9-RLI 25003JD WORKERS COMPENSATION THIRD PARTY ADMIN SERVICES - FINAL SCOPE.pdf

RLI # 25003JD | Workers Compensation Third-Party Administrative Services

BACKGROUND, OBJECTIVES, REQUIREMENTS, RESPONSIBILITIES

1. BACKGROUND AND OBJECTIVES:

1.1 The Broward Sheriff’s Office (BSO) is seeking a qualified Proposer(s) to provide all services necessary for Workers’ Compensation Third-Party Administrative (TPA) Services. BSO seeks a qualified firm(s) capable of delivering comprehensive, efficient, and cost-effective workers’ compensation program to support the agency’s mission of ensuring public safety and employee well-being.

Third Party Administrative Services encompass two (2) distinct yet interconnected components:

1. Claims Administration - including, but not limited to, claims processing, investigation, adjudication, and reporting in compliance with applicable federal, state, and local regulations and;

2. Medical Managed Care Services – including, but not limited to, medical case management, utilization review, bill review, and coordination of care to optimize outcomes and control costs;

1.2 It is anticipated that BSO will award all services to one (1) Proposer; however, we reserve the right to award to more than one vendor.

1.3 The specifications set forth herein are for informational purposes and to provide a general description of requirements. Proposers will be responsible to submit a technical Proposal based upon their program that will meet the goals, objectives and requirements set forth herein.

1.4 It is anticipated that the term of this agreement will be for three (3) years with two (2) one-year renewal options, subject to mutual agreement of both parties.

1.5 Awarded Proposer will be responsible to set up, maintain and provide all required services as set forth in this Solicitation.

2. RESPONSIVENESS AND RESPONSIBILITY CRITERIA

2.1 Responsiveness Criteria:

A Responsive Proposer means a contractor, business entity or individual who has submitted a Proposal that conforms in all material respects to the requirements of this solicitation. The requirements of this solicitation include, but are not limited to, the scope of work requirements; the required forms included in this solicitation which contain all requested information, signatures, notarizations, insurance, bonding, security and any other solicitation documents.

Failure to provide the information required may result in a Proposer being deemed non-responsive. BSO reserves the right to waive minor technicalities or irregularities as is in the best interest of BSO.

2.2 Responsibility Criteria:

A Responsible Proposer means a contractor, business entity or individual who is capable of meeting all the requirements of this solicitation and resulting contract. Capable includes the financial and technical ability to perform as contractually required.

At any time prior to award, BSO may find that a Proposer is not responsible to receive a particular award.

3. REQUIREMENTS OF THE SOLICITATION:

Failure to meet the following requirements listed in this Section may result in removing your Proposal from consideration. Any documents/information requested anywhere in the Scope of Services should be included in the Proposal and labeled as indicated in this Section 3.

Documentation which is not included with Proposal, or other documentation requested within Bonfire, must be received within five (5) working days of request by BSO unless otherwise extended in writing by BSO at its discretion.

3.1 General:

3.1.1 Responsibilities of Proposer. It is the responsibility of each Proposer to:

3.1.1.1 Examine the solicitation documents thoroughly.

3.1.1.2 Visit the site, if applicable, to become familiar with conditions which may affect cost, progress, performance of furnishing of required services.

3.1.1.3 Take into account any federal, state, local laws which may affect cost, progress, performance or furnishing of required services.

3.1.1.4 Carefully correlate Proposer’s observations with the RLI solicitation and supporting documents.

3.1.1.5 Carefully review solicitation and supporting documents and notify BSO through

Bonfire’s "Public Q&A" section by clicking the "Ask a Question" button, of any questions or requests for clarifications.

3.1.2 Each Proposer acknowledges that:

3.1.2.1 The specifications set forth are for informational purposes and to provide a general description of the requirement. Proposers shall be responsible to submit technical submittal based upon their program that will meet the goals, objectives and requirements set forth herein.

3.1.2.2 Proposer’s submittal in response to this RLI shall constitute an incontrovertible representation by Proposer that it has complied with the above requirements and that without exception, the Proposal is premised upon performing and furnishing the services required by the RLI solicitation.

3.1.2.3 In preparing a response to this solicitation, Proposer shall rely on its own assumptions, investigations, examinations, studies, interpretations, expertise and opinions. Proposer shall base its submission on its own judgment, analysis and opinion of feasibility of the project. BSO does not guarantee the details pertaining to existing reports, on any documents included with this solicitation to be more than a general indication of the services.

3.2 Laws, Ordinances, Regulations: Awarded Proposer(s) must comply with all Federal, State and Local laws, ordinances for work required for services listed in this Solicitation.

3.3 Questionnaire: If applicable, Proposer should answer all questions and provide as much information as possible in a concise manner. If responses exceed the maximum characters accepted on the Questionnaire(s), attach separate document to the proposal titled “Supplemental Reponses”. List the Questionnaire Title, question number, restate the question, and provide the supplemental information and/or detailed response.

Clarification to any of the questions must be submitted as a question through Bonfire before the Q & A deadline.

3.4 Financial Stability: Proposers will be stable and financially solvent.

Proposer should include documentation of financial stability, including Proposer’s most recent three (3) years of Financial Statements, SEC filings, or Dun & Bradstreet Reports. Financial Statements are a Compilation, Review or Audit Report from a Certified Public Accountant and include, at a minimum, a balance sheet and statement of operations. SEC filings and/or Dun & Bradstreet Reports, if submitted, must also include this minimum data. The financial documentation submitted must include a classified balance sheet which shows the components of current assets and current liabilities and a statement of operations showing net income after interest, taxes, depreciation and amortization. This documentation should be uploaded to Bonfire when submitting the Proposal and labeled as “Financial Stability".

If not included the Proposal, Proposer must submit these documents within five (5) working days upon request by Broward Sheriff’s Office, unless otherwise extended in writing by BSO at its discretion.

3.5 BSO may consider the unavailability of the most recent year’s financial statements and whether the Proposer acted in good faith in disclosing the financial documents.

3.5.1 Any claim of confidentiality on financial statements should be asserted at the time of submittal.

3.5.2 Although the review of a Proposer's financial information is an issue of responsibility, the failure to either provide the financial documentation or correctly assert a confidentiality claim pursuant the Florida Public Records Law and the solicitation requirements (Public Record and Exemptions section) may result in a recommendation of non-responsiveness and/or release of Proposer’s proposal sections in accordance with Florida Public Records Laws and pursuant to a public records request placed upon BSO.

3.6 Scope of Services:

Provide a complete response to section 3.6 Scope of Services of the Solicitation. Please note responses do not need to restate anything specifically requested to be uploaded as Exhibits in the subsections below. Response should be uploaded to Bonfire when submitting and label as “Proposal” and state the subsections corresponding to the information provided.

3.6.1 General Information

3.6.1.1 The Scope of Services set forth herein is general in nature and not intended to be a complete description of the services that may be required by BSO.

3.6.1.2 The Broward Sheriff’s Office (“BSO”), with approximately 5,500 employees;

whether full-time, part-time, regular, temporary, or seasonal are eligible to receive Workers’ Compensation in accordance with Chapter 440, Florida Statutes Workers’ Compensation Law.

3.6.1.3 USIS, Inc. currently acts as BSO’s third-party administrator and is responsible for the management of all workers compensation claims which include managed care coordination (currently provided by AmeriSys), lost time management, return to work and coordination of services with in-network providers and pharmacies. Historical claims data is detailed in Exhibit D: Loss Run - Claims Report 2019-2024, attached document in Bonfire.

3.6.1.4 The Broward Sheriff Office has created and maintained a Self-Insurance

Program which provides protection to the Broward Sheriff Office for all property and casualty loss exposures and workers’ compensation claims. Attention is focused in the areas of safety awareness, prevention, treatment of injured workers, rehabilitation, job placement, education, and communications with the employees and the departments.

3.6.1.5 Guidelines for the treatment and care of injured employees are based on

Chapter 440, Florida Statutes, which governs the State’s requirements for the provision of Workers’ Compensation benefits. However, as a result of collective bargaining agreements, additional benefits may be due depending on the applicable collective bargaining agreement. The Awarded Proposer(s) must become familiar with the existing collective bargaining agreements.

3.6.1.6 BSO’s current Third-Party Claims Administrator, utilizes Risx FACS and

Luminos Plus claim processing system (their proprietary system) wherein all data is maintained, updated, and payments are issued. The adjudication of workers’ compensation medical bills and payments of the Broward Sheriff Office providers are performed through this system.

3.6.1.7 The Broward Sheriff Office seeks a Third-Party Administrator to deliver the best quality claims services and provide reliable, valid data through an efficient, user-friendly claims system. BSO uses a panel of attorneys on all litigated claims, as necessary. BSO works closely with the panel in a best-practices approach to manage litigated claims. A strong emphasis on return to work is implemented, as Broward Sheriff Office recognizes that prompt reintegration aids in controlling claims costs. Individual department heads are directly responsible for claims occurring in their departments, as claims costs are allocated by department. Therefore, each department is highly motivated to support effective lost control, safety, liability, and workers compensation claims management.

3.6.1.8 The Broward Sheriff Office utilizes a 24/7/365 claims intake center through it’s current provider. This type of system facilitates expedited handling, ensuring efficient claim processing and resolution, for the benefit of the employees. The Awarded Proposer(s) will be expected to continue to provide and maintain such level of services.

3.6.2 Transfer of Existing Files

3.6.2.1 Proposer will be responsible for transition of all necessary services, including transfer of all claims. There are approximately 750 open claims at any given time. The Proposer will work in coordination with USIS, to transfer all open claims from USIS, if necessary. The physical files will be moved, if necessary, from the current provider’s offices (located in Broward County, FL) to the Proposer’s premises, making files available to BSO when or as needed.

3.6.2.2 Information provided in this RLI regarding the volume and type of pending claims to be assumed is based on the latest information provided to BSO by our current TPA. It is the responsibility of the Proposer to determine what the takeover cost per claim will be for all current open files. The Proposer will be required to download the takeover claims data into their system with the current information for further handling of the takeover claims. It is required that the claims data associated with all the current claims be transferred to the new computer information system so that future loss runs will contain a complete history of all claim years.

3.6.2.3 If necessary, claims data from current provider’s database (Risx FACS or

Luminos Plus) to Proposer’s database should be transferred within 30 days of Contract execution.

3.6.2.4 Costs associated with the takeover of claims should be included in appropriate

Bonfire line item Price Proposal in the spreadsheet labeled “Pricing Sheet“ attached in Bonfire.

3.6.3 Staffing, Quality Control, and Supervision

The Proposer shall deliver high-quality claims management and adjusting services throughout the term of the Agreement, by employing personnel having, as a minimum, the following levels of experience and licensing:

3.6.3.1 Staffing Philosophy: It is BSO’s claims management philosophy that the proper and most cost-effective method to handle claims and thereby reduce and control BSO’s self-insured loss payments, is to ensure the Proposer hires and retains Florida State Licensed adjuster(s) to handle BSO’s claims. Additionally, an adequate number of adjusters and a manageable caseload enables qualified adjusters to perform the required services. BSO, therefore, requires that the Proposer agree to staffing, qualifications, and caseload criteria established by BSO.

3.6.3.2 Adjuster Requirements: The Proposer must have a minimum of five (5) full-time dedicated lost-time adjusters licensed in the State of Florida with at least three

(3) years’ recent experience preferred. These adjusters must be directed by a dedicated Supervisor, with at least (5) years’ recent experience preferred.

3.6.3.3 BSO Approval: BSO reserves the right to the final approval of the hiring and assignment of the claims manager, supervisors, and adjusters prior to their assignment to BSO’s account.

3.6.3.4 Caseload Management: The Proposer agrees to add staff as necessary, to maintain the maximum pending caseload thresholds. The Proposer in its response to the RLI must explain how its office or unit will be staffed, and the level of supervision that will be provided.

3.6.3.5 Personnel Standards: All Claims personnel must be direct employees of the

Proposer. The use of independent adjusters, subcontractors, or temporary adjusters is prohibited without prior written approval from BSO. Adjuster trainees are not acceptable for managing BSO’s claims.

3.6.3.6 The Proposer must submit with its proposal, the resumes and copies of current

Florida Adjuster’s license of all claims professionals specifically to be assigned to BSO’s account. All of the Proposer’s claims professionals must possess a current Florida Adjuster’s license.

3.6.3.7 Management Access: The Proposer shall make available to BSO an individual with management authority to meet with the BSO Human Resources Director, or the designee, upon reasonable notice. This individual shall have the authority to make “agreed to changes.” The Proposer’s employees will be expected to meet with BSO Human Resources, or designee quarterly, or on as needed basis, to discuss claims of interest. Sufficient advance notice will be given by BSO Human Resources to allow adequate preparation and data collection. The Proposer’s personnel, including the adjuster or Supervisor, may also be available to attend mediation conferences, as necessary.

3.6.3.8 Professional Standards: Proposer’s employees must perform all services to the highest professional standards. Proposer must achieve a passing score of 95% or higher on state and other audits.

3.6.3.9 Emergency Availability: The Proposer shall provide a dedicated supervisor with a cell phone that must be available 24/7 for emergencies.

3.6.3.10 Team Modifications: Changes to the assigned claims team will only be modified with the written approval of BSO’s Director of Human Resources, or the designee.

3.6.3.11 Staffing Flexibility: Proposer will be expected to develop a cost-effective staffing structure to include the number of adjusters, designated to appropriately handle the BSO’s claims. BSO reserves the right to negotiate and approve the staffing plan and any cost associated with any modifications to the plan. In addition, BSO will have the right to request personnel removal, effective within thirty (30) calendar days of written notice.

3.6.4 Claims Administration

3.6.4.1 BSO is seeking qualified firm(s) to provide Workers’ Compensation Third Party

Claims Administration services. It is anticipated that services will include, but not be limited to:

3.6.4.1.1 Claims adjusting and investigative services;

3.6.4.1.2 Data, filing and reports management;

3.6.4.1.3 Loss fund management services;

3.6.4.1.4 Safety and loss control services;

3.6.4.2 These requirements and services are described in more detail within Exhibit A

– Claims Administration, attached document in Bonfire.

3.6.5 Medical Management Care Services

3.6.5.1 BSO aims to deliver quality medical care in a timely, cost-effective manner, facilitating a prompt return-to-work and claim resolution. The medical services shall include, but not be limited to, the following services:

3.6.5.1.1 Access to a robust Medical Network;

3.6.5.1.2 Utilization Reviews;

3.6.5.1.3 Bill Review and Audit Services;

3.6.5.1.4 Data Filing and Reports Management;

3.6.5.2 These requirements and services are described in more detail within Exhibit B

– Medical Management Care Services, attached document in Bonfire.

3.6.5.3 Please note that Pharmaceutical is typically a part of the Medical Component, but it is not part of this RLI. BSO presently uses and will continue to use MyMatrix for pharmaceutical, unless otherwise determined by BSO, in its sole discretion.

4. RESPONSIBILITIES OF PROPOSER:

The specifications set forth are for informational purposes and to provide a general description of the requirement. Proposers shall be responsible to submit technical submittal based upon their program that will meet the goals, objectives and requirements set forth herein.

4. RESPONSIBILITIES OF PROPOSER: