HomeMy WebLinkAbout1995-386RESOLUTION NO. 95-386
RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF
SAN BERNARDINO AUTHORIZING THE EXECUTION OF A WORKERS'
COMPENSATION MANAGED CARE SERVICES AGREEMENT BETWEEN BEECH STREET
OF CALIFORNIA, INC. AND THE CITY OF SAN BERNARDINO
BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY
OF SAN BERNARDINO AS FOLLOWS:
SECTION 1.
The Mayor of the City of San Bernardino is
hereby authorized and directed to execute on behalf of said City
a Workers' Compensation Managed Care Services Agreement, a copy of
9 which is attached hereto marked Exhibit "A" and incorporated
10 herein by reference as fully as though set forth at length.
11
SECTION 2.
The authorization to execute the above-
12 referenced agreement is rescinded if the parties to the agreement
13 fail to execute it within sixty (60) days of the passage of this
14 resolution.
15 I I I
16 I I I
17 I I I
18 I I I
19 I I I
20 I I I
21 I I I
22 I I I
23 III
24 I I I
25 III
26 I I I
27 I I I
28 I I I
1
"
,',
f,
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF
SAN BERNARDINO AUTHORIZING THE EXECUTION OF A WORKERS'
COMPENSATION MANAGED CARE SERVICES AGREEMENT BETWEEN BEECH STREET
OF CALIFORNIA, INC. AND THE CITY OF SAN BERNARDINO
I HEREBY CERTIFY that the foregoing resolution was duly
adopted by the Mayor and Common Council of the City of San
6th
meeting thereof, held on the
Bernardino at a
regular
November
, 1995, by the following vote, to wit:
day of
Council Members:
NEGRETE
CURLIN
HERNANDEZ
OBERHELMAN
DEVLIN
POPE-LUDLAM
MILLER
~~
The foregoing resolution is hereby approved this ~
day
November
, 1995.
of
-; ~~;({AA'~_
Tom Mlnor, Mayor
City of San Bernardino
Approved as to
form and legal content:
JAMES F. PENMAN,
City Attorney
2
I.
Res 95-386
LETTER OF AGREEMENT
2
3 This Workers' Compensation Managed Care Services Agreement ("Agreement") is
4 entered into by and between Beech Street of California, Inc., a Georgia Corporation
5 ("Beech Street") and City of San Bernardino ("City '), and is effective as of November 6,
6 1995.
7 Beech Street desires to perform the following services, subject to the terms and
8 conditions of this Agreement.
9 MEDICAL BILL REVIEW
10 Beech Street will process Workers' Compensation medical bills, pharmacy bills and
II medical-legal bills (for treatment and diagnostic services), and make appropriate
12 recommendations for adjustments for compliance with the Official Medical Fee Schedule
I3 mandated by the Department of Workers' Compensation of the State of California
14 ("DWC"). Beech Street will process medical-legal bills for consultative services and make
15 appropriate recommendations for adjustments for compliance with the DWC's medical-
16 legal evaluation guidelines.
17 MEDICAL BILL REVIEW REPORTS
18 Beech Street will deliver to City the following reports:
19 (a) An Explanation of Review ("EOR") for each bill reviewed during each
20 weekly cycle;
21 (b) An Invoice and Itemized Billing Report listing each bill reviewed during
22 each weekly cycle; and
23 (c) A Quarterly Savings Report listing, by month, the gross savings, fees, and
24 net savings to City through the use of Medical Bill Review services.
25 MEDICAL BILL REVIEW FEES
26 For each of the Medical Bill Review services set forth, City shall pay to Beech
27 Street a Bill Review fee of eight dollars ($8.00) per bill.
28 III
[rjm:n~.:dl.agrl
'"
/
......-
PREFERRED PROVIDER ORGANIZATION
2 Beech Street has established a Preferred Provider Organization ("PPO") through
3 negotiated contract rates with hospitals. Beech Street will process and apply Beech
4 Street's negotiated contract rates to Workers' Compensation bills (inpatient and
5 outpatient) from provider members of the PPO.
6 PPO REPORTS
7 Beech Street will provide to City, a monthly report which summarizes the
8 following information for all PPO Bills and a report which itemizes the following
9 information for each bill:
10 (a) Gross charges submitted;
I I (b) Recommended allowance to be paid by City based on Beech Street's
12 negotiated contract rates; and
I3 (c) Resulting savings to City.
14 PPO FEES
15 For the PPO services, City shall pay to Beech Street a PPO fee of 20% of savings.
16 UTILIZATION REVIEW
17 Beech Street will provide to City its Medical Case Management ("MCM") program
18 for:
19 (a) Hospitalizations, consisting of Pre-admission Review, Concurrent Stay
20 Review, Discharge Planning, Bill Screening;
21 (b) Case Management of Non-Catastrophic Cases; and
22 (c) Comprehensive Case Management for Catastrophic Cases.
23 UTILIZATION REVIEW REPORTS
24
25
26
27
28 III
Beech Street will provide to City the following reports
(a) A quarterly Hospital Utilization Summary (Report 900); and
(b) A monthly Explanation of Review for each case processed (Reports 220,
221, 222, and 502).
lrjm:b':'::f.:h.agrl
2
0-
)
:;> ;":
_",::; ;
UTILIZATION REVIEW FEES
2 The fees for the Utilization Review services ("U,R. services") are included in the
3 fees for the Medical Bill Review and PPO services.
4 The fee for non-PPO hospitals is $100 per case.
5 HOSPITAL BILL AUDIT/SCREEN
6 Beech Street will review inpatient hospital bills. All submissions will first be
7 screened to establish whether a need for further audit exists. If the screening process
8 results in a recommendation for audit, scheduling will take place. The audit may either be
9 a desk audit or an on-site audit. All necessary documentation and authorizations will be
10 handled by the audit staff. The audit process will provide a detail of provider overcharges,
] ] identification of items unrelated to the covered diagnosis and the medical necessity of the
]2 services billed. Services billed but not delivered will also be noted.
13 HOSPITAL BILL AUDIT/SCREEN REPORTS
]4 Beech Street will provide the following reports:
]5 (a) A Pre-screen and/or Audit Report for each bill reviewed; and
16 (b) An invoice for each bill reviewed; and
] 7 (c) A monthly report listing the gross savings, fees and net savings for each bill
18
reviewed during the month.
]9 HOSPITAL BILL AUDIT/SCREEN FEES
20 The fees for Hospital Bill AudiUScreen are as follows:
2]
(a)
(b)
For Hospital Bill Audit: $15 per case
For Hospital Bill Screen: 3% gross billed savings
22
23 INVOICES
24 Beech Street shall invoice City of San Bernardino monthly for the fees set forth. The
25 City shall pay each invoice within thirty (30) days of receipt. A service charge of one and
26 one-half percent (1.5%) per month will be added to any invoices that are not paid within
27 thirty (30) days.
28 III
Irjm:hi:~o.:h.agrl
3
CONFIDENTIAL INFORMATION AND COVENANT NOT TO COMPETE
2 The City shall cooperate with Beech Street in providing Beech Street with such
3 access to medical or other records as lawfully permissible for Beech Street to perform
4 services under this Agreement. Such access by Beech Street shall be carried out in a
5 manner agreed to between the City and Beech Street designed to protect the
6 confidentiality requirements. When necessary, The City will obtain waivers and consents
7 from employees to allow Beech Street access to medical information and records.
8 Beech Street will not disclose to any third party, without the prior written consent of
9 The City, any information concerning (I) The City's business, operations, or finances, (ii)
10 the health of the employees of The City, and (iii) any other confidential information which
II it uses, discovers, or learns in connection with its performance hereunder. Such
12 representation and warranty shall remain in effect both during and after the expiration or
13 termination of this Agreement.
14 The City represents and warrants that it will not disclose to any third party without
15 the prior written consent of Beech Street, except as required by law or regulation or the
16 action of any regulatory authority, any information concerning (I) the review procedures,
17 methods, and operations of Beech Street, including this Agreement and any exhibits or
18 amendments thereto, (ii) the business, finances, and pricing of Beech Street's services,
19 and (iii) and other confidential information of Beech Street which The City uses, discovers,
20 or learns in connection with its performance hereunder (collectively "Confidential
21 Information"). Such representation and warranty shall remain in effect both during and after
22 the expiration or termination of this Agreement.
23 THIRTY-DAY CANCELLATION
24 This Agreement may be canceled by either party upon thirty days' written notice to the
25 other.
26 INDEMNITY
27 Beech Street agrees and promises to indemnify, defend and hold harmless San
28 Bernardino, its officers, employees and agents, from and against all actions, claims,
[rjm:h<;,:~<..:h.agrl 4
/)<-
,
- ,. ('
demands, lawsuits, and liability for damages to persons or property that may be asserted
2 or claimed by any person, firm, entity, corporation, political subdivision, or other
3 organizations arising out of or in connection with the performance of this Agreement, but
4 excluding such actions, claims, demands, lawsuits and liability for damages to persons or
5 property arising from the sole negligence or willful misconduct of San Bernardino, its
6 officers, employees or agents.
7 INSURANCE
8 (a) With respect to performance of work under this agreement, Beech Street
9 shall maintain and shall require its subcontractors to maintain insurance as
10 described below:
II 1. Workers' compensation insurance as required by California law.
12 2. Commercial general liability insurance, or equivalent form, with a
13 combined single limit of not less than $1,000,000 per occurrence. If
14 such insurance contains a general aggregate limit, such limit shall
15 apply separately to each project Beech Street performs for City. Such
16 insurance shall (a) name City, its appointed and elected officials, and
17 its employees as insureds; and (b) be primary with respect to
18 insurance or self-insurance programs maintained by City.
19 3. Business automobile liability insurance, or equivalent form, with a
20 combined single limit of not less than $1,000,000 per occurrence.
21 Such insurance shall include coverage for owned, hired and non-
22 owned automobiles.
23 (b) Beech Street shall (1) furnish properly executed certificates of insurance to
24 City prior to commencement of work under this agreement which certificates
25 shall clearly evidence all coverages required above and provide that such
26 insurance shall not be materially changed, terminated or allowed to expire
27 except on 30 days' prior written notice to City; and (2) maintain such
28 insurance from the time work first commences until completion of the work
{rjm:beech.agr) 5
-7. r', ,""
Res 95-386
under this agreement; and (3) replace such certificates for policies expiring
2 prior to completion of work under this agreement.
3 IN WITNESS WHEREOF, the parties hereto have executed this Agreement by their
4 duly authorized officers, effective as of the date and year first above written.
5
BEECH STREET OF CALIFORNIA, INC.
6
7
BY:~~~
S en"(' ICe ""A es- ide...-+
8
9
CITY OF SAN BERNARDINO
10
11
12
13
..(~
B~~ WiA
If Min6r, Mayor -
ATTEST:
14
~"1c1' L ~
Rac I Clark, City Clerk
15
Approved as to form and
16 legal content:
17 JAMES F. PENMAN
City Attorney
18
19
f~
20
21
22
23
24
25
26
27
28
[rjll1:~c:ch.agrl
6
_~r-
./,""''''
'OCT-19-1995 15:3~
~ A.~..ltI...
~~-:-~-'^'''''-~~'-.'''~'''I-'t
PROI:ltJCiR~...- --~"',_...... '.
RLRNDRLE INSURRNCE
P.~2/03,".~.~" I
DAll" (MM/OCiYYJ
1011911lS
, , ,
TllIS CERllFlCA'TE ED AS A MATTER OF INFORMAllON ONLY 'ANO-"
CONFERS NO RI(l1fTS UPON lHE CERTIFICATE HOLDER. nllS CEFlTlFlCATE
DOES NOT AMEND, EXTEND OR AllER lHE COVERAGE AFFORDED BY lHE
POUCIES BElOW.
310 430 5300
~OAlE INSURANCE AGENCY
"022 WINNERS CIRCU;.
SUITE 100
LOS AlAMITOS CA 90720-2854
COMPANIES AFFORDING COVERAGE
c:oMPANV A
LiTTER
AE'IllA LIFE 6 CASUAlTY INS
INSURED
COMPANY
lDTER
B
FREMONT INSURANCE COMPANY
Beech SInIoI eo""""...
11$ TecI1nology
IMne
~~~NY C
CA 92718
l COMP.NY
LiTTER
o
COMPAJO'
: LETTEIl
E
, ~I~" "'i"''''''''''''~l'''-'''-._ ' "JI~""I'''''' '..,
I~I " ~.::r2:::~1ii~,~~"~.~.:~~,;' ~:!~:~rr:~}ji:.; ~
THIS IS TO CERTIFY TMAT THE POUCIES OF= IN IiIANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUReo NAMED ABOVE FQA TH! POLICY PEFIlOO
INOICATED. NOTWITHSTANDING ANY REOUlREMENT, TERM OR CONDITION OF #N CONTRACT OR OTHER DOCUMENT WItH RESPECT TO WHleH THIS
CERTIFICATE MAY BE ISSUEO OR MAY PERTAIN. THE lNSUAANCE AFFORDED BY THE POlICt~S OESCRIBED HEREIN IS suaJECT TO AU. THE TEAMS,
EXCLUSIONS AND CONOITIONS OF SUCH PO~ICIES, L.IMITS SOOWN MAY HAVE BEiN REDUCED BY PAID ClAIMS,
~ ;--~OFI~~.~ __,m poucy N\JMDER i~~~)'-'.i~~=~ ......-.
UMITS
A ! GEMEIW. UABIUTY
, X ; C;OMllERCIAJ.. Ga;:NEPAlI.IABlUTY
',~~'~ro'-- --
',:('h:,.:.: CLAIMS MACE : X i OCCUR
. ',....llc_ _.
, OWN!:R'S & CONTRACTO.~.S PROT.
BBGl2312901Z
i1~'-----;j~
G~NERAl AGGREGATE
--.----------.,.
.
PERSONA~ 5- AD\'. IKJUR'!'
~CH OCCURRENCE
,.
1000001l
lOOOOO1l
, '""'---,000001l
",0000ci0'-'
100000
5000 -
...---
lOOOOO1l
, PRODucT~'" AOO.--"s-'"
FlRE OAMAGE.'(A",r ~~'-~-;;J-~--.'--.
--.'" '''....--.-..-----r:---..
MED EXPENSE: (Ant CI1l;I 1l't1Wl) ,$
A ,'!"')I"UlU. UAIlILm'
ANY.a.U'rO
, AU. OWNeD AVTOS
SCHEDULED AUTOS
X HIRED t.uTOS
-'i NON.OWNED AI,JTOS
.____1
OBBACM2S1Z9012
11!l8m4
1112811lS
, COMllINEO SlNGLE
UMIT
.
60DIl If Il'iJURY
,(P,rpenOil]
s
SOQ1LY INJIJ~Y
(Petaocidenl)
,
GAAAI3E UABILITY
. PROPEIilTY DAMAGE
'S
Al EJa;ESS UAIlIUTV -. .-------..88icS2372lO12
'X UWBRElLA !=OR!.;
, OTlo4ER THAN UMBRB.lJ. FaRM
B
WOIVl8tS ~'ION
AND
EMPLCJ'tEfI8't>>.I1UN
~1
11_
1112&'85
.. ....-- 500000O n'
..-- .-.---.----..
., 500000O
:,:::;;n.~.. ~. 'i'.li,;):l&'ll;~:,O'O;j~!,l'.q , :~,."" ~
,.J,-.:d'1,.,~~~~~?~ .~
. ..... , STATUTORY UNITS ~ '~
....._______. ,,;.t~.
OCIo4 "'CClOENt 1 $ 100000o
, DisEAsE. POLICY UMIT -S.-.....-- tOOOOOO-
- -. ----.-----.--.------.--.
DISEASE. fACH EMPLOVEE $ 100000o
1,_
llIZM5
i EACwOCCUl'lREf'CE
; AGGREGATE
C"'EO
A, CONTENTS - SPECiAl FORM
BLMKET EDP
INCLUDING T\JEFT
8lIFP2:l1ZBOl Z
BGIE2872lO12
11126194
11126/95
REPl.ACEMENT COST
AU. RISK
PROPERTY OEDUGnBU;
2521800
2117800
QESCRIPTlON OF OPERAOON&iocAT~ClAL IIDfS
C..TIFICATB HOLDBa t8 ~ ADPITIO~ IHS01ED pz. eG200" ~TTACBED.
Q: ALL OPERATIO." OJ' ora QImD IHsmtBD.
. 10 nAye JIOTICB OF CARCBLr.A'1'tOIl" rQR. lItlJiJ PAnoarr OF ,lUDIttrM.
'~.;:}7':~=-
CITY OF SAN BERNARDINO
ATlN: LESUE
SOIl NORTll .0. STREET
SAN BERNAROINO
I,';:
I :1 :~
;')
;i::~AlInDmD REPfl
<,1
ie,,, USA D. IlAIWAS
~rt7~:;';.F~:;~J;~~\:r_::;'.~,'-~d(~~:\:r:J, "17li~:' '-1 ",it. /iC::~l.J,;:,I:;r(t.i'M~~jj~~. :;iI!,~rtiJ;;I'Pi:~:~':;~:';1'JI\:,;v:; I;:"
1~~..,Ji.e~>\\<<a;~,,~I,.....olI.lt li;~r.!~:l!if.'~fl~a~'!U:,Jil;;\~? ...!~~.l[{.,;J;{,:i'.o:(~,~,~. 1~d-..,:...;t,~'I:J.J:~r~_: .
CA
112418
--: '-.
,': OCT -19-1995 15; 39.
,
RI.RNDRLE I NSURRNCE
310 430 5300 P.03/03
BEECH STREET CORPORATION
POLICY NUMBER: '086Gr;23729012
COMMERCIAL GENERAL LIABILITY.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS (FORM B) .
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART,
SCHEDULE
Name of Person or Organb:atlon:
CITY OF SAN BERNARDINO
(If no entry appears above. information feQuifed to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an inSured the pefson or organization shown in the
Schedule. but only with respect to liability arising out of "your wOfk" for that inSUfed by or for you.
SUCH INSURANCE AS IS AFFORDED BY nus POLICY FOR 11iE BENEFIT OF (X~ AND GENERAL
CONl'RAC!OR SHAlL BE PRn1ARY rnsuRANCE AS RESPECl'S TO ANY CUJ.MS. lDSSES. OR
LIABILITI ARISOO DIFEClLY OR llIDIRECl'LY FRLl1 'mE CXJNrRACIOR' 's OPERATIONS AND ANY
CJIllER rnsuFAOCE MAINl'AWED BY '(XoJNER. 'AND 'GENERAL aJNl'RACIOR SHAll. BE EXCESS AND
NOr OJNlRIBUl'ORY wrnI THE INSlJRANCE l'RlJVJ.IJW HrnEUNDER.
Signed By: L i). ~
(Authorized Agent or Broker)
-.
..
CG 20 10 11 85
Copyright. Insufance ~efvices Office. Inc.. 1984
o
TOTRL P.03