HomeMy WebLinkAbout05282013 City Council Special Meeting Packet Seward City Council
Agenda Packet
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Special CCouncil Meeting
May 28, 2013
City Council Chambers 6:30 p.m.
The City of Seward, Alaska
Special City Council Meeting
May 28, 2013 6:30 p.m. Council Chambers
David Seaward 1. Call To Order
Mayor 2. Pledge Of Allegiance
Term Expires 2013 3. Roll Call
4. Citizen Comments On Any Subject Except Those Items
Jean Bardarson i
Scheduled For Public Hearing. [Those Who Have Signed Mayor g• ned
[ g
Term Expires 2014 In Will Be Given The First Opportunity To Total Time For
This Agenda Item.]
Robert Valdatta 5. Approval Of Agenda And Consent Agenda [Approval of
Council Member Consent Agenda passes all routine items indicated by
Term Expires 2013 asterisk ( *). Consent Agenda items are not considered
separately unless a council member so requests. In the event
Christy Terry of such a request, the item is returned to the Regular
Council Member Agenda.]
Term Expires 2013
Vanta Shafer 6. New Business
Council Member
Term Expires 2013 A. Resolutions
Marianna Keil 1. Resolution 2013 -040, Acknowledging Review Of The
Council Member Settlement And Release Agreement Negotiated Between The
Term Expires 2014 State Of Alaska And Providence Seward Medical And Care
Center Relating To A Medicaid Rate Appeal In An
Ristine Casagranda Approximate Amount Of $6.1 Million Over Four Years.
Council Member
Term Expires 2014
7. Council Comments
James Hunt
City Manager 8. Citizen Comments
Johanna Kinney 9. Council And Administration Response To Citizen
City Clerk Comments
Cheryl Brooking 10. Adjournment
City Attorney
City of Seward, Alaska Council Agenda
May 28, 2013 Page 1
SPECIAL MEETING REQUEST
Pursuant to Seward City Code 2.10.030 (2), this is to serve as
the written notice calling a Special City Council Meeting on tyr.seV,r,
May 28, 2013 at 6:30 p.m. for the purpose of:
1. Resolution 2013 -040, Acknowledging Review Of The
Settlement And Release Agreement Negotiated Between The State
Of Alaska And Providence Seward Medical And Care Center
Relating To A Medicaid Rate Appeal In An Approximate Amount
Of $6.1 Million Over Four Years.
Signed this 24 day of May, 2013.
Mayor
4 r Manager
or
2 Council Members
Upon this request the City Clerk will give due and proper notice as
required by SCC 2.10.032
(No business shall be transacted other than stated above.)
t 1 S Fj
NOTICE OF : 0'�' q�°
u
SPECIAL MEETING
q�s P
NOTICE IS HEREBY GIVEN that the Seward City Council will have a special meeting on Tuesday,
May 28, 2013 at 6:30 p.m. for the purpose of:
1. Resolution 2013 -040, Acknowledging Review Of The Settlement And Release
Agreement Negotiated Between The State Of Alaska And Providence Seward
Medical And Care Center Relating To A Medicaid Rate Appeal In An Approximate
Amount Of $6.1 Million Over Four Years.
The meeting will be conducted in City Council Chambers, City Hall, 410 Adams Street, Seward.
ALL INTERESTED PERSONS ARE INVITED TO ATTEND.
POSTED: Friday, May 24, 2013 at 5:00 p.m.
City Hall bulletin board
U.S. Post Office
Harbormaster's Building
Sponsored by: Hunt
CITY OF SEWARD, ALASKA
RESOLUTION 2013 -040
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SEWARD,
ALASKA, ACKNOWLEDGING REVIEW OF THE SETTLEMENT AND
RELEASE AGREEMENT NEGOTIATED BETWEEN THE STATE OF
ALASKA AND PROVIDENCE SEWARD MEDICAL AND CARE CENTER
RELATING TO A MEDICAID RATE APPEAL IN AN APPROXIMATE
AMOUNT OF $6.1 MILLION OVER FOUR YEARS
WHEREAS, the City of Seward ( "City ") owns the local hospital and long -term care facilities
which are operated by Providence Health & Services ( "Providence ") as Providence Seward Medical
and Care Center ( "PSMC "); and
WHEREAS, on February 28, 2013, the Seward City Council approved Resolution 2013 -015,
authorizing negotiations to proceed to settle a rate dispute filed by PSMC with the State of Alaska
Department of Health and Social Services ( "State ") relative to the FY2011 Seward Mountain Haven
Medicaid Rate, which was established utilizing FY2009 as the "base year" for rates to be inflation
adjusted for fiscal years 2011, 2012, 2013, and 2014; and
WHEREAS, the City and Providence are parties to a Management and Operating Agreement
which provides, in pertinent part, that: 1) the City shall own and have financial responsibility for
PSMC; 2) Providence assumes all rights, duties, liabilities and obligations arising from operation of
PSMC; 3) Providence shall negotiate, prepare and execute contracts in connection with the operation
of PSMC; 4) Providence shall notify the City of any proposed settlement of litigation on behalf of
PSMC involving payment of an amount in excess of $25,000; and) Providence shall not assume or
be liable for any claim, liability, or obligation of PSMC arising from operation of PSMC pursuant to
the Agreement, except where such claim, liability or obligation arises from Providence's negligence
or material breach of the Agreement; and
WHEREAS, the Settlement and Release Agreement substantially complies with the terms
discussed with the Seward City Council when it approved Resolution 2013 -015, with two
exceptions: 1) due to a major computer software migration, the State of Alaska DHSS is anticipating
significant potential delays in processing Medicaid reimbursements, which may adversely impact
their ability to process Seward's claims within the initial 90-day window that they were committing
to, and instead, the State is agreeing to re- process those claims by December 31, 2013; and 2) the
State of Alaska requires that the parties agree to dismiss this matter with prejudice, thereby
necessitating legal action in the event it is necessary to enforce the terms of this Agreement; and
WHEREAS, the State's settlement offer will increase the per diem base rate for Seward
Mountain Haven by approximately $137.00 per patient per day, and adjusted rate will be used as the
base rate to be inflated for fiscal years 2012, 2013, and 2014, with a total estimated increased
payment to Seward Mountain Haven resulting from this adjustment over the four -year rate cycle, of
approximately $6.1 million; and
i
CITY OF SEWARD, ALASKA
RESOLUTION 2013 -040
WHEREAS, the Seward City Council reviewed the proposed settlement offer on February
28, 2013, and required that the administration bring forward for its review a final negotiated
agreement.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY
OF SEWARD, ALASKA that:
Section 1. In the matter of the Providence Seward Medical Center Case No. 2012- MRC -02
FY2011 LTC Medicaid Rate Appeal, the Seward City Council does not object to Providence Health
& Services' acceptance of a settlement offer from the State of Alaska, subject to the conditions set
forth in this Resolution, increasing the per diem base rate for Seward Mountain Haven by $137.00
per patient per day, which adjusted rate would be used as the base rate to be inflated for fiscal years
2012, 2013, and 2014. The estimated total increased payment to Seward Mountain Haven resulting
from this adjustment over the four -year rate cycle is approximately $6.1 million
Section 2. This resolution shall take effect immediately upon its adoption.
PASSED AND APPROVED by the City Council of the City of Seward, Alaska, this 28
day of May, 2013.
THE CITY OF SEWARD, ALASKA
David Seaward, Mayor
AYES:
NOES:
ABSENT:
ABSTAIN:
ATTEST:
Johanna Kinney, CMC
City Clerk
(City Seal)
Council Agenda Statement
e o f se
Meeting Date: May 28, 2013 bja 91
Through: James Hunt, City Manager '45irwv
q� SKp'
From: Kristin Erchinger, Finance Director
Agenda Item: Final Settlement and Release Agreement Related to Seward Mountain
Haven's Medicaid Rate for 2011, 2012, 2013 and 2014
BACKGROUND & JUSTIFICATION:
The City of Seward ( "City ") owns the local hospital and long -term care facility (collectively,
"PSMC ") which are operated by Providence Health & Services ( "Providence ") under management
agreement with the City. The City is financially responsible for the operations of the health facilities.
Providence has managed the long -term care facility in Seward on the City's behalf since April 2003.
The 2009 year represented a rebasing year for the purposes of establishing Medicaid rates for the
subsequent fiscal years 2011, 2012, 2013 and 2014. The State of Alaska Department of Health and
Social Services ( "State ") established the 2011 rate for the operations of SMH at $538.44 per day.
PSMC filed a Notice of Appeal to these rates.
The Seward City Council approved Resolution 2013 -015 on February 28, 2013, authorizing
negotiation of a formal settlement agreement with the State of Alaska, and requested that the final
settlement agreement be brought before them. Attached is the Settlement and Release Agreement
which was negotiated between the State of Alaska DHSS and attorneys for Providence Health &
Services representing PSMC. The terms of the settlement agreement are consistent with the
information previously provided to Council; namely, that the facility will receive approximately $6.1
million in additional reimbursements over a four -year period, representing approximately one -half of
the amount the City and PSMC felt that PSMC was entitled to claim. The reason for settling this
claim had primarily to do with the potential downside risk associated with a prolonged legal battle,
as well as the State's intent to argue that PSMC is not entitled to either a waiver of the lower of cost
or charges issue, or correction of an error on the submitted forms used as the basis for establishing
rates. In the worst case scenario, PSMC would have been filing four separate years' rate cases with
each case taking an estimated two to four years to resolve in the courts, incurring significant legal
fees with the risk of an adverse legal decision.
Ultimately, the legal fees associated with this matter have been entirely borne by Providence Health
& Services, not by PSMC.
The administration recommends acceptance of the Settlement and Release Agreement.
INTENT:
This purpose of this resolution is to support the terms of the Settlement and Release Agreement as
negotiated by Providence Health & Services with the State of Alaska DHSS, in order to settle this
rate dispute with the State of Alaska and obtain the additional Medicaid claims funds that the facility
is entitled to, as quickly as possible.
CITY OF SEWARD
RESOLUTION 2013 -040
CONSISTENCY CHECKLIST: Yes No N/A
1. Comprehensive Plan (document source here): X
2. Strategic Plan (document source here): X
3. Other (list): X
ATTORNEY REVIEW: X Yes No
FISCAL NOTE:
This resolution does not object to the Settlement and Release Agreement with the State of Alaska. It
will result in approximately $6.1 million in additional funding coming to PSMC over a four -year
period, representing approximately one -half of the funding to which the facility felt it was entitled. It
is fair to expect that at least $2 million of that settlement will come directly to the City of Seward to
repay a loan granted to PSMC in 2011 by the Seward City Council, and be used to cover debt service
costs of Seward Mountain Haven. The remaining funds will be available to PSMC to cover
operational shortfalls, costs, and cash flow.
Finance Department:
RECOMMENDATION:
City Council approve Resolution 2013 -040, reviewing the Settlement and Release Agreement
related to a dispute with the State of Alaska relating to a Medicaid rate appeal.
Sponsored by: Hunt
CITY OF SEWARD, ALASKA
RESOLUTION 2013 -015
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SEWARD,
ALASKA, AUTHORIZING GENERAL TERMS OF SETTLEMENT OF A
RATE DISPUTE WITH THE STATE OF ALASKA AND PROVIDENCE
SEWARD MEDICAL AND CARE CENTER RELATING TO A MEDICAID
RATE APPEAL IN AN APPROXIMATE AMOUNT OF $6.1 MILLION OVER
FOUR YEARS, AND AUTHORIZING NEGOTIATION OF A FORMAL
SETTLEMENT AGREEMENT TO BE APPROVED WHEN NEGOTIATIONS
ARE COMPLETE
WHEREAS, the City of Seward ( "City") owns the local hospital and long -term care facilities
which are operated on the City's behalf by Providence Health & Services ( "Providence ") as
Providence Seward Medical and Care Center ( "PSMC "); and
WHEREAS, PSMC filed a dispute with the State ofAlaska Department of Health and Social
Services ( "State ") relative to the FY2011 Seward Mountain Haven Medicaid Rate, which was
established utilizing FY2009 as the "base year" for rates to be inflation adjusted for fiscal years
2011, 2012, 2013, and 2014; and
WHEREAS, the City and Providence are parties to a Management and Operating Agreement
which provides, in pertinent part, that: 1) the City shall own and have financial responsibility for
PSMC; 2) Providence assumes all rights, duties, liabilities and obligations arising from operation of
PSMC; 3) Providence shall negotiate, prepare and execute contracts in connection with the operation
of PSMC; 4) Providence shall notify the City of any proposed settlement of litigation on behalf of
PSMC involving payment of an amount in excess of $25,000; and ) Providence shall not assume or
be liable for any claim, liability, or obligation of PSMC arising from operation of PSMC pursuant to
the Agreement, except where such claim, liability or obligation arises from Providence's negligence
or material breach of the Agreement; and
WHEREAS, the State has given Providence a settlement offer with a deadline for acceptance
of March 1, 2013, and Providence, through their attorneys, has requested concurrence from the
Seward City Council on the proposed settlement offer based on the financial impact of the settlement
on PSMC and the City; and
WHEREAS, the State's settlement offer will increase the per diem base rate for Seward
Mountain Haven by $137.00 per patient per day, and adjusted rate will be used as the base rate to be
inflated for fiscal years 2012, 2013, and 2014, with a total estimated increased payment to Seward
Mountain Haven resulting from this adjustment over the four -year rate cycle, of approximately $6.1
million; and
WHEREAS, the Seward City Council met in executive session on February 26, 2013 to
CITY OF SEWARD, ALASKA
RESOLUTION 2013 -015
discuss the merits of the settlement offer.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY
OF SEWARD, ALASKA that:
Section 1. In the matter of the Providence Seward Medical Center Case No. 2012- MRC -02
FY2011 LTC Medicaid Rate Appeal, the Seward City Council hereby concurs with Providence
Health & Service's recommendation to approve a settlement offer from the State of Alaska, subject
to the conditions set forth in this Resolution, increasing the per diem base rate for Seward Mountain
Haven by $137.00 per patient per day, which adjusted rate would be used as the base rate to be
inflated for fiscal years 2012, 2013, and 2014. The estimated total increased payment to Seward
Mountain Haven resulting from this adjustment over the four -year rate cycle is approximately $6.1
million
Section 2. The Seward City Council hereby authorizes the City Manager and the City
Attorney to coordinate with the manager and operator of Providence Seward Medical & Care
Center, Providence Health & Services, and their legal counsel, in their negotiation of a settlement
agreement to be brought back to the Seward City Council for ratification.
Section 3. This resolution shall take effect immediately upon its adoption.
PASSED AND APPROVED by the City Council of the City of Seward, Alaska, this 28
day of February, 2013.
THE CITY OF SEWARD, ALASKA
David Seaward, Mayor
AYES:
NOES:
ABSENT:
ABSTAIN:
ATTEST:
Johanna Kinney, CMC
City Clerk
(City Seal)
Council Agenda Statement
Meeting Date: February 28, 2013 sEN
From: u � �o
Kristin Erchinger, Finance Director
Q�ASKP
Agenda Item: Settlement of Rate Dispute with State of Alaska Related to Seward Mountain
Haven's Medicaid Rate for 2011, 2012, 2013 and 2014
BACKGROUND & JUSTIFICATION:
The City of Seward ( "City") owns the local hospital and long -tern care facility (collectively,
"PSMC ") which are operated by Providence Health & Services ( "Providence ") under management
agreement with the City. The City is financially responsible for the operations of the health facilities.
Providence has managed the long -term care facility in Seward on the City's behalf since April 2003.
Elders from the former Wesley facility were moved into the new Seward Mountain Haven ( "SMH")
facility in October 2009. The 2009 year represented a rebasing year for the purposes of establishing
Medicaid rates for the subsequent fiscal years 2011, 2012, 2013 and 2014. The State of Alaska
Department of Health and Social Services ( "State ") established the 2011 rate for the operations of
SMH at $538.44 per day. PSMC filed a Notice of Appeal to these rates on the basis of two claims.
First, PSMC objected to the application and calculation of the "lower of cost or charges limitation ".
This methodology essentially reduces the Medicaid rate to the lower of either the charges assessed to
patients for the year, or the facility's costs for the year. PSMC argued this methodology should not
be applied to Seward's rate for two reasons: 1) the 2009 year was an anomaly since charges were
much lower in 2009 based on elders residing in the old Wesley facility for 75% of the year, resulting
in charges for the year being below costs, and 2) for the most part, patients in the facility were
predominantly Medicaid patients.
Second, PSMC objected to the State's decision not to allow a correction to under- reported charges
on the MR -0 -14 Form for the period used to establish the 2011 rates, which alone would justify an
increase in the per diem rate of $137.08. While the charges were under- reported on this particular
form, they were properly reported on the Medicare forms for the same year, which the State also had
available to them when establishing the 2011 rates.
Overall, the amount in dispute is estimated at approximately $12.3 million over four years. It is
difficult to provide precise estimates of the disputed amounts based on the need to make assumptions
about things such as census at SMH, the annual rate of inflation, etc. which are used to estimate total
Medicaid payments. The parties to this dispute have been in negotiations for many months, seeking
a compromise to avoid what would likely be a very lengthy and expensive litigation process for both
sides. The State has offered to settle this matter by increasing the per diem base rate for Seward
Mountain Haven by $137.00 per patient per day, and then inflation - adjusting the base rate for fiscal
years 2012, 2013, and 2014. The estimated total increased payment to Seward Mountain Haven
resulting from this adjustment over the four -year rate cycle is approximately $6.1 million. This
figure assumes an average census of 30 elders in SMH and inflation of approximately 2.09% in 2012
and 2.29% in 2013 and 2014. The parties agree that this settlement agreement does not apportion the
settlement amount among the contested issues in the Medicaid rate appeal.
CITY OF SEWARD
RESOLUTION 2013 -
INTENT:
This purpose of this resolution is to demonstrate the City Council's support of Providence's
recommendation to settle this rate dispute with the State of Alaska. This decision is made based on
the potential downside risk associated with a prolonged legal battle, as well as the State's intent to
argue that PSMC is not entitled to either a waiver of the lower of cost or charges issue, or correction
of an error on the submitted forms used as the basis for establishing rates. In the worst case scenario,
PSMC could potentially be fighting four separate years' rate cases with each case taking an estimated
two to four years to resolve, incurring significant legal fees with the risk of an adverse legal decision.
CONSISTENCY CHECKLIST: Yes No N/A
1. Comprehensive Plan (document source here): X
2. Strategic Plan (document source here): X
3. Other (list): X
FISCAL NOTE:
This resolution supports the recommendation to approve a legal settlement with the State of Alaska
in the amount of approximately $6.1 million which will accrue to the benefit of PSMC over a four -
year period. It is fair to expect that at least $2 million of that settlement will come directly to the
City of Seward to repay a loan granted to PSMC in 2011 by the Seward City Council, and be used to
cover debt service costs of Seward Mountain Haven. The remaining funds will be available to
PSMC to cover operational shortfalls, costs, and cash flow.
Finance Department:
RECOMMENDATION:
City Council approve Resolution 2013 - authorizing general terms of settlement of a rate dispute
with the State of Alaska relating to a Medicaid rate appeal, and authorizing negotiation of a formal
settlement agreement to be brought back to the City Council for ratification.
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SETTLEMENT AND RELEASE AGREEMENT
This Settlement and Release Agreement ( "Agreement ") is entered into
between the State of Alaska, Department of Health and Social Services ( "State "),
and Providence Seward Hospital ( "Providence Seward" or "the Facility "). The
State and Providence Seward are sometimes referred to in the Agreement
collectively as the "parties ".
RECITALS
A. Providence Seward operates a combined Critical Access
Hospital and Long -Term Care facility Seward, Alaska and provides medical
assistance services to eligible persons under the Alaska Medicaid program,
AS 47.07.010, etc. seq.
B. In connection with its provision of long -term care (nursing
home /skilled nursing) medical assistance services under the Alaska Medicaid
program, Providence Seward has a pending administrative appeal of its Medicaid
long term care per diem rate before the Office of Hearing and Appeals in the
consolidated appeal entitled In the Matter of Providence Seward Medical Center,
Facility FY 2011 and FY 2013 Nursing Home Medicaid Rate, Consolidated Case
No. OAH No. 12- 0364 -MDR ( "the Appeal).
C. The parties now desire to settle all claims asserted in the
Medicaid long term care rate appeal referred to in Paragraph B, as well as claims
that Providence Seward could have asserted against the State regarding facts, such
Settlement and Release Agreement /Providence Seward Page 1 of 10
Case No. OAH No. 12- 0634 -MDR; Agency No. 2012- MRC -04
as acts or omissions that arose or existed prior to and through the datc of
settlement, that relate in any way to the claims asserted by Providence Seward in
the pending appeal related to the Medicaid per diem long term care rate to be used
for the Fiscal Years 2011, 2012, 2013, and 2014 (sometimes referred to as "the
Appeal Claims "). This Agreement is binding on the parties' successors,
transferees, and assigns to the same extent it is binding on the parties.
NOW, THEREFORE, in exchange for the mutual promises contained in
this Agreement, the parties agree as follows:
1. Release. Providence Seward hereby releases, acquits, and forever
discharges the State of Alaska, its departments, agencies and other subdivisions,
officials, officers and/or employees, partners, contractors, successors and /or
predecessors in interest, agents, attorneys, and any other persons or entities acting
through or on behalf of the State of Alaska ( "the State ") from any and all actions,
causes of action, suits, controversies, claims, demands of every kind and nature,
whether mature or to mature in the future, and whether or not the existence or
nature of any such cause of action or claim is now known or contemplated, arising
out of or relating in any respect to Providence Seward's appeal of its Medicaid
long term care rates for Fiscal Years 2011, 2012, 2013 and 2014.
2. Dismissal of Appeal.
a. Concurrently with the execution of this Agreement, the
parties shall execute a stipulation for dismissal with prejudice in In The Matter of
Providence Seward Medical Center, Facility. FY 2011 and FY 2013 Nursing Home
Settlement and Release Agreement /Providence Seward Page 2 of 10
Case No. OAH No. 12- 0634 -MDR; Agency No. 2012- MRC -04
Medicaid Rate, Consolidated Case No. OAH No. 12 -0634. The stipulation for
dismissal with prejudice will be filed with the Office of Administrative Hearings
within 15 days of the last signature on the Agreement. The parties shall take
whatever additional actions may be necessary, if any, in order to accomplish
dismissal of the subject matters with prejudice to their railing.
b. The parties shall attach a copy of the executed Settlement
Agreement to the Stipulation for Dismissal. The parties agree that incorporating
the Settlement Agreement into the Order of Dismissal is appropriate to assure a
clear and accurate record and to facilitate implementation of the Agreement. The
parties will further work together to assure the terms of this Agreement are
implemented within the time frame set forth in Paragraph 3 below.
3. Payment to Providence Seward. Payment to the Facility will be
made by adjusting the Facility's Medicaid long term care per diem base rate for
FY 2011, and recalculating the rates for FY 2012, 2013 and 2014 pursuant to 7
AAC 150.150 using the adjusted base rate for FY 2011. No adjustments will be
made to any CON add -ons to the base rate; the CON add -ons are a separate and
distinct part of the overall Medicaid long term care rate and are not part of this
appeal or its settlement.
a. The adjusted Medicaid long term care base rates for
Providence Seward Medical Center's nursing home are established as follows (the
rates for Fiscal Years 2012 and 2013 include adjustment for inflation):
FY 2011: $674.41
Settlement and Release Agreement /Providence Seward Page 3 of 10
Case No. OAH No. 12- 0634 -MDR; Agency No. 2012- MRC -04
FY 2012: $688.45
FY 2013: $704.16
FY 2014 $704.16 plus adjustment for inflation under
7 AAC 150.150
b. The final long term care per diem rates, including the
previously established CON add -ons, are:
FY 2011: 674.41 + CON 193.70 = Final Rate $867.81
FY 2012: 688.45 + CON 192.96 — Final Rate $881.41
FY 2013: 704.16 + CON 192.77 = Final Rate $896.93
FY 2014: 704.16 + inflation adjustment + CON to be established.
c. The parties agree that payment to the Facility will be made as
follows:
(i). The Facility's Medicaid claims for services provided
in Fiscal Years 2011, 2012 and 2013 which have been paid through the date of the
final signature of this Agreement at the prior long term care rate will be
reprocessed at the final long term care rates established above in paragraph b.
(ii). Timely -filed Medicaid claims for services provided
during Fiscal Years 2012 and 2013 that are to be paid at the long term care rate but
have not been paid as of the date of final signature of this Agreement, and all
timely -filed Medicaid claims for services provided during Fiscal Year 2014 that
are to be paid at the long term care rate, will be processed at rates set established
above in paragraph b.
Settlement and Release Agreement /Providence Seward Page 4 of 10
Case No. OAI1 No. 12- 0634 -MDR; Agency No. 2012- MRC -04
(iii) The timing of the reprocessing of claims is dependent
upon the ability of the department to schedule the reprocessing into the claims
payment process, but the reprocessing will be done as soon as possible given the
constraints of the claims processing system, but no later than December 31, 2013.
Enforcement of the Agreement, including the release, is dependent upon payment
to the Facility under this Paragraph.
4. Effect of Settlement. The parties agree that this Settlement
Agreement is a comprehensive and final settlement for Providence Seward's
Medicaid long term care rates for its Fiscal Years 2011 — 2014. The parties agree
that this Agreement does not apportion the settlement amount among the contested
issues in the Appeal.
The parties agree that this Agrcernent does not have, and may not be
read to have, any impact of any kind on the Medicaid rates established for any
year subsequent to Providence Seward's FY 2014.
The parties agree that nothing in this Agreement is intended to affect
the claims or defenses of any person or entity other than the parties to this
Agreement. This Agreement may not be used as precedent for similar or dissimilar
issues raised by Providence Seward or any other facility in an appeal of its
Medicaid rates.
5. Fees and Costs. Each party will bear its own costs, attorneys'
fees and consultants' fees.
Settlement and Release Agreement /Providence Seward Page 5 of 10
Case No. OAII No. 12- 0634 -MDR; Agency No. 2012- MRC -04
6. Complete Agreement. The parties intend this Agreement to
incorporate the complete settlement between the parties with respect to all issues
raised in the pending appeals that are the subject of this settlement and as further
set forth in Paragraph 1 above. All prior negotiations, representations, and
agreements, whether written or oral, are hereby merged into this Agreement. This
Agreement may only be amended by a signed writing executed by both parties,
which specifically refers to this Agreement.
7. No Admission. This Agreement is the result of the compromise
of disputed claims and does not constitute an admission of liability by either party
to this Agreement. Specifically, the parties acknowledge that there has been no
agreement between them on the legal issues. Nothing in this Agreement
constitutes an admission regarding any issue of law or fact by the parties and no
party may make a statement or publication which attributes, infers, or implies fault
or liability to any of the parties.
8. Construction /Severability: This Agreement is made and entered
into in the State of Alaska and shall in all respects be interpreted, enforced, and
governed by and according to the laws of Alaska. Each party acknowledges that
the terms of this Agreement are contractual and not mere recitals, and further
represent that they have read them carefully, fully understand them, and
voluntarily accept them for the purposes of making a full and final compromise of
the Appeal Claims for the Facility's FYs 2011, 2012, 2013 and 2014.
Settlement and Release Agreement /Providence Seward Page 6 of 10
Case No. OAH No. 12- 0634 -MDR; Agency No. 2012- MRC -04
All parts of this Agreement shall be construed fairly according to their
terms. No presumption shall be applied for or against either party based on which
party originated the documents or drafts thereof. Paragraph headings are for
convenience only and shall not be construed to alter or otherwise affect the
meaning of the text of any section. Should any provision of this Agreement be
declared or determined by any court of competent jurisdiction to be illegal,
invalid, or unenforceable, the legality, validity, and enforceability of the remaining
provisions shall not be affected thereby, and said illegal, invalid, or unenforceable
part, term, or provision shall be deemed not to be a part of this Agreement,
provided that the parties agree that the court shall, if possible, construe this
Agreement so as to give full force and effect to each of its provisions.
The pending rate appeal referred to in the Recitals at Paragraph B above did
not involve any allegations or proof of, or defenses to, any claims of potential or
actual administrative, civil, or criminal liability relating to any alleged wrongful
receipt of Medicaid payments from the State of Alaska. Therefore, any such
allegations, claims, proof, and defenses are outside the scope of this agreement.
This agreement does not address in any way potential or actual wrongful actions
by the Facility relating to participation in the Alaska Medicaid program. Nothing
in this Agreement will be used to bar the State or federal government from
administrative, civil, and/or criminal sanctions for, or relating to, wrongful actions
by the Facility, or any person or entity, under the Alaska Medicaid program.
Failure by the Facility to follow Medicaid billing practice requirements, or other
Settlement and Release Agreement /Providence Seward Page 7 of 10
Case No. OAH No. 12 -0634 -MDR; Agency No. 2012- MRC -04
Medicaid requirements, during the Facility's participation in the Alaska Medicaid
program is outside the scope of this Agreement, and this Agreement is not a bar to
collection by the State from the Facility of amounts, if any, owed by the Facility to
the State because of the Facility's failure to follow Medicaid billing practice
requirements, or other Medicaid requirements, of the Alaska Medicaid program.
Nothing in this Agreement shall be construed as a limitation of any kind of any of
the rights and privileges of the Facility to oppose through proper legal process any
claim of failure by the Facility to follow Medicaid billing practice requirements, or
other Alaska Medicaid Program requirements, during the Facility's participation in
the Alaska Medicaid program, if such claim is made by the State in the future.
IN WITNESS WHEREOF, the parties have executed this Settlement and
Release Agreement on the respective dates set forth opposite their signatures.
PROVIDENCE SEWARD MEDICAL CENTER
Date: By: -.
Joseph Fong
Administrator
PROVIDENCE HEALTH & SERVICES ALASKA
Date: By:
Sean McCallister
Operations Administrator
Critical Access I lospitals
Settlement and Release Agreement /Providence Seward Page 8 of 10
Case No. OAH No. 12 -0634 -MDR; Agency No. 2012- MRC -04
DAVIS WRIGHT TREMAINE
Date: By:
Jon S. Dawson
Attorneys for Providence Seward Medical Center
STATE OF ALASKA DEPARTMENT OF
HEALTH AND SOCIAL SERVICES
Date: By:
Jared Kosin, ED, Office of Rate Review
Department of Health and Social Services
MICHAEL C. GERAGHTY
ATTORNEY GENERAL
Date: By:
Linda L. Kesterson
Assistant Attorney General
Attorneys for the State
Settlement and Release Agreement /Providence Seward Page 10 of 10
Case No. OAFI No. 12- 0634 -MDR; Agency No. 2012- MRC -04
2 BEFORE THE ALASKA OFFICE OF ADMINISTRATIVE HEARINGS ON
REFERRAL BY THE COMMISSIONER OF HEALTH AND SOCIAL SERVICES
3
In the Matter of )
5 )
PROVIDENCE SEWARD MEDICAL CENTER )
6 ) Consolidated Case
Facility. ) OAFI No. 12- 0634 -MDR
7 )
FY 2011 and FY 2013 Nursing Home Medicaid Rate )
8 )
9
10 STIPULATION FOR DISMISSAL
11 Pursuant to the attached Settlement Agreement, the parties to this matter
12 have reached a settlement of all outstanding issues. The parties hereby stipulate and
13 agree that this matter be DISMISSED, with prejudice.
14
DATED: MICHAEL C. GERAGIITY
15 ATTORNEY GENERAL
16
17 By:
Linda L. Kesterson
18 Assistant Attorney General
Alaska Bar No. 9006025
$ 19 Attorneys for State of Alaska
W = y$'o " 20 _ 8 ° DATED: DAVIS WRIGIIT TREMAINE
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c U § a 23 Alaska Bar No. 8406022
o Attorneys for Providence SF,WARD
E 24 Medical Center
25
26