HomeMy WebLinkAboutContract 47186-R1A1 4"_r
.�Y SECRETARY
a 7'IRACT N0.. 47126— E l A l
CITY SECRETARY CONTRACT NO.
FIRST RENEWAL OF AND AMENDMENT TO FORT WORTH CITY SECRETARY
CONTRACT NO. 47186—AGREEMENT FOR CLAIMS ADMINISTRATION SERVICES
This First Renewal of and Amendment to Fort Worth City Secretary Contract No. 47186 —
Agreement for Claims Administration Services (the "Renewal") is made and entered into by and
between the CITY OF FORT WORTH, a home-rule municipal corporation of the State of Texas
("PRINCIPAL" or "CITY"), and YORK RISK SERVICES GROUP, INC., a New York corporation
("YORK").
WHEREAS, CITY and YORK are parties to a contract for services related to administration of
PRINCIPAL's self-funded workers' compensation program and its managed care services and
504 Provider Network, that contract being Fort Worth City Secretary Contract No. 47186 (the
"Agreement"); and
WHEREAS,the agreement provides for an initial three-year term and two renewal options of one
year each; and
WHEREAS, the initial term of the Agreement expires October 31, 2018; and
WHEREAS, PRINCIPAL and YORK wish to renew and extend the Agreement for a first renewal
period, to adopt a clarified compensation schedule, and to incorporate a provision required
under recently enacted state law.
NOW THEREFORE, CITY and YORK do hereby covenant and agree as follows:
SECTION 1.
That Fort Worth City Secretary Contract No. 47186 is hereby renewed and extended for an
additional one year term, commencing on November 1, 2018 and ending October 31, 2019 (the
"First Renewal Term").
SECTION 2.
That Section VIII, "Compensation," of Fort Worth City Secretary Contract No. 47186 is revised to
delete the current Paragraph A in its entirety and to enact a new Paragraph A to read as
follows:
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OFFICIAL kECORD
0o� CITY SECRETARY
� enewal and Amendment of CSC 47186
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A. YORK shall be entitled to receive and PRINCIPAL shall be obligated to
pay only such fees, allowances, costs, reimbursements, or other compensation
as are specified as follows:
Compensation
SERVICE Annual Flat Fee
Claims Adjusting Fees
Annual flat fees include a total of 7
employees dedicated exclusively to City of Year 1
$799,610
Fort Worth as follows:
y 4 on-site Indemnity Adjusters
A 1 on-site Claims Associate
➢ 1 on-site Unit Manager Year 2 $822,407
➢ 1 on-site Medical Only Adjuster Year 3 $842,824
Year 4 $863,750
Annual flat fees also include employees who
provide services for the City of Fort Worth
and other clients as follows:
➢ Designated support and oversight- Year 5 $885,200
Claims Director in York's Austin Office
➢ Floating Unit Manager in York's
Austin Office
OTHER CLAIMS ADMINISTRATION FEES Fee Structure Unit Cost
Medical Bill Auditing Per Bill $8.30
Telephonic Case Management Per Hour $90
Preauthorization Per Request $90/Nurse
$160/Ph sician
Additional on-site adjuster
(This fee is for adding an on-site Indemnity
adjuster and would be added to the annual
claims adjusting fees listed above. This would
bring the total number of Indemnity Adjusters $159,635
to 5 and the total number of employees
exclusively dedicated to the City of Fort Worth
to 8).
Fee Structure Unit Cost
Per Hour $90
Per Request $90/Nurse
$160/Ph sician
$200-$600
Peer reviews Per Review Depending on
Specialty
OTHER SERVICES/FEES Fee Structure Unit Cost
First Renewal and Amendment-CSC 47186 Page 2 of 5
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SOAH/Appeals panel reviews/APA services TPA Included/Legal Fees at Cost
Reconsideration requests Per Request f $8.30
Recorded statement transcriptions Included
Vocational rehabilitation services Per Hour 1 $90
Photos Included
Mileage Included
Express mail, certified mail Included
Photocopying Included
Medicare reporting Included
Public records search Included
Private Investigative Services Per Hour $80
Retrospective Utilization Reviews -Preauth Per Review $160
One time data conversion fee One-time $7,500
IME Per Review $350
IRO Filing Included in Pre-Authorization
Designated Doctor/RME Coordination Per Request $250
Impairment Rating Review Per Request $250
Job Analysis Per Hour $90
Life Care Plan Per Hour $125
504 NETWORK SERVICES One-Time Fee Per Medical Bill
Establish network or 504 One-Time Fee $5,000
Network or 504 access Per Medical Bill $8
Administrative fees for all services Annual Flat Fee $4,000
Credential providers Included
Contract providers One-Time Fee $225 per Provider
Group/Provider
Create fee schedule Included
Information system &service fees including contract Included
load&TPA/DWC electronic interface
Train staff Included
Notify and educate employees Guidance Included
Establish/maintain website, email,telephone support included
Account audits Included
Access to provider Included
Management/data reports Included
TOTAL FOR OTHER CLAIMS ADMINISTRATION
FEES; OTHER SERVICES/FEES, AND 504 $140,000 Annually
NETWORK SERVICES NOT TO EXCEED
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SECTION 3.
That during the First Renewal Term (i) no fee identified as "one-time" in the chart in Paragraph
A of Section VIII, "Compensation," of Fort Worth City Secretary Contract No. 47186 shall apply,
(ii) the optional fifth on-site Indemnity Adjustor shall not be utilized, meaning that fee shall not
apply, and (iii)the "Year 4" fee shall apply for claims adjusting services.
SECTION 4.
That for purposes of the First Renewal term, Section XIV, "General" of Fort Worth City Secretary
Contract No. 47186 is amended to add a new Paragraph U to read as follows:
YORK acknowledges that in accordance with Chapter 2270 of the Texas Government
Code, PRINCIPAL is prohibited from entering into a contract with a company for goods
or services unless the contract contains a written verification from the company that it:
(1) does not boycott Israel; and (2) will not boycott Israel during the term of the
contract. The terms "boycott Israel" and "company" shall have the meanings ascribed
to those terms in Section 808.001 of the Texas Government Code. By signing this
Renewal, YORK certifies that YORK's signature provides written verification to the
PRINCIPAL that YORK and any wholly owned subsidiary, majority-owned subsidiary,
parent company, or affiliate of YORK(I) do not boycott Israel; and(2) will not boycott
Israel during the term of the Agreement, as amended and extended.
SECTION 5.
That all other terms and conditions of Fort Worth City Secretary Contract No. 47186 that are
not amended herein shall remain in full force and effect throughout the First Renewal Term.
[SIGNATURES APPEAR ON FOLLOWING PAGE]
First Renewal and Amendment-CSC 47186 Page 4 of 5
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IN WI NESS WHEREOF, the parties hereto have executed this Agreement this_ day of
2018.
CITY OF 1�T WORT •-- YORK RISK SERVICES GROUP, INC.:
B
y: By: _
Susan ,�ar�ys, Assistant City Manager Jody . Moses, Executive Vice President
ATTEST `" ATTEST:
F,�1�T`:
By:_ By:
Mary Kayser fj Name:
City Secretary * itle:
APPROWAL,RECOM E DED:
By:
Bria rson, Hum n R sources Director
CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the
person responsible for the monitoring and
administration of this contract, including
ensuring ali perforl-11anceand re rting
requirement
By:
Chris Lam, Workers' Compensation Manager
APPROVED AS TO FORM AND LEGALITY:
By: 1111
Denis C. M roy, Asst. ity Attorney
Contract Authorization: M&C C-27435
Date Approved: August 25, 2015
First Renewal and Amendment-CSC 47186 OFFICIAL
ay2 RECORD
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