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HomeMy WebLinkAbout1993-09-28; City Council; Resolution 93-276r! !i 0 0 4i KESOLUTION NO. 93-276 1 2 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD, CALIFORNIA, APPROVING THE SELECTION OF NATIONAL RESOURCE ASSISTANCE PROGRAM PROVIDER. 3 CONSULTANTS (NRC) AS THE CITY'S EMPLOYEE 4 5 6 WHEREAS, since January 1984, the City of Carlsbad has 7 8 offered an Employee Assistance Program (EAP) to its employees anc 9 their dependents; and 10 il WHEREAS, the City is interested in offering this service in thc 11 12 future using an alternate EAP provider; and 13 14 15 Consultants (NRC) be awarded the City's EAP contract. 16 NOW, THEREFORE, BE IT RESOLVED by the City Council of the I" City of Carlsbad, California, as follows: WHEREAS, staff has interviewed and evaluated five separate EAP providers and is recommending that National Resource 19 I.8 i 1. That the above recitations are true and correct. 20 2. That the City Council approves National Resource 21 Consultants as the City's Employee Assistance Program provider 22 23 24 3. That the City Council authorizes the attached contract 25 with National Resource Consultants to provide EAP services for thc 26 effective October 1, 1993. employees of the City of Carlsbad and their dependents. 27 28 I .r I1 0 0 *i 1 PASSED, APPROVED, AND ADOPTED at a regular meeting of the 2 3 4 Carlsbad City Council held on the 28th day of SEPTEMBER , 1993, by the following vote, to wit: 5 AYES: Council Members Lewis, Stanton, Kulchin 6 NOES: None 7 8 9 ABSENT: Council Members Nygaard, lo 11 ATTEST: 1211 &&& dp QALAL& 1.3 I ALETHA L. RAUTENKRANZ, City Cierk 1 14 15 (SEAL) l6 I1 17 18 19 20 21 22 23 24 25 I 26 27 28 0 0 NATIONAL RESOURCE CONSULTANTS, INC. GROUP SUBSCRIBER CONTRACT Agreement made and executed as of the 1 st day of October, 1993 by and betwee National Resource Consultants, Inc., hereinafter referred to as "NRC," and CITY 0 CARLSBAD, hereinafter referred to as "Group," is made with reference to the following fact A. NRC is a California corporation, licensed as a specialized box-Keene health cal service plan, whose primary purpose is to operate a specialized health care service plan offeri~ Employee Assistance Programs (EAPs). B. Group desires to obtain the services herein specified for and on behalf of Subscribers and Enrollees as defined herein. THEREFORE, the parties agree: ARTICLE I DEFINITIONS The following terms, when used in this Agreement or any amendments hereof are defirr as follows: 1.1 Act means the box-Keene Health Care Service Plan Act of 1975 (Califor Health and SafeFCode Sections 1340 et seq.). 1.2 Benefits mean those services an eligible Enrollee is entitled to receive hereunc 1.3 Group means any Employer, Labor Union or labor management Trust Fund, other Subscriber Group. 1.4 Enrollee is defined as a Subscriber and any eligible dependents as defined un the eligibility requirements of this Agreement and as determined by Group who are actus enrolled in and eligible to receive benefits under said Agreement. 1.5 Evidence of Coverage or Combined Evidence of Coverage and Disclosure Fc means the document issued to the Subscriber which summarizes the essential terms of Agreement. 1.6 Provider means a licensed California professional under contract to NR( perform assessment, brief counseling, and referral. This term also refers to outside professio who perform services upon referral from NRC. Ibkontr-kk\carlsbaQ bc 0 0 1.7 Regulations means those regulations promulgated and officially adopted by thc California Department of Corporations under the box-Keene Act. 1.8 Subscriber is defined as an eligible employee, retired employee or survivinl spouse who is otherwise eligible for coverage under the eligibility requirements determined b! Group, and who is enrolled hereunder and for whom periodic payments are made by a1 Employer. ARTICLE I1 PREPAYMENT FEES 2.1 Group shall pay NRC the total sum indicated in subparagraph 2.2, per quarter pt Subscriber. This rate is subject to change on an annual basis. NRC shall give Group 30 daj advance notice prior to change in rate. 2.2 Group shall pay to NRC a premium for each eligible Subscriber (which sha include dependents) as follows: $6.25 per employee per quarter. 2.3 The prepayment fee is paid by Group, unless other provisions for payment a: agreed to in advance by NRC. 2.4 Group shall send one check covering all Subscribers to NRC at the addre indicated in paragraph 9.3, commencing on the date indicated in paragraph 6.1, and continuir each month thereafter on said date for the duration of this contract. 2.5 Group acknowledges and understands that this contract provides solely a: exclusively for services to be performed at NRC provider facilities. This contract provides f services only, is not an insurance policy and does not indemnify nor reimburse any Subscril: or Group for the cost of health care services. 2.6 Group will furnish announcement brochures, management guidebooks, and ca as required by the program. 2.7 Group agrees to pay NRC for pre-approved travel expenses outside San Die county. ARTICLE I11 PRINCIPAL BENEFITS, EXCLUSIONS, LIMITATIONS AND ADMINISTRATIVE POLICIES 3.1 NRC and Group agree that NRC shall provide services to Subscribers of Grc under the Plan set forth attached as EXHIBIT ONE, except as limited in the Exclusions : Limitations section. EXHIBIT ONE IS AN ESSENTIAL PART OF THIS AGREEMENT. Ib\contr-kk\carlsbad bc 2 0 0 3.2 EAP Services must be obtained from NRC designated Providers by calling th NRC toll-free number 800-999-7222 or (61 9) 291-0330 in San Diego. 3.3 Additional services beyond the EAP may be covered by Group’s employee welfa benefit plan. ARTICLE IV HOW TO OBTAIN BENEFITS Benefits must be obtained from NRC designated EAP Providers by calli1 NRC. NRC provides a toll-free or local telephone number. In non-emergency situatior Enrollees are offered an appointment within 48 hours. NRC does not reimburse Enrollees f any unauthorized treatment from noncontracting providers. During business hours, any Enroll1 calling for service outside the NRC service area or with an emergency or urgent situation immediately referred to a licensed mental health professional for a telephone assessment. TI telephone assessor may provide crisis intervention over the telephone, arrange a same-d; appointment with the EAP Provider in the Enrollee’s area, locate an EAP Provider if necessar or assist the Enrollee in obtaining more intensive, acute care services. After business houl Enrollees are forwarded to NRC’s 24-hour phone number and receive a call from a licensl mental health professional for a telephone assessment within 15 minutes. ARTICLE V ELIGIBILITY 5.1 Group shall provide a monthly count of eligible Subscribers. Group shall se an eligibility list to NRC upon NRC’s request, specifying the names and other identifying d ’ for each Subscriber to be covered for the succeeding month. 5.2 The determination of who is eligible to be a subscriber and who is actually subscriber in the Plan shall be determined by Group, and NRC shall have the right to rely u~ that determination. Any disputes or inquiries regarding eligibility, including rights regardj renewal, reinstatement and the like, if any, shall be referred by NRC to Group, which shall t€ advise NRC of its determination. 5.3 Dependents shall include: a. The lawful spouse who shares the same household of the subscriber, all newborn infants whose coverage shall commence from and after moment of birth. Adopted children shall be covered from and after date of placement. Except as stated above, dependents shall be eligible coverage on the day the Subscriber acquires such dependent. lb\contr-kk\carlsbad bc 3 0 0 b. Dependents shall also include all unmarried children under the age o support and maintenance. Extension of eligibility may be made up to thl age of twenty-three (23) years for unmarried children who are principall: dependent upon the Subscriber and are registered students in regular, full time attendance at an accredited school, college or university. nineteen (19) years who are chiefly dependent on the Subscriber fo c. Coverage shall not terminate while a dependent child is and continues tl be (1) incapable of self-sustaining employment by reason of mentz disability or physical handicap; and (2) chiefly dependent upon th Subscriber for support and maintenance. d. Upon request, NRC may choose to extend the definition of dependent 1 include a significant other who shares the same household, parents in tf subscriber’s household who are chiefly dependent on the subscriber fc support and maintenance, or other person whose impact on the subscribc might adversely affect the subscriber’s well-being or work performanc If such a person is not covered under the Group’s definition of eligibilit the referral may be limited to specific community resources. ARTICLE VI COMMENCEMENT AND DURATION OF THIS CONTRACT TERMINATION - RENEWAL 6.1 Coverage shall commence at 12:Ol A.M. on October 1, 1993 for all Subscribe enrolled on the day when the Plan starts. Coverage for new subscribers shall commence at 12:l A.M. on the first day of employment or at the end of any Group designated probationary peric Coverage terminates at 11:59 P.M. on the last day of eligibility for participation in the Grot whether the last day of employment or the last day of eligibility for any continuation of covera period. 6.2 This contract shall be effective on the date indicated in paragraph 6.1 above, a shall continue until the end of the month of September, 1994. NRC shall not increase the am01 of prepaid payment, except upon at least 30 days written notice, nor shall NRC decrease benef in this agreement except upon 30 days written notice. 6.3 Renewal Provisions: The term of this contract shall be one year beginning the effective date of this contract at which time it may automatically be extended for th additional one-year periods or part thereof. Contract extension will be based upon satisfact1 performance and the Group’s needs. Or, the parties may renew this contract at the end of term hereof, and by mutual consent modify or alter this contract; provided, however, that s modifications, amendments, alterations or renewals shall be in writing, duly executed by b parties hereto, and attached to this contract. There is no individual right of renewal. Only gro are eligible to enter into or renew subscriber agreements with NRC. lb\contr-kk\carlsbad.bc 4 e 0 6.4 Termination Provisions: Should either party be in default by the failure t reasonably perform any of the covenants and conditions contained herein, the non-defaulting part shall have the right to give the defaulting party thirty (30) days written notice, specifying tk default. If the default is not cured, the contract will be terminated, excepting therefrom Group' failure to remit the monthly prepayment fees, or provide eligibility list as required, in which ca: fifteen (15) days written notice shall apply. The defaulting party shall then have the thirty (3( days, or fifteen (15) days in the case of the failure to remit the appropriate prepayment fees, ( eligibility list when due, from receipt of notice, in which to remedy the default or failure I perform. Both parties agree that NRC shall have the absolute right to terminate th contract should Group fail to remit the monthly prepayment fees or eligibility list, within tl fifteen (15) day period after notice. Receipt by the plan of the proper prepaid or periodic payment after cancellatir of the contract for nonpayment shall reinstate the contract as though it had never been cancell if such payment is received on or before the due date of the succeeding prepaid or perioc payment. The Plan may, if such payment is received more than 15 days after the issuance oft notice of cancellation, refund such payment within 20 business days and there will be : reinstatement of the contract. NRC will not terminate or fail to renew the eligibility of any individt subscriber or enrollee because of health status or use of the EAP. If any person believes that tl agreement has been terminated or any enrollee or subscriber has been denied services under tl agreement because of health status or requirements for health services, the enrollee may requc a review by the Commissioner of Corporations of the State of California. Both parties may terminate this Agreement immediately if the other party shot engage in fraudulent conduct with respect to this Agreement. This Agreement may be terminated at any time without cause by Group upon days written notice. 6.5 In the event of termination of this contract, each NRC participating provider ! agreed to complete all assessment, brief counseling, and referral services which have been star prior to the date of termination, pursuant to the terms of this contract. 6.6 Pursuant to Section 1365(b) of the box-Keene Act, any Subscriber who alle his enrollment has been canceled or not renewed because of his health status or requirement services, may request review by the California Department of Corporations. Ib\contr-kk\carlsbad.bc 5 0 0 ARTICLE VI1 ADMINISTRATION 7.1 With regard to the distribution of all materials, such as Combined Evidence ( Coverage and Disclosure Form and other materials required to be distributed pursuant to th Knox-Keene Act or any regulation issued pursuant thereto, Group shall be responsible t distribute such materials to the Subscribers andor eligible participants. 7.2 NRC shall also provide telephone or in-person emergency service twenty-fol hours a day, seven days a week, to all Enrollees. If the Enrollee’s provider office is unavailabll the Enrollee shall call NRC’s offices during normal business hours, or in the case of an afte hours emergency. 7.3 NRC agrees to duly investigate and resolve any and all complaints received fro Enrollees with regard to the nature of professional services rendered. Any inquiries or complain shall be made to NRC by writing or calling NRC at the address and telephone number indicatt herein. NRC shall maintain a grievance system in compliance with the box-Keene Act. Grievance Report Forms and copies of the Grievance Procedures are availab at each facility of the plan. Enrollees may send a written complaint or call NRC directly resolve their complaint. NRC will acknowledge receipt of the complaint and provide notice the complainant of whom may be contacted with respect to the complaint within 20 days. If the enrollee is not satisfied with the resolution offered at the first level, tl grievance is directed to the next management level. If the grievance is not resolved to the Enrollee’s satisfaction at the second levc it will be directed to the Quality Management Committee in the case of a quality of care issc or the Vice President, Operations or designee in the case of an administrative issue. The Quali Management Committee or the Vice President, Operations or hisher designee will review i applicable data within 15 days. The enrollee will be advised in writing of the findings and recornmendatio within 30 days of the receipt of the Grievance Report. Enrollees file a complaint or grievance by calling (619) 291-0330 in San Die or 1-800-999-7222 in all other areas regarding the complaint. Ib\contr-kk\carlsbad bc 6 0 0 ARTICLE VI11 QUALITY CONTROL AND PROFESSIONAL-PATIENT RELATIONSHIP 8.1 NRC is responsible for and agrees to arrange for services and care as herei provided in accordance with the prevailing professional standards. 8.2 It is expressly understood that the relationship between the Enrollee and NR participating professionals shall be subject to the rules, limitations, and privileges incident to tl doctor-patient relationship. NRC shall be solely responsible, without interference from Grot or any of its agents, to the Enrollee for arranging counseling and treatment. 8.3 It is understood by Group that the operation and maintenance of the participatir offices, and the rendition of all services shall be solely and exclusively under the control ar supervision of the NRC provider, including all authority and control over the selection of stai supervision of personnel, and operation of the professional practice, and/or the rendition of ar particular professional service or treatment. 8.4 NRC will undertake to see that the services provided to Enrollees by providc shall be performed in accordance with nationally accepted professional standards of reasonal: competence and skill of providers as applicable prevailing at the time of service. 8.5 If NRC shall subcontract any of the work to be performed under this contract NRC, NRC shall be fully responsible to Group for the acts and omissions of NRC’s subcontract and of the persons either directly or indirectly employed by the subcontractor, as NRC is for t acts and omissions of persons directly employed by NRC. Nothing contained in this contr; shall create any contractual relationship between any subcontractor of NRC and Group. NI shall bind every subcontractor and every subcontractor of a subcontractor by the terms of tl contract applicable to NRC’s work unless specifically noted to the contrary in the subcontraci question approved in writing by Group. ARTICLE IX GENERAL PROVISIONS 9.1 If a dispute should arise regarding the performance of work under this agreemc the following procedure shall be used to resolve any question of fact or interpretation ’ otherwise settled by agreement between parties. Such questions, if they become identified as 1 of a dispute among persons operating under the provisions of this contract, shall be reduced writing by the principal of NRC or the Group’s Human Resources Department. A copy of s’ documented dispute shall be forwarded to both parties involved along with recommended meth of resolution which would be of benefit to both parties. The Human Resources Departmen principal receiving the letter shall reply to the letter along with a recommended methoc resolution within ten (10) days. If the resolution thus obtained is unsatisfactory to the aggrie Ib\contrkk\carlsbad.bc 7 0 0 party, a letter outlining the dispute shall be forwarded to the City Council for their resolutior through the Office of the City Manager. The City Council may then opt to consider the directec solution to the problem. In such cases, the action of the City Council shall be binding upon tht parties involved, although nothing in this procedure shall prohibit the parties seeking remedie available to them at law. 9.2 Each party to this Agreement, together with their respective successors anc assigns, agrees to defend and indemnify the other parties to this Agreement and hold ther harmless from and against all loss, cost, claims, actions, liabilities and attorneys' fees arising i connection with this Agreement as a result of or attributable to the intentional act or negligenc of such party, or such party's officers, directors, employees, agents, or independent contractor: 9.3 Whenever it shall become necessary for either party to serve notice on the otht respecting this Agreement, such notice shall be in writing and shall be served by certified mai return receipt requested, addressed as follows: a. If served on Group, it shall be addressed to: CITY OF CARLSBAD Human Resources Department 1200 Carlsbad Village Drive Carlsbad, CA 92008-1 989 (619) 434-2852 b. If served on NRC, it shall be addressed to: NATIONAL RESOURCE CONSULTANTS, INC. 2835 Camino del Rio South, Suite 300 San Diego, California 92108 (619) 291-0330 9.4 NRC is subject to the requirements of Chapter 2.2 of Division 2 of the Hea and Safety Code (the "Act") and Subchapter 5.5 of Chapter 2 of Title 10 of the California Cc of Regulations (the "Regulations"), and any provisions required to be in the contract by either the above shall bind NRC whether or not provided in the contract. In the event that the Act or Regulations thereunder set forth any requireml which is not included herein or is contrary to this Agreement, it shall supersede the applica provisions of this Agreement and shall be binding unto the parties hereto. 9.5 Nothing contained herein shall preclude NRC from changing the location of r of its provider offices, as long as it retains a sufficient provider network to provide service: Group. Ib\contrXk\carisbad.bc 8 0 0 9.6 In the event any of NRC’s contracted participating Providers should terminat{ his relationship with NRC, breach his contract with NRC or be unable to render service! hereunder, and Group and/or its Subscribers will be adversely or materially affected, NRC wil give the Group and/or its Subscribers written notice thereof. 9.7 Upon termination of a provider contract, NRC shall be liable for covered service rendered by such provider to a Subscriber or Enrollee who retains eligibility under this contrac or by operation of law under the care of such provider at the time of such termination until th services being rendered to the Subscriber or Enrollee by such provider are completed, unless NR( makes reasonable and medically appropriate provision for the assumption of such services by contracting provider. 9.8 In the event that NRC fails to pay the participating Provider for costs c assessment, brief counseling, and referral, by statute the Enrollee shall not be liable to th Provider for any sums owed by the plan. In the event NRC or the employee’s full service healt plan fails to pay a non-participating Provider, the Enrollee may be liable to the non-participatin Provider for the cost of services rendered. 9.9 If any provision of this contract is held to be illegal or invalid for any reaso such decision shall not affect the validity of the remaining provisions of this contract, and su( remaining provisions shall continue in full force and effect unless the illegality or invalidi prevent the accomplishment of the objectives and purposes of this contract. 9.10 In the event Group is regulated under the Employee Retirement Income Securi Act of 1974 (ERISA), Group covenants and agrees that it and not NRC shall be responsible f meeting all requirements of ERISA. NRC will cooperate with Group in supplying Group wi any information within its possession to aid Group in meeting any ERISA reporting requiremen NRC is not and shall not be designated the administrator or fiduciary of the Plan. 9.1 1 If the Subscriber and/or Enrollees are eligible to retain coverage under tf contract during any Continuation of Coverage period or election period necessary for Groul compliance with requirements of the Consolidated Omnibus Budget Reconciliation Act (COBR and any regulations adopted thereunder, or any similar state law requiring the Continuation Benefits for Subscriber and/or Enrollees, the Group must continue to certify the eligibility of 1 Subscriber and/or Enrollees and pay the monthly prepayment fees for COBRA coverage for sc Subscribers and/or Enrollees. 9.12 This Agreement is non-assignable by either party without the prior writ: consent of the other party. NRC may, in its sole discretion, delegate administrative functions other entities. 9.13 NRC shall perform the services provided for herein in NRC’s own way as independent contractor and in pursuit of NRC’s independent calling, and not as an employec Group. NRC shall be under control of Group only as to the result to be accomplished, but SI consult with Group as provided for in the request for proposal. lb\contr-kk\carisbad.bc 9 0 0 NRC is an independent contractor of Group. The payment made to NR( pursuant to the contract shall be the full and complete compensation to which NRC is entitle( Group shall not make any federal or state tax withholdings on behalf of NRC. Group shall nc be required to pay any workers’ compensation insurance on behalf of NRC. NRC agrees t indemnify Group for any tax, retirement contribution, social security, overtime payment, c workers‘ compensation payment which Group may be required to make on behalf of NRC or an employee of NRC for work done under this agreement. NRC shall be aware of the requirements of the Immigration Reform and Contrc Act of 1986 and shall comply with those requirements, including, but not limited to, verifyin the eligibility for employment of all agents, employees, subcontractors and consultants that a included in this agreement. 9.14 This contract constitutes the entire agreement of the parties. This contract m; only be modified by a writing executed by the parties. IN WITNESS WHEREOF, the parties have executed this agreement on the date I forth on page one (1) hereof. CLAUDE A. LEWIS (Print) NATIONAL RESOURCE CONSULTANTS, INC. By: . /A34 ” &Q =? lu, /$&e/ Nicholas M. Krnich Presidl Ib\contr-kk\carkbad bc 10 0 0 EXHIBIT ONE PRINCIPAL BENEFITS, EXCLUSIONS, AND LIMITATIONS Benefits NRC agrees to provide the following services: 1. Ongoing consultation regarding the benefits provided in this Employee Assistanc Program Agreement, including the overall design, development, management ap implementation of such benefits. 2. Appropriate individual case management including: Evaluation of employee and family member problems, appropriate,brief counseling (or to six sessions per incident of treatment when the Enrollee’s or Enrollee’s fami member’s problem(s), in the judgement of the EAP Provider, are subject to significa improvement as a result of short-term care) and/or referral to screened resources f ongoing or specialized treatment or services. Consultation to Group employees and management to assist with reintegration employees who have been in alcohol or drug treatment or who have been absent due other mental health related reasons. Follow-up on each case to determine rate of success of the rehabilitation process or ne for further assistance. 3. Liaison between Group and all counseling and helping agencies that service Gro. employees and their families in matters related to the benefits available under t Employee Assistance Program. 4. Assistance with continuous and ongoing in-service training of Group superviso management, including one in-depth training session for Group personnel scheduled appropriate and consistent with business needs. 5. Assistance in providing information about the benefits available under the Emplo! Assistance Program to Group employees through pamphlets, posters and other appropri means. 6. Ongoing evaluation and reporting sufficient to enable Group to measure the effectiven of the Employee Assistance Program. 7. Ongoing formal recommendations for the upgrading and improvement of the Progr: including the development of an annual report of Employee Assistance Program resu 8. Critical incident debriefings, consultation and counseling in response to trauma at worksite, subject to the limitations stated herein. Ib\contrkk\carlsbad bc 11 e @ 4 EXHIBIT ONE PRINCIPAL BENEFITS, EXCLUSIONS, AND LIMITATIONS Limitations and Exclusions 1. Benefits under this Agreement are limited to a maximum of six sessions per incident treatment when the Enrollee’s or .Enrollee’s family member’s problem(s), in tl judgement of the EAP Provider, are subject to significant improvement as a result short-term care. NRC’s benefits work in conjunction with the benefits provided under tl Group’s full-service health plan that may cover, to the extent determined by the Grol services of physicians, hospitals, mental health and substance abuse providers. NRC is not responsible for the inclusion or exclusion of any particular health care bene in the Group full-service health plan. 2. Critical incident debriefings, consultation and counseling in response to trauma at t worksite shall be limited to short term intervention within the capacity of NRC’s provid network. In the case of massive trauma caused by major disasters or other events causi massive trauma, NRC shall not be responsible for the results of circumstances beyond control that prevent NRC from completely responding to all service requests. Ib\contrkk\carkbad.bc 12