RFP_PS-26-0006_Exhibit_A_-_Scope_of_Work.pdf

EXHIBIT A – SCOPE OF WORK

RFP PS-26-0006 Occupational Physical Therapy Services

1. Objective

The occupational physical therapy network provider will provide services to the City of Phoenix employees in conjunction with the occupational medical services contractor. The City employs a workforce of over 16,000 employees (full-time, full-time temporary, and part-time). In the last three years, the City has spent the following on physical therapy services for workers’ compensation:

2022 $3,978,656.51 2023 $3,829,968.76 2024 $3,712,927.56 Total $11,521,552.83

2. General Requirements

2.1. The Contractor shall provide occupational physical therapy services at a minimum of thirty-five (35) locations throughout the Phoenix Metropolitan area and all within Maricopa County with extended service hours to include Monday through Saturday and evening hours.

A. The Contractor shall notify the third-party administrators at least one week prior to of any addition or removal of locations.

2.2. The Contractor shall ensure all therapists providing physical therapy services for the City are licensed to perform such services in Arizona. Physical therapy assistants must be certified by the State of Arizona.

A. The City may, but is not required to, inspect and obtain copies of all written licenses, permits, and/or approvals issued by a governmental entity or agency to the Contractor applicable to providing these services

2.3. The Contractor shall provide all labor, tools, equipment, and supplies necessary for performing and documenting these services. The adequacy of all reporting and record keeping shall be determined by the City’s Human Resources Department Safety Division staff.

3. Service Requirements

3.1. The Contractor shall designate a contact person to work in a centralized administrative location, available to the City of Phoenix, to handle all of the administrative issues related to this contract.

A. All procedures implemented as a part of this contract and any changes to those procedures will be coordinated by this contact person.

B. The designated contact person must be available by phone or in person Monday through Friday from 8:00 am to 5:00 pm Arizona time and return all calls to City Safety Division staff as soon as possible, but within twenty-four

(24) hours.

C. The designated contact person must have an understanding of industrial medicine and the medical requirements of federal and state programs.

3.2. The Contractor shall schedule an initial physical therapy evaluation for all employee referrals from the City’s Occupational Medical Services Contractor within one business day of receiving the referral.

A. The City acknowledges that situations beyond the Contractor’s control may arise from time to time which would cause an initial physical therapy evaluation to be delayed and will evaluate these situations on a case-by-case basis. If a pattern of unacceptable initial physical therapy evaluation delays occurs, the City will require the Contractor to provide a written plan of action for the immediate resolution of any delays within the Contractor’s control.

B. If the pattern of scheduling delays that are within the Contractor’s control continues, and the Contractor is unable to provide written documentation as to why the initial evaluation could not be scheduled within one business day, the Contractor agrees to absorb the cost of each initial evaluation which falls in this category.

3.3. The Contractor shall provide each City employee receiving services with an appointment document reflecting the time of arrival and departure from the provider’s facility.

A. The Contractor shall maintain a copy of this document in the employee’s physical therapy record.

3.4. The City ensures payment for up to the first three physical therapy visits of any industrial claim before the claim is denied.

A. If the Contractor is contacted by the third-party administrator or the City’s workers’ compensation staff within the first three visits to discontinue services, the Contractor will comply.

B. The Contractor shall obtain further approval for the continuation of care from the City’s third-party administrator after the first three visits on all other claims.

C. If at any time the third-party administrator is unable to confirm acceptance of the industrial claim, the Contractor shall obtain approval for continuation of care directly from the City’s workers' compensation staff prior to providing services beyond the initial three physical therapy visits.

3.5. The City’s authorized representative shall decide all questions that may arise as to the quality or acceptability of the services performed under the contract.

A. If, in the opinion of the City’s authorized representative, the performance of the services becomes unsatisfactory, the City will notify the Contractor’s designated contact person as soon as possible of the noted discrepancy.

i. The Contractor shall correct any specific instances of unsatisfactory performance according to a time schedule provided by the City’s authorized representative. In the event the unsatisfactory performance is not corrected within the time specified above, the City has the immediate right to complete the services to its satisfaction and bill the Contractor for any costs above the contracted price.

ii. Future referral to any provider that fails to correct unsatisfactory performance is left up to the discretion of the City on a case-by-case basis.

3.6. The City may but is not required to examine any directly appurtenant books, documents, papers, and records of the provider involving any transactions related to these services during the three-year period following the final payment for the services.

A. The City will give the Contractor twenty-four (24) hours’ notice of its request to examine during regular business hours.

3.7. The Contractor shall self-audit and ensure that the contracted percentage of savings stated in the Fee Schedule is being applied correctly to the payments being received and that the Contractor’s facilities are being paid in strict accordance with that percentage of savings.

A. The Contractor’s designated contact person in charge of overseeing the City of Phoenix account will immediately notify the City of Phoenix Human Resources Department Safety Division staff when it is determined that the contracted discounts are not being applied correctly so that immediate action can be taken to identify overpayments.

B. In the event of overpayments to the Contractor’s facilities, the Contractor shall initiate, oversee and ensure prompt refund of overpayments to the City.

C. The Contractor and the City’s third-party administrator will work closely to ensure that all agreed upon discounts are applied correctly in the billing process. If the City’s bills are not audited correctly and the Contractor’s facilities have been overpaid, the Contractor shall immediately recover and return the monies owed to the City.

4. Reporting Requirements

4.1. The Contractor shall provide for immediate electronic delivery of employee status, progress reporting and Subjective, Objective, Assessment, and Plan (SOAP) notes to the referring physician no later than 24 hours after patient appointment.

A. The Contractor will be responsible for maintaining a log of the successful deliveries of electronic SOAP notes from the Contactor location to the referring physician. This log will include:

i. Patient name;

ii. Date of injury;

iii. Date of service;

iv. Contractor location;

v. Name of therapy provider;

vi. Name of treating physician;

vii. Type of electronic transmission (e.g., email, fax);

viii. Delivery address or number (e.g. email, fax);

ix. Date of successful electronic transmission.

B. It is the Contractor’s responsibility to maintain documentation that supports and confirms proof of the date of successful electronic transmission to the treating physician by email or fax.

C. The City reserves the right to request the above log be provided at any time to evaluate contract compliance with communications to treating physicians.

D. If a random audit of 25 transmissions (a maximum of one per quarter) reveals more than 10% of reviewed transmissions did not meet the 24-hour deadline, a $200 performance guarantee will be deducted from the next invoice payment.

4.2. The Contractor shall monitor wait times at its facilities and notify the City of any wait times extending past scheduled appointments.

A. In the event City employees experience excessive wait times beyond ten minutes of the scheduled appointment time at a facility, the City reserves the right to require the Contractor to remove the facility from the City’s program.

B. Future referrals to any facility in the Contractor’s network identified as having excessive wait times as defined above will be left to the discretion of the City on a case-by-case basis.

C. If a clinic/facility within the Contractor’s network has two City employee appointment times in any 30-day period in which the wait time between the scheduled appointment time and the time the employee was called in for treatment exceeded ten minutes, the following will apply: The clinic/facility will be given a written warning. If in the same 30-day period a third appointment at the same facility exceeds the allowed ten minutes, an additional discount for each late appointment will apply and the Contractor agrees to absorb any charges associated with specific cases referred to the specific facility.

4.3. The Contractor shall submit for independent utilization review of all requests for physical therapy in excess of 12 visits per non-surgical industrial case, and 18 visits per surgical industrial case to determine the medical necessity of continued physical therapy.

A. The Contractor shall notify the appropriate claims adjuster at the City’s third-party administrator at the time the case is being referred.

B. If the utilization review criteria are not followed for any reason, the Contractor will provide an additional 10% discount to the City for each individual claim and each individual date of service with therapy that was not timely submitted for review. Timely is defined as one business day after the Contractor becomes aware of the therapist’s recommendation for additional visits.

4.4. The Contractor shall submit a monthly report to City Safety staff and a pertinent Bill Review Contractor staff listing business locations where the network will be providing occupational physical therapy services to City employees. The report will provide the name of the business, if not all the same, the street address, and the telephone number for each location. The types of services for each facility should be listed, as well as operational hours for each location. In addition, an update on newly added or deleted vendors must accompany each monthly report.