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Backup Documents 09/26/2017 Item #16E20 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SL/R: (� TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO �J THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNAT Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. County Attorney Office County Attorney Office 214'r4 ' 2. BCC Office Board of County Commissioners 3. Minutes and Records Clerk of Court's Office 4)6 0-1 3'--4161-1 4. Procurement Services Procurement Services PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Barbara Lance r Sandra Herrera Contact Information 239-252-8998 Contact/ Department / Agenda Date Item was 9/26/17 Agenda Item Number 16.E 09,0 ✓ Approved by the BCC Type of Document Amendment 4 Number of Original Attached Documents Attached PO number or account N/A 11-5729 Third Party Allegiance Benefit Plan number if document is Administrator for Management, Inc. to be recorded Health Benefits INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature STAMP OK 14 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be BL signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the N/A document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's BL signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip N/A should be provided to the County Attorney Office at the time the item is input into SIRE. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on 09/26/2017 and all changes made during the meeting have been incorporated in the attached document. The County - Attorney's Office has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the BCC,all changes directed by the BCC have been made,and the document is ready for the Chairman's signature. 1 6E2 ® MEMORANDUM Date: September 28, 2017 To: Barbara Lance, Purchasing Tech Procurement Services From: Ann Jennejohn, Deputy Clerk Minutes & Records Department Re: Agreement #11-5729 Amendment #4, with Allegiance Benefit Plan Management, Inc. for Group Health Third Party Administration Services and Agmt. #17-7209 for Managed Care Services with CHP Attached, please find an original copy of the contract referenced above, (Item #16E20) approved by the Board of County Commissioners on Tuesday, September 26, 2017. The second original contract will be held in the Minutes and Records Department for the Official Record. If you have any questions, please contact me at 252-8406. Thank you. Attachment 1 6 E20 11-5729 "Third Party Administrator for Health Benefits" FOURTH AMENDMENT to the ADMINISTRATIVE SERVICES AGREEMENT and to APPENDICES A,C, D,and E between COLLIER COUNTY GOVERNMENT and ALLEGIANCE BENEFIT PLAN MANAGEMENT, INC. THIS AMENDMENT,made and entered into on th•is�)_ day of S�.c�lembee 2017,by and between ALLEGIANCE BENEFIT PLAN MANAGEMENT, INC. (the"TPA)and Collier County9Government, a political subdivision of the State of Florida, (the "County"or"Plan Sponsor". WHEREAS,on July 26,2011,Agenda Item 16.E.5.,the County entered an Agreement with the TPA for the Group Health Third Party Administration Services; and WHEREAS,on December 6,2011 the County administratively approved the First Amendment to the Agreement to clarify fees; and WHEREAS,on September 23,2014,Agenda Item 16.E.3.,the County approved the Second Amendment to the Agreement to add administration services for dental insurance claims; and WHEREAS,on October 14,2015 the County administratively approved a modification to the Agreement allowing employees to utilize a debit card for medical flexible accounts; and WHEREAS,on April 12,2016,Agenda Item 16.E.3.,the County approved the Third Amendment to the Agreement to adding an additional one year renewal and an extension period; and WHEREAS, Collier County participated in a joint solicitation through the local Collier County Healthcare Consortium,which consisted of Collier County, the Collier County Sheriffs Office, the Collier County School Board District (the CCHCC), to procure the services for administering the Collier County Group Health Plan through the selection of Group Health Third Party Administration and Managed Care; and WHEREAS, on March 21, 2017, the Collier County Public Schools purchasing department released a joint Request for Proposal (RFP)#17-100"Medical/Dental Claims and Flexible Spending Account Administration"solicitation; and WHEREAS, on June 22, 2017, the selection committee by unanimous consensus selected Allegiance Benefit Plan Management, Inc.,for award of the Group Health Third Party Administration(existing vendor under Agreement#11-5729)and Allegiance has requested to amend the existing agreement.; and WHEREAS,because the core services under the Agreement remain unaltered and the existing language is sufficient to reflect the scope of services sought under Collier County Public Schools RFP#17-100,and the primary changes resulting from the RFP are limited to the contract term and fees to be charged, an amendment to the Agreement as set forth below is in the public's best interest; NOW,THEREFORE, in consideration of the mutual promises and covenants herein,the parties agree as follows: The term of the contract is extended from January 1, 2018 through December 31, 2020 and may be renewed for two (2) additional one (1) year periods as mutually agreed by the parties in writing. Exhibit A2-A is replaced in its entirety with the attached Appendix A. Appendix C is replaced in its entirety with the attached Appendix C. Appendix A to Appendix D is replaced in its entirety with the attached Appendix A to Appendix D. Appendix A to Appendix E is replaced in its entirety with the attached Appendix A to Appendix E. Except as amended herein,all other terms and conditions of the Agreement and any prior amendments remain unchanged and in effect. APPENDIX C COBRA SERVICES AGREEMENT(Non-ERISA) APX C COBRA SVCS ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC REV.12-2014 Page 1 of 13 16E20 IN WITNESS WHEREOF,the parties have caused this Amendment to be executed on their behalf by their duly authorized representatives' signatures,effective as of the date first written above. COLLIER COUNTY GOVERNMENT ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC. 2806 S.Garfield St. Missoula,MT 59801 By: Pe',JO* Chairman / By: Ronald K.Dewsnup // (NI;me/Title) President and General Manager By: _ ' By: •nature) ar Signat Date: \Zlo\\ Date: a/37/A77 ATTEST: ‘;:'; Dwight E.Brock,Clerk of Gopits By: LI . 11 IG Dated: — Alcdk (SEMIS , ' , ^" 8 ignature c O: prov d a t fo = d Ie,: su Iciency: tits, m 'r•.Teach Deputy County Attorney Item# Ik__ Agenda atouo.,'1 Date Rete a"2-1"C� Deputy APPENDIX C: COBRA SERVICES AGREEMENT(Non-ERISA) APX C: COBRA SVCS ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC. REV.12-2014 (1)) " Page 2 of 13 5 APPENDIX A 1 6 E 2 0 Fee Schedule The Plan Sponsor and the TPA hereby agree to the compensation schedules set forth below as being the sole compensation to the TPA for the performance of its obligations under this Agreement. Monthly fees are based upon Plan Participant enrollment as of the beginning of each month. A. Administration fees are guaranteed from January 1, 2018 through December 31, 2020, as follows: 2018 2019 2020** $17.26 $17.26 $17.70 The above fees shall include services for production and maintenance of Plan Documents/Summary Plan Description, plan building,amendment production,plan document compliance,and HIPAA compliance,regulatory compliance(if applicable)and production and mailing via bulk mail to the Plan Sponsor of health plan identification cards,and all of the following services that are checked: X Medical Claims X Vision Claims X PPO Management and Provider Network Coordination X Predictive Modeling Disease Management Data Extracts X Consolidated Billing X COBRA services provided by Allegiance COBRA Services, Inc. pursuant to the COBRA Administrative Services Agreement, Appendix C attached hereto. (In addition to this fee, the TPA will also retain two (2) percent of all COBRA premiums as fees for COBRA services.) X any administrative fees charged by the Pharmacy Benefit Management(PBM)company that is utilized by the Plan Distribution of plan materials will be delivered to the Plan Sponsor. An additional postage and handling fee will be paid to the TPA for mailing materials to individual Plan Participants, except for Welcome Packets and identification cards. ** Fees for 2020 are also guaranteed for two(2)additional one(1)year renewals. B. Dental claims processing services per Employee per Month: 2018 2019 2020** $2.75 $2.75 $2.85 ** Fees for 2020 are also guaranteed for two(2) additional one(1)year renewals. C. Hourly fees for Oncology Case Management services by StarPoint: 2018 2019 2020** $115.00 $115.00 $115.00 ** Fees for 2020 are also guaranteed for two(2)additional one(1)year renewals. APPENDIX C. COBRA SERVICES AGREEMENT(Non-ERISA) APX C. COBRA SVCS ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC. REV.12-2014 (i) Page 3of13 1 6 E20 D. Case Management fee/Non-Oncology per Employee per Month effective January 1st of each year: 2018 2019 2020** $2.40 $2.40 $2.45 ** Fees for 2020 are also guaranteed for two(2)additional one (1)year renewals. E. Utilization review services by StarPoint, LLC per Employee per Month effective January 1st of each year: 2018 2019 2020** $1.65 $1.65 $1.70 ** Fees for 2020 are also guaranteed for two (2)additional one(1)year renewals. F. Disease Management fee for Deerwalk per Employee per Month effective January 1st of each year: 2018 2019 2020 $2.75 $2.75 $2.85 , A monthly fee for Healthcare Bluebook transparency tool per Employee per Month effective January 1st of each year: 2018 2019 2020 $1.50 $1.50 $1.55 G. Run out fees. Run Out services shall be based upon a separate run out agreement executed at the time Run Out is requested. However,the fees therefore shall be calculated as follows: There shall be a single fee payable in advance, equal to three times the administration fee paid for the month immediately preceding the date Run Out Services are requested to process claims for a twelve(12)month period following termination of the administrative services provided under this Agreement. H. Hourly fee of$125.00 for welfare plan consulting. Such services must be agreed to in advance by the Plan Sponsor. Hourly fee of$125.00 for stop-loss reimbursement services, audit assistance services and any other services provided by the TPA after termination of this Agreement and in the absence of a separate Run-Out Services Agreement. J. Hourly fee of$125.00 for special programming requests or research including production of any special claims history reports. Such services must be agreed to in advance by the Plan Sponsor. K. Special Reports requested by the Plan Sponsor and produced by the TPA upon prior agreement as to report(s)and fee(s),if any. APPENDIX C: COBRA SERVICES AGREEMENT(Non-ERISA) APX C: COBRA SVCS ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC. REV.12-2014 "�� Page 4 of 13 I6E20 L. Final fee of$500.00 for providing eligibility/enrollment files in electronic format acceptable to TPA without special programming to the Plan Sponsor(if requested in writing). M. Final fee of$1,500.00 for providing Claims history file in electronic format acceptable to TPA without special programming to the Plan Sponsor(if requested in writing). N. Check customization,customized printed material,special statistical reports other than those enumerated in this contract,special medical underwriting,new taxes assessed against the Plan,or other services mutually agreed upon will be billed separately at the rate of$125.00 per hour for such services. Such services must be agreed to in advance by the Plan Sponsor. O. A fee equal to the actual costs for printing Summary Plan Description Booklets,together with costs of shipping for each booklet. P. A fee of$125.00 per hour for time expended producing and providing information to agents,consultants or brokers for whom the Plan Sponsor requests Plan information be provided,together with any postage,shipping and copying costs. Paper copies will be billed at fifteen ($.15)cents per copy. Q. PPO access fees for any PPO organization or claim negotiation company that assesses a per Plan Participant fee,a per Claim fee,or a percentage of claims savings fees not to exceed twenty-five(25%)percent of the actual savings amount between the charges billed by the Health Care Provider and the discounted amount agreed to between the PPO or Claims Negotiation Company and the Health Care Provider,except for those entities specifically listed below,for which no service fee applies. The amount charged under this Agreement shall be equal to the amount charged by the PPO or Claims Negotiation Company. The TPA, its parents or its affiliates, may be paid a service fee by the PPO for claim repricing or other administrative services associated with the claims discount or negotiation. The Plan Sponsor will receive a report that outlines the total billed charges, the total discounts obtained, the net claims cost and the total claim savings to the Plan. Any additional fee in excess of this amount must be approved in advance by the Plan Sponsor. The TPA may be paid a fee not to exceed twenty-five(25%)percent of net savings payable to TPA, its parent or its affiliates, realized as a result of any negotiation or reduction in the amount of claims paid or any recovered funds obtained by TPA through employment of cost containment companies. Specific fees at the inception of this contract for which a per Participant per month rate is charged are: $ -0- per Plan Participant per month for Community Health Partners PHO Effective for 2018 and 2019,the network access fee for the Cigna PPO network is$5.50 PPPM. Effective for 2020,the network access fee for the Cigna PPO network is$5.65 PPPM. I I Funding and Fee Payment Terms Plan Sponsor will establish and maintain a zero balance Claims Payment Account for payment and reimbursement of Covered Services. TPA will notify Plan Sponsor or its designee on a weekly basis of amount required to pay claims after they have been processed for payment. Notification of the amount required will take place as follows: On Wednesday of each week(Thursday,if Wednesday coincides with a recognized Federal holiday),an electronic notification will be provided to Plan Sponsor that the weekly report of claims processed for payment is available on TPA's secured website. TPA will release the claims checks issued for the batch for that week after notice has been sent. APPENDIX C: COBRA SERVICES AGREEMENT(Non-ERISA) APX C: COBRA SVCS ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC. REV.12-2014 Page 5 of 13 16E 2 0 TPA will generate a monthly bill for fees. Payment of monthly billing will be as follows: On or about the 25th of each month,TPA will provide an electronic notification to Plan Sponsor that the monthly bill is available on TPA's secured website. Upon approval from Plan Sponsor,TPA will affect an electronic withdrawal of funds from an account designated by Plan Sponsor on the Debit Authorization Form. Initials (Plan Sponsor) TPA Initials APPENDIX C: COBRA SERVICES AGREEMENT(Non-ERISA) APX C: COBRA SVCS ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC. REV.12-2014 Page 6 of 13 1 6 E20 APPENDIX C COBRA ADMINISTRATIVE SERVICES AGREEMENT This COBRA Administrative Services Agreement(hereinafter"Agreement") is entered into January 1, 2018, by and between COLLIER COUNTY GOVERNMENT(hereinafter"Plan Sponsor"),whose address and phone number are 3299 Tamiami Trail East,Suite 303,Naples, Florida 34112,(239)252-8461,and ALLEGIANCE COBRA SERVICES,INC.,(hereinafter"TPA"),whose address and phone number are 2806 S. Garfield St, PO Box 2097, Missoula, MT 59806; (406) 721-2222. WHEREAS,the Plan Sponsor and/or the plan administrator of the group health plan sponsored by the Plan Sponsor is required to perform certain duties pursuant to continuation of benefits coverage requirements; WHEREAS, the Plan Sponsor has selected the TPA to perform certain nondiscretionary and ministerial duties pursuant to the Plan Sponsor's continuation of benefits coverage requirements; NOW THEREFORE, in consideration of the terms and conditions hereinafter set forth,the parties agree as follows: SECTION 1: Definitions employee(except for termination as a result of gross misconduct), or reduction of hours of employment 1.1 "COBRA" means the Consolidated Omnibus Budget causing the employee to become ineligible for Reconciliation Act of 1985 or the Public Health Service coverage. Act, as amended or interpreted from time to time, and applicable regulations. b. With respect to an eligible dependent or spouse of a covered employee or former employee,termination of 1.2 "COBRA Participant" means any person who is properly employment of the employee(except for termination enrolled for and entitled to benefits from the Plan, as a result of gross misconduct), reduction of hours pursuant to COBRA continuation coverage. of employment causing the employee to become ineligible for coverage, the covered employee's 1.3 "Plan" means the self-funded health and welfare benefit entitlement to Medicare, the death of the covered plan which is the subject of this Agreement and which the employee, the divorce or legal separation of the Plan Sponsor has established pursuant to the Plan spouse from the covered employee, and an eligible Document. dependent who ceases to be a dependent as that term is defined by the Plan. 1.4 "Plan Administrator" means the person or entity designated by the Plan Sponsor to manage the Plan and c. With respect to eligible retirees and their eligible make all discretionary decisions regarding Plan terms and dependents, the commencement of a bankruptcy managing Plan assets. proceeding. 1.5 "Plan Participant" is any employee, retiree or COBRA d. Any other qualifying event as defined by law and as beneficiary who is properly enrolled and eligible for the law may be amended or interpreted from time to benefits under the Plan. time. 1.6 "Qualified Beneficiary"means a covered person under the SECTION 2: Relationship of Parties Plan,who is eligible to continue coverage under the Plan in accordance with the applicable provisions of COBRA, 2.1 Independent Contractor. Plan Sponsor acknowledges regarding Qualified Medical Child Support Orders, or in that the TPA is an independent contractor as defined in accordance with any other applicable Federal or State section 39-71-120 of the Montana Code Annotated, as law. amended, for purposes of this Agreement. As such, the TPA is not an agent or employee of Plan Sponsor and "Qualified Beneficiary" also means a child born to, does not assume any liability or responsibility for any adopted by or placed for adoption with a covered breach of duty or act of omission by Plan Sponsor. employee or former employee, at any time during active COBRA continuation coverage of that employee or former 2.2 Plan Fiduciary. Plan Sponsor acknowledges and agrees employee. that the performance by the TPA of its obligations under this Agreement does not make the TPA a plan 1.7 "Qualifying Event" means: administrator, plan sponsor, or fiduciary as defined by ERISA or other applicable law, and Plan Sponsor will not a. With respect to a covered employee or former identify the TPA or any of its affiliates as such.The Plan employee, termination of employment of the Sponsor further acknowledges and agrees that it is the APPENDIX C: COBRA SERVICES AGREEMENT(Non-ERISA) APX C COBRA SVCS ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC. REV.12-2014 �75 Page 7 of 13 1 6 E 2 0 plan sponsor, plan administrator,and named fiduciary as under the Plan, and such notice is made more than 60 defined by ERISA or other applicable law. As such, Plan days after the Qualifying Event, Plan Sponsor will notify Sponsor retains full discretionary authority, control, and the TPA in writing of the same within ten (10)days after responsibility for the operation and administration of the receiving the notice. Plan. The TPA will not enroll those persons who provided notice 2.3 No Legal or Tax Advice. Plan Sponsor acknowledges and in such manner for COBRA continuation coverage,unless agrees that the TPA will not be deemed to be a legal or specifically directed to do so in writing, by the Plan tax advisor as a result of the performance of its duties Sponsor and/or the Plan Administrator. under this Agreement. 3.4 Qualified Beneficiary Information: Plan Sponsor will 2.4 Subcontractors. The TPA may subcontract the services provide the TPA the following information with notice of a of computer companies, consultants, attorneys, Qualifying Event: accountants, and other organizations that it deems necessary in the performance of its obligations under this a. The name, address, and Social Security number of Agreement. At the discretion of the TPA, such services the employee. may be performed directly by the TPA, wholly or in part, through a subsidiary or affiliate of the TPA or under an b. The name, address, and Social Security number for agreement with an organization,agent,or other person of any covered dependents. its choosing. Any such services resulting in a fee not agreed to in Appendix A, Fee Schedule and Financial c. Date and description of the Qualifying Event,or if not Arrangement in the Administrative Services Agreement a Qualifying Event,the date and reason,if known,for between Plan Sponsor and Allegiance Benefit Plan dropping or terminating Dependent coverage. If the Management,shall have prior written authorization by the Plan Sponsor knows that the Participant's reason for Plan Sponsor. dropping or terminating Dependent coverage is in contemplation of divorce or legal separation, Plan 2.5 Third Party Administrator Licensure. The TPA represents Sponsor shall notify the TPA of the same to assure that during the term of this agreement it will be licensed or that any affected Dependent receives notice of any registered as necessary in the Plan Sponsor's state of COBRA rights to which he or she is entitled. domicile. 3.5 SSI Determination Letters: Plan Sponsor will forward SECTION 3: Responsibilities of Plan Sponsor copies of any Social Security Disability Determination letters it may receive from COBRA Participants within ten 3.1 Initial Notice: If applicable, Plan Sponsor will notify the (10)days after Plan Sponsor receives the same and has TPA within thirty (30) days after employees and/or their date stamped the letter. dependents enroll in Plan Sponsor's Plan of such enrollment to allow the TPA to send the employee an 3.6 Plan Sponsor Plan, Changes, and Amendments: Plan initial COBRA notice. Sponsor will notify the TPA of any changes in benefits, eligibility and/or premiums for Plan Sponsor's Plan, in 3.2 Qualifying Event Notice: Plan Sponsor will notify the TPA accordance with the terms of the Administrative Service or cause the TPA to be notified when employees and/or Agreement for the Plan Sponsor's Plan. their dependents have a Qualifying Event as follows: 3.7 COBRA Premiums: Plan Sponsor will determine the a. Within thirty (30) days of the employee's death, amount to be charged for COBRA premiums and notify termination from employment for any reason the TPA of the same, in writing, upon execution of this including gross misconduct, or reduction of Agreement. Plan Sponsor will notify the TPA in writing of employment hours. any premium changes at least thirty(30)days prior to the effective date of the change or as soon as reasonably b. Within sixty (60) days of the divorce or legal possible thereafter. separation of the employee or the date at which a dependent child ceases eligibility under the Plan. 3.8 COBRA Election Forms: If Plan Sponsor receives requests for COBRA coverage, Plan Sponsor will record c. Within sixty(60)days of a second Qualifying Event of on the form the date it was received by Plan Sponsor. a Qualified Beneficiary dependent or spouse,such as Plan Sponsor will fax a copy of the form to the TPA on the the divorce or legal separation from the covered date it is received by Plan Sponsor,and will mail a copy of employee, death of the covered employee, the same to the TPA within five(5)days of receipt by Plan entitlement to Medicare or the dependent child Sponsor. ceasing eligibility under the Plan. 3.9 Premium Accounts:Plan Sponsor will establish,or cause 3.3 Late Notice of Qualifying Event: If any employee or to be established, a premium account at a bank dependent of an employee provides notice to the Plan designated by the Plan Sponsor. Plan Sponsor, and not Sponsor of divorce or legal separation, entitlement to the TPA,will be the owner of such account. Medicare, or that a dependent child ceases eligibility APPENDIX C: COBRA SERVICES AGREEMENT(Non-ERISA) APX C COBRA SVCS ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC. REV.12-2014(ii) Page 8 of 13 r 1 6 E 2 0 Plan Sponsor authorizes the TPA to endorse COBRA 4.7 Plan Changes and Amendments: The TPA will inform premium payments received by stamping the same with COBRA Participants under the Plan of any changes in "FOR DEPOSIT ONLY" and the applicable premium benefits,eligibility requirements,or premiums of the Plan. account number and to forward the payments to the Plan The obligations of the TPA under this subsection will be Sponsor on a monthly basis for deposit in the premium limited to mailing to COBRA Participants copies of all Plan account. amendments,changes,modifications,or other notices as 3.10 Premium Payments Received from COBRA Participants: received from the Plan Sponsor. If Plan Sponsor receives premium payments directly from 4.8 Customer Service Toll-Free Line: The TPA will provide COBRA Participants, Plan Sponsor will notify the TPA in customer service assistance regarding COBRA issues to writing on the date of receipt, or cause the TPA to be Plan Sponsor and beneficiaries under Plan Sponsor's notified in writing on the date of receipt, of the premium Plan through a toll-free telephone number during regular amount,the name of the COBRA Participant(s)for whom business hours. the premium applies, the date of receipt, and the period for which the premium applies. 4.9 COBRA Participant Premiums: The TPA will bill COBRA Participants for the premiums as designated by Plan 3.11 Initial Grace Period: Plan Sponsor designates that the initial forty-five (45) day grace period for the premium Sponsor and in accordance with applicable law. The TPA payment will begin on the date of COBRA election. will not be required to bill for any premium amount that does not comply with applicable law. 3.12 Other: Plan Sponsor will provide any other information The TPA will direct COBRA Participants to make premium required by the TPA to perform its obligations under this payments payable to the Plan Sponsor and to send Agreement. payments to the TPA. If the TPA receives premium SECTION 4: COBRA Services of the TPA checks made payable to the TPA, the TPA will endorse them over to Plan Sponsor, without recourse. The TPA will collect COBRA premiums and forward them to the 4.1 Initial Notice. If applicable, within fourteen (14) days of Plan Sponsor's on a monthly basis. receipt of notice from Plan Sponsor of a newly-enrolled employee and/or spouse, the TPA will mail to the The TPA will establish, or cause to be established, a employee and/or spouse an initial notice of COBRA system to credit the premium payments to the appropriate continuation coverage rights. Qualified Beneficiary or COBRA Participant. 4.2 Enrollment Packet:Within fourteen(14)days of receipt of 4.10 Late Premium Notices: The TPA will send a reminder notice from the Plan Sponsor of a Qualifying Event, the notice to Qualified Beneficiaries and COBRA Participants TPA will mail to Qualified Beneficiaries a notice of the whose premium payment has not been received on or right to elect COBRA continuation coverage. about the twentieth day of the month. 4.3 Enrollment of Qualified Beneficiaries:The TPA will enroll 4.11 Late Premium Payments: If the TPA receives a premium all Qualified Beneficiaries who elect COBRA continuation payment past the premium due date(including any grace coverage within the time permitted by law. period provided by law or the Plan),the TPA will return the payment to the sender with a notice that it cannot be 4.4 Notice of Open Enrollment. The TPA will notify COBRA accepted. The TPA will return the payment to the sender, participants of any open enrollment periods held for with such notice, within five (5) days of receiving the employees under Plan Sponsor's Plan. payment. 4.5 Contemplation of Divorce:Upon receipt of notice from the 4.12 COBRA Terminations: The TPA will notify the Plan Plan Sponsor, the TPA will provide notices to spouses Sponsor of the date COBRA continuation coverage will and other Dependents whose coverage is being expire, in the absence of any default, for each COBRA terminated in contemplation of divorce or legal separation Participant. Such notice will be given in an eligibility that they may have rights to COBRA continuation report provided by the TPA to the Plan Sponsor on a coverage when the divorce decree or legal separation is monthly basis. entered by a court. 4.13 Notice of Default: The TPA will notify each COBRA 4.6 Post-Election Notices: The TPA will provide all post Participant, in writing, of any default in payment of election notices to employees and their spouses required premium, or other default causing loss of coverage, by applicable law, including but not limited to notice of including the date of default and the date COBRA ineligibility for COBRA continuation coverage, notice of continuation coverage terminated. Notice will be sent by nonpayment of premium, and notice of termination of first class mail within five (5) days following receipt of COBRA coverage. If the notice of ineligibility is due to the notice from Plan Sponsor and/or Plan Administrator. employee's termination of employment for gross misconduct,the Plan Sponsor shall be solely responsible for the determination of gross misconduct. APPENDIX C COBRA SERVICES AGREEMENT(Non-ERISA) APX C: COBRA SVCS ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC. t,�, REV.12-2014 Page 9 of 13 16E20 4.14 Notice of COBRA Exhaustion: The TPA will notify each SECTION 7: Indemnification COBRA Participant of the date COBRA continuation coverage will expire in the absence of any default. Such 7.1 Plan Sponsor Indemnification: The TPA will indemnify, notice will be sent by first class mail within thirty(30)days defend, save and hold the Plan Sponsor harmless from of the termination date. and against any and all claims, suits, actions, liabilities, losses, penalties or damages including court costs and 4.15 Conversion Coverage: If applicable,the TPA shall provide attorneys'fees with respect to the Plan to the extent they notices to eligible COBRA Participants of their rights to are caused by the gross negligence, malfeasance, or obtain conversion coverage. Such notices shall be criminal acts or omissions of the TPA or its employees in supplied at the expense of the Plan. The TPA shall the performance of its duties under this Agreement and administer conversion rights in accordance with the for any acts taken at the specific direction of the Plan provisions of the Plan document. Sponsor. SECTION 5. TPA Compensation 7.2 TPA Indemnification: The Plan Sponsor will indemnify, Plan Sponsor agrees to pay the TPA its compensation for services defend, save, and hold the TPA harmless from and provided under this Agreement in accordance with the terms and against any and all claims, suits, actions, liabilities, conditions outlined in Appendix A, "Fee Schedule and Financial losses, penalties or damages, including court costs and Arrangement" in the Administrative Services Agreement between attorneys' fees, to the extent that such claims, losses, Plan Sponsor and Allegiance Benefit Plan Management. liabilities, damages and expenses are caused by the gross negligence, malfeasance or criminal acts or SECTION 7: Limitations on Liability omissions of the Plan Sponsor, its agents or employees, in the performance of its duties under this Agreement and 6.1 Premium Coverage: Except as in those situations under Section 7 where the TPA is provided for under Payments/Loss of8the TPA willE havet no exculpated from liability.To the extent authorized by law, and applicable to cont liability to any person or entity regarding the processing of indemnity claims the ms premium payments. Provided the TPA acts in accordance foregoing indemnificationnacshall and not constitute a waiver of with this Agreement, the TPA will have no liability to any sovereign immunity beyond the limits set forth in Section 768.28, Florida Statutes. person or any entity for loss of COBRA coverage as a result of late or nonpayment of premium. SECTION 8: Term and Termination of Agreement 6.2 Failure of Plan Sponsor to Notify:The TPA will provide all 8.1 Term and Renewal Term. The term of this Agreement notices to COBRA Participants and Qualified Beneficiaries shall commence on January 1, 2018, and end on in accordance with this Agreement. Provided the TPA December 31, 2020, unless terminated earlier in acts in accordance with this Agreement,the TPA will have accordance with this Section. This Agreement may be no liability to any COBRA Participant or Qualified renewed for an additional two-year renewal term upon Beneficiary for failure of the Plan Sponsor to properly mutual agreement in writing by the parties. notify the TPA and provide the information required for the TPA to perform its obligations under this Agreement. The 8.2 Termination. This Agreement shall be terminated in TPA will have no liability for the accuracy of the accordance with the provisions of Article V: Term and information provided by the Plan Sponsor nor for any Termination of the Administrative Services Agreement actions taken in reliance upon any such information. between the Plan Sponsor and Allegiance Benefit Plan 6.3 NSF Checks:This Agreement will not be construed in any Management, Inc., effective as of the 1st day of January, manner to require the TPA to collect insufficient funds, 2018. "stop-payment"or otherwise dishonored checks,or other 8.3 Survival: The provisions of Sections 2, 6, and 7 shall negotiable instruments received for premium payments, survive termination of this Agreement. which are subsequently not paid by the maker. The TPA will not be liable for any losses to Plan Sponsor or Plan SECTION 9: General Provisions Sponsor's Plan as a result of such checks or negotiable instruments. 9.1 Authorization: Plan Sponsor grants to the TPA the 6.4 Determinations of Gross Misconduct: The TPA shall not authority to do all acts it deems necessary to carry out the make any determinations of any nature regarding whether terms of this Agreement. a Qualified Beneficiary's termination from employment was due to gross misconduct.The TPA shall be entitled to 9.2 Waiver: No forbearance or neglect on the part of either rely upon any determinations of gross misconduct as party to enforce or insist upon any of the provisions of this made by the Plan Sponsor and shall have no liability for Agreement will be construed as a waiver, alteration, or actions taken in reliance upon any such information as modification of this Agreement. provided by the Plan Sponsor. 9.3 Entire Agreement, Amendments, Modification: This Agreement and any attachments constitute the entire agreement between the parties with respect to its subject APPENDIX C. COBRA SERVICES AGREEMENT(Non-ERISA) APX C. COBRA SVCS ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC. REV.12-2014 Page 10 of 13 O 16E20 matter. This Agreement supersedes all existing mail transmission agreements and all other oral, written or other communications between them concerning its subject Notice to the TPA shall be directed to: matter. This Agreement or any attachment shall not be amended or modified except as agreed upon in writing Ronald K. Dewsnup, President, Allegiance Benefit Plan and signed by the parties. If any such modification or Management,Inc.,2806 South Garfield St.,PO Box 3018, amendment increases the direct costs to the TPA under Missoula, MT 59806-3018; Phone: (406) 721-2222; this Agreement, the Plan Sponsor agrees to pay any Fax:(406)721-2252; increases in direct costs that the TPA reasonably expects Email: ron.dewsnup@askallegiance.com. to incur as a result of such modification. Notice to the Plan Sponsor shall be directed to: 9.4 Severability: If any provision of this Agreement is held to be invalid, illegal, or unenforceable by any court of final Jeff Walker, Director, Collier County Risk Management jurisdiction, it is the intent of the parties that all other Department, 3311 Tamiami Trail East, Naples, Florida provisions of this Agreement be construed to remain fully 34112; Phone: (239) 252-8906; Fax: (239) 252-8048; valid,enforceable,and binding on the parties. Email: JeffWalkerancolliergov.net. 9.5 Agreement Counterparts: This Agreement may be 9.10 Choice of Law and Venue. This Agreement shall be executed in two or more counterparts, each and all of governed and construed in accordance with the laws of which will be deemed an original and all of which together the State of Florida. will constitute but one and the same instrument. 9.11 Prior to the initiation of any action or proceeding permitted 9.6 Assignment. Neither party shall assign, transfer, or by this Agreement to resolve disputes between the subcontract any portion of this Agreement without the parties, the parties shall make a good faith effort to prior written consent of the non-assigning party. resolve any such disputes by negotiation. The negotiation shall be attended by representatives of the TPA with full 9.7 Notice of Threatened Litigation: The Plan Sponsor will decision-making authority and by Plan Sponsor's staff notify the TPA within ten (10) days of any threatened person who would make the presentation of any litigation, lawsuits or regulatory complaints or inquiries settlement reached during negotiations to Plan Sponsor pertaining to the subject matter of this Agreement,or any for approval. Failing resolution, and prior to the inquiry made by any federal or state authority regarding commencement of depositions in any litigation between the same. the parties arising out of this Agreement,the parties shall attempt to resolve the dispute through Mediation before 9.8 Compliance with Laws.The TPA shall,in the performance an agreed-upon Circuit Court Mediator certified by the of its obligations under this Agreement, comply with State of Florida. The mediation shall be attended by applicable federal, state or local laws, rules and representatives of the TPA with full decision-making regulations,including the Montana Human Rights Act,the authority and by Plan's Sponsor's staff person who would Civil Rights Act of 1964, the Age Discrimination Act of make the presentation of any settlement reached at 1975,the American Disabilities Act of 1990,and Section mediation to Plan Sponsor's board for approval. Should 504 of the Rehabilitation Act of 1973. In accordance with either party fail to submit to mediation as required section 49-3-207, Montana Code Annotated, the TPA hereunder, the other party may obtain a court order agrees that the hiring of persons to perform the requiring mediation under Section 44.102, Fla.Stats. Agreement will be made on the basis of merit and qualifications and there will be no discrimination based Any suit or action brought by either party to this upon race,creed,religion,color,national origin,sex,age, Agreement against the other party relating to or arising physical or mental disability, marital status, or political out of this Agreement must be brought in the appropriate ideas in the right to obtain and hold employment. federal or state courts in Collier County, Florida, which courts have sole and exclusive iurisdiction on all such 9.9 Service of Notice. Neither party will be bound by any matters. notice,directive or request unless and until it is received in writing, or by facsimile transmission, or by e-mail 9.12 Headings: Section headings are included only for address at the addresses in this subsection. All notices convenient reference and do not describe the sections to given to either party under this Agreement shall, unless which they relate. otherwise specified in writing, be deemed to have been given three (3) days after deposit in the U.S. Mail, first 9.13 Interpretation of Words: Words denoting the singular class postage prepaid, certified mail, return receipt include the plural and vice versa. requested.; date of facsimile transmission; or date of e- Initials (Plan Sponsor Initials (WA) APPENDIX C: COBRA SERVICES AGREEMENT(Non-ERISA) APX C. COBRA SVCS ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC. REV.12-2014 Page 11 of 13 1 6 E20 APPENDIX D 11-5729 "Third Party Administrator for Health Benefits" ADMINISTRATIVE SERVICES AGREEMENT SECTION 105 MEDICAL EXPENSE REIMBURSEMENT PLAN APPENDIX A to APPENDIX D FEE SCHEDULE AND FINANCIAL ARRANGEMENT 1. FEE SCHEDULE The Plan Sponsor and the TPA hereby agree to the compensation schedules set forth below as being the sole compensation to the TPA for any of its services which relate to the Section 105 HRA Plan. Monthly fees are based upon Plan Participant enrollment as of the beginning of the month. All fees stated below are subject to Chapter 218, Florida Statutes, also known as the"Local Government Prompt Payment Act". Plan Sponsor shall pay THE TPA the following fees as indicated: SERVICE AMOUNT DUE 2018 2019 2020** A. Monthly Service Fee HRA: Per Participant per Month $4.00 $4.00 $4.10 ** Fees for 2020 are also guaranteed for two (2) additional one (1)year renewals. B. Hourly fee of$50.00 for reconciliation of contribution listing and related accounting services. C. Hourly fee of$100.00 for welfare plan consulting. Such services must be agreed to in advance by the Plan Sponsor. D. Hourly fee of$100.00 per hour for audit assistance services and any other services provided by the TPA not specifically provided for in this Agreement. MEDICAL ASA Page 12 of 13 MED STD SNGL EMP ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC REV.2011-2(6-11) 16E2 0 APPENDIX E 11-5729"Third Party Administrator for Health Benefits" ADMINISTRATIVE SERVICES AGREEMENT FLEXIBLE BENEFITS PLAN APPENDIX A to APPENDIX E FEE SCHEDULE AND FINANCIAL ARRANGEMENT 1. FEE SCHEDULE The Plan Sponsor and the TPA hereby agree to the compensation schedules set forth below as being the sole compensation to the TPA for any of its services which relate to the FLEX Plan. Monthly fees are based upon Plan Participant enrollment as of the beginning of the month. All fees stated below are subject to Chapter 218, Florida Statutes, also known as the"Local Government Prompt Payment Act". Plan Sponsor shall pay THE TPA the following fees as indicated: SERVICE AMOUNT DUE 2018 2019 2020** A. Monthly Service fee FSA including Electronic Per Participant per Month $5.00 $5.00 $5.15 Payment Card Service: ** Fees for 2020 are also guaranteed for two(2)additional one(1)year renewals. B. Hourly fee of$50.00 for reconciliation of contribution listing and related accounting services. C. Hourly fee of$100.00 for welfare plan consulting. Such services must be agreed to in advance by the Plan Sponsor. D. Hourly fee of$100.00 per hour for audit assistance services and any other services provided by the TPA not specifically provided for in this Agreement. E. Fee for FSA COBRA services $.25/participant/month together with 2%of the COBRA fees collected. MEDICAL ASA Page 13 of 13 MED STD SNGL EMP ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC. REV.2011-2(6-11) ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS I "II 4,4e2 (� THE BOARD OF COUNTY COMMISSIONERS OFFICE FO' L. • Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwardettptlii ttorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be receive e OeMngittorney Office no later than Monday preceding the Board meeting. • **NEW** ROUTING SLIP Risk Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the documentis a rea y omp ete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. Risk Risk Management 512ceb� 2. County Attorney Office County Attorney Office ‘V4 n A tvAJ1,7 4. BCC Office Board of County Pr Commissioners /6 4. Minutes and Records Clerk of Court's Office 5. Procurement Services Procurement Services PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Barbara Lance Contact Information 239-252-8998 Contact/ Department Agenda Date Item was 9/26/17 / Agenda Item Number 16.E at) Approved by the BCC Type of Document Non-Standard Agreement 1 Number of Original ,1 Attached Documents Attached of V PO number or account N/A 17-7209 Managed Care Naples Physician number if document is &Preferred Provider Hospital Organization to be recorded Payor Network Inc.dba Community VVVVVV Health Partners INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature STAMP OK . r INVA 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be BL signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the N/A document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's BL signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip N/A should be provided to the County Attorney Office at the time the item is input into SIRE. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on-937'and all changes made during1�� N/A is not the meeting have been incorporated in the attached docu ent. The County " an option for Attorney's Office has reviewed the changes,if applicable �J -911—),x... this line. 9. Initials of attorney verifying that the attached document is the version approved by the . /A is not BCC,all changes directed by the BCC have been made,and the document is ready for the 'an option for Chairman's signature. this line. 1 6 E 2 0 MEMORANDUM Date: October 3, 2017 To: Barbara Lance, Purchasing Tech Procurement Services From: Ann Jennejohn, Deputy Clerk Minutes & Records Department Re: Agreement #17-7209, Managed Care & Preferred Provider Payor Network Contractor: Community Health Partners, Inc. Attached is an original copy of the agreement referenced above, (Item #16E20) approved by the Board of County Commissioners on Tuesday, September 26, 2017. The second original copy will be held in the Minutes and Records Department for the Official Record. If you have any questions, please contact me at 252-8406. Thank you. Attachment Community 16E20 Health Partners PH,sicIAN HOSPITAL Oji'.:AN NAPLES PHYSICIAN HOSPITAL ORGANIZATION,INC. d/b/a Community Health Partners MANAGED CARE & PREFERRED PROVIDER PAYOR NETWORK AGREEMENT (CCPS#17-100) This MANAGED CARE SERVICE AGREEMENT (the "Agreement") effective as of the January 1, 2018, (the "Effective Date"), is entered into and replaces all previous Agreements and Letters of Agreement by and between Naples Physician Hospital Organization, Inc. d/b/a Community Health Partners("CHP")and Collier County, Florida,a political subdivision of the State of Florida("County"). WITNESSETH: WHEREAS, Community Health Partners has as its primary objective arranging for the delivery or provision of certain Managed Care Services, Utilization Review Services, Case Management Services, and Preferred Provider Payor Network through a cost effective, coordinated, and integrated health care delivery system. WHEREAS, the County has adopted a self-insured employee benefit plan for the provision of Health Care Benefits, Managed Care Program and Utilization Review Program to Plan Members; WHEREAS, the County, a self-insured employer, is ultimately responsible for payment of Health Care Benefits, Managed Care Program, Utilization Review Program, Case Management Program, and Preferred Provider Payor Network in accordance with the terms and conditions of this Agreement; and WHEREAS, the County desires to increase control over the cost of providing Health Care Benefits to Plan Members and enters into this Managed Care Agreement to arrange for CHP, through CHP Providers, to render Managed Care Program(s) to Plan Members in conjunction with County's various Benefit Programs. NOW, THEREFORE, for and in consideration of the mutual covenants contained in this Agreement,the parties agree as follows: ARTICLE I DEFINITIONS For purposes of this Agreement,the following terms shall have the meaning ascribed thereto: 1.1 AGREEMENT This Managed Care Agreement. 1.2 BENEFIT PROGRAM The County's self insured employee benefit plans covered under this Agreement, as amended from time to time. Page 1 of 18 (L4 Community 16E20 Health Partners 1.3 MEDICAL EMERGENCY The sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity which, if not immediately diagnosed and treated, could reasonably be expected to result in serious physical impairment to a bodily function, or serious and permanent dysfunction of any body, organ or body part, or to cause other serious medical consequences which include placing a Plan Member's health in permanent jeopardy. 1.4 CHP HOSPITAL Any hospital facility that has contracted as an independent contractor with CHP to provide certain Health Benefit Plan to Plan Members. 1.5 CHP PHYSICIAN A physician who has contracted as an independent contractor with CHP. 1.6 CHP PROVIDER A CHP Physician, CHP Hospital, and any licensed health care facility or professional, who or which has entered into a written agreement with CHP. 1.7 CLEAN CLAIM A claim that the payor has not disputed in accordance with paragraph 5.2 of this agreement and has all required substantiating documentation similar to the information required to complete HCFA-1500 forms or UB-92 forms permitting timely payment on the claim. 1.8 COPAYMENT That portion of CHP Providers' charges, determined in accordance with this Agreement, for Plan Benefits to be paid by or on behalf of a Plan Member under a particular Benefit Program in excess of the Deductible required by Payor. 1.9 DEDUCTIBLE That portion of the charges for Plan Benefits for which Payor has no obligation to pay or reimburse on behalf of Plan Members under a particular Benefit Program. 1.10 MEDICAL EMERGENCY The sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity which, if not immediately diagnosed and treated, could reasonably be expected to result in serious physical impairment to a bodily function, or serious and permanent dysfunction of any body, organ or body part, or to cause other serious medical consequences which include placing a Plan Member's health in permanent jeopardy. Page 2of18 -- Community 1 6 E20 Health Partners } 1.11 PLAN BENEFITS Those inpatient and outpatient services that are ordered for Plan Members by physicians and other licensed health care providers, covered under a Benefit Program, and within the scope of CHP Providers' service capabilities and this Agreement. 1.12 PLAN MEMBER Any person who has elected to receive health care benefits from or through Payor's Benefit Program and who is eligible to receive Plan Benefits under a Benefit Program included in this Agreement. ARTICLE II PROVISION OF SERVICES 2.1 UTILIZATION MANAGEMENT PROGRAM Community Health Partner's Utilization Management Program shall use nationally recognized guidelines to determine the appropriateness of medical services as well as the delivery setting and length of stay for inpatient hospital and MRI, MRA, CT, CT guided, Home health and DME over $500. The appropriateness guidelines have been developed to create practice pathways that integrate with procedures that require precertification. Community Health Partners will be responsible for: • Maintaining a local telephone line and an out of area toll free telephone line for enrollees of the County's Benefit Plan to call for Precertification of defined procedures and medical services. This may include non-emergent inpatient hospital confinements, outpatient hospital services, surgeries, diagnosis testing and/or medical procedures. • Providing Utilization Management service that will be available during standard business days, Monday through Friday 8:00 am through 5:00 pm EST. Voice mail messaging will be available during non-business hours/days,and calls will be returned on the next business day. • Responding to Utilization Management requests for the medical services within twenty-four (24) hours of the request verbally when all necessary medical information and eligibility status is provided. Written confirmation of the decision will be mailed within the next business day of the decision. • Providing retrospective review of emergent admissions. • Performing concurrent review and assist with discharge planning. • Providing Precertification forms. • Assisting County to determine the medical services and procedures that are to be included in the Utilization Management Program. Page 3 of 18 (4) 1 6 E 2 0 Health Partners P- h • Providing analysis and reports of the Utilization Management Program. Standard reporting of authorizations and denials. • Providing Precertification information to the County's claim administrator via secure FTP site. CHP will coordinate with claim administrator the assignment of authorization numbers. • Following CHP Grievance Procedure process that does not include medical services excluded by the benefit plan. • Providing Nurse and Physician review as necessary. • Providing Case Management services. The County will be responsible for: • Providing written notification to their Benefit Plan enrollees of the Utilization Management Program and the requirements of this program. • Providing up to date enrollment eligibility information to CHP via their Third Party Administrator at a minimum weekly. • Assisting CHP with the integration of the Utilization Management Program with the County's Third Party Administrator. 2.2 LARGE CASE MANAGEMENT Community Health Partners will be responsible for: • Case managing catastrophic chronic and acute illness. • Case managing transplants, inclusive of negotiating rates, all authorizations, working with in-house case management with discharge planning, i.e. home health, DME, Rehab services,etc. • The CHP Case Manager will use claims data to determine which members can benefit from the program. Members will be selected by high cost and high complexity diagnoses. • The CHP Case Manager will attempt to negotiate rates for all services not available within the CHP network,or the employer's national network. • Determining inappropriate Emergency Room utilization of members that have had (3) or more emergency room visits per calendar year. The 1CD-10 codes will be reviewed, and members with inappropriate ER use will be contacted by the case manager. The case manager will encourage the member to establish with a participating Primary Care Physician. Page 4 of 18 16E20 -� community Health Partners PHYSICIAN HOSPITAL O PGANIZATION County will be responsible for: • Encouraging their enrollees to participate in the Large Case Management Program. • Assisting with the notification to employees about the Large Case Management Program. • Providing Preventative Benefits to help identify potential health problems early. • Facilitating the production of monthly claims data files to the Large Case Management program. 2.3 MANDATORY CASE MANAGEMENT Community Health Partners(CHP)will be responsible for: • Monitoring a Covered individual's emerging risk, a condition or diagnosis that may be potentially significant by utilizing several different methods such as Data Analytic/Predictive Modeling software, Pharmacy and TPA reports. • CHP Registered Nurse Case Managers communicating on a weekly basis until less intensity is needed as determined by the Case Manager or the Covered Person is dis-enrolled from program. • Communicating with individuals in the form of letters,phone calls, face to face meeting or encrypted email. • CHP Registered Nurse Case Managers, or Medical Doctor (MD) as required, provide medical chart review and referral services for client claims. 2.4 PAYOR REPRESENTATIVES AND WARRANTIES Payor represents and warrants that the terms of this Agreement do not conflict with any other agreements, whether written or oral,between Payor and any other third person or entity. For purposes of CHP Providers compliance with Rule 4-153, Florida Administrative Code, Payor represents and warrants that its Benefit Programs are completely and fully self-insured, except for any reinsurance or similar form of stop-loss insurance, and that (i) no part or portion of any expenses incurred by a Plan Member are directly reimbursed to a Plan Member by a third party commercial insurer and (ii) no Plan Member is indemnified from and against the expense by a third party commercial insurer provided or arranged for by Payor. 2.5 MEDICAL AND HOSPITAL SERVICES CHP Providers shall make available their usual and customary services to Plan Members in accordance with each CHP Provider's then current policies and procedures. CHP may increase or decrease the level and types of services made available under this Agreement; provided, however, CHP shall provide Payor with thirty (30) days written notice, if possible, if not that with reasonable prior notice of any material reduction in services arranged by CHP. During the term of this Agreement there may be additions to or deletions from the listing of CHP Providers. Such changes shall not be deemed a breach Page 5 of 18 = , Community 1 6 E20 Health Partners 2.6 MEDICAL RECORDS Each CHIP Provider shall maintain medical records of Plan Members in accordance with applicable state and federal laws. All medical information concerning Plan Members is confidential and privileged. Medical information shall not be disclosed to any third party including Payor or its representatives without the duly executed consent of the affected Plan Member or his legally authorized representative, unless required to do so by law or by court order. Subject to a Plan Member or a Plan Member's legal representative consenting to the release and/or duplication of medical records,each CEP Provider shall permit, during normal business hours, the inspection and/or copying of a Plan Member's medical records including emergency room records. The party copying such records shall reimburse the CHP Provider its reasonable costs and charges incurred in providing copies of Plan Members' medical records. Nothing in this Agreement shall require a CHP Provider to provide access to any Plan Member's medical records in violation of applicable state or federal laws or regulations. 2.7 COUNTY REPRESENTATIONS AND WARRANTIES For purposes of CHP Providers compliance with Rule 4-153, Florida Administrative Code, County represents and warrants that its Benefit Programs are completely and fully self-insured, except for any reinsurance or similar form of stop-loss insurance. 2.8 GRIEVANCES Any complaints received by County or its claims administrator with respect to the provision of the Managed Care Program by CHP shall be forwarded to CHP and shall be submitted for resolution in accordance with CHP's patient grievance resolution procedures. 2.9 FORCE MAJEURE Neither CHP, any CHP Provider, nor County shall be liable or deemed to be in default for any delay or failure in performance under this Agreement or other interruption of service or employment deemed resulting, directly or indirectly, from acts of nature, civil or military authority, acts of public enemy,war, accidents, fires,explosions,employee strikes or work interruptions, earthquakes, floods, hurricane, failure of transportation or any similar or dissimilar cause beyond the reasonable control of such party. 2.10 MANAGED CARE AND UTILIZATION REVIEW REQUIREMENTS The County and CHP will work together to determine the Utilization Review and Managed Care requirements and other conditions to be followed by CHP and Plan Members with respect to providing Managed Care Services under a particular Benefit Program. To the extent of any conflict between the terms of this Agreement and such policies the Plan Benefits shall govern if the Plan Benefits address the specific conflict and if not the terms of this Agreement shall govern provided, however, that in no event shall this Agreement amend the Benefit Program. 2.11 NOTIFICATION OF CLAIMS PAYMENT ADMINISTRATOR Upon execution of this Agreement,the County shall provide CHP with written notification of its designated third party administrator, if any, and shall thereafter provide CHP with written advance notice ninety(90)days prior to any changes. Page 6 of 18 (4CH"Illunity 16E2o ealth Partners ARTICLE III BENEFIT PROGRAM and REQUIREMENTS 3.1 BENEFIT PROGRAM REQUIREMENTS Payor shall provide CHP copies of the rules, and benefit plan design, and other conditions to be followed by CHP Providers and Plan Members with respect to providing Plan Benefits under a particular Benefit Program.To the extent of any conflict between the terms of this Agreement and such policies the Plan Benefits shall govern if the Plan Benefits address the specific conflict and if not the terms of this Agreement shall govern provided, however that in no event shall this Agreement amend the Benefit Program. 3.2 BENEFIT PROGRAM DESIGN Payor shall include incentives for Plan Members to utilize the services of CHP Providers under the Benefit Programs included in this Agreement. These incentives shall at be a greater deductible or copay or decreased coinsurance rate of benefits for out of network provider services. There shall be a minimum 10%differential for in network vs out of network benefits. ARTICLE IV PLAN ADMINISTRATION 4.1 ELIGIBILITY REQUIREMENTS Payor shall define and determine all eligibility requirements for Plan Members. Payor shall be solely responsible for all costs and expenses associated with its Benefit Programs. 4.2 EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974("ERISA") For purposes of ERISA and any other applicable state or federal laws, neither CHP nor any CHP Provider shall be deemed the "Administrator" or "Named Fiduciary" of any Benefit Program. Payor shall not seek to bar any CHP Provider from payment for Plan Benefits rendered to Plan Members based on any claims and defenses arising under ERISA or other similar state and federal laws. 4.3 IDENTIFICATION SYSTEM. Payor shall implement and maintain an identification system established for the purpose of verifying the eligibility of Plan Members to receive Plan Benefits under the applicable Benefit Program and this Agreement. Such system shall include an identification card provided to each Plan Member that includes the following information: Payor's logo, Payor's name and phone number, phone number for eligibility verification, address for claims submission,phone number for inpatient pre-certification, if any, employer or group name, plan type and account number,and CHP logo. Page 7 of 18 Q Community 1 6 E 0 Health Partnersw PHYSICIAN H OSPITAL O RGANIZATION 4.4 NOTIFICATION OF CLAIMS PAYMENT ADMINISTRATOR Upon execution of this Agreement, Payor shall provide CHP with written notification of its designated third party administrator, if any, and shall thereafter provide CHP with written advance notice ninety(90)days prior to any changes. 4.5 DISSEMINATION OF INFORMATION CHP shall provide to Payor, at no charge, an electronic directory of CHP Provider information,to be provided monthly. CHP shall maintain an updated website, at no charge and provide the website address to the Payor for access to CHP Provider information.Payor shall prepare and distribute to all Plan Members information booklets, brochures, and other information describing the benefits of utilizing the services and items offered by and through CHP and each CHP Provider. CHP shall provide to Payor or Payor's designated claim administrator the demographic information for each CHP provider and will update Payor or Payor's designated claim administrator monthly of any changes to this information. Update provider information shall be sent to the Payor's claim administrator via email in excel or access format or via paper. 4.6 PROGRAM&NETWORK FEES Payor shall pay CHP the fees listed on Schedule 4.6 as compensation for CHP providing Payor access to and use of the CHP Participating Provider network and each CHP Program. ARTICLE V REIMBURSEMENT 5.1 COMPENSATION RATES Each CHP Provider shall be compensated for Plan Benefits rendered to Plan Members pursuant to this Agreement, Schedule 5.1. as such, the fee schedule may be amended by written mutual agreement from time to time. CHP shall notify Payor and Payor's claim administrator, in writing, of any changes to the fee schedule within sixty (60) days prior to implementation of the changes. Changes to the fee schedule shall not be deemed an amendment to the agreement requiring the consent of the Payor. Fee schedule rates determined by Current Resource Based Relative Value Scale for medical procedures and Health Care Financing Administration (HCFA) weights, for Hospital Diagnostic Relational Grouping (DRG), shall be adjusted annually according to national updating of the RBRVS and HCFA by the respective US Government agencies. 5.2 CLAIMS PROCESSING PROCEDURES CHP shall require each CHP Provider to provide Payor or Payor's designated representative with billing invoices and appropriate documentation of the services provided by such CHP Provider. Payor or it designated agent shall pay all Clean Claims (described below) within thirty (30) days of receipt of each claim. For purposes of the Agreement, claims shall be deemed received by Payor three (3) days after the date of mailing by a CHP Provider to Payor or the designated agent and shall be deemed paid by Payor only upon actual receipt of funds by the CHP Provider. If additional Page 8of18 Community 1 0 Health Partners information is required to pay a claim, Payor or its agent shall request the information in writing within thirty (30) days of receipt of the claim. In the event additional information is not requested in a timely manner a claim as submitted shall be deemed a Clean Claim. In the event Payor elects to audit a claim which is submitted for payment, Payor shall provide written notice of such audit to the CHP Provider and the CFIP Provider shall be afforded the opportunity to participate in the audit process. All audits shall be completed within thirty (30) days. Failure of Payor or Payor's designated representative to comply with Section 5.2 shall result in the plan benefit payment to be determined from billed charges, no discount shall be applied nor will the of the CHP fee schedule be applied to the claim. 5.3 PHYSICIAN FEES EXCLUDED Unless otherwise expressly provided for to the contrary in Schedule 5.1, compensation and charges submitted by a CHP Hospital are exclusive of any fees incurred by or on behalf of a Plan Member for Plan Benefits rendered by a CHP Physician or other CHP Provider. With respect to a CHP Hospital all charges and related reimbursement are exclusive of any fees incurred by or on behalf of a Member for services rendered by anesthesiologists, radiologists, emergency room physicians, pathologists, or any other hospital-based physician. 5.4 LATE FILED CLAIMS CHP Provider claims shall be filed within 120 days of the date of Plan Member's discharge or the date services were rendered; provided, however, no CHP Provider shall be denied payment based upon a failure to submit a claim within one year 5.5 NON-LIABILITY FOR PAYMENT CHP shall not be liable for the payment of any claims relating to Plan Benefits or any other services rendered by any CHP Provider. CHP is neither implicitly nor explicitly the insurer, reinsurer, guarantor, indemnifier or underwriter of any Benefit Program or Payor's obligations to Plan Members. 5.6 RETROACTIVE DENIALS Payor shall not reduce any payment due, or assert a claim to any payment made including, without limitation, on the basis of medical necessity,to any CHP Provider for services rendered pursuant to this Agreement if Payor or its agent provided preauthorization approval for such services. Payor shall not arbitrarily or capriciously deny payment for services rendered by a CHP ARTICLE VI TERM AND TERMINATION 6.1 TERM The initial term of the Agreement shall be from January 1, 2018 to December 31, 2020 and may be renewed for two(2)additional one(1)year periods at the rates set forth on Schedule 4.7, unless either Page 9 of 18 16E2C' Community Health Partners ' 'f>ic hi Il::4'11Ai. ORZ(;A° =LA1 party gives the other notice of its intention not to renew at least_ninety (90 ) days prior to the annual anniversary of the Effective Date after the initial term of this Agreement. 6.2 TERMINATION WITH CAUSE If either party materially breaches this Agreement (the "Breaching Party") the other party (the "Non-Breaching Party") shall have the right to give the Breaching Party written notice of the alleged breach and the Breaching Party shall have thirty (30) days following receipt of such notice to cure the breach to the reasonable satisfaction of the Non-Breaching Party. If the breach is not cured to the reasonable satisfaction of the Non-Breaching Party within the thirty (30) day period the Non-Breaching Party shall have the right to immediately terminate this Agreement. 6.3 OBLIGATIONS AFTER TERMINATION; CONTINUATION OF CARE Termination of the Agreement shall not affect the rights, obligations and liabilities of the parties arising out of transactions occurring prior to termination. Termination of this Agreement shall be without the consent of or notice to any Plan Member or any other third party. Upon the termination of this Agreement for any reason or cause, CHP shall cooperate with County by taking reasonable and medically appropriate measures to assure the assumption of Managed Care Services to Plan Members. CHP shall be compensated for such services in accordance with the terms of this agreement. CHP shall furnish any information and take any action including, without limitation, continuing to provide Managed Care Services, for up to thirty(30)days, as the County may reasonably request in order to effectuate an orderly and systematic termination of CHP duties and activities under this Agreement and the transfer of obligations. ARTICLE VII GENERAL PROVISIONS 7.1 RELATIONSHIP OF PARTIES The County and CHP acknowledge that CHP is an independent contractor. 7.2 RECITALS Each of the recitals set forth above are true and correct and are incorporated into and made part of this Agreement by reference. 7.3 LIMITATION OF ASSIGNMENT This Agreement shall not be assigned by either party without the prior express written consent of the other party. 7.4 BINDING ON SUCCESSORS IN INTEREST To the extent permitted by this Agreement, the provisions of and obligations arising under this Agreement shall extend to, be binding upon, and inure to the benefit of the successors and assigns of CHP and the County. Page 10 of 18 --� Community • 1 6 E 2 0 Health Partners 7.5 SEVERABILITY; CHANGES IN LAW If any part of this Agreement is determined to be invalid, illegal, inoperative or contrary to law or professional ethics, the part shall be reformed, if possible, to conform to law and ethics; the remaining parts of this Agreement shall be fully effective and operative to the extent reasonably possible. If any restriction contained in this Agreement is held by any court to be unenforceable and unreasonable, a lesser restriction shall be enforced in its place and the remaining restrictions shall be enforced independently of each other. 7.6 CONFORMANCE WITH LAW Each party agrees to carry out all activities undertaken by it pursuant to this Agreement in conformance of all applicable federal, Florida and local laws,rules and regulations. 7.7 TIME OF THE ESSENCE Time shall be of the essence with respect to each and every term, covenant, and condition of this Agreement. 7.8 ATTORNEY FEES In the event of any action, dispute, litigation or other proceeding relating to or in connection with this Agreement,each party shall be responsible for their own fees,costs,and expenses of counsel incurred in connection with that action, dispute, litigation or other proceeding. 7.9 ENTIRE AGREEMENT/AMENDMENTS This Agreement supersedes all previous Managed Care Service contracts and constitutes the entire agreement between the parties relating to the subject matter of this Agreement. Oral statements or prior written materials not specifically incorporated in this Agreement shall not be of any force and effect. In entering into and executing this Agreement, the parties rely solely upon the representations and agreements contained in this Agreement. Except as otherwise expressly provided in this Agreement to the contrary, no changes in or additions to this Agreement shall be recognized unless and until made in writing and signed by an authorized officer or agent of CHP and County. 7.10 GOVERNING LAW This Agreement has been executed and delivered and shall be construed and enforced in accordance with the laws of the State of Florida excluding and without application of any choice of law principles except to the extent pre emptied by federal law. Any action brought by the parties whether at law or in equity shall be commenced and maintained and venue shall properly be in Collier County, Florida. The parties knowingly, intentionally and irrevocably waive any claim that any suit, action or proceeding brought in Collier County, Florida has been brought in an inconvenient forum. Each party further waives all rights to any trial by jury in all litigation relating to or arising out of this Agreement. Page 1 1 of 18 oCommunity 16 E o iHealth Partners .;.,n caro 7.11 WAIVER OF BREACH No provision of this Agreement shall be deemed waived unless evidenced by a written document signed by an authorized officer or agent of CHP and the County. The waiver by either party of a breach or violation of any provision of this Agreement shall not operate as, or be construed to be, a waiver of any subsequent breach of the same or other provision of this Agreement unless specifically provided for in the written instrument consenting to the waiver. 7.12 PARAGRAPH AND OTHER HEADINGS The section and other headings contained in this Agreement are for reference purposes only and shall not affect in any way the meaning or interpretation of this Agreement. 7.13 GENDER AND NUMBER When the context of this Agreement requires,the gender of all words shall include the masculine, feminine,and neuter, and the number of all words shall include the singular and plural. 7.14 EXECUTION This Agreement and any amendments may be executed in multiple originals, each counterpart shall be deemed an original, but all counterparts together shall constitute one and the same instrument. 7.15 ADDITIONAL ASSURANCES The provisions of this Agreement are self-operative and do not require further agreement by the parties: provided, however, at the request of either party, the other shall execute, except as otherwise provided in this Agreement, any additional instruments and take any additional acts as may be reasonably necessary to effectuate this Agreement. 7.16 CONSTRUCTION This Agreement shall be construed without regard to any presumption or other rule requiring construction against the party causing this Agreement to be drafted. 7.17 AUTHORITY Each signatory to this Agreement represents and warrants that he possesses all necessary capacity and authority to act for, sign, and bind the respective entity on whose behalf he is signing. 7.18 NOTICE Any notice given pursuant or relating to this Agreement shall be given by United States mail, postage prepaid, certified or registered mail, return receipt requested, hand delivery, or overnight delivery, and delivered to the addressee at the following address unless otherwise changed in accordance with the provisions of this Section: � 3 Page 12 of 18 L;. Community 16E20 Health Partners- To Community Health Partners: To Board of County Commissioners,Collier 851 5`h Ave N Suite 201 County, Florida Naples, Florida 34102 3311 Tamiami Trail East Attention: Contracting Dept. Naples, FL 34112 Attention: Risk Management Department 7.19 CUMULATIVE REMEDIES Remedies provided for in this Agreement shall be in addition to and not in lieu of any other remedies available to either party and shall not be deemed waivers or substitutions for any action or remedy the parties may have under law or in equity. 7.20 MARKETING AND PROMOTION The County and CHP each reserve the right to and control of its name, symbols, trademarks, logos and service marks presently existing or established in the future. The County agrees that CHP may use its name in any publication listing the names of managed care programs and health benefit plans with which CHP contracts. Except as provided in this Section, the use of any written promotional documents, publicity, media advertising, or any other materials for public disclosure carrying the name, trademark, service mark, or a pictorial likeness of either party shall require the prior written consent of the other party. 7.21 CONFIDENTIALITY The County and CHP shall take all reasonable precautions to maintain the confidentiality of this Agreement and any related information provided to or discovered and shall not disclose this Agreement, the terms thereof, or such other information to any party other than a party directly involved in the transaction contemplated by this Agreement. Confidentiality is subject to Chapter 119, Florida Statutes, also known as the Public Records Law. 7.22 COORDINATION OF DEFENSE OF CLAIMS The County and CHP shall promptly notify the other of any claims or demands asserted by third parties that arise under or related to this Agreement. The parties shall make all reasonable efforts, consistent with advice of counsel and the requirements of the respective insurance policies and carriers,to coordinate and assist in the defense of all claims in which the other party is either a named defendant or has a substantial possibility of being named. This Section shall survive termination or expiration of this Agreement. 7.23 COMPLIANCE WITH LAWS AND REGULATION In the event any applicable federal, state, or local law or any regulation, order or policy issued under such law is changed(or any judicial interpretation thereof is developed or changed)in a way which will have a material adverse effect on the practical realization of the benefits anticipated by one or both parties to this Agreement, the adversely affected party shall notify the other party in writing of such change and the effect of the change. The parties shall enter into good faith negotiations to modify this Agreement to compensate for such change. If an agreement is not reached within thirty(30)days of such written notice;the Agreement may be terminated by either party. Page 13of18 Community 1 6 E 2 0 Health Partners P., 0 rtiC , 7.24 INSURANCE CHP shall provide insurance to County as follows: A. Commercial General Liability: Coverage shall have minimum limits of$300,000 Per Occurrence, $2,000,000 aggregate for Bodily Injury Liability and Property Damage Liability. This shall include Premises and Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. B. Workers' Compensation: Insurance covering all employees meeting Statutory Limits in compliance with the applicable state and federal laws. C. Professional Liability: Shall be maintained by CHP to ensure its legal liability for claims arising out of the performance of professional services under this Agreement. Special Requirements: Collier County Government shall be listed as the Certificate Holder and included as an Additional Insured on the Comprehensive General Liability Policy. Current, valid insurance policies meeting the requirement herein identified shall be maintained by CHP during the duration of this Agreement. Renewal certificates shall be sent to the County ten(10)days prior to any expiration date. CHP shall insure that all sub-contractors comply with the same insurance requirements that is required to meet. The same CHP shall provide County with certificates of insurance meeting the required insurance provisions. Page 14 of 18 Community16E2Q-4 Health Partners PHYSICIAN H OSPITAL 0 RGANIZATION IN WITNESS WHEREOF,the parties have caused this Agreement to be duly executed as of the Effective Date. BOARD OF COUNTY COMMISSIONERS COLLIER COW LORIDA ATTEST: By: By: .. • t' C . Print Name: e7c.,v1 rv- ck.s... \\\a Y"" Dated: — , • Title: CN ,Gk\v-Yrau1 'Attest as to Chairman's (my' ure only Date: q\7119,\`"N NAPLES PHYSICIAN HOSPITAL ORGANIZATION,INC. d/b/a COMMUNITY HEALTH PARTNERS ATTEST: I 7 By: Corporate Secretary Print Na me�� '1 "L'�w 1 `'ti L )'7 Date: IC/ I q Print Name By: t (_. Print Name: KLv)r•. Coo®Gi Date: eputy unty • t Item • IIIMMII ..e" ame Agenda CV ' Date ------• coty R Date Page 15 of 18 RBC'dik i --.74% •epu'ty = • 16E20 --� Community Health Partners P u v'SICIAN H OSP ITA I 0 RGANIZATION SCHEDULE 4.6 PROGRAM & NETWORK FEES Board of County Commissioners, Collier County, Florida shall pay Community Health Partners monthly the fees listed below for the Managed Care/Case Management Programs and CHP Provider Network Access to be disbursed to: Community Health Partners 851 Fifth Avenue N. Suite 201 Naples, FL 34102 Utilization Management/Case Management Fees: CHP Utilization Review Management program with Large Case Management/Care Coordination including Maternity Management 01/01/2018— 12/31/2018 $2.60 per employee per month 01/01/2019— 12/31/2019 $2.68 per employee per month 01/01/2020— 12/31/2020 $2.76 per employee per month 01/01/2021 — 12/31/2022 $2.76 per employee per month Case Management Medical Chart Review/Referral Services Registered Nurse $60.00/per hour Medical Doctor(MD) $125.00/per hour CHP Provider Network Access Fees: 01/01/2018— 12/31/2022 $1.50 per employee per month • Page 16 of 18 1/4,-....) Community Li 16E20 Health Partners S AN H OSPITAL. Q R( AN!ZAT,ON Schedule 5.1 Compensation Rates COMMUNITY HEALTH PARTNERS FEE SCHEDULE For BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA NCH HealthCare System Inpatient and Outpatient Hospital pricing Effective October 1,2013 Tier 1 Tier 2 Tier 3 Rate For 75-85%of the individual Criteria (For 0-75%of the individual employer's utilization of For 85+%of the individual employer's utilization of inpatient and outpatient employer's utilization of inpatient and outpatient hospital hospital services at Naples inpatient and outpatient services at Naples Community Community Hospital, Inc. (as hospital services at Naples Hospital, Inc. (as compared to compared to the total number Community Hospital, Inc. (as the total number of the of the employer's employees compared to the total number employer's employees who are who are treated at ALL of the employer's employees treated at ALL hospital facilities hospital facilities and who are treated at ALL hospital and measured on a patient measured on a patient facilities and measured on a encounter basis)during the 12 encounter basis)during the 12 patient encounter basis)during month period following the month period following the the 12 month period following effective date of this effective date of this the effective date of this amendment(and each amendment(and each amendment(and each subsequent 12 month period subsequent 12 month period subsequent 12 month period following the annual anniversary following the annual following the annual of the effective date of this anniversary of the effective anniversary of the effective date amendment) date of this amendment) of this amendment) Inpatient DRG $9,000 per CMS case weight $8,500 per CMS case weight $8,000 per CMS case weight updated October 1st updated October 1st updated October 1st Stop-Loss Inpatient For individual admissions for For individual admissions for which billed charges exceed For individual admissions for which billed charges exceed $35,000.00, reimbursement which billed charges exceed $35,000.00, reimbursement will will be based on DRG at $35,000.00, reimbursement will be based on DRG at$9,000.00 $8,500.00 per CMS weight be based on DRG at$8,000.00 per CMS weight rate, up to the rate, up to the first per CMS weight rate,up to the first$35,000.00, a discount of $35,000.00, a discount of 50% first$35,000.00,a discount of 50%will apply to the Inpatient will apply to the Inpatient 50%will apply to the Inpatient Hospital charges in excess of Hospital charges in excess of Hospital charges in excess of $35,000.00 for that claim. $35,000.00 for that claim. $35,000.00 for that claim. Outpatient Discount I from billed charges 49% 51% 53% Pane 17 of 18 Communit 16E20 � Y Health Partners ' A PHO withhold of 1% will be applied to these accounts. This information is confidential and should not be discussed or distributed outside the hospital departments. NCH HEALTHCARE SYSTEM REIMBURSEMENT TERMS: All claims will be initially paid at the tier one level indicated below. The parties will review reports on a quarterly basis which will provide the total number of covered lives who have received inpatient and outpatient hospital services during that quarter and the number within that total who have received their inpatient and outpatient hospital services from Naples Community Hospital, Inc. Within 60 days following the annual anniversary of the effective date of this amendment, reports will be distributed for reconciliation to determine the overall percentage of inpatient and outpatient hospital services that were provided at Naples Community Hospital, Inc. during that 12 month period (as compared to the total number of the employer's employees who are treated at ALL hospital facilities and measured on a patient encounter basis). The claims for that year will then be calculated based upon the pricing tiers set forth below. Any reimbursement adjustment check that may be due will be issued within 30 days of the conclusion of the 60 day reconciliation period. The reimbursement adjustment calculation will select appropriate claims for reimbursement adjustment based on the"last in—first out"principal. For example if there are a total of 1000 patient encounters during the 12 month period and 800 of the patients received their services from Naples Community Hospital, Inc., then the charges associated with the last 50 patients who were treated at Naples Community Hospital, Inc. would be recalculated at tier two pricing for the purpose of calculating the amount of the reimbursement adjustment. Page 18 of 18 -fes PHYSI-6 2 0 ACC)R,D` E(MM/DD14��Y �� CERTIFICATE OF LIABILITY INSURANCE o2/o6;2o17 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER 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 policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT William H. Kuhlman,CPCU,ARM Insurance and Risk Management PHONE FAX No):239-649-7933 rc Services,Inc. (A ,No,Ext):239-649-1444 8950 Fontana Del Sol Way#200 E-MAIL Naples,FL 34109-4374 ADDRESS: William H.Kuhlman,CPCU,ARM INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:National Trust Insurance Co. 20141 INSURED Naples Physician Hospital INSURERB:FCCI Insurance Company 10178 Organization,Inc. INSURER C:Darwin Select Insurance Co. 24319 851 5th Avenue North,#201 Naples,FL 34102 INSURER D:FCCI Insurance Company 03499 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTRINSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 CLAIMS-MADE X OCCUR X BINDER 02/01/2017 02/01/2018 DAMAGE 10 RENTED 100,000 PREMISES(Ea occurrence) 5 MED EXP(Any one person) 5 5,000 PERSONAL&ADV INJURY - 5 1,000,000 GE IL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY I 1 PRO- JECT LOC I PRODUCTS-COMP/OPAGG_ y Included OTHER: S AUTOMOBILE LIABILITY (CMINE EO a8cideDISINGLE LIMIT s 1,000,000 D ANY AUTO BINDER 02/01/2017 02/01/2018 BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS _ — X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE 5 AUTOS (Per accident) _ 5 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE _ S 2,000,000 A EXCESS LIAB CLAIMS-MADE BINDER 02/01/2017 02/01/2018 AGGREGATE S DED X RETENTIONS 0 • $ WORKERS COMPENSATION X PER 0TH- AND EMPLOYERS'LIABILITY STATUTE X ER Y/N B ANY PROPRIETOR/PARTNER/EXECUTIVE 001 WC17A73097 01/01/2017 01/01/2018 E.L.EACH ACCIDENT 5 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Professional Liab 03043578 01/01/2017 01/01/2018 Gen Agg 4,000,000 (Claims Made Occur 4,000,000 DESCRIPTION OF OPERATIONS r LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Collier County Government is listed as Additional Insured as respects to General Liability. CERTIFICATE HOLDER CANCELLATION COLLCI8 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier CountyGovernment THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 3327 Tamiami Trail East Naples, FL 34112 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD