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HomeMy WebLinkAboutContract 47393-A1 CITY SECRETARY CONTRACT N4., 439 3-6L FIRST AMENDMENT TO ADMINISTRATIVE SERVICES AGREEMENT This First Amendment to Administrative Services Agreement ("Amendment") is made by and between United HealthCare Services, Inc. ("United") and City of Fort Worth ("Customer"), to amend that certain Administrative Services Agreement, Contract No. 905579 and City Secretary Contract No. 47393 (the "Agreement")and is effective on January 1,2017 unless otherwise specified. Any capitalized terms used in this Amendment have the meanings shown in the Agreement. These terms may or may not have been capitalized in prior contractual documents between the parties but will have the same meaning as if capitalized. The Agreement that is being amended includes any and all amendments, if any, that are effective prior to the effective date of this Amendment. Nothing shown in this Amendment alters, varies or affects any of the terms, provisions or conditions of the Agreement other than as stated herein. The parties,by signing below,agree to amend the Agreement as contained herein. 4� RECEIVED DEC 13 2018 CITY OF FORT WORTH CITY SECRETARY OFFICIAL.RECORD ggV First Amendment to Administrative Services Agreement FT. �P Tib Executed this the 1✓ day of .18. CITY: City of Fort Worth 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 By: and reporting requirements. Name: y so 0 A 4 vt�S Title: Assistant City Manager ----- Date: 1'�I I �' By: Name: Approval Recommended: Title: Approved as to Form and Legality: By: Name: Title: By: 14_144� Warne: o B. trong Attest: G k Title: Assistant City Attorney .............. '%' Tact Authorization: M3 �— By. ame: � Title: City Sec tary United: United Healthcare Services,Inc. B � P �" . By: Name: Holly Durinick Title: Regional Contract Manager Date: November 14,2018 OFFICIAL RECORD First Amendment to Administrative Services Agreement Page 2pO fi The parties hereby agree to amend the Agreement, effective as of July 1, 2018, as specified below. I. Exhibit A, Section I. Care Management and Outreach Services is amended by the addition of Obesity and Diabetes Prevention Services(Real Appeal),as follows: Service Comments Obesity and Diabetes Prevention Services,customizable Services are delivered by United Network Providers.At the program delivered to eligible Participants with a goal of Customer's request,United can direct bill for these services preventing diabetes and other obesity related diseases. The program uses a 52-week approach with online technology and live audio/video capabilities. II. Exhibit A, Section AS Claims Determinations and Appeals is amended by the addition of Catastrophic Events services,as follows: Catastrophic Events:During such time as a government agency declares a state of emergency or otherwise invokes emergency procedures with respect to Participants who may be affected by severe weather or other catastrophic events(a"Catastrophic Event Timeframe"),Customer directs United to implement certain changes in its claim procedures for affected Participants,including,for example: (a)exemption from the application of prior authorization requirements and/or penalties;(b)waiver of out-of-network restrictions(e.g.,out-of-network providers paid at the Network Provider level),(c)extension of time frames for timely claims filing and/or appeals,(d)early replacement of lost or damaged durable medical equipment,and(e)other protocols reasonably required to provide Participants with access to health plan and pharmacy benefits as applicable.Such protocols are applicable to Participants whose place of residency falls within impacted areas of the Catastrophic Event,and for dates of service that fall within the Catastrophic Event Timeframe. The parties hereby agree to amend the Agreement, effective as of August 1, 2018, as specified below. III. Exhibit A,is amended by the addition of Injury Coverage Coordination(ICC)services,as follows: a. Section A2 Recovery Services of the Agreement is amended by the addition of the following subsection: Injury Coverage Coordination. United will provide Customer with accident healthcare claim savings service on first party claims (such as workers compensation, automobile medical payments, or "No-fault" medical expense savings) through active coordination-of-benefits (COB). This is called injury coverage coordination ("ICC"). ICC works with the responsible property casualty insurance carrier, expediting claim payment by such insurance carrier and saving claim expense for Customer. Customer will not engage any entity except United to provide the services described herein without United's prior approval. Customer delegates to United the discretion and authority to develop and use standards and procedures for any recovery under this section. United will not pursue ICC if any applicable law does not permit it. b.Exhibit A, Section E. Claims Administration Services is amended by the addition of Injury Coverage Coordination services: Service Comments Injury Coverage Coordination services ICC First Amendment to Administrative Services Agreement Page 3 of 8 The Agreement is amended by replacing Exhibit B in its entirey with the following Exhibit B: EXHIBIT B-FEES This exhibit lists the fees Customer must pay United for United's services during the term of the Agreement. These fees apply for the period from January 1, 2018 through December 31, 2020. Customer acknowledges that the amounts paid for administrative services are reasonable. Standard Medical Service Fees The Standard Medical Service Fees described below, excluding optional and non-standard fees, are adjusted as set forth in the applicable performance standard(s). The Standard Medical Fees listed below are based upon an estimated 7,030 enrolled Employees. The Standard Medical Service Fees are the sum of the following: January 1,2018 through December 31,2018 • $41.54* per Employee per month covered under the Choice Plus portion of the Plan. • $42.23*per Employee per month covered under the Choice Plus with HSA portion of the Plan. January 1,2019 through December 31,2019 • $42.79*per Employee per month covered under the Choice Plus portion of the Plan. • $43.50*per Employee per month covered under the Choice Plus with HSA portion of the Plan. January 1,2020 through December 31,2020 • $44.07*per Employee per month covered under the Choice Plus portion of the Plan. • $44.81*per Employee per month covered under the Choice Plus with HSA portion of the Plan. Average Contract Size: 2.12 Other Fees Service Description Fee Fraud and Abuse Management Fee equal to thirty-two and five-tenths percent(32.5%)of the gross recovery amount Hospital Audit Program Services Fee not to exceed thirty-one percent(31%)of the gross recovery amount Credit Balance Recovery Services Fee not to exceed ten percent(10%)of the gross recovery amount. Standardized Summary of Benefits and Coverage (SBC) as United will provide,at no additional charge,standard established under The Patient Protection and Affordable Care format,electronic copies of the SBC documents(twice per Act of 2010 year)for medical benefit plans administered by United. Customer logos can be included on the SBC at no additional charge. Additional fees will apply for other services. United will not create SBCs for medical plans United does not administer. Third Party Liability Recovery(Subrogation)Services Fee equal to thirty-three and one-third percent(33.3%)of the gross recovery amount Advanced Analytics and Recovery Services Fee equal to twenty-four percent(24%)of the gross recovery amount Shared Savings Program Customer will pay a fee equal to thirty-five percent(35%) First Amendment to Administrative Services Agreement Page 4 of 8 f of the Savings Obtained as a result of the Shared Savings Program.Savings Obtained means the amount that would have been payable to a health care provider,including amounts payable by both the Participant and the Plan,if no discount were available,minus the amount that is payable to the health care provider,again,including amounts payable by both the Participant and the Plan,after the discount is taken. External Reviews For each subsequent external review beyond 10 total reviews per year,a fee of$500 will apply er review. Effective August 1,2018 Fees are assessed based on the estimated claim savings and Injury Coverage Continuation(ICC)Services will not exceed one-third(33.331/o)of the calculated savings amount. Credits * The Standard Medical Services Fees reflect credits in the following amounts: • $160,000 for Nurse Liaison included in the Administration Fee • $100,000 Annual Wellness Budget included in the Admin Fee • $100,000 Onetime Implementation Credit included in the Admin Fee • $100,000 Annual Communication Budget included in the Admin Fee If Customer terminates the Agreement prior to December 31,2020 Customer will,subject to appropriations by Customer's governing body,pay United a prorated portion of these credits. First Amendment to Administrative Services Agreement Page 5 of 8 The Agreement is amended by replacing Exhibit C in its entirey with the following Exhibit C: EXHIBIT C-PERFORMANCE STANDARDS FOR HEALTH BENEFITS The Standard Medical Service Fees (excluding Optional and Non-Standard Fees and that portion of the Standard Medical Service Fees attributable to Commission Funds, if applicable, as described in Exhibit B), (hereinafter referred to as"Fees"in this Exhibit)payable by Customer under this Agreement will be adjusted through a credit to its fees in accordance with the performance guarantees set forth below unless otherwise defined in the guarantee. Unless otherwise specified, these guarantees apply to medical benefits and are effective for the period beginning January 1, 2017 and ending on December 31, 2018 (each twelve month period is a "Guarantee Period"). With respect to the aspects of United's performance addressed in this exhibit, these fee adjustments are your exclusive financial remedies. These guarantees will become effective upon the later of(1)the effective date of the Guarantee Period; or(2)the date this Agreement is signed by both parties. In the event these guarantees become effective later than the effective date of the Guarantee Period: (1) quarterly guarantees will become effective beginning with the next calendar quarter following signature of this Agreement by both parties and (2) annual guarantees will become effective commencing with the Term of the Agreement during which this Agreement is signed by both parties. With reasonable notification to the Customer, United reserves the right from time to time to replace any report or change the format of any report referenced in these guarantees. In such event,the guarantees will be modified to the degree necessary to cant' out the intent of the parties. United shall not be required to meet any of the guarantees provided for in this Agreement or amendments thereto to the extent United's failure is due to Customer's actions or inactions or if United fails to meet these standards due to fire, embargo, strike, war, accident, act of God, acts of terrorism or United's required compliance with any law, regulation, or governmental agency mandate or anything beyond United's reasonable control. Prior to the end of the Guarantee Period, and provided that this Agreement remains in force,United may specify to Customer in writing new performance guarantees for the subsequent Guarantee Period. If United specifies new performance guarantees, United will also provide you with a new Exhibit that will replace this Exhibit for that subsequent Guarantee Period. Claim is defined as an initial and complete written request for payment of a Plan benefit made by an enrollee, physician, or other healthcare provider on an accepted format. Unless stated otherwise, the claims are limited to medical claims processed through the UNET claims systems. Claims processed and products administered through any other system, including claims for other products such as vision, dental, flexible spending accounts, health reimbursement accounts,health savings accounts,or pharmacy coverage, are not included in the calculation of the performance measurements. Also, services provided under capitated arrangements are not processed as a typical claim;therefore capitated payments are not included in the performance measurements. Tl me to Process in 10 Days The percentage of all claims United receives will be processed within the designated number of business Defirutton days of receipt. Measur mr ent '-_" Percentage of claims processed 94% Time to process,in business days or less after receipt of claim business days 10 Crta tertStandard claim operations reports Level Site Level Period Annually P nt Period Annually Fees"at RisTr Total Dollars at Risk for this metric $70,000 1?a ment.Amount Of the Fees at Risk for this metric,percentage at risk for each gradient 20% GradtenW- 11 business days 12 business days 13 business days 14 business days First Amendment to Administrative Services Agreement Page 6 of 8 15 business days or more lloilgc�+iccara" DAR lefmition Dollar accurac rate of not less than the designated percent in any quarter. Mea uremeit Percenta a of claims dollars processed accurate] 99% Statistically significant random sample of claims processed is reviewed to determine the percentage of claim dollars processed correctly out of the total claim dollars paid. Yel Office Level Petod " Annually ,Payment Pectod% .? Annually ,FeeskRi# , _ Total Dollars at Risk for this metric $70-000 'Pa- Amount; Of the Fees at Risk for this metric,percentage at risk for each gradient 20% dxents 98.99%-98.50% 98.49%-98.00% 97.99%-97.50% s ;.. 97.49%-97.00 Below 97.00% Phone service guarantees and standards apply to Participant calls made to the customer care center that primarily services Customer's Participants. If Customer elects a specialized phone service model the results may be blended with more than one call center and/or level. They do not include calls made to care management personnel and/or calls to the senior center for Medicare Participants,nor do they include calls for services/products other than medical,such as mental health/substance abuse, pharmacy(except when United is Customer's pharmacy benefit services administrator),dental,vision,Account,Health Savings Account,etc. Average Speed to Answer',', Di itti, Calls will sequence through our phone system and be answered by customer service within the parameters ..;. set forth. Measureuii t Y Percentage of calls answered 100% a: Time answered in seconds,on avera a seconds 30;. Grate Standard tracking reports produced by the phones stem for all calls Team that services Customer's account Annually P#' Period Annually Fees at TGisk Total Dollars at Risk for this metric $70,000 Pa.mentAmoutit` Of the Fees at Risk for this metric,percentage at risk for each gradient 20°fo. Gradients -,v s ; 32 seconds or less 34 seconds or less r 36 seconds or less F 38 seconds or less Greater than 38 seconds I�finition::! Time to resolve inquiries received from a Participant via a call to customer service Percentage of issues resolved 88% Time to resolve,in business days or less after the issue is re orted business days 5 Criteria Standards stem tracking reports LeYel Customerspecific Period Quarter] Pa entPeriod Annually Fm"at Rist Total Dollars at Risk for this metric 530;000 Pa:anenf:Amount Of the Fees at Risk for this metric,percentage at risk for each gradient 25% Grtttitettts H 87.99%-87.50% n' 87.49%-87.00% 86.99%-86.50% 86.49%-86.00% S "; fenitiunts Time to resolve inquiries received from a Participant via a call to customer service Percentage of issues resolved 92% Messuremest£ Time to resolve,in business days or less after the issue is reported business days 10 Gritena Standards stem tracking reports Level Customerspecific Perm Quarter] First Amendment to Administrative Services Agreement Page 7 of 8 �,Payincirt,P6riod Annually RIF Risk' Total Dollars at Risk for this metric $30,000 P "` t Amount` Of the Fees at Risk for this metric,percentage at risk for each radient 25% CrradYents" 91.99%-91.50% y f 91.49%-91.00% 90.99%-90.50% i, • ,,s 90.49%-90.00% .. a F t1" ssuc Rem > ;["r 13e60iti(ti ,,- Time to resolve inquiries received from a Participant via a call to customer service Percentage of issues resolved 95% Time to resolve,in business days or less after the issue is reported business da s " 21 Crrtena %: Standard s stem trackina reports ivet, Customerspecific Quarterly 'Pay it<<?Erind Annually Foes atlisk" Total Dollars at Risk for this metric $30;000 tAunotiiit'- Of the Fees at Risk for this metric,percentage at risk for each gradient 25% `tits f r 94.99%-94.50 Grads % 94.49%-94.00% 93.99%-93.50% 93.49%-93.00% Castor'erSatisfaction IIentttozf The overall satisfaction will be determined by the question that reads"How satisfied are you overall with r;•� UnitedHealthcare?" lleasurerhertt „ Minimum score on a 10 point scale score 5 t ttt� Standard Customer Scorecard Survey Nix 9. e elF Customerspecific Period Annually Pa ntPeradd Annually Fees"at Rcs Y'y Total Dollars at Risk for this metric $70,000' Pa me�t' Of the Fees at Risk for this metric,percentage at risk for each gradient NfA dients r, - Not applicable First Amendment to Administrative Services Agreement Page 8 of 8