HomeMy WebLinkAboutContract 37688-A2 CITY SECRETARY
CONTRACT NO..; to $-q-9
XAetna®
To: City of Fort Worth
Margaret Wise-Assistant Director of HR
1000 Throckmorton
Fort Worth,TX 76102
Re: 889000
We are forwarding an electronic file containing copies of your plan documents.
Signature Required
Please sign and return to
Aetna by August 12, 2011
Please find the attached documents to your contract ASA-889000 effective January 1,2006. These are finalized
documents.
Retiree Drug Subsidy(RDS) amendment effective 1-1-2006.
Your use of the documents in this medium shall signify your agreement not to alter or change their content in any way
without the express consent of Aetna,and your agreement to indemnify and hold Aetna harmless for all loss,liability,
damage,expense,cost,or other obligation which Aetna may incur or be required to pay as a result of any claim,
demand,or lawsuit brought by any party (including yourself) arising from or in connection with any unauthorized
changes.
Aetna
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
08-30-- 1 1 PO :28 1 N
No. 889000
Amendment - 2
Attached to and made a part of the Administrative Services Agreement or Contract No.ASA or ASC-889000
(the"Services Agreement/Contract")
between
Aetna Life Insurance Company
(hereinafter referred to as Aetna)
and the Customer or Contractholder(as defined in the applicable services agreement or contract)
City of Fort Worth
(hereinafter defined as"Customer/Contractholder")
It is understood and agreed that the Services Agreement/Contract,as constituted on the effective date of this Amendment,is
changed to reflect that Aetna will provide the following services in addition to those services elected in accordance with the
terms of the Services Agreement/Contract:
Retiree Drug Subsidy("Direct Subsidy")Reporting services under Medicare Part D as described in the attached
Appendix B.
The charge for Direct Subsidy Reporting for the period January 1,2006 through December 31,2006 is$10,000.
The charge for Direct Subsidy Reporting will be payable as a Direct Billed charge in accordance with the terms of the
Services Agreement/Contract.
This charge may be adjusted annually effective on the anniversary of the Services Agreement/Contract by Aetna in
accordance with the terms of the Services Agreement/Contract.
Administrative Fee Caveats and Assumptions:
The above pricing does not include charges for additional structure and similar work required to support the reporting.
Some examples include,but are not limited to:
• Restructure members
• Add new structure to the plan
• Reformat eligibility
• Build eligibility front end and/or back-end
Nothing contained in this amendment shall be held to alter or affect any of the terms of the contract other than as herein
G SC-50-R 1 1
specifically stated.
In Witness Whereof,the parties hereto have caused this Amendment to be executed by their duly authorized representatives,
to become effective January 1,2006.
Signed by Aetna,February 8,2006.
CITY OF FORT WORTH
AETNA LIFE INSURANCE COMPANY
("CUSTOMER") ("AETNA")
By: By:
v
Name: Susan Alanis
Ronald A.Williams
Title: Assistant City Manager Chairman,Chief Executive Officer and President
Date: D Registrar:
APPROVE.®,AS TO Date: February 8,2006
F M D LEGAL{TY:
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Financial Verification
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OFFICIAL RECORD
CITY SECRETARY
GSC-50-RI 2 FT. WORTHS TX
APPENDIX B
RETIREE DRUG SUBSIDY("DIRECT SUBSIDY")REPORTING SERVICES UNDER MEDICARE PART D
THIS APPENDIX between City of Fort Worth ("Customer/Contractholder")and Aetna Life Insurance Company or any of
its corporate affiliates("Aetna")is an attachment to Administrative Services Agreement or Contract No.ASA or ASC-
889000 (the"Services Agreement/Contract")between Aetna and Customer/Contractholder and is incorporated by reference
therein.
It is understood that Customer/Contractholder has elected to apply for the 28%subsidy available under Medicare Part D to
employers/unions that offer a pharmacy benefit that is actuarially equivalent to the standard Part D benefit("Direct
Subsidy"). Subject to the terms of the Services Agreement/Contract,the Services available from Aetna in support of
Customer/Contractholder's contracting with the Centers for Medicare and Medicaid Services("CMS")for the Direct Subsidy
are described below.
1. Services—Aetna shall make the following reports available to Customer or its designee through e.PSM(subject to
Aetna's standard form of e.PSM agreement),or such other means as determined by Aetna. It is understood and agreed
that Aetna will not be submitting information to CMS on behalf of Customer.
A. Eligibility Reports
i. Initial enrollment file in the layout required by CMS listing proposed Qualifying Covered Retirees for inclusion
in Customer's Direct Subsidy Application. Customer shall be responsible for ensuring that any files forwarded
to CMS are converted to the correct file format prior to submission.
For purposes of this Appendix,"Qualifying Covered Retiree"shall mean as defined under 42 CFR 423.882,a
Part D eligible individual who is: a participant or dependent of a participant;covered under employment-based
retiree health coverage that qualifies as a qualified prescription drug plan;and not enrolled in a Part D plan.
This enrollment file shall be based on eligibility information supplied by Customer or its vendor(s)to Aetna
regarding the membership in Customer's retiree plan(s)(including retirees and dependents). In connection with
this or any other report furnished by Aetna to Customer under this Appendix,Aetna shall not be responsible for
any delay or inaccuracies caused by Customer's or its vendor(s)'failure to furnish accurate eligibility
information with all data fields required by CMS in a timely fashion. It is understood that CMS will be
conducting a data match for all proposed Qualifying Covered Retirees submitted by plan sponsors to verify that
such individuals are Part D eligible and are not enrolled in a Part D plan,and will provide a response file to
Customer with the results of its review.
With respect to any retiree Control Suffix Account("CSA")arrangements for which Aetna will be providing
eligibility files,Aetna shall report all members who are sixty five(65)years and older. With respect to any
non-retiree only CSA arrangements for which Aetna will be providing eligibility files,the parties acknowledge
that the file provided by Aetna may contain data from members who are not Qualifying Covered Retirees.
Customer shall be responsible for removing any non-Qualifying Covered Retirees from the report prior to
Customer submitting the file to CMS.
ii. Monthly Files showing additions to/deletions from list of proposed Qualifying Covered Retirees.
These monthly reports of eligibility changes shall reflect updated eligibility information furnished by Customer
to Aetna. Customer shall be solely responsible for reconciling the CMS response files with the applicable file
submitted by Customer to CMS,and for making any necessary changes required as a result of CMS'review.
Customer shall also be solely responsible for submitting any eligibility changes to CMS in accordance with
CMS requirements. Monthly files shall only reflect added,deleted and updated information.
APP C-RDS I
B. Interim Claim Reports
Interim Claim Reports will be provided at a frequency determined by Customer(monthly,quarterly,or
annually)to support Customer's interim payment requests to CMS. Such reports shall show Gross Prescription
Drug Costs for Customer's Qualifying Covered Retirees during the applicable period. For purposes of any
reports furnished pursuant to this Appendix,"Gross Prescription Drug Costs"shall mean non-administrative
costs incurred under the plan in the plan year for Part D drugs,whether paid for by the plan or covered
individuals,as defined under 42 CFR 423.882,and shall be based upon CMS specifications. Information in
these reports shall be provided at an aggregate level.
C. Year-End Claim Reports
Report,based upon CMS specifications,showing Gross Prescription Drug Costs during the plan year at the
member level will be provided within fifteen(15)months after the end of the plan year to support Customer's
year-end reconciliation submission to CMS. It shall be the responsibility of the Customer to reconcile these
reports against response files sent by CMS in accordance with any applicable rules and regulations established
by CMS under the Direct Subsidy.
D. Rebate Reports
Reports based upon CMS specifications of total rebates attributable to Customer's Members and the amount
actually paid to Customer will be provided to Customer semi-annually,or as otherwise mutually agreed to in
writing by the parties,at the plan sponsor or Control Suffix Account level. It is understood that Aetna will not
provide actuarial services in connection with the Direct Subsidy,and it is Customer's sole responsibility to
determine the amount of rebates to be reported to CMS for its Qualified Covered Retirees as part of the interim
payment and/or year-end reconciliation process.
2. Records Retention—Aetna hereby agrees to maintain all documentation of costs incurred and other relevant
information utilized for calculating the amount of the subsidy payment,including the underlying claims data,for at least
(6)years after the expiration of the plan year in which such costs were incurred. In certain instances,a longer retention
period may be required,and Aetna hereby agrees to maintain all relevant information for such longer period. Aetna
further agrees to make the records available to CMS,the OIG and/or Customer or its designee(e.g.,in the event of an
audit or an investigation)upon request by CMS,the OIG or Customer or its designee. Claims data will be maintained by
Aetna at an individual claimant level. Any audit requested by Customer shall be subject to the guidelines set forth in the
Services Agreement.
3. False Claims Act Acknowledgement—Aetna hereby acknowledges that the data provided hereunder in support of
Customer's Direct Subsidy request is used for the purpose of obtaining Federal funds,which may be subject to the False
Claims Act.
4. Standard of Care/Indemnification-The parties acknowledge that federal laws related to the Direct Subsidy and the
Medicare Part D program are new and evolving,and that the Direct Subsidy requirements and procedures are not yet
fully defined and developed. As a result,CMS may provide subsequent guidance or requirements that may alter the
manner in which the services contemplated by this Appendix are to be provided. Aetna shall carry out its obligations
hereunder in accordance with its best understanding and interpretation of the requirements of the Drug Subsidy program.
Aetna specifically acknowledges that,in performing its responsibilities under this Appendix,it shall be subject to the
standard of care and indemnification obligations contained in the Services Agreement,
APP C-RDS 2
5. Use of Confidential MemberHealth Data-Customer acknowledges that the reports provided by Aetna pursuant to this
Appendix will include confidential member health data(the"Information"),subject to certain state and federal laws
protecting the privacy and confidentiality of such Information. Customer further acknowledges that the Information
should be treated as confidential and represents that the necessary actions have been taken in accordance with the"plan
sponsor disclosure rules"of the HIPAA Privacy Regulations(45 C.F.R. 164.504(o)for Customer to receive Protected
Health Information of Qualifying Covered Retirees. In addition,Customer agrees: (1)that except as otherwise permitted
by law,the Information will be used solely for the purpose of administering the Direct Subsidy;(2)to comply with all
applicable federal and state laws restricting access,use,or disclosure or redisclosure of the Information,including,
without limitation,the HIPAA"plan sponsor disclosure rules"and(3)to ensure that any and all third parties to whom
Aetna discloses the Information at Customer's request comply with these obligations. Under no circumstances shall
Customer use the Information for any employment-related actions or decisions,except with the express,written
authorization of the relevant employees,consistent with applicable law.
6. Response and Notification Files from CMS- Customer shall provide Aetna with a copy of any eligibility response
("Response")and weekly notification("Notification")files received from CMS(including the initial response file)as
they are received from CMS or at least twice per month. Response files for the month of December shall be provided to
Aetna on or before March 1"of the following year. Aetna shall rely upon Customer's CMS Response and Notification
files provided by Customer to Aetna,which shall include the Customer's Qualifying Covered Retirees. Aetna shall not
be responsible for any delays or inaccuracies caused by Customer's failure to furnish accurate information with all data
fields required by CMS in a timely fashion.
APP C-RDS 3
Page 1 of 1
Gray, Marta
From: Pope, Louwanna E [PopeL@aetna.coml
Sent: Monday, April 25, 2011 7:23 PM
To: Gray, Maria
Cc: Collins, Deborah D
Subject: Signature Required-Electronic Delivery 889000_City of Fort Worth- RDS Agreement-Finalized
documents
Attachments: RDS%20amend%20w%20app%20B%20%28epub%29%20w%20Aetna%20sigs%2002-08-
2006%20%282%29.pdf
Maria,I am sending this email as a follow-up to our conversations regarding the RDS
Agreement.
You requested we update the amounts within the RDS Agreement for years 2007 to current.
This agreement was drafted with a 1/1/2oo6 effective date, which at that time we did not
know the rates for the future years and adding them now to the 2oo6 agreement is not
logical and therefore, we're unable to fulfill your request.
As for the 2007-2009 charges, these were addressed and agreed to, by the City, in the
Annual Accounting packages we have provided to the City each year. There are no
additional amendments that we provide, after the initial Agreement has been signed. The
201oAccounting will be delivered by July, 2011. I have outlined the charges below as a point
of reference. If you need anything additional,please let us know. L-
The charge for Direct Subsidy Reporting for the period January 1,2006 through December 31,2006 is$10,000.
The charge for Direct Subsidy Reporting for the period January 1,2007 through December 31,2007 is$9,700.
The charge for Direct Subsidy Reporting for the period January 1,2008 through December 31,2008 is$7,000.
The charge for Direct Subsidy Reporting for the period January 1,2009 through December 31,2009 is$7,000.
The charge for Direct Subsidy Reporting for the period January 1,2010 through December 31,2010 is$7,500.
The charge for Direct Subsidy Reporting for the period January 1,2011 through December 31,2011 is$7,800.
Louwanna Pope, Account Manager I Public&Labor-Mid-America/Southwest 12777 Stemmons Freeway,#300 1 Dallas,TX 75207
1 9 972-881-4652 1 9 Cell 214-287-8785 1 Fax:860-262-7348 1 Email: PopeL@Aetna.com
"When it is obvious that the goals cannot be reached, don't adjust the goals,acuust the action
steps."-Cor}fucius
This e-mail may contain confidential or privileged information. If you think you have received this e-
mail in error,please advise the sender by reply e-mail and then delete this e-mail immediately. Thank
you. Aetna
8/25/2011
Page 1 of 1
Gray,Maria
From: McElroy,Denis C.
Sent: Tuesday,June 14,2011 1:43 PM
To: Gray,Maria
Subject: previous amendment to Aetna
Attachments:CSC 37688-A1.PDF
Maria,
Back in 2009,we signed an amendment to the ASA. Since the RDS amendment is being signed more than 2 years later,i don't think it should be titled"Amendment 1
Maybe they could give it a descriptive name instead of a number—for example"Amendment Addressing Retiree Drug Subsidy Reporting'
Also,the document that was routed makes numerous references to the"Administrative Services Only Agreement.' As you can see on the screenshot below,the word"only'
does not appear in the title,and the ASA is styled"Administrative Services Agreement."
Please ask Aetna to make these minor tweaks(changing the title from Amendment 1 and striking the word"only'from the references to the ASA)and re-send for signatures.
Thanks
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No. 889000 _ NO
AMMISTRATIVE SERVICES AGUEMENT
AGREEMENT:NUMBER ASA 889000
Tbis Administrative Services Agreement(hereinafter"Services Agreement")is made and entered into by and between Aetna Life
Insurance Company on behalf of itself and its affiliated health maintenance organizations("HMOs")(collectively"Aetna')and
City of Fort Worth(hereinafter"Customer").
WHEREAS,Customer has established a self-funded employee health benefits plain(the'Plan")for certain eligible individuals
described in Appendix I of this Services Agreement;and
WHEREAS,pursuant to the Plan,Customer wishes to make available one or more coverage products offered by the HMOs(the
"Products"),as specified in Appendix I of this Services Agreement;and
WHEREAS,Aetna has arranged to provide integrated administration of these Product(s)and,if requested by the Customer,has
also agreed to provide certain supplemental administrative services and Products not available through the HMOs;
WHEREAS,Aetna will administer the Plan as a self insured plan using the negotiated rates,network rules and policies,and
contracts for its Products.
THEREFORE,in consideration of the mutual covenants and promises stated herein and other good and valuable consideration,
the parties hereby enter into this Services Agreement. This Services Agreement includes and incorporates by reference the
attached Service and Fee Schedule,General Conditions Addendum,Description of Services Adderndunt,National Advantage
Program Adde:ndnm,and Appendices.
Customer hereby elects to receive the Services for Products/Programs designated in the Service and Fee Schedule as well
as any supplemental Services identified therein. The corresponding Service Fees effective for the period beginning
January 1,2005 and ending December 31,2005 are specified in the Service and Fie Schedule,which shall be amended for future
Periods,in accordance with Section 3 of the General Conditions Addendum,to reflect the Services elected and corresponding
Service Fees for such rims. v
8/25/2011
No.:.._KES9QOQ
Amendment 1
Attached to and made a part ofthe Administrative Services Only '-889000
(the"Services AgreenrenUtontract")
between
Aetna Life Insurance Company
thereinafler refenyd to as.Aetna)
and the Customer or Contractholdcr(as defined in the applicable services agreement or contract)(hereinafter defined as
"Custorner'('on tract holder")
City of Fort Worth
It is understood and agreed that the tiefvr cs 1.gr,cemu)t l'nnhact,a>conurtutcd on 8rc_cihUr _date of thrs.Amcndm�nt-_is
changed to reflect that Aetna will providc the following services in addition to those services elected in accordance with the
tenns of the Services Asreement'Ctmtract:
Retiree Drug Subsidy(`Direct Subsidy"Reporting services under Medicare Part t)as described in the attached
Appendix 13,
lire chase for Direct Subsidv Reportinz for the period January 1,2006 through December 31,2006 is$10,000,
fhe.charge fbr Direct Subsidy Reporting will be payable as a Direct Billed charge in accordance with the terms of the
Services A greementiContact.
This charge may by e adjusted annually effective on the annivcrsary of the Services Aereernem'Conuact by Aetna in
accordance with the terms of die Services....,1.grccmcnt_Contra,ct.
Administrative Fee Caveats and Assumptions:
The above pricing does not include charges for additional structure and similar work required to support the reporting
Some examples include.but are not Iimilyd to:
................._._.....__.._..._............_...___......_._.__.........._.._
• ..Restnrclure members [Formatted:Bullets and um ring
• Add new structure to the plan
• Reformat eli*ihility
• Build eligibility front end and'or back-end
N_Qjhing,contained...in,this_.amendment shall be_beld to alter_or..af m an ofthc terms_pf.#1e,.cong�act other_than as,herein
GSC-50-RI I