WORKERS’_COMPENSATION_THIRD_PARTY_ADMINISTRATION_AND_MANAGED_CARE_COST_CONTAINMENT_SERVICES_RFP.pdf

County of San Mateo

Request for Proposals (RFP) for WORKERS’

COMPENSATION THIRD PARTY ADMINISTRATION

AND MANAGED CARE COST CONTAINMENT

SERVICES RFP

Human Resources Department

RFP No. 2026-RFP-00430

RFP Contact: Sarah Prince sprince@smcgov.org

Page 2 of 30 Release date of June 1, 2026

1. Introduction and Schedule

1.1. Summary

The County of San Mateo (the “County”) covers most of the San Francisco Peninsula.

The region covers 744 mi2 and is home to nearly 800,000 residents and 20 incorporated cities. The County provides for the health and welfare of all people within its borders and serves as the local government for the unincorporated areas. Innovation thrives here in industries including bioscience, computer software, green technology, hospitality, financial management, healthcare, education and transportation. The County prides itself on how that prosperity fosters its commitment to protecting and enhancing the health, safety, welfare and natural resources of the community.

The County is seeking proposals from qualified Third-Party Administrators (TPA) to provide Workers’ Compensation Claims Management and Managed-Care Cost

Containment Services for its self-insured Workers' Compensation Program. Services will be for all new and existing claims. There are approximately 694 total open claims comprised of 643 indemnity, 36 medical and 15 first aid/info only, with 249 open for

Safety employees.

The County’s services and operations are supported by approximately 7,250 employees in 29 departments. We request that our future Third Party Administrator’s staffing structure includes 2 fully dedicated Claims Supervisors, 4 fully dedicated Senior Claims

Examiners, 1 fully dedicated Future Medical Claims Examiner, and 2 fully dedicated

Assistant Claims Examiners, however the chosen TPA will have some flexibility to propose staffing. The County reserves the option to adjust staffing needs after the first 6 months, and then on an annual basis going forward.

The County uses Origami Risk Management Information System, which is managed by a third-party vendor, and claims information is imported and exported through the current

TPA’s workers’ compensation information system. The County also uses third-party vendors contracted through the current TPA for Bill Review, Utilization Review, Nurse

Case Management and Investigation. The County reserves the right to approve all third-party vendors contracted through the chosen TPA.

1.2. Contact Information

Sarah Prince Workers' Compensation Manager Email: sprince@smcgov.org Phone: (650) 363-4633

Department:

Human Resources Department

Department Head:

Rocio Kiryczun Director mailto:sprince@smcgov.org tel:(650)363-4633

Page 4 of 30 Release date of June 1, 2026

1.3. Timeline

RFP Released June 1, 2026

Deadline for Questions, Comments and

Contract Exceptions

June 12, 2026, 5:00pm

Proposal Due Date and Time July 10, 2026, 5:00pm

Interviews (tentative) July 24, 2026

Anticipated Contract Award Date August 7, 2026

2. Scope of Work

Third Party Administrators responding to this Request for Proposal should have extensive experience and a knowledgeable background and qualifications in the provision of the services described, as well as holding all licensing required to provide workers’ compensation claim services, including licensing by the California Department of

Insurance (CDI) as an Administrator with all persons adjusting claims appropriately credentialed. The successful Proposer will provide comprehensive Workers’

Compensation Third Party Administrator services and Managed Care services throughout the term of the contract. These services will be provided under the direction of the

County of San Mateo’s Risk Management division in accordance with agreed upon terms and compensation. All specified services and requirements shall be provided to the

County at the prices offered by the Proposer in their submitted cost proposal.

Proposers must, in their submitted proposals, clearly present evidence that they are a competent and qualified organization capable of providing the administrative services detailed herein. Proposers shall, in their submitted proposals, detail their experience, expertise, qualifications, and proposed methodology to provide the administrative services detailed in this RFP.

The claims administrator will serve under the auspices of the County’s Risk Management

Division and their Workers’ Compensation Analysts.

2.1. ADMINISTRATOR SHALL PROVIDE THE FOLLOWING SERVICES:

A. Develop procedures, forms, instructions, schedules and other materials related to claim management within 30 days of the effective date of the signed contract and update such materials as needed. Procedure manual shall include the County’s current client handling

Page 5 of 30 Release date of June 1, 2026 instructions (CHI) provided by the County.

B. Provide group education for County staff regarding claim management as requested.

C. Assist the County in the development of directives, notices, and other program communication to employees as requested or needed based on Administrator’s expertise and suggestion.

D. Provide all forms and supplies necessary for the efficient operation of the Workers'

Compensation insurance program, including customized benefit checks bearing the County's name and logo, and prepare all legally required forms and documents including but not limited to, 1099 reports to the I.R.S., OSHA required reports, and any and all other documents and reports now or in the future required by the state or federal government or any other agency associated with the County's Workers' Compensation program. Administrator will report any

OSHA-reportable injuries to the County’s Safety Manager, Risk Manager and OSHA.

E. Work with County Controller's Office and bank to establish controls.

F. Coordinate and attend regularly scheduled meetings and conduct periodic in-person file reviews of claims as may be requested by the County.

2.2. CLAIMS ADMINISTRATION

A. Administrator shall assume all claims administration services including transfer, conversion, installation and adjustment of all open claims records as of July 1, 2027. This will include maintenance of all closed claim records.

B. Establish and maintain a claim file, with a diary date not to exceed 30 days, on each active claim where indemnity benefits are being paid; a diary system not to exceed 60 days on all other open, active Indemnity claims; and a supervisory review diary not to exceed 120 days, or more often when needed.

C. Manage timely receipt of all pertinent claim information from County providers and other sources.

D. Notify the County immediately in writing of any Application or Request for Hearing filed at the WCAB and notify the County within 1 business day of receipt of any Notice of Hearing

Page 6 of 30 Release date of June 1, 2026 issued by the Workers' Compensation Appeals Board (WCAB).

E. Attend workers’ compensation hearings and mediations as requested by the County.

F. Contact and document bi-weekly calls to injured workers while they are receiving lost time benefits and notify Risk Management when the injured worker’s work status has changed from “no work” to “light duty”. Administrator will support the County’s light duty, early return to work programs in conjunction with personnel from Risk Management.

G. Determine, on behalf of Employer for each reported employee injury or illness, those benefits, if any, that should be paid or rendered under the California Workers' Compensation

Laws. Such determination shall include an estimate of future claim payment.

H. Establish and maintain accurate claims reserves for all anticipated benefits and related cost exposures on each claim. Review at least monthly or more frequently as the claim requires.

Stair step reserving is unacceptable.

I. Report any penalties incurred on claims to the County immediately. All penalties resulting from failure to comply with statutory laws and/or administrative regulations are the sole responsibility of the Administrator. 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.

J. Comply with all applicable laws, rules and regulations governing the administrator of self-insurance as required by California and/or federal law and advise the County of any legislative or regulatory changes both when proposed and enacted.

K. Retain outside services with prior approval of the County, for the investigation and management of the claims. Outside services include but are not limited to:

1. AOE/COE Investigators

2. Activities Check/Sub-rosa Investigator

3. Medical Case Management and Rehabilitation Nurses/Consultants

4. Subrogation Investigators and Experts

5. Defense Attorney

L. Document in each Indemnity claim file good faith efforts to contact all injured workers by telephone within 1 business day of receipt of claim, and in no event later than 2 business days of receipt of claim. Establish phone contact with appropriate Employer department for initial

Page 7 of 30 Release date of June 1, 2026 discussion of claims, as needed, within 3 business days of receipt of claim.

M. Respond to inquiries from injured workers and County staff within one business day.

N. Initiate investigations, subject to approval by the County, to determine compensability of reported and actual claim status. The County shall have prior approval of the selection of any investigator used to investigate County claims of industrial injury or illness. Take necessary statements and investigate facts of the case within 30 days’ receipt of claim, when warranted.

O. Prepare documentation of cases for litigation and continue to monitor legal counsel representing the County in legal action(s) and assist counsel as necessary in preparation for and during the course of litigation. The County shall approve counsel prior to each referral to outside legal counsel. In addition, Administrator shall promptly provide the County with copies of all correspondence generated on those claim files which are litigated and shall immediately notify the County in writing and keep the County closely informed on those claims involving allegations of Serious and Willful Misconduct or alleged violation(s) of California Labor Code Section 132(a). At time of case referral to defense counsel, Administrator shall prepare a letter of direction to defense counsel outlining work to be done, by whom, and in what time frame. All assignments, instructions and communication with defense counsel must be documented in the claim file. Administrator shall communicate and coordinate with defense counsel on an ongoing basis and obtain status reports from defense counsel at least every 60 days. Administrator shall actively monitor litigated files and shall not require defense counsel to perform activities which can be accomplished effectively by claims staff. Examples of required claims examiner activity on litigated files include, but are not limited to, assuring that the following timely occurs:

1. Scheduling medical appointments

2. Writing cover letters to doctors

3. Subpoenaing medical records

4. Answering applications

5. Filing and serving requisite documents

P. Assign a Defense Attorney within 1 business day of receipt of County approval and obtain defense counsel’s written evaluation within 10 business days of assignment, including evaluation of liability, verdict potential, settlement value, and case strategy.

Such written evaluation shall be promptly shared with the County within 1 business day of receipt.

Q. Disburse payment on behalf of the County out of the bank trust account funded by the County for all "Allocated Loss Expenses," which is defined to include all costs incurred on behalf of the County specifically related to an individual claim, including but not limited to attorneys, independent examiners or investigators, expert witnesses, copying records or transcripts, court costs or Appeals Board fees, or other costs deemed proper and necessary to represent the County.

Page 8 of 30 Release date of June 1, 2026

R. Pay compensation, medical expenses, "Allocated Loss Expenses," and all other benefits as prescribed by law out of funds provided by the County. Payments made by Administrator without County approval, where approval is required, shall be the responsibility of the Administrator.

S. Maintain a comprehensive claim file on each reported claim which shall be available to the County at all times for inspection.

T. Conduct, at a time and frequency to be determined by the County, claim file reviews with the County at either the County's or Administrator's offices. Provide claim status updates in written form to the County prior to each claim file review, as requested by the County.

U. Administrator’s actions and decisions shall be in line with the County’s most current Client Handling Instructions (CHIs). Decisions that are pre-approved and/or preauthorized by the County requiring desk review only shall not be subject to additional fees.

V. Index Bureau System. On the County's behalf, Administrator shall subscribe and report to the Index Bureau System related to each claim at no charge to the County.

W. Create, reserve and enter required claim data into Administrator's computer system within 5 business days of receipt of notice of claim from the County. Enter all payments, reserve revisions, and file closings into the information system within 3 business days.

X. Review medical bills and other medical charges and treatment relating to each claim for causal relationship to all claims of injuries/illness, and reasonableness of treatment prior to payment. Authorizations pre-approved by the County should not be subject to fees for desk review.

Y. Make all disability payments and send all notices in a timely manner, abiding by all applicable provisions of the California Labor Code and California Workers' Compensation Laws, Rules and Regulations. All penalties for late payments or notices shall be the responsibility of the Administrator.

Z. Make payments of bills within 30 days of receipt and ensure timely review and payment of all medical bills in accordance with statutory deadlines and requirements. All penalties, interest or fees resulting from late payments shall be the responsibility of the Administrator.

AA. Acknowledge to the County all claims reported to Administrator within 1 business day of receipt of the notice of claim. Notify the County and injured workers within 14 calendar days of the notice of claim, whether the claim has been accepted, delayed for further investigation, or denied.

BB. Convert all Medical Only Claims to Indemnity Claims status when appropriate and notify the County once the claim type has been changed.

Page 9 of 30 Release date of June 1, 2026

CC. Recognize and where appropriate investigate all subrogation and/or contribution possibilities, preserving evidence and utilizing appropriate investigators and experts, as needed, after first obtaining County permission to engage such investigators/experts. For subrogation and contribution cases, any compromise settlements or lien reductions must be authorized by the

County prior to the Administrator finalizing or accepting third party settlements. All subrogation and contribution settlements must be approved by the County. Petitions for Credit must be filed in all cases where the injured worker recovers any dollars from a third-party case. No additional charges should be applied for Administrator-only handling of subrogation claims. Examiners will keep both defense counsel and the subrogation counsel advised of all developments on the workers’ compensation claim and subrogation claim.

DD. Provide a weekly report listing all delayed claims and their decision dates and provide notice and explanation to the County upon recommendation of acceptance or denial of the claims.

EE. Request authority as required for all settlements. Prior to any settlement conference, provide the County with a written analysis of the case and recommendations, using an agreed SAR (Settlement Authority Request) format. Settlement authority on any non-litigated claim shall be approved by the County before being presented to the injured employee. Settlement authority on litigated claims shall be approved by the County before being presented or negotiated with applicant attorney. All claims estimated with settlement valuation over $50,000.00 must obtain Board of Supervisor approval.

FF. Solicit all medical bills, medical reports and records, and documentation of alleged wage loss prior to settlement negotiations.

GG. Prepare written notification for the County’s excess insurance carrier per current excess carrier’s reporting requirements. Administrator will reimburse the County for any late reporting penalties imposed by the carrier due to late reporting, unless late reporting is caused by the

County.

HH. Submit at minimum quarterly requests to the excess carrier for all payments above each claim's Self-Insured Retention to obtain proper reimbursement for the County. Reimbursement checks will be forwarded to the County’s Risk Manager and the amount recovered will be entered into the Administrator's claims management system. The Administrator’s system should identify all claims where excess money is outstanding.

II. Administrator may receive compensation from outsourced services, either by retaining a portion of expenses charged to the Account, or by receiving fees from preferred providers. The

County shall be included in the selection process of outside vendors. All fees shall be disclosed to the County.

JJ. MSA Allocations/SCHIP Reporting: Administrator will contract with preferred third-party vendors for Medicare Set Aside allocations and State Children Health Insurance Program

Page 10 of 30 Release date of June 1, 2026

("SCHIP") reporting efforts.

KK. Maintain continual contact with medical practitioners to monitor injured worker’s treatment process and a timely return to work. Administrator shall make a good faith effort to establish contact with attending physician within 24 hours of receipt of injury report and shall make contact with attending physician's office within 48 hours of receipt of injury report, and shall document such contact in the claim file.

2.3. RECORD KEEPING AND REPORTING REQUIREMENTS

A. Provide monthly reports consisting of:

1. Daily check registers including all claim disbursements made on behalf of the

County.

2. Loss reports showing descriptive data, details of each month's payments, total payments, reserves and total expense and incurred loss values for each claim.

3. All other reports as required by Employer.

B. Provide special specific focus loss run reports within 24 hours and larger or major analysis reports within 7 business days. Should the County require that Administrator prepare special reports which require additional programming costs, it is understood that there may be an additional charge for said reports.

C. Maintain all records and statistical data on each claim, including, but not limited to, a record of each denial, delay, litigated claim and loss, for the County to review at any time. The County may audit, at their discretion, all records maintained by Administrator including, but not limited to, all payments made on behalf of the County. Such audit may incorporate random sampling or other audit procedures suitable to the County.

D. Prepare and file the OSIP (Office of Self-Insurance Plans) Self-insured Annual report and provide to the County 30 days before the deadline date.

E. Conduct injury trend analysis, loss control reviews, and develop reports to identify areas for improvement, working with the Employer regarding specific report data to be provided.

Page 11 of 30 Release date of June 1, 2026

F. Every 90 days, submit a full summary report to the County’s Risk Manager on all claims meeting the following criteria:

1. Total incurred value exceeding $50,000

2. Potentially controversial cases

3. Claims in which settlement is recommended

4. Litigated claims and status

G. Provide Stewardship Reports no less than annually, and within 30 days if an additional report is requested by the County. Administrator agrees to meet with County to review

Stewardship Reports, and to provide the reports prior to the meeting. At a minimum, the

Stewardship Report should include:

1. Top injuries, by body parts, by occupation, by cause, frequency analysis, payout by benefit type, department, settlements, rates of litigated claims, etc

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

3. Well organized and clear data which may include graphs and charts,

4. Strategic action items for program improvement with benchmarks including claims handling, action plans for each claim, closing claims, long term plan for the County.

5. Written detailed analysis of claims information provided, including ongoing or new patterns, and recommendations based on findings.

H. Prepare and submit Federal Information Return (Form 1099) by statutory deadline for applicable payments made by Administrator on the County's behalf, during the term of the contract.

I. Prepare all other reports as necessary to remain in compliance with all Workers'

Compensation Laws and other state and federal laws, rules and regulations.

J. Provide report to the County’s Accounting Department of all payments when made and any other information necessary for the County to adequately fund the bank trust account.

All such payments shall be supported with check payment detail and monthly summary report showing all payees, payment amounts and dates of payment.

Page 12 of 30 Release date of June 1, 2026

2.4. COMPUTERIZED CLAIMS MANAGEMENT SYSTEM

A. Provide the County access to Administrator's computerized claims management system.

This system will provide the County with all financial and statistical data relating to the

County’s workers' compensation claims, narrative "notepad" reports, and records on each individual claim. The system will also include OSHA Log generation; and complete report generation capabilities. All claim-related documents from any source will be put into the Administrator’s computer system.

B. Provide County staff training to utilize the computerized claims management system.

Technical support for any software-related problems will remain the ultimate responsibility of the Administrator.

C. Maintain an effective claim electronic data security system including adequate access and integrity controls, and continuity program for uninterrupted systems operations.

D. Implement and maintain any required outgoing and/or incoming data feeds from and to the County’s internal risk management information system (RMIS), currently Origami

Risk. All data from pre-existing claims to be imported in a format that is legible to

County staff.

E. All records, files, transcripts, computer tapes, media and information systems data, and any other materials on workers’ compensation claims are the exclusive property of the

County. As such, all records shall be maintained in the Administrator’s claims management system, and relinquished in good order and condition, in a method deemed feasible for operating by the County, upon termination or transition of this contract at no cost.

F. In the event of a follow-on contract award to another Administrator, the Administrator shall ensure a cooperative and smooth transition with a new Administrator and shall provide all records, status reports and contract files.

2.5. FRAUD UNIT

A. Maintain a Special Investigative Unit (SIU) program either in-house, or via 3rd party SIU.

Whenever warranted, Administrator shall aggressively pursue fraud cases with the

Page 13 of 30 Release date of June 1, 2026

District Attorney’s Office after authorization from the County.

2.6. MEDICAL MANAGEMENT / UTILIZATION REVIEW

A. Administrator shall have a Utilization Review (UR) program in place and adhere to all

Medical Treatment Utilization Schedule (MTUS) guidelines and the County’s client handling instructions (CHI).

B. UR Guidelines shall be reviewed and approved by the County to continue to maximize efficiency.

C. Medical bills shall be reduced (other than medical-legal expenses) to the Official Medical

Fee Schedule.

D. Administrator shall conduct thorough investigation of claims to prevent improper billing practices and ensure medical documentation supports level of billing.

E. Administrator shall provide Utilization Review approval for all consults, diagnostics, physical therapy, pharmaceuticals and other medical services, per the County’s Client Handling

Instructions (CHI).

2.7. STAFFING REQUIREMENTS

A. The County reserves the right to approve/accept key personnel at the level of Claims

Examiner and above, and to be involved in the interview process. The Administrator must notify the County a minimum of 14 calendar days in advance (whenever feasible) if key personnel cannot continue on the account and allow the County to respond either approving or rejecting replacement personnel.

B. Claims Examiners must possess both State of California claims examiner designation and

California Self-Insurance Plans certification and must be in good standing and with no known performance or disciplinary issues. Senior Claims Examiners to have a minimum of 5 years’ examiner level experience and a minimum of 3 years for Future Medical and Medical Only adjusters.

C. Claims Supervisors and Claims Examiners covering claims under Labor Code 4850 must have a minimum of 5 years’ qualified experience in administering claims for public safety members.

Page 14 of 30 Release date of June 1, 2026

D. Caseloads of Indemnity claims will be maintained at a maximum of 150 for each Senior

Claims Examiner.

E. Claims Examiners shall participate in effective continuing education.

F. Medical Only claims shall be handled by a Claims Examiner solely responsible for

Medical Only and Future Medical cases, except on complex claims as needed.

G. Claims Supervisors will not be assigned an ongoing caseload and will monitor those examiners who are under their direct supervision and aid in difficult claim matters. The ratio of supervisor to examiner within the program will not exceed 1 in 4. Supervisors will be required to review all open claims no less than every 120 days. Supervisor reviews will be documented in the electronic notes of the claim files and will address all pertinent pending matters on each claim, including reserves; compensability; medical management; litigation management;

subrogation; and proactive action plans ensuring timely return to work of the employee and moving the claim to resolution.

H. If the awarded Administrator is not the current TPA, it will be the responsibility of the

Administrator to review every claim within 90 days after initiation of services and identify all penalties due on cases prior to contract period within 120 days after contract inception;

otherwise, penalties become the sole responsibility of the Administrator.

I. Administrator shall ensure that each existing claim is properly identified as Medical

Only, Indemnity, or Future Medical; and claims are properly categorized and assigned on an ongoing basis.

2.8. WORKERS’ COMPENSATION TRUST FUND CHECKING ACCOUNTS

A. The County shall establish a claim clearing checking account in the County’s name to cover payments and reimbursements applicable to the self-insured Workers’

Compensation program and the payment of first aid claims.

B. 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. Administrator shall provide the bank with stock checks. Checks shall be protected with

Page 15 of 30 Release date of June 1, 2026 state-of-the-art security features. Administrator shall not draw on the trust fund checking account for any purpose other than adjustment of claims and payment of allocated loss expenses.

C. Administrator shall provide a monthly detailed account of all Workers’ Compensation benefits and allocated loss expenses paid from the fund including the date and check number of all benefit and allocated loss payments, and appropriate supporting documentation for allocated loss expense payments to the County. A monthly check register summary shall also be provided.

Administrator is responsible for erroneous payments made from the account caused by their error. The amount of any such erroneous payments made from the account shall be deducted from administrative fee payments.

D. 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 examiner fees, photography, and other incidental and special costs incurred to evaluate compensability of claims. 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.

E. Administrator 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.

2.9. PERFORMANCE EVALUATION

A. Administrator agrees to be audited annually, or more often as needed. If audit results show needs improvement or below satisfactory for any audit category (current audit contains 12 categories), Administrator agrees to forfeit 1% of annual fees per category, within 30 days of audit results.

3. Submission Requirements

3.1. Submission Deadline

Proposals must be electronically received by 5:00 pm, on Friday, July 10, 2026 via eProcurement system.

Allow sufficient time for the upload to complete by the Due Date and Time. Partial uploads will automatically terminate, and proposals will be rejected. The eProcurement system submission time will be the official submission time. The County will not be responsible for and may not accept proposals that are late due to slow internet connections or for any other failure of the eProcurement system.

Page 16 of 30 Release date of June 1, 2026

NOTE: The County does not maintain the eProcurement system and is not liable for site failures or technical problems. To resolve technical issues, contact OpenGov Technical Support by using the real time chat located in the lower right hand corner of the screen, or via email at procurement-support@opengov.com https://procurement.opengov.com/portal/smcgov

3.2. Pre-submission Registration

Organizations or individuals interested in responding to this solicitation must register online with the

County of San Mateo at:

• https://procurement.opengov.com/portal/smcgov

It is recommended that organizations complete this registration as soon as possible. The County will not be responsible for and may not accept proposals that are late due to a failure to register in the eProcurement system.

3.3. Submission via eProcurement Portal

Required Documents

Please refer to the Technical Proposal section for submittal documents and requirements.

Electronic Submissions

Include the proposer name and the RFP title and number in each filename. Submit proposals via the eProcurement website, allowing sufficient time for the upload to complete by the Due Date and Time. As noted above, the eProcurement portal submission time will be the official submission time, and partial uploads will automatically terminate, and proposals will be rejected. Contact eProcurement Portal with technical questions regarding this site.

Conflicts between Certain Requirements

Prior to the submission deadlines and solely relating to a determination of the timeliness of questions, comments, and proposal submissions, information displayed on the eProcurement portal site will take precedence in the event of a discrepancy between that information and the information within the solicitation documents. For all other discrepancies, the information in the solicitation documents will take precedence.

Format

Documents should be created in the following format:

• Text should be Times New Roman (12-point minimum font size) and unjustified (i.e., with a ragged-right margin)

• Pages should have margins of at least one inch on all sides (excluding headers and footers)

• If the proposal is lengthy, a Table of Contents should be included.

• PDF format is preferred.

mailto:procurement-support@opengov.com mailto:procurement-support@opengov.com https://procurement.opengov.com/portal/smcgov https://procurement.opengov.com/portal/smcgov https://procurement.opengov.com/portal/smcgov/projects/216886/document?section=2037871

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Errors in Proposals

The County will not be liable for any errors in proposals. Proposals may be rejected as unresponsive if they are late, incomplete, missing pages or information, or cannot be opened for any reason. The County may waive minor irregularities, but such waiver will not modify any remaining RFP requirements.

3.4. Procurement Preference for Local Businesses and Local Non-Profits

The County of San Mateo has adopted a Procurement Preference for Local Businesses Ordinance (County

Ord. Code Ch. 2.89.) The purpose of this Ordinance is to promote a strong local economy by giving preference to local businesses, local non-profits, local small and micro businesses, and local small and micro non-profits in County procurements, to the extent consistent with the law and interests of the public. The County’s process for applying local preferences to competitive procurements is set forth in

County Ordinance Code Section 2.89.030. The Ordinance and exemptions (e.g. the ordinance will be exempt when all bids or proposals received are from Non-Profit Organizations) can be reviewed here:

Chapter 2.89 - PROCUREMENT PREFERENCE FOR LOCAL BUSINESSES | Code of Ordinances |

San Mateo County, CA | Municode Library

The requirements for bidders to establish eligibility for a local preference for this solicitation are detailed below in Section III (Submission Requirements) The Ordinance does not apply if a procurement is determined to be exempt (County Ord. Code sec. 2.89.050), and the County reserves the right to waive application of the Ordinance to this procurement if determined to be in the best interests of the County

(County Ord. Code sec. 2.89.060).

4. Minimum Qualifications, Local Preference Ordinance, and Technical Proposal

4.1. Minimum Qualifications

4.1.1. Completion of the Technology Security Assessment.

Please download the below documents, complete, and upload.

• technologysecurityassessmen...

4.1.2. Has Proposer been providing Workers’ Compensation Third Party Administration and

Managed Care Cost Containment Services for a minimum of five (5) years within the last seven (7) years?*

☐ Yes

☐ No

*Response required

4.1.3. Does Proposer provide similar services for at least three (3) public entities with a minimum of 7,000 employees, one (1) of which must have been in the State of

California?*

☐ Yes

☐ No

*Response required https://library.municode.com/ca/san_mateo_county/codes/code_of_ordinances?nodeId=TIT2AD_ART2.8INFIPRCOCO_CH2.89PRPRLOBU https://library.municode.com/ca/san_mateo_county/codes/code_of_ordinances?nodeId=TIT2AD_ART2.8INFIPRCOCO_CH2.89PRPRLOBU https://government-project.s3.us-west-2.amazonaws.com/216886/c951b3b7-4978-4bad-b8b5-b3dc3ed28289_technologysecurityassessment_2023.pdf

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4.1.4. Claims Supervisors and Examiners assigned to County’s contract must possess both

State of California claims examiner destination and California Self-Insurance Plans certifications. Claims Supervisors and Senior Claims Examiners must have a minimum of five years’ examiner level experience. Does Proposer meet the certification requirements?*

☐ Yes

☐ No

*Response required

4.1.5. Claims Supervisors and Examiners covering claims under Labor Code 4850 must have a minimum of five (5) years’ qualified experience in administering claims for safety members. Does Proposer meet the five (5) years' of qualified experience with Labor

Code 4850?*

☐ Yes

☐ No

*Response required

4.1.6. Is your firm registered with System for Award Management (SAM)?

SAM.gov

☐ Yes

☐ No

4.1.7. What is the registered Business Name and Unique Entity ID (UEI) No.?

• UEI number can be obtained by registering your business through SAM.GOV

• Should you be in the process of obtaining your UEI number, please enter the digits ‘123’ temporarily for your response below in order to proceed with proposal. This temporary number should be replaced with the correct registration number for submission of the proposal.

4.2. Procurement Preference for Local Businesses and Local Non-Profits

4.2.1. Is the Proposer a "Local Business"?

As Defined by Chapter 2.89.020 of the San Mateo County Ordinance Code, a “Local Business” means any for-profit business which has its principal place of business, or is headquartered, in San Mateo

County. If this designation applies to the proposer, a self-attestation form must be completed and provided with this response.

Please download the below documents, complete, and upload. If this designation is not applicable, please leave blank.

• SMC_LocalBusiness_self-atte...

4.2.2. Is the Proposer a Non-Profit?*

A Non-Profit is defined as a tax-exempt public charity organization (within the meaning of section

501(c)(3) of the Internal Revenue Code) that is formed for purposes other than making a profit, is exempt from paying federal income taxes on the income generated for their exempt purposes.

https://www.sam.gov/ https://government-project.s3.us-west-2.amazonaws.com/153456/a16ffdc0-a0ee-44ca-b6de-1fddd010042f_SMC_LocalBusiness_self-attestation_form_120424.pdf

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☐ Yes

☐ No

*Response required

When equals "Yes"

4.2.3. Is the Proposer a "Local Non-Profit"

As Defined by Chapter 2.89.020 of the San Mateo County Ordinance Code, a “Local Non-Profit" means a tax-exempt public charity organization (within the meaning of section 501(c)(3) of the

Internal Revenue Code) that is formed for purposes other than making a profit, is exempt from paying federal income taxes on the income generated for their exempt purposes, and has its principal place of business, or is headquartered, in San Mateo County. If this designation applies to the proposer, a self-attestation form must be completed and provided with this response.

Please download the below documents, complete, and upload. If this designation is not applicable, please leave blank.

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4.2.4. Is the Proposer a Local "Small" or "Micro" Business?

As Defined by Chapter 2.89.020 of the San Mateo County Ordinance Code:

“Small Business” means any business which holds a Small Business Certification awarded by the

California Office of Small Business and Disabled Veteran Business Enterprise Services (OSDS).

“Micro Business” means any Small Business certified by the OSDS which is automatically designated by the OSDS as a Micro Business due to gross annual receipts falling below the OSDS-designated dollar amount.

If the above designations apply, please provide the OSDS provided Certification ID.

If this designation is not applicable, please leave blank.

4.2.5. Is the Proposer a Local "Small" or "Micro" Non-Profit?

As Defined by Chapter 2.89.020 of the San Mateo County Ordinance Code:

“Small Non-Profit" means a Local Non-Profit with an annual revenue of $1,000,000 to $2,500,000 according to its most recently filed IRS Form 990.

“Micro Non-Profit" means a Local Non-Profit with an annual revenue of less than $1,000,000, according to its most recently filed IRS Form 990.

If the above designations apply, please provide your latest filed IRS form 990. A filing from the last two calendar years is acceptable.

If this designation is not applicable, please leave blank.

4.3. Technical Proposal

4.3.1. Introduction and Executive Summary *

Submit a letter of introduction and executive summary of the proposal. The letter must contain:

https://government-project.s3.us-west-2.amazonaws.com/153456/80d29c2f-acda-4b87-837e-cb4ead1fb303_SMC_LocalBusiness_self-attestation_form_120424.pdf

Page 20 of 30 Release date of June 1, 2026

• Name, title and contact information (email, phone, and address) for representative of proposer that is responsible for communication related to this RFP.

• Name, title, contact information, and signature of person authorized to obligate firm to perform the commitment contained in the proposal.

Submission of the letter will constitute a representation by proposer that it is willing and able to perform the commitments contained in the proposal and has not violated the terms of this RFP.

*Response required

4.3.2. Statement of Minimum Qualifications*

Describe how the proposer meets the minimum qualifications as set forth in Minimum Qualifications section of this RFP.

Submission of the Minimum Qualifications checklist is not a substitute for providing a detailed written response.

*Response required

4.3.3. Project Approach*

Describe your proposed approach to performing the Scope of Work, including the following:

• Meeting claims handling requirements

• Explain your customer service philosophy. What have you done to improve customer service, and how do you plan to monitor customer satisfaction.

• Meeting technical requirements

• Implementation strategy

• Any notable innovations or improvements that you expect to provide (with respect to, for example, efficiency, technology, sustainability, etc.).

• Suggested performance measures for tracking the quality of performance of the services contained in this RFP.

*Response required

4.3.4. Transition Plan*

Proposer shall outline how they will transition claims administration, reporting and processing from current TPA in a manner that will ensure continuity of uninterrupted service for the County and its injured claimants. The plan description should include discussion regarding the following:

• Any previous experience taking over as Third Party Administrator

• Transition plan timeline

• Plan for transfer of electronic data

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• Service of required notices upon transition

• Information you require of the County or its current Third Party Administration for transition purposes

• Plan for training County Risk Management team on Administrator's computerized claims management system.

• The method to be used to communicate the status of the transition plan to the County

*Response required

4.3.5. Computerized Claims Management System*

Describe what information can be accessed online by the County and provide 2-3 samples of pre-defined reports.

The County’s loss information is considered confidential. Describe methods used to ensure that access to information is gained only by authorized individuals involved with the County’s account. Describe the security measures in place to protect County and injured worker data from any unauthorized access by any means.

Describe the system support and training available to the County and any related charges for system support and training.

Describe firm’s capability and resources for converting existing claim data to your RMIS if you are not the incumbent TPA. Describe the methods used for ensuring the integrity of data conversion.

*Response required

4.3.6. Firm Qualifications *

Attach information regarding background and qualifications, including the following:

• A brief description of the proposer.

• A description of not more than three (3) projects similar in size and scope conducted by the proposer, including the client, reference and telephone numbers, primary staff members involved, budget, schedule, and project summary. Descriptions should be limited to one (1) page for each project.

• If subcontractors are anticipated, identify them (if known) and provide information on how they will be used.

• Any relevant accreditations, licenses, or certifications.

• Describe the proposer’s strategy for a successful engagement with the County.

*Response required

4.3.7. Team Qualifications*

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We request that our future Third Party Administrator’s staffing structure includes 2 fully dedicated

Claims Supervisors, 4 fully dedicated Senior Claims Examiners, 1 fully dedicated Future Medical Claims

Examiner, and 2 fully dedicated Assistant Claims Examiners, however the chosen TPA will have some flexibility to propose staffing.

Provide a chart identifying:

• Claims Administration team and reporting structure

• Project implementation team

• Role each person will play in the project

Provide a brief description of the experience and qualifications of the Claims Administration team members, including short resumes if desired.

Provide a definition of the Proposer's roles, responsibilities and activities and how they will integrate with the County.

Written assurance that the key individuals listed and identified will be performing the work and will not be substituted or reassigned without the County’s prior approval.

What is the plan of action should you lose an adjuster during the contract period?

*Response required

4.3.8. References*

Provide three (3) references, preferably other public agencies, including for each the name, email address, and telephone number of your references. References should be recent clients (still contracted within the last 12 months).

*Response required

4.3.9. Fee Proposal*

The County asks that you base your pricing on caseloads of no more than 150 per Senior Claims

Examiner. Please provide a proposed annual flat fee for all services and include the following:

• A list of all services that will be provided within the basic annual flat fee (e.g., field investigation, hearing representative, medical cost containment services, medical management services, rehabilitation services, etc.)

• A list of all services that will be provided at an additional cost to the annual flat fee, and what the cost will be (e.g. one-time data conversion fee, field investigation, hearing representatives, medical cost containment services, and medical management services, rehabilitation services, etc.)

The Fee Proposal should be submitted as a separate Excel file from the Technical Proposals detailed in

Required Documents.

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The County reserves the right to accept other than the lowest priced offer and to reject any proposals that are not responsive to this request.

*Response required

5. Evaluation and Selection Criteria

The proposals will be evaluated by a selection committee with relevant expertise. The County intends to evaluate the proposals generally in accordance with the criteria itemized below. Proposers with the highest scoring proposals may be interviewed by the committee to make the final selection.

N o.

Evaluation Criteria Scori ng

Meth od

Weig ht

(Poin ts)

1. Project Approach

A. Demonstrates a clear understanding of the project/proposed services detailed in Section II -

Scope of Work and the tasks to be performed.

B. Ability of the proposed Administrator to fulfill the functionality desired by the County.

C. Reasonableness of proposed staffing level and allocation plan

D. Strategy for successful engagement with the County.

E. Effective and cost saving innovations.

Points

Based

(23.6

% of

Total)

2. Firm Qualifications

A. Relevant expertise

B. Quality of recently completed projects, including adherence to schedules and budgets.

C. Results of reference checks

Points

Based

(20.8

% of

Total)

3. Team Qualifications

A. Expertise of assigned staff in the subject area and description of the tasks to be performed by each staff person.

B. Workload, staff availability and accessibility

Points

Based

(20.8

% of

Total)

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4. Fee Proposal

Fee proposal will be scored on a combination of lowest cost and best value proposals for the full 5 year contract.

The table below explains the method by which the fee proposal is scored. The lowest cost proposal will receive the maximum number of points assigned to the fee proposal evaluation criteria. All other proposals will be assigned points by dividing the amount of the lowest total fee proposed by the amount of their respective total fee proposed and then multiplying the resulting number of the maximum number of points available to receive the contractor’s score.

For example, if a total of 25 points are assigned to evaluate the fee proposal, Firm A offers the lowest fee proposal of $1000 and receives all 25 points. Firm B is the next lowest fee proposal that offers $1200 and receives a score of 20.8 points ($1000 divided by $1200 multiplied by 25 points). Firm C has the highest fee proposal that offers $1500 and receives a score of 16.7 ($1000 divided by $1500 multiplied by 25 points).

Firm Firm A Firm B Firm C Total Cost $1000 $1200 $1500 Calculation - 1000

Points Achieved % 1.0 0.83 0.66 Points (Max 25) 25 20.8 16.7

Points

Based

(25.5

% of

Total)

5. Preferential Points

Where price is not the sole evaluation factor for a solicitation (e.g., in the case of a "best-value" solicitation), five percent (5%) of the total evaluation points awardable will be added to the proposal score for each Local Business or Local Non-Profit score for evaluation purposes. In the event of a tie between a

Local Business or Local Non-Profit and another bidder, the Local Business or Non-Profit shall be awarded the Contract, assuming agreement on other contract terms.

An additional three percent (3%) preference shall be given to a Local Business or Local Non-profit (for a total of eight percent (8%) of total points awardable) if the proposer is a Small Business or Small Non-

Profit, or an additional 5 percent preference (for a total of ten percent (10%) of total points awardable) if the proposer is a Micro Business or Micro Non-Profit.

Points

Based

(9.4% of

Total)

6. Instructions to Proposers

6.1. Instructions

There will be no pre-proposal conference or site visit for this project.

6.2. Communications

A. As of the issuance date of this RFP and continuing until it is canceled or an award is made, no proposer or person acting on behalf of a prospective proposer may…