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2017-026
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2017-026
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Last modified
8/10/2017 12:37:35 PM
Creation date
2/15/2017 2:30:55 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Amendment
Approved Date
02/14/2017
Control Number
2017-026
Agenda Item Number
15.A.1
Entity Name
PST PerSe Technologies
McKesson
Subject
Supplemental Payment Recovery Assistance
Services Agreement effective 5/01/2001
with attached performance bond effective 5/1/2017
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CONFIDENTIAL AND PROPRIETARY Client Indian Rivt!r County <br /> Arnenditicrit Number P201710013626 <br /> SCHEDULE IA <br /> SCOPE OF SERVICES-SUPPLEMENTAL PAYMENT RECOVERY ASSISTANCE SERVICES <br /> The Terms and Conditions or the Agreement and this Schedule apply to all services rendered by PST under this <br /> Schedule. <br /> 1. TERM <br /> 1.1 Initial Term ol'Schedule. The initial term or this Schedule is three years (the "Schedule Term-) <br /> beginning December 1.2016(the-Commencement Date'*). <br /> 1.2 Automatic Renewal, This Schedule will automatically renew for one year terms unless (i) either <br /> puny delivers to the other written notice of termination at least 90 days prior to the expiration of the <br /> then-current term.or(ii)as otherwise set lbrth in the Agreement. <br /> 1.3 No Cause Termination. Either party may terminate this Schedule IA at any time and lbr any reason <br /> or no reason upon 90 days prior written notice to the other party, <br /> 2 SCOPE OF SERVICES <br /> 2.1 S..pM. PST will provide supplemental payment assistant services as specified below based on <br /> intormation provided by Client for professional ambulance services rendered by Client in <br /> accordance with the terms of the Agreement and this Schedule. <br /> 2.2 Responsibilities Each party agrees to perform its respective responsibilities identified below in a <br /> timely and diligent manner. Client acknowledges and agrees that PST's performance or the <br /> Services described herein is dependent upon Client's performance of its responsibilities as set forth <br /> in this SchLdulc. <br /> 2.2.1 PST Rg§nonsibi I i ties. As part of the PST's Supplemental Payment Assistance Services, <br /> PST's responsibilities under this Schedule will include. <br /> (a) Advising and assisting Client with enrolling in the rloridu Ambulance Supplemental <br /> Payment Program: <br /> (b) Assisting Client with enrolling in the Florida Ambulance Supplemental Payment <br /> Program <br /> (C) Managing the program applications and required cost reports lbr Client in accordance <br /> with the ASPP: <br /> (d) Managing the ASPP pre-Lost report submittal process for Client. which may also <br /> include: <br /> • Developing and submitting the Provider Approval materials to the Florida <br /> Agency ror Health Cart: Administration ("Al-ICA-) agency on behalf of <br /> Client: <br /> • Developing and submitting the Cost Allocation Model and Report to ARCA <br /> on behall'orClient for rekie%% as pan ol'thc ASPP; <br /> • Changing and finalizing the Cost Allocation Model during AHCA's rc%ic"ol' <br /> the Cost Allocation Model and Report. to meet AHCA*s requirements to <br /> move forward with the cost report submittal. <br /> (e) Assisting Client in developing cost models for LNIS transports for submission to <br /> ASPP; <br /> (i) Assisting Client with submitting other annual reports as my required by the ASPP; <br /> (g) Ensuring that cost report preparer(s)engaged on behalf ol'Client by PST are ccrti fied <br /> in accordance with all applicable rules.laws and regulations:and <br /> (h) Ensuring that it utilizes separate stall for all billing and cost report preparation services <br /> provided to Client. <br /> 2.2.2 Client Responsibilities. Client acknowledges and understands that inaccurate or false data <br /> submissions, even advertent ones, can lead to a false claim charge or Medicaid program <br /> exclusion. Therefore.Client agrees that it will use best ell'orts to: <br /> ,v;r 2 4 3 <br />
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