IU Health/HR/Employee Health CLinic/458,550 CITY OF CARMEL, INDIANA
MASTER SERVICES AGREEMENT "opt
FOR DESIGNATED HEALTH CARE SERVICES A °
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This Master Services Agreement For Designated Health Care Services ("Master
Services Agreement"), effective February 1, 2013 ("Effective Date"), is hereby entered
into by and between the City of Carmel, Indiana, a municipality, ("City"), and Indiana
University Health, Inc., an Indiana nonprofit corporation ("IU Health").
Whereas, IU Health and its affiliated entities ("IUH Affiliates") provide a wide
range of health care services designed to maintain and improve the health and fitness
of the citizens of Indiana and IU Health desires to enter into agreements with local
municipalities to provide services to employees and designated dependents of the
employees of those municipalities;
Whereas, City desires to enter into an agreement with IU Health for the
provision of employee health and wellness center services;
NOW, THEREFORE, in consideration of the mutual promises contained
herein, the mutual covenants set forth below, and other good and valuable
consideration, the receipt and sufficiency of which are hereby acknowledged, IU Health
and City agree as follows:
1. Services. IU Health agrees to provide either directly or through IUH
Affiliates the health care services outlined in the Service Line Attachments (each an
"SLA"), executed by the parties, attached hereto and incorporated herein. Each SLA
describes the services to be provided by IU Health and/or the IUH Affiliate that will
provide the service, the procedures to be followed by the parties and the consideration
and payment terms applicable to each SLA. The initial SLAs to this Agreement is as
follows:
1.1 Service Line Attachment #1 - Health and Wellness Center Clinic
Services
1.2 Service Line Attachment #2 - Employee Assistance Program Services
(EAP)
1.3 Service Line Attachment #3 - Drug and Alcohol Testing Services
Additional SLAs may be entered into by the parties and become SLAs to this Master
Services Agreement by written agreement of the parties. SLAs may also be amended
or terminated by written agreement of the parties at any time.
2. Term. The initial term of this Master Services Agreement shall be from
and including February 1, 2013 to and including December 31, 2017 ("Initial Term").
The term of any particular SLA shall coincide with the term of the Master Services
Agreement. The termination of this Master Services Agreement shall automatically and
immediately terminate all SLAs incorporated herein. At the end of the Initial Term,
this Master Services Agreement shall, unless otherwise terminated in accordance with
the terms hereof, automatically renew for a five (5) year term ("Renewal Term").
3. Termination for Breach. Either party hereto may terminate this Master
Services Agreement if all of the following occur: i) the other party is in breach of one
or more of the terms of this Master Services Agreement, ii) the breaching party has
been provided written notice of the breach(es) and iii) the breaching party has failed to
fully remedy the breach(es) within thirty (30) days of receipt of notice of same. In the
event of a breach of this Master Services Agreement and/or any SLA incorporated
herein, and the failure to timely and fully cure the same, the non-breaching party
shall be entitled to terminate this Master Services Agreement and to exercise any and
all other rights and remedies available to it in law and/or in equity.
4. Termination for Convenience. Either party may terminate this Master
Services Agreement without cause by providing the other party with one hundred
twenty (120) days written notice. In the event City terminates this contract for
convenience prior to the end of the Initial Term, City shall assume the costs for the
lease and leasehold improvements of the initial dedicated clinic space (the "Clinic
Premises") contemplated hereunder.
5. Privacy and Protection of Confidential Information. Each party shall
comply with all applicable privacy laws involving the privacy and confidentiality of
medical records. Additionally each party shall maintain as confidential all proprietary
business information designated as such by the other party, in conformance with and
subject to Indiana and other applicable law.
6. Assignment. Except as otherwise provided herein, neither party hereto
may transfer or assign this Master Services Agreement without the prior written
consent of the other party; provided, however that IU Health may perform duties set
forth in the Service Line Attachments by IU Health Affiliates.
7. Business Relationship. IU Health, IUH Affiliates and the City are
independent contractors and nothing in this Master Services Agreement shall be
deemed to create an employer-employee relationship, principal-agent relationship,
partnership or joint venture.
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8. The Clinic Premises. At any time during the term of this Master Services
Agreement after the initial dedicated clinic space improvements at 1402 Chase Court,
Carmel, Indiana 46032 (the "Clinic Premises") have been completed to the City's
reasonable satisfaction, IU Health may substitute the entire Clinic Premises for other
premises in the Building or other buildings in the portfolio of IU Health's Carmel,
Indiana located real estate holdings (the "New Premises"), in which event the New
Premises shall be deemed to be the Clinic Premises for all purposes under this Master
Services Agreement; provided, that the New Premises shall be substantially similar to
the Clinic Premises in area, location, and configuration, and equipment; however
nothing in this Master Services Agreement shall require IU Health to provide a
building comprising substantially the same facility, and IU Health and City
acknowledge and agree the building is unique and any New Premises will likely not be
located in a similar building with similar activities therein. If the City is then being
served out of the Clinic Premises at time of substitution, IU Health shall pay the actual
and reasonable expenses of physically moving the City Clinic, its property and
equipment to the New Premises; IU Health shall give the City not less than sixty (60)
days prior written notice of such substitution; and IU Health, at its own expense, shall
improve the New Premises substantially similar to those in the Premises at the time of
such substitution, or if not then improved, IU Health, at its own expense shall improve
the New Premises substantially similar to that of the Clinic Premises in accordance
with plans and specifications to be approved by the City, which approval shall not be
unreasonably withheld or delayed. If such substitution takes place, IU Health shall
still be responsible for the costs of the lease and leasehold improvements pursuant to
the terms of the lease and other documents entered into by IU Health regarding same.
9. No Endorsement. IU Health acknowledges that, by entering into this
Master Services Agreement, the City does not endorse IU Health's or its Affiliates'
products, services, or business activities. IU Health acknowledges that it or its
Affiliates may not use the City's trade and service marks or the existence of the Master
Services Agreement except as otherwise provided herein or in the SLAs attached
hereto.
10. Insurance Coverage. Unless a party certifies that it is self-insured and
provides reasonable assurances as to its ability to provide such self-insurance, each
party hereto shall maintain comprehensive general liability insurance during the term
of this Master Services Agreement. IU Health and any IU Health Affiliates providing
service hereunder shall maintain professional medical malpractice coverage, and shall
also maintain professional medical malpractice coverage for their respective employed
or contracted health care providers, with those limits necessary to qualify as a health
care provider under the Indiana Medical Malpractice Act. Each party will provide a
certificate of insurance confirming such insurance coverage upon request of the other
party hereto.
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11. Indemnification. Each party hereto agrees to indemnify and hold the
other party, its officers, officials, agents, employees, assignees, legal counsel, and IU
Health Affiliates harmless from any liability, loss or damage the same may suffer as a
result of claims, demands, costs or judgments, including reasonable legal fees arising
out of the acts or omissions of the indemnifying party and/or the indemnifying party's
agents, employees, affiliates, contractors, or subcontractors, in the performance of
their respective duties and obligations under this Master Services Agreement.
12. Applicable Law. This Master Services Agreement shall be interpreted,
construed, and enforced pursuant to, and in accordance with Indiana law. Further,
the parties consent to venue in Hamilton County, Indiana.
13. Entire Agreement. This Master Services Agreement constitutes the entire
agreement between IU Health and the City and supersedes any prior negotiations,
agreements or representations, whether oral or written with IU Health or its Affiliates
and/or sub-contractors. To the extent any term or condition contained in any exhibit,
SLA, or other document attached to this Master Services Agreement conflicts with any
term or condition contained in this Master Services Agreement, the term or condition
contained in this Master Services Agreement shall govern and prevail.
14. Amendments. This Master Services Agreement may be amended or
modified only by a written document signed by both IU Health and the City.
15. Waivers. The waiver by either party of a breach or other violation of any
provision of this Master Services Agreement shall not operate as, or be construed to
be, a waiver of any subsequent breach of the same or other provision of this Master
Services Agreement.
16. Duty to Cure. If any provision of this Master Services Agreement, or the
application of such provision to any person or circumstances, is deemed invalid, then
the parties shall negotiate an amended agreement to cure such invalidity. In the event
an amended agreement is not reached, the remainder of this Master Services
Agreement, or the application of such provision to person or circumstances other than
those as to which it is held invalid, shall not be affected thereby.
17. Time Is Of Essence. Time is of the essence of this Master Services
Agreement
18. Headings. All heading and sections of this Agreement are inserted for
convenience only and do not form a part of this Agreement nor limit, expand or
otherwise alter the meaning of any provision hereof.
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19. Notice Provisions. Notices required or permitted herein shall be given the
respective parties by registered or certified mail or hand delivery at the following
addresses unless the parties hereto designate a new address by written notice:
To City:
James Brainard Copies to: Barbara Lamb
Mayor Director of Human Resources
1 Civic Square, City Hall 1 Civic Square, City Hall
Carmel, Indiana 46032 Carmel, Indiana 46032
and
Douglas Haney
Carmel City Attorney
1 Civic Square, City Hall
Carmel, Indiana 46032
To IU Health:
Clark Day
Vice President Business Solutions
Indiana University Health, Inc.
4850 West Century Plaza Road, Suite 130
Indianapolis, IN 46254
20. Disclosure and Warnings. Upon request, IU Health shall promptly
furnish to the City, in such form and detail as the City may reasonably direct, a list of
all chemicals, drugs, and similar substances used in or during the provision of the
goods and services provided hereunder, and shall ensure that the City is provided with
sufficient written warning and notice (including appropriate labels on containers and
packing) of any hazardous materials utilized in or on the Clinic Premises.
21. Liens. IU Health shall not cause or permit the filing of any lien on any of
the City's property. In the event any such lien is filed and IU Health fails to remove it
within ten (10) days after the filing thereof by payment or bonding, the City shall have
the right to pay such lien or obtain such bond at IU Health's cost and expense.
22. Advice of Counsel. The parties hereto warrant that they have read this
Master Services Agreement and understand it, have had the opportunity to obtain
legal advice and assistance of counsel throughout the negotiation of the same, and
enter into this Master Services Agreement freely, voluntarily, and without any duress,
coercion, or undue influence.
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23. Representations and Warranties. The parties hereto represent and
warrant that they are authorized to enter into this Master Services Agreement and that
the persons executing the same have the authority to bind the party which they
represent.
24. Binding Effect. The parties, and their respective officers, officials, agents,
partners, successors and assigns are bound to the other with respect to all of the
covenants, terms, warranties and obligations set forth in this Master Services
Agreement.
25. E-Verify. Pursuant to I.C. § 22-5-1.7 et seq., IU Health shall enroll in
and verify the work eligibility status of all of its newly-hired employees using the E-
Verify program, and shall, prior to the Effective Date of this Master Services
Agreement, provide the City with an affidavit and supporting documentation in a form
reasonably acceptable to the City affirming that IU Health is enrolled in and is
participating in the E-verify program and does not knowingly employ any
unauthorized aliens. IU Health shall also require all Affiliates and subcontractors to
certify the same by affidavit, maintain a copy of all such certifications for the duration
of this Master Services Agreement and for three (3) years thereafter, and, upon
request, provide the City with a copy of the same. If IU Health, or any Affiliate or
subcontractor of IU Health, knowingly employs or contracts with an unauthorized
alien, or retains an employee or other person that IU Health or any Affiliate or
subcontractor of IU Health subsequently learns is an unauthorized alien, they shall
terminate the employment of or contract with such unauthorized alien within thirty
(30) days of the date on which such knowledge was obtained. If IU Health or any
Affiliate or subcontractor of IU Health fails to do so, the City shall have the right to
immediately terminate this Master Services Agreement without penalty.
26. No Third Party Beneficiaries. This Master Services Agreement gives
no rights or benefits to anyone other than the City and IU Health.
27. Nondiscrimination. IU Health represents and warrants that it and all of
its officers, employees, agents, Affiliates, and subcontractors shall comply with all laws
of the United States, the State of Indiana and the City prohibiting discrimination
against any employee, applicant for employment or other person in the provision of
any goods or services provided under or pursuant to this Master Services Agreement
with respect to their hire, tenure, terms, conditions and privileges of employment and
any other matter related to their employment or subcontracting, because of race,
religion, color, sex, handicap, national origin, ancestry, age, disabled veteran status
and/or Vietnam era veteran status.
28. Government Compliance. IU Health agrees that it and its Affiliates and
subcontractors will comply with all federal, state and local laws, executive orders,
rules, regulations and codes which may be applicable to the performance of its
obligations under this Master Services Agreement, and all relevant provisions thereof
are incorporated herein by this reference. IU Health agrees to indemnify and hold
harmless the City from any loss, damage and/or liability resulting from any such
violation of such laws, orders, rules, regulations and codes. This indemnification
obligation shall survive the termination of this Master Services Agreement.
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29. Iran Certification. Pursuant to I.C. § 5-22-16.5, IU Health warrants
that neither it nor its Affiliates nor subcontractors engage in investment activities
within the Country of Iran.
30. Recitals. The recitals to this Master Services Agreement are
incorporated herein by this reference.
IN WITNESS WHEREOF, the parties hereto have caused this Master Services
Agreement to be executed by their duly authorized representatives as of the Effective
Date.
CITY OF CARMEL, INDIANA ("City")
By and through its Board of Public Works and Safety
By: James Brainard, Mayor
atae @/-GCG?tii o- Date: // / 13
/7
iiBy: Lori Watse , Board Member
d � Date: 3A6 // 3
By: M An urke, Board ember
By:
Date: /j
Attest: Diana Cordray, IAMC, Clerk-Treasurer
{t fi 1 �' ' Date: 3 3
Attesting Lori Watson and Mary Ann Burke's
signatures only. Did not witness Mayor signature.
INDIANA UNIVERSITY HEALTH, INC. ("IU Health")
By: Clark Day, Vice President / 2
IU Health Business So 1'Ations Date: 17�` 7
(/ E
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Service Line Attachment#1
Health and Wellness Center Clinic Services
Indiana University Health ("IU Health"), through its Affiliate, IU Health Workplace Services,
agrees to provide City of Carmel, Indiana ("City") the following Health and Wellness Center
Clinic Services at IU Health Sports Performance Center, 1402 Chase Court, Carmel, Indiana
46032 (the "Clinic Premises").
1. Service Model
A healthcare clinic for participants in the City of Carmel Employee Health Benefit Plan,
with a dedicated medical staff providing primary care, preventive care, wellness education
and related services.
Staff will include, at minimum:
• Family Practice Primary Care Physician
• Nurse Manager
• Medical Assistant
2. Services of IU Health
Primary Care
• Physical exams and routine health screenings
• Follow-up care to monitor chronic conditions or to assess progress toward meeting
health goals
• Triage and treatment of illness and injury (episodic care)
• Primary prevention including physician ordered health screenings, wellness education,
and immunizations, as such services are deemed cost-effective
• Diagnostic services
• Extended appointments with clinic physician or nurse practitioner, allowing time for
focus on total health solution for each participant
• "Nurse navigator" services to help participants identify healthcare resources that offer
the highest quality and best cost and outcomes, and to assist patients with outside
medical scheduling,billing, or other challenges
• Management of referrals to specialists and facilitation of collaboration on patient care
(see Addendum A for referral policy)
• Referrals to Employee Assistance Program for behavioral health as needed
• Annual flu shots for City employees,retirees, and their family members, whether or not
such individuals are current participants in the City's Employee Health Benefit Plan; IU
Health shall provide such vaccine for up to five hundred (500) flu shots per year at no
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additional cost to the City, and shall bill the City at cost for vaccine used in excess of
five hundred (500) flu shots per year
Immediate Care Access
• Same day visit access by appointment for triage and treatment of minor illnesses and
injuries, with hours established and managed to best meet the needs of participants and
to maximize utilization
Laboratory Services
• As needed by clinic medical staff to diagnose, monitor or treat participants
• As ordered via prescription by outside physicians (primary care or specialists)
Pharmacy Services
• Dispensing of limited generic medications as prescribed by clinic staff
• Maintenance medications may be managed through the clinic, on a case-by-case basis, if
such is deemed cost-effective
• Clinic staff will write prescriptions that may be filled at the pharmacy of the
participant's choice
Wellness, Health Education and Outreach
• Clinic staff consultations with each employee to review annual physical exam and health
screening results and develop an action plan
• Organized wellness classes (smoking cessation, weight management, etc.) in
conjunction with and in support of program activities offered through City wellness
program
• Preventive health activities (blood pressure monitoring, weigh-ins, chronic disease and
lifestyle management presentations, etc.) at various City work sites
• Employee education, including CPR, first aid, blood borne pathogens, ergonomics and
other customized programs
• Facilitation of communication with outside providers as necessary
• FMLA, short and long term disability and regulatory recordkeeping as required in
support of City Human Resources Department
Police and Fire Physicals
• In-service physical examinations (see Addendum B for physical exam requirements)
• Identification of EKG and cardiac stress test costs for departmental billing
• Monthly reports of department members who have completed physical exams
Other Available Services (at City's option)
• Occupational Care
• Enhanced Wellness Program
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3. Responsibilities of City
• Provide list of employees and retirees eligible for clinic services
• Distribute clinic information and marketing materials employees
• Serve as liaison between clinic and City employees
4. Cost of Services/Billing
Services shall be billed to City in accordance with the following fee schedule. Services shall
be invoiced monthly with payment due within thirty (30) days of receipt of billed invoice.
Clinie`Program Staffing and Management Services
Proposed Staffing and Onsite Proposed hours Cost Per Estimated Annual
Management per week (M-F) Hour Charge
Physician 25 $175 $227,500
Nurse Manager 25 $62 $80,600
Medical Assistant 25 $28 $36,400
Total Annual Staffing and Management Charges: $344,500
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
Variable EzpenseItems (charges vary by utilization and assume 570 employees) •`
Laboratory Services $ 1.10 PEPM estimated
Medication Dispensing (in clinic only) $ 7.00 PEPM estimated
Supplies $ 0.90 PEPM estimated
Total Annual Variable Expense (estimated) : $61,560
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se, . .
Lease;pf'�Clinic Premises
Lease per Month $1,800
Use of Second Floor Conference/Classroom Space as needed $0
Use of Locker Rooms and Common Waiting Room $0
Total Annual Lease: $21,600
Build'Out of Clinic Space
Event Date Amount Number Period Rate End Date
1 Loan 2/1/13 130,000.00 1
2 Payment 5/1/13 2,574.16 60 Monthly 7% 4/1/2018
Total Annual Build-out Expense= $2,574.16 per month x 12 months: $30,890
Facility charges include the following:
• Use of dedicated health clinic located at 1402 Chase Court, Carmel, Indiana.
• Clinic space is dedicated exclusively for City use and will be built out to meet City's
program needs.
• Unlimited use of building conference room space as requested and scheduled during
open facility hours of 6 a.m. to 9 p.m. for individual and group use
• Costs for utilities including heating, cooling, water, electrical, internet/cable
• Cleaning and facility maintenance are included at no additional charge to City.
• Free parking in front of and next to the facility
• All participants eligible to utilize the City clinic will be eligible to utilize IU Health
Sports Performance Center equipment, participate in classes and receive personal
training services at a 20% discounted rate.
Total ,
. . . }�,. .. . ,. Annual Budget:
Clinic Staffing and Management $344,500
Variable Expenses (medications, labs, supplies, equipment)* $61,560
Facility Lease $21,600
Facility Build-out/Customization $30,890
Total Annual Cost: $458,550
*For all variable expense items, the PEPM estimate is for budgeting only. Actual expenses
will be tracked and billed monthly as incurred.
5. Confidentiality
IU Health represents and warrants to City that it shall at all times comply with the Health
Insurance Portability and Accountability Act ("HIPAA"), as amended from time to time.
Medical records shall be and remain the property of IU Health Workplace Services. IU
Health Workplace Services maintains electronic medical records on all patients in
accordance with applicable federal and state laws and regulations. Indiana law specifies that
the medical provider owns the medical records. As such, patient medical records are retained
by IU Health. Personal health records are retained and not available to City at any
time. For records related to worker's compensation cases, medical records will be
maintained separately and only information related to the worker's compensation case will be
available to the employer or employer-representative.
6. Principal Contacts
The principal contacts for this Service Line Attachment are:
IU Health Workplace Services City of Carmel, Indiana
Lori McBride, Director Onsite Operations Barbara Lamb
4850 West Century Plaza Road Director Human Resources
Suite 140 One Civic Square
Indianapolis, IN 46254 Carmel, Indiana 46032
Phone: 317-292-4175 Phone: (317) 571-2471
Email: lmcbride@a,iuhealth.org Email: blamb(alcarmel.in.gov
[Remainder of page intentionally left blank]
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IN WITNESS WHEREOF, the parties hereto have executed this Service Line Attachment#1 as
of the date indicated below.
CITY OF CARMEL, INDIANA ("City")
By and through its Board of Public Works and Safety
By: James Brainard, Ma or
, A.._ K-----.41 .—_—.1 Date: l O
By: on Watson, Board Member
Date:
By: Mary Ann Burke, Board Member
Date:
Attest: Diana Cordray, Clerk-Treasurer
Date:
INDIANA UNIVERSITY HEALTH, INC. ("IU Health")
By: Clark Day, Vice President Date: x;7/1773
IU Health Business, Solutions 7
ew ,i 7,,,.-
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Service Line Attachment#1
Health and Wellness Center Clinic Services
Addendum A— Referral Policy
• Referrals will be made on a rotating basis to qualified facilities and physicians
• IU Health physician contracts will not include requirement to make referrals within N
Health affiliated practices or facilities
• When the clinic physician or nurse practitioner makes referrals, such referrals shall be based
upon: (1) the specific needs of the patient, (2) the City's network of preferred providers, (3)
patient preference (e.g., location, convenience, preference for a male or female doctor, etc.),
(4) clinic staffs knowledge of the skills and capabilities of the referred physician/facility,
and (5) cost of services.
• Referral tracking will be documented as follows:
Referral made to:
(A) , an IU Health provider/facility
(B) , a provider at
(C) , an independent physician group.
Referral based on the following (check all that apply):
Specific needs of patient
Preferred provider status
Patient preference, specifically
Skills and capabilities of referred physician/facility
Cost of services
• Tracking data will be provided to City on a regular basis.
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Service Line Attachment#1
Health and Wellness Center Clinic Services
Addendum B — Police and Fire Physicals
• Comprehensive physical examination, including:
• Full-body assessment of systems
o General observation
o Musculoskeletal
o Head
o Ears, eyes, nose, throat
o Neck
o Cardiovascular
o Lungs
o Abdomen
o Extremities
o Genital/urinary
o Psychological
o Breast exam
o General Fitness including flexibility, strength, balance
• Height, weight, blood pressure, pulse
> Skin examination
> Review and explanation of lab results
> Review of medical history and medications taken
> Review of immunization history
• Review of risk factors (cardiovascular risk, cancer risk, etc)
Review of life style recommendations (diet, exercise, tobacco cessation, etc.)
• Referral for preventive testing if indicated (mammogram, colonoscopy, etc.)
• Rectal exam
• Prostate exam
• TB test
• Labs: (IUH Profile 2) CBC, CMP, TSH, AIC, and Lipid panel; HIV test
• Urinalysis: bilirubin; glucose; hemoglobin; ketones; leukocytes; nitrite; Ph; protein;
specific gravity; urobilinogen
• EKG with interpretation
• Pulmonary function test (spirometry)
• Cardiac stress test (treadmill)
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Service Line Attachment#2
Employee Assistance Program Services (EAP)
Indiana University Health ("IU Health") through its affiliate, Workplace Methodist Assistance
Plan ("WMAP"), agrees to provide EAP services as described herein to City of Carmel, Indiana
("City') employees.
1. Service Model
Workplace Methodist Assistance Plan addresses a broad spectrum of issues including, but
not limited to, stress, depression, anger, alcohol, and relationship and family problems that
interfere with functioning on the job. Each member of an employee's family can have up to
six (6) counseling sessions per year at no charge to them as a part of the program.
WMAP develops specific care plans for all clients. The initial intake is both a qualitative
and quantitative analysis, helping to determine whether the individual need is urgent,
emergent or routine, and a care plan is executed accordingly. The program will be
integrated and promoted as a part of the larger wellness program umbrella to reinforce that
health is both physical and emotional.
2. Services of IU Health
• Short-term counseling, as requested by employee or by City
• Behavioral health guidance
• Critical incident support
• 24-hour help line
• Referral services
• Manager training
• Employee orientation and workshops
• Promotional materials
• Quarterly utilization reporting by department
3. Service Sites and Hours
• Counseling services are offered IU Health offices on Pennsylvania Parkway in Cannel.
• Counseling appointments are scheduled during normal business hours.
• Appointments for issues that can reasonably be identified as emergencies, using standard
professional guidelines, shall be scheduled with 48 business hours.
• Manager training. employee workshops and Critical Incident Support are scheduled to
meet the needs of participants.
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4. Responsibilities of City
• Provide list of eligible participants
• Distribute promotional materials to employees and direct employees to EAP as
appropriate.
5. Cost of Services
$1.20 per employee per month (PEPM)*
*cost assumes 500-600 eligible employees
Services shall be invoiced quarterly with payment due within thirty (30) days of receipt of
billed invoice.
6. Confidentiality:
Workplace Methodist Assistance Plan is committed to protecting employees' personal health
information. WMAP is a HIPAA-compliant organization and will not release any private
health information without employee consent, including information regarding utilization of
EAP services. Reports provide aggregate utilization information and meet HIPAA privacy
guidelines.
7. Principal Contacts
The principal contacts for this Service Line Attachment are:
Workplace Methodist Assistant Plan City of Cannel, Indiana
Michael Denton Barbara Lamb
Program Manager, Behavioral Care Director Human Resources
1-65 at 21'n Street One Civic Square
Indianapolis, IN 46206-1367 Cannel, Indiana 46032
Phone: (317) 962-2690 Phone: (317) 571-2471
Email: MDenton @IUHealth.org Email: blamb @cannel.in.gov
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IN WITNESS WHEREOF, the parties hereto have executed this Service Line Attachment #2 as
of the date indicated below.
CITY OF CARMEL, INDIANA ("City")
By and through its Board of Public Works and Safety
By: James Brainard, Mayor
C z Date: / /0), / / 3
By: Lori Watson, Board Member
Date:
By: Mary Ann Burke, Board Member
Date:
Attest: Diana Cordray, Clerk-Treasurer
Date:
INDIANA UNIVERSITY HEALTH, INC. ("IU Health")
By: Clark Day, Vice President Date: a7/015
IU Health Busine Solutions
W .
WORKPLACE METHODIST ASSISTANCE PROGRAM ("WMAP") /
By: Michael Denton, Program Manager Date: 2/2/11 3
ja„..4),
Behavioral Care
/ //
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Service Line Attachment#3
Drug and Alcohol Testing Services
Indiana University Health ("IU Health") through its affiliate IU Health Occupational Services
("IUHOS") agrees to provide City of Carmel, Indiana ("City") drug and alcohol testing services
in accordance with the City's written substances abuse and testing policies, and to provide the
consultation and support services necessary to effectively implement the policies. Drug and
alcohol testing under this Agreement will be performed in the following circumstances:
• Pre-employment (drug testing only)
• Post-accident (drug and alcohol testing)
• Reasonable suspicion (drug and/or alcohol testing)
• Follow-up testing (drug and/or alcohol testing)
• Random (drug and alcohol testing)
1. Services and Responsibilities of IU Health/IUHOS
Drug and Alcohol Testing
• Create list of all employees included in the regulated and non-regulated random testing
pool
• Randomly select from each pool of individuals provided by City the requisite number of
individuals for random drug testing at agreed upon intervals (no less than quarterly).
• Within five (5) days of the first day of each quarter, or otherwise as mutually agreed,
send to the Designated Employer Representative (DER) notification via fax or email
indicating the employees selected for drug test and/or alcohol test during the specific
selection period.
• Provide a letter for each selected individual that can be used for the purposes of
notifying the employee and serving as an authorization form for the collection site.
• Track selected employees to insure they comply with City's requirements for drug
testing and inform City of those employees who do not comply.
• Provide annual reports as required by regulatory requirements upon request.
Consultation and Support Services
• Provide professional consultation to City regarding development of policies and
procedures for drug and alcohol testing of regulated and non-regulated employees.
• Provide 24-hour point of contact for testing-related questions, particularly as they pertain
to DOT regulations.
• Ensure that all services are compliant with DOT regulations, except as specifically
requested in writing by City.
19
• Provide services of a Medical Review Officer ("MRO") as required by City or any
regulatory agency.
• Provide referral to a qualified Substance Abuse Professional ("SAP") at City's request.
• Allow one City employee the opportunity to participate in annual DER seminar at no
cost. Allow one additional participant may attend the seminar at a 50% discounted rate.
• Provide assistance in producing, explaining and testifying on behalf of City as to random
drug testing procedures for regulated drug testing, should City be audited or sued.
• Provide drug and alcohol results, drug audit logs and chain of custody control forms as
requested by City.
2. Service Sites
• The City of Carmel Employee Health Clinic at 1402 Chase Court, Carmel, Indiana, will
function as the primary City drug and alcohol testing site. The clinic will at all times
remain compliant with all appropriate regulatory requirements. Pre-employment,
follow-up and random testing will always be scheduled during clinic hours.
• If testing services are required outside the hours of the clinic's operation, such services
will be provided at IU North Hospital at the cost quoted in this Agreement.
• IU Health will provide access to a 24 hour nationwide collection site database through
South Bend Medical Foundation.
• All urine specimens will be tested at a SAMHSA—certified laboratory.
3. Responsibilities of City
• Provide IU Health a copy of City's drug and alcohol testing policy and any amendments
thereto; discuss with IU Health procedures to be followed to comply with policy
• Submit to IU Health a list of individuals included in regulated and non-regulated random
testing pools, in the format prescribed by IU Health.
• Schedule employees for collections in accordance with City policy, and communicate
with employees as necessary to ensure compliance.
• Appoint a DER who shall act as City's representative and contact for all issues related to
the random testing program.
4. Cost of Services
•
Urine Drug Screen:
*5 Panel Non-Regulated Quick-Read Cost of supplies only
5 Panel Regulated Lab S22.00
*Positive quick-read will be sent to lab at no additional cost.
Alcohol Test:
Swab Cost of supplies only
*Breath Alcohol S33.00
*Only required if swab is positive. Breath alcohol tests performed at Hi North Hospital.
20
5. Data Security
The services to be performed by IU Health for City under this contract may require or allow
access to information containing Social Security numbers. If any Social Security number(s)
is/are disclosed by IU Health, IU Health agrees to pay the cost of the notice of disclosure of a
breach of the security of the system in addition to any other claims and expenses for which it
is liable under the terms of this contract. IU Health shall indemnify and hold harmless City, '
from any and all claims, suits, actions, liabilities and costs of any kind, caused by the
performance (or failure to perform) of IU Health under this Agreement.
6. Principal Contacts
The principal contacts for this Service Line Attachment are:
IU Health Occupational Services City of Carmel, Indiana
Thomas W. Brink, President and CEO Barbara Lamb
4850 West Century Plaza Road Director Human Resources
Suite 140 One Civic Square
Indianapolis, IN 46254 Cannel, Indiana 46032
Phone: 317-216-2526 Phone: (317) 571-2471
Email: tbrink @clarian.org Email: BLamb @canmel.in.gov
[Remainder of page intentionally left blank]
21
IN WITNESS WHEREOF, the parties hereto have executed this Service Line Attachment#3 as
of the date indicated below.
CITY OF CARMEL, INDIANA ("City")
By and through its Board of Public Works and Safety
By: James Brainard, Mayor
("z i de�e Date: ., / id,/ / 3
By: Lori Watson, Board Member
Date:
By: Mary Ann Burke, Board Member
Date:
Attest: Diana Cordray, Clerk-Treasurer
Date:
INDIANA UNIVERSITY HEALTH, INC. ("IU Health") r1
By: Clark Day, Vice President Date: Gf��#5
IU Health Busines /Solutions
441
IU HEALTH OCCUPATIONAL SERVICES ("IUHOS")
By: Thomas W. Brink, President and CEO Date: .2-1t/3
e4 4-/ i_ _ _:
7?
RESOLUTION NO. BPW-03-06-13-03
RESOLUTION OF THE CITY OF CARMEL BOARD OF PUBLIC WORKS AND SAFETY
ACKNOWLEDGING RECEIPT OF CONTRACT
WHEREAS, pursuant to Indiana Code 36-1-4-7, the City of Carmel, Indiana ("City"), is authorized to
enter into contracts; and
WHEREAS, pursuant to Indiana Code 36-4-5-3, the City's mayor shall sign all contracts of the City; and
WHEREAS, pursuant to his authority under Indiana law, the City's mayor, the Honorable James C.
Brainard, has signed the City contract attached hereto as Exhibit A (the "Contract"); and
WHEREAS, Mayor Brainard now wishes to present the contract to the City's Board of Public Works and
Safety for it to be publicly acknowledged, filed in the Clerk-Treasurer's Office, and made available to the public for
review.
NOW, THEREFORE, BE IT RESOLVED by the City of Carmel Board of Public Works and Safety as
follows:
1. The foregoing Recitals are incorporated herein by this reference.
2. The receipt of the Contract is hereby acknowledged.
3. The Contract shall be promptly filed in the office of the Clerk-Treasurer and thereafter made available to
the public for review.
`` \
SO RESOLVED this (Q day of )/l L(/ZG '- , 2013.
CITY OF CARMEL, INDIANA
By and through its Board of Public Works and Safety
BY:
'---K,d A}
James Brainard, P ending Officer
Date:
'4 �� Ali.. ,
Mary Ann B rke, mbe
Date: —/3
1
Lori S. Watgon, mbe
Date: 394 i 3
ATTEST: A ft
Dia . .ordray, IMCA;Cler -Treasurer
Date: 2 13. - i
Z:1E Bass\My Documen63BPW-Resolulions12013■ knowledge IU HEALTH Agmt, BPW 03-06-13-03.dOCX2l25/2013334 PM