-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, AeSrk40+HEIKmUeYUMGzJgGtcTMA2aamzpbCNoQi5PutN9G7VzmhVOyN+It67h6Y NnHex9Wf6x5BgQSUadY4NQ== 0001145443-04-000186.txt : 20040301 0001145443-04-000186.hdr.sgml : 20040301 20040301075944 ACCESSION NUMBER: 0001145443-04-000186 CONFORMED SUBMISSION TYPE: 10-K PUBLIC DOCUMENT COUNT: 12 CONFORMED PERIOD OF REPORT: 20031231 FILED AS OF DATE: 20040301 FILER: COMPANY DATA: COMPANY CONFORMED NAME: GENTIVA HEALTH SERVICES INC CENTRAL INDEX KEY: 0001096142 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HOME HEALTH CARE SERVICES [8082] IRS NUMBER: 364335801 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 10-K SEC ACT: 1934 Act SEC FILE NUMBER: 001-15669 FILM NUMBER: 04637382 BUSINESS ADDRESS: STREET 1: 3 HUNTINGTON QUADRANGLE 2S CITY: MELVILLE STATE: NY ZIP: 11747-8943 BUSINESS PHONE: 6315017000 MAIL ADDRESS: STREET 1: 3 HUNTINGTON QUADRANGLE 2S CITY: MELVILLE STATE: NY ZIP: 11747-8943 FORMER COMPANY: FORMER CONFORMED NAME: OLSTEN HEALTH SERVICES HOLDING CORP DATE OF NAME CHANGE: 19991001 10-K 1 d14035.txt SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 10-K [X] ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the fiscal year ended December 28, 2003 Commission File No. 1-15669 GENTIVA HEALTH SERVICES, INC. (Exact name of registrant as specified in its charter) DELAWARE 36-433-5801 (State or other jurisdiction of (I.R.S. Employer incorporation or organization) Identification No.) 3 Huntington Quadrangle 2S, Melville, New York 11747-8943 (Address of principal executive offices) (Zip Code) Registrant's telephone number, including area code: (631) 501-7000 Securities registered pursuant to Section 12(b) of the Act: Title of each class Name of each exchange on which registered Common Stock, par value $.10 per NASDAQ share Securities registered pursuant to Section 12(g) of the Act: None Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes X_ No __ Indicate by check mark if disclosure of delinquent filers pursuant to Item 405 of Regulation S-K is not contained herein, and will not be contained, to the best of registrant's knowledge, in definitive proxy or information statements incorporated by reference in PART III of this Form 10-K or any amendment to this Form 10-K. [ ] Indicate by check mark whether the registrant is an accelerated filer (as defined in Exchange Act Rule 12b-2). Yes X_ No __ The aggregate market value of the registrant's Common Stock held by non-affiliates of the registrant as of June 27, 2003, the last business day of registrant's most recently completed second fiscal quarter, was $225,337,941 based on the closing price of the Common Stock on the Nasdaq National Market on such date. The number of shares outstanding of the registrant's Common Stock, as of February 26, 2004, was 25,528,593. DOCUMENTS INCORPORATED BY REFERENCE Certain information to be included in the registrant's definitive Proxy Statement, to be filed not later than 120 days after the end of the fiscal year covered by this Report, for the registrant's 2004 Annual Meeting of Shareholders is incorporated by reference into PART III. PART I ITEM 1. BUSINESS SPECIAL CAUTION REGARDING FORWARD-LOOKING STATEMENTS CERTAIN STATEMENTS CONTAINED IN THIS ANNUAL REPORT ON FORM 10-K, INCLUDING, WITHOUT LIMITATION, STATEMENTS CONTAINING THE WORDS "BELIEVES," "ANTICIPATES," "INTENDS," "EXPECTS," "ASSUMES," "TRENDS" AND SIMILAR EXPRESSIONS, CONSTITUTE "FORWARD-LOOKING STATEMENTS" WITHIN THE MEANING OF THE PRIVATE SECURITIES LITIGATION REFORM ACT OF 1995. FORWARD-LOOKING STATEMENTS ARE BASED UPON THE COMPANY'S CURRENT PLANS, EXPECTATIONS AND PROJECTIONS ABOUT FUTURE EVENTS. HOWEVER, SUCH STATEMENTS INVOLVE KNOWN AND UNKNOWN RISKS, UNCERTAINTIES AND OTHER FACTORS THAT MAY CAUSE THE ACTUAL RESULTS, PERFORMANCE OR ACHIEVEMENTS OF THE COMPANY TO BE MATERIALLY DIFFERENT FROM ANY FUTURE RESULTS, PERFORMANCE OR ACHIEVEMENTS EXPRESSED OR IMPLIED BY SUCH FORWARD-LOOKING STATEMENTS. SUCH FACTORS INCLUDE, AMONG OTHERS, THE FOLLOWING: o GENERAL ECONOMIC AND BUSINESS CONDITIONS; o DEMOGRAPHIC CHANGES; o CHANGES IN, OR FAILURE TO COMPLY WITH, EXISTING GOVERNMENTAL REGULATIONS; o LEGISLATIVE PROPOSALS FOR HEALTH CARE REFORM; o CHANGES IN MEDICARE AND MEDICAID REIMBURSEMENT LEVELS; o EFFECTS OF COMPETITION IN THE MARKETS THE COMPANY OPERATES IN; o LIABILITY AND OTHER CLAIMS ASSERTED AGAINST THE COMPANY; o ABILITY TO ATTRACT AND RETAIN QUALIFIED PERSONNEL; o AVAILABILITY AND TERMS OF CAPITAL; o LOSS OF SIGNIFICANT CONTRACTS OR REDUCTION IN REVENUE ASSOCIATED WITH MAJOR PAYOR SOURCES; o ABILITY OF CUSTOMERS TO PAY FOR SERVICES; o A MATERIAL SHIFT IN UTILIZATION WITHIN CAPITATED AGREEMENTS; AND o CHANGES IN ESTIMATES AND JUDGMENTS ASSOCIATED WITH CRITICAL ACCOUNTING POLICIES. FOR A DETAILED DISCUSSION OF THESE AND OTHER FACTORS THAT COULD CAUSE THE COMPANY'S ACTUAL RESULTS TO DIFFER MATERIALLY FROM THE RESULTS CONTEMPLATED BY THE FORWARD-LOOKING STATEMENTS, PLEASE REFER TO THE "RISK FACTORS" SECTION IN THIS ITEM 1, TO "ITEM 7. MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS" AND ELSEWHERE IN THIS REPORT. THE READER SHOULD NOT PLACE UNDUE RELIANCE ON FORWARD-LOOKING STATEMENTS, WHICH SPEAK ONLY AS OF THE DATE OF THIS REPORT. EXCEPT AS REQUIRED UNDER THE FEDERAL SECURITIES LAWS AND THE RULES AND REGULATIONS OF THE SECURITIES AND EXCHANGE COMMISSION ("SEC"), THE COMPANY DOES NOT HAVE ANY INTENTION OR OBLIGATION TO PUBLICLY RELEASE ANY REVISIONS TO FORWARD-LOOKING STATEMENTS TO REFLECT UNFORESEEN OR OTHER EVENTS AFTER THE DATE OF THIS REPORT. THE COMPANY HAS PROVIDED A DETAILED DISCUSSION OF RISK FACTORS WITHIN THIS ANNUAL REPORT ON FORM 10-K AND VARIOUS FILINGS WITH THE SEC. THE READER IS ENCOURAGED TO REVIEW THESE RISK FACTORS AND FILINGS. INTRODUCTION Gentiva Health Services, Inc. ("Gentiva" or the "Company") provides home health services throughout most of the United States. Gentiva was incorporated in the state of Delaware on August 6, 1999 and became an independent publicly owned company on March 15, 2000, when the common stock of the Company was issued to the stockholders of Olsten Corporation, a Delaware corporation ("Olsten"), the former parent corporation of the Company (the "Split-Off"). Prior to the Split-Off, all of the assets and liabilities of Olsten's health services business (formerly known as Olsten Health Services) were transferred to the Company pursuant to a separation agreement and other agreements among Gentiva, Olsten and Adecco SA ("Adecco"). On June 13, 2002, the Company sold substantially all of the assets of its specialty pharmaceutical services ("SPS") business to Accredo Health, Incorporated ("Accredo") and received payment of cash in the amount of $207.5 million (before a $0.9 million reduction resulting from a closing net book value adjustment) and 5,060,976 shares of Accredo common stock (valued at $262.6 million, based on the closing price of Accredo common stock on the Nasdaq National Market on June 13, 2002). The cash consideration (less a holdback of $3.5 million for certain income taxes the Company expected to incur) and the Accredo common stock were then distributed as a special dividend to the Company's shareholders. - 1 - Information included in this annual report on Form 10-K refers to the Company's continuing home health services business, unless the context indicates otherwise. HOME HEALTH SERVICES The Company's home health services business is conducted through more than 350 direct service delivery units and delivers a wide range of services principally through its Gentiva(R) Health Services and CareCentrix(R) brands. The Company operates licensed and Medicare-certified nursing agencies located in 35 states, substantially all of which are currently accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). These agencies provide various combinations of skilled nursing and therapy services, paraprofessional nursing services and homemaker services to pediatric, adult and elder patients. Reimbursement sources include government programs, such as Medicare and Medicaid, and private sources, such as health insurance plans, managed care organizations, long term care insurance plans and personal funds. The Company's nursing operations are organized in five geographic regions, each staffed with clinical, operational and sales teams. Regions are further separated into operating areas. Each operating area includes branch locations through which nursing agencies operate. Each agency is led by a director and is staffed with clinical and administrative support staff as well as caregivers who deliver direct patient care. The caregivers are employed on either a full-time basis or are paid on a per visit, per shift, per diem or per hour basis. The Company's CareCentrix operations provide an array of administrative services and coordinate the delivery of home nursing services, acute and chronic infusion therapies, durable medical equipment, and respiratory products and services for managed care organizations and health plans. These administrative services are coordinated within four regional coordination centers and are delivered through the Company's nursing locations as well as through an extensive nationwide network of third-party provider locations credentialed by the Company (nearly 1,900 at December 28, 2003). CareCentrix accepts case referrals from a wide variety of sources, verifies eligibility and benefits and transfers case requirements to the credentialed providers for services to the patient. CareCentrix provides services to its customers, including the fulfillment of case requirements, care management, provider credentialing, eligibility and benefits verification, data reporting and analysis, and coordinated centralized billing for all authorized services provided to the customer's enrollees. Contracts within CareCentrix are structured as fee-for-service, whereby a payor is billed on a per usage basis according to a fee schedule for various services, or as at-risk capitation, whereby the payor remits a monthly payment to the Company based on the number of members enrolled in the health plans under the capitation agreement, subject to certain limitations and coverage guidelines. The Company's home health services business also delivers services to its customers through other focused business brands that include Gentiva Orthopedic Services, a program which provides individualized home orthopedic rehabilitation services to patients recovering from joint replacement or other major orthopedic surgery, and Rehab Without Walls(R), which provides home and community-based therapies for patients with traumatic brain injury, cerebrovascular accident injury and acquired brain injury, as well as a number of other complex rehabilitation cases. Other specialty services, including therapies for patients with balance issues who are prone to injury or immobility as a result of falling, are in various stages of development. The Company also provides consulting services to home health agencies through its Gentiva Business Services unit. These services include billing and collection activities, web-based caregiver training and credentialing, on-site agency support and consulting, operational support and individualized strategies for reduction of days sales outstanding. PAYORS Net revenues attributable to major payor sources of reimbursement are as follows: FISCAL YEAR ---------------------------- 2003 2002 2001 -------- -------- -------- Medicare 22% 21% 21% Medicaid and Other Government 20 22 23 Commercial Insurance and Other 58 57 56 ---- ---- ---- 100% 100% 100% ==== ==== ==== - 2 - The Company is party to a contract with CIGNA Health Corporation ("Cigna"), pursuant to which the Company provides or contracts with third party providers to provide home nursing services, acute and chronic infusion therapies, durable medical equipment, and respiratory products and services to patients insured by Cigna. For fiscal years 2003, 2002 and 2001, Cigna accounted for approximately 36 percent, 38 percent and 36 percent, respectively, of the Company's net revenues. The Company has extended its relationship with Cigna by entering into a new national home health care contract effective January 1, 2004, with the new contract expiring on December 31, 2006. No other commercial payor accounts for 10 percent or more of the Company's net revenues. Net revenues from commercial payors are primarily generated under fee for service contracts which are traditionally one year in term and renewable automatically on an annual basis, unless terminated by either party. TRADEMARKS The Company has various trademarks registered with the U.S. Patent and Trademark Office, including CARECENTRIX(R), GENTIVA(R), GENTIVA and Butterfly Design(R) , LIFESMART(R) and REHAB WITHOUT WALLS(R), or otherwise in use by the Company, including CASEMATCH(SM) and SAFE STRIDES(SM). A federally registered trademark in the United States is effective for ten years subject only to a required filing and the continued use of the mark by the Company, with the right of perpetual renewal. A federally registered trademark provides the presumption of ownership of the mark by the Company in connection with its goods or services and constitutes constructive notice throughout the United States of such ownership. Management believes that the Company's name and trademarks are important to its operations and intends to continue to renew its trademark registrations. BUSINESS ENVIRONMENT Factors that the Company believes have contributed and will contribute to the development of home health services primarily include recognition that home health services can be a cost-effective alternative to more expensive institutional care; aging demographics; increasing consumer awareness and interest in home health services; the psychological benefits of recuperating from an illness or accident or receiving care for a chronic condition in one's own home; and advanced technology that allows more health care procedures to be provided at home. The Company is actively pursuing relationships with managed care organizations to secure additional managed care contracts. The Company believes that its nationwide network of providers, financial resources, and the quality, range and cost-effectiveness of its services are important factors as it seeks opportunities in its managed care relationships in a consolidating home health services industry. In addition, the Company believes that it has the local relationships, the knowledge of the regional markets in which it operates, and the cost-effective, comprehensive services and products required to compete effectively for managed care contracts and other referrals. The Company offers the direct and managed provision of care as a single source, which it believes optimizes utilization. MARKETING AND SALES In general, the Company obtains patients and clients through personal and corporate sales presentations, telephone marketing calls, direct mail solicitation, referrals from other clients and advertising in a variety of local and national media, including the Yellow Pages, newspapers, magazines, trade publications and radio. The Company also maintains an Internet website (www.gentiva.com) that describes the Company, its services and products. Marketing efforts also involve personal contact with physicians, hospital discharge planners, and case managers for managed health care programs, such as those involving health maintenance organizations and preferred provider organizations, insurance company representatives and employers with self-funded employee health benefit programs. COMPETITIVE POSITION The home health services industry in which the Company operates is highly competitive and fragmented. Home health care providers range from facility-based (hospital, nursing home, rehabilitation facility, government agency) agencies to independent companies to visiting nurse associations and nurse registries. They can be not-for-profit organizations or for-profit organizations. In addition, there are relatively few barriers to - 3 - entry in some of the home health services markets in which the Company operates. The Company's primary competitors for its home health nursing business are hospital-based home health agencies, local home health agencies and visiting nurse associations. Based on information contained in the Center for Medicare and Medicaid Services website, a government website containing information on the home health care market in 2002, the Company believes its home health services business holds approximately a 2 percent to 3 percent market share. The Company competes with other home health care providers on the basis of availability of personnel, quality and expertise of services and the value and price of services. The Company believes that it has a favorable competitive position, attributable mainly to its nationwide network of providers and the consistently high quality and targeted services it has provided over the years to its patients, as well as to its screening and evaluation procedures and training programs for caregivers. The Company expects that industry forces will impact it and its competitors. The Company's competitors will likely strive to improve their service offerings and price competitiveness. The Company also expects its competitors to develop new strategic relationships with providers, referral sources and payors, which could result in increased competition. The introduction of new and enhanced services, acquisitions and industry consolidation and the development of strategic relationships by the Company's competitors could cause a decline in sales or loss of market acceptance of the Company's services or price competition, or make the Company's services less attractive. SOURCE AND AVAILABILITY OF PERSONNEL To maximize the cost effectiveness and productivity of caregivers, the Company utilizes customized processes and procedures that have been developed and refined over the years. Personalized matching to recruit and select applicants who fit the patients' individual needs is achieved through initial applicant profiles, personal interviews, skill evaluations and background and reference checks. In 2003, the Company launched its proprietary CaseMatch(SM) software scheduling program that gives local Company offices the ability to identify instantly those caregivers who can be assigned to patient cases. Caregivers are recruited through a variety of sources, including advertising in local and national media, job fairs, solicitations on websites, direct mail and telephone solicitations, as well as referrals obtained directly from clients and other caregivers. Caregivers are generally paid on a per visit, per shift, per hour or per diem basis, or are employed on a full-time salaried basis. The Company, along with its competitors, is currently experiencing a shortage of licensed professionals. A continued shortage of professionals could have a material adverse effect on the Company's business. NUMBER OF PERSONS EMPLOYED At December 28, 2003, the Company had approximately 3,500 full-time employees, including approximately 700 salaried caregivers. The Company also employs caregivers on a temporary basis, as needed, to provide home health services. In fiscal 2003, the average number of non-salaried caregivers employed on a weekly basis in its home health services business was approximately 11,600. The Company believes that its relationships with its employees are generally good. OTHER MATTERS Subsequent to the sale of its specialty pharmaceutical services business in June 2002, the Company has operated its remaining home health services business as a single reporting unit. Financial information relating to the home health services business is found in the consolidated financial statements of the Company and its subsidiaries which are included in this annual report. The Company has historically experienced a seasonal decline in the demand for its home health services during the third fiscal quarter. For a discussion of certain regulations to which the Company's business is subject, see "Regulations" under Item 3, "Legal Proceedings," below. AVAILABLE INFORMATION The Company's Internet address is www.gentiva.com. The Company makes available free of charge on or through its Internet website its annual report on Form 10-K, quarterly reports on Form 10-Q, current reports on Form 8-K and amendments to those reports, filed or furnished pursuant to Section 13(a) or 15(d) of the - 4 - Securities Exchange Act of 1934, as soon as reasonably practicable after such material has been filed with, or furnished to, the SEC. The Company also makes available on or through its website its press releases, an investor presentation, Section 16 reports and certain corporate governance documents. RISK FACTORS THIS ANNUAL REPORT ON FORM 10-K CONTAINS FORWARD-LOOKING STATEMENTS WHICH INVOLVE A NUMBER OF RISKS, UNCERTAINTIES AND ASSUMPTIONS. ACTUAL RESULTS COULD DIFFER MATERIALLY FROM THOSE DISCUSSED IN THE FORWARD-LOOKING STATEMENTS. FACTORS THAT COULD CAUSE ACTUAL RESULTS TO DIFFER MATERIALLY INCLUDE, WITHOUT LIMITATION, THE RISK FACTORS DISCUSSED BELOW AND ELSEWHERE IN THIS ANNUAL REPORT. RISKS RELATED TO THE COMPANY'S BUSINESS AND INDUSTRY THE COMPANY'S GROWTH STRATEGY MAY NOT BE SUCCESSFUL. The future growth of the Company's business and its future financial performance will depend on, among other things, its ability to increase its revenue base through a combination of internal growth and strategic ventures, including acquisitions. The Company's home health services business experienced no growth during the fiscal periods from 1998 through 2001. During fiscal 2002 and 2003, revenue from the Company's home health services business grew 5.3 percent and 5.9 percent, respectively; however, future revenue growth cannot be assured as it is subject to the effects of competition, various risk factors including the uncertainty of Medicare, Medicaid, and private health insurance reimbursement, the ability to generate new and retain existing contracts with major payor sources and the ability to attract and retain qualified personnel. COMPETITION AMONG HOME HEALTH CARE COMPANIES IS INTENSE. The home health services industry is highly competitive. The Company competes with a variety of other companies in providing home health services, some of which may have greater financial and other resources and may be more established in their respective communities. Competing companies may offer newer or different services from those offered by the Company and may thereby attract customers who are presently receiving the Company's home health services. THE COST OF HEALTH CARE IS FUNDED SUBSTANTIALLY BY GOVERNMENT AND PRIVATE INSURANCE PROGRAMS. IF SUCH FUNDING IS REDUCED OR BECOMES LIMITED OR UNAVAILABLE TO THE COMPANY'S CUSTOMERS, THE COMPANY'S BUSINESS MAY BE ADVERSELY IMPACTED. Third-party payors include Medicare, Medicaid and private health insurance providers. Third-party payors are increasingly challenging prices charged for health care services. The Company cannot be assured that its services will be considered cost-effective by third-party payors, that reimbursement will be available, or that payors' reimbursement policies will not have a material adverse effect on the Company's ability to sell its services on a profitable basis, if at all. The Company cannot control reimbursement rates or policies for a significant portion of its business. POSSIBLE CHANGES IN THE CASE MIX OF PATIENTS, AS WELL AS PAYOR MIX AND PAYMENT METHODOLOGIES, MAY HAVE A MATERIAL ADVERSE EFFECT ON THE COMPANY'S PROFITABILITY. The sources and amounts of the Company's patient revenues will be determined by a number of factors, including the mix of patients and the rates of reimbursement among payors. Changes in the case mix of the patients as well as payor mix among private pay, Medicare and Medicaid may significantly affect the Company's profitability. In particular, any significant increase in the Company's Medicaid population or decrease in Medicaid payments could have a material adverse effect on its financial position, results of operations and cash flow, especially if states operating these programs continue to limit, or more aggressively seek limits on reimbursement rates or service levels. THE LOSS OF SIGNIFICANT CONTRACTS, AS WELL AS SIGNIFICANT REDUCTIONS IN MEMBERS COVERED UNDER SUCH CONTRACTS, COULD HAVE A MATERIAL ADVERSE EFFECT ON THE COMPANY'S FINANCIAL CONDITION AND RESULTS OF OPERATIONS. The Company has entered into service agreements with a number of managed care organizations to provide, or contracted with third party providers to provide, home nursing services, acute and chronic infusion therapies, durable medical equipment and respiratory products and services to patients insured by those organizations. One such contract with Cigna accounted for 36 percent of the Company's total net revenues for the year - 5 - ended December 28, 2003. The Company and Cigna entered into a new home health care contract effective January 1, 2004 and expiring on December 31, 2006. Under the termination provisions of the contract, Cigna has the right to terminate the agreement on December 31, 2005, if it provides 90 days advance written notice to the Company. If the Cigna contract or any other similar significant contract were to terminate or if there was a significant decrease in enrolled members covered under the Company's contract with Cigna or any other organization, it could materially adversely affect the Company's financial condition and results of operations. FURTHER CONSOLIDATION OF MANAGED CARE ORGANIZATIONS AND OTHER THIRD-PARTY PAYORS MAY ADVERSELY AFFECT THE COMPANY'S PROFITS. Managed care organizations and other third-party payors have continued to consolidate in order to enhance their ability to influence the delivery of health care services. Consequently, the health care needs of a large percentage of the United States population are increasingly served by a smaller number of managed care organizations. These organizations generally enter into service agreements with a limited number of providers for needed services. To the extent that such organizations terminate the Company as a preferred provider and/or engage its competitors as a preferred or exclusive provider, the Company's business could be adversely affected. In addition, private payors, including managed care payors, could seek to negotiate additional discounted fee structures or the assumption by health care providers of all or a portion of the financial risk through prepaid capitation arrangements, thereby potentially reducing the Company's profitability. THE COMPANY AND THE HEALTH CARE INDUSTRY CONTINUE TO EXPERIENCE SHORTAGES IN QUALIFIED HOME HEALTH SERVICE CAREGIVERS. The Company competes with other health care providers for its employees. As the demand for home health services continues to exceed the supply of available and qualified staff, the Company and its competitors have been forced to offer more attractive wage and benefit packages to these professionals. Furthermore, the competitive arena for this shrinking labor market has created turnover as many seek to take advantage of the supply of available positions, each offering new and more attractive wage and benefit packages. In addition to the wage pressures inherent in this environment, the cost of training new employees amid the turnover rates has caused added pressure on the Company's operating margins. AN ECONOMIC DOWNTURN, CONTINUED DEFICIT SPENDING BY THE FEDERAL GOVERNMENT AND STATE BUDGET PRESSURES MAY RESULT IN A REDUCTION IN REIMBURSEMENT AND COVERED SERVICES. An economic downturn can have a detrimental effect on state revenues. Historically, these budget pressures have translated into reductions in state spending. Given that Medicaid outlays are a significant component of state budgets, the Company can expect continuing cost containment pressures on Medicaid outlays for the Company's services in the states in which it operates. In addition, an economic downturn may also impact the number of enrollees in managed care programs as well as the profitability of managed care companies, which could result in reduced reimbursement rates. Deficit spending by the government as the result of adverse developments in the economy could lead to increased pressure to reduce government expenditures for other purposes, including governmentally funded programs in which the Company participates, such as Medicare and Medicaid. THE AGREEMENT GOVERNING THE COMPANY'S EXISTING REVOLVING CREDIT FACILITY CONTAINS, AND FUTURE DEBT AGREEMENTS MAY CONTAIN, VARIOUS COVENANTS THAT LIMIT THE COMPANY'S DISCRETION IN THE OPERATION OF ITS BUSINESS. The agreement and instruments governing the Company's existing revolving credit facility contain, and the agreements and instruments governing its future debt agreements may contain, various restrictive covenants that, among other things, require it to comply with or maintain certain financial tests and ratios and restrict the Company's ability to: o incur more debt; o pay dividends, redeem stock or make other distributions; o make certain investments; o create liens; o enter into transactions with affiliates; o make acquisitions; o merge or consolidate; and - 6 - o transfer or sell assets. In addition, events beyond the Company's control could affect its ability to comply with and maintain the financial tests and ratios. Any failure by the Company to comply with or maintain all applicable financial tests and ratios and to comply with all applicable covenants could result in an event of default with respect to its existing revolving credit facility or future debt agreements. This could lead to the acceleration of the maturity of the facility and the termination of the commitments to make further extension of credit. The Company has no outstanding debt as of December 28, 2003, but could incur debt in the future. If the Company were unable to repay debt to its senior lenders, these lenders could proceed against the collateral securing that debt. Even if the Company is able to comply with all applicable covenants, the restrictions on its ability to operate its business at its sole discretion could harm its business by, among other things, limiting its ability to take advantage of financing, mergers, acquisitions and other corporate opportunities. THE COMPANY HAS RISKS RELATED TO OBLIGATIONS UNDER ITS INSURANCE PROGRAMS. The Company is obligated for certain costs under various insurance programs, including employee health and welfare, workers compensation and professional liability. The Company may be subject to workers compensation claims and lawsuits alleging negligence or other similar legal claims. The Company maintains various insurance programs to cover these risks but is substantially self-insured for most of these claims. The Company also may be subject to exposure relating to employment law and other related matters for which the Company does not maintain insurance coverage. The Company believes that its present insurance coverage and reserves are sufficient to cover currently estimated exposures; however, there can be no assurance that the Company will not incur liabilities in excess of recorded reserves or in excess of its insurance limits. THE COMPANY HAS RISKS RESULTING FROM THE SALE OF ITS SPS BUSINESS. The Company has agreed to indemnify Accredo for losses suffered or incurred by Accredo and its affiliates arising from the retained liabilities of the Company, breaches of the Company's representations, warranties, covenants or agreements under the asset purchase agreement between the Company and Accredo dated January 2, 2002, or agreements delivered pursuant thereto, failure to deliver good, valid and marketable title to the assets of the SPS business, and specified tax liabilities of the Company, including those related to the Company's Split-Off from Olsten. The liabilities retained by the Company include litigation and causes of action arising prior to the closing of the sale of the SPS business. These indemnification obligations are discussed in more detail below under Item 3 "Legal Proceedings - Indemnifications." The Company is unable to predict the amount, if any, that may be required for it to satisfy its indemnification obligations under the asset purchase agreement should any claims arise. Should any significant payment be required, the Company may not have sufficient funds available to satisfy its potential indemnification obligations or may not be able to obtain the funds on terms satisfactory to the Company, if at all. In addition, with the sale of the SPS business, the Company is no longer able to deliver specialty pharmaceutical services, including the distribution of chronic drugs and therapies and the provision of acute infusion services, directly to payors and managed care providers, but will need to depend fully on subcontracts with third parties, including Accredo. As a result, the Company may be more susceptible to fluctuations in volume and in the prices it pays to third parties for those services. These fluctuations in pricing may add to the cost of providing the services and, as a result, adversely impact the Company's profitability. RISKS RELATED TO HEALTH CARE REGULATION LEGISLATIVE AND REGULATORY ACTIONS RESULTING IN CHANGES IN REIMBURSEMENT RATES OR METHODS OF PAYMENT FROM MEDICARE AND MEDICAID, OR IMPLEMENTATION OF OTHER MEASURES TO REDUCE REIMBURSEMENT FOR THE COMPANY'S SERVICES, MAY HAVE A MATERIAL ADVERSE EFFECT ON ITS REVENUES AND OPERATING MARGINS. In fiscal 2003, 42 percent of the Company's net revenues were generated from Medicare, and Medicaid and Other Government programs. The health care industry is experiencing a strong trend toward cost containment, as the government seeks to impose lower reimbursement and utilization rates and negotiate reduced payment schedules with providers. These cost containment measures generally have resulted in reduced rates of reimbursement for services that the Company provides. In addition, the timing of payments made under these programs is subject to regulatory action and governmental budgetary constraints. For certain Medicaid programs, the time period between submission of claims and payment has increased. Further, within the statutory framework of the Medicare and Medicaid programs, - 7 - there are a substantial number of areas subject to administrative rulings and interpretations that may further affect payments made under those programs. Additionally, the federal and state governments may in the future reduce the funds available under those programs or require more stringent utilization and quality reviews of providers. Moreover, there can be no assurances that adjustments from Medicare or Medicaid audits will not have a material adverse effect on the Company. The Benefits Improvement and Protection Act of 2000 mandates a phase out of intergovernmental transfer transactions by states whereby states inflate the payments to certain public facilities to increase federal matching funds. This action may reduce federal support for a number of state Medicaid plans. The reduced federal payments may adversely affect aggregate available funds, thereby requiring states to reduce payments to all providers. The Company operates in several of the states that will experience a contraction of federal matching funds. With the repeal of the federal payment standards, there can be no assurances that budget constraints or other factors will not cause states to reduce Medicaid reimbursement or that payments will be made on a timely basis, thereby adversely affecting payments made under these Medicaid programs. THE COMPANY CONDUCTS BUSINESS IN A HEAVILY REGULATED INDUSTRY, AND CHANGES IN REGULATIONS AND VIOLATIONS OF REGULATIONS MAY RESULT IN INCREASED COSTS OR SANCTIONS. The Company's business is subject to extensive federal, state and, in some cases, local regulation. Compliance with these regulatory requirements, as interpreted and amended from time to time, can increase operating costs or reduce revenue and thereby adversely affect the financial viability of the Company's business. Because these laws are amended from time to time and are subject to interpretation, the Company cannot predict when and to what extent liability may arise. Failure to comply with current or future regulatory requirements could also result in the imposition of various remedies, including fines, the revocation of licenses or decertification. Unanticipated increases in operating costs or reductions in revenue could adversely affect the Company's liquidity. THE COMPANY IS SUBJECT TO PERIODIC AUDITS AND REQUESTS FOR INFORMATION BY THE MEDICARE AND MEDICAID PROGRAMS OR GOVERNMENT AGENCIES, WHICH HAVE VARIOUS RIGHTS AND REMEDIES AGAINST THE COMPANY IF THEY ASSERT THAT THE COMPANY HAS OVERCHARGED THE PROGRAMS OR FAILED TO COMPLY WITH PROGRAM REQUIREMENTS. The operation of the Company's home health services business is subject to federal and state laws prohibiting fraud by health care providers, including laws containing criminal provisions, which prohibit filing false claims or making false statements in order to receive payment or obtain certification under Medicare and Medicaid programs, or failing to refund overpayments or improper payments. Violation of these criminal provisions is a felony punishable by imprisonment and/or fines. The Company may also be subject to fines and treble damage claims if it violates the civil provisions that prohibit knowingly filing a false claim or knowingly using false statements to obtain payment. State and federal governments are devoting increased attention and resources to anti-fraud initiatives against health care providers. The Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and the Balanced Budget Act of 1997 ("BBA") expanded the penalties for health care fraud, including broader provisions for the exclusion of providers from the Medicare and Medicaid programs. The Company has established policies and procedures that it believes are sufficient to ensure that it will operate in substantial compliance with these anti-fraud and abuse requirements, including the Company's Corporate Integrity Agreement. On April 17, 2003, the Company received a subpoena from the Department of Health and Human Services, Office of the Inspector General, Office of Investigations ("OIG"). The subpoena seeks information regarding the Company's implementation of settlements and corporate integrity agreements entered into with the government, as well as the Company's treatment on cost reports of employees engaged in sales and marketing efforts. With respect to the cost report issues, the government has preliminarily agreed to narrow the scope of production to the period from January 1, 1998 through September 30, 2000. On February 17, 2004, the Company received a subpoena from the U.S. Department of Justice ("DOJ") seeking additional information related to the matters covered by the OIG subpoena. The Company has provided documents and other information requested by the OIG pursuant to its subpoena and similarly intends to cooperate fully with the DOJ subpoena as well as any future OIG or DOJ information requests. To the Company's knowledge, the government has not filed a complaint against the Company. While the Company believes that its business practices are consistent with Medicare and Medicaid programs criteria, those criteria are often vague and subject to change and interpretation. The imposition of fines, criminal penalties or program exclusions could have a material adverse effect on the Company's financial condition, results of operations and cash flows. - 8 - THE COMPANY IS ALSO SUBJECT TO FEDERAL AND STATE LAWS THAT GOVERN FINANCIAL AND OTHER ARRANGEMENTS BETWEEN HEALTH CARE PROVIDERS. These laws often prohibit certain direct and indirect payments or fee-splitting arrangements between health care providers that are designed to encourage the referral of patients to a particular provider for medical products and services. Furthermore, some states restrict certain business relationships between physicians and other providers of health care services. Many states prohibit business corporations from providing, or holding themselves out as a provider of, medical care. Possible sanctions for violation of any of these restrictions or prohibitions include loss of licensure or eligibility to participate in reimbursement programs and civil and criminal penalties. These laws vary from state to state, are often vague and have seldom been interpreted by the courts or regulatory agencies. THE COMPANY FACES ADDITIONAL FEDERAL REQUIREMENTS THAT MANDATE MAJOR CHANGES IN THE TRANSMISSION AND RETENTION OF HEALTH INFORMATION. HIPAA was enacted to ensure that employees can retain and at times transfer their health insurance when they change jobs and to simplify health care administrative processes. The enactment of HIPAA expanded protection of the privacy and security of personal medical data and required the adoption of standards for the exchange of electronic health information. Among the standards that the Secretary of Health and Human Services has adopted pursuant to HIPAA are standards for electronic transactions and code sets, unique identifiers for providers, employers, health plans and individuals, security and electronic signatures, privacy and enforcement. Although HIPAA was intended to ultimately reduce administrative expenses and burdens faced within the health care industry, the Company believes that implementation of this law will result in additional costs. Failure to comply with HIPAA could result in fines and penalties that could have a material adverse effect on the Company. ITEM 2. PROPERTIES The Company's headquarters is leased and is located at 3 Huntington Quadrangle 2S, Melville, New York 11747-8943. Other major regional administrative offices leased by the Company are located in Overland Park, Kansas; Phoenix, Arizona; Hartford, Connecticut; Tampa, Florida; Endicott, New York; and Houston, Texas. The Company also maintains leases for other offices and locations on various terms expiring on various dates. ITEM 3. LEGAL PROCEEDINGS LITIGATION In addition to the matters referenced in this Item 3, the Company is party to certain legal actions arising in the ordinary course of business including legal actions arising out of services rendered by its various operations, personal injury and employment disputes. COOPER V. GENTIVA CARECENTRIX, INC. t/a/d/b/a/ GENTIVA HEALTH SERVICES, U.S. District Court (W.D. Penn), Civil Action No. 01-0508. On January 2, 2002, this amended complaint was served on the Company alleging that the defendant submitted false claims to the government for payment in violation of the Federal False Claims Act, 31 U.S.C. 3729 et seq., and that the defendant had wrongfully terminated the plaintiff. The plaintiff claimed that infusion pumps delivered to patients did not supply the full amount of medication, allegedly resulting in substandard care. Based on a review of the court's docket sheet, the plaintiff filed a complaint under seal in March 2001. In October 2001, the United States government filed a notice with the court declining to intervene in this matter, and on October 24, 2001, the court ordered that the seal be lifted. The Company filed its responsive pleading on February 25, 2002, and discovery has now commenced. The Company has denied the allegations of wrongdoing in the complaint and is defending itself vigorously in this matter. On May 19, 2003, the Company filed a motion for summary judgment on the issue of liability. On February 6, 2004, the court granted partial summary judgment for the Company, dismissing two of the three claims alleged under the False Claims Act and denying summary judgment for the Company on the wrongful termination claim. The parties are completing discovery; therefore, the Company cannot determine a range of damages, if any, at this time. - 9 - GOVERNMENT MATTERS On April 17, 2003, the Company received a subpoena from the Department of Health and Human Services, Office of the Inspector General, Office of Investigations ("OIG"). The subpoena seeks information regarding the Company's implementation of settlements and corporate integrity agreements entered into with the government, as well as the Company's treatment on cost reports of employees engaged in sales and marketing efforts. With respect to the cost report issues, the government has preliminarily agreed to narrow the scope of production to the period from January 1, 1998 through September 30, 2000. On February 17, 2004, the Company received a subpoena from the U.S. Department of Justice ("DOJ") seeking additional information related to the matters covered by the OIG subpoena. The Company has provided documents and other information requested by the OIG pursuant to its subpoena and similarly intends to cooperate fully with the DOJ subpoena as well as any future OIG or DOJ information requests. To the Company's knowledge, the government has not filed a complaint against the Company. INDEMNIFICATIONS In connection with the Split-Off, the Company agreed to assume, to the extent permitted by law, and to indemnify Olsten for, the liabilities, if any, arising out of the home health services business. In addition, the Company and Accredo have agreed to indemnify each other for breaches of representations and warranties of such party or the non-fulfillment of any covenant or agreement of such party in connection with the sale of the SPS business. The Company has also agreed to indemnify Accredo for the retained liabilities and for tax liabilities, and Accredo has agreed to indemnify the Company for assumed liabilities and the operation of the SPS business after the closing of the acquisition. The representations and warranties generally survive for the period of two years after the closing of the acquisition, which occurred on June 13, 2002, except that: o representations and warranties related to health care compliance survive for three years after the closing of the acquisition; o representations and warranties related to title of the assets and sufficiency of assets and employees survive for the applicable statute of limitations period; and o representations and warranties related to tax matters survive until thirty days after the expiration of the applicable tax statute of limitations period, including any extensions of the applicable period, subject to certain exceptions. Accredo and the Company generally may recover indemnification for a breach of a representation or warranty only to the extent a party's claim exceeds $1 million for any individual claim, or exceeds $5 million in the aggregate, subject to certain conditions and only up to a maximum amount of $100 million. These indemnification rights are the exclusive remedy from and after the closing of the acquisition, except for the right to seek specific performance of any of the agreements in the related asset purchase agreement, in any case where a party is guilty of fraud in connection with the acquisition, and with respect to tax liabilities and obligations. On May 6, 2003, the Company received correspondence from Accredo giving the Company notice of Accredo's indemnification rights for any breach under the asset purchase agreement related to the adequacy of the accounts receivable reserves in accordance with section 8.3 of the asset purchase agreement; however, no breach of a representation or warranty was asserted against the Company in the correspondence. CORPORATE INTEGRITY AGREEMENT In connection with a July 19, 1999 settlement with various government agencies, Olsten executed a corporate integrity agreement with the Office of Inspector General of the Department of Health and Human Services, which will remain in effect until August 18, 2004. The corporate integrity agreement applies to the Company's businesses that bill the federal government health programs directly for services, such as its nursing brand (but excludes the SPS business), and focuses on issues and training related to cost report preparation, contracting, medical necessity and billing of claims. Under the corporate integrity agreement, the Company is required, for example, to maintain a corporate compliance officer to develop and implement compliance programs, to retain an independent review organization to perform annual reviews and to maintain a compliance program and reporting systems, as well as to provide certain training to employees. - 10 - The Company's compliance program is required to be implemented for all newly established or acquired business units if their type of business is covered by the corporate integrity agreement. Reports under the integrity agreement are to be filed annually with the Department of Health and Human Services, Office of Inspector General. After the corporate integrity agreement expires, the Company is to file a final annual report with the government. The Company is in compliance with the corporate integrity agreement and has timely filed all required reports. If the Company fails to comply with the terms of its corporate integrity agreement, the Company will be subject to penalties. REGULATIONS The Company's business is subject to extensive federal and state regulations which govern, among other things: o Medicare, Medicaid, TRICARE (the Department of Defense's managed health care program for military personnel and their families) and other government-funded reimbursement programs; o reporting requirements, certification and licensing standards for certain home health agencies; and o in some cases, certificate-of-need requirements. The Company's compliance with these regulations may affect its participation in Medicare, Medicaid, TRICARE and other federal health care programs. The Company is also subject to a variety of federal and state regulations which prohibit fraud and abuse in the delivery of health care services. These regulations include, among other things: o prohibitions against the offering or making of direct or indirect payments to actual or potential referral sources for obtaining or influencing patient referrals; o rules against physicians making referrals under Medicare for clinical services to a home health agency with which the physician or his or her immediate family member has certain types of financial relationships; o laws against the filing of false claims; and o laws against making payment or offering items of value to patients to induce their self-referral to the provider. As part of the extensive federal and state regulation of the home health services business and under the Company's corporate integrity agreement, the Company is subject to periodic audits, examinations and investigations conducted by, or at the direction of, governmental investigatory and oversight agencies. Periodic and random audits conducted or directed by these agencies could result in a delay in receipt, or an adjustment to the amount of reimbursements due or received under Medicare, Medicaid, TRICARE and other federal health programs. Violation of the applicable federal and state health care regulations can result in excluding a health care provider from participating in the Medicare, Medicaid and/or TRICARE programs and can subject the provider to substantial civil and/or criminal penalties. On October 1, 2002, the reduction in home health payment limits mandated under the Balanced Budget Act of 1997 became effective. The change in payment limits reduced payments under the Medicare program to home health agencies for open episodes of care on or after October 1, 2002 by approximately 7 percent. Simultaneous with this reduction, market basket rate increases of 2.1 percent adjusted for certain wage indices were also implemented, resulting in an overall reduction in reimbursement rates of approximately 4.9 percent. In addition, Medicare reimbursement related to home health services performed in specifically defined rural areas of the country was further reduced as the ten percent rural add-on provision for home health services expired as of April 1, 2003. On October 1, 2003, a market basket rate increase of 3.3 percent became effective for open episodes of care as of or after that date. The market basket rate will be reduced 0.8 percent for open episodes of care on or after April 1, 2004. Furthermore, the Medicare reimbursement related to home health services performed in specifically defined rural areas of the country will increase by 5 percent for a one year period, effective April 1, 2004. - 11 - ITEM 4. SUBMISSION OF MATTERS TO A VOTE OF SECURITY HOLDERS No matters were submitted to a vote of security holders during the fourth quarter of fiscal 2003. EXECUTIVE OFFICERS OF THE COMPANY The following table sets forth certain information regarding each of the Company's executive officers as of February 26, 2004:
EXECUTIVE POSITION AND OFFICES NAME OFFICER SINCE AGE WITH THE COMPANY - ----------------------- ------------- --- ------------------------------------------ Ronald A. Malone 2000 49 Chief Executive Officer and Chairman of the Board Vernon A. Perry, Jr. 1999 52 President and Chief Operating Officer Robert Creamer 2002 45 Senior Vice President, Nursing Operations, and Chief Information Officer Mary Morrisey Gabriel 2002 38 Senior Vice President, Sales John R. Potapchuk 2001 51 Senior Vice President, Chief Financial Officer, Treasurer and Secretary Christopher L. Anderson 2001 32 Vice President, Audit Services and Quality Assurance, and Chief Compliance Officer Stephen B. Paige 2003 56 Vice President and General Counsel
The executive officers are elected annually by the board of directors. RONALD A. MALONE Mr. Malone has served as chief executive officer and chairman of the board of the Company since June 2002. He served as executive vice president of the Company from March 2000 to June 2002. Prior to joining the Company, he served in various positions with Olsten, including executive vice president of Olsten and president, Olsten Staffing Services, United States and Canada, from January 1999 to March 2000. From 1994 to December 1998, he served successively as Olsten's senior vice president, southeast division; senior vice president, operations; and executive vice president, operations. VERNON A. PERRY, JR. Mr. Perry has served as president and chief operating officer of the Company since June 2002. He served as senior vice president of the Company from November 1999 to June 2002. From 1996 to 1999, he served as senior vice president of CareCentrix for Olsten Health Services. He joined Olsten in 1994 as vice president for business development. ROBERT CREAMER Mr. Creamer has served as senior vice president, nursing operations, of the Company since September 2003 and as the Company's chief information officer since June 2002. From June 2002 to August 2003, he served as senior vice president, financial operations, of the Company. Prior thereto he served in various corporate financial management positions with the Company and Olsten Health Services, including vice president of finance-CareCentrix, vice president of financial operations and vice president of finance - Specialty Pharmaceutical Services. He first joined Olsten in 1991. - 12 - MARY MORRISEY GABRIEL Ms. Morrisey Gabriel has served as senior vice president, sales, of the Company since July 2002. From March 2000 to June 2002, Ms. Morrisey Gabriel served as senior vice president of National Accounts/North American Sales of Adecco, a staffing services company. From 1999 to March 2000, she served as Olsten's senior vice president of national accounts. JOHN R. POTAPCHUK Mr. Potapchuk has served as senior vice president, chief financial officer, treasurer and secretary of the Company since June 2002. He served as vice president of finance and controller of the Company from March 2000 to June 2002. He joined Olsten in 1991 and served in various corporate financial management positions with Olsten Health Services, including vice president and operations controller and vice president of finance. Prior to that, Mr. Potapchuk served in senior management positions for PricewaterhouseCoopers LLP and Deloitte & Touche. CHRISTOPHER L. ANDERSON Mr. Anderson has served as the chief compliance officer and vice president of audit services and quality assurance of the Company since March 2000. He served as chief compliance officer of Olsten from November 1998 to March 2000. STEPHEN B. PAIGE Mr. Paige has served as vice president and general counsel of the Company since July 2003. From 1997 to 2002, he served as senior vice president, general counsel and secretary of General Semiconductor, Inc., a technology based company. Prior thereto, Mr. Paige served in senior legal positions with several large health care, food ingredient and consumer product companies. PART II ITEM 5. MARKET FOR REGISTRANT'S COMMON EQUITY AND RELATED STOCKHOLDER MATTERS MARKET INFORMATION The Company's common stock is quoted on the Nasdaq National Market under the symbol "GTIV". The following table sets forth the high and low bid information for shares of the Company's common stock for each quarter during fiscal 2002 and 2003: 2002 (1) HIGH LOW ------------------------------- 1st Quarter $25.39 $20.65 2nd Quarter 27.55 7.90 3rd Quarter 9.29 6.72 4th Quarter 8.86 7.10 2003 HIGH LOW ------------------------------- 1st Quarter $10.34 $ 8.10 2nd Quarter 9.69 7.44 3rd Quarter 11.94 8.75 4th Quarter 13.59 10.98 (1) On June 13, 2002, the Company paid a special dividend to its shareholders consisting of $7.76 cash and 0.19253 shares of Accredo common stock per share of Gentiva common stock (valued at $9.99 per - 13 - share based on the June 13, 2002 closing price of $51.89 per share of Accredo common stock) following the sale of the Company's SPS business to Accredo. The total value of the special dividend amounted to $17.75 per share. HOLDERS As of February 26, 2004, there were approximately 2,300 holders of record of the Company's common stock including participants in the Company's employee stock purchase plan, brokerage firms holding the Company's common stock in "street name" and other nominees. DIVIDENDS Except for the special dividend in cash ($7.76) and in kind (0.19253 shares of Accredo common stock) per share of Gentiva common stock paid in June 2002, the Company has never paid any cash dividends on its common stock. Any future payments of dividends and the amount of the dividends will be determined by the board of directors from time to time based on the Company's results of operations, financial condition, cash requirements, future prospects and other factors deemed relevant by the Company's board of directors, including any substantive change in tax treatment under the United States Tax Code. In addition, the Company's credit facility also contains restrictions on the Company's ability to declare and pay dividends. See Item 7, "Management's Discussion and Analysis of Financial Condition and Results of Operations." ITEM 6. SELECTED FINANCIAL DATA The following table provides selected historical consolidated financial data of the Company as of and for each of the fiscal years in the five-year period ended December 28, 2003. The data has been derived from the Company's audited consolidated financial statements. The historical consolidated financial information presents the Company's results of operations and financial position as if the Company were a separate entity from Olsten for all years presented. In addition, the operating results of the SPS business through the closing date of the sale to Accredo, including corporate expenses directly attributable to SPS operations, restructuring and special charges related to the SPS business, as well as the gain on the sale, net of transaction costs and related income taxes, are reflected as discontinued operations in the accompanying consolidated statements of operations. Continuing operations includes the results of the home health services business, including corporate expenses that did not directly relate to SPS, as well as restructuring and special charges. In addition, for fiscal 2000 and 1999, continuing operations included the health care staffing services business and Canadian operations which were sold during the fourth quarter of fiscal 2000. Results of all prior periods have been reclassified to conform to this presentation. The historical financial information may not be indicative of the Company's future performance and may not necessarily reflect what the financial position and results of operations of the Company would have been if the Company was a separate stand-alone entity during all the years presented. - 14 -
(in thousands, except per share amounts) FISCAL YEAR ENDED ----------------------------------------------------------------- 2003 2002 2001 2000 1999 --------- --------- --------- --------- --------- STATEMENT OF OPERATIONS DATA Net revenues $ 814,029 $ 768,501 $ 729,577 $ 881,765 (8) $ 879,295 (8) Gross profit 282,042 247,600 (2) 245,660 273,493 (4) 285,402 Selling, general and administrative expenses (259,185) (283,540)(2) (266,322)(3) (356,359)(4) (342,755)(5) Income (loss) from continuing operations 56,766 (53,543) (13,910) (49,826) (41,077) Discontinued operations, net of tax (6) - 191,578 34,898 (54,374)(4) 25,991 Cumulative effect of accounting change, net of tax (7) - (187,068) - - - Net income (loss) 56,766(1) (49,033)(2) 20,988 (3) (104,200)(4) (15,086)(5) Diluted earnings per share: Income (loss) from continuing operations $ 2.07 $ (2.05) $ (0.60) $ (2.41) $ (2.02) Discontinued operations, net of tax - 7.32 1.50 (2.64) 1.28 Cumulative effect of accounting change, net of tax - (7.14) - - - Net income (loss) 2.07 (1.87) 0.90 (5.05) (0.74) Weighted average shares outstanding - diluted 27,439 26,183 23,186 20,637 20,345 (9) BALANCE SHEET DATA (AT END OF YEAR) (10) Cash items and short-term investments (11) $ 110,013 $ 101,241 $ 107,144 $ 452 $ 2,942 Working capital 136,297 104,339 417,949 348,684 438,536 Total assets 335,088 264,431 849,879 805,484 1,063,015 Long-term debt and other securities - - - 20,000 78,562 Shareholders' equity 177,179 113,048 621,707 566,149 705,291 Common shares outstanding 25,598 26,385 25,639 21,197 20,345 (9) SPECIAL DIVIDEND PER COMMON SHARE: Cash - $ 7.76 - - - Value of Accredo common stock - 9.99 - - -
(1) Net income for fiscal 2003 reflects a tax benefit of $35.0 million associated with management's decision to reverse the valuation allowance for deferred tax assets. See Notes 12 and 14 to the Company's consolidated financial statements. (2) Net loss in fiscal 2002 reflects restructuring and other special charges aggregating $46.1 million, of which $6.3 million is recorded in cost of services sold and $39.8 million is recorded in selling, general and administrative expenses. See Note 4 to the Company's consolidated financial statements. (3) Net income in fiscal 2001 reflects special charges of approximately $3.0 million in connection with the settlement of the GILE V. OLSTEN CORPORATION, ET AL. and the STATE OF INDIANA V. QUANTUM HEALTH RESOURCES, INC. AND OLSTEN HEALTH SERVICES, Inc. lawsuits and for various other legal costs. These special charges are included in selling, general and administrative expenses. See Note 4 to the Company's consolidated financial statements. (4) Net loss for fiscal 2000 reflects restructuring and other special charges aggregating $153.2 million, of which $97.0 million related to discontinued operations and $56.2 million related to continuing operations. Restructuring and special charges of $8.5 million are included in cost of services sold and $47.7 million is included in selling, general and administrative expenses. Net loss for fiscal 2000 also reflects a gain of $36.7 million relating to the sale of the Company's staffing services business and Canadian operations. (5) Net loss for fiscal 1999 reflects a restructuring charge of $15.2 million for the realignment of business units as part of a new restructuring plan. This charge is included in selling, general and administrative expenses. (6) For fiscal 2002, the Company sold its SPS business to Accredo in accordance with the asset purchase agreement, dated January 2, 2002, with the sale completed on June 13, 2002. As such, the Company has reflected discontinued operations, including the gain on sale, of $191.6 million during fiscal 2002. Results for all prior years have been reclassified to conform to this presentation. See Note 3 to the Company's consolidated financial statements. (7) For fiscal 2002, the Company adopted the provisions of SFAS 142 "Goodwill and Other Intangible Assets" and performed a transitional impairment test, resulting in a non-cash charge of $187.1 million. See Note 2 to the Company's consolidated financial statements. (8) Net revenues for fiscal 2000 and 1999 includes net revenues related to the home health services business of $736.5 million and $727.2 million, respectively. - 15 - (9) Diluted earnings per share and the weighted average shares outstanding for fiscal year 1999 and common shares outstanding at fiscal year end 1999 have been computed based on 20,345,029 shares of common stock. Such amount is based on the number of shares of the Company's common stock issued on March 15, 2000, the date of the split-off. See Note 1 to the Company's consolidated financial statements. (10) Balance sheet data for fiscal year end 2001, 2000, and 1999 includes the assets of the SPS business, which was sold to Accredo on June 13, 2002. (11) Cash items and short-term investments includes restricted cash of $21.8 million at fiscal year end 2003 and $35.2 million at fiscal year end 2001. ITEM 7. MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS The following discussion and analysis provides information which management believes is relevant to an assessment and understanding of the Company's results of operations and financial position. This discussion and analysis should be read in conjunction with the Company's consolidated financial statements and related notes included elsewhere in this report. OVERVIEW Gentiva is the nation's largest home health care company, based on the amount of revenues derived from the provision of skilled home nursing services to patients. The Company generates revenues and profits primarily by providing patients with direct home health care services, including specialty services and neuro-rehabilitation services; by delivering national, regional and local administrative services to managed care organizations and self-insured employers; and by providing home health care consulting services to independent and hospital-based home health agencies. Gentiva's direct home health services to patients include skilled nursing; physical, occupational, speech and neuro-rehabilitation therapy services; social work; nutrition; disease management education and help with daily living activities, as well as other therapies and services. The Company's specialty services involve physical therapist-led orthopedic rehabilitation services for patients who have had joint replacements or other major orthopedic surgery, as well as, commencing in 2003, therapies for patients with balance issues who are prone to injury or immobility as a result of falling. Gentiva is also piloting similar specialty programs for cardiopulmonary and wound care services that are expected to be launched during 2004. The Company's neuro-rehabilitation services, known as Rehab Without Walls(R), provide home and community-based therapies for patients with traumatic brain injury, cerebrovascular accident injury and acquired brain injury, as well as a number of other complex rehabilitation cases. Gentiva's national, regional and local administrative services for managed care organizations and self-insured employers -- provided through its CareCentrix(R) business unit -- include central access, care coordination, utilization management, and claims processing. The Company is capable of coordinating a wide range of home care services, including traditional home nursing, chronic and acute infusion therapies, and durable medical and respiratory equipment to member patients of these managed care organizations. Consulting services to home health agencies are delivered primarily by the Company's Gentiva Business Services unit. These services include billing and collection activities, web-based caregiver training and credentialing, on-site agency support and consulting, operational support, and individualized strategies for reduction of days sales outstanding. The Company's services can be delivered across the United States 24 hours a day, 7 days a week. Direct home health services to patients are delivered through more than 350 owned and operated direct service delivery units in approximately 250 locations in 35 states. Administrative services for managed care organizations and self-insured employers are coordinated within four regional coordination centers. Home care services provided to member patients of these organizations are delivered through Company-owned and nearly 1,900 third-party credentialed provider locations covering the continental United States. Gentiva's revenues are generated primarily from three major payor sources: the U.S. Medicare program, Medicaid and other state and county programs, and commercial insurers. Revenue mix by major payor classifications are as follows: - 16 - FISCAL YEAR ---------------------------- 2003 2002 2001 -------- -------- -------- Medicare 22% 21% 21% Medicaid and Other Government 20 22 23 Commercial Insurance and Other 58 57 56 ---- ---- ---- 100% 100% 100% ==== ==== ==== The Medicare and Medicaid and related programs are subject to legislative and other risk factors that can result in fluctuating reimbursement rates for Gentiva's direct home health services to patients. The commercial insurance industry is continually seeking ways to control the cost of services to patients that it covers. One of the ways it seeks to control costs is to require greater efficiencies from its providers, including home health care companies. Despite these risks, Gentiva believes it can operate effectively in the current health care climate by increasing its volume of Medicare and commercial insurance business and implementing new business practices, technologies and other methods to make the Company an even more efficient provider of services. In fact, Gentiva has made a strategic decision to seek more business from the Medicare and commercial insurance payor groups. For example, in 2003, Gentiva's revenue from its Medicare and Commercial Insurance and Other payor categories increased 10.1 percent and 7.2 percent, respectively, from the prior year. Various states have addressed budget pressures by considering or implementing reductions in various health care programs, including reductions in rates or changes in patient eligibility requirements. In addition, the Company has also decided to taper participation in certain Medicaid and other state and county programs. As a result, Gentiva's 2003 revenue from this payor category declined 1.3 percent from the prior year. Gentiva believes that several marketplace factors can contribute to its future growth. First, the Company is a leader in a highly fragmented home health care industry populated by approximately 12,000 providers of varying size and resources. Second, the cost of a home health care visit to a patient can be significantly lower than the cost of an average day in a hospital or skilled nursing institution. And third, the demand for home care is expected to grow, primarily due to an aging U.S. population. The U.S. Centers for Medicare and Medicaid Services projects that national home health and durable medical equipment spending will rise from $62.5 billion in 2004 to $103.7 billion by 2012. The U.S. Census Bureau has estimated that the age 65 and older population will increase more than 50 percent between 2000 and 2020. The Company expects to capitalize on these positive trends through a determined set of strategies, as follows: generate balanced growth by focusing on Medicare and Commercial Insurance business; continue to develop and expand specialty services for incremental revenue growth; focus on caregiver recruitment, retention and productivity; and launch technology initiatives that make Gentiva more efficient and profitable. The Company anticipates executing these strategies by continuing to expand its sales presence, developing and marketing its managed care services, making operational improvements and deploying new technologies, providing employees with leadership training and instituting retention initiatives, ensuring strong ethics and corporate governance, and focusing on shareholder value. Results from these strategies and initiatives began to appear in the Company's 2003 performance. Gentiva reported 2003 net revenue of $814.0 million, representing a $45.5 million or 5.9 percent increase from the $768.5 million reported in fiscal year 2002. The increase was due primarily to a rise in the volume of Medicare and commercial insurance business mentioned above. Net income for fiscal 2003 was $56.8 million, or $2.07 per diluted share, which included a tax benefit of $1.28 per diluted share related to the reversal of a tax valuation allowance discussed later in this annual report. This compares to a loss of $49.0 million, or $1.87 per diluted share, including restructuring and special charges, for the corresponding period of 2002. During 2003, Gentiva reported positive cash flow from operating activities of $30.7 million and increased its balance of cash items, restricted cash and short-term investments at the end of the year to approximately $110 million, compared to approximately $101 million at the end of 2002. The Company has previously stated that it would evaluate using its cash primarily for the following purposes: investments contributing to revenue growth, efficiency and profitability; selective acquisitions; share repurchases; and the possible future payment of dividends to shareholders. In 2003, Gentiva repurchased a total of over 1.4 million shares at an average cost of $10.03 per share, for a total expenditure of over $14.4 million. - 17 - Management intends the discussion of the Company's financial condition and results of operations that follows to provide information that will assist in understanding the Company's financial statements, the changes in certain key items in those financial statements from year to year, and the primary factors that accounted for those changes, as well as how certain accounting principles, policies and estimates affect its financial statements. The historical results sections in "Results of Operations" below present a discussion of the Company's consolidated operating results using the historical results of Gentiva prepared in accordance with accounting principles generally accepted in the United States (GAAP) for the fiscal years ended December 28, 2003, December 29, 2002 and December 30, 2001. SIGNIFICANT DEVELOPMENTS On June 13, 2002, the Company sold substantially all of the assets of its specialty pharmaceutical services ("SPS") business to Accredo Health, Incorporated ("Accredo") and received payment of cash in the amount of $207.5 million (before a $0.9 million reduction resulting from a closing net book value adjustment) and 5,060,976 shares of Accredo common stock (valued at $262.6 million, based on the closing price of Accredo common stock on the Nasdaq National Market on June 13, 2002). The cash consideration, less a holdback of $3.5 million for certain income taxes the Company expected to incur, and the Accredo common stock were then distributed as a special dividend to the Company's shareholders. The operating results of the SPS business through the closing date of the sale to Accredo, including corporate expenses directly attributable to SPS operations, restructuring and special charges related to the SPS business, as well as the gain on the sale, net of transaction costs and related income taxes, are reflected as discontinued operations in the accompanying consolidated statements of operations. Continuing operations includes the results of the home health services business, including corporate expenses that did not directly relate to SPS, as well as restructuring and special charges. YEAR ENDED DECEMBER 28, 2003 COMPARED TO YEAR ENDED DECEMBER 29, 2002 RESULTS OF OPERATIONS REVENUES Net revenues increased by $45 million or 5.9 percent to $814 million during fiscal 2003 as compared to $769 million during fiscal 2002. For fiscal year 2003, as compared to fiscal year 2002, net revenues from Medicare increased by $16.4 million or 10.1 percent to $178.7 million. Commercial Insurance and Other payors net revenues increased by $31.4 million or 7.2 percent to $470.2 million and Medicaid and Other Government payors net revenues decreased $2.3 million or 1.3 percent to $165.2 million. Medicare revenue growth for fiscal 2003, as compared to fiscal 2002, was primarily fueled by increases in episodes serviced of 8.7 percent. In addition, Medicare revenue was positively impacted by (i) $1.6 million due to a 3.3 percent market basket rate increase that became effective for patients on service on or after October 1, 2003 and (ii) $2.5 million due to the absence of a revenue adjustment recorded in fiscal 2002 relating to partial episode payments ("PEPs") as well as various clinical and operational process changes implemented in late 2003. In comparing the fiscal year 2003 and 2002 periods, Medicare revenues were negatively impacted by an overall 4.9 percent reduction in Medicare reimbursement rates (approximately $6.0 million for fiscal 2003), which became effective for Medicare patients beginning in October 2002, and by the elimination of the rural add-on provision ($1.4 million for fiscal 2003) for home health services, which became effective April 1, 2003. Revenue growth from Commercial Insurance and Other payors was driven by a combination of pricing and volume increases from existing customers and new contracts that were signed during the past year. Of the 7.2 percent increase in net revenues for fiscal 2003, new contracts from Commercial Insurance and Other payors accounted for 3.3 percent. Medicaid and Other Government revenues decreased for fiscal year 2003 due to revenue reductions related to more restrictive eligibility requirements in some states and lower reimbursement rates in certain other states. In addition, for fiscal 2003, revenues were negatively impacted by the Company's decision to reduce or terminate its participation in certain low-margin, hourly Medicaid and state and county programs. Revenues relating to these hourly Medicaid and state and county programs decreased $8.5 million as compared to fiscal - 18 - year 2002. These decreases were offset somewhat by increases in the intermittent care Medicaid business in selected states. GROSS PROFIT Gross profit was approximately $282 million for fiscal year 2003 compared to $248 million for fiscal year 2002. As a percentage of net revenues, gross profit margins increased from 32.2 percent for fiscal year 2002 to 34.6 percent for fiscal year 2003. Gross profit margins for fiscal 2003 as compared to fiscal 2002, were positively impacted by an increase in Medicare episodes serviced and improvements in utilization in both the commercial insurance business and Medicare (1.6 percent), reductions in insurance costs (0.5 percent), the Medicare market basket rate increase of 3.3 percent that became effective for patients on service on or after October 1, 2003 (0.2 percent) and the absence of both a $2.5 million revenue adjustment related to PEPs (0.3 percent) and the $6.3 million special charge associated with insurance costs that were recorded in fiscal 2002 (0.8 percent). These increases were partially offset by an overall 4.9 percent reduction in Medicare reimbursement rates (approximately $6.0 million or 0.8 percent), which became effective for Medicare patients beginning October 2002, and the elimination of the rural add-on provision ($1.4 million or 0.2 percent) for home health services which became effective April 1, 2003. SELLING, GENERAL AND ADMINISTRATIVE EXPENSES For fiscal year 2003, selling, general and administrative expenses, including depreciation and amortization, decreased $24 million or 8.6 percent to $259 million compared to $283 million for the corresponding period in fiscal 2002. This decrease is related to restructuring and special charges of $46.1 million, of which approximately $40 million was reflected in selling, general and administrative expenses in the accompanying consolidated statement of operations for fiscal year 2002. See Note 4 to the consolidated financial statements for further discussion of the restructuring and special charges. Excluding these special charges, selling, general and administrative expenses, including depreciation and amortization, increased $15.4 million for fiscal year 2003. This increase for fiscal 2003 related to increases in sales and field administrative expenses due to headcount additions, investments in technology initiatives and costs relating to training in connection with the implementation of provisions of the Healthcare Insurance Portability and Accountability Act of 1996 ("HIPAA") and a new software based scheduling system. These increases were partially offset by reductions in corporate administrative expenses resulting from restructuring efforts following the sale of the SPS business in the second quarter of fiscal year 2002. During fiscal 2003, headcount of personnel dedicated to sales and clinical care coordination efforts increased by approximately 19 percent while headcount relating to field and administrative personnel increased by less than 2 percent. Restructuring and special charges for fiscal year 2002 are summarized and further described below (in thousands): FISCAL YEAR ENDED DECEMBER 29, 2002 ----------------- Restructuring charges: Business realignment activities $ 6,813 -------- Special charges: Option tender offer 21,388 Settlement costs 7,731 Insurance costs 6,300 Asset writedowns and other 3,824 -------- Total special charges 39,243 -------- Total restructuring and special charges $ 46,056 ======== - 19 - FISCAL 2002 BUSINESS REALIGNMENT ACTIVITIES The Company recorded charges of $6.8 million during the second quarter ended June 30, 2002 in connection with a restructuring plan. This plan included the closing and consolidation of seven field locations and the realignment and consolidation of certain corporate and administrative support functions due primarily to the sale of the Company's SPS business. These charges included employee severance of $0.9 million relating to the termination of 115 employees in field locations and certain corporate and administrative departments, and future lease payments and other associated costs of $5.9 million resulting principally from the consolidation of office space at the Company's corporate headquarters and a change in estimated future lease obligations and other costs in excess of sublease rentals relating to a lease for a subsidiary of the Company's former parent company which the Company agreed to assume in connection with its Split-Off in March 2000. These charges are reflected in selling, general and administrative expenses in the accompanying consolidated statement of operations for the fiscal year ended December 29, 2002 During fiscal year 2002, the Company paid $2.1 million in restructuring costs, leaving approximately $4.7 million of these restructuring charges unpaid, representing severance costs of $0.2 million which were to be paid during 2003 and lease and other associated costs of $4.5 million which will be paid over the remaining lease terms. During fiscal year 2003, the Company paid $2.4 million in restructuring costs, leaving approximately $2.3 million of these restructuring charges unpaid, representing lease and other associated costs which will be paid over the remaining lease terms. OPTION TENDER OFFER During the second quarter ended June 30, 2002, the Company effected a cash tender offer for all outstanding options to purchase its common stock for an aggregate option purchase price not to exceed $25 million. In connection with this tender offer, the Company recorded a charge of $21.4 million during the second quarter of fiscal 2002, which is reflected in selling, general and administrative expenses in the accompanying consolidated statement of operations for fiscal year 2002. SETTLEMENT COSTS The Company recorded a $7.7 million charge in the second quarter of fiscal 2002 to reflect settlement costs relating to the FREDRICKSON V. OLSTEN HEALTH SERVICES CORP. AND OLSTEN CORPORATION lawsuit as well as estimated settlement costs related to government inquiries regarding cost reporting procedures concerning contracted nursing and home health aide costs (see Note 9 to the consolidated financial statements). These costs are reflected in selling, general and administrative costs in the accompanying consolidated statement of operations for fiscal year 2002. INSURANCE COSTS The Company recorded a special charge of $6.3 million in the second quarter of fiscal 2002 related primarily to a refinement in the estimation process used to determine the Company's actuarially computed workers compensation and professional liability insurance reserves. This special charge is reflected in cost of services sold in the accompanying consolidated statement of operations for fiscal year 2002. ASSET WRITEDOWNS AND OTHER The Company recorded charges of $3.8 million in the second quarter of fiscal 2002, consisting primarily of a write-down of inventory and other assets associated with home medical equipment used in the Company's nursing operations, and a write-off of deferred debt issuance costs associated with the terminated credit facility. The charges are reflected in selling, general and administrative expenses in the accompanying consolidated statement of operations for fiscal year 2002. INTEREST INCOME, NET Net interest income was approximately $0.4 million for fiscal year 2003 and $0.8 million for fiscal year 2002. Net interest income represented interest income of approximately $1.5 million for fiscal 2003 and $2.4 - 20 - million for fiscal 2002, partially offset by fees relating to the revolving credit facility and outstanding letters of credit. Interest income declined in fiscal 2003 as compared to fiscal 2002 due to a decline in interest rates on cash, cash equivalents and restricted cash and, to a lesser extent, a decrease in average cash balances during the year. Interest expense declined in the fiscal 2003 periods due to reductions in the average outstanding letters of credit, as well as reductions in fees associated with the unused portion of the credit facility. INCOME TAXES The Company recorded an income tax benefit of $33.5 million in fiscal 2003 compared to an income tax expense of $18.4 million in fiscal 2002. A federal and state tax benefit was recorded in fiscal 2002, relative to the loss from continuing operations, offset by a $26.8 million provision associated with the adoption of SFAS No. 142, as discussed in Note 2 to the consolidated financial statements, and an adjustment of $5.4 million for tax audit adjustments. As of December 29, 2002, the Company had federal net operating loss and tax credit carryforwards of $15 million and maintained a full valuation allowance against its net deferred tax assets of $63.9 million. Realization of the deferred tax assets is dependent on generating sufficient taxable income. During the interim periods of fiscal 2003, a portion of the valuation allowance ($9.4 million) was utilized to offset a corresponding decrease in net deferred tax assets. Based on management`s belief that it is more likely than not that all of the Company's net deferred tax assets will be realized due to the Company's achieved earnings trends and outlook, the remaining valuation allowance for net deferred tax assets was reversed resulting in a tax benefit of $35.0 million recorded in the statement of operations and an additional credit of $19.5 million relating to the tax benefits associated with stock compensation was recorded directly to shareholders' equity. At December 28, 2003, current net deferred tax assets were $26.5 million and non-current net deferred tax assets were $28.0 million. At December 28, 2003, the Company had federal net operating loss and tax credit carryforwards of $11.8 million. See Note 12 to the Company's consolidated financial statements. NET INCOME (LOSS) The Company recorded net income of $56.8 million or $2.07 per diluted share in fiscal 2003 compared to a net loss of $49.0 million or ($1.87) per diluted share in fiscal 2002. The net loss for fiscal 2002 included a net loss from continuing operations of $53.5 million or ($2.05) per diluted share, which included $46.1 million of restructuring and special charges, income from discontinued operations of $191.6 million or $7.32 per diluted share and a net charge of $187.1 million or ($7.14) per diluted share relating to the cumulative effect of accounting change for goodwill. - 21 - YEAR ENDED DECEMBER 29, 2002 COMPARED TO YEAR ENDED DECEMBER 30, 2001 RESULTS OF OPERATIONS REVENUES Net revenues increased by $39 million or 5.3 percent to $769 million during fiscal 2002 as compared to $730 million during fiscal 2001. This increase was driven by a combination of increased rates to Commercial Insurance and Other and certain Medicaid and Other Government payors, increased volume in nursing patient admissions and an increase in the number of Preferred Provider Organization enrollees served by the Company's CareCentrix unit, partially offset by a 4.9 percent net reduction in Medicare reimbursement rates, which became effective in October 2002. For fiscal year 2002, as compared to fiscal year 2001, net revenues from Medicare increased by $9.7 million or 6.3 percent to $162.3 million. Commercial Insurance and Other payors net revenues increased by $30 million or 7.3 percent to $438.8 million and Medicaid and Other Government payors net revenues decreased $0.7 million or 0.4 percent to $167.4 million. GROSS PROFIT Gross profit was approximately $248 million for fiscal year 2002 compared to $246 million for fiscal year 2001. As a percentage of net revenues, gross profit margins decreased from 33.7 percent for fiscal year 2001 to 32.2 percent for fiscal year 2002. The decrease in margin was primarily related to a $6.3 million special charge relating principally to a refinement in the estimation process used to determine the Company's actuarially computed workers compensation and professional liability insurance reserves (see Note 4 to the consolidated financial statements). This special charge had a negative impact on gross profit margins of 0.8 percent. In addition to the special charge, the Company also recorded a revenue adjustment of $2.5 million, which had a 0.3 percent negative impact on margins, related to a change in the estimated amount of the repayment to Medicare for partial episode payments ("PEPs") from the inception of the Prospective Payment System of reimbursement ("PPS") in October 2000 through June 30, 2002. The 4.9 percent net reduction in Medicare reimbursement rates, which became effective in October 2002, had a negative impact of approximately $2.0 million, or 0.3 percent, on gross profit margins for fiscal year 2002. The remaining net decrease in gross margin percentage was attributable to various other factors, including training costs associated with orientation of additional full-time caregivers, increased insurance costs and changes in business mix due to growth in the CareCentrix business, which generates a lower gross margin but also requires lower administrative costs to service the business, offset by increased rates to Commercial Insurance and Other and certain Medicaid and Other Government payors. SELLING, GENERAL AND ADMINISTRATIVE EXPENSES Selling, general and administrative expenses increased $17 million or 6.5 percent to $283 million during fiscal 2002 compared to $266 million during fiscal 2001. These increases were driven by restructuring and special charges of $46.1 million during the second quarter ended June 30, 2002, of which approximately $40 million was reflected in selling, general and administrative expenses in the accompanying consolidated statement of operations for the fiscal year ended December 29, 2002, as compared to $3 million of special charges which were reflected in the consolidated statement of operations for the fiscal year ended December 30, 2001. These net increases were offset by reductions in amortization expense ($10 million) due to the implementation of SFAS No. 142 and net reductions ($10 million) in field and corporate administration expenses as a result of restructuring efforts and improvements in processes and technology, partially offset by an increase in selling expenses. - 22 - FISCAL 2002 For a further discussion on restructuring and special charges for the fiscal year ended December 29, 2002, see management's discussion above on "Selling, General and Administrative Expenses" and "Fiscal 2002," under "Results of Operations" for the "Year Ended December 28, 2003 Compared to Year Ended December 29, 2002." FISCAL 2001 SETTLEMENT COSTS The Company recorded special charges of approximately $3.0 million during fiscal 2001 in connection with the settlement of the GILE V. OLSTEN CORPORATION, ET AL., and the STATE OF INDIANA V. QUANTUM HEALTH RESOURCES, INC. AND OLSTEN HEALTH SERVICES, INC. lawsuits and for various other legal costs. These legal matters are further discussed in Note 9 to the consolidated financial statements. These special charges are reflected in selling, general and administrative expenses in the accompanying consolidated statement of operations for fiscal year 2001. INTEREST EXPENSE, NET Net interest income (expense) was approximately $0.8 million and ($0.1) million in fiscal 2002 and 2001, respectively. Net interest income for fiscal 2002 primarily represented interest earned on investments of $2.4 million offset by fees relating to the revolving credit facility and outstanding letters of credit. Net interest expense for fiscal 2001 primarily represented fees relating to the revolving credit facility and outstanding letters of credit and, for the first half of fiscal 2001, the 10 percent convertible preferred trust securities, which were redeemed in the third quarter of fiscal 2001, offset by interest income of approximately $2.8 million. INCOME TAXES Income tax expense was $18.4 million in fiscal 2002 compared to an income tax benefit of $6.8 million in fiscal 2001. A federal and state tax benefit was recorded in fiscal 2002, relative to the loss from continuing operations, offset by a $26.8 million provision associated with the adoption of SFAS No. 142, as discussed in Note 2 to the consolidated financial statements, and an adjustment of $5.4 million for tax audit adjustments. The Company had a federal net operating loss carryforward at December 30, 2001 of $89.7 million that was used in part to offset the gain from the sale of the SPS division. As of December 29, 2002, the Company had a federal net operating loss carryforward of $15 million. Net deferred tax assets were $63.9 million at December 29, 2002 and $27 million at December 30, 2001. The increase in deferred tax assets relates primarily to the adoption of SFAS 142 offset by utilization of a portion of the federal net operating loss during 2002. At December 29, 2002, the Company had maintained a full valuation allowance against its net deferred tax asset. Realization of the deferred tax asset is dependent on generating sufficient taxable income. See Note 12 to the Company's consolidated financial statements. NET INCOME (LOSS) The Company recorded a net loss of $49.0 million or ($1.87) per diluted share in fiscal 2002 compared to net income of $21.0 million or $0.90 per diluted share in fiscal 2001. The net loss for fiscal 2002 includes a net loss from continuing operations of $53.5 million or ($2.05) per diluted share, which included $46.1 million of restructuring and special charges, income from discontinued operations of $191.6 million or $7.32 per diluted share and a net charge of $187.1 million or ($7.14) per diluted share relating to the cumulative effect of accounting change for goodwill. Net income for fiscal 2001 includes a net loss from continuing operations of $13.9 million or ($0.60) per diluted share, including special charges, and income from discontinued operations of $34.9 million or $1.50 per diluted share. - 23 - LIQUIDITY AND CAPITAL RESOURCES LIQUIDITY The Company's principal source of liquidity is the collection of its accounts receivable. For healthcare services, the Company grants credit without collateral to its patients, most of whom are insured under third party commercial or governmental payor arrangements. Net cash provided by operating activities increased $12.2 million to $30.7 million in fiscal 2003. This cash was used to fund capital expenditures of $8.8 million and repurchase shares of common stock of $14.4 million during fiscal 2003. Days Sales Outstanding ("DSO") for the home health services business remained flat at 59 days at December 28, 2003 as compared to December 29, 2002. Working capital at December 28, 2003 was $136 million, an increase of $32 million as compared to $104 million at December 29, 2002, primarily due to: o a $9 million increase in cash and cash equivalents, restricted cash and short-term investments; o a $8 million increase in accounts receivable; o a $26 million increase in deferred tax assets relating to the Company's reversal of the deferred tax asset valuation allowance as further described in Note 12 to the Company's consolidated financial statements; o a $3 million decrease in prepaid expenses and other assets; and o a $7 million increase in current liabilities, primarily driven by increases in other accrued expenses ($7 million), cost of claims incurred but not reported ($1 million), and Medicare liabilities ($1 million), partially offset by a decrease in accounts payable ($1 million) and obligations under insurance programs ($1 million). The Company participates in the Medicare, Medicaid and other federal and state healthcare programs. There are certain standards and regulations that the Company must adhere to in order to continue to participate in these programs, including compliance with the Company's corporate integrity agreement. As part of these standards and regulations, the Company is subject to periodic audits, examinations and investigations conducted by, or at the direction of, governmental investigatory and oversight agencies. Periodic and random audits conducted or directed by these agencies could result in a delay or adjustment to the amount of reimbursements received under these programs. Violation of the applicable federal and state health care regulations can result in the Company's exclusion from participating in these programs and can subject the Company to substantial civil and/or criminal penalties. The Company believes it is currently in compliance with these standards and regulations. The Company is party to a contract with CIGNA Health Corporation ("Cigna"), pursuant to which the Company provides or contracts with third party providers to provide home nursing services, acute and chronic infusion therapies, durable medical equipment, and respiratory products and services to patients insured by Cigna. For fiscal years 2003, 2002 and 2001, Cigna accounted for approximately 36 percent, 38 percent and 36 percent, respectively, of the Company's total net revenues. The Company has extended its relationship with Cigna by entering into a new national home health care contract, effective January 1, 2004. The term of the new contract extends to December 31, 2006, and automatically renews thereafter for additional one year terms unless terminated. Under the termination provisions, Cigna has the right to terminate the agreement on December 31, 2005 if it provides 90 days advance written notice to the Company, and each party has the right to terminate at the end of each term thereafter by providing at least 90 days advance written notice prior to the start of the new term. If Cigna chose to terminate or not renew the contract, or to significantly modify its use of the Company's services, there could be a material adverse effect on the Company's cash flow. The Company's credit facility, which was entered into on June 13, 2002, as amended, as described below, provides up to $55 million in borrowings, including up to $40 million which is available for letters of credit. The Company may borrow up to a maximum of 80 percent of the net amount of eligible accounts receivable, as defined, less any reasonable and customary reserves, as defined, required by the lender. Borrowing availability under the credit facility was reduced by $10 million until such quarter in 2003 in which the trailing 12 month EBITDA, excluding certain restructuring costs and special charges recorded by the Company during - 24 - fiscal 2002, as defined, exceeded $15 million. As of March 30, 2003, the trailing 12 months EBITDA threshold was achieved and the availability restriction lifted, effective June 1, 2003. At the Company's option, the interest rate on borrowings under the credit facility was based on the London Interbank Offered Rates (LIBOR) plus 3.25 percent or the lender's prime rate plus 1.25 percent. In addition, the Company was required to pay a fee equal to 2.5 percent per annum of the aggregate face amount of outstanding letters of credit. Beginning in 2003, the applicable margin for the LIBOR borrowing, prime rate borrowing and letter of credit fees decreases by 0.25 percent to 3.0 percent, 1.0 percent, and 2.25 percent, respectively, provided that the Company's trailing 12 month EBITDA, excluding certain restructuring costs and special charges, as defined, is in excess of $20 million. The Company was also subject to an unused line fee equal to 0.50 percent per annum of the average daily difference between the total revolving credit facility amount, as defined, and the total outstanding borrowings and letters of credit. Beginning in 2003, the unused credit line fee decreases to 0.375 percent provided the minimum EBITDA target described above is achieved. The higher margins and fees are subject to reinstatement in the event that the Company's trailing 12 month EBITDA falls below $20 million. The Company met this minimum EBITDA requirement as of March 30, 2003, with the rate reduction effective June 1, 2003 and continued to meet this requirement as of December 28, 2003. Total outstanding letters of credit were $20.8 million as of December 28, 2003. The letters of credit, which expire one year from date of issuance, were issued to guarantee payments under the Company's workers compensation program and for certain other commitments. As of December 28, 2003, there were no borrowings outstanding under the credit facility and the Company had borrowing capacity under the credit facility, after adjusting for outstanding letters of credit, of approximately $34 million. The credit facility, which expires in June 2006, includes certain covenants requiring the Company to maintain a minimum tangible net worth of $101.6 million, minimum EBITDA, as defined, and a minimum fixed charge coverage ratio, as defined. Other covenants in the credit facility include limitation on mergers, consolidations, acquisitions, indebtedness, liens, distributions including dividends, capital expenditures, stock repurchases and dispositions of assets and other limitations with respect to the Company's operations. On August 7, 2003, the credit facility was amended to make covenants relating to acquisitions and stock repurchases less restrictive, provided that the Company maintains minimum excess aggregate liquidity, as defined in the amendment, equal to at least $60 million, and to allow for the disposition of certain assets. The credit facility further provides that if the agreement is terminated for any reason, the Company must pay an early termination fee equal to $275,000 if the facility is terminated during the period from June 13, 2003 to June 12, 2004 and $137,500 if the facility is terminated from June 13, 2004 to June 12, 2005. There is no fee for termination of the facility subsequent to June 12, 2005. Loans under the credit facility are collateralized by all of the Company's tangible and intangible personal property, other than equipment. The credit facility includes provisions, which, if not complied with, could require early payment by the Company. These include customary default events, such as failure to comply with financial covenants, insolvency events, non-payment of scheduled payments, acceleration of other financial obligations and change in control provisions. In addition, these provisions include an account obligor, whose accounts are more than 25 percent of all accounts of the Company over the previous 12-month period, canceling or failing to renew its contract with the Company and ceasing to recognize the Company as an approved provider of health care services, or the Company revoking the lending agent's control over its governmental lockbox accounts. The Company does not have any trigger events in the credit facility that are tied to changes in its credit rating or stock price. As of December 28, 2003, the Company was in compliance with these covenants. The Company may be subject to workers compensation claims and lawsuits alleging negligence or other similar legal claims. The Company maintains various insurance programs to cover this risk but is substantially self-insured for most of these claims. The Company recognizes its obligations associated with these programs in the period the claim is incurred. The Company estimates the cost of both reported claims and claims incurred but not reported, up to specified deductible limits, based on its own specific historical claims experience and current enrollment statistics, industry statistics and other information. Such estimates and the resulting reserves are reviewed and updated periodically. The Company is responsible for the cost of individual workers compensation claims and individual professional liability claims up to $500,000 per incident which occurred prior to March 15, 2002 and $1,000,000 per incident thereafter. The Company also maintains excess liability coverage relating to professional liability and casualty claims which provides insurance coverage for individual claims of up to $25,000,000 in excess of - 25 - the underlying coverage limits. Payments under the Company's workers compensation program are guaranteed by letters of credit and segregated restricted cash balances. Additional items that could impact the Company's liquidity are discussed under "Risk Factors" in Item 1 of this annual report on Form 10-K. CAPITAL EXPENDITURES The Company's capital expenditures from continuing operations for the fiscal years 2003, 2002 and 2001 were $8.8 million, $4.1 million and $3.9 million, respectively. The Company intends to make investments and other expenditures to, among other things, upgrade its computer technology and system infrastructure. In this regard, management expects that capital expenditures will range between $12 million and $13.5 million for fiscal 2004. Management expects that the Company's capital expenditure needs will be met through operating cash flow and available cash reserves. CASH RESOURCES AND OBLIGATIONS The Company had cash, cash equivalents, restricted cash and short-term investments of approximately $110.0 million as of December 28, 2003. The restricted cash relates to cash funds of $21.8 million that have been segregated in a trust account to provide additional collateral and to replace approximately $7 million of letters of credit and a $5 million surety bond which had been used as collateral under the Company's insurance programs. Interest on the funds in the trust account accrues to the Company. The Company, at its option, may access the cash funds in the trust account by providing equivalent amounts of alternative security, including letters of credit and surety bonds. The Company anticipates that repayments to Medicare for partial episode payments and prior year cost report settlements will be made periodically through June 2005. These amounts are reflected as Medicare liabilities in the accompanying consolidated balance sheets. On May 16, 2003, the Company announced that its Board of Directors had authorized the Company to repurchase and to formally retire up to 1,000,000 shares of its outstanding common stock. The repurchases were to occur periodically in the open market or through privately negotiated transactions based on market conditions and other factors. As of July 23, 2003, the Company had repurchased all 1,000,000 shares of its common stock at an average cost of $9.08 per share and at a total cost of approximately $9.1 million. On August 7, 2003, the Company's Board of Directors authorized the Company to repurchase and formally retire up to an additional 1,500,000 shares of its outstanding common stock. The repurchases will occur periodically in the open market or through privately negotiated transactions based on market conditions and other factors. As of December 28, 2003, the Company had repurchased 438,464 shares at an average cost of $12.18 per share and a total cost of approximately $5.3 million. For the period from December 29, 2003 through February 26, 2004, the Company purchased 199,147 shares at an average cost of $12.77 per share and a total cost of approximately $2.5 million. CONTRACTUAL OBLIGATIONS AND COMMERCIAL COMMITMENTS At December 28, 2003, the Company had no long-term debt and no significant capital lease obligations. Future minimum rental commitments for all non-cancelable leases and purchase obligations at December 28, 2003, are as follows (in thousands):
PAYMENT DUE BY PERIOD --------------------------------------------------------- LESS THAN MORE THAN CONTRACTUAL OBLIGATIONS TOTAL 1 YEAR 1-3 YEARS 4-5 YEARS 5 YEARS ----------------------- -------- --------- --------- --------- --------- Long-term debt obligations $ - $ - $ - $ - $ - Capital lease obligations - - - - - Operating lease obligations 55,135 18,936 24,725 8,652 2,822 Purchase obligations 1,076 1,076 - - - -------- -------- --------- --------- -------- Total $ 56,211 $ 20,012 $ 24,725 $ 8,652 $ 2,822 ======== ======== ========= ========= ========
The Company had total letters of credit outstanding under its credit facility of approximately $27.6 million at December 29, 2002 and $20.8 million at December 28, 2003. The letters of credit, which expire one year - 26 - from date of issuance, are issued to guarantee payments under the Company's workers compensation program and for certain other commitments. The Company has the option to renew these letters of credit or set aside cash funds in a segregated account to satisfy the Company's obligations as further discussed in the "Liquidity and Capital Resources" section under the section "Cash Resources and Obligations". The Company has no other off-balance sheet arrangements and has not entered into any transactions involving unconsolidated, limited purpose entities or commodity contracts. Management expects that the Company's working capital needs for fiscal 2004 will be met through operating cash flow and its existing cash balances. The Company may also consider other alternative uses of cash including, among other things, acquisitions, additional share repurchases and cash dividends. These uses of cash would require the approval of the Company's Board of Directors and may require the approval of its lender. If cash flows from operations, cash resources or availability under the credit facility fall below expectations, the Company may be forced to delay planned capital expenditures, reduce operating expenses, seek additional financing or consider alternatives designed to enhance liquidity. LITIGATION AND GOVERNMENT MATTERS The Company is a party to certain legal actions and government investigations. See Item 3. "Legal Proceedings" and Note 9 to the Company's consolidated financial statements. SETTLEMENT ISSUES PRRB APPEAL As further described in the Critical Accounting Policies below, the Company's annual cost reports, which were filed with the CMS, were subject to audit by the fiscal intermediary engaged by CMS. In connection with the audit of the Company's 1997 cost reports, the Medicare fiscal intermediary made certain audit adjustments related to the methodology used by the Company to allocate a portion of its residual overhead costs. The Company filed cost reports for years subsequent to 1997 using the fiscal intermediary's methodology. The Company believed its methodology used to allocate such overhead costs was accurate and consistent with past practice accepted by the fiscal intermediary; as such, the Company filed appeals with the Provider Reimbursement Review Board ("PRRB") concerning this issue with respect to cost reports for the years 1997, 1998 and 1999. The Company's consolidated financial statements for the years 1997, 1998 and 1999 had reflected use of the methodology mandated by the fiscal intermediary. In June 2003, the Company and its Medicare fiscal intermediary signed an Administrative Resolution relating to the issues covered by the appeals pending before the PRRB. Under the terms of the Administrative Resolution, the fiscal intermediary agreed to reopen and adjust the Company's cost reports for the years 1997, 1998 and 1999 using a modified version of the methodology used by the Company prior to 1997. This modified methodology will also be applied to cost reports for the year 2000, which are currently under audit. The Administrative Resolution required that the process to (i) reopen all 1997 cost reports, (ii) determine the adjustments to allowable costs through the issuance of Notices of Program Reimbursement ("NPRs") and (iii) make appropriate payments to the Company, be completed in early 2004. Cost reports relating to years subsequent to 1997 will be reopened after the process for the 1997 cost reports is completed. On February 17, 2004, the fiscal intermediary notified the Company that it had completed the reopening of all 1997 cost reports and determined that the adjustment to allowable costs for that year approximated $9 million. As of February 27, 2004, the majority of the funds relating to this adjustment had been remitted to the Company; the settlement amount will be recorded as net revenues during the first quarter of fiscal 2004. Although the Company believes that it could recover additional funds as a result of applying the modified methodology discussed above to cost reports subsequent to 1997, the settlement amounts cannot be specifically determined until the reopening or audit of each year's cost reports is completed. This is not expected to occur until the second half of fiscal 2004 or fiscal 2005. However, in view of changes in reimbursement and the Company's operations in periods subsequent to 1997, it is likely that future recoveries relating to any cost report year from 1998 to 2000 will be significantly less than the 1997 settlement. - 27 - STOCK-BASED COMPENSATION Statement of Financial Accounting Standards ("SFAS") No. 123, "Accounting for Stock-Based Compensation" ("SFAS 123"), as amended by SFAS No. 148, "Accounting for Stock-Based Compensation - Transition and Disclosure and amendment of Financial Accounting Standards Board ("FASB") Statement No. 123" ("SFAS 148") encourages, but does not require, companies to record compensation cost for stock-based compensation plans at fair value. In addition, SFAS 148 provides alternative methods of transition for a voluntary change to the fair value based method of accounting for stock-based employee compensation, and amends the disclosure requirements of SFAS 123 to require prominent disclosures in both annual and interim financial statements about the method of accounting for stock-based employee compensation and the effect of the method used on reported results. The Company has chosen to adopt the disclosure only provisions of SFAS 148 and continue to account for stock-based compensation using the intrinsic value method prescribed in Accounting Principles Board ("APB") Opinion No. 25, "Accounting for Stock Issued to Employees" ("APB 25"), and related interpretations. Under this approach, the cost of restricted stock awards is expensed over their vesting period, while the imputed cost of stock option grants and discounts offered under the Company's Employee Stock Purchase Plan ("ESPP") is disclosed, based on the vesting provisions of the individual grants, but not charged to expense. The Company has several stock ownership and compensation plans, which are described more fully in Note 11 to the consolidated financial statements. The following table presents net income (loss) and basic and diluted earnings (loss) per common share, had the Company elected to recognize compensation cost based on the fair value at the grant dates for stock option awards and discounts granted for stock purchases under the Company's ESPP, consistent with the method prescribed by SFAS 123, as amended by SFAS 148:
FISCAL YEAR ENDED --------------------------------------------------------- DECEMBER 28, 2003 DECEMBER 29, 2002 DECEMBER 30, 2001 ----------------- ----------------- ----------------- Net income (loss) - as reported $ 56,766 $ (49,033) $ 20,988 Add: Stock-based employee compensation expense included in reported net income, net of tax - 13,160 - Deduct: Total stock-based compensation expense determined under fair value based method for all awards, net of tax (1,575) (5,022) (3,002) -------- --------- -------- Net income (loss) - pro forma $ 55,191 $ (40,895) $ 17,986 ======== ========= ======== Basic income (loss) per share - as reported $ 2.16 $ (1.87) $ 0.90 Basic income (loss) per share - pro forma $ 2.10 $ (1.56) $ 0.78 Diluted income (loss) per share - as reported $ 2.07 $ (1.87) $ 0.90 Diluted income (loss) per share - pro forma $ 2.01 $ (1.56) $ 0.78
GOODWILL AND OTHER INTANGIBLE ASSETS ("SFAS 142") In June 2001, the FASB issued SFAS No. 142 "Goodwill and Other Intangible Assets" ("SFAS 142"), which broadens the criteria for recording intangible assets separate from goodwill. SFAS 142 requires the use of a non-amortization approach to account for purchased goodwill and certain intangibles. Under a non-amortization approach, goodwill and certain intangibles are not amortized into results of operations, but instead are reviewed for impairment and an impairment charge is recorded in the periods in which the recorded carrying value of goodwill and certain intangibles is more than its estimated fair value. The Company adopted SFAS 142 as of the beginning of fiscal 2002. The provisions of SFAS 142 require that a transitional impairment test be performed as of the beginning of the year the statement is adopted. Based on the results of the transitional impairment tests, the Company determined that an impairment loss relating to goodwill had occurred and recorded a non-cash charge of $187.1 million, net of a deferred tax benefit of $30.2 million, as cumulative effect of accounting change in the accompanying consolidated statement of operations for the fiscal year ended December 29, 2002. The deferred tax benefit was recorded by eliminating a deferred tax liability of $26.8 million and recording a deferred tax asset of approximately $39 million, offset by an increase in the tax valuation allowance by the same amount. During fiscal 2002, the Company also recorded a tax benefit of approximately $3.4 million relating to tax deductible goodwill. See Note 12 to the consolidated financial statements. - 28 - For fiscal year 2001, intangibles, principally goodwill, associated with acquired businesses were being amortized on a straight-line basis over periods ranging from 10 to 40 years in accordance with APB Opinion No. 17, "Intangible Assets" based on a fair value methodology. The table below presents a reconciliation of reported net income to adjusted net income as if SFAS 142 was adopted as of January 1, 2001 (in thousands, except per share amounts). FOR THE FISCAL YEAR ENDED DECEMBER 30, 2001 ------------------------------- EARNINGS PER SHARE NET INCOME BASIC AND DILUTED ---------- ------------------ Reported net income $ 20,988 $ 0.90 Add back: Goodwill amortization, net of tax 10,023 0.43 -------- ------- Adjusted net income $ 31,011 $ 1.33 ======== ======= The provisions of SFAS 142 also require that a goodwill impairment test be performed annually or on the occasion of other events that indicate a potential impairment. The annual impairment test of goodwill was performed and indicated that there was no impairment of goodwill as of December 28, 2003. RECENT ACCOUNTING PRONOUNCEMENTS In July 2002, the FASB issued SFAS No. 146 "Accounting for Costs Associated with Exit or Disposal Activities" ("SFAS 146"), which addresses the recognition, measurement, and reporting of costs associated with exit or disposal activities, and supersedes Emerging Issues Task Force ("EITF") Issue No. 94-3 "Liability Recognition for Certain Employee Termination Benefits and Other Costs to Exit An Activity (including Certain Costs Incurred in a Restructuring)" ("EITF 94-3"). The principal difference between SFAS 146 and EITF 94-3 relates to the requirements for recognition of a liability for a cost associated with an exit or disposal activity. SFAS 146 requires that a liability for a cost associated with an exit or disposal activity, including those related to employee termination benefits and obligations under operating leases and other contracts, be recognized when the liability is incurred, and not necessarily the date of an entity's commitment to an exit plan, as under EITF 94-3. SFAS 146 also establishes that the initial measurement of a liability recognized under SFAS 146 be based on fair value. The provisions of SFAS 146 are effective for exit or disposal activities that are initiated after December 31, 2002, with early application encouraged. The Company adopted SFAS 146, effective December 30, 2002. For exit or disposal activities initiated prior to December 30, 2002, the Company followed the accounting guidelines outlined in EITF 94-3. In January 2003, the FASB issued Interpretation No. 46, "Consolidation of Variable Interest Entities," as revised in December 2003 ("FIN 46"). FIN 46 requires a variable interest entity to be consolidated by a company if that company is subject to a majority of the risk of loss from the variable interest entity's activities or entitled to receive a majority of the entity's residual returns or both. Historically, entities generally were not consolidated unless the entity was controlled through voting interests. FIN 46 also requires disclosures about variable interest entities that a company is not required to consolidate but in which it has a significant variable interest. The consolidation requirements of FIN 46 will apply to variable interest entities as of March 31, 2004 for the Company. Also, certain disclosure requirements apply to all financial statements issued after December 31, 2003, regardless of when the variable interest entity was established. The adoption of this standard is not expected to have a material impact on the Company's consolidated financial statements. IMPACT OF INFLATION The Company does not believe that inflation has had a material impact on its results of operations during the past three fiscal years. CRITICAL ACCOUNTING POLICIES AND ESTIMATES The preparation of financial statements in conformity with accounting principles generally accepted in the United States requires management to make estimates and assumptions and select accounting policies that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date - 29 - of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. The most critical estimates relate to revenue recognition, the collectibility of accounts receivable and related reserves, the cost of claims incurred but not reported, obligations under workers compensation, professional liability and employee health and welfare insurance programs and Medicare settlement issues. A description of the critical accounting policies and a discussion of the significant estimates and judgments associated with such policies are described below. REVENUE RECOGNITION Under fee-for-service agreements with patients and commercial and certain government payors, net revenues are recorded based on net realizable amounts to be received in the period in which the services and products are provided or delivered. Fee-for-service contracts with commercial payors are traditionally one year in term and renewable automatically on an annual basis, unless terminated by either party. Under capitated arrangements with certain managed care customers, net revenues are recognized based on a predetermined monthly contractual rate for each member of the managed care plan regardless of the services provided. Net revenues generated under capitated agreements were approximately 16 percent, 16 percent, and 15 percent of total net revenues for fiscal 2003, 2002, 2001, respectively. Under the Prospective Payment System ("PPS") for Medicare reimbursement, net revenues are recorded based on a reimbursement rate which varies based on the severity of the patient's condition, service needs and certain other factors; revenue is recognized ratably over the period in which services are provided. Revenue is subject to adjustment during this period if there are significant changes in the patient's condition during the treatment period or if the patient is discharged but readmitted to another agency within the same 60 day episodic period. Medicare billings under PPS are initially recognized as deferred revenue and are subsequently amortized into revenue over an average patient treatment period. The process for recognizing revenue to be recognized under the Medicare program is based on certain assumptions and judgments, including the average length of time of each treatment as compared to a standard 60 day episode, the appropriateness of the clinical assessment of each patient at the time of certification and the level of adjustments to the fixed reimbursement rate relating to patients who receive a limited number of visits, have significant changes in condition or are subject to certain other factors during the episode. Deferred revenue of approximately $5.2 million and $4.4 million relating to the Medicare PPS program was included in other Medicare liabilities in the consolidated balance sheets as of December 28, 2003 and December 29, 2002, respectively. Revenue adjustments result from differences between estimated and actual reimbursement amounts, an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. Revenue adjustments are deducted from gross accounts receivable. These revenue adjustments are based on significant assumptions and judgments which are determined by Company management based on historical trends. Third party settlements resulting in recoveries are recognized as net revenues in the period in which the funds are received. COLLECTIBILITY OF ACCOUNTS RECEIVABLE The process for estimating the ultimate collection of receivables, particularly with respect to fee-for-service arrangements, involves significant assumptions and judgments. In this regard, the Company has implemented a standardized approach to estimate and review the collectibility of its receivables based on accounts receivable aging trends. Historical collection and payor reimbursement experience is an integral part of the estimation process related to determining the allowance for doubtful accounts. In addition, the Company assesses the current state of its billing functions in order to identify any known collection or reimbursement issues to determine the impact, if any, on its reserve estimates, which involve judgment. Revisions in reserve estimates are recorded as an adjustment to the provision for doubtful accounts which is reflected in selling, general and administrative expenses in the consolidated statements of operations. The Company believes that its collection and reserve processes, along with the monitoring of its billing processes, help to reduce the risk associated with material revisions to reserve estimates resulting from adverse changes in collection, reimbursement experience and billing functions. - 30 - COST OF CLAIMS INCURRED BUT NOT REPORTED Under capitated arrangements with managed care customers, the Company estimates the cost of claims incurred but not reported based on applying actuarial assumptions, historical patterns of utilization to authorized levels of service, current enrollment statistics and other information. Under fee-for-service arrangements with certain managed care customers, the Company also estimates the cost of claims incurred but not reported and the estimated revenue relating thereto in situations in which the Company is responsible for care management and patient services are performed by a non-affiliated provider. The estimate of cost of claims incurred but not reported involves significant assumptions and judgments which relate to and may vary depending on the services authorized at each of the Company's regional coordination centers, historical patterns of service utilization and payment trends. These assumptions and judgments are evaluated on a quarterly basis and changes in estimated liabilities for costs of claims incurred but not reported are determined based on such evaluation. OBLIGATIONS UNDER INSURANCE PROGRAMS The Company is obligated for certain costs under various insurance programs, including workers compensation and professional liability and employee health and welfare. The Company may be subject to workers compensation claims and lawsuits alleging negligence or other similar legal claims. The Company maintains various insurance programs to cover this risk but is substantially self-insured for most of these claims. The Company recognizes its obligations associated with these programs in the period the claim is incurred. The cost of both reported claims and claims incurred but not reported, up to specified deductible limits, have generally been estimated based on historical data, industry statistics, the Company's own home health specific historical claims experience, current enrollment statistics and other information. Such estimates and the resulting reserves are reviewed and updated periodically. For the fiscal year ended December 29, 2002, the Company recorded a special charge of $6.3 million relating primarily to a refinement in the estimation process used to determine the Company's actuarially computed workers compensation and professional liability reserves. Management believes that, as a result of this refinement, sufficient data exists to allow the Company to more heavily rely on its own home health specific historical claims experience in determining the Company's estimates of workers compensation and professional liability reserves. Previously the Company utilized insurance industry actuarial information, as well as the Company's historical claims experience in developing reserve estimates. The Company maintains insurance coverage on individual claims. The Company is responsible for the cost of individual workers compensation claims and individual professional liability claims up to $500,000 per incident which occurred prior to March 15, 2002 and $1,000,000 per incident thereafter. The Company also maintains excess liability coverage relating to professional liability and casualty claims which provides insurance coverage for individual claims of up to $25,000,000 in excess of the underlying coverage limits. Payments under the Company's workers compensation program are guaranteed by letters of credit and segregated restricted cash balances. During the fiscal year 2003, the Company segregated $21.8 million of cash funds in a trust account to replace certain letters of credit and surety bonds. Interest on the funds in the trust account accrues to the Company. The Company, at its option, may terminate the trust agreement by providing equivalent amounts of alternative security allowed under the program, including letters of credit and surety bonds. The Company believes that its present insurance coverage and reserves are sufficient to cover currently estimated exposures, but there can be no assurance that the Company will not incur liabilities in excess of recorded reserves or in excess of its insurance limits. MEDICARE SETTLEMENT ISSUES - 31 - Prior to October 1, 2000, reimbursement of Medicare home care nursing services was based on reasonable, allowable costs incurred in providing services to eligible beneficiaries subject to both per visit and per beneficiary limits in accordance with the Interim Payment System established through the Balanced Budget Act of 1997. These costs were reported in annual cost reports which were filed with the Centers for Medicare and Medicaid Services ("CMS") and were subject to audit by the fiscal intermediary engaged by CMS. The fiscal intermediary has not finalized its audit of the fiscal 2000 cost reports. Furthermore, settled cost reports relating to certain years prior to fiscal 2000 could be subject to reopening of the audit process by the fiscal intermediary. Although management believes that established reserves are sufficient, it is possible that adjustments resulting from such audits could result in adjustments to the consolidated financial statements that exceed established reserves. ITEM 7A. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK The Company had no interest rate exposure on fixed rate debt or other market risk at December 28, 2003. ITEM 8. FINANCIAL STATEMENTS AND SUPPLEMENTARY DATA The consolidated financial statements and financial statement schedule set forth in Part IV, Item 15 (a) (1) and (2) of this report are incorporated by reference into this Item 8. ITEM 9. CHANGES IN AND DISAGREEMENTS WITH ACCOUNTANTS ON ACCOUNTING AND FINANCIAL DISCLOSURE There have been no such changes or disagreements. ITEM 9A. CONTROLS AND PROCEDURES EVALUATION OF DISCLOSURE CONTROLS AND PROCEDURES. The Company's Chief Executive Officer and Chief Financial Officer have evaluated the effectiveness of the design and operation of the Company's disclosure controls and procedures (as defined in the Securities Exchange Act of 1934 ("Exchange Act") Rule 13a-15(e)) as of the end of the period covered by this report. Based on that evaluation, the Company's Chief Executive Officer and Chief Financial Officer have concluded that the Company's disclosure controls and procedures are adequate and effective to ensure that information required to be disclosed by the Company in reports that it files or submits under the Exchange Act is recorded, processed, summarized and reported within required time periods. CHANGES IN INTERNAL CONTROL OVER FINANCIAL REPORTING. As required by the Exchange Act Rule 13a-15(d), the Company's Chief Executive Officer and Chief Financial Officer evaluated the Company's internal control over financial reporting to determine whether any change occurred during the quarter ended December 28, 2003 that has materially affected, or is reasonably likely to materially affect, the Company's internal control over financial reporting. Based on that evaluation, there has been no such change during such quarter. PART III ITEM 10. DIRECTORS AND EXECUTIVE OFFICERS OF THE REGISTRANT Information required by this item regarding the directors of the Company is incorporated herein by reference to information under the captions "Proposal 1 Election of Directors" and "Board of Directors and Committees" to be contained in the Company's Proxy Statement to be filed with the SEC with regard to the Company's 2004 Annual Meeting of Shareholders ("2004 Proxy Statement"). See also the information regarding executive officers of the Company at the end of PART I hereof. Certain other information required by this item is incorporated herein by reference to information under the caption "Section 16(a) Beneficial Ownership Reporting Compliance" to be contained in the Company's 2004 Proxy Statement. - 32 - The Company has adopted a Code of Ethics for Senior Financial Officers ("Code of Ethics") that applies to the Company's Chief Executive Officer, Chief Financial Officer and Principal Accounting Officer or Controller. A copy of the Code of Ethics is posted on its Internet website www.gentiva.com under the "Investor Relations" section. In the event that the Company makes any amendment to, or grants any waiver from, a provision of the Code of Ethics that requires disclosure under applicable SEC rules, the Company intends to disclose such amendment or waiver on its website. ITEM 11. EXECUTIVE COMPENSATION Information required by this item concerning executive compensation and compensation of directors is incorporated herein by reference to information under the captions "Executive Compensation" and "Board of Directors and Committees," respectively, to be contained in the Company's 2004 Proxy Statement. ITEM 12. SECURITIES OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT AND RELATED STOCKHOLDER MATTERS Information required by this item regarding the security ownership of certain beneficial owners and management of the Company is incorporated herein by reference to information under the caption "Security Ownership of Certain Beneficial Owners and Management" to be contained in the Company's 2004 Proxy Statement. Certain other information required by this item regarding securities authorized for issuance under the Company's equity compensation plans is incorporated herein by reference to information under the caption "Equity Compensation Plan Information" to be contained in the Company's 2004 Proxy Statement. ITEM 13. CERTAIN RELATIONSHIPS AND RELATED TRANSACTIONS There are no such relationships or transactions. ITEM 14. PRINCIPAL ACCOUNTANT FEES AND SERVICES Information regarding principal accountant fees and services is incorporated herein by reference to information under the caption "Proposal 2 Appointment of Independent Public Accountants" to be contained in the Company's 2004 Proxy Statement. - 33 - PART IV ITEM 15. EXHIBITS, FINANCIAL STATEMENT SCHEDULES AND REPORTS ON FORM 8-K (a)(1) FINANCIAL STATEMENTS
PAGE NO. -------- o Report of Independent Auditors................................................................. F-2 o Consolidated Balance Sheets as of December 28, 2003 and December 29, 2002...................... F-3 o Consolidated Statements of Operations for the three years ended December 28, 2003.............. F-4 o Consolidated Statements of Changes in Shareholders' Equity for the three years ended December 28, 2003.............................................................................. F-5 o Consolidated Statements of Cash Flows for the three years ended December 28, 2003.............. F-6 o Notes to Consolidated Financial Statements..................................................... F-7 (a)(2) FINANCIAL STATEMENT SCHEDULE o Schedule II - Valuation and Qualifying Accounts for the three years ended December 28, 2003.... F-27 (a)(3) EXHIBITS
EXHIBIT NUMBER DESCRIPTION - ------- ----------- 3.1 Restated Certificate of Incorporation of Company(1) 3.2 Certificate of Correction to Certificate of Incorporation, filed with the Delaware Secretary of State on July 1, 2002(2) 3.3 Restated By-Laws of Company(2) 4.1 Specimen of common stock(4) 4.2 Form of Certificate of Designation of Series A Junior Participating Preferred Stock(1) 4.3 Form of Certificate of Designation of Series A Cumulative Non-Voting Redeemable Preferred Stock(3) 10.1 Separation Agreement dated August 17, 1999 among Olsten Corporation, Aaronco Corp. and Adecco SA(1) 10.2 Omnibus Amendment No. 1 dated October 7, 1999 by and among Olsten Corporation, Aaronco Corp., Adecco SA and Olsten Health Services Holding Corp.(1) - 34 - 10.3 Omnibus Amendment No. 2 dated January 18, 2000 by and among Olsten Corporation, Adecco SA, Olsten Health Services Holding Corp., the Company and Staffing Acquisition Corporation (1) 10.4 Form of Rights Agreement dated March 2, 2000 between the Company and EquiServe Trust Company, N.A., as rights agent(3) 10.5 Company's Executive Officers Bonus Plan(1)* 10.6 Company's 1999 Stock Incentive Plan(5)* 10.7 Company's Stock & Deferred Compensation Plan for Non-Employee Directors, as amended and restated as of April 1, 2000 (5)* 10.8 Company's Stock & Deferred Compensation Plan for Non-Employee Directors, as amended and restated as of January 1, 2004+* 10.9 Company's Employee Stock Purchase Plan (1)* 10.10 Company's Nonqualified Retirement and Savings Plan and First, Second, Third and Fourth Amendments thereto+* 10.11 Form of Change in Control Agreement with Executive Officers of Company(2) * 10.12 Form of Severance Agreement with Executive Officers of Company (2)* 10.13 Employment Agreement with Ronald A. Malone (6)* 10.14 Change in Control Agreement with Ronald A. Malone (2)* 10.15 Loan and Security Agreement dated June 13, 2002 by and between Fleet Capital Corporation, as Administrative Agent, on behalf of the lenders named therein, Fleet Securities, Inc., as Arranger, Gentiva Health Services, Inc., Gentiva Health Services Holding Corp. and the subsidiaries named therein (7) 10.16 First Amendment and Consent Agreement dated August 7, 2003 to Loan and Security Agreement dated June 13, 2002 by and between Fleet Capital Corporation, as Administrative Agent on behalf of the lenders named therein, Fleet Securities, Inc., as Arranger, Gentiva Health Services, Inc., Gentiva Health Services Holding Corp. and the subsidiaries named therein (8) 10.17 Second Amendment dated November 26, 2003 to Loan and Security Agreement dated June 13, 2002 by and between Fleet Capital Corporation, as Administrative Agent on behalf of the lenders named therein, Fleet Securities, Inc., as Arranger, Gentiva Health Services, Inc., Gentiva Health Services Holding Corp. and the subsidiaries named therein+ 10.18 Third Amendment and Joinder dated February 25, 2004 to Loan and Security Agreement dated June 13, 2002 by and between Fleet Capital Corporation, as Administrative Agent on behalf of the lenders named therein, Fleet Securities, Inc., as Arranger, Gentiva Health Services., Inc., Gentiva Health Services Holding Corp. and the subsidiaries named therein.+ 10.19 Asset Purchase Agreement dated as of January 2, 2002 by and between Accredo Health, Incorporated, the Company and the Sellers named therein (9) - 35 - 10.20 National Home Care Provider Agreement between CIGNA Health Corporation and Gentiva CareCentrix, Inc. dated January 1, 1996, as amended (10) (confidential treatment requested as to portions of this document) 10.21 Amendment dated January 1, 2003 to National Home Care Provider Agreement between CIGNA Health Corporation and Gentiva CareCentrix, Inc. dated January 1, 1996, as amended (6) (confidential treatment requested as to portions of this document) 10.22 Managed Care Alliance Agreement between CIGNA Health Corporation and Gentiva CareCentrix, Inc. entered into as of January 1, 2004 +(confidential treatment requested as to portions of this document) 10.23 Consulting Agreement dated as of July 1, 2002 between Gail R. Wilensky and Gentiva Health Services (USA), Inc. (11)* 10.24 Amendment dated August 7, 2003 to Consulting Agreement dated as of July 1, 2002 between Gail R. Wilensky and Gentiva Health Services (USA), Inc. (8)* 21. List of Subsidiaries of Company + 23. Consent of PricewaterhouseCoopers LLP, independent accountants + 31.1 Certification of Chief Executive Officer dated March 1, 2004 pursuant to Rule 13a-14(a)+ 31.2 Certification of Chief Financial Officer dated March 1, 2004 pursuant to Rule 13a-14(a)+ 32.1 Certification of Chief Executive Officer dated March 1, 2004 pursuant to 18 U.S.C. Section 1350+ 32.2 Certification of Chief Financial Officer dated March 1, 2004 pursuant to 18 U.S.C. Section 1350+ - ---------- (1) Incorporated herein by reference to Amendment No. 2 to the Registration Statement of Company on Form S-4 dated January 19, 2000 (File No. 333-88663). (2) Incorporated herein by reference to Form 10-Q of Company for quarterly period ended June 30, 2002. (3) Incorporated herein by reference to Amendment No. 3 to the Registration Statement of Company on Form S-4 dated February 4, 2000 (File No. 333-88663). (4) Incorporated herein by reference to Amendment No. 4 to the Registration Statement of Company on Form S-4 dated February 9, 2000 (File No. 333-88663). (5) Incorporated herein by reference to Form 10-K of Company for the fiscal year ended January 2, 2000. (6) Incorporated herein by reference to Form 10-K of Company for the fiscal year ended December 29, 2002. (7) Incorporated herein by reference to Form 8-K of Company dated June 13, 2002 and filed June 21, 2002. (8) Incorporated herein by reference to Form 10-Q of Company for quarterly period ended September 28, 2003. (9) Incorporated herein by reference to definitive Proxy Statement of Company dated May 10, 2002. (10) Incorporated herein by reference to Form 10-Q of Company for quarterly period ended September 29, 2002. - 36 - (11) Incorporated herein by reference to Form 10-Q of Company for quarterly period ended March 30, 2003. * Management contract or compensatory plan or arrangement + Filed herewith (b) REPORTS ON FORM 8-K On October 30, 2003, the Company furnished a report on Form 8-K (i) furnishing in Item 7 as an exhibit a press release covering the Company's 2003 third quarter consolidated earnings and (ii) reporting in Item 12 the issuance of the Company's press release on the subject of its 2003 third quarter consolidated earnings. - 37 - SIGNATURES Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized. GENTIVA HEALTH SERVICES, INC. Date: March 1, 2004 By: /s/ RONALD A. MALONE -------------------- Ronald A. Malone Chief Executive Officer and Chairman of the Board Pursuant to the requirements of Securities Exchange Act of 1934, this report has been signed below by the following persons on behalf of the registrant and in the capacities and on the dates indicated. Date: March 1, 2004 By: /s/ RONALD A. MALONE -------------------- Ronald A. Malone Chief Executive Officer and Chairman of the Board and Director (Principal Executive Officer) Date: March 1, 2004 By: /s/ JOHN R. POTAPCHUK --------------------- John R. Potapchuk Senior Vice President, Chief Financial Officer, Treasurer and Secretary (Principal Financial and Accounting Officer) Date: March 1, 2004 By: /s/ EDWARD A. BLECHSCHMIDT -------------------------- Edward A. Blechschmidt Director Date: March 1, 2004 By: /s/ VICTOR F. GANZI ------------------- Victor F. Ganzi Director Date: March 1, 2004 By: /s/ STUART R. LEVINE -------------------- Stuart R. Levine Director Date: March 1, 2004 By: /s/ MARY O'NEIL MUNDINGER ------------------------- Mary O'Neil Mundinger Director Date: March 1, 2004 By: /s/ STUART OLSTEN ----------------- Stuart Olsten Director Date: March 1, 2004 By: /s/ RAYMOND S. TROUBH --------------------- Raymond S. Troubh Director Date: March 1, 2004 By: /s/ JOSH S. WESTON ------------------ Josh S. Weston Director Date: March 1, 2004 By: /s/ GAIL R. WILENSKY -------------------- Gail R. Wilensky Director - 38 - GENTIVA HEALTH SERVICES, INC. AND SUBSIDIARIES INDEX TO CONSOLIDATED FINANCIAL STATEMENTS
PAGE NO. -------- Report of Independent Auditors....................................................................... F-2 Consolidated Balance Sheets as of December 28, 2003 and December 29, 2002............................ F-3 Consolidated Statements of Operations for the three years ended December 28, 2003.................... F-4 Consolidated Statements of Changes in Shareholders' Equity for the three years ended December 28, 2003................................................................................. F-5 Consolidated Statements of Cash Flows for the three years ended December 28, 2003.................... F-6 Notes to Consolidated Financial Statements........................................................... F-7 Schedule II - Valuation and Qualifying Accounts for the three years ended December 28, 2003.......... F-27
F-1 REPORT OF INDEPENDENT AUDITORS To the Board of Directors and Shareholders of Gentiva Health Services, Inc. and Subsidiaries: In our opinion, the consolidated financial statements listed in the index appearing under Item 15 (a)(1) present fairly, in all material respects, the financial position of Gentiva Health Services, Inc. and Subsidiaries (the "Company") at December 28, 2003 and December 29, 2002, and the results of their operations and their cash flows for each of the three years in the period ended December 28, 2003 in conformity with accounting principles generally accepted in the United States of America. In addition, in our opinion, the financial statement schedule listed in the index appearing under Item 15(a)(2) presents fairly, in all material respects, the information set forth therein when read in conjunction with the related consolidated financial statements. These financial statements and financial statement schedule are the responsibility of the Company's management; our responsibility is to express an opinion on these financial statements and financial statement schedule based on our audits. We conducted our audits of these statements in accordance with auditing standards generally accepted in the United States of America, which require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements, assessing the accounting principles used and significant estimates made by management, and evaluating the overall financial statement presentation. We believe that our audits provide a reasonable basis for our opinion. As discussed in Note 2 to the consolidated financial statements, the Company adopted SFAS No. 142, "Goodwill and Other Intangible Assets" ("SFAS 142"), which changed the method of accounting for goodwill and other intangible assets effective December 31, 2001. /s/ PRICEWATERHOUSECOOPERS LLP - ------------------------------ PricewaterhouseCoopers LLP Stamford, Connecticut February 6, 2004, except for Note 9, as to which the date is February 27, 2004 F-2 GENTIVA HEALTH SERVICES, INC. AND SUBSIDIARIES CONSOLIDATED BALANCE SHEETS (IN THOUSANDS, EXCEPT SHARE AMOUNTS)
DECEMBER 28, 2003 DECEMBER 29, 2002 ----------------- ----------------- ASSETS Current assets: Cash and cash equivalents $ 78,263 $ 101,241 Restricted cash 21,750 - Short-term investments 10,000 - Receivables, less allowance for doubtful accounts of $7,936 and $9,032 in 2003 and 2002, respectively 132,998 125,078 Deferred tax assets 26,464 752 Prepaid expenses and other current assets 6,524 9,782 --------- --------- Total current assets 275,999 236,853 Fixed assets, net 15,135 13,025 Deferred tax assets, net 28,025 - Other assets 15,929 14,553 --------- --------- Total assets $ 335,088 $ 264,431 ========= ========= LIABILITIES AND SHAREHOLDERS' EQUITY Current liabilities: Accounts payable $ 16,079 $ 16,865 Payroll and related taxes 12,932 12,377 Medicare liabilities 12,736 11,880 Cost of claims incurred but not reported 28,525 27,899 Obligations under insurance programs 37,200 37,829 Other accrued expenses 32,230 25,664 --------- --------- Total current liabilities 139,702 132,514 Other liabilities 18,207 18,869 Shareholders' equity: Common stock, $.10 par value; authorized 100,000,000 shares; issued and outstanding 25,598,301 and 26,385,210 shares, in 2003 and 2002, respectively 2,560 2,639 Additional paid-in capital 270,468 263,024 Accumulated deficit (95,849) (152,615) --------- --------- Total shareholders' equity 177,179 113,048 --------- --------- Total liabilities and shareholders' equity $ 335,088 $ 264,431 ========= =========
See notes to consolidated financial statements. F-3 GENTIVA HEALTH SERVICES, INC. AND SUBSIDIARIES CONSOLIDATED STATEMENTS OF OPERATIONS (IN THOUSANDS, EXCEPT PER SHARE AMOUNTS)
FOR THE FISCAL YEAR ENDED --------------------------------------------------------- DECEMBER 28, 2003 DECEMBER 29, 2002 DECEMBER 30, 2001 ----------------- ----------------- ----------------- Net revenues $ 814,029 $ 768,501 $ 729,577 Cost of services sold 531,987 520,901 483,917 ---------- ---------- ---------- Gross profit 282,042 247,600 245,660 Selling, general and administrative expenses (252,334) (276,355) (247,581) Depreciation and amortization (6,851) (7,185) (18,741) ---------- ---------- ---------- Operating income (loss) 22,857 (35,940) (20,662) Interest income (expense), net 441 834 (63) ---------- ---------- ---------- Income (loss) before income taxes from continuing operations 23,298 (35,106) (20,725) Income tax benefit (expense) 33,468 (18,437) 6,815 ---------- ---------- ---------- Income (loss) from continuing operations 56,766 (53,543) (13,910) Discontinued operations, net of tax - 191,578 34,898 ---------- ---------- ---------- Income before cumulative effect of accounting change 56,766 138,035 20,988 Cumulative effect of accounting change, net of tax - (187,068) - ---------- ---------- ---------- Net income (loss) $ 56,766 $ (49,033) $ 20,988 ========== ========== ========== Basic earnings per share: Income (loss) from continuing operations $ 2.16 $ (2.05) $ (0.60) Discontinued operations, net of tax - 7.32 1.50 Cumulative effect of accounting change, net of tax - (7.14) - ---------- ---------- ---------- Net income (loss) $ 2.16 $ (1.87) $ 0.90 ========== ========== ========== Weighted average shares outstanding 26,262 26,183 23,186 ========== ========== ========== Diluted earnings per share: Income (loss) from continuing operations $ 2.07 $ (2.05) $ (0.60) Discontinued operations, net of tax - 7.32 1.50 Cumulative effect of accounting change, net of tax - (7.14) - ---------- ---------- ---------- Net income (loss) $ 2.07 $ (1.87) $ 0.90 ========== ========== ========== Weighted average shares outstanding 27,439 26,183 23,186 ========== ========== ==========
See notes to consolidated financial statements. F-4 GENTIVA HEALTH SERVICES, INC. AND SUBSIDIARIES CONSOLIDATED STATEMENTS OF CHANGES IN SHAREHOLDERS' EQUITY FOR THE THREE YEARS ENDED DECEMBER 28, 2003 (IN THOUSANDS, EXCEPT SHARE AMOUNTS)
ACCUMULATED COMMON STOCK ADDITIONAL OTHER -------------------------- PAID-IN ACCUMULATED COMPREHENSIVE SHARES AMOUNT CAPITAL DEFICIT INCOME (LOSS) TOTAL ------------ ------------ ------------ ------------ ------------- ----------- Balance at December 31, 2000 21,196,693 $ 2,120 $ 689,163 $ (124,570) $ (564) $ 566,149 Comprehensive income: Net income 20,988 - 20,988 Realized gain on investments - 564 564 ------------ ------------ ------------ ------------ --------- ----------- Subtotal - - - 20,988 564 21,552 Conversion of Gentiva-obligated man- datorily redeemable convertible securities of a subsidiary holding solely Gentiva debentures 2,146,105 214 19,786 - - 20,000 Issuance of stock upon exercise of stock options and under stock plans for employees and directors 2,295,996 230 13,776 - - 14,006 ------------ ------------ ------------ ------------ --------- ----------- Balance at December 30, 2001 25,638,794 $ 2,564 $ 722,725 $ (103,582) $ - $ 621,707 Comprehensive loss: Net loss - - - (49,033) - (49,033) Dividends paid ($17.75 per share) - - (466,597) - - (466,597) Issuance of stock upon exercise of stock options and under stock plans for employees and directors 746,416 75 6,896 - - 6,971 ------------ ------------ ------------ ------------ --------- ----------- Balance at December 29, 2002 26,385,210 $ 2,639 $ 263,024 $ (152,615) $ - $ 113,048 Comprehensive income: Net income 56,766 56,766 Income tax benefits associated with stock-based compensation 19,454 - 19,454 Issuance of stock upon exercise of stock options and under stock plans for employees and directors 651,555 65 2,271 - 2,336 Repurchase of common stock at cost (1,438,464) (144) (14,281) - (14,425) ------------ ------------ ------------ ------------ --------- ----------- Balance at December 28, 2003 25,598,301 $ 2,560 $ 270,468 $ (95,849) $ - $ 177,179 ============ ============ ============ ============ ========= ===========
See notes to consolidated financial statements F-5 GENTIVA HEALTH SERVICES, INC. AND SUBSIDIARIES CONSOLIDATED STATEMENTS OF CASH FLOWS (In thousands)
FOR THE FISCAL YEAR ENDED --------------------------------------------------------- DECEMBER 28, 2003 DECEMBER 29, 2002 DECEMBER 30, 2001 ----------------- ----------------- ----------------- OPERATING ACTIVITIES: Net income (loss) $ 56,766 $ (49,033) $ 20,988 Adjustments to reconcile net income (loss) to net cash provided by operating activities Income from discontinued operations - (191,578) (34,898) Cumulative effect of accounting change - 187,068 - Depreciation and amortization 6,851 7,185 18,741 Provision for doubtful accounts 7,684 4,936 5,120 (Gain) loss on sale / disposal of businesses and fixed assets (209) 951 (255) Stock option tender offer - 21,388 - Deferred income tax (benefit) expense (35,035) 12,837 - Changes in assets and liabilities, net of acquisitions/divestitures Accounts receivable (15,604) 10,281 32,655 Prepaid expenses and other current assets 3,048 7,825 2,610 Current liabilities 7,065 6,393 (11,702) Change in net assets held for sale - 3,300 57,711 Other, net 137 (3,024) 827 ----------- ----------- ----------- Net cash provided by operating activities 30,703 18,529 91,797 ----------- ----------- ----------- INVESTING ACTIVITIES: Purchase of fixed assets - continuing operations (8,777) (4,116) (3,864) Purchase of fixed assets - discontinued operations - (2,121) (6,203) Proceeds from sale of assets / business 200 206,564 475 Acquisition of businesses (1,300) - - Purchase of short-term investments (24,900) - - Maturities of short-term investments 14,935 - - Withdrawal from (deposits into) restricted cash (21,750) 35,164 (35,164) ----------- ----------- ----------- Net cash (used in) provided by investing activities (41,592) 235,491 (44,756) ----------- ----------- ----------- FINANCING ACTIVITIES: Proceeds from issuance of common stock 2,336 6,971 14,006 Repurchases of common stock (14,425) - - Debt issuance costs - (1,321) - Cash distribution to shareholders - (203,983) - Payments for stock option tender - (21,388) - Advance (paid to) / received from Medicare program - (5,038) 20,878 Decrease in book overdrafts - - (10,379) ----------- ----------- ----------- Net cash (used in) provided by financing activities (12,089) (224,759) 24,505 ----------- ----------- ----------- Net change in cash and cash equivalents (22,978) 29,261 71,546 Cash and cash equivalents at beginning of period 101,241 71,980 434 ----------- ----------- ----------- Cash and cash equivalents at end of period $ 78,263 $ 101,241 $ 71,980 =========== =========== ===========
SUPPLEMENTAL SCHEDULE OF NON CASH INVESTING AND FINANCING ACTIVITIES For fiscal year 2003, in connection with the reversal of the valuation allowance, deferred tax benefits associated with stock compensation deductions of $19.5 million have been credited to shareholders' equity. For fiscal year 2002, in connection with the sale of the Company's Specialty Pharmaceutical Services business on June 13, 2002, the Company received 5,060,976 shares of common stock of Accredo Health, Incorporated, which were subsequently distributed to the Company's shareholders. In fiscal 2001, $20 million of the Company's convertible preferred trust securities were converted to common stock. See notes to consolidated financial statements. F-6 GENTIVA HEALTH SERVICES, INC. AND SUBSIDIARIES NOTES TO CONSOLIDATED FINANCIAL STATEMENTS NOTE 1. BACKGROUND AND BASIS OF PRESENTATION Gentiva Health Services, Inc. ("Gentiva" or the "Company") provides home health services throughout most of the United States. Gentiva was incorporated in the state of Delaware on August 6, 1999 and became an independent publicly owned company on March 15, 2000, when the common stock of the Company was issued to the stockholders of Olsten Corporation ("Olsten"), the former parent corporation of the Company (the "Split-Off"). Continuing operations for all periods presented comprise the operating results of the home health services business, including, for fiscal 2002 and 2001, restructuring and other special charges as described in Note 4. On June 13, 2002, the Company sold substantially all of the assets of its specialty pharmaceutical services ("SPS") business to Accredo Health, Incorporated ("Accredo") and issued a special dividend to its shareholders as further described in Note 3. The operating results of the SPS business through the closing date of the sale to Accredo, including corporate expenses directly attributable to SPS operations, restructuring and special charges related to the SPS business, as well as the gain on the sale, net of transaction costs and related income taxes, are reflected as discontinued operations in the accompanying consolidated statements of operations. The Company adopted the provisions of Statement of Financial Accounting Standard ("SFAS") No. 142, "Goodwill and Other Intangible Assets" as of the beginning of fiscal 2002. In connection with this adoption, the Company recorded a non-cash charge, net of taxes, as a cumulative effect of accounting change in the accompanying consolidated statement of operations in fiscal 2002 as described in Note 2. NOTE 2. SUMMARY OF CRITICAL AND OTHER SIGNIFICANT ACCOUNTING POLICIES CONSOLIDATION The consolidated financial statements include the accounts of the Company and its wholly-owned subsidiaries. All significant intercompany balances and transactions have been eliminated. The Company's fiscal year ends on the Sunday nearest to December 31st, which was December 28, 2003 for fiscal 2003, December 29, 2002 for fiscal 2002 and December 30, 2001 for fiscal 2001. ESTIMATES The preparation of financial statements in conformity with accounting principles generally accepted in the United States requires management to make estimates and assumptions and select accounting policies that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. The most critical estimates relate to revenue recognition, the collectibility of accounts receivable and related reserves, the cost of claims incurred but not reported, obligations under workers compensation, professional liability and employee health and welfare insurance programs and Medicare settlement issues. A description of the critical and other significant accounting policies and a discussion of the significant estimates and judgments associated with such policies are described below. CRITICAL ACCOUNTING POLICIES REVENUE RECOGNITION Under fee-for-service agreements with patients and commercial and certain government payors, net revenues are recorded based on net realizable amounts to be received in the period in which the services and products are provided or delivered. Fee-for-service contracts with commercial payors are traditionally one year in term and renewable automatically on an annual basis, unless terminated by either party. Under capitated arrangements with certain managed care customers, net revenues are recognized based on a predetermined monthly contractual rate for each member of the managed care plan regardless of the ser- F-7 vices provided. Net revenues generated under capitated agreements were approximately 16 percent, 16 percent, and 15 percent of total net revenues for fiscal 2003, 2002, 2001, respectively. Under the Prospective Payment System ("PPS") for Medicare reimbursement, net revenues are recorded based on a reimbursement rate which varies based on the severity of the patient's condition, service needs and certain other factors; revenue is recognized ratably over the period in which services are provided. Revenue is subject to adjustment during this period if there are significant changes in the patient's condition during the treatment period or if the patient is discharged but readmitted to another agency within the same 60 day episodic period. Medicare billings under PPS are initially recognized as deferred revenue and are subsequently amortized into revenue over an average patient treatment period. The process for recognizing revenue to be recognized under the Medicare program is based on certain assumptions and judgments, including the average length of time of each treatment as compared to a standard 60 day episode, the appropriateness of the clinical assessment of each patient at the time of certification and the level of adjustments to the fixed reimbursement rate relating to patients who receive a limited number of visits, have significant changes in condition or are subject to certain other factors during the episode. Deferred revenue of approximately $5.2 million and $4.4 million relating to the Medicare PPS program was included in other Medicare liabilities in the consolidated balance sheets as of December 28, 2003 and December 29, 2002, respectively. Revenue adjustments result from differences between estimated and actual reimbursement amounts, an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. Revenue adjustments are deducted from gross accounts receivable. These revenue adjustments are based on significant assumptions and judgments which are determined by Company management based on historical trends. Third party settlements resulting in recoveries are recognized as net revenues in the period in which the funds are received. Net revenues attributable to major payor sources of reimbursement are as follows: FISCAL YEAR ----------------------------- 2003 2002 2001 -------- -------- --------- Medicare 22% 21% 21% Medicaid and Other Government 20 22 23 Commercial Insurance and Other 58 57 56 --- --- --- 100% 100% 100% === === === The Company is party to a contract with CIGNA Health Corporation ("Cigna"), pursuant to which the Company provides or contracts with third party providers to provide home nursing services, acute and chronic infusion therapies, durable medical equipment, and respiratory products and services to patients insured by Cigna. For fiscal years 2003, 2002 and 2001, Cigna accounted for approximately 36 percent, 38 percent and 36 percent, respectively, of the Company's total net revenues. The Company has extended its relationship with Cigna by entering into a new national home health care contract, effective January 1, 2004, with the new contract expiring on December 31, 2006. No other commercial payor accounts for 10 percent or more of the Company's net revenues. COLLECTIBILITY OF ACCOUNTS RECEIVABLE The process for estimating the ultimate collection of receivables, particularly with respect to fee-for-service arrangements, involves significant assumptions and judgments. In this regard, the Company has implemented a standardized approach to estimate and review the collectibility of its receivables based on accounts receivable aging trends. Historical collection and payor reimbursement experience is an integral part of the estimation process related to determining the allowance for doubtful accounts. In addition, the Company assesses the current state of its billing functions in order to identify any known collection or reimbursement issues to determine the impact, if any, on its reserve estimates, which involve judgment. Revisions in reserve estimates are recorded as an adjustment to the provision for doubtful accounts which is reflected in selling, general and administrative expenses in the consolidated statements of operations. The Company believes that its collection and reserve processes, along with the monitoring of its billing processes, help to reduce the risk associated with material revisions to reserve estimates resulting from adverse changes in collection, reimbursement experience and billing functions. F-8 COST OF CLAIMS INCURRED BUT NOT REPORTED Under capitated arrangements with managed care customers, the Company estimates the cost of claims incurred but not reported based on applying actuarial assumptions, historical patterns of utilization to authorized levels of service, current enrollment statistics and other information. Under fee-for-service arrangements with certain managed care customers, the Company also estimates the cost of claims incurred but not reported and the estimated revenue relating thereto in situations in which the Company is responsible for care management and patient services are performed by a non-affiliated provider. The estimate of cost of claims incurred but not reported involves significant assumptions and judgments which relate to and may vary depending on the services authorized at each of the Company's regional coordination centers, historical patterns of service utilization and payment trends. These assumptions and judgments are evaluated on a quarterly basis and changes in estimated liabilities for costs of claims incurred but not reported are determined based on such evaluation. OBLIGATIONS UNDER INSURANCE PROGRAMS The Company is obligated for certain costs under various insurance programs, including workers compensation, professional liability and employee health and welfare. The Company may be subject to workers compensation claims and lawsuits alleging negligence or other similar legal claims. The Company maintains various insurance programs to cover this risk but is substantially self-insured for most of these claims. The Company recognizes its obligations associated with these programs in the period the claim is incurred. The cost of both reported claims and claims incurred but not reported, up to specified deductible limits, have generally been estimated based on historical data, industry statistics, the Company's own home health specific historical claims experience, current enrollment statistics and other information. Such estimates and the resulting reserves are reviewed and updated periodically. For the fiscal year ended December 29, 2002, the Company recorded a special charge of $6.3 million relating primarily to a refinement in the estimation process used to determine the Company's actuarially computed workers compensation and professional liability reserves. Management believes that, as a result of this refinement, sufficient data exists to allow the Company to more heavily rely on its own home health specific historical claims experience in determining the Company's estimates of workers compensation and professional liability reserves. Previously the Company utilized insurance industry actuarial information, as well as the Company's historical claims experience in developing reserve estimates. The Company maintains insurance coverage on individual claims. The Company is responsible for the cost of individual workers compensation claims and individual professional liability claims up to $500,000 per incident which occurred prior to March 15, 2002 and $1,000,000 per incident thereafter. The Company also maintains excess liability coverage relating to professional liability and casualty claims which provides insurance coverage for individual claims of up to $25,000,000 in excess of the underlying coverage limits. Payments under the Company's workers compensation program are guaranteed by letters of credit and segregated restricted cash balances. The Company believes that its present insurance coverage and reserves are sufficient to cover currently estimated exposures, but there can be no assurance that the Company will not incur liabilities in excess of recorded reserves or in excess of its insurance limits. MEDICARE SETTLEMENT ISSUES Prior to October 1, 2000, reimbursement of Medicare home care nursing services was based on reasonable, allowable costs incurred in providing services to eligible beneficiaries subject to both per visit and per beneficiary limits in accordance with the Interim Payment System established through the Balanced Budget Act of 1997. These costs were reported in annual cost reports which were filed with the Centers for Medicare and Medicaid Services ("CMS") and were subject to audit by the fiscal intermediary engaged by CMS. The fiscal intermediary has not finalized its audit of the fiscal 2000 cost reports. Furthermore, settled cost reports relating to certain years prior to fiscal 2000 could be subject to reopening of the audit process by the fiscal intermediary. Although management believes that established reserves are sufficient, it is possible that adjustments resulting from such audits could result in adjustments to the consolidated financial statements that exceed established reserves. F-9 OTHER SIGNIFICANT ACCOUNTING POLICIES CASH, CASH EQUIVALENTS AND RESTRICTED CASH The Company considers all investments with an original maturity of three months or less on their acquisition date to be cash equivalents. Restricted cash represents segregated cash funds in a trust account designated as collateral under the Company's insurance programs. Interest on the trust account funds accrue to the Company. The Company, at its option, may access the cash funds in the trust account by providing equivalent amounts of alternative security. SHORT-TERM INVESTMENTS The Company classifies investments with an original maturity of more than three months and less than one year on the acquisition date as short-term investments in accordance with SFAS No. 115 "Accounting for Certain Investments in Debt and Equity Securities". Short-term investments are classified as "held to maturity" investments and are reported at amortized cost which approximates fair value. FIXED ASSETS Fixed assets, including costs of Company developed software, are stated at cost and depreciated over the estimated useful lives of the assets using the straight-line method. Leasehold improvements are amortized over the shorter of the life of the lease or the life of the improvement. GOODWILL AND OTHER INTANGIBLE ASSETS ("SFAS 142") In June 2001, the Financial Accounting Standards Board ("FASB") issued SFAS No. 142 "Goodwill and Other Intangible Assets" ("SFAS 142"), which broadens the criteria for recording intangible assets separate from goodwill. SFAS 142 requires the use of a non-amortization approach to account for purchased goodwill and certain intangibles. Under a non-amortization approach, goodwill and certain intangibles are not amortized into results of operations, but instead are reviewed for impairment and an impairment charge is recorded in the periods in which the recorded carrying value of goodwill and certain intangibles is more than its estimated fair value. The Company adopted SFAS 142 as of the beginning of fiscal 2002. The provisions of SFAS 142 require that a transitional impairment test be performed as of the beginning of the year the statement is adopted. Based on the results of the transitional impairment tests, the Company determined that an impairment loss relating to goodwill had occurred and recorded a non-cash charge of $187.1 million, net of a deferred tax benefit of $30.2 million, as cumulative effect of accounting change in the accompanying consolidated statement of operations for the fiscal year ended December 29, 2002. The deferred tax benefit was recorded by eliminating a deferred tax liability of $26.8 million and recording a deferred tax asset of approximately $39 million, offset by an increase in the tax valuation allowance by the same amount. During fiscal 2002, the Company also recorded a tax benefit of approximately $3.4 million relating to tax deductible goodwill. See Note 12 to the consolidated financial statements. For fiscal year 2001, intangibles, principally goodwill, associated with acquired businesses were being amortized on a straight-line basis over periods ranging from 10 to 40 years in accordance with APB Opinion No. 17, "Intangible Assets" based on a fair value methodology. The table below presents a reconciliation of reported net income to adjusted net income as if SFAS 142 was adopted as of January 1, 2001 (in thousands, except per share amounts): F-10 FOR THE FISCAL YEAR ENDED DECEMBER 30, 2001 ------------------------------- EARNINGS PER SHARE NET INCOME BASIC AND DILUTED ---------- ------------------ Reported net income $ 20,988 $ 0.90 Add back: Goodwill amortization, net of tax 10,023 0.43 ---------- -------- Adjusted net income $ 31,011 $ 1.33 ========== ======== The provisions of SFAS 142 also require that a goodwill impairment test be performed annually or on the occasion of other events that indicate a potential impairment. The annual impairment test of goodwill was performed and indicated that there was no impairment of goodwill as of December 28, 2003. ACCOUNTING FOR IMPAIRMENT AND DISPOSAL OF LONG-LIVED ASSETS The Company evaluates the possible impairment of its long-lived assets, including intangible assets which are amortized pursuant to the provisions of SFAS 142, under SFAS No. 144, "Accounting for Impairment or Disposal of Long-Lived Assets" ("SFAS 144"). The Company reviews the recoverability of its long-lived assets when events or changes in circumstances occur that indicate that the carrying value of the asset may not be recoverable. Evaluation of possible impairment is based on the Company's ability to recover the asset from the expected future pretax cash flows (undiscounted and without interest charges) of the related operations. If the expected undiscounted pretax cash flows are less than the carrying amount of such asset, an impairment loss is recognized for the difference between the estimated fair value and carrying amount of the asset. STOCK-BASED COMPENSATION PLANS SFAS No. 123, "Accounting for Stock-Based Compensation" ("SFAS 123"), as amended by SFAS No. 148, "Accounting for Stock-Based Compensation - Transition and Disclosure - an amendment of FASB No. 123" ("SFAS 148") encourages, but does not require, companies to record compensation cost for stock-based compensation plans at fair value. In addition, SFAS 148 provides alternative methods of transition for a voluntary change to the fair value based method of accounting for stock-based employee compensation, and amends the disclosure requirements of SFAS 123 to require prominent disclosures in both annual and interim financial statements about the method of accounting for stock-based employee compensation and the effect of the method used on reported results. The Company has chosen to adopt the disclosure only provisions of SFAS No. 148 and continues to account for stock-based compensation using the intrinsic value method prescribed in Accounting Principles Board ("APB") Opinion No. 25, "Accounting for Stock Issued to Employees" ("APB 25"), and related interpretations. Under this approach, the imputed cost of stock option grants and discounts offered under the Company's Employee Stock Purchase Plan ("ESPP") is disclosed, based on the vesting provisions of the individual grants, but not charged to expense. See Note 11. EARNINGS PER SHARE Basic and diluted earnings (loss) per share for each period presented has been computed by dividing the net income (loss) by the weighted average number of shares outstanding for each respective period. The computations of the basic and diluted per share amounts for the Company's continuing operations were as follows (in thousands, except per share amounts): F-11
FOR THE FISCAL YEAR ENDED --------------------------------------------------------- DECEMBER 28, 2003 DECEMBER 29, 2002 DECEMBER 30, 2001 ----------------- ----------------- ----------------- Income (loss) from continuing operations $ 56,766 $ (53,543) $ (13,910) =========================================================================================================== Basic weighted average common shares outstanding 26,262 26,183 23,186 Shares issuable upon the assumed exercise of stock options and in connection with the ESPP using the treasury stock method 1,177 - - ----------- ---------- ----------- Diluted weighted average common shares outstanding 27,439 26,183 23,186 ----------- ---------- ----------- =========================================================================================================== Income (loss) from continuing operations per common share: Basic $ 2.16 $ (2.05) $ (0.60) Diluted $ 2.07 $ (2.05) $ (0.60) ===========================================================================================================
The weighted average number of shares outstanding of 23,186,000 for fiscal year 2001 included 2,146,105 shares of common stock issued upon conversion of $20 million of the 10 percent convertible preferred trust securities from the date of conversion as discussed in Note 7. For fiscal years 2002 and 2001, in accordance with SFAS No. 128 "Earnings Per Share," the number of common shares used in computing the diluted earnings (loss) per share for continuing operations was used for discontinued operations, cumulative effect of accounting change and net income (loss), even though the impact was antidilutive. The computation of diluted earnings (loss) per share from continuing operations for fiscal year 2002 excluded an incremental 1,592,000 shares that would be issuable upon the assumed exercise of stock options and in connection with the ESPP using the treasury stock method, since their inclusion would be antidilutive on earnings. For fiscal year 2001, due to the antidilutive effect on loss from continuing operations, the diluted earnings (loss) per share computation excluded the effect of (i) an incremental 1,454,000 shares that would have been issued if the 10 percent convertible preferred trust securities were converted at the beginning of the year and (ii) 1,229,000 shares that would be issuable upon the assumed exercise of stock options under the treasury stock method. INCOME TAXES The Company uses the asset and liability approach to account for income taxes. Under this method, deferred tax assets and liabilities are recognized for the expected future tax consequences of differences between the carrying amounts of assets and liabilities and their respective tax bases using tax rates in effect for the year in which the differences are expected to reverse. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period when the change is enacted. FAIR VALUE OF FINANCIAL INSTRUMENTS The fair value of a financial instrument represents the amount at which the instrument could be exchanged in a current transaction between willing parties, other than in a forced sale or liquidation. Significant differences can arise between the fair value and carrying amount of financial instruments that are recognized at historical amounts. The carrying amounts of the Company's cash and cash equivalents, restricted cash, short-term investments, accounts receivable, accounts payable and certain other current liabilities approximate fair value because of their short maturity. F-12 DEBT ISSUANCE COSTS The Company amortizes deferred debt issuance costs over the term of its credit facility. In April 2002, the FASB issued SFAS No. 145 "Rescission of FASB Statements No. 4, 44 and 64, Amendment of FASB Statements No. 13, and Technical Correction" ("SFAS 145"). SFAS 145 rescinded SFAS No. 4 "Reporting Gains and Losses from Extinguishment of Debt" ("SFAS 4"), SFAS No. 44 "Accounting for Intangible Assets of Motor Carriers" ("SFAS 44") and SFAS No. 64 "Extinguishments of Debt Made to Satisfy Sinking-Fund Requirements" ("SFAS 64") and amended SFAS No. 13 "Accounting for Leases" ("SFAS 13"). This statement updates, clarifies and simplifies existing accounting pronouncements. As a result of rescinding SFAS 4 and SFAS 64, the criteria in APB Opinion No. 30 "Reporting the Results of Operations-Reporting the Effects of Disposal of a Segment of a Business, and Extraordinary, Unusual and Infrequently Occurring Events and Transactions" will be used to determine whether gains and losses from extinguishment of debt receive extraordinary item treatment. The Company adopted SFAS 145, effective April 1, 2002. During the fiscal year ended December 29, 2002, the impact of this adoption resulted in the Company recognizing a write-off of approximately $1.5 million of deferred debt issuance costs associated with the terminated credit facility which is reflected in selling, general and administrative expenses in the accompanying consolidated statement of operations and is further discussed in Note 4. RECLASSIFICATION Certain reclassifications have been made to the 2002 and 2001 consolidated financial statements to conform to current year presentation. RECENT ACCOUNTING PRONOUNCEMENTS In July 2002, the FASB issued SFAS No. 146 "Accounting for Costs Associated with Exit or Disposal Activities" ("SFAS 146"), which addresses the recognition, measurement, and reporting of costs associated with exit or disposal activities, and supersedes Emerging Issues Task Force ("EITF") Issue No. 94-3 "Liability Recognition for Certain Employee Termination Benefits and Other Costs to Exit An Activity (including Certain Costs Incurred in a Restructuring)" ("EITF 94-3"). The principal difference between SFAS 146 and EITF 94-3 relates to the requirements for recognition of a liability for a cost associated with an exit or disposal activity. SFAS 146 requires that a liability for a cost associated with an exit or disposal activity, including those related to employee termination benefits and obligations under operating leases and other contracts, be recognized when the liability is incurred, and not necessarily the date of an entity's commitment to an exit plan, as under EITF 94-3. SFAS 146 also establishes that the initial measurement of a liability recognized under SFAS 146 be based on fair value. The provisions of SFAS 146 are effective for exit or disposal activities that are initiated after December 31, 2002, with early application encouraged. The Company adopted SFAS 146, effective December 30, 2002. For exit or disposal activities initiated prior to December 30, 2002, the Company followed the accounting guidelines outlined in EITF 94-3. In January 2003, the FASB issued Interpretation No. 46, "Consolidation of Variable Interest Entities," as revised in December 2003 ("FIN 46"). FIN 46 requires a variable interest entity to be consolidated by a company if that company is subject to a majority of the risk of loss from the variable interest entity's activities or entitled to receive a majority of the entity's residual returns or both. Historically, entities generally were not consolidated unless the entity was controlled through voting interests. FIN 46 also requires disclosures about variable interest entities that a company is not required to consolidate but in which it has a significant variable interest. The consolidation requirements of FIN 46 will apply to variable interest entities as of March 31, 2004 for the Company. Also, certain disclosure requirements apply to all financial statements issued after December 31, 2003, regardless of when the variable interest entity was established. The adoption of this standard is not expected to have a material impact on the Company's consolidated financial statements. NOTE 3. ACQUISITIONS AND DISPOSITIONS ACQUISITION OF FIRST HOME CARE BUSINESS On March 28, 2003, the Company completed the purchase of certain assets and the business of First Home Care - Houston, Inc. and FHCH, Inc. pursuant to an asset purchase agreement for cash consideration of $1.3 million. The purchase price allocation consisted of goodwill of $1.2 million and assets and other intangibles of $0.1 million. F-13 SALE OF SPECIALTY PHARMACEUTICAL SERVICES BUSINESS On June 13, 2002, the Company consummated the sale of its SPS business to Accredo (the "SPS Sale"). The SPS Sale was effected pursuant to an asset purchase agreement (the "Asset Purchase Agreement") dated January 2, 2002, between Gentiva, Accredo and certain of Gentiva's subsidiaries named therein. Pursuant to the terms of the Asset Purchase Agreement, Accredo acquired the SPS business in consideration for: o the payment to the Company of a cash amount equal to $207.5 million (before a $0.9 million reduction resulting from a closing net book value adjustment); and o 5,060,976 shares of Accredo common stock. Based on the closing price of the Accredo common stock on June 13, 2002 ($51.89 per share), the value of the stock consideration was $262.6 million. In connection with the SPS Sale, the Company's Board of Directors declared a dividend, payable to shareholders of record on June 13, 2002, of all the common stock consideration and substantially all the cash consideration received from Accredo. The cash consideration received by the Company before the closing net book value adjustment was $207.5 million; however, the amount distributed to the Company's shareholders was reduced by $3.5 million to $204 million as a holdback for income taxes the Company expected to incur on the proceeds received in excess of $460 million as detailed in the Company's proxy statement, dated May 10, 2002. The special dividend, which was delivered to the distribution agent on June 13, 2002 for payment to the Company's shareholders, resulted in shareholders of record on the record date receiving $7.76 in cash and 0.19253 shares of Accredo common stock (valued at $9.99 per share based on the June 13, 2002 closing price of $51.89 per share of Accredo common stock) for each share of Gentiva common stock held. The total value of the special dividend amounted to $17.75 per share. Cash was paid in lieu of fractional shares. In connection with the SPS sale, the Company incurred $16.2 million in transaction costs which related to investment banking fees, legal and accounting costs, change in control and other employee related payments and miscellaneous other costs. SPS revenues and operating results for the periods presented were as follows (in thousands):
FOR THE FISCAL YEAR ENDED ------------------------------------- DECEMBER 29, 2002 DECEMBER 30, 2001 ----------------- ----------------- Net revenues $ 323,319 $ 648,110 ========== ========== Operating results of discontinued SPS business: Income before income taxes $ 11,238 $ 43,588 Income tax expense (1,313) (8,690) ---------- ---------- Net income 9,925 34,898 ---------- ---------- Gain on disposal of SPS business, including transaction costs of $16.2 million for fiscal year 2002 205,355 - Income tax expense (23,702) - ---------- ---------- Gain on disposal, net of tax 181,653 - ---------- ---------- Discontinued operations, net of tax $ 191,578 $ 34,898 ========== ==========
NOTE 4. RESTRUCTURING AND OTHER SPECIAL CHARGES During fiscal 2002 and 2001, the Company recorded restructuring and other special charges aggregating $46.1 million and $3.0 million, respectively. F-14 FISCAL 2002 BUSINESS REALIGNMENT ACTIVITIES The Company recorded charges of $6.8 million during the second quarter ended June 30, 2002 in connection with a restructuring plan. This plan included the closing and consolidation of seven field locations and the realignment and consolidation of certain corporate and administrative support functions due primarily to the sale of the Company's SPS business. These charges included employee severance of $0.9 million relating to the termination of 115 employees in field locations and certain corporate and administrative departments, and future lease payments and other associated costs of $5.9 million resulting principally from the consolidation of office space at the Company's corporate headquarters and a change in estimated future lease obligations and other costs in excess of sublease rentals relating to a lease for a subsidiary of the Company's former parent company which the Company agreed to assume in connection with its Split-Off in March 2000. These charges were reflected in selling, general and administrative expenses in the accompanying consolidated statement of operations for the fiscal year ended December 29, 2002. The major components of the restructuring charges as well as the activity during fiscal years 2003 and 2002 were as follows (in thousands):
COMPENSATION AND SEVERANCE FACILITY LEASE COSTS AND OTHER COSTS TOTAL --------------- ----------------- -------------- FISCAL 2002 CHARGE $ 920 $ 5,893 $ 6,813 Cash expenditures (726) (1,348) (2,074) -------- --------- --------- Balance at December 29, 2002 194 4,545 4,739 Cash expenditures (194) (2,239) (2,433) -------- --------- --------- Balance at December 28, 2003 $ - $ 2,306 $ 2,306 ======== ========= =========
The balance of unpaid charges, which will be paid over the remaining lease terms, was included in other accrued expenses in the consolidated balance sheets. OPTION TENDER OFFER During the second quarter ended June 30, 2002, the Company effected a cash tender offer for all outstanding options to purchase its common stock for an aggregate option purchase price not to exceed $25 million. In connection with this tender offer, the Company recorded a charge of $21.4 million during the second quarter of fiscal 2002, which is reflected in selling, general and administrative expenses in the accompanying consolidated statement of operations for the fiscal year ended December 29, 2002. SETTLEMENT COSTS The Company recorded a $7.7 million charge in the second quarter of fiscal 2002 to reflect settlement costs relating to the FREDRICKSON V. OLSTEN HEALTH SERVICES CORP. AND OLSTEN CORPORATION lawsuit as well as estimated settlement costs related to government inquiries regarding cost reporting procedures concerning contracted nursing and home health aide costs (see Note 9). These costs are reflected in selling, general and administrative costs in the accompanying consolidated statement of operations for the fiscal year ended December 29, 2002. INSURANCE COSTS The Company recorded a special charge of $6.3 million in the second quarter of fiscal 2002 related primarily to a refinement in the estimation process used to determine the Company's actuarially computed workers compensation and professional liability insurance reserves. This special charge is reflected in cost of services sold in the accompanying consolidated statement of operations for the fiscal year ended December 29, 2002. F-15 ASSET WRITEDOWNS AND OTHER The Company recorded charges of $3.8 million in the second quarter of fiscal 2002, consisting primarily of a write-down of inventory and other assets associated with home medical equipment used in the Company's nursing operations, and a write-off of deferred debt issuance costs associated with the terminated credit facility. The charges are reflected in selling, general and administrative expenses in the accompanying consolidated statement of operations for the fiscal year ended December 29, 2002. FISCAL 2001 SETTLEMENT COSTS The Company recorded special charges of approximately $3.0 million during fiscal 2001 in connection with the settlement of the GILE V. OLSTEN CORPORATION, ET AL., and the STATE OF INDIANA V. QUANTUM HEALTH RESOURCES, INC. AND OLSTEN HEALTH SERVICES, INC. lawsuits and for various other legal costs. These legal matters are further discussed in Note 9. These special charges are reflected in selling, general and administrative expenses in the accompanying consolidated statement of operations for the fiscal year ended December 30, 2001. NOTE 5. FIXED ASSETS, NET
(IN THOUSANDS) USEFUL LIVES DECEMBER 28, 2003 DECEMBER 29, 2002 - ------------------------------- ------------ ----------------- ----------------- Computer equipment and software 3-5 Years $ 43,786 $ 44,582 Furniture and fixtures 5 Years 20,031 19,337 Leasehold improvements Lease Term 9,166 10,224 Machinery and equipment 5 Years 391 171 ----------- ----------- 73,374 74,314 Less accumulated depreciation (58,239) (61,289) ----------- ----------- $ 15,135 $ 13,025 =========== ===========
Depreciation expense relating to continuing operations was approximately $6.9 million in fiscal 2003, $7.2 million in fiscal 2002 and $8.7 million in fiscal 2001. NOTE 6. LONG-TERM DEBT The Company's credit facility, which was entered into on June 13, 2002, as amended, as described below, provides up to $55 million in borrowings, including up to $40 million which is available for letters of credit. The Company may borrow up to a maximum of 80 percent of the net amount of eligible accounts receivable, as defined, less any reasonable and customary reserves, as defined, required by the lender. Borrowing availability under the credit facility was reduced by $10 million until such quarter in 2003 in which the trailing 12 month EBITDA, excluding certain restructuring costs and special charges, as defined, exceeded $15 million. As of March 30, 2003, the trailing 12 month EBITDA threshold was achieved and the availability restriction lifted, effective June 1, 2003. At the Company's option, the interest rate on borrowings under the credit facility was based on the London Interbank Offered Rates (LIBOR) plus 3.25 percent or the lender's prime rate plus 1.25 percent. In addition, the Company was required to pay a fee equal to 2.5 percent per annum of the aggregate face amount of outstanding letters of credit. Beginning in 2003, the applicable margin for the LIBOR borrowing, prime rate borrowing and letter of credit fees decreases by 0.25 percent to 3.0 percent, 1.0 percent, and 2.25 percent, respectively, provided that the Company's trailing 12 month EBITDA, excluding certain restructuring costs and special charges, as defined, is in excess of $20 million. The Company was also subject to an unused line fee equal to 0.50 percent per annum of the average daily difference between the total revolving credit facility amount and the total outstanding borrowings and letters of credit. Beginning in 2003, the unused credit line fee decreases to 0.375 percent provided the minimum EBITDA target described above is achieved. The higher margins and fees are subject to reinstatement in the event that the Company's trailing 12 month EBITDA falls below $20 million. The Company met this minimum EBITDA requirement as of March 30, 2003, with the rate reduction effective June 1, 2003, and continued to meet this requirement as of December 28, 2003. F-16 The credit facility, which expires in June 2006, includes certain covenants requiring the Company to maintain a minimum tangible net worth of $101.6 million, minimum EBITDA, as defined, and a minimum fixed charge coverage ratio, as defined. Other covenants in the credit facility include limitation on mergers, consolidations, acquisitions, indebtedness, liens, distributions including dividends, capital expenditures, stock repurchases and dispositions of assets and other limitations with respect to the Company's operations. On August 7, 2003, the Company's credit facility was amended to make covenants relating to acquisitions and stock repurchases less restrictive, provided that the Company maintains minimum excess aggregate liquidity, as defined in the amendment, equal to at least $60 million, and to allow for the disposition of certain assets. The credit facility further provides that if the agreement is terminated for any reason, the Company must pay an early termination fee equal to $275,000 if the facility is terminated during the period from June 13, 2003 to June 12, 2004 and $137,500 if the facility is terminated from June 13, 2004 to June 12, 2005. There is no fee for termination of the facility subsequent to June 12, 2005. Loans under the credit facility are collateralized by all of the Company's tangible and intangible personal property, other than equipment. As of December 28, 2003, the Company was in compliance with these covenants. Total outstanding letters of credit were approximately $20.8 million at December 28, 2003 and $27.6 million at December 29, 2002. The letters of credit, which expire one year from date of issuance, were issued to guarantee payments under the Company's workers compensation program and for certain other commitments. There were no borrowings outstanding under the credit facility as of December 28, 2003. During fiscal year 2003, the Company entered into a trust agreement and segregated $21.8 million of cash funds in a trust account to provide additional collateral and to replace approximately $7 million of letters of credit and a $5 million surety bond which had been used as collateral under the Company's insurance programs. These funds are reported as restricted cash in the accompanying consolidated balance sheet as of December 28, 2003. Interest on the funds in the trust account accrues to the Company. The Company, at its option, may access the cash funds in the trust account by providing equivalent amounts of alternative security, including letters of credit and surety bonds. The Company has no other off-balance sheet arrangements and has not entered into any transactions involving unconsolidated, limited purpose entities or commodity contracts. Net interest income was approximately $0.4 million for the fiscal year ended December 28, 2003 and $0.8 million for the fiscal year ended December 29, 2002. Net interest income represented interest income of approximately $1.5 million for fiscal 2003 and $2.4 million for fiscal 2002, partially offset by fees relating to the revolving credit facility and outstanding letters of credit. NOTE 7. MANDATORILY REDEEMABLE AND OTHER SECURITIES GENTIVA OBLIGATED MANDATORILY REDEEMABLE PREFERRED SECURITIES OF A SUBSIDIARY TRUST On March 15, 2000, certain of the Company's and Olsten's directors, officers and management and other related parties and other investors purchased $20 million of 10 percent convertible trust preferred securities issued by a Trust, of which the Company owned all the common equity. Simultaneously and in connection with the issuance by the Trust of the convertible trust preferred securities, the Company issued to the Trust $20 million of its 10 percent convertible subordinated debentures. The convertible preferred trust securities were mandatorily redeemable on March 15, 2005 and optionally redeemable after March 15, 2001 at a declining premium over face amount. The convertible subordinated debentures had the same terms as the convertible trust preferred securities, including, but not limited to, maturity, interest, conversion and redemption price. The Trust which issued the convertible trust preferred securities was a special purpose trust. The Trust's operations were limited to issuing the convertible trust preferred securities and holding the Company's convertible subordinated debentures. The Trust could pay dividends only to the extent that the Company paid interest on its convertible subordinated debentures. If the Company announced the redemption of its convertible subordinated debentures and, as a result, the Trust intended to redeem the convertible preferred trust securities, the holders of the preferred trust securities had the option to convert their securities into the Company's common stock at a conversion price of $9.319219 until two days before the scheduled redemption date. F-17 On August 7, 2001, the Company's Board of Directors authorized the Company to call for the redemption of its 10 percent convertible subordinated debentures on or about September 14, 2001 at a redemption price of 108 percent of the original principal amount of the debentures in accordance with the terms of an Indenture dated March 15, 2000, between the Company and Wilmington Trust Company. All of the holders of the preferred trust securities opted to convert their securities into the Company's common stock. During fiscal year 2001, the Company issued 2,146,105 shares of common stock upon the conversion of $20 million of the convertible preferred trust securities. No convertible preferred trust securities remained outstanding for redemption. CUMULATIVE PREFERRED STOCK The Company's authorized capital stock includes 25,000,000 shares of preferred stock, $.01 par value, of which 1,000 shares have been designated Series A Cumulative Non-voting Redeemable Preferred Stock ("cumulative preferred stock"). On March 10, 2000, 100 shares of cumulative preferred stock were issued for proceeds of $100,000. Holders of the cumulative preferred stock were entitled to receive cumulative cash dividends at an annual rate of LIBOR plus 2 percent on the stated liquidation preference of $1,000 per share, payable quarterly in arrears out of assets legally available for payment of dividends. The shares of preferred stock that were issued on March 10, 2000 were redeemed on June 12, 2002 at a redemption price of $1,000 per share. NOTE 8. SHAREHOLDERS' EQUITY On May 16, 2003, the Company announced that its Board of Directors had authorized the Company to repurchase and formally retire up to 1,000,000 shares of its outstanding common stock. The repurchases were to occur periodically in the open market or through privately negotiated transactions based on market conditions and other factors. As of July 23, 2003, the Company had repurchased the authorized 1,000,000 shares of its common stock at an average cost of $9.08 per share and a total cost of approximately $9.1 million. On August 7, 2003, the Company's Board of Directors authorized the Company to repurchase and formally retire up to an additional 1,500,000 shares of its outstanding common stock. The repurchases will occur periodically in the open market or through privately negotiated transactions based on market conditions and other factors. As of December 28, 2003, the Company had repurchased 438,464 shares at an average cost of $12.18 per share and a total cost of approximately $5.3 million. NOTE 9. LEGAL MATTERS LITIGATION In addition to the matters referenced in this Note 9, the Company is party to certain legal actions arising in the ordinary course of business including legal actions arising out of services rendered by its various operations, personal injury and employment disputes. COOPER V. GENTIVA CARECENTRIX, INC. T/A/D/B/A/ GENTIVA HEALTH SERVICES, U.S. District Court (W.D. Penn), Civil Action No. 01-0508. On January 2, 2002, this amended complaint was served on the Company alleging that the defendant submitted false claims to the government for payment in violation of the Federal False Claims Act, 31 U.S.C. 3729 et seq., and that the defendant had wrongfully terminated the plaintiff. The plaintiff claimed that infusion pumps delivered to patients did not supply the full amount of medication, allegedly resulting in substandard care. Based on a review of the court's docket sheet, the plaintiff filed a complaint under seal in March 2001. In October 2001, the United States government filed a notice with the court declining to intervene in this matter, and on October 24, 2001, the court ordered that the seal be lifted. The Company filed its responsive pleading on February 25, 2002, and discovery has now commenced. The Company has denied the allegations of wrongdoing in the complaint and is defending itself vigorously in this matter. On May 19, 2003, the Company filed a motion for summary judgment on the issue of liability. On February 6, 2004, the court granted partial summary judgment for the Company, dismissing two of the three claims alleged under the False Claims Act and denying summary judgment for the Company on the wrongful termination claim. The parties are completing discovery; therefore, the Company cannot determine a range of damages, if any, at this time. Other litigation matters that were settled in fiscal 2002 and 2001 are discussed below. FISCAL 2002 F-18 FREDRICKSON V. OLSTEN HEALTH SERVICES CORP. AND OLSTEN CORPORATION, Case No. 01C.A.116, Court of Appeals, Seventh Appellate District, Mahoning County, Ohio. In November 2000, the jury in this age-discrimination lawsuit returned a verdict in favor of the plaintiff against Olsten consisting of $675,000 in compensatory damages, $30 million in punitive damages and an undetermined amount of attorneys' fees. The jury found that, although Olsten had lawfully terminated the plaintiff's employment, its failure to transfer or rehire the plaintiff rendered Olsten liable to the plaintiff. Following post-trial motion practice by both parties, the trial court, in May 2001, denied all post-trial motions, and entered judgment for the plaintiff for the full amount of compensatory and punitive damages, and awarded the plaintiff reduced attorney's fees of $247,938. In June 2001, defendants timely filed a Notice of Appeal with the Court of Appeals, and the Company posted a supersedeas bond for the full amount of the judgment, plus interest. This matter has been settled, and settlement costs were recorded as part of special charges during the second quarter of fiscal 2002 (see Note 4). The supersedeas bond was released and the restricted cash of $35.2 million was released to the Company in September 2002. FISCAL 2001 In GILE V. OLSTEN CORPORATION, ET AL., U.S. District Court for the Central District of California, No. 97-9363-NM, plaintiff filed an age discrimination suit against Olsten Corporation, Olsten Health Services, and a certain individual in December 1997. The defendants denied the allegations of discrimination on the basis that plaintiff's termination was part of a reduction in force. The individual defendant was dismissed from the action, and the remaining corporate defendants filed a motion for summary judgment that was granted by the District Court in February 1999. The plaintiff appealed the District Court's order to the Ninth Circuit Court of Appeals and in December 2000, the Court of Appeals issued its ruling which reversed the District Court and remanded the case for trial. On or about June 19, 2001, the Company and the plaintiff agreed to settle this matter and entered into a confidential settlement agreement with full release. In July 1999, the Indiana Attorney General's Office filed a lawsuit against Olsten in Indiana Superior Court, captioned STATE OF INDIANA V. QUANTUM HEALTH RESOURCES, INC. AND OLSTEN HEALTH SERVICES, Inc., No. 49D029907CP001011, alleging that Olsten was overpaid by Medicaid, failed to properly disclose information to Medicaid and engaged in improper billing. The alleged violations predated Olsten's acquisition of Quantum Health Resources in June 1996. The lawsuit sought unspecified monetary damages, double or treble damages, penalties and investigative costs. The parties resolved this matter during fiscal 2001 pursuant to a confidential settlement agreement and full release. There is no ongoing obligation on the part of the Company arising from this settlement. INDEMNIFICATIONS In connection with the Split-Off, the Company agreed to assume, to the extent permitted by law, and to indemnify Olsten for, the liabilities, if any, arising out of the above proceedings and other liabilities arising out of the home health services business, including any such liabilities arising after the Split-Off in connection with the government matters described below. In addition, the Company and Accredo have agreed to indemnify each other for breaches of representations and warranties of such party or the non-fulfillment of any covenant or agreement of such party in connection with the sale of the specialty pharmaceutical services business. The Company has also agreed to indemnify Accredo for the retained liabilities and for tax liabilities, and Accredo has agreed to indemnify the Company for assumed liabilities and the operation of the SPS business after the closing of the acquisition. The representations and warranties generally survive for the period of two years after the closing of the acquisition, which occurred on June 13, 2002, except that: o representations and warranties related to health care compliance survive for three years after the closing of the acquisition; o representations and warranties related to title of the assets and sufficiency of assets and employees survive for the applicable statute of limitations period; and o representations and warranties related to tax matters survive until thirty days after the expiration of the applicable tax statute of limitations period, including any extensions of the applicable period, subject to certain exceptions. F-19 Accredo and the Company may recover indemnification for a breach of a representation or warranty only to the extent a party's claim exceeds $1 million for any individual claim or exceeds $5 million in the aggregate, subject to certain conditions and only up to a maximum amount of $100 million. These indemnification rights are the exclusive remedy from and after the closing of the acquisition, except for the right to seek specific performance of any of the agreements in the related asset purchase agreement, in any case where a party is guilty of fraud in connection with the acquisition, and with respect to tax liabilities and obligations. On May 6, 2003, the Company received correspondence from Accredo giving the Company notice of Accredo's indemnification rights for any breach under the asset purchase agreement related to the adequacy of the accounts receivable reserves in accordance with section 8.3 of the asset purchase agreement; however, no breach of a representation or warranty was asserted against the Company in the correspondence. GOVERNMENT MATTERS PRRB APPEAL As further described in the Critical Accounting Policies section in Note 2, the Company's annual cost reports, which were filed with the CMS, were subject to audit by the fiscal intermediary engaged by CMS. In connection with the audit of the Company's 1997 cost reports, the Medicare fiscal intermediary made certain audit adjustments related to the methodology used by the Company to allocate a portion of its residual overhead costs. The Company filed cost reports for years subsequent to 1997 using the fiscal intermediary's methodology. The Company believed its methodology used to allocate such overhead costs was accurate and consistent with past practice accepted by the fiscal intermediary; as such, the Company filed appeals with the Provider Reimbursement Review Board ("PRRB") concerning this issue with respect to cost reports for the years 1997, 1998 and 1999. The Company's consolidated financial statements for the years 1997, 1998 and 1999 had reflected use of the methodology mandated by the fiscal intermediary. In June 2003, the Company and its Medicare fiscal intermediary signed an Administrative Resolution relating to the issues covered by the appeals pending before the PRRB. Under the terms of the Administrative Resolution, the fiscal intermediary agreed to reopen and adjust the Company's cost reports for the years 1997, 1998 and 1999 using a modified version of the methodology used by the Company prior to 1997. This modified methodology will also be applied to cost reports for the year 2000, which are currently under audit. The Administrative Resolution required that the process to (i) reopen all 1997 cost reports, (ii) determine the adjustments to allowable costs through the issuance of Notices of Program Reimbursement ("NPRs") and (iii) make appropriate payments to the Company, be completed in early 2004. Cost reports relating to years subsequent to 1997 will be reopened after the process for the 1997 cost reports is completed. On February 17, 2004, the fiscal intermediary notified the Company that it had completed the reopening of all 1997 cost reports and determined that the adjustment to allowable costs for that year approximated $9 million. As of February 27, 2004, the majority of the funds relating to this adjustment had been remitted to the Company; the settlement amount will be recorded as net revenues during the first quarter of fiscal 2004. Although the Company believes that it could recover additional funds as a result of applying the modified methodology discussed above to cost reports subsequent to 1997, the settlement amounts cannot be specifically determined until the reopening or audit of each year's cost reports is completed. This is not expected to occur until the second half of fiscal 2004 or fiscal 2005. However, in view of changes in reimbursement and the Company's operations in periods subsequent to 1997, it is likely that future recoveries relating to any cost report year from 1998 to 2000 will be significantly less than the 1997 settlement. SUBPOENAS On April 17, 2003, the Company received a subpoena from the Department of Health and Human Services, Office of the Inspector General, Office of Investigations ("OIG"). The subpoena seeks information regarding the Company's implementation of settlements and corporate integrity agreements entered into with the government, as well as the Company's treatment on cost reports of employees engaged in sales and marketing efforts. With respect to the cost report issues, the government has preliminarily agreed to narrow the scope of production to the period from January 1, 1998 through September 30, 2000. On February 17, 2004, the Company received a subpoena from the U.S. Department of Justice ("DOJ") seeking additional information related to F-20 the matters covered by the OIG subpoena. The Company has provided documents and other information requested by the OIG pursuant to its subpoena and similarly intends to cooperate fully with the DOJ subpoena as well as any future OIG or DOJ information requests. To the Company's knowledge, the government has not filed a complaint against the Company. In February 2000, the Company received a document subpoena from the Department of Health and Human Services, Office of the Inspector General, Office of Investigations. The subpoena related to its agencies' cost reporting procedures concerning contracted nursing and home health aide costs. This matter has been settled and settlement costs were recorded as part of special charges during the second quarter of fiscal 2002. (See Note 4). NOTE 10. COMMITMENTS The Company rents certain properties under non-cancelable, long-term operating leases, which expire at various dates. Certain of these leases require additional payments for taxes, insurance and maintenance and, in many cases, provide for renewal options. Rent expense under all leases was $15.3 million in 2003, $16.2 million in 2002 and $18.5 million in 2001. Future minimum rental commitments and sublease rentals for all non-cancelable leases having an initial or remaining term in excess of one year at December 28, 2003, are as follows (in thousands): FISCAL YEAR TOTAL COMMITMENT SUBLEASE RENTALS NET ----------- ---------------- ---------------- --------- 2004 $ 18,936 $ 1,783 $ 17,153 2005 14,535 1,747 12,788 2006 10,190 1,058 9,132 2007 5,764 898 4,866 2008 2,888 158 2,730 Thereafter 2,822 - 2,822 In addition, the Company has purchase obligations due in fiscal 2004 of approximately $1.1 million. NOTE 11. STOCK PLANS In 1999, the Company adopted the 1999 Stock Incentive Plan ("1999 Plan") under which 5 million shares of common stock were reserved for issuance upon exercise of options thereunder. The maximum total number of shares of common stock for which grants may be made to any employee, consultant or director under the 1999 plan in any calendar year is 300,000. These options may be awarded in the form of incentive stock options ("ISOs") or non-qualified stock options ("NQSOs"). The option price of an ISO and NQSO cannot be less than 100 percent and 85 percent, respectively, of the fair market value at the date of grant. As of December 28, 2003, the Company had 1,476,698 shares available for issuance under the 1999 Plan. In 1999, the Company adopted the Stock & Deferred Compensation Plan for Non-Employee Directors, which provided for payment of annual retainer fees to non-employee directors, up to 50 percent of which such directors might elect to receive in cash and the remainder of which would be paid in the form of shares of common stock of the Company and also allowed deferral of such payment of shares until termination of director's service. The plan was amended and restated on January 1, 2004 and now provides for the deferral of annual retainer fees under the plan only into stock units which are to be paid to non-employee directors as shares of the Company's common stock upon termination of a director's service. The total number of shares of common stock reserved for issuance under this plan is 150,000, of which 81,441 shares were available for future grants as of December 28, 2003. During fiscal 2003, 2002 and 2001, the Company issued 7,575 shares, 11,928 shares and 3,370 shares, respectively, under the plan. As of December 28, 2003, 36,246 shares were deferred. In 1999, the Company adopted an employee stock purchase plan ("ESPP"). All employees of the Company, who have been employed for at least eight months and whose customary employment exceeds twenty hours per week, are eligible to purchase stock under this plan. The Compensation, Corporate Governance and Nominating Committee of the Company's Board of Directors administers the plan and has the power to determine the terms and conditions of each offering of common stock. The purchase price of the shares under the plan is the lesser of 85 percent of the fair market value of the Company's common stock on the first business day or the last business day of the six month offering period. Employees may purchase shares having a fair market F-21 value of up to $25,000 per calendar year. The maximum number of shares of common stock that may be sold to any employee in any offering, however, will generally be 10 percent of that employee's compensation during the period of the offering. A total of 1,200,000 shares of common stock are reserved for issuance under the employee stock purchase plan, of which 498,534 shares were available for future issuance as of December 28, 2003. During fiscal 2003, 2002 and 2001, the Company issued 280,664 shares, 166,003 shares and 112,014 shares, respectively, under the plan. Effective with the sale of the SPS business, the Company commenced a cash tender offer for all of the outstanding options to purchase its common stock. The tender offer resulted in 1,253,141 options being tendered and accepted by the Company with 463,829 options remaining outstanding. To preserve the aggregate intrinsic value of the options, the outstanding options were converted to new Gentiva options at the ratio of 1 to 3.369, resulting in converted options of 1,562,646. The exercise price of a new Gentiva stock option represented 29.7 percent of the corresponding option, pre-conversion. A summary of Gentiva stock options for fiscal 2003, fiscal 2002 and fiscal 2001 is presented below:
2003 2002 2001 --------------------------- --------------------------- --------------------------- WEIGHTED WEIGHTED WEIGHTED STOCK AVERAGE STOCK AVERAGE STOCK AVERAGE OPTIONS EXERCISE PRICE OPTIONS EXERCISE PRICE OPTIONS EXERCISE PRICE --------- -------------- ---------- -------------- ---------- -------------- Options outstanding, beginning of year 2,549,667 $ 4.75 2,346,600 $ 8.61 3,689,006 $ 6.09 Granted 740,900 8.85 1,152,700 7.54 939,000 13.22 Exercised (452,338) 2.12 (665,040) 7.73 (2,156,796) 6.22 Cancelled/forfeitures (151,933) 7.99 (594,098) 8.52 (124,610) 10.04 Tendered options - - (1,253,141) 8.54 - - Converted to new Gentiva options - - 1,562,646 2.63 - - --------- -------- ---------- -------- ---------- --------- Options outstanding, end of year 2,686,296 $ 6.14 2,549,667 $ 4.75 2,346,600 $ 8.61 ========= ======== ========== ======== ========== ========= Options exercisable, end of year 1,345,570 $ 4.07 1,421,567 $ 2.53 838,168 $ 5.82 ========= ======== ========== ======== ========== =========
The following table summarizes information about Gentiva stock options outstanding at December 28, 2003:
OPTIONS OUTSTANDING OPTIONS EXERCISABLE -------------------------------------------- ----------------------- NUMBER WEIGHTED WEIGHTED NUMBER WEIGHTED AT AVERAGE AVERAGE AT AVERAGE DECEMBER 28, EXERCISE REMAINING DECEMBER 28, EXERCISE RANGE OF EXERCISE PRICE 2003 PRICE CONTRACTUAL LIFE 2003 PRICE - ----------------------- -------------- -------- ---------------- ------------ -------- $1.07 to $1.30 54,234 $ 1.22 4.74 54,234 $ 1.22 $1.65 to $1.74 380,281 1.69 6.20 380,281 1.69 $2.02 to $2.95 59,454 2.27 3.02 59,454 2.27 $3.55 to $3.91 493,527 3.89 6.86 493,527 3.89 $7.50 to $7.50 956,800 7.50 8.46 330,873 7.50 $8.10 to $8.60 63,100 8.44 8.67 27,201 8.38 $8.74 to $9.75 678,900 8.86 9.06 - - --------- ------- ---- --------- ------- $1.07 to $9.75 2,686,296 $ 6.14 7.81 1,345,570 $ 4.07 ========= ======= ==== ========= =======
The Company has chosen to adopt the disclosure only provisions of SFAS 148 and continue to account for stock-based compensation using the intrinsic value method prescribed in APB 25, and related interpretations. Under this approach, the cost of restricted stock awards is expensed over their vesting period, while the imputed cost of stock option grants and discounts offered under the Company's ESPP is disclosed, based on the vesting provisions of the individual grants, but not charged to expense. The weighted average fair values of the Company's stock options, granted during 2003, 2002 and 2001, calculated using the Black-Scholes option pricing model, and other assumptions are as follows: F-22
FISCAL YEAR ENDED --------------------------------------------------------- DECEMBER 28, 2003 DECEMBER 29, 2002 DECEMBER 30, 2001 ----------------- ----------------- ----------------- Risk-free interest rate 3.51% 4.15% 4.88% Expected volatility 60% 38% 65% Expected life 6 years 5 years 5 years Contractual life 10 years 10 years 10 years Expected dividend yield 0% 0% 0% Weighted average fair value of options granted $ 5.24 $ 3.02 $ 7.76
Pro forma compensation expense is calculated for the fair value of the employee's purchase rights, under the ESPP, using the Black-Scholes model. Assumptions for the fiscal 2003 and fiscal 2002 are as follows:
FISCAL YEAR ENDED --------------------------------------------------------- DECEMBER 28, 2003 DECEMBER 29, 2002 --------------------------- --------------------------- 1ST OFFERING 2ND OFFERING 1ST OFFERING 2ND OFFERING PERIOD PERIOD PERIOD PERIOD ------------ ------------ ------------ ------------ Risk-free interest rate: 1.25% 0.97% 1.89% 1.77% Expected volatility 32% 29% 60% 60% Expected life 0.5 years 0.5 years 0.5 years 0.5 years Expected dividend yield 0% 0% 0% 0%
The following table presents net income (loss) and basic and diluted earnings (loss) per common share, had the Company elected to recognize compensation cost based on the fair value at the grant dates for stock option awards and discounts granted for stock purchases under the Company's ESPP, consistent with the method prescribed by SFAS 123, as amended by SFAS 148:
FISCAL YEAR ENDED --------------------------------------------------------- DECEMBER 28, 2003 DECEMBER 29, 2002 DECEMBER 30, 2001 ----------------- ----------------- ----------------- Net income (loss) - as reported $ 56,766 $ (49,033) $ 20,988 Add: Stock-based employee compensation expense included in reported net income, net of tax - 13,160 - Deduct: Total stock-based compensation expense determined under fair value based method for all awards, net of tax (1,575) (5,022) (3,002) ----------- ---------- ----------- Net income (loss) - pro forma $ 55,191 $ (40,895) $ 17,986 =========== ========== =========== Basic income (loss) per share - as reported $ 2.16 $ (1.87) $ 0.90 Basic income (loss) per share - pro forma $ 2.10 $ (1.56) $ 0.78 Diluted income (loss) per share - as reported $ 2.07 $ (1.87) $ 0.90 Diluted income (loss) per share - pro forma $ 2.01 $ (1.56) $ 0.78
On December 31, 2003, the Company issued 992,100 stock options at an exercise price of $12.87 per share and issued 125,039 shares under its ESPP. NOTE 12. INCOME TAXES Comparative analyses of the provision (benefit) for income taxes follows (in thousands): F-23
FISCAL YEAR ENDED --------------------------------------------------------- DECEMBER 28, 2003 DECEMBER 29, 2002 DECEMBER 30, 2001 ----------------- ----------------- ----------------- Current Federal $ - $ 5,600 $ (6,632) State and local 1,567 - (183) ----------- ---------- ----------- 1,567 5,600 (6,815) ----------- ---------- ----------- Deferred Federal (31,875) 10,114 - State and local (3,160) 2,723 - ----------- ---------- ----------- (35,035) 12,837 - ----------- ---------- ----------- Provision for income taxes $ (33,468) $ 18,437 $ (6,815) =========== ========== ===========
A reconciliation of the differences between income taxes computed at federal statutory rate and provisions (benefits) for income taxes for each year are as follows (in thousands):
FISCAL YEAR ENDED --------------------------------------------------------- DECEMBER 28, 2003 DECEMBER 29, 2002 DECEMBER 30, 2001 ----------------- ----------------- ----------------- Income taxes computed at Federal statutory tax rate $ 8,162 $ (12,287) $ (7,254) State income taxes, net of Federal benefit 1,019 (1,770) (119) Nondeductible meals and entertainment 167 155 232 Income tax audit adjustments (177) 5,439 - Deferred rate differential 1,142 - - Decrease in Federal valuation allowance (44,438) - - Valuation allowance adjustment for adoption of SFAS 142 - 26,859 - Amortization of intangibles - - 623 Other 657 41 (297) ---------- ----------- -------- $ (33,468) $ 18,437 $ (6,815) ========== =========== ========
The federal income tax rate reconciliation schedule above includes only components associated with continuing operations. Deferred tax assets and deferred tax liabilities are as follows (in thousands):
DECEMBER 28, 2003 DECEMBER 29, 2002 ----------------- ----------------- Deferred tax assets Reserves and allowances $ 21,290 $ 24,543 Net operating loss and other carryforwards (Federal and state) 4,966 5,993 Intangible assets 29,085 33,202 Depreciation 23 332 Other 208 574 Less: Valuation allowance - (63,892) ---------- ---------- Total deferred tax assets 55,572 752 Deferred tax liabilities Capitalized software (1,083) (752) ---------- ---------- Net deferred tax assets $ 54,489 $ - ========== ==========
At December 28, 2003, net deferred tax assets of $26.5 million and $28.0 million were recorded in current assets and noncurrent assets, respectively, in the accompanying consolidated balance sheet. At December 29, 2002, deferred tax assets of $0.8 million were included in current assets and deferred tax liabilities of $0.8 million were included in other liabilities in the consolidated balance sheet. The Company had maintained a valuation allowance for its deferred tax assets as of December 29, 2002 since the absence of historical pre-tax income created uncertainty about the Company's ability to realize tax benefits in future years. During the interim periods of fiscal 2003, a portion of the valuation allowance ($9.4 million) was utilized to offset a corresponding decrease in net deferred tax assets. The remaining valuation allowance was reversed at the end of fiscal 2003 based on management's belief that it is more likely than not that all of the Company's net deferred tax assets will be realized due to the Company's achieved earnings trends and outlook. In this regard, $35.0 million was recorded as an income tax benefit in the accompanying statement of F-24 operations for fiscal 2003 and $19.5 million was credited directly to shareholders' equity at December 28, 2003 to reflect the portion of the valuation allowance associated with stock compensation tax benefits. As of December 28, 2003, the Company's net operating losses and tax credit carryforwards for income tax purposes were approximately $11.1 million and $0.7 million, respectively. Income tax payments, including payments associated with discontinued operations, were $1.6 million, $7.6 million and $0.7 million for fiscal years 2003, 2002 and 2001, respectively. NOTE 13. BENEFIT PLANS FOR PERMANENT EMPLOYEES The Company maintains qualified and non-qualified defined contribution retirement plans for its salaried employees, which provide for a partial match of employee savings under the plans and for discretionary profit-sharing contributions based on employee compensation. With respect to the Company's non-qualified defined contribution retirement plan for salaried employees, all pre-tax contributions, matching contributions and profit sharing contributions (and the earnings therein) are held in a Rabbi Trust and are subject to the claims of the general, unsecured creditors of the Company. All post-tax contributions are held in a secular trust and are not subject to the claims of the creditors of the Company. The fair value of the assets held in the Rabbi Trust and the liability to plan participants as of December 28, 2003 and December 29, 2002 totaling approximately $10.0 million and $9.0 million, respectively, are included in other assets and other liabilities on the accompanying consolidated balance sheets. Company contributions under the defined contribution plans were approximately $1.8 million in 2003, $2.0 million in 2002 and $2.7 million in 2001. F-25 NOTE 14. QUARTERLY FINANCIAL INFORMATION (UNAUDITED) (in thousands, except per share amounts)
FIRST SECOND THIRD FOURTH QUARTER QUARTER QUARTER QUARTER --------- --------- --------- --------- YEAR ENDED DECEMBER 28, 2003 Net revenues $ 202,016 $ 208,446 $ 199,698 $ 203,869 Gross profit 68,766 69,624 69,241 74,411 Net income 5,201 5,247 4,547 41,771(1) Earnings Per Share: Net income - basic 0.19 0.20 0.18 1.62 Net income - diluted 0.19 0.19 0.17 1.53 Weighted average shares outstanding: Basic 26,696 26,530 25,972 25,852 Diluted 27,772 27,490 27,098 27,225 FIRST SECOND THIRD FOURTH QUARTER QUARTER QUARTER QUARTER --------- --------- --------- --------- YEAR ENDED DECEMBER 29, 2002 Net revenues $ 192,799 $ 195,623 $ 188,443 $ 191,636 Gross profit 63,613 56,731 (2) 63,545 63,711 Income (loss) from continuing operations (25,914) (33,678)(2) 2,738 3,311 Discontinued operations, net of tax (4) 7,188 184,953 (563) - Income (loss) before cumulative effect of accounting change (18,726) 151,275 2,175 3,311 Cumulative effect of accounting change, net of tax (3) (190,468) - 1,392 2,008 Net income (loss) (3) (4) (209,194) 151,275 3,567 5,319 Earnings Per Share: Basic: Income (loss) from continuing operations (1.00) (1.29) 0.10 0.12 Discontinued operations, net of tax 0.28 7.08 (0.02) - Income (loss) before cumulative effect of accounting change (0.72) 5.79 0.08 0.12 Net income (loss) (8.10) 5.79 0.14 0.20 Diluted: Income (loss) from continuing operations (1.00) (1.29) 0.10 0.12 Discontinued operations, net of tax 0.28 7.08 (0.02) - Income (loss) before cumulative effect of accounting change (0.72) 5.79 0.08 0.12 Net income (loss) (8.10) 5.79 0.13 0.19 Weighted average shares outstanding: Basic 25,842 26,143 26,365 26,380 Diluted 25,842 26,143 27,483 27,432
(1) During the fourth quarter of fiscal 2003, the Company recorded a tax benefit of $35.0 million associated with management's decision to reverse the valuation allowance for deferred tax assets. See Note 12 for further discussion. (2) During the second quarter of 2002, the Company also recorded restructuring and special charges aggregating $46.1 million, of which $6.3 million is recorded in cost of services sold and $39.8 million is recorded in selling, general and administrative expenses. See Note 4 for further discussion. (3) For fiscal year 2002, the Company adopted the provisions of SFAS 142 "Goodwill and Other Intangible Assets" and performed a transitional impairment test, resulting in a non-cash charge, net of tax,for the first quarter of 2002 of $190.5 million, with related tax benefits of $1.4 million and $2.0 million recorded in third quarter and fourth quarter of fiscal 2002, respectively. See Note 2 for further discussion. (4) During the fiscal year 2002, the Company sold its SPS business to Accredo in accordance with the asset purchase agreement, dated January 2, 2002, with the sale completed on June 13, 2002. As such, the Company has reflected discontinued operations, including the gain on sale, of $7.2 million, $185.0 million and ($0.6) million in the first quarter, second quarter and third quarter of fiscal 2002, respectively. See Note 3 for further discussion. F-26 GENTIVA HEALTH SERVICES, INC. AND SUBSIDIARIES SCHEDULE II - VALUATION AND QUALIFYING ACCOUNTS FOR THE THREE YEARS ENDED DECEMBER 28, 2003 (IN THOUSANDS)
ADDITIONS BALANCE AT CHARGED TO BALANCE BEGINNING OF COSTS AND AT END PERIOD EXPENSES DEDUCTIONS OF PERIOD ------------ ---------- ---------- --------- Allowance for Doubtful Accounts: For the Year Ended December 28, 2003 $ 9,032 $ 7,684 $ (8,780) $ 7,936 For the Year Ended December 29, 2002 10,831 4,936 (6,735) 9,032 For the Year Ended December 30, 2001 18,456 5,120 (12,745) 10,831
F-27 EX-10.8 3 ex10_8.txt EXHIBIT 10.8 GENTIVA HEALTH SERVICES, INC. STOCK & DEFERRED COMPENSATION PLAN FOR NON-EMPLOYEE DIRECTORS (As Amended and Restated as of January 1, 2004) SECTION 1. INTRODUCTION. The Gentiva Health Services, Inc. Stock & Deferred Compensation Plan for Non-Employee Directors (the "Plan") provides for the deferral of a portion of the annual retainer fees payable to non-employee directors of Gentiva Health Services, Inc. into Units which are deemed invested in Shares. The Plan is intended to encourage qualified individuals to accept nominations as directors of Gentiva Health Services, Inc. and to strengthen the mutuality of interest between the non-employee directors and Gentiva Health Services, Inc.'s other shareholders. SECTION 2. DEFINITIONS. For purposes of the Plan, the following terms shall be defined as set forth below: (a) "Annual Shareholders Meeting" means the annual general meeting of the Company's shareholders. (b) "Board" means the Board of Directors of the Company. (c) "Calculation Date" means the date as of which the number of Units to be credited to an Account is to be calculated. Generally, the Calculation Dates shall be March 1, June 1, September 1 and December 1; PROVIDED, HOWEVER, that if a person shall become a Director other than at an Annual Shareholders Meeting, the first Calculation Date applicable to such Director shall be the Director's first day of service; and PROVIDED, FURTHER, that for purposes of calculating the number of Units allocable to the $11,250 additional retainer described in Section 4(a), the Calculation Date shall be January 2, 2004. (d) "Code" means the Internal Revenue Code of 1986, as amended from time to time. References to any provision of the Code shall be deemed to include successor provisions thereto and regulations thereunder. (e) "Company" means Gentiva Health Services, Inc., a corporation organized under the laws of Delaware, or any successor corporation. (f) "Director" means a member of the Board who is not employed by the Company or any of its subsidiaries. (g) "Plan" means this Stock & Deferred Compensation Plan for Non-Employee Directors. (h) "Plan Benefits" means the benefits described in Section 6 hereof. (i) "Plan Year" means a period of approximately twelve months beginning on the date of the Annual Shareholders Meeting for a year and ending on the day immediately preceding the Annual Shareholders Meeting in the following year. (j) "Shares" means Common Stock, $0.10 par value per share, of the Company. (k) "Unit" means a contractual right, denominated in Shares, to receive Shares of the Company, as described in this Plan. SECTION 3. ADMINISTRATION. The Plan shall be administered by the Board. The Board shall have full authority to construe and interpret the Plan, and any action of the Board with respect to the Plan shall be final, conclusive, and binding on all persons. Subject to adjustment as provided in Section 7(g) hereof, the total number of Shares reserved for issuance under the Plan shall be 150,000. SECTION 4. ANNUAL RETAINER DEFERRED INTO UNITS. (a) GENERAL. Beginning with the first Annual Shareholders Meeting held after the Effective Date of this Plan, the portion of each Director's annual retainer fee to be deferred into Units for a Plan Year shall be $30,000. For the period from the Effective Date until the date of the first Annual Shareholders Meeting held after the Effective Date, each Director shall receive an additional retainer equal to $11,250. The additional retainer shall be deferred into Units as described in this Section 4. (b) CALCULATING THE NUMBER OF UNITS. The number of Units to be deferred and credited to a Director's Account as of any Calculation Date shall be $7,500 (or in the case of a person who becomes a Director other than at an Annual Shareholder Meeting, a pro-rated amount based on the number of days in the calculation period the person will be a Director) divided by the average closing price of Shares on the principal stock exchange or stock market on which the Shares may be listed or admitted to trading for the ten trading days immediately preceding the Calculation Date, and the resulting quotient shall be rounded to the nearest whole Unit. SECTION 5. UNIT ACCOUNTS. 2 The Company shall maintain a Unit account (an "Account") for each Director. Units will be credited to each such Account as follows: (a) CREDITING OF UNITS. Units shall be credited as of the Calculation Date. (b) DIVIDEND EQUIVALENTS. If any dividends are payable on Shares, dividend equivalents, equal to the dividend that would have been payable on the Units credited to a Director's Account as if such Units had constituted Shares, shall be paid to the Director in cash at the time the corresponding dividends are paid on Shares. SECTION 6. PLAN BENEFITS. (a) FORM. The Plan Benefit of a Director shall consist of Shares equal in number to the Units in the Director's Account. Any fractional Unit shall be paid in cash. (b) DISTRIBUTION. (i) The Plan Benefit of a Director shall be distributed either (A) in a single lump sum at the time of termination of the Director's service on the Board, (B) in a single lump sum up to one year after termination of the Director's service on the Board, or (C) with respect to Units credited prior to January 1, 2004 only, in up to three annual installments beginning at the time of termination of the Director's service on the Board. Each Director may elect the time of distribution in accordance with the previous sentence, and such election must be made in the form designated by the Company from time to time and must be made within 10 days after the Director first becomes eligible to participate in the Plan (and with respect to Units credited after January 1, 2004 within 10 days after such date). A Director's election shall be irrevocable once filed with the Company; PROVIDED, HOWEVER, that a Director may file a new election as to the time of distribution if such election is filed at least one year in advance of termination of service on the Board. In the absence of a timely election by a Director hereunder, the Director shall be deemed to have elected to have his or her Plan Benefit distributed in a single lump sum at the time of termination of the Director's service on the Board. (ii) In the case of the death of a Director, the Director's Plan Benefit shall be distributed, within a reasonable time as determined by the Company, after the Director's death to the Director's beneficiary or beneficiaries, as specified by the Director on a form furnished by and filed with the Secretary of the Company. If no beneficiary has been designated by the Director or if no beneficiary survives the Director, the undistributed balance of his or her Plan Benefit shall be distributed to the Director's surviving spouse as beneficiary if such spouse is still living or, if not living, in equal shares to the then living children of the Director as beneficiaries or, if none, to the Director's estate as beneficiary. 3 SECTION 7. GENERAL. (a) NONTRANSFERABILITY. Except as provided in Section 6(b)(ii), no payment of any Plan Benefit of a Director shall be anticipated, assigned, attached, garnished, optioned, transferred or made subject to any creditor's process, whether voluntarily or involuntarily or by operation of law. Any act in violation of this subsection shall be void. (b) COMPLIANCE WITH LEGAL AND TRADING REQUIREMENTS. The Plan shall be subject to all applicable laws, rules and regulations, including, but not limited to, federal and state laws, rules and regulations, and to such approvals by any regulatory or governmental agency as may be required. No provision of the Plan shall be interpreted or construed to obligate the Company to register any Shares under federal or state securities laws. The transfer by a Director of Shares distributed pursuant to the Plan will be subject to such restrictions as the Company deems necessary or desirable in connection with federal or state securities laws, and Share certificates will bear a legend setting forth any such restriction. (c) TAXES. The Company is authorized to withhold from any payment made under this Plan any amounts of withholding and other taxes due in connection therewith, and to take such other action as the Company may deem advisable to enable the Company and a Director to satisfy obligations for the payment of any withholding taxes and other tax obligations relating thereto. (d) AMENDMENT. The Board may amend, alter, suspend, discontinue, or terminate the Plan (including, without limitation, amending the dollar amount set forth in Section 4(a) hereof) without the consent of shareholders of the Company or individual Directors; PROVIDED, HOWEVER, that, without the consent of an affected Director, no amendment, alteration, suspension, discontinuation, or termination of the Plan may materially impair the rights or, in any other manner, materially and adversely affect the rights of such Director hereunder. (e) UNFUNDED STATUS OF AWARDS. This Plan is intended to constitute an "unfunded" plan of deferred compensation. With respect to any payments not yet made to a Director, nothing contained in the Plan shall give any such Director any rights that are greater than those of a general creditor of the Company; PROVIDED, HOWEVER, that the Company may authorize the creation of trusts or make other arrangements to meet the Company's obligations under the Plan to deliver cash, or other property pursuant to any award, which trusts or other arrangements shall be consistent with the "unfunded" status of the Plan unless the Company otherwise determines with the consent of each affected Director. (f) NONEXCLUSIVITY OF THE PLAN. The adoption of the Plan by the Board shall not be construed as creating any limitations on the power of the Board to adopt such other compensation arrangements as it may deem desirable, including, without limitation, the granting of options on Shares and other awards otherwise than 4 under the Plan, and such arrangements may be either applicable generally or only in specific cases. (g) ADJUSTMENTS. In the event that subsequent to the Effective Date any dividend in Shares, recapitalization, Share split, reverse split, reorganization, merger, consolidation, spin-off, combination, repurchase, or share exchange, or other such change, affects the Shares such that they are increased or decreased or changed into or exchanged for a different number or kind of Shares, other securities of the Company or of another corporation or other consideration, then in order to maintain the proportionate interest of the Directors and preserve the value of the Directors' Units and to maintain the value of the Plan, there shall automatically be substituted (i) for each Unit a new unit and (ii) for the number of Shares set forth in Section 3 above a number of Shares or other consideration, in the case of (i) and (ii) above, representing the number and kind of Shares, other securities or other consideration into which each outstanding Share shall be changed or for which each such Share shall be exchanged. The substituted units shall be subject to the same terms and conditions as the original Units. (h) NO RIGHT TO REMAIN ON THE BOARD. Neither the Plan nor the crediting of Units under the Plan shall be deemed to give any individual a right to remain a director of the Company or create any obligation on the part of the Board to nominate any Director for reelection by the shareholders of the Company. (i) GOVERNING LAW. The validity, construction, and effect of the Plan shall be determined in accordance with the laws of the State of New York, without giving effect to principles of conflict of laws thereof, (j) EFFECTIVE DATE. The Plan shall become effective, as amended and restated, on January 1, 2004 (the "Effective Date"). (k) TITLES AND HEADINGS. The titles and headings of the Sections in the Plan are for convenience of reference only. In the event of any conflict, the text of the Plan, rather than such titles or headings, shall control. 5 EX-10.10 4 ex10_10.txt Exhibit 10.10 GENTIVA HEALTH SERVICES, INC. NONQUALIFIED RETIREMENT AND SAVINGS PLAN Effective March 15, 2000 GENTIVA HEALTH SERVICES, INC. NONQUALIFIED RETIREMENT AND SAVINGS PLAN Table of Contents Page ---- ARTICLE I Background and Purpose 1.1 Background 1 1.2 Purpose......................................................... 1 1.3 Frozen Benefits................................................. 2 ARTICLE II Definitions 2.1 Account(s)...................................................... 2 2.2 Approved Leave of Absence....................................... 2 2.3 Base Salary..................................................... 2 2.4 Beneficiary..................................................... 2 2.5 Benefits Committee.............................................. 3 2.6 Bonus/Incentive Compensation.................................... 3 2.7 Break-in-Service................................................ 3 2.8 Change in Control............................................... 4 2.9 Code............................................................ 4 2.10 Company......................................................... 5 2.11 Company Contributions........................................... 5 2.12 Disability (or Disabled)........................................ 5 2.13 Effective Date.................................................. 5 2.14 Employee........................................................ 5 2.15 ERISA........................................................... 5 2.16 Highly Compensated Employee..................................... 5 2.17 Hours of Service................................................ 6 2.18 Participant..................................................... 7 2.19 Participating Employer.......................................... 7 2.20 Plan Administrator.............................................. 8 2.21 Plan Year....................................................... 8 2.22 Rabbi Trust..................................................... 8 2.23 Secular Trust................................................... 8 - ii - 2.24 Termination of Employment....................................... 8 2.25 Total Compensation.............................................. 8 2.26 Trust(s)........................................................ 9 2.27 Trustee(s)...................................................... 9 2.28 Unforseeable Emergency.......................................... 10 2.29 Valuation Date(s)............................................... 10 2.30 Year(s) of Service.............................................. 10 ARTICLE III Eligibility and Participation 3.1 Eligibility..................................................... 10 3.2 Participation................................................... 11 ARTICLE IV Contributions 4.1 Participant Contributions....................................... 12 4.2 Company or Participating Employer Contributions................. 15 ARTICLE V Investment and Valuation of Accounts 5.1 Investment of Accounts.......................................... 16 5.2 Determining the Value of Participant Accounts................... 18 ARTICLE VI Vesting and Forfeitures 6.1 Participant Contributions....................................... 18 6.2 Matching and Profit-Sharing Contributions....................... 18 6.3 Forfeitures..................................................... 19 6.4 Change in Control............................................... 19 ARTICLE VII Distributions 7.1 In-Service Withdrawals.......................................... 20 7.2 Final Distributions............................................. 20 - iii - ARTICLE VIII Leaves of Absence, Layoffs, and Reemployment 8.1 Leaves of Absence and Layoffs................................... 23 8.2 Returning to Work After Termination of Employment............... 24 ARTICLE IX Participating Employers 9.1 Adoption by Other Employers..................................... 25 9.2 Allocation of Plan and Trust Expenses........................... 26 9.3 Designation of Company as Agent................................. 26 9.4 Employee Transfers.............................................. 26 9.5 Contributions and Forfeitures of Participating Employer......... 27 9.6 Amendments by Participating Employers........................... 27 9.7 Discontinuance of Participation................................. 27 ARTICLE X Amendment and Termination 10.1 Right to Terminate.............................................. 27 10.2 Continuation of Trust........................................... 28 10.3 Right to Amend.................................................. 28 10.4 Merger or Consolidation......................................... 29 ARTICLE XI Administration 11.1 Plan Administrator.............................................. 29 11.2 Binding Effect.................................................. 30 11.3 Delegation of Authority......................................... 30 11.4 Plan Records and Expenses....................................... 30 11.5 Limited Liability............................................... 31 11.6 Insolvency...................................................... 31 11.7 Trusts; Funding of Benefits..................................... 32 - iv - ARTICLE XII Claims Procedure 12.1 Claims Submission............................................... 33 12.2 Claim Review.................................................... 34 12.3 Right of Appeal................................................. 34 12.4 Review of Appeal................................................ 34 12.5 Designation..................................................... 35 ARTICLE XIII Miscellaneous 13.1 Headings........................................................ 35 13.2 Uniformity...................................................... 35 13.3 Obligations of the Company and Participating Employers.......... 35 13.4 Insufficiency of Trust Fund..................................... 36 13.5 Contingent Nature of Accounts................................... 36 13.6 Governing Law................................................... 36 13.7 Gender and Number............................................... 36 13.8 Taxes........................................................... 36 13.9 Plan Benefits Nontransferable................................... 37 13.10 Incompetence.................................................... 37 13.11 Identity........................................................ 37 13.12 Other Benefits.................................................. 38 13.13 Construction.................................................... 38 13.14 No Guarantee of Employment...................................... 38 GENTIVA HEALTH SERVICES, INC. NONQUALIFIED RETIREMENT AND SAVINGS PLAN ARTICLE I Background And Purpose 1.1 Background. The Gentiva Health Services, Inc. Nonqualified Retirement and Savings Plan (the "Plan") was established effective March 15, 2000. The Plan is an amendment, restatement, merger and continuation of the Olsten Corporation Nonqualified Retirement and Savings Plan (effective January 1, 1999) and, as such, includes portions of benefits attributed to employees of Gentiva Health Services, Inc. (the "Company") and its affiliates that were earned under the Olsten Corporation Nonqualified Savings Plan for Selected Management Employees; the Olsten Corporation Nonqualified Retirement Plan for Selected Management Employees; and the Olsten Corporation Executive Voluntary Deferred Compensation Plan (together, the "Prior Plans"). Effective March 15, 2000, no further contributions shall be made to the Prior Plans. As of a date determined by the Plan Administrator, the assets and liabilities (if any) of the Prior Plans attributable to employees of the Company or its affiliates shall be transferred to this Plan. 1.2 Purpose. The Plan was established for the purpose of providing deferred compensation for a select group of management and highly compensated employees, as defined in Title I of the Employee Retirement Income Security Act of 1974, as amended. Participants may make pre-tax and after-tax salary deferrals under the Plan. In addition, the Participating Employers may match a portion of the Participant's pre-tax and after-tax salary deferrals. Furthermore, the Participating Employers may make profit-sharing contributions to the Plan regardless of whether the Participant has made any deferrals under the Plan. -2- 1.3 Frozen Benefits. Notwithstanding any provision of this Plan to the contrary, in all cases, any assets or liabilities transferred to this Plan from any Prior Plan shall consist solely of frozen benefits accrued under such Prior Plan. ARTICLE II Definitions 2.1 Account(s) means the Participant's Pre-Tax Deferral Account, After-Tax Deferral Account, Matching Contribution Account, and Profit Sharing Contribution Account, as determined by the Plan Administrator. 2.2 Approved Leave of Absence means any leave approved by the Participating Employer, which may or may not include unpaid leaves of absence pursuant to the Family and Medical Leave Act of 1993. 2.3 Base Salary means the amount paid to an Employee as regular, annual remuneration for services performed for the Participating Employer, as determined by the Plan Administrator. Base Salary does not include Bonus/Incentive Compensation. 2.4 Beneficiary means such beneficiary as the Participant may designate from time to time in a manner acceptable to the Plan Administrator (which may include paper, facsimile, electronic or voice response format), to receive any benefit payable in the event of the Participant's death. Unless otherwise designated, the Beneficiary with respect to a married Participant shall be the Participant's surviving spouse. If a Participant has no surviving spouse and has not made a valid Beneficiary designation hereunder, the Participant's death benefit shall be paid to the Participant's estate. Beneficiary designations made under the Olsten Corporation Nonqualified Retirement Savings Plan shall continue in effect under this Plan until changed by the Participant. -3- 2.5 Benefits Committee means the committee established by the Company to manage its various employee benefit plans. 2.6 Bonus/Incentive Compensation means the amount of remuneration for services paid to an Employee by the Participating Employer as a bonus or incentive in excess of the Employee's Base Salary, as determined by the Plan Administrator. 2.7 Break-in-Service means: (a) A Plan Year during which a Participant is not credited with more than five hundred (500) Hours of Service. (b) (1) In computing Hours of Service to determine whether a Participant has a Break in Service, a person shall be credited with up to five hundred one (501) Hours of Service based on the Participant's previous customary service with the Participating Employer for any period of absence from work as a result of: (A) the Participant's pregnancy; (B) the birth of the Participant's child; (C) the placement of a child with the Participant in connection with the Participant's adoption of such child; or (D) the Participant's caring for such child for a period beginning immediately following such birth or placement. -4- (2) If the previous customary service cannot be determined, then such credit shall be at the rate of eight (8) Hours of Service per day. (c) The Hours of Service credited under subsection (b) shall be credited in the Plan Year in which the absence from work begins, if the Participant would be prevented from having a Break in Service in such Plan Year solely because of the Hours of Service credited under subsection (b). If the Participant would not be so prevented from having a Break in Service during the period described in the preceding sentence, then such Hours of Service shall be credited in the Plan Year immediately following those in which such absence from work begins. (d) No credit shall be given under subsection (b) unless the Participant furnishes the Plan Administrator with information necessary to establish that the absence is for one of the reasons enumerated in subsection (b) and the number of days of such absence. 2.8 Change in Control means the acquisition by a "person" (as such term is used in sections 13(d) and 14(d) of the Securities Exchange Act of 1934) of more than twenty-five percent (25%) of the then outstanding voting stock of the Company, other than through a transaction arranged by, or with the consent of, the Company or the Board, or the purchase of at least ten percent (10%) of the then outstanding shares of voting stock of the Company pursuant to a tender offer or exchange offer which is opposed by a majority of the members then serving on the Board. The split off of the Company from Olsten Corporation shall not be treated as a Change in Control with respect to Participants in the Prior Plans as of the Effective Date. 2.9 Code means the Internal Revenue Code of 1986, as amended. -5- 2.10 Company means Gentiva Health Services, Inc., a Delaware corporation, and its successors. 2.11 Company Contributions means matching contributions and profit sharing contributions. 2.12 Disability (or Disabled) means a medically determinable physical or mental impairment that renders a Participant totally disabled. If the Participant qualifies to receive benefits under the Participating Employer's long term disability program, the Participant shall be presumed Disabled for purposes of this Plan. If the Participant does not qualify to receive benefits under the Participating Employer's long term disability program, the Plan Administrator may nevertheless determine that the Participant is Disabled for purposes of this Plan. 2.13 Effective Date of the Plan means March 15, 2000. 2.14 Employee means a full-time, regular employee of a Participating Employer who is designated as such on the books and records of the Participating Employer, as determined by the Plan Administrator. 2.15 ERISA means the Employee Retirement Income Security Act of 1974, as amended from time to time. 2.16 Highly Compensated Employee means any Employee who is a management or highly compensated employee (within the meaning of Title I of ERISA), and who: (a) is a five percent (5%) owner of the Participating Employer at any time during the Plan Year or the preceding Plan Year; -6- (b) for the preceding Plan Year received Total Compensation in excess of the amount specified in Code section 414(q)(1)(B)(i); or (c) for the current Plan Year, the Plan Administrator determines that the Employee's Total Compensation is expected to exceed the amount specified in Code section 414(q)(1)(B)(i) and the Employee is not, for such Plan Year, participating in a plan maintained by a Participating Employer that is intended to be qualified under Code section 401(a). 2.17 Hours of Service (a) Hours of Service includes each hour: (1) for which an individual is paid by, or entitled to pay from, a Participating Employer for the performance of duties, and (2) for which an individual is paid, or entitled to pay, by the Company or Participating Employer with respect to a period of time during which no duties are performed due to vacation, holiday, or illness, incapacity, disability, maternity leave, layoff, jury duty, military duty, or leave of absence (determined in accordance with 29 C.F.R. ss.2530.200b-2(b) and (c)), and (3) for which back pay, irrespective of mitigation of damages, is either awarded to an individual or agreed to by the Company or Participating Employer. (b) An Hour of Service shall not be credited under more than one paragraph above. Only five hundred and one (501) Hours of Service will be credited to an -7- individual for any single continuous period of time during which the individual was paid but rendered no services, even where such period spans more than one computation period. (c) An Employee will be credited with forty-five (45) Hours of Service for each week for which he or she would be credited with one Hour of Service under the Department of Labor regulations. (d) Hours of Service shall include employment with the Participating Employer and with affiliates of the Participating Employer within the meaning of Code section 1563(a). 2.18 Participant means a Highly Compensated Employee who participates in the Plan as provided in ARTICLE III. 2.19 Participating Employer (a) Participating Employer means any entity in the following group that includes the Company: (i) a controlled group of corporations, within the meaning of Code section 414(b); (ii) a group of trades or businesses under common control, within the meaning of Code section 414(c); (iii) an affiliated service group, within the meaning of Code section 414(m); or (iv) a trade or business required to be aggregated pursuant to Code section 414(o), provided such entity has adopted this Plan with the permission of the Plan Administrator. (b) Entities within the Olsten Corporation's controlled group or affiliated group through the Effective Date of this Plan shall be treated as Participating Employers hereunder, such that employment with such entities shall be counted towards crediting Hours of Service or Years of Service for purposes of eligibility -8- for participation, allocation of contributions, vesting and all other purposes and compensation from such entities shall be treated as part of Total Compensation. 2.20 Plan Administrator means the Benefits Committee. 2.21 Plan Year means the period beginning January 1 and ending on the following December 31 of each year. However, the initial Plan Year shall be the period from the Effective Date through December 31, 2000. 2.22 Rabbi Trust means the grantor trust instrument established under Code section 671 and intended to satisfy the requirements of Revenue Procedure 92-64, which is designated to hold plan assets associated with Participants' Pre-tax Salary Deferral Account, Matching Contribution Account and Profit Sharing Contribution Account, and the earnings thereon. 2.23 Secular Trust means the grantor trust instrument established under Code section 671, which is designated to hold plan assets associated with Participants' After-Tax Salary Deferral Account and the earnings thereon. 2.24 Termination of Employment means the later of (i) termination of service with the Participating Employer or (ii) termination of service with InteliStaf Holdings, Inc.; provided however, that that the Administrator may deem a Participant to have a Termination of Employment at any time following the Participant's termination of service with Gentiva. The split off of the Company from Olsten Corporation shall not be treated as a Termination of Employment for any Participant hereunder. -9- 2.25 Total Compensation means: (a) As determined by the Plan Administrator, all remuneration for services paid to an Employee by a Participating Employer, as defined in Code section 3401(a) (for purposes of income tax withholding at the source), but determined without regard to any rules that limit remuneration included in wages based on the nature and location of employment or the services performed. (b) Total Compensation as defined in subsection (a) shall exclude the following items (even if includable in gross income), as determined by the Plan Administrator: (1) reimbursement or other expense allowances; (2) fringe benefits (cash and noncash); (3) moving expenses and gross up for taxes; (4) welfare benefits (including disability income from insurance policies); (5) payments on account of severance of the Participant from employment with a Participating Employer; (6) payments on account of early retirement of the Participant; (7) income arising from the grant or exercise of stock options; -10- (8) restricted stock awards; and (9) distributions under this Plan. 2.26 Trust(s) means the assets of the Plan held in trust pursuant to the Rabbi Trust and/or the Secular Trust. 2.27 Trustee(s) means the Trustee of the Rabbi Trust and/or the Trustee of the Secular Trust as the context may require, and any successor Trustees. 2.28 Unforeseeable Emergency means a sudden, unexpected event beyond the control of the Participant that would result in severe financial hardship to the Participant if early withdrawal were not permitted. The amount of the withdrawal is limited to the amount necessary to meet the emergency. Examples of Unforeseeable Emergencies include the Participant's sudden and unexpected illness or accident (or that of the Participant's dependent), or an extraordinary and unforeseeable loss of the Participant's property due to casualty as a result of events beyond the Participant's control. Sending a child to college or purchasing a new home is not an Unforeseeable Emergency. The Plan Administrator shall determine whether a particular situation qualifies as an Unforeseeable Emergency, based on the facts and circumstances of each case. 2.29 Valuation Date(s) means each day the recordkeeper values the balances of the Participants' Accounts. 2.30 Year(s) of Service means the Plan Year during which an Employee has completed at least 1,000 Hours of Service. All Years of Service shall be considered except Years of Service prior to the Plan Year in which the Participant attained age eighteen (18). -11- ARTICLE III Eligibility And Participation 3.1 Eligibility. (a) All participants in the Prior Plans who become employed by any entity within the Company's controlled or affiliated group as of the Effective Date shall become Participants hereunder as of the Effective Date. (b) Highly Compensated Employees (i) who are age twenty-one (21) or older; (ii) who have completed six (6) months of service with a Participating Employer; (iii) who are employed by a Participating Employer on or after the Effective Date; (iv) who did not participate in the Prior Plans; and (v) who are designated by the Plan Administrator as eligible to participate in the Plan, shall become Participants as of the first day of the first payroll period of the calendar month occurring on or after the date the Employee satisfies such eligibility requirements. (c) The Plan Administrator shall have sole discretion to determine when a Highly Compensated Employee becomes eligible to participate in the Plan and the Plan Administrator may take into consideration whether the Highly Compensated Employee has received sufficient notice of his or her eligibility to participate in the Plan (such that the Employee may make a timely election to defer salary within thirty (30) days of first becoming eligible to participate in the Plan). The Plan Administrator shall also have sole discretion to determine if an Employee is expected to be a Highly Compensated Employee in the current Plan Year based on such Employee's expected Total Compensation for the current Plan Year. -12- 3.2 Participation. To participate in the Plan, an eligible Highly Compensated Employee must enroll in the Plan, regardless of whether the Employee elects to make salary deferral contributions to the Plan. If an Employee fails to enroll in the Plan, the Plan Administrator shall nevertheless enroll the Employee in the Plan. Enrollment in the Plan is required in order for the Employee to be eligible to receive profit sharing contributions hereunder (which are available to Participants even if the Participant does not make any salary deferral contributions under the Plan). Participants may enroll in the Plan in any format acceptable to the Plan Administrator, including, but not limited to, paper, facsimile, electronic record or voice response record. Participants who enrolled in the Prior Plans shall be deemed to be enrolled hereunder. ARTICLE IV Contributions 4.1 Participant Contributions (a) Amount. A Participant may defer receipt of the following amounts, in increments of one percent (1%), under procedures established by the Plan Administrator; provided, however, that if the Participant's deferrals would result in insufficient funds being available from which applicable payroll taxes or other required deductions may be withheld, the Plan Administrator may require the Participant to reduce his or her deferral amount in order to facilitate such required withholding: (1) up to thirty percent (30%) of the Participant's Base Salary on a pre-tax and/or after-tax basis; and/or (2) up to seventy-five percent (75%) of the Participant's Bonus/Incentive Compensation on a pre-tax and/or after-tax basis. -13- (b) Deferral Elections. (1) Elections. In order to elect pre-tax or after-tax salary deferrals, each eligible Employee shall deliver a salary deferral election to the Plan Administrator in such form as the Plan Administrator may accept (including, but not limited to, paper, facsimile, electronic record or voice response record). Salary deferral elections shall designate the amount of pre-tax and/or after-tax Base Salary and Bonus/Incentive Compensation to be deferred, the Participant's Beneficiary and such other items as the Plan Administrator may prescribe, such as the date the deferred amount is to be paid to the Participant. A Participant's deferral election shall remain in effect until terminated or amended, as provided below. Pre-tax and after-tax deferral elections in effect for Participants under the Prior Plans on the Effective Date shall be deemed to continue hereunder, until changed by the Participant. (2) Pre-Tax Deferrals. (A) Except as provided herein, pre-tax salary deferral elections shall be void unless submitted before the first day of the calendar year during which the amount to be deferred will be earned. However, in the Plan Year in which the Employee is first eligible to participate, such salary deferral election shall be filed within thirty (30) days of the date on which the Employee is first eligible to participate in the Plan and such election shall be with respect to Total Compensation earned from the Participating Employer during the remainder of such Plan Year. -14- (B) A Participant may not terminate or amend his or her pre-tax salary deferral election for a Plan Year during that Plan Year. Any termination or amendment of a pre-tax salary deferral election must be made during an annual open enrollment period and shall be effective as of the first payroll period of the next Plan Year following the date the Plan Administrator receives the Participant's revised salary deferral election. (C) The Plan Administrator shall credit as a bookkeeping entry to the Participant's Pre-Tax Salary Deferral Account the amount designated by the Participant on his or her pre-tax salary deferral election and any subsequent deemed earnings or losses thereon; provided however, that all such amounts shall be subject to the rights of the general unsecured creditors of the Participating Employer. The Participating Employer shall reduce the Participant's Total Compensation in accordance with the provisions of the applicable salary deferral election. (3) After-Tax Deferrals. (A) An after-tax salary deferral election may be submitted at any time; provided, however, that the after-tax deferral election shall become effective as of the first day of the first payroll period of the calendar month following the date the Plan Administrator receives the Participant's salary deferral election. (B) A Participant may terminate or amend his or her after-tax salary deferral election during a Plan Year; provided, however, that -15- such termination or amendment shall become effective as of the first day of the first payroll period of the calendar month following the date the Plan Administrator receives the Participant's revised salary deferral election. (C) The Plan Administrator shall credit to the Participant's After-Tax Salary Deferral Account the after-tax deferral amount designated by the Participant on his or her salary deferral election and any subsequent earnings or losses thereon. (c) Corrective Contributions. In the sole discretion of the Plan Administrator, a Participant may make a special election to defer additional pre-tax and/or after-tax amounts under the Plan to accommodate late enrollment in the Plan for a particular Plan Year or other non-recurring situations (such as transitions between participation in the Participating Employer's qualified retirement plans and this Plan or in order to correct errors in the operation of the Plan with respect to individual circumstances). Such amounts will be deducted from the Participant's future Total Compensation. 4.2 Company or Participating Employer Contributions. (a) Matching Contributions. (1) The Participating Employer may match a Participant's pre-tax and/or after-tax salary deferrals up to six percent (6%) of the Participant's Total Compensation. The amount of the match, if any, will be announced each year and allocated to the Participant's Matching Contribution Account. (2) Matching contributions will vest based on the vesting schedule set -16- forth in ARTICLE VI. (3) The Participating Employer shall not contribute any matching contributions to the Plan on behalf of the Participant during any period in which the Participant's contributions to the Plan have been suspended. (b) Profit-Sharing Contributions. (1) The Participating Employer may also choose to make a profit sharing contribution, in addition to, or in lieu of a matching contribution. If the Participating Employer makes a profit sharing contribution, only Participants employed by the Participating Employer on the last day of the Plan Year who have completed one thousand (1,000) Hours of Service during the Plan Year shall be eligible to receive an allocation from such profit sharing contribution. (2) The amount of any profit sharing contribution shall be determined in the sole discretion of the Participating Employer. The Participating Employer may vary the amount it contributes to each Participant's Profit Sharing Contribution Account. For example, the Participating Employer may contribute a fixed percentage of pay for earnings up to a certain level and a variable percentage of pay for earnings above a specified level. The Participating Employer may also choose other methods to determine the amount of the profit sharing contribution. (3) The amount of any profit sharing contribution, if any, will be announced each Plan Year. Profit sharing contributions will vest based on the vesting schedule set forth in ARTICLE VI. -17- ARTICLE V Investment And Valuation Of Plan Accounts 5.1 Investment of Accounts (a) Actual and Deemed Investments. The assets contributed to the Rabbi Trust shall remain the property of the Participating Employer until distributions are made to Participants employed by such Participating Employer. Accordingly, all investments under the Rabbi Trust shall be deemed investments selected by Participants, rather than actual investments. The assets contributed to the Secular Trust are treated as the property of Participants and therefore, investments under the Secular Trust shall be actual (not deemed) investments. Participants' actual or deemed investments shall continue in force for subsequent Plan Years until revoked or changed by the Participant. Investment directions made by Participants in the Prior Plans as of the Effective Date shall be deemed to continue hereunder until changed by the Participant. (b) Investment Direction. (1) Pre-tax salary deferrals, profit sharing contributions and matching contributions are invested in accordance with each Participant's deemed investment directions and after-tax contributions are invested in accordance with each Participant's actual investment directions. Participant's Accounts may be invested in any combination of investment options, in accordance with rules established by the Plan Administrator. (2) A Participant may change investment or deemed investment directions at any time by following the procedures announced from time to time by the Plan Administrator. Changes in investment direction or -18- transfer of account balances, in whole or in part, may be accomplished in any format acceptable to the Plan Administrator, including, but not limited to, paper, facsimile, electronic record or voice response record. The change in investment direction shall be effective only with respect to subsequent contributions. (c) Responsibility for Investments (1) Each Participant is solely responsible for the selection of investment funds or deemed investment funds for the Participant's Accounts, subject to such rules as the Plan Administrator may determine. The Trustees, the Plan Administrator, and the officers, supervisors and other employees of the Participating Employers are not empowered to advise Participants as to the manner in which Accounts should be invested. The fact that an investment fund is available under the Plan shall not be construed as a recommendation for investment in that fund. (2) If a Participant does not direct the investment or deemed investment of any of his or her Accounts, the Accounts will be treated as being invested in a money market account selected by the Plan Administrator until the Participant directs otherwise. Notwithstanding the preceding sentence, effective January 1, 2000, the default investment shall be a guaranteed interest account. 5.2 Determining the Value of Participant Accounts. The net value of the Accounts in the Trusts is determined on each Valuation Date. Any net earnings, losses and expenses associated with the Participant's Accounts since the preceding Valuation Date shall be allocated to each Participant's Account. -19- ARTICLE VI Vesting And Forfeitures 6.1 Participant Contributions. Vesting means a nonforfeitable right to receive the value of the Account. Pre-tax and after-tax salary deferrals and the earnings thereon are always one hundred percent (100%) vested. Pre-tax salary deferrals and earnings thereon are subject to the claims of the Company's or Participating Employer's creditors, as described in Section 11.6. 6.2 Matching and Profit-Sharing Contributions. (a) Matching and profit sharing contributions begin to vest after completion of three (3) Years of Service. A Participant's vested percentage is determined on the basis of Years of Service, as follows: Years of Service Percentage Vested ---------------- ----------------- Fewer than 3 Years 0% 3 Years but Fewer than 4 Years 33-1/3% 4 Years but Fewer than 5 Years 66-2/3% 5 Years or More 100% Matching and profit sharing contributions and earnings thereon are subject to the claims of the Company's or Participating Employer's creditors, as described in Section 11.6. (b) Notwithstanding section 6.2(a), Participants become fully vested in the value of matching and profit sharing contributions upon Disability or death while employed by a Participating Employer. -20- 6.3 Forfeitures. If a Participant has a Termination of Employment for any reason other than death or Disability, he or she will receive the value of his or her vested Matching Contribution Account and Profit Sharing Contribution Account and shall forfeit the value of any non-vested Matching and Profit-Sharing Contributions. The forfeited amount shall be used to reduce future contributions otherwise required from the Participating Employer. 6.4 Change in Control. Notwithstanding anything to the contrary contained in the Plan, in the event of a Change in Control, Participants will become fully vested in the value of matching and profit sharing contributions. Unless the Plan Administrator provides otherwise, distributions of Participant Accounts shall be made as soon as practicable following the Change in Control. ARTICLE VII Distributions 7.1 In-Service Withdrawals (a) Unforeseeable Emergency. Subject to section 7.1(c), Participants may receive an in-service withdrawal of pre-tax salary deferrals and vested profit sharing and matching contributions (and the earnings thereon) only in the event of an Unforeseeable Emergency. The amount of any withdrawal due to an Unforeseeable Emergency is limited to the amount necessary to ameliorate the emergency, as determined by the Plan Administrator. (b) After-Tax Salary Deferrals. Subject to section 7.1(c), a Participant may withdraw any after-tax salary deferrals and the earnings thereon at any time. -21- (c) Number of Withdrawals. The Plan Administrator may restrict the number of withdrawals permitted in a Plan Year. If such restrictions are imposed, the Plan Administrator shall notify Participants accordingly. 7.2 Final Distributions. (a) Distributions During Participant's Lifetime. (1) Distributions Upon Termination of Employment. Upon Termination of Employment with the Participating Employer, a Participant will be entitled to receive the full value of his or her vested Accounts in accordance with the Participant's election pursuant to Section 7.2(a)(2) below. Subject to Section 7.2(a)(3) below, the time and form of payment from a Participant's Accounts shall be determined in accordance with the last valid designation filed by the Participant with the Plan Administrator. Designations of the time and form of payment filed by Participants in the Prior Plans as of the Effective Date shall continue in force hereunder until changed by the Participant. (2) Elective Distribution Date and Form of Payment. Participants who have not experienced a Termination of Employment may designate a specific date on which to receive (or begin receiving) distributions from their Plan Accounts. Such payment shall be made (or begin) either (i) as soon as practicable following the Participant's Termination of Employment or (ii) on the later of (a) the date the Participant attains age sixty-five (65) or (b) the date the Participant has a Termination of Employment. The Participant may also designate whether the payment shall be in the form of a single, lump sum payment or approximately equal annual installments, for a period up to ten (10) years. Subject to Section -22- 7.2(a)(3) below, designations of elective distribution dates and methods of distribution may be changed so long as the Participant is employed by a Participating Employer. Furthermore, the designation of a distribution date and method of distribution made by Participants in the Prior Plan as of the Effective Date shall continue in force hereunder until changed by the Participant. (3) One Year Designation Period. (A) For Distributions Made Before January 1, 2000. Except as provided herein, the designation under Section 7.2(a)(2) above are only valid if the designation is filed with the Plan Administrator at least one year before the distributions begin. Notwithstanding the preceding sentence, the designation under Section paragraph (2) above shall be valid if the designation is filed with the Plan Administrator within thirty (30) days after the date that the Participant is first eligible to participate in the Plan. If the designation is filed with the Plan Administrator less than one year before the date the distributions are to begin and the special rule for the Participant's initial eligibility to participate in the Plan does not apply, the Participant's previous designation shall be re-instated. In the event the Participant does not have any previous designation or if the Participant does not elect a distribution date and method under this section 7.2(a), then the Participant shall be deemed to have elected to receive a single lump sum payment upon Termination of Employment with the Participating Employer. -23- (B) For Distributions Made On or After January 1, 2000. The designation of the time and form of payment shall only be valid if (i) the designation is filed with the Plan Administrator at least six (6) months before the distributions begin and no later than the last day of the Plan Year before the first Plan Year for which such designation is to apply; (ii) the designation is filed with the Plan Administrator during the first thirty (30) days that the Participant is eligible to participate in the Plan and the distribution commencement date begins not earlier than the first day of the calendar year following the date the designation is filed with the Plan Administrator; or (iii) thirty (30) days from the date this Plan is effective for eligible employees. If the Participant's designation does not satisfy the criteria described in this paragraph, then the Participant's previous designation shall be re-instated. In the event the Participant does not have any previous designation or if the Participant does not elect a distribution date and method under this section 7.2(a), then the Participant shall be deemed to have elected to receive a single lump sum payment upon Termination of Employment with the Participating Employer. (b) Distributions After Participant's Death. Upon a Participant's death, the balance in full of the Participant's Account shall be payable to the Participant's Beneficiary in a lump sum as soon as administratively practicable (generally within sixty (60) days after the Valuation Date following the Participant's date of death), regardless of whether the Participant had elected to receive installment payments. -24- ARTICLE VIII Leaves Of Absence, Layoffs, And Reemployment 8.1 Leaves of Absence and Layoffs. A Participant who is laid off or on an Approved Leave of Absence will still be considered a Participant until he or she incurs a Break-in-Service. (a) During periods of layoff, the Participating Employer will not make any contributions on the Participant's behalf. (b) During Approved Leaves of Absence, the Participant may receive an allocation of any profit sharing contribution made by the Participating Employer for such period. (c) During periods of layoff or Approved Leaves of Absence, previous matching and profit sharing contributions made on the Participant's behalf will continue to vest unless the Participant incurs a Break-in-Service and all contributions in the Participant's Accounts will continue to reflect the performance of the investment fund(s) selected by the Participant. (d) A Participant who receives severance payments from the Participating Employer shall not be entitled to participate in the Plan during the period in which such severance benefits are being paid. Accordingly, Participants shall not be permitted to make any deferral contributions or to receive any matching or profit sharing contributions with respect to such severance period. 8.2 Returning to Work After Termination of Employment. If a Participant has a Termination of Employment and is later rehired, the following provisions shall apply. -25- (a) Participation Upon Re-Employment. (1) Vested Participants. If the Participant had a vested interest in any matching and/or profit sharing contributions at the time the Participant had a Termination of Employment, the Participant will re-enter the Plan on the first day of the first pay period of the month following the date the Participant is credited with an Hour of Service after re-employment with the Participating Employer. (2) Non-Vested Participants. If the Participant did not have a vested interest in any matching or profit-sharing contributions at the time the Participant had a Termination of Employment with the Participating Employer, then the Participant will re-enter the Plan on the first day of the first payroll period of the month following the date the Participant completes six (6) months of service with the Participating Employer. (b) Vesting Upon Re-employment. Upon re-employment after a Break-in-Service, a Participant's previous Years of Service shall be restored if: (1) the Participant was vested in any matching or profit sharing contributions or (2) the Participant was not vested in any matching or profit sharing contributions and the number of years of the Participant's Break-In-Service was less than the greater of five (5) or the number of Years of Service the Participant had completed before the Break-in-Service. -26- ARTICLE IX Participating Employers 9.1 Adoption by Other Employers. (a) Notwithstanding anything herein to the contrary, a Participating Employer (other than the Company) may, with the consent of the Plan Administrator and the Trustees, adopt the Plan and all of the provisions hereof by the execution of a document evidencing such intent and setting forth the effective date of the Plan with respect to such Participating Employer. (b) The Plan Administrator shall have the authority to make any and all necessary rules or regulations to effectuate the purposes of this section. (c) The Plan is not intended to be a joint venture between the Company and any Participating Employer or between any Participating Employers. (d) Each Participating Employer shall be solely responsible for providing benefits under the Plan for its own Employees. To the extent amounts are set aside by the Participating Employer under the Rabbi Trust, such amounts shall be subject to the claims of creditors of the particular Participating Employer only, and shall not be subject to the claims of creditors of other entities participating in the Plan. 9.2 Allocation of Plan and Trust Expenses. Any expenses of the Plan and Trusts which are to be paid by the Company shall be allocated to the Participating Employers in the proportion that the total amount in the Trusts attributable to the Participating Employer's Participants bears to the total assets of the Trusts. -27- 9.3 Designation of Company as Agent. Each Participating Employer shall be deemed irrevocably to have designated the Company as its agent with respect to all matters affecting the Trustees and the Plan. 9.4 Employee Transfers. The transfer of employment of a Participant from one Participating Employer to another Participating Employer shall not affect the Participant's rights under the Plan and the number of the Participant's Years of Service shall not be deemed to be interrupted. Transfer of employment between such entities shall not be treated as a Termination of Employment and distributions shall not be made from the Plan based on such transfer of employment. The entity to which the Participant is transferred shall thereupon become obligated hereunder with respect to such Participant in the same manner as was the entity from which the Participant was transferred. 9.5 Contributions and Forfeitures of Participating Employer. All contributions made by a Participating Employer shall be determined separately and shall be paid to the Accounts of the Employees of such Participating Employer, subject to all of the terms and conditions of the Plan. 9.6 Amendments by Participating Employers. Participating Employers (other than the Company) do not have the right to amend the Plan in any regard. 9.7 Discontinuance of Participation. A Participating Employer (other than the Company) shall be permitted to discontinue or terminate its participation in the Plan at any time, upon giving reasonable advance notice to the Plan Administrator. At the time of any such discontinuance or termination, satisfactory evidence thereof shall be delivered to the Trustees and the Accounts held in the Trusts for the benefit of Employees of the withdrawing Participating Employer shall be distributed as soon as administratively feasible, unless the Plan Administrator provides otherwise. -28- ARTICLE X Amendment And Termination 10.1 Right to Terminate. The Company expressly reserves the right to terminate the Plan in whole or in part without the consent of Participants or Beneficiaries. Notice of such termination shall be given to each Participant or Beneficiary. 10.2 Continuation of Trust. (a) Unless the Plan Administrator directs otherwise, upon the termination of the Plan in whole or in part with respect to a Participating Employer or upon the bankruptcy of the Participating Employer, all unvested Participants shall become one hundred percent (100%) vested in their benefits under the Plan and distributions shall be made from the Plan as soon as practicable. (b) Notwithstanding (a) above, if the Plan Administrator so elects, the Trusts shall continue if permitted by law. In such event, the Trustees shall continue to hold and administer the Trusts for the benefit of the Participants in the same manner and with the same powers, rights, and privileges as set forth herein; and the Trustees may, in their sole and absolute discretion, pay to the Participants their respective amounts either immediately or at a future date in accordance with the provisions in ARTICLE VII. 10.3 Right to Amend. Except as hereinafter provided, the Benefits Committee shall have the right to amend the Plan and Trusts at any time and from time to time but only to the extent that such amendments are required to comply with changes in the law or such amendments do not increase the costs to the Participating Employers hereunder. Notwithstanding the preceding sentence, the Board may amend the Plan and Trusts at any time and from time to time. Amendments adopted by the Benefits Committee or Board -29- shall not (i) increase the responsibilities of the Plan Administrator or the Trustees without their written consent; or (ii) directly or indirectly reduce the Participant's vested Accounts. Notwithstanding anything herein to the contrary, this Plan may be amended at any time if necessary or desirable to conform the Plan to the Code or any federal statute with respect to employees' trusts or any regulations or rulings issued pursuant thereto and no such amendment shall be considered prejudicial to the rights of any Participant or Beneficiary. Notice of all material amendments shall be given to each Participant and Beneficiary entitled to receive distributions under the Plan. 10.4 Merger or Consolidation. The Plan may not be merged or consolidated with any other plan and its assets or liabilities may not be transferred to any other plan, unless each person entitled to benefits under the Plan would receive a benefit immediately after the merger, consolidation or transfer which is equal to or greater than the benefit he or she would have been entitled to receive immediately before the merger, consolidation or transfer. ARTICLE XI Administration 11.1 Plan Administrator. The Plan Administrator shall have the sole authority, in its absolute discretion: (a) to adopt, amend and rescind such rules and regulations as, in its opinion, may be advisable in the administration of the Plan; (b) to prescribe the form or forms used in connection with the Plan, including salary deferral election forms and beneficiary designation forms (which forms shall be consistent with the terms of the Plan but need not be identical and which may be in any format acceptable to the Plan Administrator, including, but not limited to, paper, facsimile, electronic record or voice response record); and -30- (c) to construe and interpret the Plan and any forms used in the operation of the Plan and the rules of the Plan; (d) to employ actuaries, accountants, counsel and other persons the Plan Administrator deems necessary in connection with the administration of the Plan; and (e) to take all other necessary and proper actions to fulfill its duties under the Plan. 11.2 Binding Effect. All decisions, determinations and interpretations of the Plan Administrator shall be final and binding on all Participants and Beneficiaries receiving benefits under the Plan. 11.3 Delegation of Authority. The Plan Administrator may delegate its authority to administer the Plan to any individual(s) as the Plan Administrator may determine and such individual(s) shall serve solely at the pleasure of the Plan Administrator. Any individual(s) who are authorized by the Plan Administrator to administer the Plan shall have the full power to act on behalf of the Plan Administrator, but shall at all times be subordinate to the Plan Administrator and the Plan Administrator shall retain ultimate authority for the administration of the Plan. 11.4 Plan Records and Expenses. The books and records to be maintained for the purposes of the Plan shall be maintained by the Company's employees subject to the supervision of the Plan Administrator. All expenses incurred in connection with the performance of any settlor functions with respect to the Plan and Trusts, including, but not limited to, the cost of initially establishing the various Participant Accounts, shall be paid by the Company, and may be allocated among other Participating Employers, as -31- provided in section 9.2. Unless the Company determines otherwise, each Participant's Accounts shall be charged with a pro-rata share of the administrative expenses and investment fees incurred by the Plan and Trusts, including, but not limited to, any annual fees imposed by financial institutions, brokerage firms or otherwise to maintain such Accounts, provided, however, that all expenses related to any Participant-directed investment (such as brokerage fees, commissions or other transaction-specific costs) shall be deducted from such Participant's Accounts. 11.5 Limited Liability. No member of the Company's Board of Directors or the Benefits Committee and no employee of any Participating Employer shall be liable to any person for any action taken or omitted in connection with the establishment or administration of this Plan, including the receipt of benefits thereunder, unless attributable to his or her own fraud or willful misconduct, nor shall any Participating Employer be liable to any person for any such action unless attributable to fraud or willful misconduct on the part of a director or employee of the Participating Employer. 11.6 Insolvency. (a) Should the Participating Employer be considered insolvent (such that the Participating Employer is unable to pay its debts as they come due) or subject to a proceeding as a debtor under the United States Bankruptcy Code, or should the Participating Employer become aware of its pending insolvency or bankruptcy, the affected entity, acting through its board of directors or chief executive officer shall give immediate written notice of such to the Plan Administrator and the Trustees, if any. (b) Upon receipt of such notice, the Plan Administrator and the Trustees shall cease to make any payments of matching contributions, profit sharing contributions, pre-tax contributions and all earnings thereon to Participants or Beneficiaries of the affected entity and shall hold any and all assets with respect to those Participants and Beneficiaries for the -32- benefit of the general unsecured creditors of the affected entity. For this purpose, it is expressly provided that such assets of each Participating Employer which are intended for use in this Plan shall at all times be available to creditors of such Participating Employer. Accordingly, the Plan shall be administered on an employer-by-employer basis, such that accrued liabilities under the Plan on behalf of a particular Participating Employer's Employees shall always be available to creditors of such Participating Employer. 11.7 Trusts; Funding of Benefits. (a) Nothing contained herein shall be deemed to create a trust of any kind or create any fiduciary relationship. Funds deposited into the Rabbi Trust shall continue for all purposes to be a part of the general funds of the Participating Employer and no person other than the Participating Employer shall, by virtue of the Plan, have any interest in such funds. Except for amounts held in the Secular Trust, to the extent that any person acquires a right to receive payments from the Participating Employer under the Plan, such right shall be no greater than the right of any unsecured general creditor of the Participating Employer. (b) Should any insurance contract or other investment be acquired in connection with the liabilities assumed under this Plan, it is expressly understood and agreed that the Participants and Beneficiaries shall not have any right with respect to, or claim against, such assets nor shall any such purchase be construed to create a trust of any kind or a fiduciary relationship between the Company, Participating Employers and the Participants, Beneficiaries or any other person. The Participating Employer or the Trust(s) shall be the designated owner and beneficiary of any insurance contract acquired in connection with its obligation under this Plan. -33- (c) Each Participant and Beneficiary shall be required to look to the provisions of this Plan and to the Participating Employer for enforcement of any and all benefits under this Plan. Except for amounts held in the Secular Trust, to the extent any Participant or Beneficiary acquires a right to receive payment under this Plan, such right shall be no greater than the right of any unsecured general creditor of the Participating Employer. ARTICLE XII Claims Procedure 12.1 Claims Submission. (a) All claims for benefits under the Plan by a Participant or Beneficiary, regardless of the nature of the claim, shall be initially submitted in writing to the Plan Administrator. Such claims shall be submitted within a reasonable period of time after the date such benefit was, or was purported to be, available to the Participant or Beneficiary, with such determination of reasonableness to be made by the Plan Administrator in its sole discretion. All claims must adequately state the basis for the claim including a statement of all pertinent facts and applicable law, except to the extent expressly waived by the Plan Administrator. The Plan Administrator may prescribe additional procedural requirements for claims, not inconsistent herewith. (b) In the event that a Participant or Beneficiary does not receive any Plan benefit that is claimed, such Participant or Beneficiary shall be entitled to consideration and review as provided in this ARTICLE. Such consideration and review shall be conducted in a manner designed to comply with ERISA section 503. -34- (c) Failure to follow the requirements of this ARTICLE shall result in the denial of the claim submitted. The Participant or Beneficiary submitting such deficient claim shall be deemed to have not exhausted his or her administrative remedies under the Plan. 12.2 Claim Review. Upon receipt of any written claim for benefits, the Plan Administrator shall be notified and shall give due consideration to the claim presented. If the claim is denied to any extent by the Plan Administrator, the Plan Administrator shall furnish the claimant with a written notice setting forth (in a manner calculated to be understood by the claimant): (a) the specific reason or reasons for denial of the claim; (b) a specific reference to the Plan provisions on which the denial is based; (c) a description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; and (d) an explanation of the provisions of this ARTICLE. 12.3 Right of Appeal. A claimant who has a claim denied under section 12.2 may appeal for reconsideration of that claim. A request for reconsideration under this section must be filed by written notice with the Plan Administrator within sixty (60) days after receipt by the claimant of the notice of denial under section 12.2. 12.4 Review of Appeal. Upon receipt of an appeal, the Company shall promptly assign a committee or appropriate officer independent of the Plan Administrator to review the Plan Administrator's denial of the claim. Such independent committee or officer shall take action -35- to give due consideration to the appeal. Such consideration may include a hearing of the parties involved, if the committee or officer feels such a hearing is necessary. In preparing for this appeal, the claimant shall be given the right to review pertinent documents and the right to submit in writing a statement of issues and comments. After consideration of the merits of the appeal, the committee or officer shall issue a written decision which shall be binding on all parties. The decision shall be written in a manner calculated to be understood by the claimant and shall specifically state its reasons and pertinent Plan provisions on which it relies. The decision on the appeal shall be issued within sixty (60) days after the appeal is filed, except that if a hearing is held, the decision may be issued within one hundred twenty (120) days after the appeal is filed. 12.5 Designation. The Plan Administrator may designate one or more of its members or any other person of its choosing to make any determination otherwise required to be made by the Plan Administrator under this ARTICLE. ARTICLE XIII Miscellaneous 13.1 Headings. The headings in this Plan are for convenience of reference only and are not to be considered as constructions of the provisions. 13.2 Uniformity. In the exercise of any discretionary power of authority hereunder, all Participants under similar circumstances shall be treated in a uniform and non-discriminatory manner. 13.3 Obligations of the Company and Participating Employers. The Participating Employers expect to continue the Plan in force indefinitely, but continuance of the Plan is completely voluntary and is not assumed as a contractual obligation of the Participating Employers. The obligations of the Participating Employers, which are expressly stated to be -36- noncontractual, are limited solely to the making of contributions to the Trusts provided for herein. The Participating Employers shall only be responsible for making contributions to the Trusts that correspond to the deferral elections made by the Participating Employer's Employee's, as well as any profit-sharing contributions that the Participating Employer may make. 13.4 Insufficiency of Trust Fund. The Participating Employer shall not be liable in any manner to Participants employed by such Participating Employer and the Participants' Beneficiaries if the Trusts are insufficient to provide for the payment of all benefits due to such Participants and Beneficiaries. Such benefits are to be payable only from the Trusts and only to the extent of the assets of such Trusts. Any person having any claim under the Plan shall look solely to the Trusts for payment or satisfaction thereof. 13.5 Contingent Nature of Accounts. Except for amounts held in the Secular Trust, until the deferred benefits are distributed under the Plan to the Participants or Beneficiaries, the interest of each Participant in this Plan is contingent only and is subject to forfeiture as provided hereunder. Title to and beneficial ownership of any assets, whether cash or investments, which the Participating Employer may set aside to meet its contingent deferred obligation hereunder shall at all times remain the property of the Participating Employer and no Participant or Beneficiary shall under any circumstances acquire any property interest in any specific assets of the Participating Employer. 13.6 Governing Law. This Plan is made under, and shall be subject to and governed by, the laws of the State of New York. 13.7 Gender and Number. Words used in the masculine shall be read and construed in the feminine where applicable. Wherever required, the singular of the word used in this Plan shall include the plural and the plural may be read in the singular. -37- 13.8 Taxes. The Participating Employers have the right to deduct from all benefits paid under the Plan any taxes required by law to be withheld with respect to such benefits. The Participating Employers do not represent or guarantee that any particular federal or state income, payroll, personal property or other tax consequence will result from participation in this Plan. Participants should consult their personal tax advisors to determine the tax consequences of his or her participation in the Plan. 13.9 Plan Benefits Nontransferable. Except for amounts held in the Secular Trust, the right of any Participant or Beneficiary to any payment hereunder shall not be subject in any manner to attachment or other legal process for the debts of such Participant or Beneficiary and any such benefit or payment shall not be subject to anticipation, alienation, sale, transfer, assignment, pledge or encumbrance. Any attempt to subject any benefit or payment in whole or in part to the debts, contracts, liabilities engagements or torts of the Participant or Beneficiary or any other person, entitled to any such benefit or payment pursuant to the terms of the Plan shall result, in the discretion of the Plan Administrator, in the termination of such payment. 13.10 Incompetence. If the Plan Administrator determines that any person to whom a benefit is payable under the Plan is incompetent by reason of a physical or mental Disability, the Plan Administrator shall have the power to cause the payments becoming due to such person to be made to another person for his or her benefit without the responsibility of the Plan Administrator, the Participating Employer or Trustees to see to the application of such payments. Any payment made pursuant to such power shall, as to such payment, operate as a complete discharge of the Plan Administrator, the Participating Employer and any Trustee. 13.11 Identity. If, at any time, any doubt exists as to the identity of any person entitled to any payment hereunder or the amount of time of such payment, the Plan Administrator shall be entitled to hold such sum until such identity or amount or time is determined or until an order of a court of competent jurisdiction is obtained. The Plan Administrator shall also be -38- entitled to pay such sum into court in accordance with the appropriate rules of law. Any expenses incurred by the Participating Employer, the Plan Administrator and any Trustee incident to such proceeding or litigation shall be charged against the account of the affected Participant. 13.12 Other Benefits. The benefits of each Participant or Beneficiary hereunder shall be in addition to any benefits paid or payable to the Participant or Beneficiary under any other pension, disability, annuity or retirement plan. 13.13 Construction. All questions of interpretation, construction or application arising under this Plan shall be decided by the Plan Administrator whose decision shall be final and conclusive upon all persons. 13.14 No Guarantee of Employment. Nothing contained herein shall be construed as a contract of employment or deemed to give any Participant the right to be retained in the employ of the Participating Employer, or to interfere with the rights of any such employer to discharge any individual at any time, with or without cause, except as may be otherwise agreed to in writing or provided by applicable law. IN WITNESS WHEREOF, this Plan has been executed effective March 15, 2000. GENTIVA HEALTH SERVICES, INC. By: _____________________________ -39- FIRST AMENDMENT TO THE GENTIVA HEALTH SERVICES, INC. NONQUALIFIED DEFERRED COMPENSATION PLAN WHEREAS, Gentiva Health Services, Inc. (the "Company") maintains the Gentiva Health Services, Inc. Nonqualified Deferred Compensation Plan (the "Plan"); and WHEREAS, Section 10.3 provides that the Benefits Committee may amend the Plan from time to time, to the extent that the amendment does not result in increased costs to the Company; and WHEREAS, the Benefits Committee wishes to amend the Plan to provide participants with two additional choices with respect to the timing of the payment of their benefits under the Plan and to change the default rule with respect to when timing of payments of benefits begins; NOW THEREFORE, the following sections of the Plan are amended as follows, effective January 1, 2002: FIRST Section 7.1 is amended as follows: (a) Unforeseeable Emergency. Subject to section 7.1(d), Participants may receive an in-service withdrawal of pre-tax salary deferrals and vested profit sharing and matching contributions (and the earnings thereon) in the event of an Unforeseeable Emergency. The amount of any withdrawal due to an Unforeseeable Emergency is limited to the amount necessary to ameliorate the emergency, as determined by the Plan Administrator. (b) Immediate Distribution. Subject to 7.1(d), Participants may receive an in-service withdrawal of the total balance of their pre-tax salary deferrals and vested profit sharing and matching contributions (and earnings thereon) at any time the Participant so designates on an election form specified by the Plan Administrator; provided, however, that the Participant's total balance in the Plan will be reduced by 10% as a penalty for such early withdrawal. Such payments (and forfeiture of -40- the penalty amount) shall be made as soon as practicable following the Plan Administrator's receipt of the appropriately completed distribution election form. (c) After-Tax Salary Deferrals. Subject to section 7.1(d), a Participant may withdraw any after-tax salary deferrals and the earnings thereon at any time. (d) Number of Withdrawals. Notwithstanding the foregoing provisions of this section 7.1, the Plan Administrator may restrict the number of withdrawals permitted in a Plan Year. SECOND Section 7.2(a)(2) is amended as follows: (2) Elective Distribution Date and Form of Payment. Participants who have not experienced a Termination of Employment may designate a specific date on which to receive (or begin receiving) distributions from their Plan Accounts. Such payment shall be made (or begin): (i) as soon as practicable following the Participant's Termination of Employment; (ii) in the first calendar year that begins after the calendar year in which the Termination of Employment occurs; or (iii) on the later of (a) the date the Participant attains age sixty-five (65) or (b) the date the Participant has a Termination of Employment. The Participant may also designate whether the payment shall be in the form of a single, lump sum payment or approximately equal annual installments, for a period up to ten (10) years. Subject to Section 7.2(a)(3) below, designations of elective distribution dates and methods of distribution may be changed so long as the Participant is employed by a Participating Employer. Furthermore, the designation of a distribution date and method of distribution made by Participants in the Prior Plan as of the Effective Date shall continue in force hereunder until changed by the Participant. -41- THIRD Section 7.2(a)(3)(B) is amended as follows: (B) For Distributions Made On or After January 1, 2000. The designation of the time and form of payment shall only be valid if (i) the designation is filed with the Plan Administrator at least six (6) months before the distributions begin and no later than the last day of the Plan Year before the first Plan Year for which such designation is to apply; (ii) the designation is filed with the Plan Administrator during the first thirty (30) days that the Participant is eligible to participate in the Plan and the distribution commencement date begins not earlier than the first day of the calendar year following the date the designation is filed with the Plan Administrator; or (iii) the designation is filed with the Plan Administrator during the first thirty (30) days from the date this Plan is effective for eligible employees. If the Participant's designation does not satisfy the criteria described in this paragraph, then the Participant's previous designation shall be re-instated. If for any reason the Participant has not made a valid designation, then the Participant shall be deemed to have elected to receive a single lump sum payment in the first calendar year that begins after the calendar year in which the Termination of Employment with the Participating Employer occurs. -42- IN WITNESS WHEREOF, the Benefits Committee hereby adopts this First Amendment to the Gentiva Nonqualified Deferred Compensation Plan, effective January 1, 2002. BENEFITS COMMITTEE ----------------------------------- John Collura ----------------------------------- Patty Ma ----------------------------------- David Silver -43- SECOND AMENDMENT TO THE GENTIVA HEALTH SERVICES, INC. NONQUALIFIED RETIREMENT AND SAVINGS PLAN WHEREAS, Gentiva Health Services, Inc. (the "Company") maintains the Gentiva Health Services, Inc. Nonqualified Retirement and Savings Plan (the "Plan"); and WHEREAS, Section 10.3 provides that the Benefits Committee may amend the Plan from time to time, to the extent that the amendment does not result in increased costs to the Company; and WHEREAS, the Benefits Committee wishes to amend the Plan to provide participants who will terminate employment with the Company as a result of the sale of the Company's Specialty Pharmaceutical Services ("SPS") line of business with the opportunity to elect the form and timing of the distribution of their Plan benefits and to reinstate the Plan's original default rule with respect to when payment of benefits begins; NOW THEREFORE, the following sections of the Plan are amended as follows, effective January 1, 2002: FIRST Section 7.2(a)(2) is amended as follows: (2) Elective Distribution Date and Form of Payment. Participants who have not experienced a Termination of Employment may designate a specific date on which to receive (or begin receiving) distributions from their Plan Accounts. Such payment shall be made (or begin): (i) as soon as practicable following the Participant's Termination of Employment; (ii) in the first calendar year that begins after the calendar year in which the Termination of Employment occurs; or (iii) on the later of (a) the date the Participant attains age sixty-five (65) or (b) the date the Participant has a Termination of Employment. The Participant may also designate whether the payment shall be in the form of a single, lump sum payment or approximately equal annual installments, for a period up to ten (10) years. -44- Subject to Section 7.2(a)(3) below, designations of elective distribution dates and methods of distribution may be changed so long as the Participant is employed by a Participating Employer. Furthermore, the designation of a distribution date and method of distribution made by Participants in the Prior Plan as of the Effective Date shall continue in force hereunder until changed by the Participant. SECOND Section 7.2(a)(3)(B) is amended as follows: (B) For Distributions Made On or After January 1, 2000. The designation of the time and form of payment shall only be valid if (i) the designation is filed with the Plan Administrator at least six (6) months before the distributions begin and no later than the last day of the Plan Year before the first Plan Year for which such designation is to apply; (ii) the designation is filed with the Plan Administrator during the first thirty (30) days that the Participant is eligible to participate in the Plan and the distribution commencement date begins not earlier than the first day of the calendar year following the date the designation is filed with the Plan Administrator; (iii) the designation is filed with the Plan Administrator during the first thirty (30) days from the date this Plan is effective for eligible employees; or (iv) the Participant will terminate employment with the Company as a result of the sale of the Company's Specialty Pharmaceutical Services ("SPS") line of business and the designation is filed with the Plan Administrator no later than the day before the closing date of the Company's sale of SPS. If the Participant's designation does not satisfy the criteria -45- described in this paragraph, then the Participant's previous designation shall be re-instated. If for any reason the Participant has not made a valid designation, then the Participant shall be deemed to have elected to receive a single lump sum payment upon Termination of Employment with the Participating Employer. -46- IN WITNESS WHEREOF, the Benefits Committee hereby adopts this Second Amendment to the Gentiva Nonqualified Retirement and Savings Plan, effective January 1, 2002. BENEFITS COMMITTEE ----------------------------------- John Collura ----------------------------------- Patty Ma ----------------------------------- David Silver -47- REVISED THIRD AMENDMENT TO THE GENTIVA HEALTH SERVICES, INC. NONQUALIFIED RETIREMENT AND SAVINGS PLAN WHEREAS, Gentiva Health Services, Inc. (the "Company") maintains the Gentiva Health Services, Inc. Nonqualified Retirement and Savings Plan (the "Plan"); and WHEREAS, Section 10.3 provides that the Benefits Committee may amend the Plan from time to time, to the extent that the amendment does not result in increased costs to the Company; and WHEREAS, the Benefits Committee wishes to amend the Plan to provide a vesting schedule which parallels the matching contribution vesting schedules in the Gentiva Health Services Qualified Plans; NOW THEREFORE, the following section of the Plan is amended as follows: FIRST Section 6.2 is hereby amended as follows: (a) Matching and profit sharing contributions and earnings thereon are subject to the claims of the Company's or Participating Employer's creditors, as described in Section 11.6. Notwithstanding sections 6.2(b) and (c), Participants become fully vested in the value of matching and profit sharing contributions upon Disability or death while employed by a Participating Employer. (b) With respect to Participants who experience a termination of employment before January 1, 2002, the Participant's vested percentage accrued before January 1, 2002 is determined on the basis of Years of Service, as follows: Years of Service Percentage Vested ---------------- ----------------- Fewer than 3 Years 0% 3 Years but Fewer than 4 Years 33-1/3% 4 Years but Fewer than 5 Years 66-2/3% 5 Years or More 100% -48- (c) With respect to Participants who have not terminated employment before January 1, 2002, the Participant's entire vested percentage (regardless of whether it accrued before January 1, 2002) is determined on the basis of Years of Service, as follows: Years of Service Percentage Vested ---------------- ----------------- 1 0% 2 25% 3 50% 4 75% 5 100% SECOND The effective date of this Revised Third Amendment shall be January 1, 2002, unless provided otherwise herein. IN WITNESS WHEREOF, the Benefits Committee hereby adopts this Revised Third Amendment to the Gentiva Nonqualified Retirement and Savings Plan. BENEFITS COMMITTEE ----------------------------------- John Collura ----------------------------------- Patty Ma ----------------------------------- David Silver -49- FOURTH AMENDMENT TO THE GENTIVA HEALTH SERVICES, INC. NONQUALIFIED RETIREMENT AND SAVINGS PLAN WHEREAS, Gentiva Health Services, Inc. (the "Company") maintains the Gentiva Health Services, Inc. Nonqualified Retirement and Savings Plan (the "Plan"); and WHEREAS, Section 10.3 provides that the Benefits Committee may amend the Plan from time to time, to the extent that the amendment does not result in increased costs to the Company; and WHEREAS, the Benefits Committee wishes to amend the Plan to clarify that eligible individuals may participate in the Plan immediately upon date of hire with respect to salary deferral contributions and may begin receiving matching contributions after completion of six months of service; NOW THEREFORE, the following section of the Plan is amended as follows: FIRST Section 3.1(b) is hereby amended as follows: (b) (1) Effective April 1, 2001, Highly Compensated Employees (i) who are age twenty-one (21) or older; (ii) who have completed one hour of service with a Participating Employer; (iii) who are employed by a Participating Employer on or after the Effective Date; (iv) who did not participate in the Prior Plans; and (v) who are designated by the Plan Administrator as eligible to participate in the Plan, shall become eligible to make salary deferral contributions under Section 4.1 as soon as administratively possible following date of hire; provided however, that such Highly Compensated Employees shall not be eligible to receive Matching Contributions under Section 4.2(a) until they have completed six (6) months of service with a Participating Employer. (2) Prior to April 1, 2001, Highly Compensated Employees -50- (i) who are age twenty-one (21) or older; (ii) who have completed six (6) months of service with a Participating Employer; (iii) who are employed by a Participating Employer on or after the Effective Date; (iv) who did not participate in the Prior Plans; and (v) who are designated by the Plan Administrator as eligible to participate in the Plan, shall become Participants as of the first day of the first payroll period of the calendar month occurring on or after the date the Employee satisfies such eligibility requirements. SECOND The effective date of this Fourth Amendment shall be April 1, 2001, unless provided otherwise herein. IN WITNESS WHEREOF, the Benefits Committee hereby adopts this Fourth Amendment to the Gentiva Nonqualified Retirement and Savings Plan. BENEFITS COMMITTEE -------------------------------------- John Potapchuk -------------------------------------- Doug Dahlgard -------------------------------------- Kevin Marrazo -------------------------------------- Nick Florio EX-10.17 5 ex10_17.txt EXHIBIT 10.17 SECOND AMENDMENT TO LOAN AND SECURITY AGREEMENT This SECOND AMENDMENT TO LOAN AND SECURITY AGREEMENT ("Amendment") is made this 26th day of November, 2003 by and among the lending institutions listed in Annex I to the Loan Agreement (as defined below) (each a "Lender", and collectively, "Lenders"), FLEET CAPITAL CORPORATION, a Rhode Island corporation with an office at 200 Glastonbury Boulevard, Glastonbury, CT 06033, as administrative agent for the Lenders ("Agent"), and GENTIVA HEALTH SERVICES, INC., a Delaware corporation with its chief executive office at 3 Huntington Quadrangle 2S, Melville, NY 11747 (the "Company"), GENTIVA HEALTH SERVICES HOLDING CORP., a Delaware corporation with its chief executive office at 3 Huntington Quadrangle 2S, Melville, NY 11747 ("GHS"), and each of the Subsidiary Borrowing Corporations listed on the signature pages hereto, each with a state of incorporation and chief executive office as listed on the exhibits to the Loan Agreement (each of the Company, GHS and each Subsidiary Borrowing Corporation, a "Borrower," and collectively, "Borrowers"). BACKGROUND A. Borrowers, Agent and Lenders are parties to a certain Loan and Security Agreement dated June 13, 2002, as amended by that certain First Amendment and Consent Agreement to Loan and Security Agreement among Agent, Lenders and Borrowers dated as of August 7, 2003 (as it may heretofore otherwise have been or may herein or hereafter be modified, amended, restated or replaced from time to time, the "Loan Agreement") pursuant to which Borrowers established certain financing arrangements with Lenders including a Revolving Credit Loan facility and a Letter of Credit facility. The Loan Agreement and all instruments, documents and agreements executed in connection therewith or related thereto are referred to herein collectively as the "Existing Loan Documents." All capitalized terms not otherwise defined herein shall have the meaning ascribed thereto in the Loan Agreement. NOW, THEREFORE, with the foregoing Background incorporated by reference and made a part hereof and intending to be legally bound, the parties agree as follows: 1. Amendments to Loan Agreement. Upon the effectiveness of this Amendment, subsection 8.1.9 of the Loan Agreement shall be amended by deleting such subsection in its entirety and replacing it as follows: 8.1.9 Dissolution of Inactive Subsidiaries. Borrower has and will continue to use its reasonable best efforts to cause each of the Inactive Subsidiaries to be legally dissolved prior to December 1, 2004. In no event may any of the Inactive Subsidiaries of Borrower or a Subsidiary of Borrower hold any assets of any type, other than those assets specifically transferred by Company as may be necessary to pay corresponding tax liabilities, without the Second Amendment to Loan and Security Agreement -- November 2003 1 prior written approval of Agent. 2. Representations and Warranties. To induce Agent and Lenders to enter into this Amendment, each Borrower warrants, represents and covenants to Agent and Lenders that: (i). All warranties and representations made to Agent and Lenders under the Loan Agreement and the other Existing Loan Documents are true and correct as to the date hereof. (ii). The execution and delivery by each Borrower of this Amendment and the performance by it of the transactions herein contemplated (i) are and will be within its powers, (ii) have been authorized by all necessary corporate actions and will not contravene any provision of the certificate or articles of incorporation or bylaws or other similar corporate governance documents of such Borrower, and (iii) are not and will not be in contravention of any order of any court or other agency of government, of law or any other indenture, agreement or undertaking to which such Borrower is a party or by which the property of such Borrower is bound, or be in conflict with, result in a breach of, or constitute (with due notice and/or lapse of time, if applicable) a default under any such indenture, agreement or undertaking or result in the imposition of any lien, charge or encumbrance of any nature on any of the properties of such Borrower. (iii). This Amendment and any assignment, instrument, document, or agreement executed and delivered in connection herewith, will be valid and binding on and enforceable against each Borrower in accordance with its respective terms. (iv). Both prior to and after giving effect to this Amendment, no Default, or Event of Default, exists under the Loan Agreement or any of the other Existing Loan Documents. (v). Except for actions required by the states of California and Pennsylvania to effectuate legal dissolution of Chronic Health Management of California, QHR Southwest Business Trust and QHR Southwest Holdings Corp., no authorization or approval or other action by, and no notice to or filing with, any governmental authority or other regulatory body is required in connection with the due execution, delivery and performance by any Borrower of this Amendment or the performance by such Borrower of the Loan Agreement, as amended hereby. (vi). The name, office, and signature of the officer(s) of each Borrower signing this Amendment have previously been certified to Agent in the incumbency and signature certificates of such Borrower heretofore delivered to Agent. 3. Confirmation of Security Interest. To secure the prompt payment and performance to Agent and Lenders of the Obligations and satisfaction by Borrowers of all covenants and undertakings contained in the Loan Agreement and other Existing Loan Documents, each Borrower hereby reconfirms the grant to Agent, for the ratable benefit of Lenders, of a continuing security interest in and Lien upon all of the Collateral owned by such Borrower, whether now owned or existing or hereafter created, acquired or arising and wherever located, given to Agent by such Borrower under the Existing Loan Documents. Each such Borrower hereby confirms and agrees that all such security interests and liens granted to Agent under the Existing Loan Documents Second Amendment to Loan and Security Agreement -- November 2003 2 continue in full force and effect and shall continue to secure the Obligations. All Collateral remains free and clear of any liens other than liens in favor of Agent, except for Permitted Liens. Nothing herein contained is intended to in any way impair or limit the validity, priority, and extent of Agent's existing security interest in and liens upon the Collateral. 4. Effectiveness Conditions. This Amendment shall be effective as of June 12, 2003 upon execution and delivery of this Amendment by all parties hereto and payment by Borrowers to Agent of all reasonable legal expenses of Agent incurred in relation to the preparation and execution of this Amendment. 5. Ratification of Existing Loan Documents. Except as expressly set forth herein, all of the terms and conditions of the Loan Agreement and the other Existing Loan Documents are hereby ratified and confirmed and continue unchanged and in full force and effect. All references to the Loan Agreement shall mean the Loan Agreement as modified by this Amendment. 6. Amendment as Loan Document. Borrowers hereby acknowledge and agree that this Amendment constitutes a "Loan Document" under the Loan Agreement. Accordingly, it shall be an Event of Default under the Loan Agreement if (i) any representation or warranty made by Borrowers under or in connection with this Amendment shall have been untrue, false or misleading in any material respect when made, or (ii) Borrowers shall fail to perform or observe any term, covenant or agreement contained in this Amendment. 7. Reaffirmation by Guarantors. Each Subsidiary Guarantor acknowledges and agrees that the execution, delivery and performance of this Amendment by Agent, Lenders and Borrowers, and the carrying out of the provisions hereof and the consummation of all transactions contemplated hereunder, including without limitation the waivers and amendments to the Loan Agreement provided for hereunder, shall not affect or in any way diminish or modify the obligations of each of them under the Subsidiary Guaranty and Surety Agreement executed by Subsidiary Guarantors as of June 13, 2002 or any other Existing Loan Document to which such Subsidiary Guarantor is a party, and each Subsidiary Guarantor acknowledges and affirms its obligations under the Subsidiary Guaranty and Surety Agreement and the other Existing Loan Documents. 8. Governing Law. THIS AMENDMENT HAS BEEN NEGOTIATED, EXECUTED AND DELIVERED AT AND SHALL BE DEEMED TO HAVE BEEN MADE IN NEW YORK. THIS AMENDMENT, AND ALL MATTERS ARISING OUT OF OR RELATING TO THE LOAN AGREEMENT, ANY OTHER EXISTING LOAN DOCUMENT, AND/OR THIS AMENDMENT, SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK WITHOUT REGARD TO ITS OTHERWISE APPLICABLE CONFLICTS OF LAWS RULES. 9. Waiver of Jury Trial. EACH BORROWER AND EACH SUBSIDIARY GUARANTOR WAIVES THE RIGHT TO TRIAL BY JURY (WHICH EACH LENDER AND AGENT HEREBY ALSO WAIVES) IN ANY ACTION, SUIT, PROCEEDING OR COUNTERCLAIM OF ANY KIND ARISING OUT OF OR RELATED TO ANY OF THIS AMENDMENT. EACH BORROWER AND EACH SUBSIDIARY GUARANTOR WARRANTS AND REPRESENTS THAT IT HAS REVIEWED THE FOREGOING WAIVER WITH ITS LEGAL COUNSEL AND HAS KNOWINGLY AND VOLUNTARILY WAIVED Second Amendment to Loan and Security Agreement -- November 2003 3 ITS JURY TRIAL RIGHTS FOLLOWING CONSULTATION WITH LEGAL COUNSEL. IN THE EVENT OF LITIGATION, THIS AGREEMENT MAY BE FILED AS A WRITTEN CONSENT TO A TRIAL BY THE COURT. 10. Successors and Assigns. This Amendment, along with each of the Existing Loan Documents, shall be binding upon and shall benefit Agent, Lenders, Borrowers and Subsidiary Guarantors and their respective successors and permitted assigns (as and if permitted under the Loan Agreement). 11. Counterparts. This Amendment may be executed in any number of counterparts, each of which when so executed shall be deemed to be an original, and such counterparts together shall constitute one and the same respective agreement. Signatures by facsimile shall bind the parties hereto. [REMAINDER OF PAGE INTENTIONALLY LEFT BLANK] Second Amendment to Loan and Security Agreement -- November 2003 4 IN WITNESS WHEREOF, the parties hereto have duly executed this Second Amendment and Waiver to Loan and Security Agreement as of the date first written above. BORROWERS: GENTIVA HEALTH SERVICES, INC. By:______________________________ Name: John R. Potapchuk Title: Senior Vice President and Chief Financial Officer GENTIVA HEALTH SERVICES HOLDING CORP. By:______________________________ Name: John R. Potapchuk Title: Treasurer BORROWING SUBSIDIARY CORPORATIONS: --------------------------------- Gentiva CareCentrix, INC. Gentiva CareCentrix (Area One) Corp. Gentiva CareCentrix (Area Two) Corp. Gentiva CareCentrix (Area Three) Corp. Gentiva Certified HealthCare Corp. GENTIVA HEALTH Services (Certified), Inc. GENTIVA HEALTH Services (USA), Inc. Gentiva Services of New York, Inc. New York Healthcare Services, Inc. OHS Service Corp. QC-Medi New York, Inc. Quality Care - USA, Inc. Quality Managed Care, Inc. By:______________________________ Name: John R. Potapchuk Title: Treasurer [SIGNATURES CONTINUED ON FOLLOWING PAGE] [Borrowers Signature Page to Second Amendment to June 2002 Loan Agreement] S-1 Second Amendment to Loan and Security Agreement -- November 2003 5 SUBSIDIARY GUARANTORS: Commonwealth Home Care, Inc. Kimberly Home Health Care, Inc. PartnersFirst Management, Inc. Quantum Care Network, Inc. Quantum Health Resources, Inc. The I.V. Clinic, Inc. The I.V. Clinic II, Inc. The I.V. Clinic III, Inc. By:______________________________ Name: John R. Potapchuk Title: Treasurer [SIGNATURES CONTINUED ON FOLLOWING PAGE] [Subsidiary Guarantors Signature Page to Second Amendment to June 2002 Loan Agreement] S-2 Second Amendment to Loan and Security Agreement -- November 2003 6 AGENT: FLEET CAPITAL CORPORATION, as Agent By:______________________________ Name: Adam Seiden Title: Vice President LENDERS: FLEET CAPITAL CORPORATION, By:______________________________ Name: Adam Seiden Title: Vice President Siemens Financial Services, Inc. By:______________________________ Name: Title: HFG HEALTHCO-4 LLC By:______________________________ Name: Title: [Agent and Lenders Signature Page to Second Amendment to June 2002 Loan Agreement] S-3 Second Amendment to Loan and Security Agreement -- November 2003 7 Second Amendment to Loan and Security Agreement -- November 2003 8 EX-10.18 6 ex10_18.txt EXHIBIT 10.18 THIRD AMENDMENT AND JOINDER TO LOAN AND SECURITY AGREEMENT This Third Amendment and Joinder to Loan and Security Agreement ("Joinder") is made this 25th day of February, 2004 by and among by and among the lending institutions listed in Annex I to the Loan Agreement (as defined below) (each a "Lender", and collectively, "Lenders"), Fleet Capital Corporation, a Rhode Island corporation with an office at 200 Glastonbury Boulevard, Glastonbury, CT 06033, as administrative agent for the Lenders ("Agent"), and Gentiva Health Services, Inc., a Delaware corporation with its chief executive office at 3 Huntington Quadrangle 2S, Melville, NY 11747 (the "Company"), Gentiva Health Services Holding Corp., a Delaware corporation with its chief executive office at 3 Huntington Quadrangle 2S, Melville, NY 11747 ("GHS"), and Gentiva CareCentrix, INC., Gentiva CareCentrix (Area One) Corp., Gentiva CareCentrix (Area Two) Corp., Gentiva CareCentrix (Area Three) Corp., Gentiva Certified HealthCare Corp., GENTIVA HEALTH Services (Certified), Inc., GENTIVA HEALTH Services (USA), Inc., GENTIVA Services of New York, Inc., New York Healthcare Services, Inc., OHS Service Corp., QC-Medi New York, Inc., QUALITY Care - USA, Inc., and Quality Managed Care, Inc. (each an "Existing Subsidiary Borrowing Corporation"), each Existing Subsidiary Borrowing Corporation with a state of incorporation and chief executive office as listed on the exhibits to the Loan Agreement (each of the Company, GHS and each Existing Subsidiary Borrowing Corporation, an "Existing Borrower," and collectively, "Existing Borrowers") and GENTIVA HEALTH SERVICES IPA, INC., a New York corporation with its chief executive office at 3 Huntington Quadrangle 2S, Melville, NY 11747 ("New Borrower"). (The term "Borrowers" as used herein shall refer to the Existing Borrowers prior to the execution of the execution and delivery hereof and to the Existing Borrowers and the New Borrower immediately following the execution and delivery hereof.) BACKGROUND A. Existing Borrowers, Agent and Lenders are parties to a certain Loan and Security Agreement dated June 13, 2002, as amended by that certain First Amendment and Consent Agreement to Loan and Security Agreement among Agent, Lenders and Borrowers dated as of August 7, 2003 and that certain Second Amendment to Loan and Security Agreement among Agent, Lenders and Borrowers dated as of November 26, 2003 (as it may heretofore otherwise have been or may herein or hereafter be modified, amended, restated or replaced from time to time, the "Loan Agreement") pursuant to which Existing Borrowers established certain financing arrangements with Lenders including a Revolving Credit Loan facility and a Letter of Credit facility. The Loan Agreement and all instruments, documents and agreements executed in connection therewith or related thereto are referred to herein collectively as the "Existing Loan Documents." All capitalized terms not otherwise defined herein shall have the meaning ascribed thereto in the Loan Agreement. B. Effective as of May 31, 2003, Borrowers notified Agent as required under subsection 8.2.1(iv) of the Loan Agreement that GHS intended to created a new Subsidiary as of June 30, 2003. On June 30, 2003, GHS formed New Borrower as a wholly-owned Subsidiary of GHS. Under subsection 8.2.1(iv) of the Loan Agreement, any Borrower creating such a new Subsidiary must pledge the capital stock of such newly-created Subsidiary to Agent for the ratable benefit of the Lenders and cause such newly-created Subsidiary to become a party to the Loan Agreement as a Subsidiary Borrowing Corporation pursuant to a joinder agreement acceptable to Agent. C. Borrowers, Agent and Lenders have also agreed to amend certain provisions of the Loan Agreement to modify certain requirements of the Borrowers concerning the delivery of certain reports to Agent. D. Borrowers, Agent and Lenders have agreed to execute this Joinder to (a) provide for the joinder of New Borrower as a "Borrower" under the Loan Agreement and (b) amend certain provisions of the Loan Agreement relating to the Borrower's reporting requirements. NOW, THEREFORE, with the foregoing Background incorporated by reference and made a part hereof and intending to be legally bound, the parties agree as follows: 1. Joinder. (a) Agent and Lenders acknowledge having accepted Borrower's letter dated and delivered February 13, 2004 giving notice effective as of May 31, 2003 of GHS's intention to form New Borrower as a wholly-owned subsidiary of GHS. (b) Upon the effectiveness of this Joinder, New Borrower joins in, becomes a Borrower under and assumes and accepts all of the obligations and acquires all of the rights of a Borrower under the Loan Agreement. All references to Borrower or Borrowers contained in the Loan Agreement or any other Existing Loan Document, are immediately upon the effectiveness hereof, hereby deemed for all purposes to also refer to and include New Borrower as a Borrower. New Borrower hereby agrees to comply with all of the terms and conditions of the Loan Agreement as if it were an original signatory thereto. (c) Without limiting the generality of the provisions of subparagraph (a) above, New Borrower hereby becomes and is thereby liable, on a joint and several basis, along with all other Borrowers for all existing and future Loans and Letters of Credit and any and all other Obligations. (d) The Exhibits to the Loan Agreement are hereby amended to include the information contained in the updates to such Exhibits (setting forth the requisite information relating to New Borrower) contained in Attachment I hereto. 2. Amendments to Loan Agreement. Upon the effectiveness of this Joinder, the Loan Agreement shall be amended as follows: (a) Amendment Concerning Delivery of Annual Projections. Subsection 8.1.5 of the Loan Agreement shall be amended by deleting such subsection in its entirety and replacing it as follows: 8.1.5 Projections. Not later than sixty (60) days following the end of each fiscal year of Borrowers, deliver to Agent Projections of Borrowers for the forthcoming fiscal year of Borrowers, such Projections to be prepared on a fiscal quarter by fiscal quarter basis. (b) Amendment Concerning Frequency of Borrowing Base Certificate. Subsection 8.1.6 of the Loan Agreement shall be amended by deleting such subsection in its entirety and replacing it as follows: 8.1.6 Borrowing Base Certificate. No later than twenty (20) calendar days after the last day of each fiscal quarter of Borrowers, Borrowers shall deliver to Agent a Borrowing Base Certificate in the form of Exhibit C hereto executed by the Chief Financial Officer of the Company, provided that Agent or any other Lender may at any time and from time to time require Borrowers to deliver Borrowing Base Certificates on a more frequent basis as Agent (or any such other Lender) may determine in the exercise of its sole discretion. 3. Representations and Warranties. To induce Agent and Lenders to enter into this Amendment, each Borrower, including without limitation New Borrower, represents and warrants to Lender that: (a) All warranties and representations made to Agent and Lenders under the Loan Agreement and the other Existing Loan Documents (as such warranties and representation may have been amended pursuant to the amendments to the Exhibits to the Loan Agreement set forth in Section 1(d) above) are true and correct as to the date hereof. (b) The execution and delivery by each Borrower, including without limitation New Borrower, of this Joinder and the performance by each such Borrower of the transactions herein contemplated (i) are and will be within its powers, (ii) have been authorized by all necessary corporate actions and will not contravene any provision of the certificate or articles of incorporation or bylaws or other similar corporate governance documents of such Borrower, and (iii) are not and will not be in contravention of any order of any court or other agency of government, of law or any other indenture, agreement or undertaking to which such Borrower is a party or by which the property of such Borrower is bound, or be in conflict with, result in a breach of, or constitute (with due notice and/or lapse of time, if applicable) a default under any such indenture, agreement or undertaking or result in the imposition of any lien, charge or encumbrance of any nature on any of the properties of such Borrower. (c) This Joinder, the Amended and Restated Note (as defined below) and any assignment, instrument, document or agreement executed and delivered in connection herewith, will be valid and binding on and enforceable against each Borrower in accordance with its respective terms. (d) Both prior and after giving effect to this Amendment, no Default or Event of Default, other than the Existing Default, exists under the Loan Agreement or any of the other Existing Loan Documents. (e) No authorization or approval or other action by, and no notice to or filing with, any governmental authority or other regulatory body is required in connection with the due execution, delivery and performance by any Borrower, including without limitation New Borrower, of this Amendment or the performance by such Borrower of the Loan Agreement, as amended hereby. (f) The name, office, and signature of the officer(s) of each Borrower (other than New Borrower) signing this Amendment have previously been certified to Agent in the incumbency and signature certificates of such Borrower heretofore delivered to Agent. 4. Collateral. To secure the prompt payment and performance to Agent and Lenders of the Obligations and satisfaction by Borrowers of all covenants and undertakings contained in the Loan Agreement and other Existing Loan Documents, New Borrower hereby grants to Agent, for the ratable benefit of Lenders, a continuing security interest in and Lien upon all of the Collateral owned by New Borrower, whether now owned or existing or hereafter created, acquired or arising and wherever located as more fully provided for in Section 5.1 of the Loan Agreement. New Borrower hereby irrevocably authorizes Lender at any time to execute and/or file any UCC-1 financing statements (with or without the signature of New Borrower) as are necessary, desirable or prudent to perfect Agent's Lien upon any of the Collateral owned by New Borrower, including without limitation financing statements that indicate the Collateral as being of an equal or lesser scope, or with greater or lesser detail, than as set forth in Section 5.1 of the Loan Agreement, all as more fully provided for in Section 5.3 of the Loan Agreement. Each Existing Borrower hereby reconfirms the grant to Agent, for the ratable benefit of Lenders, of a continuing security interest in and Lien upon all of the Collateral owned by such Borrower, whether now owned or existing or hereafter created, acquired or arising and wherever located, given to Agent by such Borrower under the Existing Loan Documents and each Borrower hereby confirms and agrees that all security interests and liens granted to Agent by any one of them continue in full force and effect and shall continue to secure the Obligations. All Collateral remains free and clear of any liens other than liens in favor of Agent, except for Permitted Liens. Nothing herein contained is intended to in any way impair or limit the validity, priority, and extent of Agent's existing security interest in and liens upon the Collateral of any Borrower. 5. Effectiveness Conditions. This Joinder shall be effective, and the New Borrower shall be deemed a Borrower under the Loan Agreement and Existing Loan Documents, upon completion of the following conditions precedent (all documents to be in form and substance satisfactory to Agent and Agent's counsel): (a) Execution and delivery of this Joinder by all parties hereto; (b) Execution and delivery of Amended and Restated Revolving Credit Notes dated as of the date hereof in favor of each Lender (collectively, "Amended and Restated Notes") by all of the Borrowers (including New Borrower); (c) Execution and delivery by GHS of a First Amendment to Pledge Agreement dated as of the date hereof pledging one hundred percent (100%) of the issued and outstanding capital stock of New Borrower and delivery to Agent of stock certificates (along with appropriate stock powers endorsed in blank) representing such pledged stock; (d) Filing of UCC-1 financing statements against New Borrower in favor of Agent in such jurisdictions as Agent shall deem necessary, desirable or prudent; (e) A Secretary's Certificate of New Borrower (x) containing a certification of incumbency regarding the officers of New Borrower and (y) certifying (i) the articles or certificate of incorporation of New Borrower, (ii) the bylaws of New Borrower and (iii) resolutions or written actions/consents of the Board of Directors of New Borrower authorizing the execution of this Joinder, the Amended and Restated Notes and any and all other documents, instruments and agreements required in connection herewith and therewith and the performance of the obligations of New Borrower hereunder and thereunder; (f) Good Standing Certificates in each jurisdiction where New Borrower is incorporated and/or qualified to do business; (g) Written opinion of counsel to New Borrower in form and substance satisfactory to Agent; (h) Uniform Commercial Code, judgment, federal and state tax lien searches against New Borrower showing that the Collateral is not subject to any liens, claims or encumbrances (other than Permitted Liens); and (i) Any and all other agreements, instruments and documents requested by Lender to effectuate and implement the terms hereof and the Existing Loan Documents. 6. Ratification of Existing Loan Documents. Except as expressly set forth herein, all of the terms and conditions of the Loan Agreement and Existing Loan Documents are hereby ratified and confirmed and continue unchanged and in full force and effect. All references to the Loan Agreement shall mean the Loan Agreement as modified by this Joinder. 7. Joinder as Loan Document. Borrowers hereby acknowledge and agree that this Joinder constitutes a "Loan Document" under the Loan Agreement. Accordingly, it shall be an Event of Default under the Loan Agreement if (i) any representation or warranty made by Borrowers under or in connection with this Joinder shall have been untrue, false or misleading in any material respect when made, or (ii) Borrowers shall fail to perform or observe any term, covenant or agreement contained in this Joinder. 8. Reaffirmation by Guarantors. Each Subsidiary Guarantor acknowledges and agrees that the execution, delivery and performance of this Joinder by Agent, Lenders and Borrowers, and the carrying out of the provisions hereof and the consummation of all transactions contemplated hereunder, including without limitation the amendments to the Loan Agreement provided for hereunder, shall not affect or in any way diminish or modify the obligations of each of them under the Subsidiary Guaranty and Surety Agreement executed by Subsidiary Guarantors as of June 13, 2002 or any other Existing Loan Document to which such Subsidiary Guarantor is a party, and each Subsidiary Guarantor acknowledges and affirms its obligations under the Subsidiary Guaranty and Surety Agreement and the other Existing Loan Documents. 9. Governing Law. THIS JOINDER HAS BEEN NEGOTIATED, EXECUTED AND DELIVERED AT AND SHALL BE DEEMED TO HAVE BEEN MADE IN NEW YORK. THIS JOINDER, AND ALL MATTERS ARISING OUT OF OR RELATING TO THE LOAN AGREEMENT, ANY OTHER EXISTING LOAN DOCUMENT, AND/OR THIS JOINDER, SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK WITHOUT REGARD TO ITS OTHERWISE APPLICABLE CONFLICTS OF LAWS RULES. 10. Waiver of Jury Trial. EACH BORROWER (INCLUDING WITHOUT LIMITATION NEW BORROWER) AND EACH SUBSIDIARY GUARANTOR WAIVES THE RIGHT TO TRIAL BY JURY (WHICH EACH LENDER AND AGENT HEREBY ALSO WAIVES) IN ANY ACTION, SUIT, PROCEEDING OR COUNTERCLAIM OF ANY KIND ARISING OUT OF OR RELATED TO ANY OF THIS JOINDER. EACH BORROWER (INCLUDING WITHOUT LIMITATION NEW BORROWER) AND EACH SUBSIDIARY GUARANTOR WARRANTS AND REPRESENTS THAT IT HAS REVIEWED THE FOREGOING WAIVER WITH ITS LEGAL COUNSEL AND HAS KNOWINGLY AND VOLUNTARILY WAIVED ITS JURY TRIAL RIGHTS FOLLOWING CONSULTATION WITH LEGAL COUNSEL. IN THE EVENT OF LITIGATION, THIS AGREEMENT MAY BE FILED AS A WRITTEN CONSENT TO A TRIAL BY THE COURT. 11. Successors and Assigns. This Joinder, along with each of the Existing Loan Documents, shall be binding upon and shall benefit Agent, Lenders, Borrowers and Subsidiary Guarantors and their respective successors and permitted assigns (as and if permitted under the Loan Agreement). 12. Counterparts. This Joinder may be executed in any number of counterparts, each of which when so executed shall be deemed to be an original, and such counterparts together shall constitute one and the same respective agreement. Signature by facsimile shall bind the parties hereto. [REMAINDER OF PAGE LEFT INTENTIONALLY BLANK] [SIGNATURES ON FOLLOWING PAGE] IN WITNESS WHEREOF, the parties have executed this Third Amendment and Joinder to Loan and Security Agreement the day and year first written above. EXISTING BORROWERS: GENTIVA HEALTH SERVICES, INC. By:______________________________ Name: John R. Potapchuk Title: Senior Vice President and Chief Financial Officer GENTIVA HEALTH SERVICES HOLDING CORP. Gentiva CareCentrix, INC. Gentiva CareCentrix (Area One) Corp. Gentiva CareCentrix (Area Two) Corp. Gentiva CareCentrix (Area Three) Corp. Gentiva Certified HealthCare Corp. GENTIVA HEALTH Services (Certified), Inc. GENTIVA HEALTH Services (USA), Inc. Gentiva Services of New York, Inc. New York Healthcare Services, Inc. OHS Service Corp. QC-Medi New York, Inc. Quality Care - USA, Inc. Quality Managed Care, Inc. By:______________________________ Name: John R. Potapchuk Title: Treasurer NEW BORROWER: GENTIVA HEALTH SERVICES IPA, INC. By:______________________________ Name: John R. Potapchuk Title: Treasurer [SIGNATURES CONTINUED ON FOLLOWING PAGE] [Borrowers Signature Page to Third Amendment and Joinder to June 2002 Loan Agreement] S-1 SUBSIDIARY GUARANTORS: Commonwealth Home Care, Inc. Kimberly Home Health Care, Inc. PartnersFirst Management, Inc. Quantum Care Network, Inc. Quantum Health Resources, Inc. The I.V. Clinic, Inc. The I.V. Clinic II, Inc. The I.V. Clinic III, Inc. By:______________________________ Name: John R. Potapchuk Title: Treasurer [SIGNATURES CONTINUED ON FOLLOWING PAGE] [Subsidiary Guarantors Signature Page to Third Amendment and Joinder to June 2002 Loan Agreement] S-2 AGENT: FLEET CAPITAL CORPORATION, as Agent By:______________________________ Name: Adam Seiden Title: Vice President LENDERS: FLEET CAPITAL CORPORATION, By:______________________________ Name: Adam Seiden Title: Vice President Siemens Financial Services, Inc. By:______________________________ Name: Title: HFG HEALTHCO-5 LLC By:______________________________ Name: Title: [Agent and Lenders Signature Page to Third Amendment and Joinder to June 2002 Loan Agreement] S-3 EX-10.22 7 ex10_22.txt EXHIBIT 10.22 MANAGED CARE ALLIANCE AGREEMENT CONTENTS PARTIES 2 PURPOSE 2 I. DEFINITIONS 2 II. PARTIES OBLIGATIONS 6 A. SERVICES 6 B. COMPENSATION AND BILLING 12 C. RECORDS 16 D. PARTICIPANT GRIEVANCE 17 E. INSURANCE AND LIABILITY 17 F. INSPECTIONS 18 G. REPRESENTATIONS 18 H. CONFIDENTIALITY/DAMAGING COMMUNICATIONS 20 I. MARKETING EFFORTS 21 J. REPORTING /DATA ACCESS 20 K. BEST RATE GUARANTEE 22 L. PERFORMANCE GUARANTEES 22 III. MISCELLANEOUS OBLIGATIONS 24 A. INDEPENDENT CONTRACTOR RELATIONSHIP 24 B. TERM OF AGREEMENT 24 C. TERMINATION 25 D. RIGHTS AND OBLIGATIONS UPON TERMINATION 28 E. ASSIGNMENT AND DELEGATION OF DUTIES 29 F. USE OF NAME 29 G. INTERPRETATION 29 H. AMENDMENT 29 I. PROGRAM ATTACHMENTS 30 J. ENTIRE CONTRACT 30 K. NOTICE 30 L. ENFORCEABILITY AND WAIVER 30 M. DISPUTE RESOLUTION 31 N. NON-SOLICITATION 29 MANAGED CARE ALLIANCE AGREEMENT PARTIES This Agreement is by and between CIGNA HEALTH CORPORATION, FOR AND ON BEHALF OF ITS CIGNA AFFILIATES (INDIVIDUALLY AND COLLECTIVELY, "CIGNA") and Gentiva CareCentrix, Inc. ("MCA") and is entered into as of the Effective Date. PURPOSE CIGNA contracts directly or indirectly with Payors, employers, individuals, insurers, sponsors and others to provide, insure, arrange for or administer the provision of health care services; CIGNA contracts with physicians, hospitals and other health care practitioners and entities to provide, arrange for or administer, at predetermined rates, the delivery of such health care services; MCA contracts with health care providers to arrange for their provision of health care services to enrollees in managed health care programs; and CIGNA and MCA both desire for MCA's participating health care providers to become Participating Providers under this Agreement and to make available Covered Services to Participants on the terms and conditions set forth herein. In consideration of the mutual promises herein, the parties agree as follows: I. DEFINITIONS Defined terms are set forth herein and in the Program Attachments. CIGNA AFFILIATE means any direct or indirect subsidiary of CIGNA Corporation, as designated by CIGNA. COINSURANCE means a payment that a Participant is required to make to a Participating Provider for Covered Services under a Service Agreement, which is calculated as a percentage of the contracted reimbursement rate of such services, or, if reimbursement is on a basis other than a fee-for-service amount, as a percentage of a CIGNA determined fee schedule or as a CIGNA determined percentage of actual billed charges. COMPLETE ORDER means all information and physician orders, to the extent applicable, reasonably required by MCA and/or any applicable Represented Provider in order to provide or arrange for Covered Home Care Services. MCA shall have received a Complete Order if MCA has received the information delineated in EXHIBIT III. 2 COPAYMENT OR DEDUCTIBLE means a payment that a Participant is required to make to a Participating Provider under a Service Agreement, which is calculated as a fixed dollar payment. COVERED HOME CARE SERVICES means the Medically Necessary Home Health Services, Home Infusion Therapy Services and Home Medical Equipment/Durable Medical Equipment provided to a Participant in accordance with a Service Agreement. It also includes the following services with respect to Participants receiving Covered Home Care services: (a) training and education; (b) family orientation; (c) family/caregiver training, if required; (d) instructional literature; and (e) oxygen patient assessments, if required. COVERED SERVICES means those health care services/supplies provided to a Participant in accordance with a Service Agreement. The term Covered Services includes Covered Home Care Services. EMERGENCY means a condition for which Emergency Services are required. EMERGENCY SERVICES are as defined in each applicable Service Agreement. HOME CARE SERVICES means those Home Health Services, Home Infusion Therapy Services, Home Medical Equipment, as defined below, appropriately and safely (see Exhibit IX Safe Home Care Admission Criteria) provided in a Home Setting (except that Home Infusion Therapy Services includes the administration of the first dose of home infusion therapies in a controlled medical setting for the purpose of managing potential acute anaphylactic reactions, and Home Medical Equipment includes medical equipment used in the Home Setting, except in preparation for hospital discharge), subject to the conditions and limitations of this Agreement: HOME HEALTH SERVICES means those skilled services and related services and supplies used in conjunction with those skilled services, ordered by a physician for a Participant who is homebound due to a disabling condition, and who requires skilled care, which are safely (see Exhibit IX: Safe Home Care Admission Criteria) and appropriately provided in a Home Setting, including: skilled nursing services rendered by a registered professional nurse, licensed practical nurse or licensed vocational nurse; home health aide services; physical, occupational, speech and respiratory therapy; dietary and nutritional services; medical social services; and family caregiver training and education. Home Health Services does not mean hospice services. HOME INFUSION THERAPY SERVICES means intravenously administered, subcutaneously administered or self-injected drugs and medications prescribed by a physician for a Participant (including all services and supplies necessary for such administrations), which are 3 administered in the Home Setting. Home Infusion Therapy Services includes the administration of the first dose of home infusion therapies in a controlled medical setting for the purpose of managing potential acute anaphylactic reactions. Home Infusion Therapy Services do not include those medications which are provided under a Participant's prescription drug benefit program such as oral, rectal, ophthalmic, subdermal, sublingual and topical agents, self-injected medications which are covered under a Participant's prescription drug benefit program (such as anti-diabetic agents and certain subcutaneous medications) and medications not generally considered home infusion therapy (such as skeletal muscle relaxants, anti-psychotics, anti-convulsants, diagnostic agents, vaccines and hormones (except growth hormone)), fertility agents, and intra-articular steroids. Home Infusion Therapy Services do not include the intra-spinal, intra-articular, or intra-ventricular administration of medications, unless infused via implanted closed delivery system such as a synchromed pump. Home Infusion Therapy Services include blood products, such as whole blood and platelets, home chemotherapy, and insertion of PICC line catheters and management of implantable, programmable infusion devices (i.e. Syncromed pump) only to the extent such products are appropriately and safely (see Exhibit IX: Safe Home Care Admission Criteria) provided in a Home Setting. HOME MEDICAL EQUIPMENT (HME)/DURABLE MEDICAL EQUIPMENT (DME) means equipment that can stand repeated use, is primarily and customarily used to serve a medical purpose, and is generally not useful to a Participant in the absence of an illness or injury. It is ordered or prescribed by a physician for a Participant (including all services, training, supplies, maintenance and repairs necessary for use of such equipment) including durable medical equipment, respiratory therapy equipment, and oxygen and is provided in accordance with Exhibit XIII (DME Guidelines Grid). HOME SETTING means the Participant's primary place of residence or the residence where Participant is receiving Home Care Services. MEDICALLY NECESSARY means those Covered Services which under the terms of the applicable Service Agreement are "Medically Necessary". Covered Services must be "Medically Necessary." PARTICIPANT means any individual, or eligible dependent of such individual, whether referred to as "Insured," "Subscriber," "Member," "Participant," "Enrollee," "Dependent" or otherwise, who is eligible to receive Home Care Services pursuant to a Service Agreement. PARTICIPATING HOSPITAL means a hospital that has a direct or indirect contractual agreement with CIGNA with regard to the particular Program under which the Participant is covered and to which a Participating Provider may admit Participants for care and treatment in accordance with Program Requirements. PARTICIPATING PROVIDER means a hospital, a physician or any other health care practitioner or entity that has a direct or indirect contractual 4 arrangement with CIGNA to provide Covered Services with regard to the particular Program under which the Participant is covered and includes, but is not limited to Represented Providers. PAYOR means CIGNA or such other entity which, pursuant to a Service Agreement, funds, administers, offers or insures Covered Services and which has agreed to act as Payor in accordance with this Agreement. PRE-QUALIFIED MATERNITY STAY means a maternity hospital stay of 48 hours for vaginal delivery birth, or 96 hours for caesarean section birth, that does not require prior authorization. PROGRAM means the Health Maintenance Organization (HMO), Preferred Provider Organization (PPO) or other types of health care or administrative services which are provided or arranged by CIGNA or CIGNA Affiliates and which are specifically described in applicable Program Attachments and Program Requirements. It is understood that the Health Maintenance Organization (HMO) Program includes not only benefit plans provided under service agreements by licensed HMOs, but insured or self-funded managed care plans administered by Connecticut General Life Insurance Company and referred to by various names including "FlexCare," "Network," "Network Open Access", and "Network Open Access Plus." PROGRAM REQUIREMENTS means the rules and procedures that establish conditions to be followed by Participating Providers with respect to Programs, copies of which have been provided to MCA. Reference to Program Requirements includes the Summary of Program Requirements distributed by CIGNA. QUALITY MANAGEMENT means the programs established and operated by CIGNA or its designee relating to the quality of Covered Services provided to Participants. REPRESENTED PROVIDER means a home health care, infusion therapy, durable medical equipment, or other like provider: (a) who or which is employed by, associated with or otherwise contracted with MCA; (b) who or which both MCA and CIGNA have agreed may provide services pursuant to this Agreement; (c) who or which has completed an MCA Application (which has been approved by CIGNA and a copy of which is attached in Exhibit I.) and has satisfied applicable credentialing criteria; and (d) who or which has agreed with MCA to be subject to the requirements of this Agreement to the extent applicable to Represented Provider. ROUTINE CARE means services required greater than 4 hours from receipt of Complete Order (see Exhibit III), directed by physician orders with regard to start of care requested date. SERVICE AGREEMENT means those agreements among CIGNA or a CIGNA Affiliate, and an employer, insurer, labor union, trust or other organization or entity, or an individual, that specifies services to be provided to or for the benefit of, or arranged for or reimbursed to, or 5 for the benefit of Participants, the terms and conditions under which those services are to be provided or reimbursed, and is consistent with Program Requirements. STAT CARE means services applied in the homecare setting for existing patients only, where care or professional response is required in less than 2 hours. URGENT CARE means services required, as directed by physician orders, within 4 hours from receipt of a Complete Order (see EXHIBIT III). Services which will be considered urgent for the purposes of this agreement shall include the following; nebulizers, glucometers for newly diagnosed non-hospitalized diabetic, hydration therapy for pregnant members with diagnosis of hyperemesis, hydration therapy for pediatric members, Bili-lights and infusion therapies with less than an every 12 hour dosing schedule. Urgent care services also include same day discharges requiring oxygen and pain management. Urgent care services are not intended to replace appropriate discharge planning when the Participant has been in the facility for greater than 23 hours. Inappropriate utilization of same day and urgent request for same day hospital discharge will be monitored. UTILIZATION MANAGEMENT means the processes to review and determine whether certain health care services provided, or to be provided, to Participants are in accordance with Program Requirements. II. PARTIES OBLIGATIONS A. SERVICES 1. MCA, Represented Providers and CIGNA shall act in accordance with the terms of this Agreement and applicable Program Attachments and Program Requirements. Except as otherwise stated in this Agreement, the rates set forth in this Agreement shall be payment in full for all services provided to Participants pursuant to this Agreement. 2. Subject to the terms and condition of this Agreement, MCA shall: (a) Arrange for the provision of Home Care Services to Participants; (b) Require Represented Providers to accept, treat, and otherwise render Covered Services to Participants in the same manner, in accordance with the same standards, and with the same availability, as offered to other like patients. 6 (c) not close its network to any new Participants unless CIGNA expressly consents to such closure; 3. In no event shall MCA or Represented Providers be required to accept, treat, arrange for, or otherwise be obligated to render Home Care Services to Participants under this Agreement, even if medically appropriate, if: (a) the provision of such services to Participant would pose risk of bodily harm to the Participant or caregiver personnel of Represented Provider; (b) the provision of such services to Participant would be in violation of MCA's or Represented Provider's applicable license requirements or other applicable laws, and/or MCA policies, including but not limited to admission and discharge policies or discrimination policies; (c) MCA has not received the essential information to process a referral; (d) Participant repeatedly rejects the provision of services by a qualified Represented Provider selected by MCA and/or CIGNA as mutually agreed. MCA and Represented Providers shall not differentiate or discriminate in the treatment of any Participant because of race, color, national origin, ancestry, religion, sex, marital status, sexual orientation, age, health status, handicap or source of payment. 4. MCA shall be bound by, and MCA shall require Represented Providers to be bound by, and comply with, the provisions of applicable state and federal laws, regulations, credentialing and recredentialing requirements of the National Committee for Quality Assurance ("NCQA") or of another appropriate accrediting body designated by CIGNA, and Program Requirements. MCA and its Represented Providers shall maintain all licenses and certifications required in order to perform the obligations set forth herein. MCA shall comply and require Represented Providers to comply with the requirements of, and shall cooperate with, Utilization Management and Quality Management. 5. MCA shall establish and maintain a panel of Represented Providers adequate in size, composition and distribution, as determined by CIGNA, to accommodate the Covered Services required by Participants (the "required Represented Provider panel"). Should CIGNA reasonably determine that the number, composition or distribution of Represented Providers is not 7 adequate, then CIGNA shall notify MCA of the deficiency. MCA shall have sixty (60) days from the date of the notice to contract with sufficient Represented Providers to resolve the deficiency, but if MCA fails to do so, then CIGNA may designate sufficient Participating Providers as Represented Providers until such time as MCA contracts with the necessary Represented Providers and MCA is financially responsible for any such Covered Home Care Services delivered to participants until such time as MCA contracts with the necessary Represented Providers. MCA understands and agrees that, to the extent that Covered Services are rendered under this Agreement to CIGNA's commercial HMO Participants (including "FlexCare", "Gatekeeper", "Open Access" and "Open Access Plus" participants) or to Participants in CIGNA's Medicare and Medicaid Programs, such services shall only be rendered by those Participating Providers in the required Represented Provider panel located within CIGNA's authorized service area. MCA further agrees that it shall secure binding agreements with the required Represented Provider panel three (3) weeks prior to the Effective Date of this Agreement. In the event that MCA has failed to do so, the Effective Date of this Agreement shall be delayed as determined by CIGNA. 6. Upon request, MCA will provide CIGNA with the data elements set forth in Exhibit II for each Represented Provider. MCA further agrees to update CIGNA on any changes to Represented Provider data elements as soon as possible but no less frequently than monthly. MCA will provide CIGNA with thirty (30) days advance notice of all other additions to its panel of Represented Providers. In recognition of CIGNA's need to communicate changes to Participants, MCA shall not make any material changes in the location or hours of operation of its panel of Represented Providers without first providing sixty (60) days advance written notice to CIGNA. In addition, MCA shall provide CIGNA with sixty (60) days advance written notice of the termination of a Represented Provider, or any other circumstance (e.g. death or cessation of operations, loss of licensure, etc.) that results in the Represented Provider ceasing to provide Covered Services to Participants under this Agreement. Notwithstanding the foregoing, in the event that the Represented Provider's participation under this Agreement is terminated for cause and in situations where MCA does not have sixty (60) days advance notice of such termination, MCA shall notify CIGNA in writing of such termination as soon as possible but no later than five (5) days after learning of such termination. 7. MCA shall maintain agreements with each of its Represented Providers, in the form attached hereto as Exhibit I, requiring Represented Providers to comply with all of the terms and conditions of this Agreement to the extent applicable. The 8 form of MCA's standard agreement with Represented Providers and any material amendments thereto comply with applicable law and must be approved in advance by CIGNA. Each of such agreements shall include, among other things, the following: a. a Participant hold harmless provision satisfactory to CIGNA, consistent with applicable law and which provides, among other things, that in no event, including but not limited to nonpayment by MCA, MCA's insolvency or breach of MCA's agreement with the Represented Provider, shall Represented Provider bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from or have any recourse against Participant, Payor (if Payor has made payments in accordance with this Agreement) or parties other than MCA for Covered Services provided pursuant to this Agreement; b. if payments for Covered Services rendered hereunder are directed to MCA who, in turn, distributes payments to Represented Providers: i. a provision obligating Represented Providers to notify CIGNA immediately of any payment defaults by MCA relating to services rendered hereunder; and ii. a provision obligating Represented Providers, in the event of such payment default by MCA and at CIGNA's option, to continue rendering Covered Services hereunder so long as payments due Represented Providers for Covered Services rendered after CIGNA's exercise of such option are made directly to Represented Providers by Payor and until a date specified by CIGNA but no later than one hundred twenty (120) days after CIGNA's exercise of such option. Represented Providers shall agree that any such payments during such time period shall be made, at CIGNA's election, either in accordance with the reimbursement terms set forth in Represented Providers' agreements with MCA or in accordance with CIGNA's maximum fee schedule in effect at the time of service. c. a provision or provisions obligating Represented Providers to be available to provide Covered Home Care Services to those patients designated by Gentiva, which during the term of this Agreement would include Participants. d. any other provisions required by applicable law or regulation; and e. a provision wherein the Represented Provider acknowledges and agrees that the Represented Provider's participation agreement with MCA does not contain any financial incentive 9 or make any payment that acts directly or indirectly as an inducement to limit Medically Necessary services. Upon request, MCA shall make available to CIGNA and to any applicable regulatory authority a copy of each of its provider agreements with Represented Providers. 8. For referrals, Represented Providers shall refer Participants to Represented Providers or other Participating Providers except in the case of an Emergency or as otherwise described in applicable Program Requirements or as otherwise required by law. 9. Represented Providers shall be credentialed and recredentialed in accordance with the procedures set forth in Exhibit XII to this Agreement. 10. MCA shall provide trained service personnel to answer questions from CIGNA and to assist CIGNA in responding to complaints from Payors, Participants, and Participating Providers. MCA shall promptly respond to all such inquiries and complaints in accordance with the Joint Complaint Management Process created by MCA and CIGNA, attached in Exhibit XI. 11. CIGNA shall perform administrative, accounting, enrollment, eligibility verification and other functions necessary for the administration and operation of the Programs. CIGNA shall provide MCA with information and data reasonably necessary to carry out the terms and conditions of this Agreement and for operation of the Programs. CIGNA shall establish a system of Participant identification, communicate Program Requirements to MCA or Represented Providers, as applicable, and identify Represented Providers to Payors and Participants. 12. CIGNA shall contract, directly or indirectly, with Payors who agree to pay in accordance with this Agreement for Covered Services rendered by Represented Providers. 13. CIGNA shall, upon specific request by MCA, identify the Payor responsible for payment of Covered Services. 14. Prior to the start date with respect to each of the entities described in Exhibit XIV and any subsequent entities added by amendment: (a) MCA shall obtain CIGNA's approval of MCA's list of participating home care providers (which may include both MCA affiliates and Represented Providers) who will render Covered Home Care Services under this Agreement; (b) MCA shall satisfy CIGNA that it has established a home care services network adequate in size, composition and distribution to accommodate the Covered Home Care Services required by Participants; (c) the parties shall agree upon a plan to ensure appropriate and sensitive transitioning of Participants already receiving Covered Home Care Services such that there is no disruption of care which would be detrimental to such Participants; and (d) the parties 10 shall be satisfied that adequate management systems are in place. CIGNA's financial obligations for payment of Covered Home Care Services rendered hereunder shall not commence with respect to a Service Area until the agreed upon start date for such Service Area. MCA shall not eliminate or change Represented Providers or a MCA location without sixty (60) days' prior written notice to CIGNA, except to the extent MCA is required to do so for cause and, in any such case, MCA shall notify CIGNA of such change as soon as practicable. 15. MCA shall require Represented Providers providing Home Medical Equipment to provide Home Medical Equipment in good working order and condition and ensure that Home Medical Equipment has been properly cleaned and disinfected between uses. MCA shall arrange for at MCA's expense all necessary on-site maintenance and/or repair for Home Medical Equipment (including provision of all necessary parts, mechanisms and devices) in order to maintain the Home Medical Equipment in good condition and working order; provided that such maintenance and/or repair is required as a result of normal wear and tear (as defined by warranty), or a defect in, the Home Medical Equipment. MCA shall require Represented Providers to provide or arrange for twenty-four (24) hour per day, seven (7) day per week maintenance and repair service, provided however, that Represented Provider may elect to pick up the Home Medical Equipment needing maintenance and/or repair and replace it with Home Medical Equipment in operable condition, rather than repair the Home Medical Equipment immediately. 16. MCA shall require Represented Providers to maintain an accurate inventory of solutions, medications, drugs, Home Medical Equipment and ancillary supplies, as applicable, for each Participant, to the extent necessary to provide Covered Home Care Services under this Agreement, and shall make these inventory records available to CIGNA upon request. 17. MCA shall ensure that its facilities and employees, and require that the facilities and employees of its Represented Providers, maintain a neat, clean and professional appearance at all times. 18. MCA will dedicate on a full-time basis (and part-time, as required) the services of appropriate personnel to coordinate the implementation of this Agreement on both local and national levels, and to manage the day-to-day work relationship with CIGNA. MCA will meet with designated CIGNA personnel upon request to review MCA performance, Participant utilization and quality improvement initiatives. 19. MCA will educate CIGNA case managers and CIGNA discharge planners on the capabilities of home care providers. MCA will identify potential home care candidates as early as possible in the hospital stay and prepare for the discharge. CIGNA and MCA acknowledge that none of the activities of their respective 11 personnel described in this section will substitute for the discharge planning obligations imposed on Participating Hospitals by Medicare and/or Medicaid. 20. MCA and CIGNA agree to meet on at least a quarterly basis to assist CIGNA in staying abreast of innovations in home care services (including drug protocols) and to work with CIGNA to see that these services are being appropriately applied to Participants. 21. MCA will dedicate personnel to travel to any Service Area location or to CIGNA Health Corporation's home office on twenty-four hours notice to resolve CIGNA's repeated dissatisfaction with MCA. Said personnel will include at least one officer of MCA, if requested by CIGNA. 22. MCA will provide a mutually agreed upon number of home and community care specialists whose responsibilities will include the items listed in Exhibit VI, (Guidelines for Home & Community Care Specialists). The Home and Community Care Specialists will be located in a CIGNA Health Facilitation Center or other Health Facilitation Satellite location, as mutually agreed, and shall have responsibility for a geographic region, as defined by CIGNA. The Home and Community Care Specialist will be an employee of MCA and the costs for such staffing are included in the rates set forth in the exhibits to the Program Attachments to this Agreement. 23. MCA shall deliver Covered Home Care Services to Participants; Routine, Stat and/or Urgent in accordance with the terms of this Agreement. In those instances where the Covered Home Care Service(s) referred to MCA is to be rendered by a Represented Provider, MCA shall immediately notify the Represented Provider of the referral and, to the extent applicable, the Represented Provider shall immediately attempt to make contact with the referring physician and immediately return phone calls from the referring physician in order to confirm the physician order. 24. Effective January 1, 2004, subject to state regulations, medical appropriateness and availability of personnel, MCA may arrange for physical therapy assistants (PTA) to provide services to Participants. B. COMPENSATION AND BILLING 12 1. For Covered Services provided to or arranged for Participants by MCA and/or Represented Providers consistent with the terms of this Agreement, and for all other obligations hereunder, CIGNA or its designee shall make payments to MCA as set forth in this Section B and in accordance with the applicable Program Attachments. For all fee-for-service charges, CIGNA shall pay MCA within thirty (30) days following receipt of a clean claim submitted by MCA. 2. MCA and Represented Providers shall comply with the following limitations on billing Participants: a. MCA hereby agrees and shall require its Represented Providers to agree that in no event, including, but not limited to non-payment by CIGNA, CIGNA's insolvency or breach of this Agreement, shall MCA or any Represented Provider bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against Participants or persons other than CIGNA or MCA for Home Care Services. This provision shall not prohibit collection of (i) any applicable Copayments, Deductibles or Coinsurance; (ii) payments for services provided to a patient who is no longer eligible to receive Home Care Services, including but not limited to Participants that have reached their benefit limit; or (iii) payments for services provided to Participants that are not Home Care Services. b. MCA further agrees that this provision shall survive the termination of this Agreement regardless of the cause giving rise to such termination and shall be construed to be for the benefit of Participants, and that this provision supersedes any oral or written agreement to the contrary now existing or hereafter entered into between MCA or Represented Providers and the Participant or persons acting on the Participant's behalf. c. Any modification, additions, or deletion to the provisions of this hold harmless clause shall become effective on a date no earlier than fifteen (15) days after the applicable state regulatory agency has received written notice of such proposed change. d. MCA shall not charge, and MCA shall require that its Represented Providers not charge, a Participant for a service which is not Medically Necessary unless, in advance of the provision of such service, the Participant is notified that the service may not be covered and the Participant acknowledges in writing that he or she shall be responsible for payment of charges for such service. 3. MCA or Represented Provider may bill an individual directly for any services provided following the date the individual ceases to be a Participant and for non-covered services delivered to Participants on a fee-for-service basis. Payor has no obligation under this 13 Agreement to pay for services rendered to individuals following the date the individual ceases to be a Participant. MCA may also bill a Participant for any applicable copayments, deductibles, coinsurance, or other ancillary charges. 4. The following provisions apply regarding coordination of benefits: a. CIGNA and MCA agree to cooperate to exchange information relating to coordination of benefits with regard to any Participant for whom MCA's Represented Providers are providing services. b. With respect to those services reimbursed on a capitated basis: 1. Certain claims for services rendered to Participants are claims for which another payor may be primarily responsible under coordination of benefits rules. MCA may pursue and process any such coordination of benefits claims which relate to services provided by MCA's Represented Providers and, in so doing, shall comply with the primary payor's applicable billing rules, including, but not limited to, any of the primary payor's limitations on billing Participants. 2. When Payor is other than primary under applicable coordination of benefits rules, Payor shall not be obligated to pay any amounts in addition to the capitation amounts paid pursuant to this Agreement, and MCA and its Represented Providers agree to reimburse the Participant any CIGNA Copayments, Coinsurance or Deductibles collected from the Participants, that should not have been collected, upon request by CIGNA or the Participant. In the event that MCA or its Represented Providers fail to reimburse such amounts within sixty (60) days of notification by CIGNA that such amounts are due and owing, CIGNA shall have the right to deduct any such amounts from any amounts payable under this Agreement and reimburse the Participant; provided that CIGNA advise MCA in writing of the accounts from which the deduction was taken. 3. When Payor is primary under applicable coordination of benefits rules, MCA shall consider the compensation set forth in this Agreement as payment in full for Covered Services rendered to Participants and shall not seek additional reimbursement from any secondary payors except as required by law. c. With respect to those services reimbursed on a fee-for-service basis: i. Certain claims for services rendered to Participants are claims for which another payor may be primarily responsible under coordination of benefit rules. MCA 14 may pursue and process any such coordination of benefits claims and, in so doing, shall comply with the primary payor's applicable billing rules, including, but not limited to, any of the primary payor's limitations on billing Participants. ii. When Payor is other than primary under applicable coordination of benefits rules, Payor will pay no greater amount than that which, when added to amounts payable to MCA from other sources under the applicable coordination of benefit rules, equals one hundred percent of the MCA's reimbursement for Covered Services pursuant to this Agreement. iii. When Payor is primary under applicable coordination of benefit rules, Payor will pay amounts due pursuant to this Agreement without regard for the obligations of any secondary payors. 5. Upon reasonable notice and during regular business hours, CIGNA or its designee shall have the right to inspect, review and make copies of, at CIGNA's expense, all records maintained by MCA and its Represented Providers with respect to all payments received by MCA and its Represented Providers from all sources for Covered Services rendered to Participants during the term of this Agreement. CIGNA or its designee shall have the right to conduct periodic audits of such records and may audit its own records to determine if amounts have been properly paid under this Agreement. CIGNA shall provide MCA with the results of any such audits and any amounts determined to be due and owing as a result of such audits shall be promptly paid or, at the option of the party to whom such amounts are owed, offset against amounts due and owing by such party hereunder; provided that CIGNA shall notify MCA in writing of the accounts from which any deductions are taken or offsets are made against. This provision shall survive the termination of this Agreement. 6. If MCA or its Represented Providers inappropriately refer a Participant to a non-Participating Provider in a non-Emergency situation, and thereby causes the Participant to become responsible for the charges of the non-Participating Provider, CIGNA or a CIGNA Affiliate may, in its sole discretion, satisfy the obligation of the Participant to the non-Participating Provider. If this occurs, CIGNA may offset the amount paid on behalf of the Participant against the future compensation payable to MCA or its Represented Providers; provided that CIGNA shall notify MCA in writing of the accounts from which any deductions are taken or offsets are made against. 7. MCA and its Represented Providers shall not directly or indirectly bill for or seek to collect from Payor any 15 additional payment for Covered Services beyond the amount required to be paid under this agreement except pursuant to a written request for an appeal or adjustment filed with CIGNA within one hundred eighty (180) days from the date of Payor's payment or explanation of benefits. This provision does not affect any rights MCA might have for reimbursement under any periodic risk sharing settlements described elsewhere in this Agreement. 8. For Home Medical Equipment, MCA agrees to a rental cap at purchase price. Payor shall pay a fee equal to one (1) month's rental charge every six (6) months to compensate for the cost of maintaining the equipment. MCA or Represented Provider, as applicable, shall retain title to the equipment. Notwithstanding the foregoing, oxygen, other respiratory-related equipment and services, and low air-loss beds will not be eligible for rental cap. Payor may continue to rent the equipment until the rental cap is met or purchase the piece of equipment with a maximum of two (2) months rental payments applied to the purchase price. 9. CIGNA shall provide MCA with any applicable limitations on coverage for Covered Home Care Services to Participants under specific Programs. 10. Provider waives any right to interest required to be paid to it under any state law or regulation requiring the payment of claims within a specified period of time it being understood that CIGNA's payment obligations are governed entirely by the terms of this Agreement. C. RECORDS 1. CIGNA, MCA and Represented Providers agree that clinical records of Participants and any other records containing individually identifiable information with respect to Participants shall be regarded as confidential and each shall comply with all applicable federal and state laws and regulations regarding such records. This provision shall survive the termination of this Agreement. 2. MCA or Represented Providers shall maintain and furnish such records and documents as may be required by applicable laws, regulations and CIGNA's Program Requirements. All of such records shall be maintained for the period of time required by applicable law. MCA and Represented Providers shall cooperate with CIGNA to facilitate the information and record exchanges necessary for Quality Management, Utilization Management, peer review, or other programs required for CIGNA's operations. 3. MCA and Represented Providers shall provide CIGNA, its designee and duly authorized third parties, including, but not 16 limited to, applicable governmental regulatory agencies, with reasonable access during regular business hours to specified clinical and medical records related to Covered Services rendered to Participants under this Agreement. Such access shall be provided within the time frames specified by the governmental regulatory authority requesting such access or, if such access is requested by CIGNA only, upon reasonable notice by CIGNA. This provision shall survive the termination of this Agreement. 4. MCA and its Represented Providers shall cooperate in connection with any transfers of Participants' medical records required when Represented Providers cease rendering services to a Participant whether during the term of this Agreement or after termination of this Agreement. MCA and its Represented Providers shall provide copies of such records at no charge. 5. MCA and Represented Providers shall cooperate with CIGNA in the development and maintenance of statistical data, records and procedures in support of Quality Management, Utilization Management and other applicable Program Requirements. 6. MCA and CIGNA shall maintain the confidentiality of all confidential information regarding Participants in accordance with any applicable laws and regulations. MCA shall require Represented Providers to obtain Participant's consent to the disclosure of all records and information necessary to MCA to carry out its utilization management, quality improvement, claims management and payment and other relevant programs and to allow MCA to disclose such information to CIGNA for such purposes. CIGNA agrees to abide by the confidentiality obligations set forth in this Agreement and in the Confidentiality Agreement attached hereto as Exhibit XX and incorporated herein with respect to any private and/or medical record information of Participants disclosed by MCA to CIGNA pursuant to this Agreement. 7. CIGNA agrees to indemnify and hold MCA and Represented Providers harmless for any claim by a Participant for a breach of confidentiality that results from MCA's or Represented Provider's adherence to this Section C and provided that MCA and/or Represented Provider has complied with all the requirements of this Section C and the Business Associates Agreement between MCA and CIGNA. D. PARTICIPANT GRIEVANCE MCA and its Represented Providers shall cooperate with CIGNA in the implementation of its Participant grievance procedure and 17 shall assist CIGNA in taking appropriate corrective action. MCA and its Represented Providers shall comply with all final determinations made by CIGNA pursuant to such grievance procedure. E. INSURANCE AND LIABILITY 1. Throughout the term of this Agreement, MCA shall maintain at MCA's expense general and professional liability coverage in a form and amount acceptable to CIGNA. MCA shall require each Represented Provider to maintain such coverages in a form and amount acceptable to CIGNA. MCA or Represented Providers shall give CIGNA certificates of insurance evidencing the coverages described herein upon request. MCA or Represented Providers shall give CIGNA immediate written notice of cancellation, modification or termination of any such insurances. MCA or Represented Providers shall give CIGNA prompt written notice of any professional liability claims against MCA's or any of its Represented Providers' liability coverage. The Delegated Credentialing Agreement is made part of this agreement in Exhibit XII. 2. MCA shall require that Represented Providers notify MCA immediately, and MCA shall notify CIGNA as soon as it receives notice (i) if there is a material change affecting Represented Provider's or any of Represented Provider's personnel's licensure, accreditation or certification, which would affect the provision of services to Participants under this Agreement or (ii) if a professional, regulatory or legal body (a) serves formal notice that it may take any action due to deficiencies, poor performance or failure to comply with standards, rules or regulations imposed by such professional or regulatory body or (b) initiates an investigation which is material. F. INSPECTIONS Upon reasonable notice and at reasonable hours, CIGNA or its agents may inspect MCA's or Represented Providers' premises and operations to ensure that they are adequate to meet Participants' needs. G. REPRESENTATIONS 1. MCA and each Represented Provider represent and warrant that the information set forth in the CIGNA Application, or MCA Application acceptable to CIGNA, is true and correct to the best of MCA's knowledge. MCA shall promptly notify CIGNA of any changes in the information contained in any Represented Provider's Application within thirty (30) days of such change. 2. MCA represents and warrants that only Participating Providers will be allowed to provide Covered Services under this Agreement, unless otherwise allowed by this agreement. 18 3. MCA will provide evidence of Represented Providers' agreement to abide by the terms of this Agreement upon request. 4. CIGNA makes no representations or guarantees concerning the number of Participants it can or will refer to MCA and its Represented Providers under this Agreement. CIGNA reserves the right to direct business to selected contracted providers in specified geographic areas. See Exhibit XXI for a listing of these areas. 5. CIGNA and MCA acknowledge and agree that: a. this Agreement is a negotiated, armslength transaction in which each party was represented by counsel and has chosen to enter of its own free will; b. Each party fully understands the reimbursement arrangement outlined in this Agreement and believes that it represents a mutually beneficial financial arrangement; and c. neither this Agreement nor any of MCA's participation agreements with its Represented Providers contains any financial incentive or makes any payment that acts directly or indirectly as an inducement to limit Medically Necessary services. 6. CIGNA and MCA acknowledge(s) and agree(s) that: a. Utilization Management decision making for services rendered under this Agreement shall be based only on appropriateness of care and service; b. practitioners or other individuals conducting Utilization Management are not compensated for denials of Covered Services; and c. financial incentives for Utilization Management decision makers do not encourage denials of Covered Services. 7. CIGNA shall cause its affiliate Intracorp to refer to MCA all CIGNA PPO Program Participants referred to or identified by Intracorp to utilize Covered Home Care Services when the utilization review/case management contract applicable to the Participant is between CIGNA and the party with which CIGNA has the Service Agreement. 8. Subject to the exclusions and limitations set forth in Exhibit XXI, and with respect to the HMO, Gatekeeper and PPO Programs only, CIGNA agrees that during the term of this Agreement, it shall not contract with any third party for the provision of Covered Home Care Services which are the subject of this Agreement in those Service Areas for which MCA shall have 19 commenced rendering Covered Home Care Services which are subject to this Agreement and for which all transitioning care has been completed. This provision will not prohibit or restrict CIGNA from contracting with others with regard to services which MCA does not or can not provide or arrange for or for services not included within the scope of this Agreement. 9. CIGNA designates MCA as CIGNA's preferred provider for provision of hemophilia factor products, and agrees to limit Factor providers to Gentiva Health Services and those commercial vendors currently under contract as well as CIGNA Tel-Drug. 10. Effective January 1, 2004, MCA will use all reasonable commercial efforts to arrange for the provision of CPAP and CPAP supplies via direct shipment to the Participant's home. MCA shall provide the appropriate support intervention to include clinic, telephonic or in home support. CIGNA shall establish criteria for appropriate respiratory therapist intervention and assist MCA in enforcing that criteria. 11. Effective January 1, 2004 CIGNA will make all reasonable efforts to advise MCA, in advance, of material health care initiatives, including but not limited to medical management and disease management initiatives, that have the potential to impact the utilization of Home Care Services during the term of the Agreement. MCA agrees to collaborate with CIGNA to maximize the potential of CIGNA initiatives. CIGNA agrees to discuss with MCA and consider the impact of newly developed home care programs that may increase/decrease utilization of Home Care Services activity reflected in the base period used to establish the capitation rate for the impacted period. 12. CIGNA will provide to MCA a quarterly retrospective claims paid report within 120 days following the end of each quarter, to include the HMO, FLEXCARE, PPO and Indemnity populations. MCA will review retrospective claims paid reports provided by CIGNA for the purpose of identifying providers of covered services not subcontracted with MCA. MCA shall use reasonable commercial efforts, as evidenced by contracting results. H. CONFIDENTIALITY/DAMAGING COMMUNICATIONS 1. The parties acknowledge that, as a result of this Agreement, each may have access to certain trade secrets and other confidential and proprietary information of the other. MCA, Represented Providers and CIGNA shall hold such trade secrets and other confidential and proprietary information, including the terms and conditions of this Agreement, in confidence and 20 shall not use or disclose such information, either by publication or otherwise, to any person without the prior written consent of the other party except as may be required by law and except as may be required to fulfill the rights and obligations set forth in this Agreement. With respect to CIGNA, such confidential and proprietary information shall include, without limitation, the Program Attachments, Program Requirements, client lists, and any and all data or information made known to MCA relating to the services rendered to Participants under this Agreement. This provision shall not be construed to prohibit CIGNA from disclosing information to CIGNA Affiliates. In addition, this provision shall not be construed to prohibit CIGNA from disclosing information to the agents or subcontractors of CIGNA or of CIGNA Affiliates or from disclosing the terms and conditions of this Agreement, including reimbursement rates, to existing or potential customers of CIGNA or of CIGNA Affiliates or their representatives, provided that CIGNA is acting in accordance with the terms of the Confidentiality Agreement attached hereto and incorporated herein as Exhibit XX (Confidentiality Agreement). This provision shall survive the termination of this Agreement. 2. Neither CIGNA or MCA shall issue (and MCA will require that its Represented Providers not issue) any disparaging communications which would interfere with or otherwise damage any of the other party's existing or potential contractual relationships. 3. Nothing in subsections 1. or 2. above shall be construed to prohibit: a. communications necessary or appropriate for the delivery of health care services; b. communications to Participants regarding treatment alternatives regardless of the provisions or limitations of the Participant's coverage; c. communications to Participants regarding applicable rights to appeal coverage determinations; d. communications to Participants identifying the type of reimbursement arrangement under which MCA and its Represented Providers are compensated for Covered Services under this Agreement (i.e. fee-for-service, capitation, etc.), excluding any communications with regard to the applicable rates of reimbursement; or e. any other communications expressly protected under applicable state or federal statute or regulation. 21 I. MARKETING EFFORTS MCA agrees to participate in CIGNA's marketing efforts with respect to its various Programs to the extent agreed upon by the parties. J. REPORTING/DATA ACCESS 1. MCA's compensation for the reports, studies, information exchanges and data access delineated in this section and associated exhibits is fully incorporated in the rates and/or fee schedules defined in each Program Attachment and associated exhibits attached hereto. MCA shall receive no additional compensation for the reports, studies, information exchanges and data access. 2. MCA agrees to collect data necessary to complete each report listed in Exhibit VIII. 3. MCA agrees to provide CIGNA with reports, in a form and format mutually agreed upon by both parties, and in accordance with the report timeline set forth in Exhibit VIII attached hereto and incorporated herein. Said reports shall be consolidated reports, incorporating all data from MCA and its Represented Providers. 4. MCA will maintain a quality assurance program (including process improvement initiatives) on Participants on a quarterly basis, and report to CIGNA the results of such initiatives each quarter. CIGNA may conduct home care service satisfaction surveys on Participants, Represented Providers and CIGNA personnel and will supply MCA with the results of any such satisfaction surveys. The format of the quality assurance initiatives shall be mutually developed by the parties. The format of the home care service satisfaction surveys will be developed by CIGNA with input from MCA. 5. MCA agrees to furnish ad hoc reports to CIGNA upon reasonable request by CIGNA to an individual designated by MCA. MCA agrees to provide most simple ad hoc reports requested within 2 to 5 working days. 6. MCA agrees to submit electronic utilization data to CIGNA on Participants as needed. 7. MCA agrees to share with CIGNA all on-line data and all information relating to Participants, including but not limited to, intake, patient status, utilization, outcomes, clinical records, billing and cost information, subject to any applicable confidentiality obligations set forth in this Agreement. 22 8. The parties acknowledge and agree that all of the aggregate data and reports specified in this Agreement relating to Participants and referenced in this Section or elsewhere in this Agreement: a. shall be jointly owned by CIGNA and MCA; b. with respect to such data, information, studies and reports which identify the other party, Participants or parties with whom CIGNA has Service Agreements by name, shall not be used, disclosed or sold by either party (unless such identity shall have been deleted) except as otherwise agreed. This provision shall not apply: (i) to the extent the use or disclosure of such data, information, studies, or reports is required to fulfill obligations hereunder, obligations to Participants and parties with whom CIGNA has Service Agreements or any other obligation imposed by law provided that such disclosure is permitted by the terms of this Agreement or the Confidentiality Agreement (Exhibit XX); or (ii) with respect to usage of such data, information, studies and reports for internal measurement purposes. This provision shall survive the termination of this Agreement and shall not prohibit disclosures by either party to its subsidiaries or affiliates except as otherwise set forth in this Agreement and the Confidentiality Agreement (Exhibit XX). Upon request by CIGNA and free of charge, MCA will provide CIGNA with copies of all materials sold by MCA to third parties containing such data, information, studies and reports. K. BEST RATE GUARANTEE MCA warrants that the rates, terms and benefits granted by MCA as set forth in this Agreement, viewing the package of services hereunder as a whole, are equivalent to, or better than, the rates, terms, benefits being offered by MCA to any company in any area which is contained within or overlaps a CIGNA Service Area which purchases services similar to those provided under this Agreement, viewing the package of such services as a whole. If MCA, during the term of this Agreement, enters into agreements with any other company which provides greater benefits or more favorable terms or rates with respect to like obligations of MCA and like rights of CIGNA, viewing the package of services provided hereunder as a whole, MCA shall notify 23 CIGNA immediately upon consummation of such agreement and at least 30 days prior to the effective date of such agreement. This Agreement shall thereupon be deemed automatically amended to provide the same advantages to CIGNA. This provision shall be enforceable to the extent permitted by applicable law. L. PERFORMANCE GUARANTEES MCA shall perform its obligations under this Agreement in accordance with the standards set forth in Exhibit VII. In the event that MCA fails to achieve a performance standard set forth in Exhibit VII, the amounts due MCA as set forth in the Program Attachments of this Agreement shall be reduced in accordance with the formula set forth in Exhibit VII. III. MISCELLANEOUS OBLIGATIONS A. INDEPENDENT CONTRACTOR RELATIONSHIP 1. This Agreement is not intended to create nor shall be construed to create any relationship between CIGNA and MCA other than that of independent entities contracting for the purpose of effecting provisions of this Agreement. Neither party nor any of their representatives shall be construed to be the agent, employer, employee or representative of the other. 2. Nothing in this Agreement, including MCA and its Represented Providers' participation in the Quality Management and Utilization Management process, shall be construed to interfere with or in any way affect Represented Provider's obligation to exercise independent medical judgement in rendering health care services to Participants. B. TERM OF AGREEMENT This Agreement shall be in full force and effect for a three (3) year period and terminating on December 31, 2006. Notwithstanding the foregoing, CIGNA may terminate this agreement effective December 31, 2005 by providing MCA with no less than ninety (90) days advance written notice of its intention to terminate this Agreement. If CIGNA does not provide such written notice, then the Agreement shall continue in full force and effect. Thereafter, this Agreement shall automatically renew for consecutive one year terms without any further action by either party, unless either party elects not to renew this Agreement by providing at least ninety (90) days advance written notice to the other party, prior to the commencement of the next term. 24 Notwithstanding the expiration or non-renewal of this Agreement pursuant to this Section B., this Agreement shall continue in effect with respect to those Payors covered under Service Agreements in effect as of the end of the term of this Agreement or the notice period, as applicable, but not to exceed twelve months from the effective date of termination or expiration. The parties shall establish capitation rates for year 2005 and 2006 in accordance with the methodology as set forth in Exhibit XXIV. All fee-for-service rates for 2005 and 2006 will be limited to a maximum inflation adjustments, set forth in Exhibit XXIV. MCA will provide to CIGNA the information necessary to establish a capitation rate for 2005 and 2006 no later than November 1st of 2004 and 2005, respectively. In the event that the parties are unable to reach an agreement as to new rates for 2006, either party may terminate this Agreement at any time after December 31, 2005 by giving notice to the other party at least ninety (90) days in advance of the termination specified in such notice. During the notice period (90 days), the 2005 rates shall continue in force for that period. C. TERMINATION 1. FOR CAUSE. This Agreement may not be terminated for cause, except to the extent provided in subsections a. and b. below. All other claims, disputes, controversies, or breaches shall not be cause for termination of this Agreement, but rather shall be resolved through the Dispute Resolution process described in Section III. M. a. MCA may terminate this Agreement for cause: 1. immediately upon written notice to CIGNA if: i. CIGNA ceases to engage in all business activities; ii. CIGNA files a petition for bankruptcy or any other insolvency, rehabilitation, conservation or liquidation proceeding under state or federal law; or iii. Any bankruptcy, insolvency or liquidation proceeding is commenced against CIGNA, which proceeding is (a) not contested by CIGNA or (b) if contested by CIGNA, is not dismissed within sixty (60) days after commencement. 2. upon sixty (60) days advance written notice to CIGNA if: i. CIGNA fails to adhere to any final determination of an arbitrator or, if applicable, the determination of a majority of the arbitrators, within the time frame established by the arbitrator(s), in accordance with 25 the Dispute Resolution procedures pursuant to Section III M; ii. CIGNA fails, without cause, to pay substantially all undisputed amounts due to MCA under this Agreement for more than sixty (60) days after the later of the due date or written notice by MCA. If CIGNA in good faith disputes that monies are due to MCA under this Agreement, then the notice of termination shall not be effective and this Agreement shall remain in effect, subject to sub-subsection i. above; or iii. Any material change or alteration by CIGNA of the Program Requirements is unacceptable to MCA, providing that (a) MCA gives CIGNA notice of rejection of such action within thirty (30) days of receipt by MCA of CIGNA's notice concerning the change or alteration; and (b) CIGNA does not withdraw the change or alteration to the Program Requirements or the parties do not reach an agreement with regard to a mutually acceptable change or alteration to the Program Requirements within thirty (30) days of receipt by CIGNA of MCA's notice of rejection. b. CIGNA may terminate this Agreement for cause: 1. immediately upon written notice to MCA if: i. MCA's license to engage in any business contemplated under this Agreement is revoked, after exhaustion of all appeal rights (so long as MCA is operating while the appeal rights are being exhausted); ii. MCA ceases to engage in all business activities; iii. MCA ceases to be in compliance with applicable federal or state laws, regulations or ordinances, a violation of which would materially impact the ability of MCA to conduct its business, to perform its obligations under this Agreement, to accept reimbursement on the basis described in this Agreement, or to own or control its assets; iv. MCA files a petition for bankruptcy or any other insolvency, rehabilitation, conservation or liquidation proceeding under state or federal law; v. Any bankruptcy, insolvency or liquidation proceeding is commenced against MCA, which proceeding is (a) not contested by MCA or (b) if contested by MCA, is not 26 dismissed within sixty (60) days after commencement; or vi. MCA merges into, becomes a subsidiary or wholly owned affiliate of or is otherwise acquired, in whole or in part, by any other entity. 2. upon sixty (60) days advance written notice to MCA if: i. MCA fails to adhere to any final determination of an arbitrator or, if applicable, the determination of a majority of the arbitrators, within the time frame established by the arbitrator(s), in accordance with the dispute resolution procedures outlined in section III M below; ii. MCA fails to comply with the requirements of Utilization Management and Quality Management; iii. MCA fails to maintain any guarantee of provision of Covered Services as required in this Agreement; iv. MCA fails to correct any deficiency identified by CIGNA in the performance of MCA's responsibilities with respect to any of the functions delegated to MCA under this Agreement within sixty (60) days of notification of such deficiency or, thereafter, fails to maintain compliance with such responsibilities; or v. MCA is in default of its payment obligations to any Represented Provider with respect to services rendered under this Agreement and fails to cure such default within ten (10) days of notification by CIGNA. If CIGNA elects to terminate this Agreement pursuant to this provision, during the time between CIGNA's election to terminate and the effective date of termination, CIGNA may elect to direct any and all payments due MCA hereunder directly to Represented Providers. Such payments shall be made, at CIGNA's election, either in accordance with the reimbursement arrangements set forth in MCA's provider agreements with its Represented Providers or in accordance with CIGNA's maximum fee schedule in effect at the time of service. Payor's payment obligations to MCA hereunder shall be reduced to the extent of such payments. 2. SERVICES UPON TERMINATION. Upon termination of this Agreement, MCA through its Represented Providers shall 27 continue to provide Covered Services for specific conditions for which a Participant was under Represented Provider's care at the time of such termination so long as Participant retains eligibility under a Service Agreement, until the earlier of completion of such services, CIGNA's provision for the assumption of such treatment by another provider, or the expiration of twelve (12) months. MCA shall be compensated for Covered Services provided to any such Participant in accordance with the compensation arrangements under this Agreement until sixty (60) days following termination, and compensation thereafter for continued services authorized by CIGNA shall at the existing fee for service rates. MCA and its Represented Providers have no obligation under this Agreement to provide services to individuals who cease to be Participants. 3. SERVICES AFTER CESSATION OF CIGNA OPERATIONS. In the event of CIGNA's insolvency or other cessation of operations, MCA shall continue to provide Covered Services to Participants through the period for which premium has been paid. MCA shall continue to provide Covered Services to Participants confined in an inpatient facility on the date of insolvency or other cessation of operations until their discharge. MCA further agrees that this Section i) shall survive termination of this Agreement regardless of cause; ii) supersedes any contrary agreement regarding continuation of Covered Services, after cessation of operations; and iii) shall not be modified without the prior written approval of the applicable state or federal governmental authorities. In no event, however, shall MCA be obligated to continue to provide services to Participants under this Agreement for a period of longer than thirty (30) days or as otherwise required by applicable law. 4. AMENDMENT OF MCA AGREEMENTS. If this Agreement is terminated or otherwise expires for any reason other than material breach of its terms by CIGNA, MCA shall cooperate with CIGNA to provide CIGNA with information necessary to communicate with Represented Providers directly regarding CIGNA Participants then receiving Covered Services from Represented Providers. At CIGNA's option, amend MCA's participation agreements with Represented Providers to make CIGNA a party to those agreements for one year beyond the date of termination of this Agreement. CIGNA shall prepare the amendment on behalf of MCA. MCA will cooperate with CIGNA in the implementation of, and in taking any or all action requested by CIGNA to effectuate, said amendments. Notwithstanding the foregoing, MCA shall not be required to amend its participation agreements with Represented Providers as set forth in this section in the event that this Agreement is terminated by MCA due to material breach of its terms by CIGNA. This provision shall survive the termination of this Agreement. 28 5. TERMINATION OF INDIVIDUAL REPRESENTED PROVIDERS. Upon request by CIGNA, MCA shall prohibit a Represented Provider from continuing to provide services to Participants under this Agreement. MCA shall take such action within ninety (90) days of the receipt of CIGNA's request, unless CIGNA requests immediate action by MCA. D. RIGHTS AND OBLIGATIONS UPON TERMINATION Upon termination of this Agreement for any reason, the rights of each party hereunder shall terminate, except as otherwise provided in this Agreement including any Program Attachment to this Agreement. Any such termination, however, shall not release MCA, Represented Providers or CIGNA from obligations under this Agreement prior to the effective date of termination. MCA agrees that for a period of two (2) years following termination of this Agreement by CIGNA, MCA shall not reapply for participation in CIGNA's provider network, unless otherwise agreed by CIGNA. E. ASSIGNMENT AND DELEGATION OF DUTIES Neither CIGNA nor MCA may assign duties, rights or interests under this Agreement unless the other party shall so approve by written consent. It is expressly understood by the parties that CIGNA and MCA may perform its obligations under this Agreement through their affiliates. F. USE OF NAME MCA agrees that CIGNA may include descriptive information relating to MCA and its Represented Providers in literature distributed to existing or potential Participants, Participating Providers and customers of CIGNA or a CIGNA Affiliate. Such information shall include, but not be limited to: Represented Providers' names, office telephone numbers, addresses, specialties, board certifications and hospital affiliations. MCA's use of CIGNA's name or CIGNA Affiliate's name, or any other use of MCA's or its Represented Providers' names by CIGNA shall be upon prior written approval or as the parties may agree. G. INTERPRETATION The validity, enforceability and interpretation of this Agreement shall be governed by any applicable federal law and by the applicable laws of the state in which MCA and its Represented Providers are licensed and have rendered Covered Services. 29 H. AMENDMENT 1. CIGNA may amend this Agreement and Program Attachments by providing prior written notice to MCA. Failure of MCA to object in writing to any such proposed amendment within sixty (60) days following receipt of notice shall constitute MCA's acceptance thereof. Notification to CIGNA of rejection of any proposed amendment means that this Agreement shall remain in force without the proposed amendment. 2. Notwithstanding the foregoing, in the event that state or federal law or regulation, or an arbitration or judicial interpretation of same, should change, alter or modify the present services, levels of payments to CIGNA or MCA, standards of eligibility of Participants, or any operations of CIGNA or MCA, such that the terms, benefits and conditions of this Agreement must be changed accordingly, then upon notice from CIGNA or MCA, the other party shall continue to perform under this Agreement as modified. In this regard, the parties specifically acknowledge the importance of the financial arrangements described herein and, therefore, agree, in the event that the financial arrangements are deemed invalid or unenforceable, the parties shall use best efforts to preserve the underlying economic and financial arrangements to the maximum extent possible. In the event that the parties are unable to reach agreement, then the financial terms shall be set pursuant to the dispute resolution process, giving full effect to the intent of the parties as described in this subsection. 3. Except as provided above, amendments to this Agreement shall be agreed to in advance in writing by CIGNA and MCA. I. PROGRAM ATTACHMENTS The Program Attachments and Exhibits hereto are a part of this Agreement and their terms shall supersede those of other parts of this Agreement in the event of a conflict. J. ENTIRE CONTRACT This Agreement together with all Program Attachments and Exhibits contains all the terms and conditions agreed upon by the parties, and supersedes all other agreements, express or implied, regarding the subject matter. K. NOTICE Any notice required hereunder shall be in writing and shall be sent by United States mail, postage prepaid, to CIGNA and MCA at the addresses set forth below: Al Perry, President and COO 30 3 Huntington Quadrangle 2S Melville, NY 11747 If to CIGNA: CIGNA HealthCare National Contracting 900 Cottage Grove Road, A-136 Hartford, CT 06152 And CIGNA HealthCare Legal Department 900 Cottage Grove Road, W-26 Hartford, CT 06152 L. ENFORCEABILITY AND WAIVER The invalidity and nonenforceability of any term or provision of this Agreement shall in no way affect the validity or enforceability of any other term or provision. The waiver by either party of a breach of any provision of this Agreement shall not operate as or be construed as a waiver of any subsequent breach thereof. M. DISPUTE RESOLUTION 1. Any disputes between the parties arising with respect to the performance or interpretation of the Agreement shall first be resolved in accordance with the dispute resolution procedures outlined in the Program Requirements . 2. In the event that a dispute is not resolved through the aforementioned process, the parties shall attempt in good faith to resolve the dispute promptly by negotiation between designated representatives of the parties who have authority to settle the dispute. If the matter has not been resolved within sixty (60) days of a party's request for negotiation, either party may initiate arbitration by providing written notice to the other party. 3. If a party initiates arbitration as provided above, the proceeding shall be governed by the Rules of the American Arbitration Association then in effect and shall be held in the jurisdiction of MCA's domicile. The parties will jointly appoint a mutually acceptable arbitrator. If the parties are unable to agree upon such an arbitrator within thirty (30) days after a party has given the other party written notice of its desire to submit a dispute for arbitration, then either party may apply to the American Arbitration Association for the appointment of an arbitrator or, if such Association is not then in existence or does not desire to act in the matter, each party shall appoint an arbitrator of its choice. The appointed arbitrators will select a third arbitrator, and the panel of three arbitrators will hear the parties and settle 31 the dispute. Each party shall assume its own costs, but the compensation and expenses of the arbitrator(s) and any administrative fees or costs shall be borne equally by the parties. Arbitration shall be the exclusive remedy for the settlement of disputes arising under this Agreement. The decision of the arbitrator(s) shall be final, conclusive and binding, and no action at law or in equity may be instituted by either party other than to enforce the award of the arbitrator(s). Judgment upon the award rendered by the arbitrator(s) may be entered in any court of competent jurisdiction. N. NON-SOLICITATION During the term of this Agreement and for a period of one (1) year from the date of termination, MCA shall not solicit Participants to enroll in any other insurance or health coverage or alternative delivery system, nor shall CIGNA or MCA actively solicit any employees of the other to be employed by or contracted with the other party in any capacity related to services to be performed under this Agreement during this Agreement, and for a period of one (1) year thereafter without the other party's written consent. [REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK] 32 IN WITNESS WHEREOF, the parties have executed this Agreement effective as of the EFFECTIVE DATE. EFFECTIVE DATE: CIGNA January 1, 2004 By: /s/ William Lamoreaux ---------------------------- Title: Senior Vice President Address: 900 Cottage Grove Road Hartford, CT 06152 Date Signed: 12/12/03 MCA Gentiva Health Services, Inc. Please print or type name By: /s/ Vernon A. Perry ---------------------------- Signature Title: President Address 300 Huntington Quadrangle 2S Melville, NY 11747 Federal Tax Identification Number 11-3454103 Date Signed: 12/8/03 Under penalties of perjury, by executing this Agreement above, MCA hereby certifies that 1) the taxpayer identification number set forth above is the correct taxpayer identification number; and 2) MCA is not subject to backup withholding because it a) is exempt from backup withholding; or b) has not been notified by the Internal Revenue Service (IRS) that it is subject to backup withholding as a result of a failure to report all interest or dividends; or c) the IRS has notified MCA that it is no longer subject to backup withholding. GTKP EXB - 1 GENTIVA CONTRACT EXHIBITS I. REPRESENTED PROVIDER AGREEMENT II. REQUIRED ENCOUNTER DATA ELEMENTS III. INFORMATION REQUIRED FOR A COMPLETE ORDER IV. CLEAN CLAIM DATA REQUIREMENTS V. GENTIVA CARECENTRIX SUBSIDIARIES VI. GUIDELINES FOR HOME & COMMUNITY CARE SPECIALIST VII. PERFORMANCE METRICS VIII. REPORTING TIMELINE IX. SAFE HOME CARE ADMISSION CRITERIA X. REPRESENTED PROVIDER REQUIRED DATA ELEMENTS XI. JOINT COMPLAINT MANAGEMENT PROCESS XII. 2003 STANDARDS FOR DELEGATION OF CREDENTIALING XIII. DME GUIDELINES GRID XIV. PARTICIPATING CIGNA SUBSIDIARIES & AFFILIATES XV. HOME HEALTH CARE BENEFIT CLARIFICATION GUIDELINE XVI. STANDARDS FOR DELEGATION OF CLINICAL SERVICE MANAGEMENT ACTIVITIES XVII. EXCLUSIONS DOCUMENT XVIII. CLINICAL SERVICE MANAGEMENT DELEGATION GRID XIX. MCA REPRESENTED PROVIDER APPLICATION XX. CONFIDENTIALITY AGREEMENT XXI. CIGNA NATIONAL CAPITATION HMO MARKET EXCLUSIONS XXII. STANDARDS FOR DELEGATION OF UTILIZATION MANAGEMENT ACTIVITIES FOR CIGNA HEALTHCARE OF TEXAS, INC. XXIII. MANAGED CARE ALLIANCE AGREEMENT CREDENTIALING PROCESSES XXIV. FUTURE YEARS RATE METHODOLOGY EXHIBIT I REPRESENTED PROVIDER AGREEMENT GENTIVA CARECENTRIX PROVIDER AGREEMENT THIS PROVIDER AGREEMENT is entered into as of this ____ day of _______2003, by and between ________________ located in ________________ ("PROVIDER") and Gentiva CareCentrix, Inc., located in Melville, New York ("GENTIVA"). PROVIDER's federal tax ID number: ________________________________. GENTIVA has entered into agreements with certain managed care entities ("Payors") which may require that health care services be delivered to their respective enrollees; GENTIVA desires to contract with PROVIDER to be available to provide certain of those services, and PROVIDER is willing to provide such services to the managed care patients designated by GENTIVA. NOW THEREFORE, PROVIDER and GENTIVA agree to the following terms and conditions. 1. RESPONSIBILITIES OF PROVIDER. 1.01 GENERAL. PROVIDER shall, to the extent requested by GENTIVA, sell the home care services described on Schedule A hereto (the "Services") to GENTIVA. PROVIDER shall coordinate the provision of Services to patients pursuant to this Agreement with all other providers involved in each such patient's care. GENTIVA is not required to purchase any minimum amount of Services. Upon GENTIVA's request for Services, PROVIDER assumes full responsibility for accepting the patient to home care and for the provision of the Services. 1.02 QUALIFICATIONS. PROVIDER represents and warrants that: (a) All of PROVIDER's employees, agents and representatives hold and shall continue to hold all federal, state and local licenses, registrations, certifications and training required by law, regulation and accreditation standards in order to render the Services pursuant to this Agreement. All RNs, LPNs, Pharmacists, Pharmacy Techs, PTs, OTs, MSWs and other professional and paraprofessional personnel providing the Services on behalf of PROVIDER must be qualified and have demonstrated competency, clinical experience and training in each type of clinical service they will provide. At GENTIVA's request, PROVIDER shall provide to GENTIVA copies of applicable licenses and other evidence of qualifications. (b) PROVIDER is duly licensed to provide the Services and shall furnish to GENTIVA copies of PROVIDER's valid license, certificate and accreditation applicable to the Services and itemized in Schedule A hereto. In lieu of such accreditation, PROVIDER must demonstrate substantial evidence of compliance with current JCAHO, CHAP, CARF OR ACHC accreditation standards. 1.03 PERFORMANCE STANDARDS. PROVIDER shall render the Services with the same standard of care, skill and diligence customarily used by similar providers in the community in which such services are rendered, and shall comply with all of the standards, terms and conditions set forth on Schedule A and all relevant standards, policies and procedures of GENTIVA (including those set forth in the Provider Manual) and PROVIDER. PROVIDER shall ensure that its employees maintain a neat, clean and professional appearance at all times. 1.04 QUALITY MANAGEMENT. PROVIDER shall fully cooperate with GENTIVA in GENTIVA's quality management, utilization review, outcomes monitoring, client satisfaction, complaint/grievance, credentialing and recredentialing programs, including participating in any meetings deemed appropriate by GENTIVA. Nothing in this Agreement shall render GENTIVA responsible for the manner or means by which PROVIDER renders the Services nor shall in any way affect PROVIDER's obligation to exercise independent medical judgment in rendering health care services to patients. 1.05 PERSONNEL CANCELLATION. After Services have been scheduled and confirmed, PROVIDER is responsible for delivery of the Service, and shall, in the event of any personnel cancellation, supply a qualified caregiver replacement of PROVIDER. In the event that PROVIDER cannot service the patient, PROVIDER shall notify GENTIVA immediately of cancellation. 1.06 COMPLIANCE WITH LAWS AND ACCREDITATION BODIES; NOTICE OF CERTAIN ACTIONS. (a) PROVIDER shall comply with all applicable federal, state and local laws, rules and regulations, and if applicable, JCAHO or CHAP (or CARF) (or ACHC) accreditation standards. PROVIDER shall cooperate with GENTIVA in responding to JCAHO or CHAP (or CARF) (or ACHC) inquiries, including without limitation surveys of PROVIDER premises and records by JCAHO or CHAP (or CARF) (or ACHC). (b) PROVIDER shall notify GENTIVA immediately (i) if there is a change affecting PROVIDER's or any PROVIDER's personnel's licensure, accreditation or certification, or (ii) if a professional, regulatory or legal body (x) serves formal notice that it may take any action due to deficiencies, poor performance or failure to comply with standards, rules or regulations imposed by such professional or regulatory body or (y) initiates an investigation which is material. PROVIDER shall give GENTIVA prompt written notice of any claims against PROVIDER's professional liability coverage relating to quality of care issues. (c) To the extent that the rates charged by PROVIDER pursuant to Schedule B hereof represent a discount or reduction in the amount PROVIDER generally charges for the Services, the parties agree to comply at all times with the provisions of 42 C.F.R. Section 1001.952(h), commonly known as the "discount safe harbor." 1.07 INCIDENT REPORTS AND COMPLAINTS. PROVIDER shall inform GENTIVA immediately of any incident or circumstance relating to any Services which adversely affects the health or safety of a Payor's enrollee, and/or of PROVIDER's receipt of any oral or written complaint relating to Services provided hereunder. PROVIDER shall provide copies to GENTIVA of an incident report and such other information related to any such incident and shall fully cooperate with GENTIVA in any investigation of such incident or complaint. 1.08 UNSATISFACTORY PERSONNEL. If GENTIVA reasonably determines that any PROVIDER personnel is unsatisfactory, GENTIVA may require PROVIDER to not use designated personnel, or require personnel to leave a patient's home or other care delivery site, (and in such case shall notify PROVIDER promptly). In any such case, GENTIVA's obligation to compensate PROVIDER shall be limited to the number of hours actually worked or the Services actually provided, and PROVIDER shall not reassign the individual to provide Services under this Agreement without the prior approval of GENTIVA. 1.09 SUBSTITUTION. (a) If any service not listed in Schedule A is required by GENTIVA, PROVIDER shall use reasonable efforts to provide such service and adjust its fees as mutually agreed. (b) PROVIDER shall utilize generic drugs whenever possible and appropriate. 1.10 WARRANTIES. (a) PROVIDER warrants that the Services including any product(s) delivered in connection with the Services, when used in accordance with the directions provided by PROVIDER, are fit for the intended purpose and indications described in the labeling, that all labeling is accurate, legible and can reasonably be expected to be understood by the patient receiving the Services and that all equipment (if any) provided under this Agreement shall be in good working order and condition, and properly cleaned and disinfected between uses. (b) To the extent that PROVIDER provides any equipment hereunder, PROVIDER shall provide or arrange for at PROVIDER's expense all necessary on-site maintenance and/or repair for equipment (including provision of all necessary parts, mechanisms and devices) in order to maintain the equipment in good condition and working order. PROVIDER shall provide or arrange for twenty-four (24) hour per day, seven (7) day per week maintenance and repair service by trained, competent and experienced personnel; provided however, that PROVIDER may elect to pick up the equipment needing maintenance and/or repair and replace it with equipment in operable condition, rather than repair the equipment immediately. PROVIDER shall, upon GENTIVA's request, furnish copies of all applicable inspection reports, manufacturer's operating manuals, instructions and related materials relating to the equipment. 1.11 ACCURATE INFORMATION. PROVIDER represents and warrants that all information (including without limitation information contained in the application materials) which PROVIDER has furnished to GENTIVA to induce GENTIVA to enter into this Agreement with PROVIDER is true and accurate, and that PROVIDER shall promptly notify GENTIVA of any change in the information contained in such materials. 1.12 REPORTS. PROVIDER shall prepare, maintain and deliver to GENTIVA any reports and documentation specified in the Provider Manual or otherwise reasonably requested in writing by GENTIVA including without limitation, pertaining to accurate inventories of solutions, medications, drugs, equipment and ancillary supplies for each patient provided by PROVIDER hereunder, and a listing of all equipment in use by each patient, provided by PROVIDER, including the number of months patients have had the equipment. 1.13 ADDITIONAL PAYOR SOURCES. PROVIDER shall promptly notify GENTIVA when it becomes aware of any additional primary or secondary payor sources for any patient. 1.14 EMPLOYER OBLIGATIONS. PROVIDER shall maintain full responsibility as employer of its personnel for payment of their wages and other compensation, and for any applicable mandatory withholdings and contributions such as federal, state and local income taxes, social security taxes, worker's compensation, unemployment and disability coverages. 2. RESPONSIBILITIES OF GENTIVA. 2.01 GENERAL. For each patient for whom GENTIVA requests Services, GENTIVA shall deliver by facsimile to PROVIDER a written authorization confirming a telephone request for service by next business day, and for services provided in an emergency GENTIVA shall provide authorization by next business day. 2.02 REQUESTS FOR PERSONNEL. GENTIVA shall attempt to request personnel at least 24 hours prior to reporting time and shall provide information regarding reporting time and assignment to PROVIDER at the time of the initial call. 2.03 PAYMENTS. GENTIVA shall compensate PROVIDER as provided in Article 3 below. 3. COMPENSATION. 3.01 INVOICES. PROVIDER shall provide GENTIVA with monthly invoices (on HCFA 1500 or UB92 forms) with an itemization of all Services requested by GENTIVA during the previous month. PROVIDER shall not bill any Payor directly unless PROVIDER shall have obtained GENTIVA's advance written consent in each instance. 3.02 RATES. GENTIVA shall pay to PROVIDER the rates set forth in SCHEDULE B for the Services provided in accordance with this Agreement. These rates are all inclusive and PROVIDER shall receive no additional compensation for reports, information exchanges, or other services contemplated by this Agreement. 3.03 PAYMENT TERMS. GENTIVA shall pay PROVIDER the undisputed invoiced amount under this Agreement within forty five (45) days from GENTIVA's receipt of a properly completed invoice from PROVIDER. 3.04 NON-COVERED SERVICES AND REIMBURSEMENT TO GENTIVA. Notwithstanding the foregoing, GENTIVA shall not be obligated to pay for and PROVIDER shall be required to reimburse to GENTIVA any payment made for any Services (a) that were not (i) requested by GENTIVA (except for any emergency services), or (ii) in accordance with GENTIVA's written authorization, or (iii) in accordance with the physician plan of care; (b) for which a properly completed invoice is not received by GENTIVA within 45 days of the date the Services are rendered; (c) until such time as GENTIVA shall have received from PROVIDER the reports and documentation referred to in Section 1.12; (d) delivered to a patient not enrolled in the Payor health plan at the time Services were delivered; or (e) if the respective Payor was not the primary payor at the time Services were delivered. 3.05 HOLD HARMLESS. (a) PROVIDER agrees that in no event, including but not limited to nonpayment by GENTIVA, insolvency of GENTIVA or breach of this Agreement, shall PROVIDER bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against a patient or persons acting on his/their behalf for Services provided hereunder. This provision does not prohibit PROVIDER from collecting fees for non-covered services delivered to patients, subject to subsection (b) below. PROVIDER shall not collect any applicable Co-payment, deductible or coinsurance (determined as a percentage of charges) from patients. (b) When PROVIDER has been notified in advance that a particular service is not medically necessary, PROVIDER shall not charge the patient for such service unless, in advance of the provision of such service, PROVIDER has notified the patient that the service is not covered and the patient acknowledges in writing that he or she shall be responsible for payment of charges for such services. (c) PROVIDER agrees that the provisions of this Section 3.05 shall survive the termination of this Agreement regardless of the reason for termination, and shall be construed for the benefit of the patients, and that this provision supersedes any oral or written agreement to the contrary now existing or hereafter entered into. Any modification to the provisions of this Section shall become effective 15 days after the applicable regulatory authority shall have received written notice of such proposed changes. 4. TERM AND TERMINATION. 4.01 (a) TERM. Upon execution by both parties, this Agreement shall be in effect for one (1) year from the date first written above and thereafter shall automatically renew for subsequent one year terms. (b) TERMINATION. (i) Either party may terminate this Agreement if any warranty, representation or material covenant of the other party contained herein is untrue or is breached during the term hereof, and any such breach is not cured to the satisfaction of the other party within fifteen (15) days after receipt of the written notice from the nonbreaching party; (ii) either party, at its option, may terminate this Agreement at any time upon 90 days written notice to the other party, and (iii) PROVIDER may terminate this Agreement during the first thirty (30) days after the date of this Agreement if PROVIDER objects to the terms and conditions set forth in GENTIVA's Provider Manual. If PROVIDER does not terminate this Agreement during the first thirty (30) day period, then PROVIDER shall have waived its right to terminate this Agreement based on objections to the Provider Manual. 4.02 ORDERLY TERMINATION. Upon termination of this Agreement, PROVIDER shall reasonably cooperate with GENTIVA to ensure that patients are not left without medically necessary care. PROVIDER shall, at GENTIVA's request, continue to provide the Services to any patient receiving the Services at the time of such termination for thirty (30) days thereafter and GENTIVA shall pay PROVIDER in accordance with the rates hereunder. 5. MISCELLANEOUS TERMS. 5.01 INDEMNIFICATION. (a) GENTIVA and PROVIDER ("Indemnitor") shall each defend, indemnify and hold the other party ("Indemnitee") harmless and each of Indemnitee's officers, directors, employees, agents and stockholders (the "Indemnitee Parties"), from and against any and all claims, liabilities, losses, damages, costs or expenses of any kind (including reasonable attorney's fees and disbursements) ("Indemnified Amounts") incurred by the Indemnitee Parties as a result of Indemnitor's performance under this Agreement, but only to the extent that such Indemnified Amounts are caused by the negligence or other wrongful act or omission of Indemnitor. (b) Indemnitee shall notify the Indemnitor in writing of the assertion of any claim, or the commencement of any suit, action or proceeding by any party in respect of which indemnity may be sought under this Agreement within thirty (30) days of such assertion or commencement. Failure to notify the other party shall result in the waiver of indemnity rights with respect to such claim, suit, action or proceeding, but only to the extent that the Indemnitor is prejudiced by such failure. The parties shall cooperate with each other in the defense of any such claim, suit, action or proceeding. 5.02 CORPORATE INTEGRITY COMPLIANCE. PROVIDER represents and warrants that currently, and throughout the term of this Agreement (including any extended term), (I) neither PROVIDER, nor any of its employees or agents who may perform any of the services or obligations under this Agreement ("PROVIDER Individuals"), shall (A) have been convicted of a criminal offense that would trigger exclusion pursuant to 42 USC 1320a-7(a) or (b) unless such entity or individual has been reinstated, or (B) be listed by a Federal agency as currently suspended, debarred, excluded or otherwise ineligible for Federal program participation (including as reflected on the Cumulative Sanctions Report of the United States Health and Human Services Office of the Inspector General's, or the United States General Services Administration's List of Parties Excluded from Federal Procurement and Non-Procurement Programs). Any breach of this representation and warranty shall result in immediate termination of this Agreement with respect to the affected individual or entity, in addition to any other available remedies. 5.03 INSURANCE. (a) Each party shall maintain at its sole expense the following insurances: (i) general liability coverages (including without limitation product liability and contractual liability), in an amount not less than One Million Dollars ($1,000,000) each occurrence and Two Million Dollars ($2,000,000) in the aggregate, for bodily injury and property damage; (ii) professional liability (medical malpractice) coverage in the amount of One Million Dollars ($1,000,000) each occurrence and Three Million Dollars ($3,000,000) in the aggregate (iii) statutory workers' compensation coverage meeting all state and local requirements, including employers' liability coverage in an amount not less than One Million Dollars ($1,000,000) per person; (iv) automobile liability insurance for owned, non-owned and hired automobiles with a minimum combined single limit of One Million Dollars ($1,000,000) for bodily injury and property damage each occurrence and (v) a client fidelity (3rd party) bond in the amount of Fifty Thousand Dollars ( $50,000). All Represented Providers shall at minimum maintain limits in accordance with those required by the state(s) where the Represented Provider is licensed. (b) PROVIDER agrees to ensure that any nurse, pharmacist or other licensed professional who performs an activity pursuant to this Agreement on its behalf and is not an employee of PROVIDER carry the same insurance coverages PROVIDER is required to maintain. This includes but is not limited to (i) malpractice liability insurance in an amount not less than One Million Dollars ($1,000,000) per occurrence and Three Million Dollars ($3,000,000) in the aggregate and (ii) general liability insurance in an amount not less than One Million Dollars ($1,000,000) each occurrence and Two Million Dollars ($2,000,000) in the aggregate, for bodily injury and property damage. (c) The general liability policy shall name Gentiva as an additional insured and be endorsed to cover liability assumed by the PROVIDER under the indemnity provisions of this Agreement. With respect to the workers' compensation policy, PROVIDER shall require the carrier to waive all rights of subrogation against Gentiva. Each party shall give the other immediate notice of any changes in the policy of insurance or self-insurance maintained under this Agreement. Each party shall require any insurer to give the party at least 30 days' advance notice of any cancellation, lapse, termination, or amendment of any policy of insurance. In the event that coverage is of a claims-made variety, each party shall continue to maintain policies of insurance in effect to cover claims that occur during the term of this Agreement for a period of 5 years beyond the term or any renewal term of this Agreement. Failure to maintain such coverage shall be grounds for termination of this Agreement for cause, and the breaching party shall indemnify the other party for any loss incurred as a result of the breaching party's failure to maintain such coverage, which obligation to indemnify shall survive termination of this Agreement. 5.04 ASSIGNMENT/SUBCONTRACTING. Neither party may assign or subcontract its rights or obligations under this Agreement without the prior written consent of the other party which shall not be unreasonably withheld or delayed, provided, however, either party may assign this Agreement to any entity owned by or under common control with such party. The assigning party shall remain fully responsible for compliance with this Agreement. 5.05 ACCESS TO BOOKS AND RECORDS. (a) During the term of this Agreement and for three (3) years following termination of this Agreement, GENTIVA and its duly authorized agents, during regular business hours and upon reasonable notice and demand, shall have access to all information and records related to Services rendered by PROVIDER under this Agreement or to the effectiveness of GENTIVA's utilization management, quality improvement, claims management and payment and other programs. (b) For at least five (5) years after the date of delivery of service, PROVIDER shall maintain and readily make available to government agencies with regulatory authority, medical and administrative records relating to Services, pursuant to applicable law or regulation. 5.06 NON-DISCLOSURE AND CONFIDENTIALITY; NON-SOLICITATION. (a) PROVIDER shall not disclose the terms of this Agreement, including but not limited to any fee schedule, without the prior written consent of GENTIVA. (b) PROVIDER and GENTIVA shall maintain the confidentiality of all confidential information regarding patients in accordance with any applicable laws and regulations. PROVIDER shall provide GENTIVA with all records and information necessary to carry out GENTIVA's utilization management, quality improvement, claims management and payment and other relevant programs (and shall obtain any consents which may be required to allow such disclosure to GENTIVA and to allow GENTIVA to disclose such information to third parties for such purposes). (c) PROVIDER acknowledges that in order to provide the Services hereunder, it may from time to time receive proprietary or confidential information from GENTIVA, including without limitation, patient identification, customer and client identification and lists, accounts, business operating methods, programs, policies, procedures and forms. PROVIDER shall keep such information confidential and (unless otherwise required by law) shall not disclose it to any person except as authorized in writing by GENTIVA. (d) During the term of this Agreement, PROVIDER shall not request, advise, or solicit any client, customer, supplier, or patients serviced by PROVIDER pursuant to this Agreement to curtail, terminate or cancel their relationship with GENTIVA. (e) PROVIDER shall not make any public announcement or press release with respect to its relationship to GENTIVA described in this Agreement or any other matter in connection with this Agreement, without the prior written consent of GENTIVA. (f) The provisions of this Section shall survive the termination of this Agreement. PROVIDER acknowledges that if the provisions of this Section are breached, the damage to GENTIVA shall be irreparable and thereby shall entitle GENTIVA to obtain immediate and permanent injunctive relief restraining PROVIDER from such breach or threatened breach of the provisions hereof, without need to post any bond. PROVIDER further acknowledges that such injunctive relief is in addition to any other legal or equitable remedies GENTIVA may be entitled to under this Agreement. 5.07 PROTECTED HEALTH INFORMATION: Gentiva and Provider agree that all member individually identifiable health-related information ("Protected Health Information") shall be used and disclosed only as permitted by applicable state and federal laws, including without limitation applicable Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 and regulations promulgated there-under ("HIPAA"). Gentiva and Provider shall also adopt and maintain procedures consistent with applicable law to safeguard the security and confidentiality of Protected Health Information. Provider shall cooperate and assist Payer and/or Gentiva as needed to obtain all necessary or required patient consents in compliance with applicable state and federal law. Except as required to carry out Provider's obligations under this Agreement, Provider shall not disclose, sell or otherwise transfer or provide any Protected Health Information or other Confidential Information on any individually identifiable patient basis to any third party. In no event shall Provider sell any Protected Health Information or other Confidential Information of Payer or Gentiva, whether or not such information is individually identifying. 5.08 USE OF NAME. Neither party may use any trade name or service mark of the other party or any material protected by patents, trademarks or copyrights without the express written permission of the other party, except that either party may list the other party in any relevant directory of services and related marketing materials of such party, or, in GENTIVA's case, of any Payor Directories. 5.09 INDEPENDENT CONTRACTORS. The parties enter into this Agreement as independent contractors, and nothing contained in this Agreement shall be construed to create a partnership, joint venture, agency or employment relationship between the parties or any of their respective officers, directors or employees. 5.10 CORPORATE COMPLIANCE PROGRAM. GENTIVA maintains a voluntary corporate compliance program to detect and prevent illegal and unethical activities. PROVIDER confirms that it has been informed of GENTIVA corporate compliance hotline (1-888-9NOTIFY) for reporting suspected fraud, abuse or other illegal or unethical activities, and will assure that all employees or agents of GENTIVA who may perform any of the services or obligations under this Agreement are informed of the same and instructed to report accordingly. 5.11 OWNERSHIP AND USE OF DATA AND INFORMATION. GENTIVA shall own all data, documents, software programs and other information generated in the performance of this Agreement, including all patient information submitted by PROVIDER pursuant to Section 5.05(b) above. These provisions shall not prohibit PROVIDER from owning data specific to its patients and created by PROVIDER. Subject to the confidentiality obligations under this Agreement and those imposed by law, GENTIVA shall have the right to use any such information in the general course of its business. 5.12 AMENDMENT AND WAIVER. (a) Subject to the provisions of subsection (b) of this Section, no amendment, modification or supplement of this Agreement, and no waiver hereunder shall be valid or binding unless set forth in writing and duly executed by a duly authorized signatory of the party against whom enforcement of the amendment, modification, supplement or waiver is sought. Waiver by either party of an event of default or breach of the provisions of this Agreement shall not constitute a waiver of any other event of default or breach or right, nor of the same event of default or breach or right on a future occasion. (b) GENTIVA may modify any provision of this Agreement upon thirty (30) days prior written notice to PROVIDER. PROVIDER shall be deemed to have accepted GENTIVA's modification if PROVIDER fails to object to such modification, in writing, within the thirty (30) day notice period. In the case of modifications that materially affect the responsibilities or rights of PROVIDER, PROVIDER shall have the right to terminate this Agreement on thirty (30) days prior written notice to GENTIVA delivered within the 30 day notice period referred in the preceding sentence. Amendments required by legislative, regulatory or other legal authority, as reasonably determined by GENTIVA, shall not require the consent of GENTIVA or the PROVIDER and shall be effective immediately upon PROVIDER's receipt of notice of amendment. 5.13 ENTIRE AGREEMENT. This Agreement contains the entire agreement between the parties, supersedes all discussions and writings by and between the parties which may have occurred prior to or contemporaneously with entering into this Agreement and shall be binding upon and inure to the benefit of the parties and their permitted successors and assigns. 5.14 GOVERNING LAW. This Agreement shall be governed by the laws of the State of New York. 5.15 SEVERABILITY. If any provision of this Agreement is held to be invalid or unenforceable under current or future laws, the remainder of the provisions of this Agreement shall remain in full force and effect and shall in no way be affected, impaired or invalidated, as long as the invalid provision is not material to the overall purpose and operation of this Agreement. 5.16 NOTICES. Notices provided hereunder shall be given in writing and sent to the addresses below by hand delivery; facsimile, certified mail, return receipt requested; or nationally recognized overnight courier. Any address or name specified may be changed by a notice given by the addressee to the other party in accordance with this Section. Any notice of demand or other communication shall be deemed given and effective as of the date of receipt. PROVIDER shall notify GENTIVA in writing within seven days after the occurrence of: a. A change of the PROVIDER'S business address or of any Represented PROVIDER'S address, including any relocation or elimination of a location. b. The termination, reduction or cancellation of the insurance coverages required under this Agreement; c. Any material changes in the Providers ownership, to the extent that the ownership or control of the Provider changes by twenty percent (20%) or more; d. Any situation which might materially affect the Group's or a Represented PROVIDER'S ability to carry out the duties under this Agreement or to meet any Credentialing/Re-Credentialing criteria. PROVIDER GENTIVA ___________________________ GENTIVA CARECENTRIX ___________________________ 3 Huntington Quadrangle S2 ___________________________ Melville, NY 11747 ___________________________ Attn.: Provider Relations PHONE #:_____________________ FAX#:________________________ 5.17 HEADINGS. The headings in this Agreement are for convenience only and shall not be considered a part hereof or affect the construction or interpretation of any provisions of this Agreement. 5.18 COUNTERPARTS. This Agreement may be executed simultaneously in two or more counterparts, each of which shall constitute but one and the same instrument. 5.19 SURVIVAL OF OBLIGATIONS. Termination of this Agreement for any cause shall not release either party from any liability which at the time of termination has already accrued to the other party or which thereafter may accrue in respect to any act or omission occurring prior to termination from any obligation which is expressly stated herein to survive termination. 5.20 NON-DISCRIMINATION. Neither PROVIDER or GENTIVA shall discriminate in employment or provision of services with respect to age, race, color, religion, veteran status, sex, national origin, disability, source of payment or any other category protected by law. 5.21 ARBITRATION. Any dispute relating to this Agreement shall be settled by binding arbitration conducted in accordance with the Health Care Arbitration Rules of the NHLA Alternative Dispute Resolution Services. 5.22 MEDICARE PROVISIONS. GENTIVA may request that PROVIDER provide services to enrollees PAYOR's Medicare+Choice plan ("PAYOR PLAN") and PROVIDER recognizes that federal regulations impose certain requirements on all providers, including PROVIDER, rendering services to individuals enrolled in Medicare+Choice plans. Therefore, PROVIDER shall comply with all of the standards, terms and conditions set forth on Schedule C. THEREFORE, the authorized representatives of the parties have executed this Agreement as of the date first written above. PROVIDER: GENTIVA CARECENTRIX: By: By: ---------------------------- ---------------------------- Title: Title: ------------------------- ------------------------- SCHEDULE A TO PROVIDER AGREEMENT HEALTH CARE SERVICES In addition to the terms and conditions identified in previous sections of the Provider Agreement, PROVIDER agrees to the provisions contained in this schedule: A. SERVICES TO BE PROVIDED 1. Home Health Agency [ ] Skilled Nursing [ ] Pediatric Specialty [ ] Therapists [ ] Homemakers/Companions [ ] Rehab Paraprofessional [ ] Medical Social Workers [ ] Home Health Aides/PCW [ ] Live-in [ ] Other ________________ 2. Home Infusion Therapy [ ] Infusion Products [ ] Full Service [ ] Ambulatory Center 3. Hospice Services [ ] Home-based [ ] Facility-based 4. Home Medical Equipment [ ] Standard Equipment [ ] Orthotics and [ ] Medical Supplies Prosthetics [ ] Customized Equipment 5. Respiratory Services [ ] Respiratory Products [ ] Respiratory Therapists 6. Women's Health Services [ ] High Risk OB - Level 1 [ ] Low Risk OB [ ] High Risk OB - Level 2 [ ] Prenatal Education [ ] High Risk OB - Level 3 [ ] HUAM 7. Medical Rehabilitation Services [ ] Physical Therapists [ ] Physical Therapy Assistants [ ] Occupational Therapists [ ] Occupational Therapy [ ] Speech & Language Pathologists Assistants [ ] Outpatient [ ] Rehab Paraprofessionals 8. Quality Assurance/Quality Improvement Program [ ] Proof of Quality Assurance/Quality Improvement Program 9. Other - specify ____________________________________________ B. REQUIRED QUALIFICATIONS Evidence of meeting the following qualifications shall be presented:
YES NO --- -- 1. Valid State Pharmacy license as required. _____ _____ 2. Valid individual pharmacist licenses as required. _____ _____ 3. DEA Registration as required. _____ _____ 4. Sterile area/clean room certifications as required. _____ _____ 5. Valid unrestricted state operating license or certificate as required. _____ _____ 6. Medicare Home Health Agency Certification (may be waived if other credentials are acceptable to GENTIVA). _____ _____ 7. Accreditation by JCAHO, CHAP, ACHC (or CARF for Rehab) (may be waived if other credentials are acceptable to GENTIVA). _____ _____ 8. Medicare/Medicaid Sanctions _____ _____ 9. Adequate Professional and General Liability Insurance _____ _____
C. PERFORMANCE STANDARDS The PROVIDER agrees to adhere to the following standards of performance: 1. Submit changes in the following to the Provider Relations Department in Melville, New York within a timely manner: a. Address(es). b. Telephone number(s). c. Name of key organizational contact(s). d. Name(s) of key local operations contact(s). e. Accreditation status. f. Legal status; i.e., pending or newly active litigation relative to cases, only. g. Licensing status. h. Liability insurance coverage. i. Days/hours of operation. j. Certification status. k. Service/product capabilities. l. Addition/closure of operation/business site. 2. Maintain 24-HOUR ON-CALL COVERAGE 7 DAYS PER WEEK and respond to patient and/or contacts within 30 MINUTES of call after regular business hours and on holidays (unless otherwise specified by contract). 3. Notify the Care Manager IMMEDIATELY if not able to service a referred case. 4. Start care and assessment with in 24 HOURS following acceptance of referral and comply with any other requirements of the individual health plans serviced and individual case needs. 5. Notify the Care Manager IMMEDIATELY if assessment must be delayed. 6. Notify the Care Manager within 2 HOURS of assessment if unable to service the case. 7. Render no services unless so authorized by the referring Care Manager and ordered by the primary physician except in emergencies (see #19.). 8. Notify the Care Manager of additional sources of reimbursement upon their identification. 9. Provide after hours (on call) home visits as appropriate and necessary in situations which cannot be resolved by telephone consultation. 10. Notify the Care Manager of changes in patient/family status WITHIN ONE (1) BUSINESS DAY upon occurrence/identification, including illness, hospitalization, death or other change affecting continued service delivery. 11. Follow/report patient status, progress and projected and actual date of discharge given hospitalization/institutionalization while on service. 12. Respond to all requests for contact from personnel WITHIN ONE (1) BUSINESS DAY. 13. Notify the Care Manager of patient, family, physician, health plan Case Manager complaint(s) upon occurrence and in accordance with the parameters established in the section of the Provider Manual on Complaint Management. 14. Submit/report discharge data to the Care Manager WITHIN ONE (1) BUSINESS DAY of completion of service/product delivery. 15. Routinely submit requests for care reauthorization no later than 24 HOURS prior to completion of authorized care and obtain physician orders for reauthorized services/products. 16. Contact the Care Manager within TWO (2) BUSINESS DAYS providing unauthorized emergency care on a non business day or after business hour. 17. Submit documentation as follows: a. Confirmation of care within 24 HOURS of start of care. b. Physician's orders and other clinical documentation upon confirmation of start of care and reauthorization request. c. Objective reason(s) for reauthorization of care prior to completion of authorized care. d. Discharge summary within 24 HOURS of completing service/product delivery. e. Assessment reports, progress reports, organizational forms, or other organizational documents within 48 HOURS of request by the Care Manager. 18. Report adverse incidents, as defined in Problem Management Section of GENTIVA's Provider Manual, to the Care Manager within 24 hours of occurrence. 19. Respond to grievances/complaints filed against the Provider within 2 BUSINESS DAYS and pursue timely resolution acceptable to GENTIVA staff. 20. SUBMIT NO BILLING TO THE HEALTH PLAN for services/products delivered to patients unless specifically notified to do so by the GENTIVA . 21. Treat all patients, families, physicians, health plan representatives, other providers and personnel with respect, dignity and professionalism. D. ADDITIONAL EVALUATION Provider performance also is evaluated by: 1. Patient, physician and customer satisfaction. 2. Accurate and timely billing. 3. Presence/absence of adverse clinical incidents. 4. Presence/absence of provider-related complaints/grievances from patients, physicians and/or health plan customers. In the event of any conflict between these performance standards and any Payor(s) requirements which are more stringent or restrictive than these performance standards, the Payor(s) requirements shall control and be binding. SCHEDULE B TO PROVIDER AGREEMENT REIMBURSEMENT SCHEDULE (SEE ATTACHED) PROVIDER to check applicable category and attach corresponding fee schedule. B.1 [ ] Home Health Care B.2 [ ] Home Infusion Therapy B.3 [ ] Hospice B.4 [ ] Home Medical Equipment B.5 [ ] Respiratory Services B.6 [ ] Women's Health Services B.7 [ ] Medical Rehabilitation Services B.8 [ ] Other: (Specify)_____________________________ SCHEDULE C TO PROVIDER AGREEMENT MEDICARE+CHOICE PROVISIONS 1. ADDITIONAL PROVISIONS. GENTIVA and PROVIDER agree to the following provisions: A. COMPLIANCE WITH LAWS. PROVIDER shall comply with and is subject to all applicable Medicare program rules and regulations, as implemented and as amended by the Health Care Financing Administration ("HCFA"), including without limitation federal and state regulatory agencies' rights to audit PROVIDER's operations, books, records and other documentation related to PROVIDER's obligations under the Agreement, as well as all other federal and state laws, rules and regulations applicable to individuals and entities receiving federal funds, including without limitation Title VI of the Civil Rights Act of 1964, The Age Discrimination Act of 1975, The Americans With Disabilities Act and The Rehabilitation Act of 1973. PROVIDER shall require that all health care professionals employed by or under contract with PROVIDER to render health services under the Agreement comply with this provision. B. FEDERAL FUNDS. PROVIDER acknowledges that payment from PAYOR PLAN to GENTIVA for services to Medicare+Choice enrollees is derived in whole or in part from federal funds received by PAYOR PLAN from HCFA, and that PROVIDER shall be subject to those laws, rules and regulations applicable to individuals and entities receiving federal funds. C. RECORD MAINTENANCE AND CONFIDENTIALITY. In order to ensure compliance under the Agreement, PROVIDER acknowledges and agrees to retain all contracts, books, documents, papers and other records related to the provision of services to Medicare members and/or as related to PROVIDER's obligations under the Agreement for a period of not less than 6 years. PROVIDER agrees to safeguard the privacy of any information that identifies a particular enrollee, maintain records in a timely and accurate manner, ensure timely access by enrollees to the records at a reasonable time and in a reasonable manner upon written request by the enrollee. D. RIGHT TO INSPECT. PROVIDER agrees to give the United States Department of Health and Human Services, the Comptroller General of the United States, or their designees, the right to audit, evaluate, and inspect books, contracts, medical records, patient care documentation, or other records related to the care of Medicare + Choice patients for a period of no less than six (6) years from the final date of the contract period or the completion of any audit, whichever is later, which period may be extended only in accordance with the terms of 42 CFR 422.502(e)(4). E. DATA COLLECTION/ ACCURATE INFORMATION. With respect to Medicare+Choice patients, PROVIDER acknowledges that PAYOR PLAN is required by HCFA to maintain a health information system that collects, analyzes and integrates all data necessary to compile, evaluate and report certain statistical data related to costs, utilization and quality, and such other matters as HCFA may require from time to time. PROVIDER hereby agrees to submit to GENTIVA or PAYOR PLAN, upon request, all information and/or data necessary for PAYOR PLAN to fulfill these obligations, and within the timeframes specified by GENTIVA or PAYOR PLAN to meet HCFA requirements. PROVIDER hereby represents and warrants that all data including, but not limited to, encounter data and other information submitted to GENTIVA by PROVIDER shall be truthful, reliable, accurate and complete, and upon request by GENTIVA, PROVIDER agrees to certify that such information is truthful, reliable, accurate and complete. PROVIDER further agrees to hold harmless and indemnify GENTIVA and PAYOR for any fines or penalties they may incur due to PROVIDER's submission of inaccurate or incomplete data. F. PATIENT COMMUNICATIONS. The parties acknowledge and agree that nothing contained in the Agreement is intended to interfere with or hinder communications between health care PROVIDER(s) and members regarding patient treatment. PROVIDER(s) will discuss with member their health status and all medical care and treatment options which PROVIDER and/or the member's treating physician deems clinically necessary and appropriate, regardless of any coverage or payment determination(s) made or to be made by PAYOR or GENTIVA. G. MEDICALLY NECESSARY SERVICES. Nothing contained herein is intended by GENTIVA to be a financial incentive or payment that directly or indirectly acts as an inducement for PROVIDER to limit Medically Necessary services. H. NON-DISCRIMINATION. PROVIDER will not discriminate against any enrollee on the basis of any factor related to health status, including without limitation medical condition, including mental and physical illness, claims experience, receipt of health care, medical history, genetic information, evidence of insurability, including conditions arising out of acts of domestic violence, or disability. PROVIDER agrees to observe the provisions of Title VI of the Civil Rights Act of 1964, the Age Discrimination Act of 1975 and the Americans with Disabilities Act. I. COOPERATION. PROVIDER agrees to cooperate with any independent quality review and improvement organization utilized by or under contract with PAYOR PLAN pertaining to the provision of services for Medicare + Choice enrollees. PROVIDER shall comply with applicable GENTIVA and PAYOR policies and, if requested by GENTIVA, shall cooperate in developing and implementing medical policy, quality assurance programs, and medical management programs applied to Medicare + Choice enrollees. J. PARTICIPATION IN MEDICARE. PROVIDER hereby represents that PROVIDER and all employees, subcontractors and/or independent contractors of PROVIDER providing or who will provide services under the Agreement, including without limitation health care, utilization review, medical social work and/or administrative services, each maintains full participation status in the Medicare program and/or is not excluded from participation in the Medicare program. GENTIVA may terminate the Agreement immediately upon PROVIDER'S failure to adhere to the terms of this provision. K. STANDARDS OF CARE. HMO and GENTIVA agree to provide all covered benefits to Medicare + Choice enrollees in a manner consistent with professionally recognized standards of care. L. ADDITIONAL TERMINATION PROVISIONS. Notwithstanding any provision in the Agreement, the following termination provisions shall apply to PROVIDER if rendering services to Medicare+Choice enrollees: (i) GENTIVA may terminate the Agreement immediately upon request of PAYOR due to PROVIDER'S loss or suspension of licensure or certification, or sanction by Medicare. (ii) GENTIVA may terminate the Agreement upon thirty (30) days prior written notice to PROVIDER for PROVIDER'S failure to cooperate and/or comply with any of the provisions of the Agreement (iii) If PROVIDER wishes to terminate the Agreement without cause, it must provide the other party with no less than sixty (60) days prior written notice, given in accordance with the terms of the Notice provision of the Agreement. M. DELEGATION REQUIREMENTS. PROVIDER understands and acknowledges that if any of the PAYOR PLAN'S activities or responsibilities under its contract with HCFA, related to the provision of services to Medicare+Choice enrollees, are delegated to other parties, the following requirements apply to any related entity, contractor, subcontractor, or provider: (i) Written arrangements must specify delegated activities and reporting responsibilities. (ii) Written arrangements must either provide for revocation of the delegation activities and reporting requirements or specify other remedies in instances where HCFA or the PAYOR PLAN determine that such parties have not performed satisfactorily. (iii) Written arrangements must specify that the performance of the parties is monitored by the PAYOR PLAN on an ongoing basis. (iv) Written arrangements must specify that the credentialing process will be reviewed and approved by the M+C organization and the M+C organization must audit the credentialing process on an ongoing basis. (v) All contracts or written arrangements must specify that the related entity, contractor, or subcontractor must comply with all applicable Medicare laws, regulations, and HCFA instructions. N. APPEALS. PROVIDER will adhere to Medicare's appeals procedure for Medicare+Choice enrollees, including the procedures for expedited appeals. PROVIDER shall gather and forward information on enrollee appeals to GENTIVA or PAYOR to the extent required by law or regulation so as to enable PAYOR PLAN to meet the HCFA required timeframes for grievances and appeals. O. COMPLIANCE WITH POLICIES. To the extent that a Medicare + Choice requirement is found in a policy, the Provider Manual or other procedural guide of GENTIVA and/or PAYOR PLAN and is not otherwise specified in the Agreement, PROVIDER will comply with those policies, manuals and procedures with regard to the provision of care to Medicare + Choice enrollees. Written notice of material changes to applicable policies, including the Provider Manual, shall be provided to PROVIDER prior to the effective date of such changes. P. FAILURE TO COMPLY. If GENTIVA denies payment to PROVIDER due to PROVIDER'S failure to comply with any of the provisions of the Agreement, PROVIDER shall not bill the enrollee for the denied amounts. Q. AMENDMENT. GENTIVA may amend this Attachment as needed to comply with applicable state and federal laws, rules and regulations, and shall provide PROVIDER with written notice of such amendment and its effective date. Unless required by such law, rule or regulation, PROVIDER'S signature will not be required to implement such amendment. EXHIBIT II REQUIRED ENCOUNTER DATA ELEMENTS Provider (including Provider's Subcontractors) shall provide CIGNA with the following standard data elements for each service encounter with respect to Covered Home Care Services rendered under this Agreement: o Patient Name, Address, Phone, Date of Birth o Insured's Name, Address, Phone, Date of Birth o Healthplan Identifier o Group Number o Date of Service o Primary and Secondary ICD-9 Codes o CPT-4, HCPCS, or Unique CIGNA Billing Codes o Tax ID # o Charge to CIGNA o Service, Drug, Equipment Description o Unit of Measure o Referring Physician or Other Referral Source Name o Place of Service o Any other data element agreed upon by the parties during the term of this Agreement EXHIBIT III INFORMATION REQUIRED FOR A COMPLETE ORDER o Requested Start of Care (SOC)/Actual Start of Care Date o Last Name, First Name, MI, Phone # o Address where service is to be rendered, including the phone #and zip code o Facility, Facility Discharge Date o Facility Name, Phone # o Date of Birth/Age, Sex, SS#, Marital Status o Ordering Physician (who will follow patient in the community, Office Phone #) o Type of Home Care Personnel o Home Medical Equipment o Infusion Product o All pertinent diagnoses and/or surgical procedures with onset and/or exacerbation dates o Allergies o Specific Orders/Treatment (including frequency, type of dressing, drug, dosage, etc.) Note: subcontractor must contact physician and/or physician's agent directly to validate all orders. o Has client taken ordered drugs(s) before? Y, N, comment o Venous/other access-established? Y, N, if Yes, date placed, type ordered, gauge if applicable (1st dose given?) o Anaphylaxis Order - Y, not applicable (1st dose) o Anaphylaxis medications/dosage/route (1st dose) o Primary Plan, ID# EXHIBIT IV. CLEAN CLAIM SUBMISSION REQUIREMENTS All MCA's must comply with these requirements in order to transmit claims. Below is a list of the minimum data elements required to successfully transmit a claim to CIGNA HealthCare: o Billing provider name, address and tax identification number o Rendering provider name, address and tax identification number o Employee number (9 numeric SSN/ID. If not 9 digits, MUST be zero filled to equal 9 digits) o Employee first and last name o Patient first name o Patient date of birth o Patient account number o Diagnosis code o Procedure/Revenue Code o Anesthesia Minutes/Units o Number of days when dates of service are not equal o Billed Amount (cannot be zeros) o Place of Service/Bill Type o First date of injury for accident claims o Date first consulted to verify pre-existing conditions If the above data elements are not submitted by the provider of service, the Claim Processor must reject the claim back to the MCA for correction and resubmission. EXHIBIT V. GENTIVA CARECENTRIX SUBSIDIARIES o Gentiva Health Services (USA), Inc. o Gentiva Health Services (Certified), Inc. o Gentiva Certified Healthcare Corp. o New York Healthcare Services, Inc. o QC Medi - New York, Inc. o Quality Care-USA, Inc. o Gentiva Services of New York, Inc. EXHIBIT VI. GUIDELINES FOR HOME & COMMUNITY CARE SPECIALIST SUMMARY: Analyzes utilization data, identifying areas for improvement, and provides recommendations to CIGNA Care Center management staff on homecare recovery and treatment. Works with Health Services Director and CIGNA Physician Advisor on the development of action plans to address areas for improvement. Educates and serves as a clinical resource on the safe and appropriate use of home care. Works under moderate supervision. ESSENTIAL DUTIES AND RESPONSIBILITIES: Analyzes utilization data, identifying areas for improvement, and provides recommendations to CIGNA Care Center management staff on homecare recovery and treatment. Works with Health Services Director and CIGNA Physician Advisor on the development of action plans to address areas for improvement. Provides regular reports on progress towards resolution. Educates and serves as a clinical resource on the safe and appropriate use of home care. Provides and/or coordinates training and education for CIGNA staff regarding new services or technology appropriate for the home care setting. Supports communication and promotion of existing and new programs by CIGNA providers through collaborative relationships with Gentiva CareCentrix vendors located in the same geographic community. May facilitate communication between CareCentrix, the vendor of service and patients/clients to remove potential barriers on appropriate discharges. Ensures a coordinated discharge plan for CareCentrix services on complex cases. Supports the CIGNA and Gentiva Provider Relations Teams in ensuring all vendors and providers understand goals related to home health utilization objectives. Participates in ongoing quality assessment/improvement activities as directed. Tracks and trends all issues and complaints in accordance with joint CIGNA and CareCentrix's quality management programs using both an individual and a population-based issue resolution approach. Provides information that enables root cause analysis and preparation of reports. Assists in identifying opportunities for improvement. Participates in discussions with other Regional HUB colleagues to review operational processes and procedures and shares best practices among the HUB sites. Participates in local organizations to keep abreast of current developments in the healthcare market. Participates in special projects and performs related other duties as assigned. QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION AND/OR EXPERIENCE: Current RN license in the state of residence plus a minimum of five years experience in homecare or related industry, with an emphasis in managed care carrier relations. Strong understanding of the concepts of utilization management and ability to provide recommendations to managed care carriers. Thorough knowledge of homecare and related federal and state regulations. Excellent communication, decision, and organization skills and including computer skills required. EXHIBIT VII. PERFORMANCE METRICS 2003 AREAS OF PERFORMANCE ANNUAL STANDARD OF PERFORMANCE MAXIMUM RISK * * Confidential Treatment Requested EXHIBIT VIII REPORTING TIMELINES - -------------------------------------------------------------------------------- REPORT CATEGORY EXPECTED DELIVERY DATES - -------------------------------------------------------------------------------- Annual Quality Program Evaluation Due Annually in March - -------------------------------------------------------------------------------- Quality Program Description Due Annually in March - -------------------------------------------------------------------------------- Quality Workplan Due Annually in March - -------------------------------------------------------------------------------- Utilization Management Program Description Due Annually in March - -------------------------------------------------------------------------------- Utilization Management Workplan Due Annually in March - -------------------------------------------------------------------------------- Annual UM Program Evaluation Due Annually in March - -------------------------------------------------------------------------------- Start of Care Statistics Ongoing, Due Quarterly, 45 days post end of quarter - -------------------------------------------------------------------------------- Telephone Statistics Ongoing, Due Quarterly, 45 days post end of quarter - -------------------------------------------------------------------------------- Complaint Statistics Ongoing, Due Quarterly, 45 days post end of quarter - -------------------------------------------------------------------------------- Credentialed/Recredentialed Providers Reporting Ongoing, Due Quarterly, 45 days post end of quarter - -------------------------------------------------------------------------------- Terminated Providers Ongoing, Due Quarterly, 45 days post end of quarter - -------------------------------------------------------------------------------- Patient Satisfaction Report due Annually, by August - -------------------------------------------------------------------------------- Referral Source Satisfaction Annual reporting separated from the complaint statistics. - -------------------------------------------------------------------------------- Utilization Management Report Ongoing, Due Quarterly, 45 days post end of quarter - -------------------------------------------------------------------------------- Missing Information Report Weekly - -------------------------------------------------------------------------------- FFS Qtrly PM/PM Reports Ongoing, Due Quarterly, 45 days post end of quarter - -------------------------------------------------------------------------------- AR--Aging Report Bi-Weekly - -------------------------------------------------------------------------------- Weekly Reports (admit, discharge, auths) Weekly - -------------------------------------------------------------------------------- Pended report for non-urgent FFS Weekly authorizations - -------------------------------------------------------------------------------- CIGNA Inclusion / Exclusion Grids Monthly - -------------------------------------------------------------------------------- CIGNA Capitation Payment Report Monthly - -------------------------------------------------------------------------------- CIGNA Leakage Report Quarterly - -------------------------------------------------------------------------------- EXHIBIT IX SAFE HOMECARE ADMISSION CRITERIA Acceptance of patients for home care services is to be based on the following criteria, and medical, nursing, psychosocial, and other information provided by the physician responsible for the overall plan of treatment, and other individuals involved in a patients care. Patients will be accepted for care regardless of age, race, color, national origin, religion, sex, disability, being a qualified disabled veteran, being a qualified veteran of the Vietnam era, or any other category protected by law, or decisions regarding advance directives: 1. Adequacy and suitability of personnel and resources to provide service in accordance with the needs of the patient and the physician's Plan of Treatment (if required). Not having adequate or suitable personnel and resources to provide the necessary service(s) does not however relieve MCA from the financial obligation and responsibility to provide such service(s). 2. Attitudes and coping ability of the patient and/ or family towards providing care at home. 3. Reasonable expectation that the patient's overall medical, nursing, rehabilitative, and social needs can be adequately met in his/her place of residence, including a plan to meet any medical emergencies that may arise. 4. Adequate physical facilities in the patient's residence for the safe delivery of service. 5. Availability and willingness of family members or other support services to follow through with the overall plan of care as necessary. The parents or guardians must assume responsibility for the care of a child. 6. Availability and willingness of a primary physician, or authorized professional to provide an overall Plan of Treatment if physician orders are required. 7. Patient resides within the geographic area serviced by this agreement. 8. Staff personal safety is not at risk. 9. The following patients are ineligible for admission to home care services (appropriate referrals to treatment facilities or other community resources will be made): o Patients with a history of intractable violent behavior or homicidal ideation o Patients exhibiting active suicidal behavior or considered a danger to themselves or others o Patients unable to obtain food or shelter o Patients/families persisting in discriminatory job orders EXHIBIT X REPRESENTED PROVIDER REQUIRED DATA ELEMENTS Reports shall be provided to CIGNA on a quarterly basis containing the following Provider Data Elements: o PROVIDER NAME o PROVIDER LOCATION/ADDRESS o CITY, STATE AND ZIP o TELEPHONE NUMBER o SERVICE TYPE INDICATOR (HIT, HME, RESP, THH) o MEDICARE A INDICATOR o MEDICARE B INDICATOR o MEDICARE A PROVIDER NUMBER o STATUS o ORIGINAL CREDENTIALING DATE o DATE RECREDENTIALING COMPLETED o TERMINATION DATE o TERMINATION REASON CODE EXHIBIT XI. JOINT COMPLAINT MANAGEMENT PROCESS COMPLAINT WORKFLOW GENTIVA CARECENTRIX (Definition of Complaint: Any expression of dissatisfaction, oral or written) Shaded areas are steps in process that involve Gentiva [GRAPHIC OF WORKFLOW CHART] * Physician calling on behalf of member or vendor calling with issue that has impacted quality of care or service to member ** Real-time Issue--Any issue relating to coordinating and ensuring appropriate current patient service/care. COMPLAINT WORKFLOW CIGNA HEALTHCARE (Definition of Complaint: Any expression of dissatisfaction, oral or written) Shaded areas are steps in process that involve Gentiva [GRAPHIC OF WORKFLOW CHART] * Physician calling on behalf of member or vendor calling with issue that has impacted quality of care or service to member ** Real-time Issue--Any issue relating to coordinating and ensuring appropriate current patient service/care. EXHIBIT XII. 2003 STANDARDS FOR DELEGATION OF CREDENTIALING ACTIVITIES [Any and all capitalized terms not defined herein shall have the same meaning as in the managed care provider agreement between CIGNA and the delegatee (the "Agreement").] I. GENERAL CONSIDERATIONS A. Delegatee shall be responsible for credentialing and recredentialing all providers permitted to provide Covered Services to Participants under the Agreement (the "Represented Providers"). Delegatee shall not subcontract any of its credentialing and recredentialing responsibilities except with the prior written consent of CIGNA. If delegatee subdelegates credentialing/recredentialing functions to another entity, CIGNA must approve the extent of the subdelegation and review the file oversight conducted by the entity as well as the delegatee's evaluation of the subdelegated organization's credentialing/recredentialing policies and procedures. Any subcontractor approved by CIGNA shall be required to agree in writing to comply with all standards applicable to delegatee with regard to the subcontracted services. B. Delegatee shall maintain a credentialing committee comprised of appropriately qualified persons, including primary care and specialist network providers, who shall be responsible for credentialing all Represented Providers. C. Delegatee's credentialing/recredentialing program shall be in writing. Such program must be reviewed and approved by delegatee's review body and by CIGNA both prior to the delegation hereunder and annually thereafter. Delegatee shall not materially modify its credentialing/recredentialing program without CIGNA's prior written approval which approval shall not be unreasonably withheld. D. Delegatee's credentialing/recredentialing program shall, at a minimum, satisfy the standards of an appropriate accrediting body or set of standards designated by CIGNA (i.e. NCQA, JCAHO, URAC etc.), the requirements established by CIGNA herein and in the Agreement, and any requirements set forth in applicable federal and state laws and regulations. E. Delegatee shall maintain adequate professional liability coverage relating to delegatee's credentialing/recredentialing activities. Such coverage shall be consistent with CIGNA standards for such coverage. F. CIGNA reserves the right to disapprove, terminate, or suspend any of delegatee's Represented Providers from providing Covered Services to Participants if the Represented Provider does not meet the credentialing requirements set forth herein. G. Delegatee shall credential each Represented Provider in accordance with the requirements set forth herein and shall recredential each initially credentialed Represented Provider in accordance with such requirements at least 1) every three years; or 2) as often as is mandated by applicable state or federal law; whichever is more frequent. H. For non-contracted home health care providers that may from time to time provide services in order to meet immediate demands, Delegatee shall establish a process acceptable to CIGNA to ensure that Represented Provider has an unrestricted license, as appropriate for the state in which the Represented Provider practices, has adequate professional and general liability insurance coverage and has an acceptable malpractice claims history as indicated through verifying Medicare/Medicaid sanctions or other appropriate reporting agency or data bank identified by CIGNA. Delegatee shall notify CIGNA if a non-credentialed Represented Provider is used to fulfill a service requirement. If a Represented Provider provides services to more than two different parties within a 60 day period, Delegatee must implement a full credentialing process as outlined below with that Represented Provider. I. Delegatee shall maintain a process acceptable to CIGNA which audits and evaluates delegatee's performance of its credentialing obligations hereunder. Delegatee shall report to CIGNA the results of any such evaluations, including audits by designated third parties, in a format and in time frames acceptable to CIGNA, and shall promptly correct any deficiencies identified. J. CIGNA and applicable governmental regulatory authorities and accrediting bodies shall have the right to audit delegatee's credentialing and recredentialing activities, including delegatee's credentialing and recredentialing files. Delegatee shall cooperate with any such audits. CIGNA's audits shall be conducted at least once a year or as needed. CIGNA will provide delegatee with a written report detailing the findings with respect to any such audits. If such audits reveal any deficiencies, delegatee shall implement policies and/or procedures to address the deficiencies identified in such audit within 60 days of CIGNA's submission of the report detailing such deficiencies. Failure to provide CIGNA with evidence that delegatee has implemented such policies and/or procedures to address any such identified deficiency within the 60 day time period may be cause for revocation of the delegation hereunder or termination of the Agreement. K. If CIGNA determines that delegatee cannot meet its credentialing obligations set forth herein, CIGNA may elect to assume responsibility for such activities. If CIGNA elects to assume responsibility for such activities, the rates set forth in the Agreement shall be adjusted to the extent necessary, and delegatee shall cooperate and provide to CIGNA any information necessary to perform such activities. L. Delegatee shall maintain appropriate records with respect to all credentialing and recredentialing activities hereunder for the duration of the Agreement and six years thereafter. All information relating to delegatee's credentialing and recredentialing activities hereunder shall be confidential, shall not be disclosed to any third parties except as required by applicable law or to fulfill delegatee's obligations hereunder, and shall be maintained in such a manner so that such information shall be protected from discovery and use in judicial or administrative proceedings to the fullest extent possible under applicable law, including, but not limited to, applicable state peer review laws. In the event that delegatee receives a subpoena, civil investigative demand or other similar process requesting disclosure of information relating to its credentialing and recredentialing activities hereunder, delegatee shall immediately notify CIGNA of such subpoena, demand or process so as to afford CIGNA with an adequate opportunity to seek an appropriate protective order should it choose to do so. M. This exhibit and all information provided by CIGNA to delegatee pertaining to CIGNA's delegation of credentialing activities to delegatee is confidential and proprietary information and subject to the protections set forth in the confidentiality provision contained in the Agreement. In the event that delegatee receives a subpoena, civil investigative demand or other similar process requesting disclosure of such confidential and proprietary information, delegatee shall immediately notify CIGNA of such subpoena, demand or process so as to afford CIGNA with an adequate opportunity to seek an appropriate protective order should it choose to do so. N. Delegatee shall indemnify, defend and hold harmless CIGNA and its affiliates from and against any and all liability, fines, penalties, damages and expense, including reasonable defense costs and legal fees, incurred by CIGNA or its affiliates in connection with claims or actions of any nature, governmental examinations, enforcement actions or other administrative proceedings arising from delegatee's failure to perform its obligations under these Standards. II. CREDENTIALING REQUIREMENTS A. Delegatee will ensure that all Represented Providers are in compliance with the delegatee's credentialing requirements, which, at a minimum, shall include those requirements set forth below. In addition, delegatee will meet all timelines for requirements as required by CIGNA. Any exceptions to the credentialing requirements set forth below must be approved by CIGNA prior to the Represented Provider providing Covered Services to CIGNA Participants. Any such requests for exceptions shall only be forwarded to CIGNA for review after delegatee's credentialing committee has completed its review of the provider. Delegatee shall forward to CIGNA all information required by CIGNA in connection with those providers for whom an exception is requested. FACILITY/ANCILLARY PROVIDER CREDENTIALING 1. The Chief Operating Officer, Administrator or other appropriate designated health care facility or ancillary provider representative shall sign the Represented Provider's application for participation which signature must serve to attest to the accuracy and completeness of the credentials, operational, financial and quality information summarized in the application and must serve as a release authorizing external verification of credentials. 2. All Represented Providers shall be licensed without restriction and have all licenses necessary to do business in each state in which they are providing services. 3. All Represented Providers shall maintain appropriate professional and general liability coverage, with minimum limits of liability as acceptable to CIGNA or other, greater, minimum limits that may be required by the state where the Represented Provider is licensed: Professional Liability Coverage Type of Facility Per Occurrence Aggregate ---------------- -------------- ----------- Home Health $1,000,000 $3,000,000 GENERAL LIABILITY COVERAGE Type of Facility Per Occurrence Aggregate ---------------- -------------- ----------- Home Health $1,000,000 $3,000,000 4. All Represented Providers shall have a satisfactory professional liability history. 5. The Joint Commission on Accreditation of Healthcare Organizations ("JCAHO") or the American Osteopathic Association must accredit all hospital Represented Providers. The Commission on Accreditation of Rehabilitation Facilities must accredit rehabilitation facilities. JCAHO, the Community Health Accreditation Program or the Accreditation Commission for Health Care, Inc. must accredit home health agencies. Nursing homes must be accredited by JCAHO. JCAHO or the Accreditation Association for Ambulatory Health Care must accredit ambulatory centers for Ambulatory Health Care. The foregoing accreditations shall not be required in those locations where the attainment of the applicable accreditation is not the community standard. In these instances, on-site assessments meeting CIGNA requirements must be conducted. Delegatee may substitute a CMS (HCFA) review or a State Department of Health review for the site visit if delegatee obtains the CMS/State Department of Health report and the CMS/State Department of Health review meets CIGNA's standards. 6. All Represented Providers must maintain an ongoing quality assurance/quality improvement plan designed to monitor and evaluate the quality and appropriateness of patient/resident care, pursue opportunities to improve patient/resident care, and resolve identified problems. 7. The inclusion of the Represented Provider in CIGNA's provider network must be consistent with CIGNA's business requirements as identified by CIGNA to delegatee. 8. The delegatee's application for participation shall include satisfactory answers to the following questions: Has the Represented Provider ever had or does it currently have: a. Revocations, suspensions or sanctions under the Medicare or Medicaid programs? b. Professional liability insurance cancellation in the past five years? c. General liability insurance cancellation in the past five years? d. State licensing investigations or actions? Any "yes" answers must be accompanied by an explanation. 9. Delegatee will obtain documents as listed below for all Represented Providers as part of their application for participation: a. Current state professional license b. Documentation of current state sanctions, restrictions on licensure, or limitations on scope of practice c. Documentation of sanction activity by either the Medicare or the Medicaid programs in the past 3 years. d. Proof of professional liability and general liability insurance e. The following professional liability information: (1) The number of pending claims (2) The precise facts of each legal action brought against the Represented Provider in the past six years and the resolution of such action (i.e., withdrawn, dismissed, judgment, or settlement), including the amounts of settlements and judgments. f. Proof of accreditation, if applicable B. Delegatee shall require Represented Providers to agree to notify delegatee promptly of any material change in the information on the Represented Provider's application for participation. C. Delegatee shall not credential any provider who: 1) Has been denied participating provider status by CIGNA, or 2) Has had his/her participating provider status terminated by CIGNA for cause 3) Within the last two (2) years, has terminated a CIGNA Healthcare provider contract. Any requests for credentialing from any such provider shall be forwarded to CIGNA and shall not be acted on further by the delegatee. FACILITY/ANCILLARY PROVIDER RECREDENTIALING Delegatee shall recredential every Represented Provider in accordance with the timeframes specified in Section I.G. above employing the same criteria set forth in the facility/ancillary provider credentialing section of this document. V. CONFIDENTIALITY OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION To the extent applicable, delegatee shall comply with all federal and state laws and regulations relating to the confidentiality of medical records and other individually identifiable health information, including, but not limited to, the requirements specified below. A. Definitions Applicable to this Confidentiality Section "Confidential Information" shall mean (a) Individually Identifiable Health Information that is (i) transmitted by Electronic Media, (ii) maintained in any medium constituting Electronic Media; or (iii) transmitted or maintained in any other form or medium and (b) any Nonpublic Personal Financial Information, as that term is defined by the NAIC Model Privacy of Consumer Financial and Health Information Regulation (2000) issued pursuant to the Gramm Leach Bliley Act. "Confidential Information" shall not include (i) education records covered by the Family Educational Right and Privacy Act, as amended, 20 U.S.C. Section 1232g and (ii) records described in 20 U.S.C. Section 1232g(a)(4)(B)(iv). "Designated Record Set" shall mean a group of records maintained by or for CIGNA or a CIGNA Affiliate that is (i) the medical records and billing records about individuals maintained by or for CIGNA or a CIGNA Affiliate, (ii) the enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a health plan; or (iii) used, in whole or in part, by or for CIGNA or a CIGNA Affiliate to make decisions about individuals. As used herein, the term "Record" means any item, collection, or grouping of information that includes Confidential Information and is maintained, collected, used, or disseminated by or for CIGNA or a CIGNA Affiliate. "Electronic Media" shall mean the mode of electronic transmissions. It includes the Internet, extranet (using Internet technology to link a business with information only accessible to collaborating parties), leased lines, dial-up lines, private networks, and those transmissions that are physically moved from one location to another using magnetic tape, disk, or compact disk media. "Individually Identifiable Health Information" shall mean information that is a subset of health information, including demographic information collected from an individual, and (i) is created or received by a health care provider, health plan, employer, or health care clearinghouse; and (ii) relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present or future payment for the provision of health care to an individual; and (a) identifies the individual, or (b) with respect to which there is a reasonable basis to believe the information can be used to identify the individual; and (iii) relates to identifiable non-health information including but not limited to an individual's address, phone number and/or Social Security number. "Privacy Standards" shall mean (a) the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated thereunder, including the Standard for Privacy of Individually Identifiable Health Information, 45 C.F.R. Parts 160 and 164, (b) the Gramm Leach Bliley Act and any applicable regulations governing privacy and confidentiality promulgated thereunder, and (c) other federal or state laws or regulations governing the use, disclosure, confidentiality, security or privacy of Confidential Information or other personally identifiable information. "Secretary" shall mean the Secretary of the Department of Health and Human Services. B. USE OF CONFIDENTIAL INFORMATION. Delegatee may use Confidential Information to carry out the obligations of delegatee as set forth in the Agreement and these Standards or as required by federal or state law, subject to the provisions of Sections C. through N., below. Delegatee shall ensure that its directors, officers, employees, contractors and agents do not use Confidential Information received from CIGNA or a CIGNA Affiliate in any manner that would constitute a violation of the Privacy Standards if used in a similar manner by CIGNA or a CIGNA Affiliate. Delegatee shall not use Confidential Information for the purpose of creating de-identified information that will be used for any purpose other than to carry out the obligations of delegatee set forth in the Agreement and these Standards or as required by federal or state law. C. DISCLOSURE OF CONFIDENTIAL INFORMATION. Delegatee and its directors, officers, employees, contractors and agents shall not disclose Confidential Information received from CIGNA or a CIGNA Affiliate other than as is necessary to carry out the obligations of delegatee as set forth in the Agreement or these Standards or as required by federal or state law, subject to the provisions of Sections C. through N., below. Confidential Information shall not be disclosed in any manner that would constitute a violation of the Privacy Standards if disclosed in a similar manner by CIGNA or a CIGNA Affiliate. D. SAFEGUARDS AGAINST MISUSE OF INFORMATION. Delegatee agrees that it will implement all appropriate safeguards to prevent the use or disclosure of Confidential Information in any manner other than pursuant to the terms and conditions of the Agreement and these Standards. E. REPORTING OF DISCLOSURES OF CONFIDENTIAL INFORMATION. Delegatee shall, within five (5) days of becoming aware of a loss, a suspected loss, or disclosure of Confidential Information in violation of the Agreement or these Standards by delegatee, its officers, directors, employees, contractors or agents or by a third party to which delegatee disclosed Confidential Information pursuant to Section C. of this Agreement, report any such disclosure to CIGNA's Privacy and Security Officers. This requirement will also apply to any loss, or suspected loss, of Confidential Information. F. AGREEMENTS WITH THIRD PARTIES. Delegatee shall enter into an agreement with any agent, subcontractor or other third party that will have access to Confidential Information that is received from, created or received by delegatee on behalf of CIGNA or a CIGNA Affiliate pursuant to which such third party agrees to be bound by the same restrictions, terms and conditions that apply to delegatee with respect to such Confidential Information as set forth in the Agreement and these Standards. Under such agreement, the third party shall (a) provide reasonable assurances that such Confidential Information will be held confidential as provided in the Agreement and these Standards, (b) provide reasonable assurances that such Confidential Information will be disclosed only as required by federal or state law or for the purposes for which it was disclosed to such third party, and (c) immediately notify delegatee of any breaches of the confidentiality of the Confidential Information, to the extent it has obtained knowledge of such breach. G. ACCESS TO INFORMATION. Within five (5) business days of a request by CIGNA or a CIGNA Affiliate for access to Confidential Information about an individual contained in a Designated Record Set, delegatee shall make available to CIGNA or a CIGNA Affiliate such Confidential Information for so long as such information is maintained in the Designated Record Set. In the event any individual requests access to Confidential Information directly from delegatee, delegatee may not deny access to the Confidential Information requested. Rather, delegatee shall, within two (2) business days, forward such request to CIGNA. H. AVAILABILITY OF CONFIDENTIAL INFORMATION FOR AMENDMENT. Within ten (10) business days of receipt of a request from CIGNA or a CIGNA Affiliate for the amendment of an individual's Confidential Information or a record regarding an individual contained in a Designated Record Set (for so long as the Confidential Information is maintained in the Designated Record Set), delegatee shall provide such information to CIGNA or the CIGNA Affiliate for amendment and incorporate any such amendments in the Confidential Information as required by 45 C.F.R. Section 164.526. In the event that the request for the amendment of Confidential Information is made directly to the delegatee, delegatee may not deny the requested amendment. Rather, delegatee shall, within two (2) business days, forward such request to CIGNA. I. AUDIT. Upon reasonable notice, CIGNA or a CIGNA Affiliate may audit and inspect delegatee's internal practices and the books and records in delegatee's possession for the purpose of assessing delegatee's use and disclosure of Confidential Information received from CIGNA or a CIGNA Affiliate or created by delegatee on behalf of CIGNA or a CIGNA Affiliate. Such books and records shall be made available to CIGNA or a CIGNA Affiliate for its audit or inspection during regular business hours. J. ACCOUNTING OF DISCLOSURES. Within ten business (10) days of notice by CIGNA or a CIGNA Affiliate to delegatee that it has received a request for an accounting of disclosures of Confidential Information regarding an individual during the six (6) years prior to the date on which the accounting was requested, Delegatee shall make available to CIGNA or the CIGNA Affiliate such information as is in delegatee's possession and is required for CIGNA or the CIGNA Affiliate to make the accounting required by 45 C.F.R. Section 164.528. At a minimum, delegatee shall provide CIGNA or the CIGNA Affiliate with the following information: (i) the date of the disclosure, (ii) the name of the entity or person who received the Confidential Information, and if known, the address of such entity or person, (iii) a brief description of the Confidential Information disclosed, and (iv) a brief statement of the purpose of such disclosure that includes an explanation of the basis for such disclosure. In the event the request for an accounting is delivered directly to delegatee, delegatee shall within two (2) business days forward such request to CIGNA. It shall be CIGNA's or the CIGNA Affiliate's responsibility to prepare and deliver any such accounting requested. Delegatee hereby agrees to implement an appropriate recordkeeping process to enable it to comply with the requirements of this Section. K. AVAILABILITY OF BOOKS AND RECORDS. Delegatee hereby agrees to make its internal practices, books and records relating to the use and disclosure of Confidential Information received from, created or received by delegatee on behalf of CIGNA or a CIGNA Affiliate available to the Secretary for purposes of determining CIGNA's or a CIGNA Affiliate's and delegatee's compliance with the Privacy Standards. L. MAINTENANCE AND DESTRUCTION OF RECORDS AFTER TERMINATION. Upon termination of the Agreement and at CIGNA's sole option, delegatee shall be required to either a) return to CIGNA or a CIGNA Affiliate all Confidential Information received from, created or received on behalf of CIGNA or a CIGNA Affiliate in all forms without retaining any copies; or b) maintain all such Confidential Information consistent with the requirements of this Section V. for the period of time such information is required to be maintained by applicable law after which time delegatee shall destroy all such information in all forms maintained and shall not retain any copies of such information, or, if such destruction is not feasible, extend the protections of this Section V. to such information and limit further uses and disclosures to those purposes that make the return or destruction of such information infeasible. M. AUTHORIZATION TO TERMINATE. Delegatee hereby authorizes CIGNA to terminate the Agreement if CIGNA determines that delegatee has violated a material term of this Section V. N. Indemnification Delegatee will defend, indemnify and hold harmless CIGNA and its affiliates and their directors, officers, and employees from any claims, loss, cost (including reasonable attorneys' fees and court costs) or liability resulting from delegatee's breach of this Section V. Delegatee acknowledges receipt of CIGNA's above Standards and, in accordance with the Agreement, will comply with the terms and conditions set forth herein. - ---------------------------------- Delegatee's Name By ------------------------------- Its ------------------------------- (insert CIGNA entity on provider agreement with delegatee (i.e. healthplan name or Connecticut General Life Insurance Company)________________ By ------------------------------- Its ------------------------------- EXHIBIT XIII. DME GUIDELINES GRID DURABLE MEDICAL EQUIPMENT (DME) is defined as equipment that can stand repeated use, is primarily and customarily used to serve a medical purpose, and is generally not useful to a person in the absence of an illness or injury. DME items have the following characteristics: 1. The equipment is prescribed by a physician; 2. The equipment meets the definition of DME; 3. The equipment is necessary and reasonable for the treatment of a patient's illness or injury. 4. The equipment is manufactured primarily for use in the home environment but is not limited to use in the home. Portable equipment for use outside the home may be covered as an alternative to a stationery unit when the cost of the portable unit is equal to or less than the stationery unit and the member's medical condition supports the need for the equipment periodically outside the home setting. Equipment intended for extended use in the home, but which is appropriately delivered for use and education in an inpatient environment for up to five days will be delivered to the member either in the inpatient environment prior to discharge , or in the member's home prior to an admission. Ventilators will be provided in the inpatient setting for up to two week prior to a member's discharge to home. 5. Institutional equipment requested by CIGNA to be provided by Gentiva in an inpatient facility for use in the facility when the equipment is not part of the discharge plan for use in the member's home, or when the member is not a permanent resident of the facility, is not covered under the member's DME benefit. Initial attempts should be made to have the facility provide the equipment as part of their facility charges. When this cannot be accomplished, Gentiva will contact contracte vendors to obtain the requested equipment for CIGNA on a DISCOUNT FFS basis. If the health plan is not available to issue the FFS authorization (week-ends and after hours) the request will be sent to the health plan and it is expected that a FFS authorization number will be issued by the health plan. It should be noted that Home Medical Equipment vendors do not have all institutional type equipment in stock and there may be a need to special order the equipment HOME: The home is defined as either the member's home; the home of a family member or primary care giver within the national CIGNA/ Gentiva service area. Member's who have been permanently admitted to an inpatient skilled nursing facility or inpatient hospice and who have changed their home address to that of the SNF or hospice will have the SNF or hospice defined as their home. DME covered under cap in the home would be covered under cap in these facilities. PRODUCTS. A listing of the most common items, or group of items, that are or may be perceived as home medical equipment. This listing, while reasonably complete is not intended to quantify the entire spectrum of products that may be considered DME either now or in the future. Installation of equipment that requires attachment to the structure of the home or making home modifications (construction/renovation) is not the responsibility of GENTIVA Care Centrix. COVERAGE CRITERIA. Conditions under which DME coverage is justified. These guidelines are a combination of Medicare guidelines, CIGNA benefit interpretations, and DME industry standards. Equipment noted as "not covered" only refer to coverage under the DME capitation, but may be covered under other benefit plans such as pharmacy, consumable medical supplies, external prosthetic appliances or hospital benefits. EFFORTS SHOULD BE MADE TO PROVIDE "NOT COVERED" ITEMS ON A DISCOUNT FEE FOR SERVICE BASIS TO ASSIST IN MEETING CIGNA AND PATIENT'S NEEDS. ITEMS MAY HAVE SEPARATE COVERAGE GUIDELINES NOTED FOR MEDICARE COVERAGE ISSUES AND ARE IDENTIFIED BY ITALICS. HCPC. Medicare HCFA Common Procedure Coding system. For reference only, note that the existence of a Medicare code does not indicate coverage or reimbursement acceptance. DIAGNOSIS. These are typical diagnosis indicated for each type of DME; this list is a general guideline and is not exhaustive of all potential qualifying diagnosis. SITE OF SERVICE, TRAINING AND SUPPLIES. A listing of common industry practices that are the minimal accepted levels noting how equipment is to be delivered to the patient (or picked up), who is responsible for patient education and how it is accomplished, and which accessories and supplies are included in the DME benefit. Minimum standards will be adjusted on a state by state basis to meet legal and regulatory requirements. Supplies listed as included reflect capitated coverage only, fee for service and Medicare will generally pay additional charges for supplies used with CPAP, BiPAP, ventilators, enteral pumps, suction pumps, and CPM. BRAND SUPPLIED. When completed, it will list typical manufacturers and their model numbers as specific examples of items provided for these product descriptions, but are not considered inclusive of all products that could be offered. If there is an established clinical need for a model number or product other than those listed it will be considered under capitated coverage. RENT/PURCHASE. Used internally at GENTIVA CareCentrix to determine the appropriate time to make the financial decision when it is more cost effective to purchase equipment versus ongoing rental. Patients' diagnosis, prognosis, level of care and equipment maintenance needs will be the key factors. All discount FFS equivalent rental amounts will be applied to the purchase price of any purchased equipment. COVERAGE STATEMENTS FOR GENERAL CATEGORIES. General policies for coverage of items that may fall under multiple benefits are listed beginning on page 39, are unique in their requirements, or are generally excluded from all coverage. Many of these items can be purchased at local drug stores, hardware stores or retail outlets. SITE OF SERVICE DEFINITIONS CATEGORY I (PRODUCT ONLY) - Delivered to patients home by small package delivery service (i.e. UPS or U.S. mail) is an acceptable site of service if: Consumer agrees to small package delivery via telephone or in writing. 1. Meets patients or caregivers requirements for timeliness, same day delivery may incur additional charges; 2. Is a purchase item only; 3. Requires minimal or no assembly; 4. Setup and training can be easily accomplished via written (or video) instruction; 5. Is a supply reorder; and 6. Is easily transported and can sustain shipping and handling. CATEGORY II (PRODUCT AND SERVICE, OUTPATIENT) - Items can be picked up at DME provider or from PCP (consigned from contracted DME provider) location if: 1. It meets the patients or caregivers requirements for timeliness; 2. Requires specialized fitting and measurement that can be best accomplished in a professional environment; 3. May be a stat or rush order; 4. Needs minimal patient or caregiver training (or training completed at physicians office); 5. Requires a written physician order upon pickup; 6. Can easily be transported; 7. Includes all category I items. CATEGORY III (PRODUCT AND SERVICE AT PATIENTS HOME) - Delivered by DME company employee (clinical staff if noted) to patients residence if: 1. Patient or caregiver training required; 2. Clinical assistance required; 3. Is too bulky for easy transport; 4. Is considered a hazardous material; 5. Is a stat or rush order (may apply to all categories) 6. Requires installation and setup; 7. Requires an environmental site inspection; 8. Includes category II items where customer pickup cannot be accomplished; This option may include delivery to physician office or hospital.
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ AMBULATORY EQUIPMENT - ------------------------------------------------------------------------------------------------------------------------ o NOTE: o MORE THAN ONE PIECE OF AMBULATORY EQUIPMENT MAY BE APPROPRIATE IF MEMBER IS EXPECTED TO IMPROVE DURING REHABILITATION OR IF THE DIAGNOSIS AND/OR PROGNOSIS INDICATES DETERIORATION IN MEDICAL CONDITION. CANE o Patient has impaired ambulation and E0100 -Joint pain Category I OR there is potential for ambulation. E0105 -Osteoarthritis QUAD CANE o Replacement may be available due to -Osteoporosis patient growth (children) Or change -Rheumatoid arthritis in the medical condition. -Parkinson's disease -Multiple sclerosis (ms) -Congestive heart failure -Cerebral palsy -Intracerebral hemorrhage - ------------------------------------------------------------------------------------------------------------------------ CRUTCHES o Patient has impaired ambulation and E0112 -Fracture of: Ankle, knee, Category I there is potential for ambulation. E0114 femur or foot o Replacement may be available due to E0110 -Cerebral palsy patient growth (children) And E0111 -Joint pain change in medical condition. - ------------------------------------------------------------------------------------------------------------------------ WALKERS o Patient has impaired ambulation and E0130 -Fracture of: Tibia, fibula, Category I there is potential for ambulation ankle, knee, or foot. and requires additional stability -Rheumatoid arthritis not provided by canes and crutches. -Parkinson's disease o Baskets, trays, and cup holders are -Multiple sclerosis (ms) considered convenience items and -Congestive heart failure are not covered. -Cerebral palsy o Replacement is available for any -Intracerebral hemorrhage covered DME item for growth or -Severe neurological change in medical condition. disorder - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- AMBULATORY EQUIPMENT - ------------------------------------------------- CANE Guardian xxxx Purchase only OR Guardian xxxx QUAD CANE - ------------------------------------------------- CRUTCHES Guardian xxxx Purchase only Lumex xxxx - ------------------------------------------------- WALKERS Guardian xxxx Purchase only Lumex xxxx - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ WALKER o Patient has impaired ambulation and E0143 -Obesity Category I WITH WHEELS there is potential for ambulation. -Muscular dystrophy (MD) o Patient requires additional -Rheumatoid arthritis stability not provided by canes and -Parkinson's disease crutches. -Multiple sclerosis (ms) o Wheeled feature approved if patient -Congestive heart failure lacks the strength to lift the -Cerebral palsy walker. -Intracerebral hemorrhage o Baskets, trays, and cup holders are -Fractures of: tibia, considered convenience items and fibula, ankle, knee or are not covered. foot. o Replacement is available due to patient growth or change in medical condition.. - ------------------------------------------------------------------------------------------------------------------------ HEAVY DUTY, Generally not covered, May be covered E0147 -Gross Obesity Category II MULTIPLE only: -Severe neurologic disorders BRAKING o when patient has severe neurologic SYSTEM, WHEEL disorders or; RESISTANCE o restricted use of one hand. WALKER Baskets, trays and cup holders are not covered. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- WALKER Guardian Purchase only WITH WHEELS XXXX Lumex XXXX - ------------------------------------------------- HEAVY DUTY, Guardian Purchase only MULTIPLE Lumex BRAKING Winnie walker SYSTEM, WHEEL Etac RESISTANCE Invacare WALKER - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ AMBULATORY EQUIPMENT, CONTINUED - ------------------------------------------------------------------------------------------------------------------------ WHITE CANE Not stocked by DME suppliers. Provided by the Association for the Blind. Refer the requestor to the local Association for the Blind. - ------------------------------------------------------------------------------------------------------------------------ AMBULATORY Pads, grips and tips are included with A4635 EQUIPMENT the initial provision of equipment. A4636 ACCESSORIES Replacement supplies included for NORMAL A4637 wear & tear. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ COMMODES - ------------------------------------------------------------------------------------------------------------------------ COMMODE, Patient must be confined to: E0163 -Obesity Category I STANDARD OR -Muscular dystrophy (MD) THREE IN ONE o one level of their home environment -Rheumatoid arthritis where there is no bathroom on that -Parkinson's disease floor. -Multiple sclerosis (ms) o Unable to ambulate without the -Congestive heart failure assistance of a walker or cane. -Cerebral palsy o Unable to transition from sitting -Intracerebral hemorrhage to standing without stand-by assist -Fractures of: tibia, o Padded commodes are appropriate fibula, ankle, knee or for people with decubiti/ severe foot. emaciation.. -Hemiplegia - ------------------------------------------------------------------------------------------------------------------------ COMMODE Drop arm commodes are covered when: E0165 Same as above Category I DROP ARM o Special requirements exist necessitating the feature to be used to facilitate patient transfers or; o if the patient requires extra width. - ------------------------------------------------------------------------------------------------------------------------ COMMODE, Not covered, wheeled commode chairs are E0164 Category II WHEELED OR not considered medically necessary. E0166 ALL PURPOSE - ------------------------------------------------------------------------------------------------------------------------ SITZ BATH Patient has infection or injury of E0160 Hemorrhoids Category I perineal area. E0161 Pilonidal cyst Post- delivery lacerations - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- AMBULATORY EQUIPMENT, CONTINUED - ------------------------------------------------- WHITE CANE - ------------------------------------------------- AMBULATORY Purchase only EQUIPMENT ACCESSORIES - ------------------------------------------------- - ------------------------------------------------- COMMODES - ------------------------------------------------- COMMODE, Guardian XXX Purchase only STANDARD OR Lumex XXX THREE IN ONE Invacare XXX Temco XXX - ------------------------------------------------- COMMODE Guardian Purchase only DROP ARM Lumex - ------------------------------------------------- COMMODE, . WHEELED OR ALL PURPOSE - ------------------------------------------------- SITZ BATH Duromed Purchase only Graham Field - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ HOSPITAL BEDS & ACCESSORIES - ------------------------------------------------------------------------------------------------------------------------ HOSPITAL BED Manual beds are no longer provided. See MANUAL, guidelines for semi-electric beds. FIXED HEIGHT WITH SIDE-RAILS AND MATTRESS. - ------------------------------------------------------------------------------------------------------------------------ HOSPITAL BED Manual beds are no longer provided. See MANUAL, guidelines for semi-electric beds. VARIABLE HEIGHT WITH SIDE-RAILS AND MATTRESS. - ------------------------------------------------------------------------------------------------------------------------ HOSPITAL BED, o Patient requires a hospital bed for E0260 Acute cardio pulmonary Category III SEMI-ELECTRIC use of traction equipment that can conditions, WITH manual only be used with a hospital type Arthritis, height bed. Or, Back disorders, adjustment o Patient requires specific position Neuromuscular or SIDE-RAILS of the body as part of a medical Cerebrovascular disorders AND MATTRESS treatment plan or pain relief for such as MS, MD, CP, CVA at least one month. Or, Fractures o Patient requires immediate and/or Guilliam Barre frequent changes in body position Paralysis o Patient is unable to independently Polio turn or get out of bed without Lower extremity injury. assistance of elevating head of Coma. bed, bed rails or trapeze bar Decubitus ulcers o Patient is unable to toilet Extreme weakness independently - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- HOSPITAL BEDS & ACCESSORIES - ------------------------------------------------- HOSPITAL BED MANUAL, FIXED HEIGHT WITH SIDE-RAILS AND MATTRESS. - ------------------------------------------------- HOSPITAL BED MANUAL, VARIABLE HEIGHT WITH SIDE-RAILS AND MATTRESS. - ------------------------------------------------- HOSPITAL BED, Invacare XXX Same as SEMI-ELECTRIC Joerns XXX above WITH manual Smith Davis height XXX adjustment SIDE-RAILS AND MATTRESS - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ HOSPITAL BEDS & ACCESSORIES, CONTINUED - ------------------------------------------------------------------------------------------------------------------------ HOSPITAL BED, A full electric bed is covered only in E0265 Stroke with hemiplegia Category III FULL ELECTRIC those instances where the member's Paraplegia WITH medical condition requires complete Qaudraplegia SIDE-RAILS care, or extensive skilled services, Guilliam Barre AND and the member is on a regimen of Severe advanced MATTRESS complete bedrest. or is a full lift from neuromuscular disease. bed to chair. - ------------------------------------------------------------------------------------------------------------------------ HOSPITAL BED Covered if the patient meets the basic E0305 Same as above Category III SIDE-RAILS, requirements for a hospital bed and E0310 FULL OR condition requires side rails. HALF LENGTH - ------------------------------------------------------------------------------------------------------------------------ SIDE-RAILS, Not covered, not primarily medical in HOMESTYLE nature. - ------------------------------------------------------------------------------------------------------------------------ OVERBED Not covered, comfort or convenience E0274 TABLE item, not primarily medical in nature. - ------------------------------------------------------------------------------------------------------------------------ TRAPEZE o Covered if the requirements for a E0910 Hemiplegia Category III BARS, hospital bed are met and; Lumbago o Patient has a specific condition Osteoporosis (osteoporosis, hemiplegia)and Sciatica confined to bed AND; Senile dementia o patient needs to sit up due to a Spondylosis, lumbosacral respiratory condition OR; o needs to change body position due to medical condition OR; o provide assistance getting in and out of bed. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- HOSPITAL BEDS & ACCESSORIES, CONTINUED - ------------------------------------------------- HOSPITAL BED, FULL ELECTRIC WITH SIDE-RAILS AND MATTRESS - ------------------------------------------------- HOSPITAL BED Invacare Same as above SIDE-RAILS, Lumex FULL OR Temco HALF LENGTH Smith Davis - ------------------------------------------------- SIDE-RAILS, HOMESTYLE - ------------------------------------------------- OVERBED TABLE - ------------------------------------------------- TRAPEZE Lumex Same as above BARS, Invacare Temco - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ HOSPITAL BEDS & ACCESSORIES, CONTINUED - ------------------------------------------------------------------------------------------------------------------------ TRACTION o Covered if patient has orthopedic E0840 Back disorder Category II, training EQUIPMENT impairment requiring traction E0850 Backache, unspecified on equipment setup is equipment, which prevents E0860 Disc, intervertebral done by patient ambulation during its period of disorder service technician. use. (Collars and supports usable E0870 Lumbago Supplies such as during ambulation would E0880 Osteoporosis pelvic belt, head be considered under O&P benefit.) E0900 Sciatica halter, rope, and o Systems such as Pronex, Saunders, Spine, cervical disorder weight bag included. Granberg, and Lossing are not covered unless a standard brand (see column 6) traction has been tried and shown to be ineffective. - ------------------------------------------------------------------------------------------------------------------------ FRACTURE o Covered if patient meets E0920 Same as above Category III FRAME requirements for trapeze bar E0930 and /or traction equipment E0946 E0947 E0948 - ------------------------------------------------------------------------------------------------------------------------ BED BOARD Not covered, not medical in nature E0273 Category I - ------------------------------------------------------------------------------------------------------------------------ BED CRADLE Covered for burn patients or other E0280 Category I medical/surgical situations where contact with bed linens should be limited, such as extensive skin graft - ------------------------------------------------------------------------------------------------------------------------ PADS FOR Not covered, a comfort item not SIDERAILS primarily medical in nature. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- HOSPITAL BEDS & ACCESSORIES, CONTINUED - ------------------------------------------------- TRACTION Invacare Purchase only EQUIPMENT Duromed Graham field - ------------------------------------------------- FRACTURE Invacare Same as FRAME hospital bed - ------------------------------------------------- BED BOARD - ------------------------------------------------- BED CRADLE Guardian (blanketeze) - ------------------------------------------------- PADS FOR SIDERAILS - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ PATIENT LIFTING DEVICES - ------------------------------------------------------------------------------------------------------------------------ PATIENT o If transfer between bed and chair E0630 Category III, LIFTS/Hoyer or commode requires the full Acute cardio-pulmonal training and setup on type. assistance of more than one person Alzheimer's disease equipment is done by who routinely lives in the home and Arthritis patient service is responsible for providing care Back disorders technician. Sling or CP, MS, MD, COPD seat for lift is Cerebrovascular accident included. Bathing Chronic brain syndrome accessories and scale Coma, decubitis ulcers are not covered. Diabetes w/complications Emphysema Fractures Guillain barre syndrome Heart, post myocardial infarction Lung disease Myasthenia gravis Paraplegia, quadriplegia Parkinson's disease Polymyositis Spine, cervical injuries - ------------------------------------------------------------------------------------------------------------------------ BATHTUB LIFT Not covered, only standard Hoyer E0625 lift is covered..See above. - ------------------------------------------------------------------------------------------------------------------------ PATIENT LIFT, Not covered, institutional item not E0635 ELECTRIC suitable for home use. - ------------------------------------------------------------------------------------------------------------------------ SEAT LIFT Not covered, not primarily medical in E0627 Osteoarthritis Category III CHAIR nature. Rheumatoid arthritis Muscular dystrophy Central nervous system & degenerative disease - ------------------------------------------------------------------------------------------------------------------------ STAIR OR Not covered, convenience item which is PORCH LIFT not primarily medical in nature. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- PATIENT LIFTING DEVICES - ------------------------------------------------- PATIENT Guardian Rent initially, LIFTS/Hoyer Lumex if patients' type. Invacare condition is stable and long term (longer than 1 year) then purchase should be considered. - ------------------------------------------------- BATHTUB LIFT - ------------------------------------------------- PATIENT LIFT, ELECTRIC - ------------------------------------------------- SEAT LIFT Pride CHAIR Penox ADI Golden technologies - ------------------------------------------------- STAIR OR PORCH LIFT - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ STANDING Prone standers are covered for Cerebral Covered limited to diagnosis TABLE or Palsy, or other advanced neuro-muscular of Cerebral Palsy or other PRONE degenerative disease when requested as advanced neuro-muscular STANDER part of a physical or occupational degenerative disease when therapy program. Or as replacement due requested as part of a to growth or change in condition physical or occupational therapy program or replacement due to growth or change in conditon. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ DECUBITIS CARE EQUIPMENT - ------------------------------------------------------------------------------------------------------------------------ FLOTATION o Covered if patient has or is E0196 Category III MATTRESS, highly susceptible to decubitis E0187 Acute cardio-pulmonal GEL AND ulcers and the PCP will be Alzheimer's disease WATER supervising the equipment's use in Arthritis connection with the course of Back disorders treatment; CP, MS, MD, COPD o Bed or chair confinement may Cerebrovascular accident demonstrate the need for equipment. Chronic brain syndrome Coma, decubitis ulcers Diabetes w/complications Emphysema Fractures Guillain barre syndrome Heart, post myocardial infarction Lung disease Myasthenia gravis Paraplegia, quadriplegia Parkinson's disease Polymyositis Spine, cervical injuries - ------------------------------------------------------------------------------------------------------------------------ DRY PRESSURE Same as floatation mattress E0184 Same as above Category III MATTRESS - ------------------------------------------------------------------------------------------------------------------------ DRY PRESSURE Considered a consumable and comfort item E0199 Category I PAD FOR and is not a covered benefit. . MATTRESS (EGGCRATE) - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- STANDING TABLE or PRONE STANDER - ------------------------------------------------- - ------------------------------------------------- DECUBITIS CARE EQUIPMENT - ------------------------------------------------- FLOTATION Lumex Rent only MATTRESS, Lotus GEL AND Graham field WATER - ------------------------------------------------- DRY PRESSURE BG industries Rent only MATTRESS Span America - ------------------------------------------------- DRY PRESSURE PAD FOR MATTRESS (EGGCRATE) - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ ALTERNATING Same as flotation mattress. E0180 Same as above Category III PRESSURE PUMP AND PAD - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ DECUBITIS CARE EQUIPMENT, CONTINUED - ------------------------------------------------------------------------------------------------------------------------ ALTERNATING Covered if the following criteria are E0277 Same as above Category III PRESSURE met : MATTRESS a) criterion 1,2 & 3 b) criterion 4, or c) criterion 5 & 6 1. Multiple stage II pressure ulcers located on the trunk or pelvis; 2. Patient has been on a comprehensive ulcer treatment program for at least the past month which has included the use of an appropriate group I (above items) support surface; 3. The ulcers have worsened or remained the same over the past month; 4. Large or multiple stage III or iv pressure ulcers on the trunk or pelvis; 5. Recent myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis (within 60 days); 6. Patient has been on a group 2 or 3 support service immediately prior to a recent discharge from hospital or nursing facility (within 30 days). - ------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------- ALTERNATING Grant Rent only PRESSURE Gaymar PUMP AND PAD Huntleigh Bioclinic - ------------------------------------------------- - ------------------------------------------------- DECUBITIS CARE EQUIPMENT, CONTINUED - ------------------------------------------------- ALTERNATING Huntleigh Rental only PRESSURE Bioclinic MATTRESS KCI - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ DECUBITIS CARE EQUIPMENT, CONTINUED - ------------------------------------------------------------------------------------------------------------------------ Roho or Rik Same as above K0413 Same as above Category III MATTRESS - ------------------------------------------------------------------------------------------------------------------------ Air Mattress Air mattress overlays are covered only Overlays when the overlay fits the bed the member has in their home, and the cost of the overlay alone, does not exceed the cost of the standard air mattress . - ------------------------------------------------------------------------------------------------------------------------ POWERED AIR Same as above E0193 Same as above Category III FLOTATION BED (LOW AIR LOSS) - ------------------------------------------------------------------------------------------------------------------------ AIR FLUIDIZED GSA excludes air fluidized beds from the E0194 Same as above Category III BED benefit. Not covered. - ------------------------------------------------------------------------------------------------------------------------ HYPERBARIC Not covered as home durable medical CHAMBER equipment. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- DECUBITIS CARE EQUIPMENT, CONTINUED - ------------------------------------------------- Roho or Rik Crown Rental only MATTRESS Rik - ------------------------------------------------- Air Mattress Overlays - ------------------------------------------------- POWERED AIR Huntleigh Rental only FLOTATION Bioclinic BED (LOW AIR & KCI LOSS) - ------------------------------------------------- AIR FLUIDIZED KCI Rental only BED - ------------------------------------------------- HYPERBARIC CHAMBER - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ WOUND Negative Pressure Wound Therapy VACUUM or Vacuum-Assisted Closure, COVERAGE LIMITED TO THE DEVICES including a FDA-approved pump FOLLOWING DIAGNOSES: (i.e., VAC(R), Kinetic Concepts Inc., San Antonio, TX) and CHRONIC STAGE III OR STAGE supplies, may be covered when IV PRESSURE ULCERS OR, the treating physician's request and supporting documentation CHRONIC DIABETIC NEUROPATHIC establish the following: ULCERS, OR COMPLICATIONS OF A o The ulcer, as described below, SURGICALLY CREATED WOUND demonstrates a lack of improvement* (e.g., DEHISCENCE) OR A despite: TRAUMATIC WOUND 1. Treatment with the following complete wound therapy program: o At least weekly visits with written documentation in the member's medical record of evaluation and care by a licensed medical professional and at least monthly documentation of the wound's measurements; AND o Application of moist topical dressings; AND o Serial sharp, chemical and/or mechanical debridement of necrotic tissue as appropriate; AND o Provision for adequate nutritional status as documented by a serum albumin of > 3.0 g/dl during the month prior to the use of negative pressure wound therapy. AND 1. The member has one of the following: a) CHRONIC STAGE III OR STAGE IV PRESSURE ULCERS; AND o The ulcer has demonstrated a lack of improvement* and remains full thickness despite consistent application of all of the following for at least the last two (2) continuous months prior to initiating vacuum-assisted wound closure: o The member has been appropriately turned and positioned; AND o The member has used an appropriate pressure relief device (e.g., low air loss bed, alternating pressure mattress) for pressure ulcers on the posterior trunk or pelvis; AND o The member's moisture and incontinence have been appropriately maintained. OR a) CHRONIC DIABETIC NEUROPATHIC ULCERS; AND o The ulcer has demonstrated a lack of improvement* despite the consistent application of all of the following for at least the last two (2) continuous months prior to initiating vacuum-assisted wound closure: o The member has been on a comprehensive diabetic management program; AND o The member has had appropriate foot care, including an attempt to reduce pressure on a foot ulcer; AND o The member has been non-weight bearing as appropriate. OR a) CHRONIC VENOUS STASIS ULCERS; AND o The ulcer has demonstrated a lack of improvement* despite the consistent application of all of the following for at least the last two (2) continuous months prior to initiating vacuum-assisted wound closure: o Compression garments/dressings have been consistently applied; AND o Leg elevation and ambulation have been encouraged. *LACK OF IMPROVEMENT IS DEFINED AS A LACK OF PROGRESS IN QUANTITATIVE MEASUREMENTS OF WOUND CHARACTERISTICS INCLUDING WOUND LENGTH, AND WIDTH (SURFACE AREA), AND DEPTH MEASUREMENTS MEASURED IN CENTIMETERS, AND AMOUNT OF EXUDATE (DRAINAGE), SERIALLY OBSERVED AND DOCUMENTED OVER A SPECIFIC TIME INTERVAL. OR o The member has complications of a surgically created wound (e.g., dehiscence) or a traumatic wound (e.g., pre-operative flap or graft) where there is documentation of the medical necessity for accelerated formation of granulation tissue which cannot be achieved by other topical wound treatments (e.g., the member has comorbidities that will not allow for healing times achievable with other topical wound treatments). CONTRAINDICATIONS According to the manufacturer, KCI USA Inc., contraindications to V.A.C.(R)use includes any of the following: o The presence in the wound of necrotic tissue with eschar, unless effective debridement has occurred o Untreated osteomyelitis within the vicinity of the wound; o Cancer present in the wound; o The presence of a fistula to an organ or body cavity within the vicinity of the wound. It should be used cautiously in patients with active bleeding, difficult wound hemostasis, and patients who are on anticoagulants. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- WOUND KCI VACUUM DEVICES - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ DIABETIC CARE - ------------------------------------------------------------------------------------------------------------------------ GLUCOMETERS The Roche glucometer is the preferred E0607 Diabetes mellitus, also with If training has been Glucometer. Roche dextrosticks are the E0609 ketoacidosis completed by PCP or CIGNA formulary brand. Members who want Vision difficulties hospital staff then to have their dextrosticks covered under Circulatory difficulties category I, otherwise their formulary level of coverage should category II. Initial use Roche glucometers. supplies included with glucometer. Standard device is covered for: Ongoing supplies may o Type I, Type II or Gestational be covered under diabetes; pharmacy benefit. o Special features such as large MEDICARE COVERS TEST read-out or audio are covered for STRIPS AND LANCETS visual impairments. UNDER HME BENEFIT. o Continuous monitoring devices are not covered as they do not replace the need for intermittent glucose monitoring using a standard glucometer. Alternative site or compact glucometers may be provided as an alternative to, not in addition to a standard glucometers at the member or physician request - ------------------------------------------------------------------------------------------------------------------------ INJECTORS, May be covered as an alternative to an NEEDLELESS insulin pump in children under age 16 who require three or more insulin injections to maintain a normal blood sugar. - ------------------------------------------------------------------------------------------------------------------------ Diabetic NEEDLES, LANCETS, ALCOHOL WIPES, INSULIN supplies. ETC ARE COVERED UNDER THE MEMBER'S PHARMACY PLAN AND NOT SUPPLIED THROUGH GENTIVA. MEDICALLY NECESSARY DIABETIC SHOES MAY BE COVERED UNDER THE MEMBER'S ORTHOTIC COVERAGE. CHECK PLAN LANGUAGE AND REFER TO LOCAL ORTHOTIC VENDOR. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- DIABETIC CARE - ------------------------------------------------- GLUCOMETERS Lifescan Purchase only Medisense Boehringer Mannheim - ------------------------------------------------- INJECTORS, NEEDLELESS - ------------------------------------------------- Diabetic supplies. - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ VACUUM Not covered under DME. ERECTION DEVICES (erectaids) - ------------------------------------------------------------------------------------------------------------------------ EXTERNAL Covered if prescribed by a physician E0784 Same as above Category III, AMBULATORY and; delivery should be INFUSION o the patient is injecting insulin coordinated with PUMP FOR three times daily and has PCP to handle INSULIN experienced difficulty training. Supplies in controlling blood sugar levels included. on less than three insulin injections every day.. The member does not need to attempt a fourth injection prior to coverage, - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ CPM - ------------------------------------------------------------------------------------------------------------------------ CONTINUOUS Covered: E0935 Total knee replacement Category III, PASSIVE o For patients who have TKR or ACL ACL repair delivery and training MOTION repair and and total duration only performed by patient EXERCISE up to 3 weeks. service technician. (CPM) KNEE o The 3 week limit may be repeated if CPM softgoods a second surgery is required. CPM (fleece) included. is also covered for members requiring joint manipulation after a surgical procedure as a method to prevent further adhesions or repeat surgery. - ------------------------------------------------------------------------------------------------------------------------ CPM, HAND, Not Covered WRIST, ANKLE & SHOULDER - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- VACUUM ERECTION DEVICES (erectaids) - ------------------------------------------------- EXTERNAL Minimed Purchase AMBULATORY Disetronics only., INFUSION PUMP FOR INSULIN - ------------------------------------------------- - ------------------------------------------------- CPM - ------------------------------------------------- CONTINUOUS Therakinetics Rental only PASSIVE Sutter MOTION Stryker EXERCISE (CPM) KNEE - ------------------------------------------------- CPM, HAND, WRIST, ANKLE & SHOULDER - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ COMPRESSION THERAPY - ------------------------------------------------------------------------------------------------------------------------ LYMPHEDEMA Covered only for patients with E0650 Lymphedema of extremities Category II, delivery PUMPS, lymphedema postoperative to a generally caused by: and training NON-SEGMENTAL mastectomy, or lymphedema of the Spread of malignant tumors performed by patient (single tube extremities which has been unresponsive Radical surgical procedures service technician. with set to physical therapy and manual Post radiation fibrosis Pneumatic appliance level of compression techniques. Filarlasis (sleeve) included. pressure), COMPRESSION Dual sleeves are covered when a member Post inflammatory thrombosis PUMP requires therapy on both limbs. The goal Milroy's disease of compression therapy is to allow the Congenital lymphedema member to become more active due to Mastectomy decreased edema. The prolonged bedrest required to treat bilateral lymphedema with a single sleeve is considered couterproductive. - ------------------------------------------------------------------------------------------------------------------------ LYMPHEDEMA Same as above. Segmental pump has E0651 Same as above Same as above PUMP, multiple outflow ports which lead to SEGMENTAL distinct segments on the appliance which inflates sequentially. - ------------------------------------------------------------------------------------------------------------------------ LYMPHEDEMA Covered if above therapy has been tried E0652 Same as above Same as above PUMP, and not successful or patient's lesion SEGMENTAL W/ requires limited pressure to be applied CALIBRATED to a specific area. GRADIENT Pump has a regulator on each outflow PRESSURE port that can deliver a specified pressure to each segment. - ------------------------------------------------------------------------------------------------------------------------ COMPRESSION Consumable item, not covered under DME STOCKINGS benefit. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- COMPRESSION THERAPY - ------------------------------------------------- LYMPHEDEMA Jobst Rent initially, PUMPS, Kendall if patients' NON-SEGMENTAL condition is (single tube stable and with set long term level of (longer then pressure), 1 year) then COMPRESSION purchase PUMP should be considered. - ------------------------------------------------- LYMPHEDEMA Jobst Same as above PUMP, Kendall SEGMENTAL Talley Multicom - ------------------------------------------------- LYMPHEDEMA Jobst Same as above PUMP, Kendall SEGMENTAL W/ Talley CALIBRATED Multicom GRADIENT PRESSURE - ------------------------------------------------- COMPRESSION STOCKINGS - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ STIMULATORS - ------------------------------------------------------------------------------------------------------------------------ DRIONIC Not covered, not primarily medical in DEVICES nature - ------------------------------------------------------------------------------------------------------------------------ TRANSCUTANEOUS Standard unit is covered for chronic E0720 Back injury Category II, fitting ELECTRONIC pain. E0730 Sciatica and electrode NERVE Pain in thoracic spine placement to be STIMULATOR Injury to shoulder completed by (TENS) Disc, intervertebral physician or physical disorder therapy department. Osteoporosis, or any other Initial setup of condition resulting in supplies to include chronic pain. lead wires, and one-month supply of electrodes, conductive paste and batteries. Ongoing supplies included. - ------------------------------------------------------------------------------------------------------------------------ MUSCLE Covered for patients with following E0745 Diffuse muscle atrophy Same as above STIMULATOR diagnosis. Hip replacement o Standard units (two channel,) must be utilized for a two week period, and proven ineffective prior to the four channel stimulator being covered.. - ------------------------------------------------------------------------------------------------------------------------ MUSCLE Not covered, additional features are STIMULATOR, primarily institutional in nature. INTERFERENTIAL PROGRAMMABLE - ------------------------------------------------------------------------------------------------------------------------ THERAPEUTIC Not covered, technology not yet proven ELECTRICAL to have significant medical benefit STIMULATION primarily used for pediatric cerebral (TES) palsy. - ------------------------------------------------------------------------------------------------------------------------ STIMULATOR, Not covered, technology not yet proven E0755 SALIVARY and alternative therapies exist. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- STIMULATORS - ------------------------------------------------- DRIONIC DEVICES - ------------------------------------------------- TRANSCUTANEOUS Empi Rent to ELECTRONIC Staodyne purchase NERVE Graham field STIMULATOR (TENS) - ------------------------------------------------- MUSCLE Same as above Same as above STIMULATOR - ------------------------------------------------- MUSCLE STIMULATOR, INTERFERENTIAL PROGRAMMABLE - ------------------------------------------------- THERAPEUTIC ELECTRICAL STIMULATION (TES) - ------------------------------------------------- STIMULATOR, SALIVARY - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ HOLTER Holter monitors are diagnostic and not MONITOR covered under DME, they are core medical (ELECTRO- and should not accrue to the members DME CARDIO- max.. Gentiva is not the delivery RECORDER), channel for diagnostic test or diagnostic equipment. - ------------------------------------------------------------------------------------------------------------------------ BONE GROWTH o Covered for a long bone fracture E0747 Nonunion of long bone Category III STIMULATOR & that will not be healed in 120 E0748 fractures longer than 120 ULTRASOUND days, days. o Covered for healing of post-operative spinal fusion in Spinal fusion in members who patients AT RISK FOR failure to heal smoke tobacco., due to cigarette/ tobacco abuse. No trial period is required for patients with an identified risk factor. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ ENTERAL - ------------------------------------------------------------------------------------------------------------------------ ENTERAL PUMPS B9002 Ulcerative colitis Category III, (food pumps) o Covered under the DME benefit when Gastrointestinal cancer training and setup by a member is dependent upon tube Abnormal loss of weight trained patient feedings for nutritional support. Ischemic bowel disease service technician. o Portable pumps are covered in lieu Nausea/vomiting . SNV required if of stationary pumps if condition Alzheimer's disease training not done in requires continuous feeding and/or Dysphasia facility Ongoing the member is able to leave the CVA supplies and home for prolonged periods such as Short gut syndrome nutritionals may be for physician office visits or Jaw fracture delivered by small medical therapies. package courier. Supplies for gravity feeding are also covered as long as patient meets pump criteria. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- HOLTER MONITOR (ELECTRO- CARDIO- RECORDEr), - ------------------------------------------------- BONE GROWTH EBI STIMULATOR & Orthologic ULTRASOUND Bio electron Exogen - ------------------------------------------------- - ------------------------------------------------- ENTERAL - ------------------------------------------------- ENTERAL PUMPS Sherwood Rent initially, (food pumps) medical if patients Ross labs condition is Corpak stable and Mead Johnson long term (longer than 1 year) then purchase should be considered - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ HEAT, LIGHT & COLD THERAPY - ------------------------------------------------------------------------------------------------------------------------ DIATHERMY Not covered, institutional use only UNITS - ------------------------------------------------------------------------------------------------------------------------ HEAT LAMPS Not covered, not primarily medical in E0200 Category II nature. E0205 - ------------------------------------------------------------------------------------------------------------------------ HEATING PADS Not covered, considered a comfort item E0210 not primarily medical in nature. E0215 E0238 - ------------------------------------------------------------------------------------------------------------------------ SAD lights Not covered under medical plan. - ------------------------------------------------------------------------------------------------------------------------ ULTRAVIOLET Covered for selected patients with E0690 Generalized Refractory Category III, setup PANEL LIGHTS, Refractory psoriasis; psoriasis performed by trained o MD must justify treatment at home service technician. versus alternate sites (e.g. Outpatient department at hospital). Panel lights should be considered, if several discrete body areas can be treated individually. Cabinet style should be reserved for members with extensive involvement > 54% of body surface area. - ------------------------------------------------------------------------------------------------------------------------ HYDROCOLLATOR Not covered, not essential to the E0225 UNIT administration of moist heat therapy. E0239 - ------------------------------------------------------------------------------------------------------------------------ COLD Not covered, treatment can be THERAPY UNIT accomplished using alternative methods (cryotherapy) (i.e., Ice packs). - ------------------------------------------------------------------------------------------------------------------------ PARAFFIN Not covered, not generally considered E0235 BATH effective therapy by the medical UNITS profession. (portable) - ------------------------------------------------------------------------------------------------------------------------ WHIRLPOOLS Portable whirlpools are covered in the E1300 Wounds of an extremity home only when required as part of a E1310 requiring home debridement. home physicial therapy program for wound care & debridement of a wound on an extremity. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- HEAT, LIGHT & COLD THERAPY - ------------------------------------------------- DIATHERMY UNITS - ------------------------------------------------- HEAT LAMPS Brandt Rent only, Graham Field unless under $200. - ------------------------------------------------- HEATING PADS - ------------------------------------------------- SAD lights - ------------------------------------------------- ULTRAVIOLET National Purchase only PANEL LIGHTS, biologic - ------------------------------------------------- HYDROCOLLATOR UNIT - ------------------------------------------------- COLD THERAPY UNIT (cryotherapy) - ------------------------------------------------- PARAFFIN Purchase only BATH UNITS (portable) - ------------------------------------------------- WHIRLPOOLS - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIRS - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIR, o Covered if the member is K0001 Unilateral BK or AK Category II STANDARD functionally disabled and requires amputation assistance beyond the use of a cane Bilateral AK or BK for ambulation. amputation Rheumatoid arthritis Osteoarthritis Paraplegia ALS, MS, CP, MD, CHF Quadriplegia - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIR, Same as above based on ability of K0003 Same as above Category II LIGHTWEIGHT caregiver and/or patient to handle (less than wheelchair in and outside of home in 36 lbs) tranport of patient or chair o - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIR, K0005 ALS, CP, MD, ms Category II ULTRALIGHT o Quadriplegia (less than o These are generally considered to Paraplegia 30 lbs w/adj. be sport chairs, Customization for Rear axle) sport or athletic activities is not a covered benefit. Ultralight wheelchairs are only covered when the patient's condition has reached a point where they are still able to operate a wheelchair but can only manage propelling an ultra- light weight chair. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- WHEELCHAIRS - ------------------------------------------------- WHEELCHAIR, Everest & Rent STANDARD Jennings initially, if Invacare patients Gendron condition is Sunrise Medical stable and Pogon long term Maclaren (longer then Wheelring 1 year) then purchase should be considered - ------------------------------------------------- WHEELCHAIR, Same as above Same as above LIGHTWEIGHT (less than 36 lbs) - ------------------------------------------------- WHEELCHAIR, Same as above Same as above ULTRALIGHT (less than 30 lbs w/adj. Rear axle) - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIRS - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIR, Same as standard wheelchair AND; K0002 Ms, CHF, MD Category II HEMI o chair is needed to enable the Hemiplegia patient to place feet on the ground Intracerebral hemorrhage for propulsion or short stature Parkinson's disease (5' 4" or less) - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIR, Same as standard wheelchair AND; K0100 Unilateral or bilateral AK Category II AMPUTEE o must have one of the following or BK amputation (or amputee diagnosis adapter) - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIR, Same as standard wheelchair AND; E0958 Category II ONE ARM DRIVE o patient only has use of one hand or (or adapter) arm. - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIR, Same as standard wheelchair, AND; K0006 Same as standard wheelchair Category II HEAVY DUTY o patient must weigh over 250 lbs. Or can not fit into width of standard wheelchair - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIR, Same as above AND; K0007 Same as standard wheelchair Category II EXTRA o patient must weigh over 300 lbs. HEAVY DUTY - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIR, Same as standard wheelchair AND; K0028 Same as standard wheelchair Category II RECLINING o patient must be in wheelchair at BACK least 4 hrs per day AND; o patient must have at least one of the following: quadriplegia, fixed hip angle, trunk or leg casts, extensor tone of trunk muscles; o Patient needs to be in recumbent position two or more times per day AND; o Requires frequent position change. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- WHEELCHAIRS - ------------------------------------------------- WHEELCHAIR, Same as above Same as above HEMI - ------------------------------------------------- WHEELCHAIR, Same as above Same as above AMPUTEE (or amputee adapter) - ------------------------------------------------- WHEELCHAIR, Same as above Same as above ONE ARM DRIVE (or adapter) - ------------------------------------------------- WHEELCHAIR, Same as above Same as above HEAVY DUTY - ------------------------------------------------- WHEELCHAIR, Same as above Same as above EXTRA HEAVY DUTY - ------------------------------------------------- WHEELCHAIR, Same as above Same as above RECLINING BACK - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIRS, CONTINUED - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIR, Covered if ALL the following conditions K0011 ALS, MS, MD, only when the Category II, POWER DRIVE are met: K0012 member's physical condition batteries included. o Meets standard AND; requires this level of a Battery replacement o Patient is unable to operate a wheelchair at the time of limited to once every Wheelchair manually; the request. Power twelve months. o Patient is able to safely operate wheelchairs will not be the controls; covered in "anticipation" of o Patient has severe weakness or possible future (greater other conditions affecting the than three months) need. Upper body due to neuro or muscular Paraplegia condition, usually totally Quadriplegia, non-ambulatory and reasonably independant. o - ------------------------------------------------------------------------------------------------------------------------ THREE Three wheeled scooters may be provided E1230 Same as above WHEELED POWER as an alternative to a wheel chair when OPERATED the patient has a condition for which VEHICLE they are confined to bed/chair OR unable (scooter) to endure ambulation more than 20 feet OR has fallen repeatedly within home and functional ability would improve AND; o They are unable to operate WC manually AND; are able to safely operate the controls - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- WHEELCHAIRS, CONTINUED - ------------------------------------------------- WHEELCHAIR, Same as above Same as above POWER DRIVE - ------------------------------------------------- THREE Pride Same as above WHEELED POWER Orthokinetics OPERATED Amigo VEHICLE Hoveround (scooter) - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIRS, CONTINUED - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIR Not covered. W/STANDING FEATURE - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIR, Covered when patient meets standard K0009 ALS, ms, MD Category II, fitting, CUSTOM wheelchair criteria AND; K0014 Paraplegia delivery and setup o the features are not readily Quadriplegia performed by rehab available in manufacturers standard technician trained in product offering. seating and o Must be uniquely constructed or positioning. substantially modified for the Nonstandard features specific patient AND; such as special o Assessment or fitting is required. colors or upholstery designs that are not medical in nature are not covered. - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIR Covered if patient has or is highly E0962 Paraplegia Category I CUSHION, FOAM susceptible to pressure sores. E0963 Quadriplegia o Foam cushions are not covered E0964 Decubitus ulcer when used for comfort and E0965 Alzheimer's disease convenience. ALS, CVA - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIR Same as above E0178 Same as above Category I CUSHION, GEL FLOTATION - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- WHEELCHAIRS, CONTINUED - ------------------------------------------------- WHEELCHAIR W/STANDING FEATURE - ------------------------------------------------- WHEELCHAIR, Pride Purchase only CUSTOM Invacare Quickie designs Everest & Jennings Hoveround - ------------------------------------------------- WHEELCHAIR Bioclinic Purchase only CUSHION, FOAM Mason - ------------------------------------------------- WHEELCHAIR Lumex Purchase only CUSHION, GEL Jay medical FLOTATION Lotus Action - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIRS, CONTINUED - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIR Same as above E0192 Same as above Category II CUSHION, LOW EQUALIZATION & POSITIONING PAD - ------------------------------------------------------------------------------------------------------------------------ WHEELCHAIR ACCESSORIES o Items such as cupholders, backpacks, trays, ashtrays, are convenience items and are not covered. o Items such as elevating legrests, detachable arms, anti-tipping devices, and oxygen tank attachment, are typical of covered items when required for a unique medical condition or functional limitation of the patient. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- WHEELCHAIRS, CONTINUED - ------------------------------------------------- WHEELCHAIR Jay medical Purchase only CUSHION, Roho LOW EQUALIZATION & POSITIONING PAD - ------------------------------------------------- WHEELCHAIR ACCESSORIES - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ NEWBORN CARE - ------------------------------------------------------------------------------------------------------------------------ PHOTOTHERAPY Covered if patient has following E0202 Jaundice Category III, BILILIGHTS diagnosis AND Infant is; delivery and BILIBLANKET o 24-48 hrs old if total bili is equipment training at least 12; performed by patient o 49-72 hours old if total bili is service technician. at least 15; Confirmation of o Over 72 hours old if total bili caregiver ability to is at least 17. receive equipment o Bilirubin greater than 25 is not training by considered to be safe for treatment nonclinincal staff in the home. should be discussed o Two types of equipment exist for with PCP. IF the PCP this therapy; box lights where the has additional infant is placed inside of the unit concerns an RN home (similar in size to an incubator) health visit should or blanket style where the infant also be scheduled. is wrapped with a panel of CPR training, if any, fiberoptic lights. to be done at o The blanket style is more readily hospital prior to available both units provide discharge. Supplies medically efficacious therapy. included in the o Double lights or lights and rental price. blanket are appropriate for infants who are not responsive to therapy with a single modality, or whose bilirubin is begnning to increase rather than decrease. o - ------------------------------------------------------------------------------------------------------------------------ BREAST Covered only if the infant will remain Infant has cleft palate or PUMPS hospitalized for more than seven days similar condition inhibiting post discharge of mother; or for the ability to suckle. following infant diagnosis. Battery operated unit is model of choice. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- NEWBORN CARE - ------------------------------------------------- PHOTOTHERAPY Ohmeda XXX Rental only BILILIGHTS Fiberoptic BILIBLANKET (wallaby) Physician Eng. Products - ------------------------------------------------- BREAST PUMPS - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ INCUBATOR Covered for premature infants less then Category III. Product 4 pounds in body weight. may not be available in all areas. - ------------------------------------------------------------------------------------------------------------------------ APNEA MONITOR Covered If one of the following exists: Category III, W/MEMORY = o preterm with pathologic apnea; delivery and setup standard unit. o preterm infant who could be performed by clinical discharged from the hospital but staff. CPR training has immature respiratory control to be done at with feeding; hospital prior to o infant discharged with trach. discharge. Supplies included. Check with PCP for need for RN skilled home health visit. o ;Apnea monitors for infants soley because the parents have previously had a child with SIDS are not covered. Check with state social workers for state coverage of apnea monitors for siblings of children with SIDS. Many states have programs to provide these monitors. Inform Parents and physicians about state and/or community programs to obtain monitors if available. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- INCUBATOR - ------------------------------------------------- APNEA MONITOR Corometrics Rental only W/MEMORY = Aequitron standard unit. Healthdyne Edentec - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------------ DIAGNOSTICS - ------------------------------------------------------------------------------------------------------------------------------ PNEUMOGRAM Pneumograms are diagnostic and not AND SLEEP covered under DME,, they are core STUDIES medical and should not accrue to the members DME max.. - ------------------------------------------------------------------------------------------------------------------------------ OXIMETRY Covered when used as a monitoring and Category III, setup alarm device; Anyone on a ventilator; and training o Not covered under DME benefit premies on active therapy performed by clinical when used as a diagnostic tool for apnea; Infants with staff. o Gentiva will provide "spot broncho-pulmonary dysplasia. checks" for members on chronic O2 Infants, or comatose adults to ascertain the continuing medical with trachs necessity for oxygen in the home members with advanced every 60-90 days. pulmonary disease such as pulmonary hypertension or pulmonary fibrosis who are on an active lung transplant waiting list - ------------------------------------------------------------------------------------------------------------------------------ BLOOD Covered only for the following A4660 Pregnancy induced Category I. PRESSURE diagnosis: A4663 hypertension UNIT o Pregnancy induced hypertension A4670 only. Digital or manual units are covered based on member/ physician preference. o Dynamap continuous monitoring equipment is not covered in the home setting. This is institutional equipment. - ------------------------------------------------------------------------------------------------------------------------------ BIOFEEDBACK Not a covered benefit. E0746 (electromyography) Incontinence Alarms - ------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------------- DIAGNOSTICS - ------------------------------------------------------- PNEUMOGRAM AND SLEEP STUDIES - ------------------------------------------------------- OXIMETRY Nelcor Puritan Bennett - ------------------------------------------------------- BLOOD Omron Purchase only. PRESSURE Labtron UNIT - ------------------------------------------------------- BIOFEEDBACK (electromyography) Incontinence Alarms - -------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ RESPIRATORY - ------------------------------------------------------------------------------------------------------------------------ Aerochamber Not covered as DME. May be covered under the member's pharmacy plan. Check pharmacy and Well Aware program. - ------------------------------------------------------------------------------------------------------------------------ AIR CLEANER Not covered, environmental control (PURIFIER) equipment, not primarily medical in (electrostatic nature. machines) - ------------------------------------------------------------------------------------------------------------------------ DEHUMIDIFIERS Not covered, environmental control unit; (room type) not medical in nature. - ------------------------------------------------------------------------------------------------------------------------ VAPORIZERS Not covered, considered a comfort item E0605 not primarily medical in nature. - ------------------------------------------------------------------------------------------------------------------------ NEBULIZER Covered if patient's ability to breathe E0570 Pneumonia viral or bacterial Category I, w/compressor is impaired and has difficulties in CHF, COPD, instruction may expectorating sputum or copious Black lung include videotape, secretions. Asthma initial A portable unit may be covered in lieu Chronic bronchitis administration set of a stationary unit. Emphysema included in setup, Asbestosis ongoing supplies included. Medication for nebulizer, MDI's and accessories (i.e. Aerochamber) does not fall under hme benefit. - ------------------------------------------------------------------------------------------------------------------------ NEBULIZER, Ultrasonic Nebulizer with compressor is E0575 Same as above Same as above ULTRASONIC appropriate and acceptable medication delivery system. o Covered for delivery of Pentamidine. o Requests for utrasonic nebulizers other than for administration of Pentamadine should be referred to the healthplan medical director if the ordering physician is not satisified with a standard nebulizer as a delivery system. Ultrasonic nebulizers are not covered under the capitated agreement. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- RESPIRATORY - ------------------------------------------------- Aerochamber - ------------------------------------------------- AIR CLEANER (PURIFIER) (electrostatic machines) - ------------------------------------------------- DEHUMIDIFIERS (room type) - ------------------------------------------------- VAPORIZERS - ------------------------------------------------- NEBULIZER Devilbiss Purchase only w/compressor (pulmoaide) Mada medical Invacare Healthdyne Caire - ------------------------------------------------- NEBULIZER, Same as above Purchase only ULTRASONIC - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ PEAK FLOW Not covered as DME. Refer to the E1399 METER healthplan for Well Aware program. - ------------------------------------------------------------------------------------------------------------------------ SPIROMETER Not covered under HME, not readily available for use in the home. - ------------------------------------------------------------------------------------------------------------------------ COMPRESSOR, Same as nebulizer,AND; E0565 Same as above Same as above AIR o The patient requires higher air pressure (50 psi) to nebulize thicker medications (i.e. Pentamidine) and realize deeper lung penetration. - ------------------------------------------------------------------------------------------------------------------------ IPPB Covered if the patients ability to E0550 Same as above Category III breathe is severely impaired. May require a special order as this is not a service traditionally supplied in the home. - ------------------------------------------------------------------------------------------------------------------------ SUCTION UNITS Covered for patients with one or more of E0600 Lung cancer Category II, training (aspirators) the following : Tracheostomy and setup done by Gomcos o Difficulty raising or clearing Quadriplegia clinical staff, secretions; Viral or bacterial pneumonia suction canister, o Cancer or surgery of the throat; Emphysema suction tubes and o Dysfunction of the swallowing Bronchiectasis tubing are included. muscles; CF, CP, CHF, Trachea care supplies o Unconscious or in obtunded state; Black lung are not covered. o Tracheostomy. Cancer of the throat o Gomco suction units will be Coma provided at the physician's request. Note this item may be difficult to locate and an alternative may need to be provided while Gentiva locates an available unit. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ SUCTION Portable units are covered in lieu of UNITS, stationery units when the member's PORTABLE condition requires intermittent suction OR AC/DC outside the home; I,e for physician visits of visits for outpatient activities. - ------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------- PEAK FLOW METER - ------------------------------------------------- SPIROMETER - ------------------------------------------------- COMPRESSOR, Same as above Rent initially, AIR if patients condition is stable and long term (longer then 1 year) then purchase should be considered - ------------------------------------------------- IPPB Puritan Bennett Same as above AP4 or AP5 - ------------------------------------------------- SUCTION UNITS Schuco Same as above (aspirators) Devilbiss Gomcos Mada medical - ------------------------------------------------- - ------------------------------------------------- SUCTION UNITS, PORTABLE OR AC/DC - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ Croup Tent Not covered as home DME. Insititutional in nature. - ------------------------------------------------------------------------------------------------------------------------ OXYGEN TENT Covered if patient's ability to breathe E0455 Croup Category III, initial is impaired. setup and instruction performed by clinician. Disposable supplies included - ------------------------------------------------------------------------------------------------------------------------ PERCUSSOR Not covered, consider physical therapy E0480 CF, COPD, Category II, training for acute exacerbations. Black lung disease and setup performed Chronic bronchitis by clinical staff. Emphysema Asthma - ------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------- Croup Tent - ------------------------------------------------- OXYGEN TENT Allied Rental only - ------------------------------------------------- PERCUSSOR Puritan Bennett Purchase only General physiotherapy Graham field - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ RESPIRATORY, CONTINUED - ------------------------------------------------------------------------------------------------------------------------ ThAIRapy Cystic Fibrosis. Vest(TM) ThAIRapy Vests are limited to coverage for members with Cystic Fibrosis requiring chest percussion at least three (3) times a day or more frequently. - ------------------------------------------------------------------------------------------------------------------------ POSTURAL Not covered. E0606 DRAINAGE BOARD - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- RESPIRATORY, CONTINUED - ------------------------------------------------- ThAIRapy ThAirapy vest Rent initially, Vest(TM) if patients condition is stable and long term (longer then 1 year) then purchase should be considered - ------------------------------------------------- POSTURAL DRAINAGE BOARD - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ CPAP Sleep Study results: E0601 Obstructive sleep apnea Category III, An RDI (or AHI) [ ] 15 K0193 (OSA) delivery and setup OR performed by clinical (Any two of the following) staff, initial and RDI of 10-14 supplies (mask, greater than 20 episodes of oxygen headgear, and tubing) desaturation to <85% or any one included. Replacement episode of desaturation <70% supplies included. Type II second degree heart block Specialty masks such or Pause > 3 seconds or ventricular as full face or tachycardia at a rate > 140/bpm silicone are covered with a duration of > 15 seconds. if standard mask or a. Excessive daytime pillows have been sleepiness that has been tried and failed. document through the use of Multiple Sleep Latency Testing OR and Epworth Scale Score > 10. o REQUESTS FOR cpap IN CHILDREN AGE 12 AND UNDER SHOULD BE REFERRED TO THE Healthplan Medical Director for review. If approved cover under cap - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- CPAP Devilbiss Rent for Healthdyne first month, Respironics if patient is Sullivan compliant and is receiving therapeutic benefit then convert to purchase. - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ BIPAP,DPAP & Same as above AND; E0452 Obstructive sleep apnea Same as above self-titrating o Patient did not respond to or was K0194 syndrome CPAP non-tolerant of CPAP. ** If a member failed cpap in a lab and was successful with bipap in a lab and the doctor ordered bipap,, and the member met the AHI requirements then BIPAP will be provided as the initial system. o CPAP failed to stop the regression of the patients' disorder. o BiPAP may be used for diagnosis other then OSA such as ventilatory support, if requested follow coverage guidelines for ventilator. - ------------------------------------------------------------------------------------------------------------------------ HUMIDIFIER Covered if patient qualifies for CPAP K0268 FOR CPAP therapy and MD determines humidification is needed. Heated humidifier covered on a rental basis if member is unable to tolerate standard humidifier in the home. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- BIPAP,DPAP & Respironics Same as above self-titrating CPAP - ------------------------------------------------- HUMIDIFIER Respironics Same as above FOR CPAP Healthdyne - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ RESPIRATORY, CONTINUED - ------------------------------------------------------------------------------------------------------------------------ HELIOX Not covered under the DME benefit, this Swollen vocal cords special mixture of oxygen and helium is considered a drug. May be covered under a pharmacy benefit. - ------------------------------------------------------------------------------------------------------------------------ MECHANICAL Covered, if other treatment options have Neuromuscular disease Category III, INSUFFLATION- been tried and failed including: Thoracic restrictive disease delivery and setup EXSUFFLATION o Chest percussion therapy, both Chronic respiratory failure performed by clinical manual and pneumatic; following COPD staff. o suctioning and; o drug therapy. - ------------------------------------------------------------------------------------------------------------------------ VENTILATOR & Covered for patients with the following E0450 Neuromuscular disease Category III, NPPV diagnosis: E0453 Thoracic restrictive disease delivery and (NASAL E0460 Chronic respiratory failure setup performed by POSITIVE When negative pressure ventilator is following COPD clinical staff, PRESSURE used chest shell/wrap is included. ventilator circuits VENTILATION) and trachea tubes included in the ongoing rental price, single patient use Ambu bag included. Backup emergency use ventilator included only for ventilator dependent patients. Trachea care kits are not covered. - ------------------------------------------------------------------------------------------------------------------------ HUMIDIFIER Covered if patient qualifies for W/ HEATER ventilator therapy or receives oxygen therapy via a trach tube. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- RESPIRATORY, CONTINUED - ------------------------------------------------- HELIOX - ------------------------------------------------- MECHANICAL INSUFFLATION- EXSUFFLATION - ------------------------------------------------- VENTILATOR & Aequitron Requires NPPV Lifecare frequent (NASAL Bear medical maintenance POSITIVE and PRESSURE servicing, VENTILATION) rental only. - ------------------------------------------------- HUMIDIFIER Hudson Same as above W/ HEATER Fisher Paykel - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ RESPIRATORY, CONTINUED - ------------------------------------------------------------------------------------------------------------------------ OXYGEN E1400 Chronic bronchitis Category III, CONCENTRATOR E1401 Emphysema delivery and E1402 Asthma equipment training An arterial blood gas or oxygen E1403 COPD performed by patient saturation result is required to E1404 Black lung disease service technician. demonstrate the medical necessity of Acute pulmonary heart Emergency backup unit oxygen. disease included in rental On room air the member should have a PO CHF price. Canula, 2 of 55 or less; or an SaO2 of 88% or Lung cancer humidifier and tubing less at rest. Acute cor pulmonale included. Members who desat to a PaO2 of 56-59 or SaO2 of 88% are appropriate for oxygen . Members who have a prescription for oxygen, but who have a blood gas result obtained while on oxygen, should have the results referred for medical review. If the Pa O2 on oxygen corresponds to a Pa O2 of 55 or less or an exercise value of 55- 59 then oxygen is medically appropriate.Standby oxygen will be covered for children or adults who do not meet medical necessity indications for regular oxygen coverage, when medical records show significant desaturation during suctioning or seiziure activity. Children age 10 and under who desat rapidly to 90 or below with any of these activities, should have an oxygen supply for rapid response/ resuscitation. - ------------------------------------------------------------------------------------------------------------------------ OXYGEN SYSTEM Same as above E0424 Same as above Category III, GAS (with delivery and regulator equipment training & stand) performed by patient service technician. Canula, humidifier and tubing included. - ------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------- RESPIRATORY, CONTINUED - ------------------------------------------------- OXYGEN Devilbiss Rental only, CONCENTRATOR Healthdyne requires Airsep frequent Invacare maintenance and servicing, - ------------------------------------------------- OXYGEN SYSTEM Mada medical Same as above GAS (with Contemporary regulator products & stand) Hudson - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ PORTABLE GAS E0431 Same as above Category III, OXYGEN SYSTEM delivery and (with equipment training regulator performed by patient and cart) service technician. Canula, humidifier and tubing included. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- PORTABLE GAS Mada medical Same as above OXYGEN SYSTEM Contemporary (with products regulator Hudson and cart) - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ RESPIRATORY, CONTINUED - ------------------------------------------------------------------------------------------------------------------------ OXYGEN E0439 Same as above Category III, SYSTEM, LIQUID E0434 delivery and (includes base equipment training system and performed by patient portable unit) service technician. Canula, humidifier and tubing included. - ------------------------------------------------------------------------------------------------------------------------ PORTABLE GAS THE VENDOR IS EXPECTED TO TEST MEMBER Same as above Category III, OXYGEN SYSTEM, ON A CONSERVATION DEVICE TO ENSURE delivery and Lightweight W/ APPROPRIATE SATURATION LEVEL CAN BE equipment training Conservation REACHED. performed by patient Device service technician. Canula, humidifier and tubing included. - ------------------------------------------------------------------------------------------------------------------------ OXYGEN As above. Same as above Category III, CONSERVATION delivery and DEVICE equipment training performed by patient service technician. Canula, humidifier and tubing included. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- RESPIRATORY, CONTINUED - ------------------------------------------------- OXYGEN Caire Same as above SYSTEM, LIQUID Puritan Bennett (includes base Invacare system and Penox portable unit) - ------------------------------------------------- PORTABLE GAS Chad OXYGEN SYSTEM, therapeutics Lightweight W/ Conservation Device - ------------------------------------------------- OXYGEN Penox CONSERVATION Mada medical DEVICE Chad therapeutics - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ MISCELLANEOUS - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ CONSUMABLE Not covered under the DME benefit, these A codes SUPPLIES are nonreusable for single patient use; urologicals o these may be supplied by Gentiva wound care upon request under a fee for incontinence service arrangement or as part of a ostomy home health visit by a nurse. diabetic o Diabetic strips are covered under pharmacy benefit. o Examples of non- covered consumables include: o Dressing supplies in the absence of a skilled need. o Doughnuts o Bathmats o Incontinence supplies including catheters in the absence of a skilled need. o Eye pads o Pillows o Ostomy supplies * may be covered as a separate benefit. Refer to local or 800 consumable vendor. - ------------------------------------------------------------------------------------------------------------------------ Sterile Saline Sterile saline and water in quantities or sterile of >60cc used for irrigation is water for considered a legend item and should be irrigation. obtained through the pharmacy benefit. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- MISCELLANEOUS - ------------------------------------------------- - ------------------------------------------------- CONSUMABLE SUPPLIES urologicals wound care incontinence ostomy diabetic - ------------------------------------------------- Sterile Saline or sterile water for irrigation. - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ ORTHOTICS Not covered under the DME benefit, refer AND to external prosthetic appliance PROSTHETICS benefit. (braces, o A prosthetic item is usually supports, defined as something that replaces collars & a part of the body; splints o an Orthotic is an item that shores up a weakened body part. o Exampes: o custom molded seating for wheelchairs o -Mastectomy bras, o Stump stocks, o heel cups, o girdles, o halos, o insoles, o arch supports, o vests, o rib belts, o gauntlet, o collars, o boots, o elastic wrap, o shoes, o support hose, o slings, o supports, o braces, o trusses, splints - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- ORTHOTICS AND PROSTHETICS (braces, supports, collars & splints - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ MISCELLANEOUS - ------------------------------------------------------------------------------------------------------------------------ AIDS TO DAILY Not covered, primarily convenience items LIVING (ADL), not primarily medical in nature. SELF-HELP o This includes items such as; ITEMS. reachers, dressing aids, eating aids, writing utensils, transfer boards, stethoscopes, thermometers, sphygmomanometers (blood pressure cuff or digital monitor), safety belts and personal hygiene items. - ------------------------------------------------------------------------------------------------------------------------ EQUIPMENT Repairs are covered to make the E1350 Category II, if REPAIRS equipment serviceable unless caused patient is ambulatory by abuse or improper use of and equipment is equipment. category I or II then o Equipment under manufacturer every effort should warranty may have to be sent to be made for equipment manufacturer for repair or to be brought to replacement. Repair cost limited provider location for to replacement value of equipment. repair. Items such as compressors, tires, upholstery, will be repaired/replaced no more frequently than the expected life of the particular component and is subject to any DME plan maximums. o Adjustments for growth or changes in condition are covered within plan benefit limits, Standard loaner equipment will be provided when a members equipment needs to be sent out for repair; or repair is delayed waiting for parts or service. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- MISCELLANEOUS - ------------------------------------------------- AIDS TO DAILY LIVING (ADL), SELF-HELP ITEMS. - ------------------------------------------------- EQUIPMENT REPAIRS - -------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------ SITE OF SERVICE, PRODUCTS COVERAGE CRITERIA HCPC EXAMPLE OF DIAGNOSES TRAINING, SUPPLIES - ------------------------------------------------------------------------------------------------------------------------ BATHROOM Not covered, considered comfort or EQUIPMENT; convenience items which are not BATH BENCH primarily medical in nature. TRANSFER Raised toilet seats are covered post BENCH, GRAB total hip or total knee replacement or BARS, TOILET similar surgery/ medical condition where RAILS, a member is physically incapable of RAISED TOILET either lowering themselves or raising SEATS themselves from a standard home toilet. - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------- USUAL BRAND RENT - PRODUCTS SUPPLIED PURCHASE - ------------------------------------------------- BATHROOM EQUIPMENT; BATH BENCH TRANSFER BENCH, GRAB BARS, TOILET RAILS, RAISED TOILET SEATS - -------------------------------------------------
EXHIBIT XIV. PARTICIPATING CIGNA SUBSIDIARIES AND AFFILIATES Connecticut General Life Insurance Company CIGNA HEALTHCARE MID-ATLANTIC, INC. CIGNA HEALTHCARE OF ARIZONA, INC. CIGNA HEALTHCARE OF CALIFORNIA, INC. CIGNA HEALTHCARE OF COLORADO, INC. CIGNA HEALTHCARE OF CONNECTICUT, INC. CIGNA HEALTHCARE OF DELAWARE, INC. CIGNA HEALTHCARE OF FLORIDA, INC. CIGNA HEALTHCARE OF GEORGIA, INC. CIGNA HEALTHCARE OF ILLINOIS, INC. CIGNA HEALTHCARE OF INDIANA, INC. CIGNA HEALTHCARE OF LOUISIANA, INC. CIGNA HEALTHCARE OF MAINE, INC. CIGNA HEALTHCARE OF MASSACHUSETTS, INC. CIGNA HEALTHCARE OF NEW HAMPSHIRE, INC. CIGNA HEALTHCARE OF NEW JERSEY, INC. CIGNA HEALTHCARE OF NEW YORK, INC. CIGNA HEALTHCARE OF NORTH CAROLINA, INC. CIGNA HEALTHCARE OF OHIO, INC. CIGNA HEALTHCARE OF PENNSYLVANIA, INC. CIGNA HEALTHCARE OF SOUTH CAROLINA, INC. CIGNA HEALTHCARE OF ST. LOUIS, INC. CIGNA HEALTHCARE OF TENNESSEE, INC. CIGNA HEALTHCARE OF TEXAS, INC. CIGNA HEALTHCARE OF UTAH, INC. CIGNA HEALTHCARE OF VIRGINIA, INC. EXHIBIT XV. HOME HEALTH CARE BENEFIT CLARIFICATION GUIDELINES TABLE OF CONTENTS o Benefit Clarification Examples o Medical Interpretation for Chronic and Hourly Cases o Home Health Decision Process HOME HEALTH CARE BENEFIT CLARIFICATION GUIDELINES STANDARD GSA HOME HEALTH SERVICES Home health services when you: o Require skilled care; o Are unable to obtain the required care as an ambulatory outpatient; and o Do not require confinement in a hospital or Other Participating Health Care Facility. Home health services are provided only if the Healthplan Medical Director has determined that the home is a medically appropriate and cost-effective setting. If you are a minor or an adult who is dependent upon others for non-skilled care (e.g., bathing, eating, toileting), home health services will only be provided for you during times when there is a family member or care giver present in the home to meet your non-skilled care needs. Home health services are those skilled health care services that can be provided during intermittent visits of two hours or less by Other Participating Health Professionals. Necessary consumable medical supplies, home infusion therapy, and durable medical equipment administered or used by Other Participating Health Professionals in providing home health services are covered. Home health services do not include services of a person who is a member of your family or your dependent's family or who normally resides in your house or your dependent's house. Physical, occupational, and speech therapy provided in the home are subject to the benefit limitations described under "Short-term Rehabilitative Therapy". END STATE PPO TEMPLATE COVERED EXPENSES HOME HEALTH CARE SERVICES o CHARGES MADE FOR HOME HEALTH CARE SERVICES WHEN YOU: o REQUIRE SKILLED CARE; o ARE UNABLE TO OBTAIN THE REQUIRED CARE AS AN AMBULATORY OUTPATIENT; AND o DO NOT REQUIRE CONFINEMENT IN A HOSPITAL OR OTHER HEALTH CARE FACILITY. HOME HEALTH CARE SERVICES ARE PROVIDED UNDER THE TERMS OF A HOME HEALTH CARE PLAN FOR THE PERSON NAMED IN THAT PLAN. IF YOU ARE A MINOR OR AN ADULT WHO IS DEPENDENT UPON OTHERS FOR NON-SKILLED CARE (E.G. BATHING, EATING, TOILETING), HOME HEALTH CARE SERVICES WILL ONLY BE PROVIDED FOR YOU DURING TIMES WHEN THERE IS A FAMILY MEMBER OR CARE GIVER PRESENT IN THE HOME TO MEET YOUR NON-SKILLED CARE NEEDS. HOME HEALTH CARE SERVICES ARE THOSE SKILLED HEALTH CARE SERVICES THAT CAN BE PROVIDED DURING INTERMITTENT VISITS OF 2 HOURS OR LESS BY OTHER HEALTH CARE PROFESSIONALS. NECESSARY CONSUMABLE MEDICAL SUPPLIES, HOME INFUSION THERAPY, AND DURABLE MEDICAL EQUIPMENT ADMINISTERED OR USED BY OTHER HEALTH CARE PROFESSIONALS IN PROVIDING HOME HEALTH CARE SERVICES ARE COVERED. HOME HEALTH CARE SERVICES DO NOT INCLUDE SERVICES OF A PERSON WHO IS A MEMBER OF YOUR FAMILY OR YOUR DEPENDENT'S FAMILY OR WHO NORMALLY RESIDES IN YOUR HOUSE OR YOUR DEPENDENT'S HOUSE. PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY PROVIDED IN THE HOME ARE SUBJECT TO THE BENEFIT LIMITATIONS DESCRIBED UNDER "SHORT-TERM REHABILITATIVE THERAPY". OTHER HEALTH CARE FACILITIES ARE FACILITIES OTHER THAN A HOSPITAL OR A HOSPICE FACILITY. EXAMPLES OF OTHER HEALTH CARE FACILITIES INCLUDE, BUT ARE NOT LIMITED TO, LICENSED SKILLED NURSING FACILITIES, REHABILITATION HOSPITALS AND SUB-ACUTE FACILITIES. OTHER HEALTH CARE PROFESSIONALS INCLUDE AN INDIVIDUAL, OTHER THAN A PHYSICIAN WHO IS LICENSED OR OTHERWISE AUTHORIZED UNDER THE APPLICABLE STATE LAW TO DELIVER MEDICAL SERVICES. OTHER HEALTH CARE PROFESSIONALS INCLUDE, BUT ARE NOT LIMITED TO PHYSICAL THERAPISTS, HOME HEALTH AIDES AND NURSES. WHAT IS COVERED UNDER THE BENEFIT LANGUAGE? o Skilled services which can be provided through INTERMITTENT two hour visits will be covered. o WOUND CARE o SKILLED ASSESSMENTS o SKILLED INTERMITTENT THERAPIES o SKILLED REHABILITATIVE SERVICES- *REHAB SERVICES IN THE HOME SETTING ARE SUBJECT TO, AND ACCRUE TO THE STR BENEFIT LIMITS o ETC. o Skilled visits of two hours or less necessary to provide intermittent monitoring and/or education or training for supportive family caregivers are covered. o DIABETICS o MEMBERS WITH SELF INJECTABLES o INFANTS REQUIRING BILI-LIGHTS WHERE PARENTAL COMPLIANCE & UNDERSTANDING REQUIRES VALIDATION. o ETC. o Skilled visits of two hours or less by a participating social worker to assist the family with long term planning and access to social services are covered. o Services of home health aides are covered only when the home health aide is used in direct support of a skilled visit. Only skilled visits are covered in the home WHAT IS NOT COVERED UNDER THE BENEFIT LANGUAGE? o Skilled services which are continuous in nature; i.e. airway maintenance, continuous monitoring, are not covered under the new benefit. * WHAT SHOULD CIGNA IN COORDINATION WITH GENTIVA/CARECENTRIX DO WHEN A MEMBER HAS A MEDICAL NEED WHICH SUPPORTS SERVICES BEYOND THE BENEFIT LANGUAGE ? The case manager should discuss the participant's skilled needs, covered services and gaps with the participant or the participant's spouse/parent/guardian. The case manager should work with the family to determine what resources might be available to fill gaps in services. The new case management tools for CHILDREN WITH SPECIAL HEALTH CARE NEEDS or END STAGE MALIGNANCIES offer suggestions on resources available to assist with care for these populations. In addition, potential resources include: o the family as a caregiver o other private insurance coverage o Medicare o Medicaid o Children's Health Services o SSI o Medicaid waiver programs The case manager should assist families with obtaining the necessary forms and information to apply for eligible programs. A consult with a home health social worker should be considered to assist with identification of additional community resources. All plans and activities to assist with alternative coverage should be fully documented in the case management notes. Any gaps in services which remain after a full review of all existing programs MUST be discussed with the Healthplan Medical Director prior to initiating any authorization of services which exceed benefit definitions. DURABLE MEDICAL EQUIPMENT] GSA TEMPLATE [Purchase or rental of durable medical equipment that is ordered or prescribed by a Participating Physician and provided by a vendor approved by the Healthplan. Coverage for repair, replacement or duplicate equipment is not covered except when replacement or revision is necessary due to growth, change in medical condition, or mechanical defect covered by manufacter's warranty . Durable medical equipment is defined as items which are designed for and able to withstand repeated use by more than one person; customarily serve a medical purpose; generally are not useful in the absence of illness or injury; are appropriate for use in the home; and are not disposable. Such equipment includes, but is not limited to, crutches, hospital beds, wheel chairs, ventillators, and dialysis machines. Unless covered in connection with the services described in the "Inpatient Services at Other Participating Health Care Facilities" or "Home Health Services" provisions, the following are SPECIFICALLY EXCLUDED: o Hygienic or self-help items or equipment; o Items or equipment primarily used for comfort or convenience such as bathtub chairs, safety grab bars, stair gliders or elevators, over-the-bed tables, saunas or exercise equipment; o Environmental control equipment, such as air purifiers, room humidifiers and electrostatic machines; o Institutional equipment, such as air fluidized beds and diathermy machines; o Elastic stockings and wigs; o Equipment used for the purpose of participation in sports or other recreational activities, including, but not limited to orthotics, braces and splints; o Items, such as auto tilt chairs, paraffin bath units and stationary whirlpool baths, which are not generally accepted by the medical profession as being therapeutically effective; o Items which under normal use would constitute a fixture to real property, such as ramps, railings, and grab bars.] DURABLE MEDICAL EQUIPMENT PPO TEMPLATE o CHARGES MADE FOR THE PURCHASE OR RENTAL OF DURABLE MEDICAL EQUIPMENT PROVIDED BY A VENDOR APPROVED BY CG. COVERAGE FOR THE REPAIR, REPLACEMENT OR DUPLICATE EQUIPMENT IS NOT COVERED EXCEPT WHEN REPLACEMENT OR REVISION IS NECESSARY DUE TO GROWTH, CHANGE IN MEDICAL CONDITION OR MECHANICAL DEFECT COVERED BY MANUFACTER'S WARRANTY. DURABLE MEDICAL EQUIPMENT IS DEFINED AS ITEMS WHICH ARE DESIGNED FOR AND ABLE TO WITHSTAND REPEATED USE BY MORE THAN ONE PERSON, CUSTOMARILY SERVE A MEDICAL PURPOSE, GENERALLY ARE NOT USEFUL IN THE ABSENCE OF INJURY OR SICKNESS, ARE APPROPRIATE FOR USE IN THE HOME, AND ARE NOT DISPOSABLE. SUCH EQUIPMENT INCLUDES, BUT IS NOT LIMITED TO: CRUTCHES, HOSPITAL BEDS, WHEEL CHAIRS, VENTILLATORS, AND DIALYSIS MACHINES. UNLESS COVERED IN CONNECTION WITH THE SERVICES DESCRIBED IN ANOTHER SECTION OF THIS CERTIFICATE, THE FOLLOWING ARE SPECIFICALLY EXCLUDED: o HYGIENIC OR SELF-HELP ITEMS OR EQUIPMENT; o ITEMS OR EQUIPMENT THAT ARE PRIMARILY USED FOR COMFORT OR CONVENIENCE, SUCH AS BATHTUB CHAIRS, SAFETY GRAB BARS, STAIR GLIDERS OR ELEVATORS, OVER-THE-BED TABLES, SAUNAS OR EXERCISE EQUIPMENT; o ENVIRONMENTAL CONTROL EQUIPMENT, SUCH AS AIR PURIFIERS, ROOM HUMIDIFIERS AND ELECTROSTATIC MACHINES; o INSTITUTIONAL EQUIPMENT, SUCH AS AIR FLUIDIZED BEDS AND DIATHERMY MACHINES; o ELASTIC STOCKINGS AND WIGS; o IN SPORTS OR OTHER RECREATIONAL ACTIVITIES INCLUDING, BUT NOT LIMITED TO, ORTHOTICS, BRACES AND SPLINTS; o ITEMS, SUCH AS AUTO TILT CHAIRS, PARAFFIN BATH UNITS AND WHIRLPOOL BATHS, WHICH ARE NOT GENERALLY ACCEPTED BY THE MEDICAL PROFESSION AS BEING THERAPEUTICALLY EFFECTIVE; o ITEMS WHICH UNDER NORMAL USE WOULD CONSTITUTE A FIXTURE TO REAL PROPERTY, SUCH AS RAMPS, RAILINGS, AND GRAB BARS. COVERAGE IS SUBJECT TO THE MAXIMUM SHOWN IN THE SCHEDULE. Refer to the DME Grid for information on specific pieces of durable medical equipment. WHAT IS THE APPROPRIATE UTILIZATION OF HOME HEALTH AIDES AS A COVERED SERVICE? Home health aides are covered when utilized in support of a skilled service. This would include assisting the skilled professional to turn, position, or mobilize a patient during a skilled visit; i.e. dressing changes, wound assessment, and physical therapy. Hygienic measures or skin care provided during a skilled visit as part of the preparation for assessment or nursing / medical procedures, would be appropriate utilization of a home health aide. However, daily bathing, skin care, or assisting with dressing and activities of daily life would be considered custodial care. Home health aide services not provided in support of a skilled visit are not considered to meet the requirements for benefit coverage and therefore, would not be covered under capitation with Gentiva. Home health aide services for cooking, cleaning, or direct custodial care are not covered benefits under GSA or FlexCare and are not covered under capitation with Gentiva. Home health aides requested for safety issues, or to assist with a patients ability to rest or conserve energy are also not a covered benefit or covered under capitated with Gentiva. WHEN IS A PATIENT CONSIDERED PHYSICALLY ABLE TO ATTEND OUTPATIENT SERVICES? Due to the availability of space, equipment, and regular staff, outpatient services (i.e. rehabilitation therapy, blood draws and certain IM injectables) offer the potential for more efficient delivery of care and a greater level of improvement than may be provided in the home setting. For this reason, outpatient ambulatory services would be the preferred setting for these types of services. Home nursing, or therapy is available for those who are physically unable to attend an outpatient program. The patient must not be able to leave home without significant assistance. Lack of transportation does not qualify for home care. The patient, who poses safety risks due to dizziness, unsteadiness, or muscle wasting from an illness, may be a candidate for home services under the capitated agreement with Gentiva. The primary focus should be to transition patients to outpatient services once they improve should services continue. GSA language specifically states : COVERED EXPENSES HOME HEALTH CARE SERVICES o CHARGES MADE FOR HOME HEALTH CARE SERVICES WHEN YOU: o REQUIRE SKILLED CARE; o ARE UNABLE TO OBTAIN THE REQUIRED CARE AS AN AMBULATORY OUTPATIENT; AND o DO NOT REQUIRE CONFINEMENT IN A HOSPITAL OR OTHER HEALTH CARE FACILITY. While neither the GSA or FlexCare languages mention the term "homebound" related to home health care, the definition is generally interpreted to mean the same as the GSA terminology. However, the Gentiva contract does specifically use this term - (page 5, definition for Home Health Services) "those services, supplies, drugs/medications (limited to topical agents for wound care) and equipment ordered by a physician for a Participant who is home bound due to a disabling condition. Home Infusion Therapy Services and skilled nursing services such as wound care, sterile dressing etc. are covered in the home if provision of these services in the home is the most optimal place of service for the level of care needed. WHEN ARE CONSUMABLES COVERED? There are two situations where consumable supplies are coordinated by Gentiva and covered under capitation: 1. Other than glucose test strips, consumable medical supplies are covered if they are necessary for authorized durable medical equipment to function. Glucose strips are covered under pharmacy, not DME. 2. Consumables are covered when used directly by an authorized skilled home health professional to provide a skilled service, and are used during that visit. In the situation where a family member is educated by the nurse to perform that skilled service between the scheduled skilled visits, the consumables will also now be covered under cap in an effort to ease transition to a willing caregiver. Consumables are not covered under capitation for services, which do not require a skilled level of care. This includes situations where a patient is independent with care (i.e. self-catheterization). CAPITATED CONSUMABLES INCLUDE: Catheters: foley, suction, straight condom catheters Irrigation solution: sterile water, saline Dressing supplies: gauze pads, sterile or unsterile gloves, Vaseline gauze, ABDs, kerlix, steristrips, duoderm, opsite, packing gauze tape, tubing, connectors, trach dressings and trach care kits Betadine wipes Fleet and soap suds enemas Peroxide Syringes for nurses to administer injections (excludes specialty or special order syringes) Lab tubes, vacutainers and needles for lab work KY jelly and NG Tubes Cotton balls and alcohol sponges Band-Aids thermometers sharps containers NOTE: once there is no need for skilled visits, consumables would not be covered under capitation with Gentiva. When are medications, including injectables, covered under capitation? Self injectable subcutaneous and intramuscular medications are intended to be coordinated through the pharmacy benefit and so, are not covered under capitation with Gentiva. Approved Intravenous home infusions are covered under capitation. Gentiva and the healthplan staff will make every effort to successfully support transition of self-injectables to the patient/family within 1-2 teaching visits. The visits required to teach self-injectables are considered part of the home care benefit and covered under capitation with Gentiva. In rare situations where there is resistance by the patient or care giver to learning the skilled service, Gentiva may need to creatively manage the situation with a care plan approach which involves the treating physician, family or CHC Case Manager. Ceredase and Hemophiliac Factor are medications which are specifically mentioned as covered under our home infusion agreement and must be coordinated through Gentiva even though the reimbursement has been defined as fee for service. NON SKILLED SERVICES / CUSTODIAL SERVICES / SELF CARE. TURNING POSITIONING WEIGHING BATHING MAINTAINING A BOWEL PROGRAM OSTOMY CARE** ileostomy ureterostomy colostomy ADMINISTRATION OF ENEMAS** ADMINISTRATION OF SUPPOSITORIES** FEEDING DRESSING ASSISTING WITH ACTIVITIES OF DAILY LIVING AEROSOL THERAPY** ** The patient or family member may perform these services. Home health aides may not perform these services. DURABLE MEDICAL EQUIPMENT - - CARE EXPECTED TO BE LIMITED TO TRAINING FOR EXAMPLE: LYMPHEDEMA BOOTS CPAP NEBULIZERS APNEA MONITOR HOME HEALTH DECISION PROCESS WHAT SERVICES ARE BEING REQUESTED? Describe all services being requested. ARE THE SERVICES SKILLED? Yes. Proceed to determination of medical necessity. No. Refer participant to other resources (i.e. community or government programs, self pay options). CAN THE SERVICES BE PROVIDED THROUGH INTERMITTENT VISITS, OR WILL THE SERVICES REQUIRE CONTINUOUS SKILLED NURSING IN THE HOME? The home health benefit only covers intermittent visits. Any request requiring continuous skilled services needs to be approached from a case management , care planning perspective. I.e Assess all resources, other coverage available, family support, finances.. consult a social worker if the member requires referral for additional programs or funding. I,e medicare/ medicaid. Discuss limits of coverage with the member/ family and provider. ARE THE SERVICES MEDICALLY NECESSARY? Evaluate each service. IV therapy for pneumonia- yes Nursing assessment for a patient with pneumonia and ALS - yes Home health aide to stay with patient while family works - no Continuous skilled nursing for 16 hours a day for suctioning a ventilator dependent patient- medically necessary= yes, covered benefit = no. IS THE HOME SETTING THE APPROPRIATE SETTING FOR THIS PATIENT? Is the patient restricted to the home because of physical limitations?--yes Is a mobile patient receiving home therapy verses the more appropriate outpatient facility?--no Are home services being requested over outpatient for convenience?-- no Note: this does not apply to home infusion, which has no restrictions on the patient's mobility. WHAT SERVICES WILL BE PROVIDED, AND FOR HOW LONG? Those services that are skilled, medically necessary, and appropriate for the home setting will be provided. Short-term rehabilitation services are subject to the plan design benefit limitations. Remember the STR benefit maximum applies to all places of service. Inpatient rehab + home rehab + outpatient rehab = maximum. All places of service accrue to one maximum. The member does not have separate benefits for each place of service. All services will be reviewed for continued appropriateness on a regular basis. WHAT SHOULD THE HEALTHPLAN'S GOAL BE IN PROVIDING HOME HEALTH SERVICES? In a managed care environment, our efforts at controlling costs include providing services at the least intensive appropriate level of care. There are many "skilled services" which a family / patient / or caregiver may assume after training by a nursing professional. Our efforts should be aimed in that direction. However, CIGNA and Gentiva recognize that individual patients and families will require different levels of support to achieve the desired outcomes. We cannot force a layperson to assume skilled care. WHAT IF THE PATIENT LIVES ALONE OR HAS NO WILLING CAREGIVER AVAILABLE TO ASSUME RESPONSIBILITY? Patients who are physically incapable of assuming responsibility for their own care in an emergency situation, or who have no willing care giver available on an emergency basis, are not considered appropriate for home health services primarily for safety issues. IS THE CARE, AND THE NEED FOR CARE BEING EVALUATED ON A REGULAR BASIS BY GENTIVA CareCentrix ? The care and the need for care are being evaluated on a regular basis at two to three levels. Home health services are initially received at the Gentiva CareCentrix level. The authorization for the services are then distributed to a local agency. Often, CareCentrix will authorize visits for a limited number of days, as a process to ensure feedback on the progress of the care. The skilled personnel providing the care should continuously evaluate the care. Any patients meeting CIGNA criteria for case management should also be receiving regular evaluations by the CIGNA Case Manager. What questions are being asked when the care/ services are being periodically reevaluated? What is the primary diagnosis driving the service? Are the services skilled? Are the services medically necessary? Is the home the most appropriate location for the services for this individual patient? Is the patient responding to the skilled services? Is there a primary care giver available? WHAT IF THE PATIENT IS NOT RESPONDING TO THE SKILLED SERVICE (I.E. NO IMPROVEMENT, OR WORSENING CONDITION)? 1. The home health agency providing the service is the primary reviewer of progress. In those situations where a patient is showing no progress, or unexpectedly deteriorating, the home health agency / Home Health Nurse, would contact the Primary Care Physician to review the plan of care. 2. The home health agency and the PCP would update the patient care plan. A date for re-evaluation of patient progress would be determined. 3. Based on the patient's condition and progress, the home health agency may continue regular contact with the PCP. 4. In those situations where the home health agency is concerned about the medical appropriateness of the care plan, the home health agency should contact the Care Manager at Gentiva CareCentrix. The Gentiva CareCentrix Care Manager will contact the local CIGNA healthplan Health Services Nurse or Medical Director. 5. The CHC Nurse Reviewer or Medical Director should review the case and discuss the care plan with the PCP. 6. The results of the discussion between CHC medical management and the PCP should be communicated to the Care Manager at Gentiva CareCentrix. 7. In those situations where Gentiva and CIGNA cannot come to agreement, a Homecare Review Panel consisting of both CIGNA and Gentiva corporate staff is available for emergent, urgent, and regular weekly review. 8. If agreement has still not been reached regarding the medical management of the case, the situation should be elevated to the Corporate Medical Directors at CHC and Gentiva for review. EXHIBIT XVI STANDARDS FOR DELEGATION OF CLINICAL SERVICE MANAGEMENT ACTIVITIES FOR GENTIVA CARECENTRIX, INC. /("CIGNA") (the "Standards") [Any and all capitalized terms not defined herein shall have the same meaning as in the managed care provider agreement between CIGNA and Gentiva CareCentrix (MCA) 1. MCA shall be subject to a pre-contract site review and evaluation of its Clinical Service Management Program ("Clinical Service Management Program") for all delegated activities. 2. MCA shall maintain a written Clinical Service Management Program description which includes: A. a description of MCA's 1) policies/procedures to evaluate Medical Necessity, 2) use of nationally recognized and locally approved criteria and information sources; and 3) process to review and approve services; B. a description of MCA's mechanism to periodically update the Clinical Service Management Program description and the Clinical Service Management Program's policies and procedures; C. documented evidence of approval of MCA's Clinical Service Management Program by MCA's appropriate body of governance; D. a description of the roles and functions of MCA's Clinical Service Management Program to include a definition of the roles and responsibilities of MCA's Clinical Service Management Program staff; E. evidence demonstrating an active, current work plan which responds to identified opportunities for improvement and action steps, as well as a process for, and evidence of, an annual evaluation of the Clinical Service Management Program. MCA shall provide annual reports as specified: (i.) Clinical Service management Program Description and Work Plan by March 31st of the current year, (ii.) A written evaluation of MCA's Clinical Service Management Program for the previous year by March 31st of the current year. F. a description of the transition process when benefits end or a Represented Provider's participation in the network terminates. 3. The MCA's Clinical Service Management Program must have been operational for at least the 12-month period preceding the effective date of the delegation, as defined herein. 4. The MCA's Clinical Service Management Program shall at a minimum comply in all respects with the requirements of an appropriate accrediting body designated by CIGNA (i.e. NCQA, JCAHO, etc.), the requirements established by CIGNA herein and in the Agreement and the requirements of applicable federal and state laws and regulations. MCA shall maintain all applicable licensures and certifications required to perform the Clinical Services Management Program activities. MCA shall maintain appropriate records with respect to all Clinical Service Management Program activities for the duration of the Agreement and seven years thereafter. 5. MCA shall maintain professional liability coverage in the amount of 1 million per occurrence and 3 million aggregate, amounts less than these required amounts will be subject to approval by CIGNA. MCA shall not subcontract any of its clinical management responsibilities under its agreement with CIGNA unless otherwise agreed in writing by CIGNA. Any subcontractor approved by CIGNA shall be required to agree in writing to comply with all standards applicable to MCA with regard to the subcontracted services. 6. MCA shall provide CIGNA with a copy of its written Clinical Service Management Program description upon request. Such Clinical Service Management Program description shall be submitted to CIGNA for review and approval prior to the effective date of the contract and annually thereafter and shall not be materially modified without CIGNA's prior written approval. 7. The role of MCA and its Represented Providers is limited to performing certain activities contracted by CIGNA using standards delivered by CIGNA, and which are in compliance with applicable federal and state laws and regulations. MCA hereby agrees to perform those activities identified by an "X" in the MCA column below and understands and acknowledges that its performance of such activities is subject to CIGNA's oversight and monitoring. - ---------------------------------------------------------- ACTIVITIES MCA CIGNA - ---------------------------------------------------------- Medical Policy Adoption of Criteria X X - ---------------------------------------------------------- Precertification - Inpatient Approvals X - ---------------------------------------------------------- Precertification - Inpatient Denials X - ---------------------------------------------------------- Precertification - Outpatient Approvals X - ---------------------------------------------------------- Precertification - Outpatient Denials X - ---------------------------------------------------------- Concurrent Review* - Approvals X - ---------------------------------------------------------- Concurrent Review* - Denials X - ---------------------------------------------------------- Discharge Planning X - ---------------------------------------------------------- Retrospective - Inpatient Approvals X - ---------------------------------------------------------- Retrospective - Outpatient Approvals X - ---------------------------------------------------------- Retrospective - Outpatient Denials X - ---------------------------------------------------------- Referral Management - Approvals X - ---------------------------------------------------------- Referral Management - Denials X - ---------------------------------------------------------- Out-of-Area Management X - ---------------------------------------------------------- Case Management* - Approvals X - ---------------------------------------------------------- Case Management* - Denials X - ---------------------------------------------------------- Disease Management X - ---------------------------------------------------------- Denials Benefit Coverage X - ---------------------------------------------------------- Appeals - First Level X - ---------------------------------------------------------- Member Satisfaction w/ UM X - ---------------------------------------------------------- Provider Satisfaction w/ UM X - ---------------------------------------------------------- Pharmacy Management X - ---------------------------------------------------------- - ---------------------------------------------------------- ACTIVITIES MCA CIGNA - ---------------------------------------------------------- Member Communication X - ---------------------------------------------------------- Monitoring Quality and Timeliness of X X Decisions - ---------------------------------------------------------- Inter-rater Reliability X - ---------------------------------------------------------- Technology Assessment X - ---------------------------------------------------------- * Definitions: CONCURRENT REVIEW- An assessment that determines medical necessity or appropriateness of services as they are being rendered, such as an assessment of the need for continued inpatient care for hospitalized patients. CASE MANAGEMENT- A process for identifying covered persons with specific health care needs in order to facilitate the development and implementation of a plan that efficiently uses health care resources to achieve optimum member outcome. RETROSPECTIVE REVIEW- Assessment of the appropriateness of medical services on a case by case or aggregate basis after the services have been provided. 8. With respect to each request for medical services for which the MCA delivers hereunder, MCA shall apply the clinical service criteria set forth in the Service Agreement applicable to the Participant for whom medical services have been requested. Criteria shall be applied based on the needs of the individual patient. Criteria shall be objective and applied consistently based on the needs of the individual patient. 9. All information relating to MCA's Clinical Service Management Program activities hereunder shall be confidential, shall not be disclosed to any third parties except as required by applicable federal and state law and except as required to fulfill MCA's clinical management responsibilities hereunder, and shall be maintained in such a manner so that such information shall be protected from discovery and use in judicial or administrative proceedings to the fullest extent possible under applicable federal and state law. In the event that MCA receives a subpoena, civil investigative demand or other similar process requesting disclosure of information relating to its Clinical Service Management Program activities hereunder, MCA shall immediately notify CIGNA of such subpoena, demand or process so as to afford CIGNA with an adequate opportunity to seek an appropriate protective order should it choose to do so. 10. This exhibit, all information provided by CIGNA to MCA pertaining to CIGNA's contract with MCA and all data made known to MCA relating to services rendered to Participants under the Agreement is confidential and proprietary information subject to the protections set forth in the confidentiality provision contained in MCA's Agreement with CIGNA. In the event that MCA receives a subpoena, civil investigative demand or other similar process requesting disclosure of such confidential and proprietary information, MCA shall immediately notify CIGNA of such subpoena, demand or process so as to afford CIGNA with an adequate opportunity to seek an appropriate protective order should it choose to do so. 11. MCA shall have a national medical director who provides oversight of the Clinical Service management Program. In states which mandate that the medical director making decisions must be licensed to practice medicine in referenced states, MCA shall access CIGNA HealthCare Medical Directors identified by CIGNA on consultant basis. 12. For non-contracted home health care providers that may from time to time provide services in order to meet immediate demand, MCA shall establish a process acceptable to CIGNA to ensure that Provider has an unrestricted license, as appropriate, in the state which the Provider practices, has adequate professional and general liability insurance coverage and has an acceptable malpractice claims history as indicated through verifying Medicare/Medicaid Sanctions or other appropriate reporting agency or data bank identified by CIGNA. MCA will notify CIGNA if a non-credentialed Provider is used to fulfill a service requirement need. If a Provider provides services to more than two different members within a 60-day period, MCA must implement a full credentialing process for that Provider. 13. All Clinical Service Management Program activities shall be supervised by appropriately qualified professionals including: A. Use of a national medical director who will provide oversight of the Clinical Service Management Program and assist with the development of policies. B. Use of CIGNA board certified specialists to assist in determining Medical Necessity and in preparing documentation to support the decision. 13. Total Clinical Service management Program staff ratios (including nurses) will be maintained to enable MCA to provide a level of service to be compliant with NCQA Standards for delivery, documentation and turn around time. Non-clinical staff shall utilize protocols and criteria approved by the Medical Director and shall not make medical appropriateness/necessity decisions. All decisions of the non-clinical staff shall be supervised by clinical staff. MCA shall maintain appropriate levels of telephone line staffing for the clinical servcie management activities required to be performed hereunder and shall satisfy the following standards: (a) the overall abandonment rate for the pre-certification telephone line shall be 5% or less; (b) the average speed of answer for the pre-certification telephone line shall be less than 30 seconds; (c) telephone prompts shall be clear and user friendly; and (d) a telephone message after hours shall give normal business hours information and after hours instructions. 14. MCA shall maintain a set of mutually agreed upon written clinical service management decision protocols that are based on reasonable available medical evidence, are acceptable to and consistent with CIGNA protocols and indicate that: A. criteria for appropriateness of medical services are clearly documented, communicated to participating physicians, and available to the physician and Participants upon request; B. an appropriate mechanism is present for checking the consistency of application of criteria across physician and non-physician reviewers at least annually and opportunities for improvement are identified and resolved; and C. an appropriate mechanism is present for updating and approving review criteria periodically, actively practicing practitioners are involved in the development and adoption of the criteria and the time of the update is specified in protocol or policy. 15. In connection with all Clinical Service Management Program activities hereunder, MCA shall obtain all necessary information, including pertinent clinical information, and consult with the treating physician, as appropriate, and document such efforts. Urgent home health care services, as defined within the MCA agreement, must be covered where such services are necessary to the prudent care of the patient. 16. The Healthplan retains responsibility for rendering the final coverage determination on all services denied for medical necessity. MCA shall notify CIGNA as expeditiously as possible, but no later than the same business day, of any recommendation for denial of coverage. The notification shall include: A. documentation indicating who recommended denial, why, and any medical information used to render the recommendation; B. documentation that an explanation is provided to the applicable Represented Provider via telephone of the recommended denial. The MCA shall not send any written communication, either via US mail or facsimile, to the requesting provider. 17. CIGNA will notify the MCA, the requesting provider, the PCP, and the Participant via letter which includes all information required by applicable federal and state law. 18. CIGNA will process all requests for appeals, whether expedited or standard. In connection with any such appeal, the MCA shall assist and cooperate with CIGNA and shall promptly provide all documentation reasonably requested by CIGNA to meet all accreditation and regulatory timeframe requirements. A. MCA shall make no denials for experimental/investigative reasons unless such denials have been discussed with and approved by CIGNA. 19. MCA's Clinical Service management Program decisions shall be made in a timely manner. A. MCA's Clinical Service Management Program policies and procedures shall clearly define the maximum time frames for Clinical Service Management Program decisions. All Clinical Service Management Program decisions shall be made within the time frames that allow CIGNA to satisfy all applicable federal and state legal requirements, whichever time frame is earlier (i.e. Department of Labor, Department of Insurance, Department of Corporations, HCFA, etc.). MCA shall implement adequate coverage arrangements to ensure compliance with applicable federal and state legal requirements at all times, including, but not limited to, adequate after hours, weekend and holiday coverage. B. MCA shall implement an appropriate mechanism to monitor and document timeliness of decisions which shall include: (1) Documentation to show urgent requests are responded to within 24 hours, or within the time frame required by applicable federal and state law, if earlier; and (2) Documentation to show routine requests are responded to within one working day, or within the time frame required by applicable federal and state law or regulatory authorities, if earlier (3) The MCA shall monitor and analyze its compliance with timeliness requirements on a quarterly basis and take prompt action to meet or improve adherence to such requirements. 20. Except as otherwise agreed by CIGNA, CIGNA shall retain responsibility for responding to Participant inquiries or complaints. MCA shall notify CIGNA Member Services within 24 hours of any complaint or grievance filed with MCA by or on behalf of any Participant. 21. The MCA shall maintain a system acceptable to CIGNA to track authorizations, to evaluate the MCA's compliance with CIGNA's contract requirements as set forth in Represented Provider Agreement and herein, to monitor providers for inappropriate clinical service and to evaluate Participant satisfaction and provider satisfaction, and other measures of evaluation agreed upon by the parties. MCA shall submit reports to CIGNA, in a format acceptable to CIGNA, on a quarterly basis reflecting the MCA's performance under these measures of evaluation, including an action plan which addresses opportunities for improvement when applicable. 22. CIGNA, its designee and any applicable governmental authorities or accrediting bodies shall have the right to conduct periodic audits of the MCA's Clinical Management service Program activities upon reasonable prior notice, and the MCA shall cooperate with any such audits. In addition, the MCA's performance of its Clinical Service Management Program activities hereunder may be measured by CIGNA at least annually. The MCA shall cooperate with any such audits and shall provide any and all information reasonably requested by CIGNA in connection with such audits. Applicable performance measures include but are not limited to: (a) Participant concerns, complaints and grievances which relate to the UM Process do not exceed .10 per 1000 average eligible members per quarter for individual healthplans and for the CIGNA national rate. A "participant concern" is identified as any oral or written expression of dissatisfaction from a participant or participant's representative such as a physician, guardian or family member. (b) audits of Clinical Service Management Program activities show compliance with CIGNA, and applicable federal, state and accreditation requirements. 23. CIGNA will provide MCA with a written report detailing its findings with respect to any such audits. If such audits reveal any deficiencies, MCA shall correct any deficiencies identified in such audit within 60 days of CIGNA's submission of the report detailing such deficiencies. Failure to correct any identified deficiencies within such 60 day period may be cause for revocation of the delegation set forth herein. 24. MCA shall provide CIGNA with evidence of an appropriate internal control environment acceptable to CIGNA of MCA's Clinical Service Management Program operations on an annual basis. 25. MCA shall prepare and provide such periodic reports or other data as is reasonably requested by CIGNA relating to MCA's Clinical Service Management Program activities in association with Participant's receiving services from Represented Providers. MCA shall participate in Clinical Service Management Program oversight activities (i.e., committee meetings, report submission) to the extent reasonably required by CIGNA and at least quarterly. MCA shall provide CIGNA with any adverse event/sentinel diagnosis information relating to Participants within two business days of MCA's receipt of such information. 26. MCA shall have a process in place to ensure appropriate utilization of services including identifying areas of over utilization and under utilization including: monitoring different types of data, establishing thresholds, conducting quantitative analysis and comparison to thresholds and working with CIGNA to implement actions to address issues that are identified by CIGNA or by the MCA. 27. If CIGNA determines that MCA cannot meet its Clinical Service Management Program obligations, CIGNA may elect to assume responsibility for such activities. If CIGNA elects to assume responsibility for such activities, the rates set forth in the Agreement shall be adjusted to the extent necessary, and MCA shall cooperate and provide to CIGNA any information reasonably required to perform such activities. 28. All referrals shall be to Represented Providers, except where an Emergency requires otherwise or as otherwise required by applicable federal and state law. Except in an urgent/emergent situation, MCA shall require all Represented Providers to obtain authorization from MCA prior to rendering home health services. Or as otherwise required by applicable federal and state law. 29. All electronic data which MCA maintains concerning the detail of all Clinical Service Management Program activities made hereunder shall be made available and submitted to CIGNA using ANSI standard transaction formats or another mutually agreeable format in compliance with applicable state and federal law including, but not limited to, the Health Insurance Portability and Accountability Act (HIPAA) and Administrative Simplification. Such data shall be submitted to CIGNA at least monthly. If a non-ANSI format is agreed upon, MCA shall cooperate with CIGNA in the development of the transmission format, frequency and protocol. 30. MCA shall maintain evidence that MCA distributes a statement to all employees, and Represented Providers involved in Clinical Service Management Program activities, affirming the following: A. Clinical service decision making is based only on appropriateness of care and service. B. The MCA does not compensate practitioners/providers/employees for denials. C. The MCA does not offer incentives to encourage denials. D. The need for special concern about under utilization. MCA shall indemnify, defend and hold harmless CIGNA and its affiliates from and against any and all liability, fines, penalties, damages and expense, including reasonable defense costs and legal fees, incurred by CIGNA in connection with claims or actions of any nature, governmental examinations, enforcement actions or other administrative proceedings, arising from MCA's failure to perform its obligations under these Standards A. Confidentiality MCA shall comply with all applicable federal and state laws and regulations relating to the confidentiality of medical records and other individually identifiable health information, including but not limited to, the requirements specified below. B. Definitions Applicable to this Confidentiality Section "Confidential Information" shall mean (a) Individually Identifiable Health Information that is (i) transmitted by Electronic Media, (ii) maintained in any medium constituting Electronic Media; or (iii) transmitted or maintained in any other form or medium and (b) any Nonpublic Personal Financial Information, as that term is defined by the NAIC Model Privacy of Consumer Financial and Health Information Regulation (2000) issued pursuant to the Gramm Leach Bliley Act. "Confidential Information" shall not include (i) education records covered by the Family Educational Right and Privacy Act, as amended, 20 U.S.C. Section 1232g and (ii) records described in 20 U.S.C. Section 1232g(a)(4)(B)(iv). "Designated Record Set" shall mean a group of records maintained by or for CIGNA or a CIGNA Affiliate that is (i) the medical records and billing records about individuals maintained by or for CIGNA or a CIGNA Affiliate, (ii) the enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a health plan; or (iii) used, in whole or in part, by or for CIGNA or a CIGNA Affiliate to make decisions about individuals. As used herein, the term "Record" means any item, collection, or grouping of information that includes Confidential Information and is maintained, collected, used, or disseminated by or for CIGNA or a CIGNA Affiliate. "Electronic Media" shall mean the mode of electronic transmissions. It includes the Internet, extranet (using Internet technology to link a business with information only accessible to collaborating parties), leased lines, dial-up lines, private networks, and those transmissions that are physically moved from one location to another using magnetic tape, disk, or compact disk media. "Individually Identifiable Health Information" shall mean information that is a subset of health information, including demographic information collected from an individual, and (1) is created or received by a health care provider, health plan, employer, or health care clearinghouse; and (2) relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present or future payment for the provision of health care to an individual; and (a) identifies the individual, or (b) with respect to which there is a reasonable basis to believe the information can be used to identify the individual; and (3) relates to identifiable non-health information including but not limited to an individual's address, phone number and/or Social Security number. "Privacy Standards" shall mean (a) the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated thereunder, including the Standard for Privacy of Individually Identifiable Health Information, 45 C.F.R. Parts 160 and 164, (b) the Gramm Leach Bliley Act and any applicable regulations governing privacy and confidentiality promulgated thereunder, and (c) other federal or state laws or regulations governing the use, disclosure, confidentiality, security or privacy of Confidential Information or other personally identifiable information. "Secretary" shall mean the Secretary of the Department of Health and Human Services. C. Use of Confidential Information MCA may use Confidential Information to carry out the obligations of MCA set forth in the Agreement and these Standards or as required by federal or state law, subject to the provisions of Sections C. through N., below. MCA shall ensure that its directors, officers, employees, contractors and agents do not use Confidential Information received from CIGNA or a CIGNA Affiliate in any manner that would constitute a violation of the Privacy Standards if used in a similar manner by CIGNA or a CIGNA Affiliate. MCA shall not use Confidential Information for the purpose of creating de-identified information that will be used for any purpose other than to carry out the obligations of MCA set forth in the Agreement or these Standards or as required by federal or state law. D. Disclosure of Confidential Information MCA and its directors, officers, employees, contractors and agents shall not disclose Confidential Information received from CIGNA or a CIGNA Affiliate other than as is necessary to carry out the obligations of MCA set forth in the Agreement or these Standards or as required by federal or state law, subject to the provisions of Sections C. through N., below. Confidential Information shall not be disclosed in any manner that would constitute a violation of the Privacy Standards if disclosed in a similar manner by CIGNA or a CIGNA Affiliate. E. Safeguards Against Misuse of Information MCA agrees that it will implement all appropriate safeguards to prevent the use or disclosure of Confidential Information in any manner other than pursuant to the terms and conditions of the Agreement and these Standards. F. Reporting of Disclosures of Confidential Information MCA shall, within five (5) days of becoming aware of a loss, a suspected loss, or disclosure of Confidential Information in violation of the Agreement or these Standards by MCA, its officers, directors, employees, contractors or agents or by a third party to which MCA disclosed Confidential Information pursuant to Section C. of this Agreement, report any such disclosure to CIGNA's Privacy and Security Officers. This requirement will also apply to any loss, or suspected loss, of Confidential Information. G. Agreements with Third Parties MCA shall enter into an agreement with any agent, subcontractor or other third party that will have access to Confidential Information that is received from, created or received by MCA on behalf of CIGNA or a CIGNA Affiliate pursuant to which such third party agrees to be bound by the same restrictions, terms and conditions that apply to MCA pursuant to this Agreement with respect to such Confidential Information. Under such agreement, the third party shall (a) provide reasonable assurances that such Confidential Information will be held confidential as provided pursuant to the Agreement and these Standards, (b) provide reasonable assurances that such Confidential Information will be disclosed only as required by federal or state law or for the purposes for which it was disclosed to such third party, and (c) immediately notify MCA of any breaches of the confidentiality of the Confidential Information, to the extent it has obtained knowledge of such breach. H. Access to Information Within five (5) business days of a request by CIGNA or a CIGNA Affiliate for access to Confidential Information about an individual contained in a Designated Record Set, MCA shall make available to CIGNA or the CIGNA Affiliate such Confidential Information for so long as such information is maintained in the Designated Record Set. In the event any individual requests access to Confidential Information directly from MCA, MCA may not deny access to the Confidential Information requested. Rather, MCA shall, within two (2) business days, forward such request to CIGNA. I. Availability of Confidential Information for Amendment Within ten (10) business days of receipt of a request from CIGNA or a CIGNA Affiliate for the amendment of an individual's Confidential Information or a record regarding an individual contained in a Designated Record Set (for so long as the Confidential Information is maintained in the Designated Record Set), MCA shall provide such information to CIGNA or the CIGNA Affiliate for amendment and incorporate any such amendments in the Confidential Information as required by 45 C.F.R. Section 164.526. In the event that the request for the amendment of Confidential Information is made directly to the MCA, MCA may not deny the requested amendment. Rather, MCA shall, within two (2) business days, forward such request to CIGNA. J. Audit Upon reasonable notice, CIGNA or a CIGNA Affiliate may audit and inspect MCA's internal practices and the books and records in MCA's possession for the purpose of assessing MCA's use and disclosure of Confidential Information received from CIGNA or a CIGNA Affiliate or created by MCA on behalf of CIGNA or a CIGNA Affiliate. Such books and records shall be made available to CIGNA or a CIGNA Affiliate for its audit or inspection during regular business hours. K. Accounting of Disclosures Within ten business (10) days of notice by CIGNA or a CIGNA Affiliate to MCA that it has received a request for an accounting of disclosures of Confidential Information regarding an individual during the six (6) years prior to the date on which the accounting was requested, MCA shall make available to CIGNA or the CIGNA Affiliate such information as is in MCA's possession and is required for CIGNA or the CIGNA Affiliate to make the accounting required by 45 C.F.R. Section 164.528. At a minimum, MCA shall provide CIGNA or the CIGNA Affiliate with the following information: (i) the date of the disclosure, (ii) the name of the entity or person who received the Confidential Information, and if known, the address of such entity or person, (iii) a brief description of the Confidential Information disclosed, and (iv) a brief statement of the purpose of such disclosure that includes an explanation of the basis for such disclosure. In the event the request for an accounting is delivered directly to MCA, MCA shall within two (2) business days forward such request to CIGNA. It shall be CIGNA's or the applicable CIGNA Affiliate's responsibility to prepare and deliver any such accounting requested. MCA hereby agrees to implement an appropriate recordkeeping process to enable it to comply with the requirements of this Section. L. Availability of Books and Records MCA hereby agrees to make its internal practices, books and records relating to the use and disclosure of Confidential Information received from, created or received by MCA on behalf of CIGNA or a CIGNA Affiliate available to the Secretary for purposes of determining CIGNA's or CIGNA Affiliate's and MCA's compliance with the Privacy Standards. M. Return of Records Upon termination of the Agreement and at CIGNA's sole option, MCA shall be required to either a) return to CIGNA or a CIGNA Affiliate all Confidential Information received from, created or received on behalf of CIGNA or a CIGNA Affiliate in all forms without retaining any copies; or b) maintain all such Confidential Information consistent with the requirements of this Section 31 for the period of time such information is required to be maintained by applicable law after which time MCA shall destroy all such information in all forms maintained and shall not retain any copies of such information, or if such destruction is not feasible, extend the protections in this Section 31to such information and limit further uses and disclosures to those purposes that make the return or destruction of such information infeasible. N. Authorization to Terminate MCA hereby authorizes CIGNA to terminate the Agreement if CIGNA determines that MCA has violated a material term of this Section 31. O. Indemnification MCA will defend, indemnify and hold harmless CIGNA and its affiliates and their directors, officers, and employees from any claims, loss, cost (including reasonable attorneys' fees and court costs) or liability resulting from MCA's breach of this Section 31. Gentiva CareCentrix acknowledges receipt of CIGNA's above Standards for Delegation and, in accordance with the Agreement, will comply with the terms and conditions set forth herein. - -------------------------------------------------------------------------------- Gentiva CareCentrix's Name By ------------------------------- Its ------------------------------- Date ------------------------------ - ---------------------------------- CIGNA Entity's Name By ------------------------------- Its ------------------------------- Date ------------------------------ 9. EXHIBIT XVII CONTRACT EXCLUSIONS DOCUMENT
EXHIBIT XVII. CONTRACT EXCLUSIONS DOCUMENT EXCLUSION CATEGORY ------------------------------------------- ----------------------------------------------------- NOT DELIVERY MEDICALLY CONTRACTUAL CAT TYPE CODE DESCRIPT UOM CHANNEL NECESSARY NOT HME DIAGNOSTIC EXCLUSION - ---------------------------------------------------------------------------------------------------------------------------------- DISP DISP ADL 4544 AIDS DAILY LIVING SUPPLIES EA X DISP ADL 4544 AIDS DAILY LIVING SUPPLIES PUR X DISP DIAG 4542 DIAGNOSTIC SUPPLIES EA X DISP DIAG 4542 DIAGNOSTIC SUPPLIES PUR X DISP ONC 4545 L8000, MASTECTOMY SUPPLIES EA X DISP ONC 4545 L8000, MASTECTOMY SUPPLIES PUR X DISP OT/PT 4546 OT/PT SUPPLIES EA X DISP OT/PT 4546 OT/PT SUPPLIES PUR X DISP SKNCARE 4543 SKIN CARE SUPPLIES NOT IN ASSOCIATION WITH HME PUR X DISP URO 4540 INCONTINENCE SUPPLIES PUR X HIT HIT BRM 1087 BIOLOGICAL RESPONSE MODIFIERS THERAPY / INJOT DISP X (Self Injected Only) HIT CERZYME 2424 CEREZYME THERAPY - FULL SERVICE PD X HIT CERZYME 2425 CEREZYME THERAPY - PHARMACY ONLY PD X HIT FACTOR 1085 FACTOR VIII & IX THERAPY DISP X HIT HORM 1093 GROWTH HORMONE THERAPY DISP X HIT REMOD 7725 REMODULIN THERAPY - FULL SERVICE PD X HIT REMOD 7726 REMODULIN THERAPY - PHARMACY ONLY PD X HIT SYNAGIS 7013 SYNAGIS DISPENSING FEE DISP X HME HME BATH* 2575 BATH BENCH WITH BACK (E0245) PUR X X HME BATH* 2867 BATH TUB RAIL (E0241), WALL, L-SHAPE PUR X X HME BATH* 2042 BATH TUB RAIL, FLOOR BASE (E0242) PUR X X HME BATH* 2862 BATH TUB RAIL, WALL, 12" (E0241) PUR X X HME BATH* 2863 BATH TUB RAIL, WALL, 16" (E0241) PUR X X HME BATH* 2864 BATH TUB RAIL, WALL, 18" (E0241) PUR X X HME BATH* 2865 BATH TUB RAIL, WALL, 24" (E0241) PUR X X HME BATH* 2866 BATH TUB RAIL, WALL, 36" (E0241) PUR X X HME BATH* 2043 BATH TUB RAIL, WALL, UNSPECIFIED SIZE PUR X X HME BATH* 2058 BATH TUB STOOL OR BENCH (E0245) PUR X X HME BATH* 2053 SITZ BATH CHAIR PUR X X HME BATH* 2056 TOILET RAIL, EACH (E0243) PUR X HME BATH* 2578 TRANSFER BENCH, NON-PADDED (E0245) PUR X HME BATH* 2577 TRANSFER BENCH, PADDED (E0245) PUR X HME BATH* 2057 TRANSFER TUB RAIL(E0246), ATTACHMENT PUR X HME BED 2063 AIR FLUIDIZED BED (E0194) PUR X HME BED 2067 BED ACCESSORIES: BOARDS OR TABLES, ANY TYPE MO X X HME BED 2067 BED ACCESSORIES: BOARDS OR TABLES, ANY TYPE PUR X X HME BED 2068 BED BOARD (E1399) MO X X HME BED 2068 BED BOARD (E1399) PUR X X HME BED 2069 BED CRADLE, ANY TYPE (E1399) PUR X X HME BED 2563 BED WEDGE (E1399), 12" PUR X X HME BED 2856 BEDROOM EQUIPMENT (E1399), CUSTOM PUR X X HME BED 2082 HOSP BED, INST TYPE, OSCIL, CIRC & STRYKER, WITH MATTRESS MO X HME BED 2097 OVER-BED TABLE (*E0274) PUR X HME BED 2177 PAD, LAMBSWOOL SHEEPSKIN (E0189), ANY SIZE PUR X HME BED 2217 PAD, SYNTHETIC SHEEPSKIN (A9900) PUR X HME ENT 7551 BACK-PACK (E1399), FOR PORTABLE ENTERAL PUMP PUR X HME ENT 7161 FORMULA (B4150) CAT I,SEMI-SYN INTACT PROT/ISOLATE, CS MIN 192 OZ PUR X HME ENT 7162 FORMULA (B4151) CAT I, NATURAL INTACT PROT/ISOLATE, CS MIN 192 OZ PUR X HME ENT 7163 FORMULA (B4152) CAT II, INTACT PROT/ISOLATE, CS MIN 192 OZ PUR X HME ENT 7164 FORMULA (B4153) CAT III, HYDROL PROT AMINO PUR X ACID, CASE MIN 192 OZ HME ENT 7165 FORMULA (B4154) CAT IV, DEFINED SPEC METABOL PUR X NEED,CS MIN 192 OZ HME MISC BABY/ADULT SCALES X HME MISC BATH MATS X HME MISC CENTRIFUGES X HME MISC COMPRESSION STOCKINGS/REID SLEEVES X HME MISC CRAFTMATIC BEDS X HME MISC ENURESIS ALARMS X HME MISC ERGONOMIC OFFICE CHARIS X HME MISC EXERCISE EQUIPMENT X HME MISC GERI CHAIRS X HME MISC HIP CHAIRS X HME MISC HYPERBARIC CHAMBER X HME MISC MAGNETIC THERAPY EQUIPMENT X HME MISC NEEDLELESS INJECTORS X HME MISC POSTURPEDIC MATTRESSES X HME MISC PROTIME TESTER X HME MISC RECTAL DIALATOR X HME MISC ROLL ABOUT CHAIRS X HME MISC SAD LIGHTS X HME MISC SITZ BATHS X
EXHIBIT XVII. CONTRACT EXCLUSIONS DOCUMENT EXCLUSION CATEGORY ------------------------------------------- ----------------------------------------------------- NOT DELIVERY MEDICALLY CONTRACTUAL CAT TYPE CODE DESCRIPT UOM CHANNEL NECESSARY NOT HME DIAGNOSTIC EXCLUSION - ---------------------------------------------------------------------------------------------------------------------------------- HME MISC STANDARD MATTRESSES AND PILLOWS X HME MISC ULTRASOUND UNITS X HME MISC VITRECTOMY CHAIRS X HME MISC WHITE CANES X HME OTHER 2568 ADAPTER, AC/DC (A9900) PUR X X HME OTHER 2141 AIR BUBBLE DETECTOR FOR DIALYSIS MO X X HME OTHER 2141 AIR BUBBLE DETECTOR FOR DIALYSIS PUR X X HME OTHER 2144 AUTO INTERMITTENT PERITIONEAL DIALYSIS SYS MO X X HME OTHER 2144 AUTO INTERMITTENT PERITIONEAL DIALYSIS SYS PUR X X HME OTHER 2145 BATH CONDUCTIVITY METER FOR DIALYSIS MO X X HME OTHER 2145 BATH CONDUCTIVITY METER FOR DIALYSIS PUR X X HME OTHER 2552 BATH LIFT (E1399), CUSTOM PUR X X HME OTHER 2147 BLOOD LEAK DETECTOR FOR DIALYSIS MO X X HME OTHER 2147 BLOOD LEAK DETECTOR FOR DIALYSIS PUR X X HME OTHER 2148 BLOOD PUMP FOR DIALYSIS MO X X HME OTHER 2148 BLOOD PUMP FOR DIALYSIS PUR X X HME OTHER 2165 BOTTLE, HOT WATER MO X X HME OTHER 2165 BOTTLE, HOT WATER PUR X X HME OTHER 7168 BREAST PUMP BATTERY PACK (MEDELA) (A9900) PUR X HME OTHER 2581 BREAST PUMP, INSTITUTIONAL (E1399) PUR X HME OTHER 6779 CARDIAC EVENT MONITOR (G0015) MO X X HME OTHER 2140 CHAIR, ADJ FOR ESRD PATIENTS MO X X HME OTHER 2140 CHAIR, ADJ FOR ESRD PATIENTS PUR X X HME OTHER 2560 COLD THERAPY UNIT (E0218) MO X HME OTHER 2560 COLD THERAPY UNIT (E0218) PD X HME OTHER 2560 COLD THERAPY UNIT (E0218) PUR X HME OTHER 2593 COLD THERAPY UNIT, PAD (E1399) PUR X HME OTHER 2149 COMPACT (PORT) TRAVEL HEMODIALYZER SYS MO X X HME OTHER 2149 COMPACT (PORT) TRAVEL HEMODIALYZER SYS PUR X X HME OTHER 2150 CYCLER DIALYSIS MACH FOR PERITONEAL DIALYSIS MO X X HME OTHER 2150 CYCLER DIALYSIS MACH FOR PERITONEAL DIALYSIS PUR X X HME OTHER 2151 DEIONIZER WATER PURIFICATION SYS MO X X HME OTHER 2151 DEIONIZER WATER PURIFICATION SYS PUR X X HME OTHER 2152 DELIVERY AND/OR INSTALL CHARGES FOR RENAL MO X X DIALYSIS EQUIP HME OTHER 2152 DELIVERY AND/OR INSTALL CHARGES FOR RENAL PUR X X DIALYSIS EQUIP HME OTHER 2153 DIALYSIS EQUIP, UNSPEC, BY REPORT MO X X HME OTHER 2153 DIALYSIS EQUIP, UNSPEC, BY REPORT PUR X X HME OTHER 2104 DYNAMIC ADJ ELBOW EXTENSION/FLEXION DEVICE MO X HME OTHER 2104 DYNAMIC ADJ ELBOW EXTENSION/FLEXION DEVICE PUR X HME OTHER 2129 DYNAMIC ADJ EXTENSION/FLEXION DEVICE, SOFT PUR X INTERFACE MATERIAL HME OTHER 2106 DYNAMIC ADJ KNEE EXTENSION/FLEXION DEVICE MO X HME OTHER 2106 DYNAMIC ADJ KNEE EXTENSION/FLEXION DEVICE PUR X HME OTHER 2108 DYNAMIC ADJ WRIST EXTENSION/FLEXION DEVICE MO X HME OTHER 2108 DYNAMIC ADJ WRIST EXTENSION/FLEXION DEVICE PUR X HME OTHER 2109 ELECTROMYOGRAPHY (EMG) (E0746), BIOFEEDBACK MO X X DEVICE HME OTHER 2109 ELECTROMYOGRAPHY (EMG) (E0746), BIOFEEDBACK PUR X X DEVICE HME OTHER 2110 HARNESS (E0945), EXTREMITY BELT PUR X X HME OTHER 2223 HEAT COLD WATER (*E0237) CIRCULATING PAD W/PUMP PUR X X HME OTHER 2186 HEAT UNIT (E0249), WATER CIRCULATING PAD PUR X X HME OTHER 2155 HEATING PAD (E0215), ELECTRIC, MOIST PUR X X HME OTHER 2179 HEATING PAD (E0238), MOIST, NON-ELECTRIC PUR X X HME OTHER 2156 HEATING PAD, STANDARD (E0210) PUR X X HME OTHER 2161 HEEL OR ELBOW PROTECTOR, EACH MO X X HME OTHER 2161 HEEL OR ELBOW PROTECTOR, EACH PUR X X HME OTHER 2162 HEMODIALYSIS MACH MO X X HME OTHER 2162 HEMODIALYSIS MACH PUR X X HME OTHER 6780 HOLTER MONITOR (G0004) MO X X HME OTHER 2166 HYDROCOLLATOR UNIT, INCLUDING PADS MO X X HME OTHER 2166 HYDROCOLLATOR UNIT, INCLUDING PADS PUR X X HME OTHER 2167 HYDROCOLLATOR UNIT, PORT MO X X HME OTHER 2167 HYDROCOLLATOR UNIT, PORT PUR X X HME OTHER 2168 ICE CAP OR COLLAR MO X X HME OTHER 2168 ICE CAP OR COLLAR PUR X X HME OTHER 2176 KIDNEY, DIALYSATE DELIVERY SYST. KIDNEY MACH MO X X HME OTHER 2176 KIDNEY, DIALYSATE DELIVERY SYST. KIDNEY MACH PUR X X HME OTHER 2184 PACEMAKER MONITOR, SELF CONTAINED, WITH DIG/VIS CHECK SYSTEM MO X X HME OTHER 2184 PACEMAKER MONITOR, SELF CONTAINED, WITH DIG/VIS CHECK SYSTEM PUR X X HME OTHER 2185 PACEMAKER MONITOR, SELF-CONT'D, (WITH AUD & VIS CHECK SYSTEM) MO X X HME OTHER 2185 PACEMAKER MONITOR, SELF-CONT'D, (WITH AUD & VIS CHECK SYSTEM) PUR X X HME OTHER 2187 PARAFFIN BATH UNIT, PORT (E0235) PUR X HME OTHER 2191 PATIENT LIFT (E0625), KARTOP, BATHROOM OR TOILET PUR X X HME OTHER 2189 PATIENT LIFT (E0635), ELEC W/ SEAT OR SLING PUR X HME OTHER 2555 PATIENT LIFT, CUSTOM (E1399) PUR X X
EXHIBIT XVII. CONTRACT EXCLUSIONS DOCUMENT EXCLUSION CATEGORY ------------------------------------------- ----------------------------------------------------- NOT DELIVERY MEDICALLY CONTRACTUAL CAT TYPE CODE DESCRIPT UOM CHANNEL NECESSARY NOT HME DIAGNOSTIC EXCLUSION - ---------------------------------------------------------------------------------------------------------------------------------- HME OTHER 2102 PILLOW, CERVICAL PUR X X HME OTHER 2195 PRES ALARM FOR DIALYSIS MO X X HME OTHER 2195 PRES ALARM FOR DIALYSIS PUR X X HME OTHER 2199 PUMP (E0236) FOR WATER CIRCULATING PAD PUR X X HME OTHER 2163 PUMP, HEPARIN INFUSION FOR DIALYSIS MO X X HME OTHER 2163 PUMP, HEPARIN INFUSION FOR DIALYSIS PUR X X HME OTHER 2173 PUMP, INFUSION, IMPLANTABLE, NON-PROGRAMMABLE MO X X HME OTHER 2173 PUMP, INFUSION, IMPLANTABLE, NON-PROGRAMMABLE PUR X X HME OTHER 2174 PUMP, INFUSION, IMPLANTABLE, PROGRAMMABLE MO X X HME OTHER 2174 PUMP, INFUSION, IMPLANTABLE, PROGRAMMABLE PUR X X HME OTHER 2188 PUMP, INFUSION, PARENTERAL, STATIONARY SINGLE OR MULTI-CHANNEL MO X X HME OTHER 2188 PUMP, INFUSION, PARENTERAL, STATIONARY SINGLE OR MULTI-CHANNEL PUR X X HME OTHER 2200 RECIPROCATING PERITONEAL DIALYSIS SYS MO X X HME OTHER 2200 RECIPROCATING PERITONEAL DIALYSIS SYS PUR X X HME OTHER 2201 REPL COMPONENTS FOR OWNED HEMODIALYSIS/ MO X X PERITONEAL DIAL MACH HME OTHER 2201 REPL COMPONENTS FOR OWNED HEMODIALYSIS/ PUR X X PERITONEAL DIAL MACH HME OTHER 2202 RESTRAINTS (E0710), ANY TYPE (BODY, CHEST, MO X X WRIST OR ANKLE) HME OTHER 2202 RESTRAINTS (E0710), ANY TYPE (BODY, CHEST, PUR X X WRIST OR ANKLE) HME OTHER 2203 REVERSE OSMOSIS WATER PURIFICATION SYS MO X X HME OTHER 2203 REVERSE OSMOSIS WATER PURIFICATION SYS PUR X X HME OTHER 2204 SAFETY EQUIP (E0700) (E.G., BELT, HARNESS OR VEST FOR VEHICLES MO X X HME OTHER 2204 SAFETY EQUIP (E0700) (E.G., BELT, HARNESS OR VEST FOR VEHICLES PUR X X HME OTHER 2395 SEAT LIFT CHAIR/MOTORIZED (E0627) PUR X X HME OTHER 2205 SEAT LIFT MECH (E0627) INCORPORATED INTO A PUR X X COMB LIFT-CHAIR MECH HME OTHER 2213 SEAT LIFT MECH ONLY, USE W/PATIENT OWNED MO X FURN-ELEC HME OTHER 2213 SEAT LIFT MECH ONLY, USE W/PATIENT OWNED PUR X FURN-ELEC HME OTHER 2214 SEAT LIFT MECH ONLY, USE W/PATIENT OWNED MO X FURN-NON-ELEC HME OTHER 2214 SEAT LIFT MECH ONLY, USE W/PATIENT OWNED PUR X FURN-NON-ELEC HME OTHER 2562 SHOWER, HAND HELD (E1399) PUR X X HME OTHER 2216 SORBENT CARTRIDGES, PER CASE MO X X HME OTHER 2216 SORBENT CARTRIDGES, PER CASE PUR X X HME OTHER 2855 THERAPY EQUIPMENT, CUSTOM (E1399) PUR X HME OTHER 2220 TRANSDUCER PROTECTORS/FLUID BARRIERS, MO X X ANY SIZE, EACH HME OTHER 2220 TRANSDUCER PROTECTORS/FLUID BARRIERS, PUR X X ANY SIZE, EACH HME OTHER 2221 ULTRAVIOLET CABINET (E0690), APPROPRIATE MO X FOR HOME USE HME OTHER 2221 ULTRAVIOLET CABINET (E0690), APPROPRIATE PUR X FOR HOME USE HME OTHER 2222 UNIPUNCTURE CONTROL SYS FOR DIALYSIS MO X X HME OTHER 2222 UNIPUNCTURE CONTROL SYS FOR DIALYSIS PUR X X HME OTHER 7188 WALKER BASKET VINYL COATED (A9900) PUR X HME OTHER 7189 WALKER POUCH (A9900) LTWT W/ POCKETS PUR X HME OTHER 2225 WATER SOFTENING SYS MO X X HME OTHER 2225 WATER SOFTENING SYS PUR X X HME OTHER 2226 WEARABLE ARTIFICIAL KIDNEY MO X X HME OTHER 2226 WEARABLE ARTIFICIAL KIDNEY PUR X X HME OTHER 2061 WHIRLPOOL (E1399), NON-PORT (BUILT-IN TYPE) PUR X X HME OTHER 2062 WHIRLPOOL, PORT (OVERTUB TYPE) (E1300) MO X HME OTHER 2062 WHIRLPOOL, PORT (OVERTUB TYPE) (E1300) PUR X HME OTHER 6873 WOUND SUCTION DEVICE (K0538) PD X HME OTHER 7914 DRESSING SET, FOR WOUND SUCTION DEVICE (K0539) PUR X HME OTHER 7915 CANISTER SET, FOR WOUND SUCTION DEVICE (K0540) PUR X HME STIM 2157 STIMULATOR (E0755), ELECTRONIC SALIVARY REFLEX, NON INVASIVE PUR X X HME STIM 2157 STIMULATOR, ELECTRONIC SALIVARY REFLEX, NON MO X INVASIVE (E0755) HME STIM 2123 STIMULATOR, OSTEOGENIC, SURGICALLY IMPLANTED MO X X HME STIM 2123 STIMULATOR, OSTEOGENIC, SURGICALLY IMPLANTED PUR X X HME STIM 2172 STIMULATOR, PELVIC FLOOR INCONTINENCE MO X TREATMENT SYS HME STIM 2172 STIMULATOR, PELVIC FLOOR INCONTINENCE PUR X TREATMENT SYS HME STIM_BO 2124 STIMULATOR, OSTEOGENIC NON-INVASIVE, SPINAL MO X APPLICATIONS (E0748) HME STIM_BO 2124 STIMULATOR, OSTEOGENIC NON-INVASIVE, SPINAL PUR X APPLICATIONS (E0748) HME STIM_BO 6784 STIMULATOR, OSTEOGENIC, NON - INVA PUR X HME STIM_BO 2122 STIMULATOR, OSTEOGENIC, NON-INVASIVE (E0747) MO X HME STIM_BO 2122 STIMULATOR, OSTEOGENIC, NON-INVASIVE (E0747) PUR X HME STIM_BO 6875 STIMULATOR, OSTEOGENIC, ULTRASOUND PUR X HME SUP 2607 APPLICATOR COTTON TIP 3" OR 6" N/STRL 1000/BX EA X X (A4649A) HME SUP 2607 APPLICATOR COTTON TIP 3" OR 6" N/STRL 1000/BX UN X X (A4649A) HME SUP 2608 APPLICATOR COTTON TIP 6" STRL 200/BX SH EA X X (A4649B) HME SUP 2608 APPLICATOR COTTON TIP 6" STRL 200/BX SH UN X X (A4649B) HME SUP 2609 APPLICATOR, DRESS COTTON UN X X HME SUP 2611 BAG, URINARY (LEG) UN X X HME SUP 2616 BELT, RIB EA X X HME SUP 7173 BREAST PUMP COOLER/CARRIER (A9900) F/LACTINA PUR X X (MEDELA) HME SUP 2618 BRIEF, INCONTINENCE EA X X HME SUP 2624 CATHETER, MENTOR, SELF 408 UN X X HME SUP 2713 CATHETERIZATION MIRROR, SELF UN X X
EXHIBIT XVII. CONTRACT EXCLUSIONS DOCUMENT EXCLUSION CATEGORY ------------------------------------------- ----------------------------------------------------- NOT DELIVERY MEDICALLY CONTRACTUAL CAT TYPE CODE DESCRIPT UOM CHANNEL NECESSARY NOT HME DIAGNOSTIC EXCLUSION - ---------------------------------------------------------------------------------------------------------------------------------- HME SUP 2643 DISINFECTANT, DEM EA X X HME SUP 2645 DRESSING, LYOFOAM, 3.5X2.5 EA X X HME SUP 2655 ENTERAL FORMULAE, CAT REPLETE EA X HME SUP 2661 ENTERAL PEDIASURE W/FI EA X HME SUP 3713 ERECTION SYSTEM, VACUUM (K0163) EA X HME SUP 2672 FOAM, RESTON REHAB EA X X HME SUP 2674 GAUZE SPONGE 4X4 6PLY IV STRL, EACH (A6402) EA X X HME SUP 2675 GAUZE, MEDICATED PADS EA X X HME SUP 2673 GAUZE, NON-ADHESIVE, TELFA, 3X4 EA X X HME SUP 2676 GAUZE, NON-IMPREGNATED EA X X HME SUP 2677 GAUZE, NON-IMPREGNATED, 16" PAD EA X X HME SUP 2684 GLOVE EXAM LTX NON-STERILE 100/BX BAX (A4927) UN X X HME SUP 2678 GLOVE EXAM STERILE 100/BX (A4927) UN X X HME SUP 2679 GLOVES, EXAM, LARGE EA X X HME SUP 2680 GLOVES, EXAM, MEDIUM EA X X HME SUP 2681 GLOVES, EXAM, POWDERLESS, LARGE EA X X HME SUP 2682 GLOVES, EXAM, POWDERLESS, MEDIUM EA X X HME SUP 2683 GLOVES, STERILE, POWDERFREE EA X X HME SUP 2698 LUBRICANT, SURGICAL UN X X HME SUP 2473 NON-COVERED SUPPLIES EA X X HME SUP 2605 PREP, ALCOHOL OR PEROXIDE EA X X HME SUP 2606 PREP, ALCOHOL WIPES UN X X HME SUP 2644 PREP, HYDROGEN PEROXIDE EA X X HME SUP 2617 PUMP KIT, BREAST, DOUBLE UN X HME SUP 2725 REMOVER, ADHESIVE UN X X HME SUP 2728 SALINE (A7019) 0.9% UNIT DOSE UN X X HME SUP 2528 SIDE RAIL PADDING (A9900) PUR X HME SUP 2733 SOLUTION, CONTROL III UN X X HME SUP 2740 SPONGE, 6PLY, 2X2 UN X X HME SUP 2741 SPONGE, DRESS IV EA X X HME SUP 2741 SPONGE, DRESS IV UN X X HME SUP 2742 STOCKINGS, COMPRESSION UN X X HME SUP 2749 SUPPLIES, MEDICATION UN X X HME SUP 2755 TAPE MICROFOAM PER 18 SQ INCHES (A6265) EA X X HME SUP 2755 TAPE MICROFOAM PER 18 SQ INCHES (A6265) UN X X HME SUP 2756 TAPE, CLOTH 1/2" UN X X HME SUP 2757 TAPE, DERMICLEAR UN X X HME SUP 2758 TAPE, DRESS, DURAPORE, 1" UN X X HME SUP 2759 TAPE, DRESS, DURAPORE, 2" UN X X HME SUP 2760 TAPE, DRESS, TRANSPORE, 2" UN X X HME SUP 2767 TRACH, BRUSH PIPECLEAN UN X X HME SUP 2768 TRACHTRAY KIT STARTER W/SUPPLIES (A4625) UN X X HME SUP 2230 TRANSFER BOARD OR DEVICE (E0972) PUR X HME SUP 2796 VINEGAR UN X X HME SUP 2797 WATER, STERILE UN X X HME SUP 2801 WIPES, BABY EA X X HME SUP 2802 WIPES, SKIN BARRIER UN X X HME WC-CUST 2247 BATTERY CHARGER (E1066) PUR X HME WC-CUST 2255 BATTERY, DEEP CYCLE (E1069) PUR X HME WC-CUST 7604 CUSTOM POWER ADULT W/C ASSESSMENT EA X HME WC-CUST 7674 CUSTOM W/C REVIEW EA X HME WC-CUST 2288 SCOOTER, THREE WHEEL, STANDARD (STD) (E1230) MO X HME WC-CUST 2288 SCOOTER, THREE WHEEL, STANDARD (STD) (E1230) MS X HME WC-CUST 2288 SCOOTER, THREE WHEEL, STANDARD (STD) (E1230) PUR X HME WC-CUST 2288 SCOOTER, THREE WHEEL, STANDARD (STD) (E1230) RENPR X HME WC-CUST 2282 W/C MOTORIZED , FIX ARMS, SWING AWAY DETACH MO X FOOT RESTS (E1212) HME WC-CUST 2282 W/C MOTORIZED , FIX ARMS, SWING AWAY DETACH PUR X FOOT RESTS (E1212) HME WC-CUST 2279 W/C MOTORIZED, DETACH ARMS , S/AWAY DETACH MO X FOOT RESTS (E1211) HME WC-CUST 2279 W/C MOTORIZED, DETACH ARMS , S/AWAY DETACH PUR X FOOT RESTS (E1211) HME WC-CUST 2280 W/C MOTORIZED, DETACH ARMS S/AWAY, DETACH MO X ELEV LEG REST (E1213) HME WC-CUST 2280 W/C MOTORIZED, DETACH ARMS S/AWAY, DETACH PUR X ELEV LEG REST (E1213) HME WC-CUST 2281 W/C MOTORIZED, FIX ARMS, S/AWAY DETACH ELEV MO X LEG RESTS (E1210) HME WC-CUST 2281 W/C MOTORIZED, FIX ARMS, S/AWAY DETACH ELEV PUR X LEG RESTS (E1210) HME WC-CUST 2287 W/C POWER ATTACHMENT (E1065) PUR X HME WC-CUST 7768 W/C REPAIRS - CUSTOM (E1340) PUR X HME WC-CUST 2579 W/C XXWIDE (E1220) MO X HME WC-CUST 2579 W/C XXWIDE (E1220) MS X HME WC-CUST 2579 W/C XXWIDE (E1220) PD X HME WC-CUST 7702 W/C, CUSHION ALTERN8, ALTERNATING CUSHION (K108) PUR X HME WC-CUST 7506 W/C, CUSTOM MANUAL ADULT (E1399) PUR X HME WC-CUST 7504 W/C, CUSTOM MANUAL PEDIATRIC (E1399) PUR X HME WC-CUST 7507 W/C, CUSTOM POWER ADULT (E1399) PUR X HME WC-CUST 7505 W/C, CUSTOM POWER PEDIATRIC (E1399) PUR X
EXHIBIT XVII. CONTRACT EXCLUSIONS DOCUMENT EXCLUSION CATEGORY ------------------------------------------- ----------------------------------------------------- NOT DELIVERY MEDICALLY CONTRACTUAL CAT TYPE CODE DESCRIPT UOM CHANNEL NECESSARY NOT HME DIAGNOSTIC EXCLUSION - ---------------------------------------------------------------------------------------------------------------------------------- HME WC-STD 2249 BELT, SAFETY (E0979) W/ VELCRO CLOSURE, W/C PUR X HME WC-STD 2249 BELT, SAFETY W/ VELCRO CLOSURE, W/C (E0979) MO X HME WC-STD 2292 SAFETY VEST (E0980), W/C PUR X HME WC-STD 2292 SAFETY VEST, W/C (E0980) MO X HME WC-STD 2139 TRAY (E0950) MO X HME WC-STD 2139 TRAY (E0950) PUR X HME WC-STD 2254 W/C (E1399) COMMODE SEAT PADDED PUR X HME WC-STD 2254 W/C COMMODE SEAT PADDED (E1399) MO X HME WC-STD 2283 W/C NARROWING DEVICE MO X HME WC-STD 2283 W/C NARROWING DEVICE PUR X HME WC-STD 2231 W/C PART GRADE AID FOR WC MO X HME WC-STD 2231 W/C PART GRADE AID FOR WC PUR X HME WDCARE 2536 RX WOUND CARE $1.00,(E1399) EA X HME MISC NOVA PENS X HOSP ALL ALL HOSPICE SERVICE X LAB SUP 1421 SUPPLIES EA X X * SELF-INECTABLES THAT ARE ADMIXED WITH DILUENT AND ADMINISTERED VIA INTRAVENOUS INFUSION ARE INCLUDED IN MED THE CAPITATION PAYMENT. MED BRM 7016 ALDESLEUKIN (INTERLEUKIN-2)(22MU VIAL) VIAL X MED BRM 7705 ANAKINRA (100MG VIAL) VIAL X MED BRM 7686 DARBEPOEITIN ALFA (0.025 MG/ML) 1ML VIAL VIAL X MED BRM 7687 DARBEPOEITIN ALFA (0.04 MG/ML) 1ML VIAL VIAL X MED BRM 7688 DARBEPOEITIN ALFA (0.06 MG/ML) 1ML VIAL VIAL X MED BRM 7684 DARBEPOEITIN ALFA (0.1 MG/ML) 1ML VIAL VIAL X MED BRM 7685 DARBEPOEITIN ALFA (0.2 MG/ML) 1ML VIAL VIAL X MED BRM 7771 DARBEPOETIN ALFA (300MCG PER 1ML VIAL) VIAL X MED BRM 1487 EPOETIN ALFA UN X MED BRM 7110 EPOETIN ALFA (10,000 UNIT VIAL) VIAL X MED BRM 7017 EPOETIN ALFA (2,000 UNIT VIAL) VIAL X MED BRM 7119 EPOETIN ALFA (20,000 UNIT VIAL) VIAL X MED BRM 7095 EPOETIN ALFA (4,000 UNIT VIAL) VIAL X MED BRM 7524 EPOETIN ALFA (40,000 UNIT VIAL) VIAL X MED BRM 7069 EPOTIN ALFA (3,000 UNIT VIAL) VIAL X MED BRM 1488 FILGRASTIM (G-CSF) MCG X MED BRM 7018 FILGRASTIM (G-CSF) (300 MCG VIAL) VIAL X MED BRM 7070 FILGRASTIM (G-CSF) (480MCG VIAL) VIAL X MED BRM 7578 FILGRASTIM SINGLEJECT (300MCG PER 0.5ML SYRINGE) VIAL X MED BRM 7577 FILGRASTIM SINGLEJECT (480MCG PER 0.8ML SYRINGE) VIAL X MED BRM 6805 GLATIRAMER ACETATE MG X MED BRM 7019 GLATIRAMER ACETATE (20MG VIAL) VIAL X MED BRM 7020 INTERFERON ALFA 2A (3MU VIAL) VIAL X MED BRM 7071 INTERFERON ALFA 2A (6MU VIAL) VIAL X MED BRM 7096 INTERFERON ALFA 2A (9MU VIAL) VIAL X MED BRM 7097 INTERFERON ALFA 2B (10MU VIAL) VIAL X MED BRM 7109 INTERFERON ALFA 2B (18 MU VIAL) VIAL X MED BRM 7117 INTERFERON ALFA 2B (25MU VIAL) VIAL X MED BRM 7541 INTERFERON ALFA 2B (3MU PER 0.2ML 1.5ML PEN) VIAL X MED BRM 7021 INTERFERON ALFA 2B (3MU VIAL) VIAL X MED BRM 7118 INTERFERON ALFA 2B (50 MU VIAL) VIAL X MED BRM 7538 INTERFERON ALFA 2B (5MU PER 0.2ML 1.5ML PEN) VIAL X MED BRM 7103 INTERFERON ALFA 2B (5MU VIAL) VIAL X MED BRM 7514 INTERFERON ALFA 2B (60MU PEN) VIAL X MED BRM 7497 INTERFERON ALFA 2B 30MU KIT (6 X 5MU VIAL/SRN) KIT X MED BRM 7680 INTERFERON ALFA 2B KIT (6 X 10MU VIAL/SRN) KIT X MED BRM 6964 INTERFERON ALFA 2B/RIBAVIRIN 42 CAPS (REBETRON EA X 600 DOSE REDUCE) MED BRM 6963 INTERFERON ALFA 2B/RIBAVIRIN 70 CAPS (REBETRON EA X 1000 FOR <75KG) MED BRM 6962 INTERFERON ALFA 2B/RIBAVIRIN 84 CAPS (REBETRON EA X 1200 FOR >75KG) MED BRM 7022 INTERFERON ALFA N3 (5MU VIAL) VIAL X MED BRM 7072 INTERFERON ALFACON-1 (15MCG PER 0.5ML VIAL) VIAL X MED BRM 7023 INTERFERON ALFACON-1 (9MCG PER 0.3ML VIAL) VIAL X MED BRM 7113 INTERFERON BETA 1A (33 MCG SYR/VIAL) VIAL X MED BRM 7714 INTERFERON BETA 1A (REBIF)(22MCG PER 0.5ML SYRINGE) VIAL X MED BRM 7715 INTERFERON BETA 1A (REBIF)(44MCG PER 0.5ML SYRINGE) VIAL X MED BRM 7024 INTERFERON BETA 1A 132MCG KIT (4 X 33MCG VIALS) KIT X MED BRM 7025 INTERFERON BETA 1B (0.3MG = 9.6MU VIAL) VIAL X MED BRM 7026 INTERFERON GAMMA 1B (3MU VIAL) VIAL X MED BRM 7027 OPRELVEKIN (INTERLEUKIN-11)(5MG VIAL) VIAL X MED BRM 7713 PEGFILGRASTIM (G-CSF)(6MG PER 0.6ML SYRINGE) VIAL X MED BRM 7776 PEGINTERFERON ALFA-2A (180 MCG VIAL) VIAL X MED BRM 7777 PEGINTERFERON ALFA-2A (180 MCG VIAL, 4 VIAL KIT) VIAL X MED BRM 7666 PEGINTERFERON ALFA-2B (0.074MG KIT) VIAL X MED BRM 7601 PEGINTERFERON ALFA-2B (0.118MG KIT) VIAL X MED BRM 7667 PEGINTERFERON ALFA-2B (0.177MG KIT) VIAL X
EXHIBIT XVII. CONTRACT EXCLUSIONS DOCUMENT EXCLUSION CATEGORY ------------------------------------------- ----------------------------------------------------- NOT DELIVERY MEDICALLY CONTRACTUAL CAT TYPE CODE DESCRIPT UOM CHANNEL NECESSARY NOT HME DIAGNOSTIC EXCLUSION - ---------------------------------------------------------------------------------------------------------------------------------- MED BRM 7668 PEGINTERFERON ALFA-2B (0.222MG KIT) VIAL X MED BRM 1490 SARGRAMOSTIM (GM-CSF) MCG X MED BRM 7073 SARGRAMOSTIM (GM-CSF) (500MCG VIAL) VIAL X MED BRM 7028 SARGRAMOSTIM (GM-CSF)(250MCG VIAL) VIAL X MED CERZYME 7074 ALGLUCERASE (400 UNITS 5ML VIAL) VIAL X MED CERZYME 7030 ALGLUCERASE (50 UNITS PER 5 ML VIAL) VIAL X MED CERZYME 7032 IMIGLUCERASE (200 UNIT VIAL) VIAL X MED CERZYME 7496 IMIGLUCERASE (400 U VIAL) VIAL X MED CERZYME 7303 IMIGLUCERASE, PER UNIT UN X MED CHEMO 7908 ALEMTUZUMAB (CAMPATH) 30MG PER VIAL KIT X (3 VIAL KIT) MED CHEMO 7140 AMIFOSTINE (3 X 500MG VIAL) VIAL X MED CHEMO 7139 AMIFOSTINE (500MG VIAL) VIAL X MED CHEMO 7575 ARSENIC TRIOXIDE (10MG PER 10ML VIAL) VIAL X MED CHEMO 7481 ASPARAGINASE (10,000 UN VIAL) VIAL X MED CHEMO 1493 BLEOMYCIN SULFATE UN X MED CHEMO 7401 BLEOMYCIN SULFATE (15 UNIT VIAL) VIAL X MED CHEMO 7402 BLEOMYCIN SULFATE (30 UNIT VIAL) VIAL X MED CHEMO 6791 CARBOPLATIN MG X MED CHEMO 7404 CARBOPLATIN (150MG VIAL) VIAL X MED CHEMO 7405 CARBOPLATIN (450MG VIAL) VIAL X MED CHEMO 7403 CARBOPLATIN (50MG VIAL) VIAL X MED CHEMO 1494 CARMUSTINE MG X MED CHEMO 7406 CARMUSTINE (100MG VIAL) VIAL X MED CHEMO 1495 CISPLATIN MG X MED CHEMO 7408 CISPLATIN (100MG PER 100ML VIAL) VIAL X MED CHEMO 7407 CISPLATIN (50MG PER 50ML VIAL) VIAL X MED CHEMO 1496 CLADRIBINE MG X MED CHEMO 7409 CLADRIBINE (10MG PER 10ML VIAL) VIAL X MED CHEMO 1499 DACARBAZINE MG X MED CHEMO 7419 DACARBAZINE (200MG VIAL) VIAL X MED CHEMO 1500 DACTINOMYCIN MCG X MED CHEMO 7420 DACTINOMYCIN (500MCG VIAL) VIAL X MED CHEMO 7422 DAUNORUBICIN CITRATE LIPOSOME (50MG PER 25ML VIAL) VIAL X MED CHEMO 1501 DAUNORUBICIN HYDROCHLORIDE MG X MED CHEMO 7421 DAUNORUBICIN HYDROCHLORIDE (20MG VIAL) VIAL X MED CHEMO 6799 DAUNORUBICIN LIPOSOMAL MG X MED CHEMO 7502 DOCETAXEL (20MG VIAL) VIAL X MED CHEMO 7503 DOCETAXEL (80MG VIAL) VIAL X MED CHEMO 2487 DOXIL MG X MED CHEMO 7423 DOXORUBICIN LIPOSOME (20MG PER 10ML VIAL) VIAL X MED CHEMO 7769 EPIRUBICIN HYDROCHLORIDE 200MG (100ML VIAL) VIAL X MED CHEMO 7770 EPIRUBICIN HYDROCHLORIDE 50MG (25ML VIAL) VIAL X MED CHEMO 1503 ETOPOSIDE MG X MED CHEMO 7430 ETOPOSIDE (1000MG PER 50ML VIAL) VIAL X MED CHEMO 7427 ETOPOSIDE (100MG PER 5ML VIAL) VIAL X MED CHEMO 7428 ETOPOSIDE (150MG PER 7.5ML VIAL) VIAL X MED CHEMO 7429 ETOPOSIDE (500MG PER 25ML VIAL) VIAL X MED CHEMO 1504 FLOXURIDINE MG X MED CHEMO 7431 FLOXURIDINE (500MG VIAL) VIAL X MED CHEMO 1505 FLUDARABINE PHOSPHATE MG X MED CHEMO 7432 FLUDARABINE PHOSPHATE (50MG VIAL) VIAL X MED CHEMO 2853 GEMCITABINE HYDROCHLORIDE MG X MED CHEMO 7437 GEMCITABINE HYDROCHLORIDE (1000MG VIAL) VIAL X MED CHEMO 7436 GEMCITABINE HYDROCHLORIDE (200MG VIAL) VIAL X MED CHEMO 2492 IDARUBICIN MG X MED CHEMO 2493 IDARUBICIN (MULTIPLE 2ND) MG X MED CHEMO 7439 IDARUBICIN HYDROCHLORIDE (10MG VIAL) VIAL X MED CHEMO 7440 IDARUBICIN HYDROCHLORIDE (20MG VIAL) VIAL X MED CHEMO 7438 IDARUBICIN HYDROCHLORIDE (5MG VIAL) VIAL X MED CHEMO 7528 IFOSFAMIDE/MESNA (10GM-10GM PER KIT) VIAL X MED CHEMO 6986 IFOSFAMIDE/MESNA (5GM-3GM PER KIT) VIAL X MED CHEMO 7531 IFOSFAMIDE/MESNA (6GM-6GM PER KIT) VIAL X MED CHEMO 6807 IRINOTECAN HYDROCHLORIDE MG X MED CHEMO 7442 IRINOTECAN HYDROCHLORIDE (100MG PER 5ML VIAL) VIAL X MED CHEMO 7441 IRINOTECAN HYDROCHLORIDE (40MG PER 2ML VIAL) VIAL X MED CHEMO 1512 MECHLORETHAMINE HYDROCHLORIDE MG X MED CHEMO 7446 MECHLORETHAMINE HYDROCHLORIDE (10MG VIAL) VIAL X MED CHEMO 7765 MELPHALAN VIAL X MED CHEMO 2411 MESNA MG X MED CHEMO 7447 MESNA (1000MG PER 10ML VIAL) VIAL X MED CHEMO 1515 MITOMYCIN MG X MED CHEMO 7452 MITOMYCIN (20MG VIAL) VIAL X MED CHEMO 7453 MITOMYCIN (40MG VIAL) VIAL X MED CHEMO 7451 MITOMYCIN (5MG VIAL) VIAL X
EXHIBIT XVII. CONTRACT EXCLUSIONS DOCUMENT EXCLUSION CATEGORY ------------------------------------------- ----------------------------------------------------- NOT DELIVERY MEDICALLY CONTRACTUAL CAT TYPE CODE DESCRIPT UOM CHANNEL NECESSARY NOT HME DIAGNOSTIC EXCLUSION - ---------------------------------------------------------------------------------------------------------------------------------- MED CHEMO 6815 MITOXANTRONE MG X MED CHEMO 7454 MITOXANTRONE (20MG PER 10ML VIAL) VIAL X MED CHEMO 7455 MITOXANTRONE (25MG PER 12.5ML VIAL) VIAL X MED CHEMO 7456 MITOXANTRONE (30MG PER 15ML VIAL) VIAL X MED CHEMO 7764 OXALIPLATIN (50MG VIAL) VIAL X MED CHEMO 7761 OXALPLATIN (100MG VIAL) VIAL X MED CHEMO 1516 PACLITAXEL MG X MED CHEMO 7458 PACLITAXEL (100.2MG PER 16.7ML VIAL) VIAL X MED CHEMO 7459 PACLITAXEL (300MG PER 50ML VIAL) VIAL X MED CHEMO 7457 PACLITAXEL (30MG PER 5ML VIAL) VIAL X MED CHEMO 1517 PEGASPARGASE UN X MED CHEMO 7460 PEGASPARGASE (3750 UNITS PER 5ML VIAL) VIAL X MED CHEMO 1519 PLICAMYCIN MCG X MED CHEMO 7461 PLICAMYCIN (2500 MCG VIAL) VIAL X MED CHEMO 7132 RITUXIMAB (100MG PER 10ML VIAL) VIAL X MED CHEMO 7133 RITUXIMAB (500MG PER 50ML VIAL) VIAL X MED CHEMO 1520 STREPTOZOCIN MG X MED CHEMO 7462 STREPTOZOCIN (1GM VIAL) VIAL X MED CHEMO 1521 TENIPOSIDE MG X MED CHEMO 7474 TENIPOSIDE (50MG PER 5ML VIAL) VIAL X MED CHEMO 1522 THIOTEPA MG X MED CHEMO 7463 THIOTEPA (15MG VIAL) VIAL X MED CHEMO 2831 TOPOTECAN MG X MED CHEMO 7464 TOPOTECAN HYDROCHLORIDE (4MG VIAL) VIAL X MED CHEMO 7501 TRASTUZUMAB (440MG VIAL) VIAL X MED CHEMO 6679 VINORELBINE TARTRATE MG X MED CHEMO 7469 VINORELBINE TARTRATE (10MG PER 1ML VIAL) VIAL X MED CHEMO 7470 VINORELBINE TARTRATE (50MG PER 5ML VIAL) VIAL X MED ENT 1525 ENTERAL FORMULAE: CALORICALLY DENSE INTACT CAN X MED ENT 1525 ENTERAL FORMULAE: CALORICALLY DENSE INTACT ML X MED ENT 1526 ENTERAL FORMULAE: DEFINED FORMULAE FOR SPECIAL NEEDS CAN X MED ENT 1526 ENTERAL FORMULAE: DEFINED FORMULAE FOR SPECIAL NEEDS ML X MED ENT 1527 ENTERAL FORMULAE: HYDROLYZED PROTEIN/AMINO ACIDS CAN X MED ENT 1527 ENTERAL FORMULAE: HYDROLYZED PROTEIN/AMINO ACIDS ML X MED ENT 1528 ENTERAL FORMULAE: MODULAR COMPONENTS CAN X MED ENT 1528 ENTERAL FORMULAE: MODULAR COMPONENTS ML X MED ENT 1529 ENTERAL FORMULAE: NATURAL INTACT PROTEIN/PROTEIN CAN X MED ENT 1529 ENTERAL FORMULAE: NATURAL INTACT PROTEIN/PROTEIN ML X MED ENT 2413 ENTERAL FORMULAE: NON-SPECIFIED CAN X MED ENT 2413 ENTERAL FORMULAE: NON-SPECIFIED ML X MED ENT 2413 ENTERAL FORMULAE: NON-SPECIFIED PD X MED ENT 2414 ENTERAL FORMULAE: NON-SPECIFIED - FULL SERVICE CAN X MED ENT 2414 ENTERAL FORMULAE: NON-SPECIFIED - FULL SERVICE ML X MED ENT 1530 ENTERAL FORMULAE: SEMI-SYNTHETICS CAN X MED ENT 1530 ENTERAL FORMULAE: SEMI-SYNTHETICS ML X MED ENT 1531 ENTERAL FORMULAE: STANDARD NUTRIENTS CAN X MED ENT 1531 ENTERAL FORMULAE: STANDARD NUTRIENTS ML X MED FACTOR 6750 ANTIHIBITOR -- PROPLEX UN X MED FACTOR 6748 ANTIHIBITOR (J7196) AUTOPLEX UN X MED FACTOR 6749 ANTIHIBITOR (J7196) FEIBA UN X MED FACTOR 6744 FACTOR IX (J7194) ALFANINE UN X MED FACTOR 6747 FACTOR IX (J7194) BEBULIN UN X MED FACTOR 6745 FACTOR IX (J7194) KONYNE UN X MED FACTOR 6743 FACTOR IX (J7194) MONONINE UN X MED FACTOR 6746 FACTOR IX (J7194) PROFILNINE UN X MED FACTOR 6891 FACTOR IX RECOM (J7194) BENEFIX UN X MED FACTOR 7599 FACTOR VII -- NOVOSEVEN (AUTH IN 1200 OR 4800 QTY) MCG X MED FACTOR 7134 FACTOR VII (NOVOSEVEN 1200MCG VIAL) VIAL X MED FACTOR 7135 FACTOR VII (NOVOSEVEN 4800MCG VIAL) VIAL X MED FACTOR 6739 FACTOR VIII HIPUR (J7190) ALFANATE UN X MED FACTOR 6741 FACTOR VIII HIPUR (J7190) HUMATE UN X MED FACTOR 6740 FACTOR VIII HIPUR (J7190) KOATE UN X MED FACTOR 6742 FACTOR VIII HIPUR (J7191) HYATE UN X MED FACTOR 6736 FACTOR VIII MONO (J7190) HEMOPHIL UN X MED FACTOR 6737 FACTOR VIII MONO (J7190) MONOCLATE UN X MED FACTOR 6738 FACTOR VIII MONO (J7190) RED CROSS METHOD-M UN X MED FACTOR 7598 FACTOR VIII MONOCLONAL -- MONARC-M UN X MED FACTOR 6732 FACTOR VIII RECOM (J7192) BIOCLATE UN X MED FACTOR 6733 FACTOR VIII RECOM (J7192) HELIXATE UN X MED FACTOR 6735 FACTOR VIII RECOM (J7192) KOGENATE UN X MED FACTOR 6734 FACTOR VIII RECOM (J7192) RECOMBINATE UN X MED FACTOR 7909 FACTOR VIII RECOMBINANT - ADVATE UN X MED FACTOR 7572 FACTOR VIII RECOMBINANT - HELIXATE FS UN X MED FACTOR 7596 FACTOR VIII RECOMBINANT -- KOGENATE FS UN X
EXHIBIT XVII. CONTRACT EXCLUSIONS DOCUMENT EXCLUSION CATEGORY ------------------------------------------- ----------------------------------------------------- NOT DELIVERY MEDICALLY CONTRACTUAL CAT TYPE CODE DESCRIPT UOM CHANNEL NECESSARY NOT HME DIAGNOSTIC EXCLUSION - ---------------------------------------------------------------------------------------------------------------------------------- MED FACTOR 7597 FACTOR VIII RECOMBINANT -- REFACTO UN X MED HORM 7142 SERMORELIN ACETATE (GH-RELEASING HORMONE) (0.5MG VIAL) VIAL X MED HORM 7143 SERMORELIN ACETATE (GH-RELEASING HORMONE) (1MG VIAL) VIAL X MED HORM 1489 SOMATREM MG X MED HORM 7075 SOMATREM (10MG VIAL) VIAL X MED HORM 7033 SOMATREM (5MG VIAL) VIAL X MED HORM 7545 SOMATROPIN (.8MG VIAL)(MINIQUICK) VIAL X MED HORM 7746 SOMATROPIN (0.4MG SYR)(GENOTROPIN) VIAL X MED HORM 7747 SOMATROPIN (0.6MG SYR)(GENOTROPIN) VIAL X MED HORM 7748 SOMATROPIN (1.0MG SYR)(GENOTROPIN) VIAL X MED HORM 7749 SOMATROPIN (1.2MG SYR)(GENOTROPIN) VIAL X MED HORM 7750 SOMATROPIN (1.4MG SYR)(GENOTROPIN) VIAL X MED HORM 7751 SOMATROPIN (1.6MG SYR)(GENOTROPIN) VIAL X MED HORM 7752 SOMATROPIN (1.8MG SYR)(GENOTROPIN) VIAL X MED HORM 7753 SOMATROPIN (2.0MG SYR)(GENOTROPIN) VIAL X MED HORM 7744 SOMATROPIN (24MG VIAL)(HUMOTROPE) VIAL X MED HORM 7754 SOMATROPIN (5MG CARTRIDGE)(NORDITROPIN) VIAL X MED HORM 7758 SOMATROPIN (5MG VIAL)(HUMOTROPE) VIAL X MED HORM 7755 SOMATROPIN (5MG/VIAL)(SAIZEN) VIAL X MED HORM 7757 SOMATROPIN (5MG/VIAL)(SEROSTIM) VIAL X MED HORM 7743 SOMATROPIN (6MG VIAL)(HUMOTROPE) VIAL X MED HORM 7756 SOMATROPIN (8.8MG/VIAL)(SAIZEN) VIAL X MED HORM 6672 SOMATROPIN (RDNA ORIGIN) MG X MED HORM 7076 SOMATROPIN (RDNA ORIGIN) (10MG VIAL) VIAL X MED HORM 7115 SOMATROPIN (RDNA ORIGIN) (13.8 MG CARTRIDGE/VIAL) VIAL X MED HORM 7114 SOMATROPIN (RDNA ORIGIN) (5.8 MG CARTRIDGE/VIAL) VIAL X MED HORM 7034 SOMATROPIN (RDNA ORIGIN) (5MG VIAL) VIAL X MED HORM 7123 SOMATROPIN (RDNA ORIGIN)(1.5MG CARTRIDGE/VIAL) VIAL X MED HORM 7559 SOMATROPIN (RDNA ORIGIN)(12MG CARTRIDGE/VIAL) VIAL X MED HORM 7669 SOMATROPIN (RDNA ORIGIN)(15MG/1.5ML CARTRIDGE) VIAL X MED HORM 7122 SOMATROPIN (RDNA ORIGIN)(4MG VIAL) VIAL X MED HORM 7121 SOMATROPIN (RDNA ORIGIN)(6MG VIAL) VIAL X MED HORM 7124 SOMATROPIN (RDNA ORIGIN)(8 MG VIAL) VIAL X MED HORM 7741 SOMATROPIN AQ (10MG CARTRIDGE/VIAL)(NUTROPIN) VIAL X MED HORM 7740 SOMATROPIN AQ (10MG VIAL)(NUTROPIN) VIAL X MED HORM 7562 SOMATROPIN DEPOT (RDNA ORIGIN) (13.5MG VIAL) VIAL X MED HORM 7563 SOMATROPIN DEPOT (RDNA ORIGIN) (18MG VIAL) VIAL X MED HORM 7564 SOMATROPIN DEPOT (RDNA ORIGIN) (22.5MG VIAL) VIAL X MED INJOT 7035 ACETYLCYSTEINE (10% 10ML VIAL) VIAL X MED INJOT 7077 ACETYLCYSTEINE (20% 10ML VIAL) VIAL X MED INJOT 7789 ADALIMUMAB (HUMIRA)(40MG PER 0.8ML SYRINGE) VIAL X MED INJOT 7912 AGALSIDASE BETA (FABRAZYME) 35MG VIAL VIAL X MED INJOT 2824 ALBUTEROL INHALER EA X MED INJOT 6787 ALBUTEROL SULFATE SOLUTION ML X MED INJOT 7078 ALPROSTADIL (10MCG VIAL) VIAL X MED INJOT 7098 ALPROSTADIL (20MCG VIAL) VIAL X MED INJOT 7036 ALPROSTADIL (5MCG VIAL) VIAL X MED INJOT 7543 ALTEPLASE, RECOMBINANT MG X MED INJOT 7537 ALTEPLASE, RECOMBINANT (50MG VIAL) VIAL X MED INJOT 7542 ALTEPLASE, RECOMBINANT (50MG VIAL) VIAL X MED INJOT 7790 ANAKINRA (KINERET)(100MG PER .67ML SYRINGE) VIAL X MED INJOT 7397 ATROPINE SULFATE (1MG PER 1ML VIAL) VIAL X MED INJOT 7015 BACITRACIN (50,000 U VIAL) VIAL X MED INJOT 7037 BCG VACCINE (50MG VIAL) VIAL X MED INJOT 2819 BETAMETHASONE PHOSPHATE MG X MED INJOT 6973 BETAMETHOSONE ACETATE/BETAMETHOSONE SOD PHOS VIAL X (15MG PER 5ML VIAL) MED INJOT 6790 BITOLTEROL MESYLATE EA X MED INJOT 7108 BOTULINUM TOXIN TYPE A (100 UNIT VIAL) VIAL X MED INJOT 7727 BOTULINUM TOXIN TYPE B (2500 U PER 0.5ML) VIAL X MED INJOT 2483 CALCITONIN SALMON UN X MED INJOT 7038 CALCITRIOL (1MCG PER 1 ML VIAL) VIAL X MED INJOT 2826 CHORIONIC GONADATROPIN (HCG) UN X MED INJOT 7675 COLCHICINE (1MG VIAL) VIAL X MED INJOT 7039 CORTICOTROPIN (400 UNITS PER 5ML VIAL) VIAL X MED INJOT 6884 DALTEPARIN SODIUM MG X MED INJOT 6884 DALTEPARIN SODIUM UN X MED INJOT 6937 DANAPAROID SODIUM (750U) VIAL X MED INJOT 6938 DANAPAROID SODIUM (750U) (MULTIPLE 2ND) VIAL X MED INJOT 7041 DEPO-TESTADIOL (10ML VIAL) VIAL X MED INJOT 7532 DESMOPRESSIN (STIMATE) NASAL SPRAY 2.5ML VIAL X MED INJOT 7079 DESMOPRESSIN ACETATE (15MCG VIAL) VIAL X MED INJOT 7533 DESMOPRESSIN ACETATE (30MCG PER 2ML VIAL) VIAL X MED INJOT 7530 DESMOPRESSIN ACETATE (40MCG PER 10ML VIAL) VIAL X MED INJOT 7042 DESMOPRESSIN ACETATE (4MCG VIAL) VIAL X MED INJOT 7005 DEXRAZONE (250MG VIAL) VIAL X MED INJOT 2825 DIMENHYDRINATE MG X
EXHIBIT XVII. CONTRACT EXCLUSIONS DOCUMENT EXCLUSION CATEGORY ------------------------------------------- ----------------------------------------------------- NOT DELIVERY MEDICALLY CONTRACTUAL CAT TYPE CODE DESCRIPT UOM CHANNEL NECESSARY NOT HME DIAGNOSTIC EXCLUSION - ---------------------------------------------------------------------------------------------------------------------------------- MED INJOT 7044 DIMERCAPROL (10% 3ML VIAL) VIAL X MED INJOT 7742 DORNASE ALFA (30AMP/VIAL)(PULMOZYME) VIAL X MED INJOT 2823 DORNASE ALFA (PULMOZYME) MG X MED INJOT 1611 ENOXAPRIN SODIUM MG X MED INJOT 1986 ENOXAPRIN SODIUM (MULTIPLE 2ND) MG X MED INJOT 6677 ESTRADIOL CYPIONATE MG X MED INJOT 7045 ESTRADIOL CYPIONATE (25MG VIAL) VIAL X MED INJOT 7080 ESTRADIOL CYPIONATE (50MG VIAL) VIAL X MED INJOT 7679 ESTRADIOL MEDROXYPROGESTERONE (0.5ML VIAL) VIAL X MED INJOT 7046 ESTRADIOL VALERATE (200MG VIAL) VIAL X MED INJOT 7081 ESTRADIOL VALERATE (400MG VIAL) VIAL X MED INJOT 7002 ESTROGENS, CONJUGATED (25MG VIAL) VIAL X MED INJOT 7006 ETANERCEPT 4PK (4 X 25MG) (ENBREL) VIAL X MED INJOT 7006 ETANERCEPT 4PK (4 X 25MG) (ENBREL) KIT X MED INJOT 7521 ETHACRYNATE SODIUM (50MG VIAL) VIAL X MED INJOT 7004 FOLLITROPIN ALFA (75IU VIAL) VIAL X MED INJOT 7719 FONDAPARINUX SODIUM (2.5MG PER 0.5ML SYRINGE) VIAL X MED INJOT 7082 GOLD SODIUM THIOMALATE (500MG VIAL) VIAL X MED INJOT 7048 GOLD SODIUM THIOMALATE (50MG VIAL) VIAL X MED INJOT 2830 GONADORELIN ACETATE MG X MED INJOT 7720 GONADORELIN HYDROCHLORIDE (FACTREL)(0.1MG POWDER) VIAL X MED INJOT 6959 GONADOTROPIN, CHORIONIC UN X MED INJOT 7083 GONADOTROPIN, CHORIONIC (10,000 UNIT VIAL) VIAL X MED INJOT 7049 GONADOTROPIN, CHORIONIC (5,000 UNIT VIAL) VIAL X MED INJOT 6826 GOSERELIN ACETATE MG X MED INJOT 6899 HEPATITIS A VACCINE, INACTIVATED P ML X MED INJOT 7050 HEPATITIS B IMMUNE GLOBULIN (0.5ML VIAL) VIAL X MED INJOT 7084 HEPATITIS B IMMUNE GLOBULIN (1ML VIAL) VIAL X MED INJOT 7099 HEPATITIS B IMMUNE GLOBULIN (5ML VIAL) VIAL X MED INJOT 7051 HISTOPLASMIN (1:100 1ML VIAL) VIAL X MED INJOT 6676 HISTRELIN ACETATE EA X MED INJOT 1563 HUMAN INSULIN ML X MED INJOT 7671 HUMAN INSULIN, LISPRO (100UN/ML 10ML VIAL) VIAL X MED INJOT 7549 HYALURONATE, SODIUM (20MG PER 2ML VIAL) VIAL X MED INJOT 1564 HYDROXYPROGESTERONE CAPROATE MG X MED INJOT 7131 HYLAN POLYMERS A & B (16MG PER 2ML VIAL) VIAL X MED INJOT 7009 HYLAN POLYMERS A&B (3 X 2ML) VIAL X MED INJOT 6999 INFLIXIMAB (100MG VIAL) VIAL X MED INJOT 7000 INFLUENZA VIRUS VACCINE (45MCG VIAL) VIAL X MED INJOT 6806 IPRATROPIUM BROMIDE EA X MED INJOT 7697 IRON SUCROSE 100MG (5ML VIAL) VIAL X MED INJOT 1539 IRRIGATING SOLUTIONS LITER X MED INJOT 2833 KETOROLAC TROMETHAMINE MG X MED INJOT 7911 LARONIDASE (ALDURAZYME) 5ML VIAL VIAL X MED INJOT 1511 LEUPROLIDE ACETATE EA X MED INJOT 7399 LEUPROLIDE ACETATE -- PED (11.25 MG/VIAL) VIAL X MED INJOT 7010 LEUPROLIDE ACETATE -- PED (15MG/VIAL) VIAL X MED INJOT 7007 LEUPROLIDE ACETATE -- PED (7.5MG/VIAL) VIAL X MED INJOT 6971 LEUPROLIDE ACETATE 11.25 MG EA X MED INJOT 6855 LEUPROLIDE ACETATE 2.8ML VIAL (5MG/ML) EA X MED INJOT 6854 LEUPROLIDE ACETATE 3.75 MG EA X MED INJOT 7762 LEUPROLIDE ACETATE DEPOT (22.5MG) VIAL X MED INJOT 7672 LEUPROLIDE ACETATE DEPOT (30MG VIAL) VIAL X MED INJOT 7052 LIVER DERIVATIVE COMPLEX (510MG PER 20ML VIAL) VIAL X MED INJOT 7085 MEDROXYPROGESTERONE ACETATE (1000MG VIAL) VIAL X MED INJOT 7053 MEDROXYPROGESTERONE ACETATE (150MG VIAL) VIAL X MED INJOT 7100 MEDROXYPROGESTERONE ACETATE (4000MG VIAL) VIAL X MED INJOT 2827 MENOTROPINS (HMG) UN X MED INJOT 7054 MENOTROPINS (HMG) (75 UNIT VIAL) VIAL X MED INJOT 6685 METHYLENE BLUE ML X MED INJOT 7055 METHYLPREDNISOLONE ACETATE (40MG VIAL) VIAL X MED INJOT 7086 METHYLPREDNISOLONE ACETATE (80MG VIAL) VIAL X MED INJOT 2499 NANDROLONE DECANOATE MG X MED INJOT 7571 NEOSTIGMINE METHYLSULFATE (10MG PER 10ML VIAL) VIAL X MED INJOT 7570 NEOSTIGMINE METHYLSULFATE (5MG PER 10ML VIAL) VIAL X MED INJOT 2500 OCTREOTIDE MCG X MED INJOT 7093 OCTREOTIDE ACETATE (100MCG VIAL) VIAL X MED INJOT 7708 OCTREOTIDE ACETATE (5000MCG VIAL) VIAL X MED INJOT 7065 OCTREOTIDE ACETATE (50MCG VIAL) VIAL X MED INJOT 7476 OCTREOTIDE LAR DEPOT (10MG VIAL) VIAL X MED INJOT 7477 OCTREOTIDE LAR DEPOT (20MG VIAL) VIAL X MED INJOT 7478 OCTREOTIDE LAR DEPOT (30MG VIAL) VIAL X MED INJOT 7910 OMALIZUMAB (XOLAIR) 150MG PER VIAL VIAL X MED INJOT 6972 PALIVIZUMAB (100 MG/VIAL) VIAL X
EXHIBIT XVII. CONTRACT EXCLUSIONS DOCUMENT EXCLUSION CATEGORY ------------------------------------------- ----------------------------------------------------- NOT DELIVERY MEDICALLY CONTRACTUAL CAT TYPE CODE DESCRIPT UOM CHANNEL NECESSARY NOT HME DIAGNOSTIC EXCLUSION - ---------------------------------------------------------------------------------------------------------------------------------- MED INJOT 7513 PALIVIZUMAB (50 MG/VIAL) VIAL X MED INJOT 7087 PAPAVERINE HYDROCHLORIDE (300MG VIAL) VIAL X MED INJOT 7056 PAPAVERINE HYDROCHLORIDE (60MG VIAL) VIAL X MED INJOT 7519 PEGADEMASE BOVINE (375 UNITS PER 1.5ML VIAL) VIAL X MED INJOT 6820 PHENTOLAMINE MESYLATE MG X MED INJOT 7199 PNEUMOCOCCAL VACCINE (575MCG PER 0.5ML VIAL) VIAL X MED INJOT 7057 PROGESTERONE IN OIL (500MG VIAL) VIAL X MED INJOT 6990 SINCALIDE (KINEVAC) (5MCG VIAL) VIAL X MED INJOT 6821 SUMATRIPTAN SUCCINATE MG X MED INJOT 7058 SUMATRIPTAN SUCCINATE (6MG VIAL) VIAL X MED INJOT 7779 TERIPARATIDE (750 MCG PER 3ML VIAL) VIAL X MED INJOT 2508 TESTOSTERONE MG X MED INJOT 7059 TESTOSTERONE CYPIONATE (1,000MG VIAL) VIAL X MED INJOT 7088 TESTOSTERONE CYPIONATE (2,000MG VIAL) VIAL X MED INJOT 7120 TESTOSTERONE CYPIONATE (200 MG VIAL) VIAL X MED INJOT 7600 THERACYS BCG VACCINE (81MG) VIAL X MED INJOT 7014 THYROTROPIN ALFA (2 X 1.1 MG KIT) KIT X MED INJOT 7677 TINZAPARIN SODIUM (40,000 UNITS PER 2ML VIAL) VIAL X MED INJOT 7724 TREPROSTINIL SODIUM 10MG/ML VIAL X MED INJOT 7721 TREPROSTINIL SODIUM 1MG/ML VIAL X MED INJOT 7722 TREPROSTINIL SODIUM 2.5MG/ML VIAL X MED INJOT 7723 TREPROSTINIL SODIUM 5MG/ML VIAL X MED INJOT 7089 TRIAMCINOLONE DIACETATE (200MG VIAL) VIAL X MED INJOT 7060 TRIAMCINOLONE DIACETATE (40MG VIAL) VIAL X MED INJOT 7090 UROFOLLITROPIN (150 UNIT VIAL) VIAL X MED INJOT 7061 UROFOLLITROPIN (75 UNIT VIAL) VIAL X MED INJOT 7913 ZEMAIRA (1GM PER 50ML VIAL) VIAL X MED SYNAGIS 6972 PALIVIZUMAB (100 MG/VIAL) MG X ORTH ALL ALL ORTHOTIC DEVICES / SERVICES (HCPCS WITH L-CODES) X X ORTH ARCH SUPPORTS X X ORTH BOOTS X X ORTH BRACES X X ORTH COLLARS X X ORTH ELASTIC WRAP X X ORTH GAUNTLET X X ORTH GIRDLES X X ORTH HALOS X X ORTH HEEL CUPS X X ORTH INSOLES X X ORTH MASTECTOMY BRAS X X ORTH RIB BELTS X X ORTH SHOES X X ORTH SLINGS X X ORTH SPLINTS X X ORTH STUMP SOCKS X X ORTH SUPPORT HOSE X X ORTH SUPPORTS X X ORTH TRUSSES X X ORTH VESTS X X PROST ALL ALL PROSTHETIC DEVICES - BODY PART REPLACEMENTS X X RESP RESP EQUIP 2588 MONITOR, VITAL SIGNS (E1399) MO X RESP EQUIP 6775 OXIMETRY TEST (E1399) PD X RESP EQUIP 6775 OXIMETRY TEST (E1399) PUR X RESP EQUIP 2373 PERCUSSOR (E0480), ELEC OR PNEUM, HOME MODEL MO X RESP EQUIP 2373 PERCUSSOR (E0480), ELEC OR PNEUM, HOME MODEL PUR X RESP EQUIP 2373 PERCUSSOR (E0480), ELEC OR PNEUM, HOME MODEL RENPR X RESP EQUIP 2567 PNEUMOGRAM (*E1399) PUR X RESP EQUIP 2380 POSTURAL DRAINAGE BOARD (E0606) PUR X X RESP EQUIP 2592 SLEEP STUDY, ADULT (E1399) PUR X RESP EQUIP 2391 VAPORIZER, ROOM TYPE (E0605) PUR X RESP MISC AEROCHAMBERS X RESP MISC AIR PURIFIERS X RESP MISC CROUP/ O2 TENTS X RESP MISC INCUBATORS X RESP MISC IPPB MACHINES X RESP MISC NASAL ASPIRATORS X RESP MISC ROOM HUMIDIFIERS/DEHUMIDIFIERS X RESP MISC VAPORIZERS X RESP NEB* 2571 NEBULIZER (E0575), ULTRASONIC, AC/DC MO X RESP NEB* 2571 NEBULIZER (E0575), ULTRASONIC, AC/DC PUR X RESP NEB* 2571 NEBULIZER (E0575), ULTRASONIC, AC/DC RENPR X RESP NEB* 2338 NEBULIZER; ULTRASONIC (E0575) MO X RESP NEB* 2338 NEBULIZER; ULTRASONIC (E0575) PUR X
EXHIBIT XVII. CONTRACT EXCLUSIONS DOCUMENT EXCLUSION CATEGORY ------------------------------------------- ----------------------------------------------------- NOT DELIVERY MEDICALLY CONTRACTUAL CAT TYPE CODE DESCRIPT UOM CHANNEL NECESSARY NOT HME DIAGNOSTIC EXCLUSION - ---------------------------------------------------------------------------------------------------------------------------------- RESP NEB* 2338 NEBULIZER; ULTRASONIC (E0575) RENPR X RESP NEB* 2561 PEAK FLOW METER (E1399) PUR X X RESP OXYGEN 2529 O2 ANALYZER (A9900) MO X RESP OXYGEN 2529 O2 ANALYZER (A9900) PUR X RESP VEST_TH 6876 PERCUSSION VEST (A9900), THERAPY PUR X RESP VEST_TH 6774 THERAPY PERCUSSION, GENERATOR ONLY MO X RESP VEST_TH 6774 THERAPY PERCUSSION, GENERATOR ONLY PUR X THH OTHER 2845 X-RAY, CHEST EA X X THH UNSKILL 1617 COMPANION/LIVE IN PD X THH UNSKILL 1617 COMPANION/LIVE IN HR X THH UNSKILL 1617 COMPANION/LIVE IN VI X THH UNSKILL 1619 HOMEMAKER HR X THH WDCARE 2548 PRESCRIPTION WOUND CARE EA X WHS OTHER 2558 CRITICAL PATHWAY, HYPERTENSION PD X WHS OTHER 2559 CRITICAL PATHWAY, PREECLAMPSIA PD X WHS SKILLED 1650 HUAM/PERINATAL NURSING SERVICES LEVEL 1 PD X WHS SKILLED 1651 HUAM/PERINATAL NURSING SERVICES LEVEL 2 PD X WHS SKILLED 1652 HUAM/PERINATAL NURSING SERVICES LEVEL 3 PD X WHS SKILLED 1654 POST PARTUM WELL BABY/WELL MOM HR X WHS SKILLED 1654 POST PARTUM WELL BABY/WELL MOM PD X
EXHIBIT XVIII CLINICAL SERVICE MANAGEMENT DELEGATION GRID
- ------------------------------------------------------------------------------------------------------------------------------------ MCA responsibilities CIGNA responsibilities Rationale - ------------------------------------------------------------------------------------------------------------------------------------ Eligibility verification Provide regular member updates MCA should periodically verify if the electronically "ongoing member is still eligible. - ------------------------------------------------------------------------------------------------------------------------------------ Benefits verification Respond through customer service inquiries Varying benefit packages - ------------------------------------------------------------------------------------------------------------------------------------ Home health, DME and Infusion criteria Clinical Resource Unit feedback and MCA has the expertise in this development with input from practicing recommendations to MCA related to benefit specialty area. physicians and approval by their Quality interpretaion in the application of MCA Committee clinical criteria. CIGNA annual oversight review and approval of criteria used by MCA to make review determinations. - ------------------------------------------------------------------------------------------------------------------------------------ Central intake for home health, DME and Route calls to MCA Easy for providers and members. infusion services. - ------------------------------------------------------------------------------------------------------------------------------------ Collection of enough clinical information from None Intake must consist of gathering providers (any extenuating circumstances) to enough information to make a decision make a coverage determination or evidence to about coverage. support that efforts were made to obtain the clinical information. - ------------------------------------------------------------------------------------------------------------------------------------ Initial approval of covered services according None to established criteria and protocols - ------------------------------------------------------------------------------------------------------------------------------------ Referral of all urgent requests for Receive the faxed request and respond to Some states have a 1 day turn around non-covered services or services not meeting MCA within the NCQA timeframes. on all requests once all information approved clinical criteria requirements to the Make a determination of coverage and is gathered healthplan within 1 hour of receiving all issue denial letters with proper pertinent information. Refer non-urgent notification when indicated. requests of the same to the healthplan the (during initial phase of "partial" same day. delegation) - ------------------------------------------------------------------------------------------------------------------------------------ Send approval letters to all members where state Provide template letters to MCA MCA has real time access to members mandate exists in compliance with regulatory receiving services. requirements. - ------------------------------------------------------------------------------------------------------------------------------------ Submit all claims and encounters to CIGNA for Track and identify members to CIGNA of CIGNA pays claims and has access all tracking member benefit limits those reaching benefit limits paid claims for specific member. - ------------------------------------------------------------------------------------------------------------------------------------ Submit all claims and encounters to CIGNA for Notify members in writing when they are Same as above tracking member benefit limits reaching their benefit maximums - ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------ Provide authorizations for ongoing cases None Aspect of managing ongoing care. according to established criteria and available benefits. - ------------------------------------------------------------------------------------------------------------------------------------ Early identification and referral of complex Accept cases for evaluation by case Important for continuity of care and cases receiving services to healthplan case management management of ALL aspects of the and managers according to established criteria members needs process - ------------------------------------------------------------------------------------------------------------------------------------ Refer all experimental or investigational TEC Assessment will review according to CIGNA does not delegate this function. equipment or services to CIGNA TEC Assessment CIGNA protocols for evaluation prior to providing the service. - ------------------------------------------------------------------------------------------------------------------------------------ Establishes Overutilization and Underutilization Provide oversight of the process Capitated entities must be aware of thresholds and measures on a regular basis. trends and take action with providers as necessary. - ------------------------------------------------------------------------------------------------------------------------------------ Coordinates pre-certification requirements for Defines which services are non-capitated Some services will not be included in all non-capitated services and responds to FFS requests to meet NCQA the capitated arrangement and FFS with the healthplan standards pre-certification may be required. according to NCQA timelines. - ------------------------------------------------------------------------------------------------------------------------------------ Tracks all services that are "rent to Establishes parameters for transitioning More efficiently manage DME costs. purchase" and transitions to purchase rental items to purchase. according to contractually agreed upon parameters. - ------------------------------------------------------------------------------------------------------------------------------------ Conducts Network Assessment of the home health Reviews adequacy of the MCA Network in Identifies opportunities based on network according to the CIGNA membership and combination with member and provider changing membership and customer unique needs of the membership and reports complaints and satisfaction. satisfaction. annually to CIGNA. - ------------------------------------------------------------------------------------------------------------------------------------ Credentials network providers according to Provide CIGNA standards for credentialing Delegated function. CIGNA standards. of home health providers - ------------------------------------------------------------------------------------------------------------------------------------
EXHIBIT XIX MCA REPRESENTED PROVIDER APPLICATION PROPRIETARY AND CONFIDENTIAL THE PROVIDER CREDENTIALING APPLICATION KIT CONTAINS COMPANY POLICIES RELATED TO THE PROVIDER NETWORK OF GENTIVA CARECENTRIX. THIS DOCUMENT AND THE INFORMATION CONTAINED HEREIN ARE THE PROPERTY OF AND SUBJECT TO THE RIGHTS (INCLUDING COPYRIGHT) OF GENTIVA CARECENTRIX. NEITHER THIS DOCUMENT NOR ITS INFORMATION MAY BE DISCLOSED TO ANYONE OR USED FOR ANY PURPOSE EXCEPT AS EXPRESSLY AUTHORIZED IN WRITING BY GENTIVA CARECENTRIX. UNAUTHORIZED DISCLOSURE OR USE MAY RESULT IN CIVIL LIABILITY AND CRIMINAL PENALTIES. COPYING OF THE KIT CONTENTS, EXCEPT AS DIRECTED FOR SUBMISSION OR OTHERWISE MAKING THE MATERIALS AVAILABLE TO UNAUTHORIZED PERSONS IS PROHIBITED. *** (c) 1995 Gentiva CareCentrix All Rights Reserved Printed in USA TABLE OF CONTENTS I. Introduction II. CareCentrix As a Health Care Strategy III. Gentiva Corporation Background IV. Mission and Vision Statements V. Application Instructions VI. Conditions of Review VII. Inquiries VIII. Provider Applicant Application Section I. Provider Profile and Service Information Section II. Provider Qualifications IX. Authorization and Certification Statements X. Document Transmittal XI. Provider Agreement I. INTRODUCTION Thank you for your interest in becoming a credentialed provider in the Gentiva CareCentrix national home health care network. We are pleased to provide you with our PROVIDER CREDENTIALING APPLICATION KIT, which we hope you will complete and submit for consideration as a member in our integrated home health care network provider panel. You may currently have an existing contractual agreement with one or more Gentiva CareCentrix home health care branches. Those agreements bear no relationship to our network management line of business. EACH PROVIDER PARTICIPATING ON OUR INTEGRATED HOME HEALTH CARE NETWORK MUST BE CREDENTIALED. Therefore, you will need to complete and submit the enclosed application, which will be used to determine if your organization meets the established credentialing criteria. If your organization meets the credentialing criteria, and is selected to participate on our network provider panel, a contract pertaining to the relationship between your organization and Gentiva CareCentrix will need to be in place. Below you will find information regarding our network business strategy, a description of our network management line of business, the application and instructions for its completion, rates pertaining to the services and/or products you provide and an agreement for your signature. Please read and follow the instructions carefully and return all required documents to us within the time frame specified in the cover letter. II. NETWORK MANAGEMENT AS A HEALTH CARE STRATEGY "Network management" has existed in the United States for many years. Historically, health management organizations (HMOs) have delegated responsibility for the administration and management of specific benefits to contractors with focused expertise in specific clinical areas. Organizations providing these delegated services to managed health plans act as surrogates by developing networks of credentialed providers, designing clinical guidelines, managing utilization and administering benefits, services and products, evaluating effectiveness and efficiency and implementing correlated quality improvement initiatives, and reporting statistical data illustrating results, cost savings and outcomes to health plan customers. The need for managed care organizations (MCOs) to further delegate the development and management of provider networks is clear. As managed care penetration has increased in the market place, and networks of providers have developed, the demands upon the MCO have become overwhelming. The larger the network, the more time, expertise, effort and expense demanded of the MCO to manage groups of providers for any given coverage plan. Multiply this by the types and numbers of coverage within any given health plan and the number of health plans administered within an MCO, and the challenges faced by the MCO are evident. Therefore, our managed care customers are seeking new and innovative solutions to this problem. At Gentiva CareCentrix, we have responded by building the most advanced home care network available today. The Gentiva CareCentrix is a separate line of business that we believe offers a solution essential to the continuum of health care services in today's managed care arena. It is based upon: A. Managed care principles B. A customer-tailored provider panel C. Administrative simplicity D. Performance accountability E. Service consistency F. Risk sharing G. A philosophical shift from "vendor" to "provider/partner" III. GENTIVA BACKGROUND Gentiva Corporation is headquartered in Melville, New York and is a publicly held organization providing health care. Gentiva CareCentrix is in the forefront of two key elements of change: the move to managed care in the health care delivery system and the corporate restructuring within a more global economy. Gentiva CareCentrix has provided home health care services since 1971. Based upon industry sales, we are the largest home health care provider in North America. With over 600 locations and 175,000 caregivers throughout the United States and Canada, we offer a broad range of integrated services and care for more than 400,000 patients annually. Our health care division also offers diversified services such as our Flying Nurses(TM) and centrally coordinated programs to provide specially skilled health care personnel to support product sales, research and other clinical needs. We also take pride in being the nation's leading provider of management services to hospital-based home health agencies. As the industry's largest home health network manager, we currently provide a single source for managed nursing, home infusion, home medical equipment, respiratory therapy, rehabilitation, neonatal, pediatric, women's health and hospice services. Our network management business, housed within our health care division has the capacity to accommodate customer contracts covering more than 20 million lives. Greater than 5 million covered lives fall within capitated arrangements. We believe we are operating within an environment of great opportunity. Opportunity for home care and other post-acute health care solutions currently benefits from rapid growth of an aging population, continued advances in medical technology, managed care penetration into all aspects of health care delivery and reimbursement, and the sociological benefits of services delivered outside of traditional medical settings. As we continue to enhance and expand our service and information technology, it is with vision and commitment to our most recently developed line of business...network management. IV. MISSION AND VISION OUR MISSION STATEMENT Gentiva CareCentrix is a team of dedicated professionals committed to improving the quality of health care for patients and their families. We provide value to our entire spectrum of customers by exceeding expectations, controlling costs and ensuring quality outcomes. We set the standards that become the benchmark of our industry. OUR NETWORK VISION STATEMENT Gentiva CareCentrix will be the premier managed care delivery network. We will distinguish ourselves by offering customer-focused, specialized services and programs covering a broad continuum of health care. We are committed to leading the industry in: o Managed care o Customer consultation o Integrated services o High tech excellence o Information services o The Gold Standard To make our vision a reality, we will: o Develop and maintain a national network of qualified providers for each specialty service in all key markets that ensures services and product excellence and results in high customer satisfaction o Develop information systems and processes that support network management and facilitate information exchange among and between all network stakeholders o Implement sales and service strategies for targeted network customers and key markets that position us as the network manager of choice o Expand our network in the post-acute sector through market assessment, strategic business decisions and alliances o Collaborate with other industry leaders to develop and report customer satisfaction and performance measurements that meet the rigorous requirements of managed care organizations, NCQA and our own internal standards V. APPLICATION INSTRUCTIONS {PRIVATE} GUIDELINES FOR COMPLETING THE APPLICATION The PROVIDER CREDENTIALING APPLICATION is organized into two (2) major sections. The following guidelines and instructions are intended to assist you in both understanding how the data and information you provide will be used and directing you through the preparation process with a minimum of difficulty. We urge you to take this and the next page out of this package and keep it beside you while responding to each part of the application. We also encourage you to review this page before mailing your completed application to ensure that you have met all requirements as defined on this page and the following set of instructions. SECTION I, PROVIDER PROFILE AND SERVICE INFORMATION, entails four (4) pages (12, 13, 14 and 15). It seeks data regarding EACH SERVICE LOCATION of your organization. The data will be used with data from Section II to obtain a weighted credentialing score. If you are awarded membership on our provider panel, the data also will be used to identify and profile EACH service location participating in care delivery. For example, using computer software, provider selection for each network case is based upon first matching patient location zip code to provider type and location zip code. Therefore, it is vital that you ENTER ALL ZIP CODES EACH LOCATION IS ABLE TO SERVICE. After bringing up all providers of your service type by zip code match on the computer screen, the remainder of data you enter in this section will be used to profile each location's specific staffing and expertise. Therefore, it is important that you complete PAGES 12, 13, 14 AND 15, FOR EACH OF YOUR PROVIDER LOCATIONS. If any of your locations use SUBCONTRACTORS, you must complete SECTION I FOR EACH SUBCONTRACTOR AND ATTACH BEHIND THE SECTION I COMPLETED FOR THE CORE LOCATION. SECTION II, PROVIDER QUALIFICATIONS, seeks information about your organization AS A WHOLE. You need to complete ONLY ONE (1) SECTION II REGARDLESS OF THE NUMBER OF PROVIDER LOCATIONS you have. The responses provided in this Section will be used for purposes of obtaining a credentialing score. Complete the application AS APPLICABLE TO THE TYPE OF SERVICES OR PRODUCTS PROVIDED BY YOUR ORGANIZATION. In some cases, certain parts of one or more sections may not be applicable. We are aware of this and have adjusted our credentialing thresholds accordingly. However, all portions of the application, which are applicable, and all applicable attachments, must be completed and submitted. Page 30, APPLICATION DOCUMENT TRANSMITTAL, may be used as a guide to the attachments required to supplement the application. If one or more of the attachments is not applicable to your type of organization, please indicate "NA", or not applicable. SECTION COMPLETION INSTRUCTIONS o COMPLETING PROVIDER APPLICATION SECTION I - PROVIDER PROFILE & SERVICE INFORMATION o Complete each section as applicable for types of service you wish to provide. o Complete (1) PROFILE FOR EACH SITE/LOCATION that will provide care (PAGES 12, 13, 14 AND 15). o If you utilize SUB-CONTRACTORS, complete the full profile (PAGES 12, 13, 14 AND 15) for each sub-contractor used and ATTACH TO THE PROFILE OF THE CORE PROVIDER LOCATION. o Enter ALL ZIP CODES each service location on PAGE 12. o Statistical data should accurately reflect AN AVERAGE MONTH of patient volumes. o Data of sub-contractors should reflect their full capability and not be limited to those services/products provided only to your location. o COMPLETING PROVIDER SECTION II - PROVIDER QUALIFICATIONS o Complete ONE SECTION FOR YOUR ENTIRE ORGANIZATION. Mark each column as applicable to the types of services you wish to provide. o Fill in the appropriate square in INK to answer each question with a "yes", a "no" or "not applicable" response unless otherwise instructed. o If you attach any explanations or additional information on a separate piece of paper, AFFIX A CORRESPONDING REFERENCE number to identify the question to which the response is related. Limit response length as much as possible. o COMPLETING THE PROVIDER APPLICATION DOCUMENT TRANSMITTAL o Collect and submit IN DUPLICATE an original or copy of each and every APPLICABLE item listed on the form. o Return TWO (2) COPIES OF THE FORM AND THE APPLICABLE ATTACHMENTS with your completed application. o Omissions of applicable data/information will result in rejection of the application. o COMPLETING THE PROVIDER AGREEMENT (CONTRACT) o Review the terms and conditions as stated within the agreement. o Fill in the accurate LEGAL ENTITY NAME AND LOCATION on PAGE 1. DO NOT INSERT THE DATE you are completing the application. Upon full execution of the agreement, Gentiva CareCentrix will insert that date. Insert your federal tax ID number. IF MORE THAN ONE TAX ID NUMBER AND/OR LOCATION WILL BE CONTRACTED, INSERT THE PHRASE, "SEE SCHEDULE D," and attach a page labeled SCHEDULE D after Schedule B listing EACH LOCATION AND THE CORRESPONDING FEDERAL TAX ID NUMBER. o Fill in the appropriate ADDRESS AND FACSIMILE NUMBER FOR MAILING ANY NOTICE, DEMAND OR OTHER COMMUNICATION TO YOUR ORGANIZATION on PAGE 9 of the agreement. o Complete all schedules as instructed below. Upon award of provider status, you will receive under separate cover: o An EXECUTED AND DATED AGREEMENT with approved changes, and o A NETWORK PROVIDER MANUAL stipulating conditions of participation in full. c. SCHEDULE A: Place a check (X) before each service you intend to provide. d. SCHEDULE B: Place a check (X) before the appropriate service Attach the corresponding reimbursement schedule to Schedule B o Modification of terms and conditions as given, should be documented and provide alternate language on the contract or on a separate sheet of paper with referenced page and clause numbers. o If in agreement with the terms and conditions of the agreement, affix the appropriate signature and return in DUPLICATE. o COMPLETING THE AUTHORIZATION AND CERTIFICATION STATEMENTS o Review the authorization and certification statements on PAGE 28. o Affix the appropriate signature, title and date and return IN DUPLICATE. o SUBMITTING THE APPLICATION o Submit the completed application IN DUPLICATE with ONLY those attachments requested. o Do not place the application in a binder or other similar hard cover. o SUBMIT COMPLETED APPLICATIONS (A THROUGH E AS ABOVE) IN DUPLICATE TO THE ASSIGNED REVIEWER ON THE COVER LETTER OF THIS APPLICATION. VI. CONDITIONS OF REVIEW o Processing of applications will be initiated upon receipt of applications that are COMPLETE, LEGIBLE AND SUBMITTED IN DUPLICATE AS SPECIFIED ABOVE. o Applications completed and submitted as instructed shall be reviewed and processed based upon objective, weighted scoring criteria. o Applications meeting scoring threshold criteria shall be forwarded to the Provider Credentialing Committee for review, recommendation and determination. o The Provider Credentialing Committee reserves the right to request additional documentation, information and/or data, including an on-site visit, to verify application responses. o The Provider Credentialing Committee shall notify applicants of their credentialing status within 45 days of receipt of acceptable application or 5 business days following a final determination. o All submitted applications and contents therein shall be maintained in confidence and shall be provided to third parties only as indicated within the network Credentialing Policies and Procedures. o Applicants may request information from the Provider Relations Department regarding Credentialing Policies and Procedures. VII. INQUIRIES APPLICATION COMPLETION: GENTIVA HEALTH SERVICES ATTN: Rebecca Warren 3 HUNTINGTON QUADRANGLE 2S MELVILLE, NY 11747 Corporate Credentialing/Contracting Phone (631) 501-7131 FAX (913) 814-5759 LOCAL CONTRACTING AND NETWORK OPERATIONS: Karen Harkness Provider Relations Manager Phoenix Regional CareCentrix Center (602) 604-9241 DOLORES MULCAHY PROVIDER RELATIONS MANAGER Hartford Regional CareCentrix Center (860) 528-4038 Karen Harkness Provider Relations Manager Houston Regional CareCentrix Center (800) 453-8003 Dolores Mulcahy Provider Relations Manager Tampa Regional CareCentrix Center (800) 218-2505 VII. GENTIVA CARECENTRIX PROVIDER APPLICATION SECTION I. PROVIDER PROFILE LEGAL NAME: OWNER(s) NAME(s) D/B/A: ADDRESS: REMIT TO ADDRESS: CONTACT NAME AND TITLE: PHYSICIAN OWNERSHIP? [ ] YES [ ] NO BUSINESS TELEPHONE NO: ( ) 24-HR TELEPHONE NO: ( ) FACSIMILE NO: ( ) FEDERAL TAX ID NO _______________ MY OFFICE IS A: [ ] Branch [ ]Satellite of:* [ ] Subcontractor to:* *_______________
Branch Name TYPE OF PROVIDER: (CHECK ALL THAT APPLY) [ ] Home Health Agency [ ] HIT - Pediatric [ ] Respiratory Products [ ] Pediatric HH Agency [ ] Ambulatory Infusion Center [ ] Respiratory Therapy [ ] Home Medical Equipment [ ] Rehab - Home [ ] Hospice - Facility [ ] HIT - Nursing [ ] Rehab - Pediatric [ ] Hospice - Home [ ] HIT - Products [ ] Rehab - Outpatient [ ] Women's Health [ ] HIT - Full Service [ ] Rehab - Subacute
HOURS OF OPERATION: M _______ T_______ W_______ T_______ F______ S_______ S_______ ON-CALL ARRANGEMENTS: [ ] Answering Service [ ] Live Clinician [ ] Voice Mail [ ] On-Call Hrs:
SERVICE AREA: (PLEASE COMPLETE ZIP CODE AND COUNTY TABLE BELOW) - -------------------------------------------------------------------------------- COUNTY ZIP CODES - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- o GENTIVA CARECENTRIX PROVIDER APPLICATION SECTION I. PROVIDER PROFILE ACCREDITATION/CERTIFICATION/LICENSURE ACCREDITATION SUMMARY (Attach copy of current full accreditation summary report and result of any focus surveys) CHECK ALL ACCREDITATIONS THAT YOUR ORGANIZATION CURRENTLY HOLDS: [ ] JCAHO [ ] CHAP [ ] CARF OTHER _______________________(SPECIFY)_______ Accreditation No._________________Grid Score (if applicable)_________________% ACCREDITATION DECISION CATEGORY [ ] Commendation [ ] Accreditation type 1 [ ] Conditional [ ] Pending* [ ] Scheduled* [ ] Planned* *___________indicate date INDICATE DATES OF CURRENT ACCREDITATION PERIOD:_____ /_____ to _____/_____ m y m y INDICATE EFFECTIVE DATES OF LAST ACCREDITATION PERIOD:_____/_____ to _____/_____ m y m y LIST ALL SERVICES FOR WHICH ACCREDITATION HAS BEEN AWARDED: [ ] Clinical respiratory [ ] Home health [ ] Personal care/support [ ] Rehabilitation [ ] Equipment management [ ] Hospice [ ] Pharmacy [ ] Other____________ INDICATE THE NUMBER OF TYPE I RECOMMENDATIONS RECEIVED FOR MOST CURRENT ACCREDITATION:_______________ HAVE ALL TYPE 1 RECOMMENDATIONS BEEN RESOLVED TO THE SATISFACTION OF THE APPROPRIATE ACCREDITING BODY? [ ] Yes [ ] No IF NO, ATTACH COPY OF ACTION PLAN TO RESOLVE CERTIFICATION SUMMARY (Attach copy of most recent Medicare/Medicaid Certification survey reports [where required]) Medicare A Provider #____________________ Effective Date_____________________ Medicare B Provider #____________________ Effective Date_____________________ Medicaid Provider #______________________ Effective Date_____________________ Other____________________________________ Effective Date_____________________ LICENSURE SUMMARY (Attach copy of most recent license survey reports [where applicable]) LIST ALL LICENSE NUMBER(S) (AS APPLICABLE): DEA______________________________________ Respiratory________________________ Pharmacy_________________________________ State Business_____________________ HHA/Nursing______________________________ Other______________________________ HME______________________________________ Other______________________________ INSURANCE SUMMARY (Attach copy of insurance certificate) CARRIER NAME COVERAGE LIMITS General Liability________________________ ___________________________________ Medical Malpractice______________________ ___________________________________ Employer's Liability_____________________ ___________________________________ Automobile Liability_____________________ ___________________________________ PROVIDE MONTHLY AVERAGE ACTIVE PATIENT STATISTICS FOR EACH LINE ITEM LISTED UNDER EACH SERVICE TYPE. IF <1, ENTER 0:
A. PATIENT & SUB-SPECIALTY/PRODUCT CENSUS - -------------------------------------------------------------------------------------------------------- HOME RESPIRATORY HOME MEDICAL INFUSION THERAPY THERAPY EQUIPMENT AVG. CASE LOAD AVG. CASE LOAD AVG. CASE LOAD # pts # pts # pts - -------------------------------------------------------------------------------------------------------- Anti-infective Oxygen Wheelchairs - -------------------------------------------------------------------------------------------------------- Pain management Aerosol medications Ambulatory Aids - -------------------------------------------------------------------------------------------------------- Chemotherapy Apnea Monitor CPM - -------------------------------------------------------------------------------------------------------- TPN Ventilator Orthotics - -------------------------------------------------------------------------------------------------------- Enteral CPAP, BIPAP, BIPAP S/T Prosthetics - -------------------------------------------------------------------------------------------------------- Hydration Trach Care Multiple HME - -------------------------------------------------------------------------------------------------------- IV Cath Access Only Clinical Monitoring/Assessment Phototherapy - -------------------------------------------------------------------------------------------------------- Deferoxamine RT Testing (Sleep Studies, etc.) Custom Equipment - -------------------------------------------------------------------------------------------------------- IVIG Supplies Only Supplies Only - -------------------------------------------------------------------------------------------------------- Steroid Concentrator Beds - -------------------------------------------------------------------------------------------------------- Hemophil Factors REHABILITATION HOSPICE - -------------------------------------------------------------------------------------------------------- Dobutamine AVG. CASE LOAD # PTS AVG. CASE LOAD # PTS - -------------------------------------------------------------------------------------------------------- Ceredase/cerezyme Amputations Cancer - -------------------------------------------------------------------------------------------------------- Colony stimulating factor Burn injuries HIV - -------------------------------------------------------------------------------------------------------- Interferon Cardiac Other (specify) - -------------------------------------------------------------------------------------------------------- Growth Hormone Complex orthopedics Other (specify) - -------------------------------------------------------------------------------------------------------- Multiple Therapy Joint replacements WOMEN'S HEALTH - -------------------------------------------------------------------------------------------------------- Nursing Only Neuromuscular diseases AVG. CASE LOAD # PTS - -------------------------------------------------------------------------------------------------------- Pediatric Infusion Spinal cord injuries High Risk OB - Level I - -------------------------------------------------------------------------------------------------------- Other (specify) Strokes High Risk OB - Level 2 - -------------------------------------------------------------------------------------------------------- Traumatic brain injuries High Risk OB - Level 3 - -------------------------------------------------------------------------------------------------------- Pediatrics Low Risk OB - -------------------------------------------------------------------------------------------------------- Adults HUAM - -------------------------------------------------------------------------------------------------------- Other (specify) Prenatal Education - --------------------------------------------------------------------------------------------------------
INDICATE NUMBERS AND TYPES OF NON-ADMINISTRATIVE PERSONNEL (DO NOT WRITE IN SHADED AREAS):
B. FULL TIME EQUIVALENTS BY SERVICE TYPE - ---------------------------------------------------------------------------------- CAREGIVER TYPE INFUSION HOME HEALTH REHAB PEDI/NEONATE WOMEN SVCS - ---------------------------------------------------------------------------------- EXAMPLE 1 8 2 2 2 - ---------------------------------------------------------------------------------- RN - ---------------------------------------------------------------------------------- HIGH TECH RN - ---------------------------------------------------------------------------------- LPN/LVN - ----------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------- HHA/PCW - ---------------------------------------------------------------------------------- HOMEMAKER/COMP - ---------------------------------------------------------------------------------- PHARMACIST - ---------------------------------------------------------------------------------- PHARM. TECH - ---------------------------------------------------------------------------------- PT - ---------------------------------------------------------------------------------- SLP - ---------------------------------------------------------------------------------- OT - ---------------------------------------------------------------------------------- REHAB PARAPROF - ---------------------------------------------------------------------------------- RESP. THERAPIST - ---------------------------------------------------------------------------------- MSW - ---------------------------------------------------------------------------------- TECHNICIAN - ---------------------------------------------------------------------------------- OTHER: ================================================================================== TOTAL - ----------------------------------------------------------------------------------
INDICATE MONTHLY AVERAGE HOURS AND/OR VISITS FOR PAST TWO (2) MONTHS:
C. HOURS/VISITS CENSUS BY SERVICE TYPE TOTAL - --------------------------------------------------------------------------------------------------- CAREGIVER TYPE V/H INFUSION ADULT/GERI REHAB PEDI/NEONATE WOMEN SVCS MO. AVG - --------------------------------------------------------------------------------------------------- EXAMPLE: RN VST 50 77 22 28 24 201* - --------------------------------------------------------------------------------------------------- HRS - 640 - 320 - 960 =================================================================================================== RN HRS - --------------------------------------------------------------------------------------------------- VST - --------------------------------------------------------------------------------------------------- HIGH TECH RN HRS - --------------------------------------------------------------------------------------------------- VST - --------------------------------------------------------------------------------------------------- LPN/VN HRS - --------------------------------------------------------------------------------------------------- VST - --------------------------------------------------------------------------------------------------- PT HRS - --------------------------------------------------------------------------------------------------- VST - --------------------------------------------------------------------------------------------------- SLP HRS - --------------------------------------------------------------------------------------------------- VST - --------------------------------------------------------------------------------------------------- OT HRS - --------------------------------------------------------------------------------------------------- VST - --------------------------------------------------------------------------------------------------- Resp. Therapist HRS - --------------------------------------------------------------------------------------------------- VST - --------------------------------------------------------------------------------------------------- CRTT HRS - --------------------------------------------------------------------------------------------------- VST - --------------------------------------------------------------------------------------------------- MSW HRS - --------------------------------------------------------------------------------------------------- VST - --------------------------------------------------------------------------------------------------- HHA/PCW HRS - ---------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------- VST - --------------------------------------------------------------------------------------------------- HOMEMAKER HRS - --------------------------------------------------------------------------------------------------- VST - --------------------------------------------------------------------------------------------------- COMPANION HRS - --------------------------------------------------------------------------------------------------- VST - --------------------------------------------------------------------------------------------------- OTHER HRS - --------------------------------------------------------------------------------------------------- VST - ---------------------------------------------------------------------------------------------------
Visit definition: Procedure - specific care rendered in increments that usually do not exceed two hours. Hour's definition: Care rendered in blocks of time comprising no less than four (4) continuous hours. *Note: For the purpose of completing the table above, DO NOT convert hours to visits or visits to hours. Also make certain that your numbers are non-duplicative. For example, if you have a geriatric infusion Visit count the visit as EITHER geriatric OR infusion not both. o GENTIVA CARECENTRIX PROVIDER APPLICATION SECTION II. PROVIDER QUALIFICATIONS
INFUSION HOME HEALTH CLINICAL HOME SERVICES AGENCY/REHAB/ RESPIRATORY MEDICAL PROVIDER THERAPY CO. PROVIDER EQUIPMENT MANAGEMENT AND ORGANIZATION Y N N/A Y N N/A Y N N/A Y N N/A 1. Does your organization maintain bylaws, [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] charter, articles of incorporation or constitution that delineate legal authority and responsibility? 2. Do you maintain written agreements to define [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] the nature and scope of services provided if subcontracting patient services to other providers? Respond N/A if not using formally subcontracted or informally referred patient services. o Is your organization in compliance with state [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] and federal employment laws? 4. Has your organization or any employee in your [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] organization ever been involved in any malpractice suits or decisions? If yes, explain. o Has your organization been involved in any [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] sanctions, investigations, or limitations of any kind imposed by any health care institution, professional health care society, Medicare, Medicaid, accrediting organization, managed care organization Better Business Bureau or regulatory authority within the past two years and/or have any complaints been filed with such institutions, societies, or authorities about your organization within the past two years? If yes, explain on a separate sheet of paper and label your response VIII.5.
o GENTIVA CARECENTRIX PROVIDER APPLICATION SECTION II. PROVIDER QUALIFICATIONS
INFUSION HOME HEALTH CLINICAL HOME SERVICES AGENCY/REHAB/ RESPIRATORY MEDICAL PROVIDER THERAPY CO. PROVIDER EQUIPMENT MANAGEMENT AND ORGANIZATION CONTINUED Y N N/A Y N N/A Y N N/A Y N N/A 6. Has your organization's license to practice or [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] do business, or your participation in Medicare, Medicaid, or any managed care organization ever been suspended, revoked, modified or terminated? If yes, explain and label your response as VIII.6. 7. Has your organization or any of its employees, [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] owners, directors or officers ever been named as a defendant in a criminal action or civil false claims action in the past two years? If yes, explain and label your response as VIII.7. QUALITY IMPROVEMENT 8. Do you have a written quality improvement [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] program that is consistent with JCAHO/CHAP/CARF standards? Attach a current copy of the program and its results. 9. Do you include a budget line for quality [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] improvement activities? 10. Do you monitor indicators for each service [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] type you provide, e.g. infusion, home health, HME, respiratory therapy? 11. Do you track compliance with QI indicators, [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] utilize action plans to follow-up with problems and implement changes as needed to improve performance? 12. Do you track problems, interventions and [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] resolution of issues apart from QI indicator monitoring using incident reports and/or problem logs?
o GENTIVA CARECENTRIX PROVIDER APPLICATION SECTION II. PROVIDER QUALIFICATIONS
INFUSION HOME HEALTH CLINICAL HOME SERVICES AGENCY/REHAB/ RESPIRATORY MEDICAL PROVIDER THERAPY CO. PROVIDER EQUIPMENT QUALITY IMPROVEMENT CONTINUED Y N N/A Y N N/A Y N N/A Y N N/A 13. Do you have a formal client satisfaction [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] survey process? Attach a copy of the survey and results for the past 12 months. EQUIPMENT MANAGEMENT FOR IV PUMPS 14. Do you have a designated "dirty area" for [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] storage of contaminated, reusable equipment? 15. Do you maintain functionally separate "clean" [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] and "dirty" areas? 16. Can you produce documentation that routine [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] maintenance is performed/completed for all owned, leased and rented equipment? 17. Is back up equipment available to promote [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] uninterrupted service capability? Specify the type of back up equipment provided to patient. 18. Is all equipment recalibrated, cleaned and [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] certified by a certified biomedical company or employed manufacturers' certified technician per manufacturers' recommendations? Name the certification firm or technician used. 19. Are written reports submitted at least TWICE [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] YEARLY to the FDA for any illness, injury or death related to any product or equipment?
o GENTIVA CARECENTRIX PROVIDER APPLICATION SECTION II. PROVIDER QUALIFICATIONS
INFUSION HOME HEALTH CLINICAL HOME SERVICES AGENCY/REHAB/ RESPIRATORY MEDICAL PROVIDER THERAPY CO. PROVIDER EQUIPMENT INFECTION/EXPOSURE CONTROL SAFETY/HAZARD COMMUNICATION Y N N/A Y N N/A Y N N/A Y N N/A 20. Do you have a designated infection control [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] coordinator? 21. Do you have a designated safety coordinator? [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 22. Do you comply with all OSHA, DOT and FDA [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] standards for hazardous materials management, transport and disposal? 23. Is a waste container provided to every [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] patient, when appropriate, e.g., Sharps, infectious, chemotherapy? 24. Are universal precautions practiced by all [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] applicable staff to decrease exposure to risk? 25. Do you document follow up to blood borne [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] pathogen exposure? 26. Are infection rates tracked and reported? [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] Attach report for the past twelve (12) months. OPERATIONS 27. Specify your usual service/product delivery ______hours _______hours ______hours ______hours time once your organization receives benefit confirmation or coverage authorization and confirmed physician orders? 28. Do you track turn around time as part of your [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] performance improvement program?
o GENTIVA CARECENTIX PROVIDER APPLICATION SECTION II. PROVIDER QUALIFICATIONS
INFUSION HOME HEALTH CLINICAL HOME SERVICES AGENCY/REHAB/ RESPIRATORY MEDICAL PROVIDER THERAPY CO. PROVIDER EQUIPMENT OPERATIONS CONTINUED Y N N/A Y N N/A Y N N/A Y N N/A 29. Do you provide 24-hour answering service? [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 30. Are you capable of processing a referral [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] during non-business hours? 31. Check all staff types available on-call 24 [ ]RPH [ ]RN [ ]RN [ ]Tech hours a day, 7 days a week. Attach others on a [ ]RN [ ]HHA [ ]Driver [ ]Driver separate sheet of paper. [ ]Driver [ ]LP/VN [ ]RT [ ]CRTT 32. Is all patient information, including schedule [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] boards, out of public view, but accessible to all applicable personnel? 33. Is there a private area available for patient [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] related telephone calls? 34. Is patient/caregiver education provided and [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] documented in the medical record? 35. Do you have documentation of interdisciplinary [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] communication based on patient's clinical status? 36. Are periodic patient assessments performed and [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] communicated to the physician? 37. Do you have an Emergency Preparedness Plan [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] specific to your locale and service types that all personnel understand and can implement if required?
o GENTIVA CARECENTRIX PROVIDER APPLICATION SECTION II. PROVIDER QUALIFICATIONS
INFUSION HOME HEALTH CLINICAL HOME SERVICES AGENCY/REHAB/ RESPIRATORY MEDICAL PROVIDER THERAPY CO. PROVIDER EQUIPMENT OPERATIONS CONTINUED Y N N/A Y N N/A Y N N/A Y N N/A 38. Have you ever used your Emergency Preparedness [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] Plan? 39. Do you have an inventory control process to [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] manage the utilization of medication, supplies and equipment? 40. Is a current technical and medical reference [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] library maintained to support the services, medications, supplies and/or equipment provided to patients? 41. Do you provide delivery service when required? [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] PATIENT RECORDS 42. Are patient records maintained for all [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] patients and all services rendered? 43. Do you document multi-disciplinary care [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] conferences and care coordination with other providers? 44. Do you document the drug and food allergy [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] status on all patients? 45. Do you develop and maintain a [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] care/treatment/service plan for all patients? 46. Do you maintain a complete medication profile [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] for every patient?
o GENTIVA CARECENTRIX PROVIDER APPLICATION SECTION II. PROVIDER QUALIFICATIONS
INFUSION HOME HEALTH CLINICAL HOME SERVICES AGENCY/REHAB/ RESPIRATORY MEDICAL PROVIDER THERAPY CO. PROVIDER EQUIPMENT PATIENT RECORDS CONTINUED Y N N/A Y N N/A Y N N/A Y N N/A 47. Do you maintain a drug-monitoring plan and [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] drug related problem list? 48. Do you maintain a copy of written patient [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] discharge instructions in closed medical records when appropriate for patients with ongoing health care or psychosocial needs? 49. Do you conduct patient record reviews as part [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] of your operations and clinical quality assessment process? 50. Do you have physician orders or prescriptions [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] for each patient and for all services and products provided? PERSONNEL PRACTICES 51. Do you maintain current written position [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] descriptions for all employees? 52. Do you have written personnel [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] policies/procedures, e.g., employee handbook? 53. Do you maintain current and complete personnel [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] records for owners and staff? 54. Do all personnel files include signed [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] acknowledgement of a written confidentiality and conflict of interest policy?
o GENTIVA CARECENTRIX PROVIDER APPLICATION SECTION II. PROVIDER QUALIFICATIONS
INFUSION HOME HEALTH CLINICAL HOME SERVICES AGENCY/REHAB/ RESPIRATORY MEDICAL PROVIDER THERAPY CO. PROVIDER EQUIPMENT PERSONNEL PRACTICES CONTINUED Y N N/A Y N N/A Y N N/A Y N N/A 55. Do you maintain documentation of employee [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] training and orientation? o Do you check and document applicant [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] employment history and references? 57. Do you conduct and document job specific [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] performance evaluations? 58. Do you verify and document, and can you [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] provide upon request, all appropriate licenses or certifications as required for each specific job/profession? 59. Do you maintain documentation of [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] qualifications to perform specific job responsibilities, e.g., discipline-specific SKILLS CHECKLIST? 60. Do you maintain and document a staff [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] in-service program that teaches and/or reinforces operational standards, patient and staff safety, and technological and/or clinical practices updates? Attach sample in-service calendar for past year. 61. Do you maintain results of annual TB skin [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] tests or chest X-rays for all employees having patient contact? Note: More frequent testing may be required by new OSHA guidelines. 62. Do you document proof of continuing education [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] related to employees' specialty?
o GENTIVA CARECENTRIX PROVIDER APPLICATION SECTION II. PROVIDER QUALIFICATIONS
INFUSION HOME HEALTH CLINICAL HOME SERVICES AGENCY/REHAB/ RESPIRATORY MEDICAL PROVIDER THERAPY CO. PROVIDER EQUIPMENT PERSONNEL PRACTICES CONTINUED Y N N/A Y N N/A Y N N/A Y N N/A o Do you maintain proof of hepatitis [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] immunization (or Hepatitis B Vaccine Declination) for all staff responsible for Category 1 procedures? 64. Can you verify and provide upon request, [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] documentation of CPR certification as required for each specific job? 65. Identify classifications of employees required [ ]RPH [ ]RN [ ]RN [ ]Tech to maintain CPR certification. Attach others on a [ ]RN [ ]HHA [ ]Driver [ ]Driver separate sheet of paper. [ ]Driver [ ]LP/VN [ ]RT [ ]CRTT 66. Do you verify possession of a current driver's [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] license and automobile insurance coverage for all appropriate employees? 67. Do you have a completed I-9 Immigration form [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] for every applicable employee? 68. Do you maintain and can you provide [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] documentation of employees' health status/examinations where required by state or local regulations? 69. Are your personnel practices consistent with [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] an Equal Employment Opportunity and Affirmative Action philosophy? PHARMACY COMPOUNDING SERVICES 70. Are your parenteral compounding policies and [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] practices consistent with applicable JCAHO, CHAP, ASHP and USP standards? 71. Are all IV admixtures done in a laminar flow [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] hood?
o GENTIVA CARECENTRIX PROVIDER APPLICATION SECTION II. PROVIDER QUALIFICATIONS
INFUSION HOME HEALTH CLINICAL HOME SERVICES AGENCY/REHAB/ RESPIRATORY MEDICAL PROVIDER THERAPY CO. PROVIDER EQUIPMENT PHARMACY COMPOUNDING SERVICES CONTINUED Y N N/A Y N N/A Y N N/A Y N N/A o Are all IV admixtures done in a class 100 [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] clean room/environment? 73. Are only IV compounding supplies stored near [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] the hood or in the clear room? 74. Is corrugated cardboard stored outside of hood [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] room? 75. Are chemotherapy drugs stored separately from [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] other drugs? o Are maintenance logs completed for all [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] hood(s), refrigerator/freezer(s) and incubator(s)? 77. Is your horizontal laminar hood certified at [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] least annually? 78. Are laminar hood pre-filter inspections done [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] at least every 60 days? 79. Are all biohazard medications compounded in a [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] biological safety cabinet? If you do not provide chemotherapy, respond N/A to question 79 and 80. 80. Is your biological safety cabinet certified at [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] least every six months? 81. Is a batch quality assurance process part of [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] the pharmacy quality control program?
o GENTIVA CARECENTRIX PROVIDER APPLICATION SECTION II. PROVIDER QUALIFICATIONS
INFUSION HOME HEALTH CLINICAL HOME SERVICES AGENCY/REHAB/ RESPIRATORY MEDICAL PROVIDER THERAPY CO. PROVIDER EQUIPMENT PHARMACY COMPOUNDING SERVICES CONTINUED Y N N/A Y N N/A Y N N/A Y N N/A 82. Are lot numbers of all pharmaceutical products [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] recorded for each dispensing? 83. Is a drug recall management process [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] established? 84. Are written compounding instructions used for [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] all admixtures? o Is a Controlled Substance Delivery and [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] Disposal process in place for all patients receiving these drugs? 86. Does a pharmacist verify every verbal [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] prescription PRIOR to dispensing? 87. Is there a pharmacist responsible for [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] selection and supervision of all technical personnel? 88. Does a pharmacist screen each medication order [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] for potential adverse effects or interactions with other medications on the complete patient profile?
[ ] GENTIVA CARECENTIRX PROVIDER APPLICATION SECTION II. PROVIDER QUALIFICATIONS
INFUSION HOME HEALTH CLINICAL HOME SERVICES AGENCY/REHAB/ RESPIRATORY MEDICAL PROVIDER THERAPY CO. PROVIDER EQUIPMENT DATA COLLECTION CAPABILITIES Y N N/A Y N N/A Y N N/A Y N N/A DO YOU HAVE THE CAPABILITY TO CAPTURE AND REPORT THE FOLLOWING DATA? 89. Authorization number [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 90. Patient name [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 91. Payer patient ID number [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 92. Group number [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 93. Date of service [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 94. CPT-4 and HCPCS Codes [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 95. Charge to Gentiva NetWORKS [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 96. Usual charge [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 97. Service provided [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 98. Service description [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 99. Visits provided by discipline [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 100. Total visits provided [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 101. Drug provided, including NDC number [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 102. Equipment provided, sorted by patient [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] category 103. Equipment provided, sorted by equipment [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] category 104. Equipment utilization duration [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 105. Equipment description [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 106. Referring physician name [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 107. Referring physician license number [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 108. Referring facility [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 109. Place of service [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]
IX. AUTHORIZATION AND CERTIFICATION STATEMENTS The applicant authorizes Gentiva CareCentrix or its representative to: 1. Consult with any third party who may have information regarding the applicant's professional qualifications, credentials, clinical or service delivery competence or any other matters reasonably having a bearing on the applicant's satisfactory performance. 2. Inspect or obtain any and all communications, reports, records, statements, documents, recommendations or disclosures including without limitation that relating to credit history or financial standing by or from third parties that may be relevant to determining applicant's qualification or performance. 3. Review historical claims information with data specific to the applicant's utilization patterns and compare the applicant's information with that of its peers, 4. Release said information, as indicated above in numbers 1, 2 and 3, to payers, hospitals, other healthcare providers and their agents who solicit such information for the purpose of evaluating network qualifications. 5. Conduct site visits at the applicant's site to determine the adequacy of facilities, office/branch procedures and related compliance to network standards, and 6. Obtain information from the applicant's present and past professional liability insurance carrier(s). Upon Gentiva CareCentrix request, the applicant authorizes the release of all communications, reports, records, statements, documents, recommendations or disclosures by or from all third parties as may be relevant to the network and/or its representatives to determine competency. The applicant certifies that the facts in all parts of this completed application are accurate and complete to the best of the applicant's knowledge and understands that if approved as a Network provider, falsified statements and/or responses on this application may be grounds for dismissal, contract termination and/or other legal action if indicated. (The applicant certifies that an authorized representative of the applying organization has read and understands the accompanying provider credentialing conditions of review.) THE APPLICANT AND GENTIVA CARECENTRIX MUTUALLY AGREE THAT THE APPLICATION INFORMATION AND MATERIALS BEING RECEIVED BY EITHER PARTY ARE CONFIDENTIAL AND ARE INTENDED FOR USE ONLY AS EXPLICITLY STATED. ANY OTHER USE OF INFORMATION AND MATERIALS BY EITHER PARTY IS EXPRESSLY PROHIBITED. - ------------------------------------ ------------------- Authorized Applicant Representative (Typed or Printed) Title - ------------------------------------ ------------------- Authorized Signature Date X. GENTIVA CARECENTIRX PROVIDER APPLICATION DOCUMENT TRANSMITTAL NOTE: APPLICATIONS THAT DO NOT INCLUDE EVERY ITEM LISTED BELOW WILL BE REJECTED. o Copy of State License/Certification and/or Inspection Report (CHECK TYPE) [ ]Pharmacy [ ]HHA/Nursing [ ]Manufacturer [ ]Distributor [ ]Medical Equipment [ ]Medicare [ ]Wholesaler and Inspection Report [ ]Other o Copy of Federal Registration/License (CHECK TYPE): [ ]DEA [ ]Wholesaler [ ]Manufacturer [ ]Other o Copy of most recent Accreditation, including all reports, summaries recommendations and grid score letter (CHECK TYPE): [ ]JCAHO [ ]CARF [ ]NONE [ ]CHAP [ ]OTHER:_______________________________________ o Copy of current general and professional liability insurance certificate. o Summary of quality improvement program key indicators and quality improvement results measuring indicators for past two years. o Copy of one full year of client satisfaction survey results. o Document describing all litigation; assignment of business; investigations of business or any directors, officers or employees; suspension, revocation or limitation of any license, certificates, provider status. o Copy of your organization's patient consent form and/or service agreement. o Any and all documents providing additional explanations as requested for of the provider qualifications (if applicable). o Completed Gentiva CareCentirx Provider Application. o Signed Gentiva CareCentrix Provider Agreement. o Signed Gentiva CareCentrix authorization and certification statement. REFERENCES: 1. o Dunn & Bradstreet report or audited financial statement o Name, address, telephone number and contact name of 2 vendors o Name, address, telephone number and contact name of 1 payor o Name and address of 1 bank o Name, address, telephone number and contact name of 2 referral sources o Name of largest account by dollar volume EXHIBIT XX CONFIDENTIALITY AGREEMENT CIGNA understands that as part of its relationship with MCA as reflected in a Managed Care Alliance Agreement dated __________, 2003 (the "Provider Agreement"), it may be granted access to certain confidential information, including protected health information, created and/or maintained by MCA. As a condition of CIGNA's relationship with MCA, CIGNA agrees that all information it obtains during the course of its relationship with MCA is strictly confidential, and CIGNA agrees to handle such information in accordance with the following requirements unless provided otherwise in the Provider Agreement. 1. NONDISCLOSURE/NONUSE. CIGNA agrees to treat all highly sensitive, confidential and proprietary information, communications, and data pertaining to MCA and/or MCA's patients, including, but not limited to, clinical and patient confidential and/or private information (i.e. diagnoses and treatments) ("Protected Health Information"), claim and payment information, and pricing and costs, (collectively, "Confidential Information"), which may be disclosed to, received and/or accessed by CIGNA, as confidential. No Confidential Information will be disclosed directly or indirectly to any other person without first obtaining the written consent of MCA. 2. DISCLOSURE TO CERTAIN PARTIES. CIGNA may, however, disclose and/or permit access to certain Confidential Information to those persons directly under CIGNA's control on a "need to know" basis, provided that all such persons will be directed and required to maintain the Confidential Information in confidence at all times, and to sign a Confidentiality and Security Agreement prior to accessing the Confidential Information. CIGNA agrees to indemnify and hold harmless MCA from and against any claim or loss sustained by MCA as a result of the unauthorized release or use of the Confidential Information by any such person. 3. COPYING CONFIDENTIAL INFORMATION. CIGNA will not make, or permit to be made, except for the purposes agreed upon, any copies, abstracts, or summaries of Confidential Information. MCA will retain title to all such documents and copies thereof. 4. SAFEGUARD. CIGNA agrees to take all reasonable precautions including the establishment of appropriate security controls and procedures, protection programs and protocols and disciplines to safeguard the confidential nature of the Confidential Information; provided, however, CIGNA will not be liable for disclosure of such information that: A. has passed into the public domain through no act or omission of CIGNA; B. is lawfully received by CIGNA from a third party under no obligation to keep such information confidential; C. is required to be disclosed by CIGNA pursuant to an order issued by a court of law or any federal, state or municipal regulatory or administrative agency; D. was in the possession of CIGNA prior to the date of this Agreement as evidenced by written records kept in the ordinary course of business by CIGNA or by proof of actual use of CIGNA. In the event of disclosure as required by law, CIGNA will notify MCA promptly so that MCA may seek a protective order or other appropriate remedy, and CIGNA will not oppose action by MCA to obtain any such order or remedy. 5. INJUNCTION. CIGNA acknowledges that failure to comply with the provisions of this Agreement would cause irreparable harm to MCA and that MCA's remedy at law for such breach would be inadequate. CIGNA agrees that if there is any material or threatened breach, MCA may, in addition to any other legal or equitable remedies available to it, obtain an injunction or restraining order to enjoin CIGNA from the breach or threatened breach of such covenants, without need to post bond. 6. ATTORNEY'S FEES. In the event MCA finds it necessary to employ legal counsel or to bring an action at law or other proceedings against CIGNA to enforce any of the terms, covenants, or conditions of this Agreement, and MCA prevails in any such action or other proceeding, MCA will be paid all reasonable attorney's fees by CIGNA. In the event a judgment is secured by the prevailing party, all attorney's fees, as determined by the court and not by a jury, will be included in any such judgement. 7. APPLICABLE LAW. This Agreement and the rights of the parties hereto will be governed and construed in accordance with the laws of the state of New York. 8. COMPLIANCE WITH HIPAA. In addition, to the extent required by the provisions of 42 U.S.C. 1171 et seq. enacted by the Health Insurance Portability and Accountability Act of 1996 and regulations promulgated thereunder ("HIPAA"), CIGNA does hereby assure MCA that CIGNA will appropriately safeguard protected health information made available to or obtained by CIGNA. Without limiting the obligations of CIGNA otherwise set forth in this Agreement or imposed by applicable law, CIGNA hereby agrees to comply with applicable requirements of law relating to Protected Health Information to the extent MCA would be required to comply with such requirements. 9. AMENDMENT; WAIVER. This Agreement may not be amended except by written form signed by duly authorized representatives of both parties and specifically stating that it amends this Agreement and MCA will not be deemed to have waived any term or provision of this Agreement unless such waiver will be in writing signed by a duly authorized representative of MCA and specifically stating that it waives such term or provision. No failure or delay by MCA in exercising any right hereunder shall operate as a waiver thereof, nor shall any single or partial waiver preclude any further exercise thereof or of any other right hereunder. 10. BINDING EFFECT. This Agreement will inure to the benefit of, and will be binding upon, the parties and their respective successors and assigns. CIGNA has acknowledged its understanding of and agreement to the mutual promises written above by executing this Agreement. CIGNA HEALTH CORPORATION By: ---------------------------------- Name: -------------------------------- Title: ------------------------------- Date: -------------------------------- EXHIBIT XXI CIGNA NATIONAL CAPITATION HMO MARKET EXCLUSIONS CIGNA HEALTHCARE MEMBERS ENROLLED IN MANAGED CARE PRODUCTS (CHMO, FLEX, AND GATEKEEPER ) IN THE CIGNA HEALTHCARE AFFILIATE MARKETS LISTED BELOW, ARE EXCLUDED FROM THE TERMS AND CONDITIONS OF THIS AGREEMENT: CIGNA HealthCare of Massachusetts, Inc. CIGNA HealthCare of Maine, Inc. CIGNA HealthCare of North Carolina, Inc. CIGNA HealthCare of New Hampshire, Inc. CIGNA HealthCare of California, Inc. (Southern California Markets only) EXHIBIT XXII STANDARDS FOR DELEGATION OF UTILIZATION MANAGEMENT ACTIVITIES FOR CIGNA HEALTHCARE OF TEXAS, INC. ("CIGNA") (THE "STANDARDS") [Any and all capitalized terms not defined herein shall have the same meaning as in the managed care provider agreement between CIGNA and the delegatee (the Agreement).] 1. The delegatee shall be subject to a pre-delegation site review and evaluation of its utilization management program ("UM Program") for all delegated activities. 2. The delegatee shall maintain a written UM Program description which includes: A. a description of delegatee's 1) policies/procedures to evaluate Medical Necessity, 2) use of nationally recognized and locally approved criteria and information sources; and 3) process to review and approve services; B. a description of delegatee's mechanism to periodically update the UM Program description and the UM Program's policies and procedures; C. documented evidence of approval of the delegatee's UM Program by the delegatee's appropriate body of governance; D. a description of the roles and functions of delegatee's UM Program to include a definition of the roles and responsibilities of delegatee's UM Program staff; E. evidence demonstrating a utilization management work plan which responds to identified opportunities for improvement and action steps, as well as a process for, and evidence of, an annual evaluation of the UM Program. The delegatee shall provide annual reports as specified: (i) UM Program Description and Work Plan by March 31st of the current year. (ii) A written evaluation of delegatee's UM program for the previous year by March 31st of the current year. F. a description which specifically addresses behavioral health care; and G. a description of the transition process when benefits end or a practitioner's participation in the network terminates. 3. The delegatee's UM Program must have been operational for at least the 12-month period preceding the effective date of the delegation. 4. The delegatee's UM Program shall at a minimum comply in all respects with the requirements of an appropriate accrediting body designated by CIGNA (i.e. NCQA, JCAHO, etc.), the requirements established by CIGNA herein and in the Agreement and the requirements of applicable federal and state laws and regulations. The delegatee shall maintain all applicable licensures and certifications required to perform the delegated utilization management activities. The delegatee shall maintain appropriate records with respect to all utilization management activities for the duration of the Agreement and seven years thereafter. 5. The delegatee shall maintain adequate professional liability coverage as determined by CIGNA The delegatee shall not subcontract any of its utilization management responsibilities under its agreement with CIGNA unless otherwise agreed in writing by CIGNA. Any subcontractor approved by CIGNA shall be required to agree in writing to comply with all standards applicable to delegatee with regard to the subcontracted services. 6. The delegatee shall provide CIGNA with a copy of its written UM Program description upon request. Such UM Program description shall be submitted to CIGNA for review and approval prior to the effective date of the delegation and annually thereafter and shall not be materially modified without CIGNA's prior written approval. 7. The role of the Delegatee and its subcontractors is limited to performing certain UM activities delegated by CIGNA using standards approved by CIGNA, and which are in compliance with applicable federal and state laws and regulations. Delegatee hereby agrees to perform those UM activities identified by an "X" in the "Delegatee" column below and understands and acknowledges that its performance of such delegated UM activities is subject to CIGNA's oversight and monitoring. UM ACTIVITIES DELEGATEE CIGNA - -------------------------------------------------------------------------------- Medical Policy Adoption of Criteria X X - -------------------------------------------------------------------------------- Precertification - Inpatient Approvals X - -------------------------------------------------------------------------------- Precertification - Inpatient Denials X - -------------------------------------------------------------------------------- Precertification - Outpatient Approvals X - -------------------------------------------------------------------------------- Precertification - Outpatient Denials X - -------------------------------------------------------------------------------- Concurrent Review*- Approvals X - -------------------------------------------------------------------------------- Concurrent Review*- Denials X - -------------------------------------------------------------------------------- Discharge Planning X - -------------------------------------------------------------------------------- Retrospective - Inpatient Approvals X - -------------------------------------------------------------------------------- Retrospective - Outpatient Approvals X - -------------------------------------------------------------------------------- Retrospective - Outpatient Denials X - -------------------------------------------------------------------------------- Referral Management - Approvals X - -------------------------------------------------------------------------------- Referral Management - Denials X - -------------------------------------------------------------------------------- Out-of-Area Management X - -------------------------------------------------------------------------------- Case Management* - Approvals X - -------------------------------------------------------------------------------- Case Management* - Denials X - -------------------------------------------------------------------------------- Disease Management X - -------------------------------------------------------------------------------- Denials Benefit Coverage X - -------------------------------------------------------------------------------- Appeals - First Level X - -------------------------------------------------------------------------------- Member Satisfaction w/ UM X - -------------------------------------------------------------------------------- Provider Satisfaction w/ UM X - -------------------------------------------------------------------------------- Pharmacy Management X - -------------------------------------------------------------------------------- Member Communication X - -------------------------------------------------------------------------------- Monitoring Quality and Timeliness of X X Decisions - -------------------------------------------------------------------------------- Inter-rater Reliability X - -------------------------------------------------------------------------------- Technology Assessment X - -------------------------------------------------------------------------------- * Definitions: CONCURRENT REVIEW- An assessment that determines medical necessity or appropriateness of services as they are being rendered, such as an assessment of the need for continued inpatient care for hospitalized patients. CASE MANAGEMENT- A process for identifying covered persons with specific health care needs in order to facilitate the development and implementation of a plan that efficiently uses health care resources to achieve optimum member outcome. RETROSPECTIVE REVIEW- Assessment of the appropriateness of medical services on a case by case or aggregate basis after the services have been provided. 8. With respect to each request for coverage of medical services for which the delegatee performs utilization management hereunder, the delegatee shall apply the utilization management criteria set forth in the Service Agreement applicable to the Participant for whom medical services have been requested. Criteria shall be objective and applied consistently based on the needs of the individual patient. 9. All information relating to delegatee's utilization management activities hereunder shall be confidential, shall not be disclosed to any third parties except as required by applicable federal and state law and except as required to fulfill delegatee's utilization management responsibilities hereunder, and shall be maintained in such a manner so that such information shall be protected from discovery and use in judicial or administrative proceedings to the fullest extent possible under applicable federal and state law. In the event that delegatee receives a subpoena, civil investigative demand or other similar process requesting disclosure of information relating to its utilization management activities hereunder, delegatee shall immediately notify CIGNA of such subpoena, demand or process so as to afford CIGNA with an adequate opportunity to seek an appropriate protective order should it choose to do so. 10. This exhibit, all information provided by CIGNA to delegatee pertaining to CIGNA's delegation of utilization management to delegatee and all data made known to delegatee relating to services rendered to Participants under the Agreement is confidential and proprietary information subject to the protections set forth in the confidentiality provision contained in delegatee's Agreement with CIGNA. In the event that delegatee receives a subpoena, civil investigative demand or other similar process requesting disclosure of such confidential and proprietary information, delegatee shall immediately notify CIGNA of such subpoena, demand or process so as to afford CIGNA with an adequate opportunity to seek an appropriate protective order should it choose to do so. 11. The delegatee shall have a full time medical director who provides oversight of the UM Program and: A. is licensed to practice medicine as required by the State of Texas; B. has a defined scope of responsibilities; and C. demonstrates evidence of their participation in the utilization management process. 12. The delegatee shall not authorize coverage for services requested to be provided by noncredentialed providers unless CIGNA's prior consent is obtained, except in an emergency. 13. All UM Program activities shall be supervised by appropriately qualified professionals including: A. use of a licensed physician to conduct medical review prior to any denial; and B. use of board certified specialists to assist in determining Medical Necessity and in preparing documentation to support the decision. 14. Total UM Program staff ratios (including nurses) shall be at least 1 per 40,000 Participants. The UM Program shall utilize clinical nurses (RN or LPN/LVN) licensed to practice nursing as required by the State of Texas with a ratio of at least 1 licensed clinical nurse per 150,000 Participants. The UM Program shall utilize physicians licensed to practice medicine as required by the State of Texas with a ratio of at least 1:150,000. The Total UM staffing ratio is determined by adding the number of all clinical and non-clinical staff and dividing by the total number of Participants. Non-clinical staff shall utilize protocols and criteria approved by the Medical Director and shall not make medical appropriateness/necessity decisions. All decisions of the non-clinical staff shall be supervised by clinical staff. Delegatee shall maintain appropriate levels of telephone line staffing for the utilization management activities required to be performed hereunder and shall satisfy the following standards: (a) the overall abandonment rate for the pre-certification telephone line shall be 5% or less; (b) the average speed of answer for the pre-certification telephone line shall be less than 30 seconds; (c) telephone prompts shall be clear and user friendly; and (d) a telephone message after hours shall give normal business hours information and after hours instructions. 15. The delegatee shall maintain a set of written utilization management decision protocols that are based on reasonable available medical evidence, are acceptable to and consistent with CIGNA protocols and indicate that: A. criteria for appropriateness of medical services are clearly documented, communicated to participating physicians, and available to the physician and Participants upon request; B. an appropriate mechanism is present for checking the consistency of application of criteria across physician and non-physician reviewers at least annually and opportunities for improvement are identified and resolved; and C. an appropriate mechanism is present for updating and approving review criteria periodically, actively practicing practitioners are involved in the development and adoption of the criteria and the time of the update is specified in protocol or policy. 16. In connection with all utilization management activities hereunder, the delegatee shall obtain all necessary information, including pertinent clinical information, and consult with the treating physician, as appropriate, and document such efforts. Emergency services, without precertification, must be covered where such services were necessary to screen and stabilize Participants in cases where a prudent layperson, acting reasonably, would have believed an emergency medical condition existed, when services were authorized by a delegatee representative, or as otherwise required by applicable federal and state law. 17. The Healthplan retains responsibility for rendering the final coverage determination on all services denied for medical necessity. The delegatee shall notify CIGNA as expeditiously as possible, but no later than the same business day, of any recommendation for denial of coverage. The notification shall include: A. documentation indicating who recommended denial, why, and any medical information used to render the recommendation; B. documentation that an explanation is provided to the applicable provider via telephone of the recommended denial. The delegatee shall not send any written communication, either via US mail or facsimile, to the requesting provider. CIGNA will notify the delegatee, the requesting provider, the PCP, and the Participant via letter which includes all information required by applicable federal and state law. CIGNA will process all requests for appeals, whether expedited or standard. In connection with any such appeal, the delegatee shall assist and cooperate with CIGNA and shall promptly provide all documentation reasonably requested by CIGNA to meet all accreditation and regulatory timeframe requirements. The delegatee shall notify the requesting provider via telephone of CIGNA's final determination with information regarding CIGNA's appeal process. 19. Delegatee's UM Program decisions shall be made in a timely manner. A. Delegatee's UM Program policies and procedures shall clearly define the maximum time frames for utilization management decisions. All utilization management decisions shall be made within the time frames that satisfy all applicable federal and state legal requirements, whichever time frame is earlier (i.e. Department of Insurance, Department of Corporations, HCFA, etc.). Delegatee shall implement adequate coverage arrangements to ensure compliance with applicable federal and state legal requirements at all times, including, but not limited to, adequate after hours, weekend and holiday coverage. B. Delegatee shall implement an appropriate mechanism to monitor and document timeliness of decisions which shall include: (1) Documentation to show Emergency requests are responded to as soon as possible and no later than within 2 hours, or within the time frame required by applicable federal and state law, if earlier; (2) Documentation to show urgent requests are responded to within 24 hours, or within the time frame required by applicable federal and state law, if earlier; and (3) Documentation to show routine requests are responded to within 2 working days, or within the time frame required by applicable federal and state law, if earlier. C. The delegatee shall monitor and analyze its compliance with timeliness requirements on a quarterly basis and take prompt action to meet or improve adherence to such requirements. 20. Except as otherwise agreed by CIGNA, CIGNA shall retain responsibility for responding to Participant inquiries or complaints. Delegatee shall notify CIGNA Member Services within 24 hours of any complaint or grievance filed with delegatee by or on behalf of any Participant. 21. The delegatee shall maintain a system acceptable to CIGNA to track authorizations, to evaluate the delegatee's compliance with CIGNA's utilization management requirements as set forth in the delegatee's Agreement and herein, to monitor providers for inappropriate utilization and to evaluate Participant satisfaction and provider satisfaction, and other measures of evaluation agreed upon by the parties. Delegatee shall submit reports to CIGNA, in a format acceptable to CIGNA reflecting the delegatee's performance under these measures of evaluation, including an action plan which addresses opportunities for improvement when applicable. On a monthly basis by the 15th of every month for the previous month's data, delegatee shall provide a report of referral approvals, non-emergency hospital admissions and elective outpatient procedures to include the following: a). Participant Name b). Participant ID# c). Date of Request d). Date of Determination e). Date of Notification to Provider f). Services Requested 22. CIGNA, its designee and any applicable governmental authorities or accrediting bodies shall have the right to conduct periodic audits of the delegatee's UM Program activities upon reasonable prior notice, and the delegatee shall cooperate with any such audits. In addition, the delegatee's performance of its utilization management activities hereunder may be measured by CIGNA at least annually. The delegatee shall cooperate with any such audits and shall provide any and all information reasonably requested by CIGNA in connection with such audits. Applicable performance measures include but are not limited to: A. Participant satisfaction survey results which indicate a significant overall satisfaction with the service provided and document an improvement process for any specific areas identified with satisfaction lower than 90%; B. Participant concerns, complaints and grievances do not exceed CIGNA averages in any six month period; and C. audits of utilization management activities show compliance with CIGNA, federal, state and accreditation requirements. CIGNA will provide delegatee with a written report detailing its findings with respect to any such audits. If such audits reveal any deficiencies, delegatee shall correct any deficiencies identified in such audit within 60 days of CIGNA's submission of the report detailing such deficiencies. Failure to correct any identified deficiencies within such 60 day period may be cause for revocation of the delegation set forth herein or termination of the Agreement. 23. Delegatee shall provide CIGNA with evidence of an appropriate internal control environment acceptable to CIGNA or a SAS70 audit of delegatee's utilization management operations on an annual basis. 24. Delegatee shall prepare and provide such periodic reports or other data as is reasonably requested by CIGNA, state and/or federal regulatory agency or accrediting entity relating to delegatee's utilization management activities, within the time frame given by CIGNA or the agency or entity. Delegatee shall participate in utilization management oversight activities (i.e., committee meetings, report submission) to the extent reasonably required by CIGNA. Delegatee shall provide CIGNA with any adverse event/sentinel diagnosis information relating to Participants within 5 business days of delegatee's receipt of such information. 25. Delegatee shall have a process in place to ensure appropriate utilization of services including identifying areas of over utilization and under utilization including: monitoring different types of data, establishing thresholds, conducting quantitative analysis and comparison to thresholds and working with CIGNA to implement actions to address issues that are identified by the CIGNA or by the delegatee. 26. If CIGNA determines that delegatee cannot meet its utilization management obligations, CIGNA may elect to assume responsibility for such activities. If CIGNA elects to assume responsibility for such activities, the rates set forth in the Agreement shall be adjusted to the extent necessary, and delegatee shall cooperate and provide to CIGNA any information reasonably required to perform such activities. 27. All referrals shall be to Represented Providers, except where an Emergency requires otherwise or as otherwise required by applicable federal and state law. Except in an Emergency or as otherwise required by applicable federal and state law, delegatee shall require all Represented Providers to obtain authorization from delegatee prior to hospital admission of any Participant or outpatient surgical procedures. 28. All electronic data which delegatee maintains concerning the detail of all utilization management decisions made hereunder shall be made available and submitted to CIGNA using ANSI standard transaction formats or another mutually agreeable format in compliance with applicable state and federal law including, but not limited to, the Health Insurance Portability and Accountability Act (HIPAA) and Administrative Simplification. Such data shall be submitted to CIGNA at least monthly. If a non-ANSI format is agreed upon, delegatee shall cooperate with CIGNA in the development of the transmission format, frequency and protocol. 29. Delegatee shall maintain evidence that delegatee distributes a statement to all employees, contracted practitioners and providers affirming the following: E. UM decision making is based only on appropriateness of care and service. F. The delegatee does not compensate practitioners/providers/employees for denials. G. The delegatee does not offer incentives to encourage denials. H. The need for special concern about under utilization. 30. Delegatee shall indemnify, defend and hold harmless CIGNA and its affiliates from and against any and all liability, fines, penalties, damages and expense, including reasonable defense costs and legal fees, incurred by CIGNA in connection with claims or actions of any nature, governmental examinations, enforcement actions or other administrative proceedings, arising from delegatee's failure to perform its obligations under these Standards. 31. Confidentiality Delegatee shall comply with all applicable federal and state laws and regulations relating to the confidentiality of medical records and other individually identifiable health information, including but not limited to, the requirements specified below. A. Definitions Applicable to this Confidentiality Section "CONFIDENTIAL INFORMATION" shall mean (a) Individually Identifiable Health Information that is (i) transmitted by Electronic Media, (ii) maintained in any medium constituting Electronic Media; or (iii) transmitted or maintained in any other form or medium and (b) any Nonpublic Personal Financial Information, as that term is defined by the NAIC Model Privacy of Consumer Financial and Health Information Regulation (2000) issued pursuant to the Gramm Leach Bliley Act. "Confidential Information" shall not include (i) education records covered by the Family Educational Right and Privacy Act, as amended, 20 U.S.C. Section 1232g and (ii) records described in 20 U.S.C. Section 1232g(a)(4)(B)(iv). "DESIGNATED RECORD SET" shall mean a group of records maintained by or for CIGNA or a CIGNA Affiliate that is (i) the medical records and billing records about individuals maintained by or for CIGNA or a CIGNA Affiliate, (ii) the enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a health plan; or (iii) used, in whole or in part, by or for CIGNA or a CIGNA Affiliate to make decisions about individuals. As used herein, the term "RECORD" means any item, collection, or grouping of information that includes Confidential Information and is maintained, collected, used, or disseminated by or for CIGNA or a CIGNA Affiliate. "ELECTRONIC MEDIA" shall mean the mode of electronic transmissions. It includes the Internet, extranet (using Internet technology to link a business with information only accessible to collaborating parties), leased lines, dial-up lines, private networks, and those transmissions that are physically moved from one location to another using magnetic tape, disk, or compact disk media. "INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION" shall mean information that is a subset of health information, including demographic information collected from an individual, and (iv) is created or received by a health care provider, health plan, employer, or health care clearinghouse; and (v) relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present or future payment for the provision of health care to an individual; and (a) identifies the individual, or (b) with respect to which there is a reasonable basis to believe the information can be used to identify the individual; and (vi) relates to identifiable non-health information including but not limited to an individual's address, phone number and/or Social Security number. "PRIVACY STANDARDS" shall mean (a) the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated thereunder, including the Standard for Privacy of Individually Identifiable Health Information, 45 C.F.R. Parts 160 and 164, (b) the Gramm Leach Bliley Act and any applicable regulations governing privacy and confidentiality promulgated thereunder, and (c) other federal or state laws or regulations governing the use, disclosure, confidentiality, security or privacy of Confidential Information or other personally identifiable information. "SECRETARY" shall mean the Secretary of the Department of Health and Human Services. B. USE OF CONFIDENTIAL INFORMATION. Delegatee may use Confidential Information to carry out the obligations of delegatee set forth in the Agreement and these Standards or as required by federal or state law, subject to the provisions of Sections C. through N., below. Delegatee shall ensure that its directors, officers, employees, contractors and agents do not use Confidential Information received from CIGNA or a CIGNA Affiliate in any manner that would constitute a violation of the Privacy Standards if used in a similar manner by CIGNA or a CIGNA Affiliate. Delegatee shall not use Confidential Information for the purpose of creating de-identified information that will be used for any purpose other than to carry out the obligations of delegatee set forth in the Agreement or these Standards or as required by federal or state law. C. DISCLOSURE OF CONFIDENTIAL INFORMATION. Delegatee and its directors, officers, employees, contractors and agents shall not disclose Confidential Information received from CIGNA or a CIGNA Affiliate other than as is necessary to carry out the obligations of delegatee set forth in the Agreement or these Standards or as required by federal or state law, subject to the provisions of Sections C. through N., below. Confidential Information shall not be disclosed in any manner that would constitute a violation of the Privacy Standards if disclosed in a similar manner by CIGNA or a CIGNA Affiliate. D. SAFEGUARDS AGAINST MISUSE OF INFORMATION. Delegatee agrees that it will implement all appropriate safeguards to prevent the use or disclosure of Confidential Information in any manner other than pursuant to the terms and conditions of the Agreement and these Standards. E. REPORTING OF DISCLOSURES OF CONFIDENTIAL INFORMATION. Delegatee shall, within five (5) days of becoming aware of a loss, a suspected loss, or disclosure of Confidential Information in violation of the Agreement or these Standards by delegatee, its officers, directors, employees, contractors or agents or by a third party to which delegatee disclosed Confidential Information pursuant to Section C. of this Agreement, report any such disclosure to CIGNA's Privacy and Security Officers. This requirement will also apply to any loss, or suspected loss, of Confidential Information. F. AGREEMENTS WITH THIRD PARTIES. Delegatee shall enter into an agreement with any agent, subcontractor or other third party that will have access to Confidential Information that is received from, created or received by delegatee on behalf of CIGNA or a CIGNA Affiliate pursuant to which such third party agrees to be bound by the same restrictions, terms and conditions that apply to delegatee pursuant to this Agreement with respect to such Confidential Information. Under such agreement, the third party shall (a) provide reasonable assurances that such Confidential Information will be held confidential as provided pursuant to the Agreement and these Standards, (b) provide reasonable assurances that such Confidential Information will be disclosed only as required by federal or state law or for the purposes for which it was disclosed to such third party, and (c) immediately notify delegatee of any breaches of the confidentiality of the Confidential Information, to the extent it has obtained knowledge of such breach. G. ACCESS TO INFORMATION. Within five (5) business days of a request by CIGNA or a CIGNA Affiliate for access to Confidential Information about an individual contained in a Designated Record Set, delegatee shall make available to CIGNA or the CIGNA Affiliate such Confidential Information for so long as such information is maintained in the Designated Record Set. In the event any individual requests access to Confidential Information directly from delegatee, delegatee may not deny access to the Confidential Information requested. Rather, delegatee shall, within two (2) business days, forward such request to CIGNA. H. AVAILABILITY OF CONFIDENTIAL INFORMATION FOR AMENDMENT. Within ten (10) business days of receipt of a request from CIGNA or a CIGNA Affiliate for the amendment of an individual's Confidential Information or a record regarding an individual contained in a Designated Record Set (for so long as the Confidential Information is maintained in the Designated Record Set), delegatee shall provide such information to CIGNA or the CIGNA Affiliate for amendment and incorporate any such amendments in the Confidential Information as required by 45 C.F.R. Section 164.526. In the event that the request for the amendment of Confidential Information is made directly to the delegatee, delegatee may not deny the requested amendment. Rather, delegatee shall, within two (2) business days, forward such request to CIGNA. I. AUDIT. Upon reasonable notice, CIGNA or a CIGNA Affiliate may audit and inspect delegatee's internal practices and the books and records in delegatee's possession for the purpose of assessing delegatee's use and disclosure of Confidential Information received from CIGNA or a CIGNA Affiliate or created by delegatee on behalf of CIGNA or a CIGNA Affiliate. Such books and records shall be made available to CIGNA or a CIGNA Affiliate for its audit or inspection during regular business hours. J. ACCOUNTING OF DISCLOSURES. Within ten business (10) days of notice by CIGNA or a CIGNA Affiliate to delegatee that it has received a request for an accounting of disclosures of Confidential Information regarding an individual during the six (6) years prior to the date on which the accounting was requested, delegatee shall make available to CIGNA or the CIGNA Affiliate such information as is in delegatee's possession and is required for CIGNA or the CIGNA Affiliate to make the accounting required by 45 C.F.R. Section 164.528. At a minimum, delegatee shall provide CIGNA or the CIGNA Affiliate with the following information: (i) the date of the disclosure, (ii) the name of the entity or person who received the Confidential Information, and if known, the address of such entity or person, (iii) a brief description of the Confidential Information disclosed, and (iv) a brief statement of the purpose of such disclosure that includes an explanation of the basis for such disclosure. In the event the request for an accounting is delivered directly to delegatee, delegatee shall within two (2) business days forward such request to CIGNA. It shall be CIGNA's or the applicable CIGNA Affiliate's responsibility to prepare and deliver any such accounting requested. Delegatee hereby agrees to implement an appropriate record keeping process to enable it to comply with the requirements of this Section. K. AVAILABILITY OF BOOKS AND RECORDS. Delegatee hereby agrees to make its internal practices, books and records relating to the use and disclosure of Confidential Information received from, created or received by delegatee on behalf of CIGNA or a CIGNA Affiliate available to the Secretary for purposes of determining CIGNA's or CIGNA Affiliate's and delegatee's compliance with the Privacy Standards. L. RETURN OF RECORDS. Upon termination of the Agreement and at CIGNA's sole option, delegatee shall be required to either a) return to CIGNA or a CIGNA Affiliate all Confidential Information received from, created or received on behalf of CIGNA or a CIGNA Affiliate in all forms without retaining any copies; or b) maintain all such Confidential Information consistent with the requirements of this Section 31 for the period of time such information is required to be maintained by applicable law after which time delegatee shall destroy all such information in all forms maintained and shall not retain any copies of such information, or if such destruction is not feasible, extend the protections in this Section 31to such information and limit further uses and disclosures to those purposes that make the return or destruction of such information infeasible. M. AUTHORIZATION TO TERMINATE. Delegatee hereby authorizes CIGNA to terminate the Agreement if CIGNA determines that delegatee has violated a material term of this Section 31. N. INDEMNIFICATION Delegatee will defend, indemnify and hold harmless CIGNA and its affiliates and their directors, officers, and employees from any claims, loss, cost (including reasonable attorneys' fees and court costs) or liability resulting from delegatee's breach of this Section 31. Delegatee acknowledges receipt of CIGNA's above Standards for Delegation and, in accordance with the managed care provider agreement between CIGNA and delegatee, will comply with the terms and conditions set forth herein. - --------------------------------- Delegatee's Name By ------------------------------ Its ----------------------------- CIGNA HealthCare of ______________ Inc. By ------------------------------ Its ------------------------------ EXHIBIT XXIII MANAGED CARE ALLIANCE AGREEMENT CREDENTIALING (Delegated Credentialing) 1. MCA shall be responsible for credentialing and recredentialing of all Represented Providers. 2. MCA's credentialing/recredentialing criteria shall, at a minimum, satisfy NCQA standards or the standards of another appropriate accrediting body designated by CIGNA, and the standards established by CIGNA. CIGNA reserves the right to disapprove, terminate or suspend any of MCA's Represented Providers if a Represented Provider does not meet CIGNA's requirements. 3. MCA shall review and externally verify the credentials of every Represented Provider at least once every three years. 4. MCA shall provide CIGNA with a summary of the credentials of each Represented Provider in a format acceptable to CIGNA and such other information as may reasonably be requested by CIGNA from time to time. 5. MCA shall require Represented Providers to represent and warrant that the information contained in their applications for participation is true and accurate and to agree to notify MCA promptly of any material change in the information on such application. MCA shall, in turn, immediately notify CIGNA of all such changes. 6. CIGNA may audit MCA's credentialing/recredentialing activities, including MCA's credentialing/recredentialing files. If CIGNA determines that MCA cannot meet its credentialing obligations set forth herein, CIGNA may elect to assume responsibility for such activities. If CIGNA elects to assume responsibility for such activities, the rates set forth in this Agreement shall be renegotiated by the parties to reflect such change in responsibility. MCA shall cooperate and provide to CIGNA any information necessary to perform such activities. 7. MCA acknowledges that the credentialing and recredentialing performed by MCA pursuant to this Exhibit may be relied upon for Programs for which CIGNA or a CIGNA Affiliate contracts directly with Participating Providers. EXHIBIT XXIV CIGNA/GENTIVA FUTURE YEARS RATE METHODOLOGY YEARS 2005/2006 - -------------------------------------------------------------------------------- * * Confidential Treatment Requested EXHIBITS: EXHIBIT 1A - REQUIRED DATA ELEMENTS PROGRAM ATTACHMENTS: HMO PROGRAM ATTACHMENT - CAPITATION EXHIBIT A - SCHEDULE OF CAPITATION RATES EXHIBIT B- MCA PAYMENT RESPONSIBILITY EXHIBIT C - UTILIZATION MANAGEMENT REQUIREMENTS HMO PROGRAM ATTACHMENT - FEE FOR SERVICE EXHIBIT A - REIMBURSEMENT FOR OTHER SERVICES PPO & INDEMNITY PROGRAM ATTACHMENT EXHIBIT A - REIMBURSEMENT FOR OTHER SERVICES GATEKEEPER PROGRAM ATTACHMENT - CAPITATION EXHIBIT A - SCHEDULE OF CAPITATION RATES EXHIBIT B - MCA PAYMENT RESPONSIBILITY EXHIBIT C - UTILIZATION MANAGEMENT REQUIREMENTS GATEKEEPER PROGRAM ATTACHMENT - FEE FOR SERVICE EXHIBIT A - REIMBURSEMENT FOR OTHER SERVICES EXHIBIT 1A MANAGED CARE ALLIANCE AGREEMENT REPRESENTED PROVIDER REQUIRED DATA ELEMENTS Upon request, MCA shall provide CIGNA with the following data elements for each Represented Provider: ANCILLARY PROVIDERS Full Name of Ancillary Physical Locations (Street Number, Street, Suite Number, City, State, Zip) Phone Numbers Billing Addresses and Phone Numbers Federal Tax ID Number(s) Ancillary Types (e.g., DME, Lab, Home Health, etc.) HMO PROGRAM ATTACHMENT TO MANAGED CARE ALLIANCE AGREEMENT (CAPITATION) PURPOSE The terms and provisions of this HMO Program Attachment and the Agreement are applicable to services rendered by MCA's Represented Providers to HMO Program Participants. As used in this Program Attachment, Participant means a HMO Program Participant. I. DEFINITIONS BASELINE ASSESSMENT means CIGNA's assessment of MCA's capacity to assume the obligations described in the Agreement and this Program Attachment in particular. CAPITATION PAYMENT means a periodic payment for certain covered Home Care Services that is made to MCA for each Participant who is a member of MCA's Patient Panel. CARVED OUT SERVICES means the following services (see Exhibit XIX): MEDICAL DIRECTOR means a physician designated by CIGNA to manage Quality Management and Utilization Management responsibilities, or that physician's designee. HMO PROGRAM PARTICIPANT means a Participant enrolled in a non-governmental, fully insured Standard HMO or Point of Service product and which product is underwritten based on a community rating methodology (i.e. community rating, community rating by class, adjusted community rating by class). This definition includes, but is not limited to, Participants covered under commercial HMO and Open Access plans issued by CIGNA. PATIENT PANEL means those HMO Program Participants for which MCA will receive a global Capitation Payment for all Home Care Services rendered. POINT OF SERVICE means a product offered pursuant to a Service Agreement which allows the Participant to choose, in addition to Standard HMO benefits, a lower level of benefits if the Participant receives Home Care Services from (i) a Participating Provider without a necessary authorization or (ii) from a non-Participating Provider, at the time such services are sought. PRIMARY CARE PHYSICIAN means a physician duly licensed to practice medicine who is a Participating Provider with CIGNA to provide Covered Services in the field of general medicine, internal medicine, family practice or pediatrics, and who has agreed to provide primary care physician services to Participants in accordance with HMO Program Requirements. STANDARD HMO means a product offered pursuant to a Service Agreement where Covered Services are available to Participants only from Participating Providers, except in the case of an Emergency or with the prior authorization of CIGNA or Affiliate where Covered Services are not available from Participating Providers. II. SERVICES AND COMPENSATION A. COVERED HOME CARE SERVICES 1. MCA, through its Represented Providers, shall provide all Home Care Services that are required by Participants in MCA's Patient Panel, for which such Participants are eligible, in accordance with the terms of this Agreement, this HMO Program Attachment and HMO Program Requirements. The compensation set forth in this HMO Program Attachment shall be payment in full for Home Care Services rendered to HMO Program Participants. 2. MCA, through its Represented Providers, shall arrange to provide Medically Necessary Home Care Services to Participants on a 24-hour per day, 7-day per week basis or arrange with other qualified providers (which meet all CIGNA and MCA credentialing requirements or other applicable guidelines) to provide such Medically Necessary Home Care Services to Participants. MCA shall require that such covering providers (a) are Participating Providers (unless otherwise agreed); (b) will not seek compensation from CIGNA for services for which MCA receives compensation hereunder; and (c) will not bill Participants for covered Home Care Services under any circumstances except for (i) Copayments, Deductibles or Coinsurance; (ii) the provision of services to a patient who is not eligible to receive Home Care Services, including but not limited to Participants that have reached their benefit limit; and (iii) services provided to Participants that are not Home Care Services. (d) will direct the participant and/or the Represented Provider to obtain, authorization from CIGNA prior to all hospitalizations or referrals of Participants, except in Emergencies or for a Pre-Qualified Maternity Stay or as otherwise required by law. 3. MCA through its Represented Providers shall provide Home Care Services to all Participants in MCA's Patient Panel who are eligible to receive Home Care Services. 4. Subject to the terms and condition of this Agreement, MCA shall: a. Arrange for the provision of Home Care Services to Participants; b. Require Represented Providers to accept, treat, and otherwise render covered Home Care Services to Participants in the same manner, in accordance with the same standards, and with the same availability, as offered to other like patients. c. not close its network to any new Participants unless CIGNA expressly consents to such closure; 5. In no event shall MCA or Represented Providers be required to accept, treat, arrange for, or otherwise be obligated to render Home Care Services to Participants under this Agreement, even if medically appropriate, if: (a) the provision of such services to Participant would pose risk of bodily harm to the Participant or caregiver personnel of Represented Provider; (b) the provision of such services to Participant would be in violation of MCA's or Represented Provider's applicable license requirements or other applicable laws, and/or MCA policies, including but not limited to admission and discharge policies or discrimination policies; (c) MCA has not received the essential information to process a referral; (d) Participant repeatedly rejects the provision of services by a qualified Represented Provider selected by MCA and/or CIGNA has mutually agreed. (e) MCA and Represented Providers shall not differentiate or discriminate in the treatment of any Participant because of race, color, national origin, ancestry, religion, sex, marital status, sexual orientation, age, health status, handicap or source of payment. 6. A CIGNA Participating Physician or CIGNA will notify Provider's Network Manager of each referral for Covered Home Care Services for Participants in its Patient Panel. MCA will provide or arrange to provide for all Medically Necessary Covered Home Care Services for all such Participants, in accordance with the authorization and Utilization Management procedures set forth in Exhibit XVII. 7. MCA and CIGNA will jointly develop clinical pathways to establish a plan of treatment for more difficult Participant cases requiring Covered Home Care Services. B. CAPITATION PAYMENTS 1. On or before the 15th day of each month, CIGNA or its designee shall pay MCA a monthly Capitation Payment for each Participant in MCA's Patient Panel. THE CAPITATION PAYMENT SHALL BE COMPENSATION FOR ALL HOME CARE SERVICES PROVIDED TO PARTICIPANTS IN THE PATIENT PANEL EXCEPT FOR CARVED OUT SERVICES as referenced in EXHIBIT XIX. The monthly capitation rates are set forth in Exhibit A. 2. If a Participant is added to MCA's Patient Panel on or before the 15th day of a month, a full month's Capitation Payment will be due for that Participant for that month. There will be no Capitation Payment due for Participants added after the 15th day of the month. 3. A full month's Capitation Payment will be due for the month of termination of a Participant if the Participant terminates after the 15th day of the month. If a Participant terminates on or before the 15th day of a month, no Capitation Payment will be due for the month of termination. 4. Where CIGNA, due to information delays, must make a retroactive addition or deletion to MCA's Patient Panel, a retroactive capitation adjustment shall be made concurrent therewith subject to Section II.B.6 of this HMO Program Attachment. In those instances where a Participant has been retroactively deleted and has received services from MCA after the effective date of deletion but prior to CIGNA informing MCA of such deletion, MCA may bill participant for such services rendered. 5. Any amendments of Capitation Payment rates, whether on an annual basis or upon changes in benefit designs, shall be in accordance with the amendment provisions of this Agreement, or as otherwise agreed to in writing by the parties. 6. Capitation Adjustment Process: a. Where CIGNA, due to information delays, must make a retroactive addition or deletion to MCA's Patient Panel, a retroactive capitation adjustment shall not exceed 6 months, nor shall a retroactive addition be added greater than 6 months. b. Services rendered to participants prior to the capitation period or following the capitation period may be billed to CIGNA directly, and shall be in accordance with Exhibit A of the HMO Program Attachment - Fee For Service, attached hereto. Standard Coordination of Benefits rules shall be applied. In the event that CIGNA is not identified as the payor, MCA may bill participant directly for services rendered during this time. c. For those Participants in the Providers patient panel, MCA shall have 120 days following the receipt of the monthly capitation payment, to notify CIGNA of any discrepancies in the capitation payment. The discrepancies shall be determined by the MCA through a review of the electronic eligibility and capitation roster documentation supplied by CIGNA. For all eligibility or capitation roster data that continues to be in a paper format, CIGNA will use its best efforts to move to an electronic basis. d. CIGNA shall investigate and validate capitation errors and notify Gentiva within 60 days the results of such investigation. e. Any necessary adjustments to capitation shall be made through the next scheduled capitation cycle. f. All adjustments to capitation payments shall be provided to MCA in writing, by CIGNA, no less than 30 days prior to the adjustment. 7. MCA guarantees that the Capitation Payment rates set forth in this Attachment are effective from the Effective Date of this Agreement. Notwithstanding the foregoing, the parties agree to meet to discuss possible adjustments to the Capitation Payment rates should any of the following circumstances occur during the term of this Attachment: a. treatments, products, supplies or equipment which are excluded from Covered Home Care Services for HMO Program Participants as of the Effective Date on the basis that they are considered Experimental are no longer considered Experimental and become a Covered Home Care Service for such Participants. b. shifts in treatment sites for Covered Home Care Service therapies occurring after the Effective Date result in a material change to the services which are Covered Home Care Services for HMO Program Participants. c. material changes are made to HMO Program Participants' Service Agreements after the Effective Date such that there is a material change to those Home Care Services which are Covered Home Care Services for such Participants. d. utilization associated with material changes in membership from which the base period was derived after the Effective Date of this Agreement results in a material change in HMO Program Participant volume under this Agreement which has a material financial impact on MCA. e. Any such adjustment of Capitation Payment rates shall only be made to the extent required to address the change in costs directly resulting from the above changed circumstance. 8. Leakage a. On a quarterly basis, CIGNA will provide MCA with leakage reports and the claims for Covered Home Care Services submitted by providers that are not Represented Provider's. MCA shall review the quarterly leakage reports provided by CIGNA to determine the need to contract with additional providers so as to reduce the leakage. MCA shall make a good faith effort to contract with identified providers in order to reduce the amount of leakage and it shall act promptly to contract with those providers identified as appropriate in order to reduce leakage. In an effort to better manage leakage and overall utilization, CIGNA will attempt to provide MCA, an overview of CIGNA's administration of out of network claims for Covered Home Care Services rendered to Participants. CIGNA also agrees to review the feasibility of adopting usual and customary charges for Covered Home Care Services. MCA commits to provide CIGNA all reasonable assistance in the development and implementation of the aforementioned process. b. The Parties shall meet quarterly (each April, July, October and January) to review the utilization of Covered Home Health Services that are not reimbursed on a capitated basis under this Agreement for the purpose of identifying opportunities to reduce this utilization and the Parties shall cooperate in good faith to effect such actions as they may agree upon to accomplish this objective. c. MCA shall meet with those referring physicians identified by CIGNA to educate them regarding the service provided by Represented Providers. 9. Insulin Pumps Effective January 1, 2004, MCA will use all reasonable commercial efforts to arrange for the provision of Dana brand devices and supplies for insulin pump orders on new referral authorizations. For Participants reimbursed according to a capitation methodology, MCA will bill CIGNA a fee-for-service charge for a rate differential for new non-Dana devices based upon a CIGNA authorization. Supplies for insulin pumps provided to participants reimbursed according to a capitation methodology prior to 1/1/04 shall not be subject to a fee for service charge or consideration. For all other Participants, billing for pumps and supplies shall be in accordance with the appropriate fee schedules. C. REPRESENTED PROVIDER PAYMENT/CLAIM AND ENCOUNTER DATA Represented Providers shall be reimbursed for covered Home Care Services rendered in accordance with the requirements set forth in Exhibit B. MCA shall provide CIGNA with the claim and/or encounter data as required in Exhibit B. D. FINANCIAL REPORTS 1. MCA represents and warrants that the information set forth in the CIGNA Baseline Assessment submitted to CIGNA by MCA prior to the execution of this Agreement is true and accurate. MCA shall promptly notify CIGNA of any material changes in the information contained in such Baseline Assessment within thirty (30) days of becoming aware of such change. 2. MCA shall provide CIGNA with the following financial reports on a timely basis: a) MCA's annual audited financial reports, including, but not limited to, MCA's audited annual income statement and balance sheet; b) quarterly financial reports including an income statement, balance sheet and any other reports identifying payments made to Represented Providers in the preceding quarter and the incurred but not reported claims as of the end of the preceding quarter in sufficient detail to determine if payments have been made in accordance with this Agreement and applicable law; c) any financial reports required by applicable regulatory authorities; and d) such other financial reports as are reasonably requested by CIGNA. 3. MCA shall notify CIGNA immediately of any of MCA's material payment defaults with respect to any of MCA's creditors if MCA reasonably determines that any such payment defaults would affect the provision of services to the HMO Program Participants. E. ASSIGNMENT AND IDENTIFICATION OF PARTICIPANTS MCA shall comply with the requirements of and shall participate in CIGNA's procedures with respect to the assignment and identification of Participants as outlined in the HMO Program Requirements. F. REIMBURSEMENT OF CIGNA EXPENDITURES In the event that MCA does not arrange for the provision of Home Care Services to HMO Program Participants as required by Section II.A.1 through II.A.4 of this HMO Program Attachment, Payor may arrange for and/or reimburse for such Home Care Service and shall be entitled to recover from MCA any expenditure made, or recover any cost incurred, including, but not limited to, any reasonable administrative costs, in arranging or reimbursing such covered Home Care Service. An amount sufficient to compensate for such expenditures and costs may be deducted from the payments due to MCA under this Agreement; provided that, CIGNA shall provide MCA with written notice and full disclosure of costs incurred prior to any such deductions. This provision shall survive the termination of this Agreement for a period of one (1) year. G. OTHER REQUIREMENTS MCA and its Represented Providers shall use best efforts to prescribe or authorize the substitution of generic pharmaceuticals when appropriate and shall cooperate with CIGNA's formulary and HMO Program Requirements regarding the substitution of generic pharmaceuticals. H. TRANSFERS In a timeframe to be mutually agreed upon the parties, CIGNA will provide to MCA all information reasonably required by MCA in order to accomplish transition, but nothing herein shall require MCA to purchase or assume payments for any Durable Medical Equipment (DME/HME), which has been previously placed with any Participant. CIGNA agrees to work with MCA to identify those Participants that are in possession of DME/HME and for which CIGNA has made payment on a rental basis for such DME/HME, and advise MCA of the same. MCA shall be relieved of any obligation to assume financial responsibility for DME/HME that MCA determines to be DME/HME that is routinely purchased or converted to purchase, or that does not meet CIGNA/MCA Durable Medical Equipment Guidelines for Medical Necessity, and such DME/HME shall be converted to purchase at CIGNA's expense prior to the transition of Participants to MCA. However, MCA shall assume responsibility for the continued maintenance of the DME/HME. I. LIMITATIONS ON BILLING PARTICIPANTS 1. MCA hereby agrees and shall require its Represented Providers to agree that in no event, including, but not limited to non-payment by CIGNA, CIGNA's insolvency or breach of this Agreement, shall MCA or any Represented Provider bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against Participants or persons other than CIGNA or MCA for Home Care Services. This provision shall not prohibit collection of (i) any applicable Copayments, Deductibles or Coinsurance; (ii) payments for services provided to a patient who is no longer eligible to receive Home Care Services, including but not limited to Participants that have reached their benefit limit; or (iii) payments for services provided to Participants that are not Home Care Services. 2. MCA further agrees that this provision shall survive the termination of this Agreement regardless of the cause giving rise to such termination and shall be construed to be for the benefit of Participants, and that this provision supersedes any oral or written agreement to the contrary now existing or hereafter entered into between MCA or Represented Providers and the Participant or persons acting on the Participant's behalf. 3. Any modification, additions, or deletion to the provisions of this hold harmless clause shall become effective on a date no earlier than fifteen (15) days after the applicable state regulatory agency has received written notice of such proposed change. 4. MCA shall not charge, and MCA shall require that its Represented Providers not charge, a Participant for a service which is not Medically Necessary unless in advance of the provision of such service, the Participant is notified that the service may not be covered and the Participant acknowledges in writing that he or she shall be responsible for payment of charges for such service. J. UTILIZATION MANAGEMENT MCA shall perform and comply with the Utilization Management requirements set forth in Exhibits XVII and XXI. K. CIGNA VISION/JOINT STEERING COMMITTEE Any and all services rendered by MCA and its Represented Providers under this Agreement shall be consistent with CIGNA's vision to provide or arrange to provide quality health care at a reasonable cost. Each party agrees to designate representatives, the number and identity of which shall be agreed upon by the parties, to participate in a Joint Steering Committee. The Joint Steering Committee shall meet on a periodic basis, but no less frequently than twice yearly, for the purpose of discussing the status of each party's performance under this Agreement and to resolve any complaints or problems with such performance. L. GUARANTEE OF PROVISION OF COVERED SERVICES 1. Throughout the term of this Agreement and for six (6) months following the termination of this Agreement, MCA shall secure and maintain an irrevocable letter(s) of credit in favor of CIGNA in an amount and form acceptable to CIGNA, for all states in which such a letter of credit is required by state law, regulation, statute, or as required by state insurance/HMO regulators. 2. CIGNA shall have the right to make immediate demand for payment under the irrevocable letter(s) of credit in the event that MCA has failed to pay any amounts due and owing to CIGNA, Represented Providers or others in accordance with MCA's obligations under this Agreement. 3. Prior to each anniversary date of this Agreement, CIGNA will evaluate the adequacy of the amount of the irrevocable letter(s) of credit by reviewing any and all state laws, regulations, and statutes. The amount of the irrevocable letter(s) of credit required to be maintained by MCA for the next contract year shall be a minimum of the amount equal to the individual state requirements for the contract year. 4. At least thirty (30) days prior to each anniversary date of this Agreement, CIGNA will advise MCA of the amount of the irrevocable letter of credit required to be maintained by MCA for the next contract year as calculated pursuant to subsection 3 above. MCA shall secure an irrevocable letter of credit in such amount and in a form acceptable to CIGNA prior to the anniversary date. M. PERFORMANCE FEEDBACK 1. CIGNA may provide feedback to MCA for MCA's own use in assessing and enhancing Represented Providers' performance with regard to quality of care, patient satisfaction and efficient practice. 2. For purposes of providing helpful performance feedback, CIGNA may perform telephone surveys and analyze medical costs of Participants in MCA's HMO Patient Panel. Subject to any applicable confidentiality limitations, CIGNA may also from time to time review a sample of medical records and provide performance feedback on past treatment. N. REIMBURSEMENT FOR COVERED SERVICES RENDERED TO PARTICIPANTS OUTSIDE OF PATIENT PANEL/OPT OUT SERVICES In the event that MCA's Represented Providers render Home Care Services to Participants outside of MCA's Patient Panel or services covered pursuant to a Participant's opt out benefits, MCA shall be reimbursed for such services at the rates established in the HMO Program Attachment - Fee For Service, attached hereto, less applicable Coinsurance, Copayments and Deductibles. Only those charges for Home Care Services billed in accordance with CIGNA's standard claim coding and bundling methodology will be allowed. O. REPRESENTED PROVIDER ACCEPTANCE OF PAYMENT. MCA represents and warrants that each and every Represented Provider has contractually agreed with MCA to accept as payment in full due from CIGNA and its Affiliates for Home Care Services rendered to Patient Panel Participants by that Provider the amounts that the Represented Provider is entitled to receive from MCA. MCA will indemnify and hold harmless Patient Panel Participants, CIGNA and its Affiliates from any claim for payment for Home Care Services rendered to Patient Panel Participants by each Represented Provider, unless the claim arises from CIGNA's wrongful failure to pay MCA for Home Care Services. EXHIBIT A HMO PROGRAM ATTACHMENT - CAPITATION SCHEDULE OF CAPITATION RATES CAPITATION RATES EFFECTIVE 1/1/04 - 12/31/04 These are the capitation rates that apply to services rendered to Patient Panel Participants enrolled in HMO Programs. An "HMO Program" means a non-governmental, fully insured HMO or Point of Service product that is underwritten based on a community rating methodology (i.e. community rating, community rating by class, adjusted community rating by class). - -------------------------------------------------------------------------------- Gentiva Homehealth Infusion and DME/HME Capitation Rate PMPM - -------------------------------------------------------------------------------- All Commercial HMO Capitated * Affiliates - -------------------------------------------------------------------------------- * Confidential treatment requested EXHIBIT B HMO PROGRAM ATTACHMENT - CAPITATION PAYMENT RESPONSIBILITIES (MCA distributes payments) MCA shall pay Represented Providers for covered Home Care Services rendered hereunder in accordance with this Exhibit and the terms of the Agreement. 1. MCA shall pay Represented Providers for covered Home Care Services rendered hereunder in accordance with CIGNA's payment administration standards and any other standards set forth in applicable laws and regulations, including but not limited to, ERISA. MCA agrees to reimburse Represented Providers for covered Home Care Services within the time frames set forth in applicable law AND the time frames specified in MCA's provider agreements with its Represented Providers. CIGNA may withhold all or a portion of MCA's reimbursement if MCA repeatedly fails to reimburse Represented Providers on a timely basis. MCA's obligations with regard to payment for covered Home Care Services rendered hereunder shall survive the termination of this Agreement with respect to any covered Home Care Services rendered by Represented Providers during the term of this Agreement and with respect to any covered Home Care Services Represented Providers are obligated by this Agreement to provide after termination of this Agreement. 2. With reasonable notice, MCA agrees to allow CIGNA representatives to conduct on-site reviews of MCA's payment administration facilities. Such reviews shall be for the sole purpose of evaluating MCA's performance of its payment responsibilities under this Agreement, including, but not limited to, ascertaining the quality and timeliness of MCA's payment processing. MCA agrees to correct any deficiencies detected during such reviews within sixty (60) days of CIGNA's submission of a written report detailing such deficiencies. 3. If CIGNA determines that MCA cannot meet its payment administration obligations set forth herein, CIGNA may elect to assume responsibility for such activities. If CIGNA elects to assume responsibility for such activities, the rates set forth in this Agreement shall be renegotiated by the parties to reflect such change in responsibility. MCA shall cooperate and provide to CIGNA any information necessary to perform such activities. 4. MCA shall be responsible for the production of all applicable tax reporting documents (e.g., 1099s) for Represented Providers. Such documents shall be produced in a format and within the time frames set forth in applicable state and federal laws and/or regulations. 5. MCA shall require that Represented Providers submit claims for covered Home Care Services rendered to Participants in other Programs for which CIGNA has retained payment responsibility directly to CIGNA in accordance with the applicable Program Attachment and Program Requirements. 6. MCA shall produce explanations of payments for Represented Providers with respect to those services rendered by Represented Providers to Participants for which an explanation of benefits is customarily provided or legally required. Such explanations of payments shall be in a format and contain data elements acceptable to CIGNA. 7. MCA shall develop and deliver training programs for Represented Providers which outline MCA's billing and reimbursement processes. MCA shall make best efforts to ensure that Represented Providers avoid submitting requests for payment to CIGNA for those covered Home Care Services rendered to Participants for whom MCA has payment responsibility. 8. MCA shall provide CIGNA with encounter data showing all services provided to each Participant for whom MCA receives Capitation Payments in a format and frequency mutually acceptable to both parties, but no less frequently than monthly. CIGNA may elect to withhold payment of MCA's compensation if MCA fails to submit encounter data in accordance with this Agreement. EXHIBIT C HMO PROGRAM ATTACHMENT - CAPITATION UTILIZATION MANAGEMENT (partial delegation of utilization management) 1. MCA will assist CIGNA in the implementation of its Utilization Management program. Any Utilization Management program activities performed by MCA shall be in accordance with CIGNA's standards, NCQA standards or the standards of another appropriate accrediting body designated by CIGNA, and Program Requirements. MCA shall maintain any licensure required in connection with such activities. 2. MCA shall prepare such periodic reports or other data as reasonably requested by CIGNA relating to its Utilization Management activities in a format acceptable to CIGNA. 3. MCA shall not materially modify its Utilization Management activities without CIGNA's prior approval. 4. CIGNA shall have the right to audit MCA's Utilization Management activities upon reasonable prior notice. MCA shall cooperate with any such audits. 5. If CIGNA determines that MCA cannot meet its Utilization Management obligations set forth herein, CIGNA may elect to assume responsibility for such activities. If CIGNA elects to assume responsibility for such activities, the rates set forth in this Agreement shall be renegotiated by the parties to reflect such change in responsibility. MCA shall cooperate and provide to CIGNA any information necessary to perform such activities. 6. All referrals shall be to Represented Providers, except where an Emergency requires otherwise, in other cases where the referral is specifically authorized by CIGNA's Medical Director or his/her designee or MCA's medical director, if permitted by CIGNA to make such authorizations, or as otherwise required by law. Except in an Emergency or for a Pre-Qualified Maternity Stay or in those instances where prior authorization is prohibited by federal or state laws or regulations, MCA shall require all Represented Providers to obtain authorization from CIGNA or MCA, if permitted by CIGNA to make such authorizations, prior to hospital admission of any Participant or outpatient surgical procedures. 7. The parties acknowledge and agree that CIGNA or Payor shall have final decision making authority with regard to appeals of utilization management decisions. HMO PROGRAM ATTACHMENT TO MANAGED CARE ALLIANCE AGREEMENT (FEE-FOR-SERVICE) PURPOSE The terms and provisions of this HMO Program Attachment and the Agreement are applicable to services rendered by MCA's Represented Providers to HMO Program Participants. As used in this Program Attachment, Participant means a HMO Program Participant. I. DEFINITIONS HMO PROGRAM PARTICIPANT means a Participant enrolled in a non-governmental, fully insured Standard HMO or Point of Service product and which product is underwritten based on a community rating methodology (i.e. community rating, community rating by class, adjusted community rating by class). This definition includes, but is not limited to, Participants covered under commercial HMO and Open Access and Open Access Plus plans issued by CIGNA. MEDICAL DIRECTOR means a physician designated by CIGNA to manage Quality Management and Utilization Management responsibilities, or that physician's designee. PATIENT PANEL means those Participants who have been designated or have otherwise been assigned to one or more of MCA's Represented Providers as the primary source for certain Covered Services pursuant to a Service Agreement or HMO Program Requirements, and for which MCA will be reimbursed on a fee-for-service basis. POINT OF SERVICE means a product offered pursuant to a Service Agreement which allows the Participant to choose, in addition to Standard HMO benefits, a lower level of benefits if the Participant receives Home Care Services from (i) a Participating Provider without a necessary authorization or (ii) from a non-Participating Provider, at the time such services are sought. PRIMARY CARE PHYSICIAN means a physician duly licensed to practice medicine who is a Participating Provider with CIGNA to provide Covered Services in the field of general medicine, internal medicine, family practice or pediatrics, and who has agreed to provide primary care physician services to Participants in accordance with HMO Program Requirements. STANDARD HMO means a product offered pursuant to a Service Agreement where Covered Services are available to Participants only from Participating Providers, except in the case of an Emergency or with the prior authorization of CIGNA or Affiliate where Covered Services are not available from Participating Providers. II. PARTIES' OBLIGATIONS A. SERVICES 1. MCA, through its Represented Providers, shall provide all Home Care Services that are required by Participants in MCA's Patient Panel, for which such Participants are eligible, in accordance with the terms of this Agreement, this HMO Program Attachment and HMO Program Requirements. The compensation set forth in this HMO Program Attachment shall be payment in full for Home Care Services rendered to HMO Program Participants. 2. MCA, through its Represented Providers, shall arrange to provide Medically Necessary Home Care Services to Participants on a 24-hour per day, 7-day per week basis or arrange with other qualified providers (which meet all CIGNA and MCA credentialing requirements or other applicable guidelines) to provide such Medically Necessary Home Care Services to Participants. MCA shall require that such covering providers (a) are Participating Providers (unless otherwise agreed); (b) will not seek compensation from CIGNA for services for which MCA receives compensation hereunder; and (c) will not bill Participants for covered Home Care Services under any circumstances except for (i) Copayments, Deductibles or Coinsurance; (ii) the provision of services to a patient who is not eligible to receive Home Care Services, including but not limited to Participants that have reached their benefit limit; and (iii) services provided to Participants that are not Home Care Services. (d) will direct the participant and/or the Represented Provider to obtain, authorization from CIGNA prior to all hospitalizations or referrals of Participants, except in Emergencies or for a Pre-Qualified Maternity Stay or as otherwise required by law. 3. MCA through its Represented Providers shall provide Home Care Services to all Participants in MCA's Patient Panel who are eligible to receive Home Care Services. 4. Subject to the terms and conditions of this Agreement, MCA shall: (a) Arrange for the provision of Home Care Services to Participants; (b) Require Represented Providers to accept, treat, and otherwise render covered Home Care Services to Participants in the same manner, in accordance with the same standards, and with the same availability, as offered to other like patients. (c) not close its network to any new Participants unless CIGNA expressly consents to such closure; In no event shall MCA or Represented Providers be required to accept, treat, arrange for, or otherwise be obligated to render Home Care Services to Participants under this Agreement, even if medically appropriate, if: (a) the provision of such services to Participant would pose risk of bodily harm to the Participant or caregiver personnel of Represented Provider; (b) the provision of such services to Participant would be in violation of MCA's or Represented Provider's applicable license requirements or other applicable laws, and/or MCA policies, including but not limited to admission and discharge policies or discrimination policies; (c) MCA has not received the essential information to process a referral; (d) Participant repeatedly rejects the provision of services by a qualified Represented Provider selected by MCA and/or CIGNA has mutually agreed. MCA and Represented Providers shall not differentiate or discriminate in the treatment of any Participant because of race, color, national origin, ancestry, religion, sex, marital status, sexual orientation, age, health status, handicap or source of payment. 5. Except in an Emergency or for a Pre-Qualified Maternity Stay or in those instances where prior authorization is prohibited by federal or state laws or regulations, prior authorization by a Participant's Primary Care Physician or CIGNA as prescribed by HMO Program Requirements is required for payment of covered Home Care Services rendered to Participants. All referrals shall be to Participating Providers, except where an Emergency requires otherwise, in other cases where Medical Director specifically authorizes the referral or except as required by law. B. COMPENSATION AND BILLING 1. Reimbursement for Home Care Services rendered by Represented Providers shall be in accordance with the following rates, less applicable Copayments, Deductibles or Coinsurance: a. Reimbursement for Home Care services arranged by MCA and rendered by Represented Providers shall be in accordance with Exhibit A SCHEDULES 1A, 2A, AND 3A attached hereto. b. MCA will indemnify and hold harmless Payors, CIGNA and its Affiliates from any claim for payment in excess of the specified amounts for Home Care Services rendered to Participants by each Represented Provider, unless the claim arises from a Payor's wrongful failure to pay MCA for covered Home Care Services. 2. Payors shall agree to deduct any Copayments, Deductibles, or Coinsurance required by the Service Agreement from payment due. Deduction for the Copayment, Deductible or Coinsurance shall be determined on the basis of the contracted rate. 3. Reimbursement for Home Care Services rendered hereunder shall be made by CIGNA or its designees to MCA. MCA shall bill for covered Home Care Services according to the following: a. MCA shall submit claims on the appropriate claim form for all covered Home Care Services within one hundred twenty (120) days of the date those services are rendered. Claims received after this one hundred twenty (120) day period may be denied for payment. MCA shall submit claims to the location described in applicable Program Requirements. b. Any amount owing under this Agreement shall be paid within thirty (30) days after receipt of a complete claim, unless additional required information is requested within the thirty (30) day period, or the claim involves coordination of benefits, except as otherwise provided in this Agreement. 4. MCA and its Represented Providers shall not charge a Participant for a service which is not Medically Necessary unless, in advance of the provision of such service, the Participant is notified that the service may not be covered and the Participant acknowledges in writing that he or she shall be responsible for payment of charges for such service. 5. MCA will and shall require its Represented Providers to look solely to Payor for compensation for covered Home Care Services except for Copayments, Deductibles or Coinsurance. MCA agrees, for itself and on behalf of each Represented Provider, that whether or not there is any unresolved dispute for payment, under no circumstances will MCA or any Represented Provider directly or indirectly make any charges or claims, other than for Copayments, Deductibles or Coinsurance against any Participants or their representatives for covered Home Care Services and that this provision survives termination of this Agreement for services rendered prior to such termination. This provision shall not prohibit collection of (i) any applicable Copayments, Deductibles, or Coinsurance, (ii) payments for services provided to a patient who is no longer eligible to receive Home Care Services, including but not limited to Participants that have reached their benefit limit (iii) payment for services provided to Participants, which are not Home Care Services. This paragraph is to be interpreted for the benefit of Participants and does not diminish the obligation of Payor to make payments to Represented Providers according to the terms of this Agreement. 6. The rates set forth herein shall apply to all services rendered to Participants in the HMO Program. 7. Only those charges for Home Care Services billed in accordance with CIGNA's standard claim coding and bundling methodology will be allowed. C. OTHER REQUIREMENTS MCA and its Represented Providers shall use best efforts to prescribe or authorize the substitution of generic pharmaceuticals when appropriate and shall cooperate with CIGNA's formulary and HMO Program Requirements regarding the substitution of generic pharmaceuticals. EXHIBIT A HMO PROGRAM ATTACHMENT - FEE FOR SERVICE REIMBURSEMENT FOR OTHER SERVICES RATE AREA DESIGNATIONS: - -------------------------------------------------------------------------- STATE RATE AREA RATE DESIGNATION - -------------------------------------------------------------------------- Alabama LOW 3 - -------------------------------------------------------------------------- Alaska HIGH 1 - -------------------------------------------------------------------------- Arizona MEDIUM 2 - -------------------------------------------------------------------------- Arkansas LOW 3 - -------------------------------------------------------------------------- California HIGH 1 - -------------------------------------------------------------------------- Colorado MEDIUM 2 - -------------------------------------------------------------------------- Connecticut MEDIUM 2 - -------------------------------------------------------------------------- Delaware LOW 3 - -------------------------------------------------------------------------- District of Columbia HIGH 1 - -------------------------------------------------------------------------- Florida MEDIUM 2 - -------------------------------------------------------------------------- Georgia MEDIUM 2 - -------------------------------------------------------------------------- Hawaii HIGH 1 - -------------------------------------------------------------------------- Idaho LOW 3 - -------------------------------------------------------------------------- Illinois HIGH 1 - -------------------------------------------------------------------------- Indiana LOW 3 - -------------------------------------------------------------------------- Iowa LOW 3 - -------------------------------------------------------------------------- Kansas LOW 3 - -------------------------------------------------------------------------- Kentucky LOW 3 - -------------------------------------------------------------------------- Louisiana MEDIUM 2 - -------------------------------------------------------------------------- Maine LOW 3 - -------------------------------------------------------------------------- Maryland MEDIUM 2 - -------------------------------------------------------------------------- Massachusetts HIGH 1 - -------------------------------------------------------------------------- Michigan LOW 3 - -------------------------------------------------------------------------- Minnesota LOW 3 - -------------------------------------------------------------------------- Mississippi LOW 3 - -------------------------------------------------------------------------- Missouri MEDIUM 2 - -------------------------------------------------------------------------- Montana LOW 3 - -------------------------------------------------------------------------- Nebraska LOW 3 - -------------------------------------------------------------------------- Nevada LOW 3 - -------------------------------------------------------------------------- New Hampshire LOW 3 - -------------------------------------------------------------------------- New Jersey MEDIUM 2 - -------------------------------------------------------------------------- New Mexico LOW 3 - -------------------------------------------------------------------------- New York MEDIUM 2 - -------------------------------------------------------------------------- North Carolina MEDIUM 2 - -------------------------------------------------------------------------- North Dakota MEDIUM 2 - -------------------------------------------------------------------------- Ohio MEDIUM 2 - -------------------------------------------------------------------------- Oklahoma LOW 3 - -------------------------------------------------------------------------- Oregon MEDIUM 2 - -------------------------------------------------------------------------- Pennsylvania MEDIUM 2 - -------------------------------------------------------------------------- Rhode Island MEDIUM 2 - -------------------------------------------------------------------------- South Carolina MEDIUM 2 - -------------------------------------------------------------------------- - -------------------------------------------------------------------------- South Dakota LOW 3 - -------------------------------------------------------------------------- Tennessee MEDIUM 2 - -------------------------------------------------------------------------- Texas HIGH 1 - -------------------------------------------------------------------------- Utah MEDIUM 2 - -------------------------------------------------------------------------- Vermont LOW 3 - -------------------------------------------------------------------------- Virginia MEDIUM 2 - -------------------------------------------------------------------------- Washington MEDIUM 2 - -------------------------------------------------------------------------- West Virginia LOW 3 - -------------------------------------------------------------------------- Wisconsin LOW 3 - -------------------------------------------------------------------------- Wyoming LOW 3 - -------------------------------------------------------------------------- TRADITIONAL HOME HEALTH SERVICES: RATES EFFECTIVE JANUARY 1, 2004 - DECEMBER 31, 2004 THE FOLLOWING TRADITIONAL HOME HEALTH SERVICES HAVE BOTH VISIT AND HOURLY RATES. Notes 1, 2, 3, 4, 5 and 6 apply
------------------------------------------------------------------- AREA 1 AREA 2 AREA 3 ------------------------------------------------------------------- VISIT HOUR VISIT HOUR VISIT HOUR - -------------------------------------------------------------------------------------------------------------- CERTIFIED NURSES AIDE * * * * * * - -------------------------------------------------------------------------------------------------------------- HOME HEALTH AIDE * * * * * * - -------------------------------------------------------------------------------------------------------------- LVN/LPN * * * * * * - -------------------------------------------------------------------------------------------------------------- LVN/LPN - HIGH TECH * * * * * * - -------------------------------------------------------------------------------------------------------------- PEDIATRIC HIGH TECH LVN/LPN * * * * * * - -------------------------------------------------------------------------------------------------------------- PEDIATRIC HIGH TECH RN * * * * * * - -------------------------------------------------------------------------------------------------------------- PEDIATRIC LVN/LPN * * * * * * - -------------------------------------------------------------------------------------------------------------- PEDIATRIC RN * * * * * * - -------------------------------------------------------------------------------------------------------------- RN * * * * * * - -------------------------------------------------------------------------------------------------------------- RN HIGH TECH INFUSION * * * * * * - -------------------------------------------------------------------------------------------------------------- RN HIGH TECH OTHER * * * * * * - --------------------------------------------------------------------------------------------------------------
THE FOLLOWING TRADITIONAL HOME HEALTH SERVICES HAVE VISIT ONLY RATES. Notes 1, 3, 4, 5, 7 and 8 apply
------------------------------------------------------------------- AREA 1 AREA 2 AREA 3 ------------------------------------------------------------------- VISIT HOUR VISIT HOUR VISIT HOUR - -------------------------------------------------------------------------------------------------------------- DIABETIC NURSE * N/A * N/A * N/A - -------------------------------------------------------------------------------------------------------------- DIETITIAN * N/A * N/A * N/A - -------------------------------------------------------------------------------------------------------------- ENTEROSTOMAL THERAPIST * N/A * N/A * N/A - -------------------------------------------------------------------------------------------------------------- MATERNAL CHILD HEALTH * N/A * N/A * N/A - -------------------------------------------------------------------------------------------------------------- MEDICAL SOCIAL WORKER * N/A * N/A * N/A - -------------------------------------------------------------------------------------------------------------- OCCUPATIONAL THERAPIST * N/A * N/A * N/A - -------------------------------------------------------------------------------------------------------------- OCCUPATIONAL THERAPIST ASSISTANT * N/A * N/A * N/A - -------------------------------------------------------------------------------------------------------------- PHLEBOTOMIST * N/A * N/A * N/A - -------------------------------------------------------------------------------------------------------------- PHOTOTHERAPY PACKAGE SERVICE * N/A * N/A * N/A - -------------------------------------------------------------------------------------------------------------- PHYSICAL THERAPIST * N/A * N/A * N/A - -------------------------------------------------------------------------------------------------------------- PHYSICAL THERAPIST ASSISTANT * N/A * N/A * N/A - -------------------------------------------------------------------------------------------------------------- PSYCHIATRIC NURSE * N/A * N/A * N/A - --------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - -------------------------------------------------------------------------------------------------------------- REHABILITATION NURSE * N/A * N/A * N/A - -------------------------------------------------------------------------------------------------------------- RESPIRATORY THERAPIST * N/A * N/A * N/A - -------------------------------------------------------------------------------------------------------------- RESPIRATORY THERAPIST - CPAP Clinic * N/A * N/A * N/A - -------------------------------------------------------------------------------------------------------------- RN ASSESSMENT, INITIAL * N/A * N/A * N/A - -------------------------------------------------------------------------------------------------------------- RN SKILLED NURSING VISIT-EXTENSIVE * N/A * N/A * N/A - -------------------------------------------------------------------------------------------------------------- SPEECH THERAPIST * N/A * N/A * N/A - --------------------------------------------------------------------------------------------------------------
THE FOLLOWING TRADITIONAL HOME HEALTH SERVICE HAS HOURLY ONLY RATES. Notes 3, 4 and 5 apply
------------------------------------------------------------------- AREA 1 AREA 2 AREA 3 ------------------------------------------------------------------- VISIT HOUR VISIT HOUR VISIT HOUR - -------------------------------------------------------------------------------------------------------------- HOMEMAKER N/A * N/A * N/A * - --------------------------------------------------------------------------------------------------------------
THE FOLLOWING TRADITIONAL HOME HEALTH SERVICE IS PRICED ON A PER DIEM BASIS. Notes 3, 4 and 5 apply
------------------------------------------------------------------- AREA 1 AREA 2 AREA 3 ------------------------------------------------------------------- PER DIEM PER DIEM PER DIEM - -------------------------------------------------------------------------------------------------------------- COMPANION/LIVE IN * * * - --------------------------------------------------------------------------------------------------------------
NOTES: * * * * * * * * HOME INFUSION RATES: RATES EFFECTIVE JANUARY 1, 2004 - DECEMBER 31, 2004 THE FOLLOWING HOME INFUSION THERAPY SERVICE RATES EXCLUDE DRUGS. DRUGS ARE PRICED AS A PERCENTAGE DISCOUNT OFF AWP (IF APPLICABLE), AND THERE IS NO PRICE DIFFERENCE BETWEEN PRIMARY AND MULTIPLE THERAPIES
- -------------------------------------------------------------------------------------------------------------- PRIMARY OR PRIMARY OR PRIMARY OR MULTIPLE THERAPY MULTIPLE THERAPY MULTIPLE THERAPY PER DIEM DISPENSING FEE DRUG DISCOUNT OFF AWP - -------------------------------------------------------------------------------------------------------------- Ancillary Drugs * * * - ------------------------------------------------------------------------------------------------------------- Biological Response Modifiers * * * - ------------------------------------------------------------------------------------------------------------- Cardiac (Inotropic) Therapy * * * - ------------------------------------------------------------------------------------------------------------- Chelation Therapy * * * - ------------------------------------------------------------------------------------------------------------- Chemotherapy * * * - ------------------------------------------------------------------------------------------------------------- Enteral Therapy * * * - ------------------------------------------------------------------------------------------------------------- Enzyme Therapy * * * - ------------------------------------------------------------------------------------------------------------- Growth Hormone * * * - ------------------------------------------------------------------------------------------------------------- IV Immune Globulin * * * - -------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ------------------------------------------------------------------------------------------------------------- Other Injectable Therapies * * * - ------------------------------------------------------------------------------------------------------------- Other Infusion Therapies * * * - ------------------------------------------------------------------------------------------------------------- Pain Management Therapy * * * - ------------------------------------------------------------------------------------------------------------- Steroid Therapy * * * - ------------------------------------------------------------------------------------------------------------- Thrombolytic (Anticoagulation) Therapy * * * - ------------------------------------------------------------------------------------------------------------- Synagis * * * - ------------------------------------------------------------------------------------------------------------- Remodulin Therapy * * * - -------------------------------------------------------------------------------------------------------------
THE FOLLOWING HOME INFUSION THERAPY SERVICE RATES EXCLUDE DRUGS. DRUGS ARE PRICED AS A PERCENTAGE DISCOUNT OFF AWP, AND THERE IS A PRICE DIFFERENCE BETWEEN PRIMARY AND MULTIPLE ANTI-INFECTIVE THERAPIES
- -------------------------------------------------------------------------------------------------------------- PER DIEM DRUG DISCOUNT OFF AWP - -------------------------------------------------------------------------------------------------------------- Anti-Infectives - Primary Anti-Infective * * - -------------------------------------------------------------------------------------------------------------- Anti-Infectives - Multiple Anti-Infective * * - --------------------------------------------------------------------------------------------------------------
THE FOLLOWING HOME INFUSION THERAPY SERVICE RATE EXCLUDES DRUGS. DRUGS ARE PRICED PER VIAL, AND THERE IS NO PRICE DIFFERENCE BETWEEN PRIMARY AND MULTIPLE ANTI-INFECTIVE THERAPIES
- -------------------------------------------------------------------------------------------------------------- PRIMARY OR MULTIPLE THERAPY PER DIEM COST OF DRUG - -------------------------------------------------------------------------------------------------------------- Flolan Therapy * - -------------------------------------------------------------------------------------------------------------- Flolan 0.5 mg vial * - -------------------------------------------------------------------------------------------------------------- Flolan 1.5 mg vial * - -------------------------------------------------------------------------------------------------------------- Flolan diluent vial * - --------------------------------------------------------------------------------------------------------------
THE FOLLOWING HOME INFUSION THERAPY SERVICE RATES INCLUDE DRUGS, AND THERE IS NO PRICE DIFFERENCE BETWEEN PRIMARY AND MULTIPLE THERAPIES
- -------------------------------------------------------------------------------------------------------------- PRIMARY OR MULTIPLE THERAPY PER DIEM - -------------------------------------------------------------------------------------------------------------- Enteral Therapy * - -------------------------------------------------------------------------------------------------------------- Hydration Therapy * - -------------------------------------------------------------------------------------------------------------- Total Parenteral Nutrition * - --------------------------------------------------------------------------------------------------------------
NOTES: * * * * * * * * Confidential treatment requested THE FOLLOWING ARE FOR THE STATED ITEM ONLY. UNLESS OTHERWISE NOTED, NURSING, SUPPLIES, ETC. ARE NOT INCLUDED. - -------------------------------------------------------------------------------------------------------------- Blood Transfusion per Unit (Tubing, Filters) * - -------------------------------------------------------------------------------------------------------------- Catheter Care Per Diem * - -------------------------------------------------------------------------------------------------------------- Midline Insertion (Catheter & Supplies) * - -------------------------------------------------------------------------------------------------------------- PICC Line Insertion (Catheter & Supplies) * - -------------------------------------------------------------------------------------------------------------- Blood Product * - --------------------------------------------------------------------------------------------------------------
FACTOR CONCENTRATES
- -------------------------------------------------------------------------------------------------------------- Vial price Unit Price - -------------------------------------------------------------------------------------------------------------- FACTOR VII - -------------------------------------------------------------------------------------------------------------- Novoseven 1200MCG Vial * * - -------------------------------------------------------------------------------------------------------------- Novoseven 4800MCG Vial * * - -------------------------------------------------------------------------------------------------------------- Novoseven in 1200MCG or 4800MCG QTY * * - -------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------- FACTOR VIII (RECOMBINANT) - -------------------------------------------------------------------------------------------------------------- Recombinate * * - -------------------------------------------------------------------------------------------------------------- Kogenate or Helixate * * - -------------------------------------------------------------------------------------------------------------- Bioclate * * - -------------------------------------------------------------------------------------------------------------- Helixate FS * * - -------------------------------------------------------------------------------------------------------------- Kogenate FS * * - -------------------------------------------------------------------------------------------------------------- Refacto * * - -------------------------------------------------------------------------------------------------------------- Advate * * - -------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------- FACTOR VIII (MONOCLONAL) - -------------------------------------------------------------------------------------------------------------- Hemofil-M or A. R. C. Method M * * - -------------------------------------------------------------------------------------------------------------- Monoclate P * * - -------------------------------------------------------------------------------------------------------------- Monarc-M * * - -------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------- FACTOR VIII (OTHER) - -------------------------------------------------------------------------------------------------------------- Koate * * - -------------------------------------------------------------------------------------------------------------- Humate * * - -------------------------------------------------------------------------------------------------------------- Alphanate SDHT * * - -------------------------------------------------------------------------------------------------------------- FACTOR IX (RECOMBINANT) - -------------------------------------------------------------------------------------------------------------- BeneFix * * - -------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------- FACTOR IX (MONOCLONAL/HIGH PURITY) - --------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - -------------------------------------------------------------------------------------------------------------- Mononine * * - -------------------------------------------------------------------------------------------------------------- Alphanine * * - -------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------- FACTOR IX (OTHER) - -------------------------------------------------------------------------------------------------------------- Konyne - 80 * * - -------------------------------------------------------------------------------------------------------------- Proplex T * * - -------------------------------------------------------------------------------------------------------------- Bebulin * * - -------------------------------------------------------------------------------------------------------------- Profilnine SD * * - -------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------- ANTI-INHIBITOR COMPLEX - -------------------------------------------------------------------------------------------------------------- Autoplex-T * * - -------------------------------------------------------------------------------------------------------------- Feiba-VH * * - -------------------------------------------------------------------------------------------------------------- Hyate-C * * - -------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------- HEMOSTATIC AGENTS - -------------------------------------------------------------------------------------------------------------- DDAVP - 10ml vial * * - -------------------------------------------------------------------------------------------------------------- Stimate - 2.5ml vial * * - --------------------------------------------------------------------------------------------------------------
Above rates include all necessary ancillary supplies and waste disposal unit; 24-hour on-call clinical support; home infusion monitoring system; product delivery nationwide; patient training, education, and evaluation DME/HOME RESPIRATORY RATES: RATES EFFECTIVE JANUARY 1, 2004 - MARCH 31, 2004
- ---------------------------------------------------------------------------------------------------------------- HCPCS CHC GENTIVA CODE CODE CODE DESCRIPTION PURCHASE PRICE RENTAL PRICE DAILY PRICE - ---------------------------------------------------------------------------------------------------------------- A4660 DM590 2520 MONITOR, BLOOD PRESSURE (A4660) * W/STETH & CUFF - ---------------------------------------------------------------------------------------------------------------- A4670 DM590 2518 MONITOR, BLOOD PRESSURE (A4670), * AUTOMATIC - ---------------------------------------------------------------------------------------------------------------- A7034 A9900 7552 BREEZE (A9900) CPAP/BIPAP MASK * - ---------------------------------------------------------------------------------------------------------------- A7034 A9900 7553 FULL FACE (A9900) MIRAGE * CPAP/BIPAP MASK - ---------------------------------------------------------------------------------------------------------------- A7034 A9900 7554 GEL/SILICON (A9900) CPAP/BIPAP * MASK INCL GLD SEAL, PHANTM, MONARCH - ---------------------------------------------------------------------------------------------------------------- A7034 A9900 7556 SPECIALTY (A9900) CPAP/BIPAP * MASK (PROFILE OR SIMPICITY) - ---------------------------------------------------------------------------------------------------------------- B9002 HI531 2570 PUMP, ENTERAL (B9002) * * - ---------------------------------------------------------------------------------------------------------------- B9998 DM590 6828 ENTERAL SUPPLIES (B9998) * * - ---------------------------------------------------------------------------------------------------------------- DM590 DM570 7551 BACK-PACK (E1399), FOR * PORTABLE ENTERAL PUMP - ---------------------------------------------------------------------------------------------------------------- A4615 DM590 2522 CANNULA, NASAL * - ---------------------------------------------------------------------------------------------------------------- B9002 DM590 7509 ENTERAL PUMP, PORTABLE (B9002) * * - ---------------------------------------------------------------------------------------------------------------- A7034 DM590 7508 MASK, CPAP GEL OR SILICONE * (K0183) - ---------------------------------------------------------------------------------------------------------------- E0100 E0100 2020 CANE (E0100), ADJ OR FIX, W/ TIP * - ---------------------------------------------------------------------------------------------------------------- E0105 E0105 2021 CANE, QUAD (E0105) OR THREE * PRONG, ADJ OR FIX, W/ TIPS - ---------------------------------------------------------------------------------------------------------------- E0110 E0110 2028 CRUTCHES, FOREARM (E0110), ADJ * OR FIX, PAIR, W/ TIPS, GRIPS - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0111 E0111 2023 CRUTCH FOREARM (E0111), ADJ OR * FIX, EACH, W/ TIP AND GRIPS - ---------------------------------------------------------------------------------------------------------------- E0112 E0112 2027 CRUTCHES UNDERARM, WOOD (E0112), * ADJ OR FIX, PAIR, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0113 E0113 2025 CRUTCH UNDERARM, WOOD (E0113), * ADJ OR FIX, EACH, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0114 E0114 2026 CRUTCHES UNDERARM, ALUM (E0114), * ADJ OR FIX, PAIR, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0116 E0116 2024 CRUTCH UNDERARM, ALUM (E0116), * ADJ OR FIX, EACH, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0130 E0130 2037 WALKER, RIGID (E0130) (PICKUP), * ADJ OR FIX HEIGHT - ---------------------------------------------------------------------------------------------------------------- E0135 E0135 2036 WALKER, FOLDING (E0135) * (PICKUP), ADJ OR FIX HEIGHT - ---------------------------------------------------------------------------------------------------------------- E0141 E0141 2040 WALKER, WHEELED (E0141), W/OUT * SEAT - ---------------------------------------------------------------------------------------------------------------- E0142 DM570 2034 RIGID WALKER (E0142), WHEELED, * W/ SEAT, - ---------------------------------------------------------------------------------------------------------------- E0143 E0143 2029 WALKER FOLDING, WHEELED (E0143), * W/OUT SEAT - ---------------------------------------------------------------------------------------------------------------- E0145 DM570 2039 WALKER (E0145), WHEELED, * W/ SEAT AND CRUTCH ATTACHMENTS - ---------------------------------------------------------------------------------------------------------------- E0146 DM570 2038 WALKER, WHEELED, W/ SEAT (E0146) * - ---------------------------------------------------------------------------------------------------------------- E0147 E0147 2030 WALKER HVY DUT (E0147), MULT * BRAKING SYS, VAR WHEEL RESISTANCE - ---------------------------------------------------------------------------------------------------------------- E0153 E0153 2032 CRUTCH PLATFORM ATTACHMENT * (E0153), FOREARM EA - ---------------------------------------------------------------------------------------------------------------- E0154 E0154 2033 WALKER PLATFORM ATTACHMENT * (E0154), EA - ---------------------------------------------------------------------------------------------------------------- E0155 E0155 2041 WALKER WHEEL ATTACHMENT * (E0155), RIGID (PICKUP) WALKER - ---------------------------------------------------------------------------------------------------------------- E0156 DM570 2035 WALKER SEAT ATTACHMENT (E0156) * - ---------------------------------------------------------------------------------------------------------------- E0157 E0157 2022 WALKER, CRUTCH ATTACHMENT * (E0157), EACH - ---------------------------------------------------------------------------------------------------------------- E0158 E0158 2031 WALKER LEG EXTENSIONS (E0158) * - ---------------------------------------------------------------------------------------------------------------- E0163 E0163 2047 COMMODE CHAIR, STATIONARY * (E0163), W/ FIX ARMS - ---------------------------------------------------------------------------------------------------------------- E0164 E0164 2045 COMMODE CHAIR, MOBILE * (E0164), W/ FIX ARMS - ---------------------------------------------------------------------------------------------------------------- E0165 E0165 2046 COMMODE CHAIR (E0165), * STATIONARY, W/ DETACH ARMS - ---------------------------------------------------------------------------------------------------------------- E0165 E0165 2591 COMMODE, XXWIDE(E0165) * - ---------------------------------------------------------------------------------------------------------------- E0166 E0166 2044 COMMODE CHAIR (E0166), MOBILE, * W/ DETACH ARMS - ---------------------------------------------------------------------------------------------------------------- E0167 E0167 2051 COMMODE CHAIR, PAIL OR PAN * (E0167) - ---------------------------------------------------------------------------------------------------------------- E0176 E0176 2142 CUSHION (E0176) OR AIR PRESSURE * PAD, NON-POSITIONING - ---------------------------------------------------------------------------------------------------------------- E0176 E0176 2394 REPLACEMENT PAD (E0176) * ALTERNATING PRESS - ---------------------------------------------------------------------------------------------------------------- E0177 E0177 2224 CUSHION OR WATER PRESS PAD * (E0177), NONPOSITIONING - ---------------------------------------------------------------------------------------------------------------- E0178 E0178 2160 CUSHION OR GEL PRESS PAD * (E0178), NONPOSITIONING - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0179 E0179 2154 CUSHION (E0179) OR DRY PRESSURE * PAD, NONPOSTIONING - ---------------------------------------------------------------------------------------------------------------- E0180 E0180 2196 PUMP (E0180), ALTERNATING * * PRESSURES W/PAD - ---------------------------------------------------------------------------------------------------------------- E0181 E0181 2197 PUMP (E0181), ALTERNATING PRESS * * W/PAD, HVY DUTY - ---------------------------------------------------------------------------------------------------------------- E0184 E0184 2074 MATTRESS, DRY PRESSURE (E0184) * - ---------------------------------------------------------------------------------------------------------------- E0185 E0185 2076 MATTRESS (E0185), GEL OR * GEL-LIKE PRESSURE PAD - ---------------------------------------------------------------------------------------------------------------- E0186 E0186 2064 MATTRESS, AIR PRESSURE (E0186) * - ---------------------------------------------------------------------------------------------------------------- E0187 E0187 2099 MATTRESS, WATER PRESSURE (E0187) * - ---------------------------------------------------------------------------------------------------------------- E0188 DM570 2217 PAD, SYNTHETIC SHEEPSKIN (A9900) * - ---------------------------------------------------------------------------------------------------------------- E0189 DM570 2177 PAD, LAMBSWOOL SHEEPSKIN * (E0189), ANY SIZE - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2573 CUSHION, JAY FOR W/C (E0192) * * - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2572 CUSHION, ROHO FOR W/C (E0192) * * - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2178 W/C PAD (E0192), LOW PRESS AND * * POSITIONING EQUALIZATION - ---------------------------------------------------------------------------------------------------------------- E0193 E0193 2098 MATTRESS, LOW AIR LOSS (E0193), * * * INCL. BED - ---------------------------------------------------------------------------------------------------------------- E0194 DM570 2063 AIR FLUIDIZED BED (E0194) * * * - ---------------------------------------------------------------------------------------------------------------- E0196 E0196 2077 MATTRESS, GEL PRESSURE (E0196) * - ---------------------------------------------------------------------------------------------------------------- E0197 E0197 2065 MATTRESS, AIR PRESSURE PAD * (E0197) - ---------------------------------------------------------------------------------------------------------------- E0198 E0198 2100 MATTRESS (E0198), WATER * PRESSURE PAD - ---------------------------------------------------------------------------------------------------------------- E0199 E0199 2075 MATTRESS, DRY PRESSURE PAD * (E0199) - ---------------------------------------------------------------------------------------------------------------- E0200 E0200 2228 HEAT LAMP (E0200), W/OUT STAND, * INCL/BULB, OR INFRARED ELEMENT - ---------------------------------------------------------------------------------------------------------------- E0202 E0202 2229 PHOTOTHERAPY (BILIRUBIN) * * (E0202), LIGHT WIT - ---------------------------------------------------------------------------------------------------------------- E0202 E0202 2524 PHOTOTHERAPY, BILI BLANKET * * (E0202) - ---------------------------------------------------------------------------------------------------------------- E0205 E0205 2227 HEAT LAMP (E0205), WITH STAND, * INCL/ BULB, OR INFRARED ELEMENT - ---------------------------------------------------------------------------------------------------------------- E0210 DM570 2156 HEATING PAD, STANDARD (E0210) * - ---------------------------------------------------------------------------------------------------------------- E0215 DM570 2155 HEATING PAD (E0215), ELECTRIC, * MOIST - ---------------------------------------------------------------------------------------------------------------- E0218 DM570 2560 COLD THERAPY UNIT (E0218) * * * - ---------------------------------------------------------------------------------------------------------------- E0235 DM570 2187 PARAFFIN BATH UNIT, PORT (E0235) * - ---------------------------------------------------------------------------------------------------------------- E0236 DM570 2199 PUMP (E0236) FOR WATER * CIRCULATING PAD - ---------------------------------------------------------------------------------------------------------------- E0237 DM570 2223 HEAT COLD WATER (E0237) * CIRCULATING PAD W/PUMP - ---------------------------------------------------------------------------------------------------------------- E0238 DM570 2179 HEATING PAD (E0238), MOIST, * NON-ELECTRIC - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2867 BATH TUB RAIL (E0241), WALL, * L-SHAPE - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2862 BATH TUB RAIL, WALL, 12" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2863 BATH TUB RAIL, WALL, 16" (E0241) * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2864 BATH TUB RAIL, WALL, 18" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2865 BATH TUB RAIL, WALL, 24" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2866 BATH TUB RAIL, WALL, 36" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2043 BATH TUB RAIL, WALL, UNSPECIFIED * SIZE - ---------------------------------------------------------------------------------------------------------------- E0242 DM570 2042 BATH TUB RAIL, FLOOR BASE * (E0242) - ---------------------------------------------------------------------------------------------------------------- E0243 DM570 2056 TOILET RAIL, EACH (E0243) * - ---------------------------------------------------------------------------------------------------------------- E0244 E0244 2587 TOILET SEAT (E0244) RAISED WITH * ARMS - ---------------------------------------------------------------------------------------------------------------- E0244 E0244 2052 TOILET SEAT, RAISED (E0244) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2575 BATH BENCH WITH BACK (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2058 BATH TUB STOOL OR BENCH (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2578 TRANSFER BENCH, NON-PADDED * (E0245) - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2577 TRANSFER BENCH, PADDED (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0246 DM570 2057 TRANSFER TUB RAIL(E0246), * ATTACHMENT - ---------------------------------------------------------------------------------------------------------------- E0249 DM570 2186 HEAT UNIT (E0249), WATER * CIRCULATING PAD - ---------------------------------------------------------------------------------------------------------------- E0255 E0255 2090 HOSP BED (E0255), VAR HEIGHT, * * HI-LO, W/ SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0256 E0256 2091 HOSP BED (E0256), VAR HEIGHT, * * HI-LO, W/ SIDE RAILS, W/O MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0260 E0260 2083 HOSP BED (E0260), SEMI-ELEC, * * W/ SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0261 E0261 2084 HOSP BED (E0261), SEMI-ELEC, * * W/ SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0265 E0265 2086 HOSP BED (E0265), TOTAL ELEC, * * W/ SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0266 E0266 2087 HOSP BED (E0266), TOTAL ELEC, * * W/ SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0271 E0271 2096 MATTRESS, INNERSPRING (E0271) * - ---------------------------------------------------------------------------------------------------------------- E0272 E0272 2095 MATTRESS, FOAM RUBBER (E0272) * - ---------------------------------------------------------------------------------------------------------------- E0273 DM570 2068 BED BOARD (E1399) * - ---------------------------------------------------------------------------------------------------------------- E0274 DM570 2097 OVER-BED TABLE (E0274) * - ---------------------------------------------------------------------------------------------------------------- E0275 E0275 2071 BED PAN, STANDARD (E0275), METAL * OR PLASTIC - ---------------------------------------------------------------------------------------------------------------- E0276 E0276 2070 BED PAN, FRACTURE (E0276), METAL * OR PLASTIC - ---------------------------------------------------------------------------------------------------------------- E0277 E0277 2066 MATTRESS (E0277), LOW AIR LOSS, * * ALT PRESSURE - ---------------------------------------------------------------------------------------------------------------- E0280 DM570 2069 BED CRADLE, ANY TYPE (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E0292 E0292 2092 HOSP BED (E0292), VAR HEIGHT, * * HI-LO, W/OUT S/ RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0293 E0293 2093 HOSP BED (E0293), VAR HEIGHT, * * HI-LO, NO SIDE RAILS, NO MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0294 E0294 2085 HOSP BED (E0294), SEMI-ELEC, * * W/OUT SIDE RAILS, W/ MATTRESS - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0295 E0295 2094 HOSP BED (E0295), SEMI-ELEC, * * W/OUT SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0296 E0296 2089 HOSP BED (E0296), TOTAL ELEC, * * W/OUT SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0297 E0297 2088 HOSP BED (E0297), TOTAL ELEC, * * W/OUT SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0305 E0305 2073 BED SIDE RAILS (E0305), HALF * LENGTH - ---------------------------------------------------------------------------------------------------------------- E0310 E0310 2072 BED SIDE RAILS (E0310), FULL * LENGTH - ---------------------------------------------------------------------------------------------------------------- E0315 DM570 2067 BED ACCESSORIES: BOARDS OR * TABLES, ANY TYPE - ---------------------------------------------------------------------------------------------------------------- E0325 E0325 2060 URINAL; MALE (E0325), JUG-TYPE, * ANY MATERIAL - ---------------------------------------------------------------------------------------------------------------- E0326 E0326 2059 URINAL; FEMALE (E0326), * JUG-TYPE, ANY MATERIAL - ---------------------------------------------------------------------------------------------------------------- E0372 E0372 7008 MATTRESS (E0372) POWERED AIR * * * OVERLAY - ---------------------------------------------------------------------------------------------------------------- E0410 E0444 2369 O2 CONTENTS, LIQUID (E0444), * PER POUND - ---------------------------------------------------------------------------------------------------------------- E0416 E0443 2371 O2 REFILL FOR PORT (E0443) GAS * SYSTEM ONLY, UP TO 23 CUBIC FEET - ---------------------------------------------------------------------------------------------------------------- E0424 E0424 2385 O2 SYS STATIONARY (E0424) COMPR * * GAS, RENT - ---------------------------------------------------------------------------------------------------------------- E0430 E0430 2374 O2 SYS PORT GAS, PURCH (E0430) * - ---------------------------------------------------------------------------------------------------------------- E0431 E0431 2574 O2 SYS PORT GAS, LIGHTWEIGHT * * (E0431) W/CONSERV DEVICE, NO CONTENT - ---------------------------------------------------------------------------------------------------------------- E0431 E0431 2375 O2 SYS PORT GAS, RENT (E0431) * - ---------------------------------------------------------------------------------------------------------------- E0434 E0434 2377 O2 SYS PORT LIQUID,RENT (E0434) * - ---------------------------------------------------------------------------------------------------------------- E0435 E0435 2376 O2 SYS PORT LIQUID, PURCH * * (E0435) - ---------------------------------------------------------------------------------------------------------------- E0439 E0439 2388 O2 SYS STATIONARY (E0439) * * LIQUID, RENT - ---------------------------------------------------------------------------------------------------------------- E0440 E0440 2387 O2 SYS STATIONARY (E0440) * LIQUID, PURCH - ---------------------------------------------------------------------------------------------------------------- E0443 E0400 2869 O2 CONTENTS, H/K CYLINDER * (E0400), 200-300 CUBIC FT - ---------------------------------------------------------------------------------------------------------------- E0444 E0444 2379 O2 CONTENTS, PORT LIQUID * (E0444), PER UNIT (1 UNIT = 1 LB.) - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 7555 POSITIVE PRESSURE VENTS * * (E0450)(E.G. T-BIRD) - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 2392 VENTILATOR VOLUME (E0450), * * STATIONARY OR PORT - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 7522 VENTILATOR, VOLUME, (E0450) * * EMERGENCY BACKUP UNIT - ---------------------------------------------------------------------------------------------------------------- E0452 E0452 2332 BILEVEL INTERMITTENT (E0452) * * ASSIST DEVICE,(BIPAP) - ---------------------------------------------------------------------------------------------------------------- E0453 E0453 2390 VENTILATOR THERAPEUTIC (E0453); * * FOR USE 12 HOURS OR LESS PER DAY - ---------------------------------------------------------------------------------------------------------------- E0455 E0455 2372 O2 TENT (E0455), EXCLUDING * * CROUP OR PEDIATRIC TENTS - ---------------------------------------------------------------------------------------------------------------- E0457 E0457 2323 CHEST SHELL (CUIRASS) (E0457) * * - ---------------------------------------------------------------------------------------------------------------- E0459 E0459 2324 CHEST WRAP (E0459) * * - ---------------------------------------------------------------------------------------------------------------- E0460 E0460 2339 VENTILATOR (E0460), NEGATIVE * * PRESSURE, PORTABLE OR STATIONARY - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0480 DM570 2373 PERCUSSOR (E0480), ELEC OR * * PNEUM, HOME MODEL - ---------------------------------------------------------------------------------------------------------------- E0500 E0500 2333 IPPB, W/ BUILT-IN NEB (E0500) * * MAN OR AUTO VALVES; INT/EXT POWER - ---------------------------------------------------------------------------------------------------------------- E0550 E0550 2328 HUMIDIFIER (E0550) DURABLE FOR * * EXTENSIV SUP/ HUMID W/ IPPB OR O2 - ---------------------------------------------------------------------------------------------------------------- E0555 E0555 2330 HUMIDIFIER (E0555), DURABLE, * GLASS, FOR USE W/ REG OR FLOWMETER - ---------------------------------------------------------------------------------------------------------------- E0565 E0565 2325 COMPRESSOR, AIR POWER (E0565) * * - ---------------------------------------------------------------------------------------------------------------- E0570 E0570 2336 NEBULIZER, W/ COMPRESSOR (E0570) * * - ---------------------------------------------------------------------------------------------------------------- E0575 DM570 2571 NEBULIZER (E0575), ULTRASONIC, * * AC/DC - ---------------------------------------------------------------------------------------------------------------- E0575 DM570 2338 NEBULIZER; ULTRASONIC (E0575) * * - ---------------------------------------------------------------------------------------------------------------- E0585 E0585 2337 NEBULIZER(E0585), W/ COMPRESSOR * * AND HEATER - ---------------------------------------------------------------------------------------------------------------- E0600 E0600 2389 SUCTION PUMP (E0600), HOME MODEL * * - ---------------------------------------------------------------------------------------------------------------- E0600 E0600 7523 SUCTION UNIT, (E0600), PORTABLE * * AC/DC - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 2326 CONTINUOUS POSITVE (E0601) * * AIRWAY PRESSURE DEVICE (CPAP) - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 6965 CPAP, SELF TITRATING (E0601) * * - ---------------------------------------------------------------------------------------------------------------- E0605 DM570 2391 VAPORIZER, ROOM TYPE (E0605) * - ---------------------------------------------------------------------------------------------------------------- E0606 DM570 2380 POSTURAL DRAINAGE BOARD (E0606) * - ---------------------------------------------------------------------------------------------------------------- E0607 E0607 6874 MONITOR, B/GLUCOSE (E0607) * ACCUCHEK AD - ---------------------------------------------------------------------------------------------------------------- E0607 E0607 2164 MONITOR, BLOOD GLUCOSE (E0607) * - ---------------------------------------------------------------------------------------------------------------- E0618 E0608 2322 APNEA MONITOR (E0608) * * - ---------------------------------------------------------------------------------------------------------------- E0619 E0608 2576 APNEA MONITOR (E0608) W/MEM * * (INCL SMART) - ---------------------------------------------------------------------------------------------------------------- E0609 E0609 2146 MONITOR, BLOOD GLUCOSE (E0609) * W/SPECIAL FEATURES - ---------------------------------------------------------------------------------------------------------------- E0621 E0621 2215 PATIENT LIFT (E0621), SLING OR * SEAT, CANVAS OR NYLON - ---------------------------------------------------------------------------------------------------------------- E0625 DM570 2191 PATIENT LIFT (E0625), KARTOP, * BATHROOM OR TOILET - ---------------------------------------------------------------------------------------------------------------- E0627 E0627 4553 HIP CHAIR (E0627) * * - ---------------------------------------------------------------------------------------------------------------- E0627 DM570 2395 SEAT LIFT CHAIR/MOTORIZED * (E0627) - ---------------------------------------------------------------------------------------------------------------- E0627 DM570 2205 SEAT LIFT MECH (E0627) * INCORPORATED INTO A COMB LIFT-CHAIR MECH - ---------------------------------------------------------------------------------------------------------------- E0630 E0630 2190 PATIENT LIFT, HYDRAULIC * * (E0630), W/ SEAT OR SLING - ---------------------------------------------------------------------------------------------------------------- E0635 DM570 2189 PATIENT LIFT (E0635), ELEC W/ * SEAT OR SLING - ---------------------------------------------------------------------------------------------------------------- E0650 E0650 2192 PNEUM COMPRESSOR (E0650), * * NON-SEG HOME MODEL - ---------------------------------------------------------------------------------------------------------------- E0651 E0651 2194 PNEUM COMPRESSOR (E0651), SEG * * HOME MODEL W/OUT CALIB GRAD PRES - ---------------------------------------------------------------------------------------------------------------- E0652 E0652 2193 PNEUM COMPRESSOR (E0652), SEG * * HOME MODEL W/ CALIB GRAD PRES - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0655 E0655 2182 PNEUM COMPRESSOR (E0655), * NON-SEG APPLIANCE, HALF ARM - ---------------------------------------------------------------------------------------------------------------- E0660 E0660 2181 PNEUM COMPRESSOR (E0660), * NON-SEG APPLIANCE, FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0665 E0665 2180 PNEUM COMPRESSOR (E0665), * NON-SEG APPLIANCE, FULL ARM - ---------------------------------------------------------------------------------------------------------------- E0666 E0666 2183 PNEUM COMPRESSOR (E0666), * NON-SEG APPLIANCE, HALF LEG - ---------------------------------------------------------------------------------------------------------------- E0667 E0667 2210 PNEUM APPLIANCE (E0667), SEG, * FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0668 E0668 2209 PNEUM APPLIANCE (E0668), SEG, * FULL ARM - ---------------------------------------------------------------------------------------------------------------- E0669 E0669 2212 PNEUM APPLIANCE (E0669), SEG, * HALF LEG - ---------------------------------------------------------------------------------------------------------------- E0670 E0670 2211 PNEUM APPLIANCE (E0670), SEG, * HALF ARM - ---------------------------------------------------------------------------------------------------------------- E0671 E0671 2207 PNEUM APPLIANCE (E0671), SEG * GRAD PRESS, FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0672 E0672 2206 PNEUM APPLIANCE (E0672), SEG * GRAD PRESS, FULL ARM - ---------------------------------------------------------------------------------------------------------------- E0673 E0673 2208 PNEUM APPLIANCE (E0673), SEG * GRAD PRESS, HALF LEG - ---------------------------------------------------------------------------------------------------------------- E0690 DM570 2221 ULTRAVIOLET CABINET (E0690), * APPROPRIATE FOR HOME USE - ---------------------------------------------------------------------------------------------------------------- E0700 DM570 2204 SAFETY EQUIP (E0700) (E.G., * BELT, HARNESS OR VEST) - ---------------------------------------------------------------------------------------------------------------- E0710 DM570 2202 RESTRAINTS (E0710), ANY TYPE * (BODY, CHEST, WRIST OR ANKLE) - ---------------------------------------------------------------------------------------------------------------- E0720 E0720 2219 TENS (E0720), TWO LEAD, * * LOCALIZED STIMULATION - ---------------------------------------------------------------------------------------------------------------- E0730 E0730 2218 TENS (E0730), FOUR LEAD, LARGER * * AREA/MULTIPLE NERVE STIMULATION - ---------------------------------------------------------------------------------------------------------------- E0731 E0731 2159 TENS OR NMES (E0731), CONDUCTIVE * * GARMENT - ---------------------------------------------------------------------------------------------------------------- E0744 E0744 2120 STIMULATOR (E0744), * * NEUROMUSCULAR FOR SCOLIOSIS - ---------------------------------------------------------------------------------------------------------------- E0745 E0745 2121 STIMULATOR (E0745), * * NEUROMUSCULAR, ELECTRONIC SHOCK UNIT - ---------------------------------------------------------------------------------------------------------------- E0745 E0745 6915 STIMULATOR FOUR CH (E0745), * * NEUROMUSCULAR - ---------------------------------------------------------------------------------------------------------------- E0746 DM570 2109 ELECTROMYOGRAPHY (EMG) (E0746), * * BIOFEEDBACK DEVICE - ---------------------------------------------------------------------------------------------------------------- E0747 DM570 2122 STIMULATOR (E0747), OSTEOGENIC, * NON-INVASIVE - ---------------------------------------------------------------------------------------------------------------- E0748 DM570 2124 STIMULATOR (E0748), OSTEOGENIC * NON-INVASIVE, SPINAL APPLICATIONS - ---------------------------------------------------------------------------------------------------------------- E0755 DM570 2157 STIMULATOR (E0755), ELECTRONIC * SALIVARY REFLEX, NON INVASIVE - ---------------------------------------------------------------------------------------------------------------- E0776 E0776 2175 IV POLE (E0776) * * - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 2158 PUMP (E0784), EXT AMBULATORY * INFUSION, MINIMED, INSULIN - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 7925 PUMP, EXT INFUSION, MINIMED * PREMIUM, INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 6771 PUMP (E0784), INSULIN EXT * INFUSION DISETRONICS OR OTHER - ---------------------------------------------------------------------------------------------------------------- E0840 E0840 2133 TRACTION FRAME (E0840), ATTACH * * TO HEADBOARD, CERVICAL TRACTION - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0850 E0850 2134 TRACTION STAND (E0850), FREE * * STANDING, CERVICAL TRACTION - ---------------------------------------------------------------------------------------------------------------- E0855 E0855 7484 TRACTION (E0855), W/O FRAME OR * * STAND - ---------------------------------------------------------------------------------------------------------------- E0860 E0860 2130 TRACTION EQUIP (E0860), * * OVERDOOR, CERVICAL - ---------------------------------------------------------------------------------------------------------------- E0870 E0870 2131 TRACTION FRAME (E0870), ATTACH * * TO FOOTBOARD, EXTREMITY, BUCKS - ---------------------------------------------------------------------------------------------------------------- E0880 E0880 2135 TRACTION STAND (E0880) * * FREE/STAND EXTREMITY TRACTION, EG, BUCK'S - ---------------------------------------------------------------------------------------------------------------- E0890 E0890 2132 TRACTION FRAME (E0890), ATTACH * * TO FOOTBOARD, PELVIC TRACTION - ---------------------------------------------------------------------------------------------------------------- E0900 E0900 2136 TRACTION STAND (E0900) FREE/ * * STAND PELVIC TRACTION,(EG, BUCK'S) - ---------------------------------------------------------------------------------------------------------------- E0910 E0910 2138 TRAPEZE BARS (E0910), A/K/A PT * * HELPER, ATTACH TO BED W/ GRAB BAR - ---------------------------------------------------------------------------------------------------------------- E0920 E0920 2111 FRACTURE FRAME (E0920), ATTACH * * TO BED, INCLUDING WEIGHTS - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2125 PASSIVE MOTION (E0935) EXERCISE * * * DEVICE - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2859 PASSIVE MOTION (E0935) EXERCISE * * * DEVICE, ANKLE - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2860 PASSIVE MOTION (E0935) EXERCISE * * * DEVICE, ELBOW - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2857 PASSIVE MOTION (E0935) EXERCISE * * * DEVICE, HAND - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2858 PASSIVE MOTION (E0935) EXERCISE * * * DEVICE, SHOULDER - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2861 PASSIVE MOTION (E0935) EXERCISE * * * DEVICE, WRIST - ---------------------------------------------------------------------------------------------------------------- E0940 E0940 2137 TRAPEZE BAR (E0940), FREE * * STANDING, COMPLETE W/ GRAB BAR - ---------------------------------------------------------------------------------------------------------------- E0941 E0941 2116 TRACTION DEVICE (E0941), * * GRAVITY ASSISTED - ---------------------------------------------------------------------------------------------------------------- E0942 E0942 2101 HARNESS/HALTER (E0942), * * CERVICAL HEAD - ---------------------------------------------------------------------------------------------------------------- E0944 E0944 2126 HARNESS (E0944), PELVIC BELT, * * BOOT - ---------------------------------------------------------------------------------------------------------------- E0945 DM570 2110 HARNESS (E0945), EXTREMITY BELT * * - ---------------------------------------------------------------------------------------------------------------- E0946 E0946 2115 FRACTURE, FRAME (E0946), DUAL * * W/ CROSS BARS, ATTACH TO BED - ---------------------------------------------------------------------------------------------------------------- E0947 E0947 2113 FRACTURE FRAME (E0947), * * ATTACHMENTS FOR COMPLEX PELVIC TRACTION - ---------------------------------------------------------------------------------------------------------------- E0948 E0948 2112 FRACTURE FRAME (E0948) * * ATTACHMENTS FOR COMPLEX CERVICAL TRACTION - ---------------------------------------------------------------------------------------------------------------- E0950 DM570 2139 TRAY (E0950) * * - ---------------------------------------------------------------------------------------------------------------- E0958 E0958 2307 W/C PART ATTACHMENT (E0958) TO * * CONVERT ANY W/C TO ONE ARM DRIVE - ---------------------------------------------------------------------------------------------------------------- E0959 E0959 2237 W/C PART AMPUTEE ADAPTER(E0959) * * (COMPENSATE FOR TRANS OF WEIGHT) - ---------------------------------------------------------------------------------------------------------------- E0962 E0962 2232 CUSHION FOR WC 1" (E0962) * * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0963 E0963 2233 CUSHION FOR WC 2" (E0963) * * - ---------------------------------------------------------------------------------------------------------------- E0964 E0964 2234 CUSHION FOR WC 3" (E0964) * * - ---------------------------------------------------------------------------------------------------------------- E0965 E0965 2235 CUSHION FOR WC 4" (E0965) * * - ---------------------------------------------------------------------------------------------------------------- E0972 DM570 2230 TRANSFER BOARD OR DEVICE (E0972) * * - ---------------------------------------------------------------------------------------------------------------- E0977 E0977 2317 CUSHION, WEDGE FOR W/C (E0977) * * - ---------------------------------------------------------------------------------------------------------------- E0978 E0978 2248 BELT, SAFETY (E0978) W/ * * AIRPLANE BUCKLE, W/C - ---------------------------------------------------------------------------------------------------------------- E0979 DM570 2249 BELT, SAFETY (E0979) W/ VELCRO * * CLOSURE, W/C - ---------------------------------------------------------------------------------------------------------------- E0980 DM570 2292 SAFETY VEST (E0980), W/C * * - ---------------------------------------------------------------------------------------------------------------- E1031 E1031 2291 ROLLABOUT CHAIR (E1031), W/ * * CASTORS 5" OR GREATER - ---------------------------------------------------------------------------------------------------------------- E1050 E1050 2260 W/C FULL/REC (E1050), FIX ARMS, * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1060 E1060 2259 W/C FULL/REC (E1070), DETACH * * ARMS, SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1065 E1065 2287 W/C POWER ATTACHMENT (E1065) * * - ---------------------------------------------------------------------------------------------------------------- E1066 E1066 2247 BATTERY CHARGER (E1066) * * - ---------------------------------------------------------------------------------------------------------------- E1069 E1069 2255 BATTERY, DEEP CYCLE (E1069) * * - ---------------------------------------------------------------------------------------------------------------- E1070 E1070 2258 W/C FULL/REC (E1060), DETACH * * ARMS, SWING AWAY DET/ ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1083 E1083 2263 W/C HEMI (E1083), FIX ARMS, * * SWING AWAY DETACH ABLE ELEV LEG REST - ---------------------------------------------------------------------------------------------------------------- E1084 E1084 2262 W/C HEMI (E1084), DETACH ARMS, * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1085 E1085 2264 W/C HEMI (E1085), FIX ARMS, * * SWING AWAY DETACH ABLE FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1086 E1086 2261 W/C HEMI (E1086), DETACH ARMS, * * SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1087 E1087 2265 W/C HI STRENGTH LT-WT (E1087), * * FIX ARMS, S/AWAY ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1088 E1088 2268 W/C HI STRENGTH LT-WGT (E1088), * * D/ ARMS, S/AWAY ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1089 E1089 2266 W/C HI STRENGTH LT-WGT (E1089), * * FIX ARMS, S/AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1090 E1090 2267 W/C HI STRENGTH LT-WG (E1090), * * DETACH ARMS, S/AWAY D/FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1091 E1091 2321 W/C YOUTH, ANY TYPE (E1091) * * - ---------------------------------------------------------------------------------------------------------------- E1092 E1092 2319 W/C WIDE HVY DUTY (E1092), * * DETACH ARMS S/AWAY DETACH ELEVAT LEGS - ---------------------------------------------------------------------------------------------------------------- E1093 E1093 2320 W/C WIDE HVY DUTY (E1093), * * DETACH ARMS S/AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1100 E1100 2296 W/C SEMI-RECLINING (E1100), * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1110 E1110 2295 W/C SEMI-RECLINING (E1110), * * DETACH ARMS ELEV LEG REST - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1130 E1130 2303 W/C STANDARD (E1130), FIX OR * * SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1140 E1140 2313 W/C (E1140), DETACH ARMS SWING * * AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1150 E1150 2314 W/C (E1150), DETACH ARMS, SWING * * AWAY DETACH ELEVAT LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1160 E1160 2315 W/C (E1160), W/ FIX ARMS, SWING * * AWAY DETACH ELEVAT LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1160 E1160 2396 W/C (E1160), W/FIX ARMS * * REMOVABLE FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1170 E1170 2241 W/C AMPUTEE (E1170), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1171 E1171 2242 W/C AMPUTEE (E1171), FIX ARMS, * * W/OUT FOOTRESTS OR LEGREST - ---------------------------------------------------------------------------------------------------------------- E1172 E1172 2240 W/C AMPUTEE (E1172), DETACH * * ARMS W/OUT FOOTRESTS OR LEGREST - ---------------------------------------------------------------------------------------------------------------- E1180 E1180 2239 W/C AMPUTEE (E1180), DETACH * * ARMS SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1190 E1190 2238 W/C AMPUTEE (E1190), DETACH * * ARMS SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1195 E1195 2273 W/C HVY DUTY (E1195), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1200 E1200 2243 W/C AMPUTEE (E1200), FIX FULL * * LENGTH ARMS, S/AWAY D/FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1210 E1210 2281 W/C MOTORIZED (E1210), FIX * * ARMS, S/AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1211 E1211 2279 W/C MOTORIZED (E1211), DETACH * * ARMS, S/AWAY DETACH FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1212 E1212 2282 W/C MOTORIZED (E1212), FIX * * ARMS, SWING AWAY DETACH FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1213 E1213 2280 W/C MOTORIZED (E1213), DETACH * * ARMS S/AWAY, DETACH ELEV LEG REST - ---------------------------------------------------------------------------------------------------------------- E1220 E1220 2551 W/C CUSTOM (E1220) * * - ---------------------------------------------------------------------------------------------------------------- E1220 E1220 2579 W/C XXWIDE (E1220) * * * - ---------------------------------------------------------------------------------------------------------------- E1230 E1230 2288 SCOOTER (E1230), THREE OR 4 * * WHEEL - ---------------------------------------------------------------------------------------------------------------- E1240 E1240 2276 W/C LT-WGT (E1240), DETACH ARMS * * SWING AWAY DETACH, ELEV LEGREST - ---------------------------------------------------------------------------------------------------------------- E1250 E1250 2278 W/C LT-WGT (E1250), FIX ARMS, * * SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1260 E1260 2275 W/C LT-WGT (E1260), DETACH ARMS * * SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1270 E1270 2277 W/C LT-WGT (E1270), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1280 E1280 2270 W/C HVY DUTY (E1280), DETACH * * ARMS ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1285 E1285 2274 W/C HVY DUTY (E1285), FIX * * ARMS, SWING AWAY DETACH FOOTREST - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1290 E1290 2271 W/C HVY DUTY (E1290), DETACH * * ARMS SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1295 E1295 2272 W/C HVY DUTY (E1295), FIX ARMS, * * ELEV LEGREST - ---------------------------------------------------------------------------------------------------------------- E1300 DM570 2062 WHIRLPOOL (E1300), PORT * * (OVERTUB TYPE) - ---------------------------------------------------------------------------------------------------------------- E1310 DM570 2061 WHIRLPOOL (E1399), NON-PORT * * (BUILT-IN TYPE) - ---------------------------------------------------------------------------------------------------------------- E1353 E1353 2381 O2 REGULATOR (E1353) * * - ---------------------------------------------------------------------------------------------------------------- E1355 E1355 2384 CYLINDER STAND/RACK (E1355) * * - ---------------------------------------------------------------------------------------------------------------- E1372 E1372 2331 IMMERSION EXT HEATER (E1372) * * FOR NEBULIZER - ---------------------------------------------------------------------------------------------------------------- E1375 E1375 2334 NEBULIZER PORT (E1375) W/ SMALL * * COMPRESSOR, W/ LIMITED FLOW - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2568 ADAPTER (A9900), AC/DC * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2586 APNEA MONITOR DOWNLOAD (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2552 BATH LIFT (E1399), CUSTOM * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2563 BED WEDGE (E1399), 12" * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2856 BEDROOM EQUIPMENT (E1399), * * CUSTOM - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2525 BREAST PUMP, ELECTRIC (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2581 BREAST PUMP, INSTITUTIONAL * * (E1399) - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2580 BREAST PUMP, MANUAL (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2593 COLD THERAPY UNIT, PAD (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2565 COMMODE (E1399), DROP ARM, * * HEAVY DUTY - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2582 COMPRESSION PUMP BOOT (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2583 COMPRESSION PUMP, FOOT (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2569 CPAP HUMIDIFIER (A9900), HEATED * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2635 CPAP/BIPAP SUPPLIES (A9900) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2327 DURABLE MEDICAL EQUIP (E1399), * * MISCELLANEOUS - ---------------------------------------------------------------------------------------------------------------- E1399 E1220 2584 GERI CHAIR (E1399), THREE * * POSITION RECLINING - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 6780 HOLTER MONITOR (G0004) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E0265 2590 HOSP BED (E1399), ELECTRIC, * * XLONG, W/MATTRESS & SIDE RAILS - ---------------------------------------------------------------------------------------------------------------- E1399 E0200 2868 LAMP, ULTRAVIOLET (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2588 MONITOR (E1399), VITAL SIGNS * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2529 O2 ANALYZER (A9900) * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2594 O2 CONSERVATION DEVICE (A9900) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 6775 OXIMETRY TEST (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2555 PATIENT LIFT, CUSTOM (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2561 PEAK FLOW METER (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4559 PEDIATRIC WALKER (E1399) * * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2567 PNEUMOGRAM (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2553 POSITIONING, CUSTOM (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2526 PULSE OXIMETER (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2527 PULSE OXIMETER W/ PROBE (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2562 SHOWER, HAND HELD (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2592 SLEEP STUDY, ADULT (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM590 7483 STIMULATOR (E1399), MUSCLE, LOW * * VOLTAGE OR INTERFERENTIAL - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2855 THERAPY EQUIPMENT, CUSTOM * * (E1399) - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 6774 THERAPY PERCUSSION, GENERATOR * * ONLY - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7506 W/C, CUSTOM (E1399) MANUAL ADULT * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7504 W/C, CUSTOM (E1399) MANUAL * * PEDIATRIC - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7507 W/C, CUSTOM (E1399) POWER ADULT * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7505 W/C, CUSTOM (E1399) POWER * * PEDIATRIC - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2564 WALKER (E1399), HEAVY DUTY, * * EXTRA WIDE - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2585 WALKER (E1399), HEMI * * - ---------------------------------------------------------------------------------------------------------------- K0539 DM570 6873 WOUND SUCTION DEVICE (K0538) * * * - ---------------------------------------------------------------------------------------------------------------- K0539 DM570 7914 DRESSING SET, FOR WOUND SUCTION * * DEVICE (K0539) - ---------------------------------------------------------------------------------------------------------------- K0540 DM570 7915 CANISTER SET, FOR WOUND SUCTION * * DEVICE (K0540) - ---------------------------------------------------------------------------------------------------------------- E1400 E1390 2361 O2 CONC (E1390), MANUF SPEC * * MAXFLOWRATE = 2 LTS PER MIN@85% - ---------------------------------------------------------------------------------------------------------------- G0015 DM570 6779 CARDIAC EVENT MONITOR (G0015) * * - ---------------------------------------------------------------------------------------------------------------- K0163 DM590 3713 ERECTION SYSTEM, VACUUM (K0163) * * - ---------------------------------------------------------------------------------------------------------------- K0183 DM590 2516 CPAP MASK (K0183) * * - ---------------------------------------------------------------------------------------------------------------- K0184 DM590 2515 NASAL PILLOWS/SEALS (K0184) * * REPLACEMENT FOR NASAL APP/ DVC, PAIR - ---------------------------------------------------------------------------------------------------------------- K0185 DM590 2514 CPAP HEADGEAR (K0185) * * - ---------------------------------------------------------------------------------------------------------------- K0186 DM590 2513 CPAP CHIN STRAP (K0186) * * - ---------------------------------------------------------------------------------------------------------------- K0187 DM590 2512 CPAP TUBING (K0187) * * - ---------------------------------------------------------------------------------------------------------------- K0188 DM590 2511 CPAP FILTER (A9900), DISPOSABLE * * - ---------------------------------------------------------------------------------------------------------------- K0189 DM590 2510 CPAP FILTER (A9900), * * NON-DISPOSABLE - ---------------------------------------------------------------------------------------------------------------- K0268 DM590 2509 CPAP HUMIDIFIER (K0268), COOL * * - ---------------------------------------------------------------------------------------------------------------- K0413 DM590 6889 MATTRESS (K0413), NONPOWERED, * * EQUIVALENT - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7673 MATTRESS (E1399) V-CUE DYNAMIC * * * AIR THERAPY - ---------------------------------------------------------------------------------------------------------------- A4608 A9900 7621 CATHETER TRACH (A4608) 11CM 1 * * SCOOP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7664 COFFLATOR (E1399CF) MANUAL SECRETION MOBIL DEVICE * * * - ---------------------------------------------------------------------------------------------------------------- E0168B A9900 7643 COMMODE (E0168B) HVY DUTY * * BEDSIDE CHAIR 251-450 LBS. - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0168C A9900 7644 COMMODE (E0168C) HVY DUTY DROP * * ARM 451-850 LBS. - ---------------------------------------------------------------------------------------------------------------- A6234 HH591 7626 DRESSING <16 SQ IN (A6234) * * HYDROCOLLOID DRESSING, EA - ---------------------------------------------------------------------------------------------------------------- A6258 HH591 7627 DRESSING >16 SQ IN (A6258) * * TRANSPAREN FILM, EA - ---------------------------------------------------------------------------------------------------------------- A46203 HH591 7625 DRESSING COMPOSITE <16 SQ IN * * (A46203) SELF ADH, EA - ---------------------------------------------------------------------------------------------------------------- B9998B DM590 7655 ENT (B9998B) EXT SET Y SITE * * F/KANGAROO PUMP - ---------------------------------------------------------------------------------------------------------------- B9998C DM590 7656 ENT (B9998C) EXT SET W/ CLAMP * * BASIC - ---------------------------------------------------------------------------------------------------------------- B9998D DM590 7657 ENT (B9998D) FARRELL GASTRIC * * RELIEF VLV - ---------------------------------------------------------------------------------------------------------------- B9998E DM590 7658 ENT (B9998E) GASTRO EXT SET * * - ---------------------------------------------------------------------------------------------------------------- B9998F DM590 7659 ENT (B9998F) GASTRO TUBE ANY * * SIZE MIC-KEY OR HIDE A PORT - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7620 HUMID-VENT (E1399) ARTIFICIAL * * NOSE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7660 IPPB (E1399) UNIV SET UP * * W/MANIFOLD NEBULIZER - ---------------------------------------------------------------------------------------------------------------- K0105 A9900 7639 IV POLE (K0105) ATTACH F/ W/C * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7641 MECHANICAL SCALE (E1399) * * PEDIATRIC/NEONATAL - ---------------------------------------------------------------------------------------------------------------- A7008 A9900 7661 NEBULIZER (A7008) KIT PREFILL * * W/STR H20 1L BAX - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7663 O2 CONNECTOR (E1399) * * SIMS/IRRIGATION NOZZLE BAX - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7615 O2 HUMIDIFIER (E1399) * * AQUA+NEONATAL EA HUD - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7623 O2 SWIVEL (E1399) ADAPTER * * ANGLED STERILE - ---------------------------------------------------------------------------------------------------------------- L8501 A9900 7624 SPEAKING VALVE (L8501) WHITE PAS * * - ---------------------------------------------------------------------------------------------------------------- A4319 HH591 7629 STERILE WATER (A4319) F/IRRIG * * 1L BAX - ---------------------------------------------------------------------------------------------------------------- A7001 HH591 7619 SUCTION BOTTLE (A7001) W/LID & * * TUBING - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7616 SUCTION FILTER (E1399) BACTERIA * * - ---------------------------------------------------------------------------------------------------------------- A6265 HH591 7628 TAPE ALL TYPES (A6265) * * EXCLUDING MICROFOAM, PER 18 SQ INCHES - ---------------------------------------------------------------------------------------------------------------- A4481 A9900 7622 TRACH FILTER (A4481) BACTERIA * * ELECTROSTATIC - ---------------------------------------------------------------------------------------------------------------- A4623 A9900 7618 TRACH INNER (A4623) CANNULA * * - ---------------------------------------------------------------------------------------------------------------- A4621 A9900 7617 TRACH TUBE MASK (A4621) COLLAR * * OR HOLDER - ---------------------------------------------------------------------------------------------------------------- A7010 A9900 7662 TUBING (A7010) AEROSOL * * CORRUGATED PER FOOT - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7631 VENT ADAPTER (E1399) MDI HUD * * - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7630 VENT BATTERY CHARGER (A9900) * * 12V GEL - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7632 VENT CONNECTOR (E1399) PED OR * * ADULT OMNIFLEX DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7633 VENT FILTER (E1399) HYGROBAC S * * ELECTOSTATIC MAL - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7634 VENT THERMOMETER (E1399) W/ * * ADAPTER - ---------------------------------------------------------------------------------------------------------------- K0108 A9900 7638 W/C BRAKE EXTENSION (K0108) TIP * * BLK 10/PK - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7635 WALKER BASKET (E1399) VINYL * * COATED - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0159 A9900 7640 WALKER BRAKE (E0159) ATTACHMENT * * - ---------------------------------------------------------------------------------------------------------------- E0148 A9900 7636 WALKER HVY DUTY (E0148) FOLDING * * X-WIDE - ---------------------------------------------------------------------------------------------------------------- E0149 A9900 7637 WALKER HVY DUTY (E0149) W/ * * WHEELS - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7645 CPAP (E1399) DC BATTERY ADAPTER * * CABLE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7646 CPAP (E1399) EXHALATION PORT * * DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7647 CPAP (E1399) FUSE KIT * * INTERNATIONAL A/C - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7648 CPAP (E1399) HUMIDIFIER CHAMBER * * KIT DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7649 CPAP (E1399) HUMIDIFIER CHAMBER * * REUSABLE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7650 CPAP (E1399) HUMIDIFIER * * MOUNTING TRAY - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7651 CPAP (E1399) INVERTOR AC/DC * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7652 CPAP (E1399) POWER CORD * * F/ARIA-SYNC - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7653 CPAP (E1399) SHELL W/O PRESSURE * * TAP - ---------------------------------------------------------------------------------------------------------------- A9900 DM590 7566 CPAP CALIBRATION SHELL (A9900) * * - ---------------------------------------------------------------------------------------------------------------- A9900 DM590 7565 CPAP SHORT TUBING (A9900) * * - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 7690 VENT, CONTINUOUS POSITIVE * * (E0500) AIRWAY PRESSURE DEVICE - ---------------------------------------------------------------------------------------------------------------- E0452 E0452 7691 VENT, BILEVEL INTERMITTENT * * (E0500) ASSIST DEVICE (BIPAP) - ---------------------------------------------------------------------------------------------------------------- E0747 DM570 6875 STIMULATOR, OSTEOGENIC, * * ULTRASOUND - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7695 GEL/SILICON GOLD SEAL * * CPAP/BIPAP MASK (A9900) - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7701 VENT THERAPEUTIC ST BIPAP W/ * * BACKUP RATE (K0533) - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7703 O2 SYS HELIOS PORT LIQUID, RENT * * (E1399) - ---------------------------------------------------------------------------------------------------------------- HH591 HH591 7704 PUMP, EXT INFUSION, DANA * * DIABECARE, INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 7731 PUMP, EXT INFUSION, ANIMAS, * * INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7737 CPAP DREAM SEAL INTERFACE FOR * * USE WITH BREEZE MASK (A9900) - ---------------------------------------------------------------------------------------------------------------- A7036 DM590 7738 CPAP CHIN STRAP DELUXE (K0186) * * - ---------------------------------------------------------------------------------------------------------------- E1340 E1340 7768 W/C REPAIRS - CUSTOM (E1340) * * - ----------------------------------------------------------------------------------------------------------------
The following may be charged under extraordinary circumstances: - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4551 LABOR/SERVICE/SHIPPING CHARGES * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2731 SHIPPING AND HANDLING FEES * * - ----------------------------------------------------------------------------------------------------------------
The following may be charged if over and above routine on rental equipment: - ---------------------------------------------------------------------------------------------------------------- E1350 E1350 2382 REPAIR OR NON-ROUTINE (E1350) * * SERVICE REQUIRING SKILL OF A TECH - ---------------------------------------------------------------------------------------------------------------- E1340 E1340 2554 W/C REPAIRS - STANDARD (E1340) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4552 MISCELLANEOUS SUPPLIES * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2589 REPAIR (E1399), RESPIRATORY * * EQUIPMENT - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4561 RESPIRATORY SUPPLIES (A4618) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4549 TENS/APNEA SUPPLIES * * - ----------------------------------------------------------------------------------------------------------------
NOTES: * * * * * * DME/HOME RESPIRATORY RATES: RATES EFFECTIVE APRIL 1, 2004 - DECEMBER 31, 2004
- ---------------------------------------------------------------------------------------------------------------- HCPCS CHC GENTIVA CODE CODE CODE DESCRIPTION PURCHASE PRICE RENTAL PRICE DAILY PRICE - ---------------------------------------------------------------------------------------------------------------- A4660 DM590 2520 MONITOR, BLOOD PRESSURE (A4660) * W/STETH & CUFF - ---------------------------------------------------------------------------------------------------------------- A4670 DM590 2518 MONITOR, BLOOD PRESSURE (A4670), * AUTOMATIC - ---------------------------------------------------------------------------------------------------------------- A7034 A9900 7552 BREEZE (A9900) CPAP/BIPAP MASK * - ---------------------------------------------------------------------------------------------------------------- A7034 A9900 7553 FULL FACE (A9900) MIRAGE * CPAP/BIPAP MASK - ---------------------------------------------------------------------------------------------------------------- A7034 A9900 7554 GEL/SILICON (A9900) CPAP/BIPAP * MASK INCL GLD SEAL, PHANTM, MONARCH - ---------------------------------------------------------------------------------------------------------------- A7034 A9900 7556 SPECIALTY (A9900) CPAP/BIPAP * MASK (PROFILE OR SIMPICITY) - ---------------------------------------------------------------------------------------------------------------- B9002 HI531 2570 PUMP, ENTERAL (B9002) * * - ---------------------------------------------------------------------------------------------------------------- B9998 DM590 6828 ENTERAL SUPPLIES (B9998) * - ---------------------------------------------------------------------------------------------------------------- DM590 DM570 7551 BACK-PACK (E1399), FOR * PORTABLE ENTERAL PUMP - ---------------------------------------------------------------------------------------------------------------- A4615 DM590 2522 CANNULA, NASAL * - ---------------------------------------------------------------------------------------------------------------- B9002 DM590 7509 ENTERAL PUMP, PORTABLE (B9002) * * - ---------------------------------------------------------------------------------------------------------------- A7034 DM590 7508 MASK, CPAP GEL OR SILICONE * (K0183) - ---------------------------------------------------------------------------------------------------------------- E0100 E0100 2020 CANE (E0100), ADJ OR FIX, W/ TIP * - ---------------------------------------------------------------------------------------------------------------- E0105 E0105 2021 CANE, QUAD (E0105) OR THREE * PRONG, ADJ OR FIX, W/ TIPS - ---------------------------------------------------------------------------------------------------------------- E0110 E0110 2028 CRUTCHES, FOREARM (E0110), ADJ * OR FIX, PAIR, W/ TIPS, GRIPS - ---------------------------------------------------------------------------------------------------------------- E0111 E0111 2023 CRUTCH FOREARM (E0111), ADJ OR * FIX, EACH, W/ TIP AND GRIPS - ---------------------------------------------------------------------------------------------------------------- E0112 E0112 2027 CRUTCHES UNDERARM, WOOD * (E0112), ADJ OR FIX, PAIR, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0113 E0113 2025 CRUTCH UNDERARM, WOOD (E0113), * ADJ OR FIX, EACH, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0114 E0114 2026 CRUTCHES UNDERARM, ALUM (E0114), * ADJ OR FIX, PAIR, COMPLETE - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0116 E0116 2024 CRUTCH UNDERARM, ALUM (E0116), * ADJ OR FIX, EACH, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0130 E0130 2037 WALKER, RIGID (E0130) * (PICKUP), ADJ OR FIX HEIGHT - ---------------------------------------------------------------------------------------------------------------- E0135 E0135 2036 WALKER, FOLDING (E0135) * (PICKUP), ADJ OR FIX HEIGHT - ---------------------------------------------------------------------------------------------------------------- E0141 E0141 2040 WALKER, WHEELED (E0141), W/OUT * SEAT - ---------------------------------------------------------------------------------------------------------------- E0142 DM570 2034 RIGID WALKER (E0142), WHEELED, * W/ SEAT, - ---------------------------------------------------------------------------------------------------------------- E0143 E0143 2029 WALKER FOLDING, WHEELED * (E0143), W/OUT SEAT - ---------------------------------------------------------------------------------------------------------------- E0145 DM570 2039 WALKER (E0145), WHEELED, W/ * SEAT AND CRUTCH ATTACHMENTS - ---------------------------------------------------------------------------------------------------------------- E0146 DM570 2038 WALKER, WHEELED, W/ SEAT (E0146) * - ---------------------------------------------------------------------------------------------------------------- E0147 E0147 2030 WALKER HVY DUT (E0147), MULT * BRAKING SYS, VAR WHEEL RESISTANCE - ---------------------------------------------------------------------------------------------------------------- E0153 E0153 2032 CRUTCH PLATFORM ATTACHMENT * (E0153), FOREARM EA - ---------------------------------------------------------------------------------------------------------------- E0154 E0154 2033 WALKER PLATFORM ATTACHMENT * (E0154), EA - ---------------------------------------------------------------------------------------------------------------- E0155 E0155 2041 WALKER WHEEL ATTACHMENT (E0155), * RIGID (PICKUP) WALKER - ---------------------------------------------------------------------------------------------------------------- E0156 DM570 2035 WALKER SEAT ATTACHMENT (E0156) * - ---------------------------------------------------------------------------------------------------------------- E0157 E0157 2022 WALKER, CRUTCH ATTACHMENT * (E0157), EACH - ---------------------------------------------------------------------------------------------------------------- E0158 E0158 2031 WALKER LEG EXTENSIONS (E0158) * - ---------------------------------------------------------------------------------------------------------------- E0163 E0163 2047 COMMODE CHAIR, STATIONARY * (E0163), W/ FIX ARMS - ---------------------------------------------------------------------------------------------------------------- E0164 E0164 2045 COMMODE CHAIR, MOBILE * (E0164), W/ FIX ARMS - ---------------------------------------------------------------------------------------------------------------- E0165 E0165 2046 COMMODE CHAIR (E0165), * STATIONARY, W/ DETACH ARMS - ---------------------------------------------------------------------------------------------------------------- E0165 E0165 2591 COMMODE, XXWIDE(E0165) * - ---------------------------------------------------------------------------------------------------------------- E0166 E0166 2044 COMMODE CHAIR (E0166), MOBILE, * W/ DETACH ARMS - ---------------------------------------------------------------------------------------------------------------- E0167 E0167 2051 COMMODE CHAIR, PAIL OR PAN * (E0167) - ---------------------------------------------------------------------------------------------------------------- E0176 E0176 2142 CUSHION (E0176) OR AIR PRESSURE * PAD, NON-POSITIONING - ---------------------------------------------------------------------------------------------------------------- E0176 E0176 2394 REPLACEMENT PAD (E0176) * ALTERNATING PRESS - ---------------------------------------------------------------------------------------------------------------- E0177 E0177 2224 CUSHION OR WATER PRESS PAD * (E0177), NONPOSITIONING - ---------------------------------------------------------------------------------------------------------------- E0178 E0178 2160 CUSHION OR GEL PRESS PAD * (E0178), NONPOSITIONING - ---------------------------------------------------------------------------------------------------------------- E0179 E0179 2154 CUSHION (E0179) OR DRY PRESSURE * PAD, NONPOSTIONING - ---------------------------------------------------------------------------------------------------------------- E0180 E0180 2196 PUMP (E0180), ALTERNATING * * PRESSURES W/PAD - ---------------------------------------------------------------------------------------------------------------- E0181 E0181 2197 PUMP (E0181), ALTERNATING PRESS * * W/PAD, HVY DUTY - ---------------------------------------------------------------------------------------------------------------- E0184 E0184 2074 MATTRESS, DRY PRESSURE (E0184) * - ---------------------------------------------------------------------------------------------------------------- E0185 E0185 2076 MATTRESS (E0185), GEL OR * GEL-LIKE PRESSURE PAD - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0186 E0186 2064 MATTRESS, AIR PRESSURE (E0186) * - ---------------------------------------------------------------------------------------------------------------- E0187 E0187 2099 MATTRESS, WATER PRESSURE (E0187) * - ---------------------------------------------------------------------------------------------------------------- E0188 DM570 2217 PAD, SYNTHETIC SHEEPSKIN (A9900) * - ---------------------------------------------------------------------------------------------------------------- E0189 DM570 2177 PAD, LAMBSWOOL SHEEPSKIN * (E0189), ANY SIZE - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2573 CUSHION, JAY FOR W/C (E0192) * * - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2572 CUSHION, ROHO FOR W/C (E0192) * * - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2178 W/C PAD (E0192), LOW PRESS AND * * POSITIONING EQUALIZATION - ---------------------------------------------------------------------------------------------------------------- E0193 E0193 2098 MATTRESS, LOW AIR LOSS (E0193), * * * INCL. BED - ---------------------------------------------------------------------------------------------------------------- E0194 DM570 2063 AIR FLUIDIZED BED (E0194) * * * - ---------------------------------------------------------------------------------------------------------------- E0270 E1399 6887 HOSPITAL BED INSTITUTIONAL * * * - ---------------------------------------------------------------------------------------------------------------- E0196 E0196 2077 MATTRESS, GEL PRESSURE (E0196) * - ---------------------------------------------------------------------------------------------------------------- E0197 E0197 2065 MATTRESS, AIR PRESSURE PAD * (E0197) - ---------------------------------------------------------------------------------------------------------------- E0198 E0198 2100 MATTRESS (E0198), WATER * PRESSURE PAD - ---------------------------------------------------------------------------------------------------------------- E0199 E0199 2075 MATTRESS, DRY PRESSURE PAD * (E0199) - ---------------------------------------------------------------------------------------------------------------- E0200 E0200 2228 HEAT LAMP (E0200), W/OUT * STAND, INCL/BULB, OR INFRARED ELEMENT - ---------------------------------------------------------------------------------------------------------------- E0202 E0202 2229 PHOTOTHERAPY (BILIRUBIN) * * (E0202), LIGHT WIT - ---------------------------------------------------------------------------------------------------------------- E0202 E0202 2524 PHOTOTHERAPY, BILI BLANKET * * (E0202) - ---------------------------------------------------------------------------------------------------------------- E0205 E0205 2227 HEAT LAMP (E0205), WITH STAND, * INCL/ BULB, OR INFRARED ELEMENT - ---------------------------------------------------------------------------------------------------------------- E0210 DM570 2156 HEATING PAD, STANDARD (E0210) * - ---------------------------------------------------------------------------------------------------------------- E0215 DM570 2155 HEATING PAD (E0215), ELECTRIC, * MOIST - ---------------------------------------------------------------------------------------------------------------- E0218 DM570 2560 COLD THERAPY UNIT (E0218) * * * - ---------------------------------------------------------------------------------------------------------------- E0235 DM570 2187 PARAFFIN BATH UNIT, PORT (E0235) * - ---------------------------------------------------------------------------------------------------------------- E0236 DM570 2199 PUMP (E0236) FOR WATER * CIRCULATING PAD - ---------------------------------------------------------------------------------------------------------------- E0237 DM570 2223 HEAT COLD WATER (E0237) * CIRCULATING PAD W/PUMP - ---------------------------------------------------------------------------------------------------------------- E0238 DM570 2179 HEATING PAD (E0238), MOIST, * NON-ELECTRIC - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2867 BATH TUB RAIL (E0241), WALL, * L-SHAPE - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2862 BATH TUB RAIL, WALL, 12" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2863 BATH TUB RAIL, WALL, 16" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2864 BATH TUB RAIL, WALL, 18" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2865 BATH TUB RAIL, WALL, 24" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2866 BATH TUB RAIL, WALL, 36" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2043 BATH TUB RAIL, WALL, * UNSPECIFIED SIZE - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0242 DM570 2042 BATH TUB RAIL, FLOOR BASE * (E0242) - ---------------------------------------------------------------------------------------------------------------- E0243 DM570 2056 TOILET RAIL, EACH (E0243) * - ---------------------------------------------------------------------------------------------------------------- E0244 E0244 2587 TOILET SEAT (E0244) RAISED WITH * ARMS - ---------------------------------------------------------------------------------------------------------------- E0244 E0244 2052 TOILET SEAT, RAISED (E0244) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2575 BATH BENCH WITH BACK (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2058 BATH TUB STOOL OR BENCH (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2578 TRANSFER BENCH, NON-PADDED * (E0245) - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2577 TRANSFER BENCH, PADDED (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0246 DM570 2057 TRANSFER TUB RAIL(E0246), * ATTACHMENT - ---------------------------------------------------------------------------------------------------------------- E0249 DM570 2186 HEAT UNIT (E0249), WATER * CIRCULATING PAD - ---------------------------------------------------------------------------------------------------------------- E0255 E0255 2090 HOSP BED (E0255), VAR HEIGHT, * * HI-LO, W/ SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0256 E0256 2091 HOSP BED (E0256), VAR HEIGHT, * * HI-LO, W/ SIDE RAILS, W/O MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0260 E0260 2083 HOSP BED (E0260), SEMI-ELEC, W/ * * SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0261 E0261 2084 HOSP BED (E0261), SEMI-ELEC, W/ * * SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0265 E0265 2086 HOSP BED (E0265), TOTAL ELEC, * * W/ SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0266 E0266 2087 HOSP BED (E0266), TOTAL ELEC, * * W/ SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0271 E0271 2096 MATTRESS, INNERSPRING (E0271) * - ---------------------------------------------------------------------------------------------------------------- E0272 E0272 2095 MATTRESS, FOAM RUBBER (E0272) * - ---------------------------------------------------------------------------------------------------------------- E0273 DM570 2068 BED BOARD (E1399) * - ---------------------------------------------------------------------------------------------------------------- E0274 DM570 2097 OVER-BED TABLE (E0274) * - ---------------------------------------------------------------------------------------------------------------- E0275 E0275 2071 BED PAN, STANDARD (E0275), * METAL OR PLASTIC - ---------------------------------------------------------------------------------------------------------------- E0276 E0276 2070 BED PAN, FRACTURE (E0276), * METAL OR PLASTIC - ---------------------------------------------------------------------------------------------------------------- E0277 E0277 2066 MATTRESS (E0277), LOW AIR LOSS, * * * ALT PRESSURE - ---------------------------------------------------------------------------------------------------------------- E0280 DM570 2069 BED CRADLE, ANY TYPE (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E0292 E0292 2092 HOSP BED (E0292), VAR HEIGHT, * * HI-LO, W/OUT S/ RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0293 E0293 2093 HOSP BED (E0293), VAR HEIGHT, * * HI-LO, NO SIDE RAILS, NO MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0294 E0294 2085 HOSP BED (E0294), SEMI-ELEC, * * W/OUT SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0295 E0295 2094 HOSP BED (E0295), SEMI-ELEC, * * W/OUT SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0296 E0296 2089 HOSP BED (E0296), TOTAL ELEC, * * W/OUT SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0297 E0297 2088 HOSP BED (E0297), TOTAL ELEC, * * W/OUT SIDE RAILS, W/ MATTRESS - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0305 E0305 2073 BED SIDE RAILS (E0305), HALF * * LENGTH - ---------------------------------------------------------------------------------------------------------------- E0310 E0310 2072 BED SIDE RAILS (E0310), FULL * LENGTH - ---------------------------------------------------------------------------------------------------------------- E0315 DM570 2067 BED ACCESSORIES: BOARDS OR * TABLES, ANY TYPE - ---------------------------------------------------------------------------------------------------------------- E0325 E0325 2060 URINAL; MALE (E0325), JUG-TYPE, * ANY MATERIAL - ---------------------------------------------------------------------------------------------------------------- E0326 E0326 2059 URINAL; FEMALE (E0326), * JUG-TYPE, ANY MATERIAL - ---------------------------------------------------------------------------------------------------------------- E0372 E0372 7008 MATTRESS (E0372) POWERED AIR * * * OVERLAY - ---------------------------------------------------------------------------------------------------------------- E0410 E0444 2369 O2 CONTENTS, LIQUID (E0444), * PER POUND - ---------------------------------------------------------------------------------------------------------------- E0416 E0443 2371 O2 REFILL FOR PORT (E0443) GAS * SYSTEM ONLY, UP TO 23 CUBIC FEET - ---------------------------------------------------------------------------------------------------------------- E0424 E0424 2385 O2 SYS STATIONARY (E0424) COMPR * * GAS, RENT - ---------------------------------------------------------------------------------------------------------------- E0430 E0430 2374 O2 SYS PORT GAS, PURCH (E0430) * * - ---------------------------------------------------------------------------------------------------------------- E0431 E0431 2574 O2 SYS PORT GAS, LIGHTWEIGHT * * (E0431) W/CONSERV DEVICE,NO CONTENT - ---------------------------------------------------------------------------------------------------------------- E0431 E0431 2375 O2 SYS PORT GAS, RENT (E0431) * * - ---------------------------------------------------------------------------------------------------------------- E0434 E0434 2377 O2 SYS PORT LIQUID,RENT (E0434) * * - ---------------------------------------------------------------------------------------------------------------- E0435 E0435 2376 O2 SYS PORT LIQUID, PURCH * * (E0435) - ---------------------------------------------------------------------------------------------------------------- E0439 E0439 2388 O2 SYS STATIONARY (E0439) * * LIQUID, RENT - ---------------------------------------------------------------------------------------------------------------- E0440 E0440 2387 O2 SYS STATIONARY (E0440) * * LIQUID, PURCH - ---------------------------------------------------------------------------------------------------------------- E0443 E0400 2869 O2 CONTENTS, H/K CYLINDER * * (E0400), 200-300 CUBIC FT - ---------------------------------------------------------------------------------------------------------------- E0444 E0444 2379 O2 CONTENTS, PORT LIQUID * * (E0444), PER UNIT (1 UNIT = 1 LB.) - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 7555 POSITIVE PRESSURE VENTS * * (E0450)(E.G. T-BIRD) - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 7926 POSITIVE PRESSURE VENTS, EMERGENCY BACKUP (E.G.T-BIRD) * (E0450) - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 2392 VENTILATOR VOLUME (E0450), * * STATIONARY OR PORT - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 7522 VENTILATOR, VOLUME, (E0450) * * EMERGENCY BACKUP UNIT - ---------------------------------------------------------------------------------------------------------------- E0452 E0452 2332 BILEVEL INTERMITTENT (E0452) * * ASSIST DEVICE,(BIPAP) - ---------------------------------------------------------------------------------------------------------------- E0453 E0453 2390 VENTILATOR THERAPEUTIC (E0453); * * FOR USE 12 HOURS OR LESS PER DAY - ---------------------------------------------------------------------------------------------------------------- E0455 E0455 2372 O2 TENT (E0455), EXCLUDING * * CROUP OR PEDIATRIC TENTS - ---------------------------------------------------------------------------------------------------------------- E0457 E0457 2323 CHEST SHELL (CUIRASS) (E0457) * * - ---------------------------------------------------------------------------------------------------------------- E0459 E0459 2324 CHEST WRAP (E0459) * * - ---------------------------------------------------------------------------------------------------------------- E0460 E0460 2339 VENTILATOR (E0460), NEGATIVE * * PRESSURE, PORTABLE OR STATIONARY - ---------------------------------------------------------------------------------------------------------------- E0480 DM570 2373 PERCUSSOR (E0480), ELEC OR * * PNEUM, HOME MODEL - ---------------------------------------------------------------------------------------------------------------- E0500 E0500 2333 IPPB, W/ BUILT-IN NEB (E0500) * * MAN OR AUTO VALVES; INT/EXT POWER - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0550 E0550 2328 HUMIDIFIER (E0550) DURABLE FOR * * EXTENSIV SUP/ HUMID W/ IPPB OR O2 - ---------------------------------------------------------------------------------------------------------------- E0555 E0555 2330 HUMIDIFIER (E0555), DURABLE, * GLASS, FOR USE W/ REG OR FLOWMETER - ---------------------------------------------------------------------------------------------------------------- E0565 E0565 2325 COMPRESSOR, AIR POWER (E0565) * * - ---------------------------------------------------------------------------------------------------------------- E0570 E0570 2336 NEBULIZER, W/ COMPRESSOR (E0570) * * - ---------------------------------------------------------------------------------------------------------------- E0575 DM570 2571 NEBULIZER (E0575), ULTRASONIC, * * AC/DC - ---------------------------------------------------------------------------------------------------------------- E0575 DM570 2338 NEBULIZER; ULTRASONIC (E0575) * * - ---------------------------------------------------------------------------------------------------------------- E0585 E0585 2337 NEBULIZER(E0585), W/ COMPRESSOR * * AND HEATER - ---------------------------------------------------------------------------------------------------------------- E0600 E0600 2389 SUCTION PUMP (E0600), HOME MODEL * * - ---------------------------------------------------------------------------------------------------------------- E0600 E0600 7523 SUCTION UNIT, (E0600), PORTABLE * * AC/DC - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 2326 CONTINUOUS POSITVE (E0601) * * AIRWAY PRESSURE DEVICE (CPAP) - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 6965 CPAP, SELF TITRATING (E0601) * * - ---------------------------------------------------------------------------------------------------------------- E0605 DM570 2391 VAPORIZER, ROOM TYPE (E0605) * - ---------------------------------------------------------------------------------------------------------------- E0606 DM570 2380 POSTURAL DRAINAGE BOARD (E0606) * - ---------------------------------------------------------------------------------------------------------------- E0607 E0607 6874 MONITOR, B/GLUCOSE (E0607) * ACCUCHEK AD - ---------------------------------------------------------------------------------------------------------------- E0607 E0607 2164 MONITOR, BLOOD GLUCOSE (E0607) * - ---------------------------------------------------------------------------------------------------------------- E0618 E0608 2322 APNEA MONITOR (E0608) * * - ---------------------------------------------------------------------------------------------------------------- E0619 E0608 2576 APNEA MONITOR (E0608) W/MEM * * (INCL SMART) - ---------------------------------------------------------------------------------------------------------------- E0609 E0609 2146 MONITOR, BLOOD GLUCOSE (E0609) * W/SPECIAL FEATURES - ---------------------------------------------------------------------------------------------------------------- E0621 E0621 2215 PATIENT LIFT (E0621), SLING OR * * SEAT, CANVAS OR NYLON - ---------------------------------------------------------------------------------------------------------------- E0625 DM570 2191 PATIENT LIFT (E0625), KARTOP, * * BATHROOM OR TOILET - ---------------------------------------------------------------------------------------------------------------- E0627 E0627 4553 HIP CHAIR (E0627) * * - ---------------------------------------------------------------------------------------------------------------- E0627 DM570 2395 SEAT LIFT CHAIR/MOTORIZED * * (E0627) - ---------------------------------------------------------------------------------------------------------------- E0627 DM570 2205 SEAT LIFT MECH (E0627) * * INCORPORATED INTO A COMB LIFT-CHAIR MECH - ---------------------------------------------------------------------------------------------------------------- E0630 E0630 2190 PATIENT LIFT, HYDRAULIC * * (E0630), W/ SEAT OR SLING - ---------------------------------------------------------------------------------------------------------------- E0635 DM570 2189 PATIENT LIFT (E0635), ELEC W/ * * SEAT OR SLING - ---------------------------------------------------------------------------------------------------------------- E0650 E0650 2192 PNEUM COMPRESSOR (E0650), * * NON-SEG HOME MODEL - ---------------------------------------------------------------------------------------------------------------- E0651 E0651 2194 PNEUM COMPRESSOR (E0651), SEG * * HOME MODEL W/OUT CALIB GRAD PRES - ---------------------------------------------------------------------------------------------------------------- E0652 E0652 2193 PNEUM COMPRESSOR (E0652), SEG * * HOME MODEL W/ CALIB GRAD PRES - ---------------------------------------------------------------------------------------------------------------- E0655 E0655 2182 PNEUM COMPRESSOR (E0655), * NON-SEG APPLIANCE, HALF ARM - ---------------------------------------------------------------------------------------------------------------- E0660 E0660 2181 PNEUM COMPRESSOR (E0660), * NON-SEG APPLIANCE, FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0665 E0665 2180 PNEUM COMPRESSOR (E0665), * NON-SEG APPLIANCE, FULL ARM - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0666 E0666 2183 PNEUM COMPRESSOR (E0666), * NON-SEG APPLIANCE, HALF LEG - ---------------------------------------------------------------------------------------------------------------- E0667 E0667 2210 PNEUM APPLIANCE (E0667), SEG, * FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0668 E0668 2209 PNEUM APPLIANCE (E0668), SEG, FULL ARM - ---------------------------------------------------------------------------------------------------------------- E0669 E0669 2212 PNEUM APPLIANCE (E0669), SEG, * HALF LEG - ---------------------------------------------------------------------------------------------------------------- E0670 E0670 2211 PNEUM APPLIANCE (E0670), SEG, * HALF ARM - ---------------------------------------------------------------------------------------------------------------- E0671 E0671 2207 PNEUM APPLIANCE (E0671), SEG * GRAD PRESS, FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0672 E0672 2206 PNEUM APPLIANCE (E0672), SEG * GRAD PRESS, FULL ARM - ---------------------------------------------------------------------------------------------------------------- E0673 E0673 2208 PNEUM APPLIANCE (E0673), SEG * GRAD PRESS, HALF LEG - ---------------------------------------------------------------------------------------------------------------- E0690 DM570 2221 ULTRAVIOLET CABINET (E0690), * APPROPRIATE FOR HOME USE - ---------------------------------------------------------------------------------------------------------------- E0700 DM570 2204 SAFETY EQUIP (E0700) (E.G., * BELT, HARNESS OR VEST) - ---------------------------------------------------------------------------------------------------------------- E0710 DM570 2202 RESTRAINTS (E0710), ANY TYPE * (BODY, CHEST, WRIST OR ANKLE) - ---------------------------------------------------------------------------------------------------------------- E0720 E0720 2219 TENS (E0720), TWO LEAD, * * LOCALIZED STIMULATION - ---------------------------------------------------------------------------------------------------------------- E0730 E0730 2218 TENS (E0730), FOUR LEAD, LARGER * * AREA/MULTIPLE NERVE STIMULATION - ---------------------------------------------------------------------------------------------------------------- E0731 E0731 2159 TENS OR NMES (E0731), * * CONDUCTIVE GARMENT - ---------------------------------------------------------------------------------------------------------------- E0744 E0744 2120 STIMULATOR (E0744), * * NEUROMUSCULAR FOR SCOLIOSIS - ---------------------------------------------------------------------------------------------------------------- E0745 E0745 2120 STIMULATOR (E0745), * * NEUROMUSCULAR, ELECTRONIC SHOCK UNIT - ---------------------------------------------------------------------------------------------------------------- E0745 E0745 6915 STIMULATOR FOUR CH (E0745), * * NEUROMUSCULAR - ---------------------------------------------------------------------------------------------------------------- E0746 DM570 2109 ELECTROMYOGRAPHY (EMG) (E0746), * * BIOFEEDBACK DEVICE - ---------------------------------------------------------------------------------------------------------------- E0747 DM570 2122 STIMULATOR (E0747), OSTEOGENIC, * NON-INVASIVE - ---------------------------------------------------------------------------------------------------------------- E0748 DM570 2124 STIMULATOR (E0748), OSTEOGENIC * NON-INVASIVE, SPINAL APPLICATIONS - ---------------------------------------------------------------------------------------------------------------- E0755 DM570 2157 STIMULATOR (E0755), ELECTRONIC * SALIVARY REFLEX, NON INVASIVE - ---------------------------------------------------------------------------------------------------------------- E0776 E0776 2175 IV POLE (E0776) * * - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 2158 PUMP (E0784), EXT AMBULATORY * INFUSION, MINIMED, INSULIN - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 7925 PUMP, EXT INFUSION, NON - DANA * PREMIUM, INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 6771 PUMP (E0784), INSULIN EXT * INFUSION DISETRONICS OR OTHER - ---------------------------------------------------------------------------------------------------------------- E0840 E0840 2133 TRACTION FRAME (E0840), ATTACH * TO HEADBOARD, CERVICAL TRACTION - ---------------------------------------------------------------------------------------------------------------- E0850 E0850 2134 TRACTION STAND (E0850), FREE * * STANDING, CERVICAL TRACTION - ---------------------------------------------------------------------------------------------------------------- E0855 E0855 7484 TRACTION (E0855), W/O FRAME OR * * STAND - ---------------------------------------------------------------------------------------------------------------- E0860 E0860 2130 TRACTION EQUIP (E0860), * OVERDOOR, CERVICAL - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0870 E0870 2131 TRACTION FRAME (E0870), ATTACH * * TO FOOTBOARD, EXTREMITY, BUCKS - ---------------------------------------------------------------------------------------------------------------- E0880 E0880 2135 TRACTION STAND (E0880) * * FREE/STAND EXTREMITY TRACTION, EG, BUCK'S - ---------------------------------------------------------------------------------------------------------------- E0890 E0890 2132 TRACTION FRAME (E0890), ATTACH * * TO FOOTBOARD, PELVIC TRACTION - ---------------------------------------------------------------------------------------------------------------- E0900 E0900 2136 TRACTION STAND (E0900) FREE/ * * STAND PELVIC TRACTION,( EG, BUCK'S) - ---------------------------------------------------------------------------------------------------------------- E0910 E0910 2138 TRAPEZE BARS (E0910), A/K/A PT * * HELPER, ATTACH TO BED W/ GRAB BAR - ---------------------------------------------------------------------------------------------------------------- E0920 E0920 2111 FRACTURE FRAME (E0920), ATTACH * * TO BED, INCLUDING WEIGHTS - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2125 PASSIVE MOTION (E0935) EXERCISE * DEVICE - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2859 PASSIVE MOTION (E0935) EXERCISE * DEVICE, ANKLE - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2860 PASSIVE MOTION (E0935) EXERCISE * DEVICE, ELBOW - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2857 PASSIVE MOTION (E0935) EXERCISE * DEVICE, HAND - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2858 PASSIVE MOTION (E0935) EXERCISE * DEVICE, SHOULDER - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2861 PASSIVE MOTION (E0935) EXERCISE * DEVICE, WRIST - ---------------------------------------------------------------------------------------------------------------- E0940 E0940 2137 TRAPEZE BAR (E0940), FREE * * STANDING, COMPLETE W/ GRAB BAR - ---------------------------------------------------------------------------------------------------------------- E0941 E0941 2116 TRACTION DEVICE (E0941), * * GRAVITY ASSISTED - ---------------------------------------------------------------------------------------------------------------- E0942 E0942 2101 HARNESS/HALTER (E0942), * * CERVICAL HEAD - ---------------------------------------------------------------------------------------------------------------- E0944 E0944 2126 HARNESS (E0944), PELVIC BELT, * * BOOT - ---------------------------------------------------------------------------------------------------------------- E0945 DM570 2110 HARNESS (E0945), EXTREMITY BELT * * - ---------------------------------------------------------------------------------------------------------------- E0946 E0946 2115 FRACTURE, FRAME (E0946), DUAL * * W/ CROSS BARS, ATTACH TO BED - ---------------------------------------------------------------------------------------------------------------- E0947 E0947 2113 FRACTURE FRAME (E0947), * * ATTACHMENTS FOR COMPLEX PELVIC TRACTION - ---------------------------------------------------------------------------------------------------------------- E0948 E0948 2112 FRACTURE FRAME (E0948) * * ATTACHMENTS FOR COMPLEX CERVICAL TRACTION - ---------------------------------------------------------------------------------------------------------------- E0950 DM570 2139 TRAY (E0950) * - ---------------------------------------------------------------------------------------------------------------- E0958 E0958 2307 W/C PART ATTACHMENT (E0958) TO * CONVERT ANY W/C TO ONE ARM DRIVE - ---------------------------------------------------------------------------------------------------------------- E0959 E0959 2237 W/C PART AMPUTEE ADAPTER(E0959) * (COMPENSATE FOR TRANS OF WEIGHT) - ---------------------------------------------------------------------------------------------------------------- E0962 E0962 2232 CUSHION FOR WC 1" (E0962) * - ---------------------------------------------------------------------------------------------------------------- E0963 E0963 2233 CUSHION FOR WC 2" (E0963) * - ---------------------------------------------------------------------------------------------------------------- E0964 E0964 2234 CUSHION FOR WC 3" (E0964) * - ---------------------------------------------------------------------------------------------------------------- E0965 E0965 2235 CUSHION FOR WC 4" (E0965) * - ---------------------------------------------------------------------------------------------------------------- E0972 DM570 2230 TRANSFER BOARD OR DEVICE (E0972) * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0977 E0977 2317 CUSHION, WEDGE FOR W/C (E0977) * - ---------------------------------------------------------------------------------------------------------------- E0978 E0978 2248 BELT, SAFETY (E0978) W/ * AIRPLANE BUCKLE, W/C - ---------------------------------------------------------------------------------------------------------------- E0979 DM570 2249 BELT, SAFETY (E0979) W/ VELCRO * CLOSURE, W/C - ---------------------------------------------------------------------------------------------------------------- E0980 DM570 2292 SAFETY VEST (E0980), W/C * - ---------------------------------------------------------------------------------------------------------------- E1031 E1031 2291 ROLLABOUT CHAIR (E1031), W/ * * CASTORS 5" OR GREATER - ---------------------------------------------------------------------------------------------------------------- E1050 E1050 2260 W/C FULL/REC (E1050), FIX ARMS, * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1060 E1060 2259 W/C FULL/REC (E1070), DETACH * * ARMS, SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1065 E1065 2287 W/C POWER ATTACHMENT (E1065) * - ---------------------------------------------------------------------------------------------------------------- E1066 E1066 2247 BATTERY CHARGER (E1066) * * - ---------------------------------------------------------------------------------------------------------------- E1069 E1069 2255 BATTERY, DEEP CYCLE (E1069) * * - ---------------------------------------------------------------------------------------------------------------- E1070 E1070 2258 W/C FULL/REC (E1060), DETACH * * ARMS, SWING AWAY DET/ ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1083 E1083 2263 W/C HEMI (E1083), FIX ARMS, * * SWING AWAY DETACH ABLE ELEV LEG REST - ---------------------------------------------------------------------------------------------------------------- E1084 E1084 2262 W/C HEMI (E1084), DETACH ARMS, * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1085 E1085 2264 W/C HEMI (E1085), FIX ARMS, * * SWING AWAY DETACH ABLE FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1086 E1086 2261 W/C HEMI (E1086), DETACH ARMS, * * SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1087 E1087 2265 W/C HI STRENGTH LT-WT (E1087), * * FIX ARMS, S/AWAY ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1088 E1088 2268 W/C HI STRENGTH LT-WGT (E1088), * * D/ ARMS, S/AWAY ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1089 E1089 2266 W/C HI STRENGTH LT-WGT (E1089), * * FIX ARMS, S/AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1090 E1090 2267 W/C HI STRENGTH LT-WG (E1090), * * DETACH ARMS, S/AWAY D/FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1091 E1091 2321 W/C YOUTH, ANY TYPE (E1091) * * - ---------------------------------------------------------------------------------------------------------------- E1092 E1092 2319 W/C WIDE HVY DUTY (E1092), * * DETACH ARMS S/AWAY DETACH ELEVAT LEGS - ---------------------------------------------------------------------------------------------------------------- E1093 E1093 2320 W/C WIDE HVY DUTY (E1093), * * DETACH ARMS S/AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1100 E1100 2296 W/C SEMI-RECLINING (E1100), * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1110 E1110 2295 W/C SEMI-RECLINING (E1110), * * DETACH ARMS ELEV LEG REST - ---------------------------------------------------------------------------------------------------------------- E1130 E1130 2303 W/C STANDARD (E1130), FIX OR * * SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1140 E1140 2313 W/C (E1140), DETACH ARMS SWING * * AWAY DETACH FOOTRESTS - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1150 E1150 2314 W/C (E1150), DETACH ARMS, SWING * * AWAY DETACH ELEVAT LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1160 E1160 2315 W/C (E1160), W/ FIX ARMS, SWING * * AWAY DETACH ELEVAT LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1160 E1160 2396 W/C (E1160), W/FIX ARMS * * REMOVABLE FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1170 E1170 2241 W/C AMPUTEE (E1170), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1171 E1171 2242 W/C AMPUTEE (E1171), FIX ARMS, * * W/OUT FOOTRESTS OR LEGREST - ---------------------------------------------------------------------------------------------------------------- E1172 E1172 2240 W/C AMPUTEE (E1172), DETACH * * ARMS W/OUT FOOTRESTS OR LEGREST - ---------------------------------------------------------------------------------------------------------------- E1180 E1180 2239 W/C AMPUTEE (E1180), DETACH * * ARMS SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1190 E1190 2238 W/C AMPUTEE (E1190), DETACH * * ARMS SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1195 E1195 2273 W/C HVY DUTY (E1195), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1200 E1200 2243 W/C AMPUTEE (E1200), FIX FULL * * LENGTH ARMS, S/AWAY D/FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1210 E1210 2281 W/C MOTORIZED (E1210), FIX * * ARMS, S/AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1211 E1211 2279 W/C MOTORIZED (E1211), DETACH * * ARMS, S/AWAY DETACH FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1212 E1212 2282 W/C MOTORIZED (E1212), FIX * * ARMS, SWING AWAY DETACH FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1213 E1213 2280 W/C MOTORIZED (E1213), DETACH * * ARMS S/AWAY, DETACH ELEV LEG REST - ---------------------------------------------------------------------------------------------------------------- E1220 E1220 2551 W/C CUSTOM (E1220) * * - ---------------------------------------------------------------------------------------------------------------- E1220 E1220 2579 W/C XXWIDE (E1220) * - ---------------------------------------------------------------------------------------------------------------- E1230 E1230 2288 SCOOTER (E1230), THREE OR 4 * * WHEEL - ---------------------------------------------------------------------------------------------------------------- E1240 E1240 2276 W/C LT-WGT (E1240), DETACH ARMS * * SWING AWAY DETACH, ELEV LEGREST - ---------------------------------------------------------------------------------------------------------------- E1250 E1250 2278 W/C LT-WGT (E1250), FIX ARMS, * * SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1260 E1260 2275 W/C LT-WGT (E1260), DETACH ARMS * * SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1270 E1270 2277 W/C LT-WGT (E1270), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1280 E1280 2270 W/C HVY DUTY (E1280), DETACH * * ARMS ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1285 E1285 2274 W/C HVY DUTY (E1285), FIX ARMS, * * SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1290 E1290 2271 W/C HVY DUTY (E1290), DETACH * * ARMS SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1295 E1295 2272 W/C HVY DUTY (E1295), FIX * * ARMS, ELEV LEGREST - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1300 DM570 2062 WHIRLPOOL (E1300), PORT * * (OVERTUB TYPE) - ---------------------------------------------------------------------------------------------------------------- E1310 DM570 2061 WHIRLPOOL (E1399), NON-PORT * * (BUILT-IN TYPE) - ---------------------------------------------------------------------------------------------------------------- E1353 E1353 2381 O2 REGULATOR (E1353) * * - ---------------------------------------------------------------------------------------------------------------- E1355 E1355 2384 CYLINDER STAND/RACK (E1355) * * - ---------------------------------------------------------------------------------------------------------------- E1372 E1372 2331 IMMERSION EXT HEATER (E1372) * * FOR NEBULIZER - ---------------------------------------------------------------------------------------------------------------- E1375 E1375 2334 NEBULIZER PORT (E1375) W/ SMALL * * COMPRESSOR, W/ LIMITED FLOW - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2568 ADAPTER (A9900), AC/DC * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2586 APNEA MONITOR DOWNLOAD (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2552 BATH LIFT (E1399), CUSTOM * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2563 BED WEDGE (E1399), 12" * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2856 BEDROOM EQUIPMENT (E1399), * * CUSTOM - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2525 BREAST PUMP, ELECTRIC (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2581 BREAST PUMP, INSTITUTIONAL * (E1399) - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2580 BREAST PUMP, MANUAL (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2593 COLD THERAPY UNIT, PAD (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2565 COMMODE (E1399), DROP ARM, * HEAVY DUTY - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2582 COMPRESSION PUMP BOOT (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2583 COMPRESSION PUMP, FOOT (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2569 CPAP HUMIDIFIER (A9900), HEATED * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2635 CPAP/BIPAP SUPPLIES (A9900) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2327 DURABLE MEDICAL EQUIP (E1399), * * MISCELLANEOUS - ---------------------------------------------------------------------------------------------------------------- E1399 E1220 2584 GERI CHAIR (E1399), THREE * * POSITION RECLINING - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 6780 HOLTER MONITOR (G0004) * - ---------------------------------------------------------------------------------------------------------------- E1399 E0265 2590 HOSP BED (E1399), ELECTRIC, * * XLONG, W/MATTRESS & SIDE RAILS - ---------------------------------------------------------------------------------------------------------------- E1399 E0200 2868 LAMP, ULTRAVIOLET (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2588 MONITOR (E1399), VITAL SIGNS * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2529 O2 ANALYZER (A9900) * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2594 O2 CONSERVATION DEVICE (A9900) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 6775 OXIMETRY TEST (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2555 PATIENT LIFT, CUSTOM (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2561 PEAK FLOW METER (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4559 PEDIATRIC WALKER (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2567 PNEUMOGRAM (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2553 POSITIONING, CUSTOM (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2526 PULSE OXIMETER (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2527 PULSE OXIMETER W/ PROBE (E1399) * * * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2562 SHOWER, HAND HELD (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2592 SLEEP STUDY, ADULT (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM590 7483 STIMULATOR (E1399), MUSCLE, LOW * * * VOLTAGE OR INTERFERENTIAL - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2855 THERAPY EQUIPMENT, CUSTOM * * * (E1399) - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 6774 THERAPY PERCUSSION, GENERATOR * * * ONLY - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7506 W/C, CUSTOM (E1399) MANUAL ADULT * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7504 W/C, CUSTOM (E1399) MANUAL * * PEDIATRIC - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7507 W/C, CUSTOM (E1399) POWER ADULT * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7505 W/C, CUSTOM (E1399) POWER * * PEDIATRIC - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2564 WALKER (E1399), HEAVY DUTY, * * * EXTRA WIDE - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2585 WALKER (E1399), HEMI * * * - ---------------------------------------------------------------------------------------------------------------- K0538 DM570 6873 WOUND SUCTION DEVICE (K0538) * * * - ---------------------------------------------------------------------------------------------------------------- K0539 DM570 7914 DRESSING SET, FOR WOUND SUCTION * * * DEVICE (K0539) - ---------------------------------------------------------------------------------------------------------------- K0540 DM570 7915 CANISTER SET, FOR WOUND SUCTION * * * DEVICE (K0540) - ---------------------------------------------------------------------------------------------------------------- E1400 E1390 2361 O2 CONC (E1390),MANUF SPEC * * * MAXFLOWRATE = 2 LTS PER MIN@85% - ---------------------------------------------------------------------------------------------------------------- G0015 DM570 6779 CARDIAC EVENT MONITOR (G0015) * * * - ---------------------------------------------------------------------------------------------------------------- K0163 DM590 3713 ERECTION SYSTEM, VACUUM (K0163) * * * - ---------------------------------------------------------------------------------------------------------------- K0183 DM590 2516 CPAP MASK (K0183) * * * - ---------------------------------------------------------------------------------------------------------------- K0184 DM590 2515 NASAL PILLOWS/SEALS (K0184) * * * REPLACEMENT FOR NASAL APP/ DVC, PAIR - ---------------------------------------------------------------------------------------------------------------- K0185 DM590 2514 CPAP HEADGEAR (K0185) * * * - ---------------------------------------------------------------------------------------------------------------- K0186 DM590 2513 CPAP CHIN STRAP (K0186) * * * - ---------------------------------------------------------------------------------------------------------------- K0187 DM590 2512 CPAP TUBING (K0187) * * * - ---------------------------------------------------------------------------------------------------------------- K0188 DM590 2511 CPAP FILTER (A9900), DISPOSABLE * * * - ---------------------------------------------------------------------------------------------------------------- K0189 DM590 2510 CPAP FILTER (A9900), * * * NON-DISPOSABLE - ---------------------------------------------------------------------------------------------------------------- K0268 DM590 2509 CPAP HUMIDIFIER (K0268), COOL * * * - ---------------------------------------------------------------------------------------------------------------- K0413 DM590 6889 MATTRESS (K0413), NONPOWERED, * * * EQUIVALENT - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7673 MATTRESS (E1399) V-CUE DYNAMIC * * * AIR THERAPY - ---------------------------------------------------------------------------------------------------------------- A4608 A9900 7621 CATHETER TRACH (A4608) 11CM 1 * * * SCOOP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7664 COFFLATOR (E1399CF) MANUAL * * * SECRETION MOBIL DEVICE - ---------------------------------------------------------------------------------------------------------------- E0168B A9900 7643 COMMODE (E0168B) HVY DUTY * BEDSIDE CHAIR 251-450 LBS. - ---------------------------------------------------------------------------------------------------------------- E0168C A9900 7644 COMMODE (E0168C) HVY DUTY DROP * ARM 451-850 LBS. - ---------------------------------------------------------------------------------------------------------------- A6234 HH591 7626 DRESSING <16 SQ IN (A6234) * HYDROCOLLOID DRESSING, EA - ---------------------------------------------------------------------------------------------------------------- A6258 HH591 7627 DRESSING >16 SQ IN (A6258) * TRANSPAREN FILM, EA - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- A46203 HH591 7625 DRESSING COMPOSITE <16 SQ IN * (A46203) SELF ADH, EA - ---------------------------------------------------------------------------------------------------------------- B9998B DM590 7655 ENT (B9998B) EXT SET Y SITE * F/KANGAROO PUMP - ---------------------------------------------------------------------------------------------------------------- B9998C DM590 7656 ENT (B9998C) EXT SET W/ CLAMP * BASIC - ---------------------------------------------------------------------------------------------------------------- B9998D DM590 7657 ENT (B9998D) FARRELL GASTRIC * RELIEF VLV - ---------------------------------------------------------------------------------------------------------------- B9998E DM590 7658 ENT (B9998E) GASTRO EXT SET * - ---------------------------------------------------------------------------------------------------------------- B9998F DM590 7659 ENT (B9998F) GASTRO TUBE ANY * SIZE MIC-KEY OR HIDE A PORT - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7620 HUMID-VENT (E1399) ARTIFICIAL * NOSE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7660 IPPB (E1399) UNIV SET UP * W/MANIFOLD NEBULIZER - ---------------------------------------------------------------------------------------------------------------- K0105 A9900 7639 IV POLE (K0105) ATTACH F/ W/C * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7641 MECHANICAL SCALE (E1399) * PEDIATRIC/NEONATAL - ---------------------------------------------------------------------------------------------------------------- A7008 A9900 7661 NEBULIZER (A7008) KIT PREFILL * W/STR H20 1L BAX - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7663 O2 CONNECTOR (E1399) * SIMS/IRRIGATION NOZZLE BAX - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7615 O2 HUMIDIFIER (E1399) * AQUA+NEONATAL EA HUD - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7623 O2 SWIVEL (E1399) ADAPTER * ANGLED STERILE - ---------------------------------------------------------------------------------------------------------------- L8501 A9900 7624 SPEAKING VALVE (L8501) WHITE PAS * - ---------------------------------------------------------------------------------------------------------------- A4319 HH591 7629 STERILE WATER (A4319) F/IRRIG * 1L BAX - ---------------------------------------------------------------------------------------------------------------- A7001 HH591 7619 SUCTION BOTTLE (A7001) W/LID & * TUBING - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7616 SUCTION FILTER (E1399) BACTERIA * - ---------------------------------------------------------------------------------------------------------------- A6265 HH591 7628 TAPE ALL TYPES (A6265) * EXCLUDING MICROFOAM, PER 18 SQ INCHES - ---------------------------------------------------------------------------------------------------------------- A4481 A9900 7622 TRACH FILTER (A4481) BACTERIA * ELECTROSTATIC - ---------------------------------------------------------------------------------------------------------------- A4623 A9900 7618 TRACH INNER (A4623) CANNULA * - ---------------------------------------------------------------------------------------------------------------- A4621 A9900 7617 TRACH TUBE MASK (A4621) COLLAR * OR HOLDER - ---------------------------------------------------------------------------------------------------------------- A7010 A9900 7662 TUBING (A7010) AEROSOL * CORRUGATED PER FOOT - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7631 VENT ADAPTER (E1399) MDI HUD * - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7630 VENT BATTERY CHARGER (A9900) * 12V GEL - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7632 VENT CONNECTOR (E1399) PED OR * ADULT OMNIFLEX DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7633 VENT FILTER (E1399) HYGROBAC S * ELECTOSTATIC MAL - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7634 VENT THERMOMETER (E1399) W/ * ADAPTER - ---------------------------------------------------------------------------------------------------------------- K0108 A9900 7638 W/C BRAKE EXTENSION (K0108) TIP * BLK 10/PK - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7635 WALKER BASKET (E1399) VINYL * COATED - ---------------------------------------------------------------------------------------------------------------- E0159 A9900 7640 WALKER BRAKE (E0159) ATTACHMENT * - ---------------------------------------------------------------------------------------------------------------- E0148 A9900 7636 WALKER HVY DUTY (E0148) FOLDING * X-WIDE - ---------------------------------------------------------------------------------------------------------------- E0149 A9900 7637 WALKER HVY DUTY (E0149) W/ * WHEELS - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7645 CPAP (E1399) DC BATTERY ADAPTER * CABLE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7646 CPAP (E1399) EXHALATION PORT * DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7647 CPAP (E1399) FUSE KIT * INTERNATIONAL A/C - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7648 CPAP (E1399) HUMIDIFIER CHAMBER * KIT DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7649 CPAP (E1399) HUMIDIFIER CHAMBER * REUSABLE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7650 CPAP (E1399) HUMIDIFIER * MOUNTING TRAY - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7651 CPAP (E1399) INVERTOR AC/DC * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7652 CPAP (E1399) POWER CORD * F/ARIA-SYNC - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7653 CPAP (E1399) SHELL W/O PRESSURE * TAP - ---------------------------------------------------------------------------------------------------------------- A9900 DM590 7566 CPAP CALIBRATION SHELL (A9900) * - ---------------------------------------------------------------------------------------------------------------- A7037 DM590 7565 CPAP SHORT TUBING (A9900) * - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 7690 VENT, CONTINUOUS POSITIVE * * (E0500) AIRWAY PRESSURE DEVICE - ---------------------------------------------------------------------------------------------------------------- E0452 E0452 7691 VENT, BILEVEL INTERMITTENT * * (E0500) ASSIST DEVICE (BIPAP) - ---------------------------------------------------------------------------------------------------------------- E0747 DM570 6875 STIMULATOR, OSTEOGENIC, * ULTRASOUND - ---------------------------------------------------------------------------------------------------------------- A7034 A9900 7695 GEL/SILICON GOLD SEAL * CPAP/BIPAP MASK (A9900) - ---------------------------------------------------------------------------------------------------------------- KO533 A9900 7701 VENT THERAPEUTIC ST BIPAP W/ * * * BACKUP RATE (K0533) - ---------------------------------------------------------------------------------------------------------------- E0434 A9900 7703 O2 SYS HELIOS PORT LIQUID, RENT * * * (E1399) - ---------------------------------------------------------------------------------------------------------------- HH591 HH591 7704 PUMP, EXT INFUSION, DANA * * * DIABECARE, INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 7731 PUMP, EXT INFUSION, ANIMAS, * * * INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7737 CPAP DREAM SEAL INTERFACE FOR * * * USE WITH BREEZE MASK (A9900) - ---------------------------------------------------------------------------------------------------------------- A7036 DM590 7738 CPAP CHIN STRAP DELUXE (K0186) * * * - ---------------------------------------------------------------------------------------------------------------- E1340 E1340 7768 W/C REPAIRS - CUSTOM (E1340) * * - ----------------------------------------------------------------------------------------------------------------
The following may be charged under extraordinary circumstances: - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4551 LABOR/SERVICE/SHIPPING CHARGES * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2731 SHIPPING AND HANDLING FEES * * - ----------------------------------------------------------------------------------------------------------------
The following may be charged if over and above routine on rental equipment: - ---------------------------------------------------------------------------------------------------------------- E1350 E1350 2382 REPAIR OR NON-ROUTINE (E1350) * * SERVICE REQUIRING SKILL OF A TECH - ---------------------------------------------------------------------------------------------------------------- E1340 E1340 2554 W/C REPAIRS - STANDARD (E1340) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4552 MISCELLANEOUS SUPPLIES * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2589 REPAIR (E1399), RESPIRATORY * * EQUIPMENT - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4561 RESPIRATORY SUPPLIES (A4618) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4549 TENS/APNEA SUPPLIES * * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested NOTES: * * * * * * * Confidential treatment requested PPO & INDEMNITY PROGRAM ATTACHMENT TO MANAGED CARE ALLIANCE AGREEMENT PURPOSE The terms and provisions of this PPO & Indemnity Program Attachment and the Agreement are applicable to services rendered by MCA's Represented Providers to PPO & Indemnity Program Participants. I. PARTIES' OBLIGATIONS A. COMPENSATION AND BILLING 1. Reimbursement for Home Care Services rendered by Represented Providers shall be in accordance with the following rates, less applicable Copayments, Deductibles or Coinsurance: a. Reimbursement for Home Care services arranged by MCA and rendered by Represented Providers shall be in accordance with Exhibit B attached hereto. b. MCA will indemnify and hold harmless Payors, CIGNA and its Affiliates from any claim for payment in excess of the specified amounts for covered Home Care Services rendered to Participants by each Represented Provider, unless the claim arises from a Payor's wrongful failure to pay MCA for covered Home Care Services. 2. Payors shall agree to deduct any Copayments, Deductibles, or Coinsurance required by the Service Agreement from payment due. Deduction for the Copayment, Deductible or Coinsurance shall be determined on the basis of the contracted rate. 3. Reimbursement for Home Care Services rendered hereunder shall be made by CIGNA or its designees to MCA. MCA shall bill for covered Home Care Services according to the following: a. MCA shall submit claims on the appropriate claim form for all covered Home Care Services within one hundred twenty (120) days of the date those services are rendered. Claims received after this one hundred twenty (120) day period may be denied for payment. MCA shall submit claims to the location described in applicable Program Requirements. b. Any amount owing under this Agreement shall be paid within thirty (30) days after receipt of a complete claim, unless additional required information is requested within the thirty (30) day period, or the claim involves coordination of benefits, except as otherwise provided in this Agreement. 4. MCA and its Represented Providers shall not charge a Participant for a service which is not Medically Necessary unless the Participant is notified that the service may not be covered and the Participant acknowledges in writing that he or she shall be responsible for payment of charges for such service. 5. MCA will and shall require its Represented Providers to look solely to Payor for compensation for covered Home Care Services except for Copayments, Deductibles or Coinsurance. MCA agrees, for itself and on behalf of each Represented Provider, that whether or not there is any unresolved dispute for payment, under no circumstances will MCA or any Represented Provider directly or indirectly make any charges or claims, other than for Copayments, Deductibles or Coinsurance against any Participants or their representatives for covered Home Care Services and that this provision survives termination of this Agreement for services rendered prior to such termination. This provision shall not prohibit collection of (i) any applicable Copayments, Deductibles, or Coinsurance, (ii) payments for services provided to a patient who is no longer eligible to receive Home Care Services, including but not limited to Participants that have reached their benefit limit (iii) payment for services provided to Participants, which are not Home Care Services. This paragraph is to be interpreted for the benefit of Participants and does not diminish the obligation of Payor to make payments to Represented Providers according to the terms of this Agreement. 6. The rates set forth herein shall apply to all services rendered to Participants in the PPO Program. 7. Only those charges for Home Care Services billed in accordance with CIGNA's standard claim coding and bundling methodology will be allowed. B. UTILIZATION MANAGEMENT 1. To promote the participation and effectiveness of Utilization Management, if MCA is responsible for initiating the pre-certification process as indicated by the Participant's ID card, MCA or Represented Providers shall notify CIGNA or its designated Utilization Management representative of any scheduled homecare admissions at least forty-eight (48) hours prior to such admission, or as soon as reasonably possible. MCA or Represented Providers shall notify the review organization of an Emergency admission(s) within one (1) working day following the admission(s). 2. Whenever any homecare admission has not been pre-certified, CIGNA or its designated Utilization Management representative may conduct retrospective review to determine whether services provided were Medically Necessary. 3. MCA may appeal a Utilization Management decision in accordance with the dispute resolution procedure set forth in the Agreement and Program Requirements. 4. Provider shall evaluate whether each Participant order or prescription it receives for Covered Home Care Services under this Program are Medically Necessary, utilizing Utilization Management guidelines mutually developed by the parties (see Exhibits XVII AND XX1). 5. Provider will notify CIGNA's Intracorp subsidiary of each referral it receives for Covered Home Care Services, that meets case management criteria as defined by MCA and Intracorp, and will coordinate with Intracorp in the provision of case management and concurrent inpatient utilization review services to Participants under this Program. The parties will determine the specific roles and responsibilities of CIGNA, Provider and Intracorp with respect to Utilization Management during the implementation process. 6. CIGNA will review claims submitted for Covered Home Care Services by Provider and Subcontractors under this Program to assure that all billed services were Medically Necessary, based on utilization review criteria mutually developed by both parties. If an individual at Intracorp (or its successor function) identified by CIGNA certifies to Provider the Medical Necessity of a particular service in advance of the provision of such service, CIGNA shall not retrospectively deny payment for such service on the basis of Medical Necessity. 7. Where CIGNA determines billed services not to be Medically Necessary and denies payment, Provider may appeal the payment denial in accordance with the appeal procedures described in the Program Requirements to this Program Attachment. C. 24 HOUR COVERAGE Subject to the terms of this agreement, MCA, through its Represented Providers, shall arrange to provide Medically Necessary Home Care Services to Participants on a 24-hour per day, 7-day per week basis or arrange with other qualified providers (which meet all CIGNA and MCA credentialing requirements and/or other guidelines) to provide such Medically Necessary Home Care Services to Participants. MCA shall require that such covering providers (a) are Participating Providers (unless otherwise agreed); (b) will not seek compensation from CIGNA for Home Care Services for which MCA or its Represented Providers receive compensation hereunder; (c) will not bill Participants for Home Care Services under any circumstances except for; (i) any applicable Copayments, Deductibles, or Coinsurance, (ii) payments for services provided to a patient who is no longer eligible to receive Home Care Services, including but not limited to Participants that have reached their benefit limit (iii) payment for services provided to Participants, which are not Home Care Services; and (d) will direct the Participant and/or Represented Provider to obtain authorization from CIGNA prior to all hospitalizations or referrals of Participants, except in Emergencies or as otherwise required by law. EXHIBIT A PPO & INDEMNITY PROGRAM ATTACHMENT REIMBURSEMENT FOR OTHER SERVICES RATE AREA DESIGNATIONS: STATE RATE AREA RATE DESIGNATION - -------------------------------------------------------------------------- Alabama LOW 3 - -------------------------------------------------------------------------- Alaska HIGH 1 - -------------------------------------------------------------------------- Arizona MEDIUM 2 - -------------------------------------------------------------------------- Arkansas LOW 3 - -------------------------------------------------------------------------- California HIGH 1 - -------------------------------------------------------------------------- Colorado MEDIUM 2 - -------------------------------------------------------------------------- Connecticut MEDIUM 2 - -------------------------------------------------------------------------- Delaware LOW 3 - -------------------------------------------------------------------------- District of Columbia HIGH 1 - -------------------------------------------------------------------------- Florida MEDIUM 2 - -------------------------------------------------------------------------- Georgia MEDIUM 2 - -------------------------------------------------------------------------- Hawaii HIGH 1 - -------------------------------------------------------------------------- Idaho LOW 3 - -------------------------------------------------------------------------- Illinois HIGH 1 - -------------------------------------------------------------------------- Indiana LOW 3 - -------------------------------------------------------------------------- Iowa LOW 3 - -------------------------------------------------------------------------- Kansas LOW 3 - -------------------------------------------------------------------------- Kentucky LOW 3 - -------------------------------------------------------------------------- Louisiana MEDIUM 2 - -------------------------------------------------------------------------- Maine LOW 3 - -------------------------------------------------------------------------- Maryland MEDIUM 2 - -------------------------------------------------------------------------- Massachusetts HIGH 1 - -------------------------------------------------------------------------- Michigan LOW 3 - -------------------------------------------------------------------------- Minnesota LOW 3 - -------------------------------------------------------------------------- Mississippi LOW 3 - -------------------------------------------------------------------------- Missouri MEDIUM 2 - -------------------------------------------------------------------------- Montana LOW 3 - -------------------------------------------------------------------------- Nebraska LOW 3 - -------------------------------------------------------------------------- Nevada LOW 3 - -------------------------------------------------------------------------- New Hampshire LOW 3 - -------------------------------------------------------------------------- New Jersey MEDIUM 2 - -------------------------------------------------------------------------- New Mexico LOW 3 - -------------------------------------------------------------------------- New York MEDIUM 2 - -------------------------------------------------------------------------- North Carolina MEDIUM 2 - -------------------------------------------------------------------------- North Dakota MEDIUM 2 - -------------------------------------------------------------------------- Ohio MEDIUM 2 - -------------------------------------------------------------------------- Oklahoma LOW 3 - -------------------------------------------------------------------------- Oregon MEDIUM 2 - -------------------------------------------------------------------------- Pennsylvania MEDIUM 2 - -------------------------------------------------------------------------- Rhode Island MEDIUM 2 - -------------------------------------------------------------------------- South Carolina MEDIUM 2 - -------------------------------------------------------------------------- South Dakota LOW 3 - -------------------------------------------------------------------------------- Tennessee MEDIUM 2 - -------------------------------------------------------------------------------- Texas HIGH 1 - -------------------------------------------------------------------------------- Utah MEDIUM 2 - -------------------------------------------------------------------------------- Vermont LOW 3 - -------------------------------------------------------------------------------- Virginia MEDIUM 2 - -------------------------------------------------------------------------------- Washington MEDIUM 2 - -------------------------------------------------------------------------------- West Virginia LOW 3 - -------------------------------------------------------------------------------- Wisconsin LOW 3 - -------------------------------------------------------------------------------- Wyoming LOW 3 - -------------------------------------------------------------------------------- TRADITIONAL HOME HEALTH SERVICES RATES: RATES EFFECTIVE JANUARY 1, 2004 - DECEMBER 31, 2004 THE FOLLOWING TRADITIONAL HOME HEALTH SERVICES HAVE BOTH VISIT AND HOURLY RATES. Notes 1, 2, 3, 4, 5 and 6 apply
------------------------------------------------------------------- AREA 1 AREA 2 AREA 3 ------------------------------------------------------------------- VISIT HOUR VISIT HOUR VISIT HOUR - -------------------------------------------------------------------------------------------------------------- CERTIFIED NURSES AIDE * * * * * * - -------------------------------------------------------------------------------------------------------------- HOME HEALTH AIDE * * * * * * - -------------------------------------------------------------------------------------------------------------- LVN/LPN * * * * * * - -------------------------------------------------------------------------------------------------------------- LVN/LPN - HIGH TECH * * * * * * - -------------------------------------------------------------------------------------------------------------- PEDIATRIC HIGH TECH LVN/LPN * * * * * * - -------------------------------------------------------------------------------------------------------------- PEDIATRIC HIGH TECH RN * * * * * * - -------------------------------------------------------------------------------------------------------------- PEDIATRIC LVN/LPN * * * * * * - -------------------------------------------------------------------------------------------------------------- PEDIATRIC RN * * * * * * - -------------------------------------------------------------------------------------------------------------- RN * * * * * * - -------------------------------------------------------------------------------------------------------------- RN HIGH TECH INFUSION * * * * * * - -------------------------------------------------------------------------------------------------------------- RN HIGH TECH OTHER * * * * * * - --------------------------------------------------------------------------------------------------------------
THE FOLLOWING TRADITIONAL HOME HEALTH SERVICES HAVE VISIT ONLY RATES. Notes 1, 3, 4, 5, 7 and 8 apply
------------------------------------------------------------------- AREA 1 AREA 2 AREA 3 ------------------------------------------------------------------- VISIT HOUR VISIT HOUR VISIT HOUR - -------------------------------------------------------------------------------------------------------------- DIABETIC NURSE * * * * * * - -------------------------------------------------------------------------------------------------------------- DIETITIAN * * * * * * - -------------------------------------------------------------------------------------------------------------- ENTEROSTOMAL THERAPIST * * * * * * - -------------------------------------------------------------------------------------------------------------- MATERNAL CHILD HEALTH * * * * * * - -------------------------------------------------------------------------------------------------------------- MEDICAL SOCIAL WORKER * * * * * * - -------------------------------------------------------------------------------------------------------------- OCCUPATIONAL THERAPIST * * * * * * - -------------------------------------------------------------------------------------------------------------- OCCUPATIONAL THERAPIST ASSISTANT * * * * * * - -------------------------------------------------------------------------------------------------------------- PHLEBOTOMIST * * * * * * - -------------------------------------------------------------------------------------------------------------- PHOTOTHERAPY PACKAGE SERVICE * * * * * * - -------------------------------------------------------------------------------------------------------------- PHYSICAL THERAPIST * * * * * * - -------------------------------------------------------------------------------------------------------------- PHYSICAL THERAPIST ASSISTANT * * * * * * - -------------------------------------------------------------------------------------------------------------- PSYCHIATRIC NURSE * * * * * * - -------------------------------------------------------------------------------------------------------------- REHABILITATION NURSE * * * * * * - --------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - -------------------------------------------------------------------------------------------------------------- RESPIRATORY THERAPIST * * * * * * - -------------------------------------------------------------------------------------------------------------- RESPIRATORY THERAPIST - CPAP Clinic * * * * * * - -------------------------------------------------------------------------------------------------------------- RN ASSESSMENT, INITIAL * * * * * * - -------------------------------------------------------------------------------------------------------------- RN SKILLED NURSING VISIT-EXTENSIVE * * * * * * - -------------------------------------------------------------------------------------------------------------- SPEECH THERAPIST * * * * * * - --------------------------------------------------------------------------------------------------------------
THE FOLLOWING TRADITIONAL HOME HEALTH SERVICE HAS HOURLY ONLY RATES. Notes 3, 4 and 5 apply
------------------------------------------------------------------- AREA 1 AREA 2 AREA 3 ------------------------------------------------------------------- VISIT HOUR VISIT HOUR VISIT HOUR - -------------------------------------------------------------------------------------------------------------- HOMEMAKER * * * * * * - --------------------------------------------------------------------------------------------------------------
THE FOLLOWING TRADITIONAL HOME HEALTH SERVICE IS PRICED ON A PER DIEM BASIS. Notes 3, 4 and 5 apply
------------------------------------------------------------------- AREA 1 AREA 2 AREA 3 ------------------------------------------------------------------- PER DIEM PER DIEM PER DIEM - -------------------------------------------------------------------------------------------------------------- COMPANION/LIVE IN * * * * * * - --------------------------------------------------------------------------------------------------------------
NOTES: * * * * * * * * HOME INFUSION RATES: RATES EFFECTIVE JANUARY 1, 2004 - DECEMBER 31, 2004 THE FOLLOWING HOME INFUSION THERAPY SERVICE RATES EXCLUDE DRUGS. DRUGS ARE PRICED AS A PERCENTAGE DISCOUNT OFF AWP (IF APPLICABLE), AND THERE IS NO PRICE DIFFERENCE BETWEEN PRIMARY AND MULTIPLE THERAPIES
PRIMARY OR PRIMARY OR PRIMARY OR MULTIPLE THERAPY MULTIPLE THERAPY MULTIPLE THERAPY PER DIEM DISPENSING FEE DRUG DISCOUNT OFF AWP - ----------------------------------------------------------------------------------------------------------- Ancillary Drugs * * * - ----------------------------------------------------------------------------------------------------------- Biological Response Modifiers * * * - ----------------------------------------------------------------------------------------------------------- Cardiac (Inotropic) Therapy * * * - ----------------------------------------------------------------------------------------------------------- Chelation Therapy * * * - -----------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ----------------------------------------------------------------------------------------------------------- Chemotherapy * * * - ----------------------------------------------------------------------------------------------------------- Enteral Therapy * * * - ----------------------------------------------------------------------------------------------------------- Enzyme Therapy * * * - ----------------------------------------------------------------------------------------------------------- Growth Hormone * * * - ----------------------------------------------------------------------------------------------------------- IV Immune Globulin * * * - ----------------------------------------------------------------------------------------------------------- Other Injectable Therapies * * * - ----------------------------------------------------------------------------------------------------------- Other Infusion Therapies * * * - ----------------------------------------------------------------------------------------------------------- Pain Management Therapy * * * - ----------------------------------------------------------------------------------------------------------- Steroid Therapy * * * - ----------------------------------------------------------------------------------------------------------- Thrombolytic (Anticoagulation) Therapy * * * - ----------------------------------------------------------------------------------------------------------- Synagis * * * - ----------------------------------------------------------------------------------------------------------- Remodulin Therapy * * * - -----------------------------------------------------------------------------------------------------------
THE FOLLOWING HOME INFUSION THERAPY SERVICE RATES EXCLUDE DRUGS. DRUGS ARE PRICED AS A PERCENTAGE DISCOUNT OFF AWP, AND THERE IS A PRICE DIFFERENCE BETWEEN PRIMARY AND MULTIPLE ANTI-INFECTIVE THERAPIES
- ----------------------------------------------------------------------------------------------------------- PER DIEM DRUG DISCOUNT OFF AWP - ----------------------------------------------------------------------------------------------------------- Anti-Infectives - Primary Anti-Infective * * * - ----------------------------------------------------------------------------------------------------------- Anti-Infectives - Multiple Anti-Infective * * * - -----------------------------------------------------------------------------------------------------------
THE FOLLOWING HOME INFUSION THERAPY SERVICE RATE EXCLUDES DRUGS. DRUGS ARE PRICED PER VIAL, AND THERE IS NO PRICE DIFFERENCE BETWEEN PRIMARY AND MULTIPLE ANTI-INFECTIVE THERAPIES
- ----------------------------------------------------------------------------------------------------------- PRIMARY OR MULTIPLE THERAPY PER DIEM COST OF DRUG - ----------------------------------------------------------------------------------------------------------- Flolan Therapy * - ----------------------------------------------------------------------------------------------------------- Flolan 0.5 mg vial * - ----------------------------------------------------------------------------------------------------------- Flolan 1.5 mg vial * - ----------------------------------------------------------------------------------------------------------- Flolan diluent vial * - -----------------------------------------------------------------------------------------------------------
THE FOLLOWING HOME INFUSION THERAPY SERVICE RATES INCLUDE DRUGS, AND THERE IS NO PRICE DIFFERENCE BETWEEN PRIMARY AND MULTIPLE THERAPIES
- ----------------------------------------------------------------------------------------------------------- PRIMARY OR MULTIPLE THERAPY PER DIEM - ----------------------------------------------------------------------------------------------------------- Enteral Therapy * - ----------------------------------------------------------------------------------------------------------- Hydration Therapy * - ----------------------------------------------------------------------------------------------------------- Total Parenteral Nutrition * - -----------------------------------------------------------------------------------------------------------
NOTES: * * * Confidential treatment requested * * * * * THE FOLLOWING ARE FOR THE STATED ITEM ONLY. UNLESS OTHERWISE NOTED, NURSING, SUPPLIES, ETC. ARE NOT INCLUDED. - ----------------------------------------------------------------------------------------------------------- Blood Transfusion per Unit (Tubing, Filters) * - ----------------------------------------------------------------------------------------------------------- Catheter Care Per Diem * - ----------------------------------------------------------------------------------------------------------- Midline Insertion (Catheter & Supplies) * - ----------------------------------------------------------------------------------------------------------- PICC Line Insertion (Catheter & Supplies) * - ----------------------------------------------------------------------------------------------------------- Blood Product * - -----------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------- FACTOR CONCENTRATES - ----------------------------------------------------------------------------------------------------------- Vial price Unit Price - ----------------------------------------------------------------------------------------------------------- FACTOR VII - ----------------------------------------------------------------------------------------------------------- Novoseven 1200MCG Vial * - ----------------------------------------------------------------------------------------------------------- Novoseven 4800MCG Vial * - ----------------------------------------------------------------------------------------------------------- Novoseven in 1200MCG or 4800MCG QTY * - ----------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------- FACTOR VIII (RECOMBINANT) - ----------------------------------------------------------------------------------------------------------- Recombinate * - ----------------------------------------------------------------------------------------------------------- Kogenate or Helixate * - ----------------------------------------------------------------------------------------------------------- Bioclate * - ----------------------------------------------------------------------------------------------------------- Helixate FS * - ----------------------------------------------------------------------------------------------------------- Kogenate FS * - ----------------------------------------------------------------------------------------------------------- Refacto * - ----------------------------------------------------------------------------------------------------------- Advate * - ----------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------- FACTOR VIII (MONOCLONAL) - ----------------------------------------------------------------------------------------------------------- Hemofil-M or A. R. C. Method M * - ----------------------------------------------------------------------------------------------------------- Monoclate P * - ----------------------------------------------------------------------------------------------------------- Monarc-M * - ----------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------- FACTOR VIII (OTHER) - ----------------------------------------------------------------------------------------------------------- Koate * - ----------------------------------------------------------------------------------------------------------- Humate * - ----------------------------------------------------------------------------------------------------------- Alphanate SDHT * - ----------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------- FACTOR IX (RECOMBINANT) - ----------------------------------------------------------------------------------------------------------- BeneFix * - -----------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ----------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------- FACTOR IX (MONOCLONAL/HIGH PURITY) - ----------------------------------------------------------------------------------------------------------- Mononine * - ----------------------------------------------------------------------------------------------------------- Alphanine * - ----------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------- FACTOR IX (OTHER) - ----------------------------------------------------------------------------------------------------------- Konyne - 80 * - ----------------------------------------------------------------------------------------------------------- Proplex T * - ----------------------------------------------------------------------------------------------------------- Bebulin * - ----------------------------------------------------------------------------------------------------------- Profilnine SD * - ----------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------- ANTI-INHIBITOR COMPLEX - ----------------------------------------------------------------------------------------------------------- Autoplex-T * - ----------------------------------------------------------------------------------------------------------- Feiba-VH * - ----------------------------------------------------------------------------------------------------------- Hyate-C * - ----------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------- HEMOSTATIC AGENTS - ----------------------------------------------------------------------------------------------------------- DDAVP - 10ml vial * - ----------------------------------------------------------------------------------------------------------- Stimate - 2.5ml vial * - -----------------------------------------------------------------------------------------------------------
Above rates include all necessary ancillary supplies and waste disposal unit; 24-hour on-call clinical support; home infusion monitoring system; product delivery nationwide; patient training, education, and evaluation DME/HOME RESPIRATORY RATES: RATES EFFECTIVE JANUARY 1, 2004 - MARCH 31, 2004
- ---------------------------------------------------------------------------------------------------------------- HCPCS CHC CODE CODE GENTIVA CODE DESCRIPTION PURCHASE PRICE RENTAL PRICE DAILY PRICE - ---------------------------------------------------------------------------------------------------------------- A4660 DM590 2520 MONITOR, BLOOD PRESSURE (A4660) * W/STETH & CUFF - ---------------------------------------------------------------------------------------------------------------- A4670 DM590 2518 MONITOR, BLOOD PRESSURE (A4670), * AUTOMATIC - ---------------------------------------------------------------------------------------------------------------- A7034 A9900 7552 BREEZE (A9900) CPAP/BIPAP MASK * - ---------------------------------------------------------------------------------------------------------------- A7034 A9900 7553 FULL FACE (A9900) MIRAGE * CPAP/BIPAP MASK - ---------------------------------------------------------------------------------------------------------------- A7034 A9900 7554 GEL/SILICON (A9900) CPAP/BIPAP * MASK INCL GLD SEAL,PHANTM, MONARCH - ---------------------------------------------------------------------------------------------------------------- A7034 A9900 7556 SPECIALTY (A9900) CPAP/BIPAP * MASK (PROFILE OR SIMPICITY) - ---------------------------------------------------------------------------------------------------------------- B9002 HI531 2570 PUMP, ENTERAL (B9002) * * - ---------------------------------------------------------------------------------------------------------------- B9998 DM590 6828 ENTERAL SUPPLIES (B9998) * - ---------------------------------------------------------------------------------------------------------------- DM590 DM570 7551 BACK-PACK (E1399), FOR PORTABLE * ENTERAL PUMP - ---------------------------------------------------------------------------------------------------------------- A4615 DM590 2522 CANNULA, NASAL * - ---------------------------------------------------------------------------------------------------------------- B9002 DM590 7509 ENTERAL PUMP, PORTABLE (B9002) * * - ---------------------------------------------------------------------------------------------------------------- A7034 DM590 7508 MASK, CPAP GEL OR SILICONE * (K0183) - ---------------------------------------------------------------------------------------------------------------- E0100 E0100 2020 CANE (E0100), ADJ OR FIX, W/TIP * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0105 E0105 2021 CANE, QUAD (E0105) OR THREE * PRONG, ADJ OR FIX, W/ TIPS - ---------------------------------------------------------------------------------------------------------------- E0110 E0110 2028 CRUTCHES, FOREARM (E0110), ADJ * OR FIX, PAIR, W/ TIPS, GRIPS - ---------------------------------------------------------------------------------------------------------------- E0111 E0111 2023 CRUTCH FOREARM (E0111), ADJ OR * FIX, EACH, W/ TIP AND GRIPS - ---------------------------------------------------------------------------------------------------------------- E0112 E0112 2027 CRUTCHES UNDERARM, WOOD * (E0112), ADJ OR FIX, PAIR, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0113 E0113 2025 CRUTCH UNDERARM, WOOD (E0113), * ADJ OR FIX, EACH, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0114 E0114 2026 CRUTCHES UNDERARM, ALUM (E0114), * ADJ OR FIX, PAIR, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0116 E0116 2024 CRUTCH UNDERARM, ALUM (E0116), * ADJ OR FIX, EACH, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0130 E0130 2037 WALKER, RIGID (E0130) (PICKUP), * ADJ OR FIX HEIGHT - ---------------------------------------------------------------------------------------------------------------- E0135 E0135 2036 WALKER, FOLDING (E0135) * (PICKUP), ADJ OR FIX HEIGHT - ---------------------------------------------------------------------------------------------------------------- E0141 E0141 2040 WALKER, WHEELED (E0141), W/OUT * SEAT - ---------------------------------------------------------------------------------------------------------------- E0142 DM570 2034 RIGID WALKER (E0142), WHEELED, * W/ SEAT, - ---------------------------------------------------------------------------------------------------------------- E0143 E0143 2029 WALKER FOLDING, WHEELED (E0143), * W/OUT SEAT - ---------------------------------------------------------------------------------------------------------------- E0145 DM570 2039 WALKER (E0145), WHEELED, W/ SEAT * AND CRUTCH ATTACHMENTS - ---------------------------------------------------------------------------------------------------------------- E0146 DM570 2038 WALKER, WHEELED, W/ SEAT (E0146) * - ---------------------------------------------------------------------------------------------------------------- E0147 E0147 2030 WALKER HVY DUT (E0147), MULT * BRAKING SYS, VAR WHEEL RESISTANCE - ---------------------------------------------------------------------------------------------------------------- E0153 E0153 2032 CRUTCH PLATFORM ATTACHMENT * (E0153), FOREARM EA - ---------------------------------------------------------------------------------------------------------------- E0154 E0154 2033 WALKER PLATFORM ATTACHMENT * (E0154), EA - ---------------------------------------------------------------------------------------------------------------- E0155 E0155 2041 WALKER WHEEL ATTACHMENT (E0155), * RIGID (PICKUP) WALKER - ---------------------------------------------------------------------------------------------------------------- E0156 DM570 2035 WALKER SEAT ATTACHMENT (E0156) * - ---------------------------------------------------------------------------------------------------------------- E0157 E0157 2022 WALKER, CRUTCH ATTACHMENT * (E0157), EACH - ---------------------------------------------------------------------------------------------------------------- E0158 E0158 2031 WALKER LEG EXTENSIONS (E0158) * - ---------------------------------------------------------------------------------------------------------------- E0163 E0163 2047 COMMODE CHAIR, STATIONARY * (E0163), W/ FIX ARMS - ---------------------------------------------------------------------------------------------------------------- E0164 E0164 2045 COMMODE CHAIR, MOBILE (E0164), * W/ FIX ARMS - ---------------------------------------------------------------------------------------------------------------- E0165 E0165 2046 COMMODE CHAIR (E0165), * STATIONARY, W/ DETACH ARMS - ---------------------------------------------------------------------------------------------------------------- E0165 E0165 2591 COMMODE, XXWIDE(E0165) * - ---------------------------------------------------------------------------------------------------------------- E0166 E0166 2044 COMMODE CHAIR (E0166), MOBILE, * W/ DETACH ARMS - ---------------------------------------------------------------------------------------------------------------- E0167 E0167 2051 COMMODE CHAIR, PAIL OR PAN * (E0167) - ---------------------------------------------------------------------------------------------------------------- E0176 E0176 2142 CUSHION (E0176) OR AIR PRESSURE * PAD, NON-POSITIONING - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0176 E0176 2394 REPLACEMENT PAD (E0176) * ALTERNATING PRESS - ---------------------------------------------------------------------------------------------------------------- E0177 E0177 2224 CUSHION OR WATER PRESS PAD * (E0177), NONPOSITIONING - ---------------------------------------------------------------------------------------------------------------- E0178 E0178 2160 CUSHION OR GEL PRESS PAD * (E0178), NONPOSITIONING - ---------------------------------------------------------------------------------------------------------------- E0179 E0179 2154 CUSHION (E0179) OR DRY PRESSURE * PAD, NONPOSTIONING - ---------------------------------------------------------------------------------------------------------------- E0180 E0180 2196 PUMP (E0180), ALTERNATING * * PRESSURES W/PAD - ---------------------------------------------------------------------------------------------------------------- E0181 E0181 2197 PUMP (E0181), ALTERNATING * * PRESS W/PAD, HVY DUTY - ---------------------------------------------------------------------------------------------------------------- E0184 E0184 2074 MATTRESS, DRY PRESSURE (E0184) * - ---------------------------------------------------------------------------------------------------------------- E0185 E0185 2076 MATTRESS (E0185), GEL OR * GEL-LIKE PRESSURE PAD - ---------------------------------------------------------------------------------------------------------------- E0186 E0186 2064 MATTRESS, AIR PRESSURE (E0186) * - ---------------------------------------------------------------------------------------------------------------- E0187 E0187 2099 MATTRESS, WATER PRESSURE (E0187) * - ---------------------------------------------------------------------------------------------------------------- E0188 DM570 2217 PAD, SYNTHETIC SHEEPSKIN (A9900) * - ---------------------------------------------------------------------------------------------------------------- E0189 DM570 2177 PAD, LAMBSWOOL SHEEPSKIN * (E0189), ANY SIZE - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2573 CUSHION, JAY FOR W/C (E0192) * * - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2572 CUSHION, ROHO FOR W/C (E0192) * * - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2178 W/C PAD (E0192), LOW PRESS AND * * POSITIONING EQUALIZATION - ---------------------------------------------------------------------------------------------------------------- E0193 E0193 2098 MATTRESS, LOW AIR LOSS (E0193), * * * INCL. BED - ---------------------------------------------------------------------------------------------------------------- E0194 DM570 2063 AIR FLUIDIZED BED (E0194) * * * - ---------------------------------------------------------------------------------------------------------------- E0196 E0196 2077 MATTRESS, GEL PRESSURE (E0196) * - ---------------------------------------------------------------------------------------------------------------- E0197 E0197 2065 MATTRESS, AIR PRESSURE PAD * (E0197) - ---------------------------------------------------------------------------------------------------------------- E0198 E0198 2100 MATTRESS (E0198), WATER PRESSURE * PAD - ---------------------------------------------------------------------------------------------------------------- E0199 E0199 2075 MATTRESS, DRY PRESSURE PAD * (E0199) - ---------------------------------------------------------------------------------------------------------------- E0200 E0200 2228 HEAT LAMP (E0200), W/OUT STAND, * INCL/BULB, OR INFRARED ELEMENT - ---------------------------------------------------------------------------------------------------------------- E0202 E0202 2229 PHOTOTHERAPY (BILIRUBIN) * (E0202), LIGHT WIT - ---------------------------------------------------------------------------------------------------------------- E0202 E0202 2524 PHOTOTHERAPY, BILI BLANKET * (E0202) - ---------------------------------------------------------------------------------------------------------------- E0205 E0205 2227 HEAT LAMP (E0205), WITH STAND, * INCL/ BULB, OR INFRARED ELEMENT - ---------------------------------------------------------------------------------------------------------------- E0210 DM570 2156 HEATING PAD, STANDARD (E0210) * - ---------------------------------------------------------------------------------------------------------------- E0215 DM570 2155 HEATING PAD (E0215), ELECTRIC, * MOIST - ---------------------------------------------------------------------------------------------------------------- E0218 DM570 2560 COLD THERAPY UNIT (E0218) * * * - ---------------------------------------------------------------------------------------------------------------- E0235 DM570 2187 PARAFFIN BATH UNIT, PORT (E0235) * - ---------------------------------------------------------------------------------------------------------------- E0236 DM570 2199 PUMP (E0236) FOR WATER * CIRCULATING PAD - ---------------------------------------------------------------------------------------------------------------- E0237 DM570 2223 HEAT COLD WATER (E0237) * CIRCULATING PAD W/PUMP - ---------------------------------------------------------------------------------------------------------------- E0238 DM570 2179 HEATING PAD (E0238), MOIST, * NON-ELECTRIC - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2867 BATH TUB RAIL (E0241), WALL, * L-SHAPE - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2862 BATH TUB RAIL, WALL, 12" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2863 BATH TUB RAIL, WALL, 16" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2864 BATH TUB RAIL, WALL, 18" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2865 BATH TUB RAIL, WALL, 24" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2866 BATH TUB RAIL, WALL, 36" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2043 BATH TUB RAIL, WALL, UNSPECIFIED * SIZE - ---------------------------------------------------------------------------------------------------------------- E0242 DM570 2042 BATH TUB RAIL, FLOOR BASE * (E0242) - ---------------------------------------------------------------------------------------------------------------- E0243 DM570 2056 TOILET RAIL, EACH (E0243) * - ---------------------------------------------------------------------------------------------------------------- E0244 E0244 2587 TOILET SEAT (E0244) RAISED * WITH ARMS - ---------------------------------------------------------------------------------------------------------------- E0244 E0244 2052 TOILET SEAT, RAISED (E0244) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2575 BATH BENCH WITH BACK (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2058 BATH TUB STOOL OR BENCH (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2578 TRANSFER BENCH, NON-PADDED * (E0245) - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2577 TRANSFER BENCH, PADDED (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0246 DM570 2057 TRANSFER TUB RAIL(E0246), * ATTACHMENT - ---------------------------------------------------------------------------------------------------------------- E0249 DM570 2186 HEAT UNIT (E0249), WATER * CIRCULATING PAD - ---------------------------------------------------------------------------------------------------------------- E0255 E0255 2090 HOSP BED (E0255), VAR HEIGHT, * * HI-LO, W/ SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0256 E0256 2091 HOSP BED (E0256), VAR HEIGHT, * * HI-LO, W/ SIDE RAILS, W/O MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0260 E0260 2083 HOSP BED (E0260), SEMI-ELEC, * * W/ SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0261 E0261 2084 HOSP BED (E0261), SEMI-ELEC, * * W/ SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0265 E0265 2086 HOSP BED (E0265), TOTAL ELEC, * * W/ SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0266 E0266 2087 HOSP BED (E0266), TOTAL ELEC, * * W/ SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0271 E0271 2096 MATTRESS, INNERSPRING (E0271) * - ---------------------------------------------------------------------------------------------------------------- E0272 E0272 2095 MATTRESS, FOAM RUBBER (E0272) * - ---------------------------------------------------------------------------------------------------------------- E0273 DM570 2068 BED BOARD (E1399) * - ---------------------------------------------------------------------------------------------------------------- E0274 DM570 2097 OVER-BED TABLE (E0274) * - ---------------------------------------------------------------------------------------------------------------- E0275 E0275 2071 BED PAN, STANDARD (E0275), METAL * OR PLASTIC - ---------------------------------------------------------------------------------------------------------------- E0276 E0276 2070 BED PAN, FRACTURE (E0276), METAL * OR PLASTIC - ---------------------------------------------------------------------------------------------------------------- E0277 E0277 2066 MATTRESS (E0277), LOW AIR LOSS, * * ALT PRESSURE - ---------------------------------------------------------------------------------------------------------------- E0280 DM570 2069 BED CRADLE, ANY TYPE (E1399) * - ---------------------------------------------------------------------------------------------------------------- E0292 E0292 2092 HOSP BED (E0292), VAR HEIGHT, * * HI-LO, W/OUT S/ RAILS, W/ MATTRESS - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0293 E0293 2093 HOSP BED (E0293), VAR HEIGHT, * * HI-LO, NO SIDE RAILS, NO MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0294 E0294 2085 HOSP BED (E0294), SEMI-ELEC, * * W/OUT SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0295 E0295 2094 HOSP BED (E0295), SEMI-ELEC, * * W/OUT SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0296 E0296 2089 HOSP BED (E0296), TOTAL ELEC, * * W/OUT SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0297 E0297 2088 HOSP BED (E0297), TOTAL ELEC, * * W/OUT SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0305 E0305 2073 BED SIDE RAILS (E0305), HALF * LENGTH - ---------------------------------------------------------------------------------------------------------------- E0310 E0310 2072 BED SIDE RAILS (E0310), FULL * LENGTH - ---------------------------------------------------------------------------------------------------------------- E0315 DM570 2067 BED ACCESSORIES: BOARDS OR * TABLES, ANY TYPE - ---------------------------------------------------------------------------------------------------------------- E0325 E0325 2060 URINAL; MALE (E0325), JUG-TYPE, * ANY MATERIAL - ---------------------------------------------------------------------------------------------------------------- E0326 E0326 2059 URINAL; FEMALE (E0326), * JUG-TYPE, ANY MATERIAL - ---------------------------------------------------------------------------------------------------------------- E0372 E0372 7008 MATTRESS (E0372) POWERED AIR * * OVERLAY - ---------------------------------------------------------------------------------------------------------------- E0410 E0444 2369 O2 CONTENTS, LIQUID (E0444), PER * POUND - ---------------------------------------------------------------------------------------------------------------- E0416 E0443 2371 O2 REFILL FOR PORT (E0443) GAS * SYSTEM ONLY, UP TO 23 CUBIC FEET - ---------------------------------------------------------------------------------------------------------------- E0424 E0424 2385 O2 SYS STATIONARY (E0424) COMPR * GAS, RENT - ---------------------------------------------------------------------------------------------------------------- E0430 E0430 2374 O2 SYS PORT GAS, PURCH (E0430) * - ---------------------------------------------------------------------------------------------------------------- E0431 E0431 2574 O2 SYS PORT GAS, LIGHTWEIGHT * * (E0431) W/CONSERV DEVICE,NO CONTENT - ---------------------------------------------------------------------------------------------------------------- E0431 E0431 2375 O2 SYS PORT GAS, RENT (E0431) * - ---------------------------------------------------------------------------------------------------------------- E0434 E0434 2377 O2 SYS PORT LIQUID,RENT (E0434) * - ---------------------------------------------------------------------------------------------------------------- E0435 E0435 2376 O2 SYS PORT LIQUID, PURCH * (E0435) - ---------------------------------------------------------------------------------------------------------------- E0439 E0439 2388 O2 SYS STATIONARY (E0439) * LIQUID, RENT - ---------------------------------------------------------------------------------------------------------------- E0440 E0440 2387 O2 SYS STATIONARY (E0440) * LIQUID, PURCH - ---------------------------------------------------------------------------------------------------------------- E0443 E0400 2869 O2 CONTENTS, H/K CYLINDER * (E0400), 200-300 CUBIC FT - ---------------------------------------------------------------------------------------------------------------- E0444 E0444 2379 O2 CONTENTS, PORT LIQUID * (E0444), PER UNIT (1 UNIT = 1 LB.) - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 7555 POSITIVE PRESSURE VENTS (E0450) * * (E.G. T-BIRD) - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 2392 VENTILATOR VOLUME (E0450), * * STATIONARY OR PORT - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 7522 VENTILATOR, VOLUME, (E0450) * * EMERGENCY BACKUP UNIT - ---------------------------------------------------------------------------------------------------------------- E0452 E0452 2332 BILEVEL INTERMITTENT (E0452) * * ASSIST DEVICE,(BIPAP) - ---------------------------------------------------------------------------------------------------------------- E0453 E0453 2390 VENTILATOR THERAPEUTIC (E0453); * * FOR USE 12 HOURS OR LESS PER DAY - ---------------------------------------------------------------------------------------------------------------- E0455 E0455 2372 O2 TENT (E0455), EXCLUDING * * CROUP OR PEDIATRIC TENTS - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0457 E0457 2323 CHEST SHELL (CUIRASS) (E0457) * * - ---------------------------------------------------------------------------------------------------------------- E0459 E0459 2324 CHEST WRAP (E0459) * * - ---------------------------------------------------------------------------------------------------------------- E0460 E0460 2339 VENTILATOR (E0460), NEGATIVE * * PRESSURE , PORTABLE OR STATIONARY - ---------------------------------------------------------------------------------------------------------------- E0480 DM570 2373 PERCUSSOR (E0480), ELEC OR * * PNEUM, HOME MODEL - ---------------------------------------------------------------------------------------------------------------- E0500 E0500 2333 IPPB , W/ BUILT-IN NEB (E0500) * * MAN OR AUTO VALVES; INT/EXT POWER - ---------------------------------------------------------------------------------------------------------------- E0550 E0550 2328 HUMIDIFIER (E0550) DURABLE FOR * * EXTENSIV SUP/ HUMID W/ IPPB OR O2 - ---------------------------------------------------------------------------------------------------------------- E0555 E0555 2330 HUMIDIFIER (E0555), DURABLE, * * GLASS, FOR USE W/ REG OR FLOWMETER - ---------------------------------------------------------------------------------------------------------------- E0565 E0565 2325 COMPRESSOR, AIR POWER (E0565) * * - ---------------------------------------------------------------------------------------------------------------- E0570 E0570 2336 NEBULIZER, W/ COMPRESSOR (E0570) * * - ---------------------------------------------------------------------------------------------------------------- E0575 DM570 2571 NEBULIZER (E0575), ULTRASONIC, * * AC/DC - ---------------------------------------------------------------------------------------------------------------- E0575 DM570 2338 NEBULIZER; ULTRASONIC (E0575) * * - ---------------------------------------------------------------------------------------------------------------- E0585 E0585 2337 NEBULIZER(E0585), W/ COMPRESSOR * * AND HEATER - ---------------------------------------------------------------------------------------------------------------- E0600 E0600 2389 SUCTION PUMP (E0600), HOME MODEL * * - ---------------------------------------------------------------------------------------------------------------- E0600 E0600 7523 SUCTION UNIT, (E0600), PORTABLE * * AC/DC - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 2326 CONTINUOUS POSITVE (E0601) * * AIRWAY PRESSURE DEVICE (CPAP) - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 6965 CPAP, SELF TITRATING (E0601) * * - ---------------------------------------------------------------------------------------------------------------- E0605 DM570 2391 VAPORIZER, ROOM TYPE (E0605) * * - ---------------------------------------------------------------------------------------------------------------- E0606 DM570 2380 POSTURAL DRAINAGE BOARD (E0606) * * - ---------------------------------------------------------------------------------------------------------------- E0607 E0607 6874 MONITOR, B/GLUCOSE (E0607) * * ACCUCHEK AD - ---------------------------------------------------------------------------------------------------------------- E0607 E0607 2164 MONITOR, BLOOD GLUCOSE (E0607) * * - ---------------------------------------------------------------------------------------------------------------- E0618 E0608 2322 APNEA MONITOR (E0608) * * - ---------------------------------------------------------------------------------------------------------------- E0619 E0608 2576 APNEA MONITOR (E0608) W/MEM * * (INCL SMART) - ---------------------------------------------------------------------------------------------------------------- E0609 E0609 2146 MONITOR, BLOOD GLUCOSE (E0609) * * W/SPECIAL FEATURES - ---------------------------------------------------------------------------------------------------------------- E0621 E0621 2215 PATIENT LIFT (E0621), SLING OR * * SEAT, CANVAS OR NYLON - ---------------------------------------------------------------------------------------------------------------- E0625 DM570 2191 PATIENT LIFT (E0625), KARTOP, * * BATHROOM OR TOILET - ---------------------------------------------------------------------------------------------------------------- E0627 E0627 4553 HIP CHAIR (E0627) * * - ---------------------------------------------------------------------------------------------------------------- E0627 DM570 2395 SEAT LIFT CHAIR/MOTORIZED * (E0627) - ---------------------------------------------------------------------------------------------------------------- E0627 DM570 2205 SEAT LIFT MECH (E0627) * INCORPORATED INTO A COMB LIFT-CHAIR MECH - ---------------------------------------------------------------------------------------------------------------- E0630 E0630 2190 PATIENT LIFT, HYDRAULIC (E0630), * * W/ SEAT OR SLING - ---------------------------------------------------------------------------------------------------------------- E0635 DM570 2189 PATIENT LIFT (E0635), ELEC W/ * SEAT OR SLING - ---------------------------------------------------------------------------------------------------------------- E0650 E0650 2192 PNEUM COMPRESSOR (E0650), * * NON-SEG HOME MODEL - ---------------------------------------------------------------------------------------------------------------- E0651 E0651 2194 PNEUM COMPRESSOR (E0651), SEG * * HOME MODEL W/OUT CALIB GRAD PRES - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0652 E0652 2193 PNEUM COMPRESSOR (E0652), SEG * * HOME MODEL W/ CALIB GRAD PRES - ---------------------------------------------------------------------------------------------------------------- E0655 E0655 2182 PNEUM COMPRESSOR (E0655), * NON-SEG APPLIANCE, HALF ARM - ---------------------------------------------------------------------------------------------------------------- E0660 E0660 2181 PNEUM COMPRESSOR (E0660), * NON-SEG APPLIANCE, FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0665 E0665 2180 PNEUM COMPRESSOR (E0665), * NON-SEG APPLIANCE, FULL ARM - ---------------------------------------------------------------------------------------------------------------- E0666 E0666 2183 PNEUM COMPRESSOR (E0666), * NON-SEG APPLIANCE, HALF LEG - ---------------------------------------------------------------------------------------------------------------- E0667 E0667 2210 PNEUM APPLIANCE (E0667), SEG, * FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0668 E0668 2209 PNEUM APPLIANCE (E0668), SEG, * FULL ARM - ---------------------------------------------------------------------------------------------------------------- E0669 E0669 2212 PNEUM APPLIANCE (E0669), SEG, * HALF LEG - ---------------------------------------------------------------------------------------------------------------- E0670 E0670 2211 PNEUM APPLIANCE (E0670), SEG, * HALF ARM - ---------------------------------------------------------------------------------------------------------------- E0671 E0671 2207 PNEUM APPLIANCE (E0671), SEG * GRAD PRESS, FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0672 E0672 2206 PNEUM APPLIANCE (E0672), SEG * GRAD PRESS, FULL ARM - ---------------------------------------------------------------------------------------------------------------- E0673 E0673 2208 PNEUM APPLIANCE (E0673), SEG * GRAD PRESS, HALF LEG - ---------------------------------------------------------------------------------------------------------------- E0690 DM570 2221 ULTRAVIOLET CABINET (E0690), * APPROPRIATE FOR HOME USE - ---------------------------------------------------------------------------------------------------------------- E0700 DM570 2204 SAFETY EQUIP (E0700) (E.G., * BELT, HARNESS OR VEST) - ---------------------------------------------------------------------------------------------------------------- E0710 DM570 2202 RESTRAINTS (E0710), ANY TYPE * (BODY, CHEST, WRIST OR ANKLE) - ---------------------------------------------------------------------------------------------------------------- E0720 E0720 2219 TENS (E0720), TWO LEAD, * * LOCALIZED STIMULATION - ---------------------------------------------------------------------------------------------------------------- E0730 E0730 2218 TENS (E0730), FOUR LEAD, LARGER * * AREA/MULTIPLE NERVE STIMULATION - ---------------------------------------------------------------------------------------------------------------- E0731 E0731 2159 TENS OR NMES (E0731), CONDUCTIVE * GARMENT - ---------------------------------------------------------------------------------------------------------------- E0744 E0744 2120 STIMULATOR (E0744), * * NEUROMUSCULAR FOR SCOLIOSIS - ---------------------------------------------------------------------------------------------------------------- E0745 E0745 2121 STIMULATOR (E0745), * * NEUROMUSCULAR, ELECTRONIC SHOCK UNIT - ---------------------------------------------------------------------------------------------------------------- E0745 E0745 6915 STIMULATOR FOUR CH (E0745), * * NEUROMUSCULAR - ---------------------------------------------------------------------------------------------------------------- E0746 DM570 2109 ELECTROMYOGRAPHY (EMG) (E0746), * * BIOFEEDBACK DEVICE - ---------------------------------------------------------------------------------------------------------------- E0747 DM570 2122 STIMULATOR (E0747), OSTEOGENIC, * NON-INVASIVE - ---------------------------------------------------------------------------------------------------------------- E0748 DM570 2124 STIMULATOR (E0748), OSTEOGENIC * NON-INVASIVE, SPINAL APPLICATIONS - ---------------------------------------------------------------------------------------------------------------- E0755 DM570 2157 STIMULATOR (E0755), ELECTRONIC * SALIVARY REFLEX, NON INVASIVE - ---------------------------------------------------------------------------------------------------------------- E0776 E0776 2175 IV POLE (E0776) * * - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 2158 PUMP (E0784), EXT AMBULATORY * INFUSION, MINIMED, INSULIN - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 7925 PUMP, EXT INFUSION, MINIMED * PREMIUM, INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 6771 PUMP (E0784), INSULIN EXT * INFUSION DISETRONICS OR OTHER - ---------------------------------------------------------------------------------------------------------------- E0840 E0840 2133 TRACTION FRAME (E0840), ATTACH * TO HEADBOARD, CERVICAL TRACTION - ---------------------------------------------------------------------------------------------------------------- E0850 E0850 2134 TRACTION STAND (E0850), FREE * * STANDING, CERVICAL TRACTION - ---------------------------------------------------------------------------------------------------------------- E0855 E0855 7484 TRACTION (E0855), W/O FRAME OR * * STAND - ---------------------------------------------------------------------------------------------------------------- E0860 E0860 2130 TRACTION EQUIP (E0860), * * OVERDOOR, CERVICAL - ---------------------------------------------------------------------------------------------------------------- E0870 E0870 2131 TRACTION FRAME (E0870), ATTACH * * TO FOOTBOARD, EXTREMITY, BUCKS - ---------------------------------------------------------------------------------------------------------------- E0880 E0880 2135 TRACTION STAND (E0880) * * FREE/STAND EXTREMITY TRACTION, EG, BUCK'S - ---------------------------------------------------------------------------------------------------------------- E0890 E0890 2132 TRACTION FRAME (E0890), ATTACH * * TO FOOTBOARD, PELVIC TRACTION - ---------------------------------------------------------------------------------------------------------------- E0900 E0900 2136 TRACTION STAND (E0900) FREE/ * * STAND PELVIC TRACTION,(EG, BUCK'S) - ---------------------------------------------------------------------------------------------------------------- E0910 E0910 2138 TRAPEZE BARS (E0910), A/K/A PT * * HELPER, ATTACH TO BED W/ GRAB BAR - ---------------------------------------------------------------------------------------------------------------- E0920 E0920 2111 FRACTURE FRAME (E0920), ATTACH * * TO BED, INCLUDING WEIGHTS - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2125 PASSIVE MOTION (E0935) EXERCISE * DEVICE - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2859 PASSIVE MOTION (E0935) EXERCISE * DEVICE, ANKLE - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2860 PASSIVE MOTION (E0935) EXERCISE * DEVICE, ELBOW - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2857 PASSIVE MOTION (E0935) EXERCISE * DEVICE, HAND - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2858 PASSIVE MOTION (E0935) EXERCISE * DEVICE, SHOULDER - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2861 PASSIVE MOTION (E0935) EXERCISE * DEVICE, WRIST - ---------------------------------------------------------------------------------------------------------------- E0940 E0940 2137 TRAPEZE BAR (E0940), FREE * * STANDING, COMPLETE W/ GRAB BAR - ---------------------------------------------------------------------------------------------------------------- E0941 E0941 2116 TRACTION DEVICE (E0941), GRAVITY * * ASSISTED - ---------------------------------------------------------------------------------------------------------------- E0942 E0942 2101 HARNESS/HALTER (E0942), CERVICAL * HEAD - ---------------------------------------------------------------------------------------------------------------- E0944 E0944 2126 HARNESS (E0944), PELVIC BELT, * BOOT - ---------------------------------------------------------------------------------------------------------------- E0945 DM570 2110 HARNESS (E0945), EXTREMITY * BELT - ---------------------------------------------------------------------------------------------------------------- E0946 E0946 2115 FRACTURE, FRAME (E0946), DUAL W/ * * CROSS BARS, ATTACH TO BED - ---------------------------------------------------------------------------------------------------------------- E0947 E0947 2113 FRACTURE FRAME (E0947), * ATTACHMENTS FOR COMPLEX PELVIC TRACTION - ---------------------------------------------------------------------------------------------------------------- E0948 E0948 2112 FRACTURE FRAME (E0948) * * ATTACHMENTS FOR COMPLEX CERVICAL TRACTION - ---------------------------------------------------------------------------------------------------------------- E0950 DM570 2139 TRAY (E0950) * - ---------------------------------------------------------------------------------------------------------------- E0958 E0958 2307 W/C PART ATTACHMENT (E0958) TO * CONVERT ANY W/C TO ONE ARM DRIVE - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0959 E0959 2237 W/C PART AMPUTEE ADAPTER(E0959) * (COMPENSATE FOR TRANS OF WEIGHT) - ---------------------------------------------------------------------------------------------------------------- E0962 E0962 2232 CUSHION FOR WC 1" (E0962) * - ---------------------------------------------------------------------------------------------------------------- E0963 E0963 2233 CUSHION FOR WC 2" (E0963) * - ---------------------------------------------------------------------------------------------------------------- E0964 E0964 2234 CUSHION FOR WC 3" (E0964) * - ---------------------------------------------------------------------------------------------------------------- E0965 E0965 2235 CUSHION FOR WC 4" (E0965) * - ---------------------------------------------------------------------------------------------------------------- E0972 DM570 2230 TRANSFER BOARD OR DEVICE (E0972) * - ---------------------------------------------------------------------------------------------------------------- E0977 E0977 2317 CUSHION, WEDGE FOR W/C (E0977) * - ---------------------------------------------------------------------------------------------------------------- E0978 E0978 2248 BELT, SAFETY (E0978) W/ AIRPLANE * BUCKLE, W/C - ---------------------------------------------------------------------------------------------------------------- E0979 DM570 2249 BELT, SAFETY (E0979) W/ VELCRO * CLOSURE, W/C - ---------------------------------------------------------------------------------------------------------------- E0980 DM570 2292 SAFETY VEST (E0980), W/C * - ---------------------------------------------------------------------------------------------------------------- E1031 E1031 2291 ROLLABOUT CHAIR (E1031), W/ * * CASTORS 5" OR GREATER - ---------------------------------------------------------------------------------------------------------------- E1050 E1050 2260 W/C FULL/REC (E1050), FIX ARMS, * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1060 E1060 2259 W/C FULL/REC (E1070), DETACH * * ARMS, SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1065 E1065 2287 W/C POWER ATTACHMENT (E1065) * - ---------------------------------------------------------------------------------------------------------------- E1066 E1066 2247 BATTERY CHARGER (E1066) * - ---------------------------------------------------------------------------------------------------------------- E1069 E1069 2255 BATTERY, DEEP CYCLE (E1069) * - ---------------------------------------------------------------------------------------------------------------- E1070 E1070 2258 W/C FULL/REC (E1060), DETACH * * ARMS, SWING AWAY DET/ ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1083 E1083 2263 W/C HEMI (E1083), FIX ARMS, * * SWING AWAY DETACH ABLE ELEV LEG REST - ---------------------------------------------------------------------------------------------------------------- E1084 E1084 2262 W/C HEMI (E1084), DETACH ARMS, * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1085 E1085 2264 W/C HEMI (E1085), FIX ARMS, * * SWING AWAY DETACH ABLE FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1086 E1086 2261 W/C HEMI (E1086), DETACH ARMS, * * SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1087 E1087 2265 W/C HI STRENGTH LT-WT (E1087), * * FIX ARMS, S/AWAY ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1088 E1088 2268 W/C HI STRENGTH LT-WGT (E1088), * * D/ ARMS, S/AWAY ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1089 E1089 2266 W/C HI STRENGTH LT-WGT (E1089), * * FIX ARMS, S/AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1090 E1090 2267 W/C HI STRENGTH LT-WG (E1090), * * DETACH ARMS, S/AWAY D/FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1091 E1091 2321 W/C YOUTH, ANY TYPE (E1091) * * - ---------------------------------------------------------------------------------------------------------------- E1092 E1092 2319 W/C WIDE HVY DUTY (E1092), * * DETACH ARMS S/AWAY DETACH ELEVAT LEGS - ---------------------------------------------------------------------------------------------------------------- E1093 E1093 2320 W/C WIDE HVY DUTY (E1093), * * DETACH ARMS S/AWAY DETACH FOOTRESTS - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1100 E1100 2296 W/C SEMI-RECLINING (E1100), * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1110 E1110 2295 W/C SEMI-RECLINING (E1110), * * DETACH ARMS ELEV LEG REST - ---------------------------------------------------------------------------------------------------------------- E1130 E1130 2303 W/C STANDARD (E1130), FIX OR * * SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1140 E1140 2313 W/C (E1140), DETACH ARMS SWING * * AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1150 E1150 2314 W/C (E1150), DETACH ARMS, SWING * * AWAY DETACH ELEVAT LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1160 E1160 2315 W/C (E1160), W/ FIX ARMS, SWING * * AWAY DETACH ELEVAT LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1160 E1160 2396 W/C (E1160), W/FIX ARMS * * REMOVABLE FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1170 E1170 2241 W/C AMPUTEE (E1170), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1171 E1171 2242 W/C AMPUTEE (E1171), FIX ARMS, * * W/OUT FOOTRESTS OR LEGREST - ---------------------------------------------------------------------------------------------------------------- E1172 E1172 2240 W/C AMPUTEE (E1172), DETACH ARMS * * W/OUT FOOTRESTS OR LEGREST - ---------------------------------------------------------------------------------------------------------------- E1180 E1180 2239 W/C AMPUTEE (E1180), DETACH ARMS * * SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1190 E1190 2238 W/C AMPUTEE (E1190), DETACH ARMS * * SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1195 E1195 2273 W/C HVY DUTY (E1195), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1200 E1200 2243 W/C AMPUTEE (E1200), FIX FULL * * LENGTH ARMS, S/AWAY D/FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1210 E1210 2281 W/C MOTORIZED (E1210), FIX ARMS, * * S/AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1211 E1211 2279 W/C MOTORIZED (E1211), DETACH * * ARMS , S/AWAY DETACH FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1212 E1212 2282 W/C MOTORIZED (E1212) ,FIX ARMS, * * SWING AWAY DETACH FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1213 E1213 2280 W/C MOTORIZED (E1213), DETACH * * ARMS S/AWAY, DETACH ELEV LEG REST - ---------------------------------------------------------------------------------------------------------------- E1220 E1220 2551 W/C CUSTOM (E1220) * - ---------------------------------------------------------------------------------------------------------------- E1220 E1220 2579 W/C XXWIDE (E1220) * - ---------------------------------------------------------------------------------------------------------------- E1230 E1230 2288 SCOOTER (E1230), THREE OR 4 * * WHEEL - ---------------------------------------------------------------------------------------------------------------- E1240 E1240 2276 W/C LT-WGT (E1240), DETACH ARMS * * SWING AWAY DETACH, ELEV LEGREST - ---------------------------------------------------------------------------------------------------------------- E1250 E1250 2278 W/C LT-WGT (E1250), FIX ARMS, * * SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1260 E1260 2275 W/C LT-WGT (E1260), DETACH ARMS * * SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1270 E1270 2277 W/C LT-WGT (E1270), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1280 E1280 2270 W/C HVY DUTY (E1280), DETACH * * ARMS ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1285 E1285 2274 W/C HVY DUTY (E1285), FIX ARMS, * * SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1290 E1290 2271 W/C HVY DUTY (E1290), DETACH * * ARMS SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1295 E1295 2272 W/C HVY DUTY (E1295), FIX ARMS, * * ELEV LEGREST - ---------------------------------------------------------------------------------------------------------------- E1300 DM570 2062 WHIRLPOOL (E1300), PORT (OVERTUB * TYPE) - ---------------------------------------------------------------------------------------------------------------- E1310 DM570 2061 WHIRLPOOL (E1399), NON-PORT * (BUILT-IN TYPE) - ---------------------------------------------------------------------------------------------------------------- E1353 E1353 2381 O2 REGULATOR (E1353) * * - ---------------------------------------------------------------------------------------------------------------- E1355 E1355 2384 CYLINDER STAND/RACK (E1355) * - ---------------------------------------------------------------------------------------------------------------- E1372 E1372 2331 IMMERSION EXT HEATER (E1372) FOR * * NEBULIZER - ---------------------------------------------------------------------------------------------------------------- E1375 E1375 2334 NEBULIZER PORT (E1375) W/ SMALL * COMPRESSOR, W/ LIMITED FLOW - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2568 ADAPTER (A9900), AC/DC * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2586 APNEA MONITOR DOWNLOAD (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2552 BATH LIFT (E1399), CUSTOM * - --------------------------------------------------------------------------------------------------------------- - E1399 DM570 2563 BED WEDGE (E1399), 12" * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2856 BEDROOM EQUIPMENT (E1399),CUSTOM * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2525 BREAST PUMP, ELECTRIC (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2581 BREAST PUMP, INSTITUTIONAL * (E1399) - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2580 BREAST PUMP, MANUAL (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2593 COLD THERAPY UNIT, PAD (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2565 COMMODE (E1399), DROP ARM, HEAVY * DUTY - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2582 COMPRESSION PUMP BOOT (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2583 COMPRESSION PUMP, FOOT (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2569 CPAP HUMIDIFIER (A9900), HEATED * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2635 CPAP/BIPAP SUPPLIES (A9900) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2327 DURABLE MEDICAL EQUIP (E1399), * MISCELLANEOUS - ---------------------------------------------------------------------------------------------------------------- E1399 E1220 2584 GERI CHAIR (E1399), THREE * * POSITION RECLINING - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 6780 HOLTER MONITOR (G0004) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E0265 2590 HOSP BED (E1399), ELECTRIC, * * XLONG, W/MATTRESS & SIDE RAILS - ---------------------------------------------------------------------------------------------------------------- E1399 E0200 2868 LAMP, ULTRAVIOLET (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2588 MONITOR (E1399), VITAL SIGNS * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2529 O2 ANALYZER (A9900) * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2594 O2 CONSERVATION DEVICE (A9900) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 6775 OXIMETRY TEST (E1399) * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2555 PATIENT LIFT, CUSTOM (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2561 PEAK FLOW METER (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4559 PEDIATRIC WALKER (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2567 PNEUMOGRAM (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2553 POSITIONING, CUSTOM (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2526 PULSE OXIMETER (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2527 PULSE OXIMETER W/ PROBE * * (E1399) - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2562 SHOWER, HAND HELD (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2592 SLEEP STUDY, ADULT (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM590 7483 STIMULATOR (E1399), MUSCLE, LOW * * VOLTAGE OR INTERFERENTIAL - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2855 THERAPY EQUIPMENT, CUSTOM * (E1399) - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 6774 THERAPY PERCUSSION, GENERATOR * * ONLY - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7506 W/C, CUSTOM (E1399) MANUAL ADULT * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7504 W/C, CUSTOM (E1399) MANUAL * * PEDIATRIC - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7507 W/C, CUSTOM (E1399) POWER ADULT * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7505 W/C, CUSTOM (E1399) POWER * * PEDIATRIC - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2564 WALKER (E1399), HEAVY DUTY, * EXTRA WIDE - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2585 WALKER (E1399), HEMI * - ---------------------------------------------------------------------------------------------------------------- K0539 DM570 6873 WOUND SUCTION DEVICE (K0538) * * - ---------------------------------------------------------------------------------------------------------------- K0539 DM570 7914 DRESSING SET, FOR WOUND SUCTION * DEVICE (K0539) - ---------------------------------------------------------------------------------------------------------------- K0540 DM570 7915 CANISTER SET, FOR WOUND SUCTION * DEVICE (K0540) - ---------------------------------------------------------------------------------------------------------------- E1400 E1390 2361 O2 CONC (E1390),MANUF SPEC * * MAXFLOWRATE = 2 LTS PER MIN@85% - ---------------------------------------------------------------------------------------------------------------- G0015 DM570 6779 CARDIAC EVENT MONITOR (G0015) * - ---------------------------------------------------------------------------------------------------------------- K0163 DM590 3713 ERECTION SYSTEM, VACUUM (K0163) * - ---------------------------------------------------------------------------------------------------------------- K0183 DM590 2516 CPAP MASK (K0183) * - ---------------------------------------------------------------------------------------------------------------- K0184 DM590 2515 NASAL PILLOWS/SEALS (K0184) * REPLACEMENT FOR NASAL APP/ DVC, PAIR - ---------------------------------------------------------------------------------------------------------------- K0185 DM590 2514 CPAP HEADGEAR (K0185) * - ---------------------------------------------------------------------------------------------------------------- K0186 DM590 2513 CPAP CHIN STRAP (K0186) * - ---------------------------------------------------------------------------------------------------------------- K0187 DM590 2512 CPAP TUBING (K0187) * - ---------------------------------------------------------------------------------------------------------------- K0188 DM590 2511 CPAP FILTER (A9900), DISPOSABLE * - ---------------------------------------------------------------------------------------------------------------- K0189 DM590 2510 CPAP FILTER (A9900), * NON-DISPOSABLE - ---------------------------------------------------------------------------------------------------------------- K0268 DM590 2509 CPAP HUMIDIFIER (K0268), COOL * - ---------------------------------------------------------------------------------------------------------------- K0413 DM590 6889 MATTRESS (K0413), NONPOWERED, * * EQUIVALENT - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7673 MATTRESS (E1399) V-CUE DYNAMIC * * AIR THERAPY - ---------------------------------------------------------------------------------------------------------------- A4608 A9900 7621 CATHETER TRACH (A4608) 11CM 1 * SCOOP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7664 COFFLATOR (E1399CF) MANUAL * SECRETION MOBIL DEVICE - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0168B A9900 7643 COMMODE (E0168B) HVY DUTY * BEDSIDE CHAIR 251-450 LBS. - ---------------------------------------------------------------------------------------------------------------- E0168C A9900 7644 COMMODE (E0168C) HVY DUTY DROP * ARM 451-850 LBS. - ---------------------------------------------------------------------------------------------------------------- A6234 HH591 7626 DRESSING <16 SQ IN (A6234) * HYDROCOLLOID DRESSING, EA - ---------------------------------------------------------------------------------------------------------------- A6258 HH591 7627 DRESSING >16 SQ IN (A6258) * TRANSPAREN FILM, EA - ---------------------------------------------------------------------------------------------------------------- A46203 HH591 7625 DRESSING COMPOSITE <16 SQ IN * (A46203) SELF ADH, EA - ---------------------------------------------------------------------------------------------------------------- B9998B DM590 7655 ENT (B9998B) EXT SET Y SITE * F/KANGAROO PUMP - ---------------------------------------------------------------------------------------------------------------- B9998C DM590 7656 ENT (B9998C) EXT SET W/ CLAMP * BASIC - ---------------------------------------------------------------------------------------------------------------- B9998D DM590 7657 ENT (B9998D) FARRELL GASTRIC * RELIEF VLV - ---------------------------------------------------------------------------------------------------------------- B9998E DM590 7658 ENT (B9998E) GASTRO EXT SET * - ---------------------------------------------------------------------------------------------------------------- B9998F DM590 7659 ENT (B9998F) GASTRO TUBE ANY * SIZE MIC-KEY OR HIDE A PORT - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7620 HUMID-VENT (E1399) ARTIFICIAL * NOSE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7660 IPPB (E1399) UNIV SET UP * W/MANIFOLD NEBULIZER - ---------------------------------------------------------------------------------------------------------------- K0105 A9900 7639 IV POLE (K0105) ATTACH F/ W/C * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7641 MECHANICAL SCALE (E1399) * PEDIATRIC/NEONATAL - ---------------------------------------------------------------------------------------------------------------- A7008 A9900 7661 NEBULIZER (A7008) KIT PREFILL * W/STR H20 1L BAX - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7663 O2 CONNECTOR (E1399) * SIMS/IRRIGATION NOZZLE BAX - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7615 O2 HUMIDIFIER (E1399) * AQUA+NEONATAL EA HUD - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7623 O2 SWIVEL (E1399) ADAPTER ANGLED * STERILE - ---------------------------------------------------------------------------------------------------------------- L8501 A9900 7624 SPEAKING VALVE (L8501) WHITE PAS * - ---------------------------------------------------------------------------------------------------------------- A4319 HH591 7629 STERILE WATER (A4319) F/IRRIG 1L * BAX - ---------------------------------------------------------------------------------------------------------------- A7001 HH591 7619 SUCTION BOTTLE (A7001) W/LID & * TUBING - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7616 SUCTION FILTER (E1399) BACTERIA * - ---------------------------------------------------------------------------------------------------------------- A6265 HH591 7628 TAPE ALL TYPES (A6265) EXCLUDING * MICROFOAM, PER 18 SQ INCHES - ---------------------------------------------------------------------------------------------------------------- A4481 A9900 7622 TRACH FILTER (A4481) BACTERIA * ELECTROSTATIC - ---------------------------------------------------------------------------------------------------------------- A4623 A9900 7618 TRACH INNER (A4623) CANNULA * - ---------------------------------------------------------------------------------------------------------------- A4621 A9900 7617 TRACH TUBE MASK (A4621) COLLAR * OR HOLDER - ---------------------------------------------------------------------------------------------------------------- A7010 A9900 7662 TUBING (A7010) AEROSOL * CORRUGATED PER FOOT - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7631 VENT ADAPTER (E1399) MDI HUD * - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7630 VENT BATTERY CHARGER (A9900) 12V * GEL - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7632 VENT CONNECTOR (E1399) PED OR * ADULT OMNIFLEX DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7633 VENT FILTER (E1399) HYGROBAC S * ELECTOSTATIC MAL - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7634 VENT THERMOMETER (E1399) W/ * ADAPTER - ---------------------------------------------------------------------------------------------------------------- K0108 A9900 7638 W/C BRAKE EXTENSION (K0108) TIP * BLK 10/PK - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7635 WALKER BASKET (E1399) VINYL * COATED - ---------------------------------------------------------------------------------------------------------------- E0159 A9900 7640 WALKER BRAKE (E0159) ATTACHMENT * - ---------------------------------------------------------------------------------------------------------------- E0148 A9900 7636 WALKER HVY DUTY (E0148) FOLDING * X-WIDE - ---------------------------------------------------------------------------------------------------------------- E0149 A9900 7637 WALKER HVY DUTY (E0149) W/ * WHEELS - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7645 CPAP (E1399) DC BATTERY ADAPTER * CABLE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7646 CPAP (E1399) EXHALATION PORT * DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7647 CPAP (E1399) FUSE KIT * INTERNATIONAL A/C - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7648 CPAP (E1399) HUMIDIFIER CHAMBER * KIT DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7649 CPAP (E1399) HUMIDIFIER CHAMBER * REUSABLE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7650 CPAP (E1399) HUMIDIFIER MOUNTING * TRAY - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7651 CPAP (E1399) INVERTOR AC/DC * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7652 CPAP (E1399) POWER CORD * F/ARIA-SYNC - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7653 CPAP (E1399) SHELL W/O PRESSURE * TAP - ---------------------------------------------------------------------------------------------------------------- A9900 DM590 7566 CPAP CALIBRATION SHELL (A9900) * - ---------------------------------------------------------------------------------------------------------------- A9900 DM590 7565 CPAP SHORT TUBING (A9900) * - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 7690 VENT, CONTINUOUS POSITIVE * * (E0500) AIRWAY PRESSURE DEVICE - ---------------------------------------------------------------------------------------------------------------- E0452 E0452 7691 VENT, BILEVEL INTERMITTENT * * (E0500) ASSIST DEVICE (BIPAP) - ---------------------------------------------------------------------------------------------------------------- E0747 DM570 6875 STIMULATOR, OSTEOGENIC, * * ULTRASOUND - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7695 GEL/SILICON GOLD SEAL CPAP/BIPAP * * MASK (A9900) - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7701 VENT THERAPEUTIC ST BIPAP W/ * * BACKUP RATE (K0533) - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7703 O2 SYS HELIOS PORT LIQUID, RENT * (E1399) - ---------------------------------------------------------------------------------------------------------------- HH591 HH591 7704 PUMP, EXT INFUSION, DANA * DIABECARE, INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 7731 PUMP, EXT INFUSION, ANIMAS, * INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7737 CPAP DREAM SEAL INTERFACE FOR * USE WITH BREEZE MASK (A9900) - ---------------------------------------------------------------------------------------------------------------- DM590 DM590 7738 CPAP CHIN STRAP DELUXE (K0186) * - ---------------------------------------------------------------------------------------------------------------- E1340 E1340 7768 W/C REPAIRS - CUSTOM (E1340) * - ----------------------------------------------------------------------------------------------------------------
The following may be charged under extraordinary circumstances: - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4551 LABOR/SERVICE/SHIPPING CHARGES * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2731 SHIPPING AND HANDLING FEES * * - ----------------------------------------------------------------------------------------------------------------
The following may be charged if over and above routine on rental equipment: - ---------------------------------------------------------------------------------------------------------------- E1350 E1350 2382 REPAIR OR NON-ROUTINE (E1350) * * SERVICE REQUIRING SKILL OF A TECH - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1340 E1340 2554 W/C REPAIRS - STANDARD (E1340) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4552 MISCELLANEOUS SUPPLIES * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2589 REPAIR (E1399), RESPIRATORY * * EQUIPMENT - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4561 RESPIRATORY SUPPLIES (A4618) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4549 TENS/APNEA SUPPLIES * * - ----------------------------------------------------------------------------------------------------------------
NOTES: * * * * * * * DME/HOME RESPIRATORY RATES: RATES EFFECTIVE APRIL 1, 2004 - DECEMBER 31, 2004
- ---------------------------------------------------------------------------------------------------------------- HCPCS CHC GENTIVA CODE CODE CODE DESCRIPTION PURCHASE PRICE RENTAL PRICE DAILY PRICE - ---------------------------------------------------------------------------------------------------------------- A4660 DM590 2520 MONITOR, BLOOD PRESSURE (A4660) * W/STETH & CUFF - ---------------------------------------------------------------------------------------------------------------- A4670 DM590 2518 MONITOR, BLOOD PRESSURE * (A4670), AUTOMATIC - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7552 BREEZE (A9900) CPAP/BIPAP MASK * - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7553 FULL FACE (A9900) MIRAGE * CPAP/BIPAP MASK - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7554 GEL/SILICON (A9900) CPAP/BIPAP * MASK INCL GLD SEAL,PHANTM,MONARCH - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7556 SPECIALTY (A9900) CPAP/BIPAP * MASK (PROFILE OR SIMPICITY) - ---------------------------------------------------------------------------------------------------------------- B9002 HI531 2570 PUMP, ENTERAL (B9002) * * - ---------------------------------------------------------------------------------------------------------------- B9998 DM590 6828 ENTERAL SUPPLIES (B9998) * - ---------------------------------------------------------------------------------------------------------------- DM590 DM570 7551 BACK-PACK (E1399), FOR * PORTABLE ENTERAL PUMP - ---------------------------------------------------------------------------------------------------------------- A4615 DM590 2522 CANNULA, NASAL * - ---------------------------------------------------------------------------------------------------------------- B9002 DM590 7509 ENTERAL PUMP, PORTABLE (B9002) * * - ---------------------------------------------------------------------------------------------------------------- A7034 DM590 7508 MASK, CPAP GEL OR SILICONE * (K0183) - ---------------------------------------------------------------------------------------------------------------- E0100 E0100 2020 CANE (E0100), ADJ OR FIX, W/ TIP * - ---------------------------------------------------------------------------------------------------------------- E0105 E0105 2021 CANE, QUAD (E0105) OR THREE * PRONG, ADJ OR FIX, W/ TIPS - ---------------------------------------------------------------------------------------------------------------- E0110 E0110 2028 CRUTCHES, FOREARM (E0110), ADJ * OR FIX, PAIR, W/ TIPS, GRIPS - ---------------------------------------------------------------------------------------------------------------- E0111 E0111 2023 CRUTCH FOREARM (E0111), ADJ OR * FIX, EACH, W/ TIP AND GRIPS - ---------------------------------------------------------------------------------------------------------------- E0112 E0112 2027 CRUTCHES UNDERARM, WOOD * (E0112), ADJ OR FIX, PAIR, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0113 E0113 2025 CRUTCH UNDERARM, WOOD (E0113), * ADJ OR FIX, EACH, COMPLETE - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0114 E0114 2026 CRUTCHES UNDERARM, ALUM * (E0114), ADJ OR FIX, PAIR, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0116 E0116 2024 CRUTCH UNDERARM, ALUM (E0116), * ADJ OR FIX, EACH, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0130 E0130 2037 WALKER, RIGID (E0130) * (PICKUP), ADJ OR FIX HEIGHT - ---------------------------------------------------------------------------------------------------------------- E0135 E0135 2036 WALKER, FOLDING (E0135) * (PICKUP), ADJ OR FIX HEIGHT - ---------------------------------------------------------------------------------------------------------------- E0141 E0141 2040 WALKER, WHEELED (E0141), W/OUT * SEAT - ---------------------------------------------------------------------------------------------------------------- E0142 DM570 2034 RIGID WALKER (E0142), WHEELED, * W/ SEAT, - ---------------------------------------------------------------------------------------------------------------- E0143 E0143 2029 WALKER FOLDING, WHEELED * (E0143), W/OUT SEAT - ---------------------------------------------------------------------------------------------------------------- E0145 DM570 2039 WALKER (E0145), WHEELED, W/ * SEAT AND CRUTCH ATTACHMENTS - ---------------------------------------------------------------------------------------------------------------- E0146 DM570 2038 WALKER, WHEELED, W/ SEAT (E0146) * - ---------------------------------------------------------------------------------------------------------------- E0147 E0147 2030 WALKER HVY DUT (E0147), MULT * BRAKING SYS, VAR WHEEL RESISTANCE - ---------------------------------------------------------------------------------------------------------------- E0153 E0153 2032 CRUTCH PLATFORM ATTACHMENT * (E0153), FOREARM EA - ---------------------------------------------------------------------------------------------------------------- E0154 E0154 2033 WALKER PLATFORM ATTACHMENT * (E0154), EA - ---------------------------------------------------------------------------------------------------------------- E0155 E0155 2041 WALKER WHEEL ATTACHMENT * (E0155), RIGID (PICKUP) WALKER - ---------------------------------------------------------------------------------------------------------------- E0156 DM570 2035 WALKER SEAT ATTACHMENT (E0156) * - ---------------------------------------------------------------------------------------------------------------- E0157 E0157 2022 WALKER, CRUTCH ATTACHMENT * (E0157), EACH - ---------------------------------------------------------------------------------------------------------------- E0158 E0158 2031 WALKER LEG EXTENSIONS (E0158) * - ---------------------------------------------------------------------------------------------------------------- E0163 E0163 2047 COMMODE CHAIR, STATIONARY * (E0163), W/ FIX ARMS - ---------------------------------------------------------------------------------------------------------------- E0164 E0164 2045 COMMODE CHAIR, MOBILE * (E0164), W/ FIX ARMS - ---------------------------------------------------------------------------------------------------------------- E0165 E0165 2046 COMMODE CHAIR (E0165), * STATIONARY, W/ DETACH ARMS - ---------------------------------------------------------------------------------------------------------------- E0165 E0165 2591 COMMODE, XXWIDE(E0165) * - ---------------------------------------------------------------------------------------------------------------- E0166 E0166 2044 COMMODE CHAIR (E0166), MOBILE, * W/ DETACH ARMS - ---------------------------------------------------------------------------------------------------------------- E0167 E0167 2051 COMMODE CHAIR, PAIL OR PAN * (E0167) - ---------------------------------------------------------------------------------------------------------------- E0176 E0176 2142 CUSHION (E0176) OR AIR PRESSURE * PAD, NON-POSITIONING - ---------------------------------------------------------------------------------------------------------------- E0176 E0176 2394 REPLACEMENT PAD (E0176) * ALTERNATING PRESS - ---------------------------------------------------------------------------------------------------------------- E0177 E0177 2224 CUSHION OR WATER PRESS PAD * (E0177), NONPOSITIONING - ---------------------------------------------------------------------------------------------------------------- E0178 E0178 2160 CUSHION OR GEL PRESS PAD * (E0178), NONPOSITIONING - ---------------------------------------------------------------------------------------------------------------- E0179 E0179 2154 CUSHION (E0179) OR DRY PRESSURE * PAD, NONPOSTIONING - ---------------------------------------------------------------------------------------------------------------- E0180 E0180 2196 PUMP (E0180), ALTERNATING * * PRESSURES W/PAD - ---------------------------------------------------------------------------------------------------------------- E0181 E0181 2197 PUMP (E0181), ALTERNATING PRESS * * W/PAD, HVY DUTY - ---------------------------------------------------------------------------------------------------------------- E0184 E0184 2074 MATTRESS, DRY PRESSURE (E0184) * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0185 E0185 2076 MATTRESS (E0185), GEL OR * GEL-LIKE PRESSURE PAD - ---------------------------------------------------------------------------------------------------------------- E0186 E0186 2064 MATTRESS, AIR PRESSURE (E0186) * - ---------------------------------------------------------------------------------------------------------------- E0187 E0187 2099 MATTRESS, WATER PRESSURE (E0187) * - ---------------------------------------------------------------------------------------------------------------- E0188 DM570 2217 PAD, SYNTHETIC SHEEPSKIN (A9900) * - ---------------------------------------------------------------------------------------------------------------- E0189 DM570 2177 PAD, LAMBSWOOL SHEEPSKIN * (E0189), ANY SIZE - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2573 CUSHION, JAY FOR W/C (E0192) * * - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2572 CUSHION, ROHO FOR W/C (E0192) * * - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2178 W/C PAD (E0192), LOW PRESS AND * * POSITIONING EQUALIZATION - ---------------------------------------------------------------------------------------------------------------- E0193 E0193 2098 MATTRESS, LOW AIR LOSS (E0193), * * * INCL. BED - ---------------------------------------------------------------------------------------------------------------- E0194 DM570 2063 AIR FLUIDIZED BED (E0194) * * - ---------------------------------------------------------------------------------------------------------------- E0270 E1399 6887 HOSPITAL BED INSTITUTIONAL * * - ---------------------------------------------------------------------------------------------------------------- E0196 E0196 2077 MATTRESS, GEL PRESSURE (E0196) * - ---------------------------------------------------------------------------------------------------------------- E0197 E0197 2065 MATTRESS, AIR PRESSURE PAD * (E0197) - ---------------------------------------------------------------------------------------------------------------- E0198 E0198 2100 MATTRESS (E0198), WATER * PRESSURE PAD - ---------------------------------------------------------------------------------------------------------------- E0199 E0199 2075 MATTRESS, DRY PRESSURE PAD * (E0199) - ---------------------------------------------------------------------------------------------------------------- E0200 E0200 2228 HEAT LAMP (E0200), W/OUT * STAND, INCL/BULB, OR INFRARED ELEMENT - ---------------------------------------------------------------------------------------------------------------- E0202 E0202 2229 PHOTOTHERAPY (BILIRUBIN) * (E0202), LIGHT WIT - ---------------------------------------------------------------------------------------------------------------- E0202 E0202 2524 PHOTOTHERAPY, BILI BLANKET * (E0202) - ---------------------------------------------------------------------------------------------------------------- E0205 E0205 2227 HEAT LAMP (E0205), WITH STAND, * INCL/ BULB, OR INFRARED ELEMENT - ---------------------------------------------------------------------------------------------------------------- E0210 DM570 2156 HEATING PAD, STANDARD (E0210) * - ---------------------------------------------------------------------------------------------------------------- E0215 DM570 2155 HEATING PAD (E0215), ELECTRIC, * MOIST - ---------------------------------------------------------------------------------------------------------------- E0218 DM570 2560 COLD THERAPY UNIT (E0218) * * * - ---------------------------------------------------------------------------------------------------------------- E0235 DM570 2187 PARAFFIN BATH UNIT, PORT (E0235) * - ---------------------------------------------------------------------------------------------------------------- E0236 DM570 2199 PUMP (E0236) FOR WATER * CIRCULATING PAD - ---------------------------------------------------------------------------------------------------------------- E0237 DM570 2223 HEAT COLD WATER (E0237) * CIRCULATING PAD W/PUMP - ---------------------------------------------------------------------------------------------------------------- E0238 DM570 2179 HEATING PAD (E0238), MOIST, * NON-ELECTRIC - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2867 BATH TUB RAIL (E0241), WALL, * L-SHAPE - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2862 BATH TUB RAIL, WALL, 12" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2863 BATH TUB RAIL, WALL, 16" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2864 BATH TUB RAIL, WALL, 18" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2865 BATH TUB RAIL, WALL, 24" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2866 BATH TUB RAIL, WALL, 36" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2043 BATH TUB RAIL, WALL, * UNSPECIFIED SIZE - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0242 DM570 2042 BATH TUB RAIL, FLOOR BASE * (E0242) - ---------------------------------------------------------------------------------------------------------------- E0243 DM570 2056 TOILET RAIL, EACH (E0243) * - ---------------------------------------------------------------------------------------------------------------- E0244 E0244 2587 TOILET SEAT (E0244) RAISED WITH * ARMS - ---------------------------------------------------------------------------------------------------------------- E0244 E0244 2052 TOILET SEAT, RAISED (E0244) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2575 BATH BENCH WITH BACK (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2058 BATH TUB STOOL OR BENCH (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2578 TRANSFER BENCH, NON-PADDED * (E0245) - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2577 TRANSFER BENCH, PADDED (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0246 DM570 2057 TRANSFER TUB RAIL(E0246), * ATTACHMENT - ---------------------------------------------------------------------------------------------------------------- E0249 DM570 2186 HEAT UNIT (E0249), WATER * CIRCULATING PAD - ---------------------------------------------------------------------------------------------------------------- E0255 E0255 2090 HOSP BED (E0255), VAR HEIGHT, * * HI-LO, W/ SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0256 E0256 2091 HOSP BED (E0256), VAR HEIGHT, * * HI-LO, W/ SIDE RAILS, W/O MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0260 E0260 2083 HOSP BED (E0260), SEMI-ELEC, W/ * * SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0261 E0261 2084 HOSP BED (E0261), SEMI-ELEC, W/ * * SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0265 E0265 2086 HOSP BED (E0265), TOTAL ELEC, * * W/ SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0266 E0266 2087 HOSP BED (E0266), TOTAL ELEC, * * W/ SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0271 E0271 2096 MATTRESS, INNERSPRING (E0271) * - ---------------------------------------------------------------------------------------------------------------- E0272 E0272 2095 MATTRESS, FOAM RUBBER (E0272) * - ---------------------------------------------------------------------------------------------------------------- E0273 DM570 2068 BED BOARD (E1399) * - ---------------------------------------------------------------------------------------------------------------- E0274 DM570 2097 OVER-BED TABLE (E0274) * - ---------------------------------------------------------------------------------------------------------------- E0275 E0275 2071 BED PAN, STANDARD (E0275), * METAL OR PLASTIC - ---------------------------------------------------------------------------------------------------------------- E0276 E0276 2070 BED PAN, FRACTURE (E0276), * METAL OR PLASTIC - ---------------------------------------------------------------------------------------------------------------- E0277 E0277 2066 MATTRESS (E0277), LOW AIR LOSS, * * * ALT PRESSURE - ---------------------------------------------------------------------------------------------------------------- E0280 DM570 2069 BED CRADLE, ANY TYPE (E1399) * - ---------------------------------------------------------------------------------------------------------------- E0292 E0292 2092 HOSP BED (E0292), VAR HEIGHT, * * HI-LO, W/OUT S/ RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0293 E0293 2093 HOSP BED (E0293), VAR HEIGHT, * * HI-LO, NO SIDE RAILS, NO MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0294 E0294 2085 HOSP BED (E0294), SEMI-ELEC, * * W/OUT SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0295 E0295 2094 HOSP BED (E0295), SEMI-ELEC, * * W/OUT SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0296 E0296 2089 HOSP BED (E0296), TOTAL ELEC, * * W/OUT SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0297 E0297 2088 HOSP BED (E0297), TOTAL ELEC, * * W/OUT SIDE RAILS, W/ MATTRESS - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0305 E0305 2073 BED SIDE RAILS (E0305), HALF * LENGTH - ---------------------------------------------------------------------------------------------------------------- E0310 E0310 2072 BED SIDE RAILS (E0310), FULL * LENGTH - ---------------------------------------------------------------------------------------------------------------- E0315 DM570 2067 BED ACCESSORIES: BOARDS OR * TABLES, ANY TYPE - ---------------------------------------------------------------------------------------------------------------- E0325 E0325 2060 URINAL; MALE (E0325), JUG-TYPE, * ANY MATERIAL - ---------------------------------------------------------------------------------------------------------------- E0326 E0326 2059 URINAL; FEMALE (E0326), * JUG-TYPE, ANY MATERIAL - ---------------------------------------------------------------------------------------------------------------- E0372 E0372 7008 MATTRESS (E0372) POWERED AIR * * OVERLAY - ---------------------------------------------------------------------------------------------------------------- E0410 E0444 2369 O2 CONTENTS, LIQUID (E0444), * PER POUND - ---------------------------------------------------------------------------------------------------------------- E0416 E0443 2371 O2 REFILL FOR PORT (E0443) GAS * SYSTEM ONLY, UP TO 23 CUBIC FEET - ---------------------------------------------------------------------------------------------------------------- E0424 E0424 2385 O2 SYS STATIONARY (E0424) COMPR * GAS, RENT - ---------------------------------------------------------------------------------------------------------------- E0430 E0430 2374 O2 SYS PORT GAS, PURCH (E0430) * * - ---------------------------------------------------------------------------------------------------------------- E0431 E0431 2574 O2 SYS PORT GAS, LIGHTWEIGHT * * (E0431) W/CONSERV DEVICE,NO CONTENT - ---------------------------------------------------------------------------------------------------------------- E0431 E0431 2375 O2 SYS PORT GAS, RENT (E0431) * - ---------------------------------------------------------------------------------------------------------------- E0434 E0434 2377 O2 SYS PORT LIQUID,RENT (E0434) * - ---------------------------------------------------------------------------------------------------------------- E0435 E0435 2376 O2 SYS PORT LIQUID, PURCH * (E0435) - ---------------------------------------------------------------------------------------------------------------- E0439 E0439 2388 O2 SYS STATIONARY (E0439) * LIQUID, RENT - ---------------------------------------------------------------------------------------------------------------- E0440 E0440 2387 O2 SYS STATIONARY (E0440) * LIQUID, PURCH - ---------------------------------------------------------------------------------------------------------------- E0443 E0400 2869 O2 CONTENTS, H/K CYLINDER * (E0400), 200-300 CUBIC FT - ---------------------------------------------------------------------------------------------------------------- E0444 E0444 2379 O2 CONTENTS, PORT LIQUID * (E0444), PER UNIT (1 UNIT = 1 LB.) - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 7555 POSITIVE PRESSURE VENTS * * (E0450)(E.G. T-BIRD) - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 7926 POSITIVE PRESSURE VENTS, * EMERGENCY BACKUP (E.G. T-BIRD)(E0450) - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 2392 VENTILATOR VOLUME (E0450), * * STATIONARY OR PORT - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 7522 VENTILATOR, VOLUME, (E0450) * * EMERGENCY BACKUP UNIT - ---------------------------------------------------------------------------------------------------------------- E0452 E0452 2332 BILEVEL INTERMITTENT (E0452) * * ASSIST DEVICE,(BIPAP) - ---------------------------------------------------------------------------------------------------------------- E0453 E0453 2390 VENTILATOR THERAPEUTIC (E0453); * * FOR USE 12 HOURS OR LESS PER DAY - ---------------------------------------------------------------------------------------------------------------- E0455 E0455 2372 O2 TENT (E0455), EXCLUDING * * CROUP OR PEDIATRIC TENTS - ---------------------------------------------------------------------------------------------------------------- E0457 E0457 2323 CHEST SHELL (CUIRASS) (E0457) * * - ---------------------------------------------------------------------------------------------------------------- E0459 E0459 2324 CHEST WRAP (E0459) * * - ---------------------------------------------------------------------------------------------------------------- E0460 E0460 2339 VENTILATOR (E0460), NEGATIVE * * PRESSURE , PORTABLE OR STATIONARY - ---------------------------------------------------------------------------------------------------------------- E0480 DM570 2373 PERCUSSOR (E0480), ELEC OR * * PNEUM, HOME MODEL - ---------------------------------------------------------------------------------------------------------------- E0500 E0500 2333 IPPB , W/ BUILT-IN NEB (E0500) * * MAN OR AUTO VALVES; INT/EXT POWER - ---------------------------------------------------------------------------------------------------------------- E0550 E0550 2328 HUMIDIFIER (E0550) DURABLE FOR * * EXTENSIV SUP/ HUMID W/ IPPB OR O2 - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0555 E0555 2330 HUMIDIFIER (E0555), DURABLE, * * GLASS, FOR USE W/ REG OR FLOWMETER - ---------------------------------------------------------------------------------------------------------------- E0565 E0565 2325 COMPRESSOR, AIR POWER (E0565) * * - ---------------------------------------------------------------------------------------------------------------- E0570 E0570 2336 NEBULIZER, W/ COMPRESSOR (E0570) * * - ---------------------------------------------------------------------------------------------------------------- E0575 DM570 2571 NEBULIZER (E0575), ULTRASONIC, * * AC/DC - ---------------------------------------------------------------------------------------------------------------- E0575 DM570 2338 NEBULIZER; ULTRASONIC (E0575) * * - ---------------------------------------------------------------------------------------------------------------- E0585 E0585 2337 NEBULIZER(E0585), W/ COMPRESSOR * * AND HEATER - ---------------------------------------------------------------------------------------------------------------- E0600 E0600 2389 SUCTION PUMP (E0600), HOME MODEL * * - ---------------------------------------------------------------------------------------------------------------- E0600 E0600 7523 SUCTION UNIT, (E0600), PORTABLE * * AC/DC - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 2326 CONTINUOUS POSITVE (E0601) * * AIRWAY PRESSURE DEVICE (CPAP) - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 6965 CPAP, SELF TITRATING (E0601) * * - ---------------------------------------------------------------------------------------------------------------- E0605 DM570 2391 VAPORIZER, ROOM TYPE (E0605) * - ---------------------------------------------------------------------------------------------------------------- E0606 DM570 2380 POSTURAL DRAINAGE BOARD (E0606) * - ---------------------------------------------------------------------------------------------------------------- E0607 E0607 6874 MONITOR, B/GLUCOSE (E0607) * ACCUCHEK AD - ---------------------------------------------------------------------------------------------------------------- E0607 E0607 2164 MONITOR, BLOOD GLUCOSE (E0607) * - ---------------------------------------------------------------------------------------------------------------- E0618 E0608 2322 APNEA MONITOR (E0608) * * - ---------------------------------------------------------------------------------------------------------------- E0619 E0608 2576 APNEA MONITOR (E0608) W/MEM * * (INCL SMART) - ---------------------------------------------------------------------------------------------------------------- E0609 E0609 2146 MONITOR, BLOOD GLUCOSE (E0609) * W/SPECIAL FEATURES - ---------------------------------------------------------------------------------------------------------------- E0621 E0621 2215 PATIENT LIFT (E0621), SLING OR * SEAT, CANVAS OR NYLON - ---------------------------------------------------------------------------------------------------------------- E0625 DM570 2191 PATIENT LIFT (E0625), KARTOP, * * BATHROOM OR TOILET - ---------------------------------------------------------------------------------------------------------------- E0627 E0627 4553 HIP CHAIR (E0627) * * - ---------------------------------------------------------------------------------------------------------------- E0627 DM570 2395 SEAT LIFT CHAIR/MOTORIZED * (E0627) - ---------------------------------------------------------------------------------------------------------------- E0627 DM570 2205 SEAT LIFT MECH (E0627) * INCORPORATED INTO A COMB LIFT-CHAIR MECH - ---------------------------------------------------------------------------------------------------------------- E0630 E0630 2190 PATIENT LIFT, HYDRAULIC * * (E0630), W/ SEAT OR SLING - ---------------------------------------------------------------------------------------------------------------- E0635 DM570 2189 PATIENT LIFT (E0635), ELEC W/ * SEAT OR SLING - ---------------------------------------------------------------------------------------------------------------- E0650 E0650 2192 PNEUM COMPRESSOR (E0650), * * NON-SEG HOME MODEL - ---------------------------------------------------------------------------------------------------------------- E0651 E0651 2194 PNEUM COMPRESSOR (E0651), SEG * * HOME MODEL W/OUT CALIB GRAD PRES - ---------------------------------------------------------------------------------------------------------------- E0652 E0652 2193 PNEUM COMPRESSOR (E0652), SEG * * HOME MODEL W/ CALIB GRAD PRES - ---------------------------------------------------------------------------------------------------------------- E0655 E0655 2182 PNEUM COMPRESSOR (E0655), * NON-SEG APPLIANCE, HALF ARM - ---------------------------------------------------------------------------------------------------------------- E0660 E0660 2181 PNEUM COMPRESSOR (E0660), * NON-SEG APPLIANCE, FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0665 E0665 2180 PNEUM COMPRESSOR (E0665), * NON-SEG APPLIANCE, FULL ARM - ---------------------------------------------------------------------------------------------------------------- E0666 E0666 2183 PNEUM COMPRESSOR (E0666), * NON-SEG APPLIANCE, HALF LEG - ---------------------------------------------------------------------------------------------------------------- E0667 E0667 2210 PNEUM APPLIANCE (E0667), SEG, * FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0668 E0668 2209 PNEUM APPLIANCE (E0668), SEG, * FULL ARM - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0669 E0669 2212 PNEUM APPLIANCE (E0669), SEG, * HALF LEG - ---------------------------------------------------------------------------------------------------------------- E0670 E0670 2211 PNEUM APPLIANCE (E0670), SEG, * HALF ARM - ---------------------------------------------------------------------------------------------------------------- E0671 E0671 2207 PNEUM APPLIANCE (E0671), SEG * GRAD PRESS, FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0672 E0672 2206 PNEUM APPLIANCE (E0672), SEG * GRAD PRESS, FULL ARM - ---------------------------------------------------------------------------------------------------------------- E0673 E0673 2208 PNEUM APPLIANCE (E0673), SEG * GRAD PRESS, HALF LEG - ---------------------------------------------------------------------------------------------------------------- E0690 DM570 2221 ULTRAVIOLET CABINET (E0690), * APPROPRIATE FOR HOME USE - ---------------------------------------------------------------------------------------------------------------- E0700 DM570 2204 SAFETY EQUIP (E0700) (E.G., * BELT, HARNESS OR VEST) - ---------------------------------------------------------------------------------------------------------------- E0710 DM570 2202 RESTRAINTS (E0710), ANY TYPE * (BODY, CHEST, WRIST OR ANKLE) - ---------------------------------------------------------------------------------------------------------------- E0720 E0720 2219 TENS (E0720), TWO LEAD, * * LOCALIZED STIMULATION - ---------------------------------------------------------------------------------------------------------------- E0730 E0730 2218 TENS (E0730), FOUR LEAD, LARGER * * AREA/MULTIPLE NERVE STIMULATION - ---------------------------------------------------------------------------------------------------------------- E0731 E0731 2159 TENS OR NMES (E0731), * CONDUCTIVE GARMENT - ---------------------------------------------------------------------------------------------------------------- E0744 E0744 2120 STIMULATOR (E0744), * * NEUROMUSCULAR FOR SCOLIOSIS - ---------------------------------------------------------------------------------------------------------------- E0745 E0745 2120 STIMULATOR (E0745), * * NEUROMUSCULAR, ELECTRONIC SHOCK UNIT - ---------------------------------------------------------------------------------------------------------------- E0745 E0745 6915 STIMULATOR FOUR CH (E0745), * * NEUROMUSCULAR - ---------------------------------------------------------------------------------------------------------------- E0746 DM570 2109 ELECTROMYOGRAPHY (EMG) (E0746), * * BIOFEEDBACK DEVICE - ---------------------------------------------------------------------------------------------------------------- E0747 DM570 2122 STIMULATOR (E0747), OSTEOGENIC, * NON-INVASIVE - ---------------------------------------------------------------------------------------------------------------- E0748 DM570 2124 STIMULATOR (E0748), OSTEOGENIC * NON-INVASIVE, SPINAL APPLICATIONS - ---------------------------------------------------------------------------------------------------------------- E0755 DM570 2157 STIMULATOR (E0755), ELECTRONIC * SALIVARY REFLEX, NON INVASIVE - ---------------------------------------------------------------------------------------------------------------- E0776 E0776 2175 IV POLE (E0776) * * - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 2158 PUMP (E0784), EXT AMBULATORY * INFUSION, MINIMED, INSULIN - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 7925 PUMP, EXT INFUSION, NON - DANA * PREMIUM, INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 6771 PUMP (E0784), INSULIN EXT * INFUSION DISETRONICS OR OTHER - ---------------------------------------------------------------------------------------------------------------- E0840 E0840 2133 TRACTION FRAME (E0840), ATTACH * TO HEADBOARD, CERVICAL TRACTION - ---------------------------------------------------------------------------------------------------------------- E0850 E0850 2134 TRACTION STAND (E0850), FREE * * STANDING, CERVICAL TRACTION - ---------------------------------------------------------------------------------------------------------------- E0855 E0855 7484 TRACTION (E0855), W/O FRAME OR * * STAND - ---------------------------------------------------------------------------------------------------------------- E0860 E0860 2130 TRACTION EQUIP (E0860), * OVERDOOR, CERVICAL - ---------------------------------------------------------------------------------------------------------------- E0870 E0870 2131 TRACTION FRAME (E0870), ATTACH * * TO FOOTBOARD, EXTREMITY, BUCKS - ---------------------------------------------------------------------------------------------------------------- E0880 E0880 2135 TRACTION STAND (E0880) * * FREE/STAND EXTREMITY TRACTION, EG, BUCK'S - ---------------------------------------------------------------------------------------------------------------- E0890 E0890 2132 TRACTION FRAME (E0890), ATTACH * * TO FOOTBOARD, PELVIC TRACTION - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0900 E0900 2136 TRACTION STAND (E0900) FREE/ * * STAND PELVIC TRACTION,( EG, BUCK'S) - ---------------------------------------------------------------------------------------------------------------- E0910 E0910 2138 TRAPEZE BARS (E0910), A/K/A PT * * HELPER, ATTACH TO BED W/ GRAB BAR - ---------------------------------------------------------------------------------------------------------------- E0920 E0920 2111 FRACTURE FRAME (E0920), ATTACH * * TO BED, INCLUDING WEIGHTS - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2125 PASSIVE MOTION (E0935) EXERCISE * DEVICE - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2859 PASSIVE MOTION (E0935) EXERCISE * DEVICE, ANKLE - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2860 PASSIVE MOTION (E0935) EXERCISE * DEVICE, ELBOW - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2857 PASSIVE MOTION (E0935) EXERCISE * DEVICE, HAND - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2858 PASSIVE MOTION (E0935) EXERCISE * DEVICE, SHOULDER - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2861 PASSIVE MOTION (E0935) EXERCISE * DEVICE, WRIST - ---------------------------------------------------------------------------------------------------------------- E0940 E0940 2137 TRAPEZE BAR (E0940), FREE * * STANDING, COMPLETE W/ GRAB BAR - ---------------------------------------------------------------------------------------------------------------- E0941 E0941 2116 TRACTION DEVICE (E0941), * * GRAVITY ASSISTED - ---------------------------------------------------------------------------------------------------------------- E0942 E0942 2101 HARNESS/HALTER (E0942), * CERVICAL HEAD - ---------------------------------------------------------------------------------------------------------------- E0944 E0944 2126 HARNESS (E0944), PELVIC BELT, * BOOT - ---------------------------------------------------------------------------------------------------------------- E0945 DM570 2110 HARNESS (E0945), EXTREMITY BELT * - ---------------------------------------------------------------------------------------------------------------- E0946 E0946 2115 FRACTURE, FRAME (E0946), DUAL * * W/ CROSS BARS, ATTACH TO BED - ---------------------------------------------------------------------------------------------------------------- E0947 E0947 2113 FRACTURE FRAME (E0947), * * ATTACHMENTS FOR COMPLEX PELVIC TRACTION - ---------------------------------------------------------------------------------------------------------------- E0948 E0948 2112 FRACTURE FRAME (E0948) * * ATTACHMENTS FOR COMPLEX CERVICAL TRACTION - ---------------------------------------------------------------------------------------------------------------- E0950 DM570 2139 TRAY (E0950) * - ---------------------------------------------------------------------------------------------------------------- E0958 E0958 2307 W/C PART ATTACHMENT (E0958) TO * CONVERT ANY W/C TO ONE ARM DRIVE - ---------------------------------------------------------------------------------------------------------------- E0959 E0959 2237 W/C PART AMPUTEE ADAPTER(E0959) * (COMPENSATE FOR TRANS OF WEIGHT) - ---------------------------------------------------------------------------------------------------------------- E0962 E0962 2232 CUSHION FOR WC 1" (E0962) * - ---------------------------------------------------------------------------------------------------------------- E0963 E0963 2233 CUSHION FOR WC 2" (E0963) * - ---------------------------------------------------------------------------------------------------------------- E0964 E0964 2234 CUSHION FOR WC 3" (E0964) * - ---------------------------------------------------------------------------------------------------------------- E0965 E0965 2235 CUSHION FOR WC 4" (E0965) * - ---------------------------------------------------------------------------------------------------------------- E0972 DM570 2230 TRANSFER BOARD OR DEVICE (E0972) * - ---------------------------------------------------------------------------------------------------------------- E0977 E0977 2317 CUSHION, WEDGE FOR W/C (E0977) * - ---------------------------------------------------------------------------------------------------------------- E0978 E0978 2248 BELT, SAFETY (E0978) W/ * AIRPLANE BUCKLE, W/C - ---------------------------------------------------------------------------------------------------------------- E0979 DM570 2249 BELT, SAFETY (E0979) W/ VELCRO * CLOSURE, W/C - ---------------------------------------------------------------------------------------------------------------- E0980 DM570 2292 SAFETY VEST (E0980), W/C * - ---------------------------------------------------------------------------------------------------------------- E1031 E1031 2291 ROLLABOUT CHAIR (E1031), W/ * * CASTORS 5" OR GREATER - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1050 E1050 2260 W/C FULL/REC (E1050), FIX ARMS, * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1060 E1060 2259 W/C FULL/REC (E1070), DETACH * * ARMS, SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1065 E1065 2287 W/C POWER ATTACHMENT (E1065) * - ---------------------------------------------------------------------------------------------------------------- E1066 E1066 2247 BATTERY CHARGER (E1066) * - ---------------------------------------------------------------------------------------------------------------- E1069 E1069 2255 BATTERY, DEEP CYCLE (E1069) * - ---------------------------------------------------------------------------------------------------------------- E1070 E1070 2258 W/C FULL/REC (E1060), DETACH * * ARMS, SWING AWAY DET/ ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1083 E1083 2263 W/C HEMI (E1083), FIX ARMS, * * SWING AWAY DETACH ABLE ELEV LEG REST - ---------------------------------------------------------------------------------------------------------------- E1084 E1084 2262 W/C HEMI (E1084), DETACH ARMS, * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1085 E1085 2264 W/C HEMI (E1085), FIX ARMS, * * SWING AWAY DETACH ABLE FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1086 E1086 2261 W/C HEMI (E1086), DETACH ARMS, * * SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1087 E1087 2265 W/C HI STRENGTH LT-WT (E1087), * * FIX ARMS, S/AWAY ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1088 E1088 2268 W/C HI STRENGTH LT-WGT (E1088), * * D/ ARMS, S/AWAY ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1089 E1089 2266 W/C HI STRENGTH LT-WGT (E1089), * * FIX ARMS, S/AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1090 E1090 2267 W/C HI STRENGTH LT-WG (E1090), * * DETACH ARMS, S/AWAY D/FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1091 E1091 2321 W/C YOUTH, ANY TYPE (E1091) * * - ---------------------------------------------------------------------------------------------------------------- E1092 E1092 2319 W/C WIDE HVY DUTY (E1092), * * DETACH ARMS S/AWAY DETACH ELEVAT LEGS - ---------------------------------------------------------------------------------------------------------------- E1093 E1093 2320 W/C WIDE HVY DUTY (E1093), * * DETACH ARMS S/AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1100 E1100 2296 W/C SEMI-RECLINING (E1100), * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1110 E1110 2295 W/C SEMI-RECLINING (E1110), * * DETACH ARMS ELEV LEG REST - ---------------------------------------------------------------------------------------------------------------- E1130 E1130 2303 W/C STANDARD (E1130), FIX OR * * SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1140 E1140 2313 W/C (E1140), DETACH ARMS SWING * * AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1150 E1150 2314 W/C (E1150), DETACH ARMS, SWING * * AWAY DETACH ELEVAT LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1160 E1160 2315 W/C (E1160), W/ FIX ARMS, SWING * * AWAY DETACH ELEVAT LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1160 E1160 2396 W/C (E1160), W/FIX ARMS * * REMOVABLE FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1170 E1170 2241 W/C AMPUTEE (E1170), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1171 E1171 2242 W/C AMPUTEE (E1171), FIX ARMS, * * W/OUT FOOTRESTS OR LEGREST - ---------------------------------------------------------------------------------------------------------------- E1172 E1172 2240 W/C AMPUTEE (E1172), DETACH * * ARMS W/OUT FOOTRESTS OR LEGREST - ---------------------------------------------------------------------------------------------------------------- E1180 E1180 2239 W/C AMPUTEE (E1180), DETACH * * ARMS SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1190 E1190 2238 W/C AMPUTEE (E1190), DETACH * * ARMS SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1195 E1195 2273 W/C HVY DUTY (E1195), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1200 E1200 2243 W/C AMPUTEE (E1200), FIX FULL * * LENGTH ARMS, S/AWAY D/FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1210 E1210 2281 W/C MOTORIZED (E1210), FIX * * ARMS, S/AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1211 E1211 2279 W/C MOTORIZED (E1211), DETACH * * ARMS , S/AWAY DETACH FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1212 E1212 2282 W/C MOTORIZED (E1212) , FIX * * ARMS, SWING AWAY DETACH FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1213 E1213 2280 W/C MOTORIZED (E1213), DETACH * * ARMS S/AWAY, DETACH ELEV LEG REST - ---------------------------------------------------------------------------------------------------------------- E1220 E1220 2551 W/C CUSTOM (E1220) * * - ---------------------------------------------------------------------------------------------------------------- E1220 E1220 2579 W/C XXWIDE (E1220) * - ---------------------------------------------------------------------------------------------------------------- E1230 E1230 2288 SCOOTER (E1230), THREE OR 4 * * WHEEL - ---------------------------------------------------------------------------------------------------------------- E1240 E1240 2276 W/C LT-WGT (E1240), DETACH ARMS * * SWING AWAY DETACH, ELEV LEGREST - ---------------------------------------------------------------------------------------------------------------- E1250 E1250 2278 W/C LT-WGT (E1250), FIX ARMS, * * SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1260 E1260 2275 W/C LT-WGT (E1260), DETACH ARMS * * SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1270 E1270 2277 W/C LT-WGT (E1270), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1280 E1280 2270 W/C HVY DUTY (E1280), DETACH * * ARMS ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1285 E1285 2274 W/C HVY DUTY (E1285), FIX ARMS, * * SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1290 E1290 2271 W/C HVY DUTY (E1290), DETACH * * ARMS SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1295 E1295 2272 W/C HVY DUTY (E1295), FIX ARMS, * * ELEV LEGREST - ---------------------------------------------------------------------------------------------------------------- E1300 DM570 2062 WHIRLPOOL (E1300), PORT * (OVERTUB TYPE) - ---------------------------------------------------------------------------------------------------------------- E1310 DM570 2061 WHIRLPOOL (E1399), NON-PORT * * (BUILT-IN TYPE) - ---------------------------------------------------------------------------------------------------------------- E1353 E1353 2381 O2 REGULATOR (E1353) * * * - ---------------------------------------------------------------------------------------------------------------- E1355 E1355 2384 CYLINDER STAND/RACK (E1355) * - ---------------------------------------------------------------------------------------------------------------- E1372 E1372 2331 IMMERSION EXT HEATER (E1372) * * FOR NEBULIZER - ---------------------------------------------------------------------------------------------------------------- E1375 E1375 2334 NEBULIZER PORT (E1375) W/ SMALL * COMPRESSOR, W/ LIMITED FLOW - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2568 ADAPTER (A9900), AC/DC * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2586 APNEA MONITOR DOWNLOAD (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2552 BATH LIFT (E1399), CUSTOM * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2563 BED WEDGE (E1399), 12" * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2856 BEDROOM EQUIPMENT (E1399), * CUSTOM - ---------------------------------------------------------------------------------------------------------------- E0603 E1399 2525 BREAST PUMP, ELECTRIC (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E0604 DM570 2581 BREAST PUMP, INSTITUTIONAL * (E1399) - ---------------------------------------------------------------------------------------------------------------- E0602 E1399 2580 BREAST PUMP, MANUAL (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2593 COLD THERAPY UNIT, PAD (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2565 COMMODE (E1399), DROP ARM, * HEAVY DUTY - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2582 COMPRESSION PUMP BOOT (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2583 COMPRESSION PUMP, FOOT (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2569 CPAP HUMIDIFIER (A9900), HEATED * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2635 CPAP/BIPAP SUPPLIES (A9900) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2327 DURABLE MEDICAL EQUIP (E1399), * MISCELLANEOUS - ---------------------------------------------------------------------------------------------------------------- E1399 E1220 2584 GERI CHAIR (E1399), THREE * POSITION RECLINING - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 6780 HOLTER MONITOR (G0004) * - ---------------------------------------------------------------------------------------------------------------- E1399 E0265 2590 HOSP BED (E1399), ELECTRIC, * * XLONG, W/MATTRESS & SIDE RAILS - ---------------------------------------------------------------------------------------------------------------- E1399 E0200 2868 LAMP, ULTRAVIOLET (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2588 MONITOR (E1399), VITAL SIGNS * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2529 O2 ANALYZER (A9900) * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2594 O2 CONSERVATION DEVICE (A9900) * * - ---------------------------------------------------------------------------------------------------------------- E0455 DM570 6775 OXIMETRY TEST (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2555 PATIENT LIFT, CUSTOM (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2561 PEAK FLOW METER (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4559 PEDIATRIC WALKER (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2567 PNEUMOGRAM (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2553 POSITIONING, CUSTOM (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2526 PULSE OXIMETER (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2527 PULSE OXIMETER W/ PROBE (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2562 SHOWER, HAND HELD (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2592 SLEEP STUDY, ADULT (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 DM590 7483 STIMULATOR (E1399), MUSCLE, LOW * * VOLTAGE OR INTERFERENTIAL - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2855 THERAPY EQUIPMENT, CUSTOM * (E1399) - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 6774 THERAPY PERCUSSION, GENERATOR * * ONLY - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7506 W/C, CUSTOM (E1399) MANUAL ADULT * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7504 W/C, CUSTOM (E1399) MANUAL * * PEDIATRIC - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7507 W/C, CUSTOM (E1399) POWER ADULT * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7505 W/C, CUSTOM (E1399) POWER * PEDIATRIC - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2564 WALKER (E1399), HEAVY DUTY, * EXTRA WIDE - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2585 WALKER (E1399), HEMI * - ---------------------------------------------------------------------------------------------------------------- K0538 DM570 6873 WOUND SUCTION DEVICE (K0538) * * - ---------------------------------------------------------------------------------------------------------------- K0539 DM570 7914 DRESSING SET, FOR WOUND SUCTION * DEVICE (K0539) - ---------------------------------------------------------------------------------------------------------------- K0540 DM570 7915 CANISTER SET, FOR WOUND SUCTION * DEVICE (K0540) - ---------------------------------------------------------------------------------------------------------------- E1400 E1390 2361 O2 CONC (E1390),MANUF SPEC * * MAXFLOWRATE = 2 LTS PER MIN@85% - ---------------------------------------------------------------------------------------------------------------- G0015 DM570 6779 CARDIAC EVENT MONITOR (G0015) * - ---------------------------------------------------------------------------------------------------------------- K0163 DM590 3713 ERECTION SYSTEM, VACUUM (K0163) * - ---------------------------------------------------------------------------------------------------------------- K0183 DM590 2516 CPAP MASK (K0183) * - ---------------------------------------------------------------------------------------------------------------- K0184 DM590 2515 NASAL PILLOWS/SEALS (K0184) * REPLACEMENT FOR NASAL APP/ DVC, PAIR - ---------------------------------------------------------------------------------------------------------------- K0185 DM590 2514 CPAP HEADGEAR (K0185) * - ---------------------------------------------------------------------------------------------------------------- K0186 DM590 2513 CPAP CHIN STRAP (K0186) * - ---------------------------------------------------------------------------------------------------------------- K0187 DM590 2512 CPAP TUBING (K0187) * - ---------------------------------------------------------------------------------------------------------------- K0188 DM590 2511 CPAP FILTER (A9900), DISPOSABLE * - ---------------------------------------------------------------------------------------------------------------- K0189 DM590 2510 CPAP FILTER (A9900), * NON-DISPOSABLE - ---------------------------------------------------------------------------------------------------------------- K0268 DM590 2509 CPAP HUMIDIFIER (K0268), COOL * - ---------------------------------------------------------------------------------------------------------------- K0413 DM590 6889 MATTRESS (K0413), NONPOWERED, * EQUIVALENT - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7673 MATTRESS (E1399) V-CUE DYNAMIC * AIR THERAPY - ---------------------------------------------------------------------------------------------------------------- A4608 A9900 7621 CATHETER TRACH (A4608) 11CM 1 * SCOOP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7664 COFFLATOR (E1399CF) MANUAL * SECRETION MOBIL DEVICE - ---------------------------------------------------------------------------------------------------------------- E0168B A9900 7643 COMMODE (E0168B) HVY DUTY * BEDSIDE CHAIR 251-450 LBS. - ---------------------------------------------------------------------------------------------------------------- E0168C A9900 7644 COMMODE (E0168C) HVY DUTY DROP * ARM 451-850 LBS. - ---------------------------------------------------------------------------------------------------------------- A6234 HH591 7626 DRESSING <16 SQ IN (A6234) * HYDROCOLLOID DRESSING, EA - ---------------------------------------------------------------------------------------------------------------- A6258 HH591 7627 DRESSING >16 SQ IN (A6258) * TRANSPAREN FILM, EA - ---------------------------------------------------------------------------------------------------------------- A46203 HH591 7625 DRESSING COMPOSITE <16 SQ IN * (A46203) SELF ADH, EA - ---------------------------------------------------------------------------------------------------------------- B9998B DM590 7655 ENT (B9998B) EXT SET Y SITE * F/KANGAROO PUMP - ---------------------------------------------------------------------------------------------------------------- B9998C DM590 7656 ENT (B9998C) EXT SET W/ CLAMP * BASIC - ---------------------------------------------------------------------------------------------------------------- B9998D DM590 7657 ENT (B9998D) FARRELL GASTRIC * RELIEF VLV - ---------------------------------------------------------------------------------------------------------------- B9998E DM590 7658 ENT (B9998E) GASTRO EXT SET * - ---------------------------------------------------------------------------------------------------------------- B9998F DM590 7659 ENT (B9998F) GASTRO TUBE ANY * SIZE MIC-KEY OR HIDE A PORT - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7620 HUMID-VENT (E1399) ARTIFICIAL * NOSE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7660 IPPB (E1399) UNIV SET UP * W/MANIFOLD NEBULIZER - ---------------------------------------------------------------------------------------------------------------- K0105 A9900 7639 IV POLE (K0105) ATTACH F/ W/C * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7641 MECHANICAL SCALE (E1399) * PEDIATRIC/NEONATAL - ---------------------------------------------------------------------------------------------------------------- A7008 A9900 7661 NEBULIZER (A7008) KIT PREFILL * W/STR H20 1L BAX - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7663 O2 CONNECTOR (E1399) * SIMS/IRRIGATION NOZZLE BAX - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7615 O2 HUMIDIFIER (E1399) * AQUA+NEONATAL EA HUD - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7623 O2 SWIVEL (E1399) ADAPTER * ANGLED STERILE - ---------------------------------------------------------------------------------------------------------------- L8501 A9900 7624 SPEAKING VALVE (L8501) WHITE PAS * - ---------------------------------------------------------------------------------------------------------------- A4319 HH591 7629 STERILE WATER (A4319) F/IRRIG * 1L BAX - ---------------------------------------------------------------------------------------------------------------- A7001 HH591 7619 SUCTION BOTTLE (A7001) W/LID & * TUBING - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7616 SUCTION FILTER (E1399) BACTERIA * - ---------------------------------------------------------------------------------------------------------------- A6265 HH591 7628 TAPE ALL TYPES (A6265) * EXCLUDING MICROFOAM, PER 18 SQ INCHES - ---------------------------------------------------------------------------------------------------------------- A4481 A9900 7622 TRACH FILTER (A4481) BACTERIA * ELECTROSTATIC - ---------------------------------------------------------------------------------------------------------------- A4623 A9900 7618 TRACH INNER (A4623) CANNULA * - ---------------------------------------------------------------------------------------------------------------- A4621 A9900 7617 TRACH TUBE MASK (A4621) COLLAR * OR HOLDER - ---------------------------------------------------------------------------------------------------------------- A7010 A9900 7662 TUBING (A7010) AEROSOL * CORRUGATED PER FOOT - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7631 VENT ADAPTER (E1399) MDI HUD * - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7630 VENT BATTERY CHARGER (A9900) * 12V GEL - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7632 VENT CONNECTOR (E1399) PED OR * ADULT OMNIFLEX DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7633 VENT FILTER (E1399) HYGROBAC S * ELECTOSTATIC MAL - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7634 VENT THERMOMETER (E1399) W/ * ADAPTER - ---------------------------------------------------------------------------------------------------------------- K0108 A9900 7638 W/C BRAKE EXTENSION (K0108) TIP * BLK 10/PK - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7635 WALKER BASKET (E1399) VINYL * COATED - ---------------------------------------------------------------------------------------------------------------- E0159 A9900 7640 WALKER BRAKE (E0159) ATTACHMENT * - ---------------------------------------------------------------------------------------------------------------- E0148 A9900 7636 WALKER HVY DUTY (E0148) FOLDING * X-WIDE - ---------------------------------------------------------------------------------------------------------------- E0149 A9900 7637 WALKER HVY DUTY (E0149) W/ * WHEELS - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7645 CPAP (E1399) DC BATTERY ADAPTER * CABLE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7646 CPAP (E1399) EXHALATION PORT * DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7647 CPAP (E1399) FUSE KIT * INTERNATIONAL A/C - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7648 CPAP (E1399) HUMIDIFIER CHAMBER * KIT DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7649 CPAP (E1399) HUMIDIFIER CHAMBER * REUSABLE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7650 CPAP (E1399) HUMIDIFIER * MOUNTING TRAY - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7651 CPAP (E1399) INVERTOR AC/DC * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7652 CPAP (E1399) POWER CORD * F/ARIA-SYNC - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7653 CPAP (E1399) SHELL W/O PRESSURE * TAP - ---------------------------------------------------------------------------------------------------------------- A9900 DM590 7566 CPAP CALIBRATION SHELL (A9900) * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- A9900 DM590 7565 CPAP SHORT TUBING (A9900) * - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 7690 VENT, CONTINUOUS POSITIVE * * (E0500) AIRWAY PRESSURE DEVICE - ---------------------------------------------------------------------------------------------------------------- E0452 E0452 7691 VENT, BILEVEL INTERMITTENT * * (E0500) ASSIST DEVICE (BIPAP) - ---------------------------------------------------------------------------------------------------------------- E0747 DM570 6875 STIMULATOR, OSTEOGENIC, * ULTRASOUND - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7695 GEL/SILICON GOLD SEAL * CPAP/BIPAP MASK (A9900) - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7701 VENT THERAPEUTIC ST BIPAP W/ * * BACKUP RATE (K0533) - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7703 O2 SYS HELIOS PORT LIQUID, RENT * * (E1399) - ---------------------------------------------------------------------------------------------------------------- HH591 HH591 7704 PUMP, EXT INFUSION, DANA * DIABECARE, INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 7731 PUMP, EXT INFUSION, ANIMAS, * INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7737 CPAP DREAM SEAL INTERFACE FOR * USE WITH BREEZE MASK (A9900) - ---------------------------------------------------------------------------------------------------------------- A7036 DM590 7738 CPAP CHIN STRAP DELUXE (K0186) * - ---------------------------------------------------------------------------------------------------------------- E1340 E1340 7768 W/C REPAIRS - CUSTOM (E1340) * - ----------------------------------------------------------------------------------------------------------------
The following may be charged under extraordinary circumstances: - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4551 LABOR/SERVICE/SHIPPING CHARGES * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2731 SHIPPING AND HANDLING FEES * - ----------------------------------------------------------------------------------------------------------------
The following may be charged if over and above routine on rental equipment: - ---------------------------------------------------------------------------------------------------------------- E1350 E1350 2382 REPAIR OR NON-ROUTINE (E1350) * SERVICE REQUIRING SKILL OF A TECH - ---------------------------------------------------------------------------------------------------------------- E1340 E1340 2554 W/C REPAIRS - STANDARD (E1340) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4552 MISCELLANEOUS SUPPLIES * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2589 REPAIR (E1399), RESPIRATORY * * EQUIPMENT - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4561 RESPIRATORY SUPPLIES (A4618) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4549 TENS/APNEA SUPPLIES * * - ----------------------------------------------------------------------------------------------------------------
NOTES: * * * * * * * Confidential treatment requested GATEKEEPER PROGRAM ATTACHMENT TO MANAGED CARE ALLIANCE AGREEMENT (CAPITATION) PURPOSE The terms and provisions of this Gatekeeper Program Attachment and the Agreement are applicable to services rendered by MCA's Represented Providers to Gatekeeper Program Participants. As used in this Program Attachment, Participant means a Gatekeeper Program Participant. HMO Program Requirements shall apply to Covered Services provided to Gatekeeper Program Participants. I. DEFINITIONS BASELINE ASSESSMENT means CIGNA's assessment of MCA's capacity to assume the obligations described in the Agreement and this Program Attachment in particular. CAPITATION PAYMENT means a periodic payment for certain covered Home Care Services that is made to MCA for each Participant who is a member of MCA's Patient Panel. CARVED OUT SERVICES means the following services: EXHIBIT XIX. GATEKEEPER PROGRAM PARTICIPANT means a Participant, other than a HMO Program Participant, enrolled in either (i) a product which includes fully insured Standard HMO, Point of Service, or Gatekeeper PPO benefits and which product is underwritten by a licensed insurance company based on an experience rating methodology, or (ii) a self funded product which includes Standard HMO, Point of Service, or Gatekeeper PPO benefits. This definition includes, but is not limited to, Participants covered under FlexCare, True Access and Open Access plans insured/administered by Connecticut General Life Insurance Company. GATEKEEPER PPO means a product offered pursuant to a Service Agreement which provides the Participant with an incentive to obtain Covered Services from Participating Providers and which generally requires the Participant to obtain an authorization from their Primary Care Physician in order to access such Covered Services from Participating Providers. HMO PROGRAM PARTICIPANT means a Participant enrolled in a non-governmental, fully insured Standard HMO or Point of Service product and which product is underwritten based on a community rating methodology (i.e. community rating, community rating by class, adjusted community rating by class). This definition includes, but is not limited to, Participants covered under commercial HMO and Open Access plans issued by CIGNA. MEDICAL DIRECTOR means a physician designated by CIGNA to manage Quality Management and Utilization Management responsibilities, or that physician's designee. PATIENT PANEL means those Gatekeeper Program Participants for which MCA will receive a global Capitation Payment for all Home Care Services rendered. POINT OF SERVICE means a product offered pursuant to a Service Agreement which allows the Participant to choose, in addition to Standard HMO benefits, a lower level of benefits if the Participant receives Covered Services from (i) a Participating Provider without a necessary authorization or (ii) from a non-Participating Provider, at the time such services are sought. PRIMARY CARE PHYSICIAN means a physician duly licensed to practice medicine who is a Participating Provider with CIGNA to provide Covered Services in the field of general medicine, internal medicine, family practice or pediatrics, and who has agreed to provide primary care physician services to Participants in accordance with HMO Program Requirements. STANDARD HMO means a product offered pursuant to a Service Agreement where Covered Services are available to Participants only from Participating Providers, except in the case of an Emergency or with the prior authorization of CIGNA or Affiliate where Covered Services are not available from Participating Providers. II. SERVICES AND COMPENSATION A. COVERED HOME CARE SERVICES 1. MCA, through its Represented Providers, shall provide all Home Care Services that are required by Participants in MCA's Patient Panel, for which such Participants are eligible, in accordance with the terms of this Agreement, this Gatekeeper Program Attachment and HMO Program Requirements. The compensation set forth in this Gatekeeper Program Attachment shall be payment in full for Home Care Services rendered to Gatekeeper Program Participants. 2. MCA, through its Represented Providers, shall arrange to provide Medically Necessary Home Care Services to Participants on a 24-hour per day, 7-day per week basis or arrange with other qualified providers (which meet all CIGNA and MCA credentialing requirements or other applicable guidelines) to provide such Medically Necessary Home Care Services to Participants. MCA shall require that such covering providers (a) are Participating Providers (unless otherwise agreed); (b) will not seek compensation from CIGNA for services for which MCA receives compensation hereunder; and (c) will not bill Participants for covered Home Care Services under any circumstances except for (i) Copayments, Deductibles or Coinsurance; (ii) the provision of services to a patient who is not eligible to receive Home Care Services, including but not limited to Participants that have reached their benefit limit; and (iii) services provided to Participants that are not Home Care Services. (d) will direct the participant and/or the Represented Provider to obtain, authorization from CIGNA prior to all hospitalizations or referrals of Participants, except in Emergencies or for a Pre-Qualified Maternity Stay or as otherwise required by law. 3. MCA through its Represented Providers shall provide Home Care Services to all Participants in MCA's Patient Panel who are eligible to receive Home Care Services. 4. Subject to the terms and condition of this Agreement, MCA shall: a. Arrange for the provision of Home Care Services to Participants; b. Require Represented Providers to accept, treat, and otherwise render covered Home Care Services to Participants in the same manner, in accordance with the same standards, and with the same availability, as offered to other like patients. c. not close its network to any new Participants unless CIGNA expressly consents to such closure; 5. In no event shall MCA or Represented Providers be required to accept, treat, arrange for, or otherwise be obligated to render Home Care Services to Participants under this Agreement, even if medically appropriate, if: a. the provision of such services to Participant would pose risk of bodily harm to the Participant or caregiver personnel of Represented Provider; b. the provision of such services to Participant would be in violation of MCA's or Represented Provider's applicable license requirements or other applicable laws, and/or MCA policies, including but not limited to admission and discharge policies or discrimination policies; c. MCA has not received the essential information to process a referral; d. Participant repeatedly rejects the provision of services by a qualified Represented Provider selected by MCA and/or CIGNA has mutually agreed. e. MCA and Represented Providers shall not differentiate or discriminate in the treatment of any Participant because of race, color, national origin, ancestry, religion, sex, marital status, sexual orientation, age, health status, handicap or source of payment. 6. A CIGNA Participating Physician or CIGNA will notify MCA of each referral for Covered Home Care Services for Participants in its Patient Panel. MCA will provide or arrange to provide for all Medically Necessary Covered Home Care Services for all such Participants, in accordance with the authorization and Utilization Management procedures set forth in Exhibit XVII. 7. MCA and CIGNA will jointly develop clinical pathways to establish a plan of treatment for more difficult Participant cases requiring Covered Home Care Services. B. CAPITATION PAYMENTS 1. On or before the 15th day of each month, CIGNA or its designee shall pay MCA a monthly Capitation Payment for each Participant in MCA's Patient Panel. THE CAPITATION PAYMENT SHALL BE COMPENSATION FOR ALL HOME CARE SERVICES PROVIDED TO PARTICIPANTS IN THE PATIENT PANEL EXCEPT FOR CARVED OUT SERVICES as referenced in exhibit XIX. The monthly capitation rates are set forth in Exhibit A. 2. If a Participant is added to MCA's Patient Panel on or before the 15th day of a month, a full month's Capitation Payment will be due for that Participant for that month. There will be no Capitation Payment due for Participants added after the 15th day of the month. 3. A full month's Capitation Payment will be due for the month of termination of a Participant if the Participant terminates after the 15th day of the month. If a Participant terminates on or before the 15th day of a month, no Capitation Payment will be due for the month of termination. 4. Where CIGNA, due to information delays, must make a retroactive addition or deletion to MCA's Patient Panel, a retroactive capitation adjustment shall be made concurrent therewith subject to Section II.B.6 of this Gatekeeper Program Attachment. In those instances where a Participant has been retroactively deleted and has received services from MCA after the effective date of deletion but prior to CIGNA informing MCA of such deletion, MCA may bill participant for such services rendered. 5. Any amendments of Capitation Payment rates, whether on an annual basis or upon changes in benefit designs, shall be in accordance with the amendment provisions of this Agreement, or as otherwise agreed to in writing by the parties. 6. Capitation Adjustment Process: a. Where CIGNA, due to information delays, must make a retroactive addition or deletion to MCA's Patient Panel, a retroactive capitation adjustment shall not exceed 6 months, nor shall a retroactive addition be added greater than 6 months. b. Services rendered to participants prior to the capitation period or following the capitation period may be billed to CIGNA directly, and shall be in accordance with Exhibit A of the Gatekeeper Program Attachment - Fee For Service, attached hereto. Standard Coordination of Benefits rules shall be applied. In the event that CIGNA is not identified as the payor, MCA may bill participant directly for services rendered during this time. c. For those Participants in the Providers patient panel, MCA shall have 120 days following the receipt of the monthly capitation payment, to notify CIGNA of any discrepancies in the capitation payment. The discrepancies shall be determined by the MCA through a review of the electronic eligibility and capitation roster documentation supplied by CIGNA. For all eligibility or capitation roster data that continues to be in a paper format, CIGNA will use its best efforts to move to an electronic basis. d. CIGNA shall investigate and validate capitation errors and notify Gentiva within 60 days the results of such investigation. e. Any necessary adjustments to capitation shall be made through the next scheduled capitation cycle. f. All adjustments to capitation payments shall be provided to MCA in writing, by CIGNA, no less than 30 days prior to the adjustment. 7. MCA guarantees that the Capitation Payment rates set forth in this Attachment are effective from the Effective Date of this Agreement. Notwithstanding the foregoing, the parties agree to meet to discuss possible adjustments to the Capitation Payment rates should any of the following circumstances occur during the term of this Attachment: a. treatments, products, supplies or equipment which are excluded from Covered Home Care Services for Gatekeeper Program Participants as of the Effective Date on the basis that they are considered Experimental are no longer considered Experimental and become a Covered Home Care Service for such Participants. b. shifts in treatment sites for Covered Home Care Service therapies occurring after the Effective Date result in a material change to the services which are Covered Home Care Services for Gatekeeper Program Participants. c. material changes are made to Gatekeeper Program Participants' Service Agreements after the Effective Date such that there is a material change to those Home Care Services which are Covered Home Care Services for such Participants. d. utilization associated with material changes in membership from which the base period was derived after the Effective Date of this Agreement results in a material change in Gatekeeper Program Participant volume under this Agreement which has a material financial impact on MCA. e. Any such adjustment of Capitation Payment rates shall only be made to the extent required to address the change in costs directly resulting from the above changed circumstance. 8. Leakage a. On a quarterly basis, CIGNA will provide MCA with leakage reports and the claims for Covered Home Care Services submitted by providers that are not Represented Provider's. MCA shall review the quarterly leakage reports provided by CIGNA to determine the need to contract with additional providers so as to reduce the leakage. MCA shall make a good faith effort to contract with identified providers in order to reduce the amount of leakage and it shall act promptly to contract with those providers identified as appropriate in order to reduce leakage. In an effort to better manage leakage and overall utilization, CIGNA will attempt to provide MCA, an overview of CIGNA's administration of out of network claims for Covered Home Care Services rendered to Participants. CIGNA also agrees to review the feasibility of adopting usual and customary charges for Covered Home Care Services. MCA commits to provide CIGNA all reasonable assistance in the development and implementation of the aforementioned process. b. The Parties shall meet quarterly (each April, July, October and January) to review the utilization of Covered Home Health Services that are not reimbursed on a capitated basis under this Agreement for the purpose of identifying opportunities to reduce this utilization and the Parties shall cooperate in good faith to effect such actions as they may agree upon to accomplish this objective. c. MCA shall meet with those referring physicians identified by CIGNA to educate them regarding the service provided by Represented Providers. 9. Insulin Pumps Effective January 1, 2004, MCA will use all reasonable commercial efforts to arrange for the provision of Dana brand devices and supplies for insulin pump orders on new referral authorizations. For Participants reimbursed according to a capitation methodology, MCA will bill CIGNA a fee-for-service charge for a rate differential for new non-Dana devices based upon a CIGNA authorization. Supplies for insulin pumps provided to participants reimbursed according to a capitation methodology prior to 1/1/04 shall not be subject to a fee for service charge or consideration. For all other Participants, billing for pumps and supplies shall be in accordance with the appropriate fee schedules. C. REPRESENTED PROVIDER PAYMENT/CLAIM AND ENCOUNTER DATA Represented Providers shall be reimbursed for covered Home Care Services rendered in accordance with the requirements set forth in Exhibit B. MCA shall provide CIGNA with the claim and/or encounter data as required in EXHIBITS II. & IV. D. FINANCIAL REPORTS 1. MCA represents and warrants that the information set forth in the CIGNA Baseline Assessment submitted to CIGNA by MCA prior to the execution of this Agreement is true and accurate. MCA shall promptly notify CIGNA of any material changes in the information contained in such Baseline Assessment within thirty (30) days of becoming aware of such change. 2. MCA shall provide CIGNA with the following financial reports on a timely basis: a) MCA's annual audited financial reports, including, but not limited to, MCA's audited annual income statement and balance sheet; b) quarterly financial reports including an income statement, balance sheet and any other reports identifying payments made to Represented Providers in the preceding quarter and the incurred but not reported claims as of the end of the preceding quarter in sufficient detail to determine if payments have been made in accordance with this Agreement and applicable law; c) any financial reports required by applicable regulatory authorities; and d) such other financial reports as are reasonably requested by CIGNA. 3. MCA shall notify CIGNA immediately of any of MCA's material payment defaults, with respect to any of MCA's creditors if MCA reasonably determines that any such payment defaults would affect the provision of services to the Gatekeeper Program Participant. E. ASSIGNMENT AND IDENTIFICATION OF PARTICIPANTS MCA shall comply with the requirements of and shall participate in CIGNA's procedures with respect to the assignment and identification of Participants as outlined in the HMO Program Requirements. F. REIMBURSEMENT OF CIGNA EXPENDITURES In the event that MCA does not arrange for the provision of Home Care Services to Gatekeeper Program Participants as required by Section II.A.1 through II.A.4 of this Gatekeeper Program Attachment, Payor may arrange for and/or reimburse for such covered Home Care Service and shall be entitled to recover from MCA any expenditure made, or recover any cost incurred, including, but not limited to, any reasonable administrative costs, in arranging or reimbursing such covered Home Care Service. An amount sufficient to compensate for such expenditures and costs may be deducted from the payments due to MCA under this Agreement. CIGNA shall provide MCA with written notice and full disclosure of costs incurred prior to any such deductions. This provision shall survive the termination of this Agreement for a period of one year. G. OTHER REQUIREMENTS MCA and its Represented Providers shall use best efforts to prescribe or authorize the substitution of generic pharmaceuticals when appropriate and shall cooperate with CIGNA's formulary and HMO Program Requirements regarding the substitution of generic pharmaceuticals. H. TRANSFERS In a timeframe to be mutually agreed upon the parties, CIGNA will provide to MCA all information reasonably required by MCA in order to accomplish transition, but nothing herein shall require MCA to purchase or assume payments for any durable medical equipment (HME/DME), which has been previously placed with any CIGNA Participant. CIGNA agrees to work with MCA to identify those Participants that are in possession of HME/DME and for which CIGNA has made payment on a rental basis for such DME/HME, and advise MCA of the same. MCA shall be relieved of any obligation to assume financial responsibility for DME/HME that MCA determines to be DME/HME that is routinely purchased or converted to purchase, or that does not meet CIGNA/MCA Durable Medical Equipment Guidelines for Medical Necessity, and such DME/HME shall be converted to purchase at CIGNA's expense prior to the transition of Participants to MCA. However, MCA shall assume responsibility for the continued maintenance of the DME/HME. I. LIMITATIONS ON BILLING PARTICIPANTS 1. MCA hereby agrees and shall require its Represented Providers to agree that in no event, including, but not limited to non-payment by CIGNA, CIGNA's insolvency or breach of this Agreement, shall MCA or any Represented Provider bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against Participants or persons other than CIGNA or MCA for Home Care Services. This provision shall not prohibit collection of (i) any applicable Copayments, Deductibles or Coinsurance; (ii) payments for services provided to a patient who is no longer eligible to receive Home Care Services, including but not limited to Participants that have reached their benefit limit; or (iii) payments for services provided to Participants that are not Home Care Services. 2. MCA further agrees that this provision shall survive the termination of this Agreement regardless of the cause giving rise to such termination and shall be construed to be for the benefit of Participants, and that this provision supersedes any oral or written agreement to the contrary now existing or hereafter entered into between MCA or Represented Providers and the Participant or persons acting on the Participant's behalf. 3. Any modification, additions, or deletion to the provisions of this hold harmless clause shall become effective on a date no earlier than fifteen (15) days after the applicable state regulatory agency has received written notice of such proposed change. 4. MCA shall not charge, and MCA shall require that its Represented Providers not charge, a Participant for a service which is not Medically Necessary unless, in advance of the provision of such service, the Participant is notified that the service may not be covered and the Participant acknowledges in writing that he or she shall be responsible for payment of charges for such service. J. UTILIZATION MANAGEMENT MCA shall perform and comply with the Utilization Management requirements set forth in Exhibits XVII and XXI. K. CIGNA VISION/JOINT STEERING COMMITTEE Any and all services rendered by MCA and its Represented Providers under this Agreement shall be consistent with CIGNA's vision to provide or arrange to provide quality health care at a reasonable cost. Each party agrees to designate representatives, the number and identity of which shall be agreed upon by the parties, to participate in a Joint Steering Committee. The Joint Steering Committee shall meet on a periodic basis, but no less frequently than twice yearly, for the purpose of discussing the status of each party's performance under this Agreement and to resolve any complaints or problems with such performance. L. GUARANTEE OF PROVISION OF COVERED SERVICES 1. Throughout the term of this Agreement and for six (6) months following the termination of this Agreement, MCA shall secure and maintain an irrevocable letter(s) of credit in favor of CIGNA in an amount and form acceptable to CIGNA, for all states in which such a letter of credit is required by state law, regulation, statute, or as required by state insurance/HMO regulators. 2. CIGNA shall have the right to make immediate demand for payment under the irrevocable letter(s)of credit in the event that MCA has failed to pay any amounts due and owing to CIGNA, Represented Providers or others in accordance with MCA's obligations under this Agreement. 3. Prior to each anniversary date of this Agreement, CIGNA will evaluate the adequacy of the amount of the irrevocable letter(s) of credit by reviewing any and all state laws, regulations, and statutes. The amount of the irrevocable letter(s) of credit required to be maintained by MCA for the next contract year shall be a minimum of the amount equal to the individual state requirements for the contract year. 4. At least thirty (30) days prior to each anniversary date of this Agreement, CIGNA will advise MCA of the amount of the irrevocable letter of credit required to be maintained by MCA for the next contract year as calculated pursuant to subsection 3 above. MCA shall secure an irrevocable letter of credit in such amount and in a form acceptable to CIGNA prior to the anniversary date. M. PERFORMANCE FEEDBACK 1. CIGNA may provide feedback to MCA for MCA's own use in assessing and enhancing Represented Providers' performance with regard to quality of care, patient satisfaction and efficient practice. 2. For purposes of providing helpful performance feedback, CIGNA may perform telephone surveys and analyze medical costs of Participants in MCA's Gatekeeper Patient Panel in comparison with physician peers. CIGNA may also from time to time review a sample of medical records and provide performance feedback on past treatment. N. REIMBURSEMENT FOR COVERED SERVICES RENDERED TO PARTICIPANTS OUTSIDE OF PATIENT PANEL/OPT OUT SERVICES In the event that MCA's Represented Providers render covered Home Care Services to Participants outside of MCA's Patient Panel or services covered pursuant to a Participant's opt out benefits, MCA shall be reimbursed for such services at the rates established in the Gatekeeper Program Attachment - Fee For Service, attached hereto, less applicable Coinsurance, Copayments and Deductibles. Only those charges for covered Home Care Services billed in accordance with CIGNA's standard claim coding and bundling methodology will be allowed. O. REPRESENTED PROVIDER ACCEPTANCE OF PAYMENT. MCA will indemnify and hold harmless Payors, CIGNA and its Affiliates from any claim for payment in excess of the specified amount for covered Home Care Services rendered to Participants by each Represented Provider, unless the claim arises from a Payor's wrongful failure to pay MCA for covered Home Care Services. EXHIBIT A GATEKEEPER PROGRAM ATTACHMENT - CAPITATION SCHEDULE OF CAPITATION RATES CAPITATION RATES EFFECTIVE 1/1/04 - 12/31/04 These are the capitation rates that apply to services rendered to Patient Panel Participants enrolled in Gatekeeper Programs. A "Gatekeeper Program" means (i) a product that includes fully insured Standard HMO, Point of Service, or Gatekeeper PPO benefits and which is underwritten by a licensed insurance company based on an experience rating methodology, or (ii) a self funded product which includes Standard HMO, Point of Service, or Gatekeeper PPO benefits. This definition includes, but is not limited to, Participants covered under FlexCare plans insured/administered by Connecticut General Life Insurance Company. - --------------------------------------------------------------- Gentiva HomeHealth, Infusion, DME/HME Capitation Rates PMPM - --------------------------------------------------------------- All Gatekeeper (FlexCare) Capitated Affiliates * - --------------------------------------------------------------- * Confidential treatment requested EXHIBIT B GATEKEEPER PROGRAM ATTACHMENT - CAPITATION PAYMENT RESPONSIBILITIES (MCA distributes payments) MCA shall pay Represented Providers for covered Home Care Services rendered hereunder in accordance with this Exhibit and the terms of the Agreement. 1. MCA shall pay Represented Providers for covered Home Care Services rendered hereunder in accordance with CIGNA's payment administration standards and any other standards set forth in applicable laws and regulations, including but not limited to, ERISA. MCA agrees to reimburse Represented Providers for covered Home Care Services within the time frames set forth in applicable law AND the time frames specified in MCA's provider agreements with its Represented Providers. CIGNA may withhold all or a portion of MCA's reimbursement if MCA repeatedly fails to reimburse Represented Providers on a timely basis. MCA's obligations with regard to payment for covered Home Care Services rendered hereunder shall survive the termination of this Agreement with respect to any covered Home Care Services rendered by Represented Providers during the term of this Agreement and with respect to any covered Home Care Services Represented Providers are obligated by this Agreement to provide after termination of this Agreement. 2. With reasonable notice, MCA agrees to allow CIGNA representatives to conduct on-site reviews of MCA's payment administration facilities. Such reviews shall be for the sole purpose of evaluating MCA's performance of its payment responsibilities under this Agreement, including, but not limited to, ascertaining the quality and timeliness of MCA's payment processing. MCA agrees to correct any deficiencies detected during such reviews within sixty (60) days of CIGNA's submission of a written report detailing such deficiencies. 3. If CIGNA determines that MCA cannot meet its payment administration obligations set forth herein, CIGNA may elect to assume responsibility for such activities. If CIGNA elects to assume responsibility for such activities, the rates set forth in this Agreement shall be renegotiated by the parties to reflect such change in responsibility. MCA shall cooperate and provide to CIGNA any information necessary to perform such activities. 4. MCA shall be responsible for the production of all applicable tax reporting documents (e.g., 1099s) for Represented Providers. Such documents shall be produced in a format and within the time frames set forth in applicable state and federal laws and/or regulations. 5. MCA shall require that Represented Providers submit claims for covered Home Care Services rendered to Participants in other Programs for which CIGNA or Payor has retained payment responsibility directly to CIGNA in accordance with the applicable Program Attachment and Program Requirements. 6. MCA shall produce explanations of payments for Represented Providers with respect to those services rendered by Represented Providers to Participants for which an explanation of benefits is customarily provided or legally required. Such explanations of payments shall be in a format and contain data elements acceptable to CIGNA. 7. MCA shall develop and deliver training programs for Represented Providers which outline MCA's billing and reimbursement processes. MCA shall make best efforts to ensure that Represented Providers avoid submitting requests for payment to CIGNA for those covered Home Care Services rendered to Participants for whom MCA has payment responsibility. 8. MCA shall provide CIGNA with encounter data showing all services provided to each Participant for whom MCA receives Capitation Payments in a format and frequency mutually acceptable to both parties, but no less frequently than monthly. CIGNA may elect to withhold payment of MCA's compensation if MCA fails to submit encounter data in accordance with this Agreement. EXHIBIT C GATEKEEPER PROGRAM ATTACHMENT - CAPITATION UTILIZATION MANAGEMENT (partial delegation of utilization management) 1. MCA will assist CIGNA in the implementation of its Utilization Management program. Any Utilization Management program activities performed by MCA shall be in accordance with CIGNA's standards, NCQA standards or the standards of another appropriate accrediting body designated by CIGNA, and Program Requirements. MCA shall maintain any licensure required in connection with such activities. 2. MCA shall prepare such periodic reports or other data as reasonably requested by CIGNA relating to its Utilization Management activities in a format acceptable to CIGNA. 3. MCA shall not materially modify its Utilization Management activities without CIGNA's prior approval. 4. CIGNA shall have the right to audit MCA's Utilization Management activities upon reasonable prior notice. MCA shall cooperate with any such audits. 5. If CIGNA determines that MCA cannot meet its Utilization Management obligations set forth herein, CIGNA may elect to assume responsibility for such activities. If CIGNA elects to assume responsibility for such activities, the rates set forth in this Agreement shall be renegotiated by the parties to reflect such change in responsibility. MCA shall cooperate and provide to CIGNA any information necessary to perform such activities. 6. All referrals shall be to Represented Providers, except where an Emergency requires otherwise, in other cases where the referral is specifically authorized by CIGNA's Medical Director or his/her designee or MCA's medical director, if permitted by CIGNA to make such authorizations, or as otherwise required by law. Except in an Emergency or for a Pre-Qualified Maternity Stay or in those instances where prior authorization is prohibited by federal or state laws or regulations, MCA shall require all Represented Providers to obtain authorization from CIGNA or MCA, if permitted by CIGNA to make such authorizations, prior to hospital admission of any Participant or outpatient surgical procedures. 7. The parties acknowledge and agree that CIGNA or Payor shall have final decision making authority with regard to appeals of utilization management decisions. GATEKEEPER PROGRAM ATTACHMENT TO MANAGED CARE ALLIANCE AGREEMENT (FEE-FOR-SERVICE) PURPOSE The terms and provisions of this Gatekeeper Program Attachment and the Agreement are applicable to services rendered by MCA's Represented Providers to Gatekeeper Program Participants. As used in this Program Attachment, Participant means a Gatekeeper Program Participant. HMO Program Requirements shall apply to covered Home Care Services provided to Gatekeeper Program Participants. I. DEFINITIONS GATEKEEPER PROGRAM PARTICIPANT means a Participant, other than a HMO Program Participant, enrolled in either (i) a product which includes fully insured Standard HMO, Point of Service, or Gatekeeper PPO benefits and which product is underwritten by a licensed insurance company based on an experience rating methodology, or (ii) a self funded product which includes Standard HMO, Point of Service, or Gatekeeper PPO benefits. This definition includes, but is not limited to, Participants covered under FlexCare, True Access Open Access and Open Access Plus plans insured/administered by Connecticut General Life Insurance Company. GATEKEEPER PPO means a product offered pursuant to a Service Agreement which provides the Participant with an incentive to obtain Covered Services from Participating Providers and which generally requires the Participant to obtain an authorization from their Primary Care Physician in order to access such Covered Services from Participating Providers. HMO PROGRAM PARTICIPANT means a Participant enrolled in a non-governmental, fully insured Standard HMO or Point of Service product and which product is underwritten based on a community rating methodology (i.e. community rating, community rating by class, adjusted community rating by class). This definition includes, but is not limited to, Participants covered under commercial HMO or Open Access and Open Access Plus plans issued by CIGNA. MEDICAL DIRECTOR means a physician designated by CIGNA to manage Quality Management and Utilization Management responsibilities, or that physician's designee. PATIENT PANEL means those Gatekeeper Program Participants who have designated or have otherwise been assigned to one or more of MCA's Represented Providers as the primary source for certain Covered Services pursuant to a Service Agreement or HMO Program Requirements, and for which MCA will be reimbursed on a fee-for-service basis. POINT OF SERVICE means a product offered pursuant to a Service Agreement which allows the Participant to choose, in addition to Standard HMO benefits, a lower level of benefits if the Participant receives Covered Services from (i) a Participating Provider without a necessary authorization or (ii) from a non-Participating Provider, at the time such services are sought. PRIMARY CARE PHYSICIAN means a physician duly licensed to practice medicine who is a Participating Provider with CIGNA to provide Covered Services in the fields of general medicine, internal medicine, family practice or pediatrics, and who has agreed to provide primary care physician services to Participants in accordance with HMO Program Requirements. STANDARD HMO means a product offered pursuant to a Service Agreement where Covered Services are available to Participants only from Participating Providers, except in the case of an Emergency or with the prior authorization of CIGNA or Affiliate where Covered Services are not available from Participating Providers. II. PARTIES' OBLIGATIONS A. SERVICES 1. MCA, through its Represented Providers, shall provide all Home Care Services that are required by Participants in MCA's Patient Panel, for which such Participants are eligible, in accordance with the terms of this Agreement, this Gatekeeper Program Attachment and HMO Program Requirements. The compensation set forth in this Gatekeeper Program Attachment shall be payment in full for Home Care Services rendered to Gatekeeper Program Participants. 2. MCA, through its Represented Providers, shall arrange to provide Medically Necessary Home Care Services to Participants on a 24-hour per day, 7-day per week basis or arrange with other qualified providers (which meet all CIGNA and MCA credentialing requirements or other applicable guidelines) to provide such Medically Necessary Home Care Services to Participants. MCA shall require that such covering providers (a) are Participating Providers (unless otherwise agreed); (b) will not seek compensation from CIGNA for services for which MCA receives compensation hereunder; and (c) will not bill Participants for covered Home Care Services under any circumstances except for (i) Copayments, Deductibles or Coinsurance; (ii) the provision of services to a patient who is not eligible to receive Home Care Services, including but not limited to Participants that have reached their benefit limit; and (iii) services provided to Participants that are not Home Care Services. (d) will direct the participant and/or the Represented Provider to obtain, authorization from CIGNA prior to all hospitalizations or referrals of Participants, except in Emergencies or for a Pre-Qualified Maternity Stay or as otherwise required by law. 3. MCA through its Represented Providers shall provide Home Care Services to all Participants in MCA's Patient Panel who are eligible to receive Home Care Services. 4. Subject to the terms and condition of this Agreement, MCA shall: (a) Arrange for the provision of Home Care Services to Participants; (b) Require Represented Providers to accept, treat, and otherwise render covered Home Care Services to Participants in the same manner, in accordance with the same standards, and with the same availability, as offered to other like patients. (c) not close its network to any new Participants unless CIGNA expressly consents to such closure; In no event shall MCA or Represented Providers be required to accept, treat, arrange for, or otherwise be obligated to render Home Care Services to Participants under this Agreement, even if medically appropriate, if: (a) the provision of such services to Participant would pose risk of bodily harm to the Participant or caregiver personnel of Represented Provider; (b) the provision of such services to Participant would be in violation of MCA's or Represented Provider's applicable license requirements or other applicable laws, and/or MCA policies, including but not limited to admission and discharge policies or discrimination policies; (c) MCA has not received the essential information to process a referral; (d) Participant repeatedly rejects the provision of services by a qualified Represented Provider selected by MCA and/or CIGNA as mutually agreed. MCA and Represented Providers shall not differentiate or discriminate in the treatment of any Participant because of race, color, national origin, ancestry, religion, sex, marital status, sexual orientation, age, health status, handicap or source of payment. 5. Except in an Emergency or for a Pre-Qualified Maternity Stay or in those instances where prior authorization is prohibited by federal or state laws or regulations, prior authorization by a Participant's Primary Care Physician or CIGNA as prescribed by HMO Program Requirements is required for payment of covered Home Care Services rendered to Participants. All referrals shall be to Participating Providers, except where an Emergency requires otherwise, in other cases where Medical Director specifically authorizes the referral or except as required by law. B. COMPENSATION AND BILLING 1. Reimbursement for Home Care Services rendered by Represented Providers shall be in accordance with the following rates, less applicable Copayments, Deductibles or Coinsurance: a. Reimbursement for Home Care services arranged by MCA and rendered by Represented Providers shall be in accordance with Exhibit A attached hereto. b. MCA will indemnify and hold harmless Payors, CIGNA and its Affiliates from any claim for payment in excess of the specified amounts for Home Care Services rendered to Participants by each Represented Provider, unless the claim arises from a Payor's wrongful failure to pay MCA for covered Home Care Services. 2. Payors shall agree to deduct any Copayments, Deductibles, or Coinsurance required by the Service Agreement from payment due. Deduction for the Copayment, Deductible or Coinsurance shall be determined on the basis of the contracted rate. 3. Reimbursement for Home Care Services rendered hereunder shall be made by CIGNA or its designees to MCA. MCA shall bill for covered Home Care Services according to the following: a. MCA shall submit claims on the appropriate claim form for all covered Home Care Services within one hundred twenty (120) days of the date those services are rendered. Claims received after this one hundred twenty (120) day period may be denied for payment. MCA shall submit claims to the location described in applicable Program Requirements. b. Any amount owing under this Agreement shall be paid within thirty (30) days after receipt of a complete claim, unless additional required information is requested within the thirty (30) day period, or the claim involves coordination of benefits, except as otherwise provided in this Agreement. 4. MCA and its Represented Providers shall not charge a Participant for a service which is not Medically Necessary unless, in advance of the provision of such service, the Participant is notified that the service may not be covered and the Participant acknowledges in writing that he or she shall be responsible for payment of charges for such service. 5. MCA will and shall require its Represented Providers to look solely to Payor for compensation for covered Home Care Services except for Copayments, Deductibles or Coinsurance. MCA agrees, for itself and on behalf of each Represented Provider, that whether or not there is any unresolved dispute for payment, under no circumstances will MCA or any Represented Provider directly or indirectly make any charges or claims, other than for Copayments, Deductibles or Coinsurance against any Participants or their representatives for covered Home Care Services and that this provision survives termination of this Agreement for services rendered prior to such termination. This provision shall not prohibit collection of (i) any applicable Copayments, Deductibles, or Coinsurance, (ii) payments for services provided to a patient who is no longer eligible to receive Home Care Services, including but not limited to Participants that have reached their benefit limit (iii) payment for services provided to Participants, which are not Home Care Services. This paragraph is to be interpreted for the benefit of Participants and does not diminish the obligation of Payor to make payments to Represented Providers according to the terms of this Agreement. 6. The rates set forth herein shall apply to all services rendered to Participants in the Gatekeeper Program. 7. Only those charges for Home Care Services billed in accordance with CIGNA's standard claim coding and bundling methodology will be allowed. C. OTHER REQUIREMENTS MCA and its Represented Providers shall use best efforts to prescribe or authorize the substitution of generic pharmaceuticals when appropriate and shall cooperate with CIGNA's formulary and HMO Program Requirements regarding the substitution of generic pharmaceuticals. [THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK] EXHIBIT A GATEKEEPER PROGRAM ATTACHMENT - FEE FOR SERVICE REIMBURSEMENT FOR OTHER SERVICES RATE AREA DESIGNATIONS: - -------------------------------------------------------------------------------- STATE RATE AREA RATE DESIGNATION - -------------------------------------------------------------------------------- Alabama LOW 3 - -------------------------------------------------------------------------------- Alaska HIGH 1 - -------------------------------------------------------------------------------- Arizona MEDIUM 2 - -------------------------------------------------------------------------------- Arkansas LOW 3 - -------------------------------------------------------------------------------- California HIGH 1 - -------------------------------------------------------------------------------- Colorado MEDIUM 2 - -------------------------------------------------------------------------------- Connecticut MEDIUM 2 - -------------------------------------------------------------------------------- Delaware LOW 3 - -------------------------------------------------------------------------------- District of Columbia HIGH 1 - -------------------------------------------------------------------------------- Florida MEDIUM 2 - -------------------------------------------------------------------------------- Georgia MEDIUM 2 - -------------------------------------------------------------------------------- Hawaii HIGH 1 - -------------------------------------------------------------------------------- Idaho LOW 3 - -------------------------------------------------------------------------------- Illinois HIGH 1 - -------------------------------------------------------------------------------- Indiana LOW 3 - -------------------------------------------------------------------------------- Iowa LOW 3 - -------------------------------------------------------------------------------- Kansas LOW 3 - -------------------------------------------------------------------------------- Kentucky LOW 3 - -------------------------------------------------------------------------------- Louisiana MEDIUM 2 - -------------------------------------------------------------------------------- Maine LOW 3 - -------------------------------------------------------------------------------- Maryland MEDIUM 2 - -------------------------------------------------------------------------------- Massachusetts HIGH 1 - -------------------------------------------------------------------------------- Michigan LOW 3 - -------------------------------------------------------------------------------- Minnesota LOW 3 - -------------------------------------------------------------------------------- Mississippi LOW 3 - -------------------------------------------------------------------------------- Missouri MEDIUM 2 - -------------------------------------------------------------------------------- Montana LOW 3 - -------------------------------------------------------------------------------- Nebraska LOW 3 - -------------------------------------------------------------------------------- Nevada LOW 3 - -------------------------------------------------------------------------------- New Hampshire LOW 3 - -------------------------------------------------------------------------------- New Jersey MEDIUM 2 - -------------------------------------------------------------------------------- New Mexico LOW 3 - -------------------------------------------------------------------------------- New York MEDIUM 2 - -------------------------------------------------------------------------------- North Carolina MEDIUM 2 - -------------------------------------------------------------------------------- North Dakota MEDIUM 2 - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- Ohio MEDIUM 2 - -------------------------------------------------------------------------------- Oklahoma LOW 3 - -------------------------------------------------------------------------------- Oregon MEDIUM 2 - -------------------------------------------------------------------------------- Pennsylvania MEDIUM 2 - -------------------------------------------------------------------------------- Rhode Island MEDIUM 2 - -------------------------------------------------------------------------------- South Carolina MEDIUM 2 - -------------------------------------------------------------------------------- South Dakota LOW 3 - -------------------------------------------------------------------------------- Tennessee MEDIUM 2 - -------------------------------------------------------------------------------- Texas HIGH 1 - -------------------------------------------------------------------------------- Utah MEDIUM 2 - -------------------------------------------------------------------------------- Vermont LOW 3 - -------------------------------------------------------------------------------- Virginia MEDIUM 2 - -------------------------------------------------------------------------------- Washington MEDIUM 2 - -------------------------------------------------------------------------------- West Virginia LOW 3 - -------------------------------------------------------------------------------- Wisconsin LOW 3 - -------------------------------------------------------------------------------- Wyoming LOW 3 - -------------------------------------------------------------------------------- TRADITIONAL HOME HEALTH SERVICES: RATES EFFECTIVE JANUARY 1, 2004 - DECEMBER 31, 2004 THE FOLLOWING TRADITIONAL HOME HEALTH SERVICES HAVE BOTH VISIT AND HOURLY RATES. Notes 1, 2, 3, 4, 5 and 6 apply AREA 1 AREA 2 AREA 3 ------------------------------------------ VISIT HOUR VISIT HOUR VISIT HOUR ------------------------------------------ CERTIFIED NURSES AIDE * * * * * * - --------------------------------------------------------------------------- HOME HEALTH AIDE * * * * * * - --------------------------------------------------------------------------- LVN/LPN * * * * * * - --------------------------------------------------------------------------- LVN/LPN - HIGH TECH * * * * * * - --------------------------------------------------------------------------- PEDIATRIC HIGH TECH LVN/LPN * * * * * * - --------------------------------------------------------------------------- PEDIATRIC HIGH TECH RN * * * * * * - --------------------------------------------------------------------------- PEDIATRIC LVN/LPN * * * * * * - --------------------------------------------------------------------------- PEDIATRIC RN * * * * * * - --------------------------------------------------------------------------- RN * * * * * * - --------------------------------------------------------------------------- RN HIGH TECH INFUSION * * * * * * - --------------------------------------------------------------------------- RN HIGH TECH OTHER * * * * * * - --------------------------------------------------------------------------- THE FOLLOWING TRADITIONAL HOME HEALTH SERVICES HAVE VISIT ONLY RATES. Notes 1, 3, 4, 5, 7 and 8 apply AREA 1 AREA 2 AREA 3 ------------------------------------------ VISIT HOUR VISIT HOUR VISIT HOUR ------------------------------------------ DIABETIC NURSE * * * * * * - -------------------------------------------------------------------------------- DIETITIAN * * * * * * - -------------------------------------------------------------------------------- ENTEROSTOMAL THERAPIST * * * * * * - -------------------------------------------------------------------------------- MATERNAL CHILD HEALTH * * * * * * * Confidential treatment requested - -------------------------------------------------------------------------------- MEDICAL SOCIAL WORKER * * * * * * - -------------------------------------------------------------------------------- OCCUPATIONAL THERAPIST * * * * * * - -------------------------------------------------------------------------------- OCCUPATIONAL THERAPIST ASSISTANT * * * * * * - -------------------------------------------------------------------------------- PHLEBOTOMIST * * * * * * - -------------------------------------------------------------------------------- PHOTOTHERAPY PACKAGE SERVICE * * * * * * - -------------------------------------------------------------------------------- PHYSICAL THERAPIST * * * * * * - -------------------------------------------------------------------------------- PHYSICAL THERAPIST ASSISTANT * * * * * * - -------------------------------------------------------------------------------- PSYCHIATRIC NURSE * * * * * * - -------------------------------------------------------------------------------- REHABILITATION NURSE * * * * * * - -------------------------------------------------------------------------------- RESPIRATORY THERAPIST * * * * * * - -------------------------------------------------------------------------------- RESPIRATORY THERAPIST - CPAP Clinic * * * * * * - -------------------------------------------------------------------------------- RN ASSESSMENT, INITIAL * * * * * * - -------------------------------------------------------------------------------- RN SKILLED NURSING VISIT-EXTENSIVE * * * * * * - -------------------------------------------------------------------------------- SPEECH THERAPIST * * * * * * - -------------------------------------------------------------------------------- THE FOLLOWING TRADITIONAL HOME HEALTH SERVICE HAS HOURLY ONLY RATES. Notes 3, 4 and 5 apply AREA 1 AREA 2 AREA 3 ------------------------------------------ VISIT HOUR VISIT HOUR VISIT HOUR ------------------------------------------ HOMEMAKER * * * * * * - -------------------------------------------------------------------------------- THE FOLLOWING TRADITIONAL HOME HEALTH SERVICE IS PRICED ON A PER DIEM BASIS. Notes 3, 4 and 5 apply AREA 1 AREA 2 AREA 3 -------------------------------------------------- PER PER PER DIEM DIEM DIEM -------------------------------------------------- COMPANION/LIVE IN * * * * * * - -------------------------------------------------------------------------------- NOTES: * * * * * * * * * Confidential treatment requested HOME INFUSION RATES: RATES EFFECTIVE JANUARY 1, 2004 - DECEMBER 31, 2004 THE FOLLOWING HOME INFUSION THERAPY SERVICE RATES EXCLUDE DRUGS. DRUGS ARE PRICED AS A PERCENTAGE DISCOUNT OFF AWP (IF APPLICABLE), AND THERE IS NO PRICE DIFFERENCE BETWEEN PRIMARY AND MULTIPLE THERAPIES
PRIMARY OR PRIMARY OR PRIMARY OR MULTIPLE THERAPY MULTIPLE THERAPY MULTIPLE THERAPY PER DIEM DISPENSING FEE DRUG DISCOUNT OFF AWP ------------------------------------------------------------- Ancillary Drugs * * * - ---------------------------------------------------------------------------------------------------------------- Biological Response Modifiers * * * - ---------------------------------------------------------------------------------------------------------------- Cardiac (Inotropic) Therapy * * * - ---------------------------------------------------------------------------------------------------------------- Chelation Therapy * * * - ---------------------------------------------------------------------------------------------------------------- Chemotherapy * * * - ---------------------------------------------------------------------------------------------------------------- Enteral Therapy * * * - ---------------------------------------------------------------------------------------------------------------- Enzyme Therapy * * * - ---------------------------------------------------------------------------------------------------------------- Growth Hormone * * * - ---------------------------------------------------------------------------------------------------------------- IV Immune Globulin * * * - ---------------------------------------------------------------------------------------------------------------- Other Injectable Therapies * * * - ---------------------------------------------------------------------------------------------------------------- Other Infusion Therapies * * * - ---------------------------------------------------------------------------------------------------------------- Pain Management Therapy * * * - ---------------------------------------------------------------------------------------------------------------- Steroid Therapy * * * - ---------------------------------------------------------------------------------------------------------------- Thrombolytic (Anticoagulation) Therapy * * * - ---------------------------------------------------------------------------------------------------------------- Synagis * * * - ---------------------------------------------------------------------------------------------------------------- Remodulin Therapy * * * - ----------------------------------------------------------------------------------------------------------------
THE FOLLOWING HOME INFUSION THERAPY SERVICE RATES EXCLUDE DRUGS. DRUGS ARE PRICED AS A PERCENTAGE DISCOUNT OFF AWP, AND THERE IS A PRICE DIFFERENCE BETWEEN PRIMARY AND MULTIPLE ANTI-INFECTIVE THERAPIES
PER DIEM DRUG DISCOUNT OFF AWP --------------------------------------------------------- Anti-Infectives - Primary Anti-Infective * * * - ---------------------------------------------------------------------------------------------------------------- Anti-Infectives - Multiple Anti-Infective * * * - ----------------------------------------------------------------------------------------------------------------
THE FOLLOWING HOME INFUSION THERAPY SERVICE RATE EXCLUDES DRUGS. DRUGS ARE PRICED PER VIAL, AND THERE IS NO PRICE DIFFERENCE BETWEEN PRIMARY AND MULTIPLE ANTI-INFECTIVE THERAPIES
PRIMARY OR MULTIPLE THERAPY PER DIEM COST OF DRUG --------------------------------------------------------- Flolan Therapy * - ------------------------------------------------------------------------------------------------------------ Flolan 0.5 mg vial * - ------------------------------------------------------------------------------------------------------------ Flolan 1.5 mg vial * - ------------------------------------------------------------------------------------------------------------ Flolan diluent vial * - ------------------------------------------------------------------------------------------------------------
* Confidential treatment requested THE FOLLOWING HOME INFUSION THERAPY SERVICE RATES INCLUDE DRUGS, AND THERE IS NO PRICE DIFFERENCE BETWEEN PRIMARY AND MULTIPLE THERAPIES
PRIMARY OR MULTIPLE THERAPY PER DIEM --------------------------------------------------------- Enteral Therapy * - ------------------------------------------------------------------------------------------------------------ Hydration Therapy * - ------------------------------------------------------------------------------------------------------------ Total Parenteral Nutrition * - ------------------------------------------------------------------------------------------------------------
NOTES: * * * * * * * THE FOLLOWING ARE FOR THE STATED ITEM ONLY. UNLESS OTHERWISE NOTED, NURSING, SUPPLIES, ETC. ARE NOT INCLUDED. - ------------------------------------------------------------------------------------------------------------ Blood Transfusion per Unit (Tubing, Filters) * - ------------------------------------------------------------------------------------------------------------ Catheter Care Per Diem * - ------------------------------------------------------------------------------------------------------------ Midline Insertion (Catheter & Supplies) * - ------------------------------------------------------------------------------------------------------------ PICC Line Insertion (Catheter & Supplies) * - ------------------------------------------------------------------------------------------------------------ Blood Product * - ------------------------------------------------------------------------------------------------------------
- -------------------------------------------------------------------------------- * Confidential treatment requested FACTOR CONCENTRATES
Vial price Unit Price - ----------------------------------------------------------------------------------------------------------- FACTOR VII - ----------------------------------------------------------------------------------------------------------- Novoseven 1200MCG Vial * - ----------------------------------------------------------------------------------------------------------- Novoseven 4800MCG Vial * - ----------------------------------------------------------------------------------------------------------- Novoseven in 1200MCG or 4800MCG QTY * - ----------------------------------------------------------------------------------------------------------- FACTOR VIII (RECOMBINANT) - ----------------------------------------------------------------------------------------------------------- Recombinate * - ----------------------------------------------------------------------------------------------------------- Kogenate or Helixate * - ----------------------------------------------------------------------------------------------------------- Bioclate * - ----------------------------------------------------------------------------------------------------------- Helixate FS * - ----------------------------------------------------------------------------------------------------------- Kogenate FS * - ----------------------------------------------------------------------------------------------------------- Refacto * - ----------------------------------------------------------------------------------------------------------- Advate * - ----------------------------------------------------------------------------------------------------------- FACTOR VIII (MONOCLONAL) - ----------------------------------------------------------------------------------------------------------- Hemofil-M or A. R. C. Method M * - ----------------------------------------------------------------------------------------------------------- Monoclate P * - ----------------------------------------------------------------------------------------------------------- Monarc-M * - ----------------------------------------------------------------------------------------------------------- FACTOR VIII (OTHER) - ----------------------------------------------------------------------------------------------------------- Koate * - ----------------------------------------------------------------------------------------------------------- Humate * - ----------------------------------------------------------------------------------------------------------- Alphanate SDHT * - ----------------------------------------------------------------------------------------------------------- FACTOR IX (RECOMBINANT) - ----------------------------------------------------------------------------------------------------------- BeneFix * - ----------------------------------------------------------------------------------------------------------- FACTOR IX (MONOCLONAL/HIGH PURITY) - ----------------------------------------------------------------------------------------------------------- Mononine * - ----------------------------------------------------------------------------------------------------------- Alphanine * - ----------------------------------------------------------------------------------------------------------- FACTOR IX (OTHER) - ----------------------------------------------------------------------------------------------------------- Konyne - 80 * - ----------------------------------------------------------------------------------------------------------- Proplex T * - ----------------------------------------------------------------------------------------------------------- Bebulin * - ----------------------------------------------------------------------------------------------------------- Profilnine SD * - ----------------------------------------------------------------------------------------------------------- ANTI-INHIBITOR COMPLEX - ----------------------------------------------------------------------------------------------------------- Autoplex-T * - -----------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ----------------------------------------------------------------------------------------------------------- Feiba-VH * - ----------------------------------------------------------------------------------------------------------- Hyate-C * - ----------------------------------------------------------------------------------------------------------- HEMOSTATIC AGENTS - ----------------------------------------------------------------------------------------------------------- DDAVP - 10ml vial * - ----------------------------------------------------------------------------------------------------------- Stimate - 2.5ml vial * - -----------------------------------------------------------------------------------------------------------
Above rates include all necessary ancillary supplies and waste disposal unit; 24-hour on-call clinical support; home infusion monitoring system; product delivery nationwide; patient training, education, and evaluation DME/HOME RESPIRATORY RATES: RATES EFFECTIVE JANUARY 1, 2004 - MARCH 31, 2004
HCPCS CHC GENTIVA CODE CODE CODE DESCRIPTION PURCHASE PRICE RENTAL PRICE DAILY PRICE - ---------------------------------------------------------------------------------------------------------------- A4660 DM590 2520 MONITOR, BLOOD PRESSURE (A4660) * W/STETH & CUFF - ---------------------------------------------------------------------------------------------------------------- A4670 DM590 2518 MONITOR, BLOOD PRESSURE (A4670), * AUTOMATIC - ---------------------------------------------------------------------------------------------------------------- A7034 A9900 7552 BREEZE (A9900) CPAP/BIPAP MASK * - ---------------------------------------------------------------------------------------------------------------- A7034 A9900 7553 FULL FACE (A9900) MIRAGE * CPAP/BIPAP MASK - ---------------------------------------------------------------------------------------------------------------- A7034 A9900 7554 GEL/SILICON (A9900) CPAP/BIPAP * MASK INCL GLD SEAL,PHANTM,MONARCH - ---------------------------------------------------------------------------------------------------------------- A7034 A9900 7556 SPECIALTY (A9900) CPAP/BIPAP * MASK (PROFILE OR SIMPICITY) - ---------------------------------------------------------------------------------------------------------------- B9002 HI531 2570 PUMP, ENTERAL (B9002) * * - ---------------------------------------------------------------------------------------------------------------- B9998 DM590 6828 ENTERAL SUPPLIES (B9998) * * - ---------------------------------------------------------------------------------------------------------------- DM590 DM570 7551 BACK-PACK (E1399), FOR * PORTABLE ENTERAL PUMP - ---------------------------------------------------------------------------------------------------------------- A4615 DM590 2522 CANNULA, NASAL * - ---------------------------------------------------------------------------------------------------------------- B9002 DM590 7509 ENTERAL PUMP, PORTABLE (B9002) * * - ---------------------------------------------------------------------------------------------------------------- A7034 DM590 7508 MASK, CPAP GEL OR SILICONE * (K0183) - ---------------------------------------------------------------------------------------------------------------- E0100 E0100 2020 CANE (E0100), ADJ OR FIX, W/ TIP * - ---------------------------------------------------------------------------------------------------------------- E0105 E0105 2021 CANE, QUAD (E0105) OR THREE * PRONG, ADJ OR FIX, W/ TIPS - ---------------------------------------------------------------------------------------------------------------- E0110 E0110 2028 CRUTCHES, FOREARM (E0110), ADJ * OR FIX, PAIR, W/ TIPS, GRIPS - ---------------------------------------------------------------------------------------------------------------- E0111 E0111 2023 CRUTCH FOREARM (E0111), ADJ OR * FIX, EACH, W/ TIP AND GRIPS - ---------------------------------------------------------------------------------------------------------------- E0112 E0112 2027 CRUTCHES UNDERARM, WOOD * (E0112), ADJ OR FIX, PAIR, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0113 E0113 2025 CRUTCH UNDERARM, WOOD (E0113), * ADJ OR FIX, EACH, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0114 E0114 2026 CRUTCHES UNDERARM, ALUM * (E0114), ADJ OR FIX, PAIR, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0116 E0116 2024 CRUTCH UNDERARM, ALUM (E0116), * ADJ OR FIX, EACH, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0130 E0130 2037 WALKER, RIGID (E0130) * (PICKUP), ADJ OR FIX HEIGHT - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0135 E0135 2036 WALKER, FOLDING (E0135) * (PICKUP), ADJ OR FIX HEIGHT - ---------------------------------------------------------------------------------------------------------------- E0141 E0141 2040 WALKER, WHEELED (E0141), W/OUT * SEAT - ---------------------------------------------------------------------------------------------------------------- E0142 DM570 2034 RIGID WALKER (E0142), WHEELED, * W/ SEAT, - ---------------------------------------------------------------------------------------------------------------- E0143 E0143 2029 WALKER FOLDING, WHEELED * (E0143), W/OUT SEAT - ---------------------------------------------------------------------------------------------------------------- E0145 DM570 2039 WALKER (E0145), WHEELED, W/ * SEAT AND CRUTCH ATTACHMENTS - ---------------------------------------------------------------------------------------------------------------- E0146 DM570 2038 WALKER, WHEELED, W/ SEAT (E0146) * - ---------------------------------------------------------------------------------------------------------------- E0147 E0147 2030 WALKER HVY DUT (E0147), MULT * BRAKING SYS, VAR WHEEL RESISTANCE - ---------------------------------------------------------------------------------------------------------------- E0153 E0153 2032 CRUTCH PLATFORM ATTACHMENT * (E0153), FOREARM EA - ---------------------------------------------------------------------------------------------------------------- E0154 E0154 2033 WALKER PLATFORM ATTACHMENT * (E0154), EA - ---------------------------------------------------------------------------------------------------------------- E0155 E0155 2041 WALKER WHEEL ATTACHMENT * (E0155), RIGID (PICKUP) WALKER - ---------------------------------------------------------------------------------------------------------------- E0156 DM570 2035 WALKER SEAT ATTACHMENT (E0156) * - ---------------------------------------------------------------------------------------------------------------- E0157 E0157 2022 WALKER, CRUTCH ATTACHMENT * (E0157), EACH - ---------------------------------------------------------------------------------------------------------------- E0158 E0158 2031 WALKER LEG EXTENSIONS (E0158) * - ---------------------------------------------------------------------------------------------------------------- E0163 E0163 2047 COMMODE CHAIR, STATIONARY * (E0163), W/ FIX ARMS - ---------------------------------------------------------------------------------------------------------------- E0164 E0164 2045 COMMODE CHAIR, MOBILE * (E0164), W/ FIX ARMS - ---------------------------------------------------------------------------------------------------------------- E0165 E0165 2046 COMMODE CHAIR (E0165), * STATIONARY, W/ DETACH ARMS - ---------------------------------------------------------------------------------------------------------------- E0165 E0165 2591 COMMODE, XXWIDE(E0165) * - ---------------------------------------------------------------------------------------------------------------- E0166 E0166 2044 COMMODE CHAIR (E0166), MOBILE, * W/ DETACH ARMS - ---------------------------------------------------------------------------------------------------------------- E0167 E0167 2051 COMMODE CHAIR, PAIL OR PAN * (E0167) - ---------------------------------------------------------------------------------------------------------------- E0176 E0176 2142 CUSHION (E0176) OR AIR PRESSURE * PAD, NON-POSITIONING - ---------------------------------------------------------------------------------------------------------------- E0176 E0176 2394 REPLACEMENT PAD (E0176) * ALTERNATING PRESS - ---------------------------------------------------------------------------------------------------------------- E0177 E0177 2224 CUSHION OR WATER PRESS PAD * (E0177), NONPOSITIONING - ---------------------------------------------------------------------------------------------------------------- E0178 E0178 2160 CUSHION OR GEL PRESS PAD * (E0178), NONPOSITIONING - ---------------------------------------------------------------------------------------------------------------- E0179 E0179 2154 CUSHION (E0179) OR DRY PRESSURE * PAD, NONPOSTIONING - ---------------------------------------------------------------------------------------------------------------- E0180 E0180 2196 PUMP (E0180), ALTERNATING * * PRESSURES W/PAD - ---------------------------------------------------------------------------------------------------------------- E0181 E0181 2197 PUMP (E0181), ALTERNATING PRESS * * W/PAD, HVY DUTY - ---------------------------------------------------------------------------------------------------------------- E0184 E0184 2074 MATTRESS, DRY PRESSURE (E0184) * - ---------------------------------------------------------------------------------------------------------------- E0185 E0185 2076 MATTRESS (E0185), GEL OR * GEL-LIKE PRESSURE PAD - ---------------------------------------------------------------------------------------------------------------- E0186 E0186 2064 MATTRESS, AIR PRESSURE (E0186) * - ---------------------------------------------------------------------------------------------------------------- E0187 E0187 2099 MATTRESS, WATER PRESSURE (E0187) * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0188 DM570 2217 PAD, SYNTHETIC SHEEPSKIN (A9900) * - ---------------------------------------------------------------------------------------------------------------- E0189 DM570 2177 PAD, LAMBSWOOL SHEEPSKIN * * (E0189), ANY SIZE - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2573 CUSHION, JAY FOR W/C (E0192) * * - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2572 CUSHION, ROHO FOR W/C (E0192) * * - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2178 W/C PAD (E0192), LOW PRESS AND * * POSITIONING EQUALIZATION - ---------------------------------------------------------------------------------------------------------------- E0193 E0193 2098 MATTRESS, LOW AIR LOSS (E0193), * * * INCL. BED - ---------------------------------------------------------------------------------------------------------------- E0194 DM570 2063 AIR FLUIDIZED BED (E0194) * * * - ---------------------------------------------------------------------------------------------------------------- E0196 E0196 2077 MATTRESS, GEL PRESSURE (E0196) * - ---------------------------------------------------------------------------------------------------------------- E0197 E0197 2065 MATTRESS, AIR PRESSURE PAD * (E0197) - ---------------------------------------------------------------------------------------------------------------- E0198 E0198 2100 MATTRESS (E0198), WATER * PRESSURE PAD - ---------------------------------------------------------------------------------------------------------------- E0199 E0199 2075 MATTRESS, DRY PRESSURE PAD * (E0199) - ---------------------------------------------------------------------------------------------------------------- E0200 E0200 2228 HEAT LAMP (E0200), W/OUT * STAND, INCL/BULB, OR INFRARED ELEMENT - ---------------------------------------------------------------------------------------------------------------- E0202 E0202 2229 PHOTOTHERAPY (BILIRUBIN) * * (E0202), LIGHT WIT - ---------------------------------------------------------------------------------------------------------------- E0202 E0202 2524 PHOTOTHERAPY, BILI BLANKET * * (E0202) - ---------------------------------------------------------------------------------------------------------------- E0205 E0205 2227 HEAT LAMP (E0205), WITH STAND, * INCL/ BULB, OR INFRARED ELEMENT - ---------------------------------------------------------------------------------------------------------------- E0210 DM570 2156 HEATING PAD, STANDARD (E0210) * - ---------------------------------------------------------------------------------------------------------------- E0215 DM570 2155 HEATING PAD (E0215), ELECTRIC, * MOIST - ---------------------------------------------------------------------------------------------------------------- E0218 DM570 2560 COLD THERAPY UNIT (E0218) * * * - ---------------------------------------------------------------------------------------------------------------- E0235 DM570 2187 PARAFFIN BATH UNIT, PORT (E0235) * - ---------------------------------------------------------------------------------------------------------------- E0236 DM570 2199 PUMP (E0236) FOR WATER * CIRCULATING PAD - ---------------------------------------------------------------------------------------------------------------- E0237 DM570 2223 HEAT COLD WATER (E0237) * CIRCULATING PAD W/PUMP - ---------------------------------------------------------------------------------------------------------------- E0238 DM570 2179 HEATING PAD (E0238), MOIST, * NON-ELECTRIC - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2867 BATH TUB RAIL (E0241), WALL, * L-SHAPE - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2862 BATH TUB RAIL, WALL, 12" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2863 BATH TUB RAIL, WALL, 16" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2864 BATH TUB RAIL, WALL, 18" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2865 BATH TUB RAIL, WALL, 24" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2866 BATH TUB RAIL, WALL, 36" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2043 BATH TUB RAIL, WALL, * UNSPECIFIED SIZE - ---------------------------------------------------------------------------------------------------------------- E0242 DM570 2042 BATH TUB RAIL, FLOOR BASE * (E0242) - ---------------------------------------------------------------------------------------------------------------- E0243 DM570 2056 TOILET RAIL, EACH (E0243) * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0244 E0244 2587 TOILET SEAT (E0244) RAISED WITH * ARMS - ---------------------------------------------------------------------------------------------------------------- E0244 E0244 2052 TOILET SEAT, RAISED (E0244) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2575 BATH BENCH WITH BACK (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2058 BATH TUB STOOL OR BENCH (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2578 TRANSFER BENCH, NON-PADDED * (E0245) - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2577 TRANSFER BENCH, PADDED (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0246 DM570 2057 TRANSFER TUB RAIL(E0246), * ATTACHMENT - ---------------------------------------------------------------------------------------------------------------- E0249 DM570 2186 HEAT UNIT (E0249), WATER * CIRCULATING PAD - ---------------------------------------------------------------------------------------------------------------- E0255 E0255 2090 HOSP BED (E0255), VAR HEIGHT, * * HI-LO, W/ SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0256 E0256 2091 HOSP BED (E0256), VAR HEIGHT, * * HI-LO, W/ SIDE RAILS, W/O MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0260 E0260 2083 HOSP BED (E0260), SEMI-ELEC, W/ * * SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0261 E0261 2084 HOSP BED (E0261), SEMI-ELEC, W/ * * SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0265 E0265 2086 HOSP BED (E0265), TOTAL ELEC, * * W/ SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0266 E0266 2087 HOSP BED (E0266), TOTAL ELEC, * * W/ SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0271 E0271 2096 MATTRESS, INNERSPRING (E0271) * - ---------------------------------------------------------------------------------------------------------------- E0272 E0272 2095 MATTRESS, FOAM RUBBER (E0272) * - ---------------------------------------------------------------------------------------------------------------- E0273 DM570 2068 BED BOARD (E1399) * - ---------------------------------------------------------------------------------------------------------------- E0274 DM570 2097 OVER-BED TABLE (E0274) * - ---------------------------------------------------------------------------------------------------------------- E0275 E0275 2071 BED PAN, STANDARD (E0275), * METAL OR PLASTIC - ---------------------------------------------------------------------------------------------------------------- E0276 E0276 2070 BED PAN, FRACTURE (E0276), * METAL OR PLASTIC - ---------------------------------------------------------------------------------------------------------------- E0277 E0277 2066 MATTRESS (E0277), LOW AIR LOSS, * * ALT PRESSURE - ---------------------------------------------------------------------------------------------------------------- E0280 DM570 2069 BED CRADLE, ANY TYPE (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E0292 E0292 2092 HOSP BED (E0292), VAR HEIGHT, * * HI-LO, W/OUT S/ RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0293 E0293 2093 HOSP BED (E0293), VAR HEIGHT, * * HI-LO, NO SIDE RAILS, NO MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0294 E0294 2085 HOSP BED (E0294), SEMI-ELEC, * * W/OUT SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0295 E0295 2094 HOSP BED (E0295), SEMI-ELEC, * * W/OUT SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0296 E0296 2089 HOSP BED (E0296), TOTAL ELEC, * * W/OUT SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0297 E0297 2088 HOSP BED (E0297), TOTAL ELEC, * * W/OUT SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0305 E0305 2073 BED SIDE RAILS (E0305), HALF * LENGTH - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0310 E0310 2072 BED SIDE RAILS (E0310), FULL * LENGTH - ---------------------------------------------------------------------------------------------------------------- E0315 DM570 2067 BED ACCESSORIES: BOARDS OR * TABLES, ANY TYPE - ---------------------------------------------------------------------------------------------------------------- E0325 E0325 2060 URINAL; MALE (E0325), JUG-TYPE, * ANY MATERIAL - ---------------------------------------------------------------------------------------------------------------- E0326 E0326 2059 URINAL; FEMALE (E0326), * JUG-TYPE, ANY MATERIAL - ---------------------------------------------------------------------------------------------------------------- E0372 E0372 7008 MATTRESS (E0372) POWERED AIR * * OVERLAY - ---------------------------------------------------------------------------------------------------------------- E0410 E0444 2369 O2 CONTENTS, LIQUID (E0444), * PER POUND - ---------------------------------------------------------------------------------------------------------------- E0416 E0443 2371 O2 REFILL FOR PORT (E0443) GAS * SYSTEM ONLY, UP TO 23 CUBIC FEET - ---------------------------------------------------------------------------------------------------------------- E0424 E0424 2385 O2 SYS STATIONARY (E0424) COMPR * GAS, RENT - ---------------------------------------------------------------------------------------------------------------- E0430 E0430 2374 O2 SYS PORT GAS, PURCH (E0430) * - ---------------------------------------------------------------------------------------------------------------- E0431 E0431 2574 O2 SYS PORT GAS, LIGHTWEIGHT * * (E0431) W/CONSERV DEVICE,NO CONTENT - ---------------------------------------------------------------------------------------------------------------- E0431 E0431 2375 O2 SYS PORT GAS, RENT (E0431) * - ---------------------------------------------------------------------------------------------------------------- E0434 E0434 2377 O2 SYS PORT LIQUID,RENT (E0434) * - ---------------------------------------------------------------------------------------------------------------- E0435 E0435 2376 O2 SYS PORT LIQUID, PURCH * (E0435) - ---------------------------------------------------------------------------------------------------------------- E0439 E0439 2388 O2 SYS STATIONARY (E0439) * LIQUID, RENT - ---------------------------------------------------------------------------------------------------------------- E0440 E0440 2387 O2 SYS STATIONARY (E0440) * LIQUID, PURCH - ---------------------------------------------------------------------------------------------------------------- E0443 E0400 2869 O2 CONTENTS, H/K CYLINDER * (E0400), 200-300 CUBIC FT - ---------------------------------------------------------------------------------------------------------------- E0444 E0444 2379 O2 CONTENTS, PORT LIQUID * (E0444), PER UNIT (1 UNIT = 1 LB.) - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 7555 POSITIVE PRESSURE VENTS * (E0450)(E.G. T-BIRD) - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 2392 VENTILATOR VOLUME (E0450), * * STATIONARY OR PORT - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 7522 VENTILATOR, VOLUME, (E0450) * * EMERGENCY BACKUP UNIT - ---------------------------------------------------------------------------------------------------------------- E0452 E0452 2332 BILEVEL INTERMITTENT (E0452) * * ASSIST DEVICE,(BIPAP) - ---------------------------------------------------------------------------------------------------------------- E0453 E0453 2390 VENTILATOR THERAPEUTIC (E0453); * * FOR USE 12 HOURS OR LESS PER DAY - ---------------------------------------------------------------------------------------------------------------- E0455 E0455 2372 O2 TENT (E0455), EXCLUDING * * CROUP OR PEDIATRIC TENTS - ---------------------------------------------------------------------------------------------------------------- E0457 E0457 2323 CHEST SHELL (CUIRASS) (E0457) * * - ---------------------------------------------------------------------------------------------------------------- E0459 E0459 2324 CHEST WRAP (E0459) * * - ---------------------------------------------------------------------------------------------------------------- E0460 E0460 2339 VENTILATOR (E0460), NEGATIVE * * PRESSURE , PORTABLE OR STATIONARY - ---------------------------------------------------------------------------------------------------------------- E0480 DM570 2373 PERCUSSOR (E0480), ELEC OR * * PNEUM, HOME MODEL - ---------------------------------------------------------------------------------------------------------------- E0500 E0500 2333 IPPB , W/ BUILT-IN NEB (E0500) * * MAN OR AUTO VALVES; INT/EXT POWER - ---------------------------------------------------------------------------------------------------------------- E0550 E0550 2328 HUMIDIFIER (E0550) DURABLE FOR * * EXTENSIV SUP/ HUMID W/ IPPB OR O2 - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0555 E0555 2330 HUMIDIFIER (E0555), DURABLE, * * GLASS, FOR USE W/ REG OR FLOWMETER - ---------------------------------------------------------------------------------------------------------------- E0565 E0565 2325 COMPRESSOR, AIR POWER (E0565) * * - ---------------------------------------------------------------------------------------------------------------- E0570 E0570 2336 NEBULIZER, W/ COMPRESSOR (E0570) * * - ---------------------------------------------------------------------------------------------------------------- E0575 DM570 2571 NEBULIZER (E0575), ULTRASONIC, * * AC/DC - ---------------------------------------------------------------------------------------------------------------- E0575 DM570 2338 NEBULIZER; ULTRASONIC (E0575) * * - ---------------------------------------------------------------------------------------------------------------- E0585 E0585 2337 NEBULIZER(E0585), W/ COMPRESSOR * * AND HEATER - ---------------------------------------------------------------------------------------------------------------- E0600 E0600 2389 SUCTION PUMP (E0600), HOME MODEL * - ---------------------------------------------------------------------------------------------------------------- E0600 E0600 7523 SUCTION UNIT, (E0600), PORTABLE * * AC/DC - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 2326 CONTINUOUS POSITVE (E0601) * * AIRWAY PRESSURE DEVICE (CPAP) - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 6965 CPAP, SELF TITRATING (E0601) * * - ---------------------------------------------------------------------------------------------------------------- E0605 DM570 2391 VAPORIZER, ROOM TYPE (E0605) * - ---------------------------------------------------------------------------------------------------------------- E0606 DM570 2380 POSTURAL DRAINAGE BOARD (E0606) * - ---------------------------------------------------------------------------------------------------------------- E0607 E0607 6874 MONITOR, B/GLUCOSE (E0607) * ACCUCHEK AD - ---------------------------------------------------------------------------------------------------------------- E0607 E0607 2164 MONITOR, BLOOD GLUCOSE (E0607) * - ---------------------------------------------------------------------------------------------------------------- E0618 E0608 2322 APNEA MONITOR (E0608) * * - ---------------------------------------------------------------------------------------------------------------- E0619 E0608 2576 APNEA MONITOR (E0608) W/MEM * * (INCL SMART) - ---------------------------------------------------------------------------------------------------------------- E0609 E0609 2146 MONITOR, BLOOD GLUCOSE (E0609) * W/SPECIAL FEATURES - ---------------------------------------------------------------------------------------------------------------- E0621 E0621 2215 PATIENT LIFT (E0621), SLING OR * SEAT, CANVAS OR NYLON - ---------------------------------------------------------------------------------------------------------------- E0625 DM570 2191 PATIENT LIFT (E0625), KARTOP, * BATHROOM OR TOILET - ---------------------------------------------------------------------------------------------------------------- E0627 E0627 4553 HIP CHAIR (E0627) * * - ---------------------------------------------------------------------------------------------------------------- E0627 DM570 2395 SEAT LIFT CHAIR/MOTORIZED * (E0627) - ---------------------------------------------------------------------------------------------------------------- E0627 DM570 2205 SEAT LIFT MECH (E0627) * INCORPORATED INTO A COMB LIFT-CHAIR MECH - ---------------------------------------------------------------------------------------------------------------- E0630 E0630 2190 PATIENT LIFT, HYDRAULIC * * (E0630), W/ SEAT OR SLING - ---------------------------------------------------------------------------------------------------------------- E0635 DM570 2189 PATIENT LIFT (E0635), ELEC W/ * * SEAT OR SLING - ---------------------------------------------------------------------------------------------------------------- E0650 E0650 2192 PNEUM COMPRESSOR (E0650), * * NON-SEG HOME MODEL - ---------------------------------------------------------------------------------------------------------------- E0651 E0651 2194 PNEUM COMPRESSOR (E0651), SEG * * HOME MODEL W/OUT CALIB GRAD PRES - ---------------------------------------------------------------------------------------------------------------- E0652 E0652 2193 PNEUM COMPRESSOR (E0652), SEG * * HOME MODEL W/ CALIB GRAD PRES - ---------------------------------------------------------------------------------------------------------------- E0655 E0655 2182 PNEUM COMPRESSOR (E0655), * NON-SEG APPLIANCE, HALF ARM - ---------------------------------------------------------------------------------------------------------------- E0660 E0660 2181 PNEUM COMPRESSOR (E0660), * NON-SEG APPLIANCE, FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0665 E0665 2180 PNEUM COMPRESSOR (E0665), * NON-SEG APPLIANCE, FULL ARM - ---------------------------------------------------------------------------------------------------------------- E0666 E0666 2183 PNEUM COMPRESSOR (E0666), * NON-SEG APPLIANCE, HALF LEG - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0667 E0667 2210 PNEUM APPLIANCE (E0667), SEG, * FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0668 E0668 2209 PNEUM APPLIANCE (E0668), SEG, * FULL ARM - ---------------------------------------------------------------------------------------------------------------- E0669 E0669 2212 PNEUM APPLIANCE (E0669), SEG, * HALF LEG - ---------------------------------------------------------------------------------------------------------------- E0670 E0670 2211 PNEUM APPLIANCE (E0670), SEG, * HALF ARM - ---------------------------------------------------------------------------------------------------------------- E0671 E0671 2207 PNEUM APPLIANCE (E0671), SEG * GRAD PRESS, FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0672 E0672 2206 PNEUM APPLIANCE (E0672), SEG * GRAD PRESS, FULL ARM - ---------------------------------------------------------------------------------------------------------------- E0673 E0673 2208 PNEUM APPLIANCE (E0673), SEG * GRAD PRESS, HALF LEG - ---------------------------------------------------------------------------------------------------------------- E0690 DM570 2221 ULTRAVIOLET CABINET (E0690), * APPROPRIATE FOR HOME USE - ---------------------------------------------------------------------------------------------------------------- E0700 DM570 2204 SAFETY EQUIP (E0700) (E.G., * BELT, HARNESS OR VEST) - ---------------------------------------------------------------------------------------------------------------- E0710 DM570 2202 RESTRAINTS (E0710), ANY TYPE * (BODY, CHEST, WRIST OR ANKLE) - ---------------------------------------------------------------------------------------------------------------- E0720 E0720 2219 TENS (E0720), TWO LEAD, * * LOCALIZED STIMULATION - ---------------------------------------------------------------------------------------------------------------- E0730 E0730 2218 TENS (E0730), FOUR LEAD, LARGER * * AREA/MULTIPLE NERVE STIMULATION - ---------------------------------------------------------------------------------------------------------------- E0731 E0731 2159 TENS OR NMES (E0731), * CONDUCTIVE GARMENT - ---------------------------------------------------------------------------------------------------------------- E0744 E0744 2120 STIMULATOR (E0744), * * NEUROMUSCULAR FOR SCOLIOSIS - ---------------------------------------------------------------------------------------------------------------- E0745 E0745 2121 STIMULATOR (E0745), * * NEUROMUSCULAR, ELECTRONIC SHOCK UNIT - ---------------------------------------------------------------------------------------------------------------- E0745 E0745 6915 STIMULATOR FOUR CH (E0745), * * NEUROMUSCULAR - ---------------------------------------------------------------------------------------------------------------- E0746 DM570 2109 ELECTROMYOGRAPHY (EMG) (E0746), * * BIOFEEDBACK DEVICE - ---------------------------------------------------------------------------------------------------------------- E0747 DM570 2122 STIMULATOR (E0747), OSTEOGENIC, * NON-INVASIVE - ---------------------------------------------------------------------------------------------------------------- E0748 DM570 2124 STIMULATOR (E0748), OSTEOGENIC * NON-INVASIVE, SPINAL APPLICATIONS - ---------------------------------------------------------------------------------------------------------------- E0755 DM570 2157 STIMULATOR (E0755), ELECTRONIC * SALIVARY REFLEX, NON INVASIVE - ---------------------------------------------------------------------------------------------------------------- E0776 E0776 2175 IV POLE (E0776) * * - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 2158 PUMP (E0784), EXT AMBULATORY * INFUSION, MINIMED, INSULIN - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 7925 PUMP, EXT INFUSION, MINIMED * PREMIUM, INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 6771 PUMP (E0784), INSULIN EXT * INFUSION DISETRONICS OR OTHER - ---------------------------------------------------------------------------------------------------------------- E0840 E0840 2133 TRACTION FRAME (E0840), ATTACH * TO HEADBOARD, CERVICAL TRACTION - ---------------------------------------------------------------------------------------------------------------- E0850 E0850 2134 TRACTION STAND (E0850), FREE * * STANDING, CERVICAL TRACTION - ---------------------------------------------------------------------------------------------------------------- E0855 E0855 7484 TRACTION (E0855), W/O FRAME OR * * STAND - ---------------------------------------------------------------------------------------------------------------- E0860 E0860 2130 TRACTION EQUIP (E0860), * * OVERDOOR, CERVICAL - ---------------------------------------------------------------------------------------------------------------- E0870 E0870 2131 TRACTION FRAME (E0870), ATTACH * * TO FOOTBOARD, EXTREMITY, BUCKS - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0880 E0880 2135 TRACTION STAND (E0880) * * FREE/STAND EXTREMITY TRACTION, EG, BUCK'S - ---------------------------------------------------------------------------------------------------------------- E0890 E0890 2132 TRACTION FRAME (E0890), ATTACH * * TO FOOTBOARD, PELVIC TRACTION - ---------------------------------------------------------------------------------------------------------------- E0900 E0900 2136 TRACTION STAND (E0900) FREE/ * * STAND PELVIC TRACTION,( EG, BUCK'S) - ---------------------------------------------------------------------------------------------------------------- E0910 E0910 2138 TRAPEZE BARS (E0910), A/K/A PT * * HELPER, ATTACH TO BED W/ GRAB BAR - ---------------------------------------------------------------------------------------------------------------- E0920 E0920 2111 FRACTURE FRAME (E0920), ATTACH * * TO BED, INCLUDING WEIGHTS - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2125 PASSIVE MOTION (E0935) EXERCISE * DEVICE - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2859 PASSIVE MOTION (E0935) EXERCISE * DEVICE, ANKLE - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2860 PASSIVE MOTION (E0935) EXERCISE * DEVICE, ELBOW - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2857 PASSIVE MOTION (E0935) EXERCISE * DEVICE, HAND - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2858 PASSIVE MOTION (E0935) EXERCISE * DEVICE, SHOULDER - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2861 PASSIVE MOTION (E0935) EXERCISE * DEVICE, WRIST - ---------------------------------------------------------------------------------------------------------------- E0940 E0940 2137 TRAPEZE BAR (E0940), FREE * * STANDING, COMPLETE W/ GRAB BAR - ---------------------------------------------------------------------------------------------------------------- E0941 E0941 2116 TRACTION DEVICE (E0941), * * GRAVITY ASSISTED - ---------------------------------------------------------------------------------------------------------------- E0942 E0942 2101 HARNESS/HALTER (E0942), * CERVICAL HEAD - ---------------------------------------------------------------------------------------------------------------- E0944 E0944 2126 HARNESS (E0944), PELVIC BELT, * BOOT - ---------------------------------------------------------------------------------------------------------------- E0945 DM570 2110 HARNESS (E0945), EXTREMITY BELT * - ---------------------------------------------------------------------------------------------------------------- E0946 E0946 2115 FRACTURE, FRAME (E0946), DUAL * * W/ CROSS BARS, ATTACH TO BED - ---------------------------------------------------------------------------------------------------------------- E0947 E0947 2113 FRACTURE FRAME (E0947), * ATTACHMENTS FOR COMPLEX PELVIC TRACTION - ---------------------------------------------------------------------------------------------------------------- E0948 E0948 2112 FRACTURE FRAME (E0948) * * ATTACHMENTS FOR COMPLEX CERVICAL TRACTION - ---------------------------------------------------------------------------------------------------------------- E0950 DM570 2139 TRAY (E0950) * - ---------------------------------------------------------------------------------------------------------------- E0958 E0958 2307 W/C PART ATTACHMENT (E0958) TO * CONVERT ANY W/C TO ONE ARM DRIVE - ---------------------------------------------------------------------------------------------------------------- E0959 E0959 2237 W/C PART AMPUTEE ADAPTER(E0959) * (COMPENSATE FOR TRANS OF WEIGHT) - ---------------------------------------------------------------------------------------------------------------- E0962 E0962 2232 CUSHION FOR WC 1" (E0962) * - ---------------------------------------------------------------------------------------------------------------- E0963 E0963 2233 CUSHION FOR WC 2" (E0963) * - ---------------------------------------------------------------------------------------------------------------- E0964 E0964 2234 CUSHION FOR WC 3" (E0964) * - ---------------------------------------------------------------------------------------------------------------- E0965 E0965 2235 CUSHION FOR WC 4" (E0965) * - ---------------------------------------------------------------------------------------------------------------- E0972 DM570 2230 TRANSFER BOARD OR DEVICE (E0972) * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0977 E0977 2317 CUSHION, WEDGE FOR W/C (E0977) * - ---------------------------------------------------------------------------------------------------------------- E0978 E0978 2248 BELT, SAFETY (E0978) W/ * AIRPLANE BUCKLE, W/C - ---------------------------------------------------------------------------------------------------------------- E0979 DM570 2249 BELT, SAFETY (E0979) W/ VELCRO * CLOSURE, W/C - ---------------------------------------------------------------------------------------------------------------- E0980 DM570 2292 SAFETY VEST (E0980), W/C * - ---------------------------------------------------------------------------------------------------------------- E1031 E1031 2291 ROLLABOUT CHAIR (E1031), W/ * * CASTORS 5" OR GREATER - ---------------------------------------------------------------------------------------------------------------- E1050 E1050 2260 W/C FULL/REC (E1050), FIX ARMS, * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1060 E1060 2259 W/C FULL/REC (E1070), DETACH * * ARMS, SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1065 E1065 2287 W/C POWER ATTACHMENT (E1065) * * - ---------------------------------------------------------------------------------------------------------------- E1066 E1066 2247 BATTERY CHARGER (E1066) * * - ---------------------------------------------------------------------------------------------------------------- E1069 E1069 2255 BATTERY, DEEP CYCLE (E1069) * * - ---------------------------------------------------------------------------------------------------------------- E1070 E1070 2258 W/C FULL/REC (E1060), DETACH * * ARMS, SWING AWAY DET/ ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1083 E1083 2263 W/C HEMI (E1083), FIX ARMS, * * SWING AWAY DETACH ABLE ELEV LEG REST - ---------------------------------------------------------------------------------------------------------------- E1084 E1084 2262 W/C HEMI (E1084), DETACH ARMS, * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1085 E1085 2264 W/C HEMI (E1085), FIX ARMS, * * SWING AWAY DETACH ABLE FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1086 E1086 2261 W/C HEMI (E1086), DETACH ARMS, * * SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1087 E1087 2265 W/C HI STRENGTH LT-WT (E1087), * * FIX ARMS, S/AWAY ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1088 E1088 2268 W/C HI STRENGTH LT-WGT (E1088), * * D/ ARMS, S/AWAY ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1089 E1089 2266 W/C HI STRENGTH LT-WGT (E1089), * * FIX ARMS, S/AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1090 E1090 2267 W/C HI STRENGTH LT-WG (E1090), * * DETACH ARMS, S/AWAY D/FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1091 E1091 2321 W/C YOUTH, ANY TYPE (E1091) * * - ---------------------------------------------------------------------------------------------------------------- E1092 E1092 2319 W/C WIDE HVY DUTY (E1092), * * DETACH ARMS S/AWAY DETACH ELEVAT LEGS - ---------------------------------------------------------------------------------------------------------------- E1093 E1093 2320 W/C WIDE HVY DUTY (E1093), * * DETACH ARMS S/AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1100 E1100 2296 W/C SEMI-RECLINING (E1100), * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1110 E1110 2295 W/C SEMI-RECLINING (E1110), * * DETACH ARMS ELEV LEG REST - ---------------------------------------------------------------------------------------------------------------- E1130 E1130 2303 W/C STANDARD (E1130), FIX OR * * SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1140 E1140 2313 W/C (E1140), DETACH ARMS SWING * * AWAY DETACH FOOTRESTS - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1150 E1150 2314 W/C (E1150), DETACH ARMS, SWING * * AWAY DETACH ELEVAT LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1160 E1160 2315 W/C (E1160), W/ FIX ARMS, SWING * * AWAY DETACH ELEVAT LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1160 E1160 2396 W/C (E1160), W/FIX ARMS * * REMOVABLE FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1170 E1170 2241 W/C AMPUTEE (E1170), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1171 E1171 2242 W/C AMPUTEE (E1171), FIX ARMS, * * W/OUT FOOTRESTS OR LEGREST - ---------------------------------------------------------------------------------------------------------------- E1172 E1172 2240 W/C AMPUTEE (E1172), DETACH * * ARMS W/OUT FOOTRESTS OR LEGREST - ---------------------------------------------------------------------------------------------------------------- E1180 E1180 2239 W/C AMPUTEE (E1180), DETACH * * ARMS SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1190 E1190 2238 W/C AMPUTEE (E1190), DETACH * * ARMS SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1195 E1195 2273 W/C HVY DUTY (E1195), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1200 E1200 2243 W/C AMPUTEE (E1200), FIX FULL * * LENGTH ARMS, S/AWAY D/FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1210 E1210 2281 W/C MOTORIZED (E1210), FIX * * ARMS, S/AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1211 E1211 2279 W/C MOTORIZED (E1211), DETACH * * ARMS , S/AWAY DETACH FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1212 E1212 2282 W/C MOTORIZED (E1212) , FIX * * * ARMS, SWING AWAY DETACH FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1213 E1213 2280 W/C MOTORIZED (E1213), DETACH * * * ARMS S/AWAY, DETACH ELEV LEG REST - ---------------------------------------------------------------------------------------------------------------- E1220 E1220 2551 W/C CUSTOM (E1220) * * * - ---------------------------------------------------------------------------------------------------------------- E1220 E1220 2579 W/C XXWIDE (E1220) * * * - ---------------------------------------------------------------------------------------------------------------- E1230 E1230 2288 SCOOTER (E1230), THREE OR 4 * * * WHEEL - ---------------------------------------------------------------------------------------------------------------- E1240 E1240 2276 W/C LT-WGT (E1240), DETACH ARMS * * SWING AWAY DETACH, ELEV LEGREST - ---------------------------------------------------------------------------------------------------------------- E1250 E1250 2278 W/C LT-WGT (E1250), FIX ARMS, * * SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1260 E1260 2275 W/C LT-WGT (E1260), DETACH ARMS * * SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1270 E1270 2277 W/C LT-WGT (E1270), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1280 E1280 2270 W/C HVY DUTY (E1280), DETACH * * ARMS ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1285 E1285 2274 W/C HVY DUTY (E1285), FIX ARMS, * * SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1290 E1290 2271 W/C HVY DUTY (E1290), DETACH * * ARMS SWING AWAY DETACH FOOTREST - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1295 E1295 2272 W/C HVY DUTY (E1295), FIX ARMS, * * ELEV LEGREST - ---------------------------------------------------------------------------------------------------------------- E1300 DM570 2062 WHIRLPOOL (E1300), PORT * * (OVERTUB TYPE) - ---------------------------------------------------------------------------------------------------------------- E1310 DM570 2061 WHIRLPOOL (E1399), NON-PORT * * (BUILT-IN TYPE) - ---------------------------------------------------------------------------------------------------------------- E1353 E1353 2381 O2 REGULATOR (E1353) * * - ---------------------------------------------------------------------------------------------------------------- E1355 E1355 2384 CYLINDER STAND/RACK (E1355) * * - ---------------------------------------------------------------------------------------------------------------- E1372 E1372 2331 IMMERSION EXT HEATER (E1372) * * FOR NEBULIZER - ---------------------------------------------------------------------------------------------------------------- E1375 E1375 2334 NEBULIZER PORT (E1375) W/ SMALL * * * COMPRESSOR, W/ LIMITED FLOW - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2568 ADAPTER (A9900), AC/DC * * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2586 APNEA MONITOR DOWNLOAD (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2552 BATH LIFT (E1399), CUSTOM * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2563 BED WEDGE (E1399), 12" * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2856 BEDROOM EQUIPMENT (E1399), * * CUSTOM - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2525 BREAST PUMP, ELECTRIC (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2581 BREAST PUMP, INSTITUTIONAL * * * (E1399) - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2580 BREAST PUMP, MANUAL (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2593 COLD THERAPY UNIT, PAD (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2565 COMMODE (E1399), DROP ARM, * * * HEAVY DUTY - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2582 COMPRESSION PUMP BOOT (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2583 COMPRESSION PUMP, FOOT (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2569 CPAP HUMIDIFIER (A9900), HEATED * * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2635 CPAP/BIPAP SUPPLIES (A9900) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2327 DURABLE MEDICAL EQUIP (E1399), * * MISCELLANEOUS - ---------------------------------------------------------------------------------------------------------------- E1399 E1220 2584 GERI CHAIR (E1399), THREE * * * POSITION RECLINING - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 6780 HOLTER MONITOR (G0004) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 E0265 2590 HOSP BED (E1399), ELECTRIC, * * * XLONG, W/MATTRESS & SIDE RAILS - ---------------------------------------------------------------------------------------------------------------- E1399 E0200 2868 LAMP, ULTRAVIOLET (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2588 MONITOR (E1399), VITAL SIGNS * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2529 O2 ANALYZER (A9900) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2594 O2 CONSERVATION DEVICE (A9900) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 6775 OXIMETRY TEST (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2555 PATIENT LIFT, CUSTOM (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2561 PEAK FLOW METER (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4559 PEDIATRIC WALKER (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2567 PNEUMOGRAM (E1399) * * * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2553 POSITIONING, CUSTOM (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2526 PULSE OXIMETER (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2527 PULSE OXIMETER W/ PROBE (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2562 SHOWER, HAND HELD (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2592 SLEEP STUDY, ADULT (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM590 7483 STIMULATOR (E1399), MUSCLE, LOW * * * VOLTAGE OR INTERFERENTIAL - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2855 THERAPY EQUIPMENT, CUSTOM * * * (E1399) - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 6774 THERAPY PERCUSSION, GENERATOR * * * ONLY - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7506 W/C, CUSTOM (E1399) MANUAL ADULT * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7504 W/C, CUSTOM (E1399) MANUAL * * PEDIATRIC - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7507 W/C, CUSTOM (E1399) POWER ADULT * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7505 W/C, CUSTOM (E1399) POWER * * PEDIATRIC - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2564 WALKER (E1399), HEAVY DUTY, * * * EXTRA WIDE - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2585 WALKER (E1399), HEMI * * * - ---------------------------------------------------------------------------------------------------------------- K0539 DM570 6873 WOUND SUCTION DEVICE (K0538) * * * - ---------------------------------------------------------------------------------------------------------------- K0539 DM570 7914 DRESSING SET, FOR WOUND SUCTION * * * DEVICE (K0539) - ---------------------------------------------------------------------------------------------------------------- K0540 DM570 7915 CANISTER SET, FOR WOUND SUCTION * * * DEVICE (K0540) - ---------------------------------------------------------------------------------------------------------------- E1400 E1390 2361 O2 CONC (E1390),MANUF SPEC * * * MAXFLOWRATE = 2 LTS PER MIN@85% - ---------------------------------------------------------------------------------------------------------------- G0015 DM570 6779 CARDIAC EVENT MONITOR (G0015) * * * - ---------------------------------------------------------------------------------------------------------------- K0163 DM590 3713 ERECTION SYSTEM, VACUUM (K0163) * * * - ---------------------------------------------------------------------------------------------------------------- K0183 DM590 2516 CPAP MASK (K0183) * * * - ---------------------------------------------------------------------------------------------------------------- K0184 DM590 2515 NASAL PILLOWS/SEALS (K0184) * * * REPLACEMENT FOR NASAL APP/ DVC, PAIR - ---------------------------------------------------------------------------------------------------------------- K0185 DM590 2514 CPAP HEADGEAR (K0185) * * - ---------------------------------------------------------------------------------------------------------------- K0186 DM590 2513 CPAP CHIN STRAP (K0186) * * - ---------------------------------------------------------------------------------------------------------------- K0187 DM590 2512 CPAP TUBING (K0187) * * - ---------------------------------------------------------------------------------------------------------------- K0188 DM590 2511 CPAP FILTER (A9900), DISPOSABLE * * - ---------------------------------------------------------------------------------------------------------------- K0189 DM590 2510 CPAP FILTER (A9900), * * NON-DISPOSABLE - ---------------------------------------------------------------------------------------------------------------- K0268 DM590 2509 CPAP HUMIDIFIER (K0268), COOL * * - ---------------------------------------------------------------------------------------------------------------- K0413 DM590 6889 MATTRESS (K0413), NONPOWERED, * * EQUIVALENT - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7673 MATTRESS (E1399) V-CUE DYNAMIC * * * AIR THERAPY - ---------------------------------------------------------------------------------------------------------------- A4608 A9900 7621 CATHETER TRACH (A4608) 11CM 1 * * SCOOP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7664 COFFLATOR (E1399CF) MANUAL * * SECRETION MOBIL DEVICE - ---------------------------------------------------------------------------------------------------------------- E0168B A9900 7643 COMMODE (E0168B) HVY DUTY * BEDSIDE CHAIR 251-450 LBS. - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0168C A9900 7644 COMMODE (E0168C) HVY DUTY DROP * ARM 451-850 LBS. - ---------------------------------------------------------------------------------------------------------------- A6234 HH591 7626 DRESSING <16 SQ IN (A6234) * HYDROCOLLOID DRESSING, EA - ---------------------------------------------------------------------------------------------------------------- A6258 HH591 7627 DRESSING >16 SQ IN (A6258) * TRANSPAREN FILM, EA - ---------------------------------------------------------------------------------------------------------------- A46203 HH591 7625 DRESSING COMPOSITE <16 SQ IN * (A46203) SELF ADH, EA - ---------------------------------------------------------------------------------------------------------------- B9998B DM590 7655 ENT (B9998B) EXT SET Y SITE * F/KANGAROO PUMP - ---------------------------------------------------------------------------------------------------------------- B9998C DM590 7656 ENT (B9998C) EXT SET W/ CLAMP * BASIC - ---------------------------------------------------------------------------------------------------------------- B9998D DM590 7657 ENT (B9998D) FARRELL GASTRIC * RELIEF VLV - ---------------------------------------------------------------------------------------------------------------- B9998E DM590 7658 ENT (B9998E) GASTRO EXT SET * - ---------------------------------------------------------------------------------------------------------------- B9998F DM590 7659 ENT (B9998F) GASTRO TUBE ANY * SIZE MIC-KEY OR HIDE A PORT - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7620 HUMID-VENT (E1399) ARTIFICIAL * NOSE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7660 IPPB (E1399) UNIV SET UP * W/MANIFOLD NEBULIZER - ---------------------------------------------------------------------------------------------------------------- K0105 A9900 7639 IV POLE (K0105) ATTACH F/ W/C * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7641 MECHANICAL SCALE (E1399) * PEDIATRIC/NEONATAL - ---------------------------------------------------------------------------------------------------------------- A7008 A9900 7661 NEBULIZER (A7008) KIT PREFILL * W/STR H20 1L BAX - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7663 O2 CONNECTOR (E1399) * SIMS/IRRIGATION NOZZLE BAX - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7615 O2 HUMIDIFIER (E1399) * AQUA+NEONATAL EA HUD - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7623 O2 SWIVEL (E1399) ADAPTER * ANGLED STERILE - ---------------------------------------------------------------------------------------------------------------- L8501 A9900 7624 SPEAKING VALVE (L8501) WHITE PAS * - ---------------------------------------------------------------------------------------------------------------- A4319 HH591 7629 STERILE WATER (A4319) F/IRRIG * 1L BAX - ---------------------------------------------------------------------------------------------------------------- A7001 HH591 7619 SUCTION BOTTLE (A7001) W/LID & * TUBING - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7616 SUCTION FILTER (E1399) BACTERIA * - ---------------------------------------------------------------------------------------------------------------- A6265 HH591 7628 TAPE ALL TYPES (A6265) * EXCLUDING MICROFOAM, PER 18 SQ INCHES - ---------------------------------------------------------------------------------------------------------------- A4481 A9900 7622 TRACH FILTER (A4481) BACTERIA * ELECTROSTATIC - ---------------------------------------------------------------------------------------------------------------- A4623 A9900 7618 TRACH INNER (A4623) CANNULA * - ---------------------------------------------------------------------------------------------------------------- A4621 A9900 7617 TRACH TUBE MASK (A4621) COLLAR * OR HOLDER - ---------------------------------------------------------------------------------------------------------------- A7010 A9900 7662 TUBING (A7010) AEROSOL * CORRUGATED PER FOOT - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7631 VENT ADAPTER (E1399) MDI HUD * - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7630 VENT BATTERY CHARGER (A9900) * 12V GEL - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7632 VENT CONNECTOR (E1399) PED OR * ADULT OMNIFLEX DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7633 VENT FILTER (E1399) HYGROBAC S * ELECTOSTATIC MAL - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7634 VENT THERMOMETER (E1399) W/ * ADAPTER - ---------------------------------------------------------------------------------------------------------------- K0108 A9900 7638 W/C BRAKE EXTENSION (K0108) TIP * BLK 10/PK - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7635 WALKER BASKET (E1399) VINYL * COATED - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0159 A9900 7640 WALKER BRAKE (E0159) ATTACHMENT * - ---------------------------------------------------------------------------------------------------------------- E0148 A9900 7636 WALKER HVY DUTY (E0148) FOLDING * X-WIDE - ---------------------------------------------------------------------------------------------------------------- E0149 A9900 7637 WALKER HVY DUTY (E0149) W/ * WHEELS - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7645 CPAP (E1399) DC BATTERY ADAPTER * CABLE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7646 CPAP (E1399) EXHALATION PORT * DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7647 CPAP (E1399) FUSE KIT * INTERNATIONAL A/C - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7648 CPAP (E1399) HUMIDIFIER CHAMBER * KIT DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7649 CPAP (E1399) HUMIDIFIER CHAMBER * REUSABLE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7650 CPAP (E1399) HUMIDIFIER * MOUNTING TRAY - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7651 CPAP (E1399) INVERTOR AC/DC * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7652 CPAP (E1399) POWER CORD * F/ARIA-SYNC - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7653 CPAP (E1399) SHELL W/O PRESSURE * TAP - ---------------------------------------------------------------------------------------------------------------- A9900 DM590 7566 CPAP CALIBRATION SHELL (A9900) * - ---------------------------------------------------------------------------------------------------------------- A9900 DM590 7565 CPAP SHORT TUBING (A9900) * - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 7690 VENT, CONTINUOUS POSITIVE * * (E0500) AIRWAY PRESSURE DEVICE - ---------------------------------------------------------------------------------------------------------------- E0452 E0452 7691 VENT, BILEVEL INTERMITTENT * * (E0500) ASSIST DEVICE (BIPAP) - ---------------------------------------------------------------------------------------------------------------- E0747 DM570 6875 STIMULATOR, OSTEOGENIC, * ULTRASOUND - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7695 GEL/SILICON GOLD SEAL * CPAP/BIPAP MASK (A9900) - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7701 VENT THERAPEUTIC ST BIPAP W/ * * BACKUP RATE (K0533) - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7703 O2 SYS HELIOS PORT LIQUID, RENT * * (E1399) - ---------------------------------------------------------------------------------------------------------------- HH591 HH591 7704 PUMP, EXT INFUSION, DANA * DIABECARE, INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 7731 PUMP, EXT INFUSION, ANIMAS, * INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7737 CPAP DREAM SEAL INTERFACE FOR * USE WITH BREEZE MASK (A9900) - ---------------------------------------------------------------------------------------------------------------- A7036 DM590 7738 CPAP CHIN STRAP DELUXE (K0186) * - ---------------------------------------------------------------------------------------------------------------- E1340 E1340 7768 W/C REPAIRS - CUSTOM (E1340) * - ----------------------------------------------------------------------------------------------------------------
The following may be charged under extraordinary circumstances: - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4551 LABOR/SERVICE/SHIPPING CHARGES * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2731 SHIPPING AND HANDLING FEES * * - ----------------------------------------------------------------------------------------------------------------
The following may be charged if over and above routine on rental equipment: - ---------------------------------------------------------------------------------------------------------------- E1350 E1350 2382 REPAIR OR NON-ROUTINE (E1350) * * SERVICE REQUIRING SKILL OF A TECH - ---------------------------------------------------------------------------------------------------------------- E1340 E1340 2554 W/C REPAIRS - STANDARD (E1340) * * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4552 MISCELLANEOUS SUPPLIES * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2589 REPAIR (E1399), RESPIRATORY * * EQUIPMENT - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4561 RESPIRATORY SUPPLIES (A4618) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4549 TENS/APNEA SUPPLIES * * - ----------------------------------------------------------------------------------------------------------------
NOTES: * * * * * * DME/HOME RESPIRATORY RATES: RATES EFFECTIVE APRIL 1, 2004 - DECEMBER 31, 2004
HCPCS CHC GENTIVA CODE CODE CODE DESCRIPTION PURCHASE PRICE RENTAL PRICE DAILY PRICE - ---------------------------------------------------------------------------------------------------------------- A4660 DM590 2520 MONITOR, BLOOD PRESSURE (A4660) * W/STETH & CUFF - ---------------------------------------------------------------------------------------------------------------- A4670 DM590 2518 MONITOR, BLOOD PRESSURE (A4670), * AUTOMATIC - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7552 BREEZE (A9900) CPAP/BIPAP MASK * - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7553 FULL FACE (A9900) MIRAGE * CPAP/BIPAP MASK - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7554 GEL/SILICON (A9900) CPAP/BIPAP * MASK INCL GLD SEAL,PHANTM,MONARCH - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7556 SPECIALTY (A9900) CPAP/BIPAP * MASK (PROFILE OR SIMPICITY) - ---------------------------------------------------------------------------------------------------------------- B9002 HI531 2570 PUMP, ENTERAL (B9002) * * - ---------------------------------------------------------------------------------------------------------------- B9998 DM590 6828 ENTERAL SUPPLIES (B9998) * - ---------------------------------------------------------------------------------------------------------------- DM590 DM570 7551 BACK-PACK (E1399), FOR * PORTABLE ENTERAL PUMP - ---------------------------------------------------------------------------------------------------------------- A4615 DM590 2522 CANNULA, NASAL * - ---------------------------------------------------------------------------------------------------------------- B9002 DM590 7509 ENTERAL PUMP, PORTABLE (B9002) * * - ---------------------------------------------------------------------------------------------------------------- A7034 DM590 7508 MASK, CPAP GEL OR SILICONE * (K0183) - ---------------------------------------------------------------------------------------------------------------- E0100 E0100 2020 CANE (E0100), ADJ OR FIX, W/ TIP * - ---------------------------------------------------------------------------------------------------------------- E0105 E0105 2021 CANE, QUAD (E0105) OR THREE * PRONG, ADJ OR FIX, W/ TIPS - ---------------------------------------------------------------------------------------------------------------- E0110 E0110 2028 CRUTCHES, FOREARM (E0110), ADJ * OR FIX, PAIR, W/ TIPS, GRIPS - ---------------------------------------------------------------------------------------------------------------- E0111 E0111 2023 CRUTCH FOREARM (E0111), ADJ OR * FIX, EACH, W/ TIP AND GRIPS - ---------------------------------------------------------------------------------------------------------------- E0112 E0112 2027 CRUTCHES UNDERARM, WOOD * (E0112), ADJ OR FIX, PAIR, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0113 E0113 2025 CRUTCH UNDERARM, WOOD (E0113), * ADJ OR FIX, EACH, COMPLETE - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0114 E0114 2026 CRUTCHES UNDERARM, ALUM * (E0114), ADJ OR FIX, PAIR, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0116 E0116 2024 CRUTCH UNDERARM, ALUM (E0116), * ADJ OR FIX, EACH, COMPLETE - ---------------------------------------------------------------------------------------------------------------- E0130 E0130 2037 WALKER, RIGID (E0130) * (PICKUP), ADJ OR FIX HEIGHT - ---------------------------------------------------------------------------------------------------------------- E0135 E0135 2036 WALKER, FOLDING (E0135) * (PICKUP), ADJ OR FIX HEIGHT - ---------------------------------------------------------------------------------------------------------------- E0141 E0141 2040 WALKER, WHEELED (E0141), W/OUT * SEAT - ---------------------------------------------------------------------------------------------------------------- E0142 DM570 2034 RIGID WALKER (E0142), WHEELED, * W/ SEAT, - ---------------------------------------------------------------------------------------------------------------- E0143 E0143 2029 WALKER FOLDING, WHEELED * (E0143), W/OUT SEAT - ---------------------------------------------------------------------------------------------------------------- E0145 DM570 2039 WALKER (E0145), WHEELED, W/ * SEAT AND CRUTCH ATTACHMENTS - ---------------------------------------------------------------------------------------------------------------- E0146 DM570 2038 WALKER, WHEELED, W/ SEAT (E0146) * - ---------------------------------------------------------------------------------------------------------------- E0147 E0147 2030 WALKER HVY DUT (E0147), MULT * BRAKING SYS, VAR WHEEL RESISTANCE - ---------------------------------------------------------------------------------------------------------------- E0153 E0153 2032 CRUTCH PLATFORM ATTACHMENT * (E0153), FOREARM EA - ---------------------------------------------------------------------------------------------------------------- E0154 E0154 2033 WALKER PLATFORM ATTACHMENT * (E0154), EA - ---------------------------------------------------------------------------------------------------------------- E0155 E0155 2041 WALKER WHEEL ATTACHMENT * (E0155), RIGID (PICKUP) WALKER - ---------------------------------------------------------------------------------------------------------------- E0156 DM570 2035 WALKER SEAT ATTACHMENT (E0156) * - ---------------------------------------------------------------------------------------------------------------- E0157 E0157 2022 WALKER, CRUTCH ATTACHMENT * (E0157), EACH - ---------------------------------------------------------------------------------------------------------------- E0158 E0158 2031 WALKER LEG EXTENSIONS (E0158) * - ---------------------------------------------------------------------------------------------------------------- E0163 E0163 2047 COMMODE CHAIR, STATIONARY * (E0163), W/ FIX ARMS - ---------------------------------------------------------------------------------------------------------------- E0164 E0164 2045 COMMODE CHAIR, MOBILE * (E0164), W/ FIX ARMS - ---------------------------------------------------------------------------------------------------------------- E0165 E0165 2046 COMMODE CHAIR (E0165), * STATIONARY, W/ DETACH ARMS - ---------------------------------------------------------------------------------------------------------------- E0165 E0165 2591 COMMODE, XXWIDE(E0165) * - ---------------------------------------------------------------------------------------------------------------- E0166 E0166 2044 COMMODE CHAIR (E0166), MOBILE, * W/ DETACH ARMS - ---------------------------------------------------------------------------------------------------------------- E0167 E0167 2051 COMMODE CHAIR, PAIL OR PAN * (E0167) - ---------------------------------------------------------------------------------------------------------------- E0176 E0176 2142 CUSHION (E0176) OR AIR PRESSURE * PAD, NON-POSITIONING - ---------------------------------------------------------------------------------------------------------------- E0176 E0176 2394 REPLACEMENT PAD (E0176) * ALTERNATING PRESS - ---------------------------------------------------------------------------------------------------------------- E0177 E0177 2224 CUSHION OR WATER PRESS PAD * (E0177), NONPOSITIONING - ---------------------------------------------------------------------------------------------------------------- E0178 E0178 2160 CUSHION OR GEL PRESS PAD * (E0178), NONPOSITIONING - ---------------------------------------------------------------------------------------------------------------- E0179 E0179 2154 CUSHION (E0179) OR DRY PRESSURE * PAD, NONPOSTIONING - ---------------------------------------------------------------------------------------------------------------- E0180 E0180 2196 PUMP (E0180), ALTERNATING * * PRESSURES W/PAD - ---------------------------------------------------------------------------------------------------------------- E0181 E0181 2197 PUMP (E0181), ALTERNATING PRESS * * W/PAD, HVY DUTY - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0184 E0184 2074 MATTRESS, DRY PRESSURE (E0184) * - ---------------------------------------------------------------------------------------------------------------- E0185 E0185 2076 MATTRESS (E0185), GEL OR * GEL-LIKE PRESSURE PAD - ---------------------------------------------------------------------------------------------------------------- E0186 E0186 2064 MATTRESS, AIR PRESSURE (E0186) * - ---------------------------------------------------------------------------------------------------------------- E0187 E0187 2099 MATTRESS, WATER PRESSURE (E0187) * - ---------------------------------------------------------------------------------------------------------------- E0188 DM570 2217 PAD, SYNTHETIC SHEEPSKIN (A9900) * - ---------------------------------------------------------------------------------------------------------------- E0189 DM570 2177 PAD, LAMBSWOOL SHEEPSKIN * (E0189), ANY SIZE - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2573 CUSHION, JAY FOR W/C (E0192) * * - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2572 CUSHION, ROHO FOR W/C (E0192) * * - ---------------------------------------------------------------------------------------------------------------- E0192 E0192 2178 W/C PAD (E0192), LOW PRESS AND * * POSITIONING EQUALIZATION - ---------------------------------------------------------------------------------------------------------------- E0193 E0193 2098 MATTRESS, LOW AIR LOSS (E0193), * * * INCL. BED - ---------------------------------------------------------------------------------------------------------------- E0194 DM570 2063 AIR FLUIDIZED BED (E0194) * * - ---------------------------------------------------------------------------------------------------------------- E0270 E1399 6887 HOSPITAL BED INSTITUTIONAL * * - ---------------------------------------------------------------------------------------------------------------- E0196 E0196 2077 MATTRESS, GEL PRESSURE (E0196) * - ---------------------------------------------------------------------------------------------------------------- E0197 E0197 2065 MATTRESS, AIR PRESSURE PAD * (E0197) - ---------------------------------------------------------------------------------------------------------------- E0198 E0198 2100 MATTRESS (E0198), WATER * PRESSURE PAD - ---------------------------------------------------------------------------------------------------------------- E0199 E0199 2075 MATTRESS, DRY PRESSURE PAD * (E0199) - ---------------------------------------------------------------------------------------------------------------- E0200 E0200 2228 HEAT LAMP (E0200), W/OUT * STAND, INCL/BULB, OR INFRARED ELEMENT - ---------------------------------------------------------------------------------------------------------------- E0202 E0202 2229 PHOTOTHERAPY (BILIRUBIN) * (E0202), LIGHT WIT - ---------------------------------------------------------------------------------------------------------------- E0202 E0202 2524 PHOTOTHERAPY, BILI BLANKET * (E0202) - ---------------------------------------------------------------------------------------------------------------- E0205 E0205 2227 HEAT LAMP (E0205), WITH STAND, * INCL/ BULB, OR INFRARED ELEMENT - ---------------------------------------------------------------------------------------------------------------- E0210 DM570 2156 HEATING PAD, STANDARD (E0210) * - ---------------------------------------------------------------------------------------------------------------- E0215 DM570 2155 HEATING PAD (E0215), ELECTRIC, * MOIST - ---------------------------------------------------------------------------------------------------------------- E0218 DM570 2560 COLD THERAPY UNIT (E0218) * * * - ---------------------------------------------------------------------------------------------------------------- E0235 DM570 2187 PARAFFIN BATH UNIT, PORT (E0235) * - ---------------------------------------------------------------------------------------------------------------- E0236 DM570 2199 PUMP (E0236) FOR WATER * CIRCULATING PAD - ---------------------------------------------------------------------------------------------------------------- E0237 DM570 2223 HEAT COLD WATER (E0237) * CIRCULATING PAD W/PUMP - ---------------------------------------------------------------------------------------------------------------- E0238 DM570 2179 HEATING PAD (E0238), MOIST, * NON-ELECTRIC - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2867 BATH TUB RAIL (E0241), WALL, * L-SHAPE - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2862 BATH TUB RAIL, WALL, 12" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2863 BATH TUB RAIL, WALL, 16" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2864 BATH TUB RAIL, WALL, 18" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2865 BATH TUB RAIL, WALL, 24" (E0241) * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2866 BATH TUB RAIL, WALL, 36" (E0241) * - ---------------------------------------------------------------------------------------------------------------- E0241 DM570 2043 BATH TUB RAIL, WALL, * UNSPECIFIED SIZE - ---------------------------------------------------------------------------------------------------------------- E0242 DM570 2042 BATH TUB RAIL, FLOOR BASE * (E0242) - ---------------------------------------------------------------------------------------------------------------- E0243 DM570 2056 TOILET RAIL, EACH (E0243) * - ---------------------------------------------------------------------------------------------------------------- E0244 E0244 2587 TOILET SEAT (E0244) RAISED WITH * ARMS - ---------------------------------------------------------------------------------------------------------------- E0244 E0244 2052 TOILET SEAT, RAISED (E0244) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2575 BATH BENCH WITH BACK (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2058 BATH TUB STOOL OR BENCH (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2578 TRANSFER BENCH, NON-PADDED * (E0245) - ---------------------------------------------------------------------------------------------------------------- E0245 DM570 2577 TRANSFER BENCH, PADDED (E0245) * - ---------------------------------------------------------------------------------------------------------------- E0246 DM570 2057 TRANSFER TUB RAIL(E0246), * ATTACHMENT - ---------------------------------------------------------------------------------------------------------------- E0249 DM570 2186 HEAT UNIT (E0249), WATER * CIRCULATING PAD - ---------------------------------------------------------------------------------------------------------------- E0255 E0255 2090 HOSP BED (E0255), VAR HEIGHT, * * HI-LO, W/ SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0256 E0256 2091 HOSP BED (E0256), VAR HEIGHT, * * HI-LO, W/ SIDE RAILS, W/O MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0260 E0260 2083 HOSP BED (E0260), SEMI-ELEC, W/ * * SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0261 E0261 2084 HOSP BED (E0261), SEMI-ELEC, W/ * * SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0265 E0265 2086 HOSP BED (E0265), TOTAL ELEC, * * W/ SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0266 E0266 2087 HOSP BED (E0266), TOTAL ELEC, * * W/ SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0271 E0271 2096 MATTRESS, INNERSPRING (E0271) * - ---------------------------------------------------------------------------------------------------------------- E0272 E0272 2095 MATTRESS, FOAM RUBBER (E0272) * - ---------------------------------------------------------------------------------------------------------------- E0273 DM570 2068 BED BOARD (E1399) * - ---------------------------------------------------------------------------------------------------------------- E0274 DM570 2097 OVER-BED TABLE (E0274) * - ---------------------------------------------------------------------------------------------------------------- E0275 E0275 2071 BED PAN, STANDARD (E0275), * METAL OR PLASTIC - ---------------------------------------------------------------------------------------------------------------- E0276 E0276 2070 BED PAN, FRACTURE (E0276), * METAL OR PLASTIC - ---------------------------------------------------------------------------------------------------------------- E0277 E0277 2066 MATTRESS (E0277), LOW AIR LOSS, * * * ALT PRESSURE - ---------------------------------------------------------------------------------------------------------------- E0280 DM570 2069 BED CRADLE, ANY TYPE (E1399) * - ---------------------------------------------------------------------------------------------------------------- E0292 E0292 2092 HOSP BED (E0292), VAR HEIGHT, * * HI-LO, W/OUT S/ RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0293 E0293 2093 HOSP BED (E0293), VAR HEIGHT, * * HI-LO, NO SIDE RAILS, NO MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0294 E0294 2085 HOSP BED (E0294), SEMI-ELEC, * * W/OUT SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0295 E0295 2094 HOSP BED (E0295), SEMI-ELEC, * * W/OUT SIDE RAILS, W/OUT MATTRESS - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0296 E0296 2089 HOSP BED (E0296), TOTAL ELEC, * * W/OUT SIDE RAILS, W/OUT MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0297 E0297 2088 HOSP BED (E0297), TOTAL ELEC, * * W/OUT SIDE RAILS, W/ MATTRESS - ---------------------------------------------------------------------------------------------------------------- E0305 E0305 2073 BED SIDE RAILS (E0305), HALF * * * LENGTH - ---------------------------------------------------------------------------------------------------------------- E0310 E0310 2072 BED SIDE RAILS (E0310), FULL * * * LENGTH - ---------------------------------------------------------------------------------------------------------------- E0315 DM570 2067 BED ACCESSORIES: BOARDS OR * * TABLES, ANY TYPE - ---------------------------------------------------------------------------------------------------------------- E0325 E0325 2060 URINAL; MALE (E0325), JUG-TYPE, * * * ANY MATERIAL - ---------------------------------------------------------------------------------------------------------------- E0326 E0326 2059 URINAL; FEMALE (E0326), * * * JUG-TYPE, ANY MATERIAL - ---------------------------------------------------------------------------------------------------------------- E0372 E0372 7008 MATTRESS (E0372) POWERED AIR * * * OVERLAY - ---------------------------------------------------------------------------------------------------------------- E0410 E0444 2369 O2 CONTENTS, LIQUID (E0444), * PER POUND - ---------------------------------------------------------------------------------------------------------------- E0416 E0443 2371 O2 REFILL FOR PORT (E0443) GAS * SYSTEM ONLY, UP TO 23 CUBIC FEET - ---------------------------------------------------------------------------------------------------------------- E0424 E0424 2385 O2 SYS STATIONARY (E0424) COMPR * * GAS, RENT - ---------------------------------------------------------------------------------------------------------------- E0430 E0430 2374 O2 SYS PORT GAS, PURCH (E0430) * * - ---------------------------------------------------------------------------------------------------------------- E0431 E0431 2574 O2 SYS PORT GAS, LIGHTWEIGHT * * (E0431) W/CONSERV DEVICE,NO CONTENT - ---------------------------------------------------------------------------------------------------------------- E0431 E0431 2375 O2 SYS PORT GAS, RENT (E0431) * * - ---------------------------------------------------------------------------------------------------------------- E0434 E0434 2377 O2 SYS PORT LIQUID,RENT (E0434) * * - ---------------------------------------------------------------------------------------------------------------- E0435 E0435 2376 O2 SYS PORT LIQUID, PURCH * * (E0435) - ---------------------------------------------------------------------------------------------------------------- E0439 E0439 2388 O2 SYS STATIONARY (E0439) * LIQUID, RENT - ---------------------------------------------------------------------------------------------------------------- E0440 E0440 2387 O2 SYS STATIONARY (E0440) * * LIQUID, PURCH - ---------------------------------------------------------------------------------------------------------------- E0443 E0400 2869 O2 CONTENTS, H/K CYLINDER * * (E0400), 200-300 CUBIC FT - ---------------------------------------------------------------------------------------------------------------- E0444 E0444 2379 O2 CONTENTS, PORT LIQUID * * (E0444), PER UNIT (1 UNIT = 1 LB.) - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 7555 POSITIVE PRESSURE VENTS * (E0450)(E.G. T-BIRD) - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 7926 POSITIVE PRESSURE VENTS, * * EMERGENCY BACKUP (E.G. T-BIRD) (E0450) - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 2392 VENTILATOR VOLUME (E0450), * * STATIONARY OR PORT - ---------------------------------------------------------------------------------------------------------------- E0450 E0450 7522 VENTILATOR, VOLUME, (E0450) * * EMERGENCY BACKUP UNIT - ---------------------------------------------------------------------------------------------------------------- E0452 E0452 2332 BILEVEL INTERMITTENT (E0452) * * ASSIST DEVICE,(BIPAP) - ---------------------------------------------------------------------------------------------------------------- E0453 E0453 2390 VENTILATOR THERAPEUTIC (E0453); * * FOR USE 12 HOURS OR LESS PER DAY - ---------------------------------------------------------------------------------------------------------------- E0455 E0455 2372 O2 TENT (E0455), EXCLUDING * * CROUP OR PEDIATRIC TENTS - ---------------------------------------------------------------------------------------------------------------- E0457 E0457 2323 CHEST SHELL (CUIRASS) (E0457) * * - ---------------------------------------------------------------------------------------------------------------- E0459 E0459 2324 CHEST WRAP (E0459) * * - ---------------------------------------------------------------------------------------------------------------- E0460 E0460 2339 VENTILATOR (E0460), NEGATIVE * * PRESSURE, PORTABLE OR STATIONARY - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0480 DM570 2373 PERCUSSOR (E0480), ELEC OR * * PNEUM, HOME MODEL - ---------------------------------------------------------------------------------------------------------------- E0500 E0500 2333 IPPB, W/ BUILT-IN NEB (E0500) * * MAN OR AUTO VALVES; INT/EXT POWER - ---------------------------------------------------------------------------------------------------------------- E0550 E0550 2328 HUMIDIFIER (E0550) DURABLE FOR * * EXTENSIV SUP/ HUMID W/ IPPB OR O2 - ---------------------------------------------------------------------------------------------------------------- E0555 E0555 2330 HUMIDIFIER (E0555), DURABLE, * * GLASS, FOR USE W/ REG OR FLOWMETER - ---------------------------------------------------------------------------------------------------------------- E0565 E0565 2325 COMPRESSOR, AIR POWER (E0565) * * - ---------------------------------------------------------------------------------------------------------------- E0570 E0570 2336 NEBULIZER, W/ COMPRESSOR (E0570) * - ---------------------------------------------------------------------------------------------------------------- E0575 DM570 2571 NEBULIZER (E0575), ULTRASONIC, * * AC/DC - ---------------------------------------------------------------------------------------------------------------- E0575 DM570 2338 NEBULIZER; ULTRASONIC (E0575) * * - ---------------------------------------------------------------------------------------------------------------- E0585 E0585 2337 NEBULIZER(E0585), W/ COMPRESSOR * * AND HEATER - ---------------------------------------------------------------------------------------------------------------- E0600 E0600 2389 SUCTION PUMP (E0600), HOME MODEL * * - ---------------------------------------------------------------------------------------------------------------- E0600 E0600 7523 SUCTION UNIT, (E0600), PORTABLE * * AC/DC - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 2326 CONTINUOUS POSITVE (E0601) * * AIRWAY PRESSURE DEVICE (CPAP) - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 6965 CPAP, SELF TITRATING (E0601) * * - ---------------------------------------------------------------------------------------------------------------- E0605 DM570 2391 VAPORIZER, ROOM TYPE (E0605) * - ---------------------------------------------------------------------------------------------------------------- E0606 DM570 2380 POSTURAL DRAINAGE BOARD (E0606) * - ---------------------------------------------------------------------------------------------------------------- E0607 E0607 6874 MONITOR, B/GLUCOSE (E0607) * ACCUCHEK AD - ---------------------------------------------------------------------------------------------------------------- E0607 E0607 2164 MONITOR, BLOOD GLUCOSE (E0607) * - ---------------------------------------------------------------------------------------------------------------- E0618 E0608 2322 APNEA MONITOR (E0608) * * - ---------------------------------------------------------------------------------------------------------------- E0619 E0608 2576 APNEA MONITOR (E0608) W/MEM * * (INCL SMART) - ---------------------------------------------------------------------------------------------------------------- E0609 E0609 2146 MONITOR, BLOOD GLUCOSE (E0609) * W/SPECIAL FEATURES - ---------------------------------------------------------------------------------------------------------------- E0621 E0621 2215 PATIENT LIFT (E0621), SLING OR * * SEAT, CANVAS OR NYLON - ---------------------------------------------------------------------------------------------------------------- E0625 DM570 2191 PATIENT LIFT (E0625), KARTOP, * * BATHROOM OR TOILET - ---------------------------------------------------------------------------------------------------------------- E0627 E0627 4553 HIP CHAIR (E0627) * * - ---------------------------------------------------------------------------------------------------------------- E0627 DM570 2395 SEAT LIFT CHAIR/MOTORIZED * * (E0627) - ---------------------------------------------------------------------------------------------------------------- E0627 DM570 2205 SEAT LIFT MECH (E0627) * INCORPORATED INTO A COMB LIFT-CHAIR MECH - ---------------------------------------------------------------------------------------------------------------- E0630 E0630 2190 PATIENT LIFT, HYDRAULIC * * (E0630), W/ SEAT OR SLING - ---------------------------------------------------------------------------------------------------------------- E0635 DM570 2189 PATIENT LIFT (E0635), ELEC W/ * * SEAT OR SLING - ---------------------------------------------------------------------------------------------------------------- E0650 E0650 2192 PNEUM COMPRESSOR (E0650), * * NON-SEG HOME MODEL - ---------------------------------------------------------------------------------------------------------------- E0651 E0651 2194 PNEUM COMPRESSOR (E0651), SEG * * HOME MODEL W/OUT CALIB GRAD PRES - ---------------------------------------------------------------------------------------------------------------- E0652 E0652 2193 PNEUM COMPRESSOR (E0652), SEG * * HOME MODEL W/ CALIB GRAD PRES - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0655 E0655 2182 PNEUM COMPRESSOR (E0655), * NON-SEG APPLIANCE, HALF ARM - ---------------------------------------------------------------------------------------------------------------- E0660 E0660 2181 PNEUM COMPRESSOR (E0660), * NON-SEG APPLIANCE, FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0665 E0665 2180 PNEUM COMPRESSOR (E0665), * NON-SEG APPLIANCE, FULL ARM - ---------------------------------------------------------------------------------------------------------------- E0666 E0666 2183 PNEUM COMPRESSOR (E0666), * NON-SEG APPLIANCE, HALF LEG - ---------------------------------------------------------------------------------------------------------------- E0667 E0667 2210 PNEUM APPLIANCE (E0667), SEG, * FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0668 E0668 2209 PNEUM APPLIANCE (E0668), SEG, * FULL ARM - ---------------------------------------------------------------------------------------------------------------- E0669 E0669 2212 PNEUM APPLIANCE (E0669), SEG, * HALF LEG - ---------------------------------------------------------------------------------------------------------------- E0670 E0670 2211 PNEUM APPLIANCE (E0670), SEG, * HALF ARM - ---------------------------------------------------------------------------------------------------------------- E0671 E0671 2207 PNEUM APPLIANCE (E0671), SEG * GRAD PRESS, FULL LEG - ---------------------------------------------------------------------------------------------------------------- E0672 E0672 2206 PNEUM APPLIANCE (E0672), SEG * GRAD PRESS, FULL ARM - ---------------------------------------------------------------------------------------------------------------- E0673 E0673 2208 PNEUM APPLIANCE (E0673), SEG * GRAD PRESS, HALF LEG - ---------------------------------------------------------------------------------------------------------------- E0690 DM570 2221 ULTRAVIOLET CABINET (E0690), * APPROPRIATE FOR HOME USE - ---------------------------------------------------------------------------------------------------------------- E0700 DM570 2204 SAFETY EQUIP (E0700) (E.G., * BELT, HARNESS OR VEST) - ---------------------------------------------------------------------------------------------------------------- E0710 DM570 2202 RESTRAINTS (E0710), ANY TYPE * (BODY, CHEST, WRIST OR ANKLE) - ---------------------------------------------------------------------------------------------------------------- E0720 E0720 2219 TENS (E0720), TWO LEAD, * * LOCALIZED STIMULATION - ---------------------------------------------------------------------------------------------------------------- E0730 E0730 2218 TENS (E0730), FOUR LEAD, LARGER * * AREA/MULTIPLE NERVE STIMULATION - ---------------------------------------------------------------------------------------------------------------- E0731 E0731 2159 TENS OR NMES (E0731), * * CONDUCTIVE GARMENT - ---------------------------------------------------------------------------------------------------------------- E0744 E0744 2120 STIMULATOR (E0744), * * NEUROMUSCULAR FOR SCOLIOSIS - ---------------------------------------------------------------------------------------------------------------- E0745 E0745 2120 STIMULATOR (E0745), * * NEUROMUSCULAR, ELECTRONIC SHOCK UNIT - ---------------------------------------------------------------------------------------------------------------- E0745 E0745 6915 STIMULATOR FOUR CH (E0745), * * NEUROMUSCULAR - ---------------------------------------------------------------------------------------------------------------- E0746 DM570 2109 ELECTROMYOGRAPHY (EMG) (E0746), * * BIOFEEDBACK DEVICE - ---------------------------------------------------------------------------------------------------------------- E0747 DM570 2122 STIMULATOR (E0747), OSTEOGENIC, * NON-INVASIVE - ---------------------------------------------------------------------------------------------------------------- E0748 DM570 2124 STIMULATOR (E0748), OSTEOGENIC * NON-INVASIVE, SPINAL APPLICATIONS - ---------------------------------------------------------------------------------------------------------------- E0755 DM570 2157 STIMULATOR (E0755), ELECTRONIC * SALIVARY REFLEX, NON INVASIVE - ---------------------------------------------------------------------------------------------------------------- E0776 E0776 2175 IV POLE (E0776) * * - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 2158 PUMP (E0784), EXT AMBULATORY * INFUSION, MINIMED, INSULIN - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 7925 PUMP, EXT INFUSION, NON - DANA * PREMIUM, INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 6771 PUMP (E0784), INSULIN EXT * INFUSION DISETRONICS OR OTHER - ---------------------------------------------------------------------------------------------------------------- E0840 E0840 2133 TRACTION FRAME (E0840), ATTACH * TO HEADBOARD, CERVICAL TRACTION - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0850 E0850 2134 TRACTION STAND (E0850), FREE * * STANDING, CERVICAL TRACTION - ---------------------------------------------------------------------------------------------------------------- E0855 E0855 7484 TRACTION (E0855), W/O FRAME OR * * STAND - ---------------------------------------------------------------------------------------------------------------- E0860 E0860 2130 TRACTION EQUIP (E0860), * * OVERDOOR, CERVICAL - ---------------------------------------------------------------------------------------------------------------- E0870 E0870 2131 TRACTION FRAME (E0870), ATTACH * * TO FOOTBOARD, EXTREMITY, BUCKS - ---------------------------------------------------------------------------------------------------------------- E0880 E0880 2135 TRACTION STAND (E0880) * * FREE/STAND EXTREMITY TRACTION, EG, BUCK'S - ---------------------------------------------------------------------------------------------------------------- E0890 E0890 2132 TRACTION FRAME (E0890), ATTACH * * TO FOOTBOARD, PELVIC TRACTION - ---------------------------------------------------------------------------------------------------------------- E0900 E0900 2136 TRACTION STAND (E0900) FREE/ * * STAND PELVIC TRACTION,( EG, BUCK'S) - ---------------------------------------------------------------------------------------------------------------- E0910 E0910 2138 TRAPEZE BARS (E0910), A/K/A PT * * HELPER, ATTACH TO BED W/ GRAB BAR - ---------------------------------------------------------------------------------------------------------------- E0920 E0920 2111 FRACTURE FRAME (E0920), ATTACH * * TO BED, INCLUDING WEIGHTS - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2125 PASSIVE MOTION (E0935) EXERCISE * DEVICE - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2859 PASSIVE MOTION (E0935) EXERCISE * DEVICE, ANKLE - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2860 PASSIVE MOTION (E0935) EXERCISE * DEVICE, ELBOW - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2857 PASSIVE MOTION (E0935) EXERCISE * DEVICE, HAND - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2858 PASSIVE MOTION (E0935) EXERCISE * DEVICE, SHOULDER - ---------------------------------------------------------------------------------------------------------------- E0935 E0935 2861 PASSIVE MOTION (E0935) EXERCISE * DEVICE, WRIST - ---------------------------------------------------------------------------------------------------------------- E0940 E0940 2137 TRAPEZE BAR (E0940), FREE * * STANDING, COMPLETE W/ GRAB BAR - ---------------------------------------------------------------------------------------------------------------- E0941 E0941 2116 TRACTION DEVICE (E0941), * * GRAVITY ASSISTED - ---------------------------------------------------------------------------------------------------------------- E0942 E0942 2101 HARNESS/HALTER (E0942), * * CERVICAL HEAD - ---------------------------------------------------------------------------------------------------------------- E0944 E0944 2126 HARNESS (E0944), PELVIC BELT, * * BOOT - ---------------------------------------------------------------------------------------------------------------- E0945 DM570 2110 HARNESS (E0945), EXTREMITY BELT * * - ---------------------------------------------------------------------------------------------------------------- E0946 E0946 2115 FRACTURE, FRAME (E0946), DUAL * * W/ CROSS BARS, ATTACH TO BED - ---------------------------------------------------------------------------------------------------------------- E0947 E0947 2113 FRACTURE FRAME (E0947), * * ATTACHMENTS FOR COMPLEX PELVIC TRACTION - ---------------------------------------------------------------------------------------------------------------- E0948 E0948 2112 FRACTURE FRAME (E0948) * * ATTACHMENTS FOR COMPLEX CERVICAL TRACTION - ---------------------------------------------------------------------------------------------------------------- E0950 DM570 2139 TRAY (E0950) * - ---------------------------------------------------------------------------------------------------------------- E0958 E0958 2307 W/C PART ATTACHMENT (E0958) TO * CONVERT ANY W/C TO ONE ARM DRIVE - ---------------------------------------------------------------------------------------------------------------- E0959 E0959 2237 W/C PART AMPUTEE ADAPTER(E0959) * (COMPENSATE FOR TRANS OF WEIGHT) - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E0962 E0962 2232 CUSHION FOR WC 1" (E0962) * - ---------------------------------------------------------------------------------------------------------------- E0963 E0963 2233 CUSHION FOR WC 2" (E0963) * - ---------------------------------------------------------------------------------------------------------------- E0964 E0964 2234 CUSHION FOR WC 3" (E0964) * - ---------------------------------------------------------------------------------------------------------------- E0965 E0965 2235 CUSHION FOR WC 4" (E0965) * - ---------------------------------------------------------------------------------------------------------------- E0972 DM570 2230 TRANSFER BOARD OR DEVICE (E0972) * - ---------------------------------------------------------------------------------------------------------------- E0977 E0977 2317 CUSHION, WEDGE FOR W/C (E0977) * - ---------------------------------------------------------------------------------------------------------------- E0978 E0978 2248 BELT, SAFETY (E0978) W/ * AIRPLANE BUCKLE, W/C - ---------------------------------------------------------------------------------------------------------------- E0979 DM570 2249 BELT, SAFETY (E0979) W/ VELCRO * CLOSURE, W/C - ---------------------------------------------------------------------------------------------------------------- E0980 DM570 2292 SAFETY VEST (E0980), W/C * - ---------------------------------------------------------------------------------------------------------------- E1031 E1031 2291 ROLLABOUT CHAIR (E1031), W/ * * CASTORS 5" OR GREATER - ---------------------------------------------------------------------------------------------------------------- E1050 E1050 2260 W/C FULL/REC (E1050), FIX ARMS, * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1060 E1060 2259 W/C FULL/REC (E1070), DETACH * * ARMS, SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1065 E1065 2287 W/C POWER ATTACHMENT (E1065) * * - ---------------------------------------------------------------------------------------------------------------- E1066 E1066 2247 BATTERY CHARGER (E1066) * * - ---------------------------------------------------------------------------------------------------------------- E1069 E1069 2255 BATTERY, DEEP CYCLE (E1069) * * - ---------------------------------------------------------------------------------------------------------------- E1070 E1070 2258 W/C FULL/REC (E1060), DETACH * * ARMS, SWING AWAY DET/ ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1083 E1083 2263 W/C HEMI (E1083), FIX ARMS, * * SWING AWAY DETACH ABLE ELEV LEG REST - ---------------------------------------------------------------------------------------------------------------- E1084 E1084 2262 W/C HEMI (E1084), DETACH ARMS, * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1085 E1085 2264 W/C HEMI (E1085), FIX ARMS, * * SWING AWAY DETACH ABLE FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1086 E1086 2261 W/C HEMI (E1086), DETACH ARMS, * * SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1087 E1087 2265 W/C HI STRENGTH LT-WT (E1087), * * FIX ARMS, S/AWAY ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1088 E1088 2268 W/C HI STRENGTH LT-WGT (E1088), * * D/ ARMS, S/AWAY ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1089 E1089 2266 W/C HI STRENGTH LT-WGT (E1089), * * FIX ARMS, S/AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1090 E1090 2267 W/C HI STRENGTH LT-WG (E1090), * * DETACH ARMS, S/AWAY D/FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1091 E1091 2321 W/C YOUTH, ANY TYPE (E1091) * * - ---------------------------------------------------------------------------------------------------------------- E1092 E1092 2319 W/C WIDE HVY DUTY (E1092), * * DETACH ARMS S/AWAY DETACH ELEVAT LEGS - ---------------------------------------------------------------------------------------------------------------- E1093 E1093 2320 W/C WIDE HVY DUTY (E1093), * * DETACH ARMS S/AWAY DETACH FOOTRESTS - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1100 E1100 2296 W/C SEMI-RECLINING (E1100), * * SWING AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1110 E1110 2295 W/C SEMI-RECLINING (E1110), * * DETACH ARMS ELEV LEG REST - ---------------------------------------------------------------------------------------------------------------- E1130 E1130 2303 W/C STANDARD (E1130), FIX OR * * SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1140 E1140 2313 W/C (E1140), DETACH ARMS SWING * * AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1150 E1150 2314 W/C (E1150), DETACH ARMS, SWING * * AWAY DETACH ELEVAT LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1160 E1160 2315 W/C (E1160), W/ FIX ARMS, SWING * * AWAY DETACH ELEVAT LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1160 E1160 2396 W/C (E1160), W/FIX ARMS * * REMOVABLE FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1170 E1170 2241 W/C AMPUTEE (E1170), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1171 E1171 2242 W/C AMPUTEE (E1171), FIX ARMS, * * W/OUT FOOTRESTS OR LEGREST - ---------------------------------------------------------------------------------------------------------------- E1172 E1172 2240 W/C AMPUTEE (E1172), DETACH * * ARMS W/OUT FOOTRESTS OR LEGREST - ---------------------------------------------------------------------------------------------------------------- E1180 E1180 2239 W/C AMPUTEE (E1180), DETACH * * ARMS SWING AWAY DETACH FOOTRESTS - ---------------------------------------------------------------------------------------------------------------- E1190 E1190 2238 W/C AMPUTEE (E1190), DETACH * * ARMS SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1195 E1195 2273 W/C HVY DUTY (E1195), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1200 E1200 2243 W/C AMPUTEE (E1200), FIX FULL * * LENGTH ARMS, S/AWAY D/FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1210 E1210 2281 W/C MOTORIZED (E1210), FIX * * ARMS, S/AWAY DETACH ELEV LEG RESTS - ---------------------------------------------------------------------------------------------------------------- E1211 E1211 2279 W/C MOTORIZED (E1211), DETACH * * ARMS, S/AWAY DETACH FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1212 E1212 2282 W/C MOTORIZED (E1212), FIX * * ARMS, SWING AWAY DETACH FOOT RESTS - ---------------------------------------------------------------------------------------------------------------- E1213 E1213 2280 W/C MOTORIZED (E1213), DETACH * * ARMS S/AWAY, DETACH ELEV LEG REST - ---------------------------------------------------------------------------------------------------------------- E1220 E1220 2551 W/C CUSTOM (E1220) * - ---------------------------------------------------------------------------------------------------------------- E1220 E1220 2579 W/C XXWIDE (E1220) * - ---------------------------------------------------------------------------------------------------------------- E1230 E1230 2288 SCOOTER (E1230), THREE OR 4 * * * WHEEL - ---------------------------------------------------------------------------------------------------------------- E1240 E1240 2276 W/C LT-WGT (E1240), DETACH ARMS * * SWING AWAY DETACH, ELEV LEGREST - ---------------------------------------------------------------------------------------------------------------- E1250 E1250 2278 W/C LT-WGT (E1250), FIX ARMS, * * SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1260 E1260 2275 W/C LT-WGT (E1260), DETACH ARMS * * SWING AWAY DETACH FOOTREST - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1270 E1270 2277 W/C LT-WGT (E1270), FIX ARMS, * * SWING AWAY DETACH ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1280 E1280 2270 W/C HVY DUTY (E1280), DETACH * * ARMS ELEV LEGRESTS - ---------------------------------------------------------------------------------------------------------------- E1285 E1285 2274 W/C HVY DUTY (E1285), FIX ARMS, * * SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1290 E1290 2271 W/C HVY DUTY (E1290), DETACH * * ARMS SWING AWAY DETACH FOOTREST - ---------------------------------------------------------------------------------------------------------------- E1295 E1295 2272 W/C HVY DUTY (E1295), FIX ARMS, * * ELEV LEGREST - ---------------------------------------------------------------------------------------------------------------- E1300 DM570 2062 WHIRLPOOL (E1300), PORT * (OVERTUB TYPE) - ---------------------------------------------------------------------------------------------------------------- E1310 DM570 2061 WHIRLPOOL (E1399), NON-PORT * (BUILT-IN TYPE) - ---------------------------------------------------------------------------------------------------------------- E1353 E1353 2381 O2 REGULATOR (E1353) * * - ---------------------------------------------------------------------------------------------------------------- E1355 E1355 2384 CYLINDER STAND/RACK (E1355) * * - ---------------------------------------------------------------------------------------------------------------- E1372 E1372 2331 IMMERSION EXT HEATER (E1372) * * FOR NEBULIZER - ---------------------------------------------------------------------------------------------------------------- E1375 E1375 2334 NEBULIZER PORT (E1375) W/ SMALL * * COMPRESSOR, W/ LIMITED FLOW - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2568 ADAPTER (A9900), AC/DC * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2586 APNEA MONITOR DOWNLOAD (E1399) * * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2552 BATH LIFT (E1399), CUSTOM * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2563 BED WEDGE (E1399), 12" * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2856 BEDROOM EQUIPMENT (E1399), * * CUSTOM - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2525 BREAST PUMP, ELECTRIC (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2581 BREAST PUMP, INSTITUTIONAL * (E1399) - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2580 BREAST PUMP, MANUAL (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2593 COLD THERAPY UNIT, PAD (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2565 COMMODE (E1399), DROP ARM, * HEAVY DUTY - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2582 COMPRESSION PUMP BOOT (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2583 COMPRESSION PUMP, FOOT (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2569 CPAP HUMIDIFIER (A9900), HEATED * * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2635 CPAP/BIPAP SUPPLIES (A9900) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2327 DURABLE MEDICAL EQUIP (E1399), * * MISCELLANEOUS - ---------------------------------------------------------------------------------------------------------------- E1399 E1220 2584 GERI CHAIR (E1399), THREE * POSITION RECLINING - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 6780 HOLTER MONITOR (G0004) * - ---------------------------------------------------------------------------------------------------------------- E1399 E0265 2590 HOSP BED (E1399), ELECTRIC, * * XLONG, W/MATTRESS & SIDE RAILS - ---------------------------------------------------------------------------------------------------------------- E1399 E0200 2868 LAMP, ULTRAVIOLET (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2588 MONITOR (E1399), VITAL SIGNS * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2529 O2 ANALYZER (A9900) * * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 2594 O2 CONSERVATION DEVICE (A9900) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 6775 OXIMETRY TEST (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2555 PATIENT LIFT, CUSTOM (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2561 PEAK FLOW METER (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4559 PEDIATRIC WALKER (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2567 PNEUMOGRAM (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2553 POSITIONING, CUSTOM (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2526 PULSE OXIMETER (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2527 PULSE OXIMETER W/ PROBE (E1399) * * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2562 SHOWER, HAND HELD (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2592 SLEEP STUDY, ADULT (E1399) * - ---------------------------------------------------------------------------------------------------------------- E1399 DM590 7483 STIMULATOR (E1399), MUSCLE, LOW * * VOLTAGE OR INTERFERENTIAL - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 2855 THERAPY EQUIPMENT, CUSTOM * (E1399) - ---------------------------------------------------------------------------------------------------------------- E1399 DM570 6774 THERAPY PERCUSSION, GENERATOR * * ONLY - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7506 W/C, CUSTOM (E1399) MANUAL ADULT * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7504 W/C, CUSTOM (E1399) MANUAL * * PEDIATRIC - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7507 W/C, CUSTOM (E1399) POWER ADULT * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7505 W/C, CUSTOM (E1399) POWER * * PEDIATRIC - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2564 WALKER (E1399), HEAVY DUTY, * EXTRA WIDE - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2585 WALKER (E1399), HEMI * - ---------------------------------------------------------------------------------------------------------------- K0538 DM570 6873 WOUND SUCTION DEVICE (K0538) * - ---------------------------------------------------------------------------------------------------------------- K0539 DM570 7914 DRESSING SET, FOR WOUND SUCTION * DEVICE (K0539) - ---------------------------------------------------------------------------------------------------------------- K0540 DM570 7915 CANISTER SET, FOR WOUND SUCTION * DEVICE (K0540) - ---------------------------------------------------------------------------------------------------------------- E1400 E1390 2361 O2 CONC (E1390),MANUF SPEC * * MAXFLOWRATE = 2 LTS PER MIN@85% - ---------------------------------------------------------------------------------------------------------------- G0015 DM570 6779 CARDIAC EVENT MONITOR (G0015) * - ---------------------------------------------------------------------------------------------------------------- K0163 DM590 3713 ERECTION SYSTEM, VACUUM (K0163) * - ---------------------------------------------------------------------------------------------------------------- K0183 DM590 2516 CPAP MASK (K0183) * - ---------------------------------------------------------------------------------------------------------------- K0184 DM590 2515 NASAL PILLOWS/SEALS (K0184) * REPLACEMENT FOR NASAL APP/ DVC, PAIR - ---------------------------------------------------------------------------------------------------------------- K0185 DM590 2514 CPAP HEADGEAR (K0185) * - ---------------------------------------------------------------------------------------------------------------- K0186 DM590 2513 CPAP CHIN STRAP (K0186) * - ---------------------------------------------------------------------------------------------------------------- K0187 DM590 2512 CPAP TUBING (K0187) * - ---------------------------------------------------------------------------------------------------------------- K0188 DM590 2511 CPAP FILTER (A9900), DISPOSABLE * - ---------------------------------------------------------------------------------------------------------------- K0189 DM590 2510 CPAP FILTER (A9900), * NON-DISPOSABLE - ---------------------------------------------------------------------------------------------------------------- K0268 DM590 2509 CPAP HUMIDIFIER (K0268), COOL * - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- K0413 DM590 6889 MATTRESS (K0413), NONPOWERED, * * EQUIVALENT - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 7673 MATTRESS (E1399) V-CUE DYNAMIC * * AIR THERAPY - ---------------------------------------------------------------------------------------------------------------- A4608 A9900 7621 CATHETER TRACH (A4608) 11CM 1 * SCOOP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7664 COFFLATOR (E1399CF) MANUAL * SECRETION MOBIL DEVICE - ---------------------------------------------------------------------------------------------------------------- E0168B A9900 7643 COMMODE (E0168B) HVY DUTY * BEDSIDE CHAIR 251-450 LBS. - ---------------------------------------------------------------------------------------------------------------- E0168C A9900 7644 COMMODE (E0168C) HVY DUTY DROP * ARM 451-850 LBS. - ---------------------------------------------------------------------------------------------------------------- A6234 HH591 7626 DRESSING <16 SQ IN (A6234) * HYDROCOLLOID DRESSING, EA - ---------------------------------------------------------------------------------------------------------------- A6258 HH591 7627 DRESSING >16 SQ IN (A6258) * TRANSPAREN FILM, EA - ---------------------------------------------------------------------------------------------------------------- A46203 HH591 7625 DRESSING COMPOSITE <16 SQ IN * (A46203) SELF ADH, EA - ---------------------------------------------------------------------------------------------------------------- B9998B DM590 7655 ENT (B9998B) EXT SET Y SITE * F/KANGAROO PUMP - ---------------------------------------------------------------------------------------------------------------- B9998C DM590 7656 ENT (B9998C) EXT SET W/ CLAMP * BASIC - ---------------------------------------------------------------------------------------------------------------- B9998D DM590 7657 ENT (B9998D) FARRELL GASTRIC * RELIEF VLV - ---------------------------------------------------------------------------------------------------------------- B9998E DM590 7658 ENT (B9998E) GASTRO EXT SET * - ---------------------------------------------------------------------------------------------------------------- B9998F DM590 7659 ENT (B9998F) GASTRO TUBE ANY * SIZE MIC-KEY OR HIDE A PORT - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7620 HUMID-VENT (E1399) ARTIFICIAL * NOSE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7660 IPPB (E1399) UNIV SET UP * W/MANIFOLD NEBULIZER - ---------------------------------------------------------------------------------------------------------------- K0105 A9900 7639 IV POLE (K0105) ATTACH F/ W/C * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7641 MECHANICAL SCALE (E1399) * PEDIATRIC/NEONATAL - ---------------------------------------------------------------------------------------------------------------- A7008 A9900 7661 NEBULIZER (A7008) KIT PREFILL * W/STR H20 1L BAX - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7663 O2 CONNECTOR (E1399) * SIMS/IRRIGATION NOZZLE BAX - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7615 O2 HUMIDIFIER (E1399) * AQUA+NEONATAL EA HUD - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7623 O2 SWIVEL (E1399) ADAPTER * ANGLED STERILE - ---------------------------------------------------------------------------------------------------------------- L8501 A9900 7624 SPEAKING VALVE (L8501) WHITE PAS * - ---------------------------------------------------------------------------------------------------------------- A4319 HH591 7629 STERILE WATER (A4319) F/IRRIG * 1L BAX - ---------------------------------------------------------------------------------------------------------------- A7001 HH591 7619 SUCTION BOTTLE (A7001) W/LID & * TUBING - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7616 SUCTION FILTER (E1399) BACTERIA * - ---------------------------------------------------------------------------------------------------------------- A6265 HH591 7628 TAPE ALL TYPES (A6265) * EXCLUDING MICROFOAM, PER 18 SQ INCHES - ---------------------------------------------------------------------------------------------------------------- A4481 A9900 7622 TRACH FILTER (A4481) BACTERIA * ELECTROSTATIC - ---------------------------------------------------------------------------------------------------------------- A4623 A9900 7618 TRACH INNER (A4623) CANNULA * - ---------------------------------------------------------------------------------------------------------------- A4621 A9900 7617 TRACH TUBE MASK (A4621) COLLAR * OR HOLDER - ---------------------------------------------------------------------------------------------------------------- A7010 A9900 7662 TUBING (A7010) AEROSOL * CORRUGATED PER FOOT - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7631 VENT ADAPTER (E1399) MDI HUD * - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7630 VENT BATTERY CHARGER (A9900) * 12V GEL - ----------------------------------------------------------------------------------------------------------------
* Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7632 VENT CONNECTOR (E1399) PED OR * ADULT OMNIFLEX DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7633 VENT FILTER (E1399) HYGROBAC S * ELECTOSTATIC MAL - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7634 VENT THERMOMETER (E1399) W/ * ADAPTER - ---------------------------------------------------------------------------------------------------------------- K0108 A9900 7638 W/C BRAKE EXTENSION (K0108) TIP * BLK 10/PK - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7635 WALKER BASKET (E1399) VINYL * COATED - ---------------------------------------------------------------------------------------------------------------- E0159 A9900 7640 WALKER BRAKE (E0159) ATTACHMENT * - ---------------------------------------------------------------------------------------------------------------- E0148 A9900 7636 WALKER HVY DUTY (E0148) FOLDING * X-WIDE - ---------------------------------------------------------------------------------------------------------------- E0149 A9900 7637 WALKER HVY DUTY (E0149) W/ * WHEELS - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7645 CPAP (E1399) DC BATTERY ADAPTER * CABLE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7646 CPAP (E1399) EXHALATION PORT * DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7647 CPAP (E1399) FUSE KIT * INTERNATIONAL A/C - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7648 CPAP (E1399) HUMIDIFIER CHAMBER * KIT DISP - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7649 CPAP (E1399) HUMIDIFIER CHAMBER * REUSABLE - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7650 CPAP (E1399) HUMIDIFIER * MOUNTING TRAY - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7651 CPAP (E1399) INVERTOR AC/DC * - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7652 CPAP (E1399) POWER CORD * F/ARIA-SYNC - ---------------------------------------------------------------------------------------------------------------- E1399 A9900 7653 CPAP (E1399) SHELL W/O PRESSURE * TAP - ---------------------------------------------------------------------------------------------------------------- A9900 DM590 7566 CPAP CALIBRATION SHELL (A9900) * - ---------------------------------------------------------------------------------------------------------------- A9900 DM590 7565 CPAP SHORT TUBING (A9900) * - ---------------------------------------------------------------------------------------------------------------- E0601 E0601 7690 VENT, CONTINUOUS POSITIVE * * (E0500) AIRWAY PRESSURE DEVICE - ---------------------------------------------------------------------------------------------------------------- E0452 E0452 7691 VENT, BILEVEL INTERMITTENT * * (E0500) ASSIST DEVICE (BIPAP) - ---------------------------------------------------------------------------------------------------------------- E0747 DM570 6875 STIMULATOR, OSTEOGENIC, * * ULTRASOUND - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7695 GEL/SILICON GOLD SEAL * * CPAP/BIPAP MASK (A9900) - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7701 VENT THERAPEUTIC ST BIPAP W/ * * BACKUP RATE (K0533) - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7703 O2 SYS HELIOS PORT LIQUID, RENT * * (E1399) - ---------------------------------------------------------------------------------------------------------------- HH591 HH591 7704 PUMP, EXT INFUSION, DANA * * DIABECARE, INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- E0784 E0784 7731 PUMP, EXT INFUSION, ANIMAS, * * INSULIN (E0784) - ---------------------------------------------------------------------------------------------------------------- A9900 A9900 7737 CPAP DREAM SEAL INTERFACE FOR * * USE WITH BREEZE MASK (A9900) - ---------------------------------------------------------------------------------------------------------------- A7036 DM590 7738 CPAP CHIN STRAP DELUXE (K0186) * * - ---------------------------------------------------------------------------------------------------------------- E1340 E1340 7768 W/C REPAIRS - CUSTOM (E1340) * * - ----------------------------------------------------------------------------------------------------------------
The following may be charged under extraordinary circumstances: * Confidential treatment requested - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4551 LABOR/SERVICE/SHIPPING CHARGES * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2731 SHIPPING AND HANDLING FEES * - ----------------------------------------------------------------------------------------------------------------
The following may be charged if over and above routine on rental equipment: - ---------------------------------------------------------------------------------------------------------------- E1350 E1350 2382 REPAIR OR NON-ROUTINE (E1350) * SERVICE REQUIRING SKILL OF A TECH - ---------------------------------------------------------------------------------------------------------------- E1340 E1340 2554 W/C REPAIRS - STANDARD (E1340) * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4552 MISCELLANEOUS SUPPLIES * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 2589 REPAIR (E1399), RESPIRATORY * * EQUIPMENT - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4561 RESPIRATORY SUPPLIES (A4618) * * - ---------------------------------------------------------------------------------------------------------------- E1399 E1399 4549 TENS/APNEA SUPPLIES * * - ----------------------------------------------------------------------------------------------------------------
NOTES: * * * * * * * Confidential treatment requested EX-21 8 ex21.txt Exhibit 21 Subsidiaries of Gentiva Health Services, Inc. Subsidiary* Jurisdiction of Incorporation ----------- ----------------------------- CCI-ASDS, Inc. Massachusetts Commonwealth Home Care, Inc. Massachusetts Gentiva CareCentrix, Inc. Delaware Gentiva CareCentrix (Area One) Corp. Delaware Gentiva CareCentrix (Area Two) Corp. Delaware Gentiva CareCentrix (Area Three) Corp. Delaware Gentiva Certified Healthcare Corp. Delaware Gentiva Health Services (Certified), Inc. Delaware Gentiva Health Services Holding Corp. Delaware Gentiva Health Services IPA, Inc. New York Gentiva Health Services (USA), Inc. Delaware Gentiva Services of New York, Inc. New York The IV Clinic, Inc. Texas The IV Clinic II, Inc. Texas The IV Clinic III, Inc. Texas Kimberly Home Health Care, Inc. Missouri New York Healthcare Services, Inc. New York OHS Service Corp. Texas Partnersfirst Management, Inc. Florida QC-Medi-New York, Inc. New York Quality Care-USA, Inc. New York Quality Managed Care, Inc. Delaware Quantum Care Network, Inc. Massachusetts Quantum Health Resources, Inc. Delaware QHR Southwest Business Trust Pennsylvania QHR Southwest Holdings Corp. California *All subsidiaries do business under the name "Gentiva Health Services" and/or "Gentiva" except for Gentiva Health Services (USA), Inc., which does business under the name "Gentiva Rehab Without Walls." EX-23 9 ex23.txt EXHIBIT 23 CONSENT OF INDEPENDENT ACCOUNTANTS We hereby consent to the incorporation by reference in the Registration Statements on Form S-3 (No. 333-41284) and in the Post Effective Amendment No. 1 on Form S-8 to Form S-4 (No.333-88663) of Gentiva Health Services, Inc. of our report dated February 6, 2004, except for Note 9, as to which the date is February 27, 2004, relating to the consolidated financial statements and financial statement schedule, which appears in this Form 10-K. PricewaterhouseCoopers LLP Stamford, Connecticut March 1, 2004 EX-31.1 10 ex31_1.txt EXHIBIT 31.1 CERTIFICATIONS I, Ronald A. Malone, certify that: 1. I have reviewed this annual report on Form 10-K of Gentiva Health Services, Inc.; 2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report; 3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report; 4. The registrant's other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) for the registrant and have: (a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared; (b) Evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and (c) Disclosed in this report any change in the registrant's internal control over financial reporting that occurred during the registrant's most recent fiscal quarter (the registrant's fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant's internal control over financial reporting; and 5. The registrant's other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant's auditors and the audit committee of the registrant's board of directors (or persons performing the equivalent functions): (a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant's ability to record, process, summarize and report financial information; and (b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant's internal control over financial reporting. Date: March 1, 2004 /s/ Ronald A. Malone -------------------- Ronald A. Malone Chairman and Chief Executive Officer EX-31.2 11 ex31_2.txt EXHIBIT 31.2 CERTIFICATIONS I, John R. Potapchuk, certify that: 1. I have reviewed this annual report on Form 10-K of Gentiva Health Services, Inc.; 2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report; 3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report; 4. The registrant's other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) for the registrant and have: (a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared; (b) Evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and (c) Disclosed in this report any change in the registrant's internal control over financial reporting that occurred during the registrant's most recent fiscal quarter (the registrant's fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant's internal control over financial reporting; and 5. The registrant's other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant's auditors and the audit committee of the registrant's board of directors (or persons performing the equivalent functions): (a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant's ability to record, process, summarize and report financial information; and (b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant's internal control over financial reporting. Date: March 1, 2004 /s/ John R. Potapchuk --------------------- John R. Potapchuk Senior Vice President and Chief Financial Officer EX-32.1 12 ex32_1.txt Furnished (but not filed) as an exhibit to the periodic report identified in the Certification. Exhibit 32.1 CERTIFICATION PURSUANT TO 18 U.S.C. SECTION 1350, AS ADOPTED PURSUANT TO SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002 In connection with the Annual Report of Gentiva Health Services, Inc. (the "Company") on Form 10-K for the period ended December 28, 2003 as filed with the Securities and Exchange Commission on the date hereof (the "Report"), I, Ronald A. Malone, Chief Executive Officer of the Company, certify, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that, to the best of my knowledge: (1) The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and (2) The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company. Date: March 1, 2004 /s/ Ronald A. Malone -------------------- Ronald A. Malone Chief Executive Officer A signed original of this written statement required by Section 906 has been provided to the Company and will be retained by the Company and furnished to the Securities and Exchange Commission or its staff upon request. EX-32.2 13 ex32_2.txt Furnished (but not filed) as an exhibit to the periodic report identified in the Certification. Exhibit 32.2 CERTIFICATION PURSUANT TO 18 U.S.C. SECTION 1350, AS ADOPTED PURSUANT TO SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002 In connection with the Annual Report of Gentiva Health Services, Inc. (the "Company") on Form 10-K for the period ended December 28, 2003 as filed with the Securities and Exchange Commission on the date hereof (the "Report"), I, John R. Potapchuk, Chief Financial Officer of the Company, certify, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that, to the best of my knowledge: (1) The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and (2) The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company. Date: March 1, 2004 /s/ John R. Potapchuk --------------------- John R. Potapchuk Chief Financial Officer A signed original of this written statement required by Section 906 has been provided to the Company and will be retained by the Company and furnished to the Securities and Exchange Commission or its staff upon request. -----END PRIVACY-ENHANCED MESSAGE-----