Executive/Council Action Form (ECAF)
ITEM TITLE:
Title
Approve Amendment No. 2 with Providence Health & Services WA dba Providence Regional Medical Center Everett for x-ray services
body
DEPARTMENT: Health
ORIGINATOR: Rhonda Smids-Osborne
EXECUTIVE RECOMMENDATION: Approved
PURPOSE: Providence Health & Services WA dba Providence Regional Medical Center Everett, will provide chest x-ray services chest x-ray (CRX) services in Snohomish County to specifically designated Snohomish County residents who have been referred by the Health Department’s Tuberculosis clinical staff.
BACKGROUND: Providence Health & Services will provide health care services to low-income individuals who are not entitled to benefits under the Title XVIII of the Social Security Act or eligible for assistance under the State plan of Title XVIII of the Social Security Act. Providence Health & Services have provided ongoing x-ray services for the Health Department, and we would like to continue this partnership. Original agreement was executed under Snohomish Health District.
FISCAL IMPLICATIONS:
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EXPEND: FUND, AGY, ORG, ACTY, OBJ, AU |
CURRENT YR |
2ND YR |
1ST 6 YRS |
|
125 5 15 625 4101 |
Varies |
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TOTAL |
Varies |
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REVENUE: FUND, AGY, ORG, REV, SOURCE |
CURRENT YR |
2ND YR |
1ST 6 YRS |
|
125 3 15 625 9700 |
Varies |
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TOTAL |
Varies |
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DEPARTMENT FISCAL IMPACT NOTES: Each imaging service shall be reimbursed to the Contractor at 75% of the current Medicare allowable rate. Monthly average $400-$700.
CONTRACT INFORMATION:
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ORIGINAL |
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CONTRACT# |
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AMOUNT |
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AMENDMENT |
X |
CONTRACT# |
5373 |
AMOUNT |
Varies |
Contract Period
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ORIGINAL |
START |
12/06/2018 |
END |
12/31/2021 |
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AMENDMENT No. 1 |
START |
09/20/2021 |
END |
12/31/2024 |
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AMENDMENT No. 2 |
START |
12/31/2024 |
END |
12/31/2027 |
OTHER DEPARTMENTAL REVIEW/COMMENTS: PA cannot approve as to form; original agreement was executed under the Health District.