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#14-6293 Amendment No. 2 (Millennium Physician Group) SECOND AMENDMENT TO AGREEMENT#14-6293 FOR "COLLIER COUNTY ON-SITE MEDICAL CLINIC" THIS AMENDMENT, made and entered into on this O day of(AK 2019, by and between Millennium Physician Group, LLC (the "Provider" or "Millennium") and Collier County,a political subdivision of the State of Florida, (the "County" or"Owner"): WHEREAS, on September 9, 2014 (Agenda Item 16.E.7), the County entered into an Agreement with Provider,with a commencement date of November 14,2014,to provide on-site primary care health services with an initial five-year term with five (5) additional one (1) year renewal terms; and WHEREAS, on October 10, 2017 (Agenda Item 16.E.2), the County approved the First Amendment to the Agreement expanding all four clinic models to include limited pharmacy services with reimbursement from the County for the actual cost paid by Provider with no additional markup to the County; and WHEREAS,the parties desire to further amend the Agreement to:(i)replace Exhibit A Scope of Services in its entirety by deleting the expanded language for options 2, 3, and 4, (ii) incorporate the Exhibit B-1 Fee Schedule to include pricing for the next five year period (years 6, 7, 8, 9 and 10), and (iii) renew the agreement for an additional five (5)year term. NOW, THEREFORE, in consideration of the mutual promises and covenants herein contained, it is agreed by the parties as follows: 1. The Exhibit A- Scope of Services is hereby replaced in its entirety with the attached. 2. The attached Exhibit B-1 Fee Schedule is hereby incorporated into the Agreement. 3. To renew the Agreement for an additional five (5) year period to begin on November 14, 2019 and ending on November 13,2024. SIGNATURE PAGE TO FOLLOW EXHIBIT A& EXHIBIT B-1 to follow Signature page **Remainder of this page left blank intentionally** Page 1 of 8 Second Amendment to Agreement#14-6293 o 1 (�.A IN WITNESS WHEREOF,the Parties have executed this Amendment on the date and year first written above by an authorized person or agent. ATTEST: Crystal K.]f ibzkl,'Cl2y1�of Courts& BOARD OF COUNTY COMMISSIONERS Comptroll•.. ••."9 6,:r. COLLIER CO • Y FLORIDA Vi � � � .., (SCJ• 0/0 By J . .C. By: �. :�, �,r ,r, , � vv,,iam L. McDaniel Jr.,Chairm.n Dated: (SEAL) '''ttest AS.tO Chairman's .ignature only. Provid• '• itnesses: PROVIDER: 1' ille i ;ium Physician roup,LLC / first Witness Bo L • .1___:k___Cfer//e-e- igna ure TTy e/print witness nameT r 1r. i'L---Y/ TType/print signature and titl T Second Witn 9 (ct. (( s /-6,5 Gl Date TType/print nameT Ap roved .s to o • ► -gality: . . 'each,Deputy County Attorney Agreement #14-6293 Collier County On Site Medical Clinic Page 2 of 8 Second Amendment to Agreement#14-6293 6i Agreement#14-6293 Collier County On Site Medical Clinic Exhibit A Scope of Services This Agreement is for On-Site Primary Care Health Services,utilizing an integral approach to promote a healthy and productive workforce through the provision of cost-effective onsite primary healthcare services to employees enrolled under the Collier County Group Insurance Plan,along with the provision of on-site limited pharmacy services 1. REQUIRED SERVICES-Current and General Services The Provider shall provide on-going support to onsite professional staff serving CCG through its corporate infrastructure and management resources,to include the following: 1. Provision of primary care services to employees,eligible spouses and covered dependents age fifteen(15) or older who choose to use the clinic for that purpose. 2. Occupational Injuries/illnesses treatment following a referral by the County's Occupational Health Nurse or Risk Analyst. 3. Treatment of non-occupational injuries/illnesses. 4. Treatment of episodic health conditions. 5. Phlebotomy Services. 6. Follow up blood chemistry screening and measurement. 7. Counseling on health related issues. 8. Maintain patient health records consistent with all applicable State and Federal laws, to include relevant privacy regulations and HIPAA guidelines. 9. The clinic will be expected to export lab and measurement results to CHP in a CVA or Excel format with the person's name and ID number they have been assigned by the medical plan administrator Allegiance Benefit Plan Administrations. Transfers are to occur on a weekly basis. The clinic will also be expected to retain this data in its own EMR. 10. Provide an electronic medical records system to house all screening data as well as the data that might be collected in the course of providing primary care and other services. Such medical record system will be required to interface with the HIE (Health Information Exchange) that may be established in Collier County. 11. The MedCenter will initiate and then transfer of medical records to the employee/spouse's primary care physician after seeking the appropriate releases from the patient. 12. Maintain open and frequent communication with CCG's Risk Management representatives regarding observable trends in workplace injuries and illnesses as indicated by patient utilization of onsite health care services. 13. Administer the Commit to Quit-Nicotine Cessation program, Take Charge Diabetes program and the New You Medically Managed Weight Loss program. Page 3 of 8 Second Amendment to Agreement#14-6293 cAc� 14. Limited Occupational Health and Worker's Comp treatment following a referral by the County's Occupational Health Nurse or Risk Analyst. 15. Claims for medical services are filed with current TPA for record keeping and payment purposes, as needed. Claim data must be submitted within thirty (30) days of the date incurred. 16. Foster efficient patient care by coordinating efforts with CHP Health Advocates and the CCG Wellness Program staff. 17. Clinical oversight and support of onsite professional staff; 18. Regular onsite visitation by the Manager of Client Operations, the Senior Director of Operations and other vendor senior management at appropriate intervals to ensure program success and client satisfaction; 19. Regular meetings with CCG's Risk Management and Wellness staff. The focus of these meetings is to: a. Address emerging issues regarding operations; b. Foster efficient operations and provide a platform to address questions and promptly address service concerns; c. Promote two-way communications to ensure that the clinic is fulfilling the needs of CCG and its employees; d. Assist the Provider in understanding the business practices and culture of the CCG;and e. Discuss the results of customer satisfaction surveys and other data and, where appropriate,formulate strategies and processes to address concerns 20. Training and oversight of onsite professionals; 21. Reporting of onsite health care facility and program activity consistent with CCG's requirements; 22. Training of the onsite staff in the use of information systems and ongoing support of the information systems used by the onsite staff in operating the program; 23. Nursing practice standards and protocols to be used by onsite professional staff; 24. Quality assurance programs to ensure compliance with practice standards by onsite professional staff; 25. Maintenance and replacement of medical equipment located in the onsite medical facility; 26. Maintenance of medical and medication supply inventory consistent with program needs; 27. Maintenance and replacement of information technology workstations,to include printers, copiers and fax machines; and 28. Maintenance of information systems applications operating on the medical facility workstations hosted by the selected vendor or its information technology partners. The onsite clinic currently has operating hours of 8:00 AM until 5:00 PM Monday through Friday and it is closed on County recognized holidays.The County reserves the right to modify Page 4 of 8 Second Amendment to Agreement#14-6293 CA the schedule to allow for evening and/or Saturday hours at no additional cost to the County provided the total hours per week do not exceed the current total operating hours. Quality Improvement and Grievance Procedures The Provider is an independent contractor and shall follow the practices and standards applicable to all similarly situated medical professionals. The Provider shall make every effort to accommodate the medical needs of patients according to these standards.The Provider shall establish a formal grievance process to address questions or complaints, if any, that may arise and shall maintain a continuous quality improvement process to address opportunities to improve medical services. The Provider shall address patient complaints and concerns in accordance with the grievance procedure required herein,and in accordance with the dismissal procedures under Exhibit C Provider Patient Dismissal Policy and Procedure,attached herein and incorporated by reference. Staffing for Current Clinic Model Staffing shall be based on the following staff: • Receptionist Staff-forty (40)hours per week • Medical Technician-forty (40) hours per week • PA-C- forty (40) hours per week • Physician Medical Director who is responsible for the general oversight of the clinic- two (2)hours per week • Administrative Services-two (2)hours per week CCG wants to continue to receive these services, however; the services under this Agreement are expanded and clarified to include three (3) additional potential options, as identified in Section 2 below. The Invest in Your Health Program The onsite clinic currently has operating hours of 7:30 AM until 5:00 PM,and is an integral part of the County's Health plan which includes an innovative wellness program referred to as Invest in Your Health Program.Under the program,covered employees and spouses do not have a choice of health plans in the traditional sense where an employee can buy better coverage. Under the plan that was implemented in 2009,employees earn their way to better coverage by completing a variety of"qualifiers" that are intended to help members become aware of their health status and act on that knowledge. These activities can be summarized as follows: • Have blood drawn and specific tests performed including Hemoglobin AIC, Fasting Glucose, Lipid Panel, Kidney Function (BUN, eGFR, Creatine, and Serum Cotinine. In addition to blood chemistry, the individual's weight, height, waist circumference, blood pressure and BMI are taken. Once the labs are processed,this information is relayed to the Health Advocates to follow-up with the member. This service is currently provided by Quest Diagnostics. Page 5 of 8 Second Amendment to Agreement#14-6293 CA • The member meets with a Health Advocate to discuss the results of the tests,measurements and reports. This service is provided locally in person by Community Health Partners (CHP) to those employees categorized with multiple health risks. The participants identified at high risk or with Diabetes also meet with the Wellness Educators. CHP and the Wellness Team will continue to provide this service and will coordinate efforts with the clinics. • Participate in programs that are provided by CHP and CCG's Wellness Manager which includes: o Programs include disease management programs offered by CHP for Gastric Bypass Nutrition Program. o Case management services for patients who have acute health episodes that result in significant expenses o Structured programs developed and coordinated by the CCG's Wellness Programs Manager. 2. CLINIC OPTIONS-BRIEF DESCRIPTIONS Additional clinic options may be considered, in addition to the Current Clinic (Option 1) for implementation in the future.These options are: Option 1: Current Clinic (Current and General Services), along with the provision of on-site limited pharmacy services as further set forth in Section 3, Clinic Options-Detailed Descriptions Option 2: Expanded Model Option 3: Medical Home Model Option 4: Primary Care Model The County reserves the right to phase the implementation of Options 2,3, and 4,beyond Option 1 over a period of time provided,in the County's sole opinion,that Millennium has the capability to deliver each of the options requested. It is understood that should the County wish to expand services in subsequent years and should a new location be required, Millennium shall assist the County in the required analysis and possess the required expertise to implement this expansion. 2.1. LABORATORY AND BIOMETRIC SCREENING SERVICES Under the Expanded,Medical Home,and Primary Care models,the CCG wishes for the Clinic to become the focal point for the Laboratory and Biometric Screening portion of the Invest in Your Health Program. The Provider shall be responsible for coordinating the annual Lab Draw and Biometric Screening program to assist members in meeting program qualifiers. The following laboratory panel will be measured as part of the program. The current laboratory panel shall consist of the following tests: Page 6 of 8 Second Amendment to Agreement#14-6293 • Hemoglobin A1C • Fasting Glucose • Lipid Panel • Kidney Function(BUN,eGFR,Creatine) • Serum Cotinine Any additional tests may be added to this list at the discretion of the County, and pricing for those tests shall be quoted in writing to the County and added to the existing price list. The cost to perform the draw shall be included in the clinic proposal price,however,the cost of the testing shall be billed separately to the County's third party administrator for payment. The CCG is interested in a simplified personal wellness report which communicates lab values, normative values and past values for comparison. The Provider shall also integrate lab values into a personal wellness profile report to be utilized by health coaches,clinic staff and wellness staff for health counseling purposes. The County reserves the right not to include the Laboratory and Biometric screening portion as part of the Provider's services,and to select a firm of its choosing. The County also reserves the right to implement the Laboratory and Biometric Screening Services portion of this Agreement in year two(2)or subsequent years of the Agreement. 4. CLINIC OPTIONS-BRIEF DESCRIPTIONS-DETAILED DESCRIPTIONS Option 1-Current Clinic Model-Duplicate the current clinic model, including the provision of on-site pharmacy services to be provided under all clinic models options, should they be implemented,under this Agreement,which will stock and dispense medications to treat acute episodic illness and chronic disease to include but not limited to: Flu Vaccine,antibiotics, and Steroid packs. Medications will be purchased directly from Provider and the County will reimburse Provider at actual cost paid with no additional markup to County. Staffing to match what is in the pricing sheet in Exhibit B. Page 7 of 8 Second Amendment to Agreement#14-6293 CA Exhibit B-1 FEE SCHEDULE Pricing-Years 6-10 ...-..1 6apiMe lead Ped bedded In meted C &,rend 22 Spam 12001 Dependents ear We SS• 101 • "time we WNW Crap G^q.. Yews 6 Year 7 Year/ Yew f Year 10 Cat Cow OP 1 Est Con OP 1 Eel Cat CM 1 Co.Con OP 1 En Cent OP 1 Option 1 Rate I••en Option l Roe Opt;en 1 Rate 1.. Option 1 Rets '' Option 1 Rate •'r Cur•emCyK Serr a _, .._ _...:et Ctnent Met Watt: [anent Clete Santa: CvrtM Gina:tercet -re %V.,-,tt a--t Corr(rote as PCPM1 5 1176 5 31616662 $ 1225 32641350 $ 1274 5 34196401 $ 1323 S 35164161 5 LIN S 37342691 a'ce Mee ca'S-ad et and,nt e".(5tate r PIM) 305 6I 10520 5 317 6507762 S 330 6641072 $ 343 92 019 95 . SN 5 96 610 95 Maratemert fee(nee u a KPMG 5 222 59 695 63 231 62 043 67 $ 241 S 6136701 $ 2S0 67,14969 S 1N 70.50711 Urp'e•rertat a+fee O.epa+m pid at incepton( $ • S 5 S S s S PROM/Estimated Anwel $ 17.06 5 457,66606 $ 17.74 5 475,976.7/ S 16.45 S 153,013.77 $ 19.19 5 51431432 S 2013 $ 540}53.06 .,.. .w Only.RadGtre NOT Ind.,' Curru.t Option 1 Curren Option I Current Olden l Covert Option 1 Current Option 1 Opts,1 Rate ITeW Caw 011 Option 1 Rate I Total Cat a.f opeio.t t Pete iatY taw'WI Option 1 Rete'Ttt.Itxt 051 Option 1 RoteTotalCert 011 ^[n6.Cen<'ArVtli Curare C.r.<:lr,.lel CrrtCw-,!r+:tt QlnMC.n<Serllei [vie at Coat knees '"n6 N 1116.1410•1.4Mott.p 510%4 COO(nate at ECK') $ 6h 1628591 $ 6Sl 169,)]195 ' 156 1'611251 $ 665 '. 113157 01 + 717 19231466 163 4 Oa<e kited..Sopprva and.naursnn(Stare at P(Pht1 a 157 S 4212975 S 163 5 43/1437 Ino 4556757 $ 177 S 47.15027 1.71579 htara5emert fee(Ade at P8P E( 113 30 1195197309 1 6.14 3325201 779 $ 5151209 5 131 5 )f 31120 !este..erne fee(lump we,peel at inception) • , . • , , /ra6rated M. S /.7/ S 235,09303 S 9.12 5 213,12701 $ 9.50 S 254,932.09 5 P.15 $ 265,12931 5 1036 S 271,3/515 rat PMPM 15 25 64 I 15 26.17 1 I$ 17.95l 15 row! 15 30 52 1 Per Daae Pmnr(Pneomaniaraconel 5 21000 5n:r6.i<ISlOnttnratone•Serve al 2) $ 315.00 banded Cede Ree 507 S 2002 . 10012 50 • rowed Anneal S 10,012 50 (1°1-.----- Page 8 of 8 Second Amendment to Agreement#14-6293 ACCPREPat CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/21/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Ashlee Hill NAME: Iron Ridge Insurance PHONE (800)775-8526 FAX No: (239)288-7544 (A/C,No,Ext): ( ) 4971 Royal Gulf Circle E-MAILSS: ahill@ironridgeinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Fort Myers FL 33966INSURER A: National Fire&Marine Insurance Company 20079 INSUREDINSURER B: Technology Insurance Company 42376 Millennium Healthcare,LLC INSURER C: 6321 Daniels Parkway INSURER D: Suite 200 INSURER E: Fort Myers FL 33912 INSURER F: COVERAGES CERTIFICATE NUMBER: CL1952104612 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD wVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A Y HN010657 05/28/2019 05/28/2020PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 3,000,000 PRO X 00000 POLICY JECT LOC PRODUCTS , OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE Y EN010657 05/28/2019 05/28/2020 AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE NIA TWC3767481 01/01/2019 01/01/2020 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1 000 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Contract#11-573-NS Auto Coverage as follows: Policy#BAS-19-58360034;Ohio Casualty Insurance Company,$1,000,000 CSL,effective 11/20/18-11/20/19 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Collier County Board of County Commission ACCORDANCE WITH THE POLICY PROVISIONS. 3299 Tamiami Trail East AUTHORIZED REPRESENTATIVE Suite 303 \\ �,p Naples FL 34112-5746 rVR.I�N..,µ . t.PLu 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds Millennium IPA, LLC (462881666) Limited Liability Company, Additional Named Insured Millennium Physician Group, LLC (262909414) Limited Liability Company, Additional Named Insured ProCare Med, LLC d/b/a Millennium Accountable Care Limited Liability Company, Additional Named Insured OFAPPINF(02/2007) COPYRIGHT 2007,AMS SERVICES INC