242646FB_Solicitation_Documents.pdf

REQUEST FOR PROPOSALS (“RFP”) – PART I

RFP Template Revised 10/11/23 Page 1 of 5

RFP #: 242646FB

RFP TITLE: WORKERS COMPENSATION THIRD PARTY ADMINISTRATOR

1.0 PURPOSE

Sarasota County (“County”), a political subdivision of the State of Florida, will receive proposals on the date indicated in OpenGov Procurement (OpenGov), the County’s electronic procurement portal, for the purpose of selecting a qualified Proposer to provide administration of workers compensation claims for Sarasota County programs. Proposers are required to comply with Part II, Scope of Services.

OpenGov is located at https://procurement.opengov.com/portal/scgov

2.0 PROPOSER

2.1 For the purpose of this RFP, the term “Proposer” is defined as the legal entity submitting a proposal.

2.2 Proposers intending to submit a bid as a joint venture with another company must provide documentation attesting to the formation of that joint venture with their submittal. For purposes of this solicitation, all vendors who make up the joint venture will be considered together as the Proposer.

3.0 QUALIFICATIONS

3.1 Proposer must demonstrate experience administering workers’ compensation claims.

3.2 Required Licenses and Certifications

Proposer must have a 6-20 Resident All Lines Adjuster License issued by the Florida Department of Financial Services.

3.3 Preferred Qualifications

3.3.1. Proposer’s project team has experience providing and

administering workers’ compensation programs for a Florida public entity employer within the past seven (7) years.

3.3.2. Proposer’s project team includes personnel with knowledge of public sector claims handling, experienced adjusters of lost time claims management, and personnel with experience in adjusting complex claims, including Presumption Claims.

3.3.3. Proposer’s project team has experience with Pharmacy Benefit Management.

3.3.4. Proposer’s project team has experience with a "sports medicine" model focused on supporting criteria-based medicine.

3.3.5. Proposer’s project team has experience with Pain Management options.

https://procurement.opengov.com/portal/scgov

RFP Template Revised 10/11/23 Page 2 of 5

4.0 MEETINGS & SCHEDULE

An anticipated schedule is provided in the Timeline posted in OpenGov. All meetings will take place at the time, date, and location specified in the solicitation Timeline.

Short-listed Proposers should be prepared to attend presentations and/or interviews either in Sarasota, Florida or virtually, at the County’s discretion.

5.0 SUBMITTAL INSTRUCTIONS

Refer to Submittal Instructions section in OpenGov for instructions on how to submit a proposal. Proposers are advised to review the General Terms and Conditions of Solicitations which are available in OpenGov.

6.0 VENDOR QUESTIONNAIRE

All proposers must complete the required forms and information included in the Vendor Questionnaire section of OpenGov. Completed forms and other requested documents must be uploaded with proposer’s submittal in OpenGov. Proposers who fail to complete and upload required forms and documents or fail to provide responses to questions in the Vendor Questionnaire section of OpenGov may be found non-responsive.

7.0 WRITTEN PROPOSALS

The information requested in each section below will be used by the evaluation committee to evaluate and score written proposals. All proposal documents must be submitted in the Vendor Questionnaire section in OpenGov in the format requested.

7.1 Qualifications

7.1.1. Single page Letter of Interest summarizing Proposer’s

qualifications.

7.1.2. Required and preferred Licenses and Certifications.

7.1.3. Resumes of key personnel, including subcontractors, demonstrating individual qualifications and experience

7.2 Experience

7.2.1. Narrative – Provide a narrative that describes the Proposer’s experience, including, but not limited to the number of years in business, pertinent capabilities, and evidence of experience and resources necessary to successfully provide the requested services.

7.2.2. Customer List - Provide a list of customers who have been provided services similar to the services described in this RFP in the last five

(5) years. Customer list should include contact information for a minimum of five (5) and a maximum of ten (10) customers. At a minimum, include customer name, a brief description of services provided, contract start and end dates, and the name, email, and telephone number of a contact person who can verify information.

When possible, include the dollar value of the contract. If unable to

RFP Template Revised 10/11/23 Page 3 of 5 provide detailed information regarding private sector customers due to confidentiality concerns, provide as much information as possible for those customers.

7.3 Approach

7.3.1. Project Approach - Provide a detailed project approach, including the proposed strategy for providing the requested services.

Anticipated resources, including, but not limited to, staffing levels, technology and equipment should be provided.

7.3.2. Organization – Provide an organizational chart identifying all key personnel and their role in the providing the requested services.

7.3.3. Performance – Provide maximum guaranteed percentage of compliance as part of the proposal.

7.4 Compensation

Proposers must complete the Pricing Table provided in OpenGov. Provide an all-inclusive annual rate for providing all services pursuant to Part II, Scope of Services. Proposers who fail to fully complete the pricing table in OpenGov may be found non-responsive.

8.0 SELECTION PROCESS

8.1 Written Proposals

8.1.1. All timely responses meeting the criteria set forth in this RFP shall be considered by the County.

8.1.2. Written proposals will be evaluated and scored using the evaluation criteria in the Evaluation Criteria section of OpenGov.

8.1.3. Only proposers who submit required documentation will be eligible to receive Local and American Preference points.

8.1.4. When evaluating written proposals, the evaluation committee will use the following scale to score each criterion. Only whole numbers are to be used when scoring. Scores will be given weight as indicated in the evaluation criteria in OpenGov.

Score Description

5 Excellent

4 Very Good

3 Good

2 Satisfactory

1 Unsatisfactory

RFP Template Revised 10/11/23 Page 4 of 5

8.2 Presentations

8.2.1. If any member of the evaluation committee requests presentations, presentations shall be scheduled.

8.2.2. If presentations are requested or required, the evaluation committee shall determine the number of Proposers to be short-listed for presentations prior to scoring. The format of presentation will be determined by the County and may consist of presentations, interviews, or a combination of presentations and interviews.

Presentations will be required from no fewer than the three highest scoring Proposers (or all responsive and responsible Proposers if there are 3 or fewer) under the following circumstances.

1. The estimated costs of services are in excess of $350,000 (either annually or for the total project); or

2. Scoring results in 5 points or less between the highest scoring proposer and the 2nd highest scoring proposer; or

3. The solicitation documents specify that presentations or interviews will be required.

4. The Procurement Official has determined that presentations are required for this solicitation.

If this box is checked, the Procurement Official has determined that presentations are required for this solicitation

8.3 Ranking

Following presentations, the evaluation committee will rank the short-listed proposers. The ranking shall be based on the written proposals, clarifications (if any), and information presented during presentations.

8.4 Evaluation Committee Recommendation of Award

8.4.1. If presentations are not requested or required, the evaluation committee will recommend the highest scoring Proposer for award.

8.4.2. If presentations are requested or required, following presentations the evaluation committee will rank the short-listed Proposers, and recommend the first ranked Proposer for award.

9.0 AWARD

9.1 It is the intent of the County to award a contract to the Proposer who, in the sole opinion of the evaluation committee is most qualified to provide the scope of services required and will provide the best value to the County.

9.2 The County reserves the right to contract for a term less than or greater than the duration indicated in OpenGov.

9.3 The successful Proposer(s) shall be required to submit proof of licenses or certifications as required by the County.

RFP Template Revised 10/11/23 Page 5 of 5

9.4 In the event of a tie, the RFP tie-breaking procedures identified in the Sarasota County Procurement Manual will apply. To be considered, tied Proposers will be required to provide documentation certifying they have implemented a drug-free workplace program meeting the requirements stipulated in Section 287.087, Florida Statutes. Documentation must be provided within the time specified by the County at the time of request.

9.5 Preferences

Proposers wishing to be considered for Local Business Preference or American Business Preference must complete and submit a Local & American Business Certification Form with their submittal. The Local & American Business Certification Form can be found in the Vendor Questionnaire section of OpenGov.

In awarding this RFP, preference shall be given to local businesses and American businesses in accordance with Section 2-215 of the Sarasota County Procurement Code.

Local and American business preferences do not apply to the award of this RFP, due to Grant funding requirements

9.6 Contract

A draft of the contract that the successful Proposer(s) will be expected to sign (a Consultant Agreement) is posted on the Procurement website, shown below. The County may, in its sole discretion, select a different contract type or make revisions to the one referenced above following the recommended award of this solicitation.

https://www.scgov.net/government/procurement/contract-templates

10.0 CHANGES IN KEY PERSONNEL

10.1 A change in the key personnel of a short-listed firm after the submission of the response to this RFP could result in reconsideration of the scoring of applicable evaluation criteria, at the sole discretion of the County.

10.2 Any changes in the key personnel of a short-listed firm should be brought to the attention of the County as soon as possible after the change is made.

The changes, the reasons for the changes, and resumes for the individuals being substituted for an individual identified in the response, must be submitted, prior to oral presentations, to the Procurement Analyst identified on the Solicitation Summary.

10.3 Decreases in scoring may result from the reconsideration of changes in the key personnel of a short-listed firm. No increases in scoring will result from the reconsideration of changes in the key personnel of a short-listed firm.

10.4 After award of a contract, the successful Proposer shall not be allowed to substitute key personnel named in this response, including subcontractors, without the prior written permission of the County. Substitution may, in the sole opinion of the County, be grounds for cancellation of selection, or termination of contract.

https://www.scgov.net/government/procurement/contract-templates

PART II

SCOPE OF SERVICES

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1. OVERVIEW

A. The County workers compensation program includes all departments and the Elected Official offices of Tax Collector, Clerk of Courts, Property Appraiser, and Board of County Commissioners. The program does not include the Sheriff’s Office. Law enforcement and corrections staff are not included in the program; however Emergency Services staff (Fire Department, Lifeguards, Emergency Services) are included.

B. The County has self-insured its workers compensation program for more than thirty (30) years. The County maintains excess workers’ compensation insurance with a $500,000 per occurrence retention.

C. The County’s current program is a “sports medicine” model, focused on supporting criteria-based medicine and supporting treatment to achieve the best possible medical outcomes and facilitating the County’s Stay at Work Program.

D. Vendor shall assume the complete handling of all new and existing claims, including pending claims, and incurred but not yet reported (IBNR) claims being handled by the County’s current claims administrator. It is required that a copy of claims data and all other documentation associated with claims occurring prior to the effective date of this Contract be transferred into the Vendor’s Claims Management System to maintain a consistent, comprehensive history of all claim years. Vendor shall work with Sarasota County Staff to obtain claim historical data to convert all previous claims into their system for continuity and historical purposes. The transfer of all data shall be completed no later than the effective date of this Contract.

2. ADMININSTRATIVE SERVICES

Vendor shall provide the following administrative services:

A. Prepare and file with the appropriate state agencies all applications, bonds, documentation, and data required, on behalf of the County and in accordance with state mandated time frames, for implementation and continuance of the program.

B. Prepare, maintain, and file all records and reports on behalf of the County as may be required by any local, state, and federal legal authorities within the mandated time frames.

C. Prepare, maintain and file statistical or other records and reports as required by the County’s excess insurer(s). Report claims to the County’s excess insurer(s) in accordance with the applicable policy requirements and provide the County with a copy of all reports submitted. All applicable notification, investigative and reporting procedures shall be followed.

D. Prepare, maintain, and file statistical information required by the State, workers’ compensation rating bureaus and, as applicable, Content Management System (CMS) or other appropriate agencies in accordance

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E. Comply fully with all rules, regulations, guidelines, or procedures established by the County, the State of Florida, and CMS Medicare Secondary Payor requirements to maintain the legal operation of the County’s self-insurance program.

F. Regularly keep the County informed of any significant regulatory or industry changes that may impact the County or it is workers’ compensation program.

G. Prepare and distribute all required 1099 forms.

H. Reimburse County for payment of any fines, penalties or assessments assigned by the State of Florida for failure to comply with rules and regulations, including but not limited to EDI reporting, associated with the performance or responsibility of the Vendor.

I. Cooperate with any audits of the Vendor’s files and procedures conducted by or on behalf of the County. The County shall have the right to audit during the contract period and for five (5) years following the termination of the agreement. No additional fees shall be due the Vendor for cooperation with such audits.

J. Provide the County with a SAS 70 (or similar) audit annually, as required by the financial auditors.

K. Provide the County a copy of the Vendor’s written Continuity of Operations Plan which outlines the Vendor’s post disaster operational procedures, including but not limited to, how advance indemnity payments will be made and how medical care direction will be provided.

L. Assist the County with its ongoing efforts to maintain a Stay at Work program, including the creation and offer of light duty positions. Claim Management throughout the light duty assignment, with regular reporting of status outcomes, in line with the requirements of the County light duty program is required.

M. Establish procedures acceptable to the County for the payment of compensable claims. Procedures will include periodic funding requests submitted to the County with detailed backup information. Funds will be provided by the County following review and approval of the funding requests.

N. Conduct and report results from employee satisfaction surveys to measure items such as customer service, clinician access and overall claim handling, including performance expectations such as timely communication, follow-up and medical case management tasks.

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O. Upon request, provide formal classroom-style training and education to County staff regarding topics of interest to the County such as case law updates, regulatory or rule changes, claims management best practices and medical consumerism.

P. Work with County staff to integrate functions of the County’s employee health and wellness programs with the workers’ compensation program, where appropriate, to facilitate a holistic approach to employee health management.

3. BANKING/RECONCILIATION SERVICES

A. The County’s claim funding account will be maintained at a financial institution chosen by the County. All interest earned or service credits generated will accrue to the benefit of the County.

B. The County may establish an escrow amount to facilitate the payment of claims. Vendor shall comply with Florida laws concerning public deposits.

C. All claims or expense payments shall be made by the Vendor on checks drawn on the County’s claim funding account. It is understood and agreed upon that all funds in this account are the County’s funds and shall be returned to the County upon request or termination of any agreement resulting from this RFP. No payments due to the Vendor for administrative fees or reimbursable expenses shall be deducted from these funds.

D. Vendor shall be responsible for monthly reconciliation of the County’s claim funding account and shall provide bank statements to the County monthly.

Vendor shall provide the County with a monthly list of all checks issued for the prior month and checks outstanding. All bank charges, if any, shall be incurred by and paid by the Vendor.

E. Vendor shall cooperate fully with any audit of the County’s claim funding account by either the County or County authorized independent auditor.

4. CLAIMS HANDLING SERVICES

Vendor shall provide the following claims handling services:

A. Prepare and follow service instructions that have been approved by the County in the handling of the County’s claims and catastrophic claims. The service instructions should outline the details of the expected tasks, timeframes for completion and authority levels for all claim activity.

B. Receive, examine, and adjust on behalf of the County all reports of employee injury, per the agreed upon service level instructions.

C. In conjunction with the County Employee Health Center services, provide initial clinical triage and medical referral supported by predetermined criteria, appropriate deployment of resources including telephonic case management, field case management using staff knowledgeable in the criteria, protocols, and appropriate utilization of internal and external medical management resources.

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D. Complete 3-point contacts: Contact injured worker, employer, and medical provider, either in writing or orally, within 24 hours of Vendor’s receipt of claim report. Follow-up by telephone and in writing if there is no response to the initial contacts. Advise County risk management liaison if there is no response after 3 attempts of contact.

E. Continue to maintain communication with injured worker, supervisor and medical providers at appropriate intervals (after medical appointments and claim milestones related to the plan of action) throughout the claim to determine status and next steps toward recovery and claim conclusion.

F. Conduct such investigation as in the exercise of professional judgment would seem necessary. Enhanced efforts shall be taken to identify possible fraudulent claims, including recorded statements and discussions from injured workers, witnesses, and supervisors. Fraudulent claims could also include the attempt to have personal injuries or illnesses paid under a workers compensation claim, rather than employee health insurance.

G. Subject to applicable workers’ compensation law and the exercise of professional judgment, including input provided by County staff, as determined by the investigation process above, accept and adjust, settle or deny (denials and settlements need prior approval by the Risk Manager or its designee) each reported claim of employee injury.

H. Report claims to County’s excess insurer(s) in accordance with the requirements of the excess insurer(s) policies.

I. Advise the County and obtain prior approval of the Risk Manager or its designee on claim reserve increases in excess of $25,000.

J. Up to a discretionary limit determined by the County and subject to the foregoing provisions, review and, if appropriate, pay in a timely fashion;

and in conformity with legally imposed medical and surgical fee schedules, network discounts and/or contracted fees, all on-going claims and expenses pertaining thereto. The final decision to accept, deny or settle any claims shall rest with the County.

K. Fees, interest, and civil penalties required due to late payments or adjuster mishandling shall be paid by Vendor unless the error is solely caused by later reporting or misreporting of information by the County. Any such payments made by Vendor shall be reimbursed to the County within 60 days of the payment.

L. Consult with County on the selection and referral to outside professionals such as surveillance personnel, expert witnesses, and field adjusters/nurses to assist in the investigation, adjustment, and medical management of claims. Vendor will review all bills for such services for reasonableness and conformity to pre-established rates or fees and can adhere to any set pricing schedules.

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M. Calculate wage statements, validate compensable lost time and pay in a timely manner, all indemnity benefits due to injured employees.

N. Review all medical bills and bills for other services for which a claim is being made for reasonableness and conformity to rules, regulations, and legally imposed medical and surgical fee schedules.

O. Prepare and maintain files necessary for legal defense of claims and/or other litigation or other proceedings, such as actions for subrogation, contribution, or indemnity. All Legal filings must be approved by the assigned defense attorney prior to response. Defense of all claims will be handled by a County approved Defense Firm.

P. Attend hearings, depositions, mediations, and other proceedings, as necessary. Prepare status reports for County Risk Management staff outlining the case details, status and plan of action to resolve the claim.

Q. At the request of the County, provide a complete copy of all files involving litigation, potential or actual subrogation or potential or actual recovery from special or second injury funds.

R. Aggressively pursue all possibilities of subrogation, excess insurance reimbursement, third party liens, contribution, or indemnity and/or recovery from special or second injury funds on behalf of the County.

S. Perform timely, periodic review of all open cases to establish the status of disabled employees in order to assist in the appropriate action to be taken.

Vendor shall meet with County staff on a monthly basis or as otherwise requested to review any claims or overall program performance. Every open claim should have a plan of action to keep the claim moving forward toward a conclusion.

T. Identify opportunities for vocational rehabilitation for injured employees, when indicated. Manage employees with limited physical performance arising from compensable injuries to determine if there are light duty work opportunities and provide those offers to injured workers, based on their medical capabilities. Manage light duty assignments to conform with the County’s parameters for light duty positions

U. Assist County in the maintenance and development of its Stay at Work program, including identification of stay at work opportunities, communication of individual case strategies among key parties and managing the stay at work plan for each case, including appropriate use of outside vendors if appropriate.

V. Provide access to a local health care clinician network practicing criteria-based medical care to support Occupational Health and recovery. Develop a full and comprehensive list of medical providers to provide prompt treatment to injured workers through recovery and until Maximum Medical Improvement is achieved.

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W. Provide full disclosure to the County regarding clinician contracting and credentialing.

X. Develop and follow appropriate written policies when the injured employee requests a one-time change or medical treatment is questioned.

Y. Assist in the scheduling of independent medical evaluations.

Z. Follow all provisions of Florida Statutes regarding indemnity and medical benefit entitlement and administration.

5. FIRST NOTICE OF INJURY REPORTING SERVICES

Vendor shall provide the following services:

A. Assist County in establishing claim reporting procedures compatible with the needs and structure of the County.

B. Provide 24-hour telephonic claim reporting and intake capabilities. Provide at least one other form of intake capability – website, email form, etc. Send First Notice of Injury to the State of Florida in a timely manner in compliance with proscribed statutory requirements. Vendor must accept responsibility for penalties for late notice to the State when caused by reason other than delay by the County.

C. Provide a toll-free phone line for claims reporting, inquiries and after-hour access.

D. Provide medical triage at the time of claim reporting to assess the nature of injury and refer employees to the most appropriate medical services needed, including specialists, at the earliest possible opportunity.

6. DATA ACCESS/REPORTING SERVICES

A. Vendor shall provide the County, at no additional cost, the ability to access comprehensive, real-time online electronic claim, financial and reporting data, and information. In addition, Vendor shall provide the County regularly scheduled statistical and loss reports as agreed upon by the parties in an acceptable format to the County.

B. Vendor agrees that the County shall have real-time, online access to all claim files, including adjuster notes, supervisory notes, case management notes, diary items, payment records, medical bills, and expense bills in an electronic format with internet-based access.

C. Vendor shall provide reporting capabilities to evaluate the success of the program and whether the Vendor’s staff, medical clinicians, associated services vendor(s), and contracted entities are performing services and achieving the best possible outcomes in an effective and efficient manner.

D. Vendor agrees to provide County with data and reports to comply with its annual audit and actuarial requirements no later than October 10th of each calendar year.

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7. NETWORK ACCESS & DEVELOPMENT SERVICES

Vendor shall provide the following services:

A. Provide the County access to a clinician network that contains appropriate, effective clinician partners. The County is interested in working with the Vendor to assure that high quality clinicians are encouraged to participate in the program and who contractually agree to expedited appointment scheduling, real-time communication, performance standards and guarantees and the practice of evidence-based medicine to best address the medical and rehabilitative needs of County employees.

B. Assist the County in the development of a custom panel of clinicians, particularly in key specialties such as orthopedics, physiatry, psychiatry, neurosurgery, cardiology, occupational medicine, pain management and physical therapy. Provide to the County full disclosure of contracting and credentialing services required to develop this custom panel. The County reserves the right to approve, deny or add or remove any provider from the approved panel, for any or no reason.

C. Provide peer review and utilization review services as appropriate.

D. Provide reporting regarding network access, provider costs and outcomes.

E. Develop and distribute a periodic clinician panel satisfaction survey and provide the results of said surveys to the County.

8. MEDICAL BILL REVIEW AND AUDIT SERVICES

Vendor shall provide the following services:

A. For Medical Bill Review:

i. Promptly review medical/surgical bills (in and out of network) for accuracy including, but not limited to, as they relate to the following:

a. Duplicate billings

b. Unbundling of charges

c. Upcoding of charges

d. Approval and appropriate precertification

ii. Review of all medical bills that:

a. Are not subject to fee schedule coding

b. Are for services not specifically addressed in the fee schedule

c. Need an in-depth medical interpretation of the rules and regulations

d. In the exercise of professional judgment, specifically warrant review

iii. Process, pay, and mail bills within State mandated guidelines.

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B. Reimburse County for overpayments made in the bill review process, within 30 days of identification of overpayment.

C. For Medical Auditing Services:

i. Audit in-network and out-of-network hospital/clinician bills exceeding $5,000, and

ii. Audit others at the Vendor’s discretion, based upon industry standards or specific request by the County for accuracy and appropriateness

iii. Develop and follow written policies on how late charges, no show charges and special payment arrangements are to be handled and provide those written policies to the County.

D. Develop and provide communication materials to explain the policies and procedures of the Medical Bill Review and Audit Services to:

i. The County

ii. Clinicians

9. PHARMACY BENEFIT MANAGEMENT (PBM) SERVICES

A. Vendor shall recommend a pharmacy benefit management (PBM) vendor.

It is anticipated that the successful Vendor will sub-contract these services;

however alternative solutions will be considered. Details regarding the PBM’s services should be provided, including fee arrangements, access, utilization review services, pharmacist consultation services, provider penetration guarantees, and coordination of claims data and reporting.

B. Vendor shall address their procedures and payment terms including the following:

i. Name of PBM used

ii. Cost basis of charges (fill fee, discount from Average Wholesale Price (AWP), Workers’ Compensation Administration (WCA) or other)

iii. Distribution of rebates

iv. Describe if contract with PBM is on a pass-through basis or transparent basis

v. Explain policies and procedures used to mitigate costs and steerage to generics when applicable

10. OTHER REQUIREMENTS

A. Staffing Requirements

i. The use of independent adjusters, subcontractors or temporary adjusters is not allowed. The County will have final approval of all staff assigned to handle County claims.

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ii. Vendor shall maintain a dedicated staffing unit, with adjusting, supervisory, and support staff, at a claim’s office within a radius of 100 miles of Sarasota County.

iii. Proposals should clearly outline the staffing which will be provided along with the following information:

a. Define caseload of recommended adjusters and provide the average caseload per adjuster within Proposer’s organization.

b. Provide an outline of a dedicated unit based upon the historical information contained herein.

c. Provide details regarding any adjuster caseload maximums which will be applied.

B. Obligations Not Terminated by Contract Period

i. Vendor shall be required to provide service on all claims occurring during the contract period and until three (3) months after the termination of the contract (including renewals, extensions, or replacements thereof), all legally required reports for the contract period rendered, and all required reports to appropriate agencies.

Vendor’s fees shall include the full consideration for such continuing obligations and, except as noted herein, no additional compensation shall be due for such obligations which extend beyond the contract period.

C. Compliance with Rules of the Division of Workers’ Compensation

i. Vendor shall comply with all rules and regulations promulgated by the various state agencies prescribing the practices and procedures of self-insurer service companies. Vendor shall be responsible for all required EDI Division of Workers' Compensation (DWC) reporting.

D. Ownership of Claims Files

i. The County shall have all right, title, interest, and ownership to all loss statistics and claim files, in electronic and hard copy form, created as a result of the services to be provided by Vendor. Further, at the sole option of the County and upon ten (10) days written notice, Vendor shall deliver such files to County.

ii. At the termination of the contract, at the sole expense of the Vendor, Vendor shall provide County with electronic files or other data feeds acceptable to the County containing all of the claim data. Such data shall be made available in a format generally importable into a commonly recognized database for claims administration services.

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11. PERFORMANCE STANDARDS

A. Vendor and County agree that Performance Standard Reviews will be conducted annually. Each annual Performance Standard Review will include:

i. Claim File Review

ii. Program Management Review

B. In the Claim File Review process, for each claim file that is reviewed, the Vendor will assign a score from 0 to 100 based upon the criteria outlined in the Scope of Services. At the conclusion of reviewing all selected claim files, an average score for all claim files reviewed will be calculated. In the Program Management Review process, a separate single score between 0 and 100 will be calculated.

C. The average score for the Claim File Reviews will account for 60% of the overall scoring and the Program Management Review will account for 40% of the overall scoring for the Performance Review.

D. As an example, if the average Claim File Review score is 90 points and the Program Management Review score is 80, the total score will be 86.

Performance Review Performance Period

Total Review Points (Compliance Benchmark)

Penalty

Contract Effective Date – September 30, 2026

95 6%

2 October 1, 2026 – September 30, 2027 95 6%

3 October 1, 2027 – September 30, 2028 95 6%

4* October 1, 2028 – September 30, 2029 95 6%

5* October 1, 2029 – September 30, 2030 95 6%

*Reviews 4 and 5 are contingent upon the parties exercising the renewal option(s) outlined in the Agreement.

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E. Vendor shall submit Performance Guarantee Reports detailing compliance with all agreed Performance Guarantees and applicable percentages on an annual basis and must be submitted by September 30th, the end of the County’s fiscal year.

F. The Performance Reviews will measure objective performance standards which are easily identified and measured. After each Performance Review is performed, Vendor shall meet with the County to discuss initial evaluation results. Vendor shall be given an opportunity to factually rebut the initial findings. Thereafter, a final tally of the review results will be prepared by the County.

G. Failure to perform at or above expected levels for the Performance Reviews will result in a financial penalty (based on the percentage agreed upon) of the amount that was charged by Vendor for the performance period. Any financial penalties will be deducted from future amounts invoiced by Vendor to the County.

12. CLAIM FILE REVIEW

A. The Claim File Review will include twenty-five (25) open files and ten (10) closed files. The closed files will have closed during the performance period.

The County may elect to have the Claim File Reviews performed by a third party at the County's expense.

B. Each claim will generate a score from 1 to 100 points. All timeliness standards of performance are stated in business, not calendar, days. In any instances where a standard is not applicable to a particular claim file, the file will be awarded the appropriate point(s) for that standard. Only transactions that are paid or processed during the performance period will be subject to scoring.

C. The following grid outlines the scoring criteria for each claim:

# of Points Description of Standards

20 Quality and timeliness of investigation

20 File documentation, and proper coding of claim type and claim description

5 Proper reporting of excess claims

10 Supervisory reviews and diary follow up on the claim files

10 Settlement Negotiation and authority

5 Pursuit of subrogation and Second Injury Fund Claims

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# of Points Description of Standards

10 Reserve accuracy and documentation

Control and proper use of claim file vendors such as attorneys, appraisers, private investigators, field case management nurses, etc.

5 Accuracy of indemnity payments

5 Accuracy of medical payments

13. PROGRAM MANAGEMENT REVIEW

The following grid outlines the scoring criteria for the Program Management Review:

# of Points Description of Standards

25 Attendance at regularly scheduled meetings

25 Delivery of agreed upon reports

25 Agreed upon staffing and case load maximums

Prompt Reporting of Excess Claims - where the County has paid in excess of the self-insured retention for the accident period, Vendor shall within 30 days, notify excess insurer. Vendor shall follow up with excess insurer every 30 days until the County has been reimbursed.

PART III – INSURANCE REQUIREMENTS

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CONTRACTOR’S INSURANCE

Contractor shall, on a primary basis and at its sole expense, maintain in full force and effect, at all times during the life of this Contract, insurance coverage (including endorsements) and limits as described herein. These requirements, as well as the County’s review or acceptance of insurance maintained by Contractor, are not intended to and shall not in any manner limit or qualify the liabilities or obligations assumed by Contractor under this Contract.

Insurance requirements itemized in this Contract and required of the Contractor shall extend to all subcontractors to cover their operations performed under this Contract.

The Contractor shall be responsible for any modifications, deviations, or omissions in these insurance requirements as they apply to subcontractors.

Insurance carriers providing coverage required herein must be licensed to conduct business in the State of Florida and must possess a current A.M. Best’s Financial Strength Rating of A- Class VII or better.

Each insurance policy required by this Contract shall apply separately to each insured against whom claim is made and suit is brought, except with respect to limits of the insurer’s liability.

The Contractor shall be solely responsible for payment of all premiums for insurance contributing to the satisfaction of this Contract and shall be solely responsible for the payment of all deductibles and retentions to which such policies are subject.

Contractor shall furnish Certificates of Insurance to the County Administrative Agent evidencing the types and amounts of coverage, including endorsements, required by this Contract prior to commencement of work and prior to expiration of the insurance contract, when applicable. Such Certificate(s) of Insurance shall, to the extent allowable by the insurer, include a minimum thirty (30) day notice of cancellation (10 days for non-payment of premium) or non-renewal of coverage. Notwithstanding these notification requirements, the Contractor will be required to provide County with 5-day prior written notice of any policy cancellation or non-renewal.

The County reserves the right to review, modify, reject, or accept any required policies of insurance, including limits, coverage, or endorsements, herein from time to time throughout the term of this Contract. County reserves the right, but not the obligation, to review and reject any insurer providing coverage due to its poor financial condition or failure to operate legally.

A. COMMERCIAL GENERAL LIABILITY: Contractor shall maintain Commercial General Liability per ISO form CG0001 or its equivalent, including but not limited to coverage for premises and operations, personal injury, products & completed operations, liability assumed under an insured contract, and independent contractors with limits of not less than $1,000,000.00 each occurrence, $2,000,000.00 aggregate covering all work performed under this Contract.

Contractor agrees to endorse Sarasota County Government as an additional insured on the Commercial General Liability coverage.

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B. PROFESSIONAL LIABILITY: Contractor shall maintain Professional Liability, or equivalent Errors & Omissions Liability, with limits not less than $1,000,000.00 per claim/occurrence for professional services rendered under this Contract. If coverage is written on a claims-made basis: a. Any retroactive date shall precede the effective date of this Contract; b. Contractor shall provide certificates of insurance evidencing the required coverage for a period of two years after final payment under this Contract is made, or provide evidence showing Contractor has obtained a two-year extended reporting period endorsement.

C. WORKERS’ COMPENSATION: Contractor agrees to maintain Workers’

Compensation insurance on in accordance with Florida Statutes, Chapter 440.

Employers Liability to be included with a minimum limit of $500,000 per accident/per disease/per employee. If work is to be performed over or adjacent to navigable water and involves maritime exposure, applicable LHWCA, Jones Act, or other maritime law coverage shall be included.

In the event the Contractor has “leased” employees, the Contractor or the employee leasing company must provide evidence of a Workers’ Compensation policy for all personnel on the worksite.

Contractors who are exempt from Florida’s Workers’ Compensation law must provide proof of such exemption issued by the Florida Department of Financial Services, Bureau of Workers’ Compensation.

D. Cyber LIABILITY (TECHNOLOGY ERRORS & OMISSIONS AND NETWORK

SECURITY/PRIVACY LIABILITY): Consultant agrees to maintain Technology Errors & Omissions and Network Security & Privacy Liability insurance, or equivalent coverage, with limits not less than $1,000,000 per claim/occurrence and in the aggregate for professional services rendered under this contract.

Coverage shall include, but not be limited to, technology errors and omissions to cover both liability and property loss exposures including technology services, technology products, media content, network security breaches, extortion threats, crisis management expense, and business interruption and negligent acts, errors, mistakes, and omissions arising out of the work or services performed by Consultant, or any person employed or contracted by Consultant. Coverage shall also include, but not be limited to, coverage for unauthorized access, denial of service attacks, computer viruses, transmission of malicious code, and failure of security; breach of privacy and the failure to protect and disclosure of personally identifiable information, payment card

Insurance Template Adopted 04/19/19 Page 3 of 3 information, and health information; violation of any federal, state or local law or regulation in connection with the protection of information including fines and penalties to the extent allowed by applicable law; notification and crisis management costs, identity theft monitoring and regulatory defense;

disclosure of any third party’s proprietary information including, without limitation, trade secrets, and liability for interruption of County or any third party’s business including, without limitation, claims for loss of use and loss of profits. If coverage is written on a claims-made basis: a. Any retroactive date shall precede the effective date of this contract; b. Consultant shall provide certificates of insurance evidencing the required coverage for a period of two years after final payment under this contract is made, or provide evidence showing Consultant has obtained a two year extended reporting period endorsement.