RFP_5800_SLW3034_ADD_1_v1.pdf

SOLICITATION ADDENDUM

AUSTIN FINANCIAL SERVICES – CENTRAL PROCUREMENT

Revised 7/22/2026

Solicitation: RFP 5800 SLW3034 Addendum No: 1 Date: July 22, 2026

This addendum is to incorporate the following changes to the above-mentioned solicitation:

1.0 Clarifications: The original Workbook has been replaced with Workbook V2.

2.0 Extension: The solicitation due date is hereby extended until July 28, 2026 at 2 PM.

3.0 Questions:

Q1 Question: Is this strictly for stand-alone managed care solutions, entirely excluding claims handling?

Q1 Answer: Yes. This solicitation is for managed care services only. Third-party claims administration services are being procured separately under a different solicitation.

Q2 Question: The City is not looking for fully bundled solutions that include both services, correct? Would the City be open to a provider that can provide a full solution including both services?

Q2 Answer: Correct. This solicitation is limited to managed care services. Respondents will be evaluated only on the services requested under this solicitation.

Q3 Question: Can another vendor administer the City’s current 504 network?

Q3 Answer: Subcontracting is acceptable. All responses to the requested information must still be included in the submitted offer and pricing would be all inclusive.

Q4 Question: Please provide the total bill volume, broken down by bill type, PPO penetration rate or PPO volume, pharmacy, and specialty review. Are you able to break it down by fees including the BR fee per bill, percentage of savings fee, professional fee, PBM fee, or total BR fee all-inclusive of services above?

Q4 Answer: Available historical billing data has been included within the solicitation exhibits. Additional breakdowns by bill type, savings methodology, administrative fees, PPO penetration, or vendor-specific financial arrangements are not available.

Q5 Question: What is the average annual volume of medical procedure precertification’s processed, including clinical and non-clinical?

Q5 Answer: The City averages approximately 1,200–1,400 preauthorization requests annually, including both clinical and non-clinical requests. This volume may fluctuate depending on claim activity.

Q6 Question: What is the number of TCM assigned per year and the duration of assignment?

Q6 Answer: Telephonic Case Management is assigned on all medical and lost time claims.

Q7 Question: Does the City require the newly selected vendor administer the 504 network directly, or will the City allow integration with another administrator to provide the service? If a vendor can provide all other services outlined in RFP, would the City allow the vendor to integrate rather than administer the network directly?

Q7 Answer: Subcontracting is acceptable. All responses to the requested information must still be included in the submitted offer and pricing would be all inclusive.

Q8 Question: Does the City’s current vendor, IMO, administer the 504 network directly or integrate with another administrator to provide the service? If directly administered, which regulation is being used to support a 504 network? Please provide any additional relevant details to clarify the arrangement.

Q8 Answer: The City's current certified workers' compensation health care network operates under Chapter 504 of the Texas Labor Code. The current contractor is responsible for administration of the certified network in accordance with all applicable statutory and regulatory requirements.

Q9 Question: Please clarify the scope of Performance Guarantee #8. Does the City's AI restriction apply only to decisions made for services delivered under this contract? How does the City define “human decision making” in Performance Guarantee #8?

Q9 Answer: The City's intent is to ensure that professional judgment affecting injured employees is exercised by appropriately licensed or qualified personnel. Artificial intelligence and other automated technologies may be used to assist personnel but shall not independently make decisions regarding medical management, utilization review, provider selection, return-to-work recommendations, or other services requiring professional judgment. The City defines "human decision making" as review and approval by an appropriately qualified individual who remains accountable for the final determination.

Q10 Question: Please verify whether Local Business Preference points will be applicable and awarded for this solicitation.

Q10 Answer: Local preference information can be found in Section 10.6 and 10.8 of the Solicitation Instructions as well as page 5 of the offer and certifications.

Q11 Question: Please provide your current bill-review workflow. Where do adjusters provide approval in the process? Are there any pain points with the current workflow or bill-review vendor?

Q11 Answer: Medical providers submit bills electronically or by paper to the managed care vendor. Bills undergo fee schedule review, contractual reductions, coding review, and other applicable bill review processes prior to payment recommendation. The claims administrator remains responsible for overall claim administration. The City continually evaluates opportunities to improve workflow efficiency.

Q12 Question: Besides the current contract(s) coming to an end, are there any other business reasons to be put out for bid for these services? Can you share current pricing?

Q12 Answer: The solicitation is being issued as part of the City's normal competitive procurement process to ensure continued high-quality managed care services and compliance with City procurement requirements. The City of Austin responds to all public information requests (PIRs) promptly and in accordance with the Public Information Act (PIA). Pursuant to section 552.301(c) of the Government Code, the City of Austin has designated certain addresses to receive requests for public information sent by electronic mail. Please submit your request for more information using one of the prescribed methods below to help us ensure we answer all requests in a timely manner.

- Electronic mail: public.information@austintexas.gov

- City’s online Public Records Center:www.austintexas.gov/pir

Q13 Question: Will the Ready Rebound pilot continue? What specific services does Ready Rebound provide that the City’s current vendor does not?

Q13 Answer: Ready Rebound services are specific to first responder claim navigation. The city has not decided whether the contract will be extended.

Q14 Question: Would the City please provide your total in-network PBM spend and prescription volume for 2025?

Q14 Answer: Historical pharmacy utilization information included within the solicitation represents the City's available reporting. Additional proprietary financial reports are not available.

Q15 Question: Would the City please provide the percentage of brand versus generic medications dispensed in 2025?

Q15 Answer: Brand versus generic utilization data is not separately tracked in a format available for release.

Q16 Question: Would the City please provide your total out-of-network prescriptions spend/volume received by paper billing outside of the PBM spend 2025?

Q16 Answer: The City does not maintain this information in a reportable format separate from overall pharmacy reporting.

Q17 Question: Would the City please provide a drug usage report with the following pharmacy data for 2025?

a. Drug name

b. NDC

c. Quantity

d. Days Supply

e. Date of service (fill date)

f. Pharmacy name

g. Retail or Mail?

h. Pharmacy NPI or NABP

i. Injury state

j. Network Indicator (in or out of network)

k. Compound Indicator (Y/N)

l. Current cost

Q17 Answer: The requested prescription-level data contains protected health information and proprietary vendor reporting. The City will not release this information.

Q18 Question: Please clarify if the awarded respondent will be developing a new 504 panel or taking over administration of an existing 504 panel.

Q18 Answer: The City owns its certified workers' compensation health care network. The successful respondent will assume responsibility for administration of the existing network while continuing to develop, maintain, credential, contract with, and expand the provider network as necessary to meet the City's operational needs and all applicable regulatory requirements.

Q19 Question: If the awarded respondent will be taking over administration of an existing 504 panel, would the City be willing to share a copy of the provider agreement for respondents to review to ensure transferability to a new administrator?

Q19 Answer: Existing provider agreements are confidential contractual documents and will not be released. Respondent would execute new contracts with medical providers.

Q20 Question: Please provide a copy of the provider handbook.

Q20 Answer: The City's current provider handbook is considered operational documentation and will not be distributed as part of this procurement.

Q21 Question: Please provide a detailed copy of the preauthorization services.

Q21 Answer: Respondents shall provide all preauthorization services required under Texas workers' compensation laws, Texas Department of Insurance regulations, and the Statement of Work contained within this solicitation.

Q22 Question: Would the City be willing to consider a 60-day termination clause in lieu of the 10 days set forth in the request for proposal (RFP) to allow time for an orderly transition of services?

Q22 Answer: Exceptions may be submitted as indicated in Section 4.3 of the solicitation instructions.

Q23 Question: Would the City consider making all transition timeline requirements within the scope of work contingent upon timely receipt of all necessary data in the agreed upon format from the current service provider?

Q23 Answer: The City expects all parties to cooperate in an orderly transition. No changes are being made to the solicitation requirements.

Q24 Question: In the Statement of Work, Section C (4), does the City anticipate potentially moving open/active claims and not just those noted as “new claims with injury date of 10/1/2025”?

Q24 Answer: The awarded contractor will assume responsibility for managed care services in accordance with the implementation requirements described in the solicitation.

Q25 Question: Does the City anticipate a separate claim review meeting for managed care services as noted in Section J (2)(b) or coordinated at the same time of the third-party administrator (TPA)?

Q25 Answer: The City anticipates coordinating managed care review meetings with other program meetings whenever practical. Additional meetings may be scheduled as operational needs require.

Q26 Question: In the Workbook, tab 1 (6), it references key personnel in number 5 and 6, but is it meant to be number 4 and 5?

Q26 Answer: Correct.

Q27 Question: In the Workbook, tab 4:

o (1) Would the results of TPA apply to the performance guarantees? Would that be covered under the

TPA contract? Answer: This is covered under the TPA contract.

o (2) Would the results of the claims management apply to the performance guarantees? Would that be covered under the TPA contract? Answer: Correct, covered separately in the TPA contract.

o (5) Does the City anticipate the managed care company and the TPA pool the information in order to produce the report as requested as the TPA RMIS would house the return to work (RTW) information?

Answer: The managed care contractor will be expected to coordinate with the City's Third-Party Administrator to produce required reporting where necessary.

o (8) Please expand on what the City is defining as artificial intelligence (AI). Also, please provide the City’s policy as referenced under the section “acceptable performance” as mandatory compliance.

Also, please explain the referral to external law enforcement and/or regulatory agency.

Q27 Answer: The City's intent is to ensure that professional judgment affecting injured employees is exercised by appropriately licensed or qualified personnel. Artificial intelligence and other automated technologies may be used to assist personnel but shall not independently make decisions regarding medical management, utilization review, provider selection, return-to-work recommendations, or other services requiring professional judgment.

The City defines "human decision making" as review and approval by an appropriately qualified individual who remains accountable for the final determination.

Q28 Question: Please provide a copy of the current contract rates.

Q28 Answer: The City of Austin responds to all public information requests (PIRs) promptly and in accordance with the Public Information Act (PIA). Pursuant to section 552.301(c) of the Government Code, the City of Austin has designated certain addresses to receive requests for public information sent by electronic mail. Please submit your request for more information using one of the prescribed methods below to help us ensure we answer all requests in a timely manner.

- Electronic mail: public.information@austintexas.gov

- City’s online Public Records Center:www.austintexas.gov/pir

Q29 Question: Please provide any statistical information from the past fiscal year to date (10.1.2025 to 6.30.2026), including total number of bills by type.

Q29 Answer: Available statistical information has been included within the solicitation exhibits.

Q30 Question: Within Exhibit C, there are bill counts of 14,878 (excluding hospital, pharmacy, lab and DME); however, in Tab 7, there are bill counts of 14,948. Is the difference made up of the previously mentioned excluded bill types?

Q30 Answer: Yes. The variance reflects bill categories that are excluded from Exhibit C.

Q31 Question: Within Exhibit D Fund Agency report.xls, is the “Pay Amt” the net pay after reductions for fee schedule, network/panel reduction and audit? Please confirm if that spend includes or excludes hospital, pharmacy, lab, and DME, as well as charges from the current vendor.

Q31 Answer: The "Pay Amount" reflects the amount paid after applicable fee schedule adjustments, contractual reductions, and bill review processing. Vendor administrative fees are not included.

Q32 Question: Please provide gross charges, fee schedule reductions and other reductions, such as contracted rates and audit.

Q32 Answer: The City has provided the financial information available for this solicitation.

Q33 Question: Please confirm the total number of FCM noted as 10 and VCM noted as 5. Is that referred within the last fiscal year or currently open?

Q33 Answer: The figures represent the current active case management inventory during the reporting period reflected in the solicitation

Q34 Question: If we are unable to find 504 subcontractor, would the City be open to considering a Texas HCN as an alternative network solution to the 504 panel?

Q34 Answer: HCN is not something the City would consider.

4.0 ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME.

ACKNOWLEDGED BY:

Offeror Name Offeror Authorized Signature Date

RETURN ONE COPY OF THIS ADDENDUM WITH YOUR RESPONSE PRIOR TO THE SOLICITATION CLOSING

DATE. FAILURE TO DO SO MAY CONSTITUTE GROUNDS FOR REJECTION OF YOUR OFFER.