HomeMy WebLinkAboutContract 46329 70W IC5AL ESN C,(f�)VA,i CITY SECRETA
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CONTRACT NO.
's'),RT H9 YX PROFESSIONAL SERVICES AGREEMENT
1.--—AGREEMENT BETWEEN PARTIES
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 Susan Alanis, its duly authorized Assistant City Manager, and
Occupational Health Centers of the Southwest, P.A., dba Concentra Medical Centers
("PROVIDER"), acting by and through W. Tom Fogarty, M.D., its duly authorized President.
2. GENERAL
2.1 PROVIDER 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 Exhibits "A" through "D," including any attachments thereto, all of which are hereby
made part of this Agreement for all purposes. Exhibit "D" constitutes, at least in part, a
proposal presented by PROVIDER 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.
2.2 CITY and PROVIDER 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.
2.3 Services under this Agreement will be provided at PROVIDER'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 PROVIDER and CITY.
2.4 To the extent that the services to be performed under this Agreement constitute (i) injury-
related occupational health and workers compensation services compensable or defined
under the Texas Labor Code, as currently in effect or hereafter amended, or (ii) constitute
non-injury related occupational health care services performed by persons other than
PROVIDER 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.
3. AGREEMENT TERM
3.1 The initial term of this Agreement shall commence on January 1, 2015 ("Effective Date") and
shall expire on December 31, 2017, unless terminated earlier in accordance with the
provisions of this Agreement.
3.2 The parties may renew this Agreement for up to two additional one-year periods by signed
written mutual consent. If a party desires to exercise an option to renew, that party shall
notify the other party in writing at least sixty (60) days prior to the end of the then-current
term. Compensation to be paid during any option term shall be mutually agreed upon in
writing between the parties.
RECEIVED JAN ® 8
Professional Services Agreement Occupational Health—Concentra Page 'Aq
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4.INVOICING AND COMPENSATION
4.1 The Parties agree the Schedule for Compensation as shown in the attached Exhibits "B" and
"C" is acceptable as the compensation to be paid to PROVIDER for occupational health care
services provided to current and prospective CITY employees during the initial contract
period and the subsequent option periods, if exercised by the CITY. The parties
acknowledge that additional services provided by PROVIDER 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.
4.2 Billing of all medical services related to a compensable on-the-job injury will be submitted
directly to the CITY's contractor/third party administrator ("TPA") for workers' compensation
claims in accordance with the Texas Labor Code and related administrative rules, as outlined
in Exhibit"B."
4.3 For any alleged on-the-job injury that the TPA determines is not a compensable injury, CITY
agrees to pay, through its TPA, for initial and follow-up office visits (including medical
treatments provided during those visits) that occur prior to the TPA's determination.
4.4 For any alleged on-the-job injury that the TPA determines is a compensable injury, the CITY,
through its TPA, shall pay for care and services that are related to the compensable injury
with the amount of such payments to be determined according to reasonableness and
medical necessity of the treatment or service, in accordance with Texas Department of
Insurance — Division of Workers' Compensation ("TDI-DWC" or "DWC") treatment guidelines
and DWC-approved medical fee schedules.
4.5 For occupational health care services that do not relate to an on-the-job injury, PROVIDER
shall issue monthly invoices to the CITY and will provide the CITY sufficient documentation to
reasonably substantiate the invoices. The invoice shall be broken down by CITY department
and shall list the name, CITY employee identification number, dates of service, and service
provided. The invoice shall be provided to the CITY on or before the 10th day of the month
following the end of the month in which services were provided. CITY shall pay such invoices
in accordance with CITY Financial Management Services procedures and requirements.
Invoices are due and payable within thirty (30) days from the date the invoices are received
by the CITY.
4.6 For services related to any alleged on-the-job injury, billing issues, including contests,
disputes, and requests for additional documentation, shall be handled in accordance with
Section 408.027 of the Texas Labor Code or its successor.
For occupational health care services that do not relate to an on-the-job injury, billing issues
shall be handled in accordance with the terms of this Agreement. 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 PROVIDER within sixty (60) days of the
date the contested matter is resolved.
5. RECORDS AND RECORDS MANAGEMENT
5.1 PROVIDER 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
Professional Services Agreement Occupational Health—Concentra Page 2 of 27
purposes and agrees to reimburse PROVIDER for the cost of such copies at the rate
published in the Texas Administrative Code in effect as of the time copying is performed.
5.2 Upon termination or expiration of this Agreement, PROVIDER agrees to return to the CITY,
or its designated agent, all medical records delivered to PROVIDER on or about the Effective
Date (the "Pre-Existing Medical Records"). Upon receipt of authorization from the affected
CITY employees or their representatives for PROVIDER 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), PROVIDER
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.
5.3 It is recognized that additional medical records created by PROVIDER in the performance of
this Agreement, regardless of form or medium of storage ("New Medical Records") shall be
and remain the property of PROVIDER and shall not be moved or transferred from
PROVIDER except in accordance with applicable law and PROVIDER'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 PROVIDER, 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 PROVIDER agrees to use all reasonable efforts to obtain
the written consent of each patient seen by PROVIDER under this Agreement authorizing
PROVIDER to release copies of such "New Medical Records" to the CITY upon its request
therefor. Upon expiration or termination of this Agreement, PROVIDER 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
PROVIDER for the cost of such copies at the rate published in the Texas Administrative
Code in effect as of the time copying is performed.
5.4 PROVIDER 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 PROVIDER, and CITY and PROVIDER agree to utilize
appropriate records retention and destruction schedules for the purpose of lawful and efficient
records management.
5.5 PROVIDER will exercise appropriate care to preserve necessary and useful medical records
generated during the term of this Agreement. PROVIDER 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 PROVIDER 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.
5.6 All reports and records provided to PROVIDER by the CITY shall remain the sole property of
the CITY. PROVIDER 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 PROVIDER's normal working hours and will provide
PROVIDER with reasonable advance notice of a need for access. PROVIDER 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
Professional Services Agreement Occupational Health—Concentra Page 3 of 27
advance written consent. PROVIDER 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 PROVIDER. PROVIDER 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
PROVIDER at any time.
6. MINORITY BUSINESS ENTERPRISE (MBE) PARTICIPATION
6.1 In accord with the CITY Code of Ordinances, the CITY has goals for the participation of
minority business enterprises in CITY agreements. PROVIDER acknowledges the MBE 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 PROVIDER 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.
6.2 The established goal for this Agreement is ten percent (10%) of the value of non-injury
occupational health services portion of the Agreement. PROVIDER agrees to furnish, on a
quarterly basis, documentation of MBE participation as may be reasonably requested by the
CITY. The first quarterly report for the CITY's second Fiscal Quarter (months of January,
February, and March 2015) shall be submitted on or before April 30, 2015, and each
subsequent quarterly report shall be submitted at the end of the month immediately following
the end of the CITY's Fiscal Quarter. Because subcontracting opportunities for occupational
injury medical treatment and care services are negligible, no MBE goal has been set for such
services provided under this Agreement.
7. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT ("HIPAA")
7.1 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,
amendments thereto, 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. PROVIDER agrees not to use or further disclose Protected Health
Information other than as permitted or required by this Agreement or as required by law.
PROVIDER 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,
PROVIDER shall:
7.1.1 Use appropriate safeguards to prevent use or disclosure of the Protected Health
Information other than as provided for by this Agreement.
7.1.2 Mitigate, to the extent practicable, any harmful effect that is known to PROVIDER of the
use or disclosure of Protected Health Information by PROVIDER in violation of the
requirements of this Agreement.
7.1.3 Report to the CITY any use or disclosure of the Protected Health Information not
provided for by this Agreement.
7.1.4 Ensure that any agent, including a subcontractor, to whom PROVIDER provides
Protected Health Information received from, or created or received by PROVIDER on
Professional Services Agreement Occupational Health—Concentra Page 4 of 27
behalf of the CITY, agrees to the same restrictions and conditions that apply through
this Agreement to PROVIDER with respect to such information.
7.1.5 Make internal practices, books, and records, including policies and procedures and
Protected Health Information received from, or created or received by PROVIDER 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 PROVIDER compliance with HIPAA.
7.1.6 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.
7.1.7 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.
7.1.8 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.
7.1.9 Provide to the CITY or an individual, in time and manner designated by the CITY,
information collected in accordance with Section 5 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.
7.1.10 Consistent with HIPAA requirements, report to appropriate federal and state authorities
violations of law relating to Protected Health Information.
7.2 Permitted Uses and Disclosures by PROVIDER
Except as otherwise limited in this Agreement, PROVIDER may use or disclose Protected
Health Information on behalf of, or to provide services to, the CITY for the proper
management and administration by PROVIDER or to carry out the legal responsibilities of
PROVIDER.
7.3 Obligations of the CITY
The CITY shall inform PROVIDER of Privacy Practices and Restrictions by:
7.3.1 Providing PROVIDER with the notice of privacy practices that the CITY produces for
Occupational Health and Safety.
7.3.2 Providing PROVIDER with any changes in, or revocation of, permission by an
individual to use or disclose Protected Health Information, if such changes affect
PROVIDER's permitted or required uses and disclosures.
7.3.3 Providing notification to PROVIDER 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,
7.4 Termination for material breach of HIPAA by PROVIDER
Upon the CITY's knowledge of a material breach by PROVIDER, the CITY shall either:
Professional Services Agreement Occupational Health—Concentra Page 5 of 27
7.4.1 Provide an opportunity for PROVIDER to cure the breach or end the violation and
terminate the Agreement if PROVIDER does not cure the breach or end the violation
within the time specified by the CITY;
7.4.2 Immediately terminate this Agreement if PROVIDER has breached a material term of
the HIPAA requirements of this Agreement and a cure is not possible; or
7.4.3 If neither termination nor cure is feasible, report the violation to the Secretary.
7.5 Effect of Termination
7.5.1 Except as provided in Section 5, upon termination of this Agreement, for any reason,
PROVIDER shall return or destroy all Protected Health Information received from the
CITY, or created or received by PROVIDER on behalf of the CITY. This Provision shall
also apply to Protected Health Information that is in the possession of subcontractors or
agents of PROVIDER. PROVIDER shall retain no copies of the Protected Health
Information as described in this paragraph.
7.5.2 In the event that PROVIDER determines that returning or destroying the Protected
Health Information is infeasible, PROVIDER 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, PROVIDER
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 PROVIDER
maintains such Protected Health Information.
7.6 Miscellaneous
7.6.1 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.
7.6.2 The respective rights and obligations of PROVIDER under Section 7.5 of this
Agreement shall survive the termination of this Agreement.
7.6.3 Any ambiguity in this Agreement shall be resolved to permit PROVIDER to comply with
the Privacy Rule of HIPAA.
8. TERMINATION
8.1 Written Notice The CITY or PROVIDER may terminate this Agreement at any time, with or
without cause, by providing the other party with sixty (60) days' written notice of termination.
Upon the receipt of any such notice, PROVIDER 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.
8.2 Non-appropriation of Funds In the event no funds or insufficient funds are appropriated by
the CITY in any fiscal period for any payments due hereunder, CITY will notify PROVIDER 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.
Professional Services Agreement Occupational Health—Concentra Page 6 of 27
8.3 Duties and Obligations of the Parties following Termination
In the event that this Agreement is terminated prior to the expiration of the then-current term,
PROVIDER 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 PROVIDER 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
PROVIDER for services actually rendered up to the effective date of termination and
PROVIDER 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 PROVIDER'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 PROVIDER 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 PROVIDER 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 PROVIDER documenting the performance of such work.
9. DISCLOSURE OF CONFLICTS AND CONFIDENTIAL INFORMATION
PROVIDER hereby warrants to the CITY that PROVIDER 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,
PROVIDER hereby agrees immediately to make full disclosure to the CITY in writing. PROVIDER,
for itself and its officers, agents and employees, further agrees that it shall treat all information
provided to it by the CITY ("City Information") as confidential and shall not disclose any such
information to a third party without the prior written approval of the CITY. PROVIDER 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. PROVIDER shall notify the CITY
immediately if the security or integrity of any City Information has been compromised or is believed
to have been compromised.
10. RIGHT TO AUDIT
10.1 PROVIDER 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 PROVIDER involving transactions relating to this Agreement at no
additional cost to the CITY. PROVIDER agrees that the CITY shall have access during
normal working hours to all necessary PROVIDER 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 PROVIDER reasonable advance notice of intended
audits. PROVIDER agrees to photocopy such documents as may requested by the CITY.
CITY agrees to reimburse PROVIDER for the cost of copies at the rate published in the
Texas Administrative Code in effect as of the time copying is performed.
10.2 PROVIDER 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
Professional Services Agreement Occupational Health—Concentra Page 7 of 27
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.
11. INDEPENDENT CONTRACTOR
It is expressly understood and agreed that PROVIDER 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, PROVIDER 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. PROVIDER acknowledges that the
doctrine of respondeat superior shall not apply as between the CITY, its officers, agents, servants
and employees, and PROVIDER 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 PROVIDER.
12. LIABILITY AND INDEMNIFICATION
12.1 PROVIDER 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 PROVIDER, ITS OFFICERS,
AGENTS, SERVANTS, OR EMPLOYEES ARISING FROM OR IN CONNECTION WITH
PERFORMANCE OF SERVICES UNDER THIS AGREEMENT.
12.2 PROVIDER 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 PROVIDER'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 THE PERFORMANCE OF SERVICES UNDER THIS AGREEMENT,
TO THE EXTENT CAUSED BY THE NEGLIGENT ACTS OR OMISSIONS OR
MALFEASANCE OF PROVIDER, ITS OFFICERS, AGENTS, SERVANTS, OR
EMPLOYEES, PROVIDED, HOWEVER, THAT THE INDEMNITY PROVIDED FOR IN
THIS SECTION SHALL NOT APPLY TO ANY LIABILITY RESULTING FROM THE SOLE
NEGLIGENCE OF THE CITY OR ITS OFFICERS, AGENTS, EMPLOYEES, OR
SEPARATE CONTRACTORS, AND IN THE EVENT OF JOINT AND CONCURRENT
NEGLIGENCE OF BOTH PROVIDER AND CITY, RESPONSIBILITY, IF ANY, SHALL BE
APPORTIONED COMPARATIVELY IN ACCORDANCE WITH THE LAWS OF THE
STATE OF TEXAS. NOTHING HEREIN SHALL BE CONSTRUED AS A WAIVER OF
THE CITYRTIGOVERNMENTAL IMMUNITY AS FURTHER PROVIDED BY THE LAWS
OF TEXAS.
13. ASSIGNMENT AND SUBCONTRACTING
PROVIDER 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 PROVIDER under
which the assignee agrees to be bound by the duties and obligations of PROVIDER under this
Agreement. PROVIDER 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 PROVIDER referencing this Agreement under which the
subcontractor shall agree to be bound by the duties and obligations of PROVIDER under this
Professional Services Agreement Occupational Health—Concentra Page 8 of 27
Agreement as such duties and obligations may apply. PROVIDER shall provide the CITY with a
fully executed copy of any such subcontract. Any attempted assignment or delegation of
PROVIDER shall be wholly void and totally ineffective for all purposes unless made in conformity
with this section.
14. INSURANCE
14.1 Prior to commencement of any work pursuant to this Agreement, PROVIDER shall provide
the CITY's Occupational Health and Safety Division and Risk Management Division with
certificate(s) of insurance documenting policies that are required to be in effect throughout
the term of this Agreement and any renewals thereof and that are to provide minimum
coverage limits in accordance with this section.
14.2 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.
14.3 PROVIDER's financial integrity is of interest to the CITY; therefore, subject to PROVIDER's
right to maintain reasonable deductibles, PROVIDER shall obtain and maintain in full force
and effect for the duration of the Agreement, and any extension hereof, at PROVIDER'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 (i) 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 or (ii) through the use of a wholly owned insurance
subsidiary ("captive") approved by the City as an alternative risk financing program. Seller
shall provide fully audited financial statements for the captive. Coverage shall be written in
the following types and amounts:
14.3.1 Workers' Compensation —Statutory
Employers' Liability- $500,000/$500,000/$500,000
14.3.2 Commercial General (Public) Liability Insurance to include the following types of
coverage: 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)
14.3.3 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)
14.3.4 Commercial Umbrella-$1,000,000 per occurrence$1,000,000 Aggregate
14.3.5 Technology Liability-$1,000,000 per Claim, $1,000,000 Aggregate
14.3.6 Medical Professional Liability - $1,000,000 per medical incident and $3,000,000
Aggregate
Professional Services Agreement Occupational Health—Concentra Page 9 of 27
14.4 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.
14.5 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.
14.6 PROVIDER 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.
14.7 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, PROVIDER shall exercise reasonable efforts to accomplish
such changes in policy coverage and shall pay the cost thereof.
14.8 PROVIDER agrees that with respect to the above-required insurance, all insurance contracts
and Certificate(s) of Insurance will contain the following required provisions:
14.8.1 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.
14.8.2 An endorsement stating that PROVIDER's insurance shall be deemed primary and
that any self-funded or commercial coverage maintained by the CITY shall not be
called upon to contribute to loss recovery.
14.8.3 PROVIDER's Workers' Compensation and Employers' Liability policy will provide a
waiver of subrogation in favor of the CITY.
14.9 PROVIDER 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 ninety (90) 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.
14.10 If PROVIDER 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 PROVIDER to
maintain said insurance or secure such endorsement. In addition to any other remedies the
CITY may have upon PROVIDER's failure to provide and maintain any insurance or policy
Professional Services Agreement Occupational Health—Concentra Page 10 of 27
endorsements to the extent and within the time herein required, the CITY shall have the right
to order PROVIDER to stop work hereunder, and/or the right to withhold any payment(s) that
become due to PROVIDER hereunder until PROVIDER demonstrates compliance with the
requirements hereof.
14.11 Nothing herein contained shall be construed as limiting in any way the extent to which
PROVIDER may be held responsible for payments of damages to persons or property
resulting from PROVIDER's or its subcontractors' performance of the work covered under
this Agreement.
15. COMPLIANCE WITH LAWS, ORDINANCES, RULES AND REGULATIONS
In fulfilling its obligations under this Agreement, PROVIDER agrees to comply with all applicable
federal, state and local laws, ordinances, rules and regulations. If the CITY notifies PROVIDER of
any violation of such laws, ordinances, rules or regulations, PROVIDER shall immediately desist
from and correct the violation.
16. NON-DISCRIMINATION COVENANT
PROVIDER, for itself, its personal representatives, assigns, subcontractors and successors in
interest, as part of the consideration herein, agrees that in the performance PROVIDER'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 PROVIDER its personal representatives, assignees,
subcontractors or successors in interest, PROVIDER agrees to assume such liability and to
indemnify and defend the CITY and hold the CITY harmless from such claim.
17. 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 PROVIDER
City of Fort Worth Occupational Health Centers of the Southwest
Attn: Ron Josselet P.A., dba Concentra Medical Centers
1000 Throckmorton Attn: Legal- Contracting
Fort Worth TX 76102-6311 Address: 5080 Spectrum Drive, Suite 120OW
Facsimile: (817) 392-7766 Addison, TX 75001
E-mail: Ron.Josselet(a)_fortworthtexas.gov Facsimile: (972) 720-7770
Email: legal_contracts @concentra.com
With copy to
City Attorney's Office at same address.
18. SOLICITATION OF EMPLOYEES
Neither the CITY nor PROVIDER 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.
Professional Services Agreement Occupational Health—Concentra Page 11 of 27
19. 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.
20. NO WAIVER
The failure of the CITY or PROVIDER 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
PROVIDER's respective right to insist upon appropriate performance or to assert any such right on
any future occasion.
21. 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.
22. SEVERAEILITY
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.
23. FORCE MAJEURE
The CITY and PROVIDER 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 (each a "Force Majeure Event"), the obligations so affected by such
Force Majeure Event will be suspended only during the continuance of such event.
24. 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.
25. REVIEW OF COUNSEL
The parties acknowledge that each party and its counsel have had the opportunity to review and
revise 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.
26. 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-Concentra Page 12 of 27
27. SIGNATURE AUTHORITY
Each person signing this Agreement hereby warrants that he/she has the legal authority to execute
this Agreement on behalf of his/her respective party, and further warrants that such binding
authority has been granted by proper order, resolution, ordinance, or other authorization of the
entity. The other party is fully entitled to rely on this warranty and representation in entering into this
Agreement.
28. 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
PROVIDER, 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.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement in multiples this 1 day of
2014.
CITY OF FORT WORTH: OCCUPATIONAL HEALTH CENTERS OF THE
SOUTHWEST, P.A., DDA CONCENTRA
MEDICAL CENTERS
By, By: i, ;
Susan a s,Assistant City Manager W. Tom Fogarty, re ident
Date: l ' 15- Date: t-
ATT ATTEST:
By: 1�G�,� ('ol'
Ma Kayser, City Secretary 1
Of F. ssistant General Counsel
°°°p°°°°pp"O
APPROVED AS TO ORM AND LEGA
' �S
°�
By: 8
Denis McElro ssistant City Attorney °
°OC°DOG°°C°
CONTRACT AUTHORIZATION:
M&C: C-27056 --
Date Approved: 10/28/2014 !� RECORD
Professional Services Agreement Occupational Health—Concentra Page 13 of 27
EXHIBIT A e SCOPE OF SERVICES
A.I. PROVIDER FACILITIES
AAA PROVIDER's facilities shall be of adequate size and capability to provide all necessary health
care for injured employees, as well as provide other occupational health or other related
services as outlined in this Agreement and its exhibits. These facilities must be operated and
maintained to ensure a healthful and safe environment for CITY employees.
A.1.2 Clinic Locations
A.1.2.1 PROVIDER must operate sufficient clinic locations in the Fort Worth/Dallas area to
provide convenient occupational health care services to CITY employees. The CITY
will primarily utilize facilities located in Fort Worth. However current and prospective
CITY employees may access any other Concentra Medical Centers located in the Fort
Worth/Dallas metroplex, or any other Concentra Medical Center locations in Texas and
the United States as necessary.
A.1.2.2 PROVIDER operates sixteen (16) clinic locations in the Fort Worth/Dallas area and
hundreds of other locations around the United States. The CITY will primarily utilize
PROVIDER's Fort Worth locations as detailed in PROVIDER's Response to City RFP
No. 14-0225, a copy of which proposal is attached as Exhibit "D" to the Agreement.
However, CITY-associated personnel can access any other PROVIDER location as
necessary.
A.1.3 Primary Clinic Location
The facility listed below shall be designated as the primary,facility for use of CITY Employees.
Hours of operation of the primary facility shall at a minimum be 7:00 a.m. to 7:00 p.m. Monday
through Friday. However, it is desirable that PROVIDER provide extended hours during
weekdays and on weekends and holidays at the designated primary facility and/or other
facilities as a means to better accommodate CITY employees who work evening, night,
weekend and/or holiday shifts. The designated clinic facility that shall serve as CITY's primary
clinic facility is:
Concentra Medical Center Forest Park
2500 West Freeway(130), Suite 100
Fort Worth, TX 76102
Phone: 817.882.8700
Fax: 817.882.8707
Hours of Operation
8:00 a.m. —8:00 p.m. (M-F)
8:00 a.m.—5:00 p.m. Sat.
A.1.4 Convenience of Employees
The designated primary facility shall have at a minimum: a dedicated telephone and fax
numbers for CITY employees; a CITY check-in desk; a private waiting room; a minimum of two
(2) exam rooms dedicated to CITY employees; and a sufficient number qualified medical
doctors dedicated to the examination and treatment of CITY employees.
A.1.5 Wait Times
Maximum wait times for CITY employees to wait for medical treatment and/or other
occupational health care services shall not exceed fifteen(15) minutes.
Professional Services Agreement Occupational Health—Concentra Page 14 of 27
A.1.6 Hours of Operation
PROVIDER must make contracted services available weekdays, Monday through Friday from
7:00 a.m. to 7:00 p.m. The CITY considers these hours of operation as a minimum requirement
and would provide favorable consideration to providing medical services at additional times.
A.1.7 Accreditation
If PROVIDER currently is not accredited by the Urgent Care Center Accreditation (UCCA)
Program and/or the Joint Commission on Accreditation of Healthcare Organizations (The Joint
Commission), PROVIDER agrees to consider seeking such accreditation.
A.2 CLINIC PERSONNEL
A.2.1 PROVIDER's health care practitioners must be credentialed, experienced in occupational
medicine, and possess documented expertise in the evaluation, treatment, oversight, and
recovery of employees injured on the job. This expertise must also encompass an effective
system of communication with the CITY and their agents to ensure prompt delivery of
necessary services and overall coordination of the CITY's programs.
A.2.2 PROVIDER must utilize Texas licensed medical doctors and other licensed health care
practitioners and administrative staff sufficient to perform all necessary health care and other
required services. PROVIDER must exercise due diligence to ensure health care practitioners
are properly credentialed in their respective and specific areas of medical practice.
A.2.3 PROVIDER' medical doctors and health care practitioners must be familiar with and utilize
evidenced-based medicine in the evaluation, treatment, oversight, and recovery of employees
injured on the job as required by the Texas Labor Code and related Rules.
A.2.4 Health care practitioners and facilities must be capable of providing the full range of
occupational health care services required by the CITY and its employees (refer to the non-
injury occupational health care services list in Exhibit"C".
A.2.5 Treating Doctors
A.2.5.1 PROVIDER agrees to employ or contract with occupational medicine physicians to
provide occupational injury medical treatment and care for injured CITY employees.
PROVIDER physicians shall be in good standing with State of Texas regulatory
agencies including the Texas Department of Insurance, Division of Workers'
Compensation (DWC) regarding being an approved doctor on the Division's
Approved Doctors List.
A.2.5.2 PROVIDER physicians shall perform and function as Treating Doctors, in accordance
with the Texas Labor Code and related Rules.
A.3 PANEL OF SPECIALTY PHYSICIANS AND HEALTH CARE PROVIDERS
A.3.1 PROVIDER agrees to assist the CITY to establish and maintain a panel of specialized medical
professionals/ physicians and other health care providers for referral as necessary in the
appropriate treatment of the CITY's employees who are injured in the course and scope of their
employment. PROVIDER also agrees to maintain the panel during the initial term of this
Agreement, as well as any of the option terms.
A.3.2 The panel will be composed of medical professionals / physicians, including but not limited to
Neurologists, Orthopedists / Orthopedic Surgeons, Neurologists / Neurosurgeons, Plastic
Surgeons, Psychologists, Psychiatrists, Pain Management Specialists, Chiropractors, Physical
Professional Services Agreement Occupational Health—Concentra Page 15 of 27
and Occupational Therapists, Pain Management Specialists, Oncologists, Pulmonologists and
Cardiovascular Surgeons.
A.3.3 Each medical specialist must be willing to accept workers' compensation patients and agree to
be paid for services in accordance with the Texas Labor Code and related Rules for medical
services and fees.
A.3.4 PROVIDER agrees that Treating Doctors shall monitor performance of referral specialists and
other health care providers as to the following:
A.3.4.1 Usage of Treatment Guidelines adopted by the Texas Department of Insurance —
Department of Workers' Compensation ("TDI-DWC")
A.3.4.2 Usage of Return-To-Work Guidelines adopted by the TDI-DWC
A.3.4.3 Medical Outcomes
A.3.4.4 Return-To-Work Outcomes
CITY shall require frequent reports as to the performance of referral specialists and other health
care providers relating to A.3.4.1 through A.3.4.4 above.
A.3.5 PROVIDER also agrees to replace, if necessary, any or all of panel members as warranted and
agreed upon by the CITY.
A.3.6 PROVIDER shall coordinate with the CITY regarding the initial panel of doctors and any
changes to the members of the panel.
A.4 OCCUPATIONAL INJURY MEDICAL TREATMENT AND CARE
AAA PROVIDER shall provide reasonable and necessary health care services to CITY
employees injured in the course and scope of their employment with the CITY, as
defined and instructed in the Texas Labor Code and related Rules.
A.4.2 Employees injured on the job will be referred to the PROVIDER medical facilities as
appropriate by the CITY, as a preferred provider of health care services. Employees
of the CITY currently retain the right to choose a different initial treating doctor as
allowed in the Texas Labor Code and related Rules.
A.4.3 If the injured employee chooses to seek initial and subsequent health care with
PROVIDER then the PROVIDER will become the employee's treating doctor and will
perform all of the necessary functions and responsibilities of a treating doctor as
required by the Texas Labor Code and related Rules.
AAA PROVIDER shall accelerate and expedite treatment and/or referrals for treatment of
the following CITY employees, in accordance with Section 504.055 of the Texas
Labor Code: (1) peace officers; (2) emergency medical care attendants, emergency
medical technicians, and paramedics; and (3) fire fighters.
A.4.5 Treatment Guidelines
PROVIDER shall specifically provide medical treatment and render services in
accordance with Treatment Guidelines adopted by TDI-DWC in the Rules, Chapter
137, "Disability Management". Any treatment that is not covered by the Guidelines
shall be documented and shall be based on other credible evidence-based medicine
as defined in Section 401.011(18-a) of the Texas Labor Code.
Professional Services Agreement Occupational Health—Concentra Page 16 of 27
A.4.6 Return-To-Work Guidelines
PROVIDER shall specifically utilize the disability duration guidelines adopted by TDI-
DWC in the Rules, Chapter 137, "Disability Management, § 137.10" in coordinating
an employee's safe return to the CITY after an on the job injury. Specifically,
PROVIDER will effectively communicate and coordinate with the CITY's Return to
Work Program to ensure that injured employees are safely and appropriately
returned to restricted (modified) or full duty employment. Deviations from these
Return-To-Work Guidelines shall be documented in a treatment plan designed to
(1) provide required treatment of the employee in accordance with subsection A.4.1.5
above and (2) effect the earliest return to work date the employee is medically able to
do so.
A.4.7 Restrictions to Duty
PROVIDER shall recognize and discuss with injured CITY employees the general
availability of restricted or limited duty assignments provided by the CITY.
PROVIDER shall identify appropriate restrictions to duty based on CITY provided
detailed physical demand requirements of the injured employee's position, or of any
limited duty assignments that may be available to the injured employee.
A.4.8 DWC-073 "Work Status Report"
PROVIDER shall ensure that health care providers completely and accurately fill out
the TDI-DWC form DWC-073 "Work Status Report" on each CITY employee for each
medical evaluation or for medical treatment provided. PROVIDER shall provide each
such DWC-073 form to the CITY Occupational Health and Safety / Workers'
Compensation Division (the "OHS") within one (1) work day of the employee's office
visit or medical treatment event.
A.4.9 Preauthorization Requests; Requests for Reconsideration
A.4.9.1 PROVIDER shall ensure that requests for pre-authorization of medical
services and requests for reconsideration of pre-authorization denials
shall include all necessary medical documentation based upon the
Treatment Guidelines to support and justify the request prior to
submission to the CITY's third party claims administrator.
A.4.9.2 In accordance with the Texas Labor Code § 504.055, PROVIDER shall
accelerate and expedite the preparation and submission of
preauthorization requests relating to the following CITY employees: (1)
peace officers; (2) emergency medical care attendants, emergency
medical technicians, and paramedics; and (3) fire fighters.
A.4.9.3 PROVIDER agrees to expedite preparation and submission of all
preauthorization requests and requests for reconsideration to the CITY's
contracted third party claims administrator so as to minimize the amount
of time an employee may be off work, on limited duty, and/or awaiting
medical services. CITY agrees to include expedited preauthorization
determinations and expedited determinations of requests for
reconsideration in the third party claims administrator's account handling
instructions for the CITY.
Professional Services Agreement Occupational Health—Concentra Page 17 of 27
A.5 REPORTS
A.5.1 CITY shall require quarterly and annual reports, or as otherwise required by CITY, as to the
performance of Treating Doctors, referral specialists and other health care providers to include,
but not necessarily limited to the following:
A.5.1.1 Usage of Treatment Guidelines adopted by the TDI-DWC
A.5.1.2 Usage of Return-To-Work Guidelines adopted by the TDI-DWC
A.5.1.3 Medical Outcomes
A.5.1 A Return-To-Work Outcomes
A.5.2 CITY shall require additional reports including but not necessarily limited to the following:
A.5.2.1 Utilization Report of CITY employees compared to utilization of other
employer (including other municipalities) in the Fort Worth/Dallas Metroplex,
to include injury frequency, cost by body area, age profile, male to female
profile, case duration and cost, referral utilization and management, return-
to-work outcomes and management
A.5.2.2 Average clinic wait times of CITY employees
A.5.2.3 Patient/ Employee Satisfaction with medical treatment and services provided
A.5.2.4 Services provided by Treating Doctor, and by category of treatment and
service provided—number and cost
A.5.2.5 Average length of time from date of medical evaluation to date of submission
of preauthorization requests and requests for reconsideration
A.5.2.6 Monthly Report of CITY employees who fail to keep medical and/or other
health care appointments — dates and type of appointment. Information and
data for this report shall be captured and reported by City Department.
A.6 WORKERS' COMPENSATION HEALTH CARE NETWORK
A.6.1 Certified Workers' Compensation Health Care Network
PROVIDER must be willing to participate in a workers' compensation
health care network certified under Chapter 1305 of the Insurance Code,
if the CITY determines that provision of medical benefits through a
workers' compensation health care network is available and practical to
the CITY.
A.6.2 Direct Contract Network
In the event the CITY chooses to provide medical benefits to injured
employees by directly contracting with health care providers or through a
health benefits pool established under Chapter 172 of the Local
Government Code and in accordance with Section 504.053 of the Texas
Labor Code, PROVIDER must be willing to participate in such a panel or
network of health care providers specifically developed by or on behalf of
CITY.
A.7 NON-INJURY OCCUPATIONAL HEALTH CARE SERVICES
A.7.1 Post-Offer Employment / Promotional / Return-to-Work Physical Exams or
Fitness for Duty and other Assessments
PROVIDER will perform CITY Pre-Placement Physical Examinations, DOT Physical
Examinations, Fitness for Duty Examinations, Physical Demand Job Assessments,
Physical Ability Testing, Physical Fitness Assessments, Medical Surveillance
Examinations, Medical and Work History Questionnaires Clinical Testing"Services;
Professional Services Agreement Occupational Health—Concentra Page 18 of 27
Immunization and Infectious Disease Screening, and Respirator Fit Testing
Clearance for Post-Offer Physicals and annual compliance.
A.7.2 Drug Screening and Alcohol Testing
A.7.2.1 PROVIDER shall 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 authorize one or more specific persons who will
have authorization and access to all positive post-accident drug screen
results.
A.7.2.2 PROVIDER will utilize Quest Diagnostics for all laboratory testing.
PROVIDER at its sole cost and expense will provide the necessary
software to allow access to test results from Quest.
A.7.2.3 A Medical Review Officer ("MRO") must be dedicated to the CITY's
account for the purposes of PROVIDER's participation in the CITY's
Commercial Driver's License ("CDL") program.
A.7.2.4 PROVIDER will subcontract its Medical Review Officer("MRO") services,
and the CITY consents to such subcontracting. The MRO services
include the random selection task.
A.7.2.5 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.
A.7.2.6 Two copies of PROVIDER'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.
A.7.2.7 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.
A.7.3 Clinical Testing
PROVIDER agrees to offer the CITY clinical testing, including but not limited to
pulmonary function, audiometric, EKG, chest x-rays, and lumbar x-rays. PROVIDER
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.
A.7.4 Exposure Control Program
A.7.4.1 PROVIDER 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. Such immunizations may be required to be
Professional Services Agreement Occupational Health—Concentra Page 19 of 27
administered on-site and after standard work hours at City designated
facilities.
A.7.4.2 In addition, PROVIDER will be required to provide information and may
be required to provide 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
PROVIDER following exposure to a disease for assessment, counseling,
and required medical treatment.
A.7.4.3 PROVIDER will administer influenza vaccines to CITY employees at
designated on-site CITY locations. PROVIDER will be required to
provide information to each employee regarding the vaccine to be
administered, prior to the vaccination(s). Some on-site vaccination
events may occur after standard work hours.
A.7.4.4 PROVIDER will test and monitor CITY employees exposed to
communicable diseases, 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.
A.7.4.5 PROVIDER will 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.
A.7.5 Medical Surveillance
PROVIDER will test and monitor CITY employees exposed to noise, lead, asbestos,
hazardous chemicals or other potential hazards associated with the performance of
their duties, and to provide medical surveillance services for the CITY'S Commercial
Driver's License (CDL) Program.
A.7.6 Commercial Driver's License(CDL) Program
A.7.6.1 PROVIDER will 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.
A.7.6.2 PROVIDER must dedicate a Medical Review Officer("MRO") to the CITY
for purposes of PROVIDER's participation in the CITY's CDL Program.
A.7.7 Reports and Validation Studies
A.7.7.1 PROVIDER will 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.
A.7.7.2 The CITY and PROVIDER will share workers' compensation data for an
annual Validation Study of work related injury outcomes.
Professional Services Agreement Occupational Health-Concentra Page 20 of 27
A.7.8 Additional Services
PROVIDER may provide additional services relating to occupational health care or other
related services for consideration by the CITY.
Professional Services Agreement Occupational Health—Concentra Page 21 of 27
EXHIBIT B - OCCUPATIONAL INJURY MEDICAL TREATMENT AND
CARE; SCHEDULE OF COMPENSATION
B.1 Medical services/health care rendered by PROVIDER and the panel of medical specialists to CITY employees injured in the
course and scope of their employment with the CITY shall be provided in accordance with the Texas Labor Code and Texas
Department of Insurance,Division of Compensation adopted Rules.
B.2 Compensation to PROVIDER and the panel of medical specialists shall be paid by the CITY in accordance with the
Medical/Professional Services and Fee Guidelines as specified in the Texas Labor Code and Texas Department of Insurance,
Division of Compensation adopted Rules.
B.3 The following provisions of the Texas Labor Code relating to medical treatment and care,compensation for services,
reimbursement and medical fees specifically apply:
Chapter 408 Workers'Compensation Benefits
Sub-Chapter B.Medical Benefits
Chapter 409 Compensation Procedures
Section 409.009
Section 409.0091
Chapter 413 Medical Review
Sub-Chapter A General Provisions
Sub-Chapter B Medical Services and Fees
Sub-Chapter C Dispute Resolution
Sub-Chapter D Health Care Providers
Chapter 504 Workers'Compensation Coverage for Employees of Political Subdivisions
Sub-Chapter C Benefits and Offsets
Section 504.055 Expedited Provision of Medical Benefits
Section 504.056 Intent of Expedited Provision of Medical Benefits
B.4 The following provisions of the Texas Department of Insurance,Division of Workers'Compensation Rules(Texas
Administrative Code,Title 28,Part 132)relating to medical treatment and care,compensation for services,reimbursement
and medical fees specifically apply:
Chapter 126 General Provisions Applicable to All Benefits
Rule 126.9 Choice of Treating Doctor and Liability for Payment
Rule 126.14 Treating Doctor Examination to Define the Compensable Injury
Rule 126.17 Guidelines for Examination by a Treating Doctor or Referral Doctor after a
Designated Doctor Examination to Address Issues Other Than Certification of
Maximum Medical Improvement and the Evaluation of Permanent Impairment
Chapter 133 General Medical Provisions
Sub-Chapter A General Rules for Medical Billing and Processing
Sub-Chapter B Health Care Provider Billing Procedures
Sub-Chapter C Medical Bill Processing/Audit by Insurance Carrier
Sub-Chapter D Dispute and Audit of Bills by Insurance Carriers
Sub-Chapter G Electronic Medical Billing,Reimbursement,and Documentation
Chapter 134 Guidelines for Medical Services,Charges and Payments
Sub-Chapter A Medical Reimbursement Policies
Sub-Chapter B Miscellaneous Reimbursement
Sub-Chapter C Medical Fee Guidelines
Sub-Chapter E Health Facility Guidelines
Sub-Chapter F Pharmaceutical Fees
Sub-Chapter G Prospective and Concurrent Review of Health Care
Sub-Chapter I Medical Bill Reporting
Sub-Chapter J Reviews and Audits
Chapter 138 Disability Guidelines
Professional Services Agreement Occupational Health—Concentra Page 22 of 27
Sub-Chapter A General Provisions
Sub-Chapter C Treatment Guidelines
Chapter 140 Dispute Resolution/General Provisions
Rule 140.6(d)Claims for Reimbursement of Medical Benefits
Chapter 180 Monitoring and Enforcement
Sub-Chapter B Medical Benefit Regulation
13.2. NON-INJURY OCCUPATIONAL HEALTH CARE SERVICES
Professional Services Agreement Occupational Health—Concentra Page 23 of 27
EXHIBIT C -NON-INJURY OCCUPATIONAL HEALTH CARE SERVICES
SCHEDULE OF COMPENSATI®N
C.1 Breath Alcohol Tests
Service Fee Service Fee Service Fee Service Fee Service Fee Option
Service Description Contract Year Contract Year Contract Year Option Contract Contract Year 5
1 2 3 Year 4
Breath Alcohol Test Post-Job $18.00 $18.00 $18.00 $18.00 $18.00
Offer
Breath Alcohol Test Random $18.00 $18.00 $18.00 $18.00 $18.00
Breath Alcohol Test Post $18.00 $18.00 $18.00 $18.00 $18.00
Accident
Breath Alcohol Test Follow-up $18.00 $18.00 $18.00 $18.00 $18.00
Breath Alcohol Test Reasonable
Suspicion $18.00 $18.00 $18.00 $18.00 $18.00
After hours Breath Alcohol Test $18.00 $18.00 $18.00 $18.00 $18.00
C.2 Urinary Drug Screens(UDS)
Service Fee Service Fee Service Fee Service Fee Service Fee Option
Service Description Contract Year Contract Year Contract Year Option Contract Contract Year 5
1 2 3 Year 4
UDS-Non Regulated Pre- $40.00 $40.00 $40.00 $40.00 $40.00
Placement
UDS-Non Regulated Random $40.00 $40.00 $40.00 $40.00 $40.00
UDS-Non Regulated Post
Accident $40.00 $40.00 $40.00 $40.00 $40.00
UDS-Non Regulated Follow
Up $40.00 $40.00 $40.00 $40.00 $40.00
UDS-Non Regulated $40.00 $40.00 $40.00 $40.00 $40.00
Reasonable Suspicion
UDS-Regulated PrePlacement $40.00 $40.00 $40.00 $40.00 $40.00
UDS-Regulated Random $40.00 $40.00 $40.00 $40.00 $40.00
UDS-Regulated Post Accident $40.00 $40.00 $40.00 $40.00 $40.00
UDS-Regulated Follow Up $40.00 $40.00 $40.00 $40.00 $40.00
UDS-Regulated Reasonable $40.00 $40.00 $40.00 $40.00 $40.00
Suspicion
C.3 Physical Examinations/Assessments
Service Fee Service Fee Service Fee Service Fee Service Fee Option
Service Description Contract Year Contract Year Contract Year Option Contract Contract Year 5
1 2 3 Year 4
Physical Examination Post Offer
Placement $40.00 $40.00 $42.00 $44.00 $46.00
Physical Examination-Other $40.00 $40.00 $42.00 $44.00 $46.00
DOT Physical Examination- $40.00 $40.00 $42.00 $44.00 $46.00
Post-Job Offer Placement
DOT Physical-Recertification $40.00 $40.00 $42.00 $44.00 $46.00
Respirator Physical Examination $35.00 $35.00 $37.00 $39.00 $41.00
Physical Demand Job $350.00 $350.00 $350.00 $350.00 $350.00
Asscssmcnts
Professional Services Agreement Occupational Health-Concentra Page 24 of 27
Physical Fitness for Duty Testing $38.00 $38.00 $40.00 $42.00 $44.00
Level 1
Physical Fitness for Duty Testing $40.00 $40.00 $42.00 $44.00 $46.00
Level 2
Physical Fitness for Duty Testing
Level 3 $42.00 $42.00 $44.00 $46.00 $48.00
Physical Fitness for Duty Testing $45.00 $45.00 $47.00 $49.00 $51.00
Level 4
Medical Surveillance Physical $100.00 $100.00 $100.00 $100.00 $100.00
Exam
Physical Return to Work $40.00 $40.00 $42.00 $44.00 $46.00
HPE Level 4 $75.00 $75.00 $79.00 $83.00 $87.00
HPE Level 5 $125.00 $125.00 $131.00 $137.00 $143.00
HPE Development $350.00 $350.00 $350.00 $350.00 $350.00
HPE Admin Fee $100.00 $100.00 $100.00 $100.00 $100.00
C.4 Laboratory Testing
Service Fee Service Fee Service Fee Service Fee Service Fee Opfiol
Service Description Contract Year Contract Year Contract Year Option Contract Contract Year 5
1 2 3 Year 4
Blood Collection Medical $235.00 $235.00 $235.00 $235.00 $235.00
Surveillance Exam
Drug Screen-Blood $165.00 $165.00 $165.00 $165.00 $165.00
Drug Screen Re-Test(Split
Specimen) $175.00 $175.00 $175.00 $175.00 $175.00
Hemoccult(in Center) $8.00 $8.00 $8.00 $8.00 $8.00
Glucose Finger Stick $13.00 $13.00 $13.00 $13.00 $13.00
Complete Blood Count(CBC) $15.00 $15.00 $15.00 $15.00 $15.00
Blood Chemistry 20/23 $38.00 $38.00 $38.00 $38.00 $38.00
Hemoglobin AIC $58.00 $58.00 $58.00 $58.00 $58.00
Hydrocg Volatiles
Blood/Urine $75.00 $75.00 $75.00 $75.00 $75.00
Blood/Urine
U/A Manual Microscopic $33.00 $33.00 $33.00 $33.00 $33.00
Blood-Lead $70.00 $70.00 $70.00 $70.00 $70.00
Blood-Chloroform $127.00 $127.00 $127.00 $127.00 $127.00
Blood-Formaldehyde Screen $100.00 $100.00 $100.00 $100.00 $100.00
Blood-PCB $130.00 $130.00 $130.00 $130.00 $130.00
Blood-Hepatitis A Surface $65.00 $65.00 $65.00 $65.00 $65.00
Antibody
Blood-Hepatitis B Surface $90.00 $90.00 $90.00 $90.00 $90.00
Antibody
Blood Hepatitis B Surface $40.00 $40.00 $40.00 $40.00 $40.00
Antigen
Blood-HepatitisCAntibody $97.35 $97.35 $97.35 $97.35 $97.35
Blood-HIV%Screen $47.00 $47.00 $47.00 $47.00 $47.00
Blood-HIV Confirmation $65.00 $65.00 $65.00 $65.00 $65.00
(Western Blot)
MMR Titer $147.00 $147.00 $147.00 $147.00 $147.00
Rabies Titer $95.00 $95.00 $95.00 $95.00 $95.00
Professional Services Agreement Occupational Health-Concentra Page 25 of 27
Hepatitis A Titer $65.00 $65.00 $65.00 $65.00 $65.00
Hepatitis B Titer $55.00 $55.00 $55.00 $55.00 $55.00
C.5 I m m u niza do usNa c ci n es
Service Fee Service Fee Service Fee Service Fee Service Fee Optioj
Service Description Contract Year Contract Year Contract Year Option Contract Contract Year 5
1 2 3 Year 4
Rabies Vaccines/Is`Injection $1,885.00 $1,885.00 $1,885.00 $1,885.00 $1,885.00
Rabies Vaccines/2nd Injection $1,885.00 $1,885.00 $1,885.00 $1,885.00 $1,885.00
Rabies Vaccines/3rd Injection $1,885.00 $1,885.00 $1,885.00 $1,885.00 $1,885.00
Tetanus Toxoid $20.00 $20.00 $20.00 $20.00 $20.00
PPD(Mantoux) $15.00 $15.00 $15.00 $15.00 $15.00
TB Skin Test $15.00 $15.00 $15.00 $15.00 $15.00
Influenza(Flu Shots) $15.00 $15.00 $15.00 $15.00 $15.00
Hepatitis A Vaccine/I`Injection $65.00 $65.00 $65.00 $65.00 $65.00
Hepatitis B Vaccine/IS`Injection $55.00 $55.00 $55.00 $55.00 $55.00
Hepatitis B Vaccine/2nd $55.00 $55.00 $55.00 $55.00 $55.00
Injection
Hepatitis BVaccine/3rd $55.00 $55.00 $55.00 $55.00 $55.00
Injection
Hepatitis B Surface Antibody $90.00 $90.00 $90.00 $90.00 $90.00
Hepatitis A&BVaccine/15` $120.00 $120.00 $120.00 $120.00 $120.00
Injection
Varicilla Titer $82.00 $82.00 $82.00 $82.00 $82.00
Tdap(pertussis/whooping $70.00 $70.00 $70.00 $70.00 $70.00
cough)
MMR Vaccine $80.00 $80.00 $80.00 $80.00 $80.00
Varicilla Vaccine $125.00 $125.00 $125.00 $125.00 $125.00
C.6 Other Procedures/Services
Service Fee Service Fee Service Fee Service Fee Service Fee Option
Service Description Contract Year Contract Year Contract Year Option Contract Contract Year 5
1 2 3 Year 4
Audiogram $20.00 $20.00 $20.00 $20.00 $20.00
Chest X-Ray $52.00 $52.00 $52.00 $52.00 $52.00
X-Ray Interpretation $34.50 $34.50 $34.50 $34.50 $34.50
Pulmonary Function Test $21.00 $21.00 $21.00 $21.00 $21.00
EKG Resting $0.65 $0.65 $0.65 $0.65 $0.65
Functional Capacity Testing* $35.66 $35.66 $35.66 $35.66 $35.66
OSHA Respirator Questionnaire $25.00 $25.00 $25.00 $25.00 $25.00
Respirator Fit Test $38.00 $38.00 $38.00 $38.00 $38.00
Review of Information $15.00 $15.00 $15.00 $15.00 $15.00
*For 15 Minutes
Professional Services Agreement Occupational Health-Concentra Page 26 of 27
EXHIBIT D -PROVIDER'S RESPONSE TO CITY RFP
Professional Services Agreement Occupational Health—Concentra Page 27 of 27
Medical Provider of Occupational
Health Care Services
RFP No. 14=0225 W
PRESENTED TO DUE:
September 11, 2014
City of Fort Worth, Tx 1:30 P.rn.Central
PRESENTED BY
concewitra,
Jerry Francis
Sales Manager
2.500 West Freeway,Suite 100
Fort Worth,TX 76102
Phone. 0117.100'2.01700
Fax.- 80 17.1018 2.00 7 0 7
Mobile: 214.649.1213
Email.jerry_i rancis @concentra.com
City of Fort Worth,TX^nFPNo.14-0225
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_~_----.2
1. Execut�eSmmnmnary .---...--~—~--~—.—..—~---------...--.—.—..
Z. Conflict nf Interest Questionnaire........................................................................................................Z1
��
3. Qualifications Questionnaire................................................................................................................
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4` Fees and Charges Schedule -------~—.—~—.—.----------.--~—~—.—..—.--..
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5. ��BEUbUzat�n �on —.---.-----------.—.—~-------~---..--.—~..--....
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�� Finanda| |nforn�a�on—.—.—.—...—.-----------~—.—.—.—~-------_----_
22
7. Organizational Information ............._..—.----.--------~—..—~-------~—.~.—_
�.
Location Map. ---.--.—~-----~..---~—...~--.------------.—~------ .
9. Organizational Chart.............................................................................................................................Z4
,_.---.I5
10. Sanno� Repn�s—.---------~—.—.—~—.—~.--.--.-----.—~—.—~—
� _...--...2�
11. References---.—.--.-----~—~—.—.------..—.—..—.--~------''
Attachments
A—Ci�-requiredQocurnen1s
— D ocurnen 1s
( 8—Legal/Risk,
` C—Persmnne| Qua|ifications
0—Fees and Charges Schedule
E—Rmmmcial In-formation
F—Sanop|eReports
`
�
\ (D2oz4Cnncentm operating Corporation.All rights reserved.
Table of Contents
City�Fort WorLh,-T,'(*nFP No.z4-o22S
Medical Provider of Occupational Health Care Services
concemt. a.
,
September 1l, 2Ol4
`
Doris Brent,Contract Compliance Specialist
City of Fort Worth, Purchasing Division
10O0ThnmcknnoMom Street, Lower Level
Fort Worth,TX761B2
RE: Medical Provider of Occupational Health Care Services,RFP No. 14-O2ZS
Dear Ms. Brent:
Cnncentra is pleased to present our capabilities 10 the City of Fort Worth(the City). In issuing Request
YorProposal (RFP) Wu. 14-O23S,vveunde�tmnd that the City seeks mqua!i�ed vendor toprovide
occupational healthcare hcaresen/iceo.Concentra is highly qualified and well positioned to perform the
services the City is seeking.Concentra values our role as the City's current provider of the s ervices
requested in the RFP and if selected,we will remain committed to assisting the City reach ftshealthcare
goals.
To best serve our clients' needs, Cuncentra draws from a pool of experienced professionals to provide
local program oversight and support. For the City's program, Concentra assigns Mc Jerry Francis, Soles
Manager, to serve as the initial contact and customer liaison between Concentra and the City.Should
the City hove questions concern;ng our response, please contoct Mr. Francis via phone: 224.649.1213, or
/
by email:jerry froncis@concent/o,corn.
` i � t 's response tothe services outlined in the City's specifications, pricing
This�ocwnn�ntcomtans on��nra
information,and relevant attachments. Concentra affirms that all information contained herein is
current, complete, accurate,and remains valid for 1080 days following the due date,September 11,2014.
Furthermore,we include all required forms and business credentials as Attachment A—City-req uired
Documents.
Our Legal and Risk Departments reviewed the terms, conditions, and insurance requirements and made
minor modifications to the language.VVeinclude these suggested revisions as Attachment B—Legal/Risk
Documents. Additionally, CVn ` ntnadoesnoto8neetoemterintoacanperatixepuruhasing agreement at
this time. If Concentra is the successful bidder,we desire to engage in open dialogue with '-the City,
review the proposed modifications,and ultimately create an agreement that not only outlines the
schedule of services,but also protects the business interests of both the City and Concentra.
Concentra values the City's consideration of our response.We are confident that when the City takes
into account our experience,capabilities,technology,infrastructure, project management,and price,
Conmemtravvi||emerge as the clear choice to perform the occupational healthcare services the City of
Fort Worth desires.
Re ly sub
d
Arlene�
/ - �
Authorized Representative
Page I
City of Fort Worth,TX�RFP No.14-0225
Ir Medical Provider of Occupational Health Care Services
concem-Ma
19 Executive Summary
Program Overview
Concentra acknowledges that the City seeks a qualified vendor to provide occupational healthcare
services. For the purposes of this RFP,the City specifically requires:
• injury care/treatment 3 Exposure control program
• Physical examinations Medical surveillance
Drug and alcohol testing Commercial Driver's License (CDQ program
Clinical testing
Concentra Solution
Concentra has direct experience serving as the City's preferred vendor for the specific services
requested in the bid specifications.We are confident that our involvement in the current program,
expertise,and best practices approach make us right company to assist the City in meeting its program
objectives.
Concentra assures the City that we will:
Leverage our decades of experience a nd use company best practices that are compliant with OSHA,
DOT,ADA,City rules,and other applicable regulations and guidelines
Include all City-specified components in the examination process
Conduct drug and alcohol screenings in accordance with DOT standard,49 CPR Part 40
Utilize our conveniently located Fort Worth Forest Pork medical center to render primary services
during the program,with other locations available as convenient alternatives
Employ only properly credentialed and trained med ical professionals and support staff to perform
the scope of work
• Assign a designated team of qualified professionals to oversee th e City's program and ensure
continued compliance
• Document patient visits and generate meaningful reports
Maintain records securely to ensure confidentiality of personal health information according to
HIPAA guidelines
113 Lan
Service Sites Overview
Concentra Medical Centers offer a full complement of healthcare services including, but not limited to,
physical examinations,substance abuse t esting,clinical services(hearing tests,pulmonary function
tests, laboratory collections,vision screenings,X-rays),vaccinations, injury care,physical therapy, and
wellness screenings.To accommodate our broader service offering, Concentra has extended clinic hours
evening and weekend hours for patient convenience.
in many locations to include convenient
Facility Layout. Since inception,Concentra's affiliated physicians and management have continued to
evaluate the layout of our centers to ensure we design each location to promote the most efficient
patient flow throughout each area.Therefore,the physical dimension, layout,and staffing of each
Concentra Medical Center varies depending on the location.
Paee 2
City of Fort worth,TX°0FP No.14-0225
������ ��d�ipm�������na|H���m���
` e�m�mmn�w�wm�" ,�`
' i ize�e�meen� 10Dand� 000aquarefee�nnaintainsecurityservioes,nnostoffer
Our centers in ' ,
� ' -- ---between
all are handicapped-accessible and confo/mmto
` free�arki���npr»Pe�Y�raU��o�n�| fet ddisa�iHty�avvsAsdescribedimthefollo»»{ngtab|e' each
�||a�p|i���|e����r��,stat�, amd local safety .
center's layout consists of support/common areas and clinical areas.
Waiting Room-seating for Manager Office Restroom
patients with a Break Room Records Storage Area
�
Business office-work area for
clerical staff
Procedure Rooms-for minor . Audio Testing Room-a single- Storage Area-for patient
procedures person booth with a charts
"
Lab Area-separate'==""~''~ T Physician's(ADA'compUant)for drug and 0 Physician S aU mn-with X-ray strength and flexibility �
alcohol collections,blood viewing areas and privacy to equipment,
collection area enter patient data into hydrocu|aton��eeze�and a
° BreathAno|yuis/ExamRnono- computer system wide variety oftherapy
tu maximize privacy for " X-ray Facilities(with darkroom modalities
fedemUy'mandatedtosting and file storage)-afuUsemiue
�
X-ray room
`
Proposed Service Facilities
Primary Service Site
Of the hundreds mf clinics vve operate na tionwide,
16 are in Dallas/Fort Worth (DFVV).Asmentioned, I5O0VVestFreevvay(i3O)
Comcentra proposes that our Fort Worth Forest Ste.100
Pork location serve as the primary service sit-e Fort Worth,TX76102
during this engagement.This facility maintains Con\ac1Information
the necessary equipment and staffing resources phone� 817.182.87V0
and employs clinicians who are thoroughly M0 017.082.8707
Fax�O17�882.D7U7
knowledgeable uf the state and federal HouoofOperation
regulations applicable tothe requested scope of O� 8
0Oom- :OOpm (K8-F)
vwork.P/uozenotethotoaw/th /nonyother �
�-- -
/ocobnns/n the DFN//norket our Fort N/orth -
Forest Pork location of�ocx�endedevening and weekend houoco accommodate u'''p/"/=e^ ,"'.~.'../
'' nentƒor evening and
g hours. Th�o0gns with the [/ty�nequ�e
nyqu�eservices outside ofnonnn/mo/�n
weekend hours os Outlined/n sections 30.2.2ond3D.2.4of the RFP.
Additional Locations ,
VVhi!ethe Fort N/orthForest Pork serves as the p�nnam/facility for service deY� �e� Conmemtnas
additional 15 locations im the DFVV area will serve as secondary locations and are available as
`
pn=^r o
City of Fort Worth, X -�RFP No.14-0225
Medical Provider of occupational Health Care Services
convenience necessitates. In the following table, t.ve iClel7tlfy the four locations that are within 16 miles
of the City's address, including addreSs, hours of operotion, and contact information.
� 4
- e e
Arlington 2150 E. Lamar 8:00 am-8:00 pm (M-F)
Arlington TX 76006 972.900.0DO 41 9:00 am-5:00 pm(Sat-Sun)
North Blvd.
Arlington 817.261.5166 8:00 am-8:00 pm(M-F)
ArlinArlier
511 E.1-20 Arlington TX 76018 817.275.5432 9:00 am-5:00 pm(Sat-Sun)
017.293.7311 8:00 am-0-:00 pm(M-F)
o11 NE Alsbury Burleson TX 75020 0
Burleson Blvd,Ste.000 017.551.1055 8:00 am-5:00 pm(Sat)
Fort Worth 817.306.9777 S:DO am-5:00 m M-F i
! Fossil Creek 4060 Sandshell Dr. Worth TX 76137 817.306.9780 p ( ) j
Managing Wait Time and Total Time in Clinic
As a clinical healthcare resource to the City,Concentra assures that we will make every reasonable
effort to minimize wait time for the City's employees and applicants. However, because Concentra is a
walk-in medical facility and injury care is prioritized, it has been our experience that wait time outliers
occur periodically.Should wait time ever exceed the target time,a designated colleague will
communicate the status to the patient a minimum of every 15 minutes. In addition,we can establish
communication processes in which we notify the City's designated representative when wait time is
expected to exceed the agreed upon timeframe.
Regarding the services requested in the City's RFP:
• Physicals: We perform physicals according to definitive service standards,which provide sufficient
time to render comprehensive,quality care. Medical examinations and clinical procedures follow
injury treatment.
• Drug and Alcohol Testing:of relevance, in a majority of our medical care centers implement"fast
track"drug/alcohol testing services in which employees experience a 30 minute or less wait time for
a drug specimen collection and alcohol testing.
Concentra currently measures the patient's total time i n clinic, which includes wait time,the time it
takes the center staff to provide the service,and any wait times involved after the service is provided up
until the patient is checked out of the center. in our DFVV market, Concentra's average total time in
clinic year to date is:
Injury Care Non-Injury Care
✓ Initial Visits 112 minutes Physical exams 106 minutes
✓ Recheck Visits 65 minutes ✓ Drug Screens 42 minutes
✓ Therapy Visits 66 minutes
Page 3
City of Fort Worth,TX�RFP No.14-0225
����� M��|p��r�����|n������us
' �^�'wme"��mm�m ��
/
' Prograrn Management
While consistently looking for opportunities to improve,Concentra has proven to be a valuable partner
to the City for more than 1O years, as evidenced bv the following:
" 28O9 validation study illustrating that the City achieved a 6AY6 cost savings when employees chose
Concentna for work-related injury treatment
" Concentra's partneohipvviththe C� vv
ytmdexe|op�au�cessfmUandeU-renVvxnedCDLReviexv �oard�
a model that has gained the attention of other large municipalities across the country
"
Development of an innovative survey process that measures patient satisfaction specific to the
Cit/senmp|oyee�aUovvinQCity and Concentra leaders tocnlUabonatively develop customized
'
ao|utionsas employees' |thcareneedsmndexpec1ationsevo|ve
Many of Concentra's leaders who have worked closely with the City over the past decade to achieve
these results will continue to serve in this capacity for the upcoming engagement. Based on their years
of experience working with the City,as well aso firm understanding of the City's current and future
needs,these individuals will lead our service delivery efforts to ensure successful program outcomes
These leaders include:
"
Kevin Boehle.. DO, MPH, Regional(Vedicol Director:7 years with Concentra; board certified in
Occupational Medicine and Family Medicine
• jcrryFronci� Soles Manager: 13 years with Comcentra;more than Gyears of direct experience with
the City's account
• Ryon Smith, Area Therapy Director: More than 6 years with Conce ntra;over 5 years as Physical
'
Therapy Director at our Fort Worth Forest Park location
` = Dee Harrington,Area Operations Director: Operations leader overseeing six Concentra centers in the
DFVVnoetmnp|ex
In the following sections,we identify the local leadership team we propose to provide ongoing oversight
and per-form services during the upcoming engagement.
Program Advisor
During uuntract review and negotiation,ve assign an initial contact toserve asa liaison between
Comcen1ra and the City. For this p 'e��8��JerryF(onci� So�s8�unoge� serves as the city's�rstpoint
' �. Fr����� curnent|y��pportsc hi en 1 en�aQ�me�t�imDFW
'
ofuontactthrnughnom1nactexecution. M
including the City.With a background and knowledge of the market and a direct relationship with the
City, Mr. Francis is well equipped to continue supporting the city's program. Mr. Francis remains
knowledgeable of contract deliverables and is available to answer the City's questions during this
period
of the engagement.
As Sales Manager, Mr. Francis:
"
Serves asCuncentra"s liaison ta the City
"
Leads and directs contract implementation
"
Ensures a clear understanding of contract objectives and deliverables through the successful
execution of programs and projects
"
Negotiates work approach and specific deliverables based on expected contract outcomes
Directs c ontract execution efforts to ensure programs are completed according to contract
Page 4
`
City of Folt Worth,Tx^0FP No.z+O225
0�u���0�0�m��§��
Medical Provider nfnco/pa�ona|Heabh Care senx�s
^ w=m�mme=�"mwm.m ��.
! ° Participates with center,area, and regional leadership team' to effectively monitor and maintain
`
existing accounts and develop new business
KVr, }u/esImten. Major AccountExecubue,will provide support and assistance to Mr. Francis, asneeded,
to ensure continued service excellence. Mr.Staten has been a Concentra employee for eight years and
possesses direct experience overseeing many engagements with QFVVclients.
0menmt�nnn/ ��ven�gh�
'�
Center Opera tlfonz Director/coD/for the F ort or thfo nss t Park center, Mr. David Lambing, AM77RMA
,
serves as the City's da�to'day contact for progranm operations. In this role, Mr. Lambing regularly
monitors processes and procedures forareadionta1mensureon8oin8cnrnpliamce with relevant
guidelines and program specifications. David Lambing,AMT/RMA
As COD, Mc Lambing: Center Operations Urector
• oversees dayAo-day center operations ~ '^~'' ^`'^'' --��--� --
= �mmp|emoento�nd �nsureson�oinQconop!iancevvithall �------'-------------
operational policies,procedures,and training programs within the center
• Manages patient care issues and other center issues requiring resolution
• Acts asa liaison between Cmmoen1ra and our preferred vendors
Additionally, MS. Goby8ctoncou/t, City of Fort Worth Lead
,
will serve asaday-to-day contact for the City. Ms. Betanoourt
,
will be invaluable tV the success of the City's program and is
available to answer questions, address issues, and ensure the A years with Concentra '
program continues to operate efficiently.
Medical Oversight
��n�er8�eoY�u/D�ec�or/[8�U/for�he Fo/�N/u/�h Fonyst Pork cente� RoyXreuse( &YD' provides primary
oversight for clinical medical practices,ensuring continued compliance. In this role, Dr. Kreusel ensures
that the medical interpretations and associated clearances comply with the most recent medical
guide|inesused by regulatory agencies. Dr. Kreuaeys expertise nf the guidelines and regulations relevant
tm the�outlined scope of work will be instrumental intheprovisinnofsen/icesforthe[it/spnogranm.
AsCW4D, Dr. Krewsek
"
Reviews all medical hist
oryamd perform medical physical
i4 years with Cancentra
examinations /
• Understands all medical surveillance requirements of
OSHA, DOT,AD/, F&8LA,and other regulated examinations
• Reports the results of the medical evaluation to the employee, including any medical condition(s)
identified during the medical evaluation
• Provides the recommendation as to whether-the individual is medically certified to safely perform
the essential job tasks
• Fnnwar�� oopiesofomy�������|Ke����a|omBvvith��tien�instructiomsmegamdingpr{maarycaoe
� � � � � ��mU to address
follow-up,toindk/idma1sxvMovxereim�rmo1ed to seek(as appropnate, rne follow-up
any medical conditions or lab abnormalities identified during the medical evaluation
Page 5
'
�
City of Fort Worth,TX+0FP No.14-O22s
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/ " Provdesora�amQ�s�or��r�sch�dv� nehabil�atimnand/orf�messpro8ranmwhenindica1edtwaid in
' ' '
` the individual's recovery from illness or injury an d enhance his/her ability 10 safely perform essential
-
job tasks
° Reviews medical evaluations conducted by other physicians or medical providers
° Reviews individual medical evaluations and aggregate data to detect evidence of occupational
exposure/s\or clusters of occupational disease
phys/ca/ TMeropyon«Y Functional Testing Oversight u 'e/ P� �PT, prov�d
es
Center 7heropyD�cctor/[TD/for the Fort Worth Forest Pa/kcente� M/choe/M
oversight for the physical therapy services rendered as part of the program.Mr. Murrell is an expert in
his field and possesses a wide breadth ofknowledge
overseeing these services for other area clients. Mr. Murrell / Michael Murrell,PT, DPT
will utilize this expertise to deliver services that objectively
Center TherapyDirector |
assess the employee's functional abilities and expedite the 5 years with Concentra
return-to-work process.
As[TD, Mr. Murrell:
" �ondu��anin-~-a| ev��uadunonphysid�nrefe��bonddeve|opapprophate1neatnmentplans
"
Ensures that other treating medical professionals have the necessary information to appropriately
evaluate the employee's functional ability
"
Communicates with all medical providers and the City regarding employees'diagnoses,sets
expectations for return-to-work,emphasizes education and motivation,and discusses specific
rehabilitation issues and early intervention opportunities
' ^
Develops knowledge of best demonst rated practices and specific quality indicators to measure and
improve them of h bi|itationqumUtymnona8ernent
" Pavticipatesm/i1htheeva�uad�nofthee��c�imaness e re �
process and assists in new and improved processes
"
Ensures compliance wit
h rules and regulations established by the relevant licensing,certification,
and accrediting bodies, including the ADA and other applicable guidelines
VVe provide leadership personnel qualificmtionsandcredentia|aasAtachnoentC-Personne}
Qualifications.
Clinic Staff
~~ ~�~�''ndfes��a�hcareprofe�siun��ondsmppurts�Afxvhoposseasthe and specific
Concentra /�enon �
--��-- - '� professionals
hands-on experience delivering aervice�that are relevant tm our core offering.
our staff includes any
combination of physicians, mid'|ove|s, nurses, physical therapists, radiology technicians, and medical
the�i� that assistants,and we assure �/n Y/sor noentravvill only utilize qualified and mppnopriatelYcredentia!ed
° &Yed/mz�Therm�yP/o�ess nm ��o
` fe i | toservetheneedsmftheCityand its emmp1myeem.These
moedica|and therapy pro professionals
professionals are skilled�n their respe ctive area of expertise and undergo extenskeammual training
in addition to the continuing educadomclasses that Cnnrentna�nmncialk/supports. Furthermore,the
medical �d�n�cxxi�kbeviQiantinapplyimQ1heirknovv|ed8etopecuQnize
ed�ca|�n�1�enapy�emunn�i in /
potential exposures and resmtt|n��hea|thigsues�and vvillcontinue tmnnomitorTexas,
and�ie�nusepo�eme«�
OSHA, DOT,ADA, and other applicable federal and state regulations to ensure that all associated
services remain compliant.
Page 6
`
City of Fort Worth,TX�RFP No. 14-n22s
����� Med|�|p��der������|H�hh��sem�,
� n=n�mmm=r=mm�" ~�.
copportSto/jf,Concentra Medical Centers employ qualified support personnel whom we train and
`
fully ce/�ifvtope�orm their aosoda1edtasks.Speci�caUy,our personnel include druAspedmmen
collectors certify to
t� perform DOT collections,certified Breath Alcohol Technicians(BAT), N|{�SH-
� �A���� rti�ed personnel to perform audiometric testing,certified radioUo8ic
cer�if�edP�Ttes�ers, �e
technologists,certified medical assistants, and certified phlebotomists.
'
~re^@ent^aUing Practices
Concentra clinicians must undergo a stringent credentialing process.Once the Concentra Credentials
Committee Choin/p�edica�Advaordearsthecandida�,Concentma follows NCK��guidelines for
' toverifvthe licensure board certifications, and
cnedent�a�in8,vvhichmequine�prim«�'yoour��verification sanE�LS' uerytaidentify' �fau�ndidet��� b�rre�
any provider sanctions. In addition,Concentna performs o 9
fnznn contracting with the federal government.Conuemtra uses secondary sources(copies of
documentation)
to verify curriculum vitae and DEAcertifications. Finally,we check the National
Practitioner Databank for malpractice history.Additionally,Concentra re-credentials our providers exery
three years and, in the interim,we monitor these providers' Ucensmres for expiration to ensure that they
remain active and current.
Physician, mid-level, nurse,and therapy candidates for employment must pass a ve I stringent
credentiaUng process that includes, but is not limited to,the fn}|mVxing:.
"
in-depth review nf employment application and resume
° Face-to-face inten/iemsvvith Concentra Management personnel
" Verification of clinical,peer,and employment references
" Verification of negative test results for illegal drugs where applicable
` ° Documentation of continuing education and training
"
Provide copies ofACLS/BCLSor PALS certifications
"
Primary source verification of the following:
/ Education and training
/ State |icensmreb\
DEA and state controlled substance registration (if app icabk4'
v'
Board certification/�app\ioa�ke��the prmddeh
` � veh���t� r�moht�e�ppUc�tonandattestadon;Qapsof
/ VVorkhistory/nnostreoemtf}veyeao', through ,
six months or more are verified /explained bvthe provider
/
Malpractice history is verified through the NPD0query
Sanctions against liceosure,verified through the|icensume verification and the NRDQquery
/ ��edicere/ edicoidsanctimn4vehfiedthrough the NPQB query and aquen/ofthe O1G
" Background check(including criminal and credit history for previous 1Oyears)
a m letters fro
previous employers ) �f appropriate
* Approval bv contracting organization (governnnentagency orcormnneroia|customer), a�propr
= Ap��ova|�rmmn �omcen�na'sCmedentiaUnAConnmni1tee
All[oncentro personnel, regardless ofpos/dnn' are requ�cdto hove obockgrouod check cons�t/ngofo
felon v�n�derneonorchec�Social S`~u�tyvalidation and�oce, nobono/sex of�/nde/check�orsto�
d'�� oden�core} no�ono/cr�'n/no/seorch crcd�hbtorK ondocheckogo/ns�theOf�cenfFone/yn
rendering poi -'' ' , �
Assets Control list,
'
City of Fort Worth,TX+nFP No.14'nz23
������ M�i�|��c�������|H����Se�us
*=*�mm���=mm�m ma
Approach to the C^ty/S Scope 0' WOF"k
Com / mtrahasperfomnedoocunstionaUheakhcareasrvicessinceimoeptiommorethan three decades
ago.We reviewed the scope of work requirements set forth in the City's RFP, and we affirm that we are
fully capable of performing all of the requested services with the highest level of success,efficiency, and
professionalism. Furthermore,Concewtra has written procedures om all DOT,OSHA,A0/, and other
regulatory standards, including the testing(surveillance examinations, pulmonary function, audiometric,
laboratory, )e��. required im each s1an . Likewise,�
treatment offers am advantage over our conpe titoro. [o ncent/o assures the City that ourphysicians
possess the appro.pinote credentials to perform, the Cit cifeziredoccupofionat health serviceS.
Occupational Injury Medical Treatment and Care
8ost-/n-CYo5sAppnmad-,
Through exhaustive research including engaging clients, patients, and vendors, as well as leveraging our
35-year history as an occupational health services provider,we identified four cornponents a company
must address for a best-in-class occupational medicine program.These four integrated ecosystems are
critical to achieving a solution that assists in the prevention of workplace injuries and reduces employer
costs. Todav Concentro treats one in every Seven work-re lo te dinjurieslilln esses in the United States.
We determined that to be truly"best-in-class,'each program component must exhibit the following
specific characteristics,which m/e describe below our four keys tna bemt'in-damx occupational medicine
program.
Quality em9ioye/[n�a�emen�
' |`
regarding services to drive a clear
Uccupabona| madicineexpe�i�e�n d Educate employees
understandingofscopeofcare
philosophy
> Open access to clinicians ncouroloe relationship bui|din between provider and
� Focusnnoutcomes emp}oyerthrough reciprocal facility tours
and staff
Our extensive occupational medicine expertise introductions
ensures informed recommendations that follow Develop processes that enable interacbvecnmmunicationS'
regulatory guidelines. generate meaningful reports' and enxuie conop|iance traoking
VVe collaborate with employers to develop occupational health
programs tailored to the specific needs of the workforce
population.
��ear�onnmmnicat{mns
Paden�En�e�epne��
7`
Focus on en, p|cyaehealth and patient S-tructure and managed communicat|onsprocesses
experience >1 Clinical informatics
� One fadUty(o,Multiple services VVe follow a communication pathway,from the initial visit to
The better the patient experience,the more likely case closure,that ensures employers and employees are
they are to follow through nn the treatment plan updated uncases.
too successful outcome.
Medical Guidelines
Concentre has always focused our approach unproviding quality medicine that achieves the best
outcomes; as such,currently published, evidence-based clinical practice guidelines direct the medical
evaluation and treatment decisions of Concentra's clinicians.As a large medical practice,we are able to
e� �kmf���d�r �VV����1�i�����athrou8hn��the
��th��d�1�onrniUUiomsof��aesacno�snu�nex�or n,.
organization ta improve practice.patterns,develop medical guidelines,support our research institute,
/
and create an environment of continual learning for our clinicians.
Page
`
City of Fort Worth,Tx �,RFP No,1+o22s
JL
���� �� M��a|pm�������na|H����se�ms
w=o�mmm=x�mm�m ��,
/
our clinics will utilize the following medical practice standards:
°
Texas Labor Code Regulatory
°
Evidence based guidelines / occupational Health and Safety
Administration/��SH/\\
��
� A� EKA guidelines
(OSHA)
/ Uffida| Disability Guidelines/ODG\ / Department of Transportation (DOT)
/ E�dence-bmsedclinical practice guidelines / �omp�n��pecihcexams
� Up'to-dmte online professional medical Americans With Disabilities Act(ADA),
resource Family Medical Leave Act(FMLA)
Concentra physician manual Stendin8onders/procedunes
��utcomnes-bamedevaluation and education
� N�id'|�v�| pnmv�decs—co�|abana1ive
/ United States Preventive Services Task agreements
Force (USPSTF) / Registered nurses
Our Injury Care philosophy
Concentma tracks and documeny employee
� vioitsconsistertUy, enauhngpnnpardVournentatio» in
federal �� VVmrkstatus m/i|| inonoediate|ybe faxed oremnui|edtothe
�cmordon�evxith |uCaU state,and era laws.'-to �mek/conmnnmnio��on econtentnfeacAphvsicianvisitimdudes
Uesi�mate�Ci�ycontact ensure timely . .^^ '
key elements in order to maximize the likelihood of a favorable outcome.
Concentra'o affiliated physicians treat and document en estimated 56O,QOO injuries eachyear, al|oxv|ng
us to study comprehensive outcome data.This evidenced-based,outcomes-focused approach set a
standard of excellence for the healthcare industry and has proven effective in returning people to work,
'
to play, and to life faster and more affordably, resulting in lower overall healthcare costs.
Treatment and FaUmm/'up
Process monogernsntis the system that 0nnoentna employs to treat injured xvorkens, uti!izin8proven
outcomes to medically manage care in order to achieve the highest patient satisfaction and shortest
duration ofoane.VVebe!ieve that the-foremost method of cost control in the workers' compensation
arena lies in the timeliness and management of quality delivery system.
[oncen�o'soch/evestt�goo/byutJ�/ngourfourKeys�o�uccesceor/y/n�ervcndon, eo�ymot/vo�on'
oodyeducot/on'`ondse0cnsp onsibility. These factors contribute to Con centra's ability ta reduce case
duration for occupational injuries,thereby driving down the total costs our client's spend omworkers'
i Ubein1eQraU �m
compensation.This philosophy ofa sports medidneapproach n a work wvi
the success ofConcemtra's relationship with the City.
[ontentrnonogennentnefenstntheinfornnutionobtainedondconveyedbetvveenthaphysidan and
patient during the course of the evaluation, as well ao the nature nf the interaction.The content well as
elenmen1sof the visit focus mn achieving a good outcommeimatin^e\y and cost ef#ective noanne�asvve
ensuring patient satisfaction with the encounter. Process management provides the structure ofthe
practice'and content mnamaQennentisvvhat�l!sthat structure.Content mmamaQemem�w/henappKiedvv�h process management, helps ensu d well as favorable outcomes of treatment.
When Concemtia hires clinicians,they are required to participate ima formal educational program in the
areas of:
~ Content and process management
/ ~ Lo �ao�pei� nmana�emen�emn��aa�zim�abiopsyohosoci�|nn�de�nfdisease
w/
City of Fort Worth,TX+RFP No.1+o22s
������ M�ks|pm��������|H��h�����
Con cent-
m�m ��.
~ Ethics
` ~ NIPAAavvaremess
~
Other topics related to the practice of occupational medicine
In addition,C�ncen�naprovide�diwiciansvxitAnegu|arfeedbackmntheirVmcmpationa| nmedical practice in
' which include such mneasuresaa percentage uf cases taken offvv or��
the form o��u�rter!yreports,vv n
percentage of cases on work restrictions, rate of referral to specialists,case duration,and others.
� ncentnaaUaoprovidesnationml data for conmpanativepurposes,including dataonConcentraphysicians
considered to have best practices.
All of Concentra's clinicians are trained in occupational health and each will have knowledge of the City's
workers'compensation rules and regulations.Aaa current provider tu the City,Connentra affirms xxe
participate in a workers' compensation healthcare network certified under Chapter 1305 of the
Insurance Code. Concentna also ensures that the physicians/providemare continuaHytrained and
updated onworkers'compensation rules, best practices,OSHA, DOT, HUPAA,and all other applicable
regulations.
,Retunn'to'm/onk Functional Testing Procedures
Cnncentra's longstanding ethodo|oQyan� �r�cticehaab�enonoof�xpeditinQ the re1mrn-to+mmrk
methodology
process'Concentra's clinicians communicate immediately with employers, review job analyses, and,
ib| for limited lost dmefronnwork.Comcen1ra focuses nn
vvhene»e�po��possible, just t reduction This focus requires the Con«entra
increas|n#thefunctionmftheenop|oyee, not]u symptom .
staff to have a thorough understanding of the various jobs in the workplace,educating the employees
/
on enhancing �n�suppor�fnzmo�heennp|oye'sfvnnt-linesupen/isors.ThiscoUoborationxvill
` ' n . N/s include o dditiono/inhonnotinnregord/ngouropprooch
lead toa successful neturn'to-vorkpnoQra
to physical therapy later in our response.
Re�����8�
^~ ^ �
If, during a xvork're1mtedvioi� Concentra's provider discovers mn employee has a secondary medical
condition or a non-occupational condition that warrants an outside referral,our physicians seek the
expertise of the local healthcare community.The strength of Concentra's local employer relationships
necessitate our integration xxitharea providers Vvithimthe connmmnityto ensure the highest quality of
continued-�re for our patients vvhanservices are beyond our nea|nonf care.As such,our centers
maintain relationships community specialists(usually within the local hospital system);through
theseestablished relationships,Comcentra effectively expedites the referral process.
selec t onof Qualified Speda\ists
��meen��aev�Vuatesspecia|is�yba�ednmse«ena� inop�rtantfacturx, imcludimQ, butnut|imoiteWtothe
following:
• Successful medical outcomes
• Reputation in the community
• Willingness to have open communication with the Comcentraprovider
• Ability to provide cost efficient services
• Whether or not the specialist isin the our client's network
/
it is Cmncentra's practice to create specialist relationships through co
mmunicating directly with them d
`
and understanding their processes.Concenira has identified specialis ts that are the "best in class"an
_____ -----------
Page 10 u
City of Fort Worth,TX+mFP No.z4-o22S
A��Q����� M��!��,���[��|U��mm��
v��Nmm,=n=mmm.w m�,
--
/
provide exceptional,quality services. During implementation, Concentra will work with the City to
establish a customized referra! netxvorkuniquetotheCito'smeedsandspeciOcadons.
Rehennz/ Prmcess
Co''centre completes referrals as necessary and as quickly as possible in order to minimize employee
loss
referral department with Concemtra's Center Support Team (CST)to assist in coordinating routine
referrals-for diagnostic procedures and specialist care. Concentra CST schedules referral appointments
for procedures, diagnostic testing, and specialist visits. Concentra centers have designated Referral
Coordinators who are careful to observe any special handling instructions related to claim administrator
notification, pme-authorizaden,or preferred provider networks.
Merj/ca/&4aoagennemt
Managing the case of an injured/sick worker is imperative for success. Concentra reaJilizes that the job 4/
the clinician does not end-with the/ ' na/—it is the dw-Lynf the provider to work with the specialist nma
prognosis and treatment plan. Concentra providers follow the medical care of every injured or ill worker
treated within the Conoentranetwork,from the very first visit until the patient goes back to full duty mr
reaches maximum medical improvement.The purpose of medically managing the case is to provide a
proactive, phyoicion-directed, cost containment and communication service to our client that assures
quality healthcare delivered in the most cost effective manner possible.
Specific medical case management procedures practiced by Concentra include:
. " K8aintaimin8constant communication,xvhethertelephonically,face-to�ace,or v ia Internet(vviththe
`
appropriate security in p lace)
�
Establishing preferred communication methods between the referring physicians and specialist
providers
" Tracking all specialty referrals and reporting on the percent referred and type of referral
" Tracking the medical outcome of each referral made bv our affiliated physician tn ensure the
successful resolution mf the case
Physical Examinations
Pre'enmp/oymnent Physical fxmnms .
&4edica| HistoryQuest|onnaire
Cuncemtra has custom medical and work history questionnaires in both English and Spanish and can
provide an array of comprehensive and mandated questionnaires necessary to maintain compliance.
Examples of mandated questionnaires include the Asbestos Questionnaire and the Respiratory Medical
Evaluation Questionnaire.The applicant/employee completes athorough medical history questionnaire
that includes medical, personal,occupational,family,and medication history.
Once the questionnaire is completed,the Concentra Medical Director reviews the questionnaire and
makes medical recommendations(in conjunction xxi1htherevievvnftheappiinant/ennpluyee'stest
results). Concentra immediately contacts any fi findings that�m seam immediate danger tV the life mr
health of the applicant/employee. once the review of the questionnaire is complete, a comprehensive
phys/co/exorn/notionconn/nences,
Page 11
'
City of Fort worth,TX+mFP No.14-022s
ConcentLra Medical Provider of Occupational Health Care Services
Pre'p>ecenoenL Physical Examination
` Concentra has comprehensive policies and procedures outlining examination requirements Kn
accordance with, DOT,OSHA,/\DAand general occupational health. Cnmoentna will orient and train all
clinical staff on the requirements associated with the City's evaluations. FuMLhermone,Concentre realizes
any medical examination must beperformed post-offer and pre-placement and must be"job-reUated
and consistent with business necessity" /29 CFR163Q.14(b)\.The purpose ofa post-offer physical
examination is to ensure that the employee (or prospective employee)does not have a medical
condition that precludes performing the job safely,that could be seriously aggravated by the job duties,
or that could affect the safety of others ip the workplace.Tomake this determination,the physician
needs to evaluate the individual's health status, and the job requirements.
While the City will define the specific examination components,we recommend that a thorough medical
examination include atleast the following:
^
Complete medical history(family, " Skin and lymphatic examination
occupational, health,disease) ° Neurological evaluation
^ K8uscufoske|eta|exanninat|on ^ Evaluation of the cardiovascular systemm
^
Evaluation of the respiratory system ^ Visual acuity and vital signs, including but
^
Gastrointestinal examination not limited to, blood pressure
^
Examination of head,eyes,ears, nose,throat
|n addition,vve can perform any ancillary testing asrequested and/or when indicated,and upon the
City's approval.
/
Re turn--10-worik/ModifiedN/orl(
Employees undergo a basic medical examination administered by a center physician,who determines if
the patient is medically able to proceed with the functional test. In some cases,the employee may have
a medical condition that precludes participation in a functional test(recent back,/knee/shoulder surgery,
an active hernia,a cardiac omndition). ;n these'cases,prior to administering any functional testing,
Conoentns requires clearance from the employee's personal physician.Once the physician completes
the medical exam,the center's physical therapist conducts the functional test. Concentra may require
additional testing, upon approval from the City,to ensure our examining clinician renders the proper
medical decision. However,Cmmoentra will not conduct any additional testing without exclusive
authorization bya designated City contact.
DOTEganm/natioms
Concemtna has been per-forming DOT examinations for our clients since inception. Dƒre/evonoe, we
Performed more than 765,000 DOT examinotions notionally in 2013. We maintain comprehensive
policies and procedures for these examinations and thoroughly train our staff on each testing
component.Specifically,when performing these exams,the treating provider adheres to the physical
examination components outlined in the Federal Motor Carrier Safety Administration's(FMCSA)
regulations, §391.41-Physical Qualifications-for Drivers. If the driver passes,the physician immediately
generates the required Medical Examiner Certificate.Although the certificate isva|id fur24months,
Concentra physicians may limit certification based on medical results. Concentro affirms that 0
providers who perform these exams possess the proper cprtificotion in accordance with the up&oted
' FM{SAgu/de//nec
PaRe 12
'
City of Fort Worth,Tx+mFPNo.14-0225
������ ��a|Pmwd������a|H��h����ms
m=n�mme=e=mm�° *�.
/
Examination Purpose
|
The purpose of this history and physical examination is tm detect the presence of physical, mental,mr
organic conditions ofsuch a character and extent as to affect the driver's ability to operate a commercial
motor vehicle safely.The examination should be conducted carefully and should mt least imdude all of
the e|e—entsoutlined below. History of certain conditions nmaybe cause for�jectionand mmeyindicate
the ne''forfur�Aer1estin8a` d/nrmeqmire evaluation byaspecia|ist Conditions moaybe recorded vvhich
-- d indicate th��certi���tionofphysi��|fi�nesss�ou|� be
dmno� degree,because
denied Hovveve�these condidnnsshould be discussed m/iththe driver and he/she should be advised to
teketh' necessary steps to insure correction, particularly ofthose conditions,which, if neglected, might
affect the driver's ability to drive safely. '
Specifically,the physicians will examine:
• General appearance and development ° Abdomen and Viscera
• Head-eyes " Genital-urinary and rectal examination
"
Ears " Neurological
" Throat " Spine, nnuacu|oskefeta|
" Extremities
" Heart
"
Blood pressure(BP) " Laboratory and Other Testing
" Diabetes
" Lungs
Fitness-for-duty Exams
The purpose mf the eva>uatinnisto�nd out if the ernp|oyeecan peMbrmohbor her job ina safe mmanner.Patients are given ocompne comprehensive exarnthatfocusesonindividuaYs ability tn perform the
'
essential functions nf their particu\ar'ob. VVe recommend that e functional evaluation be perform ed (if
` the ''obhas associated physical demands) in addition to the medical examination.A medical exam will
reveal conditions that may affect the performance nfthejnb;thefunctioma|examnm/i)! identifvifthe
individual is capable of physically performing the essential functions of the job.The cost per exam is
typically fixed, but may be dependent on the complexity ofthe health issue. (Additional testing, upon
the City's no/s�ppmmva\, aVbenequined1ocnsunethattheprupernmedicaUdecisionismnade.\ Noadditiana|
testing will be conducted without exclusive authorization by a designated client contact.
A fitness for duty examination is performed when an employee is: '
"
Having observable difficulty performing work duties in a manner that is safe for the employee,for _
the employee's coworkers,for the University,or for the public, as determined bv the supervisor; ur _
°
Posing animminent and serious safety threat to self orothers.
Drug Testing and AlcoW Testing
Fo�nmnmet��n35yeamvxehav�peQu|�dyperformmedpne-ennp|oymen� pVst'occidentremdomm, and
reasonable cause dru' testing services for our clients and affirm we can perform the requested drug
screens for the City.
Conoentna believes that DOT Federal Regulation 49CFR Part 4O,which outlines Procedures for
Transportation Workplace DruQondA6coho/ 7es�ngPrugrornz, �rovid�sC�ear8mide�ines�Pd �i��
'
standards ayit relates tm drug and alcohol testin 8proce d res.
For more than two decades,these.
l to d legal haUemQesand have benonme knuvvmas the gold
procedures have m/�hs�o�dv�r�o�aneBu�regulatory e�a c
' stawdard. Therefone, [uncentroconductzo//d/ugtsst/ng /DDTondnon'DO71/nfu//cump//oncevv/&hDDT
Regulation 49 CFR Part 40, and adheres to oil Substance Abuse and Mental Health Services
City ol0rt Worth,TX^RFP No.14-o22S
����� M�i�|pmwd����p�o�|H������c�
. m=m�wme=s�mm�o v�.
/ �drn�n�t/r�/on /I48�68�/po//c�son�proceduor� �oensure4o�ropr�otechomqfcos�ody. By following
`
these procedures imfederaU,esxve||asmom�ederal testing,Cmmcentrais able toainop|ifv the collection
process,offer the most defensible procedures for our collectors and clients,and provide the optimal
level of confidentiality for the donors. As required by item 31.2.2.6in the RFP,Concentra affirms that
prior to the effective date of the agreement,we will provide two copies of our"Drug/Alcohol Testing
Manual"to the City employee the City designates
'
Drug Screen �Cn0eetionondTestinc
Collectors
Concentra's certification course meets and exceeds the DOT training model.To help ensure consistency
among all Comcentra markets imadhering to DOT regulations,wve developed a three-phase [oncentro
Collector Certification Program. Our policy is that all collectors(new hires and existing) successfully
complete each phase ofthe program prior to Concentra certifying the individual to perform drug screen
collections.Concentra's intention is to maintain high standards and quality in the collection process. To
thot end, [oncen� requires
regu/ot/ons roquire refresher fr. /n/ngtooccurm/thinfiveyeo/s, }ftheco||ectordoesnatronmp|ete
re�eyher training within the designated tinoeframe,w/e will not allow him/her to perform DOT
collections.
CoUectionProcess
Concentra will administer all drug tests using the split sample method as required by the DOT and will
test all samples for substances outlined in the most recent regulations.The certified collector and
/
appropriate laboratory adhere to the following guidelines:
� ° Collect minimum of 45 milliliters(Mn;.)ofurine
= Divide the specimen into two bottles, 30 nni in one and 15 noi into a second bottle
- " Seal the specimen appropriately
" Send each specimen bm the laboratory
" Once received,the lab analyzes the primary 3O mi. bottle;the second bottle is held im the laboratory
pending orequest from the employee for asecond test in the event ofa verified positive ofthe
primary test. [oncen//oocknuu//edgesthat the employee will be responsible for the cost ozsnc/oted
with testing of the second zo/np/e.
ChainofCustody
When collecting urine specimens,Concemtra adheres to all SAMHSA policies and procedures taensure
appropriate chain of custody to document the integrity and security of the specimen from the time of
collection until receipt by the laboratory. For DOT collections,we use the federal chain of custody form;
#zr non-regulated drug screens,vxeuse their non-federal chain of custody form.
Specific to DOT testing, Concentra completes the federal chain of custody form in accordance with
SAM HSA guidelines asvxe outline below:
0 Collector ensures that-the name and address of the drug testing laboratory appear on the top of the
Chain of Custody and Control Form (CCF) and the specimen UD number on the top ofthe CCF
matches the specimen |0 number un the labels/seals
" Collector provides the required information in step 1 on the CCF and provides a remark,io step 2jf
the donor refuses to provide his/her Social Security or employee I0number
' ° Collector gives a collection container to the donor tn provide specimen
�
City of Fort Worth,TX-`RFP No.14-0z25
����� ,�d|�|Pn��r������|H���m�mk�
��~�� ������� �' ��'
/3terthe donor gives the upecinnento the oz|lecto��he�o||�c1�rchec�sthe�enm�e���mreof�he
�
`
specimen within-four minutes,marks the appropriate temperature box im step Zon the CCF, and
provides a remark if the temperature is outside the acceptable range
" Collector checks the split or single specimen collection box:
' if no specimen 11-5 colected,the collector checks that box, provides a remark, discards Cop
� �,
and distributes the remaining copies as required
If it isanobservedco//ect/nn' the collector checks that box and provides aremnark
" Donor watches as the collector pours the specimen from the collection container into the specimen
bott|e(s), places the cap(s) on the specimen bottle(s),and affixes the label(s)/seal(s)on the
specimen bottle(s)
° After affixing the labels/seals,the collector dates the specimen bottle label(s)
° Donor initials affixed and dated specimen bottle label(s)
* Collector turns to Copy 2 (K8RO Copy) and instructs the donor to(1) read the certification statement
in step S and /2\sign, print name, date,provide phone numbers,and date ofbirth; if the donor
refuses to sign the certification statement,the collector provides a remark in step 2 on Copy 1
° Collector completes srep-d/Le, provides signature, printed name,date,time of collection,and
name of delivery service),immediately places the sealed specimen bottle(s)and Copy:1 of the CCF in
a leak-proof plastic bag, releases specimen package to the delivery service, and distributes the other
copies asrequired
Medical Review Officer(MR{7)Services
Cnncentra proposes to utilize Stephen krocht, DO, ofeJcroen' Inc. 'eScreen/for any required MRO
services.The ��R��service reviews and interprets non-negative test results obtained through the City's
'
pruQra nnto assure ascienti�caUy valid resu|� and then determines xvhethera |e8itinoetemedical
`
explanation could account for a laboratory-confirmed non-negative result.Specifically,the MRO
typically makes three or more attempts during a 24-hour period to reach the donor, barring unforeseen
circumstances (such as donor's phone disconnected). During the interview, the MRO does not typically
analyze the collection process with the donor, but rotherfocuses on alternative, legitimote medical
explonotionsfor test results, Utilizing an MRO decreases the risk of a non-negative result due to donor's
ingestion of a lawfully prescribed substance.The MRO can ask medically related questions(which the
City cannot under the ADA)and definitely ascertain a positive or negative result.
` The K8RO always reviews the MRD copy ofthe Chain of Custody form for non-negative tests. If not
transmitted prior tuthe lab results,the MRO assistant calls the collection site to request timely
transmission of the K8ROcopy. If the Lob copy is not transmitted with the lab results,the MKQassistant
calls the lab to request timely transmission of the Lab copy es well. The MR0 will not/n/botendonor
interview until receiving the MRDC4myoy the [CF, and will not transmit verified results until receiving the
Lob copy. If the &XRO is unable tuobtain either copy,the K8ROvvi(| notify the City ofe"canceled" test.
Breath Alcohol Testing
Concentra conducts breath alcohol testing using an evidential breath testing(EBT) device approved om
the National Highway Traffic Safety Administration's(NH T3A) Conforming Products List for both
screening and confirmation testing.Tu ensure quality results,each EBT device has o calibration check
performed daily and after every positive result(no exceptioms)- records of the calibration are placed on
file with e retention period of five years. In addition, personnel performing breath alcohol testing are
'
trained and certified asB/gsim accordance with DOT guidelines.
'
City of Fort Worth,TX+RFPNo.14-0225
Conce Medical Provider of Occupational Health Care Services
` icaVly, breath alcohol tests that register less than 0.02Bms/21Q| are reported as"negative"(for the
purposes
of DOT)and mo additional testing isrequired. Breath alcohol tests that register 0.02 gnms./2101
or greater require a second confirmatory test. If the confirmatory test is less than 0.02 gms./2101,the
results are reported as"negative." Breath alcohol results that register 0.04 gms./2101 or greater on the
confirmation test are immediately reported tm the City. (AO.04 gms./210|iaconsidered a DOT positive
result).
Laboratory 7esti mg
Concentra acknowledges the City's request that the medical provider utilize Advanced Toxicology
Network/ATN> and affirms our ability to meet this requirement. VVe have many relationships with
national laboratories, including ATN, and will work with ATN and the City to provide substance abuse
and clinical testing,when needed.
On-site Drug Testing
Concentra acknowledges that the City may require infrequent on-site drug testing(less than four per
month) during the contract period. Concentra affirms our ability to conduct on-site testing and will not
chmr0etheCityanon'siteserviceoharQe. |ntheeventofunschedu|edon-sitetesting,Concentrevvi!|
charge the City an on-site fee plus the cost of services rendered.
Clinical Testing
Concentra acknowledges that the City may require various clinical testing as part of the examination
process and we affirm our ability to meet this requirement,Concentra offers a selection of clinical
/
testing services in our medical care clinics, which we perform on equipment that has been thoroughly
` examined and calibrated prior to testing.We can provide calibration reports to the City upon request.
The following table outlines CoMcentra'sclinical testing capabilities:
Audritometric All audiometdc testing conforms to the OSHA standard 29 CUR 1910.95.We have CAOHC-
Testina certified technicians to perform the tests,and we will provide all certifications upon request.
^
Audiometers that pause testing n ambient sound levels temporarily exceed OSHA levels
^
Immediate STS identification and retest capability
^ CADHC'oertified hearing specialists
^
Acoustic Systems audio booth professionally designed and installed in each clinic
~
Daily equipment calibration
^
Microprocessor audiometers
EKG Concentra will perform a 12-lead EKG that measures the electrical activity of the heart.A center
(Resting) physician will read the EKG.
Pulmonary A technician penorms all pulmonary function testing in such a way as to allow real-time graphic
Function and numeric data to verify the test validity. Data returns of VC, FEV|,PEFR, FEF25%-75/., and
Testing FEVi/FVC are required.
Vision Atrained technician performs a vision test that meets OSHA standards for visual acuity.The
technician screens for visual acuity with corrective lenses,lateral and vertical
depth perception,and color discrimination for red,green,and amber.
`
City of Fort worth,-X a RFP No.14-0225
concen'tral Medical Provider of Occupational Health Care Services
Vitals A drained technician records resting pulse rates and Mood pressure using a hospital grade
sphygmomanometer and stethoscope.The examining physician must obtain a repeat reading for
any person who does not meet normal pulse rate or blood pressure criteria.
X,-rays All posterior-anterior X-rays are performed by registered X-ray technicians and certified 13-
readers will review selected chest X-rays in accordance with OSHA regulations.
Immunizations/Exposure ControI Program
Concentra realizes that employees working in occupational settings may have the potential for exposure
to infectious materials(e.g., blood,tissue,specific body fluids and medical supplies,equipment,or
environmental surfaces contaminated with these substances),depending on their job functions.
Concentra will support treatment of employees exposed to bloodborne pathogens by medically
managing the employee's occupational exposure including but not limited to:the determination of an
exposure,vaccination administration,source testing, laboratory testing (HIV), recheck visits, post-
exposure prophylaxis,and counseling.
Concentra physicians provide the recommendations for the occupational exposure of blood and other
potentially infectious materials(OPIM) in accordance with the Centers for Disease Control's(CDC)
Updated U.S. Public Heaith Service Guidelines for the Management of Occupational Exposures to HIV cnd
Recommendations for Post Exposure Prophylaxis.The recommendations apply to situations in which a
person has been exposed to a source person who either has,or is considered likely to have, human
immunodeficiency virus(HIV), hepatitis B, and/or hepatitis C infection.The risk of hepatitis B infection is
primarily related to the degree of contact with blood in the work place and to the hepatitis B e antigen
(HgeAg) status of the source person.
Concentra provides a comprehensive service offering to ensure the City's employees have the necessary
vaccinations to prevent disease and protect their health.Concentra clinicians are trained, qualified,and
readily able to provide a myriad of immunizations and infectious disease screenings for the City. We
immunize all candidates and employees against infectious diseases in accordance with 29 CER
1910.1030, "Bloodborne Pathogens".
t. o- �k _
Hepatitis A Vaccine Vaccine can be offered to high risk(Hazmat, Response Team)and other
personnel with frequent or expected exposures to contaminated water
Hepatitis B Vaccine and Titers As specified in CDC guidelines;a series of three vaccinations that occur
throughout a six-month period
Hepatitis C Virus Screen Baseline and following occupational exposure
IV Scriee,,in ' Screening is available to all exposed personnel,as needed
Influenza Vaccine Concentra can administer flu vaccinations to all personnel annually,if desired.
As appropriate,Concentra will discuss with the City the specifics regarding
administering the shots and anticipated volumes.
Measles, N 1;sil Rubella in accordance with the CDC guidelines
Vac C iInle (lsfi IR)
Meningitis(bacterial) in accordance with the CDC guidelines
Polio klaccine In accordance with the CDC guidelines
__.____ .- _---___ PaRe 17
�� City of Fort worth,TX 4 RFP No.14-0225
cc 6r Medical Provider of Occupational Health Care Services
Tetanus;D43htheria Vaccine Booster every 10 years
Tuberculosis Screen (PPID) Annually,or more frequently,accordingto CDC guidelines unless the member
has a history of positive PPD.If positive by history,CDC guidelines for
management and subsequent chest radiographic surveillance shall be
followed.
Medical Surveillance Evaluations
Concentra has been performing medical surveillance testing for our clients for more than 30 years.
Nationally,Concentra is responsible for thousands of our client's medical surveillance programs. We
have comprehensive surveillance policies and procedures for each examination and all staff is trained in
examination components.
Concentra's staff will administer and maintain all necessary records associated with any OSHA medical
surveillance requirement, including respiratory physicals in accordance with 29 CFR 1910.134, hearing
tests—1910.95,and bloodborne pathogens—1910.1030.We also follow the recommendations of the
CDC for the administration of hepatitis F vaccinations.We also abide by and assist our employers with
the Recordkeeping Standard. Concentra has written guidelines on all OSHA standards, including the
testing(examinations, pulmonary function, audiometric, laboratory,and respiratory fit testing) required
in each standard. Concentra will also ensure that all personnel have the appropriate certifications to
perform the audiograms and pulmonary function tests(CAOHC and NIOSH respectively).
Respirator Clearance
Concentra affirms our ability to deliver this service as part of the medical testing program.We describe
our capabilities in the table below.
Respirator We acknowledge that the OSHA respirator questionnaire is a required component of the overall
Medical respirator examination.As such,Concentra will utilize the OSHA Respirator Medical Evaluation
Questionnaire Questionnaire when rendering services for the City.After the individual completes the questionnaire,
the attending physician reviews the responses and makes medical recommendations hi-conjunction
with the review of the employee's test results.If the individual answered "yes"to any of the questions
in 1 through 9 of the questionnaire,ancillary tests,such as a medical exam and vital sign testing,may
be required at the discretion of the attending medical professional.
Miedical Exam Concentra recognizes that an evaluation may be required based on questionnaire responses and we
affirm our ability to render this service.The respirator exam will include all components desired by the
City and may consist of any combination of the following clinical services:chest X-ray, EKG,and/or
pulmonary function testing.We will conduct the evaluation in accordance with OSHA standards,as
outlined in 29 CFR 1910.134,and will perform all follow-up testing required as allowed by law and
after obtaining authorization from the City.
Fit Test(if OSHA and NIOSH provide the recommendations for those workers who may be required to wear
required,for respirators due to environmental contaminants.A fit test determines the ability of each individual
an additional respirator wearer to obtain a satisfactory fit with an air-purifying respirator and/or supplied air
feel respirator. if desired,Concentra can perform fit testing for the City's employees for an additional fee.
Hie perform quolitotive fit testing in oll of our clinics;a select number-of our facilities also perform
quontitotive testing.All fit testing is performed in accordance with OSHA regulation 29 CFR 1910.134.
Paee 110
`
City of Fort Worth,Tx+0FP No.14-0z25
concemtra, Medical Provider ol occupational Health Care Services
/
CDL '—� K�
` ' r-
Robe/tHmsse/t, DO, MPH, Vice President, AYedicu/operations, has served on the City's CDL Review Board
for more than eight years. Br. Hassett provides medical oversight,consulting with the City to ensure
that employee healthcare goals are in line with what is medically appropriate. Qr. Hassett is board
certified by the American Osteopathic Board of Family Physicians,the American Osteopathic Board of
Preventive Medicine,and holds certification in occupational medicine.
Data CoUUection and Reporting
In all of our medical care centers,Concentra utilizes a provider database, referred to as OCCOSOUrce that
enables Concentnato capitalize on superior knowledge of workplace injuries and their predictable
outcomes.OcomSuurce supports daily management nfinformation and patient flow Within each center
and offers unique,timely, and meaningful information to our customers una daily,weekly, quarterly, bi-
annual, and annual basis according to specific requirements.This benefits employers,employees, and
payer groups bV ensuring consistent guidelines, e user-friendly system, and statistical outcomes.
OccuSource is proprietary to Concentra, and is far superior to similar programs in its ability to track
patient care and provide outcomes data.As a cumulative database,OccuSource maintains demographic
and visit information for all patients treated at our clinics,and is readily available to create several types
of outcomes data.Concentra believes that OccuSource's ability to capture valuable information on all
patient visits—more than (5 million visits annually—distinguishes this database from all others utilized
in the occupational healthcare industry. OccuSource creates outcome reporting that not only provides
valuable/nfonnobbn ' rourclients, but also enables[oncentrotu utilize dototo develop best
' — de/nonstrotedprochtepotte/ns.
`
Standard Reporting
Individual patient encounters provide the basis for the reporting system.The system creates a report-far
each employee visit seen at Concentra and generates an email or fax notification (based on the City's
preferences)to the City's designated contact. Concentra can set up notification for multiple contacts, if
desired.
The following table outlines examples of daily reports Concentra can generate for the City.Sample
reports are available upon request. .
Activity Status Report " Generated ot the conclusion of each injury visit
�
Report includes the patient s name,company department, date ofviuit,
cheok'in/check'outtime,diagnosis,treatingphysician,restrictionson
duty, next scheduled appointment,and anticipated date ofmaximum
medical improvement
Non-|njury Status Report " Generated at the conclusion of each noninjury visit
" Report includes os,date seen,time checked
in and out of the center,results,and,remarks
Missed Appointment " Generated the day after a-missed an appointment .
° Report includes the employee and employer demographics,Umeanddate
' uf the missed appointment,and physician's name
/
City of Fort worth,TX o RFP No. 14-0225
t. ' Medical Provider of Occupational Health Care Services
® 9 P o IN
11 Patient Referral Generated when a referral to a specialist takes pace
9 Report includes basic demograpliks,bitting informati®n,specialist
information,and referrals details(Le_,type of referral,recommendations,
priority,notes) ,
;7tilization Management Reports
In addition to our standard reports, Concentra offers our clients quarterly utilization reports that share
key injury information.This report offers a roll up of all injuries treated at Concentra and provides
detailed information specific to injury care services, including but not limited to the following:
• Number of workers treated 0 Average days to discharge
• Distribution of body type injured - Percentage of cases with off duty and limited
• Number and percentage of cases closed duty days
• Average visits per case 4 Average number of off duty and limited duty days
• Percentage of cases referred to a specialist 9 Average cost per case
provider a Comparisons of the project data to the entire
• Percentage of cases referred to physical client market for the same period
therapy
Additional Services and Wormation
Result
s Communication
Physicals
Concentra will'integrate, review, and report oil medicol information bock to the City's designated
representative within 24 hours of receipt of all relevant data. The report will provide a recommendation
based on the results, any recommended referrals, and/or restrictions, and recommendations for
necessary follow up to remedy the referral The physician will note if additional testing is necessary and
advise of the clearance status for job placement. If the results require supplemental testing,Concentra
will notify the City's designated representative prior to performing any additional testing. Depending on,
the specific components tested for(i.e., blood or urine onolysis), results may take up to five days to
report.
Dreg Screens
Concentra's average turnaround time for a negative drug screen result is 24-410 hours upon receipt at
the lab. However,a positive result turnaround timeframe,including MRO review,varies for non-DOT
and DOT tests,and may take 400 to 72 hours depending on the MRO verifications.
Non-DOT Positives—For a non-DOT positive drug test, MRO review is at the employer's discretion
and results can take 4101 to 72 hours upon receipt at the lab.
DOT Positives—MRO review is required for all DOT positive drug tests.While we can report a
confirmed positive result to the MRO within 400 hours,the average turnaround time for a positive
DOT drug screen review by the MRO varies due to the responsiveness of the donor to the MRO in
accordance with DOT regulations.The donor has up to five days to make contact with the MRO per
DOT guidelines before the MRO reports a result. Unless otherwise noted,the MRO will conduct the
MRO investigation in accordance with the DOT guidelines.
Breath Alcohol `yeiir3
We report breath alcohol testing results the same day/that we obtain the specimen.
PaLye 20
City of Fort worth,TX+RFP No.z4-o22s
��D��� a�dx�|pm����mp�o�|H�khcaescm�s
n�e�om*=x�xmv.0 ��
Injury5erices
Conmentma generates an activity status report immediately upon checkout that includes the following
information:
"
General patient demographics
" Basic employer information
" Visit information, including name of treating provider and diagnosis
"
Patient status, includingany restrictions, return-to-work status, and date of anticipated maximum
medical improvement/K8MU
"
Name of1meadnQprovider
,
Date,time,and provider for next scheduled appointment
[oncentro'snned/co/ondc//n/co/expert�e � un/no�zhed� VVehavedeve|nped�orn�nehensivepm|�cie�
and procedures for examinations,aswell asdrur/a|coho\testing, injury oere, meturn-to-vvorh, preventive
drug
/alcohol
cane' and more 1h�tcomply with OSHA,DOT,A0A^and th erregulatory guide|ines.
We provide avariety of healthcare sen/�esna �nxv e i nationwide through our 38Q+urgent care centers and nearly 20O Health and
Wellness Centers(HWC), and deliver comprehensive health and wellness programs.
Auf^on summary
�oncen�rarevi�vxedt�eCdxscopeofvvmrkundxvecom�rnnuurabiUitytope�ormthemut|inedaen/ices
'
effectively and professionally.We believe Concen1ra's longevity in the healthcare marketplace, expert
infrastructure, and consistency in delivering healthcare services —along with our report/og copob///t/es
_ ond comprehensive suite of serv/ces -- differentiate us from our competitors.
'
` Concentra appreciates the opportunhytu present our services and capabilities'We are confident that
we can address all the outlined service re quirements efficiently, professionally, and in accordance with
regulatory standards. Concentra is prepared to deliver a best-in-class solution that exceeds the
expectations of the City of Fort Worth,TX.
2" Conflict of Uk��������� Questionnaire
We indude the completed Conflict of interest Questionnaire as part oflAttachment A-City-required
Documents.
3, quaff^r-a- flons Questionnaire
We include the completed Quo[ifications Questionnaire as part of Attachment A-City-required
Documents.
4" Fees and Charges SchedWe
Concentra appreciates the opportunity to present our proposed fee schedule-for the City's program.VVe
include the City's required Attachment D:Service Fees and Charges Schedule es Attachment D- Fees
and Charges Schedule.VVe affirm all in-formation contained herein iscurrent,complete,accurate,and
remains valid for 1000 days-following the due date, September 11,2O14.
Page 21
'
City ol Fort Worth,TX*RFPNo�z+o22s
��>��� M�ka|pmw�r�Oc����|H��h��sem�s
` v=r�m mv=m=m w�m =°.
/ 5, ��BE Utilization Plaq.
Concentra acknowledges that as of June 1, 2012,the City implemented a new Business Diversity
Omdinance /Q0Q� Asaresu|t the City has innp|ernenteda1896K8BE utilization goal,speci�ceUyfor
' i ''fi t��edbvtheNorth Central Texas Regional Certification Agency(NCRONCA).
African American firms '
Overthepastfiveyean�CnncentnahasmnorethandoubledtheCit/sstandard10%MWBEmtUizatimn
Qoa! fn �ne�orttorenmainas1rongcornnmunitypadLnerandnmainta�nmpr�on8s�amd�n8re�atiomsMipvvi��
'
the City, Conoen tro will continue our efforts to identify opportunities in which tm engage qualified
African American MBE firms and achieve the level of participation outlined inthe City'sRFP.
Concentra currently maintains relationships with several thousand employers that have internal Diverse
Supplier requirements.Typically, are munidpaV,federal,or federal contractors. Un
'
many cases Concentra, although not a minority or disadvantaged business enterprise,
has been asked to
participate toward our client's goals through our own sub vendoringefforts.
Our process for compliance isasfollows:
"
Meet with the local/area team to identify subcontracting opportunities
�
Write the Certification Agencies t o obtain copies ofK /V0Edirectories
and cross-reference with market/state
• Review internal tracking ofM/ VBEsubcontractors
• Generate letters to subcontractors indicating interest in subcontracting opportunities and aquote
for services
" �nntac1recrui�nnen��mdp1axennen�or8anizationsifa|ovvnumbernfsubnnn1n*ctumsmeypond
su bcontractVrsasnecessary
� Recor� anddocurnentqualified
`
6, Financial Information
VVe include our more cumemtyeapendAnnua| Report and audhed�nonda|statennentas part ot
Attachment E-Financial Information.
7, Oruan.zat~onaK Kn�m^rmafion
Experience�^,r ^^ --- - ^ have n�eserv�8���heC�»�oru»�erof1he
�uncentr��on�decs�a �r�UeQeto experience _- ,�
requested services. Du�ngthe course of our re�tonshi�� Conoentrahas become intricately
kmovvhed8eableof'he City's gmideUmesand operational pnoceduve� and aoaresult has established
e�e���meonnmmmun�-eti�m' ond msiness relationships xv�hthe C�vsper��nne1tu ensure m/e
~ pathways is.With a clear understanding of the demographics and
meet the City's needs oaa continual bas
designated
workplace culture, Comcemtrou�ers the city compelling advantages. {n addition,our
rtise necessary to perform medical examinations
provider possesses om intimate knowledge and the expe
�d sider[1amhonor
thatconnply\mithne|event8uide|inesamd�he�i�yspecif�o�dmn�.�nnment��vvom consider
�ocon��nmeinuuroz\e�s�he�itv/��c�inioalnesourcrfor the requested scope ofvxork.
/
City of Fort Worth,TX+nFP No.14-o223
���������� ^�dka|���r������|H����senxc�
^ v�w�mm�*�mm�m e�
/
I�°^�K� K�are Experience
` � ' h �o �/e��cor�b 'oggress/ve/yconservo�/ve''—conservnt/ve /ntheprocbceqf
[onusnhnsopprooc po /
medicine, ond aggressive /n the nnonogementofthe cose. In our practice,Cwmoentra employs the system
of process management,which re fers to monitoring and directing the processes and events that make
wp the structure and flow of an individual case,all with the focus of achieving the optimal outcome.
These processes and events include many variables,such as frequency and timing of patient visits,
communication with the patient's employer, and referral patterns for consultations and diagnostic
testing.
This analysis of comprehensive outcomes data proves that the following factors have a considerable
impact on the ultimate outcome and cost of a workers'compensation case: .
• Treating the patient at frequent intervals in the initial period following an injury
• Communicating with the employer about the activity/duty status nf the injured ennp|oyee
�
Monitoring referrals to ensure that a patient is evaluated in a timely manner
�
Paying attention 1ocase closure following release tm full-duty activity
Non-injury E�K��%�rieK0ce
Conoen." regularly pe�ormsphysicals and conducts drmu/ knho|testin0forourdient� prnQranns.VVe
assure-- City that only qualified individuals will perform the services in accordance with all local, state,
and federal guidelines. To dote in 2014, our DrFW centers h(jve collectively perforaled n7ore thon 50,000
physicals and 83,2U0 drug screens.
'
Concentra's acquired experience performing the healthcare services desired by the City uniquely
positions us to deliver a complete solution that exceeds the City's expectations.Our proposed program
incorporates extensive expertise in the areas of examinations and other occupational healthcare
services, and maintaining compliance with various regulatory agencies.As appropriate,we are happy to
discuss our additional capabilities with the City.
'Customer Satisfaction
Patient ra� �
eemce
Concentra'' oonmnni1mmentturenem/omrfmcusonthepa1iemt experience began with creating new .
mission,vision,and values(MVV)statements.These words defined our goal to provide superior
customer service toevery `atientduring every visit.To ensure the nmeasagereached Comcentra
�
colleagues nationwide,xvecreated th e Orange Book,O B k, desi8nedto8uideCo\lea0uesintheir service
delivery. Concentra expects our employees to abide by the principles set forth in the Orange Book to
ensure continued service excellence to all Comcentra employers and their employees. Ensuring apositive
experience to every patient visiting our medical center is a key initiative throughout Concentra's
organization,from our Executive Leadership Team to our local clinic staff.Our colleagues strive to
nedefinepatien� staff n�re �y�re���m8each �mtient�o�vxel�nmnimQ, /espectful,endsk0\fw!experience.
Concentra assures the City that our local clinic otaahares this same passion and concern for our
patients and each individual will work tirelessly to ensure the City's employees enjoy a positive
experience.
Measuring/Tracking Sob�acbnn
' Asa }eadi~ national provider of occupational, urgen� preventive, and p�maryheo&hcawesen�ce�
� Concemtrz �understands the importance of combining quality medicine with superior customer service. Um
------------------ o~..,v v
City of Fort worth,TX�RFP No.z4-o22s
������ M�kz|px�d������a|H��h�e���
, n=�vmnx=w=mm�" ��
'
fact,customer priorities.Concentra has developed a
'
`
comprehensive customer service training program,and vve continue 10 refine and expand upon that
core foundation to ensure w/e consistently deliver superior services.
To track sa1isfac1ion �omos�trm imparts metrics:
'
° VetPromoter Score/iVPS1-This simple,yet powerful tool measures customer satisfaction and,
in
turn,serves asan indicator nfcmstoner loyalty and potential business growth.The NPS provides the
mmestablishing ccou��nbi�i� and prioritizing investnnents. Net
e�n�for�au�in8�e� nn
performance, � �
Promoter indexes provide for actionable opportunities and benchmarks Concentra's data against
industry norms. Franklin mni�VVestQateResearch,conducts a 12-question
' '
telephomicsurvey with a rating system from 1/unsatidactory\t 10(excellent).The questions relate
to facility appearance,wait time,perceptions of the medical provider, and quality of care. Patients
can also convey specific comments about their experience.The firm performs all telephonic surveys
in accordance with local,state,and federal confidentiality laws. Westgate Research gathers the
' nuen1t�ann as As of
acquired da�a and generates reports for Conoentn«smanage ' .
July 2024, [oncentrv'5NPffor the South Central Region, which includes our DFN/locations, isG296.
= Net PutientfxparicnceRoting(NPfR)-TheWPERisthepercentageofresponsestotheaun/ey
questions "Rate Your Overall 8 Satisfaction"t����re�oand10s(uutof�U\.TheNPERisimportant
neone is v i||i m�to recommend Comoentma.0 oncen tre tracks
because itisa predictor of whether so
Vm� nnomth|y�as�s�T�eNPERref|ectshovvvve||Concen1ma
andreportson1hepatientexperience
fulfills our purpose and predicts our ability to continue serving patients in the future.The patient
experienoeisaoimpoMantas-- ifnotmo| innportmntthan -- anyothermneasureofperfornnamce,
' asitioa predictor of whether an individual iawilling tm recommend Concentra.A1Concentna,vve
/
exist 10 serve patients;therefore, a stellar patient experience isnot someth|nQVvestrivefor -- itis
our purpuSe.4sof July 2D14, Concentro'sNPER for the South Central Reg/on, which /nc/udcsuur
DFN/locations, is 55Y6.
8" Location Map
include m�aN�mncentna locations kr
right, ama�
within the Fort\Nur1h/DaU metropolitan
R.
AIM
center is indicated byam orange marker. ..
9" Organ~zzat^ona8 Chart
The-following organizational Chart depicts Conoentra'sproposed leadership team at the Fort Worth
Forest Park center:
PROJECT MANAGEMENT AND SERVICE DELIVERY
gernen Medical Managerneft Therapy management
David Lambing,AMT/RMA Roy Kreusel,MD Michael PAurrelj,PT,DP
Center Medical Director CenterTherapy Director
Center Operations Director
Nurs-
City of Fort Worth,T)( ',RFP No.14-0225
cen t
'Ir Provider Medical Pvider of Occupational Health Care Services
Con 'r a
10. 5-ann p I e R e p o its
We include sample reports for the City's review as part of Attachment F—Sample Reports.
11. References
Concentra offers the following three current client references for the City's review.We encourage the
City to contact these entities as they can attest to our ability to perform a variety of healthcare services
per each client's specifications and in full compliance with all regulatory guidelines.
111;XTIF
Contact Dolores Lewis,Employee Lisa Zepeda, HR Director Sandra Vera-Summers, HR
Benefits Director Coordinator/Risk Management
Address 1500 Madlla Street 6A—N 101 S.Mesquite St,Ste.790 505 Barton Springs Road,Ste.750
Dallas,TX 15201 Adington,TX 16010 Austin,TX 78704
Phone 214.670.7391 10117.459.60069 512.974.3334
Services Employer services,injury Employer services,injury care Injury care,employer services
care,health and wellness
Page 25
City of Fort Worth,X RFP No. 14-0225
conceniru
r Medical Provider of occupational Health Care Services
Uaci1 im e n t A
City-required Documents
_.__._.__-----,-_—_.-- _„__�,.us_._,...�__ �—. �—______ —•--_----Attachments
Fo-
Pv-RCH.ASP-4GDIVISION
REQUEST FOR PROPOSALS ")
for
IiDICAL PROVIDER OF OCCUPATIONAL 14EALTH CARE SERVICES
51 No.14-0225
Issued:August 13,201
PROPOSAL S`llTBA 1SSION DEAD M-
w w Seutexrnber 11,2014 by 1o30PM Central'e ime
NO L4 PF PROP0,5-4L q WILL BE-4CCEPTED
R ESPQNSES SHALL ICE-DELIVEREID TO- RESPONSES SHALL RE MAILE D TO:
CITE'OF FORT WORTH PI1TW ASING DIV'SI0�
CITY Or FORT��®l�TH PUI�CIiASING IDI�IISI(�I�T
LOWED L�VET LOWER 11E L
1 000 Tf OCI tDI�T®1�T STET 1000 THROC ORTON STMEET
FORT WORTH,TEXAS 76102 FORT WORTH,TEXAS 7610
A Pre-proposal Conference will be held from 1030 PM NAME AND ADDRESS®P COMPANY
to 3;30 PI-on Wednesday,August 20,2014,in S MITTW PIE1t➢P®SALo
Purchasing Large Conference DOOM,City H121E,Lower Occupational Health Centers of the Southwest,PA,
Level,1000 Throckmorton Street,Port Worth,Texas dba Concentra Medical Centers
5080 Spectrum Drive,Suite 120OW
m��=:��`���r 5;�:;�Yr7�rn3cmm��t���='r•Mm��'.'�m�:r��;�r'�^���r:a^m^
Addison,TX 75001
FOR-ADDITIONAL ILi '®l ATION
REGARDING THIS RFP PLEASE CONTACT:
Doris Brent,Contract Compliance Specialist Jules Staten
I<D®u nse9��eunt�P®>t ton t0I a aso�®� Contact I erson:
m�����;��m,m��y..�l,'mm�m�=ym�'T'..`''n��mm����f:m��;:.�.,•.°; ;mxmz�
Title, Major Account Executive
COVER SHEET WITH 63�160 817 313.6621 Fax: 817 882.8707
RETURN RESPONSE TLO Empilo lutes_, to @concentja.qom
Doris Brent
Contract Compliance Specialist Signature:
Arlene G.King
Pu rchasing Division Printed Nanie. Authorized Re resentative
1000 Throcl Horton Street,Lower Level
Font Worth,Texas 76102
Will contract be available for Cooperative Agreement, use? (See Section 27,page 10)Nes No Y—
Ael ®viled,-ffleffit of Addenda:#1 X, 3'T'2 # #t. #5
t--Wo
-V
ADDENDUM TO THE REQUEST FOR PROPOSALS
PFP 14-0225,MEDICAL PROBER OF OCCUPATIONAL HEALTH CARE
SERVICES
CITY OF FORT NORTH
PURCHASING DIMSION
ADDENDUM NO. I DATE ISS UEIDo August 27,2014
REQUEST FOR PROPOSALS NUMBER' 14-0225
ORIGIIN.L PROPOSAL SUBMISSION DATE, September 11,2014
CLARIFICATIONS:
1, Questions and Answers received throng pre-proposal conference and email are hereby
incorporated,in fall text,page 20
REVISIONS:
1, Revision to RFP 14-0225,dated August 13,2014,is hereby issued to amend the following
provision:
Section 3L61,Scope ofWork,Subsection 31.2°7 is revised to read;Medical Provider will
provide reports to City designated individuals in a timely manner.Specific reports may
include.,but are not limited to the"Utilization Management deport..65A'ctivity Status
Report�9g'Won-injury Status Deport,""Patient Referral Report,99 and"Patient Visit
hiforn?ation.99 Reports-will be generated at no additional cost to the City.
All other terms and conditions remain the same.
-FAC BCE
PURCHASING MANAGER
���� ��� e ccupational Health Centers of the Southwest,PA,dba Concentra Medical Centers
SIGT-,4A'LW:
Arlene G.King,Authorized Representa ve
NOTE: Compaany na me aIlrnd signaAture eons be the game as on the bid docu eats
Questions and Answers (Q&A)for City of Fort Worth
RFP 14-0225
MEDICAL PROVIDER OF OCCUPATIONAL]HEALTH CARE SERVICES
Q1. in Section 30 Qualifications,Subsection 30.1.4 Hours of Operation,it states that hours of
operation at all Fort Worth facilities shall at a minimum be from 7:00 a.m.to 7:00 p.m.Does
that mean that an of our facilities must be open during those hours,or just our main clinic?
Al. The City hopes to procure a vendor who can have more than one facility open during the minimum
hours requested in Section 30 Qualifications,Subsection 30.1.4 Hours of Operation.Please clearly
state your company's capabilities regarding hours of operation in your response to this RFP.
Q2. In Section 26.0 Involvement of Minority Business Enterprises(MBEs)it is no longer called
YI/NVBE.Does that mean that women-owned businesses are no longer considered towards
points for MME?Is the goal for this RFP for 10%MBE only(African American)?
A2. yes women-owned businesses are no longer considered towards points for MBE.The last
disparity study conducted by the City of Fort Worth indicated that Women-owned,Hispanic-
owned,Asian-owned and Native American-owned businesses met parity for subcontracting
opportunities on professional contracts outside of Architectural and Engineering
Services. Therefore,as June 1,2012,the City of Fort Worth M/WBE Office assigns Minority
Business Enterprise(MBE)African American(AA)subcontracting goals on all professional
contracts outside of Architectural and Engineering Services.
Q3. in Section 31.0,Scope of Work Subsection 31.2.7 Reports and Validation Studies,can You
please clarify what an OCCU 300 Report is?
A3. Section 31.0,Scope of Work Subsection 31.2.7 is revised to read:Medical Provider will 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,"'Won-Injury Status
Report,""Patient Referral Report,"and"Patient Visit Information."Reports will be generated at
no additional cost to the City.
A revised copy of the RFP will be posted with this Addendum.
RFP 14-0225,Medical Provider of Occupational Health Care Services,Page 2 of 2
.ATTAC NT A
CONFLICT OF INTEREST DISCLOSURE REQITIl2EIVIENT
Pursuant to Chapter 176 of the Local Government Code, any person or agent of a person who
contracts or seeks to contract for the sale or purchase of property, goods, or services with a local
governmental entity(i.e. The City.of Fort Worth.)must disclose in the Questionnaire Form. CIQ
("Questionnaire") the person's affiliation or business relationship that might cause a conflict of
interest with the local governmental entity.Bylaw,the Questionnaire must be filed with the Fort
Worth City Secretary no later than seven days after the date the person begins contract
discussions or negotiations with the City, or submits an application or response to a request for
proposals or bids, correspondence, or another writing related to a potential agreement with the
City.Updated Questionnaires must be filed in conformance with Chapter 176.
A copy of the Questionnaire Form CIQ is enclosed with the submittal documents.The
form is also available at hft•//www ethics.state tx.us/forms/CIQ.udf
If you have any questions about compliance,please consult your own legal counsel.
Compliance is the individual responsibility of each person or agent of a person who is
subject to the filing requirement.An offense under Chapter 176 is a Class C
misdemeanor.
RFP Into. 14-0225,Medical Provider of Occupational Health Care Services,Page 19 of 52
Not Applicable
CONFLICT OF UNTEIMST QUESTIONNIAME FOILM CIQ
For vendor or other person doing business with local governin_ OFFICE USE ONLY
This questionnaire is being filed in accordance-with chapter 176 of the Local Date Ptecobted
Govemn entity.
k ent Code by a person doing business with the governmental
By law this questiomah—e must be filed with the records administrator of the
local goven- Lment not later than the 7th business day after the date the person
becomes a-ware of facts that require the statement to be filed, See Section
176.006,Local Government Code.
A person commits an offense if the. person violates Section 176.006, Local
Government Code.
An offense under this section is a Class C misdemeanor.
�2me of person doing business with local governmental entity.
Check this box if you are filing an update to a previously riled questionnaire.
(The law requires that you file an updated completed questionnaire with the appropriate filing authority
not later than September I of the year for which an activity described in Section 176.006(a), Local
Government Code, is pending and not later than the 7th business day after the date the originally filed
quostioniiaire becomes incomplete or inaccurate,.)
Describe each afffliation or busines
s relationship with an employee or contractor Of the 16CRI
governmental entity who makes recommendations to a local government Officey Of the local
it re of mo ey.
o Vernmental entity-svith respect to expendi u
0
Not Applicable
40 Describe each affiliation or business relationship with a person Who is 2 local government
officer and who appoints or employs 2 local 90veyument officer of the local governmental
entity that is the subject of this quesfionnaire.
Not Applicable
RFP No. 14-0225,1,A-e Health ageMof`5129
,dicaj provider of ocowpatio-nal -Care ScrVices P
Not Applicable
FORM CIQ
CONFLICT OF INTEREST QUESTION-NATHU
For,gvendor or other person doing business with ROCRI gffernmeilltRl entity pa's 2
-K-Name of local government officer with whom filer has affiliation or business relatioflship�
(Complete this section only if the answer to A,B,or C is YES.)
This section, item 5 including subparts A, B, C &D,inust be completed for each officer with whom the
filer has allfiliatio-In or business relationship. Attach additional pages to this Form CIQ as necessary.
A. Is the local government officer named in this section receiving or Rely to receive taxable income
from the filer of the questionnaire?
yes El No
'th
B. Is the filer of the questionnaire receiving or ljj<ejy to receive taxable income from or at -e direction
-D the taxable income is not from- the local
of the local governmen
t officer named i-.i this section-AN
governmental entity?
11 yes El No
C. Is the filer of this questionnaire affiliated with a corporation or other business entity that the local
government officer serves as an officer or director,or holds an owunership of 10 percent or more?
yes No
D. Describe each affiliation or business relationship.
N
Not Applicable
6. Describe any other affiliation or business relationship that might cause 2 c00flict of interest.
Not Applicable
7o
Signature of person doing.business with the govennnental entity Date
RFP--No. 14-0225,Medical Provider of Occupational Health, Care Services,Page 21 of 52
ATTACIMENT C
QUA kTLQ-NS_QUESTIONN AME.
_
The purpose of this Quest!Onfl2irc Is t®assist iIR the initial stages of selectiag a Medical Provider to provide
occupation -vice,
al health care ser 9 as requested by the City. All questions must be answered
PART A.MEDICAL PROVIDER GENERAL—INrA ORMATION
1 Legal Name oMedical Provider Occupational Health centers of the Southwest PA,dba Concentra Medical Centers
Physical Address of Corporate 5080 Spectrum Drive,Suite 1200W
Office or-Headquarters
city I Addison State TX Z' Code 75001
Telephone- 800232.3550 Fax
Wobsito-Adckcss www-concentra.com
2 EdEcipai Owner(s)/Partners/Officers(add rows asnecessmy)
W.Tom Fogarty,MD,President Treasurer,and Corporate Secretary
Roy A.Beveridge,MD,Senior ice President and Chief Medical Officer
Date Medical Provider was Founded 1 Opened
1979
incorporated
Total or of Medical Provider employees
8,800+
Total
Provider o ployees Wor g in
5 number of Medical Pro m kin Approximately 300
Texas,
Total number of Texas licensed health care practitioners More than 200
employed by Medical Provider.
7— Totalnaumber of Texas licensed health care practitioners Concentra does not keep records on contracted medical
on CITY's contract with Medical Provider. personnel.
Total number of current clients of Medical Provider with Approximately 30,800
locations in Texas 51
9 Total number of current!Egg 90V0rnM0UtaVPubHc Approximately 250;Concentra can provide a complete
entity clients of Medical Provider list upon award
10 Total Amount of Medical Provider health care services billed from Texas locations in $
Calendar Year 2013 Approx. $109m
11 Total unt of Medical Provider health care,services billed from Texas locations in $
Calendar Year 2013 related to the treatment of on the job injwrios. Approx$54m
12 Does Medical Provider have the capability to electronically report in-formation to the CITE' es
regarding services rendered on a detailed and summary format? No El
13 Can Medical Provider provide sample reports indicating the lovel of reporting capability of Yes
information or data to the City regarding-services rendered? No
14 List below nE three Q lar est current Texas clients,
Name of Client HEB Grocery
Address 646 S.Main St,
7M
pity
San Antonio state TX ZiD Code 78204
Length 0I Relationship with this entity Years 19-
Contact Name Linda Bade Phone 800.305.7587 Retail
Name of Client Walmart
Address 702 SW 8th St.
City I Bentonville state AR Zip Code 72716
Length of Relat'011shr' With this entity #Years 15+
Contact Name Store Managers -phone 501.2714000 1 EMail
Name of client I UPS
Address 2925 Merrell Rd
city I Dallas State TX Zip Code
Length of Relationship with this entity #years 15+
Contact Name I Thelma Lee phone 214.914.9359 Eia�aii
15 list. below your three(B)largest Texas ernm- ental/ ublic entity clients:
Name of Gov.Enfi!X City of Fort Worth
Address 1000 Throckmorton St. 76102
City I Fort Worth I State TX Zip Cade
Length of Relations with this entity. #Years 8+
Contact Name Ron Josselet Phone 817.392.7766 Email_
Name of Gov.Ivritity City of Houston
Address 611 Walker St.
City Houston state TX Z p Code 77002
Length ofRelationslri With this entity #years 13+
Contact Name
Jim Mihalic Phone 713.247.1000 1 E-mail
Name of Gov.Entity City of San Antonio
Address
343 W.Houston St.,Suite 405
— Z �j
City San Antonio state -rX ip Code 78205
Length of Relationshi With this en 117 years 12+
—
Contact Name Ella Anaya Phone 210.207.7316 EM
Yes
an' an s,transfer of ownership
-f6-- woes Medical Provider tici-Pate Y Merger Ala
management reorganization,or departure of key Personnel Within the next 36
months that may affect the Medical Provider's ability to perform Services
required in this RFP?
Has Medicat Provider ever declared bmlauptu? s Igo
8— Please provide the most current annual report and/or audited f linancial
X
statement prepared for Medical Provider.
19 Has Medical Provider been issued any penalty or fines from the Texas No
Department of Insurance relating,to any-violation of the Texas Labor Code Or
Rules since 1/1/290107
20 Total amount of penalty or fines paid to the Texas Department of insurance
relating to violation of the Texas Labor Code and Rules since 1/1/29010 by N/A
Medical Frovider.
—
21 leas anyone filed aco Yes complaint with the Texas Department of Insurance Li No
regarding any health care services rendered by Medical Provider or their
designated agents since 111/2010?
If yes,please explain below:
Has Medical Provider been audited for compliance or othemise Investigated by the e, Yes NO
Texas Department of Insurance relating to workers'compensation.medical clam?
I subn3issions or set vices rendered?
24 if ycs, lease ex lain below:
RFP No. 14-0225,Medical Provider of Occupational-Health Care SeIrvices,Page 38 of 52
ated to provide health care or medical yes T-To
Has an-Y health care practitioner,anticipated "0::]
services to the City solicited in this RFP,employed by or contracted With
Medical Provider been disciplined by any State licensing board or regulatory
— agency in the past 5 years. um:s'
26 If Yes,please identify the healthcare practitioner and provide a detailed explanation of the circ instances
involved.
2 has anyone filed a complaint regarding any health care practitioner, _Ws_E1 iT0_
anticipated to provide health care or medical services to the City solicited in
this RFP,with any State licensing board or regulatory agency in the past 5
years?
28 H Yes,please identify the healthcare practitioner and-provide a detailed explanation ofthe circumstances
involved.
PART B.NEDYCAL PROVIDER CONTACT
29 Provide the following information for designated contact that CITY may call regarding MEDI
PROVIDER proposal.
Name of Cop-tact Jerry Francis,Sales Manager
Address 2500 West Freeway,Suite 100
City Addison State TX Zip Code 17'
I Email lerry_rancis @concentra.com
Telephone 1 214.649.1213 FaX 1 817.882.8707
PART C>MEpIcAL PRACTICE GUIDELINES
30 Use ofiScientific,Evidence Based Medicine–To what extent does Medical Provider incor scientific,
poriate scie c,
't and care of patients? Please describe
evidence-based medicine into health care practitioners'medical treatmen
below, Please refer to our proposal narrative.
31 Utfliz7ation of Treatment Guidelines–To whet extent does-Medical Provider follow Texas Department,of
Insurance,Division of Workers'Compensation adopted rules for Medical Treatinent Guidelines,Rule 137.100?
Please describe below.How health care practitioners i incorporate the atmelf g u! el no s into medical
treatment regimens and treatment,plans to manage patient care.
Please refer to our proposal narrative.
RFP_No. 14-0225,Medical Provider of Occupational Health Care Services,Page 39 of 52
PART D.-MEDICAlL,PlE£®V DER FAClLI7[ ES TO SERVICE CITY
33. ldentify each WEDICAL PROVIDER facility anticipated to provide services to the Clay and complete the
belovr reoested information for each facility and their personnel. Add additional sheets if necessary.
FACILITY I
Facility Name Fort Worth Forest Park
Hacili-w Address 2500 West Freeway(130),Ste.100
Cit Fort Worth State TX Zip Code 76102
Y -
Telephone 817.882.8700 817.882.8707
Bate Facilj!y Founded/Opened Center opened in 2002
Days/`amour of Operation M-F:Barn-8pm,Sat_Sam-5pm
Name of Facility Office Manager David Lambing,AMT/RMA,Center Operations Director
Services to be Performed at this Paca9ef�v�
Acute injury medical treatment for job-related injwles/occupatio 1 diseases Yes EXI ?do
[Reference:Attachment D,Sub art A of this RFP
lion
j Occupational Health Care Services:
Breath Alcohol Vests[Ref.Attachment D,Subpart B.1] Yes El No
Urinary Drug Screens( DS)[Ref Attachment D,Subpart B.2] Yes® iedo
Physical Examinations/Assessments ef.Attachment D,Subpart B.3] Yes �To
Laboratory Testing[ref.Attacl!�Sub art 13.41 Yes No�
imrnuarizzations/Vaccinations[Ref Attachment D,Subpart 13.51 Yes No El
0t1 er Procedures t Services[Ref Attachment D,Subpart B.6] Yes[XI NO
Health Care Practitioners at this Facility
Please complete the following information fear each Texas Licensed Health Care Practitioner serving this facility that
is anticipated to pKLvide services to the CITY as outlined in this IFP.
Health Care Practitioner Name Medical Specialty Texas License A #Years 0 Years Practking
Practicing
? at this Faoility
Roy Kreusel,MD Occupational Health F4179 25+year 10+
Mark Moms,DO Occupational Health H8268 22 year 8+
-RFP No. 14-09-25,h4edical Provider of Occupational Health Care Set-vices,Page 40 of 52
PART R MERICAL FRO-VI DER FACILI 8 TO SE13VI
TH M, (contirtued)
mcmm 2
Facility Name Fort Worth Fossil Creek
-F
Facility Address 4060 Sandshell Dr.
C"lre'gs u 76137
(.Nt Fort Worth State TX Zip Code. 76137
Y Fax 817.306�.9780
Tqjqpjj0R0 817.306.9777 99
t Center opened in 8
Date Facility Founn�ded �ened Ceenter opened in 1998
Days/Hours of eration M-F:Sam-5prn
Name of Facility office Manager Marquisha Paris,Center Operations Director
his
Acute jrjury medical treatment for job-related injuriedoccupational diseases Yes
[Reference:Attachtnent D,Subpart A of this FIT]—
Non-Injull/Occi_Mation al Health Care So!vices:Breath Alcohol Tests L
Attachment D,dub j_part B,11 Yes L El No El
_j- Drag Screens QOM �eff:Attachment D.Subpart B.21 Yes
B.31 Yes ICI®
—E]
Physical Examinations I AssesSISIOMIS&-f-,Attachment A M -
Laboratory Westin l [Pef:Attachment D,Sub paAB-4] yes EF No FI
9
Immunizations/Vaccinations lRer.Attachment D,Sub art B.51 Yes X No Q
€Dtl Attachment art 13,61 des Ix I Ro El
-or-Procedures/Services jjt�f
Health Care Practitioners at this FacURY,
Please complete the following infor
mation f6r each Texas Licensed Health Care practitioner serving this facility that
is anticipated to provide services to the CITY as outlined in this FX�P-
Healill care Practitioner Name Medical SaecialF Texas-11cense h:Years 4 Nears Practicing
�racticin at dais P'aciLfy
—7George—Niemirowski,MD Occupational Health H0686 25+years With Goncentra for 20+years
r
Kenneth Baldwin,DO Family Practice D8501 s With Concentra fo 18+years
UP No. 14-0225,Madjeal Provider of occupational Health Care Services,Page 41 of 52
Concentra has fourteen(14)additional clinics in the DFW metroplex;The Fort Worth locations will serve as the primary locations
pART D.ME_I)IC�AL PR R7
O_VME—R FACILITIES TO SE VICE CIM 00ndnll d)
F-ACILITY3
Facility Name
Facility Address
City State Zip Code
I
`feleahonb fax
Date Facility Founded/Opened
Days/Hours of Operation
Name of Facjk,Office Manager
Services to be Performed at this Facility;
Acute injury medical treattment for jobrelated.inj1h-jes/occapational diseases Yes Lj No
I-Aeference:Attachment D,Subpart A of this RFPI
Non-Injury Occupational Health Caic Services: ubpar-t 11.J1 -TTO—LI
't - —a=
Brea; Alcohol Tests[Raf.Affachment D,8 B.2] Yes U No
urinary Drug Screens -Vas—0 No
Physical Examinations/Assessments[Ref,Attachment A Subpart B.3] No
Yes
Laboratory 71 esting[Ref.Attachment D,Sub art BA] --�R7-[]
L[rm-tm ions UL -Attachment D,S art 77es cl— 0
nations/vaccinations ef. Yes No Li
Health Care Practitioners at this Facifty;
Please complete the following Information for each Texas Licensed Health Care Practitioner serving this facility that
is anticipated to provide services to the CITY as outlined in this RFP.
4 Years Rag-ficipgg
Texas License F,Years
Health care Prartitioner Name Mgdicai N120claitY
—practicing? at tats aciii v
R
UP No. 14-0225,Medical Provider of Occupational Health Care Services,Page 42 of 52
Concentra has fourteen(14)addifional clinics in the DFW metroplex;The Fort Worth locations will serve as the primary locations
PART D.MEW—AL DER FACILITIES TO armna, cay I(continued)
FACHLITY 4
Facility Name
Facility Address
cis State Zip Code
y Fax
T el-whone
Date Facility Founded Ppened
DaysrHours of Operation
rNam-e of Facility Off 1C.-Manager
Services to be Performed at this-r,—acifitv-
Acute injury medical treatment forjob-related injuries/occupational diseases Yes El
JP -1
,eforence:Attacbm ent D,Sub A of this RFPI
Non.Injiuy Occgafional Health Care Services:
Breath Alcohol Tests[Ref:Attacb-ment D,Sub art B.I] -rqo El
Urinary Drug Screens(102S)[Lef-Attachment D,Sub[)art B.2] Yes To—E-1
Physical Examinations/Assessments[lief;Attachment D,Subpart B.31 Yes El 10
Laborato-a Testing[Ref.Attachment D,Subpart BA] Yes El 10�171
Immunizations I Vaccinations s[Ref.Attachment D,Sub art B.51 Yes El NO U
Other Procedures/Services ?'es[Ell -To El
Health Care Practitioners at this FaeRity.
Please complete the ing inibrmation for each Texas Licensed Health Care Practitioner serving this facility that
is wdci atedto rovidese es to the CIl-V--as outlined in this RFP.
Healrlr Care Practitioner Name Medical Ssreciafl y Texas License 4' 4 Years 4 Years Practicin
i�s�Fgcffl
Practicing? A j
t
PUP No. 1400225,Medical Provider of occupational Health Care Services,Page 439 V-L 52
ConcentFa has fourteen(14)additional clinics in the DFW metroplex;The Fort Worth locations will serve as the primary locations
PART D,i V (conflnaed)
_vIEDICALBROVIDERFACHITTES TO SERVICE CIT
FACILITY 5
Facility I-Tame
Facility-Address
cft -state Zip Co�de ��
y
Tile hone Fax
Date Facility Pounded/O-pened
Days/Hours of Operation -
Name of Facility Office Manager - I
e Performed atoklUffilyj
.Seirvicesto be Per
Acute injury medical treatment for job-Talated injuries/occupational diseases Yes U --No U
LRefere-nce:.-Affachment A§!!b
Tart A of this REPI
Non-Injury 00011PW01121 Health Care Services:
Breath Alcohol Tests[Ref.Attachment A Subpart B.11 Yes
Urinary Drug Scre s(LJDS)[1,�ef-Attachment D,S!Lb_oartB.2] Yes -N- O
Physical Examinations I Assessments[ref Attach rent A Sifopart B.31, Ye No
-- E]
Laboratory Testing LRef*Attachment D,Sub art DAI Yes 0 No
immunizations/Vaccinations[Ref.Attachment D,Subpart E.5] Yes El No
Other Procedures Services[Ref Attachment D,Subpart B.6] I Yes Li I to L-J I
Health Care Practitioners at this La_cIfity: are P
ractitio
Please complete the following informan -nor sw ving this fac
on for each Texas Licensed Health C ffilty
that isanflci pitcdtopr vide ervices to the CITY as outlined in tbi-S-RFP.
9A Texas License. A�fears
Heaftli Care Practitioner Medical 512ccid aye
Practicing? Pfactichng at this
Facilijy
TO THE BEST OF MY KNOWLEDGE',TIEIE ABOVE INYOR-W411ON IS TRUE AND CORRECT.
Signature.of Autdiorizzed e Romsentativ D.
iv
Arlene G.King
Authorized Representative
Ty-Name of-Authorized Representative,
Occupational Health Centers of the Southwest,PA,
dba Concentra Medical Centers
Name of Medical Provider I Proposer 1 P n d On
RFF No. 14-0225,Medical Provider of Occupational Health Care Services,Page 441 of 52
Corporations Section E 0 John Steen
P.O.Box 13697 CIA Secretary of State
Austin,Texas 78711-3697
C6
Office of the Secretary of State
Certificate of Fact
The undersigned, as Secretary of State of Texas, does hereby certify that the document, Articles Of
Association for OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST, P.A. (file number
80997203), a Professional Association, was filed in this office on January 25, 1985.
It is further certified that the entity status in Texas is in existence.
In testimony whereof, I have hereunto signed my name
officially and caused to be impressed hereon the Seal of
State at my office in Austin, Texas on January 23, 2013.
C6
John Steen
Secretary of State
Conte visit us on the internet athttp::/Www,sos.state.tx.us.,
Phone: (512)463-5555 Fax-(512)4635709 Dial:7-1-1 for Relay Services
� City of For Worth,1 X PFP No.14-0225
Cjtr Medical Provider of Occupational Health Care Services
Attachment B
September 11,2014 _ _— -- - ttachments
PROFESSIONAL SERVICES AGREEMENT
I. AGREEMENT BETWEEN PARTIES
This PROFESSIONAL SERVICES AGREEMENT("Agreement')is made and entered into by and between
the CrFY OF FORT WORT�t1(the"City"),a home rule municipal corporation of the State of Texas,acting by
and through Susan Alanis,its duly authorized Assistant City Manager,and Occupational Health Centers of
the Southwest P.A.yd/b/a Concentra Medical Centers
("Provider", l Titlej. --FFarmatlted.Body Text,Justified,Space pt,L ne spacing: Multiple 0.99 li,:Not at 1.68"+ 3.65"
2, GENERAL
2.1 Provider 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 Provider 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 oftftethis Agreement shall control.
2.2 City and Provider 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.
23 Services under this Agreement will be provided at Provider 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 Provider and City.
2A 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 Provider 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 CrTY's Police and Fire
Departments;and(iii)such other matters as are contained in such contracts,and(b)any renewals thereof.
2.5 Provider 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. Provider also agrees to
maintain the panel during the initial term of this Agreement,as well as any of the option terms.Provider
agrees to monitor performance of and replace,if necessary,any or all of panel members as warranted.
Fnr.ma'tbed,Font:10.5 pt,Bold,Underline,
3. AGREEMEN I II RPJ -----------------------------—---------------- Underline color:Auto,(Ind)+Body(Calibri),
Character scale:100%
3.1 The initial term of this Agreement shall commence on January 1,2015("Effective Date")and Fasaraa€ d:Font:10.5 pt Bold,Underline,
shall expire on December 31, 2017, unless terminated earlier in accordance with the provisions of this (Ind)+Body(Calibri)
Agreement.
�it3 The parties may 4' mo �
t m
' ly agee to renew this Agreement for two additional one-year
terms. If Qty-the parties desires to exercise an option to renew, C-it)the party requesting the renewal shall notiij
IeF the other party in writing of its intention to renew at least sixty(60)days prior to the end of the then-
cur-tint term.Compensation to be paid during any option term shall be the same as-that
Termmutually am-Led upon between the parties Any chanties to the terms and conditions or extensions of this
Agreement shall be effective only when reduced to an amendment which references this Agreement executed by
a duly authorized representative of each party.
4 -- F®ruam3ted- No bullets or numbering
4 ®ICING AND COIMPENSATTOM - _- Fan-named:Font:10.5 pt,Bold,Underline,
------------------------------------
Underline color:Auto,(Intl)+Body(Calibri)
4.1 The Parties agree the Schedule for Compensation as shown in the attached Exhibit "B" is Farmatted.Font:10.5 pt,Bold,Underline,
acceptable as the compensation to be paid to Provider for specified services provided to the City during the (Ini)+Body(Calibri)
initial contract period and the subsequent option periods,if exercised by the City.The parties acknowledge
that additional services provided by Provider 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 ag'eement or by a written amendment to this Agreement signed by the parties.
4.2 Billing of 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.
4.3 For occupational health care services other than medical treatment of compensable on the job
injuries,Provider shall issue monthly invoices to the City and will provide the City sufficient documentation
to reasonably substantiate the invoices.The invoice shall be broken down by City department and shall list
the name,City employee identification number, dates of service,and service provided.The invoice shall be
provided to the City on or before the 10th day of the month following the end of the month in which services
were provided. City shall pay such invoices in accordance with City Financial Management Services
' procedures and requirements.Invoices are due and payable within thirty(301 days from the date the invoices
are received by the City.
4.4 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 Provider within si (601 days of the date the contested matter is
resolved.
5. RECORDS Ate UCOPDS MANAGEPMr T _______________Y-- Erman-ed°Font: pt,Bold,Underline,
------------------
Underline color:Auto,(Intl)+Body(Calibri)
5.1 Provider will adhere to and follow the governing guidelines as they pertain to the protection and (Ind)+Buda Font:10.5 pt,Bold,Underline,
(?n l)+Body(Calibri)
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 Provider for the
cost of such copies at the rate published in the Texas Administrative Code in effect as of the time copying is
performed.
5.2 Upon termination or expiration of this Agreement,Provider agrees to return to the City,or its
designated agent,all medical records delivered to Provider on or about the Effective Date(the"Pre-existing
Medical Records").Upon receipt of authorization from the affected City employees or their representatives
for Provider 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),
Provider 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.
It is recognized that additional medical records created by Provider in the performance of this Agreement,
regardless of form or medium or storage("New Medical Records") shall be and remain the property of
Provider and shall not be moved or transferred from Provider except in accordance with applicable law and
Provider 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 Provider,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
Provider agrees to use all reasonable efforts to obtain the written consent of each patient seen by Provider
under this Agreement authorizing Provider to release copies of such"New Medical Records"to the City upon
its request therefor.Upon expiration or termination of this Agreement,Provider 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 Provider for the cost of such copies at the rate published in
the Texas Administrative Code in effect as of the time copying is performed.
5.3 Provider 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 Provider and City and Provider agree to
utilize appropriate records retention and destruction schedules for the purpose of lawful and efficient records
management.
5.4 Provider will exercise appropriate care to preserve necessary and useful medical records generated
during the term of this Agreement.Provider 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 Provider 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.
5.5 All reports and records provided to Provider by the City shall remain the sole property of the City.
Provider 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 Provider normal working hours and will
provide Provider with reasonable advance notice of a need for access. Provider 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 thud parties without the City's advance written consent.Provider 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 Provider.Provider 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 Provider upon written notice from the City at its sole
expense and at any time.
6. MINORITY BUSINESS ENTERPRISE ERPRISE(MOO)PARTICIPATION
6.1 In accord with the City Code of Ordinances,the City has goals for the participation of minority
and woman business enterprises in City Agreements.Provider acknowledges the MBE 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 Provider 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.
6.2 The established goal for this Agreement is 10 percent (10%) of the value of non-injury
occupational health services portion of the Agreement. Provider agrees to furnish, on a quarterly basis,
documentation of MBTE participation as may be reasonably requested by the City.The first quarterly report
for the City's second Fiscal Quarter(months of January,February,and March 2015)shalt be submitted on or
before April 30,2015, and each subsequent quarterly report shall be submitted at the end of the month
immediately following the end of the City's Fiscal Quarter.
7. HE,EALTH INSITRANCE PORTABILITY AND ACCOUNTABILTPY ACT (11HAAD
7.1 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.Provider agrees not to use or further disclose Protected Health Information
other than as permitted or required by this Agreement or as required by law. Provider 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,Provider shall:
7.1.1 Use appropriate safeguards to prevent use or disclosure of the Protected Health
Information other than as provided for by this Agreement.
7.1.2 Mitigate,to the extent practicable,any harmful effect that is known to Provider of the use
or disclosure of Protected Health Information by Provider in violation of the requirements of
this Agreement.
7.1.3 Report to the City any use or disclosure of the Protected Health Information not provided
for by this Agreement.
7.1.4 Ensure that any agent, including a subcontractor, to whom Provider provides
Protected Health Information received from,or created or received by Provider on behalf of the
City, agrees to the same restrictions and conditions that apply through this Agreement to
Provider with respect to such information.
7.1.5 Make internal practices,books,and records,including policies and procedures and
Protected Health Information received from,or created or received by Provider 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 Provider
compliance with HIPAA.
7.1.6 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.
7.1.7 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.
7.1.8 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.
7.1.9 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.
7.1.10 Use Protected Health Information to report violations of law to appropriate federal
and state authorities consistent with HIPAA.
7.2 Permitted Uses and Disclosures by Provider
Except as otherwise limited in this Agreement,Provider may use or disclose Protected Health Information on
behalf of,or to provide services to,the City for the proper management and administration by Provider or to
carry out the legal responsibilities of Provider.
7.3 Obligations of the City
The City shall inform Provider of Privacy Practices and Restrictions by:
7.3.1 Providing Provider with the notice of privacy practices that the City produces for
Occupational Health and Safety.
7.3.2 Providing Provider with any changes in,or revocation of,permission by individual to use or
disclose Protected Health Information,if such changes affect Provider permitted or required uses
and disclosures.
7.3.3 Providing notification to Provider 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.
7.4 Termination for material breach of HIPAA by Provider_Upon the City's knowledge of a material
breach by Provider the City shall either:
7.4.1 Provide an opportunity for Provider to cure the breach or end the violation and terminate the
Agreement if Provider does not cure the breach or end the violation,within the time specified by the
City;
7.4.2 Immediately terminate this Agreement if Provider has breached a material term of the
HIPAA requirements of this Agreement and a cure is not possible;or
7.4.3 If neither termination nor cure is feasible,the City shall report the violation to the Secretary.
7.5 Effect of Termination
7.5.1 Except as provided in Section 4, upon termination of this Agreement, for any reason,
Provider shall return or destroy all Protected Health information received from the City,or created
or received by Provider on behalf of the City.This Provision shall also apply to Protected Health
information that is in the possession of subcontractors or agents of Provider.Provider shall retain no
copies of the Protected Health information as described in this paragraph.
7.5.2 In the event that Provider determines that returning or destroying the Protected Health
information is infeasible,Provider 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,Provider shall extend the protections of this Agreement
to such Protected Health information and limit finther uses and disclosures of such Protected Health
information to those purposes that make the return or destruction infeasible,for so long as Provider
maintains such Protected Health information.
T6 Miscellaneous
7.6.1 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.
7.6.2 The respective rights and obligations of Provider under the section 6.5 of this Agreement
shall survive the termination of this Agreement.
7.6.3 Any ambiguity in this Agreement shall be resolved to permit Provider to comply with the
Privacy Rule of HIPAA.
0. TERMNATION
00.1 Written Notice
The City or Provider may terminate this A_g eement at any time,with orrwithout cause,by providing the other
party with si. 60)days'written notice of ter nination.Upon the receipt of any such notice,Provider 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.
o 2 Non-appropriation of Funds
In the event no funds or insufficient funds are appropriated by the City in any fiscal period for any payments
due hereunder,City will notify Provider 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 weed upon for which funds shall have
been appropriated.
03 Duties and Obligations ofthe Parties following Termination
In the event that this Agreement is terminated prior to the expiration of the then current term,Provider 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 Provider 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 Provider for services actually rendered up to the effective date of termination and Provider
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 Provider 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
Provider 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 Provider 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 Provider documenting the
performance of such work.
9. DISCLOSURE Or,CONFLICTS AND CONFIDEtNTIAL!NFORP�tti A71ION
Provider hereby warrants to the City that Provider has made full disclosure in writing of any existing or
potential conflicts of interest related to services to be peiorned under this Agreement.In the event that any
conflicts of interest arise after the Effective Date of this Agreement,Provider hereby agrees immediately to
make full disclosure to the City in writing.Provider,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. Provider 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.Provider shall notify the City immediately if the
security or integrity of any City information has been compromised or is believed to have been compromised.
I®. RIGHT TO AUDIT
J
10.1 Provider 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 (excluding confidential
proprietary business data)of Provider involving transactions relating to this Agreement at no additional cost
to the City to access Provider s space to conduct such audit.Provider zgrees that the City shall have access
during normal working hours to all necessary Provider facilities znd shall be provided adequate and
appropriate work space in order to conduct audits incompliance with the provisions of this section.The City
shall give Provider reasonable advance notice of intended audits. Provider agrees to photocopy such
documents as may be requested by the City.City agrees to reimburse Provider for the cost of copies at the
rate published in the TT exas Adminis rative Code in effect as of the time copying is performed.
10.2 Provider 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 dining 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.
11. INDEPENDENT CONTRACT®Ib
It is expressly understood and agreed that Provider 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,Provider 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.Provider acknowledges that the
doctrine of respondent superior shall not apply as between the City, its officers, agents, servants and
employees,and Provider its officers, agents,employees, servants, contractors and subcontractors.Nothing
herein shall be construed as the creation of a partnership or joint enterprise betvveen City and Provider.
12. LIABILIT4 AND IMNDEA,UNIF'ICA'I'I®N
12.1 PROVIDER SHALL BE LIABLE AND RESPONSIBLE FOR ANY AND ALL PROPERTY
LOSS,PROPERTY DAMAGE AND/OR PERSONAL INJURY(INCLUDING DEATH)10 ANY AFB
PERSONS, n r R4D OR n n n n C;TER �x crcT crco o> n r no n ce n rc�TO THE
EXTENT CAUSED BY THE NEGLIGENT ACT(S) OR OMISSION(S),
a,r n r ri-n e n�rnc no
INTENTIONAL MISCONDUCT OF PROVI7ER 11S OFFICERS, AGENTS, SERVANTS, OR
EMPLOYEES WHILE PERFORMING THE SERVICES UNDER THIS AGREEMENT.
d -- �rsraa �r3s Justified,indent:Left: 0",First
12.2 PROVIDER COVENANTS AND AGREES TO, AND DOES HEREBY,INDEMNIFY,HOLD line: o",Right: 0.63"
HIARMULESS AND DEFEND THE CITY, ITS OFFICERS, AGENTS, SERVANTS AND
EMPLOYEES, FROM AND AGAINST ANY AND ALL CLAllmS OR LAWSUITS FOR EITFIER
PROPERTY DAMAGE OR LOSS
T) PAW9F OR
nccrn TTAr(' r s; vnn��l AND/OR PERSONAL R (INCLU DING
nren ec n rm n ry nn n AW n.m no r *n n n nTcn rrrrsc n REAL
DEATH) TO ANY�m A66 PERSOI TS,
nn
IIARISMZNG OUT OF OR ITN CONNECTION WITH TFIE SERVICES PERFORMED UNDER
THIS AGREEMENT,TO TIM EXTENT CAUSED BY T TIE SOLE NEGLIGENT ACTS OR OMISSIONS
9^ nTn"r ncn r r OF PROVIDER tS OFFICERS, AGENTS, SERVANTS, OR EMPLOYEES;
PROVIDED. HOWEVER THAT IN NO EVENT SHALL PROVIDER BE LIABLE FOR CLAIMS OR
LEGAL ACTIONS THAT ARE THE RESULT OF CITY'S NEGLIGENT OR WILLFUL MISCONDUCT.
FURTHERMORE PROVIDER SHALL NOT BE LIABLE FOR ANY CONSEQUENTIAL,INCIDENTAL,
PUNITIVE, INDIRECT SPECIAL OR ANY OTHER FORM OF EXEMPLARY DAMAGES
REGARDLESS OF WHETHER THE LEGAL THEORY FOR ANY SUCH DAMAGES IS BASED IN
CONTRACT.TORT OR OTHER LEGAL THEORY.
13, ASSIGNMENT AND SUBCOPlTRACITITC
Provider 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'Provider under which the assignee agrees to be bound by the
duties and obligations of Provider under this Agreement.Provider 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 Provider referencing this Agreement under which
the subcontractor shall agree to be bound by the duties and obligations of Provider under this Agreement as
such duties and obligations may apply.Provider shall provide the City with a fully executed copy of any such
subcontract.
14. INSURANCE
14.1 Prior to commencement of any work pursuant to this Agreement,Provider 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.
14.2 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 Iaw,
court decisions, or circumstances surrounding this Agreement, but in no instance will the City allow
modification whereupon the City may incur increased risk.
14.3 Provider's financial integrity is of interest to the City;therefore,subject to Provider's right to
maintain reasonable deductibles,Provider shall obtain and maintain in full force and effect for the duration of
the Agreement, and any extension hereof, at Provider'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 or through the use of a wholly owned insurance subsidiary
("captive') as an altemative risk financing program Vendor shall provide fully audited financial f
statements for the captive at the request of the City..Coverage shall be wntten in the following types and
amounts:
14.3.1 Workers'Compensation-Statutory
Employers'L iability-$500,0001$500,0001$500,000
14.3.2 Commercial.General(Public)"Liability Insurance to include the following types of
coverage: 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)
14.3.3 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)
143.4 Commercial Umbrella-$1,000,000 per occurrence$1,000,000 Aggregate
143.5 Technology Liability-$1,000,000 per Claim,$1,000,000 Aggregate
14.3.6 Medical Professional Liability-$1,000,000 per medical incident and $3,000,000
Aggregate
14.4 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.
14.5 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. Am annual certificate of insurance
submitted to the City shall evidence such insurance coverage.
14.6 Provider 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
14.7 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,Provider shall exercise reasonable efforts to
accomplish such changes in policy coverage and shall pay the cost thereof.
14.8 Provider agrees that with respect to the above-required insurance, all insurance contracts and
Certificate(s)of k-isurance will contain the following required provisions:
14.8.1 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.
14.8.2 An endorsement stating that Provider'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.
14.8.3 Provider's Workers'Compensation and Employers' Liability policy will provide a
waiver of subrogation in favor of the City.
14.9 Provider 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,or per policy terms and
conditions 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 I 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.
14.10 If Provider 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 Provider to maintain said insurance or secure such endorsement.In addition to any other remedies the City,
may have upon Provider'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 Provider to stop work
hereunder,and/or the right to withhold any payment(s)that become due to Provider hereunder until Provider
demonstrates compliance with the requirements hereof.
14.11 Nothing herein contained shall be construed as limiting in any way the extent to which
Provider may be held responsible for payments of damages to persons or property resulting from Provider's or
its subcontractors'performance of the work covered under this Agreement.
$5e COMPUIANCE WITH LAWS ORDINANCES,RULES AND REGULATIONS
In fulfilling its obligations under this Agreement,Provider agrees to comply with all applicable federal,state
and local laws,ordinances,rules and regulations.If the City notifies Provider of any violation of such laws,
ordinances,rules or regulations,Provider shall immediately desist from and correct the violation.
Provider,for itself,its personal representatives,assigns,subcontractors and successors in interest,as part of
the consideration herein,agrees that in the perionmance Provider's duties and obligations hereunder,it b all
not discriminate in the treatment or employment of any individual or group of individuals on any basis
prohibited by la-w. If any claim arises from an alleged violation of this non-discrimination covenant by
Provider its personal representatives,assio ecs,subcontractors or successors m interest,Provider agrees to
assume such liability and to indemnify and defend the City and hold the City harmless from such claim.
17. 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 confumaafion of the transmission;or(iii)received by the other party by
United States Mail,registered,return receipt requested,addressed as follows: 0.63",Space Before: 0 pt
Fasrsaa4ted:Right: 0.63"
To CITY: -_
City of Fort Worth Attn:Ron 7osselet �naaaY =Right: 0.63",Space Before: 0 pt
1000 Tbrockmorton a -- fosma :Right: 0.63"
Fort Worth TX 76102-6311 Facsimile:(017)392-7766
E-mail:Ron.JosseIet @fortworthtexas..gov
To PROVIDER
Occupational Health Centers of the Southwest.P.A.d/b/a Concentra Medical Centers
5080 Spectrum Drive Suite 1200W
Addison-Texas 75001
Attn: Legal-Contracting
tg. SOLICIIAEION OF EMPLOYEES
Neither the City nor Provider 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.
19. 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.
20. NO WAAFVE
The failure of the City or Provider 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 Providers respective right
to insist upon appropriate performance or to assert any such right on any future occasion.
21. GO e E NG LA W/VENUE
This Agreement shall be construed in accordance with the internal laws of the State of Texas.Ifany 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.
22. SEVERABILIT
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.
The City and Providers 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 parry'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.
24. 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.
25. 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.
26. AMENDMENTS I MODIFICATIONS I 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.
27. ASSIGNMENT-DELEGATION
No right, interest or obligation of Provider under this contract shall be assigned or delegated without the
written agreement of the City.Any attempted assignment or delegation of Provider shall be wholly void and
totally ineffective for all purposes unless made in conformity with this paragraph.
28. 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 Provider,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.
29. 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.
[SIGNATURE PAGE FOLLOWS]
IN WPTNESS WHEREOF,the parties hereto have executed this Agreement in multiples on this the
day of 2014.
CITY OF FORT WORTH OCCUPATIONAL HEALTH CENTERS OF
THE SOUTHWEST,P.A.DB/A
CONCENTRA MEDICAL CENTERS
Assistant City Manager W.Tom Fogarty,M.D.,President
D
Date:
ate:
APPROVED AS TO FORM AND LEGALITY:
Assistant City Attorney
ATTEST:
Mary Kayser City Secretary
CONTRACT AUTHORIZATION:
M&C:
M&C Review Page 3 of 3
term, beginning January 1, 2015 and each Agreement will allow for up to two, one-year
renewals. Execution of the renewal Agreements will not require additional City Council authority,
provided that funds have been appropriated to pay the City's obligations during the renewal terms.
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/AccountlCenters FROM FundfAccount/Centers
FE73 539120 0147310 $316.106.17
Submitted for Clty Manager's Office by: Susan Alanis (8180)
Originating Department Head: Brian Dickerson (7783)
Additional Information Contact: Margaret Wise (8058)
ATTACHMENTS
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http://aoos.efwnet.ora/council nacketJmc re.view.acn?1T)=?04ddRrrrnmrilriatP=i n/9 2/7M d 11/1 4/7f11 A