HomeMy WebLinkAboutContract 47186-R2A2 v
NOV 22 2019
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T S�REWTARY�H �a CITY SECRETARY CONTRACT NO. +715� -�a>Pra
SECOND RENEWAL OF AND AMENDMENT TO FORT WORTH CITY SECRETARY
CONTRACT NO. 47186 — AGREEMENT FOR CLAIMS ADMINISTRATION SERVICES
This Second Renewal of City Secretary Contract No. 47186, Agreement for Claims
Administration Services (the "Renewal") is made and entered into by and between the CITY OF
FORT WORTH, a home-rule municipal corporation of the State of Texas ("PRINCIPAL" or "CITY"),
and YORK RISK SERVICES GROUP, INC., a New York corporation("YORK").
WHEREAS, CITY and YORK are parties to a contract for services related to administration of
PRINCIPAL'S self-funded workers' compensation program and its managed care services and
504 Provider Network, that contract being Fort Worth City Secretary Contract No. 47186 (the
"Agreement"); and
WHEREAS, the agreement provides for an initial three-year term and two renewal options of
one year each; and
WHEREAS,the initial term of the Agreement expired on October 31, 2018, and the First
Renewal Option expired on October 31, 2019; and
WHEREAS, CITY and YORK wish to renew and extend the Agreement for a second renewal
period, to adopt a clarified compensation schedule, and to incorporate a provision required
under recently enacted state law.
NOW THEREFORE, CITY and YORK do hereby covenant and agree as follows:
SECTION 1.
Fort Worth City Secretary Contract No. 47186 is hereby renewed and extended for a second,
additional one year term, commencing on November 1, 2019 and ending October 31, 2020 (the
"Second Renewal Term").
SECTION 2.
For purposes of the Second Renewal term, Section VIII. Compensation,Subsection A., of Fort
Worth City Secretary Contract No. 47186 is deleted in its entirety and replaced with the
following:
OFFICIAL RECORD
CITY SECRETARY
FT. WORTHo TX
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VIII. COMPENSATION
A. YORK shall be entitled to and receive and PRINCIPAL shall be obligated to pay
only such fees, allowances,costs, reimbursements,or other compensation as are specified as
follows:
Compensation
SERVICE Annual Flat Fee
Claims Adjusting Fees
Annual flat fees include a total of 7 Year 1
employees dedicated exclusively to the $799,610
City of Fort Worth as follows:
➢ 4 on-site Indemnity Adjusters
➢ 1 on-site Claims Associate Year 2 $822,407
➢ 1 on-site Unit Manager
➢ 1 on-site Medical Only Adjuster Year 3 $842,824
Year 4 $863,750
Annual flat fees include employees who
provide services for the City of Fort Worth
and other clients as follows:
➢ Designated support and oversight— Year 5 $885,200
Claims Director in York's Austin
Office
➢ Floating Unit Manager in York's
Austin Office
OTHER CLAIMS ADMINISTRATION FEES Fee Structure Unit Cost
Medical Bill Auditing Per Bill $8.30
Telephonic Case Management Per Hour $90
Preauthorization Per Request $90/Nurse
$160/Physician
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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 $159,635
of Indemnity Adjusters to 5 and the total number of
employees exclusively dedicated to the City of Fort
Worth to 8).
Fee Structure Unit Cost
$200-$600
Peer reviews Per Review Depending on
Specialty
OTHER SERVICES/FEES Fee Structure Unit Cost
SOAH/Appeals panel reviews/APA services TPA Included/Legal Fees at Cost
Reconsideration requests Per Request $8.30
Recorded statement transcriptions Included
Vocational rehabilitation services Per Hour $90
Photos Included
Mileage Included
Express mail, certified mail Included
Photocopying Included
Medicare reporting Included
Public records search Included
Private Investigative Services Per Hour $80
Retrospective Utilization Reviews- Preauth Per Review $160
One time data conversion fee One-time $7,500
[ME Per Review $350
IRO Filing Included in Pre-Authorization
Designated Doctor/RME Coordination Per Request $250
Impairment Rating Review Per Request $250
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Job Analysis Per Hour $90
Life Care Plan Per Hour $125
504 NETWORK SERVICES One-Time Fee Per medical Bill
Per Medical $8
Network or 504 access Bill
Administrative fees for all services Annual Flat $4,000
Fee
Credential providers Included
Contract providers One-Time Fee $225 Per Provider
Group/Provider
Create fee schedule Included
Information system &service fees including contract load & Included
TPA/DWC electronic interface
Train staff Included
Notify and educate employees Guidance Included
Establish/maintain website, email, telephone support Included
Account audits Included
Access to provider Included
Management/data reports Included
TOTAL FOR OTHER CLAIMS ADMINISTRATION FEES,
OTHER SERVICES/FEES,AND 504 NETWORK SERVICES $140,000
NOT TO EXCEEDNOT TO EXCEED
SECTION 3.
That during the Second Renewal Term (i) no fee identified as "one-time" in the chart in
Paragraph A of Section VIII, "Compensation," of Fort Worth city Secretary Contract No. 47186
shall apply, (ii)the optional fifth on-site Indemnity Adjuster shall not be utilized, meaning that
fee shall not apply, and (iii) the "Year 5"fee shall apply for claims adjusting services.
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SECTION 4.
That all other terms and conditions of Fort Worth City Secretary Contract No. 47186 are not
amended herein shall remain in full force and effect throughout the Second Renewal Term.
[SIGNATURES APPEAR ON FOLLOWING PAGE]
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IN WITNESS WHEROF, the parties hereto have executed this Renewal effective as of November
1, 2019.
CITY OF FORT WORTH: YORK RISK SERVICES GROUP, INC.:
By: By: r
Jesus J. Chapa,Assistant City Manager Jody A. ses,
Executive Vice President
Approval Recommended:
By: i
Bri Dickerson ¢O� �..
Human Resources Director fin ..•••••
Approved as TF and Legality: Attest:
By: / By. C;. .
John B. Strong, Assistant Ciy Attorney Mary Kayse it vS c etary "
Contract Authorizatio, M&C C-27435
Date Approved: August 25, 2015
OFFICIAL RECORC
CITY SECRETARY
FT. WORTH,TX
Second Renewal of CSC 4718C/17546 age 6 M 6
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IN WITNESS WHEROF, the parties hereto have executed this Renewal effective as of November
1, 2019.
CITY OF FORT WORTH: YORK RISK SERVICES GROUP, INC.:
By:_ By:
Jesus J. Chapa, Assistant City Manager Jody M04es,
Executive Vice President
App'rov R ed:
Brdaarcl(erson
Human Resources Di rector
Approved a to Form and Legality: Attest:.
..........
Z�
By: By:
John B trong',Assistant ty Attorney Mary Kayser, ft/Se `e'
Contract Authorization: M&C C-27435
Date Approved: August 25, 2015
01H0AL RECORD
-,C,'TY SECRETARY
WORTH,TX
Second Renewal of CSC 4718C/17546 Page b Ot b
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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.
v S lam, e-1 jin., l
K , 14
Name of Employee/Signature
Title
❑ This form is N/A as No City Funds are associated with this Contract
Printed Name Signature
OFFICIAL RECORD'
CITY SECRETARY i
FT: WORTH,TX