Medina County Board of Commissioners
Medina County, Ohio
Workers’ Compensation Third Party Administrator
September 28, 2023
Request for Proposals
I. General Information
Established in 1812, Medina County is located in northeast Ohio and serves more than 185,000 residents. With 1400+ employees, Medina County is one of the top employers in northeast Ohio.
The Board of County Commissioners make up the legislative body for county government and is comprised of three (3) members. The Commissioners are elected by the residents of the County to serve a four-year term. The Commissioners provide authority for taxing, budgeting, purchasing and appropriating funds for the government structure. The Board of Commissioners also acts on annexations, drainage improvements/ditch petitions, establishing water/sewer districts and solid waste disposal. The Board of Commissioners appoint department directors including a County Administrator to oversee their mission and ensure the County is an excellent place to visit, work and to call home.
The Medina County Commissioners, Human Resources Department is seeking proposals from qualified companies interested in serving as the County’s Workers’ Compensation Program Third Party Administrator (TPA) from December 1, 2023 through December 1, 2025. This is a two (2) year contract, with two (2), one (1)-year renewal options upon mutual agreement between the TPA and Medina County.
Medina County currently has two risk numbers. The County’s primary [current] self-insured Workers’ Compensation risk number 20005600-0. The self-insured policy began on December 2, 2008. The Prior State Fund risk number is 35200001-0.
The goal of this Request for Proposal (RFP) is to find a TPA team that will partner with the County to administer its Workers’ Compensation Program in accordance with Ohio Revised Code (ORC) 4123.
The primary goal of the County’s Program is to return the injured worker to his/her position as soon as medically possible with or without restrictions. The County will partner with a Third Party Administrator to make sure all fee bills and compensation payments are made timely and correctly in accordance with ORC 4123.
The County’s Loss Control/Risk Manager serves as the Program Administrator. This individual oversees the day-to-day operations and works closely with the TPA to ensure that the needs of injured County workers are being met, monitors and maintains control over all expenditures under the Program and ensures that the medical providers and vendors are providing appropriate and timely medical services.
Medina County employs approximately 1,450 employees in a variety of positions ranging from administrative to public safety [no fire]. Its Program also covers roughly 25 auxiliary deputy sheriffs.
The County shall select a company based on the proposal that is most advantageous to Medina County. Factors to be considered will include, but not necessarily be limited to; a sound comprehensive plan to coordinate and administer all functions under the scope of work, responses to all requirements listed in this RFP, the ability to deliver all services, cost of services, physical location of the company to Medina County offices, reliability, comprehensiveness of the submitted proposal, relevant experience, responsiveness to special needs, and willingness to cooperate with Medina County throughout the entire RFP Process.
DELIVERY OF PROPOSALS
In order to be considered, proposals must be delivered by the date and time specified below. Companies submitting proposals must allow ample delivery time to ensure the timely receipt of their proposals by the County.
Please submit one SIGNED original and four copies of your proposal no later than 4:30 PM on 10/12/2023 to:
144 N. Broadway St.
Medina, OH 44256
Medina County will not accept any proposals received after the date/time stated above. Medina County shall not bear the responsibility for proposals delivered past the stated date or time, or to an incorrect address by company’s personnel or by the company’s outside carrier. Proposals must include one (1) completed and signed original and four (4) copies of the proposal. Proposals shall be submitted in a sealed, opaque envelope or box marked “Proposal Enclosed for RFP – Workers’ Compensation Third Party Administrator.” Any proposals submitted to Medina County, Ohio are to be prepared at the submitter’s expense. Medina County reserves the right to reject any and all proposals in whole or in part.
Acceptance of a proposal shall not constitute an agreement between the company and Medina County. Medina County shall have no liability whatsoever to any company whose proposal is not accepted.
IT IS ABSOLUTELY ESSENTIAL THAT COMPANIES CAREFULLY REVIEW ALL ELEMENTS
IN THEIR FINAL PROPOSALS. ONCE OPENED, PROPOSALS CANNOT BE ALTERED; HOWEVER, MEDINA COUNTY RESERVES THE RIGHT TO REQUEST INFORMATION OR RESPOND TO INQUIRIES FOR CLARIFICATION PURPOSES.
Medina County reserves the right to withdraw this RFP at any time and for any reason, and to issue such clarifications, modifications, and/or amendments as it may deem appropriate. Medina County reserves the right to waive minor irregularities in proposals, provided that such action is in the best interest of the County. Any such waiver shall not modify any remaining RFP requirements or excuse the company from full compliance with the RFP specifications and other contract requirements if the proposal is selected. A proposal may include a proposed contract with its response to the RFP, but the terms and conditions stated in this RFP shall be incorporated into and will take precedence in any final contract. All proposals shall be valid for a period of 90 days from the submission date.
To facilitate the fair evaluation and comparison of proposals, all proposals must conform to the guidelines set forth in this RFP.
All materials submitted and accepted by Medina County in response to this RFP shall become the property of Medina County and will be retained by Medina County in accordance with the Ohio Public Records Act and the Ohio Records Retention Act. The contents of the proposal are subject to the Ohio Public Records Act unless otherwise exempted by law. The proposal should note whether it considers any part of the proposal as proprietary or trade secret. Medina County will attempt to keep, to the best of its ability, proprietary or trade secret material confidential, only to the extent permitted by law. Notwithstanding the foregoing, Medina County shall have the sole discretion in determining whether any part(s) of the proposals contain information that is exempt from Ohio Public Records law.
Medina County will accept questions regarding the RFP only through the following email address: email@example.com. The deadline for question submission is ten (10) days prior to the proposal submission deadline.
The submitted proposal response shall give a description of the company [company overview]. The maximum ten-page double-spaced description should provide the County with narrative information on the company’s proposal credentials, history, status within the Ohio Workers’ Compensation Community, personnel, experience and ability to serve the County as a whole, including the needs of its agencies and injured workers.
Proposals shall indicate in their narratives whether they:
- Are engaged as a TPA in the business of representing employers’ interests in workers’ compensation matters before the Ohio Bureau of Workers’ Compensation and the Ohio Industrial Commission; and
- Have been in this profession or business in Ohio for at least ten years; and
- Have expertise in matters regarding the laws and policies of the Ohio Workers’ Compensation System for both self-insured and state fund claims; and
- Possess the ability to manage effectively and continuously all workers’ compensation claims to avoid the development of unnecessary liability and associated costs.
Proposals shall also include the following:
- Demonstrate why your organization is the best choice for Medina County.
- Have a list of five business references, including the name and contact person for each reference given. At least TWO of the references should be Ohio public sector employers.
- Demonstrate their organization’s ability to provide adequate and consistent staffing for all the products and services requested below under Self-Insured Claims Scope of Work. In order to demonstrate this ability, proposals must include a current table of organization that shows the company’s entire staff that will service the County’s account.
- What is your company’s turnaround time for posting newly received claims information to its website? Demonstrate your company’s process for doing this.
- Is there a separate fee for additional access points to your Internet-based self-insured claims data warehouse systems for self-insured claims? If so, what is the charge?
- What is your company’s fee (% of recovery) on claims subrogated on behalf of Medina County?
- How many claims persons will be assigned to the County’s account both for medical only and lost time claims? On a separate page(s), please provide appropriate curriculum vitae for this/these employees.
- Your company’s proposal response submission must include copy of fee schedule.
- Your company’s proposal response submission must include copies of standard self-insured claim activity reports.
Additional Narratives Required
- On a separate page, please describe any affiliations your company has with Preferred Provider Organization networks [PPO] for reducing claims’ medical costs.
- On a separate page please describe your company’s pharmacy benefit management program/services. Include whether your company performs this service in-house or uses a third party vendor (PBM).
Companies submitting a proposal must have an Internet-based website for storing claims information, which provides imaged claim documents. The website(s) must offer the ability for the County to download claim reports as well as up-to-date medical and claims information.
Under a paragraph labeled ‘IT Capabilities’, companies must describe in detail the respective system’s search/query features. The County will rate your company’s computer system for its clientele based on: user friendliness/ease of use, amount of detail captured, how quickly uploaded documents are available for viewing and other factors to ease the County’s internal workers’ compensation claims administration.
Companies submitting a proposal shall include a maximum two-page double-spaced disaster and emergency recovery procedure plan/report that details how the company will recover IT capability, software, stored data and databases systems after an unplanned event, which renders your company’s office location inoperable.
Please provide answers or verification of the following:
Companies submitting proposals must carry errors and omissions insurance coverage with policy limits of at least $1,000,000 per occurrence and $5,000,000 aggregate. Please include proof of this coverage with the proof of other types of insurance coverages requested in this proposal.
Will your company charge an implementation or an account set up fee and if so, what is the amount?
Does your company have at least ten years of experience in rate verification and actuarial analysis under the Ohio BWC System?
Does your company maintain a fully staffed office located within Ohio, preferably Northeast Ohio? This office must have the necessary storage space for housing the County’s claim files needed for Industrial Commission hearings, holding meetings with County personnel, for conducting daily business and representing the County at Industrial Commission hearings.
Does your company own or is it the parent company of an OBWC certified managed care organization (MCO)? If yes what is the MCO name?
Your Company’s bid response submission must include copies of sample standard claim reports.
All claim records shall remain the County’s property and shall be surrendered when requested at no charge to the County.
Self-Insured Claims Scope of Work
The self-insured TPA is responsible for the management of every Medina County self-insured claim for as long as it is open, active or if it is reactivated.
Claims Adjuster Responsibilities
The claims adjusters shall monitor each injury claim with the objective of returning the injured employee to work as soon as is medically possible following the injury. In order to meet this objective, the claims adjusters must be completely familiar with the details of each injury and must work directly with the injured employee and corresponding medical personnel. The claims adjuster must also be well versed in the requirements of the Ohio Bureau of Workers’ Compensation and Industrial
Commission of Ohio to keep current and timely on all filings required by these state agencies.
Specific duties shall include but are not limited to:
- Work with the County’s legal counsel, when appropriate to provide information and documentation to assist in the litigation of claims.
- Accept self-insured injury reports via email or fax and forward the appropriate information within a reasonable amount of time to a claims adjuster.
- Post same listed information on to the company’s Internet based data warehousing system.
- Evaluate any open claim and make recommendations to the County as to its proper disposition in accordance with the Workers’ Compensation Act.
- Maintain complete records (hard copy and/or electronic) on all reported claims on behalf of and as custodian for the County. Maintain electronic and when necessary paper files. Document in clear, concise, easily understood language all medical claims notes.
- All claim records shall remain the County’s property and shall be surrendered when requested at no charge to the County.
- Submit a weekly summary of claim expenditures to the County. This will be billed weekly as a summary. Submit a sample monthly billing statement with your RFP submission.
- Prepare and deliver all appropriate benefit payments (indemnity and medical) for self-insured claims utilizing a payment method accepted by the OBWC. All payments are to be made on a timely and accurate basis and in accordance with Ohio BWC self-insured requirements, rules and statutes.
- Maintain contact with physicians and other involved medical personnel to maintain a current perspective on the claimants’ progress toward their RTW.
- Maintain contact with the injured workers. Indicate how often your adjuster would contact an injured employee who is off work for a prolong period of time due to a lost time injury.
- Keep current on all claimants’ treatment plans and on any barriers to the expected return to work (RTW) date. Notify the Loss Control/Risk Manager if any barriers to RTW are found.
- Prepare reports as required by the County for presentation at workers’ compensation claims staffing meetings.
- Prepare and send letters to physicians regarding maximum medical improvement and other medical issues as well as letters regarding independent medical exams or reviews (IME & IMR).
- Evaluate cases with the potential for litigation and provide the County with recommendation(s) on the most cost effective manner for resolution. Recommendations should include expected legal outcome, settlement potential and/or cost savings.
- Document in clear, concise, easily understood language all medical claims notes.
- Participate in periodic, scheduled non-litigated claims reviews and be prepared to discuss each claimant’s medical progress.
- Provide the County with at least two points of access to your Internet-based self-insured claims data warehouse systems for self-insured claims. Be prepared to demonstrate your data warehousing systems if requested.
- Capture the designated County Department for each claim.
- Maintain a fully staffed working office within Medina County or Central Ohio.
- Work with Loss Control/Risk Manager to track and monitor trends relating to types of injuries, locations of injuries, length/severity of injuries in order to provide a safe work environment for all employees.
- Review all medical bills, in conjunction with the adjusters, for appropriateness to employee injury and diagnosis. Pay all medical bills at or below BWC fee schedule in a timely manner.
- Review all claims for determination of possible relief from costs under the provisions pertaining to subrogation and other cost deflection methods. Provide meaningful documentation of the results.
- Provide assistance, as requested, to the County in preparation of annual selfinsurance renewal filings and periodic OBWC audits.
- Set reserves in conjunction with the County’s Loss Control/Risk Manager based on the most probable case outcome. Reserves must be monitored and updated (both indemnity and medical) as required by history and reserve protocols. On a separate page(s), detail your company’s protocols for reserving and be specific regarding procedures and their accuracy.
- Review each file for potential fraud or specifically potential systematic abuse and keep the County alerted to any findings.
- Work directly with County’s Loss Control/Risk Manager to ensure the Program is meeting all of the standards required by the OBWC.
- Assist the Loss Control/Risk Manager in answering any and all complaints filed by injured employees and attorneys of record.
- Provide the Loss Control/Risk Manager with an Executive Summary of Program performance on a yearly basis outlining key performance indicators, including costs, return to work statistics and other important variables, including recommendations on overall Program improvement.
- Meet with the Loss Control/Risk Manager on (at minimum) a semiannual basis to review Program costs to include medical expenses and administrative costs (i.e. deposition, surveillance, court reports, drug & alcohol testing, etc).
- Comply with Federal Standards for Medicare reporting requirements as stipulated in Section 111 Medicare Secondary Payer Mandatory Reporting. Describe your company’s process for reporting under Section 111 Medicare Secondary Payer Mandatory Reporting.
- Conform and communicate with excess insurance carrier in regards to any claim that may be potentially piercing the excess retention limit or reporting requirements. This certain criteria will be communicated by the excess carrier on an annual basis.
- Provide the County with predictable workers’ compensation budget projections and assist the County in budget preparation.
- Regularly (at least once every 30 days) review all active claims, monitor active claims and advise the County on recent filings [motions, additional allowance requests, PPD, wage loss, PTD applications and change of physicians to name a few] and actions by either the claimants, the attorney of record and/or the BWC/IC within 72 hours after filing.
- Obtain medical documentation from current and past treating physicians as such documentation pertains to cost containment activities.
- Consult with the County regarding the benefit of returning an injured worker to a modified or transitional duty position.
- Notify the County of the potential need for an independent medical exam or review at the County’s expense for a County employee who is receiving or applying for workers’ compensation benefits. Schedule independent medical exams or reviews based on Loss Control/Risk Manager’s approval. Costs for said exams and reviews are not covered in this bid or contract.
- Develop objective medical findings in support of maximum medical improvement (MMI) to minimize the County’s workers’ compensation liability and exposure. This includes notifying the County in situations when and where a substantial aggravation issue may exist in a claim.
- Keep the County informed in writing of any and all new regulations and/or BWC or ICO procedures pertaining to self-insured and state fund workers’ compensation claims.
- Represent the County at workers’ compensation hearings before the BWC and/or ICO and electronically send post-hearing letters documenting the facts and arguments made at said hearings to the Loss Control/Risk Manager.
- Provide annual reports showing all claims in the self-insured experience with claim numbers, quarterly and historical costs and assigned departments. All reports shall be submitted electronically and if requested in hard copy form. Perform rate calculations for figuring the County’s workers’ compensation selfinsured assessments. This includes providing the County with calculations and projections for self-insured assessments and claims’ reserves costs based on standard, acceptable actuarial practices.
- Advise the County as to the settlement figures for workers’ compensation claims.
- Assist the County in negotiating claim settlements by contacting claimants and or their attorneys of record. Pursue settlements of claims on the County’s behalf when requested by the County.
State Fund Rated Claims
The TPA is responsible for the claims management of all Medina County pre December 2, 2008 claims for as long as they are open, active or being reactivated.
State Fund Claims Scope of Work:
Specific duties shall include but are not limited to all requirements under the above self-insured claims scope of work section excluding payment of bills and compensation.
VII. EVALUATION OF PROPOSALS
Medina County will weigh four (4) factors to determine which submitted proposal that is determined to be the most advantageous to Medina County. Proposals will be scored based on allocation of points shown below.
Proposals that do not contain all information and documents required in the RFP will be determined to be non-responsive and will be disqualified as failing to meet the basic requirements of the RFP.
Four Key Factors for Contract Award
Factor Weight Given
|1. Timely and accurate payment of medical bills and compensation||25 points|
|2. Easy to navigate website and electronic reporting capabilities||25 points|
|3. Accurate and dependable hearing attendance||25 points|
- Claims management skills and pricing 25 points
TOTAL CRITERIA WEIGHT 100 points
A selection committee established by the Medina County Administrator will evaluate the proposals. The composition will remain consistent for all responses and the selection committee will be responsible for documenting and tabulating the scores for all responses.
Medina County shall evaluate all proposals received based upon the evaluation factors specified above. Medina County may select one or multiple proposals with which to hold additional discussions based upon the evaluation factors specified above. Medina County shall review the apparent best proposal contract(s) and both parties must agree to the terms and conditions. Medina County shall engage in contract negotiations with only one (1) proposal at a time. Failure to agree upon the terms and condition shall eliminate the proposal from further consideration. Requests by Medina County for clarification of proposals shall be in writing.