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Home My WebLink AboutContract 36319-A1 CITY SECRETARY CONTRACT N0. �3 9 -11 FIRST AMENDMENT TO CITY SECRETARY CONTRACT NO. 36319 AGREEMENT FOR WORKERS' COMPENSATION CLAIMS ADMINISTRATION SERVICES STATE OF TEXAS § COUNTY OFTARRANT § This First Amendment to City Secretary Contract No. 36319, Agreement for Workers' Compensation Claims Administration Services (the "Amendment") is made and entered into this I5{ day of July, 2010, by and between the City of Fort Worth ("CITY"), a home-rule municipal corporation of the State of Texas, acting by and through its duly authorized Assistant City Manager, and CCS Consulting, LP ("CCS"), a Texas Limited Partnership, acting by and through the duly authorized President of CCS's general partner, Contract Claim Services, Inc. WITNESSETH: WHEREAS, CITY and CCS have entered into a certain Agreement for Workers' Compensation Claims Administration Services effective as of January 1, 2008 ("Effective Date"), the same being City Secretary Contract No. 36319 (the"Agreement"), and WHEREAS, the Agreement calls for medical cost containment services to be provided through independent third party subcontractor Argus Services Corporation ("Argus"), and WHEREAS, Argus has given notice that, effective August 1, 2010, it will no longer provide medical cost containment services under the Agreement, and WHEREAS, CITY and CCS wish to amend the Agreement to allow for CCS to directly provide medical cost containment services through its in-house cost containment unit. NOW THEREFORE, in consideration of the foregoing and the mutual covenants and agreements contained herein and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, CITY and CCS hereby agree as follows: SECTION 1. That Section 1,4, "Medical Cost Containment Services," of the Agreement is hereby deleted in its entirety and replaced with a new Section 1.4 to read as follows: 1.4 Medical Cost Containment Services 1.4.1 Medical Cost Containment Contracted Services — It is the expressed intent that medical cost containment services be provided by CCS through its in-house cost containment unit. CITY agrees that CCS shall provide medical cost containment services for bill re-pricing at the rates specified in Schedule 3 of Attachment A of the Agreement but shall not charge a re-pricing fee for duplicate bills. CCS shall with good faith and due diligence ensure that the services provided by its cost containment Fib MAO`Mftnt of CSC 36319 � � � } 3 Page 1 of 3 Pages unit are appropriate and in compliance with the Texas Labor Code and Texas Insurance Code, as appropriate, and in compliance with Texas Department of Insurance Rules. 1.4.2 Compliance—CCS shall provide workers' compensation medical cost containment services to CITY in a manner that is in full compliance with the Texas Labor Code (Texas Workers' Compensation Act), Texas Insurance Code, and Texas Department of Insurance Administrative Rules. 1.4.3 Treatment Guidelines — It is the expressed intent of CITY that, in its administration and handling of CITY claims, CCS shall fully implement and maximize the use of the Texas Administrative Code, Chapter 137, Sub-Chapter C, Rule 137.100, "Disability Management Guidelines." CCS shall routinely consult the Treatment Guidelines and actively engage health care providers and injured CITY employees in discussions that are intended to provide high quality medical care within the Guidelines. 1.4.4 Medical Cost Containment Services — CCS shall provide the full range of medical cost containment services that is usual and customary of an exemplary medical cost containment services company, and shall include but not necessarily be limited to the following: medical bill auditing, review and repricing; preauthorization; determinations of medical necessity and relatedness; utilization reviews; peer reviews; MMI/IR reviews; designated doctor reviews; designated doctor determination letters; IME coordination; preferred provider organization (PPO) networks; medical case management (telephonic and field); pharmacy benefits management; vocational rehabilitation; on-line access; reports; and document imaging, indexing and records management. 1.4.5 Pharmacy Benefits Management — CCS shall arrange for and provide comprehensive pharmacy benefits management services for injured CITY employees. 1.4.6 Loss Adjustment Expense — All medical cost containment services provided by CCS shall be "loss adjustment expenses"charged directly to the appropriate claim. CCS shall pay for such services out of funds provided by CITY to CCS through its trustee bank account (reference Section 1.1.6 of this Agreement). 1.4.7 Workers' Compensation Healthcare Network — In the event that CITY contracts for workers' compensation medical care or other occupational health care services for its employees through: (a) a preferred provider of occupational healthcare services; (b) a TDI-certified Workers' Compensation Healthcare Network; and/or (c) a custom-developed healthcare benefits delivery system under the provisions of the Texas Labor Code, Section 504.053(b), CCS shall fully cooperate in the implementation and provision of such medical services, occupational healthcare services and/or healthcare network services. SECTION 2. That Section 1.6, "Return-to-Work and Vocational Rehabilitation Services," is hereby deleted in its entirety and replaced with a new Section 1.6 to read as follows: 1.6 Return-To-Work and Vocational Rehabilitation Services 1.6.1 Stay-at-Work/Return-to-Work - CCS adjusters and cost-containment medical case managers shall actively work with and through the Occupational Health and Safety/Workers' Compensation Division, and with other CITY employees, supervisors and managers to maximize opportunities for injured CITY employees to stay-at-work and/or retum-to-work as quickly as medically feasible following injury. 1.6.2 Vocational Rehabilitation Services- CCS adjusters and cost-containment medical case managers shall actively look for opportunities for vocational rehabilitation services to be provided to facilitate CITY's stay-at-work/retum-to-work efforts. Upon request to and approval of CITY, CCS shall arrange for the provision of appropriate vocational rehabilitation services on a case-by-case basis. Specific vocational rehabilitation services may include, but not be limited to, conducting vocational assessments, job analyses, transfer skills analysis, labor market survey,job seeking skills survey, vocational testing,job placement services. The services of the Texas Department of Assistive and Rehabilitative Services shall be utilized to the greatest extent possible to provide such vocational rehabilitation services. First Amendment of CSC 36319 Page 2 of 3 Pages 1.6.3 The costs of vocational rehabilitation services shall be billed to the specific claim file as an allocated loss adjustment expense. 1.6.4 A report summarizing the activities and costs of vocational rehabilitation services shall be provided to CITY on a quarterly basis,or upon specific request of CITY. SECTION 3. That this Amendment shall take effect August 1, 2010. SECTION 4. That all other terms and conditions of City Secretary Contract No. 36319 that are not amended herein shall remain in full force and effect throughout the term of the Agreement and any subsequent renewals IN WITNESS WHEREOF, the parties hereto have executed this Amendment, this A151 day of July, 2010 CITY OF FORT WORTH: FCS CONSULTING, LP: B gat B < Y• Y Karen L. Montgomery, Assista6l Cit Mana r Lisa McManus, President ��O//p Contract Claim Services, Inc., General Partner or CCS Consulting, L.P Approval Recommended: By: A ` Karen'M all, Human Res rces Director Approved as to Fornh a d Legality: C By: Assistant City Attom Contract Authorization: M&C C-22526 Dated: 11-27-2007 Attest: p�F�RT*O�� V OoI�Y� By: o Marty Hendrix, Cit cretary o 0° 0 �0 n� a d .tea First Amendment of CSC 36319 Page 3 of 3 Pages