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Ambulance ServiceAMBULANCE SERVICE CONTRACT This Contract, dated this 16l day of is entered into by and between: City of Salina, E.M.S., hereinafter refer •ed to as " Ambulance Transport Provider" and Windsor Estates, hereinafter referred to as "Nursing Facility". RECITALS 1. The Nursing Facility is engaged in the business of providing skilled nursing services and is duly licensed to do so. The Ambulance Transport Provider is engaged in the business of medical transportation and other emergency medical services. The Ambulance Transport Provider is a licensed Type I Ambulance Service and all its technicians are certified by the Kansas Board of Emergency Medical Services. 2. The Nursing Facility desires to obtain certain services of the Ambulance Transportation Provider on the terms and conditions stated in the Contract and the Ambulance Provider desires to provide services to these terms and conditions. 3. In consideration of the mutual promises contained in the Contract, the parties agree as following. TERM b lq,c 7 4. This Contract is effective the from the first day of July, 205 through the thirtieth day of June, 2006? Z-) 5. This Contract will automatically renew for additional periods on the same terms and conditions unless either party sends to the other party a written notice of termination by certified mail, return receipt requested, thirty (30) days before the expiration date. SERVICES 6. The Ambulance Transportation Provider shall be responsible for furnishing the necessary personnel and equipment necessary in its opinion to provide the services within the scope of this Contract. At the request of the Nursing Facility, the Ambulance Transportation Provider agrees to provide to patients of the Nursing Facility the services described in the attached Schedule 1, which is incorporated herein by reference. CALL ARRANGEMENT 7. The Nursing Facility may enter into contracts with other transport providers, at their option. FEES AND BILLING 8. The fees for services provided under the Contract are stated in the attached Schedule 2, and may be modified by the Ambulance Provider during the term of the Contract which is incorporated herein by reference. 9. The Ambulance Transportation Provider shall bill the patient and/or any available reimbursement source for services, except that in the case of specific services provided by the Ambulance Transportation Provider that are covered by applicable laws or regulations - including without limitation, and as an example only, provisions of Section 4432 of the Balanced Budget Act of 1997 and relevant sections of the Code of Federal Regulation and other authoritative documents implementing, Section 4432, that require that reimbursement be made to the Nursing Facility, the Ambulance Transportation Provider shall bill the Nursing Facility for such services. 10. The Nursing Facility agrees to provide the Ambulance Transportation Provider with information regarding the patient's care plan, status, and history to facilitate proper determination by the Ambulance Transportation Provider whether the Nursing Facility should be billed for specific services. To the extent patient consent is required for provision of information to the Ambulance Transportation Provider, the Nursing Facility will use its best efforts to obtain that consent. 11. The parties agree to develop a process whereby they will use their best efforts to work together and consult in good faith to expeditiously address patient information and billing issues relating to this Contract. 12. The Nursing Facility agrees to advise the Ambulance Transportation Provider whether it is a Medicare's Prospective Payment System Provider. 13. The Nursing Facility agrees to pay the fees stated on Schedule 2 for services properly billed to it within thirty (30) days of the mailing of an invoice to it for services, subject to the Ambulance Transportation Provider's standard billing and collection procedures 14. In the event the Nursing Facility is billed for services, it may collect any available co- insurance or deductible. MEDICAL NECESSITY 15. With the respect to any services for which the Ambulance Transportation Provider bill the Nursing Facility, the Nursing Facility shall be responsible for determining medical necessity of the services and shall pay the Ambulance Transportation Provider without regard for whether reimbursement sources challenge the medical the medical necessity of the services, audit claims relating to the services, or make claims against the Nursing Facility relating to the services. With respect to any services which the Ambulance Transportation Provider does not submit a bill to the Nursing Facility, the Ambulance Transportation Provider releases the Nursing Facility of any responsibility for payment. PHYSICIAN CERTIFICATION 16. The Nursing Facility agrees to comply with any rules or regulation with respect to physician certification for ambulance transportation. In the event required physician certification is not obtained, the Ambulance Transportation Provider reserves the right not to provide transportation. INSURANCE AND INDEMNIFICATION 17. Each party shall maintain liability insurance in the minimum amounts required by law. ENTIRE AGREEMENT 18. This Contract, including any schedules attached hereto, constitutes the sole and only agreement of the parties regarding its subject matter and supersedes any prior understandings or written or oral agreements between the parties respecting this subject matter. Neither party has received or relied upon any written or oral representations to induce it to enter into this Contract except that each party has relied only on any written representations contained herein. AMENDMENT 19. No agreement or understandings varying or extending this Contract shall be binding upon the parties unless it is memorialized in a written amendment signed by an authorized officer or representative of both parties. The parties agree that they will not seek any oral amendment of this Contract. ASSIGNMENT 20. This Contract s11 inu to the benefit of and shall be binding upon the successors and assigns of each pa y. Neither party shall assign their rights or obligations under this Contract without the prior written approval of the other party, except that a party may assign this Contract to any person or entity that acquires substantially all of that party's business. LEGAL CONSTRUCTION 21. In the event that anyone or more of the provisions contained in this Contract shall for any reason be held to be invalid, illegal, or unenforceable in any respect, such invalidity, illegality, or unenforceability shall not affect any other provisions and the Contract shall be construed as if such invalid, illegal, or unenforceable provision had never been contained in it. It COMPLAINTS 22. The Nursing Facility agrees that all complaints or unusual incidents involving personnel or service of the Ambulance Transportation Provider will be promptly reported to management of the Ambulance Transportation Provider and will be described in an incident report detailing the circumstances surrounding the complaint or detailing the circumstances surrounding the complaint or incident, including the persons or entities involved, date and time of the event at issue, and description of events at issue. City of Salina, E.M.S. By: /odFranz, Director oftKinance Date: Windsor Estates By: Kara Fiske, Administrator Date: ��� I FINANCE DEPARTMENT Rod Franz Director of Finance 300 West Ash - P.O. Box 736 Salina, Kansas 67402-0736 CITY OF SALINA EMERGENCY MEDICAL SERVICE SCHEDULE 1 City of Salina, Emergency Medical Service is licensed as a Type I Ambulance Service; a Type I service is a ground-based service which provides emergency response and Advanced Life Support to include all authorized activities of Mobile Intensive Care Technician (Paramedic).