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RESOLUTION NO. 12287
A RESOLUTION APPROVING A SERVICE AGREEMENT
BETWEEN THE CITY OF PUEBLO AND SUMMIT POINT
CONSULTING RELATING TO WORKERS’
COMPENSATION FOR FISCAL YEAR 2012
BE IT RESOLVED BY THE CITY COUNCIL OF PUEBLO, that:
SECTION 1.
The Service Agreement between the City of Pueblo and Summit Point Consulting
relating to third-party administration for the City’s self-insured workers’ compensation
program and Medicare reporting requirement for the year 2012, a copy of which is
attached hereto, having been approved as to form by the City Attorney, is hereby
approved.
SECTION 2.
The President of the City Council is authorized to execute and deliver the Service
Agreement in the name of the City and the City Clerk is directed to affix the seal of the
City thereto and attest same.
SECTION 3.
This Resolution shall become effective upon final passage and approval.
INTRODUCED December 27, 2011
BY: Leroy Garcia
COUNCILPERSON
Background Paper for Proposed
RESOLUTION
DATE: DECEMBER 27, 2011AGENDA ITEM # M-7
DEPARTMENT: LAW DEPARTMENT
CITY ATTORNEY – THOMAS J. FLORCZAK
HUMAN RESOURCES DEPARTMENT
DIRECTOR – MARISA WALKER
TITLE
A RESOLUTION APPROVING A SERVICE AGREEMENT BETWEEN THE CITY OF
PUEBLO AND SUMMIT POINT CONSULTING RELATING TO WORKERS’
COMPENSATION FOR FISCAL YEAR 2012
ISSUE
Should the City Council approve the Services Agreement with Summit Point Consulting
relating to workers' compensation?
RECOMMENDATION
Approval of this Resolution.
BACKGROUND
Summit Point Consulting will continue to act as third-party administrator for the City’s
self-insured workers’ compensation program and Medicare reporting requirement for
2012 for the annual fee of $59,730, payable monthly. Computer access will be provided
for an additional fee of $10,000. The Medicare reporting fee will be $2,500. The annual
fee represents an increase of 2.5%. The computer access fee and Medicare reporting
fee remain the same as 2011
FINANCIAL IMPACT
See Background.
i
COP SERVICE AGREEMENT
Effective January 1, 2012
In consideration of the mutual covenants herein contained, Summit Point Consulting,
an independent contractor, hereinafter referred to as "SPC ", does hereby contract
and agree with The City of Pueblo, hereinafter referred to as the "Employer ", as
follows:
1. Appointment. The Employer hereby appoints SPC as Service Agent upon
the terms and conditions hereinafter set forth.
2. Term. This Service Agreement shall be effective from 12:01 a.m., January
1, 2012 to December 31, 2012. The financial obligations of the City in any
fiscal year after fiscal year 2012 is subject to funds being appropriated and
budgeted specifically for such purpose. The City may terminate this
agreement upon sixty (60) days' written notice to SPC. SPC may withdraw
from this agreement upon sixty (60) days' written notice to the City.
3. Duties and Authority of SPC. The services to be performed by SPC, during
the time this Agreement remains in effect, shall include:
3.1 Act as advisor and representative of the Employer in all
matters pertaining to the administration of Workers'
Compensation injuries imposed by the Colorado Workers'
Compensation Act.
3.2 Compile and file notices, reports, and forms required under the
Colorado Workers' Compensation Act upon receipt of the first
report of injury from the Employer.
3.3 Maintain records by departments of all details incident to
payments made to fulfill the obligations of the Employer under
the Colorado Workers' Compensation Act with appropriate
claims reporting software. Access to adjuster notes and
reporting software will be provided upon request.
3.4 It is expressly understood that SPC shall not be required to
advance its own funds to pay losses or allocated Toss
expenses hereunder. It is further understood that if Employer
fails to provide funds sufficient to allow required payments to
be made timely, SPC will have no obligation to perform any
further services and may terminate this Agreement upon three
(3) days written notice. The Employer is liable for any fees,
fines, or penalties resulting from any delays in providing funds
to SPC.
3.5 Make such investigations as SPC deems necessary to
determine such obligations and negotiate the settlement of
and /or affect the compromise of any claims or suits arising out
of such obligations. Claims handling and settlements will be
handled as outlined by the Quality Service Plan (hereinafter
referred to as "QSP ").
3.6 Arrange for the defense of any claims, suits, or other
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proceeding arising out of, or claimed to arise out of, such
obligations per the QSP. The cost of any such defense shall
be paid by the Employer and included in its allocated loss
adjustment expenses.
3.7 Furnish claim reports and records per the QSP, which will
include records by departments showing:
a. The number, type, and severity of accidents.
b. All payments made by, or on behalf of, Employer for
benefits or expenses.
c. Estimate of all reserves for actual, anticipated, or
potential benefits or expenses.
All work, data, drawings, designs, plans, reports, studies,
computer programs (nonproprietary), computer input and
output, analyses, tests, maps, surveys, or any other materials
developed and maintained as a part of these contracted
services are and shall be the sole and exclusive property of
the Employer. Claim files will be maintained and stored by
SPC for a period of seven (7) years from the date of closing as
long as this Agreement or a renewal of such Agreement
remains in effect. At the end of this period or the termination
of this agreement, all physical records will be turned over to
the Employer. All computer records will be maintained
indefinitely as long as this Agreement or its renewal remains in
effect. Upon termination of this Agreement an extract of the
data will be provided to the Employer for an agreed upon fee.
3.8 Conduct loss prevention inspections, attend safety meetings,
and perform such other duties as requested by the Employer
to assist in the conduct of the Employer's Workers'
Compensation Loss Prevention Program at an additional rate
of $100 per hour.
3.9 Provide comprehensive solution wherein SPC will contract
with CS Stars and its Strategic Service Provider (SSP), Gould
and Lamb, to facilitate the full cycle of reporting Medicare
beneficiary data to Centers for Medicare and Medicaid
Services (CMS) on behalf of Employer as more fully outlined
in Appendix A.
4. Compensation. The annual service fee payable during the term of this
Agreement by the Employer to SPC in consideration of the services outlined
above shall be:
Term Fee
January 1, 2012 — December 31, 2012 $59,730
Employer will pay an additional annual administrative fee of
$10,000. This fee covers such costs associated with maintaining
and balancing the Employer's escrow account, maintaining
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information in the claims database as well as providing claim
reports.
Employer will pay an additional $2,500 for the annual maintenance
fee for Medicare reporting cost.
At the beginning of each month, the Employer will be billed
$6,019.16 (as calculated below) and payment shall be due and
payable by the Employer upon receipt.
$59,730 — Annual Service Fee
$10,000 — Annual Administrative Fee
$ 2,500 — Medicare reporting fee
$72,230
(divided by 12 months) =
$6,019.16
In addition, the Employer will be billed each month for the actual
banking fees and charges from the previous quarter.
5. Termination. In addition to the provisions of paragraph 2 above, either party
may terminate this Agreement at any time for material breach of contract,
gross negligence, wanton misconduct, or fraud. Such termination for cause
shall be by written notice specifying the grounds for termination. Said notice
shall be effective when received except in the case of material breach of
contract. In the case of material breach of contract, said notice shall be
effective if the breach is not cured within thirty (30) days of receipt of written
notice specifying the material breach.
Upon any termination of this Agreement, SPC shall return all books,
records, files, and other items pertaining to the Employer and its claims and
shall have no further obligation to perform any services imposed upon SPC
by this Agreement. SPC shall further assist in the orderly transition of such
administration.
At the Employer's option, SPC agrees to continue to the handling of all
claims open 45 days after termination of this Agreement to conclusion for a
fee of $300.00 per claim. In the event of cancellation or non - renewal of
subsequent year contracts, this per claim charge shall be adjusted by the
Consumer Price Index changes from January 1, 2011.
6. Claims Payments. SPC will maintain an escrow account in its name and will
issue claim checks out of this account. This account will be funded by the
Employer with an initial deposit equal to four (4) weeks of expected claim
payments. SPC will provide Employer a weekly check register and the
Employer will make an ACH deposit equal to the amount of the weekly
check register to restore the escrow account to its original balance. Such
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ACH deposit will be made within one week of receipt of the check register.
The Employer is responsible only for the bank fees and charges to maintain
the escrow account.
7. Waiver of Breach. Failure to either party to claim a breach or to terminate
this Agreement when cause for termination exists shall not constitute a
waiver of subsequent breaches or subsequent causes for termination.
8. Indemnification. To the extent permitted by law, SPC will indemnify and
save harmless Employer from all claims, losses, damages, penalties and
expenses caused by or resulting from the negligence or fraud of SPC or its
officers, employees or agents. SPC shall not be responsible for any CMS,
Employer, CSStars, Gould & Lamb or other third party system failures or
connectivity issues which may results in failures to transmit Client's
transactions within the CMS required time frames. SPC shall not be
responsible for errors or omissions, negligence of, or connectivity issues or
delays by Gould & Lamb. SPC shall not be responsible for any claim,
damages, fines, losses or expenses arising in connection with or as a result
of any errors, omissions, or negligence of Gould & Lamb if Employer does
not respond within five (5) business days of receipt of any E -mail notification
from SPC about a CMS response regarding Employer's Claim Input
information with any applicable corrected information.
9. Modification. This Agreement may only be amended or modified by a
writing signed by the parties hereto.
10. Binding Effect. The Agreement is binding upon and shall inure to the benefit
of the parties hereto, their successors by merger or consolidation, and upon
their assigns approved by the other party in writing.
11. Entire Agreement. This Agreement constitutes the entire Agreement
between the parties.
12. Applicable Law. This Agreement shall be governed, construed, and
enforced in accordance with the laws of the State of Colorado.
13. SPC certifies that it does not knowingly employ or contract with an illegal
alien nor will SPC enter into a contract with a subcontractor that fails to
certify to SPC that the subcontractor shall not knowingly employ or contract
with an illegal alien to perform work under this contract.
If SPC obtains actual knowledge that a subcontractor performing work
under this contract knowingly employs or contracts with an illegal alien, SPC
shall:
A. Notify the subcontractor within three (3) days that the SPC has received
such knowledge; and
B. Terminate the subcontract with the subcontractor if within three (3) days
of receiving the notice required pursuant to subparagraph A. above the
subcontractor does not stop employing or contracting with the illegal
alien; except that SPC shall not terminate the contract with the
subcontractor if, during such three (3) days, the subcontractor provides
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information to establish that the subcontractor has not knowingly
employed or contracted with an illegal alien.
SPC will comply with any reasonable request by the Colorado Department
of Labor and Employment (hereinafter referred to as "CDLE ") made in the
course of an investigation that CDLE is undertaking pursuant to its authority
under 8- 17.5- 102(5), C.R.S.
Violation of the provisions of Item 13 by SPC shall constitute a breach of
contract and grounds for termination. In the event of such termination, SPC
shall be liable for the City's actual damages.
14. Employer shall register as a Responsible Reporting Entity (RRE) on the
CMS Coordination of Benefits Secure Website (COBSW) as required by
The Medicare, Medicaid, and SCHIP Extension Act of 2007 (SCHIP) and
subsequent memorandum by CMS and subsequent memorandum by CMS
during the period between May 1, 2009 and September 30, 2009, or such
other end date as CMS may provide (the "RRE Registration "). Compliance
with the requirements of the COBSW (and all CMS Mandatory Insurer
Reporting, or Section 111, obligations generally) is solely Employer's
responsibility. To ascertain its Section 111 obligations and determine
whether it is an RRE, Employer should consult the CMS Section 111
website at www.cros,hhs.gov /MandatorylnsRep or such other website as
CMS might provide. Employer is responsible for registration with the
COBSW and designation of the applicable organization as Reporting Agent
(RA) or making any changes to the designated RA as may be required by
CSStars. Employer is responsible for providing RRE ID information to
CSStars and Gould and Lamb as outlined in Appendix A. Employer is
responsible for ensuring that the CMS Data Elements have been provided
by Employer for all data elements /fields required by the CMS Section 111
guidelines in a timely manner for accurate reporting to CMS.
Dated at Pueblo, Colorado, as of December 27 , 2011 .
SUMMIT POINT CONSULTING THE CITY OF PUEBLO,
INDEPENDENT CONTRACTOR COLORADO
By: - aa�.. -- --- By:. . l . . .
Title: Jf • v I« 19(( cie Title; President of City Council
Agreement Page 5
City of Pueblo (Employer) & Summit Point Consulting Service
Agreement
Appendix A
1. SPC will maintain all required SCHIP data elements in Employer's
database effective October 1, 2009.
2. SPC will contract with CSStars and Gould & Lamb on behalf of
Employer to provide an automated solution to comply with CMS 111
reporting requirements. This automated solution will:
a. Verify Medicare eligibility of all claimants every month.
b. Report new or existing claims as required under the Act during
the designated reporting period Employer provides.
c. Report closed claims as required under the Act during the
designated reporting period Employer provides.
3. SPC will provide a registration manual to assist Employer in registering
as an RRE as well as designating the appropriate reporting agent(s)
and designee(s).
4. SPC will maintain the Employer's RRE ID number supplied by
Employer in its database.
5. SPC will update Employer's database for any Medicare eligible claim
so the automated solution is launched properly.
6. SPC will conduct all testing of the automated solution during the
designated testing period.
7. SPC will notify Employer of any errors in data supplied by Employer
within 24 hours so Employer can provide correct information to SPC
within 4 days to avoid fines from CMS for data transmission errors.
Agreement Page 6