HomeMy WebLinkAboutAgreement A-17-598-1 with AIMS.pdfAgreement No. 17-598-1
10th August
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AMENDMENT I TO AGREEMENT
THIS AMENDMENT I TO AGREEMENT (hereinafter "Amendment") is made and entered into
3 this __ day of ____ , 2021, by and between COUNTY OF FRESNO, a Political Subdivision of
4 the State of California, Fresno, California (hereinafter "CLIENT'), and Acclamation Insurance
5 Management Services, Inc., (AIMS), a California corporation, whose address is 10445 Old Placerville
6 Road, Sacramento, CA 95827, hereinafter referred to as "CONTRACTOR".
7 WITNESSETH:
8 WHEREAS, COUNTY and CONTRACTOR entered into a services agreement, identified as
9 CLIENT agreement No. A-17-598, effective January 1, 2018, pursuant to which CONTRACTOR
10 agreed to provide third party claims administration for CLIENT'S workers' compensation program; and
11 WHEREAS, CLIENT and CONTRACTOR now desire to amend the Agreement in order to
12 retroactively include on-site examiner consultation services, which include but are not limited to,
13 training, file review, and program evaluation during the terms outlined below; and
14 WHEREAS, CLIENT and CONTRACTOR desire to amend the Agreement in order to correct
15 textual and numerical inaccuracies.
16 NOW, THEREFORE, in consideration of the promises herein, and for other good and valuable
17 consideration, the receipt and adequacy of which is hereby acknowledged , CLIENT and
18 CONTRACTOR agree as follows:
19 1. Subsection A of Section One (1) (Services) of the Original Agreement, beginning on
20 Page One (1), Line Twenty-two (22) with the word "CONTRACTOR" and ending on Page Four (4),
21 Line Five (5) with the word "Files", is deleted in its entirety and replaced with the following:
22 "CONTRACTOR's General Obligations-Contractor shall perform services to include workers'
23 compensation claims administration, bill review, utilization review, CMS/MMSEA Section 111
24 reporting, Nurse Case Management/Advocate, Medical Provider Network administration, and examiner
25 consultation as specified by COUNTY in accordance with the specifications, requirements , terms, and
26 c onditions set forth in COUNTY's Request for Proposal No. 17-084, which includes the PR ISM
27 Workers' Compensation Adjudication Guidelines, and Addendum 1 to Request for Proposal No. 17-
28 084 (collectively referred to as RFP No. 17-084), the CONTRACTOR's response to Request for
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1 Proposal No. 17-084; and all applicable portions of Title 8 of the California Code of Regulations and
2 the Labor Code and all other applicable laws, rules, and regulations. RFP No. 17-084 and
3 CONTRACTOR's response to RFP No. 17-084 are incorporated herein by reference. Fresno County
4 Human Resources shall maintain copies of RFP No. 17-084 and CONTRACTOR's response to RFP
5 No. 17-084 during the term of this Agreement and make a copy available to CONTRACTOR at its
6 request.
7 Additionally, CONTRACTOR shall:
8 1. Consult and assist County Personnel in the development and maintenance of
9 procedures, practices, and the coordination of the COUNTY's self-insured
10 workers' compensation program within legal requirements established by state
11 and federal law. This includes, but is not limited to, on-site examiner
12 consultation for fifteen (15) hours per week, three (3) days per week, at the rate
13 of Three Thousand Dollars ($3,000) per month.
14 2. At request of COUNTY, conduct or assist in conducting training sessions for
15 COUNTY personnel involved directly or indirectly in the administration and/or
16 processing of industrial industry claims.
17 3. Update COUNTY with respect to all changes or proposed changes relating to
18 any and all statutes, rules, or regulations affecting the COUNTY's rights and
19 obligations relating to COUNTY's self-insured workers' compensation plan.
20 4. Review with COUNTY Risk Management staff at least quarterly the then status
21 of the self-insured program, including identification of areas of concern and
22 recommended changes for the purpose of improving the program. At a
23 minimum, an annual Stewardship Report will be prepared and reviewed with
24 COUNTY that supports this process. Quarterly reports are preferred as a means
25 of facilitating effective ongoing analysis of program efficacy.
26 5. Establish and implement procedures to accurately, efficiently and timely pay all
27 costs associated with the operation of the County's self-insured workers'
28 compensation program and provide appropriate supporting documentation for all
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payments.
6. Maintain fiscal records supporting all payments for a period of at least five (5)
years from the date of payment and make such records available to the
COUNTY, its auditors, or designees for review within ten (10) working days of
receiving a written request.
7. Adhere to Accounting Principles Generally Accepted in the United States
(GAAP) and best-practice internal controls in processing of all payments related
to workers' compensation claims.
8. Provide COUNTY Risk Management staff with access to the CONTRACTOR's
risk management information system, or successor risk management
information system, and any affiliated reporting system. CONTRACTOR shall
provide appropriate training relating to the operation of each system, including
but not limited to, the generation of reports associated with the COUNTY's
workers' compensation program. Easy to use ad hoc reporting capabilities shall
be included for COUNTY Risk Management staff to access and utilize.
9. Provide on line access to Employer's Report of Occupational Injury or Illness,
Form 5020, for designated COUNTY staff, and provide appropriate training
relating to the use of the online 5020 to COUNTY staff as requested and/or
required.
10. Ensure that detailed claim notes are annotated in each individual claim in the
CONTRACTOR's risk management information system. At a minimum, any
paperless process will ensure that adequate claim note annotations include the
contents of all documents scanned into the system, any issues related to the
claim summarized from the scanned document, and provide an updated status
of the claim and/or claimant work status as appropriate.
11. Ensure Claims Management Reviews in the CONTRACTORS risk management
information system are updated and approved by CONT ACTOR's staff every 45
days for active claims and every 90 days for future medical claims.
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12. Assume control and custodial responsibility for all existing hard copies of
COUNTY workers' compensation files."
2 . Section Two (2) (Term) of the Original Agreement, beginning on Page Ten (10), Line
4 Sixteen (16) with the word "This" and ending on Line Twenty-One (21) with the word "performance." is
5 deleted in its entirety and replaced with the following:
6 "This Agreement shall become effective on the 1st day of January, 2018 and shall terminate on the 3P1
7 day of December, 2022. •
8 3 . Subsection A of Section Four (4) (Compensation/Invoicing) of the Original Agreement,
9 beginning on Page Eleven (11), Line Twenty-One (21) with the word "COUNTY" and ending on Page
10 Thirteen (13), Line Twenty-Five (25) with the word "CONTRACTOR", is deleted in its entirety and
11 replaced with the following:
12 "COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
13 compensation as follows :
14 Summarv of Maximum Com=nsation
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Fee Description
Claims Administration
Anciffary Seniices
Medical Provider Network
Conversion Fee
On-Site Examiner Consultation
Ill
!II
Ill
Ill
Ill
Year1
2018
$1,337,909
$913,156
$42,000
$15,000
$2 308065
Base Period
Year2
2019
$1 ,378,046
$913,156
$4 2 ,000
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$ 2 333 202
Year3 3-Yr
2020 Maximum
$1 ,419,388 $4,135,343
$913,156 $2,739,468
$42,000 $125,000
-$15,000
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$ 2 374 544 $7015811
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Renewal Period
Year4 Years TOTAL
2021 2022 CONTRACT
$ 1,461 ,969.00 $ 1 ,505,825 .00 $7,103,137
$913,156.00 $913,156.00 $4,565,780
$42,000.00 $42,000.00 $210,000
--$15,000
$ 18 000 $ 18 000 $ 36 000
$2435125 $ 2 478 981 S 11 929 917
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Monthly Compensation Breakdown
Year1 Year2 Year3
Claims Administration -Annual 3% Increase
January-November $ 111,492.42 $114,837.17 $ 118,282.34
December $ 111 ,492.38 $114,837.13 $ 118,282.26
On-site Examiner Consultation
July-December ---
January-June ---
Ancillary Services
January-November $76,096.34 $76,096.34 $76,096.34
December $76,096.26 $76,096.26 $76,096.26
Medical Provider Network
January-December $3,500.00 $3,500.00 $3,500.00
Year4 Years
121,831 .00 125,486.00
121,828.00 125,479.00
$ 18,000 -
$18,000
$76,096.34 $76,096.34
$76,096.26 $ 76,096.26
$3,500.00 $3,500.00
16 The services covered in the annual costs cited in this section include, but are not limited to, fees for
17 claims administration, bill review, utilization review, CMS/MMSEA Section 111 reporting, Nurse Case
18 ManagemenUAdvocate, medical provider network services, and transition costs. The maximum
19 amount over the term of the three (3) year Agreement shall not exceed Seven Million, Fifteen
20 Thousand, Eight Hundred and Eleven Dollars ($7,015,811). Annual costs shall include all services
21 required in the RFP and included in the CONTRACTOR's response and contained in th is Agreement.
22 In addition to the above payment schedule, on-site consultation will be available for a period of
23 six (6) months from July 1, 2021 through December 31, 2022 in the first renewal year, and six (6)
24 months from January 1, 2022 through June 30, 2022 in the second renewal year at a rate of Three
25 Thousand Dollars ($3,000) per month, to be invoiced and paid separately as services are rendered .
26 The maximum amount for both six-month terms of service s hall not exceed Thirty-Six Thousand
27 Dollars ($36,000).
28 Payment for services shall be processed as follows:
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1 A one-time conversion fee will be paid at a rate of Fifteen Thousand Dollars ($15,000) and will be
2 billed at the initiation of the contract. Claims Administration Services will be paid monthly at a rate of
3 One Hundred Eleven Thousand, Four Hundred Ninety Two Dollars and Forty Two Cents
4 ($111,492.42) for the first eleven (11) months of the first year and One Hundred Eleven Thousand,
5 Four Hundred Ninety Two Dollars and Thirty Eight Cents ($111,492.38) for the last month of the first
6 year. Claims Administration Services will be paid monthly at the rate of One Hundred Fourtee n
7 Thousand, Eight Hundred Thirty Seven Dollars and Seventeen Cents ($114,837.17) for the first eleven
8 (11) months of the second year and at One Hundred Fourteen Thousand, Eight Hundred Thirty Seven
9 Dollars and Thirteen Cents ($114,837.13) for the last month of the second year, and paid at a monthly
10 rate of One Hundred Eighteen Thousand, Two Hundred Eighty Two Dollars and Thirty Four Cents
11 ($118,282.34) for the first eleven ( 11) months of the third year and at One Hundred Eighteen
12 Thousand, Two Hundred Eighty Two Dollars and Twenty Six Cents ($118,282.26) for the last month of
13 the third year. Ancillary services shall be billed to the workers' compensation trust account at a
14 monthly rate of Seventy Six Thousand Ninety Six Dollars and Thirty Four Cents ($76,096.34) for the
15 first eleven (11) months of the year, and at Seventy Six Thousand Ninety Six Dollars and Twenty Six
16 Cents ($76,096.26) for the last month of the year, and shall be allocated to individual claims processed
17 during that month. MPN services will be paid monthly at the rate of Three Thousand Five Hundred
18 Dollars ($3,500) for the term of the contract.
19 CONTRACTOR shall submit monthly invoices to the County of Fresno, Department of Human
20 Resources, Risk Management Division, 2220 Tulare Street, 16th Floor, Fresno, CA 93721. COUNTY
21 will issue payment within forty-five (45) days of receipt of an approved invoice.
22 Initial Three (3) Year Term Maximum Compensation: In no event shall services performed
23 under this Agreement be in excess of Seven Million Fifteen Thousand Eight Hundred Eleven Dollars
24 ($7,015,811.00) during the initial three (3) year term of this Agreement.
25 Renewal Period Maximum Compensation: Should the term of this Agreement be extended
26 for the additional two one year renewals, the cost for all services, including Claims Administration,
27 Ancillary Services, Medical Provider Network, and On-site Examiner Consultation, shall not exceed
28 Two Million Four Hundred and Thirty Five Thousand One Hundred Twenty Five Dollars ($2,435,125)
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1 for the first renewal year and Two Million Four Hundred and Seventy Eight Thousand Nine Hundred
2 and Eighty One Dollars ($2,478,981) for the second renewal period. During any renewal period,
3 payment for services should be processed as follows:
4 Claims Administration Services will be paid at the monthly rate of One Hundred Twenty One Thousand
5 Eight Hundred Thirty One Dollars ($121,831) for the first eleven (11) months of fi rst renewal year and
6 at One Hundred Twenty One Thousand Eight Hundred Twenty Eight Dollars ($121,828) for the last
7 month of the first renewal year. Claims Administration Services will be paid at the rate of One Hundred
8 Twenty Five Thousand Four Hundred Eighty Six Dollars ($125,486) for the first eleven (11) months of
9 the second renewal year and at One Hundred Twenty Five Thousand Four Hundred Seventy Nine
10 Dollars ($125,479) for the last month of the second renewal year. Ancillary Services shall be billed to
11 the workers' compensation trust account at a monthly rate of Seventy Six Thousand Ninety Six Dollars
12 and Thirty Four Cents ($76,096.34) for the first eleven (11) months of a renewal year, and at Seventy
13 Six Thousand Ninety Six Dollars and Twenty Six Cents ($76,096.26) for the last month of a renewal
14 year, and shall be allocated to individual claims processed during that month . MPN services will be
15 paid monthly at the rate of Three Thousand Five Hundred Dollars ($3,500) during any renewal year.
16 On-site Examiner Consultation shall be paid monthly at the rate of Three Thousand Dollars ($3,000)
17 during the last six-months of the first renewal year and the first six months of the second renewal year.
18 It is understood that all expenses incidental to CONTRACTOR's performance of services and
19 obligations under this Agreement shall be borne by CONTRACTOR."
20 4. Except as otherwise provided in this Amendment I, all other provisions of the Agreement
21 remain unchanged and in full force and effect. This Amendment I shall become effective July 1, 2021.
22 COUNTY and CONTRACTOR agree that this Amendment is sufficient to amend the
23 Agreement and, that upon execution of this Amendment, the Agreement and this Amendment together
24 shall be considered the Agreement.
25 The parties agree that this Amendment may be executed by electronic signature as provided in
26 this section. An "electronic signature" means any symbol or process intended by an individual signing
27 this Amendment to represent their signature, including but not limited to (1) a digital signature; (2) a
28 faxed version of an original handwritten signature; or (3) an electronically scanned and transmitted (for
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1 example by PDF document) of a handwritten signature . Each electronic signature affixed or attached
2 to this Amendment (1) is deemed equivalent to a valid original handwritten signature of the person
3 signing this Amendment for all purposes, including but not limited to evidentiary proof in any
4 administrative or judicial proceeding, and (2) has the same force and effect as the valid original
5 handwritten signature of that person . The provisions of this section satisfy the requirements of Civil
6 Code section 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,
7 Part 2, Title 2 .5 , beginning with section 1633.1 ). Each party using a digital signature represents that it
8 has undertaken and satisfied the requirements of Government Code section 16 .5 , subdivision (a),
9 paragraphs (1) through (5), and agrees that each other party may rely upon that representation. This
10 Amendment is not conditioned upon the parties conducting the transactions under it by electronic
11 means and either party may sign this Amendment with an original handwritten signature.
12 The Agreement, as hereby amended, is ratified and continued . All provisions, terms,
13 covenants, conditions and promises contained in the Agreement and not amended herein shall remain
14 in full force and effect.
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1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment I to Agreement as of
2 the day and year first hereinabove written.
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(Authorized Signatur
~Mt....i\c:.. tRL4sso. Cl:o
Print Name & Title '
lt>4'+5 old. 1'\.~CJLV'\J ~llL Pd
s~~~ Le.A:-°\Sf;>"l-,
Mailing Address
FOR ACCOUNTING USE ONLY :
18 Fund: 1060
19 Subciass : 10000
20 ORG : 89250100
21 Account: 7295
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Steve Bra aau , hairman of the Board
of Supervisors o the County of Fresno
ATTEST:
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno , State of California
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