HomeMy WebLinkAboutContract 57224-A4AMENDMENT TO CSC No. 57224-A4
ADMINISTRATIVE SERVICES AGREEMENT
This Amendment to the Administrative Services Agreement (this "Amendment') dated as of January 01, 2024
(the "Amendment Effective Date") amends the Administrative Services Agreement (the "Agreement') entered
into as of January 01, 2021, as amended, by and between Meritain Health, Inc. ("Meritain") and City of Fort
Worth ("Client') as follows:
I. FEE SCHEDULE
A. As of January 01, 2024 the following Administrative Fees set forth under Section 1 of the Fee Schedule are
hereby deleted by the following fees:
Per Employee Per Month
Administrative Services January 01, 2024 —
December 31, 2024
• Appeals Vendor (Phia/PACE) Fee(s)
• Hello Heart
• Data File Feed
• Medical Plan Administration
• PBM Administration Fee $19.86
• Run -Out Fee
• State Reporting and Remittance
• Stop Loss Integration Fee
• Summary of Benefits and Coverage ("SBC") Production
• Telemedicine0-,(�
Fee
January 01,
Administrative Services
2023 —
Frequency of Occurrence
December 31,
2025
Telemedicine - Behavioral Health0*
$0.35
Per Employee Per Month
Utilization Management
$2.15
Per Employee Per Month
Case Management
$4.75
Per Employee Per Month
24x7 Nurseline
$0.45
Per Employee Per Month
II. CREDITS/ALLOWANCES:
Section 3 of the Fee Schedule is hereby deleted in its entirety and replaced with the following new Section 3
as follows:
Credit/Allowance Type
Wellness Program Allowance♦
Communication Allowance►
Amount Frequency/Availability
Per Year for the
$200,000 Applicable Period
Per Year for the
$50,000 Applicable Period
Applicable Period
January 01, 2024 -
December 31, 2024
January 01, 2024 -
December 31, 2024
♦The wellness program allowance is limited to the amount, frequency/availability, and applicable period for this
allowance set forth in the table above (the "Wellness Allowance"). The Wellness Allowance is intended to provide
Client with an allowance of money from which Client can utilize to offset reasonable, identifiable expenses that
City of Fort Worth — Amendment 4 to City of Fort Worth CSC No. 57224 1 OFFICIAL RECORD v022324
CITY SECRETARY
FT. WORTH, TX
Client may incur for its wellness program and activities provided to Participants under the Plan (the "Wellness
Program").
The Wellness Allowance shall only be available for expenses incurred by Client in connection with the Wellness
Program and may not be used for non -wellness services or services unrelated to the Wellness Program. Client's
receipt of the Wellness Allowance is subject to: (i) Client providing Meritain an invoice detailing the expenses
incurred for the Wellness Program; and (ii) Meritain's review and approval of such submitted expenses in
accordance with Meritain's then -current policies. Meritain will not credit the Wellness Allowance or any portion
thereof if Client does not incur eligible expenses for its Wellness Program during the year. Any unused Wellness
Allowance or allowance amount will not carry over nor can be applied to any subsequent year.
Client represents and warrants that its use of the Wellness Allowance and any offering of prizes, gift cards,
and/or giveaways in connection with the Wellness Allowance shall be in compliance with Applicable Laws. Client
is solely responsible for filing any notices and/or forms, such as Form 1099, required by Applicable Law.
►The communication allowance is limited to the amount, frequency/availability, and applicable period for this
allowance set forth in the table above and is only available for expenses incurred for communication materials
related the Plan. Client's receipt of communication allowance shall be subject to Client providing Meritain an
invoice detailing the expenses incurred. In no event will Meritain be required to credit Client for the
communication allowance if Client does not incur expenses for communication materials for the Plan. Meritain
shall only be responsible to credit Client the lessor of the amount for this allowance or the actual expenses
incurred by Client. Any unused allowance or allowance amount will not carry over nor can be applied to any
subsequent year.
C. Section 4 of the Fee Schedule is hereby deleted in its entirety and replaced with the following new Section
4 as follows:
4. REMITTANCE SERVICES.
Upon written request and if agreed to by Meritain, Meritain may collect certain fees and premiums from Client
for remittance to a third party with whom Client has a direct relationship, e.g. a broker commission. In these
instances, Meritain will pass -through all fees and will not collect or retain an administrative or service fee. Meritain
has no relationship with any such third parties, and assumes no risk or liability with respect to such third parties'
services or Client's payment of such fees. Those amounts known to Meritain as of the Effective Date are set
forth below, and are subject to change predicated upon Client's agreement with such third -parties.
Appeals Vendor (Phis/PACE) Fee(s)
III. MISCELLANEOUS
April 01, 2023 — December 31,
2025
$0.75
Frequency of Occurrence
Per Employee Per
Month
Any capitalized term not defined in this Amendment shall have the meaning ascribed to it in the Agreement.
Except as specifically amended by the terms of this Amendment, all surviving terms, provisions, and fees of the
Agreement are hereby ratified and confirmed and the Agreement, as modified by this Amendment, remains in
full force and effect.
City of Fort Worth — Amendment 4 to City of Fort Worth CSC No. 57224 2 v022324
In Witness Whereof, the parties have executed this Amendment on the dates set forth below.
MERITAIN HEALTH, INC.
Name:
Jeremy M. Hensel
Title:
Regional President
Date:
February 29, 2024
City of Fort Worth
By: C
Name: Jesica McEachern
Title: Assistant City Manager
Date: Mar 18, 2024
Approval Recommended:
B ko/!v Moye✓
Name: Holly Moyer
Title: Assistant Human Resources Director
Attest:
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By:
Name: Jannette Goodall
Title: City Secretary
VENDOR:
By:
Name
Title:
Date
CITY OF FORT WORTH
opl*�
Name: Jesica McEachern
Title: Assistant City Manager
Date: Mar 18, 2024
Contract Compliance Manager:
By signing I acknowledge that I am the person
responsible for the monitoring and
administration of this contract, including
ensuring all performance and reporting
requirements.
By:
Name: Joanne Hinton
Title: Benefits Manager
Approved as to Form and Legality:
By:
Name: Jessika J. Williams
Title: Assistant City Attorney
Contract Authorization:
M&C:
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
City of Fort Worth — Amendment 4 to City of Fort Worth CSC No. 57224 3 v022324
3/6/24, 12:27 PM
M&C Review
CITY COUNCIL AGENDA
Create New From This M&C
Official site of the City of Fort Worth, Texas
FoRTWoRyn
REFERENCE **M&C 20- 13P 20-0109 MEDICAL
DATE: 6/23/2020 NO.: 0444 LOG NAME: TPA/ASO, EAP AND PC -DM
SERVICES HR JPB
CODE: P TYPE: CONSENT PUBLIC NO
HEARING:
SUBJECT: Authorize Execution of Agreements with Meritain Health, Inc., for the Medical Third Party
Administrator/Administrative Services Only Services in the Amount Up to $1,475,000.00
Annually, Aetna Behavioral Health, LLC for the Employee Assistance Program in the
Amount Up to $157,000.00 Annually and Accolade, Inc., for the Plan Concierge -Disease
Management Services in the Amount Up to $1,550,000.00 Annually with an Additional
Implementation Fee Up to $98,600.00 in the First Year, for a Three-year Initial Term with
Option to Renew Up to an Additional Two Year Term at the City's Sole Discretion (ALL
COUNCIL DISTRICTS)
RECOMMENDATION:
It is recommended that the City Council authorize the execution of agreements with Meritain Health,
Inc., for the Medical Third Party Administrator/Administrative Services Only Services in the amount up
to $1,475,000.00 annually, Aetna Behavioral Health, LLC, for the Employee Assistance Program in
the amount up to $157,000.00 annually and Accolade, Inc., for the Plan Concierge -Disease
Management Services in the amount up to $1,550,000.00 annually, with an additional implementation
fee up to $98,600.00 in the first year, for a three-year initial term with option to renew up to an
additional two year term at the City's sole discretion.
DISCUSSION:
The Human Resources Department (HRD) approached the Purchasing Division to secure
agreements for the Medical Third Party Administrator (TPA)/Administrative Services Only (ASO)
Services, the Employee Assistance Program (EAP) and the Plan Concierge -Disease Management
(PC -DM) Services.
The City's Medical and Disease Management Programs are self -funded and utilize a third party
administrator to process claims. The United Healthcare Services, Inc. has been providing these
services since January 1, 2016 under its previous Agreement (City Secretary Contract (CSC)
No. 47393; Mayor and Council communication (M&C) C-27347 & C-28386) with the City.
This agreement expires on December 31, 2020.
The EAP services are a minimum of six face-to-face visits to assist employees in addressing personal
issues, make referrals to qualified professionals for specialized issues such as mental health and
stress, parenting, midlife and retirement, disability, financial issues, addictive behaviors, education,
caring for older adults, health and wellness, and legal issues. Welcome packets for all new
employees and unlimited 24/7/365 telephonic support services are included. Aetna Behavioral Health,
LLC has been providing administration of the City's Employee Assistance Program under its previous
Agreement (CSC 47547; M&C C-27334) with the City. This agreement expires on December 31,
2020.
Staff determined it would be in the City's best interest to ensure it was getting the best overall product
and price by going out to the market and giving all providers the opportunity to compete for the City's
business and issuing a Request for Proposals (RFP) that consisted of detailed scope of services. The
RFP was designed to solicit proposals for the following services individually or in combination with
each other: (1) Medical TPA/ASO Services; (2) EAP; and (3) PC -DM Services. The RFP was
advertised in the Fort Worth Star -Telegram every Wednesday starting on March 18, 2020 through
April 22, 2020. Sixteen vendors were solicited from the purchasing database; eleven responses were
received.
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M&C Review
The proposals were evaluated separately for Medical TPA/ASO Services, EAP and PC -DM Services.
The evaluation team was provided with resources and assistance by the City's benefits consultant,
Holmes Murphy.
(1) Medical TPA/ASO Services:
An Evaluation team consisting of staff from the different departments and a retiree evaluated
proposals received for Medical TPA/ASO Services. The evaluation team ranked the proposals based
on pre -defined factors. Finalists were selected for presentations. Following the presentations, the
evaluation team determined Meritain Health, Inc. provides the best overall solution for the
TPA/ASO Services and recommended that the City Council authorize the execution of agreement for
an initial three year period term with option to renew up to an additional two year term at the City's
sole discretion.
The associated cost and fees for Medical TPA/ASO Services is $926.20 per month per employee and
non -medicare eligible retirees. The benefit plan operates on a plan calendar year basis and the
expected overall total administrative costs are $1,475,000.00 for Calendar Year 2021. Prices will
remain flat for the base three years of the Agreement. The estimated medical claims for Calendar
Year 2020 are $64,000,000.00 and anticipated to trend at about a 1 percent increase in years two to
five. Trend projections may vary depending on Calendar Year 2020 claims experience. It is
anticipated that Staff will make a recommendation to the City Manager on premium contribution rates
and plan design. Open enrollment for the 2021 medical plan is scheduled to begin on October 2020.
(2) EAP:
An Evaluation team consisting of staff from the Human Resources Department evaluated proposals
received for EAP. The evaluation team ranked the proposals based on pre -defined factors and
determined Aetna Behavioral Health, LLC provides the best overall solution for EAP and
recommended that the City Council authorize the execution of agreement for an initial three year
period term with option to renew up to an additional two year term at the City's sole discretion. The
associated cost and fee is $1.59 per month per employee (PEPM) for the 1 st year, $1.69 PEPM for
the 2nd year, $1.79 PEPM for the 3rd year, and $1.89 PEPM for the 4th & 5th years. The annual cost
(Calendar Year) is $132,000.00 for year 1, $140,000.00 for year 2, $149,000 for year 3, and
$157,000.00 for year 4 and year 5.
(3) PC -DM Services:
An Evaluation team consisting of staff from the different departments and a retiree evaluated
proposals received for PC -DM Services. The evaluation team ranked the proposals based on pre-
defined factors. Finalists were selected for presentations. Following the presentations, the evaluation
team determined Accolade, Inc. provides the best overall solution for the PC -DM Services and
recommended that the City Council authorize the execution of agreement for an initial three year
period term with option to renew up to an additional two year term at the City's sole discretion.
The associated cost and fee is up to $1,550,000.00 per year for PM -DC Services with an additional
implementation fee up to $98,600.00 in the first year.
An administrative change order or increase may be made by the City Manager up to the amount
allowed by relevant law and the Fort Worth City Code and does not require specific City Council
approval as long as sufficient funds have been appropriated.
A waiver of the goal for MBE/SBE subcontracting requirements was requested by the Department
and approved by the M/WBE Office, in accordance with the BDE Ordinance, because the purchase of
goods or services from source(s) where subcontracting or supplier opportunities are negligible.
Upon City Council approval, the three-year term of this contracts shall begin on January 1, 2021 and
expire on December 31, 2023. The contract may be renewed for up to one successive two-year
term at the City's option. This action does not require specific City Council approval, provided that the
City has appropriated sufficient funds to satisfy the City's obligations during the renewal term. 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
Council elects not to appropriate funds for contracted services.
FISCAL INFORMATION/CERTIFICATION:
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The Director of Finance certifies that upon approval of this recommendation, funds are available
within existing appropriations in the current operating budget of the Group Health Insurance and
Retiree Healthcare Trust Funds and anticipates, upon adoption of the Fiscal Year 2021 Budget by the
City Council, to include the recommended payments mandated by state statutes, the funds will be
available in the Fiscal Year 2021 budget, as appropriated. Prior to any expenditure being incurred, the
Human Resources Department has the responsibility to validate the availability of funds.
BQN\\
TO
Fund Department Account Project Program Activity Budget Reference # Amount
ID ID Year I (Chartfield 2)
FROM
Fund Department Account Project Program Activity Budget Reference # Amount
ID ID Year (Chartfield 2)
Submitted for City Manaqer's Office by: Jay Chapa (5804)
Originating Department Head:
Additional Information Contact:
Reginald Zeno (8517)
Cynthia Garcia (8525)
John Padinjaravila Baby (2279)
ATTACHMENTS
1295-Meritain-Aetna-Accolade.pdf (CFW Internal)
20-0109 RFP Waiver RFP Medical ASO or TPA Services. pdf (CFW Internal)
EAP Concierae fundina availability at cateaorv.PNG (CFW Internal)
SAMs 6-1-2020 Meritain-Aetna-Accolade.pdf (CFW Internal)
TPA ASO EAP Concierae FID.XLSX (CFW Internal)
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