Loading...
HomeMy WebLinkAbout2011-1241 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Resolution No 2011-124 RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE EXECUTION OF AN AGREEMENT WITH CORVEL TO PROVIDE UTILIZATION REVIEW SERVICES FOR THE CITY'S WORKERS' COMPENSATION PROGRAM. BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AS FOLLOWS: SECTION 1: The City Manager of the City of San Bernardino is hereby authorized and directed to execute on behalf of said City an Agreement with CorVel to provide Utilization Review services for a period of one (1) year with two (2) one (1) year extensions, a copy of which is attached hereto, marked Exhibit "A" and incorporated herein by reference as fully as though set forth at length. SECTION 2: The Purchasing Manager is hereby authorized to issue a Purchase Order to CorVel for Utilization Review services for the Workers' Compensation Division for a total amount not to exceed $95,000. SECTION 3: The authorization to execute the above mentioned agreement is rescinded if the parties to the agreement fail to sign it within sixty (60) days of the passage of this resolution. /// /// /// /// /// /// /// 25 I 2011-124 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 I RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE EXECUTION OF AN AGREEMENT WITH CORVEL TO PROVIDE UTILIZATION REVIEW SERVICES FOR THE CITY'S WORKERS' COMPENSATION PROGRAM. i I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor and the Common Council of the City of San Bernardino at a joint regular meeting thereof, held on 6th day of June , 2011, by the following vote, to wit: COUNCILMEMBERS: AYES MARQUEZ x VACANT BRINKER x SHORETT x KELLEY x JOHNSON x MCCAMMACK x G. Clark, City NAYES ABSTAIN ABSENT c.~ c The foregoing resolution is hereby approved this day of June , 2011. atri J. Morris, r f San Bernardino Approved as to form: JAMES F. PENMAN, City Attorney BY~ ~ Cam/ Agend ems:Reso.CorVe1.2011 EXHIBIT "A" 2011-124 1 VENDOR SERVICE AGREEMENT 2 This Vendor Service Agreement is entered into this 1st day of July 2011, by and betwee 3 CorVel ("VENDOR") and the City of San Bernardino ("CITY"). 4 WITNESSETH: 5 WHEREAS, the Mayor and Common Council has determined that it is advantageous an 6 in the best interest of the CITY to acquire Utilization Review Services; and 7 WHEREAS, the CITY did solicit and accept proposals and bids from a number c 8 vendors for Utilization Review Services; 9 1o NOW, THEREFORE, the parties hereto agree as follows: 11 1. SCOPE OF SERVICES. 12 For the remuneration stipulated, San Bernardino hereby engages the services o 13 VENDOR to provide those products and services as set forth in Exhibit "A", attaches 14 hereto and incorporated herein by this reference. If a conflict arises between this Vendo 15 Services Agreement (hereinafter "Agreement") and Exhibit "A," the teens of the 16 Agreement shall govern. 17 2. COMPENSATION AND EXPENSES. 18 a. For the services delineated above, the CITY, upon presentation of an invoice. 19 shall pay the VENDOR the amount of monthly invoices for services renderer 20 dun`ng the previous month. Invoices shall include task description, the number of 21 22 hours spent on each task, and applicable hourly rate. Cost not to exceed $95,000 23 annually. 24 b. No other expenditures made by VENDOR shall be reimbursed by CITY. 25 1 2011-124 i 3. TERM. 2 The term of this Agreement shall be for a period of one (1) year with two (2) one (1) yep 3 extensions. 4 This Agreement may be terminated at any time by thirty (30) days written notic 5 by either party. The terms of this Agreement shall remain in force unless mutuall 6 amended. The duration of this Agreement may be extended with the written consent o 7 both parties. 8 4. INDEMNITY. 9 10 Vendor agrees to and shall indemnify and hold the City, its elected officials, employees 11 agents or representatives, free and harmless from all claims, actions, damages anc 12 liabilities of any kind and nature arising from bodily injury, including death, or property 13 damage, based or asserted upon any actual or alleged act or omission of Vendor, it: 14 employees, agents, or subcontractors, relating to or in any way connected with the 15 accomplishment of the work or performance of services under this Agreement, unless the 16 bodil m'ur or ro ert dams a was actuall caused b the sole ne li ence of the Cit Y J Y p p Y g Y Y g g y, 1'i its elected officials, employees, agents or representatives. As part of the foregoing 18 indemnity, Vendor agrees to protect and defend at its own expense, including attorney' 19 fees, the City, its elected officials, employees, agents or representatives from any and al 20 legal actions based upon such actual or alleged. acts or omissions. Vendor hereby waive 21 22 any and all rights to any types of express or implied indemnity against the City, it 23 elected officials, employees, agents or representatives, with respect to third party claim 24 against the Vendor relating to or in any way connected with the accomplishment of th 25 work or performance of services under this Agreement. 2 2011-124 1 115. INSURANCE. 2 II While not restricting or limiting the foregoing, during the term of this Agreemf 3 VENDOR shall maintain in effect policies of comprehensive public, general < 4 automobile liability insurance, in the amount of $1,000,000.00 combined single limit, 5 statutory Workers' Compensation coverage in accordance with the laws of the State 6 California. VENDOR shall maintain professional malpractice insurance for professiona 7 negligence, including errors, omissions, or other professional acts in the amount o 8 $100,000.00. VENDOR shall file Certificate(s) of Insurance with the CITY's Risl 9 to Manager prior to undertaking any work under this Agreement. CITY shall be set forth 11 an additional named insured in each Certificate of Insurance provided hereunder. T 12 Certificate(s) of Insurance furnished to the CITY shall require the insurer to notify CI7 13 of any change or termination in the policy. 14 6. NON-DISCRIMINATION. 15 I I ~ the performance of this Agreement and in the hiring and recruitment of employee 16 VENDOR shall not engage in, nor permit its officers, employees or agents to engage i 17 discrimination in employment of persons because of their race, religion, color, nation 18 origin, ancestry, age, mental or physical disability, medical condition, marital state 19 sexual gender or sexual orientation, or any other status protected by law, except 20 permitted pursua*at to Section 12940 of the California Government Code. 21 22 7. CONFIDENTIALITY. 23 ~ ~ VENDOR understands and agrees that CITY, as a public entity, and can mai 24 ~ ~ VENDOR's confidentiality only to the extent that doing so does not conflict with its 25 3 2011-124 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1% 18 19 20 ~21 22 23 24 25 duties under the California Public Records Act, the Ralph M. Brown Act or any requirement of law, regulation, rule, or court or other government decision. 8. INDEPENDENT CONTRACTOR. VENDOR shall perform work tasks provided by this Agreement, but for all intents an. purposes VENDOR shall be an independent contractor and not an agent or employee o the CITY. VENDOR shall secure, at its expense, and be responsible for any and al payment of Income Tax, Social Security, State Disability Insurance Compensation Unemployment Compensation, and other payroll deductions for VENDOR and it; officers, agents, and employees, and all business licenses, if any are required, it connection with the services to be performed hereunder. 9. BUSINESS REGISTRATION CERTIFICATE AND OTHER REQUIREMENTS. 10 VENDOR warrants that it possesses or shall obtain, and maintain a business registrat certificate pursuant to Chapter 5 of the Municipal Code, and any other licenses, perm qualifications, insurance and approval of whatever nature that are legally required VENDOR to practice its business or profession. NOTICES. Any notice to be given pursuant to this Agreement shall be deposited with the States Postal Service, postage prepaid and addressed as follows: TO THE CITY: Linn Livingston, Human Resources Director 300 North "D" Street, 2na Floor San Bernardino, CA 92418 Telephone: (909) 384-5161 4 2011-124 1 TO THE VENDOR: 2 Sharon O'Connor Leann Farlander Director of Legal Services Account Executive 3 CorVel Corporation CorVel Corporation 4 2010 Main Street, Suite 600 600 City Parkway West, Suite 700 Irvine, CA 92614 Orange, CA 92868 5 11. ATTORNEYS' FEES. 6 In the event that litigation is brought by any party in connection with this Agreement, tl 7 prevailing party shall be entitled to recover from the opposing party all costs ar 8 expenses, including reasonable attorneys' fees, incurred by the prevailing party in tl 9 1o exercise of any of its rights or remedies hereunder or the enforcement of any of the term 11 conditions or provisions hereof. The costs, salary and expenses of the City Attorney an 12 members of his office in enforcing this Agreement on behalf of the CITY shall 1 13 considered as "attorneys' fees" for the purposes of this paragraph. 14 12. ASSIGNMENT. 15 VENDOR shall not voluntarily or by operation of law assign, transfer, sublet c 16 encumber all or any part of the VENDOR'S interest in this Agreement without CITY' 17 prior written consent. Any attempted assignment, transfer, subletting or encumbranc 18 shall be void and shall constitute a breach of this Agreement and cause for th 19 termination of this Agreement. Regardless of CITY'S consent, no subletting o 20 assignment shall rele-ase VENDOR of VENDOR's obligation to perform all otl?; 21 22 obligations to be performed by VENDOR hereunder for the term of this Agreement. 23 13. VENUE. 24 The parties hereto agree that all actions or proceedings arising in connection with this 25 5 2011-124 1 2 3 4 5 6 7 s 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Agreement shall be tried and litigated either in the State courts located in the County o San Bernardino, State of California or the U.S. District Court for the Central District o California, Riverside Division. The aforementioned choice of venue is intended by the parties to be the mandatory and not permissive in nature. 14. ' GOVERNING LAW. This Agreement shall be governed by the laws of the State of California. 15. SUCCESSORS AND ASSIGNS. This Agreement shall be binding on and inure to the benefit of the parties to Agreement and their respective heirs, representatives, successors, and assigns. 16. HEADINGS. The subject headings of the sections of this Agreement are included for the purposes convenience only and shall not affect the construction or the interpretation of any of i provisions. 17 SEVERABILITY. If any provision of this Agreement is determined by a court of competent jurisdiction be invalid or unenforceable for any reason, such determination shall not affect t validity or enforceability of the remaining terms and provisions hereof or of the offendi provision in any other circumstance, and the remaining provisions of this Agreeme shall remain in full force and effect. 18. ENTIltE AGREEMENT; MODIFICATION. This Agreement constitutes the entire agreement and the understanding between t] parties, and supersedes any prior agreements and understandings relating to the subject 6 2011-124 1 2 3 4 manner of this Agreement. This Agreement may be modified or amended only by written instrument executed by all parties to this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the d. and date first above shown. 5 ATTEST: 6 7 -- 8 ~ ~ Rachel Clark, City Clerk 9 10 11 12 13 14 15 16 17 is 19 20 21 22 23 24 25 Approved as to form: JAMES F. PENMAN City Attorney By: CITY OF SAN BERNARDINO Charles McNeely, City Manager CORVEL CORPORATION By: 7 2011-124 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 I VENDOR SERVICE AGREEMENT This Vendor Service Agreement is entered into this 1st day of July 2011, by and betw~ CorVel ("VENDOR") and the City of San Bernardino ("CITY"). WITNESSETH: WHEREAS, the Mayor and Common Council has determined that it is advantageous in the best interest of the CITY to acquire Utilization Review Services; and WHEREAS, the CITY did solicit and accept proposals and bids from a number vendors for Utilization Review Services; NOW, THEREFORE, the parties hereto agree as follows: 1. SCOPE OF SERVICES. For the remuneration stipulated, San Bernardino hereby engages the services VENDOR to provide those products and services as set forth in Exhibit "A", attac hereto and incorporated herein by this reference. If a conflict arises between this Ven Services Agreement. (hereinafter "Agreement") and Exhibit "A," the terms of the Agreement shall govern. 2. COMPENSATION AND EXPENSES. a. For the services delineated above, the CITY, upon presentation of an invoice shall pay the VENDOR the amount of monthly invoices for services renderer during the previous month. Invoices shall include task description, the number o hours spent on each task, and applicable hourly rate. Cost not to exceed $95,00( annually. b. No other expenditures made by VENDOR shall be reimbursed by CITY. 1 2011-124 1 I 2 3 4 51 6 7 8 9 10 11 12 13 14 15 16 li is 19 20 21 22 23 24 25 13. TERM. The term of this Agreement shall be for a period of one (1) year with two (2) one (1) extensions. This Agreement may be terminated at any time by thirty (30) days written not by either party. The terms of this Agreement shall remain in force unless mutua amended. The duration of this Agreement may be extended with the written consent both parties. 4. INDEMNITY. Vendor agrees to and shall indemnify and hold the City, its elected officials, employf agents or representatives, free and harmless from all claims, actions, damages liabilities of any kind and nature arising from bodily injury, including death, or propE damage, based or asserted upon any actual or alleged act or omission of Vendor, employees, agents, or subcontractors, relating to or in any way connected with the accomplishment of the work or performance of services under this Agreement, unless the bodily injury or property damage was actually caused by the sole negligence of the City, its elected officials, employees, agents or representatives. As part of the foregoing indemnity, Vendor agrees to protect and defend at its own expense, including attorney'; fees, the City, its elected officials, employees, agents or representatives from any and al legal actions based upon such actual or alleged. acts or omissions. Vendor hereby waive; any and all rights to any types of express or implied indemnity against the City, it; elected officials, employees, agents or representatives, with respect to third party claim against the Vendor relating to or in any way connected with the accomplishment of the work or performance of services under this Agreement. 2 2011-124 1 5. INSURANCE. 2 While not restricting or limiting the foregoing, during the term of this Agreement 3 VENDOR shall maintain in effect policies of comprehensive public, general anc 4 automobile liability insurance, in the amount of $1,000,000.00 combined single limit, anc 5 statutory Workers' Compensation coverage in accordance with the laws of the State o: 6 California. VENDOR shall maintain professional malpractice insurance for professions 7 negligence, including errors, omissions, or other professional acts in the amount o 8 $100,000.00. VENDOR shall file Certificate(s) of Insurance with the CITY's Risl 9 to Manager prior to undertaking any work under this Agreement. CITY shall be set forth a 11 an additional named insured in each Certificate of Insurance provided hereunder. The 12 Certificate(s) of Insurance furnished to the CITY shall require the insurer to notify CITE 13 of any change or ternunation in the policy. 14 6. NON-DISCRIMINATION. 15 ~ the performance of this Agreement and in the hiring and recruitment of employees 16 VENDOR shall not engage in, nor permit its off cers, employees or agents to engage in 17 discrimination in employment of persons because of their race, religion, color, nations 18 origin, ancestry, age, mental or physical disability, medical condition, marital status 19 sexual gender or sexual orientation, or any other status protected by law, except a 20 permitted pursuant to Section 12940 of the California Government Code. 21 7. CONFIDENTIALITY. 22 23 VENDOR understands and agrees that CITY, as a public entity, and can maintain 24 VENDOR's confidentiality only to the extent that doing so does not conflict with its 25 3 2011-124 1 2 3 4 9 10 11 12 13 14 15 ~ 16 17 is 19 20 ~21 22 23 24 25 duties under the California Public Records Act, the Ralph M. Brown Act or any othe requirement of law, regulation, rule, or court or other government decision. 8. IlvDEPENDENT CONTRACTOR. VENDOR shall perform work tasks provided by this Agreement, but for all intents an purposes VENDOR shall be an independent contractor and not an agent or employee c the CITY. VENDOR shall secure, at its expense, and be responsible for any and a payment of Income Tax, Social Security, State Disability Insurance Compensation Unemployment Compensation, and other payroll deductions for VENDOR and i~ officers, agents, and employees, and all business licenses, if any are required, i connection with the services to be performed hereunder. 9. BUSINESS REGISTRATION CERTIFICATE AND OTHER REQUIREMENTS. ~'i VENDOR warrants that it possesses or shall obtain, and maintain a business registratio certificate pursuant to Chapter 5 of the Municipal Code, and any other licenses, permit qualifications, insurance and approval of whatever nature that are legally required c VENDOR to practice its business or profession. 10. NOTICES. Any notice to be given pursuant to this Agreement shall be deposited with the Uni States Postal Service, postage prepaid and addressed as follows: TO THE CITY: Linn Livingston, Human Resources Director 300 North "D" Street, 2°d Floor San Bernardino, CA 92418 Telephone: (909) 384-5161 4 2011-124 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 I TO THE VENDOR: Sharon O'Connor Director of Legal Services CorVel Corporation 2010 Main Street, Suite 600 Irvine, CA 92614 11. ATTORNEYS' FEES. Leann Farlander Account Executive CorVel Corporation 600 City Parkway West, Suite 700 Orange, CA 92868 In the event that litigation is brought by any party in connection with this Agreement, prevailing party shall be entitled to recover from the opposing party all costs expenses, including reasonable attorneys' fees, incurred by the prevailing party in exercise of any of its rights or remedies hereunder or the enforcement of any of the tee conditions or provisions hereof. The costs, salary and expenses of the City Attorney ; members of his office in enforcing this Agreement on behalf of the CITY shall considered as "attorneys' fees" for the purposes of this paragraph. 12. ASSIGNMENT. 13 VENDOR shall not voluntarily or by operation of law assign, transfer, sublet encumber all or any part of the VENDOR's interest in this Agreement without CIT prior written consent. Any attempted assignment, transfer, subletting or encumbra shall be void and shall constitute a breach of this Agreement and cause for termination of this Agreement. Regardless of CITY's consent, no subletting assignment shall release VENDOR of VENDOR's obligation to perform all o~ obligations to be performed by VENDOR hereunder for the term of this Agreement. VENUE. The parties hereto agree that all actions or proceedings arising in connection with this 5 2011-124 1 Agreement shall be tried and litigated either in the State courts located in the County of 2 San Bernardino, State of California or the U.S. District Court for the Central District of 3 California, Riverside Division. The aforementioned choice of venue is intended by the 4 parties to be the mandatory and not permissive in nature. 5 14. ' GOVERNING LAW. " 6 This Agreement shall be governed by the laws of the State of California. 7 15. SUCCESSORS AND ASSIGNS. s This Agreement shall be binding on and inure to the benefit of the parties to thi; 9 Agreement and their respective heirs, representatives, successors, and assigns. 1o 11 16. HEADINGS. 12 The subject headings of the sections of this Agreement are included for the purposes o: `L 13 convenience only and shall not affect the construction or the interpretation of any of it; 14 provisions. 15 17 SEVERABILITY. 16 If any provision of this Agreement is determined by a court of competent jurisdiction tc 17 be invalid or unenforceable for any reason, such determination shall not affect the 18 validity or enforceability of the remaining terms and provisions hereof or of the offending 19 provision in any other circumstance, and the remaining provisions of this Agreemen 20 shall remain in full force and effect. 21 1 S. ENTIRE AGREEMENT; MODIFICATION. - 22 3 This Agreement constitutes the entire agreement and the understanding between th 2 and supersedes any prior agreements and understandings relating to the subject parties 24 , 25 6 2011-124 1 2 3 4 5 6 7 8 9 to 11 12 13 14 15 16 I' 17 is 19 20 21 22 23 24 25 manner of this Agreement. This Agreement may be modified or amended only by written instrument executed by all parties to this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the d. and date first above shown. ATTEST: ~ ~~ chel OF S'AN BERNARDINO City Clerk ~ ~ Charles McNeely, City Approved as to form: JAMES F. PENMAN City Attorney By: '~ CORVEL CORPORATION By 7 2011-124 ~~ f` ,~ ~~;-~-- 2011-124 _._.._. _ ~ ~t°~g~ f C~~l~e~ ~t Table of Contents Confidentiality Statement ............................................................................................... 3 Cover Letter .................................................................................:..:..............................4 Proposal Content ........................................................................................................... 5 ............................................................................. Attachments ................. ...................12 CorVel Corporation Page 2 City of San Bernardino Workers' Comp Utilization Review 2011-124 Note: Prior to reviewing our RFP response, please read the following carefully. CORVEL HEALTHCARE CORPORATIOI,V~~ CONFIDENTIAL TREATMENT REQUESTED Pursuant to the City of San Bernardino's Request for Proposal ("RFP"), RFP No. F-11- 16, CorVel Healthcare Corporation, awholly-owned subsidiary of CorVel Corporation ("CorVel"), hereby provides its statement regarding Requests for Confidentiality of Proposal pursuant to the California Public Records Act (Government Code § 6250). CorVel hereby states that certain confidential information shall be attached under this RFP which shall fall under the section of the California Code of Regulations, Title 10, § 250.10(a)(1) whereby it defines and provides a exemption for Confidential Information being provided under this RFP bid proposal as "Information which is of a proprietary business nature and is in fact confidential, including but not limited to trade secrets" and § 250.10(a)(2) which is defined as "Information which is of a confidential business nature and which is in fact confidential, the release of which would be damaging or prejudicial to the business concerned". These exempt trade secret documents that CorVel shall provide as part of the RFP shall be marked to read "CONFIDENTIAL INFORMATION" and must be treated as such as defined under the California Code of Regulations and not be disclosed publicly under this RFP. CorVel hereby represents that pursuant to the California Code of Regulations, Title 10, § 250.10(b)(1-7) it is fully in compliance with its obligations for approval of its request for the Confidential In#ormation being protected as stipulated in the above referenced Bade. CorVel Corporation Page 3 City of Sari Bernardino Workers' Comp Utilization Review 2011-124 March 16, 2011 City of San Bernardino 300 N. "D" Street, 4th Floor Finance Department San Bernardino, CA 92418 Attn: Deborah Morrow, Purchasing Manager Dear Ms. Morrow, Thank you for considering CorVel Corporation as a strategic partner to continue to help the City of San Bernardino (the City) reduce the cost of its workers' compensation program with our industry-leading Utilization Review solutions. CorVel applies technology, intelligence and a human touch to the challenge of treating work-related injuries proactively and cost-effectively. With more than two decades of experience, CorVel understands the cost drivers associated with treating work-related injuries. Our innovative approach is distinguished by: z.. • Utilization Review -Assure that inpatient admissions and outpatient procedures are provided in the most appropriate setting and time to reduce costs and maximize savings. • CorVel's is committed to quality service delivered by experienced staff s!apported by industry leading technology. • Local, Superior Account Management -CorVel offers quality services measured by objectives and performance driven standards. We are committed to high standards of excellence with customer service available 7 days a week, 24 hours a day. The program described in our proposal has been based on the objectives and services contained in your RFP. We look forward to continue working collaboratively with your team so we can-.help the City to continue achieving the same outstanding results. Thank you again for your consideration. Sincerely, Richard J. Schweppe Leann Farlander Director Account Executive CorVel Corporation Page 4 City of San Bernardino Workers' Comp Utilization Review 2011-124 CorVel's utilization review program provides prospective, concurrent and retrospective review of all treatments. CorVel's experienced staff of Utilization Review Case Managers, board certified Medical Directors and peer review physicians utilize medical treatment protocols and expert systems technology to determine the medical appropriateness of care as well as frequency, d~ratiQn end eet#ing. The gQe~ 4f Qur ~t~li~attQn revievr program is to avoid unnecessary treatments and their associated costs and to ensure high quality, timely, cost effective medical care for injured workers, Key utilization review features include: • Medical treatment plan review • Patient referral to select CorVel PPO providers • Pre-certification of an admission and approval of a specific length of stay Coordination of discharge planning, DME and other services • Timeliness of service: compliance with California legislation • Confirmation letter to the provider, claimant and claims administrator of any certification or denial .~. As the City's current UR provider, CorVel understand the City's treatment protocols and processes. On a daily bases CorVel works with the City's claims staff to ensure that the City's injured workers are receiving the proper level of care while concurrently ensuring that RTW timelines are eompressed. The City's claims examiners utilize our web-enabled application platform, Care"" to submit UR requests and view nurse notes in real time. The City's examiners have an excellent working relationship with CorVel's nurses. This positive relationship impacts the injured workers' overall satisfaction which in turns affects the programs outcomes. CorVel has been providing utilization review services since 1991. • Minimum of three professional references San Diego and Imperial County Schools Risk Management Diane Crosier, Executive Director, Risk Management Phone: (858) 292-3747 CorVel Corporation Page 6 City of San Bernardino Workers' Comp Utilization Review • An overview of your company's experience in providing UR services for cities and other clients. 2011-124 Foster Farms Niel Piethe, Claims Manager (209) 398-6708 List of physicians/nurses who will be performing UR services, along with reSUn9eS. Joanna Palladino, Utilization Review Case Manager and Ann Deon, Utilization Review Case Manager will continue to assist the City with their UR needs. CorVel utilizes more than 100 California licensed, board-certified physician specialists who currently practice and have knowledge of California's Workers' Compensation. All of CorVel's physician specialists are board certified in their specialty. These physicians are educated in Califot~nia's UR Labor Cade, including all medical guidelines pertaining to Cali#ornia's UR protocols. Please see Attachment A: Resumes • Experience and tr-aining of UR staff, including nurses who will conduct initial reviews Case Managers responsible for handling utilization reviews are graduates of an accredited school of nursing and hold a current license in their state of operation. CorVel's UR Case Managers have a strong elinieal background in orthopedics, neurology or rehabilitation. We also require our staff to have a strong cost containment background, such as utilization review or healthcare management. We require three or more. years of recent clinical experience, preferably in rehabilitation, and/or at least one year experience in workers' compensation or STD/LTD .case manager=.~ent. Negotiation and extensive clear and tactful communication skills (writing, reading, telephone calls, note taking, letter writing, memoranda) are also required. As with all CorVel staff, we encourage continuing education and the company policy participates and reimburses for those expenses. Each local/regional/national office is encouraged to host monthly meetings, offer continuing education programs and solicit guest speaker continuing education programs. CorVel Corpofation Page 6 City of San Bemaalino Workers' Comp Utilization Review Private Adjusting Services, Rancho Cucamonga Denise Ashley, Vice President Phone: (909) 481-4111 2011-124 CorVel's average turn around time for UR services is 2.5 days. Our internal standards for turn around time are as follows: • Prospective UR requests are completed within 4 business days, in moat inatancea they are completed within 72 hours, • Retrospective UR requests have an aver turn around time of 4 days. • Concurrent hospital UR requests are completed within 72 hours, in most instances they are completed within 24 hours. • Appeal reviews are completed within 5 days. • Denial letters are sent within 24 hours to the requesting physician, facility, claims administrator and claimant. The claims professional, provider, applicant attorney and claimant receive copies of CorVel's recommendations for certification or non-certification within 24 hours of a determination being made. CQrYeI is able to transmit our UR results through email, fax, electronic copy, eRoster or Care"" Browser. UR determination letters are entered directly into the claims system and can also be emailed or faxed upon request. In the case of a non-certification determination, the claims payor is also notified via phone, fax or email at the time of determination. • Fee options and how fees are calculated n Please see the attached Summary Proposal Submission Form (Fee Schedule) for fee options and how fees are calculated. • Samples of reports documenting claims review and action taken Please see Attachment B: Sample Report • Describe workflow and the method information is gathered and exchanged between City's medical providers and your company in performing UR services. Please see Attachment C for CorVel's utilization review process flow chart with the accompanying description that follows: CorVel's utilization review program is designed to assure that inpatient admissions and outpatient procedures are provided in the most appropriate setting and at the most appropriate time. CorVel Corporation Page 7 City of San Bernardino Workers' Comp Utilization Review • Your company's average turn around time for UR requests. 2011-124 • Pre-Certification • Concurrent Review • Discharge Planning Pre-Certification CorVel's pre-certification process is a review service that helps reduce unnecessary inpatient stays and outpatient surgeries. Utilizing the nationally recognized Institute for Healthcare Quality's Quality First guidelines and other medically recognized criteria a CorVel's utilization review Case Manager verifies the medical necessity of Inpatient Admissions, Outpatient Surgeries and high cost diagnostic procedures. Appropriate lengths of stay for inpatient admissions are also certified utilizing the Quality First guidelines. Concurrent Review The CorVel continued stay review service concurrently evaluates the medical necessity and appropriateness of the patient's hospitalization. This ongoing review assures that the patient's care is progressing and that a continued hospital stay is warranted. Discharge Planning Early Discharge may be appropriate #or cases, which lend themselves to alternate treatment settings or at home care. CorVel's Discharge Planning service develops alternative treatment plans, that can be delivered without sacrificing the quality of care, in a more cost effective setting. Process • Notification of an impending, non emergency, or active, emergency, hospital admission may be made to the CorVel pre-cent department by the employer, employee, claims Ad~uster, physician or hospital by telephone (an 800 number) or by Care ~. • Initial demographic information is input into our pre-certification' so#tware system by the utilization review Case Manager or an Intake Coordinator. • The utilization review Case Manager contacts the physician office for clinical information to make a determination of medical necessity. • Clinical information is compared to established criteria for d~tarirnination of medical necessity of in-patient s~arg~ry/treatment vs. outpatient or denial. In California, request is reviewed in accordance with the state mandated American College of CorVel Corporation Page 8 City of San Bernardino Workers' Comp Utilization Review CorVel's utilization review program includes three components: 2011-124 Pre-eert decision is made within 5 days of receipt of information. Length of stay is certified. Verbal notification of the certification and length of stay is given by telephone to the physician and facility. Confirmation letters automatically generated by the software system are mailed to all pertinent parties within 24 hours of certification. Case is diaried automatically for expected discharge date. • Telephone contact is made on expected discharge date to determine if discharge has occurred as scheduled. • Upon discharge, case is closed, completion date is entered into the system and a claim data report is printed to initiate the billing process. CorVel utilization review Case Managers are trained to utilize internal policies and procedures that address the following: Confidentiality First level review • Peer review Appeals process Performance standards Quality assurance Physician advisors are utilized for all cases that fail to meet standards of practice guidelines. Denials CorVel physician reviewers may deny requests for authorization that do not meet standards of care guidelines or due to lack of medical information to support the treatment being requested. Denials are communicated to the health care provider telephonically and in the form of a Denial Letter, faxed or mailed. The explanation shall include, but not be limited to: The name of the medical reviewer. • The telephone number of the reviewer, and hours of availability. The medical criteria upon which the denial is based. CorVel Corporation Page 9 City of San Bernardino Workers' Comp Utilization Review Occupational and Environmental Medicine Practice Guiaeunes (ACOEM). 2011-124 The utilization review, bill review and case management processes are linked through Care"" to provide a comprehensive program. When the utilization review Case Managers pre-certifies treatment, modalities frequency, duration, and care setting, the information is transmitted into bill review tQ await receipt 4f the biU. only thQae services that have beer certified are accepted and processed for payment. Exchanaina Information If a decision has been reached to pursue a complete review of a claim against medical records, CorVel will obtain atl medical records including diagnosis, treatment, as well as CorVel's history with the facility to complete our review. CorVel will work with customer to establish full claim suspension until info has been received. In addition, CorVel may need request for authorization from the City. CorVel's proprietary healthcare management website Care"" connects payors, employers, healthcare management professionals, and providers in real time. With Care"" customers can access timely and comprehensive case information at their convenience, communicate with other healthcare professionals instantl~, and collaborate on claims without any delay or all the paperwork. Care"" tools address: claim status reporting, case manager updates, FNOL and treatment calendar. By integrating all of the managed care services involved in an episode of care, Care"" extends value from the automated processing of incident reporting to the other components of claims management. Request services online, in real time. Manage files throughout the life of the claim. Receive and relay case notes from case managers in the field. Integrate information from multiple claims management sources into one database. Any distinguishing or unique qualifications that your company possesses or any other information that more fully documents your ability to provide UR services. As the City's current Utilization Review partner, CorVel understands your program needs and expectations. CorVel will continue to provide the City with excellent customer service and superior savings. We value our CorVel Corporation Page 10 City of San Bernardino Workers' Comp Utilization Review • The process whereby the objection may be appealed, mcwamg ine time period for appeal and -the telephone and fax number for initiating the appeal. 2011-124 Co~Vel Corporation Page 11 City of San Bernardino Workers' Comp Utilization Review partnership with the City and hope to continue our relationship. The utilization of our technology coupled with our expertise and compress timeframes result in greater savings and faster return to work. CorVel offers the most comprehensive solution for your case management needs. 2011-124 Attachments 2011-124 Attachment List Attachment A: Resumes Attachment B: Sample Report Attachment C: Utilization Review Workflow Attachment D: City Forms Attachment E: Proof of Insurance Attachment F: Expectations t, CorVel Corporation Page 12 City of San Bernardino Workers' Compensation Utilization Review 2011-124 Attachment A: Resumes CorVel Corporation City of San Bernardino Workers' Comp Utilization Review 2011-124 ~~sir~°~S~;t3?dAL ~iST.°3RY • 2004 to present: CorVel Corporation, Utilization Review Case Manager 2001 to 2004: Field Medical Case Manager • 1992 to 1998: Interim Healthcare, Director, Health Care Services • 1984 to 1992: Interim Healthcare, Director of Nursing 1978 to 1983: Parkview Community Hospital, Patient Care Coordinator ~"~ucA;io~a • Associate of Science, Nursing. Northern Arizona University (1965) • Bachelor of Science, Nursing. California State University San Bernardino (1992) • Master of Science, Nursing. California State University San Bernardino (2003) • Certified Public Health Nurse • Clinical Nurse Specialist Confidential JoAnne, rr~• suw, ... ~, ...-- - -- -- U~rILIZATION REVIEW CASE MANAGER JOANNE_PALLADI NO@CORVEL.COM 2011-124 F3 tat~~ES5i~4~3:~L ~9:57C~~'Y • 2009 to present: CorVel Corporation, Utilization Review Case Manager • 2008 to 2009: Forensics Psychiatric and Civil Contract • 2005 to 2008: Behavioral Health/Psychiatric Nursing • 2004 to 2007: Disability Case Management Specialty • 2001 to 2004: Medical Case Manager • 1996 to 2001: Staff RN- Pre-op, PACU, Emergency Department F'(Z9 7a°.~'~'iG~1 • Associates Degree, Nursing (199 • Board Certified Psychiatric Mental Health RN (2004) • Certified Case Manager • Multi-State ~.~censed RN Confidential ANN IJEON, Kry-aC:, G4a.:m UTILIZATION REVIEW CASE MANAGER ANN_DEON@CORVEL.COM 2011-124 Attachment B: Sample Report t CorVel Corporation City of San Bemaniino Workers' Comp Utilization Review 2011-124 3 m r _ ... s . ~ ~ 0 0 0o 0 c 0 o 0 0 0 .ri d LL N N ~ ~ ~ fA ~ p O O G p O O ~ O O O O O G ~ ~ ~ 1(i LL7 ~ ~ LL ~ ~ ~ i O ~ ~ ~ 6 9 6A ~ ~ ~ O C C ~ O O O N C ~ O O LL7 ~ G ~ 0 O iA C p O O N to O 0 _ b9 O j U m O O ~ N iR O ~ ~ ~ fn ~ c d ~ ~ ~ .e m 3 ~ ~ v ~ O ~ 'p C ~ r U C ~ ~ (3 ~i d ~ d U O ~ ~ U ~ ~ ~ p O O N N N N N N N N C. O d' O N N N E ~ M N ~ N N N N N N N N r C O N N N N N N ti ~ N N Q N N ~ N r N r N N N N N O C ~_ N N N 7. E m E c U d m o V N ~ C_ O l0 C Q U~- ~ Of d -Np W $S Z N C m Y O j'c c~ -y~'° ° m°-' ~°n~E W _ vJ~ ~t ~ C A. _ ~ N C X V C N ~ ~ U aiS LL J W a~ fG~ N o3 Q 3 J fn ~ V ~ ~ N ~ U V d ~ ~ d d ~ a o_ N a N y p m O ~ N I- W . a ` o a a a a a a a a ~ N M ~ ~ ~ N ~ Obi m h ~ r f7 [O T r r N n O ~ O O ~ ~ t7 ~p O ~ ~ ~ r a0 ~ N d' ~ N LL~ a O N r N r Q~ N C 7 N ~ O O G ~ O O O O~ O N ~~ N r p N ~ N O U~ Z N m O N O O O O O N ~ N O (") O O O O N O O O O O O O O O O O O O N C ~ p O r N N N N N N N N f0 O ~ V N ~ o ~ r N N ~ N N ~ N N N N N N y ~. p p O N N N N_ N ~ N ch O O ~ ~ N Q y N N N N N ~ r ~ f~J ~ N N C t fC0 C tn l0 C U?v f0 C t~v d ~ '~ tna N=o w~ ~~ !?v om v o0 0o c~ _ m m O Um SJm Ua0 UW Uao U Um U fJ O UO m ~_ c O U N .` Q C O N Q Q O U U 0 N 2011-124 Attachment C: Utilization Review Workflow CorVel Corporation City of San Bernardino Workers' Comp Utilization Review 2011-124 Certification I -Notification to Adjuster -Certification letters to provider, facility, attorney, adjusters ~;,~ - - - Utilization Review Program Level I and 11 If medicals are not received from provider aftev 3 days.or 2 phone calls, non-cert letter will be issued for'lack of information'. L__ey_ e) II - Unable to Certify -Notification to Adjuster -Referral to Clinical Peer Physician r_ ~,. ~.T..~ ,rte, ~ ~~ ~ __r. Clinical Peer Physician -Cert vs. Not-Cert determination -Clinical Peer Report to UR Nurse Gertlfy . fit' Non-Certification -Receive Clinical Peer Report -Notification to Adjuster -Non-Certification letters with appeals process __ Confidential Referral Received by CorVel ~~-~ 2011-124 Utilization Program Review -Appeals Level III Clinical Peer Physician -Review and make determination to approve or deny appeal '- -Report to UR Nurse ~~~~ ~` ~t}enied " ,~ UR Nurse -Contact Adjuster -Prepare and send appeal-upheld or appeal-denied to Provider or Injured worker Confidential 2011-124 Attachment D: City Forms CorVel Corporation City of San Bernardino Workers' Comp Utilization Review 2011-124 RFP F-11-16 WC Utilization R~yigw City of San Bernardino, Finance Department Purchasing Division RFP F-11-16 Worker's Comp Utilization Review Bid Documents to Be Returned Company Background/Overview Description of Proposed Program Workflow and Methodologies Samples of Reports Staff Backgrounds/Resume's Qualifications and References Statement of Proposers) Past Contract Disqualifications (City Form) One (1) signed original of Proposal '- Two (2) copies of Proposal in a SEALED (envelope separate from Pricing) Summary Proposal Submission Form (SEALED envelope separate from proposal) (City Form)' Authorized Binding Signature(s) Verifications of Addenda Received (City Form) iv F°""S Non-Collusion Affidavit (City Form)'v Forrt,S Listing of Proposed Subcontractor (City Form)'v Fom,s 90 Day Minimum Proposal Validity Statement10 Aaaiuonai Requirements, VI General Spec~cations#4 Worker's Compensation Insurance Certificate Copy of Contractor License or other appropriate Licenses where applicable ~ Generai Specifications #35 Offerors) are requested to submit this checklist completed with all bid documents. This list may not be inclusive of all documents needed to submit vour RFP. Please refer to entire packet for additional documents. 3 2011-124 RFP F-l 1-16 WC_ Ukilization Review __ V. STATEMENT OF PROPOSER'S QUALIFICATIONS AND REFERENCES UTLIZATION REVIEW The proposer is required to state the proposers) financial ability and a general description of similar work performed. Number of years engaged in proyiding the work included within the scope of the specifications under the present business name: 32 List and describe fully the last three contracts performed by your firm, which demonstrate your ability to complete the work included with the scope of the specifications. Attach additional pages if required. The City reserves the light to contact each of the references listed for additional information regarding your firm's qualifications. Reference No.1 Customer Name: Private Adjusting Services Contact individual: C~i~ Ashley, Vice President -_ Address: 9570 Central Ave. Rancho Cucamonga, CA phone No: {909} 466-9595 Contract Amount: Confidential Year: 2008 Description of Work Done: CorVel provided Bill Review, Case Management and Utilizaton Review services for Private Adjusting Services. _ _ __ __ ___ _ Reference No.2 Customer Name: County of Los Angeles COntaCt Individual: Alex Rossi, CEQ Risk Management Address: 3333 Wilshire Blvd. Suite 820, Los Angel, CA phone No: {213} 639-607Y Contract Amount: Conrdential Year: ts98 Description f Work Done: CorVel provided Bill Review Case Management and Utilization Review services for the County of Los Angeles. Reference No.3 Customer Name: City of Redding Contact individual: Gail Crowley Manager Address: 777 Cypress Ave. Redding, CA Phone NO: (530} 225-4348 Contract Amount: Confidential Year: ions Description Of Work Done: Coryel provided BIII Review Case Management and Utilization Review services for the City of Redding. ~ ~ Signature !'~-~~~ -~" Richard J. S apps Title: Director 16 2011-124 1tFP F-11-16 _ . }fir i r~li?a~on R_~iew VI. STATEMENT OF PROPOSER'S PAST CONTRACT DISQUALIFICATIONS Pursuant to Section 10162 of Public Contract Code, the proposer shall state whether such proposer, any officer of employee of such proposer who has proprietary interest in such proposer has ever been disqualified, removed, or otherwise prevented from proposal on, or completing a Federal, State, or local government project because of a violation of law or a safety regulation; and if so, explain the circumstances. 1. Do you have any disqualifications, removal, etc., as described in the above paragraph to declare? Yes No 2. If yes, explain the circumstances. Not Applicable Executed on March 14.2011 at Irvine , CalifOrnla. I decl a under pen Ity of perjury, that the foregoing 's true and correct. ~~ ~~ ra ~. schwa e Signature( f Autho d Proposer Signature of Authorized Proposer Director Title ~ ~~ Title 17 2011-124 RFP F-11-16 WC Utilization Review VII. WORKERS' COMPENSATION INSURANCE CERTIFICATE Sections 1860 and 1861 of the California Labor Code require every contractor to whom a public works contract is awarded to sign and file with the awarding body the following statement: "I am aware of the Provisions of Section 3700 of the labor Code which, requires every employer to be insured against I liability for Workers' Compensation or to undertake sell-insurance in accordance with the provisions of that code, and I will comply with such Provisions before commencing the perfomlance of the work of this Contract. " !~Q ~~/ ~ ichard J. Schwe By Date: ~~a~2o» Title: director -~~. By: Date:~~ Title: ~k=~J~'13~' ~i1!e~ is 2011-124 RFP F-l 1-16 WC Utilization Review SUBCONTRACTOR'S LIST As required by Calffomia State Law, the General Contractor bidding will hereinafter state the subcontractor who will be the subcontractor on the job for each particular trade or subdivision of the work in an amount in excess of one-half of one percent of the General Contractor's total bid and will state the firm name and principal location of the mill, shop, or office of each. If a General Contractor fails to specify a subcontractor, or if he specifies more than one subcontractor for the same portion of work to be performed under the contract in excess of one-half of one percent, he agrees that he is fully qualified to perform that portion himself and that he shall perform that portion himself. DIVISION OF NAME OF FIRM OR LOCATION WORK OR CONTRACTOR CITY TRADE None None None we a Director ~`'~' A~~'"~~ Richard J. Sch pp , Print Name Signature of Bidder Company Name: CorVel Healthcare Corporatlon __ Address: 2010 Main Street, Suite 600, Irvine, CA 92614 REJECTION OF BIDS The undersigned agrees that the City of San Bernardino reserves the right to reject any or all bids, and reserves the right to waive informalities in a bid or bids not affected by law, if to do seems to best serve the public interest. 22 2011-124 RFP F-11-16 WC Utilization Review NON -COLLUSION AFFIDAVIT TO: THE COMMON COUNCIL, CITY OF SAN BERNARDINO In accordance with Title 23, United States Code, Section 112, the _undersigned hereby states, under penalty of perjury: That he/she has not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken action in restraint of free competitive proposal in connection with RFP F-11-16. Business Name CorVel Healthcare Corporation Business Address 2010 Main Street, Sine 6Q0, Irvine, CA Signature of Offerors) YU1 ~ ~' Place of Residence Subscribed and sworn before me this Notary Public in and for the County My commission expires 20 State of California. 20 State of Calitrnnio, County of Onmge K. FARtIAN~ Subs~bed and sworn io (aefllm~ed)befaetne Otllhb t;oep. ~ 180109Q ! 4 doy of O~ . 201 i . by 1'r4'sh ~ ~'. t hie pt-~e N ~ proved fo me on the-bads of w oc er caw. ~. oe~. r~, m>, to be the personis) red betas me. 23 2011-124 Attachment E: Proof of Insurance CorVel Corporation City of San Bernardino Workers' Comp Utilization Review 2011-124 ~ l ® DATE (MM/DDM'Yl~ ,~,ccorro CERTIFICATE OF LIABILITY INSURANCE 0,lD6Y1D„ THIS ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS _ _ . rFR~IFII^,AT€ D[).ES NOT l-FFIRMATIVELY OR NF:GATIVEI Y AMEN9; EXTENfa t.)R AI. TFR THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poliey(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the farms and conditions of the policy, certain policies may require an endorsement. A statement on this cert~cate does not conf8r rights to the certificate holder in lieu of such endorsement(s). PRODUCER 'CO ACT NAME: MARSH USA INC. PHONE F'~ 500 WEST MONROE STREET No xt : A/C No CHICAGO, IL 60661 E-MaL ADDRESS: Attrl: Fax: 212-94&0770 or Chicago.CertRequest(Qmalsh.eom PRODUCER 401944-DNU-wPROF-10-11 INSURERS AFFORDING COVERAGE NAIC t: INSURED INSURER A : Travelers Propefty CaSllalty Company Gf America 25674 CorVel Healthcare Corpora0on INSURER e : ~ Paul F'ne & Marine Ins Co 24767 AOn: Jeanette Mungcal Employers Fire Insurance Company 20648 2010 Main Street, SUlle 600 INSURER C Irvine, GA 92614 INSURER D INSURER E INSURER F i.~ntr~rn wre ~u canoe. r•ul_nna~rn~nn REVISION NUMBER: IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRQGT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE P.OLIEtES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY NAVE BEEN REDUCED, BY'PAID CLAIMS.. INSrnR TYPE OF INSURANCE DDL SUER POLICY NUMBER POLICY EFF ~ MMIDD POLICY EXP MM/OD ~ LIMITS A GENERAL LUUIILITY TJ-GLSA-280K509-5-1D ~ ~ 0413012010 -- 0413012011 EACH OCCURRENCE $ 1,000,000 - DAMA E;TO RE ED 1 000 000 X COMMERCIAL GENERAL LIABILITY PREM SES Ea occunance , , $ MADE ~ OCCUR CLAIMS MED EXP (Arty ane person) $ 10,000 - PERSONAL & ADV INJURY':. $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 EN'L AGGREGATE LIMIT APPLIES PER: ~ PRODUCTS - COMPIOP AGG $ 2,000,000 G POLICY PRO- X LOC ~ $ A AUT OMOBILE LIABILITY TJ-CAP-280K510-2-10 Q413012010 04!30!2011 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO - BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) S X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per aexidenQ X OWNED AUTOS NON - $ X - PHYSICAL DAMAGE DED COMP $SODICOLL $500 g 9 X UMBRELLA une X OCCUR QKO'1202397 0413012010 0413012011 EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE- AGGREGATE $ 1,000,000 $ DEDUCTIBLE X RETENTION 10,00© - ~ , - $ A wowceRS coMPENSnnoN TC2d-ll&280K507-t-10 (AOS) 0413012010 0413012011 X We STATU- oTH- A AND EMPLOYERS' LI/IBILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE TRJ-U8-280K5083-10 0413012010 0413012011 E.L. EACH ACCIDENT 1,000,000 $ ~ L DED~ N / A ~ 0 OFFICER/MEMBER.EXC U i NH) - M d t '(pK,AZ,MA,NE,NH,NJ,OK,OR)' - - E.L. DISEASE - EA EMPLOYE S 1,000,00 n ( an a ory If yes, describe under E.L DISEASE -POLICY LIMB $ 1,000,000 DESCRIPTION OF OPERATIONS below C MANAGED HEALTHCARE PROF LIAB MCP-0514-10 10131(2010 1013112011 PER CLAIM 5,000,000 $250,000 SIR 'RETRO DATE: 04-10-1987 AGGREGATE 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS ! VENIGLES (Attach ACORD te7, Additional Remarks Schedule,.N more space is required) ENdence of Insurance CorVel Healttlcare Corpora0on 2010 Main Street, Suite 600 Irvine, CA 92614 AUTHORRED REPRESENTATIVE of Marsh USA Inc. Katey E. Jones ~p-~~ ~ ~~- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. lJ IDOO-LVV7 lllivnV vvnr vrv+r.v... nu naJnw 1cClcr~cu ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD Confidential 2011-124 Attachment F: Exceptions CorVel Corporation City of san Bernardino Workers' Comp Utilization Review 2011-124 City of San Bernardino Request for Proposal ("RFP") RFP No. F-11-16 If awarded the contract, CorVel reserves the right to negotiate the following sections: • Page 12, Section 3, Aggregated Limits/Blanket Coverage • Page 12, Section 4, Modification of Coverage • Page 93, Section ~, Automobile Liability • Page 31, Section 30 • Page 31, Section 31 O 2011 CorVel Corporation. All rights reserved. Confidential 2011-124 City of San Bernardino Request for Proposal F-11-16 Workers' Compensation Utilization Review CorVel's Contractual Exceptions Section II(1)(d). General Conditions: Insurance CorVel ("Contractor") can provide insurance certificate and any endorsements, but cannot provide any form of the insurance policy. Terms CorVel ("Contractor") would like included in contract: REPRESENTATIONS, WARRANTIES AND COVENANTS OF THE CITY A. Authori .The City represents and warrants that (i) it has all necessary corporate power and authority to enter into this Agreement and to perform its obligations hereunder, and the execution and delivery of this Agreement and the consummation of the transactions contemplated hereby have been duly authorized by all necessary corporate actions on its part, (ii) this Agreement constitutes a legal, valid and binding obligation of The City, enforceable against it in accordance with its terms, and (iii) the execution, delivery and performance of this Agreement will not constitute a violation of any judgment, order or decree or a breach of a material agreement that would materially impair or prevent The City from complying with its obligations under this Agreement. B. Authorizations. The City represents and warrants that (i) it has obtained or shall obtain such authorizations or approvals as are required for Contractor to perform the services described in this Agreement, including but not limited to receiving and disclosing patient-specific data as contemplated hereunder, (ii) it shall maintain the compliance of its workers' compensation program under all applicable laws, (iii) it has obtained and shall maintain during the Term any regulatory approval needed in order for Contractor to perform its obligations hereunder, and (iv) it shall promptly notify Contractor if any such approval is terminated, suspended or otherwise materially limited. C. Non-Solicitation. The City agrees that during the Term of this Agreement and for a period of one (1) year after any expiration or termination thereof, The City shall not, directly or indirectly, recruit or solicit for employment, employ or in any manner engage the services of or otherwise interfere with the employment relationship of any Contractor employee who was in any way involved in providing services to The City pursuant to the Agreement without the prior written consent of Contractor. In the event The City breaches this covenant of non-solicitation and non- employment, Contractor shall be entitled to recover the amount of one (1) times annual salary per employee from The City as liquidated damages. The parties acknowledge that Contractor's actual damages in the event of such a breach by The City would be extremely difficult or impracticable to determine and acknowledge that this liquidated damages amount has been agreed upon as a reasonable estimate of Contractor's damages and as Contractor's exclusive remedy against The City in the event of a breach of this Section 3D by The City. The parties further agree that in any action brought on account of any alleged breach of this covenant, the prevailing party shall be entitled to recover its reasonable attorney's fees and costs. 2011-124 REPRESENTATIONS, WARRANTIES AND COVENANTS OF CONTRACTOR A. Authori .Contractor represents and warrants that (i) it has all necessary corporate power and authority to enter into this Agreement and to perform its obligations hereunder, and the execution and delivery of this Agreement and the consummation of the transactions contemplated hereby have been duly authorized by all necessary corporate actions on its part, (ii) this Agreement constitutes a legal, valid and binding obligation of Contractor, enforceable against it in accordance with its terms, and (iii) the execution, delivery and performance of this Agreement will not constitute a violation of any judgment, order or decree or .a breach of a material agreement that would materially impair or prevent Contractor from complying with its obligations under this Agreement. B. Performance. Contractor represents and warrants that (i) it has the necessary knowledge, skills and experience to provide and perform the Managed Care Services in accordance with the Agreement, and (ii) it will perform the Managed Care Services in a diligent, professional and workmanlike manner using an appropriate number of properly trained and qualified individuals and in accordance with applicable industry standards. DISCLAIMERS A. Coverage and Compensability. CONTRACTOR IS NEITHER A HEALTH CARE PROVIDER NOR A CLAIMS ADMINISTRATOR AND CONTRACTOR DOES NOT MAKE FINAL DETERMINATIONS REGARDING THE COVERAGE OR COMPENSABILITY OF HEALTH CARE SERVICES RENDERED BY HEALTH CARE PROVIDERS TO INJURED PERSONS. THE SERVICES PROVIDED BY CONTRACTOR UNDER THIS AGREEMENT ARE ADVISORY ONLY AND ARE PROVIDED SOLELY TO FACILITATE THE CITY'S BUSINESS OPERATIONS. THE CITY AND THE CITY'S EMPLOYEES AND/OR AGENTS HAVE THE OPTION TO ACCEPT OR REJECT ANY ADVICE OFFERED BY CONTRACTOR HEREUNDER. CONTRACTOR DOES NOT MAKE DETERMINATIONS RELATING TO THE CITY'S BUSINESS, INCLUDING, BUT NOT LIMITED TO, THOSE REGARDING THE COVERAGE OR COMPENSABII.,ITY OF HEALTH CARE SERVICES. THE CITY SHALL RETAIN FULL RESPONSIBILITY FOR ALL FINAL DETERMINATIONS REGARDING THE PAYMENT OF POLICY BENEFITS. B. Healthcare Authority. CONTRACTOR AND ITS AGENTS HAVE NO AUTHORITY TO CONTROL OR DIIZECT THE HEALTH CARE SERVICES PROPOSED FOR OR PROVIDED TO INJURED PERSONS. THIS AUTHORITY SHALL LIE ONLY WITH THE INJURED PERSON AND HIS/HER TREATING PHYSICIAN IN ANY CASE, AND THOSE INDIVIDUALS MAY ACCEPT, REJECT OR MODIFY ANY ADVISORY DETERMINATIONS MADE BY CONTRACTOR OR ITS AGENTS, EXCEPT INSOFAR AS STATE WORKERS' COMPENSATION LAWS MAY REQUIItE THEM TO FOLLOW THE DETERMINATIONS OF THE CITY, THE CITY'S AGENTS, A WORKERS' COMPENSATION JUDGE OR REVIEW PANEL, OR ANOTHER THIRD PARTY. C. No Interference with Practice of Medicine. Neither Contractor nor The City shall attempt to directly or indirectly, to control, direct or interfere with the practice of medicine by any health care provider. CONFIDENTIALITY A. Definition of Confidential Information. "Confidential Information" shall mean any non- public data, information and other materials regarding the products, services or business of a party (and/or, if either party is bound to protect the confidentiality of any third party's information, of a third party) provided to either party by the other party where such information is 2011-124 marked or otherwise communicated as being "proprietary" or "confidential" or the like, or where such information should, by its nature, be reasonably considered to be confidential and/or proprietary. Without limiting the foregoing, the parties agree that (i) the CareMC Application, Documentation, Contractor Content (as defined in the in the CareMC License Agreement) and all software, source code, source documentation, inventions, know-how, and ideas, updates and any documentation and information relating thereto constitutes Confidential Information of Contractor, (ii) the The City Data (as defined in the CareMC License Agreement) constitute Confidential Information of The City, and (iii) this Agreement, the .Exhibits and Schedules attached hereto, and the terms and conditions set forth herein and therein are Confidential Information of both parties. B. Disclosure and Use of Confidential Information. The Confidential Information disclosed by either party ("Disclosing Party") to the other ("Receiving Party") constitutes the confidential and proprietary information of the Disclosing Party and the Receiving Party agrees to treat such Confidential Information in the same manner as it treats its own similar proprietary information, but in no case will the degree of care be less than reasonable care. The Receiving Party shall use the Confidential Information of the Disclosing Party only in performing under this Agreement and shall retain the Confidential Information in confidence and not disclose it to any third party (except as authorized under this Agreement) without the Disclosing Party's express written consent. The Receiving Party shall disclose the Disclosing Party's Confidential Information only to those employees and contractors of the Receiving Party who have a need to know such information for the purposes of this Agreement, and such employees and contractors mast be bound by this Agreement or have entered into agreements with the Receiving Party containing confidentiality provisions covering the Confidential Information with terms and conditions at least as restrictive as those set forth herein. C. Exceptions. Notwithstanding the foregoing, the parties' confidentiality obligations hereunder shall not apply to information which: (i) is already known to the Receiving Party prior to disclosure by the Disclosing Party, (ii) becomes publicly available without fault of the Receiving Party, (iii) is rightfully obtained by the Receiving Party from a third party without restriction as to disclosure, (iv) is approved for release by written authorization of the Disclosing Party, (v) is developed independently by the Receiving Party without use of or access to the Disclosing Party's Confidential Information, or (vi) is required to be disclosed by law, rule, regulation, court of competent jurisdiction or governmental order, provided, however, that the Receiving Party shall advise the Disclosing Party of the Confidential Information required to be disclosed promptly upon learning thereof in order to afford the Disclosing Party a reasonable opportunity to contest, limit or assist the Receiving Party in crafting the disclosure, and then such disclosure shall be made only to the extent necessary to satisfy such requirements. D. Use of Data. Nothing shall prohibit Contractor from using aggregate, non-identifying, statistical data generated through its customers', including The City, use of the CareMC Application and Online Services for marketing purposes, provided that Contractor shall not use or disclose any such data or information in a manner that would reveal the identity of, or other confidential information concerning, The City. Such aggregate, non-identifying statistical data could include, without limitation, statistics regarding usage of the CareMC Application and Online Services, the number of case referrals generated through the CareMC Application and Online Services and the efficiencies gained by Contractor customers through their use of the CareMC Application and Online Services.