HomeMy WebLinkAboutContract 39329 (2)CITY SEC RETAR Y
CONTRACT NO . :fl~
PROFESSIONAL SERVICES AGREEMENT
This PROFESSIONAL SERVICES AGREEMENT ("Agreement") is made and entered into by and between the
CITY OF FORT WORTH (the "CITY "}, a home rule mun icipal corporat ion of the State of Texas , acting by and through
Karen L. Montgomery , its duly authorized Assistant City Manager, and OCCUPATIONAL HEALTH CENTERS OF THE
SOUTHWEST, P.A., OBA CONCENTRA MEDICAL CENTERS ("CONCENTRA"), acting by and through W. Tom
Fogarty, MD , its duly authorized Pres ident and Chief Medical Officer .
1. GENERAL
1.1 CONCENTRA hereby agrees to provide the CITY , in accordance with medically necessary or
appropriate professional standa rds , a full range of occupational health care services , as outlined in
Exhibit "A", including any attachments thereto , all of which are hereby made part of this Agreement for
all purposes . Exhibit "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 the Agreement
shall control.
1.2 CITY and CONCENTRA both recogn ize 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 ensu re
performance of this Agreement without hindrance.
1.3 Services under this Agreement will be provided at CONCENTRA's current facilities, at a subcontractor's
facil ities (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 agreed to in writing
by CONCENTRA and CITY .
1 .4 To the extent that the services to be performed under this Agreement constitute services compensable
or defined under the Texas Labor Code , as currently in effect or hereafter amended , or constitute
services performed by persons other than CONCENTRA and covered by the "Police and Fire Physical
Assessment Contracts" (hereafter defined}, both parties recognize the non-exclusive nature of this
Agreement. The "Police and Fire Physical Assessment Contracts " are defined as (a) those certa in
contracts entered into by the CITY for the performance of: (i) post-otter physicals for persons ottered
jobs by the CITY 's Police and Fire Departments; (ii) routine physical fitness assessments for persons
employed by the CITY's Police and Fire Departments; and (iii) such other matters as are contained in
such contracts , and (b) any renewals thereof.
1.5 CONCENTRA agrees to provide and maintain a pane l of specialized medical professionals/phys icians
for referral as necessary in the appropriate treatment of the CITY 's employees who are injured in the
course and scope of their employment. The panel will be composed of medical
professionals/physicians , inc lud ing but not limited to Neurologists, Orthopedists, Neurosurgeons , and
Plastic Surgeons. CONCENTRA also agrees to maintain the panel during the initial term 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 panel members as warranted .
2. AGREEMENT TERM
2.1
2.2
The initi al term of this Agreement shall commence on October 1, 2009 ("Effective Date ") and shall exp ire
on September 30 , 2012 , unless terminated earlier in accordance with the provisions of this Agreement.
CITY sha ll have the sole right to renew th is Agreement for two add itional 1-year terms . If CITY desires to
exercis~ an option to renew, CITY shall notify CONCENT~A in writing_ of its_ intention t~ renew at least 60
days pnor to the end of the then-current term . C:ompensat1on to be paid dun frg-any-e ptteA terrrrstra'II e
the same as that provided for in the Init ial Term . OFFICI L RECORD
Professional Serv ices Agreement -Occupat ional Health Centers of the Southwest , PA , dba Conce r ra ~ecl1 cal Centers
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FT. WORTH, TX
PROFESSIONAL SERVICES AGREEMENT
3. COMPENSATION
3 .1 The Parties agree the Schedule for Compensation as shown in the attached Exhibit "B" is
acceptable as the compensation to be paid to CONCENTRA for specified services prov ided to the CITY
during the initial contract period and the subsequent option periods , if exercised by the CITY. The
parties acknowledge that additional services provided by CONCENTRA to the CITY may become
des irab le and agree to conduct negotiations on such additional services in good faith to arrive at
mutually agreeable terms for such addi t ional services with respect to performance and compensation .
Any additional services will be reflected by a separate agreement or by a written amendment to this
Ag reement signed by the parties.
3.2 All medical services related to a compensable on the job injury will be submitted directly to the CITY's
th ird party workers' compensation claims administrator in accordance with the Texas Labor Code and
related adm inistrative rules . For serv ices other than treatment of compensable on the job injuries ,
CONCENTRA shall issue monthly invoices 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 o r contested billing ,
only the portion so contested will be withheld from payment , and the und isputed portion w ill be paid .
The CITY will exercise reasonableness in contesting any bill or portion thereof. No interest will accrue
on any contested portion of the billing ; provided , however, that CITY shal l make payment in full to
CONCENTRA within 60 days of the date the contested matter is resolved.
4. RECORDS AND RECORDS MANAGEMENT
4.1 CONCENTRA will adhere to and follow the governing guidelines as they pertain to the protection and
use of collected data (personal/medical information). CITY may, to the extent permissible under
app li cable law , obta in cop ies 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 .
4.2 Upon termination or expiration of th is Agreement , CONCENTRA agrees to return to the CITY , or its
des ignated agent , all medical records delivered to CONCENTRA on or about the Effective Date (the
"Pre -existing Medica l Records "). Upon receipt of authorization from the affected CITY employees or
their representatives for CONCENTRA to view and use the "Pre -Exist ing Medical Records " (wh ich
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 copy ing expense,
or may subsequently request copies thereof from the CITY and shall re imburse the CITY at the rate
published the Texas Administrative Code in effect as of the time copying is performed .
4.3 It is 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 moved or transferred from CONCENTRA except in
accordance w ith appl icable law and CONCENTRA's policies as set forth in th is Agreement or as
otherw ise a pproved in advance and in wr iti ng by the CITY . Before requesti ng New Med ical Records
from CONCENTRA, CITY shall obta in from CITY 's employee (o r tha t person 's legal rep resentative )
authorization to re lease cop ies of med ic al records in accordance w it h app li cable state and federa l law
concern ing the confident ial ity of med ical records ; prov ided , however, that CONCENTRA agrees to use
all reasonab le efforts to obta in the written consen t of each pat ient seen by CONCENTRA under this
Agreement authorizing CONCENTRA to release copies of such "New Medical Records " to the CITY
upon its request therefor. Upon expiration or termination of this Agreement, CONCENTRA shall retain
the or iginals of all "New Medical Records" in its possession , and CITY shall , to the extent permissible by
appl icab le law, have the right to receive cop ies . CITY agrees to reimburse CONCENTRA for the cost of
such copies at the rate publ ished in the Texas Admin istrative Code in effect as of the t ime copy ing is
performe d .
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5.
PROFESSIONAL SERVICES AGREEMENT
4.4 CONCENTRA agrees that no med ical records covered by the terms of th is Agreement will be a ltered or
des t royed unless (i ) the CITY has provided express written authorization and (i i) destr uct ion of such
records is otherwise permitted under applicable law. CITY recognizes that medical records will , from
time to time , cease to have administrative , financial , and/or legal va lue to e ithe r CITY or CONCENTRA,
and CITY and CONCENTRA agree to utilize appropriate records retention and destruction schedules for
the purpose of lawful and efficient records management.
4.5 CONCENTRA will exerc ise appropriate care to preserve necessary and useful medical records
generated during the term of this Agreement. CONCENTRA will timely notify and solicit C ITY's input
concerning any change or modification to any system or process change involving the management,
use, storage , and retent ion of medica l records generated du ring the term of this Agreement
to allow the CITY to ascertain if any issues or consequences , legal, financial , or practica l, are reasonably
foreseeable because of the facility or systems mod ifications . CITY and CONCENTRA agree to negotiate
in good faith to address any such issues and consequences in a manner equitable to both parties and
consistent with the purposes of th is Agreement.
4.6 All reports and records provided to CONCENTRA by the CITY shall rema in the so le property of the
CITY . CONCENTRA shall store and ma intain 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 permissib le under applicable law , shall have access to such reports and records during
CONCENTRA's normal working hours and will provide CONCENTRA with reasonable advance notice of
a need for access . CONCENTRA shall t reat 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 or reports , un less (i) the CITY has provided advance written consent and (ii) such reproduction is
otherw ise permitted under app licable law. The CITY will prov ide a list of te rminated employees annually
to CONCENTRA. CONCENTRA will separate records relating to term inated employees from other
records. The CITY may , to the extent permiss ible under appl icable law, retrieve original cop ies of all
reports and records relating to terminated employees from CONCENTRA at any time .
MINORITY AND WOMEN BUSINESS ENTERPRISE (M/WBE) PARTICIPATION
In accord with the CITY Code of Ordinances , the CITY has goals for the participation of m inority and woman
bus iness enterprises in CITY Agreements. CONCENTRA acknowledges the M/WBE goal established for this
Agreement , as set forth below , and its commitment to meet that goal. Any misrepresentation of facts (other than
negligent misrepresentation) and/or the comm iss ion of fraud by CONCENTRA may result in the term ination of this
Agreement and debarment from participating in CITY contracts for a period of time of not less than three (3)
years .
The establ ished goal for th is Agreement is ten percent (10 %) of the va lue of non-occupational injury serv ices
portion of the Agreement. CONCENTRA agrees to furnish , on a quarterly basis , documentation of M/WBE
participat ion as may be reasonably requested by the CITY. The fi rst quarterly report for the CITY 's first Fiscal
Quarte r (months of October , Novem ber , and December 2009 ) sha ll be subm itted on or before Jan uary 31 , 2 010 ,
and each subseq uent q uarterly report sha ll be subm itted at the end of the month immediate ly fo ll owing the end of
the CITY 's Fisca l Quarte r.
Profess ional Services Agreeme nt -Occupat iona l Health Ce nters of the So uthwest , PA , dba Concentra Med ica l Centers
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6.
PROFESSIONAL SERVICES AGREEMENT
HEAL TH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT ("HIPAA")
6.1 Comp li ance
In the conduct of performing their obligations under th is Agreement, the parties shall comply in all material
aspects with a ll applicable federal , sta te and local laws and regulations , including , without limitation , the
Hea lth Insurance Portability and Accountab ility Act of 1996 and any associated administrative regulations
(collectively , "HIPAA"). 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 term
is defined in HIPAA . CONCENTRA agrees not to use or further disclose Protected Hea lth Information
other than as perm itted or requ ired by this Agreement or as requ ired by law. CONCENTRA will assume
the responsib ility as a bus iness associate in accordance w ith HIPAA on behalf of the CITY as it relates to
non-occupational injury care services . In addition , CONCENTRA shall :
6.1.1 Use appropriate safeguards to prevent use or disclosure of the Protected Health Information
other than as provided for by this Agreement.
6.1 .2 Mit igate , to the extent practicable, any harmful effect that is known to CONCENTRA of the use or
disclosure of Protected Health Information by CONCENTRA in violation of the requ irements of
this Agreement.
6 .1.3 Report to the CITY any use or disclosure of the Protected Health Information not provided for by
this Agreement.
6 .1.4 Ensure that any agent, including a subcontractor, to whom CONCENTRA provides Protected
Hea lth Information received from , or created or rece ived by CONCENTRA on behalf of the CITY ,
agrees to the same restrictions and cond itions that apply through this Agreement to
CONCENTRA with respect to such information .
6.1 .5 Make internal pract ices , books , and records , including policies and procedures and Protected
Health Information rece ived from , or created or received by CONCENTRA on beha lf of the CITY
available to the Secretary of the Department of Health and Human Services or his or her
des ignee ("Secretary"), in a time and manner des ignated by the Secretary to determine
CONCENTRA's compl iance w ith HIPAA.
6 .1.6 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 requ irements unde r 45 CFR 164 .524 .
6 .1.7 Make any amendment(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.
6 .1.8 Document such d isclosures of Protected Hea lth Information and information related to such
disclosures as would be required for the CITY to respond to a request by an indiv idual for an
accounting of disclosures of Protected Health Information in accordance w ith 45 CFR 164 .528.
6 .1.9 Provide to the CITY or an individual , in time and manner designated by the CITY, information
collected in accordance with Section 4 of this Agreement , to permit the CITY to respond to a
request by an individual for an accounting of disclosures of Protected Hea lth Information in
accordance with 45 CFR 164 .528 .
6.1.1 0 Use Protected Health Information to report v iolations of law to appropriate federal and state
aut horiti es consisten t w ith HIPAA.
6.2 Perm itted Uses and Disclosures by CONCENTRA
Except as otherw ise limited in this Agreement , CONCENTRA may use or d isclose Protected Health
Informat ion on behalf of, or to prov ide serv ices to , the CITY for the proper management and
adm inistration by CONCENTRA or to carry out the legal responsibilit ies of CONCENTRA.
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PROFESSIONAL SERVICES AGREEMENT
6.3 Obligations of the CITY
The CITY shall inform CONCENTRA of Privacy Practices and Restrictions by :
6.3 .1 Providing CONCENTRA with the notice of privacy practices that the CITY produces for
Occupational Health and Safety .
6.3 .2 Providing CONCENTRA with any changes in , or revocation of, permiss ion by individual to use or
d isclose Protected Health Information , if such changes affect CONCENTRA's permitted or
required uses and disclosures .
6 .3.3 Providing notification to 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 .
6.4 Termination for material breach of HIPAA by CONCENTRA
Upon the CITY 's knowledge of a material breach by CONCENTRA , the CITY shall either:
6.4 .1 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 ;
6.4.2 Immediately terminate this Agreement if CONCENTRA has breached a material term of the
HIPAA requirements of this Agreement and a cure is not possible ; or
6.4 .3 If neither termination nor cure is feasible , the CITY shall report the violation to the Secretary.
6.5 Effect of Termination
6 .5.1 Except as provided in Section 4 , 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 also 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 .
6 .5.2 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 return or destruction of
the Protected Health Information is infeasible , CONCENTRA shall extend the protections of this
Agreement to such Protected Health Information and limit further uses and disclosures of such
Protected Health Information to those purposes that make the return or destruction infeasible, for
so long as CONCENTRA maintains such Protected Health Information .
6 .6 Miscellaneous
6 .6 .1 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 requirements of HIPAA.
6 .6 .2 The respective rights and obligations of CONCENTRA under the section 6.5 of this Agreement
shall surv ive the termination of this Agreement.
6 .6 .3 Any ambiguity in this Agreement shall be resolved to permit CONCENTRA to comply with the
Pr ivacy Rule of HIPAA.
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PROFESSIONAL SERVICES AGREEMENT
7. TERMINATION
8.
7.1 Written Notice
7.2
7.3
The CITY or CONCENTRA may terminate this Agreement at any time , with or without cause, by providing
the other party with 60 days' written notice of termination. Upon the receipt of any such notice,
CONCENTRA shall immediately discontinue all services and work and the placing of all orders or the
entering into contracts for all suppl ies, 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.
Non -appropriation of Funds
In the event no funds or insufficient funds are appropriated by the CITY in any fiscal period for any
payments due hereunder, CITY will notify CONCENTRA of such occurrence and this Agreement shall
terminate on the last day of the fiscal period for which appropriations were received without penalty or
expense to the CITY of any kind whatsoever, except as to the portions of the payments herein agreed
upon for which funds shall have been appropriated .
Duties and Obligations of the Parties following Termination
In the event that this Agreement is terminated prior to the expiration of the then current term ,
CONCENTRA shall , to the extent permissible by applicable law, provide the CITY with copies of all
completed or partially comp leted documents prepared under 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 . CITY shall pay CONCENTRA for serv ices actually rendered
up to the effective date of termination and CONCENTRA shall continue to provide the CITY with
services requested by the CITY and in accordance with this Agreement up to the effective date of
termination . If CONCENTRA's treatment of a CITY employee is commenced before the effective date
of termination of this Agreement and continues beyond that date, CITY shall continue to pay
CONCENTRA for medically appropriate services necessary to complete such treatment in accordance
with the Texas Labor Code and Administrative Rules until such care is completed . 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 documenting the performance of such work.
DISCLOSURE OF CONFLICTS AND CONFIDENTIAL INFORMATION
CONCENTRA hereby warrants to the CITY that CONCENTRA has made full disclosure in writing of any existing
or potential conflicts of interest related to services to be performed under this Agreement. In the event that any
conflicts of interest arise after the Effective Date of this Agreement, CONCENTRA hereby agrees immediately
to make full disclosure to the CITY in writing . CONCENTRA, for itself and its officers , agents and employees,
further agrees that it shall treat all information prov ided to it by the CITY as confident ial and shall not disclose
any such information to a th ird party without the prior written approval of the CITY . CONCENTRA shall store and
maintain CITY information in a secure manner and shall not allow unauthorized users to access , modify, delete ,
or otherwise corrupt CITY information in any way . CONCENTRA shall notify the CITY immediately if the security
or integrity of any CITY information has been compromised or is believed to have been compromised.
Profess ional Services Agreement-Occupational Health Centers of the Southwest, P.A ., dba Concentra Medical Centers
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9.
PROFESSIONAL SERVICES AGREEMENT
RIGHT TO AUDIT
CONCENTRA agrees that the CITY shall , until the expiration of five (5) years after final payment under this
Agreement, have access to and the right to exam ine , to the extent permissible by applicable law , at reasonable
times any directly pertinent books , documents , papers and records of CONCENTRA involving transactions
relating to th is Agreement at no add itional cost to the CITY . CONCENTRA agrees that the CITY shall have
access during normal working hours to all necessary CONCENTRA facilit ies and shall be prov ided adequate
and appropriate work space in order to conduct audits in compliance with the provisions of th is section . The
CITY shall give CONCENTRA reasonable advance notice of intended audits . CONCENTRA agrees to
photocopy such documents as may requested by the CITY . CITY agrees to reimburse CONCENTRA for the
cost of cop ies at the rate published in the Texas Administrative Code in effect as of the time copying is
performed .
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 expiration of five (5) years after final payment of the
subcontract, have access to and the right to examine at reasonable times any directly pertinent books ,
documents , papers and records of such subcontractor involving transactions related to the subcontract , and
further that CITY shall have access during normal working hours to all subcontractor facilit ies and shall be
provided adequate and appropriate work space in order to conduct audits in compliance with the prov isions of
this paragraph. CITY shall give subcontractor reasonable notice of intended audits. Subcontractor shall be
required to photocopy such documents as may be requested by the CITY . CITY agrees to reimburse
subcontractor for the cost of copies at the rate published in the Texas Adm inistrative Code in effect as of the
time copying is performed.
10. INDEPENDENT CONTRACTOR
It is expressly understood and agreed that CONCENTRA shall operate hereunder as an independent contractor
as to all rights and privileges granted herein , and not as agent, representative or employee of the CITY . Subject
to and i n accordance with the cond itions and provisions of this Agreement, CONCENTRA shall have the
exclusive right to control the details of its operations and activ ities and be solely respons i ble for the acts and
omiss ions of its officers, agents , servants , employees , contractors and subcontractors . CONCENTRA
acknowledges that the doctrine of respondeat superior shall not apply as between the CITY , its officers ,
agents , servants and employees , and CONCENTRA, its officers , agents , employees, servants , contractors and
subcontractors . Nothing herein shall be construed as the creation of a partnership or joint enterprise
between CITY and CONCENTRA.
11. LIABILITY AND INDEMNIFICATION
CONCENTRA SHALL BE LIABLE AND RESPONSIBLE FOR ANY AND ALL PROPERTY LOSS, PROPERTY
DAMAGE AND/OR PERSONAL INJURY (INCLUDING DEATH) TO ANY AND ALL PERSONS, OF ANY KIND
OR CHARACTER , WHETHER REAL OR ASSERTED, TO THE EXTENT CAUSED BY THE NEGLIGENT
ACT(S) OR OMISSION(S), MALFEASANCE OR INTENTIONAL MISCONDUCT OF CONCENTRA, ITS
OFFICERS, AGENTS , SERVANTS, OR EMPLOYEES.
CONCENTRA COVENANTS AND AGREES TO, AND DOES HEREBY, INDEMNIFY, HOLD HARMLESS
AND DEFEND THE CITY , ITS OFFICERS, AGENTS , SERVANTS AND EMPLOYEES, FROM AND AGAINST
ANY AND ALL CLAIMS OR LAWSUITS FOR EITHER PROPERTY DAMAGE OR LOSS (INCLUDING
ALLEGED DAMAGE OR LOSS TO CONCENTRA'S BUSINESS AND ANY RES UL TING LOST PROFITS)
AND/OR PERSONAL INJURY (INCLUDING DEATH) TO ANY AND ALL PERSONS, OF ANY KIND OR
CHARACTER , WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN CONNECTION WITH THIS
AGREEMENT, TO THE EXTENT CAUSED BY THE NEGLIGENT ACTS OR OMISSIONS OR
MALFEASANCE OF CONCENTRA, ITS OFFICERS, AGENTS, SERVANTS, OR EMPLOYEES.
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PROFESSIONAL SERVICES AGREEMENT
12. ASSIGNMENT AND SUBCONTRACTING
CONCENTRA shall not assign or subcontract any of its duties , obl igations or rights under this Agreement without
the express prior written consent of the CITY. If the C ITY grants consent to an assignment, the assignee shall
execute a written agreement with the CITY and CONCENTRA unde r which the assignee agrees to be bound by
the duties and obligations of CONCENTRA under this Agreement. CONCENTRA and Ass ignee shall be jointly
liable for all ob li gations under this Agreement prior to the date of assignment. If the CITY grants consent to a
subcontract, the subcontractor shall execute a written agreement with CONCENTRA referencing this Agreement
under which the subcontractor shall agree to be bound by the duties and obligations of CONCENTRA under th is
Agreement as such duties and obligations may app ly. CONCENTRA shall provide the CITY with a fully executed
copy of any such subcontract.
13. INSURANCE
13.1 Prior to commencement of any work pursuant to this Agreement, CONCENTRA sha l l prov ide the CITY's
Occupatio nal Health and Safety Division and Risk Management Div ision with cert ificate(s ) of insurance
documenting policies of the following minimum coverage limits that are to be in effect.
13 .2 The CITY reserves the right to review the insurance requ irements of this section during the effective
period of the Agreement and any extension or renewal hereof, and to modify insurance coverage and
limits when deemed necessary and prudent by the CITY 's Risk Manager based upon changes in
sta t utory law, court decisions , or circumstances surrounding this Agreement, but in no instance will the
CITY allow mod ification whereupon the CITY may incur increased r isk .
13.3 CONCENTRA's financial integrity is of interest to the CITY; therefore , subject to CONCENTRA's right to
ma inta in reasonable deductibles , CONCENTRA shall obtain and maintain in full force and effect for the
duration of the Agreement , and any extension hereof, at CONCENTRA's sole expense , insurance
coverage wr itten on an occurrence basis , except Technology and Profess iona l Liability , which may be
written on a cla ims-made bas is. All insurance required under this Agreement must be written by a
company that is authorized and admitted to do business in the State of Texas and that is rated A-VII or
better by AM. Best Company or similar rating acceptable to the CITY. Coverage shal l be written in the
following types and amounts :
13 .3.1 Workers ' Compensation -Statutory
Employers ' Liability -$500,000 / $500,000 / $500,000
13 .3.2 Commercial General (Public) Liab ility Insurance to include the following coverages:
Premises/Operations , Independent contracto rs , Products/Completed Operations , Personal Injury ,
and Contractual Liabil ity .
(Combined Single Limit for Bodily Injury and Property Damage $1,000,000 per
Occurrence and $2,000,000 Aggregate)
13.3.3 A uto mob il e Li ab ility for Ow ned /Leased veh ic les , Non -Owned veh icl es , and Hire d Veh icles
(Combined Single Limit for Bodily Injury and Property Damage $1,000,000 per accident)
13.3.4 Commercial Umbrella -$1 ,000 ,000 per occurrence $1,000 ,000 Aggregate
13.3 .5 Techno logy Liability-$1,000 ,000 per Claim, $1,000,000 Aggregate
13 .3.6 Med ical Professional Liability -$1,000,000 per medical incident and $3,000,000 Aggregate
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PROFESSIONAL SERVICES AGREEMENT
13.4 For coverage underwritten on a claims-made basis, the retroactive date shall be coincident with or prior to
the Effective Date of the Agreement and the certificate of insurance shall state the coverage is claims-
made and indicate the retroactive date .
13.5 All required insurance shall be maintained for the duration of the Agreement and for five (5) years
following completion of the service provided under the Agreement. An annual certificate of insurance
submitted to the CITY shall evidence such insurance coverage.
13.6 CONCENTRA additionally warrants that any physician providing health care to CITY employees shall
have Medical Malpractice coverage with minimum limits of $200,000 per medical incident, with a
$600,000 aggregate limit.
13.7 CITY shall be entitled , upon request and without expense, to receive copies of the policies and all
endorsements thereto as they apply to the limits required by the CITY, and may make a reasonable
request for deletion , revision , or modification of particular policy terms , conditions, limitations or
exclusions (except where policy provisions are established by law or regulation binding upon either of the
parties hereto or the underwriter of any such policies). Upon such request by the CITY, CONCENTRA
shall exercise reasonable efforts to accomplish such changes in policy coverage and shall pay the cost
thereof.
13.8 CONCENTRA agrees that with respect to the above-required insurance, all insurance contracts and
Certificate(s) of Insurance will contain the following required provisions:
13 .8.1 With the exception of Workers' Compensation and Professional Liability policies, name the CITY
and its officers , employees, officials, agents, and volunteers as additional insureds in
respect to operations and activities of, or on behalf of, the named insured performed under the
Agreement with the CITY.
13.8 .2 An endorsement stating that CONCENTRA's insurance shall be deemed primary and non-
contributory with respect to any insurance or self-insured retention carried by the CITY for liability
arising out of operations under the Agreement with the CITY.
13.8 .3 CONCENTRA's Workers' Compensation and Employers' Liability policy will provide a waiver of
subrogation in favor of the CITY .
13.9 CONCENTRA shall notify the CITY in the event of any notice of cancellation, non-renewal or material
change in coverage and shall give such notices not less than thirty(30) days prior to the change , or ten
(10) days notice for cancellation due to nonpayment of premiums, which notice must be accompanied by
a replacement Certificate of Insurance . All notices shall be given to the CITY at the following address :
City of Fort Worth
Attn : Ron Josselet, Human Resources Manager
Occupational Health & Safety/ Workers' Compensation Division
1000 Throckmorton Street
Fort Worth, Texas 76102
A copy must also be sent to the CITY 's Risk Manager at the same address .
13.10 If CONCENTRA fai ls to maintain the aforementioned insurance , or fails to secure and maintain the
aforementioned endorsements , the CITY may obtain such insurance , and deduct and retain the amount
of the premiums for such insurance from any sums due under the Agreement ; however, procuring of said
insurance by the CITY is an alternative to other remedies the CITY may have , and is not the exclusive
remedy for failure of CONCENTRA to maintain said insurance or secure such endorsement. In addition to
any other remedies the CITY may have upon CONCENTRA's failure to provide and maintain any
insurance or policy endorsements to the extent and within the time herein required , the CITY shall have
the right to order CONCENTRA to stop work hereunder, and/or the right to withhold any payment(s) that
become due to CONCENTRA hereunder until CONCENTRA demonstrates compliance w ith the
requ irements hereof.
Professional Services Agreement -Occupational Health Centers of the Southwest , P.A., dba Concentra Medical Centers
Page 9 of 21
PROFESSIONAL SERVICES AGREEMENT
13.11 Nothing herein contained shall be construed as limiting in any way the extent to which CONCENTRA
may be held responsible for payments of damages to persons or property resulting from CONCENTRA's
or its subcontractors ' performance of the work covered under this Agreement.
14. COMPLIANCE WITH LAWS, ORDINANCES, RULES AND REGULATIONS
In fulfilling its obligations under this Agreement , CONCENTRA agrees to comply with all applicable federal, state
and local laws, ordinances , rules and regulations . If the CITY notifies CONCENTRA of any violation of such laws ,
ordinances , rules or regulations , CONCENTRA shall immediately des ist from and correct the violation .
15. NON-DISCRIMINATION COVENANT
CONCENTRA, for itself, its personal representatives , assigns, subcontractors and successors in interest, as part
of the cons ideration herein , agrees that in the performance of CONCENTRA's duties and obligations hereunder, it
shall not discriminate in the treatment or employment of any individual or group of individuals on any basis
prohibited by law . If any claim arises from an alleged violation of this non-discrimination covenant by
CONCENTRA, its personal representatives , assignees , subcontractors or successors in interest, CONCENTRA
agrees to assume such liability and to indemnify and defend the CITY and hold the CITY harmless from
such claim.
16. NOTICES
Notices required pursuant to the provisions of this Agreement shall be conclusively determined to have been
delivered when (i) hand -del ivered to the other party , its agents , employees , servants or representatives ; (ii)
delivered by facs imile with electronic confirmation of the transmission ; or (iii) received by the other party by
United States Mail , registered , return receipt requested , addressed as follows :
To CITY :
City of Fort Worth
Attn : Ron Josselet
1000 Throckmorton
Fort Worth TX 76102-6311
Facsim ile : (817) 392-8654
E-mail : C larenceRon .Josse let@fortworthgov .org
17. SOLICITATION OF EMPLOYEES
To CONCENTRA:
Concentra
Attn : Jerry Francis
15800 Midway Road
Addison, TX 75001
Facsimile: (972) 720 -7770
Email: ie rry francis@concentra .com
Ne it he r the CITY nor CONCENTRA shall , during the term of th is Agreement and add itionally for a period of one
year after its term inat ion , solicit for emp loyment or employ , whether as employee or independent contractor , any
pe rson who is or has been employed by the other during the term of this Agreement , without the prior written
consent of the person's employer .
'-
18. GOVERNMENTAL POWERS
It is understood and agreed that by execution of this Agreement , the CITY does not wa ive or surrender any of its
governmental powers .
Profess io nal Services Agreement -Occupational Health Centers of the Southwest, P.A., dba Concentra Medical Centers
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PROFESSIONAL SERVICES AGREEMENT
19. NO WAIVER
The failure of the CITY or CONCENTRA to insist upon the performance of any term or provis ion of this
Agreement or to exercise any right granted herein shall not constitute a waiver of the CITY 's or CONCENTRA's
respective right to insist upon appropriate performance or to assert any such right on any future occasion .
20. GOVERNING LAW/ VENUE
This Agreement shall be construed in accordance with the internal laws of the State of Texas . If any action ,
whether real or asserted , at law or in equity, is brought on the basis of this Agreement, venue for such action shall
lie in state courts located in Tarrant County , Texas or the United States District Court for the Northern District of
Texas, Fort Worth Division .
21. SEVERABILITY
If any provision of this Agreement is held to be invalid , illegal or unenforceable, the validity , legality and
enforceabi lity of the remaining provisions shall not in any way be affected or impaired .
22. FORCE MAJEURE
The CITY and CONCENTRA shall exercise their best efforts to meet their respective duties and obligations as
set forth in this Agreement. If either party is unable, either in whole or part, to fulfill its obligations under this
Agreement due to acts of God ; strikes , lockouts , or other industrial disturbances ; acts of public enemies; wars ;
blockades; insurrections; riots; epidemics ; public health crises; earthquakes ; fires; floods ; restraints or
prohibitions by any court , board , department, commission, or agency of the United States or of any state ;
declaration of a state of disaster or of emergency by the federal , state , county , or City government in accordance
with appl icable law; issuance of a Level Orange or Level Red Alert by the United States Department of
Homeland Security ; any arrests or restraints; civil disturbances; explosions; or some other reason beyond the
party's reasonable control (collectively, "Force Majeure Event"), the obligations so affected by such Force
Majeure Event will be suspended only during the continuance of such event.
23. HEADINGS NOT CONTROLLING
Headings and titles used in this Agreement are for reference purposes only and shall not be deemed a part of this
Agreement.
24. REVIEW OF COUNSEL
The parties acknowledge that each party and its counsel have reviewed and revised this Agreement and that the
normal rules of construction to the effect that any ambiguities are to be resolved against the drafting party shall
not be employed in the interpretation of this Agreement or exh ibits hereto.
25. AMENDMENTS/ MODIFICATIONS/ EXTENSIONS
No extens ion , modification , o r amendment of th is Agreement sha ll be binding upon a party hereto unless such
extension , modification , or amendment is set forth in a written instrument that is executed by both part ies .
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PROFESSIONAL SERVICES AGREEMENT
26. ENTIRETY OF AGREEMENT
This instrument (including any exhibits and attachments hereto and any documents incorporated herein by
reference) contains the entire understanding and agreement between the CITY and CONCENTRA, their assigns
and successors in interest, as to the matters contained herein. Any prior or contemporaneous oral or written
agreement purporting to vary from the terms of this document is hereby declared null and void .
27. SIGNATURE AUTHORITY
Each person signing this Agreement hereby warrants that he/she has the legal authority to execute this
Agreement on behalf of his/her respective party , and further warrants that such binding authority has been
granted by proper order, resolution, ordinance, or other authorization of the entity. The other party is fully entitled
to rely on this warranty and representation in entering into this Agreement.
IN WITNESS WHEREOF , the parties hereto have executed this Agreement in multiples this ;(}~ day of Oc:.t. . 2009 .
CITY OF FORT WORTH:
By :~W
Assistant City Manager
Date : _---L.../~0 -1--'/;'--"'SD""-'----'='0____.7'.___
A 0 FORM AND LEGALITY:
M&C: C-23812
Date Approved: September 29, 2009
OCCUPATIONAL HEALTH CENTERS OF THE
SOUTHWEST, P.A., DBA CONCENTRA
MEDICAL CENTERS:
ATTEST:
By: __________ _
Vice President/Assistant General Counsel
------
Profe,s;onal Se,,;ce, Agceement -Occopahonal Health Centecs of the Soothwest, PA , dba Cone~"'' Oe t "CORO
Page 12 of21 I E
l . WORTH, TX \
PROFESSIONAL SERVICES AGREEMENT
EXHIBIT A -SCOPE OF SERVICES
1. CONCENTRA LOCATIONS/FACILITIES AND HOURS OF OPERATION
CONCENTRA operates fourteen (14) clinic locations in the Fort Worth/Dallas area and 300 other
locations around the United States . The CITY will primarily utilize CONCENTRA's Fort Worth locations
as seen below , but can access any other CONCENTRA location as necessary:
CONCENTRA CLINIC PHYSICAL CITY STATE ZIP TELEPHONE FAX OPERATING
NAME ADDRESS CODE HOURS
Fort Worth/Forest Park 2500 West FRWY, (817) Mon-Fri 8:00 am to 9:00
Clinic Suite 100 Fort Worth TX 76102 (817) 882-8700 882-8707 pm
Sat 8:00 am to 3 om
Fort Worth/Fossil 4060 Sandshell Dr. Fort Worth TX 76137 (817) 306-9777 (817) Mon-Fri 8:00am to 5:00
Creek Clinic 306-9780 pm
Fort Worth/South 1132 Everman Fort Worth TX 76140 (817) 293-7311 (817) Mon -Fri 8:00am to 5:00
Clinic PKWY 551-1066 pm
CITY employees will have their own entrance to the Fort Worth/Forest Park Clinic. CONCENTRA will
dedicate the back half of the Fort Worth/Forest Park Clinic for the CITY services and needs , including a
dedicated telephone number (817) 335-3320, a CITY check-in desk, a private waiting room, and two
CITY dedicated exam rooms .
2 . OCCUPATIONAL INJURY HEAL TH CARE
a. CONCENTRA will prov ide all reasonable and necessary health care to CITY's employees
injured in the course and scope of their employment with the CITY subject to the Texas Labor
Code and Rules . CONCENTRA shall specifically provide medical treatment and render services
that are in accordance with treatment and disability guidelines adopted by the Texas Labor Code
and Rules .
b. CONCENTRA will use disability duration expectancy guidelines adopted by the Texas Labor
Code and Rules in coordinating an employee's safe return to the CITY after an on the job injury.
Specifically , CONCENTRA will effective ly communicate and coordinate with the CITY's Return to
Work Program to ensu re that injured employees are safely and appropriately returned to modified
or full duty employment.
c. CONCENTRA will assist the CITY in the selection of a preferred referral panel of medical
specialists . CONCENTRA will utilize the preferred panel of medical specialists for referral
of injured CITY employees when appropriate and necessary .
d . CONCENTRA is willing participate in a workers ' compensation health care network certified
under Chapter 1305 of the Insurance Code, if the CITY determines that provision is ava ilable and
practical to the CITY . Alternatively , CONCENTRA is willing to participate and assist the CITY in
establish in g a panel of providers directly contracted in accordance with Section 504 .053 of the
Labor Code .
Professional Services Agreement -Occupational Health Centers of the Southwest, P.A., dba Concentra Medical Centers
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PROFESSIONAL SERVICES AGREEMENT
3 . DRUG AND/OR ALCOHOL TESTING
a . CONCENTRA agrees to provide drug and/or alcohol testing in accordance with 49 CFR part 40
Department of Transportation ("DOT") regulations for collection, handling , testing , and reporting
of results. The CITY will have the opportunity to identify a specific person(s) who will be
authorized to receive or access all drug and alcohol testing results. The CITY will also have the
opportunity to identify one or more specific persons who w ill have authorization and 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 access
to test results from ATN.
c . A Medical Review Officer ("MRO") must be dedicated to the CITY's account for the purposes of
CONCENTRA's participation in the CITY's Commercial Drivers License ("COL") program .
d. CONCENTRA will subcontract its Medical Review Officer ("MRO") services, and the CITY
consents to such subcontracting . The MRO services include the random selection task .
e. 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 or fees associated with this service.
f . Two copies of CONCENTRA's "Drug/Alcohol Testing Manual" will be provided to the CITY and
delivered to the indiv idual identified by the CITY prior to the Effective Date of this Agreement.
g . 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.
4. PHYSICAL ABILITY/FITNESS EXAMINATIONS OR OTHER ASSESSMENTS
CONCENTRA agrees to offer CITY Pre-Placement Physical Examinations, DOT Physical Examinations ,
Fitness for Duty Examinations, Physical Ability Testing , Physical Fitness Assessments, Medical
Surveillance Examinations, Medical and Work History Questionnaires, Clinical Testing Services ,
Immunization and Infectious Disease Screening , and Respirator Fit Testing Clearance for Post-Offer
Physicals and annual compliance .
5 . CLINICAL TESTING
CONCENTRA agrees to offer the CITY clinical testing, including but not limited to pulmonary function ,
audiometric, EKG , chest x-rays , and lumbar x-rays. CONCENTRA warrants that all equipment being
utilized for clinical testing services is calibrated prior to testing and in working order. All chest and lumbar
x-rays are performed by registered technicians . All audiometric testing will conform to the OSHA
standard 29 CFR 1910.95 and be performed by CAOHC-certifi ed technicians.
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Page 15 of 21
PROFESSIONAL SERVICES AGREEMENT
6. EXPOSURE CONTROL PROGRAM
CONCENTRA may be requ ired to admin ister any existi ng preventative immun izations o r t reatments to
employees , and the ir immediate family members, to a d isease that they may be exposed in performing
official duties in accordance with requ irements unde r the Texas Government Code , Chapter 607 . In
addition , CONCENTRA will be required to provide information and tra ining to CITY's employees and
im mediate fami ly members about the disease and vaccine , prior to any vaccination for preventative
measure . T he CITY may refer an employee to CONCENTRA follow ing exposu re to a d isease fo r
assessment, counsel ing , and requ ired medical treatment.
a. CONCENTRA will be requ ired to adm inister influenza vaccines to CITY employees at designated
CITY locat ions . CONCENTRA w ill be required to p rov ide information to each employee
regard i ng the vaccine to be adm in istered , prior to th e vacci nation (s).
b . CONCENTRA may be requi red to test and monitor CITY employees exposed to no ise , lead,
hazardous chem icals , or other potential hazards in the performance of the ir duties , and to provide
med ica l surveillance services in accordance w ith the CITY's CDL Program .
c . CONCENTRA may be requ ired to provide any necessary counseling services relevant to urinary
drug screen ing, human immunodeficiency virus (HIV) testing and other health and safety re lated
issues associated with the CITY's workplace .
7. COMMERCIAL DRIVERS LICENSE ("COL") PROGRAM
8 .
CONCENTRA will be requ ired to actively participate in the CITY's CDL Program . Participation will include
prov is io n of phys ical exam inations that meet US Department of Labor requ irements , determi nations and
reporting to CITY of the condition of CITY employees to operate a commerc ial vehicle , issuance of
medica l certificat ion ca rds , and partici pat ion on the CITY's M e dica l Review Board for these purposes .
CONCENTRA must ded ica te a Med ical Rev iew Officer ("MRO") to the C ITY fo r purposes of
CONCENTRA's participa ti on in the C ITY's CDL Prog ram .
REPORTS & VALIDATION STUDIES
CONCENTRA will continue to provide reports to CITY designated individ ua ls in a timely manner. Specific
reports may include , but are not lim ited to the "Utilization Management Report", "Activity Status Report",
"Non-Injury Status Report", "Patient Referral Report", "Patient V is it Informati on ", and the OCCU 300
Report". Reports will be generated at no add it ional cost to the C ITY.
The CITY and CONCENTRA w ill share workers ' compensation data for an annual Validation Study of
work related in j ury outcomes .
Professional Services Agreeme nt -Occupational Hea lth Centers of the Southwest, P .A., dba Concen tra Medical Centers
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PROFESSIONAL SERVICES AGREEMENT
EXHIBIT B-SCHEDULE OF COMPENSATION
1. OCCUPATIONAL INJURY HEALTH CARE SERVICES
Service Descri!;!tiOn Contract Year Service Fee
Medica l services/health care rendered to
CITY employees injured in the course and *90% of the adopted Med ical/P rofessional
scope of the ir emp loyment with the CITY Year1 Fee Gu idel ines as ind icated in the Texas
and provided in accordance with t he Texas Labor Code and Ru les .
Labor Code and Ru les .
Med ica l serv ices/health care rendered to
CITY employees injured in the course and *90% of the adopted Med ical/Professional
scope of their employment with the CITY Year2 Fee Guidel ines as indicated i n the Texas
and provided in accordance with the Texas Labor Code and Rules .
Labor Code and Rules .
Medical services/health care rendered to
CITY emp loyees injured in the course and *93% of the adopted Medical/Professional
scope of their employment with the CITY Year3 Fee Guidelines as ind icated in the Texas
and provided in accordance with the Texas Labor Code and Ru les.
Labor Code and Rules .
Med ica l serv ices/health care rendered to
CITY employees inj ured in the course and *93% of the adopted Med ical/Professional
scope of their employmen t with the CITY Option Year 4 Fee Gu idelines as ind icated in the Te xas
and provided in accordance with the Texas Labor Code and Rules .
Labor Code and Rules .
Medical services/hea lt h care rendered to
CITY employees injured in the course and *93% of the adopted Med ical/Professional
scope of the ir employment with the CITY Op tion Year 5 Fee Guidelines as ind icated in the Texas
and provided in accordance with the Texas Labor Code and Rules .
Labor Code and Rules .
*This discounted fee structure is specific to the CITY and no other TPA or PPO discounts may be applied.
2 . NON-OCCUPATIONAL INJURY HEAL TH CARE SERVICES
Breath Alcohol Tests
Service Service Fee Service Fee Service Fee Service Fee Service Fee
Description Contract Year 1 Contract Year 2 Contract Year 3 Option Contract Option Contract
Year4 Year 5
Breath A lcoho l Test $1 4 .00 $14 .00 $14 .00 $14 .00 $14 .00 Post Offe r
Breath A lcoho l Test $1 4 .00 $1 4 .00 $1 4 .00 $1 4 .00 $14 .00 Ra ndom
Breath Al coho l Test $1 4 .00 $1 4 .00 $1 4 .00 $14 .00 $14 .00 Post Acciden t
Breath Alcoho l Test $14 .00 $14 .00 $1 4 .00 $1 4 .00 $14 .00 Fo ll ow-u p
B reat h Al cohol T est $14 .00 $14 .00 $14 .00 $1 4 .00 $14 .00 Reasona ble Susp ici on
Profess iona l Services Agre em e nt -Occupa tiona l He a lth Centers of th e So uthwest , P.A., dba Concentra Medical Centers
Page 17 of21
PROFESSIONAL SERVICES AGREEMENT
NON-OCCUPATIONAL INJURY HEAL TH CARE SERVICES (Continued)
Urinary Drug Screens (UDS)
Service Service Fee Service Fee Service Fee Service Fee Service Fee
Description Contract Year 1 Contract Year 2 Contract Year 3 Option Contract Option Contract
Year4 Year 5
UDS -Non Regu lated $32 .00 $32 .00 $32.00 $32 .00 $32 .00 Pre-Placement
UDS -Non Regulated $32 .00 $32 .00 $32 .00 $32 .00 $32 .00 Random
UDS -Non Regu lated $32 .00 $32 .00 $32 .00 $32 .00 $32 .00 Post-Accident
UDS -Non Regulated $32 .00 $32 .00 $32 .00 $32.00 $32 .00 Follow-up
UDS -Non Regulated $32.00 $32 .00 $32 .00 $32 .00 $32 .00 Reasonable Suspic ion
UDS -Regulated $32 .00 $32 .00 $32.00 $32 .00 $32.00 Pre-Placement
UDS -Reg ul ated $32 .00 $32.00 $32 .00 $32 .00 $32 .00 Random
UDS -Regulated $32 .00 $32 .00 $32 .00 $32 .00 $32 .00 Post-Accident
UDS -Regulated $32 .00 $32 .00 $32 .00 $32 .00 $32.00 Follow-up
UDS -Regulated $32 .00 $32 .00 $32 .00 $32 .00 $32 .00 Reasonable Suspicion
Physical Examinations/Assessments
Service Service Fee Service Fee Service Fee Service Fee Service Fee
Description Contract Year 1 Contract Year 2 Contract Year 3 Option Contract Option Contract
Year4 Year 5
Phys ica l $25 .00 $25 .00 $25 .00 $25 .00 $25 .00 Pre-Placement
Physi cal -Leve l 2 $25 .00 $25 .00 $25 .00 $25 .00 $25 .00
DOT Physica l $32 .00 $3 2.00 $32 .00 $32 .00 $32 .00 Pre-Placement
DOT Phys ical $3 2 .00 $32 .00 $32 .00 I $32 .00 $32 .00 Re ce rt ificati on
Res pirator Phys ica l $30 .00 $30 .00 $30 .00 $30 .00 $30 .00
HPE ADApt-Level 4 $65 .00 $65 .0 0 $65 .00 $65 .00 $65 .00
Phys ica l
Fitness for Duty $40 .00 $40 .00 $4 0 .00 $40 .00 $40 .00
Level2
Phys ica l $1 00 .00 $1 00 .00 $10 0 .00 $100 00 $100 .00 Medica l Surve illance
Ph ysi ca l $35 .00 $35 .00 $35 .00 $3 5.00 $35.00 Re turn to W ork
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Page 18 of 21
I
PROFESSIONAL SERVICES AGREEMENT
NON-OCCUPATIONAL INJURY HEAL TH CARE SERVICES (Continued)
Laboratory Testing
Service Service Fee Service Fee Service Fee Service Fee Service Fee
Description Contract Year 1 Contract Year 2 Contract Year 3 Option Contract Option Contract
Year4 Year 5
Blood Collection
Medical Su_rveillance $235.00 $235 .00 $235 .00 $235.00 $235 .00
Exam
Drug Screen -Blood $160 .00 $160.00 $160 .00 $160 .00 $160 .00
Drug Screen -Re-$175 .00 $175 .00 $175 .00 $175.00 $175 .00 Test (Sp lit Specimen)
Hemoccult (in Center) $6 .00 $6 .00 $6 .00 $6 .00 $6 .00
Glucose Finger Stick $12 .00 $12 .00 $12 .00 $12 .00 $12 .00
Complete Blood Count $10 .00 $10 .00 $10 .00 $10.00 $10 .00 (CBC)
Blood Chemistry 20/23 $35 .00 $35 .00 $35 .00 $35 .00 $35.00
Hemoglobin A1C $53 .00 $53 .00 $53 .00 $53 .00 $53 .00
Hydrocar/Oxyg
Volatiles -$70.00 $70 .00 $70 .00 $70 .00 $70 .00
Blood/Urine
U/A Manua l $30 .00 $30 .00 $30.00 $30 .00 $30 .00 Microscopic
Blood-Lead $65 .00 $65 .00 $65 .00 $65 .00 $65 .00
Blood -Chloroform $123 .00 $123 .00 $123.00 $123.00 $123 .00
Blood -Formaldehyde $96 .00 $96 .00 $96 .00 $96 .00 $96 .00 Screen
Blood-PCB $125 .70 $125 .70 $125 .70 $125 .70 $125.70
Blood -Hepatitis A $60 .00 $60 .00 $60 .00 $60 .00 $60 .00 Surface Antibody
Blood -Hepatitis B $85 .00 $85 .00 $85 .00 $85 .00 $85 .00 Surface Antibody
Blood Hepatitis B $35 .00 $35 .00 $35 .00 $35 .00 $35 .00 Surface Ant igen
Blood -Hepatitis C $92 .35 $92 .35 $92 .35 $92 .35 $92 .35 Ant ibody
Blood -HIV Y:i Screen $42 .00 $42 .00 $42 .00 $42 .00 $42 .00
Blood-HIV
Confirmation (Western $60 .00 $60 .00 $60 .00 $60 .00 $60 .00
Blot)
MMR T iter $142 .00 $142 .00 $142 .00 $142 .00 $142 .00
Rabies Titer $90 .00 $90 .00 $90 .00 $90 .00 $90 .00
Hepatitis A Titer $60 .00 $60 .00 $60 .00 $60 .00 $60 .00
Hepatitis B Titer $5 0 .00 $50 .00 $50 .00 $50 00 $50 .00
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PROFESSIONAL SERVICES AGREEMENT
NON-OCCUPATIONAL INJURY HEALTH CARE SERVICES (Continued)
lmmunizationsNaccines
Service Service Fee Service Fee Service Fee Service Fee Service Fee
Description Contract Year 1 Contract Year 2 Contract Year 3 Option Contract Option Contract
Year4 Years
Rabies Vaccines/1 '1
$178.50 $178 .50 $178 .50 $178 .50 $178.50 Injection
Rab ies Vaccines/1 51
$178.50 $178 .50 $178 .50 $178 .50 $178 .50 Injection
Rabies Vaccines/1 " $178 .50 $178 .50 $178 .50 $178.50 $178 .50 Injection
Tetanus Toxoid $15 .00 $15 .00 $15 .00 $15.00 $15 .00
PPD (Mantoux) $10 .00 $10.00 $10 .00 $10.00 $10.00
TB Skin Test $10 .00 $10 .00 $10.00 $10.00 $10.00
Influenza (Flu Shots) $20 .00 $20 .00 $20.00 $20 .00 $20 .00
Hepatit is A Vaccine/1 " $60 .00 $6 0 .00 $60 .00 $60.00 $60.00 Injection
Hepatitis B Vaccine/1 51
$50 .00 $50.00 $50 .00 $50.00 $50 .00 Injection
Hepatitis B $50 .00 $50 .00 $50.00 $5 0.00 $50 .00 Vaccine/2nd Injection
Hepatitis B $50.00 $50 .00 $50 .00 $50.00 $50 .00 Vaccine/3rd Injection
Hepatitis B Surface $50.00 $50.00 $50.00 $50.00 $50.00 A ntibody
Hepatitis A & B $110 .00 $110 .00 $110 .00 $110.00 $110.00 Vaccine/1 " Injection
Hepatitis A & B $110 .00 $110 .00 $110 .00 $110.00 $110.00 Vaccine/1 " Injection
Hepatitis A & B
Vaccine/1 '' Injection $110 .00 $110.00 $110.00 $110 .00 $110 .00
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PROFESSIONAL SERVICES AGREEMENT
NON-OCCUPATIONAL INJURY HEALTH CARE SERVICES (Continued)
Other Procedures/Services
Service Service Fee Service Fee Service Fee Service Fee Service Fee
Description Contract Year 1 Contract Year 2 Contract Year 3 Option Contract Option Contract
Year4 Year 5
Audiogram $15 .00 $15.00 $15 .00 $15 .00 $15 .00
Chest X-Ray ( 1 View) $47 .00 $47 .00 $47 .00 $47 .00 $47 .00
X-Ray Interpretation $29 .50 $29.50 $29 .50 $29 .50 $29.50
Pu lmon ary Function $15 .0 0 $15 .00 $15.00 $15 .00 $15 .00 Test
EKG Rest ing $6 0 .00 $60 .00 $60.00 $60.00 $60.00
Functional Capacity $35 .66 per 15 minutes $35.66 per 15 minutes $35 .66 per 15 minutes $35.66 per 15 minutes $35 .66 per 15 minutes Te sting
OSHA Respirator $20 .00 $20 .00 $20 .00 $20 .00 $20 .00 Questionnaire
Resp irator Fit Test $33 .00 $33.00 $33 .00 $33.00 $33.00
Rev iew of Information $15 .00 $15 .00 $15.00 $15.00 $15 .00
Professional Serv ices Agreement -Occupational Health Centers of the Southwest, P.A., dba Concentra Med ical Centers
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PROFESSIONAL SERVICES AGREEMENT
EXHIBIT C -CONCENTRA's Response to Request for Proposal RFP No . 09-0093 Document(s)
Professional Services Agreement -Occupat ional Health Centers of the Southwest . P.A .. dba Concentra Med ical Centers
Page 22 of 21
M&C R ev iew
CITY COUNCIL AGENDA
DATE:
CODE:
9/29/2009
C
COUNCIL ACTION: Approved on 9/29/2009
REFERENCE
NO .:
TYPE:
C-23812
NON-
CONSENT
LOG NAME:
PUBLIC
HEARING:
Page 1 o f 2
Official s,te of the City of Fort Worth, Texas
FORTW'ORTH
14CONCENTRA
RENEWAL
NO
~
SUBJECT: Authorize an Agreement with Occupational Health Centers of the Southwest , P.A ., d/b/a
Concentra Medical Centers , as the City's Preferred Provider for Occupational Health Care
Services for an Anticipated Annual Cost of $260 ,000.00
RECOMMENDATION:
It is recommended that the City Council authorize the City Manager to execute an agreement with
Occupational Health Centers of the Southwest, P .A., d/b/a Concentra Medical Centers, for
occupational health care services with an initial three-year term and two, one-year options to renew
for an anticipated initial annual cost of $260 ,000 .00 .
DISCUSSION:
On September 14, 2004, (M&C C-20266) the City Council authorized the City Manager to execute an
Agreement with Concentra Medical Centers to provide occupational health care services for the City
effective October 1, 2004. The M&C and agreement included an initial one-year term and four, one-
year renewals . The City exercised the 4th and final year option under this Agreement that term i nates
September 30 , 2009 .
A Request for Proposals (RFP) was therefore prepared to solicit proposals from qualified providers of
these services. On May 13 , 2009 , RFP No . 09-0093 was released by the City's Purchasing Division
soliciting proposals from qualified prov iders . In addition , a pre-proposal conference was held on June
2, 2009, to provide potential respondents an opportunity to clarify or understand the scope of the
RFP . On June 18 , 2009, the Purchas ing Division rece ived three proposals in response to the RFP .
An evaluation team composed of 16 employees from the Human Resources and other departments
and a consultant with McGriff, Seibels and Williams participated in evaluating the proposals according
to evaluation criteria outlined in the RFP . The evaluation team unanimously recommended
Occupational Health Centers of the Southwest , P.A., d/b/a Concentra Medical Centers (Concentra),
based on its responsiveness to the requirements of the RFP , the M/WBE goal , the scope and cost of
services and its ability to provide necessary serv ices .
Concentra is one of the nation's leading providers of primary occupational health care services and
currently provides health care services to the City for both occupational injuries and non -injury
occupational services . Services provided include medical treatment of employees injured on the job ,
pre-employment physicals , return to work physicals , drug and alcohol screenings , vaccinations,
United States Department of Transportation physicals, medical surveillance and other related
services .
The agreement contemplated by this M&C would only address medical services that do not relate to
treatment of occupational injuries. Examples of these services include pre-employment physicals
and vaccinations . Fees for these services are billed directly to the City . There is no guaranteed
amount for this contract since services are billed according to the amount of services that are actually
required . However, it is anticipated that the cost of these services for Fiscal Year 2009/2010 will be
http ://a pps.cfwnet.org/ council _packet/me _review .as p?ID= 12290&councildate=9/29 /2009 10 /20/2009
M&C R ev iew P age 2 of 2
$260 ,000.00 .
Concentra also offers medical treatment for workers' compensation occupational injuries to City
employees in accordance with the Texas Labor Code and Rules . Fees for these services are not be
included in this M&C because the C ity cannot dictate where employees receive treatment for
occupational injuries , a lthough the City can designate a preferred provider. Services for treatment of
occupational injuries are not billed directly to the City but instead are billed to and paid on behalf of
the City by CCS Consulting , LP , the City's contracted workers' compensation third party cla i m
administrator (TPA) (M&C C-22526). When injured C ity employees receive medical treatment for
occupational injuries from Concentra and the services bill through the TPA , Concentra, as the City's
designated preferred provider, offers a discount below State-established medical fee schedules.
The proposed agreement would provide for an initial three-year term and two , one-year options to
renew . Exercising the renewal options would not require specific City Council approva l as long as the
C ity Council has appropriated sufficient funds to satisfy the City' s obligations during the renewal
term.
Occupational Health Centers of the Southwest, P.A., d/b/a Concentra Medical Centers , is in
compliance with the City 's M/WBE Ordinance by committing to 22 percent M/WBE participation . The
C ity's goal on this project is 10 percent.
FISCAL INFORMATION/CERTIFICATION:
The Financial Management Services Director certifies that funds are ava ilable in the current operating
budget , as appropriated , of the Workers' Compensation Insurance Fund.
TO Fund/Account/Centers
Submitted for City Manager's Office by:
Originating Department Head:
Additional Information Contact:
ATTACHMENTS
FROM Fund/Account/Centers
FE73 539120 0147310 $260 ,000.00
Karen Montgomery (6222)
Karen Marshall (7783)
Ron Josselet (8058)
http ://a pp s.cfwnet.o rg/co un ci l_packet/m c _rev iew .asp ?ID= 12290&counc ild at e=9/29/2009 10/20/2009