HomeMy WebLinkAbout1988-099
, .
"
,At
, ,
"
~.
1
2
RESOLUTION NO.
RR q q
RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE
3 EXECUTION OF AN AMENDMENT TO THE PREFERRED PROVIDER AGREEMENT
4 WITH SAINT BERNARDINE HOSPITAL FOR MEDICAL AND HOSPITAL CARE
BENEFITS FOR ACTIVE AND RETIRED CITY EMPLOYEES.
5
AND COMMON COUNCIL OF
THE
BE IT RESOLVED BY THE MAYOR
6 CITY OF SAN BERNARDINO AS FOLLOWS:
7
8
SECTION 1. The Director of Personnel is hereby author-
ized and directed to execute on behalf of said City an
9 amendment to the Preferred Provider agreement with Saint
10 Bernardine Hospital, relating to employees' medical and
11 hospital care benefits, effective January 1, 1988, which
12 agreement is attached hereto, marked Exhibit nAn, and
13 incorporated herein by reference as fully as though set
14 forth as length.
15
I HEREBY CERTIFY that the foregoing resolution was duly
16 adopted by the Mayor and Common Council of the City of San
17 Bernardino at a reqular
18 the 21st of March
19 to wit:
meeting thereof, held on
, 1988, by the following vote
20
21
22
23
24
25
26
AYES:
Councilmembers Reilly Florp." M;l11n"lpy
PODe-Ludlam, Millp.r
NAYS:
None
ABSENT:
Council Members F.~trRnRr Minor
~/H2d/~~
/City Clerk
27
(Continued)
28 Page
2-17-88
.
'I'
1
2 The foregoing resolution is hereby approved this
.z.211/
3 day of
March
, 1988.
4
5
6
7 Approved as to form and legal content:
8 .uL
9 Attorney
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27 Page 2
28 2-17-88
. .
,
.......:;- .w.",', .....,,_.......:. .... ',.'~' ...._... .....-.
F!(Jlf
J/
AMENDMENT TO PREFERREO PROVIDER AGREEMENT
BETWEEN
CITY OF SAN BERNARDINO
AND
ST. BERNARDINE MEDICAL CENTER
The parties to the Preferred Provider Agreement entered into effective January
1. 1987. hereby amend the Hospital compensation rates as per new Exhibit "B"
attached herein by reference.
This Amendment shall be effective for health care services rendered on or
after January 1. 1988.
:::,~~L CCR
Title: Administrator ~
Date: }j,S/ft
(
CITY~AN BERNARD~ "
By: ~!~. l;J~
Title: Mayor
Date: ~jJ <. /1? Y
By:
Title:
~//47/1/ &.LUb'
./
City Clerk
Date:
~Ju:/ /., /9' j) Y
" '. ~ _ _. ._ '. ... .._.' ,__...... ." a...
EXHIBIT "B"
PAYMENT SCHEDULE
Refer to Exhibit B.1, B.2, and B.3 attached.
THIS EXHIBIT IS EFFECTIVE FOR SERVICES RENDERED ON OR AFTER JANUARY I, 1988.
J HOSPITAL
By,l/f~
Title: Administra or
Date of Signature: J!ttJ/f1-
::~ t;'"~j<j
Tltle: Mavor
Date of Signature: ~j,/fJ:r
By: ~.d&Z-~~
./
Title: City Clerk
Date of Signature: ~!.,j'l'r
.:.,.:.. ~'.. .;'.: .'':,....> .J .. .. . .... .",M" ~
.
.
Exhibit 81 - Attach.ent I
ORB PER CASE
ST. BERNARDINE HOSPITAL
MEDICARE PROVIDER NO. 050128
Percentage of Charges
to be used
with DRG Per Case Rates
H1U!!!:I
fr!!2!!!!~ f!r~!nl!l! !!1 ~h!rl!!
DRG 468 DEATHS AND TRANSPERS
75 ,
Outpatient Services
90 ,
Ellergency RoolI
Clinics
A.bulatory Surgery
Other Outpatient Service
90 ,
90 ~
90 ,
90 ,
NOTE: The proposed percentage discount for Outpatient
Services (90" reflects the Cact that Outpatient
Services are already reduced Cro. those applicable
to the rates proposed Cor Inpatient Service..
,-..o....',..... .~..... _...~... .;.
~.. ............
!!~~A!n!!~~I
EKG
BEO
.
ftI
BXHIBIT B.2
PHYSICIAN PBBS INCLUDBD IN PAYMBNT RAT!
~!iQQ~!!!!!i~!
EKG
Rhytha Strip
VCG's
CPR's
EEG
OPG
Echocardiograas
Stresa Test (Treadaill)
pace.aker
Holter Monitor
CARDIOVASCULAR
PULMONARY LAB
Spiroaetry w/Bronch
Residuai Air
Spiroaetry
Screening
DLCO
Exercise Tolerance
Stress Test(Tread.ill)
CARDIAC REHABILITARION
Professional Pee
OUTPATIENT CLINIC
I:"-:~',
. .
. r4-
,
. - .
.11.. 'II ,1 L.__1i _'.~
__;. . .~''''~'1~t,..1",,~~''7~/v-~~.~''f.-,.
... .~~"1'~",''''....-~;r''' ~......- 'T.'~ '''-.'It.....~...~'
Exhibit B.3
ST. BBRNARDINE HOSPITAL
MEDICARE PROVIDBR NO. 050129
SBRVICBS NOT AVAILABLE AT ST. BERNARDINB HOSPITAL
103 HEART TRANSPLANT
302 KIDNEY TRANSPLANT
351 STERILIZATION, MALE
359 TUBAL INTERRUPTION FOR NON-MALIGNANCY
362 LAPAROSCOPIC TUBAL INTERRUPTION
457 EXTENSIVE BURNS
PREFERRED PROVIDER AGREEMENT
THIS PREFERRED PROVIDER AGREEMENT is
Bernardino (hereinafter "city"), and st.
hospital licensed under the laws of the
after "Hospital").
by and between City of San
Bernardine Medical Center, a
State of California (herein-
I.
DEFINITIONS
1.1 "Benefit Agreement" means the written or verbal contract
entered into between the City and its Employees that establishes city's
obligations to its Employees for payment for medical, hospital, and
other health care benefits.
1.2 "Employee" means any person who is covered under City's
Benefit Agreement.
II.
HOSPITAL PERFORMANCE PROVISIONS
2.1 Hospital shall provide those services that it customarily and
usually provides to the pUblic. Hospital agrees (1) to not
differentiate or discriminate in the access to, treatment of, or
quality of services delivered to Employees on the basis or race, color,
national origin, sex, age, religion, ancestry, marital status, sexual
orientation, place of residence, health status, or source of payment
and (2) to render health services to all Employees in the same manner,
in accordance with the same standards and within the same time
availability as offered its other patients.
2.2 In no event is Hospital obligated to provide any services in
contravention of the Ethical and Religious Directive for Catholic
Health Facilities, a copy of which has been given to City and is
incorporated herein.
2.3 Exhibit "B", which is the payment provision, shall indicate
what physician services are to be included in the rates of Exhibit "B".
Except as affirmatively stated in Exhibit "B", Hospital shall not be
responsible for assuring that Employees will be able to obtain
physician services, including hospital-based physician services.
2.4 Hospital hereby represents and warrants that it is currently,
and for the duration of this Agreement shall remain: (1) licensed as a
general acute care hospital in accardance with state licensing
provisions, (2) accredited by JCAH, and (3) certified as a Medicare and
Medicaid provider.
PREFERRED PROVIDER AGREEMENT
Between city of San Bernardino and st. Bernardine Medical Center
Page 2
III.
CITY PERFORMANCE PROVISIONS
3.1 City shall alter its Benefit
"Financial Incentives" for its Employees
other hospitals in the area. Such
provide, at a minimum that:
Agreement to provide
to use Hospital rather
"Financial Incentives"
for
than
shall
(a) There shall be no deductible amount owed by the Employee
when receiving medically necessary, covered hospital services from
Hospital, but there shall be at least a one hundred dollar
($100.00) deductible when receiving such services from another
hospital; and
(b) There shall
Employee when receiving
services from Hospital,
(10%) coinsurance amount
hospital.
3.2 City shall provide Hospital with the complete Benefit Agree-
ment and a summary statement of the Benefit Agreement. City shall
provide Hospital with any and all amendments, modifications, and
revisions to the Benefit Agreement that materially affect this Agree-
ment prior to the date such amendments, modifications, and revisions
become effective.
be no coinsurance amount owed by the
medically necessary, covered hospital
but there shall be at least a ten percent
when receiving such services from another
3.3 City shall supply Employees with an identification card or
other means of indicating coverage under the Benefit Agreement. city
shall also supply with the card or other method a phone number where
eligibility and coverage questions will be answered. Hospital shall
make a reasonable effort to confirm that the individual presenting an
identification card is in fact the individual whose name appears on the
identification card.
IV.
SERVICE LOCATION
Hospital shall provide
within those facilities listed in
city of any changes to Exhibit "A"
health care services to Employees
Exhibit "A". Hospital shall notify
prior to their effective date.
V.
PAYMENT
5.1 Hospital shall accept the amounts specified in Exhibit "B",
which is attached hereto and incorporated herein, as ;full payment for
all health care services provided to Employees in accordance with the
Benefit Agreement, except where Hospital may bill and collect its usual
charges for the provision of non-covered and not medically necessary
services and coordination of benefit payments.
PREFERRED PROVIDER AGREEMENT
Between City of San Bernardino and st. Bernardine Medical Center
Page 3
5.2 During the inital three year term of this Agreement, the per
diem rates stated in Exhibit B shall increase on the two annual anni-
versaries of the commencement of this Agreement by the same amount as
then most recently published California Hospital price Index but not
more than seven (7%) annually. This mechanism will continue into
renewal terms unless the parties agree otherwise.
5.3 If an Employee requests services from Hospital that are not
covered or not medically necessary under the Benefit Agreement,
Hospital is entitled to enter into an agreement with the Employee to
provide such services at the Hospital's then usual charges.
5.4 Hospital must accept assignment of benefits as a condition
precedent to City's payment. Hospital may use its customary assignment
form. If an Employee refuses to asslgn a benefit claim upon the
Hospital's request and Hospital has reason to believe the Employee will
not honor the bill, Hospital may collect the amounts otherwise due from
City from the Employee at the time of service. Hospital may also
collect amounts for the provision of non-covered and not medically
necessary services at the time of service.
5.5 Although City retains the right to review all claims (includ-
ing) inpatient, outpatient, emergency, or otherwise) retrospectively to
determine whether services rendered were covered by the Benefit Agree-
ment including retrospective review of whether the services were
medically necessary, City acknowledges and agrees that utilization
review and quality assurance determinations that services rendered were
not covered or medically necessary under the Benefit Agreement shall
not limit Hospital's right to payment in full unless prior to
Hospital's rendition of such services (i) Hospital had reason to know
such services were not covered or medically necessary under the Benefit
Agreement, or (ii) Hospital was notfied that such services were not
covered or medically necessary under the Benefit Agreement. In no
event shall there be a retroactive denial of claims for (i) emergencies
as defined by the Benefit Agreement or (ii) services rendered for
approved admissions and lengths of stay. Hospital acknowledges and
agrees that Hospital shall not be paid for inpatient services furnished
past a Patient's approved length of stay or approved extension thereof.
Nothing in this Agreement is intended to, nor shall be construed to
alter or otherwise restrict Hospital's right to conduct its own utili-
zation review for its own purposes.
VI.
BILLINGS
6.1 Hospital shall submit all bills on its customary billing
forms and use its customary billing procedures. Billings shall include
identifying patient information, diagnosis, and itemized records of
services and charges even though the only amout due to Hospital by City
is the payment set forth in this Agreement.
PREFERRED PROVIDER AGREEMENT
Between City of San Bernardino and st. Bernardine Medical Center
Page 4
6.2 Hospital shall submit its bills no later than thirty (30)
days after the service is rendered or the discharge of the Employee,
whichever is later. In the event Hospital is unable to submit bills
within the time specified herein because of circumstances beyond its
control, the time for submission of such bill shall be extended as
reasonably necessary from the date such bills would be required to be
submitted in the absence of such circumstances.
6.3 Pursuant to its usual procedures
Employee or responsible party for that portion
for which the Employee or responsible party is
Hospital may bill the
of the Hospital charges
responsible.
6.4 In the event City is a secondary payor under the Benefit
Agreement, city's liability established by the rates of this Agreement
shall be reduced in accordance with the Benefit Agreement. It shall be
the responsibility of the Hospital to attempt to collect payment from
the primary payor, following the Hospital's customary collection
procedures with respect thereto and being free to bill the Hospital's
then usual charges to the primary payor without being limited in such
collection by the rates agreed to under this Agreement. On the other
hand, if City is the primary payor and there is a secondary payor, the
Hospital may attempt to collect its usual charges from the secondary
payor without being limited in such collection by the rates agreed to
under this Agreement.
6.5
completed
be paid)
due.
within fifteen (15) days of City's receipt of Hospital's
bill and evidence of assignment, City shall pay (or cause to
or advise Hospital of the reason for nonpayment of the amount
VII.
INDEPENDENT RELATIONSHIP
No provision of this Agreement is intended to create nor
shall be deemed or construed to create any relationship between City
and Hospital solely for the purpose of effecting the provisions of this
Agreement. Neither of the parties hereto, nor any of their respective
employees, shall be construed to be the joint venturer, partner, agent,
employee, or representative of the other.
VIII.
INSPECTION OF RECORDS AND AUDITS
8.1 Hospital shall maintain with respect to each Employee
rece1v1ng health care a hospital medical record in such form,
containing such information, and preserved for such time period(s) as
are required by the rules and regulations of the California Department
of Health, the federal Medicare Program, and the Joint commission on
Accreditation of Hospitals.
PREFERRED PROVIDER AGREEMENT
Between City of San Bernardino and st. Bernardine Medical Center
Page 5
8.2 It is understood that the medical records referred to in
Section 8.1 above shall be and remain the property of Hospital and
shall not be removed or transferred from Hospital except in accordance
with applicable California and Federal law and regulations promulgated
thereto and Hospital rules and regulations. In accordance with
procedures required by law, Hospital shall permit City to inspect and
make copies of said records, and shll provide copies of such records to
City upon request. City shall reimburse Hospital for all reasonable
costs incurred by Hospital as a result of such record duplication.
8.3 City or its designated representative shall at City's own
cost and expense have the right to investigate and audit whether
Hospital's bill accurately reflects the services actually provided.
Hospital shall cooperate with this audit by making available all
necessary files and records pertinent to the particular bill(s) being
audited as may be reasonably requested. Any such audit or investiga-
tion shall be carried out without requiring Hospital to reveal any
physician-patient confidential information not otherwise subject to
disclosure pursuant to law or the Employee's consent.
IX.
PROMOTION AND LISTING OF HOSPITAL
9.1 City shall list the name, address and telephone number of
Hospital, provide a description of the facilities and services provided
by Hospital, and provide a description of the Financial Incentives for
Employees to use Hosptial under this Agreement in all communications
from City to its Employees regarding the Benefit Agreement.
9.2 Nothing in this Agreement shall prohibit Hospital from
appealing to Employees through individual solicitation or general
public advertising to use Hospital rather than other providers as long
as City approved the solicitation or advertising and any applicable
governmental approval is obtained. To this end City will offer
reasonable cooperation (e.g., Employee mailing lists).
X.
TERM OF AGREEMENT
10.1 The Term of this Agreement shall be for three (3) years
commencing on January 1, 1987, provided Hospital has the right upon at
least ninety (90) days written notice to terminate this Agreement, with
or without cause, effective on either of the two annual anniversaries
of this Agreement. This Agreement shall automatically renew on a year
to-year basis thereafter unless either party, with or without cause,
gives at least ninety (90) days written notice prior to the expiration
of the then current term.
PREFERRED PROVIDER AGREEMENT
Between City of San Bernardino and st. Bernardine Medical Center
Page 6
10.2 As a conditon precedent to the City's exercise of its right
during any renewal term to the without cause termination provision
under Section 10.1 for the purpose of contracting with another hospital
provider located within the area set forth in Exhibit "c", city shall
allow Hospital sixty (60) days to agree to prices no less favorable to
city than those offered by the other Hospital. If Hospital agrees to
accept those prices, Exhibit B of this Agreement shall be renewed to
incorporate such prices with all other terms remaining as set forth
herein and the City will not contract with the other hospital.
10.3 Either party shall have the right to terminate this Agreement
upon providing thirty (30) days prior written notice to the other party
if the Party to whom such notice is given materially breaches any
provision of this Agreement. The party claiming the right to terminate
hereunder shall set forth in the notice of intended termination
required hereby the facts underlying its claim that the other party is
in breach of this Agreement. Remedy of such breach within twenty (20)
days of the receipt of such notice shall revive the Agreement in effect
for the remaining term, subject to any other rights of termination
contained in this Paragraph or in any other provision of this Agree-
ment.
10.4 As of
Agreement shall
and each of the
except that:
the date of termination
be considered of no further
parties shall be relieved
of this Agreement, this
force of effect whatsoever
and discharged herefrom,
A. Termination shall have no effect upon the rights and obliga-
tions of the parties arising out of any transactions occurring prior to
the effective date of such termination.
B. Hospital and City shall remain liable for any obligations or
liabilities arising from activities carried on by such party or its
agents, servants, or employees during the period this Agreement shall
have been in effect.
C. In the event an Employee is an admitted inpatient of Hosptial
as of the date of termination of this Agreement, Hospital reimbursement
for services rendered during the period the Employee remains as an
admitted inpatient of Hospital will continue to be governed by the
applicable terms of this Agreement. Hospital shall be compensated in
accordance with this Agreement for all health care services rendered by
Hospital to an Employee on the date of the termiantion of this Agree-
ment and until such time as appropriate transfer or discharge (or other
medically acceptable disposition) of Employees receiving inpatient
services on the date of termination is completed.
PREFERRED PROVIDER AGREEMENT
Between City of San Bernardino and st. Bernardine Medical Center
Page 7
XI.
NOTICES
Any notice required to be given pursuant to the terms and
provisions hereof, unless otherwise indicated herein, shall be in
writing and shall be sent by certified mail, return receipt requested,
postage prepaid, to the addresses listed below. Notices shall be
deemed received upon receipt by the addressee.
XII.
MODIFICATIONS
It is the express intention of City and Hospital that the
terms of this totally integrated writing shall comprise the entire
Agreement between the parties and it shall not be subject to
rescission, modification, or waiver except as defined in a subsequent
written instrument executed by both parties hereto. In furtherance of
this Agreement, City and Hospital mutually covenant and request of any
reviewing tribunal that any claim of rescission, modification, or
waiver predicated upon any evidence other than a subsequent written
instrument executed by the parties hereto shall be regarded as void.
XIII.
ASSIGNABILITY
Neither this Agreement nor any right
assigned, transferred, or otherwise conveyed by
the prior written acceptance of the other.
hereunder shall be
either party without
XIV.
PARTICIPATION IN ALTERNATIVE HEALTH CARE PROGRAMS
Nothing contained in this Agreement shall prevent Hospital
from participating in or contracting with any insurer, preferred
provider organization, health maintenance organization, or otherwise
entering into contracts regarding health care delivery with any other
entity. During the term of this Agreement however, City agrees that
with the exception of contracts for services that the Hospital will not
perform under the Ethical and Reliqious Directives for Catholic Health
Facilities, City will not contract with any hospital provider of health
care services that is physically located within the geogrpahic area
defined by Exhibit C, attached hereto and incorporated herein. If,
during the term of this Agreement or any extension thereof, the
Hospital's service area is expanded, Hospital shall have a right of
first refusal to be the exclusive provider of covered services and
benefits to patients within the expanded service area on terms no less
favorable to city than are available from other providers of covered
services and benefits. If, prior to the expansion of the Hospital's
service area, however, city has executed contracts with one or more
providers of covered services and benefits within the expanded service
~..
PREFERRED PROVIDER AGREEMENT
Between City of San Bernardino and st. Bernardine Medical Center
Page 8
area, Hospital shall have the right
covered services and benefits to
nonexclusive basis under terms no
the other hospital.
to contract with
patients within
less favorable to
and to provided
such area on a
Hospital than to
xv.
INVALIDITY OR UNENFORCEABILITY
The
hereof shall
other term or
invalidity
in no way
provision.
or unenforceability of any terms or provisions
affect the validity or enforceability of any
XVI.
THIRD PARTY BENEFICIARIES
Hospital and City agree that Employees to whom
services are provided by Hospital and for which Hospital is
hereunder shall not be third party beneficiaries of the
obligations assumed by either party hereto.
health care
compensated
rights and
XVII.
BUSINESS INTERRUPTION
In the event the operations of either party's facilities or
any substantial portion thereof are interrupted by war, fire, insurrec-
tion, labor troubles, riots, the elements, earthquakes, acts of God,
or, without limiting the foregoing, any other cause beyond their power,
each provision of this Agreement that is rendered incapable of per-
formance shall be suspended for the duration of such interruption. If
a substantial part of the services which either party has agreed to
provide is interrupted for a period in excess of sixty (60) days,
however, the other party shall have the right to terminate this
Agreement upon twenty (20) days' written notice.
XVII.
WAIVER
The informal toleration by either party of defective per-
formance of any provision of this Agreement shall not be construed as a
waiver of either the right to performance or the express conditions
which have been created in this Agreement.
XIX.
COUNTERPARTS
This Agreement may be executed
shall be deemed to be an original, but
constitute one and the same agreement.
in counterparts, each of which
all of which together shall
..~..;.-;....:.."',,....',:,..,.~'.~;"..- ....._...~-.. ~ ....-....,',. '-. .::.~..;:.~:.:.;.- ..::.:.:.'......:.:....;._.~......:.:
......~......_:,..."...'-;_.. - ::.;.:":......'.,- ....~ .:':.-...:.'~... ..,. ."-' ......,- .,.....-.. ..-..... ""''- '.
...' .:-- ",-.:,:','.
LLF Draft: 11/5/86
THIS AGREEMENT SHALL BE EFFECTIVE FOR HEALTH CARE SERVICES REN-
DERED ON OR AFTER: Januarv 1. 1987 (Date).
ST. BERNARDINE ~~RXnL 5"",N")>
MEDICAL CENTER
CITY OF SAN BERNARDINO
By' )n . 'vlo-roJ J! Iv.f"O.A-"
Tit e:
Date of Signature:
~
By:
Title: !r;:l!
Date 0 g ture: ~-I u-F
2101
1&11 N. Waterman Avenue
San Bernardino. CA 92404
(714)883-8711
FFF6417 !7
i'~m:-
10
ST. BERNARDIN~ MEDIC~L CENTER
DRG 001
DRG 002
DRG 003
DRG 004
ORG 005
ORG 006
DRG 007
'eRG 008
DRG 009
DRG 010
DRG 011
DRG 012
DRG 013
DRG 014
DRG 015
ORG 016
DRG 017
ORG 018
DRG 019
DRG 020
DRG 021
DRG 022
DRG 023
DRG 024
DRG 025
DRG 026
DRG 027
ORG 028
DRG 029
DRG 030
DRG 031
DRG 032
DRG 033
ORG 034
DRG 035
DRG 036
DRG 037
DRG 038
DRG 039
DRG 040
DRG 041
DRG 042
DRG 043
DRG 044
DRG 045
DRG 046
DRG 047
DRG 048
DRG 049
DRG 050
MEDICARE PROVIDER NO.: 050129
EXHIBIT 1/29/88
ORG PER CASE RATES
DIAGNOSIS RELATED GROUP (ORG2)
PROPOSED
RATE/CASE
CRANIOTOMY AGE ):18 EXCEPT FOR TRAUMA
CRANIOTOMY FOR TRAUMA AGE ):18
CRANIOTOMY AGE {18
SPINAL PROCEDURES
EXTRACRANIAL VASCULAR PROCEDURES
CARPAL TUNNEL RELEASE
PERI PH . CRANIAL NERVE' OTHER NERV SYST PROC AGE ):70 AND/OR C.C.
PERIPH . CRANIAL NERVE' OTHER NERV SYST PROC AGE {70 W/O C.C.
SPINAL DISORDERS' INJURIES
NERVOUS SYSTEM NEOPLASMS AGE ):70 AND/OR C.C.
NERVOUS SYSTEM NEOPLASMS AGE (70 W/O C.C.
DEGENERATIVE NERVOUS SYSTEM OISOROERS
MULTIPLE SCLEROSIS' CERE8ELLAR ATAXIA
SPECIFIC CERE8ROVASCULAR OISOROERS EXECEPT TIA
TRANSIENT ISCHEMIC ATTACKS
NONSPECIFIC CEREBROVASCULAR OISOROERS WITH C.C.
NONSPECIFIC CEREBROVASCULAR DISOROERS W/O C.C.
CRANIAL' PERIPHERAL NERVE OISOROERS AGE ): 70 AND/OR C.C.
CRANIAL' PERIPHERAL NERVE OISOROERS AGE {7- W/O C.C.
NERVOUS SYSTEM INFECTION EXCEPT VIRAL MENINGITIS
VIRAL MENINGITIS
HYPERTENSIVE ENCEPHALOPATHY
NONTRAUMATIC STUPOR' COMA
SEIZURE' HEAOACHE AGE ):70 ANO/OR C.C
SEIZURE' HEAOACHE AGE 18-69 W/O C.C.
SEIZURE' HEADACHE AGE 0-17
TRAUMATIC STUPOR' COMA, COMA )IHR
TRAUMATIC STUPOR' COMA, COMA {I HR AGE ):70 ANO/OR C.C.
TRAUMATIC STUPOR' COMA {I HR AGE 18-69 W/O C.C.
TRAUMATIC STUPOR' COMA {I HR AGE 0-17
CONCUSSION AGE ):70 AND/OR C.C.
CONCUSSION AGE 18-69 W/O C.C.
CONCUSSION AGE 0-17
OTHER OISOROERS OF NERVOUS SYSTEM AGE ):70 ANO/OR C.C.
OTHER DISORDERS OF NERVOUS SYSTEM AGE {70 W/O C.C.
RETINAL PROCEDURES
ORBITAL PROCEDURES
PRIMARY IRIS PROCEOURES
LENS PROCEOURES
EXTRAOCULAR PROCEDURES EXCEPT OR81T AGE ):18
EXTRAOCULAR PROCEDURES EXCEPT ORBIT AGE 0-17
INTRAOCULAR PROCEDURES EXCEPT RETINA, IRIS' LENS
HYPHEMIA
ACUTE MAJOR EYE INFECTIONS
NEUROLOGICAL EYE OISOROERS
OTHER OISOROERS OF THE EYE AGE ):18 W/O C.C.
OTHER DISORDERS OF THE EYE AGE ):70 ANO/OR CC
OTHER OISOROERS OF THE EYE AGE 0-17
MAJOR HEAD , NECK PROCEOURES
SIALOAOENECTOMY
I 13,995
I 9,993
I 75\
I 10,559
I 8,016
I 75\
I 75\
I 75\
I 75\
I 6,983
I 75\
I 3,990
I 75\
I 7,148
I 2,976
I 75\
I 75\
I 16,217
I 75\
I 6,463
I 75\
I 75\
I 75\
I 5,097
I 1,807
I 75\
I 75\
I 75\
I 75\
I 75\
I 75\
S 75'
I 75\
I 75\
I 75\
I 3,982
I 75\
I 75\
I 75\
I 75\
I 75\
I 3,14l
I 75\
I 75\
I 75\
I 75\
I 75\
I 75\
I 13,860
I 75\
ST. ~ERNARDINE "EDICAL CENTER
DRG 051
DRG 052
DRG 053
DRG OS.
DRG 055
DRG 056
DRG 057
'DRG 058
DRG 059
DRG 060
DRG 061
DRG 062
DRG 063
DRG 064
DRG 065
DRG 066
DRG 067
DRG 068
DRG 069
DRG 070
DRG 071
DRG 072
DRG 073
DRG 074
DRG 075
DRG 076
DRG 077
DRG 078
DRG 079
DRG 080
DRG 081
DRG 082
DRG 083
DRG 08.
DRG 085
DRG 086
DRG 087
DRG 088
DRG 089
DRG 090
DRG 091
DRG 092
DRG 093
DRG 09.
DRG 095
DRG 096
DRG 097
DRG 098
DRG 099
DRG 100
"EDICARE PROVIDER NO. " 050129.
EXHIBIT 1/29/8
DRG PER CASE RATES
DIAGNOSIS RELATED GROUP (DRG2)
PROPOSED
RATE/CASE
SALIVARY GLAND PRDCEOURES EXCEPT SIALOADENECTO"Y
CLEFT LIP' PALATE REPAIR
SINUS' "ASTOID PROCEDURES AGE )'18
SINUS' "AS TOlD PROCEDURES AGE 0-17
"ISCELLANEOUS EAR, NOSE' THROAT PROCEDURES
RHINOPLASTY
T'A PRDC EXCEPT TONSILLECTO"Y 'lOR ADENDIDECTO"Y AGE )'18
T'A PROC EXCEPT TONSILLECTO"Y 'lOR ADENOIOECTO"Y AGE 0-17
TONSILLECTO"Y AND/OR ADENOIDECTOR"Y AGE )'18
TONSILLECTO"Y AND/OR ADENOIDECTO"Y 0-17
"YRINGOTD"Y AGE )'18
"YRINGOTO"Y AGE 0-17
OTHER EAR, NOSE' THROAT D.R. PROCEDURES
EAR, NOSE' THROAT "ALIGNANCY
DYSEQUILlBRIU"
EPISTAXIS
EPIGLOTTITIS
OTITIS "EDIA , URI AGE )'70 AND/OR C.C.
OTITIS "EDIA , URI AGE 18-69 W/O C.C.
OTITIS "EDIA , URI AGE 0-17
LARYNGOTRACHEITIS
NASAL TRAU"A , DEFOR"ITY
OTHER EAR, NOSE' THROAT DIAGNOSES AGE )'18
OTHER EAR, NOSE' THROAT DIAGNOSES AGE 0-17
"AJOR CHEST PROCEDURES
O.R. PROC OF THE RESP SYSTE" EXCEPT "AJOR CHEST WITH C.C.
O.R. PROC OF THE RESP SYSTE" EXCEPT "AJOR CHEST W/O C.C.
PUL"ONARY E"80LIS"
RESPIRATORY INFECTIONS' INFLA""ATIONS AGE )'70 AND/OR C.C.
RESPIRATORY INFECTIONS' INFLA""ATIONS AGE 18-69 W/O C.C.
RESPIRATORY INFECTIONS' INFLA""ATIONS AGE 0-17
RESPIRATORY NEOPLAS"S
"AJOR CHEST TRAU"A AGE ('70 ANO/OR C.C.
"AJOR CHEST TRAU"A AGE (70 W/O C.C.
PLEURAL EFFUSION AGE )'70 AND/OR C.C.
PLEURAL EFFUSION AGE (70 W/O C.C.
PUL"ONARY EDE"A , RESPIRATORY FAILURE
CHRONIC OBSTRUCTIVE PUL"ONARY DISEASE
SI"PLE PNEU"ONIA , PLEURISY AGE )'70 AND/OR C.C.
SI"PLE PNEU"ONIA , PLEURISY AGE 18-69 W/O C.C.
SI"PLE PNEU"ONIA , PLEURISY AGE 0-17
INTERSTITIAL LUNG DISEASE AGE )'70 ANO/OR C.C.
INTERSTITIAL LUNG DISEASE AGE (70 W/O C.C.
PNEU"OTHORAX AGE )'70 AND/OR C.C.
PNEU"OTHORAX AGE (70 W/O C.C.
BRONCHITIS' ASTH"A AGE )'70 AND/OR C.C.
BRONCHITIS' ASTH"A AGE 18-69 W/O C.C.
BRONCHITIS' ASTH"A AGE 0-17
RESPIRATORY SIGNS' SY"PTD"S AGE )70 AND/OR C.C.
RESPIRATORY SIGNS' SY"PTO"S AGE (70 W/O c.e
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 14,574
I 11,099
I 75'
I 5,907
I 18,539
I 75'
I 75'
I 5,850
I 75'
I 75'
I 5,075
I 75'
I 9,828
I 9,172
I 8,17.
I ',130
I 2,10.
I 5,686
I 75'
I 6,502
I 75'
I 5,929 .
I .,0.9
I 2,216
I 3,884
I 75'
SI. SERNARDINE "EDIC.l.L CENTER
DRG 101
DRG 102
DRG 103
DRG 104
DRG 105
DRG 106
DRG 107
'DRG 108
ORG 109
ORG 110
DRG III
ORG 112
DRG 113
DRG 114
DRG 115
DRG 116
DRG 117
DRG 118
DRG 119
DRG 120
ORG 121
DRG 122
DRG 123
DRG 124
DRG 125
DRG 126
DRG 127
DRG 128
DRG 129
ORG 130
DRG 131
DRG 132
DRG 133
DRG 134
DRG 135
DRG 136
DRG 137
DRG 138
DRG 139
DRG 140
DRG 141
DRG 142
DRG 143
DRG 144
DRG 14 5
DRG 146
DRG 14 7
DRG 148
DRG 14 9
DRG 150
"EDICARE PROVIDER NO.:' 050129.
EXHIBIT 1/29/8
DRG PER CASE RATES
DIAGNOSIS RELATED GROUP (DRG2J
PROPOSED
RATElcASE
OTHER RESPIRATORY DIAGNOSES AGE >.70 ANOIDR C.C.
OTHER RESPIRATORY DIAGNOSES AGE (70
HEART TRANSPLANT
CARDIAC VALVE PROCEDURE WITH PU"P 8 CARDIAC CATH
CARDIAC VALVE PROCEDURE WITH PU"P 8 WiD CARDIAC CAOTH
CORONARY BYPASS WITH CARDIAC CATH
CORONARY BYPASS W/O CARDIAC CATH
CAROIOTHOR PROC. EXCEPT VALVE 8 CORONARY BYPASS, WITH PU"P
CARDIOTHORACIC PROCEDURES WiD PU"P
"AJOR RECONSTRUCTIVE VASCULAR PROCEOURES AGE >.70 ANDloR C.C.
"AJOR RECONSTRUCTIVE VASCULAR PROCEDURES AGE (70 wlo C.C.
VASCULAR PROCEDURES EXCEPT "AJOR RECONSTRUCTION
A"PUTATION fOR CIRC SYSTE" DISORDERS EXCEPT UPPER LI"B 8 TOE
UPPER LI"B 8 TOE A"PUTATION fOR CIRC SYSTE" DISORDERS
PER"ANENT CAROIAC PACE"AKER I"PLANT WITH A"I OR CHf
PER"ANENT CAROIAC PACE"AKER I"PLANT wlo A"I OR CHf
CARDIAC PACE"AKER REPLACE 8 REVIS EXC PULSE GEN REPL ONLY
CAROIAC PACE"AKER PULSE GENERATOR REPLACE"ENT ONLY
VEIN LIGATION 8 STRIPPING
OTHER O.R. PROCEDURES ON THE CIRCULATORY SYSTE"
CIRCULATORY DISORDERS WITH A"I 8 C.V. CO"P. DISCH. ALIVE
CIRCULATORY DISORDERS WITH A"I W/O C.V. CO"P. DISCH. ALIVE
CIRCULATORY DISORDERS WITH A"I, EXPIRED
CIRCULATORY DISORDERS EXC A"I, WITH CARO CATH 8 CO"PLEX DIAG
CIRCULATORY DISORDERS EXC A"I, WITH CARD CATH W/O CO"PLEX DIAG
ACUTE 8 SUBACUTE ENDOCARDITIS
HEART fAILURE 8 SHOCK
DEEP VEIN THRO"BOPHLEBITIS
CARDIAC ARREST
PERIPHERAL VASCULAR OISORDERS AGE )'70 ANO/OR C.C.
PERIPHERAL VASCULAR DISORDERS AGE (70 W/O C.C.
ATHEROSCLEROSIS AGE >'70 ANO/OR C.C.
ATHEROSCLEROSIS AGE (70 W/O C.C.
HYPERTENSION
CARDIAC CONGENITAL 8 VALVULAR DISORDERS AGE ).70 AND/OR C.C.
CARDIAC CONGENITAL 8 VALVULAR OISORDERS AGE 18-69 WiD C.C.
CAROIAC CONGENITAL 8 VALVULAR DISORDERS AGE 0-17
CARDIAC ARRHYTH"IA 8 CONDUCTION OISORDERS AGE ).70 ANO/OR C.C.
CAROIAC CONGENITAL 8 VALVULAR DISORDERS AGE (70 W/O C.C.
ANGINA PECTORIS
SYNCOPE 8 COLLAPSE AGE ).70 AND/OR C.C.
SYNCOPE 8 COLLAPSE AGE (70 WID C.C.
CHEST PAIN
OTHER CIRCULATORY DIAGNOSES WITH C.C.
OTHER CIRCULATORY DIAGNOSES W/O C.C.
RECTAL RESECTION AGE )'70 AND/OR C.C.
RECTAL RESECTION AGE (70 wlo C.C.
"AJOR S"ALL 8 LARGE BOWEL PROCEDURES AGE ).70 AND/OR C.C.
"AJDR 5"ALL 8 LARGE BOWEL PROCEDURES AGE >70 AND/OR C.C.
PERITONEAL ADHESIOLYSIS AGE >'70 ANO/OR C.C.
I 6,849
I 75'
I N/ A
I 36,380
I 23,179
I 21,308
I 17,266
I 6,601
I 8,625
I 17, 7J1
I 9,795
I 9,237
I 9,721
I 9,535
I 20,609
I 13,810
I 75'
I 7,189 .
I 75'
I 31,083
I 9,485
I 4,423
I 8,451
I 3,239
I 2,274
I 75'
I 5,880
I 4,959
I 75'
I 3.877
I 75'
I 3,486
I 75'
I 2,230
I 75'
I 75'
I 75'
I 3,919
I 2,547
I 2,749
I 3,308
I 75'
I 2,584
I 8,227
I 75'
I 16,824
I 75'
I 15,176'
I 7,902
I 11,451
ST. 1ERNARDINE. "EDICA!. CENTER
DRG 151
DRG 152
DRG 153
DRG 154
DRG 155
DRG 156
DRG 157
'DRG 158
DRG 159
DRG 160
DRG 161
DRG 162
ORG 163
DRG 164
DRG 165
DRG 166
DRG 167
DRG 168
DRG 169
ORG 170
DRG 171
ORG 172
DRG 173
DRG 174
DRG 175
DRG 176
DRG 1))
DRG 178
DRG 179
DRG 180
DRG 181
DRG 182
DRG 183
DRG 184
DRG 185
DRG 186
DRG 18 7
DRG 188
DRG 189
DRG 190
DRG 191
DRG 192
DRG 193
DRG 194
DRG 195
DRG 196
DRG 197
DRG 198
DRG 199
DRG 200
"EDICARE PROVIDER NO.: '050129 .
EXHI81T 1/29/88
DRG PER CASE RATES
DIAGNOSIS RELATED GROUP (DRG2)
PROPOSED
RATE/CASE
PERITONEAL ADHESIOLYSIS AGE (70 W/O C.C.
"INOR S"ALL 8 LARGE 80WEL PROCEOURES AGE )'70 AND/OR C.C.
"INOR S"ALL 8 LARGE BOWEL PROCEDURES AGE (7- W/O C.C.
STO"ACH, ESOPHAGEAL 8 DUODENAL PROCEOURES AGE )'70 AND/OR C.C.
STO"ACH, ESOPHAGEAL a DUODENAL PROCEDURES AGE 18-69 W/O C.C.
STO"ACH, ESOPHAGEAL a OUOOENAL PROCEDURES AGE 0-17
ANAL PROCEDURES AGE )'70 AND/OR CC
ANAL PROCEDURES AGE (70 W/O C.C.
HERNIA PROCEDURES EXCEPT INGUINAL a FE"ORAL AGE )'70 AND/OR C.C.
HERNIA PROCEOURES EXCEPT INGUINAL a FE "ORAL AGE 18-69 E/O C.C.
INGUINAL a FE"ORAL HERNIA PROCEDURES AGE ).70 AND/OR C.C.
INGUINAL a fE"ORAL HERNIA PROCEOURES AGE 18-69 w/o C.C.
HERNIA PROCEOURES AGE 0-17
APPENOECTO"Y WITH CO"PLICATEO PRINC. OIAG AGE )'70 AND/OR C.C.
APPENDECTO"Y WITH CO"PLICATED PRINC. DIAG AGE (70 W/O C.C.
APPENOECTO"Y W/O CO"PLICATED PRINC. OIAG AGE ).70 W/O C.C.
APPESDECTO"Y W/O CO"PLICATED PRINC. OIAG AGE (70 W/D C.C.
PROCEDURES ON THE "OUTH AGE ).70 ANO/OR C.C.
PROCEOURES ON THE "OUTH AGE (70 w/o C.C.
OTHER DIGESTIVE SYSTE" PROCEOURES AGE ).70 AND/OR C.C.
OTHER DIGESTIVE SYSTE" PROCEDURES AGE (70 w/o C.C.
DIGESTIVE "ALIGNANCY AGE )70 AND/OR C.C.
OIGESTIVE "ALIGNANCY AGE (70 w/o C.C.
G.I. HE"ORRHAGE AGE ). 70 AND/OR C.C.
G.I. HE"ORRHAGE AGE (70 W/O C.C.
CO"PLICATEO PEPTIC ULCER
UNCO"PLICATED PEPTIC ULCER ).70 AND/OR C.C.
UNCO"PLICATED PEPTIC ULCER (70 W/O C.C.
INFLA""ATORY BOWEL DISEASE
G.I. OBSTRUCTION AGE ).70 ANO/OR C.C.
G. I. OBSTRUCTION AGE (70 W/O C.C.
ESOPHAGITIS, GASTROENT. a "ISC. OIGEST. OIS AGE ).70 a/OR C.C.
ESOPHAGITIS, GASTROENT. a "ISC. DIGEST. OIS AGE 18-69 W/O C.C.
ESOPHAGITIS, GASTROENTERITIS a "ISC. DIGEST. DISORDERS AGE 0-17
DENTAL a ORAL DIS. EXC EXTRACTIONS a RESTORATIONS, AGE )'18
DENTAL a ORAL DIS. EXC EXTRACTIONS 8 RESTORATIONS, AGE 0-17
DENTAL EXTRACTIONS a RESTORATIONS
OTHER DIGESTIVE SYSTE" OIAGNOSES AGE ).70 ANOloR C.C.
OTHER DIGESTIVE SYSTE" DIAGNOSES AGE 18-69 wlo C.C.
DTHER DIGESTIVE SYSTE" DIAGNOSES AGE 0-17
"AJOR PANCREAS, LIVER a SHUNT PROCEDURES
"INOR PANCREAS, LIVER a SHUNT PROCEDURES
BILIARY TRACT PRDC EXC TOT CHOLECYSTECTO"Y AGE ).70 a/OR C.C.
8ILIARY TRACT PROC EX TOT CHOLECYSTECTO"Y AGE (70 OR C.C.
TOTAL CHOLECYSTECTO"Y WITH C.D.E. AGE )'70 ANDloR C.C.
TOTAL CHOLECYSTECTO"Y WITH C.D.E. AGE (70 W/O C.C.
TOTAL CHOLECYSTECTO"Y wlo C.D.E. AGE ).70 AND/OR C.C.
TOTAL CHOLECYSTECTO"Y WIO C.D.E. AGE (70 Wlo C.C.
HEPATOBILIARY DIAGNOSTIC PROCEDURE fOR "ALIGNANCY
HEPATOBILIARY DIAGNOSTIC PROCEDURE fOR NON-"ALIGNANCY
I 7.193
I 75'
I 7St
I 12,648
I 5,707
I 75'
I 3,843
I 2.329
I 5,178
I 2,556
I 751
I 1,829
I 751
I 13,794
I 5,150
I 75'
I 3,105
I ':l
I 3,772
I 6,809
I 751
I 6,223
I 751
I 4,242
I 751
I 6,157
I i51
I 751
I 751
I 3,678
I 751
I 3,186
I 1,954
I 1,329
I 751
I 751
I 751
I 5,683
I 751
I 751
I 9,132
I 751
I 14,286
I 751
I 9,508
I 751
I 5,744
I 4,250
I 751
I 11, 556
ST. 3ERNA~DINE ItEDIC~L CENTER
DRG 201
DRG 202
DRG 203
DRG 204
DRG 205
DRG 206
DRG 207
'DRG 208
DRG 209
DRG 210
DRG 211
DRG 212
DRG 213
DRG 214
DRG 215
DRG 216
DRG 217
DRG 218
DRG 219
DRG 220
DRG 221
DRG 222
DRG 223
DRG 224
DRG 225
DRG 226
DRG 227
DRG 228
DRG 229
DRG 230
DRG 231
DRG 232
DRG 233
DRG 234
DRG 235
DRG 236
DRG 237
DRG 238
DRG 239
DRG 240
DRG 241
DRG 242
DRG 243
DRG 244
DRG 245
DRG 246
DRG 247
DRG 248
DRG 249
DRG 250
"EDICARE PROVIDER NO.; D5012~
EXHIBIT 1/29/8
DRG PER CASE RATES
DIAGNOSIS RELATED GROUP (DRG2)
PROPOSED
RATElcASE
OTHER HEPATOBILIARY OR PANCREAS D.R. PROCEDURES
C[RRHDSIS a ALCOHOL[C HEPATITIS
"ALIGNANCY OF HEPATOBIL[ARY SYSTE" OR PANCREAS
DISORDERS OF PANCREAS EXCEPT "AL[GNANCY
DISORDERS OF LIVER EXC "ALIG, CIRR, ALC HEPA AGE (70 wlo C.C.
DISORDERS OF LIVER EXC /tALIG, CIRR, ALC HEPA AGE (70 WIO C.C.
DISORDERS OF THE BILIARY TRACT AGE )=70 ANDloR C.C.
D[SORDERS OF THE BIL[ARY TRACT AGE {70 wlo C.C.
/tAJDR JOINT PROCEDURES
HIP a FE/tUR PROCEDURES EXCEPT /tAJOR JOINT AGE )=70 ANDloR C.C.
HIP a FE"UR PROCEDURES EXCEPT "AJOR JOINT AGE 18-69 wlo C.C.
HIP 'FE"UR PROCEDURES EXCEPT "AJDR JO[NT AGE 0-17
A/tPUTATIONS FOR "USCULOSKELETAL SYSTE/t a CONN. T[SSUE DISORDERS
BACK a NECK PROCEOURES AGE )=70 ANDloR C.C.
BACK a NECK PROCEDURES AGE (70 Wlo C.C.
BIDPS[ES OF "USCULOSKELETAL SYSTE/t a CONNECTIVE T[SSUE
WND DEBRID a SKIN GRFT EX HAND, FOR /tUSCSKELETAL a CONN. TISS. DIS
LOWER EXTRE" a HU"ER PROC EXC HIP, FOOT, FE"UR AGE )=70 a/DR C.C.
LOWER EXTRE" a HU/tER PROC EX HIP, FOOT, FE"UR AGE 18-69 wlo C.C.
LOWER EXTRE" a HU"ER PROC EXC H[P, FOOT, FE"UR AGE 0-17
KNEE PROCEDURES AGE )=70 ANDloR C.C.
KNEE PROCEDURES AGE (70 wlo C.C.
UPPER EXTRE"ITY PRDC HU/tERUS a HAND AGE )=70 ANDloR C.C.
UPPER EXTRE"ITY PROC EXC HU"ERUS a HAND AGE (70 Wlo C.C.
FOOT PROCEDURES
SOFT T[SSUE PRDCEOURES AGE )=70 ANOloR C.C.
SOFT TISSUE PROCEDURES AGE {70 WiD C.C.
GANGLION (HAND) PROCEDURES
HAND PROCEDURES EXCEPT GANGLION
LOCAL EXCISION a RE"OVAL OF INT FIX DEYICES OF HIP a FE/tUR
LOCAL EXCISION a RE"OYAL OF INT FIX DEVICES EXCEPT HIP a FE/tUR
ARTHROSCOPY
OTHER "USCULOSKELET SYS a CONN TISS O.R. PROC AGE )=70 a/OR C.C.
OTHER "USCULOSKELET SYST a CONN T[SS O.R. PROC AGE {70 wlo C.C.
FRACTURES OF FE"UR
FRACTURES OF HIP a PELVIS
SPRAINS, STRAINS, a DISLOCATIONS OF H[P, PELVIS, a THIGH
DSTEO"YELlTIS
PATHOLOGICAL FRACTURES a "USCULOSKELETAL a CONN. TISS. "ALIGNANCY
CONNECTIVE T[SSUE D[SORDERS AGE )=70 ANDloR C.C.
CONNECTIVE TISSUE DISORDERS AGE {70 WiD C.C.
SEPTIC ARTHRIT[S
"ED[CAL BACK PROBLE"S
BONE DISEASES a SEPTIC ARTHROPATHY AGE )=70 ANDloR C.C.
BONE DISEASES' SEPTIC ARTHROPATHY AGE {70 WiD C.C.
NDN-SPEC[FIC ARTHROPATHIES
SIGNS a SY"PTO"S OF /tUSCULDSKELETAL SYSTE/t a CONN TISSUE
TENOONITIS, "YOS[TIS a BURS[T[S
AFTERCARE, "USCULDSKELETAL SYSTE/t a CONNECTIVE TISSUE
FX, SPRNS, STRNS, , D[SL OF FOREAR/t, HAND, FOOT AGE )=70 ANDloR C.C.
I 9,684
I 4,437
I 5,719
I 4,971
I 7.362
I 75'
I 75'
I 75'
I 10,769
I 9,583
I 7,278
I 75'
I 75'
I 7,270
I 4,878
I 75'
I 75'
I 7,514
I 5,196
I 75'
I 75'
I 2,607
I 75'
I 2.795
I 2,544
I 75'
I 75'
I 75'
I 75'
I 75'
I 2,726
I 75'
I 5,375
I 3,009
I 75'
I 4,906
I 75'
I 75'
I 3,907
I 75'
I 75'
I 75'
I 2,054
I 75'
I 75'
I 75'
I 2,590
I 75'
I 75'
I 75'
ST. PERNARDINE "[DIC~L CENTER
DRG 251
DRG 252
DRG 253
DRG 254
DRG 255
DRG 256
DRG 257
'DRG 258
DRG 259
DRG 260
DRG 261
DRG 262
DRG 263
DRG 264
DRG 265
DRG 266
DRG 267
DRG 268
DRG 269
DRG 270
DRG 271
DRG 272
DRG 273
DRG 27 4
DRG 275
DRG 276
DRG 277
DRG 278
DRG 279
DRG 280
DRG 281
DRG 282
DRG 283
DRG 284
DRG 285
DRG 286
DRG 287
DRG 288
DRG 289
DRG 290
DRG 291
DRG 292
DRG 293
DRG 294
DRG 295
DRG 296
DRG 297
DRG 298
DRG 299
DRG 300
"EDICARE PROVIDER NO. ( DSOI2~
EXHIBIT 1/29/8
DRG PER CASE RATES
DIAGNOSIS RELATED GROUP (DRG21
PROPOSED
RATElcASE
fX, SPRNS, STRNS, , DISL Of fDREAR", HAND, fOOT AGE 18-69 wlo C.C.
fX, SPRNS, STRNS, , DISL Of fOREAR", HAND, fOOT AGE 0-17
fX, SPRNS, STRNS, , DISL Of UPAR", LOWLEG EX fOOT AGE ):70 'lOR C.C.
fX, SPRNS, STRNS , DISL Of UPAR", LOWLEG EX fOOT AGE 18-69 wlo C.C.
fX, 5PRNS, 5TRNS, , DISL Of UPAR", LDWLEG EX FOOT AGE 0-17
OTHER DIAGNOSES Of "USCULOSKELETAL SYSTE" , CONNECTIVE TISSUE
TOTAL "ASTECTO"Y fOR "ALIGNANCY AGE ):70 ANDloR C.C.
TOTAL "ASTECTO"Y fOR "ALIGNANCY AGE (70 WIO C.C.
SUBTOTAL "ASTECTD"Y fOR "ALIGNANCY AGE ):70 AND lOR C.C.
SUBTOTAL "ASTECTO"Y fOR "ALIGNANCY AGE (70
8REAST PROC fOR NON-"ALIG EXCEPT BIOPSY , LOC EXC
8REAST BIOPSY' LOCAL EXCISION fOR NON-"ALIGNANCY
SKIN GRAfTS fOR SKIN ULCER OR CELLULITIS AGE ):70 ANDloR C.C.
SKIN GRAfT5 fOR SKIN ULCER OR CELLULITIS AGE (70 wlo C.C.
SKIN GRAfTS EXCEPT fOR SKIN ULCER OR CELLULITIS WITH C.C.
SKIN GRAfTS EXCEPT fOR SKIN ULCER OR CELLULITIS WIO C.C.
PERIANAL' PILONIDAL PROCEDURES
SKIN, SUBCUTANEOUS TISSUE' BREAST PLASTIC PROCEDURES
OTHER SKIN, SUBCUT TISS , BREAST O.R. PROC AGE ):70 DR C.C.
OTHER SKIN, SUBCUT TISS , BREAST O.R. PROC AGE )70 wlo C.C.
SKIN ULCERS
"AJDR SKIN OISORDER AGE ):70 ANDloR C.C.
"AJOR SKIN DISORDERS AGE (70 wlo C.C.
"ALIGNANT BREAST DISOROERS AGE ):70 ANOloR C.C.
"ALIGNANT BREAST DISORDERS AGE (70 WID C.C.
NON-"ALIGNANT BREAST DISOROERS
CELLULITIS AGE )70 'lOR C.C.
CELLULITIS AGE 18-69 wlo C.C.
CELLULITIS AGE 0-17
TRAU"A TO THE SKIN, SUBCUT TISS , BREAST AGE ):70 'lOR C.C.
TRAU"A TO THE SKIN, SUBCUT TISS , BREAST AGE 18-69 wlo C.C.
TRAU"A TO THE SKIN, SUBCUT TISS , BREAST AGE 0-17
"INOR SKIN DISORDERS AGE ):70 ANDIOR C.C.
"INOR SKIN DISORDERS AGE (70 wlo C.C.
A"PUTATIONS fOR ENDOCRINE, NUTRITIONAL' "ETABOLIC DISORDERS
ADRENAL' PITUITARY PROCEDURES
SKIN GRAfTS' WOUND DEBRIDE fOR ENDOC, NUTRIT , "ETAB DISORDERS
O.R. PROCEDURES fOR OBESITY
PARATHYROID PROCEDURES
THYROID PROCEOURES
THYROGLOSSAL PROCEDURES
OTHER ENOOCRINE, NUTRIT , "ETAB O.R. PROC AGE )70 'lOR C.C.
OTHER ENDOCRINE, NUTRIT , "ETAB O.R. PROC AGE (70 wlo C.C.
DIABETES AGE ):36
DIABETES AGE 0-35
NUTRITIONAL' "ISC. "ETABOLIC DISORDERS AGE ):70 AND lOR C.C.
NUTRITIONAL' "ISC. "ETABOLIC DISORDERS AGE 18-69 WIO C.C.
NUTRITIONAL' "ISC. "ETABOLIC OISORDERS AGE 0-17
INBORN ERRORS Of "ETABOLIS"
ENDOCRINE DISORDERS AGE ):70 ANDloR C.C.
I 75t
I 75t
I 2,388
I 75t
I 75t
I 751
I 3,803
I 75t
I 751
I 7St
I 751
I 7St
I 8,577
I 75t
I 7St
I 751
I 7St
I 7St
I 5,1B9
I 75t
I 75t
I 7St
I 75t
I 7St
I 7St
I 75t
I 4,661
I 3,366
I 7St
I 7St
I 75t
I 751
I 7St
I 751
I 18,368
I 7St
I 751
I 751
I 75t
I 751
I 75t
I 11,418'
I 75t
I 3,586
I 2,408
I 5,205
I 751
I 751
I 75t
I 75t
. SI. BERNARDINE. "EOICA. CENTER
DRG 301
DRG 302
DRG 303
DRG 304
DRG 305
DRG 306
DRG 307
'ORG 308
DRG 309
ORG 310
DRG 311
DRG 312
DRG 313
ORG 314
DRG 315
DRG 316
DRG 317
DRG 318
DRG 319
DRG 320
DRG 321
DRG 322
DRG 323
ORG 324
DRG 325
ORG 326
ORG 327
ORG 328
DRG 329
ORG 330
DRG 331
ORG 332
DRG 333
DRG 334
DRG 335
DRG 336
DRG 337
DRG 338
DRG 339
DRG 340
DRG 341
DRG 342
DRG 343
DRG 344
DRG 345
DRG 346
DRG 347
DRG 348
DRG 34 9
DRG 350
"EDICARE PROVIDER NO.: 050129'
EXHIBIT 1/29/88
DRG PER CASE RATES
DIAGNOSIS RELATED GROUP (DRG2)
PROPOSED
RATElcASE
ENDOCRINE DISORDERS AGE }70 wlo C.C.
KIONEY TRANSPLANT
KIDNEY, URETER' "AJOR BLADDER PROCEDURE FOR NEOPLAS"
KIDNEY, URETER' "AJ BLDR PROC FOR NON-"ALIG AGE }'70 'lOR C.C.
KIDNEY, URETER' "AJ BLDR PROC FOR NON-"ALIG AGE (70 wlo C.C.
PROSTATECTO"Y AGE }'70 ANDIOR C.C.
PROSTATECTO"Y AGE 170 wlo C.C.
"INOR BLADDER PROCEDURES AGE }'70 ANDloR C.C.
"INOR BLADDER PROCEDURES AGE (70 wlo C.C.
TRANSURETHRAL PROCEDURES AGE }'70 ANDloR C.C.
TRANSURETHRAL PROCEDURES AGE (70 wlo C.C.
URETHRAL PROCEDURES, AGE }'70 ANDloR C.C.
URETHRAL PROCEDURES, AGE 18-69 wlo C.C.
URETHRAL PROCEDURES, AGE 0-17
OTHER KIDNEY' URINARY TRACT O.R. PROCEDURES
RENAL FAILURE wlo DIALYSIS
RENAL FAILURE WITH DIALYSIS
KIDNEY' URINARY TRACT NEOPLAS"S AGE )'70 ANDIOR C.C.
KIDNEY' URINARY TRACT NEDPLAS"S AGE (70 WIO C.C.
KIDNEY' URINARY TRACT INFECTIONS AGE ), 70 AND lOR C.C.
KIONEY , URINARY TRACT INFECTIONS AGE 1B-69 wlo C.C.
KIDNEY' URINARY TRACT INFECTIONS AGE 0-17
URINARY STONES AGE )'70 ANDloR C.C.
URINARY STONES AGE (70 wlo C.C.
KIDNEY' URINARY TRACT SIGNS' SY"PTO"S AGE )'70 AND lOR C.C.
KIDNEY' URINARY TRACT SIGNS' SY"PTO"S AGE 18-69 wlo C.C.
KIDNEY' URINARY TRACT SIGNS' SY"PTO"S AGE 0-17
URETHRAL STRICTURE AGE }'70 ANOIOR C.C.
URETHRAL STRICTURE AGE 1B-69 wlo C.C.
URETHRAL STRICTURE AGE 0-17
OTHER KIDNEY' URINARY TRACT DIAGNOSES AGE )=70 ANDloR C.C.
OTHER KIDNEY' URINARY TRACT DIAGNOSES AGE 18-69 wlo C.C.
OTHER KIDNEY' URINARY TRACT DIAGNOSES AGE 0-17
"AJOR "ALE PELVIC PROCEDURES WITH C.C.
"AJOR "ALE PELVIC PROCEOURES WIO C.C.
TRANSURETHRAL PROSTATECTO"Y AGE )=70 AND lOR C.C.
TRANSURETHRAL PROSTATECTO"Y AGE (70 wlo C.C.
TESTES PROCEDURES, FOR "ALIGNANCY
TESTES PROCEDURES, NON-"ALIGNANT AGE }=lB
TESTES PROCEDURES, NON-"ALIGNANT AGE 0-17
PENIS PROCEDURE
CIRCU"CISION AGE }=18
CIRCU"CISION AGE 0-17
OTHER "ALE REPRODUCTIVE SYSTE" O.R. PROCEDURES FOR "ALIGNANCY
OTHER "ALE REPRODUCTIVE SYSTE" O.R. PROC EXCEPT FOR "ALIGNANCY
"ALIGNANCY, "ALE REPRODUCTIVE SYSTE", AGE )=70 ANDloR C.C.
"ALIGNANCY, "ALE REPRODUCTIVE SYSTE", AGE (70 wlO C.C.
BENIGN PROSTATIC HYPERTROPHY AGE )=70 ANDIOR C.C.
BENIGN PROSTATIC HYPERTROPHY AGE (70 wlo C.C.
INFLA""ATION OF THE "ALE REPROOUCTIVE SYSTE"
I 75'
I NIA
I 9,973
I 9,151
I 5,555
I 7,975
I 75'
I 75'
I 75'
I 3,010
I 75'
I 75'
I 75'
I 75'
I 9,427
I 6,840
I 75'
I 75'
I 75'
I 4,846
I 2,777
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 10,882
I 75'
I 4,293
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
. 51. 3ERNARDIN.E "EDICH CENTER
DRG 351
DRG 352
DRG 353
ORG 354
DRG 355
DRG 356
DRG 357
'ORG 358
DRG 359
ORG 360
DRG 361
DRG 362
ORG 363
DRG 364
ORG 365
DRG 366
ORG 367
ORG 368
ORG 369
DRG 370
DRG 371
ORG 372
DRG 373
ORG 374
ORG 375
ORG 376
DRG 377
ORG 378
ORG 379
DRG 380
ORG 381
ORG 382
DRG 383
DRG 384
ORG 385
ORG 386
DRG 387
ORG 388
DRG 389
ORG 390
DRG 391
DRG 392
DRG 393
ORG 394
ORG 395
ORG 396
DRG 397
DRG 398
ORG 399
DRG 400
"EOICARE PRDVIOER NO.; 050129
EXHI81T 1/29/8
ORG PER CASE RATES
OIAGNOSIS RELATED GROUP (ORG2)
PROPOSED
RATE/CASE
STERILIZATION, "ALE
OTHER "ALE REPROOUCTIVE SYSTE" DIAGNOSES
PELVIC EVISCERATION, RAOICAL HYSTERECTO"Y I VULVECTO"Y
NON-RAOICAL HY5TERECTO"Y AGE )70 ANO/OR C.C.
NON-RAOICAL HYSTERECTO"Y AGE (70 W/O C.C.
FE"ALE REPROOUCTIVE SYSTE" RECONSTRUCTIVE PROCEOURES
UTERUS I AOENEXA PROCEOURES, FOR "ALIGNANCY
UTERUS I AOENEXA PROC FOR NON-"ALIGNANCY EXCEPT TU8AL INTERRUPT
TU8AL INTERRUPTION FOR NON-"ALIGNANCY
VAGINA, CERVIX I VULVA PROCEOURES
LAPAROSCOPY I ENOOSCOPY (FE"ALE) EXCEPT TU8AL INTERRUPTION
LAPAROSCOPIC TU8AL INTERRUPTION
DIC, CONIZATION I RADIO-I"PLANT, FOR "ALIGNANCY
OIC, CONIZATION EXCEPT FOR "ALIGNANCY
OTHER FE"ALE REPROOUCTIVE SYSTE" O.R. PROCEDURES
"ALIGNANCY, FE"ALE REPROOUCTIVE SYSTE" ):70 ANO OR/C.C.
"ALIGNANCY, FE"ALE REPRODUCTIVE SYSTE" AGE (70 W/O C.C.
INFECTIONS, FE"ALE REPROOUCTIVE SYSTE"
"ENSTRUAL I OTHER FE"ALE REPRODUCTIVE SYSTE" DISOROERS
CESAREAN SECTION WITH C.C.
CESAREAN SECTION W/O C.C.
VAGINAL DELIVERY WITH CO"PLICATING DIAGNOSES
VAGINAL OELIVERY W/O CO"PLICATING DIAGNOSIS
VAGINAL OELIVERY WITH STERILIZATION ANO/OR OIC
VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL ANO/OR DIC
POSTPARTU" OIAGNOSIS W/O O.R. PROCEDURE
POSTPARTU" OIAGNOSES WITH O.R. PROCEDURE
ECTOPIC PREGNANCY
THREATENEO A80RTION
A80RTION wlo DIC
A80RTION WITH OIC
FALSE LA80R
OTHER ANTEPARTU" OIAGNOSIS WITH "EOICAL CO"PLICATIONS
OTHER ANTEPARTU" OIAGNOSES w/o "EOICAL CO"PLICATIONS
NEONATES, OlEO OR TRANSFERRED
EXTRE"E I""ATURITY, NEONATE
PRE"ATURITY WITH "AJaR PR08LE"S
PRE"ATURITY WIO "AJaR PR08LE"S
FULL TER" NEONATE WITH "AJaR PR08LE"S
NEONATES WITH OTHER SIGNIFICANT PR08LE"S
NOR"AL NEW80RNS
SPLENECTO"Y AGE )=18
SPLENECTO"Y AGE 0-17
OTHER O.R. PROCEOURES OF THE 8LOOO I 8LOOO FOR"ING ORGANS
REO 8LOOO CELL OISOROERS AGE ):18
REO 8LOOO CELL OISOROERS AGE 0-17
COAGULATION OISOROERS
RETICULOENOOTHELIAL I I""UNITY OISOROERS AGE ):70 ANO/OR C.C.
RETICULOENOOTHELIAL I I""UNITY OISOROERS AGE (70 W/O C.C.
LY"PHO"A OR LEUKE"IA WITH "AJaR O.R. PROCEOURE
I N/ A
I 75'
I 75'
I 6,276
I 3,655
I 4,348
I 75'
I 3,124
I N/ A
I 75'
I 2,161
I N/ A
I 75'
I 75'
I 4,096
I 75'
I 75'
I 2,562
I 75'
I 3,539
I 2,876
I 1,538
I 1,146
I 75'
I 75'
I 75'
I 75'
I 2,704
I 75'
I 75'
I 1,439
I 75'
I 1,646
I 1,741
I 75'
I 4,671
I 4,601
I 1,481
I 828
I 527
I 319
I 8,637
I 75'
I 75'
I 5,183
I 75'
I 5,266
I 75'
I 75'
I 9,338 .
, .
ST. :ERNARvIN~ "EDICA! CENTER
EXHIBIT 1/29/8
DRG 401
DRG 402
DRG 403
DRG 404
DRG 405
DRG 406
DRG 407
'DRG 40B
DRG 409
ORG 410
DRG 411
DRG 412
DRG 413
ORG 414
DRG 415
DRG 416
DRG 417
DRG 41B
DRG 419
DRG 420
DRG 421
DRG 422
DRG 423
ORG 424
DRG 425
DRG 426
ORG 427
DRG 428
DRG 429
DRG 430
DRG 431
DRG 432
DRG 433
DRG 434
DRG 435
DRG 436
DRG 43 7
DRG 43B
DRG 439
DRG 440
DRG 441
DRG 44 2
DRG 443
DRG 444
DRG 445
DRG 446
DRG 44 7
ORG 448
DRG 44 9
DRG 450
"EDICARE PROVIDER NO.: 050129'
DRG PER CASE RATES
DIAGNOSIS RELATEO GROUP IDRG2)
PROPOSED
RATEICASE
LY"PHO"A OR LEUKE"IA WITH "INOR O.R. PROC AGE ):70 ANOIOR C.C.
LY"PHO"A OR LEUKE"IA WITH "INOR O.R. PROCEDURE AGE (70 WIO C.C.
LY"PHO"A OR LEUKE"IA AGE ):70 ANDloR C.C.
LY"PHO"A OR LEUKE"IA AGE 18-69 wlo C.C.
LY"PHO"A OR LEUKE"IA AGE 0-17
"YELOPROLIF OISORO OR POORLY OIFF NEOPLAS" W "AJ O.R. PROC I C.C.
"YELOPROLIF DISORD OR POORLY OIFF NEOPL W "AJ O.R. PROC W/O C.C.
"YELOPROLIF OISORD OR POORLY OIFF NEOPL WITH "INOR O.R. PROC
RADIOTHERAPY
CHE"OTHERAPY
HISTORY OF "ALIGNANCY W/O ENDOSCOPY
HISTORY OF "ALIGNANCY WITH ENDOSCOPY
OTHR "YELOPROLIF DISORD OR POORLY DIFF NEOPL OX AGE ):70 I/OR C.C.
OTHR "YELOPROLIF OISORO OR POORLY DIFF NEOPL OX AGE (70 wlo C.C.
O.R. PROCEDURE FOR INFECTIOUS I PARASITIC DISEASE
SEPTECE"IA AGE ):18
SEPTICE"IA AGE 0-17
POSTOPERATIVE I POST-TRAU"ATIC INFECTIONS
FEVER OF UNKNOWN ORIGIN AGE ):70 AND/OR C.C.
FEVER OF UNKNOWN ORIGIN AGE 18-69 WiD C.C.
VIRAL ILLNESS AGE ):18
VIRAL ILLNESS I FEVER OF UNKNOWN ORIGIN AGE 0-17
OTHER INFECIOUS I PARASITIC DISEASES DIAGNOSES .
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF "ENTAL ILLNESS
ACUTE ADJUST REACT I DISTURBANCES OF PSYCHOSOCIAL DYSFUNCTION
DEPRESSIVE NEUROSES
NEUROSES EXCEPT DEPRESSIVE
DISORDERS OF PERSONALITY I I"PULSE CONTROL
ORGANIC DISTURBANCES I "ENTAL RETARDATION
PSYCHOSES
CHILDHOOD "ENTAL DISORDERS
OTHER DIAGNOSES OF "ENTAL DISORDERS
SUBSTANCE USE I SUBST INDUCED ORGANIC "ENTAL DISORDERS, LEFT A"A
DRUG DEPENDENCE
DRUG USE EXCEPT DEPENDENCE
ALCOHOL DEPENDENCE
ALCOHOL USE EXCEPT DEPENDENCE
ALCOHOL I SUBSTANCE INDUCED ORGANIC "ENTAL SYNDRO"E
SKIN GRAFTS FOR INJURIES
WOUND DE8RIDE"ENTS FOR INJURIES
HAND PROCEDURES FOR INJURIES
OTHER D.R. PROCEDURES FOR INJURIES AGE ):70 AND/OR C.C.
OTHER O.R. PROCEDURES FOR INJURIES AGE (70 WID C.C.
"ULTIPLE TRAU"A AGE ):70 AND/OR C.C.
"ULTIPLE TRAU"A AGE 18-69 W/O C.C.
"ULTIPLE TRAU"A AGE 0-17
ALLERGIC REACTIONS AGE ):18
ALLERGIC REACTIONS AGE 0-17
TOXIC EFFECTS OF DRUGS AGE ):70 AND lOR C.C.
TOXIC EFFECTS OF DRUGS AGE 18-69 WiD C.C.
I 75'
I 75'
I 16,400
I 18,468
I 75'
I 21. 764
I 75'
I 75'
I 75'
I 2,477
I 75'
I 75'
I 6,186
I 75'
I 19,669
I 10,329
I 75'
I 6,543
I 4,293
I 75'
I 3,217
I 75'
I 10,313
I 75'
I 4,213
I 5,469
I 4,059
I 75'
I 4,611
I 6,804
I 7,116
I 75'
I 75'
I 75'
I 7St
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 9,449
I 5,125
I 75'
I 75'
I 7St
I 75'
I 75'
I 3,524
I 2,691
. .
. ST. dERNARbINE "ED!CkL CENTER
EXHIBIT 112918
.'
DRG 451
DRG 452
DRG 453
DRG 454
DRG 455
DRG 456
DRG 457
'DRG 45B
DRG 459
DRG 460
DRG 461
DRG 462
DRG 463
DRG 464
DRG 465
DRG 466
DRG 467
"EDICARE PROVIDER NO.: 050129'
DRG PER CASE RATES
DIAGNOSIS RELATEO GROUP (DRG2)
PROPOSED
RATElcASE
TOXIC EFFECTS OF DRUGS AGE 0-17
CO"PLICATIONS OF TREAT"ENT AGE )'70 ANDloR C.C.
CO"PLICATIONS Of TREAT"ENT AGE (70 wlO C.C.
OTHER INJURIES, POISONINGS 8 TOXIC EFF OIAG AGE )'70 ANOloR C.C.
OTHER INJURIES, POISONINGS 8 TOXIC EFf OIAG AGE )70 wlo C.C.
BURNS, TRANSFERREO TO ANOTHER ACUTE CARE FACILITY
EXTENSIVE BURNS
NON-EXTENSIVE BURNS WITH SKIN GRAFTS
NON-EXTENSIVE BURNS WITH WOUND DEBRIDE"ENT 8 OTHER O.R. PROC
NON-EXTENSIVE BURNS wlo C.C. PROCEOURE
O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES
REHABILITATION
SIGNS 8 SY"PTO"S WITH C.C.
SIGNS 8 SY"PTO"S wlo C.C.
AfTERCARE WITH HISTORY OF "ALIGNANCY AS SECONDARY DX
AFTERCARE wlO HISTORY OF "ALIGNANCY AS SECONDARY OX
OTHER FACTORS INFLUENCING HEALTH STATUS
I 75'
I 4,977
I 75'
I 75'
I 75'
I 75'
I NIA
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
I 75'
C I T
.
PI\GE 1 OF 2
Y o F SAN B ERN A R DIN 0
N I C A L S PEe I FIe A T ION S
F - 88- 0 9
roll off refuse containers (bin)
I T EM/ DES C RIP T ION
C I A L INS T R U C T ION S T 0 BID D E R II
GHT HAND COLUMN INDICATING SPECIFIC SIZE AND/OR MAKE AND
WHEN NOT EXACTLY AS SPECIFIED. STATE "AS SPECIFIED" IF
RTH IN THE LEFT HAND COLUMN.
LETE RIGHT HAND COLUMN WILL INVALIDATE BID.
specifications to describe a
ty metal refuse container
constructed "Heavy Duty"
1e to withstand unusual
and use.
imum. Bidders are expected
ifications in their entirety
d to submit complete factory
s for all proposed equipment
dimensions and type of metal
c yards (8) each.
ubic yard 22' long 3' high
.
T E C H
BID SPECIFICATION NO.
Eight (8) 20 cubic yard
NOT ICE: II S P E
BIDDER SHALL COMPLETE RI
MODEL OF ALL COMPONENTS
ITEM IS EXACTLY AS SET FO
FAILURE TO COMP
It is the intent of these
20 cubic yard rated capaci
(bin). Each bin shall be
throughout and shall be ab
strain, temperature, wear,
All specifications are min
to meet or .exceed the spec
Note: Bidders are require
sepcifications and drawing
Information shall include
protective coatings, etc.
Rated bin capacity 20 cubi
Heavy duty drop body (20 c
8' wide)
,
fI-. . .
PAGE
BID SPEC: F-88-09
7 gauge floor
12 gauge sides
12 gauge front
2 doors each 47" wide and 48" high
16" cross members
16" cross post
Standard western pick up hook
7 rope hooks on each side
Front and back ladders on both sides
Bottom rail and gussets to be modified.
(2) each 2x6" steel channel to the inside.
Gussets to be welded in the inside of channel.
Gussets to be welded to each cross member.
See drawing attached.
Drop body shall be consturcted in such a manner and
in such detail to be mechanically compatible with
city designated refuse truck carrier units. This
requirement shall be coordinated with the Public
Services Superintendent (714) 384-5053.
1 . c7
/1/1 ., (/ ~- 'I /1
./ /' I (.l~ Ll.o< /" '-7 (
MANUEL P. MORENO, JR.
DIRECTOR, PUBLIC SERVICES
t..~ -v (
2
2
OF
