HomeMy WebLinkAboutContract 62344CSC No. 62344
CLAIM ADMINISTRATOR
BUSINESS ASSOCIATE AGREEMENT
This Claim Administrator Business Associate Agreement ("Agreement") by and between Blue Cross
and Blue Shield of Texas ("BCBSTX"), a division of Health Care Service Corporation, a Mutual Legal
Reserve Company ("Claim Administrator"), and City of Fort Worth ("Employer") and the Employer
on behalf of its Group Health Plan ("GHP"), collectively the "Parties," is effective on January 1, 2025.
The purpose of this Agreement is to set forth the Parties' mutual agreement on the terms for their
compliance with the Health Insurance Portability and Accountability Act and its implementing
regulations (45 C.F.R. Parts 160-164), and the Health Information Technology for Economic and
Clinical Health Act, as incorporated in the American Recovery and Reinvestment Act of 2009, and its
implementing regulations, each as issued and amended by the Secretary (all the foregoing, collectively
"HIPAA") for the services and functions related to the underlying services agreement. executed
between the Parties. Capitalized terms used in this Agreement and not otherwise defined shall have
the meanings set forth in HIPAA, which definitions are incorporated by reference.
The Parties acknowledge and agree that Claim Administrator is a Business Associate and the
Employer's GHP is a Covered Entity as defined by HIPAA. In addition, the Employer acknowledges
its employee welfare benefit plan meets the definition of a Health Plan in 45 CFR § 160.103.
1. Obligations and Activities of Claim Administrator as a Business Associate.
a. Claim Administrator agrees to use or disclose Protected Health Information ("PHI") it creates
for or receives from Employer/GHP only as permitted or required by this Agreement or by
Law.
(i) Claim Administrator is permitted to use or disclose PHI to perform the functions, activities,
and services as the Claim Administrator for Employer's GHP. In addition, the Parties may
enter into other agreements from time to time that include additional functions, activities,
and services provided by the Claim Administrator, and to the extent that such agreements
include the Use or Disclosure of PHI, the Parties agree that the terms of this Agreement
shall also apply.
(ii) Claim Administrator is permitted to use or disclose PHI to perform functions, activities, or
services for, or on behalf of, the GHP as the Covered Entity, provided that such Use or
Disclosure does not violate HIPAA if done by GHP and is done in compliance with the
requirements of HIPAA.
(iii) Except as otherwise limited in this Agreement, Claim Administrator may use PHI for the
proper management and administration of the Agreement, the Employer's GHP and
functions related thereto, or to carry out the legal responsibilities of the Claim
Administrator.
(iv) Except as otherwise limited in this Agreement, Claim Administrator may disclose PHI for
Claim Administrator's proper management, administration, and legal responsibilities,
provided that the Disclosures are: Required by Law; or Claim Administrator obtains
reasonable assurances from the person to whom the information is disclosed that it will
remain confidential and not be used or further disclosed unless it is Required by Law or
for the purpose for which it was disclosed to the person. The person shall be required to
notify the Claim Administrator of any instances in which the confidentiality of the
information has been compromised or breached.
(v) Except as otherwise limited in this Agreement, Claim Administrator may use PHI to
provide Data Aggregation services relating to the Health Care Operations of the GHP and
as permitted by 45 CFR § 164.504(e)(2)(i)(B).
OFFICIAL RECORD
bcbstx.as.baa.Rev.04.01.2024.doc CITY SECRETARY
FT. WORTH, TX
CSC No. 62344
CLAIM ADMINISTRATOR
BUSINESS ASSOCIATE AGREEMENT
(vi) Claim Administrator may use PHI to report violations of law to appropriate federal and
state authorities, consistent with 45 CFR § 164.5020)(1).
b. Claim Administrator agrees to use appropriate safeguards to prevent Use or Disclosure of PHI
that is not provided for by this Agreement. Claim Administrator agrees to implement
administrative, technical, and physical measures required by HIPAA that reasonably and
appropriately protect the confidentiality, integrity, and availability of the Electronic PHI that
Claim Administrator creates, receives, maintains, or transmits on GHP's behalf.
c. Claim Administrator agrees to report to GHP any use or disclosure of PHI and any successful
privacy or security incidents ("Incidents") affecting GHP which result in the unauthorized
access, use, disclosure, modification, or destruction of PHI. Claim Administrator will make
report available without delay after the Claim Administrator's Privacy Office becomes aware of
the Incident. The report will include Claim Administrator's determination as to whether the
Incident meets the definition of a Breach of Unsecured PHI under HIPAA along with the
identification (if known) of any individuals whose PHI has been, or is reasonably believed to
have been accessed, acquired, or disclosed. Claim Administrator will cooperate with GHP in
investigating the Breach and in assisting GHP in meeting its HIPAA and state privacy or
security law obligations as described in Attachment 1 of this Agreement.
GHP will check YES if they are delegating to Claim Administrator the obligations listed in
Attachment 1. GHP will check NO if they are not delegating to Claim Administrator the
obligations listed in Attachment 1. If no selection is made, the GHP is responsible for the
obligations listed in Attachment 1.
®YES ❑NO
d. To reduce the administrative burden of reporting, the Claim Administrator will not be required
to report unsuccessful Security Incidents which could include unsuccessful broadcast attacks or
pings on Claim Administrator's firewalls, port scans, unsuccessful log -on attempts, denials of
service and any combination of the above as long as such incident does not result in the
unauthorized access, use, of disclosure of GHP's member data or a Breach of Unsecured
Protected Health Information.
e. Claim Administrator agrees to enter into a written agreement that meets the requirements of 45
CFR § 164.504(e) and § 164.314(a)(2) with its subcontractors (including, without limitation, a
subcontractor that is an agent under applicable law) that creates, receives, maintains, or
transmits PHI on behalf of Claim Administrator. Claim Administrator will ensure the written
agreement with each subcontractor obligates the subcontractor to comply with restrictions and
conditions that are at least as restrictive as the restrictions and conditions that apply to Claim
Administrator under this Agreement.
f. Claim Administrator agrees to make internal practices, books, and records, including policies
and procedures, relating to the Use and Disclosure of PHI received from, or created or received
by Claim Administrator on behalf of GHP, available to the Secretary, in a time and manner as
reasonably requested by or designated by the Secretary, for purposes of the Secretary
determining GHP's compliance with HIPAA.
g. Claim Administrator agrees to document such Disclosures of PHI and information related to
such Disclosures as would be required for GHP to respond to a request by an Individual for an
Accounting of Disclosures of PHI in accordance with 45 CFR § 164.528.
h. Individual Rights Requests. The Party identified on Attachment 2 of this Agreement
("Attachment 2") agrees to respond to requests to exercise the following HIPAA individual
rights.
bcbstx.as.baa.Rev.04.01.2024.doc
CSC No. 62344
CLAIM ADMINISTRATOR
BUSINESS ASSOCIATE AGREEMENT
(i) Requests for an Accounting of Disclosures in accordance with 45 CFR § 164.528. Upon
termination of this Agreement, Claim Administrator will respond to an Individual's request
for an Accounting of Disclosures of PHI for a period of up to six years.
(ii) Requests for Access in accordance with 45 CFR § 164.524. Upon termination of
Agreement, Claim Administrator will respond to an Individual's request while it maintains
the data.
(iii) Requests for an Amendment in accordance with 45 CFR § 164.526. GHP shall consult with
Claim Administrator to determine if Claim Administrator created the PHI maintained in a
designated record set for which amendment is sought. Upon termination of this
Agreement, Claim Administrator will respond to an Individual's request during such time
that Claim Administrator maintains the data.
(iv) Privacy Complaints in accordance with 45 CFR § 164.530(d)
i. When Claim Administrator conducts Standard Transactions on behalf of GHP, Claim
Administrator will comply with HIPAA rules for Standard Transactions and Code Sets.
2. Obligations of GHP as a Covered Entity.
a. GHP shall identify and document any limitation(s) in the GHP's Notice of Privacy Practices, as
required by 45 CFR § 164.520 or any changes to their privacy policies, procedures or practices
that may affect Claim Administrator's Use or Disclosure of PHI on Attachment 2.
b. GHP is responsible for responding to Confidential Communications Requests in accordance
with 45 CFR § 164.522 (a) and (b). Prior to responding or approving any Restriction or
Confidential Communication Requests, GHP shall consult with Claim Administrator for
information on the feasibility of implementing or accommodating the request.
c. GHP shall provide Claim Administrator the necessary information to fulfill Claim
Administrator's obligations under this Agreement, including and if applicable, a written
statement of the restrictions for the Disclosure of PHI by Claim Administrator to the Employer.
d. Employer or GHP on behalf of Employer certifies that the Employer's benefit plan documents
have been amended in compliance with 45 CFR § 164.314(b) and 45 CFR § 164.504(f).
e. GHP shall identify its Business Associates and GHP employees on Attachment 2 of this
Agreement to whom Claim Administrator is permitted to directly Disclose PHI. GHP shall
provide information on any limitations or restrictions on Claim Administrator's Disclosure to a
specific Business Associate or GHP employee.
f. GHP acknowledges that it cannot request Claim Administrator to use or disclose PHI in a
manner that is not permitted or allowed by HIPAA or any other applicable state or federal
regulation.
3. Term and Termination.
a. Term. The Term of this Agreement shall be effective on the date stated on the first page of this
Agreement and shall terminate without notice upon termination of any agreement or
arrangement between the Parties for Claim Administrator to provide administrative services to
Employer's self -insured health benefit welfare plan.
b. Termination for Cause. Upon GHP's knowledge of a material breach by Claim Administrator,
GHP shall either:
(i) Provide an opportunity for Claim Administrator to cure the breach or end the violation. GHP
may terminate this Agreement if Claim Administrator does not cure the breach or end the
violation within a reasonable time frame agreed to by the parties; or
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CSC No. 62344
CLAIM ADMINISTRATOR
BUSINESS ASSOCIATE AGREEMENT
(ii) Immediately terminate this Agreement if Claim Administrator has breached a material term
of this Agreement and cure is not possible.
Effect of Termination. The Parties agree that returning or destroying the PHI is not feasible due
to state or federal regulatory requirements applicable to Claim Administrator or GHP and
Claim Administrator's record retention policies. Claim Administrator shall extend the
protections of this Agreement to such PHI, including limiting further Uses and Disclosures of
the PHI to those purposes that make the return or destruction infeasible, for so long as Claim
Administrator maintains such PHI.
4. Miscellaneous.
a. Regulatory References. Any regulatory reference to HIPAA found in this Agreement includes
the relevant and applicable implementing regulations as issued and amended by the Secretary.
b. Amendment. The Parties agree to take such action as is necessary to amend this Agreement as
necessary for the Parties to comply with HIPAA as it may be amended from time to time.
c. Survival. The respective rights and obligations of GHP and Claim Administrator under Section
3.c. of this Agreement shall survive the termination of this Agreement.
d. Interpretation.
(i) Ambiguities in the Agreement will be resolved to permit Parties to comply with HIPAA.
(ii) Any conflict between the terms of this Agreement and any other agreement between the
Parties concerning the Employer's health welfare benefits plan shall be resolved so the
terms of this Agreement supersede and replace the relevant terms of any such other
agreement concerning the use and disclosure of PHI, except for uses and disclosures
permitted under the underlying services agreement or other agreements between the
Parties.
(iii) If Claim Administrator's Business Confidential Information (as defined in the services
agreement) is imbedded in any of the GHP's PHI, the Parties acknowledge that Claim
Administrator retains ownership of that information. The GHP further acknowledges that
there may be terms in the services agreement that place additional restrictions on the use
and disclosure of the Claim Administrator's Business Confidential Information.
e. Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed
an original, and all of which shall constitute one binding agreement.
f. Severability. The provisions of this Agreement shall be severable, and if a provision is
determined or declared to be illegal, invalid, or unenforceable, the remainder of this Agreement
will continue in full force and effect as if such illegal, invalid, or unenforceable provision were
not included.
g. Notice. All notices, requests or demands and other communications from any of the Parties to
the others related to this Agreement shall be made to the Privacy Officer of such other Party at
the mailing address or fax number set forth on Attachment 2.
bcbstx.as.baa.Rev.04.01.2024.doc
CSC No. 62344
CLAIM ADMINISTRATOR
BUSINESS ASSOCIATE AGREEMENT
IN WITNESS WHEREOF, the Parties hereto have authorized this Agreement to be executed.
City of Fort Worth,
Employer [or Plan Sponsor] and
Employer on behalf of its Group Health
Plan, the Covered Entity:
Signature: C>3�-Q
Printed Name: Jesica McEachern
Title: Assistant City Manager
Date: Nov 20, 2024
Blue Cross and Blue Shield of Texas, a
Division of Health Care Service Corporation,
A Mutual Legal Reserve Company, the
Claim Administrator:
Signature:5z/= -Ij�
Printed Name: Jim Springfield
Title: Texas Plan President
Date: Click here to enter text.
ATTACHMENT 1: BREACH OBLIGATIONS
ATTACHMENT 2: ADDITIONAL INFORMATION FORM
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CSC No. 62344
ACCEPTED AND AGREED:
CITY:
City of Fort Worth
By: C>--ea—
Name: Jesica McEachern
Title: Assistant City Manager
Date: Nov 20, 2024
Approval Recommended:
By: 9,— "/'w
Name: Joanne Hinton
Title: Interim Human Resources Asst Dir
Attest:
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Name: Jannette Goodall
Title: City Secretary
VENDOR:
By:
Name:
Title:
Date:
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: Meagan Hailey
Title: Interim Benefits Manager
Approved as to Form and Legality:
By: .)
Name: Jessika J. Williams
Title: Assistant City Attorney
Contract Authorization:
M&C: 24-0703
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
CSC No. 62344
CLAIM ADMINISTRATOR
BUSINESS ASSOCIATE AGREEMENT
ATTACHMENT 1: Breach Obligations
The GHP delegates the following to Claim Administrator:
• Investigate any unauthorized access, use, or disclosure of GHP's PHI (Incident) by Claim
Administrator or its subcontractors.
• Evaluate the Incident using the risk assessment criteria of HIPAA to determine whether it rises
to the level of Breach and whether a HIPAA notification exception applies.
• Document and retain each risk assessment and exception analyses (documentation will be
provided to GHP upon request).
• Notify the GHP in writing, a detailed description of the Incident including a list of impacted
individuals and if it is a Breach, a copy of the notification to the individual.
• Notify the impacted individuals if required within the applicable statutory timeframes and
include the following information about the Breach in the notice:
■ Description of the Breach including the date it occurred and the date it was
discovered;
■ The specific PHI data elements that were involved in the Breach;
■ The steps that individuals should take to protect themselves from potential harm;
■ The actions that Claim Administrator or subcontractor is taking to mitigate the harm
and avoid further incidents; and
■ A toll -free number that individuals can call to get more information about the
Breach.
• Provide substitute notice, as described in HIPAA, to impacted individuals if there is
insufficient mailing address information.
• Submit reports to the Department of Health and Human Services ("DHHS") regarding
Breaches that impact fewer than 500 individuals. Upon GHP request, provide, a list of the
reports that were submitted.
• Notify DHHS in the event the Breach impacts more than 500 individuals and provide notice
to the GHP that notification was made.
• Notify media in the event the Breach impacts more than 500 residents of a state or
jurisdiction and provide notice to GHP that notification was made.
These services may need to change to comply with new HIPAA requirements or DHHS guidance.
The information provided in Attachment I or the services described in Attachment I shall not be
construed as legal advice or as a legal opinion on any specific requirements under HIPAA and is not
intended to replace GHP's independent legal counsel's guidance.
bcbstx.as.baa.Rev.04.01.2024.doc
CSC No. 62344
CLAIM ADMINISTRATOR
BUSINESS ASSOCIATE AGREEMENT
ATTACHMENT 2: Additional Information Form for Self -Funded Accounts
This replaces and amends any existing Additional Information Form. If any information changes, the
GHP is responsible for providing an updated form to the Claim Administrator.
(Please print or type & complete the form in its entirety)
Employer or Plan Sponsor: City of Fort Worth
BCBSTX Account number: TX 394609
BCBSTX group number(s): 394611, 394610
Claim Administrator's Privacy Officer: Jill Wolowitz
Address: HCSC Privacy Office; 300 E. Randolph St., Chicago, IL 60601-5099
Primary Privacy Contact
Additional Privacy Contact (required)
Name: Joanne Hinton
Name: Dianna Giordano
Title: Interim Assistant Director, Human
Title: Director of Human Resources
Resources
Phone #: 817-392-7783
Phone #: 817-392-6275
Fax #:
Fax #:
Mailing Address: 100 Fort Worth Way
Mailing Address: 100 Fort Worth Way
City, State, Zip: Fort Worth, Texas 76102
City, State, Zip: Fort Worth, TX 76102
e-Mail Address:
e-Mail Address:
Dianna.Giordano@fortworthtexas.gov
Joanne.Hinton@fortworthtexas.gov
Additional Privacy Contact (Optional)
Additional Privacy Contact (Optional) J
Name:
Name:
Title:
Title:
Phone #:
Phone #:
Fax #:
Fax #:
Mailing Address:
Mailing Address:
City, State, Zip: City, State, Zip:
e-Mail Address: e-Mail Address:
Signature: (Form should only be signed by an authorized employee of the account)
Name of individual signing this form:
Title of individual signing this form:
Name (print): Jesica McEachern
Signature: C> t�
Limitations
Date: Nov 20, 2024
bcbstx.as.baa.Rev.04.01.2024.doc
CSC No. 62344
CLAIM ADMINISTRATOR
BUSINESS ASSOCIATE AGREEMENT
Employer or Plan Sponsor: City of Fort Worth
BCBSTX Account number: TX 394609
BCBSTX group number(s): 394611, 394610
As required by this Agreement, GHP will identify limitations in the following documents that
may affect Claim Administrator's use or disclosure of PHI. List the limitation or indicate "none."
a) Notice of Privacy Practices (NoPP) None
b) GHP Plan Document None
c) Other: None
Individual Rights Requests
As required by this Agreement, GHP shall identify the entity responsible for responding to these
individual rights requests. Choose Employer/GHP or Claim Administrator (not Both).
a) Access: ❑ Employer/GHP
® Claim Administrator
b) Disclosure Accounting: ❑ Employer/GHP
® Claim Administrator
c) Amendment: ❑ Employer/GHP
® Claim Administrator
d) Complaint: ❑ Employer/GHP
® Claim Administrator
Employer/GHP authorizes Claim Administrator to release PHI for Plan Administrator Purposes
to the following employees of the GHP. (Use a different line for each employee and list: Job
Title; Name (optional); and any limitations/restrictions on their access to PHI).
HR Director, no restrictions, Dianna Giordano
Benefits Manager, no restrictions
Assistant HR Director, no restrictions, Joanne Hinton
Senior Human Resources Analyst, no restrictions Vivianee Haydon
Human Resources Analyst, no restrictions - Deborah Smith, Cindy Berzoza
Human Resources Coordinator, no restrictions - Meagan Hailey
Employer/GHP provides Claim Administrator or a Business Associate of the Claim
Administrator with the authority to release PHI to Business Associates of the Employer/GHP.
The Employer/GHP agrees to hold the Claim Administrator or the Business Associate of the
Claim Administrator harmless for the release of PHI as long as the release is done in compliance
with the security requirements outlined in the agreement between Claim Administrator and the
Employer/GHP or the agreement between Claim Administrator and its Business Associate. (Use
a different line for each Business Associate of the Employer/GHP along with a contact name).
IMA, Inc, Account Executive, National Employee Benefits - no restrictions
Health Equity - no restrictions
Alight - no restrictions
Optum RX - no restrictions
Virta Health - no restrictions
Hello Heart - no restrictions
bcbstx.as.baa.Rev.04.01.2024.doc
CSC No. 62344
CLAIM ADMINISTRATOR
BUSINESS ASSOCIATE AGREEMENT
Employer or Plan Sponsor: City of Fort Worth
BCBSTX Account number: TX 394609
BCBSTX group number(s): 394611, 394610
SmartLight Analytics - no restrictions
Wondr Health - no restrictions
Empyrean - no restricitons
Lantern - no restrictions
bcbstx. as.baa.Rev.04.01.2024.doc
11/21/24, 10:16AM M&C Review CSC No. 62344
Official site of the City of Fort Worth, Texas
ACITY COUNCIL AGEND FOR`H
Create New From This M&C
REFERENCE **M&C 24- 13P RFP 24-0180 MEDICAL
DATE: 8/27/2024 NO.: 0703 LOG NAME: ASO OR TPA SERVICES
HR CB
CODE: P TYPE: CONSENT PUBLIC NO
HEARING:
SUBJECT: (ALL) Authorize Execution of Agreement with Health Care Service Corporation dba Blue
Cross and Blue Shield of Texas in an Amount Up to $7,682,282.00 for the Initial Three -
Year Term for Medical Third -Party Administrator/Administrative Services with Two One -
Year Options to Renew in an Amount Up to $3,164,986.00 for Renewal Option One, and
$3,236,041.00 for Renewal Option Two for the Human Resources Department
RECOMMENDATION:
It is recommended that the City Council authorize execution of an Agreement with Health Care
Service Corporation dba Blue Cross and Blue Shield of Texas in an amount up to $7,682,282.00 for
the Initial Three -Year Term for medical third -party administrator/administrative services with two one-
year options to renew in an amount up to $3,164,986.00 for renewal option one, and $3,236,041.00
for renewal option two for the Human Resources Department.
DISCUSSION:
The City's Medical and Disease Management Programs are self -funded and utilize a third -party
administrator to process claims. The Human Resources Department approached the Purchasing
Division to secure an annual agreement for medical third -party administrator/administrative services
for a vendor to provide claim processing services.
As a result, Purchasing Staff issued Request for Proposal (RFP) Number 24-0180. The RFP consisted
of detailed specifications describing the responsibilities and requirements to provide these services for
the City of Fort Worth. The RFP was advertised in the Fort Worth Star -Telegram on April 17, 2024,
April 24, 2024, May 1, 2024, May 8, 2024, and May 15, 2024. The City received seven (7) responses.
An evaluation panel consisting of representatives from the Human Resources and Police Departments
reviewed and scored the submittals using Best Value criteria. Individual scores were averaged for
each of the criteria. The evaluation panel invited the top three vendors to interview with the panel. The
final scores are listed in the table below.
Vendor
a b
Blue Cross and Blue Shield of Texas 21.50 7
Meritain Health, Inc. 16.50 5.60
Evaluation Factors
d e f Total
Score
10.80 12.60 3.80 24.24 79.94
9.90 9.60 3 30 74.60
Allegiance Benefit Plan Management 14 5.20 8.70 9.60 2.90 24.45 64.85
Best Value Criteria
a. The assessment of the responses including a review of the proposer's capability, plan design,
administration services, and previous experience with entities of the same size and type.
b. Verification of proposer's references
c. Network and disruption
d. Value-added services
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M&C Review
CSC No. 62344
e. Ability to integrate pharmacy data, disease management, and wellness data
f. Cost
After evaluation, the panel concluded that Health Care Service Corporation dba Blue Cross and Blue
Shield of Texas (BCBSTX) presents both the best value and the necessary coverage for the City;
therefore, the panel recommends that the Council authorize an agreement with BCBSTX. No
guarantee was made that a specific amount of services would be purchased. Staff certifies that the
recommended vendor bid met specifications.
FUNDING: The maximum amount allowed under this agreement will be $7,682,282.00 for the Initial
Term, $3,164,986.00 for renewal option one, and $3,236,041.00 for renewal option two; however, the
actual amount used will be based on the needs of the department and the available budget. Funding is
budgeted in the Group Health Insurance Fund and the Retiree Healthcare Trust Fund.
BUSINESS EQUITY: This solicitation was reviewed by The Business Opportunity Division for available
business equity prospects according to the City's Business Equity Ordinance. There were limited
business equity opportunities available for the services/goods requested, therefore, no business equity
goal was established.
AGREEMENT TERMS: Upon City Council approval, the agreement will begin on January 1, 2025, and
will end on December 31, 2027.
RENEWAL OPTIONS: This agreement may be automatically renewed for up to two (2) one-year
renewal periods. This action does not require specific City Council approval provided that City Council
has appropriated sufficient funds to satisfy the City's obligations during the renewal term.
ADMINISTRATIVE CHANGE ORDER: 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.
FISCAL INFORMATION/CERTIFICATION:
The Director of Finance certifies that upon approval of the recommendation, funds are available in the
current operating budget, as previously appropriated in the Group Health Insurance Fund and the
Retiree Healthcare Trust Fund. Prior to an expenditure being incurred, the Human Resources
Department has the responsibility to validate the availability of funds.
BQN\\
TO
Fund Department Account Project
ID ID
FROM
Fund Department Account Project
ID ID
Submitted for City Manager's Office by_
Originating Department Head:
Additional Information Contact:
Program I Activity Budget Reference # Amount
Year (Chartfield 2)
Program Activity Budget Reference #
Year (Chartfield 2)
Reginald Zeno (8517)
Jesica McEachern (5804)
Reginald Zeno (8517)
Dianna Giordano (7783)
Jo Ann Gunn (8525)
Charles Benson (8063)
Amount
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11/21/24, 10:16AM M&C Review
ATTACHMENTS CSC No. 62344
13P RFP 24-0180 MEDICAL ASO OR TPA SERVICES HR CB.docx (CFW Internal)
BCBSTX 1295.pdf (CFW Internal)
BCBSTX TDI.pdf (Public)
FID TABLE BLANK WITH INSTRUCTIONS V2 (4).xlsx (CFW Internal)
HCSC SOS.pdf (Public)
MWBE Waiver.pdf (CFW Internal)
SAMs BCBSTX.pdf (CFW Internal)
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