Indiana University Health/Human Res/468,751/Amendment To Master Services Agreement for Designated Health Care ServicesDocuSign Envelope ID: 22C68CBF-OC29-41EB-6908-08F491C4172D
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Indiana :University Health, ��e1
JADr
Worlcplace,-Ser.vices:
AMENDMENT TO
CITY OF CARMEL, INDIANA
MASTER SERVICES AGREEMENT FOR DESIGNATED HEALTH CARE SERVICES
This Amendment, effective as of January 25, 2016 amends the City of Carmel, Indiana Master
Services Agreement for Designated Health Care Services dated February 1, 2013, (the "Agreement"), by
and between City of Carmel, Indiana (hereinafter "CITY") and IU HEALTH WORKPLACE
SERVICES (hereinafter "IU HEALTH").
WHEREAS, the parties wish to change the staffing model and work hours for services
performed by the Physicians/Nurse Practitioners (MD/NP), registered nurse (RN) and medical assistant(s)
(MA), and Health Coach (HC).
NOW, THEREFORE, the parties agree as follows:
Attachment One attached hereto and incorporated herein shall become effective on the Effective date
written above and will replace:
Section 1. Service Model and Section 4. Cost of Services/Billing of the Service Line Attachment #1
Health and Wellness Center Clinic Services
IN WITNESS WHEREOF, the parties hereto have caused their duly authorized representatives
to execute this First Amendment to City of Carmel, Indiana Master Services Agreement for Designated
Health Care Services as of the date first above written, regardless of the actual date of the signature.
CITY OF CARMEL, INDIANA
M
Name:
Title:
Date:
IU HEALTH WORKPLACE SERVICES
Docuftned by,
E
�
By:8B38A7OABCDD4FF...
Name: Clark Day
vice President Business Solutions
Title:
Date:
2/19/2016 1 12:58 PM PT
Approved and Adopted this � day of MU C , 20_L�.
CITY OF CARMEL, INDIANA
By and through its Board of Public Works and Safety
BY:
1
Ja es Brainard esiding Officer
Date:%G' "
aL4&I
Mary ABine_&berDate: C
Lori S. Watson,Me/
epi
Date: / ��
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Service Line Attachment #1
1. Service Model:
A healthcare clinic for participants in the City of Carmel Employee Health
Benefit Plan, with dedicated medical staff providing primary care, preventive
care, wellness education and related services. Staff will include the following:
• IU Health Physician — Twenty five (25) hours per week
• IU Health Nurse Practitioner— Eight (8) hours per week
• lU Health Medical Assistant —Thirty three (33) hours per week
• IU Health Nurse Manager - Thirty three (33) hours per week
• IU Health Health Coach — Twelve (12) hours per week
4. Cost of Services/Billing
Services shall be billed to City in accordance with the following fee schedule. Services shall be
invoiced monthlv with pavment due within thirtv (30) days of receipt of billed invoice.
Hourly rates for staff include the following:
• Staff recruitment and retention
• Staff education, insurance and oversight
• Support services for staff, including payroll, information technology, legal and human
resources
• Computer hardware
• Online scheduling system
• Electronic medical recordkeeping system
• Telephones and telephone lines
• Office equipment, including printer, scanner, and facsimile machine
• Clinic communication and marketing program
Rate per hour
Hours per week
Annual estimated total
Physician
$ 175.00
25
$227,500
Nurse Practitioner
$ 112.68
8
$ 46,875
Registered Nurse
Manager
$ 62.00
33
$106,392
Medical Assistant
$ 28.00
33
$ 48,048
Health Coach
$ 64.00
12
$ 39,936
Total Annual Estimated
Staffing and Management
$468,751
Hourly rates for staff include the following:
• Staff recruitment and retention
• Staff education, insurance and oversight
• Support services for staff, including payroll, information technology, legal and human
resources
• Computer hardware
• Online scheduling system
• Electronic medical recordkeeping system
• Telephones and telephone lines
• Office equipment, including printer, scanner, and facsimile machine
• Clinic communication and marketing program