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HomeMy WebLinkAboutContract 63467CSC No. 63467 MEDICALLY HOME MOBILE INTEGRATED HEALTHCARE PROVIDER AGREEMENT This Mobile Integrated Healthcare Provider Agreement (the "Agreement") is entered into as of the I" day of July, 2025 (the "Effective Date"), by and between Medically Home Group, Inc. (hereinafter called "MHG") and the City of Fort Worth (the "Provider"). Provider and MHG shall be collectively referred to as the "Parties," and individually as a "Party," as the circumstances require. WHEREAS, the Parties entered into a Rapid Response Provider Agreement for Transportation Services dated May 4`h, 2022 ("Transportation Agreement"); and WHEREAS, MHG has entered, or will enter, into a services agreement with customers (e.g., hospital systems and provider groups) (collectively, "Customer"), pursuant to which MHG will assist with Customer's efforts in coordinating in -home care services, which services may include the services that Provider is licensed and qualified to provide; and WHEREAS, Provider, being duly registered and appropriately licensed as required by the state of Texas, agrees to establish a provider -patient relationship with and provide, furnish, and supply the Community Paramedic Services and supplies described in Exhibit A (the "Services") to patients receiving such coordinated care ("Patients"); NOW THEREFORE, in consideration of the mutual covenants and agreements of the parties set forth in this Agreement, the receipt and sufficiency of such consideration being hereby acknowledged, the parties agree as follows: 1. ENGAGEMENT OF SERVICES. a. Services. Provider shall provide the Services described in Exhibit A to Patients as arranged for by MHG pursuant to this Agreement and shall, for each such Patient, establish a provider -patient relationship, and provide the Services in accordance with (1) accepted professional standards of practice, (2) the service level expectations described in Exhibit A, (3) the in -home processes and health and safety requirements described in Exhibit B, and (4) the terms of this Agreement. Provider represents and warrants to MHG that the performance of this Agreement will not interfere with or violate the terms of any other agreement that Provider may have. b. Participation in Medicare and Medicaid Programs. Provider hereby represents and warrants that, to the best of Provider's knowledge, Provider and any Provider staff or personnel, contracted or employed by Provider, who provide Services under this Agreement are not and at no time have been sanctioned by or excluded from participation in any federally funded health care program, including Medicare and Medicaid. Provider hereby agrees to immediately notify MHG of any threatened, proposed, or actual sanction or exclusion from any federally funded health care programs of which it becomes aware, including Medicare and Medicaid, or any investigation of Provider or Provider staff by such a program. OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Mobile Integrated Healthcare Provider Agreement Page I of 23 City of Fort Worth and Medically Home Group, Inc. ii. To the extent applicable to the Services, Provider is and will remain a participant in the Medicare program in compliance with all applicable Centers for Medicare and Medicaid Services ("CMS") conditions of participation and is and will remain accredited by an approved accreditation entity and will maintain such accreditation during the Term of the Agreement. C. Provider Qualification. Provider represents, warrants, and covenants that, at all times during the Term, Provider and all employed or contracted Provider staff and personnel shall, as applicable to Provider's Services provided, satisfy all of the following minimum qualifications: (i) have a current and unrestricted license to practice his or her profession in each state where Services will be provided; (ii) be authorized by the federal Drug Enforcement Agency and state agency equivalent to prescribe legal drugs; (iii) be a participating provider in such healthcare programs maintained by private or governmental payers as designated by MHG; (iv) be a member in good standing with appropriate privileges of the medical staff of such facilities as designated by MHG; (v) be board certified or board eligible in Provider's specialty; (vi) not be under threat of disciplinary action or not be expelled, suspended, or finally disciplined by any professional or scientific organization including, but not limited to, any specialty certifying board. As to Provider, Provider represents warrants, and covenants that, at all times during the Term; (i) Provider has not been convicted of any crime punishable as a felony or of any crime involving moral turpitude or immoral conduct, or entered a plea of nolo contendere; (ii) that Provider has never had its privileges restricted or revoked by any professional practice entity or health care facility (including a hospital), been disciplined for any reason by any state licensing board, or been convicted, reprimanded, or otherwise sanctioned under any healthcare program maintained by a private or governmental payer; and (iii) has necessary and requisite training and skill and will devote such time and effort as needed to perform the Services in a competent, efficient, safe, professional, and satisfactory manner, consistent with accepted standards of practice for Provider's agency and the Services provided, in cooperation with MHG, and in compliance with MHG procedures and protocols. Provider will provide documentation to MHG demonstrating compliance with the foregoing upon request. Notwithstanding any other provision to the contrary, if at any time an employee or contracted staff of Provider is deemed, in MHG's sole judgment, to be unacceptable to MHG, Provider shall, upon receiving notice from MHG, immediately replace the individual with another employee or member of their staff who is acceptable to MHG. d. State and Federal Laws. Provider represents, warrants, and covenants that, throughout the Term of this Agreement, Provider will, and shall cause its employees and contracted personnel to, at all times provide Services in accordance with all applicable federal, state, and local laws, rules, and regulations, and the standards of any and all governmental authorities and regulatory and accreditation bodies applicable to Provider and MHG and to the provision of the Services. In addition, Provider represents and warrants that no employee of MHG whose position enables him/her to influence any purchase or other transaction as a result of this Agreement, and no MHG employee's spouse or economic dependent of such employee, shall be employed in any capacity by Provider, or have any other direct or indirect financial interest in any transaction resulting from this Agreement. e. HIPAA and Medical Record Keeping. Provider shall create and maintain an accurate record of all Services provided by Provider to Patients in connection with this Agreement Mobile Integrated Healthcare Provider Agreement Page 2 of 23 City of Fort Worth and Medically Home Group, Inc. and provide a copy of such information as permitted by HIPAA (as defined below) and applicable state privacy laws. The parties shall abide by all applicable federal, state, and local laws, rules, regulations, and standards with respect to clinical recordkeeping and maintenance of the confidentiality and security of medical records and personal information, and the handling, storage, transmission, and release of such information. The parties agree to comply with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and regulations promulgated thereunder from and after the compliance date of such requirements, and/or any other applicable federal and state privacy and/or security requirements and to execute any necessary agreements (e.g., a HIPAA compliant business associate agreement) memorializing the parties' obligations to comply with such requirements relating to the Services provided pursuant to this Agreement. f. Insurance. At all times during the term of this Agreement, Provider shall maintain insurance in the amounts and in accordance with the requirements of Exhibit C. Alternatively and the above notwithstanding, Provider is a governmental entity under the laws of the state of Texas and pursuant to Chapter 2259 of the Texas Government Code, entitled "Self -Insurance by Governmental Units," and in compliance with Section 25 Texas Administrative Code Section 157.11 may elect to self -insure. And, in fact, Provider is self - insured and therefore is not required to purchase insurance. Provider will provide a letter of self -insured status as requested by Vendor. g. Compliance with Policies and Procedures. After review and approval by Provider, Provider shall comply with all agreed upon policies, protocols and procedures developed pursuant to the collaboration between MHG and its Customers related to the delivery of Services, care coordination, recordkeeping requirements, and visit scheduling. Provider shall maintain appropriate records and reports, including clinical summaries and progress notes, as applicable, including as required in Section 1.e., above, and notify MHG promptly of any significant developments or changes in any Patient's clinical status or behavior, including adherence to the care/treatment plan or protocol. Provider will adhere to all applicable payer and state law requirements related to professional supervision, evaluation, and coordination of personnel. Each quarter, Provider shall confirm to MHG the absence of certain events. These events include, but are not limited to, any incident relating to Provider's provision of Services that may be need to be reported to any state or federal agency; any incident causing Provider to be reported to any state or federal agency; any disciplinary action relating to provision of Services concerning any Provider, or any of its employees or subcontractors, taken by any state or federal agency responsible for clinician licensing, certification or the payment for professional services; any adverse final disposition of any claim, suit, disciplinary action, criminal or administrative proceeding, or investigation relating to the provision of the Services by Provider; any disciplinary action or restriction of privileges concerning any Provider imposed by any hospital, payer or other entity or agency relating to the provision of the Services; loss of credentialing by or participation with any commercial payers; and any incident relating to the provision of the Services that may cause MHG to be reported Mobile Integrated Healthcare Provider Agreement Page 3 of 23 City of Fort Worth and Medically Home Group, Inc. to any state or federal agency or any disciplinary action concerning the Provider taken by any state or federal agency responsible for licensing or certification of the Provider. h. Use of Subcontractors. Provider may not, without the express written approval of MHG, use or delegate any of the Services hereunder to a subcontractor or delegate. 2. COMPENSATION AND PAYMENT. a. If eligible to enroll in Medicare, Provider agrees as a condition of entering into this Agreement, it will be and remain a properly and currently enrolled Medicare fee for service (traditional Medicare) provider and a participating provider with such other health plans and payers as MHG shall require. b. Compensation for Services furnished by Provider under this Agreement shall be made in accordance with the requirements described in Exhibit D. At the end of each calendar year, Provider may request an adjustment in any or all of the rates on Exhibit D to take effect with a minimum 60 day advance notice. If the parties are unable to reach an agreement on an increase, either party may invoke the one -hundred -and -eighty (180) day notice period for termination under Section 9(b) below and such period shall run from the date of the request for an increase in the rates. In the event Provider provides notice of a price increase pursuant to terms of this Agreement, and MHG refuses such price increase, Provider may terminate pursuant to the one -hundred -and -eighty (180) days advance written notice. In such event, however, such new pricing shall take effect sixty (60) days from MHG's receipt of notice of such price increase through the termination date, in an amount not to exceed 115% of the then current pricing. C. The parties acknowledge and agree that the fees and compensation to be paid by MHG to Provider pursuant to this Agreement do and will represent the fair market value for the Services provided by Provider, have been and will be negotiated in an arms -length transaction, and have not been and will not be determined in a manner that takes into account the volume or value of any referrals or other business otherwise generated between the parties. The parties to this Agreement specifically intend to comply with all applicable laws, rules, and regulations, including the federal anti -kickback statute (42 U.S.C. 1320a- 7b), the related safe harbor regulations and the Limitation on Certain Physician Referrals, also referred to as the "Stark Law" (42 U.S.C. 1395 (n)). Accordingly, no part of any consideration paid hereunder is a prohibited payment for the recommending or arranging for the referral of business or the ordering of items or services; nor are the payments intended to induce illegal referrals of business. d. Provider represents it is aware of the federal and state false claims laws, administrative remedies, and employee rights and protections available under the federal and state false claims laws. 3. PAYMENT IN FULL AND HOLD HARMLESS. For all Medicare and other fee for service Patients which Provider bills directly pursuant to Section 1 in Exhibit D hereto, Provider agrees to accept its separately billed collections as payment in full for the Services rendered to such patients under this Agreement. For other Patients, Provider agrees to accept the applicable rate set forth in Mobile Integrated Healthcare Provider Agreement Page 4 of 23 City of Fort Worth and Medically Home Group, Inc. Exhibit D as payment in full for its Services that are billed to, and paid in full by, MHG. Provider hereby agrees that if MHG or Medicare pays Provider's agreed upon fees in full, the Provider will not bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against Patients or any other third party, except for copays and deductibles. Provider further agrees that (1) this section shall survive the termination of this Agreement regardless of the cause giving rise to such termination and shall be construed to be for the benefit of the Patients, and (2) this section supersedes any oral or written agreement to the contrary now existing or hereafter entered into by Provider and the Patients, or persons acting on the Patient's behalf, unless otherwise provided in this Agreement. 4. NON-DISCRIMINATION. In the performance of this Agreement, the parties will not discriminate or permit discrimination against any person or group of persons on the grounds of race, color, sex, age, religion, national origin, or other protected class in any manner prohibited by federal or state laws. 5. ACCESS TO RECORDS. If applicable, for the purpose of implementing Section 1861(v)(1)(I) of the Social Security Act, as amended, and any written regulations thereto, Provider agrees to comply with the following statutory requirements governing the maintenance of documentation to verify the cost of Services rendered under this Agreement: Until the expiration of four years after the furnishing of such Services pursuant to such Agreement, Provider shall make available, upon written request by the Secretary of Health and Human Services, or upon request by the Comptroller General of the United States, or any of their duly authorized representatives, this Agreement, and books, documents and records of such that are necessary to certify the nature and extent of such costs; If Provider carries out any of the duties of this Agreement through a subcontract, with a value or cost of $10,000 or more over a twelve-month period, with a related organization, such subcontract shall contain a clause to the effect that until the expiration of four years after the furnishing of such Services pursuant to such subcontract, the related organization shall make available, upon written request to the Secretary of Health and Human Services, or upon request by the Comptroller General of the United States, or any of their duly authorized representatives, the subcontract, and books, documents and records of such organization that are necessary to verify the nature and extent of such costs; and If Provider is required to disclose any books, documents and records relevant to this Agreement for the purpose of an audit or investigation, Provider shall notify MHG of the nature and scope of the request. 6. RELATIONSHIP BETWEEN PARTIES. None of the provisions of this Agreement are intended to create nor shall be deemed or construed to create any relationship between the parties other than that of independent entities contracting with each other hereunder solely for the purpose of affecting the provisions of this Agreement. Neither of the parties, nor any of their employees shall be construed to be the agent, employer, or representative of the other. MHG shall not withhold or in any way be responsible for the payment of any federal, state, or local income or occupational taxes, F.I.C.A. taxes, unemployment compensation or workers' compensation contributions, vacation pay, sick leave, retirement benefits, professional licensing fees, or any other payments for Mobile Integrated Healthcare Provider Agreement Page 5 of 23 City of Fort Worth and Medically Home Group, Inc. or on behalf of Provider or its employees. A failure of MHG to perform under this Agreement shall not relieve Provider of its obligations to Patients. 7. CONFIDENTIALITY AND NON -DISCLOSURE. The parties acknowledge and agree that in the course of performance under this Agreement a party may have access to certain confidential information belonging to the other party and the receiving party agrees not to directly or indirectly disclose such information, this Agreement or the terms and conditions herein, including but not limited to, all schedules and financial terms to any third party and to treat such information as strictly confidential. However, this shall not include disclosures as required by law, provided such disclosures are limited to the extent required by law, disclosures to persons who are regularly in the business of providing legal or business advice to the parties and who have been informed of and have agreed to abide by the covenant set forth herein. The receiving party shall take reasonable precautions against disclosure of any of the confidential information to unauthorized persons by any of its officers, directors, employees, or agents. The parties agree that the breach of this provision will cause irreparable harm for which money damages may not be adequate. The parties therefore agree that the non -breaching party may pursue other remedies available to it. Upon termination of this Agreement for any reason, the receiving party shall cease all use of any of the confidential information and shall return to the disclosing party any copies thereof. This paragraph will survive termination of this Agreement. 8. INDEMNIFICATION. To the extent permitted by law, Provider and MHG (each an "Indemnifying Party") each agree to defend, indemnify and hold the other, and its subsidiaries, affiliates, directors, officers, employees, and agents (each an "Indemnified Party") harmless from any and all losses, actions, claims, suits, judgments, awards, damages, liability, and costs including attorney's fees, arising from any breach of this Agreement or any fraud, willful misconduct or negligent act or omission of the Indemnifying Party or its employees and agents, including claims and suits in which it is claimed that an Indemnified Party is also or partially at fault (but in such cases, only to the extent that it is claimed that the Indemnifying Party is at fault). The obligations of the parties under this Section shall extend beyond the expiration or termination of this Agreement. Nothing in the provision shall otherwise limit or waive any other defense or immunity otherwise available to Provider or its agents and employees. In no event will this provision be interpreted so as to require the Provider to establish a sinking fund and in no event will the Provider establish a sinking fund. 9. TERM; TERMINATION. a. Term. This Agreement will commence on the Effective Date and continue until terminated as provided herein ("Term"). b. Termination without Cause. This Agreement may be terminated at any time, without cause upon one -hundred -and -eighty (180) days' written notice by any party to the other at the address set forth in the Notice paragraph, sent certified or registered mail, return receipt requested. C. Termination with Cause. This Agreement may be terminated for cause in the event of a material breach of any provision of this Agreement by either party. The non -breaching party shall give written notice of the material breach to the breaching party containing a Mobile Integrated Healthcare Provider Agreement Page 6 of 23 City of Fort Worth and Medically Home Group, Inc. specific statement describing the material breach. The breaching party shall have ten (10) days from the receipt of such notice to correct the material breach. Should the breaching party fail to correct the material breach, the non -breaching party may immediately terminate this Agreement effective at the end of said ten (10) day period. d. Exclusion from Government Programs. Provider represents that, to the best of its knowledge, neither it nor any of its directors, trustees, officers, employees, or contractors providing Services under this Agreement have been convicted of a criminal offense related to healthcare, barred, suspended, declared ineligible, or excluded from participating with Medicare, Medicaid or any other governmental plan or program that provides health benefits, whether directly through insurance or otherwise, which is funded directly, in whole or in part, by the United States Government or any State health care program. This shall be an ongoing representation during the Term of this Agreement. If Provider or any of the individuals listed above is excluded from participation in any federally funded health care program during the Term of this Agreement, or if at any time after the Effective Date of this Agreement it is determined that Provider is in breach of this section, this Agreement shall, as of the effective date of such exclusion or breach, automatically terminate. Provider shall indemnify and hold MHG harmless against all loss, damage, costs, and expenses, including reasonable attorneys' fees, arising directly or indirectly out of Provider's exclusion from a Federal Health Care Program or any breach of this section. e. Third Partv Beneficiaries. Provider expressly and acknowledges that MHG's Customers accessing Services hereunder are third party beneficiaries of the Agreement, and as such receive the benefit of the rights and remedies of MHG, including the right to enforce any and all of the provisions of the Agreement against Provider. Notwithstanding the foregoing, it is understood that MHG's Customers will not have any duties under this Agreement or any liabilities arising therefrom. Except as set forth above, this Agreement is not intended to confer any rights or remedies hereunder upon, and shall not be enforceable by, any person or entities other than MHG's Customers accessing Services. f. Effect of Termination. Upon the expiration or termination of this Agreement, no party shall have any further obligation hereunder except for obligations due and owing that arose prior to the date of termination and obligations, promises, or covenants contained herein which expressly or by their nature extend beyond the term of this Agreement. 10. NOTICE. Any notice required to be given pursuant to this Agreement shall be in writing and sent certified or registered mail to the other party at the address listed below: Send to MHG: Medically Home Group, Inc. Attn: Chief Executive Officer 500 Harrison Ave. Boston, MA 02118 Send to Provider at: City of Fort Worth Mobile Integrated Healthcare Provider Agreement Page 7 of 23 City of Fort Worth and Medically Home Group, Inc. Attention: City Attorney 100 Fort Worth Trail. Fort Worth, TX 76102 Either party may, at any time, change or amend its address for notification purposes, by mailing a notice as required hereinabove, stating the change and setting forth the new address. The new address shall be effective on the date specified in such notice, or if no date is specified, on the tenth day following the date such notice is received. 11. PRIOR AGREEMENT. This Agreement is not intended to amend, restate, or replace that certain Transportation Agreement between the parties dated on or around May 4, 2022. 12. MISCELLANEOUS PROVISIONS. a. Severabilitv. If any one or more of the provisions of this Agreement is deemed invalid, illegal, or unenforceable in any respect, the validity, legality, and enforceability of the remaining provisions of this Agreement shall not be affected or impaired. If necessary, the parties hereto shall meet to agree upon an amendment or modification to this Agreement to replace the unenforceable or invalid provision. b. Entire Agreement. There are no other agreements or understandings, either oral or written, between the parties affecting this Agreement except as otherwise specifically provided for or referred to herein. This Agreement cancels and supersedes all previous agreements between the parties relating to the subject matter covered by this Agreement. C. Amendments. This Agreement may be amended at any time by mutual agreement of the parties, provided that before any amendment shall be operative or valid, it shall have been reduced to writing and signed by both parties. d. Assi2mnent. Provider may not assign its rights and/or duties hereunder, directly or indirectly by operation of law or otherwise, without the prior written consent of MHG. MHG may assign all or part of its interest hereunder to an organization affiliated with MHG without obtaining the prior written consent of Provider. e. Binding Effect/Effectiveness. This Agreement shall be binding upon and inure to the benefit of the parties hereto and their respective successors and permitted assigns. Notwithstanding anything herein to the contrary, neither this Agreement, nor any amendment hereto, shall become effective unless approved in writing by MHG. Strict Performance. No failure by either party to insist upon the strict performance of any covenant, agreement, term, or condition of this Agreement, or to exercise a right or remedy shall constitute a waiver. No waiver of any breach shall affect or alter this Agreement, but each and every covenant, condition, agreement, and term of this Agreement shall continue in full force and effect with respect to any other existing or subsequent breach. f. Choice of Law. This Agreement shall be governed by the laws of the State of Texas without regard to its conflict of laws provisions. The venue of any litigation arising from this Agreement will be in the United States District Courts, Fort Worth Division of the Northern District of Texas if the litigation arises in Federal Court or in the District Courts of Tarrant Mobile Integrated Healthcare Provider Agreement Page 8 of 23 City of Fort Worth and Medically Home Group, Inc. County, Texas if the litigation arises in State Court. The venue of any dispute resolution activity shall be in Fort Worth, Tarrant County, Texas. g. Counterparts. This Agreement may be executed in any number of counterparts each of which shall be deemed to be an original, but all of which when taken together shall constitute one and the same instrument. A signature page received by facsimile or other electronic transmission shall be deemed an original. h. Survival. Provisions of this Agreement which, by their terms or by reasonable implication, are to be performed after the termination or expiration of this Agreement shall survive the termination or expiration of this Agreement. IN WITNESS WHEREOF, the parties have executed this Agreement to be effective as of the day, month, and year first written above. FORT WORTH: CONTRACT COMPLIANCE n' MANAGER: J�`•^� By signing I acknowledge that I am the William J,6hnson (Jun 17, 2025 12:04 CDT) By: person responsible for the monitoring and Name: William Johnson administration of this contract, including Title: Assistant City Manager ensuring all performance and reporting Date: 06/ 17/2025 requirements. APPROVAL RECOMMENDED: By: 4� Name: Brenda Ray Title: Purchasing Manager By: Jame Davis (Jun 17, 2025 09:37 CDT) Name: Jim Davis Date: Title: Fire Chief Date: APPROVED AS TO FORM AND LEGA"TY� _ ATTEST: By: f jC n Name: Taylor Paris ((� e y C � � fORT�9.10 °A Title: Assistant City Attorney P°8 o y� >ezps =0 B °°o*°. o.°a aan 44p Name: Jannette Goodall °°an Date: OFFICIAL RECORD Title: City Secretary CITY SECRETARY FT. WORTH, TX Date: CONTRACT AUTHORIZATION: M&C: 25-0531 6.10.2025 Mobile Integrated Healthcare Provider Agreement Page 9 of 23 City of Fort Worth and Medically Home Group, Inc. FACILITY: By: Jessica din (Jun 13, 2025 168 EDT) Name: Jessica Landin Title: Chief Operating Officer Date: 06/13/2025 Mobile Integrated Healthcare Provider Agreement Page 10 of 23 City of Fort Worth and Medically Home Group, Inc. EXHIBIT A — SERVICES MOBILE INTEGRATED HEALTHCARE Provider will provide the following Mobile Integrated Healthcare Services: Service Description Admission Manage in home patient admission process Test all equipment and train patient on how to use the home Home Technology technology equipment. Provide home tech install, service, and de -install services as needed. Provider agrees to stock, maintain, deliver and administer MHG designated formulary of medications, supplies and equipment. Medication, Supply, Equipment MHG is responsible for the additional cost of medications not in Formulary Provider's standard MIH formulary. The Parties mutually agree to have Provider stock non -formulary medications, supplies or equipment in specific quantities on an agreed upon number of trucks included in Exhibit E. Home Safety Evaluation Complete home safety checklist to confirm that the patient's home is a safe place for care. Monitor and Evaluate Key Wellness Key vital signs: Weight, blood pressure, peak flow, temperature, Indicators etc. Testing for diseases or infections Including but not limited to Strep, flu, urinary tract infection ECG Monitoring, 4 & 12. Lead acquisition and transmission. Deliver all kinds of oxygen therapy from supplemental care via a nasal cannula to more extensive care using CPAP or BiPAP (patient's device) delivery devices. Nebulized medications can Oxygen Therapy also be delivered. Medics are also trained in deep tracheal suctioning. Each car carries: - Oxygen Concentrator as provided by MHG - 02 tanks Medication Administration Medics are able to gain IV and 10 access if needed as well. Point of care testing Provide point of care (POC) testing Done with the patient under the direction of their physician. As a part of this service, if medication need to be obtained at a local Medication Reconciliation/Reviews pharmacy, the medics can pick up/deliver medications to patients who are unable to obtain the medications through other means. Medics are trained in basic wound care and will work with other Wound care clinical staff to monitor progress and provide care to those patients recovering from pressure wounds etc. Mobile Integrated Healthcare Provider Agreement Page 11 of 23 City of Fort Worth and Medically Home Group, Inc. HOME TECH SERVICES Provider will enter the patient home and provide the following Services: 1. Provider will assemble each tech kit and register the kit components in MHG's software platform. 2. Provider will store MHG tech kits at its facility, assembled, cleaned, tested, and ready to deploy. 3. Provider will periodically inspect tech kits to confirm they remain ready for deployment. 4. During admission, Provider will install tech kits in the Patient's home, test tech kits to ensure all components are functional and will assist clinician in training each patient before leaving the home. 5. At the completion of an admission, Provider will provide a summary of the admission in the format required by MHG. 6. Provider will store and maintain backup components and supplies (batteries, cables, etc.) as recommended by MHG. 7. Provider will collect MHG tech kit from the Patient's home when requested, and shall clean and reprocess the kit as required by MHG before returning to storage. 8. Provider will maintain proper inventory of all home tech kits and supplies notifying MHG when items need to be replaced or serviced. 9. Provider will provide the first level of triage technical support for installers and kits in market. Mobile Integrated Healthcare Provider Agreement Page 12 of 23 City of Fort Worth and Medically Home Group, Inc. IUIIIKiel 170[11151Do toDo0 ►IVA04W:T"; 04Old IBiel I 1. Provider shall be available twenty-four (24) hours per day, seven (7) days per week, 365 days per year for fulfillment of Service requests. 2. A "Visit" shall be one of the following types of visits that result in an associated charge under the terms of this Agreement. a. hi -home Services Visit: An In -home Services Visit includes the travel to the Patient's home along with the bundle of Services scheduled to be provided during the Visit performed in the home. For example, if medical reconciliation, infusion of medication, and a lab draw are performed, this shall count as one (1) Visit and result in one (1) patient care record. In -home Services shall be charged at 100% of the Visit charge. This charge also includes any associated documentation time. ("hi -Home Services Visit") b. Non -Ambulance Transport Visit. If mutually agreed upon by Provider and MHG in writing the Parties may implement Non -Ambulance Transport. A Non -Ambulance Transport Visit is any visit where Provider transports the Patient from point A to point B. This may include transport from hospital to home or from home back to hospital for procedure/testing. If Provider must wait for the Patient and transport the Patient for a return trip as part of the Services, the Non -Ambulance Transport Visit will be charged for both legs of the trip. ("Non -Ambulance Transport Visit" or "MIH Transport Visit"). The Non -Ambulance Transport Visit is strictly restricted for Non -Ambulance Transport for patients that do not require medical attention or supervision for transport, as directed by the qualified healthcare professional "QHP". c. Logistics Service Visit: A Logistics Services Visit includes Services that originate from or terminate at a location other than the location where Services are provided to the Patient ("Logistics Service Visit"). For clarification, this is not an In -home Services Visit. By way of example, the pick-up of paperwork from the command center prior to proceeding to the home shall count as one (1) Logistics Service Visit and the delivery of a specimen to the brick -and -mortar lab following the patient in - home services shall count as an additional one (1) Logistics Services Visit. Services shall not include any items which regulatory approval, licenses, permits and/or certifications are required. 3. Provider shall fulfill all MHG request for Mobile Integrated Health Services and Home Technology Installation and De -installation Services, which may include, admission install, deinstall, tech support, and emergency home tech relocation (to support a patient relocation). within the Service Delivery Response Time determined by MHG. Service Delivery Response Time timeframes shall be defined as follows: a. One Hour Response or Acute Rapid Response ("ARR") defined as- one (1) hour or less from request being made by MHG; or b. Four Hour Response defined as no more than four (4) hours from receipt of request. If MHG communicates a Clinical Window, as defined herein, Provider response will be in compliance with that Clinical Window timeframe; or c. Patient Admission defined as — two (2) hours or less from receipt of request; or d. Pre -scheduled Admission — Admission scheduled for a specific time that is greater than two (2) hours from time of request; or e. De -installation Service, Same Day or Next Day Advanced Scheduled Visit defined as - As scheduled at specified time for either the same day or a future date with at least four (4) hours or more advance notice. Mobile Integrated Healthcare Provider Agreement Page 13 of 23 City of Fort Worth and Medically Home Group, Inc. 4. Provider shall fulfill 95% of all MIH Service requests within the Response Time determined by MHG, measured on a rolling 90-day basis. 5. Response Time begins when the initial request for services is made by MHG and accepted by Provider and ends when the Provider arrives at the Patient's home or designated location. 6. A request will be considered made by MHG if the request includes i) the Services required ii) the specified location of the Services, and iii) the requested arrival time. A request is considered accepted when Provider's dispatch center confirms that Provider can and will respond to the request within the requested timeframe. 7. A Clinical Window start and/or stop time may be provided when the request is given. The Clinical Window is defined as the earliest time that it is acceptable to clinically administer Services and/or the latest time that Services can be clinically administered ("Clinical Window"). 8. Arrival Window will be no earlier than the Clinical Window start time if one is provided by MHG and no later than the Service Delivery Response Time stated for One Hour Response or Acute Rapid Response, Four Hour Response, Patient Admission, and Pre -scheduled Admission. For Routine Scheduled Visits, the Arrival Window will not be more than 30 minutes prior and 30 minutes after the scheduled appointment unless otherwise determined by the Customer and Medically Home. 9. Provider agrees to accept a minimum of 90% of all MHG service requests originating within a zip code that is all or partially contained in one of Provider's member jurisdictions. Provider may accept other calls as resources permit. 10. Provider shall provide MHG with appropriate contacts and process to communicate and address service escalations. Escalation contacts shall be available twenty-four (24) hours per day, seven (7) days per week, 365 days per year. Provider shall provide advance notification to MHG of any changes to key contact personnel or contact methods where possible. 11. MHG and MHG Customer reserve the right to reschedule or cancel Services as necessary. Such changes to scheduled services shall not incur the agreed upon cancellation fee unless those changes are made less than one hour prior to the scheduled service time and would place an undue burden upon Provider. Provider's failure to respond or acknowledge a request for rescheduling or cancellation made more than one hour prior to the scheduled service time will result in a waiver of the cancellation fee. 12. Provider will communicate all Patient related Service issues promptly, as defined herein, including but not limited to any changes in ability to provide Services to Patient within the Service call visit. Changes in Patient condition shall be reported immediately, as defined herein. Any other changes to the requested Service shall be reported to the command center within one (1) hour of referral receipt or as soon as possible after appointment is scheduled. Reporting times are defined as follows: a. Promptly — during the course of the Service call or at check out from service call. b. Immediately —as soon as reasonably practicable after discovery but not more than one (1) hour after discovery, and within the Service Call Visit. c. Forthwith — without delay upon discovery. 13. Provider shall use MHG and MHG Customer's safety processes to follow up with MHG and MHG Customer regarding any safety events. At a minimum, Provider will notify MHG and MHG's Customer as listed below: a. Forthwith in any event related to the death of a Patient. Mobile Integrated Healthcare Provider Agreement Page 14 of 23 City of Fort Worth and Medically Home Group, Inc. b. Immediately in instances of major or severe harm event, defined as a change in condition that: may be life threatening if not treated; may be permanent; may require admission to a hospital; and/or may require major intervention including, but not limited to, intubation or blood product transfusion. c. All other safety events must be reported to the command center promptly, before and/or during checkout, whether or not the event resulted in Patient harm. d. MHG acknowledges that Provider personnel are required by Texas statute to report potential incidents of abuse or neglect to the appropriate state authorities. Provider's personnel shall complete Mandated Reporter activities in a timely fashion. Provider agrees to advise MHG in the event of any such report within 24 hours. If the situation poses a risk of immediate harm, Provider personnel shall notify law enforcement and their supervisor. Provider's management team shall notify the command center within one (1) hour of departure from the patient's home. MHG shall grant an additional one (1) hour extension on this requirement when the situations so justify. 14. MHG acknowledges that the Provider's Office of the Medical Director (OMD) has authorized Provider personnel to follow the reasonable medical instructions provided by Customer's physicians in Customer's command center. Pursuant to Texas law, and MAEMSA protocol, these instructions must be given by a physician. The MHG command center will provide Provider personnel with the name of the physician authorizing the medical care at the time the instructions are provided. 15. In the event Provider determines that an MHG Patient being assessed is experiencing an acute medical condition, Provider's medics shall follow the medical protocols established by the Metropolitan Area EMS Authority (MAEMSA) Office of the Medical Director (OMD) and promptly inform MHG of the protocols followed. 16. Provider will package and label any specimen collected in accordance with MHG requirements and place the specimen in the MHG designated location at the patient's home. 17. Provider personnel shall wear standard Provider uniform and identification, as well as other identification agreed upon with MHG and MHG Customer. Provider shall clearly communicate the identity of the company its personnel represent and their purpose upon arrival. 18. Provider must bill MHG in accordance with MHG's billing requirements, which include, but are not limited to, submitting bills through electronic data interchange (EDI) to MHG's designated agent. 19. Provider must comply with the service communication process required by MHG for checking in with the assigned medical command center and checking out with the assigned medical command center. 20. Provider will complete any needed documentation in accordance with MHG policies and procedures and submit such documentation to MHG within four (4) hours of the provision of Services. 21. Provider shall participate in a quarterly program review with MHG. Provider shall also be promptly available to discuss any performance challenges or failures, and to discuss performance improvement opportunities outside of the quarterly review, as needed. 22. Provider and MHG shall define service level quality metrics to be measured and reported quarterly by MHG. Such metrics shall include: a. On time arrival within defined arrival window b. Check in and check out compliance c. Order acceptance rate d. Service cancelation rate and no shows Mobile Integrated Healthcare Provider Agreement Page 15 of 23 City of Fort Worth and Medically Home Group, Inc. e. Average MHG service rating f. Compliance to on -time document submission g. Additional metrics as reasonably requested or agreed upon 23. MHG may, at its discretion, audit or otherwise conduct reviews of Provider's provision of Services under this Agreement. MHG shall measure the provision of Services by Provider and Provider's personnel according to both industry standards, and, where applicable, standards and policies used by MHG to evaluate its own staff. Provider shall cooperate fully with MHG including, but not limited to, providing any and all documents, materials, or other information reasonable requested to complete such audits or reviews. Further specifications regarding performance metrics may be mutually agreed upon by the parties. 24. Provider agrees to ensure all staff providing Services are trained on proper handling of specimens, medications, and biohazards. 25. Provider agrees to provide HIPAA and privacy training to all staff as required by Federal guidelines. 26. Provider shall ensure that prior to any of Provider's employees providing Services to MHG Customer's patients are trained on all relevant Service Level Agreement requirements. 27. Provider shall be available to attend Customer meetings or attend training sessions, as reasonably requested by MHG or MHG Customer. Mobile Integrated Healthcare Provider Agreement Page 16 of 23 City of Fort Worth and Medically Home Group, Inc. EXHIBIT B PROCESSES AND HEALTH AND SAFETY REOUIREMENTS As applicable, Provider will adhere to the following required practices: For Provider personnel who enter the home of a Patient, Provider shall encourage the following of such personnel unless prohibited by law: a. A negative tuberculosis test and/or x-ray done prior to admission to the patient's home, Provider personnel must be screened for latent or active TB infection, via PPD skin testing or interferon gamma release assay ("IGRA"), or a normal chest x-ray within the past year if the skin test history is positive. Such TB testing shall be repeated in cases of known exposure, as recommended by the CDC. b. Annual seasonal influenza immunization. c. Hepatitis B vaccine. d. MMR vaccine. e. COVID-19: As an EMS agency, Provider is not a facility covered by the CMS Interim Final Rule (86 FR 61555, Nov. 5, 2021). As a local government entity in the State of Texas, Provider is barred from mandating COVID-19 vaccines for its employees by the executive orders of the Governor Greg Abbot (GA-38 and GA-40). £ Provider shall require that all personnel providing Services under this Agreement wear a surgical mask or higher -level respirator approved by the National Institute of Occupational Safety and Health (NIOSH), such as an N95 filtering facepiece respirator, at all times, with no exceptions, while in the home of a Patient. g. Provider will maintain documentation of all of the above and such proof shall be made immediately available to MHG upon request. 2. Provider shall ensure that any Provider personnel entering the home of a patient: a. Perform proper hand hygiene each time they enter and exit a Patient home by washing their hands thoroughly with waterless, alcohol -based hand sanitizer or soap and water. b. Read and abide by any designated transmission -based precaution signage found at Patient door. c. Supply and don proper PPE prior to entry into Patient home. 3. Provider shall ensure that no personnel experiencing the following symptoms of a contagious infection process shall enter the home of Patient, including but not limited to: a. Fever; b. cough; c. runny nose; d. diarrhea; e. vomiting; f. rash; g. discharge from the eyes; and h. other health concerns will refrain from entering the patient's home. Mobile Integrated Healthcare Provider Agreement Page 17 of 23 City of Fort Worth and Medically Home Group, Inc. 4. Provider has in place a mechanism to review the Office of Inspector General (OIG) exclusion lists upon initial hire, and monthly thereafter, and System for Award Management (SAM) and Office of Foreign Assets Control (OFAC) exclusion lists upon initial hire, and annually thereafter to ensure that no employee, contractor, volunteer, consultant, or governing body member responsible for administering or delivering Services is excluded from federal health care programs and if Provider identifies an individual as being on such list(s), the Provider take appropriate corrective action immediately, including removing the individual from providing Services hereunder and notifying MHG. 5. Provider has performed and will maintain an ongoing process to perform statewide and Federal Bureau of Investigation background checks and required state background studies to the extent applicable on all Provider personnel. Provider will not utilize any personnel who do not have a satisfactory background check. 6. Provider represents and warrants that it has in place a drug screening program for all Provider personnel such that each individual is required to pass a drug screening test before hire and is thereafter either subject to (a) random screening or (b) subsequent drug screening upon reasonable suspicion of drug usage. Provider will not utilize personnel who do not pass drug screening. 7. Provider shall provide validation that the above requirements are being continuously met and maintained by each employee though one of the following methods: a. Credentialin2 Delegation. Provider shall provide documentation to MHG of the processes used to validate employees. For so long as Provider continues to meet or exceed the requirements described herein, MHG may delegate any and all credentialing responsibility to provider. Should Provider fail to provide or meet the requirements set forth herein, MHG shall notify Provider of such a deficit. Provider shall have seven (7) days from receipt of notice to cure any deficits in credentialing process. Failure to cure within seven (7) days may result in cessation of Services and Service calls under this agreement until such time that Provider can cure the defect in process. Provider agrees participate in a Pre -Delegation assessment allowing MHG determine if Provider screening and credentialing processes meet the requirements. During this process Provider shall provide to MHG its documented policies and procedures pertaining to pre -employment screening, credentialing review, and ongoing monitoring. The policy must include well defined processes for any Personnel entering the home of a Patient under the terms of this Agreement. Such policies and procedures shall include the following elements: The types of Personnel to credential and recredential. The verification sources used by Provider. The criteria for credentialing and recredentialing. The process for making credentialing and recredentialing decisions. The process for managing credentialing files that meet the organization's established criteria. The process for notifying employees if information obtained during the organization's credentialing process varies substantially from the information they provided to the organization. • The process for securing the confidentiality of all information obtained in the credentialing process, except as otherwise provided by law. • The process for oversight of the credentialing policies, controls, and compliance. Mobile Integrated Healthcare Provider Agreement Page 18 of 23 City of Fort Worth and Medically Home Group, Inc. • The process for ongoing monitoring of credentials between recredentialing cycles to include Sanction review, license limitations, complaint investigation, adverse event review and reporting, intervention process for quality issues. i. Provider shall provide a list of all employees that have been verified by the above process for meeting all requirements with a signature of the person who verified the qualification. ii. Provider shall provide evidence of immunization, verification of appropriate background and drug screening, and any testing or licensing requirements, as required under this agreement, through a random sampling of Personnel upon request by MHG ("Audit"). Audits shall occur at least annually. iii. M G shall collect Audit and credentialing materials provided by Provider upon request. Such materials shall be considered highly confidential shall not be shared or made available except as evidence of proper credentialing to MHG Customer. iv. All Provider Personnel who enter the home of a Patient must be verified to ensure that they meet all requirement as described under the terms of this Agreement, prior to entry. Provider shall, upon execution of this Agreement, and at least annually upon request, provide the following to MHG. b. Direct Credentialin2. For providers that cannot meet the above delegated credentialing requirements, the Provider shall require Provider's Personnel to undergo MHG's credentialing process for all employees prior to entering a Patient's home to perform Services. Provider must present MHG with a list of Personnel who may enter the home of a Patient and their email addresses for enrollment into MHG's third -party confidential credentialing service. Individual Personnel shall individually consent to such credentialing by following the link sent by MHG's third -party credentialing service through a secured portal. Personnel will be required to upload documentation and evidence of above described requirements to meet MHG's credentialing requirements. The third -party credentialing service shall notify MHG if Personnel return a passing result. While MHG may inform provider of the pass/fail status of individual personnel, any information or reports generated from the credentialing process shall be strictly confidential and may be returned to the individual Personnel. Provider shall not assign any employee to Service until Provider has been notified that employee has passed the credentialing process. 8. Notwithstanding any other provision to the contrary, if at any time Provider Personnel who has not passed either Direct or Delegated Credentialing, Provider shall, upon receiving notice from MHG, immediately replace the individual with another employee or member of their staff who is acceptable to MHG. Such Excluded Personnel shall not be scheduled for future Service calls for MHG without express approval from MHG. In the event that Provider uses Excluded Personnel for a Service calls, replacement personnel shall be expedited at Provider's own cost. For avoidance of any doubt, MHG will not reimburse Provider for any Service calls performed by Personnel who have not sufficiently passed either Delegated or Direct Credentialing without express written permission from MHG. Mobile Integrated Healthcare Provider Agreement Page 19 of 23 City of Fort Worth and Medically Home Group, Inc. 1*14111:311IKO INSURANCE REOUIREMENTS Commercial or Comprehensive General Liability insurance in an amount not less than one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) annual aggregate covering any and all damage to property or injury to persons arising from performance of the work under this Agreement. 2. For itself and each of its employees, contractor personnel and agents Professional Liability insurance in the amount of at least one million dollars $1,000,000 per occurrence and three million dollars $3,000,000 in the aggregate. 3. Worker's Compensation insurance and Employer's Liability insurance of at least: Worker's compensation statutory limits for employer liability: i. - each employee $1,000,000 Bodily Injury by Accident ii. - each employee $1,000,000 Bodily Injury by Disease iii. - policy limit $1,000,000 Bodily Injury by Disease 4. Automobile liability insurance with a minimum combined single limit of $1,000,000. Cyber and Network Security Liability coverage with a minimum limit of $2,000,000. 6. All insurance policies required shall be issued by companies authorized to transact business in the state of Texas. 7. If any insurance required by this Agreement is written on a claims made basis, Provider warrants that any retroactive date under the policy shall precede the Effective Date of this Agreement; and that either continuous coverage will be maintained or an extended reporting period will be exercised for a period of three (3) years beginning at the time Services under this Agreement are completed. Upon request, Provider shall furnish a certificate or certificates of insurance coverage for the above prior to the Effective Date and annually thereafter. Should any of such policies be cancelled or materially changed during the Term, Provider will provide thirty (30) days' prior written notice to MHG. To the fullest extent permitted by law, MHG shall be named as an additional insured on all policies of insurance for liabilities assumed by Provider under the Agreement, including, but not limited to general liability, automobile liability and umbrella coverages. Mobile Integrated Healthcare Provider Agreement Page 20 of 23 City of Fort Worth and Medically Home Group, Inc. EXHIBIT D - COMPENSATION 1. MHG shall pay Provider for Services, equipment, and supplies in accordance with the fee schedule set herein. Provider will bill MHG within sixty (60) days following the date of service. Unless otherwise instructed, or required by applicable law, Provider will submit bills to MHG using appropriate and current coding and data fields acceptable to MHG. The current MHG invoicing requirements are attached hereto and are subject to change by MHG by providing advance notice to Customer. MHG will make payment to Provider within sixty (60) days after MHG receives an undisputed invoice. In the event MHG receives a bill for Services more than 60 days after the Services were rendered, MHG may refuse payment. If MHG does not pay within 60 days, a late payment fee equal to 2% of the outstanding balance shall accrue monthly until the balance is paid. In the event that MHG receives an invoice more than thirty (30) days after the provision of services, MHG has the right to refuse payment. 2. Provider will submit clinical documentation as required by the Service Level Agreement set forth herein. In order to remit payment Provider must submit clinical documentation, which adheres to CMS documentation requirements and is complete, accurate, and authenticated, no later than Forty -Eight (48) hours from the date of provision of Service or Seventy -Two (72) hours if timeframe spans over a weekend. In the event MHG receives clinical documentation that is deemed insufficient, incomplete, inaccurate, or unauthorized documentation ("Insufficient Documentation"), MHG may refuse payment provided that MHG has given notice to Provider of Insufficient Documentation and Provider has not provided additional documentation to MHG within three (3) business days of notice. If payment is made by MHG for Service where documentation is later deemed to be Insufficient Documentation by MHG, Customer, or any third Party or government payor after payment has been made to Provider, MHG reserves the right to offset future payments by the same amount paid for such Services with Insufficient Documentation. 3. Provider may once per calendar year beginning in 2026 request an increase to rates by providing at least sixty (60) days prior written notice. Such written notice shall include the effective date of the increase and the specific new rates for all applicable services. [Fee Schedule on next page] Mobile Integrated Healthcare Provider Agreement Page 21 of 23 City of Fort Worth and Medically Home Group, Inc. FEE SCHEDULE: 1. Fee schedule for Services shall be $195.00 per Visit. Visit shall include the travel to the home along with the bundle of services scheduled to be provided during the Visit performed in the home. For example, if med reconciliation, infusion of medication, and a lab draw are performed, this shall count as one (1) Visit and result in one (1) patient care record. This charge also includes any associated documentation time. ("Visit") 2. The Parties have agreed to the per Visit rate based on historical Visit duration average data. In the event that more than 40% of Visits exceed two (2) hours in length, the Parties agree to revisit the fee schedule to either adjust per Visit rate or establish tiered rates based on Visit type average duration of Visit. Any fee schedule changes shall follow the process defined in Section 2(b) of this Agreement. 3. In the event that any Visits exceed four (4) hours from arrival to departure, Provider may Invoice MHG an additional overage charge. Additional time would be invoiced in fifteen (15) minute increments beginning at the four (4) hour mark, calculated as the Visit rate divided by six (6) per fifteen (15) minutes. For example, Visit rate $195 divided by 6 = $32.50 per fifteen (15) minutes. 4. Home Depot Services costs have been built into the per Visit charge. Provider shall not invoice any additional charges for Home Depot Services. 5. Per Visit fees include the use of equipment, supplies, and Provider formulary medications. Each Provider vehicle providing Services shall carry medications, as set forth in Exhibit E, which are not currently part of Provider medication formulary but are required as part of MHG's formulary ("Program Formulary Medications"). a. As Program Formulary Medications are administered to Patients or expire, Provider shall invoice MHG at Provider's cost plus 10% for the Program Formulary Medications necessary to replenish stock. b. Provider will include detail on the invoices which will include which patient Program Formulary Medication was administered to that required the reorder charge or if reorder is caused by expiration, clearly identify that the charge is for expired Program Formulary Medication. c. Provider will, upon request or at a routine cadence the Parties mutually agree upon, generate utilization reports to allow the Parties to reassess list of the Program Formulary Medications. d. For the avoidance of doubt, medications which are part of Provider's standard formulary and not listed on the Program Formulary Medications will not be charged to MHG, as the cost of such medications is included in the Visit fee. 6. Cancellation Fee: If Visit is cancelled by MHG after Provider has deployed a vehicle then Provider may charge a $75.00 cancellation fee. If Visit is cancelled by MHG after Provider arrival, then Provider may charge a $150.00 cancellation fee. Mobile Integrated Healthcare Provider Agreement Page 22 of 23 City of Fort Worth and Medically Home Group, Inc. EXHIBIT E — PROGRAM FORMULARY MEDICATIONS Diltiazem 25 mg/5 ml diltiazem 25mg/5mL (5mL vial) Isosorbide Dinitrate 2 x 5mg tabs Nitroglycerin 2% topical packets Labetalol 100 mg tablet 2 tabs Metoprolol 5 mg/5 ml 3 vials Metoprolol Tartrate 25 mg tablet 4 tabs Analgesics/Pain Medications Ibuprofen 200 mg tablet 4 tabs Lidocaine 2% topical Hydromorphone 1mg/mL 1 syringe Morphine Sulfate 4mg/mL 1 syringe Anticholinergic/Antihistamine Diphenhydramine 25 mg capsule Famotidine 20mg inj Meclizine 25mg tabs 2 caps 1 vial 2 tabs Antiemetic Metoclopramide 10mg/2mL Corticosteroid Prednisone 3 x 20mg tabs Antiepileptic Lorazepam 4 mg vial 2 vials; kit with NS vial Electrolytes/Fluids Potassium Chloride 10mEq/100mL premix IVPB Potassium Chloride 20 mEq oral packet 2 packets Lactate Ringers 1 liter bag 1 bag Sodium Chloride 0.9% 250 ml bag 2 bags Sodium Chloride 0.9% 1 liter bag 2 bags Antibiotics Cefazolin 2 gm 2 x 1gm vials (1gm or 2gm dose) Cefepime 2 gm for injection 2gm vial Ceftriaxone 1 gm for injection 2x 1gm vials (can give 1gm or 2 gm) Metronidazole 500 mg/100 ml 0.9% NACL Premix bag Piperacillin - Tazobactam 3.375 gm/50 ml 0.9% NACL Premix bag or mini -bag plus Vancomycin 2x1gm vials and 1 x 500mg vial with vial adaptors Azithromycin 500mg 1 x 500mg vial with vial adaptor Levofloxacin 750mg Premix bag Mobile Integrated Healthcare Provider Agreement Page 23 of 23 City of Fort Worth and Medically Home Group, Inc. City of Fort Worth, Texas Mayor and Council Communication DATE: 06/10/25 M&C FILE NUMBER: M&C 25-0531 LOG NAME: 36FD EMS MIH PROGRAM SUBJECT (ALL) Authorize Execution of Agreements for the Mobile Integrated Health Program within the City of Fort Worth Fire Department's Emergency Medical Services Operation in Collaboration with Multiple Agencies RECOMMENDATION: It is recommended that the City Council authorize execution of agreements for the Mobile Integrated Health Program within the City of Fort Worth Fire Department's Emergency Medical Services operation, in collaboration with multiple agencies. DISCUSSION: The purpose of this Mayor and Council Communication (M&C) is to authorize execution of agreements with Kindful Health, LLC, Health Masters HomeCare, Inc., Holy Savior Hospice, LLC., Klarus Home Care, LLC, Landmark Health of California, LLC, Texas Health Harris Methodist Hospital Alliance, Cook Children's Health Plan, Holy Hospice & Palliative Care, LLC, Medically Home Group, Inc., Molina Healthcare of Texas, Inc., Silverado Hospice and Supportive Care, and Vitas Healthcare of Texas, L.P. The City of Fort Worth recognizes the growing need for innovative, cost-effective, and community -based healthcare delivery models. The Mobile Integrated Health (MIH) Program represents a proactive approach to addressing non -emergent 911 calls, frequent system users, chronic disease management, behavioral health crises, and social determinants of health by integrating public safety and healthcare resources. Through partnerships with these agencies, the Fort Worth Fire Department seeks to implement and enhance MIH services that: • Reduce non -emergency calls to 911 • Decrease avoidable emergency room visits • Provide targeted care to high -utilizer populations • Offer in -home assessments, telehealth services, and follow-up care • Improve community health outcomes and patient satisfaction • Support continuity of care for patients with chronic or complex needs One critical element of this collaborative approach includes coordination with healthcare facilities to identify and enroll eligible patients in the MIH Program. Facilities will introduce the concept of enrollment to all patients they determine to be eligible, provided those patients reside within the Fort Worth Emergency Medical Services (EMS) System service area. At the request or desire of the patient, the facility will facilitate enrollment into the MIH program. Facilities will notify the City's MIH program of each patient enrolled and provide relevant patient information necessary for continuity of care, data tracking, and program evaluation. Importantly, this program will not require funding from the City of Fort Worth. All services performed under this agreement will be compensated by the participating facilities or organizations. This ensures that MIH resources are sustainably deployed while expanding access to care through strategic partnerships. Programs under this initiative may include, but are not limited to: • Nurse Triage and Alternative Destination Transport • High Utilizer Outreach Programs • Behavioral Health and Crisis Intervention Response • Transitional Care and Chronic Disease Management • Community Paramedicine Programs The execution of agreements with partner agencies is essential to clearly define roles, responsibilities, data -sharing protocols, reimbursement models, and operational procedures. These agreements will serve ALL COUNCIL DISTRICTS. A Form 1295 is not required because: This contract legally does not require City Council approval. FISCAL INFORMATION / CERTIFICATION: The Director of Finance certifies that approval of this recommendation will have no material effect on City funds. Submitted for Citv Manaaer's Office bv: William Johnson Oriainatina Business Unit Head: Jim Davis 6801 Additional Information Contact: