SR 07-12-2022 5E
City Council
Report
City Council Meeting: July 12, 2022
Agenda Item: 5.E
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To: Mayor and City Council
From: Gigi Decavalles-Hughes, Director, Finance Department, Risk Management
Subject: Approval of First Modification to Agreement with Intercare Holdings Insurance
Services, Inc. for Workers' Compensation Claims Administration Services
Recommended Action
Staff recommends that the City Council authorize the City Manager to negotiate and
execute a first modification to agreement #10506 in the amount of $1,090,267 with
Intercare Holdings Insurance Services, Inc. (Intercare) for workers’ compensation claims
administration services. This will result in an eight-year amended agreement with a new
total amount not to exceed $2,789,776, with future year funding contingent on Council
budget approval.
Summary
The City Council authorized a pilot program at the Big Blue Bus, now Department of
Transportation (DoT) to determine the most cost-effective model for managing workers’
compensation claims. Consequently, effective November 1, 2017, claims administration
responsibilities for all Big Blue Bus claims transferred from the City’s in-house workers’
compensation staff to Intercare, a Third-Party Administrator (TPA). Based on the pilot
program’s performance, staff recommends a permanent shift to a TPA for management
of DoT’s workers’ compensation claims. The current agreement with Intercare is set to
expire on August 31, 2022. Intercare agreed to extend the agreement for three years
with no year-to-year increase for the first year of the extension and 1.5% annual
increase each year thereafter. Staff believes that such a modification to the agreement
would be prudent and cost-effective for the City. The extension will provide additional
time for the City to evaluate moving its entire Workers’ Compensation Program to the
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TPA model and engage with bargaining groups regarding any potential labor relations
issues.
Discussion
The Risk Management Division of the Finance Department is responsible for managing
the City’s self-insured Workers’ Compensation Program. Self-insured employers can
either administer the claims in-house or subcontract this service to a TPA. In 2001, the
City moved to the internal management model to improve program outcomes through
direct control and provide better customer service to injured employees. As a result, the
Risk Management Division’s staff became responsible for coordinating medical care
and financial benefits to injured workers, as mandated by State regulations.
Pilot Program: Background
In early 2017, a cross-departmental working group, tasked with developing initiatives to
contain the City’s rising workers’ compensation costs, conducted an assessment of the
TPA model. The working group found that the TPA model offers several advantages
over a self-administered program like the City’s. Most significantly, a well-established
TPA has more resources to support better claim outcomes. TPAs, by virtue of working
with more than one client agency, have the ability to provide more supervisory and
backup resources for their claims examiners, as well as dedicated assistants
responsible for all clerical tasks. This ensures that claims are managed effectively even
when the assigned examiner is out of the office. The City’s self-administered program
is too small to have this level of staffing. In addition, many TPAs have in-house units to
provide ancillary workers’ compensation services, such as fraud investigations, staff
trainings, and medical management.
Given a favorable assessment of the TPA model, the working group developed a three-
year pilot program to determine whether the City could benefit from using a TPA to
manage its workers’ compensation claims. The Big Blue Bus was selected as the
Department to pilot the model primarily due to its sizable workforce consisting of
employees in both physically demanding and sedentary jobs, and the Department’s
desire to be more involved in management of its claims. On July 25, 2017 (Attachment
A), Council approved the pilot program and the selection of Intercare as the TPA to
manage the workers’ compensation claims for the Big Blue Bus. As a result, the City
entered into an agreement with Intercare for three years with two one-year renewal
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options (Attachment B). To avoid making any major changes to the City’s Workers’
Compensation Program during the pandemic, staff exercised the two renewal options,
extending the duration of the pilot program to five years. This ensured stability for
injured employees already dealing with the effects of the public health crisis.
Pilot Program: Assessment and Recommendation
Staff evaluated the pilot program’s success against a set of objective performance
measures. The results from the pilot program are outlined below. It is important to note
that most of the claims administered by City staff were filed by sworn public safety
employees, who receive more generous workers’ compensation benefits, which makes
those claims more costly.
• Total Liabilities (i.e., an estimated future value of all open claims) for DoT’s
claims declined from $7.4 million to $5.4 million by March 31, 2022. In contrast,
total liabilities for the claims from all other Departments increased from $21.9
million to $26.1 million.
• Total Expenses during FY 2020-21 for claims managed by Intercare increased by
0.4% from FY 2016-17. By comparison, total expenses for claims managed by
in-house staff increased by 25.2%.
• In FY 2020-21, Temporary Disability Payments (i.e., payments for lost wages)
per open claim for DoT increased by $628 from FY 2016-17. For all other
Departments, the payments increased by $6,080.
Given the pilot program’s success, staff prepared a cost-benefit analysis to project
savings if a TPA took over the administration of the remaining workers' compensation
claims. The analysis is based on Intercare’s performance with DoT’s claims over the
duration of the pilot program. It assumes that a TPA would achieve the same cost
savings in total liabilities and total expenses for the Public Works Department since its
employees receive the same State workers’ compensation benefits as DoT employees.
Sworn public safety employees, however, are entitled to a different set of benefits (e.g.,
injury presumptions, 4850 disability benefit, higher permanent disability, etc.). As such,
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it is harder to project the cost savings – if there are any – that a TPA might achieve for
claims from the Fire and Police Departments. The analysis below accounts for this
difference by presenting three scenarios showing varying levels of impact on total
liabilities and expenses when shifting all claims to a TPA:
• Scenario #1, a TPA would achieve a 50% reduction in liabilities and expenses for
the Fire and Police Departments when compared to reductions achieved for the
DoT over four years of the pilot program.
• Scenario #2, which staff believes to be the most likely scenario, assumes that
reductions for these two departments would be 25% of what Intercare has
achieved for the DoT.
• Scenario #3, assumes a TPA would not be able to reduce total liabilities and total
expenses for claims from the Fire and Police Departments. As a result, in the
third scenario, unlike under the other two scenarios, the City would not realize
savings from shifting to the TPA model.
Below is a summary of the results from the analysis.
Likelihood Impact Annual Savings
Scenario #1 25% High $898,845
Scenario #2 50% Medium $351,756
Scenario #3 25% None ($195,333)
Given the uncertainty in cost savings realized from shifting all other departments to the
TPA model, as well as the additional staffing disruption that it would create in the Risk
Management Division, staff does not believe that a program-wide shift is feasible at this
time. Staff therefore recommends a permanent shift to the TPA model for the
management of DoT’s workers’ compensation claims only. However, the Risk
Management Division would like the option to consider shifting portions of its in-house
program to a TPA as attrition occurs over time and if ongoing analysis continues to
show that a TPA can assist with lowering the City’s liabilities. As such, staff is
requesting an authorization from the Council to extend the contract with Intercare, set to
expire on August 31, 2022, for an additional three years. After three years, staff will
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complete a new request for proposal (RFP) process and reconsider the manner in
which the program is delivered.
Past Council Actions
Meeting Date Description
July 25, 2017
(attachment A)
Authorize agreement with Intercare Holdings Insurance Services, Inc.
following an RFP process
Financial Impacts and Budget Actions
Staff seeks authority to approve funding from the Self Insurance, Workers’
Compensation Fund to increase the amount of the agreement with Intercare Holdings
Insurance Services, Inc. for Workers’ Compensation Claims Administration Services.
The annual cost for the first year of the extension is $358,025, which is the same as the
cost for the last year of the current agreement; each year thereafter contains an annual
increase of 1.5%. Future year funding is contingent on Council budget approval.
Contract Modification Request
Agreement #
Current
Authorized
Amount
Modified
Request
Amount
Dept Account #
Total Revised
Contract
Amount
10506 $1,699,509 $1,090,267 74800002.534510 $2,789,776
Prepared By: Oles Gordeev, Risk Manager
Approved
Forwarded to Council
Attachments:
A. 7.25.17 Staff Report (Attachment A)
B. Intercare Executed Agreement (Attachment B)
C. Intercare Oaks Initiative Disclosure Form
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City Council
Report
City Council Meeting: July 25, 2017
Agenda Item: 3.B
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To: Mayor and City Council
From: Gigi Decavalles-Hughes, Director, Finance Department, Risk Management
Edward F King, Director, Department of Transportation
Subject: Workers' Compensation Claims Administration Services
Recommended Action
Staff recommends that the City Council:
1. Award RFP #105 to Intercare Holdings Insurance Services, Inc., a California-
based company, for workers’ compensation claims administration services;
2. Authorize the City Manager to negotiate and execute an agreement with
Intercare Holdings Insurance Services, Inc. for three years, with two one-year
renewal options in an amount not to exceed $1,699,509 over a five-year period,
with future year funding contingent on Council budget approval; and
3. Authorize the City Manager to negotiate and execute a first modification to
agreement #10234 in the amount of $113,800 with TCS Risk Management
Services, LLC, a California-based company, for workers’ compensation data
analysis and consulting services. This will result in a five-year amended
agreement with a new total amount not to exceed $326,300, with future year
funding contingent on Council budget approval.
Executive Summary
The Finance Department and Big Blue Bus (BBB) are requesting to engage in a three-
year pilot program to determine the most cost-effective model for managing workers’
compensation claims. BBB will serve as the test group for the pilot program. As
proposed, administration of BBB’s workers’ compensation claims will transfer from in-
house staff in the Risk Management Division of the Finance Department to a private
claims administrator, referred to as a “Third Party Administrator” (TPA). Pilot program
performance will be evaluated and monitored by BBB and Finance throughout the pilot
period.
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Packet Pg. 49 Attachment: 7.25.17 Staff Report (Attachment A) (5188 : Workers' Compensation Claims Administration Services)
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In order to pursue the pilot program, staff from the Finance, BBB and Human Resources
Departments solicited formal proposals from TPAs for workers’ compensation claims
administration services. Based on this process, staff recommends that the City enter
into an agreement with Intercare Holdings Insurance Services, Inc. for an amount not to
exceed $1,699,509 over a five-year period. In addition, staff recommends that the City
amend its existing contract with TCS Risk Management Services, the City’s workers’
compensation consultant, for assistance with transitioning claims administration
services to the TPA and tracking and monitoring the pilot program’s performance. The
amendment will cost $113,800 and result in a new agreement amount not to exceed
$326,300.
Background
The City’s workers’ compensation costs continue to grow at an accelerated pace. In FY
2017-18 alone, the City’s contributions to the Workers’ Compensation Self-Insurance
Fund increased by 50%. Further, contributions are projected to rise by 10% annually
thereafter if current claims trends continue. In response to this, the Finance Director
convened a Workers’ Compensation Working Group composed of the Assistant City
Manager, City Attorney, Human Resources Director, and Risk Manager for the purpose
of promoting initiatives to curb the City’s growing workers’ compensation costs. Under
the guidance of the Working Group, a variety of pilot cost control projects have been put
in place across the City. Examples include the “Wow, That’s Fast” Program, which
provides comprehensive case management services to injured sworn personnel and
post-job-offer functional capacity testing to ensure prospective employees are capable
of safely carrying out essential job functions prior to placement. The most recent idea to
emerge from the Working Group involves a BBB/Risk Management Division proposal to
contract with a TPA to manage the BBB’s workers’ compensation claims. The idea was
intriguing to the Working Group due to the many advantages a reputable and
established TPA could have over an in-house program, and it resulted in the
development of a three-year pilot program proposal to determine which model is more
cost-effective. The details of the pilot program proposal follow.
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Packet Pg. 50 Attachment: 7.25.17 Staff Report (Attachment A) (5188 : Workers' Compensation Claims Administration Services)
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Discussion
The Risk Management Division of the Finance Department is responsible for managing
the City’s Workers’ Compensation Program. In this capacity, the Department has relied
on in-house personnel to administer workers’ compensation claims since 2001. The
decision to use internal or external staff to administer claims is unique to each
employer. In 2001, the City selected an internal management model in hopes of
improving program outcomes through direct control over claims administration. Over
the past two decades, however, TPAs have made advancements in the quality,
sophistication, and breadth of services offered to their clients. TPAs also have a variety
of advantages over an in-house program like the City’s. A few key examples include:
• TPAs can provide their employees with incentives for consistently exceeding
performance targets. Public sector compensation plans are not set up to
contemplate incentive plans of this nature.
• Due to size, TPAs have systems in place to automatically redeploy examiner
staff when the account’s assigned examiner is out of the office (e.g., vacation,
medical/family leaves, etc.). This ensures that claims continue to move forward
when the assigned examiner is unavailable. The City’s program is too small to
provide this type of back-up.
• TPAs have more resources available to support claims staff and improve
outcomes. An established TPA can provide everything from proprietary risk
management information systems (RMIS) that offer unique capabilities (e.g.,
employees can track claim status and medical appointments on smart phones,
etc.) to in-house training units devoted to keeping claims staff up-to-date on the
latest developments/best practices in the workers’ compensation arena.
• TPAs are able to spread their fixed administrative costs (e.g., administrative staff,
training, RMIS, office rents, etc.) across all of their clients.
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Packet Pg. 51 Attachment: 7.25.17 Staff Report (Attachment A) (5188 : Workers' Compensation Claims Administration Services)
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Collectively, these advancements and advantages have positioned TPAs to provide
very cost-effective claims administration services. This information was presented to
the Working Group and prompted their subsequent support for pursuing a pilot program
to determine whether the City could benefit from using a TPA to manage its workers’
compensation claims.
Pilot Program Proposal
The Working Group selected BBB to serve as the test group for the pilot program. BBB
represents a little over one-quarter of the City’s workers’ compensation open claim
inventory and generates roughly 90 to 100 new claims per year. Further, it receives
claims from a cross-section of workers that mirrors the City’s total inventory of claims
(i.e., claims from workers performing sedentary jobs and physically demanding jobs).
These characteristics, coupled with the BBB’s keen desire to be more involved in
managing its workers’ compensation claims, make it the ideal test group in the City for
the pilot program.
Once BBB was selected for the pilot, a group of staff from BBB, Finance/Risk
Management, and Human Resources was assembled to develop and issue an RFP for
claims administration services. The group also established the following parameters for
pursuing the pilot program:
• Implementation: The TPA will manage all of BBB’s existing workers’
compensation claims and any new claims received during the pilot period. BBB
staff, in turn, will serve as the TPA’s primary contact throughout the pilot
program. BBB already handles certain human resources-oriented tasks with
internal staff, and as such, is uniquely positioned to effectively oversee the efforts
of a TPA.
The balance of the City’s claims will continue to be managed by the City’s in-
house staff in Risk Management. Efforts of the in-house staff previously devoted
to BBB will be redeployed to the remaining claim inventory. This will bring down
internal staff caseloads to approximately 110 claims per examiner, which is
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equivalent to the TPA examiner caseload requirements set out in the RFP and
considered an industry best practice.
• Ongoing Oversight: BBB, Finance/Risk Management, and Human Resources
will work together to closely monitor the TPA’s performance during the pilot
period to ensure that any issues with TPA performance are detected and
addressed in a timely manner.
• Employee Notification: Injured employees with open workers’ compensation
claims will be provided ample notice of the changeover so all questions/concerns
can be addressed and all medical services and benefit payments continue
without interruption.
• Accounting Arrangements: The BBB’s share of the Workers’ Compensation
Self-Insurance Fund’s (Fund 59) assets and liabilities will be calculated and
transferred to a newly created fund so that pilot program financial performance
can be accurately tracked. Once these figures are available, staff will return to
Council for authorization to create a Transit Workers’ Compensation Self-
Insurance Fund and transfer the assets/liabilities.
• Program Evaluation: BBB and Finance/Risk Management will evaluate the pilot
program’s success against a set of objective performance measures (e.g., total
cost per claim, lost-time per claim, total open claim inventory, overhead costs per
claim, etc.) and subjective performance measures (e.g., employee satisfaction
surveys, employee focus groups, etc.) throughout the pilot period and at its
conclusion. BBB and Risk Management will be responsible for reporting out at
regular intervals to the Working Group on the pilot program’s performance. At
the conclusion of the three-year pilot period, the Working Group will make a
recommendation to the City Council as to whether the TPA contract should be
terminated, extended for BBB only (thus the inclusion of the two, one-year
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renewal options), or possibly expanded to include a larger segment of the City’s
workers’ compensation claims.
TPA Selection Results
On March 7, 2017, the City published an RFP for workers’ compensation claims
administration services for the BBB. The RFP was posted on the City’s online bidding
site and notices were advertised in the Santa Monica Daily Press in accordance with
City Charter and Municipal Code provisions. 373 potential firms were notified of the
RFP and 31 downloaded the bid. The following seven firms submitted a response:
AdminSure Inc.; Athens Administrators; Broadspire Services Inc.; CorVel Corporation;
Intercare Holdings Insurance Services, Inc.; Tristar Risk Management; and York Risk
Management Services.
An evaluation panel comprised of staff from BBB, Finance/Risk Management, and
Human Resources evaluated all seven RFP responses based on the criteria in SMMC
2.24.073, including price, staffing commitment, understanding of program goals and
objectives, references/experience, incentive plan commitment, and value-added
services. The panel used the criteria to narrow the field to four firms who were invited to
make on-site presentations. The interviews confirmed all four of the firms were capable
of competently fulfilling the RFP’s scope of work and offered competitive pricing and
value-added services. On balance, however, Intercare Holdings Insurance Services
offered the best combination of staffing, transit claim experience, references, and price.
Therefore, staff recommends Intercare Holdings Insurance Services as the best-
qualified firm to provide the claims administration services requested in the RFP.
Contracted Services Policy
While the City’s Contracted Services Policy contemplates physical or manual work as
opposed to professional services, the intent of the policy, coupled with its evaluation
criteria, provided staff with guidance for assessing the appropriateness of pursuing the
pilot program. Specifically, the proposal contained in this staff report meets the “spirit”
of at least five of the criteria set out in the policy: 1) it is a pilot program; 2) the City
would benefit cost-wise from the contractor’s economies of scale; 3) the contractor is
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better positioned to respond to workload fluctuations; 4) the contractor is equipped with
back-up staffing options; and 5) the contractor’s performance can be measured through
objective means. In light of this, staff determined that pursuit of the pilot program was
consistent with the Council’s policy for contracting out services.
TCS Contract
The City currently has an agreement in place with TCS Risk Management Services,
LLC for workers’ compensation consulting services. The contract was awarded to TCS
by the City Council at its December 2015 meeting (attachment A) after engaging in a
competitive selection process. TCS provides Risk Management with indepth quarterly
analyses on the financial and operational performance of the Workers’ Compensation
Program. Staff is requesting to amend TCS’s agreement to include assistance with
developing the pilot program’s performance measures, transitioning claims
administration services to the TPA, and monitoring pilot program performance. This
assistance will ensure the TPA transition goes smoothly for staff and injured workers,
and BBB and Risk Management are able to closely and accurately monitor the pilot
program’s performance. The contract amendment will cost $113,800.
Financial Impacts and Budget Actions
The agreement to be awarded to Intercare Holdings Insurance Services, Inc. is for an
amount not to exceed $1,699,509 over a five-year period. FY 2017-18 contract costs
total $327,900. Further, the agreement modification to be awarded to TCS Risk
Management Services, LLC is $113,800 for an amended agreement total not to exceed
$326,300. This will increase the FY 2017-18 contract costs by an additional $41,067.
Funds for the initial payments required in FY 2017-18 for both agreements have been
budgeted in the Workers’ Compensation Self-Insurance Fund (Fund 59) in account
59235.555060. Once the Transit Workers’ Compensation Self-Insurance Fund
referenced in the “Discussion” portion of this staff report is created (September 2017),
the new Transit Workers’ Compensation Self-Insurance Fund will reimburse Fund 59 for
all costs incurred to date for these two agreements. All subsequent expenses for the
Intercare agreement will be paid out of the Transit Workers’ Compensation Self-
Insurance Fund. All subsequent expenses for the TCS agreement will be paid out of
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Fund 59. However, each year, the Transit Workers’ Compensation Self-Insurance Fund
will reimburse Fund 59 for its share of TCS’s expenses. Future funding for both
agreements is contingent on Council budget approval.
Prepared By: Deb Hossli, Risk Manager
Approved
Forwarded to Council
Attachments:
A. December 15, 2015 Staff Report
B. Intercare Holdings Insurance Services Inc Oaks Form
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Packet Pg. 56 Attachment: 7.25.17 Staff Report (Attachment A) (5188 : Workers' Compensation Claims Administration Services)
Contract No. 10506 (CCS)
PROFESSIONAL SERVICES AGREEMENT This Professional Services Agreement ("Agreement"), entered into as of S119� · f � ,20JJ_ ("Execution Date"), by and between the City of Santa Monica ("City'� andIntercare Holdings Insurance Services, Inc. ("INTERCARE"), is made with reference to /the following:RECITALS: A.The City is a municipal corporation duly organized and validly existing under the lawsof the State of California with the power to carry on its business as it is now beingconducted under the statutes of the State of California and the Charter of the City.B. INTERCARE is qualified to do business, and is doing business, in the State ofCalifornia. INTERCARE represents it has the background, knowledge, experienceand expertise necessary to provide the services set forth in this Agreement.C.The City and INTERCARE now desire to enter into an agreement for INTERCAREto provide professional services to the City.NOW, THEREFORE, it is mutually agreed by and between the undersigned parties asfollows:TERMS AND CONDITIONS 1.Term. This Agreement begins on the Execution Date and terminates on August 31,2020 unless sooner terminated in accordance with Section 14. The City may, in itssole discretion, extend the term of this Agreement for up to two (2) additional one (1)year periods (each an "Extension Term").2.INTERCARE Services. INTERCARE will perform all of the services ("Services")described in Exhibit A, Request for Proposal, Exhibit B, INTERCARE's Proposal,Exhibit C, INTERCARE's Oral Presentation Proposal, and Exhibit D, Scope ofServices. INTERCARE will complete the Services in accordance with Exhibit E,Budget.3.City Services.The City agrees to:3.1 Make available to INTERCARE any currently existing documents, data orinformation required for the performance of the Services.3.2 Designate a representative authorized to act on behalf of City.3.3 Promptly examine and render findings on all documents submitted for staffreview by INTERCARE.4.Compensation. The City will compensate INTER CARE for the Services performed inan amount not to exceed Nine Hundred Ninety-Three Thousand Fifty Three Dollars- 1 -
January 2017
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Packet Pg. 57 Attachment: Intercare Executed Agreement (Attachment B) (5188 : Workers' Compensation Claims Administration Services)
($993,053), as set forth in Exhibit E. The total compensation for this agreement including any Extension Terms shall not exceed One Million, Six Hundred NinetyNine Thousand, Five Hundred Nine Dollars ($1,699,509). 5.Invoices. INTERCARE will invoice the City for the Services in accordance withExhibit E and the City will pay any undisputed amount within 30 days of receipt.6.Notices. All notices, demands, requests or approvals to be given under thisAgreement, must be in writing and will be deemed served when delivered personally,by email, or on the third business day after deposit in the United States mail, postageprepaid, registered or certified, addressed as follows:6.1 All notices, demands, requests or approvals to the City:Big Blue Bus 1660 7th Street Santa Monica, California 90401-3324 Attention: Chief Administrative Officer Re: Contract No. 10506 with a copy to: Santa Monica City Attorney's Office 1685 Main Street, Third Floor Santa Monica, California 90401 Attention: City Attorney Re: Contract No. 10506 6.2 All notices, demands, requests or approvals to INTERCARE: INTER CARE P.O. Box 5915 Orange, CA 92563 USA Attention: Agnes Hoeberling, Chief Operating Officer Re: Contract No. 10506 7.Independent Parties. Both parties to this Agreement will be acting in an independentcapacity and not as agents, employees, partners, or joint venturers of one another.Neither the City nor its officers or employees will have any control over the conductofINTERCARE or any ofINTERCARE's agents, employees, or subconsultants,except as otherwise provided in this Agreement.8.Integrated Contract. This Agreement represents the full and complete understandingof every kind or nature whatsoever between the parties. Any preliminary negotiationsand agreements of any kind or nature are merged into this Agreement. No oralagreement or implied covenant may be held to vary the provisions of this Agreement.- 2 -
January 2017
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Packet Pg. 58 Attachment: Intercare Executed Agreement (Attachment B) (5188 : Workers' Compensation Claims Administration Services)
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Packet Pg. 65 Attachment: Intercare Executed Agreement (Attachment B) (5188 : Workers' Compensation Claims Administration Services)
Exhibit E
Budget
INTERCARE will be compensated in an amount not to exceed $1,699,509 as shown
below:
Year 1 Year 2 Year 3 Year4 Year 5 Notes
Base Fee $272,225 $280,617 $289,260 $298,163 $307,333 1 Performance $7,500 $7,500 $7,500 $7,500 $7,500 2
Guarantee
Incentive $5,000 $5,000 $6,000 $7,500 $7,500 3
Program
MPN Fee $1,500 $1,545 $1,591 $1,639 $1,688 MMSEAFee $600 $618 $637 $656 $675 5 Database $4,575 $2,000 $2,122 $2,185 $2,251 6
Storage
Data Transfer $11,500 $5,250 $5,513 $5,788 $6,078 7
Contingency $25,000 $25,000 $25,000 $25,000 $25,000 8
Total $327,900 $327,530 $337,623 $348,431 $358,025 Grand Total $1,699,509 Notes •1 -Annual Base Fee: The annual base fee will be paid monthly in twelve equalinstallments.•2 -Annual Performance Guarantee: The City will compensate INTER CARE upto $7,500 per contract year, pursuant to terms established in Section 2 of ExhibitD, Scope of Work, for meeting its annual performance guarantee objectives.•3 -Annual Incentive Program: The City will compensate INTERCARE up to theamounts established in the above chart per contract year, pursuant to the termsestablished in Section 3 of Exhibit D, Scope of Work, for meeting its "stretch"performance objectives.•4 -Annual Medical Provider Network (MPN) Access Fee: The City willcompensate INTERCARE if it opts to participate in INTERCARE's MPN in 5.E.b
Packet Pg. 66 Attachment: Intercare Executed Agreement (Attachment B) (5188 : Workers' Compensation Claims Administration Services)
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Packet Pg. 71 Attachment: Intercare Executed Agreement (Attachment B) (5188 : Workers' Compensation Claims Administration Services)
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OR OTH ER BEBENEFITSTS FROM TH EH E CICITY OFSASANTA MONICA
Sananta Mononicacajsvotersadopteded a CiCityChahartrtereramendmentcommononly knonown asas
the Oaks Initiative.Thehe Oaks Initiative requires thehe CiCity to providede this nonoticece and
informrmationonabouttheheInitiatitivejsrequirements.YououmayayobobtainafullcopyoftheheInitiativejs
textfrom theheCiCityClClerk.
This informrmationon isrequireded bybyCiCityChahartrtererArtrticle XXIIgTaxpapayererProtection.It
prohohibitsapublilicofficialalfrfrom receiving,andnd apepersonorenentityfrfrom coconferrrring,spspecifieded
personalbenefitsororcampapaignadvanantagesfrfromom apersonon ororentityaftfterertheheofficialalvotes,
ororotherwisese takesesofffficialalaction,to awaward ahpublilicbenefiti tothatpersonororenentity.The
prohibitiononapplilieseswithinand ououtsidedeofthegeographicalboundariesesofSanantaMononica.
AlAllpepersonsororentitiesesapppplyingng orreceivingng publicbenefititsfrfromom theheCiCityofSanta
Mononicaca shallprovidede thehenamesesoftrtrustees,directors,partrtners,and officers,andnanames
ofpepersosonswith more thana10%equity, partrticipapationonorrevenue interest.An exceptionon
existsfororpepersonsnsseservingng in thosese capacitiesasvolununteeeers,withoutcompensation,for
organizations exemptfrfrom income taxes underSection 501(c)(3),(4),oror(6),ofthe
InternalRevenueCode.H owever,thisexceptionon doesnotapplyiftheorgananizationon isa
popoliliticalalcocommitteeorcocontrtrolspoliliticalcommitttteeees.Examplesesofahpublilicbenefiti incnclude
publilic contrtractsto providede goodsorseservices wortrth more than $2$25,000 orora land usese
apapprovalwortrthmorethan$2$25,000 overera1212-monthpeperiod.
InordertofacacilitatecompliliancewiththeherequirementsoftheheOaksInitiative,e,theheCiCity
cocompililesesand maintainsnscecertain informrmation.Thatinformrmationon incncludes thehe name ofany
personorpersonswhohoisseseekingahpubublilicbenefit.i Ifthehehpublilicbenefiti issoughthtbyan
entity,ratherthanananindndividualpeperson,theheinformrmationincncludesthehenameofeveryperson
whoisis:(a)trtrustee,(b)b)director,(c)partrtner,(d)officer,orhas(e)e)morethanatenpercent
interestinthehe entity.Therefore,e,ifyououareseseeking ahpublilicbenefiticocoverededbybytheheOaks
Initiative,e,yououmustsupplythatinformrmationononon theheO aksInitiative DiDiscsclosure FoForm.This
informationonmustbebeupdatededand suppppliliedevery1212 mononths.
5.E.c
Packet Pg. 72 Attachment: Intercare Oaks Initiative Disclosure Form (5188 : Workers' Compensation Claims Administration Services)
CITY OF SANTA MONICA
OAKSKS INITIATITIVE DIDISCLOSURE FORM
In orderto facacilitate compliliance with thehe requiremenentsofthe O aks Initiative,e,thehe CiCity
cocompililesesand maintainsnscecertaininformrmation.Thatinformrmationon incncludesthehenameofany
personorpersonswhohoisseseekingahpubublilicbenefit.i Ifthehehpublilicbenefiti issoughthtby
anan entity,ratherthananan indndividualpeperson,theheinformrm ationincncludesthehe name ofevery
personwhois:(a)trtrustee,(b)b)director,(c)partrtner,(d)officer,orhas(e)e)morethanaten
pepercentinterestintheheentity.
Pubublilicbenefitsincnclude:
1.1.Personalservicescocontrtractsinexcessof$25,000 overerany1212-monthperiod;
2.2.Saleofmaterial,equipmentorsuppliliesestotheheCityinexcessof$2$25,000 overera1212-
m ononthpeperiod;
3.3.Purchase, saleorleaseofrealpropopertrtytoorfrfrom theheCiCityinexcessof$2525,000
overera1212-mononthpeperiod;
4.4.Nonon-cocompetitivefranchiseawardsdswithgrossrevenue of$50,000 ormoreinany
1212-monthperiod;
5.5.Landusevariance, specialuse pepermitit,orotherexceptionontoananesestabablilishedland
useplan,wheherethehe decisiononhasa valueueinexcessof$2$25,000;
6.6.Taxaxhababatement, exception,orbenefitiofavalueueinexcessof$5,000 inany1212-
m ononthpeperiod;or
7.7.PaymentofhcashshorspspeciRiRi ofanetvalueuetotheherececipientof$1$10,000 inanyny1212-
m ononthpeperiod.
Name(s)ofpepersonsorentitiesreceivingpublicbebenenefit:
Name(s)oftrusteeees,s,directctors,s,partneners,s,anandofficicers:s:
Name(s)ofpersonswithmorethana1010%equityty,paparticipapatitionon,orrevenueinterest:
Preparedby:____________________________Title:__________________________
Signature: ______________________________________Date:________________
Email: ____________________________________Phone: ____________________
FOR CITY USE ONLY:
Bid/PO/Contract# ____________________________ Permit# ___________________________
JodiEllington CFO
07/17/2021
jellington@ ihiservices.com 9 16-677-2114
PacificSecuredEquities,DBA IntercareH oldingsInsuranceServices,Inc.
GeorgeW .W .McCleary,Director
AgnesR H oeberling,CEO
AlanAvriett,Secretary
JodiEllington,CFO
N/A
5.E.c
Packet Pg. 73 Attachment: Intercare Oaks Initiative Disclosure Form (5188 : Workers' Compensation Claims Administration Services)