HomeMy WebLinkAboutResolution - 2008-R0025 - Contract - UMC Physicians Network Services - Medical Services Clinic - 01/24/2008Resolution No. 2008—ROO25
January 24, 2008
Item No. 4.2
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock or his designee BE and is hereby
authorized and directed to execute for and on behalf of the City of Lubbock, a Contract
with UMC Physicians Network Services for a medical services clinic for employees and
eligible dependents, a copy of which Contract is attached hereto and incorporated herein
as part of this Resolution; and
THAT the Mayor or his designee may execute any routine documents and forms
associated with said Contract.
Passed by the City Council this 24th day of January , 2008.
gs/ccdocs/UMC Physicians Network 5rvs.res
01/14/2008
DAVID A. MILLER, MAYOR
Resolution No. 2008—R0025
AGREEMENT FOR SERVICES
for
City of Lubbock Employee Medical Clinic Services
This Agreement is between UMC Physician Network Services ("PNS") and the City of Lubbock ("the
City").
City is a Texas municipality. It maintains the City of Lubbock Health Care Plan for its employees and
their eligible dependents (hereinafter called "Plan Members"). City desires to establish medical clinic
locations within the city limits of Lubbock, Texas for City's Plan Members. The availability of one or
more medical clinics would provide convenience and greater access to quality health care for Plan
Members at an efficient and affordable cost to the City.
PNS is a Texas nonprofit corporation that operates and manages medical clinics and physician practices.
PNS desires to provide medical services to Plan Members.
Therefore, the parties agree:
ARTICLE 1: TERM AND TERMINATION
1.1 Term. The term of this Agreement begins on February 1, 2008 and continues for a three-year
term through January 31, 2011.
1.2 Renewal. This Agreement shall renew only upon further written agreement of the parties.
1.3 Termination. Either party may terminate this Agreement at any time without cause by giving the
other party ninety (90) days written notice of termination. Either party may terminate the agreement for
cause provided the other party fails to cure a default within fifteen days prior written notice of the default.
ARTICLE 2: RESPONSIBILITIES
2.1 Medical Clinics. PNS shall provide access to Plan Members age two years and above at three
medical clinic locations as described below.
2.1.1. West Wind Primary Health Center. West Wind is located at 4`" Street and Elkhart
Avenue, Lubbock, Texas (Northwest location). West Wind Primary Health Center will offer a
full range of primary health care services. These services will include, but are not limited to:
chronic illness evaluation, treatment and management of diabetes, high cholesterol and asthma;
acute conditions such as sore throats/strep/ears/headache, fever, body aches, allergies/rashes;
cough/sinus, stomach aches, strains/sprains/musculoskeletal problems, acute urinary complaints;
general physical examinations; injections and immunizations; minor surgical procedures such as
sutures for laceration treatment; vaginal and breast exams; prostate exams; digital rectal exams
ECG; urine pregnancy tests; and ordinary and routine care of the nature of visit to a family
practice doctor's office. All of these services will be directed by the health care provider as
needed to provide the high quality health care. If the Plan Member needs care outside the scope
of the services offered at West Wind, PNS will assist in obtaining an appointment for the Plan
Member with an appropriate health care provider within the Plan Member's Health Plan Network.
West. Wind will be open seven days a week with extended hours. West Wind will be open
Monday through Friday 8:00 AM until 8:00 PM, Saturday 9:00 AM until 5:00 PM, and Sunday
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1:00 PM until 5:00 PM. If these hours change substantially, PNS will notify the City. Plan
Members may obtain services on a walk-in or appointment basis.
2.1.2 Living Well Express Care (Boston) and Living Well Express Care (Avenue Q). The
Boston Living Well Express Care clinic is located in the United Supermarket at 82"d and Boston
Avenue, Lubbock, Texas (South location). The Avenue Q Living Well Express Care clinic is
located in the Untied Supermarket at 50'b Street and Avenue Q. The clinics will provide acute
care service to include but not be limited to the following symptoms: headache, fever, ear ache,
sore throat, cough, congestion, stomach ache, sinus pain, rashes, body aches, allergies, insect
bites, minor lacerations, minor strains/sprains/musculoskeletal problems and other acute
symptoms. Other services offered will include injections, exams, and physicals. The Health Care
Provider will determine if the Plan Member needs to be treated at a different location. If the Plan
Member needs care outside the scope of the services offered at the clinic, PNS will assist in
obtaining an appointment for the Plan Member with an appropriate health care provider within
the Plan Member's Health Plan Network. The clinics will be open Monday through Friday 7:30
AM until 8:00 PM, Saturday 9:00 AM until 6:00 PM, and Sunday 1:00 PM until 6:00 PM. If
these hours change substantially, PNS will notify the City. Plan Members may obtain services on
a walk-in basis.
2.2 Services. PNS shall use its best efforts to provide safe, high-quality, efficient healthcare to Plan
Members.
2.2.1 Primary and Acute Medical Services. Pian Members may obtain medical care for
primary and acute health care issues at any of the three clinics. Primary and acute medical
services include, but are not limited to, the services listed in Paragraph 2.1 above. Immunizations
are available only at the West Wind location.
2.2.2 Health Risk Assessment. The Plan Member may obtain a. Health Risk Assessment
(HRA) at any of the three clinics by appointment only. The Plan Member will complete a
detailed HRA questionnaire and return it to the clinic. The clinic will obtain lab work. The lab
results and questionnaire information will be entered into an HRA software program that assists
the health care provider in developing a final assessment. The Plan Member will return to the
clinic for a consultation with the health care provider. The provider will recommend health and
lifestyle actions for the Plan Member based on the HRA. The provider will make appropriate
educational materials available to the Plan Member.
2.2.3 Reporting. PNS will provide to the City, no later than the 15 1h day of the month
immediately following the end of each month of the calendar year, a written report with respect to the
provision of the medical services during the immediately preceding month. The written report shall be in
a form reasonably satisfactory to the City and shall specifically indicate (a) the number of covered Plan
Members seen with diagnosis codes, (b) the number of Health Risk Assessments conducted, and (c)
savings report in a farm to be agreed upon by PNS and the City.
2.3 Medical Staffing. The Living Well Express Care clinics will be staffed with nurse practitioners
and physician assistants under the supervision and oversight of an off-site physician. A supervising
physician will always be available by phone for consultation with the provider. The West Wind clinic
will be staffed with physicians, nurse practitioners, physician assistants, laboratory technicians, radiology
technicians, and other ancillary personnel. All personnel will be appropriately qualified, licensed and
credentialed to provide medical services in the State of Texas.
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2.4 Operational Issues. PNS and the City designate the following contact persons for operational
issues and coordination of services, as well as for any notices required to be delivered hereunder:
PNS: Joel Hohenberger
Director, Corporate Operations
5219 City Bank Parkway, Suite 135
Lubbock, TX 79407
(806)722-7360
jhohenberger@teamume.com
City: Lcisa Hutcheson
Director of Risk Management
1625 1P Street
Lubbock, TX 79408
(806)775-2277
lhutcheson@mylubbock.us
With copy to:
City Attorney
City of Lubbock
1625 13" Street
Lubbock, Texas 79401
A party will notify the other party promptly of any change to the contact information
2.5 City Health Plan. PNS will cooperate with the City to work within the City's health benefit
structure and assure proper services and referrals within the provider network and available benefits. This
provision shall not restrict a healthcare provider from discussing all health care options with a patient.
The parties will cooperate to promote the use of the clinics to Plan Members.
2.6 Plan Member Identification. The City will provide its Plan Members with identification cards
that show the person's status as a Plan Member,
2.7 Patient Information. All medical records and patient information maintained by the medical
clinic shall be the property of PNS. PNS shall protect the confidentiality of patient information in
compliance with all state and federal laws. PNS shall not disclose patient information to the City without
the Plan Member's written authorization unless disclosure is permitted by law. If PNS ceases operation
of a medical clinic, PNS will transfer medical records and patient information to a successor medical
provider in accordance with applicable laws.
2.8 Insurance. PNS shall maintain professional liability insurance for itself and its medical
providers throughout the term of this Agreement, in the minimum annual coverage amounts and type
acceptable to the City. In the alternative, if PNS self -insures as defined under the Texas Insurance Code,
PNS shall provide to the City all state filings indicating solvency of any self-insured plan and any other
proof of solvency as may be required by the City. PNS shall maintain general liability insurance with a
combined single limit of a minimum of $1,000,000 each occurrence and in the aggregate. PNS shall
maintain workers compensation insurance for its employees and shall provide a waiver of subrogation in
favor of the City.
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2.9 Indemnity. PNS SHALL PROTECT, DEFEND, INDEMNIFY, AND HOLD HARMLESS,
TO THE FULLEST EXTENT PERMITTED BY LAW, THE CITY AND CITY'S OFFICERS,
EMPLOYEES, ELECTED OFFICIALS, AND/OR AGENTS FROM AND AGAINST ANY AND
ALL LOSSES, DAMAGES, CLAIMS OR LIABILITIES, OF ANY KIND OR NATURE, WHICH
ARISE DIRECTLY OR INDIRECTLY FROM, OR ARE RELATED TO, IN ANY WAY,
MANNER OR FORM, THE ACTIVITIES OF PNS CONTEMPLATED HEREUNDER, OR THE
OMISSION OF THE ACTIVITIES OF PNS CONTEMPLATED HEREUNDER. PNS FURTHER
COVENANTS AND AGREES TO DEFEND ANY SUITS OR ADMINISTRATIVE
PROCEEDINGS BROUGHT AGAINST THE CITY AND/OR THE CITY'S OFFICERS,
EMPLOYEES, ELECTED OFFICIALS, AND/OR AGENTS ON ACCOUNT OF ANY SUCH
CLAIM, AND, WITHOUT LIMITING THE INDEMNITY PROVIDED HEREIN, TO PAY OR
DISCHARGE THE FULL AMOUNT OR OBLIGATION OF ANY SUCH CLAIM INCURRED
BY, ACCRUING TO, OR IMPOSED ON THE CITY, OR THE CITY'S OFFICERS,
EMPLOYEES, ELECTED OFFICIALS, AND/OR AGENTS, AS APPLICABLE, RESULTING
FROM ANY SUCH SUITS, CLAIMS, AND/OR ADMINISTRATIVE PROCEEDINGS OR ANY
MATTERS RESULTING FROM THE SET'T'LEMENT OR RESOLUTION OF SAID SUITS,
CLAIMS, AND/OR ADMINISTRATIVE PROCEEDINGS. PNS DOES NOT AGREE TO
PROTECT, DEFEND, INDEMNIFY, AND HOLD HARMLESS THE CITY AND CITY'S
OFFICER EMPLOYEES ELECTED OFFICIALS AND/OR AGENTS FROM AND AGAINST
CLAIMS AND LIABILITIES ARISING FROM THE CITY'S DUTIES, ACTS, OR OMISSIONS
REGARDING ACTIVITIES UNDER THIS AGREEMENT.
THE INDEMNI'T'Y AND RELEASE PROVIDED HEREIN SHALL SURVIVE THE
TERMINATION OR VOIDANCE OF THIS AGREEMENT.
ARTICLE 3: COMPENSATION
3.1 Fees. The City will pay PNS the following amounts, payable within 30 days of the City's receipt
of a monthly invoice from PNS:
Primary/Acute Medical Services -- $39,435 each month for up to 600 Plan Member visits per
month PLUS $70 for each Plan Member visit over 600 per month. Member Visits for the purpose
of counting against the base 600 visits shall include only those visits where the Member is seen
and treated by the health care professional. Member Visits shall not include paperwork drop-offs
by Members, telephone consultations, if any, setting of appointments by Members, or other
contacts wherein direct, in-person professional medical services are not rendered.
• The health care provider will administer allergy injections if the Plan Member provides
the allergy serum. The administration of the injection is included in the visit fee.
• All lab work that is available and ordered through the scope of primary care services at
the location is included in the visit fee. Lab tests ordered from an outside location are not
included in the visit fee and will be an additional fee or billed by the outside provider.
• Lab work does not include drug screens.
• All radiology tests ordered through the scope of primary care services at the clinic
locations and that can be performed and read by a physician at West Wind are included in
the visit fee. If a Plan Member is referred to West Wind for radiology services from a
Living Well Express Care clinic, the Plan Member will be considered to have two visits.
Radiology tests performed at other locations and films referred for reading to a
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radiologist are not covered. Examples of radiology services not provided at West Wind
are MRI scans, CT scans, bone density scans, and mammograms.
Health Risk Assessment -- $97.00 per HRA
Immunizations (available at West Wind only) --
• HEP B -- $75 per injection (requires 3 injections)
• Zostavax (shingles vaccine) -- $250 per injection
• HPV — $165 per injection
• Flu Vaccine -- $20 per injection
• Pneumonia Vaccine -- $40 per injection
If PNS provides services to Plan Members and the services are not covered by this Agreement,
PNS will bill the Health Plan, and the Plan Member will be responsible for applicable
copayments.
3.2 Nonappropriation. All funds for payment by the City under this Contract are subject to the
availability of an annual appropriation for this purpose by the City. In the event of non -appropriation of
funds by the City Council of the City of Lubbock, for the services provided under this Agreement, the
City may terminate the Agreement, without termination charge or other liability, on the last day of the
then -current fiscal year or when the appropriation made for the then -current year for the services is spent,
whichever event occurs first. If at any time funds are not appropriated for the continuance of this
Agreement, cancellation shall be accepted by PNS on thirty (30) days prior written notice.
ARTICLE 4: RELATIONSHIP OF THE PARTIES
INDEPENDENT CONTRACTOR STATUS: Nothing in this agreement is intended nor shall be
construed to create an employer/employee relationship between the contracting parties. The sole interest
and responsibility of the parties is to ensure that the services covered by this agreement shall be
performed and rendered in a competent, efficient and satisfactory manner.
ARTICLE 5 GENERAL PROVISIONS
5.1 Non -Discrimination. Each party shall provide services without discrimination on the basis of
race, color, national origin, ethnicity, age, sex, disability, or political or religious beliefs. PNS shall not
discriminate in hiring, promotion, treatment, or other terms and conditions of employment based on race,
sex, national origin, ethnicity, age, disability, or political or religious beliefs, or in any way violative of
Title VI1 of 1964 Civil Rights Act and amendments, except as permitted by said laws.
5.2 Waiver. The waiver by either party of a breach or violation of any provision of this Agreement
shall not operate as or be construed to be a waiver of any subsequent breach of any provision of the
Agreement.
5.3 Severability. If any term or provision of this agreement is held to be invalid for any reason, the
invalidity of that section shall not affect the validity of any other section of this agreement provided that
any invalid provisions are not material to the overall purpose and operation of this agreement. The
remaining provisions of this agreement shall remain in full force and shall in no way be affected,
impaired, or invalidated.
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5.4 Assignment. Neither party shall have the right to assign or transfer their rights to any third
parties under this agreement.
5.5 Governing Law And Venue. This agreement shall be governed by and construed and enforced
in accordance with the taws of the State of Texas and any applicable Federal Law or Statute. Venue shall
be in Lubbock, Lubbock County, Texas for all purposes.
5.6 Amendment. This agreement may be amended in writing to include any provisions that are
agreed to by the contracting parties.
5.7 Exclusion. Each party certifies that neither it nor its employees or contractors is presently
debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in any government program by any federal department or agency or by the State of Texas.
EACH PARTY WILL NOTIFY PROMPTLY THE OTHER PARTY if this status changes and the name
of any person who provides services under this Agreement or is an agent or managing employee who is
convicted of a criminal offense related to the person's involvement in a government program or is
suspended, debarred, or excluded from participation in a government program.
5.8 Notice. All notices required or permitted to be given under this Agreement shall be sufficient if
furnished in writing, sent by certified mail, return receipt requested to the party's last known principal
office.
5.9 Authority. The undersigned to this Agreement hereby represent and warrant their respective
authority to execute this Agreement.
Date: January 24, 2008 Date:
CITY OF LUBBOCK
Aff If
By,
DAVID A. MILLER, Mayor
ATTEST:
ecca G a, City Secretary
APPROV AS TO CONTENT:
Leisa Hutcheson, Director of Risk Management
UM PICIAN NETWORK SERVICES
By:
Paul A. Acreman
Chief Executive Officer
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