HomeMy WebLinkAboutAmendmentHffiCEIVED
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KITTIT.A.S COUNTY SHERIFF
This AMENDMENT, effective the lstday of June 2l2l,amends the AGREEMENT dated April
7n 2021between KVH Wor$lace Health (Clinic) and the Kittitas County Sheriff (Client), a
copy of which is attached hereto. Other than the terms specifically referenced herein, all other
terms and conditions of the existing AGREEMENT remain in full force and effect.
This AMENDMENT is entered into by the authority of section 9 of the AGREEMENT which
allows for the modification of the AGREEMENT when such modification is in writing and
signed by a duly authorized representative of the Parties to the AGREEMENT.
The purpose of this AMENDMENT is to ensure that the prices set in Exhibit "A" to the original
AGREEMENT are corrected to reflect the correct pricing structure. These prices are a reflection
of a standardized billing structure intended to ensure that the prices charged to all organizations
are accurate and equitable.
The following tests or examinations are impacted, with the original and corrected prices:
ORIGII.IALPRICE AMENDED PRICE
AUDIOGRAM: $55,00 $56.00
EKG: $75.00 $76.00
SPIROMETRY: $60.00 $7s.00
No other pricing or other term of the original AGREEMENT is changed in any manner
whatsoever.
IN WITNESS WHEREOF, the parties have executed this instrument to be effective as of the
Effective Date first above written.
For the Clinic: I For the Client: trl^ M-'
Dale Scott Olander
Chief FinancialOfficer
Clayt{nMyers
Sheriff
KYIJ,#
Youlr Llo'rfi,e for tle.a'Lth
KVH Workplace Health
Guarantor lnformation
XCheck if the same as physical address
Services Pricing
Physical Examination nstandard: $100
Audiogram nstandard: $56
Venipuncture nstandard:S22
CM P14+LP+CBC/D/Plt+TSHw/rflx T4F nstandard: $83
Non-Federal Drug Screen, 5 panel nstandard:$+s
EKG nstandard:$26
U/A with micro nstandard: $27
Stool Guaiac nstandard: $40
Range of Motion nstandard:S45
Spirometry nstandard: $25
PA Chest X-Ray (L view)nstandard: $100
L Spine X-Ray nstandard: $60
T Spine X-Ray Estandard: 560
Optional Services
Hep B Titer nstandard:560
Hep B lnjections, each (series of 3)nstandard:$103
PSA (if medically indicated)nstandard: $L00
Total w/o Optional Services Sttz
Lab and MRO
LabCorp house account
Forms/ Reporting Results
Report results via email to Kim Dawson
General lnformation
Company Name Kittitas County Sheriff's Office
Physical Street Address 307 W. Umptanum Rd
City, State, Zip:Ellensburg, WA 98926
Mailing Address (if different from physical)
Primary Contact Kim Dawson
Office Phone 509-962-7089
Contact Email Kim.dawson @co. kittitas.wa. us
Office Fax:
Secondary Contact (if applicable):
Secondary Contact Phone
Independent contractor occupatio*t }[g|5i;lil;e'
j.,rli i r /rirrOCCUPATIONAL MEDICINE SERVICES AGREEMENT " ,I '{.IT I
,ru.. fi ff YfnlTr"r*E (,. crin ic,r
*' tt' to t co uN rY'.HEB'FF
And
Kittitas 9ountv Sheriffs Office ("Client")
THIS AGREEMENT, effective the ?{}' day of l, (the "Effective Date"),
ls by and between KVH Workplace Health, having principal place of business at 702 E
Mountain View Ave., Suite 2, Ellensburg, Washington ("Clinic"), and Kittitas County Sheriffs
Offtce, having its principal place of business at307 W. Umptanum Rd., Ellensburg, Washington
("Client"). Clinic and Client may individually be referred to as a "Partr" or collectively as the
'oParties."
RECITALS
L Clinic's pu{pose is to provide occupational medicine services for persons within the Kittitas
County community that Clinic serves.
2 Client desires to obtain occupational medicine services that are reasonable and necessary for
certain employees of Client.
3. Client has determined it is in the best interests of its employees to contract with Clinic for
Clinic's services.
4. Clinic is willing to provide such services pursuant to the terms and conditions of this
Agreement.
NOW, THEREFORE, in order to provide for Clinic's provision of occupational medicine
services for Client's employees who have work-related health matters (the "Patients"), the
Parties agree as follows:
l. SERVICES. During the term of this Agreement and as provided below, Clinic will make
available to Client's Patients, as determined appropriate, the occupational medicine services
as described on Exhibit'oA" attached to and incorporated in this Agreement (the "services").
l.l Coordination of Services. Client, or its designee, will determine which of its employees
should be referred to Clinic as Patients for the purpose of assessment and determination of
the appropriate course of clinic care, and provision of Services. Client will communicate
with Clinic to schedule an appointment. Client will designate a contact staff person, or
designee, for communications between Client and Clinic with respect to the scheduling and
provision of Services to be provided. Client will pay Clinic for Services rendered as provided
in Section 4 and Exhibit "A" of this Agreement. If a Patient requires Services that are
covered by or subject to workers compensation insurance pursuant to a Washington State
program andlor pursuant to a self-insured program or other third party administrative
program, to the extent coverage for the cost of the Services is not accepted by any such
program, Client will pay Clinic for Services rendered as provided in Section 4 and Exhibito'A" of this Agreement.
1.2 Provision of Servicgs by Clinic. Clinic will be responsible for arranging the schedule for
provision of the Services at Clinic's location, determining the appropriate course of clinic
care by Clinic, providing Services, documenting the provision of Services, and billing Client
(and/or any program as described in Paragraph L1 above) for the Services rendered.
1.3 Licensure/Certification. Clinic will maintain appropriate licensure and/or certification as
required to provide the Services. Upon written request of Client, Clinic shall provide current
information with respect to the Services, documenting appropriate licensure, staff credentials,
including Washington State licensure and Medicare and Medicaid licensure/certification
when applicable. Clinic and Client each agree to notifu the other Party up reasonable
knowledge of circumstances that may threaten Clinic's licensure/certification.
1.4 Insurance. Clinic shall maintain professional liability insurance for the Services rendered
pursuant to this Agreement with limits of at least $1,000,000 per occuffence and $3,000,000
annual aggregate, which insurance shall provide coverage for all acts or omissions of Clinic
for those Services at the Clinic during the Term. Client shall be responsible for any
additional desired or required coverage. Clinic retains the right to choose any method of
professional liability protection including provisions for self-insured retention or purchase of
insurance policies during the Term.
1.5 Risk Management. Client shall immediately report to Clinic any concerns andlor complaints
of which Client becomes aware with respect to the provision of Services by Clinic.
2. STAFFING. The Clinic staff who will direct or provide Services to Client's Patients are
employees or independent contractors of Clinic. Clinic shall be responsible for the
compensation to the Clinic staff involved in the provision of the Services, and worker's
compensation, benefits and withholdings, as applicable.
Client shall be responsible for the compensation to Client's employees or independent
contractors, and worker's compensation, benefits and withholdings, as applicable. Client
shall designate an individual to act as its authorized representative for purposes of decision-
making with respect to the Services, as requested by Clinic.
No employee of either party will be considered to be an employee of the other party for any
purpose whatsoever at any time.
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3. TERM AND TERMINATION.
3.1 Term. This Agreement shall be for a term of one (1) year commencing on Effective Date and
shall continue for one (l) year, unless terminated sooner as provided by the terms of this
Agreement ("Initial Term"). Unless otherwise terminated, this Agreement shall
automatically renew for successive one (1) year terms ("subsequent Term(s)), unless aPafi
provides written notice of its intent to permit the Agreement to expire, which written notice
must be given at least 90 days before the end of the then current Term. The Initial Term and
the Subsequent Terms, if applicable, are referred to as the "Term."
3.2 Termination with 90-day Notice. Subject to the rights and duties imposed pursuant to this
Section 3, this Agreement may be terminated at any time, without cause, by giving the other
Party at least ninety (90) days' advance written notice, in which event this Agreement shall
terminate on the future date specified in such notice.
3.3 Termination Due to Defauh In the event of default by a Party of any covenant or obligation
hereof, which default is not cured within fifteen (15) days after receipt of written notice from
the non-defaulting Party describing such default (unless such default is not reasonably
capable of being cured, if curable, within such 15 days then if the defaulting Party fails to
commence the curing of such default within such l5 days or thereafter fails to complete such
cure within a reasonable time), the non-defaulting Party may terminate this Agreement upon
the giving of written notice of such termination.
3.4Immediate Termination. This Agreement may be terminated immediately if any payment
made hereunder is determined by opinion of Clinic's legal counsel, by a court of competent
jurisdiction or by an appropriate govemmental agency to be illegal or inconsistent with
Clinic's tax-exempt status or in violation of the federal Anti-Kickback Statute or the federal
Physician Self-Refenal Statute, as each may be amended from time to time. This Agreement
may also be terminated by either Party immediately upon the exclusion or suspension of the
other Party, or any employee of the other Party, from the Medicare, Medicaid, or any similar
govemment program.
3.5 In the event this Agreement shall terminate prior to the end of its Initial Term, the Parties
shall not enter into another agreement with one another until the expiration of the Initial
Term. Upon termination of this Agreement, Client shall pay Clinic for all Services
performed to the date of termination.
4. COMPENSATION. Client (and/or any program as described in Paragraph 1.1 of this
Agreement) will compensate Clinic for Services provided under this Agreement at the rate
agreed upon for the particular Services (as identified in Exhibit "A"), based upon the actual
Services provided. Clinic shall provide Client with invoices on a monthly basis for Services
provided and costs incurred and Client shall pay such invoice within ten (45) days of the
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invoice date. All fees and compensation received or realized as a result of the Services
provided by Clinic under this Agreement shall belong to and be paid and delivered to Clinic.
The Parties agree the above terms have been negotiated at arm's length and the compensation
is consistent with fair market value that does not take into consideration the volume or value
of any referrals or business otherwise generated or that may be generated between the Parties
for which payment may be made in whole or in part under Medicare or a State health care
program.
5. SPACE. EOUIPMENT AND ASSISTANCE. Clinic will make reasonably necessary space,
equipment, and supplies available in order for Clinic staff to provide the Services. Client
agrees to make its employees available as necessary and appropriate to coordinate the
provision of the Services by Clinic.
6. MEDICAL REPORTING REOUIREMENT. In the event the Services exceed $10,000.00
during the term hereof or during the combined term hereof and any preceding or succeeding
Agreement or renewal between the Parties, Client agrees, with, to and for the benefit ol the
Secretary of Health and Human Services ("HHS") or the Comptroller General of the United
States, and their authorized representatives including Medicare fiscal intermediaries, to grant
access for a period of seven (7) years after the end of the cost reporting period in which such
Services are fumished pursuant to this Agreement and to any similar Agreement between the
Parties and any organization related to Client and its books, documents and records to verifu
the costs of this Agreement in furnishing the Services in the event that the implementing
regulations issued by HHS are deemed applicable to the parties hereto and this Agreement.
Clinic agrees to cooperate with client to the extent necessary with regard to the maintenance
of records and to allow Client such access as may needed for any audit of fiscal practices and
compliance, and for Client to address it's obligations under the Public Records Act, RCW
42.56.
7. BINDING EFFECT/ASSIGNMENT. This Agreement shall be binding upon, and inure to
the benefit of, the Parties and their respective successors and assigns. Neither Party shall
delegate or assign its rights or duties under this Agreement without the prior written consent
of the other Party. Any delegation or assignment, without such consent, shall not relieve the
transferor or assignor of its duties or obligations under this Agreement. This provision shall
not be construed to prevent Clinic from engaging independent contractors to perform certain
Services.
LAW . All questions relative to the execution, validity,
interpretation and performance of this Agreement shall be governed by the laws of the State
of Washington. The Parties agree that any action related to this Agreement shall be instituted
and maintained as provided in Section 13. The Parties agree that venue for any action shall
lie in Kittitas County, State of Washington, and each Party waives the right to change of
venue.
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9. WAIVER AND MODIFICATION INEFFECTIVE UNLESS IN WRITING. No waiver,
alteration, or modification of any of the provisions of this Agreement shall be binding unless
in writing and signed by a duly authorized representative of both Parties.
10. COMPETITION. Client recognizes that Clinic has invested considerable time and money in
developing the knowledge and experience related to the Services. Client further recognizes
the fact that staffing costs, including but not limited to, recruitment, insurance, fringe
benefits, continuing education, and salary, are major expenses to Clinic. In consideration
thereof, Client agrees not to employ or offer employment to any present or former employee
or independent contractor of Clinic who may be involved in the provision of the Services, for
a period of one (l) year from the date of termination of his or her employment or contract
with Clinic.
ll.COMPLIANCE. Each Parfy agrees to comply with applicable laws, rules and regulations
with respect to the Services provided under this Agreement.
ll.1 HIPAA. Each party agrees to comply with all applicable laws, including the Health
Insurance Portability and Accountability Act of 1996, Subtitle F - Administrative
Simplification, and its implementing regulations as they currently exist and as from time to
time amended ("HIPAA") and Washington state law protecting the confidentiality of health
care information, including without limitation any requirement for a written release of
information from Client's Patient(s). The parties further agree to negotiate in good faith
any additional agreements or amendments to this Agreement that are necessary to ensure
compliance with HIPAA or state law. If after good faith negotiations the parties are not
able to agree to the terms necessary to comply with HIPAA or state law, this Agreement
may be terminated by either party upon written notice.
I 1.2 The parties are aware of laws prohibiting practices involving kickbacks, rebates, payments
for referrals, private inurement and the unauthorized practice of medicine. Each party
acknowledges that it has entered into this Agreement without intent to violate such laws
and believes that this Agreement does not violate such laws. Each party agrees to seek to
enforce this Agreement as it is written and not to assert that the relationship between the
parties is anything other than a bona fide contractual relationship.
If any federal or state law or regulation is interpreted by judicial decision, regulatory action
or a party's legal counsel in a manner that indicates that this Agreement may be in violation
of such law or regulation, the parties shall work in good faith to amend this Agreement as
necessary to comply with such law or regulation to the maximum extent possible, any such
amendment shall preserve the financial terms of this Agreement. If the parties are unable
to reach agreement on' an amendment that preserves the financial terms, the parties shall
unwind the financial terms and terminate this Agreement within a reasonable time.
12. RELATIONSHIP OF PARTIES. Clinic is an independent contractor in the provision of the
Services under this Agreement. This Agreement does not constitute either Party the agent or
3
representative of the other, or create a partnership or joint venture between the Parties, and
neither Party shall have the power to obligate the other in any manner whatsoever, except as
expressly provided herein. It is further expressly agreed that except with respect to the
obligations specifically set forth in this Agreement, Client neither has nor may exercise any
control over the professional medical judgment or methods used by Clinic in the performance
of the Services.
13. ARBITRATION. Should a dispute arise between the Parties as to the interpretation or
meaning with regard to the Services provided pursuant to this Agreement, the dispute shall
be resolved by binding arbitration. Either Party may, by written notice to the other Party at
any time after an impasse has been reached with regard to any dispute as to Services, appoint
an arbitrator. tf the other Party is not satisfied with the choice of arbitrator, then such Party
may, by written notice, within 15 business days after receipt of such notice by the first Party,
appoint an additional arbitrator. In default of such additional appointment of arbitrator by the
other party, the first arbitrator appointed shall be the sole arbitrator.
When two or more arbitrators have been appointed as provided above, they shall, if possible,
agree upon an additional arbitrator as necessary to avoid a deadlock, by written notice signed
by each of the appointed arbitrators and a copy mailed to each Party. Within 30 days after the
appointment of the arbitrator(s), the Parties shall submit all facts in written or oral form, and
under the procedure prescribed by the arbitrator(s). Thereafter, the arbitrator(s) shall have 30
days in which to reach a decision upon the matter presented. The decision of the arbitrator(s)
shall be binding upon both parties and shall be the conclusive, final determination,
Each Party shall bear its own cost of arbitration, including attorney's fees and fees for the
arbitrator appointed by such Party and a proportionate share of the fees of any arbitrator
appointed by the arbitrators to avoid a deadlock. If only one arbitrator is appointed, the
Parties shall share the cost of such arbitrator.
The provisions of this section shall not be applicable in the event Clinic seeks to legally
enforce payments due under this Agreement. In the event Client defaults with respect to
payment of compensation due under this Agreement, Clinic shall have every right to pursue
legal remedies for collection in a court of law in Kittitas County, Washington, without first
having to resort to arbitration. In the event such legal action is necessary with respect to
collection, the prevailing Party in such action shall be entitled to recover from the other all
reasonable attorney's fees, costs and expenses.
14. TNpEMNTFICATTON.
l4.l Client shall be responsible for the negligent acts or omissions of itself, its employees,
directors, trustees, consultants, and agents within the scope of their duties and agrees to
indemniff and hold harmless and defend Clinic, its directors, officers, employees,
volunteers, and agents from and against claims, suits, damages, fines, penalties, liabilities
and expenses (including reasonable attorney's fees and court costs) resulting from or
6
arising out of any negligent act or omission by Client or any of its directors, officers,
employees, agents or volunteers pertaining to the Services hereunder.
14.2 Clinic shall be responsible for the negligent acts or omissions of itself, its employees,
directors, trustees, consultants, and agents within the scope of their duties and agrees to
indemni$ and hold harmless and defend Client, its directors, officers, employees,
volunteers, and agents from and against claims, suits, damages, fines, penalties, liabilities
and expenses (including reasonable attomey's fees and court costs) resulting from or
arising out of any negligent act or omission by Clinic or any of its directors, officers,
employees, agents or volunteers pertaining to the Services hereunder.
14.3 Notice of Claim. The party seeking indemnification under this Section (the "Indemnified
Party") shall provide written notice within thirty (30) days after the receipt of any third
party claim covered hereunder to the party from whom indemnif,rcation is sought (the
"Indemnifying Party"). The Indemni$ing Party shall have the right to assume exclusive
control of the defense of such claim, or at the option of the Indemnifuing party, to settle
same. The Indemnified Party agrees to cooperate reasonably with the Indemni$ing Party
in connection with the performance by the Indemnifying Party of its obligations under this
Section, and failure to do so shall terminate the Indemnifying Party's obligations.
15. SEVERABILITY. The provisions of this Agreement are severable. If any one or more of
the provisions of this Agreement are held invalid by any court of competent jurisdiction or
are voided or nullified for any reason, the remaining provisions and paragraphs shall continue
in full force and effect and shall be binding on the parties so as to carry out the intent and
purposes as nearly as possible; provided, however, that any final determination of invalidity
which eliminates or minimizes the consideration due to either party hereunder shall entitle
such party to terminate this Agreement.
16. NOTICES. All correspondence and notices required to be sent hereunder shall be deemed
sufficient if in writing and if personally delivered, delivered by facsimile, or if mailed by
certified mail, postage pre-paid, return receipt requested to:
In the case of Client In the case of Clinic:
Attention: CEO
Kittitas Valley Healthcare
603 S. Chestnut Street
Ellensburg,WA 98926
Telephone: 509-962-7302
Facsimile : 509 -9 62-7 3 5 I
Telephone:
The designated representative and addresses may be changed as necessary by giving notice
in the same manner. Notice shall be deemed effective immediately if delivered personally
or by facsimile documented as successfully completed and effective 72 hours following
Facsimi
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delivery by certified mail
17. ENTIRE AGREEMENT. This Agreement and Exhibit "A" supersede all prior agreements
and understandings, whether written or oral, between the Parties regarding the subject hereof
and this Agreement and Exhibit o'A" constitute the entire understanding of the Parties
regarding the subject hereof. This Agreement and Exhibit "A" may only be amended by a
written agreement signed by both Parties.
18. NO THIRD PARTY RIGHTS. The Parties do not intend the benefits of this Agreement to
inure to any third person not a signatory hereto. Nothing in this Agreement or the course of
conduct by a Party shall be construed as creating any right, claim or cause of action against
either Party by any person or entity not a party to this Agreement.
19. NO ASSIGNMENI Client shall not assign, delegate, or otherwise transfer any duties or
obligations under this Agreement without the prior written consent of Clinic. Any effort to
do so shall be void and be cause for immediate termination of this Agreement by Clinic.
20. NO WAIVER. No failure by either Party to insist upon the strict performance of any
provision of this Agreement shall be construed as depriving that Party of the right to insist on
strict perfonnance of such provision or of any other provision in the future, and no waiver
shall be deemed to have been made unless expressly in writing and signed by the other Party.
21. BINDING EFFECT. This Agreement is binding on the parties and on their respective
executors, administrators, representative. successors and assigns.
22. CONSTRUCTION OF AGREEMEM. The parties agree that each party and its/his/her
counsel have participated in the review and revision of this agreement and that any rule of
construction to the effect that ambiguities are to be resolved against the drafting party shall
not apply in the interpretation of this Agreement and any Attachment or amendment.
23. COUNTERPARTS. This Agreement may be executed in one or more counterparts, each of
which shall be deemed an original, but all of which together shall constitute one and the same
instrument, notwithstanding the fact that each Party may not have executed the same
counterpart.
IN WITNESS WHEREOF, the parties have executed this instrument to be effective as of the
Effective Date first above written.
CLIENT:CLINIC:
By
Its
By
lts
8
EXHIBIT ''A''
SEE ATTACHED - KVH Workplace Health Service and Pricing Sheet.
KVH/agrservicesoccupmedicine0T3 I I TCLEAN
9
Kytffi
Yail'r Htwe frr Hookh
KVH Workplace Health
Company Name Kittitas County Sheriff's Office
Physical Street Address:307 W. Umptanum Rd
City, State, Zip:Ellensburg, WA 98926
Mailing Address (if different from physical)
Primary Contact:Kim Dawson
Office Phone s09-962-7089
Contact Email:Kim.dawson @co. kittitas.wa. us
Office Fax:
Secondary Contact (if applicable)
Secondary Contact Phone
ECheck if the same as physicaladdress
Company Name:
Street Address (Mailine):
City, State, Zip
Phone:
Fax
Physical Examination nstandard: $100
Audiogram nstandard: S55
Venipuncture nstandard: S22
Exec 1 Panel Dstandard:5gg
Non-Federal Drug Screen, 5 panel nstandard: S+s
EKG nstandard: $75
U/A with micro Istandard: Szz
StoolGuaiac nstandard:5q0
Range of Motion !standard:5q5
Spirometry nstandard: $60
PA Chest X-Ray (1 view)lstandard: 5100
L Spine X-Ray flstandard: $60
T Spine X-Ray trstandard: 560
Optional Services
Hep B Titer flstandard: 560
Hep B lnjections, each (series of 3)nstandard: 5103
PSA (if medically indicated)Estandard:5100
Total w/o Optional Services Sttz
K",)Jlffi
Yrwr Hnne fo'r uool'th
LabCorp
ere sperific ilF& instrurti*ns will go, where tct send paperwark, spe{ial biiling instructit.tns, etc
'thi:; is wh
) )t, ,l i'i. ;: i. t:,/ t\,.i.
Kittitas County
Review Form
Grants & Contract Agreement
Today's Date
June 21,2021
Agenda Date
2021
Fund/Department
30 / Sheriff
Contract I Grant Informatio n
Financial Information
Bud Information
Pass Throu Information
Contract /Grant Agency: SH21-014 Amendment to test/examination prices to the cunent Occupational
Medicine Services Agreement between KVH workplace Health Medicine and Kittitas County Sheriff s
Office.
Period Begin Date: June 1,202I Period End Date: one vear from start date
Total Grant/Contract Amount: n/a
Grant/Contract Number: SH2 I -014
ContracVGrant Summary: This is amending some test/examination prices to the current Agreement
between Kittitas County Sheriff s Office and KVH Workplace Health Medicine to conduct appropriate
pre-employment and other examinations.
Total Amount State Funds $0 Federal Funds $0
Percentage County Funds Matching Funds $0 CFDA# n/a
In-Kind $
Explain
Is Equipment being purchased? NO Who owns equipment? rVa
New Personnel being hired? NO Contact HR hiring - reporting requirements - rVa
Future impacts or liability to Kittitas County
Budget Amendment Needed?
New Division Created?
Yes! attach budget form No $ Why not - In Budget.
Revenue Code
Expense Code 00130xxx41 l3
Agency to Pass Through NA
Amount to Pass Through $o
Sub-Contract Approved Date:
Grant/Contract Review Page 1
Prosecutor Review
Has the Prosecutor reviewed this agreement?Yes[K NoL-.] CAMAS# 52134
Coun D rtments Im ted
Submitted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Signature: 4"* A++<r *t Date: Z-t/.2-t
Department: Stdrifl
ent of Trackin Information
Auditor's Office
Human Resource ""*2
Prosecutor's Office ! --\ '* aZl 7y
Who Siened the srant application /
Reviewer Date
Grant/Contract Review Page 2