Workers'_Compensation_Third_Party_Administration_(Addendum_#1_Revision).pdf

Workers' Compensation Third Party Administration

Request For Proposal (RFP #RFP-2023-0047)

Tuolumne County

Human Resources

Issued: Tuesday, September 5, 2023

REQUEST FOR PROPOSAL (RFP No. RFP-

2023-0047)

WORKERS' COMPENSATION THIRD PARTY

ADMINISTRATION

Deadline for Submission of Proposals: Friday, December 1, RESPONSES MUST BE SUBMITTED ELECTRONICALLY TO:

https://procurement.opengov.com/portal/tuolumnecountyca

Table of Contents

I. Introduction

II. Scope of Services

III. Minimum Qualifications

IV. Proposal Package Requirements

V. RFP Process

VI. Evaluation of Proposals

Attachments:

A - PRISM_Addendum_A_Final_070119

B - TuolCo WC Performance Standards

C - TuolCo 2017 - Present WC Claims Data

1. Introduction

1.1. Summary

The County of Tuolumne, hereinafter referred to as “County”, is soliciting proposals from qualified third-party administrators, hereinafter referred to as “TPA”, for claims administration of the County’s Workers’ Compensation Program. The County is seeking a strong, long-term partnership with a TPA to manage its Self-Insured Workers’ Compensation claims. It is the intent of the County to contract with a qualified firm to provide claims administration and medical cost containment services for the period beginning July 1, 2024, through June 30, 2026 with an option for two (2) two (2) year extensions. The County is seeking proposals for bundled and unbundled services, whichever is determined to be in the best interest of the County.

The County requires a TPA partner who demonstrates an innovative and effective claims management process that is streamlined, user-friendly, and that allows for exceptional customer service to the County and its staff served through the Workers’ Compensation program.

Customer service includes the provision of consistently correct claims management and appropriate internal oversight for checks and balances, consistent direct dissemination of communication via reporting, updated technological capabilities, timely dissemination of information to the County’s Human Resources-Risk Management office (HR-RM) and employees served through the Workers’ Compensation program. Competitive rates and fees and the ability and willingness to comply with PRISM’s Claims Administration Standards are also desired. The proposing TPA’s staff should have proper licensing to perform claims administration services. The proposing TPA should demonstrate a strong regional presence in the

County’s surrounding areas and maintain the staff necessary to perform the claims administration services requested now, and into the future.

This Request for Proposal (RFP) contains specifications covering the administration of the

County ’s Workers’ Compensation program. This RFP and all subsequent modifications thereto are hereby designated as the sole reference and authority for the preparation of proposals. The release of this RFP supersedes all other documents related to the work to be done. The contents of this RFP and subsequent modifications thereto take precedence over any and all information related to the administration of the program obtained from any source, either by written or verbal communications

This RFP shall not be construed:

A. to create an obligation on the part of the County to enter into a contract with any firm, or

B. to serve as the basis of a claim for reimbursement for expenditures related to the development of a proposal.

Also enclosed is a draft of the scope of services required of the selected TPA and includes a pricing request. The selected TPA will enter into mutually agreed upon, binding, client specific service procedures. These procedures are anticipated to be detailed in all areas of specific claims handling requirements, including experience levels for technical claims staff, caseload levels, authority levels, reporting requirements, and claims file documentation format, supervisor and manager file review requirements (e.g. how often, how the review will be conducted, form of documentation, etc.). Additionally, the TPA must follow all standards outlined within both the

County’s Performance Standards and PRISM’s Addendum A Claims Administration Standards.

Respondents must respond within the prescribed timeline and must indicate willingness to agree to a performance guarantee subject to mutual agreement between the TPA and the County.

1.2. Background

Currently, the County’s open claims count includes 96 indemnity claims, and 14 medical-only claims. The County averages 76 claims per year. The County’s Workers’ Compensation budgeted payroll is $53,123,359.00.

The County’s goal is to support, retain, and return the injured employee to work while the employee’s physical and mental health are prioritized. The County’s philosophy is that the outcome of a workers’ compensation claim is driven by experience the employee has throughout the life of the claim, starting from the point of the employer’s first knowledge of injury or illness and ending with resolution. At no point in the process should an employee experience confusion or lack of clarity about steps in the process, who to contact for resolution, or payment status, as this should be clearly and effectively communicated through a true partnership between the TPA and HR-RM in mutual advocacy for the employee. County HR-RM is responsible for the oversight of the Workers’ Compensation program, including analyzing the process of reporting of injuries and illnesses and tracking the injured employee’s progress. One of the County’s top priorities is to retain its employees and ensure the injured employees’ career advancement is not delayed by a work-related injury or illness. The TPA is expected to propose and agree to a structured return to work program that is based in strong and timely communication with all interested parties. This includes the TPA working with the County and the injured employee’s

Primary Treating Physician (PTP) to determine when a modified duty assignment becomes the appropriate step in the employee’s recovery.

Additionally, the County aims to decrease the frequency and severity of workplace injuries and illnesses and employs a data driven risk control program that focuses on areas of concern and implementing preventative measures. The proposing TPA should include stewardship reports for the County and, in this RFP, include what data will be analyzed, how areas of concern will be identified, what type of details and action items are included in the plan, frequency of updating the plan, and how progress will be monitored.

1.3. Contact Information

Nathan Birtwhistle

Senior Risk Management Analyst

2 S Green St.

Sonora, CA 95370

Email: nbirtwhistle@co.tuolumne.ca.us

Phone: (209) 533-6956 mailto:nbirtwhistle@co.tuolumne.ca.us tel:(209)533-6956

Department:

Human Resources

Department Head:

Tracie Riggs

County Administrative Officer

1.4. Timeline

Release of published RFP September 5, 2023

Deadline for receiving all questions October 13, 2023, 5:00pm

Question Response Deadline

(Tenative)

October 27, 2023, 5:00pm

Deadline for RFP responses to be received by County

December 1, 2023, 5:00pm

Presentations/Interviews (Tentative) January 16, 2024

Request Board Approval of Contract

(Tentative)

February 6, 2024

Commencement of Claims

Administration

July 1, 2024

2. Scope of Services

2.1. Claims Administration

The County requires that all claims be handled with consistency and fairness. Attempts to contact the injured employee shall start the same day the claim is submitted, and the County shall be notified if these attempts fail. The TPA is expected to meet or exceed the County’s

Performance Standards and PRISM’s Addendum A Claims Administration Standards

(Attachment A). Please review these standards and provide responses to the following questions:

A. Please confirm the firm’s ability to provide claims administration services that comply with both the County’s and PRISM’s Performance Standards and also note any areas the

TPA believes they exceed these Standards.

B. Please confirm what, if any, internal process your firm has in place to audit files to ensure compliance with our guidelines and standards.

C. Identify the firm’s criteria for designating first aid, medical only, indemnity and future medical claims.

D. Identify the firm’s criteria for referring a claim for utilization review.

E. Identify the firm’s criteria for referring a claim for nurse case management.

F. Identify the firm’s criteria for referring a claim for investigation (both AOE/COE and sub-rosa).

G. Identify the firm’s criteria for referring a claim for legal representation. Describe the internal process for legal referrals and the claims examiners' involvement in claims after referral.

H. Identify the frequency with which the firm’s examiners contact injured workers who are temporarily disabled.

I. Identify the frequency with which the firm’s examiners contact injured workers who are not temporarily disabled.

J. Describe how the firm will guarantee return phone calls to employees within one (1) business day when:

a. an employee is litigated,

b. an employee is hostile, and

c. the claims examiner is on vacation, sick, or out of the office.

K. Describe how the firm maintains direct contact with medical providers to ensure reports are received in a timely manner and the County is notified.

L. Describe the firm's practices in regard to rating medical reports and issuing permanent disability advances. Please include any checks and balances in place to ensure amounts are calculated correctly. Also include how the County is notified.

M. Indemnity Payments

a. Describe the firm’s proactive process to ensure all indemnity payments are calculated and made correctly.

b. Describe how your firm reconciles indemnity payments.

N. Describe the firm's reserving philosophy including the firm's policies and practices in establishing and maintaining reserves for indemnity, medical and allocated expenses.

Please describe the firm’s future medical claim reserving practices.

O. Describe the firm’s philosophy in regard to allocating benefits (indemnity and medical) when an injured worker has multiple claims with overlapping body parts.

P. Describe how the firm handles penalties and overpayments.

Q. Describe the firm’s experience with handling run-off (tail) claims and resolutions.

R. Describe the claims resolution philosophy.

S. Identify, if known, the proposed supervisor(s) for the County’s claims and provide a copy of their resume. Additionally, please include the following:

1. The total years of claims handling experience

2. The total years of claims supervision experience

3. The total years of handling or supervising files for public agencies

4. The total years of handling or supervising files for public safety employees

5. A list of the public agencies for whom they have handled or supervised files

6. Any certifications held by the supervisor, notably whether or not they are certified as a Workers’ Compensation claims adjuster by the California Department of Insurance and whether or not they are certified as a Self-Insurance Administrator by the Office of Self-Insurance Plans. If they are certified by the Office of Self-Insurance Plans, please provide a copy of their certificate(s).

If a supervisor has not yet been designated to service the account, provide the criteria for selecting a qualified supervisor.

T. Identify, if known, the proposed examiner(s) for the County’s claims and provide a copy of their resume. Additionally, please include the following:

1. The total years of claims handling experience

2. The total years of claims supervision experience

3. The total years of handling or supervising files for public agencies

4. The total years of handling or supervising files for public safety employees

5. A list of the public agencies for whom they have handled or supervised files

6. Any certifications held by the examiner, notably whether or not they are certified as a

Workers’ Compensation claims adjuster by the California Department of Insurance and whether or not they are certified as a Self-Insurance Administrator by the Office of Self-Insurance Plans. The County requires all claims examiners to have received the Office of Self-Insurance Plans certification. Please provide a copy of the proposed examiners certificates.

If staff has not yet been designated to service the account, provide the criteria for selecting qualified personnel.

U. SSAE18 (or updated version) Audit Compliance: Indicate the firm's compliance with

SSAE18 annual audit compliance reporting and indicate the date of the most recent completed audit report.

2.2. Managed Care Services

The County reserves the right to bundle managed care services with claims administration services or to unbundle any or all of the services. Please describe how the firm will work with outside vendors to provide effective and efficient service to program members, specifically noting any limitations you may have in working with outside vendors. Please provide a list of outside vendors with whom you currently work.

The County may work with a consulting service to provide oversight of all managed care services, including bill review, utilization review and nurse case management. Please outline any prior experience the firm has in working with this type of service and indicate the firm's willingness and ability to cooperate with and provide data as required to enable the organization to provide their contracted services.

Please state your willingness to agree to this type of fee arrangement should your firm be selected to provide bill review and utilization review services.

A. Bill Review

1. Describe the firm and provide a brief statement of qualifications in providing bill review services. Describe the firm’s experience doing business with self-insured public entities in California. Discuss what distinguishes your organization from other bill review providers.

2. Provide a brief summary of the qualifications and experience of each proposed team member, including their length of service with your firm and their resume.

3. Describe the firm’s bill review services, features of the system, any unique capabilities, and ability to customize the delivery of services for County needs.

Provide the average monthly bill volume processed by the firm and the average savings achieved for the clients served.

B. Utilization Review

1. Describe the firm and provide a brief statement of qualifications in providing utilization review services. Describe the firm’s experience doing business with self-insured public entities in California. Discuss what distinguishes your organization from other utilization review providers.

2. Provide a summary of the qualifications and experience of each proposed team member, including their length of service with your firm and their resume.

3. Describe the utilization review services, including standards and guidelines used to review treatment requests. Describe any unique capabilities or approaches the firm has for reviewing medical treatment requests. Discuss any methods employed to help your clients reduce utilization review costs. Provide the average turnaround time on treatment requests and your average denial rate.

C. Nurse Case Management Services

1. Describe your firm and provide a brief statement of qualifications in providing nurse case management services. Describe your experience doing telephonic and field case management business with self-insured public entities in California. Discuss what distinguishes your organization from other nurse case management providers.

2. Provide a summary of the qualifications and experience of each proposed team member, including their length of service with your firm and their resume. Indicate the office location nurses would be working from.

3. Describe your nurse case management services, including guidelines and expectations regarding your nurse case management program. Describe any unique capabilities or approaches your firm has for providing nurse case management services.

D. Medical Provider Network

1. Is your firm’s MPN leased or owned? If leased, please identify the provider, outline related fees and negotiated discounts.

2. How will your firm assist the County with a customized MPN providing sufficient coverage in the geographic area?

2.3. Records Retention and Inspection

A. TPA agrees that the County shall have access to and the right to examine, audit, excerpt, copy, or transcribe any pertinent records pertaining to the agreement.

B. All records shall be kept and maintained by the TPA and made available to the County during the term of the agreement and for a period of three (3) years thereafter. All such records shall be delivered to the County in the format and media specified upon termination of the agreement.

C. Ownership of Records

TPA must stipulate that all claim files, electronic data processing/management information system records, and all records generated on behalf of the County are owned by the County and that claim files will be available to the County upon request.

2.4. Quarterly File Reviews

A. TPA must provide quarterly file reviews.

1. Provide your firms philosophy on preparing and presenting file reviews.

2. Provide examples of materials used in a file review and explain how they are used.

2.5. Stewardship Reports

A. TPA agrees to provide Stewardship Reports no less than annually, and within 30 days if an additional report is requested by the County.

B. At a minimum, the Stewardship Report should include:

1. top injuries, body parts, how they occurred (Slip and fall, lifting, MVA, etc),

2. new losses, closures, reopens, avg cost per claim on open and closed files,

3. well organized and understandable data which may include graphs and charts,

4. discussions on potential training, risk control measures, what steps can be taken to reduce severity/frequency, etc.,

5. strategic action items for program improvement with benchmarks including claims handling, communication with staff, action plan for each claim, closing claims, long term plan for the County.

C. The report should address the concerns of a Chief Administrative Officer, Auditor, Treasurer, Senior Managers, Directors, HR-RM, Excess Insurance, and the Board of

Supervisors.

D. Provide examples of the materials used by your firm in a Stewardship Report and describe how they are used.

2.6. Claims Service Fees

A. Fee Structure and Pricing: The County asks that you base your pricing on caseloads of

125 per examiner, counting future medical claims at 2:1. Medical Only claims are not included within the caseload pricing; however, should be considered within the claim inventory as 2:1 if they are intermixed. Please provide a proposed flat fee for all services or broken-down fees as follows:

1. List all services that will be provided within the basic per claims fees (e.g., field investigation, hearing representative, medical cost containment services, medical management services, rehabilitation services, etc.)

2. List all services that will be provided at an additional cost to the basic per claims fees, and what the cost will be (e.g. field investigation, hearing representatives, medical cost containment services, and medical management services, rehab services, etc.)

3. Any additional cost for having a dedicated staff at our location.

4. Cost per Medical Only file (go forward claims).

5. Cost per Indemnity file (go forward claims).

6. Cost per First Aid file (go forward claims).

7. Other charges such as annual administration fees, computer setup fees and time & expense.

8. When will the service charge be due? What are the payment terms? Include frequency, method of payment?

9. What services are included in the service charge? (i.e., subrogation, investigation, excess reporting, medical management, loss control, etc.)

10. What services are excluded in the service charge? (i.e., banking fee, outside investigators, attorneys, etc.)

11. How will the excluded costs be charged to the County?

a. Upon contract termination, does your fee include handling of all open files to conclusion?

b. What standard reporting service is provided in your claim service fee? If not provided, can standard statistical reports be provided? At what charge?

c. When will the service fee quotes as described in your RFP response expire?

d. What would be the cost to the County to cancel your services mid-term in the contract and at expiration of the contract?

e. Statement of Services:

• Provide a detailed statement of services as included in the Scope of Services.

• Indicate which services are included in the unit pricing, and what services will be considered allocated expenses.

• Provide your firm's definition of allocated expenses.

• Discuss any services listed under Scope of Services which are not included in your proposal.

f. Describe the payment schedule for services to be provided as described in the

Proposal.

The County will require the successful bidder(s) to indemnify the County for payment of any penalties incurred as a result of claims handling related errors and omissions. This includes but is not limited to errors incurred as a result of failure to properly comply with reporting under

Medicare section 111, failure to timely provide benefits to injured workers, or the inappropriate or unnecessary overpayment of benefits. Please state any exceptions your firm has to the sample

TPA contract.

2.7. Workers' Compensation Trust Fund Checking Accounts

A. The County shall establish a claim clearing checking account to cover payments and reimbursements applicable to the self-insured Workers’ Compensation program and the payment of first aid claims.

B. The claim clearing checking accounts shall be established in the name of the County. The

County shall fund the account as required to ensure that funds are available for payment of claims for settlement and allocated loss expenses upon presentation of check or warrant. The administrator shall provide the bank checks stock. Checks shall be protected with state-of-the-art security features. The TPA shall not draw on the trust fund checking account for any purpose other than adjustment of claims and payment of allocated loss expenses.

C. The TPA shall monitor the trust fund account and make recommendations to the County as to the appropriate level of funding for the account in order to comply with established laws.

D. Once each month, TPA shall provide the County with a detailed accounting of all

Workers’ Compensation benefits and allocated loss expenses paid from the fund. The detailed accounting shall include the date and check number of all benefit and allocated loss payments and shall also include appropriate supporting documentation for allocated loss expense payments. A monthly check register summary shall be provided also. TPA is responsible for erroneous payments made from the account by their error. The amount of any such erroneous payments made from the account shall be deducted from administrative fee payments. TPA shall develop, implement, and maintain security procedures to ensure safeguard of funds in the account and the bank checks. Such procedures shall be approved by the County.

E. Allocated expenses are defined as: all attorney fees, court and or hearing costs, depositions and other discovery costs, documents and exhibits, witness and expert fees, medical and engineering appraisals, surveillance, sub-rosa, independent adjuster fees, photography, and other incidental and special costs incurred to evaluate compensability of claims. Any and all assignments for outside investigation and or surveillance require prior approval from the County. Allocated expense payments will be paid from the individual claim file.

F. The TPA shall develop, implement and maintain security procedures to ensure safeguard of funds in the account and the bank checks. Such procedures shall be approved by the County.

3. Minimum Qualifications

Each proposal submitted will be evaluated to determine if the firm meets the following minimum qualifications. Proposals that do not meet these minimum qualifications may not advance to the

Selection Committee for further evaluation.

A. The firm, its principals, and the supervisors and lead examiners servicing the account shall have at least five years’ experience in California as a TPA or provider of ancillary services such as bill review or utilization review for public entities and public safety employers. Please describe the firm and outline its experience performing Workers'

Compensation claims or managed care services in California.

B. Provide certificates of insurance confirming the firm meets the insurance requirements and agree to the County's indemnification language, both outlined in Section 5.7

C. Provide five (5) current client public agency references with full contact information. At least three (3) of these references must have public safety employees. Please note what services are being provided.

D. Provide two (2) former client references with full contact information. Please note what services were provided and the reason for leaving.

E. Provide a complete list of other public entity clients.

F. Disclose and submit with proposal any current and/or pending lawsuits, litigation or proceedings with clients that you are or were contracted with for Worker’s Compensation claims administration.

G. TPAs must be able to meet or exceed all standards outlined within both the County’s

Performance Standards (Attachment B) and PRISM’s Addendum A Claims

Administration Standards (Attachment A).

4. Proposal Package Requirements

Proposals are to be straightforward, clear, concise and responsive to the information requested.

In order for proposals to be considered complete, proposers must provide all requested information.

Each proposer must submit their response online via the County’s e-Procurement platform, https://procurement.opengov.com/portal/tuolumnecountyca.

4.1. Proposal Elements*

A. Statement of Understanding and Approach o This section must demonstrate an understanding of the Services. It should describe the general approach, organization and staffing required for the Services requested. If necessary, preliminary investigations, due diligence, and research shall be discussed in this section.

o This section should include the following:

▪ An implementation plan that describes in detail (i) the methods, including controls by which the TPA manages projects of the type sought by this RFP; (ii) methodology for soliciting and documenting views of internal and external stakeholders; (iii) and any other project management or implementation strategies or techniques that the TPA intends to employ in carrying out the work.

▪ Detailed description of efforts the TPA will undertake to achieve client satisfaction and to satisfy the requirements of the "Scope of Work" section.

▪ Detailed project schedule, identifying all tasks and deliverables to be performed, durations for each task, and overall time of completion, including a complete transition plan. Include the TPA’s plan to deal with fluctuation in service needs and any associated price adjustments.

▪ Detailed description of specific tasks you will require from County staff. Explain what the respective roles of County staff and the TPA’s staff would be to complete the tasks specified in the Scope of Work.

▪ Proposers are encouraged to provide additional innovative and/or creative approaches for providing the service that will maximize efficient, cost-effective operations or increased performance capabilities. In addition, the County will consider proposals that offer alternative service delivery means and methods for the services desired. Such as

• Loss Control - partnering to conduct on-site inspections,

• Safety – assist in policy development and/or starting a safety committee,

• Training - online modules available for County use.

B. TPA Information o This section shall include contact person information, address and telephone number of the TPA main office and branch offices. Each TPA shall identify itself as to the type of organizational entity (corporation, sole proprietorship, partnership, joint venture, etc.). Any supplemental information that the TPA believes may be pertinent to the selection process may be provided.

o The TPA shall identify any litigation, mediation, or arbitration, regarding the performance of any services similar to the Services, in which the TPA has been involved in the past five (5) years. If the Services require a license or certification, the

TPA shall include any claims or disciplinary action taken against the TPA or any of

Company’s key personnel within the past five years.

C. TPA Personnel o An affirmative statement should be included that the proposer and all assigned key professional staff are properly licensed to practice in California.

D. Disclosure o Please disclose any and all past or current business and personal relationships with any current County elected official, appointed official, County employee, or family member of any current County elected official, appointed official, or County employee. Any past or current business relationship may not disqualify the firm from consideration.

E. Experience and References o The Proposal must demonstrate that the TPA, or its key personnel, meets the minimum experience requirement in the Minimum Qualifications Section with a legally registered business name, that provides services of a similar type and scope as described in the Scope of Services. A Company shall not have filed for bankruptcy under any business name over the past five (5) years.

o The TPA shall provide references, as described in the Minimum Qualifications section, of clients for whom services have been performed that are comparable in quality and scope to that specified in this RFP. The references shall include client names, addresses, telephone numbers and e-mail addresses of the clients for whom prior work was performed and include an explanation of the services provided along with project start and end dates.

*Response required

4.2. Proposal Cost*

In addition to completing section 2, the TPA shall upload a fee schedule here. Information should include any and all costs associated with the fulfillment of the Scope of Services.

*Response required

5. RFP Process

5.1. Submittal of Proposals

Sealed proposals must be received online, NO LATER THAN 5:00 pm on Friday, December 1, 2023.

Proposals are to be submitted electronically using the County’s e-Procurement platform, https://procurement.opengov.com/portal/tuolumnecountyca. Proposals will be received only as instructed above, and must be received before 5:00 pm on Friday, December 1, 2023. Proposals shall not be submitted via hard copy, (hand delivered or mailed), facsimile, nor via email. It is the sole responsibility of the proposer to properly upload its proposal so that it is received by the time and date required. Any proposal received after said time and/or date or in any other format other than as instructed herein, cannot be considered and will not be accepted. The County’s e-

Procurement Platform records the time stamp for every proposal submitted properly in the system. Once a proposal is submitted in the e-procurement platform, the Proposer will receive an email confirmation, and the proposal status will also show as “submitted.”

5.2. Submitter's Questions

Questions regarding the RFP must be submitted exclusively in writing to the County by 5:00 pm on Friday, October 13, 2023 via the County’s e-Procurement platform, in the Q&A tab. Except for questions that might render the award of this contract invalid, the County will not respond to any questions submitted after this time. The County will use an addendum to the RFP to post any questions received, along with written responses, on the County e-Procurement platform, https://procurement.opengov.com/portal/tuolumnecountyca. It is the responsibility of the proposers to check the County website to review the questions and responses. Any oral responses to questions are not binding on the County.

5.3. Cost of Developing the Proposal

All costs incurred in the preparation of a proposal are the responsibility of each proposer and will not be reimbursed by the County.

5.4. Proposal Terms and Conditions

It is the responsibility of each proposer to be familiar with all of the specifications, terms and conditions of the RFP. By the submission of a proposal, the proposer certifies that if awarded a contract, proposer will make no claim against the County based upon ignorance of or misunderstanding of the specifications.

Each proposer shall submit its proposal with the understanding that the proposal will become a part of the official file on this matter and shall be subject to disclosure, if requested by a member of the public, following the completion of negotiations.

By submitting a proposal, each proposer certifies that all statements in this proposal are true.

This constitutes a warranty, the falsity of which shall include the right, at the County’s option, of declaring any contract made, as a result thereof, null and void. Proposals shall be completed, executed, and submitted in accordance with the instructions of this RFP. If a proposal is not submitted in the format specified in this RFP, it may be rejected, unless the County determines that the nonconformity is either a minor irregularity or that the defect or variation in the proposal is immaterial or inconsequential. The County may give the proposer an opportunity to cure any deficiency resulting from a minor irregularity or an immaterial or inconsequential defect, or

County may waive such deficiency, whichever is most advantageous to the County.

The County cannot accept proposals from any individual who is currently employed with the

County of Tuolumne (California Government Code §29708).

5.5. Successful Proposal as Part of Contract Services

Proposals received in response to this solicitation, at the County’s discretion, may be incorporated into the awarded contract and may serve as basic terms and conditions for the ultimate contract. Therefore, proposers are advised that, if successful, they will be held responsible for levels of services proposed at the funding levels quoted. The County reserves the right to negotiate modifications or revisions to any awarded contract.

5.6. Evaluation of Proposals

See #Evaluation of Proposals.

5.7. Other Requirements

In order to contract with the County of Tuolumne, a proposer must meet the following requirements:

• Make available to the County its federal Tax Identification Number (TIN) or Social

Security Number (SSN).

• Comply with all Federal, State and local rules, regulations and policies, including but not limited to:

o Standard contract language of the County;

o Insurance coverage to include

▪ WORKERS' COMPENSATION: as required by the State of California, with

Statutory Limits, and Employer’s Liability Insurance with limit of no less than

$1,000,000 per accident for bodily injury or disease.

▪ GENERAL LIABILITY: Insurance Services Office Form CG 00 01covering

CGL on an “occurrence” basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG

25 03 05 09 or 25 04 05 09) or the general aggregate limit shall be twice the required occurrence limit. the County named as an additional named insured.

https://secure.procurenow.com/portaluolumnecountyca/projects/20451?section=156154

▪ AUTO LIABILITY: ISO Form Number CA 00 01 covering any auto (Code 1), or if Contractor has no owned autos, covering hired, (Code 8) and non-owned autos

(Code 9), with limit no less than $1,000,000 per accident for bodily injury and property damage.

▪ PROFESSIONAL LIABILITY/ERRORS & OMMISSIONS: Insurance appropriate to the Contractor’s profession, with limit no less than $1,000,000 per occurrence or claim, $2,000,000 aggregate.

▪ BLANKET FIDELITY BOND in an amount not less than One Million Dollars

($1,000,000) with an approved corporate surety carrier covering any and all principals, officers and employees involved in the performance of the agreement and the trust fund (impress) account. TPA will maintain said bond or insurance for a period of two (2) years after the expiration of the contract.

▪ CYBER LIABILITY INSURANCE policy which provides coverage including but not limited to Privacy Notification and Crises, E-threat Expenses coverage, E-vandalism Expenses which names CRSIG as an additional insured and provides a limit of no less than Two Million dollars ($2,000,000).

▪ Provide that the aforementioned policies contain a waiver of subrogation in favor of the County.

o Hold Harmless/Indemnification

▪ Contactor shall hold harmless, defend and indemnify County and its officers, officials, employees and volunteers from and against any and all liability, loss, damage, expense, costs (including without limitation costs and fees of litigation) of every nature arising out of or in connection with Contractor's performance of work hereunder or its failure to comply with any of its obligations contained in the agreement, except such loss or damage which was caused by the sole negligence or willful misconduct of the County.If such indemnification becomes necessary, the County Counsel for the County shall have the absolute right and discretion to approve or disapprove of any and all counsel employed to defend the

County. This indemnification clause shall survive the termination or expiration of this Agreement.

• Meet the requirements for audit of its expenditures if required in the above documents.

5.8. Non-Discrimination

Non-Discrimination: The Contractor selected through this RFP shall provide services without discrimination based on race, creed, color, ethnic or linguistic identification, gender or sexual preference, disability or handicap or any other basis prohibited by law.

5.9. Protest/Appeal Process

The following procedure is provided in the event that a proposer wishes to protest the RFP process or appeal the recommendation to award a contract for Workers' Compensation Third

Party Administration once the Notices of Award/Non-Award have been issued.

Any protest must be submitted in writing to Human Resources, 2 S Green St., Sonora, CA

95370, Attention: Nathan Birtwhistle

The protest must be submitted before 5:00 p.m. of the tenth (10th) business day following the date of the Notice of Award.

The protest must contain a complete statement of the basis for the protest. The protest must include the name, address, telephone number and e-mail address of the person representing the protesting party.

The procedure and time limits are mandatory and are the proposer’s sole and exclusive remedy in the event of a bid protest.

Proposer’s failure to comply with these procedures shall constitute a waiver of any right to further pursue the protest, including filing a Government Code claim or legal proceedings.

Upon receipt of written protest/appeal, the County Administrative Officer will review and provide an opportunity to settle the protest/appeal by mutual agreement, will schedule a meeting to discuss or issue a written response to advise of an appeal/protest decision within five (5) business days of receipt of the appeal/protest.

5.10. Public Records Access

Proposers should be aware that submitted proposals are subject to the California Public Records

Act and may be disclosed to members of the public upon request. It is the responsibility of the proposers to clearly identify information in their proposals that they consider to be confidential under the California Public Records Act. To the extent that the County agrees with that designation, such information will be held in confidence whenever possible. All other information will be considered public.

All information regarding the proposals will be held as confidential until such time as the

Review Committee has completed its evaluation and, or if, contract negotiations are complete.

5.11. Presentations/Interviews

A review committee will evaluate all responses to the RFP that meet the submittal requirements.

The review committee will rank the proposals and arrange interviews with the finalists prior to selection.

6. Evaluation of Proposals

The objective is to perform a thorough and fair evaluation of submitted proposals and facilitate the selection of a contractor/consultant that best satisfies the County’s requirements. The following describes the evaluation process and associated components.

A. Selection Process:

1. The County shall name, for the purpose of evaluating the proposals for this RFP, a

Review Committee composed of representatives from the County. The County may also elect to include as part of the Review Committee qualified representatives from other agencies or entities.

2. Proposal documentation requirements set forth in this RFP are designed to provide guidance to proposers concerning the type of information that will be used by the

Review Committee. Proposers shall be prepared to respond to requests by the Review

Committee for additional items deemed necessary to assist in the evaluation process.

B. Evaluation Criteria & Scoring:

1. The Review Committee shall be responsible for performing the evaluations of each proposal. Each member of the Committee shall rate the proposers separately. The scores of each of the Committee members shall then be averaged to provide a total score for each of the proposers. The proposals shall be evaluated on the following categories and the maximum weight possible for each category is listed below.

2. The review committee will consider the following criteria when evaluating the proposals:

I. Demonstrated experience in the Workers’ Compensation and Risk

Management field

II. Demonstrated relationships with medical providers

III. Innovative approach to reducing claims

IV. Demonstrated competent, knowledgeable and sufficient staffing levels

V. Familiarity with the County of Tuolumne and its Board of Supervisors’ goals, priorities, etc.

VI. Other factors such as quality and thoroughness of the proposal; quality and thoroughness of the interview; references (see section 2.5 (C) and (D));

and cost proposal will also be measured in the final evaluation.

VII. A mutually acceptable contract will be negotiated between the

County and the TPA. The TPA will be required to comply with the

County’s non-discrimination provisions.

C. Award:

Award will be made to the qualified proposer whose proposal will be most advantageous to the

County, with price and all other factors considered. The County will negotiate with the highest ranked proposer to develop the scope of work and contract for mutual satisfaction.

If the County cannot successfully negotiate a contract with the highest ranked proposer, the

County will terminate negotiations and begin negotiations with the next highest ranked proposer.

Proposers will receive mailed Award/Non-Award notification(s), which will include the name of the proposer to be awarded this contract.

Proposers are advised County reserves the following prerogatives:

• To reject any or all proposals;

• To consider historic information and fact, whether gained from the proposer’s proposal or any other source, in the evaluation process; and

• The proposer is cautioned that it is the proposer’s sole responsibility to submit information related to the evaluation categories and the County is under no obligation to solicit such information if it is not included with the proposal. Failure of the individual or firm to submit such information may cause an adverse impact on the evaluation of the proposal.

No. Evaluation Criteria Scoring Method Weight (Points)

1. Completeness of Proposal Pass / Fail 10 (10% of Total)

2. Qualifications & Experience 0-5 Points 20 (20% of Total)

3. Service Delivery/Methodology 0-5 Points 30 (30% of Total)

4. Reasonable Cost of Service 0-5 Points 20 (20% of Total)

5. Quality and Thoroughness of Interview 0-5 Points 20 (20% of Total)