FIRST AMENDMENT TO SERVICE PROVIDER AGREEMENT
This Amendment of the Agreement, entered into this Ist day of September 2018, by and between the CITY OF ALAMEDA, a municipal corporation (hercinafter "City") and The Permanente Medical Group, Inc., a California Corporation whose address is 1800 Harrison Street, gth Floor, Oakland, CA 94612, (hereinafter " Provider"), is made with reference to the following:
RECITALS:
On September 1, 2015, an agreement was entered into by and between City and Provider (hereinafter " Agreement") with compensation not to exceed $200,000.
B. City and Provider desire to modify the Agreement on the terms and conditions set forth herein.
NOW, THEREFORE, it is mutually agreed by and between the undersigned parties as follows:
Paragraph 1 of the Agreement is modified to read as follows:
The term of this Agreement shall commence on the I" day of September, 2015, and shall terminate on the 31" day of August, 202l, unless terminated earlier as set forth herein per Section
19. This contract may be amended to add up to one additional three year term, based upon satisfactory performance by the provider and upon the discretion and agreement of both parties:
provided, however, that with respect to any term beginning on or after July 2, 2021, Provider may revise the billing rates set forth in Exhibit A with respect to any three-year renewal term. In such event, Provider will provide at least sixty (60) days prior written notice to the City of any such changes in rate.
Paragraph 3A of the Agreement is modified to read as follows:
Service Provider shall be compensated for the Services performed in accordance with this Agreement at the hourly rates set forth in Exhibit A. Payment under this contract shall not exceed $230,000 for the three year term. Payment shall be made by checks drawn on the treasury of the City.
3. Paragraph 8 of the Agreement is modified to read as follows:
To the extent prohibited by law, there shall be no discrimination or harassment of any kind ased on any statutorily (federal, state or local) protected class, including but not limited to; race religious creed, color, national origin, ancestry, physical disability (including HIV and AIDS) mental disability, medical condition (ex. Cancer), genetic information, marital status, sex, gender. gender identity, gender expression, age, sexual orientation, pregnancy, political affiliation, militar and veteran status or legitimate union activities, against any employee or applicant for employmen Exhibit A to the Agreement is deleted and replaced with a new Exhibit A in the form attached hereto.
AMEND. AGR
Except as expressly modified herein, all other terms and covenants set forth in the Agreement shall remain the same and shall be in full force and effect. 6/10/0:
MEND. AGI
IN WITNESS WHEREOF, the parties hereto have caused this modification of Agreement to be executed on the day and year first above written.
The Kaiser Permanente Medical CITY OF ALAMEDA
Group, Inc. A California Corporation A Municipal Corporation alL
Chris Palkowski, Elizabeth D. Warmerdam
Chair of the Board Acting City Manager
RECOMMENDED FOR APPROVAL:
Chief Financial Officer nar
Nancy Bronstein
Human Resources Director
APPROVED AS TO FORM:
City Attorney
aricker
Janet C. Ker
City Attorney
06/10/03
AMEND.AGH
City of Alameda
Exhibit A
Billing Code Description of Services Cost of Services
PREPLACEMENT EXAM (PP1)
300388 Preplacement Physical Exam $65.00
As Employer Requested:
86580 PPD, one placement and one reading $20.00
300422 PPD, two step 2 placement and readings $30.00
92552 Audiogram, screening $30.00
300413 Form Completion (2 or more pages for DMV/DOT Exam) $25.00 90746 Vaccine: Hepatitis B, may need series of 3 injections $94.00/injection 90632 Hepatitis A vaccine (Havrix), may need series of 2 injections $96.00/injection 86317 Titer: Rabies Antibody Testing $43.00
300411 Collection for Drug Screen-Preferred Alliance Billed by Preferred Alliance
As Clinically Indicated:
94010 Spirometry $35.00
93000 EKG, resting $50.00
93015 Cardiac Stress Test with Treadmill $230.00
71045 Chest X-Ray, 1 view $55.00
71046 Chest X-Ray, 2 views $65.00
90675 Rabies Vaccine, series of 3 injections $371.00/injection 92081 Visual Exam Extended $62.00
PREPLACEMENT EXAM (POSTPP)
300399 POST Physical Exam $95.00
92552 Audiogram, screening $30.00
94010 Spirometry $35.00
93000 EKG, resting $50.00
93015 Cardiac Stress Test with Treadmill $230.00
86580 PPD, one placement and one reading-OR- $20.00
300422 PPD, 2 step, 2 placements and readings T $30.00
85025 CBC with automated differential $15.00
80053 Chem Comprehensive Panel $35.00
86706 Hepatitis B Surface Antibody, HBsAb $31.00
86704 Titer: Hepatitis B Core Antibody, HBcAb $31.00
86803 Titer: Hepatitis C $45.00
36415 Venipuncture $15.00
300411 Collection for Drug Screen-Preferred Alliance Billed by Preferred Alliance As Clinically Indicated:
90632 Hepatitis A vaccine (Havrix), may need series of 2 injections $96.00/injection 90746 Vaccine: Hepatitis B, may need series of 3 injections $94.00/injection 90707 Vaccine: MMR injection, may need series of 2 injections $76.00/injection 90716 Vaccine: Varivax (chickenpox), may need series of 2 $132.00/injection injections
90715 Vaccine: Tdap (tetanus, diphtheria, pertussis) $63.00 -OR-
90714 Vaccine: Td $34.00
90658 Vaccine: Influenza; flu (when seasonally available) $20.00 81001 Urinalysis with microscopic (if abnormal UA dipstick) $15.00 710145 Chest X-Ray, 1 view - $55.00
71046 Chest X-Ray, 2 views - $65.00
PREPLACEMENT DISPATCHER EXAM (DISPATCH)
300388 Preplacement Physical Exam $65.00
92552 Audiogram, screening $30.00
DRUG SCREEN (DRUG) PREFERRED ALLIANCE
300411 Collection for Drug Screen-Preferred Alliance Billed by Preferred Alliance As Indicated:
82075 Breathalyzer, alcohol screen Billed by Preferred Alliance 300421 Breathalyzer, alcohol confirmatory test (positive screen test) Billed by Preferred Alliance
DMV/DOT EXAM (DMV)
300390 DMV/DOT Physical Exam $115.00
AUDIOGRAM (AUD)
92552 Audiogram, screening $30.00
As Clinically Indicated:
300408 Physician Consultation; each 15 minutes $60.00
PPD/TB Clearance Baseline/Annual/Periodic (PPD/TB)
86580 PPD, one placement and one reading T $20.00
As Clinically Indicated:
71045 Chest X-Ray, 1 views $55.00
71046 Chest X-Ray, 2 views $65.00
300422 PPD, 2 step, 2 placements and readings $30.00
99211 Brief encounter with non-MD Provider (PPD-Review Of $20.00 Symptoms Form)
VACCINATION ONLY (VAX)
90632 Vaccine: Hepatitis A (Havrix), may need series of 2 injections $96.00/injection 90746 Vaccine: Hepatitis B, may need series of 3 injections $94.00/injection 90675 Rabies Vaccine, series of 3 injections $371.00/injection RESPIRATOR CLEARANCE BASELINE OR PERIODIC (with RESP Fit testing) 300415 Review of Respirator Questionnaire by MD/NP/RN $35.00 300410 Respirator Fit Test, qualitative (When employer requested) $35.00 As Clinically Indicated:
71046 Chest X-Ray (2 views) $65.00
300391 Respirator Physical Exam $60.00
93000 EKG, resting $50.00
93015 Cardiac Stress Test with Treadmill $230.00
94010 Spirometry $35.00
300408 Physician Consultation; each 15 minutes $60.00
FIREFIGHTER PREPLACEMENT EXAM (FFPP)
300398 Firefighter Physical Exam $95.00
300411 Collection for Drug Screen-Preferred Alliance Billed by Preferred Alliance 92552 Audiogram, screening $30.00
94010 Spirometry $35.00
300422 PPD, two step, 2 placements and readings $30.00
71046 Chest X-Ray, 2 views (baseline) $65.00
85025 CBC with automated differential $15.00
80053 Chem Comprehensive Panel $35.00
86706 Hepatitis B Surface Antibody, HBsAb $31.00
86704 Titer: Hepatitis B Core Antibody, HBcAb $31.00
86803 Titer: Hepatitis C $45.00
36415 Venipuncture $15.00
93000 EKG, resting $50.00
93015 Cardiac Stress Test with Treadmill $230.00
As Clinically Indicated:
90746 Vaccine: Hepatitis B, may need series of 3 injections $94.00/injection 90632 Vaccine: Hepatitis A (Havrix), may need series of 2 injections $96.00/injection 90707 Vaccine: MMR injection, may need series of 2 injections $76.00/injection 90716 Vaccine: Varivax (chickenpox), may need series of 2 $132.00/injection injections.
90658 Vaccine: Influenza; flu (when seasonally available $20.00 90715 Vaccine: Tdap (tetanus, diphtheria, pertussis) $63.00 -OR-
90714 Vaccine: Td $34.00
86580 PPD, one placement and one reading (no charge to current $20.00 KP HP members)
81001 Urinalysis with microscopic (if abnormal UA dipstick) $15.00
ONSITE SERVICES NURSING
300418 Site: Nursing Onsite each 15 min. (minimum one hour) $30.00 300412 Administrative Activity $60.00
Vision Testing
99173 Visual screen only, near, far, color, depth $25.00 As Clinically Indicated:
92081 Visual Exam Extended | $62.00