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HomeMy WebLinkAboutR-03-0877J-03-661 07/23/03 RESOLUTION NO. 0 3 r 877 A RESOLUTION OF THE MIAMI CITY COMMISSION, WITH ATTACHMENT(S), AUTHORIZING THE CITY MANAGER TO EXECUTE A PROFESSIONAL SERVICES AGREEMENT ("AGREEMENT"), IN SUBSTANTIALLY THE ATTACHED FORM, WITH PREFERRED GOVERNMENTAL CLAIMS SOLUTIONS AND BROWN & BROWN, INC., D/B/A AMERISYS, THE TOP-RANKED FIRM SELECTED AS A RESULT OF THE COMPETITIVE SELECTION PROCESS TO PROVIDE ALL MANAGED CARE SERVICES RELATED TO THE CITY'S WORKERS COMPENSATION MANAGED CARE CLAIMS FOR AN INITIAL THREE-YEAR PERIOD, WITH THE OPTION TO EXTEND FOR FIVE (5) ADDITIONAL ONE-YEAR PERIODS WITHOUT FURTHER APPROVAL OF THE CITY COMMISSION IN AN AMOUNT NOT TO EXCEED THE NEGOTIATED AMOUNT SET FORTH IN "EXHIBIT 2," ATTACHED AND INCORPORATED, WITH INCREASES IN THE AMOUNT OF COMPENSATION PAYABLE DURING EACH OF THE OPTIONAL YEAR PERIODS NOT TO EXCEED THE CONSUMER PRICE INDEX FOR THE IMMEDIATELY PRECEDING YEAR; AND ALLOCATING FUNDS FROM ACCOUNT CODE NO. 515001.624401.6.668. WHEREAS, the City of Miami ("City") issued Request for Proposal No. 02-03-010 seeking qualified and experienced firms to provide Managed Care Services for the Department of Risk Management; and i CITY COMOS31,0N MEETING OF j 111 2 4 70,03 j hesolution No. 3" 877 WHEREAS, the Evaluation Committee evaluated the proposals received and ranked Preferred Governmental Claims Solutions ("PGCS") as the top ranked firm, and recommended that the City Manager negotiate a Professional Services Agreement ("Agreement") with PGCS for an initial three-year period with the option to extend for five (5) additional one-year periods, without further approval of the City Commission, provided that the increase in the amount of compensation payable during each of the additional one (1) year periods does not exceed consumer price index over the immediately preceding year; and WHEREAS, PGCS's proposal included AmeriSys, a division of Brown & Brown, Inc., a Florida corporation ("Provider"), as the provider of the Managed Care Services; and WHEREAS, the City Manager concurred with the recommendation of the Evaluation Committee; and WHEREAS, Resolution No. 03-364, adopted April 10, 2003, authorized the City Manager to negotiate an Agreement with PGCS, the top-ranked firm, and present the negotiated agreement to the City Commission for review and consideration; and WHEREAS, funds for said services will be allocated from Account Code No. 515001.624401.6.668 in an amount not to exceed the negotiated amount set forth in "Exhibit 2," attached and incorporated; Page 2 of 4 03— 877 NOW, THEREFORE, BE IT RESOLVED BY THE COMMISSION OF THE CITY OF MIAMI, FLORIDA: Section 1. The recitals and findings contained in the Preamble to this Resolution are adopted by reference and incorporated as if fully set forth in this Section. Section 2. The City Manager is authorizedll to execute an Agreement, in substantially the attached form, with PGCS and Brown & Brown, Inc., d/b/a AmeriSys, the top-ranked firm selected as a result of the competitive selection process to provide all Managed Care Services related to the City's Workers Compensation Managed Care Claims, for an initial three-year period with the option to extend for five (5) additional one-year periods, without further approval of the City Commission, in an amount not to exceed the negotiated amount set forth in "Exhibit 2," attached and incorporated, with increases in the amount of compensation payable during each of the optional year periods not to exceed the consumer price index for the immediately preceding year, with funds allocated from Account Code No. 515001.624401.6.668. 1� The herein authorization is further subject to compliance with all requirements that may be imposed by the City Attorney, including but not limited to those prescribed by applicable provisions of the City Charter and Code. Page 3 of 4 03— 877 Section 3. This Resolution shall become effective immediately upon its adoption and signature of the Mayor.2/ PASSED AND ADOPTED this 24th day of July , 2003. MANUEL A. DIAZ, MAYOR In accordance with Miami Code Sec. 2-36, since the Mayor did not Indicate aperu'jal of this logislation by s i 1`1ti,�� �.�<� ,a e � place provided, said legislation no°w becomes effecitive y from the date of commissi '::"Jn'n regarding same, without the Mayor ex ATTEST: ,PRISCILLA A. THOMPSON CITY CLERK APPROVED A� 70 FOPM,XD CORRECTNESS ITDROVILARELLO ATTORNEY 406:tr:AS:BSS If the Mayor does not sign this Resolution, it shall become effective at the end of ten calendar days from the date it was passed and adopted. If the Mayor vetoes this Resolution, it shall become effective immediately upon override of the veto by the City Commission. Page 4 of 4 03— 877 �A*Ibi-ri PROFESSIONAL SERVICES AGREEMENT This Agreement is entered into this _ day of 2003 by and between the City of Miami, a municipal corporation of the State of Florida ("City") and Preferred Governmental Claims Solutions, a corporation ("PGCS") and Brown and Brown, Inc., a Florida corporation d/b/a AmeriSys ("AmeriSys"). PGCS and AmeriSys are referred to herein, collectively, as the" Provider". RECITAL A. The City has issued a Request for Proposal ("RFP") for the provision of Managed Care Services ("Services") and PGSC's proposal ("Proposal"), in response thereto, has been selected as the most qualified proposal for the provision of the Services. B. The Proposal provides that the Services will be rendered by AmeriSys, which by execution of this Agreement, agrees to provide the Services as described therein. The RFP and the Proposal are sometimes referred to herein, collectively, as the Solicitation Documents, and are by this reference incorporated into and made a part of this Agreement. C. The Commission of the City of Miami, by Resolution No. 03-364, adopted on April 10, 2003, approved the selection of Provider and authorized the City Manager to negotiate an agreement for an initial term of three (3) years with the options to extend the Agreement for five (5) additional one (1) year periods. C. The Commission of the City of Miami, by Resolution No. , adopted on 2003, authorized the City Manager to execute this Agreement under the terms and conditions set forth herein. NOW, THEREFORE, in consideration of the mutual covenants and promises herein contained, Provider and the City agree as follows: 03- 877 TERMS 1. RECITALS: The recitals are true and correct and are hereby incorporated into and made a part of this Agreement. 2. TERM: The initial term of this Agreement shall be three (3) years, commencing on the date hereof and may be extended by the City, for a maximum period of five (5) additional years, in accordance with Section 3 below. In the event the City requires Provider to continue to handle claim files that remain open as of the termination date of the Agreement, until their conclusion, then the provisions of this Agreement shall continue to apply to Provider's performance of Services for such claims until they are closed. 3. OPTION TO EXTEND: The City shall have five (5) options to extend the Term, each for a period of one (1) year subject to availability and appropriation of funds and the parties reaching an agreement on the amount or schedule of compensation payable during the extended term. If Provider requests an increase in compensation during a proposed extended term, it must submit its proposed change to City at least one (1) year prior to the expiration of the initial term. In such event, the amount of compensation shall be renegotiated by the parties, in good faith, but shall not exceed lowest of CPI increase over the immediately preceding year, or prevailing rates charged by PGSC or AmeriSys, to their preferred clients as of that date. The City may exercise the options in its sole discretion, and without City Commission approval, by written notice to the Provider given at least sixty (60) days prior to the expiration of the then current term. 4. SCOPE OF SERVICE: A. Provider agrees that the Services shall be provided by AmeriSys, as specifically described, and under the special terms and conditions set forth in Attachment "A" hereto, which by this reference is incorporated into and made a part of this Agreement. The City reserves the 03- 877 right not to turn over to Provider, and to retain management, handling and control of, all or a portion of the claims that are the subject of this Agreement. The City also reserves the right to perform, or caused to be performed by other parties, some or all of the services that are subject to Allocated Expenses, as the term is defined in Attachment "A". B. Provider represents and warrants to the City that: (i) it possesses all qualifications, licenses and expertise required under the Solicitation Documents for the performance of the Services; (ii) it is not delinquent in the payment of any sums due the City, including payment of permit fees, occupational licenses, etc., nor in the performance of any obligations to the City; (iii) all personnel assigned to perform the Services are and shall be, at all times during the term hereof, fully qualified and trained to perform the tasks assigned to each; and (iv) the Services will be performed in the manner described in Attachment "A". 5. COMPENSATION: A. The amount of compensation payable by the City to Provider shall be based on the rates and schedules described in Attachment `B" hereto, which by this reference is incorporated into this Agreement. . B. Unless otherwise specifically provided in Attachment `B", payment shall be made within forty-five (45) days after receipt of Provider's invoice, which shall be accompanied by sufficient supporting documentation and contain sufficient detail, to allow a proper audit of expenditures, should City require one to be performed. 6. DESIGNATED PERSONNEL: Provider acknowledges that in selecting Provider as the most qualified firm for the provisions of the Services the City has relied on Provider's representations regarding its staffing model and its commitment to dedicate personnel exclusively to the City for the provisions of Services. Provider agrees to assign exclusively to 03- 877 the City, the personnel specified in Attachment "C", which is incorporated by reference and made a part to this Agreement, to perform the Services (the "Designated Personnel"). 7. OWNERSHIP OF DOCUMENTS: A. Provider understands and agrees that any information, document, report or any other material whatsoever which is given by the City to Provider or which is otherwise obtained or prepared by Provider pursuant to or under the terms of this Agreement is and shall at all times remain the property of the City. Provider agrees not to use any such information, file, document, report or material for any purpose whatsoever, except as authorized hereunder, without the written consent of City, which may be withheld or conditioned by the City in its sole discretion. Every two (2) years, during the Term, Provider shall deliver to the City all files that have been closed during the corresponding period, categorized by year, and in alphabetical order, and labeled as required by the City. Pending delivery to the City the files shall be maintained and stored by Provider, at no cost to the City. . B. At all times during the Term, and for a period of five (5) years after its termination, Provider shall provide City access to all files and records maintained on City's behalf. Provider further agrees to deliver to the City or to such address as requested by the City, all files, or such files as the City may request, in hard copies or such electronic format as may be required by the City, not later than ten (10) days after receipt of City's written request. C. Not later than ten (10) days after the termination of the Term, Provider shall deliver to the City, in addition to all other documents, information and data described in Attachment "A", all original claim files, computer tapes or other computer media containing all of the data required for claims adjudication and loss statistics. Such data shall be made available in a format generally importable into a commonly recognized database for claims adjudication 03- 877 and loss statistics. 8. AUDIT AND INSPECTION RIGHTS: A. The City may, at reasonable times, and for a period of up to five (5) years following the date of final payment by the City to Provider under this Agreement, audit, or cause to be audited, those books and records of Provider which are related to Provider' s performance under this Agreement. Provider agrees to maintain all such books and records at its principal place of business for a period of five (5) years after final payment is made under this Agreement. B. The City may, at reasonable times during the term hereof, inspect Provider's facilities and perform such tests, as the City deems reasonably necessary, to determine whether the goods or Services required to be provided by Provider under this Agreement conform to the terms hereof and/or the terms of the Solicitation Documents, if applicable. Provider shall make available to the City all reasonable facilities and assistance to facilitate the performance of tests or inspections by City representatives. All tests and inspections shall be subject to, and made in accordance with, the provisions of Section 18-100 of the Code of the City of Miami, Florida, as same may be amended or supplemented, from time to time. 9. AWARD OF AGREEMENT: Provider represents and warrants to the City that it has not employed or retained any person or company employed by the City to solicit or secure this Agreement and that it has not offered to pay, paid, or agreed to pay any person any fee, commission, percentage, brokerage fee, or gift of any kind contingent upon or in connection with, the award of this Agreement. 10. PUBLIC RECORDS: Provider understands that the public shall have access, at al reasonable times, to all documents and information pertaining to City contracts, subject to the provisions of Chapter 119, Florida Statutes, and agrees to allow access by the City and the public 03- 877 to all documents subject to disclosure under, applicable law. Provider's failure or refusal to comply with the provisions of this section shall result in the immediate cancellation of this Agreement by the City. 11. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS: Provider understands that agreements between private entities and local governments are subject to certain laws and regulations, including laws pertaining to public records, conflict of interest, record keeping, etc. City and Provider agree to comply with and observe all applicable laws, codes and ordinances as they may be amended from time to time. Additionally, at all times during the Term, if applicable, Provider shall comply with and observe all applicable Federal, State and Local laws, statues, rules and regulations applicable to the Services, including specifically, but without limitation, the provisions of the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and the Privacy Standards contained therein. Provider shall enter into a Business Associate Agreement with the City of Miami for HIPAA compliance. 12. INDEMNIFICATION: Provider shall indemnify, defend and hold harmless the City and its officials, employees and agents (collectively referred to as "Indemnities") and each of them from and against all loss, costs, penalties, fines, damages, claims, expenses (including attorney's fees) or liabilities (collectively referred to as "Liabilities") arising out of, resulting from, or in connection with (i) the performance or non-performance of the Services contemplated by this Agreement which is or is alleged to be directly or indirectly caused, in whole or in part, by any act, omission, default or negligence (whether active or passive) of Provider or its employees, agents or subcontractors (collectively referred to as "Provider"), regardless of whether it is, or is alleged to be, caused in whole or part (whether joint, concurrent or contributing) by any act, omission, default or negligence (whether active or passive) of the 03- 877 Indemnities, or any of them or (ii) the failure of the Provider to comply with any of the paragraphs herein or the failure of the Provider to observe, comply with, or conform to statutes, ordinances, or other regulations or requirements of any governmental authority, federal or state, in connection with the performance of this Agreement. Provider expressly agrees to indemnify and hold harmless the Indemnities, or any of them, from and against all liabilities which may be asserted by an employee or former employee of Provider, or any of its subcontractors, as provided above, for which the Provider's liability to such employee or former employee would otherwise be limited to payments under state Workers' Compensation or similar laws. 13. DEFAULT: If Provider fails to comply with any term or condition of this Agreement, or fails to perform any of its obligations hereunder, then Provider shall be in default. Upon the occurrence of a default hereunder the City, in addition to all remedies available to it by law, may immediately, upon written notice to Provider, terminate this Agreement whereupon all payments, advances, or other compensation paid by the City to Provider while Provider was in default shall be immediately returned to the City. Provider understands and agrees that termination of this Agreement under this section shall not release Provider from any obligation accruing prior to the effective date of termination. Should Provider be unable or unwilling to commence to perform the Services within the time provided or contemplated herein, then, in addition to the foregoing, Provider shall be liable to the City for all expenses incurred by the City in preparation and negotiation of this Agreement, as well as all costs and expenses incurred by the City in the re - procurement of the Services, including consequential and incidental damages. 14. RESOLUTION OF CONTRACT DISPUTES: Provider understands and agrees that all disputes between Provider and the City based upon an alleged violation of the terms of this Agreement by the City shall be submitted to the City Manager for his/her resolution, prior to 03- 877 Provider being entitled to seek judicial relief in connection therewith. In the event that the amount of compensation hereunder exceeds $50,000.00, the City Manager' s decision shall be approved or disapproved by the City Commission. Provider shall not be entitled to seek judicial relief unless: (i) it has first received City Manager' s written decision, approved by the City Commission if the amount of compensation hereunder exceeds $50,000.00, or (ii) a period of sixty (60) days has expired, after submitting to the City Manager a detailed statement of the dispute, accompanied by all supporting documentation (ninety (90) days if City Manager' s decision is subject to City Commission approval); or (iii) City has waived compliance with the procedure set forth in this section by written instruments, signed by the City Manager. 15. CITY'S TERMINATION RIGHTS: A. The City shall have the right to terminate this Agreement, in its sole discretion, at any time, by giving written notice to Provider at least sixty (60) days prior to the effective date of such termination. In such event, the City shall pay to Provider compensation for Services rendered prior to the effective date of termination. In no event shall the City be liable to Provider for any additional compensation, other than that provided herein, or for any consequential or incidental damages. B. The City shall have the right to terminate this Agreement, without notice to Provider, upon the occurrence of an event of default hereunder. In such event, the City shall not be obligated to pay any amounts to Provider and Provider shall reimburse to the City all amounts received while Provider was in default under this Agreement. C. If on the date of termination of this Agreement the compensation earned by the Provider for Services rendered up to that date is less than the amounts paid by the City under Attachment `B", the Provider shall immediately, but in no event later than ten (10) days after the 03- 877 termination of the Agreement, return the amount of the overpayment to the City. D. Not later than ten (10) days after the termination of this Agreement, Provider shall, at no cost to the City, deliver to the City such tapes, discs or other medial containing all data pertaining to the Services for transference to the Department, or to a successive administrator, in the data or media format required by the City to ensure the successful conversion of the computer systems software and data to the systems of a successive provider. E. Not later than five (5) business days after termination of this Agreement, the City shall notify the Provider, in writing, if the City requires Provider to continue to handle open files, until their conclusion, in accordance with the provisions of Attachment "A". 16. INSURANCE: Provider shall, at all times during the term hereof, maintain such insurance coverage as stated in Attachment "C", which is incorporated by reference and made a part of this Agreement. All such insurance, including renewals, shall be subject to the approval of the City for adequacy of protection and evidence of such coverage shall be furnished to the City on Certificates of Insurance indicating such insurance to be in force and effect and providing that it will not be canceled during the performance of the Services under this contract without thirty (30) calendar days prior written notice to the City. Completed Certificates of Insurance shall be filed with the City prior to the performance of Services hereunder, provided, however, that Provider shall at any time upon request file duplicate copies of the policies of such insurance with the City. If, in the judgment of the City, prevailing conditions warrant the provision by Provider of additional liability insurance coverage or coverage which is different in kind, the City reserves the right to require the provision by Provider of an amount of coverage different from the amounts or kind previously required and shall afford written notice of such change in 03- 877 requirements thirty (30) days prior to the date on which the requirements shall take effect. Should the Provider fail or refuse to satisfy the requirement of changed coverage within thirty (30) days following the City' s written notice, this Contract shall be considered terminated on the date that the required change in policy coverage would otherwise take effect. 17. NONDISCRIMINATION: Provider represents and warrants to the City that Provider does not and will not engage in discriminatory practices and that there shall be no discrimination in connection with Provider' s performance under this Agreement.on account of race, color, sex, religion, age, disability, marital status, national origin or sexual preference. Provider further covenants that no otherwise qualified individual shall, solely by reason of his/her race, color, sex, religion, age, disability, marital status or sexual preference, be excluded from participation in, be denied Services, or be subject to discrimination under any provision of this Agreement. 18. MINORITY AND WOMEN BUSINESS AFFAIRS AND PROCUREMENT PROGRAM: The City has established a Minority and Women Business Affairs and Procurement Program (the "M/WBE Program") designed to increase the volume of City procurement and contracts with Blacks, Hispanic and Women -owned business. The M/WBE Program is found in Ordinance No. 10062, a copy of which has been delivered to, and receipt of which is hereby acknowledged by, Provider. Provider understands and agrees that the City shall have the right to terminate and cancel this Agreement, without notice or penalty to the City, and to eliminate Provider from consideration and participation in future City contracts if Provider, in the preparation and/or submission of the Proposal, submitted false of misleading information as to its status as Black, Hispanic and/or Women owned business and/or the quality and/or type of minority or women owned business participation. 19. ASSIGNMENT: This Agreement shall not be assigned by Provider, in whole or in 03- 877 part, without the prior written consent of the City's, which may be withheld or conditioned, in the City's sole discretion. 20. NOTICES: All notices or other communications required under this Agreement shall be in writing and shall be given by hand -delivery or by registered or certified U.S. Mail, return receipt requested, addressed to the other party at the address indicated herein or to such other address as a party may designate by notice given as herein provided. Notice shall be deemed given on the day on which personally delivered; or, if by mail, on the fifth day after being posted or the date of actual receipt, whichever is earlier. If to Provider: If to City: Ron Warble, Director AmeriSys Joe Arriola, City Manager City of Miami Managed Care Services 140 3500 Pan American Drive Miami, Florida Alexandria Blvd, Suite H Oviedo, 33133 Florida 32765 If to PGCS: (same as above) With conies to: Alejandro Vilarello, City Attorney City of Miami 444 S.W. 2"d Avenue, Suite 945 Miami, Florida 33130 Diane Ericson, Director of Risk Management City of Miami 444 S.W. 2nd Avenue, Ninth Floor Miami, Florida 33130 21. MISCELLANEOUS PROVISIONS: A. This Agreement shall be construed and enforced according to the laws of the State of Florida. B. Title and paragraph headings are for convenient reference and are not a part of this Agreement. C. No waiver or breach of any provision of this Agreement shall constitute a waiver of any subsequent breach of the same or any other provision hereof, and no waiver shall be 03- 877 effective unless made in writing. D. Should any provision, paragraph, sentence, word or phrase contained in this Agreement be determined by a court of competent jurisdiction to be invalid, illegal or otherwise unenforceable under the laws of the State of Florida or the City of Miami, such provision, paragraph, sentence, word or phrase shall be deemed modified to the extent necessary in order to conform with such laws, or if not modifiable, then same shall be deemed severable, and in either event, the remaining terms and provisions of this Agreement shall remain unmodified and in full force and effect or limitation of its use. 22. SUCCESSORS AND ASSIGNS: This Agreement shall be binding upon the parties hereto, their heirs, executors, legal representatives, successors, or assigns. 23. INDEPENDENT CONTRACTOR: Provider has been procured and is being engaged to provide Services to the City as an independent contractor, and not as an agent or employee of the City. Accordingly, Provider shall not attain, nor be entitled to, any rights or benefits under the Civil Service or Pension Ordinances of the City, nor any rights generally afforded classified or unclassified employees. Provider further understands that Florida Workers' Compensation benefits available to employees of the City are not available to Provider, and agrees to provide workers' compensation insurance for any employee or agent of Provider rendering Services to the City under this Agreement. 24. CONTINGENCY CLAUSE: Funding for this Agreement is contingent on the availability of funds and continued authorization for program activities and the Agreement is subject to amendment or termination due to lack of funds, reduction of funds and/or change in regulations, upon thirty (30) days notice. 25. REAFFIRMATION OF REPRESENTATIONS: Provider hereby reaffirms all of the 03- 877 representations contained in the Solicitation Documents. Provider further reaffirms that the Services shall be provided by AmeriSys and by no other party. 26. ENTIRE AGREEMENT: This instrument and its attachments constitute the sole and only agreement of the parties relating to the subject matter hereof and correctly set forth the rights, duties, and obligations of each to the other as of its date. Any prior agreements, promises, negotiations, or representations not expressly set forth in this Agreement are of no force or effect. IN WITNESS WHEREOF, the parties hereto have caused this instrument to be executed by their respective officials thereunto duly authorized, this the day and year above written. "Provider" ATTEST Brown & Brown, Inc., a _Florida corporation d/b/a AmeriSys By: Print Name: Print Name: Title: Corporate Secretary Title: President ATTEST Print Name: Title: Corporate Secretary Preferred Governmental Claims Solutions, a corporation By: Print Name: Title: President 03- 877 ATTEST: Priscilla A. Thompson, City Clerk APPROVED AS TO FORM AND CORRECTNESS: Alejandro Vilarello City Attorney "City" CITY OF MIAMI, a municipal corporation By: Joe Arcola, City Manager APPROVED AS TO INSURANCE REQUIREMENTS: Diane Ericson Risk Management Administrator 03- 8' ATTACHMENT "A" SCOPE OF SERVICES The Services that are the subject of the Agreement are described in the Proposal, as modified hereunder. In the event of a conflict in the description of the Services as described in the Proposal and hereunder, the description or interpretation of the Services that is most favorable to the City shall control. I. MANAGED CARE ARRANGEMENT: Prior to the performance of any services under this Agreement, each of the following stipulations shall occur: Provider and City shall jointly develop and prepare a managed care plan of operations ("the Plan") setting forth the managed care arrangement to be offered to City's injured workers. To the extent the State of Florida's Agency for Health Care Administration (the "Agency") seeks modification of the Plan or requests additional information relative to the Plan, Network PPO, Provider and the City will devote all reasonable time and diligence necessary to adequately respond to the Agency's request. Notwithstanding the foregoing, all filing fees required by the Agency shall be paid for by City. 2. The Plan shall be approved by the Agency. 3. The Agency shall authorize City to offer and/or utilize the managed care arrangement. Provider and the City shall use their best efforts to cause the foregoing stipulations to occur as soon as possible following the date of this Agreement, but in no event later than September 30, 2003. Network PPO and Provider shall be prepared to provide managed care services to the City's injured workers immediately upon satisfaction of the foregoing stipulations. Provider, Network PPO and the City shall perform all services required by the Plan and/or otherwise necessary to implement the managed care arrangement. Network PPO shall provide network access services to the City. Specific services to be provided by Provider, in accordance with its Agreement with the City, may include, but are not limited to, pre -certification, concurrent review, discharge planning, telephonic case management, hospital bill auditing, arrangement of independent medical evaluations, testimony and/or depositions, provider bill review, file negotiations, together with other services that may be reasonably requested by City. II. RESPONSIBILITIES OF PROVIDER: 03- 877 Provider shall be responsible for the provision of such services that constitute a Certified Managed Care Arrangement on behalf of the City including, but not limited to, Telephonic Case Management, Utilization Review, Grievance Handling, Quality Assurance, Dispute Resolution, Network PPO access and medical bill repricing. Provider shall cause, DimensionComp and Matrix or a subsequent network provider ("Network PPO"), in accordance with their existing contract to provide, and hold to, the following services and terms: 1. Network PPO shall maintain the Network as a comprehensive panel of health care providers and health care facilities which shall provide for the appropriate care and treatment of the City's injured workers. 2. During the term of this Agreement, Provider shall cause Network PPO to require all providers and facilities, which participate in the Network, to remain in compliance with all applicable local, state, and federal laws relating to the provision of medical services. Network PPO shall require all such providers and health care professionals to be licensed or authorized by law to practice their profession. Network PPO agrees that all providers and all health care professionals shall be credentialed by Network PPO or an Affiliated Network and meet all applicable credentialing criteria prior to rendering medical services to the City's insured workers. An Affiliated Network shall be an affiliated IPA, PHO, or PPO as defined as follows. 3. Network PPO will arrange, whenever possible, to make available as part of the Network, qualified health care providers within fifteen (15) minutes, but in no event more than sixty (60) minutes for tertiary facilities or thirty (30) minutes for other Network providers, travel time from City's locations in Florida. 4. Provider shall ensure that Explanations of Benefits shall include a statement which identifies to the Network provider that its services and discounted rates were accessed through this Agreement. 5. In accordance with AHCA regulations, make available a list of the Network PPO and Providers to City's employees. 6. Ensure that the Managed Care Arrangement in which Provider participates is in accordance with the terms of this Agreement. 7. Provider, through contract, shall cause Network PPO to accommodate City's and/or Provider` reasonable written requests for information. Additionally, Provider shall cause, through contract, Network PPO in structuring, as needed, specific managed care reports regarding network composition, network compliance with applicable Florida Workers' laws, and network related grievances. 03- 877 8. Provider represents and warrants that it is authorized under the Florida Workers' Compensation Laws to offer or utilize a Workers' Compensation Managed Care Arrangement, and that it is duly licensed and authorized to administer, conduct or transact business in the State of Florida and the county and community in which it is located. 9. Provider shall cause Network PPO to require Physicians, Hospitals, and Providers to make available their usual and customary services to City employees in accordance with their Provider Participation Agreement. Network PPO may increase the level and types of services made available under this Agreement. Such changes shall not require prior notice and shall not be deemed a breach of this Agreement or cause for termination provided that such changes do not materially interfere with the ability of Network PPO to perform in accordance with the terms of this Agreement or remain in compliance with minimum AHCA standards for network adequacy. 10. Provider shall cause, through contract that each Network Provider maintain medical, financial, social services, and administrative records and information regarding City's employees in accordance with applicable state and federal laws; provided, however, no Network Provider shall be required to disclose medical information without the duly executed consent of the affected Employee or his legally authorized representative for health related information not dealing with work related injuries, unless required by law or court order. Subject to the foregoing, each Network Provider shall permit, during normal business hours, the inspection and/or copying of an Employee's medical records by the City. The City and Provider shall abide by the confidentiality requirements of applicable law for medical records. III. PROVIDER'S DUTIES: Provider will provide managed care services for any open workers' compensation claim files turned over to Provider upon the effective date of this Agreement, as well as any occupational injuries occur'ing on or after the effective date of this Agreement: Provider shall provide nurse case managers 24/7 and shall be available to assist the injury intake services on any medical issues. Provider shall work closely and in conjunction with the claims administrator selected by the City. Provider shall work closely with the claims administrator's staff in the control of the file and Provider's work shall be complimentary and supportive in the claims administration process. Provider shall provide telephonic case management as part of the City's inclusive annual fee. Provider shall provide Field Case Managers for the provision of vocational and on-site medical case management. These services will be coordinated and made available at the request and pre - approval of the Administrator or designee. 03- 877 Provider shall provide training sessions for the Department of Risk Management (the "Department") and supervisors of other City Departments at locations mutually agreed upon by the parties and provide orientation materials for each City location at no additional cost to the City. Provider shall customize its Network PPO, where possible, to accommodate requests made by the City. Provider shall make available a Field Service Manager for training as identified in the RFP and other services deemed necessary by Provider and the City. Provider shall adjudicate all the medical bills with three EOBS attached per bill. Provider shall not charge for re -opening files or multiple claims. Provider shall comply with the City's established exposure control protocols as provided by the City and as amended. Provider shall agree and comply with the Performance Agreement herein provided under Attachment "E". IV. WORKERS' COMPENSATION MANAGED CARE STANDARDS: 1. PROCESSING Active case management files shall be reviewed at least every thirty (30) days, or more often as needed, by the nurse case manager. File notes must reflect the file was reviewed. Inactive case management files shall reflect the diary date for the next review by the nurse case manager based on the type of care being provided and the complexity of the case. Provide shall make contact with the injured worker within one (1) business day. Three point contact must be completed within three (3) business days by the nurse case manager. Files must document 3 attempts by phone. Call card/letter must be sent to the injured worker if no phone contact is made in two attempts on successive days. 2. INVESTIGATION Within one (1) business day of receipt of the Notice of Injury, contact will be made with the City (reporting supervisor where applicable) on all claims to verify work status, establish the medical treatment plan and timely return to work, and to determine if there are any issues involving compensability. Contact with the treating medical provider must be made within 48 hours after the initial visit. All nurse case manager notes shall be provided to the City's designated claims administrator. 03- 877 A written medical report will be obtained within twenty (20) working days of the first day of lost time and, as often as needed thereafter, to justify continuing indemnity payments. The treating medical facility will be contacted within 24 hours of claimant medical visits to verify all continuing indemnity payments. This report shall be provided to the City's designated claims administrator. Where medical evaluation is questioned, an independent medical examination will be scheduled with a qualified physician. Any and all relevant medical and job information shall be provided to the physician that will assist the physician in making an objective evaluation. The City will be provided with a copy of the consultative report. This medical evaluation shall be coordinated with the City's designated claims administrator. Any medical bills received will be reviewed for causal relationship to the accident/work-related injury prior to submitting medical bills to the City's designated claims administrator. Where needed, rehabilitation and/or retraining will be recommended. The recommendation will be discussed with City to see if there is a permanent modified job available. If City does not have a job available, rehabilitation will be initiated with concurrence by City as soon as practicable and the progress will be closely monitored and controlled. City will be provided with a copy of all rehabilitation plans. The City's designated Claims Administrator and Provider will coordinate these services. Outside services will be used only where necessary, on a limited investigation basis, and only after approved by City. The file will include the reason for the outside assignment and the approving source at City. There will be direction and control exercised on the outside person retained. 3. OTHER SERVICES: The Provider shall be responsible for performing, at a minimum, the following services: Perform job site visits to become familiar with exposures unique to the City, at no additional cost to the City. The City shall have at all times on-line access to case notes and documentation on the following claim types: (i) claims in which an injured worker is not working full -duty, (ii) cardiovascular claims-, and (iii) any other claim type as may be requested by the City. While the City Attorney is responsible for the defense of claims, the Provider shall provide the City Attorney a complete copy of the file in question and monitor and actively participate, if 03- 877 requested, in the activities of the City Attorney. Attend Workers' compensation hearings, mediations, discovery, depositions, and Pension Board hearings involving work-related injuries as requested by the City. Make written recommendations to the Department regarding any procedure or condition that should be examined to prevent future claims, which are revealed during the Provider's investigation of a claim. Contact the City's designated claims administrator as soon as practicable, by telephone or e-mail on all claims where the compensability or the relatedness of the medical expenses on the claim is in question. Contact injured workers who experience lost time, at least every two (2) weeks, for the duration of temporary or total disability payments, unless there is clear documentation of periods of inactivity, in which case contact will be made at least every thirty (30) days. . . Provide notification of suit being filed against the City for any reason, to the City Attorney's Office and to the City's designated claims administrator within twenty-four (24) hours. Obtain the pre -approval of the Administrator or designee to incur Allocated Expenses as defined. on Attachment `B". Provide training for supervisory personnel of the City for those individuals responsible for workers' compensation activities. V. STATUS REPORTS/REQUIRED REPORTS/STATE REQUIRED FILINGS: The Provider shall meet with the Administrator and other personnel as may be designated to discuss selected files subject to review in accordance with the provisions of the Performance Agreement, attached to the Agreement as Attachment "E", at no additional cost to the City. The files to be reviewed must be accompanied by status reports and printed claim file notes. City requires Provider to provide the following reports, and, if available, on-line access: a. Cases MMI for the month b. All grievances filed for the month C. All open cases d. Detail bill review report (with line item -detail provided when requested by the City on specific cases) e. SAF 300 (OSHA log) f. Other reports as may be requested by the City With respect to the SAF 300 (OSHA log) report, the City acknowledges that Provider will prepare this report based on information to be furnished by the City and/or the City's designated claims administrator. The City agrees that Provider shall not be liable for any inaccuracies in the 03- 877 SAF 300 report, to the extent caused by information provided by the City or the City's designated claims administrator. The City may from time to time request interim reports or information on specific files, at no additional cost to the City. The City requires Provider to be available to attend meetings, when requested, at no additional cost to the City. . Provider shall prepare and file all required State reports, including specifically, but not limited to: a. OSHA reports b. Filing of annual grievance reports C. Filing of the bi-annual Managed Care Arrangement - d. Electronic filing hospital bills, UB92, pharmacy bills (DWC-9 forms filed monthly) VI. LITIGATION MANAGEMENT: Provider acknowledges that all cases involving the City of Miami are handled by the City's Law Department (the "City Attorney"). Provider shall coordinate and assist the City or its designated Claims Administrator on those cases requiring legal intervention, (i.e., need for deposition, appearance at legal proceedings, etc.), at no additional cost to the City, unless the assistance requires the services of a field case manager, in which case the rates set forth in Attachment B for the work of field case managers shall apply. VII. COMMUNICATION: Provider shall maintain open, general lines of communication with the Department on an ongoing basis and shall respond to requests of the Department or the City Attorney, on a timely basis and in a cooperative manner. Provider shall return phone calls from the City or injured workers within 24 hours. Other requests from the City will be responded to in a timely manner. Failure to comply with the provisions of this Section shall be taken into account during the audit conducted for purposes of the Performance Agreement. VIII. COMPUTER SERVICES (ON LINE ACCESS): Provider will provide all systems capabilities, at no expense to the City, as outlined in the Proposal. In addition, Provider will train City designated personnel on the use of their case management system and report processes. IX. OTHER GENERAL INFORMATION: Provider shall: 03- 877 Provide a directory of personnel with addresses, direct phone numbers, and fax numbers to the City. New copies to be provided as updates become available. Provide designated nurse case managers to the City. In the event of a change in service personnel, the City requires advance notification and an introduction of new personnel within thirty (30) days of such change. Be available to meet with City personnel prior to program inception for introduction of processes and procedures, at no additional cost to the City. Provide managed care reporting and service procedures to be approved by the City and submit any changes thereto to City. X. BAD FAITH" LAWSUITS: The City shall be notified of all "bad faith" lawsuits filed against the Provider, which include breach of good faith and fair dealing. Any "bad faith" lawsuits filed against the City shall be handled by the City Attorney. If the allegation is that the Provider committed or acted in "bad faith," the defense of the lawsuit and attorneys' fees and expenses shall be the Provider' s responsibility, but the City Attorney shall have the right to monitor the progress of the lawsuit to its conclusion. Once a "bad faith" lawsuit has been filed, a separate file pertaining only to the issues on "bad faith" shall be established. XI. PENALTIES AND FINES: Provider shall be responsible for the payment of any penalties, assessments, late fees, or fines assessed against the City by any entity whatsoever resulting from the untimely or negligent performance of this Agreement. 03- 877 ATTACHMENT "B" COMPENSATION SERVICE FEES AND NETWORK PROVIDER COMPENSATION 1. Provider shall pay a service fee to Network PPO for services rendered in accordance with the rates set forth in the agreement between Network PPO and Provider. 2. City shall be obligated to make payment for Covered Services rendered by a Network Provider unless the Network Provider fails to file a claim within one (1) year of the date of service. Each Network Provider shall be compensated and accept as payment in full for Covered Services rendered to City's injured workers, the Preferred Provider Agreement Rates set forth in their Preferred Provider Agreement, whether directly with Network PPO or indirectly with Network PPO through an Affiliated Network. - 3. Each Network Provider shall be entitled to bill and collect from an injured worker any applicable co -payment for Covered Services, provided Maximum Medical Improvement of the injured worker has been attained, EXCEPT for exclusions under the City's bargaining unit/labor contracts as amended. Each Network Provider shall also be entitled to bill and collect from an injured worker the Network Provider's full Usual and Customary Charges for services provided to the injured worker that are not related to the compensable incident or for services which were not authorized by the Managed Care Arrangement. Prior to billing and collecting these charges, Provider must have obtained a Denial of Benefits from the City's designated claims administrator on the injured worker. 4. As full compensation to Provider for the Services rendered hereunder, City shall pay Provider as follows: Year One $258,180.00 Year Two 207,144.00 Year Three 207,144.00 This pricing is for "Life of Relationship". ALLOCATED EXPENSES Peer Review will be billed at cost based on physician/specialist fees Field Case Management expenses are priced on the following schedule as they are not mandated components of the managed care program and will be assigned only in cases approved and authorized by the City's designated claims administrator and the Department. 03- 877 Catastrophic Case Management $ 85.00 hr* Reemployment Assessments 70.00 hr* On-site/Field Case Management 70.00 hr* Vocational Services 70.00 hr* Life Care Plan 100.00 hr* Computerized Transferable Skills Analysis (TSA) 150.00 Labor Market Survey 350.00 Ergonomic Job Analysis 250.00 All other services will be billed at our standard rate of $71.00-$100.00/hour *Travel mileage will be billed at $.35/mile and misc. costs (i.e., tolls, parking) Provider shall submit to the Administrator it's proposed fees for any extended term, at least twelve (12) months, prior to the commencement date of the new term. Provider understands that any change in the compensation is subject to the approval of the City Commission. Payments to the Provider shall be made in arrears, and based on work performed to the satisfaction of the City. No advance payments will be made at any time. ADDITIONAL CONTRACT SAVINGS Where there are secondary or other contracted savings available to the Provider, other than the primary PPO network, Provider agrees to capture these savings and pass them on to the City and the City agrees to pay to Provider its fee for obtaining the savings, provided that said fee will not exceed an amount equal to 30% of the savings. 03- 877 ATTACHMENT "C" PROVIDER'S PERSONNEL Provider shall assign the following personnel to provide Services specified in this Agreement: ACCOUNT REPRESENTATIVE: The Account Representative is fully qualified and responsible for the performance of Provider's responsibilities under the Agreement. The Account Representatives responsibilities include, but are not limited to: Act as Provider's representative on any claims issue or problems; Act as a liaison between the City, medical network, City's designated claims administrator and any other parties as deemed necessary by the City; - Participate with and assist the Department in the performance reviews, as required under the Performance Agreement attached to the Agreement as Exhibit `B" and review other claims as requested by the Department under the Agreement. The Account Representative assigned to the City is Ron Warble, Director of Managed Care Services. NURSE CASE MANAGERS: (describe duties of nurse case manager(s) and give required information about the nurse case manager(s) dedicated to the City). NAME TITLE Upon approval by the City, Provider may assign or change such other personnel as Provider deems necessary to provide the Services to the City. In such event, Provider shall replace the personnel listed above, with qualified and experienced personnel. 03- 877 ATTACHMENT "D" PROVIDER'S INSURANCE Provider agrees to maintain in full force and effect the following policies of insurance during the term of this Agreement: TYPE LIMITS OF LIABILITY Workers Compensation Statutory Employers Liability $1,000,000 Each Acc., Bodily Injury $1,000,000 Each Employee, Disease $1,000,000 Policy Limit, Disease Commercial General Liability $1,000,000 Each Occurrence $2,000,000 General Aggregate Business Auto Liability $1,000,000 Each Accident Errors & Omissions $1,000,000 Each Occurrence $3,000,000 Aggregate Provider shall submit a certificate or certificates evidencing the coverages in a form satisfactory to City. Said certificates(s) shall provide for thirty (30) days notice to City prior to cancellation, non -renewal or material change of any insurance required by this Agreement. Receipt of deficient certificates by City, or by any of City's representatives, does not constitute a waiver of Provider's obligation to fulfill the insurance requirements herein. 03- 877 ATTACHMENT "E" PERFORMANCE AGREEMENT AmeriSys ("Provider") has been retained to provide workers' compensation managed care services to the City of Miami ("City"). In accordance with the provisions of the Professional Services Agreement dated , 2003. The service contract is effective on , 2003, and is for an initial period of three (3) years, with five (5) one (1) year renewal options at the discretion of the City. The Provider and the City agree that Performance Reviews will be conducted after the first six months of operations, affecting all claims received during the said 6 month period, and every six (6) month period thereafter (each, a "Performance Period"). Each Performance Review will involve 100 randomly selected files, approximately 50 "medical only" and 50 "indemnity" type files. Claims for review will be randomly selected. Provider will provide the City with a listing of all claims incurred during each performance period sorted by types of claims. The City will select random claims, such as every tenth claim, from each category until the appropriate number of claims has been selected. The City will perform two Performance Reviews for each annual period of the Agreement. The initial review will be after the Provider has been providing managed care services for six (6) months. Each Performance Review will occur approximately 1-2 months after the conclusion of the performance period. The following chart outlines this schedule. Failure to perform at or above expected levels will result in a financial penalty of 5% of the annual fixed fee that would be charged by the Provider for the performance period. If fees are annualized and the performance period is for a six month period, a penalty will be applied to 50% of the annual fee. Any financial penalties will be credited to future amounts invoiced by Provider to the City. The review will measure six (6) objective performance standards which are easily identified and measured. Each claim will generate a maximum of 20 points. All timeliness standards of performance are stated in business, not calendar, days. In all instances where a standard is not applicable to a particular claim file, the file will be awarded the appropriate point(s) for that standard. After each review is performed, Provider will meet with the City of Miami Risk Management Administrator or designee to discuss initial evaluation results. Thereafter, a final tally of the review results will be prepared. The outcome of all reviews will be presented to the Self - Insurance and Insurance Trust Committee for approval. The first review will be for information purposes only, and no penalties will be imposed. 93- 877 A minimum of 80% average compliance (i.e., average of 16 of the possible 20 points for each claim reviewed) with claims administration expectations is expected in the first annual period of the contract. The minimum average compliance expectation is raised to 90% on the second annual period, and 95% for annual periods thereafter. Failure to meet these average compliance expectations will result in the penalty noted above. q3- 877 Performance Review Performance Period (Claims incurred during Performance Period are subject to review Expected Time of Review (months after initiation of contract) % Average Compliance for No Penalty to Apply Penalty 1 Months 1— 6 of Contract 7 — 8 months 80% NA 2 Months 7 — 12 of Contract 13 — 14 months 80% 5% 3 Months 13 — 18 of Contract 19 — 20 months 90% 5% 4 Months 19 — 24 of Contract 25 — 26 months 90% 5% 5 Months 25 — 30 of Contract 31 — 32 months 95% 5% 6 Months 31 — 36 of Contract 37 — 38 months 95% 5% 03- 877 PERFORMANCE STANDARDS 1) Timeliness of Initial Visit (2 points per claim for compliance) File/system documentation will reflect that claimant was able to see a physician within 60 minutes of time of arrival at medical facility. 2) Three Point Contact by Telephonic Case Manager Within one (1) business day of Claim Receipt (2 points per claim for compliance) A minimum of "three attempts" by the case manager to contact the appropriate claimant(s) will be considered a "contact," if followed up with appropriate correspondence within the measurement period. 3) Bill Review and Repricing Services (2 points per claim for compliance — 1 point for documenting bill review, 1 point for file documenting medical invoice repricing) File/system documentation of both bill review services and bill repricing to network negotiated rates services. 4) Utilization Review Services (2 points per claim for compliance) Case notes will include documentation of utilization review services. 5) Network Access (2 points per claim for compliance) Case notes will include referral information for claimant to a network provider. If claimant is referred to a non -network provider, file will document reason for referral to non -network provider. 6) Return Phone Calls from Injured Worker and the City (3 points per claim for compliance) File/system documentation will include documentation of return phone calls to the injured worker and the City within 24 hours. 7) Timely referral to specialist visits (3 points per claim for compliance) File/system documentation will include documentation that referral appointment was made for a claimant to a network provider specialist (i.e., neurologist, orthopedic) and that claimant was seen by specialist within two (2) weeks of the date of receipt of the referral from the primary treating physician, unless it is clearly documented that, despite Provider's best efforts, no specialist was 03- 877 available to see the claimant within the requisite two (2) week period.. 8) Timely medical bill repricing (3 points per claim for compliance) File/system documentation will include documentation that the medical bill repricing has occurred within 15 days of receipt of said bill for timely submission to City's designated claims administrator for payment purposes. 03- 877 Exh i biT 2 SERVICE FEES AND NETWORK PROVIDER COMPENSATION 1. Provider shall pay a service fee to Network PPO for services rendered in accordance with the rates set forth in the agreement between Network PPO and Provider. 2. City shall be obligated to make payment for Covered Services rendered by a Network Provider unless the Network Provider fails to file a claim within one (1) year of the date of service. Each Network Provider shall be compensated and accept as payment in full for Covered Services rendered to City's injured workers, the Preferred Provider Agreement Rates set forth in their Preferred Provider Agreement, whether -directly with Network PPO or indirectly with Network PPO through an Affiliated Network. - 3. Each Network Provider shall be entitled to bill and collect from an injured worker any applicable co -payment for Covered Services, provided Maximum Medical Improvement of the injured worker has been attained, EXCEPT for exclusions under the City's bargaining unit/labor contracts as amended. Each Network Provider shall also be entitled to bill and collect from an injured worker the Network Provider's full Usual and Customary Charges for services provided to the injured worker that are not related to the compensable incident or for services which were not authorized by the Managed Care Arrangement. Prior to billing and collecting these charges, Provider must have obtained a Denial of Benefits from the City's designated claims administrator on the injured worker. 4. As full compensation to Provider for the Services rendered hereunder, City shall pay Provider as follows: Year One $258,180.00 Year Two 207,144.00 Year Three 207,144.00 This pricing is for "Life of Relationship". ALLOCATED EXPENSES Peer Review will be billed at cost based on physician/specialist fees Field Case Management expenses are priced on the following schedule as they are not mandated components of the managed care program and will be assigned only in cases approved and authorized by the City's designated claims administrator and the Department. i)3- 877 Catastrophic Case Management $ 85.00 hr* Reemployment Assessments 70.00 hr* On-site/Field Case Management 70.00 hr* Vocational Services 70.00 hr* Life Care Plan 100.00 hr* Computerized Transferable Skills Analysis (TSA) 150.00 Labor Market Survey 350.00 Ergonomic Job Analysis 250.00 All other services will be billed at our standard rate of $71.00-$100.00/hour *Travel mileage will be billed at $.35/mile and misc. costs (i.e., tolls, parking) Provider shall submit to the Administrator it's proposed fees for any extended term, at least twelve (12) months, prior to the commencement date of the new term. Provider understands that any change in the compensation is subject to the approval of the City Commission. Payments to the Provider shall be made in arrears, and based on work performed to the satisfaction of the City. No advance payments will be made at any time. ADDITIONAL CONTRACT SAVINGS Where there are secondary or other contracted savings available to the Provider, other than the primary PPO network, Provider agrees to capture these savings and pass them on to the City and the City agrees to pay to Provider its fee for obtaining the savings, provided that said fee will not exceed an amount equal to 30% of the savings. o_ 877 CITY OF MIAMI, FLORIDA 36 INTER -OFFICE MEMORANDUM TO: The Honorable Ma or and DATE : JUL 17 M FILE Members of e City Commis n A resolution authorizing the SUBJECT : City Manager to execute a Professional Services I Agreement with Preferred FROM : REFERENCES: Governmental Claims JoYf'ola Solutions (PGCS) and C Administrator/City Manager ENCLOSURES: Blown & Brown, Inc. d/h/a/ AmeriS3m RECOMMENDATION It is respectfully recommended that the City Commission adopt the attached resolution, pursuant to Resolution No. 03-364, authorizing the City Manager to execute a professional services agreement, in substantially the attached form, attached as Exhibit 1 hereto, with Preferred Governtnental Claims Solution (PGCS), the top ranked firm, and Brown and Brown, Inc. d/b/a AmeriSys, for an initial term of three years with the City having the option to extend the term for five (5) additional one (1) year periods, without further approval of the City Commission, provided that the increase in the amount of compensation payable during each of the additional one (1) year periods does not exceed CPI. Funds will be allocated from Account Code No. 515001.624401.6.668 in an amount not to exceed the negotiated amount set forth in Exhibit 2 hereto. BACKGROUND The City of Miami issued RFP No. 02-03-010 seeking qualified and experienced firms to provide Managed Care Services (Part III Services). The City Commission accepted the recommendation of the City Manager to negotiate a professional services agreement with Preferred Governmental Claims Solutions (PGCS), the top-ranked firm. The Department of Risk Management has negotiated this agreement and the City Manager will present the negotiated agreement to the City Commission for review and consideration. J E/db 03- 877 Budgetary Impact Analysis Department Risk Management Division Commission Meeting Date: July 24, 2003 Title and brief description of legislation or attached ordinance/resolution: r+erisis Managed Care Vendor 1. Is this item related to revenue? NO ❑ Ye9B (If yes, skip to item #4) 2. Are there sufficient funds in Line Item? CIP Project #: (If applicable) Yes: Index Code: 515001 Minor: 668 No: Complete the following information: 3. Source of funds: Amount budgeted in the line item: Balance in line item: Amount needed in line item: Amount: 300,000 Q„ffir;Ant fimAe wall 1-.P- trancfP. rxl form the fnilnurina line items: $ 1,952,000.00 $ 541,217.00 $ 300,000.00 ACTION ACCOUNT NUMBER TOTAL Project NoJindea/Minor Object From $ From $ To $ To $ 4. Comments: rY Appro teQb.i�mit Ito 'MIM�M�M Depa=enLDk"*1Pbesignee Date APPROVALS Venfi d 0008 Verified by CIP: (If applicable) Director/Designee Date: ATTACHMENT B -COMPENSATION Service Fees and Network Provider Compensation 1. Provider shall pay a service fee to Network PPO for services rendered in accordance with the rates set forth in the Agreement between Network PPO and Provider. 2. City shall be obligated to make payment for Covered Services rendered by a Network Provider unless the Network Provider fails to file a claim within one (1) year of the date of service. Each Network Provider shall be compensated and accept as payment in full for Covered Services rendered to City's injured workers, the Preferred Provider Agreement Rates set forth in their Preferred Provider Agreement, whether directly with Network PPO or indirectly with Network PPO through an Affiliated Network. 3. Each Network Provider shall be entitled to bill and collect from an injured worker any applicable co -payment for Covered Services, provided Maximum Medical Improvement of the injured worker has been attained, EXCEPT for exclusions under the City's bang fining unit/labor contracts as amended. Each Network Provider shall also be entitled to bill and collect from an injured worker the Network Provider's full Usual and Customary Charges for services provided to the injured worker that are not related to the compensable incident or for services which were not authorized by the Managed Care Arrarigement. Prior to billing and collecting these charges, Provider must have obtained a Denial of Benefits from the City's designated claims administrator on the injured worker. 4. As full compensation to Provider for the Services rendered hereunder, City shall pay Provider as follows: Year One $258,180.00 Year Two 207,144.00 Year Three 207,144.00 This pricing is for "Life of Relationship". ALLOCATED EXPENSES Peer Review will be billed at cost based on physician/specialist fees Field Case Management expenses are priced on the following schedule as they are not mandated components of the managed care program and will be assigned only in cases approved and authorized by the City's designated claims administrator and the Department. ©3- 877 Catastrophic Case Management $ 85.00 hr* Reemployment Assessments 70.00 hr* On-site/Field Case Management 70.00 hr* Vocational Services 70.00 hr* Life Care Plan 100.00 hr* Computerized Transferable Skills Analysis (TSA) 150.00 Labor Market Survey 350.00 Ergonomic Job Analysis 250.00 All other services will be billed at our standard rate of 71.00-100.00/hour *Travel mileage will be billed at $.35/mile and misc. costs (i.e., tolls, parking) Provider shall submit to the Administrator it's proposed fees for any extended term, at least twelve (12) months, prior to the commencement date of the new term. Provider understands that any change in the compensation is subject to the approval of the City Commission. Payments to the Provider shall be made in arrears, and based on work performed to the satisfaction of the City. No adi(mnce payments will be made at any time. 03-s $77 MAY -13-2003 12:40 CITY CLERKS OFFICE 305 858 1610 P.02 J-03-227 3/13/03 RESOLUTION NO. 0 3- 364 A RESOLUTION OF THE MIAMI CITY COMMISSION APPROVING THE FINDINGS OF THE EVALUATION COMMITTEE PURSUANT TO REQUEST FOR PROPOSAL NO. 02-03-010, FOR WORKERS COMPENSATION CLAIMS ADMINISTRATION (PART I SERVICES); GENERAL, AUTOMOBILE AND PROFESSIONAL LIABILITY HANDLING CLAIMS ADMINISTRATION (PART II SERVICES), AND/OR MANAGED CARE SERVICES (PART III SERVICES); AUTHORIZING THE CITY MANAGER TO NEGOTIATE A PROFESSIONAL SERVICES AGREEMENT ("AGREEMENT"), WITH GALLAGHER BASSETT SERVICES, INC., THE TOP-RANKED FIRM, FOR THE PROVISION OF PART I AND PART II SERVICES, AND SHOULD NEGOTIATIONS FAIL WITH THE TOP-RANKED FIRM, TO NEGOTIATE WITH CRAWFORD-'AND COMPANY, THE SECOND -RANKED FIRM, UNTIL A CONTRACT IS NEGOTIATED; FURTHER AUTHORIZING THE CITY MANAGER TO NEGOTIATE AN AGREEMENT WITH PREFERRED GOVERNMENTAL CLAIMS SOLUTIONS (PGCS), THE TOP-RANKED FIRM, FOR THE PROVISION OF PART III SERVICES, FOR A THREE-YEAR PERIOD, -WITH THE OPTION TO EXTEND FOR FIVE ADDITIONAL ONE-YEAR PERIODS, AND SHOULD NEGOTIATIONS FAIL, THE EVALUATION COMMITTEE SHALL RECONVENE TO RECONSIDER ITS RECOMMENDATION FOR AWARD; DIRECTING THE CITY MANAGER TO PRESENT THE NEGOTIATED AGREEMENT(S) TO THE CITY COMMISSION FOR CONSIDERATION. WHEREAS, the City of Miami ("City") issued Request for Proposal No. 02-03-010 seeking qualified and experienced firms for the provision of the following services for the Department of Risk Management: 03- 877 CITY CSSiOi�t MEETING OF- APP F APP 1 C 2003 R6101ufim DA MAY -13-2003 12:40 CJTV CLERKS OFFICE 305 858 1610 P.03 Part I Services: Workers Compensation Claims Administration Part II Services: General, Automobile and Professional Liability Claims Administration (Police Tort and Public officials Liability) Part III Services: Managed Care Services; and WHEREAS, Risk Management requires the services of a qualified and experienced third -party claims administrator and workers compensation managed care provider to proviae alternatives to its Risk Management Division to more efficiently and effectively utilize its resources to reduce the overall number and/or severity of workers compensation and liability claims as well as develop, implement, and monitor certain service quality indicators in an effort to improve the overall quality and efficiency of services provided to the citizens, vendors and employees of the City; and WHEREAS, Parts I and II Services require a Third -party Claims Administrator ("TPA") to assume the daily activities, currently performed by staff in the Risk Management Division, to process and handle the City's claims for Workers' Compensation, and Liability - general, auto, and professional liability (police tort and public officials liability), including all specified adjusting services and other required services such as Page 2 of 6 �3- 364 MAY -13-2003 12:41 C?TY CLERKS OFFICE 305 858 1610 P.04 administration, computerized claim/loss statistical information, and loss fund reconciliation; and WHEREAS, the TPA will also provide 24-hour call center service, recommend risk control measures to protect the City's interests, implement an enhanced comprehensive Safety program, and implement an enhanced comprehensive Light Duty Program for the entire City and all labor groups; and WHEREAS, Part III Services provide that the Managed Care vendor provide all of bhe services related to the City's workers Compensation Managed Care Claims, which is essentially a change of vendors, as the City is currently utilizing occupational Health Systems, Inc. for the provision of these services; and WHEREAS, the Evaluation. Committee recommended Gallagher Bassett Services, Inc., as the top-ranked firm, for the provision of both Parts I and II Services; and WHEREAS, the Evaluation Committee further recommended that should negotiations fail with Gallagher Bassett Services, Inc., that the City negotiate with Crawford and Company, the second -ranked firm, until a contract is negotiated to present to the City Commission for final approval; and 03. Page 3 of 6 MAY -13-2003 12:41 CITY CLERKS OFFICE 305 858 1610 P.05 WHEREAS, the Evaluation Committee recommended Preferred Governmental Claim Solutions ("PGCS"), as the top-ranked firm, for the provision of Part III Services; and WHEREAS, the Evaluation Committee further recommended that should negotiations fail with PGCS, the Evaluation Committee shall reconvene to reconsider its recommendation for award; and WHEREAS, the City Manager concurred with the recommendations of the Evaluation Committee; NOW, THEREFORE, BAIT RESOLVED BY THE COMMISSION OF THE CITY OF MIAMI, FLORIDA: Section 1. The recitals and findings contained in the Preamble to this Resolution are adopted by reference and incorporated as if fully set forth in this Section. Section 2. The recommendation of the City Manager to approve the findings of the Evaluation Committee pursuant to Request for Proposal No. 02-03-010, that the firms most qualified to provide Worker's Compensation Claims Administration (Part I Services) and General Automobile and Professional Liability Handling Claims Administration (Part II Services), in rank order are; (1) Gallagher Bassett Services, Inc., the top-ranked firm and (2) Crawford and Company, the second -ranked firm, and the 03- 877 Page 4 of 6 -� " MAY -13-2003 12:41 CITY CLERKS OFFICE 305 858 1610 P.06 firm most qualified to provide Managed Care Services (Part III Services) is Preferred Governmental Claims Solutions ("PGCS"), are approved. Section 3. The City Manager is authorized' -'l to negotiate a Professional Services Agreement ("Agreement"), with Gallagher Bassett Services, Inc., the top-ranked firm, for Parts I and II Services, for a three-year period, with the option to extend for five additional one-year periods. Section 4. The,City Manager is further authorized!' to negotiate an Agreement with Crawford and Company, the second -ranked firm, should negotiations fail with Gallagher Bassett Services, Inc. Section 5. The City Manager is authorizedll to negotiate an Agreement, in a form acceptable to the City Attorney, with Preferred Governmental Claims Solutions ("PGCS") the top-ranked firm, for the provision of Part III services, for a three-year period, with the option to extend for 'five additional one-year periods. -'� The herein authorization is further subject to compliance with all requirements that may be imposed by the City Attorney, including but not limited to those prescribed by applicable provisions of the City Charter and Code_ Page 5 of 6 �" 87 MAY -13-2003 12:41 CITY CLERKS OFFICE 305 858 1610 P.07 Section 6. The Evaluation Committee shall reconvene to reconsider its recommendation for award should negotiations fail with PGCS. Section 7. The City Manager is directed to present the negotiated Agreements to the City Commission for consideration. Section e. This Resolution shall become effective immediately upon its adoption and signature of the Mayoral PASSED AND ADOPTED this 10th day of April 2003. 1/114�L A. DIAZ, MAYOR AT 1 PkISCILLA A. THOMPSON CITY CLERK APPROVED 'AS TO t ATdWA;�BRO VILAR 'CITY, -ATTORNEY 447033:tr:AS:ESS CORRECTNESS: If the Mayor does not sign this Resolution, it shall become effective at the end of ten calendar days from the date it was passed and adopted. If the Mayor vetoes this Resolution, it shall become effective immediately upon override of the veto by the City Commission. Page 6 of 6 03— 877