HomeMy WebLinkAboutItem 06.gDate: May 3, 2010 Item No.
U0
Agreement with CSMR WorkSystems (Northfield Hospital) to provide
Occupational Health Services to Lakeville Fire Department
Proposed Action
Staff recommends adoption of the following motion: Move to enter into an agreement
with CSMR WorkSystems to provide occupational health services to the City of
Lakeville Fire Department.
Passage of this motion will result in a continuance of occupational health services for
fire department members by CSMR.
Overview
Lakeville Fire has used CMSR as its provider for firefighter physicals and OSHA —
mandated health evaluations for the past 3 years. These services are provided locally
from the Family Health Clinic in Lakeville, which is affiliated with the Northfield Hospital.
Early in 2010, CSMR requested this relationship be formalized in an agreement. The
agreement accurately reflects the service and cost that CSMR has been providing.
Minor edits to the agreement were made after review by our City Attorney.
Staff recommends approval of this agreement, which will provide for continued
occupational health services for the Fire Department.
Primary Issues to Consider
• What is the impact if the City does not use CSMR for occupational health
services?
• How can this agreement be terminated?
• What is the budget impact of entering into this agreement?
Supporting Information
Co y of Agreement with CSMR WorkSystems.
Scott Nelson, Fire Chief
Financial Impact: _Budgeted: Y/N X Yes_ Source: 2010 Operating 1300-6220
Related Documents (CIP, ERP, etc.):
Notes:
Council Report CSMR Agreement
Page 2
Primary Issues to Consider
• What is the impact if the City does not enter into this agreement with CSMR
to provide occupational health services to fire department members?
The City may need to find another provider for this service, however; it is
likely that an agreement would be requested with the other provider as this is
a normal business practice. This agreement has been reviewed and CSMR
has made the changes that were requested by the Lakeville City Attorney.
• How can this agreement be terminated?
This agreement can be terminated with 30 days written notice or at any time
by mutual consent.
• What is the budget impact of entering into this agreement?
There is no budget impact for entering into this agreement. Costs are
currently reflected in the 2010 budget. This agreement formalizes current
practices.
Nortl�� Hospial
CSMR WorkSystems AGREEMENT
With
CITY OF LAKEVILLE FIRE DEPARTMENT
LAKEVILLE MN
This contract is entered into on January 14, 2010 (Effective Date) by and between
CSMR WorkSystems, a service of Northfield Hospital (hereinafter referred to as
Provider) and City of Lakeville Fire Department, Lakeville, Minnesota (hereinafter
referred to as Employer).
RECITATIONS
WHEREAS, the parties desire to enter into agreement defining their rights, duties,
and liabilities; and
WHEREAS, the Provider will provide occupational health services to the Employer
as set forth below; and
WHEREAS, the Employer will reimburse the Provider for services rendered, and
NOW, THEREFORE, Employer and Provider agree as follows:
A. STATUS OF PARTIES
The Provider and Employer agree that they are unrelated by ownership,
control, affiliation, or employment status, within the meaning of Minn. Stat.
256.433, subd. 3(b).
B. SUPPORTIVE PERSONNEL
The Provider has exclusive control of Provider's employees and the right to
hire and discharge any Provider employee.
C. DISCRIMINATION
The Provider and Employer will comply with all laws regarding discrimination
on the basis of race, color, creed, religion, national origin, sex, marital status,
status with regard to public assistance, disability or age.
D. PROVIDER OBLIGATIONS
(1) Provider agrees to provide occupational health services as indicated in
Section J.
(2) Service will be provided upon request of Employer on a mutually
agreed upon schedule/timeline.
(3) Provider assumes professional and administrative responsibility for the
overall conduct of the sports medicine and rehabilitation agency
pursuant to 42 CFR 405.1716, and for compliance with applicable laws
and regulations. Obligations extend to all requested occupational
health services.
E. EMPLOYER OBLIGATIONS
(1) Reimburse Provider within 30 days of receipt of an itemized monthly
billing statement from Provider.
(2) Provide current billing contact information to Provider within 5 days of
any billing contact changes.
(3) Provide space for therapy or other health-related activities that offers
privacy, as needed.
(4) Arrange for scheduled and authorized access by Provider to
production, service, and/or education area(s) for the purpose of
functional job analysis, education, early intervention, health-related
testing and/or ergonomic assessment, as needed.
(5) Ensure adherence to appointment times by employees and
prospective employees, as required in post -offer screening, physical
examination, drug test collection, etc.
(6) Arrange a team meeting with Northfield Hospital representative(s) to
discuss the progress of occupational health services rendered by
Provider and to ensure that new Employer representatives are kept
informed of all aspects of the occupational health services.
F. EQUIPMENT AND SUPPLIES
Provider will provide and maintain the necessary equipment and supplies for
the provision of occupational health services. Employer will provide onsite
space for hearing tests and early intervention services if Employer requires
onsite services.
G. INDEMNITY
Subject to the limitations, immunities and defenses in Minnesota Statutes
Chapter 466, which are incorporated herein, each party agrees to indemnify,
defend, and hold harmless the other party, its officers, employees, and agents
against all claims, liability, loss, damage, cost, or expenses of any kind
including, but not limited to reasonable attorney's fees arising out of or in
connection with acts or omission of the first party, its employees or agent;
which are in any way related to service provided under this Agreement.
H. RECORDS AND REPORTS
Provider agrees to make all records of employees, prospective employees,
and interns within the Employer's work force, to whom the Provider has
rendered service, available to a designated Employer representative for
inspection, so long as the Provider has obtained an Authorization for Release
of Information form signed by the employee, prospective employee, or intern
to whom the information pertains.
INSURANCE
Provider will at all times during the term of this Agreement have and keep in
force a liability insurance policy with coverage for bodily injury in the amount
of one million dollars ($1,000,000) for each claim and three million dollars
($3,000,000) for each aggregate claim. Provider will provide evidence of
such insurance upon Employer's written request.
J. BILLING
1. Provider will bill and collect on a quarter-hour and/or per recipient
basis, including travel expenses, if applicable, for all services rendered
to the Employer and its employees under this Agreement.
2. Standard fee(s) for service(s) are detailed (below). For some service
items and/or combined services, the fee may be negotiated. Each
occupational health service chosen by the Employer will carry a
corresponding quarter-hour, half-hour and/or per recipient fee.
Service(s):
Fire -Fighter Examination:
Medical History Review- Repeat
$
300.00/ea.
Medical History Review- New
$
320.00/ea.
Fit -For -Work Exam
$
.00
OSHA Respirator Medical Questionnaire MD Review
$
.00
Vision Screen
$
.00
Audiometric Test
$
.00
Body Mass Index (BMI)
$
.00
Pulmonary Function Test (Spirometry)
$
.00
Resting Electrocardiogram
$
.00
Urine Drug Test Collection
$
.00
Dipstick Urinalysis
$
.00
Blood Analysis
$
.00
Hemoglobin
$
.00
Lipid Panel
$
.00
Iron Total
$
.00
Uric Acid
$
.00
Liver Panel
$
.00
Comp Panel
$
.00
Mantoux
$
52.00/ea.
Hepatitis B Titers
$
44.00/ea.
Tdap
$
95.00/ea.
Hepatitis B Series
$
372.00/ea.
Provider shall submit each itemized bill for the above services to:
Company name:
LAKEVILLE FIRE DEPARTMENT
C/O CITY OF LAKEVILLE
20190 HOLYOKE AVE
LAKEVILLE MN 55044
ATTN: JULIE KAUFMAN-BOOM
(3) If Provider has not received payment within 60 days of sending the bill
to Employer, Provider may refuse to schedule or provide any further
services until payment on all outstanding bills is received in full.
K. TERM AND TERMINATION
1. Service under this Agreement will begin on the Effective Date.
2. Either the Employer or Provider may cancel this Agreement with 30
days written notice to the other party or at any time by mutual consent.
L. MISCELLANEOUS
1. The service performed by either party to this Agreement shall not be
assigned or transferred without the prior written approval of the other
party.
2. This Agreement shall be binding upon and enforceable by the parties
and their respective executors, administrators, heirs, devises, legatees,
successors, and assigns.
3. All notices to be given under the provisions of this Agreement shall be
given to the following addresses:
If to Employer: LAKEVILLE FIRE DEPARTMENT
C/O CITY OF LAKEVILLE
20190 HOLYOKE AVE
LAKEVILLE MN 55044
ATTN: JULIE KAUFMAN-BOOM
If to Provider: CSMR WORKSYSTEMS
ATTN: DAVID OLEJNICZAK
1381 PROFESSIONAL DRIVE
NORTHFIELD, MN 55057
4. This Agreement contains all of the agreements and conditions made
between the parties and their respective successors in interest. This
Agreement may be amended in writing upon the parties' mutual
consent.
5. This Agreement, together with each and all of the terms, provisions,
conditions, and stipulations thereof shall be construed, interpreted and
enforced pursuant to and in accordance with the laws of the State of
Minnesota.
IN WITNESS WHEREOF, the parties have executed this Agreement as of the day
and year first above written.
Northfield Hospital
Employer
Title Title
Date: Date:
4-2009