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HomeMy WebLinkAboutContract 47186 GWRAM NO. AGREEMENT FOR CLAIMS ADMINISTRATION SERVICES This Agreement (the "Agreement") is effective as of the 1St day of November, 2015 (the "Effective Date") between CITY OF FORT WORTH, a home-rule municipal corporation of the State of Texas, ("PRINCIPAL"), having offices at 1000 Throckmorton Street, Fort Worth, Texas 76102, and YORK RISK SERVICES GROUP, INC., ("YORK"), a New York corporation with its principal place of business at One Upper Pond Road, Bldg. F, 4t" Floor, Parsippany, New Jersey 07054. PRINCIPAL and YORK may be referred to herein individually as a "party" and collectively as the "parties." WHEREAS, PRINCIPAL desires to provide Claims Administration Services and Managed Care Services on claims arising out of PRINCIPAL'S self-insured workers' compensation program along with managed care and a 504 Provider Network (the "Program") during the term of this Agreement; and WHEREAS, YORK submitted a proposal and best and final offer in response to the PRINCIPAL'S Request for Proposal No. 15-0239 Workers' Compensation Claims and 504 Network Administration Services, attached hereto as Exhibit "A" and incorporated herein for all purposes incident to this Agreement; and WHEREAS, YORK desires to be retained by PRINCIPAL pursuant to the terms and provisions of this Agreement to provide Claims Administration Services on claims arising out of the Program during the term of this Agreement; and WHEREAS, YORK, by entering into this Agreement, shall be obligated to provide Claims Administration Services to PRINCIPAL on the terms and conditions set forth herein; NOW THEREFORE, for and in consideration of the promises set forth hereinabove, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, YORK and PRINCIPAL agree as follows: I. DEFINITIONS A. "PRINCIPAL" shall mean CITY OF FORT WORTH. B. "CLAIMS ADMINISTRATION SERVICES" shall include the administration, adjustment, management, and oversight of claims arising out of PRINCIPAL'S self-insured workers' compensation program. CLAIMS ADMINISTRATION SERVICES shall also include, but not limited to, the following services: 1. Providing supervision of the loss adjustment process; C EtcE C R Page I of 23 WFN 2. Determining and implementing appropriate claims practices to adjust assigned claims in accordance with YORK'S established practices as measured in Tab G of Exhibit "A' 3. Adhering to high standards of professional conduct; 4. Adjusting and managing assigned claims to assure that PRINCIPAL and claimants receive high quality service as measured in Tab C of Exhibit "A"; 5. Establishing, monitoring and timely revisions of case reserves; 6. Settling claims within the applicable coverage terms and conditions; 7. Maintaining current knowledge of applicable adjustment practices and procedures, local practices, applicable insurance coverage, court decisions, current guidelines in the claims function, and Program changes and modifications (as advised by PRINCIPAL); 8. Assisting in the preparation of claims for suit, hearing, trial, or subrogation as appropriate; 9. Acting as PRINCIPAL'S liaison with medical personnel, first notice of loss reporting services and defense counsel; 10.Performance of services related to managed care cost containment including but not limited to medical bill review, Medical Provider Network ("MPN") administration and access, utilization review, nurse case management, Medicare secondary payor compliance services. These services shall include outcome reporting and results obtained through cost containment measures. 11.Preparing and submitting status and administrative reports in accordance with YORK'S established practices as agreed upon with the PRINCIPAL; 12.Preserving subrogation rights and overseeing subrogation recovery. C. "CLAIMS" shall mean claims, arising under the Program and which are referred to YORK for adjusting during the term of this Agreement. D. "INFORMATION" or "CONFIDENTIAL INFORMATION" shall mean documentation, data or information relevant to PRINCIPAL or claimant that is created by YORK or that comes into its possession as a result of the rendering of services by YORK to PRINCIPAL, pursuant to the Agreement. E. "CONFIDENTIAL INFORMATION" is information not publicly available and includes, without limitation, the work product, investigation materials, trial preparation materials including but not limited to opinions and mental impressions of YORK personnel, communications with defense and coverage counsel and non-public personal information of insureds. Page 2 of 23 F. "LOSS ADJUSTMENT EXPENSE" shall mean, in addition to fees to be paid in accordance with items listed or inferred herein Agreement, all reasonable expenses necessary to the adjustment of a claim in accordance with this Agreement, including but not limited to, legal fees where applicable and agreed to in writing by PRINCIPAL, court costs and fees for court reporters, expert witnesses, investigation, photocopies, subpoenas, photographs, maps, accounting, chemical or physical analysis, independent medical exams or other evaluations, depositions, appraisal fees and expenses, bill review, utilization review and any other similar cost, fee or expense reasonably chargeable to the investigation, negotiation, settlement or defense of a claim or loss or subrogation actions. YORK may, but need not, elect to utilize its own staff to perform these services. G. "Managed Care Services" shall mean the administration and deployment of cost containment measures offered through Rockport Community Network and WellComp Managed Care Services, Inc. York affiliates, that serve to reduce the overall risk of claims while maintaining compliance with Labor Code and Regulatory oversight. The suite of services offered are: medical bill review, utilization review, Medical Provider Network, case management, Medicare secondary payor compliance services, lien resolution, and ancillary services supporting the overall integrated managed care effort. H. The "504 Provider Panel" shall be provided in compliance with Chapter 504 of the Texas Labor Code, including section 504.053 specifically. I. "SYSTEMS" shall mean severally or collectively, YORK'S proprietary claims handling system. II. TERM OF AGREEMENT The term of this Agreement shall commence on November 1, 2015, with the 504 Provider Panel implemented by January 1, 2016, and shall continue until and through October 31, 2018 (the "TERM") with two (2) one year options to renew at the PRINCIPAL's sole discretion and agreement reached with YORK. III. CLAIMS ADMINISTRATION SERVICES (the "Services") PRINCIPAL is very demanding with respect to quality services, responsiveness, timeliness, accuracy and cost control. PRINCIPAL desires to provide quality, efficient and effective workers' compensation claims administration services to PRINCIPAL and PRINCIPAL employees in the most cost-effective manner. PRINCIPAL generally defines such services as timely and accurate filing, processing, adjusting and administration of claims, all of which meet or exceed the state statutory requirements in a manner that exemplifies superlative customer service, and which meet or exceed workers' Page 3 of 23 compensation industry standards of best practices. PRINCIPAL requires achieving and maintaining a "high performer" status on Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) Performance Based Oversight audits. PRINCIPAL expects full cooperation from its workers' compensation third party administrator to assist PRINCIPAL in achieving and maintaining these standards of quality. PRINCIPAL hereby retains YORK to provide Claims Administration Services, as set forth in this Agreement, including any Exhibits attached hereto, for the Claims that arise out of PRINCIPAL'S self-insured workers compensation program and that are assigned by PRINCIPAL to YORK. A. The Services to be rendered by YORK shall be in conformance with the requirements and provisions of this Agreement together with all applicable rules, orders, and interpretations issued by the applicable regulatory authorities as of the date hereof, including, but not limited to: Texas Labor Code, Chapters 401 — 451 and Chapter 504; Texas Insurance Code, Chapter 4151; Texas Local Government Code, Chapter 143; Texas Government Code (Chapter 607); Texas Health & Safety Code, Chapter 81; and the Texas Administrative Code, Title 28, Parts 1, 2, and 6. B. YORK acknowledges its obligation to comply with all applicable statues and any rules or regulations of the applicable regulatory authorities. C. York shall perform Claims Administration Services for each Claim assigned to it hereunder during the life of the contract. D. YORK acknowledges that execution of this Agreement does not guarantee that YORK will be assigned any particular number of Claims by PRINCIPAL. IV. DUTIES OF YORK A. YORK shall prepare, coordinate with PRINCIPAL, and fully implement a transition plan to ensure the smooth transfer of claims data, information and claim files from the previous third party administrator and to establish necessary computer system interfaces. YORK shall work with PRINCIPAL and the prior third party administrator to ensure all state statutory and regulatory requirements are met with regards to timely payment of indemnity and medical benefits during the transition period. YORK will take responsibility for all items under its control as of November 1, 2015. B. YORK shall maintain four indemnity adjusters and one administrative assistant at PRINCIPAL'S site, dedicated specifically and solely to the handling of the Claims that arise out of PRINCIPAL'S self-insured workers compensation program, with the necessary experience and management oversight. In addition, York shall maintain one medical only adjuster and one supervisor over adjusters assigned to Principal's account. Adjusters assigned to Claims shall have a case load that allows proper Page 4 of 23 attention to the work. The maximum caseload shall not exceed a monthly average of 100 claims for indemnity adjusters working on PRINCIPAL'S account. C. To the extent required by law, YORK shall utilize only licensed adjusters and licensed private investigators, where applicable and such adjusters and investigators shall in the rendering of their services conform to the provisions of all applicable laws, rules, orders or written interpretations issued by the applicable regulatory authorities. YORK shall provide documentation of the adjusters' and licensed private investigators' current licensure and experience to the PRINCIPAL on request. D. YORK shall investigate, evaluate, negotiate, or deny Claims within the standing authority granted to YORK from time to time by PRINCIPAL. Claims shall be administered and adjusted in accordance with PRINCIPAL'S "Account Instructions Manual" and any subsequent revisions to such Manual as may be promulgated from time to time by PRINCIPAL. Where subrogation potential exists, YORK shall actively pursue PRINCIPAL'S subrogation interests in accordance with procedures set forth by PRINCIPAL in the Account Instructions Manual with expenses paid as incurred. E. Upon termination of this Agreement, all hard copy and electronic files shall be transferred to PRINCIPAL at PRINCIPAL'S expense. F. YORK acknowledges that all of the Claims files in its possession are the property of PRINCIPAL and agrees to promptly provide access to or deliver any such file to PRINCIPAL, at PRINCIPAL'S expense, at any time upon PRINCIPAL'S request. In exchange for PRINCIPAL'S absolute right to obtain the Claims files, PRINCIPAL agrees that it shall not have the right to set off any sums claimed due from YORK against fees due YORK under this Agreement. G. YORK acknowledges that all of the files related to the 504 Provider Panel, including the 504 Network as established by YORK under this Agreement, (collectively the "504 Network") will be the sole and exclusive property of the PRINCIPAL. 1. PRINCIPAL acknowledges that the 504 network provided already contains providers that have an existing contract with YORK affiliate Rockport Community Network, Inc., hereinafter Rockport. When YORK affiliate Rockport and the provider have a pre-existing contract, an addendum will be added to the Rockport-provider agreement naming the PRINCIPAL as a Payor. Upon termination of the contract, said Rockport — PRINCIPAL— Provider addendums shall also terminate. 2. Within the contract period, when a desired provider does not currently have an existing contract with YORK affiliate Rockport, a new contract Page 5 of 23 shall be entered into by the PRINCIPAL and provider, with each party responsible for attaining its own legal advice. YORK shall facilitate and manage said contract at a charge of two hundred twenty-five dollars ($225). Upon termination of the YORK - PRINCIPAL agreement, all contracts with providers in effect and with paid service charge of two hundred twenty-five dollars ($225) shall be the sole and exclusive property of the PRINCIPAL. H. YORK shall provide and maintain a document management system capable of scanning and indexing claim file documents and of attaching the indexed documents to the specific computerized claim file. Each scanned document shall undergo a quality review or check to ensure the scanned image is legible, is not subject to alteration, and represents an accurate facsimile of the original document. At a minimum, original documents shall be maintained until such time as the quality review confirms a legible and complete scanned image. Original claim file information and documents shall be maintained and disposed of in accordance with applicable PRINCIPAL'S policy, procedures and applicable record retention schedules. I. YORK expressly agrees to hold all funds and assets of PRINCIPAL that come into its control or possession during the term of this Agreement as a fiduciary of PRINCIPAL. J. YORK shall make available, through YORK'S proprietary claims system, claim-related data and standard reports with "web-enabled" access. PRINCIPAL will have "view only" access to the system. PRINCIPAL will bear its own hardware, software, connection and similar costs for accessing YORK'S electronic claims management system. K. During the TERM of this Agreement and at all times that there are open Claims being handled by YORK, YORK shall fully cooperate with PRINCIPAL to ensure the claims are adjusted in strict compliance with the Texas Workers' Compensation Act, administrative rules enacted by TDI-DWC. L. YORK will develop, implement, and administer the MPN, including the following: 1. Employee notice. YORK will develop a notice ("Employee Notice") and will (i) advise PRINCIPAL in the distribution of the Employee Notice to covered employees and (ii) work with PRINCIPAL to produce confirmation that the Employee Notice was distributed. 2. Website. YORK will provide PRINCIPAL and covered employees with a website for the 504 physician panel. Page 6 of 23 3. Member education and training. YORK will undertake notices and explanations as agreed upon between PRINCIPAL and YORK to educate PRINCIPAL on utilizing the 504 physician panel, including, for example, educational materials, trainings, and teleconferences. 4. Information services. YORK will publicize and monitor a toll free telephone number that is available to the PRINCIPAL and its covered employees, who may call to learn more about the 504 physician panel and its provider network; 5. Patient services. YORK will coordinate patient services with PRINCIPAL. YORK will be responsible for developing and distributing materials, such as a provider directory, that may reasonably be requested by PRINCIPAL and covered employees. 6. Medical and ancillary provider services. YORK will be responsible for communication with medical and ancillary providers within the 504 physician panel regarding providers' participation in the medical provider network. 7. On-going administration. YORK will perform such acts as required for the on-going administration of the 504 physician panel, including any such acts as may reasonably be requested by PRINCIPAL. M. Prior to the commencement of any work by YORK under this Agreement, YORK shall furnish one or more Certificates of Insurance forms to the PRINCIPAL'S Risk Management Division and Office of the City Secretary evidencing insurance coverage in the types and amounts required by PRINCIPAL. Each certificate shall indicate the types of coverage, liability limits, and termination provisions applicable to the underlying insurance policy. Each form must indicate the name, address, and telephone number of the insurance company issuing coverage. YORK further agrees to maintain the following during the Term of this Agreement: (1) Maintain in force a fidelity bond or equivalent insurance, such as Third Party Crime insurance, for the protection of PRINCIPAL, at a limit not less than one million dollars ($1,000,000), to cover the risk of loss due to the wrongful conversion of any funds and assets of PRINCIPAL by YORK or its employees or independent contractors during the term of this Agreement. York shall maintain said bond or insurance for a period of two (2) years after the expiration of this Agreement; (2) Maintain in force an errors and omissions policy, at a limit not less than five million dollars ($5,000,000) per occurrence and to maintain coverage for a period of at least two (2) years after the expiration of the last contract with PRINCIPAL, or if the errors and omissions coverage is claims- made, YORK agrees that, for said two (2) year period, the "retro" date will not be later than the inception date of this Agreement; Page 7 of 23 (3) Maintain in force a general liability policy, which names PRINCIPAL as an Additional Insured and which provides limits not less than one million dollars ($1,000,000) per occurrence, two million dollars ($2,000,000) aggregate and two million dollars ($2,000,000) products/completed operations aggregate; (4) Maintain in force a workers' compensation and employers liability policy, which provides statutory workers' compensation coverage to employees of YORK and employer's liability coverage at limits not less than one million dollars ($1,000,000); (5) Maintain in force an automobile liability policy, which names PRINCIPAL as an additional insured and which provides a limit of no less than one million dollars ($1,000,000); (6) Provide that the aforementioned policies contain a waiver of subrogation in favor of PRINCIPAL. N. All insurance-related notices shall be given to PRINCIPAL at the following address: Human Resources Director—Workers' Compensation Program, 1000 Throckmorton Street, Fort Worth, Texas 76102 with copy to Assistant Director for Risk Management, Human Resources Department, at the same address. O. The PRINCIPAL shall be entitled on request and without expense to receive copies of the policy declarations and all blanked additional ensured endorsements thereto as they apply to the limits required by the PRINCIPAL. P. YORK'S financial integrity is of interest to PRINCIPAL; therefore, subject to YORK'S right to maintain reasonable deductibles in such amounts as are approved by PRINCIPAL, YORK shall obtain and maintain in full force and effect for the duration of this Agreement, and any extension hereof, at YORK'S sole expense, insurance coverage written on a claims made basis, by companies authorized and admitted to do business in the State of Texas and rated A- or better by A.M. Best Company and/or otherwise acceptable to PRINCIPAL, in the following types and amounts referenced above. Q. PRINCIPAL reserves the right to review the insurance requirements of this Agreements during the Initial Term and any Renewal Term and to modify insurance coverage types and limits when deemed necessary and prudent by PRINCIPAL'S Risk Manager based on changes in statutory law, administrative regulations, court decisions, or circumstances surrounding the Agreement, provided however that in no instance will PRINCIPAL allow modification whereupon the PRINCIPAL may incur increased risk. Page 8 of 23 R. If YORK fails to maintain the aforementioned insurance or fails to secure and maintain the aforementioned endorsements, the PRINCIPAL may obtain such insurance and deduct and retain the amount of the premiums for such insurance from any sums due under the Agreement; however, procuring of said insurance by PRINCIPAL is an alternative to other remedies the PRINCIPAL may have, and is not the exclusive remedy for failure of YORK to maintain said insurance or secure such endorsement. In addition to any other remedies the PRINCIPAL may have for YORK'S failure to provide and maintain any insurance or policy endorsements to the extent and within the time herein required, the PRINCIPAL shall have the right to order YORK to stop work hereunder and/or withhold any payment(s) that become due to YORK hereunder until YORK demonstrates compliance with the requirements hereof. S. Nothing herein contained shall be construed as limiting in any way the extent to which YORK may be held responsible for payments of damages to persons or property resulting from YORK'S or its subcontractors' performance of the work covered by this Agreement. T. YORK shall notify PRINCIPAL'S insurer of all claims which may affect the insurer's coverage in excess of PRINCIPAL'S Self-Insured Retention layer in accordance with the instructions of PRINCIPAL'S insurer as provided to YORK pursuant to Section V. (A) of this Agreement. U. Notwithstanding anything to the contrary contained herein, and to the extent applicable, YORK agrees to comply with all obligations imposed upon it by law. V. DUTIES OF PRINCIPAL A. PRINCIPAL shall promptly provide YORK with such information as YORK may require, including, but not limited to, any copy of documents describing its self-insured workers' compensation program, and all amendments thereto including but not limited to documents submitted to any governmental tribunals for approval of the Program, as well as incident reports and information related thereto in PRINCIPAL'S possession and otherwise cooperate with YORK in carrying out YORK'S tasks hereunder. B. Upon receipt of loss notices, PRINCIPAL shall promptly assign the loss to YORK. C. PRINCIPAL shall promptly make funds available, in accordance with Section VI, for Claim and Loss Adjustment expense payments with respect to claims referred to YORK and respond to YORK'S requests to issue checks in payment of Page 9 of 23 Claims and such checks shall be distributed in accordance with PRINCIPAL'S Claims processing procedures. D. PRINCIPAL shall provide YORK with training materials, along with initial and subsequent training on PRINCIPAL'S forms and other documents affecting PRINCIPAL'S obligations which are provided to YORK and any written interpretation thereof issued by PRINCIPAL or any applicable regulatory body. During the term of this Agreement and at all times that there are open Claims being handled by YORK, PRINCIPAL shall fully cooperate with YORK. E. PRINCIPAL covenants and agrees that PRINCIPAL, its employees, agents or independent contractors, will not misuse the information contained within the Claims files. PRINCIPAL further covenants and agrees to maintain the confidentiality of the information contained within the Claims files, as required by applicable State and Federal law and regulations. F. PRINCIPAL acknowledges that the timely and successful filing and implementation and administration of the MPN will require cooperation between PRINCIPAL and YORK, and PRINCIPAL hereby agrees to make good faith efforts to perform such acts as may be reasonably requested by YORK including: 1. Nominations of medical and ancillary providers. PRINCIPAL shall provide information on medical providers nominated by Client in the form requested by YORK. 2. Required data. PRINCIPAL shall provide information about PRINCIPAL, as requested by YORK for performance of YORK obligations under this Agreement, including information required to file the MPN application such as the facilities locations of Client, Licensing and Tax documents. VI. BANK ACCOUNT A. PRINCIPAL shall set up a claims account ("Bank Account") with JP Morgan utilizing the PRINCIPAL'S Tax ID. The Bank Account shall be established as an individual entity, which will have pledged collateral assigned to the balance as required under state law. The Bank Account shall be an interest earning account with the interest received on a monthly basis based upon the available balance of the account. PRINCIPAL shall fund the account with an initial $800,000.00 escrow balance. This shall include the booking of a restricted asset account within the general ledger, attached to the Risk Financing Fund of the PRINCIPAL. Interest earned will be credited back to the Bank Account on a periodic basis. Expenses for maintenance of the account will be debited to the Bank Account. PRINCIPAL will record interest earned and expenses charged to the Bank Page 10 of 23 B. Account and on a periodic basis, which shall be monthly, reconcile the balance of the Bank Account back to an amount of$800,000.00 based upon the expense and interest earnings. PRINCIPAL shall fund or replenish the Bank Account based on the funding statement and check register. The PRINCIPAL will book the expenses minus interest credit. C. YORK will provide bi-monthly a funding statement and check register of the prior period's checks issued to the PRINCIPAL. YORK will initiate positive payee and utilize this service under the guidelines of JP Morgan Chase. YORK will provide PRINCIPAL a monthly reconciliation of the Bank Account. YORK further agrees to send all 1099s at the end of the calendar year. D. Upon termination of this Agreement, proceeds remaining in the Bank Account, including any earned interest, will remain the sole property of PRINCIPAL. E. PRINCIPAL will provide to York PRINCIPAL'S authorized signor facsimile that will be scanned by YORK. PRINCIPAL shall authorize the bank to provide to YORK treasury dedicated staff online access to enable delivery of services, including but not limited to positive pay exception handling and bank reconciliation. VII. SYSTEMS AND DATA PROCESSING A. Although YORK authorizes PRINCIPAL to use or have access to its Systems in performance of Claims Administration Services enumerated in this Agreement, this does not license YORK'S system to PRINCIPAL nor shall PRINCIPAL have intellectual property rights to the Systems, or additions YORK makes to its Systems during and/or in the course of YORK'S performance under this Agreement, whether or not such improvements or additions were made at the suggestions, request or direction of PRINCIPAL. Notwithstanding the foregoing, the data entered or maintained thereon pursuant to this Agreement is the property of PRINCIPAL. B. This Agreement grants to the PRINCIPAL no right to possess or reproduce all or any part of the Systems used, owned or controlled by YORK performing all or any part of Claims Administration Services and PRINCIPAL covenants that it shall not do so. C. YORK expressly agrees that claim-related data generated and/or maintained in connection with this Agreement or any Exhibit hereto shall be and remains the sole property of PRINCIPAL and YORK shall have no right, title, or interest in such data other than such rights necessary to perform Claim Administration Services. Page 11 of 23 VI II.COMPENSATION A. YORK shall be entitled to 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 4 on-site Indemnity djusters Year 1 y l $799,61.0 and 1.on-site Claims Associate,l Unit Manager,and 1.Medical Only Adjuster located in York's Port worth office. Total employees exclusively dedicated Year 2 $822,407 to the City of Port'Worth:7 Designated support and oversight Year 3 $842,824 provided by: Claims Director-Dallas Floating UM-Dallas Year 4 $863,750 AVP Operations-Dallas Regional VIA Operations-Austin) Year 5 $885,200 OTHER CLAIMS ADMINISTRATION Fee Structure Unit Cost FEES Medical Bill Auditing Per Bill $8.30 Telephonic Case Management Per Hour 90 Preauthorization Per Request $90/Burge $160/Physician. 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 X159,635 number of Indemnity Adjusters to 5 and the total number of employees exclusively dedicated to the City of Port Worth to 8). Fee Structure Unit Cost Per Hour $90 Per Request $90/Nurse $160/I hysician. $200-$600 Depending on Peer reviews Per Review Specialty Page 12 of 23 OTHER,;SERVIGES%PEES Fee Structure orlit Cost SOAH/Appeals panel reviews/APA services TPA Included/Legal Fees at Cost Reconsideration requests Per Request $3.30 Recorded statement transcriptions Included Vocational rehabilitation services Per Hour 1 $90 Photos Included Mileage Included Express mail, certified mail Included Photocopying Included Medicare reporting Included Public records search Included Private Investigative Services Per Hour $30 Retrospective Utilization Reviews - Preauth Per Review $160 One time data conversion fee One-time $7,500 IME Per Review $350 IRO Filing Included in Pre-Authorization Designated Doctor/RME Coordination Per Request $250 Impairment Rating Review Per Request $250 Job Analysis Per Hour $90 Life Care Plan Per Hour $125 Safety and Loss Control Services Per Hour $110 5014 NeTW6RNC SERVICES One-`h"Yne Fee P'er Mddical'Bll1 Establish network or 504 One-Time Fee $5,000 Network or 504 access Per Medical Bill $8 Administrative fees for all services Annual Flat Fee $4,000 Credential providers Included Contract providers One-Time Fee $225 per Provider Group/Provider Create fee schedule Included Information system &service fees including Included contract load &TPA/DWC electronic interface Train staff Included Notify and educate employees Guidance Included Establish/maintain website, email, telephone Included support Account audits Included Access to provider Included Management/data reports Included TaTAL,NbT'TO X Ep 9�0,t1 0 Page 13 of 23 B. PRINCIPAL shall pay YORK fees due under VIII. A of this Agreement no later than thirty (30) days after PRINCIPAL'S receipt of YORK'S invoice as rendered from time to time. Timely payment is an express condition of YORK'S obligations hereunder. All services shall be performed to PRINCIPAL'S satisfaction, and PRINCIPAL shall not be liable for any payment under this Agreement for any material breaches or which PRINCIPAL has not approved and has not been cured by YORK pursuant to section XII or XIV B. In the event of a disputed or contested billing, only the portion being contested will be withheld from payment, and the undisputed portion will be paid. PRINCIPAL will exercise reasonableness in contesting any bill or portion thereof. No interest will accrue on any contested portion of the billing until the contest has been mutually resolved. C. All payments under this Agreement shall be made by PRINCIPAL solely to YORK. PRINCIPAL shall not be obligated or liable under this Agreement to any party other than YORK for payment of any monies or provision of any goods or services. IX. AUDIT A. YORK shall maintain books, records, reports and other documents, in electronic or other format reasonably acceptable to PRINCIPAL relating to its Claims Administration Services performed under this Agreement. All such records and documents pertaining to Claims and the services rendered by York shall be the property of PRINCIPAL and be open for inspection, audit and copying, at PRINCIPAL'S expense, by PRINCIPAL and its agents or their representatives during all regular business hours with reasonable prior notice to YORK. B. YORK shall cooperate fully with all such agents or other representative of PRINCIPAL during audits or examinations conducted by PRINCIPAL or its agents. Auditors shall sign a nondisclosure/confidentiality agreement provided by YORK. C. The PRINCIPAL agrees to the disclosure of all information and reports resulting from access to the records pursuant to the subsection above. Where the audit concerns a contractor, the auditing agency will afford YORK an opportunity for an audit exit conference and an opportunity to comment on the pertinent portions of the draft audit report. The final audit report will include written comments, if any, of the audited parties. D. At any time during the Term of this Agreement, or thereafter, provided PRINCIPAL is not in default under this Agreement, PRINCIPAL may conduct, or cause to have conducted, an audit of YORK'S operations to determine whether YORK has performed its obligations hereunder in compliance with this Agreement. Page 14 of 23 E. YORK agrees that PRINCIPAL shall, during the Initial Term, any Renewal Term, and until the expiration of three (3) years after final payment under this Agreement and at no additional cost to PRINCIPAL, have access to and the right to examine any directly pertinent books, documents, papers and records of YORK involving transactions relating to this Agreement. YORK agrees that PRINCIPAL shall have access during YORK's normal working hours to all necessary YORK facilities and shall be provided adequate and appropriate workspace in order to conduct audits in compliance with the provisions of this section. PRINCIPAL shall give YORK no less than thirty (30) days advance notice of intended audits. If YORK subcontracts any of its obligations under this Agreement, YORK shall include language in any subcontractor whereby subcontractor agrees to be bound by the same rights, duties and obligations of YORK under this provision. F. Audits pursuant to this Section VIII shall be conducted in a manner that does not interfere with YORK'S daily operations. X. CONFIDENTIALITY A. Both parties hereto acknowledge and agree that PRINCIPAL'S information, data and documentation, including but not limited to, non-public and personal information subject to the provisions of the Gramm-Leach-Bliley Act, 15 U.S.C. Subchapter 1, Sections 6801-6809 et. Seq., and further including, without limitation, all information, data and documentation related to manuals, lists, policyholder information, operating and other systems, business practices and procedures, any information regarding insureds insurance policies, claimants, and Claims, any business, governmental or regulatory matters of PRINCIPAL, and other information furnished to or obtained by YORK, pursuant to or in connection with this Agreement or in connection with the Services to be rendered, may be confidential ("Confidential Information"). YORK shall not divulge, disclose or use the Confidential Information except for purposes of this Agreement, or as may be expressly agreed in writing by the parties, or as may otherwise be required or directed by applicable law or judicial process. This Section IX shall survive the termination of this Agreement, regardless of the reason for termination. B. During the Term of this Agreement, and after its termination for any reason, PRINCIPAL shall have the right to request in writing and receive from YORK either: (i) the immediate return or (ii) confirmation of the immediate destruction of any tangible records, documents, e-mails, computer files, CDs, disks, and any other tangible item that contains, represents, or otherwise includes any Confidential Information of PRINCIPAL. In addition, PRINCIPAL shall have the right, during the Term of this Agreement and after its termination, to request that YORK permanently delete and destroy any Confidential Information contained in any computers, hard drives, servers or Page 15 of 23 other data storage systems of YORK. YORK agrees that PRINCIPAL may seek an injunction by a court of competent jurisdiction enjoining YORK from violating any terms of this Agreement or the confidentiality and non-use provisions of this Section IX. Injunctive relief shall be in addition to any other remedies that PRINCIPAL may have under the law. Notwithstanding the foregoing, YORK may retain a record copy of Claims files and the data therein, for accounting, insurance and similar purposes. YORK shall secure said record copy against improper use or disclosure. C. YORK acknowledges and agrees that any Confidential Information disclosed to, or acquired by it is disclosed and/or acquired solely for the purposes of facilitating the provision of the services to be rendered by YORK for and on behalf of PRINCIPAL. YORK shall be solely responsible for informing its employers, officers and directors of the provisions of the Section and for any acts of its employees, officers or directors that violate the provisions of the Section. D. Notwithstanding the foregoing, PRINCIPAL and YORK agree that information used for adjusting claims is not subject to statutory or regulatory restrictions against disclosure for that purpose. Therefore, as otherwise limited in this Agreement, YORK and PRINCIPAL may share information for the proper management and administration of PRINCIPAL's workers' compensation program. E. YORK understands and acknowledges that PRINCIPAL is a public entity under the laws of the State of Texas, and as such, the following information is subject to disclosure under Chapter 552 of the Texas Government Code, the Texas Public Information Act (the "Act") — 1) All documents and data held by the PRINCIPAL, including information obtained from YORK and 2) information held by YORK for or on behalf of PRINCIPAL that relates to the transaction of PRINCIPAL'S business to which PRINCIPAL has a right of access. If the PRINCIPAL receives a request for any documents that may reveal any of YORK'S Confidential Information under the Act, or by any other legal process, law, rule, or judicial order by a court of competent jurisdiction, PRINCIPAL will utilize its best efforts to notify YORK prior to disclosure of such documents. PRINCIPAL will not be liable or responsible in any way for the disclosure of information not clearly marked as "Proprietary / Confidential Information" or if disclosure is required by the Act of any other applicable law or court order. In the event there is a request for such information, it will be the responsibility of YORK to submit reasons objecting to disclosure. A determination on whether such reasons are sufficient will not be decided by PRINCIPAL, but by the Office of the Attorney General of the State of Texas, or by a court of competent jurisdiction. XI. INDEMNIFICATION A. YORK agrees to indemnify, defend and hold harmless PRINCIPAL and PRINCIPAL elected officials, directors, officers, employees, and agents, from and Page 16 of 23 against any and all causes of action, claims, damage, loss, costs and expenses (including, without limitation, fines, damages, liabilities, liens, losses, costs and expenses, including reasonable attorney's fees and litigation expenses) incurred by PRINCIPAL or any of PRINCIPAL directors, officers, attorneys, employees and agents by reason and to the extent of any material breach of this Agreement by YORK, or by reason and to the extent of any negligent, or otherwise wrongful act or omission of YORK or of its officers, directors, attorneys, employees or agents. B. The above defense, indemnification and hold harmless undertakings shall survive the termination of this Agreement. C. PRINCIPAL acknowledges that YORK has been engaged to provide professional services and that it is not the intent of the parties that YORK assumes any insurance risk. D. Nothing herein shall be construed as a waiver of any governmental immunity available to the PRINCIPAL under Texas Law or as a waiver of any defenses of the parties under Texas Law. The provisions of the INDEMNIFICATION are solely for the benefit of the parties hereto and not intended to create or grant any rights, contractual or otherwise, to any other person or entity. The parties' indemnification obligations under this section are contingent upon: (i) the indemnified party giving prompt written notice to the indemnifying party of any claim under this Section (provided, however, that failure to give such notification shall not affect the indemnification provided hereunder except to the extent, and only to the extent, that the indemnifying party shall have been actually prejudiced as a result of such failure), and (ii) at the indemnifying party's request and expense, the indemnified party cooperating in the investigation and defense of such claim(s). If the indemnifying party assumes the defense of any claim hereunder, the indemnified party shall be entitled to participate in (but not control) such defense and to retain its own counsel, at its own expense. The indemnifying party shall not settle or consent to an adverse judgment in any such claim that adversely affects the rights or interests of the indemnified party or imposes additional obligations on the indemnified party, without the prior express written consent of the indemnified party XII. BREACH AND TERMINATION A. If a material breach by either party of this Agreement occurs, the non- breaching party shall identify the breach by delivery of written notice thereof to the breaching party. B. Upon delivery of written notification of breach, the breaching party shall have a period of fifteen (15) business days or an agreed upon date made within the Page 17 of 23 fifteen (15) business days within which time the breaching party shall cure the breach. Should the breaching party fail to fully cure the breach within the designated time frame, the non-breaching party may terminate this Agreement by delivery of thirty (30) days written notice of termination to the breaching party. Any notice of breach or termination shall be delivered pursuant to Section XII. A hereto. C. This Agreement may be terminated by a party without the necessity of any notice or right to cure, upon the occurrence of any of the following events: (1) The expiration of the Term set forth in Section 11 or any renewal Thereof, (2) The commencement of bankruptcy, insolvency or conservatorship proceedings by the other party, or, if such proceedings are brought against the other party, the other party's failure to have such proceedings dismissed within 45 days. D. Either party may, without reason, terminate this Agreement with at least sixty (60) days prior written notice to the other party. E. YORK may terminate this Agreement and discontinue Services immediately upon notice to PRINCIPAL, if PRINCIPAL fails to maintain sufficient balances in the escrow account to properly and adequately fund daily maintenance and indemnity needs, as well as settlement of Claims and any Loss Adjustment Expense. At no time shall YORK be liable or obligated to make any payments, out of YORK'S own funds, of any type or character on behalf of PRINCIPAL, including benefits PRINCIPAL is legally required to provide to its employees. F. In the event no funds or insufficient funds are appropriated by PRINCIPAL in any fiscal period for any payments hereunder, PRINCIPAL will notify YORK of such occurrence, and this Agreement shall terminate on the last day of the fiscal period for which appropriations were received without penalty or expense to PRINCIPAL of any kind whatsoever, provided, however, that YORK shall be paid for all services rendered up to the termination of the Agreement. G. In the event of termination, YORK shall fully cooperate with PRINCIPAL and continue to perform all duties and obligations under this Agreement up to the effective date of termination. XIII. EQUITABLE ADJUSTMENT A. PRINCIPAL shall have the right to direct YORK to perform additional services or to perform services in a specific or different way. Page 18 of 23 B. This Agreement contemplates that the standards applicable to this Agreement are those in effect on the date of this Agreement, whether such standards are set forth in statutes, regulations, rules, orders, case laws or otherwise. C. In the event of a directive from PRINCIPAL as set forth in Section XII. A or a change in a standard as set forth in Section XII B., YORK shall be entitled to an equitable adjustment in its compensation if such directive or change increases YORK'S cost of providing the services YORK renders under this Agreement. XIV. GENERAL A. YORK shall not be liable or deemed to be in default for any delay or failure in performance under this Agreement or any Exhibit of this Agreement, or any interruption of Claims Administration Services resulting, directly or indirectly, from acts of God, civil or military authority, or any similar cause beyond the reasonable control of YORK for as long as such condition exists. YORK shall give immediate notice to PRINCIPAL of any delay or failure in performance or of any interruption of Claims Administration Services that has or may occur as soon as YORK becomes aware of such events. B. If any dispute or claim arises hereunder that the parties are not able to resolve amicably, the parties agree and stipulate that such litigation shall be resolved in Tarrant County Texas. C. This Agreement is made and is to be performed in Tarrant County, Texas and is governed by the laws of the State of Texas. D. All notices which are required to be given or submitted pursuant of this Agreement shall be in writing and shall be transmitted or delivered by certified mail, return receipt requested or by a commercial overnight delivery service to the parties at the addresses set forth below, or to such other addresses as a party may, by notice, specify: Notices to YORK shall be delivered to: York Risk Services Group, Inc. York Risk Services Group, Inc. 333 City Boulevard West, Suite 1500 One Upper Pond Road, Bldg. F, 4t" Floor Orange, CA 92868 Parsippany, New Jersey 07054 Attention: Jody A. Moses, SR. VP Attn: Michael Krawitz, General Counsel SR. VP Notices to PRINCIPAL shall be delivered to the following: CITY OF FORT WORTH 1000 Throckmorton Street, Fort Worth, Texas 76102 Attention: Brian Dickerson, Human Resources Director With copy to the City Attorney's Office at the same address Page 19 of 23 E. This Agreement and any Exhibit or Schedule made a part hereof constitute the entire Agreement between the parties and supersedes and merges any and all prior discussions, representations, negotiations, correspondence, writing, and other agreements and together states the entire understanding and agreement between PRINCIPAL and YORK with respect to Claims Administration Services to be provided hereunder. Except for unilateral changes made by the PRINCIPAL pursuant to Section XI I, for which YORK shall, be entitled to an equitable adjustment in its compensation this Agreement may be amended or modified only in writing if agreed to and signed by PRINCIPAL and YORK and shall be construed, performed and enforced in all respects in accordance with the laws of the State of Texas. F. PRINCIPAL typically provides its own legal representation at workers' compensation administrative hearings and in the courts by using its own legal resources. However, PRINCIPAL may from time-to-time determine that PRINCIPAL'S position and case would best be presented through outside attorney representation. Therefore, at the request of PRINCIPAL, and upon approval of the Fort Worth City Council by Resolution, YORK shall arrange for highly qualified attorney representation to represent PRINCIPAL'S interests and shall assist PRINCIPAL in ensuring that any contracts required between the PRINCIPAL and the outside attorney are timely and fully executed. Such outside attorney representation shall be billed to the specific claim as a legal expense. YORK claims adjusters shall represent PRINCIPAL at benefit review conference hearings at no additional cost to PRINCIPAL. G. In the event that either PRINCIPAL or YORK is notified by the Texas Department of Insurance that an administrative violation may have occurred that could adversely impact PRINCIPAL claims and/or either party's standing with TDI, the receiving party shall immediately notify the other party. Administrative penalties or fines imposed by TDI or any other entity that relate to PRINCIPAL claims or to PRINCIPAL as a workers' compensation self-insured political subdivision and that result from violations of the Texas Labor Code or Texas Insurance Code attributable to the negligence, error or omission of YORK, its employees, agents, or authorized vendors shall be paid by YORK. Administrative penalties or fines imposed by TDI or any other entity that relate to PRINCIPAL claims or PRINCIPAL as a workers' compensation self-insured political subdivision and that result from violations of the Texas Labor Code or Texas Insurance Code attributable to the negligence, error or omission of PRINCIPAL or its employees shall be paid by PRINCIPAL. Administrative penalties or fines imposed by TDI or any other entity that result from violations of the Texas Labor Code or Texas Insurance Code attributable to the negligence, error or omission of both parties shall be paid equally by both parties. H. No party hereto shall be deemed to have waived any rights or remedies accruing to it hereunder unless such waiver is in writing and signed by such party. No Page 20 of 23 delay or omission by either party hereto in exercising any right shall operate as a waiver of said right on any future occasion. All rights and remedies hereunder shall be cumulative and may be exercised singularly or concurrently. I. The descriptive headings of this Agreement are intended for reference only and shall not affect the construction or interpretation of this Agreement. J. Wherever the singular of any term is used herein it shall be deemed to include the plural wherever the plural thereof may be applicable. K. No party may assign its rights or obligations under this Agreement; provided, however, that YORK may subcontract all or part of the Services required hereunder with PRINCIPAL'S written consent, (which consent shall not be unreasonably delayed or withheld) and may at its discretion delegate to a subsidiary such of its duties as it deems appropriate, provided that such subcontracting or delegation shall not relieve YORK of any of its obligations hereunder. L. It is expressly understood and agreed that the relationship of YORK to PRINCIPAL shall be that of an independent contractor at all times, and nothing herein shall constitute either the YORK or PRINCIPAL as the partner, agent, or legal representative of the other, for any purpose whatsoever, except to the extent that YORK is the agent of PRINCIPAL for the purpose of adjusting claims. YORK shall have no right or authority to bind or obligate PRINCIPAL with respect to any matter that is not specifically provided for in this Agreement without the prior approval of PRINCIPAL. All employees or agents of YORK performing duties hereunder for YORK shall be solely and exclusively under the direction and control of YORK and shall not be deemed employees of PRINCIPAL. M. Nothing in this Agreement is intended to require YORK to engage in the practice of law. N. Whenever the PRINCIPAL has reason to question the YORK's intent to perform; the PRINCIPAL may demand that YORK give written assurance of YORK's intent to perform. In the event a demand is made, and no assurance is given within ten (10) calendar days, the PRINCIPAL may treat this failure as an anticipatory repudiation of the Agreement. O. YORK warrants and certifies, and this Agreement is made in reliance thereon, that it, its individual officers, employees and agents are neither officers nor employees of PRINCIPAL or any PRINCIPAL agencies, such as PRINCIPAL-owned utilities. In the event that any conflicts of interest arise after the execution of this Agreement, YORK hereby agrees to make full disclosure to PRINCIPAL in writing immediately upon learning of such conflict. Page 21 of 23 P. PRINCIPAL shall not utilize YORK'S trade names, logos, trademarks, service marks or other identification in any press release, advertisement, marketing materials, promotional literature, article, presentation or other type of communication without the prior written consent of YORK, which consent may be withheld or denied in YORK'S sole discretion. Q. In the event of any conflict between the documents, the terms and conditions of this Agreement shall control. If any clause or provision of this Agreement is held invalid, illegal or unenforceable under present or future laws during the term of this Agreement, including any extension and renewal hereto, it is the intention of the parties hereto that the remainder of the Agreement shall not be affected hereby, and that in lieu of each invalid clause or provision of this Agreement, a clause or provision as similar in terms to such illegal, invalid or unenforceable clause or provision as may be possible shall be drafted to comply with all applicable laws and shall replace the clause or provision held invalid, illegal or unenforceable. R. Neither PRINCIPAL nor YORK shall, during the term of this Agreement and additionally for a period of one year after its termination, solicit for employment or employ, whether as employee or independent contractor, any person who is or has been employed by the other party during the term of this Agreement without the prior written consent of the person's employer. S. The parties acknowledge that each party and its counsel have had the opportunity to review and revise this Agreement and that the normal rules of construction to the effect that any ambiguities are to be resolved against the drafting party of that section shall not be employed in the interpretation of this Agreement or any attachments or exhibits hereto. T. The person signing this Agreement hereby warrants that he or she has the legal authority to execute this Agreement on behalf of his or her respective party and that such binding authority has been granted by proper order, resolution, ordinance, or other authorization of the entity. The other party is fully entitled to rely on this warranty and representation in entering into this Agreement. Sign page Page 22 of 23 IN WITNESS WHEREOF, the parties hereto have read and signed this Agreement as dated below and the Agreement is effective as of November 1, 2015 for TPA with the 504 Provider Panel implemented on January 1, 2016. ACCEPTED AND AGREED: CITY OF FORT WORTH, TEXAS YORK RISK SERVICES GROUP, INC. By- Bv: 21foL Sos",an Alanis J 0`d A. Moses Assistant City Manager Senior Vice President Date: Date: Oc,trba_/,-Z 2015- APPROVAL OE MMENDED: ATTEST: ri Dicker on Lynda Smith-Kelly uman Re urces Dir Rr Process Manager ATTEST: 00 0 ox 0 0 By: 0 City Sect tar APPROVED AS TO FORM AND LEGALITY: By: Guillermo (Will) S. Trevino Assistant City Attorney CONTRACT AUTHORIZATION: M&C: Date Approved: t FFICIAL R1E,,`,C,'N D Page 23 of 23 M&C Review Page 1 of 3 Official site of the City of Fort Worth,Texas OR f RT1 CITY COUNCIL AGENDA I COUNCIL ACTION: Approved on 8125/2015 DATE: 8/25/2015 REFERENCE NO.: C-27435 LOG NAME: 14YORK2015 CODE: C TYPE: NON-CONSENT HEARING: NO SUBJECT: Authorize Execution of an Agreement with York Risk Services Group, Inc,, for the Administration of the Workers' Compensation Program in an Amount of$1,414,420.00 for the First Year (ALL COUNCIL DISTRICTS) RECOMMENDATION: It is recommended that the City Council authorize the City Manager to execute an Agreement with York Risk Services Group, inc., in the amount of$1,414,420.00 for the first year with a three-year initial term and two one-year renewal options for the administration of the City of Fort Worth's Workers' Compensation Program including claims administration, medical cost containment services and health care network. } I DISCUSSION: The City of Fort Worth currently contracts with CorVel Enterprise Comp, Inc., to provide workers' compensation claims adjusting, claims administration, medical cost containment, safety and loss control services. The third year of a three-year Professional Services Agreement with CorVel will expire December 31, 2015. CorVel has been notified that the City will exercise its option to terminate services early on October 31, 2015 with the commencement of the new vendor contract described below. On June 3, 2015, a Request for Proposals (RFP) was issued requesting that interested vendors submit proposals by July 2, 2015. This RFP was advertised in the Fork Worth Star-Telearam each Wednesday from June 3, 2015 through July 1, 2015. The RFP was designed to solicit proposals on: (1) third party claims administration services for a self-funded workers' compensation program (including payment and adjusting, claim Investigations, subrogation, establishing reserves, defense of denied claims), (2) medical cost containment services (including medical bill review, utilization review, preauthorization, telephonic and field case management, vocational case management), (3) 504 workers' compensation health care network program (including program administration, health care provider credentialing) (4) safety and loss control services, (5) serving as Austin representative for the City at the Texas Department of Insurance and the Texas Workforce Commission, (S) Medicare and Medicaid reporting for worker's compensation, (7) document scanning and indexing and (8) other miscellaneous claims-related services. The City received 10 competitive proposals in response to the RFP. Proposals were thoroughly evaluated by a committee comprised of representatives from the Human Resources, Water and Transportation & Public Works Departments and representatives from the Fort Worth Police Association and Fire Association Local 440. The Committee considered several factors in evaluating proposals, including price competitiveness, an organization's ability to administer the workers' compensation program, qualifications of each organization's staff, M/WBE participation and quality of service. The Committee agreed to recommend that York be awarded the contract based upon York's proposal representing the best combination of low/competitive pricing, experience and quality of services to provide the best services to the City, Overall, the expected total fixed administrative costs in the amount of$1,414,420,00 for York are within the requested proposed budget for Fiscal Year )� 2016, littp://apps.cfwne,t.org/couiicit packet/nac review.asp?JD=21392&councildatc=8/25/201 8/26/2015 M&C Review Page 2 of 3 Staff recommends the contract be awarded to York Risk Services Group, Inc. (York), for an annual contract cost of$1,414,420.00 for the first year. Contract cost will not exceed $1,437,217.00 in Fiscal Year 2017 and $1,457,634.00 in Fiscal Year 2018. The City Manager's budget proposal for Fiscal j Year 2015-2016 will include a recommendation to fund this contract through September 2016. Authority for the remaining fiscal years that are encompassed by the Agreement will be requested annually as part of the overall budget process and the contract will include a standard fiscal funding out clause that would comply with state law requirements by allowing the City to terminate the Agreement without penalty, if in the future, the City Council elects not to appropriate funds for services covered by this Mayor and Council Communication. While this is about a 23 percent increase in administration cost for the Workers' Compensation Program, services and quality are greatly enhanced with seven exclusively dedicated staff from York for the City of Fort:Worth's Program (four on-site Indemnity Adjusters and one on-site Claims Associate, one Unit Manager and one Medical Only Adjuster located in York's Fort Worth office), The increase also includes the development and administration of a customized 504 health provider network. In 2005, the 79th Texas Legislature passed House Bill (HB) 7, which authorized the use of workers' compensation health care networks certified by the Texas Department of Insurance (Department)for political subdivisions. HB 7 also added Section 504.053 which authorized political subdivisions to contract directly with health care providers for the provision of medical benefits, treatment and care for its injured employees. The York proposal includes establishment of such a direct contract"504 health care network"for City of Fort Worth employees. This 504 health care network will be customized to provide treating and referral doctors and other health care providers to meet the specific needs and requirements of the City. M/WBE OFFICE -A waiver of the goal for MBE/SBE subcontracting requirements was requested by the Purchasing Division and approved by the M/WBE Office, in accordance with the BDE Ordinance, because the purchase of goods or services is from sources where subcontracting or supplier opportunities are negligible. TERMS AND RENEWALS-On City Council approval, services under this contract will commence on November 1, 2015 for a three-year initial term. The Agreement may be renewed for two one-year terms at the City's option. This action does not require specific City Council approval, provided that the City Council has appropriated sufficient funds to satisfy obligations during the renewal term. FISCAL INFORMATION/CERTIFICATION: The Financial Management Services Director certifies that funds will be included in the City Manager's proposed budget for Fiscal Years 2015-2016 for the Workers' Compensation Fund. Upon approval of the above recommendations and upon the adoption of the Fiscal Year 2015-2016 Budget by the City Council to include the above recommendations, funds will be available in the Fiscal Year 2016 operating budget, as appropriated. Prior to expenditure being made, the Workers' r Compensation Fund has the responsibility to validate the availability of funds. Funding for the FY2017 and FY2018 will be contingent upon approval of funding in the FY2017 and FY2018 adopted budgets for the Workers' Compensation Fund. TO Fund/Account/Centers FROM Fund/Account/Centers 60111 5310101 0147310 $1,096,029.00 60111 5330201 0147310 $200.522.63 Submitted for City Manager's Office by: Susan Alanis (8180) Ortainatina Department Head: Brian Dickerson (7783) Additional Information Contact: Margaret Wise (8058) littp://apps.cfwnet.org/council 8/26/2015