HomeMy WebLinkAboutOCCUPATIONAL HEALTH SERVICES - CONTRACT - RFP - P863 MEDICAL PROVIDER RISK MANAGEMENTSERVICES AGREEMENT
THIS AGREEMENT made and entered into the day and year set forth below by and between
THE CITY OF FORT COLLINS, COLORADO, a Municipal Corporation, hereinafter referred to as the
"City" and Occupational Health Services, hereinafter referred to as "Service Provider".
W ITNESSETH:
In consideration of the mutual covenants and obligations herein expressed, it is agreed by
and between the parties hereto as follows:
1. Scope of Services. The Service Provider agrees to provide services in accordance
with the scope of services attached hereto as Exhibit "A", consisting of one (1) page, and
incorporated herein by this reference.
2. Contract Period. This Agreement shall commence January 1, 2003, and shall
continue in full force and effect until December 31, 2003, unless sooner terminated as herein
provided. In addition, at the option of the City, the Agreement may be extended for additional one
year periods not to exceed four (4) additional one year periods. Pricing changes shall be negotiated
by and agreed to by both parties and may not exceed the Denver - Boulder CPI-U as published by
the Colorado State Planning and Budget Office. Written notice of renewal shall be provided to the
Service Provider and mailed no later than ninety (90) days prior to contract end.
3 Delay. If either party is prevented in whole or in part from performing its obligations
by unforeseeable causes beyond its reasonable control and without its fault or negligence, then the
party so prevented shall be excused from whatever performance is prevented by such cause. To
the extent that the performance is actually prevented, the Service Provider must provide written
notice to the City of such condition within fifteen (15) days from the onset of such condition.
4. Early Termination by City/Notice. Notwithstanding the time periods contained herein,
the City may terminate this Agreement at any time without cause by providing written notice of
termination to the Service Provider. Such notice shall be delivered at least fifteen (15) days prior to
the termination date contained in said notice unless otherwise agreed in writing by the parties. All
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Physical Performance Test
Other Specialty Services/Fees
Fit for Duty Evaluation (1st hour)
Fit for Duty Eval. (each add. '/2 hour)
OSHA Respirator Physical
Basic Physical
DOT Physical
Dipstick Urine
Vision Testing
Whisper Hearing Test
Breath Alcohol Testing (BAT)
Random DOT Drug Testing
(Collection only)
Pre -employment Drug Testing
(On -site testing)
Audiogram
Range of Motion Testing
(Per AMA Guidelines — 5 sites)
WorkSTEPS Employment Test
EKG including interpretation
$ 42.00 $ 39.48
OHS Fee City Fee
$ 125.00 $ 117.50
$ 112.50 $ 105.75
$ 30.00
$
28.20
$ 55.00
$
50.00
$ 60.00
$
50.00
$ 5.00
$
5.00
N/C
N/C
N/C
N/C
$ 25.00 $ 25.00
$ 15.00 $ 15.00
$ 30.00 $ 25.00
$ 20.00 $ 20.00
$ 70.00 $ 70.00
$ 95.00 $ 95.00
$ 108.00 $ 108.00
Immunizations — as requested for Rabies, Influenza, MMR, etc.
(Fees per schedule + 20%)
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notices provided under this Agreement shall be effective when mailed, postage prepaid and sent to
the following addresses:
City: Service Provider
City of Fort Collins Occupational Health Services
Risk Management 1330 Oakridge Dr
PO Box 580 Fort Collins, CO 80525
Fort Collins, CO 80522
In the event of early termination by the City, the Service Provider shall be paid for services rendered
to the date of termination, subject only to the satisfactory performance of the Service Provider's
obligations under this Agreement. Such payment shall be the Service Provider's sole right and
remedy for such termination.
5. Contract Sum. The City shall pay the Service provider for the performance of this
Contract, subject to additions and deletions provided herein according to the Cost Breakdown Fee
schedule attached as Exhibit "C", consisting of three (3) pages, and incorporated herein by this
reference.
6. City Representative. The City will designate, prior to commencement of the work, its
representative who shall make, within the scope of his or her authority, all necessary and proper
decisions with reference to the services provided under this agreement. All requests concerning this
agreement shall be directed to the City Representative.
7. Independent Service provider. The services to be performed by Service Provider are
those of an independent service provider and not of an employee of the City of Fort Collins. The
City shall not be responsible for withholding any portion of Service Provider's compensation
hereunder for the payment of FICA, Workmen's Compensation or other taxes or benefits or for any
other purpose.
8. Personal Services. It is understood that the City enters into the Agreement based on
the special abilities of the Service Provider and that this Agreement shall be considered as an
agreement for personal services. Accordingly, the Service Provider shall neither assign any
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responsibilities nor delegate any duties arising under the Agreement without the prior written
consent of the City.
9. Acceptance Not Waiver. The City's approval or acceptance of, or payment for any of
the services shall not be construed to operate as a waiver of any rights or benefits provided to the
City under this Agreement or cause of action arising out of performance of this Agreement.
10. Warranty.
(a) Service Provider warrants that all work performed hereunder shall be
performed with the highest degree of competence and care in accordance
with accepted standards for work of a similar nature.
(b) Unless otherwise provided in the Agreement, all materials and equipment
incorporated into any work shall be new and, where not specified, of the most
suitable grade of their respective kinds for their intended use, and all
workmanship shall be acceptable to City.
(c) Service Provider warrants all equipment, materials, labor and other work,
provided under this Agreement, except City -furnished materials, equipment
and labor, against defects and nonconformances in design, materials and
workmanship/workwomanship for a period beginning with the start of the
work and ending twelve (12) months from and after final acceptance under
the Agreement, regardless whether the same were furnished or performed by
Service Provider or by any of its subcontractors of any tier. Upon receipt of
written notice from City of any such defect or nonconformances, the affected
item or part thereof shall be redesigned, repaired or replaced by Service
Provider in a manner and at a time acceptable to City.
11. Default. Each and every term and condition hereof shall be deemed to be a material
element of this Agreement. In the event either party should fail or refuse to perform according to the
terms of this agreement, such party may be declared in default thereof.
12. Remedies. In the event a party has been declared in default, such defaulting party
shall be allowed a period of ten (10) days within which to cure said default. In the event the default
remains uncorrected, the party declaring default may elect to (a) terminate the Agreement and seek
damages; (b) treat the Agreement as continuing and require specific performance; or (c) avail
himself of any other remedy at law or equity. If the non -defaulting party commences legal or
equitable actions against the defaulting party, the defaulting party shall be liable to the non -
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defaulting party for the non -defaulting party's reasonable attorney fees and costs incurred because
of the default.
13. Binding Effect. This writing, together with the exhibits hereto, constitutes the entire
agreement between the parties and shall be binding upon said parties, their officers, employees,
agents and assigns and shall inure to the benefit of the respective survivors, heirs, personal
representatives, successors and assigns of said parties.
14. Indemnity/Insurance. a. The Service Provider agrees to indemnify and save
harmless the City, its officers, agents and employees against and from any and all actions, suits,
claims, demands or liability of any character whatsoever brought or asserted for injuries to or death
of any person or persons, or damages to property arising out of, result from or occurring in
connection with the performance of any service hereunder.
b. The Service Provider shall take all necessary precautions in performing the work
hereunder to prevent injury to persons and property.
c. Without limiting any of the Service Provider's obligations hereunder, the Service Provider
shall provide and maintain insurance coverage naming the City as an additional insured under this
Agreement of the type and with the limits specified within Exhibit "B", consisting of one (1) page,
attached hereto and incorporated herein by this reference. The Service Provider before
commencing services hereunder shall deliver to the City's Director of Purchasing and Risk
Management, P. O. Box 580 Fort Collins, Colorado 80522 one copy of a certificate evidencing the
insurance coverage required from an insurance company acceptable to the City.
15. Entire Agreement. This Agreement, along with all Exhibits and other documents
incorporated herein, shall constitute the entire Agreement of the parties. Covenants or
representations not contained in this Agreement shall not be binding on the parties.
16. Law/Severability. The laws of the State of Colorado shall govern the construction
interpretation, execution and enforcement of this Agreement. In the event any provision of this
Agreement shall be held invalid or unenforceable by any court of competent jurisdiction, such
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holding shall not invalidate or render unenforceable any other provision of this Agreement.
CITY OF FORT COLLINS, COLORADO
a mun_ic'pal corpo . n
By
John F. i ch ch
City Manag
By:
Jame B. 'Neill II, CPPO, FNIGP
DirectbL,of Purchasing and Risk Management
Date:
i
T:
City Clerk
APP S O FORM:
Assistant CRy Attorney
OCCONAL HEA H SERVICES
By:
�2 G 5u��
PRINT NAME
CORPORATE PRESIDENT OR VICE PRESIDENT
Date: 1 z f 7,31 D<_
(Corporate Sea])
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EXHIBIT "A"
SCOPE OF WORK
Provide appropriate medical care and case management five (5) days a week from 7:00
a.m. to 5:00 p.m., for City of Fort Collins employees that have injuries or illnesses alleged
to have occurred as a result of their employment.
2. Maintain accurate medical records for every City employee receiving medical care.
Individual patient records and reporting systems necessary to carry out program
administrative, planning, and legal requirements will be established and maintained.
Contact Risk Management after medical treatment is rendered. The severity of the injury
and/or type of visit will determine when a report must be made. The report will include
information on the accident/exposure, work restrictions, and prognosis for return to work.
This information should be transmitted to the city's electronic mail system. The
successful provider shall be on-line electronically within 30 days of contract award.
4. Notify Risk Management upon referral of employee from your facility to another
physician, or upon admission to a hospital or other facility. All information for on -going
treatment shall be sent promptly to the receiving physician, hospital or other facility.
5. Provide employee with written "status" report outlining work restrictions, if any, for every
visit.
6. Provide a written report within five (5) days of initial treatment to claim administrator.
Provide employee copies of all written communications regarding medical treatment.
8. Provide specialty services as requested, by Risk Management, such as physical
examinations, audiograms, x-rays, EKG's, immunizations, physical therapy, and
inclinometer testing for the back.
Familiar with Workers' Compensation Laws and provide hearing testimony when needed.
10. City employees shall be treated only by Level II accredited physicians.
11. Cooperate with the City's claim administrator and risk management staff in submitting
information at their request as needed in a timely manner.
12. Participate in consultations with employer and claim administrator as requested to
discuss specific cases and procedures. Meetings are held every two weeks with the
current medical provider.
13. Provide a written medical treatment plan when requested.
14. Conduct return to work (fitness for duty) examinations as requested by the Human
Resources staff, and provide appropriate feedback to staff regarding employee's work
restrictions vis-a-vis the employee's job duties
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EXHIBIT "B"
INSURANCE REQUIREMENTS
1. The Service Provider will provide, from insurance companies acceptable to the City, the insurance coverage
designated hereinafter and pay all costs. Before commencing work under this bid, the Service Provider
shall furnish the City with certificates of insurance showing the type, amount, class of operations covered,
effective dates and date of expiration of policies, and containing substantially the following statement:
"The insurance evidenced by this Certificate will not be cancelled or materially altered, except after ten (10)
days written notice has been received by the City of Fort Collins."
In case of the breach of any provision of the Insurance Requirements, the City, at its option, may take out
and maintain, at the expense of the Service Provider, such insurance as the City may deem proper and may
deduct the cost of such insurance from any monies which may be due or become due the Service Provider
under this Agreement. The City, its officers, agents and employees shall be named as additional insureds
on the Service Provider's general liability and automobile liability insurance policies forany claims arising out
of work performed under this Agreement.
2. Insurance coverages shall be as follows:
A. Workers' Compensation & Employer's Liability. The Service Provider shall maintain during the life of
this Agreement for all of the Service Provider's employees engaged in work performed under this
agreement:
1. Workers' Compensation insurance with statutory limits as required by Colorado law.
2. Employer's Liability insurance with limits of $100,000 per accident, $500,000 disease
aggregate, and $100,000 disease each employee.
B. Commercial General & Vehicle Liability. The Service Provider shall maintain during the life of this
Agreement such commercial general liability and automobile liability insurance as will provide
coverage for damage claims of personal injury, including accidental death, as well as for claims for
property damage, which may arise directly or indirectly from the performance of work under this
Agreement. Coverage for property damage shall be on a "broad form" basis. The amount of
insurance for each coverage, Commercial General and Vehicle, shall not be less than $500,000
combined single limits for bodily injury and property damage.
In the event any work is performed by a subcontractor, the Service Provider shall be responsible forany
liability directly or indirectly arising out of the work performed under this Agreement by a subcontractor,
which liability is not covered by the subcontractor's insurance.
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Exhibit "C"
Cost Breakdown
FEE SCHEDULE
The following fee schedule reflects the Colorado Workers' Compensation Medical Fee
Schedule rate and the discounted rate offered to the City of Fort Collins. Occupational
Health Services will accept 94% of the Medical Fee Schedule for clinic visits, impairment
ratings, rehabilitation therapies, reports and telephone calls. Discounted charges are listed
for specific specialty services, i.e., physicals, drug testing, etc.
There is no charge for the case management meetings held twice a month. This is a
service we feel adds value to our care of the injured worker to allow opportunity for input
from the employer regarding specific job related issues and clarification of treatment plans.
New Patient
Colorado Comp
City of FC
Fee Schedule
Fee
(per visit)
(per visit)
Brief
$ 46.54
$ 43.75
Limited
$ 68.02
$ 63.94
Intermediate
$ 100.24
$ 94.22
Extensive
$ 143.20
$ 134.61
Comprehensive
$ 186.16
$ 174.99
Established Patient
Colorado Comp
City of FC
Fee Schedule
Fee
(per visit)
(per visit)
Brief
$ 25.06
$ 23.56
Limited
$ 42.96
$ 40.38
Intermediate
$ 64.44
$ 60.57
Extensive
$ 96.66
$ 90.86
Comprehensive
$ 139.62
$ 131.24
Impairment Ratinas
Colorado Comp
City of FC
Fee Schedule
Fee
Treating Physician
$112.50/30 min., max $279.24
$108.00/30
Consulting Physician
$112.50/30 min., max $537.00
min.
$108.00/30
min.
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Depositions
Expert Testimony
Colorado Comp
Fee Schedule
$ 250.60/60 min.
$ 400/60 min.
City of FC
Fee
$ 235.56/60 min.
$ 376.00/60 min
Testimony Fees: As defined in Rule XVIII (Medical Fee Schedule) of the Department of
Labor and Employment, Division of Workers' Compensation.
Medical Conference
$ 71.60
$
67.30
Telephone Calls:
Brief
$ 14.32
$
13.46
Intermediate
$ 28.64
$
26.92
Complex
$ 42.96
$
40.38
Physical Medicine
Colorado Comp
City of FC
Fee Schedule
Fee
Initial Eval PT
$
71.00
$
66.74
Re-eval PT
$
48.00
$
45.12
Initial Eval OT
$
71.00
$
66.74
Re-evalOT
$
48.00
$
45.12
Hot/Cold Pack App.
$
9.00
$
8.46
Mechanical Traction
$
20.00
$
18.80
Elect. Stimulation
$
16.00
$
15.04
Vasopneumatic Device
$
17.60
$
16.54
Paraffin Bath
$
13.00
$
12.22
Whirlpool
$
20.00
$
18.80
Manual E-Stim (15 min)
$
20.00
$
18.80
lontophoreses (15 min)
$
22.00
$
20.68
Ultrasound (15 min)
$
18.00
$
16.92
Therapeutic Exercise (15 min)
$
22.00
$
20.68
Neuromuscular Re -Ed. (15 min)
$
22.00
$
20.68
Aquatic Therapy
$
20.00
$
18.80
Gait Training (15 min)
$
20.00
$
18.80
Massage (15 min)
$
24.00
$
22.56
Manual Therapy (15 min)
$
27.00
$
25.38
Orthotics Fit/Train (15 min)
$
21.00
$
19.74
Therapeutic Activity (15 min)
$
22.00
$
20.68
Self Care/Home Mgmt. Tng.
$
33.00
$
31.02
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