HomeMy Public PortalAbout053-2016 - Roseview - Administrator - IU Health - Connection with the City's Medical Qualifications PolicyIndiana 'University Health
IU Health
Medical Qualification
Third Party Administrator Contract
This agreement is made between Rose View Transit and Paratransit System.at.401 South Q Street
Richmond, Indiana, hereinafter referred to as System, and,.IU Health Occupational Services located
at 3443 West Third Street Bloomington, Indiana, hereinafter referred to as Vendor.
This agreement outlines the services and responsibilities of the Vendor to provide medical
.qualification services to Indiana Rural Transit Systems, including the System named above. Said
services are to support Indiana's Medical Qualification Policy and Program, and other applicable
programs, and to ensure the safety of Indiana's safety -sensitive transit employees and the traveling
public. In. addition, this agreement acknowledges that the System has a policy for Medical
Qualification of applicants for safety -sensitive functions and/or safety -sensitive employees and
requires medical examination services from the Vendor. In -consideration of the mutual covenants
and promises set forth, the parties hereby enter into this agreement, the terms and conditions of
which shall apply from the execution date of this agreement.
The Vendor shall provide services pursuant to the United States Department of Transportation's
"Physical Qualifications for Drivers" 49 CFR part 391; the Americans with Disabilities.Act (ADA).;
Indiana Code 20-9.1-3-1; and the Indiana Medical Qualification Policy and Program, which also
includes the Indiana Rx/OTC Medication Policy, all of which apply to all Indiana Rural Transit
Systems. Furthermore, Vendor must allow regulating agencies (Federal Transit Administration,
Indiana Department of Transportation, its authorized representatives and -the System as a part of
its vendor oversight) to interview employees of the company and review. files necessary to
complete program audits and ensure compliance.
In consideration of the premises and the mutual promises, covenants, and agreements contained
herein, the parties agree as follows.
SCOPE OF SERVICES
Services shall include the following outlined items.
A. Evaluating lob Positions
1. As required, conduct on -site job evaluations of safety -sensitive transit positions and
develop standards for each position that include physical and health demands in accordance
with ADA regulations. Review and update job standards at least biennially.
B. Conducting Physical Examinations
Perform physical examination services at the request of the System; provide a complete
written report including when applicable completion of the BMV required CDL and PPC
Contract No. 53-2016
physical forms. Physical examinations will, at a minimum, be conducted for all safety -
sensitive transit positions in the following circumstances:
a. New hires;
b. Biannual (subsequent annual, six month or three month follow-up evaluations as
identified during the biannual evaluation);
c. Return to work (as defined in the Indiana Medical Qualification Policy);
d. Following a qualifying accident (as defined in the Indiana Medical Qualification
Policy);
e. As required to comply with the Indiana Prescription and Over -the -Counter
(Rx/OTC) Medication Policy and Procedures;
f. On a case -by -case basis as requested by the individual purchasers and/or required
in accordance with other applicable Indiana policies and procedures.
2. Review each applicant for a safety -sensitive position and all safety -sensitive employees'
health -histories to issue__a_determination_ about -an -operator's physical qualifications and
ability to operate a small urban and rural (5311) public transit vehicle pursuant to Indiana
Code 20-9.1-3-1 and applicable transit system substance abuse and Rx/OTC policies.
3. Provide recommendation for an applicant's ability to perform the essential duties of a job
based upon a review of a physical capabilities examination or assessment exercise,
conducted either by the Contractor or an independent physical therapist.
4. Request and evaluate laboratory tests sufficient to render a medical decision regarding an
applicant's or employee's health as it relates to the position for which he or she is being
examined.
S. Following all physical examinations as specified in #1 above, render a decision as to the
applicant's ability to fully perform the essential functions of his or her assigned job duties.
DOT and non -DOT physical examinations shall at a minimum contain the following:
a. Completion of a comprehensive health and occupational history questionnaire,
including inquiries into an applicant's on -and -off -job injury history as related to the
job duties.
b. Measurement of job -related work activities such as lifting, pushing, turning, etc.,
against the load, accordingto proper -physical and -occupational therapy procedures.
c. A complete examination by a licensed physician.
d. Urine sample collection according to DOT regulations, 49 CFR Part 40; dipstick
evaluation test to include a minimum of specific gravity, PH, protein, and sugar;.
e. X-Rays, if deemed necessary by the physician and approved by the transit system's
Human Resources Department.
f. Other tests as deemed necessary by the physician and approved by the transit
system's Human Resources Department.
Note: Required medical examinations, including non -DOT drug and alcohol testing, may be
required to determine an employee's physical and/or mental fitness for duty. The results should,
therefore, include an evaluation of the issues and recommended action for the transit system.
C. Assessing and Determining Medical Oualification
1. Consult with an employee's treating physician to obtain additional information about an
employee's medical .qualification following an extended medical absence or transit system
management required fitness for duty assessment.
2. Consult with transit system management to provide the ultimate and final determining
decision for transit system management regarding an employee's medical qualification.
This may include overruling a prescribing medical practitioner's determination. The
decision may, in some cases, medically disqualify the employee from performing his or her
safety -sensitive function(s).
D. Developing Policy Statements
Provide technical expertise on the United States Department of Transportation's "Physical
Qualifications for Drivers" 49 CFR Part 391.41 Federal Transit Administration's regulations (49 CFR
Part 655 and 40), relevant guidelines pertaining to Rx/OTC medication use as developed by the
Federal Motor Carrier Safety Administration (FMCSA), and to assist systems with policy
modification or updates. Describe the company's ability, preparedness, and strategy for informing
systems of fitness for duty requirements while using Prescription and Over -the -Counter (Rx/OTC)
medications.
F. P_erform_Required _Recor_dkeeping and Reporting
1. Maintain all necessary records of services provided and appropriate procedure's to assure
_ __ _ confidentiality of records and reporting.
2. Maintain documentation of medical evaluations for four (4) years.
3. Report on the results of each evaluation to the transit system's Human Resources
Department by telephone within 24 hours of the physical. Provide complete written,
quantified test results to the transit system's Human Resources Department within two (2)
days of the examination in a format acceptable to the INDOT.
4. Prepare and submit monthly progress reports along with a monthly invoice as described in
Section H of this contract.
G. Exx ert Testimony
Provide expert testimony, including explanation of tests and examination results, as needed.
H. Invoices
Payment shall be net thirty (30) days upon receipt of a satisfactory monthly progress report.
Proposers should note any discounts for payment before thirty (30) days. Invoices should be sent
to the attention of the Accounts Payable Department or each respective Purchaser. Invoices shall
reflect the following: purchase order number, description of service, and total amount of payment
due.
OTHER CONDITIONS
1. PROVIDER RESPONSIBILITIES
The Vendor will maintain facilities and personnel adequate to the performance of services outlined
in this agreement to System. In particular, the Vendor will maintain personnel with the proper
professional licensure of all physicians, medical personnel and administrative personnel who will
be providing direct services to the System. The Vendor will maintain, in a secure location with
controlled access, -all -dated :records, -information, and motifieations, identified by individual for
specific information and records for the minimum time period of four (4) years and as applicable to
the services provided by the Vendor to the System.
The Vendor will not release individual evaluation results to any person, without first obtaining
specific written authorization from the individual. Nothing in this paragraph shall prohibit the
Vendor from releasing, to the System, its agents or to officials of the Federal Transit
Administration or the Indiana Department of Transportation or its designated representative with
regulatory authority over the testing program, individual evaluation results or related information
to comply with requests resulting from a legal action and on the behalf of the employee.
The Vendor will make available to the System, at location(s) of the System's choosing, and at
reasonable expense to the System for copying and shipping charges, all records related to medical
examination services performed by the Vendor for the System, except records containing
confidential medical information, within two business days of notification by the System of such
request. Evaluation results are sent directly to the System from the Vendor. Furthermore, the
Vendor shall not hold hostage any records relating to this program or its compliance for purposes
of collecting outstanding payments from the System.
Quarterly -reporting of specified._information_to theAndiana Department of Transportations Safety
and Security Program Manager and annual reporting to the System will be by facsimile
transmission, electronic transmission, or U.S. mail.
2. SYSTEM RESPONSIBILITIES
The System will provide the Vendor with the most recent applicable Medical Qualification and
RX/OTC policies of the System. The System will designate a primary- representative and an
alternate representative to whom the Vendor will report evaluation results and discuss or report
other necessary information. A password will be established for each representative to ensure
confidentiality of information passed between the Vendor and the System. The means of obtaining
results from the Vendor, (including, but not limited to, electronic or computer transmission,
facsimile transmission (fax), or written communication) with password protection will assure that
the results and other information remain secure and confidential with distribution of or access to
such information to System officials with a business need for the information only.
The System authorizes the Vendor to request specific information or to order additional tests as
necessary for System to comply with the United States Department of Transportation's "Physical
Qualifications for Drivers" 49 CFR Part 391; the Americans with Disabilities Act (ADA); Indiana
Code 20-9.1-3-1; and the Indiana Medical Qualification Policy and Program, which also includes the
Indiana Rx/OTC Medication Policy. The System agrees to pay for additional costs and charges
related to such information requests or additional testing performed.
The System acknowledges that performance of necessary verification procedures may be
dependent upon cooperation by System representatives, evaluated individuals, and/or personal
physicians and/or health care providers that may possess vital medical history information.
3. TERM
This contract shall be in effect from the date of execution and continuing for a period of two (2)
years. The responsibilities and obligations and liabilities shall survive the term of this contract.
This contract shall automatically Trenew-on -an=annual basis for up to two (2) additional years,
subject to the approval of the System unless either party has given written notice of intent to
change the terms of the contract no less than sixty (60) days prior to the renewal date.
4. INDEPENDENT CONTRACTORS
Both parties to this contract are independent contractors,®and nothing contained herein shall be
construed to place the parties in the relationship of partners, joint venture, or employer -employee,
and neither party shall have the power to obligate or blind the other whatsoever beyond the terms
of this contract.
5. RESPONSIBILITY FOR COMPANY POLICY AND PROGRAM
The parties understand and agree that the Vendor does not make any employee decisions for the
system such as hiring of applicants, termination, discipline or retention of any employee or former
employee and that the System has sole responsibility for all such decisions. The Vendor shall not
be responsible for any damages resulting from acts or omissions of the System under the System's
-_.._.___--substance_abuse_policy.___-_
6._ -DEBARMENT
The Vendor will be required to certify that it is not included on the U.S. Comptroller General's
Consolidated List of Persons or Firms Currently Debarred for Violations of Various Contracts
Incorporating Labor Standards Provisions.
7. NON -COLLUSION
The Vendor guarantees that this contract is not a product of collusion with any other proposer. An
affidavit of non -collusion form is included and must be signed and submitted with the contract.
8. INTEREST OF MEMBERS OF, OR DELEGATES TO, CONGRESS
In accordance with 18 U. S. C. 431, no member of, or delegates to, the Congress of the United States
shall be admitted to a share of part of-thiscontract or to any benefit arising there from.
9. CONFLICT OF INTEREST
No employee, officer, or agent of the grantee shall participate in the selection or in the award of
administration of a contract if a conflict of interest, real or apparent, would be involved. Such a
conflict would arise when:
The employee, officer or agent, any member of his immediate family, his or her partner, or any
organization which employs, or is 'about to employ, has a financial or other interest in the firm
selected for award.
The grantee's officers, employees, or agents shall neither solicit nor accept gratuities, favors, or
anything of monetary value from contractors, potential contractors, or parties of sub -agreement.
10. SEVERABILITY
If any provision of this contract is held to be illegal, invalid or unenforceable by a court of
competent jurisdiction, the parties shall, if possible, agree on a legal, valid and enforceable
substitute provision, which is as similar in effect to..the deleted provision as possible. The remaining
portion of the contract not declared illegal, invalid or enforceable shall, in any event, remain valid
and effective for the term remaining unless the provision found illegal, invalid or unenforceable
goes to the essence of this contract Either party has the right to terminate this contract, for any
reason whatsoever, upon 60 days notice by the terminating party.
In no event shall the Vendor have any responsibility or liability to company for any failure or delay
in performance by the Vendor, which results from or is due to, directly or indirectly and in whole
or in part, any cause or circumstances beyond the reasonable control of the Vendor. Such causes
and circumstances shall include but are not limited to acts of God, acts of the System, rules or
regulations or orders of any governmental authority or agency thereof (whether civil, military,
executive, legislative, judicial, or otherwise), strikes or other concerted actions of workers, lockouts,
or other labor disputes or disasters, accidents, wars, riots, rebellion, sabotage, insurrection or civil
disturbances, difficulties or delays in private or public transportation, or any other cause beyond
the Vendor's reasonable control.
11. INDEMNIFICATION
The System shall indemnify, defend and hold harmless the Vendor, the Vendor's directors,
officers, agents and employees, and each one of them, from and against any and all claims, suits, and
damages of whatever nature made or asserted by a present or former employee or agent or
applicant for employment of the System, of its parent, subsidiaries or affiliate companies, arising
out of or in any way related to services provided by the Vendor under this agreement, related to
negligent, fraudulent, or illegal action or omission of the System or the System's employees, agents,
or related personnel. The System agrees to indemnify and hold harmless the Vendor, its parent
companies, subsidiaries, and affiliates from any loss, or damage, or claim brought by third parties
(including the System's evaluated individuals) resulting form any negligent act or omission on the
part of the System or System's representatives.
The Vendor shall indemnify, defend and hold harmless the System, System's directors, officers,
agents and employees, and each one of them, from and against any and all claims, suits, and
damages of whatever nature made or asserted by a present or former employee or agent of
Vendor, of its parent, subsidiaries or affiliate companies, arising out of or in any way related to
services provided by the Vendor under this Agreement, related to negligent, fraudulent, or illegal
action or omission of the Vendor, or the Vendor's employees agents, or related personnel. The
Vendor agrees to indemnify company from and against any and all claims arising out of its
submission of data or analytical results which are false or incorrect as a result of willful, intentional,
or negligent acts or omissions by the Vendor personnel.
12. GOVERNING LAW
The provisions of the Agreement shall be construed, interpreted and governed by the substantive
laws of the State of Indiana, including all matters of construction, validity and performance but
without giving effect to Indiana choice -of -law or conflict -of -law principles.
13. ENTIRE AGREEMENT
This agreement represents the entire agreement between the Vendor and the System. This
agreement supersedes all prior agreements, understandings, negotiations and discussions, written
or oral, and may be modified only by a written document signed by both the Vendor and the
System.
IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed as of the day
and year executed below:
Vendor: IU Health S st t R
By: Mark E. M
Signature
Title: Presiden
Date:
y em. ose View Transit(and Paratransit
By�� ; �t e�
Signature: i
Title:
Date:
i
BOARD OF PUBLIC WORKS AND SAFETY
RESOLUTION NO. 6-2016
A. RESOLUTION ADOPTING A THIRD PARTY ADMINISTRATOR CONTRACT IN CONNECTION
WITH THE MEDICAL QUALIFICATION POLICY FOR ROSE VIEW TRANSIT DEPARTMENT
WHEREAS, On August 11, 2011, the City of Richmond, Indiana, by and through its Board of Public Works
and Safety, passed a Resolution (Resolution No. 5-2011) to approve a Medical Qualification
- --- - --- Policy and related supplemental policies for prescription (Rx) and over-the-counter (OTC)
medications (Medical Qualification Policy) for the Richmond Rose View Transit Department
(RVT) as required by the Federal Transit Administration (FTA); and
WHEREAS, Said Resolution No: 15-2011 also approved a related Services Contract with Public Safety Medical
as the -designated Medical Determination Officer- (MDO) for -said -Medical -Qualification Policy,
which Contract was referenced as Contract No. 1 l I-2011; and
WHEREAS -=A-new Ser-vices-Contract with-IU Health Occupational Services (IU Health) titled as -the "Third
WHEREAS,
Party Administrator Contract" that is designated as: ContractNo.-.53-2Q.16,-and is attached hereto
as Exhibit. A, outlines the services and. -responsibilities _ of _ IU ..Health to provide medical
examinations and other related services to the RVT to support the Medical Qualification Policy
previously adopted by the City; and - -- -- ---- -- ---
It is in the best interest of the City of Richmond that the new Services Contract with IU Health be
approved to replace the prior MDO contract with the prior vendor and that the Manager of Rose
View Transit be authorized to sign the new Third Party Administrator Contract with IU Health in
order that the City will be in compliance with FTA requirements pursuant to the Medical
Qualification Policy.
NOW THEREFORE, BE IT RESOLVED by the Board of Public Works and Safety of the City of Richmond,
Indiana, that said Board hereby approves the new Third Party Administrator Contract with IU Health (Contract
No. 53-2016) and authorizes the Manager of Rose View Transit to sign said Contract in order that the City will be
in compliance with FTA requirements pursuant to the Medical Qualification Policy which Contract No. 53-2016
is attached hereto as Exhibit A.
- Passed and adopted this day of , 2016, by the Board of Public Works and Safety of
the City of Richmond, Indiana.
BOARD OF PUBLIC WORKS AND SAFETY
- qX�
Vicki Robinson, President
APpro —e- - - -- - --
Richard Foore, Member
Anthony L. Fos er, I1, Membtr