HomeMy WebLinkAboutContract 39329_ITY
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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 municipal corporation 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., DBA CONCENTRA MEDICAL CENTERS ("CONCENTRA"), acting by and through W. Tom
Fogarty, MD, its duly authorized President and Chief Medical Officer.
1. GENERAL
1.1 CONCENTRA hereby agrees to provide the CITY, in accordance with medically necessary or
appropriate professional standards, 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 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 ensure
performance of this Agreement without hindrance.
1.3 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 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 certain
contracts entered into by the CITY for the performance of: (i) post -offer physicals for persons offered
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 panel of specialized medical professionals/physicians
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, including 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.
AGREEMENT TERM
2.1 The initial term of this Agreement shall commence on October 1, 2009 ("Effective Date") and shall expire
on September 30, 2012, unless terminated earlier in accordance with the provisions of this Agreement.
2.2 CITY shall have the sole right to renew this Agreement for two additional 1-year terms. If CITY desires to
exercise an option to renew, CITY shall notify CONCENTRA in writing of its intention to renew at least SO
days prior to the end of the then -current term. Compensation to be paid during any option term shall be
the same as that provided for in the Initial Term.
Professional Services Agreement - Occupational Health Centers of the Southwest, P.A., dba Concentra Medical 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 provided 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
desirable and agree to conduct negotiations on such additional services in good faith to arrive at
mutually agreeable terms for such additional services with respect to performance and compensation.
Any additional services will be reflected by a separate agreement or by a written amendment to this
Agreement 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
third party workers' compensation claims administrator in accordance with the Texas Labor Code and
related administrative rules. For services 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 or contested billing,
only the portion so contested will be withheld from payment, 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 contested portion of the billing; provided, however, that CITY shall 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
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.
4.2 Upon termination or expiration of this Agreement, 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 from the CITY and shall reimburse 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 with applicable law and CONCENTRA's policies as set forth in this Agreement or as
otherwise approved in advance and in writing by the CITY. Before requesting New Medical Records
from CONCENTRA, CITY shall obtain from CITY's employee (or that person's 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 therefor. Upon expiration or 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.
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PROFESSIONAL SERVICES AGREEMENT
4.4 CONCENTRA agrees that no medical records covered by the terms of this Agreement will be altered or
destroyed unless (i) the CITY has provided express written authorization and (ii) destruction 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 value to either 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 exercise appropriate care to preserve necessary and useful medical records
generated during the term of this Agreement. CONCENTRA will timely notify and solicit CITY's input
concerning any change or modification to any system or process change involving the management,
use, storage, and retention of medical records generated during the term of this Agreement
to allow the CITY to ascertain if any issues or consequences, legal, financial, or practical, are reasonably
foreseeable because of the facility or systems modifications. 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 this Agreement.
4.6 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 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 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 or reports, unless (i) the CITY has provided advance written consent and (ii) such reproduction is
otherwise permitted under applicable law. The CITY will provide a list of terminated employees annually
to CONCENTRA. CONCENTRA will separate records relating to terminated employees from other
records. The CITY may, to the extent permissible under applicable law, retrieve original copies of all
reports and records relating to terminated employees from CONCENTRA at any time.
5. MINORITY AND WOMEN BUSINESS ENTERPRISE (M/WBE) PARTICIPATION
In accord with the CITY Code of Ordinances, the CITY has goals for the participation of minority and woman
business 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 commission of fraud by CONCENTRA may result in the termination 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 non -occupational injury services
portion of the Agreement. CONCENTRA agrees to furnish, on a quarterly basis, documentation of MMBE
participation as may be reasonably requested by the CITY. The first quarterly report for the CITY's first Fiscal
Quarter (months of October, November, and December 2009) shall be submitted on or before January 31, 2010,
and each subsequent quarterly report shall be submitted at the end of the month immediately following the end of
the CITY's Fiscal Quarter.
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PROFESSIONAL SERVICES AGREEMENT
6. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT ("HIPAA"),
6.1 Compliance
In the conduct of performing their obligations under this Agreement, the parties shall comply in all material
aspects with all applicable federal, state and local laws and regulations, including, without limitation, the
Health Insurance Portability and Accountability 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 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 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 Mitigate, 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 requirements 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
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.
6.1.5 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 to determine
CONCENTRA's compliance with 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 requirements under 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 disclosures of Protected Health Information and information related to such
disclosures as would be required for the CITY to respond to a request by an individual for an
accounting of disclosures of Protected Health Information in accordance with 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 Health Information in
accordance with 45 CFR 164.528.
6.1.10 Use Protected Health Information to report violations of law to appropriate federal and state
authorities consistent with HIPAA.
6.2 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 for the proper management and
administration by CONCENTRA or to carry out the legal responsibilities 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, permission by individual to use or
disclose 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 survive the termination of this Agreement.
6.6.3 Any ambiguity in this Agreement shall be resolved to permit CONCENTRA to comply with the
Privacy Rule of HIPAA.
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PROFESSIONAL SERVICES AGREEMENT
TERMINATION
7.1 Written Notice
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 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.
7.2 Non-aoorooriation 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.
7.3 Duties and Oblioations of the Parties followina 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 completed 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 services 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 provided to it by the CITY as confidential and shall not disclose
any such information to a third 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.
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PROFESSIONAL SERVICES AGREEMENT
9. 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 examine, to the extent permissible by applicable law, at reasonable
times any directly pertinent books, documents, papers and records of CONCENTRA involving transactions
relating to this Agreement at no additional cost to the CITY. CONCENTRA agrees that the CITY shall have
access during normal working hours to all necessary CONCENTRA facilities and shall be provided adequate
and appropriate work space in order to conduct audits in compliance with the provisions of this 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 copies 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 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 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 Administrative 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 in accordance with the conditions and provisions of this Agreement, CONCENTRA shall have the
exclusive right to control the details of its operations and activities and be solely responsible for the acts and
omissions 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 RESULTING 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, obligations or rights under this Agreement without
the express prior written consent of the CITY. If the CITY grants consent to an assignment, the assignee shall
execute a written agreement with the CITY and CONCENTRA under which the assignee agrees to be bound by
the duties and obligations of CONCENTRA under this Agreement. CONCENTRA and Assignee shall be jointly
liable for all obligations 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 this
Agreement as such duties and obligations may apply. 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 shall provide the CITY's
Occupational Health and Safety Division and Risk Management Division with certificate(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 requirements 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
statutory law, court decisions, or circumstances surrounding this Agreement, but in no instance will the
CITY allow modification whereupon the CITY may incur increased risk.
13.3 CONCENTRA's financial integrity is of interest to the CITY; therefore, subject to CONCENTRA's right to
maintain 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 written on an occurrence basis, except Technology and Professional Liability, which may be
written on a claims -made basis. 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 A.M. Best Company or similar rating acceptable to the CITY. Coverage shall be written in the
following types and amounts:
13.3.1 Workers' Compensation — Statutory
Employers' Liability - $500,0001$500,0001$500,000
13.3.2 Commercial General (Public) Liability Insurance to include the following coverages:
Premises/Operations, Independent contractors, Products/Completed Operations, Personal Injury,
and Contractual Liability.
(Combined Single Limit for Bodily Injury and Property Damage $1,000,000 per
Occurrence and $2,000,000 Aggregate)
13.3.3 Automobile Liability for Owned/Leased vehicles, Non -Owned vehicles, and Hired Vehicles
(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 Technology Liability - $1,000,000 per Claim, $1,000,000 Aggregate
13.3.6 Medical 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 fails 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 with the
requirements hereof.
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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 desist 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 consideration 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 -delivered to the other party, its agents, employees, servants or representatives; (ii)
delivered by facsimile 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:
To CONCENTRA:
City of Fort Worth Concentra
Attn: Ron Josselet Attn: Jerry Francis
1000 Throckmorton 15800 Midway Road
Fort Worth TX 76102-6311 Addison, TX 75001
Facsimile: (817) 392-8654 Facsimile: (972) 720-7770
E-mail: ClarenceRon. Josselet()o,fortworthctov.orq Email: lerry francis(a)concentra.com
17. SOLICITATION OF EMPLOYEES
Neither the CITY nor CONCENTRA shall, during the term of this Agreement and additionally for a period of one
year after its termination, solicit for employment or employ, whether as employee or independent contractor, any
person 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 waive or surrender any of its
governmental powers.
Professional Services Agreement — Occupational Health Centers of the Southwest, P.A., dba Concentra Medical Centers
Page 10 of 21
PROFESSIONAL SERVICES AGREEMENT
19. NO WAIVER
The failure of the CITY or CONCENTRA to insist upon the performance of any term or provision 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
enforceability 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 applicable 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 exhibits hereto.
25. AMENDMENTS / MODIFICATIONS / EXTENSIONS
No extension, modification, or amendment of this Agreement shall be binding upon a party hereto unless such
extension, modification, or amendment is set forth in a written instrument that is executed by both parties.
Professional Services Agreement -- Occupational Health Centers of the Southwest, P.A., dba Concentra Medical Centers
Page 11 of 21
0
27.
PROFESSIONAL SERVICES AGREEMENT
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.
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.
114 WITNESS WHEREOF, the parties hereto have executed this Agreement in multiples this day of
C-' • 2009.
CITY OF FORT WORTH: OCCUPATIONAL HEALTH CENTERS OF THE
SOUTHWEST, P.A., DBA CONCENTRA
MEDICAL CENTERS:
By:
Assistant City Manager �/�orUuGLPresident a C f ica Officer
Date: /O//C� I v Date:
AT
BY .V��ty
CiSecretary
I Ii
A VED A, TO FORM AND LEGALITY:
By: I '
ist�nt C Attorney
CONTRACT AUTHORIZATION:
M&C: C-23812
Date Approved: September 29, 2009
ATTEST:
By. -
Vice President/Assistant General Counsel
Professional Services Agreement — Occupational Health Centers of the Southwest, P.A., dba Concen" Medical CentersCOR
Page 12 of 21 '. CITY SECRkT.AR
FT. WORTH, TX
PROFESSIONAL SERVICES AGREEMENT
EXHIBIT A — SCOPE OF SERVICES
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
i CITY
STATE
J
TELEPHONE
FAX
PERATING
ADDRESS
CODE
_NAME
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 pm
Fort Worth/Fossil
4060 Sandshell Dr.
Fort Worth
TX
76137
I (817) 306-9777
(817)
Mon -Fri 8:00am to 5:00
Creek Clinic
306-s7ao
pm
Fort Worth/South
1132 Everman
Fort Worth
TX
76140
I (817) 293-7311
(817)
I 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 HEALTH CARE
a. CONCENTRA will provide 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 effectively communicate and coordinate with the CITY's Return to
Work Program to ensure 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 available and
practical to the CITY. Alternatively, CONCENTRA is willing to participate and assist the CITY in
establishing 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
Page 14 of 21
PROFESSIONAL SERVICES AGREEMENT
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 will 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 ("CDL") 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 individual 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-certified technicians.
Professional Services Agreement — Occupational Health Centers of the Southwest, P.A., dba Concentra Medical Centers
Page 15 of 21
PROFESSIONAL SERVICES AGREEMENT
EXPOSURE CONTROL PROGRAM
CONCENTRA may be required to administer any existing preventative immunizations or treatments to
employees, and their immediate family members, to a disease that they may be exposed in performing
official duties in accordance with requirements under the Texas Government Code, Chapter 607. In
addition, CONCENTRA will be required to provide information and training to CITY's employees and
immediate family members about the disease and vaccine, prior to any vaccination for preventative
measure. The CITY may refer an employee to CONCENTRA following exposure to a disease for
assessment, counseling, and required medical treatment.
a. CONCENTRA will be required to administer influenza vaccines to CITY employees at designated
CITY locations. CONCENTRA will be required to provide information to each employee
regarding the vaccine to be administered, prior to the vaccination(s).
b. CONCENTRA may be required to test and monitor CITY employees exposed to noise, lead,
hazardous chemicals, or other potential hazards in the performance of their duties, and to provide
medical surveillance services in accordance with the CITY's CDL Program.
C. CONCENTRA may be required to provide any necessary counseling services relevant to urinary
drug screening, human immunodeficiency virus (HIV) testing and other health and safety related
issues associated with the CITY's workplace.
7. COMMERCIAL DRIVERS LICENSE ("CDL") PROGRAM
CONCENTRA will be required to actively participate in the CITY's CDL Program. Participation will include
provision of physical examinations that meet US Department of Labor requirements, determinations and
reporting to CITY of the condition of CITY employees to operate a commercial vehicle, issuance of
medical certification cards, and participation on the CITY's Medical Review Board for these purposes.
CONCENTRA must dedicate a Medical Review Officer ("MRO") to the CITY for purposes of
CONCENTRA's participation in the CITY's CDL Program.
8. REPORTS & VALIDATION STUDIES
CONCENTRA will continue to provide reports to CITY designated individuals in a timely manner. Specific
reports may include, but are not limited to the "Utilization Management Report", "Activity Status Report",
"Non -Injury Status Report", "Patient Referral Report", "Patient Visit Information", and the OCCU 300
Report". Reports will be generated at no additional cost to the CITY.
The CITY and CONCENTRA will share workers' compensation data for an annual Validation Study of
work related injury outcomes.
Professional Services Agreement - Occupational Health Centers of the Southwest, P.A., dba Concentra Medical Centers
Page 16 of 21
PROFESSIONAL SERVICES AGREEMENT
EXHIBIT B — SCHEDULE OF COMPENSATION
1. OCCUPATIONAL INJURY HEALTH CARE SERVICES
Service Description
Contract Year
Service Fee
Medical services/health care rendered to
CITY employees injured in the course and
*90% of the adopted Medical/Professional
scope of their employment with the CITY
Year 1
Fee Guidelines as indicated in the Texas
and provided in accordance with the Texas
Labor Code and Rules.
Labor Code and Rules.
Medical services/health care rendered to
CITY employees injured in the course and
*90% of the adopted Medical/Professional
scope of their employment with the CITY
Year 2
Fee Guidelines as indicated in the Texas
and provided in accordance with the Texas
Labor Code and Rules.
Labor Code and Rules.
Medical services/health care rendered to
CITY employees injured in the course and
*93% of the adopted Medical/Professional
scope of their employment with the CITY
Year 3
Fee Guidelines as indicated in the Texas
and provided in accordance with the Texas
Labor Code and Rules.
Labor Code and Rules.
Medical services/health care rendered to
CITY employees injured in the course and
*93% of the adopted Medical/Professional
scope of their employment with the CITY
Option Year 4
Fee Guidelines as indicated in the Texas
and provided in accordance with the Texas
Labor Code and Rules.
Labor Code and Rules.
Medical services/health care rendered to
CITY employees injured in the course and
*93% of the adopted Medical/Professional
scope of their employment with the CITY
Option Year 5
Fee Guidelines as indicated 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 HEALTH 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
Year 4
Year 5
Breath Alcohol Test
$14.00
$14.00
$14.00
$14.00
$14.00
Post Offer
Breath Alcohol Test (
$14.00
$14.00
$14.00
$14.00
$14.00
Random '
Breath Alcohol Test
$14.00
$14.00
$14.00
$14.00
$14.00
Post Accident
Breath Alcohol Test I
$14.00
$14.00
$14.00
$14.00
$14.00
Follow-up !I
Breath Alcohol Test
$14.00
$14.00
$14.00
$14.00
$14.00
Reasonable Suspicion
Professional Services Agreement — Occupational Health Centers of the Southwest, P.A., dba Concentra Medical Centers
Page 17 of 21
PROFESSIONAL SERVICES AGREEMENT
NON -OCCUPATIONAL INJURY HEALTH CARE SERVICES (Continued)
Urinary Drua Screens (UDSj
Service
Service Fee
Service Fee
Service Fee
Service Fee I
Service Fee
Description
Contract Year 1
Contract Year 2
Contract Year 3
Option Contract
Option Contract
Year 4 I
Year 5
UDS - Non Regulated
$32,00
$32.00 I
$32.00
$32.00 I
$32.00
Pre -Placement
UDS - Non Regulated
$32.00
$32.00 I
$32.00
$32,00 I
$32.00
Random
UDS - Non Regulated
$32.00
$32.00
$32.00
$32.00 I
$32.00
Post -Accident
UDS - Non Regulated
$32.00
$32.00
$32.00
$32.00
$32.00
Follow-up
I
UDS - Non Regulated
$32.00
$32.00
$32.00
$32.00
l
$32.00
Reasonable Suspicion
UDS - Regulated
$32.00
$32.00
$32.00
$32.00
$32.00
Pre -Placement
UDS - Regulated
$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 I
$32.00
Follow-up
UDS - Regulated
$32.00
$32.00 (
$32.00
$32.00 I
$32.00
Reasonable Suspicion
Phvsica! 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
Year 4
Year 5
Physical
Pre -Placement
$25.00
$25.00
$25.00
$25.00 I
$25.00
Physical - Level 2
$25.00
$25.00
$25,00
$25.00
$25.00
DOT Physical
$32.00
$32.00
$32.00
$32.00
$32.00
Pre -Placement
f
DOT Physical
$32.00
$32,00
$32,00
$32,00 I
$32.00
II Recertification
Respirator Physical
$30.00
$30.00
$30.00
$30.00
$30,00
HPE ADApt-Level 4
$65.00
$65.00
$65.00
$65.00
$65.00
Physical I
Fitness for Duty
1
$40.00
$40.00
$40.00
$40.00
$40.00
Level 2
Physical
$100.00
$100.00
$100,00 i
$100.00
I
$100.00
Medical Surveillance
Physical
Return to Work +
I
$35.00
$35.00
$35.00 I
$35.00
$35.00
I
Professional Services Agreement - Occupational Health Centers of the Southwest, P.A.,
dba Concentra Medical Centers
Page 18 of 21
PROFESSIONAL SERVICES AGREEMENT
NON -OCCUPATIONAL INJURY HEALTH CARE SERVICES (Continued)
Laboratory Testing
Service
Service Fee
Service Fee
Service Fee
Service Fee
Service Fee
Description I
Contract Year 1
Contract Year 2
Contract Year 3
Option Contract
Option Contract
Year 4
Year 5
Blood Collection
Medical Surveillance
$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 (Split 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 I
$10,00
$10.00
$10.00
$10.00 I
$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 Manual I
Microscopic
$30.00
$30.00
$30.00
$30.00
$30.00
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 I
$96.00
Screen
Blood - PCB I
$125.70
$125.70
$125.70
$125.70 (
$125.70
Blood - Hepatitis A
$60.00
$60.00
$60.00
$60.00 I
$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 Antigen
Blood - Hepatitis C
$92.35
$92.35
$92.35
$92.35
$92.35
Antibody
Blood - HIV'/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)
i
MMR Titer
$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 i
$50.00
$50.00
$50.00
$50.00 I
$50.00
Professional Services Agreement - Occupational Health Centers of the Southwest, P.A., dba Concentra Medical Centers
Page 19 of 21
PROFESSIONAL SERVICES AGREEMENT
NON -OCCUPATIONAL INJURY HEALTH CARE SERVICES (Continued)
Immunizations/Vaccines
Service
Service Fee
Service Fee
Service Fee
Service Fee
Description
Contract Year 1
Contract Year 2
Contract Year 3
Option Contract
Year 4
Rabies Vaccines/1"
$178.50
$178.50
$178.50
$178,50
Injection
Rabies Vaccines/1"
Injection
$178.50
$178.50
$178.50
$178.50
Rabies Vaccines/1"
Injection
$178,50
$178,50
$178.50
$178.50
Tetanus Toxoid
$15.00
$15.00
$15.00
$15.00
PPD (Mantoux)
$10.00
$10.00
$10.00
$10.00
TB Skin Test
$10.00
$10.00
$10.00
$10.00
Influenza (Flu Shots)
$20.00
$20.00
$20.00
$20.00
Hepatitis A Vaccine/I"
Injection
$60.00
$60.00
$60.00
$60.00
Hepatitis B Vaccine/151
Injection
$50.00
$50.00
$50.00
$50.00
Hepatitis B
$50.00
$50.00
$50.00
$50.00
Vaccine/2nd Injection
Hepatitis B
$50.00
$50.00
$50.00
$50.00
Vaccine/3rd Injection
Hepatitis B Surface
$50.00
$50.00
$50.00
$50.00
Antibody
Hepatitis A & B
$110.00
$110.00
$110.00
$110.00
Vaccine/1 Injection
Hepatitis A & B
$110.00
$110.00
$110.00
$110.00
Vaccine/1 Injection
Hepatitis A & B
Vaccine/1 st Injection
$110.00
$110.00
$110.00
$110.00
Service Fee
Option Contract
Year 5
$178.50
$178.50
$178.50
$15.00
$10.00
$10.00
$20.00
$60.00
$50.00
$50.00
$50.00
$50.00
$110.00
$110.00
$110.00
Professional Services Agreement - Occupational Health Centers of the Southwest, P.A., dba Concentra Medical Centers
Page 20 of 21
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 9
Contract Year 2
Contract Year 3
O ption Contract
Option Contract
Year 4
Year 5
Audiogram
$15.00
$15.00 I
$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
Pulmonary Function
$15.00
$15.00
$15.00
$15.00
$15.00
Test
EKG Resting
$60.00
$60.00
$60.00
$60.00
$60.00
Functional Capacity
Testing
$35.66 per 15 minutes
$35.66 per 15 minutes
I $35.66 per 15 minutes
$35.66 per 15 minutes
$35.66 per 15 minutes
OSHA Respirator
$20.00
$20,00
$20.00
I
$20.00
$20.00
Questionnaire
Respirator Fit Test
$33.00
$33.00
$33.00
$33.00
$33.00
Review of Information $15.00 $15.00 $15.00 $15.00 $15.00
Professional Services Agreement - Occupational Health Centers of the Southwest, P.A., dba Concentra Medical Centers
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PROFESSIONAL SERVICES AGREEMENT
EXHIBIT C — CONCENTRA's Response to Request for Proposal RFP No. 09-0093 Documents)
Professional Services Agreement -- Occupational Health Centers of the Southwest, P.A., dba Concentra Medical' Centers
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M&C Review
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Offit" ., . it.J o) Ne (, I! y Or;. Vvoi tE. . E'AdQ
DATE: 9/29/2009 REFERENCE C-23812 LOG NAME: 14CONCENTRA
NO.: RENEWAL
CODE: C TYPE: NON- PUBLIC CONSENT HEARING: 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 terminates
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 providers. 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 Purchasing Division received 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 services.
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://apps.cfwnet.org/council_packet/mc review. asp?ID=12290&councildate=9/29/2009 10/20/2009
M&C Review
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$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 City cannot dictate where employees receive treatment for
occupational injuries, although 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 claim
administrator (TPA) (M&C C-22526). When injured City 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 approval as long as the
City 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
City's goal on this project is 10 percent.
FISCAL INFORMATION/CERTIFICATION:
The Financial Management Services Director certifies that funds are available in the current operating
budget, as appropriated, of the Workers' Compensation Insurance Fund.
TO Fund/Account/Centers
Submitted for Citv 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://apps. cfwnet.org/council_packet/mc_review.asp?ID=12290&councildate=9/29/2009 10/20/2009