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Contract 30880
CITY SECRETARY CONTRACT NO. aac CONTRACT FOR PROFESSIONAL SERVICES This Contract for Professional Services ("Agreement") is made and entered into by and between the City of Fort Worth ("City"), a home-rule municipality situated in portions of Tarrant, Wise and Denton Counties, Texas, acting herein by and through Richard Zavala, its duly authorized assistant city manager, and Concentra Health Services, hic. d/b/a Concentra Medical Centers, hereinafter referred to as "Concentra". 1. Services to be provided: a. Concentra agrees to provide to City, in accordance with medically necessary or appropriate professional standards, a ftill range of occupational health care services, as outlined in Appendix "A", including any exhibits thereto, all of which are hereby made a part of this Agreement for all purposes. Appendix "A" constitutes, at least in part, a proposal presented by Concentra to the City prior to the Effective Date of this Agreement, as hereafter defined. Therefore, in the event there is any conflict between the provisions and conditions of the proposal and the provisions and conditions set forth in the body of this Agreement, the provisions and conditions set forth in the body of this Agreement shall control. b. City and Concentra both recognize and acknowledge the professional nature of this Agreement. Being cognizant that issues of interpretation and performance will inevitably arise, both parties agree to consult with each other and covenant to negotiate in the utmost good faith in order to assure performance of this Agreement without hindrance. c. Services under this Agreement will be provided at Concentra's current facilities, at a subcontractor's facilities if the subcontractor and the facilities are approved in writing by the City prior to such services being provided, and at such City facilities and other locations as may be mutually agreeable in writing to Concentra and City. d. To the extent that the services to be performed under this Agreement constitute services compensable tu-ider the Texas Workers Compensation Act, as in effect or hereafter amended, or constitute services performed by persons other than Concentra and covered by the Police and Fire Departments' Contracts (hereafter defined), both Flo" 4A parties recognize the non-exclusive nature of this Agreement. The "Police and Fire Departments' Contracts" are defined as (a) those certain pre-existing contracts entered into by the City for the perfonnance of post-offer physicals for persons offered jobs in the City's police and fire departments, and such other matters as are contained in such contracts, and (b) any renewals thereof. e. Concentra agrees to provide and maintain a network of medical professionals/physicians as listed in the Proposal. The Specialist Network will be composed of Medical Professionals/Physicians, including but ,not limited to Neurologists, Orthopedists, and Plastic Surgeons. Concentra also agrees to maintain the Specialist Network during the initial tern of this Agreement as well as any of the option terms. Concentra agrees to monitor performance of and replace, if necessary, any or all of the members of the Specialist Network. 2. Compensation: a. The parties agree that the Schedule for Compensation as shown in Exhibit "B" attached hereto is acceptable as the compensation to be paid to Concentra for lab and case management services for the City. All non-injury service pricing will be negotiated by the parties every two (2) years, with no increase in pricing to exceed 5% of the prior two (2) years pricing. The parties acknowledge that additional services provided by Concentra to the City may become desirable and agree to conduct negotiations on such additional services in good faith to arrive at mutually agreeable performance and compensation. Any additional services will be reflected by a written amendment to this Agreement signed by the parties. b. All injury services will be invoiced by Concentra daily to the CITY's third party administrator. Concentra shall issue monthly invoices for all non-injury services provided under this Agreement to the CITY and will provide the City sufficient documentation to reasonably substantiate the invoices. Invoices are due and payable within 30 days from the date the invoices are received by the City. In the event of a disputed or contested billing, only that portion so contested will be withheld from payinent, and the undisputed portion will be paid. The CITY will exercise reasonableness in contesting any bill or portion thereof. No interest will accrue on any CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA Page 2 of 2525 contested.portion of the billing; provided, however, that once the dispute is resolved, payment will be made as provided for herein. CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA Page 3 of 252.5 3. Tenn: a. Unless terminated earlier as provided in this Agreement, the Initial Tenn of this Agreement shall conmmence on October 1, 2004 ("Effective Date") and shall terminate on September 30, 2005 ("Expiration Date"). b. Options to Renew and Notice: City shall have the sole right to renew this Agreement for four additional 1-year terms. If City desires to exercise the first option to renew, City shall notify Concentra in writing at least 90 days prior to the end of the Initial Tenn or any option tens that has been exercised of its intention to renew. Compensation to be paid during any option tern shall be that as provided for in the Initial Tern. 4. Records and Records Management: a. Concentra will adhere and follow the governing guidelines as it pertains to the protection and use of collected data (personal/medical information). City may, to the extent permissible by applicable law, obtain copies of such records solely for its internal purposes and agrees to reimburse Concentra for the cost of such copies at the rate published in the Texas Administrative Code in effect as of the time copying is performed. b. Upon the tennnination or expiration, Concentra agrees to return to the City or its designated agent all medical records delivered to Concentra on or about the Effective Date (the "Pre-existing Medical Records"). Upon receipt of authorization from the affected City employees or their representatives for Concentra to view and use the Pre-existing Medical Records (which authorization may be given at any time so long as it is in accordance with applicable law concerning confidentiality of medical records), Concentra may keep copies thereof at its sole copying expense, or may subsequently request copies thereof and shall reimburse City at the rate published in the Texas Administrative Code in effect as of the time copying is performed. c. It is additionally recognized that additional medical records created by Concentra in the performance of this Agreement, regardless of form or medium of storage ("New Medical Records") shall be and remain the property of Concentra and shall not be removed or transferred fiom Concentra, except in accordance with applicable law and Concentra's policies, provided that such policies are set forth in this Agreement or CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA Page 4 of 252.5 have been approved in advance and in writing by the City. Before requesting New Medical Records from Concentra, City shall obtain from City's employee or legal representative authorization to release copies of medical records in accordance with applicable state and federal law concerning the confidentiality of medical records; provided, however, that Concentra agrees to use all reasonable efforts to obtain the written consent of each patient seen by Concentra under this Agreement authorizing Concentra to release copies of such New Medical Records to the City upon its request therefore. Upon termination of this Agreement, Concentra shall retain the originals of all New Medical Records in its possession, and City shall, to the extent permissible by applicable law, have the right to receive copies. City agrees to reimburse Concentra for the cost of such copies at the rate published. in the Texas Administrative Code in effect as of the time copying is performed. d. Concentra agrees that no medical records covered by the terns of this Agreement will be altered or destroyed without express authorization by City and in accordance with applicable law. City recognizes that medical records will from time to time cease to have administrative, financial and/or legal value to either City or Concentra, and City and Concentra agree to utilize appropriate record retention and destnrction schedules for the purpose of lawfiil and efficient records management. e. Concentra will exercise appropriate care in the management, use, storage and retention of medical records generated during the tern of this Agreement to preserve necessary and/or usefiil modifications of the facility and systems used by Concentra for records management. Concentra will solicit City's input concerning any such modifications in order to ascertain if any issues or consequences, legal, financial, or practical, are reasonably foreseeable because of facility or system modifications. City and Concentra agree to negotiate in good faith to resolve any such issues and consequences in a mamzer equitable to both parties and consistent with the purposes of this Agreement. £ All reports and records provided to Concentra by the City shall remain the sole property 'of the City. Concentra shall store and maintain such reports and records separately from any other documents and in a manner and location that is easily accessible to City staff members. The City, to the extent permissible with applicable CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA Page 5 of 2525 law, shall have access to such reports and records during Concentra norinal working hours and will provide Concentra with reasonable advance notice of a need for access. Concentra shall treat as strictly confidential all reports and records provided by the City and shall not release any such reports or records, or any portion of their contents, to third parties without the City's advance written consent. Concentra shall not copy or reproduce any such records of reports without the City's advance written consent and in accordance with applicable law. The City will provide a list of terminated employees aiulually to Concentra. Concentra will separate these records from other records. The City may, to the extent permissible with applicable law, retrieve original copies of all such reports and records from Concentra at any time. 5. Termination: a. The City may terminate this Agreement at any time for breach of this Agreement by providing a 10-day written notice or without cause by providing a 90-day written notice to Concentra. Upon the receipt of any such notice, Concentra shall innnediately discontinue all services and work and the placing of all orders or the entering into contracts for all supplies, assistance, facilities and materials in connection with the performance of this Agreement and shall proceed to cancel promptly all existing contracts insofar as they are chargeable to this Agreement. b. Upon termination of this Agreement for any reason, Concentra shall, to the extent permissible by applicable law, provide the City with copies of all completed or partially completed documents prepared ruider this Agreement. City agrees to reimburse Concentra for the cost of such copies at the rate published in the Texas Administrative Code in effect as of the time copying is performed. c. If Concentia's treatment of a City employee is commenced before the effective date of termination of this Agreernent and continues beyond that date, City shall continue to pay Concentra for medically-appropriate services necessary to complete such treatment at Concentra usual and customary rates until such care is completed, and the City also shall pay Concentra for services actually performed in accordance herewith prior to such termination, less such payments as have been previously made, in accordance with a final statement submitted by Concentra doctunenting the performance of such work. AI 11 JU ��> Jti CONTRACT FOR PROFESSIONAL SERVICE (^'i C. CONCENTRA •n n Page 6 of 2525 �c IV'Y,JI��� I➢ � GS`o 6. Indemnification: Concentra shall be liable for, and shall indemnify and hold the City and its officers, agents and employees harmless from, any loss, damage, liability or expense for damage to property and/or personal injuries, including death, to any person, including, but not limited to third persons not a party to this Agreement, officers, agents or employees of Concentra or its contractors or subcontractors, which may arise out of any grossly negligent act, or intentional misconduct by Concentra, its officers, agents, servants, employees, contractors and/or subcontractors. Concentra shall defend at its own expense any suits or other proceedings brought against the City, its officers, agents, servants and/or employees based on or resulting from any such grossly negligent act, or intentional misconduct; and shall pay all expenses and satisfy all judgments which may be incurred by or rendered against Concentra, its officers, agents, servants, employees, contractors and/or subcontractors, or the City, its officers, agents, servants and/or employees in connection with any such grossly negligent act, or intentional misconduct. It is understood that the foregoing is not intended to cover matters to the extent to which City, its officers, employees or agents have been found to be negligent or grossly negligent or to have committed malfeasance. 7. Insurance: a. Concentra shall not commence work under the Agreement until it has fillly complied with all insurance requirements set forth in this Agreement and such insurance has been approved in writing by the City, nor shall Concentra allow any subcontractor to commence work on its subcontract witil all similar insurance of the subcontractor has been so obtained and approval given by the City. b. Workers' Compensation Insurance: Concentra shall take out and maintain during the life of this Agreement statutory Workers' Compensation Insurance for all of its employees performing any of the services hereunder, and, in case any work is sublet, Concentra shall require the subcontractor similarly to provide Workers' Compensation Insurance for all of the latter's employees unless such employees are covered by the protection afforded by Concentra's insurance. Concentra will additionally acquire Employer's Liability coverage in the following amounts: Employer's Liability CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA �=' Page 7 of 2525 $100,000 Each accident/occurrence $100,000 Disease—per each employee $500,000 Bodily Injury/Disease—Policy Limit c. Connnercial General Liability Insurance: Concentra shall take out and maintain during the life of this Agreement such commercial general liability insurance as shall protect Concentra and any subcontractor perforining work covered by this Agreement from claims for personal injuries, including death, as well as from claims for property damages or losses which may arise from operations under this Agreement, whether such operations be done by Concentra or by any subcontractor or by anyone directly or indirectly employed by either of them. The amount of such insurance shall be as follows: (1) CSL(combined single limit)per occurrence: $1,000,000 mini niun (2) Aggregate: $2,000,000 minimum d. Professional Liability: Professional liability or medical malpractice insurance shall be required in the minimum amount of $1,000,000 each medical incident and $3,000,000ain1ual aggregate. e. Auto Liability: Automobile liability insurance in the minimum amount of$1,000,000 CSL (combined single limit)per accident shall be required. f Additional Insurance Requirements: 1. The City, its officers, employees and servants shall be endorsed as additional insureds on Concentra connnercial general liability and auto liability insurance policies. 2. Certificates of insurance shall be delivered to the City of Fort Worth,Human Resources Department, 1000 Tluockmorton Street,Fort Worth, TX 76102, prior to connnencement of work on the contracted project. 3. Any failure on part of the City to request required insurance documentation shall not constitute a waiver of the insurance requirements specified herein. 4. Each insurance policy shall be endorsed to provide the City a minimuun thirty days notice of cancellation, non-renewal, and/or material change in policy terms or coverage. A ten days notice shall be acceptable in the event of non-payment of premium. CONTRACT FOR PROFESSIONAL SERVICE !����% CONCENTRA pq Page 8 of 252a 5. Insurers must be authorized to do business in the State of Texas and have a current A.M. Best rating of A: VII or equivalent measure of financial strength and solvency. 6. Deductible limits, or self-fiulded retention limits, on each policy must not exceed $10,000.00 per occurrence unless otherwise approved in writing by the City. 7. Other than worker's compensation insurance, in lieu of traditional insurance, City may consider alternative coverage or risk treatment measures through insurance pools or risk retention groups. The City must approve in writing any alternative coverage. 8. Workers' compensation insurance policy(s) covering employees employed on the project shall be endorsed with a waiver of subrogation providing rights of recovery in favor of the City. 9. City shall not be responsible for the direct payment of insurance premium costs for Concentra's insurance. 10. Each of Concentra's insurance policies shall be endorsed to provide that such insurance is primary protection and any self-fiulded or commercial coverage maintained by the City shall not be called upon to contribute to loss recovery. 11. In the course of the project, Concentra shall report, in a timely manner, to City's officially designated contract administrator any known loss occurrence which could give rise to a liability claim or lawsuit or which could result in a property loss. 12. Concentra's liability shall not be limited to the specified amounts of insurance required herein. 13. Upon the request of City, Concentra shall provide complete copies of all insurance policies required by these contract documents. 8. Disclosure of Conflicts: Concentra warrants to the City that it has made fiill disclosure in writing of any known existing or potential conflicts of interest related to the services to be performed hereunder. Concentra firrtber warrants that it will make prompt disclosure in writing of any known conflicts of interest, which develop subsequent to the signing of this Agreement. a CONTRACT FOR PROFESSIONAL SERVICE ilJ CONCENTRA ;q^n�j tJ; rr4• Page 9 of 252-5 9. Right to Audit: a. Concentra agrees that the City shall, until the expiration of three (3) years after final payment under this Agreement, have access to and the right to examine, to the extent permissible by applicable law, any directly pertinent books, documents, papers and records of Concentra involving transactions relating to this Agreement. Concentra agrees that the City shall have access during norinal working hours to all necessary Concentra facilities and shall be provided adequate and appropriate workspace in order to conduct audits in compliance with the provisions of this section. The City shall give Concentra not less than 7 working days' advance notice of intended audits. b. Concentra further agrees to include in all its subcontractor agreements hereunder a provision to the effect that the subcontractor agrees that the City shall, until the expiration of three (3) years after final payment udder the subcontract involving transactions to the subcontract, and further that City shall have access during normal working hours to all subcontractor facilities and shall be provided adequate and appropriate work space in order to conduct audits in compliance with the provisions of this paragraph. City shall give subcontractor reasonable advance notice of intended audits. c. Concentra agrees to photocopy such documents as may be requested by the City. City agrees to reimburse Concentra for the cost of copies at the rate published u1 the Texas Administrative Code in effect as of the time copying is performed. 10. Prohibition of Assignment: Neither party hereto shall assign, sell, convey or otherwise transfer its interest herein without the prior written consent of the other pasty, and any attempted assignment, sale, conveyance or transfer of all or any part hereof without such prior written consent shall be void. Notwithstanding, Concentra may assign this Agreement, without the prior written consent of the City, to any of its affiliates or subsidiaries or any surviving entity in the event of a merger or sale of the majority of its assets. 11. Minority and Woman Business Enterprise(M/WBE)Participation In accord with City of Fort Worth Ordinance No. 133500, the City has goals for the participation of minority business enterprises and woman business enterprises in City contracts. Concentra acla-rowledges the MVBE goal established for tlris c rrtraot;as set.e CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA 1 '•��d�� �?!5 � � s; Page 10 of 252.5 forth below, and its conumitment to meet that goal. Any misrepresentation of facts (other than a negligent misrepresentation) and/or the conunission of fraud by Concentra may result in the tenmination of this agreement and debarment from participating in City contracts for a period of time of not less than three (3)years. The established goal for this Agreement is ten percent (10%) of the value of services to be provided in Sections B and C of Appendix B. Concentra agrees to furnish on a quarterly basis such documentation of M/VWBE participation as may be reasonably requested by the City. The first quarterly report for the months of October, November and December 2004 shall be submitted on or before January 30, 2005, and each subsequent quarterly report shall be submitted at the end of the next month following the end of the quarter. 12. Nondiscrimination: Concentra covenants and agrees that it will take all necessary actions to insure that, in connection with any work under this Agreement, Concentra, its officers, agents, servants, employees, associates and subcontractors, will not discriminate in the treatment or employment of any individual or groups of individuals on the ground of race, color, religion, national origin, age, sex, sexual orientation, faimilial status or physical handicap unrelated to job performance, either directly, indirectly or through contractual or other arrangements. 13. Choice of Laws; Venue: a. This Agreement shall be construed in accordance with the internal law of the State of Texas. b. Venue for any cause of action arising out of this Agreement shall lie exclusively in Tarrant County, Texas. 14. Perfor7mance Goals: Performance Goals are established to benefit, evaluate and improve upon the efforts of Concentra throughout the term of this Agreement and any option period. The Performance Goals are established to evaluate progress, improvement, satisfaction and efficiency of services rendered for the City. Concentra shall prepare and submit to the City quarterly reports to monitor the status of the Performance Goals. Concentra and the City shall meet on a quarterly basis to review the status of the Performance Goals and discuss any issues related to such Performance Goals. On or before November ,' 0• ;;! )) ; cc�, ,; •,:'',��'' CONTRACT FOR PROFESSIONAL SERVICE ,..(�Cs�,;' :�1 CONCENTRA Page 11 of 2585 � `•?i �, �� LID' Concentra will produce an alunial report that measures its annual performance of each of the Performance Goals. On or before November lof each subsequent year that this Agreement is in effect, Concentra shall prepare and submit an annual report. In the event any one Performance Goal does not meet the performance requirements on annual basis as set forth below, Concentra shall credit the annual incentive amount related to such umnet Performance Goal against amounts due from the City for services rendered by Concentra in the month of January following the year for which such annual performance was measured. The Performance Goals are as set forth below. ANNUAL INCENTIVES Wait time Matrix-Objective: City of Fort Worth Employee will Credited Annually if not not wait for more than an average of the wait time minutes set forth reached: Expected Credit: herein to be seen(initiate service) by a healthcare professional(for Yr 1=$2500; Yr 2=$2500; both a scheduled appt. time or walk-in with appropriate Yr 3=$2500 Yr 4= $2500 authorization) Initial injuiy care wait time does not apply due to the fact that these cases will be immediately triaged and seen accordingly. Expected Time Scale: Yr.1=40 min; Yr. 2=30 min; Yr. 3=30 min; Yr. 4=30 min. Injured Worker Satisfaction-Objective: Based on city wide Credited Aimually if not satisfaction questiomzaire conducted by an independent third party, reached: Expected Credit: expected percentage reaching percentiles. Yr 1=$2500; Yr 2=$2500; Expected Satisfaction Scale: Yr.1=70%; Yr.2=75%; Yr.3=80%; Yr. Yr 3=$2500; Yr 4=$2500 4=85% Primary Care Entity Utilization Rate-Objective: Credited Aimually if not reached: Expected Credit: Concentra will seek to increase the rate at which the City of Fort Yr 1=$0.00; Yr 2=$2500; Yr Worth injured employees utilize the Primary Care Entity 3=$2500; Yr 4=$2500 (Concentra) by 5%per yr. The number of City of Fort Worth injured employees seen at the Primary Care Entity (Concentra) during the first year of this Agreement shall be the base number CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA Page 12 of 2525 u, ''�v✓'J� IJl' U LGS:;, upon which increases in firture years will be measured. Expected Utilization Rate: Yr.1=Base Year; Yr.2=+5%; Yr.3=+10%; Yr. 4=+15% 15. Multiple Counterparts: This Agreement may be executed in multiple corulterparts, each of which shall be considered to be original. 16. Independent Contractor: This Agreement will not be construed in any form or manrier to establish a partnership, joint venture or agency, express or implied, nor any employer-employee, borrowed servant or joint enterprise relationship by and among the parties. Concentra shall be an independent contractor and shall be responsible at all times for directing its employees in the course of their duties. The doctrine of respondeat superior shall not apply to the relationship between the Parties. 17. H1PAA: The parties shall comply in all material respects with all applicable federal, state and local laws and regulations, including, without limitation, the Health Insurance Portability and Accountability Act of 1996 ("HIPAA°'), in the conduct of performing their obligations tuider this Agreement. Each party agrees to abide by the policies and procedures applicable to the relationship created hereunder for the privacy and security of Protected Health Information, as such tern is defined in HIPAA. Concentra agrees to not use or further disclose Protected Health Information other than as permitted or required by this Agreement or as required by law. Concentra will assume the responsibility as a business associate in accordance with 45 CFR 164 on behalf of the City as it relates to non-occupational injury care services. In addition, Concentra shall: a. Use appropriate safeguards to prevent use or disclosure of the Protected Health Information other than as provided for by this Agreement. b. Mitigate, to the extent practicable, any harmful effect that is luiown to Concentra of a use or disclosure of Protected Health Information by Concentra in violation of the requirements of this Agreement. CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA ' Page 13 of 252-5 c. Report to the City any use or disclosure of the Protected Health Information not provided for by this Agreement. d. Ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by Concentra on behalf of the City agrees to the same restrictions and conditions that apply through this Agreement to Concentra with respect to such information. e. Make internal practices, books, and records, including policies and procedures and Protected Health Information received from, or created or received by Concentra on behalf of the City available to the Secretary of the Department of Health and Human Services or his or her designee ("Secretary"), in a time and manner designated by the Secretary determining Concentra's compliance with the Privacy Rule.. £ Provide access, at the request of the City, and in the time and manner designated by the City, to Protected Health Information in a Designated Record Set, to the City or, as directed by the City, to an Individual in order to meet the requirements murder 45 CFR 164.524. g. Make any annendment(s) to Protected Health Information in a Designated Record Set that the City directs or agrees to pursuant to 45 CFR 164.526 at the request of the City or an Individual, and in the time and manner designated by the City. h. Document such disclosures of Protected Health Information and information related to such disclosures as would be required for the City to respond to a request by all Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528. i. Provide to the City or an individual, in time and manner designated by the City, information collected in accordance with Section of this Agreement, to permit the City to respond to a request by an Individual for an accounting of disclosures of Protected Health Inforrmation in accordance with 45 CFR 164.528. j. Use Protected Health Information to report violations of law to appropriate federal and state authorities consistent with HIPAA. CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA Page 14 of 2525 � �a LL J1• Permitted Uses and Disclosures by Concentra Except as otherwise limited in this Agreement, Concentra may use or disclose Protected Health Information on behalf of, or to provide services to, the City the proper management and administration of Concentra or to cagy out the legal responsibilities of Concentra. Obligations of City of Fort Worth Provisions for the City to Inforn Concentra of Privacy Practices and Restrictions a. The City shall provide Concentra with the notice of privacy practices that the City produces for Occupational Health and Safety. b. The City shall provide Concentra with any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, if such changes affect Concentra's permitted or required uses and disclosures. c. The City shall notify Concentra of any restriction to the use or disclosure of Protected Health Information that the City has agreed to in accordance with 45 CFR 164.522. Termination for material breach of HIPAA by Concentra Upon the City's lalowledge of a material breach by Concentra, the City shall either: a. Provide an opportunity for Concentra to cure the breach or end the violation and terminate the Agreement if Concentra does not cure the breach or end the violation within the time specified by the City; b. Immediately terminate this Agreement if Concentra has breached a material tern of the HIPAA requirements of this Agreement and a cure it not possible; or c. If neither termination nor cure is feasible, the City shall report the violation to the Secretary. Effect of termination a. Except as provided in paragraph (2) of this section, upon termination of this Agreement, for any reason, Concentra shall return or destroy all Protected Health Information received from the City, or created or received by Concentra on behalf of the City. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of Concentra. Concentra shall retain no copies of the protected health Information as described in this paragraph. CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA Page 15 of 2525 b. In the event that Concentra determines that returning or destroying the Protected Health Information is infeasible, Concentra shall provide to the city notification of the conditions that make return or destruction infeasible. Upon the City's determination that Protected Health Information is infeasible, Concentra shall extend the protections of this Agreement to such Protected Health Inforination and limit fin-ther uses and disclosures of such Protected Health Inforrmation to those purposes that make the return or destruction infeasible, for so long as Concentra maintains such protected Health Information. Miscellaneous a. Amendment. The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for the City to comply with the requirements of the Privacy Rule of HIPAA. b. Survival. The respective rights and obligations of Concentra under the section "Effect of Termination" of this Agreement shall survive the termination of this Agreement. c. Interpretation. Any ambiguity in this Agreement shall be resolved to permit Concentra to comply with the Privacy Rule of HIPAA. 18. Entire Agreement: This Agreement, including its attachments and schedules, constitutes the entire tulderstand ng between the Parties, supersedes all prior written or oral understandings, and may only be changed by a written amendment executed by both Parties. The following attachments and schedules are hereby made a part of this Agreement: 1. Appendix A—Scope of Services 2. Appendix B—Schedule for Compensation 3. Appendix C-Reports - CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA Page 16 of 2525 EXECUTED on this'-1 day of 1 2004. ATTEST: CITY OF FORT WORTH l By' Martyr Hendri chard Zava a City Secretary cting Assistant City Manager Approval Recommended: CONCENTRA HEALTH SERVICES, INC. D/B/A CONCENTRA MEDICAL CENTERS Karen Marshal Director e jami, Breier Department of Human Resources en' .__' ice President of Operations Pacific Region Approved as to Form and Legality By: W. Torn F g , Clvef Me ' ficer/Servor Vice Assistant City Attorney President contract- Author' zatiola Date F-5 G p al CONTRACT FOR PROFESSIONAL SERVICE G CONCENTRA � ^.' !ar y Page 17 of 2525 Appendix `A' — Scope of Services Drug and/or Alcohol Testing a. Concentra agrees to provide drug and/or alcohol testing in accordance with 49 CFR part 40 DOT guidelines for collection, handling, testing, and reporting of results. The City will have the opportunity to identify a specific person(s) who will be eligible to receive all results of drug and alcohol testing. The City will also have the opportunity to identify one or more specific persons who will have access to all positive post accident drug screen results. b. Concentra will utilize Advanced Toxicology Network (ATN) for all laboratory testing. Concentra, at its sole cost and expense, will provide the necessary software to allow receiving test results directly from ATN. c. Concentra will subcontract its Medical Review Officer (MRO) services, and the City consents to such subcontracting. The MRO services include the random selection task. d. In the event a City employee requests testing of the `B' vial, the employee will be responsible for the cost associated with the testing before the process will be initiated. City shall not be responsible for any cost associated with this service. e. Two copies of Concentra's `Drug/Alcohol Testing Manual' will be provided to the City and delivered to the individual identified by the City prior to the effective date of this Agreement. f. Infrequent on-site drug testing (less than 4 per month) may be conducted with no on-site service charge to the City. However, if a permanent need exists, an amendment to this Agreement will be negotiated and executed in writing by the Parties. Office Hours and Locations a. Concentra will operate 4 different clinics located in Tarrant County. The primary facility designated to serve the City employees will be located at 2500 West Freeway (I-30), Suite 100. b. Beginning October 1, 2004, City employees will be able to seek treatment at any of the following locations during the hours shown: Fort Worth—Forest Park 2500 West Freeway (I-30), Ste. 100 Fort Worth, TX 76102 Hours: Monday through Friday 5:00 am to 9:00 pin Saturday 8:00 ain to 3:00 pm Sun Closed CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA Page 18 of 252-5 Fort Worth—Fossil Creek 4060 Sandshell Drive Fort Worth, TX 76137 Hours: Monday through Friday 7:00 am to 7:00 pm Saturday and Sunday Closed Fort Worth—South 1132 Evernnan Parkway Fort Worth, TX 76140 Hours: Monday through Friday 8:00 am to 5:00 pm Saturday and Sunday Closed Arlington 2100 E. Randol Mill Rd. Arlington, TX 76011 Hours: Monday through Friday 8:00 am to 5:00 pm Saturday and Sunday Closed Concentra operates medical facilities in the following cities that may also be used by City employees if the need should arise. Hours vary depending on the locations: Addison Garland Mesquite Carrollton Grand Prairie Plano Dallas (4) Irving Clinic hours are subject to change. Concentra will, in good faith, participate in discussions regarding the City's request to extend clinic hours for special needs of its employees. Reports a. Concentra will provide reports to designated City personnel on each- department as designated by the City. See Appendix C for sample reports and delivery schedule. b. All reports produced by Concentra will be provided in a timely manner (duration will be limited to specific type of report being generated). For any customized reporting, upon agreement of the parties, Concentra will formulate such reports within 30 days. Other Services a. Concentra will schedule provider visits to designated City departments to view tasks and job- duties associated with essential job fiinctions. This will allow the Concentra medical staff to develop a better understanding of the different occupations, required functional abilities, and the potential injuries that might occur. Concentra will also attend and/or conduct a presentation of various safety topics (relevance identified by the City Safety Committee and CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA Page 19 of 2525 all presentation material pre-approved by the Occupational Health and Safety Department) once a quarter at the discretion of the City and at no charge. b. If made available by Center for Disease Control and supplying vendors, Concentra will conduct on-site flu vaccinations for the City employees at the pre-approved on-site location. This will be identified and approved by the City Workers' Compensation Manager and put in writing as to place, time of delivery of service. The cost for this service will be $14.50 per person. The cost. of Flu vaccine can vary from season to season and Concentra reserves the right to increase the cost of the flu shot each year in association with the cost of the vaccine. In addition, Concentra will provide flu vaccines to one dependent spouse at the current price. The City shall determine a process for prior signage. There shall be no on-site charges for such service, other than as allowed in this paragraph. c. Concentra will assist the City with developing a Return to Work Program at no cost to the City. d. Concentra will work with the City to develop an Exposure Counseling Program for the employees of the City. e. Concentra will perform On-Site Job Analysis/Ergonomic Hazards Assessment that include identification of potential safety hazards, identification and measuring of critical dimensions and forces associated with performing a given task, and written to meet the standards of the American with Disabilities Act. All on-site services shall be approved in writing by the City's Occupational Health and Safety Manager and/or designee prior to such services being provided The cost for on-site Job Analysis would be determined by degree of involvement but shall not exceed an hourly fee of$250 per job analysis and shall be billed directly to the City's Third Party Administrator (TPA) for the service allocated as an expense to a claim with a CPT dedicated code. £ Concentra will provide Functional Capacity Evaluations upon request at the rate indicated in the Schedule for Compensation. It Billing a. All billing associated with `work-related' injuries will be directed to the City's third party administrator. The City, and if necessary in conjunction with the City's third party administrator, will set forth a plan to insure remuneration (partial or in-fiill) to Concentra for any and all `injury care' provided in good faith. (i.e. Concentra treats an injured employee of CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA Page 20 of 2525 the city, authorized by supervisor per authorization slip, and at a later date the inj-a y is denied as compensable. Since initial care was authorized by a City employee/supervisor and provided in good faith, Concentra is entitled to remuneration of services provided from initial visit to time of notification of claim denial.) b. Regarding a denied claim,payments made to Concentra for the City would not deem services provided as an acceptance of liability. c. Concentra will bill the City directly for non-inj-a y care (occupational services). The appropriate TWCC/ CPT codes, description of services and protocol will be followed as standard order during this Agreement. Concentra will be paid as described in accordance with this Agreement. I i R7-��C G°?C R"G.?CONTRACT FOR PROFESSIONAL SERVICE CONCENTRAPage 21 of 2525 �F � ,� Appendix B - Schedule for Compensation Services Cost A. Occupational Injuries: Initial Injury Visits Year One: 80%of TWCCFG Year Two: 85%of TWCCFG Year Three: 85%of TWCCFG Year Four: 90%of TWCCFG Year Five: 90%of TWCCFG Follow-up Treatment of Injuries Year One: 85%of TWCCFG Year Two: 90% of TWCCFG Year Three: 90%of TWCCFG Year Four: 90%of TWCCFG Year Five: 90%of TWCCFG B. Occupational Medical Services (Non-injury) Health Assessments Post-offer/Promotional/Return-to-worlc(RTW) $25.00 Other lab tests HIV $25.00 HIV Confirmation(Western Blot) $130 Lead Levels $50.00 Miscellaneous Tests. To be negotiated prior to request Health and Safety Education: DOT training No charge Inoculations and titers: Hepatitis A $60.00 Hepatitis A titers $60.00 Hepatitis B $55.00 Hepatitis B titers $50.00 Rabies Injections $170.00 CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA Page 22 of 2525 Rabies titers $90.00 Tetanus/Diphtheria injections $15.00 TB skin test $10.00 Hearing: Audiogrz ns $15.00 Respiratory Protection: Pulmonary Function Test $15.00 Miscellaneous Procedures & Services: Blood Pressure (only) $5.00 Worksite Visits No charge Vision Wall $5.00 Vision Titnnis $17.00 Medical Surveillance To be negotiated prior to request C. Urine/Drug Screenings. Non-Regulated and DOT Drug Screens $33.00* Random $33.00'` Post-offer/Promotional/RTW $33.00'` Post-Accident $33.00" -1. All drug screen prices include MRO review D. Other Services DOT Physicals $32.00 Flu shots $14.50 per shot Functional Capacity Evaluations $35.66 per 15 minute Increment All non-injury service pricing will be negotiated by the parties every two (2) years, with no increase in pricing to exceed 5% of the prior two (2) years pricing. CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA Page 23 of 252.5 �� � 9 YgLo ADApt Program • Initial Essential Job Function Analyses (per position) 1-8 jobs $250 each 9-20jobs $200 each 21+jobs $175 each • Pre-Placement Human Performance Evaluation TBA* • Return-to-Work Hiunan Performance Evaluation TBAI` • Pricing will be based on initial analysis per job and factor in quantity of tasks evaluated and time it takes to perform in the center. Currently, HPE's for the City are running between ) $65-$85 and will not exceed $85. Volume discotulting is available. Cost includes HPE only and does not cover physical exam and/or additional examination components. CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA Page 24 of 252.5 Appendix `C' -Reports Sample Reports are provided to indicate the content of information requested: • Activity Status Reports Injury - emailed after each injuiy/recheck/physical therapy visit Non-hljury—emailed after each non-injury visit • No show/missed appointment report- emailed at end of each day if missed appointment • Patient Referral Report- emailed at time of referral to specialist • Employer Patient Visit Report- emailed weekly • Occu300 Report- emailed weekly • Level III Utilization Report-hand-delivered quarterly and broken out by department CONTRACT FOR PROFESSIONAL SERVICE CONCENTRA Page 25 of 252-5 Appendix - Reports Claim Number: Concentra Medical Centers Service Date: 02/01/2002 1735 South Redwood Road,Suite 115 SLC,UT 84104 Case Date: 02/01/2002 Phone: (801)972-4434 Fax: (972)720-7999 Activity Status Report Patient: SSN: Address: Employer Location:, Contact:( Address: Role: Warehouse Manager Home: Phone: Ext.:' Work: Ext.: Auth.by: Fax: This Visit: Time In: 03:55 pm Time Out: 04:30 pm Recordable:Yes Visit Type: New Treating Physician: Mark Carvalho, MD Diagnosis: 924.21 Ankle Contusion-Right 719.47 Ankle/Foot Pain-Right 928.20 Crush Injury, Foot-Right Patient Status: Modified Activity - Returning for follow-up visit Restricted Activity(In effect until next physician visit): Return to work on 02/02/2002 with the following restrictions Off work rest of shift with limited activity as follows: No prolonged standing and/or walking longer than 30 Minutes No pushing and/or pulling over 5 lbs.of force Keep wound clean and dry Must wear Splint Remarks: Anticipated Date of MMI: 02/15/2002 Next Visit(s): Visit Date: Saturday February 2,2002 8:15 am Provider/Facility:Mark Carvalho, MD Activity Status Report © 1996-2001 Concentra Managed Care,Inc.All Rights Reserved. AAIEEO Employer Eevi�slrote:41•11}/200;,,' n Claim Number: Concentra Medical Centers Service Date: 06/30/2003 701 E Plano Pkwy Ste 103 Plano,TX 75074 Phone: (972)578-2212 Fax: (972)881-7666 Non-Injury Status Report Patient: SSN: Address: , Employer Location: Contact:, Address: Role: Primary Home: Phone: Ext.: Work: Ext.: Auth. by: Fax: This Visit: Time In: 09:45 am Time Out: 11:09 am Visit Type: New Physical Pre-Placement Non Regulated UDS-Pre-Placement Physicals-Pre-Placement Result Status: Able to perform essential functions No medical restrictions Remarks: ....... U'PH"Il�1 41 1 1i��>1',i J��J J U Il � Status-Non-Injury ©1996-2004 Concentra Health Services,Inc.All Rights Reserved. AA/EEO Employer Revision Date: 08/09/2001 Concentra Medical Centers 1735 South Redwood Road,Suite 115 SAC,UT 84104 Phone:(801)972-4434 Fax:(972)720-7999 Employer: Phone: Fax: Re: Employer: Location: SS#: Claim#: Injury Date: Dear This letter is to inform you that you have missed your appointment with our Medical Center. We are concerned about you and we want you to know that failure to keep your scheduled medical appointment could affect your benefit eligibility. The following appointment was missed : .at 02/02/2002 09:30 am It is our policy to notify you in writing when you miss an appointment and notify your employer and the insurance company. If you have questions or wish to reschedule, please call. Sincerely, Concentra Medical Centers cc:Adjuster a� 1rl .c 1 Jy� loyei• Concentra Medical Centers Service Date: 02/02/2002 1735 South Redwood Road,Suite 115 SLC,UT 84104 Phone: (801)972-4434 Fax: (972)720-7999 Patient Referral Referred by: Barry M. Diskant, MD Patient Information: Patient: Employer Location: Contact:t SSN: Address: Role: Address: 1 Phone: Ext.:301 Auth. by: Fax: Home Phone: Work Phone: Ext: DOi: 02/01/2002 Diagnosis: 924.21 Ankle Contusion-Right Program: 719.47 Ankle/Foot Pain-Right 928.20 Crush Injury, Foot-Right Billing Information: Carrier: CNA Insurance Billing: CNA Insurance Address:3075 E Imperial Address: 3075 E Imperial IRVINE,CA 92620 IRVINE,CA 92620 Phone: (800)262-8714 Claim#: Fax: (972)720-7999 Notes: Referred to: Centralized Referral Destination:Provider Notes: Referral: Provider Type: Physical Therapist Provider Specialty: Occupational Medicine Recommendation: Employer Notified: No Priority: Routine "NOTE TO THE ABOVE FACILITY OR PHYSICIAN: Please send a copy of all reports on this patient to the above insurance carrier,employer,and this center. D1....�....•.�.......11•........ni v_rn.•e 4..thn nh...•n•+•...4•.. r_referral © 1996-2001 Concentra Managed Care,Inc.All Rights Reserved. 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City of Fort Worth., Texas Mayor and Council Communication COUNCIL ACTION: Approved on 9/14/2004 DATE: Tuesday, September 14, 2004 LOG NAME: 14CONCENTRA REFERENCE NO.: **C-20266 SUBJECT: Authorization to Enter into an Agreement with Concentra Medical Centers as the City's Preferred Occupational Health Provider RECOMMENDATION: It is recommended that the City Council authorize the City Manager to enter a one-year agreement with Concentra Medical Centers beginning October 1, 2004, and expiring September 30, 2005, with four (4) one- year options for renewal. DISCUSSION: MedAlert HealthCare Systems, Inc. is the current provider of occupational health services for the City of Fort Worth. The City's contract with MedAlert began February 1, 2004. Some of the services provided by MedAlert HealthCare Systems, Inc. include: medical treatment for on-the-job injuries, drug and alcohol testing and counseling, pre-employment physicals and vaccinations. The contract with MedAlert expires January 31, 2005. On July 2, 2004, a temporary injunction from the courts prohibited MedAlert HealthCare Systems, Inc. from performing some of the medical contractual services to which they are obligated to perform for the City of Fort Worth. As a result, the City of Fort Worth gave notice to terminate the contract with MedAlert HealthCare Systems, Inc., effective November 30, 2004. Based on a previous competitive process of soliciting qualifications of potential occupational health care providers, staff recommends awarding the contract to Concentra Medical Centers. Concentra is a national provider and one of the largest occupational health providers in the nation. There are three clinics in Fort Worth and fourteen clinics in the metropolex. The main Fort Worth clinic is located within two miles of City Hall. The personnel at this facility will include licensed physicians and medical staff dedicated to City employees. Concentra was previously the preferred provider for the City of Fort Worth from October 1, 1997, to January 31, 2004. Concentra's services are priced on a per unit basis. It is anticipated that the cost for all services will be approximately $673,014.00 for the first contract year. The pricing for all services is listed on Appendix A. M[WBE - Concentra is in compliance with the City's MANBE Ordinance by committing to 10 percent M/WBE participation medical services for occupational injuries. The City's goal on this project is 10 percent. Logname: 14CONCENTRA Page 1 of.2. FISCAL INFORMATION/CERTIFICATION: The Finance Director certifies that funding will be available in the General and Workers' Compensation Funds contingent on the approval of the FY2004-05 City Manager's Proposed Budget. TO Fund/Account/Centers FROM Fund/Account/Centers FE73 534600 0147310 $375,000.00 FE73 539120 0147310 $237,000.00 GG01 539120 0144000 $61,000.00 Submitted for City Manager's Office by: Richard Zavala (Acting) (6183) Originating Department Head: Karen Marshall (7783) Additional Information Contact: Mark Washington (8058) Logname: 14CONCENTRA Page 2 of 2