Third_Party_Administration_for_Workers_Compensation.pdf

CITY OF TUCSON

REQUEST FOR PROPOSAL

230084

THIRD PARTY ADMINISTRATION FOR WORKERS COMPENSATION

Due Date: Thursday, May 25, 2023

City of Tucson

255 W Alameda St

Tucson, AZ 85701

Procurement portal https://secure.procurenow.com/portal/tucson-az

Public Portal https://secure.procurenow.com/portal/tucson-az/projects/33892

PUBLISH DATE: April 20, 2023 https://secure.procurenow.com/portal/%7Bproject.government.code%7D https://secure.procurenow.com/portal/%7Bproject.government.code%7D/projects/%7Bproject.id%7D https://secure.procurenow.com/portal/%7Bproject.government.code%7D/projects/%7Bproject.id%7D

CITY OF TUCSON REQUEST FOR PROPOSAL NO. 230084

BUSINESS SERVICES DEPARTMENT Page 2 of 52 SHARED SERVICES PROCUREMENT DIVISION RESPONSIBLE CONTRACT OFFICER: Ladd Lyons

255 W. ALAMEDA, 6TH FLOOR, TUCSON, AZ 85701 PH: (520) 837-4113

Attachments:

A - OFFER AND ACCEPTANCE

G - 230084 Third Party Administration for Workers Compensation- Price Page

BUSINESS SERVICES DEPARTMENT Page 3 of 52

A. NOTICE

A.1. CITY OF TUCSON

NOTICE OF REQUEST FOR PROPOSAL NO 230084

TITLE: Third Party Administration for Workers Compensation

SUBMITTAL DUE DATE: Thursday, May 25, 2023 AT 2:00 P.M. LOCAL AZ TIME

PRE-SUBMITTAL CONFERENCE DATE: Tuesday, May 9, 2023

TIME: 10:30 am LOCAL AZ TIME

LOCATION: TEAMS MEETING https://teams.microsoft.com/l/meetup-join/19%3ameeting_OTE2ZDNkYzUtZjYwYS00NzI3LTk4ZGQtZmM4Nzk4NmUyOWRh%40thread.v2 /0?context=%7b%22Tid%22%3a%22d21e59ec-c208-43eb-aaf1-cf06d9a196e0%22%2c%22Oid%22%3a%22f1bbce9c-2eb2-4c80-b35f-94c94cf35b93%22%7d

QUESTIONS SHALL BE DIRECTED TO: Ladd Lyons

(520) 837-4113 ladd.lyons@tucsonaz.gov

Posted Date: Thursday, April 20, 2023

Competitive sealed offers for the material or service specified in this solicitation must be submitted through the City’s online bidding system. No late submitted offer will be accepted or considered.

Reponses submitted in physical form or by facsimile or email will not be considered. Offerors are cautioned to commence the submittal process sufficiently ahead of time to allow for unanticipated delays resulting from things like a slow internet connection, internet outage, difficulty uploading large documents, differing system requirements, etc.

Questions about this solicitation must be addressed to the responsible Contract Officer listed herein.

BUSINESS SERVICES DEPARTMENT Page 4 of 52

B. INTRODUCTION

B.1. Summary

The City of Tucson is seeking bundled and/or unbundled proposals from specialist firms for third party administration (TPA) services for workers’ compensation claims, per specifications called for herein.

The City is requesting that the Contractor provides a definition of an indemnity adjuster and medical only adjuster.

The City is looking for a best value solution with a multi-year TPA contract and is requesting bundled and/or unbundled responses from TPA’s. The City may at a later date chose to perform any of these services in house. The city has a preference for a fully bundled solution but reserves the right in subsequent years to evaluate the value and performance of these ancillary services:

• Comprehensive Bill Review and Audit

• Utilization Review

• Pharmacy Benefit Management

• PPO and Other Network Services

• MSA Preparation

• CMS Lien Investigation

• Telephonic Case Management

• Field Case Management

• Other

The TPA shall be expected to provide data to demonstrate successful outcomes and added value of these ancillary services in six (6) month intervals. It is the expectation of the client that the TPA make recommendations and manage the use of the vendors necessary to provide these services. Finally we ask that you list the vendors that will be providing the above to include what services they provide and the length of your relationship with said vendor. If TPA will be providing any of the above services in house, please provide a list of these services.

The City is a full service, qualified self-insurer authorized by the Industrial Commission of Arizona. The City employs approximately 4750 employees and has filed an average of 453 claims per year for the last five years. The claims history for recent years is as follows:

Year Total Claim Indemnity Medical Only

2021/2022 351 136 215

2020/2021 426 166 260

2019/2020 478 191 287

2018/2019 483 170 313

2017/2018 530 171 359

BUSINESS SERVICES DEPARTMENT Page 5 of 52

The Contractor must be experienced in administering claims in accordance with Arizona Workers Compensation law and will provide services for all workers compensation claims for the City including new claims and run-off or “tail” claims. Offerors must carefully examine the Scope of Work to determine the risks to be covered. The City will assume that each Offeror has made such investigations and is fully informed of the extent and character of any and all requirements included in the Scope of Work.

The contractor will be licensed to conduct business in the State of Arizona. The Contractor agrees that all services performed pursuant to the Contract will be rendered through an Arizona-based office. The employees assigned to work under the Contract will have the appropriate adjuster’s license, experience and training applicable to the types of claims they are handling, i.e. Senior Adjusters must have the experience to properly handle indemnity claims in accordance with Arizona Workers Compensation law. The Contractor will assign dedicated adjusters to the City with no more than 100 indemnity claims per indemnity adjuster and no more than 200 medical only and/or low activity claims to medical only adjusters. Assigned adjusters must be permanent employees of the contractor (non-permanent employees are not permitted assignments under this contract). The City retains the right at any time during the Contract to prohibit any of the Contractor’s staff from performing services on behalf of the City. The City may request a specific staff member employed by the Contractor to perform one or more particular assignments.

Failure to maintain and adequately staff an Arizona-based office, perform all claims services timely and competently in compliance with Arizona workers compensation law, and to protect the City’s interests at all times against actions resulting in a conclusion of bad faith by the City, will be a material breach of the Contract and will be grounds for termination of the contract. The City reserves the right to unbundle specific elements of service associated with the City’s workers compensation claims. These can include, but are not limited to medical case management, bill review cost containment, utilization review, and pharmacy benefit management.

Offeror should submit a response in both PDF and WORD unprotected.

B.2. Contact Information

Ladd Lyons Contract Officer Email: ladd.lyons@tucsonaz.gov Phone: (520) 837-4113 Department:

Human Resources

B.3. Timeline mailto:ladd.lyons@tucsonaz.gov tel:(520)837-4113

BUSINESS SERVICES DEPARTMENT Page 6 of 52

Release Project Date April 20, 2023

Pre-Proposal Meeting (Non- Mandatory)

May 9, 2023, 10:30am

TEAMS MEETING

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Question Submission Deadline May 12, 2023, 5:00pm

Proposal Submission Deadline May 25, 2023, 2:00pm https://teams.microsoft.com/l/meetup-join/19%3ameeting_OTE2ZDNkYzUtZjYwYS00NzI3LTk4ZGQtZmM4Nzk4NmUyOWRh%40thread.v2/0?context=%7b%22Tid%22%3a%22d21e59ec-c208-43eb-aaf1-cf06d9a196e0%22%2c%22Oid%22%3a%22f1bbce9c-2eb2-4c80-b35f-94c94cf35b93%22%7d https://teams.microsoft.com/l/meetup-join/19%3ameeting_OTE2ZDNkYzUtZjYwYS00NzI3LTk4ZGQtZmM4Nzk4NmUyOWRh%40thread.v2/0?context=%7b%22Tid%22%3a%22d21e59ec-c208-43eb-aaf1-cf06d9a196e0%22%2c%22Oid%22%3a%22f1bbce9c-2eb2-4c80-b35f-94c94cf35b93%22%7d https://teams.microsoft.com/l/meetup-join/19%3ameeting_OTE2ZDNkYzUtZjYwYS00NzI3LTk4ZGQtZmM4Nzk4NmUyOWRh%40thread.v2/0?context=%7b%22Tid%22%3a%22d21e59ec-c208-43eb-aaf1-cf06d9a196e0%22%2c%22Oid%22%3a%22f1bbce9c-2eb2-4c80-b35f-94c94cf35b93%22%7d https://teams.microsoft.com/l/meetup-join/19%3ameeting_OTE2ZDNkYzUtZjYwYS00NzI3LTk4ZGQtZmM4Nzk4NmUyOWRh%40thread.v2/0?context=%7b%22Tid%22%3a%22d21e59ec-c208-43eb-aaf1-cf06d9a196e0%22%2c%22Oid%22%3a%22f1bbce9c-2eb2-4c80-b35f-94c94cf35b93%22%7d https://teams.microsoft.com/l/meetup-join/19%3ameeting_OTE2ZDNkYzUtZjYwYS00NzI3LTk4ZGQtZmM4Nzk4NmUyOWRh%40thread.v2/0?context=%7b%22Tid%22%3a%22d21e59ec-c208-43eb-aaf1-cf06d9a196e0%22%2c%22Oid%22%3a%22f1bbce9c-2eb2-4c80-b35f-94c94cf35b93%22%7d https://teams.microsoft.com/l/meetup-join/19%3ameeting_OTE2ZDNkYzUtZjYwYS00NzI3LTk4ZGQtZmM4Nzk4NmUyOWRh%40thread.v2/0?context=%7b%22Tid%22%3a%22d21e59ec-c208-43eb-aaf1-cf06d9a196e0%22%2c%22Oid%22%3a%22f1bbce9c-2eb2-4c80-b35f-94c94cf35b93%22%7d https://teams.microsoft.com/l/meetup-join/19%3ameeting_OTE2ZDNkYzUtZjYwYS00NzI3LTk4ZGQtZmM4Nzk4NmUyOWRh%40thread.v2/0?context=%7b%22Tid%22%3a%22d21e59ec-c208-43eb-aaf1-cf06d9a196e0%22%2c%22Oid%22%3a%22f1bbce9c-2eb2-4c80-b35f-94c94cf35b93%22%7d

BUSINESS SERVICES DEPARTMENT Page 7 of 52

C. SCOPE OF WORK

C.1. Claims Administration

A. Compensability

• Contractor will determine compensability of injuries and illnesses in accordance with Arizona’s workers compensation law. Questionable claims will be discussed with City Risk Management prior to a decision being made and Notice of Claim Status being issued; and no claim will be denied without prior approval from the City.

• Contractor will perform a three-point contact, (employee, City Risk Management and/or the employee’s department, and the evaluating/treating physician) within one (1) working day of receipt of lost time claims and will document the information in the claims file and/or the claims software program.

• Claims in which validity is questioned will be investigated to include, but not be limited to: on-site investigations, recorded statements of all parties involved, medical record reviews, and possibly Independent Medical Examinations (IME). These investigations will commence prior to issuance of any denial, time permitting, and will be discussed with the City’s Risk Management Division prior to accepting or denying the claim.

• If the claim is denied, prior to mailing the Notice of Claim Status (NCS), the adjuster will contact and personally advise, or attempt to personally advise, the employee that a denial of their work-related claim is being issued and the reason(s) for the denial. If no phone number is available, or the adjuster is unable to reach the employee by phone, Contractor will simultaneously issue the NCS and send a letter to the employee with the adjuster’s contact information. In cases where the Contractor intends to deny a claim but does not have notification from the Industrial Commission of Arizona (ICA), Contractor will send the employee a “letter of intent” to deny the claim, copying City Risk Management and the medical provider.

Contractor will make the same attempts to call/notify the employee of the intent to deny their claim.

• Contractor will contact City Risk Management within three (3) working days of receipt of a Workers & Physician’s Report of Injury, Form 102 if an Employer’s Report of Injury, Form 101 has not been received. Claims are not to be denied based solely on the absence of an Employer’s Report of Injury.

B. Claim Management

• The contractor will create a Workers’ Compensation Claims Manual, with input from the City, for the program, outlining roles and responsibilities for all involved in the program within the first six (6) months of the contract to include but not limited to the following:

• Contractor will perform all work necessary to effectively manage each accepted claim, including, but not limited to: determining eligibility for and authorizing payment of all appropriate medical and indemnity benefits in a timely manner and in compliance with Arizona workers compensation laws. All bills will be reviewed as outlined in the cost-containment section of this contract.

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• “Medical only” claims will be managed in the same way as indemnity or lost time claims with respect to diary and medical management. A Notice of Claim Status will be issued on each claim notifying the employee of whether their claim is accepted or denied. Claims will not be accepted solely by responding to the notification list from the ICA.

• Contractor will review physician findings and consult with doctors to resolve medical questions.

• Contractor will pay indemnity benefits appropriately and timely on all lost time claims. The City has a salary continuation benefit for permanent employees of up to six (6) months. Contractor will work closely with City Risk Management to: determine which employees qualify for the salary continuation benefit; determine the amount of temporary compensation benefits to be paid by pay voucher; and determine when to discontinue the pay voucher and pay live checks to the employee. Contractor will properly record compensation and not overpay the employee.

• Contractor will aggressively monitor claims to ensure the best possible medical outcome.

Contractor will make recommendations for the following services which must be pre-approved by City Risk Management and acted on timely once services are approved:

o In Person Nurse Case Management o Independent Medical Evaluations o Investigation and surveillance o Special Investigation Unit i.e., Social Media o Vocational Rehabilitation o Labor Market Consults o Functional Capacity Evaluations o Attorney assignment and legal services o Subrogation Reports- detailed Quarterly and Annual Report

• City Risk Management retains the right to designate the providers performing all the services listed above, (section 1 B. Paragraph 6).

• Contractor will act timely and appropriately, and in accordance with Arizona workers compensation law on information/documentation provided as a result of the services listed above.

• Contractor will work closely with the employee and the employee’s department on all cases involving light/modified duty, providing City Risk Management with the following:

o Date the employee was released to light/modified work o Specific restrictions o Did the employee return to work?

o If yes, what day? (Was the date the employee returned to work the date of release and/or the first scheduled day?) Is the employee performing essential functions? Or transfer or modification of duties?

BUSINESS SERVICES DEPARTMENT Page 9 of 52 o If not returned to light duty when released, why not? Was modified duty available? If yes, what date and was the employee notified? If not, why not?

• Contractor will review all permanent impairment ratings for appropriateness and make recommendations to City Risk Management if the rating is questionable or unsupported. Once the permanent impairment is determined to be appropriate, the Contractor will review the claim for potential apportionment opportunities, or prior credits on the claim and will provide documentation of that review to City Risk Management prior to issuing closing notices.

Contractor may use the City’s template for this purpose or utilize a similar format as long as it covers the areas of review required by Risk Management. Contractor will notify City Risk Management of any claims where the Special Fund has approved apportionment, monitor and request the annual reimbursement, and report the annual reimbursement to the City.

Contractor will notify Human Resources immediately if it is determined employee cannot return to work.

• Contractor will close all claims timely and issue the appropriate notices and supporting documentation when the claim has come to conclusion.

• Contractor will pay permanent disability compensation benefits timely, in compliance with Arizona law, Findings & Awards, and/or settlement agreements. An Annual Report of Income will be required on all Loss of Earning (LEC) claims. Contractor will review all LEC claims annually for any potential changes in earning capacity and/or the potential for rearrangement.

Contractor will discuss their findings with City Risk Management to determine what action to take, if any.

• Contractor will pay death benefits timely, and in accordance with Arizona law, Findings & Awards and/or settlement agreements. The widow/widower affidavit is required to be submitted annually on all death claims. Contractor will also monitor all minors receiving benefits and require documentation of college attendance semi-annually for dependents receiving benefits after age 18. Contractor will contact City Risk Management on any claims wherein the widow/widower has remarried; the dependent has ceased to attend college full time, or has achieved the age of 21.

• Contractor will notify City Risk Management of lost time claims approaching three (3) months of time lost, or sooner if restrictions are determined to be permanent, for the purpose of determining if the employee can be returned to work with or without a reasonable accommodation under the American’s with Disabilities Act, ADA.

• Contractor will be available for a bi-weekly claims call, at a minimum, to discuss claims that need prior authorization for services, a decision to deny, post litigation plan of action, etc.

C. Subrogation

• Contractor will investigate all claims in either a bundled or unbundle approach for potential third party recovery at no additional cost to the City. Once a third party has been identified, the Contractor will notify City Risk Management via email advising of potential subrogation and recommending an approach for collection.

• Contractors will pursue every avenue necessary to recover funds and protect the lien rights of the City. Per City of Tucson Code Sec. 2-13(2), if a remedy is pursued as allowed by A.R.S.

23-1023, the City will have a lien on the amount actually collectible, to the extent of the monies

BUSINESS SERVICES DEPARTMENT Page 10 of 52 paid by the City pursuant to this section. The amount actually collectible will be the total recovery less allocated loss expenses, including attorney fees.

• Contractor will keep City Risk Management informed, via email, of the status of all activity with regard to recovery of funds from a third party and document all attempts in the electronic claim file.

• Contractor will not abandon any attempt for subrogation recovery without the express approval of City Risk Management.

• Contractor will record all recovery checks on the claim and deposit them into the City’s bank account managed by the Contractor. Contractor will include subrogation recovery in the weekly check register provided to City Risk Management.

• Contractor will submit all requests for reduction in the lien and future credits to City Risk Management. Any waiver or reduction of any lien must be approved by the City.

• Contractor will notify employees or their attorney and any applicable court of the existence of workers’ compensation liens and will issue the appropriate Notice of Claim Status with the lien amount.

• Contractor will have zero settlement authority.

D. Supportive Care

• Contractor will review all supportive care claims on an annual basis and discuss any recommended actions for change with City Risk Management.

• Contractor will notify injured workers 30 days in advance of terminating their supportive care award. Notification will be by phone, in writing, or both, depending on the history of the award and will include the adjuster’s name and contact information.

E. Reserves

• Contractor will review all active claims quarterly for appropriateness. Reserve worksheets, will be completed and on file, and provided to City Risk Management when an increase, or a significant decrease is being recommended. Contractor will document all reserve changes in the claim notes.

• All reserve increases of $50,000 or greater must be approved by City Risk Management.

• Contractor will review all lifetime and large loss claims on an annual basis for appropriate reserving. The review will be completed by November 30th of each year.

F. Cost Containment

• Contractor will provide a comprehensive program designed to ensure all medical bills are reviewed and processed for payment in accordance with the Arizona Fee Schedule, and discounted pursuant to any City-provided or Contractor-provided PPO Network or other managed-care contracts/agreements. Contractor will also provide hospital bill/surgical center review and discounting. This service may be done by the contractor, or a sub-contractor, as agreed upon by the City. The City also retains the right to contract separately for bill review and PPO discount services. The contractor will remain responsible for coordination of claims payments with the bill review contractor.

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• If the Contractor provides a PPO Network, the Contractor will make every effort to ensure quality health care services are provided on a cost-effective basis and contains sufficient health care providers to ensure that employees have access to specialists and ancillary services as medically necessary and authorized by the City.

• Contractor will make a determination whether to deny or pay a medical bill on an accepted claim, in whole or in part, including the decision as to the amount to pay, within thirty days from the date the claim is accepted, if the billing is received before the date of acceptance, or within thirty days from the date of receipt of the billing if the billing is received after the date of acceptance; and, payment will be made within thirty days after the determination is made. Any interest incurred for bills not paid as outlined above will not be the responsibility of the City to pay, but instead will be paid by the Contractor.

• Payment may be made on denied bills as approved by City Risk Management, i.e. City contracted services for the initial evaluation by the City’s designated providers.

• All medical bills will be reviewed for processing to determine the lowest possible rate, (fee schedule and any applicable cost-containment programs such as PPOs, etc.).

• Contractor will arrange for discounts with local area hospitals if they are not already included in a PPO Network, or contract/agreement of a comprehensive managed care program.

• Cost containment detailed reports will be submitted quarterly to City Risk Management on a quarterly basis, with an annual report submitted during the stewardship meeting.

• The City reserves the right to unbundle specific elements of service associated with the City’s workers compensation claims. These can include, but are not limited to, medical case management, bill review, cost containment, utilization review, and pharmacy benefit management.

G. Litigation Management

• All requests for defense counsel must be pre-approved by City Risk Management. Once approved, contractor will promptly, and no later than ten (10) calendar days, provide the complete claims file, and any other appropriate documents to the assigned attorney.

• City Risk Management will be copied on all litigation correspondence.

• Claims handling functions, specifically non-litigated functions, are not to be transferred to defense counsel subsequent to the initiation of litigation. Assignment of defense counsel does not eliminate the Contractor’s responsibility for prompt investigation, claim evaluation and management, when appropriate.

• Contractor will work closely with defense counsel and the City on litigated cases.

• Contractor will review all Findings & Awards promptly to determine if a request for review is recommended. Recommendations for a request for review must be approved by City Risk Management.

• Contractor will timely pay any and all benefits due the injured worker as awarded once the award becomes final.

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C.2. Communication

• Contractor will work closely with City Risk Management and communicate via telephone, facsimile, correspondence (US mail) and/or email, including encrypted or password protected email, depending on the circumstances, and as agreed upon by the City. Documentation of communication must be made in the claims software program immediately to ensure the most up to date information is available for the City’s review. All Medical documentation and information provided to the City via email must be encrypted/password protected.

• Contractor will promptly return phone calls from City employees, current and separated, within 24 hours of receipt of the call (excluding weekends and holidays).

• Contractor will respond to written correspondence from injured workers within three (3) business days of receipt of the correspondence, and when requested, must send a copy to City Risk Management.

• Contractor will ensure that City Risk Management will be copied on all correspondence regarding:

1. Litigation

2. Subrogation

3. Excess insurance

4. Labor market consultants

5. Nurse case management

6. Functional capacity evaluations

7. Investigation and surveillance

8. Vocational rehabilitation

9. Reserve Changes

10. Denied Claims

11. Independent Medical Exams

• Contractor will provide City Risk Management with copies of medical records from specialists, diagnostics and hospital admission/discharge and surgical reports, upon request of the City.

• Contractor will provide timely IME reports to the employee, the treating physicians and City Risk Management.

• Contractor will alert City Risk Management of statute changes, court decisions (state and federal) and ICA procedures that impact the workers’ compensation program.

• The Contractor will agree not to discuss the nature of any claim, or the amount paid or reserved under it, with any person who is not a party to this contract, except when and to the extent that the City authorizes the Contractor to do so, or when ordered by a court of competent jurisdiction.

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• The City retains the right at any time during the Contract to prohibit any of the Contractor’s staff from performing services on behalf of the City. The City may request a specific staff member employed by the Contractor to perform one or more particular assignments.

• The City retains the right at any time during the Contract to prohibit specific subcontractors from performing services on behalf of the City.

C.3. Reporting

• Contractor will provide the City with industry standard electronic reports including case information, program and department statistics, benchmarking, cost reduction, improving care and analytics to assist in managing the program. Contractor will ensure reports substantiate documentation provided by including detail and summary. Standard reports will include:

1. Claims summary by department, loss type and comparison to claim history.

2. Lag reports.

3. Loss ratio.

4. New/closed claims.

5. High exposure claims.

6. Open/closed claims.

7. Subrogation report.

8. Cause of loss, claim detail report.

9. Monthly report of denied claims.

10. Current litigated claims report

11. Reserve Reports

12. PPO detailed reports

13. Cost Containment Reports

14. Monthly Bank Statements and reconciliations

15. Data reporting meeting Excess Carrier’s serious injury criteria

• Loss runs not limited to, the following: employee name, date of loss, description of injury;

cause, body part, injury type and: medical paid and reserved; indemnity paid and reserved;

total incurred loss; expenses paid and reserved; vocational rehabilitation paid and reserved;

and, contain a field for recovery payments/collections. Loss runs should be provided for periods of time as requested by the City.

• Data required for the City’s Self-Insurers Annual Request submission to the Industrial Commission of Arizona.

• Data required for the City’s Self-Insurers Annual Request submission to the Industrial Commission of Arizona for the annual Fire Fighters Cancer Reporting.

BUSINESS SERVICES DEPARTMENT Page 14 of 52

• Data required for the City’s Self-Insurers Annual tax reporting to the Industrial Commission of Arizona.

• Contractor will serve as the Account Manager/Technical Contact and Submission Agent for Section111 Mandatory Reporting. Contractor will implement and maintain proper safeguards against unauthorized use and disclosure of the data exchanged for the purpose of complying with the Medicare Secondary Payer Mandatory Reporting Provision in Section 111 of the Medicare, Medicaid and SCHIP Extension Act, (MMSEA) of 2007; and promptly and timely provide all reporting required to maintain compliance.

• Contractor will provide reports necessary required by Medicare, Medicaid SCHIP Extension Act MMSEA and/or Workers’ Compensation Medicare Set-aside Arrangement, (WCMSA).

• Contractor will submit reports on all applicable claims to the City’s excess insurance carrier at their request. City Risk Management will be copied on all correspondence directed to the excess insurance carrier.

• Ad Hoc Loss run reporting needed for specific projects.

• Maintain and produce accurate OSHA 300 reports monthly which will be accomplished by the process of continuous tracking, monitoring and updating claims meeting the OSHA criteria by the TPA and by adding City specific data provided by the City. Discrepancies may be identified by either the City and/or the TPA, and corrections to the log made by the TPA will need to be done in a timely manner to ensure federal compliance.

• Provide an email alert when a city employee has passed. Any additional reports and required documents for internal and external auditors at the City’s request.

C.4. Record keeping/Data Base Services and Access

• Contractor will maintain complete records on all active and inactive reported claims on behalf of, and as custodian for, the City. Contractor will provide real-time access to the data and the means to create specific loss reports. City will have access for multiple users and the ability to add notes to employee files in the Contractor’s claim software program/database and the ability to electronically submit claim forms required by the State of Arizona.

• Documentation will include, but is not limited to: the status of the claim, contact information for all parties involved, basic claim information such as description of injury, average monthly wage, whether the claim is OSHA recordable, an action plan outlining medical management of the claim and objectives to bring the claim to successful conclusion, financial information including what was paid, reimbursed and collected, reserve information, and prior claim history.

• Contractor will maintain and update the RMIS file as needed at no additional charge.

• At the end of the contract period, and as part of the transition from the incumbent TPA to the newly contracted TPA, data conversion of all data on existing claims, including run-off claims between the incumbent TPA and the newly contracted TPA will be handled at no cost to the City of Tucson. Data conversion will be timely and scheduled to be done at a time agreed upon by all parties. Data conversion will be validated by the new TPA prior to the date established to receive new claims and begin claims administration.

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C.5. Data Security

• The contractor will be responsible for the protection of all data, including personally identifiable information (PII), confidential data, and sensitive data. The contractor shall describe all data protection systems and procedures within their organization, including but not limited to physical, administrative, and technical safeguards, incident response plans, and data backup and recovery procedures. The contractor shall also certify that they are in compliance with all applicable data protection laws and regulations.

C.6. Banking

• Contractor will establish a bank account on behalf of the City which will be funded by electronic fund transfer, (EFT) in an amount determined by the City at the time the account is opened.

The City will replenish the account weekly for the amount of payments processed.

• Contractor will assume all annual banking fees for the account.

• Contractor will make payments on a weekly basis and provide City Risk Management and designated City staff with a weekly check register including all payments made, voided transactions, voucher payment records, and collections, (either third party recovery or reimbursement). The register will provide a summary of the claim and payee information to include, but not limited to: employee name/claim number, date of injury, date processed, payee, type of payment/description, service dates, amount of payment, and the category of payment.

• Contractor will submit all bills meeting a threshold amount established by the City for Second Signature review prior to releasing the payment.

• Contractor will print checks that meet banking MICR standards.

• Contractor will send the electronic check data to the bank for every check written to reduce the probability of fraud.

• Future scheduled payments will not be listed on the check register that is submitted to the City for reimbursement.

• Contractor will be responsible for a monthly bank account reconciliation and provide to the City a copy of the reconciliation along with a detailed and a summary report upon completion.

C.7. City of Tucson RMIS

Contractor will Maintain electronic feeds with City of Tucson RMIS

Hierarchy and organizational structure maintenance

• System access to losses, financials and reserves

• Adjuster and supervisor notes access

• State annual and periodic reporting as required

• Periodic cost containment reports

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• Customer Service unit support

• Maintenance of electronic data exchanges

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D. INSTRUCTIONS TO OFFERORS

D.1. DEFINITION OF KEY WORDS USED IN THE SOLICITATION

For purposes of this solicitation and any subsequent contract, the following terms have the meanings set forth below:

City:The City of Tucson, Arizona

Contract:The legal agreement(s) executed between City and the Successful Offeror(s). The Contract will be deemed to include all the conditions and requirements set forth in this solicitation and any Addenda to the solicitation, all the Special Terms and Conditions and Standard Terms and Conditions, and all the terms of the Offer submitted by Offeror as finally negotiated and accepted by the City.

Contractor/Consultant:A Successful Offeror that enters into a Contract with the City.

Contract Representative:The City employee or employees who have been designated to act as the City contact for this solicitation process and who are responsible for monitoring and overseeing the Contractor's performance under the Contract.

Business Services Director:The contracting authority for the City, authorized to sign contracts and addenda thereto on behalf of the City.

May: Indicates something that is not mandatory but permissible.

May not:The indicated party is prohibited from taking the action.

Must: The action or condition is required.

Offer:Any proposal, statement of qualifications, bid, or other submission provided by an Offeror in response to this Solicitation.

Offeror: Each individual or entity that submits an Offer in response to this solicitation.

Successful Offeror: An Offeror who received a Notice of Award or a Notice of Intent to Award from the City.

Will:The indicated party is promising to take the action or abide by the condition.

D.2. PRE-SUBMITTAL MEETING

A Pre-Submittal Meeting will be held at the date and time stated on the cover page of this solicitation, if such a date and time is provided. Attendance at this meeting is not mandatory, but written minutes and/or notes regarding the meeting will NOT be provided, so attendance is encouraged. The purpose of this meeting will be to clarify the contents of this solicitation in order to prevent any misunderstanding of the City's position.

D.3. INQUIRIES

Any questions about this solicitation or the proposed Contract must be presented at the Pre-Submittal Meeting, if there is one (see above), or submitted in writing, via email, or through the online bidding system, to the Contract Officer by the Question Submission Deadline. The email must refer to the solicitation number and the paragraph number of the provision that the question concerns. The Contract

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Officer may respond by email or may, if they deem it appropriate, address the question in a solicitation addendum or response through the question and answer portal in the online bidding system. Offeror may not rely on oral interpretations or clarifications about the solicitation; only questions answered in an email by the Contract Officer, posted through the online bidding system, or posted as a formal solicitation addendum will be binding.

D.4. ADDENDUM OF SOLICITATION

Solicitation Addenda will be posted on the City’s link to the online bidding website. Offeror is responsible for checking the webpage regularly for new solicitation addenda and must acknowledge each addendum to this solicitation in its submittal. Please note that vendors who have registered with the Business Services Department at https://procurement.opengov.com/portalucson-az and follow the City of Tucson will receive email notifications of solicitation addenda.

D.5. UNDERSTANDING SCOPE OF WORK

Before submitting an Offer to this solicitation, Offeror must familiarize itself with the Scope of Work, laws, regulations, physical conditions, and other factors affecting the obligations – including the expense and difficulty of fulfilling those obligations – that Offeror will have under the Contract if awarded to Offeror. No adjustment to the financial or other terms of the Contract will be justified by Offeror’s failure to fully understand or appreciate the Contract requirements or other factors affecting Contract performance.

D.6. PREPARATION OF OFFER

A. Form and Organization. If Offer forms are included in this Solicitation, Offeror’s Submittal must be on those forms. Supporting documentation must be arranged in a manner that follows and clearly refers to corresponding sections of the solicitation. Offeror may copy the submittal forms in order to complete them electronically but may not alter or rearrange them or change any paragraph designations.

B. Confidential Information. Any information in its submittal that Offeror wishes to be treated as confidential must be clearly marked “CONFIDENTIAL.”

C. Offer Contents. Offeror’s submittal must contain responses to all sections of this solicitation, any Offer forms provided must be completed and any requested supporting documentation must be attached.

D. Signatures. Offeror must include in their submittal signed copies of the Offer and Acceptance page. Any cover letter accompanying the proposal documents must be signed. Offeror must initial each erasure, interlineation or other modification in the submittal. The person signing and initialing on behalf of Offeror must be a person authorized to legally bind Offeror.

E. Prices. Where a unit price is provided it will govern over any erroneous extension of the price.

F. Time Periods. Periods of time, stated as a number of days, will be calendar days unless specifically stated otherwise.

G. Accuracy. Mistakes in preparation of its submittal confers on Offeror no right to modify or withdraw its submittal after the Submittal Deadline.

https://procurement.opengov.com/portalucson-az

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H. Cost of Preparation. The City will not reimburse Offeror for the cost of developing, presenting, submitting or providing any response to this solicitation.

I. Subcontractors. Offeror must, in their submittal, list any subcontractors that it will utilize in the performance of the Contract if they are awarded the Contract and must describe their qualifications in detail.

J. Incomplete Information. Failure to include all requested information may have a negative impact on the evaluation of Offeror’s submittal.

D.7. PAYMENT DISCOUNTS

Payment discount periods shall be computed from the date of receipt of the material/service or correct invoice, whichever is later, to the date City’s payment warrant is mailed. Unless freight and other charges are itemized, any discount provided shall be taken on full amount of invoice. Payment discounts of twenty-one calendar days or more shall be deducted from the proposed price in determining the price points. However, the City shall be entitled to take advantage of any payment discount offered by a vendor provided payment is made within the discount period. The payment discount shall apply to all purchases and to all payment methods.

D.8. TAXES

The City is exempt from federal excise tax, including the federal transportation tax, but is not exempt from any other taxes, including state and local sales and excise taxes.

D.9. EXCEPTIONS TO CONTRACT PROVISIONS

By submitting an offer in response to this solicitation, Offeror is offering to enter into the Contract with the City. If Offeror wishes to modify any Contract terms and conditions, Offeror must, in its Offer, clearly identify the changes it is requesting. No requested modification will be deemed accepted by the City unless and until the City’s Business Services Director or their designee expressly accepts it in writing.

D.10. PUBLIC RECORD

Any documents submitted by Offeror in response to this solicitation will become the property of the City.

Except as set forth below with respect to Confidential Information, the Submittal will be deemed to be a public record available for review by the public after the award notification.

D.11. CONFIDENTIAL INFORMATION

The City is obligated to abide by the Arizona Public Records Law, A.R.S. §§ 39-101 through 39-161. If Offeror believes that any portion of its Offer, specification, protest or correspondence contains information that is confidential and subject to being withheld from disclosure in the event that the City receives a public records request to which the record is responsive, Offeror must, when the record is submitted, provide the Contract Officer written notification of that fact. The records or portions of records that Offeror wishes to be treated as confidential must also be clearly marked “CONFIDENTIAL” on their face. Pricing will not be treated as confidential.

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If the City, after award notification, receives a public-records request the scope of which includes a document submitted by Offeror and marked "CONFIDENTIAL", the Contract Officer will make a written determination regarding whether the document will be provided to the requestor. If the Contract Officer determines that the document should be released, City will notify Offeror in writing. Unless Offeror, within 10 days after the date of that notice, obtains and provides to City an order from a court of competent jurisdiction prohibiting the City from releasing the documents, the City may release the documents without any liability to Offeror.

D.12. WHEN AND HOW TO SUBMIT OFFERS

In order to be considered, Offeror must, no later than the Offer Submittal Deadline, submit its Offer electronically through the City’s online bidding system: https://procurement.opengov.com/portalucson-az.

NOTE: THE ENTIRE OFFER MUST BE IN "“SUBMITTED"” STATUS IN THE CITY’S ONLINE

BIDDING SYSTEM IN ORDER TO BE CONSIDERED. RESPONSES THAT HAVE BEEN CREATED

IN THE SYSTEM, BUT THAT ARE NOT IN "“SUBMITTED"” STATUS BY THE OFFER SUBMITTAL

DEADLINE WILL NOT BE CONSIDERED.

D.13. CERTIFICATION OF NONCOLLUSION; CONFLICTS OF INTEREST

Offeror will not communicate, orally or in writing, with any member of the Mayor and Council, or with any City staff outside the Procurement Division of the Business Services Department, regarding this Solicitation. By submitting an Offer, Offeror warrants that:

A. Preparation and submission of the submittal did not involve collusion or other anti-competitive practices.

B. Offeror has not given, offered to give, nor intends to give at any time hereafter, any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, meal or service to a public servant in connection with this solicitation.

C. No person has been employed or retained to solicit or secure a Contract under this solicitation upon a promise of a commission, percentage, brokerage, or contingent fee.

D. No employee of the City involved in this Solicitation process, or any family member of such an employee, has any substantial financial interest in Offeror’s firm. No member of the City of Tucson Mayor and Council who has, or whose family member has, any substantial financial interest in Offeror’s firm will participate in any action taken by the Mayor and Council with respect to this Contract. The terms “relative” and “substantial interest” have the meanings assigned in A.R.S. § 38-502

The City may disqualify Offeror from further participation in the solicitation process if the City determines that any City employee or official involved in this Solicitation process has an actual or apparent conflict of interest or if Offeror has engaged in any collusion or anti-competitive practices.

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D.14. WITHDRAWAL OF OFFER; BINDING OFFER

By submitting an Offer in response to this Solicitation, Offeror is offering to enter into the Contract with the City. Offeror may withdraw a submitted Offer at any time prior to the Offer Submittal Deadline.

Telephonic or oral withdrawals are not effective.

Offeror cannot withdraw an Offer that is in “submitted” status as of the Offer Submittal Deadline unless the Director of the Business Services Department consents in writing to the withdrawal. The Offer will be irrevocable for 90 days after the Offer Submittal Deadline.

D.15. DISCUSSIONS

The City may, at its discretion, conduct discussions with Offeror for the purpose of eliminating minor irregularities, informalities, or apparent clerical mistakes in Offeror’s submittal in order to clarify the offer and assure full understanding of, and responsiveness to, solicitation requirements.

D.16. VENDOR REGISTRATION; BUSINESS LICENSE

In order to be eligible for award of a Contract, Offeror must:

A. Register with the City’s Business Services Department. Registration can be completed at https://procurement.opengov.com/portalucson-az.

B. Obtain a City of Tucson Business License or a written determination from the City's Business License Section that a license is not required. Application for a City Business License can be completed at http://www.tucsonaz.gov/etax. For questions contact the City's Business License Section at (520) 791- 4566 or email at tax-license@tucsonaz.gov

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E. OFFER EVALUATION AND CONTRACT AWARD

E.1. PROPOSAL EVALUATION CRITERIA – (listed in relative order of importance)

A. Method of Approach

B. Price Proposal

C. Qualifications and Experience

E.2. INTERVIEWS

The City may interview some or all of the offerors at any point during the evaluation process. If interviews are conducted, information provided during the interview process will be taken into consideration in the evaluation process. The City will not reimburse the Offeror for any costs Offeror incurs during its participation in the interview process.

E.3. ADDITIONAL INVESTIGATIONS

The City may undertake any additional investigations it deems appropriate to evaluate the competence and financial stability of any offeror.

E.4. OTHER INFORMATION

Information that evaluation committee members have about an offeror beyond what is provided in the offeror’s Offer may be taken into consideration during the evaluation process.

E.5. PRICE

A. Tax Offset Policy. If applicable under Section 28-18(6) or Section 28-17(7)(d) of the Tucson Procurement Code, the City will include the amount of all business privilege taxes other than the City’s in evaluating the pricing component of each Offer.

B. Payment Discounts. Any discounts offered by Offeror for payments made within 21 calendar days or more will be deducted from the proposed price in evaluating an offeror’s pricing.

However, the City may take advantage of any early- or timely-payment discounts offered by a vendor. Any proposed payment discount will apply to all purchases and to all payment methods

E.6. CITY’S RIGHT TO WAIVE DEFECTS OR REJECT OFFERS

Notwithstanding any other provision of this solicitation, the City may:

A. Waive any immaterial defect or informality; or

B. Reject any or all submittals, or portions thereof; or

C. Reissue the solicitation.

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E.7. CONTRACT NEGOTIATIONS

At the City’s discretion, it may negotiate with one or more responsible offerors to agree upon the final conditions, terms and price of the Contract. In doing so, the City will treat offerors fairly and will not disclose to any offeror information from responses submitted by other offerors. Exclusive or concurrent negotiations do not constitute a contract award and do not confer any rights to the offerors participating in such negotiations. In the event the City deems that negotiations are not progressing, the City may formally terminate these negotiations and may enter into concurrent or exclusive negotiations with the next most qualified firm(s).

E.8. AWARD OF CONTRACT

A Contract is created when, and only when, it is formally awarded, which occurs when the Business Services Director and the City Attorney sign the Offer and Acceptance page of the Successful Offeror’s submittal. When a Contract is awarded, the City will send the Contractor a Notice of Award.

The City may first issue a Notice of Intent to Award to the Successful Offeror(s). Offeror, if it receives a Notice of Intent to Award from the City, must sign and file with the City, within five (5) days after receipt of the Notice, all documents necessary for execution of the Contract. A Notice of Intent to Award does not create a contract. Only a subsequent formal award, as described above, creates a Contract.

E.9. MULTIPLE AWARDS

The City, at its sole discretion, may award multiple Contracts.

E.10. SOLICITATION RESULTS

After the City issues a Notice of Award, the City…