RFP Document~19.pdf

Surgery Benefit for Health PPO Plan | RFP - HR-26-753 | Template v3.14.25 | 1 r

City of

Long Beach Request for Proposals RFP - HR-26-753

Surgery Benefit for Health PPO Plan

Surgery Benefit for Health PPO Plan | RFP - HR-26-753 |

Template v3.14.25 | 1

Please read this entire document carefully as it contains important information essential to your proposal

Overview

Summary

The City of Long Beach (City) is seeking proposals from qualified firms to provide eligible surgical and medical procedures through vetted Centers of Excellence

(COE) for benefited employees, retirees, and their dependents enrolled in the City’s Anthem Blue Cross

Preferred Provider Organization (PPO) plan on a voluntary basis. The surgical and medical procedure carve-out solution would offer pre- and post-care for knee, hip, orthopedic, shoulder, spine, heart, weight loss, and oncology.

Key Dates

Release Date: August 26, 2026

Questions Due to the City: September 9, 2026

Proposals Due: October 7, 2026

The City reserves the right to modify these dates at any time, with appropriate notice to prospective Contractors.

Proposal Information

Instructions for what to include in your proposal and how to submit it are detailed in Section 4.

Proposals must be submitted electronically via

LongBeachBuys.com.

This is a competitive process, and the City intends to award the opportunity based on the information submitted in the proposal that best meets the needs of the City.

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Official Contact

Janet Kariuki rfppurchasing@longbeach.gov

All communication with the City related to this RFP must be directed to the contact listed above.

Assistance & Resources For assistance using Long Beach Buys, please contact us directly

Customer Service Form rfppurchasing@longbeach.gov

(562) 570-6200

Additional support available for small businesses in Long Beach

BizCare

BizCare staff connect business owners and nonprofit leaders to important resources and information, such as grants, loans, technical assistance, information on City policies, and more.

562-570-4BIZ (4249)

4Biz@longbeach.gov

Request Assistance Form mailto:rfppurchasing@longbeach.gov file:///C:/Users/casinoh/Downloads/longbeachbuys.com https://forms.office.com/Pages/ResponsePage.aspx?id=wxE_MWhCak-NO8fmUBg-eJhZqE0zY4JHucmtLMnWlxRUMzlJTVpROTNONUpZQ0tPMzVIQU5WQkk2Uy4u mailto:rfppurchasing@longbeach.gov https://longbeach.gov/economicdevelopment/business-development/bizcare-program/bizcare-request/ mailto:4Biz@longbeach.gov https://longbeach.gov/economicdevelopment/business-development/bizcare-program/bizcare-request/

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Contents

BizCare

1 The Opportunity

1.1 Project Summary

1.2 Background

1.3 Goals

1.4 Award Terms

2 Scope of Work

2.1 Description of Services

2.2 Performance Metrics & Contract Management

2.2.1 Performance Metrics

2.2.2 Contract Management

2.2.3 Contract Payment

3 How We Choose

3.1 Minimum Qualifications

3.2 Evaluation Criteria

4 Proposal Instructions & Content

4.1 Timelines & Instructions

4.2 Proposal Content

4.3 Narrative Proposal Template

5 Terms & Conditions

5.1 Acronyms/Definitions

5.2 Solicitation Terms & Conditions

5.3 Contract Terms & Conditions

5.4 Additional Requirements

5.5 Protest Procedures

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1 The Opportunity

1.1 Project Summary

The City of Long Beach is seeking proposals from qualified firms to provide eligible surgeries through vetted Centers of Excellence for benefited employees, early retirees, and their dependents enrolled in the City’s Anthem Blue Cross PPO plan on a voluntary basis.

The surgical and medical procedure carve-out solution would offer pre- and post-care for knee, hip, orthopedic, shoulder, spine, heart, weight loss, and oncology. In addition, the member experience will include access to end-to-end concierge service, online tools, and zero out of pocket costs.

1.2 Background

The City of Long Beach is the seventh largest city in California and employs approximately

6,500 full-time and part-time personnel throughout 23 departments. The Employee

Benefits Division, housed in the City’s Human Resources Department, oversees the implementation, monitoring, and compliance of 20+ benefit contracts that offer competitive and comprehensive benefits to City employees, retirees, and their dependents.

In addition to the administration of benefit plans, staff in the Employee Benefits Division provide the following services:

• Benefits-related training to departmental staff

• Unemployment claims processing

• Citywide Benefit Education program

• Oversight/coordination of retirement counseling

The City has approximately 3,800 active employees and retirees under the Anthem Blue

Cross PPO plan.

1.3 Goals

This RFP has the following stated goals:

• Maintain the existing voluntary surgical carve-out benefit plan design with minimal disruption to members currently utilizing the elective surgical carve-out benefit.

• Enhance the member experience and maximize total cost savings by improving communication and education regarding eligibility and coverage for the surgical carve-out benefit.

1.4 Award Terms

This contract will be for a period of two years with the option to renew for three additional one-year periods. The total contract term will not exceed five years.

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2 Scope of Work

2.1 Description of Services

The City of Long Beach is looking to maintain its current service level by partnering with a single firm that will be the primary carrier responsible for providing elective surgery carve-out benefits for eligible active employees, early retirees, and their dependents over the age of 18 enrolled in the City’s Anthem Blue Cross PPO plan.

Note that this partnership with the City does not include a volume guarantee in regard to member steerage toward any new or existing provider network included in any bidder’s proposal. The City is willing to work with the selected firm to develop and implement solutions to drive steerage, but the City will not make any guarantees of steerage prior to the completion and evaluation of the first contract year. Additionally, the City is open to learning about alternative programs, solutions, and plan options that proposers have to offer. However, for scoring and evaluation purposes, submitted proposals should be based on the City’s current network and plan design.

General Proposing Requirements

• Ability to comply with the Freedom of Information Act (FOIA) throughout the bidding process.

• Demonstrate the capacity to seamlessly integrate with the City’s PPO plan provider, Anthem Blue Cross, and pharmacy benefit manager, CVS Caremark, in regard to both data sharing and communications.

• Demonstrate an ability to continue the current plan designs.

• During the contract term, the City will have no data restrictions and may obtain and share data with any third party.

• Upon termination, send data and all relevant transfer files in a timely manner to the

City’s new vendor at no additional cost. Relevant data will include but is not limited to information on eligibility, claims history and any other pertinent information.

• Provide responses to this RFP that are true and accurate, and if awarded business, the firm will uphold their commitments in good faith in a City contract.

• During the contract term, the City will retain control over plan design modifications, employee contribution methodology, and changes during the contract term except for state and federal required changes where applicable.

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Administration Process Requirements

• Demonstrate the ability to provide the City’s eligible population with access to a broad network of vetted COEs for surgical and medical procedures for knee, hip, orthopedic, shoulder, spine, heart, weight loss, and oncology.

• Require participating COE providers to maintain good standing regarding all licenses, permits, governmental and/or board authorizations or approvals required by law.

• Regularly monitor the quality of providers with whom the selected firm has contracted and demonstrate an intent to terminate contracts with providers if quality deteriorates.

• Provide the City with the firm’s provider selection criteria.

• Ensure full compliance with Health Insurance and Portability and Accountability Act

(HIPAA) and Health Information Technology for Economic and Clinical Health Act

(HITECH) regulations to safeguard the confidentiality and security of members’ protected health information.

• Ensure full compliance with all federal and state laws and provisions governing the

City’s benefit program.

• Ensure stability and continuity of service delivery, including client experience, by avoiding any major system changes that may impact City employees within the initial 18 months.

• Demonstrate the capacity for secure data migration from the incumbent vendor as well as continuity of care safeguards for employees currently utilizing the elective surgical carve-out benefit.

Eligibility Management

• Capability to securely send and receive eligibility electronically.

• Ability to assign a unique identifier for eligibility with the capacity to cross reference against social security number (SSN) or use a unique identifier assigned by the City or its medical third-party administrators.

• Ensure non-binary gender information/codes can be incorporated into the eligibility system.

• Capacity to process and load eligibility information and inform the City of discrepancies within 48 hours of receipt.

Customer Service and Communications

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• Ability to support various program-related member communications including customer service phone support, attendance at the open enrollment Benefits Fair, direct mailings, and communications via other media.

• Provide access to end-to-end concierge service including support with locating a provider, handling all medical data collection, scheduling appointments, arranging travel if needed, and coordinating follow-up care.

• Provide members with a secure online platform and mobile application for accessing provider information and searching for COE locations.

• Guarantee the website and mobile application maintain at least 99% availability.

• Ensure 24/7 customer service support availability with defined escalation and resolution procedures.

• Provide knowledgeable and accessible member support service staff.

• Ensure the availability of multi-lingual speaking representatives to accommodate members and their dependents at all times.

• Ensure Americans with Disabilities Act (ADA)-compliant website and mobile application design.

• Guarantee a 24-hour response turnaround time for customer service emails received from members.

• Capacity to provide the City with a summary of member inquiries upon request.

• Implement and maintain a call tracking system that logs member or client inquiries.

• Provide customized support or communication materials according to the City’s specific needs and preferences in areas such as eligibility education.

Account Service Support

• Assign a highly experienced, dedicated, and accessible account management team to the City.

• Ensure that at least one live account service team member will be available to the City between the hours of 8am and 5pm Pacific Time, Monday to Friday.

• Attend quarterly meetings with the City’s Human Resources staff to discuss strategic initiatives related to the City’s objectives.

• Attend ad-hoc meetings with the City’s Human Resources staff upon request.

• Participate in the City’s in-person open enrollment Benefits Fair and other information sessions as needed.

• Provide the City’s Human Resources staff training on all digital platforms available to the City.

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Reporting and Data Management

• Provide standard management and utilization reports as well as non-standard or ad hoc reports upon request.

• Offer comprehensive reporting around program fees, savings, and member impact to support the City’s decision-making processes.

• Provide quarterly reporting on all call center metrics.

• Maintain full and accurate records with respect to all matters and services to the City for a minimum of seven years from December of the affected plan year.

Audit Requirements

• Allow the City or its third-party representative (not subject to approval by the vendor) access and the right to audit all claims, utilization data, performance guarantee provisions, contracts, administrative fees, and other information relevant to account services at no additional cost. Any associated charges to conduct an audit by the auditor will be covered by the City.

• Confirm the City will be able to select an auditor of their choosing without being subject to a pre-selected or limited number of auditors approved by the bidder.

• Identify and inform the City of any aspects of the proposed plan administration services that are not able to be audited.

• Ensure that all aspects of claims transacted for the City by the selected firm are subject to audit even if the firm deems the information to be confidential in nature, subject to a signed confidentiality agreement.

• Grant the City the right to audit records in any one given contract year for the entire term of the contract and up to one year post termination.

• Conduct periodic audits as part of the course of business. Provide copies of any internal audits and quality assurance reports.

2.2 Performance Metrics & Contract Management

2.2.1 Performance Metrics

The table below highlights the targets that will be tracked and reviewed collaboratively with the Awarded Contractor during the contract. This list is an indication of the performance metrics of interest to the City, and is not exhaustive or final. As a part of a response to this

RFP, Proposers may propose additional or alternative performance metrics to be tracked on a regular basis. The final set of performance metrics and frequency of collection will be negotiated by the successful Proposer and the City prior to the finalization of an agreement between parties, and may be adjusted over time as needed.

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METRIC DESCRIPTION TARGET

1. Account Management

Satisfaction

Overall satisfaction with

Account team, responsiveness, reporting, and issue resolution

To be determined during implementation

2. Communications Plan

Implementation

Clear and timely communication with members utilizing the benefit during transition

100% outreach to members regarding any ch anges or network disruption

3. Meeting Attendance and Preparation

Attendance and preparation of materials for required meetings

99% attendance and submission of required reports and documents

4. Network Accessibility Adequate accessibility of

COEs for eligible members within a designated radius or travel time

100% of eligible members have access to at least one

COE within 150 miles of their place of residence

5. Online Platform

Availability

Availability and functionality of website and mobile application

Online platform availability and functionality at least 99% of the time

2.2.2 Contract Management

The awarded firm will receive consistent support and communications from a designated

City liaison throughout the duration of the contract. The liaison will serve as the primary contact for the awarded firm. The City’s designated liaison will send out reminders regarding upcoming deadlines for reports, invoices, and narrative metrics.

These efforts aim to provide clarity and address any questions or concerns to ensure that any issues can be openly shared and resolved in a timely manner.

Kick-Off Meeting

The awarded firm is required to participate in a project kick-off meeting, which will include an introduction of key project staff, a review of the project scope and timelines, an overview of the awarded firm’s invoice and reporting requirements, and the establishment of a regular schedule for project meetings and reporting.

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Milestones and Deliverables

The awarded firm shall submit the following deliverables to City staff by the designated deadline and receive approval before implementation. Final deadlines shall be determined and agreed upon during contract negotiations.

• Comprehensive report outlining the integration process, including timelines, milestones, and resource requirements to ensure readiness for the April 1, 2027 go-live date.

• Detailed plan outlining strategies and procedures to maintain the service delivery outlined in the scope of work.

Communications and Reporting

The awarded firm and City liaison shall meet regularly during the start of the engagement to review project status, address any issues, and identify potential opportunities to improve the effectiveness and efficiency of the project. After the go-live date, the awarded firm and

City staff shall meet quarterly to review project status, performance, and service data.

2.2.3 Contract Payment

The City of Long Beach issues payment based upon services rendered. After a contract is finalized and work is performed, the Contractor should invoice the City. The City will remit payment within 30 calendar days of being billed.

3 How We Choose

3.1 Minimum Qualifications

Proposers must meet the following mandatory requirements to be eligible:

• Must have a business license upon award and be qualified to conduct business in the City.

• Not having been debarred by federal, state, or local government.

• Must possess all trade, professional, or business licenses as may be required by the work contemplated by this RFP.

• At least three (3) years of consecutive, verifiable experience managing specialized

COE networks and bundled payment models for other large-scale government entities, municipalities, or public sector clients.

• Ability to keep records in accordance with any federal, state, or local mandates and document retention standards.

• Must have HIPAA-compliant practices regarding the handling and transmission of members’ protected health and personal information.

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• Attest that key personnel will be available to the extent proposed for the duration of the engagement and acknowledge that no person designated as key personnel shall be removed or replaced without prior written notice and discussion with the City.

• Ability to provide the most recent Audited Financial Statement or Corporate Annual

Report and Business Tax Return.

• Indication of the number and description of any outstanding legal actions pending against the firm’s organization with an explanation of how the firm will ensure that these actions will not disrupt business operations.

3.2 Evaluation Criteria

Proposals shall be consistently evaluated based upon the following criteria:

CRITERIA Weight

1. Organizational Capacity & Experience

• Demonstrated experience providing the services described in this RFP to similar public entities

• Evidence of availability of skilled personnel with relevant expertise in surgical carve-out benefit/health plan administration and management

• Evidence of strong organizational infrastructure and resources to support this project

30%

2. Method of Approach

• Demonstrated ability to maintain scope of work

• Detailed description of proposed methodology for integrating with existing systems and processes

• Demonstrated capability to ensure an April 1, 2027 go-live date

• Proven plan for addressing potential challenges or obstacles and implementing proactive measures for risk mitigation, especially regarding continuity of care

40%

3. Communications & Reporting

• Proven ability to participate in mandatory meetings

• Demonstrated ability and experience in data collection and reporting

• Proven comprehensive communication plan outlining regular updates, channels of communication, and escalation procedures

• Evidence of commitment to responsiveness and transparency in addressing City inquiries, feedback, and concerns throughout the contract term

20%

4. Reasonableness of Cost 10%

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4 Proposal Instructions & Content

4.1 Timelines & Instructions

MILESTONE

TIME

(PACIFIC) &

DATE LOCATION / ADDITIONAL INFORMATION

Release date August 26, Questions due to the

City

September

9, 2026

• Submit all inquiries via email to rfppurchasing@longbeach.gov

Posting of the Q&A September

23, 2026

• Responses to the questions will be posted on

LongBeachBuys.com.

Proposals due October 7,

• Proposals should be submitted electronically via LongBeachBuys.com.

• Late proposals, or proposals submitted through other channels will not be accepted.

• Proposers are responsible for submitting their proposals completely and on time.

o Proposers will receive an e-bid confirmation number with a time stamp from LongBeachBuys.com indicating that the proposal was submitted successfully. The City will only receive proposals that were transmitted successfully.

o For technical support, email or call the

City during normal business hours at

LBPurchasing@longbeach.gov or (562)

570-6200.

Evaluation of Narrative

& Cost Proposals

November -

December

• An Evaluation Committee will review Narrative

& Cost Proposals to select the proposal that best meets the needs of the City.

• Evaluations will be conducted using a methodology derived from the evaluation criteria listed in Section 3.2.

mailto:rfppurchasing@longbeach.gov file:///C:/Users/meid/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/X47PW9A6/LongBeachBuys.com file:///C:/Users/meid/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/X47PW9A6/LongBeachBuys.com file:///C:/Users/meid/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/X47PW9A6/LongBeachBuys.com mailto:LBPurchasing@longbeach.gov

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Negotiation &

Contractor Selection

January -

March 2027

• Selected Contractor(s) will be notified in writing.

• Any award is contingent upon the successful negotiation of final contract terms. If contract negotiations cannot be concluded successfully, the City reserves the right to negotiate a contract with another Contractor or withdraw the RFP.

• Negotiations shall be confidential and not subject to disclosure to Public Records Act requests unless and until an agreement is reached.

Estimated Contract

Execution

April 1, Proposer Debrief After

Contractor is Selected

• Successful and unsuccessful Proposers are encouraged to request phone call or in person meeting with the City to discuss the strengths and weaknesses of their proposal.

The intent of the debrief is to provide the

Proposer with constructive feedback to equip them with information to effectively meet the

City’s needs and be successful in future proposals.

4.2 Proposal Content

Complete proposals will include the following. Proposers are encouraged to use this table as a checklist to ensure all components are included in their proposal. Please note proposals that are NOT complete will NOT be considered for the opportunity and will be deemed nonresponsive.

PROPOSAL

☐ Narrative

Proposal

The Narrative Proposal should be prepared using the provided template. Proposers should provide a straightforward, concise delineation of capabilities to satisfy the RFP. Guidance on preparing a Narrative Proposal is detailed in Section 4.3.

• The Narrative Proposal must be named the following:

Attachment 1_Narrative Proposal_Name of Firm

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☐ Cost Proposal The Cost Proposal should provide a straightforward, all-inclusive description of the cost for the proposed services.

Proposers may use their preferred format and should address the following:

• Describe the pricing transparency available to the employer and member prior to scheduling a procedure.

Specifically, explain what financial information is available before a member elects care, including the estimated employer cost, member cost-share, and total bundled episode cost.

• Describe any pricing guarantees offered by your organization, including multi-year rate guarantees, administrative fee guarantees, annual fee caps, or other contractual pricing protections available to clients.

• Describe the methodology your organization uses to calculate projected and realized savings. Please explain the baseline used for comparison, how savings are measured, and how savings are validated and reported to clients.

PROPOSAL APPENDICES

☐ Financial

Stability

Proposers should include one or more of the following financial statements to provide the City with enough information to determine financial stability of the Proposer and subcontractor.

• Financial Statement or Annual Report

• Business tax return

• Statement of income and balance sheet

☐ Other Addenda

(if applicable)

Colored displays, promotional materials, and other collateral are not necessary or desired. However, if a complete response cannot be provided without referencing supporting documentation, it may be provided as an addendum clearly cited in the Narrative or Cost Proposal.

MANDATORY ATTACHMENTS | The following are included as Attachments in Long

Beach Buys. They must be signed by the individual legally authorized to bind the

Proposer.

☐ A. Authorization & Certification

☐ B. Equal Benefits Ordinance (EBO) Form

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Attachments Which May be Submitted Upon Award | Upon award, Awarded

Contractors will be required to submit the following. We encourage you to take note of these requirements, and where possible, include available information as part of your proposal to expedite processing.

☐ C. W-9

☐ D. Business License

☐ E. Proof of Registration with the California Secretary of State

☐ F. Certificates of Insurance: [See section 5.3]

☐ G. Faithful Performance Bond

☐ H. Labor and Materials Bond

☐ I. Current Contractor’s State License Board print out

☐ Contact Information | Ensure your organization’s profile is up to date in Long Beach

Buys, including an email address, phone number, and for any classifications you may qualify for.

☐ Conformation of Attachments | Ensure you have checked ALL the attachments in

Long Beach Buys and have confirmed that all the required documents have been uploaded and labeled correctly.

4.3 Narrative Proposal Template

An editable version of the template below has been posted to Long Beach Buys. Proposers are required to use the provided template, labeled “Attachment 1:

Narrative Proposal_Name of Firm.” Proposers may submit other attachments as supporting documentation

Organizational Capacity & Experience

PROPOSER CONTACT INFORMATION

Organization

Company Name

Company Address

Federal Tax ID Number

Website

Authorized

Representative

Name

Title

Email Address

Phone Number

Other Point of

Contact (if required)

Name

Title

Email Address

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Phone Number

PROPOSER CAPACITY & EXPERIENCE

What type of enterprise is the organization?

☐ Non-Profit

☐ Sole Proprietorship

☐ General Partnership

☐ Corporation

State and Date of incorporation:

☐ Limited Liability Company

☐ Other _________________________________

Please describe why the organization is qualified to provide the services described in this RFP (1-2 paragraphs).

Describe the length of time your firm has been providing the services described in this

RFP (1-3 sentences)

By what other names has your organization been known?

Briefly describe your firm’s background, culture, and mission statement.

Describe your success with similar clients and where you see your value stand out in comparison to competing vendors

How is your client team structured?

How is your staff retention rate?

What is your client retention rate?

How many employees does the organization have in total and residing in Long Beach?

Where are the representative(s) that would service the City’s account located?

Provide a plan of overview for how the project will be staffed, including the percentage of time each employee will be allocated to the project and their titles, qualifications, and number of years with the firm.

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List and describe any legal actions taken against your firm that are outstanding or that have occurred within the last ten (10) years.

Explain how your firm will ensure any outstanding actions will not disrupt business operations with the City.

Has your firm experienced recent merger or acquisition activity within the last five (5) years? If so, provide a brief summary and address any reorganization or operational changes that would affect your services.

Are there any recent or anticipated changes in your organizational structure (e.g., key personnel, consolidation of operations, new service centers) that would impact business with the City? Include a project plan and timeline if applicable.

Has your firm ever filed for bankruptcy? If so, when, and what is the current status of your filing?

Has your firm had a contract terminated for case or non-renewed within the last five (5) years? If so, by whom and for what circumstances? Provide the name and telephone number of any clients that have terminated your firm for cause in the last five (5) years.

REFERENCES

Reference 1

Company

Project Manager

Phone Number

Project Description

Project Start and

End Dates

Reference 2

Company

Project Manager

Phone Number

Project Description

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Reference 3

Company

Project Manager

Phone Number

Project Description

SUB-CONTRACTOR CONTACT INFORMATION

Does the proposal include subcontractors?

☐ Yes

☐ No

If applicable, provide the following for all subcontractors included in this proposal.

Organization Company Name

Company Address

Authorized

Representative

Name

Title

Email Address

Phone Number

Other Point of

Contact (if required)

Name

Title

Email Address

Phone Number

SUBCONTRACTOR CAPACITY & EXPERIENCE

What type of enterprise is the organization?

☐ Non-Profit

☐ Sole Proprietorship

☐ General Partnership

☐ Corporation

State and Date of incorporation:

☐ Limited Liability Company

☐ Other _________________________________

Which specific requirements of this RFP will the subcontractor perform?

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Is the subcontractor registered with the

California Department of Industrial

Relations? If yes, provide registration number.

Please describe why the organization is qualified to provide the services described in this RFP (1-2 paragraphs).

Please describe the length of time the organization has been providing the services described in this RFP (1-3 sentences).

How many employees does the organization have nationally, locally, and residing in Long

Beach?

Where are the representative(s) that would service the City’s account located?

Method of Approach

1. Provide an executive summary. It should demonstrate a clear understanding of the scope of work as well as describe how your firm will fulfill the requirements outlined in the Scope of Services.

2. Does your firm have a conflict of interest policy? If so, please provide a copy.

Additionally, if applicable, describe any conflicts that have arisen within the firm in the last five (5) years and how they were resolved.

3. Describe your firm’s approach to integrating seamlessly with third-party plan providers, addressing data security, file transfer and data reconciliation procedures, and any past experience successfully integrating with major plan providers.

4. Describe how your firm evaluates and selects COE providers for your network.

What are your firm’s selection criteria? How do you evaluate outcome data?.

5. Describe your pricing methodology in detail, including how the employer is billed for your services. Please explain your overall pricing structure, including administrative fees, access fees, implementation fees, bundled episode pricing, and any other costs that may be incurred throughout the contract term

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6. Describe your bundled pricing methodology for surgical episodes. Please explain what services are included within a bundled episode of care, how bundled rates are established, and identify any services or circumstances that would not be included within the bundled price and could result in additional employer or member financial responsibility.

7. Describe how your organization manages complex or outlier cases that exceed the scope of a standard bundled episode. Please explain how additional costs are determined, communicated, approved, and billed.

8. What specific quality metrics (e.g., complication rates, readmission rates, surgeon volume) does your firm use to evaluate provider performance?

9. Describe any financial guarantees or warranties associated with your surgical episodes. Please explain how your organization manages readmissions, post-operative complications, revision procedures, hospital-acquired infections, emergency department visits, or other events related to the surgical episode.

Include the duration of any warranty period, financial responsibility of each party, and any exclusions that may apply.

10. Describe how your pricing methodology has evolved over the past five years and discuss any anticipated changes to your pricing model, provider reimbursement methodology, or contractual guarantees over the next three to five years.

11. Describe your data security procedures and detail your notification procedures in the event of a breach of confidentiality or sensitive data. Additionally, specify any available legal remedies or other relief measures.

12. Confirm that you will be able to answer member transition questions during open enrollment and prior to the go-live date. Describe your process and available tools for assisting members with the transition.

13. Describe your firm’s approach to adhering to accessibility standards, ensuring website and mobile application usability for people with visual, hearing, motor, or other disabilities. Provide a link to a public website designed and developed for your firm that demonstrates the described manner of accessibility compliance.

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14. Does your firm use AI in the delivery of its services? If so, describe the specific functions performed by AI and how they improve member experience as well as your data protection measures regarding AI. Also note if clients are able to opt in or out of features that utilize AI.

15. Describe your firm’s approach to care navigation. What support is provided to members pre- and post-surgery?

16. Provide a detailed implementation plan, including a listing of all standard communications and target release dates, structured around an April 1, 2027, launch date. Identify and describe any potential challenges or obstacles to implementation and describe your mitigation approach.

17. What would your firm need from the City to implement the contract successfully?

Communications & Reporting

1. Describe how your organization will proactively share standard and non-standard reporting and utilization reports. Provide a list of standard reports you can provide and outline the process for requesting customized reports.

2. Describe how your organization will ensure compliance with all laws

3. Describe your firm’s approach to enhancing member communication, including how you identified and shared opportunities for improved member engagement with similar clients.

4. Describe how your organization will work collaboratively with other service providers to improve the quality and cost of services provided to members under their health benefit plans.

5. Describe how your organization will communicate COE disruptions and ongoing negotiations to the City and its members with an active case

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6. The City requires that the Awarded Contractor provide proof of payment of any subcontractors used for this project. If the proposal includes subcontractors, please describe the plan for how the City will be notified of such payments.

7. Describe your approach to collaborating with clients to develop customized, targeted member communications or any limitations.

8. Describe your firm's approach to member communication frequency, including any minimum, recommended, or required communication cadence.

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5 Terms & Conditions

5.1 Acronyms/Definitions

1. ADA: Americans with Disabilities Act

2. Awarded Contractor: The organization/individual that is awarded a contract with the

City of Long Beach, California for the services identified in this RFP.

3. City: The City of Long Beach and any department or agency identified herein.

4. COE: Center of Excellence

5. Contractor / Proposer: Organization/individual submitting a proposal in response to this RFP.

6. Department / Division: City of Long Beach, Human Resources

7. Evaluation Committee: An independent committee comprised solely of representatives of the City established to review proposals submitted in response to the RFP, evaluate the proposals, and select a Contractor.

8. FOIA: Freedom of Information Act

9. HIPAA: Health Insurance Portability and Accountability Act

10. HITECH: Health Information Technology for Economic and Clinical Health Act

11. May: Indicates something that is not mandatory but permissible.

12. PPO: Preferred Provider Organization

13. RFP: Request for Proposals.

14. Shall / Must: Indicates a mandatory requirement. Failure to meet a mandatory requirement will result in the rejection of a proposal as non-responsive.

15. Should: Indicates something that is recommended but not mandatory. If the

Proposer fails to provide recommended information, the City may, at its sole option, ask the Proposer to provide the information or evaluate the proposal without the information.

16. SSN: Social Security Number

17. Subcontractor: Third party not directly employed by the Proposer who will provide services identified in this RFP.

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5.2 Solicitation Terms & Conditions

1. The City reserves the right to alter, amend, or modify any provisions of this RFP, or to withdraw this RFP, at any time prior to the award of a contract pursuant hereto, if it is in the best interest of the City to do so.

2. The City reserves the right to request clarification of any proposal term from

Proposers.

3. The City may contact the references provided; contact any Proposer to clarify any response; contact any current users of a Proposer’s services; solicit information from any available source concerning any aspect of a proposal; and seek and review any other information deemed pertinent to the evaluation process.

4. The level and term of documentation required from the Proposer to satisfy the City will be commensurate with the size and complexity of the contract and Proposers should submit accordingly. If the information submitted by the Proposer, or available from other sources, is insufficient to satisfy the City as to the Proposer’s contractual responsibility, the City may request additional information from the Proposer or may deem the proposal non-responsive.

5. The City reserves the right to waive informalities and minor irregularities in proposals received.

6. The City reserves the right to reject any or all proposals received prior to contract award.

7. The City’s determination of the Proposer’s responsibility, for the purposes of this RFP, shall be final.

8. Unless otherwise specified, the City prefers to award to a single Contractor but reserves the right to award contracts to multiple contractors.

9. The City shall not be obligated to accept the lowest priced proposal, but will make an award in the best interests of the City of Long Beach after all factors have been evaluated.

10. If the City receives a single responsive, responsible proposal, the City may request an extension of the proposal acceptance period and/or conduct a price or cost analysis on such proposal. The Proposer shall promptly provide all cost or pricing data, documentation and explanation requested by the City to assist such analysis. By

Surgery Benefit for Health PPO Plan | RFP - HR-26-753 | Template v3.14.25 | 25 conducting such analysis, the City shall not be obligated to accept the single proposal.

The City reserves the right to reject such proposal or any portion thereof.

11. Any irregularities or lack of clarity in the RFP should be brought to the Purchasing

Division designee’s attention as soon as possible so that corrective addenda may be furnished to Proposers.

12. Proposals must include any and all proposed terms and conditions, including, without limitation, written warranties, maintenance/service agreements, license agreements, lease purchase agreements and the Proposer’s standard contract language. The omission of these documents may render a proposal non-responsive.

13. Alterations, modifications or variations to a proposal may not be considered unless authorized by the RFP or by addendum or amendment.

14. Proposals which appear unrealistic in the terms of technical commitments, lack of technical competence, or are indicative of failure to comprehend the complexity and risk of this contract, may be rejected.

15. Proposals may be withdrawn by written notice received prior to the proposal opening time.

16. The price and amount of this proposal must have been arrived at independently and without consultation, communication, agreement or disclosure with or to any other

Contractor or prospective Contractor.

17. No attempt may be made at any time to induce any firm or person to refrain from submitting a proposal or to submit any intentionally high or noncompetitive proposal.

All proposals must be made in good faith and without collusion.

18. Prices offered by Proposers in their proposals are an irrevocable offer for the term of the contract and any contract extensions. The Awarded Contractor agrees to provide the purchased services at the costs, rates and fees as set forth in their proposal in response to this RFP. No other costs, rates or fees shall be payable to the Awarded

Contractor for implementation of their proposal.

19. The City is not liable for any costs incurred by Proposers prior to entering into a formal contract. Costs of developing the proposals or any other such expenses incurred by the Proposer in responding to the RFP, are entirely the responsibility of the Proposer, and shall not be reimbursed in any manner by the City.

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20. In the event a Proposer received assistance from City staff or a representative of the City (technical assistance provider), the City is not responsible for any mistakes, inaccuracies, delays, or any other impact that the assistance provided did to impact the Proposer’s final product. Available technical assistance support services are only intended to provide advice and does not constitute a basis for any protest to this contract opportunity. It is solely the Proposer’s responsibility to prepare and submit a response to the RFP.

21. Proposal will become public record after the Notice of Intent to Award has been posted and the protest period has closed unless the proposal or specific parts of the proposal can be shown to be exempt by law. Each Proposer may clearly label all or part of a proposal as "CONFIDENTIAL" provided that the Proposer thereby agrees to indemnify and defend the City for honoring such a designation. The failure to so label any information that is released by the City shall constitute a complete waiver of any and all claims for damages caused by any release of the information.

22. A proposal submitted in response to this RFP must identify any subcontractors, and outline the contractual relationship between the Proposer and each subcontractor.

An official of each proposed subcontractor must sign, and include as part of the proposal submitted in response to this RFP, a statement to the effect that the subcontractor has read and will agree to abide by the Proposer’s obligations.

23. If the Contractor elects to use subcontractors, the City requires that the Awarded

Contractor provide proof of payment of any subcontractors used for this project.

Proposals shall include a plan by which the City will be notified of such payments.

24. Each Proposer must adhere to the City’s Vendor Code of Conduct, including, but not limited to, disclose any existing or potential conflict of interest relative to the performance of the contractual services resulting from this RFP. Any such relationship that might be perceived or represented as a conflict should be disclosed.

The City reserves the right to disqualify any Proposer on the grounds of actual or apparent conflict of interest. The Vendor Code of Conduct can be found at https://longbeach.gov/globalassets/finance/media-library/documents/business-info/purchasing-division/final-vendor-code-of-conduct-2023

25. Each Proposer must include in its proposal a complete disclosure of any alleged significant prior or ongoing contract failures, any civil or criminal litigation or investigation pending which involves the Proposer or in which the Proposer has been judged guilty or liable. Failure to comply with the terms of this provision will disqualify https://longbeach.gov/globalassets/finance/media-library/documents/business-info/purchasing-division/final-vendor-code-of-conduct-2023 https://longbeach.gov/globalassets/finance/media-library/documents/business-info/purchasing-division/final-vendor-code-of-conduct-2023

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Proposer’s prior history with the City or with any other party, which documents, without limitation, unsatisfactory performance, adversarial or contentious demeanor, significant failure(s) to meet contract milestones or other contractual failures.

26. The City reserves the right to negotiate final contract terms with any Proposers selected. The contract between the parties will consist of the RFP together with any modifications thereto, and the Awarded Contractor’s proposal, together with any modifications and clarifications thereto that are submitted at the request of the City during the evaluation and negotiation process. In the event of any conflict or contradiction between or among these documents, the documents shall control in the following order of precedence: the final executed contract, the RFP, any modifications and clarifications to the Awarded Contractor’s proposal, and the

Awarded Contractor’s proposal. Specific exceptions to this general rule may be noted in the final executed contract.

27. The City will not be responsible for or bound by any oral communication or any other information or contact that occurs outside the official communication process specified herein, unless confirmed in writing by the City Contact.

28. Any contract resulting from this RFP shall not be effective unless and until approved by the City Council / City Manager, as applicable.

29. The City will not be liable for Federal, State, or Local excise taxes.

30. Execution of Attachment A of this RFP shall constitute an agreement to all terms and conditions specified in the RFP, including all contract terms and conditions therein, except such terms and conditions that the Proposer expressly excludes.

31. Proposer understands and acknowledges that the representations above are material and important, and will be relied on by the City in evaluation of the proposal. Any

Proposer misrepresentation shall be treated as fraudulent concealment from the City of the true facts relating to the proposal.

32. Proposals shall be kept confidential until the Notice of Intent to Award has been posted and the protest period has closed.

33. No announcement concerning the award of a contract as a result of this RFP may be made without the prior written approval of the City.

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Proposers are advised that any contract awarded pursuant to this procurement process that exceeds $100,000 shall be subject to the applicable provisions of Long

Beach Municipal Code Section 2.73 et seq, the Equal Benefits Ordinance.

34. All Proposers shall complete and return, with their bid, the Equal Benefits Ordinance

Compliance form contained in Attachment B, if applicable. Unless otherwise specified in the procurement package, Proposers do not need to submit with their bid supporting documentation proving compliance. However, supporting documentation verifying that the benefits are provided equally shall be required if the proposer is selected for award of a contract.

35. Independent contractors or employees of a third-party employer who are CalPERS retirees are subject to provisions of the Government Code. A CalPERS retiree is an employee of a CalPERS employer who terminates active employment and receives a monthly CalPERS retirement allowance. Any individual qualifying as a CalPERS retiree doing business as an independent contractor or employee of a third- party employer is required to submit a CalPERS determination to ensure the services provided are considered that of a true independent contractor position. All third-party employers are required to notify any individual they are having work for the City of Long Beach of this requirement. You may reach out directly to CalPERS at membership_reporting@calpers.ca.gov for a determination.

5.3 Contract Terms & Conditions

1. The Awarded Contractor will be the sole point of contract responsibility. The City will look solely to the Awarded Contractor for the performance of all contractual obligations which may result from an award based on this RFP, and the Awarded

Contractor shall not be relieved for the non-performance of any or all subcontractors.

2. The Awarded Contractor…