Occupational Testing Program Account Set-up Form


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If DOT Regulated, Enter your DOT number


Agreement Between Mega Health Services, Inc (C/TPA) and Employers



Mega Health Services, Inc a Consortium and Third-Party Administrator (C/TPA) which owns and manages a drug and alcohol testing program designed for businesses and regulated entities with S.S.E. (s) and drug free employees. This agreement is made between the parties with the following understanding:

  1. Company elects to participate in Mega Health Services, Inc (C/TPA) program that is compliant with the requirements of the 49 CFR, Parts 40, 382 (FMCSA), 219 (FRA), 655 (FTA), 199 (PHMSA), 14 & 120 (FAA), 46 CFR Parts 4 & 16 (USCG).
  2. Company elects to retain Mega Health Services, Inc to administer its drug and alcohol testing program for compliance.
  3. For purposes of this agreement the term “S.S.E.” describes an employee with a safety sensitive position (Safety Sensitive Employee) that is subject to all applicable regulation guidelines noted in the given agencies DOT regulations and operates under the authority of the Company. “Drug Free” refers to all employee’s subject to the Company’s drug free testing program as defined within its drug and alcohol testing policy.
In consideration of the mutual obligations hereunder, both parties agree as follows:

PART - 1

Mega Health Services, Inc General Obligations and Responsibilities:

To administer the Company’s drug and alcohol testing program, Mega Health Services, Inc shall:

  1. Maintain qualified random testing pools for regulated Company employees. Meet or exceed minimum testing rates set forth by the DOT for each calendar year, or other percentages defined by the Company for other employees.
  2. Manage a random selection and notification program minimally consistent with DOT or other regulated controlled substance and alcohol testing requirements.
  3. Provide the following:
    • Access to Alere/eScreen Laboratories collection sites.
    • A laboratory certified by the Department of Health and Human Services’ SAMHSA Agency.
    • A Medical Review Officer (MRO) to provide test result notifications to the Company/employee and blind specimens to the lab as required by DOT regulations. The MRO service is also provided for all non-DOT testing.
  4. Maintain records documenting Company’s participation in Mega Health Services, Inc random testing program and will provide Company with these records and other compliance information within two (2) business days of its designated Representatives request.
  5. Upon Company’s request by written consent, Mega Health Services, Inc will release drug and alcohol testing history and information in accordance with DOT, other regulatory agencies or a Company’s D&A Policy. Information requested may include verification of participation in the C/TPA program and/or current enrollment status. Test results for a Company’s S.S.E. within the last two years, and positive information for the last 5 years (DOT) or consistent with other noted regulatory requirements.

PART - 2


Company’s Obligations and Responsibilities:
To qualify for and maintain enrollment in Mega Health Services, Inc C/TPA program, the Company agrees to:

  1. Maintain a Company Policy for controlled substance and alcohol (D&A) misuse implemented before initiating testing. Complete verification of prior drug, alcohol and driving violations for each new S.S.E.
  2. For reasons of reasonable suspicion testing, Company agrees to have a person who supervises S.S.E. (s) or employees trained in the aid of recognizing the signs and symptoms of substance abuse and alcohol misuse.
  3. Notify Mega Health Services, Inc immediately of any changes in Company information including name, address, telephone number(s), (office, mobile and/or emergency numbers), fax number(s), authorized contact(s), Designated Employer Representative (DER) or enrolled Company employee(s) information.
  4. Notify Mega Health Services, Inc immediately of any changes in the status of a Company’s S.S.E. (s) or employee(s) including termination, out-of-service, S.S.E. license changes, etc. (The Company understands that if there is more than a 30-day lapse of enrollment in a random testing program, they are responsible to have the S.S.E. submit to a pre-employment drug testing before returning to a safety sensitive position.)
  5. Have new S.S.E. complete a pre-employment drug screen. Employees can only be added to the Random Pool with a negative DOT drug test result.
  6. Have S.S.E. or employee proceed immediately to the closest available authorized drug and/or alcohol collection site once they are notified of a random testing selection.
  7. Fully document any reason(s) leading to the failure to comply with all requests for a random test. Failure to randomly test your S.S.E. (s) or employees may result in termination from Mega Health Services, Inc program and Company agrees to the release of this information to any applicable and appropriate regulatory enforcement agencies.
  8. Determine if post-accident drug and alcohol testing is necessary following any accident.
  9. Ensure a S.S.E. does not resume employment prior to SAP approval and Return-to-Duty testing.
  10. Notify Mega Health Services, Inc immediately and remove DOT or covered S.S.E. from service upon notification from either:
    • A Medical Review Officer (MRO) that S.S.E. tested positive on a DOT drug test; or
    • Breath Alcohol Technician (BAT) or Saliva Alcohol Technician that the S.S.E. ’s confirmation test result has an alcohol concentration of .04 or greater.
  11. Responsibility to establish an alternate provision within their Company’s D&A policy pertaining to post accident testing when a Mega Health Services, Inc collection site or personnel is unavailable. (e.g. out of the area, on site needed, after hours, holidays, etc.)
  12. Have available a same gender observer, if necessary, when a direct observed collection is required, and the collection site is unable to provide a same gender observer.
  13. Should Company request the assistance of Mega Health Services, Inc to prepare the Management Information System Report (MIS), Company shall contact Mega Health Services, Inc at least three (3) business days prior to a scheduled enforcement inspection date.
  14. Company accepts full responsibility for understanding the obligations under and participating in Mega Health Services, Inc C/TPA program in a manner that is compliant with their DOT agencies regulations.

PART -3 Fees


For Services:

  1. For performance of Mega Health Services, Inc obligations listed in Part-1 of this Agreement, Company shall pay a fee according to the current pricing schedule or prior written agreement at the time of enrollment or renewal.
  2. Company is responsible to pay Mega Health Services, Inc directly for testing fees regardless of the payment arrangements made between the Company and employee.
  3. Arrangement for split specimen testing fees shall be made between Company, employee and MRO at the time of the request; the cost of split specimen testing is not Mega Health Services, Inc responsibility.
  4. Company is responsible for payment directly to collector/collection facility for any fees if not using an authorized Collection site.
  5. Should Company utilize entities for testing that are not affiliated with Mega Health Services, Inc, e.g., using an outside collection site or Laboratory, it is the Company’s obligation to pay the cost of all fees associated with the collection, testing and reporting directly to that site.
  6. All NSF check returns will be subject to an $80 handling fee.
  7. Company agrees to promptly pay all invoices or will be subject to a credit hold and penalty late fee to accrue per month starting 60 days after Mega Health Services, Inc billing date. Company will be expelled from Mega Health Services Consortium after 60-days of non-payment and Company’s information will be sent to a collection’s agency for payment at which time the Company is responsible for all collection’s fees applied by the collection agency and legal fees incurred.
  8. Credit Card Charges by Internet & Phone:
    Payment on-line and by phone with credit card may be accepted, but the client agrees not to dispute any non-fraudulent charges once Mega Health Services, Inc products or services have been received. If enrollment is disputed without cause, the client will be dropped permanently from our program and sent immediately to collections if the dispute is not resolved to the satisfaction of both parties.
  9. Signed agreement and annual membership fee is due before account is active. Membership will automatically renew unless canceled by Company in writing. If timely payment is not received, the Company’s membership is revoked, and written notice will be given.
  10. Listed fees are subject to change. Written notice will be given for any rate changes. Changes will take effect upon renewal of Service Agreement.
  11. Fee Schedule:
    • Annual Membership Fee - $125.00
    • Additional S.S.E. s / Employees - $25 (up to a maximum of $300)

    When using Mega Health Services for collection services, fees are as follows:
    • DOT 5 Panel - $72 (includes supplies, MRO & Collection Fees).
    • NON-DOT 5 Panel - $72 (includes supplies, MRO & Collection Fees).
    • Breath Alcohol Screening - $49
    • Follow up testing and Return-to-Duty / Observed testing - $125.00
    • Afterhours surcharge - $150.00 plus the cost of the test.
    • Emergency surcharge - $200.00 plus the cost of the test and millage fees.
  12. Company is responsible for any and all fees incurred when using any service other than those performed by Mega Health Services, Inc.

Part 4


Indemnification Obligations of Company:

Company shall hold harmless Mega Health Services, Inc and any certified laboratory, medical review officer (MRO) or collection site providing services to Company pursuant to this Agreement, from any claim, loss, liability, damage, detriment or obligation arising from any matter other than their willful misconduct or gross negligence. The Company agrees to indemnify Mega Health Services CTPA and to hold harmless from and against any and all claims, losses, damages, costs or liabilities and penalties imposed on the Company for non-compliance to 49 CFR Part 40 and any applicable Parts. Indemnification includes being held harmless for any legal fees and other expenses arising out of any alleged or actual breach by Mega Health Services CTPA of any of the warranties, representations, or agreements applicable to this service agreement.

The Company and Mega Health Services agree that should any suit or action be implemented to enforce the terms outlined in this service agreement, the prevailing party will be entitled to reasonable attorney fees surrounding litigation and appeal.

PART - 5


Terms and Conditions

This Agreement shall be governed in all respects by state law, where applicable, except to the extent specifically preempted by federal regulations, The Department of Transportation regulations governing drug and alcohol testing programs (49 CFR Part 40) make it very clear that the Employer (also referred to as 'Company') is responsible for all aspects of compliance with the regulations. That applies even if a company such as Mega Health Services, Inc has been designated as a service agent.

In the event of Company non-compliance to 49 CFR Part 40, Mega Health Services reserves the right to make a decision to move the Companies employees into a non-conforming random selection pool for a period of up to 180 days. Should the employer continue in failure to comply with 49 CFR Part 40 at the end of this period, Mega Health Services reserves the right to expel the Company from all random selection pools. If expulsion occurs, it may result in immediate notification to the Department of Transportation (DOT) and any applicable transportation administration falling under the authority and structure of the DOT. Self employed individuals will be terminated from the program for any positive drug or alcohol test result, or failing to respond to random testing requirements.

The company is required to stay compliant with all DOT requirements. Mega Health Services, Inc cannot be held liable to any non-compliance rulings or citations against the Company for any reason.

OVERVIEW:


SERVICES MEGA HEALTH SERVICES ROLE COMPANY ROLE
Service Agreement Provide:
Certificate of Membership Copy of signed agreement Applicable Policies
Complete Service Agreement. Remit annual fee Review Policies.
Billing / Fees Issue invoices and reminders. Process payments, issue receipts Understand fees for services. Stay current with payments.
Drug & Alcohol Tests Stay current with Drug and Alcohol Testing responsibilities.
Provide Member rates when using Mega Health Services as collector.
DOT 5 Panel $72.00
NON-DOT 10 Panel $72.00
Breath Alcohol Screening $49.00
RTD and Observed testing $125.00
After hours surcharge $150.00
Emergency surcharge $200 .00
Provide DER(s) and any Alternate DER names and contact information to CTPA. Determine when applicants and employees must be tested. Locate testing facilities if not using Mega Health Services as Collector. Ensure alternate collection sites meet DOT regulations.
If Alcohol Screening is positive, provide transportation of employee to BAT facility for confirmation.
Supplies for Testing Ensure Mega Health Services testing site is equipped with CCF forms and testing supplies. Ensure 3rd party sites are eCCF compatible. Store any required copies or supplies in a secure manner
Test Results Receive results from MRO Transmit results to DER in confidential manner. Establish means for secure transmission of results. Follow-up with employee based on test results or refusal. Decide action needed for employee based on test results or refusal.
Quality Control Ensure technicians are trained and qualified Report problems or concerns to CTPA
Random Pool Management Provide scientific means for selection. Enter employee information in database and verify with employer. Generate random selections at appropriate intervals. Notify DER when selections are made. Follow-up to ensure people get tested or alternates are sent. Provide list of names and ID numbers (or SSN) of safety sensitive employees. S.S.E. lists can be emailed or faxed. Provide updates to list of names as list changes. Review and confirm list with CTPA prior to quarterly draw. Assure selected individuals get tested in timely manner.
Certified Lab Services Utilize SAMSHA certifies labs for testing. Maintain confidentiality Alert CTPA when delays occur in receiving test results.
Medical Review Officer (MRO) Acquire MRO services on behalf of employer. Receive test results from MRO Maintain confidentiality. Ensure MRO can reach employee for interview if necessary.
Substance Abuse Professionals Provide referral information for Substance Abuse Professionals (SAP) Coordinate follow up testing. Request contact information as needed. Determine and manage employees referred to SAP.
Reasonable Suspicion Training for Supervisors Provide referral information for training based on need. Request training if necessary.
Reviews and Audits Assist where appropriate for audits. Make any requests for assistance. Assumes full responsibility for outcomes of audits / reviews.
Post-Accident Testing Ensure employee is sent for testing when required
Reasonable Suspicion Testing Ensure employee is sent for testing when required
Records / Reports Receive and file results. Notify CTPA of any test results and reports produced outside the CTPA network.
Compliance Assist and provide support for compliance. The employer remains obligated to the DOT and applicable administrations for compliance.
DOT Physicals Ensure employees needing DOT physicals have current health cards.

Company agrees to use Mega Health Services for Random Pool Management for the term of the service agreement. Company may choose any provider for the listed services and is not required to use Mega Health Services for Collections or Physicals, but would be responsible for selecting, and paying for such services separate from this services agreement. The service agreement is for a 12-month period, which commences upon receipt of signed service agreement and payment annual membership fee. Company may terminate services at any time in writing. Annual membership fee is non-refundable and will otherwise automatically renew.

As the designated Representative of the Company, I hereby agree to the terms of this Agreement and further acknowledge that I/we must participate with every aspect of this Agreement. I/we do recognize that Mega Health Services, Inc has the right to terminate our enrollment as a participant should I/we fail to abide by the terms set forth in this Agreement, including those terms outlined on the random test notifications. This agreement shall be extended automatically for successive 12-month terms until Company or Representative gives Mega Health Services, Inc written notice of your desire to terminate this agreement, or this agreement is cancelled for any reason by Mega Health Services, Inc. It is ultimately the Companies responsibility to stay compliant with their own DOT regulations.


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