Exhibit_A_-_Scope_of_Work.pdf

EXHIBIT A – SCOPE OF WORK

1. INTRODUCTION

The City seeks to contract with Contractor to provide health services for the operation of Employee Health Care Clinics near multiple City sites. The Clinics shall provide accessible, high-quality, and cost-effective health care to employees and their eligible dependents, focusing on primary care, urgent care, same-day care, and limited pharmaceutical services for City Eligible Employees and their Eligible Dependents covered on the City’s Active medical insurance plans, hereinafter “Participants”.

The City offers three self-funded medical insurance plan options to Participants that include a High-Deductible Health Plan (HDHP), PPO plan and an HMO plan.

There are approximately 32,000 combined covered Participants under the three medical plans.

City employees and their eligible dependents shall be eligible to access services at the Employee Health Near- Site Clinic at no cost for those Participants enrolled in the PPO or HMO plan. Participants enrolled in the HDHP shall be subject to a copayment as determined by the City and in accordance with applicable laws and regulations.

1.1 GENERAL ADMINISTRATION REQUIREMENTS

1.1.1 Contractor shall conduct internal audit of its service operations related to this Agreement on an annual basis to assure compliance with applicable law, regulatory and data privacy (HIPAA,FMLA,) requirements, and City-mandated operational procedures. Audit shall be conducted by qualified internal auditor(s) or an internal compliance team and independent from the day-to-day account management staff. A summary report of the audit findings shall be provided to the City within thirty (30) days of audit completion or upon request by the City. Contractor agrees to implement timely corrective actions for any deficiencies identified and shall report progress to the City until fully corrected. The first audit to be completed within twelve (12) months from Agreement effective date or upon request by the City.

1.1.2 Contractor shall, in the event this contract expires, is terminated, or a subsequent contract for the same or similar services is awarded to another contractor, the Contractor shall fully cooperate in an orderly transition to the new awardee.

The Contractor shall, at no additional cost, transfer and deliver all related data, reports, documentation, file mappings, configurations, and other materials developed, maintained, or used in the performance of this contract, in a mutually agreed – upon format.

All such data and materials shall be complete, current, and usable by the successor contractor to ensure timely continuity of services.

2. SCOPE OF SERVICES

2.1 HEALTH CLINIC GENERAL SERVICES

2.1.1 Contractor shall establish and operate each Near-Site Clinic, at its own cost and expense, which shall include (a) leasing or owning the real property on which the Near-Site Clinic(s) will operate, (b) constructing or leasing the building(s), (c) furnishing the Near-Site Clinic(s), including the design, equipment, signs, interior and exterior decor items, fixtures, furnishings, supplies and other products and materials, and (d) any costs for any future renovation or remodeling of the property. Each clinic shall maintain the following:

a. Adequate clinical space, waiting areas, and private exam rooms, medical and diagnostic equipment for basic lab testing and monitoring.

b. Secure, electronic health record integrated across all clinic sites.

c. HIPAA-compliant telehealth capability.

d. Secure storage and tracking for limited pharmaceutical operations with the option to expand to more comprehensive, pharmacist-run operations.

e. ADA-compliant facilities.

f. Clinical operations must comply with HIPAA and applicable state and federal health regulations.

g. All clinical staff shall annually complete privacy, ethics, and compliance training.

h. All clinical staff shall be credentialed appropriately.

i. Cobranded signage that includes the City approved logo.

j. Downtown near-site employee clinic shall preferably be located within approximately two (2) city blocks of 1st Avenue and Washington Street, Phoenix Arizona. Alternative location(s) outside of the two-block radius may be considered provided the near-site location(s) demonstrate comparable and/or improved accessibility. Additional features may include:

i. Walking distance of 5 minutes or less

ii. Safe Pedestrian access

iii. ADA accessibility

iv. Hours of Operation access Monday through Friday, 7AM to

6PM AZ time.

v. Parking that can accommodate standard and high-profile vehicles. Any parking structure with heigh restrictions should clearly be marked and disclosed. If covered parking does not accommodate high-profile vehicles, Contractor shall identify reasonable proximate alternative parking with no additional cost to the Participant(s). Alternate parking solution shall be within a short walking distance from the downtown near-site clinic.

The City reserves the right to evaluate and accept alternative locations that meet operational and employee access objectives.

2.1.2 Contractor shall integrate primary care, wellness care, and urgent/same-day walk-in appointments under one coordinated model. City reserves the right to request additional service options through the term of the Agreement, e.g. behavioral health services.

2.1.3 Contractor shall ensure that the Employee Health Near-site clinic that is within a 2-block radius, refer to 2.1.1, item j. shall serve as a designated in-network Primary Care Provider (PCP) for Participants who elect PCP services. Range of services shall include:

a. Comprehensive primary care for adults and dependents (ages 2+).

b. Preventive health and wellness visits.

c. Routine physical exams – age/gender appropriate screenings.

d. Chronic disease management (e.g., hypertension, diabetes, asthma) with proactive outreach to address gaps in care and social drivers of health.

e. Women’s and men’s health primary and preventative care services that may include coordination with OB-GYNs or women’s / men’s health specialists, urologists, etc.

f. Health risk assessments/biometric screenings, annual flu vaccinations, lifestyle counseling.

g. Laboratory services that are granted waived status under the Clinical Laboratory Improvement Amendments (CLIA) (e.g., strep, influenza, glucose, urinalysis, RSV, etc.), imaging, point of care testing.

h. Access to third party laboratory services that are not eligible for CLIA waiver status

i. Coordination of referrals and specialist care, as needed, including coordination of preventive screenings.

j. Perform Dive Physicals and related services as follows:

Respirator Physicals / Questionnaires

Contractor shall furnish respirator physical examinations that are appropriate to the respirator, exposure, and physical demands of the job. Respirator questionnaires shall be as required in 29 CFR 1910.134 App C visit:

https://www.osha.gov/dte/library/respirators/majorrequireme nts.html).

Respirator examinations will be provided as needed to City of Phoenix Police Department employees. Respirator physical examinations and Respirator questionnaires shall be completed by a provider licensed and certified to complete said examination and questionnaires. Contractor shall ensure that a licensed provider is certified by or before Agreement effective date, January 1, 2027.

Police Respirator Physical All respirator physicals shall require the completion of the OSHA Respirator Medical Evaluation Questionnaire. The questionnaire shall be completed as a stand-alone document or as part of the physical examination medical history.

Police Level A Physical shall comprise of:

• Chest X-ray (when medically necessary)

• Medical history

• Physical examination

• Physician or other licensed health care professional

(PLHCP) statement

• Respiratory history

• Spirometry

Police Level A Physical with Blood Work and Stress Test If medically necessary (Chem23, CBC w/Diff, TSH, Treadmill) Police Level B Physical

• Chest X-ray (when medically necessary)

• Medical history

• Physical examination

• PLHCP statement

Evaluation of Questionnaire and PLHCP Statement must meet all requirements established by OSHA as set forth in 29 CFR 1910.134.

Contractor shall provide notification within one (1) business day, but no later than two (2) business days, to the Human Resources Department Safety Division designated point of contact, when an employee fails a respirator physical, or the physical is being held/suspended due to further testing or there is a need for additional information from the employee’s healthcare provider.

2.1.4 Contractor shall provide Urgent/Same-Day Care Services that offer evaluation and treatment for non-emergency, short-term conditions that include:

a. Common illnesses (cold, flu, sinus infections, allergies, etc.).

b. Minor injuries (sprains, strains, minor burns, cuts, etc.)

c. Respiratory and ear/nose/throat conditions.

d. Skin conditions and rashes.

e. Fractures and dislocations.

f. Gastrointestinal concerns.

g. Medication management and follow-up for acute conditions.

h. Triage and stabilization before referral for emergency-level care, as necessary.

2.1.5 Upon Request by the City, Contractor shall provide behavioral and mental health support to address emotional well-being and stress management. This service may be considered as an optional service to add in the future through the duration of the Agreement. Range of services may include:

a. Stress, anxiety, depression screening and management.

b. Crisis intervention and referrals to higher levels of care when appropriate.

c. Coordination with City Employee Assistance Program (EAP) and community mental health resources, as necessary.

d. Health coaching and wellness programs focusing on mental health.

2.1.6 Contractor shall ensure that the clinic(s) maintain a limited pharmaceutical formulary dispensary to support convenient access to commonly prescribed medications. Services shall include:

a. Dispensing limited formulary of episodic and maintenance medications.

b. Medication counseling and education.

c. Maintenance medication adherence support and refill management.

d. Coordination with external pharmacies for e-prescriptions outside the clinic formulary.

e. Compliance with all federal and state pharmacy dispensing regulations.

2.1.7 Contractor shall provide preventive health and wellness that include the following services:

a. Immunizations and routine vaccines (e.g., flu, tetanus, etc.)

b. Nutrition counseling, health coaching for weight management and healthy living.

2.1.8 Contractor shall provide an option for a multi-site delivery model that includes clinics strategically located across the greater metropolitan Phoenix area to include neighboring cities/towns within a 35-mile radius from downtown Phoenix to ensure convenient access for all eligible Participants. Services may be delivered through a mix of near-site clinic options, and virtual/telehealth platforms.

2.1.9 Contractor shall ensure that each clinic is staffed with credentialed, qualified, licensed professionals appropriate to the services offered, which may include:

a. Physician (MD, DO) that provides oversight, diagnosis, and clinical leadership and a Physician certified as a Medical Examiner of Divers to perform Dive Physicals for assigned City of Phoenix Public Safety Personnel.

b. Nurse Practitioner (NP)/Physician Assistant (PA) that can provide primary and urgent/same-day service delivery.

c. Registered Nurse (RN)/Licensed Practical Nurse (LPN) – Clinical and patient education support.

d. Medical assistant (MA) – Administrative and clinical support.

e. Clinic Coordinator/Administrative Staff that provides scheduling, intake, and record management.

f. Pharmacy technician (if applicable) that can assist with limited dispensary operations.

g. Behavioral health clinician, e.g., licensed counselor, therapist, or psychologist, should the City in the future add additional services, e.g., behavioral health services.

2.1.10 Contractor shall ensure that hours of operation include the following clinic and telehealth coverage hours: Monday through Friday, 7:00AM to 6:00PM AZ time. Contractor shall provide:

a. Same and next day medical appointments.

b. Dedicated local phone number.

c. Web-based platform for on-line appointment scheduling with up to three appointment availability per hour and automated reminders to participants of upcoming appointments.

d. City Participants shall not experience excessive waiting periods.

Excessive waiting period is defined as more than thirty (30) minutes from scheduled appointment time.

e. Provide sufficient patient parking spaces and provide parking validation, as needed, when City participant visits the clinic.

f. Contractor shall provide Participants with access to their electronic health records including test results within one week or less.

g. Contractor shall provide Participants with secure messages detailing health care reminders and recommendations for care.

2.1.11 Contractor shall Include the following optional services:

a. Obstetrical services

b. Wellness coaching

c. Behavioral health evaluations/therapy

d. Nutrition & Dietary consultations

e. Smoking cessation

f. Stress Management

g. Weight Management – weight loss program.

2.1.12 Contractor shall Exclude the following services:

a. Ergonomic assessments.

b. Occupational Health Services.

2.1.13 Contractor shall provide health screening services to provide clinical assessment biometric values for blood pressure, cholesterol, blood glucose/blood sugar and body mass index (BMI) to include explanation of results.

2.1.14 Contractor shall, in the event this contract expires, is terminated, or a subsequent contract for the same or similar services is awarded to another contractor, the Contractor shall fully cooperate in an orderly transition to the new awardee.

The Contractor shall, at no additional cost, transfer and deliver all related data, reports, documentation, file mappings, configurations, and other materials developed, maintained, or used in the performance of this contract, in a mutually agreed – upon format.

All such data and materials shall be complete, current, and usable by the successor contractor to ensure timely continuity of services.

2.2 CUSTOMER SERVICE AND ENROLLMENT

2.2.1 Contractor shall provide a conversion team to work with City staff and City vendors to identify information needed, file formatting, and communication to current Plan Participants. Confirm you have provided a resume for each team member.

2.2.2 Contractor shall have its customer call center, Participant portal, and website fully operational and in a state of readiness by/before the Open Enrollment Period for Eligible Employees by October 2026.

Customer service representatives must be fully trained on the City’s specific benefits prior to the initial and thereafter all subsequent annual Open Enrollment start date(s).

2.2.3 Contractor shall designate an Account Manager who has authority to act on behalf of the contractor who has at least three (3) years of experience as an account manager for Health Clinic clients similar in size to the City and the authority to make same-day decisions regarding company policy.

2.2.3.1 The Contractor shall make available designated

representatives to coordinate with City staff during the initial and future Open Enrollment periods and participation in multiple virtual and in-person group information and planning meetings upon request by the City’s designated Benefit staff at no additional cost to the City.

2.2.3.2 The Contractor shall provide an employer portal that provides authorized designated benefit staff liaison access to utilization reports.

2.2.3.3 The Contractor shall provide training on the Participant and employer portal to all identified benefits liaisons, upon request by the City at no additional cost to the City.

2.2.3.4 Contractor agrees that the use of any written or visual communication materials or changes to materials being used must be approved by the City in writing in advance of any distribution.

2.3 PARTICIPANT SERVICES

2.3.1 The Contractor shall provide at no additional cost to the City, a fully operational, toll-free line that is answered by a live member service representative Monday through Friday (7:00 am to 6:00 pm) Arizona Time (Arizona does not participate in Daylight Saving Time), excluding City observed holidays (https://www.phoenix.gov/calendar/holidays).

Calls outside of these hours shall be handled by voice mailbox or equivalent system, available twenty-four (24) hours a day, seven (7) days a week, and three hundred sixty-five (365) days a year.

Responses to messages shall be returned by a knowledgeable staff member by the end of the following business day.

The toll-free line will include alternative language options (or access to language translation services). The toll-free line will include oral language services that include answering questions in at least the following non- English language(s): Spanish.

2.3.2 The Contractor shall at no additional cost to the City, ensure that the City and its Participants who are deaf or hearing impaired have access to communication services that enable them to use phone services to communicate with customer service/clinic staff.

2.3.3 The Contractor shall provide an escalation process to respond to Participant service issues within one (1) business day for issues that cannot be resolved at the customer service level.

https://www.phoenix.gov/calendar/holidays

2.4 ELIGIBILITY & DATA INTEGRATION

2.4.1 The City shall determine eligibility of Participants for enrollment in and coverage by City Health Plans.

2.4.2 The City’s determination of eligibility for City Health Plans shall be guided by federal, state and local rules, regulations and laws, including, but not limited to 26 U.S. Code 125, the Internal Revenue Code of 1986, the Patient Protection and Affordable Care Act (PPACA), Public Health Service Act (PHSA); the Consolidated Omnibus Budget Reconciliation Act (COBRA), the Family Medical Leave Act (FMLA), Medicare, Medicaid, and the Uniformed Services Employment and Reemployment Rights Act (USERRA), Federal Emergency Management Agency Act (FEMA), as well as City policies and collective bargaining agreements to the extent such policies and agreements meet or exceed other legal requirements.

2.4.3 Contractor shall, upon request by the City, securely accept enrollment eligibility, qualified life event changes, and cancellation dates as stated in the City’s transmissions, reports, or files. Discrepancies of less than 5% between amounts owed based on Contractor’s eligibility system and fees/premiums remitted by the City will be written off at the end of each contract year.

2.4.4 Contractor shall check the eligibility of claimants against the eligibility files that will be supplied electronically by the City that shows new enrollments, cancellations, terminations, and other changes applicable to City plans before authorizing benefits. Contractor shall process such enrollments, cancellations, terminations and changes in a timely manner.

2.4.5 The City shall provide Contractor with a weekly eligibility file in a secure electronic format. The City may determine it is beneficial to change the format in the future and reserves the right to do so at no additional charge to the City by the Contractor.

2.4.6 The Contractor shall accept the City’s HIPAA compliant, weekly electronic data transmissions as the official Participant eligibility/enrollment records, subject to adjustments as authorized by the City.

2.4.7 Contractor shall securely and timely process the weekly electronic transaction file noting Participant enrollment changes (additions, deletions, and changes of address, employment status, etc.) and the full file showing all Participants that are eligible for benefits.

2.4.8 Contractor agrees to incur all expenses of any modifications that are necessary to its systems to process the information provided by the City.

The City will not make any modifications to its current system or file content or structure to accommodate the Contractor.

2.4.9 Contractor shall have and maintain HIPAA compliant hardware, software, and systems that are capable of retrieving or receiving electronic data transmission form the City regarding enrollments, changes to enrollments, premiums and other matter related to the contract.

Contractor shall at the highest level protect and maintain the confidentiality and security of all City Confidential information, implement and maintain adequate and necessary security systems, policies and appropriate protocols in adherence to this Agreement.

2.5 CREDITS AND ALLOWANCES

2.5.1 Contractor shall provide credits and allowances (“CA Funds”). The City retains full discretion over the use of such funds. Unused CA Funds roll over year over year through the term of the Contract. At City’s discretion, CA Funds may be maintained as a single fund to encompass the initiatives which include but are not limited to the following:

2.5.1.1 Initial and Ongoing Implementation Allowance.

2.5.1.2 Implementation Audit Allowance.

2.5.1.3 Compliance Review Allowance.

2.5.1.4 Training/Client Summit/ Allowance.

2.5.1.5 Communication Allowance.

2.6 TECHNOLOGY

2.6.1 Employer support:

2.6.1.1 Dashboard Reporting Services: The Contractor shall provide quarterly reporting to the City the includes access and performance data. The City can request access and performance data on a more frequent cadence, as necessary. All confidential information should be redacted to comply with HIPAA standards. Access limited to authorized designated Benefit liaison(s) as approved by the City's Benefit Management Liaison(s).

2.6.1.2 The Contractor shall provide authorized City staff access to the City’s data via any and all Contractor’s tools and relevant databases. Authorized staff shall be determined by the City Human Resources designated Benefits Management liaison. Contractor agrees to grant/rescind user access within one (1) day of receipt of notice. Contractor shall confirm in writing all City authorized staff at the beginning of each plan year.

2.6.1.3 Data Warehouse Services: The Contractor shall electronically transfer claims, health data, performance analytics and other relevant information to the City's claims data warehouse and the

City's health plan carriers on a monthly or quarterly basis, in a format specified by the City.

2.6.1.4 The Contractor shall image and retain Health Clinic documentation in an electronic transferable and standard readable format to the City or other Contractors should the City change vendors.

2.6.1.5 The Contractor shall maintain disaster recovery procedures for eligibility, billing and accounts receivable, which includes but is not limited to: daily data backups maintained at an off-site/onshore (offshoring outside of the United States, not permitted) facility; and documentation to support regulatory compliance.

2.6.1.6 The Contractor shall accept the City of Phoenix defined data elements when building the vendor account structure.

2.6.1.7 The Contractor shall be capable of accepting participant eligibility electronically. Contractor shall be responsible for establishing, maintaining, and accurately updating eligibility records.

2.6.2 Participant support

2.6.2.1 Secure multi-factor authentication Participant Portal: Contractor shall ensure that Participants shall be able to access their personal health information, to include patient medical records, lab work, radiology results, provider notes, and secure messaging to the provider. This site shall be subject to requirements as stated in Section 10 (Data and Security) of Exhibit A, Scope of Work.

2.6.2.2 The Contractor shall ensure that Participant Portal is compliant with all language, formatting, accessibility standards and/or guidelines that provide accessibility to Participants with disabilities.

2.7 PERFORMANCE GUARANTEES

2.7.1 The Contractor shall offer competitive implementation performance guarantees as well as aggregate performance guarantees through the duration of the Agreement.

2.7.2 The Contractor shall place annual fees at risk for failing to maintain the performance guarantees. Performance fees at risk will be calculated at the same frequency with which performance guarantees are reported. At no time will quarterly or monthly measurements be re-averaged to alter results.

2.7.3 The City reserves the right to allocate the percent of the fees at risk for each performance guarantee. Additionally, the City requires the ability to re-allocate the amount at risk for each performance standard on an annual basis.

2.7.4 The City may request the inclusion of additional performance measurements annually. Any additional performance measurements shall be mutually agreed upon through a written Contract amendment.

2.7.5 The Contractor shall measure all performance standards and provide to the City any supporting reports as City-specific. Reports shall show actual results for the current period versus: (1) prior period(s); and (2) the guaranteed standard. Such reports shall be submitted on a schedule consistent with Section 2.11 Reporting or as otherwise agreed by the Parties.

2.7.6 The Contractor shall provide proposed performance guarantees as noted in Scope of Work, section 2.7 - 2.7.1 - 2.7.5 with amount at risk as Attachment 5.

2.8 IMPLEMENTATION

2.8.1 The Contractor shall submit an implementation plan and begin the implementation process within ten (10) business days of Contract award.

Implementation process shall begin within (5) business days of City's review and approval of implementation and transition plan. The City may request changes to the implementation plan at its discretion. The Implementation Plan commencement date shall commence no later than June 2026, or date requested by the City (if different).

2.8.2 The Contractor agrees the City may conduct a pre- or post- implementation audit to verify readiness to administer the City’s program. The pre-implementation audit must be completed before the program effective date, and the post-implementation audit will be conducted at a mutually agreed upon time frame post effective date.

2.8.3 The Contractor agrees to provide a designated implementation manager and support team (not part of the regular account management team) that will be assigned to lead and coordinate the implementation activities with the City. Contractor agrees the implementation manager shall not be managing more than three (3) implementations in total while leading the implementation for the City.

2.8.4 The Contractor shall provide a team of individuals dedicated to implementing the provisions of this Contract upon award. The implementation team shall include, but not be limited to programmers, data analysts, a project manager, an account manager, a network contracting manager, an audit/quality assurance lead, enrollment specialists, and member services lead staff.

2.8.5 The Contractor shall provide an administrative manual for the program that provides the information necessary for the City team members to operate the program. The manual shall be provided at the time of implementation and shall be updated on an ongoing basis by the account management team and/or by the City. This manual shall be provided as part of the premiums and with no additional cost to the City.

2.8.6 The manual shall be in a mutually agreed upon format and include, but not be limited to, the following information:

2.8.6.1 Account management structure and contact information.

2.8.6.2 A process for handling questions and the escalation process.

2.8.6.3 Eligibility file layout and exchanges.

2.8.6.4 System testing and documentation.

2.8.6.5 A catalog for all Participant communication.

2.8.6.6 Eligibility processes and time frames.

2.8.7 The designated implementation manager shall continue to support the City through completion of the implementation process and for a minimum of forty-five (45) calendar days after the Contract effective date of January 1, 2027. Such support includes but is not limited to weekly calls with the City and the designated account management team, maintenance of issue tracking logs, and issue resolution. This support must be provided as part of the premiums with no additional cost to the City.

2.8.8 The Contractor shall be required to begin Services prior to the plan year effective date to prepare and implement the program prior to the go live date of January 1, 2027. (e.g., implementation, communication initiatives, vendor to vendor transition, vendor to vendor file integration (e.g., encounter claims), etc.).

2.9 PLAN PARTICIPANT COMMUNICATION MATERIALS

2.9.1 All communication materials to Participants shall be sent using First Class mail at no additional cost to the City unless another class is required or authorized by the City.

2.9.2 The Contractor shall co-brand any communication material with the City logo or other logo determined by the City as part of the premiums and at no additional cost to the City.

2.9.3 The Contractor shall include a toll-free telephone number on the website and on all communication material.

2.9.4 The Contractor shall provide a web portal for Participants that provides the information necessary to comport with federal and state law and meets the confidentiality and data security specifications required by this Agreement, City policy and HIPAA privacy regulations.

2.9.5 The Contractor shall prepare, design, produce, and mail all announcements, letters, notices, brochures forms, and other supplies and Services at no additional cost to the City. All communication is subject to review and approval by the City prior to any distribution.

2.9.6 The Contractor shall submit copies of all Plan Participant communication materials to the City. The City reserves the right to review the content of any communication and to make revisions. All such materials shall be approved in writing by the City prior to use in promoting the applicable program to Participants. Materials include but are not limited to customized Participant communication materials during the transition and implementation activities, notification letters, error/correction letters, appeal letters, newsletters, and/or any material distributed to the City Medical plan Participants.

2.9.7 All communication materials, advertisements, and marketing materials

2.9.8 The Contractor shall facilitate secure links between the City websites and Contractor’s website as part of the premiums and at no additional cost to the City.

2.10 ACCOUNT MANAGEMENT TEAM

2.10.1 The Contractor shall provide a team of designated professionals who are responsible for ensuring that all Contractual requirements and service deliverables are met by the Contractor. The City reserves the right to approve the staffing of the City service team. The Designated Teams may also serve other clients if such assignment does hinder timely performance of Services for the City.

2.10.2 The Contractor shall provide an account management team that is experienced in providing Services for similar entities, trained on the applicable City medical plans, accessible to the City geographically, and with sufficient capacity and authority to respond to the City issues in a timely manner. The account management team shall include:

2.10.2.1 Account Manager – shall be the single, day-to-day contact for the

City with the primary responsibilities of responding to all issues, coordinating the efforts of the Contractor’s staff to resolve issues, and overseeing all aspects of project management including, but not limited to the initial implementation and ongoing new program facilitation. The Account Manager shall have a minimum of three

(3) years of experience with the Contractor’s organization or a similar industry. If possible, Account Manager shall also be a local resident of Arizona.

2.10.2.2 Implementation Manager – Responsible for development and execution of implementation plan. Coordinates with the City, internal and other external designated resources. The Implementation Manager shall represent the sole, consistent point of contact to the City during the implementation process. Three (3) years of experience as an Implementation Manager and experience with groups of 20,000 Participants and larger are also required.

2.10.2.3 Executive Sponsor – shall be responsible for collaborating with the City on issues related to legislation and policy and shall provide recommendations to the City. The Executive Sponsor shall work with the entire senior management team in other roles as well, including high-level operational issues resolution.

2.10.2.4 IT System Manager – shall be a day-to-day contact who will have the primary responsibility of responding to and resolving all IT-related issues that arise for the duration of the Contract.

2.10.2.5 Clinic Office Manager – shall have the primary responsibility of ensuring orderly clinic day-to-day operations and addressing issues that arise.

2.10.2.6 Member Services Manager –The Contractor shall provide a minimum of one Member Services Manager who is responsible for all customer service functions and reporting. The Member Services Manager shall be intimately familiar with the City’s Health Clinic and Medical Plans to serve the Participants. Three (3) years of experience as a Member Services Manager and experience with groups of 20,000 members and larger are also required.

2.10.2.7 Data Analytics Manager – shall be responsible for providing analysis, assessment, and recommendations to the City based on the City’s medical trend and utilization to improve the Health Clinic performance. The Data Analytics Manager shall participate in the City data analytics manager meetings and shall provide recommendations to support quality improvement programs, wellness initiatives, and plan design changes.

2.10.2.8 Medical Director – shall be a licensed physician, accredited by the state board to oversee clinical operations of the clinic.

2.10.3 The Contractor shall provide to the City’s designated Benefits Management liaison(s) at least thirty (30) calendar days advanced notice of any planned change to the primary account manager.

2.10.4 The Contractor shall provide to the City an escalation process to assist in matters which are unable to be resolved at the account team level.

2.10.5 The Contractor shall provide the City with access to an electronic tracking and resolution log of all open and closed the City issues in the required format.

2.10.6 The Contractor shall provide to the City documentation of a process for prompt issue resolution in the event of a failure to perform a required service.

2.10.7 The Contractor shall attend virtual account management meetings, as needed, with appropriate personnel to address potential questions as requested by the City. Contractor account management shall be available to meet in person at the City designated location, should the need arise at any point for the duration of the Contract.

2.10.8 The core members of the account management team: account manager, member services manager, IT system manager, clinic office manager, medical director and data analytics manager, and executive sponsor shall meet with the City’s designated Benefits Management team and designated Benefits Consultant representatives quarterly within fifty-five (55) calendar days after the close of each quarter. Meetings are to be held by virtual platform unless the City requests in person meeting.

2.10.9 The Contractor shall conduct a Participant satisfaction survey as it relates to health clinic services under this Contract. The survey shall be conducted annually during the plan year. The Contractor shall provide the City with a copy of the survey instrument for its review. Such surveys shall be for the purpose of assessing Participant and provider satisfaction with Services performed by Contractor.

2.10.10 The Contractor shall conduct an annual account management satisfaction survey/score card. The survey and scoring methodology shall be mutually agreed upon by the City and the Contractor during implementation.

2.10.11 The City may make public the results of such surveys for distribution among Medical Plan Participants, Phoenix City Council, and/or the media if requested.

2.10.12 The Contractor shall ensure that staff is appropriately trained on the City Medical Plan and that quality assurance and financial accuracy procedures are in place so that procedures are applied consistently, fairly, and accurately.

2.10.13 The Contractor agrees to participate in vendor summit discussions to identify opportunities to enhance the Participant experience.

2.10.14 The Contractor agrees that the City of Phoenix has the right to review, meet with and approve changes to the account team assigned to service City of Phoenix, and agrees not to change the assigned account team without prior consent from the City.

2.10.15 The Contractor agrees to participate in regular Account Team meetings with City of Phoenix management as frequently as on a weekly basis immediately following implementation and on a weekly, semi-monthly, or monthly basis after implementation is fully achieved.

2.10.16 The Contractor agrees that designated account representatives shall be available to answer questions from the City’s designated Benefits Staff, designated City Consultants, as approved by the City’s designated Benefits & Wellness Management. Contractor agrees to provide the City with open enrollment readiness support each contract year. Such support shall include but not limited to: training customer service staff on plan/service changes, implementing plan design changes, biometric screenings, flu vaccine initiatives, Participant communication(s), etc.

Review and applicable testing for accuracy will occur and results will be reviewed with the City.

2.10.17 The Contractor agrees City of Phoenix may assess a penalty if the account team performance (as rated by members of City’s benefits management team), does not meet City expectations. All members of the Contractor’s account management team will be reviewed as part of this guaranteed measurement. Account management team performance measures will include but will not be limited to timely and complete communication with Benefits Division management, Participant satisfaction, and serving as the primary liaison to the Benefits Division staff.

2.11 REPORTING

2.11.1 The Contractor shall provide detailed monthly reports related to all claims in process, paid and reserved. Financial data provided on a monthly basis must include, but not limited to, utilization and financial data specific to the City’s group. If the reports do not adequately meet the City requirements, Contractor shall customize the reports to the City’s specifications at no additional cost to the City. The City’s requirements may change from time to time during the life of the Contract. All claims' data specific to the City is the specific property of the City and the Contractor shall not impose restrictions or charges on its’ use by the City.

2.11.2 The Contractor shall provide comprehensive and meaningful reporting across the Plan, including summary analysis and consultative proposed action items to address any identified concerns at no additional cost to the City.

2.11.3 Contractor shall provide reports on a monthly, quarterly and annual basis that include the following:

a. Utilization by service type (e.g., PCP/preventive care, urgent/same-day appointments, wellness, behavioral health, pharmacy).

b. Preventive Screening and chronic management, including clinical interventions by type of intervention.

c. Provider utilization rate for City participants, defined as the percentage of providers’ time treating City participants out of providers’ available working hours.

d. Average Wait Time, defined as the amount of time City participants spend from check-in until seeing the provider.

e. Appointment Lead Time, defined as the length of time in which City participants need to schedule in advance to be seen by service type.

f. Wait Time, separately calculated for New, Same-Day, Walk-In, and Follow-Up Appointments.

g. Patient Satisfaction Scores, measured through surveys and feedback.

h. Clinical Outcomes Metrics measuring patient adherence, efficacy of addressing gaps in care, and key outcomes to be mutually decided between the City and the Contractor.

i. Participant Retention Rate to track the percentage of participants returning for future visits.

j. Estimated cost avoidance.

k. Performance Guarantee metrics as mutually agreed upon.

l. All reports should be deidentified and adhere to all privacy laws.

2.11.4 The Contractor will agree to all required electronic file feed(s) in the designated format at the designated cadence as required by the City. The City may determine that it is beneficial to change a file format in the future and reserves the right to change the format at no additional cost to the City.

2.11.5 The Contractor shall submit required, City-specific reports to the City within thirty (30) calendar days of the end of the month for monthly reports, within forty-five (45) calendar days of the end of the quarter for quarterly reports, and within ninety (90) calendar days of the end of the Plan year for annual reports at no additional cost to the City.

2.11.6 The City will specify the reporting formats, file specifications, and frequency of written or electronic reports required from the Contractor to the City, Contractor to designated City vendor or from the City to the Contractor during implementation. Additional fees shall not be charged to the City related to the Contractor’s standard reports or the designing and development of required regular or ad-hoc reporting.

2.11.7 The Contractor shall submit all sensitive data electronically securely and in accordance with Section 2.12.

2.11.8 The Contractor shall provide up to 5 user IDs to access the employer web-enabled online reporting tools as part of the premiums with no additional charge to the City (including designees). City reserves the right to request additional user IDs to access the employer web-enabled platform at no cost to the City.

2.11.9 The Contractor shall offer comprehensive on-site or web-based training for the online reporting tool as part of the premiums and with no additional cost to the City (including designees).

2.11.10 The Contractor shall agree to all required electronic file feed(s) in the designated format at the designated cadence as required by the City. This includes agreement to provide necessary file feeds to any other City Contractor, i.e. Consultant, Medical, etc., if applicable. The City may determine that it is beneficial to change a file format in the future and reserves the right to change the format at no additional cost to the City.

2.12. ADDITIONAL DATA AND SECURITY

2.12.1 The Contractor agrees to accept weekly eligibility files from the City at no additional cost to the City in adherence to the City’s Security and EDI Protocols. The City uses Oracle’s PeopleSoft for payroll processing. The City requires receipt of a weekly discrepancy report from the selected Contractor.

2.12.1.1 Integrate using the City’s EDI file layout.

2.12.1.2 Post the electronic eligibility file feed within one (1) business day of receipt.

2.12.1.3 Encrypt all data storage and back up media.

2.12.1.4 Use secure and encrypted PGP, FTP, SFTP, HTTPS, and

VPN methods of data transmission as a means of sending and receiving files between City approved parties. Contractor shall provide the City sufficient, but no less than sixty (60) day notice prior to any request to apply an update, conversion, or alteration to the secure and encrypted PGP, FTP, SFTP, HTTPS, and VPN methods of data transmission as it relates to this Contract. Notice shall detail the reason(s) for update, conversion, or alteration with effective date of requested change. Notice shall be submitted in accordance with the Notice Section, 2.7.14, of the Agreement.

2.12.1.5 Use a secure site to send and receive email communication from administrative staff.

2.12.2 The Contractor shall provide technical assistance to the City as it relates to organizing, supplying, processing, or reporting the data.

2.12.3 The Contractor shall provide all necessary codes, definitions, and data sets or subsets, or other information the City requires within sixty (60) calendar days of the City’s request. The Contractor shall provide data dictionaries in industry standard format, including crosswalk files. This data shall be maintained for no less than seven (7) years from termination of the Contract and shall be provided to the City at the termination of the Contract.

2.12.4 The Contractor shall conduct reconciliation on each data feed and work with the appropriate vendors to keep the data accurate and consistent among all parties as part of the premiums and at no additional cost to the City.

2.12.5 The Contractor shall provide the City, or its designee all required electronic file feeds as requested by the City. Contractor shall not charge programming fees associated with data file transfers in current data file compliant formats. This data shall be made available through the City’s File Transfer Protocol (FTP).

2.12.6 The Contractor shall establish PGP Encryption connections with the City as part of the administrative fees and at no additional cost to the City and at a minimum provide a sixty (60) day advanced notice to the City prior to any update, conversion or alternation of PGP Encryption.

2.12.7 The Contractor shall revise any data feeds according to any new file specifications requested or necessary by the City or its’ designee and at no additional charge to the City.

2.12.8 The Contractor shall work with any of its internal systems, subcontractors’ systems, or with the City’s contracted vendors to identify opportunities to improve operational efficiencies and program efficacies. Contractor shall develop executive summary of findings and submit it to designated City Benefit Management for consideration and approval.

2.12.9 Upon identification and determination of system problems, programming problems, or transfer problems, the Contractor shall notify the City of the issue immediately, but no later than 24 hours. The Contractor shall make every effort necessary to correct such problem as soon as possible including, but not limited to, working nights, weekends, and holidays, to minimize any negative impact to Participants and to maintain continual operations of the Health Clinic at no additional charge to the City.

2.12.10 The City shall develop, and the Contractor shall use the City’s six-digit Employee Identification Numbers (EINs) in a format and style developed by the City to enroll and identify all City Participants. Alternative identification numbers will not be accepted. This service shall be included as part of the premiums and at no additional cost to the City. Please note that the City’s six-digit EIN starts with a zero.

2.12.11 The Contractor shall provide and be able to receive eligibility files from any vendor contracted with the City who requires such files. These files shall be in a standard 834 format (or modified format) as agreed upon between the City and the Contractor to meet specific file layout requirements of the City at no additional cost to the City.

2.12.12 The Contractor shall notify the City via e-mail within one (1) business day, should they uncover any eligibility discrepancies within the file transfer (i.e., errors, duplicates, etc.)

2.12.13 The Contractor shall agree to communicate through HIPAA-compliant electronic sites to exchange data between itself and any other required vendor as requested by the City and at no additional cost.

2.12.14 The Contractor shall load and reconcile daily and monthly eligibility files or other files within one (1) business day of receipt.

2.12.15 The Contractor shall make all data available to the City via the SFTP site established during implementation. In addition, all schemata and file definitions shall be made available to the City upon request.

2.13 BILLING OF MEMBERS AND CLAIMS SUBMISSION

2.13.1 Contractor shall submit a detailed monthly invoice for each medical plan.

Each invoice must itemize all charges, including but not limited to fixed charges by service type, and shall clearly identify the service description, quantity/units, unit cost, and total amount. All charges must be sufficiently detailed to allow full audit reconciliation and verification by the City. The Contractor shall submit invoice to the City no later than the 10th of every month for payment processing.

2.13.2 The Contractor shall not charge additional fees or impose any limitations for Services unless specifically provided in Exhibit B, Fee Schedule, and approved by the City.

2.13.3 City and Contractor shall identify any overpayments, underpayments, non-payments or payments made in error within one (1) year of payment and either party shall return any such payment to the other party within forty-five

(45) days from date of notice. If a request for payment is made, request shall be investigated by the other party and paid if applicable. Offset of future funds shall not be allowed unless Contractor does not pay refund within sixty (60) days of initial request.

2.13.4 For members enrolled in the City’s health plans that are compatible with a Health Savings Account (HSA), shall pay a co-pay for certain services (excluding Preventative Services), which will be the established fair market value as determined by the City. Contractor shall collect the co-pay from the member at time of service. Co-payments collected from members shall be credited back to the City and reflected on the invoice. Contractor may bill any individual determined not to be a covered Member at the time of service rendered.

2.13.5 Contractor shall submit encounter claims to the appropriate Payor for the Services rendered to Members. A Clean Claim shall include patient data and identifying information on CMS 1500 forms, a subsequent industry form adopted for that purpose, or any other secured electronic format as agreed to by the City.