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BILL NO. 2000-89
SPONSORED BY COUNCILMAN Vincent
ORDINANCE NO.
AN ORDINANCE OF THE CITY OF JEFFERSON, MISSOURI, AUTHORIZING THE
MAYOR AND CITY CLERK TO EXECUTE AN AGREEMENT WITH CAPITAL REGION
},ors{}yyi MEDICAL CENTER FOR PROFESSIONAL MEDICAL SERVICES. 5'
BE IT ENACTED BY THE COUNCIL OF THE CITY OF JEFFERSON, MISSOURI, AS :?
FOLLOWS: # .
'i
ryt4 j ,
Section 1. The Mayor and City Clerk are hereby authorized and directed to execute
an agreement with Capital Region Medical center for professional medical services. `;..,4
Section 2. The agreement shall be substantially the same in form and content as
` that agreement attached hereto as Exhibit A.
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Section 3. This Ordinance shall be in full force and effect from and after the date ��H .����•
of its passage and approval. � yjk�
{{{ yJ 4
..rtV ;`, ^rid
t Passe Approved:_ 4D
residing Officer Mayor
:'4 x ATTEST: APPROV D AS FORM: "}'
ity Clerk City Counselor `
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CITY OF JEFFERSON
AMENDMENT CAPITAL REGION MEDICAL CENTER
r: EEMENT
;��u�;. DtrcctNct PAYOR AGR
Missouri, a ►municipal corporation, with offices at 320 East McCarty, Jefferson
WHEREAS, the City of Jefferson,
'�; City, Missouri, 65101, hereinafter designated "City," entered into a Contract with Capital Region Medical Center
!r t
47f d/b/a DirectNet, a worker's compensation program hereinafter referred to as "DirectNet", on November 7, 2000, ,t`• ;Yvy1
4 and amended on October 19, 2001; and s r
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WHEREAS, the Contract included coverage for certain medical expenses incurred by employees work related
illnesses and/or injuries; and
e ;?' WHEREAS,the parties wish to renew the agreement for one year; }' •:`',',,
NOW,THEREFORE,be it agreed as follows: V.�
}r A. Paragraph VI of the Contract dated November 7, 2000, is hereby amended to read as follows:
VI. TERM AND TERMINATION
A. Terms,
This Agreement "•` (1)
.._ car unless sooner terminated b the parties hereto in
p� is renewed for its final y y P
accordance with the provision set forth in Section VI.
B. All other sections of the Contract dated November 7, 2000, and amended October 19, -
7;t� �x�,•�it
=iht 2001, shall remain in effect as stated. �' 1✓ bk"•_7,
�� day
IN TES'T'IMONY WHEREOF, the parties have hereunto set their hands and seals this of �' � 41,x.•;1;
'sn October, 2002.
CITY OF JEFFERSON, MISSOURI CAPITAL REGION MEDICAL CENTER
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Hea thDirect Sates Coordinator
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ATTEST: ATTEST
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APPROVED AS TO FORM: ty
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Cit Counselor
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CAPITAL REGION MEDICAL CENTER
DirectNet PAYOR AGREEMENT
T
`M1 },4Y
/
This City Agreement ("Agreement") is entered into effective as of the�_ of November, 2000
("Effective Date")by and between the City ofJefferson a Missouri corporation("City")and Capital �� 7�tai i
,, t �' Fir�j^y:
Region Medical Center, d/b/a DirectNet, a worker's compensation program ("DirectNet").
t
WHEREAS, such benefits include coverage for certain medical expenses incurred by employeesti
with work related illnesses and/or injuries; and
WHEREAS, DirectNet has established a network of hospitals, physicians and other healthcare G
providers for the provision of healthcare services for work related illnesses and/or injuries; and S •'
WHEREAS, City has requested DirectNet to furnish access to its network of providers to provide
certain administrative services in connection therewith; and
WHEREAS, DirectNet submitted a proposal to the City, which included additional services r .
including Workers' Compensation Treatment and Medical Care,Case Management(24 hours a day, ,
7 days a week), Physical Examinations Physical Fitness Testin g, Corporate Fitness Programs,
Work-site Evaluation, Work Injury Rehabilitation, Drug and Alcohol Testing, Immunizations, ,•
Laboratory Services, x-ray procedures; and
WHEREAS, it is the purpose of this Agreement to establish a contractual relationship whereby
DirectNet shall provide City with such access and administrative services as set forth herein.
z '
NOW, THEREFORE, in consideration of the premises and covenants set forth herein, the parties
hereto mutually agree as follows:
L'Yyl:
I, DEFINITIONS 5
�5 1
i.
4%
As used herein, the following terms shall have the following meaning:
n
A. COVERED SERVICES" means those MEDICALLY NECESSARY services and supplies a
provided by a PARTICIPATING PROVIDER to an EMPLOYEE. i
i
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H:<Si�'Mxyl('n!nrd.I FdNI'n,rtwartal Scitict,`c:y,ital tcgion dha dirwrto1AGREEMENT 21w Y1%I,J 1
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.. Z. �
4 B. "EMPLOYEE" means any person referred to DirectNet by City for the coordination of
medical services relative to an actual or alleged work related illness and/or injury;
C. "MEDICALLY NECESSARY" services and supplies means those services and supplies
` deemed by DireetNet's CASE MANAGEMENT PROGRAM,to be medically appropriate services
�t )
t and supplies for the evaluation and/or treatment of the actual or alleged work related illness and/or
injury. d.i
11 s���°Y1 � r�•"�
D. "PARTICIPATING PROVIDER means those licensed physicians hospitals and other
providers under written contract with DirectNet to provide medical services for actual or alleged
work related illness and/or injury in accordance with the terms of the Participating Provider ;
Agreement as well as the policies and procedures referenced therein. A copy of DirectNet's
Participating Provider A Agreement form as well as the po',izies referenced therein shall be provided
b
p yhGti'Cf+'
C to City upon request. ���; ;���;>��,�<rS��•d
E. "CASE MANAGEMENT PROGRAM" means the process of assessing,
II ig, planning, .Y.
coordinating,monitoring and evaluating the services required to respond to an individual's healthcare "` ryr
needs to attain the goals of quality and cost effective care.
y tr! .� .{l•t V.1
,� 'x ,• v r,�'s• i
,1
F. "PROPOSAL means that proposal submitted by DirectNet to City dated July 28, 2000 as }� H
'i supplemented.
t'+>;fir=�•.- +r ..�. is 1.R�'i
Y y +
ll. RELATIONSHIP BETWEEN CITY AND DlRECTNET
j
A. Relationship between City and DirectNet ; ;:'
•9,,,55• MV••'S
The relationship between City and DirectNet is that of independent contracting parties and neither '
City nor DirectNet nor the employees, servants, agents, or representatives or either shall be
considered the employee, servant, agent, or representative of the other. Nothing herein should be
construed as creating any relationship between the contracting parties hereunder other than the
relationship of independent entities contracting together to affect the arrangement which is the
subject of this Agreement. '
B. Relationship between DirectNet and PARTICIPATING PROVIDERS
w+'f•,
The relationship between DirectNet and any PARTICIPATING PROVIDER is that of an it
independent contractor relationship. PARTICIPATING PROVIDERS are not agents or
representatives of DirectNet and do not have any expressed or implied right or authority to create
or assume any obligation or responsibility on behalf of DirectNet. In addition, PARTICIPATING
PROVIDERS are solely responsible for any and all care and treatment provided to EMPLOYEES ` '
•x.°
and at all times are free to exercise their independent medical judgment. Neither DirectNet, nor its
directors,employees and/or agents,shall be liable,or held responsible,for any damages arising from
the act or failure to act of any PARTICIPATING PROVIDER.
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III, SERVICES OF DirectNet
t)f
DirectNet shall provide the following services to City under this Agreement:
A. Establish and maintain a network of PARTICIPATING PROVIDERS. DirectNet will � a'':
NN�,
monitor PARTICIPATING PROVIDERS for their compliance with the Participating Provider
Agreement as well as any all policies and procedures developed by DirectNet and referenced : +�_ }
i therein.City acknowledges,however,that DirectNet does not practice medicine nor does it exercise ;R, J � '±`;?
-f( control over the methods or professional judgments by which a PARTICIPATING ING PROVIDER
renders services to an EMPLOYEE. �;iia:� u�r•r' ��t.-
B. Upon referral, from City; or City's designee, DirectNet shall coordinate provision of � -' �t�:�i,
COVERED SERVICES to EMPLOYEES on behalf of the EMPLOYEE'S employer. Such
coordination will include,but not be limited to utilization and case management services including
external management and oversight from the initial date of the EMPLOYEE'S referral to DirectNet
with respect to the injury and/or illness. 4�
C. DirectNet shall review and discount all billed services for work comp injuries from
Yrc'§r`rih,: PARTICIPATING PROVIDERS by 20%and forward the adjusted bill to City for payment directly
to the PARTICIPATING PROVIDER. ,a#;,n: ;
D. In addition to the services set out in paragraphs A, B, and C above, DirectNet shall provide
all services as set out in its PROPOSAL. `r '
' Tfs'd 4 f'r.
IV. COMPENSATION
?' A. City shall compensate PARTICIPATING PROVIDERS for ALL COVERED services
provided to EMPLOYEES under this Agreernent within thirty(30)days of its receipt of the adjusted
ry PROVIDER
bill from DirectNet in accordance with DirectNet's negotiated PARTICIPATING ROVIDER
schedule.City shall return a copy of the adjusted bill to the PARTICIPATING PROVIDER with its
payment. Provided that an EMPLOYEE was referred to DirectNet for medical treatment pursuant ` '
to this Agreement, City shall be bound by DirectNet's decision regarding what services constitute n:;r
COVERED SERVICES pursuant to this Agreement.Notwithstanding the foregoing,nothing herein '
shall prevent City for compensating PARTICIPATING PROVIDERS for services which do not
j constitute COVERED SERVICES underthis Agreement but nothing in this Agreement so requires, °
B. City shall pay such additional fees and charges as set out in DirectNet's PROPOSAL: and
.{%
any fees and charges shall be limited to the amounts included in the PROPOSAL.
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"1 V. INSURANCE
DirectNet, at its sole cost and expense, shall obtain or maintain coverage for general liability,
;k professional liability and other exposures as may be necessary to insure itself, its directors, and
employees against any liability, claims or damages arising by reason of acts or omissions of n< rx
DirectNet or its directors, or employees in the performance of its responsibilities under this u� , ; • ��,;;-¢•
Agreement. Upon request, DirectNet will provide evidence of such coverage and DirectNet shall
notify City promptly if it receives notice of the termination of such coverage in the event that it is
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;. not able to secure alternative coverage. Such coverage shall carry a minimum limit of$2,000,000.
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VI. TERM AND TERMINATION
A. Term
= Y This Agreement shall commence as of the Effective Date and shall continue in effect for initial term
of one(1)year of such date. Thereafter,this Agreement maybe renewed by agreement of the parties
for two successive one(1 )year periods unless sooner terminated by the parties hereto in accordance
•k4., with the provisions set forth in this Section VI. •
" I B, Voluntary Termination
Either DirectNet or City, may terminate this Agreement upon ninety(90) days prior written notice ;
` given at any time with or without cause. a z'
.r". •fi1.4;�tj;
f" C. Involuntary Termination
This Agreement may be involuntarily terminated by either party as follows; tis"=
I. If City fails to pay DirectNet, or any PARTICIPATING PROVIDER, amounts due under
this Agreement in accordance with the terms herewith and fails to make entire payment within five
(5)days of DirectNet's written notice of such failure,then DirectNet may terminate this Agreement
r° immediately without further notice. tk
' 2. If either party is in material default in the performance of the terms and conditions of this
3 Agreement, then the non-defaulting party may terminate this Agreement immediately upon written ;
notice upon the expiration of a thirty (30) day written notice (specifying the nature of the default) '
and cure period. T a
3. Either party can terminate this Agreement immediately upon written notice in the event that
the other party files for bankruptcy or is declared insolvent.
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D. In the event of the termination of this Agreement,City shall remain obligated to pay for any
services provided prior to the effective date of termination including, but not limited to, any
COVERED SERVICES provided by PARTICIPATING PROVIDERS.
VII. CONFIDENTIALITY AND PROPRIETARY RIGHTS
During DirectNet's perfon-nance of service hereunder, City may obtain information relating to the
business affairs of DirectNet which is highly confidential and proprietary including,but not limited
to, PARTICIPATING PROVIDER discount, claims data, and case management processes,
programs, systems and software.
City hereby agrees to treat such information as secret and confidential and to obligate its employees
and agents to treat such information as secret and confidential and not to disclose or make available
any such information to any fin-n, person or corporation or use it in any manner (except as
contempiated in this Agreement) without the prior written c onsent of DirectNet unless required by
valid court order or subpoena. This provision shall survive the termination of this Agreement.
2 VIII. RECORD RETENTION AND AUDIT
DirectNet shall maintain records pertaining to the performance of its obligations under this
Agreement. Such records shall be maintained for as long as this Agreement is in effect plus three
years unless otherwise required by law. DirectNet shall make its records available for its inspection
by City or any other a uthorized regulatory body or agency at reasonable times upon reasonable
notice in a manner consistent with laws and regulations relating to patient confidentiality.DirectNet
shall have the right, upon reasonable notice, to audit the records of City to verify the number of
EMPLOYEES covered under this Agreement.
IX. MISCELLANEOUS
A. Assignment hx
This Agreement may not be assigned by either party without the prior written consent of the other.
Consent shall not be withheld unreasonably.
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y; K f ��s e'k it`:,}afs 'd• {y'..4+7Y..;u, ,�L �i }.j 1 .fit �, .c' .,v rp+t :` ,1� lY°n�. .,,1J.,'•tv ,+S#y.t ;�;y S.••ty`t 1:'•i
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# B. Agreement Modification
„. This Agreement constitutes the entire understanding of the parties hereto and supersedes any and all
{ written or oral agreements, representations or understandings. No modifications, amendments or J t
Sr°
alterations shall be effective unless evidenced by an instrument in writing signed by both parties. 4 rjr „ ,JYY
Furthermore nei th er thi s A greem en t nor an y mod i fi cati o n s,amendments o r a I te rat i o ns t 11 c reo I's h a I I
k be considered executed by,or binding upon, DirectNet unless and until signed by a duly authorized
officer of IDireetNet.
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C. Invalid Provisions };W, V'y
Notwithstanding Section IX-B above, any provision of this Agreement which is in violation of an
state or federal laws or regulations shall be deemed amended to corrtor•rn with such laws or ,�'
regulations, pursuant to the terms of this Agreement, except that i f such change will materially and a
substantially alter the obligations of the parties under this Agreement, any such provision shall be �G;�? ` '`•
renegotiated by the parties. The invalidity or nonenforceability of any terms or provisions hereof
shall in no way effect the validity or enforceability of any terms or provisions hereof:
D. Governing Law
This Agreement shall be governed by and construed in accordance with the laws of the state al' ' " 1
Missouri,including but not limited to those laws and regulations governing Workers'Compensation.
tl Accordingly, City is hereby advised that the premium discount program available to Missouri
employers who direct their employees to receive medical services for work related illnesses and/or
injuries from DFireetNet is dependent upon the status of Missouri statutes and Department of
Insurance regulations. The premium discount program is subject to change as required to comply Mks �t.+ a b�T
'��;�t'`�` �� ;.�;;��':�?:
with these laws. A
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For example the premium discount program may be modified or terminated if Missouri ceases to '� ' ",av
require that the rates for Workers' Compensation insurance be set by the Missouri Department of
Insurance. In addition, an Employer who repeatedly fails to cooperate with DireetNet may have its
premium discount terminated by its insurer.
E. Reserved Right Of City Ott
i The City reserves the right to obtain services elsewhere. ,1
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