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HomeMy WebLinkAboutAgenda Report - January 18, 2023 C-10CITY OF f01o i CALIFORNIA AGENDA ITEM Ca /0 COUNCIL COMMUNICATION AGENDA TITLE: Adopt Resolution Approving Renewal of Chiropractic Benefit Administration Agreement with Landmark Healthplan of California; and Further Authorizing the City Manager to Execute Agreement MEETING DATE: January 18, 2023 PREPARED BY: Human Resources Manager RECOMMENDED ACTION: Adopt Resolution Approving Renewal of Chiropractic Benefit Administration Agreement with Landmark Healthplan of California; and Further Authorizing the City Manager to Execute Agreement BACKGROUND INFORMATION: The City of Lodi is contracted with Landmark Healthplan of California to provide chiropractic services to the City's full-time employees and COBRA participants. This chiropractic plan is a stand alone policy separate from the City's medical plans offered through CalPERS. The term of this agreement shall begin on February 1, 2023 and continue in effect until January 31, 2024. This contract shall automatically renew for successive one-year terms on each anniversary of the commencement date of this Agreement. The city may terminate this Agreement by providing Landmark Healthplan with 30 calendar days' prior written notice. FISCAL IMPACT: Annual cost of approximately $70,000. FUNDING AVAILABLE: Included in Benefits Fund appropriations (65522000), Adele Post Human Resources Manager OOAI&Ar X.�JhJ Andrew Keys Deputy City Manager/Internal Services Director APPROVED: OjrtA� /uviod Stephen Schwabauer, City Manager AMENDMENT to the GROUP AGREEMENT Between City of Lodi And LANDMARK HEALTHPLAN OF CALIFORNIA, INC This Amendment dated February, 2023, is entered into by and between City of Lodi ("Group"), and Landmark Healthplan of California, Inc. ("Plan"), collectively referred to herein as "Parties", in order to modify the Group Agreement ("Agreement"), February 1, 2021, as amended. In consideration of the recitals, covenants, conditions, and promises contained in the Agreement, the Parties agree to modify the Agreement as follows: 1. Cover Sheet, Provision 1, "Periodic Charges" is deleted in its entirety and replaced with the following: Renewal For Current Benefits $10 copay/40 visits Chiropractic Current Rates $5.71 S11.47 Family 1 $15.00 Renewal Rates $6.57 $13.19 $17.25 All other provisions of the Agreement, its Addenda or Amendments not inconsistent herein shall remain in full force and effect. Pursuant to Section 3.06 of the Agreement, this Amendment is effective on the day and year set forth above. Please sign digitally and return via email or sign and fax to (916) 307-5250 Signature Date Stephen Schwabauer City Manager Print Name and Title Approved as to Form: JANICE D. MAGDICH City Attorney EXHIBIT A&B SCHEDULE OF BENEFITS Chiropractic Benefit Your Employer Group has contracted with Landmark Healthplan of California, Inc. (Landmark) to provide you with a chiropractic benefit that requires the use of Participating Chiropractors. You can obtain a direc- tory of Participating Chiropractors through your employer, plan administrator, or Landmark, or you can access a continuously updated directory on Landmark's Web site at www.LHP-CA.com under the "Mem- ber" option. You may also call Landmark's Customer Service Department at 1-800-298-4875, option 2, for referrals to Participating Practitioners in your area. FREE LANGUAGE ASSISTANCE IS AVAILABLE If you need help in understanding your Landmark chiropractic benefits or need help to handle an issue about your benefits, please contact Landmark's Customer Service Department at 1-800-298-4875, option 2, between 8:30 AM and 5:00 PM, Monday through Friday, for free help. We can also help you in lan- guages other than English. If you or your dependents would like Landmark and your doctor to use a specific language when speaking or writing to you, please go to https://www.LHP-CA.com/Survey.aspx on the Internet and complete Land- mark's brief language preference survey. The survey only takes about 3 minutes to complete and your answers will be strictly confidential. If you prefer to complete a paper copy of this survey, you may re- quest one by writing to us at: Landmark Healthplan of California, Inc. Attn: QM Dept. -SURVEY 2629 Townsgate Road, Suite 235 Westlake Village, CA 91361 *X-ray Services must be prescribed by a Participating Chiropractor. **Services provided by Non -Participating Chiropractors are covered for Emergency Services only. ***Durable Medical Equipment must be prescribed by a Participating Chiropractor. A. Covered Services 1. Chiropractic Treatment Covered Chiropractic Services are those within the scope of chiropractic care that are support- ive to help Members achieve the physical state enjoyed before an injury or illness and that are furnished for the diagnosis and/or treatment of a neuromusculoskeletal condition associated with an injury or illness including the following sevic- es: ■ Examinations ■ Manipulation ■ Conjunctive Physiotherapy ■ X-rays ■ Emergency Services 2. Emergency Services Emergency Services are covered for the sudden and unexpected onset of an acute illness, ex- treme neuromusculoskeletal pain or accidental injury to the nervous, musculoskeletal and/or skeletal body systems, that, in the reasonable judgment of the Member, requires immediate care, the delay of which could decrease the like- lihood of maximum recovery, and for which the Member seeks to secure chiropractic services immediately after the onset, or as soon thereaf- ter as practicable. Emergency Services do not require pre -authorization; however, Emergency Services rendered by a Non -Participating Chiro- practor are subject to Landmark's determination Landmark Healthplan of California, Inc. • 2629 Townsgate Road, Suite 235 • Westlake Village, CA 91361 • 1-800-298-4875 Page 1 Benefits and Co -payments Office Visit $10 co -payment Maximum Annual Visits 40 visits X-ray Services* $75 annual maximum benefit Emergency Care** I Same co -payment as office visit Durable Medical Equipment Purchase or Rental*** 1 $50 annual maximum benefit *X-ray Services must be prescribed by a Participating Chiropractor. **Services provided by Non -Participating Chiropractors are covered for Emergency Services only. ***Durable Medical Equipment must be prescribed by a Participating Chiropractor. A. Covered Services 1. Chiropractic Treatment Covered Chiropractic Services are those within the scope of chiropractic care that are support- ive to help Members achieve the physical state enjoyed before an injury or illness and that are furnished for the diagnosis and/or treatment of a neuromusculoskeletal condition associated with an injury or illness including the following sevic- es: ■ Examinations ■ Manipulation ■ Conjunctive Physiotherapy ■ X-rays ■ Emergency Services 2. Emergency Services Emergency Services are covered for the sudden and unexpected onset of an acute illness, ex- treme neuromusculoskeletal pain or accidental injury to the nervous, musculoskeletal and/or skeletal body systems, that, in the reasonable judgment of the Member, requires immediate care, the delay of which could decrease the like- lihood of maximum recovery, and for which the Member seeks to secure chiropractic services immediately after the onset, or as soon thereaf- ter as practicable. Emergency Services do not require pre -authorization; however, Emergency Services rendered by a Non -Participating Chiro- practor are subject to Landmark's determination Landmark Healthplan of California, Inc. • 2629 Townsgate Road, Suite 235 • Westlake Village, CA 91361 • 1-800-298-4875 Page 1 that the Member would reasonably have consid- ered that Emergency Services were required. Emergency Services rendered by a Non -Participating Chiropractor are covered only when the chiropractor rendering services can show that the services were for a neuromuscu- loskeletal condition and were provided to reduce the severity of the condition including pain until a Participating Chiropractor could safely assume treatment. Similarly, Emergency Services re- ceived outside of Landmark's Service Area will be covered only when the Non -Participating Chi- ropractor rendering services can show that the services were for a neuromusculoskeletal condi- tion and were provided to reduce the severity of the condition including pain until a Participating Chiropractor could safely assume treatment. Un- der the Landmark Plan, emergency care must be transferred to a Participating Chiropractor as soon as such transfer would not create an un- reasonable risk to the Member's health. B. Second Opinions and Referrals 1. Second opinions On occasion, a Participating Chiropractor may require a second opinion, which is for consulta- tion only, from another chiropractor. Landmark does not require an authorization for any second opinion. Second opinions initiated by your Par- ticipating Chiropractor will not count against your maximum annual visits and will not require a Member office visit co -payment. Second opinions initiated by Members do not require prior authorization but will count against the maximum annual visits and will require a Member office visit co -payment. 2. Referrals to non -chiropractic practitioners For referrals to non -chiropractic practitioners, Members or enrollees of full-service plans or HMOs will be referred to the plan or HMO practi- tioner network for non -neuromusculoskeletal conditions, conditions not improving with chiro- practic care, and other such services that cannot be provided by another Participating Chiroprac- tor. C. Limitations and Exclusions Circumstances Causing Services to be Excluded or Limited 1. Services provided by a Non -Participating Chiropractor, except for emergencies 2. Services provided outside of Landmark's Service Area, except for emergencies 3. Services incurred prior to the beginning or after the end of coverage 4. Services that exceed the maximum covered visits for the benefit year 5. X-ray services that exceed the annual max- imum benefit 6. Charges incurred for missed appointments 7. Educational programs 8. Pre-employment, school entrance, or athlet- ic physical exams 9. Services for conditions arising out of em- ployment, including self-employment or cov- ered under any workers' compensation act or law 10. Services for any bodily injury arising from or sustained in an automobile accident that is covered under an automobile insurance pol- icy 11. Charges for which the Member is not legally required to pay 12. Services rendered by a person who ordinari- ly resides in the Member's home or who is related to the Member by marriage or blood. Specific Services that are Excluded or Limited 1. Drugs, vitamins, nutritional supplements, or herbs 2. Experimental or investigational services 3. Vocational, or long-term rehabilitation 4. Hypnotherapy, behavior training, sleep ther- apy, or biofeedback 5. Rental or purchase of Durable Medical Equipment (DME) 6. Treatment primarily for purposes of weight control 7. Lab services 8. Thermography, hair analysis, heavy metal screening, or mineral studies 9. Transportation costs, including ambulance charges 10. Inpatient services 11. Massage 12. Manipulation under anesthesia 13. Services related to diagnosis and treatment of jaw joint or TMJ disorders 14. Treatment of non -neuromusculoskeletal dis- orders 15. Advanced diagnostic services, such as MRI, CT, EMG, SEMG, and NCV Landmark Healthplan of California, Inc. • 2629 Townsgate Road, Suite 235 • Westlake Village, CA 91361 • 1-800-298-4875 Page 2 RESOLUTION NO. 2023-16 A RESOLUTION OF THE LODI CITY COUNCIL APPROVING RENEWAL OF CHIROPRACTIC BENEFIT ADMINISTRATION AGREEMENT WITH LANDMARK HEALTHPLAN OF CALIFORNIA; AND FURTHER AUTHORIZING THE CITY MANAGER TO EXECUTE THE AGREEMENT ------------------------------------------------------------------------ ------------------------------------------------------------------------ WHEREAS, the City of Lodi utilizes Landmark Healthplan of California for the administration of the chiropractic benefits offered to City of Lodi employees. NOW, THEREFORE, BE IT RESOLVED that the Lodi City Council does hereby approve the renewal of the Chiropractic Benefit Administration Agreement with Landmark Healthplan of California; and BE IT FURTHER RESOLVED that the City Council does hereby authorize the City Manager to execute the agreement with Landmark Healthplan of California on behalf of the City of Lodi; and BE IT FURTHER RESOLVED that the term of the Agreement shall be effective February 1, 2023 through January 31, 2024, and in the event no termination notice has been given by either party, and a new agreement has not been negotiated, the contract shall automatically renew for successive one-year terms on each anniversary of the commencement date of this agreement; and BE IT FURTHER RESOLVED, pursuant to Section 6.3q of the City Council Protocol Manual (adopted 11/6/19, Resolution No. 2019-223), the City Attorney is hereby authorized to make minor revisions to the above -referenced document(s) that do not alter the compensation or term, and to make clerical corrections as necessary. Dated: January 18, 2023 I hereby certify that Resolution No. 2023-16 was passed and adopted by the City Council of the City of Lodi in a regular meeting held January 18, 2023 by the following vote: AYES: COUNCIL MEMBERS — Craig, Khan, and Nakanishi NOES: COUNCIL MEMBERS — None ABSENT: COUNCIL MEMBERS — Bregman and Mayor Hothi ABSTAIN: COUNCIL MEMBERS — None g1iu,;.na�a�, OLIVIA NASHED City Clerk 2023-16