HomeMy WebLinkAboutContract 47186 (2)f ` rrs
RECEtVW
a22015
0 fiat \No
AGREEMENT FOR CLAIMS ADMINISTRATION SERVICES
ma
ZORN
This Agreement(the A reement is effective as of the 1st of Novemberg "Agreement") day
2015 (the "Effective Date") between CITY OF FORT WORTH, a home -rule municipal
corporation of the State of Texas, ("PRINCIPAL"), having offices at 1000 Throckmorton
Street, Fort Worth, Texas 76102, and YORK RISK SERVICFS GROUP, INC , ("YORK"),
a New York corporation with its principal place of business at One Upper Pond Road,
Bldg. F, 4th Floor, Parsippany, New Jersey 07054. PRINCIPAL and YORK may be
referred to herein individually as a "party" and collectively as the "parties."
CITY SECF&TAI! / 1
CONTRACT MO. '7
WHEREAS, PRINCIPAL desires to provide Claims Administration Services and
Managed Care Services on claims arising out of PRINCIPAL'S self -insured workers'
compensation program along with managed care and a 504 Provider Network (the
"Program") during the term of this Agreement; and
WHEREAS, YORK submitted a proposal and best and final offer in response to
the PRINCIPAL'S Request for Proposal No. 15-0239 Workers' Compensation Claims
and 504 Network Administration Services, attached hereto as Exhibit "A" and
incorporated herein for all purposes incident to this Agreement, and
WHEREAS, YORK desires to be retained by PRINCIPAL pursuant to the terms
and provisions of this Agreement to provide Claims Administration Services on claims
arising out of the Program during the term of this Agreement; and
WHEREAS, YORK, by entering into this Agreement, shall be obligated to provide
Claims Administration Services to PRINCIPAL on the terms and conditions set forth
herein;
NOW THEREFORE, for and in consideration of the promises set forth
hereinabove, and other good and valuable consideration, the receipt and sufficiency of
which is hereby acknowledged, YORK and PRINCIPAL agree as follows:
I. DEFINITIONS
A. "PRINCIPAL" shall mean CITY OF FORT WORTH.
B. "CLAIMS ADMINISTRATION SERVICES" shall include the administration,
adjustment, management, and oversight of claims arising out of
PRINCIPAL'S self -insured workers' compensation program.
CLAIMS ADMINISTRATION SERVICES shall also include, but not limited
to, the following services:
1. Providing supervision of the loss adjustment process;
Page 1 of 23
IOFFICIgI, RECORD
CITY SECRETARY
b`T WORI'H, TX
2. Determining and implementing appropriate claims practices to adjust
assigned claims in accordance with YORK'S established practices as
measured in Tab G of Exhibit "A";
3. Adhering to high standards of professional conduct;
4. Adjusting and managing assigned claims to assure that PRINCIPAL
and claimants receive high quality service as measured in Tab C of
Exhibit "A";
5 Establishing monitoring and timely revisions of case reserves
6. Settling claims within the applicable coverage terms and conditions;
7. Maintaining current knowledge of applicable adjustment practices and
procedures, local practices, applicable insurance coverage court
decisions, current guidelines in the claims function, and Program
changes and modifications (as advised by PRINCIPAL);
8. Assisting in the preparation of claims for suit, hearing, trial, or
subrogation as appropriate;
9. Acting as PRINCIPAL S liaison with medical personnel, first notice of
loss reporting services and defense counsel
10. Performance of services related to managed care cost containment
including but not limited to medical bill review, Medical Provider
Network (` MPN") administration and access, utilization review, nurse
case management, Medicare secondary payor compliance services
These services shall include outcome reporting and results obtained
through cost containment measures.
11. Preparing and submitting status and administrative reports in
accordance with YORK'S established practices as agreed upon with
the PRINCIPAL;
12. Preserving subrogation rights and overseeing subrogation recovery.
C. "CLAIMS" shall mean claims, arising under the Program and which are
referred to YORK for adjusting during the term of this Agreement.
D. "INFORMATION" or "CONFIDENTIAL INFORMATION" shall mean
documentation, data or information relevant to PRINCIPAL or claimant that is created
by YORK or that comes into its possession as a result of the rendering of services by
YORK to PRINCIPAL, pursuant to the Agreement.
E "CONFIDENTIAL INFORMATION" is information not publicly available and
includes, without limitation, the work product, investigation materials, trial preparation
materials including but not limited to opinions and mental impressions of YORK
personnel, communications with defense and coverage counsel and non-public
personal information of insureds.
Page 2 of 23
F. "LOSS ADJUSTMENT EXPENSE" shall mean, in addition to fees to be
paid in accordance with items listed or inferred herein Agreement, all reasonable
expenses necessary to the adjustment of a claim in accordance with this Agreement,
including but not limited to, legal fees where applicable and agreed to in writing by
PRINCIPAL, court costs and fees for court reporters, expert witnesses, investigation,
photocopies, subpoenas, photographs, maps, accounting, chemical or physical
analysis, independent medical exams or other evaluations, depositions, appraisal fees
and expenses, bill review, utilization review and any other similar cost, fee or expense
reasonably chargeable to the investigation, negotiation, settlement or defense of a
claim or loss or subrogation actions. YORK may, but need not, elect to utilize its own
staff to perform these services.
G. "Managed Care Services" shall mean the administration and deployment
of cost containment measures offered through Rockport Community Network and
WellComp Managed Care Services, Inc. York affiliates, that serve to reduce the overall
risk of claims while maintaining compliance with Labor Code and Regulatory oversight.
The suite of services offered area medical bill review, utilization review, Medical
Provider Network, case management, Medicare secondary payor compliance services,
lien resolution, and ancillary services supporting the overall integrated managed care
effort.
H The "504 Provider Panel" shall be provided in compliance with Chapter 504 of
the Texas Labor Code, including section 504.053 specifically.
I. "SYSTEMS" shall mean severally or collectively, YORK'S proprietary claims
handling system.
II. TERM OF AGREEMENT
The term of this Agreement shall commence on November 1 2015, with the 504
Provider Panel implemented by January 1, 2016, and shall continue until and through
October 31, 2018 (the 'TERM') with two (2) one year options to renew at the
PRINCIPAL's sole discretion and agreement reached with YORK.
III. CLAIMS ADMINISTRATION SERVICES (the "Services")
PRINCIPAL is very demanding with respect to quality services, responsiveness,
timeliness, accuracy and cost control. PRINCIPAL desires to provide quality efficient
and effective workers' compensation claims administration services to PRINCIPAL and
PRINCIPAL employees in the most cost-effective manner. PRINCIPAL generally defines
such services as timely and accurate filing, processing, adjusting and administration of
claims, all of which meet or exceed the state statutory requirements in a manner that
exemplifies superlative customer service, and which meet or exceed workers'
Page 3 of 23
compensation industry standards of best practices. PRINCIPAL requires achieving and
maintaining a "high performer" status on Texas Department of Insurance, Division of
Workers' Compensation (TDI-DWC) Performance Based Oversight audits. PRINCIPAL
expects full cooperation from its workers' compensation third party administrator to
assist PRINCIPAL in achieving and maintaining these standards of quality. PRINCIPAL
hereby retains YORK to provide Claims Administration Services, as set forth in this
Agreement, including any Exhibits attached hereto, for the Claims that arise out of
PRINCIPAL'S self -insured workers compensation program and that are assigned by
PRINCIPAL to YORK.
A. The Services to be rendered by YORK shall be in conformance with the
requirements and provisions of this Agreement together with all applicable rules, orders,
and interpretations issued by the applicable regulatory authorities as of the date hereof,
including, but not limited to. Texas Labor Code, Chapters 401 — 451 and Chapter 504;
Texas Insurance Code Chapter 4151; Texas Local Government Code, Chapter 143;
Texas Government Code (Chapter 607)ff Texas Health & Safety Code, Chapter 81; and
the Texas Administrative Code, Title 28, Parts 1, 2, and 6.
B. YORK acknowledges its obligation to comply with all applicable statues
and any rules or regulations of the applicable regulatory authorities.
C. York shall perform Claims Administration Services for each Claim
assigned to it hereunder during the life of the contract.
D YORK acknowledges that execution of this Agreement does not guarantee
that YORK will be assigned any particular number of Claims by PRINCIPAL.
IV. DUTIES OF YORK
A. YORK shall prepare, coordinate with PRINCIPAL and fully implement a
transition plan to ensure the smooth transfer of claims data, information and claim files
from the previous third party administrator and to establish necessary computer system
interfaces. YORK shall work with PRINCIPAL and the prior third party administrator to
ensure all state statutory and regulatory requirements are met with regards to timely
payment of indemnity and medical benefits during the transition period. YORK will take
responsibility for all items under its control as of November 1, 2015.
B YORK shall maintain four indemnity adjusters and one administrative
assistant at PRINCIPAL'S site dedicated specifically and solely to the handling of the
Claims that arise out of PRINCIPAL'S self -insured workers compensation program, with
the necessary experience and management oversight In addition, York shall maintain
one medical only adjuster and one supervisor over adjusters assigned to Principal's
account. Adjusters assigned to Claims shall have a case load that allows proper
Page 4 of 23
attention to the work. The maximum caseload shall not exceed a monthly average of
100 claims for indemnity adjusters working on PRINCIPAL'S account.
C. To the extent required by law, YORK shall utilize only licensed adjusters
and licensed private investigators, where applicable and such adjusters and
investigators shall in the rendering of their services conform to the provisions of all
applicable laws, rules, orders or written interpretations issued by the applicable
regulatory authorities. YORK shall provide documentation of the adjusters and
licensed private investigators' current Iicensure and experience to the PRINCIPAL on
request.
D. YORK shall investigate, evaluate, negotiate, or deny Claims within the
standing authority granted to YORK from time to time by PRINCIPAL. Claims shall be
administered and adjusted in accordance with PRINCIPAL'S 'Account Instructions
Manual' and any subsequent revisions to such Manual as may be promulgated from
time to time by PRINCIPAL. Where subrogation potential exists, YORK shall actively
pursue PRINCIPAL'S subrogation interests in accordance with procedures set forth by
PRINCIPAL in the Account Instructions Manual with expenses paid as incurred.
E Upon termination of this Agreement, all hard copy and electronic files
shall be transferred to PRINCIPAL at PRINCIPAL'S expense.
F. YORK acknowledges that all of the Claims files in its possession are the
property of PRINCIPAL and agrees to promptly provide access to or deliver any such
file to PRINCIPAL, at PRINCIPAL'S expense, at any time upon PRINCIPAL S request.
In exchange for PRINCIPAL S absolute right to obtain the Claims files, PRINCIPAL
agrees that it shall not have the right to set off any sums claimed due from YORK
against fees due YORK under this Agreement.
G YORK acknowledges that all of the files related to the 504 Provider
Panel, including the 504 Network as established by YORK under this Agreement,
(collectively the ' 504 Network") will be the sole and exclusive property of the
PRINCIPAL.
1. PRINCIPAL acknowledges that the 504 network provided already
contains providers that have an existing contract with YORK affiliate
Rockport Community Network, Inc., hereinafter Rockport. When YORK
affiliate Rockport and the provider have a pre-existing contract an
addendum will be added to the Rockport -provider agreement naming the
PRINCIPAL as a Payor. Upon termination of the contract, said Rockport
— PRINCIPAL — Provider addendums shall also terminate.
2. Within the contract period, when a desired provider does not currently
have an existing contract with YORK affiliate Rockport, a new contract
Page 5 of 23
shall be entered into by the PRINCIPAL and provider with each party
responsible for attaining its own legal advice. YORK shall facilitate and
manage said contract at a charge of two hundred twenty-five dollars
($225). Upon termination of the YORK - PRINCIPAL agreement, all
contracts with providers in effect and with paid service charge of two
hundred twenty-five dollars ($225) shall be the sole and exclusive
property of the PRINCIPAL.
H. YORK shall provide and maintain a document management system
capable of scanning and indexing claim file documents and of attaching the indexed
documents to the specific computerized claim file Each scanned document shall
undergo a quality review or check to ensure the scanned image is legible, is not subject
to alteration, and represents an accurate facsimile of the original document. At a
minimum, original documents shall be maintained until such time as the quality review
confirms a legible and complete scanned image. Original claim file information and
documents shall be maintained and disposed of in accordance with applicable
PRINCIPAL'S policy, procedures and applicable record retention schedules.
I. YORK expressly agrees to hold all funds and assets of PRINCIPAL that
come into its control or possession during the term of this Agreement as a fiduciary of
PRINCIPAL.
J. YORK shall make available, through YORK'S proprietary claims system,
claim -related data and standard reports with `web -enabled" access. PRINCIPAL will
have "view only" access to the system. PRINCIPAL will bear its own hardware,
software, connection and similar costs for accessing YORK'S electronic claims
management system.
K. During the TERM of this Agreement and at all times that there are open
Claims being handled by YORK, YORK shall fully cooperate with PRINCIPAL to ensure
the claims are adjusted in strict compliance with the Texas Workers' Compensation Act,
administrative rules enacted by TDI-DWC.
L. YORK will develop, implement, and administer the MPN, including the
following:
1. Employee notice. YORK will develop a notice ("Employee
Notice") and will (i) advise PRINCIPAL in the distribution of the Employee Notice
to covered employees and (ii) work with PRINCIPAL to produce confirmation that
the Employee Notice was distributed.
2. Website. YORK will provide PRINCIPAL and covered
employees with a website for the 504 physician panel.
Page 6 of 23
3. Member education and training. YORK will undertake notices
and explanations as agreed upon between PRINCIPAL and YORK to educate
PRINCIPAL on utilizing the 504 physician panel, including, for example, educational
materials, trainings, and teleconferences.
4. Information services. YORK will publicize and monitor a toll free
telephone number that is available to the PRINCIPAL and its covered employees, who
may call to learn more about the 504 physician panel and its provider network;
5. Patient services. YORK will coordinate patient services with
PRINCIPAL. YORK will be responsible for developing and distributing materials, such
as a provider directory, that may reasonably be requested by PRINCIPAL and covered
employees.
6. Medical and ancillary provider services. YORK will be
responsible for communication with medical and ancillary providers within the 504
physician panel regarding providers' participation in the medical provider network.
7. On -going administration. YORK will perform such acts as
required for the on -going administration of the 504 physician panel, including any such
acts as may reasonably be requested by PRINCIPAL.
M. Prior to the commencement of any work by YORK under this
Agreement, YORK shall furnish one or more Certificates of Insurance forms to the
PRINCIPAL'S Risk Management Division and Office of the City Secretary evidencing
insurance coverage in the types and amounts required by PRINCIPAL Each certificate
shall indicate the types of coverage, liability limits, and termination provisions applicable
to the underlying insurance policy. Each form must indicate the name, address, and
telephone number of the insurance company issuing coverage. YORK further agrees to
maintain the following during the Term of this Agreement:
(1) Maintain in force a fidelity bond or equivalent insurance, such as
Third Party Crime insurance for the protection of PRINCIPAL, at a limit not less
than one million dollars ($1,000,000), to cover the risk of loss due to the wrongful
conversion of any funds and assets of PRINCIPAL by YORK or its employees or
independent contractors during the term of this Agreement York shall maintain
said bond or insurance for a period of two (2) years after the expiration of this
Agreement;
(2) Maintain in force an errors and omissions policy, at a limit not
less than five million dollars ($5,000,000) per occurrence and to maintain
coverage for a period of at least two (2) years after the expiration of the last
contract with PRINCIPAL, or if the errors and omissions coverage is claims -
made YORK agrees that, for said two (2) year period, the "retro" date will not be
later than the inception date of this Agreement,
Page 7 of 23
(3) Maintain in force a general liability policy which names
PRINCIPAL as an Additional Insured and which provides limits not less than one
million dollars ($1,000,000) per occurrence, two million dollars ($2,000,000)
aggregate and two million dollars ($2,000,000) products/completed operations
aggregate;
(4) Maintain in force a workers' compensation and employers
liability policy, which provides statutory workers' compensation coverage to
employees of YORK and employer's liability coverage at limits not less than one
million dollars ($1,000,000)
(5) Maintain in force an automobile liability policy, which names
PRINCIPAL as an additional insured and which provides a limit of no less than
one million dollars ($1,000,000);
(6) Provide that the aforementioned policies contain a waiver of
subrogation in favor of PRINCIPAL.
N. All insurance -related notices shall be given to PRINCIPAL at the
following address: Human Resources Director — Workers' Compensation Program, 1000
Throckmorton Street, Fort Worth, Texas 76102 with copy to Assistant Director for Risk
Management, Human Resources Department, at the same address.
O. The PRINCIPAL shall be entitled on request and without expense to
receive copies of the policy declarations and all blanked additional ensured
endorsements thereto as they apply to the limits required by the PRINCIPAL.
P. YORK'S financial integrity is of interest to PRINCIPAL; therefore,
subject to YORK'S right to maintain reasonable deductibles in such amounts as are
approved by PRINCIPAL, YORK shall obtain and maintain in full force and effect for the
duration of this Agreement, and any extension hereof, at YORK'S sole expense,
insurance coverage written on a claims made basis, by companies authorized and
admitted to do business in the State of Texas and rated A- or better by A M Best
Company and/or otherwise acceptable to PRINCIPAL, in the following types and
amounts referenced above.
Q. PRINCIPAL reserves the right to review the insurance requirements of
this Agreements during the Initial Term and any Renewal Term and to modify insurance
coverage types and limits when deemed necessary and prudent by PRINCIPAL'S Risk
Manager based on changes in statutory law, administrative regulations, court decisions
or circumstances surrounding the Agreement, provided however that in no instance will
PRINCIPAL allow modification whereupon the PRINCIPAL may incur increased risk.
Page 8 of 23
R. If YORK fails to maintain the aforementioned insurance or fails to
secure and maintain the aforementioned endorsements, the PRINCIPAL may obtain
such insurance and deduct and retain the amount of the premiums for such insurance
from any sums due under the Agreement; however, procuring of said insurance by
PRINCIPAL is an alternative to other remedies the PRINCIPAL may have, and is not the
exclusive remedy for failure of YORK to maintain said insurance or secure such
endorsement. In addition to any other remedies the PRINCIPAL may have for YORK'S
failure to provide and maintain any insurance or policy endorsements to the extent and
within the time herein required, the PRINCIPAL shall have the right to order YORK to
stop work hereunder and/or withhold any payment(s) that become due to YORK
hereunder until YORK demonstrates compliance with the requirements hereof.
S. Nothing herein contained shall be construed as limiting in any way the
extent to which YORK may be held responsible for payments of damages to persons or
property resulting from YORK'S or its subcontractors' performance of the work covered
by this Agreement.
T. YORK shall notify PRINCIPAL'S insurer of all claims which may affect
the insurer's coverage in excess of PRINCIPAL'S Self -Insured Retention layer in
accordance with the instructions of PRINCIPAL S insurer as provided to YORK pursuant
to Section V. (A) of this Agreement.
U. Notwithstanding anything to the contrary contained herein, and to the
extent applicable, YORK agrees to comply with all obligations imposed upon it by law.
V DUTIES OF PRINCIPAL
A. PRINCIPAL shall promptly provide YORK with such information as
YORK may require, including, but not limited to, any copy of documents describing its
self -insured workers' compensation program, and all amendments thereto including but
not limited to documents submitted to any governmental tribunals for approval of the
Program, as well as incident reports and information related thereto in PRINCIPAL'S
possession and otherwise cooperate with YORK in carrying out YORK'S tasks
hereunder.
B Upon receipt of loss notices, PRINCIPAL shall promptly assign the loss
to YORK.
C. PRINCIPAL shall promptly make funds available, in accordance with
Section VI, for Claim and Loss Adjustment expense payments with respect to claims
referred to YORK and respond to YORK S requests to issue checks in payment of
Page 9 of 23
Claims and such checks shall be distributed in accordance with PRINCIPAL'S Claims
processing procedures.
D PRINCIPAL shall provide YORK with training materials, along with initial
and subsequent training on PRINCIPAL'S forms and other documents affecting
P RINCIPAL'S obligations which are provided to YORK and any written interpretation
thereof issued by PRINCIPAL or any applicable regulatory body During the term of this
Agreement and at all times that there are open Claims being handled by YORK,
P RINCIPAL shall fully cooperate with YORK.
E PRINCIPAL covenants and agrees that PRINCIPAL, its employees,
agents or independent contractors, will not misuse the information contained within the
Claims files. PRINCIPAL further covenants and agrees to maintain the confidentiality of
the information contained within the Claims files, as required by applicable State and
Federal law and regulations.
F. PRINCIPAL acknowledges that the timely and successful filing and
implementation and administration of the MPN will require cooperation between
P RINCIPAL and YORK, and PRINCIPAL hereby agrees to make good faith efforts to
perform such acts as may be reasonably requested by YORK including:
1. Nominations of medical and ancillary providers. PRINCIPAL
shall provide information on medical providers nominated by Client in the form
requested by YORK.
2. Required data. PRINCIPAL shall provide information about
PRINCIPAL, as requested by YORK for performance of YORK obligations under
this Agreement, including information required to file the MPN application such as
the facilities locations of Client, Licensing and Tax documents.
VI. BANK ACCOUNT
A. PRINCIPAL shall set up a claims account ("Bank Account") with JP
Morgan utilizing the PRINCIPAL S Tax ID. The Bank Account shall be established
as an individual entity which will have pledged collateral assigned to the balance as
required under state law. The Bank Account shall be an interest earning account
with the interest received on a monthly basis based upon the available balance of
the account. PRINCIPAL shall fund the account with an initial $800,000.00 escrow
balance. This shall include the booking of a restricted asset account within the
general ledger, attached to the Risk Financing Fund of the PRINCIPAL. Interest
earned will be credited back to the Bank Account on a periodic basis Expenses for
maintenance of the account will be debited to the Bank Account. PRINCIPAL will
record interest earned and expenses charged to the Bank
Page 10 of 23
B. Account and on a periodic basis, which shall be monthly, reconcile
the balance of the Bank Account back to an amount of $800,000.00 based upon the
expense and interest earnings. PRINCIPAL shall fund or replenish the Bank
Account based on the funding statement and check register. The PRINCIPAL will
book the expenses minus interest credit.
C. YORK will provide bi-monthly a funding statement and check
register of the prior penod's checks issued to the PRINCIPAL. YORK will initiate
positive payee and utilize this service under the guidelines of JP Morgan Chase.
YORK will provide PRINCIPAL a monthly reconciliation of the Bank Account. YORK
further agrees to send all 1099s at the end of the calendar year.
D. Upon termination of this Agreement, proceeds remaining in the
Bank Account, including any earned interest, will remain the sole property of
PRINCIPAL.
E PRINCIPAL will provide to York PRINCIPAL'S authorized signor
facsimile that will be scanned by YORK. PRINCIPAL shall authorize the bank to
provide to YORK treasury dedicated staff online access to enable delivery of
services, including but not limited to positive pay exception handling and bank
reconciliation.
VII. SYSTEMS AND DATA PROCESSING
A. Although YORK authorizes PRINCIPAL to use or have access to its
Systems in performance of Claims Administration Services enumerated in this
Agreement, this does not license YORK'S system to PRINCIPAL nor shall PRINCIPAL
have intellectual property rights to the Systems, or additions YORK makes to its Systems
during and/or in the course of YORK'S performance under this Agreement,
whether or not such improvements or additions were made at the suggestions request
or direction of PRINCIPAL. Notwithstanding the foregoing, the data entered or
maintained thereon pursuant to this Agreement is the property of PRINCIPAL.
B. This Agreement grants to the PRINCIPAL no right to possess or reproduce
all or any part of the Systems used, owned or controlled by YORK performing all or any
part of Claims Administration Services and PRINCIPAL covenants that it shall not do so.
C. YORK expressly agrees that claim -related data generated and/or
maintained in connection with this Agreement or any Exhibit hereto shall be and remains
the sole property of PRINCIPAL and YORK shall have no right, title, or interest in such
data other than such rights necessary to perform Claim Administration Services.
Page 11 of 23
Vlll COMPENSATION
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:
SERVICE
Claims Adjusting Fees (Annual flat fees
include 4 on -site Indemnity Adjusters
and 1 on -site Claims Associate, 1 Unit
Manager, and 1 Medical Only Adjuster
located in York's Fort Worth office.
Total employees exclusively dedicated
to the City of Fort Worth: 7
Designated support and oversight
provided by: Claims Director- Dallas
Floating UM - Dallas
AVP Operations- Dallas
Regional VP Operations- Austin)
OTHER CLAIMS ADMINISTRATION
FEES
Medical Bill Auditing
Telephonic Case Management
Preauthorization
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 to 5 and
the total number of employees
exclusively dedicated to the City of Fort
Worth to 8).
Peer reviews
Compensation
Year 1
Year 2
Year 3
Year 4
Year 5
Annual Flat Fee
$799,610
$822,407
$842,824
$863,750
$885,200
Fee Structure
Unit Cost
Per Bill
Per Hour
Per Request
1Fee Structure
Per Hour
$8.30
$90
$90/Nurse
$160/Physician
$159,635
Per Request
Per Review
Page 12 of 23
i
Unit Cost
$90
$90/Nurse
$160/Physician
$200-$600
Depending on
Specialty
OTHER SERVICES/FEES
Fee Structure I Unit Cost
SOAH/Appeals panel reviews/APA services
Reconsideration requests
Recorded statement transcriptions
Vocational rehabilitation services
Photos
Mileage
Express mail, certified mail
Photocopying
Medicare reporting
Public records search
Private Investigative Services
Retrospective Utilization Reviews - Preauth
One time data conversion fee
IME
IRO Filing
Designated Doctor/RME Coordination
Impairment Rating Review
Job Analysis
Life Care Plan
Safety and Loss Control Services
504 NETWORK SERVICES
Establish network or 504
Network or 504 access
Administrative fees for all services
Credential providers
Contract providers
Create fee schedule
Information system & service fees including
contract load & TPA/DWC electronic interface
Train staff
Notify and educate employees
Establish/maintain website, email, telephone
support
Account audits
Access to provider
Management/data reports
TPA Included/Legal Fees at Cost
Per Request
Per Hour
Per Hour
Per Review
One-time
Per Review
Included
Per Request
Per Request
Per Hour
Per Hour
Per Hour
One -Time Fee
One -Time Fee
Per Medical Bill
Annual Flat Fee
One -Time Fee
i
Included
Included
Included
Included
Included
Included
Included
$8.30
$90
$80
$160
$7,500
$350
in Pre -Authorization
$250
$250
$90
$125
$1 10
Per Medical Bill
$5,000
$8
$4,000
Included
$225 per Provider
Group/ Provider
Included
Included
Included
Guidance Included
Included
Included
Included
Included
TOTAL NOT TO EXCEED
i
i
$140,000
Page 13 of 23
B. PRINCIPAL shall pay YORK fees due under VIII A of this Agreement no
later than thirty (30) days after PRINCIPAL'S receipt of YORK'S invoice as rendered
from time to time. Timely payment is an express condition of YORK'S obligations
hereunder. All services shall be performed to PRINCIPAL'S satisfaction, and
PRINCIPAL shall not be liable for any payment under this Agreement for any material
breaches or which PRINCIPAL has not approved and has not been cured by YORK
pursuant to section XII or XIV B. In the event of a disputed or contested billing, only the
portion being contested will be withheld from payment, and the undisputed portion will
be paid. PRINCIPAL will exercise reasonableness in contesting any bill or portion
thereof. No interest will accrue on any contested portion of the billing until the contest
has been mutually resolved.
C. All payments under this Agreement shall be made by PRINCIPAL solely to
YORK. PRINCIPAL shall not be obligated or liable under this Agreement to any party
other than YORK for payment of any monies or provision of any goods or services.
IX. AUDIT
A. YORK shall maintain books, records, reports and other documents, in
electronic or other format reasonably acceptable to PRINCIPAL relating to its Claims
Administration Services performed under this Agreement. All such records and
documents pertaining to Claims and the services rendered by York shall be the
property of PRINCIPAL and be open for inspection audit and copying, at
PRINCIPAL'S expense by PRINCIPAL and its agents or their representatives during
all regular business hours with reasonable prior notice to YORK.
B. YORK shall cooperate fully with all such agents or other representative
of PRINCIPAL during audits or examinations conducted by PRINCIPAL or its agents.
Auditors shall sign a nondisclosure/confidentiality agreement provided by YORK.
C. The PRINCIPAL agrees to the disclosure of all information and reports
resulting from access to the records pursuant to the subsection above. Where the audit
concerns a contractor, the auditing agency will afford YORK an opportunity for an audit
exit conference and an opportunity to comment on the pertinent portions of the draft
audit report. The final audit report will include written comments, if any, of the audited
parties.
D. At any time during the Term of this Agreement, or thereafter, provided
PRINCIPAL is not in default under this Agreement, PRINCIPAL may conduct, or cause
to have conducted, an audit of YORK'S operations to determine whether YORK has
performed its obligations hereunder in compliance with this Agreement.
Page 14 of 23
E YORK agrees that PRINCIPAL shall, during the Initial Term, any Renewal
Term, and until the expiration of three (3) years after final payment under this
Agreement and at no additional cost to PRINCIPAL, have access to and the right to
examine any directly pertinent books, documents, papers and records of YORK
involving transactions relating to this Agreement. YORK agrees that PRINCIPAL shall
have access during YORK's normal working hours to all necessary YORK facilities and
shall be provided adequate and appropriate workspace in order to conduct audits in
compliance with the provisions of this section. PRINCIPAL shall give YORK no Tess
than thirty (30) days advance notice of intended audits. If YORK subcontracts any of its
obligations under this Agreement, YORK shall include language in any subcontractor
whereby subcontractor agrees to be bound by the same rights, duties and obligations of
YORK under this provision.
F. Audits pursuant to this Section VIII shall be conducted in a manner that
does not interfere with YORK'S daily operations.
X. CONFIDENTIALITY
A. Both parties hereto acknowledge and agree that PRINCIPAL'S
information, data and documentation, including but not limited to, non-public and
personal information subject to the provisions of the Gramm -Leach -Bliley Act 15
U.S.C. Subchapter 1, Sections 6801-6809 et. Seq , and further including, without
limitation, all information, data and documentation related to manuals, lists, policyholder
information, operating and other systems, business practices and procedures, any
information regarding insureds insurance policies, claimants, and Claims, any business,
governmental or regulatory matters of PRINCIPAL, and other information furnished to
or obtained by YORK, pursuant to or in connection with this Agreement or in connection
with the Services to be rendered, may be confidential ("Confidential Information").
YORK shall not divulge disclose or use the Confidential Information except for
purposes of this Agreement or as may be expressly agreed in writing by the parties, or
as may otherwise be required or directed by applicable law or judicial process. This
Section IX shall survive the termination of this Agreement, regardless of the reason for
termination.
B. During the Term of this Agreement, and after its termination for any
reason, PRINCIPAL shall have the right to request in writing and receive from YORK
either (i) the immediate return or (ii) confirmation of the immediate destruction of any
tangible records, documents, e-mails, computer files, CDs, disks, and any other tangible
item that contains, represents, or otherwise includes any Confidential Information of
PRINCIPAL. In addition, PRINCIPAL shall have the right, during the Term of this
Agreement and after its termination, to request that YORK permanently delete and
destroy any Confidential Information contained in any computers hard drives, servers or
Page 15 of 23
other data storage systems of YORK. YORK agrees that PRINCIPAL may seek an
injunction by a court of competent jurisdiction enjoining YORK from violating any terms
of this Agreement or the confidentiality and non-use provisions of this Section IX.
Injunctive relief shall be in addition to any other remedies that PRINCIPAL may have
under the law. Notwithstanding the foregoing YORK may retain a record copy of
Claims files and the data therein, for accounting, insurance and similar purposes.
YORK shall secure said record copy against improper use or disclosure.
C. YORK acknowledges and agrees that any Confidential Information
disclosed to, or acquired by it is disclosed and/or acquired solely for the purposes of
facilitating the provision of the services to be rendered by YORK for and on behalf of
PRINCIPAL. YORK shall be solely responsible for informing its employers, officers and
directors of the provisions of the Section and for any acts of its employees, officers or
directors that violate the provisions of the Section.
D Notwithstanding the foregoing PRINCIPAL and YORK agree that
information used for adjusting claims is not subject to statutory or regulatory restrictions
against disclosure for that purpose. Therefore, as otherwise limited in this Agreement,
YORK and PRINCIPAL may share information for the proper management and
administration of PRINCIPAL's workers' compensation program.
E. YORK understands and acknowledges that PRINCIPAL is a public entity
under the laws of the State of Texas, and as such, the following information is subject
to disclosure under Chapter 552 of the Texas Government Code, the Texas Public
Information Act (the "Act") — 1) All documents and data held by the PRINCIPAL,
including information obtained from YORK and 2) information held by YORK for or on
behalf of PRINCIPAL that relates to the transaction of PRINCIPAL'S business to which
PRINCIPAL has a right of access. If the PRINCIPAL receives a request for any
documents that may reveal any of YORK S Confidential Information under the Act, or
by any other legal process law, rule, or judicial order by a court of competent
jurisdiction, PRINCIPAL will utilize its best efforts to notify YORK prior to disclosure of
such documents. PRINCIPAL will not be liable or responsible in any way for the
disclosure of information not clearly marked as "Proprietary / Confidential Information"
or if disclosure is required by the Act of any other applicable law or court order. In the
event there is a request for such information, it will be the responsibility of YORK to
submit reasons objecting to disclosure. A determination on whether such reasons are
sufficient will not be decided by PRINCIPAL but by the Office of the Attorney General
of the State of Texas, or by a court of competent jurisdiction.
XI. INDEMNIFICATION
A. YORK agrees to indemnify, defend and hold harmless PRINCIPAL and
PRINCIPAL elected officials, directors, officers, employees, and agents, from and
Page 16 of 23
against any and all causes of action, claims, damage, loss, costs and expenses
(including, without limitation fines, damages, liabilities, liens, losses, costs and
expenses, including reasonable attorney's fees and litigation expenses) incurred by
PRINCIPAL or any of PRINCIPAL directors, officers, attorneys, employees and agents
by reason and to the extent of any material breach of this Agreement by YORK, or by
reason and to the extent of any negligent, or otherwise wrongful act or omission of
YORK or of its officers, directors, attorneys, employees or agents.
B. The above defense, indemnification and hold harmless undertakings shall
survive the termination of this Agreement.
C. PRINCIPAL acknowledges that YORK has been engaged to provide
professional services and that it is not the intent of the parties that YORK assumes any
insurance risk.
D. Nothing herein shall be construed as a waiver of any governmental
immunity available to the PRINCIPAL under Texas Law or as a waiver of any defenses
of the parties under Texas Law The provisions of the INDEMNIFICATION are solely for
the benefit of the parties hereto and not intended to create or grant any rights,
contractual or otherwise, to any other person or entity. The parties' indemnification
obligations under this section are contingent upon (i) the indemnified party giving
prompt written notice to the indemnifying party of any claim under this Section
(provided, however, that failure to give such notification shall not affect the
indemnification provided hereunder except to the extent, and only to the extent, that the
indemnifying party shall have been actually prejudiced as a result of such failure), and
(u) at the indemnifying party's request and expense, the indemnified party cooperating
in the investigation and defense of such claim(s). If the indemnifying party assumes the
defense of any claim hereunder, the indemnified party shall be entitled to participate in
(but not control) such defense and to retain its own counsel, at its own expense. The
indemnifying party shall not settle or consent to an adverse judgment in any such claim
that adversely affects the rights or interests of the indemnified party or imposes
additional obligations on the indemnified party, without the prior express written consent
of the indemnified party
XII. BREACH AND TERMINATION
A. If a material breach by either party of this Agreement occurs, the non -
breaching party shall identify the breach by delivery of written notice thereof to the
breaching party.
B. Upon delivery of written notification of breach, the breaching party shall
have a period of fifteen (15) business days or an agreed upon date made within the
Page 17 of 23
fifteen (15) business days within which time the breaching party shall cure the breach.
Should the breaching party fail to fully cure the breach within the designated time
frame, the non -breaching party may terminate this Agreement by delivery of thirty (30)
days written notice of termination to the breaching party. Any notice of breach or
termination shall be delivered pursuant to Section XII. A hereto.
C. This Agreement may be terminated by a party without the necessity of
any notice or right to cure, upon the occurrence of any of the following events:
(1) The expiration of the Term set forth in Section II or any renewal
Thereof
(2) The commencement of bankruptcy, insolvency or
conservatorship proceedings by the other party, or, if such
proceedings are brought against the other party, the other party's
failure to have such proceedings dismissed within 45 days.
D Either party may, without reason, terminate this Agreement with at least
sixty (60) days prior written notice to the other party.
E YORK may terminate this Agreement and discontinue Services
immediately upon notice to PRINCIPAL, if PRINCIPAL fails to maintain sufficient
balances in the escrow account to properly and adequately fund daily maintenance and
indemnity needs, as well as settlement of Claims and any Loss Adjustment Expense. At
n o time shall YORK be liable or obligated to make any payments out of YORK'S own
funds, of any type or character on behalf of PRINCIPAL, including benefits PRINCIPAL
is legally required to provide to its employees.
F. In the event no funds or insufficient funds are appropriated by PRINCIPAL
in any fiscal period for any payments hereunder, PRINCIPAL will notify YORK of such
o ccurrence, and this Agreement shall terminate on the last day of the fiscal period for
which appropriations were received without penalty or expense to PRINCIPAL of any
kind whatsoever, provided, however, that YORK shall be paid for all services rendered
u p to the termination of the Agreement.
G. In the event of termination, YORK shall fully cooperate with PRINCIPAL
and continue to perform all duties and obligations under this Agreement up to the
effective date of termination.
XIII EQUITABLE ADJUSTMENT
A. PRINCIPAL shall have the right to direct YORK to perform additional
services or to perform services in a specific or different way.
Page 18 of 23
B. This Agreement contemplates that the standards applicable to this
Agreement are those in effect on the date of this Agreement, whether such standards
are set forth in statutes, regulations, rules, orders, case laws or otherwise.
C. In the event of a directive from PRINCIPAL as set forth in Section XII. A
or a change in a standard as set forth in Section XII B., YORK shall be entitled to an
equitable adjustment in its compensation if such directive or change increases YORK'S
cost of providing the services YORK renders under this Agreement.
XIV GENERAL
A. YORK shall not be liable or deemed to be in default for any delay or
failure in performance under this Agreement or any Exhibit of this Agreement, or any
interruption of Claims Administration Services resulting, directly or indirectly, from acts
of God, civil or military authonty, or any similar cause beyond the reasonable control of
YORK for as long as such condition exists. YORK shall give immediate notice to
PRINCIPAL of any delay or failure in performance or of any interruption of Claims
Administration Services that has or may occur as soon as YORK becomes aware of
such events.
B If any dispute or claim arises hereunder that the parties are not able to
resolve amicably, the parties agree and stipulate that such litigation shall be resolved in
Tarrant County Texas.
C. This Agreement is made and is to be performed in Tarrant County, Texas
and is governed by the laws of the State of Texas.
D All notices which are required to be given or submitted pursuant of this
Agreement shall be in writing and shall be transmitted or delivered by certified mail,
return receipt requested or by a commercial overnight delivery service to the parties at
the addresses set forth below, or to such other addresses as a party may, by notice,
specify:
Notices to YORK shall be delivered to:
York Risk Services Group, Inc.
333 City Boulevard West, Suite 1500
Orange CA 92868
Attention: Jody A. Moses, SR. VP
York Risk Services Group, Inc.
One Upper Pond Road, Bldg. F, 4th Floor
Parsippany, New Jersey 07054
Attn: Michael Krawitz, General Counsel SR. VP
Notices to PRINCIPAL shall be delivered to the following:
CITY OF FORT WORTH 1000 Throckmorton Street, Fort Worth, Texas 76102
Attention: Brian Dickerson Human Resources Director
With copy to the City Attorney's Office at the same address
Page 19 of 23
E This Agreement and any Exhibit or Schedule made a part hereof
constitute the entire Agreement between the parties and supersedes and merges any
and all prior discussions, representations, negotiations, correspondence, writing, and
other agreements and together states the entire understanding and agreement between
PRINCIPAL and YORK with respect to Claims Administration Services to be provided
hereunder. Except for unilateral changes made by the PRINCIPAL pursuant to Section
XII, for which YORK shall be entitled to an equitable adjustment in its compensation this
Agreement may be amended or modified only in writing if agreed to and signed by
PRINCIPAL and YORK and shall be construed, performed and enforced in all respects
in accordance with the laws of the State of Texas.
F. PRINCIPAL typically provides its own legal representation at workers'
compensation administrative hearings and in the courts by using its own legal
resources. However, PRINCIPAL may from time -to -time determine that PRINCIPAL'S
position and case would best be presented through outside attorney representation.
Therefore, at the request of PRINCIPAL, and upon approval of the Fort Worth City
Council by Resolution, YORK shall arrange for highly qualified attorney representation
to represent PRINCIPAL'S interests and shall assist PRINCIPAL in ensuring that any
contracts required between the PRINCIPAL and the outside attorney are timely and fully
executed. Such outside attorney representation shall be billed to the specific claim as a
legal expense. YORK claims adjusters shall represent PRINCIPAL at benefit review
conference hearings at no additional cost to PRINCIPAL.
G. In the event that either PRINCIPAL or YORK is notified by the Texas
Department of Insurance that an administrative violation may have occurred that could
adversely impact PRINCIPAL claims and/or either party's standing with TDI, the
receiving party shall immediately notify the other party. Administrative penalties or fines
imposed by TDI or any other entity that relate to PRINCIPAL claims or to PRINCIPAL as
a workers' compensation self -insured political subdivision and that result from violations
of the Texas Labor Code or Texas Insurance Code attributable to the negligence, error
or omission of YORK, its employees, agents, or authorized vendors shall be paid by
YORK. Administrative penalties or fines imposed by TDI or any other entity that relate to
PRINCIPAL claims or PRINCIPAL as a workers' compensation self -insured political
subdivision and that result from violations of the Texas Labor Code or Texas Insurance
Code attributable to the negligence error or omission of PRINCIPAL or its employees
shall be paid by PRINCIPAL. Administrative penalties or fines imposed by TDI or any
other entity that result from violations of the Texas Labor Code or Texas Insurance
Code attributable to the negligence, error or omission of both parties shall be paid
equally by both parties.
H. No party hereto shall be deemed to have waived any rights or remedies
accruing to it hereunder unless such waiver is in writing and signed by such party. No
Page 20 of 23
delay or omission by either party hereto in exercising any right shall operate as a waiver
of said right on any future occasion All rights and remedies hereunder shall be
cumulative and may be exercised singularly or concurrently.
I. The descriptive headings of this Agreement are intended for reference
only and shall not affect the construction or interpretation of this Agreement.
J. Wherever the singular of any term is used herein it shall be deemed to
include the plural wherever the plural thereof may be applicable.
K. No party may assign its rights or obligations under this Agreement,
provided, however, that YORK may subcontract all or part of the Services required
hereunder with PRINCIPAL'S written consent, (which consent shall not be unreasonably
delayed or withheld) and may at its discretion delegate to a subsidiary such of its duties
as it deems appropriate, provided that such subcontracting or delegation shall not
relieve YORK of any of its obligations hereunder.
L. It is expressly understood and agreed that the relationship of YORK to
PRINCIPAL shall be that of an independent contractor at all times, and nothing herein
shall constitute either the YORK or PRINCIPAL as the partner, agent, or legal
representative of the other, for any purpose whatsoever, except to the extent that YORK
is the agent of PRINCIPAL for the purpose of adjusting claims. YORK shall have no right
or authority to bind or obligate PRINCIPAL with respect to any matter that is not
specifically provided for in this Agreement without the prior approval of PRINCIPAL. All
employees or agents of YORK performing duties hereunder for YORK shall be solely
and exclusively under the direction and control of YORK and shall not be deemed
employees of PRINCIPAL.
M. Nothing in this Agreement is intended to require YORK to engage in the
practice of law.
N. Whenever the PRINCIPAL has reason to question the YORK's intent to
perform; the PRINCIPAL may demand that YORK give written assurance of YORK's
intent to perform. In the event a demand is made, and no assurance is given within ten
(10) calendar days, the PRINCIPAL may treat this failure as an anticipatory repudiation
of the Agreement.
O. YORK warrants and certifies, and this Agreement is made in reliance
thereon, that it, its individual officers, employees and agents are neither officers nor
employees of PRINCIPAL or any PRINCIPAL agencies, such as PRINCIPAL -owned
utilities. In the event that any conflicts of interest arise after the execution of this
Agreement, YORK hereby agrees to make full disclosure to PRINCIPAL in writing
immediately upon learning of such conflict.
Page 21 of 23
P. PRINCIPAL shall not utilize YORK'S trade names, logos, trademarks,
service marks or other identification in any press release, advertisement, marketing
materials, promotional literature, article, presentation or other type of communication
without the prior written consent of YORK, which consent may be withheld or denied in
YORK'S sole discretion.
Q. In the event of any conflict between the documents, the terms and
conditions of this Agreement shall control. If any clause or provision of this Agreement is
held invalid, illegal or unenforceable under present or future laws during the term of this
Agreement, including any extension and renewal hereto, it is the intention of the parties
hereto that the remainder of the Agreement shall not be affected hereby, and that in lieu
of each invalid clause or provision of this Agreement, a clause or provision as similar in
terms to such illegal, invalid or unenforceable clause or provision as may be possible
shall be drafted to comply with all applicable laws and shall replace the clause or
provision held invalid, illegal or unenforceable.
R. Neither PRINCIPAL nor YORK shall, during the term of this Agreement
and additionally for a period of one year after its termination, solicit for employment or
employ, whether as employee or independent contractor, any person who is or has been
employed by the other party during the term of this Agreement without the prior written
consent of the person's employer.
S. The parties acknowledge that each party and its counsel have had the
opportunity to review and revise this Agreement and that the normal rules of construction
to the effect that any ambiguities are to be resolved against the drafting party of that
section shall not be employed in the interpretation of this Agreement or any attachments
or exhibits hereto.
T. The person signing this Agreement hereby warrants that he or she has the
legal authority to execute this Agreement on behalf of his or her respective party and that
such binding authority has been granted by proper order, resolution, ordinance, or other
authorization of the entity. The other party is fully entitled to rely on this warranty and
representation in entering into this Agreement.
/ / / Sign page
Page 22 of 23
IN WITNESS WHEREOF, the parties hereto have read and signed this Agreement as
dated below and the Agreement is effective as of November 1, 2015 for TPA with the
504 Provider Panel implemented on January 1, 2016.
ACCEPTED AND AGR,n AD:
CITY OF FORT WORTH, TEXAS
PORK RISK SERVICES 6 OUP, INC.
By: Letzl 0---,1 • VaAA-%.,--, Bv: ot a i .....
Susan Alan's Jody A. Moses
Assistant City Manager Senior Vice President
Date: t t I i ?va IS
APPROVAL E4,t MENDED:
t ,
e
/fl
gDicke'on\
uman Res�urces Dir
.i
ATTEST:
By:
Marct a�
City Secr»tar
APPROVED AS TO FORM AND LEGALITY:
By:�, /'
Guillermo (Will) S Trevino
Assistant City Attorney
CONTRACT AUTHORINATION:
rO\ E--( 3
Date Approved: 0 /3st5 /3i)I5
Date: nthbt /a. a0IS
ATTEST:
Bv:
Lynda Smith -Kelly
Process Manager
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Page 23 of 23
M&C Review
C ';r11y
(ci-:oft_voc,L
COt_1NCIL ACTION: Approved on 8125/2015
Page 1 of. 3
Official site of the City of Fort Worth, Texas
FORT Woui'i 1
J
DATE: 8/25/2015 REFERENCE NO.: C-27435 LOG NAME: 14YORK2015
CODF: C WPC: NONCONSENT PUBLIC NO
HEARING:
SUBJECT: Authorize Execution of an Agreement with York Risk Services Group, Inc., for the
Administration of the Workers' Compensation Program in an Amount of $1,414,420.00 for
the First Year (ALL COUNCIL DISTRICTS)
rCCMMENDATIGN:
It is recommended that the City Council authorize the City Manager to execute an Agreement with
York Risk Services Group, Inc., in the amount of $1,414,420.00 for the first year with a three year
initial term and two one-year renewal options for the administration of the City of Fort Worth's
Workers' Compensation Program including claims administration, medical cost containment services
and health care network.
DISCUSSION:
The City of Fort Worth currently contracts with CorVol Enterprise Comp, Inc., to provide workers'
compensation claims adjusting, claims administration, medical cost containment, safety and Toss
control services. The third year of a three-year Professional Services Agreement with CorVel will
expire December 31, 2015. CorVel has been notified that the City will exercise its option to terminate
services early on October 31, 2015 with the commencement of the new vendor contract described
below.
On June 3, 2015, a Request for Proposals (RFP) was issued requesting that interested vendors
submit proposals by July 2, 2015. This RFP was advertised in the Fort Worth StarJelearam each
Wednesday from June 3, 2015 through July 1, 2015,
The RFP was designed to solicit proposals on: (1) third party claims administration services for a
self -funded workers' compensation program (including payment and adjusting, claim investigations,
subrogation, establishing reserves, defense of denied claims), (2) medical cost containment services
(including medical bill review, utilization review, preauthorization, telephonic and field case
management, vocational case management), (3) 504 workers' compensation health care network
program (including program administration, health care provider credentialing) (4) safety and Toss
control services, (5) serving as Austin representative for the City at the Texas Department of
Insurance and the Texas Workforce Commission, (6) Medicare and Medicaid reporting for worker's
compensation, (7) document scanning and indexing and (8) other miscellaneous claims -related
services.
The City received 10 competitive proposals in response to the RFP. Proposals were thoroughly
evaluated by a committee comprised of representatives from the Human Resources, Water and
Transportation & Public Works Departments and representatives from the Fort Worth Police
Association and Fire Association Local 440. The Committee considered several factors in evaluating
proposals, including price competitiveness, an organization's ability to administer the workers'
compensation program, qualifications of each organization's staff, MANSE participation and quality of
service. The Committee agreed to recommend that York be awarded the contract based upon York's
proposal representing the best combination of low/competitive pricing, experience and quality of
services to provide the best services to the City. Overall, the expected total fixed administrative costs
in the amount of $1,414,420,00 for York are within the requested proposed budget for Fiscal Year
2016.
1
lath://apes.efwnet.org/council_packet/me review.asp?ID=21392&councildate '8/25/2015 8/26/2015
M&C Review Page 2 of 3
Staff recommends the contract be awarded to York Risk Services Group, Inc. (York), for an annual
contract cost of $1,414,420.00 for the first year. Contract cost will not exceed $1 437,217.00 in Fiscal
Year 2017 and $1,457,634 00 in Fiscal Year 2018. The City Manager's budget proposal for Fiscal
Year 2015-2016 will include a recommendation to fund this contract through September
2016. Authority for the remaining fiscal years that are encompassed by the Agreement will be
requested annually as part of the overall budget process and the contract will include a standard
fiscal funding out clause that would comply with state law requirements by allowing the City to
terminate the Agreement without penalty, if in the future, the City Council elects not to appropriate
funds for services covered by this Mayor and Council Communication
While this is about a 23 percent increase in administration cost for the Workers' Compensation
Program, services and quality are greatly enhanced with seven exclusively dedicated staff from York
for the City of Fort Worth's Program (four on -site Indemnity Adjusters and one on -site Claims
Associate, one Unit Manager and one Medical Only Adjuster located in York's Fort Worth office). The
increase also includes the development and administration of a customized 504 health provider
network.
In 2005, the 79th Texas Legislature passed House Bill (HB) 7, which authorized the use of workers'
compensation health care networks certified by the Texas Department of Insurance (Department) for
political subdivisions. HB 7 also added Section 504.053 which authorized political subdivisions to
contract directly with health care providers for the provision of medical benefits, treatment and care
for its injured employees. The York proposal includes establishment of such a direct contract "504
health care network" for City of Fort Worth employees. This 504 health care network will be
customized to provide treating and referral doctors and other health care providers to meet the
specific needs and requirements of the City.
M/WBE OFFICE - A waiver of the goal for MBE/SBE subcontracting requirements was requested by
the Purchasing Division and approved by the M/WBE Office, in accordance with the BDE Ordinance,
because the purchase of goods or services is from sources where subcontracting or supplier
opportunities are negligible.
TERMS AND RENEWALS - On City Council approval, services under this contract will commence on
November 1, 2015 for a three-year initial term. The Agreement may be renewed for two one-year
terms at the City's option This action does not require specific City Council approval, provided that
the City Council has appropriated sufficient funds to satisfy obligations during the renewal term.
FISCAL INFORMATION/CERTIFICATION:
The Financial Management Services Director certifies that funds will be included in the City
Manager's proposed budget for Fiscal Years 2015-2016 for the Workers' Compensation Fund. Upon
approval of the above recommendations and upon the adoption of the Fiscal Year 2015-2016 Budget
by the City Council to include the above recommendations, funds will be available in the Fiscal Year
2016 operating budget, as appropriated. Prior to expenditure being made, the Workers
Compensation Fund has the responsibility to validate the availability of funds. Funding for the
FY2017 and FY2018 will be contingent upon approval of funding in the FY2017 and FY2018 adopted
budgets for the Workers Compensation Fund.
TO Fund/Account/Centers
FROM Fund/Account/Centers
60111 5310101 0147310 $1.096.029.00
60111 5330201 0147310 $200.522.63
Submitted for City Manager's Office bv: Susan Alanis (8180)
Originating Department Head: Brian Dickerson (7783)
Additional Information Contact: Margaret Wise (8058)
littp://apps.cfwnet.org/councilrpacket/mcnreview.asp7ID=21392&councildate=78/25/2015 8/26/2015