- ------------------------------------- ---------------------------------- ----------------------------------
Indiana LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
Iowa LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
Kansas LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
Kentucky LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
Louisiana MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
Maine LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
Maryland MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
Massachusetts HIGH 1
- ------------------------------------- ---------------------------------- ----------------------------------
Michigan LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
Minnesota LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
Mississippi LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
Missouri MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
Montana LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
Nebraska LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
Nevada LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
New Hampshire LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
New Jersey MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
New Mexico LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
New York MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
North Carolina MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
North Dakota MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
Ohio MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
Oklahoma LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
Oregon MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
Pennsylvania MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
Rhode Island MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
South Carolina LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
South Dakota LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
Tennessee MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
Texas HIGH 1
- ------------------------------------- ---------------------------------- ----------------------------------
Utah MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
Vermont LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
Virginia MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
Washington MEDIUM 2
- ------------------------------------- ---------------------------------- ----------------------------------
West Virginia LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
Wisconsin LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
Wyoming LOW 3
- ------------------------------------- ---------------------------------- ----------------------------------
-1-
- -------------------------------------------------------------------------------------------------------------------
CIGNA HEALTHCARE
EXHIBIT D(2) - OLSTEN KIMBERLY QUALITYCARE
MEDICARE RISK FEE SCHEDULE - HOME INFUSION
Effective Dates: 03/1/98 - 01/31/99
- -------------------------------------------------------------------------------------------------------------------
(1) (2) (3)
PER DIEMS
FOR
MULTIPLE
PER DIEMS PER DIEMS THERAPIES
INCLUDING EXCLUDING DRUGS % (EXCL. DRUGS %
SERVICE DRUGS DRUGS OFF AWP DRUGS) OFF AWP
- ------------------------------------------ ---------------- --------------- ----------- -------------- ------------
Total Parenteral Nutrition * * * * *
- ------------------------------------------ ---------------- --------------- ----------- -------------- ------------
Enteral Nutrition * * * * *
- ------------------------------------------ ---------------- --------------- ----------- -------------- ------------
Anti-Infective-Infusion * * * * *
- ------------------------------------------ ---------------- --------------- ----------- -------------- ------------
Chemotherapy (Continuous or Bolus) * * * * *
- ------------------------------------------ ---------------- --------------- ----------- -------------- ------------
Pain Management * * * * *
- ------------------------------------------ ---------------- --------------- ----------- -------------- ------------
Hydration Therapy * * * * *
- ------------------------------------------ ---------------- --------------- ----------- -------------- ------------
Chelation Therapy * * * * *
- ------------------------------------------ ---------------- --------------- ----------- -------------- ------------
Inotropic Therapy * * * * *
- ------------------------------------------ ---------------- --------------- ----------- -------------- ------------
Anticoagulation * * * * *
- ------------------------------------------ ---------------- --------------- ----------- -------------- ------------
Methylprednisolone * * * * *
- ------------------------------------------ ---------------- --------------- ----------- -------------- ------------
Immunoglobulin,(4) * * * * *
- ------------------------------------------ ---------------- --------------- ----------- -------------- ------------
Specialty-Dosed IV Therapies (5) * * * * *
- ------------------------------------------ ---------------- --------------- ----------- -------------- ------------
Ceradase/cerazyme (6) * * * * *
- ------------------------------------------ ---------------- --------------- ----------- -------------- ------------
IV Push/IWSQ Injections (7) * * * * *
- ------------------------------------------ ---------------- --------------- ----------- -------------- ------------
Hemophilia Factor (8) * * * * *
- ------------------------------------------ ---------------- --------------- ----------- -------------- ------------
(1) Per Diems under column 1 include ALL costs -- including but not limited
to cost of drugs. facility overhead, supplies, delivery, professional
labor including compounding and monitoring, all nursing required,
maintenance of specialized catheters, equipment/patient supplies,
disposables, pumps, general and administrative expenses, etc.
(2) Per Diems under column 2 are only for those specific therapies for
which a per diem inclusive of drugs cannot be provided. For such
therapies, the quoted per diems plus * will apply, with the only
exception being Ceradase/Cerazyme which shall be paid at its applicable
per them plus AWP with no discount.
(3) For patients receiving two or more therapies on the same day, Provider
will receive the highest applicable per diem for the first therapy. For
most therapies, this per diem will include drugs as per the fee
schedule above. For each additional therapy except for parenteral,
enteral and IV Push/IM/SQ injections, Provider will receive * for each
therapy, plus AWP less the applicable discount for those drugs used in
the additional therapies. Parenteral, enteral and IV Push/IM/SQ,
injections will be paid in their usual manner.
(4) The per diems for Immunoglobulin do not include drugs. As a single
therapy, Immunoglobulin will be paid at *
(5) The per diems for Specialty-Dosed IV Therapies do not include drugs. As
a single therapy, a Specialty-Dosed Therapy will be paid at *.
(6) The per diems for Ceradase/Cerazyme do not include drugs. As a single
therapy, Ceradase or Cerazyme will be paid at *.
(7) The per diems for IV Push/IM/SQ Injections do not include drugs. IV
Push/IM/SQ injections will be paid at *.
(8) The per diem for Hemophilia Factor does not include drugs. Hemophilia
Factor will be paid at *.
(9) The per diem rate shall only be charged for those days the Participant
receives medication.
(10) Prices effective 03/01/98 through 1/31/99.
(11) For home infusion pharmaceuticals not listed on fee schedule, * will
apply.
- ------------------------------------------------------------------------------------------------------------------
*Confidential Treatment Requested.
-2-
- -------------------------------------------------------------------------------------------------------------------
CIGNA HEALTHCARE
EXHIBIT D(3) - OLSTEN KIMBERLY QUALITYCARE
MEDICARE RISK FEE SCHEDULE - HOME MEDICAL EQUIPMENT
03/01/98 -- 01/31/99
- -------------------------------------------------------------------------------------------------------------------
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0100 CANE *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0105 QUAD CANE/3PRONG/FIXED ADJ *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0110 FOREARM CRUTCH/PAIR/FIXED ADJ *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0111 FOREARM CRUTCH/EACH *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0112 UNDERARM CRUTCH/WOOD/PAIR FIXED/ADJ *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0113 UNDERARM CRUTCH/WOOD/EACH FIXED ADJ *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0114 UNDERARM CRUTCH/ALUM/PAIR FIXED/ADJ *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0116 UNDERARM CRUTCH/ALUM/EACH FIXED/ADJ *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0130 WALKER/RIGID/FIXED/ADJ *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0135 WALKER/FOLDING/FIXED/ADJ *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0141 WALKER/RIGID/WHEELED *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0142 WALKER/RIGID/WHEELED/SEAT *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0143 WALKER/FOLDING/WHEELED *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0145 WALKER/WHEELED W/SEAT & CRUTCH ATT. *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0146 WALKER/WHEELED W/SEAT *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0147 WALKER/HD/MULTI BRAKE/VARI-TENSION *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0153 PLATFORM ATTACHMENT/FOREARM CRUTCH *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0154 WALKER PLATFORM ATTACHMENT ONLY *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0155 WHEEL ATTACH/RIGID PICKUP WALKER *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0156 SEAT ATTACHMENT WALKER *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0157 CRUTCH ATTACHMENT/WALKER EA *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0158 LEG EXTENSIONS FOR WALKER *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0160 SITZ BATH/PORT/FIT COMMODE *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0161 SITZ-BATH/PORT/FITS COMMODE W/FAUCETT *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0163 COMMODE/CHAIR STATIONARY FIXED ARMS *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0164 COMMODE/CHAIR MOBILE FIXED ARMS *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0165 COMMODE/CHAIR STATIONARY/DETACH ARMS *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0166 COMMODE/CHAIR MOBILE/DETACH ARMS *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0167 PAIL OR PAN FOR USE W/COMMODE CHAIR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0176 AIR PRESS. PAD/CUSH. NON-POSITIONING *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0177 H20 PRESS. PAD/CUSH. NON POSITIONING *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0178 GEL PRESS. PAD/CUSH. NON-POSITIONING *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0179 DRY PRESS. PAD/CUSH. NON-POSITIONING *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0180 PRESSURE PAD/ALTERNATING W. PUMP * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0181 PRESSURE PAD/ALTERNATING/W/PUMP/HD * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0182 PUMP FOR ALTERNATING PRESSURE PAD * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0184 DRY PRESSURE MATTRESS *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0185 GEL PRESSURE PAD FOR MATTRESS *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0186 AIR PRESSURE MATTRESS *
- ------------------ ------------------------------------------------------- ------------------- --------------------
-3-
- -------------------------------------------------------------------------------------------------------------------
CIGNA HEALTHCARE
EXHIBIT D(3) - OLSTEN KIMBERLY QUALITYCARE
MEDICARE RISK FEE SCHEDULE - HOME MEDICAL EQUIPMENT
03/01/98 -- 01/31/99
- -------------------------------------------------------------------------------------------------------------------
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0187 WATER PRESSURE MATTRESS *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0188 SYNTHETIC SHEEP SKIN PAD *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0189 LAMB WOOL, SHEEP SKIN PAD/ANY SIZE *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0191 HEAT/ELBOW/PROTECTOR/EA *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0192 LOW PRESSURE & POS. EQUALIZATION * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0193 LOW AIR LOSS-BED MATTRESS REPLACEMENT *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0194 AIR FLUIDIZED BED *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0195 REPLACEMENT PAD/ALTERNATING PRESS *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0196 GEL PRESSURE MATTRESS *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0197 AIR PRESSURE PAID FOR MATTRESS *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0198 WATER PRESSURE PAD FOR MATTRESS *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0199 DRY PRESSURE PAD FOR MATTRESS *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0210 PAD, ELECTRIC, HEAT, STANDARD *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0215 PAD, ELECTRIC, MOIST HEAT *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0237 H2O CIRC. HEAT PAD W/PUMP * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0238 PAD, HEAT PAD, NON-ELECTRlC, MOIST *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0243 TOILET RAIL, EACH *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0244 RAISED TOILET SEAT *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0245 TUB STOOL OR BENCH W/O BACK *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0246 TRANSFER TUB RAIL ATTACHMENT *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0249 PAD FOR WATER CIRCULATING HEAT UNIT *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0250 BED/FH/SR/MATT * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0251 BED/FH/SR/W/O MATT * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0255 BED/VH/HI-LOW/SR/MATT * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0256 BED/VH/HI LOW/SR/W/O MATT * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0260 BED/SEMI-ELEC/SR/MATT * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0261 HOSPITAL BED/VARI HGHT/SR/W/O MATT * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0265 BED/FULL-ELEC/SR/MATT * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0266 BED/FULL-ELEC/SR/W/O MATT * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0271 MATTRESS/INNER SPRING *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0272 MATTRESS/FOAM RUBBER *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0274 OVERBED TABLE * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0275 BED PAN/STD/METAL OR PLASTIC *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0276 BED PAN/FRACTURE/METAL OR PLASTIC *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0280 BED CRADLE, ANY TYPE *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0290 BED/F/W/O SR/MATT * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0291 BED/FH/W/O/SR W/O MATT * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0292 BED/VH/HI-LO/WO/SR/MATT * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0293 BED/VH/HI-LO/WO/SR/WO/MATT * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0294 BED/SEMI-ELEC/WO/SR/MATT * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0295 BED/SIME-ELEC/WO/SR/WO/MATT * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0296 BED/FULL-ELEC/WO/SR/WO/MATT * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0297 BED/FULL-ELEC/WO/SR/MATT * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0325 URINAL/MALE/JUG-TYPE/ANY MATERIAL *
- ------------------ ------------------------------------------------------- ------------------- --------------------
*Confidential Treatment Requested.
- -------------------------------------------------------------------------------------------------------------------
CIGNA HEALTHCARE
EXHIBIT D(3) - OLSTEN KIMBERLY QUALITYCARE
MEDICARE RISK FEE SCHEDULE - HOME MEDICAL EQUIPMENT
03/01/98 -- 01/31/99
- -------------------------------------------------------------------------------------------------------------------
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0326 URINAL/FEMALE/JUG-TYPE/ANY MATERIAL *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0425 STATIONARY GAS SYS. PURCH * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0430 O2 GAS SYS/PORT/ACCESS/PURCH * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0431 O2 GAS SYS/PORT/ACCESS/RENTAL *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0434 O2 LIQUID/PORT/ACCESS/RENTAL *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0435 O2 LIQUID SYS/PORT/ACCESSORIES/PURCH *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0439 STATIONARY LIQUID SYSTEM/RENTAL *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0440 STATIONARY LIQUID SYSTEM/PURCHASE *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0442 O2 CONTENTS/LIQUID/PER UNIT *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0444 PORTABLE 02 CONTENTS/LIQUID/1 LB. *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0450 VOLUME VENTILATOR/STAT OR PORT * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0452 INTERMITTENT ASSIST DEVICE/BIPAP/TU * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0453 THERAPEUTIC VENT FOR <12 HRS. DAY * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0460 NEG PRESSURE VENT/PORT/STATIONARY * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0480 PERCUSSOR/ELEC. OR PNEUMATIC HOME * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0500 IPPB MACHINE/ALL TYPES * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0550 HUMIDIFIER/DURABLE/FOR IPPB OR O2 * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0555 HUMIDIFIER/REUSE/PLASTIC OR GAS *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0565 COMPRESSOR/BEDSIDE CONTINUOUS * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0570 NEBULIZER W/COMP IE/PULMO-AIDE *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0575 NEBULIZER/ULTRASONIC, HD CONTIN. USE * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0585 NEBULIZER/COMPRESSOR & HEATER * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0600 SUCTION PUMP/HOME USE/PORTABLE * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0601 CONT. AIRWAY PRESSURE DEVICE/CPAP * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0607 HOME BLOOD GLUCOSE MONITOR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0608 APNEA MONITOR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0620 SEAT LIFT CHAIR/MOTORIZED * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0621 SLING/SEAT FOR PATIENT LIFT *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0630 PATIENT LIFT/HYDRAULIX W/ST OR SLN * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0650 PNEUMATIC COMP/LYMPHEDEMA PUMP * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0651 PNEUMATIC COMP/LYMPH PUMP/NON GRAD * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0652 PNEUMATIC COMP/LYMPH PUMP/CAL GRAD * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0655 PNEUMATIC APPLIANCE/HALF ARM *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0660 PNEUMATIC APPLIANCE/FULL LEG *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0665 PNEUMATIC APPLIANCE/FULL ARM *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0666 PNEUMATIC APPLIANCE/HALF LEG *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0667 PNEUMATIC APP/USED W/SEG COMP/LEG *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0720 TENS/2 LEAD * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0730 TENS/4 LEAD * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0745 NEUROMUSCULAR STIM/ELECTRIC SCHOCK * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0776 IV POLE * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0840 CERVICAL TRACTION FRAME/HEADBOARD *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0850 CERVICAL TRACTION STAND FREE STANDING *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0860 OVERDOOR CERVICAL TRACTION * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
*Confidential Treatment Requested.
- -------------------------------------------------------------------------------------------------------------------
CIGNA HEALTHCARE
EXHIBIT D(3) - OLSTEN KIMBERLY QUALITYCARE
MEDICARE RISK FEE SCHEDULE - HOME MEDICAL EQUIPMENT
03/01/98 -- 01/31/99
- -------------------------------------------------------------------------------------------------------------------
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0870 EXTREMITY TRACTION/FOOTBOARD/BUCKS * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0880 EXTREMITY TRACTION/FREE STANDING * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0890 PELVIC TRACTION/FOOTBOARD * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0900 PELVIC TRACTION/FREE STANDING * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0910 TRAPEZE BAR ATTACHED TO BED * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0920 FRACTURE FRAME ATT'D TO BED W/WEIGHTS * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0930 FRACTURE FRAME/FREE STANDING W/WEIGHTS * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0935 KNEE CPM PER DAY *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0940 TRAPEZE BAR/FREE STANDING W/BAR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0942 CERVICAL HEAD HARNESS/HALTER *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0946 FRACTURE FRAME DUAL W/CROSS BARS *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0951 LOOP HEEL/EACH *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0952 LOOP TOE/EACH *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0953 PNEUMATIC TIRE/EACH *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0954 SEMI PNEUMATIC CASTER/EACH *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0958 W/C ATTACH TO CONVERTER TO 1 ARM DRIV *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0959 AMPUTEE ATTACHMENT *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0961 W/C BRAKE EXTENSION *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0962 1" CUSHION FOR WHEELCHAIR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0963 2" CUSHION FOR WHEELCHAIR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0964 3" CUSHION FOR WHEELCHAIR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0965 4" CUSHION FOR WHEELCHAIR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0966 HOOK ON HEAD REST EXT. *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0967 WC HANDRIMS WITH 8 VERT TIPS FAIR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0968 COMMODE SEAT/WHEELCHAIR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0969 NARROWING DEVICE/WHEELCHAIR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0970 #2 FOOTPLATES/EXC FOR ELEC LEG REST *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0971 ANTI-TIPPING DEVICE FOR WHEELCHAIR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0972 TRANSFER BOARD/WHEELCHAIR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0973 ADJ HGHT/DETACH ARMS/DESK FULL M/C *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0974 GRADE AID FIR WC *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0975 REINFORCED SEAT UPHOLSTERED *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0976 REINFORCED BACK/WC/UPHOLSTERY *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0977 WEDGE CUSHION/WHEELCHAIR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0978 WC SAFETY BELT/AIRLINE BUCKLE *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0979 WC SAFETY BELT/VELCRO CLOSURE *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0980 SAFETY VEST/WHEELCHAIR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0990 ELEVATING LEG REST/EACH *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0991 UPHOLSTERY SEAT *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0992 SOLID SEAT INSERT *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0993 BACK/UPHOLSTERY *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0994 ARM REST/EACH *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0995 CALF REST/EACH *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0996 TIRE/SOLID/EACH *
- ------------------ ------------------------------------------------------- ------------------- --------------------
*Confidential Treatment Requested.
CIGNA HEALTHCARE
EXHIBIT D(3) - OLSTEN KIMBERLY QUALITYCARE
MEDICARE RISK FEE SCHEDULE - HOME MEDICAL EQUIPMENT
03/01/98 -- 01/31/99
- -------------------------------------------------------------------------------------------------------------------
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- -------------------------------------------------------------------------------------------------------------------
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0997 CASTER W/FORK/EACH *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0998 CASTER W/O FORK/EACH *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E0999 PNEUMATIC TIRE WITH WHEEL *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1000 TIRE PNEUMATIC CASTER *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1001 WHEEL/SINGLE *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1030 WC/FA REMOVABLE FOOTRESTS * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1031 ROLLABOUT CHAIR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1050 FULL RECLINE/FIXED ARMS/DELR/WC * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1060 FULL RECLINE/DETACH ARMS/DELR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1065 POWER ATTACH TO CONVERT WC TO POWER * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1070 FULL RECLINE/DA/SDFR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1083 HEMI WC/FA/ELR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1084 HEMI WC/DA/SDFR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1085 HEMI WC/FA/SDFR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1086 W/C STANDARD HEMI DA SDFR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1087 W/C HI STRENGTH LT WT FA ELR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1088 W/C HI STRENGTH LT WT DA ELR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1089 W/C HI STRENGTH FA SDFR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1090 W/C HI STRENGTH LT WT RA SDFR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1091 YOUTH WHEELCHAIR, ANY TYPE * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1092 W/C HD WIDE DA ELR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1093 W/C HD WIDE DA FR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1100 SEMI RECLINING W/C FA ELR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1110 WC SEMI-RECLINING/DA OR ELR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1130 WC STANDARD FA/SDFR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1140 WC STANDARD DA/SDFR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1150 WC STANDARD DA/ELR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1160 WC STANDARD FA/ELLR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1170 AMPUTEE WC FA/ELR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1171 AMPUTEE WC FA W/O SDFR OF ELR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1172 AMPUTEE WC DA W/O SDFR OR ELR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1180 AMPUTEE WC DA/SDFR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1190 AMPUTEE WC DA/ELR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1195 HEAVY DUTY WC FA/ELR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1200 AMPUTEE WC FA/SDFR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1210 MOTORIZED WC FA/ELR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1211 MOTORIZED WC DA/ELR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1212 WC/MOTORIZED/FFLA/SDFR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1213 MOTORIZED WC DA/SDFR *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1240 WC LIGHTWEIGHT DA/ELR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1250 WC LIGHTWEIGHT FA/SDFR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1260 WC LIGHTWEIGHT/DA/SDFR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1270 WC LIGHTWEIGHT FA/ELR * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1353 REGULATOR, FOR PURCHASED TANK *
- ------------------ ------------------------------------------------------- ------------------- --------------------
* Confidential Treatment Requested.
CIGNA HEALTHCARE
EXHIBIT D(3) - OLSTEN KIMBERLY QUALITYCARE
MEDICARE RISK FEE SCHEDULE - HOME MEDICAL EQUIPMENT
03/01/98 -- 01/31/99
- -------------------------------------------------------------------------------------------------------------------
HCPC PURCHASE RENTAL
CODE DESCRIPTION RATE RATE
- -------------------------------------------------------------------------------------------------------------------
E1355 TANK STAND/RACK *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1372 EXTERNAL HEATER IMMERSION FOR NEB * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1375 PORTABLE NEB W/SMALL COMP./LTD. FLOW *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1377 COMPRESSOR, LIGHT DUTY ADJ. PRESSURE * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1378 O2 CONCENTRATOR/HI HUMID/=488 CU FT. * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1379 O2 CONCENTRATOR/HI HUMID/=732 CU FT. * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1380 O2 CONCENTRATOR/HI HUMID/=976 CU FT. * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1381 O2 CONCENTRATOR/HI HUMID/=1220 CU FT. * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1382 PULSE OXIMETER CONT/OVERNOC INCL. PROVE * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1383 O2 CONCENTRATOR/HI HUMID/=1708 CU FT. * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1384 O2 CONCENTRATOR/HI HUMID/=1952 CU FT. * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1385 OXYGEN ANALYZER * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1400 OXYGEN CONCENTRATOR 2 LITER * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1401 O2 CONCENTRATOR BETWEEN 2L & 4L * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1402 O2 CONCENTRATOR BETWEEN 3L & 4L * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1403 O2 CONCENTRATOR BETWEEN 4L & 5L * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1404 O2 CONCENTRATOR OVER 5L @ 85% CONC * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1405 O2 & H20 ENRICHING SYS/HTD DELIVERY * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
E1406 O2 & H20 ENRICHING SYS/NON HTD DELIVERY * *
- ------------------ ------------------------------------------------------- ------------------- --------------------
1) HME PROVIDED TO PATIENTS OTHER THAN LISTED ABOVE WILL BE BILLED AT *
DISCOUNT FROM PROVIDER'S USUAL AND CUSTOMARY CHARGE.
2) SPECIAL ORDER, CUSTOM WHEELCHAIRS WILL BE DISCOUNTED * FROM
MANUFACTURERS' SUGGESTED RETAIL
3) PRICES EFFECTIVE 03/01/98 THROUGH 1/31/99.
*Confidential Treatment Requested.
- ---------------------------------------------------------------------------------------------------------------
EXHIBIT D(4) - OLSTEN KIMBERLY QUALITYCARE
MEDICARE RISK FEE SCHEDULE - TOCOLYTICS
EFFECTIVE DATE: 03/01/98 - 01/31/99
- ---------------------------------------------------------------------------------------------------------------
(1)
SERVICE PER DIEMS
- ---------------------------------------------------------------------------------------------------------------
Level I Monitoring *
- ---------------------------------------------------------- ----------------------------------------------------
Level II Monitoring *
- ---------------------------------------------------------- ----------------------------------------------------
Level III Monitoring *
- ---------------------------------------------------------- ----------------------------------------------------
(1) Per Diems include ALL costs--including but not limited to all nursing
required, telephonic monitoring, family caregiver training and education,
durable medical equipment administered or used in the course of rendering
services, medical supplies, disposables, pumps, drugs and medications,
general and administrative expenses, etc.
(2) Prices effective 03/01/98 through 01/31/99.
- ---------------------------------------------------------------------------------------------------------------
*Confidential Treatment Requested.
MEDICARE RISK PROGRAM ATTACHMENT
EXHIBIT D.5
MEDICARE RISK PROGRAM REQUIREMENTS
This highlights the essential features of CIGNA's Medicare Risk Program
Requirements for Provider. Provider must follow the Program Requirements in
order to receive payment for services rendered to Medicare Contract
Participants. Medicare Contract Participants must also follow applicable Program
Requirements in order to receive benefits.
V. MEDICARE CONTRACT PARTICIPANT IDENTIFICATION
1. Medicare Contract Participants must present a Medicare Risk Program ID
card to Provider or Subcontractor at the time of service.
2. The ID card itself does not guarantee eligibility. Provider or
Subcontractor should verify Medicare Contract Participant eligibility
with CIGNA.
VI. COMPENSATION AND BILLING
1. Claims must be clearly identified as "CIGNA Medicare Risk" and sent to
the centralized billing location designated by CIGNA.
2. Provider's Subcontractors may not bill CIGNA directly for Covered Home
Care Services referred to Provider rendered to Medicare Contract
Participants under any circumstances.
3. Provider and Subcontractors must not bill Medicare Contract
Participants for Covered Home Care Services rendered. Provider or
Subcontractor will collect from or bill to Medicare Contract
Participant any applicable Copayments.
4. Questions concerning the payment of individual claims should be
directed to CIGNA.
VII. ROLES AND RESPONSIBILITIES
Provider or Subcontractor must communicate and collaborate with the
Medicare Contract Participant's Primary Care Physician in management of
the Participant's care.
VIII. DISPUTE RESOLUTION
1. Disputes arising with respect to the performance or the interpretation
of this Agreement shall be submitted to the Healthplan Medical Director
for review and resolution. If Provider is not satisfied with the
resolution, Provider may submit the matter to the National Medical
Director, CIGNA Health Corporation. The National Medical Direc-
-1-
tor or his designee will review the matter and may seek written
statements from the Healthplan Medical Director, Provider,
Subcontractor and others as appropriate. The decision of the National
Medical Director will be binding on CIGNA and Provider if the
resolution is accepted by Provider.
2. If the parties are unable to resolve the dispute through the
aforementioned process, the parties shall resolve the dispute pursuant
to the dispute resolution procedures set forth in Section III.N. of the
Agreement.
-2-
AMENDMENT TO AGREEMENT
The National Home Care Provider Agreement dated the 1st day of January, 1996 by
and between Cigna Health Corporation and Kimberly Home Health Care, Inc.:
1. Any reference to "Kimberly Home Health Care, Inc." shall be
changed to "Olsten Network Management, Inc."
2. All other terms and conditions will remain unchanged as stated
in the Agreement and subsequent amendment(s).
The parties have executed this Amendment this 31st day of October, 1998.
Kimberly Home Health Care, Inc. Cigna Health Corporation
By: By:
------------------------------------- ------------------------------
Robert J. Nixon
Title: Senior Vice President, Operations Title:
--------------------------------- ----------------------------
Date: Date:
--------------------------------- ----------------------------
Olsten Network Management, Inc.
TIN: 11-3454103
By:
-------------------------------------
Robert J. Nixon
Title: Senior Vice President, Operations
---------------------------------
Date:
---------------------------------
-1-
AMENDMENT TO NATIONAL HOME CARE PROVIDER AGREEMENT
THIS AMENDMENT is entered into this 1st day of January. 1999 by and
between CIGNA Health Corporation, for and on behalf of its wholly-owned
subsidiaries and affiliates (individually and collectively, "CIGNA"), and Olsten
Network Management, Inc. d/b/a Olsten Health Services, for and on behalf of its
wholly owned subsidiaries and affiliates (individually and collectively,
"Provider").
W I T N E S S E T H :
WHEREAS, CIGNA and Provider entered into a National Home Care Provider
Agreement dated January 1, 1996 and amended from time to time thereafter
(together, the "Agreement"), whereby Provider provided or arranged for the
provision of certain health care services to Participants;
WHEREAS, the parties wish to amend certain provisions of the Agreement
as set forth below;
NOW THEREFORE, CIGNA and Provider agree as follows:
1. This Amendment shall be effective commencing on January 1, 1999.
2. The Agreement is hereby amended by deleting Section 7 of the October 1,
1996 Amendment to the Agreement in its entirety.
3. Unless otherwise amended by this Amendment or amendments with earlier
effective dates, all other terms and conditions of the Agreement,
including the Program Attachments and the Exhibits attached thereto,
shall remain the same and in full force and effect. To the extent that
the provisions in the Agreement or in any amendments with earlier
effective dates conflict with the terms of this Amendment, the terms in
this Amendment shall supersede and control.
4. Capitalized terms not defined herein but defined in the Agreement shall
have the same meaning as defined in the Agreement.
IN WITNESS WHEREOF, CIGNA and Provider have caused their duly
authorized representatives to execute this Amendment as of the date first
written above.
CIGNA HEALTH CORPORATION OLSTEN NETWORK MANAGEMENT,
INC.
By: By:
------------------------------- --------------------------------
Its: Its:
------------------------------- -------------------------------
Date: Date:
------------------------------- ------------------------------
AMENDMENT TO NATIONAL HOME CARE PROVIDER AGREEMENT
THIS AMENDMENT is entered into this 1st day of February, 1999 by and
between CIGNA Health Corporation, for and on behalf of its wholly owner
subsidiaries and affiliates, (individually and collectively, "CIGNA"), and
Olsten Network Management, Inc. d/b/a Olsten Health Services, for and on behalf
of its wholly owned subsidiaries and affiliates (individually and collectively,
"Provider").
W I T N E S S E T H :
WHEREAS, CIGNA and Provider entered into a National Home Care Provider
Agreement, dated January 1, 1996 and amended from time to time thereafter
(together the "Agreement"), whereby Provider provided or arranged for the
provision of certain health care services to Participants;
WHEREAS, the parties wish to amend a certain provision of the Agreement
as set forth below;
NOW THEREFORE, CIGNA and Provider agree as follows:
1. Effective January 1, 1999, Exhibit IX, Performance Guarantees, is
modified from "Years 2 and 3" to "Years 2, 3 and each year thereafter."
2. Effective February 1, 1999, Article II, Section B, Subsection 3 of the
HMO Program Attachment to the Agreement is deleted in its entirety and
replaced with the following:
a) Compensation for Traditional Home Health which is a Covered
Home Care Service is included in the Capitation Rate set forth
in Exhibit A.1 to the Agreement. In the event that CIGNA
elects to reimburse Provider for such Traditional Home Health
on a fee-for-service basis or for Traditional Home Health that
are not included within the Capitation Rate, then the rates
set forth in Schedule 1 attached hereto shall apply.
b) Compensation for Home Infusion Therapy which is a Covered Home
Care Service is included in the Capitation Rate set forth in
Exhibit A.1 to the Agreement. In the event that CIGNA elects
to reimburse Provider for such Home Infusion Therapy on a
fee-for service basis or for Home Infusion Therapy that are
not included within the Capitation Rate, then the rates set
forth in Schedule 2 attached hereto shall apply.
c) Compensation for Home Medical Equipment which is a Covered
Home Care Service is included in the Capitation Rate set forth
in Exhibit A.1 to the Agreement. In the event that CIGNA
elects to reimburse Provider for such Home Medical Equipment
on a fee-for-service basis or for Home Medical
Equipment that is not included within the Capitation Rate,
then the rates set forth in Schedule 3 attached hereto shall
apply.
3. Effective February 1, 1999, Exhibit A.3 of the HMO Program Attachment
to the Agreement is deleted in its entirety and replaced by Schedule 3
attached hereto.
4. Effective February 1, 1999, Exhibit A.4 of the HMO Program Attachment
to the Agreement is deleted in its entirety.
5. Unless otherwise amended by this Amendment or amendments with earlier
effective dates, all other terms and conditions of the Agreement,
including the Program Attachments and the Exhibits attached thereto,
shall remain the same and in full force and effect. To the extent that
the provisions in the Agreement or in any amendments with earlier
effective dates conflict with the terms of this Amendment, the terms in
this Amendment shall supersede and control.
6. Capitalized terms not defined herein but defined in the Agreement shall
have the same meaning as defined in the Agreement.
[Next Page Is Signature Page]
-2-
IN WITNESS WHEREOF, CIGNA and Provider have caused their duly
authorized representatives to execute this Amendment as of the date first
written above.
CIGNA HEALTH CORPORATION
By:
---------------------------------
Its:
---------------------------------
Date:
---------------------------------
OLSTEN NETWORK MANAGEMENT, INC.
By:
---------------------------------
Its:
---------------------------------
Date:
---------------------------------
-3-
OLSTEN HEALTH SERVICES NETWORK
SCHEDULE 1: TRADITIONAL HOME HEALTH FEE-FOR-SERVICE SCHEDULE
PAGE 1 OF 2
EFFECTIVE DATE: FEBRUARY 1, 1999
THE FOLLOWING TRADITIONAL HOME HEALTH SERVICES HAVE BOTH VISIT AND HOURLY RATES.
Notes 1, 2, 3, 4, 5 and 6 apply AREA 1 AREA 2 AREA 3
--------------------- ---------------------- -----------------
VISIT HOUR VISIT HOUR VISIT HOUR
- ---------------------------------------------------- ---------- ---------- ---------- ----------- -------- --------
CERTIFIED NURSES AIDE * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ----------- -------- --------
HOME HEALTH AIDE * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ----------- -------- --------
LVN/LPN * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ----------- -------- --------
LVN/LPN - HIGH TECH * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ----------- -------- --------
PEDIATRIC HIGH TECH LVN/LPN * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ----------- -------- --------
PEDIATRIC HIGH TECH RN * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ----------- -------- --------
PEDIATRIC LVN/LPN * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ----------- -------- --------
PEDIATRIC RN * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ----------- -------- --------
RN * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ----------- -------- --------
RN HIGH TECH INFUSION * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ----------- -------- --------
RN HIGH TECH OTHER * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ----------- -------- --------
THE FOLLOWING TRADITIONAL HOME HEALTH SERVICES HAVE BOTH VISIT RATES.
Notes 1, 3, 4, 5 and 7 apply AREA 1 AREA 2 AREA 3
--------------------- --------------------- ------------------
VISIT HOUR VISIT HOUR VISIT HOUR
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
DIABETIC NURSE * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
DIETITIAN * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
ENTEROSTOMAL THERAPIST * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
MATERNAL CHILD HEALTH * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
MEDICAL SOCIAL WORKER * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
OCCUPATIONAL THERAPIST * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
OCCUPATIONAL THERAPIST ASSISTANT * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
PHLEBOTOMIST * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
PHOTOTHERAPY PACKAGE SERVICE * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
PHYSICAL THERAPIST * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
PHYSICAL THERAPIST ASSISTANT * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
PSYCHIATRIC NURSE * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
REHABILITATION NURSE * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
RESPIRATORY THERAPIST * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
RN ASSESSMENT, INITIAL * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
RN SKILLED NURSING ADMISSION VISIT * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
RN SKILLED NURSING VISIT-EXTENSIVE * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
SPEECH THERAPIST * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
THE FOLLOWING TRADITIONAL HOME HEALTH SERVICE HAS HOURLY ONLY RATES.
Notes 3, 4 and 5 apply AREA 1 AREA 2 AREA 3
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
VISIT HOUR VISIT HOUR VISIT HOUR
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
HOMEMAKER * * * * * *
- ---------------------------------------------------- ---------- ---------- ---------- ---------- -------- ---------
THE FOLLOWING TRADITIONAL HOME HEALTH SERVICE IS PRICED ON A PER DIEM BASIS.
Notes 3, 4 and 5 apply AREA 1 AREA 2 AREA 3
- ---------------------------------------------------- --------------------- --------------------- ------------------
PER DIEM PER DIEM PER DIEM
- ---------------------------------------------------- --------------------- --------------------- ------------------
COMPANION/LIVE IN * * *
- ---------------------------------------------------- --------------------- --------------------- ------------------
NOTES:
1. Visits are defined as two (2) hours or less in duration (EXCEPT
MATERNAL CHILD HEALTH VISITS, WHICH HAVE NO MAXIMUM DURATION).
2. Hourly rate for visits exceeding two (2) hours in duration, starting
with hour 3.
3. CIGNA does not reimburse for travel time, weekend, holiday or evening
differentials.
4. Above prices have no exclusions.
5. All services not listed above will be billed at cost plus * until rates
are mutually established and become part of the fee schedule.
6. RN High Tech Infusion visit and hourly utilization/costs to be reported
with HIT.
7. Respiratory therapist visit utilization/costs to be reported with
HME/RT
*Confidential Treatment Requested.
OLSTEN HEALTH SERVICES NETWORK
SCHEDULE 1: TRADITIONAL HOME HEALTH ZONE RATE AREAS
PAGE 2 OF 2
EFFECTIVE DATE: FEBRUARY 1, 1999
STATE RATE AREA RATE DESIGNATION
- -------------------------------------------------------------------------------------------------------------------
Alabama LOW 3
- -------------------------------------------------------------------------------------------------------------------
Alaska HIGH 1
- -------------------------------------------------------------------------------------------------------------------
Arizona MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
Arkansas LOW 3
- -------------------------------------------------------------------------------------------------------------------
California HIGH 1
- -------------------------------------------------------------------------------------------------------------------
Colorado MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
Connecticut MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
Delaware LOW 3
- -------------------------------------------------------------------------------------------------------------------
District of Columbia HIGH 1
- -------------------------------------------------------------------------------------------------------------------
Florida MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
Georgia MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
Hawaii HIGH 1
- -------------------------------------------------------------------------------------------------------------------
Idaho LOW 3
- -------------------------------------------------------------------------------------------------------------------
Illinois HIGH 1
- -------------------------------------------------------------------------------------------------------------------
Indiana LOW 3
- -------------------------------------------------------------------------------------------------------------------
Iowa LOW 3
- -------------------------------------------------------------------------------------------------------------------
Kansas LOW 3
- -------------------------------------------------------------------------------------------------------------------
Kentucky LOW 3
- -------------------------------------------------------------------------------------------------------------------
Louisiana MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
Maine LOW 3
- -------------------------------------------------------------------------------------------------------------------
Maryland MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
Massachusetts HIGH 1
- -------------------------------------------------------------------------------------------------------------------
Michigan LOW 3
- -------------------------------------------------------------------------------------------------------------------
Minnesota LOW 3
- -------------------------------------------------------------------------------------------------------------------
Mississippi LOW 3
- -------------------------------------------------------------------------------------------------------------------
Missouri MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
Montana LOW 3
- -------------------------------------------------------------------------------------------------------------------
Nebraska LOW 3
- -------------------------------------------------------------------------------------------------------------------
Nevada LOW 3
- -------------------------------------------------------------------------------------------------------------------
New Hampshire LOW 3
- -------------------------------------------------------------------------------------------------------------------
New Jersey MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
New Mexico LOW 3
- -------------------------------------------------------------------------------------------------------------------
New York MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
North Carolina MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
North Dakota MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
Ohio MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
Oklahoma LOW 3
- -------------------------------------------------------------------------------------------------------------------
Oregon MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
Pennsylvania MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
Rhode Island MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
South Carolina LOW 3
- -------------------------------------------------------------------------------------------------------------------
South Dakota LOW 3
- -------------------------------------------------------------------------------------------------------------------
Tennessee MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
Texas HIGH 1
- -------------------------------------------------------------------------------------------------------------------
Utah MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
Vermont LOW 3
- -------------------------------------------------------------------------------------------------------------------
Virginia MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
Washington MEDIUM 2
- -------------------------------------------------------------------------------------------------------------------
West Virginia LOW 3
- -------------------------------------------------------------------------------------------------------------------
Wisconsin LOW 3
- -------------------------------------------------------------------------------------------------------------------
Wyoming LOW 3
- -------------------------------------------------------------------------------------------------------------------
OLSTEN HEALTH SERVICES NETWORK
SCHEDULE 2: HOME INFUSION THERAPY FEE-FOR-SERVICE SCHEDULE
EFFECTIVE DATE: FEBRUARY 1, 1999
THE FOLLOWING HOME INFUSION THERAPY SERVICES RATES EXCLUDE DRUGS, DRUGS ARE
PRICED AS A PERCENTAGE DISCOUNT OFF AWP (IF APPLICABLE), AND THERE IS NO PRICE
DIFFERENCE BETWEEN PRIMARY AND MULTIPLE THERAPIES.
PRIMARY OR PRIMARY OR PRIMARY OR
MULTIPLE THERAPY MULTIPLE THERAPY MULTIPLE THERAPY
PER DIEM DISPENSING FEE DRUG DISCOUNT OFF AWP
- ------------------------------------------------- ---------------------- -------------------- -----------------------
Ancillary Drugs * *
- ------------------------------------------------- ---------------------- -------------------- -----------------------
Biological Response Modifiers * *
- ------------------------------------------------- ---------------------- -------------------- -----------------------
Cardiac (Inotropic) Therapy * *
- ------------------------------------------------- ---------------------- -------------------- -----------------------
Chelation Therapy * *
- ------------------------------------------------- ---------------------- -------------------- -----------------------
Chemotherapy * *
- ------------------------------------------------- ---------------------- -------------------- -----------------------
Enteral Therapy * *
- ------------------------------------------------- ---------------------- -------------------- -----------------------
Enzyme Therapy * *
- ------------------------------------------------- ---------------------- -------------------- -----------------------
Growth Hormone * *
- ------------------------------------------------- ---------------------- -------------------- -----------------------
IV Immune Globulin * *
- ------------------------------------------------- ---------------------- -------------------- -----------------------
Other Injectable Therapies * *
- ------------------------------------------------- ---------------------- -------------------- -----------------------
Other Infusion Therapies * *
- ------------------------------------------------- ---------------------- -------------------- -----------------------
Pain Management Therapy * *
- ------------------------------------------------- ---------------------- -------------------- -----------------------
Steroid Therapy * *
- ------------------------------------------------- ---------------------- -------------------- -----------------------
Thrombolytic (Anticoagulation) Therapy * *
- ------------------------------------------------- ---------------------- -------------------- -----------------------
THE FOLLOWING HOME INFUSION THERAPY SERVICE RATE EXCLUDES DRUGS, DRUGS ARE
PRICED AS A PERCENTAGE DISCOUNT OFF AWP, AND THERE IS A PRICE DIFFERENCE BETWEEN
PRIMARY AND MULTIPLE ANTI-INFECTIVE THERAPIES.
PER DIEM DRUG DISCOUNT OFF AWP
- ------------------------------------------------- ------------------------------------------- -----------------------
Anti-Infectives - Primary Anti-Infective * *
- ------------------------------------------------- ------------------------------------------- -----------------------
Anti-Infectives - Multiple Anti-Infective * *
- ------------------------------------------------- ------------------------------------------- -----------------------
THE FOLLOWING HOME INFUSION THERAPY SERVICE RATE EXCLUDES DRUGS, DRUGS ARE
PRICED PER VIAL, AND THERE IS NO PRICE DIFFERENCE BETWEEN PRIMARY AND MULTIPLE
THERAPIES.
PRIMARY OR
MULTIPLE THERAPY
PER DIEM COST OF DRUG
- ------------------------------------------------- ------------------------------------ -------------------------
Flolan Therapy *
- ------------------------------------------------- ------------------------------------ -------------------------
Flolan 0.5 mg vial *
- ------------------------------------------------- ------------------------------------ -------------------------
Flolan 1.5 mg vial *
- ------------------------------------------------- ------------------------------------ -------------------------
Flolan diluent vial *
- ------------------------------------------------- ------------------------------------ -------------------------
THE FOLLOWING HOME INFUSION THERAPY SERVICES RATES INCLUDE DRUGS, AND THERE IS
NO PRICE DIFFERENCE BETWEEN PRIMARY AND MULTIPLE THERAPIES.
PRIMARY OR
MULTIPLE THERAPY
PER DIEM
- ------------------------------------------------- ------------------------------------------- -----------------------
Enteral Therapy *
- ------------------------------------------------- ------------------------------------------- -----------------------
Hydration Therapy *
- ------------------------------------------------- ------------------------------------------- -----------------------
Total Parenteral Nutrition *
- ------------------------------------------------- ------------------------------------------- -----------------------
NOTES:
1. Per Diems EXCLUDING drugs include all costs related to the therapy
except the cost of drugs, including but not limited to facility
overhead, supplies, delivery, professional labor including compounding
and monitoring, all nursing required, maintenance of specialized
catheters, equipment/patient supplies, disposables, pumps, general and
administrative expenses, etc.
2. Per Diems INCLUDING drugs include ALL costs - including but not limited
to cost of drugs, facility overhead, supplies, delivery, professional
labor including compounding and monitoring, all nursing required,
maintenance of specialized catheters, equipment/patient supplies,
disposables, pumps, general and administrative expenses, etc.
3. "DISPENSING FEE" is defined as per each time the drug is dispensed by
the home infusion provider.
4. "PER DIEM" costs are the same for primary or multiple treatments for
all drug categories, except ANTI-INFECTIVES.
5. The per diem rate shall only be charged for those days the Participant
receives medication.
6. For home infusion pharmaceuticals not listed on fee schedule, * will
apply.
*Confidential Treatment Requested. 1/2
OLSTEN HEALTH SERVICES NETWORK
SCHEDULE 2: HOME INFUSION THERAPY FEE-FOR-SERVICE SCHEDULE
EFFECTIVE DATE:. FEBRUARY 1, 1999
OTHER HOME INFUSION THERAPIES
- ------------------------------------------------------------ ---------------------------------------------------------
Blood Transfusion per Unit *
- ------------------------------------------------------------ ---------------------------------------------------------
Catheter Care Per Diem *
- ------------------------------------------------------------ ---------------------------------------------------------
Midline Insertion (Catheter & Supplies) *
- ------------------------------------------------------------ ---------------------------------------------------------
PICC Linie Insertion (Catheter & Supplies) *
- ------------------------------------------------------------ ---------------------------------------------------------
BLOOD PRODUCT
- ------------------------------------------------------------ ---------------------------------------------------------
<s>
Blood Product *
- ------------------------------------------------------------ ---------------------------------------------------------
FACTOR CONCENTRATES
- ------------------------------------------------------------ ---------------------------------------------------------
Unit Price
- ------------------------------------------------------------ ---------------------------------------------------------
Factor VIII (Recombinant)
- ------------------------------------------------------------ ---------------------------------------------------------
Recombinate *
- ------------------------------------------------------------ ---------------------------------------------------------
Kogenate or Helixate *
- ------------------------------------------------------------ ---------------------------------------------------------
Bioclate *
- ------------------------------------------------------------ ---------------------------------------------------------
- ------------------------------------------------------------ ---------------------------------------------------------
Factor VIII (Monoclonal)
- ------------------------------------------------------------ ---------------------------------------------------------
Hemofil-M or A.R.C. Method M *
- ------------------------------------------------------------ ---------------------------------------------------------
Monoclate P *
- ------------------------------------------------------------ ---------------------------------------------------------
- ------------------------------------------------------------ ---------------------------------------------------------
Factor VIII (Other)
- ------------------------------------------------------------ ---------------------------------------------------------
Koate *
- ------------------------------------------------------------ ---------------------------------------------------------
Humate *
- ------------------------------------------------------------ ---------------------------------------------------------
Alphanate SDHT *
- ------------------------------------------------------------ ---------------------------------------------------------
- ------------------------------------------------------------ ---------------------------------------------------------
Factor IX (Recombinant)
- ------------------------------------------------------------ ---------------------------------------------------------
BeneFix *
- ------------------------------------------------------------ ---------------------------------------------------------
- ------------------------------------------------------------ ---------------------------------------------------------
Factor IX (Monoclonal/High Purity)
- ------------------------------------------------------------ ---------------------------------------------------------
Mononine *
- ------------------------------------------------------------ ---------------------------------------------------------
Alphanine *
- ------------------------------------------------------------ ---------------------------------------------------------
- ------------------------------------------------------------ ---------------------------------------------------------
Factor IX (Other)
- ------------------------------------------------------------ ---------------------------------------------------------
Konyne - 80 *
- ------------------------------------------------------------ ---------------------------------------------------------
Proplex T *
- ------------------------------------------------------------ ---------------------------------------------------------
Bebulin *
- ------------------------------------------------------------ ---------------------------------------------------------
Profilnine SD *
- ------------------------------------------------------------ ---------------------------------------------------------
- ------------------------------------------------------------ ---------------------------------------------------------
Anti-Inhibitor Complex
- ------------------------------------------------------------ ---------------------------------------------------------
Autoplex-T *
- ------------------------------------------------------------ ---------------------------------------------------------
Feiba-VH *
- ------------------------------------------------------------ ---------------------------------------------------------
Hyate-C *
- ------------------------------------------------------------ ---------------------------------------------------------
- ------------------------------------------------------------ ---------------------------------------------------------
HEMOSTATIC AGENTS
- ------------------------------------------------------------ ---------------------------------------------------------
- ------------------------------------------------------------ ---------------------------------------------------------
DDAVP - 10ml vial *
- ------------------------------------------------------------ ---------------------------------------------------------
Stimate - 2.5ml vial *
- ------------------------------------------------------------ ---------------------------------------------------------
Above rates include all necessary ancillary supplies and waste disposal unit;
24-hour on-call clinical support; home infusion monitoring system; product
delivery nationwide; patient training, education and evaluation.
*Confidential Treatment Requested. 2/2
OLSTEN HEALTH SERVICES NETWORK
SCHEDULE 3: HOME MEDICAL EQUIPMENT/RESPIRATORY THERAPY FEE-FOR-SERVICE SCHEDULE
EFFECTIVE DATE: FEBRUARY 1, 1999
HCPCS CHC OLSTEN PURCHASE RENTAL DAILY
CODE CODE CODE DESCRIPTION PRICE PRICE PRICE
- ----- ---- ------ ----------------------------------------------------------------------- -------- ------ -----
A4660 DM590 2520 MONITOR, BLOOD PRESSURE (A4660) W/STETH & CUFF *
A4670 DM570 2518 MONITOR, BLOOD PRESSURE (A4670), AUTOMATIC *
B9000 DM590 2570 PUMP, ENTERAL (B9000) * *
B9998 DM590 6828 ENTERAL SUPPLIES (B9998) *
DM590 DM590 2522 CANNULA, NASAL *
E0100 E0100 2020 CANE (E0100), ADJ OR FIX, W/TIP *
E0105 E0105 2021 CANE, QUAD (E0105) OR THREE PRONG, ADJ OR FIX, W/TIPS *
E0110 E0110 2028 CRUTCHES, FOREARM (E0110), ADJ OR FIX, PAIR, W/TIPS, GRIPS *
E0111 E0111 2023 CRUTCH FOREARM (E0111), ADJ OR FIX, EACH, W/TIP AND GRIPS *
E0112 E0112 2027 CRUTCHES UNDERARM, WOOD (E0112), ADJ OR FIX, PAIR, COMPLETE *
E0113 E0113 2025 CRUTCH UNDERARM, WOOD (E0113), ADJ OR FIX, EACH, COMPLETE *
E0114 E0114 2026 CRUTCHES UNDERARM, ALUM (E0114), ADJ OR FIX, PAIR, COMPLETE *
E0116 E0116 2024 CRUTCH UNDERARM, ALUM (E0116), ADJ OR FIX, EACH, COMPLETE *
E0130 E0130 2037 WALKER, RIGID (E0130) (PICKUP), ADJ OR FIX HEIGHT *
E0135 E0135 2036 WALKER, FOLDING (E0135) (PICKUP), ADJ OR FIX HEIGHT *
E0141 E0141 2040 WALKER, WHEELED (E0141), W/OUT SEAT *
E0142 DM570 2034 RIGID WALKER (E0142), WHEELED, W/SEAT *
E0143 E0143 2029 WALKER FOLDING, WHEELED (E0143), W/OUT SEAT *
E0145 DM570 2039 WALKER (E0145), WHEELED, W/SEAT AND CRUTCH ATTACHMENTS *
E0146 DM570 2038 WALKER/ WHEELED, W/SEAT (E0146) *
E0147 DM570 2030 WALKER HVY DUTY (E0147), MULT BRAKING SYS. VAR WHEEL RESISTANCE *
E0153 E0153 2032 CRUTCH PLATFORM ATTACHMENT (E0153), FOREARM EA *
E0154 E0154 2033 WALKER PLATFORM ATTACHMENT (0154), EA *
E0155 E0155 2041 WALKER WHEEL ATTACHMENT (E0155), RIGID (PICKUP) WALKER *
E0156 DM570 2035 WALKER SEAT ATTACHMENT (E0156) *
E0157 E0157 2022 WALKER/ CRUTCH ATTACHMENT (E0157), EACH *
E0158 E0158 2031 WALKER LEG EXTENSIONS (E0158) *
E0163 E0163 2047 COMMODE CHAIR, STATIONARY (E0163), W/FIX ARMS *
E0164 DM570 2045 COMMODE CHAIR, MOBILE (E0164), W/FIX ARMS *
E0165 E0165 2046 COMMODE CHAIR (E0165), STATIONARY, W/DETACH ARMS *
E0165 E0165 2591 COMMODE, XXWIDE (E0165) *
E0166 DM570 2044 COMMODE CHAIR (E0166), MOBILE, W/DETACH ARMS *
E0167 E0167 2051 COMMODE CHAIR, PAIL OR PAN (E0167) *
E0176 E0176 2142 CUSHION (E0176) OR AIR PRESSURE PAD, NON-POSITIONING *
E0176 E0176 2394 REPLACEMENT PAD (E0176) ALTERNATING PRESS *
E0177 E0177 2224 CUSHION OR WATER PRESS PAD (E0177), NONPOSITIONING *
E0178 E0178 2160 CUSHION OR GEL PRESS PAD (E0178), NONPOSITIONING *
E0179 E0179 2154 CUSHION (E0179) OR DRY PRESSURE PAD, NONPOSITIONING *
E0180 E0180 2196 PUMP (E0180), ALTERNATING PRESSURES W/PAD * *
E0181 E0181 2197 PUMP (E0181), ALTERNATING PRESS W/PAD, HVY DUTY * *
E0184 E0184 2074 MATTRESS, DRY PRESSURE (E0184) *
E0185 E0185 2076 MATTRESS (E0185), GEL OR GEL-LIKE PRESSURE PAD *
E0186 E0186 2064 MATTRESS, AIR PRESSURE (E0186) *
E0187 E0187 2099 MATTRESS, WATER PRESSURE (E0187) *
E0188 DM570 2217 PAD, SYNTHETIC SHEEPSKIN (E0188) *
E0189 DM570 2177 PAD, LAMBSWOOL SHEEPSKIN (E0189), ANY SIZE *
E0192 E0192 2573 CUSHION, JAY FOR W/C (E0192) * *
E0192 E0192 2572 CUSHION, ROHO FOR W/C (E0192) * *
E0192 E0192 2178 PAD (E0192), LOW PRESS AND POSITIONING EQUALIZATION * *
E0193 E0193 2098 MATTRESS, LOW AIR LOSS (E0193) * * *
E0194 DM570 2063 AIR FLUIDIZED BED (E0194) * *
E0196 E0196 2077 MATTRESS, GEL PRESSURE (E0196) *
E0197 E0197 2065 MATTRESS, AIR PRESSURE PAD (E0197) *
E0198 E0198 2100 MATTRESS (E0198), WATER PRESSURE PAD *
E0199 E0199 2075 MATTRESS, DRY PRESSURE PAD (E0199) *
E0200 E0200 2228 HEAT LAMP (E0200), W/OUT STAND, INCL/BULB, OR INFRARED ELEMENT *
E0202 E0202 2229 PHOTOTHERAPY (BILIRUBIN) (E0202), LIGHT WIT *
E0202 E0202 2524 PHOTOTHERAPY, BILI BLANKET (E0202) *
E0205 E0205 2227 HEAT LAMP (E0205), WITH STAND, INCL/BULB, OR INFRARED ELEMENT *
E0210 DM570 2156 HEATING PAD, STANDARD (E0210) *
E0215 DM570 2155 HEATING PAD (E0215), ELECTRIC, MOIST *
E0218 DM570 2560 COLD THERAPY UNIT (E0218) * * *
E0235 DM570 2187 PARAFFIN BATH UNIT, PORT (E0235) *
E0236 DM570 2199 PUMP (E0236) FOR WATER CIRCULATING PAD *
E0237 DM570 2223 HEAT COLD WATER (E0237) CIRCULATING PAD W/PUMP *
E0238 DM570 2179 HEATING PAD (E0238), MOIST, NON-ELECTRIC *
E0241 DM570 2867 BATH TUB RAIL (E0241), WALL, L-SHAPE *
E0241 DM570 2862 BATH TUB RAIL, WALL, 12" (E0241) *
E0241 DM570 2863 BATH TUB RAIL, WALL, 16" (E0241) *
* Confidential Treatment Requested
1/5
OLSTEN HEALTH SERVICES NETWORK
SCHEDULE 3: HOME MEDICAL EQUIPMENT/RESPIRATORY THERAPY FEE-FOR-SERVICE SCHEDULE
EFFECTIVE DATE: FEBRUARY 1, 1999
HCPCS CHC OLSTEN PURCHASE RENTAL DAILY
CODE CODE CODE DESCRIPTION PRICE PRICE PRICE
- ----- ---- ------ ----------------------------------------------------------------------- -------- ------ -----
E0241 DM570 2864 BATH TUB RAIL, WALL, 18" (E0241) *
E0241 DM570 2865 BATH TUB RAIL, WALL, 24" (E0241) *
E0241 DM570 2866 BATH TUB RAIL, WALL, 36" (E0241) *
E0241 DM570 2043 BATH TUB RAIL, WALL, UNSPECIFIED SIZE *
E0242 DM570 2042 BATH TUB RAIL, FLOOR BASE (E0242) *
E0243 DM570 2056 TOILET RAIL, EACH (E0243) *
E0244 E0244 2587 TOILET SEAT (E0244) RAISED WITH ARMS *
E0244 E0244 2052 TOILET SEAT, RAISED (E0244) *
E0245 DM570 2575 BATH BENCH WITH BACK (E0245) *
E0245 DM570 2058 BATH TUB STOOL OR BENCH (E0245) *
E0245 DM570 2578 TRANSFER BENCH, NON-PADDED (E0245) *
E0245 DM570 2577 TRANSFER BENCH, PADDED (E0245) *
E0246 DM570 2057 TRANSFER TUB RAIL (E0256), ATTACHMENT *
E0249 DM570 2186 HEAT UNIT (E0249), WATER CIRCULATING PAD *
E0255 E0255 2090 HOSP BED (E0255), VAR HEIGHT, HI-LO, W/SIDE RAILS, W/MATTRESS * *
E0256 E0256 2091 HOSP BED (E0256), VAR HEIGHT, HI-LO, W/SIDE RAILS, W/O MATTRESS * *
E0260 E0260 2083 HOSP BED (E0260), SEMI-ELEC, W/SIDE RAILS, W/MATTRESS * *
E0261 E0261 2084 HOSP BED (E0261), SEMI-ELEC, W/SIDE RAILS, W/OUT MATTRESS * *
E0265 E0265 2086 HOSP BED (E0265), TOTAL ELEC, W/SIDE RAILS, W/MATTRESS * *
E0266 E0266 2087 HOSP BED (E0266), TOTAL ELEC, W/SIDE RAILS, W/OUT MATTRESS * *
E0271 E0271 2096 MATTRESS, INNERSPRING (E0271) *
E0272 E0272 2095 MATTRESS, FOAM RUBBER (E0272) *
E0273 DM570 2068 BED BOARD (E0273) *
E0274 DM570 2097 OVER-BED TABLE (E0274) *
E0275 E0275 2071 BED PAN, STANDARD (E0275), METAL OR PLASTIC *
E0276 E0276 2070 BED PAN, FRACTURE (E0276), METAL OR PLASTIC *
E0277 E0277 2066 MATTRESS (E0277), ALTERNATING PRESSURE * *
E0280 DM570 2069 BED CRADLE, ANY TYPE (E0280) *
E0292 E0292 2092 HOSP BED (E0292), VAR HEIGHT, HI-LO, W/OUT S/RAILS, W/MATTRESS * *
E0293 E0293 2093 HOSP BED (E0293), VAR HEIGHT, HI-LO, NO SIDE RAILS, NO MATTRESS * *
E0294 E0294 2085 HOSP BED (E0294), SEMI-ELEC, W/OUT SIDE RAILS, W/MATTRESS * *
E0295 E0295 2094 HOSP BED (E0295), SEMI-ELEC, W/OUT SIDE RAILS, W/OUT MATTRESS * *
E0296 E0296 2089 HOSP BED (E0296), TOTAL ELEC, W/OUT SIDE RAILS, W/OUT MATTRESS * *
E0297 E0297 2088 HOSP BED (E0297), TOTAL ELEC, W/OUT SIDE RAILS, W/MATTRESS * *
E0305 E0305 2073 BED SIDE RAILS (E0305), HALF LENGTH *
E0310 E0310 2072 BED SIDE RAILS (E0310), FULL LENGTH *
E0315 DM570 2067 BED ACCESSORIES: BOARDS OR TABLES, ANY TYPE *
E0325 E0325 2060 URINAL: MALE (E0325), JUG-TYPE, ANY MATERIAL *
E0326 E0326 2059 URINAL: FEMALE (E0326), JUG-TYPE, ANY MATERIAL *
E0410 E0410 2369 O2 CONTENTS, LIQUID (E0410), PER POUND *
E0416 E0416 2371 O2 REFILL FOR PORT (E0416) GAS SYSTEM ONLY, UP TO 23 CUBIC FEET *
E0424 E0424 2385 O2 SYS STATIONARY (E0424) COMPR GAS, RENT *
E0430 E0430 2374 O2 SYS PORT GAS, PURCH (E0430) *
E0431 E0431 2375 O2 SYS PORT GAS, RENT (E0431) *
E0431 DM570 2574 O2 SYSTEM, LIGHTWEIGHT (E0431) * *
E0434 E0434 2377 O2 SYS PORT LIQUID, RENT (0434) *
E0435 E0435 2376 O2 SYS PORT LIQUID, PURCH (E0435) *
E0439 E0439 2388 O2 SYS STATIONARY (E0439) LIQUID, RENT *
E0440 E0440 2387 O2 SYS STATIONARY (E0440) LIQUID, PURCH *
E0443 E0443 2869 O2 CONTENTS, H/K CYLINDER (E0443), 200-300 CUBIC FT *
E0444 E0444 2379 O2 CONTENTS, PORT LIQUID (E0444), PER UNIT (1 UNIT = 1 LB.) *
E0450 E0450 2392 VENTILATOR VOLUME (E0450), STATIONARY OR PORT * *
E0452 E0452 2332 BILEVEL INTERMITTENT (E0452) ASSIST DEVICE (BIPAP) * *
E0453 E0453 2390 VENTILATOR THERAPEUTIC (E0453); FOR USE 12 HOURS OR LESS PER DAY * *
E0455 E0455 2372 O2 TENT (E0455), EXCLUDING GROUP OR PEDIATRIC TENTS * *
E0457 E0457 2323 CHEST SHELL (CUIRASS) (E0457) * *
E0459 E0459 2324 CHEST WRAP (E0459) * *
E0460 E0460 2339 VENTILATOR (E0460), NEGATIVE PRESSURE, PORTABLE STATIONARY * *
E0480 DM570 2373 PERCUSSOR (E0480), ELEC OR PNEUM. HOME MODEL * *
E0500 E0500 2333 IPPB, W/BUILT-IN NEB (E0500) MAN OR AUTO VALVES, INT EXT POWER * *
E0550 E0550 2328 HUMIDIFIER (E0550) DURABLE FOR EXTENSIV SUP/HUMID W/IPPB OR O2 * *
E0555 E0555 2330 HUMIDIFIER (E0555), DURABLE, GLASS, FOR USE W/REG OR FLOWMETER *
E0565 E0565 2325 COMPRESSOR, AIR POWER (E0565) * *
E0570 E0570 2336 NEBULIZER, W/COMPRESSOR (E0570) *
E0575 DM570 2571 NEBULIZER (E0575), ULTRASONIC, AC/DC * *
E0575 DM570 2338 NEBULIZER; ULTRASONIC (E0575) * *
E0585 E0585 2337 NEBULIZER (E0585), W/COMPRESSOR AND HEATER * *
E0600 E0600 2389 SUCTION PUMP (E0600), HOME MODEL, PORT * *
E0601 E0601 2326 CONTINUOUS POSITIVE (E0601) AIRWAY PRESSURE DEVICE (CPAP) * *
* Confidential Treatment Requested
2/5
OLSTEN HEALTH SERVICES NETWORK
SCHEDULE 3: HOME MEDICAL EQUIPMENT/RESPIRATORY THERAPY FEE-FOR-SERVICE SCHEDULE
EFFECTIVE DATE: FEBRUARY 1, 1999
HCPCS CHC OLSTEN PURCHASE RENTAL DAILY
CODE CODE CODE DESCRIPTION PRICE PRICE PRICE
- ----- ---- ------ ----------------------------------------------------------------------- -------- ------ -----
E0605 DM570 2391 VAPORIZER, ROOM TYPE (E0605) *
E0606 DM570 2380 POSTURAL DRAINAGE BOARD (E0606) *
E0607 E0607 6874 MONITOR, B/GLUCOSE (E0607) ACCUCHEK AD *
E0607 E0607 2164 MONITOR, BLOOD GLUCOSE (E0607) *
E0608 E0608 2322 APNEA MONITOR (E0608) * *
E0608 E0608 2576 APNEA MONITOR (E0608) W/MEM (INCL SMART) * *
E0609 E0609 2146 MONITOR, BLOOD GLUCOSE (E0609) W/SPECIAL FEATURES *
E0621 DM570 2215 PATIENT LIFT (E0621), SLING OR SEAT, CANVAS OR NYLON *
E0625 DM570 2191 PATIENT LIFT (E0625), KARTOP, BATHROOM OR TOILET *
E0627 E0627 4553 HIP CHAIR (E0627) * *
E0627 DM570 2395 SEAT LIFT CHAIR/MOTORIZED (E0627) *
E0627 DM570 2205 SEAT LIFT MECH (E0627) INCORPORATED INTO A COMB LIFT-CHAIR MECH *
E0630 DM570 2190 PATIENT LIFT, HYDRAULIC (E0630), W/SEAT OR SLING * *
E0635 DM570 2189 PATIENT LIFT (E0635), ELEC W/SEAT OR SLING *
E0650 E0650 2192 PNEUM COMPRESSOR (E0650), NON-SEG HOME MODEL * *
E0651 E0651 2194 PNEUM COMPRESSOR (E0651), SEG HOME MODEL W/OUT CALIB GRAD PRES * *
E0652 E0652 2193 PNEUM COMPRESSOR (E0652), SEG HOME MODEL W/CALIB GRAD PRES * *
E0655 E0655 2182 PNEUM COMPRESSOR (E0655), NON-SEG APPLIANCE, HALF ARM *
E0660 E0660 2181 PNEUM COMPRESSOR (E0660), NON-SEG APPLIANCE, FULL LEG *
E0665 E0665 2180 PNEUM COMPRESSOR (E0665), NON-SEG APPLIANCE, FULL ARM *
E0666 E0666 2183 PNEUM COMPRESSOR (E0666), NON-SEG APPLIANCE, HALF LEG *
E0667 E0667 2210 PNEUM APPLIANCE (E0667), SEG, FULL LEG *
E0668 E0668 2209 PNEUM APPLIANCE (E0668), SEG, FULL ARM *
E0669 E0669 2212 PNEUM APPLIANCE (E0669), SEG, HALF LEG *
E0670 E0670 2211 PNEUM APPLIANCE (E0670), SEG, HALF ARM *
E0671 E0671 2207 PNEUM APPLIANCE (E0671), SEG GRAD PRESS, FULL LEG *
E0672 E0672 2206 PNEUM APPLIANCE (E0672), SEG GRAD PRESS, FULL ARM *
E0673 E0673 2208 PNEUM APPLIANCE (E0673), SEG GRAD PRESS, HALF LEG *
E0690 DM570 2221 ULTRAVIOLET CABINET (E0690), APPROPRIATE FOR HOME USE *
E0700 DM570 2204 SAFETY EQUIP (E0700) (E.G., BELT, HARNESS OR VEST) *
E0710 DM570 2202 RESTRAINTS (E0710), ANY TYPE (BODY, CHEST, WRIST OR ANKLE) *
E0720 E0720 2219 TENS (E0720), TWO LEAD, LOCALIZED STIMULATION * *
E0730 E0730 2218 TENS (E0730), FOUR LEAD, LARGER AREA/MULTIPLE NERVE STIMULATION * *
E0731 E0731 2159 TENS OR NMES (E0731), CONDUCTIVE GARMENT *
E0744 E0744 2120 STIMULATOR (E0744), NEUROMUSCULAR FOR SCOLIOSIS * *
E0745 E0745 2121 STIMULATOR (E0745), NEUROMUSCULAR, ELECTRONIC SHOCK UNIT * *
E0745 E0745 6915 STIMULATOR (E0745), NEUROMUSCULAR, FOUR CH * *
E0746 DM570 2109 ELECTROMYOGRAPHY (EMG) (E0746), BIOFEEDBACK DEVICE * *
E0747 DM570 2122 STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE *
E0748 DM570 2124 STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL APPLICATIONS *
E0755 DM570 2157 STIMULATOR (E0755), ELECTRONIC SALIVARY REFLEX, NON INVASIVE *
E0776 E0776 2175 IV POLE (E0776) * *
E0784 E0784 2158 PUMP (E0784), EXT AMBULATORY INFUSION, MINIMED, INSULIN *
E0784 E0784 6771 PUMP (E0784), INSULIN EXT INFUSION DISETRONICS *
E0840 E0840 2133 TRACTION FRAME (E0840), ATTACH TO HEADBOARD, CERVICAL TRACTION *
E0850 E0850 2134 TRACTION STAND (E0850), FREE STANDING, CERVICAL TRACTION * *
E0860 E0860 2130 TRACTION EQUIP (E0860), OVERDOOR, CERVICAL *
E0870 E0870 2131 TRACTION FRAME (E0870), ATTACH TO FOOTBOARD, EXTREMITY, BUCKS * *
E0880 E0880 2135 TRACTION STAND (E0880) FREE/STAND EXTREMITY TRACTION, EG, BUCK'S * *
E0890 E0890 2132 TRACTION FRAME (E0890), ATTACH TO FOOTBOARD, PELVIC TRACTION * *
E0900 E0900 2136 TRACTION STAND (E0900) FREE/STAND PELVIC TRACTION (EG. BUCK'S) * *
E0910 E0910 2138 TRAPEZE BARS (E0910), A/K/A PT HELPER, ATTACH TO BED W/GRAB BAR * *
E0920 E0920 2111 FRACTURE FRAME (E0920), ATTACH TO BED, INCLUDING WEIGHTS * *
E0935 E0935 2125 PASSIVE MOTION (E0935) EXERCISE DEVICE *
E0935 E0935 2859 PASSIVE MOTION (E0935) EXERCISE DEVICE, ANKLE *
E0935 E0935 2860 PASSIVE MOTION (E0935) EXERCISE DEVICE, ELBOW *
E0935 E0935 2857 PASSIVE MOTION (E0935) EXERCISE DEVICE, HAND *
E0935 E0935 2858 PASSIVE MOTION (E0935) EXERCISE DEVICE, SHOULDER *
E0935 E0935 2861 PASSIVE MOTION (E0935) EXERCISE DEVICE, WRIST *
E0940 E0940 2137 TRAPEZE BAR (E0940), FREE STANDING, COMPLETE W/GRAB BAR * *
E0941 E0941 2116 TRACTION DEVICE (E0941), GRAVITY ASSISTED * *
E0942 E0942 2101 HARNESS/HALTER (E0942), CERVICAL HEAD *
E0944 E0944 2126 HARNESS (E0944), PELVIC BELT, BOOT *
E0945 DM570 2110 HARNESS (E0945), EXTREMITY BELT *
E0946 E0946 2115 FRACTURE, FRAME (E0946), DUAL W/CROSS BARS, ATTACH TO BED * *
E0947 E0947 2113 FRACTURE FRAME (E0947), ATTACHMENTS FOR COMPLEX PELVIC TRACTION * *
E0948 E0948 2112 FRACTURE FRAME (E0948) ATTACHMENTS FOR COMPLEX CERVICAL TRACTION * *
E0950 DM570 2139 TRAY (E0950) *
* Confidential Treatment Requested.
3/5
OLSTEN HEALTH SERVICES NETWORK
SCHEDULE 3: HOME MEDICAL EQUIPMENT/RESPIRATORY THERAPY FEE-FOR-SERVICE SCHEDULE
EFFECTIVE DATE: FEBRUARY 1, 1999
HCPCS CHC OLSTEN PURCHASE RENTAL DAILY
CODE CODE CODE DESCRIPTION PRICE PRICE PRICE
- ----- ---- ------ ----------------------------------------------------------------------- -------- ------ -----
E0958 E0958 2307 W/C PART ATTACHMENT (E0958) TO CONVERT ANY W/C TO ONE ARM DRIVE *
E0959 E0959 2237 W/C PART AMPUTEE ADAPTER (E0959) (COMPENSATE FOR TRANS OF WEIGHT) *
E0962 E0962 2232 CUSHION FOR WC 1" (E0962) *
E0963 E0963 2233 CUSHION FOR WC 2" (E0963) *
E0964 E0964 2234 CUSHION FOR WC 3" (E0964) *
E0965 E0965 2235 CUSHION FOR WC 4" (E0965) *
E0972 DM570 2230 TRANSFER BOARD OR DEVICE (E0972) *
E0977 E0977 2317 CUSHION, WEDGE FOR W/C (E0977) *
E0978 E0978 2248 BELT, SAFETY (E0978) W/AIRPLANE BUCKLE, W/C *
E0979 DM570 2249 BELT, SAFETY (0979) W/VELCRO CLOSURE, W/C *
E0980 DM570 2292 SAFETY VEST (E0980), W/C *
E1031 E1031 2291 ROLLABOUT CHAIR (E1031), W/CASTORS 5" OR GREATER * *
E1050 E1050 2260 W/C FULL/REC (E1050), FIX ARMS, SWING AWAY DETACH ELEV LEG RESTS * *
E1060 E1060 2259 W/C FULL/REC (E1060), DETACH ARMS, SWING AWAY DETACH FOOTREST * *
E1065 E1065 2287 W/C POWER ATTACHMENT (E1065) *
E1066 E1066 2247 BATTERY CHARGER (E1066) *
E1069 E1069 2255 BATTERY, DEEP CYCLE (E1069) *
E1070 E1070 2258 W/C FULL/REC (E1070), DETACH ARMS, SWING AWAY DET/ELEV LEG RESTS * *
E1083 E1083 2263 W/C HEMI (E1083), FIX ARMS, SWING AWAY DETACHABLE ELEV LEG REST * *
E1084 E1084 2262 W/C HEMI (E1084), DETACH ARMS, SWING AWAY DETACH ELEV LEG RESTS * *
E1085 E1085 2264 W/C HEMI (E1085), FIX ARMS, SWING AWAY DETACHABLE FOOT RESTS * *
E1086 E1086 2261 W/C HEMI (E1086), DETACH ARMS, SWING AWAY DETACH FOOTRESTS * *
E1087 E1087 2265 W/C HI STRENGTH LT-WT (E1087), FIX ARMS, S/AWAY ELEV LEG RESTS * *
E1088 E1088 2268 W/C HI STRENGTH LT-WGT (E1088), D/ARMS, S/AWAY ELEV LEG RESTS * *
E1089 E1089 2266 W/C HI STRENGTH LT-WGT (E1089), FIX ARMS, S/AWAY DETACH FOOTREST * *
E1090 E1090 2267 W/C HI STRENGTH LT-WG (E1090), DETACH ARMS, S/AWAY D/FOOTRESTS * *
E1091 E1091 2321 W/C YOUTH, ANY TYPE (E1091) * *
E1092 E1092 2319 W/C WIDE HVY DUTY (E1092), DETACH ARMS S/AWAY DETACH ELEVAT LEGS * *
E1093 E1093 2320 W/C WIDE HVY DUTY (E1093), DETACH ARMS S/AWAY DETACH FOOTRESTS * *
E1100 E1100 2296 W/C SEMI-RECLINING (E1100), SWING AWAY DETACH ELEV LEG RESTS * *
E1110 E1110 2295 W/C/ SEMI-RECLINING (E1110), DETACH ARMS ELEV LEG REST * *
E1130 E1130 2303 W/C STANDARD (E1130), FIX OR SWING AWAY DETACH FOOTRESTS * *
E1140 E1140 2313 W/C (E1140), DETACH ARMS SWING AWAY DETACH FOOTRESTS * *
E1150 E1150 2314 W/C (E1150), DETACH ARMS, SWING AWAY DETACH ELEVAT LEGRESTS * *
E1160 E1160 2315 W/C (E1160), W/FIX ARMS, SWING AWAY DETACH ELEVAT LEGRESTS * *
E1160 E1160 2396 W/C (E1160), W/FIX ARMS REMOVABLE FOOTRESTS * *
E1170 E1170 2241 W/C AMPUTEE (E1170), FIX ARMS, SWING AWAY DETACH ELEV LEGRESTS * *
E1171 E1171 2242 W/C AMPUTEE (E1171), FIX ARMS, W/OUT FOOTRESTS OR LEGREST * *
E1172 E1172 2240 W/C AMPUTEE (E1172), DETACH ARMS W/OUT FOOTRESTS OR LEGREST * *
E1180 E1180 2239 W/C AMPUTEE (E1180), DETACH ARMS SWING AWAY DETACH FOOTRESTS * *
E1190 E1190 2238 W/C AMPUTEE (E1190), DETACH ARMS SWING AWAY DETACH ELEV LEGRESTS * *
E1195 E1195 2273 W/C HVY DUTY (E1195), FIX ARMS, SWING AWAY DETACH ELEV LEGRESTS * *
E1200 E1200 2243 W/C AMPUTEE (E1200), FIX FULL LENGTH ARMS, S/AWAY D/FOOTREST * *
E1210 E1210 2281 W/C MOTORIZED (E1210), FIX ARMS, S/AWAY DETACH ELEV LEG RESTS * *
E1211 E1211 2279 W/C MOTORIZED (E1211), DETACH ARMS, S/AWAY DETACH FOOT RESTS * *
E1212 E1212 2282 W/C MOTORIZED (E1212), FIX ARMS, SWING AWAY DETACH FOOT RESTS * *
E1213 E1213 2280 W/C MOTORIZED (E1213), DETACH ARMS S/AWAY, DETACH ELEV LEG REST * *
E1220 E1220 2551 W/C CUSTOM (E1220) *
E1220 E1220 2579 W/C XXWIDE (E1220) * *
E1230 E1230 2288 SCOOTER (E1230), THREE OR 4 WHEEL * *
E1240 E1240 2276 W/C LT-WGT (E1240), DETACH ARMS SWING AWAY DETACH, ELEV LEGREST * *
E1250 E1250 2278 W/C LT-WGT (E1250), FIX ARMS, SWING AWAY DETACH FOOTREST * *
E1260 E1260 2275 W/C LT-WGT (E1260), DETACH ARMS SWING AWAY DETACH FOOTREST * *
E1270 E1270 2277 W/C LT-WGT (E1270), FIX ARMS, SWING AWAY DETACH ELEV LEGRESTS * *
E1280 E1280 2270 W/C HVY DUTY (E1280), DETACH ARMS ELEV LEGRESTS * *
E1285 E1285 2274 W/C HVY DUTY (E1285), FIX ARMS, SWING AWAY DETACH FOOTREST * *
E1290 E1290 2271 W/C HVY DUTY (E1290), DETACH ARMS SWING AWAY DETACH FOOTREST * *
E1295 E1295 2272 W/C HVY DUTY (E1295), FIX ARMS, ELEV LEGREST * *
E1300 DM570 2062 WHIRLPOOL (E1300), PORT (OVERTUB TYPE) *
E1310 DM570 2061 WHIRLPOOL (E1310), NON-PORT (BUILT-IN TYPE) *
E1353 E1353 2381 02 REGULATOR (E1353) * *
E1355 E1355 2384 CYLINDER STAND/RACK (E1355) *
E1372 E1372 2331 IMMERSION EXT HEATER (E1372) FOR NEBULIZER * *
E1375 E1375 2334 NEBULIZER PORT (E1375) W/SMALL COMPRESSOR, W/LIMITED FLOW *
E1399 DM570 2568 ADAPTER, AC/DC (E1399) *
E1399 E1399 2586 APNEA MONITOR DOWNLOAD (E1399) * *
E1399 DM570 2552 BATH LIFT (E1399), CUSTOM *
E1399 DM570 2563 BED WEDGE (E1399), 12" *
E1399 DM570 2856 BEDROOM EQUIPMENT (E1399), CUSTOM *
* Confidential Treatment Requested
4/5
OLSTEN HEALTH SERVICES NETWORK
SCHEDULE 3: HOME MEDICAL EQUIPMENT/RESPIRATORY THERAPY FEE-FOR-SERVICE SCHEDULE
EFFECTIVE DATE: FEBRUARY 1, 1999
HCPCS CHC OLSTEN PURCHASE RENTAL DAILY
CODE CODE CODE DESCRIPTION PRICE PRICE PRICE
- ----- ---- ------ ----------------------------------------------------------------------- -------- ------ -----
E1399 DM570 2525 BREAST PUMP, ELECTRIC (E1399) * *
E1399 DM570 2581 BREAST PUMP, INSTITUTIONAL (E1399) *
E1399 E1399 2580 BREAST PUMP, MANUAL (E1399) *
E1399 DM570 2593 COLD THERAPY UNIT, PAD (E1399) *
E1399 E1399 2565 COMMODE (E1399), DROP ARM, HEAVY DUTY *
E1399 E1399 2582 COMPRESSION PUMP BOOT (E1399) *
E1399 E1399 2583 COMPRESSION PUMP, FOOT (E1399) *
E1399 E1399 2327 DURABLE MEDICAL EQUIP (E1399), MISCELLANEOUS *
E1399 E1399 2584 GERI CHAIR (E1399), THREE POSITION RECLINING *
E1399 DM570 6780 HOLTER MONITOR (G0004) *
E1399 E1399 2590 HOSP BED (E1399), ELECTRIC, XLONG, W/MATTRESS & SIDE RAILS * *
E1399 E1399 2569 HUMIDIFIER (E1399), HEATED * *
E1399 E1399 2868 LAMP, ULTRAVIOLET (E1399) *
E1399 DM570 2588 MONITOR (E1399), VITAL SIGNS *
E1399 DM570 2529 O2 ANALYZER (E1399) * *
E1399 DM570 2594 O2 CONSERVATION DEVICE (E1399) * *
E1399 DM570 6775 OXIMETRY SPOT CHECK (E1399) *
E1399 DM570 2555 PATIENT LIFT, CUSTOM (E1399) *
E1399 DM570 2561 PEAK FLOW METER (E1399) *
E1399 E1399 4559 PEDIATRIC WALKER (E1399) *
E1399 DM570 2567 PNEUMOGRAM (E1399) *
E1399 E1399 2553 POSITIONING, CUSTOM (E1399) *
E1399 E1399 2526 PULSE OXIMETER (E1399) * *
E1399 E1399 2527 PULSE OXIMETER W/PROBE (E1399) * *
E1399 DM570 2562 SHOWER, HAND HELD (E1399) *
E1399 DM570 2592 SLEEP STUDY, ADULT (E1399) *
E1399 DM570 2855 THERAPY EQUIPMENT, CUSTOM (E1399) *
E1399 DM570 6774 THERAPY PERCUSSION VEST * *
E1399 E1399 2564 WALKER (E1399), HEAVY DUTY, EXTRA WIDE *
E1399 E1399 2585 WALKER (E1399), HEMI *
E1399 E1399 6873 WOUND SUCTION DEVICE *
E1400 E1400 2361 O2 CONC (E1400), MANUF SPEC MAX FLOW RATE = 2 LTS PER MIN @85% * *
G0015 DM590 6779 CARDIAC EVENT MONITOR (G0015) *
K0163 DM590 3713 ERECTION SYSTEM, VACUUM (K0163) *
K0183 DM590 2516 CPAP MASK (K0183) *
K0184 DM590 2515 NASAL PILLOWS/SEALS (K0184) REPLACEMENT FOR NASAL APP/DVC, PAIR *
K0185 DM590 2514 HEADGEAR (K0185), USED WITH CPAP DEVICE *
K0186 DM590 2513 CHIN STRAP (K0186) USED WITH CPAP DEVICE *
K0187 DM590 2512 TUBING (K0187), USED WITH CPAP DEVICE *
K0188 DM590 2511 FILTER (K0188), DISPOSABLE, USED WITH CPAP DEVICE *
K0189 DM590 2510 FILTER (K0189), NON-DISPOSABLE, USED WITH CPAP DEVICE *
K0268 DM590 2509 HUMIDIFIER (K0258), USED WITH CPAP DEVICE *
K0413 DM590 6889 MATTRESS (K0413), NONPOWERED EQUIVALENT *
The following may be charged under extraordinary circumstances:
E1399 E1399 4551 LABOR/SERVICE/SHIPPING CHARGES *
E1399 E1399 2731 SHIPPING AND HANDLING FEES *
The following may be charged if over and above routine on rental equipment:
E1350 E1350 2382 REPAIR OR NON-ROUTINE (E1350) SERVICE REQUIRING SKILL OF A TECH *
E1340 E1340 2554 W/C REPAIRS (E1340) *
E1399 E1399 4552 MISCELLANEOUS SUPPLIES * *
E1399 E1399 2589 REPAIR (E1399), RESPIRATORY EQUIPMENT *
E1399 E1399 4561 RESPIRATORY SUPPLIES (A4618) * *
E1399 E1399 4549 TENS/APNEA SUPPLIES * *
NOTES:
1. Whether rental or purchase, rates include all shipping, labor and
set-up.
2. If item is rented, rates include all supplies to enable the equipment
to function effectively, with the exception of supplies for CPAP,
BIPAP, Ventilators, Suction, Enteral Pumps and CPM. Such exception
supplies will be billed at cost plus *
3. If item is rented, rates include repair and maintenance costs.
4. If item is purchased, supplies, repair and maintenance will be billed
at cost plus *
5. All equipment not listed above will be billed at cost plus * until
rates are mutually established and become part of the fee schedule.
6. Rates effective through 12/31/99.
* Confidential Treatment Requested
5/5
OLSTEN HEALTH SERVICE NETWORK
SCHEDULE 3: HOME MEDICAL EQUIPMENT/RESPIRATORY THERAPY FEE-FOR-SERVICE SCHEDULE
EFFECTIVE DATE: FEBRUARY 1, 1999
E0241 DM570 2867 BATH TUB RAIL (E0241), WALL, L-SHAPE *
E0241 DM570 2862 BATH TUB RAIL, WALL, 12" (E0241) *
E0241 DM570 2863 BATH TUB RAIL, WALL, 16" (E0241) *
E0241 DM570 2864 BATH TUB RAIL, WALL, 18" (E0241) *
E0241 DM570 2865 BATH TUB RAIL, WALL, 24" (E0241) *
E0241 DM570 2866 BATH TUB RAIL, WALL, 36" (E0241) *
E0241 DM570 2043 BATH TUB RAIL, WALL, UNSPECIFIED SIZE *
E0242 DM570 2042 BATH TUB RAIL, FLOOR BASE (E0242) *
E0243 DM570 2056 TOILET RAIL, EACH (E0243) *
E0244 E0244 2587 TOILET SEAT (E0244) RAISED WITH ARMS *
E0244 E0244 2052 TOILET SEAT, RAISED (E0244) *
E0245 DM570 2575 BATH BENCH WITH BACK (E0245) *
E0245 DM570 2058 BATH TUB STOOL OR BENCH (E0245) *
E0245 DM570 2578 TRANSFER BENCH, NON-PADDED (E0245) *
E0245 DM570 2577 TRANSFER BENCH, PADDED (E0245) *
E0246 DM570 2057 TRANSFER TUB RAIL (E0256), ATTACHMENT *
E0249 DM570 2186 HEAT UNIT (E0249), WATER CIRCULATING PAD *
E0255 E0255 2090 HOSP BED (E0255), VAR HEIGHT, HI-LO, W/SIDE RAILS, W/MATTRESS * *
E0256 E0256 2091 HOSP BED (E0256), VAR HEIGHT, HI-LO, W/SIDE RAILS, W/O MATTRESS * *
E0260 E0260 2083 HOSP BED (E0260), SEMI-ELEC, W/SIDE RAILS, W/MATTRESS * *
E0261 E0261 2084 HOSP BED (E0261), SEMI-ELEC, W/SIDE RAILS, W/OUT MATTRESS * *
E0265 E0265 2086 HOSP BED (E0265), TOTAL ELEC, W/SIDE RAILS, W/MATTRESS * *
E0266 E0266 2087 HOSP BED (E0266), TOTAL ELEC, W/SIDE RAILS, W/OUT MATTRESS * *
E0271 E0271 2096 MATTRESS, INNERSPRING (E0271) *
E0272 E0272 2095 MATTRESS, FOAM RUBBER (E0272) *
E0273 DM570 2068 BED BOARD (E0273) *
E0274 DM570 2097 OVER-BED TABLE (E0274) *
E0275 E0275 2071 BED PAN, STANDARD (E0275), METAL OR PLASTIC *
E0276 E0276 2070 BED PAN, FRACTURE (E0276), METAL OR PLASTIC *
E0277 E0277 2066 MATTRESS (E0277), ALTERNATING PRESSURE * *
E0280 DM570 2069 BED CRADLE, ANY TYPE (E0280) *
E0292 E0292 2092 HOSP BED (E0292), VAR HEIGHT, HI-LO, W/OUT S/RAILS, W/MATTRESS * *
E0293 E0293 2093 HOSP BED (E0293), VAR HEIGHT, HI-LO, NO SIDE RAILS, NO MATTRESS * *
E0294 E0294 2085 HOSP BED (E0294), SEMI-ELEC, W/OUT SIDE RAILS, W/MATTRESS * *
E0295 E0295 2094 HOSP BED (E0295), SEMI-ELEC, W/OUT SIDE RAILS, W/OUT MATTRESS * *
E0296 E0296 2089 HOSP BED (E0296), TOTAL ELEC, W/OUT SIDE RAILS, W/OUT MATTRESS * *
E0297 E0297 2088 HOSP BED (E0297), TOTAL ELEC, W/OUT SIDE RAILS, W/MATTRESS * *
E0305 E0305 2073 BED SIDE RAILS (E0305), HALF LENGTH *
E0310 E0310 2072 BED SIDE RAILS (E0310), FULL LENGTH *
E0315 DM570 2067 BED ACCESSORIES: BOARDS OR TABLES, ANY TYPE *
E0325 E0325 2060 URINAL: MALE (E0325), JUG-TYPE, ANY MATERIAL *
E0326 E0326 2059 URINAL: FEMALE (E0326), JUG-TYPE, ANY MATERIAL *
E0410 E0410 2369 O2 CONTENTS, LIQUID (E0410), PER POUND *
E0416 E0416 2371 O2 REFILL FOR PORT (E0416) GAS SYSTEM ONLY, UP TO 23 CUBIC FEET *
E0424 E0424 2385 O2 SYS STATIONARY (E0424) COMPR GAS, RENT *
E0430 E0430 2374 O2 SYS PORT GAS, PURCH (E0430) *
E0431 E0431 2375 O2 SYS PORT GAS, RENT (E0431) *
E0431 DM570 2574 O2 SYSTEM, LIGHTWEIGHT (E0431) * *
E0434 E0434 2377 O2 SYS PORT LIQUID, RENT (0434) *
E0435 E0435 2376 O2 SYS PORT LIQUID, PURCH (E0435) *
E0439 E0439 2388 O2 SYS STATIONARY (E0439) LIQUID, RENT *
E0440 E0440 2387 O2 SYS STATIONARY (E0440) LIQUID, PURCH *
E0443 E0443 2869 O2 CONTENTS, H/K CYLINDER (E0443), 200-300 CUBIC FT *
E0444 E0444 2379 O2 CONTENTS, PORT LIQUID (E0444), PER UNIT (1 UNIT = 1 LB.) *
E0450 E0450 2392 VENTILATOR VOLUME (E0450), STATIONARY OR PORT * *
E0452 E0452 2332 BILEVEL INTERMITTENT (E0452) ASSIST DEVICE (BIPAP) * *
E0453 E0453 2390 VENTILATOR THERAPEUTIC (E0453); FOR USE 12 HOURS OR LESS PER DAY * *
E0455 E0455 2372 O2 TENT (E0455), EXCLUDING GROUP OR PEDIATRIC TENTS * *
E0457 E0457 2323 CHEST SHELL (CUIRASS) (E0457) * *
E0459 E0459 2324 CHEST WRAP (E0459) * *
E0460 E0460 2339 VENTILATOR (E0460), NEGATIVE PRESSURE, PORTABLE STATIONARY * *
E0480 DM570 2373 PERCUSSOR (E0480), ELEC OR PNEUM. HOME MODEL * *
E0500 E0500 2333 IPPB, W/BUILT-IN NEB (E0500) MAN OR AUTO VALVES, INT EXT POWER * *
E0550 E0550 2328 HUMIDIFIER (E0550) DURABLE FOR EXTENSIV SUP/HUMID W/IPPB OR O2 * *
E0555 E0555 2330 HUMIDIFIER (E0555), DURABLE, GLASS, FOR USE W/REG OR FLOWMETER *
E0565 E0565 2325 COMPRESSOR, AIR POWER (E0565) * *
E0570 E0570 2336 NEBULIZER, W/COMPRESSOR (E0570) *
E0575 DM570 2571 NEBULIZER (E0575), ULTRASONIC, AC/DC * *
E0575 DM570 2338 NEBULIZER; ULTRASONIC (E0575) * *
E0585 E0585 2337 NEBULIZER (E0585), W/COMPRESSOR AND HEATER * *
E0600 E0600 2389 SUCTION PUMP (E0600), HOME MODEL, PORT * *
E0601 E0601 2326 CONTINUOUS POSITIVE (E0601) AIRWAY PRESSURE DEVICE (CPAP) * *
E0605 DM570 2391 VAPORIZER, ROOM TYPE (E0605) *
E0606 DM570 2380 POSTURAL DRAINAGE BOARD (E0606) *
E0607 E0607 6874 MONITOR, B/GLUCOSE (E0607) ACCUCHEK AD *
*Confidential Treatment Requested.
1/5
OLSTEN HEALTH SERVICE NETWORK
SCHEDULE 3: HOME MEDICAL EQUIPMENT/RESPIRATORY THERAPY FEE-FOR-SERVICE SCHEDULE
EFFECTIVE DATE: FEBRUARY 1, 1999
E0607 E0607 2164 MONITOR, BLOOD GLUCOSE (E0607) *
E0608 E0608 2322 APNEA MONITOR (E0608) * *
E0608 E0608 2576 APNEA MONITOR (E0608) W/MEM (INCL SMART) * *
E0609 E0609 2146 MONITOR, BLOOD GLUCOSE (E0609) W/SPECIAL FEATURES *
E0621 DM570 2215 PATIENT LIFT (E0621), SLING OR SEAT, CANVAS OR NYLON *
E0625 DM570 2191 PATIENT LIFT (E0625), KARTOP, BATHROOM OR TOILET *
E0627 E0627 4553 HIP CHAIR (E0627) * *
E0627 DM570 2395 SEAT LIFT CHAIR/MOTORIZED (E0627) *
E0627 DM570 2205 SEAT LIFT MECH (E0627) INCORPORATED INTO A COMB LIFT-CHAIR MECH *
E0630 DM570 2190 PATIENT LIFT, HYDRAULIC (E0630), W/SEAT OR SLING * *
E0635 DM570 2189 PATIENT LIFT (E0635), ELEC W/SEAT OR SLING *
E0650 E0650 2192 PNEUM COMPRESSOR (E0650), NON-SEG HOME MODEL * *
E0651 E0651 2194 PNEUM COMPRESSOR (E0651), SEG HOME MODEL W/OUT CALIB GRAD PRES * *
E0652 E0652 2193 PNEUM COMPRESSOR (E0652), SEG HOME MODEL W/CALIB GRAD PRES * *
E0655 E0655 2182 PNEUM COMPRESSOR (E0655), NON-SEG APPLIANCE, HALF ARM *
E0660 E0660 2181 PNEUM COMPRESSOR (E0660), NON-SEG APPLIANCE, FULL LEG *
E0665 E0665 2180 PNEUM COMPRESSOR (E0665), NON-SEG APPLIANCE, FULL ARM *
E0666 E0666 2183 PNEUM COMPRESSOR (E0666), NON-SEG APPLIANCE, HALF LEG *
E0667 E0667 2210 PNEUM APPLIANCE (E0667), SEG, FULL LEG *
E0668 E0668 2209 PNEUM APPLIANCE (E0668), SEG, FULL ARM *
E0669 E0669 2212 PNEUM APPLIANCE (E0669), SEG, HALF LEG *
E0670 E0670 2211 PNEUM APPLIANCE (E0670), SEG, HALF ARM *
E0671 E0671 2207 PNEUM APPLIANCE (E0671), SEG GRAD PRESS, FULL LEG *
E0672 E0672 2206 PNEUM APPLIANCE (E0672), SEG GRAD PRESS, FULL ARM *
E0673 E0673 2208 PNEUM APPLIANCE (E0673), SEG GRAD PRESS, HALF LEG *
E0690 DM570 2221 ULTRAVIOLET CABINET (E0690), APPROPRIATE FOR HOME USE *
E0700 DM570 2204 SAFETY EQUIP (E0700) (E.G., BELT, HARNESS OR VEST) *
E0710 DM570 2202 RESTRAINTS (E0710), ANY TYPE (BODY, CHEST, WRIST OR ANKLE) *
E0720 E0720 2219 TENS (E0720), TWO LEAD, LOCALIZED STIMULATION * *
E0730 E0730 2218 TENS (E0730), FOUR LEAD, LARGER AREA/MULTIPLE NERVE STIMULATION * *
E0731 E0731 2159 TENS OR NMES (E0731), CONDUCTIVE GARMENT *
E0744 E0744 2120 STIMULATOR (E0744), NEUROMUSCULAR FOR SCOLIOSIS * *
E0745 E0745 2121 STIMULATOR (E0745), NEUROMUSCULAR, ELECTRONIC SHOCK UNIT * *
E0745 E0745 6915 STIMULATOR (E0745), NEUROMUSCULAR, FOUR CH * *
E0746 DM570 2109 ELECTROMYOGRAPHY (EMG) (E0746), BIOFEEDBACK DEVICE * *
E0747 DM570 2122 STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE *
E0748 DM570 2124 STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL APPLICATIONS *
E0755 DM570 2157 STIMULATOR (E0755), ELECTRONIC SALIVARY REFLEX, NON INVASIVE *
E0776 E0776 2175 IV POLE (E0776) * *
E0784 E0784 2158 PUMP (E0784), EXT AMBULATORY INFUSION, MINIMED, INSULIN *
E0784 E0784 6771 PUMP (E0784), INSULIN EXT INFUSION DISETRONICS *
E0840 E0840 2133 TRACTION FRAME (E0840), ATTACH TO HEADBOARD, CERVICAL TRACTION *
E0850 E0850 2134 TRACTION STAND (E0850), FREE STANDING, CERVICAL TRACTION * *
E0860 E0860 2130 TRACTION EQUIP (E0860), OVERDOOR, CERVICAL *
E0870 E0870 2131 TRACTION FRAME (E0870), ATTACH TO FOOTBOARD, EXTREMITY, BUCKS * *
E0880 E0880 2135 TRACTION STAND (E0880) FREE/STAND EXTREMITY TRACTION, EG, BUCK'S * *
E0890 E0890 2132 TRACTION FRAME (E0890), ATTACH TO FOOTBOARD, PELVIC TRACTION * *
E0900 E0900 2136 TRACTION STAND (E0900) FREE/STAND PELVIC TRACTION (EG. BUCK'S) * *
E0910 E0910 2138 TRAPEZE BARS (E0910), A/K/A PT HELPER, ATTACH TO BED W/GRAB BAR * *
E0920 E0920 2111 FRACTURE FRAME (E0920), ATTACH TO BED, INCLUDING WEIGHTS * *
E0935 E0935 2125 PASSIVE MOTION (E0935) EXERCISE DEVICE *
E0935 E0935 2859 PASSIVE MOTION (E0935) EXERCISE DEVICE, ANKLE *
E0935 E0935 2860 PASSIVE MOTION (E0935) EXERCISE DEVICE, ELBOW *
E0935 E0935 2857 PASSIVE MOTION (E0935) EXERCISE DEVICE, HAND *
E0935 E0935 2858 PASSIVE MOTION (E0935) EXERCISE DEVICE, SHOULDER *
E0935 E0935 2861 PASSIVE MOTION (E0935) EXERCISE DEVICE, WRIST *
E0940 E0940 2137 TRAPEZE BAR (E0940), FREE STANDING, COMPLETE W/GRAB BAR * *
E0941 E0941 2116 TRACTION DEVICE (E0941), GRAVITY ASSISTED * *
E0942 E0942 2101 HARNESS/HALTER (E0942), CERVICAL HEAD *
E0944 E0944 2126 HARNESS (E0944), PELVIC BELT, BOOT *
E0945 DM570 2110 HARNESS (E0945), EXTREMITY BELT *
E0946 E0946 2115 FRACTURE, FRAME (E0946), DUAL W/CROSS BARS, ATTACH TO BED * *
E0947 E0947 2113 FRACTURE FRAME (E0947), ATTACHMENTS FOR COMPLEX PELVIC TRACTION * *
E0948 E0948 2112 FRACTURE FRAME (E0948) ATTACHMENTS FOR COMPLEX CERVICAL TRACTION * *
E0950 DM570 2139 TRAY (E0950) *
E0958 E0958 2307 W/C PART ATTACHMENT (E0958) TO CONVERT ANY W/C TO ONE ARM DRIVE *
E0959 E0959 2237 W/C PART AMPUTEE ADAPTER (E0959) (COMPENSATE FOR TRANS OF WEIGHT) *
E0962 E0962 2232 CUSHION FOR WC 1" (E0962) *
E0963 E0963 2233 CUSHION FOR WC 2" (E0963) *
E0964 E0964 2234 CUSHION FOR WC 3" (E0964) *
E0965 E0965 2235 CUSHION FOR WC 4" (E0965) *
*Confidential Treatment Requested.
2/5
OLSTEN HEALTH SERVICE NETWORK
SCHEDULE 3: HOME MEDICAL EQUIPMENT/RESPIRATORY THERAPY FEE-FOR-SERVICE SCHEDULE
EFFECTIVE DATE: FEBRUARY 1, 1999
E0972 DM570 2230 TRANSFER BOARD OR DEVICE (E0972) *
E0977 E0977 2317 CUSHION, WEDGE FOR W/C (E0977) *
E0978 E0978 2248 BELT, SAFETY (E0978) W/AIRPLANE BUCKLE, W/C *
E0979 DM570 2249 BELT, SAFETY (0979) W/VELCRO CLOSURE, W/C *
E0980 DM570 2292 SAFETY VEST (E0980), W/C *
E1031 E1031 2291 ROLLABOUT CHAIR (E1031), W/CASTORS 5" OR GREATER * *
E1050 E1050 2260 W/C FULL/REC (E1050), FIX ARMS, SWING AWAY DETACH ELEV LEG RESTS * *
E1060 E1060 2259 W/C FULL/REC (E1060), DETACH ARMS, SWING AWAY DETACH FOOT REST * *
E1065 E1065 2287 W/C POWER ATTACHMENT (E1065) *
E1066 E1066 2247 BATTERY CHARGER (E1066) *
E1069 E1069 2255 BATTERY, DEEP CYCLE (E1069) *
E1070 E1070 2258 W/C FULL/REC (E1070), DETACH ARMS, SWING AWAY DET/ELEV LEG RESTS * *
E1083 E1083 2263 W/C HEMI (E1083), FIX ARMS, SWING AWAY DETACHABLE ELEV LEG REST * *
E1084 E1084 2262 W/C HEMI (E1084), DETACH ARMS, SWING AWAY DETACH ELEV LEG RESTS * *
E1085 E1085 2264 W/C HEMI (E1085), FIX ARMS, SWING AWAY DETACHABLE FOOT RESTS * *
E1086 E1086 2261 W/C HEMI (E1086), DETACH ARMS, SWING AWAY DETACH FOOT RESTS * *
E1087 E1087 2265 W/C HI STRENGTH LT-WT (E1087), FIX ARMS, S/AWAY ELEV LEG RESTS * *
E1088 E1088 2268 W/C HI STRENGTH LT-WGT (E1088), D/ARMS, S/AWAY ELEV LEG RESTS * *
E1089 E1089 2266 W/C HI STRENGTH LT-WGT (E1089), FIX ARMS, S/AWAY DETACH FOOT REST * *
E1090 E1090 2267 W/C HI STRENGTH LT-WG (E1090), DETACH ARMS, S/AWAY D/FOOT RESTS * *
E1091 E1091 2321 W/C YOUTH, ANY TYPE (E1091) * *
E1092 E1092 2319 W/C WIDE HVY DUTY (E1092), DETACH ARMS S/AWAY DETACH ELEVAT LEGS * *
E1093 E1093 2320 W/C WIDE HVY DUTY (E1093), DETACH ARMS S/AWAY DETACH FOOT RESTS * *
E1100 E1100 2296 W/C SEMI-RECLINING (E1100), SWING AWAY DETACH ELEV LEG RESTS * *
E1110 E1110 2295 W/C/ SEMI-RECLINING (E1110), DETACH ARMS ELEV LEG REST * *
E1130 E1130 2303 W/C STANDARD (E1130), FIX OR SWING AWAY DETACH FOOT RESTS * *
E1140 E1140 2313 W/C (E1140), DETACH ARMS SWING AWAY DETACH FOOT RESTS * *
E1150 E1150 2314 W/C (E1150), DETACH ARMS, SWING AWAY DETACH ELEVAT LEG RESTS * *
E1160 E1160 2315 W/C (E1160), W/FIX ARMS, SWING AWAY DETACH ELEVAT LEG RESTS * *
E1160 E1160 2396 W/C (E1160), W/FIX ARMS REMOVABLE FOOT RESTS * *
E1170 E1170 2241 W/C AMPUTEE (E1170), FIX ARMS, SWING AWAY DETACH ELEV LEG RESTS * *
E1171 E1171 2242 W/C AMPUTEE (E1171), FIX ARMS, W/OUT FOOT RESTS OR LEG REST * *
E1172 E1172 2240 W/C AMPUTEE (E1172), DETACH ARMS W/OUT FOOT RESTS OR LEG REST * *
E1180 E1180 2239 W/C AMPUTEE (E1180), DETACH ARMS SWING AWAY DETACH FOOT RESTS * *
E1190 E1190 2238 W/C AMPUTEE (E1190), DETACH ARMS SWING AWAY DETACH ELEV LEG RESTS * *
E1195 E1195 2273 W/C HVY DUTY (E1195), FIX ARMS, SWING AWAY DETACH ELEV LEG RESTS * *
E1200 E1200 2243 W/C AMPUTEE (E1200), FIX FULL LENGTH ARMS, S/AWAY D/FOOT REST * *
E1210 E1210 2281 W/C MOTORIZED (E1210), FIX ARMS, S/AWAY DETACH ELEV LEG RESTS * *
E1211 E1211 2279 W/C MOTORIZED (E1211), DETACH ARMS, S/AWAY DETACH FOOT RESTS * *
E1212 E1212 2282 W/C MOTORIZED (E1212), FIX ARMS, SWING AWAY DETACH FOOT RESTS * *
E1213 E1213 2280 W/C MOTORIZED (E1213), DETACH ARMS S/AWAY, DETACH ELEV LEG REST * *
E1220 E1220 2551 W/C CUSTOM (E1220) *
E1220 E1220 2579 W/C XXWIDE (E1220) * *
E1230 E1230 2288 SCOOTER (E1230), THREE OR 4 WHEEL * *
E1240 E1240 2276 W/C LT-WGT (E1240), DETACH ARMS SWING AWAY DETACH, ELEV LEG REST * *
E1250 E1250 2278 W/C LT-WGT (E1250), FIX ARMS, SWING AWAY DETACH FOOT REST * *
E1260 E1260 2275 W/C LT-WGT (E1260), DETACH ARMS SWING AWAY DETACH FOOT REST * *
E1270 E1270 2277 W/C LT-WGT (E1270), FIX ARMS, SWING AWAY DETACH ELEV LEG RESTS * *
E1280 E1280 2270 W/C HVY DUTY (E1280), DETACH ARMS ELEV LEG RESTS * *
E1285 E1285 2274 W/C HVY DUTY (E1285), FIX ARMS, SWING AWAY DETACH FOOT REST * *
E1290 E1290 2271 W/C HVY DUTY (E1290), DETACH ARMS SWING AWAY DETACH FOOT REST * *
E1295 E1295 2272 W/C HVY DUTY (E1295), FIX ARMS, ELEV LEG REST * *
E1300 DM570 2062 WHIRLPOOL (E1300), PORT (OVERTUB TYPE) *
E1310 DM570 2061 WHIRLPOOL (E1310), NON-PORT (BUILT-IN TYPE) *
E1353 E1353 2381 02 REGULATOR (E1353) * *
E1355 E1355 2384 CYLINDER STAND/RACK (E1355) *
E1372 E1372 2331 IMMERSION EXT HEATER (E1372) FOR NEBULIZER * *
E1375 E1375 2334 NEBULIZER PORT (E1375) W/SMALL COMPRESSOR, W/LIMITED FLOW *
E1399 DM570 2568 ADAPTER, AC/DC (E1399) *
E1399 E1399 2586 APNEA MONITOR DOWNLOAD (E1399) * *
E1399 DM570 2552 BATH LIFT (E1399), CUSTOM *
E1399 DM570 2563 BED WEDGE (E1399), 12" *
E1399 DM570 2856 BEDROOM EQUIPMENT (E1399), CUSTOM *
E1399 DM570 2525 BREAST PUMP, ELECTRIC (E1399) * *
E1399 DM570 2581 BREAST PUMP, INSTITUTIONAL (E1399) *
E1399 E1399 2580 BREAST PUMP, MANUAL (E1399) *
E1399 DM570 2593 COLD THERAPY UNIT, PAD (E1399) *
E1399 E1399 2565 COMMODE (E1399), DROP ARM, HEAVY DUTY *
E1399 E1399 2582 COMPRESSION PUMP BOOT (E1399) *
E1399 E1399 2583 COMPRESSION PUMP, FOOT (E1399) *
E1399 E1399 2327 DURABLE MEDICAL EQUIP (E1399), MISCELLANEOUS *
*Confidential Treatment Requested.
3/5
OLSTEN HEALTH SERVICE NETWORK
SCHEDULE 3: HOME MEDICAL EQUIPMENT/RESPIRATORY THERAPY FEE-FOR-SERVICE SCHEDULE
EFFECTIVE DATE: FEBRUARY 1, 1999
E1399 E1399 2584 GERI CHAIR (E1399), THREE POSITION RECLINING *
E1399 DM570 6780 HOLTER MONITOR (G0004) *
E1399 E1399 2590 HOSP BED (E1399), ELECTRIC, XLONG, W/MATTRESS & SIDE RAILS * *
E1399 E1399 2569 HUMIDIFIER (E1399), HEATED * *
E1399 E1399 2868 LAMP, ULTRAVIOLET (E1399) *
E1399 DM570 2588 MONITOR (E1399), VITAL SIGNS *
E1399 DM570 2529 O2 ANALYZER (E1399) * *
E1399 DM570 2594 O2 CONSERVATION DEVICE (E1399) * *
E1399 DM570 6775 OXIMETRY SPOT CHECK (E1399) *
E1399 DM570 2555 PATIENT LIFT, CUSTOM (E1399) *
E1399 DM570 2561 PEAK FLOW METER (E1399) *
E1399 E1399 4559 PEDIATRIC WALKER (E1399) *
E1399 DM570 2567 PNEUMOGRAM (E1399) *
E1399 E1399 2553 POSITIONING, CUSTOM (E1399) *
E1399 E1399 2526 PULSE OXIMETER (E1399) * *
E1399 E1399 2527 PULSE OXIMETER W/PROBE (E1399) * *
E1399 DM570 2562 SHOWER, HAND HELD (E1399) *
E1399 DM570 2592 SLEEP STUDY, ADULT (E1399) *
E1399 DM570 2855 THERAPY EQUIPMENT, CUSTOM (E1399) *
E1399 DM570 6774 THERAPY PERCUSSION VEST * *
E1399 E1399 2564 WALKER (E1399), HEAVY DUTY, EXTRA WIDE *
E1399 E1399 2585 WALKER (E1399), HEMI *
E1399 E1399 6873 WOUND SUCTION DEVICE *
E1400 E1400 2361 O2 CONC (E1400), MANUF SPEC MAX FLOW RATE = 2 LTS PER MIN @85% * *
G0015 DM590 6779 CARDIAC EVENT MONITOR (G0015) *
K0163 DM590 3713 ERECTION SYSTEM, VACUUM (K0163) *
K0183 DM590 2516 CPAP MASK (K0183) *
K0184 DM590 2515 NASAL PILLOWS/SEALS (K0184) REPLACEMENT FOR NASAL APP/DVC, PAIR *
K0185 DM590 2514 HEADGEAR (K0185), USED WITH CPAP DEVICE *
K0186 DM590 2513 CHIN STRAP (K0186) USED WITH CPAP DEVICE *
K0187 DM590 2512 TUBING (K0187), USED WITH CPAP DEVICE *
K0188 DM590 2511 FILTER (K0188), DISPOSABLE, USED WITH CPAP DEVICE *
K0189 DM590 2510 FILTER (K0189), NON-DISPOSABLE, USED WITH CPAP DEVICE *
K0268 DM590 2509 HUMIDIFIER (K0258), USED WITH CPAP DEVICE *
K0413 DM590 6889 MATTRESS (K0413), NONPOWERED EQUIVALENT *
The following may be charged under extraordinary circumstances:
E1399 E1399 4551 LABOR/SERVICE/SHIPPING CHARGES *
E1399 E1399 2731 SHIPPING AND HANDLING FEES *
The following may be charged if over and above routine on rental equipment:
E1350 E1350 2382 REPAIR OR NON-ROUTINE (E1350) SERVICE REQUIRING SKILL OF A TECH *
E1340 E1340 2554 W/C REPAIRS (E1340) *
E1399 E1399 4552 MISCELLANEOUS SUPPLIES * *
E1399 E1399 2589 REPAIR (E1399), RESPIRATORY EQUIPMENT *
E1399 E1399 4561 RESPIRATORY SUPPLIES (A4618) * *
E1399 E1399 4549 TENS/APNEA SUPPLIES * *
NOTES:
1. Whether rental or purchase, rates include all shipping, labor and
set-up.
2. If item is rented, rates include all supplies to enable the equipment
to function effectively, with the exception of supplies for CPAP,
BIPAP, Ventilators, Suction, Enteral Pumps and CPM. Such exception
supplies will be billed at cost plus *
3. If item is rented, rates include repair and maintenance costs.
4. If item is purchased, supplies, repair and maintenance will be billed
at cost plus *
5. All equipment not listed above will be billed at cost plus * until
rates are mutually established and become part of the fee schedule.
6. Rates effective through 12/31/99.
*Confidential Treatment Requested.
4/5
AMENDMENT TO NATIONAL HOME CARE PROVIDER AGREEMENT
THIS AMENDMENT is entered into this 1st day of February, 1999
by and CIGNA Health Corporation, for and on behalf of its wholly owned
subsidiaries and affiliates (individually and collectively, "CIGNA"), and Olsten
Network Management, Inc. d/b/a Olsten Health Services, for and on behalf of its
wholly owned subsidiaries and affiliates (individually and collectively,
"Provider").
W I T N E S S E T H :
WHEREAS, CIGNA and Provider entered into a National Home Care
Provider Agreement dated January 1, 1996 and amended from time to time
thereafter (together the "Agreement"), whereby Provider provided or arranged for
the provision of certain health care services to Participants;
WHEREAS, the parties wish to amend a certain provision of the
Agreement as set forth below;
NOW THEREFORE, CIGNA and Provider agree as follows:
1. This Amendment shall be effective February 1, 1999.
2. The Indemnity Program Attachment to the Agreement is
hereby amended by deleting all reference to any or all of Exhibits C.1, C.2 and
C.3 and replacing such references with Schedules 1, 2, and 3, respectively.
3. Exhibits C.1, C.2, C.3 of the Indemnity Program
Attachment are deleted in their entirety and replaced by Schedules 1, 2 and 3,
respectively, attached hereto.
4. Unless otherwise amended by this Amendment or
amendments with earlier effective dates, all other terms and conditions of the
Agreement, including the Program Attachments and the Exhibits attached thereto,
shall remain the same and in full force and effect. To the extent that the
provisions in the Agreement or in any amendments with earlier effective dates
conflict with the terms of this Amendment, the terms in this Amendment shall
supersede and control.
5. Capitalized terms not defined herein but defined in
the Agreement shall have the same meaning as defined in the Agreement.
[Next Page Is Signature Page]
OLSTEN HEALTH SERVICES NETWORK
SCHEDULE 3: HOME MEDICAL EQUIPMENT/RESPIRATORY THERAPY FEE-FOR-SERVICE SCHEDULE
EFFECTIVE DATE: FEBRUARY 1, 1999
IN WITNESS WHEREOF, CIGNA and Provider have caused their duly
authorized representatives to execute this Amendment as of the date first
written above.
CIGNA HEALTH CORPORATION
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
OLSTEN NETWORK MANAGEMENT, INC.
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
-2-
OLSTEN HEALTH SERVICES NETWORK
SCHEDULE 3: HOME MEDICAL EQUIPMENT/RESPIRATORY THERAPY FEE-FOR-SERVICE SCHEDULE
EFFECTIVE DATE: FEBRUARY 1, 1999
1/5
AMENDMENT TO NATIONAL HOME CARE PROVIDER AGREEMENT
THIS AMENDMENT is entered into this 24th day of March, 1999 by
and between CIGNA Health Corporation, for and on behalf of its wholly owned
subsidiaries and affiliates (individually and collectively, "CIGNA"), and Olsten
Network Management, Inc. d/b/a Olsten Health Services, for and on behalf of its
wholly owned subsidiaries and affiliates (individually and collectively, the
"Provider").
W I T N E S S E T H :
WHEREAS, CIGNA and Provider entered into a National Home Care
Provider Agreement dated January 1, 1996, amended by amendments dated October 1,
1996, October 31, 1998 and January 1, 1999 (together the "Agreement"), whereby
Provider provided or arranged for the provision of certain health care services
to Participants;
WHEREAS, the parties wish to amend a certain provision of the
Agreement as set forth below;
NOW THEREFORE, CIGNA and Provider agree as follows:
6. This Amendment shall be effective commencing on March
24, 1999 and shall continue unless terminated in accordance with the Agreement,
as amended hereby.
7. Section III.C of the Agreement (Termination) is
hereby amended by deleting Subsection III.C.7 of the Agreement and replacing it
with a new Subsection III.C.7, which shall read:
"7. Termination Due To Failure To Execute New Contract. In the event
that the parties are unable to execute a new contract by June 30, 1999
with respect to the subject matter of this Agreement containing such
terms and conditions as the parties may mutually agree, then either
party may, without cause, terminate this Agreement with sixty (60) days
prior written notice to the other party; provided that neither party
may terminate this Agreement pursuant to this Section effective earlier
than June 30, 1999."
8. Capitalized terms not defined herein but defined in
the Agreement shall have the same meaning as defined in the Agreement. To the
extent that the provisions in any prior amendments conflict with the terms of
this Amendment, the terms in this Amendment shall supercede and control.
9. Unless otherwise amended by this Amendment or prior
amendments, all other terms and conditions of the Agreement, including the
Program Attachments and the Exhibits attached thereto, shall remain the same and
in full force and effect.
IN WITNESS WHEREOF, CIGNA and Provider have caused their duly
authorized representatives to execute this Amendment as of the date first
written above.
CIGNA HEALTH CORPORATION
By:
-----------------------------------
Its:
OLSTEN NETWORK MANAGEMENT, INC.
By:
-----------------------------------
Its:
-2-
OLSTEN HEALTH SERVICES NETWORK
SCHEDULE 3: HOME MEDICAL EQUIPMENT/RESPIRATORY THERAPY FEE-FOR-SERVICE SCHEDULE
EFFECTIVE DATE: FEBRUARY 1, 1999
AMENDMENT TO NATIONAL HOME CARE PROVIDER AGREEMENT
THIS AMENDMENT is entered into this 3rd day of June, 1999 by
and between CIGNA Health Corporation, for and on behalf of its wholly owned
subsidiaries and affiliates (individually and collectively, "CIGNA"), and Olsten
Network Management, Inc. d/b/a Olsten Health Services, for and on behalf of its
wholly owned subsidiaries and affiliates (individually and collectively, the
"Provider").
W I T N E S S E T H :
WHEREAS, CIGNA and Provider entered into a National Home Care
Provider Agreement dated January 1, 1996, amended by amendments dated October 1,
1996, October 31, 1998, January 1, 1999, and March 24, 1999 (together, the
"Agreement"), whereby Provider provided or arranged for the provision of certain
health care services to Participants;
WHEREAS, the parties wish to amend a certain provision of the
Agreement to extend the time for negotiating a new contract as set forth below;
NOW THEREFORE, CIGNA and Provider agree as follows:
10. This Amendment shall be effective commencing on July
1, 1999 and shall continue unless terminated in accordance with the Agreement,
as amended hereby.
11. Section III.C of the Agreement (Termination) is
hereby amended by deleting Subsection III.C.7 of the Agreement and replacing it
with a new Subsection III.C.7, which shall read:
"7. Termination Due To Failure To Execute New Contract. In the event
that the parties are unable to execute a new contract by September 30,
1999 with respect to the subject matter of this Agreement containing
such terms and conditions as the parties may mutually agree, then
either party may, without cause, terminate this Agreement with sixty
(60) days prior written notice to the other party; provided that
neither party may terminate this Agreement pursuant to this Section
effective earlier than September 30, 1999."
12. Capitalized terms not defined herein but defined in
the Agreement shall have the same meaning as defined in the Agreement. To the
extent that the provisions in any prior amendments conflict with the terms of
this Amendment, the terms in this Amendment shall supercede and control.
13. Unless otherwise amended by this Amendment or prior
amendments, all other terms and conditions of the Agreement, including the
Program Attachments and the Exhibits attached thereto, shall remain the same and
in full force and effect.
IN WITNESS WHEREOF, CIGNA and Provider have caused their duly
authorized representatives to execute this Amendment as of the date first
written above.
CIGNA HEALTH CORPORATION
By:
----------------------------------
Its:
1/5
OLSTEN HEALTH SERVICES NETWORK
SCHEDULE 3: HOME MEDICAL EQUIPMENT/RESPIRATORY THERAPY FEE-FOR-SERVICE SCHEDULE
EFFECTIVE DATE: FEBRUARY 1, 1999
OLSTEN NETWORK MANAGEMENT, INC.
By:
----------------------------------
Its:
2/5
AMENDMENT TO NATIONAL HOME CARE PROVIDER AGREEMENT
THIS AMENDMENT is entered into this 1st day of August, 1999 by
and between CIGNA Health Corporation, for and on behalf of its wholly owned
subsidiaries and affiliates (individually and collectively, "CIGNA"), and Olsten
Network Management, Inc. d/b/a Olsten Health Services, for and on behalf of its
wholly owned subsidiaries and affiliates (individually and collectively,
"Provider").
W I T N E S S E T H :
WHEREAS, CIGNA and Provider entered into a National Home Care
Provider Agreement dated January 1, 1996 and amended from time to time
thereafter (together the "Agreement"), whereby Provider provided or arranged for
the provision of certain health care services to Participants;
WHEREAS, the parties wish to amend a certain provision of the
Agreement as set forth below;
NOW THEREFORE, CIGNA and Provider agree as follows:
14. This Amendment shall be effective commencing on
August 1, 1999 and shall continue unless terminated in accordance with the
Agreement.
15. The parties agree that Capitation Payments under this
Agreement do not include payment for Growth Hormone product. However, the
parties agree that Provider shall provide in-home training services for CIGNA
members receiving Growth Hormone product, in accordance with patient need and
physician orders. For Growth Hormone patients requiring training in the home,
training visits for self-injection instruction will be included under the
capitated payment. CIGNA shall not pay Provider for Growth Hormone product
unless authorized by CIGNA personnel. In the event that Growth Hormone product
that has been authorized by CIGNA personnel is furnished by Provider, Provider
shall be reimbursed for Growth Hormone in accordance with Schedule 2 of the
National Home Care Provider Agreement.
16. Exhibit A.1 of the HMO Program Attachment is deleted
in its entirety and replaced by the new Exhibit A.1 hereto.
17. Unless otherwise amended by this Amendment or
amendments with earlier effective dates, all other terms and conditions of the
Agreement, including the Program Attachments and the Exhibits attached thereto,
shall remain the same and in full force and effect. To the extent that the
provisions in the Agreement or in any amendments with earlier effective dates
conflict with the terms of this Amendment, the terms in this Amendment shall
supersede and control.
18. Capitalized terms not defined herein but defined in
the Agreement shall have the same meaning as defined in the Agreement.
[Next Page Is Signature Page]
-2-
IN WITNESS WHEREOF, CIGNA and Provider have caused their duly
authorized representatives to execute this Amendment as of the date first
written above.
CIGNA HEALTH CORPORATION
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
OLSTEN NETWORK MANAGEMENT, INC.
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
-3-
HMO PROGRAM ATTACHMENT
EXHIBIT A.1
HMO CAPITATION RATES--NON-MEDICARE/NON-MEDICAID
The HMO Capitation Payment per month for each member of
Provider's Patient Panel shall be $ for Home Health and Home Infusion Therapy
Services, and $ for Home Medical Equipment.
AMENDMENT TO NATIONAL HOME CARE PROVIDER AGREEMENT
THIS AMENDMENT is entered into this 4th day of January, 2000
by and between CIGNA Health Corporation, for and on behalf of its wholly owned
subsidiaries and affiliates listed on Exhibit I (individually and collectively,
CIGNA, and Olsten Network Management, Inc. d/b/a Olsten Health Services, for and
on behalf of its wholly owned subsidiaries and affiliates listed on Exhibit II
(individually and collectively, the Provider).
W I T N E S S E T H :
WHEREAS, CIGNA and Provider entered into a National Home Care
Provider Agreement dated January 1, 1996, and amended from time to time
thereafter (collectively, the Agreement), whereby Provider provided or arranged
for the provision of certain health care services to Participants;
WHEREAS, the parties wish to amend certain provisions of the
Agreement as set forth below;
NOW THEREFORE, CIGNA and Provider agree as follows:
19. This Amendment shall be effective commencing on
January 1, 2000.
20. Exhibit A.1 is deleted in its entirety and replaced
by the new Exhibits A.1.A and A.1.B attached hereto. These new Exhibits shall
expire at midnight on December 31, 2000.
21. Schedules 1A, 2 and 3 as deleted in their entirety
and replaced by the new Schedules of the same name and designation attached
hereto. These new Schedules shall expire at midnight on December 31, 2000.
22. All Exhibits and Schedules attached to this Amendment
are incorporated by reference as though fully set forth herein.
23. The following new paragraph 11 is added to Article
II, Section B of the HMO Program Attachment:
For those Covered Services rendered by Provider that are not included
within the capitation rate, or that are not rendered to Patient Panel
Participants (see definition of Patient Panel), the rates described in
schedules 1A, 1B, 2 and 3 shall apply.
24. Section III.C of the Agreement (Termination) is
hereby amended by adding a new Subsection III.C.7, which shall read:
Termination Without Cause. Either party may, without cause, terminate
this Agreement with one hundred and twenty (120) days prior written
notice to the other party.
25. The parties agree that by January 1, 2000, or as soon
thereafter as practicable and permissible under any other preexisting valid
contracts, CIGNA shall cause all Healthsource HMO plans and all
Healthsource/Provident PPO plans (enrollees in such plans are hereinafter
collectively referred to as Healthsource Participants) to be included as
Participating CIGNA Subsidiaries and Affiliates under the Agreement. In a
timeframe to be mutually agreed upon the parties, CIGNA will provide to Provider
all information reasonably required by Provider in order to accomplish this
transition, but nothing herein shall require Provider to purchase or assume
payments for any durable medical equipment (Equipment), which has been
previously placed with any Healthsource Participant. CIGNA agrees to work with
Provider to identify those Healthsource Participants that are in possession of
Equipment and for which CIGNA has made payment on a rental basis for such
Equipment, and advise Provider of the same. Provider shall be relieved of any
obligation to assume financial responsibility for Equipment that Provider
determines to be Equipment that is routinely purchased or converted to purchase,
or that does not meet CIGNA/Provider Durable Medical Equipment Guidelines for
Medical Necessity, and such Equipment shall be converted to purchase at CIGNA's
expense prior to the transition of Healthsource Participants to Provider.
However, Provider shall assume responsibility for the continued maintenance of
the Equipment.
26. The parties agree that they will continue to work
together in good faith and with due diligence to amend, modify and/or update the
agreement as needed to address certain outstanding issues, including but not
limited to those issues referenced in the Olsten-CIGNA Workplans (including the
Service Metric Specific Workplan, Vendor Management Specific Workplan, Medical
Management Specific Workplan, Pharmacy Specific Workplan, and Financial Specific
Workplan) previously addressed by the parties. CIGNA and Provider shall execute
such amendments, modifications and/or updates by March 1, 2000.
27. Both parties agree to be subject to and act in
accordance with all applicable laws, rules and regulations governing their
conduct under the Agreement.
To the extent that the provisions in the Agreement, including
any prior amendments, conflict with the terms of this Amendment (including the
exhibits and schedules hereto), the terms in this Amendment shall supersede and
control. This specifically includes repeal of Section 2 of the Amendment of
January 1, 1999 and the entire Amendment of June 3, 1999. All other terms and
conditions of the Agreement, as previously amended, including the Program
Attachments and the Exhibits attached thereto, shall remain the same and in full
force and effect. Capitalized terms not defined herein but defined in the
Agreement shall have the same meaning as defined in the Agreement.
-2-
IN WITNESS WHEREOF, CIGNA and Provider have caused their duly
authorized representatives to execute this Amendment as of the date first
written above.
CIGNA HEALTH CORPORATION
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
OLSTEN NETWORK MANAGEMENT, INC.
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
-3-
AMENDMENT TO NATIONAL HOME CARE PROVIDER AGREEMENT
THIS AMENDMENT is entered into this 1st day of May, 2000 by
and between CIGNA Health Corporation, for and on behalf of its wholly owned
subsidiaries and affiliates (individually and collectively, "CIGNA"), and
Olsten Network Management, Inc., d/b/a Gentiva Network Management, Inc., for and
on behalf of its wholly owned subsidiaries and affiliates (individually and
collectively, "Provider").
W I T N E S S E T H :
WHEREAS, CIGNA and Provider entered into a National Home Care
Provider Agreement dated January 1, 1996 whereby Provider provided or arranged
for the provision of certain health care services to Participants, and amended
it from time to time thereafter (the agreement, as amended, is the "Agreement");
WHEREAS, the parties wish to amend certain provisions of the
Agreement as set forth below;
NOW THEREFORE, CIGNA and Provider agree as follows:
28. This Amendment is made effective May 1, 2000.
29. The HMO Program Attachment to the Agreement is
revised in the manner described in the Amendment to HMO Program Attachment
attached hereto and incorporated herein.
30. The PPO Program Attachment to the Agreement is
revised in the manner described in the Amendment to PPO Program Attachment
attached hereto and incorporated herein.
31. The Indemnity Program Attachment to the Agreement is
revised in the manner described in the Amendment to the Indemnity Program
Attachment attached hereto and incorporated herein.
32. Unless otherwise amended by this Amendment or
amendments with earlier effective dates, all other terms and conditions of the
Agreement, including the Program Attachments and the Exhibits attached thereto,
shall remain the same and in full force and effect. To the extent that the
provisions in the Agreement or in any amendments with earlier effective dates
conflict with the terms of this Amendment, the terms in this Amendment shall
supersede and control.
[Next Page Is Signature Page]
IN WITNESS WHEREOF, CIGNA and Provider have caused their duly
authorized representatives to execute this Amendment as of the date first
written above.
CIGNA HEALTH CORPORATION
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
OLSTEN NETWORK MANAGEMENT, INC.
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
-2-
MAY 1, 2000 AMENDMENT TO HMO PROGRAM ATTACHMENT
1. For HMO Program Participants enrolled in South Carolina, the HMO rates
in Schedule I are increased from Level III rates to Level II rates.
2. Provider will include at least the following South Carolina hospitals
and their associated home health care agencies as Subcontractors: Roper
Hospital, McLeod Regional Medical Center, Greenville Hospital System,
and Palmetto Baptist Medical Center. Provider shall notify CIGNA if any
of the listed hospitals cease participating in Provider's network.
Should more than one (1) of the named hospitals be terminated from or
otherwise fail to be included in Provider's network at any time after
May 1, 2000, CIGNA may (a) terminate this amendment upon ninety (90)
days' notice; or (b) reduce the HMO rates referenced in section 1 above
back to Level III rates immediately.
MAY 1, 2000 AMENDMENT TO PPO PROGRAM ATTACHMENT
1. For PPO Participants enrolled in South Carolina, the PPO rates in
Schedule I are increased from Level III rates to Level II rates.
2. Provider will include at least the following South Carolina hospitals
and their associated home health care agencies as Subcontractors: Roper
Hospital, McLeod Regional Medical Center, Greenville Hospital System,
and Palmetto Baptist Medical Center. Provider shall notify CIGNA if any
of the listed hospitals cease participating in Provider's network.
Should more than one (1) of the named hospitals be terminated from or
otherwise fail to be included in Provider's network at any time after
May 1, 2000, CIGNA may (a) terminate this amendment upon ninety (90)
days' notice; or (b) reduce the PPO rates referenced in section 1 above
back to Level III rates immediately.
MAY 1, 2000 AMENDMENT TO INDEMNITY PROGRAM ATTACHMENT
1. For Indemnity Participants enrolled in South Carolina, the Indemnity
rates in Schedule I are increased from Level III rates to Level II
rates.
2. Provider will include at least the following South Carolina hospitals
and their associated home health care agencies as Subcontractors: Roper
Hospital, McLeod Regional Medical Center, Greenville Hospital System,
and Palmetto Baptist Medical Center. Provider shall notify CIGNA if any
of the listed hospitals cease participating in Provider's network.
Should more than one (1) of the named hospitals be terminated from or
otherwise fail to be included in Provider's network at any time after
May 1, 2000, CIGNA may (a) terminate this amendment upon ninety (90)
days' notice; or (b) reduce the Indemnity rates referenced in section 1
above back to Level III rates immediately.
AMENDMENT TO NATIONAL HOME CARE PROVIDER AGREEMENT
THIS AMENDMENT is entered into this 1st day of January, 2001
by and between CIGNA Health Corporation, for and on behalf of its wholly owned
subsidiaries and affiliates listed on Exhibit I (individually and collectively,
"CIGNA"), and Olsten Network Management, Inc. d/b/a Gentiva Health Network, for
and on behalf of its wholly owned subsidiaries and affiliates listed on Exhibit
II (individually and collectively, "Provider").
W I T N E S S E T H :
WHEREAS, CIGNA and Provider entered into a National Home Care
Provider Agreement dated January 1, 1996, and amended from time to time
thereafter (collectively, the Agreement), whereby Provider provided or arranged
for the provision of certain health care services to Participants;
WHEREAS, the parties wish to amend certain provisions of the
Agreement as set forth below;
NOW THEREFORE, CIGNA and Provider agree as follows:
33. This Amendment shall be effective commencing on
January 1, 2001.
34. Exhibits A.I.A and A.I.B are to be deleted in their
entirety and replaced by the new Exhibits of the same name and designation
attached hereto.
35. Exhibit B(4) shall be deleted in its entirety.
36. Schedules IA, IB, 2 and 3 are deleted in their
entirety and replaced by the new Schedules of the same name and designation
attached hereto.
37. All Exhibits and Schedules attached to this Amendment
are incorporated by reference as though fully set forth herein.
38. Section 2 of the Amendment of January 1, 1999 and the
entire amendment of June 3, 1999 are repealed and deleted.
39. Capitation amounts otherwise payable under this
Agreement shall be subject to adjustment based on either of the following
baseline comparisons. The adjustments, if any, shall be made at the beginning of
each calendar quarter. There shall be 2 separate adjustments, one based on CPAP
and the other on Insulin Pump utilization. If Actual Quarter utilization is more
than 15% higher than Baseline Utilization, then capitation payments otherwise
due for the following Quarter shall be increased on an amortized basis to
account for the difference beyond the 15%; if Actual Quarter Utilization is less
than 15% higher than Baseline Quarter utilization, then the capitation payments
otherwise due for the following quarter shall be decreased on an amortized basis
to account for the difference less than the 15%; subject to the fol-
lowing. To the extent that the utilization variation is greater than 24% for
CPAP utilization, or greater than 25% for Insulin Pump utilization, then the
parties will reduce the capitation increase/decrease by 50%. The increase or
decrease will not continue beyond the time necessary to offset the increase or
decrease.
For purposes of this section, "Baseline Utilization" means the
number of CPAPs or Insulin Pumps provided to capitated Participants per 1000
capitated member months for the Calendar Year 2000. "Actual Quarter Utilization"
means the number of CPAPs or Insulin Pumps provided to capitated Participants in
each quarter of 2001, per 1000 capitated member months.
In addition, within 30 days of the end of the first quarter of
2002, CIGNA will conduct a year end reconciliation to compare all 2001 Actual
Utilization to all 2000 Baseline Utilization and provide Provider with the
results. If the quarterly adjustments made during 2001 were larger or smaller
than necessary to account for the real difference between 2001 Actual
Utilization and 2000 Baseline Utilization, then the party who benefited from the
earlier calculation shall repay the difference within 60 days of the end of the
first quarter of 2002.
40. The parties agree that they will continue to work
together in good faith and with due diligence to amend, modify and/or update the
Agreement as needed to address certain outstanding issues, including but not
limited to those issues referenced in the Olsten-CIGNA Workplans (including the
Service Metric Specific Workplan, Vendor Management Specific Workplan, Medical
Management Specific Workplan, Pharmacy Specific Workplan, and Financial Specific
Workplan) previously addressed by the parties. CIGNA and Provider shall execute
such amendments, modifications and/or updates by March 31, 2001.
41. Capitalized terms not defined herein but defined in
the Agreement shall have the same meaning as defined in the Agreement.
42. Both parties agree to be subject to and act in
accordance with all applicable laws, rules and regulations governing their
conduct under the Agreement.
To the extent that the provisions in the Agreement, including
any prior amendments, conflict with the terms of this Amendment (including the
exhibits and schedules hereto), the terms in this Amendment shall supersede and
control. All other terms and conditions of the Agreement, as previously amended,
including the Program Attachments and the Exhibits attached thereto, shall
remain the same and in full force and effect.
-2-
IN WITNESS WHEREOF, CIGNA and Provider have caused their duly
authorized representatives to execute this Amendment as of the date first
written above.
CIGNA HEALTH CORPORATION
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
OLSTEN NETWORK MANAGEMENT, INC.
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
-3-
AMENDMENT TO
NATIONAL HOME CARE PROVIDER AGREEMENT
THIS AMENDMENT is entered into this 1st day of June, 2001 by
and between CIGNA Health Corporation, for and on behalf of its wholly owned
subsidiaries and affiliates listed on Exhibit I (individually and collectively,
"CIGNA"), and Gentiva CareCentrix Inc., for and on behalf of its wholly owned
subsidiaries and affiliates listed on Exhibit II (individually and collectively,
"Provider").
W I T N E S S E T H :
WHEREAS, CIGNA and Provider entered into a National Home Care
Provider Agreement dated January 1, 1996, and amended from time to time
thereafter (collectively, the Agreement), whereby Provider provided or arranged
for the provision of certain health care services to Participants;
WHEREAS, the parties wish to amend certain provisions of the
Agreement as set forth below;
NOW THEREFORE, CIGNA and Provider agree as follows:
43. This Amendment shall be effective commencing on June
1st, 2001.
44. The Agreement is amended by the addition of the
following definition to Section 1 of the HMO Program Attachment:
"HMO Program Participant means a Participant enrolled in a
non-governmental, fully insured Standard HMO or Point of Service
Product and which product is underwritten based on a community rating
methodology (i.e., community rating, community rating by class,
adjusted community rating by class). This definition includes, but is
not limited to, Participants covered under commercial HMO and Opens
Access plans issued by CIGNA."
45. The Agreement is hereby further amended to include
the GATEKEEPER PROGRAM ATTACHMENT (attachment included).
46. Both parties agree to be subject to and act in
accordance with all applicable laws, rules and regulations governing their
conduct under the Agreement.
To the extent that the provisions in the Agreement, including
any prior amendments, conflict with the terms of this Amendment (including the
exhibits and schedules hereto), the terms in this Agreement shall supersede and
control. All other terms and conditions of the Agreement, as previously amended,
including the Program Attachments and the Exhibits at-
tached thereto, shall remain the same and in full force and effect. Capitalized
terms not defined herein but defined in the Agreement shall have the same
meaning as defined in the Agreement.
-2-
IN WITNESS WHEREOF, CIGNA and Provider have caused their duly
authorized representatives to execute this Amendment as of the date first
written above.
CIGNA HEALTH CORPORATION
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
GENTIVA CARECENTRIX, INC.
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
-3-
AMENDMENT TO
NATIONAL HOME CARE PROVIDER AGREEMENT
THIS AMENDMENT is entered into this 1st day of June, 2001 by
and between CIGNA Health Corporation, for and on behalf of its wholly owned
subsidiaries and affiliates listed on Exhibit I (individually and collectively,
"CIGNA"), and Gentiva CareCentrix Inc., for and on behalf of its wholly owned
subsidiaries and affiliates listed on Exhibit II (individually and collectively,
"Provider").
W I T NE S S E T H:
WHEREAS, CIGNA and Provider entered into a National Home Care
Provider Agreement dated January 1, 1996, and amended from time to time
thereafter (collectively, the Agreement), whereby Provider provided or arranged
for the provision of certain health care services to Participants;
WHEREAS, the parties wish to amend certain provisions of the
Agreement as set forth below;
NOW THEREFORE, CIGNA and Provider agree as follows:
47. This Amendment shall be effective commencing on June
1st, 2001.
48. The Agreement is amended by the addition of the
following definition to Section 1 of the HMO Program Attachment:
"HMO Program Participant means a Participant enrolled in a
non-governmental, fully insured Standard HMO or Point of Service
Product and which product is underwritten based on a community rating
methodology (i.e. community rating, community rating by class, adjusted
community rating by class). This definition includes, but is not
limited to, Participants covered under commercial HMO and Opens Access
plans issued by CIGNA."
49. The Agreement is hereby further amended to include
the GATEKEEPER PROGRAM ATTACHMENT (attachment included).
50. Both parties agree to be subject to and act in
accordance with all applicable laws, rules and regulations governing their
conduct under the Agreement.
To the extent that the provisions in the Agreement, including
any prior amendments, conflict with the terms of this Amendment (including the
exhibits and schedules hereto), the terms in this Amendment shall supersede and
control. All other terms and conditions of the Agreement, as previously amended,
including the Program Attachments and the Exhibits at-
tached thereto, shall remain the same and in full force and effect. Capitalized
terms not defined herein but defined in the Agreement shall have the same
meaning as defined in the Agreement.
IN WITNESS WHEREOF, CIGNA and Provider have caused their duly
authorized representatives to execute this Amendment as of the date first
written above.
CIGNA HEALTH CORPORATION
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
GENTIVA CARECENTRIX, INC.
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
-2-
GATEKEEPER PROGRAM ATTACHMENT
TO
NATIONAL HOME CARE MANAGED CARE AGREEMENT
PURPOSE
The terms and provisions of this Gatekeeper Program Attachment
and the Agreement are applicable to services rendered by Provider to Gatekeeper
Program Participants.
II. DEFINITIONS
CIGNA's Maximum Fee Schedule means CIGNA's customary fee
schedule in effect at the time of service and applicable to Provider with
respect to this Gatekeeper Program (Exhibit A of the National Homecare Provider
Agreement, as amended effective January 1, 2001).
Gatekeeper Program Participant means a Participant, other than
a HMO Program Participant, enrolled in either (i) a product which includes fully
insured Standard HMO, Point of Service, or Gatekeeper PPO benefits and which
product is underwritten by a licensed insurance company based on an experience
rating methodology, or (ii) a self funded product which includes Standard HMO,
Point of Service, or Gatekeeper PPO benefits. This definition includes, but is
not limited to, Participants covered under FlexCare, True Access plans and Open
Access plans insured/administered by Connecticut General Life Insurance Company.
Gatekeeper PPO means a product offered pursuant to a Service
Agreement which provides the Participant with an incentive to obtain Covered
Services from Participating Providers and which generally requires the
Participant to obtain an authorization from their Primary Care Physician in
order to access such Covered Services from Participating Providers.
HMO Program Participant means a Participant enrolled in a
nongovernmental, fully insured Standard HMO or Point of Service product and
which product is underwritten based on a community rating methodology (i.e.
community rating, community rating by class, adjusted community rating by
class).
Medical Director means a physician designated by CIGNA to
manage Quality Management and Utilization Management responsibilities, or that
physician's designee.
Point of Service means a product offered pursuant to a Service
Agreement which allows the Participant to choose, in addition to Standard HMO
benefits, a lower level of benefits if the Participant receives Covered Services
from (i) a Participating Provider without a necessary authorization or (ii) from
a non-Participating Provider, at the time such services are sought.
Primary Care Physician means a physician duly licensed to
practice medicine who is a Participating Provider with CIGNA to provide Covered
Services in the fields of general
medicine, internal medicine, family practice or pediatrics, and who has agreed
to provide primary care physician services to Participants in accordance with
HMO Program Requirements.
Standard HMO means a product offered pursuant to a Service
Agreement where Covered Services are available to Participants only from
Participating Providers, except in the case of an Emergency or with the prior
authorization of CIGNA or CIGNA Affiliate where Covered Services are not
available from Participating Providers.
III. PARTIES' OBLIGATIONS
A. Services
1. Except as set forth below, Provider shall provide all
Covered Services within the scope of Provider's practice that are required by
Participants in accordance with the terms of this Agreement, this Gatekeeper
Program Attachment and HMO Program Requirements. Provider shall provide Covered
Services to all Participants. The compensation set forth in this Gatekeeper
Program Attachment shall be payment in full for such services.
2. Except in an Emergency or for a Pre-Qualified
Maternity Stay or in those instances where prior authorization is prohibited by
federal or state laws or regulations, prior authorization by a Participant's
Primary Care Provider or CIGNA as prescribed by HMO Program Requirements is
required for payment of Covered Services rendered to Participants. Referrals, if
any, shall be to Participating Providers, except where an Emergency requires
otherwise, in other cases where Medical Director specifically authorizes the
referral or as otherwise required by law.
B. Compensation and Billing
1. Provider shall be compensated for Covered Services at
the lesser of usual and customary charges or the rates set forth in Exhibit A,
less applicable Copayments, Deductibles and Coinsurance.
2. The rates set forth herein shall apply to all
services rendered to Gatekeeper Program Participants including services covered
under a Participant's in-network or opt out benefits.
3. The applicable rate includes all Medically Necessary
services that Provider customarily provides to the home or outpatient and
specifically excludes those services which, in accordance with community
standards, are considered office-based procedures or services.
4. The reimbursement under this Agreement shall be for
services which are Medically Necessary and otherwise covered under the
Participant's Service Agreement, and the applicable reimbursement rate for such
services shall be that rate applicable to the level of care
-2-
which is Medically Necessary notwithstanding the level of care actually provided
unless prior authorized by payor.
C. Limitations on Billing Participants
1.a. Provider shall look solely to Payor for compensation
for Covered Services except for Copayments, Deductibles or Coinsurance. Provider
agrees that whether or not there is any unresolved dispute for payment, under no
circumstances will Provider directly or indirectly make any charges or claims,
other than for Copayments, Deductibles or Coinsurance, against any Participants
or their representatives for Covered Services and that this provision survives
termination of this Agreement for services rendered prior to such termination.
1.b. Except for the collection of Copayments, Deductibles
or Coinsurance, only those services that are not Covered Services may be billed
directly to Participants subject to the limitations set forth in subsection 3.
below. This provision is to be interpreted for the benefit of Participants and
does not diminish the obligation of Payor to make payments according to the
terms of this Agreement.
2. Provider shall not charge a Participant for a service
which is not a Covered Service unless, in advance of the provision of such
service, the Participant has been notified by Provider that the particular
service will not be covered and the Participant acknowledges in writing that he
or she shall be responsible for payment of charges for such service.
3.a. Should Provider collect, or cause to be collected,
any payment from Participant or any representative of Participant in violation
of Section II.C. Limitations on Billing Participants, then Provider shall repay
the inappropriately collected amount within two (2) weeks of demand from CIGNA
or Participant. Provider shall at that time also repay Participant any legal
costs incurred by Participant as the result of Provider's breach of this
section. If Provider fails to make the repayments, then CIGNA may (but is not
obligated to) reimburse the Participant the amount inappropriately paid as well
as Participant's legal costs. Provider must pay CIGNA such amount upon demand;
if Provider fails to do so within thirty (30) days, then CIGNA may withhold such
amount and costs from future payments otherwise due to Provider.
3.b. If Provider bills or attempts to collect from
Participant or any representative of Participant a payment to which Provider is
not entitled by virtue of Section II.C. Limitations on Billing Participants,
then CIGNA may (but is not obligated to) forward the demanded payment amount on
behalf of the Participant. Provider must then repay CIGNA such amount upon
demand; if Provider fails to do so, then CIGNA may withhold such amount and
costs from future payments otherwise due to Provider.
3.c. Notwithstanding any Dispute Resolution provision
described in the Agreement, Provider agrees that CIGNA, CIGNA Affiliate, Payor
or Participant may seek specific enforcement of the provisions of this section
in any court of law or equity.
-3-
3.d. These remedies are in addition to, and not in lieu
of, any other legal or equitable remedies that CIGNA or Participant may have
against Provider for breach of this section.
-4-
AMENDMENT TO
NATIONAL HOME CARE PROVIDER AGREEMENT
THIS AMENDMENT is entered into this 1st day of June, 2001 by
and between CIGNA Health Corporation, for and on behalf of its wholly owned
subsidiaries and affiliates listed on Exhibit I (individually and collectively,
"CIGNA"), and Gentiva CareCentrix Inc., for and on behalf of its wholly owned
subsidiaries and affiliates listed on Exhibit II (individually and collectively,
"Provider").
W I T N E S S E T H :
WHEREAS, CIGNA and Provider entered into a National Home Care
Provider Agreement dated January 1, 1996, and amended from time to time
thereafter (collectively, the Agreement), whereby Provider provided or arranged
for the provision of certain health care services to Participants;
WHEREAS, the parties wish to amend certain provisions of the
Agreement as set forth below;
NOW THEREFORE, CIGNA and Provider agree as follows:
1. This Amendment shall be effective commencing on June
1st, 2001.
2. The Agreement is amended by the addition of the
following definition to Section 1 of the HMO Program Attachment:
"HMO Program Participant means a Participant enrolled in a
nongovernmental, fully insured Standard HMO or Point of Service
Product and which product is underwritten based on a community
rating methodology (i.e. community rating, community rating by
class, adjusted community rating by class). This definition
includes, but is not limited to, Participants covered under
commercial HMO and Opens Access plans issued by CIGNA."
3. The Agreement is hereby further amended to include
the GATEKEEPER PROGRAM ATTACHMENT (attachment included).
4. Both parties agree to be subject to and act in
accordance with all applicable laws, rules and regulations governing their
conduct under the Agreement.
To the extent that the provisions in the Agreement, including
any prior amendments, conflict with the terms of this Amendment (including the
exhibits and schedules hereto), the terms in this Amendment shall supersede and
control. All other terms and conditions of the Agreement, as previously amended,
including the Program Attachments and the Exhibits at-
tached thereto, shall remain the same and in full force and effect. Capitalized
terms not defined herein but defined in the Agreement shall have the same
meaning as defined in the Agreement.
-2-
IN WITNESS WHEREOF, CIGNA and Provider have caused their duly
authorized representatives to execute this Amendment as of the date first
written above.
CIGNA HEALTH CORPORATION
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
GENTIVA CARECENTRIX, INC.
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
-3-
AMENDMENT TO
NATIONAL HOME CARE PROVIDER AGREEMENT
THIS AMENDMENT is entered into this 1st day of January, 2002
by and between CIGNA Health Corporation, for and on behalf of its wholly owned
subsidiaries and affiliates listed on Exhibit I (individually and collectively,
"CIGNA"), and Olsten Network Management, Inc. d/b/a Gentiva Health Network, for
and on behalf of its wholly owned subsidiaries and affiliates listed on Exhibit
II (individually and collectively, "Provider").
W I T N E S S E T H :
WHEREAS, CIGNA and Provider entered into a National Home Care
Provider Agreement dated January 1, 1996, and amended from time to time
thereafter (collectively, the Agreement), whereby Provider provided or arranged
for the provision of certain health care services to Participants;
WHEREAS, the parties wish to amend certain provisions of the
Agreement as set forth below;
NOW THEREFORE, CIGNA and Provider agree as follows:
5. This Amendment shall take effect commencing on
January 1, 2002 and shall continue in force and effect for a period of two (2)
years thereafter, or until terminated as provided herein or in accordance with
the Agreement.
The rates shall be in effect for the first year of this
Agreement. During the first year, the parties agree to meet and negotiate in
good faith and due diligence to reach agreement as to new rates for the period
beginning January 1, 2003 through December 31, 2003 ("Year 2"). In the event
that the parties are unable to reach an agreement as to new rates for Year 2,
either party may terminate this Agreement at any time after January 1, 2003 by
giving notice to the other party at least ninety (90) days in advance of the
termination specified in such notice. During the notice period (90 days), the
rates contained in this Amendment, effective 1/1/02, shall continue in force for
that period.
6. Exhibit A.1.A and A.1.B are to be deleted in its
entirety and replaced by the new Exhibits of the same name and designation
attached hereto.
7. Exhibit B(4) and Exhibit C(4) shall be deleted in its
entirety.
8. Schedules IA, IB, 2A and 3A are deleted in their
entirety and replaced by the new Schedules of the same name and designation
attached hereto.
9. Exhibits B1, B2, B3 are deleted in their entirety and
replaced by the new Exhibits of the same name and designation attached hereto.
10. Exhibits C1, C2, C3 are deleted in their entirety and
replaced by the new Exhibits of the same name and designation attached hereto.
11. All Exhibits and Schedules attached to this Amendment
are incorporated by reference as though fully set forth herein.
12. Capitation amounts, otherwise payable under this
Agreement, shall be subject to up (+) or down (-) adjustments based upon
comparisons of: (1) purchased ppk utilization levels and (2) 2002 actual ppk
utilization levels for the contract term; limited to CPAP, Oxygen and Custom
Wheelchair utilization. Utilization calculations shall be separate for each of
the following services: CPAPS (EXHIBIT D2), OXYGEN (EXHIBIT D3) and CUSTOM
WHEELCHAIRS (EXHIBIT D4). Capitation adjustments, if any, shall be summed to
determine the aggregate and appropriate adjustment, as required.
Actual 2002 ppk shall be measured as the number of unique
patients provided services per 1,000 capitated member months. For purposes of
the calculations, each service is identified on a calculation sheet attached as
Exhibits D2, D3, and D4 to the Amendment to the National Home Care Provider
Agreement, effective 1/l/02.
If the actual 2002 ppk exceeds the purchased ppk then a
capitation adjustment shall be determined, not to exceed the projected ppk. If
the aggregate amount of appropriate adjustments related to the measured services
equal or exceed the value of a whole penny, as illustrated on Exhibit D1
(summary), the capitation payments otherwise due for the following quarter shall
be increased or decreased to account for the difference, as required. The
adjustments (increase or decrease) will not continue beyond the time necessary
to offset the increase or decrease determined by the quarterly calculations, to
be limited by the purchased and projected ppk corridor.
Adjustments (up or down) will be made in whole penny values
throughout the year, as required, with a final reconciliation due before 4/30/03
for fiscal year 2002. If the adjustments made during 2002 are larger or smaller
than necessary, then the party who benefited from the earlier calculation shall
repay the difference within 60 days to the other party.
13. CIGNA designates Provider as CIGNA's preferred
provider for provision of hemophilia factor products, and agrees to limit Factor
providers in 2002 to Gentiva Health Services and those commercial vendors
currently under contract. CVS and Tel-Drug, CIGNA's preferred providers for
injectable medications, will re-direct all cases to Provider for admission.
14. Both parties agree to be subject to and act in
accordance with all applicable laws, rules and regulations governing their
conduct under the Agreement.
To the extent that the provisions in the Agreement, including
any prior amendments, conflict with the terms of this Amendment (including the
exhibits and schedules hereto),
-2-
the terms in this Amendment shall supersede and control. All other terms and
conditions of the Agreement, as previously amended, including the Program
Attachments and the Exhibits attached thereto, shall remain the same and in full
force and effect. Capitalized terms not defined herein but defined in the
Agreement shall have the same meaning as defined in the Agreement.
-3-
IN WITNESS WHEREOF, CIGNA and Provider have caused their duly
authorized representatives to execute this Amendment as of the date first
written above.
CIGNA HEALTH CORPORATION
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
OLSTEN NETWORK MANAGEMENT, INC.
By:
----------------------------------
Its:
---------------------------------
Date:
--------------------------------
-4-
EXHIBIT A.1.A
*
*Confidential Treatment Requested.
EXHIBIT A.1.B
*
*Confidential Treatment Requested.
SCHEDULE IA
*
*Confidential Treatment Requested.
SCHEDULE IB
*
*Confidential Treatment Requested.
SCHEDULE 2A
*
*Confidential Treatment Requested.
SCHEDULE 3A
*
*Confidential Treatment Requested.
EXHIBIT B1
*
*Confidential Treatment Requested.
EXHIBIT B2
*
*Confidential Treatment Requested.
EXHIBIT B3
*
*Confidential Treatment Requested.
EXHIBIT C1
*
*Confidential Treatment Requested.
EXHIBIT C2
*
*Confidential Treatment Requested.
EXHIBIT C3
*
*Confidential Treatment Requested.
EXHIBIT D1
*
*Confidential Treatment Requested.
EXHIBIT D2
*
*Confidential Treatment Requested.
SCHEDULE D3
*
*Confidential Treatment Requested.
SCHEDULE D4
*
*Confidential Treatment Requested.
AMENDMENT TO
NATIONAL HOME CARE PROVIDER AGREEMENT
CIGNA Health Corporation ("CIGNA") and Gentiva Care Centrix, Inc., the
successor in interest to Kimberly Home Health Care, Inc., hereby agree to amend
their National Home Care Provider Agreement effective January 1, 1996 and
amended periodically thereafter (the "Agreement") as follows:
1. The following provision is added as Section II.B.12:
"12. By September 1, 2002, Provider shall review the quarterly leakage
reports provided by CIGNA to determine the need to contract with additional
providers so as to reduce the "leakage." Gentiva shall make a good faith effort
to contract with identified providers by January 1, 2003. On a prospective
basis (i.e. on and after August 1, 2002), Gentiva shall review CIGNA's
quarterly leakage reports and the claims for Covered Home Care Services
submitted by providers that are not Provider's Subcontractors to assess the
need to contract with additional providers in order to reduce the amount of
"leakage" and it shall act promptly to contract with those providers identified
as appropriate in order to reduce leakage. In an effort to better manage
leakage and overall utilization, CIGNA will attempt to provide Gentiva, an
overview of CIGNA's administration of out of network claims for Covered Home
Care Services rendered to Participants. CIGNA also agrees to review the
feasibility of adopting usual and customary charges for Covered Home Care
Services. Gentiva commits to provide CIGNA all reasonable assistance in the
development and implementation of the aforementioned process."
2. The following provision is added as Section II.A.22:
"22. The Parties shall meet quarterly (each April, July, October and
January) to review the utilization of Covered Home Health Services that are not
reimbursed on a capitated basis under this Agreement for the purpose of
identifying opportunities to reduce this utilization and the Parties shall
cooperate in good faith to effect such actions as they may agree upon to
accomplish this objective."
3. The following provision is added as Section II.A.23:
"23. Provider shall meet with those referring physicians identified by
CIGNA to educate them regarding the service provided by CareCentrix network
providers."
4. The following provision is added as Section III. P:
"P. Provider waives any right to interest required to be paid to it under any
state law or regulation requiring the payment of claims within a specified
period of time is being understood that CIGNA's payment obligations are governed
entirely by the terms of this Agreement."
5. The following provision is added as Section II.C.9:
"Both Parties agree to cooperate in good faith to create a mutually beneficial
capitation reconciliation process for those Participants in the Providers
Patient Panel that an electronic eligibility and capitation roster are not
available. For those Participants in the Providers Patient Panel that an
electronic eligibility and capitation roster are available, the Parties shall
have ninety (90) days following payment of any capitation payment made pursuant
to this Agreement in which to notify the other party of any claims for
additional payments or refunds with respect to such payment and thereafter
neither party may claim any additional adjustment in the capitation amount
paid."
6. The Agreement shall be amended in whatever manner may additionally be
required to reflect the terms of a Settlement and Release Agreement between the
parties effective August 15, 2002.
This Amendment shall be effective August 15, 2002 and, in the event of a
conflict between the terms of this Amendment and any other terms of the
Agreement, the provisions of this amendment shall supersede any other
provision in the Agreement.
WHEREFORE, the Parties have executed this Amendment by their duly authorized
representatives.
CIGNA HEALTH CORPORATION
BY: /s/ DATE: 8/19, 2002
----------------------------------
GENTIVA CARE CENTRIX, INC.
BY: /s/ DATE: 8/9, 2002
----------------------------------