Loading...
HomeMy WebLinkAbout12-075 - Eide Bailly - Self-Insured Plan AuditContract No 12 -075' CONTRACT FOR SERVICES Council Approval N/A This Agreement is entered into by and between the City of Tukwila, Washington, a noncharter optional municipal code city hereinafter referred to as "the City and Eide Baillv, hereinafter referred to as "the Contractor whose principal office is located at 4310 17' Ave.. Farvo. North Dakota. WHEREAS, the City has determined the need to have certain services performed for its citizens but does not have the manpower or expertise to perform such services; and WHEREAS, the City desires to have the Contractor perform such services pursuant to certain terms and conditions; now, therefore, IN CONSIDERATION OF the mutual benefits and conditions hereinafter contained, the parties hereto agree as follows: 1. Scone and Schedule of Services to be Performed by Contractor. The Contractor shall perform those services described on Exhibit A attached hereto and incorporated herein by this reference as if fully set forth. In performing such services, the Contractor shall at all times comply with all Federal, State, and local statutes, rules and ordinances applicable to the performance of such services and the handling of any funds used in connection therewith. The Contractor shall request and obtain prior written approval from the City if the scope or schedule is to be modified in any way. 2. Comuensation and Method of Pavment. The City shall pay the Contractor for services rendered according to the rate and method set forth on Exhibit B attached hereto and incorporated herein by this reference. The total amount to be paid shall not exceed $8,000. 3. Contractor Budeet. The Contractor shall apply the funds received under this Agreement within the maximum limits set forth in this Agreement. The Contractor shall request prior approval from the City whenever the Contractor desires to amend its budget in any way. 4. Duration of Agreement. This Agreement shall be in full force and effect for a period commencing June 1, 2012 and ending August 30, 2012 unless sooner terminated under the provisions hereinafter specified. 5. Independent Contractor. Contractor and City agree that Contractor is an independent contractor with respect to the services provided pursuant to this Agreement. Nothing in this Agreement shall be considered to create the relationship of employer and employee between the parties hereto. Neither Contractor nor any employee of Contractor shall be entitled to any benefits accorded City employees by virtue of the services provided under this Agreement. The City shall not be responsible for withholding or otherwise deducting federal income tax or social security or contributing to the State Industrial Insurance Program, or otherwise assuming the duties of an employer with respect to the Contractor, or any employee of the Contractor. 6. Indemnification. The Contractor shall indemnify, defend and hold harmless the City, its officers, agents and employees, from and against any and all claims, losses or liability, including attorney's fees, arising from injury or death to persons or damage to property occasioned by any act, omission or failure of the Contractor, its officers, agents and employees, in performing the work required by this Agreement. With respect to the performance of this Agreement and as to claims against the City, its officers, agents and employees, the Contractor expressly waives its immunity, under Title 51 of the Revised Code of Washington, the Industrial Insurance Act, for injuries to its employees, and agrees that the obligation to indemnify, defend and hold harmless provided for in this paragraph extends to any claim brought by or on behalf of any employee of the Contractor. This waiver is mutually negotiated by the parties. This paragraph shall not apply to any damage resulting from the sole negligence of the City, its agents and employees. To the extent any of the damages referenced by this paragraph were caused by or resulted from the concurrent negligence of the City, its'agents or employees, this obligation to indemnify, defend and hold harmless is valid and enforceable only to the extent of the negligence of the Contractor, its officers, agents, and employees. 7. Insurance. A. The Contractor shall procure and maintain in full force throughout the duration of the Agreement comprehensive general liability insurance with a minimum coverage of $500,000.00 per occurrence /aggregate for personal injury and property damage. Said policy shall name the City of Tukwila as an additional named insured and shall include a provision prohibiting cancellation or reduction in the amount of said policy except upon thirty (30) days prior written notice to the City. Cancellation of the required insurance shall automatically result in termination of this Agreement. Pag6,1 of .I B. Certificates of coverage as required by Paragraph A above shall be delivered to the City within fifteen (15) days of execution of this Agreement. 8. Record Keeping and Reporting. A. The Contractor shall maintain accounts and records, including personnel, property, financial and programmatic records which sufficiently and properly reflect all direct and indirect costs of any nature expended and services performed in the performance of this Agreement and other such records as may be deemed necessary by the City to ensure the performance of this Agreement. B. These records shall be maintained for a period of seven (7) years after termination hereof unless permission to destroy them is granted by the office of the archivist in accordance with RCW Chapter 40.14 and by the City. 9. Audits and Inspections. The records and documents with respect to all matters covered by this Agreement shall be subject at all times to inspection, review or audit by law during the performance of this Agreement. 10. Termination. This Agreement may at any time be terminated by the City giving to the Contractor thirty (30) days written notice of the City's intention to terminate the same. Failure to provide products on schedule may result in contract termination. If the Contractor's insurance coverage is canceled for any reason, the City shall have the right to terminate this Agreement immediately. 11. Discrimination Prohibited. The Contractor shall not discriminate against any employee, applicant for employment, or any person seeking the services of the Contractor to be provided under this Agreement on the basis of race, color, religion, creed, sex, age, national origin, marital status or presence of any sensory, mental or physical handicap. 12. Assignment and Subcontract. The Contractor shall not assign or subcontract any portion of the services contemplated by this Agreement without the written consent of the City. 13. Entire Agreement. This Agreement contains the entire Agreement between the parties hereto and no other Agreements, oral or otherwise, regarding the subject matter of this Agreement, shall be deemed to exist or bind any of the parties hereto. Either party may request changes in the agreement. Proposed changes which are mutually agreed upon shall be incorporated by written amendments to this Agreement. 14. Notices. Notices to the City of Tukwila shall be sent to the following address: City Clerk, City of Tukwila 6200 Southcenter Blvd. Tukwila, Washington 98188 Stephanie Brown, Human Resources Director 6200 Southcenter Blvd. Tukwila, Washington 98188 Notices to the Contractor shall be sent to the address provided by the Contractor upon the signature line below. 15. Applicable Law; Venue: Attornev's Fees. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. In the event any suit, arbitration, or other proceeding is instituted to enforce any term of this Agreement, the parties specifically understand and agree that venue shall be properly laid in King County, Washington. The prevailing party in any such action shall be entitled to its attorney's fees and costs of suit. DATED this day of 20 1 CITY OF TUKWIL CONTRACTOR: ►de Lea �llv ZI" By: '�'7 By: r Title: i Haggert yor Title: 'OL A ST /AUTHENTICATED: Printed Name: /V1 f 4 Christ O'Fla rty, MC, City Clerk Address: `1 3 0 1- A e- APPROVED AS TO FO Fa �c.o /VD SP l4 3 Office of the C' e Date approved by City Council: By: (Applicable if contract amount is over $40,000) 6/1/2012 v f Page 2'of2 Eic e ailly May 18, 2012" (TAs S BUSINESS ADVISORS Stephanie Brown City of Tukwila 6200 South Center Blvd. Tukwila, WA 98188 Introduction. We are pleased to confirm our understanding of the nature and limitations of the services we are to perform for the City of Tukwila (Client) which is subject to the WAC Standards in Section 200 100 -120. Attached and incorporated herein as Exhibit A is the Work Plan outlining the scope of the agreed upon procedures for the purposes of satisfying the State of Washington requirements related to regulation of self-funded government plans. Such requirements require both individual and self firnded plans to obtain an audit of claims filing procedures, internal financing control mechanisms and claims adjustment expense records every three years per WAC 200 100 -120. This engagement is solely to assist the City of Tukwila in complying with the requirements of WAC 200 -100 -120. Our engagement to apply agreed -upon procedures will be conducted of Healthcare Management Administrators (1-IMA) in accordance with the attestation standards established by the American Institute of Certified Public Accountants. The sufficiency of the procedures is solely the responsibility of those parties specified in the report. Consequently, we make no representation regarding the sufficiency of the procedures described in the attached schedule either for the purpose for which this report has been requested or for any other purpose. If, for good cause, we are unable to complete the procedure, we will describe any restrictions on the performance of the procedure in our report, or will not issue a report as a result of this engagement. Because the agreed -upon procedures listed in the attached schedule do not constitute an audit, we will not express an opinion on the financial condition or internal control environment of HMA. In addition, we have no obligation to perform any duties which are outside the scope of this engagement. Eide Bailly Duties We will submit a written report evaluating the results of the review of HMA subject to the WAC standards. The report is intended to be solely for the use of the City of Tukwila, and should not be disclosed to or used by anyone other than these specified parties and their designated representatives. Our report will contain a paragraph indicating that had we performed additional procedures, other matters might have come to our attention that would have been reported to you. Eide Bailly, upon agreement with the City of Tukwila, will begin this engagement on or before June 1, 2012, and will review HMA activities from January 1, 2011, through December 31, 2011, unless the dates of the review period are changed by the City of Tukwila. Eide Bailly will submit its proposed Agreed -Upon Procedures Report to the City of Tukwila on or before August 15, 2012, for review and comment. Eide Bailly will discuss the contents of the Agreed -Upon Procedures Report with the City of Tukwila. www.ei(Jeboilly.com 4310 171h Ave. S. j P.O. Box 2545 1 Forgo, ND 58108.2545 T 701.239.8500 F 701.239.8600 EOE We will protect and treat as confidential the Agreed -Upon Procedures Report and all information (whether provided orally, in writing or in any other form) provided to us during the scope of this review, and will not disclose or permit our employees or representatives to disclose the Agreed upon Procedures Report or any information received from you (other than to our employees involved in the performance of services hereunder), or otherwise use such Agreed -Upon. Procedures Report or information, except as contemplated in this letter agreement, or as may be required by law. If we receive any request or demand to produce the Agreed -Upon Procedures Report or any information received from you or to provide any testimony related thereto, whether pursuant to a subpoena, summons, governmental order or otherwise, we will notify you immediately of such request or demand. If you object to the release of the Agreed -Upon Procedures Report or other information, we agree to give you sole control of the defense of such request or demand and will not release the Agreed -Upon Procedures Report or other information unless ordered by a court of competent jurisdiction, provided that you will indemnify us for any expenses incurred in connection with resisting such release. City of Tukwila Duties. The City of Tukwila agrees to perform the following functions in connection with this agreement: a. Make all management decisions and perform all management functions pertaining to the Agreed -Upon Procedures. b. Designate a competent individual to oversee the Agreed -Upon Procedures on behalf of the City of Tukwila. c. Provide Eide Bailly with access to appropriate personnel at HMA and all relevant documentation and information Eide Bailly deems reasonably necessary to carry out the Agreed -Upon Procedures. The City of Tukwila will review the Agreed -Upon Procedures Report and discuss the findings with Eide Bailly. Costs of Audit. The City of Tukwila will pay for all reasonable fees incurred by Eide Bailly in association with this Agreed -Upon Procedures We estimate that our fees for performing the Agreed -Upon Procedures will be $5,775.00. You will also be billed for our actual travel and other out -of- pocket costs related solely to the Agreed-Upon Procedures, such as report production, work processing, postage, etc, but not to exceed $2,000. The fee and travel and other out -of- pocket cost estimate is based on two to three days working onsite to perform interviews and process walkthroughs, offsite performance of detail claims test work at our home offices, and on anticipated cooperation from HMA and the assumption that unexpected circumstances will not be encountered during the engagement. If significant additional time is necessary, we will discuss it with you and arrive at a new fee estimate before we incur the additional cost. Each fee estimate is based upon each associate's rate, hours worked and out -of- pocket expenses relating to the Agreed -Upon Procedures. Our invoices for these fees will be rendered each month as work progresses. All invoices received by the City of Tukwila will be paid within 30 days of receipt. In accordance with our firm policies, work may be suspended if your account becomes 60 days or more overdue and will not be resumed until your account is paid in full. If we elect to terminate our services for nonpayment, our engagement will deem to have been completed upon written notification of termination even if we have not completed our report. You will be obligated to compensate us for all time expended and to reimburse us for all out -of- pocket expenditures through the date of termination. Conclusion We appreciate the opportunity to assist you and believe this letter accurately stunmarizes the significant terms of our engagement. If you have any questions, please let us know. If you agree with the terms of our engagement as described in this letter, please sign the enclosed copy and return it to us. If the need for additional procedures arises, our agreement with you will need to be revised. It is customary for us to enumerate these revisions in an addendum to this letter. If additional specified parties of the report are added, we will require that they acknowledge in writing their responsibility for the sufficiency of procedures. Very Truly,. ours, Eide Bad ly LLP RESPONSE: This letter correctly sets forth the understanding of the City of Tukwila. Title: Date: Exhibit A: Expected Methodology The phases involved in the project and estimate of time to complete each phase is noted below. A more detailed description of our approach follows: Phase I Estimated Timing Planning May /June Fieldwork June /July Report Writing I July Reporting I August Plannina: Project planning consists of the following activities: 1. Meet the contacts from each company to be reviewed. Arrange the timing of the on -site fieldwork. 2. Obtain information for each client company, including: a. Claims administration program and guidelines, b. Claims appeal program and guidelines, c. Claims processing guidelines, reserving guidelines, and adjusting and payment procedures, d. Available health plan documents, e. Adjudicated claims populations, f. Administrative contracts,. g. SAS 70 /SOC reports covering the claims process., h. Available .internal audit claims review reports for each Plan, i. Available Sarbanes -Oxley claims process documentation and control testing for each Plan, j. Tailor other data and schedule requests as needed. 3. Set up testing templates. 4. Select samples for review. 5. Communicate expectations as to timing of work and presentation of draft reports and final results. Fieldwork This phase of the project includes the primary portion of the claims and appeals processing overview and detail claims examination on -site at the TPAs. During this phase, we will review the documentation of claims and appeals processes that are in place and will conduct walk-throughs to ensure that these items are documented and .meet the minimum requirements of the WAC. We will detail test a sample of adjudicated claims for each company (Medium reliance was requested which will be reflected in our sample sizes for testing). Our fieldwork is discussed in more detail as follows: 1. Review of Written Claims Administration Program We will review the written claims administration program to ensure it includes formal documented claims filing procedures, internal financial control procedures and reporting, and claim and claim adjustment reporting requirements. 2. Review of Appeals and Grievance Procedures We will review the written appeals and grievance program to ensure it includes time limits for filing an appeal and a time limit for responses, and ensure it includes first and second level review procedures. 3. Test of Detail Claims We will examine the documentation supporting each claim in each sample testing the following attributes: Established procedures were followed per the administrative contract and followed during adjudication. Claims reserves were established according to guidelines and were adequate for incurred amounts. Claims reserves were appropriately reduced for claims paid according to guidelines. Claims and claims adjustment expense reporting requirements met contract requirements. Claim files were adequately documented. Denied claims are appropriate per Plan benefits and notification requirements were followed. Claims system attributes (.EOB) match attributes in the claims file. Payment or denial was timely and made to the proper party. We will document any errors found and verify such with the administrator. Reporting We will assemble and report our finding to include at a.minimum: Total .number of claims examined and total dollar amount represented in the claims audited. Number of claims audited versus number of claims with errors, separately and combined for financial and procedural errors. Summary of reasons for any denied claims included in the sample. Processing time (calendar days) from receipt in the claims office to date of processing and date of payment or denial notification sent. Determination of whether the written claims administration program and appeals procedures met the minimum requirements of the WAC. We can present our findings in person if desired and will be available to discuss any questions or concerns. We anticipate efficiencies in our audits due to four of the clients utilizing the same TPA (I-EvIA). For the detail testing phase per employer medium reliance testing level was requested including testing of 60 claim files per employer. Eide Bailly meets the claims auditor qualification requirements of WAC 200 110 -020 (7). I DATE (MM/DD/YYYY) L CERTIFICATE OF LIABILITY INSURANCE 6/$/2012 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 CUNTACT NAME: Ryan Hoffm Dawson Insurance Agency (ac No. E t):701- 237 -3 311 I (A/C N oi:701- 2 721 1st Avenue North E -MAIL Fargo ND 58107 ADDREss:rvan(a)dawsonins.com INSURER(S) AFFORDING COVERAGE L NAIC it INSURER A :Travelers 6606 INSURED INSURERB:Contlnental Casualty_ Comnanv Eide Bailly L.L.P. INSURERC: PO Box 2545 INSURER D: Fargo ND 58103 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 1657364991 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. ILA I TYPE OF INSURANCE A DDL S UBR S WVD POLICY NUMBER (M (MMIDD/YYYYI I LIMITS A I GENERAL LIABILITY 6307206X385 4/29/2012 4/29/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE 1 O REN IEU PREMISES (Ea occurrence) $300,000 CLAIMS MADE [i� OCCUR I MED EXP (Any one person) I $10,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 I GEN' L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP /OPAGG $2,000,000 LOC POLICY �X 1 A AUTOMOBILE LIABILITY 8107206X385 4/29/2012 4/29/2013 (E ac idenfl iNGLC LIMI I $1,000,000 ANY AUTO I BODILY INJURY (Per person) ALL OWNED SCHEDULED I BODILY INJURY (Per accident) AUTOS AUTOS X X NON -OWNED I PROPERTY DAMAGE HJIRE DAUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR CUP7206X385 d EXCESS LIAR CLAIMS -MADE L DED IX `RETENTION $10,000 WORKERS COMPENSATION PFUB7206X385 AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Employee Theft and 287424652 Dishonesty Crime Policy 4/29/2012 4/29/2013 4/29/2012 4/29/2013 5/1/2012 5/1/2013 DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, fF more space is required) Workers Compensation applies to: AZ, CO, IA, ID, ME, MI, MN, MO ,NE,NV,OK,SD,TX,VT,IL,NY,NC,WY EACH OCCURRENCE $6,000,000 AGGREGATE $6,000,000 X I WCSTATU- OTH -I LIM E.L. EACH ACCIDENT I $1,000,000 E.L. DISEASE EA EMPLOYEq J $1,000,000 E.L. DISEASE POLICY LIMIT I $1,000,000 Limit $5,000,000 Ded $25,000 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Tukwila ACCORDANCE WITH THE POLICY PROVISIONS. 6200 Southcenter Blvd Tukwila WA 98188 AUTHORIZED REPRESENTATIVE 1" ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD